Sleep among Obstetrics and Gynecology Trainees: Results from a Yoga-Based Wellness Initiative.

OBJECTIVE: This study aimed to determine the feasibility of using a wrist-based fitness tracking device to assess sleep among Obstetrics and Gynecology (OBGYN) trainees who engaged in a yoga-based wellness program. We also sought to evaluate the effects of yoga on sleep. STUDY DESIGN: A quality improvement initiative consisting of an 8-week wellness program of weekly yoga classes, nutrition, and physical challenges was implemented for OBGYN residents and Maternal-Fetal Medicine fellows. The Polar A370 fitness tracker device was provided and synced to the Polar Flow for Coach program for inclusion. Data obtained included total and restful sleep from each night the device were worn. Pre- and post-assessment of the Pittsburg Sleep Quality Index (PSQI) were compared. Linear mixed models were used to estimate and test the effect of yoga on sleep while controlling for on-call shifts. RESULTS: Of the 15 participants who synced their device, 13 (87%) were included for analysis. Sleep data from 572 nights were analyzed. The mean (SD) total sleep was 434.28 (110.03) minutes over the 8 weeks. A minimum of 7 hours (420 minutes) of total sleep occurred 59.3% of the time. After controlling for Friday or Saturday night on-call, those who attended yoga class had a significantly greater total sleep (yoga: 425.14 minutes [41.89], no yoga: 357.33 [43.04] minutes; p = 0.04). There was no significant change in the mean global PSQI score after the program (pre: 5.0 [1.6], post: 5.1 [2.5], p = 0.35). CONCLUSION: Wearable fitness monitors provide insight into sleep patterns displayed during training and can serve as a tool to identify those who are sleep deprived and assist in the evaluation of trainee wellness. Training programs are encouraged to provide access to yoga and mindfulness interventions to improve sleep and possibly clinical performance. KEY POINTS: · Yoga improves trainee sleep by approximately 60 minutes.. · Total and restful sleep are reduced during night float rotation.. · Trainees obtained 7 hours of sleep approximately 60% of the time..

The Utility of the Modified Dionne's Egress Test as a Predictor of Falls in Adult Medical and Surgical Patients.

OBJECTIVE: The aim of this study was to compare the efficacy of a modified Dionne's Egress Test (Egress) as a predictor of falls with the Morse Fall Scale (MFS) in adult medical and surgical patients in an acute care setting. BACKGROUND: Nurses must identify fall risk while balancing fall prevention and early mobility in their care delivery. Fall risk screening tools alone are not enough to assist nurses in predicting patients at risk of falling. METHODS: A retrospective observational study design was used to compare the Egress as a predictor of falls to the MFS. The sample included data abstracted from 197 electronic health records and internal falls data. RESULTS: The Egress and the MFS are moderately and negatively correlated; however, only Egress was a significant predictor of falls. Passing the Egress, not being on benzodiazepines, and having a longer length of stay (LOS) results were associated with being less likely to fall. CONCLUSION: Egress is a better predictor of falls than MFS when benzodiazepines and LOS are controlled in the model.

Treatment of Prepubertal Labial Adhesions: A Randomized Controlled Trial.

STUDY OBJECTIVE: Although various treatment options have been proposed for the treatment of labial adhesions, there are currently no clearly outlined limits on the duration of topical therapy, amount of lateral traction to apply, and methods to decrease the recurrence. This clinical trial was undertaken to assess the need for estrogen for treatment of prepubertal labial adhesions. DESIGN: Randomized, double-blinded, controlled trial. SETTING: Pediatric and Adolescent Gynecology Clinic at a children's hospital in a metropolitan area. PARTICIPANTS: Prepubertal girls ages 3 months to 12 years with labial adhesions. INTERVENTIONS: Lateral traction with topical estrogen or topical emollient. MAIN OUTCOME MEASURES: The primary outcome was resolution of labial adhesions. The secondary outcome was the change in severity of labial adhesions over time between the 2 groups. RESULTS: Forty-three girls were enrolled and 38 (88%) completed the study. The difference in complete resolution between the topical emollient group (19%) and the topical estrogen group (36%) was not statistically significant (P = .21). There was a statistically significant decrease in severity of labial adhesions over time, with the magnitude of improvement favoring the topical estrogen group. CONCLUSION: Although labial adhesion severity decreased when treated with lateral traction and topical emollient or topical estrogen, the magnitude of the effect was significantly greater for topical estrogen.

Resident and Faculty Attitudes Toward Osteopathic-Focused Education.

