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Danish Medical Journal Mar 2024Capacity constraints in Danish hearing healthcare may lead to diagnostic delays and repetitive pre-treatment audiological exams for hearing-impaired patients. This study...
INTRODUCTION
Capacity constraints in Danish hearing healthcare may lead to diagnostic delays and repetitive pre-treatment audiological exams for hearing-impaired patients. This study investigated the effectiveness of remote ear-nose-throat (ENT) specialist assessments (RESA) for complicated hearing loss, comparing the accuracy of private ENT specialists and medical audiologists.
METHODS
RESA screening accuracy was determined for four ENT specialists, individually and as subspecialised groups. These assessments were benchmarked against "gold standard" in-person ENT assessments for 445 potential adult first-time hearing aid users.
RESULTS
Medical audiologists initially recorded lower RESA screening specificity and positive predictive values than private ENT specialists. However, after making two adjustments to the dataset, these differences were neutralised. Screening sensitivity was consistent across individual and grouped subspecialities.
CONCLUSIONS
RESA screening is a promising tool for timely diagnosis and treatment. The findings reveal that both private ENT specialists and medical audiologists may conduct RESA with high consistency and uniformity.
FUNDING
This research was funded by the Danish Health Data Authority and the North Denmark Region, but does not reflect their views. The study received no commercial support.
TRIAL REGISTRATION
Not relevant.
Topics: Adult; Humans; Hearing Aids; Hearing; Hearing Loss
PubMed: 38533878
DOI: 10.61409/A08230501 -
Telemedicine Journal and E-health : the... Mar 2024Universal newborn hearing screening programs allow for early identification of congenital hearing loss. However, some families experience difficulties accessing...
Universal newborn hearing screening programs allow for early identification of congenital hearing loss. However, some families experience difficulties accessing diagnostic audiology services following a refer screen result. This study aimed to assess the opinions of families who had experienced infant diagnostic audiology assessments regarding a telehealth option for these appointments within Victoria, Australia. Families who attended in-person infant diagnostic audiology appointments were sent a questionnaire exploring their experiences of the service and their opinion regarding a proposed telehealth option for infant diagnostic audiology (50 responses received). These results were also compared to those of families who were surveyed following testing in 2020, where the audiologist conducted the appointment remotely to comply with COVID-19-related social distancing recommendations at the time (10 responses received). There were not significant differences between the duration or number of appointments, perceived understanding of results, or concerns regarding a tele-audiology model between families who experienced face-to-face and tele-audiology infant diagnostic audiology appointments. Opinions of infant diagnostic audiology appointments utilizing telehealth technology were largely positive, and minimal technological difficulties were identified. Overall positive attitudes of many families with infant diagnostic appointment experiences toward a tele-audiology option of this service suggest that offering a telehealth model of appointments may be an appropriate model to improve service access for families requiring infant diagnostic audiology in Victoria.
PubMed: 38527282
DOI: 10.1089/tmj.2023.0652 -
South African Medical Journal =... Mar 2024Local and international research has identified rural origin as an important reason why healthcare professionals (HCPs) work in rural areas, and in South Africa (SA)...
BACKGROUND
Local and international research has identified rural origin as an important reason why healthcare professionals (HCPs) work in rural areas, and in South Africa (SA) considerable effort has gone into recruiting and training rural-origin students. However, there is little information in the SA literature on where graduates supported by these initiatives work, and whether they contribute to the rural workforce long term.
OBJECTIVE
To determine the number of years that rural-origin Umthombo Youth Development Foundation (UYDF)-supported graduates of different disciplines worked at rural public healthcare facilities (PHCFs).
METHODS
A retrospective descriptive study reviewed work record data of 405 UYDF graduates, to calculate the number of years they worked at a rural PHCF. Data were analysed descriptively and presented in tables with totals and percentages.
