Magister Scientiae Dentium - MSc(Dent) / Aim To analyze the demographic profile, clinical data and radiographs of patients who had third molar surgery under general anaesthesia at the Faculty of Dentistry at the University of the Western Cape over a 10 year period. Introduction Minor oral surgical procedures are carried out by Maxillofacial and Oral Surgeons daily. The surgical removal of third molars is a large part of Minor Oral Surgery which is common throughout the world. The general impression of third molar surgery performed by experienced professionals is the ease of the operation, however no-matter how experienced one may be, a simple procedure should never be underestimated (Carvalho and Do Egito Vasconselos, 2011). New surgical techniques, as well as extensive training, skill and experience have led to the evolution of oral surgery and allowed this procedure to be carried out in a less traumatic manner. Certain factors precipitate third molar surgery to be performed in theatre as opposed to the dental clinic setting. These factors will be discussed in this research report.

Benign paroxysmal positional vertigo (BPPV) is a condition characterized by brief spinning episodes that occur with a rapid change in head position. Although considered benign, BPPV can have many personal, social, health, and financial implications. Yet, providers in a variety of settings are frequently mismanaging the condition leading to incomplete resolution of symptoms, decreased quality of life, reduced productivity, and increased healthcare spending. This study sought to better understand why providers fail to follow current evidence-based BPPV guidelines and the impact BPPV-specific education could have on improving their practices. Questionnaires assessing BPPV-specific knowledge as well as inquiring about provider barriers to following guidelines were distributed to 11 providers in a rural Colorado mountain town. A 45-minute education session was then presented to providers in order to update them on current recommendations. Following the education, similar questionnaires reassessing provider knowledge of BPPV guidelines were disseminated. Results showed an improvement in provider knowledge as evidenced by an increase in the percentage of correct response scores following the education session compared to pre-education. Additionally, providers identified difficulty in interpreting nystagmus patterns as well and remembering how to perform the various maneuvers as major barriers to guidelines adherence. Future BPPV education should focus on these two barriers to ensure better guidelines adherence. In order to evaluate long-term practice changes following the intervention, a 16-month retrospective chart analysis was performed in a small rural emergency department where three of the participating providers from the education session worked. Results from the chart analysis were inconclusive due to a scarcity of patient encounters during the post-intervention period. Future studies should be performed with a larger participation pool and longer analysis period to better evaluate the effectiveness of BPPV-specific education on improving provider practices. The ultimate goals of providing BPPV education are to promote a quicker resolution of patient’s symptoms, improve their quality of life, reduce unnecessary healthcare spending, while still allowing for appropriate provider compensation.

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Benign paroxysmal positional vertigo (BPPV), characterized by a history of brief attacks of intense positional vertigo and rotary nystagmus, results from otoconial migration into the semicircular canals, making the sensory structures in the canal gravity sensitive. Treatment methods include positioning maneuvers, which return the otoconia back into the otolith, and typically include a variety of activity limitations for the subsequent 24-48 hours. Previous studies suggest BPPV treatment can be successful without any limitations of the patient post- therapy. The purpose of this study was to determine the necessity of post-maneuver restrictions on BPPV patients treated with the Canalith Repositioning Maneuver. Twenty participants were identified as having BPPV of the posterior canal and treated with the Canalith Repositioning Maneuver. During post-maneuver instruction, the ten participants assigned to the restricted group were provided with typical instructions. Ten participants assigned to the non-restricted group were given no post-maneuver restrictions. At the one-week post-treatment follow-up, all patients were free of vertigo and/or nystagmus. Results indicated that given two groups of subjects matched for age, gender, and symptoms, post-maneuver restrictions are not necessary for successful outcome using the CRM to treat posterior-canal BPPV.

