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INTRODUCTION: Restraints in the inpatient child/adolescent psychiatric population pose a threat to client safety and quality of care. Nurses are key in reducing restraints through implementation of evidenced-based interventions to improve quality and safety. AIM: To identify the impact of milieu nurse–client shift assignments on monthly restraint rates when compared with individual nurse–client shift assignments on an inpatient child/adolescent psychiatric unit. METHODS: A quantitative, retrospective, comparative project design was used. The sample included all inpatient child/adolescent clients admitted to the child/adolescent psychiatric unit between the months of January–May 2016 and 2017 who were physically or mechanically restrained. Retrospective chart audits were conducted, and information transcribed onto an adapted chart audit tool by Edwards et al. (2006). Monthly restraint rates were compared using the Mann–Whitney U test. A p value of <.05 was used to determine statistical significance. RESULTS: The Mann–Whitney U test revealed statistical significance between the impact that the individual nurse–client shift assignments (Mdn = 61.2, n = 6) and the milieu nurse–client shift assignments (Mdn = 6.8, n = 6) had on monthly restraint rates, U =.000, z = −2.88, p =.004, r =.83. CONCLUSION: Use of milieu nurse–client shift assignments are associated with lower monthly restraint rates when compared to individual nurse–client shift assignments. Milieu nurses provide structure, safety, consistency, and security, leading to early intervention and de-escalation of clients who display aggressive behaviors. Nurse staffing structures also need to be optimized to meet the needs of this population. [ABSTRACT FROM AUTHOR]

Recent work suggests that hair cells are not the most vulnerable elements in the inner ear; rather, it is the synapses between hair cells and cochlear nerve terminals that degenerate first in the aging or noise-exposed ear. This primary neural degeneration does not affect hearing thresholds, but likely contributes to problems understanding speech in difficult listening environments, and may be important in the generation of tinnitus and/or hyperacusis. To look for signs of cochlear synaptopathy in humans, we recruited college students and divided them into low-risk and high-risk groups based on self-report of noise exposure and use of hearing protection. Cochlear function was assessed by otoacoustic emissions and click-evoked electrocochleography; hearing was assessed by behavioral audiometry and word recognition with or without noise or time compression and reverberation. Both groups had normal thresholds at standard audiometric frequencies, however, the high-risk group showed significant threshold elevation at high frequencies (10–16 kHz), consistent with early stages of noise damage. Electrocochleography showed a significant difference in the ratio between the waveform peaks generated by hair cells (Summating Potential; SP) vs. cochlear neurons (Action Potential; AP), i.e. the SP/AP ratio, consistent with selective neural loss. The high-risk group also showed significantly poorer performance on word recognition in noise or with time compression and reverberation, and reported heightened reactions to sound consistent with hyperacusis. These results suggest that the SP/AP ratio may be useful in the diagnosis of “hidden hearing loss” and that, as suggested by animal models, the noise-induced loss of cochlear nerve synapses leads to deficits in hearing abilities in difficult listening situations, despite the presence of normal thresholds at standard audiometric frequencies. [ABSTRACT FROM AUTHOR]

Purpose: To estimate real-environment iPod listening levels for listeners in 4 environments to gain insight into whether average listeners receive dosages exceeding occupational noise exposure guidelines as a result of their listening habits. Method: The earbud outputs of iPods were connected directly into the inputs of a digital recorder to make recordings of listening levels. These recordings were used to estimate listening levels using reference recordings made in a real ear. Recordings were made in 4 environments with a wide range of background noises: (a) a library, (b) a student center, (c) busy streets, and (d) the subway. Results: None of the 64 listeners were estimated to exceed allowable occupational dosages, with a maximum dose of 7.57% based on Occupational Safety and Health Administration (OSHA; 1998) methods and 10.83% based on National Institute for Occupational Safety and Health (NIOSH; 1998) methods. Conclusions: All of the listeners surveyed were exposed to dosages well below OSHA and NIOSH occupational regulations. Although this does not guarantee individual safety, the results do not support the widespread concern regarding the safety of common iPod usage. However, measurements made in this study agree with the finding that iPod output can exceed safe levels and further support recommendations to monitor and limit listening volume and listening duration. [ABSTRACT FROM AUTHOR]

Spondyloepiphyseal dysplasia is a disorder characterized by abnormalities of growth. Previous studies of this disorder have identified a significant incidence of associated hearing loss. Hearing loss has been reported to occur in 25 to 30% of affected patients. To date, all reports of associated hearing loss have indicated the presence of a sensorineural component. In this article, we report the case of a child who was diagnosed with spondyloepiphyseal dysplasia congenita and who was found to have a significant conductive hearing loss with a Carhart's notch, indicating the likely presence of stapes footplate fixation. We also review the diagnosis of this condition and the literature associated with hearing loss as it occurs with this disorder. [ABSTRACT FROM AUTHOR]

Objective: While pseudohypacusis or nonorganic hearing loss is a well-recognized phenomenon in adults, it is the aim of this report to heighten the physician' awareness of the occurrence of nonorganic hearing loss in pediatric patients. The medical and otologic histories of 18 cases identified consecutively between 1983 and 1991 at The Children' Hospital, Boston, Massachusetts, were retrospectively reviewed. In these selected cases an analysis of the audiometric configuration, age range, and sex distribution is undertaken. This review highlights the need to rule out pseudohypacusis even in pediatric cases where suspicion is low. A precedent trauma was the presenting complaint in a high percentage of our patient population. This association has not been previously reported in the pediatric literature. While the severity of the traumatic incident was often minor, extensive medical and surgical investigations had been considered before the identification of nonorganic hearing loss. Study Design: A retrospective chart analysis of patients identified with pseudohypacusis over a 7-year period. Methods: A tertiary care children' hospital in an urban community. Eighteen consecutively identified patients examined by a staff audiologists at a tertiary care children' hospital. A specific battery of standard audiologic testing with the goal of detecting pseudohypacusis in children. Results: Successful if additional interventions such as exploratory tympanotomy were avoided. Conclusions: Pseudohypacusis was identified in 18 patients with a majority having an antecedent history of trauma. Additional interventions were canceled upon the detection of true threshold values. A high index of suspicion of pseudohypacusis in children and an organized standardized battery of audiologic testing will facilitate early identification of these patients and will avert inappropriate interventions. Laryngoscope, 108:1534-1538, 1998 [ABSTRACT FROM AUTHOR]

The article discusses the use of nursing case studies as an effective technique to help nursing students engage in critical thinking. It mentions that the student-centered case study approach has received increased attention in nursing education. Methods used include providing case studies to students. Advanced medical surgical nursing lectures were presented to the students. It includes a modular format inludes a module overview, module objectives and a written case study. The article mentions that medical based television show was used as the basis for case study.