The Effect of Interprofessional Education on Student Readiness for Collaborative Practice.

BACKGROUND: Health care reform promotes interprofessional patient-centric health care models associated with improved population health outcomes. Interprofessional education (IPE) programs are necessary to cultivate collaborative care, yet little evidence exists to support IPE pedagogy within nursing and other health science academia. METHOD: This quasiexperimental study examined differences in pre- and posttest Readiness for Interprofessional Learning Scale (RIPLS) scores following an IPE intervention. The IPE intervention consisted of a video presentation and a debriefing session after a simulated interprofessional collaborative patient care conference that introduced baccalaureate nursing and health science students to the roles and responsibilities of clinicians in team-based primary care. Pre- and postintervention RIPLS scores were analyzed. RESULTS: Pre- and postintervention RIPLS scores increased across all subscales, with distinct variation between nursing and health science student subscales. CONCLUSION: This IPE intervention had positive effects on students' readiness for interprofessional learning. Additional research is warranted to support health science pedagogy. [J Nurs Educ. 2024;63(5):304-311.].

Evaluation of the Performance of a Card Game to Introduce Students to Interprofessional Collaboration: A Randomized 2-Group Comparison Study.

BACKGROUND: Gamification is an approach that can be used to introduce interprofessional collaboration in nursing and health science. Card games are an effective and convenient way to educate students about clinical professions. PURPOSE: We compared the perception of an experimental group of students who played an educational card game to a control group that played an uninstructive card game. METHODS: College students (n = 148) from nursing and health science majors consented to play a 30-minute card game and complete a 13-item survey. RESULTS: Perceptions of the card game were significantly better for students in the experimental group who played the interprofessional collaboration game than for those in the control group (t = 10.33, P < .001). Survey subscales were rated significantly higher for respondents who played the interprofessional card game. CONCLUSIONS: The use of an innovative card game teaching strategy significantly increased the perception of interprofessional collaboration among college students.

Pre-Existing Audiometric Hearing Loss is a Predictor of Significant Threshold Shift Following Injury During Combat Deployment.

OBJECTIVES: Military personnel are exposed to multiple risk factors for hearing loss, particularly on the battlefield. The objective of this study was to determine whether pre-existing hearing loss predicted hearing threshold shift in male U.S. military personnel following injury during combat deployment. DESIGN: This was a retrospective cohort study with 1573 male military personnel physically injured in Operations Enduring and Iraqi Freedom between 2004 and 2012. Audiograms before and after injury were analyzed and used to calculate significant threshold shift (STS), defined as a 30 dB or greater change in the sum of hearing thresholds at 2000, 3000, and 4000 Hz in either ear on the postinjury audiogram, relative to the same frequencies on the preinjury audiogram. RESULTS: Twenty-five percent (n = 388) of the sample had preinjury hearing loss, which mostly occurred in the higher frequencies (i.e., 4000 and 6000 Hz). The prevalence of postinjury STS ranged from 11.7% to 33.3% as preinjury hearing level moved from better to worse. In multivariable logistic regression, preinjury hearing loss was a predictor of STS, and there was a dose-response relationship between severity of preinjury hearing threshold and postinjury STS, specifically for preinjury hearing levels of 40 to 45 dBHL (odds ratio [OR] = 1.99; 95% confidence interval [CI] = 1.03 to 3.88), 50 to 55 dBHL (OR = 2.33; 95% CI = 1.17 to 4.64), and >55 dBHL (OR = 3.77; 95% CI = 2.25 to 6.34). CONCLUSIONS: These findings suggest that better preinjury hearing provides increased resistance to threshold shift than impaired preinjury hearing. Although STS is calculated using 2000 to 4000 Hz, clinicians must closely attend to the pure-tone response at 6000 Hz and use this test frequency to identify service members at-risk for STS prior to combat deployment.

Relationship Between Tinnitus and Hearing Outcomes Among US Military Personnel After Blast Injury.