Benign paroxysmal positional vertigo (BPPV) is a specific type of short-duration vertigo that is provoked by changes in head position and usually lasts less than one minute. It is a common vestibular pathology that can have significant effects on patient safety, quality of life, and medical costs. Therefore, it is crucial that medical students are educated and trained to facilitate and coordinate care of patients who may have undiagnosed BPPV. Because there is evidence to suggest that physicians—specifically primary care physicians—may not be properly equipped in their education to manage patients with BPPV, the purpose of this study was to investigate medical students’ evaluations of their preparedness to provide evidence-based care in the diagnosis and treatment of BPPV. An anonymous survey was administered via email to medical students in their fourth and final year of medical school at East Tennessee State University’s Quillen College of Medicine. This survey includes statements about the evidence-based Clinical Practice Guideline on BPPV provided by the American Academy of Otolaryngology. Respondents rated the degree to which they agreed or disagreed with how prepared they felt to address each item using a 5-point response scale from “strongly disagree” to “strongly agree.” Of the 70 students in the current fourth year class, 41 (59%) completed the survey. Students felt prepared for some aspects of diagnosing and treating BPPV, especially with regard to their general knowledge of BPPV, its impact on patients’ lives, and the options available to manage it. They felt less prepared to know when or if it is appropriate to recommend additional testing, imaging, or medication. They did not feel confident in their ability to perform the maneuvers to diagnose and treat BPPV. Overall, these results suggest medical students have a good foundation in their knowledge of BPPV. These results also propose topics to support more specialized training during their residencies to build upon the foundational knowledge obtained during their didactic training and optimize diagnosis and management of BPPV.

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Made available in DSpace on 2014-07-29T15:29:12Z (GMT). No. of bitstreams: 1 Dissertacao Gabriella A Alvarenga.pdf: 1532935 bytes, checksum: d0ff0c9eaffd1c72955c2eee2058c498 (MD5) Previous issue date: 2010-10-18 / Dissertation built modality scientific article. In the first article submitted to "Journal of Otolaryngology" with the title benign paroxysmal positional vertigo without nystagmus: diagnosis and treatment, there was a literature review, using the following keywords: "dizziness / vertigo, diagnosis / diagnosis, therapeutic / therapeutical approaches. " Scientific publications are included in the period 2001-2009 in Portuguese, English and German. We found nine papers dealt with BPPV without nystagmus, whose diagnosis was based exclusively on clinical history and physical examination. The treatment of BPPV without nystagmus was made by Epley maneuvers, Semont, discharge modified for posterior semicircular canal and Brandt-Daroff exercises. All show that 50% to 97.1% of patients with BPPV without nystagmus, had remission of symptoms, while patients with BPPV nystagmus with remission of symptoms ranged from 76% to 100%. Hence one can conclude that the differences may not be significant, which demonstrates the need for further studies on BPPV without nystagmus. In the second paper, Functional Capacity of Elderly with benign paroxysmal positional vertigo, compared the functional capacity among elderly patients with BPPV and elderly without clinical diagnosis of BPPV and that / or dizziness or vertigo, identifying the physical activities of daily living and instrumental activities of daily living in elderly people in both the Group of Elderly with BPPV (EBPPVG) and Control Group (CG). This is a cross-sectional study, case-control study in Hospital Geral de Goiânia (HGG), with the participation of 14 elderly patients with a diagnosis of BPPV and the Programa de Gerontologia Social / Universidade Aberta à Terceira Idade (UNATI) from the Pontificia Universidade Católica de Goiás (PUC-GO), with the participation of 13 subjects without dizziness or vertigo and / or clinical diagnosis was of BPPV. Functional capacity