Middle ear barotrauma in diving

2021 ◽  
Vol 51 (1) ◽  
pp. 44-52
Author(s):  
Oskari H Lindfors ◽  
◽  
Anne K Räisänen-Sokolowski ◽  
Jari Suvilehto ◽  
Saku T Sinkkonen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Ear ◽  
Response Rate ◽  
Survey Study ◽  
Medical Complication ◽  
Comprehensive Overview ◽  
Rescue Services ◽  
Subjective Success ◽  
Secondary Outcomes ◽  
E Mail

Introduction: Middle ear barotrauma (MEBt) is the most common medical complication in diving, posing a serious risk to dive safety. Given this prevalence and the continuing growth of the diving industry, a comprehensive overview of the condition is warranted. Methods: This was a survey study. An anonymous, electronic questionnaire was distributed to 7,060 recipients: professional divers of the Finnish Border Guard, the Finnish Rescue Services, and the Finnish Heritage agency; and recreational divers registered as members of the Finnish Divers’ Association reachable by e-mail (roughly two-thirds of all members and recreational divers in Finland). Primary outcomes were self-reported prevalence, clinical characteristics, and health effects of MEBt while diving. Secondary outcomes were adjusted odds ratios (OR) for frequency of MEBt with respect to possible risk factors. Results: A total of 1,881 respondents participated in the study (response rate 27%). In total, 81% of the respondents had experienced MEBt while diving. Of those affected, 38% had used medications and 1% had undergone otorhinolaryngology-related surgical procedures due to MEBt. Factors most associated with MEBt were poor subjective success in Valsalva (‘occasionally’ versus ‘always’ successful: OR 11.56; 95% CI 7.24–18.47) and Toynbee (‘occasionally’ versus ‘always’ successful: OR 3.51; 95% CI 1.95–6.30) manoeuvres. Conclusions: MEBt is common in both recreational and professional divers, having affected 81% of the respondents. The main possible risk factors include poor success in pressure equalisation manoeuvres.

Middle Ear Barotraumas in Commercial Aircrew

2021 ◽  
Vol 92 (3) ◽  
pp. 182-189
Author(s):  
Oskari H. Lindfors ◽  
Kimmo S. Ketola ◽  
Tuomas K. Klockars ◽  
Tuomo K. Leino ◽  
Saku T. Sinkkonen
Keyword(s):  
Risk Factors ◽  
Middle Ear ◽  
Surgical Procedures ◽  
Poor Performance ◽  
Target Population ◽  
Survey Study ◽  
Upper Respiratory Tract ◽  
Commercial Aviation ◽  
Pressure Equalization ◽  
Tract Infections

BACKGROUND: Middle ear (ME) barotraumas are the most common condition in aviation medicine, sometimes seriously compromising flight safety. Considering this and the ever-increasing amount of commercial aviation, a detailed overview is warranted.METHODS: In this survey study, an anonymous, electronic questionnaire was distributed to commercial aircrew of the three major commercial airlines operating in Finland (N 3799), covering 93% of the target population (i.e., all commercial aircrew operating in Finland, N 4083). Primary outcomes were self-reported prevalence, clinical characteristics, and health and occupational effects of ME barotraumas in flight. Secondary outcomes were adjusted odds ratios (OR) for frequency of ME barotraumas with respect to possible risk factors.RESULTS: Response rate was 47% (N 1789/3799), with 85% (N 1516) having experienced ME barotraumas in flight. Of those affected, 60% had used medications, 5% had undergone surgical procedures, and 48% had been on sick leave due to ME barotraumas (40% during the last year). Factors associated with ME barotraumas included a high number of upper respiratory tract infections [3 URTIs/yr vs. 0 URTIs/yr: OR, 9.02; 95% confidence interval (CI) 3.9920.39] and poor subjective performance in Valsalva (occasionally vs. always successful: OR, 7.84; 95% CI 3.9715.51) and Toynbee (occasionally vs. always successful: OR, 9.06; 95% CI 2.6730.78) maneuvers.CONCLUSION: ME barotraumas were reported by 85% of commercial aircrew. They lead to an increased need for medications, otorhinolaryngology-related surgical procedures, and sickness absence from flight duty. Possible risk factors include a high number of URTIs and poor performance in pressure equalization maneuvers.Lindfors OH, Ketola KS, Klockars TK, Leino TK, Sinkkonen ST. Middle ear barotraumas in commercial aircrew. Aerosp Med Hum Perform. 2021; 92(3):182189.

