Cartilage tympanoplasty in the treatment of adhesive otitis media with and without Eustachian tube balloon dilatation

Purpose:To compare cartilage tympanoplasty(CT)combined with eustachian tube balloon dilatation(ETBD)and cartilage tympanoplasty alone as a surgical treatment modality for adhesive otitis media(AdOM)in terms of graft healing,audiological outcomes,and impact on life style,using Chronic Otitis Media Outcome Test 15(COMOT-15).Methods:50 patients with AdOM were randomly classified into 2 groups:25 patients for cartilage tympanoplasty only(CT group)and 25 patients for cartilage tympanoplasty combined with eustachian tube balloon dilatation(CT t ETBD group).Clinical outcomes in both groups were compared at 3 and 6 months of follow up.Results:There was no significant difference in graft healing between the two groups.Postoperative COMOT-15 scores significantly decreased in both groups with a significant difference between the groups with regard to the decrease in COMOT-15 scores at 3 and 6 months of follow-up(P<0.05).Hearing improvement was achieved,as the mean preoperative ABG was 26.5±5.4 and 27.1±4.6 dB,and the mean postoperative ABG at 6 months was 19.4±4.4 and 14.6±3.9 dB in the CT and the CT t ETBD groups,respectively.The difference in the magnitude of ABG reduction in the two groups was significant at 3 and 6 months of postoperative follow-up(P<0.05)in favour of the CT t ETBD group.Conclusion:ETBD can increase the success rate of cartilage tympanoplasty in patients with AdOM by enhancing the audiological outcome and quality of life.

An integrative risk assessment approach to enhancing patient safety in Continuous Renal Replacement Therapy(CRRT)

Continuous Renal Replacement Therapy(CRRT)serves as an intervention strategy for the management of acute kidney injury(AKl)in critically ill patients.However,owing to its complex nature and the potential for com-plications,the implementation of CRRT demands continuous monitoring to prevent patient safety risks.This study aims to identify and validate prevalent risks linked to CRRT within a real-world clinical setting,intending to propose preventive measures grounded in expert insights.To systematically categorize and visually depict the risks,their consequences,preventive measures,and recovery controls,our study employed the Bowtie method in conjunction with the Systems Engineering Initiative for Patient Safety(SEIPS)model.In addition to considering patient-related factors that exhibit variability among critically ill individuals,our key findings showed that the most influential risks impacting the effective delivery of CRRT are incidents of clotted filters,bleeding risks arising from the necessity of anticoagulation for filter efficacy,vascular catheter-related bloodstream infections,variations in proficiency levels among healthcare professionals regarding CRRT modalities,especially in oper-ating the CRRT machines,high nursing workload,frequent nursing turnover,occurrences of hypophosphatemia,variability in CRRT prescribing patterns,and issues related to communication among stakeholders.This research sheds light on the primary risks associated with CRRT and provides practical and viable strategies for effective management.Furthermore,the Bowtie diagram developed as part of this study serves as a valuable tool for visually representing the healthcare system and facilitating the identification of system-related risks within healthcare settings.