#stopbanging

[mcatmemoranda]

[intolerablexsacrifice]

"All you have to do is bring a few of those wretched men on board, and the ship will be appeased. You can keep fighting your war honey," She assured warmly, laying a hand on his cheek, "We'll keep you unstoppable, don't you worry one little bit."

It feels like a deal with the devil, in a way.

The hand is strange on his cheek, but Flint doesn’t pull away: he searches her eyes with his own, knowing he ought to be cautious, but far too drawn by the promise of an unsinkable ship aiding his war to listen to that caution. Those wretched men, she had said. The ship doesn’t need his men. Doesn’t need him. What does it matter, if he feeds it a few of the already-damned souls of his enemies? The only obstacle would seem to be his own men, who might have a few things to say about such a thing, but Flint can deal with them.

(Well. Silver can deal with them.)

“Why?” he asks, quiet and rasping, eyes narrowing. “What does my war mean to someone--” He pointedly does not say something. “--like you?”

[missy-looloo]

( Truth Be Told ) ...... . I applied this to a SOMETHING and to that SOMETHING ungodly !! . I am a Spiritual Gangster 🦾👁🎚 I made the cut !! ONLY AFTER I CUT ties to bad habits and alibi and fake crocodile cries .... . #spiritualjourney #spiritualgrowth #spiritualawakening #removenegativity #startingwithself #stopbadhabits #stopillwishing #stopcomplaining #stopbanging #read #study #dotheunthinkable #aslongasitsgood #peaceandlove #harmony #failbig #succedbigger #leadbyexample #keepyourcirclesmall #teachyourchildren #whattolearn #nothowtolearn #mentalhealthawareness (at In The House) https://www.instagram.com/p/B_VgRrrg2Ha/?igshid=10en3a4jz245q

[healthforkiddies]

THIS IS ONE DREAM YOU SHOULD NEVER IGNORE..

THIS IS ONE DREAM YOU SHOULD NEVER IGNORE..This can signal a serious underlying health problem. You can test this at home with a simple 2 minute test..

ONE DREAM YOU SHOULD NEVER IGNORE Is there a Dream that one should never ignore? Yes, this one dream where unpleasant dream appears very real should never be ignored. This can indicate a serious underlying health problem. You can take this simple 2 minute test at home to test to see if you have a problem. What is a Dream? Dream is a natural phenomena that occurs in everyone. This one dream…

[theypissedonme]

[ clean ] your muse cleaning a smudge of something off mine’s cheek | tfw you take an eerie prize ship and a woman shows up out of the ether to wipe soot of your cheek probably activates the Jack Rackham John Mulaney mood of 'this might as well happen'

True enough- this might as well happen. 

Jack sees now the truth behind all the rumours and stories surrounding this ship: it’s clearly haunted, honest-to-Christ actually fucking haunted, in a way that would make any good, pious, god-fearing man shit himself and run. But, well. Jack’s neither good nor pious. And the value of the ship is heavier than the weight of his unease. 

The ghost touches his cheek. The scales tip a little, unease weighing slightly heavier than before. Jack stares with curious black eyes and the only fucking thing he can think to do is to touch his cheek where her fingertips had been and not think about how she appeared out of practically nowhere and just say-

“Oh. Thank you.”

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Stop-Bang Tool for Sleep Apnea and Related Self-Efficacy

Authored by Urmila Harold*

Summary

Obstructive sleep apnea (OSA) is a health issue that can cause many complications perioperatively if it is left undiagnosed or unidentified in the pre-operative assessment. The staff of the post-operative anesthesia care unit (PACU) at one of the hospitals in Missouri was managing the complications from the unidentified patients with OSA on an everyday basis. The problems associated with the complications included extended recovery room stay and an unexpected need to transfer the patients to a monitored bed. This DNP project aimed to assess the self-efficacy in the nurses after the education and implementation of the STOP-Bang tool to screen patients for OSA. The objectives of the project: To complete a pre-education self-efficacy survey utilizing the Evidence-Based Nursing Practice Self-Efficacy Survey, to educate and provide the resources about the STOP-Bang tool, and to evaluate the self-efficacy after the implementation of the STOP-Bang tool. The Iowa model of evidence-based practice was chosen for this project because the Iowa model guides step by step through the change process. An evidenced-based Self-Efficacy Survey tool was used to collect data. There was a significant increase in self-efficacy in nurses from pre-intervention to post-intervention. The data analysis demonstrated a significant increase in confidence scores from pre to post, t (13) =-5.90, p<0.001.

