Kristien Wouters

Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing

Background Oral appliance (OA) therapy is increasingly prescribed as a non-continuous positive airway pressure treatment modality for sleep-disordered breathing (SDB). Although OA therapy is reported to be efficacious for the treatment of SDB, data on compliance remain limited to self-report. Methods In this 3-month prospective clinical trial, the main outcome was to assess the safety and feasibility of an objective measurement of compliance during OA therapy using an embedded microsensor thermometer with on-chip integrated readout electronics in 51 consecutive patients with an established diagnosis of SDB (AHI 18.0±11.9/h; age 47±10 y; BMI 26.6±4.0 kg/m2; men/women: 31/20). Patients were unaware of the purpose of the study. Results No microsensor-related adverse events were recorded. In addition, no problems were encountered during the readout of the compliance data. Out of 51 microsensors, one had a technical defect and was lost to follow-up. In this study, the overall objective mean rate of OA use was 6.6±1.3 h per day with a regular OA users’ rate of 82% at the 3-month follow-up. Statistical analysis revealed no significant differences between objective and self-reported OA compliance data in this study. Measurement of the objective OA compliance allowed us to calculate the mean disease alleviation (MDA) as the product of objective compliance and therapeutic efficacy. MDA serves as a measure of the overall therapeutic effectiveness, and turned out to be 51.1%. Conclusions The results illustrate the safety and feasibility of objective measurement of OA compliance. The objective measurement of OA compliance allows for calculation of the MDA.

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey

AIM To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. BACKGROUND Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. DESIGN A cross-sectional design with a survey. METHOD In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. RESULTS Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. CONCLUSION Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development.

Drug‐induced sleep endoscopy in sleep‐disordered breathing: Report on 1,249 cases

To describe upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) in a large cohort of patients with sleep‐disordered breathing (SDB) and to assess associations with anthropometric and polysomnographic parameters.

Refractive and topographic results of benzalkonium chloride–assisted transepithelial crosslinking

PURPOSE: To evaluate the effect of benzalkonium chloride–assisted (BAC) transepithelial collagen crosslinking (CXL) in eyes with progressive keratoconus and a minimum follow‐up of 6 months. SETTING: Department of Ophthalmology, Antwerp University Hospital, Antwerp, Belgium. DESIGN: Cohort study. METHODS: Eyes with progressive keratoconus had CXL treatment without epithelial debridement. The standard CXL irradiation was preceded by instillation of proparacaine drops 0.5% preserved with BAC 0.005% every 5 minutes for 30 minutes. Selected parameters of refraction assessed by Placido disk (Eyesys) and Scheimpflug (Pentacam) examinations were compared before CXL and after CXL at 6, 12, and 18 months. RESULTS: The study enrolled 53 eyes of 38 patients. Sphere, cylinder, as well as maximum keratometry (K max) simulated K values (steep, flat, astigmatism), and refractive power values (steep, flat, astigmatism) measured using the Placido disk device remained stable over the 18‐month follow‐up. Only corrected distance visual acuity showed a statistically significant improvement at 6 months and 12 months. The Scheimpflug device measurements of maximum K and pachymetry at the thinnest point showed statistically significant progression throughout the study. No patient developed corneal haze or other complications. CONCLUSION: Transepithelial CXL using proparacaine drops 0.5% preserved with BAC 0.005% was less effective than standard CXL in stabilizing progressive keratoconus. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Sleep endoscopy with simulation bite for prediction of oral appliance treatment outcome

The aim of this study was to assess the value of drug‐induced sleep endoscopy (DISE) using a custom‐made simulation bite in maximal comfortable protrusion (MCP) of the mandible, in the prediction of treatment outcome for obstructive sleep apnea (OSA) with a mandibular advancement device (MAD). Two hundred patients (74% male; age 46 ± 9 years; apnea–hypopnea index [AHI] 19 ± 13 h−1 sleep; body mass index [BMI] 27 ± 4 kg m−2) with sleep‐disordered breathing underwent DISE with a simulation bite in MCP. One hundred and thirty‐five patients with an established diagnosis of OSA commenced MAD treatment. The associations between the findings during DISE with simulation bite and treatment outcome were evaluated. Treatment response was defined as a reduction in AHI following MAD treatment of ≥ 50% compared to baseline. Overall MAD treatment response in the studied population was 69%. The results of this study demonstrated a statistically significant association between a positive effect of the simulation bite on the upper airway patency during DISE and treatment response with MAD (P < 0.01). The results of this study suggest that the use of a simulation bite in maximal comfortable protrusion (MCP) of the mandible, as used during DISE in patients with OSA, tends to be effective in predicting treatment response of MAD treatment.

Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears?

PurposeTo determine the ability of 3.0T magnetic resonance (MR) imaging to identify partial tears of the anterior cruciate ligament (ACL) and to allow distinction of complete from partial ACL tears.Materials and methodsOne hundred seventy-two patients were prospectively studied by 3.0T MR imaging and arthroscopy in our institution. MR images were interpreted in consensus by two experienced reviewers, and the ACL was diagnosed as being normal, partially torn, or completely torn. Diagnostic accuracy of 3.0T MR for the detection of both complete and partial tears of the ACL was calculated using arthroscopy as the standard of reference.ResultsThere were 132 patients with an intact ACL, 17 had a partial, and 23 had a complete tear of the ACL seen at arthroscopy. Sensitivity, specificity, and accuracy of 3.0T MR for complete ACL tears were 83, 99, and 97%, respectively, and, for partial ACL tears, 77, 97, and 95%, respectively. Five of 40 ACL lesions (13%) could not correctly be identified as complete or partial ACL tears.ConclusionMR imaging at 3.0T represents a highly accurate method for identifying tears of the ACL. However, differentiation between complete and partial ACL tears and identification of partial tears of this ligament remains difficult, even at 3.0T.

Effects of SolCos Model-Based Individual Reminiscence on Older Adults With Mild to Moderate Dementia Due to Alzheimer Disease: A Pilot Study

OBJECTIVE To examine effects of individual thematically-based reminiscence sessions based on the SolCos model for older adults with dementia because of Alzheimer disease (AD) as a pilot study. BACKGROUND Reminiscence activities are popular within nursing homes and generally considered to be enjoyable and helpful, however, there is a paucity of robust data demonstrating therapeutic impact. Criticisms of existing reminiscence studies include the failure to explicate the reminiscence protocol and to standardize delivery and choice of outcome measures. METHODS In this study, 82 older adults with probable AD were recruited from psychiatric day care, inpatient, and long term care facilities. Of the study group, 41 participants were randomly selected for individual reminiscence sessions during 4 weeks performed by 1 facilitator. A control group of 41 older adults were randomly involved and had no planned reminiscence treatment of any kind in the study period. All study participants were tested pre- and postintervention period with validated assessment scales to evaluate cognition and behavior. Analyses were based on delta scores, the differences between assessment scales pre- and postintervention scores, compared between the intervention and the control group. RESULTS A structured reminiscence protocol was developed with user involvement, and intervention group participants received 6-8 reminiscence sessions (average 7.4). The primary outcomes of Mini- Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-30) delta scores of the intervention group were significantly better than those of the control group. Participants of the intervention group with both mild and moderate AD had significantly better GDS-30 delta scores compared with the control group. Significantly better MMSE delta scores were found only in the intervention sub-group with moderate AD. Logistic regression analyses with all study participants showed an impact of reminiscence sessions on depressive symptoms measured with GDS-30. CONCLUSIONS The pilot study results showed positive effects associated with individual thematically-based reminiscence on well-being such as depressive symptoms and cognition of participants. This is an encouraging finding after a relatively short period. Further study is necessary to confirm these results, determine sustainability and optimal delivery methods.

