Variation in Antibiotic Prescribing Across a Pediatric Primary Care Network.

Variation in Antibiotic Prescribing Across a Pediatric Primary Care Network.

J Pediatric Infect Dis Soc. 2015 Dec;4(4):297-304

Authors: Gerber JS, Prasad PA, Russell Localio A, Fiks AG, Grundmeier RW, Bell LM, Wasserman RC, Keren R, Zaoutis TE

Abstract
BACKGROUND: Outpatient respiratory tract infections are the most common reason for antibiotic prescribing to children. Although prior studies suggest that antibiotic overuse occurs, patient-specific data or data exploring the variability and determinants of variability across practices and practitioners is lacking.
METHODS: This study was conducted from a retrospective cohort of encounters to 25 diverse pediatric practices with 222 clinicians, from January 1 to December 31, 2009. Diagnoses, medications, comorbid conditions, antibiotic allergy, and demographic data were obtained from a shared electronic health record and validated by manual review. Practice-specific antibiotic prescription and acute respiratory tract infection diagnosis rates were calculated to assess across-practice differences after adjusting for patient demographics and clustering of encounters within clinicians.
RESULTS: A total of 102 102 (28%) of 399 793 acute visits by 208 015 patients resulted in antibiotic prescriptions. After adjusting for patient age, sex, race, and insurance type, and excluding encounters by patients with chronic conditions, antibiotic prescribing by practice ranged from 18% to 36% of acute visits, and the proportion of antibiotic prescriptions that were broad-spectrum ranged from 15% to 58% across practices, despite additional exclusion of patients with antibiotic allergies or prior antibiotic use. Diagnosis of (Dx) and broad-spectrum antibiotic prescribing (Broad) for acute otitis media (Dx: 8%-20%; Broad: 18%-60%), sinusitis (Dx: 0.5%-9%; Broad: 12%-78%), Streptococcal pharyngitis (Dx: 1.8%-6.4%; Broad: 2%-30%), and pneumonia (Dx: 0.4%-2%; Broad: 1%-70%) also varied by practice (P < 0.001 for all comparisons).
CONCLUSIONS: Antibiotic prescribing for common pediatric infections varied substantially across practices. This variability could not be explained by patient-specific factors. These data suggest the need for and provide high-impact targets for outpatient antimicrobial stewardship interventions.

PMID: 26582868 [PubMed - as supplied by publisher]

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Effects of Unilateral Cochlear Implantation on Balance Control and Sensory Organization in Adult Patients with Profound Hearing Loss.

Effects of Unilateral Cochlear Implantation on Balance Control and Sensory Organization in Adult Patients with Profound Hearing Loss.

Biomed Res Int. 2015;2015:621845

Authors: Parietti-Winkler C, Lion A, Montaut-Verient B, Grosjean R, Gauchard GC

Abstract
Many studies were interested in the consequence of vestibular dysfunction related to cochlear implantation on balance control. This pilot study aimed to assess the effects of unilateral cochlear implantation on the modalities of balance control and sensorimotor strategies. Posturographic and vestibular evaluations were performed in 10 patients (55 ± 20 years) with profound hearing loss who were candidates to undergo unilateral multichannel cochlear implantation. The evaluation was carried out shortly before and one year after surgery. Posturographic tests were also performed in 10 age-matched healthy participants (63 ± 16 years). Vestibular compensation was observed within one year. In addition, postural performances of the patients increased within one year after cochlear implantation, especially in the more complex situations, in which sensory information is either unavailable or conflicting. Before surgery, postural performances were higher in the control group compared to the patients' group. One year after cochlear implantation, postural control was close to normalize. The improvement of postural performance could be explained by a mechanism of vestibular compensation. In addition, the recovery of auditory information which is the consequence of cochlear implantation could lead to an extended exploration of the environment possibly favoring the development of new balance strategies.

PMID: 26583121 [PubMed - as supplied by publisher]

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RNA-Seq and microarray analysis of the Xenopus inner ear transcriptome discloses orthologous OMIM(®) genes for hereditary disorders of hearing and balance.

RNA-Seq and microarray analysis of the Xenopus inner ear transcriptome discloses orthologous OMIM(®) genes for hereditary disorders of hearing and balance.

