ABSTRACT
OBJECTIVE: Prevention of temporary threshold shift (TTS) after laboratory-based exposure to pure-tones, broadband noise, and narrowband noise signals has been achieved, but prevention of TTS under these experimental conditions may not accurately reflect protection against hearing loss following impulse noise. This study used a controlled laboratory-based TTS paradigm that incorporated impulsive stimuli into the exposure protocol; development of this model could provide a novel platform for assessing proposed therapeutics. DESIGN: Participants played a video game that delivered gunfire-like sound through headphones as part of a target practice game. Effects were measured using audiometric threshold evaluations and distortion product otoacoustic emissions (DPOAEs). The sound level and number of impulses presented were sequentially increased throughout the study. STUDY SAMPLE: Participants were normal-hearing students at the University of Florida who provided written informed consent prior to participation. RESULTS: TTS was not reliably induced by any of the exposure conditions assessed here. However, there was significant individual variability, and a subset of subjects showed TTS under some exposure conditions. CONCLUSIONS: A subset of participants demonstrated reliable threshold shifts under some conditions. Additional experiments are needed to better understand and optimize stimulus parameters that influence TTS after simulated impulse noise.
Subject(s)
Auditory Fatigue , Firearms , Hearing Loss, Noise-Induced/etiology , Noise/adverse effects , Video Games , Acoustic Stimulation , Acoustics , Adolescent , Adult , Audiometry, Pure-Tone , Female , Florida , Hearing Loss, Noise-Induced/diagnosis , Hearing Loss, Noise-Induced/physiopathology , Hearing Loss, Noise-Induced/psychology , Humans , Male , Otoacoustic Emissions, Spontaneous , Pressure , Recovery of Function , Risk Assessment , Risk Factors , Sound Spectrography , Time Factors , Tinnitus/diagnosis , Tinnitus/etiology , Tinnitus/psychology , Young AdultABSTRACT
No disponible
Subject(s)
Male , Middle Aged , Humans , Sputum , Lung Neoplasms/secondary , Adenocarcinoma/secondary , Rectal Neoplasms/pathologySubject(s)
Lung Neoplasms/secondary , Sputum , Adenocarcinoma/secondary , Cough , Humans , Male , Middle Aged , Rectal Neoplasms/pathologyABSTRACT
"Syndrome of recommended patient" is manifested as the presence of numerous unexpected and unusual complications in patients that the treating physician is trying to give a better assistance. Even assuming that a few complications may appear by chance, there are several factors from daily clinical practice that facilitate the presence of such a syndrome, and some of them can be corrected in order to reduce its incidence. All of them come from the change on daily clinical practice on these patients, as if they do not fit for the attention provided for other people. These factors favouring the presence of this syndrome come from: patients' attitude, inefficient use of health resources, absence of an adequate register of clinical data and change in usual clinical practice on interpretation of diagnostic tests as well as in the indication of treatment of these patients. The best way to prevent this "syndrome of recommended patient" is to maintain, even within these patients, an attitude based on solid clinical knowledge and to follow up the same clinical rules accepted for other patients.
Subject(s)
Evidence-Based Medicine , Iatrogenic Disease , Medical Errors , HumansABSTRACT
El "síndrome del recomendado" se manifiesta como la aparición de imprevistos y de complicaciones no habituales en pacientes con los que se pretende desarrollar una atención más esmerada. Aparte de lo que pueda ser debido al azar, hay factores de la práctica clínica habitual que favorecen la manifestación de este síndrome, muchos de los cuales se pueden corregir. Todos provienen del cambio de la práctica habitual que se da con estos pacientes, como si en ellos no fuera adecuado seguir la misma actitud que con los demás. Algunos de los factores que favorecen la aparición de este síndrome son: la actitud del propio paciente, el empleo ineficiente de los recursos sanitarios, la ausencia de un registro adecuado de datos en la historia clínica y el cambio en la conducta habitual en la indicación y la interpretación de los estudios diagnósticos y en el tratamiento de estos enfermos. El mejor modo de prevenir este "síndrome del recomendado" es mantener, también con estos pacientes, una actitud clínica basada en unos conocimientos sólidos y seguir la misma línea de conducta que con los demás enfermos (AU)
"Syndrome of recommended patient" is manifested as the presence of numerous unexpected and unusual complications in patients that the treating physician is trying to give a better assistance. Even assuming that a few complications may appear by chance, there are several factors from daily clinical practice that facilitate the presence of such a syndrome, and some of them can be corrected in order to reduce its incidence. All of them come from the change on daily clinical practice on these patients, as if they do not fit for the attention provided for other people. These factors favouring the presence of this syndrome come from: patients' attitude, inefficient use of health resources, absence of an adequate register of clinical data and change in usual clinical practice on interpretation of diagnostic tests as well as in the indication of treatment of these patients. The best way to prevent this "syndrome of recommended patient" is to maintain, even within these patients, an attitude based on solid clinical knowledge and to follow up the same clinical rules accepted for other patients (AU)
Subject(s)
Humans , Evidence-Based Medicine , Medical Errors , Iatrogenic DiseaseABSTRACT
La quimioterapia es un tratamiento efectivo en numerosos cánceres avanzados. Sin embargo, sus efectos secundarios pueden ensombrecer el beneficio de la respuesta antitumoral. A la hora de valorar la indicación de este tratamiento es preciso conocer la sensibilidad del tumor al tratamiento, los efectos secundarios y el beneficio que se espera obtener, sobre todo expresado como: alivio de síntomas o retraso en su aparición, mejoría de la calidad de vida, aumento de la supervivencia y reducción del volumen tumoral. También es necesario tener en cuenta el estado general y funcional del enfermo, el pronóstico, la sintomatología y su interés en recibir un tratamiento oncológico. De acuerdo con estos parámetros se puede individualizar el esquema terapéutico y seleccionar aquellos pacientes en los que es mayor la expectativa de beneficio por el efecto paliativo de la quimioterapia (AU)
Subject(s)
Female , Male , Humans , Antineoplastic Agents/therapeutic use , Palliative Care , Neoplasm Staging , Neoplasms , Neoplasms/drug therapy , Neoplasms/pathologyABSTRACT
Chemotherapy shows antitumoral activity in several advanced cancers. However, toxicity is frequent and may even overwhelm the clinical benefit of antineoplastic activity. To recommend such a treatment, we need to know the sensibility of cancer to therapy, its toxic effects and the clinical benefit we are looking for, expressed as: symptoms relief or delay in its presentation, improvement in quality of life, increase in overall survival and reduction in tumor volume. We need also to evaluate the performance status and functional status of each patient, its prognosis, the severity of symptoms and its interest to receive any antitumor treatment. According to these parameters we can individualize each therapy to select those patients whose expected benefit from this palliative chemotherapy is higher.
