Usability testing of the Philippine Electronic National Newborn Hearing Screening Registry (ENNHSR).

PURPOSE AND OBJECTIVES: The study determined the usability of the online and offline versions of the Philippine Electronic National Newborn Hearing Screening Registry (ENNHSR) as well as user perspectives and satisfaction on the training modules and the online and offline systems. The steps in creating the systems, training modules, and evaluation of the user training manual and video training modules, accuracy and time and motion studies on data entry as well as determination of user perspectives and satisfaction were the specific objectives. METHODOLOGY: With the combined efforts of the staff of Newborn Hearing Screening Reference Center (NHSRC), Philippine National Ear Institute (PNEI) and the National Telehealth Center (NTHC) of the National Institutes of Health UP Manila, the development of the online and offline versions of the ENNHSR took six (6) months from January 2021 to June 2021 to complete. Creation of the user manual and training modules took three (3) months from July 2021 to September 2021. The pilot of the systems was carried out in 2 Zoom Conferencing sessions with the participation of 28 existing certified newborn hearing center users with different roles, backgrounds, demographics from all over the Philippines. Written evaluation as well as focused group discussions on the training modules and the database were conducted during the sessions. Effectivity of the training modules was determined using a 10-point learning check. The time and accuracies in encoding each data field per user were also determined. RESULTS: All 28 participants were able to attend and actively participate in the required Zoom Conferencing sessions as well as submit the 2 evaluation surveys for the training modules and the ENNHSR. During the learning check 93% or 26 out of 28 passed. The surgical intervention module took the longest time to encode while the fastest module to complete was for speech therapy. The average mean time to complete all modules was 3382 s or around 57 min while the time range was between 32 and 104 min. A screener would need 18 min while an implant programmer who is a clinical audiologist would need 52 min to enter data. The accuracy in encoding patient data was 92% while hearing screening results was 88.64%. The system usability scale (SUS) score of ENNHSR was computed at 75.5 which was the average of individual SUS scores, falling within grade B or 74.1 to 77.1 as its corresponding numerical score range in percentile. Most of the participants noted that it was easy to find patient data, results and that it was streamlined with easy to track information. CONCLUSIONS AND RECOMMENDATIONS: Data gathering and analysis both play important roles in health management, policy implementation and quality assurance. We were able to uncover areas where the system performed well - effectively, efficiently, and with satisfaction. We realize that all the possible problems cannot be detected with a small number of participants and variety in information. This testing will serve as both a means to record or benchmark current usability, but also to identify areas where improvements must be made.

Current assessment of newborn hearing screening protocols.

PURPOSE OF REVIEW: The objective of this article is to assess current newborn hearing screening protocols. We will focus on technologies or modalities used, protocol steps, training of screeners, timing of first screen, and loss to follow-up. A summary of program reports focusing on protocols from Greece, China, South Africa, France, Spain, South Korea, Denmark, Italy, Turkey, Taiwan, South Korea, Poland and Iran as they are recently reported will also be presented. RECENT FINDINGS: Community-based hearing screening programs in South Africa and efforts in the Asian region are being reported. The use of automated auditory brainstem response and staged procedures are gaining popularity because of low refer rates. However, follow-up issues remain a problem. The importance of having trained nonprofessional screeners and an efficient database is becoming more evident as the number of newborns screened for hearing loss increase each year. SUMMARY: There are many reported protocols using different technologies, involving several stages, implemented in different settings which should not confuse but rather guide stakeholders so that programs may attain certain benchmarks and ultimately help the hard-at-hearing child in achieving his or her full potential.

Prevalence of medication errors in admitted patients at the Philippine General Hospital

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Medication errors are preventable events that can cause or lead to inappropriate drug use. Knowing the prevalence and types of errors can help us institute corrective measures and avoid adverse drug events.<br /><strong>OBJECTIVE:</strong> This study determined the prevalence of medication errors and its specific types in the four main service wards of a tertiary government training medical center.<br /><strong>METHODS:</strong> This is a retrospective, descriptive chart review study. From the master list of admissions, systematic sampling was done to retrieve the required number of charts. Relevant pages such as order sheets, nurses' notes, therapeutic sheets were photographed. For prolonged admissions, only the first 7 days were reviewed. Each chart was evaluated by two people who then met and agreed on the errors identified.<br /><strong>RESULTS:</strong> The overall prevalence of medication errors is 97.8%. Pediatrics had the most (63.3/chart), followed by Medicine, OB-Gynecology, and Surgery (7.3/chart). The most common type of errors identified were prescribing, followed by compliance, then administration errors.<br /><strong>CONCLUSION:</strong> Medication errors are present in the four main wards in our hospital. We recommend orientation of all incoming first year residents on proper ordering and prescribing of drugs, as well as a prospective observational study to determine true prevalence of all types of medication errors.</p>

Capillary Hemangioma of the temporal bone

OBJECTIVES: To discuss a rare case of temporal bone capillary hemangioma and its diagnosis and management.METHODS:Design: Case ReportSetting: Tertiary Government HospitalPatient: OneRESULTS: A 44-year-old woman with a history of on-and-off right ear discharge, tinnitus and decreased hearing, and a pinkish, smooth-surfaced, non-friable, non-pulsating mass occluding the right external auditory canal, was initially treated for chronic suppurative otitis media with aural polyp. A punch biopsy due to persistence of disease despite medical treatment revealed capillary hemangioma. She underwent canal wall down mastoidectomy with obliteration to completely resect the tumor.CONCLUSION: Capillary hemangiomas of the temporal bone are benign lesions that may lead to complications such as bone erosion, hearing loss, recurrent infection and bleeding if left untreated. Surgery remains the ideal treatment and recurrence is rare and the prognosis is good if resection is complete.

