Court reiterates that a consultant is competent to accept/treat patients as an MBBS doctor

Medical Law Cases for Doctors 2016 9(2):33-34



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Taking consent/acknowledgments/endorsements in the patient's "own handwriting"

Medical Law Cases for Doctors 2016 9(2):28-29



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Patients producing prescriptions selectively to suit their case - A recent trend fast catching up

Medical Law Cases for Doctors 2016 9(2):22-23



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Doctor performs an emergency surgery without following the pre-surgery protocol - Court holds him "wee bit negligent" and leaves him with a warning only

Medical Law Cases for Doctors 2016 9(2):19-21



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"Giving preference to one mode of investigation over another cannot be turned as a case of medical negligence"

Medical Law Cases for Doctors 2016 9(2):24-25



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Surgeon's failure to provide post-surgery care will always be viewed suspiciously by the courts

Medical Law Cases for Doctors 2016 9(2):30-32



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Precautions in case the patient ignores the best advice and chooses the next best alternative

Medical Law Cases for Doctors 2016 9(2):26-27



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Patient crosses all limits - First maligns the doctor in press, then files affidavit of fictitious doctors in court

Medical Law Cases for Doctors 2016 9(2):35-38



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Identifying Mechanisms Behind the Tullio Phenomenon: a Computational Study Based on First Principles

Abstract

Patients with superior canal dehiscence (SCD) suffer from events of dizziness and vertigo in response to sound, also known as Tullio phenomenon (TP). The present work seeks to explain the fluid-dynamical mechanisms behind TP. In accordance with the so-called third window theory, we developed a computational model for the vestibular signal pathway between stapes and SCD. It is based on first principles and accounts for fluid–structure interactions arising between endolymph, perilymph, and membranous labyrinth. The simulation results reveal a wave propagation phenomenon in the membranous canal, leading to two flow phenomena within the endolymph which are in close interaction. First, the periodic deformation of the membranous labyrinth causes oscillating endolymph flow which forces the cupula to oscillate in phase with the sound stimulus. Second, these primary oscillations of the endolymph induce a steady flow component by a phenomenon known as steady streaming. We find that this steady flow of the endolymph is typically in ampullofugal direction. This flow leads to a quasi-steady deflection of the cupula which increases until the driving forces of the steady streaming are balanced by the elastic reaction forces of the cupula, such that the cupula attains a constant deflection amplitude which lasts as long as the sound stimulus. Both response types have been observed in the literature. In a sensitivity study, we obtain an analytical fit which very well matches our simulation results in a relevant parameter range. Finally, we correlate the corresponding eye response (vestibulo-ocular reflex) with the fluid dynamics by a simplified model of lumped system constants. The results reveal a “sweet spot” for TP within the audible sound spectrum. We find that the underlying mechanisms which lead to TP originate primarily from Reynolds stresses in the fluid, which are weaker at lower sound frequencies.

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How clarinettists articulate: The effect of blowing pressure and tonguing on initial and final transients

Articulation, including initial and final note transients, is important to tasteful music performance. Clarinettists' tongue-reed contact, the time variation of the blowing pressuremouth, the mouthpiece pressure, the pressure in the instrument bore, and the radiated sound were measured for normal articulation, accents, sforzando, staccato, and for minimal attack, i.e., notes started very softly. All attacks include a phase when the amplitude of the fundamental increases exponentially, with rates r ∼1000 dB s⁻¹ controlled by varying both the rate of increase in mouth and the timing of tongue release during this increase. Accented and sforzando notes have shorter attacks (r∼1300 dB s⁻¹) than normal notes. mouth reaches a higher peak value for accented and sforzando notes, followed by a steady decrease for accented notes or a rapid fall to a lower, nearly steady value for sforzando notes. Staccato notes are usually terminated by tongue contact, producing an exponential decrease in sound pressure with rates similar to those calculated from the bandwidths of the bore resonances: ∼400 dB s⁻¹. In all other cases, notes are stopped by decreasing mouth. Notes played with different dynamics are qualitatively similar, but louder notes have larger mouth and larger r.

