A Multicenter Validity Study of Four Smartphone Hearing Test Apps in Optimized and Home Environments.

OBJECTIVE: Pure tone audiometry (PTA) is the gold standard for hearing assessment. However, it requires access to specialized equipment. Smartphone audiometry applications (apps) have been developed to perform automated threshold audiometry and could allow patients to perform self-administered screening or monitoring. This study aimed to assess the validity and feasibility of patients using apps to self-assess hearing thresholds at home, with comparison to PTA. METHODS: A multi-center, prospective randomized study was conducted amongst patients undergoing PTA in clinics. Participants were randomly allocated to one of four publicly-available apps designed to measure pure tone thresholds. Participants used an app once in optimal sound-treated conditions and a further three times at home. Ear-specific frequency-specific thresholds and pure tone average were compared using Pearson correlation coefficient. The percentage of app hearing tests with results within ±10 dB of PTA was calculated. Patient acceptability was assessed via an online survey. RESULTS: One hundred thirty-nine participants submitted data. The results of two at-home automated smartphone apps correlated strongly/very strongly with PTA average and their frequency-specific median was within ±10 dB accuracy. Smartphone audiometry performed in sound-treated and home conditions were very strongly correlated. The apps were rated as easy/very easy to use by 90% of participants and 90% would be happy/very happy to use an app to monitor their hearing. CONCLUSION: Judicious use of self-performed smartphone audiometry was both valid and feasible for two of four apps. It could provide frequency-specific threshold estimates at home, potentially allowing assessments of patients remotely or monitoring of fluctuating hearing loss. LEVEL OF EVIDENCE: 2 Laryngoscope, 134:2864-2870, 2024.

Informing ENT training bootcamps - operating out-of-hours: a multicentre prospective evaluation.

OBJECTIVE: ENT specialty trainees are invited to national bootcamps to prepare for critical events to which they may have never been exposed. Here, we evaluate the frequency of out-of-hours ENT operations and the level of supervision provided to inform aspiring trainees and the national bootcamps. METHODS: Information on all ENT operations performed out-of-hours was prospectively recorded by trainees in Kent, Surrey and Sussex over seven months. RESULTS: There was a 100 per cent response rate. The trainee was the most senior surgeon present for 48.4 per cent of out-of-hours operations. Four of the six most frequently performed out-of-hours operations are not included in the ENT indicator procedures, and two are not included in the national ENT bootcamps. CONCLUSION: Trainees should be aware of the most common procedures they may be expected to perform out-of-hours. Training in these should be provided prior to the commencement of specialty training. The audit design can be replicated across surgical specialties.

Combatting climate change using education and training in pharmacology and therapeutics.

The climate crisis has implications for the physical and mental health of people worldwide, while, paradoxically, healthcare itself contributes significant greenhouse gas emissions. Healthcare professionals need to be prepared to both mitigate the impacts of climate change and also manage the health effects of the climate crisis. Widespread adoption of sustainable healthcare models is required, with sustainability-driven improvements in clinical pharmacology intrinsically linked to this. Recognizing that education and training are essential steps to equip medical professionals with the knowledge to face the unprecedented challenges that the climate crisis presents, here, with reference to pharmacology and therapeutics, we discuss how the theme of Education for Sustainable Healthcare (ESH) can be integrated into undergraduate and postgraduate teaching programmes and how barriers to successful implementation can be tackled. We support the use of the Principles of Sustainable Clinical Practice as a framework to guide educational interventions and draw upon examples of our own practice at Brighton and Sussex Medical School where ESH has become a core component of medical education in our undergraduate curriculum.

Should Sedillot's triangle be used for central venous cannulation? A cadaveric study.

Central venous access remains an integral part of perioperative and intensive care, and several methods have been described to locate the internal jugular vein (IJV) prior to cannulation. The apex of Sedillot's triangle between the manubrial and clavicular heads of the sternocleidomastoid (SCM) muscle is a commonly used anatomical landmark for a central percutaneous approach to the IJV, but the literature highlights failures and complications when adopting this method. This cadaveric study was designed to investigate the usefulness of Sedillot's triangle to locate the IJV. Sixty-one cadavers were used for investigation at the University of Cambridge Human Anatomy Centre. Sedillot's triangle was dissected and a pin was inserted in a sagittal plane at the apex of the triangle. The location of the pin in relation to the IJV was recorded. The distance between the sternal and clavicular heads of SCM was also measured. In total, the pin inserted at the apex of Sedillot's triangle pierced the IJV in 72/117 (61.5%) of dissections, with 71.4% on the right and 52.5% on the left. There was important variation in SCM anatomy, and there was no gap between its two heads in 12% of the neck dissections. We demonstrate an overall poor success rate of the central percutaneous approach using Sedillot's triangle, although our findings are limited being a simulated cadaveric study. We support education and use of ultrasound in addition to landmark techniques to aid the safe insertion of central venous catheters.

Surgical management of pneumomediastinum in the COVID-19 patient.

