Language development in deaf or hard-of-hearing children with additional disabilities: type matters!

BACKGROUND: This study examined language development in young children with hearing loss and different types of additional disabilities (ADs). METHOD: A population-based cohort of 67 children who were enrolled in the Longitudinal Outcomes of Children with Hearing Impairment study took part. Language ability was directly assessed at 3 and 5 years of age using the Preschool Language Scale, Fourth Edition and the Peabody Picture Vocabulary Test, Fourth Edition. Standard scores were used to enable comparison with age-based expectations for typically developing children. RESULTS: Analysis of variance showed that, across the total cohort, children's language scores remained stable over the 2-year period. However, this overall stability masked a significant difference between children with different types of ADs; in particular, children with autism, cerebral palsy and/or developmental delay showed a decline in standard scores, whereas children with other disabilities showed a relative improvement. In addition, larger improvements in receptive vocabulary were associated with use of oral communication only. CONCLUSIONS: The results suggest that type of AD can be used to gauge expected language development in the population of children with hearing loss and ADs when formal assessment of cognitive ability is not feasible.

Predicting 3-year outcomes of early-identified children with hearing impairment.

UNLABELLED: PROBLEM/OBJECTIVES: Permanent childhood hearing loss has major negative impacts on children's health and development. To improve outcomes, universal newborn hearing screening (UNHS) has been implemented widely. However, high-quality evidence on its efficacy was lacking. To address this evidence gap, we conducted the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study to directly compare outcomes of early- and late-identified children. This paper investigates whether early performance measured shortly after initial amplification predicts language development at 3 years of age. METHODOLOGY: This is a prospective, population-based study. We assessed outcomes at 6- and 12-months after amplification, and then at 3 and 5 years of age. Main outcome measures included directly-assessed language, receptive vocabulary, speech production; and parent-reported functional performance in everyday life. A range of demographic and audiological information was also collected at evaluation intervals. RESULTS: About 450 children participated, and 3-year outcomes scores were available for 356 participants. Multiple regression analysis revealed that early language scores or functional performance ratings were significant predictors of 3-year outcomes. Other significant predictors included the presence or absence of additional disabilities, severity of hearing loss, and age at cochlear implant activation. CONCLUSIONS: Early performance, either directly-assessed language ability (PLS-4) or parent-reported functional ratings (PEACH), were significant predictors of 3-year outcomes; along with presence or absence of additional disabilities, severity of hearing loss, and age at CI activation. Earlier implantation is possible with early detection of hearing loss via UNHS. Monitoring performance after initial amplification allows preventive strategies to be implemented early to improve outcomes.

Binaural-bimodal fitting or bilateral implantation for managing severe to profound deafness: a review.

There are now many recipients of unilateral cochlear implants who have usable residual hearing in the non-implanted ear. To avoid auditory deprivation and to provide binaural hearing, a hearing aid or a second cochlear implant can be fitted to that ear. This article addresses the question of whether better binaural hearing can be achieved with binaural/bimodal fitting (combining a cochlear implant and a hearing aid in opposite ears) or bilateral implantation. In the first part of this article, the rationale for providing binaural hearing is examined. In the second part, the literature on the relative efficacy of binaural/bimodal fitting and bilateral implantation is reviewed. Most studies on comparing either mode of bilateral stimulation with unilateral implantation reported some binaural benefits in some test conditions on average but revealed that some individuals benefited, whereas others did not. There were no controlled comparisons between binaural/bimodal fitting and bilateral implantation and no evidence to support the efficacy of one mode over the other. In the third part of the article, a crossover trial of two adults who had binaural/bimodal fitting and who subsequently received a second implant is reported. The findings at 6 and 12 months after they received their second implant indicated that binaural function developed over time, and the extent of benefit depended on which abilities were assessed for the individual. In the fourth and final parts of the article, clinical issues relating to candidacy for binaural/ bimodal fitting and strategies for bimodal fitting are discussed with implications for future research.

Antiulcer drug prescribing in hospital successfully influenced by "immediate concurrent feedback".

