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.

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 Investigating the Impact of Hearing Aid Use and Auditory Training on Cognition, Depressive Symptoms, and Social Interaction in Adults With Hearing Loss: Protocol for a Crossover Trial (Preprint)

2017 ◽  
Author(s):  
Joanna Nkyekyer ◽  
Denny Meyer ◽  
Peter J Blamey ◽  
Andrew Pipingas ◽  
Sunil Bhar
Keyword(s):  
Hearing Loss ◽  
Depressive Symptoms ◽  
Social Interaction ◽  
Sensorineural Hearing Loss ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Sensorineural Hearing ◽  
Auditory Training ◽  
Face To Face ◽  
Hearing Aid Use

BACKGROUND Sensorineural hearing loss is the most common sensory deficit among older adults. Some of the psychosocial consequences of this condition include difficulty in understanding speech, depression, and social isolation. Studies have shown that older adults with hearing loss show some age-related cognitive decline. Hearing aids have been proven as successful interventions to alleviate sensorineural hearing loss. In addition to hearing aid use, the positive effects of auditory training—formal listening activities designed to optimize speech perception—are now being documented among adults with hearing loss who use hearing aids, especially new hearing aid users. Auditory training has also been shown to produce prolonged cognitive performance improvements. However, there is still little evidence to support the benefits of simultaneous hearing aid use and individualized face-to-face auditory training on cognitive performance in adults with hearing loss. OBJECTIVE This study will investigate whether using hearing aids for the first time will improve the impact of individualized face-to-face auditory training on cognition, depression, and social interaction for adults with sensorineural hearing loss. The rationale for this study is based on the hypothesis that, in adults with sensorineural hearing loss, using hearing aids for the first time in combination with individualized face-to-face auditory training will be more effective for improving cognition, depressive symptoms, and social interaction rather than auditory training on its own. METHODS This is a crossover trial targeting 40 men and women between 50 and 90 years of age with either mild or moderate symmetric sensorineural hearing loss. Consented, willing participants will be recruited from either an independent living accommodation or via a community database to undergo a 6-month intensive face-to-face auditory training program (active control). Participants will be assigned in random order to receive hearing aid (intervention) for either the first 3 or last 3 months of the 6-month auditory training program. Each participant will be tested at baseline, 3, and 6 months using a neuropsychological battery of computer-based cognitive assessments, together with a depression symptom instrument and a social interaction measure. The primary outcome will be cognitive performance with regard to spatial working memory. Secondary outcome measures include other cognition performance measures, depressive symptoms, social interaction, and hearing satisfaction. RESULTS Data analysis is currently under way and the first results are expected to be submitted for publication in June 2018. CONCLUSIONS Results from the study will inform strategies for aural rehabilitation, hearing aid delivery, and future hearing loss intervention trials. CLINICALTRIAL ClinicalTrials.gov NCT03112850; https://clinicaltrials.gov/ct2/show/NCT03112850 (Archived by WebCite at http://www.webcitation.org/6xz12fD0B).

Recruitment and Retention of Psychiatrists in Non-Metropolitan Public Positions in Queensland: Research on ‘Queensland Health's Response’

1996 ◽  
Vol 30 (5) ◽  
pp. 667-671 ◽  
Author(s):  
Brett Emmerson ◽  
Peggy Brown ◽  
Harvey Whiteford ◽  
Ness McVie ◽  
Willem Kuipers
Keyword(s):  
Public Sector ◽  
Metropolitan Areas ◽  
Personal Contact ◽  
Full Time ◽  
Recruitment And Retention ◽  
Face To Face

Objective: To evaluate Queensland Health's recruitment campaign of 15 full-time psychiatrists to non-metropolitan areas between July 1992 and December 1993. Method: A detailed 170-item Likert-type questionnaire was designed and mailed to all 15 psychiatrists. Thirteen questionnaires were completed and followed-up by a face to face interview. Results: Findings indicate that most of those recruited were experienced senior specialists who came to the positions as result of personal contact and were attracted to non-metropolitan positions because of ‘lifestyle’ and ‘professional challenge’ variables. ‘Lifestyle’ and ‘professional’ variables were identified as major contributors to their retention. They reported that ‘bureaucracy’ and ‘social and family’ reasons would be the most likely cause of them considering leaving their current positions. Conclusions: While the recruitment campaign was evaluated as successful, some aspects were clearly more influential than others. It was noted that factors which were likely to influence psychiatrists to leave non-metropolitan public sector positions were more ‘public’ than ‘non-metropolitan’ in nature.

