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Biomedical subjects

M J Friedman

Publications and source records attributed to M J Friedman.

At least 37 records · Page 2Linked to original sources
PubMed2000

In vitro study of needle deflection: a linear insertion technique versus a bidirectional rotation insertion technique.

OBJECTIVE: Deflection of dental needles during tissue penetration has been associated with a failure to achieve successful anesthesia. The purpose of this study was to determine whether needle deflection in a tissuelike substance could be minimized through the use of a bidirectional rotation insertion technique. METHOD AND MATERIALS: Three in vitro deflection test models were constructed, each incorporating a different tissuelike substance of a different density. Each substance was tested with 3 different needle sizes (30-guage, 27-gauge, and 25-gauge). A customized dental surveyor allowed for standardized needle insertions to a standardized depth of 20 mm. Two different insertion techniques, a linear insertion technique and a newly described bidirectional rotation insertion technique, were tested. Radiographic analysis was performed after each insertion. RESULTS: The bidirectional rotation insertion technique described was consistently more effective in minimizing needle shaft deflection for 30-, 27-, and 25-gauge needles. The differences were statistically significant. Each of the different tissuelike substances consistently demonstrated this reduction in needle deflection. CONCLUSION: The factor that most greatly affects the path taken by a needle through a tissuelike substance is the force vectors that act on the needle's beveled surface. The use of a bidirectional rotation insertion technique minimized needle deflection, resulting in a straighter tracking path for 30-, 27-, and 25-gauge dental needles, in 3 different tissuelike substances tested in this study.

Anesthesia, Dental↗
PubMed1999

P-ASA block injection: a new palatal technique to anesthetize maxillary anterior teeth.

UNLABELLED: This technique article presents a new local anesthetic injection that is reported to produce anesthesia of the six maxillary anterior teeth, the anterior third of the palate, and the facial gingiva from a single-site injection. The injection is referred to as the palatal approach anterior superior alveolar (P-ASA) nerve block. The 0.9 to 1.4 mL dosage recommendation for this block injection is significantly less than for a traditional supraperiosteal approach. The primary advantage of this injection is that it allows the dentist to anesthetize the teeth and gingiva without collateral anesthesia to the lips, face, or muscles of facial expression. Therefore, the smile line is not distorted during the operative phase of an appointment, and the patient is more comfortable postoperatively. CLINICAL SIGNIFICANCE: The P-ASA is a new block injection technique that provides anesthesia of the maxillary anterior teeth from a single injection without numbness of the face, lips, and muscles of facial expression. This injection technique prevents distortion of the smile line and enhances restorative procedures that use the lip line as an esthetic reference element.

Anesthesia, Dental↗
PubMed1998

Health symptoms reported by Persian Gulf War veterans two years after return.

The role of actual or perceived events has considerable importance for individual well-being. Although the Persian Gulf War (PGW) has raised questions about the presence of hazardous environmental exposures, few, if any confirmed exposure data are available. Yet, a substantial number of PGW veterans report health problems since their return from that war. The present study was conducted to investigate possible associations between opportunities for exposure and increased rates of health symptom reporting. First, we examined descriptive data on types and rates of health symptoms reported by a cohort of Gulf War veterans. Then, using proxies for three wartime experiences, we examined associations between health symptoms reports and different Persian Gulf exposure scenarios (reported exposure to poison gas or germ warfare, being in a transportation unit, or high levels of combat exposure), adjusting for the effects of background characteristics (e.g., gender, psychological distress). Findings suggest that reported exposure to poison gas or germ warfare is related to higher symptom reporting by this cohort of New England area veterans. Limitations in the study design and the challenges involved in studying PGW veterans' illnesses are discussed.

Adult↗
PubMed1998

Increases in retrospective accounts of war-zone exposure over time: the role of PTSD symptom severity.

Retrospective reports of the frequency of war-zone exposure are commonly used as objective indices in studies investigating the mental health consequences of exposure to such stressors. To explore the temporal stability of these types of reports, we obtained frequency estimates of exposure to war-zone stressors at two time points from 460 U.S. soldiers who had served in the peace-keeping mission in Somalia. On average; soldiers demonstrated a significant increase in their frequency reports from initial (postdeployment) to subsequent (follow-up) assessment. Severity of posttraumatic symptomatology was uniquely associated with this change, indicating a possible systematic bias in which severity of symptoms leads to increased reports of stressor frequency. The implications of these findings for research in the field of traumatic stress are discussed.

Adult↗
PubMed1998

Psychiatric symptomatology associated with contemporary peacekeeping: an examination of post-mission functioning among peacekeepers in Somalia.