Keywords: Self efficacy; STOP-bang; Obstructive sleep apnea; Perioperative complications; Lowa model; Pre and post-anesthesia care unit

Introduction

Obstructive sleep apnea (OSA) causes many complications perioperatively if it is left unidentified in the pre-operative assessment. These complications include hypoxemia, myocardial injury, cardiac arrhythmias, and unexpected transfer to the intensive care unit [1]. STOP-Bang tool (Snore, Tired, Observed apnea, High Blood Pressure, Body Mass Index (BMI) more than 35, Age more than 50, Neck circumference more than 40cm, and male gender) was developed to screen the risk of sleep apnea in patients by Dr. Frances Chung of University Health Network [2].

PICOT

The PICOT question for this DNP scholarly project was: Among professional nurses in the pre and post-anesthesia care unit of a local hospital in Missouri, how does the education and implementation of the STOP-Bang tool increase evidence-based nursing practice self-efficacy over an eight-week time frame.

Objectives and aims

The DNP project aimed to assess the self-efficacy in the nurses after the education and implementation of the STOP-Bang tool in the pre-operative assessment. The author identified the following objectives to be serving as a guide to the DNP scholar during the project:

• To inform the stakeholders about the project and gain cooperation.

• To complete a pre-education self-efficacy survey utilizing the Evidence-Based Nursing Practice Self-Efficacy Scale (EBNPSE).

• To educate and provide the resources about the STOPBang tool.

• To evaluate the self-efficacy after the implementation of the STOP-Bang tool.

Theoretical framework

The idea behind educating nurses about STOP-Bang was patient safety and care. Thus, an appropriate theoretical framework for the project, Watson’s Caring theory, was selected which is based on the core concepts and ten Caritas. The core concepts of Jean Watson’s Caring theory are relational caring for self and others, transpersonal caring, caring moment, multiple ways of knowing, reflective approach, caring is inclusive, caring changes self and others, and ten Caritas to put caring into action [3].

Change model

The Iowa model of evidence-based practice was chosen for this project because the Iowa model guides clearly step by step through the change process. The steps include the selection of a topic, forming a team, evidence retrieval, grading the evidence, developing an evidence-based practice standard, implementing EBP, and evaluation. Some of the nurses from the University of Iowa hospitals and clinics, along with the college of nursing, developed the Iowa model in the early 1990s to improve healthcare quality [4].

Sample and setting

The DNP project was implemented in a pre- and post-anesthesia care unit in one of the hospitals in Missouri. The hospital offered services to a variety of patients, including oncology, stroke, women’s services, cardiac, trauma, and orthopedic surgery. The nurses working in these units were mostly BSN prepared nurses, male and female, and belonged to a diverse age group. These units had one charge nurse each. There were full time and part-time nurses that float back and forth in pre- and post-operative units. The culture of the units was based on cooperation and team building. Selection criteria included all the nurses responsible for patient assessment and none of the nurses excluded from the project.

Intervention

In the first week, the self-efficacy survey was administered after a brief introduction to staff who were willing to participate in the project. The author evaluated the self-efficacy before and after the implementation of the STOP-Bang by using the Evidence-Based Nursing Practice Self-Efficacy (EBNPSE) scale survey tool. The EBNPSE tool was developed by nurses from the hospitals of Iowa and clinics in 2009 to assess participants’ confidence in completing the practice by self-rating [5,6]. The surveys were anonymous and confidential. The participants were asked to write a unique identifier instead of their names. In the second week, the author actualized the educational plan. Education on the STOP-Bang tool was provided three to four different times to ensure the complete coverage of nurses that work in the pre- and post-anesthesia care unit. From the third through the sixth week, the nurses assessed the patients using the STOP-Bang screening tool for high risk for OSA and post-operative complications. Resources and support were provided to the nurses if they had any questions. The collected data from the pre- and post-education EBNPSE survey was evaluated and analyzed by using SPSS version 25 (Armonk, NY: IBM Corp.).

