Audiological Diagnosis in a Case of Retrocochlear Pathology Post Traumatic Brain Injury: A Case Report.

This case report is a follow up of a patient with traumatic brain injury (TBI) post road traffic accident; hearing loss, speech understanding difficulty and tinnitus being the main complaints. CT scan showed brainstem contusion. The diagnosis of retro-cochlear pathology was arrived at after using a test battery approach.

A Bespoke Electronic Health Journal for Monitoring Response to Botulinum Toxin in Treatment of Cervical Dystonia: Open-Label Observational Study of User Experience.

BACKGROUND: The mainstay of treatment for cervical dystonia (CD) is regular botulinum toxin injections every 3-4 months. Clinical evaluation of response is dependent on the patient's recall of how well symptoms responded to the previous injection. A mobile health app could assist both patients and health care professionals to monitor treatment benefits and side effects to assist with the selection of muscle and toxin dose to be injected at the next visit. The DystoniaDiary is a bespoke electronic health journal for monitoring symptoms of CD and response to treatment. OBJECTIVE: The objective of this study was to assess the acceptability and utility of the DystoniaDiary in patients with CD treated with botulinum toxins as part of their usual care. METHODS: In this open-label, single-center, single-arm observational study, patients attending a botulinum toxin injection clinic were invited to download the DystoniaDiary app. Patients selected up to 3 of their most troublesome CD symptoms (from a predefined list) and were prompted every 3 days to rate the control of these symptoms on a scale from 0 (very badly) to 100 (very well). Dates of onset and wearing off of response to injected botulinum toxin and responses to the Cervical Dystonia Impact Profile (CDIP-58) questionnaire at baseline and week 6 were also recorded in the app. RESULTS: A total of 34 patients installed DystoniaDiary. Twenty-five patients (25/34, 74%) recorded data for ≥12 weeks and 21 patients (21/34, 62%) for ≥16 weeks. Median time between the first and last data input was 140 days with a median of 13 recordings per patient. User experience questionnaires at weeks 4 and 12 (20 respondents) indicated that the majority of respondents found the DystoniaDiary app easy to install and use, liked using it, would recommend it to others (19/20), and wished to continue using it (16/20). A smaller proportion indicated that the DystoniaDiary gave a greater sense of control in managing their CD (13/20). There was interindividual variation in patients' perceptions of control of their symptoms after botulinum toxin injection. Response to treatment was apparent in the symptom control scores for some patients, whereas the severity of other patients' symptoms did not appear to change after treatment. CONCLUSIONS: This observational study demonstrated that the DystoniaDiary app was perceived as useful and acceptable for a large proportion of this sample of patients with CD attending a botulinum toxin clinic. Patients with CD appear to be willing to regularly record symptom severity for at least the duration of a botulinum injection treatment cycle (12-16 weeks). This app may be useful in monitoring and optimizing individual patient responses to botulinum toxin injection.

Otolaryngology Surgical Activity in Tertiary Care Center During the Covid-19 Lockdown.

Corona virus disease (COVID 19) is an infectious respiratory disease caused by the novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With many countries implementing lockdown the surgical activities in the division of otolaryngology across the world has been affected with many hospital confining themselves to only emergency or essential surgeries. The aim of this work is to report and discuss the in the surgical activity of the otolaryngology unit of the St John's National Academy of Health Sciences, Bangalore (India) during the pandemic. We performed acute and subacute emergencies which include diagnosis and treatment of malignant tumors of the head and neck, management of airway emergencies in adults and children, drainage of abscesses of the head and neck, Foreign body removal, emergency nasal debridement and surgeries for the unsafe ear. With the pandemic the surgical activities in otolaryngology changed drastically and with strict protocol and triaging put in place the risk for Health care workers was avoided and services to patients delivered.

Evaluation of an intervention to individualise patient education at a nurse-led heart failure clinic: a mixed-method study.

AIMS AND OBJECTIVES: The main aim of this study was to evaluate whether addressing the written questions of heart failure patients could individualise the education and increase patient satisfaction. A further aim was to describe the learning needs of patients with newly diagnosed heart failure. BACKGROUND: Despite well-designed patient education, daily problems and self-care sometimes seem difficult to manage for the patient with heart failure. The literature suggested that nurses should include individualised educational interventions. DESIGN: The study had an evaluative and descriptive design. METHODS: A mixed-method approach was used. A quasi-experimental method was used to compare patients in the control group (n = 41), who received regular education at the nurse-led heart failure clinic, with patients in the intervention group (n = 44), who received regular education but also education addressing questions they had written down at home before coming to the clinic. Two instruments were used to investigate, respectively, whether the intervention caused patients to experience a greater sense of involvement in their education and greater satisfaction. The patients' questions were subjected to manifest content analysis. RESULTS: There was no significant difference in satisfaction with the education between the control group and the intervention group. However, the intervention group did feel more strongly that the information they received was related to their personal situation. The patients' learning needs before education were categorised as: causes and meaning of illness, control and management of the disease, impact on daily living and future health. CONCLUSION: Asking heart failure patients to write down their learning needs before the education increases their chances of receiving education based on their individual needs. RELEVANCE TO CLINICAL PRACTICE: The method is simple and cost-effective and could be a way to improve the patient education and facilitate person-centred care.

The STRATIFY tool and clinical judgment were poor predictors of falling in an acute hospital setting.