Reestablishing Speech Understanding through Musical Ear Training after Cochlear Implantation

2009 ◽  
Vol 1169 (1) ◽  
pp. 437-440 ◽  
Author(s):  
Bjørn Petersen ◽  
Malene V. Mortensen ◽  
Albert Gjedde ◽  
Peter Vuust
Keyword(s):  
Cochlear Implantation ◽  
Speech Understanding ◽  
Ear Training

Analysis of live interactive teledermatologic consultations for prisoners in Korea for 3 years

2017 ◽  
Vol 24 (9) ◽  
pp. 623-628 ◽  
Author(s):  
Jung Eun Seol ◽  
So Hee Park ◽  
Hyojin Kim
Keyword(s):  
Infectious Disease ◽  
Clinical Outcome ◽  
Medical Records ◽  
Underserved Populations ◽  
Common Type ◽  
Face To Face ◽  
Different Types ◽  
The Mean ◽  
Dermatologic Disease

Introduction Teledermatology has contributed to the enhanced accessibility of underserved populations. This study investigated the prevalence and clinical outcomes of dermatologic diseases in prisoners in Korea through live interactive teledermatology (LITD) Method The medical records of patients in a Busan prison, who interacted with a dermatologist using LITD from July 2013 to August 2016, were reviewed retrospectively. Results The mean age of the 406 patients enrolled in the study was 39.0 years and 91.4% were male. Infectious disease (42.8%) was the most common type of disease, followed by eczematous disease (29.4%) and diseases of the skin appendages (14.5%). Among the 187 (38.2%) patients who had a follow-up consultation, 162 (86.7%) showed clinical improvement, whereas 21 showed either no change or a worse clinical outcome. Twenty patients were diagnosed with different types of dermatologic disease at follow-up consultations. Discussion LITD can contribute to a favourable clinical outcome and may thus be an effective alternative to face-to-face consultation in prisoners and other underserved populations.

scholarly journals 842 Teleurology; A Prospective Study of Patient’s Perception and Real Time Experience in A Tertiary UK Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Abdalla ◽  
S Patel ◽  
T Nambi Rajan ◽  
M Kumar
Keyword(s):  
Clinical Outcome ◽  
Prospective Study ◽  
Real Time ◽  
Continuity Of Care ◽  
Attendance Rate ◽  
Patient’S Satisfaction ◽  
Face To Face ◽  
Validated Questionnaire ◽  
Patient’S Perception ◽  
A Prospective Study

Abstract Aim To evaluate the clinical outcome and patient’s satisfaction of our real-time teleurology experience. Materials A prospective study, the whole cohort of face-to-face [FTF] clinics was shifted for telephone clinics. The data were collected prospectively for all appointments from 30th March to 3rd April. The primary objectives were clinic outcome and patient’s satisfaction evaluated using a validated questionnaire. The secondary objectives were number of non-attendance, percentage of face-to-face clinics and clinic demographics. Results Overall, 95 scheduled appointments for 7 consultants and 2 trainees. Telephone consultations performed for 75 patients, while 6 patients reviewed in FTF Clinics, and 14 patients classified as non-attendant. The non-attendance rate was 14.7%, with estimated 50% reduction in comparison to FTF rate prior to pandemic. The majority of patients (58%) treated conservatively while 14 (17.2%) patients commenced on medications, and 20 patients (24.6%) were listed for surgery. All patients but one (98.1%) agreed that cancelling FTF clinics was reasonable. The majority of the patients 94.2%, 96.2%, 84.6% found the telephone clinic was effective, long enough, and was easy to express their concerns over the phone, respectively. Approximately 90.4% and 100% satisfied with teleurology service and that clinicians were careful, respectively. Conclusions Our study elucidated the feasibility of teleurology in a real time setting and showed that it meets the tetrafecta of clinical outcomes, continuity of care, patient’s safety, and patient’s satisfaction. To our knowledge, this is the first study to assess patient’s perception of teleurology using a validated questionnaire.

