Objectives/Hypothesis
Three surgical approaches: cochleostomy (C), round window (RW), and extended round window (ERW); and two electrodes types: lateral wall (LW) and perimodiolar (PM), account for ...the vast majority of cochlear implantations. The goal of this study was to analyze the relationship between surgical approach and electrode type with final intracochlear position of the electrode array and subsequent hearing outcomes.
Study Design
Comparative longitudinal study.
Methods
One hundred postlingually implanted adult patients were enrolled in the study. From the postoperative scan, intracochlear electrode location was determined and using rigid registration, transformed back to the preoperative computed tomography which had intracochlear anatomy (scala tympani and scala vestibuli) specified using a statistical shape model based on 10 microCT scans of human cadaveric cochleae. Likelihood ratio chi‐square statistics were used to evaluate for differences in electrode placement with respect to surgical approach (C, RW, ERW) and type of electrode (LW, PM).
Results
Electrode placement completely within the scala tympani (ST) was more common for LW than were PM designs (89% vs. 58%; P < 0.001). RW and ERW approaches were associated with lower rates of electrode placement outside the ST than was the cochleostomy approach (9%, 16%, and 63%, respectively; P < 0.001). This pattern held true regardless of whether the implant was LW or PM. When examining electrode placement and hearing outcome, those with electrode residing completely within the ST had better consonant‐nucleus‐consonant word scores than did patients with any number of electrodes located outside the ST (P = 0.045).
Conclusion
These data suggest that RW and ERW approaches and LW electrodes are associated with an increased likelihood of successful ST placement. Furthermore, electrode position entirely within the ST confers superior audiological outcomes.
Level Of Evidence
2b. Laryngoscope, 124:S1–S7, 2014
Problem
Depression and anxiety are highly prevalent and frequently comorbid mental health disorders that often manifest during childhood and adolescence. The purpose of this study was to ...prospectively examine potential common underlying mechanisms predicting the development of depressive and anxiety symptoms to identify mutual underlying modifiable risk factors to target with mental health promotion and prevention interventions.
Methods
A community‐based sample of 11‐ to 15‐year‐old adolescents participated in a prospective, longitudinal pilot study with three waves of data collection over a 6‐month period.
Findings
At baseline, stressful life events, worry, and rumination accounted for 35% of the variance in anxiety scores (adjusted R2 = 0.28) and 58% of the variance in depressive symptoms (adjusted R2 = 0.53), while at Time 3 (T3; 6 months post baseline) these variables accounted for 63% of the variance in anxiety scores (adjusted R2 = 0.59) and 45% of the variance in depressive symptoms (adjusted R2 = 0.39). After controlling for baseline values, increases in stress, worry, and rumination were predictive of both depressive and anxiety symptoms at T3.
Conclusions
Study findings point to the importance of prevention and early intervention programs including content addressing stress management, rumination, and worry.
Advance care planning (ACP) is essential to elicit goals, values, and preferences of care in older adults with serious illness and on trajectories of frailty. An exploration of ACP uptake in older ...adults may identify barriers and facilitators.
To conduct an integrative review of research on the uptake of ACP in older adults and create a conceptual model of the findings.
Using Whittemore and Knafl's methodology, we systematically searched four electronic databases of ACP literature in older adults from 1996 through December 2019. Critical appraisal tools were used to assess study quality, and articles were categorized according to level of evidence. Statistical and thematic analysis was then undertaken.
Among 1081 studies, 78 met inclusion criteria. Statistical analysis evaluated ACP and variables within the domains of demographics, psychosocial, disability and functioning, and miscellaneous. Thematic analysis identified a central category of enhanced communication, followed by categories of 1) provider role and preparation; 2) patient/family relationship patterns; 3) standardized processes and structured approaches; 4) contextual influences; and 5) missed opportunities. A conceptual model depicted categories and relationships.
