“What's Going on With My Ears?”: Some Reflections on Managing Uncertainty in the Audiology Consultation

2020 ◽  
Vol 29 (3) ◽  
pp. 1-9
Author(s):  
Jennifer Watermeyer ◽  
Amisha Kanji ◽  
Liora Brom
Keyword(s):  
Research Note ◽  
Patient Treatment ◽  
Routine Practice ◽  
Management Options ◽  
Data Set ◽  
Clinical Encounters ◽  
Resistant Tuberculosis ◽  
Semistructured Interviews ◽  
Uncertainty Management Theory

Purpose Feedback sessions after audiology consultations predominantly involve information counseling or patient education, where the patient is informed about their hearing status and possible management options. Effective communication is vital to ensure that information about the hearing impairment, recommendations, and/or management options is appropriately provided and understood by patients and that patient needs and expectations from the session are met. This research note reports on an exploratory study that sought to describe communication in follow-up audiological consultations within a context where ototoxicity monitoring is routine practice. Method Six interactions between patients and audiologists were video-recorded at an in-patient treatment facility for drug-resistant tuberculosis in Johannesburg and analyzed using a sociolinguistic approach. Semistructured interviews were also conducted with participants and analyzed using content analysis. Results These interactions differed considerably to other audiology consultations we have analyzed in terms of aspects such as the length of the interaction and the type of information given to patients. We observed a substantial amount of mitigative, vague, and exaggerated language in these interactions. Conclusions In this research note, we offer some reflections on this data set using a lens of uncertainty management theory and explore factors within the broader context that may contribute to the interactional features observed in the current study. Overall findings suggest the need for clinicians to be trained to embrace and address uncertainty rather than avoid it within challenging clinical encounters.

scholarly journals Intermittent treatment interruption and its effect on multidrug resistant tuberculosis treatment outcome in Ethiopia

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Habteyes H. Tola ◽  
Kourosh Holakouie-Naieni ◽  
Mohammad A. Mansournia ◽  
Mehdi Yaseri ◽  
Ephrem Tesfaye ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Treatment Interruption ◽  
Multidrug Resistant ◽  
Considerable Proportion ◽  
Adjusted Risk ◽  
Successful Treatment Outcome ◽  
Resistant Tuberculosis ◽  
Unsuccessful Treatment ◽  
Poor Treatment Outcome

AbstractTreatment interruption is one of the main risk factors of poor treatment outcome and occurrence of additional drug resistant tuberculosis. This study is a national retrospective cohort study with 10 years follow up period in MDR-TB patients in Ethiopia. We included 204 patients who had missed the treatment at least for one day over the course of the treatment (exposed group) and 203 patients who had never interrupted the treatment (unexposed group). We categorized treatment outcome into successful (cured or completed) and unsuccessful (lost to follow up, failed or died). We described treatment interruption by the length of time between interruptions, time to first interruption, total number of interruption episodes and percent of missed doses. We used Poisson regression model with robust standard error to determine the association between treatment interruption and outcome. 82% of the patients interrupted the treatment in the first six month of treatment period, and considerable proportion of patients demonstrated long intervals between two consecutive interruptions. Treatment interruption was significantly associated with unsuccessful treatment outcome (Adjusted Risk Ratio (ARR) = 1.9; 95% CI (1.4–2.6)). Early identification of patients at high risk of interruption is vital in improving successful treatment outcome.

scholarly journals SuperWASP variable stars: classifying light curves using citizen science

2021 ◽  
Vol 502 (1) ◽  
pp. 1299-1311
Author(s):  
Heidi B Thiemann ◽  
Andrew J Norton ◽  
Hugh J Dickinson ◽  
Adam McMaster ◽  
Ulrich C Kolb
Keyword(s):  
Variable Stars ◽  
Eclipsing Binaries ◽  
Light Curves ◽  
Data Set ◽  
Resultant Data ◽  
Sky Survey ◽  
Short Period ◽  
Contact Binaries ◽  
Analysis Of Results

