The DizzyQuest: relation between self-reported hearing loss, tinnitus and objective hearing thresholds in patients with Meniere's disease.

BACKGROUND: Combining a mobile application-based vestibular diary called the DizzyQuest and an iPad-based hearing test enables evaluation of the relationship between experienced neuro-otological symptoms and hearing thresholds in daily life setting. The aim was to investigate the relationship between self-reported hearing symptoms and hearing thresholds in patients with Meniere's disease (MD), using the DizzyQuest and the iPad-based hearing test simultaneously. METHODS: The DizzyQuest was administered for 3 weeks in 21 patients. Using the experience-sampling-method (ESM), it assessed hearing loss and tinnitus severity for both ears separately. Each day after the DizzyQuest, an iPad-based hearing test was used to measure hearing thresholds. A mixed model regression analysis was performed to investigate relationships between hearing thresholds and self-reported hearing loss and tinnitus severity. RESULTS: Fifteen patients were included. Overall, pure-tone averages (PTAs) were not correlated with self-reported hearing loss severity and tinnitus. Individual differences in PTA results between both ears did not significantly influence the difference in self-reported hearing loss severity between both ears. Self-reported hearing loss and tinnitus scores were significantly higher in ears that corresponded with audiometric criteria of MD (p < 0.001). Self-reported tinnitus severity significantly increased with self-reported hearing loss severity in affected (p = 0.011) and unaffected ears (p < 0.001). CONCLUSION: Combining the DizzyQuest and iPad-based hearing test, facilitated assessment of self-reported hearing loss and tinnitus severity and their relationship with hearing thresholds, in a daily life setting. This study illustrated the importance of investigating neuro-otological symptoms at an individual level, using multiple measurements. ESM strategies like the DizzyQuest should therefore be considered in neuro-otological research.

Introducing the DizzyQuest: an app-based diary for vestibular disorders.

BACKGROUND: Most questionnaires currently used for assessing symptomatology of vestibular disorders are retrospective, inducing recall bias and lowering ecological validity. An app-based diary, administered multiple times in daily life, could increase the accuracy and ecological validity of symptom measurement. The objective of this study was to introduce a new experience sampling method (ESM) based vestibular diary app (DizzyQuest), evaluate response rates, and to provide examples of DizzyQuest outcome measures which can be used in future research. METHODS: Sixty-three patients diagnosed with a vestibular disorder were included. The DizzyQuest consisted of four questionnaires. The morning- and evening-questionnaires were administered once each day, the within-day-questionnaire 10 times a day using a semi-random time schedule, and the attack questionnaire could be completed after the occurrence of a vertigo or dizziness attack. Data were collected for 4 weeks. Response rates and loss-to-follow-up were determined. Reported symptoms in the within-day-questionnaire were compared within and between patients and subgroups of patients with different vestibular disorders. RESULTS: Fifty-one patients completed the study period. Average response rates were significantly higher than the desired response rate of > 50% (p < 0.001). The attack-questionnaire was used 159 times. A variety of neuro-otological symptoms and different disease profiles were demonstrated between patients and subgroups of patients with different vestibular disorders. CONCLUSION: The DizzyQuest is able to capture vestibular symptoms within their psychosocial context in daily life, with little recall bias and high ecological validity. The DizzyQuest reached the desired response rates and showed different disease profiles between subgroups of patients with different vestibular disorders. This is the first time ESM was used to assess daily symptoms and quality of life in vestibular disorders, showing that it might be a useful tool in this population.

The DizzyQuest: to have or not to have a vertigo attack?

BACKGROUND: The DizzyQuest, an app-based vestibular diary, provides the opportunity to capture the number and nature of vertigo attacks in daily life. To accomplish this, the DizzyQuest provides different strategies: event sampling using an attack questionnaire, and time sampling using an evening questionnaire. Objective of this study was to investigate whether the number and nature of reported vertigo attacks was comparable between the two questionnaires. METHODS: Fifty-seven patients, who reported vertigo attacks, used the DizzyQuest for on average 24 days. The number and nature (including symptoms, triggers and duration) of vertigo attacks were compared between the attack and the evening questionnaire. RESULTS: The attack questionnaire was used 192 times. In contrast, at least 749 new vertigo attacks were reported in 446 evening questionnaires. A vertigo attack was not always reported in both questionnaires during the same day. Vertigo attacks that were most likely captured by both questionnaires were not always reported the same in both questionnaires regarding triggers and duration. CONCLUSION: Event sampling using an attack questionnaire has low recall bias and, therefore, reliably captures the nature of the attack, but induces a risk of under-sampling. Time sampling using an evening questionnaire suffers from recall bias, but seems more likely to capture less discrete vertigo attacks and it facilitates registration of the absence of vertigo attacks. Depending on the clinical or research question, the right strategy should be applied and participants should be clearly instructed about the definition of a vertigo attack.

