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Aims and Objectives\ud To explore healthcare staff’s experiences of how dehydration is identified and managed in hospitalised patients after acute stroke, and facilitators and challenges to optimising hydration.\ud \ud Background\ud Optimal hydration post-stroke reduces the risk of neurological deterioration and other complications. Patients are at risk of dehydration in acute stroke, particularly those with dysphagia. \ud \ud Design\ud A descriptive qualitative study reported following the COREQ guidelines. \ud \ud Methods\ud Semi-structured interviews, utilising patient vignettes, were conducted in 2018 (Apr-Oct) with a purposive sample of 30 multi-disciplinary staff members from two UK stroke units. Interviews were digitally recorded and transcribed verbatim. Content analysis identified common themes which were mapped to the Theoretical Domains Framework and the Behaviour Change Wheel. \ud \ud Results\ud The themes mapped to twelve of the fourteen domains in the Theoretical Domains Framework. Participants believed that inadequate hydration management had potentially serious consequences, and described complex knowledge, skills and cognitive elements to effective hydration care. Participants felt that maintaining hydration was a multidisciplinary responsibility requiring good communication. Although the performance of initial dysphagia screening was reinforced by external \ud audit, other areas of post-stroke hydration management were not; notably, there was no established method of assessing hydration. Barriers to maintaining good hydration included lack of staff, out-of-hours working patterns, low priority given to hydration, patients’ co-morbidities, and complex post-stroke disabilities such as dysphagia, aphasia, inattention and hemiparesis. \ud \ud Conclusion\ud Findings highlighted the importance of assessing and maintaining hydration but identified barriers to, and variation in, clinical practice. To provide optimal care, barriers to the prevention and treatment of dehydration after stroke must be further understood and addressed. \ud \ud Relevance to Clinical Practice\ud Multidisciplinary teamwork is important in hydration care after stroke, but clarity is required about the specific contributions of each team member. Without this, hydration care becomes ‘everybody’s and nobody’s job’.

Objective: 1) Report our experience with custom-made and thermoplastic mandibular advancement devices (MADs). 2) Compare the cost, efficacy, and compliance of thermoplastic mandibular advancement devices vs custom made MADs.Method: Retrospective review of 287 consecutive adult outpatients treated between July 2009 and August 2010. Compliance was assessed using chart review and phone interviews after 1 and 6 months. Endpoints included: 1. Efficacy measured by post-MAD AHI.Results: The percentage of patients achieving AHI reduction criteria for efficacy was 70.3% and 72.2% for thermoplastic vs custom-made devices (P = .204). Compliance more than 4 hours a night for 70% of nights within the first month after receiving MAD was 88.2% for thermoplastic vs 64.3% for custom-made (P < .001). At 6 months compliance was 47.4% for thermoplastic devices vs 61.1% for custom devices (P = .01). The average cost for the thermoplastic devices was $150 vs $1450 for the custom-made devices.Conclusion: Thermoplastic devices r...

Objective: 1) Present the safety, morbidity, and efficacy of robotic midline glossectomy (RG) for the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the first series of patients undergoing this procedure without tracheotomy. 2) Compare the efficacy of robotic midline glossectomy (RG) vs coblation and radiofrequency base-of-tongue (RFBOT) MG.Method: Retrospective review of patients treated between January 2009 and December 2010 at a tertiary care center. Efficacy and morbidity of 40 RG patients was compared with a matched cohort of 40 patients who underwent traditional MG. Outcome variables included: postoperative pain, narcotic use, postoperative reduction of AHI, disposable costs, and complications.Results: Twenty patients with severe disease treated with ZPP+RG were compared with 20 patients with ZPP + Coblation. The mean AHI of patients undergoing RG decreased from 55.1 (SD 28.7) preoperative to 25.9 (SD 9.9) postoperative which was significantly greater than the AHI reduction for (P...

Objective: 1) Compare the efficacy of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone in the treatment of pediatric OSAHS. 2) Compare the morbidity of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone.Method: Randomized single-blind controlled study of 60 pediatric patients treated between January 2009 to January 2010 at a tertiary care center. Patients were randomized into 2 groups: adenotonsillectomy alone (group I) and adenotonsillectomy with pharyngoplasty (group II). Endpoints included: pre- and postsurgical AHI, number of cures, pain levels, and change in OSA-18.Results: Sixty patients were enrolled and 52 patients completed the study (group I n = 27, group II n = 25). The mean age, BMI, and baseline AHI did not differ significantly between the two groups. The change in AHI from pre- to postsurgery was not found to be significant between the 2 groups (P = .337). No significant differences were found in the number of cures (P = .709). There was no significant diffe...

Objective: 1) Report the accuracy of subjective Reflux Symptom Index scores (RSI) and objective Reflux Finding Scores (RFS) in identifying patients with laryngopharyngeal reflux (LPR) using ambulatory pH monitoring as confirmation. 2) Present clinical recommendations for the use of subjective and objective tools in the diagnosis of LPR.Method: Retrospective chart review of 300 adult outpatients from January 3, 2009 to December 30, 2010 in a tertiary care setting. Patients with a diagnosis of LPR based on abnormal RSI and positive findings on laryngeal endoscopic examination using RFS were tested for confirmation with a 24-hour oropharyngeal pH study using the Restech Dx-pH system.Results: Among 300 consecutive patients with an RSI score >5, 58.6% were confirmed to have reflux after undergoing 24-hour oropharyngeal pH-monitoring. Of these 300 patients, 146 had an RFS score >5. Among patients with a RSI >5 and a RFS 5 and RFS>5 the positive predictive value (PPV) increased to 71.9% (105 of 146). Therefore, ...