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Frontiers in Public Health 2024This work describes a sustainable and replicable initiative to optimize multi-disciplinary care and uptake of clinical best practices for patients in a pediatric...
BACKGROUND
This work describes a sustainable and replicable initiative to optimize multi-disciplinary care and uptake of clinical best practices for patients in a pediatric intensive care unit in Low/Middle Income Countries and to understand the various factors that may play a role in the reduction in child mortality seen after implementation of the Quality Improvement Initiative.
METHODS
This was a longitudinal assessment of a quality improvement program with the primary outcome of intubated pediatric patient mortality. The program was assessed 36 months following implementation of the quality improvement intervention using a -test with linear regression to control for co-variates. An Impact Pathway model was developed to describe potential pathways for improvement, and context was added with an exploratory analysis of adoption of the intervention and locally initiated interventions.
RESULTS
147 patients were included in the sustainability cohort. Comparing the initial post-implementation cohort to the sustainability cohort, the overall PICU unexpected extubations per 100 days mechanical ventilation decreased significantly from baseline (6.98) to the first year post intervention (3.52; < 0.008) but plateaued without further significant decrease in the final cohort (3.0; = 0.73), whereas the mortality decreased from 22.4 (std 0.42) to 9.5% (std 0.29): value: 0.002 (confidence intervals: 0.05;0.21). The regression model that examined age, sex, diagnosis and severity of illness (via aggregate Pediatric Risk of Mortality (PRISM) scores between epochs) yielded an adjusted R-squared (adjusting for the number of predictors) value of 0.046, indicating that approximately 4.6% of the variance in mortality was explained by the predictors included in the model. The overall significance of the regression model was supported by an F-statistic of 3.198 ( = 0.00828). age, weight, diagnosis, and severity of illness. 15 new and locally driven quality practices were observed in the PICU compared to the initial post-implementation time period. The Impact Pathway model suggested multiple unique potential pathways connecting the improved patient outcomes with the intervention components.
CONCLUSION
Sustained improvements were seen in the care of intubated pediatric patients. While some of this improvement may be attributable to the intervention, it appears likely that the change is multifactorial, as evidenced by a significant number of new quality improvement projects initiated by the local clinical team. Although currently limited by available data, the use of Driver Diagram and Impact Pathway models demonstrates several proposed causal pathways and holds potential for further elucidating the complex dynamics underlying such improvements.
Topics: Humans; Intensive Care Units, Pediatric; Quality Improvement; Male; Female; Child, Preschool; Infant; Child; Longitudinal Studies; Developing Countries; Child Mortality; Respiration, Artificial
PubMed: 38932785
DOI: 10.3389/fpubh.2024.1411681 -
Children (Basel, Switzerland) Jun 2024we aim to assess the contribution of the EarPopper device to hearing in children with middle ear effusion (MEE).
OBJECTIVES
we aim to assess the contribution of the EarPopper device to hearing in children with middle ear effusion (MEE).
METHODS
The study has three parts, including 1. tympanometry and audiometry before and six weeks after using the EarPopper to evaluate the treatment's effect over time compared to a control group; 2. tympanometry before and immediately after using the EarPopper to evaluate immediate changes in middle ear pressure (MEP); 3. length of effect 90 min after use to assess pressure fluctuations over time.
RESULTS
Part 1 was a follow-up six weeks after using the device, and the patients in the study group that completed the study showed a significant improvement in hearing threshold. The average gain in hearing threshold ranged from 9.1 dB to 14 dB compared to the control group's max improvement of 1.1 dB. In addition, MEP was significantly improved in the study group, as most Type Bs improved to Type A and C. Part 2 was the tympanometry immediately after using EarPopper and showed the majority of Type Cs turned into Type As. The majority of Type Bs remained unchanged. Part 3 was a follow-up 90 min after use; Type Cs that had improved to Type A demonstrated a decrease in pressure and return to negative pressure.
CONCLUSIONS
use of the EarPopper device for six weeks is associated with an improved hearing threshold and middle ear status.
PubMed: 38929323
DOI: 10.3390/children11060744 -
CoDAS 2024To analyze the performance of auditory speech perception (PF) after cochlear implant (CI) replacement surgery and associations with age, times of use of the first CI,...
PURPOSE
To analyze the performance of auditory speech perception (PF) after cochlear implant (CI) replacement surgery and associations with age, times of use of the first CI, deprivation, recovery and use of the second device.
