Efficacy of oral appliance therapy in patients following uvulopalatopharyngoplasty failure

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149311/1/lio2256.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149311/2/lio2256_am.pd

Impact of the COVID-19 Pandemic on the Clinical Learning Environment: Addressing Identified Gaps and Seizing Opportunities

The clinical learning environment (CLE) encompasses the learner’s personal characteristics and experiences, social relationships, organizational culture, and the institution’s physical and virtual infrastructure. During the COVID-19 pandemic, all four of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communications have been limited to virtual interactions or shifted to unfamiliar clinical spaces because of redeployment. Rapid changes to the organizational culture required prompt adaptations from learners and educators in their complex organizational systems yet caused increased confusion and anxiety among them. A traditional reliance on a physical infrastructure for classical educational practices in the CLE was challenged when all institutions had to undergo a major transition to a virtual learning environment. However, disruptions spurred exciting innovations in the CLE. An entire cohort of physicians and learners underwent swift adjustments in their personal and professional development and identity as they rose to meet the clinical and educational challenges they faced due to COVID-19. Social networks and collaborations were expanded beyond traditional institutional walls and previously held international boundaries within multiple specialties. Specific aspects of the organizational and educational culture, including epidemiology, public health, and medical ethics, were brought to the forefront in health professions education, while the physical learning environment underwent a rapid transition to a virtual learning space. As health professions education continues in the era of COVID-19 and into a new era, educators must take advantage of these dynamic systems to identify additional gaps and implement meaningful change. In this article, health professions educators and learners from multiple institutions and specialties discuss the gaps and weaknesses exposed, opportunities revealed, and strategies developed for optimizing the CLE in the post–COVID-19 world

Craniofacial Growth Series Volume 54

Obstructive sleep apnea (OSA) is a relatively common disorder characterized by the repeated collapse of the upper airway, resulting in sleep fragmentation and episodic hypoxemia. The consequences of untreated sleep apnea can be significant and include increased risk of cardiovascular events (e.g., heart attack, stroke), decreased quality of life and motor vehicle accidents. It is estimated that over 80% of individuals who have sleep apnea do not know that they have this medical problem, emphasizing the need for greater awareness among both clinicians and the lay population. OSA has a complex multi-factorial etiology and is more common in older adults who are overweight, but it can affect individuals of any age and body type. Even children, especially those with enlarged tonsillar or constricted nasopharyngeal tissues, may have OSA. It requires long- term management; lifestyle changes, positive airway pressure, oral appliances and/or surgery can be used treat sleep apnea successfully once the condition is diagnosed. The Moyers Symposium has had a long history of dealing with interdisciplinary topics and the 44th Annual Moyers Symposium was no exception. We brought together ten healthcare providers in both medicine and dentistry who have expertise in sleep-disordered breathing to discuss the diagnosis and treatment of OSA patients, considering in detail the multiple treatment approaches that are available. Some of the attendees also may have discovered that this condition was relevant personally, as the signs, symptoms and history of OSA were presented during the meeting. The 44th Annual Moyers Symposium was held at The University of Michigan on Saturday and Sunday, March 4-5, 2017. The interdisciplinary audience was large, with approximately 550 individuals in attendance. The annual Presymposium meeting (aka the 42nd Annual International Conference on Craniofacial Research) was held on Friday March 2, 2017 in the 4th Floor Amphitheater of the Horace H. Rackham School of Graduate Studies Building. Thirteen of the 16 papers presented by an international group of investigators were focused specifically on the topic of the 2017 Moyers Symposium. Many of the Presymposium papers are included as chapters in this volume. As in previous years, the Symposium honored the late Dr. Robert Edison Moyers, Professor Emeritus of Dentistry and Fellow Emeritus and Founding Director of the Center for Human Growth and Development at The University of Michigan. This meeting was co-sponsored by the School of Dentistry and the Center for Human Growth and Development. First, I would like to thank my co-editor of this volume, Anita V. Shelgikar, MD, for her tireless work in helping us plan and execute the 2017 Moyers Symposium. Anita was instrumental in identifying out- standing speakers in sleep medicine to participate, as well as delivering the keynote 21st Annual Robert E. Moyers Memorial Lecture entitled Sleep Apnea: What Is It and Why Should We Care? She then demon- strated excellent editing skills in critiquing chapters from both medical and dental disciplines, making many suggestions that have clarified and improved each chapter. Her participation was integral from beginning to end both for the Symposium and the subsequent volume. We continue to recognize the enormous contribution of Kris De Koster, Associate Editor of the Craniofacial Growth Series, for her efforts on this book. For the past ten years, Kris has facilitated the publication of this annual volume through her interactions with the authors, editing, manipulating a variety of figure formats and formatting the layout of the book. It is always a challenge for us to produce such a volume in the time frame prior to the next Symposium; Kris has a stellar record of producing a high-quality book within this limited period. In addition, we recognize the work of Kathy Ribbens who provided assistance in the final format- ting the book for publication. We also thank the contributors for sending us their material in a timely fashion. We acknowledge and thank Dr. Nan Hatch, Chair of the Depart- ment of Orthodontics and Pediatric Dentistry, for providing the financial resources to underwrite partially the publication of this book. We also must thank Dr. Brenda Volling, the Director of the Center for Human Growth and Development, for the continued financial and moral sup- port of the Moyers Symposium provided by the Center for the last 44 years. We are fortunate to work with the staff from the Office of Continuing Dental Education, who organize and run the Presymposium and Symposium. Michelle Jones, Karel Barton and Elizabeth Fee managed both meetings in an exceptionally smooth and efficient fashion. We all are very pleased that the 44th Moyers Symposium was so successful. The topic obviously was of heightened clinical relevance to clinicians and researchers in both medicine and dentistry. The chapters within this volume are written with both the clinician and patients in mind, so that we all can benefit from sharing our knowledge provided from a variety of perspectives. James A. McNamara, Jr. Editor-in-Chief, Craniofacial Growth Series The University of Michigan Ann Arbor, Michigan December 2017UM Center for Human Growth and DevelopmentUM Department of Orthodontics and Pediatric Dentistryhttps://deepblue.lib.umich.edu/bitstream/2027.42/146772/1/Moyers Proceedings Symp 2017 Sleep Apnea.pdf53Description of Moyers Proceedings Symp 2017 Sleep Apnea.pdf : Proceedings of the 44th Annual Moyers Symposiu