BMC Res Notes. 2015;8(1):691

Authors: Ramírez-Gordillo D, Powers TR, van Velkinburgh JC, Trujillo-Provencio C, Schilkey F, Serrano EE

Abstract
BACKGROUND: Auditory and vestibular disorders are prevalent sensory disabilities caused by genetic and environmental (noise, trauma, chemicals) factors that often damage mechanosensory hair cells of the inner ear. Development of treatments for inner ear disorders of hearing and balance relies on the use of animal models such as fish, amphibians, reptiles, birds, and non-human mammals. Here, we aimed to augment the utility of the genus Xenopus for uncovering genetic mechanisms essential for the maintenance of inner ear structure and function.
RESULTS: Using Affymetrix GeneChip(®) X. laevis Genome 2.0 Arrays and Illumina-Solexa sequencing methods, we determined that the transcriptional profile of the Xenopus laevis inner ear comprises hundreds of genes that are orthologous to OMIM(®) genes implicated in deafness and vestibular disorders in humans. Analysis of genes that mapped to both technologies demonstrated that, with our methods, a combination of microarray and RNA-Seq detected expression of more genes than either platform alone.
CONCLUSIONS: As part of this study we identified candidate scaffold regions of the Xenopus tropicalis genome that can be used to investigate hearing and balance using genetic and informatics procedures that are available through the National Xenopus Resource (NXR), and the open access data repository, Xenbase. The results and approaches presented here expand the viability of Xenopus as an animal model for inner ear research.

PMID: 26582541 [PubMed - as supplied by publisher]

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Fragen für die Facharztprüfung.

Fragen für die Facharztprüfung.

Laryngorhinootologie. 2015 Nov;94(11):790

Authors:

PMID: 26584214 [PubMed - as supplied by publisher]

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[From the Expert's Office: How to Simplify the Calculation of the Hearing Loss in the Speechaudiogram According to the Scale of Boenninghaus and Röser].

[From the Expert's Office: How to Simplify the Calculation of the Hearing Loss in the Speechaudiogram According to the Scale of Boenninghaus and Röser].

Laryngorhinootologie. 2015 Nov;94(11):772-774

Authors: Brusis T

PMID: 26584213 [PubMed - as supplied by publisher]

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[Septoplasty].

[Septoplasty].

Laryngorhinootologie. 2015 Nov;94(11):732-733

Authors: Roesch S, Rasp G, Dejaco M

PMID: 26584212 [PubMed - as supplied by publisher]

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Cardiac comorbidity in head and neck cancer patients and its influence on cancer treatment selection and mortality: a prospective cohort study.

Cardiac comorbidity in head and neck cancer patients and its influence on cancer treatment selection and mortality: a prospective cohort study.

Eur Arch Otorhinolaryngol. 2015 Nov 18;

Authors: Simeoni R, Breitenstein K, Eßer D, Guntinas-Lichius O

Abstract
Comorbidity assessment and a profound cardiac examination were implemented into pre-treatment diagnostics to analyze their influence on head and neck squamous cell carcinoma (HNSCC) therapy selection and short-term mortality. Comorbidity was measured prospectively in 49 HNSCC patients using standard indices between 2012 and 2013. Cardiac examinations included electrocardiogram, echocardiography, and bicycle ergometry. Most patients had stage IV tumors (61 %), smoked (61 %), and showed alcohol abuse (57 %); 38 patients (78 %) received a multimodal therapy; 65 % had an adult comorbidity evaluation 27 index ≥2, 59 % a Charlson comorbidity index (CCI) ≥4, and 12 % a revised cardiac risk index (RCRI) ≥2. Additional cardiac examinations revealed moderate to severe cardiovascular pathologies in 32 % of the patients and led to recommendations for additional therapy in 4 patients (8 %) necessary only after cancer treatment. RCRI was associated with CCI and cardiac examinations (p = 0.009, p = 0.030). Chemotherapy, stroke history, and RCRI ≥2 were risk factors for early mortality within first 2 years after cancer therapy (p = 0.037; p = 0.012; p = 0.015). Although one-third of a strongly smoking and drinking patient cohort had relevant cardiac morbidity, extended unselected cardiac diagnostics had only low impact on HNSCC therapy selection. The risk of early mortality after HNSCC cancer treatment seems to be sufficiently reflected by the RCRI.

PMID: 26581475 [PubMed - as supplied by publisher]

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Assessment of Blinding in a Tinnitus Treatment Trial-Reply.

Assessment of Blinding in a Tinnitus Treatment Trial-Reply.

JAMA Otolaryngol Head Neck Surg. 2015 Nov 1;141(11):1031-1032

Authors: Folmer RL, Theodoroff SM

PMID: 26583514 [PubMed - as supplied by publisher]

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Psychophysiological Associations between Chronic Tinnitus and Sleep: A Cross Validation of Tinnitus and Insomnia Questionnaires.

Psychophysiological Associations between Chronic Tinnitus and Sleep: A Cross Validation of Tinnitus and Insomnia Questionnaires.

