Daily FOUR score assessment provides accurate prognosis of long-term outcome in out-of-hospital cardiac arrest.

BACKGROUND: The accurate prediction of outcome after out-of-hospital cardiac arrest (OHCA) is of major importance. The recently described Full Outline of UnResponsiveness (FOUR) is well adapted to mechanically ventilated patients and does not depend on verbal response. OBJECTIVE: To evaluate the ability of FOUR assessed by intensivists to accurately predict outcome in OHCA. METHODS: We prospectively identified patients admitted for OHCA with a Glasgow Coma Scale below 8. Neurological assessment was performed daily. Outcome was evaluated at 6 months using Glasgow-Pittsburgh Cerebral Performance Categories (GP-CPC). RESULTS: Eighty-five patients were included. At 6 months, 19 patients (22%) had a favorable outcome, GP-CPC 1-2, and 66 (78%) had an unfavorable outcome, GP-CPC 3-5. Compared to both brainstem responses at day 3 and evolution of Glasgow Coma Scale, evolution of FOUR score over the three first days was able to predict unfavorable outcome more precisely. Thus, absence of improvement or worsening from day 1 to day 3 of FOUR had 0.88 (0.79-0.97) specificity, 0.71 (0.66-0.76) sensitivity, 0.94 (0.84-1.00) PPV and 0.54 (0.49-0.59) NPV to predict unfavorable outcome. Similarly, the brainstem response of FOUR score at 0 evaluated at day 3 had 0.94 (0.89-0.99) specificity, 0.60 (0.50-0.70) sensitivity, 0.96 (0.92-1.00) PPV and 0.47 (0.37-0.57) NPV to predict unfavorable outcome. CONCLUSION: The absence of improvement or worsening from day 1 to day 3 of FOUR evaluated by intensivists provides an accurate prognosis of poor neurological outcome in OHCA.

Resistive Index or color-Doppler semi-quantitative evaluation of renal perfusion by inexperienced physicians: results of a pilot study.

BACKGROUND: Doppler-based renal resistive index (RI) calculation may help in the early detection of acute kidney injury (AKI). Its feasibility and reproducibility by inexperienced operators remain unknown. The main objective of this study was to compare performances of junior and senior operators in assessing renal perfusion using both the semiquantitative color-Doppler scale and RI calculation. METHODS: Prospective cohort study performed in 3 ICUs. Inexperienced juniors physicians attended a half-day course on renal perfusion assessment using RI calculation and color-Doppler (from 0, absence of renal perfusion; to 3, renal vessels identifiable in the entire field of view). Junior and senior operators used both methods in 69 mechanically ventilated patients, in blind fashion. RESULTS: Failure to obtain RI occurred for a junior operator in a single patient. RI and color-Doppler semi-quantitative values obtained by operators were correlated (r²=0.64 and r²=0.61, respectively). Systematic bias across operators as assessed using Bland-Altman plots was negligible (-0.001 and -0.29, respectively), although precision was limited (95% confidence intervals, +0.105 to -0.107 and +0.98 to -1.04, respectively). RI calculation and semi-quantitative assessment performed well for diagnosing persistent AKI (area under the receiver-operating characteristic curve, 0.84 [95% confidence interval, 0.73-0.97] and 0.87 [0.77-0.97], respectively). CONCLUSION: A brief course on renal Doppler allowed inexperienced operators to assess effectively renal perfusion with a good reliability when compared to senior operators. In addition, our results suggest the good diagnostic performance of both Doppler-based RI and semi-quantitative renal perfusion assessment in predicting short-term renal dysfunction reversibility.

A plastic surgery literature review to assist in the management of patients seeking elective esthetic dental treatments.

This article reviews plastic surgery literature to help identify and manage the risk presented by patients interested in elective esthetic dentistry whose physiologic profile would compromise the success of the procedure. A questionnaire, designed to help identify patients with problematic physiologic profiles, is presented. In addition, risk management techniques adapted from the plastic surgery literature are reviewed.

Increasing patient satisfaction with natural denture teeth.

Successful laboratory communication in removable prosthodontics will always be more complex than in fixed prosthodontics. However, the unique characteristics of natural denture teeth (SR-Antaris/SR-Postaris), Ivoclar Williams, Amherst, NY) are enabling clinicians to overcome functional and aesthetic challenges. Specifically, the characterized anatomy of these anterior and posterior teeth, and their translucency and natural layering, facilitate the reestablishment of a natural smile. This article describes the benefits of SR-Antaris/SR-Postaris denture teeth and provides guidelines for communication with the laboratory to ensure predictable results.

A survey to design the ideal complete denture laboratory prescription.

Dentists often do not supply the dental laboratory sufficient information to select and arrange maxillary denture prosthetic teeth. This article reports results from a 1995 survey that asked dental technicians certified in complete dentures what elements they would like to see on an ideal dental laboratory prescription. With regard to tooth selection, dental technicians rated most important on a prescription shade, lip length and shape of face; with regard to tooth arrangement, dental technicians rated very important the patient's sex and age.