METHODS
The retrospective study analyzed the medical records of 68 participants reimplanted from 1990 to 2016, and evaluated with PF performance tests, considering as a reference, the greater auditory capacity identified during the use of the first CI. Also analyzed were: Etiology of hearing loss; the reasons for the reimplantation; device brands; age range; sex; affected ear; age at first implant; time of use of the first CI, deprivation, recovery and use of the second device. The analyzes followed with the Chi-Square and Spearman, Mann-Whitney and Kruskal-Wallis tests (CI=95%; p≤0.05; Software SPSS®.v22).
RESULTS
Most were children with hearing loss due to idiopathic causes and meningitis. Abrupt stoppage of operation was the most common cause for device replacement. Most cases recovered and maintained or continued to progress in PF after reimplantation. Adults have the worst recovery capacity when compared to children and adolescents. The PF capacity showed a significant association (p≤0.05) with: age at first implant; time of use of the first and second CI.
CONCLUSION
Periodic programming and replacement of the device when indicated are fundamental for the maintenance of auditory functions. Being young and having longer use of implants represent advantages for the development of speech perception skills.
Topics: Humans; Speech Perception; Retrospective Studies; Female; Child; Male; Adolescent; Cochlear Implantation; Adult; Cochlear Implants; Child, Preschool; Young Adult; Middle Aged; Hearing Loss; Infant; Aged; Age Factors; Replantation
PubMed: 38922246
DOI: 10.1590/2317-1782/20242023220pt -
Audiology Research May 2024Outer and middle ear pathologies are known to disproportionately affect low-income countries but data is limited. We aim to quantify the prevalence rate of patients...
Outer and middle ear pathologies are known to disproportionately affect low-income countries but data is limited. We aim to quantify the prevalence rate of patients presenting with middle/outer ear pathologies at ABC Hearing Clinic and Training Centre in Lilongwe, Malawi. Audiological consultations (adult and paediatric) from 2018-2020 were reviewed for outer and middle ear pathologies. Secondary outcomes included patient type (private vs. community) compared to otoscopy findings, tympanometry findings, need for follow up, and follow up compliance. Out of 1576 patients reviewed, the proportion of abnormal cases' was 98.2%, with 41.4% being unilateral and 57.4% bilateral. Eighty-three percent presented with outer/middle ear pathologies. 68% of those presented with a pathology often associated with some degree of conductive hearing loss (occluding wax, perforation, discharge, Type B/Type C tympanogram). Average age was 29 + 0.527 years; 41.6% private and 58.2% community patients. Cerumen impaction was most common finding (51%). Higher rates of otoscopic abnormalities and type B tympanograms were noted in community vs. private patient (~40% vs. ~30%; ~70% vs. ~30%). Adherence to follow up was higher for community vs. private patients (29% vs. 17%); ~70% reported subjective improvement upon follow up. The majority required multiple interventions on follow up. Secondary follow up was recommended in 64.8%. A significant disease burden of outer and middle ear pathologies was identified. Further research is required to understand the disease burden and promote health policy.
PubMed: 38920962
DOI: 10.3390/audiolres14030041 -
Frontiers in Neuroscience 2024Sensorineural hearing loss (SNHL) can arise from a diverse range of congenital and acquired factors. Detecting it early is pivotal for nurturing speech, language, and...
INTRODUCTION
Sensorineural hearing loss (SNHL) can arise from a diverse range of congenital and acquired factors. Detecting it early is pivotal for nurturing speech, language, and cognitive development in children with SNHL. In our study, we utilized synthetic magnetic resonance imaging (SyMRI) to assess alterations in both gray and white matter within the brains of children affected by SNHL.
METHODS
The study encompassed both children diagnosed with SNHL and a control group of children with normal hearing {1.5-month-olds ( = 52) and 3-month-olds ( = 78)}. Participants were categorized based on their auditory brainstem response (ABR) threshold, delineated into normal, mild, moderate, and severe subgroups.Clinical parameters were included and assessed the correlation with SNHL. Quantitative analysis of brain morphology was conducted using SyMRI scans, yielding data on brain segmentation and relaxation time.Through both univariate and multivariate analyses, independent factors predictive of SNHL were identified. The efficacy of the prediction model was evaluated using receiver operating characteristic (ROC) curves, with visualization facilitated through the utilization of a nomogram. It's important to note that due to the constraints of our research, we worked with a relatively small sample size.
