4 research outputs found
Cost-Effectiveness of <b><i>IL28Β</i></b> Genotype-Guided Protease Inhibitor Triple Therapy versus Standard of Care Treatment in Patients with Hepatitis C Genotypes 2 or 3 Infection
Early initiation of enteral feeding after percutaneous endoscopic gastrostomy tube placement.
Enteral feeding through the percutaneous endoscopic gastrostomy (PEG) tube is usually initiated about 12 to 24 hours after insertion of the tube. There have been earlier studies evaluating the efficacy of early initiation of enteral feedings that had encouraging results. However, delayed initiation of feeding following PEG placement continues to be practiced widely. We believe that feeding can be done earlier without any increase in associated morbidity or mortality and with obvious reduction in the need for parenteral nutrition and healthcare costs. We evaluated a protocol to initiate enteral nutrition 4 hours after the PEG tube insertion with subsequent discharge of the outpatients on the same day. We conducted a prospective study to assess the efficacy of early initiation of PEG feeding. We enrolled 77 patients in our study who were having PEG tubes placed for enteral feeding. Only patients who had a PEG placed for gastric venting procedures were excluded from our study. During the course of our study, no patient had to be excluded for the latter reason. Patients were evaluated by the physician performing the procedure, 4 hours after the tube was inserted. Their vital signs were checked, and a thorough abdominal examination was performed. Minimal tenderness around the PEG site was the most frequent finding. Otherwise, all the patients had a benign abdominal examination. The tube was flushed with 60 mL of sterile water. Following the examination, orders were given to restart the feedings. These patients were followed for a 30-day period to evaluate complications associated with PEG tube placement and early initiation of PEG feeding. There was one case of aspiration pneumonia (1.3%) and one death that was attributed to the underlying disease out of our 77 patients. Early initiation of enteral feeding after PEG tube placement can be successfully completed with a systematic protocol and close observation. Not only was this protocol found to be safe, it can also have significant cost savings by eliminating the need for inpatient hospitalization for the procedure
Categorization of everyday sounds by cochlear implanted children
International audienceAuditory categorization is an important process in the perception and understanding of everyday sounds. The use of cochlear implants (CIs) may affect auditory categorization and result in poor abilities. The current study was designed to compare how children with normal hearing (NH) and children with CIs categorize a set of everyday sounds. We tested 24 NH children and 24 children with CI on a free-sorting task of 18 everyday sounds corresponding to four a priori categories: nonlinguistic human vocalizations, environmental sounds, musical sounds, and animal vocalizations. Multiple correspondence analysis revealed considerable variation within both groups of child listeners, although the human vocalizations and musical sounds were similarly categorized. In contrast to NH children, children with CIs categorized some sounds according to their acoustic content rather than their associated semantic information. These results show that despite identification deficits, children with CIs are able to categorize environmental and vocal sounds in a similar way to NH children, and are able to use categorization as an adaptive process when dealing with everyday sounds. When an infant is identified as having profound-to-total bilateral hearing loss, the surgical implantation of coch-lear implants (CIs) is envisaged as a means of restoring his or her access to auditory information. The benefits of CIs for speech perception in children with prelingual hearing loss have been widely documented over the past three decades, resulting in an extension of prescription criteria 1,2. One of the greatest proven benefits of CIs is speech comprehension 3,4. Alongside improvements in oral language skills, speech comprehension is seen as one of the key objectives of rehabilitation with CIs. A CI does not function in the same manner as a conventional hearing aid (i.e., by contributing to the amplification of sounds). Instead, it turns sounds into trains of electrical pulses that directly stimulate the auditory nerve. This information is then relayed to the auditory centres of the brain, which in turn transform the impulses into auditory percepts. However, the auditory information provided by the implant is spectrally degraded 5 and lacks the fine spectrotemporal information that is crucial to certain aspects of speech comprehension-most notably the perception of prosodic information 6-9. This means that other aspects of auditory perception are also problematic for CI users, such as the identification and recognition of environmental and musical sounds. Development of nonlinguistic sound perception The recovery and/or development of speech comprehension is normally seen as the main goal of CI implantation. Accordingly, only limited attention has been paid to the perception of nonlinguistic sounds in CI users. For example, whilst CIs may enhance users' awareness of their immediate auditory environment 10 , a substantial deficit remains in the perception and identification of specific environmental sounds 11-13 , that is, those not classified as speech or music. This deficit has a negative impact on how CI users interact with their environment, and it is therefore important for more studies to be conducted on this topic. To our knowledge, the identification of nonlinguistic sounds by implanted adults with postlingual deafness has only been reported in a small number of studies 11-15. There have been even fewer studies among children with CIs 16,17. Furthermore, owing to a lack of standardized protocols for assessing auditory performance and the use of different evaluation procedures (open-set or closed-set identification assessments, written words or images