scholarly journals Setting and Reaching Targets with Computer-Assisted Cochlear Implant Fitting

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Bart Vaerenberg ◽  
Geert De Ceulaer ◽  
Zoltán Szlávik ◽  
Patrizia Mancini ◽  
Andreas Buechner ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Outcome Measures ◽  
Free Field ◽  
Computer Assisted ◽  
Retrospective Data Analysis ◽  
Spectral Discrimination ◽  
Systematic Methodology ◽  
Adults And Children ◽  
Loudness Growth

Objective. The paper aims to demonstrate the feasibility of defining a substantial set of psychoacoustic outcome measures with preset targets and to adopt a systematic methodology for reaching these targets in a large group of subjects, by more than one clinical centre.Design. Retrospective data analysis.Setting. Multicentre with 14 participating centres.Patients. 255 adults and children using the Advanced Bionics HiRes90k cochlear implant.Intervention. Target driven fitting with the fitting to outcomes expert (FOX) system.Main Outcome Measures. For each patient, 66 measurable psychoacoustical outcomes were recorded several times after cochlear implantation: free field audiometry (6 measures) and speech audiometry (4), spectral discrimination (20), and loudness growth (36), defined from the A§E test battery. These outcomes were reduced to 22 summary variables. The initial results were compared with the latest results.Results. The state of the fitting process could be well monitored by means of the measured variables. The use of the FOX computer assisted CI-programming significantly improved the proportion of the 22 variables on target. When recipients used the automated MAPs provided at switch-on, more than half (57%) of the 22 targets were already achieved before any further optimisation took place. Once the FOX system was applied there was a significant 24% (P<0.001) increase in the number of targets achieved.Conclusions. This study demonstrates that it is feasible to set targets and to report on the effectiveness of a fitting strategy in terms of these targets. FOX provides an effective tool for achieving a systematic approach to programming, allowing for better optimisation of recipients' MAPs. The setting of well-defined outcome targets allowed a range of different centres to successfully apply a systematic methodology to monitoring the quality of the programming provided.

ECONOMIC EVALUATION OF COCHLEAR IMPLANT

1999 ◽  
Vol 15 (3) ◽  
pp. 520-530 ◽  
Author(s):  
Rob Carter ◽  
David Hailey
Keyword(s):  
Economic Evaluation ◽  
Cochlear Implant ◽  
Cost Utility ◽  
Health Programs ◽  
Value For Money ◽  
Hearing Improvement ◽  
Deaf Adults ◽  
Functional Consequences ◽  
Adults And Children

Objectives: To examine the economic efficiency of current cochlear implant technology under Australian conditions in profoundly deaf adults, partially deafened adults, and childrenMethods:> Cost—utility study, with weights based on judgments from persons experienced with the technology, and cost data from Australian sources.Results: Quality—of— improvements due to functional consequences of hearing improvement were greater than those due to amelioration of hearing disability. Costs in Australian dollars per QALY (15—year assessment) ranged from $5,070—$11,100 for children, $11,790—$38,150 for profoundly deaf adults, and $14,410—$41,000 for partially deaf adults.Conclusions: Results suggest cochlear implantation is acceptable value for money when compared with other health programs to which resources are committed in Australia.

Evidence-based review of intrathecal chemotherapy in outcome of patients with leptomeningeal metastasis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1529-1529 ◽  
Author(s):  
L. R. Rogers ◽  
M. Chamberlain ◽  
M. Glantz
Keyword(s):  
Quality Of Life ◽  
Outcome Measures ◽  
Leptomeningeal Metastasis ◽  
Intrathecal Chemotherapy ◽  
Cochrane Library ◽  
Computer Assisted ◽  
Evidence Based ◽  
Class Iii ◽  
Csf Cytology

