Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006

There is widespread recognition that consistency between research centres in the ways that patients with tinnitus are assessed and outcomes following interventions are measured would facilitate more effective co-operation and more meaningful evaluations and comparisons of outcomes. At the first Tinnitus Research Initiative meeting held in Regensburg in July 2006 an attempt was made through workshops to gain a consensus both for patient assessments and for outcome measurements. It is hoped that this will contribute towards better cooperation between research centres in finding and evaluating treatments for tinnitus by allowing better comparability between studies.

Deconstructing persecution and betrayal in the discourse of Anders Behring Breivik: A preliminary essay

On 22 July 2011, a 32-year-old Norwegian launched two planned murderous rampages claiming the lives of 77 victims. Shortly before his attacks, Anders Behring Breivik uploaded to the internet a self-styled compendium written in English in which he explained the motivation for his attacks. By deconstructing this text and the documentation contained in the first [court-ordered] psychiatric evaluation of Breivik, we can undertake to analyse his sense of persecution. In pursing this analysis, we start with Breivik's description of his personal concept of contemporary European history and politics, and then proceed to the autobiographical and phantasmic aspects of his discourse. The analysis reveals the transformation of love into hate, the original persecutor, the installation of a projection mechanism, notions of betrayal and their subsequent development into an ideology. With Breivik's conceptions thus revealed, we conclude by comparing different psychoanalytic hypotheses which deepen or challenge the Freudian thesis of a defence against a feeling of homosexual love in persecution, and which to the contrary favour the importance of the relationship with the mother, anal sadism or the 'narcissistic rage' behind the genesis of these ideas. We leave open the question of whether there is a constant relationship between feelings of persecution and the tendency to commit criminal acts.

Lessons from seabird conservation in Alaskan longline fisheries

Although bycatch of seabirds and other long-lived species is a critical conservation issue in world fisheries, case studies documenting significant reductions in the mortality of these low-productivity species in a fishery are rare. We studied progress toward seabird conservation in the Alaskan longline fisheries, one of the largest and most diverse demersal fisheries. We generated annual seabird bycatch rates in 4 target fisheries and all fisheries combined from 23 years of fisheries observer data. We used 0-inflated negative binomial models to evaluate variables influencing seabird bycatch per unit effort (BPUE) in 2 target fisheries. Following adoption of streamer lines, at first voluntarily and then mandatorily, seabird BPUE was reduced by 77-90%, preventing mortality of thousands of birds per year. Despite this, BPUE increased significantly in 2 of 4 target fisheries since streamer lines were adopted. Although night setting yielded significant reductions (74-97%) in seabird BPUE and significant increases (7-11%) in fish catch per unit effort over daytime setting, nighttime setting increased the BPUE of Northern Fulmar (Fulmarus glacialis) by 40% and nontarget fish species by 5-17%. Thus, best practices to prevent seabird mortalities in longline fisheries varied by species assemblage and fishery. Our results inform global efforts toward fisheries bycatch reduction by illustrating that successful conservation requires fishery-specific solutions, strong industry support, constant vigilance in analysis and reporting observer data, and ongoing outreach to fleets, especially to vessels with anomalously high BPUE.

Jargon: A barrier in case history taking? - A cross-sectional survey among dental students and staff

Background:

The use of jargon has become very common in the healthcare field, especially in medical/dental records. Although the use of standard medical jargon can be seen as professional, efficient shorthand, a lack of awareness regarding the standard medical abbreviations and incessant and overzealous use of slang among the healthcare professionals can act as a barrier to effective communication and understanding among patients and peers. The aim of this study was to assess the acceptance and use of jargon in case history taking among clinical dental students and dental teaching faculty members of dental colleges in Ernakulam and Idukki districts of Kerala.

Materials and Methods:

A cross-sectional questionnaire-based survey was carried out, consisting of 15 questions, to assess the objectives of the study. The study was conducted among clinical dental undergraduate students, house surgeons, postgraduate students and teaching faculty members of five dental colleges in Ernakulam and Idukki districts, Kerala. The results were expressed as a number and percentage of response for each question and Chi-squared test was used for inferential statistical analysis.

Results:

All the 549 respondents used jargon in case history taking. Approximately 22.4% of the respondents admitted that they always used jargon and 55.8% admitted of using jargon only when there was a lack of time. The majority of the respondents (71.4%) learned the jargon from their colleagues. Approximately 50% of the respondents admitted use of jargon in a history section and about 32% of the respondents in all the sections of case history taking. Approximately 74% were of the opinion that abbreviations should be permitted in case history taking.

Conclusion:

This study showed widespread use of jargon/abbreviations in case history taking among the respondents. There is a lack of knowledge regarding standard medical abbreviations. Although the majority of the respondents were comfortable with the use of jargon, the majority of the postgraduates and faculty members felt the use of jargon should be stopped.