CONTEXT: The transition period for the single accreditation system for graduate medical education under the Accreditation Council for Graduate Medical Education (ACGME) began on July 1, 2015, and will end June 30, 2020. As of February 5, 2018, 82.6% of residency programs accredited by the American Osteopathic Association (AOA) have applied for or achieved ACGME accreditation and 160 programs have applied for or achieved osteopathic recognition. OBJECTIVE: To assess baseline attitudes of osteopathic and allopathic faculty and residents in AOA-accredited and dually accredited residency programs regarding the value of osteopathic-focused educational curricula and mentors. METHODS: A survey was emailed to 60 program directors of AOA-accredited programs and dually accredited residency programs, some of which had obtained ACGME osteopathic recognition. The survey was to be completed by residents and faculty. Items were formulated to obtain baseline measurements regarding the level of awareness of osteopathic principles and practice (OPP), attitudes regarding osteopathic culture, and the weighted importance of aspects of the osteopathic curriculum. Principal components analysis with Varimax rotation was used. Comparison analysis was accomplished by either independent t tests for subscale scores or Mann-Whitney U tests for item-level scores. RESULTS: A total of 327 people responded to the survey (115 faculty members, 211 residents, and 1 no response). Of the 60 program directors contacted, 53 replied with at least 1 program representative. One hundred twenty-nine of all 211 residents (61.7%), including 107 of 134 osteopathic family medicine residents (79.9%), agreed that they intended to use OMT when in practice. The curricular component item with the lowest total survey score, indicating the highest-ranked level of importance, was the ability to work with osteopathic faculty (mean [SD], 1.98 [0.98]). Of the items measuring osteopathic awareness, statements with the strongest level of agreement from all respondents were "I have seen OMT performed on a patient or a peer" and "I am familiar with the basic tenets of OPP." CONCLUSION: Residents in AOA-accredited programs value osteopathic mentors and OMT, and they generally intend to use OMT when in practice. Respondents from programs with osteopathic recognition had more favorable attitudes toward osteopathic culture and curriculum than did respondents from programs without osteopathic recognition.

Dental anomalies in pediatric patients with familial adenomatous polyposis.

Familial adenomatous polyposis patients often present with non-malignant extra-intestinal manifestations which include dental anomalies that may be evident prior to the appearance of the colonic adenomas. The aims of this study were to describe the prevalence and type of dental anomalies and the relationships between gene mutations and dental anomalies in these patients. Twenty-two pediatric familial adenomatous polyposis patients and 46 controls, who were age and gender matched participated. Familial adenomatous polyposis patient's had a dental examination with panoramic radiograph and medical record review for age at diagnosis, the presence of the adenomatous polyposis coli gene mutation, and determination of other extra-intestinal manifestations on the body. The control group was identified from a retrospective chart review and selected if there was a current panoramic radiograph. The only significant difference between familial adenomatous polyposis patients and controls were the presence of jaw osteomas and sclerosis (p = .0001). Patients with a mutation in, or upstream of codon 1309 had a higher frequency of osteomas (77.8%) and jaw-bone sclerosis (44.4%), and 77% of these had at least one dental anomaly. This preliminary study showed an association between a genetic variant at, or upstream of codon 1309, and radiographic dental anomalies.

Factors associated with depressive symptoms in uncontrolled asthmatics.

RATIONALE: Recent epidemiological data indicate that approximately 6.7% of US adults suffer from depression in any given year. The purpose of the study is to identify factors associated with depressive symptoms in a large diverse group of patients with poorly controlled asthma. The factors include quality of life (QOL), lung function, asthma knowledge, attitudes, self-efficacy, symptoms and control of disease. METHODS: Baseline characteristics of a cohort of 599 subjects with asthma recruited from twenty Asthma Clinical Research Centers across the United States were examined. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to stratify subjects into those with depressive symptoms (CES-D score ≥ 16) and those without depressive symptoms (CES-D < 16). Bivariate statistics were used to compare the two groups; additionally, logistic regression was used to determine factors that have the greatest association with depressive symptoms. RESULTS: Subjects with depressive symptoms had significantly lower QOL scores and less knowledge about their disease than subjects with no depression; however, lung function (FEV1%) and asthma control were not significantly associated with depressive symptoms in the logistic regression analysis. Subjects who were non-white had lower household income, high school diploma or less, and those who were unemployed or disabled had significantly higher scores for depressive symptoms. CONCLUSION: Subjects with depressive symptoms have significantly less knowledge of their disease and poorer QOL compared to those without depressive symptoms. Evaluating depressive symptoms in subjects with asthma will provide a more complete picture of their overall condition. The role of asthma education on depressive symptoms in this population needs to be further investigated. The effect of QOL on treating depression in asthma patients also needs to be studied.

