36 A Randomised Trial to Compare How Undergraduates Diagnose Common Ear Pathology Using A Smartphone Otoscope and Standard Otoscope in A Simulated Setting

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Schuster-Bruce ◽  
A Ali ◽  
M Van ◽  
J Rogel-Salazar ◽  
E Ofo ◽  
...  
Keyword(s):  
Middle Ear ◽  
Correct Diagnosis ◽  
Randomised Trial ◽  
Intervention Group ◽  
Smart Phone ◽  
Standard Group ◽  
Medical Careers ◽  
Medical Undergraduates ◽  
Future Learning ◽  
Didactic Presentation

Abstract Introduction Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate’s confidence to perform otoscopy is reported as low. This study aimed to evaluate whether a smartphone-otoscope could enhance medical undergraduates recognition of common ear pathology. Method 52 medical students were randomised into a standard group (traditional otoscope) and an intervention group (smartphone-otoscope). Following a short didactic presentation, participants were asked to diagnose four simulated pathologies. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope. Results The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs 39%, p = <0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone-otoscope was preferential for their learning. The same number expressed they want to use it in future learning. The remainder were indifferent. Conclusions The smart-phone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.

Middle ear tuberculosis - clinical case

ORL ro ◽  
2016 ◽  
Vol 2 (1) ◽  
pp. 12-14
Author(s):  
A. Sandul ◽  
M. Buracovschi ◽  
N. Buracovschi
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Human Population ◽  
Clinical Case ◽  
Correct Diagnosis ◽  
Tuberculous Otitis Media ◽  
Type V

Tuberculosis is one of the oldest pathologies that affect human population, being a significant cause of morbidity/mortality in several countries. Middleear tuberculosis is a rare pathology, often misdiagnosed because of an atipic evolution, as a result leading to severe complications. This paper presents a case of tuberculous otitis media complicated with facial nerveparalysis House Brackmann type V in a patient who underwent multiple middleear surgeries before correct diagnosis was established.  

scholarly journals Hypotension in Preterm Infants (HIP) randomised trial

2021 ◽  
pp. fetalneonatal-2020-320241
Author(s):  
Eugene M Dempsey ◽  
Keith J Barrington ◽  
Neil Marlow ◽  
Colm Patrick Finbarr O'Donnell ◽  
Jan Miletin ◽  
...  
Keyword(s):  
Brain Injury ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Intraventricular Haemorrhage ◽  
Standard Group ◽  
Double Blind ◽  
Group Assignment ◽  
Standard Management ◽  
Postmenstrual Age ◽  
Registration Number

ObjectiveTo determine whether restricting the use of inotrope after diagnosis of low blood pressure (BP) in the first 72 hours of life affects survival without significant brain injury at 36 weeks of postmenstrual age (PMA) in infants born before 28 weeks of gestation.DesignDouble-blind, placebo-controlled randomised trial. Caregivers were masked to group assignment.Setting10 sites across Europe and Canada.ParticipantsInfants born before 28 weeks of gestation were eligible if they had an invasive mean BP less than their gestational age that persisted for ≥15 min in the first 72 hours of life and a cerebral ultrasound free of significant (≥ grade 3) intraventricular haemorrhage.InterventionParticipants were randomly assigned to saline bolus followed by either a dopamine infusion (standard management) or placebo (5% dextrose) infusion (restrictive management).Primary outcomeSurvival to 36 weeks of PMA without severe brain injury.ResultsThe trial terminated early due to significant enrolment issues (7.7% of planned recruitment). 58 infants were enrolled between February 2015 and September 2017. The two groups were well matched for baseline variables. In the standard group, 18/29 (62%) achieved the primary outcome compared with 20/29 (69%) in the restrictive group (p=0.58). Additional treatments for low BP were used less frequently in the standard arm (11/29 (38%) vs 19/29 (66%), p=0.038).ConclusionThough this study lacked power, we did not detect major differences in clinical outcomes between standard or restrictive approach to treatment. These results will inform future studies in this area.Trial registration numberNCT01482559, EudraCT 2010-023988-17.