ABSTRACT We present the first analysis of results from the SuperWASP variable stars Zooniverse project, which is aiming to classify 1.6 million phase-folded light curves of candidate stellar variables observed by the SuperWASP all sky survey with periods detected in the SuperWASP periodicity catalogue. The resultant data set currently contains >1 million classifications corresponding to >500 000 object–period combinations, provided by citizen–scientist volunteers. Volunteer-classified light curves have ∼89 per cent accuracy for detached and semidetached eclipsing binaries, but only ∼9 per cent accuracy for rotationally modulated variables, based on known objects. We demonstrate that this Zooniverse project will be valuable for both population studies of individual variable types and the identification of stellar variables for follow-up. We present preliminary findings on various unique and extreme variables in this analysis, including long-period contact binaries and binaries near the short-period cut-off, and we identify 301 previously unknown binaries and pulsators. We are now in the process of developing a web portal to enable other researchers to access the outputs of the SuperWASP variable stars project.

scholarly journals Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013–2018

2021 ◽  
Vol 18 (9) ◽  
pp. 4663
Author(s):  
Khasan Safaev ◽  
Nargiza Parpieva ◽  
Irina Liverko ◽  
Sharofiddin Yuldashev ◽  
Kostyantyn Dumchev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
National Level ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Loss To Follow Up ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

scholarly journals Perspectives and experiences of people who were randomly assigned to wait-and-see approach in a gluteal tendinopathy trial: a qualitative follow-up study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e044934
Author(s):  
Melanie Louise Plinsinga ◽  
Rebecca Mellor ◽  
Jenny Setchell ◽  
Kelsie Ford ◽  
Leonard Lynch ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Corticosteroid Injection ◽  
Imaging Diagnosis ◽  
Parallel Group ◽  
Data Collection And Analysis ◽  
Gluteal Tendinopathy ◽  
Semistructured Interviews ◽  
Registration Number ◽  
Wait And See

ObjectiveTo explore participants’ perspectives on, and experiences of, being assigned to a wait-and-see arm of a gluteal tendinopathy trial.DesignDescriptive qualitative.SettingGeneral community in Brisbane and Melbourne, Australia.ParticipantsFifteen participants who had been randomly allocated to the wait-and-see group in a recent parallel group superiority clinical trial. That trial compared the wait-and-see approach to a physiotherapist-led education plus exercise approach, and an ultrasound-guided corticosteroid injection. The wait-and-see approach involved one physiotherapy session in which participants received reassurance, general advice and encouragement to stay active for the management of gluteal tendinopathy.Data collection and analysisSemistructured interviews were conducted by four interviewers in person or over the internet, audio recorded and transcribed verbatim. Transcripts were coded and data analysed using an inductive thematic approach.ResultsFive themes were extracted from the interview transcripts: (1) Feeling disenfranchised by being assigned to a wait-and-see approach; (2) the importance of having a clinical and imaging diagnosis during screening for inclusion into the clinical trial; (3) feelings regarding the effectiveness of the approach; (4) the convenient and easy to follow nature of the wait-and-see approach and (5) the connotation of wait-and-see not always being perceived as an intervention.ConclusionsParticipants found the wait-and-see approach convenient and easy to follow, yet almost always felt disenfranchised that nothing was being done. Participants highlighted the importance of a definite clinical and imaging diagnosis.Trial registration numberACTRN12612001126808; Post-results.

Development and Validation of a Cognitive Reserve Index in HIV

2021 ◽  
pp. 1-9
Author(s):  
Navaldeep Kaur ◽  
Lesley K. Fellows ◽  
Marie-Josée Brouillette ◽  
Nancy Mayo
Keyword(s):  
Cognitive Reserve ◽  
Study Entry ◽  
Video Gaming ◽  
Everyday Functioning ◽  
Data Set ◽  
Multiple Indicators ◽  
And Performance ◽  
Competitive Games ◽  
Development And Validation

