Public health policy-making for hearing loss: stakeholders' evaluation of a novel eHealth tool.

BACKGROUND: Hearing loss (HL) affects 466 million people of all ages worldwide, with a rapidly increasing prevalence, and therefore requires appropriate public health policies. Multi-disciplinary approaches that make use of eHealth services can build the evidence to influence public policy. The European Union-funded project EVOTION developed a platform that is fed with real-time data from hearing aids, a smartphone, and additional clinical data and makes public health policy recommendations based on hypothetical public health policy-making models, a big data engine and decision support system. The present study aimed to evaluate this platform as a new tool to support policy-making for HL. METHODS: A total of 23 key stakeholders in the United Kingdom, Croatia, Bulgaria and Poland evaluated the platform according to the Strengths, Weaknesses, Opportunities and Threats methodology. RESULTS: There was consensus that the platform, with its advanced technology as well as the amount and variety of data that it can collect, has huge potential to inform commissioning decisions, public health regulations and affect healthcare as a whole. To achieve this, several limitations and external risks need to be addressed and mitigated. Differences between countries highlighted that the EVOTION tool should be used and managed according to local constraints to maximise success. CONCLUSION: Overall, the EVOTION platform can equip HL policy-makers with a novel data-driven tool that can support public health policy-making for HL in the future.

Adult normative data for the speech in babble (SiB) test.

Objective: The Speech in Babble (SiB) test assesses the perception of speech in noise in UK adults. Here, we define the normal range of SiB scores to enable the use of the test in clinic.Design: In each test, 25 monosyllabic words were played in background multi-talker babble. Listeners had to repeat the word they heard. An adaptive procedure was used to determine the signal-to-noise ratio needed to reach 50% correct responses (i.e. the Speech Reception Threshold). Eight distinct equivalent lists were available.Study sample: Sixty-nine normal-hearing adults (aged 20-57 years) with no reported listening difficulties participated in the study and completed the SiB test twice in both ears.Results: Normative SiB scores varied from -0.8 dB to 3.7 dB suggesting that patients outside these limits should be considered as having abnormal scores. No statistically significant difference between ears and no effect of age or sex was found. There was "fair" test-retest reliability.Conclusion: The SiB test is a short, valid and reliable test that can be used in UK clinics, e.g. as part of a standard APD battery or evaluating the performance of hearing impaired patients.

Experiences of Patients With Auditory Processing Disorder in Getting Support in Health, Education, and Work Settings: Findings From an Online Survey.

Objective: To explore the views and experiences of individuals with Auditory Processing Disorder (APD) and/or their families in getting support from services and to receive their suggestions for improvement. Design: Cross-sectional random sample survey with descriptive analysis. Settings: Online survey. Participants: One hundred and fifty six individuals with APD and/or their family members from the APD Support UK patient support organization and four associated APD Facebook groups. Main Outcome Measure: A 16-item questionnaire on negative and positive experiences in getting a referral for diagnosis, funding for the FM system, and overall support for APD. Results: The key findings that emerged included reports of difficulty in getting a referral for diagnosis (54%), obtaining funding for an FM system (45%), getting support for APD (61%), and poor recognition and awareness of APD (63%) in Education, Health or Work settings. The positive experiences reported were ease in getting a referral for diagnosis (46%), in obtaining an FM system (20%), and with diagnosis leading to help at school or to a better understanding of the condition and the required adjustments. The recommended improvement areas were raising awareness of APD and related management in Education (30%), the Health sector (25%), and the public (18%). Conclusions: Individuals and families of individuals with APD overwhelmingly report a lack of awareness of APD across health, education, and work sectors, and difficulties in getting access to diagnosis and support. This information may provide an initial understanding of the patients' needs for clinical services for APD, identify research priorities, and influence longer-term public health decisions toward improved care.

Involving Children and Teenagers With Bilateral Cochlear Implants in the Design of the BEARS (Both EARS) Virtual Reality Training Suite Improves Personalization.