OBJECTIVE: To determine whether immediate concurrent feedback (ICF) focused on inpatient omeprazole prescribing achieved more rational and cost-effective antiulcer drug prescribing and usage. METHODS: In a 1400-bed teaching hospital, an audit (by specially trained personnel) was conducted to monitor inpatient prescribing of omeprazole (1) in preference to H2-antagonists and other drugs according to agreed criteria (Helicobacter pylori eradication, severe reflux esophagitis, rapid ulcer healing deemed urgent because of severe symptoms or complications, high-dose steroid therapy of > or =30 mg/day prednisolone) and (2) appropriateness of intravenous dosing (oral route not feasible or contraindicated). After baseline monitoring for 1 month, followed by relevant antiulcer drug therapy education, ICF was instituted for 1 year. This entailed explanatory memoranda requesting a change in prescribing issued to the respective medical teams of patients whose omeprazole prescription did not "conform." The main outcomes of the study were omeprazole prescription numbers per month and the proportion conforming, defined daily doses of antiulcer drugs used and corresponding expenditures, and pertinent antiulcer drug utilization data from 9 other local hospitals. RESULTS: Baseline omeprazole prescribing conformed in 32 of 173 (18%) of the patients compared with 451 of 546 (83%) during institution of ICF (P < 0001; chi2 test). Correspondingly, average overall omeprazole and ranitidine usage (inpatient and outpatient) and expenditure decreased (44% and 45%, respectively); collectively, use of less expensive alternatives increased about 61%. Estimated savings averaged about HK$150,000 ($20,000) per month. No comparable changes in usage were noted in 9 other local hospitals. CONCLUSION: Regarding hospital antiulcer drugs, this ICF strategy was associated with more rational prescribing and usage, and an important saving of resources.

The enhancement of infection control in-service education by ward opinion leaders.

Opinion leaders are members within a social group with significant social influence over others. A guideline on urinary catheter care was introduced in three groups (A, B, and C) of two randomly allocated wards. Two opinion leaders per ward were identified by nurses in groups A and B with the use of a sociometric method. For education, in-service lectures for 30% of nurses and opinion leaders' tutorials for all nurses were used in group A; opinion leaders' tutorials alone in B, and lectures alone in C. Before and after the education program, the guideline's frequency of practice was assessed by surveying 30% of randomly selected nurses and by direct observation. Results of the survey were comparable for groups A and B and both groups were significantly higher (p less than 0.05) than C, suggesting that informational transmission by opinion leaders was superior to that by the lecture. However, practices by direct observation in group A were significantly better (p less than 0.05) than those in B, indicating that staff compliance is best achieved by using both opinion leaders and lectures. The lecture probably endorsed the opinion leaders' leadership, enhancing their ability to influence the staff.

Educational needs in patient care practices in Hong Kong.

We conducted a survey on staff perceptions of what the educational needs would be for an infection surveillance and control program in patient care practices in 10 hospitals in Hong Kong. Seven hundred twenty nurses were interviewed and were requested to select their needs from six topics: isolation procedures, disinfection of environment and instruments, surgical wound care, urinary catheter care, prevention of hospital-acquired pneumonia, and prevention of infusion therapy sepsis. According to their pattern of needs, the clinical units could be divided into three groups. Staff members in the "medically oriented units," consisting of the medical, geriatric, obstetric, and intensive care units, indicated that their greatest needs were in the areas of isolation procedures and disinfection of environment and instruments, whereas nurses in the "surgically oriented units," consisting of surgical, orthopedic, and gynecologic units, indicated that surgical wound care was the area where education was most needed. The pattern in the third group, the pediatric units, was similar to that of medical units in indicating isolation procedures and disinfection of environment and instruments as the greatest needs but differed in having a higher score for prevention of hospital-acquired pneumonias and a lower score for surgical wound care. An effective educational program should take these needs into consideration. We discuss the application of the survey findings in planning in-service education in infection control.

Hospital use of chlorine disinfectants in a hepatitis B endemic area--a prevalence survey in twenty hospitals.

A survey was conducted to assess the uses of chlorine disinfectants in twenty hospitals in Hong Kong. In the 149 areas visited, the charge nurses were interviewed on the use of chlorine disinfectants. A high proportion of uses (44%) were not at the recommended dilution and only 88 (57%) of the 154 samples were within +/- 10% of the manufacturers quoted chlorine content. Samples with inadequate chlorine were found among all six types of chlorine disinfectants, although sodium dichloroisocyanurate tablets conformed to the quoted strength on 88% occasions. Higher usage frequency and better dilution practices were noted for hospitals with a disinfectant policy.

Evaluation of staff compliance with 'influencing' tactics in relation to infection control policy implementation.

The efficacy of 'influencing' tactics for inducing compliance to infection control policies was assessed in 20 Hong Kong hospitals. In phase 1, 45 infection control nurses (ICNs) were surveyed on the frequency of use of possible tactics. Twenty-three of the more frequently used tactics were selected for phase 2 in which a random sample of 881 nurses were questioned on whether they would willingly, reluctantly or not comply with these tactics. Based on factor analysis of the responses in phase 2, six dimensions of compliance were identified. These were, in their order of effectiveness in achieving compliance: professional-resources (providing specialized or expert help); professional-respect (esteeming others as fellow professionals); coalition (obtaining staff support), ingratiation (cultivating goodwill), hierarchical (exerting pressure derived from rank) and non-communicative (ignoring or disregarding other's point of view).