scholarly journals Inequities of Access, Utilization and Clinical Outcome of Lung Cancer in Indonesia

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 83s-83s
Author(s):  
R.V. Ramadani ◽  
H. Thabrany ◽  
A.E. Putri
Keyword(s):  
Lung Cancer ◽  
Health Insurance ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Local Governments ◽  
Health Concern ◽  
Access To Treatment ◽  
Assistance Program ◽  
Lung Cancer Patients

Background: Indonesia integrated all social health insurance and social assistance program into the National Health Insurance Scheme (NHIS) aiming to achieve universal health coverage by 2019. Currently, 194 million people are registered in the NHIS. Lung cancer absorbed a significant amount of the NHIS Indonesia and one of the leading cause of deaths among men in Indonesia. Lung cancer is rising major public health concern due to a high prevalence of smokers yet most lung cancer is diagnosed at late stage leading to short survival rate in Indonesia. Aim: This study aimed at investigating access, utilization, and clinical outcomes of lung cancer's patients. The second aim is to investigate differences in access to treatments of lung cancer patients among different member groups of the NHIS. Methods: The data were drawn from a 2014-2015 claim of the NHIS. The number of lung cancer patients of the outpatient's care was 5939 in 2014 and was 6595 in 2015. The number of inpatients diagnosed with lung cancer was 8969 and 9455 respectively for 2014 and 2015. Descriptive analysis was performed to investigate the differences in access, utilization (consumption), and in clinical outcome across class and membership. Results: Access to treatment of lung cancer patients was 0.5 for outpatient care and 0.7 for inpatient care per 10,000 members. This prevalence was higher compared with the national reported prevalence of lung cancer which was 0.3 per 10,000 populations. However, access and utilization among poorer members (third class and PBI membership) were only 0.1 for outpatient and 0.2 for inpatient per 10,000 members. The quality of treatment mortality and self-discharges were 6.04% and 5.68% compared with the higher class of members which account for 0.48% and 2.31% in 2015. Conclusion: There were inequities in access, utilization, and clinical outcomes among lung cancer patients suggesting disparities of supplies side and nonfinancial barriers among lower socioeconomic groups. The authors suggest the national and local governments should accelerate to produce oncologists and subnational cancer centers to ensure access among NHIS members.

scholarly journals An inter-agency expert panel’s prioritisation of clinical quality improvement topics in a paramedic system

2021 ◽  
Vol 18 ◽  
Author(s):  
Anthony Campeau ◽  
Maud Huiskamp ◽  
Nicole Sykes ◽  
Susan Kriening ◽  
Scott Bourn ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Outcome ◽  
Outcome Measures ◽  
System Level ◽  
Face To Face ◽  
Modified Delphi ◽  
Wide Range ◽  
High Participation ◽  
Improvement Programs ◽  
Quality Improvement Programs

Introduction Quality improvement (QI) programs have become common in paramedic systems, but they are often limited to individual agencies. Modern paramedicine involves many different agencies and inter-agency QI programs would better reflect their co-operative efforts. Similarly, inter-agency use of clinical outcome measurements can offer system level performance data. This study’s intent was to explore the feasibility of planning an inter-agency QI program that uses outcome measures. Methods This study used a modified Delphi methodology. A 49-member panel of inter-agency representatives was convened to identify and prioritise clinical outcome-based topics. Over a 3-month period, two online surveys were conducted followed by a 1-day face-to-face meeting. Results The study demonstrated very high participation rates. Results progressed from an initial wide range of 38 topics to a final consensus of two: infection/sepsis and patient safety/care pathways, complete with outcome measures. Conclusion Inter-agency quality improvement planning is an under investigated area, but this study demonstrates that it is feasible. Additionally, this planning can incorporate clinical outcome measures that inform system level discussions about quality. Other paramedic agencies may draw on the study’s processes when planning their own quality improvement programs.

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