Sinus barotrauma in diving

2021 ◽  
Vol 51 (2) ◽  
pp. 182-189
Author(s):  
Oskari H Lindfors ◽  
◽  
Anne K Räisänen-Sokolowski ◽  
Jari Suvilehto ◽  
Saku T Sinkkonen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Tract Infections ◽  
Response Rate ◽  
Survey Study ◽  
Upper Respiratory Tract ◽  
Factors Associated ◽  
Diving Medicine ◽  
Sinus Barotrauma ◽  
Upper Respiratory ◽  
Tract Infections

Introduction: Sinus barotrauma is a common occurrence in diving and subaquatic medicine, potentially compromising dive safety. To gain a more thorough understanding of the condition, an in-depth investigation is justified. Methods: This was a survey study. An anonymous, electronic questionnaire was distributed to 7,060 recipients: professional divers of the Finnish Border Guard, the Finnish Rescue Services, and the Finnish Heritage agency, as well as recreational divers registered as members of the Finnish Divers’ Association reachable by email (roughly two-thirds of all members and recreational divers in Finland). Primary outcomes were self-reported prevalence, clinical characteristics, and health effects of sinus barotrauma while diving. Secondary outcomes were adjusted odds ratios (OR) for frequency of sinus barotrauma with respect to possible risk factors. Results: In total, 1,881 respondents participated in the study (response rate 27%). A total of 49% of the respondents had experienced sinus barotrauma while diving and of those affected, 32% had used medications to alleviate their symptoms. The factors associated with sinus barotrauma were pollen allergies (OR 1.59; 95% CI 1.10–2.29), regular smoking (OR 2.04; 95% CI 1.07–3.91) and a high number of upper respiratory tract infections per year (≥ 3 vs. < 3 infections per year: OR 2.76; 95% CI 1.79–4.24). Conclusions: Sinus barotrauma is the second most common condition encountered in diving medicine, having affected 49% of the respondents. Possible risk factors include allergies to pollen, regular smoking, and a high number of URTIs per year.

scholarly journals Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045482
Author(s):  
Didier Collard ◽  
Nick S Nurmohamed ◽  
Yannick Kaiser ◽  
Laurens F Reeskamp ◽  
Tom Dormans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Icu Admission ◽  
Lowering Therapy ◽  
Secondary Outcomes ◽  
Age And Sex

ObjectivesRecent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes.DesignWe analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection.SettingPatients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included.ParticipantsAdmitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics.Primary and secondary outcomes measuresThe primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors.ResultsWe included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91).ConclusionsThe accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.

scholarly journals Postinterview Communication between Obstetrics and Gynecology Residency Programs and Candidates

2012 ◽  
Vol 4 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Diana S. Curran ◽  
Pamela B. Andreatta ◽  
Xiao Xu ◽  
Clark E. Nugent ◽  
Samantha R. Dewald ◽  
...  
Keyword(s):  
United States ◽  
Response Rate ◽  
Educational Leaders ◽  
Program Directors ◽  
The United States ◽  
Obstetrics And Gynecology ◽  
Residency Programs ◽  
Ethical Conflicts ◽  
Communication Practices ◽  
E Mail

