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Issue 196 - 14 Sept 2011

Sunday 19 September 
 -  Women’s Suffrage Day -
A celebration of  New Zealand women getting the vote in 1893

Articles -International Journal of Audiology

1. Understanding compression: Modeling the effects of dynamic-range compression in hearing aids
By Kates, James M.
International Journal of Audiology
, Jun 2010, Vol. 49 Issue 6: p395-409
The purpose of this paper is to study the effects of dynamic-range compression and linear amplification on speech intelligibility and quality for hearing-impaired listeners. The paper focuses on the relative benefit of compression compared to linear amplification and the effect of varying the number of compression channels and the compression time constants. The stimuli are sentences in a background of stationary speech-shaped noise. Speech intelligibility and quality indices are used to predict the listener responses for a mild, moderate sloping, and moderate/severe hearing loss. The results show a strong interaction between signal processing, speech intensity, and hearing loss. The results are interpreted in terms of the two major effects of compression on speech: the increase in audibility and the decrease in temporal and spectral envelope contrast

2. Otoacoustic emissions in a hearing conservation program: General applicability in longitudinal monitoring and the relation to changes in pure-tone thresholds
By Helleman, Hiske W. et al. International Journal of Audiology, Jun 2010, Vol. 49 Issue 6: p410-419
The hearing status of workers (N = 233) in a printing office was assessed twice within seventeen months by pure-tone audiometry and otoacoustic emissions (OAEs). One of the questions was how a quality criterion of OAE-measurements based on a minimum signal-to-noise-ratio (SNR) would affect the applicability on the entire population. Secondly, effects of noise exposure were investigated in overall changes in audiogram and OAE-measurements. For TEOAEs (transient evoked OAEs) in the frequency band of 4 kHz, only 55% of the data points meet the SNR-inclusion criterion. For DPOAEs (distortion product OAEs) around 6 kHz approximately 80% of the data points satisfy the criterion. Thus OAEs have a limited applicability for monitoring the hearing status of this entire population. Audiometry shows significant deteriorations at 6 and 8 kHz. TEOAEs show a significant decline at all frequency bands (1–4 kHz), DPOAEs between 4 and 8 kHz and less pronounced between 1 and 2 kHz. On group level, OAEs show a decline in a larger frequency region than the audiogram, suggesting an increased sensitivity of OAEs compared to audiometry.

3. Assessing the benefit of adaptive null-steering using real-world signals
By Woods, William al.
International Journal of Audiology
, Jun 2010, Vol. 49 Issue 6: p434-443
This study compared the noise reduction of adaptive null-steering and near-hypercardioid directional hearing-aid algorithms via performance on real-world signals. Using subject-individualized and generic (i.e. similar to current hearing aids), off-line frequency-domain implementations, we processed recordings made through two microphones of a BTE device worn by five subjects. Recording scenarios included homes, offices, cafés, streets, buses, and automobiles. We found practically all (> 95% of recording time) adaptive noise-reduction benefit for generic implementations is below 1.2 dB, and 96% and 92% is below 2 dB for 16-and 32-band individualized implementations, respectively. A 256-band, individualized implementation showed a majority of benefit between 1–4 dB. We found no extended (> 2 s) continuous periods of significant (> 2 dB) benefit for the generic adaptive implementations. The recordings—having many independent and simultaneously active sources, spatially extended sources, significant reverberation, or combinations thereof—indicate an environment comprising few instances of high direct-to-diffuse energy situations. Combined with results from previous field trials, the evidence suggests that such an environment is common and represents a significant limitation on adaptive benefit.

