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Exploring listening-related fatigue in children with and without hearing loss using self-report and parent-proxy measures
Get PDFChildren with hearing loss appear to experience greater fatigue than children with normal hearing (CNH). Listening-related fatigue is often associated with an increase in effortful listening or difficulty in listening situations. This has been observed in children with bilateral hearing loss (CBHL) and, more recently, in children with unilateral hearing loss (CUHL). Available tools for measuring fatigue in children include general fatigue questionnaires such as the child self-report and parent-proxy versions of the PedsQLTM-Multidimensional Fatigue Scale (MFS) and the PROMIS Fatigue Scale. Recently, the Vanderbilt Fatigue Scale (VFS-C: child self-report; VFS-P: parent-proxy report) was introduced with a specific focus on listening-related fatigue. The aims of this study were to compare fatigue levels experienced by CNH, CUHL and CBHL using both generic and listening-specific fatigue measures and compare outcomes from the child self-report and parent-proxy reports. Eighty children aged 6-16 years (32 CNH, 19 CUHL, 29 CBHL), and ninety-nine parents/guardians (39 parents to CNH, 23 parents to CUHL, 37 parents to CBHL), completed the above fatigue questionnaires online. Kruskal-Wallis H tests were performed to compare fatigue levels between the CNH, CUHL and CBHL. To determine the agreement between parent-proxy and child self-report measures, Bland-Altman 95% limits of agreement were performed. All child self-report fatigue measures indicated that CBHL experience greater fatigue than CNH. Only the listening-specific tool (VFS-C) was sufficiently able to show greater fatigue in CUHL than in CNH. Similarly, all parent-proxy measures of fatigue indicated that CBHL experience significantly greater fatigue than CNH. The VFS-P and the PROMIS Fatigue Parent-Proxy also showed greater fatigue in CUHL than in CNH. Agreement between the parent-proxy and child self-report measures were found within the PedsQL-MFS and the PROMIS Fatigue Scale. Our results suggest that CBHL experience greater levels of daily-life fatigue compared to CNH. CUHL also appear to experience more fatigue than CNH, and listening-specific measures of fatigue may be better able to detect this effect. Further research is needed to understand the bases of fatigue in these populations and to clarify whether fatigue experienced by CBHL and CUHL is comparable in nature and degree
Feasibility within-subject RCT of neuromuscular electrical stimulation; an Intervention to Maintain and improve neuroMuscular function during period of Immobility (IMMI)
Get PDFINTRODUCTION: Neuromuscular electrical stimulation (NMES) is a potentially effective intervention to improve outcomes after a fragility fracture, but its feasibility in this group has not been established., METHODS: A feasibility study was conducted in two phases: 1) in the hospital only, and 2) hospital, rehabilitation centres, and participants' homes. Patients with fragility fracture were randomised to receive NMES for 6 weeks/discharge either to the right or left leg, with the other leg serving as control. Patients who had no mobility issues had contraindications to NMES and were unable to give consent were excluded. NMES was applied to quadriceps and tibialis anterior muscles for 30 min, 3 days/week. Sessions were progressed to achieve 60 min, 5-7 days/week. Feasibility outcomes included participant characteristics, recruitment rate, tolerability, and number of NMES sessions. Clinical outcomes included muscle strength, and ADL at six months., RESULTS: Overall, 1052 patients were identified, of whom 113 (11%) were eligible, and 29 (3%) were recruited (median Clinical Frailty Score 3, median Barthel ADL score 93/100). The recruitment rate was 0.45/week in phase 1 and 0.9/week in phase 2. Fifty-three percent achieved the target of 24 NMES sessions. However, 5/29 withdrew due to intolerance of NMES. Leg muscle strength improved in both treated and untreated legs, with marginally greater improvement observed in the tibialis anterior of treated legs., CONCLUSION: Although it would be feasible to evaluate the specific effect of NMES in fragility fracture patients in a multi-centre trial using home-based NMES, this would be possible only in a minority of mildly frail fragility fracture patients with little premorbid disability. Copyright © 2024. The Author(s).https://doi.org/10.1007/s41999-024-01133-
Falls risk stratification. One size doesn't fit all
No full textAvailable to read at the publisher's website here: https://doi.org/10.1093/ageing/afae292.https://doi.org/10.1093/ageing/afae29
Transcranial Direct Current Stimulation (tDCS) and online wellbeing training used at home for perinatal and maternal loss patients with adiagnosis of depression: depression, real world-functioning, and quality of life outcomes
Get PDFCopyright © 2025 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/Background: There is a high prevalence of depression in the perinatal period and for women who experience maternal loss, which is linked to worse real-world functioning and quality of life. Research evidence indicates that transcranial direct current stimulation (tDCS) can reduce symptoms of depression. Flow FL-100 is a tDCS device self-administered by a patient at home in combination with a software application-delivered wellbeing behaviour therapy training. Training modules include: “Behaviour activation”, “Mindfulness”, “Exercise for your brain”, “An anti-depression diet”, and “Therapeutic sleep”. Purpose/Aim: This study is the first to introduce Flow FL-100 tDCS in combination with a software application-delivered wellbeing behaviour therapy training into a Specialist Perinatal Mental Health Service and Maternal Mental Health Service. In addition to the support and interventions provided by these services, this study investigated the impact on depression, real-world functioning, and health-related quality of life for patients diagnosed with depression. Methods: An open-label patient cohort design with no control group. Baseline and 6-week follow-up assessments were completed