Abstract Introduction Residency programs seek to match the best candidates with their positions. To avoid ethical conflicts in this process, the National Residency Matching Program (NRMP or Match) has rules regarding appropriate conduct, including guidelines on contact between candidates and programs. Our study examined communication between obstetrics and gynecology (Ob-Gyn) programs and residency candidates after interviewing and prior to ranking. Methods Ob-Gyn program directors in the United States were sent a self-administered survey via e-mail. Data were collected and analyzed using descriptive methods to examine communication practices of these programs. Results The response rate was 40%. The findings showed that respondents had variable interpretations of the NRMP rules and suggest that programs may be communicating their match intentions especially to favored candidates. Respondents' open text comments highlighted program directors' frustrations with current NRMP rules. Discussion NRMP communication rules are intended to minimize pressure on residency candidates. Our findings suggest they may be leading to unforeseen stresses on program directors and candidates. Conclusions As educational leaders in medicine, we must consider what professional communications are acceptable without increasing the pressure on candidates during the ranking and match process.

Predictors of progression in untreated keratoconus: a Save Sight Keratoconus Registry study

2021 ◽  
pp. bjophthalmol-2020-317547
Author(s):  
Alex Ferdi ◽  
Vuong Nguyen ◽  
Himal Kandel ◽  
Jeremy C K Tan ◽  
Francisco Arnalich-Montiel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
New Zealand ◽  
Corneal Thickness ◽  
Clinical Parameter ◽  
Clinical Parameters ◽  
Registry Study ◽  
Factors Associated ◽  
Younger Age ◽  
Secondary Outcomes

AimsWe set out to identify risk factors for progression in untreated keratoconus patients from 34 centres across Australia, New Zealand, Spain and Italy.MethodsPatients were divided into ‘progressors’ and ‘stable’ patients for each clinical parameter: visual acuity (VA), steepest keratometry (maximum keratometry (Max-K)) and thinnest corneal thickness (TCT). Primary outcomes were the proportion of eyes with sustained progression in VA, Max-K or TCT within 3 years. Secondary outcomes included predictors of progression.ResultsThere were 3994 untreated eyes from 2283 patients. The proportion of eyes with VA, Max-K and TCT progression at 1 year were 3.2%, 6.6% and 3.1% respectively. Factors associated with VA loss were higher baseline VA (HR 1.15 per logMAR line increase in VA; p<0.001) and steeper baseline Max-K (HR 1.07 per 1D increase; p<0.001). Younger baseline age was associated with Max-K steepening (HR 0.96 per year older; p=0.001). Thicker baseline TCT, steeper baseline Max-K and younger baseline age were associated with TCT thinning: (HR 1.08 per 10 µm increase in TCT; p<0.001), (HR 1.03 per 1D increase; p=0.02) and (HR 0.98 per year younger; p=0.01), respectively.ConclusionsSteeper Max-K and younger age were the most clinically useful baseline predictors of progression as they were associated with worsening of two clinical parameters. Every 1D steeper Max-K was associated with a 7% and 3% greater risk of worsening VA and thinning TCT, respectively. Each 1 year younger was associated with a 4% and 2% greater risk of steepening Max-K and thinning TCT, respectively.

scholarly journals Paper, E-mail, or Both? Effects of Contact Mode on Participation in a Web Survey of Establishments

2018 ◽  
Vol 37 (6) ◽  
pp. 750-765 ◽  
Author(s):  
Joseph W. Sakshaug ◽  
Basha Vicari ◽  
Mick P. Couper
Keyword(s):  
Response Rate ◽  
Population Based ◽  
High Response Rate ◽  
Nonresponse Bias ◽  
Web Survey ◽  
Participation Rates ◽  
Web Surveys ◽  
Contact Mode ◽  
Mail Address ◽  
E Mail

