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D L Field

Publications and source records attributed to D L Field.

5 recordsLinked to original sources
PubMed1994

Validation of parameters for assessing Obscure Auditory Dysfunction--robustness of determinants of OAD status across samples and test methods.

About 5% of those presenting at an ENT clinic with ear or hearing complaints are found to have normal pure-tone thresholds. Many of this group complain specifically of difficulties understanding speech in background noise. We have termed this complaint 'Obscure Auditory Dysfunction' (OAD). Previous research on OAD (Saunders and Haggard, 1992) on a sample of 50 patients and 50 matched controls showed that 83% of the deviance (binary variance) in membership of group (OAD/control) could be explained by four variables, with three underlying factors. These four variables are performance threshold in noise for speech; discrepancy between this and a self-adjusted signal-to-noise ratio value (i.e. a measure of auditory confidence); dichotic listening performance; and performance on a psychoacoustic test, the threshold for detecting a tone in a spectrally notched noise. This paper reports a study on a further 59 new OAD patients and 64 unmatched controls, using the tests in the form present in the test package, plus certain others. For routine practice, slightly differing implementations of the auditory test techniques were used. Compared to the earlier sample, the new sample had poorer measures of speech reception threshold in noise and they considered themselves more handicapped by their OAD state; however there was no significant difference between the two samples on the other performance variables. Overall, the results demonstrate the robustness of the conclusions reached from the previous study, as the test-variable determinants of OAD status (i.e. case-control differences) were similar. The items on the OAD interview questionnaire which had shown significant differences between OADs and controls were also similar for the two OAD samples, giving a consistent picture of patient profile. These were: difficulties learning to read or write as a child (which relates to dichotic listening scores); adult ear problems; and tinnitus (which relate to the psychoacoustic scores). This necessary replication confirms the validity of the three-factor model of OAD status and the utility of the clinical test package based upon it.

Adolescent↗
PubMed1992

A clinical test battery for obscure auditory dysfunction (OAD): development, selection and use of tests.

Obscure auditory dysfunction (OAD) is defined as convincing self-report of auditory disability accompanied by normal pure-tone thresholds. This has been increasingly recognized as a clinical problem, but until now there has not been a standard clinical procedure for dealing with such patients. This paper summarizes a demographic and clinical characterization of a sample of 50 OAD patients, reports new norms on the tests in the version issued, and describes a test package developed from a case-control research study that can be routinely used with OAD patients. The package enables clinicians: (i) to confirm, or otherwise, OAD as the appropriate classification for individuals presenting with OAD-like symptoms; (ii) to elucidate the underlying basis of OAD in such individuals and hence in most cases to provide explanations that are justified by test findings; and (iii) to counsel cases in a fashion appropriate for each individual. The package consists of four performance tests, a specialized clinical interview and a brief questionnaire to determine the severity of OAD. The assessment takes approximately 37 min and can be run using a two-channel audiometer and a cassette recorder.

Adolescent↗
PubMedDate not supplied

Limitations of chest pain follow-up from an urban teaching hospital emergency department.

Close outpatient follow-up of chest pain patients released from the emergency department (ED) has been suggested as an important means of detecting atypical presentations of cardiac ischemia. Urban teaching hospital patient populations often have limited private physician follow-up options and rely upon standard teaching hospital clinic systems. We analyzed the follow-up of 318 patients 30 or more years of age with nontraumatic chest pain released from the ED of a large urban teaching hospital. The planned disposition of the released patients was as follows: a medical clinic (136), another clinic or a private physician (76), or ED "as needed" (98); in addition, some patients left against medical advice (AMA) (8). The medical clinics received only 38% (51/136) of planned referrals. No subsequent record could be found for 13% (17/136) of referred patients. Only 17% (23/136) of referred patients were reevaluated within seven days. Two of the patients referred to medical clinics were admitted to the hospital within 24 hours for unstable angina and another was admitted from a medical clinic 16 days after ED evaluation with an acute myocardial infarction. Of patients with ED follow-up "as needed," one patient required admission for unstable angina 27 days after ED evaluation. Of the patients who left AMA, only two were reevaluated within 30 days. These findings suggest that specific measures to enhance follow-up must be instituted at urban teaching hospitals if chest pain patients are to be closely followed after ED release.

Adult↗