Contemporary peacekeepers frequently confront complex stressors including the need to directly enforce peace between warring factions, to deliver humanitarian aid in the midst of political-social devastation, and to balance shifting rules of engagement. As such, it is proposed that participants may be at increased risk for the development of psychiatric distress. The present study examined the types of stressors encountered by 3,461 peacekeepers in Somalia, their current psychiatric functioning as measured by the Brief Symptom Inventory, and the relationship between exposure to various stressors and adjustment. Over one third of participants met criteria for psychiatric caseness. The most commonly reported symptoms included hostility, psychoticism, depression, and paranoid ideation. The best predictors of current functioning were found to be exposure to traditional war-zone-related stressors and general military pride and cohesion. These findings highlight the mental health consequences that service in a peacekeeping mission may have for United States solidiers. Further research is needed to investigate potential mechanisms that could serve as buffers to the stress associated with peacekeeping service.

Adult↗
PubMed1998

Microscope-assisted precision (MAP) dentistry. A challenge for new knowledge.

The purpose of this paper is to acquaint the dentist with the learning needs associated with the use of microscope-assisted precision dentistry (MAP) and identify certain concepts that will assist in the education process. Although the learning curve is considered to be lengthy and often difficult, the authors believe that the clinical benefits of MAP dentistry are well worth the necessary effort to achieve a level of competency with this methodology.

Dentistry, Operative↗
PubMed1998

A 15-year review of porcelain veneer failure--a clinician's observations.

The interest in porcelain veneers has followed the trend in restorative dentistry to conserve natural tooth structure. Although these restorations have been widely accepted, certain patterns have begun to emerge relative to their limitations. It is important for dental practitioners to recognize the limitations of porcelain veneers and to communicate this information to their patients before such treatment is initiated. This article presents a clinician's observation of porcelain veneer failure patterns over a 15-year period. These findings are based on a review of approximately 3,500 restorations.

Adult↗
PubMed1998

The AMSA injection: a new concept for local anesthesia of maxillary teeth using a computer-controlled injection system.

This article describes a new injection technique for the maxillary arch that achieves pulpal anesthesia of the central incisor through the second premolar without collateral anesthesia of the face and muscles of expression. This palatal injection can be delivered easily, consistently, and virtually imperceptibly with a recently introduced computer-controlled local anesthesia delivery system. The anterior (AMSA) middle superior alveolar block, is a single-site injection requiring less than one cartridge of anesthetic and is ideal for maxillary esthetic restorative dentistry because it does not distort the smile line. A clinical example is also presented.

Anesthesia, Dental↗
PubMed1997

Warriors as peacekeepers: features of the Somalia experience and PTSD.

There has been scant empirical study of the psychological consequences of contemporary peacekeeping missions. This study examined relationships among 4 variables characterizing this type of operation (traditional combat events, negative aspects of peacekeeping, pressure to uphold restraint, and positive aspects of peacekeeping) and symptoms of posttraumatic stress disorder (PTSD). Participants were 3,310 male and female soldiers who served in the 1992-1994 Somalia mission. Structural equation modeling procedures were applied to data from subsamples of non-African Americans and African Americans. For both groups, traditional combat and negative aspects of peacekeeping were associated with PTSD, frustration with restraint, and positive aspects of peacekeeping; however, restraint was not related to PTSD. Discrepancies between the groups involved relationships among the restraint, positive aspects, and PTSD variables. Recommendations are offered to foster inquiry into this new research.

Adult↗
PubMed1997

Posttraumatic stress disorder.

This article reviews concepts that help synthesize the data on posttraumatic stress disorder (PTSD), a very complex condition in terms of its etiology, psychobiology, epidemiology, comorbidity, and treatment. At least four neurobiologic systems are involved in PTSD: the catecholamine, the hypothalamic-pituitary-adrenocortical, the thyroid, and the endogenous opioid systems. Six other systems are probably or possibly implicated as well. The avoidance and hyperarousal of PTSD distort the patient's appraisal of the world. The symptoms of PTSD can be understood through models of learning and memory, which form the basis of behavioral treatments. The concepts of tonic and phasic alteration and of allostasis versus homeostasis also shed light on PTSD. In addition to PTSD, there may be other identifiable posttraumatic syndromes that might be diagnosed separately, such as "complex" PTSD. Cross-cultural issues may also affect clinical phenomenology and thereby confuse the diagnosis. Comorbid disorders may actually be clues to subtypes of PTSD. The fact that victims of PTSD are also more vulnerable to medical illnesses makes a closer relationship with primary care providers and other specialists mandatory. New approaches to prevention, treatment of chronic PTSD, psychotherapy, pharmacotherapy, and research hold promise of an improved prognosis for patients with PTSD.

Cognitive Behavioral Therapy↗