4. Polish sentence matrix test for speech intelligibility measurement in noise
By Ozimek, Edward et al.
International Journal of Audiology, Jun 2010, Vol. 49 Issue 6: p444-454
: The purpose of this study was to develop the Polish sentence matrix test (PSMT) to measure intelligibility of speech presented against a background noise. The PSMT consists of five columns containing: 10 names, 10 verbs, 10 numerals, 10 adjectives, and 10 nouns. Since each word was available as a separate sound file, it was possible to generate different sentences by juxtaposing randomly selected words taken from respective columns. This approach allows 100 000 unique sentences of a fixed grammatical structure to be generated. The speech reception threshold (SRT), i.e. the signal-to-noise ratio (SNR) providing 50% speech intelligibility and S50, the slope of an intelligibility function at the SRT point, were shown to be −9.6 dB and 17.1 %/dB, respectively. Note that in this study dB is regarded as dB SNR, otherwise reference is given. PSMT was also evaluated using an adaptive 1-up/ 1-down staircase procedure in investigations with and without participation of an experimenter. No significant differences were shown for SRTs obtained in these investigations

5. Auditory steady-state evoked potentials vs. compound action potentials for the measurement of suppression tuning curves in the sedated dog puppy
By Markessis, Emily et al.
International Journal of Audiology, Jun 2010, Vol. 49 Issue 6: p455-462
Auditory steady-state evoked potential (ASSEP) tuning curves were compared to compound action potential (CAP) tuning curves, both measured at 2 Hz, using sedated beagle puppies. The effect of two types of masker (narrowband noise and sinusoidal) on the tuning curve parameters was assessed. Whatever the masker type, CAP tuning curve parameters were qualitatively and quantitatively similar to the ASSEP ones, with a similar inter-subject variability, but with a greater incidence of upward tip displacement. Whatever the procedure, sinusoidal maskers produced sharper tuning curves than narrow-band maskers. Although these differences are not likely to have significant implications for clinical work, from a fundamental point of view, their origin requires further investigations. The same amount of time was needed to record a CAP and an ASSEP 13-point tuning curve. The data further validate the ASSEP technique, which has the advantages of having a smaller tendency to produce upward tip shifts than the CAP technique. Moreover, being non invasive, ASSEP tuning curves can be easily repeated over time in the same subject for clinical and research purposes.

6. Are real-ear measurements (REM) accurate when using the modified pressure with stored equalization (MPSE) method?
By Shaw, Paul.
International Journal of Audiology
, Jun 2010, Vol. 49 Issue 6: p463-466
Audiologists typically verify hearing instrument fitting using real-ear measurements (REM). Recently the modified pressure with stored equalization method (MPSE) has been recommended for use when verifying open non-occluding hearing instruments. The MPSE method does not use a reference microphone to maintain loudspeaker output during real-ear measurements and is therefore susceptible to changes in the signal level at the client's ear which result from movement of the client's head and torso during the verification process. To determine the size of these errors, the real-ear unaided response (REUR) was measured prior to and following the fitting of a non-functioning hearing aid in the contralateral ear. Twenty young adults participated. Identical head positions for the two measurements should yield zero difference measures across all frequencies measured. Loudspeaker-to-client azimuths of 0° and 45° were investigated. Mean difference measures across the frequencies investigated were less than 1dB for both azimuths with one standard deviation from these mean differences typically less than 1.5 dB. Results suggest that the MPSE method does not introduce clinically significant errors in real-ear measurements when verifying hearing instrument fitting in the population examined.

7. Interaural attenuation for Sennheiser HDA 200 circumaural earphones
By Brännströma, K. Jonas & Lantz, Johannes.
International Journal of Audiology, Jun 2010, Vol. 49 Issue 6: p467-471
Interaural attenuation (IA) was evaluated for pure tones (frequency range 125 to 16000 Hz) using Sennheiser HDA 200 circumaural earphones and Telephonics TDH-39P earphones in nine unilaterally deaf subjects. Audiometry was conducted in 1-dB steps using the manual ascending technique in accordance with ISO 8253-1. For all subjects and for all tested frequencies, the lowest IA value for HDA 200 was 42 dB. The present IA values for TDH-39P earphones closely resemble previously reported data. The findings show that the HDA 200 earphones provide more IA than the TDH-39P, especially at lower frequencies (≤500 Hz). It is concluded that contralateral masking should be applied during pure-tone audiometry with the HDA 200 earphones when the level at the test ear is more than 40 dB above the threshold of the non-test ear.