RESULTS
Ninety percent (363/405) of UYDF-supported graduates returned to work at a rural PHCF. High percentages of social workers (85%), optometrists (80%), speech therapists, nurses (72%) and dental therapists (70%) worked for ≥5 years at a rural PHCF, while only 13% of audiologists, 14% of doctors, 29% of pharmacists, and 28% of dentists and occupational therapists worked at a rural PHCF for ≥5 years. Ten percent (42/405) of graduates did not work at a rural PHCF at all. A total of 110/124 (89%) of doctors supported by UYDF had worked at a rural PHCF, with 32% (40/124) working at a rural PHCF for ≥3 years. Overall, 54% of UYDF-supported graduates (219/405) worked for ≥3 years at a rural PHCF, and 38.5% (157/405) worked for ≥5 years at rural PHCFs. The majority of UYDF graduates had contributed towards long-term staffing of rural PHCFs. Lack of professional development opportunities at rural PHCFs as well as the reduced number of funded posts at rural PHCFs reduced the effectiveness of the UYDF initiative.
CONCLUSION
The UYDF Scholarship Scheme has shown that investment in rural students through a bonded scholarship can contribute to staffing rural PHCFs, as >90% of graduates worked at rural PHCFs, and for some disciplines >70% of graduates worked for ≥5 years at a rural PHCF. Allied HCPs worked on average for longer periods at rural PHCFs than doctors.
Topics: Adolescent; Humans; Fellowships and Scholarships; Retrospective Studies; South Africa; Health Personnel; Workforce; Rural Health Services
PubMed: 38525572
DOI: 10.7196/SAMJ.2024.v114i3.1608 -
Laryngoscope Investigative... Apr 2024Gaps in gender-based equity persist in academic otolaryngology. Here we present a needs-based assessment of otolaryngology faculty and trainees regarding facilitators...
OBJECTIVE
Gaps in gender-based equity persist in academic otolaryngology. Here we present a needs-based assessment of otolaryngology faculty and trainees regarding facilitators and barriers to professional satisfaction and career development in academic medicine.
METHODS
A qualitative study of otolaryngology faculty, trainees, and administrators who identify as women at an academic tertiary care center was performed from 2020 to 2021 using focus groups and semi-structured interviews. Five confidential, virtual focus group sessions moderated by a third-party executive coach were audio-taped, transcribed, and reviewed for thematic content.
RESULTS
Of 48 women invited, 77% participated (18 faculty/administrative leaders, 10 residents/fellows, 4 audiologists). Participants noted direct patient care, support from colleagues who identify as women, and the transition to virtual meetings as facilitators of current professional satisfaction. Five themes emerged as barriers to workplace satisfaction and career development including (1) limited professional schedule flexibility, (2) competing commitments such as childcare exacerbated by pandemic, (3) lack of visible departmental leadership who identify as women, (4) perceived lack of organic sponsorship within subspecialty divisions, and (5) frequent identity-associated microaggressions from patients and staff outside the department. Strategies identified for improving gender-based equity included (1) promoting department-wide awareness of workplace gender-based differences, (2) implicit bias training within established programming such as grand rounds conferences, and (3) novel faculty programming such as leadership development training and formal junior faculty mentorship.
CONCLUSION
Confidential needs-based assessment of otolaryngology faculty and trainees identified both persistent gaps and strategies to enhance recruitment, support career development, and grow professional satisfaction of women within academic otolaryngology.
LEVEL OF EVIDENCE
3.
PubMed: 38525113
DOI: 10.1002/lio2.1217 -
International Journal of Audiology Mar 2024Knowledge regarding hearing acuity in the nonagenarian age group is sparse. In this study we aimed to advance our understanding of hearing loss in the 10 decade of life.
OBJECTIVE
Knowledge regarding hearing acuity in the nonagenarian age group is sparse. In this study we aimed to advance our understanding of hearing loss in the 10 decade of life.
DESIGN
A cross-sectional study in which standardised hearing measurements were performed during home visits, which included care home facilities and nursing homes to maximise participation.
STUDY SAMPLE
Two unselected groups of individuals aged 90 ( = 42) and 95 ( = 49), sampled from the population-based Gothenburg H70 Birth Cohort Studies.
RESULTS
98% of the participants (95% CI [95, 100]) had some degree of hearing loss in their better ear, with 83% (95% CI [73, 89]) having a potentially disabling hearing loss of moderate degree or worse, according to WHO criteria. Furthermore, differences between the two age groups (five years apart) indicate an increasing hearing loss, primarily at frequencies ≥ 2 kHz.
CONCLUSION
Hearing loss was present in almost all of the participants in the nonagenarian age group and among a majority of them potentially to a degree that would warrant rehabilitation. Carrying out standardised hearing measurements in a home setting was feasible in this age group and enhanced the representativeness of the study population.