RESULTS
Neonatal hyperbilirubinemia (NH) and children with inner ear malformation (IEM) were associated with the onset of SNHL both at 1.5 and 3-month groups. At 3-month group, the moderate and severe subgroups exhibited elevated quantitative T1 values in the inferior colliculus (IC), lateral lemniscus (LL), and middle cerebellar peduncle (MCP) compared to the normal group. Additionally, WMV, WMF, MYF, and MYV were significantly reduced relative to the normal group. Additionally, SNHL-children with IEM had high T1 values in IC, and LL and reduced WMV, WMF, MYV and MYF values as compared with SNHL-children without IEM at 3-month group. LL-T1 and WMF were independent risk factors associated with SNHL. Consequently, a prediction model was devised based on LL-T1 and WMF. ROC for training set, validation set and external set were 0.865, 0.806, and 0.736, respectively.
CONCLUSION
The integration of T1 quantitative values and brain volume segmentation offers a valuable tool for tracking brain development in children affected by SNHL and assessing the progression of the condition's severity.
PubMed: 38919907
DOI: 10.3389/fnins.2024.1365141 -
Cureus May 2024Introduction The Eustachian tube regulates middle ear functions such as ventilation and pressure normalization. Eustachian tube dysfunction (ETD) is defined as the...
Introduction The Eustachian tube regulates middle ear functions such as ventilation and pressure normalization. Eustachian tube dysfunction (ETD) is defined as the failure of the Eustachian tube to maintain one or more of its functions. It is a common condition that is associated with other middle ear disorders such as cholesteatoma, tympanic membrane atelectasis, and otitis media with effusion (OME). This study aims to assess ETD prevalence and risk factors in the Qassim region. Methodology This cross-sectional study was conducted in the Qassim region of Saudi Arabia during the period from September 20 to October 10, 2023. Data were gathered via a validated, self-administered electronic questionnaire that encompasses socio-demographic information, the prevalence of ETD, and the prevalence of its various symptoms, as assessed by the Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Results Our study in Qassim, Saudi Arabia, with 467 participants reveals a high prevalence of ETD at 12.2%. The 18-25 age group dominates (50.1%), with a majority of females (66.2%). Symptom analysis using the ETDQ-7 questionnaire shows varied prevalence, with severe pain (7%) and muffled hearing (29.8%) notable. Logistic regression identifies significant predictors, including hearing loss history (odds ratio = 28.2) and smoking (odds ratio = 3.70). Specific symptoms, such as feeling blocked or underwater, significantly correlate with more severe ETD symptoms (odds ratio = 1.73). Conclusion Our study highlights a notable prevalence of ETD. Significant predictors, including hearing loss history and smoking, were identified. Specific symptoms, such as feeling blocked or underwater, were associated with more severe ETD symptoms.
PubMed: 38919244
DOI: 10.7759/cureus.61087 -
Asian Pacific Journal of Cancer... Jun 2024Exposure to noise by generation of free radicals causes oxidative stress in body. The aim of this study was the evaluation of oxidative stress in workers who have used...
BACKGROUND AND OBJECTIVE
Exposure to noise by generation of free radicals causes oxidative stress in body. The aim of this study was the evaluation of oxidative stress in workers who have used hearing protection devices during working time.
MATERIAL AND METHOD
Pressing workers (n=24) of a home appliance industry were studied using hearing protection devices to reduce noise exposure. Twenty two office staff (without exposure to noise) were considered as a control group. Two groups were matched for age, work experience and smoking. Exposure to noise was measured by dosimeter method at workstations. By obtaining 3 ml blood sample, Malondialdehyde levels, Thiol groups and total antioxidant capacity were evaluated in all subjects.
RESULTS
Exposure to sound pressure level in pressing workers by considering the noise reduction factor of the earplug was observed in 77.65 dB with minimum 75.1 dB and Maximum 81.22 dB. Plasma thiol groups (0.076 (0.041-0.119) vs (0.110 (0.076-0.197), mmol/l P =0.0001) and total antioxidant capacity (361.33± 54.65 vs 414.14± 96.82, µmol/ml P = 0.026) in pressing workers significantly decreased than control group. Pearson correlation showed significant results between exposure to noise and oxidative stress parameters.
CONCLUSION
Exposure to noise wave cause oxidative stress in different site of body. Oxidative stress is an intermediate way for different disease due to noise exposure. Reducing of noise exposure by earplug in pressing workers is not efficient protection for oxidative stress generation. Therefore, hearing protection devices are not a barrier to the harmful effects of noise in occupational exposure.
Topics: Humans; Oxidative Stress; Occupational Exposure; Adult; Male; Noise, Occupational; Case-Control Studies; Ear Protective Devices; Hearing Loss, Noise-Induced; Antioxidants; Middle Aged; Follow-Up Studies; Malondialdehyde; Female; Occupational Diseases; Industry; Prognosis
PubMed: 38918653
DOI: 10.31557/APJCP.2024.25.6.1929 -
Asian Pacific Journal of Cancer... Jun 2024Iodine intake can affect thyroid and breast cells, and urinary iodine concentration (UIC) is an effective biomarker for iodine intake.