Granulation tissue mimicking a glomus tumor in a patient with chronic middle ear infection

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To present an unusual cause of pulsatile tinnitus, presenting in a young adult suffering from chronic recurrent foul-smelling discharge from the same ear.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary National University Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 24 year-old woman presented with pulsatile tinnitus on a background of chronic recurrent foul-smelling discharge. Clinico-radiologic findings seemed consistent with a glomus tympanicum coexisting with chronic suppurative otitis media with cholesteatoma. She underwent tympanomastoidectomy with excision of the mass. Histopathologic evaluation revealed the mass to be granulation tissue.<br /><strong>CONCLUSION:</strong> Pulsatile tinnitus is rarely associated with chronic middle ear infection. Granulation tissue arising at the promontory may mimic glomus tumors when accompanied with this symptom. Despite this revelation, it would still be prudent to prepare for a possible glomus tumor intraoperatively so that profuse bleeding and complications may be avoided.</p>

Prevalence of clinically diagnosed acute otitis media (AOM) in the Philippines: A national survey with a developing country's perspective

BACKGROUND AND AIMS: Acute otitis media (AOM) seems to be a significant public health problem, but national data on its prevalence is lacking. This study aims to determine the prevalence of acute otitis media in the Philippines and characterize this population.METHODS: A cross-sectional survey of children 0-12 years old in community health centers and schools was performed, utilizing a multi-stage cluster sampling design.RESULTS: Thirteen areas were included in the survey with 26 household and school clusters, surveying a total of 2,277 children. There were 218 children with clinically diagnosed acute otitis media, with an overall prevalence rate of 9.6%. Among the children with AOM, 108 (10%) were male while 110 (9.2%) were female. There were 32 (14.6%) cases of AOM in the 0-2 year olds, 56 (9.5%) in the 3-6 year olds, and 117 (8.4%) in the 7-12 year old children.CONCLUSIONS: The overall prevalence of clinically diagnosed acute otitis media in the Philippines is 9.6%, with a variables area-specific prevalence. There is no gender predilection, with the 0-2 age group having the most prevalent cases of AOM in the sample.

Prevertebral soft tissue thickness among pediatric patients

@#<p style="text-align: justify;"><strong>OBJECTIVES</strong>: This study aimed to determine the prevertebral soft tissue thickness among normal patients aged 0-14 years old in a tertiary government training hospital, to compare these values with divergent criteria in the standard otorhinolaryngology and radiology texts used in our institution, and to recommend adoption of a set of criteria based on the results.<br /><br /><strong>METHODS</strong>:<br /><strong>Design</strong>: Descriptive Study <br /><strong>Setting</strong>: Tertiary Government Hospital<br /><strong>Subjects and Methods</strong>: Lateral cervical radiographs taken from May 2007 to August 2009 which were initially read as normal were collected. Fifty (50) patients, 39 males and 11 females, aged 0-14 years old meeting inclusion criteria were reviewed and prevertebral soft tissue thicknesses (PVST) and cervical vertebral body diameter at levels C2, C5, C6 were measured and compared to criteria set by standard otorhinolaryngology and radiology textbooks.<br /><br /><strong>RESULTS</strong>: The average PVST at C2 ranged from 4.02 mm for 2-3 year-olds (n= 2) to 8.16 mm for 1 -2 year-olds (n=2). The average PVST at C5 ranged from 8.11mm for 1-2 year-olds to 10.75 mm for for 0-1 year-olds. The average PVST at C6 ranged from 7.13 mm for 1 - 2 year-olds to 10.36 mm for 0-1 year-olds. Only 12% of the patients satisfied the criteria set by Keats and Lusted, while 100% satisfied Duncan's criteria, 94% and 98% satisfied Wippold's first and second criteria respectively. <br /><br /><strong>CONCLUSION</strong>: All of the PVST criteria mentioned in Cummings' Textbook of Otorhinolaryngology Head and Neck Surgery had a more than 90% accuracy compared to only 12% for those mentioned in Keats and Lusted's Atlas of Roentgenographic Measurement. Therefore, we recommend the use of any criteria for PVST contained in the former over the latter.</p>

A benign maxillary tumour with malignant features.

Non-specific biopsy results such as chronic inflammation, hemorrhage, necrosis can be frustrating to the clinician. This is especially true if the patient presents with clinical features suggestive of an aggressive tumour. This is a review of the clinical features, diagnostic dilemmas and surgical management of a benign maxillary mass with malignant features - a disease called hematoma-like mass of the maxillary sinus (HLMMS). Our experience with five cases will also be cited.