PubMed: 38517324
DOI: 10.1080/14992027.2024.2329710 -
The International Tinnitus Journal Mar 2024COVID - 19 (Corona Virus Infectious Disease) situations reported in 2019, declared by World Health Organization (WHO) as a pandemic is still a prevailing global crisis....
COVID - 19 (Corona Virus Infectious Disease) situations reported in 2019, declared by World Health Organization (WHO) as a pandemic is still a prevailing global crisis. Common regulations were implemented such as lockdown, wearing face masks as mandatory, face shields, gloves and maintaining physical and social distance in public places to reduce the spread of the virus. These pandemic induced challenges affected social communication, technical and behavioral aspects in lifestyle of people with hearing impairment. Along with medical, paramedical services, the crisis had challenged hearing, speech language pathology and therapy services too. The study aimed to explore the challenges that adults with hearing impairment had experienced during the pandemic and to suggest some practical solutions that can be implemented by audiologists. It is a questionnaire-based study with purposive sampling method employed in data collection. The questionnaire was administered on adult hearing aid users (mean age: 18 years) recruited for participation from different parts/ clinical setups across India. The outcome of the questionnaire did support the assumption that availing audiological services was difficult or impossible for most of the hearing aid users. Accessing batteries was reported to be the most frequent issue. Adequate level of hearing though hearing aid was important to them and clinical services could not be availed for long period of time due to travel related issues and closure of audiological services. Also, social isolation impacted on their quality of life and effective communication. As a possible solution most of the users chose tele services as a better solution.
Topics: Adult; Humans; Adolescent; COVID-19; Pandemics; Pilot Projects; Quality of Life; Travel; Communicable Disease Control; Travel-Related Illness; Hearing Loss; Hearing Aids
PubMed: 38507625
DOI: 10.5935/0946-5448.20230020 -
The International Tinnitus Journal Mar 2024Health care providers must be aware of the choices in aural rehabilitation methods and assessment procedures available presently to those with hearing impairment in...
BACKGROUND
Health care providers must be aware of the choices in aural rehabilitation methods and assessment procedures available presently to those with hearing impairment in order to facilitate early identification and intervention and ensure quality of care to those hearing impaired individuals. The referrals from the medical fraternities for the audiological services are not uniform across India. Part of reason may be that awareness about the roles of and responsibilities of audiologist's is poor among medical practitioners. In some regions of India medical practitioners may be only grossly be aware of audiologists per se. They may not know enough to refer all individuals with hearing or balance disorders for the required audiological services.
AIM
To evaluate changes in pre survey and post survey after education intervention specifically planned for medical practitioners in the state of Sikkim, India. Education intervention included awareness about hearing impairment and its assessment and management by audiologists.
METHOD
A pre and post survey comparison research design with purposive convenient sampling technique was applied. Participants were medical practitioners working in geographical area of Sikkim at the time of the study. Inspection of demographic data of respondents showed that they were in their age range of 24 and 60 years and with work experience ranging 1-40 years. Participants were invited for an awareness talk which included, information about hearing loss, early identification and early intervention, tests and management of hearing loss in different age groups, need for hearing aids/cochlear implants, auditory training, and the role of an audiologist in the management of hearing loss and ways to prevent hearing loss. A pre and post awareness program responses were collected from all the participants using a customized questionnaire tool.
RESULTS
Respondents exhibited, in the pre-survey questionnaire, lack of awareness in many aspects of audiology, including assessing hearing impairment, diagnosing hearing loss, and the role of an audiologist. There was an overall, statistically significant difference in the level of performance on the pre-awareness and post-awareness responses.
CONCLUSION
Following an awareness campaign among the medical professionals in Sikkim, there was a considerable change in their level of awareness of hearing impairment, its assessment, and management by audiologists. The reach of the awareness campaign was significant as around 70% of subjects showed significant change in their knowledge and attitude towards hearing impairment, its management.
Topics: Humans; Young Adult; Adult; Middle Aged; Sikkim; Hearing Loss; Hearing; Deafness; Audiologists; India
PubMed: 38507622
DOI: 10.5935/0946-5448.20230017 -
Patient Education and Counseling Jul 2024The study aimed to explore facilitators and barriers in delivering person-centered care from the perspective of speech-language pathologists and audiologists in a socio-...