using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Results: Twenty-five female patients completed six weeks of tDCS treatment. Their average age was 36 years, and their ages ranged from 27 to 42 years. Reliable improvement and remission rates for PHQ-9 were 64% and 52%, respectively. PHQ-9 and WSAS scores significantly improved, with large effect sizes. EQ-5D-5L results showed significant improvements in the EQ health index score and EQ-VAS score, with medium effect sizes. Conclusion: tDCS and online wellbeing behaviour therapy training can be successfully integrated into Perinatal Mental Health Service and Maternal Mental Health Service depression treatment offer. This study’s findings provide evidence that tDCS and online wellbeing behaviour therapy training delivered in conjunction with the interventions provided by Specialist Perinatal Mental Health and Maternal Loss Psychology Services for patients with depression diagnosis can provide improvements in depression symptoms, functioning and quality of life. It is important to be able to offer an evidence-based addition and/or alternative to existing depression treatments (antidepressant medication and psychotherapies).https://www.scirp.org/journal/paperinformation?paperid=14197
Male breast cancer: a single institutional clinicopathological profiling
No full textBackground/Aim: Male breast cancer (MBC) is an infrequent occurrence accounting for <1% of overall breast cancers. With limited data, MBC remains a therapeutic challenge, warranting the need for meticulous recording of all cases encountered. Patients and Methods: A retrospective observational study in an Indian tertiary public hospital where 29 MBC cases registered between August 2020 and July 2023 were recorded and their epidemiological data, clinical profile, treatment history and survival data were analyzed. Results: MBC was 3% of all breast cancer cases reported in three years, and the most common age group affected was between 41 and 60 years. Most cases presented at Stage IIIB, with the majority showing axillary nodal involvement. Invasive ductal carcinoma was the most frequent histology with luminal B and triple-negative variants having the highest incidence. Most patients underwent upfront surgery followed by adjuvant chemotherapy. At the end of one year, 50% of patients were found to survive with no disease progression. Conclusion: Our results corroborate with previously recorded experience with MBC in terms of age distribution, stage of presentation, histology and treatment offered. However, our results demonstrated a higher proportion of triple-negative breast cancer (TNBC) cases, as compared to previous literature. The increment of TNBC cases among males, therefore, reassures the need for breast cancer (BRCA) gene testing among all males afflicted with breast cancer.https://ar.iiarjournals.org/content/45/3/1097.lon
Management and mitigation of metabolic bone disease and cardiac adverse events throughout the prostate cancer pathway: clinical review and practical recommendations
No full textSome current prostate cancer (PCa) treatment regimens are known to have adverse effects on bone, for example androgen deprivation therapy (ADT), and on cardiovascular health, for example ADT and antiandrogen therapy. Strengthened recommendations for the practical assessment and management of bone and cardiovascular health in men with PCa are needed. This review aims to provide practical guidance for healthcare providers along the continuum of patient care on the management of bone and cardiovascular health in men with PCa undergoing ADT and antiandrogen therapy based on real-world evidence. Evidence was identified by searching PubMed for publications that reported the effects of PCa treatment on bone or cardiovascular health in a real-world setting and were published between January 2017 and August 2023. Review articles were excluded. The evidence identified indicates that ADT decreases bone mineral density (BMD) and increases the risk of osteoporosis and fractures. Bone-protecting agents (BPAs) are effective at improving bone health in patients undergoing ADT and antiandrogen therapy at all stages of the PCa pathway. Despite this, the use and timing of initiation of BPAs are variable. Furthermore, real-world studies have confirmed an association between ADT and cardiovascular risk. As survival outcomes improve, maintenance of bone and cardiovascular health is increasingly important in men with PCa. Risk is a continuous variable that must be assessed throughout the continuum of PCa treatment. Therefore, all men starting ADT should be assessed for bone and cardiovascular risk. Lifestyle adjustments, dietary supplementation and pharmacological intervention may be advised.https://www.tandfonline.com/doi/full/10.1080/03007995.2025.247075
Surgical presentations of Eosinophilic Gastroenteritis: a case report
No full textEosinophilic gastroenteritis (EGE) is a rare disorder characterized by eosinophilic infiltration of the gastrointestinal (GI) tract without any definitive cause of eosinophilia. It presents with various non-specific GI symptoms, depending on the affected site and layer of involvement, often leading to delayed diagnosis and treatment. While the primary treatment consists of oral corticosteroids, extreme cases may necessitate surgical intervention. We present a case of a 50-year-old female who arrived at the emergency department with a three-day history of vomiting, diffuse abdominal pain, and tachycardia. She underwent emergency surgery due to acute abdominal symptoms. Intraoperatively, a mass-like lesion was identified in the distal antrum of the stomach, causing pyloric narrowing. Histopathological examination confirmed EGE. The patient had previously undergone laparoscopic cholecystectomy and open appendectomy for abdominal pain, which we now believe were misdiagnosed as separate surgical pathologies when they were possibly early manifestations of EGE. After an extensive literature review, this may be the first reported case of EGE in Jordan and the first case requiring a surgical procedure in the country.https://www.cureus.com/articles/347774-surgical-presentations-of-eosinophilic-gastroenteritis-a-case-report#!