Patterns of Treatment of Accidental Genital Trauma in Girls.

STUDY OBJECTIVE: To evaluate the characteristics of girls with accidental genital trauma (AGT) who can be managed in the emergency department (ED) vs the operating suite (OS). DESIGN: Retrospective cohort. SETTING: ED at a children's hospital in a metropolitan area. PARTICIPANTS: Girls aged 0-18 years with AGT. INTERVENTIONS AND MAIN OUTCOME MEASURES: Factors associated with need for evaluation and repair of AGT in the OS. RESULTS: A total of 359 girls were included in the analysis. The mean age was 6 ± 3 years. Most girls presented with pain and bleeding, 321/359 (89%). Straddle injury was the most common mechanism, 258/355 (73%). The most commonly injured site was the labia, 225/358 (63%) and the most common type of injury was laceration, 308/357 (86%). Factors significantly associated with treatment in the OS included older age, transfer from another institution, penetrating injuries, injuries involving the hymen/vagina/urethra/anus, and injuries larger than 3 cm in size. The odds of requiring general anesthesia in the OS were 5.5 times higher for injuries larger than 3 cm (95% confidence interval, 2.8-10.9; P < .0001) and 4.1 times greater if the patient was transferred from another facility (95% confidence interval, 1.3-13.3; P < .02). CONCLUSION: Most AGT can be managed expectantly. Penetrating injuries, injuries to the hymen/vagina/urethra/anus, and injuries with a maximal size of 3 cm should be considered as indications for management in the OS. With adequate procedural sedation, most girls with minor injuries as a result of AGT can undergo a thorough examination and repair of AGT in the ED.

The Impact of Prenatal Yoga on Exercise Attitudes and Behavior: Teachable moments from a Randomized Controlled Trial.

OBJECTIVE: Pregnancy serves as an opportune time for "teachable moments" to elicit positive behavior change. We evaluated change in exercise perception, behavior and gestational weight gain in participants engaged in a one-hour educational experience. METHODS: Women between 28 0/7 to 36 6/7 weeks with no prior yoga experience carrying a non-anomalous singleton fetus participated in a randomized controlled trial on prenatal yoga. The yoga group engaged in a one-hour yoga class; the attention control educational group, in a one-hour presentation on exercise, nutrition and obesity in pregnancy. Maternal perception of yoga, exercise effects and current health status was conducted before and after the intervention. Gestational weight gain (GWG) and body mass index (BMI) were assessed. A postpartum survey was performed to determine self-reported behavioral changes during and after pregnancy. RESULTS: Over 6 months, 52 women were randomized and 46 (88%) completed the study. Women reported a more positive attitude towards exercise and yoga after the yoga intervention. Total GWG was similar (yoga 32.9 versus education 32.8 pounds, p = 0.98). Stratified by pre-pregnancy BMI, 13% gained within and 61% gained above the Institute of Medicine guidelines in each group. Of 29 inactive women prior to the intervention, 60% of the yoga group and 75% of the education group began prenatal exercises after the intervention and 50% of each group continued to exercise after delivery. There were no significant differences between groups. CONCLUSION: A one-time, one-hour intervention teaching a new exercise or educating women during pregnancy can positively impact pregnancy behaviors and perception with the potential to improve maternal and neonatal outcomes. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, www.clinicaltrials.gov , NCT02063711.

The oral microbiome and adverse pregnancy outcomes.

Significant evidence supports an association between periodontal pathogenic bacteria and preterm birth and preeclampsia. The virulence properties assigned to specific oral pathogenic bacteria, for example, Fusobacterium nucleatum, Porphyromonas gingivalis, Filifactor alocis, Campylobacter rectus, and others, render them as potential collaborators in adverse outcomes of pregnancy. Several pathways have been suggested for this association: 1) hematogenous spread (bacteremia) of periodontal pathogens; 2) hematogenous spread of multiple mediators of inflammation that are generated by the host and/or fetal immune response to pathogenic bacteria; and 3) the possibility of oral microbial pathogen transmission, with subsequent colonization, in the vaginal microbiome resulting from sexual practices. As periodontal disease is, for the most part, preventable, the medical and dental public health communities can address intervention strategies to control oral inflammatory disease, lessen the systemic inflammatory burden, and ultimately reduce the potential for adverse pregnancy outcomes. This article reviews the oral, vaginal, and placental microbiomes, considers their potential impact on preterm labor, and the future research needed to confirm or refute this relationship.

