scholarly journals Diagnosis and Management of Depression in CRS: A Knowledge, Attitudes and Practices Survey

2020 ◽  
Author(s):  
Amarbir S. Gill ◽  
Joshua M. Levy ◽  
Machelle Wilson ◽  
E. Bradley Strong ◽  
Toby O. Steele
Keyword(s):  
Negative Impact ◽  
Hospital Setting ◽  
Cost Of Care ◽  
Screening Tools ◽  
Sinus Surgery ◽  
Prognostic Information ◽  
Attitudes And Practices ◽  
Academic Settings ◽  
Chi Squared ◽  
The Impact

Abstract Introduction Comorbid major depressive disorder (MDD) is present in up to 25% of chronic rhinosinusitis (CRS) cases and provides prognostic information for patients undergoing endoscopic sinus surgery (ESS). Clinical visits offer an opportunity to identify at-risk patients. Objective The purpose of the present study is to evaluate practice patterns among members of the American Rhinologic Society (ARS) in screening for/diagnosing MDD. Methods A 21-question survey was distributed to 1,206 members of the ARS from May 26, 2018 to June 12, 2018. The impact of demographic factors, including hospital setting, fellowship status, and experience were assessed through chi-squared analysis. Results A total of 80 members of the ARS completed the survey, yielding a response rate of 7%. Half of the respondents worked in academic settings and 43% had completed a rhinology fellowship. Twenty percent of the participants felt comfortable diagnosing or managing MDD, while only 10% of participants screened for MDD in patients with CRS. Respondents cited a lack of training (76%) and unfamiliarity with diagnostic criteria (76%) as barriers to the routine assessment of MDD. Most respondents (95%) considered comorbid psychiatric illness to negatively impact outcomes following ESS. Fellowship-trained respondents were significantly more likely to implement screening tools in their practice (p = 0.05), and believe in the negative impact of MDD on postoperative outcomes (p = 0.007), cost of care (p = 0.04) and quality of life (p = 0.047). Conclusion Amongst ARS members, 95% of the respondents consider comorbid MDD to negatively impact patient outcomes following ESS. Regardless, a large proportion of surgeons neither screen nor feel comfortable diagnosing MDD.

scholarly journals Low-Fouling Substrates for Plasmonic Sensing of Circulating Biomarkers in Biological Fluids

Biosensors ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 63
Author(s):  
Elba Mauriz
Keyword(s):  
Biological Fluids ◽  
Point Of Care ◽  
Disease Onset ◽  
Screening Tools ◽  
Circulating Biomarkers ◽  
Prognostic Information ◽  
Wide Range ◽  
Biomarker Analysis ◽  
Surface Enhanced Raman ◽  
The Impact

The monitoring of biomarkers in body fluids provides valuable prognostic information regarding disease onset and progression. Most biosensing approaches use noninvasive screening tools and are conducted in order to improve early clinical diagnosis. However, biofouling of the sensing surface may disturb the quantification of circulating biomarkers in complex biological fluids. Thus, there is a great need for antifouling interfaces to be designed in order to reduce nonspecific adsorption and prevent inactivation of biological receptors and loss of sensitivity. To address these limitations and enable their application in clinical practice, a variety of plasmonic platforms have been recently developed for biomarker analysis in easily accessible biological fluids. This review presents an overview of the latest advances in the design of antifouling strategies for the detection of clinically relevant biomarkers on the basis of the characteristics of biological samples. The impact of nanoplasmonic biosensors as point-of-care devices has been examined for a wide range of biomarkers associated with cancer, inflammatory, infectious and neurodegenerative diseases. Clinical applications in readily obtainable biofluids such as blood, saliva, urine, tears and cerebrospinal and synovial fluids, covering almost the whole range of plasmonic applications, from surface plasmon resonance (SPR) to surface-enhanced Raman scattering (SERS), are also discussed.

scholarly journals Dementia Friendly Hospital Design: Key Issues for Patients and Accompanying Persons in an Irish Acute Care Public Hospital

2019 ◽  
Vol 13 (1) ◽  
pp. 48-67 ◽  
Author(s):  
Dimitra Xidous ◽  
Tom Grey ◽  
S. P. Kennelly ◽  
Cathy McHale ◽  
Desmond O’Neill
Keyword(s):  
Older People ◽  
Negative Impact ◽  
Spatial Scales ◽  
Hospital Setting ◽  
Hospital Environment ◽  
Multiple Perspectives ◽  
Structured Interviews ◽  
People With Dementia ◽  
Person With Dementia ◽  
The Impact