Enhanced communication and ACP facilitators improve uptake of ACP. Clinicians should be cognizant of these factors. This review provides a guide for clinicians who are considering implementation strategies to facilitate ACP in real-world settings.
Injury is an external stressor that often initiates a cycle of decline in many older adults. The influence of physical frailty and cognitive decline on 6-month and 1-year outcomes after injury is ...unreported. We hypothesized that physical frailty and cognitive impairment would be predictive of 6-month and 1-year postinjury function and overall mortality.
The sample involved patients who are 65 years or older admitted to a Level I trauma center between October 2013 and March 2014 with a primary injury diagnosis. Surrogates of 188 patients were interviewed within 48 hours of hospital admission to determine preinjury cognitive and physical frailty impairments using brief screening instruments. Follow-up was completed on 172 patients at 6 months and 176 patients at 1 year to determine posthospitalization status and outcomes. Data analysis involved frequencies, measures of central tendency, χ analyses, linear and logistic regression.
The mean age of the patients was 77 years. The median Injury Severity Score (ISS) was 10. The mechanism of injury involved falls from standing (n = 101, 54%). Preinjury vulnerabilities included cognitive impairment (AD8 Dementia Screen AD8 score ≥ 2, n = 93, 50%) and physical frailty (Vulnerable Elders Survey VES-13 score ≥ 4, n = 94, 50%). Overall, median physical frailty scores did not return to baseline in the majority of survivors at 1 year. Multivariate regression analysis revealed that preinjury cognitive impairment (6 months, AD8, β = -0.20, p = 0.002) and preinjury physical frailty (6 months, Barthel Index, β = 0.60, p < 0.001; 1 year, Barthel Index, β = 0.52, p < 0.001) are independently associated with physical function (frailty). Multivariate logistic regression analysis revealed that age (odds ratio OR, 1.09; 95% confidence interval CI, 1.04-1.14), injury severity (OR, 1.07; 95% CI, 1.02-1.12), and preinjury physical frailty (OR, 1.28; 95% CI, 1.14-1.47) are independently associated with overall mortality at 1 year.
Preinjury physical frailty is the predominant predictor of postinjury functional status and mortality in geriatric trauma patients. Identification of frailty and appropriate follow-up are crucial for decision making by providers, patients, and family caregivers.
Prognostic study, level II.
Purpose: This study aimed to determine how tongue and jaw displacement changes impact acoustic vowel contrast in talkers with amyotrophic lateral sclerosis (ALS) and controls. Method: Ten talkers ...with ALS and 14 controls participated in this study. Loud, clear, and slow speech cues were used to elicit tongue and jaw kinematic as well as acoustic changes. Speech kinematics was recorded using three-dimensional articulography. Independent tongue and jaw displacements were extracted during the diphthong /ai/ in "kite." Acoustic distance between diphthong onset and offset in Formant 1-Formant 2 vowel space indexed acoustic vowel contrast. Results: In both groups, all three speech modifications elicited increases in jaw displacement (typical < slow < loud < clear). By contrast, only slow speech elicited significantly increased independent tongue displacement in the ALS group (typical = loud = clear < slow), whereas all three speech modifications elicited significantly increased independent tongue displacement in controls (typical < loud < clear = slow). Furthermore, acoustic vowel contrast significantly increased in response to clear and slow speech in the ALS group, whereas all three speech modifications elicited significant increases in acoustic vowel contrast in controls (typical < loud < slow < clear). Finally, only jaw displacements accounted for acoustic vowel contrast gains in the ALS group. In controls, however, independent tongue displacements accounted for increases in vowel acoustic contrast during loud and slow speech, whereas jaw and independent tongue displacements accounted equally for acoustic vowel contrast change during clear speech. Conclusion: Kinematic findings suggest that slow speech may be better suited to target independent tongue displacements in talkers with ALS than clear and loud speech. However, given that gains in acoustic vowel contrast were comparable for slow and clear speech cues in these talkers, future research is needed to determine potential differential impacts of slow and clear speech on perceptual measures, such as intelligibility. Finally, findings suggest that acoustic vowel contrast gains are predominantly jaw driven in talkers with ALS. Therefore, the acoustic and perceptual consequences of direct instructions of enhanced jaw movements should be compared to cued speech modification, such as clear and slow speech in these talkers.