International Consensus Statement on Obstructive Sleep Apnea.

Background: 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).

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.

Virtual vs in-person otolaryngology evaluation: The patient perspective.

Objective: To compare patient responses to validated satisfaction surveys for in-person vs virtual otolaryngology ambulatory evaluation.

Methods: National Research Corporation (NRC) Health patient survey answers between April 2020 and February 2021 were divided into in-person and virtual visit modalities. Responses were compared with two group t-tests or Wilcoxon rank sum tests.

Post-operative Complication Rate Comparison Between Airway Surgery and Upper Airway Stimulation Using NSQIP and ADHERE.

Objective: Postoperative complication rates were compared between obstructive sleep apnea surgery (OSAS) and hypoglossal nerve upper airway stimulation (UAS).

Study Design: Cohort.

Setting: Multi-institutional international databases.

Referral Center Experience With Nonpalpable Contraceptive Implant Removals.

Objective: To describe our experience with office removal of nonpalpable contraceptive implants at our referral center.

Methods: We performed a retrospective cohort study by reviewing the charts of patients referred to our family planning specialty center for nonpalpable or complex contraceptive implant removal from January 2015 through December 2018. We localized nonpalpable implants using high-frequency ultrasonography and skin mapping in radiology, followed by attempted removal in the office using local anesthesia and a modified vasectomy clamp.

Previous Surgery and Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.

Objective: To examine whether previous palate or hypopharyngeal surgery was associated with efficacy of treatment of obstructive sleep apnea with hypoglossal nerve stimulation.

Study Design: Cohort (retrospective and prospective).

Setting: Eleven academic medical centers.

Medical abortion with mifepristone and vaginal misoprostol between 64 and 70 days' gestation.

Objective: To evaluate outcomes with mifepristone 200 mg orally followed 24-48 h later by misoprostol 800 mcg vaginally for medical abortion at 64-70 days of gestation.

Study Design: We reviewed electronic databases and medical records for medical abortion cases at 64-70 days' gestation at British Pregnancy Advisory Service clinics in England and Wales from May 2015 through October 2016. Women selected in-office follow-up or self-evaluation of abortion outcome using a checklist along with low-sensitivity urine pregnancy testing.

Drug-Induced Sleep Endoscopy and Surgical Outcomes: A Multicenter Cohort Study.

Objective: To evaluate the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort.

Methods: Retrospective, multi-center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils.

Prospective quantification of fetomaternal hemorrhage with dilation and evacuation procedures.

Objective: To describe fetomaternal hemorrhage (FMH) during second-trimester dilation and evacuation (D&E) to evaluate if Rhesus-immune globulin (RhIG) 100 mcg (used in the United Kingdom) and 300 mcg (used in the United States) provide adequate prophylaxis.

Study Design: We conducted an exploratory prospective descriptive study of women undergoing D&E between 15 weeks 0 days and 23 weeks 6 days of gestation. Enrolled participants had Kleihauer-Betke testing on specimens obtained before and after D&E.

Post-approval upper airway stimulation predictors of treatment effectiveness in the ADHERE registry.

Upper airway stimulation (UAS) has been shown to reduce severity of obstructive sleep apnoea. The aim of this study was to identify predictors of UAS therapy response in an international multicentre registry.Patients who underwent UAS implantation in the United States and Germany were enrolled in an observational registry.

Comparing Postpartum Visit Attendance with a Scheduled 2- to 3-Week or 6-Week Visit after Delivery.

Objective: To evaluate whether scheduling a 2- to 3-week versus 6-week postpartum visit results in higher visit attendance.

Study Design: We conducted a secondary analysis of a quasi-experimental before-after study to compare postpartum visit attendance after changing routine scheduling of visits from 6 weeks to 2 to 3 weeks after delivery. Secondary outcomes include patient satisfaction and breastfeeding continuation at 3 and 6 months postpartum.

Hypoglossal nerve stimulator generator migration: INSPIRE device reimplantation with parallels to cardiac implantable electronic devices.

Implantation rates of hypoglossal nerve stimulators, such as INSPIRE, are increasing. The device is still in its early stages of complication reporting, which to date includes implant related infection requiring device removal, and stimulation lead cuff dislodgement requiring replacement. Here we present a 48-year-old female who experienced generator migration and stimulator lead tension requiring an additional operation in order to resecure the generator device.

Etonogestrel implant use in women primarily choosing a combined oral contraceptive pill: A proof-of-concept trial.

Objective: We evaluated a novel concept of initiating the etonogestrel implant as a "back-up" method in women who desire using combined oral contraceptives (COC) but want to decrease their risk of unintended pregnancy with a more effective method.

Study Design: In this prospective cohort study, we planned to include 20 women as a proof-of-concept. We enrolled both new COC starters and continuing COC users and placed an etonogestrel implant.

Long-Acting Reversible Contraception Initiation With a 2- to 3-Week Compared With a 6-Week Postpartum Visit.

Objective: To evaluate whether a department policy changing the scheduling of the postpartum visit from 6 weeks to 2-3 weeks after delivery is associated with higher long-acting reversible contraception initiation at the postpartum visit.