scholarly journals Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial

Heart Asia ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. e011201
Author(s):  
Yotsawee Chotechuang ◽  
Arintaya Phrommintikul ◽  
Srun Kuanprasert ◽  
Roungtiva Muenpa ◽  
Jayanton Patumanond ◽  
...  
Keyword(s):  
Randomised Trial ◽  
Intervention Group ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Intermediate Risk ◽  
Successful Therapy ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
Delayed Group ◽  
Coronary Events

BackgroundThe benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK.MethodsWe randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at Lampang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke).ResultsOne hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054).ConclusionsThe delayed coronary intervention (>24 hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention.Trial registration numberNCT02131103.

scholarly journals Sustained discontinuation of infliximab with a raising-dose strategy after obtaining remission in patients with rheumatoid arthritis: the RRRR study, a randomised controlled trial

2019 ◽  
Vol 79 (1) ◽  
pp. 94-102
Author(s):  
Yoshiya Tanaka ◽  
Koji Oba ◽  
Takao Koike ◽  
Nobuyuki Miyasaka ◽  
Tsuneyo Mimori ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Treatment Group ◽  
Treatment Strategy ◽  
Activity Index ◽  
Randomised Trial ◽  
Standard Group ◽  
Sustained Remission ◽  
Inadequate Response ◽  
Baseline Serum ◽  
Tnf Α

ObjectivesThe aim of this study is to determine whether the ‘programmed’ infliximab (IFX) treatment strategy (for which the dose of IFX was adjusted based on the baseline serum tumour necrosis factor α (TNF-α)) is beneficial to induction of clinical remission after 54 weeks and sustained discontinuation of IFX for 1 year.MethodsIn this multicentre randomised trial, patients with IFX-naïve rheumatoid arthritis with inadequate response to methotrexate were randomised to two groups; patients in programmed treatment group received 3 mg/kg IFX until week 6 and after 14 weeks the dose of IFX was adjusted based on the baseline levels of serum TNF-α until week 54; patients in the standard treatment group received 3 mg/kg of IFX. Patients who achieved a simplified disease activity index (SDAI) ≤3.3 at week 54 discontinued IFX. The primary endpoint was the proportion of patients who sustained discontinuation of IFX at week 106.ResultsA total of 337 patients were randomised. At week 54, 39.4% (67/170) in the programmed group and 32.3% (54/167) in the standard group attained remission (SDAI ≤3.3). At week 106, the 1-year sustained discontinuation rate was not significantly different between two groups; the programmed group 23.5% (40/170) and the standard group 21.6% (36/167), respectively (2.2% difference, 95% CI −6.6% to 11.0%; p=0.631). Baseline SDAI <26.0 was a statistically significant predictor of the successfully sustained discontinuation of IFX at week 106.ConclusionProgrammed treatment strategy did not statistically increase the sustained remission rate after 1 year discontinuation of IFX treatment.

Efficacy of medical treatment as an adjunct to surgery in the treatment of secretory otitis media

1986 ◽  
Vol 100 (12) ◽  
pp. 1347-1350 ◽  
Author(s):  
T. H. J. Lesser ◽  
M. I. Clayton ◽  
D. Skinner
Keyword(s):  
Medical Treatment ◽  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Randomised Trial ◽  
Control Group ◽  
Middle Ear Effusion ◽  
Secretory Otitis Media ◽  
Ear Effusion

AbstractIn a pilot controlled randomised trial of 38 children who had bilateral secretory otitis media, with effusion demonstrated at operation, we compared the efficacy of a six-week course of an oral decongestant—antihistamine combination and a mucolytic preparation with a control group in preventing the presence of middle-ear effusion six weeks after myringotomy and adenoidectomy. The mucolytic preparation decreased the presence of middle-ear effusion when compared to the decongestant-antihistamine combination and the control group (p=0.06).

scholarly journals Food Choices of Adolescents and Testing the Efficacy of Smart Phone Aided Nutrition Education Program (P21-062-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Nida Jawed ◽  
Anishta Mehndi ◽  
Nilofer Safdar
Keyword(s):  
Nutritional Status ◽  
Nutrition Education ◽  
Vegetable Intake ◽  
Promising Result ◽  
Intervention Group ◽  
Smart Phone ◽  
Smartphone App ◽  
Control Group ◽  
Lifestyle Behaviors ◽  
Health And Nutrition