1529 Background: Intrathecal chemotherapy (ITC) is commonly employed to treat leptomeningeal metastasis (LM). An evidence-based literature review supporting this practice is lacking. We therefore searched the literature for evidence of efficacy of ITC on LM patient outcome in order to provide evidence-based treatment recommendations. Methods: Computer-assisted searches of the Medline and Cochrane Library databases were performed. Only prospective, randomized, controlled trials in which ITC chemotherapy was used to treat LM were selected. Study design, patient characteristics, interventions, and outcome measures were independently compiled by each of the authors using customized data extraction forms. Each article was assigned a class of evidence by each of the authors. Disagreements were resolved by consensus. Results: Five articles met the criteria. Four studies compared different ITC regimens. One compared ITC to controls who did not receive ITC. Study populations included solid tumors (3 [2 of these included lymphoma]), lymphoma only (1), breast cancer only (1). Positive CSF cytology was a requirement for study entry in three trials. In each trial patients were allowed to receive CNS radiation as needed and non-investigational chemotherapy to treat the underlying cancer. Outcome measures included neurological status (5), survival (5), toxicity (5), CSF cytology (4), cause of death (3), time to neurologic progression (3), and quality of life (2). All studies lacked masked outcome assessment, and some suffered from additional design flaws including insufficient size, inequalities in baseline characteristics, inadequate characterization of treatment arms, and poor choice or definition of primary endpoints. Consequently, all studies provided only Class III evidence. Conclusions: There is no Class I or II evidence that ITC improves outcome in patients with LM. Improved quality of life, survival, or time to neurologic progression in treatment responders vs. non-responders in some of these trials provides a weak suggestion that effective therapy improves clinical outcome. Well-designed, adequately powered studies are urgently needed to determine efficacy of ITC in LM. No significant financial relationships to disclose.

The Effect of Nonlinear Amplitude Growth on the Speech Perception Benefits Provided by a Single-Sided Vocoder

2019 ◽  
Vol 62 (3) ◽  
pp. 745-757 ◽  
Author(s):  
Jessica M. Wess ◽  
Joshua G. W. Bernstein
Keyword(s):  
Transfer Functions ◽  
Spatial Configuration ◽  
Free Field ◽  
Spatial Separation ◽  
Compression And Expansion ◽  
Interaural Difference ◽  
Interaural Differences ◽  
Single Sided Deafness ◽  
Perceptual Separation ◽  
Loudness Growth

PurposeFor listeners with single-sided deafness, a cochlear implant (CI) can improve speech understanding by giving the listener access to the ear with the better target-to-masker ratio (TMR; head shadow) or by providing interaural difference cues to facilitate the perceptual separation of concurrent talkers (squelch). CI simulations presented to listeners with normal hearing examined how these benefits could be affected by interaural differences in loudness growth in a speech-on-speech masking task.MethodExperiment 1 examined a target–masker spatial configuration where the vocoded ear had a poorer TMR than the nonvocoded ear. Experiment 2 examined the reverse configuration. Generic head-related transfer functions simulated free-field listening. Compression or expansion was applied independently to each vocoder channel (power-law exponents: 0.25, 0.5, 1, 1.5, or 2).ResultsCompression reduced the benefit provided by the vocoder ear in both experiments. There was some evidence that expansion increased squelch in Experiment 1 but reduced the benefit in Experiment 2 where the vocoder ear provided a combination of head-shadow and squelch benefits.ConclusionsThe effects of compression and expansion are interpreted in terms of envelope distortion and changes in the vocoded-ear TMR (for head shadow) or changes in perceived target–masker spatial separation (for squelch). The compression parameter is a candidate for clinical optimization to improve single-sided deafness CI outcomes.