Older children and teenagers with bilateral cochlear implants often have poor spatial hearing because they cannot fuse sounds from the two ears. This deficit jeopardizes speech and language development, education, and social well-being. The lack of protocols for fitting bilateral cochlear implants and resources for spatial-hearing training contribute to these difficulties. Spatial hearing develops with bilateral experience. A large body of research demonstrates that sound localisation can improve with training, underpinned by plasticity-driven changes in the auditory pathways. Generalizing training to non-trained auditory skills is best achieved by using a multi-modal (audio-visual) implementation and multi-domain training tasks (localisation, speech-in-noise, and spatial music). The goal of this work was to develop a package of virtual-reality games (BEARS, Both EARS) to train spatial hearing in young people (8-16 years) with bilateral cochlear implants using an action-research protocol. The action research protocol used formalized cycles for participants to trial aspects of the BEARS suite, reflect on their experiences, and in turn inform changes in the game implementations. This participatory design used the stakeholder participants as co-creators. The cycles for each of the three domains (localisation, spatial speech-in-noise, and spatial music) were customized to focus on the elements that the stakeholder participants considered important. The participants agreed that the final games were appropriate and ready to be used by patients. The main areas of modification were: the variety of immersive scenarios to cover age range and interests, the number of levels of complexity to ensure small improvements were measurable, feedback, and reward schemes to ensure positive reinforcement, and an additional implementation on an iPad for those who had difficulties with the headsets due to age or balance issues. The effectiveness of the BEARS training suite will be evaluated in a large-scale clinical trial to determine if using the games lead to improvements in speech-in-noise, quality of life, perceived benefit, and cost utility. Such interventions allow patients to take control of their own management reducing the reliance on outpatient-based rehabilitation. For young people, a virtual-reality implementation is more engaging than traditional rehabilitation methods, and the participatory design used here has ensured that the BEARS games are relevant.

The Optimising Cardiac Surgery ouTcOmes in People with diabeteS (OCTOPuS) randomised controlled trial to evaluate an outpatient pre-cardiac surgery diabetes management intervention: a study protocol.

INTRODUCTION: Cardiothoracic surgical outcomes are poorer in people with diabetes compared with those without diabetes. There are two important uncertainties in the management of people with diabetes undergoing major surgery: (1) how to improve diabetes management in the weeks leading up to an elective procedure and (2) whether that improved management leads to better postoperative outcomes. We previously demonstrated the feasibility of delivering the Optimising Cardiac Surgery ouTcOmes in People with diabeteS (OCTOPuS) intervention, an outpatient intervention delivered by diabetes healthcare professionals for people with suboptimally managed diabetes over 8-12 weeks before elective cardiac surgery. The present study will assess the clinical and cost-effectiveness of the intervention in cardiothoracic centres across the UK. METHODS AND ANALYSIS: A multicentre, parallel group, single-blinded 1:1 individually randomised trial comparing time from surgery until clinically fit for discharge in adults with suboptimally managed type 1 diabetes or type 2 diabetes undergoing elective surgery between the OCTOPuS intervention and usual care (primary endpoint). Secondary endpoints will include actual time from surgery to discharge from hospital; days alive and either out of hospital or judged as clinically fit for discharge; mortality; time on intensive therapy unit (ITU)/ventilator; infections; acute myocardial infarction; change in weight; effect on postoperative renal function and incidence of acute kidney injury; change in HbA1c; frequency and severity of self-reported hypoglycaemia; operations permanently cancelled for suboptimal glycaemic levels; cost-effectiveness; psychosocial questionnaires. The target sample size will be 426 recruited across approximately 15 sites. The primary analysis will be conducted on an intention-to-treat population. A two-sided p value of 0.05 or less will be used to declare statistical significance for all analyses and results will be presented with 95% CIs. ETHICS AND DISSEMINATION: The trial was approved by the South Central-Hampshire A Research Ethics Committee (20/SC/0271). Results will be disseminated through conferences, scientific journals, newsletters, magazines and social media. TRIAL REGISTRATION NUMBER: ISRCTN10170306.

Developing an intervention to optimise the outcome of cardiac surgery in people with diabetes: the OCTOPuS pilot study.