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objective: The objective of this work is to introduce and demonstrate the effectiveness of a novel sensing modality for contact detection between an off-the-shelf aspiration catheter and a thrombus. ...Methods: A custom robotic actuator with a pressure sensor was used to generate an oscillatory vacuum excitation and sense the pressure inside the extracorporeal portion of the catheter. Vacuum pressure profiles and robotic motion data were used to train a support vector machine (SVM) classification model to detect contact between the aspiration catheter tip and a mock thrombus. Validation consisted of benchtop accuracy verification, as well as user study comparison to the current standard of angiographic presentation. Results: Benchtop accuracy of the sensing modality was shown to be 99.67%. The user study demonstrated statistically significant improvement in identifying catheter-thrombus contact compared to the current standard. The odds ratio of successful detection of clot contact was 2.86 (p = 0.03) when using the proposed sensory method compared to without it. Conclusion: The results of this work indicate that the proposed sensing modality can offer intraoperative feedback to interventionalists that can improve their ability to detect contact between the distal tip of a catheter and a thrombus. Significance: By offering a relatively low-cost technology that affords off-the-shelf aspiration catheters as clot-detecting sensors, interventionalists can improve the first-pass effect of the mechanical thrombectomy procedure while reducing procedural times and mental burden.
Purpose
Lymphedema associated with head and neck cancer (HNC) therapy causes adverse clinical outcomes. Standard treatment includes professionally administered complete decongestive therapy (CDT). ...Cost and availability of trained therapists are known barriers to therapy. Advanced pneumatic compression devices (APCD) may address these issues. A randomized, wait-list controlled trial was undertaken to evaluate an APCD in post-treatment HNC patients with lymphedema.
Material and methods
Eligible patients had completed treatment for HNC, were disease free, and had lymphedema at enrollment. Participants were randomized to wait-list lymphedema self-management (standard of care) or lymphedema self-management plus the use of the APCD bid. Safety (CTCAE V4.0) and feasibility were primary endpoints; secondary endpoints included efficacy measure by objective examination and patient reported outcomes (symptoms, quality of life, function), adherence barriers, and satisfaction. Assessments were conducted at baseline and weeks 4 and 8.
Results
Forty-nine patients were enrolled (wait-list
n
= 25; intervention
n
= 24). In total, forty-three patients completed the study. No device-related Serious Adverse Events were reported. Most patients used the APCD once per day, instead of the prescribed twice per day, citing time related factors as barriers to use. APCD use was associated with significant improvement in perceived ability to control lymphedema (
p
= 0.003) and visible external swelling (front view
p
< 0.001, right view
p
= 0.004, left
p
= 0.005), as well as less reported pain.
Conclusion
This trial supports the safety and feasibility of the APCD for the treatment of secondary lymphedema in head and neck cancer patients. In addition, preliminary data supports efficacy.
Introduction
The Maternal Infant Health Outreach Worker (MIHOW) program is a home visiting program, utilizing peer mentors to improve maternal/child health outcomes in underserved communities. ...Findings are presented from a randomized clinical trial (RCT) testing the efficacy of the MIHOW model in a sample of Hispanic women in Tennessee. We hypothesized maternal and infant outcomes would be better in women assigned to MIHOW than women assigned to the minimal education intervention (MEI) group (receipt of educational materials).
Methods
Women entered the study during pregnancy (< 26 weeks gestation) and were followed through 6 months postpartum. A total of 188 women were enrolled and randomly assigned (MEI = 94; MIHOW = 94), with 178 women completing the study (MEI = 87; MIHOW = 91).