Abstract Objectives: In the neuroHIV literature, cognitive reserve has most often been operationalized using education, occupation, and IQ. The effects of other cognitively stimulating activities that might be more amenable to interventions have been little studied. The purpose of this study was to develop an index of cognitive reserve in people with HIV, combining multiple indicators of cognitively stimulating lifetime experiences into a single value. Methods: The data set was obtained from a Canadian longitudinal study (N = 856). Potential indicators of cognitive reserve captured at the study entry included education, occupation, engagement in six cognitively stimulating activities, number of languages spoken, and social resources. Cognitive performance was measured using a computerized test battery. A cognitive reserve index was formulated using logistic regression weights. For the evidence on concurrent and predictive validity of the index, the measures of cognition and self-reported everyday functioning were each regressed on the index scores at study entry and at the last follow-up [mean duration: 25.9 months (SD 7.2)], respectively. Corresponding regression coefficients and 95% confidence intervals (CIs) were computed. Results: Professional sports [odds ratio (OR): 2.9; 95% CI 0.59–14.7], visual and performance arts (any level of engagement), professional/amateur music, complex video gaming and competitive games, and travel outside North America were associated with higher cognitive functioning. The effects of cognitive reserve on the outcomes at the last follow-up visit were closely similar to those at study entry. Conclusion: This work contributes evidence toward the relative benefit of engaging in specific cognitively stimulating life experiences in HIV.

scholarly journals Efficacy and Tolerability after Unusually Low Doses of Dasatinib in Chronic Myeloid Leukemia Patients Intolerant to Standard-Dose Dasatinib Therapy

2010 ◽  
Vol 4 ◽  
pp. CMO.S6413 ◽  
Author(s):  
Mariana Serpa ◽  
Sabri S. Sanabani ◽  
Israel Bendit ◽  
Fernanda Seguro ◽  
Flávia Xavier ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Standard Dose ◽  
Chronic Phase ◽  
Patient Treatment ◽  
Hematological Toxicity ◽  
Drug Discontinuation ◽  
Once Daily ◽  
Starting Dose

We report our experience in 4 patients with chronic myeloid leukemia (CML) who had discontinued imatinib as a result of adverse events and had switched to dasatinib. The chronic phase ( n 2) and accelerated phase ( n 2) CML patients received dasatinib at starting dose of 100 and 140 mg once daily, respectively. Reappearance of hematological toxicity was observed in 3 patients and pancreatitis in one patient. Treatment was given at a lower dose and patients were followed. The median follow-up was 13 months and the median dose of dasatinib until achievement of complete cytogenetic remission (CCyR) was 60 mg daily (range = 20 to 120 mg). All four patients had achieved CCyR at a median of 4 months (range = 3 to 5 months) and among them, three had also achieved major molecular remission. We conclude that low-dose dasatinib therapy in intolerant patients appears safe and efficacious and may be tried before drug discontinuation.

Lymphoscintigraphy in clinical routine practice: Reproducibility and accuracy in melanoma patients with a long-term follow-up

2014 ◽  
Vol 40 (1) ◽  
pp. 55-60 ◽  
Author(s):  
G.C. Vitali ◽  
G. Trifirò ◽  
M. Zonta ◽  
E. Pennacchioli ◽  
L. Santoro ◽  
...  
Keyword(s):  
Routine Practice ◽  
Clinical Routine ◽  
Long Term Follow Up ◽  
Melanoma Patients

scholarly journals Causal inference with multiple concurrent medications: A comparison of methods and an application in multidrug-resistant tuberculosis

2018 ◽  
Vol 28 (12) ◽  
pp. 3534-3549 ◽  
Author(s):  
Arman Alam Siddique ◽  
Mireille E Schnitzer ◽  
Asma Bahamyirou ◽  
Guanbo Wang ◽  
Timothy H Holtz ◽  
...  
Keyword(s):  
Propensity Score ◽  
Simulation Study ◽  
Antimicrobial Agents ◽  
Treatment Success ◽  
Likelihood Estimation ◽  
Multidrug Resistant ◽  
Patient Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Propensity Score Adjustment