Findings

Out of 17 surveys, there were only 14 valid surveys that could be used for data analysis. After the assumption of abnormality was met, repeated-measures t-test was done. Means (M) and standard deviations (SD) were reported for the t-test analysis. Statistical significance was assumed at an alpha value of 0.05. All analyses were conducted using SPSS Version 25 (Armonk, NY: IBM Corp.). Repeated-measures t-test found that there was a statistically significant increase in total survey scores from pre-intervention (M = 42.38, SD = 27.51) to post-intervention (M = 85.87, SD = 11.08).

Conclusion

The significant statistical increase in self-efficacy in the staff demonstrated the effectiveness of the education and implementation of the STOP-Bang tool.

To read more about this article:https://irispublishers.com/ijnc/fulltext/stop-bang-tool-for-sleep-apnea-and-related-self-efficacy.ID.000548.php 

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[healthyeatinglifestyle]

If your bed partner complains about your loud snoring, it might be a disruptive nuisance נor something more serious. High-volume snoring punctuated by snorts, gasps, and brief pauses in breathing is the hallmark of obstructive sleep apnea. Although this condition occurs most often in men over 40 who are overweight or obese, it can affect people of all ages and sizes. The resulting daytime sleepiness נa direct result of not getting enough high-quality sleep נcan leave people moody and forgetful. Even more worrisome: car accidents are two to three times more common in people with sleep apnea. Sleep apnea also can boost blood pressure and may increase the risk of clogged heart arteries, heart rhythm disorders, heart failure, and stroke. What is the STOPBANG test for sleep apnea? The easy-to-remember acronym STOPBANG can help you decide whether itҳ wise to talk to a doctor about having a sleep study to determine whether you have sleep apnea. It helps to have input from someone who sees you sleep. A ӹesԠanswer to three or more of these questions suggests possible sleep apnea. Ask your doctor if you should have a sleep study. S Snore: Have you been told that you snore? T Tired: Do you often feel tired during the day? O Obstruction: Do you know if you briefly stop breathing while asleep, or has anyone witnessed you do this? P Pressure: Do you have high blood pressure or take medication for high blood pressure? B Body mass index (BMI): Is your BMI 30 or above? (For a calculator, seewww.health.harvard.edu/bmi.) A Age: Are you 50 or older? N Neck: Is your neck circumference more than 16 inches (women) or 17 inches (men)? G Gender: Are you male? Sleep monitoring can be done at home Diagnosing sleep apnea is less complicated that many people realize. In the past, diagnosing this condition always required an overnight stay in a sleep lab. Ӕoday, about 60% to 70% of sleep studies for suspected sleep apnea are done using home-based tests,Ԡsays Dr. Sogol Javaheri, a sleep specialist at Harvard-affiliated Brigham and Womenҳ Hospital. If your symptoms suggest moderate to severe sleep apnea and you donҴ have any other significant medical problems, home sleep monitoring is almost as accurate for detecting apnea as a night in a sleep lab, she says. So, if you suspect you have sleep apnea, ask your doctor for an evaluation. Or if your health insurance allows you to see a specialist without a referral, you can start there instead. ӓleep specialists are better versed in insurance-related barriers, and they know how to order testing to avoid problems and delays in care,Ԡsays Dr. Javaheri. For the test, youҬl get a small, lightweight monitor, a belt you slip around your midsection, a small finger clip that monitors your oxygen, and an airflow sensor to place under your nose. These sensors and devices measure your oxygen saturation, heart rate, and airflow, as well as the movements of your chest and abdomen and your position while you sleep. One main advantage of home-based testing is the cost, which runs between $150 and $500, compared to testing done in a sleep laboratory, which usually tops $1,000. But the best part about home sleep test is the convenience. You sleep in your own bed, not an unfamiliar hospital bed, and you do the test based on your schedule. However, youҬl need to borrow the monitor from a hospital sleep lab, and you may have to wait a few weeks to get it. Later, if you are diagnosed with sleep apnea, home-based tests also provide an easy way for a physician to check how well your treatment is working. The postWorried about sleep apnea? Home-based testing is now the norm appeared first onHarvard Health Blog.