Biomed Res Int. 2015;2015:461090

Authors: Schecklmann M, Pregler M, Kreuzer PM, Poeppl TB, Lehner A, Crönlein T, Wetter TC, Frank E, Landgrebe M, Langguth B

Abstract
Background. The aim of the present study was to assess the prevalence of insomnia in chronic tinnitus and the association of tinnitus distress and sleep disturbance. Methods. We retrospectively analysed data of 182 patients with chronic tinnitus who completed the Tinnitus Questionnaire (TQ) and the Regensburg Insomnia Scale (RIS). Descriptive comparisons with the validation sample of the RIS including exclusively patients with primary/psychophysiological insomnia, correlation analyses of the RIS with TQ scales, and principal component analyses (PCA) in the tinnitus sample were performed. TQ total score was corrected for the TQ sleep items. Results. Prevalence of insomnia was high in tinnitus patients (76%) and tinnitus distress correlated with sleep disturbance (r = 0.558). TQ sleep subscore correlated with the RIS sum score (r = 0.690). PCA with all TQ and RIS items showed one sleep factor consisting of all RIS and the TQ sleep items. PCA with only TQ sleep and RIS items showed sleep- and tinnitus-specific factors. The sleep factors (only RIS items) were sleep depth and fearful focusing. The TQ sleep items represented tinnitus-related sleep problems. Discussion. Chronic tinnitus and primary insomnia are highly related and might share similar psychological and neurophysiological mechanisms leading to impaired sleep quality.

PMID: 26583109 [PubMed - as supplied by publisher]

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The Relevance of the High Frequency Audiometry in Tinnitus Patients with Normal Hearing in Conventional Pure-Tone Audiometry.

The Relevance of the High Frequency Audiometry in Tinnitus Patients with Normal Hearing in Conventional Pure-Tone Audiometry.

Biomed Res Int. 2015;2015:302515

Authors: Vielsmeier V, Lehner A, Strutz J, Steffens T, Kreuzer PM, Schecklmann M, Landgrebe M, Langguth B, Kleinjung T

Abstract
Objective. The majority of tinnitus patients suffer from hearing loss. But a subgroup of tinnitus patients show normal hearing thresholds in the conventional pure-tone audiometry (125 Hz-8 kHz). Here we explored whether the results of the high frequency audiometry (>8 kHz) provide relevant additional information in tinnitus patients with normal conventional audiometry by comparing those with normal and pathological high frequency audiometry with respect to their demographic and clinical characteristics. Subjects and Methods. From the database of the Tinnitus Clinic at Regensburg we identified 75 patients with normal hearing thresholds in the conventional pure-tone audiometry. We contrasted these patients with normal and pathological high-frequency audiogram and compared them with respect to gender, age, tinnitus severity, pitch, laterality and duration, comorbid symptoms and triggers for tinnitus onset. Results. Patients with pathological high frequency audiometry were significantly older and had higher scores on the tinnitus questionnaires in comparison to patients with normal high frequency audiometry. Furthermore, there was an association of high frequency audiometry with the laterality of tinnitus. Conclusion. In tinnitus patients with normal pure-tone audiometry the high frequency audiometry provides useful additional information. The association between tinnitus laterality and asymmetry of the high frequency audiometry suggests a potential causal role for the high frequency hearing loss in tinnitus etiopathogenesis.

PMID: 26583098 [PubMed - as supplied by publisher]

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Temporal Bone Pneumatization and Pulsatile Tinnitus Caused by Sigmoid Sinus Diverticulum and/or Dehiscence.

Temporal Bone Pneumatization and Pulsatile Tinnitus Caused by Sigmoid Sinus Diverticulum and/or Dehiscence.

Biomed Res Int. 2015;2015:970613

Authors: Wenjuan L, Zhaohui L, Ning Z, Pengfei Z, Cheng D, Zhenchang W

Abstract
Background. Although air cells within temporal bone may play an important role in the transmission of pulsatile tinnitus (PT) noise, it has not been studied systematically. Purpose. To evaluate the difference in temporal bone pneumatization between PT patients with sigmoid sinus diverticulum and/or dehiscence (SSDD) and healthy people. Material and Methods. A total of 199 unilateral persistent PT patients with SSDD and 302 control subjects underwent dual-phase contrast-enhanced CT (DP-CECT), to assess the grade of temporal bone pneumatization in each ear. Results. In the bilateral temporal bone of 302 controls, 16 ears were grade I, 53 were grade II, 141 were grade III, and 394 were grade IV. Among the affected ears of 199 PT cases, 1 ear was grade I, 18 were grade II, 53 were grade III, and 127 were grade IV. There was no significant difference in the pneumatization grade between the affected PT ear and either ear in the healthy subjects (p > 0.05).  Conclusion. Although air cells within the temporal bone are an important factor in the occurrence of PT, its severity does not differ significantly from the pneumatization of healthy people.

PMID: 26581544 [PubMed - as supplied by publisher]

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Subepidermal Calcified Nodule in the Periocular Region: A Report of 6 Cases.

Subepidermal Calcified Nodule in the Periocular Region: A Report of 6 Cases.

