ABSTRACT
BACKGROUND: Patients with cleft palate often suffer from recurrent otitis media chronica with effusion during infancy. The consecutive binaural conductive hearing loss is seen as a risk factor for developing auditory processing disease. Since there are just a few studies examining auditory processing in this population this study aimed to investigate on an own patient cohort with different cleft manifestations in terms of auditory processing disorders in context to given studies. MATERIAL AND METHODS: This study included 48 patients (5-16 years): all patients had a non-syndromic cleft palate and normal peripheral hearing at the time of examination. The protocol included otoscopy, pure tone audiogram, speech intelligibility in noise, dichotic speech discrimination, auditory short-term memory and a parental questionnaire. RESULTS: The majority of the parents did not indicate problems in the parental questionnaire. 69â% of the participants showed conspicuous results in the speech intelligibility in noise, whereas the dichotic speech discrimination and the auditory short-term memory were suspicious in 16.7â% only. The results in both tests proved mainly a problem in younger children. Noticeable results in speech intelligibility in noise were found in all age groups. CONCLUSION: Children and adolescents with cleft palate are at risk to develop auditory processing disorders. In this study population speech intelligibility in noise was the most common problem. 90â% of the children had received a speech therapy which could have already compensated problems concerning dichotic speech discrimination and the auditory short-term memory but not problems in speech intelligibility in noise.
Subject(s)
Auditory Perceptual Disorders , Cleft Palate , Speech Perception , Adolescent , Auditory Perception , Auditory Perceptual Disorders/diagnosis , Auditory Perceptual Disorders/epidemiology , Child , Humans , NoiseABSTRACT
OBJECTIVE: This article aims to examine the implementation process of diagnosis-related groups (DRGs) in the clinical departments of a German hospital group and to explain why some gain competitive advantage while others do not. STUDY SETTING: To investigate this research question, we conducted a qualitative study based on primary data obtained in six clinical departments in a German hospital group between 2003 and 2005. STUDY DESIGN: We chose the case study method in order to gain deep insights into the process dynamics of the implementation of DRGs in the six clinical departments. The dynamic capability approach is used as a theoretical foundation. Employing theory-driven categories we focused on idiosyncratic and common patterns of "successful coders" and "unsuccessful coders." DATA COLLECTION: To observe the implementation process of DRGs, we conducted 43 semistructured interviews with key persons, carried out direct observations of the monthly meetings of the DRG project group, and sampled written materials. PRINCIPAL FINDINGS: "Successful coders" invest into change resources, demonstrate a high level of acceptance of innovations, and organize effective processes of coordination and learning. CONCLUSIONS: All clinical departments only put an emphasis on the coding aspects of the DRGs. There is a lack of vision regarding the optimization of patient treatment processes and specialization. Physicians are the most important key actors, rather than the main barriers.
Subject(s)
Diagnosis-Related Groups/classification , Hospital Departments/organization & administration , Medical Records , Diagnosis-Related Groups/economics , Economic Competition , Efficiency, Organizational , Forms and Records Control , Germany , Health Plan Implementation , Health Services Research , Hospital Departments/economics , Humans , Interviews as Topic , Organizational Case Studies , Outcome and Process Assessment, Health Care , Outliers, DRG , Qualitative ResearchABSTRACT
The LEOPARD syndrome is a complex of multisystemic congenital abnormalities characterized by lentiginosis, electrocardiographic conduction abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retardation of growth, and deafness (sensorineural). Mutations in PTPN11, a gene encoding the protein tyrosine phosphatase SHP-2 located on chromosome 12q24.1, have been identified in 88% of patients with LEOPARD syndrome. A missense mutation (836-->G; Tyr279Cys) in exon 7 of PTPN11 gene was identified in this patient and his mother with LEOPARD syndrome. This mutation is one of the two recurrent mutations most often associated with the syndrome. Leukemia has not previously been reported in patients with LEOPARD syndrome. The authors describe a 13-year-old boy diagnosed with both LEOPARD syndrome and acute myelomonocytic leukemia (AML-M4).