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Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

J Laryngol Otol. 2016 Mar;130(3):235-241

Authors: Harris AT, Mettias B, Lesser TH

Abstract
BACKGROUND: Cholesteatoma is keratinising epithelium within the middle-ear cleft or mastoid. This disease destroys the peripheral organs of balance and hearing, with possible intracranial sequelae. The management of cholesteatoma is surgical and the primary aim is to remove the disease and prevent recurrence. Secondary aims are to obtain a non-discharging, hearing ear. Cholesteatoma surgery falls into two broad categories: open cavity surgery and combined approach surgery. A third surgical category is reconstruction of an open mastoid cavity after open surgery. This study performed a pooled analysis of the worldwide literature to compare the rates of cholesteatoma not being cured (i.e. recidivism), ear discharge and hearing change among open cavity, combined approach and reconstruction mastoid surgery for primary cholesteatoma.
METHODS: A literature search for all types of cholesteatoma surgery in the PubMed, Google Scholar and Medline databases and in published conference proceedings was undertaken.
RESULTS: There was no level 1 evidence for the best method of primary cholesteatoma surgery. The highest evidence level found (level 2; 5366 patients) shows no difference in hearing change or discharge rate between open and combined approach surgery; however, these methods fail to cure the cholesteatomas in 16.0 per cent and 29.4 per cent of cases, respectively. In a total of 640 patients, reconstruction and/or repair mastoid surgery using a variety of non-comparable techniques had a failure rate of between 5.3 per cent and 20 per cent.
CONCLUSION: The available evidence suggests that reconstruction of the posterior canal wall and/or obliteration of the mastoid may be the best surgical treatment alternative. This technique appears to provide the lowest recidivism rate combined with a low post-operative ear discharge rate.

PMID: 26878375 [PubMed - as supplied by publisher]

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Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

J Laryngol Otol. 2016 Mar;130(3):235-241

Authors: Harris AT, Mettias B, Lesser TH

Abstract
BACKGROUND: Cholesteatoma is keratinising epithelium within the middle-ear cleft or mastoid. This disease destroys the peripheral organs of balance and hearing, with possible intracranial sequelae. The management of cholesteatoma is surgical and the primary aim is to remove the disease and prevent recurrence. Secondary aims are to obtain a non-discharging, hearing ear. Cholesteatoma surgery falls into two broad categories: open cavity surgery and combined approach surgery. A third surgical category is reconstruction of an open mastoid cavity after open surgery. This study performed a pooled analysis of the worldwide literature to compare the rates of cholesteatoma not being cured (i.e. recidivism), ear discharge and hearing change among open cavity, combined approach and reconstruction mastoid surgery for primary cholesteatoma.
METHODS: A literature search for all types of cholesteatoma surgery in the PubMed, Google Scholar and Medline databases and in published conference proceedings was undertaken.
RESULTS: There was no level 1 evidence for the best method of primary cholesteatoma surgery. The highest evidence level found (level 2; 5366 patients) shows no difference in hearing change or discharge rate between open and combined approach surgery; however, these methods fail to cure the cholesteatomas in 16.0 per cent and 29.4 per cent of cases, respectively. In a total of 640 patients, reconstruction and/or repair mastoid surgery using a variety of non-comparable techniques had a failure rate of between 5.3 per cent and 20 per cent.
CONCLUSION: The available evidence suggests that reconstruction of the posterior canal wall and/or obliteration of the mastoid may be the best surgical treatment alternative. This technique appears to provide the lowest recidivism rate combined with a low post-operative ear discharge rate.

PMID: 26878375 [PubMed - as supplied by publisher]

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Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Int J Audiol. 2016 Feb 15;:1-10

Authors: Schulz KA, Modeste N, Lee J, Roberts R, Saunders GH, Witsell DL

Abstract
OBJECTIVE: There is limited application of health behavior-based theoretical models in hearing healthcare, yet other fields utilizing these models have shown their value in affecting behavior change. The health belief model (HBM) has demonstrated appropriateness for hearing research. This study assessed factors that influence an individual with suspected hearing loss to pursue clinical evaluation, with a focus on perceived burden of hearing loss on communication partners, using the HBM as a framework.
DESIGN: Cross-sectional design collecting demographics along with three validated hearing-loss related questionnaires.
STUDY SAMPLE: Patients from Duke University Medical Center Otolaryngology Clinic aged 55-75 years who indicated a communication partner had expressed concern about their hearing. A final sample of 413 completed questionnaire sets was achieved.
RESULTS: The HBM model construct 'cues to action' was a significant (p <0.001) predictor of pursuing hearing evaluation. Perceived burden of hearing loss on communication partners was a significant (p <0.001) predictor of pursuing hearing evaluation and improves the model fit when added to the HBM: 72.0% correct prediction when burden is added versus 66.6% when not (p <0.0001).
CONCLUSIONS: Hearing healthcare initiatives that incorporate these factors may improve hearing help-seeking behavior. More research using sound theoretical models in hearing healthcare is warranted.

PMID: 26878243 [PubMed - as supplied by publisher]

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Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Int J Audiol. 2016 Feb 15;:1-10

Authors: Wu YH, Ho HC, Hsiao SH, Brummet RB, Chipara O

Abstract
OBJECTIVE: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting.
DESIGN: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique.
STUDY SAMPLE: A total of 132 adults with hearing impairment.
RESULTS: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (∼18 dB) than first-time hearing-aid users (∼10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs.
CONCLUSIONS: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.