Results
Positive and statistically significant (p < 0.01) effects of MIHOW were observed on breastfeeding self-efficacy and exclusivity, levels of depressive symptoms and parenting stress, safe sleep practices, and infant stimulation in the home. No statistically significant differences were noted in number of prenatal visits.
Discussion
Results expand limited empiric evidence and provide strong support of the effectiveness of MIHOW on improving health outcomes in this sample of Hispanic mothers and their infants. MIHOW is a viable option for providing culturally sensitive services to immigrant and underserved families.
1) To complete a follow-up investigation of postoperative outcomes for adult cochlear implant (CI) recipients scoring ≥30% Consonant-Nucleus-Consonant (CNC) preoperatively, and 2) to describe the ...postoperative performance trajectory for this group of higher performing patients.
Retrospective chart review.
Tertiary referral center.
One hundred four (105 ears) postlingually deafened adults who scored ≥30% CNC word recognition in the ear to be implanted preoperatively.
One hundred four subjects underwent cochlear implantation.
Pre- and postoperative CNC word scores and AzBio sentences in quiet and noise in the ear to be implanted as well as the bilateral-aided condition pre-CI and at 1, 3, 6, and 12 months post-CI.
Statistically significant improvement was demonstrated for CNC and AzBio sentences in quiet and noise for the CI alone and bilateral listening conditions. Most improvement was demonstrated by 6-months postoperatively (p < 0.001) with the exception of AzBio sentences in noise demonstrating improvement within 3 months (p < 0.001). For patients with preop CNC scores up to 40% (n = 57), all recipients demonstrated either equivocal (n = 17) or statistically significant improvement (n = 40) for CNC word recognition in the CI-alone condition and none demonstrated a significant decrement in the bilateral condition. For patients with preop CNC scores >40% (n = 47, 48 ears), 89.3% (42 patients) demonstrated either equivocal (n = 24, 50%) or statistically significant improvement (n = 19, 39.6%) for CNC word recognition in the CI-only condition and none demonstrated a significant decrement in the bilateral condition.
CI candidates with preoperative CNC word scores higher than conventional CI recipients derive statistically significant benefit from cochlear implantation for both the CI ear and best-aided condition. These data provide further support for the expansion of adult CI candidacy up to at least 40% CNC word recognition preoperatively with consideration given to further expansion possibly up to 60%.
Purpose
Neuroinflammation and central sensitization from cancer and its therapy may result in chronic systemic symptoms (CSS) such as fatigue, sleep disturbance, chronic widespread pain, mood ...disorders, neuropsychiatric symptoms, and temperature dysregulation. We undertook a cross-sectional study of CSS in head and neck cancer (HNC) survivors to determine their frequency, severity, and impact.
Methods
HNC patients without evidence of recurrence who were at least 12 months post-treatment completed a one-time battery of self-report measures including the Vanderbilt Head and Neck Symptom survey plus the General Symptom Subscale, the Body Image Quality of Life Inventory, Neurotoxicity Rating Scale, the Profile of Mood States, and a five-item quality of life measure.
Results
One hundred five patients completed the surveys. Forty-eight point four percent of patients experienced one or more moderate-to-severe systemic symptom. The frequency of individual symptoms was between 20% and 56% with almost half of patients rating symptoms as moderate-to-severe in intensity. Low and high systemic symptom burden populations were identified. Previously undescribed chronic neuropsychiatric symptoms were also found to be frequent and severe. The vigor score on the POMS was low. Body image was not adversely impacted. At least 40% of HNC survivors have diminished quality of life, and up to 15% have a poor quality of life.
Conclusions
CSS are common among HNC survivors and are frequently moderate to severe in intensity. Of note, previously underrecognized neuropsychiatric symptoms were endorsed by a significant cohort of patients warranting further study. Quality of life was diminished in a significant cohort.
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