OBJECTIVES: To examine the association between tinnitus and hearing outcomes among US military personnel after blast injury, including any hearing loss, low-frequency hearing loss, high-frequency hearing loss, early warning shift, and significant threshold shift. DESIGN: In this retrospective study, the Blast-Related Auditory Injury Database was queried for male military service members who had audiometric data 2 years before and after blast injury between 2004 and 2012 with no history of hearing loss or tinnitus before injury (n = 1693). Tinnitus was defined by diagnostic codes in electronic health records. Multivariable logistic regression examined the association between tinnitus and hearing outcomes, while adjusting for covariates. RESULTS: Overall, 14.2% (n = 241) of the study sample was diagnosed with tinnitus within 2 years after blast injury. The proportions of all examined hearing outcomes were higher among service members with tinnitus than those without ( p < 0.001). In multivariable analysis, service members with tinnitus had higher adjusted odds of any hearing loss (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.20-2.47), low-frequency hearing loss (OR = 2.77, 95% CI = 1.80-4.26), high-frequency hearing loss (OR = 2.15, 95% CI = 1.47-3.16), early warning shift (OR = 1.83, 95% CI = 1.36-2.45), and significant threshold shift (OR = 2.15, 95% CI = 1.60-2.89) compared with service members without tinnitus. CONCLUSIONS: The findings of this study demonstrate that tinnitus diagnosed within 2 years after blast injury is associated with the examined hearing outcomes in US military personnel. Service members with blast injury who subsequently experience tinnitus should receive routine audiometric hearing conservation testing and be carefully examined for poor hearing outcomes by an audiologist.

Hearing Health Outcomes as a Function of Age, Gender, and Diversity.

The United States does not ensure equitable access to hearing health care for all age groups, largely because these services are costly and even unobtainable in some places. Barriers to care are discussed within a context of the social determinants of health, under-representativeness of hearing-care professionals from historically marginalized communities, older adults and age-related hearing loss, and associated health conditions. The MarkeTrak 2022 study generated a sample of 15,138 respondents with information on 43,597 individuals. Data analysis revealed that self-reported hearing difficulty appears to increase with age with a rate of 12.4% for adults 18 years of age and older. A substantial proportion of individuals with hearing difficulty assumed that their problem was age-related, followed by exposure to loud sound and noise. Individuals with hearing difficulty were nearly three to four times more likely to have tinnitus, cognitive problems, and issues with balance and falling than those with no hearing problems. Self-reported hearing difficulty was lower for historically marginalized groups (7%) than for the White population (12%). Recommendations are presented to reduce the burden of hearing difficulty and hearing aid deserts for rural and urban populations.

Occupational Noise Exposure and Longitudinal Hearing Changes in Post-9/11 US Military Personnel During an Initial Period of Military Service.

OBJECTIVES: Auditory impairments, particularly those resulting from hazardous occupational noise exposures, are pressing concerns for the US Departments of Defense (DoD) and Veterans Affairs (VA). However, to date, no studies have estimated the rate of hearing threshold change that occurs during service or how changes may vary by military occupation. Hearing threshold changes during military service have historically been reported as the proportion of Service members demonstrating a significant threshold shift. This approach does not capture the rate of the hearing threshold change or the specific audiometric frequencies impacted. Determining the rate of hearing threshold change, and factors that affect the rate of change, is important to elucidate the impact of military service on hearing and to guide prevention strategies and subsequent hearing health care. Our primary objective was to estimate the annual rate of hearing threshold change during military service as a consequence of military occupational noise exposure ranking. DESIGN: We linked audiometric data, collected from military personnel as part of a DoD hearing conservation program, to data describing demographic and military-service characteristics obtained from individuals enrolled in the Noise Outcomes In Service members Epidemiology Study. The analytic cohort included Veterans who enlisted in military service after September 2001 (n = 246). We examined the longitudinal association between military occupations categorized as having a low, moderate, or high noise exposure ranking and pure-tone hearing thresholds (500 to 6000 Hz) using a hierarchical linear model. The average annual rate of hearing threshold change and their 95% confidence intervals were estimated by service branch, military occupational noise exposure ranking, and audiometric test frequency. RESULTS: On average, hearing threshold change ranged between -0.5 and 1.1 dB/year and changes over time varied by service branch, audiometric test frequency, and military occupation noise ranking. Generally, higher test frequencies (3000 to 6000 Hz) and military occupations with moderate or high noise exposure rankings had the greatest average annual rates of hearing threshold change; however, no dose-response relationship was observed. Among Marine Corps personnel, those exposed to occupations with high noise rankings demonstrated the greatest average annual rate of change (1.1 dB/year at 6000 Hz). Army personnel exposed to occupations with moderate noise rankings demonstrated the greatest average annual rate of change (0.6 dB/year at 6000 Hz). CONCLUSIONS: This study (1) demonstrates the unique use of DoD hearing conservation program data, (2) is the first analysis of hearing threshold changes over time using such data, and (3) adds to the limited literature on longitudinal changes in hearing. The difference in hearing threshold changes across military branches is likely indicative of their varying noise exposures, hearing protection device use and enforcement, and surveillance practices. Results suggest Marine Corps and Army personnel are at risk for hearing threshold changes and that, among Army personnel, this is most pronounced among those exposed to moderate levels of occupational noise exposure. Estimates of the rate of hearing threshold change by frequency and factors that impact hearing are useful to inform the DoD's efforts to protect the hearing of their Service members and to the Veterans Affairs's efforts to identify and rehabilitate those most likely to experience hearing threshold change.