The Ecology of Sustainable Implementation: Reflection on a 10-Year Case History Illustration

The primary aim of this paper is to illustrate the strategic and ecological nature of implementation. The ultimate aim of implementation is not dissemination but sustainability beyond the implementation effort. A case study is utilized to illustrate these broad and long-term perspectives of sustainable implementation based on qualitative analyses of a 10-year implementation effort. The purveyors aimed to develop selective community prevention services for children in families burdened by parental psychiatric or addictive problems. Services were gradually disseminated to 23 sites serving 40 municipalities by 2013. Up to 2013, only one site terminated services after initial implementation. Although many sites suspended services for shorter periods, services are still offered at 22 sites. This case analysis is based on project reports, user evaluations, practitioner interviews, and service statistics. The paper focuses on the analyses and strategies utilized to cope with quality decay and setbacks as well as progress and success in disseminating and sustaining the services and their quality. Low-cost multilevel strategies to implement services at the community level were organized by a prevention unit in child psychiatry, supervised by a university department (purveyors). The purveyors were also involved in national and international collaboration and development. Multilevel strategies included manualized intervention, in-practice training methods, organizational responsibility, media strategies, service evaluation, staff motivation maintenance, quality assurance, and proposals for new law regulations. These case history aspects will be discussed in relation to the implementation literature, focusing on possible applicability across settings.

Indolent pneumonia in a pregnant recent immigrant from Ethiopia: think TB

Time delay to tuberculosis (TB) diagnosis remains a public health concern. In pregnancy, early TB diagnosis is challenging and acquires further significance due to the risk of infection of the newborn as well as others in the maternity setting. We report a delay of 12 weeks in the diagnosis of TB in a pregnant recent immigrant from Ethiopia to Israel. Contact investigation revealed pulmonary TB in her two daughters aged four and seven years. We discuss the reasons for this delay in diagnosis, how a more timely diagnosis might have been made, and the dilemma of initiating treatment in unconfirmed TB.

Rehabilitation and multiple limb amputations: A clinical report of patients injured in combat

This clinical report describes the outpatient rehabilitation program for patients with multiple limb amputations enrolled in the Comprehensive Combat and Complex Casualty Care facility at the Naval Medical Center San Diego. Injury-specific data for 29 of these patients wounded by blast weaponry in Afghanistan in 2010 or 2011 were captured by the Expeditionary Medical Encounter Database at the Naval Health Research Center and were reviewed for this report. Their median Injury Severity Score was 27 (N = 29; range, 11-54). Patients averaged seven moderate to serious injuries (Abbreviated Injury Scale scores ≥2), including multiple injuries to lower limbs and injuries to the torso and/or upper limbs. All patients received care from numerous clinics, particularly physical therapy during the first 6 mo postinjury. Clinic use generally declined after the first 6 mo with the exception of prosthetic devices and repairs. The clinical team implemented the Mayo-Portland Adaptability Inventory, 4th Revision (MPAI-4) to assess functioning at outpatient program initiation and discharge (n = 23). At program discharge, most patients had improved scores for the MPAI-4 items assessing mobility, pain, and transportation, but not employment. Case reports described rehabilitation for two patients with triple amputations and illustrated multispecialty care and contrasting solutions for limb prostheses.

Evolution of diagnostic criteria in psychoses

The term psychosis was first introduced in the mid-19th century for the separation of psychiatric disorders from neurological disorders within the neuroses. The concept of psychosis has become gradually restricted from a generic term for psychiatric disorders to one of the major classes of mental illness, which was assumed to be the result of a disease process, and, more recently, to a symptom present in many psychiatric disorders. In the course of this development, the díagnostic criteria for psychosis shifted from the severity of the clinical manifestations and the degree of impairment in social functioning to the presence of one or more symptoms in a set of psychopathological symptoms, which include hallucinations, formal thought disorder manifest in disorganized or odd speech, delusions, flat/inappropriate affect, avolition/apathy disorganized behavior, catatonic motor behavior, and depersonalization/derealization. The changes in the conceptualization of psychosis and in the diagnostic criteria for psychosis are documented in the various editions of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Assocíation (from DSM-I to DSM-IV] and the International Classification of Diseases of the World Health Organization (from ICD-9 to ICD-10].

The Impact of Pharmaceutical Side Effects on Audiological and Vestibular Measurements

There are over 2,000 drugs with a combined total of over 400 side effects that could result in obtaining inaccurate case history information or inaccurate test results that may lead to misdiagnosing the patient's hearing or vestibular problem. The recommendations that are made could be inappropriate and thus can lead to management errors. A review of the auditory, vestibular, and cognitive side effects of many of the drugs patients take regularly (including drugs that can cause tinnitus) is provided. This article offers suggestions to obtain a more accurate case history. A review of preferred Web sites to obtain drug side effect information is included. Suggestions for improved communication strategies between the audiologist, the physician, the patient, and the pharmacist are highlighted.

