Assessment of Digital Workflow in Predoctoral Education and Patient Care in North American Dental Schools

Technology has revolutionized the field of dentistry, and digital workflow has become commonplace in everyday dental practices. However, are future practitioners prepared to enter into an increasingly digitized world? The aim of this study was to determine the extent to which digital modalities were being taught to predoctoral dental students and used for patient care in dental schools throughout North America. A 35-question survey was sent in February 2019 to all 76 dental schools in the U.S. and Canada. After 90 days, 54 recorded responses were received, for a 71% response rate. Students were reported to be using CAD/CAM technology in 50 (93%) of the 54 responding schools. While almost all schools responding to the survey were using digital scanning, there was disparity among them in terms of the types and frequency of procedures for which digital impressions were utilized. This study found that the incorporation of CAD/CAM technology in predoctoral dental curricula varied widely. However, it was clear that the relative dearth of well-trained faculty members and the number of CAD/CAM units available to students limited its use. It is imperative that more emphasis is placed on the utilization of digital workflow in North American dental schools for future practitioners to practice contemporary restorative dentistry.

Intracranial pressure monitoring and liver transplantation for fulminant hepatic failure

Cerebral edema and intracranial hypertension, commonly present in fulminant hepatic failure, may lead to brainstem herniation and limit the survival of comatose patients awaiting liver transplantation before a donor organ becomes available. Also, they are likely responsible for postoperative neurological morbidity and mortality. Although intracranial pressure monitoring has been proposed to aid clinical decision making in this setting, its use in the prevention of brainstem herniation preoperatively, in the selection of patients for liver transplantation who have the potential for neurological recovery and in the maintenance of cerebral perfusion during liver transplantation has not been examined in detail. To address these issues, we established a protocol for intracranial pressure monitoring in comatose patients with fulminant hepatic failure as part of their preoperative and intraoperative management. Twenty adults and three children underwent intracranial pressure monitoring. Ten patients required preoperative medical therapy with mannitol, barbiturates or both for a rise in intracranial pressure above 25 mm Hg. Four patients had a sustained lowering of intracranial pressure, three of whom survived hospitalization. Six patients had intracranial hypertension refractory to medical management, were removed from a waiting list for a donor organ and died with brainstem herniation. Of the remaining 17 patients, 3 died of other causes while awaiting a donor organ, 2 recovered spontaneously without neurological sequelae and 12 underwent liver transplantation. All but one patient undergoing liver transplantation had transient intraoperative intracranial hypertension develop, requiring medical treatment. The 12 patients who had transplants recovered neurologically and were discharged from the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Care of organ donors

In summary, anesthesiologists play a pivotal role in maintaining adequate organ function in the donor. Anesthesiologists are responsible for integrating the needs of all transplant services involved in donor organ retrieval. In addition, anesthesiologists can play critical roles in expediting preparation of the patient for surgery, and they can lend emotional support to operating room personnel during the surgery. The care of the organ donor is really the care of several patients--the donor and the fortunate recipients of the donated organs--and can afford great personal satisfaction.