Is histologic esophagitis associated with dental erosion: a cross-sectional observational study?

BACKGROUND: Gastroesophageal reflux disease (GERD) affects 15-25% of children and adolescents in the United States. The diagnosis of GERD in children is complex as reported symptoms or symptom profiles have been found to be unreliable. Frequently, the diagnosis must be confirmed by objective tests such as pH monitoring or histological evidence of esophagitis on an esophageal biopsy. Dental erosion has been shown to be associated with GERD as an atypical complication and has the potential to be a marker of GERD. The purposes of this study were to compare the frequency and patterns of dental erosion in children and adolescents with and without histologic esophagitis. METHODS: Twenty-five subjects were recruited from patients scheduled for an upper gastrointestinal endoscopy. Information regarding potential GERD symptoms, food habits, and dental hygiene habits were obtained. Intra-oral photographs were taken, and a dental exam for erosion was performed. The results of a standard biopsy taken from the lower third of the esophagus during an endoscopy were used to divide subjects into either the control group or the GERD group (i.e. those with histologic esophagitis). RESULTS: Twenty-two subjects yielded 586 evaluable teeth. No significant difference was found between frequency or erosion patterns of those with and without histologic esophagitis. Dental erosions were more frequent in primary teeth. CONCLUSIONS: Dental erosions do not appear to be associated with histologic esophagitis indicative of GERD.

Attitudes of Family Medicine Program Directors Toward Osteopathic Residents Under the Single Accreditation System.

BACKGROUND: Between 2015 and 2020, residency programs accredited through the American Osteopathic Association (AOA) are preparing the single graduate medical education (GME) system through the Accreditation Council for Graduate Medical Education (ACGME). OBJECTIVES: (1) To assess the attitudes of family medicine program directors in programs accredited dually by the AOA and ACGME (AOA/ACGME) or ACGME only toward the clinical and academic preparedness of osteopathic residency candidates and (2) to determine program director attitudes toward the perceived value of osteopathic-focused education, including osteopathic manipulative treatment (OMT) curricula. METHODS: A survey was sent to program directors of AOA/ACGME and ACGME-only accredited family medicine residency programs. Items concerned program directors' perception of the academic and clinical strength of osteopathic residents at the onset of residency, the presence of osteopathic faculty and residents currently in the program, and the presence of formal curricula for teaching OMT. The perceived value of osteopathic focus was obtained through a composite score of 5 items. RESULTS: A total of 38 AOA/ACGME family medicine residency program directors (17%) and 211 ACGME family medicine residency program directors (45.6%) completed the survey (N=249). No difference was found in the ranking of the perceived clinical preparation of osteopathic residents vs allopathic residents in programs with and without OMT curricula (P=.054). Directors of programs with OMT curricula perceived the academic preparation of their osteopathic residents vs allopathic residents more highly than those without OMT curricula (P=.039). Directors of AOA/ACGME programs perceived both the academic preparation and clinical preparation of their osteopathic residents more highly than those at ACGME-only programs (P=.004 and P=.002, respectively). CONCLUSION: Directors of AOA/ACGME programs, as well as those whose programs have an osteopathic focus in curricular offerings, were more likely to rank the academic preparation of osteopathic residents higher than directors of ACGME-only programs and those without OMT curricula. Further research is needed to determine the value of osteopathic recognition in attracting strong family medicine residency candidates.

Complementary and Alternative Medicine Use in Modern Obstetrics: A Survey of the Central Association of Obstetricians & Gynecologists Members.

The use of complementary and alternative medicine during pregnancy is currently on the rise. A validated survey was conducted at the Central Association of Obstetrician and Gynecologists annual meeting to evaluate the knowledge, attitude, and practice of general obstetricians and gynecologists and maternal-fetal medicine specialists in America. We obtained 128 responses: 73 electronically (57%) and 55 via the paper survey (43%). Forty-five percent reported personally using complementary and alternative medicine and 9% of women respondents used complementary and alternative medicine during pregnancy. Overall, 62% had advised their patients to utilize some form of complementary and alternative medicine in pregnancy. Biofeedback, massage therapy, meditation, and yoga were considered the most effective modalities in pregnancy (median [semi-interquartile range] = 2 [0.5]). Maternal-fetal medicine specialists were significantly more likely to disagree on the use of complementary and alternative medicine for risk reduction of preterm birth compared to obstetricians and gynecologists ( P = .03). As the use of complementary and alternative medicine continues to rise in reproductive-age women, obstetricians will play an integral role in incorporating complementary and alternative medicine use with conventional medicine.