BACKGROUND: Cardiothoracic surgical outcomes are poorer in people with diabetes compared with those without diabetes. There are two important uncertainties in the management of people with diabetes undergoing major surgery: (1) how to improve diabetes management in the weeks leading up to an elective procedure and (2) whether that improved management leads to improved postoperative outcomes. The aim of this study was to develop and pilot a specialist diabetes team-led intervention to improve surgical outcomes in people with diabetes. DESIGN: Open pilot feasibility study SETTING: Diabetes and cardiothoracic surgery departments, University Hospital Southampton NHS Foundation Trust PARTICIPANTS: Seventeen people with diabetes undergoing cardiothoracic surgery INTERVENTION: Following two rapid literature reviews, a prototype intervention was developed based on a previously used nurse-led outpatient intervention and tested. PRIMARY OUTCOME: Feasibility and acceptability of delivering the intervention SECONDARY OUTCOMES: Biomedical data were collected at baseline and prior to surgery. We assessed how the intervention was used. In depth qualitative interviews with participants and healthcare professionals were used to explore perceptions and experiences of the intervention and how it might be improved. RESULTS: Thirteen of the 17 people recruited completed the study and underwent cardiothoracic surgery. All components of the OCTOPuS intervention were used, but not all parts were used for all participants. Minor changes were made to the intervention as a result of feedback from the participants and healthcare professionals. Median (IQR) HbA1c was 10 mmol/mol (3, 13) lower prior to surgery than at baseline. CONCLUSION: This study has shown that it is possible to develop a clinical pathway to improve diabetes management prior to admission. The clinical and cost-effectiveness of this intervention will now be tested in a multicentre randomised controlled trial in cardiothoracic centres across the UK. TRIAL REGISTRATION: ISRCTN; ISRCTN10170306 . Registered 10 May 2018.

A Data-informed Public Health Policy-Makers Platform.

Hearing loss is a disease exhibiting a growing trend due to a number of factors, including but not limited to the mundane exposure to the noise and ever-increasing size of the older population. In the framework of a public health policymaking process, modeling of the hearing loss disease based on data is a key factor in alleviating the issues related to the disease and in issuing effective public health policies. First, the paper describes the steps of the data-driven policymaking process. Afterward, a scenario along with the part of the proposed platform responsible for supporting policymaking are presented. With the aim of demonstrating the capabilities and usability of the platform for the policy-makers, some initial results of preliminary analytics are presented in the framework of a policy-making process. Ultimately, the utility of the approach is validated throughout the results of the survey which was presented to the health system policy-makers involved in the policy development process in Croatia.

Challenges and Strengths of Multidisciplinary Research in Audiology: The EVOTION Example.

Purpose The EU-funded research project EVOTION has brought together clinical, technical, and public health experts with the aim to offer a solution for the holistic management of hearing loss. This report presents the challenges, strengths, and key take-home messages of working in this multidisciplinary consortium. Method Fifteen consortium members completed an online survey with 6 open-ended questions. Responses were analyzed using a thematic approach. Results Analysis identified 4 main themes: (a) communication, that is, cross-disciplinary communication difficulties but also range of expertise; (b) opportunities, that is, innovation, learning, and collaborations; (c) technology, that is, technical requirements and data collection and management issues; and (d) local constraints, that is, institutional limitations, resources, and planning. Conclusions Although the challenges reported differed by country and specialty, there was consensus about the value, expertise, and opportunities of the project. It is recommended that in future similar multidisciplinary projects in audiology, researchers establish a common language and assess technical requirements and local constraints prior to initiating research activities.

Clinical validation of a public health policy-making platform for hearing loss (EVOTION): protocol for a big data study.

INTRODUCTION: The holistic management of hearing loss (HL) requires an understanding of factors that predict hearing aid (HA) use and benefit beyond the acoustics of listening environments. Although several predictors have been identified, no study has explored the role of audiological, cognitive, behavioural and physiological data nor has any study collected real-time HA data. This study will collect 'big data', including retrospective HA logging data, prospective clinical data and real-time data via smart HAs, a mobile application and biosensors. The main objective is to enable the validation of the EVOTION platform as a public health policy-making tool for HL. METHODS AND ANALYSIS: This will be a big data international multicentre study consisting of retrospective and prospective data collection. Existing data from approximately 35 000 HA users will be extracted from clinical repositories in the UK and Denmark. For the prospective data collection, 1260 HA candidates will be recruited across four clinics in the UK and Greece. Participants will complete a battery of audiological and other assessments (measures of patient-reported HA benefit, mood, cognition, quality of life). Patients will be offered smart HAs and a mobile phone application and a subset will also be given wearable biosensors, to enable the collection of dynamic real-life HA usage data. Big data analytics will be used to detect correlations between contextualised HA usage and effectiveness, and different factors and comorbidities affecting HL, with a view to informing public health decision-making. ETHICS AND DISSEMINATION: Ethical approval was received from the London South East Research Ethics Committee (17/LO/0789), the Hippokrateion Hospital Ethics Committee (1847) and the Athens Medical Center's Ethics Committee (KM140670). Results will be disseminated through national and international events in Greece and the UK, scientific journals, newsletters, magazines and social media. Target audiences include HA users, clinicians, policy-makers and the general public. TRIAL REGISTRATION NUMBER: NCT03316287; Pre-results.

