Quality of Life in Obstructive Sleep Apnea Patients Who Underwent Maxillomandibular Advancement Surgery.

This study assessed health-related quality of life (HRQOL) and daytime sleepiness in moderate or severe obstructive sleep apnea patients who underwent maxillomandibular advancement (MMA) surgery. We invited patients who had undergone MMA 1 year ago and preoperative patients to answer a self-administered questionnaire to evaluate HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey-SF-36 and Functional Outcomes of Sleep Questionnaire-FOSQ) and daytime sleepiness (Epworth Sleepiness Scale-ESS). Twenty-two patients who underwent MMA and 28 preoperative patients participated in the present study. Patients who underwent MMA reduced their daytime sleepiness [5.0 (3.00-8.00) versus 16.0 (9.00-21.00), P<0.01] and increased their quality of life in the following domains: physical role functioning [100.0 (50.00-100.00) versus 62.5 (0.00-100.00), P<0.05], vitality [65.0 (58.75-90.00) versus 55.0 (21.25-67.50), P<0.0], mental health [78.0 (67.00-88.00) versus 62.0 (45.00-75.00), P<0.01], and social role functioning [88.0 (75.00-100.00) versus 69.0 (41.00-100.00), P<0.05]. Patients also improved their rates of sleep-related quality of life in general productivity [4.00 (3.63-4.00) versus 2.9 (2.03-3.75), P<0.01], social outcome [4.00 (4.00-4.00) versus 3.2 (2.00-4.00), P<0.01], activity level [3.7 (3.56-3.88) versus 2.8 (1.64-3.53), P<0.01], and vigilance [3.9 (3.55-4.00) versus 2.7 (2.03-3.67), P<0.01] when compared with the control group. The results suggest that moderate and severe obstructive sleep apnea patients who undergo MMA have positive impacts on quality of life and daytime sleepiness when compared with preoperative patients.

Introducing the Dilation and Evacuation Technique in Brazil: Lessons Learned From an International Partnership to Expand Options for Brazilian Women and Girls.

Dilation and evacuation (D&E) is the recommended surgical procedure for uterine evacuation in the second trimester. Despite its established safety record, it is not routinely available in most countries around the world. In this paper, we describe the multi-phase capacity-building project we undertook to introduce D&E in Brazil. First, we invited a highly motivated obstetrician-gynecologist and abortion provider to complete an observership at an established D&E site in the United States. We then organized a month-long clinical training for two experienced gynecologists in Brazil, followed by ongoing remote mentorship. Almost all patients we approached during the training opted for D&E, and all expressed satisfaction with their experience. Despite the restrictive legal setting and prevailing abortion stigma in Brazil, our training was well-received, and we did not experience any overt resistance from hospital staff. We learned that obtaining institutional support is essential; and that presenting scientific evidence during dedicated didactic times was an important strategy to obtain buy-in from other local healthcare providers. An important challenge we encountered was low case volume given the restrictive legal setting. We addressed this by partnering with nearby hospitals and non-profit organizations for patient referrals. We also rescheduled, adapted and optimized this project for implementation in the midst of the COVID-19 pandemic. Despite the challenges we faced, this project led to the successful introduction of D&E up to 16-18 weeks at two sites in Brazil. In the future, we plan additional training to increase capacity for D&E at more advanced gestational ages.