[jesseneufeld]

Worried about sleep apnea? Home-based testing is now the norm

If your bed partner complains about your loud snoring, it might be a disruptive nuisance — or something more serious. High-volume snoring punctuated by snorts, gasps, and brief pauses in breathing is the hallmark of obstructive sleep apnea.

Although this condition occurs most often in men over 40 who are overweight or obese, it can affect people of all ages and sizes. The resulting daytime sleepiness — a direct result of not getting enough high-quality sleep — can leave people moody and forgetful. Even more worrisome: car accidents are two to three times more common in people with sleep apnea. Sleep apnea also can boost blood pressure and may increase the risk of clogged heart arteries, heart rhythm disorders, heart failure, and stroke.

What is the STOPBANG test for sleep apnea?

The easy-to-remember acronym STOPBANG can help you decide whether it’s wise to talk to a doctor about having a sleep study to determine whether you have sleep apnea. It helps to have input from someone who sees you sleep.

A “yes” answer to three or more of these questions suggests possible sleep apnea. Ask your doctor if you should have a sleep study. S Snore: Have you been told that you snore? T Tired: Do you often feel tired during the day? O Obstruction: Do you know if you briefly stop breathing while asleep, or has anyone witnessed you do this? P Pressure: Do you have high blood pressure or take medication for high blood pressure? B Body mass index (BMI): Is your BMI 30 or above? (For a calculator, see www.health.harvard.edu/bmi.) A Age: Are you 50 or older? N Neck: Is your neck circumference more than 16 inches (women) or 17 inches (men)? G Gender: Are you male?

Sleep monitoring can be done at home

Diagnosing sleep apnea is less complicated that many people realize. In the past, diagnosing this condition always required an overnight stay in a sleep lab. “Today, about 60% to 70% of sleep studies for suspected sleep apnea are done using home-based tests,” says Dr. Sogol Javaheri, a sleep specialist at Harvard-affiliated Brigham and Women’s Hospital. If your symptoms suggest moderate to severe sleep apnea and you don’t have any other significant medical problems, home sleep monitoring is almost as accurate for detecting apnea as a night in a sleep lab, she says.

So, if you suspect you have sleep apnea, ask your doctor for an evaluation. Or if your health insurance allows you to see a specialist without a referral, you can start there instead. “Sleep specialists are better versed in insurance-related barriers, and they know how to order testing to avoid problems and delays in care,” says Dr. Javaheri.

For the test, you’ll get a small, lightweight monitor, a belt you slip around your midsection, a small finger clip that monitors your oxygen, and an airflow sensor to place under your nose. These sensors and devices measure your oxygen saturation, heart rate, and airflow, as well as the movements of your chest and abdomen and your position while you sleep.

One main advantage of home-based testing is the cost, which runs between $150 and $500, compared to testing done in a sleep laboratory, which usually tops $1,000. But the best part about home sleep test is the convenience. You sleep in your own bed, not an unfamiliar hospital bed, and you do the test based on your schedule. However, you’ll need to borrow the monitor from a hospital sleep lab, and you may have to wait a few weeks to get it. Later, if you are diagnosed with sleep apnea, home-based tests also provide an easy way for a physician to check how well your treatment is working.

The post Worried about sleep apnea? Home-based testing is now the norm appeared first on Harvard Health Blog.

Worried about sleep apnea? Home-based testing is now the norm published first on https://drugaddictionsrehab.tumblr.com/

[mcatmemoranda]

Do not use CPT 95807 for sleep study, it is not a useable code. Please refer to your Sleep Guidelines.

o Home study- G0399 or 95806 o Diagnostic in-lab 95810 o Diagnostic in-lab w/ CPAP titration 95811 o Sleep studies require Epworth Sleepiness Scale and/or STOPBANG

[mhealthb007]

If your bed partner complains about your loud snoring, it might be a disruptive nuisance — or something more serious. High-volume snoring punctuated by snorts, gasps, and brief pauses in breathing is the hallmark of obstructive sleep apnea.

Although this condition occurs most often in men over 40 who are overweight or obese, it can affect people of all ages and sizes. The resulting daytime sleepiness — a direct result of not getting enough high-quality sleep — can leave people moody and forgetful. Even more worrisome: car accidents are two to three times more common in people with sleep apnea. Sleep apnea also can boost blood pressure and may increase the risk of clogged heart arteries, heart rhythm disorders, heart failure, and stroke.