OBJECTIVE: To compare the effectiveness of the STRATIFY falls tool with nurses' clinical judgments in predicting patient falls. STUDY DESIGN AND SETTING: A prospective cohort study was conducted among the inpatients of an acute tertiary hospital. Participants were patients over 65 years of age admitted to any hospital unit. Sensitivity, specificity, and positive predictive value (PPV) and negative predictive values (NPV) of the instrument and nurses' clinical judgments in predicting falls were calculated. RESULTS: Seven hundred and eighty-eight patients were screened and followed up during the study period. The fall prevalence was 9.2%. Of the 335 patients classified as being "at risk" for falling using the STRATIFY tool, 59 (17.6%) did sustain a fall (sensitivity=0.82, specificity=0.61, PPV=0.18, NPV=0.97). Nurses judged that 501 patients were at risk of falling and, of these, 60 (12.0%) fell (sensitivity=0.84, specificity=0.38, PPV=0.12, NPV=0.96). The STRATIFY tool correctly identified significantly more patients as either fallers or nonfallers than the nurses (P=0.027). CONCLUSION: Considering the poor specificity and high rates of false-positive results for both the STRATIFY tool and nurses' clinical judgments, we conclude that neither of these approaches are useful for screening of falls in acute hospital settings.

Satisfied patients are also vulnerable patients--narratives from an acute care ward.

AIM: To illuminate the experience of being a patient and cared for in an acute care ward. BACKGROUND: Patients may be the best source of information for assessing the quality of care in acute care wards. Studies often show that patients' satisfaction with their hospital stay is interpreted by managers and care providers as a measure for quality of care. DESIGN: Ten patients were interviewed as part of a comprehensive investigation by four researchers into the narratives of five enrolled nurses (study No. 1--published in Nursing Ethics 2004), five Registered Nurses (study No. 2 published in Nursing Ethics 2005) and 10 patients (study No. 3) about their experiences from an acute care ward at one university hospital in Sweden. METHOD: A phenomenological hermeneutical method (inspired by the French philosopher Paul Ricoeur) was conducted in all three studies. FINDINGS: The patients are very satisfied with their treatment and care. They also tell about factors that they do not consider as optimal, but which they explain as compromises, which must be accepted as a necessary part of their stay in the ward. This study demonstrates a close connection between patient satisfaction and vulnerability. CONCLUSIONS: It is important for all health care providers not to be complacent and satisfied when patients express their satisfaction with their treatment and care. This can result in losing the focus on the patients' vulnerability and existential thoughts and reflections which are difficult for them, and which need to be addressed. RELEVANCE TO CLINICAL PRACTICE: The findings can be seen as a challenge for the health care providers as well as the organization to provide quality of care to patients in acute care ward. When listening to the patients' voice it makes it easier to be aware of the content of their vulnerability.

Do allegations of emotional maltreatment predict developmental outcomes beyond that of other forms of maltreatment?

OBJECTIVES: To understand the features of child abuse/neglect (CA/N) allegations in cases with emotional maltreatment (EMT) allegations, as well as the features of the EMT allegations themselves, and to describe any associations of EMT with distinct impairments of children's behavior, emotion and functioning. METHOD: The sample consisted of 806 high-risk children, 545 with one or more maltreatment reports to CPS. The Maltreatment Classification System was used to record the number and severity levels of maltreatment allegations, which compared cases with and without EMT. Multiple regression analyses were conducted using 10 outcome scales from the Child Behavior Checklist, Vineland Screener, and Trauma Symptom Checklist. Successive blocks of predictor variables included demographics, maltreatment classification variables, maternal and family characteristics, and study site. RESULTS: When there were allegations of EMT as well as CA/N in a CPS case-record (by age 8), the CA/N allegations tended to be either more frequent or less severe than those kinds of allegations in cases without EMT. When neglect was alleged to occur with EMT, neglect allegations outnumbered allegations of EMT. However, when sexual abuse allegations were accompanied by EMT allegations, there were more EMT allegations than sexual abuse allegations in the cases. Higher severity ratings for EMT allegations than for physical abuse occurred when cases included any abuse. Distinctive effects of EMT subtypes were found between problems of safety/restriction and self-reported anger symptoms, and between problems of self-esteem/autonomy and posttraumatic stress. CONCLUSION: Differences exist between the CA/N allegations in cases with and without EMT. Having few cases containing only EMT allegations made it difficult to assess distinctive harm associated with EMT. Certain types of EMT allegations were associated with increases in children's anger and posttraumatic stress.

Annular ligament reconstruction - a better technique in the surgical treatment of stapes fixation.

Reconstruction of the annular ligament using vein graft at the stapedotomy site gives a very good gain at low, frequencies as compared to Stapedotomy without a tissue seal It also protects against perilymph leak 1 0 8mm stapedotomy with a 0 4mm piston with 0 2 mm vein graft interposition is a better technique in the surgical treatment of stapes fixation The purpose of the present study is to determine the effectiveness of vein graft in sealing the oval window in small fenestra stapedotomy for stapedial otoselerosis We performed a prospective randomi ed trial in 80 cases of stapedial otoselerosis, 40 with and 40 without having a tissue seal at a tertiary referal center Ihere was a good air bone gap closure in both the groups There was a better gain in the lower frequencies in subjects where the vein graft was used.