An outbreak of Candida tropicalis peritonitis in patients on intermittent peritoneal dialysis.

An outbreak of Candida tropicalis peritonitis in intermittent peritoneal dialysis patients during a 6-week period is reported from a general hospital. Five patients were involved and there were three deaths. The strains recovered from affected patients were identical to those recovered from the water baths on the basis of biotyping, antimicrobial susceptibility pattern and chromosomal DNA fingerprints. No further cases were identified on subsequent surveillance after the prohibition of wet-warming of peritoneal dialysate in the hospital.

Improvements in speech perception with use of the AVR TranSonic frequency-transposing hearing aid.

Five adults with sensorineural hearing impairment participated in a trial comparing the performance of the AVR TranSonic frequency-transposing hearing aid with that of their own conventional aids. They used the TranSonic for approximately 12 weeks, during which time systematic changes were made to the transposition parameters. Speech perception was assessed with each setting of those parameters and with the participants' own hearing aids. Four participants obtained significantly higher scores with the TranSonic than with their own aids on at least one of the tests. However, analysis of the consonant confusions suggested that the improvement resulted mostly from the TranSonic's low-frequency electro-acoustic characteristics. There was only limited evidence for 2 of the participants that the frequency-lowering function was effective at improving speech perception.

Evaluating the efficacy of the infection control liaison nurse in the hospital.

The infection control liaison nurse (ICLN) is a nurse in the ward, appointed to participate in education for infection control, and to liaise between the ward and the infection control nurse (ICN). The efficacy of ICLNs was evaluated when a guideline on urinary catheter care was introduced in a 1000-bed hospital in Hong Kong. The 27 public wards were divided randomly into a test (24 wards) and control group (three wards), and ICLNs were appointed in the test group by the nursing administration. For education, the ICN conducted in-service lectures for both groups, while in the test group, the ICLNs also conducted tutorials for all ward nurses. Before and after the education programme, prevalence surveys were conducted to detect incorrect practices on urinary catheter care. Three practices were evaluated: the securing of catheters, presence of kinking and the use of urinary bags with a drainage spigot. Before education, the percentage of incorrect practices in the test groups was 63%, which was comparable to the 68% of the control group (P = 0.40, chi 2 = 0.71). After education, the percentage of incorrect practices in the test group (36%) was significantly lower than the 48% in the control group (P less than 0.05, chi 2 = 4.25). This indicates that ICLNs can indeed enhance the education programme for infection control.

Communication of lexical tones in Cantonese alaryngeal speech.

Cantonese is a tone language with six lexical tones. Each word has a distinctive tone, signaled by fundamental frequency variations at the syllable level. We investigated the relative efficiency of alaryngeal Cantonese speakers in conveying tonal variations in words in citation form. Isolated tone tokens were produced by three esophageal speakers, two tracheoesophageal speakers, two pneumatic artificial laryngeal speakers, and two electrolaryngeal speakers for perceptual tests. The correct responses from 22 listeners were highest for the pneumatic artificial laryngeal speakers, and could be graded in order of proficiency as esophageal, tracheoesophageal, and electrolaryngeal speakers. These results provide a linguistic perspective for guiding voice rehabilitation and the choice of voice in alaryngeal patients who speak a tone language.

Speech recognition of hearing-impaired listeners: predictions from audibility and the limited role of high-frequency amplification.

Two experiments were conducted to examine the relationship between audibility and speech recognition for individuals with sensorineural hearing losses ranging from mild to profound degrees. Speech scores measured using filtered sentences were compared to predictions based on the Speech Intelligibility Index (SII). The SII greatly overpredicted performance at high sensation levels, and for many listeners, it underpredicted performance at low sensation levels. To improve predictive accuracy, the SII needed to be modified. Scaling the index by a multiplicative proficiency factor was found to be inappropriate, and alternative modifications were explored. The data were best fitted using a method that combined the standard level distortion factor (which accounted for decrease in speech intelligibility at high presentation levels based on measurements of normal-hearing people) with individual frequency-dependent proficiency. This method was evaluated using broadband sentences and nonsense syllables tests. Results indicate that audibility cannot adequately explain speech recognition of many hearing-impaired listeners. Considerable variations from audibility-based predictions remained, especially for people with severe losses listening at high sensation levels. The data suggest that, contrary to the basis of the SII, information contained in each frequency band is not strictly additive. The data also suggest that for people with severe or profound losses at the high frequencies, amplification should only achieve a low or zero sensation level at this region, contrary to the implications of the unmodified SII.