Exploring facilitators and barriers for delivering person-centered care in a socio-economically diverse context: Perspectives of speech-language pathologists and audiologists.
OBJECTIVE
The study aimed to explore facilitators and barriers in delivering person-centered care from the perspective of speech-language pathologists and audiologists in a socio- economically diverse workplace across micro, meso, and macro levels.
METHOD
A national cross-sectional e-survey was conducted among pooled speech-language pathologists and/or audiologists from South Africa. The e-survey included quantitative components to describe participant demographics which was analysed using descriptive and inferential statistics. The qualitative data was analyzed using metaphor and thematic analysis approaches to describe respondents' perspectives of barriers and facilitators in delivering person-centered care.
RESULTS
The e-survey was completed by 63 clinicians (36.5% Audiologists; 36.5% Speech-Language Therapists; 27.0% dually qualified Speech-Language Therapists and Audiologists) mostly between the ages of 26 to 35 years old (33.3%). Respondents were working in various settings including the public sector (41.3%), private sector (44.4%) and in academia (14.3%). Facilitators and barriers were identified within all three systems (macro, meso and micro). The metaphor analysis resulted in six categories: uncertainty of Person centered care; its essential nature; associated challenges; relational aspect; analogies referring to animals; and food-related analogies. Thematic analysis of open-ended questions revealed five barriers, with three relating to micro systems; i) clinician factors, ii) client factors, iii) clinician and client interaction, and two related to factors within the meso system; iv) resources, and v) workplace. Only two themes were identified as facilitators towards PCC, clinician factors (mirco) and workplace factors (meso).'
CONCLUSIONS
Insights gained from exploring Speech-Language Pathologists' and Audiologists' perceptions of implementing PCC in a socio-economically diverse setting highlight the need to address contextual (meso and macro systems) and personal (micro system) factors to promote and deliver PCC effectively. Notably, for the public sector, resources emerged as a major concern and barrier on the macro system level. Despite these challenges, the investigation revealed two noteworthy facilitators: clinician factors, at the micro level, and workplace factors, at the meso level. This nuanced understanding emphasizes the necessity of tailored interventions targeting both individual and systemic aspects to enhance the successful implementation of person-centered care.
PRACTICAL IMPLICATIONS
Strategies should focus on enhancing clinicians' communication skills, collaboration, and teamwork, as well as addressing resource limitations through the adaptation of tools and implementation of PCC ISO standards.
Topics: Humans; Patient-Centered Care; Speech-Language Pathology; Adult; Female; Cross-Sectional Studies; Male; South Africa; Surveys and Questionnaires; Audiologists; Attitude of Health Personnel; Qualitative Research; Middle Aged; Workplace
PubMed: 38503035
DOI: 10.1016/j.pec.2024.108250 -
JAMA Apr 2024US government personnel stationed internationally have reported anomalous health incidents (AHIs), with some individuals experiencing persistent debilitating symptoms.
IMPORTANCE
US government personnel stationed internationally have reported anomalous health incidents (AHIs), with some individuals experiencing persistent debilitating symptoms.
OBJECTIVE
To assess the potential presence of magnetic resonance imaging (MRI)-detectable brain lesions in participants with AHIs, with respect to a well-matched control group.
DESIGN, SETTING, AND PARTICIPANTS
This exploratory study was conducted at the National Institutes of Health (NIH) Clinical Center and the NIH MRI Research Facility between June 2018 and November 2022. Eighty-one participants with AHIs and 48 age- and sex-matched control participants, 29 of whom had similar employment as the AHI group, were assessed with clinical, volumetric, and functional MRI. A high-quality diffusion MRI scan and a second volumetric scan were also acquired during a different session. The structural MRI acquisition protocol was optimized to achieve high reproducibility. Forty-nine participants with AHIs had at least 1 additional imaging session approximately 6 to 12 months from the first visit.
EXPOSURE
AHIs.
MAIN OUTCOMES AND MEASURES
Group-level quantitative metrics obtained from multiple modalities: (1) volumetric measurement, voxel-wise and region of interest (ROI)-wise; (2) diffusion MRI-derived metrics, voxel-wise and ROI-wise; and (3) ROI-wise within-network resting-state functional connectivity using functional MRI. Exploratory data analyses used both standard, nonparametric tests and bayesian multilevel modeling.