What is the STOPBANG test for sleep apnea?

The easy-to-remember acronym STOPBANG can help you decide whether it’s wise to talk to a doctor about having a sleep study to determine whether you have sleep apnea. It helps to have input from someone who sees you sleep.

A “yes” answer to three or more of these questions suggests possible sleep apnea. Ask your doctor if you should have a sleep study. S Snore: Have you been told that you snore? T Tired: Do you often feel tired during the day? O Obstruction: Do you know if you briefly stop breathing while asleep, or has anyone witnessed you do this? P Pressure: Do you have high blood pressure or take medication for high blood pressure? B Body mass index (BMI): Is your BMI 30 or above? (For a calculator, see www.health.harvard.edu/bmi.) A Age: Are you 50 or older? N Neck: Is your neck circumference more than 16 inches (women) or 17 inches (men)? G Gender: Are you male?

Sleep monitoring can be done at home

Diagnosing sleep apnea is less complicated that many people realize. In the past, diagnosing this condition always required an overnight stay in a sleep lab. “Today, about 60% to 70% of sleep studies for suspected sleep apnea are done using home-based tests,” says Dr. Sogol Javaheri, a sleep specialist at Harvard-affiliated Brigham and Women’s Hospital. If your symptoms suggest moderate to severe sleep apnea and you don’t have any other significant medical problems, home sleep monitoring is almost as accurate for detecting apnea as a night in a sleep lab, she says.

So, if you suspect you have sleep apnea, ask your doctor for an evaluation. Or if your health insurance allows you to see a specialist without a referral, you can start there instead. “Sleep specialists are better versed in insurance-related barriers, and they know how to order testing to avoid problems and delays in care,” says Dr. Javaheri.

For the test, you’ll get a small, lightweight monitor, a belt you slip around your midsection, a small finger clip that monitors your oxygen, and an airflow sensor to place under your nose. These sensors and devices measure your oxygen saturation, heart rate, and airflow, as well as the movements of your chest and abdomen and your position while you sleep.

One main advantage of home-based testing is the cost, which runs between $150 and $500, compared to testing done in a sleep laboratory, which usually tops $1,000. But the best part about home sleep test is the convenience. You sleep in your own bed, not an unfamiliar hospital bed, and you do the test based on your schedule. However, you’ll need to borrow the monitor from a hospital sleep lab, and you may have to wait a few weeks to get it. Later, if you are diagnosed with sleep apnea, home-based tests also provide an easy way for a physician to check how well your treatment is working.

The post Worried about sleep apnea? Home-based testing is now the norm appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/2CKvCae Original Content By : https://ift.tt/1UayBFY

[intolerablexsacrifice]

BOLD any fears which apply to your muse. italicize what makes them uncomfortable. (repost, don’t r/b) // strikethrough is for things that provide comfort

the dark  ⋆  fire  ⋆  open water  ⋆  deep water  ⋆  being alone  ⋆  crowded spaces  ⋆ confined spaces ⋆  change  ⋆ failure ⋆  war  ⋆ loss of control ⋆  powerlessness  ⋆  prison  ⋆  blood  ⋆  drowning  ⋆  suffocation  ⋆  public speaking  ⋆  natural animals  ⋆  the supernatural  ⋆  heights  ⋆  death  ⋆  dying  ⋆  intimacy  ⋆ rejection ⋆  abandonment  ⋆  loss ⋆  the unknown  ⋆  the future  ⋆  not being good enough  ⋆  scary stories  ⋆  speaking to new people  ⋆  poverty  ⋆  loud noises  ⋆  being touched  (it’s complicated) ⋆  forgetting  ⋆ being forgotten

TAGGED BY :  @stopbanging TAGGING  : please just assume i’ve tagged you okay kjdsnlfkdsnfg

[plush-draw15]

Worried about sleep apnea? Home-based testing is now the norm

If your bed partner complains about your loud snoring, it might be a disruptive nuisance — or something more serious. High-volume snoring punctuated by snorts, gasps, and brief pauses in breathing is the hallmark of obstructive sleep apnea.