was assessed by the subscale of the Functional Assessment Questionnaire Brazilian Multidimensional Functional Capacity / Operating Older American Resources and Services Multidimensional Functional Assessment Questionnaire (BOMFAQ/OARS), verifying that the difficulty in performing 15 activities of daily living (ADL), eight physical activities of daily living (AFVD): throw / out of bed, eating, combing hair, walk on the plane, bathing, dressing, going to the bathroom in time and trimming toenails, and seven instrumental activities of living daily living (IADL): climbing stairs (one flight), doctor-on time, walk close to home, shopping, preparing meals, driving out and do house cleaning. Arrived at the following conclusions: a) elderly people with BPPV showed a statistically significant lower functional capacity than subjects without this diagnosis, b) in EBPPVG, the average number of daily activities (physical and instrumental), those with difficulty was 6.53 with a maximum of 11 activities committed while in the CG, the average impairment was 0.86 with a maximum of 4 activities referred with difficulty in performing c) EBPPVG affected performance in 13 activities of daily living, including physical seventh floor in the plan, bathing, dressing, combing hair, going to the bathroom in time, bedtime and getting up from bed or chair and cut nails feet, and 6 which are instrumental, climbing stairs, walking around the house, shopping, preparing meals, driving out and do house cleaning in the comparison between groups, d) Activities that were cited as the most difficult among the elderly were similar in both groups. However, the degree of impairment, characterized in: without commitment (when the elderly did not report any difficulty in any of the 15 evaluated ADL), mild (1 to 3 activities impaired), moderate (4-6 impaired activities) and severe (for seven or more impaired activities) was significantly higher in EBPPVG, where 7 (50%) showed severe impairment in ADL performance. / Dissertação construída na modalidade artigo científico. No primeiro artigo enviado para a Revista Brasileira de Otorrinolaringologia com o título Vertigem Posicional Paroxística Benigna sem nistagmo: diagnóstico e tratamento, realizou-se uma revisão da literatura, utilizando-se os seguintes descritores: vertigem/vertigo, diagnóstico/diagnosis, conduta terapêutica/ therapeutical approaches , palavras e assunto vertigem , nistagmo , VPPB , VPPB sem nitagmo , VPPB subjetiva . As publicações científicas incluídas são do período de 2001 a 2009 nos idiomas português, inglês, espanhol e alemão. Foram encontrados nove artigos que abordam a VPPB sem nistagmo, cujo diagnóstico foi baseado exclusivamente na história clínica e no exame físico. O tratamento da VPPB sem nistagmo foi realizado pelas manobras de Epley, Sémont, liberatória modificada para canal semicircular posterior e exercícios de Brandt-Daroff. Todos evidenciam que de 50% a 97.1% dos pacientes com VPPB sem nistagmo, tiveram remissão dos sintomas, enquanto nos pacientes com VPPB com nistagmo a remissão dos sintomas variou de 76% a 100%. Conclui-se que as diferenças podem não ser significativas, o que demonstra a necessidade de mais estudos sobre a VPPB sem nistagmo. No segundo artigo, com o título Capacidade Funcional de Idosos com Vertigem Posicional Paroxística Benigna, comparou-se a capacidade funcional entre idosos com VPPB e idosos sem diagnóstico clínico referido de VPPB e/ou queixa de tontura ou vertigem, identificando as atividades físicas de vida diária e as atividades instrumentais de vida diária comprometidas nos idosos tanto no Grupo de Idosos com VPPB (GIVPPB) quanto no Grupo Controle (GC). Trata-se de um estudo transversal, analítico, observacional e comparativo, realizado no Hospital Geral de Goiânia (HGG), com a participação de 12 idosos com diagnóstico de VPPB e no Programa de Gerontologia Social/ Universidade Aberta á Terceira Idade (UNATI) da Pontifícia Universidade Católica de Goiás (PUC-GO), com a participação de 13 idosos sem queixa de tontura ou vertigem e/ou diagnóstico clínico referido de VPPB. A capacidade funcional foi avaliada por meio da subescala funcional do Questionário Brasileiro da Avaliação Multidimensional de Capacidade Funcional/Brazilian Older American Resources and Services Multidimensional