PMID: 26878163 [PubMed - as supplied by publisher]

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Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Int J Audiol. 2016 Feb 15;:1-10

Authors: Schulz KA, Modeste N, Lee J, Roberts R, Saunders GH, Witsell DL

Abstract
OBJECTIVE: There is limited application of health behavior-based theoretical models in hearing healthcare, yet other fields utilizing these models have shown their value in affecting behavior change. The health belief model (HBM) has demonstrated appropriateness for hearing research. This study assessed factors that influence an individual with suspected hearing loss to pursue clinical evaluation, with a focus on perceived burden of hearing loss on communication partners, using the HBM as a framework.
DESIGN: Cross-sectional design collecting demographics along with three validated hearing-loss related questionnaires.
STUDY SAMPLE: Patients from Duke University Medical Center Otolaryngology Clinic aged 55-75 years who indicated a communication partner had expressed concern about their hearing. A final sample of 413 completed questionnaire sets was achieved.
RESULTS: The HBM model construct 'cues to action' was a significant (p <0.001) predictor of pursuing hearing evaluation. Perceived burden of hearing loss on communication partners was a significant (p <0.001) predictor of pursuing hearing evaluation and improves the model fit when added to the HBM: 72.0% correct prediction when burden is added versus 66.6% when not (p <0.0001).
CONCLUSIONS: Hearing healthcare initiatives that incorporate these factors may improve hearing help-seeking behavior. More research using sound theoretical models in hearing healthcare is warranted.

PMID: 26878243 [PubMed - as supplied by publisher]

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Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Int J Audiol. 2016 Feb 15;:1-10

Authors: Wu YH, Ho HC, Hsiao SH, Brummet RB, Chipara O

Abstract
OBJECTIVE: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting.
DESIGN: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique.
STUDY SAMPLE: A total of 132 adults with hearing impairment.
RESULTS: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (∼18 dB) than first-time hearing-aid users (∼10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs.
CONCLUSIONS: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.

PMID: 26878163 [PubMed - as supplied by publisher]

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Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Int J Audiol. 2016 Feb 15;:1-10

Authors: Schulz KA, Modeste N, Lee J, Roberts R, Saunders GH, Witsell DL

Abstract
OBJECTIVE: There is limited application of health behavior-based theoretical models in hearing healthcare, yet other fields utilizing these models have shown their value in affecting behavior change. The health belief model (HBM) has demonstrated appropriateness for hearing research. This study assessed factors that influence an individual with suspected hearing loss to pursue clinical evaluation, with a focus on perceived burden of hearing loss on communication partners, using the HBM as a framework.
DESIGN: Cross-sectional design collecting demographics along with three validated hearing-loss related questionnaires.
STUDY SAMPLE: Patients from Duke University Medical Center Otolaryngology Clinic aged 55-75 years who indicated a communication partner had expressed concern about their hearing. A final sample of 413 completed questionnaire sets was achieved.
RESULTS: The HBM model construct 'cues to action' was a significant (p <0.001) predictor of pursuing hearing evaluation. Perceived burden of hearing loss on communication partners was a significant (p <0.001) predictor of pursuing hearing evaluation and improves the model fit when added to the HBM: 72.0% correct prediction when burden is added versus 66.6% when not (p <0.0001).
CONCLUSIONS: Hearing healthcare initiatives that incorporate these factors may improve hearing help-seeking behavior. More research using sound theoretical models in hearing healthcare is warranted.

PMID: 26878243 [PubMed - as supplied by publisher]

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Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Int J Audiol. 2016 Feb 15;:1-10

Authors: Wu YH, Ho HC, Hsiao SH, Brummet RB, Chipara O

Abstract
OBJECTIVE: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting.
DESIGN: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique.
STUDY SAMPLE: A total of 132 adults with hearing impairment.
RESULTS: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (∼18 dB) than first-time hearing-aid users (∼10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs.
CONCLUSIONS: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.