Although this condition occurs most often in men over 40 who are overweight or obese, it can affect people of all ages and sizes. The resulting daytime sleepiness — a direct result of not getting enough high-quality sleep — can leave people moody and forgetful. Even more worrisome: car accidents are two to three times more common in people with sleep apnea. Sleep apnea also can boost blood pressure and may increase the risk of clogged heart arteries, heart rhythm disorders, heart failure, and stroke.

What is the STOPBANG test for sleep apnea?

The easy-to-remember acronym STOPBANG can help you decide whether it’s wise to talk to a doctor about having a sleep study to determine whether you have sleep apnea. It helps to have input from someone who sees you sleep.

A “yes” answer to three or more of these questions suggests possible sleep apnea. Ask your doctor if you should have a sleep study. S Snore: Have you been told that you snore? T Tired: Do you often feel tired during the day? O Obstruction: Do you know if you briefly stop breathing while asleep, or has anyone witnessed you do this? P Pressure: Do you have high blood pressure or take medication for high blood pressure? B Body mass index (BMI): Is your BMI 30 or above? (For a calculator, see www.health.harvard.edu/bmi.) A Age: Are you 50 or older? N Neck: Is your neck circumference more than 16 inches (women) or 17 inches (men)? G Gender: Are you male?

Sleep monitoring can be done at home

Diagnosing sleep apnea is less complicated that many people realize. In the past, diagnosing this condition always required an overnight stay in a sleep lab. “Today, about 60% to 70% of sleep studies for suspected sleep apnea are done using home-based tests,” says Dr. Sogol Javaheri, a sleep specialist at Harvard-affiliated Brigham and Women’s Hospital. If your symptoms suggest moderate to severe sleep apnea and you don’t have any other significant medical problems, home sleep monitoring is almost as accurate for detecting apnea as a night in a sleep lab, she says.

So, if you suspect you have sleep apnea, ask your doctor for an evaluation. Or if your health insurance allows you to see a specialist without a referral, you can start there instead. “Sleep specialists are better versed in insurance-related barriers, and they know how to order testing to avoid problems and delays in care,” says Dr. Javaheri.

For the test, you’ll get a small, lightweight monitor, a belt you slip around your midsection, a small finger clip that monitors your oxygen, and an airflow sensor to place under your nose. These sensors and devices measure your oxygen saturation, heart rate, and airflow, as well as the movements of your chest and abdomen and your position while you sleep.

One main advantage of home-based testing is the cost, which runs between $150 and $500, compared to testing done in a sleep laboratory, which usually tops $1,000. But the best part about home sleep test is the convenience. You sleep in your own bed, not an unfamiliar hospital bed, and you do the test based on your schedule. However, you’ll need to borrow the monitor from a hospital sleep lab, and you may have to wait a few weeks to get it. Later, if you are diagnosed with sleep apnea, home-based tests also provide an easy way for a physician to check how well your treatment is working.

The post Worried about sleep apnea? Home-based testing is now the norm appeared first on Harvard Health Blog.

from https://ift.tt/2CKvCae Check out Worried about sleep apnea? Home-based testing is now the norm

[brassandblue]

BOLD any fears which apply to your muse. italicize what makes them uncomfortable.

the dark  ⋆  fire  ⋆  open water  ⋆  deep water  ⋆  being alone  ⋆  crowded spaces  ⋆ confined spaces ⋆  change  ⋆ failure ⋆  war  ⋆ loss of control ⋆  powerlessness  ⋆  prison  ⋆  blood  ⋆  drowning  ⋆  suffocation  ⋆  public speaking  ⋆  natural animals  ⋆  the supernatural  ⋆  heights  ⋆  death  ⋆  dying  ⋆  intimacy  ⋆ rejection ⋆  abandonment  ⋆  loss ⋆  the unknown  ⋆  the future  ⋆  not being good enough  ⋆  scary stories  ⋆  speaking to new people  ⋆  poverty  ⋆  loud noises  ⋆  being touched  ⋆  forgetting  ⋆ being forgotten

TAGGED BY :   @stopbanging TAGGING  : EVERYONE. Assume you have been tagged.

[ellymackay]

Does Cone Beam Computed Tomography Make Sense in Your Dental Practice?

