1263 Mandibular Advancement Device referrals and compliance at the VA

Introduction For patients with obstructive sleep apnea (OSA) who are either intolerant or otherwise non-compliant with positive airway pressure (PAP) therapy, the use of a mandibular advancement device (MAD) is a viable and minimally invasive alternative for select individuals. Many device variations exist, but the common mechanism of action involves airway augmentation via traction on the lower jaw provided by a dental appliance. Prior studies have identified factors associated with treatment success, however, actual clinical experiences fluctuate widely. To identify patients within the VA that might benefit most from MAD, we conducted a preliminary review of MAD referrals within a one-year period at the West Los Angeles VA (WLA VA). Report of Case This retrospective database review was performed to identify areas for improvement in MAD referrals within the West Los Angeles VA network. The need for informed consent was waived as part of reviews preparatory to research as outlined in paragraph 23c of the VHA Directive 1200.05. Our database was queried for all MAD dental referrals between January 1, 2017 and Dec 31, 2017. All patients that completed at least one dental visit were included, those that did not complete referrals were excluded. Patient charts were reviewed for demographic data, comorbidities, dentition quality, pre- and post- MAD sleep studies, prior failed therapies, duration of MAD usage, reasons for discontinuation, and final OSA treatment modality. Between January 1, 2017 and December 31, 2017, 246 patients were referred for MAD dental evaluation. 184 initial evaluations were completed, 55 were discontinued for various reasons, and 7 were cancelled. *** Preliminary data for first 84 patients*** Of 84 patients seen in dental clinic, 33 (39%) were deemed poor candidates either because of insufficient dentition or because of existing temporal-mandibular joint discomfort, 4 patients declined any intervention. Of 47 patients that received an MAD, 6 patients continued to use MAD alone, 20 switched to PAP or other modalities, and 21 were lost to follow up. Conclusion Pending more in depth analysis

Map Room

In the minds of Californians, then, Mulholland’s aqueduct represents a historical pivot; a before-and-after event when farmers lost and the city won; a moment when Los Angeles began to soak the desert with water and populate it with people. The idea that the city is an actual desert disguised by uninhibited water theft has permeated the minds of policy makers and popular culture (i.e. “Chinatown”) for so long that it is hard to rectify the map above with the “genesis myth” of the Owens River Aqueduct. Yet, in the minds of engineers in 1888 (when the population of Los Angeles stood at around 50,000—roughly half the size of Santa Monica today), Los Angeles—particularly West Los Angeles, was anything but a parched landscape. This map, in fact, reveals an incredibly complex series of patchworks containing irrigation lines (both newly constructed and older Rancho era Zanjas), “moist areas,” pipelines, washes, creeks, streams, swamps, rivers, canals, wells, and of course, the large and still wild Los Angeles River.

The Soldiers’ City

The Pacific Branch of the National Home for Disabled Volunteer Soldiers, a domicile and hospital for Union veterans of the Civil War, opened west of Los Angeles in 1888 on land donated by real-estate developers. Barrett Villa Tract, a development of small plots later renamed Sawtelle, was established outside the south gate of the Soldiers’ Home. There veterans bought homes where they could “live out” and enjoy family life while continuing to avail themselves of the services of the Pacific Branch. Sawtelle incorporated as a city in 1906 but consolidated with Los Angeles in 1922. Issues of Pacific Branch members’ votes, behavior, and community leadership mark Sawtelle’s history. Union veterans played a significant role in the development of West Los Angeles.