Identifying strategies that maximize participation rates in population-based web surveys is of critical interest to survey researchers. While much of this interest has focused on surveys of persons and households, there is a growing interest in surveys of establishments. However, there is a lack of experimental evidence on strategies for optimizing participation rates in web surveys of establishments. To address this research gap, we conducted a contact mode experiment in which establishments selected to participate in a web survey were randomized to receive the survey invitation with login details and subsequent reminder using a fully crossed sequence of paper and e-mail contacts. We find that a paper invitation followed by a paper reminder achieves the highest response rate and smallest aggregate nonresponse bias across all-possible paper/e-mail contact sequences, but a close runner-up was the e-mail invitation and paper reminder sequence which achieved a similarly high response rate and low aggregate nonresponse bias at about half the per-respondent cost. Following up undeliverable e-mail invitations with supplementary paper contacts yielded further reductions in nonresponse bias and costs. Finally, for establishments without an available e-mail address, we show that enclosing an e-mail address request form with a prenotification letter is not effective from a response rate, nonresponse bias, and cost perspective.

scholarly journals Portuguese Primary Care physicians response rate in surveys: A systematic review

2018 ◽  
Vol 64 (3) ◽  
pp. 272-280 ◽  
Author(s):  
Nuno Basílio ◽  
Sara Cardoso ◽  
José Mendes Nunes ◽  
Liliana Laranjo ◽  
Maria da Luz Antunes ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Internal Validity ◽  
Response Rates ◽  
Monetary Incentives ◽  
Average Response ◽  
Average Response Rate ◽  
Effective Strategies ◽  
E Mail

Summary Introduction: Surveys are a useful tool in primary care. However, low response rates can introduce selection bias, impairing both external and internal validity. The aim of this study was to assess the average response rate in surveys with Portuguese general practitioners (GPs). Method: We searched the Medline, Web of Science, Scopus, Embase, PsychInfo, SciELO, IndexRMP, RCAAP, Revista Portuguesa de Medicina Geral e Familiar, Acta Médica Portuguesa and the proceedings of conferences of general practice from incepton to December 2016. We included all postal, e-mail, telephone and personal surveys to primary care physicians without language restrictions. We did not assess risk of bias of included studies, since the main outcome was survey response rate. We performed planned subgroup analyses of the use of monetary incentives, the use of non-monetary incentives, survey delivery modes and prior contact with participants. Results: A total of 1,094 papers were identified and 37 studies were included in this review. The response rate in surveys done to Portuguese GPs was 56% (95CI 47-64%). There was substantial heterogeneity among included studies (I2=99%), but subgroup analysis did not explain this heterogeneity. Conclusion: Consistent with other published studies, the average response rate in surveys done with Portuguese GPs was 56%, with substantial variation among studies. Use of monetary incentives, one of the most effective strategies to increase response rates, was not present in any of the included studies.

scholarly journals Risk factors and appropriate therapeutic strategies for thrombotic microangiopathy after allogeneic HSCT

2020 ◽  
Vol 4 (13) ◽  
pp. 3169-3179 ◽  
Author(s):  
Hiroyuki Matsui ◽  
Yasuyuki Arai ◽  
Hiroharu Imoto ◽  
Takaya Mitsuyoshi ◽  
Naoki Tamura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Thrombotic Microangiopathy ◽  
Treatment Strategy ◽  
Response Rate ◽  
Therapeutic Strategies ◽  
Clinical Aspects

Abstract Transplant-associated thrombotic microangiopathy (TA-TMA) is a fatal complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, so far, no large cohort study determined the risk factors and the most effective therapeutic strategies for TA-TMA. Thus, the present study aimed to clarify these clinical aspects based on a large multicenter cohort. This retrospective cohort study was performed by the Kyoto Stem Cell Transplantation Group (KSCTG). A total of 2425 patients were enrolled from 14 institutions. All patients were aged ≥16 years, presented with hematological diseases, and received allo-HSCT after the year 2000. TA-TMA was observed in 121 patients (5.0%) on day 35 (median) and was clearly correlated with inferior overall survival (OS) (hazard ratio [HR], 4.93). Pre- and post-HSCT statistically significant risk factors identified by multivariate analyses included poorer performance status (HR, 1.69), HLA mismatch (HR, 2.17), acute graft-versus-host disease (aGVHD; grades 3-4) (HR, 4.02), Aspergillus infection (HR, 2.29), and veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS; HR, 4.47). The response rate and OS significantly better with the continuation or careful reduction of calcineurin inhibitors (CNI) than the conventional treatment strategy of switching from CNI to corticosteroids (response rate, 64.7% vs 20.0%). In summary, we identified the risk factors and the most appropriate therapeutic strategies for TA-TMA. The described treatment strategy could improve the outcomes of patients with TA-TMA in the future.