Does Cone Beam Computed Tomography Make Sense in Your Dental Practice? is courtesy of Elly Mackay

A dentist explains how he uses his CBCT daily as well as the benefits and limitations of this technology in dental sleep medicine.

By Ryan O’Neill, DMD

The cost of cone beam computed tomography (CBCT) is a common barrier to entry for anyone considering investing in 3D imaging. The cost of a new CBCT can exceed $125,000. How do dentists justify such a large investment?

The answer depends on the clinician, but for my dental practice, I analyzed the various treatment services I was already incorporating or wanted to begin incorporating in my practice. I purchased my first CBCT in 2014. That allowed me to add services to my office that I’d been reluctant to regularly offer, such as sinus augmentations, guided implant surgery, third molar extractions, complex endodontics, and more.

Interpreting CBCT Data

Today, remote radiology reports let clinicians of all types acquire large amounts of data and outsource the interpretation. Companies such as Dental Radiology Diagnostics (DRDx) provide reports of uploaded CBCT data to dentists. According to DRDx’s site, “Many practices routinely have all of their CBCT scans reviewed by a radiologist to eliminate concerns over reviewing the scans themselves and missing an important finding.”

Contact your state dental board before reading or outsourcing any CBCT scans as some states require a license to read the scans. Vet outsourced providers to be sure they have the state license (if needed) and that you are comfortable with the level of education and board certifications of the radiologists who will be reading your patients’ scans.

Sleep Specifics

Sleep Nashville, our dental practice devoted entirely to treating sleep-disordered breathing through oral appliance therapy, utilizes 3D imaging through the airway analysis feature of SICAT AIR, which is the CBCT software we use.

In a study published in 2016 comparing upright CBCT scans on mild-moderate OSA patients versus patients without OSA, the data revealed significantly smaller average airway area, volume and width in those patients with OSA. Interestingly, the mean anterior-posterior distance did not show a significant difference between groups.1

In another small study, the CBCT data of mild OSA patients were compared supine versus upright, revealing a total airway volume decrease by 32% when supine as opposed to upright.2

CBCT can be used in conjunction with traditional screening tools (Epworth Sleepiness Scale, STOPBANG, etc) but should never completely replace these tools to identify high risk individuals. The possibility of a false negative can be created when patients whose airway awake and upright appears adequate in volume but does not take into account the collapsibility of the airway when asleep and supine. Before and after treatment sleep studies remain the standard of care to diagnose and determine treatment efficacy of oral appliance therapy rather than CBCT imaging alone. However, CBCT scans for other routine dental procedures can often identify high risk individuals as an incidental finding that would prompt a sleep study referral.

Ryan O’Neill, DMD

In our practice, we find that CBCT airway visualization helps patients understand how mandibular advancement devices (MADs) are effective at improving airflow. Anecdotally, we show an increase in airway volume of 50% to 100% on average in successful MAD responders. Our CBCT is a great conversation starter with patients in helping understand the need for a sleep study, which furthers our collaborative efforts with local pulmonologists.

Final Thoughts

CBCT used primarily for the screening and assessment of OSA alone is not the most advantageous use of this expensive equipment (due to its limitations discussed earlier). CBCT is not a diagnostic tool for OSA and should not replace polysomnography or home sleep apnea testing in the diagnostic process.

Owning a CBCT imaging device is most effective for general dentists who perform a wide range of services, in addition to OSA treatment. My CBCT allows me to screen and educate my patients in such a way that the monthly production generated by my CBCT justifies the monthly expense of my CBCT. SR

Ryan O’Neill, DMD, is a general dentist in Nashville, Tenn, and owner of Sleep Nashville, a dental practice devoted entirely to treating sleep-disordered breathing through oral appliance therapy. O’Neill lectures nationally on sleep apnea, 3D imaging, and medical billing, and he is an instructor and thought leader for the OPTISLEEP oral appliance. O’Neill has a passion for training and equipping general dentists on how to treat sleep apnea; he offers courses “3D Sleep” and “True Sleep” through True North Continuing Education. O’Neill personally wears an oral appliance, which he says changed his sleep and his life.