Impact of music on the quality of life of cochlear implant users: a focus group study.

OBJECTIVE: To study the aspects of the quality of life (QoL) on which music has an impact in adult cochlear implant (CI) users. METHODS: Thirty adult CI users aged between 18 and 81 years old with a wide range of patient characteristics and musical backgrounds participated in the study. Six focus group discussions about music in everyday life were conducted and data were analysed using template analysis based on the QoL model of the World Health Organisation Quality of Life BREF questionnaire. RESULTS AND DISCUSSION: A theoretical framework of the impact of music on the QoL was developed. Music was reported to contribute to many aspects of physical, psychological, and social well-being in adult CI users. These positive effects of music on QoL were similar to what has been reported in the literature for normal-hearing adults. However, difficulties in music perception and enjoyment were found to have a negative impact on CI users' QoL, especially by causing unpleasant feelings and limited participation in music-related or routine daily activities. CONCLUSIONS: These findings suggest that an improvement in music experiences of CI users may lead to improvements in QoL and therefore support the need for music rehabilitation. However, the relative importance of music overall and of specific aspects of music for each individual should be measured for an accurate assessment of the impact of music on the QoL of CI users.

A Music-Related Quality of Life Measure to Guide Music Rehabilitation for Adult Cochlear Implant Users.

PURPOSE: A music-related quality of life (MuRQoL) questionnaire was developed for the evaluation of music rehabilitation for adult cochlear implant (CI) users. The present studies were aimed at refinement and validation. METHOD: Twenty-four experts reviewed the MuRQoL items for face validity. A refined version was completed by 147 adult CI users, and psychometric techniques were used for item selection, assessment of reliability, and definition of the factor structure. The same participants completed the Short Form Health Survey for construct validation. MuRQoL responses from 68 CI users were compared with those of a matched group of adults with normal hearing. RESULTS: Eighteen items measuring music perception and engagement and 18 items measuring their importance were selected; they grouped together into 2 domains. The final questionnaire has high internal consistency and repeatability. Significant differences between CI users and adults with normal hearing and a correlation between music engagement and quality of life support construct validity. Scores of music perception and engagement and importance for the 18 items can be combined to assess the impact of music on the quality of life. CONCLUSION: The MuRQoL questionnaire is a reliable and valid measure of self-reported music perception, engagement, and their importance for adult CI users with potential to guide music aural rehabilitation.

The effect of spectral smearing on the identification of pure F0 intonation contours in vocoder simulations of cochlear implants.

OBJECTIVES: Performance of cochlear implant (CI) users on linguistic intonation recognition is poorer than that of normal-hearing listeners, due to the limited spectral detail provided by the implant. A higher spectral resolution is provided by narrow rather than by broad filter slopes. The corresponding effect of the filter slope on the identification of linguistic intonation conveyed by pitch movements alone was tested using vocoder simulations. METHODS: Re-synthesized intonation variants of naturally produced phrases were processed by a 15-channel noise vocoder using a narrow (40 dB/octave) and a broad (20 dB/octave) filter slope. There were three different intonation patterns (rise/fall/rise-fall), differentiated purely by pitch and each associated to a different meaning. In both slope conditions as well as a condition with unprocessed stimuli, 24 normally hearing Dutch adults listened to a phrase, indicating which of two meanings was associated to it (i.e. a counterbalanced selection of two of the three contours). RESULTS: As expected, performance for the unprocessed stimuli was better than for the vocoded stimuli. No overall difference between the filter conditions was found. DISCUSSION AND CONCLUSIONS: These results are taken to indicate that neither the narrow (20 dB/octave) nor the shallow (40 dB/octave) slope provide enough spectral detail to identify pure F(0) intonation contours. For users of a certain class of CIs, results could imply that their intonation perception would not benefit from steeper slopes. For them, perception of pitch movements in language requires more extreme filter slopes, more electrodes, and/or additional (phonetic/contextual) cues.