Occurrence of major complications after cochlear implant surgery in Ireland.

OBJECTIVES: Cochlear implantation (CI) is considered an effective and relatively safe procedure for patients with severe-profound hearing loss. However, severe complications are reported in several studies. The purpose of this study was to report the frequency and management of major complications following CI surgery at the National CI Programme (NCIP) in Ireland. METHODS: Major complications were defined according to the classification of Hansen et al. 2010. The medical records of 1017 patients undergoing CI between 1995 and 2016 were analyzed retrospectively for major complications. In addition, radiological and intraoperative findings as well as therapeutic management of all patients with a major complication were reviewed. RESULTS: Altogether, 1017 patients underwent 1266 CI surgeries. The median follow-up of all CI surgeries was 44 months. The total number of major complications identified was 21 which corresponds to an overall rate of 1.7%. The majority of major complication (71%) occurred at least one week after surgery. The most common major complications were internal receiver/stimulator protrusion and migration (6/21), followed by migration of the electrode array (4/21) and recurrent otitis media requiring re-implantation (4/21). All patients with major complications required additional surgery, with reimplantation necessary in 19 patients (90%). DISCUSSION: CI surgery is a safe surgical procedure for hearing rehabilitation associated with a low rate of severe complications. However, major complications can occur many years after surgery, making revision surgery necessary. CONCLUSION: Long-term follow-up is necessary for the early identification of complications to facilitate appropriate care.

Si vous êtes chargé de ... : guide de gestion à l' usage des responsables des soins de santé primaires / Rosemary McMahon, Elizabeth Barton et Maurice Piot ; en collaboration avec Naomi Gelina et Felton Ross / On being in charge : a guide to management in primary health care / Guía para la gestión de la atención primaria de salud

Ce livre est la deuxième édition révisée d'un guide de formation très populaire, traduit en 16 langues, conçu pour aider les agents de santé, et notamment les infirmières, les sages-femmes et les auxiliaires médicaux, à améliorer leurs compétences gestionnaires. Constatant le lien étroit qui existe entre une bonne gestion et des soins de santé de qualité, ce manuel explique comment utiliser un large éventail d'outils gestionnaires simples pour tirer le meilleur profit de maigres ressources, par une meilleure gestion du temps ou par un gaspillage moindre des médicaments. L'ouvrage propose de nombreux exercices et présente des exemples pratiques, des études de cas, des illustrations, des tableaux et des échantillons de formulaires qui aideront le lecteur à adopter une attitude orientée vers la solution des problèmes et lui donneront des conseils et des suggestions pour ses problèmes de tous les jours. Le guide est divisé en 14 chapitres divisés en quatre grande parties, chacune d'entre elles pouvant être étudiée séparément ou comme partie d'un tout, en fonction des besoins d'apprentissage individuels. L'exercice préliminaire, qui a rencontré beaucoup de succès dans la première édition, aide le lecteur à diagnostiquer ses carences gestionnaires et le guide vers les chapitres qui l'aideront à combler ses lacunes. Chaque chapitre commence avec une description des objectifs d'apprentissage et chaque partie se termine avec des exercices destinés à faciliter l'apprentissage individuel et la solution de problèmes en équipes. Cette deuxième édition offre 70 nouvelles pages de solutions proposées aux exercices

On being in charge : a guide to management in primary health care / by Rosemary McMahon, Elizabeth Barton & Maurice Piot ; in collaboration with Naomi Gelina & Felton Ross / Si vous êtes chargé de ... : guide de gestion à l' usage des responsables des soins de santé primaires / Guía para la gestión de la atención primaria de salud

A practical, instructive training guide that has proven its capacity to improve the managerial skills of middle-level health workers responsible for the management or supervision of health services. Presented as an activity-centered working guide, the book uses numerous questionnaires, exercises, practical examples, illustrations, charts, and sample forms to help readers relate advice and suggestions to their own daily problems. Emphasis is placed on ways to improve the management of health services provided by full-time, qualified staff. The guide features 18 chapters presented in four main parts, any one of which can be studied separately or as part of the whole, according to individual learning needs. The first provides a straightforward explanation of the general principles and functions of management. Part two is concerned with personal relations, offering advice on how to encourage and coordinate a health team, communicate with groups of people, and supervise in a supportive way. The third and most extensive part presents problem-solving methods for the management of common problems involving equipment, drug supply, money, time, space in the office or clinic as well as in the community, and paperwork. The guide concludes with chapters addressing the management of primary health care services, including advice on how to plan, implement, and evaluate health activities. Each chapter begins with a statement of learning objectives and each part concludes with a number of exercises to facilitate self-learning. Widely used and highly praised, published in 1980 and reprinted many times since, the book has demonstrated its enduring value as both a problem-solving reference work and a training guide for the testing and development of managerial skills