Strategi Penyelenggaraan Diklat Dan Ujian Sertifikasi Keahlian Pengadaan Barang/ Jasa Pemerintah Di Lingkungan Pemerintah Kabupaten Magelang

2017 ◽  
Vol 24 (1) ◽  
pp. 87-106
Author(s):  
Wiharyanto Wiharyanto
Keyword(s):  
Education And Training ◽  
Test System ◽  
Civil Servants ◽  
Quality Of Education ◽  
Alternative Formulation ◽  
Computer Assisted ◽  
Certification Exams ◽  
The Government ◽  
And Training

The study aims to analyze about the low graduation and certification exam training participants of the procurement of goods / services of the government and its contributing factors, and formulate a strategy of education and training and skills certification exams procurement of goods / services of the government. Collecting data using the method of study documentation, interviews, and questionnaires. Is the official source of information on the structural and functional Regional Employment Board, as well as the participants of the training and skills certification exams procurement of goods / services of the government in Magelang regency government environment. Analysis using 4 quadrant SWOT analysis, to determine the issue or strategic factors in improving the quality of education and training and skills certification exams procurement of government goods / services within the Government of Magelang regency. The results show organizer position is in quadrant I, which is supporting the growth strategy, with 3 alternative formulation strategies that improve the quality of education and training and skills certification exams procurement of government goods / services, and conducts certification examination of the procurement of government goods / services with computer assisted test system (CAT). Based on the research recommendations formulated advice to the organizing committee, namely: of prospective participants of the training and skills certification exams procurement of goods / services the government should consider the motivation of civil servants, is examinees who have attended training in the same period of the year, the need for simulation procurement of goods / services significantly, an additional allocation of training time, giving sanction to civil servants who have not passed the exam, the provision of adequate classroom space with the number of participants of each class are proportional, as well as explore the evaluation of education and training and skills certification exams procurement of goods / services for Government of participants.

scholarly journals SWE and SMI ultrasound techniques for monitoring needling treatment of ankylosing spondylitis: study protocol for a single-blinded randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mengyu Wang ◽  
Wen Fu ◽  
Lingcui Meng ◽  
Jia Liu ◽  
Lihua Wu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Flow ◽  
Ankylosing Spondylitis ◽  
Outcome Measures ◽  
Healthy Subjects ◽  
Acupuncture Group ◽  
Musculoskeletal Ultrasound ◽  
Sham Control ◽  
Post Intervention

Abstract Background Ankylosing spondylitis (AS) is a high-incidence disease in young men that interferes with patients’ physical and mental wellbeing and overall quality of life (QoL). It is often accompanied by arthralgia, stiffness, and limited lumbar flexibility. Acupuncture is safe and effective for reducing the symptoms of AS, but the underlying mechanisms by which it does so are not fully understood. Therefore, to objectively assess acupuncture efficacy, which is critical for patients making informed decisions about appropriate treatments, we will use shear-wave elastography (SWE) and superb microvascular imaging (SMI) ultrasound techniques to evaluate elasticity of lumbar paraspinal muscles and blood flow to the sacroiliac joint (SIJ) in AS. Methods We will recruit a total of 60 participants diagnosed with AS and 30 healthy subjects. Participants will be randomly allocated 1:1 to either an acupuncture group or a sham control acupuncture group. Primary-outcome measures will be musculoskeletal ultrasound, Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Metrology Index (BASMI), and the Visual Analogue Scale (VAS) for pain. Secondary outcome measures will be the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Function Index (BASFI), and Fatigue Scale-14 (FS-14). We will monitor the effect of acupuncture or sham acupuncture on blood flow and SIJ inflammation using SMI, lumbar-muscle stiffness using SWE and the lumbar paraspinal-muscle cross-sectional area (CSA) using a two-dimensional (2D) grayscale imaging. QoL, physical function, and fatigue will be assessed using an evaluation scale or questionnaire developed for this study, with outcomes measured by the ASQoL, BASMI, BASDAI, BASFI, and FS-14. Healthy subjects will not receive acupuncture but undergo only musculoskeletal ultrasound at baseline. Acupuncture and sham control acupuncture interventions will be conducted for 30 min, 2–3 times/week for 12 weeks. Musculoskeletal ultrasound will be conducted at baseline and post-intervention, while other outcomes will be measured at baseline, 6 weeks, and post-intervention. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Discussion The results of this single-blinded, randomized trial with sham controls could help demonstrate the efficacy of acupuncture and clarify whether musculoskeletal ultrasound could be used to evaluate AS. Trial registration ClinicalTrials.gov ChiCTR2000031476. Registered 3 April 2020.

