Medical Education in Armenia: An Overview.

This article serves to describe the medical education system of Armenia, a country located in the cross-section of Europe and Asia. Similar to other countries in the region, its medical education system is structured into undergraduate (6 years), postgraduate (1-4 years), and continuing education components. Its largest medical university, Yerevan State Medical University (YSMU), is the predominant institute for medical education and has enrollment of not only Armenian citizens, but also international students from India, Iran, Russia, and other countries. According to publication metrics, research activity at YSMU is increasing. Finally, the unique relationship between the country and its global diaspora has facilitated collaborative efforts in not only medical education, but also the delivery of care and capacity building. Significant challenges remain for each stage of medical education, such as the lack of standardized licensing or board examinations and oversight of the number of resident physicians per specialty.

Longitudinal outcomes for educational placement and quality of life in a prospectively recruited multinational cohort of children with cochlear implants.

OBJECTIVES: The aim of this study was to report on the educational placement, quality of life and speech reception changes in a prospectively recruited group of children after they received a cochlear implant (CI). METHOD: Data was collected on 1085 CI recipients of as part of a prospective, longitudinal, observational, international, multi-centre, paediatric registry, initiated by Cochlear Ltd (Sydney, NSW, Australia). Outcome data from children (≤10 years old) implanted in routine practice was voluntarily entered into a central, externally hosted, e-platform. Collection occurred prior to initial device activation (baseline) and at six monthly follow-up intervals up to 24 months and then at 3 years post activation. Clinician reported baseline and follow up questionnaires and Categories of Auditory Performance version II (CAP-II) outcomes were collated. Self-reported evaluation forms and patient information were provided by the parent/caregiver/patient via the implant recipient baseline and follow up, Children Using Hearing Implants Quality of Life (CuHIQoL) and Speech Spatial Qualities (SSQ-P) Parents Version questionnaires. RESULTS: Children were mainly bilaterally profoundly deaf, unilaterally implanted and used a contralateral hearing aid. Prior to implant 60% used signing or total communication as their main mode of communication. Mean age at implant was 3.2 ± 2.2 years (range 0-10 years). At baseline 8.6% were in mainstream education with no additional support and 82% had not yet entered school. After three years of implant use, 52% had entered mainstream education with no additional support and 38% had not yet entered school. In the sub-group of 141 children who were implanted at or after three years of age and were thus old enough to be in mainstream school at the three-year follow up, an even higher proportion (73%) were in mainstream education with no support. Quality of life scores for the child improved statistically significantly post implant compared to baseline and continued to improve significantly at each interval up to 3 years (p < 0.001). Parental expectation scores reduced statistically significantly from baseline compared to all intervals (p < 0.028) and then increased significantly at 3 years compared to all post baseline follow-up intervals (p < 0.006). The impact on family life was reduced post implant compared to baseline and continued to reduce between annual intervals (p < 0.001). At three years post follow up median CAP II scores were 7 (IQR 6-7) and mean SSQ-P scores were 6.8 (SD1.9) 6.0 (SD1.9) and 7.4 (SD 2.3) for speech spatial and qualities scales respectively. SSQ-P and CAP II scores improved statistically and clinically significantly compared to baseline by one year post implantation. CAP II scores continued to improve at each test interval up to three years post implant. Speech and Qualities scores improved significantly between years 1 and 2 (p < 0.001), but only the Speech scores improved significantly between years 2 and 3 (p = 0.004). CONCLUSIONS: Mainstream educational placement was achievable for most of the children, including those implanted at an older age. Quality of life for the child and the wider family improved. Future research could focus on the impact of mainstream school placement on children's academic progress, including measures of academic attainment and social functioning.

Comparison of speech recognition in cochlear implant patients with and without residual hearing: A review of indications.

OBJECTIVE: This study evaluated existing guidelines for cochlear implantation (CI) according to the residual hearing of the patient. Speech recognition performance of adults implanted according to their degree of residual hearing was retrospectively evaluated. METHODS: Speech recognition results of 174 adult cochlear implant recipients were analyzed. All participants had pure tone thresholds of >75 dB at 2 and 4 kHz and were divided into three groups based on differing levels of low-frequency residual hearing. RESULTS: Findings indicate that CI was of benefit for all patients with bilateral severe hearing loss and patients with nonfunctional residual hearing both in quiet and noisy conditions. Patients with residual low-frequency hearing could benefit from combined electro-acoustic stimulation compared to CI alone or to hearing aids alone preoperatively. The speech recognition performance of all CI recipients with different levels of residual hearing in the low frequencies was similar except that superior performance was observed in the group using electro-acoustic stimulation compared to electrical stimulation alone. DISCUSSION AND CONCLUSIONS: Study results demonstrate the success of CI in accordance with current guidelines and also support expanding implantation guidelines to include patients who have severe-to-profound high-frequency sensorineural hearing loss and usable residual low frequency hearing.