Articles from Journal of Clinical Nursing

8. Editorial: The changing face of nursing in a developing country
By Battice, Juliet.
Journal of Clinical Nursing, Jul 2010, Vol. 19 Issue 13/14: p1765-1766
: The author comments on the changing face of nursing in a developing country. The author points out the absence of male nurses on a small island in the Caribbean due to stereotyping and gender discrimination. The author observes the gradual acceptance of male nurses and believes that nursing schools should encourage male nursing students to become involved in the recruitment of other male student nurses.

9. Metastatic spinal cord compression: a review of practice and care
By Kilbride, Lynn et al. Journal of Clinical Nursing, Jul 2010, Vol. 19 Issue 13/14: p1767-1783
Aim and objectives
. The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in? Background. Controversy surrounds the care for patients with metastatic spinal cord compression (MSCC). There is some evidence to indicate that care for patients with MSCC is based on individual clinician preference rather than evidence-based guidelines which has been shown to cause delays and discrepancies in patient treatment.
Design. A structured literature review to synthesise the available evidence about the management of MSCC.
Methods. The following databases were searched: Medline, EMBASE, Cochrane Systematic Reviews Database, SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for Clinical Excellence), AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and BNI (British Nursing Index). Publications were selected from the past 10 years. The search yielded a total of 1057 hits, 755 abstracts were screened, and 73 articles were retrieved and examined. Thirty-five articles were included.
Results. The findings identified a gap and evidence relating to spinal stability, bracing, patient mobilisation, and positioning is limited and may be inconclusive. It is important for patients with a poor prognosis that their preferences and quality of life are considered.
Conclusion. Currently, the evidence base to underpin care is limited, and further research in this area is necessary for patients and healthcare professionals alike.
Relevance to clinical practice. Patients who suffer from MSCC suffer numerous physical, psychological and social issues. Because of lack of consensus, the current guidelines to inform clinical decision-making of professional staff are of limited benefit. [ABSTRACT FROM AUTHOR]

10. Satisfaction with care in oncology outpatient clinics: psychometric characteristics of the Icelandic EORTC IN-PATSAT32 version
By Hjörleifsdóttir, Elísabet et al. Journal of Clinical Nursing, Jul 2010, Vol. 19 Issue 13/14: p1784-1794
Aim and objectives.
To assess the psychometric characteristics of the Icelandic European Organisation for Research and Treatment of Cancer IN-PATSAT32 (EORTC IN-PATSAT32) version and to compare satisfaction with care between gender and different age groups.
Background. The majority of patients with cancer receive either chemotherapy or radiotherapy on an outpatient basis. There is a need to evaluate satisfaction with care and service for these patients using reliable and valid instruments.
Design. Cross-sectional comparative study. Method. Participants ( n = 217) who received treatment for cancer as outpatients answered the EORTC IN-PATSAT32 questionnaire. Participants were 22–91 years old and 57% of them were female.
Results. Overall high satisfaction was found with communication, information and care that patients receive from doctors and nurses. Principal component analysis extracted four factors: ‘satisfaction with nurses’ conduct’, ‘satisfaction with doctors’ conduct’, ‘satisfaction with information’ and ‘satisfaction with service and care organisation’. Patients were most satisfied with nurses’ conduct but least satisfied with service and care organisation. Cronbach’s alpha for the four factors ranged from 0·95–0·67.
Conclusion. Although the validity of this instrument including its sensitivity to patients’ level of dissatisfaction as well as satisfaction with care and service was evident, this needs to be further explored in future studies. The psychometric strengths of the EORTC IN-PATSAT32 are its internal consistency and its construct validity, but there are several issues indicating a need to change and develop the instrument and specifically adopting it to outpatient care.
Relevance to clinical practice. Outpatient treatment options offered to cancer patients have increased, and this calls for knowledge of their satisfaction with care and service. Sparse studies are available, and there is a need for further development of reliable instruments. Our study indicates that outpatients with cancer are quite satisfied with the care they receive. Findings may contribute to improvement in outpatients’ clinics that provide treatment to patients with cancer. [ABSTRACT FROM AUTHOR]