Abstract Objectives To assess the nutritional status & lifestyle behaviors and see the response of nutrition education delivery by smartphone technology among school going adolescents. Methods A cross-sectional analytical study design was conducted on total of 150 adolescents (aged 14–19 years) from private schools of Karachi (East) using multi-staged random sampling. Data was collected on adolescent's socio-demographics, lifestyle behaviors, nutritional status and dietary behaviors. Based on the need for providing the health and nutrition literacy to our adolescent population through m-health, the smartphone app by the name of ‘Health and Nutrition Daily guidelines for Youth” ‘HANDY’ was developed for the project. Also, a brochure was designed which included the same information as the app, representing the conventional form of education. Participants were divided into two groups – Control group was provided information through brochures and the Intervention group was given brochures and Smartphone App. Results Majority of the students were from upper middle income group. Almost 30% adolescents were obese. Among lifestyle behaviors, 32% didn't meet the criteria for 60 minutes of physical activity per day and excessive use of screen time (>2 hours a day) was 70% among adolescents. According to WHO recommendation only 36.6% were consuming vegetable intake, whereas fruit consumption was slightly better (50.3%). Snacking between meals was also found to be very common (32%) amongst adolescents. Different type of processed food including carbonated beverages and junk food consumption varied between 22–48%. After the baseline information, the intervention group was exposed to smartphone app and brochure versus brochure only and results showed that 76% of the participants in the intervention group liked the smart-phone application versus 34% who preferred brochure for healthier lifestyle. This shows a promising result of smartphone App usage in adolescents for inculcating healthy lifestyle habits. Conclusions As it was a pilot project, the potentiality of the app was found to be highly encouraging. Thus, longitudinal study with larger sample size, will be beneficial to test the efficacy of this app in producing a healthy behavior change. Funding Sources This project was funded by Scaling up Nutrition Academia and Research Pakistan, AusAid, and (ASK development).

scholarly journals Effects of the Preschool-Based Family-Involving DAGIS Intervention on Family Environment: A Cluster Randomised Trial

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3387
Author(s):  
Carola Ray ◽  
Rejane Figueiredo ◽  
Riikka Pajulahti ◽  
Henna Vepsäläinen ◽  
Elviira Lehto ◽  
...  
Keyword(s):  
Family Environment ◽  
Interaction Effect ◽  
Repeated Measures ◽  
Randomised Trial ◽  
Intervention Group ◽  
Cluster Randomised Trial ◽  
Control Group ◽  
Intervention Effects ◽  
Role Modelling ◽  
The Family

Interventions promoting young children’s healthy energy balance-related behaviours (EBRBs) should also examine changes in the family environment as this is an important determinant that may affect the effectiveness of the intervention. This study examines family environmental effects of the Increased Health and Wellbeing in Preschools (DAGIS) intervention study, and whether these effects differed when considering three parental educational level (PEL) groups. The DAGIS intervention was conducted in preschools and involving parents in Southern Finland from September 2017 to May 2018. It was designed as a randomised trial, clustered at preschool-level. Parents of 3–6-year-olds answered questionnaires recording PEL, parental role modelling for EBRBs, and the family environment measured as EBRBs availability and accessibility. Linear Mixed Models with Repeated Measures were used in order to detect intervention effects. Models included group by time interactions. When examining intervention effects separated by PEL groups, models with three-level interactions (group × time-points × PEL) were evaluated. There was an interaction effect for the availability of sugary everyday foods and drinks (p = 0.002). The analyses showed that the control group increased availability (p = 0.003), whereas in the intervention group no changes were detected (p = 0.150). In the analysis separated by PEL groups, changes were found only for the accessibility of sugary treats at home; the high PEL control group increased the accessibility of sugary treats (p = 0.022) (interaction effect: p = 0.027). Hence, results suggest that the DAGIS multicomponent intervention had a limited impact on determinants for children’s healthy EBRBs, and no impact was found in the low PEL group.

scholarly journals Establishing a Theory-Based Multi-Level Approach for Primary Prevention of Mental Disorders in Young People

2020 ◽  
Vol 17 (24) ◽  
pp. 9445
Author(s):  
Giuseppina Lo Moro ◽  
Emma Soneson ◽  
Peter B. Jones ◽  
Julieta Galante
Keyword(s):  
Mental Health ◽  
Young People ◽  
Randomised Trial ◽  
Intervention Group ◽  
Stakeholder Involvement ◽  
Population Based ◽  
Health Determinants ◽  
Local Stakeholder ◽  
Effective Interventions ◽  
Multi Level