scholarly journals Staffing at Ambulatory Endoscopy Centers in the United States: Practice, Trends, and Rationale

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Deepak Agrawal ◽  
Rajeev Jain
Keyword(s):  
United States ◽  
Patient Care ◽  
Response Rate ◽  
The United States ◽  
Survey Study ◽  
Moderate Sedation ◽  
Endoscopic Procedures ◽  
Staffing Patterns ◽  
And Training

Background. Endoscopy nurse (RN) has a pivotal role in administration and monitoring of moderate sedation during endoscopic procedures. When sedation for the procedure is administered and monitored by an anesthesia specialist, the role of an RN is less clear. The guidelines on this issue by nursing and gastroenterology societies are contradictory. Methods. Survey study of endoscopy lab managers and directors at outpatient endoscopy units in Texas. The questions related to staffing patterns for outpatient endoscopies and responsibilities of different personnel assisting with endoscopies. Results. Responses were received from 65 endoscopy units (response rate 38%). 63/65 (97%) performed at least a few cases with an anesthesia specialist. Of these, 49/63 (78%) involved only an endoscopy technician, without an additional RN in the room. At 12/49 (25%) units, the RN performed tasks of an endoscopy technician. At 14/63 (22%), an additional RN was present during endoscopic procedures and performed tasks not directly related to patient care. Conclusions. Many ambulatory endoscopy units do not have an RN present at all times when sedation is administered by an anesthesia specialist. An RN, when present, did not perform tasks commensurate with the education and training. This has implications about optimal utilization of nurses and cost of performing endoscopies.

scholarly journals Evolving injury profiles amid advancing sport: Musculoskeletal injuries in ringball players

2020 ◽  
Vol 32 (1) ◽  
pp. 1-6
Author(s):  
Blessing Mkhwanazi ◽  
Julian David Pillay
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Injury Prevention ◽  
Response Rate ◽  
Musculoskeletal Injuries ◽  
Ankle Injuries ◽  
Categorical Variables ◽  
Future Research ◽  
Current Season ◽  
Kwazulu Natal

Background: Ringball, a sport historically derived from conventional basketball and netball, demonstrates the evolution of traditional sport. The variations between these sports may predispose players to different risk factors and consequent injuries and their impact, yet they are usually considered comparably. Objective: To determine the prevalence of musculoskeletal injuries and to profile injuries based on location, severity, and mechanisms of occurrence. A further objective was to compare the injuries sustained in ringball with that of basketball and netball. Methods: A questionnaire-based study, administered to 110 ringball players in KwaZulu-Natal, South Africa, was applied. Data were described and compared using frequencies/ percentages for categorical variables. Results: Seventy-six ringball players completed the questionnaire (69% response rate). The prevalence of at least one injury during/after the last or current season was 80% (n=61). The most commonly reported injury was to the foot/ankle (36%; n=33) followed by the knee (29%; n=27) and wrist (9%; n=8). The most common mechanisms of injury reported were landing (15%; n=9), jumping (9%; n=5), goal shooting (7%; n=4), defending (7%; n=4) and collision (7%; n=4). Discussion: Ringball shares similar injuries to that of basketball/netball, with foot/ankle injuries being the most prevalent. The prevalence of other injuries in ringball differed from basketball/netball, suggesting variations between these sports as a contributor to the injuries described. Conclusion: The evolution of sport and the modifications in rules/techniques may create a nuanced injury profile to those commonly identified. The combination of a sport’s uniqueness/modification and its similarities to other sports warrants the need for more tailored approaches to injury prevention and a platform for future research.

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