Determining Peak Cough Flow Cutoff Values to Predict Aspiration Pneumonia Among Patients With Dysphagia Using the Citric Acid Reflexive Cough Test

Objective

To investigate the clinical usefulness of the peak cough flow generated during the citric acid reflexive cough test (0.28 mol/L) by determining the appropriate cutoff values that could accurately predict aspiration pneumonia within the first 6 months after onset.

Evaluation of speech intelligibility in short-reverberant sound fields

Objective

The purpose of this study was to explore the differences in speech intelligibility in short-reverberant sound fields using deteriorated monosyllables. Generated using digital signal processing, deteriorated monosyllables can lack the redundancy of words, and thus may emphasize differences in sound fields in terms of speech clarity.

Methods

Ten participants without any hearing disorders identified 100 monosyllables convolved with eight impulse responses measured in different short-reverberant sound fields (speech transmission index >0.6 and reverberation time <1 s), and we compared speech recognition scores between normal and deteriorated monosyllables. Deterioration was produced using low-pass filtering (cut off frequency = 1600 Hz).

Results

Speech recognition scores associated with the deteriorated monosyllables were lower than those for the normal monosyllables. In addition, scores were more varied among the different sound fields, although this result was not significant according to an analysis of variance. In contrast, the variation among sound fields was significant for the normal monosyllables. When comparing the intelligibility scores to the acoustic parameters calculated from eight impulse responses, the speech recognition scores were the highest when the reverberant/direct sound energy ratio (R/D) was balanced.

Conclusions

Although our deterioration procedure obscured differences in intelligibility score among the different sound fields, we have established that the R/D is a useful parameter for evaluating speech intelligibility in short-reverberant sound fields.     

Clinical deterioration of ward patients in the presence of antecedents: A systematic review and narrative synthesis

AimThe aim of this review was to identify and synthesise published accounts of recognising and responding to patient deterioration in the presence of deterioration antecedents.DesignThe systematic review canvassed four electronic databases/search engines for studies of adult ward patients who had altered physiological parameters before developing major adverse events.Synthesis MethodsThe findings were synthesised using a narrative approach.ResultsClinical deterioration can be missed by nurses, even with adequate charting. Delays in recognising and responding to patient deterioration remains an international patient safety concern, and strategies to enhance recognition of patient deterioration have not achieved consistent improvements. The lack of significant and sustained improvement through targeted training suggests the problem may be rooted in human behaviour and local ward culture. Nurses play a pivotal role in recognising and responding to patient deterioration; however, patient records do not facilitate tracking of all nurse decisions and actions, and any undocumented care cannot be easily captured by auditing processes.ConclusionFailure to recognise clinical deterioration was evident even with adequate charting. It is not clear if nurses do not recognise clinical deterioration because they failed to interpret the signs of deterioration or they made a conscious decision not to escalate based on their clinical judgement or they lacked attention at the time of the event. Whatever the reason, focus is warranted for nurses' decision-making after the recording of clinical deterioration signs and the role of human factors in delayed recognition, before maximum benefit of any strategy can be achieved.     

Deterioration/relapse of depression during pregnancy in Japanese women associated with interruption of antidepressant medications

This study examined the risk of deterioration/relapse in pregnant women who discontinued their antidepressant medications based on the discretion of the psychiatric specialists compared with those who performed self-interruption. We reviewed the obstetric records of all singleton deliveries beyond 22 weeks of gestation at Japanese Red Cross Katsushika Maternity Hospital from January 2009 through December 2015. Compared with the women continuing antidepressant medications throughout pregnancy, the incidence of deterioration/relapse was higher in the women who discontinued their antidepressant medications regardless of who made the decision (interruption based on the discretion of the psychiatric specialists: 61%, odds ratio (OR), 8.05; 95% confidence interval (CI), 2.4–27; p?p?相似文献   

Traumatic cervical artery dissection in head injury: The value of follow-up brain imaging

Introduction

Traumatic cervical artery dissection (TCAD) is a relative infrequent complication of traumatic brain injury (TBI). Since TCAD is associated with morbidity in a considerable percentage of patients, it is important to obtain clues for recognising TCAD in this category of patients.

Methods

Retrospective case-cohort study in severe TBI patients.

Results

Five patients with traumatic cervical artery dissection after severe TBI, leading to ischemic strokes, are described. Secondary deterioration to coma was present in four out of five patients during admission. The diagnosis of TCAD was delayed in most cases because the secondary deterioration was often attributed to multisystem problems related to trauma patients, i.e. shock or hypoxia or medication effects. Local clinical symptoms and signs suggestive of TCAD are difficult to detect in this patient group. In all patients, the CT-scan on admission demonstrated no abnormalities. A follow-up scan at day 2 revealed that in all patients abnormalities in the vascular territories had evolved.

Conclusion

With this case-cohort study we underline the importance of considering TCAD in severe TBI patients and emphasise the role for standard follow-up brain imaging. Also possible treatment consequences are discussed.     

Deterioration of suture materials at prosthetic–host anastomoses

We experienced a case of polypropylene suture rupture at anastomosis 5 years after fabric vascular graft implantation. Under a scanning electron microscope, the removed suture had a tapering-off breakage at the end and tortoiseshell-like deep cracks near the end. The tapered stump indicated that the suture had been stretched out gradually and had finally fractured.     

Following drug degradation and consequent taste deterioration of an oral reconstituted paediatric suspension during dosing interval via electronic tongue

BackgroundThe taste of oral liquid dosage forms is a crucial factor that impacts pediatric patient compliance. Taste of suspensions can be typically evaluated by human volunteers. Recently, the electronic tongue (ET) has been proven as an emerging tool that could be useful to follow up various formulations’ properties like taste and composition. This study aimed to evaluate the potential use of ET in assessing the taste deterioration of reconstituted oral suspensions and compare the results obtained with the typical in vivo panel taste method.MethodsFour commercially available brands of amoxicillin/ clavulanic acid suspensions (one brand and three generic formulations) were reconstituted and stored in refrigerator to assess their taste on a daily basis. The taste of these products was assessed using Alpha-Astree ET and the obtained results were compared with those obtained from an in vivo panel taste assessment using a hedonic panel test (the 5-point hedonic scale).ResultsAll evaluated suspensions exhibited similar trends. ET and in vivo analysis indicated low taste scores for all evaluated suspensions immediately after reconstitution, possibly due to the incomplete dissolution of sucrose. The scores for all formulations were higher on day 2, followed by a steady state for the next two days. After that, a significant decay in the scores was observed in the fifth day for all evaluated suspensions. ET results were in excellent agreement with the results obtained via in vivo panel test method.ConclusionThe ET seems to be promising for testing the taste of pharmaceutical liquid preparations and evaluate possible deterioration upon storage or after reconstitution. It may provide a platform to avoid the involvement of pediatric volunteers in clinical evaluation and can be employed as a quality control tool during manufacturing.     

The juvenile head trauma syndrome – Deterioration after mild TBI: Diagnosis and clinical presentation at the Emergency Department

Background

Annually 14.000 children with traumatic brain injury (TBI) are admitted to the Emergency Department (ED) in the Netherlands. Presentation varies and a specific entity comprises the juvenile head trauma syndrome (JHTS) with secondary deterioration after a mild trauma. As outcome of JHTS can be fatal, early recognition is essential.