This paper investigates different approaches for causal estimation under multiple concurrent medications. Our parameter of interest is the marginal mean counterfactual outcome under different combinations of medications. We explore parametric and non-parametric methods to estimate the generalized propensity score. We then apply three causal estimation approaches (inverse probability of treatment weighting, propensity score adjustment, and targeted maximum likelihood estimation) to estimate the causal parameter of interest. Focusing on the estimation of the expected outcome under the most prevalent regimens, we compare the results obtained using these methods in a simulation study with four potentially concurrent medications. We perform a second simulation study in which some combinations of medications may occur rarely or not occur at all in the dataset. Finally, we apply the methods explored to contrast the probability of patient treatment success for the most prevalent regimens of antimicrobial agents for patients with multidrug-resistant pulmonary tuberculosis.

A Literature Review of Medical Record Keeping by Foreign Medical Teams in Sudden Onset Disasters

2015 ◽  
Vol 30 (2) ◽  
pp. 216-222 ◽  
Author(s):  
Anisa J. N. Jafar ◽  
Ian Norton ◽  
Fiona Lecky ◽  
Anthony D. Redmond
Keyword(s):  
Literature Review ◽  
Medical Record ◽  
Medical Records ◽  
Sudden Onset ◽  
World Health ◽  
Publication Type ◽  
Data Set ◽  
Record Keeping ◽  
Medical Teams

AbstractBackgroundMedical records are a tenet of good medical practice and provide one method of communicating individual follow-up arrangements, informing research data, and documenting medical intervention.MethodsThe objective of this review was to look at one source (the published literature) of medical records used by foreign medical teams (FMTs) in sudden onset disasters (SODs). The published literature was searched systematically for evidence of what medical records have been used by FMTs in SODs.FindingsThe style and content of medical records kept by FMTs in SODs varied widely according to the published literature. Similarly, there was great variability in practice as to what happens to the record and/or the data from the record following its use during a patient encounter. However, there was a paucity of published work comprehensively detailing the exact content of records used.InterpretationWithout standardization of the content of medical records kept by FMTs in SODs, it is difficult to ensure robust follow-up arrangements are documented. This may hinder communication between different FMTs and local medical teams (LMTs)/other FMTs who may then need to provide follow-up care for an individual. Furthermore, without a standard method of reporting data, there is an inaccurate picture of the work carried out. Therefore, there is not a solid evidence base for improving the quality of future response to SODs. Further research targeting FMTs and LMTs directly is essential to inform any development of an internationally agreed minimum data set (MDS), for both recording and reporting, in order that FMTs can reach the World Health Organization (WHO) standards for FMT practice.JafarAJN, NortonI, LeckyF, RedmondAD. A literature review of medical record keeping by foreign medical teams in sudden onset disasters. Prehosp Disaster Med. 2015;30(2):1-7.

scholarly journals What is New on Thyroid Cancer Biomarkers

2008 ◽  
Vol 3 ◽  
pp. BMI.S669 ◽  
Author(s):  
Rosaria M. Ruggeri ◽  
Alfredo Campennì ◽  
Sergio Baldari ◽  
Francesco Trimarchi ◽  
Maria Trovato
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Needle Aspiration ◽  
Follicular Epithelium ◽  
Routine Practice ◽  
Appropriate Treatment ◽  
Follicular Lesions ◽  
Needle Aspiration Cytology ◽  
Well Differentiated

Thyroid cancer harbours in about 5% of thyroid nodules. The majority of them are well-differentiated cancers originating from the follicular epithelium, and are subdivided into papillary and follicular carcinomas. Undifferentiated carcinomas and medullary thyroid carcinomas arising from C cells are less common. Although most thyroid nodules are benign, distinguishing thyroid cancer from benign lesions is crucial for an appropriate treatment and follow-up. The fine needle aspiration cytology (FNAC) allows the diagnosis of nature of thyroid nodules in the majority of cases. However, FNAC has some limitations, particularly in the presence of follicular lesions which can appear dubious in rare instances even at histology. In an effort to improve diagnostic accuracy and offer new prognostic criteria, several immunohistochemical and molecular markers have been proposed. However, most of them have to be validated on large series before being used in routine practice.

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