11. Perception of risk factors and DXA T score among at-risk females of osteoporosis
By: Chang, Shu al. Journal of Clinical Nursing, Jul 2010, Vol. 19 Issue 13/14: p1795-1802
This paper reports a study to investigate the relationships among bone mineral density, demographics, knowledge of osteoporosis, beliefs concerning osteoporosis and preventive behaviours of at-risk females with family histories of osteoporosis. Background. Strong evidence demonstrates that genetics is a significant determinant of peak bone mass, with a heritability of 50–90%. However, few studies have examined the bone mineral density of at-risk females with family histories of osteoporosis, particularly in an Asian population.
Design. Telephone survey. Methods. The study population ( n = 2890) was recruited from a radiology department at a national university medical centre in northern Taiwan during 2005–2006. In total, 886 females completed a questionnaire via the telephone; the participation rate was 30·7%.
Results. The bone mineral density of at-risk females was close to osteopenia status (T score of −1 to −2·49). Most subjects were aware of osteoporosis-related information; however, few clearly understood osteoporosis. Furthermore, subjects reported difficult implementing strategies to improve bone mineral density. Variation in bone mineral density was correlated with self-rated health ( r = 0·56, p < 0·05), knowledge of osteoporosis ( r = 0·66, p < 0·05) and preventive behaviours ( r = 0·68, p < 0·05).
Conclusions. This study is to examine risk factors associated with bone mineral density of females with family histories of osteoporosis. Early identification of risk factors for osteoporosis and development of prevention programmes are required to halt the increasing in the incidence of osteoporosis and improve the bone mineral density of at-risk females. Relevance to clinical practice. Nursing care professionals, who emphasise primary, secondary and tertiary prevention with individuals and families, should develop effective prevention strategies for women with family the history of osteoporosis to protect the health of these vulnerable populations at-risk for osteoporosis. [ABSTRACT FROM AUTHOR]

12. Implementation of a guideline for pressure ulcer prevention in home care: pretest–post-test study
By Paquay, Louis et al. Journal of Clinical Nursing, Jul 2010, Vol. 19 Issue 13/14: p1803-1811
Aims and objectives.
To investigate the effect of the implementation of a patient and family education programme for pressure ulcer prevention in an organisation for home care nursing on guideline adherence and on prevalence and severity of pressure ulcers and to examine the determining factors for the application of measures for pressure ulcer prevention. Background. Quality improvement programmes in pressure ulcer prevention are not always successful.
Design. Implementation study using a pretest–post-test design. Data were collected in three probability samples. The first post-test data collection was held after six months, the second after 18 months. Method. Statistical analysis was used, comparing the pretest sample and the second post-test sample.
Results. After 18 months, the proportion of subjects with adherent measures had increased from 10·4–13·9%, the proportion of subjects with non-adherent measures decreased from 45·7–36·0%, the proportion of subjects without pressure ulcer prevention increased from 43·9–50·1% ( p < 0·0001, Chi-square test). Sub-analysis revealed that a positive change in guideline adherence was observed principally in the group at risk. Better process-of-care indicators were associated by lower pressure ulcer prevalence and less severe skin lesions. The nurses’ judgement of a patient risk status was the most important factor for applying preventive measures. Furthermore, application of pressure ulcer prevention was determined by higher age (from the age category of 70–79 years), higher dependency for the activities of daily living, higher than baseline mobility score and the presence of a pressure ulcer.
Conclusions. Guideline adherence in pressure ulcer prevention changed significantly after implementation of the education programme. There might have been inconsistencies in the nurses’ risk judgement. Relevance to clinical practice. Quality of pressure ulcer prevention improved, but several items for improvement remain. Adaptation of risk assessment procedures is needed.