The Relationship Between Blast-related Hearing Threshold Shift and Insomnia in U.S. Military Personnel.

INTRODUCTION: Hearing loss and insomnia emerged as preeminent sources of morbidity among military service members and veterans who served in the recent Iraq and Afghanistan conflicts. Significant threshold shift (STS), an early indicator of hearing loss, has not been studied in relation to insomnia. This study's objective was to examine the co-occurrence of STS and insomnia among U.S. military personnel with blast-related injury. MATERIALS AND METHODS: A total of 652 service members who were blast-injured during military operations in Iraq or Afghanistan between 2004 and 2012 were identified from the Blast-Related Auditory Injury Database. Pre- and post-injury audiometric data were used to ascertain new-onset STS, defined as 30 dB or greater increase for the sum of thresholds at 2,000, 3,000, and 4,000 Hz for either ear. Insomnia diagnosed within 2 years post-injury was abstracted from electronic medical records. Multivariable logistic regression analysis examined the relationship between STS and insomnia, while adjusting for age, year of injury, occupation, injury severity, tinnitus and concussion diagnosed in-theater, and PTSD. RESULTS: A majority of the study sample was aged 18-25 years (79.9%) and sustained mild-to-moderate injuries (92.2%). STS was present in 21.1% of service members. Cumulative incidence of diagnosed insomnia was 22.3% and 11.1% for those with and without STS, respectively. After adjusting for covariates, those with STS had nearly 2-times higher odds of insomnia (odds ratio (OR) = 1.91, 95% CI = 1.12-3.24) compared with those without STS. In multivariable modeling, the strongest association was between PTSD and insomnia (OR = 5.57, 95% CI = 3.35-9.26). A secondary finding of note was that military personnel with STS had a significantly higher frequency of PTSD compared with those without STS (28.1% vs. 15.2%). CONCLUSIONS: Hearing threshold shift was associated with insomnia in military personnel with blast-related injury and could be used to identify service members at risk. Multidisciplinary care is needed to manage the co-occurrence of both conditions during the post-deployment rehabilitation phase. Future research should evaluate the specific mechanisms involved in this relationship and further explore the association between hearing threshold shift and PTSD.

Co-occurrence of hearing loss and posttraumatic stress disorder among injured military personnel: a retrospective study.

BACKGROUND: Posttraumatic stress disorder (PTSD) and hearing loss are hallmark public health issues related to military service in Iraq and Afghanistan. Although both are significant individual contributors to disability among veterans, their co-occurrence has not been specifically explored. METHODS: A total of 1179 male U.S. military personnel who sustained an injury between 2004 and 2012 during operations in Iraq or Afghanistan were identified from clinical records. Pre- and postinjury audiometric data were used to define new-onset hearing loss, which was categorized as unilateral or bilateral. Diagnosed PTSD was abstracted from electronic medical records. Logistic regression analysis examined the relationship between hearing loss and PTSD, while adjusting for age, year of injury, occupation, injury severity, injury mechanism, and presence of concussion. RESULTS: The majority of the study sample were aged 18-25 years (79.9%) and sustained mild-moderate injuries (94.6%). New-onset hearing loss was present in 14.4% of casualties (10.3% unilateral, 4.1% bilateral). Rates of diagnosed PTSD were 9.1, 13.9, and 29.2% for those with no hearing loss, unilateral hearing loss, and bilateral hearing loss, respectively. After adjusting for covariates, those with bilateral hearing loss had nearly three-times higher odds of PTSD (odds ratio = 2.92; 95% CI, 1.47-5.81) compared to those with no hearing loss. Unilateral hearing loss was not associated with PTSD. CONCLUSIONS: Both PTSD and hearing loss are frequent consequences of modern warfare that adversely affect the overall health of the military. Bilateral, but not unilateral, hearing loss was associated with a greater burden of PTSD. This has implications for warfighter rehabilitation and should encourage collaboration between audiology and mental health professionals.

Prevalence of Tinnitus and Association with Self-Rated Health among Military Personnel Injured on Combat Deployment.