scholarly journals Ordinal outcome analysis improves the detection of between-hospital differences in outcome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. E. Ceyisakar ◽  
N. van Leeuwen ◽  
Diederik W. J. Dippel ◽  
Ewout W. Steyerberg ◽  
H. F. Lingsma
Keyword(s):  
Logistic Regression ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Statistical Power ◽  
Ordinal Scale ◽  
Efficiency Gain ◽  
Number Of Patients ◽  
Dichotomous Outcomes ◽  
Ordinal Outcome

Abstract Background There is a growing interest in assessment of the quality of hospital care, based on outcome measures. Many quality of care comparisons rely on binary outcomes, for example mortality rates. Due to low numbers, the observed differences in outcome are partly subject to chance. We aimed to quantify the gain in efficiency by ordinal instead of binary outcome analyses for hospital comparisons. We analyzed patients with traumatic brain injury (TBI) and stroke as examples. Methods We sampled patients from two trials. We simulated ordinal and dichotomous outcomes based on the modified Rankin Scale (stroke) and Glasgow Outcome Scale (TBI) in scenarios with and without true differences between hospitals in outcome. The potential efficiency gain of ordinal outcomes, analyzed with ordinal logistic regression, compared to dichotomous outcomes, analyzed with binary logistic regression was expressed as the possible reduction in sample size while keeping the same statistical power to detect outliers. Results In the IMPACT study (9578 patients in 265 hospitals, mean number of patients per hospital = 36), the analysis of the ordinal scale rather than the dichotomized scale (‘unfavorable outcome’), allowed for up to 32% less patients in the analysis without a loss of power. In the PRACTISE trial (1657 patients in 12 hospitals, mean number of patients per hospital = 138), ordinal analysis allowed for 13% less patients. Compared to mortality, ordinal outcome analyses allowed for up to 37 to 63% less patients. Conclusions Ordinal analyses provide the statistical power of substantially larger studies which have been analyzed with dichotomization of endpoints. We advise to exploit ordinal outcome measures for hospital comparisons, in order to increase efficiency in quality of care measurements. Trial registration We do not report the results of a health care intervention.

scholarly journals Qualitative assessment of YouTube videos as a source of patient information for cochlear implant surgery

2021 ◽  
pp. 1-4
Author(s):  
C Thomas ◽  
J Westwood ◽  
G F Butt
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implants ◽  
Qualitative Assessment ◽  
Supplementary Information ◽  
Implant Surgery ◽  
Critical Elements ◽  
Positive Elements ◽  
Cochlear Implant Surgery ◽  
Youtube Videos

Abstract Background YouTube is increasingly used as a source of healthcare information. This study evaluated the quality of videos on YouTube about cochlear implants. Methods YouTube was searched using the phrase ‘cochlear implant’. The first 60 results were screened by two independent reviewers. A modified Discern tool was used to evaluate the quality of each video. Results Forty-seven videos were analysed. The mean overall Discern score was 2.0 out of 5.0. Videos scored higher for describing positive elements such as the benefits of a cochlear implant (mean score of 3.4) and scored lower for negative elements such as the risks of cochlear implant surgery (mean score of 1.3). Conclusion The quality of information regarding cochlear implant surgery on YouTube is highly variable. These results demonstrated a bias towards the positive attributes of cochlear implants, with little mention of the risks or uncertainty involved. Although videos may be useful as supplementary information, critical elements required to make an informed decision are lacking. This is of particular importance when patients are considering surgery.

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