Success rates in restoring hearing loss in patients with chronic otitis media:A systematic review

Abstract Objective To assess the effectiveness of tympanoplasty in treating chronic otitis media‐related hearing loss, published literature was systematically reviewed to determine the clinical success rate of tympanoplasty at restoring hearing in chronic otitis media patients at a minimum follow‐up period of 12‐months. Data Sources PubMed, Embase and the Cochrane Library. Methods Two independent reviewers performed literature searches. Publications reporting long‐term (≥12‐month) hearing outcomes and complications data on adult and pediatric patients with chronic otitis media were included and assessed for risk of bias and strength of evidence. To assess how tympanoplasty influences long‐term hearing outcomes, data on pure tone audiometry (air‐bone gap) and complications were extracted and synthesized. Results Thirty‐nine studies met the inclusion criteria. Data from 3162 patients indicated that 14.0% of patients encountered postoperative complications. In adult patients, mean weighted air‐bone gap data show closure from 26.5 dB hearing level (HL) (preoperatively) to 16.1 dB HL (postoperatively). In studies that presented combined adult and pediatric data, the mean preoperative air‐bone gap of 26.7 dB HL was closed to 15.4 dB HL. In 1370 patients with synthesizable data, 70.7% of patients had a postoperative air‐bone gap ˂ 20 dB HL at long‐term follow‐up. Finally, subgroup analysis identified that mean improvement in ABG closure for patients with and without cholesteatoma was 10.0 dB HL and 12.4 dB HL, respectively. Conclusion In patients with chronic otitis media, tympanoplasty successfully closed the air‐bone gap to within 20 dB HL in 7/10 cases and had an overall complication rate of 14.0%. Level of Evidence 2a

Examining the economic impact [i.e. implications] autistic spectrum disorder

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Return on investment in blended advanced cardiac life support training compared to face-to-face training in Singapore

Background Internet adoption during the past decade has provided opportunities for innovation in advanced cardiac life support (ACLS) training. With pressure on budgets across health care systems, there is a need for more cost-effective solutions. Recently, traditional ACLS training has evolved from passive to active learning technologies. The objective of this study is to compare the cost, cost-savings and return on investment (ROI) of blended ACLS (B-ACLS) and face-to-face ACLS (F-ACLS) in Singapore. Methods: B-ACLS and F-ACLS courses are offered in two training institutes in Singapore. Direct and indirect costs of training were obtained from one of the training providers. ROI was computed using cost-savings over total cost if B-ACLS was used instead of F-ACLS. Results: The estimated annual cost to conduct B-ACLS and F-ACLS were S$43,467 and S$72,793, respectively. Discounted total cost of training over the life of the course (five years) was S$107,960 for B-ACLS and S$280,162 for F-ACLS. Annual productivity loss cost account for 52% and 23% of the costs among the F-ACLS and B-ACLS, respectively. B-ACLS yielded a 160% return on the money invested. There would be 61% savings over the life of the course if B-ACLS were to be used instead of F-ACLS. Conclusion: The B-ACLS course provides significant cost-savings to the provider and a positive ROI. B-ACLS should be more widely adopted as the preferred mode of ACLS training. As a start, physicians looking for reaccreditation of the ACLS training should be encouraged to take B-ACLS instead of F-ACLS

Quality and costs of supported living residences and group homes in the United Kingdom

Information was collected on 63 adults in supported living residences, 55 adults in small group homes, and 152 adults in large group homes. Results indicated that (a) there were no statistically significant differences in service costs once these had been adjusted to take account of participant characteristics; (b) compared with participants living in small group homes, those in supported living residences had greater choice, participated in more community-based activities, experienced fewer scheduled activities, were more likely to have had their home vandalized, and were considered at greater risk of exploitation; (c) compared with participants living in large group homes, those in small group homes had larger social networks, more people in their social networks who were not staff, not family, and did not have mental retardation. These residents were considered at less risk of abuse

Review of the potential health effects of light and environmental exposures in underground workplaces

Underground workplaces are an important element in modern urban planning. As a result, an increasing but unquantified proportion of the population is being regularly exposed to them. We narratively reviewed the literature on the range of possible environmental exposures, and the possible health effects, to identify future research directions. There is a large but mainly observational research literature on likely underground exposures, including effects of artificial lighting, shift working and light at night on circadian disruptions and associated health effects. There are five studies comparing underground and aboveground environments. Shift working, artificial lighting and poor sleep quality leading to circadian disruption is one physiologic pathway. Working underground may increase exposure to these risks, and may also be associated with vitamin D deficiency, sick building syndrome, excessive noise, radon exposure, and negative psychological effects. In order to plan appropriate interventions, we need to expand our knowledge of the health effects of underground environments. Larger and longer-term studies are required to measure a range of human factors, environmental exposures and confounders. Controlled trials with health economic analyses of new lighting technologies are also required.NRF (Natl Research Foundation, S’pore)Accepted versio

Additional file 3: Table S3. of Melatonin and health: an umbrella review of health outcomes and biological mechanisms of action

Quality ratings for included systematic reviews of melatonin for health. (DOCX 254 kb

Additional file 2: Table S2. of Melatonin and health: an umbrella review of health outcomes and biological mechanisms of action

Summary of studies on the effects of endogenous melatonin on health outcomes (N = 75). (DOCX 111 kb

Additional file 5: Table S5. of Melatonin and health: an umbrella review of health outcomes and biological mechanisms of action

Summary of the adverse effects of MLT reported in the studies included (N = 11). (DOCX 24 kb