Tinnitus referral pathways within the National Health Service in England: a survey of their perceived effectiveness among audiology staff

<p>Abstract</p> <p>Background</p> <p>In the UK, audiology services deliver the majority of tinnitus patient care, but not all patients experience the same level of service. In 2009, the Department of Health released a Good Practice Guide to inform commissioners about key aspects of a quality tinnitus service in order to promote equity of tinnitus patient care in UK primary care, audiology, and in specialist multi-disciplinary centres. The purpose of the present research was to evaluate utilisation and opinions on pathways for the referral of tinnitus patients to and from English Audiology Departments.</p> <p>Methods</p> <p>We surveyed all audiology staff engaged in providing tinnitus services across England. A 36-item questionnaire was mailed to 351 clinicians in all 163 National Health Service (NHS) Trusts identified as having a tinnitus service. 138 clinicians responded. The results presented here describe experiences and opinions of the current patient pathways to and from the audiology tinnitus service.</p> <p>Results</p> <p>The most common referral pathway was from general practice to a hospital-based Ear, Nose & Throat department and from there to a hospital-based audiology department (64%). Respondents considered the NHS tinnitus referral process to be generally effective (67%), but expressed needs for improving GP referral and patients' access to services. 'Open access' to the audiology clinic was rarely an option for patients (9%), nor was the opportunity to access specialist counselling provided by clinical psychology (35%). To decrease the number of inappropriate referrals, 40% of respondents called for greater awareness by referrers about the audiology tinnitus service.</p> <p>Conclusions</p> <p>Respondents in the present survey were generally satisfied with the tinnitus referral system. However, they highlighted some potential targets for service improvement including 1] faster and more appropriate referral from GPs, to be achieved through education on tinnitus referral criteria, 2] improved access to psychological services through audiologist training, and 3] ongoing support from tinnitus support groups, national charities, or open access to the tinnitus clinic for existing patients.</p

Influence of Manganese on Ochratoxin A Detoxification in Rats

The Influence of manganese on ochratoxin A detoxification was studied in 3- month old female white albino rats administered with 0.00, 500 and 500μg/kg body weight of ochratoxin A intraperitoneally daily for five days. In addition to the ochratoxin A, 0.5ml of 5% Manganese (II) chloride was administered to one of the test groups by intubation. The rats were monitored for mortality and clinical signs for five days before sacrifice. Serum samples were assayed for liver enzymes and kidney biomarkers. Histopathological examinations of the liver and kidney were conducted. The results showed that the administration of 500μg/kg body of ochratoxin A caused injury to the liver and kidney of the test groups though it was milder in the group given manganese and there was no mortality recorded. There was a significant increase (P&lt; 0.05) in activities of the enzymes aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and Alkaline Phosphatase (ALP) in the test groups, while it was a non significant (P &gt; 0.05) increase for creatinine level. Histopathological examinations showed degeneration of portal nuclei , walls of porteries and veins, pericholongitis, congestion of portal vessels by white blood cells, hepatocellular necrosis and perivascular cuffing in the liver and lymphocytic infiltration, haematin fragments, edema and tubular necrosis in the kidney of the test groups only. This study indicates clearly that manganese no significant influence on ochratoxin A detoxification.Key Words: Ochratoxin A, Biochemical, Histological, Detoxification, Manganese, Rats

Chemical Constituents of Essential Oil of Lantana camara Linn. Leaves

Abstract: The determination of the chemical profile of essential oil of the leaves of Lantana camara Linn. was undertaken in this study. Essential oil was extracted from the dried leaf sample using hydro distillation method. Gas Chromatograph coupled with Mass Spectrometer (GC-MS) was used for chemical analysis of the extracted essential oil. Eighteen constituents were identified, representing 100% composition of the oil. The constituents were mainly monoterpenes and sesquiterpenes. The major constituents were found to be caryophllene oxide (21.75%), (-) -spathulenol (14.95%), D-nerolidol (10.39%) and (-) -β-caryophyllene (9.90%). The yield of essential oil obtained was 0.19%. Some of the identified constituents of the essential oil have proven pharmacological activities, uses in food, drink and cosmetic industries. The essential oil of L. camara leaves is worth exploiting for use by relevant industries

Ultrasonographic biometry: Biparietal Diameter of Nigerian foetuses

Background: Foetal biparietal diameter has been studied previously in Nigerian foetuses but populations have been too small to make categorical conclusions regarding the reference values/data. Materials and Methods: In a cross sectional study, the foetal biparietal diameter (BPD) of 13,740 foetuses in Jos were measured with grey ultrasound machine in 13,740 Nigerian women during normal pregnancy and the mean BPD values for each week of pregnancy between 12 and 42 weeks were determined. Results: The mean biparietal diameter value was 29.4mm at 14 weeks, 49.4mm at 20 weeks, 78.4mm at 30 weeks, 91.5 at 37 weeks and 95.6mm at 40 weeks. There was a positive relationship between gestational age and biparietal diameter with correlation coefficient of R 2 = 0.9996 (P < 0.001), and with fetal weight. The increase in BPD with increasing age in the study population showed a curve similar to that of Europeans. Conclusions: Ultrasonographic measurement of biparietal diameter in Nigerian fetuses showed a linear correlation exists between BPD and gestational age, as well as BPD and foetal weight in normal foetuses

The high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) in a large Zambian prison: a public health alert.

BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) represent two of the greatest health threats in African prisons. In 2010, collaboration between the Centre for Infectious Disease Research in Zambia, the Zambia Prisons Service, and the National TB Program established a TB and HIV screening program in six Zambian prisons. We report data on the prevalence of TB and HIV in one of the largest facilities: Lusaka Central Prison. METHODS: Between November 2010 and April 2011, we assessed the prevalence of TB and HIV amongst inmates entering, residing, and exiting the prison, as well as in the surrounding community. The screening protocol included complete history and physical exam, digital radiography, opt-out HIV counseling and testing, sputum smear and culture. A TB case was defined as either bacteriologically confirmed or clinically diagnosed. RESULTS: A total of 2323 participants completed screening. A majority (88%) were male, median age 31 years and body mass index 21.9. TB symptoms were found in 1430 (62%). TB was diagnosed in 176 (7.6%) individuals and 52 people were already on TB treatment at time of screening. TB was bacteriologically confirmed in 88 cases (3.8%) and clinically diagnosed in 88 cases (3.8%). Confirmed TB at entry and exit interventions were 4.6% and 5.3% respectively. Smear was positive in only 25% (n = 22) of bacteriologically confirmed cases. HIV prevalence among inmates currently residing in prison was 27.4%. CONCLUSION: Ineffective TB and HIV screening programs deter successful disease control strategies in prison facilities and their surrounding communities. We found rates of TB and HIV in Lusaka Central Prison that are substantially higher than the Zambian average, with a trend towards concentration and potential transmission of both diseases within the facility and to the general population. Investment in institutional and criminal justice reform as well as prison-specific health systems is urgently required