scholarly journals Tablet-Based Telerehabilitation Versus Conventional Face-to-Face Rehabilitation After Cochlear Implantation: Prospective Intervention Pilot Study

10.2196/20405 ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e20405
Author(s):  
Christiane Völter ◽  
Carolin Stöckmann ◽  
Christiane Schirmer ◽  
Stefan Dazert
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
Cochlear Implantation ◽  
Standard Therapy ◽  
Auditory Training ◽  
Subjective Rating ◽  
Speech Understanding ◽  
Face To Face ◽  
Computer Based ◽  
Speech Tracking

Background Technologies allowing home-based rehabilitation may be a key means of saving financial resources while also facilitating people’s access to treatment. After cochlear implantation, auditory training is necessary for the brain to adapt to new auditory signals transmitted by the cochlear implant (CI). To date, auditory training is conducted in a face-to-face setting at a specialized center. However, because of the COVID-19 pandemic’s impact on health care, the need for new therapeutic settings has intensified. Objective The aims of this study are to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and compare the clinical outcomes and economic benefits of this platform with those derived from conventional face-to-face rehabilitation settings in a clinic. Methods In total, 20 experienced adult CI users with a mean age of 59.4 (SD 16.3) years participated in the study. They completed 3 weeks of standard (face-to-face) therapy, followed by 3 weeks of computer-based auditory training (CBAT) at home. Participants were assessed at three intervals: before face-to-face therapy, after face-to-face therapy, and after CBAT. The primary outcomes were speech understanding in quiet and noisy conditions. The secondary outcomes were the usability of the CBAT system, the participants’ subjective rating of their own listening abilities, and the time required for completing face-to-face and CBAT sessions for CI users and therapists. Results Greater benefits were observed after CBAT than after standard therapy in nearly all speech outcome measures. Significant improvements were found in sentence comprehension in noise (P=.004), speech tracking (P=.004) and phoneme differentiation (vowels: P=.001; consonants: P=.02) after CBAT. Only speech tracking improved significantly after conventional therapy (P=.007). The program’s usability was judged to be high: only 2 of 20 participants could not imagine using the program without support. The different features of the training platform were rated as high. Cost analysis showed a cost difference in favor of CBAT: therapists spent 120 minutes per week face-to-face and 30 minutes per week on computer-based sessions. For CI users, attending standard therapy required an average of approximately 78 (SD 58.6) minutes of travel time per appointment. Conclusions The proposed teletherapeutic approach for hearing rehabilitation enables good clinical outcomes while saving time for CI users and clinicians. The promising speech understanding results might be due to the high satisfaction of users with the CBAT program. Teletherapy might offer a cost-effective solution to address the lack of human resources in health care as well as the global challenge of current or future pandemics.

scholarly journals Tablet-based Telerehabilitation Versus Conventional Face-to-Face Rehabilitation After Cochlear Implantation: A Prospective Intervention Pilot Study (Preprint)

2020 ◽  
Author(s):  
Christiane Völter ◽  
Carolin Stöckmann ◽  
Christiane Schirmer ◽  
Stefan Dazert
Keyword(s):  
Clinical Outcome ◽  
Cochlear Implantation ◽  
Sentence Comprehension ◽  
Auditory Training ◽  
Personal Contact ◽  
Subjective Rating ◽  
Speech Understanding ◽  
Access To Treatment ◽  
Face To Face ◽  
Speech Tracking

BACKGROUND Technologies allowing home-based rehabilitation may be a key means saving financial resources, but also facilitating people’s access to treatment. After cochlear implantation (CI) auditory training is necessary to adapt the brain to the new auditory signals transmitted by the CI. So far auditory training takes place in a face-to-face setting in a specialized center. But due to the world-wide COVID-19 pandemic with a tremendous impact on health care, the urge for new therapeutic settings has emerged. OBJECTIVE The aims of this study were 1) to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and 2) to compare the clinical outcome with regard to a conventional face-to-face rehabilitation setting in a clinic. METHODS 20 experienced adult CI users with a mean age of 59.4 years (SD 16.3) participated in the study. For the study they completed 3 weeks of standard (face-to-face) therapy, followed by 3 weeks of computer-based auditory training (CBAT) at home. Participants were assessed at three intervals: before face-to-face therapy, after face-to-face therapy, and after CBAT. The primary outcomes were speech understanding in quiet and noise. The secondary outcomes were the usability of the CBAT system and participants’ subjective rating of their own listening abilities. The amount of time necessary to complete face-to-face sessions and CBAT sessions was noted for CI users and for therapists. RESULTS Greater benefits were observed after the CBAT than after standard therapy in nearly all speech outcome measures. Significant improvement was found in sentence comprehension in noise (Pw.0036), speech tracking (Pw .0036), and syllable differentiation (vowels: Pw .002; consonants: Pw.023) after CBAT. Only speech tracking improved significantly after conventional therapy (Pw.0095). The program’s usability was judged to be high; only 2/20 participants could not imagine using the program without support. The different features of the training platform were rated high except for videoconferencing, which could not replace personal contact with the therapist. Therapists spent 360 min per week on face-to-face sessions and 60 min per week on CBAT. For CI users, attending face-to-face sessions necessitated approximately 2 hours of travel time per week. CONCLUSIONS The new teletherapeutic approach for hearing rehabilitation enables a good clinical outcome while saving time for CI users and clinicians. The promising speech understanding results might be due to the increased CI users’ empowerment, as shown by the high satisfaction of the users with the CBAT program. Teletherapy might be a solution to address to the global challenge of current or further pandemics.

