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To compare the measured bone conduction threshold at 3 kHz with the calculated threshold in newly diagnosed sudden sensorineural hearing loss.
A retrospective chart review was conducted of pure tone audiograms in confirmed sudden sensorineural hearing loss cases.
Of 157 patients with sudden sensorineural hearing loss, 144 had idiopathic hearing loss, 8 had vestibular schwannoma and 5 had Ménière's disease. The r value for the correlation between the two methods of 3 kHz assessment for all patients was 0.887 (p < 0.001). The mean difference between the measured and calculated 3 kHz thresholds was 0.76 ± 7.96 dB, 0.4 ± 8.08 dB and 1.5 ± 1.8 dB in the sudden sensorineural hearing loss, idiopathic and Ménière's disease groups, respectively. The mean difference between the measured and calculated 3 kHz thresholds was significantly greater in the vestibular schwannoma group (6.86 ± 4.38 dB) than in the idiopathic group (p = 0.013).
The 3 kHz frequency may encompass important audiometric information. A discrepancy between the measured and calculated bone conduction 3 kHz thresholds raises suspicion of an underlying vestibular schwannoma as an aetiology for sudden sensorineural hearing loss, and these thresholds should therefore be measured independently and routinely.
Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys.
The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women.
Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs.
Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.
Background and objectives: The On-Line Electronic Help (OLEH) is a point-of-care information system for anaesthesia providers prepared by the European Society of Anaesthesiologists. In this preliminary study the effect of the OLEH availability on the incidence of knowledge-based errors during the management of case scenarios and participants' subjective evaluation of the OLEH were evaluated. Methods: After a short training session, 48 anaesthesiologists (24 junior residents, 12 senior residents and 12 board-certified) were presented randomly with six computer screen-based case scenarios with, and six without, the option of using the OLEH. Two reviewers evaluated the answers independently according to preconfigured guidelines. Results: The availability of the OLEH was associated with higher scores in 11 of the 12 scenarios, and with a decrease in the incidence of critical errors in 10 scenarios. Time to task completion was increased in one scenario only when the OLEH was used. The degree of professional experience was associated with better scores in five of the scenarios and with a reduced occurrence of critical errors in three scenarios. Forty-two out of 48 participants stated that finding information in the OLEH software was easy and that the system was helpful in managing the scenarios. Conclusions: This preliminary study demonstrates the potential value of the OLEH in decreasing the number of knowledge-based errors made by anaesthesiologists. According to the encouraging results, the OLEH system is currently under evaluation using full-scale simulation scenarios in an operating room environment.
Otitis media with effusion was the presenting symptom in 23 per cent of patients suffering from chronic sinusitis. The inter-relationship between chronic sinusitis and otitis media with effusion was studied in 29 patients. Endoscopic evaluation of intranasal structures including sinus ostia and Eustachian tube orifices was carried out. We further suggest that otitis with media with effusion is not a separate entity but a presentation of sinus disease, predominantly of the ethmoid system. Patients with otitis media with effusion should be evaluated for sinusitis and vice versa. The value of careful nasendoscopy is demonstrated.