Clinical and financial aspects of cholecystectomy: laparoscopic versus open technique.

Clinical and financial aspects of laparoscopic (LC) (n = 119) and open (OC) (n = 117) cholecystectomy are compared in a retrospective study. The number and nature of perioperative complications do not differ importantly between these techniques. In favor of LC, significant differences are observed regarding the numbers of days severe pain was suffered (mean 1.7 days versus 5.4 days), the total number of days pain was suffered (mean 7.0 days versus 12.2 days), the number of postoperative days in hospital (mean 3.1 days versus 8. 8 days), the extent of perioperative monitoring performed, and the number of days before patients could return to (every day) work (mean 12.8 days versus 34.8 days). In this study total charges for LC (hospital and professional charges) are significantly lower than the total charges for OC [means, in dutch guilders (DG) were 4425 for LC versus 9215 for OC; $1 US = 1.93 DG]. The difference is the result of fewer days of postoperative hospitalization and reduced perioperative screening for LC. Furthermore, hospital charges for LC in The Netherlands (DG 3655) are less expensive than average hospital charges reported so far (US $1894 compared to $4948). For the hospital itself, however, on an annual base LC might well be more expensive than OC because of a maximum quota-annex-budgetizing system installed by the government to keep national health care costs controllable and low. In conclusion, LC has clear advantages over OC in clinical, social, and financial respects. Unjustly, the hospital does not seem to gain financial benefit from this fact.

Body fluid compartment volumes in chronically hypoxemic lambs.

Chronic hypoxemia is associated with a decreased growth rate and a decreased rate of cell division. In lambs with experimental cyanotic heart disease, the gain in body mass was decreased. In this study, we determined to what extent the lower body mass in these lambs was related to alterations in body fluid compartment volumes, specifically whether intracellular volume was decreased. Therefore, fluid compartment volumes were studied in nine lambs, after 3 to 4 wk of experimental cyanotic heart disease, and in 13 control lambs. Hypoxemic lambs had a lower arterial oxygen saturation (65 +/- 11 versus 91 +/- 2%, p < 0.001) and a higher Hb concentration (142 +/- 16 versus 101 +/- 8 g.L-1, p < 0.001). The lower body mass in hypoxemic lambs (10.5 +/- 2.3 versus 13.0 +/- 2.8 kg) could be mainly accounted for by a decrease in intracellular water volume (4.7 +/- 1.3 versus 6.6 +/- 1.5 L, p < 0.01). Total body water (753 +/- 27 versus 780 +/- 40 mL.kg-1) and extracellular water volume (307 +/- 25 versus 277 +/- 15 mL.kg-1) in hypoxemic lambs were not significantly different from those in control lambs, but intracellular water volume was decreased (445 +/- 27 versus 501 +/- 35 mL.kg-1, p < 0.01). The ratio of extracellular to intracellular water volume was higher in hypoxemic lambs (0.69 +/- 0.10 versus 0.55 +/- 0.04, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of sample takers on the cellular composition of cervical smears.

In a population-based cervical cancer screening program, the performances of five sample takers and their influence on the cellular composition of the smears and the numbers of epithelial abnormalities diagnosed were analyzed. As measured by the presence of endocervical columnar cells, there were remarkable variations in the quality of the smears between sample takers and between years of sampling. There was also a positive relationship between the presence of endocervical columnar cells in the smear and the number of epithelial abnormalities found. A lower quality of smear was reflected by a lower incidence of epithelial atypical changes found, both between sample takers and by a single sample taker over a period of time. These findings show that sample takers influence the cellular composition of smears and, therefore, the diagnostic outcome of smear screening. Their competence in executing their tasks must be frequently reviewed.