An Exploration of the Occupational Therapy Doctoral Capstone: Perspectives from Capstone Coordinators, Graduates, and Site Mentors

Few studies have investigated entry-level doctoral capstone outcomes regarding how the experience and project relate to employment opportunities. This descriptive study reports various stakeholders’ perspectives regarding the entry-level occupational therapy doctoral (OTD) capstone in relation to employment opportunities and awareness of the profession. Authors disseminated a nationwide survey to doctoral capstone coordinators, entry-level OTD graduates, and capstone site mentors. Ten doctoral capstone coordinators, 68 OTD graduates, and 22 capstone site mentors responded to the survey. Collectively, doctoral capstone coordinators reported that 117 OTD graduates obtained employment in a setting related to the focus of their doctoral capstone and gave examples of graduates employed as entrepreneurs, faculty, program specialists, and supervisors. OTD graduates most often completed their doctoral capstones in community-based settings with projects focusing on program development. Sixty-four percent of the OTD graduates were employed at their doctoral capstone site or at a site similar to where they completed their doctoral capstone. Professional background of capstone site mentors varied, and all mentors who were not occupational therapy professionals reported improved awareness of occupational therapy after mentoring an OTD student. Outcomes of the OTD doctoral capstone are needed to support the efficacy of this experience and project. This study begins to provide such outcomes by reporting findings related to employment and awareness of the profession

A Snapshot of How Entry-Level Occupational Therapy Programs Collect and Use Doctoral Capstone Outcomes

Entry-level occupational therapy doctorate (OTD) programs are required to gather program evaluation data regarding the doctoral capstone for accreditation purposes. This study aims to describe the processes used by a sample of OTD programs to gather doctoral capstone outcome data and to determine the type of data collected in order to understand the perspectives regarding doctoral capstone outcomes by doctoral capstone coordinators (DCCs) within the United States. The investigators used purposeful sampling to recruit DCCs at accredited entry-level OTD programs in the United States. The most common outcome data collected included information about the doctoral capstone experience from students, student performance outcomes, employment and scholarship outcomes from alumni and employers, and various outcomes from site/expert/faculty mentors. Results highlight the need to disseminate doctoral capstone outcomes as few participants in this study used the data they were collecting outside of their program. By sharing and reporting outcomes of the doctoral capstone, OTD programs, and the profession can collectively benefit. Development of common outcomes, collected across programs, can help to provide data large enough to draw meaningful conclusions regarding the value of the doctoral capstone in occupational therapy education and in strengthening the knowledge of the profession among the public

Nerve lesions in pharynx : an aetiology of obstructive sleep apnoea

"Heavy snorers disease" is defined as the progression from habitual snoring to obstructive sleep apnoea (OSA). Apart from a significant weight gain, the aetiology underlying progression to a collapse of the upper airways during inspiration and sleep remains unclear. Previous studies have shown that nocturnal respiratory disturbances became worse even in some OSA patients who did not gain weight. Chronic vibration of a tissue may cause neuronal damage. Therefore, our hypothesis is that the snoring vibration, may cause a progressive pharyngeal nerve lesion. To study whether uvulopalatopharyngoplasty (UPPP) prevents progression in habitual snorers without OSA, we performed a five-year follow-up in 56 such patients. In the patients' estimation, the postoperative results were good. However, sleep recordings before and five years after surgery in 53 of them showed a slight but significant increase in respiratory disturbances, significantly correlated to weight gain. Six patients developed OSA postoperatively, one of them despite a weight loss of 10 kg. The patency of the upper airways depends on the balance between the negative intrapharyngeal pressure developed during inspiration and its counteraction by dilating muscles. The reflexogenic dilation is probably mediated by afferent nerve endings in the pharyngeal mucosa. To investigate whether there are signs of a local nerve lesion, three methods were used in patients with habitual snoring and various degrees of respiratory disturbances and in non-snoring controls: I) Biopsies of m. palatopharyngeus from 21 patients (10 with OSA) and 10 controls were investigated. The severity of the morphological abnormalities, including signs of efferent nerve lesions (e.g., type-grouping), was significantly greater in patients than in controls. The individual abnormality score correlated significantly to the amount of obstructive breatbing, but not to the oxygen desaturation index. 2) The vascular reaction in the soft palatal mucosa after afferent nerve stimulation was recorded by a laser Doppler perfusion monitoring method in 35 patients (24 with OSA) and in 13 controls Electrical stimulation activates nerve endings of C-fibre type, which release vasoactive agents- e.g., substance P (SP) and calcitonin gene-related peptide (CGRP)- resulting in vasodilation. The snorers and some mild OSA patients showed significantly more vasodilation after stimulation, than did controls, indicating sensitized nerves, e.g., due to sprouting. Patients with moderate-to-severe OSA demonstrated significantly less vasodilation than in controls, indicating degenerated nerves. 3) Biopsies of the soft palatal mucosa from 21 patients (10 with OSA) and 11 controls were immunohistochemically stained with PGP 9.5 (specific nerve-protein), SP and CGRP. All three substances showed an increase in the number of varicose nerve endings, in and below the epithelium in nine of 10 patients with rnild-to-moderate OSA and in four of 11 habitual snorers, compared to controls. This indicates a nerve lesion, e.g., nervous sprouting. CONCLUSIONS: UPPP does not completely prevent the development of OSA, especially if the patients gain weight postoperatively. The histological and physiological methods used indicate a progressive local nerve lesion. This lesion may be an aetiology to the collapse of upper airways in OSA