Auditory Training to Improve Speech Perception and Self-Efficacy in Aging Adults

2020 ◽  
Vol 63 (4) ◽  
pp. 1270-1281
Author(s):  
Leah Fostick ◽  
Riki Taitelbaum-Swead ◽  
Shulamith Kreitler ◽  
Shelly Zokraut ◽  
Miriam Billig
Keyword(s):  
Speech Perception ◽  
Self Efficacy ◽  
Temporal Order Judgment ◽  
Auditory Training ◽  
Intensity Discrimination ◽  
Training Design ◽  
Auditory Temporal Processing ◽  
Temporal Properties ◽  
Computer Based ◽  
Aging Adults

Purpose Difficulty in understanding spoken speech is a common complaint among aging adults, even when hearing impairment is absent. Correlational studies point to a relationship between age, auditory temporal processing (ATP), and speech perception but cannot demonstrate causality unlike training studies. In the current study, we test (a) the causal relationship between a spatial–temporal ATP task (temporal order judgment [TOJ]) and speech perception among aging adults using a training design and (b) whether improvement in aging adult speech perception is accompanied by improved self-efficacy. Method Eighty-two participants aged 60–83 years were randomly assigned to a group receiving (a) ATP training (TOJ) over 14 days, (b) non-ATP training (intensity discrimination) over 14 days, or (c) no training. Results The data showed that TOJ training elicited improvement in all speech perception tests, which was accompanied by increased self-efficacy. Neither improvement in speech perception nor self-efficacy was evident following non-ATP training or no training. Conclusions There was no generalization of the improvement resulting from TOJ training to intensity discrimination or generalization of improvement resulting from intensity discrimination training to speech perception. These findings imply that the effect of TOJ training on speech perception is specific and such improvement is not simply the product of generally improved auditory perception. It provides support for the idea that temporal properties of speech are indeed crucial for speech perception. Clinically, the findings suggest that aging adults can be trained to improve their speech perception, specifically through computer-based auditory training, and this may improve perceived self-efficacy.

Potentially Inappropriate Medications Use in A Population of Iraqi Geriatric Outpatients According to Beers Criteria

2019 ◽  
Vol 10 (02) ◽  
Author(s):  
Ola Albaghdadi ◽  
Salam , Mohammad Hassan Morteza, Firas A Ahjel ◽  
Mohammad Hassan Morteza ◽  
Firas Aziz Rahi
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Public Health Issue ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Face To Face ◽  
Inappropriate Drugs ◽  
Elderly Outpatients ◽  
Inappropriate Medications

Aims: Elderly in Iraq kept suffering multiple burdens, as they are a truly fragile and vulnerable segment. A major public health issue among elderly is adverse drug reactions. This study is aimed at contributing in overcoming this treatment gap by determining the prevalence of inappropriate medications used by a group of Iraqi elderly outpatients. Methods: A cross-sectional, questionnaire-based study was conducted in a sample of 85 Iraqi elderly aged ≥65 years of either gender. Participants had face-to-face interviews to answer a comprehensive questionnaire. Each drug taken by the patient was evaluated according to Beers criteria. Results: Females constituted 45.9% of the total. The average age was 69.9 years (± 4.6). Nearly 30% of the patients had 3 different diseases, and 17.8% had ≥4 different ones, with cardiovascular diseases were the most prevalent. Polypharmacy was notably identified in 47.1% of the total studied population. Twenty-eight out of 85 patients did not know the actual reason of taking at least one of their medications, and 42% were not taking their drugs as directed. Remarkably, 43.5% of patients were recognized as taking at least one medication to be avoided in elderly people according to the Beers criteria. The most common inappropriate drugs were glyburide, and proton-pump inhibitors. Conclusion: There was an obvious absence of any role of pharmacists in the health care system for our studied population. Health care professionals are encouraged to review the medications prescribed for geriatric patients using updated safety guidelines to prevent the risks associated with potentially inappropriate medications.

