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Selected AbstractsChildren's and young people's experiences of chronic renal disease: a review of the literature, methodological commentary and an alternative proposalJOURNAL OF CLINICAL NURSING, Issue 6 2006Philip Darbyshire MN Aim., The aims of this paper were to review and critique existing research literature on children's and young people's experiences of chronic renal disease and to propose alternative approaches that may be more fruitful in addressing existing research shortcomings. Background., Chronic renal disease, which results in approximately 1·6,4 new cases per year per million population in the 0,15 years age group, is a serious illness that causes severe and irreversible reduction in kidney function. Despite modern medical advances, its significance and implications for the lives of the children and young people concerned are profound. Method., Salient literature for this review was obtained using the major health and social science electronic databases such as Medline, CINAHL, Psyclit and Sociofile. Manual searching of relevant books, journals and ,grey literature', combined with the genealogy approach, extended and strengthened the search. Conclusions., Research in this area focuses mainly on two areas, namely psychological adjustment and adaptation to end-stage renal disease. This research is grounded within a framework of empirical psychology that values objectivity, measurement and quantification. This predominantly psychometric approach is critiqued for simplifying the complex experience of end-stage renal disease and for pathologizing children and young people with this disease. We identify a significant gap in the research literature, namely the lack of research that takes into account these children's and young peoples'own perspectives of their experiences. Relevance to clinical practice., Chronic renal disease has a significant impact on children's and young people's lives. Understanding the experiences of these children is important for the provision of effective healthcare. Conducting child-centred qualitative research in this area would allow us to explore vital questions of meaning, perception and understanding. If health and social care organizations claim to provide ,consumer-focused' services, it behoves us to develop first a clearer understanding of the lives and experiences of children and families who seek our help and to use this knowledge and understanding to plan and provide more grounded and responsive services. [source] Clinical education facilitators: a literature reviewJOURNAL OF CLINICAL NURSING, Issue 6 2005Veronica Lambert BNS Aims and objectives., The aim of this literature review, set within an Irish context, is to present a broad overview of former and existing clinical support personnel, explore the concept of facilitation and examine what is known about the role of the clinical education facilitator. Background., The importance of providing a supportive clinical environment to enhance clinical teaching and learning is strongly portrayed in the literature. While the past two decades have borne witness to various clinical support personnel, the literature identifies conflicting demands that these personnel face. No suggestions are advanced as to how to overcome these difficulties, which inevitably influence the quality and quantity of their clinical teaching role. An identifiable gap exists over who has prime responsibility for clinical teaching. It is timely that alternative possibilities for organizing clinical teaching are investigated. A new post emerging in practice settings is that of the clinical education facilitator who is meant to be the key linchpin in clinical areas for reducing the theory,practice gap. Method., Relevant literature for this review was sourced using the computerized databases CINAHL, Medline and Synergy. Manual searching of relevant nursing journals and sourcing of secondary references extended the search. Government reports and other relevant documents were obtained through pertinent websites. Results., Papers that explicitly examined the concept of facilitation and explored the posts of clinical education facilitators were included; six research papers were accessed and reviewed. In addition seven non-empirical papers were included. Conclusions., It is clear that considerable lack of role clarity resides over what constitutes clinical facilitation and the role of the clinical facilitator. Thus, it is paramount to strengthen this support role with Irish empirical evidence. Relevance to clinical practice., A major advantage in having a ward-based clinical education facilitator is the benefit of having access to someone