Persistent pulmonary hypertension among infants undergoing therapeutic hypothermia for Hypoxic Ischemic Encephalopathy: a systematic review and meta-analysis
No full textTo perform a systematic review and meta-analysis to examine the association between persistent pulmonary hypertension (PPHN) and receipt of therapeutic hypothermia (TH), compared to those who did not receive TH, among infants with moderate or severe hypoxic-ischemic encephalopathy (HIE). Systematic review and meta-analysis based on Ovid, Medline, Embase and Cochrane central searches from 01/01/2000 to 31/03/2025. We included only randomized control trials for meta-analysis and followed international guidelines for conducting systematic reviews. The primary outcome of the study was PPHN in infants undergoing TH for moderate to severe HIE. Among 185 articles identified using search strategy, 19 articles were assessed for eligibility. Eight randomized control trials (RCTs) met the inclusion criteria, and seven were included in meta-analysis. A random effects model used for the outcome of PPHN, comparing TH with NT or usual care, involving a pooled population of 1006 infants across seven studies. The relative risk of PPHN for TH versus NT was 1.13 (95% confidence interval 0.81 to 1.57). We noted risk of bias in the blinding of participants across included RCTs. We assessed nine observational studies and performed a narrative review. We noted that a considerable number of infants developed PPHN across TH and NT groups. We did not find evidence of an association between TH and PPHN in infants with moderate to severe HIE, although a considerable number of infants developed PPHN across both groups. We suggest that clinicians should be aware of the risk of PPHN to allow prompt investigation and management.https://www.liebertpub.com/doi/10.1177/2153765825137095
Mentorship Scheme - a Novel Approach for Plugging the Gap in Differential Attainment for Psychiatry Core Trainees in East Midlands
No full textAims: The MRCPsych results report and GMC annual report on trainee performance highlighted that UK PMQ candidates perform better than OS PMQ candidates and that White candidates perform better compared with candidates with other ethnic backgrounds. A mentoring scheme was designed as a proposed solution to bridge the gap of differential attainment in Core trainees in Psychiatry with a focus on improving ARCP outcome and Exam Pass rate in Psychiatry. Method(s): The Mentorship Scheme was piloted between August 2023 to August 2024 among Core trainees and Higher Trainees working in Psychiatry in Mental Health Trusts in East Midlands. Higher trainees took part in the project as mentors and were required to complete mentorship course from e-lfh hub prior to start of mentorship. The evaluation was of a longitudinal, prospective design. It spanned 12 months, with two waves of data collection. Using a mixed methods approach core trainees were required to complete survey with numerically rated items and open-ended questions pre- and post-intervention. Recruitment of core trainees and higher trainees was achieved through purposive sampling. A 18-item survey was designed to enable quantitative analysis of training needs in Psychiatry and qualitative analysis of conceptions of mentorship. There were a total of 9 Likert questions and 1 openended question that enabled free text entry for qualitative analysis. A 23-item questionnaire was designed to evaluate Mentees response post-mentorship scheme. Result(s): Pre-intervention: 75% identified career goals as an area that they would mostly likely value support with, closely followed by 68.3% reporting exam preparation, 31.3% reported support with e-Portfolio training and 25% with ARCP preparation as areas that they were hoping to get support with through mentorship. Post-intervention: 66.7% reported improvement in competence in areas of difficulty which included: 55.6% improvement in clinical skills. 44.4% improvement in exam preparation. 66.7% improvement in diary management. 33.3% improvement in ARCP preparation. 44.4% improvement in e-portfolio training. 88.9% valued the presence of having to speak to someone as a useful aspect of the mentoring scheme and 44.4% reported recommending mentoring scheme to other trainees. Conclusion(s): There is a breadth of evidence substantiating use of mentorship as a helpful tool in improving competence in doctors across different levels of their training. This finding was supported through a 12-month evaluation of the Mentorship scheme which appears to afford core trainees a cost-effective opportunity in improving training needs.https://www.cambridge.org/core/journals/bjpsych-open/article/mentorship-scheme-a-novel-approach-for-plugging-the-gap-in-differential-attainment-for-psychiatry-core-trainees-in-east-midlands/A492A4B02BFD1E983764FFC600917C8