Pharyngeal disturbances in OSAS patients before and 1 year after UPPP

Conclusions: The results indicate that conservative uvulopalatopharyngoplasty with tonsillectomy (UPPP) did not change the degree of pharyngeal disturbances in patients with obstructive sleep apnea syndrome (OSAS). Objectives: To investigate if the symptom scores of pharyngeal disturbances in OSAS patients were changed 1 year after UPPP, by using a questionnaire pre- and postoperatively, and to compare with healthy non-snoring controls. Methods: Fifty men and eight women, median age 46 years (range 25–75), median body mass index (BMI) 28 kg/m2 (20–38), and median preoperative oxygen desaturation index 16 (7–100) were included as they had all failed non-surgical treatment and wanted pharyngeal surgery. The questionnaire consisted of 10 questions with 4 degrees of disturbances; the maximum score was 30 and was evaluated before and 1 year after surgery. Fifteen age-, gender- and BMI-matched controls responded to the same questionnaire. Results: Responses to the questionnaire were provided pre- and postoperatively by 47 of 58 patients (81%). Their median score was unchanged from 5 (range 0–17) to 5 (0–19), compared with controls 1 (0–3). Analyses of separate questions showed a significant decrease in the score for ‘globus sensation’ and ‘swelling’ postoperatively

Uvulopalatopharyngoplasty in 158 OSAS patients failing non-surgical treatment

Conclusions: Uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnoea syndrome (OSAS) who had failed treatment with continuous positive airway pressure (CPAP) and mandibular retaining device (MRD) was effective and safe. The satisfaction rate was high. We recommend UPPP in selected OSAS patients, especially younger patients. Objectives: To evaluate the efficacy and complication rate of UPPP. Patients and methods: This was a non-randomized prospective study of 139 men and 19 women, median age 45 years (range 20–75), median body mass index (BMI) 29 (range 20–48), who underwent UPPP. One year follow-up comprised ambulant sleep apnoea recordings and questionnaires with the Epworth Sleepiness Scale (ESS). Results: In all, 76% of the patients underwent sleep recordings preoperatively and postoperatively. The oxygen desaturation index (ODI4) decreased from median 23 (range 6–100) to 8 (range 0–60), p<0.001. Criteria of success (>50% reduction and ODI<20), was 64%. The ESS value decreased from median 12 (range 0–21) to 6 (0–22), p<0.001. In all, 88% of the patients were satisfied. Four of 158 patients (2.5%) had serious postoperative complications. There was neither sequel of complications nor mortality

Low inter-examiner agreement of the Friedman staging system indicating limited value in patient selection

The Friedman staging system is a clinical method for selecting patients with obstructive sleep apnoea who are likely to benefit from uvulopalatopharyngoplasty. The objective of this study was to evaluate the system by determining its inter-examiner agreement. Twelve patients with obstructive sleep apnoea were examined by 14 doctors. The Friedman stage was derived from tonsil size and tongue position, and a Cohen's kappa analysis was performed to assess inter-examiner agreement. One hundred and sixty-eight ratings were performed. The median kappa for tongue position was 0.32 (first and third quartiles: 0.21 and 0.44) and was 0.62 (0.50 and 0.63) for tonsil size. The median kappa for the Friedman stage was 0.38 (0.24 and 0.55), which corresponds to only a slight or fair agreement. The Friedman staging system demonstrated a low inter-examiner agreement, indicating that the system is an uncertain method for selecting patients for uvulopalatopharyngoplasty. Level of evidence: 2B