Experiences with a psychosocial screening instrument (S-FIRST) to identify the psychosocial support needs of parents of children suffering from cancer

OBJECTIVES

A large proportion of families with a child suffering from cancer are heavily burdened, both psychologically and socially functions, thus requiring treatment. Therefore, a systematic assessment of burden and needs is essential to identify clients with a high psychosocial burden and to allow for accurate decision making regarding indications for treatment. There is a great need for the development and validation of screening instruments in psychosocial counseling.

METHODS

The receiver operating characteristic curve is a basic method to evaluate the discriminatory power of diagnostic tests. We computed sensitivity/specificity indices based on a sample of parents of pediatric cancer patients; the parents were screened with the S-FIRST and completed another standardized instrument with reliable indicators.

RESULTS

We found significant area under the curve (AUC) values from 0.671 to 0.882, meaning that the S-FIRST screening instrument has small to medium discriminatory power.

CONCLUSION

Our results support the use of a screening instrument for case history analyses in psychosocial counseling to identify clients with a high psychosocial burden.

Akathisia treated with olanzapine: Three case reports

There have been reports of clozapine being used in the treatment of neuroleptic-induced akathisia. However, due to clozapine's side effects, its use has been limited. Olazapine has been shown to have a similar receptor occupancy to that of clozapine and also a similar chemical structure. We present three case histories where the commencement of olanzapine has had a dramatic improvement of in the symptoms of akathisia induced by other neuroleptics.

Investigating current clinical practice in assessment and diagnosis of voice disorders: A cross-sectional multidisciplinary global web survey

BACKGROUND

Published best-practice guidelines and standardized protocols for voice assessment recommend multidisciplinary evaluation utilizing a comprehensive range of clinical measures. Previous studies report variations in assessment practices when compared with these guidelines.

AIMS

To provide an up-to-date evaluation of current global multidisciplinary practice patterns and the opinions of otolaryngologist, ear, nose and throat (ENT) and speech-language pathology (SLP) clinicians on initial assessment and differential diagnosis of adults with voice disorders (VDs).

METHODS & PROCEDURES

ENTs and SLPs worldwide who had worked with VDs within the last 10 years completed an anonymous online survey. Themes explored demographic information about the clinical practice, information about diagnostic assessment pathways, clinical assessments routinely used for initial voice evaluation and clinician perceived value of clinical assessments important for diagnosis.

OUTCOMES & RESULTS

Patterns in the clinical practice of 88 SLPs and 21 ENTs from 18 countries with 1 to more than 25 years' experience were analysed. Clinicians provided services across a range of locations, and a range of assessment pathways was available for initial evaluation. Case history, laryngoscopy and auditory-perceptual measures were the most frequently selected assessments. Most clinicians favoured formal assessment measures for auditory-perceptual evaluation. Clinicians placed equal weighting on ENT and SLP assessment to aid diagnosis for muscle tension VDs and functional neurological voice disorders (FVDs).

CONCLUSIONS & IMPLICATIONS

Practice patterns for initial diagnostic voice assessment are largely consistent with the currently published guidelines. Decisions for the selection of assessment tools vary according to VD classification, and assessment decisions appear to be guided by case history. Clinicians are not always following established protocols for obtaining reliable standardized measures. Further research is needed to understand the barriers to adhering to standardized protocols and to develop evidence for the use of case history in the process of VD diagnosis.

WHAT THIS PAPER ADDS

What is already known on the subject Best-practice guidelines recommend a multidisciplinary and multidimensional assessment of adults with vocal symptoms. Prior uni-disciplinary survey studies have reported a divergence in clinical practice with the recommended guidelines. No previous studies have examined otolaryngologists and SLPs concurrently to investigate the multidisciplinary approach clinicians' use in a diagnostic voice assessment. What this paper adds to the existing knowledge This study highlights new insights into multidisciplinary voice evaluation practice patterns with an emphasis on diagnostic assessment from a global perspective. The findings build on prior research exploring clinical assessment pathways, service utilization and clinicians' preferences when selecting clinical tools to inform a differential diagnosis. What are the potential or actual clinical implications of this work? This paper provides insights to inform future service and resource planning to ensure the delivery of evidenced-based diagnostic assessment pathways. This study also makes recommendations for areas of future research to understand barriers to clinicians following recommended best-practice guidelines.

Hopeless Cases: Queer Chronicities and Gertrude Stein's "Melanctha"

For this contribution to the special issue on "Mapping Queer Bioethics," the author offers a reflection on the nature of the literary, written word as the ethically fraught site of queer bioethics. By invoking the historical tendencies and tropes of the clinical case history alongside a seminal text by Gertrude Stein, the author at once asks if we should liberate a queer bioethics from biomedical discourse via mainstream narrative; or if we should see this strategy as unavoidably housed in narrative forms of storytelling because it echoes the tropes and stakes of the clinical, pathologized case history as regards queer sensibilities.