Acute feTal behavioral Response to prenatal Yoga: a single, blinded, randomized controlled trial (TRY yoga).

BACKGROUND: In 2012, yoga was practiced by 20 million Americans, of whom 82% were women. A recent literature review on prenatal yoga noted a reduction in some pregnancy complications (ie, preterm birth, lumbar pain, and growth restriction) in those who practiced yoga; to date, there is no evidence on fetal response after yoga. OBJECTIVES: We aimed to characterize the acute changes in maternal and fetal response to prenatal yoga exercises using common standardized tests to assess the well-being of the maternal-fetal unit. STUDY DESIGN: We conducted a single, blinded, randomized controlled trial. Uncomplicated pregnancies between 28 0/7 and 36 6/7 weeks with a nonanomalous singleton fetus of women who did not smoke, use narcotics, or have prior experience with yoga were included. A computer-generated simple randomization sequence with a 1:1 allocation ratio was used to randomize participants into the yoga or control group. Women in the yoga group participated in a 1-time, 1 hour yoga class with a certified instructor who taught a predetermined yoga sequence. In the control group, each participant attended a 1-time, 1 hour PowerPoint presentation by an obstetrician on American Congress of Obstetricians and Gynecologists recommendations for exercise, nutrition, and obesity in pregnancy. All participants underwent pre- and postintervention testing, which consisted of umbilical and uterine artery Doppler ultrasound, nonstress testing, a biophysical profile, maternal blood pressure, and maternal heart rate. A board-certified maternal-fetal medicine specialist, at a different tertiary center, interpreted all nonstress tests and biophysical profile data and was blinded to group assignment and pre- or postintervention testing. The primary outcome was a change in umbilical artery Doppler systolic to diastolic ratio. Sample size calculations indicated 19 women per group would be sufficient to detect this difference in Doppler indices (alpha, 0.05; power, 80%). Data were analyzed using a repeated-measures analysis of variance, a χ(2), and a Fisher exact test. A value of P < .05 was considered significant. RESULTS: Of the 52 women randomized, 46 (88%) completed the study. There was no clinically significant change in umbilical artery systolic to diastolic ratio (P = .34), pulsatility index (P = .53), or resistance index (P = .66) between the 2 groups before and after the intervention. Fetal and maternal heart rate, maternal blood pressure, and uterine artery Dopplers remained unchanged over time. When umbilical artery indices were individually compared with gestational age references, there was no difference between those who improved or worsened between the groups. CONCLUSION: There was no significant change in fetal blood flow acutely after performing yoga for the first time in pregnancy. Yoga can be recommended for low-risk women to begin during pregnancy.

Understanding Patient Perceptions of Hypertension for Optimal Management in a Student-Run Free Clinic.

The burden of hypertension (HTN) is disproportionately high among adults with low socio-economic status. Our objective was to examine the knowledge, attitudes and barriers related to HTN among this cohort. Using a mixed-methods approach, we interviewed twenty adults at a student-run safety-net health clinic. Most patients recognized HTN-related risks, but themes of denial, financial burden and misinformation emerged when addressing treatment adherence. Our findings highlight an urgent need to address patient-centric approaches in HTN management.

Attitudes and motivations regarding willingness to participate in dental clinical trials.

BACKGROUND: This study examined attitudes about research, knowledge of the research process, reasons for and satisfaction with participation in a dental clinical trial as a function of demographic characteristics. MATERIALS AND METHODS: 180 adults were invited to complete a 47-item survey at the completion of a 10-week dental product study at a Midwestern academic dental center. Seven demographic items included gender, race/ethnicity, age, education, household income, location of usual dental care, and dental insurance. Forty items assessed: attitudes about research; knowledge of the research process; perception of the study team; perceived risks/benefits; health perceptions; and general satisfaction with the study. RESULTS: 176 participants completed the questionnaire for a 98% response rate. African Americans were more likely to attribute Fate/God as more important to their health and their willingness to participate in research than whites, and more likely to report non-supportive social norms when compared to whites and other groups. Individuals in the 45-59 age group were less likely to attribute financial reimbursement as a motivator for their participation in research compared to all other age groups. Individuals with less education rated Fate/God attitudes as important to their research participation, reported lower autonomy for participation, and reported less supportive social norms compared to those with some college education. Participants in the four income categories showed significant differences in reasons for participation and desire for free care. CONCLUSION: Motivations for participation of a Midwestern population of research subjects are dependent on age, ethnicity, belief in Fate/God, education, social norms and income.