Assessing changes in the quality of quantitative health educations research: a perspective from communities of practice

Abstract Background As a community of practice (CoP), medical education depends on its research literature to communicate new knowledge, examine alternative perspectives, and share methodological innovations. As a key route of communication, the medical education CoP must be concerned about the rigor and validity of its research literature, but prior studies have suggested the need to improve medical education research quality. Of concern in the present study is the question of how responsive the medical education research literature is to changes in the CoP. We examine the nature and extent of changes in the quality of medical education research over a decade, using a widely cited study of research quality in the medical education research literature as a benchmark to compare more recent quality indicators. Methods A bibliometric analysis was conducted to examine the methodologic quality of quantitative medical education research studies published in 13 selected journals from September 2013 to December 2014. Quality scores were calculated for 482 medical education studies using a 10-item Medical Education Research Study Quality Instrument (MERSQI) that has demonstrated strong validity evidence. These data were compared with data from the original study for the same journals in the period September 2002 to December 2003. Eleven investigators representing 6 academic medical centers reviewed and scored the research studies that met inclusion and exclusion criteria. Primary outcome measures include MERSQI quality indicators for 6 domains: study design, sampling, type of data, validity, data analysis, and outcomes. Results There were statistically significant improvements in four sub-domain measures: study design, type of data, validity and outcomes. There were no changes in sampling quality or the appropriateness of data analysis methods. There was a small but significant increase in the use of patient outcomes in these studies. Conclusions Overall, we judge this as equivocal evidence for the responsiveness of the research literature to changes in the medical education CoP. This study identified areas of strength as well as opportunities for continued development of medical education research.http://deepblue.lib.umich.edu/bitstream/2027.42/173627/1/12909_2022_Article_3301.pd

Assessing changes in the quality of quantitative health educations research: a perspective from communities of practice.

BackgroundAs a community of practice (CoP), medical education depends on its research literature to communicate new knowledge, examine alternative perspectives, and share methodological innovations. As a key route of communication, the medical education CoP must be concerned about the rigor and validity of its research literature, but prior studies have suggested the need to improve medical education research quality. Of concern in the present study is the question of how responsive the medical education research literature is to changes in the CoP. We examine the nature and extent of changes in the quality of medical education research over a decade, using a widely cited study of research quality in the medical education research literature as a benchmark to compare more recent quality indicators.MethodsA bibliometric analysis was conducted to examine the methodologic quality of quantitative medical education research studies published in 13 selected journals from September 2013 to December 2014. Quality scores were calculated for 482 medical education studies using a 10-item Medical Education Research Study Quality Instrument (MERSQI) that has demonstrated strong validity evidence. These data were compared with data from the original study for the same journals in the period September 2002 to December 2003. Eleven investigators representing 6 academic medical centers reviewed and scored the research studies that met inclusion and exclusion criteria. Primary outcome measures include MERSQI quality indicators for 6 domains: study design, sampling, type of data, validity, data analysis, and outcomes.ResultsThere were statistically significant improvements in four sub-domain measures: study design, type of data, validity and outcomes. There were no changes in sampling quality or the appropriateness of data analysis methods. There was a small but significant increase in the use of patient outcomes in these studies.ConclusionsOverall, we judge this as equivocal evidence for the responsiveness of the research literature to changes in the medical education CoP. This study identified areas of strength as well as opportunities for continued development of medical education research

Age and weight considerations for the use of continuous positive airway pressure therapy in pediatric populations: an American Academy of Sleep Medicine position statement.

UNLABELLED: This position statement provides guidance for age and weight considerations for using continuous positive airway pressure therapy in pediatric populations. The American Academy of Sleep Medicine commissioned a task force of experts in pediatric sleep medicine to review the medical literature and develop a position statement based on a thorough review of these studies and their clinical expertise. The American Academy of Sleep Medicine Board of Directors approved the final position statement. It is the position of the American Academy of Sleep Medicine that continuous positive airway pressure can be safe and effective for the treatment of obstructive sleep apnea for pediatric patients, even in children of younger ages and lower weights, when managed by a clinician with expertise in evaluating and treating pediatric obstructive sleep apnea. The clinician must make the ultimate judgment regarding any specific care in light of the individual circumstances presented by the patient, accessible treatment options, patient/parental preference, and resources. CITATION: Amos L, Afolabi-Brown O, Gault D, et al. Age and weight considerations for the use of continuous positive airway pressure therapy in pediatric populations: an American Academy of Sleep Medicine position statement

International consensus statement on obstructive sleep apnea

BACKGROUND: Evaluation and interpretation of the literature on obstructive sleep apnea is needed to consolidate and summarize key factors important for clinical management of the OSA adult patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS: The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA and treatment on the multiple comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION: This review of the literature in OSA consolidates the available knowledge and identifies the limitations of the current evidence. This effort aims to highlight the basis of OSA evidence-based practice and identify future research needs. Knowledge gaps and opportunities for improvement include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy

International Consensus Statement on Obstructive Sleep Apnea

Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy