Erosive pustular dermatosis of the scalp following topical ingenol mebutate for actinic keratoses

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Evaluation and management of nonsyndromic congenital hearing loss.

Purpose of review: Nonsyndromic congenital hearing loss represents the largest proportion of paediatric sensorineural hearing loss. The optimal evaluation and management of affected patients remains clinically challenging. Current controversies in the diagnostic work-up of nonsyndromic congenital hearing loss are presented in this review. Recent findings: The improved diagnostic yield of comprehensive genetic testing due to new sequencing technologies is changing the diagnostic for congenital hearing loss. Concerns for both ionizing radiation and general anaesthetic exposure are also driving shifts in imaging modality preferences for infants and toddlers. Summary: A thoughtful systematic, targeted approach taking into consideration the audiologic phenotype of the patient is recommended for the work-up of nonsyndromic congenital hearing loss. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Current assessment of newborn hearing screening protocols.

Purpose of review: The objective of this article is to assess current newborn hearing screening protocols. We will focus on technologies or modalities used, protocol steps, training of screeners, timing of first screen, and loss to follow-up. A summary of program reports focusing on protocols from Greece, China, South Africa, France, Spain, South Korea, Denmark, Italy, Turkey, Taiwan, South Korea, Poland and Iran as they are recently reported will also be presented. Recent findings: Community-based hearing screening programs in South Africa and efforts in the Asian region are being reported. The use of automated auditory brainstem response and staged procedures are gaining popularity because of low refer rates. However, follow-up issues remain a problem. The importance of having trained nonprofessional screeners and an efficient database is becoming more evident as the number of newborns screened for hearing loss increase each year. Summary: There are many reported protocols using different technologies, involving several stages, implemented in different settings which should not confuse but rather guide stakeholders so that programs may attain certain benchmarks and ultimately help the hard-at-hearing child in achieving his or her full potential. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Increasing access to hearing rehabilitation for older adults.

Purpose of review: To provide an update on the recent research and policy developments affecting the current and future care of the 23 million older Americans with untreated hearing loss. Recent findings: Increasing evidence supports the association of age-related hearing loss with significant negative outcomes that affect the ability of older adults to age well. Despite an evolving understanding of the role hearing loss plays in the well being and vitality of older adults, the vast majority of older adults go untreated and hearing health care disparities exist. Recent work to understand the multitude of factors involved in hearing health care decisions, coupled with innovative approaches and technology to deliver hearing care, aim to provide more older adults with equal access to the tools needed to age well. Most importantly, significant national efforts and policy proposals substantiate these efforts and will be reviewed. Summary: Age-related hearing loss is a critical public health issue that affects almost all older adults. Through the application of novel approaches and perspectives, the delivery of hearing health care for older adults is evolving to provide more affordable and accessible care. Accompanying policy efforts provide the necessary support needed to increase access to care significantly. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Novel insights in the adaptation of avian H9N2 influenza viruses to swine

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Work-family conflict and mental health in newlywed and recently cohabiting couples : a couple perspective

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Baseline Morphine Consumption May Explain Between-Study Heterogeneity in Meta-analyses of Adjuvant Analgesics and Improve Precision and Accuracy of Effect Estimates.

BACKGROUND: Statistical heterogeneity can increase the uncertainty of results and reduce the quality of evidence derived from systematic reviews. At present, it is uncertain what the major factors are that account for heterogeneity in meta-analyses of analgesic adjuncts. Therefore, the aim of this review was to identify whether various covariates could explain statistical heterogeneity and use this to improve accuracy when reporting the efficacy of analgesics. METHODS: We searched for reviews using MEDLINE, EMBASE, CINAHL, AMED, and the Cochrane Database of Systematic Reviews. First, we identified the existence of considerable statistical heterogeneity (I2 > 75%). Second, we conducted meta-regression analysis for the outcome of 24-hour morphine consumption using baseline risk (control group morphine consumption) and other clinical and methodological covariates. Finally, we constructed a league table of adjuvant analgesics using a novel method of reporting effect estimates assuming a fixed consumption of 50 mg postoperative morphine. RESULTS: We included 344 randomized controlled trials with 28,130 participants. Ninety-one percent of analyses showed considerable statistical heterogeneity. Baseline risk was a significant cause of between-study heterogeneity for acetaminophen, nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors, tramadol, ketamine, [alpha]2-agonists, gabapentin, pregabalin, lidocaine, magnesium, and dexamethasone (R2 = 21%-100%; P 10 mg). We could not exclude a moderate clinically significant effect with ketamine. Dexamethasone demonstrated a small clinical benefit (>5 mg). CONCLUSIONS: We empirically identified baseline morphine consumption as the major source of heterogeneity in meta-analyses of adjuvant analgesics across all surgical interventions. Controlling for baseline morphine consumption, clinicians can use audit data to estimate the morphine-reducing effect of adding any adjuvant for their local population, regardless which surgery they undergo. Moreover, we have utilized these findings to present a novel method of reporting and an amended method of graphically displaying effect estimates, which both reduces confounding from variable baseline risk in included trials and is able to adjust for other clinical and methodological confounding variables. We recommend use of these methods in clinical practice and future reviews of analgesics for postoperative pain. (C) 2017 International Anesthesia Research Society

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