who can concentrate solely on clinical education and support with attempts to narrow the theory,practice divide. [source] Barriers to the self-care of type 2 diabetes from both patients' and providers' perspectives: literature reviewJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 1 2009Sandra PY Pun MHA Aim., To review systematically the literature about barriers to diabetes self-care from both patients' and healthcare providers' perspectives. Background., Diabetes mellitus is a global health concern due to rapidly increasing prevalence. The healthcare costs for diabetes care and related complications are high. Tight glycaemic control achieved by intensive therapy has been shown to lower the risk of complications. Despite the provision of comprehensive management programmes, patients are often unable to achieve the desired outcomes. It is essential to understand the barriers to diabetes self-care in order to promote successfully self-care behaviours. Methods., A search of OVID Medline (R), CINAHL, Cochrane Library and British Nursing Index was carried out during 1986,2007 using keywords: Type 2 Diabetes Mellitus, self care, patient compliance, patient adherence and barriers to diabetes self care. Manual searching of relevant nursing journals and sourcing of secondary research extended the search. Results., A total of 16 original research papers using various methods including survey, descriptive correlational, sequential explanatory mixed-method and qualitative exploratory design were reviewed. In total, over 8900 patients and 4550 healthcare providers were recruited from over 28 countries in these studies. Major barriers identified included psychosocial, socioeconomic, physical, environmental and cultural factors. Conclusions., Healthcare providers can enhance patient empowerment and participation with family support to achieve feasible targets. Better health care delivery systems and reforms that improve affordability, accessibility, and efficiency of care are essential for helping both providers and patients to meet desirable standards of diabetes care. Relevance to clinical practice., Understanding barriers to diabetes self-care is the first step in facilitating providers to identify their role in enabling patients to overcome these barriers. Healthcare providers can develop strategies to clarify and individualise treatment guidelines, implement continuing education, improve communication skills, and help motivate patients to achieve desired behavioral changes. [source] Determining Molecular Structures and Conformations Directly from Electron Diffraction using a Genetic AlgorithmCHEMPHYSCHEM, Issue 2 2006Scott Habershon Dr. Abstract A global optimization strategy, based upon application of a genetic algorithm (GA), is demonstrated as an approach for determining the structures of molecules possessing significant conformational flexibility directly from gas-phase electron diffraction data. In contrast to the common approach to molecular structure determination, based on trial-and-error assessment of structures available from quantum chemical calculations, the GA approach described here does not require expensive quantum mechanical calculations or manual searching of the potential energy surface of the sample molecule, relying instead upon simple comparison between the experimental and calculated diffraction pattern derived from a proposed trial molecular structure. Structures as complex as all- trans retinal and p -coumaric acid, both important chromophores in photosensing processes, may be determined by this approach. In the examples presented here, we find that the GA approach can determine the correct conformation of a flexible molecule described by 11 independent torsion angles. We also demonstrate applications to samples comprising a mixture of two distinct molecular conformations. With these results we conclude that applications of this approach are very promising in elucidating the structures of large molecules directly from electron diffraction data. [source] A systematic review of the survival and complication rates of implant supported fixed dental prostheses with cantilever extensions after an observation period of at least 5 yearsCLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2009Marco Aglietta Abstract Objective: The aim of this systematic review was to assess the survival rates of short-span implant-supported cantilever fixed dental prostheses (ICFDPs) and the incidence of technical and biological complications after an observation period of at least 5 years. Material and methods: An electronic MEDLINE search supplemented by manual searching was conducted to identify prospective or retrospective cohort studies