Objectives: Research was conducted to investigate the impact of the hospital environment on older people including patients with dementia and their accompanying persons (APs). The article presents key research findings in the case study hospital. Background: For many patients, the hospital is challenging due to the busy, unfamiliar, and stressful nature of the environment. For a person with dementia, the hospital experience can be exacerbated by cognitive impairment and behavioral or psychological symptoms and can therefore prove to be a frightening, distressing, and disorientating place. Method: The findings are based on a stakeholder engagement process where the research team spent approximately 150 hr observing within the hospital, administered 95 questionnaires to patients and/or APs, and conducted 12 structured interviews with patients and APs. A thematic analysis was employed to analyze and generate key themes emerging from the process. Results: Themes were grouped into overarching issues and design issues across spatial scales. Conclusion: This research confirms the negative impact of the acute hospital setting on older people with cognitive impairments including dementia and delirium. The multiple perspectives captured in this study, including most importantly people with dementia, ensure that stakeholder needs can be used to inform the design of the hospital environment. The research points to the value of understanding the lived experience of the person with dementia and APs. The voices of patients, particularly persons with dementia and their APs, are a crucial element in helping hospitals to fulfill their role as caregiving and healing facilities.

scholarly journals Role of gender & age in chronic periodontal disease

2021 ◽  
Vol 6 (2) ◽  
pp. 117-125
Author(s):  
Ashish Jain ◽  
Neeta V Bhavsar
Keyword(s):  
Periodontal Disease ◽  
Hospital Setting ◽  
Screening Tools ◽  
Pocket Depth ◽  
Cross Sectional ◽  
Diagnostic Strategies ◽  
Periodontal Inflammation ◽  
Chronic Periodontal Disease ◽  
Significant Difference ◽  
The Impact

There is lot of literature suggesting a gender based heterogeneity in many human chronic diseases including periodontal disease. To analyze and compare the clinical periodontal disease parameters & serum biochemical markers of periodontal inflammation in systemically healthy age stratified adult male and female patients suffering from chronic destructive periodontal disease. Cross sectional observational study in a hospital setting A total of 300 subjects, both genders were enrolled based on predefined criteria and were categorized in 6 groups of 50 subjects each. Complete medical and dental history was taken to screen before enrollment. All subjects underwent complete periodontal examination, including evaluation of Plaque index (PI), Probing pocket depth (PPD) and Clinical attachment level (CAL), Bleeding on Probing (BOP). Blood samples were taken for analysis of inflammatory biomarkers viz interleukin (IL)-1β, osteoprotegrin (OPG), matrix metalloproteinase (MMP)- 8 & interleukin (IL)- 6. IBM SPSS STATISTICS (version 22.0) Clinical parameters of periodontal status were higher in females as compared to males except BOP. However, only PPD and CAL showed significant difference. Higher serum levels of IL-1β, OPG and Il-6 were observed in females (2.10 + 26.82, 168.18 + 49.84 , 29.17 + 99.20 pg/ml) than males (1.90 + 7.27 , 145.00 + 39.60 , (25.83 + 189.09pg/ml) respectively, but significant difference was observed only for OPG. A statistically significant higher level of MMP-8 was observed in males (3003.33 + 772.33 pg/ml) as compared to females (1398.33 + 1218.10 pg/ml). The findings of current investigation has identified significant differences in the clinical and specific biochemical mediators(IL-1β, IL-6, OPG, MMP-8) across groups and subgroups of the population To ascertain the impact of gender and age in the causation and pathogenesis of inflammatory periodontal disease, further well designed prospective investigations are needed . The study findings point towards the identification of specific biomarkers in individual subgroup/group based on age and gender. These shall pave path to develop predictive models, screening tools and early diagnostic strategies for chronic periodontal disease for Indian population.

scholarly journals Real-Time Operative Coding for Endoscopic Sinonasal Procedures: Quality Improvement in Practice

Sinusitis ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 32-44
Author(s):  
Bassem Mettias ◽  
Joshua D. Whittaker ◽  
Yujay Ramakrishnan
Keyword(s):  
Quality Improvement ◽  
Endoscopic Sinus Surgery ◽  
Human Error ◽  
Financial Impact ◽  
Sinus Surgery ◽  
Clinical Coding ◽  
Tertiary Centre ◽  
Chi Squared ◽  
The Impact ◽  
Control Firm