Ophthalmology. 2015 Nov 12;

Authors: Shields CL, Marous MR, Casey MG, Douglass AM, Khoo CT, Bilyk JR, Shields JA, Eagle RC

PMID: 26581555 [PubMed - as supplied by publisher]

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Metabolic alterations in adolescents with obstructive sleep apnea.

Metabolic alterations in adolescents with obstructive sleep apnea.

Int J Pediatr Otorhinolaryngol. 2015 Nov 3;

Authors: Bhushan B, Ayub B, Loghmanee DA, Billings KR

Abstract
IMPORTANCE: Obesity is one of the leading health concerns in developed and in developing countries. The risk of obstructive sleep apnea (OSA) is greatly increased by obesity. Obesity is known to be associated with the Metabolic Syndrome and cardiovascular disease in adults. This same association in children is not well defined. Understanding the relationship of obesity, OSA, and metabolic alterations in children would improve understanding of the risks of cardiovascular disease into adulthood.
OBJECTIVE: To evaluate the association of OSA and metabolic outcomes, including lipid variables and insulin resistance, in obese adolescents.
METHODS: Retrospective, case-control series at a tertiary care children's hospital. Obese adolescents aged 12-18 years who underwent overnight polysomnography (PSG) and routine laboratory testing for lipid levels, fasting glucose, and insulin from January 1, 2006 to December 31, 2012.
RESULTS: A total of 42 patients with a mean age of 14.1±1.9 years were analyzed. Nineteen (45.2%) were male. The mean body mass index (BMI) z score was 2.23±0.86, and all patients were obese (BMI z score >95th percentile). Triglyceride, fasting blood glucose, insulin, and homeostasis model assessment-insulin resistance (HOMA-IR) levels were significantly higher in patients with OSA when compared to those with No-OSA (p<0.01). There was incremental worsening of insulin and HOMA-IR with greater severity of OSA. The apnea-hypopnea index (AHI) was positively and significantly correlated with blood glucose and HOMA-IR (p=0.01and p<0.001, respectively). Multiple linear regression analysis showed that the AHI was a predictor of blood glucose (p=0.04) and HOMA-IR (p=0.01) independent of age, gender, total sleep time and BMI z score. Logistic regression analysis showed that elevated levels of blood glucose predicted severe OSA (p=0.02) independent of gender and BMI z score. Elevation in HOMA-IR predicted severe OSA (p=0.004).
CONCLUSION: OSA severity is associated with increased fasting insulin, blood glucose and HOMA-IR even after controlling for the age, and BMI z score in adolescents.

PMID: 26581829 [PubMed - as supplied by publisher]

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Deep neuromuscular block improves the surgical conditions for laryngeal microsurgery.

Deep neuromuscular block improves the surgical conditions for laryngeal microsurgery.

Br J Anaesth. 2015 Dec;115(6):867-872

Authors: Kim HJ, Lee K, Park WK, Lee BR, Joo HM, Koh YW, Seo YW, Kim WS, Yoo YC

Abstract
BACKGROUND: Adequate neuromuscular block is required throughout laryngeal microsurgery. We hypothesized that the surgical conditions would improve under a deeper level of rocuronium-induced neuromuscular block.
METHODS: Seventy-two patients undergoing laryngeal microsurgery were randomly allocated to either the 'post-tetanic counts 1-2' (PTC1-2) group or the 'train-of-four counts 1-2' (TOFcount1-2) group according to the level of neuromuscular block used. Two different doses of rocuronium (1.2 or 0.5 mg kg(-1)) were used after anaesthetic induction, and two respective targets of neuromuscular block (post-tetanic counts ≤2 or train-of-four count of 1 or 2) were used. Surgical conditions were assessed by the surgeon using a five-point rating scale (extremely poor/poor/acceptable/good/optimal), and clinically acceptable surgical conditions were defined as those which were rated acceptable, good, or optimal. The occurrence of vocal cord movement and postoperative adverse events was assessed.
RESULTS: The surgical conditions were significantly different between the PTC1-2 and TOFcount1-2 groups (extremely poor/poor/acceptable/good/optimal: 0/2/1/7/26 and 3/10/2/14/7, respectively, P<0.001). The incidence of clinically acceptable surgical conditions was significantly higher in the PTC1-2 group than in the TOFcount1-2 group (94 vs 64%, P=0.003). The percentage of patients who exhibited vocal cord movement was significantly lower in the PTC1-2 group than in the TOFcount1-2 group (3 vs 39%, P<0.001). The incidence of postoperative adverse events was not significantly different except for the less frequent occurrence of mouth dryness in the PTC1-2 group (P=0.035).
CONCLUSIONS: Deep neuromuscular block (post-tetanic count of 1-2) surgical conditions in patients undergoing laryngeal microsurgery improves.
CLINICAL TRIAL REGISTRATION: NCT01980069.

PMID: 26582847 [PubMed - as supplied by publisher]

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