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T Fortune

Publications and source records attributed to T Fortune.

8 recordsLinked to original sources
PubMed2001

Telephone triage: an Irish view.

This paper examines the issue of telephone triage for an Irish Emergency Department and includes definitions of triage and telephone triage. At St. James Hospital, Dublin the first attempt at formal telephone triage failed. In hindsight this was attributed to inadequate research into the topic and lack of staff motivation. This paper forms part of a larger literature review undertaken by the author following the first failed attempt. An overview of the international literature addresses both the positive and negative sides of a telephone helpline. The body of literature reviewed suggests telephone triage can be successful but advises the use of formal protocols, training of staff and accurate documentation. The purpose of this paper is therefore to investigate the benefits and recommended practices of implementing telephone triage with a view to successfully changing policy and practice in a busy Emergency Department.

Communication↗
PubMed2000

Duration, compression, and the aided loudness discomfort level.

OBJECTIVE: The purpose of this investigation is to determine how the unaided and aided loudness discomfort level (LDL) varies with the duration of the input signal and whether the electroacoustic characteristics of compression circuits affect this relationship in a manner that may alter the listener's dynamic range for short duration sounds. DESIGN: Ten hearing-impaired and 20 normal-hearing listeners participated. LDLs were determined for noise bursts of durations ranging in six steps from 32 to 1024 msec, using a two-alternative, forced-choice adaptive tracking procedure in which input level varied until LDL was achieved. LDLs were also obtained for continuous discourse, using a clinical procedure. Subjects were also given the opportunity to self adjust maximum output SPL to their LDL using either output limiting or volume controls in response to fixed 90 dB SPL noise bursts. Testing was conducted unaided and with hearing aids representing two analog (output compression limiting, wide dynamic range compression) and four digital compression circuits. Primary circuit contrasts included compression threshold, compression ratio, attack time and the presence or absence of unity gain at high levels. RESULTS: For the unaided condition, both normal-hearing and hearing-impaired subjects showed increasing LDLs with decreasing signal duration. Under aided conditions, circuits with compression thresholds of 45 to 50 dB SPL and compression ratios of 2:1 produced LDL functions that were similar in slope to the impaired listener's unaided functions. Slopes were steeper when the attack time was slow (128 msec) than when it was fast (2 msec). Circuits with compression ratios of 8:1 produced flat LDL duration functions (i.e., a loss of duration-dependent effects). Similar duration-dependent LDL effects were also observed when subjects adjusted their own hearing aid output characteristics in response to 90 dB noise bursts. CONCLUSION: For the unaided condition, results suggest that normal-hearing and hearing-impaired listeners can tolerate short duration sounds at higher levels than long duration sounds, a finding that has implications for hearing aid design. Circuits that preserve the relationship between duration and LDL should allow brief phonemes to be presented at higher levels without discomfort than circuits that do not, possibly resulting in greater audibility or speech recognition. Current results suggest that circuits with low compression thresholds, low compression ratios, and slow attack times might accomplish this objective better than circuits with high compression thresholds, high compression ratios and fast attack times.

Adult↗
PubMed1999

Aided growth of masking for speech and nonspeech signals.

OBJECTIVE: Growth of masking (GOM) functions for speech and nonspeech signals were obtained in normal and impaired ears, with an emphasis on aided listening conditions. The purpose of the investigation was to determine whether electroacoustic contrasts between hearing aid circuits would manifest themselves in aided GOM functions and to determine whether amplification alters the slopes of GOM functions in impaired ears. DESIGN: Five normal-hearing and 10 hearing-impaired listeners with sloping high-frequency losses participated. GOM functions were obtained in the sound field using a two-interval forced choice forward masking paradigm. Four sets of test signals consisted of narrowband noise maskers and sinusoidal probes. Two additional stimulus sets consisted of phonemes used as masker and probe. Both on-frequency and off-frequency masking conditions were examined. Test circuits included wide dynamic range compression (low compression threshold and low compression ratio) and output compression limiting (high compression threshold and high compression ratio), each adjusted to the DSL[i/o] prescriptive target. GOM slopes were calculated for normal-hearing and hearing-impaired subjects unaided, and for impaired subjects aided, in an effort to determined whether amplification compensates for abnormal growth of masking and whether electroacoustic contrasts between circuits differentially affect level-dependent masker effectiveness. RESULTS: Results indicated large differences between normal and impaired functions unaided. Under aided conditions, narrowband noise masked thresholds were reduced re: unaided at lower masker levels but not at higher masker levels. Masked thresholds for phoneme maskers were reduced at all masker levels. In general, aided GOM slopes changed in the direction of normal but did not match normal slopes. Aided results were highly dependent on stimulus test conditions and were consistent with the compression thresholds and release times of the aids under test. Circuit contrasts were more apparent when phonemes were used as masker and probe than when conventional signals were used. CONCLUSION: Results suggest that GOM functions can be altered by amplification in ways that are consistent with the electroacoustic characteristics of the circuits being used. Although these data address only a small number of conditions, they suggest a possible application for aided growth of masking in the evaluation of hearing aid performance.

Adult↗
PubMed1991

Tourette's syndrome and treatment with clomipramine hydrochloride.

Clomipramine hydrochloride, a tricyclic antidepressant that blocks serotonin and norepinephrine reuptake, is indicated in the treatment of Obsessive-Compulsive Disorder. It has been reported that patients with Obsessive-Compulsive Disorder and a concomitant diagnosis of Tourette's Syndrome respond well to treatment with clomipramine (1). It has also been reported that these dually-diagnosed patients, when treated with clomipramine, receive relief from the symptoms of both disorders (2). Published reports of Tourette's patients, without a concomitant Obsessive-Compulsive Disorder, successfully responding to treatment with clomipramine are rare. To the authors' knowledge, no such report has been published since 1975. This article reports the case of a 41-year-old male Tourette's patient, without a dual diagnosis of Obsessive-Compulsive Disorder, who successfully responded to clomipramine therapy.

Adult↗