Objective: investigate the impact of an intraoperative coding sticker (ICS) on the accuracy of coding in endoscopic sinonasal procedures. Methods: this was a two-cycle audit evaluating the accuracy (and financial impact) of intraoperative coding of sinonasal procedures at a single tertiary centre. An ICS was introduced following consultation with the coding department. The accuracy of coding was measured before (cycle 1) and after (cycle 2) the ICS was introduced to a pilot firm and compared to a control firm. The ICS was used in 35% of the pilot firm cases. Results: the accuracy of clinical coding for endoscopic sinus surgery was 60% in the first cycle. Switching to the ICS has improved the accuracy in that firm from 50% in first cycle to 70% in the second cycle (p = 0.936; Chi-squared test). The median reimbursement for endoscopic sinus surgery was equal in both cycles of £1493.00 per patient. However, inaccurate coding resulted in £109.92 excess tariff payment in first cycle and £130.96 deficiency in the second cycle. Users of ICS reported it to be easy to use for clinicians, staff and clinical coders, whilst minimizing human error. Conclusions: The integration of the ICS improves the coding in sinonasal procedures and offers low-fidelity option alternative to live coding on the computer. The accuracy was not statistically significant in the study possibly due to the low number of observations. This can allow a precise coding standard with reliable service remuneration.

Hyperglycemia in the Hospital Setting: The Case for Improved Control among Non-Diabetics

2005 ◽  
Vol 39 (3) ◽  
pp. 492-501 ◽  
Author(s):  
Therese M Conner ◽  
Kelly R Flesner-Gurley ◽  
Jamie C Barner
Keyword(s):  
Glucose Control ◽  
Negative Impact ◽  
Data Extraction ◽  
Hospital Setting ◽  
Data Sources ◽  
Diabetes Diagnosis ◽  
Lengths Of Stay ◽  
Randomized Controlled Studies ◽  
Risk Of Mortality ◽  
The Impact

OBJECTIVE: To review studies on the role of hyperglycemia in acutely ill adults, regardless of diabetes diagnosis, and the impact of glucose control on health outcomes. DATA SOURCES: Searches on Ovid MEDLINE, Ovid Evidence-Based Medicine (EBM), and PubMed MEDLINE, limited to articles written in English, trials conducted on adult subjects, and material published between 1994 and April 2004. Search words included the major MeSH term hyperglycemia and title words glucose, hyperglycemia/hyperglycemic, or insulin therapy, with text words admission, hospitalized, inhospital, or inpatient. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated, and all information deemed relevant was included in this review. DATA SYNTHESIS: Hyperglycemia, even in patients without diabetes, has been shown to be detrimental among inpatients in medical and surgical units, as well as in critical care. A review of 25 outcomes studies indicated that the majority of research on this topic used retrospective or prospective cohort designs; only 2 were conducted as randomized controlled studies. In general, the findings demonstrated negative impact on outcomes among various patient populations with hyperglycemia including increased lengths of stay, health complications, utilization of resources, and risk of mortality. CONCLUSIONS: Studies report that hyperglycemia is a common but detrimental condition and that better control in the hospital setting decreases short- and long-term risk of mortality, illness complications, hospital lengths of stay, and healthcare costs. Increased efforts to treat hyperglycemia and screen for diabetes are needed in the hospital setting. Future studies on cost-effective approaches to glucose control are recommended.

scholarly journals The effects of smoking on quality of life recovery after surgery for chronic rhinosinusitis

2014 ◽  
Vol 52 (4) ◽  
pp. 341-347
Author(s):  
Michael Katotomichelakis ◽  
Efthimios Simopoulos ◽  
Gregory Tripsianis ◽  
Nan Zhang ◽  
Gerasimos Danielides ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Rhinosinusitis ◽  
Negative Impact ◽  
Short Form ◽  
Depression Scale ◽  
Sinus Surgery ◽  
Pre Treatment ◽  
Zung Depression Scale ◽  
The Impact

Background: The effects of smoking on quality of life (QoL) results in chronic rhinosinusitis (CRS) patients still remain a matter of debate. Objective: To explore the impact of smoking on QoL and determine how quantity of daily smoking and duration affect QoL results after endoscopic sinus surgery (ESS). Methodology: Patients with CRS were prospectively asked to evaluate their QoL pre- and after ESS. All subjects' QoL was evaluated by means of validated questionnaires either specific (Questionnaire of Olfactory Deficits), for assessing psychology (Zung Anxiety Scale, State -Trait Anxiety Inventory, Zung Depression Scale and Beck Depression Inventory) or generic (Short-Form-36). Smoking habits were expressed in pack-years. Results: No statistically significant differences were found in the pre-treatment scores in any of the questionnaires between smokers and non smokers. Post-operatively, all QoL questionnaires' results were significantly improved among both groups, although non smokers exhibited significantly greater improvement compared to smokers. There was a negative impact of the number of pack-years on the changes of QoL results; less improvement was observed as the number of pack-years was increasing. Conclusion: Although smoking did not improve preoperative QoL results and proved not to be a contra-indication factor for ESS regarding QoL, smokers presented worse treatment outcomes. Quantity and duration of smoking were significantly associated with worse postoperative results in all QoL questionnaires.

