Resonance frequency analysis of osseo-integrated implants for bone conduction in a pediatric population - a novel approach for assessing stability for early loading.

OBJECTIVES: The purpose of our study was to directly measure the stability of a bone anchored hearing device (BAHD) abutment using resonance frequency analysis (RFA) in a pediatric population. RFA was used to guide early loading of the abutment following single stage surgery. METHODS: The principle behind RFA is to obtain a numerical value relating to stability. A Smartpeg (1 cm commercially manufactured attachment) is screwed onto the abutment - its resonance in a magnetic field is measured with an Osstell recording device. The degree of movement (vibration) is inversely proportional to the stability of the abutment and a numerical figure, the Implant Stability Quotient (ISQ), is derived. RFA measurements were obtained at surgery, 4 weeks and 16 weeks post implant surgery. Patients were fitted with the new CochlearTM Baha(®) BI300 series implant using a one-stage procedure and based on RFA stability measures, loading of the sound processor occurred any time from 1 week after implant surgery if the RFA measure was 60 units or over. RESULTS: Twenty two consecutive patients were recruited. Eight patients had bilateral BAHD's fitted giving a total of 30 implants. The age range was 2-16 years with an average age of 9 years at time of fitting. The time interval from surgery to loading the processor ranged from 1 to 16 weeks, with an average time of 6 weeks. The mean ISQ value at time of surgery was 61.29 (95% CI = 2.03), at 4 weeks was 61.92 (95% CI = 2.97) and at 16 weeks was 63.45 (95% CI = 3.18). CONCLUSIONS: Our study shows we have been able to operate a successful program of earlier BAHD loading using single stage surgery in children. This is supported by favorable RFA measures of implant stability with average ISQ values of over 60 units.

Evidence for early loading of osseointegrated implants for bone conduction at 4 weeks.

INTRODUCTION: The purpose of our study was to directly measure the stability of the abutment using resonance frequency analysis (RFA) and to report on the change in stability over time for implants loaded 4 weeks postoperatively. MATERIALS AND METHODS: The principle behind RFA is to obtain a numerical value relating to stability. The Osstell RFA recording device measures the resonance in a magnetic field of a 1 cm commercially manufactured attachment (SmartPeg) that is screwed onto the bone conduction device abutment. RFA measurements were obtained at surgery, 1, 4, and 16 weeks after implant surgery. The degree of movement (vibration) is inversely proportional to the stability of the abutment, and a numerical figure, the implant stability quotient (ISQ), is derived. Patients were fitted with the new Cochlear Bone-Anchored Hearing Aid (BAHA) BI300 series implant using a 1-stage procedure and loaded 4 weeks postoperatively. RESULTS: Prospectively 68 consecutive patients were recruited with a male to female ratio of 23:45. Nineteen patients had bilateral BAHA devices fitted, giving a total of 88 implants. The average ISQ change (delta) for the cohort gives a value of 0 at time of surgery. The change in ISQ at 1 week was -0.10 (95% confidence interval [CI], 0.74), at 4 weeks was 1.21 (95% CI, 0.59), and at 16 weeks was 1.60 (95% CI, 0.77). DISCUSSION: Successful early loading of the BAHA sound processor has been achieved. RFA provides a reliable means of assessing stability for loading and measuring implant stability in the longer term. These data support the evidence for early loading at 4 weeks with good clinical safety.

Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study.

OBJECTIVE: To evaluate attitudes of Europeans regarding end-of-life decisions. DESIGN AND SETTING: Responses to a questionnaire by physicians and nurses working in ICUs, patients who survived ICU, and families of ICU patients in six European countries were compared for attitudes regarding quality and value of life, ICU treatments, active euthanasia, and place of treatment. MEASUREMENTS AND RESULTS: Questionnaires were distributed to 4,389 individuals and completed by 1,899 (43%). Physicians (88%) and nurses (87%) found quality of life more important and value of life less important in their decisions for themselves than patients (51%) and families (63%). If diagnosed with a terminal illness, health professionals wanted fewer ICU admissions, uses of CPR, and ventilators (21%, 8%, 10%, respectively) than patients and families (58%, 49%, 44%, respectively). More physicians (79%) and nurses (61%) than patients (58%) and families (48%) preferred being home or in a hospice if they had a terminal illness with only a short time to live. CONCLUSIONS: Quality of life was more important for physicians and nurses than patients and families. More medical professionals want fewer ICU treatments and prefer being home or in a hospice for a terminal illness than patients and families.

Nurse involvement in end-of-life decision making: the ETHICUS Study.

OBJECTIVE: The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making. DESIGN: This study was part of a larger study sponsored by the Ethics Section of the European Society of Intensive Care Medicine, the ETHICUS Study. Physicians described whether they thought nurses were involved in such decisions, whether nurses initiated such a discussion and whether there was agreement between physicians and nurses. The items were analyzed and comparisons were made between different regions within Europe. SETTING: The study took place in 37 intensive care units in 17 European countries. PATIENTS AND PARTICIPANTS: Physician investigators reported data related to patients from 37 centers in 17 European countries. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Physicians perceived nurses as involved in 2,412 (78.3%) of the 3,086 end-of-life decisions (EOLD) made. Nurses were thought to initiate the discussion in 66 cases (2.1%), while ICU physicians were cited in 2,438 cases (79.3%), the primary physician in 328 cases (10.7%), the consulting physician in 105 cases (3.4%), the family in 119 cases (3.9%) and the patient in 19 cases (0.6%). In only 20 responses (0.6%) did physicians report disagreement between physicians and nurses related to EOLD. A significant association was found between the region and responses to the items related to nursing. Physicians in more northern regions reported more nurse involvement. CONCLUSIONS: Physicians perceive nurses as involved to a large extent in EOLDs, but not as initiating the discussion. Once a decision is made, there is a sense of agreement. The level of perceived participation is different for different regions.