Functional Assessment Questionaire (BOMFAQ/OARS), verificando a dificuldade referida na realização de 15 atividades de vida diária (AVD), sendo oito atividades físicas de vida diária (AFVD): deitar/levantar da cama, comer, pentear cabelo, andar no plano, tomar banho, vestir-se, ir ao banheiro em tempo e cortar unhas dos pés, e sete atividades instrumentais de vida diária (AIVD): subir escada (um lance), medicar-se na hora, andar perto de casa, fazer compras, preparar refeições, sair de condução e fazer limpeza de casa. Chegou-se às seguintes conclusões: a) idosos com VPPB apresentam uma capacidade funcional estatisticamente significativa menor do que idosos sem este diagnóstico; b) no GIVPPB, o número médio de atividades de vida diária (físicas e instrumentais), referidas com dificuldade foi de 6,53 com o máximo de 11 atividades comprometidas, enquanto no GC, a média de comprometimento foi de 0,86 com o máximo de 4 atividades referidas com dificuldade no desempenho; c) A VPPB prejudicou o desempenho em 13 atividades de vida diária, 7 físicas incluindo andar no plano, tomar banho, vestir-se, pentear-se, ir ao banheiro em tempo, deitar e levantar-se da cama ou cadeira e cortar unhas dos pés; e 6 instrumentais quais sejam, subir escada, andar perto de casa, fazer compras, preparar refeições, sair de condução e fazer limpeza da casa na comparação entre os grupos; d) As atividades que foram referidas como mais difíceis entre os idosos, foram similares em ambos os grupos. Contudo, o grau de comprometimento, caracterizado em: sem comprometimento (quando o idoso não referia dificuldade em nenhuma das 15 AVD avaliadas), leve (de 1 a 3 atividades comprometidas), moderado (de 4 a 6 atividades comprometidas) e severo (de sete ou mais atividades comprometidas) foi significativamente maior no GIVPPB, onde 7(50%) evidenciaram severo comprometimento no desempenho das AVD.

Submitted by Franciele Moreira (francielemoreyra@gmail.com) on 2017-12-27T12:14:00Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese - Gabriella Assumpção Alvarenga Schimchak - 2017.pdf: 1840051 bytes, checksum: 09ab566a12fa9b2b1ab4c9c52b7a75d2 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-12-28T09:41:10Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese - Gabriella Assumpção Alvarenga Schimchak - 2017.pdf: 1840051 bytes, checksum: 09ab566a12fa9b2b1ab4c9c52b7a75d2 (MD5) / Made available in DSpace on 2017-12-28T09:41:10Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Tese - Gabriella Assumpção Alvarenga Schimchak - 2017.pdf: 1840051 bytes, checksum: 09ab566a12fa9b2b1ab4c9c52b7a75d2 (MD5) Previous issue date: 2017-06-05 / Thesis held in the papers format. The first article is a systematic review that aimed to investigate the relationship between BPPV and falls (with and without fracture). The review was carried out independently by two researchers, using the combined descriptors in English, Portuguese and Spanish, "vertigo" and "elderly" and "accidental falls"; "benign paroxysmal positional vertigo" and "accidental falls"; in the Virtual Health Library and United States National Library of Medicine (PubMED) databases, being the last search in August 2016. Six scientific papers were selected. The results showed that there were double falls in the elderly with the diagnosis of BPPV and this the relationship increased with advancing age. There was evidence of a decrease in episodes of falls above 60% of the elderly who were treated for BPPV. In elderly people with more than one cause for dizziness, BPPV can not be considered as an independent risk factor for falls. However, in the hospital environment, the relationship between BPPV and falls was not observed when the investigation was performed from the hip fracture. However, when the study included elderly patients hospitalized for various consequences of falls, BPPV could be identified in more than 50% of the patients. It can be concluded that BPPV is associated with falls. The second article, whose primary objective was to evaluate dizziness in the elderly in the primary care for the recognition of BPPV and the secondary one, to analyze the association between dizziness and BPPV with falls. It was a cross-sectional study of 298 diabetic and / or hypertensive elderly individuals enrolled in the Hypertensive and Diabetic