Screening, Assessment, and Diagnosis of Mood and Anxiety Disorders During Pregnancy and the Postpartum Period

2014 ◽  
Author(s):  
Kimberly J. Hart ◽  
Heather A. Flynn
Keyword(s):  
Anxiety Disorders ◽  
Negative Impact ◽  
Positive Impact ◽  
Well Being ◽  
Adverse Outcomes ◽  
Screening Tools ◽  
Screening Programs ◽  
Mood And Anxiety Disorders ◽  
The Impact ◽  
Screening Measures

Mood and anxiety disorders are highly prevalent in perinatal samples, affecting as many as 20% of childbearing women (Gavin et al., 2005). In an effort to prevent adverse outcomes associated with perinatal mood and anxiety disorders, researchers and clinicians have advocated routine screening during the perinatal period (NRC, 2009). Although, there are several screening measures for depression, many of which have been used or validated in perinatal populations, few screening tools have been developed specifically for or validated in perinatal samples for bipolar disorder or anxiety disorders. Despite the ongoing need for brief, accurate, and easily administered screening measures, it seems clear that perinatal mood and anxiety screening is associated with substantial improvement in rate of detection (Georgiopoulous et al., 1999; Georgiopoulos, Bryan, Wollan, and Yawn, 2001; Gilbody, Sheldon, and House, 2008). However, in the absence of systematic protocols to ensure further assessment, treatment, and follow-up, screening is unlikely to have a positive impact on depression-associated morbidity (Gjerdingen, Katon, and Rich, 2008; Gilbody et al., 2008; Miller et al., 2012; NRC, 2009). Preliminary evidence suggests that screening for perinatal mood and anxiety disorders, when embedded within larger systems to ensure comprehensive assessment, connection to treatment, and regular monitoring, has the potential to improve outcomes for women and their families. The question of whether screening programs can ultimately decrease depression-associated morbidity and prevent adverse outcomes cannot be answered given the existing research base (Myers et al., 2013). Although much is left to be understood about perinatal screening for mood and anxiety disorders, the impact of this research lies in potential for reducing negative maternal outcomes as well as for prevention of the negative impact of perinatal depression on the health and well-being of babies born to depressed or anxious mothers.

Urbanization of fauna on the example of marsh frog (Pelophylax ridibundus)

2015 ◽  
Vol 26 (3-4) ◽  
pp. 116-123
Author(s):  
A. P. Korzh ◽  
T. V. Zahovalko
Keyword(s):  
Urban Areas ◽  
Cognitive Modeling ◽  
Negative Impact ◽  
Natural Populations ◽  
Cellular Level ◽  
Anthropogenic Factors ◽  
Migration Routes ◽  
Corrective Effect ◽  
The Impact ◽  
The City

