Search

Background: Digital otoscopy can be used to evaluate a range of clinical conditions, including otitis media and the status of tympanostomy tubes. Our center completed a pilot project integrating digital otoscopy into tele-audiology visits to improve access to hearing aid support services. Ten families were provided with inexpensive video otoscopes capable of generating images submitted to our electronic medical record system using a smartphone. Methods: Families were mailed the video otoscope along with the following instructions: 1. Plug in the device and charge it for 3--4 hours; 2. Download the appropriate app on their phone or tablet; 3. Connect the device and take/save pictures; and 4. Log into the hospital's medical record system (MyChart) and message the audiologist, attaching the appropriate pictures. Additionally, families were provided with instructional materials from the device manufacturer which explained how to download an app and to save an image. This documentation contained one picture of an intact ear canal but no additional instructions about how an ideal image should appear. The process of educating families in the use of the digital otoscope evolved over the course of the project: the process was modified with families receiving detailed instructions by mail or reviewed in person. In these instances, families were provided. Results: When using the initial, manufacturer generated instructions, only four of nine families were able to generate usable pictures. After modifying the handouts and instructions, an additional four families were able to submit usable pictures, including two children with chronic ear infections. Families were also asked to rate as Not At All True, Mostly True or Very True the following statements: 1. Downloading the App was easy to do; 2. The remote video otoscope was easy to use; 3. Transferring the information to MyChart was easy to do; 4. The information I received from the Audiologist was helpful; and 5. I would use the video otoscope again. 100% of families reported that it was "Mostly/Very True" that downloading the app, using the video otoscope, and transferring the images was easy. 100% of the families reported that it was Mostly/Very True that the information they received was helpful. 78% reported that it was "Very True" that they would use the video otoscope again. Discussion: For families who are motivated to master the use of video otoscopy as a tool for providing otoscopic images to their audiologist, inexpensive video otoscopy can be successfully added to a tele-audiology program. [ABSTRACT FROM AUTHOR]

Objective: Very young children with type 1 diabetes often struggle to achieve glycemic targets, putting them at risk for long-term complications and creating an immense management burden for caregivers. We conducted the first evaluation of the Omnipod 5 Automated Insulin Delivery System in this population., Research Design and Methods: A total of 80 children aged 2.0-5.9 years used the investigational system in a single-arm study for 13 weeks following 14 days of baseline data collection with their usual therapy., Results: There were no episodes of severe hypoglycemia or diabetic ketoacidosis. By study end, HbA1c decreased by 0.55% (6.0 mmol/mol) (P < 0.0001). Time with sensor glucose levels in target range 70-180 mg/dL increased by 10.9%, or 2.6 h/day (P < 0.0001), while time with levels <70 mg/dL declined by median 0.27% (P = 0.0204)., Conclusions: Use of the automated insulin delivery system was safe, and participants experienced improved glycemic measures and reduced hypoglycemia during the study phase compared with baseline., (© 2022 by the American Diabetes Association.)

Background: Establishing and maintaining a positive, inclusive social climate in school is essential, especially given the many potential social pressures that make school a toxic environment for vulnerable students. We explored middle school physical education (PE) teachers' perceptions of the factors that influence the implementation of social-oriented approaches to include overweight and obese students., Methods: We used a qualitative multicase study design guided by the Social Ecological Constraints model to study 9 PE teachers' perspectives and actions. We analyzed the transcripts of semistructured interviews, field notes, and artifacts related to teaching, PE programs, and school policies. Trust was established in conventional ways., Results: Social-ecological factors influenced teachers including program and school culture, policies, and norms of collaboration. Teachers acted beyond their instructional setting level strategies and used school-program level strategies to socially include overweight and obese in PE., Conclusions: Some environments challenge employment of more than simple accommodations and a caring attitude; in others, teachers can collaborate with other school personnel to teach social goals through negotiating constraints, creating ingenious modifications and interactive tasks, and incorporating personal and social skills as a primary curricular goal., (© 2019, American School Health Association.)

To compare the efficacy and side effects of beta-blockers with intrinsic sympathomimetic activity (ISA) to those without ISA, we retrospectively reviewed patients diagnosed with neurocardiogenic syncope (NCS) as determined by head-up tilt table testing. Four hundred and thirty-one patients (mean age of 57 +/- 25 years) underwent head-up tilt table testing for syncope of unknown etiology, of which 120 patients were diagnosed with NCS; 87 of these patients were treated with beta-blocker therapy. Only 56 patients could be contacted during follow-up. Twenty-eight patients were treated with beta-blockers with ISA (acebutolol or pindolol) and 28 received beta-blockers without ISA (atenolol or metoprolol) based on physician preference and followed for up to 2 years. During the follow-up period, beta-blockers with or without ISA had comparable clinical efficacy in suppressing recurrent syncope in patients with NCS. However, beta-blockers with ISA were better tolerated and caused less fatigue (32% side effects) as compared to those without ISA (50% side effects; p = 0.23). The benefits of beta-blockers with ISA were more pronounced in patients less than 60 years old (19% side effects with beta-blocker with ISA as compared to 85% side effects with beta-blocker without ISA; p = 0.0004). Beta-blockers without ISA appear to be better tolerated and caused less fatigue in patients 65 years old or greater (20%) than in patients less than 65 years old (85%; p = 0.0002).