Menstrual Patterns and Treatment of Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders.

STUDY OBJECTIVE: To characterize menstrual bleeding patterns and treatment of heavy menstrual bleeding in adolescents with bleeding disorders. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective review of female patients aged nine to 21 years with known bleeding disorders who attended a pediatric gynecology, hematology, and comprehensive hematology/gynecology clinic at a children's hospital in a metropolitan area. MAIN OUTCOME MEASURES: Prevalence of heavy menstrual bleeding at menarche, prolonged menses, and irregular menses among girls with bleeding disorders and patterns of initial and subsequent treatment for heavy menstrual bleeding in girls with bleeding disorders. RESULTS: Of 115 participants aged nine to 21 years with known bleeding disorders, 102 were included in the final analysis. Of the 69 postmenarcheal girls, almost half (32/69, 46.4%) noted heavy menstrual bleeding at menarche. Girls with von Willebrand disease were more likely to have menses lasting longer than seven days. Only 28% of girls had discussed a treatment plan for heavy menstrual bleeding before menarche. Hormonal therapy was most commonly used as initial treatment of heavy menstrual bleeding. Half (53%) of the girls failed initial treatment. Combination (hormonal and non-hormonal therapy) was more frequently used for subsequent treatment. CONCLUSIONS: Adolescents with bleeding disorders are at risk of heavy bleeding at and after menarche. Consultation with a pediatric gynecologist and/or hematologist prior to menarche may be helpful to outline abnormal patterns of menstrual bleeding and to discuss options of treatment in the event of heavy menstrual bleeding.

Oral health status and physical, mental and cognitive disabilities among nursing home residents in Jordan.

OBJECTIVE: The purpose of this study is to describe physical, mental and cognitive disabilities and periodontal status as indicated by periodontal health, edentulism and use of dentures among nursing home residents in Jordan. METHODS: A sample of 221 subjects with a mean age of 62.4 years (121 males and 100 females) from nursing home residents in Jordan were recruited to participate in this study. Oral health status, mini mental state examination (MMSE), Geriatric Depression Scale (GDS), Tinetti Assessment Battery for gait and balance (TAB) and disability of arm, shoulder and hand test (DASH) were assessed for all subjects. RESULTS: The response rate was about 88%. The multivariate analysis showed that the degree of upper limb disabilities, as measured by DASH, and reporting not brushing of teeth were the main risk indicators for severity of periodontal disease. Residents with dentures were found to have significantly higher cognitive abilities scores (MMSE), better upper arm abilities (DASH) and gait and balance score (TAB) in comparison with edentulous adults without dentures. Edentulous residents were found to suffer more from cognitive impairment (MMSE) than dentate residents. There was no predilection of upper limb (DASH) and lower limb (TAB) disabilities or depressive symptoms (GDS) for edentulous over dentate subjects. CONCLUSIONS: Results suggest that nursing home residents with a variety of physical, cognitive and psychological disabilities are at increased risk of deterioration of their oral health. All those associated with the health of residents need to be aware of this issue and take preventive and therapeutic measures as needed.

Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.

This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ≥6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient.

A qualitative study of extended care permit dental hygienists in Kansas.

PURPOSE: Currently, 37 states allow some type of alternative practice settings for dental hygienists. This qualitative study was designed to explore the experiences of the Extended Care Permit (ECP) dental hygienist in the state of Kansas. As a first ever study of this workforce model, a qualitative research design was chosen to illuminate the education and experiences of extended dental hygiene practitioners in order to understand the impact ECP legislation has had on increasing the public's access to oral health care services and define the advantages and limitation of this model as one potential solution to access to oral care. Snowball sampling was used to identify study participants who were actively engaged in extended care practice. Nine subjects, which included one ECP consultant and eight ECP providers, participated in this study. Data obtained via personal interviews and through document analysis data were subsequently coded and thematically analyzed by three examiners. An independent audit was conducted by a fourth examiner to confirm dependability of results. Seven major categories emerged from the data analysis: entrepreneur dental hygienist, partnerships, funding, barriers, sustainability, models of care and the impact of the ECP. The findings of this study revealed that ECP hygienists are making an impact with underserved populations, primarily children, the elderly and special needs patients.