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      Availability of a remote online hemodynamic monitoring system during treatment in a private dental office for medically high-risk patients

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          Abstract

          The importance of systemic management to prevent accidents is increasing in dentistry because co-morbid illnesses in an aging society and invasive surgical procedures are increasing. In this prefecture, a new medical system called the remote online hemodynamic monitoring system (ROHMs) was started in 2001. Eight private dental offices participated in this trial. When dental practitioners feel the risk of a dental procedure, they can contact via ROHMs to this hospital. Then, the hemodynamic data (blood pressure, heart rate, ECG, SpO 2, and RPP) of the patient in the clinic can be transmitted here via the internet, and the images and the voice can be transmitted as well. The availability of this system was assessed in 66 patients (98 cases). The most frequent complications were hypertension, heart disease, and diabetes mellitus. Systemic management included monitoring during the dental procedure (71.4%), checking vital signs after an interview (15.3%), and monitoring under sedation (13.3%). There were 35.7% of all cases where an unscheduled procedure was necessary for the systemic management. Based on a questionnaire, the majority of the patients felt relieved and safe. This system creates a situation where a specialist is almost present during the procedure. This system will provide significant assistance for future medical cooperation for risk management.

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          Most cited references 11

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          Advanced surgical guidance technology: a review.

          To maximize the outcome of implant placement, the use of advanced radiographic procedures such as computerized tomography, along with fabrication of surgical guides, has been advocated to inform surgeons of ideal implant location. More recently, simulation computer software has been introduced to view radiographic images and test potential implant locations. Yet, surgical guides are processed based on ideal tooth position, with little consideration for underlying anatomical limitations, which creates a disconnection between diagnostic planning and surgical restrictions. In response to this "missing link," computer-assisted design and computer-assisted manufacturing, as well as real-time surgical navigation were recently developed to obtain fully integrated surgical and prosthetic planning. Today, there are several technologies available, but, to our knowledge, a systematic assessment of surgical guidance has not yet been performed. Therefore, the aims of this review are to introduce advanced radiographic and software modalities, and present a detailed assessment of computer-assisted design and computer-assisted manufacturing methods and surgical navigation.
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            Fatal air embolism during dental implant surgery: a report of three cases.

            Between October 6, 1986 and September 17, 1987, 11 patients underwent insertion of mandibular dental prostheses by the same oral surgeon. Three patients suffered cardiac arrest during surgery and subsequently died. Two of the patients who died had received general anaesthetics and the other had intravenous sedation given by three different anaesthetists. All three patients arrested suddenly, developing profound cyanosis and electrical mechanical dissociation, underwent prolonged resuscitative efforts, and had marked hypoxaemia and hypercapnia, despite cardiopulmonary resuscitation. Two other patients had signs of injection of air but survived, one suffering cardiac collapse and the other sustaining massive subcutaneous emphysema. Air embolism was produced by inadvertent injection of a mixture of air and water, passing through the hollow dental drill, directly into the mandible to the facial and pterygoid plexus veins and thence to the superior vena cava and right atrium.
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              Global health and justice.

               James Dwyer (2005)
              In Australia, Japan, Sweden, and Switzerland, the average life expectancy is now greater than 80 years. But in Angola, Malawi, Sierra Leone, and Zimbabwe, the average life expectancy is less than 40 years. The situation is even worse than these statistics suggest because average figures tend to mask inequalities within countries. What are we to make of a world with such inequal health prospects? What does justice demand in terms of global health? To address these problems, I characterize justice at the local level, at the domestic or social level, and at the international or global level. Because social conditions, structures, and institutions have such a profound influence on the health of populations, I begin by focusing attention on the relationship between social justice and health prospects. Then I go on to discuss health prospects and the problem of global justice. Here I distinguish two views: a cosmopolitan view and a political view of global justice. In my account of global justice, I modify and use the political view that John Rawls developed in The Law of Peoples. I try to show why an adequate political account must include three duties: a duty not to harm, a duty to reconstruct international arrangements, and a duty to assist.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                August 2008
                August 2008
                : 4
                : 4
                : 721-726
                Affiliations
                Special Care Department in Dentistry, Ohu University Dental Hospital, Koriyama city, Fukushima prefecture, Japan
                Author notes
                Correspondence: Shinya Yamazaki, 31-1 Misumido Tomita Koriyama, Fukushima, 963-8611 Japan, Tel +81 24 932 9337, Fax +81 24 938 9192, Email zakiyama@ 123456ops.dti.ne.jp
                Article
                tcrm-4-721
                2621375
                19209253
                © 2008 Dove Medical Press Limited. All rights reserved
                Categories
                Original Research

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