Prevalence of leisure noise-induced tinnitus and the attitude toward noise in university students

Background Adolescents and young adults often are exposed to potentially damaging loud music during leisure activities. As a consequence, more and more young adults suffer from tinnitus, hearing loss, and hyperacusis. The present study provides prevalence numbers for noise-induced tinnitus (NIT) in this group, the attitude toward loud music, and the factors influencing the use of hearing protection (HP). Method A questionnaire was undertaken to evaluate the influence of permanent/transient tinnitus after loud music, the attitudes toward noise, influence of peers, and the ability to manipulate HP on the use of HP. The questionnaire was completed by 145 university students. Results Approximately 89.5% of the students had experienced transient tinnitus after loud music exposure. The prevalence of transient NIT was higher in female subjects compared with male students. Permanent NIT was experienced by 14.8%. Nevertheless, few respondents were worried, and the degree of HP use was low (11%). However, the presence of permanent tinnitus was a motivation for HP use. Most respondents held a neutral to positive attitude (i.e., pronoise) toward loud music and were not fully aware of the risks of too much noise exposure. Conclusion NIT is a common phenomenon among young adults. The lack of knowledge in young adults and the underuse of HP in leisure activities provide useful information to refine preventive measures in the future.

Impacts of unit-level nurse practice environment, workload and burnout on nurse-reported outcomes in psychiatric hospitals: A multilevel modelling approach

AIM To investigate impacts of practice environment factors, nurse perceptions of workload and self-reported burnout at the unit-level on job outcomes and nurse-assessed quality of care in psychiatric hospitals. BACKGROUND Associations between practice environments and nurse and patient outcomes have been widely described in acute care hospitals in nursing research examining variables primarily at the respondent level. Research on this topic in psychiatric hospitals is sparse. DESIGN A cross-sectional design with a survey. METHOD Samples of registered nurses, licenced practical nurses and non-registered caregivers from 32 clinical units in two psychiatric hospitals were surveyed. Validated instruments were used to measure work environment, workload, burnout, job outcomes and nurse-perceived quality of care. Unit-level associations were examined using multilevel modelling techniques. RESULTS Multiple multilevel models identified depersonalization and nurse-physician relations as predictors of turnover intentions and quality of care of the interdisciplinary team. Ratings of nursing management at the unit level were predictors of all of the quality of care variables. Emotional exhaustion was predictive of quality of care at the unit level. While workload was correlated with burnout, it was not predictive of any of the outcomes examined in multiple multilevel models. CONCLUSION While relatively low levels of burnout and fairly favourable job and quality of care outcomes were reported by the mental health personnel surveyed, differences across units in ratings of practice environment factors such as nurse-physician relations and nurse management as well as levels of depersonalization were predictive of outcomes. While most findings are consistent with those from other studies of acute care settings, some (slight) differences were also identified.

Epidemiology of Noise-Induced Tinnitus and the Attitudes and Beliefs towards Noise and Hearing Protection in Adolescents

Background and objectives Previous research showed an increase of noise-induced symptoms in adolescents. Permanent tinnitus as a consequence of loud music exposure is usually considered as noise-induced damage. The objective was to perform an epidemiological study in order to obtain prevalence data of permanent noise-induced tinnitus as well as temporary tinnitus following noise exposure in a young population. In addition the attitudes and beliefs towards noise and hearing protection were evaluated in order to explain the use/non-use of hearing protection in a young population. Methods A questionnaire was completed by 3892 high school students (mean age: 16.64 years old, SD: 1.29 years). The prevalence of temporary and permanent tinnitus was assessed. In addition the ‘Youth Attitudes to Noise Scale’ and the ‘Beliefs About Hearing Protection and Hearing Loss’ were used in order to assess the attitudes and beliefs towards noise and hearing protection respectively. Results The prevalence of temporary noise-induced tinnitus and permanent tinnitus in high school students was respectively 74.9% and 18.3%. An increasing prevalence of temporary tinnitus with age was present. Most students had a ‘neutral attitude’ towards loud music and the use of hearing protection was minimal (4.7%). The limited use of hearing protection is explained by a logistic regression analysis showing the relations between certain parameters and the use of hearing protection. Conclusions Despite the very high prevalence of tinnitus in such a young population, the rate of hearing protection use and the knowledge about the risks of loud music is extremely low. Future preventive campaigns should focus more on tinnitus as a warning signal for noise-induced damage and emphasize that also temporary symptoms can result in permanent noise-induced damage.