reporting data of at least 5 years on ICFDPs. Five- and 10-year estimates for failure and complication rates were calculated using standard or random-effect Poisson regression analysis. Results: The five studies eligible for the meta-analysis yielded an estimated 5- and 10-year ICFDP cumulative survival rate of 94.3% [95 percent confidence interval (95% CI): 84.1,98%] and 88.9% (95% CI: 70.8,96.1%), respectively. Five-year estimates for peri-implantitis were 5.4% (95% CI: 2,14.2%) and 9.4% (95% CI: 3.3,25.4%) at implant and prosthesis levels, respectively. Veneer fracture (5-year estimate: 10.3%; 95% CI: 3.9,26.6%) and screw loosening (5-year estimate: 8.2%; 95% CI: 3.9,17%) represented the most common complications, followed by loss of retention (5-year estimate: 5.7%; 95% CI: 1.9,16.5%) and abutment/screw fracture (5-year estimate: 2.1%; 95% CI: 0.9,5.1%). Implant fracture was rare (5-year estimate: 1.3%; 95% CI: 0.2,8.3%); no framework fracture was reported. Radiographic bone level changes did not yield statistically significant differences either at the prosthesis or at the implant levels when comparing ICFDPs with short-span implant-supported end-abutment fixed dental prostheses. Conclusions: ICFDPs represent a valid treatment modality; no detrimental effects can be expected on bone levels due to the presence of a cantilever extension per se. [source] A systematic review of the survival and complication rates of resin-bonded bridges after an observation period of at least 5 yearsCLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2008Bjarni E. Pjetursson Abstract Objectives: The objectives of this systematic review were to assess the 5-year survival of resin-bonded bridges (RBBs) and to describe the incidence of technical and biological complications. Methods: An electronic Medline search complemented by manual searching was conducted to identify prospective and retrospective cohort studies on RBBs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data extraction were performed independently by two reviewers. Failure and complication rates were analyzed using random-effects Poissons regression models to obtain summary estimates of 5-year proportions. Results: The search provided 6110 titles and 214 abstracts. Full-text analysis was performed for 93 articles, resulting in 17 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of RBBs of 87.7% (95% confidence interval (CI): 81.6,91.9%) after 5 years. The most frequent complication was debonding (loss of retention), which occurred in 19.2% (95% CI: 13.8,26.3%) of RBBs over an observation period of 5 years. The annual debonding rate for RBBs placed on posterior teeth (5.03%) tended to be higher than that for anterior-placed RBBs (3.05%). This difference, however, did not reach statistical significance (P=0.157). Biological complications, like caries on abutments and RBBs lost due to periodontitis, occurred in 1.5% of abutments and 2.1% of RBBs, respectively. Conclusion: Despite the high survival rate of RBBs, technical complications like debonding are frequent. This in turn means that a substantial amount of extra chair time may be needed following the incorporation of RBBs. There is thus an urgent need for studies with a follow-up time of 10 years or more, to evaluate the long-term outcomes. [source] A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 yearsCLINICAL ORAL IMPLANTS RESEARCH, Issue 6 2004II. Combined tooth, implant-supported FPDs Abstract Objectives: The objective of this systematic review was to assess the 5- and 10-year survival of combined tooth,implant-supported fixed partial dentures (FPDs) and the incidence of biological and technical complications. Methods: An electronic MEDLINE search supplemented by manual searching was conducted to identify prospective and retrospective cohort studies on FPDs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by two reviewers. Failure and complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates of 5- and 10-year survival proportions. Results: From a total of 3844 titles and 560 abstracts, 176 articles were selected for full-text analysis, and 13 studies met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants in combined tooth,implant-supported FPDs of 90.1% (95 percent confidence interval (95% CI): 82.4,94.5%) after 5 and 82.1% (95% CI: 55.8,93.6%) after 10 years. The survival rate of FPDs was 94.1% (95% CI: 90.2,96.5%) after 5 and 77.8% (95% CI: 66.4,85.7%) after 10 years of function. There was no significant difference in survival of tooth and implant abutments in combined tooth,implant FPDs. After an observation period of 5 years, 3.2% (95% CI: 1.5,7.2%) of the abutment teeth and 3.4% (95% CI: 2.2,5.3%) of the