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At least 433 records · Page 24Linked to original sources
PubMed1985

Audiological findings in Down's children.

The authors have investigated the auditory function in 35 Down's subjects, aged between 1 month and 16 years. Clinical examination revealed the occurrence of impaired nasal breathing in 18 subjects (51.4%), while otoscopy results were bilaterally normal in 12 cases (34.3%). Behavioural pure-tone audiometry yielded reliable results in 10 children (28.6%), impedance tests in 28 (80.0%), and brainstem audiometry in 29 (82.9%). A clinical and audiological follow-up has been performed in 11 cases (31.4%). Pure-tone audiometry, which may be employed in all cases only beyond 8 years of age, revealed a conductive hearing loss in 7 cases (20.0%). Impedance tests, whose usefulness is limited by the high occurrence of external ear canal stenosis, showed bilateral type A tympanograms only in 8 cases (28.6%). Stapedial reflex data were often missing, even in presence of a type A tympanogram, due to the weakness of tubaric muscles and to the presence of ossicles abnormalities. ABR has been performed in 29 cases (82.9%) and resulted to be as effective as in the normal population. It revealed a normal configuration concerning threshold and morphology in 16 cases (55.1%). The authors conclude that middle ear pathology in the Down's population is more frequent than expected on clinical basis and that objective tests are mandatory in order to obtain a reliable evaluation. While impedance tests are very sensible in detecting mild middle ear pathologies, but are not effective in threshold definition, brainstem audiometry is the choice tool in the uncooperative child, even if it cannot allow a differential diagnosis between normality and mild low-frequency conductive hearing losses.

Acoustic Impedance Tests↗
PubMed1998

Why rate of absorption inferences in single dose bioequivalence studies are often inappropriate.

PURPOSE: Peak drug concentration (Cmax) measures the extremity of drug exposure and is a secondary indicator of the extent of absorption after area under the concentration time curve (AUC). Cmax serves as the indicator of absorption rate in bioequivalence (BE) studies in the US (1). The use of Cmax, not the time to Cmax (Tmax), as the metric to assess absorption rate causes erratic inferences in BE studies, and incorrect conclusions for some. We can improve BE efficiency (i.e., get the answer right the first time), by properly analyzing the time to Cmax (Tmax) instead of Cmax. METHODS: We have previously redirected attention to Tmax as the unconfounded absorption rate variable, instead of Cmax, and have called for equally spaced sampling times during the suspected absorption phase to improve the performance of the rate metric (2). Equal spacing converts Tmax easily into a count variable and we illustrated an appropriate statistical analysis for counts. This paper provides some measurement theory concepts to help judge which is the more appropriate analysis, and also provides parametric confidence limits for Tmax treatment differences. Three separate BE studies are then analyzed by both methods. RESULTS: By focusing on the differences in conclusions, or inferences, this paper identifies three major issues with the current FDA "recommended" analysis of BE studies. First, Cmax, a continuous variable peak-height or extent measure has usurped Tmax's function and performs erratically as a substitute measure for the rate of absorption. Second, Tmax, should be analyzed as a discrete attribute, not as a continuous variable. Third, since several extent measures (AUC, Cmax), not one, are actually being analyzed, an adjustment for multiple testing is mandatory if we are to maintain the size of the test at the desired alpha level (13), and not inadvertently use a narrower bioequivalence window than is intended. These actions all can have serious unintended consequences on inferences, including making inappropriate ones.

Area Under Curve↗
PubMed1994

Testing for carotid atherosclerosis.

BACKGROUND: Optometrists frequently examine patients with the signs and symptoms of carotid artery disease. Referral for appropriate testing is mandatory in such patients. METHODS: A review of the noninvasive tests which an optometrist can perform in the office is presented. The paper also describes the noninvasive tests which are performed in vascular clinics on patients in whom carotid atherosclerosis is to be ruled out. Arteriography, both conventional and digital subtraction studies, is also described. RESULTS: A discussion of the appropriate medical and surgical treatment of patients with carotid atherosclerosis and the ocular manifestations of it is included in the paper. CONCLUSIONS: With the increasing expansion of the scope of practice for optometrists, it is imperative that the signs and symptoms of carotid atherosclerosis be understood and managed appropriately. Preliminary tests for carotid arterial disease can be performed in the office, and referral for more extensive testing is better accomplished when those tests are understood by the referring optometrist.

Arteriosclerosis↗
PubMed1991

Issues in cerebrospinal fluid management. Acid-fast bacillus smear and culture.

Meningeal tuberculosis is an uncommon disease in the United States with an annual incidence of fewer than 200 cases. This study evaluates three approaches to improving the use of the cerebrospinal (CSF) acid-fast bacillus (AFB) smear and culture procedure: (1) education alone; (2) optional screening by which physicians can select to have the AFB analysis stopped if the initial CSF findings are unremarkable; and (3) mandatory screening before the performance of all CSF AFB analyses. With education alone, the CSF AFB culture rate decreased from 20.6% of all CSF acquisitions to 15.7% (P less than 0.001); however, the effect may have been related to a decrease in all types of AFB testing. Optional screening had no impact on the AFB testing rate. Mandatory screening significantly decreased the CSF AFB rate to 6.7% (P less than 0.001), unrelated to changes in other types of AFB testing. Laboratories that employ mandatory screening should report the screening results immediately and have a mechanism whereby physicians can bypass the screen, providing CSF AFB analysis on unremarkable fluid from high-risk patients.

Adolescent↗