[Computer-based auditory training for hearing rehabilitation of adult cochlear implant users]. / Computerbasiertes Hörtraining in der Hörrehabilitation Erwachsener nach Cochleaimplantation.

BACKGROUND: Digitalization has become a part of everyday life and digital applications offer an opportunity to promote health. In Germany, hearing rehabilitation after cochlear implantation (CI) typically takes place in specialized audiology centers. However, a variety of new auditory training programs have been developed and although most are for hearing aid users, some are suitable for CI patients. The purpose of this study is to give an overview of CBAT schedules and their effectiveness. MATERIALS AND METHODS: Currently available English and German CBAT programs for adult CI users identified in searches of Google, Google App Store, and Google Play Store were analyzed. A systematic literature search on studies dealing with CBAT in adult CI recipients from 2000 to 2019 was performed in PubMed, LIVIVO, and Google Scholar. RESULTS: German and English CBAT for adult hearing aid and CI users are generally intended to complement face-to-face therapies. The content of the programs differs primarily in terms of complexity and quantity of tasks, graphic design, allowed time and the device used. In contrast to the nine available German programs, some of the English CBAT include advanced concepts of adaptivity and feedback. Studies on the effectiveness of CBAT have mainly been conducted for the English versions and generally analyze only individual therapeutic subfunctions. All investigations show a short-term improvement of the auditory subfunction shortly after training. Unfortunately, the quality of the studies is low and follow-up results are only available in two cases. CONCLUSION: CBAT programs might be an effective option for auditory rehabilitation in CI patients. However, suitable German-language programs conceived as an alternative to face-to-face training and studies on longterm effects of CBAT are still lacking.

Risk of nonsteroidal anti-inflammatory drug-associated renal dysfunction among neonates diagnosed with patent ductus arteriosus and treated with gentamicin.

OBJECTIVE: To evaluate the risk of nonsteroidal anti-inflammatory drug (NSAID) therapy-associated acute kidney injury (AKI) among neonates diagnosed with patent ductus arteriosus (PDA) who are treated with gentamicin. STUDY DESIGN: Multicenter retrospective observational study of patients ⩽44 postmenstrual weeks of age diagnosed with PDA who received gentamicin during hospitalization between January 2006 and December 2014. Patients with and without NSAID exposure were matched on covariates associated with AKI and NSAID therapy. The primary end point, AKI, was defined according to Kidney Disease Improving Global Outcomes neonatal criteria. RESULTS: The rate of AKI for the entire cohort (n=594) was 12% (n=71). Among neonates receiving NSAIDS, 14.8% (n=44) experienced an AKI as compared to 9.1% (n=27) for those who were not exposed (relative risk, 1.6; 95% confidence interval, 1.0 to 2.6). Therefore, the attributable risk of NSAID use was 5.7% (95% confidence interval, 0.5 to 11.0). CONCLUSION: Among neonates with PDA and receiving gentamicin, NSAID therapy increases the risk of AKI by about 6%.

Use of Modeling and Simulation in the Design and Conduct of Pediatric Clinical Trials and the Optimization of Individualized Dosing Regimens.

Mathematical models of drug action and disease progression can inform pediatric pharmacotherapy. In this tutorial, we explore the key issues that differentiate pediatric from adult pharmacokinetic (PK) / pharmacodynamic (PD) studies, describe methods to calculate the number of participants to be enrolled and the optimal times at which blood samples should be collected, and therapeutic drug monitoring methods for individualizing pharmacotherapy. The development of pediatric-specific drug dosing dashboards is also highlighted, with an emphasis on clinical-relevance and ease of use.

How well does physician selection of microbiologic tests identify Clostridium difficile and other pathogens in paediatric diarrhoea? Insights using multiplex PCR-based detection.

The objective of this study was to compare the aetiologic yield of standard-of-care microbiologic testing ordered by physicians with that of a multiplex PCR platform. Stool specimens obtained from children and young adults with gastrointestinal illness were evaluated by standard laboratory methods and a developmental version of the FilmArray Gastrointestinal (GI) Diagnostic System (FilmArray GI Panel), a rapid multiplex PCR platform that detects 23 bacterial, viral and protozoal agents. Results were classified according to the microbiologic tests requested by the treating physician. A median of three (range 1-10) microbiologic tests were performed by the clinical laboratory during 378 unique diarrhoeal episodes. A potential aetiologic agent was identified in 46% of stool specimens by standard laboratory methods and in 65% of specimens tested using the FilmArray GI Panel (p < 0.001). For those patients who only had Clostridium difficile testing requested, an alternative pathogen was identified in 29% of cases with the FilmArray GI Panel. Notably, 11 (12%) cases of norovirus were identified among children who only had testing for Clostridium difficile ordered. Among those who had C. difficile testing ordered in combination with other tests, an additional pathogen was identified in 57% of stool specimens with the FilmArray GI Panel. For patients who had no C. difficile testing performed, the FilmArray GI Panel identified a pathogen in 63% of cases, including C. difficile in 8%. Physician-specified laboratory testing may miss important diarrhoeal pathogens. Additionally, standard laboratory testing is likely to underestimate co-infections with multiple infectious diarrhoeagenic agents.

Adequate anamnesis for the evaluation of hip function in elderly patients.

A study for the evaluation of hip function was carried out in a series of 102 patients who, together with an escort, visited the Outpatients Department for other than hip complaints. Questions derived from a number of known systems for hip assessment formed the basis of the interview and, if present, the degree of senile dementia was approximated. Auto-anamnesis proved to be sufficient for adequate hip assessment in 40 patients, in six of whom there was a mild senile dementia, and insufficient in 62 patients, in 53 of whom there was senile dementia. From the 102 patients, adequate anamnestic information was presented for proper hip assessment in only 57 percent of cases (n = 58). The results of this study show that the practical value of the current systems for hip assessment in elderly patients is rather limited.

Results of surgical treatment for hyperthyroidism.

UNLABELLED: In a 10-year period (1967-1977) 273 patients were operated upon for hyperthyroidism at the Department of Surgery of the St. Franciscus Gasthuis, Rotterdam. The evaluation of the results was carried out in 1978. A total of 205 patients appeared for investigations and drawing of blood samples. Total resection of one thyroid lobe and subtotal resection of the other lobe was the procedure of choce. RESULTS: 85% of the patients were euthyroid at the follow-up; 7% of the patients had a recurrent hyperthyroidism and 8% became hypothyroid. In three cases a persistent unilateral vocal cord paralysis was encountered. Surgery remains an effective and satisfactory method of treatment for appropriately selected cases, with a low rate of immediate and late complications.

Two cases of multiple gastric polyps.

Two cases of multiple gastric polyps are described. In both cases a large number of hyperplastic polyps were found in the antrum and body of the stomach. A total gastrectomy was performed in these two patients. Histologically the polyps were benign; in one case gastritis with metaplasia was present. The pathological and clinical aspects of multiple gastric polyps are discussed with reference to the literature.