Methods: We conducted a quasiexperimental before-after study to evaluate long-acting reversible contraception initiation, specifically an intrauterine device or contraceptive implant, at the postpartum visit between women scheduled for follow-up at 6 weeks (before policy change) and 2-3 weeks after delivery (after policy change). Secondary outcomes included postpartum visit completion, overall contraception initiation at the postpartum visit, overall contraceptive use at 6 months after delivery, and repeat pregnancies by 6 months postpartum.

Reduction of Burnout in Mental Health Care Providers Using the Provider Resilience Mobile Application.

This pilot study examined the usability, acceptability, and effectiveness of a free Provider Resilience (PR) mobile application (app) designed by the National Center for Telehealth and Technology to reduce provider burnout. Outpatient mental health providers (N = 30) used the PR app for 1 month. Participants rated the PR app on the System Usability Scale with an overall score of 79.

Intrauterine Contraception.

Currently, there are only two basic types of intrauterine devices (IUDs): copper and hormonal. However, other types of IUDs are under development, some of which are in clinical trials around the world. Continued development has focused on increasing efficacy, longer duration of use, and noncontraceptive benefits.

Snoring exclusively during nasal breathing: a newly described respiratory pattern during sleep.

Purpose: The aim of this study is to describe a distinctive respiratory pattern seen in subjects with inferior turbinate hypertrophy, nasal obstruction, and a polysomnogram-proven diagnosis of primary snoring or mild obstructive sleep apnea. These subjects demonstrated increased snoring with purely nasal breathing and alleviation of snoring with oral breathing. The study design is case series with chart review.

Continuous lesser palatine nerve block for postoperative analgesia after uvulopalatopharyngoplasty.

Objectives: Uvulopalatopharyngoplasty (UPPP) is a commonly performed surgical intervention used to treat obstructive sleep apnea (OSA) syndrome. Continuous peripheral nerve blocks have been shown to reduce postoperative pain and opioid requirements for other surgical procedures but have not been described previously for palate surgery. We present the use of a continuous lesser palatine nerve block catheter as a part of the multimodal postoperative pain management for UPPP.

Surgical therapy of obstructive sleep apnea: a review.

Obstructive sleep apnea (OSA) is a disease characterized by intermittent and repetitive narrowing of the airway during sleep. Surgical therapies for the treatment of OSA aim to improve airway patency by addressing selected site(s) of obstruction. Because several areas may each be responsible for the narrowing, different surgical modalities have also been developed.

Hunsaker Mon-Jet tube ventilation: a 15-year experience.

Objective/hypothesis: The Hunsaker Mon-Jet tube (HMJT) (Xomed, Jacksonville, FL) has been used effectively for subglottic ventilation. We previously reported a series of 552 patients over a 10-year period with no major complications. This is a continuation of that series with an additional 5 years of cases.

A lingual abscess caused by Streptococcus intermedius.

Lingual abscesses are rare. We describe a case in a healthy female with no recent history of trauma. The organism recovered by culture of drainage material collected prior to antibiotic treatment was Streptococcus intermedius, an organism recognized as flora of the oropharynx and associated with abscess formation.

Vacuum-assisted closure therapy for reconstruction of soft-tissue forehead defects.

We sought to examine the efficacy of vacuum-assisted closure (VAC) therapy for the reconstruction of full-thickness forehead defects and to determine the appropriate therapeutic strategies for its use. Medical records and photographs were reviewed for 3 patients with full-thickness tissue loss of the forehead region treated with a VAC system. All 3 patients had complete formation of healthy granulation tissue with VAC therapy alone.

Presence of soil-dwelling clostridia in commercial powdered infant formulas.

Objective: Because Clostridium botulinum was isolated from powdered infant formula (PIF) fed to an infant in the United Kingdom who subsequently developed infant botulism and from unopened PIF from the same manufacturer, we tested PIF manufactured in the United States for the presence of clostridial spores.

Study Design: Thirty PIF ingested by 19 California infants with botulism within 4 weeks of onset of illness (48% of all patients fed PIF during study) in 2006-2007 were cultured anaerobically to isolate clostridia. All isolated clostridia were identified to the species level and enumerated with standard microbiologic and molecular methods.

Effects of long-term flutamide treatment during development in zebra finches.

The molecular mechanisms responsible for the sexual differentiation of the zebra finch song system remain mysterious. Androgen receptors are expressed in a sexually dimorphic fashion in the zebra finch song system: males have more cells expressing androgen receptors, and this sex difference appears very early in development (day 9 posthatch). Estrogen administration to hatchling females up-regulates androgen receptor expression in their song system and profoundly masculinizes their song system's morphology.

The evolution of chest computed tomography for the definitive diagnosis of blunt aortic injury: a single-center experience.

Background: Chest computed tomography (CT) is an excellent screening tool for blunt aortic injuries (BAIs). Aortography is considered the "gold standard" for diagnosis. Recent evidence suggests that new-generation, multislice, helical CT technology can accurately diagnose BAI.