13. Starting a care improvement journey: focusing on the essentials of bedside nursing care in an Australian teaching hospital
By Clarke, Tracy et al. Journal of Clinical Nursing, Jul 2010, Vol. 19 Issue 13/14: p1812-1820
Aims and objectives
. To evaluate and improve patient assessment practices, care practices, recognition of patient deterioration and communication in the acute ward environment. Background. A growing recognition of patient safety-related concerns in acute hospitals, a nursing shortage and a reduction in availability of skill and experience levels at the bedside led a group of clinicians to explore the issues that impacted on patient care at a ward level within their organisation.
Design. Multimethod practice development study. This paper reports phase one of concept development.
Method. A practice review was conducted using clinical audit processes that examined practice and documentation in relation to patient assessment parameters and care planning, specifically identifying whether changes in clinical parameters were identified and acted on.
Results. Results highlighted a clear discrepancy between the care that was identified on the nursing care plan and the care the patient was receiving. Actions as a result of the disappointing audit results included changes to education programmes, strategies to improve critical discussion regarding clinical practices and the development of assessable domains of nursing care that were relevant and realistic to ward-based nurses.
Conclusion. The results enabled the identification of eight domains of care and associated care outcomes that target strategies for care improvement. Emancipatory practice development methodology will be used to further progress this work and ensure successful implementation into clinical units.
Relevance to clinical practice. This paper examines the critical discussions, audit processes and actions that took place, leading to the development of care outcomes for nurses. [ABSTRACT FROM AUTHOR]

Journals - Table of Contents

14. Selected articles from World of Irish Nursing & Midwifery, Vol 19, No 7 September 2011

14A. Continuing Education: Cardiology - Guidelines for history taking 
Finance - Money Matters - Preparing for life as a student 
What to expect on a clinical placement 
14D. Tips and tricks for student living; Social networking
. Know thyself [Give a good account of yourself in a job interview]

News - Accident Compensation Corporation

15. ACC claims chart comparing different injury classifications for 201015 August 2011
This chart compares the number of injuries in 2010 across different ACC classifications – Road, Work, Sport, Home.
ACC injury classification chart 2010 (PDF 53K)
ACC injury classification chart 2010 (JPG 431K).

16. Falls in the home cost New Zealand $272 million
15 August 2011
More than 261,000 people were injured as a result of everyday slips, trips and falls in their home last year. The cost to the country of these falls was $272 million.
Over 3,000 people were off work for more than three months as a result of falls in the home and almost 10,000 people were off work for more than a week.

News - National

17. Fruit spray linked to birth defects
NZ Herald - Sunday Sep 11, 2011 
A pregnant Te Puke woman is considering moving out of the Bay of Plenty after hearing an antibiotic being sprayed on kiwifruit vines has been linked to birth defects.New Zealand medical book MIMS New Ethicals states streptomycin has potential to cause increased rates of human fetal malformations or irreversible damage and the Parents Centre says pregnant women should avoid it.

News - International

18. Why don't people stutter when they can't hear themselves speaking?
In the film, The King's Speech, there's a great scene where Geoffrey Rush gets Colin Firth (playing King George VI) to listen to music through headphones while reading Shakespeare out loud. We hear him read perfectly, without a stutter, a miraculous transformation. What's going on? —Rebecca
Answer: It has long been recognised that people who stutter can speak fluently when their auditory feedback is blocked so they cannot hear themselves talking.however, it is not fully understood why this is so, says neuroscientist Dr Paul Sowman from Macquarie University. Auditory feedback is vital in normally fluent speech — giving speakers constant feedback on how their speech is going and allowing them to correct errors both in language and speech, says Sowman.

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