Experiences of Volunteers Supporting Parents Following a Fatal Fetal Anomaly Diagnosis

2021 ◽  
pp. 104973232098783
Author(s):  
Stacey Power ◽  
Keelin O’Donoghue ◽  
Sarah Meaney
Keyword(s):  
Health Care ◽  
Peer Support ◽  
Thematic Analysis ◽  
Health Care Professionals ◽  
Fetal Anomaly ◽  
Voluntary Organizations ◽  
Face To Face ◽  
Bereaved Parents ◽  
Collaborative Working ◽  
And Training

Ireland has had a reliance on voluntary groups to provide peer-to-peer bereavement support. The aim of this study was to explore volunteers’, within these voluntary groups, experiences of supporting parents following a fatal fetal anomaly diagnosis. Purposive sampling was used to recruit volunteers ( n = 17) and face-to-face interviews undertaken. NVivo12 was utilized to assist in the thematic analysis of the data. Five themes; “motivation for altruistic acts,” “being challenged,” “value of education and training,” “supporting volunteers to support others,” and “it is not a sprint, it is a marathon” were identified. Volunteers felt comfortable in their peer-support role but found the lack of knowledge regarding newly implemented termination of pregnancy (TOP) services challenging. The importance of education/training was identified, emphasizing the need for collaboration with health care professionals and other voluntary organizations for support. The findings illustrate the need for collaborative working between health care professionals and volunteers to assist them in supporting bereaved parents.

scholarly journals Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jennifer Pillay ◽  
Aireen Wingert ◽  
Tara MacGregor ◽  
Michelle Gates ◽  
Ben Vandermeer ◽  
...  
Keyword(s):  
Health Care ◽  
Ectopic Pregnancy ◽  
Clinical Outcomes ◽  
Pelvic Pain ◽  
Systematic Reviews ◽  
Patient Preferences ◽  
Chronic Pelvic Pain ◽  
Task Force ◽  
Ct Screening ◽  
Potential Benefits

Abstract Background We conducted systematic reviews on the benefits and harms of screening compared with no screening or alternative screening approaches for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in non-pregnant sexually active individuals, and on the relative importance patients’ place on the relevant outcomes. Findings will inform recommendations by the Canadian Task Force on Preventive Health Care. Methods We searched five databases (to January 24, 2020), trial registries, conference proceedings, and reference lists for English and French literature published since 1996. Screening, study selection, and risk of bias assessments were independently undertaken by two reviewers, with consensus for final decisions. Data extraction was conducted by one reviewer and checked by another for accuracy and completeness. Meta-analysis was conducted where appropriate. We used the GRADE approach to rate the certainty of the evidence. The Task Force and content experts provided input on determining thresholds for important effect sizes and on interpretation of findings. Results Of 41 included studies, 17 and 11 reported on benefits and harms of screening, respectively, and 14 reported on patient preferences. Universal screening for CT in general populations 16 to 29 years of age, using population-based or opportunistic approaches achieving low screening rates, may make little-to-no difference for a female’s risk of pelvic inflammatory disease (PID) (2 RCTs, n=141,362; 0.3 more in 1000 [7.6 fewer to 11 more]) or ectopic pregnancy (1 RCT, n=15,459; 0.20 more per 1000 [2.2 fewer to 3.9 more]). It may also not make a difference for CT transmission (3 RCTs, n=41,709; 3 fewer per 1000 [11.5 fewer to 6.9 more]). However, benefits may be achieved for reducing PID if screening rates are increased (2 trials, n=30,652; 5.7 fewer per 1000 [10.8 fewer to 1.1 more]), and for reducing CT and NG transmission when intensely screening high-prevalence female populations (2 trials, n=6127; 34.3 fewer per 1000 [4 to 58 fewer]; NNS 29 [17 to 250]). Evidence on infertility in females from CT screening and on transmission of NG in males and both sexes from screening for CT and NG is very uncertain. No evidence was found for cervicitis, chronic pelvic pain, or infertility in males from CT screening, or on any clinical outcomes from NG screening. Undergoing screening, or having a diagnosis of CT, may cause a small-to-moderate number of people to experience some degree of harm, mainly due to feelings of stigmatization and anxiety about future infertility risk. The number of individuals affected in the entire screening-eligible population is likely smaller. Screening may make little-to-no difference for general anxiety, self-esteem, or relationship break-up. Evidence on transmission from studies comparing home versus clinic screening is very uncertain. Four studies on patient preferences found that although utility values for the different consequences of CT and NG infections are probably quite similar, when considering the duration of the health state experiences, infertility and chronic pelvic pain are probably valued much more than PID, ectopic pregnancy, and cervicitis. How patients weigh the potential benefits versus harms of screening is very uncertain (1 survey, 10 qualitative studies); risks to reproductive health and transmission appear to be more important than the (often transient) psychosocial harms. Discussion Most of the evidence on screening for CT and/or NG offers low or very low certainty about the benefits and harms. Indirectness from use of comparison groups receiving some screening, incomplete outcome ascertainment, and use of outreach settings was a major contributor to uncertainty. Patient preferences indicate that the potential benefits from screening appear to outweigh the possible harms. Direct evidence about which screening strategies and intervals to use, which age to start and stop screening, and whether screening males in addition to females is necessary to prevent clinical outcomes is scarce, and further research in these areas would be informative. Apart from the evidence in this review, information on factors related to equity, acceptability, implementation, cost/resources, and feasibility will support recommendations made by the Task Force. Systematic review registration International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733.

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