functionally loaded implants were lost. After 10 years, the corresponding proportions were 10.6% (95% CI: 3.5,23.1%) for the abutment teeth and 15.6% (95% CI: 6.5,29.5%) for the implants. After a 5 year observation period, intrusion was detected in 5.2% (95% CI: 2,13.3%) of the abutment teeth. Intrusion of abutment teeth were almost exclusively detected among non-rigid connections. Conclusion: Survival rates of both implants and reconstructions in combined tooth,implant-supported FPDs were lower than those reported for solely implant-supported FPDs (Pjetursson et al. 2004). Hence, planning of prosthetic rehabilitation may preferentially include solely implant-supported FPDs. However, anatomical aspects, patient centered issues and risk assessments of the residual dentition may still justify combined tooth,implant-supported reconstructions. It was evident from the present search that tooth,implant-supported FPDs have not been studied to any great extent and hence, there is a definitive need for more longitudinal studies examining these reconstructions. Résumé L'objectif de cette revue systématique a été de vérifier la survie à cinq et dix années de prothèses partielles fixées portées sur implants et dents et l'incidence des complications techniques et biologiques. Une recherche Medline ainsi que manuelle ont identifié les études prospectives et rétrospectives avec un suivi d'au minimum cinq années. Les patients avaient dû subir un examen clinique lors de ce suivi. L'identification des études et l'analyse des données ont été effectuées indépendamment par deux personnes. Les taux d'échecs et de complications ont été analysés en utilisant les modèles de régression Poisson avec effets hasard pour obtenir des estimations à cinq et dix ans. De 3 844 titres et 560 résumés, 176 articles ont été sélectionnés pour l'analyse approfondie et treize études atteignaient les critères d'inclusion. La méta-analyse de ces études indiquaient une estimation de survie des implants en combinaison des prothèses fixées sur implants et dents de 90,1%(intervalle de confidence 95% : 82,4 à 94,5%) après cinq années et de 82,1% (55,8 à 93,6% après dix années. Le taux de survie de ces prothèses étaient de 94,1% (90,2 à 96,5%) après cinq ans et de 77,8% (66,4 à 85,7%) après dix années. Il n'y avait aucune différence significative dans la survie des piliers dentaires et implantaires dans ces prothèses sur implants et dents. Après une observation de cinq années, 3,2% (1,5 à 7,2%) des piliers dentaires et 3,4% (2,2 à 5,3%) des implants ont été perdus. Après dix années, les proportions correspondantes étaient de 10,6 % (3,5 à 23,1%) pour les dents et de 15,6%(6,5%à 29,5%) pour les implants. Après une observation de cinq années, l'intrusion a été détectée dans 5,2% (2,0 à 13,3%) des dents piliers. L'intrusion des dents piliers étaient presque exclusivement détectée le long des connexions non-rigides. Le taux de survie de ces prothèses sur pilier dents et implants étaient inférieur à celui rapporté pour le même type de prothèse seulement placé sur implants (Pjetursson et al. 2004). Le plan de prothèse pourrait donc avoir une préférence pour ne placer des prothèses que sur des implants. Cependant les aspects anatomiques, le respect du patient et les risques pour la dentition résiduelle peuvent justifier les reconstructions sur implants et dents. Il était évident que lors de la recherche présente les bridges sur implants et dents n'avaien pas été beaucoup étudiés; il s'avère donc nécessaire de débuter davantage d'études longitudinales. Zusammenfassung Ziel: Ziel dieser systematischen Übersicht war einerseits die Bestimmung der Überlebenszeit von kombiniert zahn-implantat-getragenem festsitzendem Zahnersatz (FPDs) nach 5 und 10 Jahren und andererseits die Häufigkeit von biologischen und technischen Komplikationen zu beschreiben. Methoden: Man führte eine manuell ergänzte elektronische Medline-Suche durch, um prospektive und retrospektive Kohortenstudien über FPDs mit einer durchschnittlichen Beobachtungszeit von mindestens 5 Jahren zu identifizieren. Die Patienten mussten bei den Nachkontrollen auch klinisch untersucht worden sein. Die Aufnahme der ausgewählten Studien und die Abstraktion der Daten wurde von zwei Personen unabhängig voneinander durchgeführt. Mit Hilfe eines Poission Regressionsmodells analysierte man die Misserfolgs- und Komplikationsraten und erhielt so zusammenfassende schätzwerte für die über lebenswahrscheindichkeit nach 5 und 10 Jahren. Resultate: Die Suche lieferte 3844 Titel und 560 Abstracts. Die Analyse des gesamten Textes erfolgte bei 176 Artikeln, von denen aus 13 Studien, die Einschlusskriterien erfüllten. Die Meta-Analyse dieser Studien ergab eine geschätzte