RESULTS
Among the 81 participants with AHIs, the mean (SD) age was 42 (9) years and 49% were female; among the 48 control participants, the mean (SD) age was 43 (11) years and 42% were female. Imaging scans were performed as early as 14 days after experiencing AHIs with a median delay period of 80 (IQR, 36-544) days. After adjustment for multiple comparisons, no significant differences between participants with AHIs and control participants were found for any MRI modality. At an unadjusted threshold (P < .05), compared with control participants, participants with AHIs had lower intranetwork connectivity in the salience networks, a larger corpus callosum, and diffusion MRI differences in the corpus callosum, superior longitudinal fasciculus, cingulum, inferior cerebellar peduncle, and amygdala. The structural MRI measurements were highly reproducible (median coefficient of variation <1% across all global volumetric ROIs and <1.5% for all white matter ROIs for diffusion metrics). Even individuals with large differences from control participants exhibited stable longitudinal results (typically, <±1% across visits), suggesting the absence of evolving lesions. The relationships between the imaging and clinical variables were weak (median Spearman ρ = 0.10). The study did not replicate the results of a previously published investigation of AHIs.
CONCLUSIONS AND RELEVANCE
In this exploratory neuroimaging study, there were no significant differences in imaging measures of brain structure or function between individuals reporting AHIs and matched control participants after adjustment for multiple comparisons.
Topics: Humans; Female; Adult; Male; Diffusion Tensor Imaging; Reproducibility of Results; Bayes Theorem; Brain; Magnetic Resonance Imaging; Neuroimaging; White Matter; Family; Government; Security Measures
PubMed: 38497822
DOI: 10.1001/jama.2024.2424 -
JAMA Apr 2024Since 2015, US government and related personnel have reported dizziness, pain, visual problems, and cognitive dysfunction after experiencing intrusive sounds and head...
IMPORTANCE
Since 2015, US government and related personnel have reported dizziness, pain, visual problems, and cognitive dysfunction after experiencing intrusive sounds and head pressure. The US government has labeled these anomalous health incidents (AHIs).
OBJECTIVE
To assess whether participants with AHIs differ significantly from US government control participants with respect to clinical, research, and biomarker assessments.
DESIGN, SETTING, AND PARTICIPANTS
Exploratory study conducted between June 2018 and July 2022 at the National Institutes of Health Clinical Center, involving 86 US government staff and family members with AHIs from Cuba, Austria, China, and other locations as well as 30 US government control participants.
EXPOSURES
AHIs.
MAIN OUTCOMES AND MEASURES
Participants were assessed with extensive clinical, auditory, vestibular, balance, visual, neuropsychological, and blood biomarkers (glial fibrillary acidic protein and neurofilament light) testing. The patients were analyzed based on the risk characteristics of the AHI identifying concerning cases as well as geographic location.
RESULTS
Eighty-six participants with AHIs (42 women and 44 men; mean [SD] age, 42.1 [9.1] years) and 30 vocationally matched government control participants (11 women and 19 men; mean [SD] age, 43.8 [10.1] years) were included in the analyses. Participants with AHIs were evaluated a median of 76 days (IQR, 30-537) from the most recent incident. In general, there were no significant differences between participants with AHIs and control participants in most tests of auditory, vestibular, cognitive, or visual function as well as levels of the blood biomarkers. Participants with AHIs had significantly increased fatigue, depression, posttraumatic stress, imbalance, and neurobehavioral symptoms compared with the control participants. There were no differences in these findings based on the risk characteristics of the incident or geographic location of the AHIs. Twenty-four patients (28%) with AHI presented with functional neurological disorders.
CONCLUSIONS AND RELEVANCE
In this exploratory study, there were no significant differences between individuals reporting AHIs and matched control participants with respect to most clinical, research, and biomarker measures, except for objective and self-reported measures of imbalance and symptoms of fatigue, posttraumatic stress, and depression. This study did not replicate the findings of previous studies, although differences in the populations included and the timing of assessments limit direct comparisons.
Topics: Male; Humans; Female; Adult; Family; Government; Biomarkers; Fatigue; Security Measures
PubMed: 38497797
DOI: 10.1001/jama.2024.2413