Recently, the number of published works devoted to the processes of synanthropization of fauna, is growing like an avalanche, which indicates the extreme urgency of this theme. In our view, the process of forming devices to coexist with human and the results of his life reflects the general tandency of the modern nature evolution. Urbanization is characteristic for such a specific group of animals like amphibians, the evidence of which are numerous literature data. Many researchers use this group to assess the bioindicative quality of the environment. For this aim a variety of indicators are used: from the cellular level of life of organization up to the species composition of the group in different territories. At the same time, the interpretation of the results is not always comparable for different areas and often have significantly different interpretations by experts. Urban environment, primarily due to the contamination is extremely aggressive to amphibians. As a consequence, the urban populations of amphibians may be a change in the demographic structure, affecting the reproductive ability of the population, the disappearance of the most sensitive species or individuals, resizing animals, the appearance of abnormalities in the development, etc. At the same time play an important amphibians in the ecosystems of cities, and some species in these conditions even feel relatively comfortable. Therefore, it is interesting to understand the mechanisms of self-sustaining populations of amphibians in urban environments. To assess the impact of natural and anthropogenic factors on the development of amphibian populations were used cognitive modeling using the program Vensim PLE. Cognitive map of the model for urban and suburban habitat conditions were the same. The differences concerned the strength of connections between individual factors (migration, fertility, pollution) and their orientation. In general, factors like pollution, parasites, predators had negative impact on the population, reducing its number. The birth rate, food and migration contributed to raising number of individuals. Some of the factors affected on the strength to of each other as well: the majority of the factors affected the structure of the population, had an influence on the fertility. Thanks to it the model reflects the additive effect of complex of factors on the subsequent status of the population. Proposed and analyzed four scenarios differing strength and duration of exposure. In the first scenario, a one-time contamination occurs and not subsequently repeated. The second and third scenario assumes half board contamination, 1 year (2 scenario) and two years (scenario 3). In the fourth scenario, the pollution affected the population of amphibians constantly. In accordance with the results of simulation, much weaker than the natural populations respond to pollution - have them as an intensive population growth and its disappearance at constant pollution is slow. Changes to other parameters of the model showed that this pollution is the decisive factor -only the constant action leads to a lethal outcome for the populations. All other components of the model have a corrective effect on the population dynamics, without changing its underlying trand. In urban areas due to the heavy impact of pollution maintaining the population is only possible thanks to the migration process – the constant replenishment of diminishing micropopulations of natural reserves. This confirms the assumption that the form of existence metapopulations lake frog in the city. In order to maintain the number of amphibians in urban areas at a high level it is necessary to maintain existing migration routes and the creation of new ones. Insular nature of the placement of suitable habitats in urban areas causes the metapopulation structure of the types of urbanists. Therefore, the process of urbanization is much easier for those species whicht are capable of migration in conditions of city. In the initial stages of settling the city micropopulationis formed by selective mortality of the most susceptible individuals to adverse effects. In future, maintaining the categories of individuals is provided mainly due to migration processes metapopulisation form of the species of existence is supported). It should be noted that the changes in the previous levels are always saved in future. In the case of reorganizations of individuals we of morphology can assume the existence of extremely adverse environmental conditions that threaten the extinction of the micropopulations. 

Modernisation of Higher Education – Willful Action or Wishful Thinking? The Case of Bulgaria

2020 ◽  
Vol 8 (3) ◽  
pp. 3-17
Author(s):  
Elena Blagoeva
Keyword(s):  
Higher Education ◽  
Economic Crisis ◽  
Negative Impact ◽  
National Level ◽  
Sustainable Growth ◽  
Research Approach ◽  
Case Study Methodology ◽  
The Impact ◽  
The Eu

The impact of the last global economic crisis (2008) on the European economy put a strain on higher education (HE), yet it also pushed the sector towards intensive reforms and improvements. This paper focuses on the “Strategy for the Development of Higher Education in the Republic of Bulgaria 2014-2020”. With a case study methodology, we explore the strategic endeavours of the Bulgarian government to comply with the European directions and to secure sustainable growth for the HE sector. Our research question is ‘How capable is the Bulgarian HE Strategy to overcome the economic and systemic restraints of Bulgarian higher education?’. Because the development of strategies for HE within the EU is highly contextual, a single qualitative case study was chosen as the research approach. HE institutions are not ivory towers, but subjects to a variety of external and internal forces. Within the EU, this is obviated by the fact that Universities obtain their funds from institutions such as governments, students and their families, donors, as well as EU-level programmes. Therefore, to explore how these pressures interact to affect strategic action on national level, the case method is well suited as it enabled us to study the phenomena thoroughly and deeply. The paper suggests the actions proposed within the Strategy have the potential to overcome the delay, the regional isolation and the negative impact of the economic crisis on the country. Nevertheless, the key elements on which the success or failure of this Strategy hinges are the control mechanisms and the approach to implementation. Shortcomings in these two aspects of strategic actions in HE seem to mark the difference between gaining long-term benefits and merely saving face in front of international institutions.

Has Aid Helped in Pakistan?

1997 ◽  
Vol 36 (4II) ◽  
pp. 947-957 ◽  
Author(s):  
Shahrukh Rafi Khan
Keyword(s):  
Economic Growth ◽  
Negative Impact ◽  
Negative Association ◽  
Causal Impact ◽  
The Impact ◽  
Over Time

This paper has a two-fold objective: first, to examine the terms on which Pakistan receives aid and whether its debt situation is sustainable, and second, to examine the impact of aid and debt on economic growth. It is found that there is little encouraging that can be said about how the terms on which Pakistan has received aid over time have changed, and its current debt situation is not sustainable. Also reported is the analysis done elsewhere which shows that aid has a negative (Granger) causal impact on GDP, and aid has a robust negative impact on economic growth after controlling for supplyside shocks. We provide various reasons for this negative association.

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