UNLABELLED
Iodine intake can affect thyroid and breast cells, and urinary iodine concentration (UIC) is an effective biomarker for iodine intake.
OBJECTIVES
This study aimed to analyze the correlation between urinary iodine concentration in differentiated thyroid cancer (DTC) and breast cancer (BC) subjects.
METHODS
The study consisted of 80 subjects divided into case (20 DTC and 20 BC subjects) and control (40 subjects). Morning urine or spot urine was used for UIC measurement.
RESULTS
In thyroid cancer, UIC median patients and controls were 195.45 ± 133.61 µg/L and 145 ± 39.64 µg/L, respectively, with p =0.33. The UIC median of PTC subjects was significantly higher compared to FTC subjects, 227.12±130.98 μg/L versus 68.75±22.95 μg/L, p=0.00, and papillary thyroid cancer is closely related to a high iodine excretion in urine with contingency coefficient (c)=0.722. In BC patients, regardless of subtypes, breast cancer subjects showed a significantly lower iodine excretion level. The median of UIC patients and controls were 80.05 ± 38.24 µg/L and 144.25 ± 36.79 µg/L, respectively, p=0.000.
CONCLUSIONS
Iodine urine concentrations strongly correlate with the type of DTC histopathology, and in BC subjects, IUC was significantly lower compared to the control.
Topics: Humans; Female; Iodine; Thyroid Neoplasms; Breast Neoplasms; Case-Control Studies; Middle Aged; Adult; Prognosis; Male; Follow-Up Studies; Carcinoma, Papillary; Adenocarcinoma, Follicular; Thyroid Cancer, Papillary
PubMed: 38918646
DOI: 10.31557/APJCP.2024.25.6.1869 -
BMC Cancer Jun 2024Psychosocial factors and socioeconomic status have been associated with incidence, survival, and quality of life among patients with head and neck cancer. We...
BACKGROUND
Psychosocial factors and socioeconomic status have been associated with incidence, survival, and quality of life among patients with head and neck cancer. We investigated the association between different psychosocial factors, socioeconomic status, and patient delays in T3-T4 oral, oropharyngeal, and laryngeal cancer.
PATIENTS AND METHODS
We conducted a nationwide prospective questionnaire-based study (n = 203) over a 3-year period.
RESULTS
We found no association between psychosocial factors (depression, social isolation, loneliness, and cynical hostility) and patient delay. Depression was three times more common among head and neck cancer patients compared with the general Finnish population. Head and neck cancer patients had lower educational levels and employment status, and were more often current smokers and heavy drinkers.
CONCLUSIONS
Although we found no association between patient delay and psychosocial factors, patients diagnosed with a large head and neck cancer appeared to have a lower socioeconomic status and higher risk for developing depression, which should be considered in clinical practice.
Topics: Humans; Male; Female; Laryngeal Neoplasms; Middle Aged; Oropharyngeal Neoplasms; Aged; Surveys and Questionnaires; Prospective Studies; Depression; Mouth Neoplasms; Adult; Quality of Life; Finland; Social Class; Neoplasm Staging; Socioeconomic Factors; Time-to-Treatment
PubMed: 38914952
DOI: 10.1186/s12885-024-12517-x -
Ear, Nose, & Throat Journal Jun 2024Myhre syndrome (MS) is a rare genetic condition that presents with multiple genetic anomalies including cleft lip and palate and Eustachian tube dysfunction. These...
Myhre syndrome (MS) is a rare genetic condition that presents with multiple genetic anomalies including cleft lip and palate and Eustachian tube dysfunction. These patients are at a high risk for airway scarring from intubation and mucosal inflammation. Hearing loss (conductive or mixed, of varying severity) is a common comorbidity in these patients, the exact etiology of which is still unclear. We present the cases of 2 unrelated children with MS who suffered progressive mixed hearing loss from fibrosis and obliteration of the middle ear spaces. Both patients had multiple sets of ear tubes that demonstrated early extrusion. The older patient underwent bone conduction implantation at age 11 which resulted in dramatic improvement of speech recognition and interactive skills. The other younger patient demonstrates a similar trajectory but has not yet undergone implantation. Otolaryngologists should take a cautious approach to surgery of the eardrum and middle ear to avoid unnecessary induction of fibrosis in this susceptible patient population. These cases highlight a newly described etiology for hearing loss and suggest a benefit to bone conduction implantation.
PubMed: 38907583
DOI: 10.1177/01455613241256474