Monitoring System of the Basic Family Health Unit of the Madre Germana II neighborhood of Goiânia, Goiás. The evaluation was carried out at the residence of the elderly, including the Mini Mental State Examination, sociodemographic profile, record of self-reported health conditions with emphasis on reporting dizziness and / or vertigo and record of falls in the last 12 months. The elderly who reported dizziness and/or vertigo were revisited for functional otoneurological evaluation for BPPV, using the Dix Hallpike test for the posterior and anterior semicircular canals and the Supine Roll test for the horizontal semicircular canal. The study included 150 elderly individuals with a mean age of 69.7 (+/- 7.36), the majority of them were female. Dizziness was reported by 50 elderly (33.3%). Among the 50 patients who reported dizziness, 19 had objective and subjective BPPV (38.8%). There was association between the complaint of dizziness and falls (p = 0.05), which did not occur with BPPV. The assessment of dizziness and BPPV can be performed in the home of the elderly in primary care. This proactive approach can help prevent falls because dizziness has increased the chances of the elderly falling. Although elderly people who presented objective or subjective BPPV did not increase their chances of falls, the identification of this disease, which has a known, effective and financially inexpensive treatment, may lead to the resolution of this clinical condition. / Tese construída na forma de artigos científicos. O primeiro artigo é uma revisão sistemática que objetivou investigar a relação entre VPPB e quedas (com e sem fratura). A revisão foi realizada de forma independente por duas pesquisadoras, utilizando os descritores combinados em inglês, português e espanhol, “vertigem” and “idoso” and “acidentes por quedas"; “vertigem posicional paroxística benigna” and idoso and acidentes por quedas”; vertigem posicional paroxística benigna” and “acidentes por quedas”, nas bases de dados Biblioteca Virtual em Saúde (BVS), United States National Library of Medicine (PubMED), sendo a última busca em agosto de 2016. Foram selecionados seis artigos. Observou-se diversidade metodológica entre os estudos. Quedas ocorreram o dobro de vezes em idosos com o diagnóstico de VPPB e esta relação aumentou com o avanço da idade. Houve evidência de diminuição de episódios de quedas acima de 60% dos idosos que foram tratados da VPPB. Em idosos com mais de uma causa para a tontura, a VPPB não pode ser considerada como fator de risco independente para quedas. Contudo, no ambiente hospitalar, a relação entre VPPB e quedas não foi observada quando a investigação foi realizada a partir da fratura de quadril. No entanto, quando o estudo incluiu idosos internados por consequências diversas de quedas, a VPPB pôde ser identificada em mais de 50% dos pacientes. Pode-se concluir que a VPPB está associada a quedas. O segundo artigo, teve como objetivos, avaliar a tontura em idosos na atenção primária para o reconhecimento da VPPB e analisar a associação entre tontura e VPPB com quedas. Foi um estudo do tipo transversal sendo estudados 298 idosos diabéticos e/ou hipertensos, cadastrados no Sistema de Acompanhamento de Hipertensos e Diabéticos da Unidade Básica de Saúde da Família do bairro Madre Germana II de Goiânia, Goiás. A avaliação foi realizada na residência dos idosos incluindo o Mini Exame do Estado Mental, perfil sociodemográfico, registro das condições de saúde auto referidas com ênfase no relato de tontura e/ou vertigem e registro de quedas nos últimos 12 meses. Os idosos que referiram tontura e/ou vertigem foram revisitados para avaliação funcional Abstract xvi otoneurológica para VPPB, utilizando o teste de Dix Hallpike para os canais semicirculares posterior e anterior e Supine Roll test para o canal semicircular horizontal. Foram incluídos no estudo 150 idosos com média de idade de 69,7(+/-7,36), a maioria do sexo feminino e 26% referiam queda. Tontura foi referida por 33% dos idosos, dentre os quais, 38,8% apresentaram VPPB. Houve associação entre a queixa de tontura e quedas (p=0,05), o que não ocorreu com a VPPB objetiva ou subjetiva. A avaliação da tontura e VPPB pode ser realizada no domicílio de idosos na atenção primária.

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