Different teams, same conclusions?: a systematic review of existing clinical guidelines for the assessment and treatment of tinnitus in adults

Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults. Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines. Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively. Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe

Comparison of operative notes with real-time observation of adhesiolysis-related complications during surgery

Item does not contain fulltextBACKGROUND: The operative report contains critical information for patient care, serves an educational purpose and is an important source for surgical research. Recent studies demonstrate that operative reports are unstructured and lack vital components. The accuracy of the operative notes has never been assessed. The aim of this study was to analyse the accuracy of operative reports by comparing notes with intraoperative observer-derived findings regarding adhesions and adhesiolysis-related complications. METHODS: The incidence of adhesions and adhesiolysis-induced injury were scored from the reports by a researcher blinded to operative findings obtained prospectively by direct observation. In addition, factors influencing correct reporting were analysed, including sex, surgical experience, delay in dictation, and the gradual introduction of a new report template with a focus on describing operative findings rather than actions taken. RESULTS: A total of 755 consecutive operative reports were analysed. Sensitivity and specificity for the incidence of adhesions was 85.1 and 72.4 per cent respectively. Six of 43 inadvertent enterotomies, and 17 of 48 other organ injuries, had not been reported. All missed bowel injuries were found in reports written in the old template. A median delay in dictating of 3 (range 1-226) working days was found for 56 reports (7.4 per cent). Documentation of inadvertent enterotomies was missing more often in delayed reports (2 of 3 versus 4 of 40 reports dictated with no delay; P = 0.022). CONCLUSION: The sensitivity and specificity of operative reports noting adhesions and adhesiolysis were low. One in seven enterotomies was not reported. Effort should be put into teaching timely, meaningful, structured and accurate reporting of surgical procedures

British journal of surgery : BJS.

Imprint varies: Guildford, UK : Butterworth Scientific <, Apr. 1986->; Chichester, UK : John Wiley & Sons Ltd. <Jan. 2003->Chemical abstractsMode of access: Internet.Official journal of: European Society for Surgical Research, <2010->"Specially related to the Association of Surgeons of Great Britain and Ireland, Association of Surgeons of the Netherlands, British Association of Endocrine Surgeons, Society of Academic and Research Surgery, Swedish Surgical Society, Swiss Society of Surgery, and Vascular Surgical Society of Great Britain and Ireland," <2005->Issued by: British Journal of Surgery Society, Ltd., <2005->Vols. 1 (1913)-10 (1923), 1 v.; Vols. 11 (1923)-20 (1933), 1 v.; Vols. 21 (1933)-30 (1943), 1 v.; Vols. 41 (1953)-50 (1963), 1 v.Latest issue consulted: Vol. 97, no. 11 (Nov. 2010).Description based on: Vol. 63, no. 1 (Jan. 1976); title from cover