The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14–24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.

scholarly journals Evaluation of a symptom-triggered front-loading detoxification technique for alcohol dependence: A pilot study

2004 ◽  
Vol 28 (11) ◽  
pp. 407-410 ◽  
Author(s):  
Ed Day ◽  
Jaimin Patel ◽  
George Georgiou
Keyword(s):  
Pilot Study ◽  
Alcohol Dependence ◽  
Randomised Trial ◽  
Intervention Group ◽  
New Approach ◽  
Acute Psychiatric Wards ◽  
Alcohol Detoxification ◽  
A New Technique ◽  
Set Up ◽  
To Receive

Aims and MethodsA pilot study was set up to compare a symptom-triggered ‘front-loading’ detoxification technique with the usual fixed dosage method. A group of 23 in-patients with alcohol dependence were randomised to receive either the intervention technique using diazepam or the standard chlordiazepoxide taper over 10 days.ResultsThe intervention group received a mean dosage of 74 mg diazepam (equivalent to 222 mg chlordiazepoxide) compared with 700 mg chlordiazepoxide in those receiving usual treatment. There was no statistical difference in the severity of alcohol withdrawal symptoms in the two groups, and the intervention group were slightly more satisfied with their treatment than the group undergoing the usual detoxification treatment. Feedback from the nursing staff was positive towards the new approach but highlighted some potential problems for its wider implementation.Clinical ImplicationsIt was possible to use a simple randomised trial design to introduce a new technique for alcohol detoxification to a specialist unit. Symptom-triggered front-loading detoxification using diazepam was as effective as a standard taper technique in terms of withdrawal severity reduction, and was acceptable to both patients and staff. This is potentially a useful technique for busy acute psychiatric wards.

Randomized Comparison of 2 Protocols to Prevent Acquisition of Methicillin-ResistantStaphylococcus aureus: Results of a 2-Center Study Involving 500 Patients

2011 ◽  
Vol 32 (11) ◽  
pp. 1064-1072 ◽  
Author(s):  
Christophe Camus ◽  
Eric Bellissant ◽  
Annick Legras ◽  
Alain Renault ◽  
Arnaud Gacouin ◽  
...  
Keyword(s):  
Compliance Rate ◽  
Intervention Group ◽  
Incidence Rates ◽  
Standard Group ◽  
University Hospitals ◽  
Standard Precautions ◽  
Acquisition Rate ◽  
Collective Risk ◽  
Medical Icus ◽  
Patients At Risk

Objective.To compare an interventional protocol with a standard protocol for preventing the acquisition of methicillin-resistantStaphylococcus aureus(MRSA) in the intensive care unit (ICU).Design.Prospective, randomized, controlled, parallel-group, nonblinded clinical trial.Setting.Medical ICUs of 2 French university hospitals.Participants.Five hundred adults with an expected length of stay in the ICU greater than 48 hours.Interventions.For the intervention group, the protocol required repeated MRSA screening, contact and droplet isolation precautions for patients at risk for MRSA at ICU admission and for MRSA-positive patients, and decontamination with nasal mupirocin and chlorhexidine body wash for MRSA-positive patients. For the standard group, the standard precautions protocol was used, and the results of repeated MRSA screening in the standard group were not communicated to investigators.Main Outcome Measure.MRSA acquisition rate in the ICU. An audit was conducted to assess compliance with hygiene and isolation precautions.Results.In the intent-to-treat analysis (n= 488), the MRSA acquisition rate in the ICU was similar in the standard (13 [5.3%] of 243) and intervention (16 [6.5%] of 245) groups (P=.58). The audit showed that the overall compliance rate was 85.5% in the standard group and 84.1% in the intervention group (P=.63), although compliance was higher when isolation precautions were absent than when they were in place (88.2% vs 79.1%;P<.001). MRSA incidence rates were higher without isolation precautions (7.57‰) than with isolation precautions (2.36‰;P=.01).Conclusions.Individual allocation to MRSA screening, isolation precautions, and decontamination do not provide individual benefit in reducing MRSA acquisition, compared with standard precautions, although the collective risk was lower during the periods of isolation.Trial Registration.Clinicaltrials.gov identifier: NCT00151606.

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