A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa.

BACKGROUND: Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline. OBJECTIVE: This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management. METHODS: A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review. RESULTS: Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately. CONCLUSION: This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.

Can smartphone vibration provide a valid alternative to tuning forks for use on the ENT ward round?

BACKGROUND: All patients undergoing tympanomastoid surgery should be assessed post-operatively for a 'dead ear'; however, tuning forks are frequently inaccessible. OBJECTIVE: To demonstrate that smartphone-based vibration applications provide equivalent accuracy to tuning forks when performing Weber's test. METHODS: Data were collected on lay participants with no underlying hearing loss. Earplugs were used to simulate conductive hearing loss. Both the right and left ears were tested with the iBrateMe vibration application on an iPhone and using a 512 Hz tuning fork. RESULTS: Occluding the left ear, the tuning fork lateralised to the left in 18 out of 20 cases. In 20 out of 20 cases, sound lateralised to the left with the iPhone (chi-square test, p = 0.147). Occluding the right ear, the tuning fork lateralised to the right in 19 out of 20 cases. In 19 out of 20 cases, sound lateralised to the right with the iPhone (chi-square test, p > 0.999). CONCLUSION: Smartphone-based vibration applications represent a viable, more accessible alternative to tuning forks when assessing for conductive hearing loss. They can therefore be utilised on the ward round, in patients following tympanomastoid surgery, for example.

Differential effects of acute and regular physical exercise on cognition and affect.

The effects of regular exercise versus a single bout of exercise on cognition, anxiety, and mood were systematically examined in healthy, sedentary young adults who were genotyped to determine brain-derived neurotrophic factor (BDNF) allelic status (i.e., Val-Val or Val66Met polymorphism). Participants were evaluated on novel object recognition (NOR) memory and a battery of mental health surveys before and after engaging in either (a) a 4-week exercise program, with exercise on the final test day, (b) a 4-week exercise program, without exercise on the final test day, (c) a single bout of exercise on the final test day, or (d) remaining sedentary between test days. Exercise enhanced object recognition memory and produced a beneficial decrease in perceived stress, but only in participants who exercised for 4 weeks including the final day of testing. In contrast, a single bout of exercise did not affect recognition memory and resulted in increased perceived stress levels. An additional novel finding was that the improvements on the NOR task were observed exclusively in participants who were homozygous for the BDNF Val allele, indicating that altered activity-dependent release of BDNF in Met allele carriers may attenuate the cognitive benefits of exercise. Importantly, exercise-induced changes in cognition were not correlated with changes in mood/anxiety, suggesting that separate neural systems mediate these effects. These data in humans mirror recent data from our group in rodents. Taken together, these current findings provide new insights into the behavioral and neural mechanisms that mediate the effects of physical exercise on memory and mental health in humans.

Psycho-markers of weight loss. The roles of TFEQ Disinhibition and Restraint in exercise-induced weight management.

Eating behaviour traits, namely Disinhibition and Restraint, have the potential to exert an effect on food intake and energy balance. The effectiveness of exercise as a method of weight management could be influenced by these traits. Fifty eight overweight and obese participants completed 12-weeks of supervised exercise. Each participant was prescribed supervised exercise based on an expenditure of 500 kcal/session, 5d/week for 12-weeks. Following 12-weeks of exercise there was a significant reduction in mean body weight (-3.26±3.63 kg), fat mass (FM: -3.26±2.64 kg), BMI (-1.16±1.17 kg/m(2)) and waist circumference (WC: -5.0±3.23 cm). Regression analyses revealed a higher baseline Disinhibition score was associated with a greater reduction in BMI and WC, while Internal Disinhibition was associated with a larger decrease in weight, %FM and WC. Neither baseline Restraint or Hunger were associated with any of the anthropometric markers at baseline or after 12-weeks. Furthermore, after 12-weeks of exercise, a decrease in Disinhibition and increase in Restraint were associated with a greater reduction in WC, whereas only Restraint was associated with a decrease in weight. Post-hoc analysis of the sub-factors revealed a decrease in External Disinhibition and increase in Flexible Restraint were associated with weight loss. However, an increase in Rigid Restraint was associated with a reduction in %FM and WC. These findings suggest that exercise-induced weight loss is more marked in individuals with a high level of Disinhibition. These data demonstrate the important roles that Disinhibition and Restraint play in the relationship between exercise and energy balance.

Physical exercise during adolescence versus adulthood: differential effects on object recognition memory and brain-derived neurotrophic factor levels.

It is well established that physical exercise can enhance hippocampal-dependent forms of learning and memory in laboratory animals, commensurate with increases in hippocampal neural plasticity (brain-derived neurotrophic factor [BDNF] mRNA/protein, neurogenesis, long-term potentiation [LTP]). However, very little is known about the effects of exercise on other, non-spatial forms of learning and memory. In addition, there has been little investigation of the duration of the effects of exercise on behavior or plasticity. Likewise, few studies have compared the effects of exercising during adulthood versus adolescence. This is particularly important since exercise may capitalize on the peak of neural plasticity observed during adolescence, resulting in a different pattern of behavioral and neurobiological effects. The present study addressed these gaps in the literature by comparing the effects of 4 weeks of voluntary exercise (wheel running) during adulthood or adolescence on novel object recognition and BDNF levels in the perirhinal cortex (PER) and hippocampus (HP). Exercising during adulthood improved object recognition memory when rats were tested immediately after 4 weeks of exercise, an effect that was accompanied by increased BDNF levels in PER and HP. When rats were tested again 2 weeks after exercise ended, the effects of exercise on recognition memory and BDNF levels were no longer present. Exercising during adolescence had a very different pattern of effects. First, both exercising and non-exercising rats could discriminate between novel and familiar objects immediately after the exercise regimen ended; furthermore there was no group difference in BDNF levels. Two or four weeks later, however, rats that had previously exercised as adolescents could still discriminate between novel and familiar objects, while non-exercising rats could not. Moreover, the formerly exercising rats exhibited higher levels of BDNF in PER compared to HP, while the reverse was true in the non-exercising rats. These findings reveal a novel interaction between exercise, development, and medial temporal lobe memory systems.

Gainsharing: providing incentives for process improvement.

Gainsharing links pay for performance with employee involvement in improving operations. As operational performance improves, employees share financially in the gain. A successful gainsharing program addresses two primary issues: employee involvement and the formula for bonus payout. The formula must be simple and understandable, and the employees must see clearly how they can influence the probability of a payout. In 1995 Boulder Community Hospital (BCH) instituted a gainsharing program called "Encore! Quality Share." A design team consisting of employees from all levels of the organization developed the plan. "Team norms" encourage group discussion without regard to the institutional power of team members and call for consensus when making decisions. Major components of the gainsharing plan include standardized cost measurement per patient discharge, quality control feedback through patient surveys and designated quality levels for adjusting the amount of payout. The plan was introduced through educational seminars for employees. Quality improvement training and new employee orientation now include presentations on Quality Share. Early indications show that BCH's gainsharing program is a success. Significant payouts were made to employees at the end of the first and second quarters. Because success in the first two quarters seemed relatively easy to attain, safeguards against complacency are now being discussed.