Überlebensrate der Implantate in gemischt zahn-implantat-getragenen FPDs von 90.1% (95% CI: 82.4,94.5%) nach 5 Jahren und 82.1% (95% CI: 55.8,93.6%) nach 10 Jahren. Die Überlebensrate der FPDs betrug 94.1% (95% CI: 90.2,96.5%) nach 5 Jahren und 77.8% (95% CI: 66.4,85.7%) nach 10 Jahren in Funktion. Man fand bei den kombiniert zahn-implantat-getragenen FPDs keine signifikanten Unterschiede bei der Überlebensrate von Zahn- und Implantatpfeilern. Nach einer Beobachtungszeit von 5 Jahren waren 3.2% (95% CI: 1.5,7.2%) der Pfeilerzähne und 3.4% (95% CI: 2.2,5.3%) der funktionell belasteten Implantate verloren gegangen. Nach 10 Jahren betrugen die entsprechenden Werte 10.6% (95% CI: 3.5,23.1%) für die Pfeilerzähne und 15.6% (95% CI: 6.5,29.5%) für die Implantate. Nach einer Beobachtungszeit von 5 Jahren konnte man bei 5.2% (95% CI: 2,13.3%) der Pfeilerzähne eine Intrusion feststellen. Eine Intrusion war fast ausschliesslich bei nicht-starren Verbindungen festzustellen. Zusammenfassung: Die Überlebensraten für Implantate und Rekonstruktionen in kombiniert zahn-implantat-getragenen FPDs waren tiefer als die, welche in der Partnerstudie (Pjetursson et al. 2004) für allein implantat-getragene FPDs festgestellt worden sind. Daher müsste die Planung von prothetischen Rehabilitationen eigentlich vorzüglich mit rein implantat-getragenen FPDs durchgeführt werde. Anatomische Aspekte, patientenspezifische Gründe und die Risikoanalysen der Restbezahnung können aber weiterhin kombiniert zahn-implantat-getragene Rekonstruktionen rechtfertigen. Bei dieser Untersuchung wurde klar, dass die zahn-implantat-getragenen FPD's noch nicht in grösserem Ausmass studiert worden sind, was einen dringenden Bedarf an weiteren Lanzeitstudien, die diese Rekonstruktionen erforschen, zeigt. Resumen Objetivos: El objetivo de esta revisión sistemática fue valorar la supervivencia de dentaduras parciales fijas soportadas por implantes (FPDs) y describir la incidencia de complicaciones biológicas y técnicas. Métodos: Se llevó a cabo una búsqueda electrónica por Medline complementada con una búsqueda manual para identificar estudios cohorte prospectivos y retrospectivos acerca de FPDs con un tiempo de seguimiento medio de al menos 5 años. Los pacientes tenían que haber sido examinados clínicamente en la visita de seguimiento. La valoración de los estudios encontrados y de la abstracción de datos se llevó a cabo independientemente por dos revisores. Los índices de fracaso y complicación se analizaron usando modelos de regresión de efectos aleatorios de Poisson para obtener estimaciones de los sumarios de las proporciones de supervivencia a los 5 y 10 años. Resultados: De un total de 3844 títulos y 560 resúmenes, se seleccionaron 176 artículos para análisis, y 13 estudios coincidieron con los criterios de inclusión. Un meta análisis de estos estudios indicaron una supervivencia estimada de los implantes en FPDs soportados por dientes e implantes combinados del 90.1% (95% CI: 82.4,94.5%) tras 5 años, y 82.1% (95% CI: 55.8,93.6%) tras 10 años. El índice de supervivencia de los FPDs fue del 94.1% (95% CI: 90.2,96.5%) tras 5 años, y 77.8% (95% CI: 66.4,85.7%) tras 10 años en función. No hubo diferencias significativas en la supervivencia de los pilares de implantes o dientes en FPDs de dientes e implantes combinados. Tras un periodo de observación de 5 años, el 3.2% (95% CI: 1.5,7.2%) de los dientes pilares y 3.4% (95% CI: 2.2,5.3%) de los implantes en carga funcional se perdieron. Tras 10 años, las proporciones correspondientes fueron del 10.6% (95% CI: 3.5,23.1%) para los dientes pilares y 15.6% (95% CI: 6.5,29.5%) para los implantes. Tras un periodo de observación de 5 años, se detectó intrusión en 5.2% (95% CI: 2,13.3%) de los dientes pilares. La intrusión de los dientes pilares se casi exclusivamente detectada entre las conexiones no rígidas. Conclusión: Los índices de supervivencia de los implantes y las reconstrucciones en FPDs soportadas por dientes e implantes combinados fueron menores que los reportados para FPDs soportados por implantes únicamente (Pjetursson et al. 2004). Por lo tanto, la planificación de la rehabilitación prostética puede incluir preferentemente FPDs soportados solo por implantes. De todos modos, los aspectos anatómicos, las necesidades exactas del paciente y las valoraciones de riesgo de la dentición residual pueden todavía justificar las reconstrucciones soportadas por dientes e implantes combinados. Fue evidente de la presente búsqueda que los FPDs soportados por dientes e implantes no han sido estudiados extensamente y por lo tanto, existe definitivamente una necesidad para mas estudios longitudinales que examinen estas reconstrucciones. [source] | ||||||||||