As the SARS-CoV-2 virus continues to infect millions of people worldwide, the medical profession is seeing a wide range of short-term and long-term complications of COVID-19. One lesser-known complication is that of pneumomediastinum. This is a rare, but significant, complication defined by the presence of air in the mediastinum with an incidence of 1.2 per 100 000. Described mortality rate is 30%, increasing to 60% in patients with concomitant pneumothoraces. Management of pneumomediastinum is typically conservative, but in cases of extensive subcutaneous emphysema, cardiac or airway compression, life-saving surgical decompression is necessary. We report a case of pneumomediastinum secondary to COVID-19, requiring a surgical approach not described in pneumomediastinum secondary to COVID-19. The case demonstrates the importance of prompt diagnosis and management, as well as the potential for good clinical outcome in selected patients.

Hydrazone- and imine-containing [PdPtL4]4+ cages: a comparative study of the stability and host-guest chemistry.

A new [PdPtL4]4+ heterobimetallic cage containing hydrazone linkages has been synthesised using the sub-component self-assembly approach. 1H and DOSY nuclear magnetic resonance (NMR) spectroscopy and electrospray ionisation mass spectrometry (ESIMS) data were consistent with the formation of the [PdPtL4]4+ architecture. The cage was stimulus-responsive and could be partially disassembled and reassembled by the addition of dimethylaminopyridine (DMAP) and p-tolenesulfonic acid (TsOH), respectively. Additionally, the stability of the hydrazone cage against hydrolysis in the presence of water and nucleophilic decomposition in the presence of guest molecules was compared to a previously synthesised imine-containing [PdPtL4]4+ cage. It was established that the hydrazone linkage was more resistant to hydrolysis. Furthermore, the host-guest (HG) chemistry with a series of drug and drug-like molecules was examined. The hydrazone cage was shown to interact with cisplatin while the smaller imine cage was shown to interact with 5-fluorouracil and oxaliplatin in CD3CN. No HG interactions were observed in the more polar d6-DMSO. In vitro antiproliferative activity studies demonstrated both cages were active against the cancer cell lines tested and displayed half-maximal inhibitory (IC50) values in the range of 25-35 µM. Most [PdPtL4]4+-drug mixtures tested had higher IC50 values than the hosts. However, the [PdPtL4]4+ cages, and [PdPtL4]4+:drug mixtures were less cytotoxic than the well established anticancer drugs cisplatin, oxaliplatin and 5-fluorouracil.

Prevalence and correlates of major depressive disorder: a systematic review

Objectives: Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD. Methods: A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018. Results: Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies. Conclusions: MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder's prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.

Climate change in healthcare: Exploring the potential role of inhaler prescribing.

Climate change has been described as the biggest global health threat of the 21st century. As a result, governments around the world are committing to legislative change in order to reduce greenhouse gas emissions (GHGEs). The healthcare sector makes a significant contribution to GHGEs and in line with national legislation in the UK, the NHS has recently committed to achieving net zero emissions by 2050. The management of asthma and COPD largely depends on the prescribing of medications that are delivered through inhalers. In the UK, the use of pressurized metered dose inhalers (pMDIs), which rely on hydrofluorocarbon (HFC) propellants accounts for 3.5% of the NHS's total carbon footprint. In contrast, dry powder inhalers (DPIs) have a much lower carbon footprint due to the absence of a HFC propellant. Here we review evidence of the impact of inhaler choices across four domains: environmental impact, clinical effectiveness, cost effectiveness and patient preferences. We find that as well as a lower global-warming potential, DPIs have additional benefits over pMDIs in other domains and should be considered first line where clinically appropriate.

Prevalence and correlates of major depressive disorder: a systematic review.

OBJECTIVES: Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD. METHODS: A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018. RESULTS: Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies. CONCLUSIONS: MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder's prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.

Apps for Depression: Are They Ready to Work?

PURPOSE OF REVIEW: To summarize the latest evidence about mobile phone applications for the management of depression. RECENT FINDINGS: Depression apps are very heterogeneous, given the absence of standards for their development, description, and evaluation. Randomized clinical trials show the effectiveness of some of these applications in reducing depressive symptoms. Attrition is an important issue whose evaluation is limited by the frequent use of incentives in the studies. The number of mobile applications for depression far exceeds the number of studies evaluating their efficacy and feasibility. Despite the limitations of the digital market, there are a small number of apps that have demonstrated sufficient effectiveness and tolerability to think of short-term clinical use. However, there are still barriers at different levels that may delay the implementation of these interventions in daily clinical practice.

Erratum: A symptom-based approach to treatment of psychosis in autism spectrum disorder in October 2017-ERRATUM.

[This corrects the article DOI: 10.1192/bjo.2017.2.].

A symptom-based approach to treatment of psychosis in autism spectrum disorder [corrected].

The optimal management of autism with psychosis remains unclear. This report describes a 22-year-old man with autism and psychosis who was referred to a tertiary-level specialist psychosis service, following a 6-year history of deterioration in mental health starting around the time of sitting GCSE examinations and an episode of bullying at school. We describe the individualised symptom-based approach that was effective in his treatment. Declaration of interest The authors declare no conflict of interest.