References

1. Buchanan A, Cohen R, Looney S, et al. Cone-beam CT analysis of patients with obstructive sleep apnea compared to normal controls. Imaging Sci Dent. 2016 Mar;46(1):9–16. 2. Camacho M, Capasso R, Schendel S. Airway changes in obstructive sleep apnoea patients associated with a supine versus an upright position examined using cone beam computed tomography. J Laryngol Otol. 2014 Sep;128(9):824­-30.

from Sleep Review http://www.sleepreviewmag.com/2018/07/cbct-dental-practice/

from Elly Mackay - Feed https://www.ellymackay.com/2018/07/05/does-cone-beam-computed-tomography-make-sense-in-your-dental-practice/

[mcatmemoranda]

In any pt you suspect obstruct sleep apnea (OSA) in, get a STOPBANG and Epworth Sleepiness Scale and refer for polysomnography. Tx is weight loss and CPAP. Untreated OSA can lead to pulmonary HTN and HF.

[blaeptein]

`           @stopbanging         ♦ ◊ ♦           POPPY           !    

                       do  angels  fall  ?     do  they  fall  through  time,  and  see  themselves,  and  scare  themselves,  and  hang  there  until  someone cuts  the  rope  ?     is  she  an  angel,  now  ?     does  god  support  such  an  unfair  treatment  ?     is  he  going  to  be  the  one  to  cut  the  damn  rope  ?     does  anyone  else  hear  her  screaming  ?     a  little  girl's  eyes,  boring  into  hers,  terrified.     BENT-NECK  LADY,  broken,  wailing,  nightmare  now  incarnated  by  the  dreamer.     does  god  know  what  this  house  has  done  to  them  ?     CAN  ANYONE  HEAR  ?  

                      she  falls.     just  like  an  autumn  leaf,  or  an  angel,  or  a  snowflake.     rope  around  her  neck,  neck  broken  &  broken  neck,  life  slipping  out.     ROTTING,  TENDER  ACHE.     baby  girl,  dead.     and  mom's  fingers  in  her  hair,  promising  that  she  will  wake  up  soon.     now.     (     life's  not  the  nightmare,  mom.     this  house  is.     nell  wants  to  tell  her  but  she  can't  talk.     or  maybe  she  can,  but  she's  too  busy  screaming.     this  house  is  the  nightmare.     this  house  is  the  nightmare.     THIS  HOUSE  IS.  ) 

                      she  remembers  arthur.     dancing.     joy.     so  much  joy.     soft  fingers  on  her  hips.     his  breath  on  her  neck.     laughing.     SMILING.     smiling  so  much  it  hurt.     their  love  chiseled  in  marble,  if  only  for  a  second.     what  a  fool.     what  a  fool  to  believe  that  things  could  be  BEAUTIFUL  again.     she  remembers,  now.     that  all  good  things  must  come  to  an  end,  and  they  did,  and  she's  dead.     D E A D.     no  need  to  sugarcoat  the  hard  truth,  not  when  it's  hiding  in  plain  sight  :     she  can  see  herself  hanging  from  the  staircase.     her  nightmare  now  in  flesh  &  bone,  herself,  neck  broken  and  wearing  mom's  dress.     hot  tears  down  the  ghost's  cheeks  ;     is  she  really  crying  ?     is  she  still  there  ? 

                      she  turns  around.     leaves  the  neck-bent  lady,  and  the  dress,  and  the  sorrow,  and  the  stairwell,  and  the  nightmare.     she  searches  for  the  door  ;     she  needs  to  tell  them.     TO  WARN  THEM.     the  house  is  the  nightmare.     the  house  wants  them  asleep.     the  house  wants  them  dead.     it  hasn't  been  a  GOOD  HOME  ;     isn't  even  a  good  house.     it's  the  guillotine  above  a  condemned  man's  neck,  waiting  to  fall.     it's  not  dangerous  as  long  as  you  don't  live  in  it.     stucking  your  neck  underneath  a guillotine  is  asking  for  trouble  :     LIVING  IN  HILL  HOUSE  WAS  A  DEATH  WISH.     she  needs  to  tell  them. 

                      the  door,  closed.     close.     so  near  she  can  almost  touch  it.     the  door,  right  there.     still  so  far.     the  house  is  waking  up,  SAYING  NO,  keeping  everything  inside.     the  house  is  breathing  down  her  neck.      ❛     i  need,  i  need  to  go.     please.     let  me  --     ❜