PMID: 26878163 [PubMed - as supplied by publisher]

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Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Int J Audiol. 2016 Feb 15;:1-10

Authors: Schulz KA, Modeste N, Lee J, Roberts R, Saunders GH, Witsell DL

Abstract
OBJECTIVE: There is limited application of health behavior-based theoretical models in hearing healthcare, yet other fields utilizing these models have shown their value in affecting behavior change. The health belief model (HBM) has demonstrated appropriateness for hearing research. This study assessed factors that influence an individual with suspected hearing loss to pursue clinical evaluation, with a focus on perceived burden of hearing loss on communication partners, using the HBM as a framework.
DESIGN: Cross-sectional design collecting demographics along with three validated hearing-loss related questionnaires.
STUDY SAMPLE: Patients from Duke University Medical Center Otolaryngology Clinic aged 55-75 years who indicated a communication partner had expressed concern about their hearing. A final sample of 413 completed questionnaire sets was achieved.
RESULTS: The HBM model construct 'cues to action' was a significant (p <0.001) predictor of pursuing hearing evaluation. Perceived burden of hearing loss on communication partners was a significant (p <0.001) predictor of pursuing hearing evaluation and improves the model fit when added to the HBM: 72.0% correct prediction when burden is added versus 66.6% when not (p <0.0001).
CONCLUSIONS: Hearing healthcare initiatives that incorporate these factors may improve hearing help-seeking behavior. More research using sound theoretical models in hearing healthcare is warranted.

PMID: 26878243 [PubMed - as supplied by publisher]

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Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Int J Audiol. 2016 Feb 15;:1-10

Authors: Wu YH, Ho HC, Hsiao SH, Brummet RB, Chipara O

Abstract
OBJECTIVE: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting.
DESIGN: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique.
STUDY SAMPLE: A total of 132 adults with hearing impairment.
RESULTS: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (∼18 dB) than first-time hearing-aid users (∼10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs.
CONCLUSIONS: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.

PMID: 26878163 [PubMed - as supplied by publisher]

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Effects of emotional videos on postural control in children

Publication date: March 2016
Source:Gait & Posture, Volume 45
Author(s): Arthur de Freitas Brandão, Estelle Palluel, Isabelle Olivier, Vincent Nougier
The link between emotions and postural control has been rather unexplored in children. The objective of the present study was to establish whether the projection of pleasant and unpleasant videos with similar arousal would lead to specific postural responses such as postural freezing, aversive or appetitive behaviours as a function of age. We hypothesized that postural sway would similarly increase with the viewing of high arousal videos in children and adults, whatever the emotional context. 40 children participated in the study and were divided into two groups of age: group 7–9 years (n=23; mean age=8 years±0.7) and group 10–12 years (n=17; mean age=11 years±0.7). 19 adults (mean age=25.8 years±4.4) also took part in the experiment. They viewed emotional videos while standing still on a force platform. Centre of foot pressure (CoP) displacements were analysed. Antero-posterior, medio-lateral mean speed and sway path length increased similarly with the viewing of high arousal movies in the younger, older children, and adults. Our findings suggest that the development of postural control is not influenced by the maturation of the emotional processing.



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Effects of emotional videos on postural control in children

Publication date: March 2016
Source:Gait & Posture, Volume 45
Author(s): Arthur de Freitas Brandão, Estelle Palluel, Isabelle Olivier, Vincent Nougier
The link between emotions and postural control has been rather unexplored in children. The objective of the present study was to establish whether the projection of pleasant and unpleasant videos with similar arousal would lead to specific postural responses such as postural freezing, aversive or appetitive behaviours as a function of age. We hypothesized that postural sway would similarly increase with the viewing of high arousal videos in children and adults, whatever the emotional context. 40 children participated in the study and were divided into two groups of age: group 7–9 years (n=23; mean age=8 years±0.7) and group 10–12 years (n=17; mean age=11 years±0.7). 19 adults (mean age=25.8 years±4.4) also took part in the experiment. They viewed emotional videos while standing still on a force platform. Centre of foot pressure (CoP) displacements were analysed. Antero-posterior, medio-lateral mean speed and sway path length increased similarly with the viewing of high arousal movies in the younger, older children, and adults. Our findings suggest that the development of postural control is not influenced by the maturation of the emotional processing.



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Effects of emotional videos on postural control in children

Publication date: March 2016
Source:Gait & Posture, Volume 45
Author(s): Arthur de Freitas Brandão, Estelle Palluel, Isabelle Olivier, Vincent Nougier
The link between emotions and postural control has been rather unexplored in children. The objective of the present study was to establish whether the projection of pleasant and unpleasant videos with similar arousal would lead to specific postural responses such as postural freezing, aversive or appetitive behaviours as a function of age. We hypothesized that postural sway would similarly increase with the viewing of high arousal videos in children and adults, whatever the emotional context. 40 children participated in the study and were divided into two groups of age: group 7–9 years (n=23; mean age=8 years±0.7) and group 10–12 years (n=17; mean age=11 years±0.7). 19 adults (mean age=25.8 years±4.4) also took part in the experiment. They viewed emotional videos while standing still on a force platform. Centre of foot pressure (CoP) displacements were analysed. Antero-posterior, medio-lateral mean speed and sway path length increased similarly with the viewing of high arousal movies in the younger, older children, and adults. Our findings suggest that the development of postural control is not influenced by the maturation of the emotional processing.



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