Stories From the Webcams: Cincinnati Children's Hospital Medical Center Audiology Telehealth and Pediatric Auditory Device Services.

PURPOSE: The purpose of this manuscript is to describe the regulatory, technological, and training considerations for audiologists investigating telehealth and to offer some examples of audiology services provided through telehealth. METHOD: The authors presented the regulatory components, the technology required for audiology staff and patients, and staff training for the audiology telehealth program at Cincinnati Children's Hospital Medical Center. Four case studies highlighting the successful use of telehealth in providing auditory device services to patients were also presented. RESULTS AND CONCLUSION: The described regulatory, technological, and training hierarchy provides a framework for audiologists interested in starting a telehealth program. The cases presented illustrate that telehealth can be used to provide some auditory device services, such as troubleshooting, mapping, and parent consulting.

Skydiving: The audiological perspective.

BACKGROUND:  Skydiving is a popular recreational sport for the young and old. There is minimal research pertaining to skydiving and its relation to the audiological system. The risks of skydiving in relation to the auditory system should be explored further. Aims: The main aim of this study was to explore the relationship between skydiving and audiology in South Africa. The sub-aims of the study focused on determining if skydivers were provided with safety precautions before they commenced with the dive, determining the middle ear pressure before and after the skydive and identifying the audiological symptoms that were present post-dive. This study also aimed at scrutinising the South African sports and recreation policy. Method: A mixed-method descriptive research design was utilised. Qualitative information pertaining to audiology was identified and recorded from the scrutiny of South Africa (SA) policy and the dropzone consent forms at two skydiving schools. Thirty-one skydivers were purposefully recruited to undergo a pre- and post-dive tympanometric assessment. Results: There is no information within the clearance forms that pertain to the audiological risks related to skydiving. There was a lack of information related to the risks of skydiving in the clearance forms at both dive schools. A statistically significant pressure change was noted in regular skydivers, regardless of the ability to equalise effectively during the skydive. Conclusion: This study identified the gaps in policy and clearance forms, highlighting the need for the inclusion of safety measures and risks in the documentation and legislation that governs the sport. Audiologists, sportspeople and medical advisors should be cognisant of the negative consequences that may be evident within the auditory system of skydivers.

Hearing loss in older adults - From epidemiological insights to national initiatives.

The broader implications of hearing loss for the health and functioning of older adults have begun to be demonstrated in epidemiologic studies. These research findings on the association between hearing loss and poorer health outcomes have formed the foundation for national initiatives on hearing loss and public health. These national initiatives range from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) clinical trial to the recent passage of the bipartisan Over-The-Counter Hearing Aid Act. Utilizing population health research methodologies to study hearing loss can provide the foundation for initiating top-down approaches to increase the adoption and accessibility of hearing care for older Americans with hearing loss.

Standing Up for Scope.

The Texas Medical Association triumphed when a Travis County district court sided with medicine in a lawsuit against the Texas Board of Chiropractic Examiners over its granting chiropractors the authority to perform certain diagnostic tests.

Legislation impacting audiology and the provision of audiological services: a review of legislation across the United States.

PURPOSE: The purpose of this review was to investigate the legislation about the provision of audiology services. Specifically, the goal of the review was to investigate the similarities and differences in legislation regarding the identification of, and audiology services provided to, children with hearing loss. METHOD: A systematic review was conducted to collect state-specific legislation regarding the audiology licensure requirements, requirements about the identification and management of children with hearing loss, and insurance coverage regulations. Compiled data were analyzed for similarities and differences between state regulations and legislature. RESULTS: All states require audiologists to hold licensure; however, many differences exist between the requirements of acquiring and maintaining the license. Some states regulate the identification and management of children with hearing loss, whereas others do not. Additionally, states differ in their regulation of services provided to children with hearing loss, who can provide these services, and what is covered by insurance. CONCLUSION: It is critical for audiologists to understand the requirements of their state in the provision of audiology services. Specifically, it is important for audiologists to understand how the laws may impact the services they provide to children with hearing loss.

Challenges for professional practice in the next decade.

This article is presented in a question and answer format and shares the thoughts of the 2006 President of the American Speech-Language-Hearing Association (ASHA), Alex Johnson, and current Executive Director of ASHA, Arlene Pietranton, regarding several regulatory issues that the professions of audiology and/or speech-language pathology are likely to have to address over the next decade. Specific topics mentioned include: trends affecting our professions; anticipated service delivery changes; public (i.e., Medicaid and Medicare) and private (i.e., health plans, consumer-driven plans) reimbursement; competing for funding dollars; pay-for-performance; the Individuals with Disabilities Education Act; No Child Left Behind; and ASHA's work with various national organizations and federal agencies in the regulatory arena. Several ASHA resources for further information are listed.

Medicaid program; provider qualifications for audiologists. Final rule.

This final rule will revise the requirements for audiologists furnishing services under the Medicaid program. As a result, the requirements will create consistency with the Medicare program's definition of a qualified audiologist by recognizing State licensure in determining provider qualifications. These revised standards will expand State flexibility in choosing qualified audiologists.

Perspectives on a state enacted hearing screening assessment program in the newborn population.

OBJECTIVE: A review of the early performance of Ohio's statewide infant hearing screening program was performed to provide insight as to the impact of the current medical and socioeconomic climate on its implementation. BACKGROUND: In March 1988, the State of Ohio enacted a law that required universal screening of newborn children for hearing loss through a program known as the Infant Hearing Screening and Assessment Program (IHSAP). The program design consisted of a universally applied high-risk questionnaire followed by a screening auditory assessment for those who fail. Although the value of such a program engendered little early public debate, the institution of such a program represented a significant challenge from a public health perspective. STUDY DESIGN: The program performance was analyzed using data from the index population of 160,000 live births per annum and hospital surveys. RESULTS: The questionnaires were found to be failing twice the number of newborns as originally projected, whereas completion rates and compliance were excellent. The assessment arm was plagued with poor compliance rates and limited resources. Lack of resources for effective data management has prevented an accurate evaluation of the program's sensitivity and specificity. CONCLUSION: IHSAP performance is being hampered by poor assessment follow-up and resource limitations, both in terms of screening equipment and habilitative follow-up services for infants identified as hearing impaired. The reasons for these problems are discussed in relation to existing legislative guidelines and medicoeconomic realities.

Nonphysician providers and limited-license practitioners: scope-of-practice issues.

The medical community recognizes that nonphysician providers are attempting to position themselves to assume larger, more independent roles in the new health care system. The American Medical Association (AMA) addressed this issue at its 1993 annual meeting of the house of delegates with the adoption of a resolution to study the role of mid-level practitioners. A report responding to the resolution was presented at the AMA's 1993 interim meeting of the house of delegates. The focus of the report was solely on the scope of practice of nurses; PAs were not included because they work under the supervision of physicians by law, and the American Academy of Physician Assistants has declared that it has no intention of seeking independent practice from physicians. The report reviews the qualifications and roles of a variety of APNs, and determines that "care by physicians does not equate to care delivered by nurses, allied health professionals, or nontraditional caregivers." It also states that substitution of physician care by nonphysicians raises questions of patient safety, competence of therapeutic decision, and fragmentation of care. The AMA report concludes that "physician care is based on cognitive and technical skills that are shaped by a unique education and experiences to form a foundation of clinical knowledge that allows physicians to decide what needs to be done across the wide variety of human maladies; that is irreplaceable by anyone with lesser training."