In Situ Simulation Training for Frailty.

BACKGROUND: People living with frailty account for a significant proportion of hospital inpatients and are at increased risk of adverse events during admission. The understanding of frailty remains variable among hospital staff, and there is a need for effective frailty training across multidisciplinary teams. Simulation is known to be advantageous for improving human factor skills in multidisciplinary teams. In situ simulation can increase accessibility and promote ward team learning, but its effectiveness with respect to frailty has not been explored. METHOD: A single-centre, multi-fidelity, inter-professional in situ frailty simulation programme was developed. One-hour sessions were delivered weekly using frailty-based clinical scenarios. Mixed-method evaluation was used, with data collected pre- and post-session for comparison. RESULTS: In total, 86 multidisciplinary participants attended 19 sessions. There were significant improvements in self-efficacy rating across 10 of 12 human factor domains and in all frailty domains (p < 0.05). The common learning themes were situational awareness, communication and teamwork. Participants commented on the value of learning within ward teams and having the opportunity to debrief. CONCLUSION: In situ simulation can improve the self-efficacy of clinical and human factor skills related to frailty. The results are limited by the nature of self-reporting methods, and further studies assessing behavioural change and clinical outcomes are warranted.

Short electrode insertion in cochlear implantation: speech perception performance of Cantonese-speaking subjects.

CONCLUSIONS: Subjects with cochlear ossification derived benefits in terms of speech performance similar to those of the non-ossified group. It is thus recommended that the insertion of short electrode arrays should be considered an alternative choice for patients with cochlear ossification. OBJECTIVE: Cochlear ossification has been recognized as a major obstacle to the full insertion of a multichannel cochlear implant electrode array. To alleviate the technical difficulty of placing a standard electrode array and the possibility of causing undesirable trauma to the cochlea, a newly designed electrode array with the same number of electrodes compressed into a shorter length has been made available. The aim of the present study was to examine the speech perception performance of patients implanted with the MED-EL C40+S compressed electrode array and to compare their results with those of matched groups implanted with the MED-EL C40+standard electrode array. MATERIAL AND METHODS: One pre-lingually and two post-lingually deaf subjects using short electrode arrays were matched with three groups of subjects using standard electrode arrays. The pre- and postoperative speech perception scores were evaluated. RESULTS: All three subjects using compressed electrode arrays achieved speech perception scores comparable to those of matched subjects using standard electrode arrays. There was also a tendency for the subjects to show similar patterns of speech perception scores as a function of the difficulty of the tests.

Audiological status of Chinese patients with cleft lip/palate.

OBJECTIVE: To review the audiological and otoscopic status of Chinese children and young adults seen at a cleft lip and palate clinic in Hong Kong and compare with previous studies of Western clinical populations. DESIGN: The hearing health status of the patients was analyzed on the basis of the results of their otoscopic, pure tone audiometric, and tympanometric examinations. The patients' sex, age, race, and type of cleft pathology were examined for their potential relationship to hearing health status. PARTICIPANTS: The records of 180 predominantly Chinese patients attending the Cleft Lip and Palate Centre, Prince Philip Dental Hospital/University of Hong Kong from July 1977 to December 1999 were reviewed. RESULTS AND CONCLUSION: The results indicated 13.4% of patient ears failed the audiometric screening and 23.7% of patient ears yielded abnormal tympanometric results. Patients' sex, age, and type of cleft pathology were found not to be related to hearing screening results. The prevalence of hearing disorder was in contrast with Western studies that show a much higher rate of audiological problems in children and young adults with cleft lip/palate. Racial factors were considered to be possible reasons for this disparity. Other factors, such as timely medical and surgical intervention, including early cleft palate repair and the insertion of ventilation tubes in cases of middle ear effusion, do not convincingly account for the study findings.