INTRODUCTION: Tinnitus is an auditory problem frequently reported by military personnel and is currently responsible for 1 billion dollars annually in disability compensation. Recent military conflicts in Iraq and Afghanistan saw high levels of combat exposure coupled with a surge in blast weaponry, both of which can adversely affect hearing. The present study explored the prevalence of tinnitus and the association with self-rated health among military personnel injured during combat deployment. MATERIALS AND METHODS: A total of 1,026 U.S. military personnel who sustained an injury during operations (592 battle blast, 73 battle nonblast, 361 nonbattle) in Iraq were identified from clinical records. Post-Deployment Health Assessments administered at two separate points in time were used to identify self-reported tinnitus symptoms and self-rated health within 1 year of injury. RESULTS: Those with a battle blast injury had the highest prevalence of tinnitus with 19.1% and 31.3% on the first and second health assessments, respectively. In a multivariate model adjusting for combat exposure, concussion, posttraumatic stress disorder, and other covariates, tinnitus was associated with lower self-rated health for both the first (odds ratio [OR] = 3.31, 95% confidence interval [CI] = 2.07-5.30, P < 0.001) and second assessments (OR = 2.52, 95% CI = 1.76-3.61, P < 0.001). CONCLUSIONS: Tinnitus is a common source of impairment among military personnel injured during combat deployment and is associated with poorer self-rated health. Future research should determine whether timing of assessment is linked to symptom recognition or reporting, and what interventions are best suited for ameliorating the negative impact of tinnitus.

Clinical audiometric patterns of hearing loss following blast-related injury in U.S. military personnel.

Objective: To identify clinical audiometric patterns of hearing loss following blast-related injury (BRI) in US military personnel.Design: Retrospective cohort study.Study sample: A total of 1186 male Navy and Marine Corps service members with normal hearing thresholds on pre-injury audiograms who had post-injury audiograms in the Blast-Related Auditory Injury Database.Results: Low- and high-frequency pure-tone averages (PTAs) were significantly higher in those with BRI than non-blast-related injury (NBRI) for both ears (p < 0.001 for all comparisons). Overall, 172 (15%) service members met criteria for post-injury hearing loss and were categorised into PTA or single-frequency hearing loss subgroups. PTA hearing loss was more common in the BRI group (50% vs. 33%, p < 0.036), whereas single-frequency hearing loss was more common in the NBRI group. Most hearing loss was mild to moderate in degree, and three distinct audiometric patterns emerged (i.e. flat, sloping and rising). A flat pattern was the most prevalent configuration among those with PTA hearing loss, especially bilateral loss. Single-frequency hearing loss was mostly unilateral and high frequency.Conclusions: In this study, BRI produced hearing loss across test frequencies, generating more clinically actionable post-injury audiograms than NBRI. We found that post-injury audiometric patterns of hearing loss among military personnel may vary.

Impact of Blast Injury on Hearing in a Screened Male Military Population.

Exposure to hazardous intensity levels of combat noise, such as blast, may compromise a person's ability to detect and recognize sounds and communicate effectively. There is little previous examination of the onset of hearing health outcomes following exposure to blast in representative samples of deployed US military personnel. Data from the prospective Blast-Related Auditory Injury Database were analyzed. We included only those participants with qualified hearing tests within a period of 12 months prior to, and following, injury (n = 1,574). After adjustment for relevant covariates and potential confounders, those who sustained a blast injury had significantly higher odds of postinjury hearing loss (odds ratio = 2.21; 95% confidence interval: 1.42, 3.44), low-frequency hearing loss (odds ratio = 1.95; 95% confidence interval: 1.01, 3.78), high-frequency hearing loss (odds ratio = 2.45; 95% confidence interval: 1.43, 4.20), and significant threshold shift compared with a group with non-blast-related injury. An estimated 49% of risk for hearing loss in these blast-injured, deployed military members could be attributed to the blast-related injury event. This study reinforced that it is imperative to identify at-risk populations for early intervention and prevention, as well as to consistently monitor the effects of blast injury on hearing outcomes.

Development of a comprehensive Blast-Related Auditory Injury Database (BRAID).

The Department of Defense Hearing Conservation Program provides specific guidance for service components to prevent occupational hearing loss; however, it does not specifically contend with the unique noise exposures observed in the theater of war, such as blasts and explosions. In order to examine the effects of blast injury on hearing sensitivity, we developed a large database composed of demographic, audiometric, point of injury, and medical outcome data, with the primary aim of developing a long-standing and integrated capability for the surveillance, assessment, and investigation of blast-related hearing outcomes. Methods used to develop the dataset are described. Encompassing more than 16,500 Navy and Marine Corps personnel, the Blast-Related Auditory Injury Database (BRAID) includes individuals with a blast-related injury and nonblast control subjects. Using baseline and postdeployment hearing threshold data, a retrospective analysis of the cohort revealed that the rate of hearing loss for the injured servicemembers was 39%. The BRAID will be useful for studies that assess hearing patterns following deployment-related injury, such as blast exposures, that facilitate exploration of health outcomes and whether they are predictive of audiometric disposition and that help establish hearing loss prevention strategies and program policies for affected military commands and servicemembers.

Referrals for alcohol use problems in an overseas military environment: description of the client population and reasons for referral.

Being stationed in an overseas installation has been associated with increased risk for alcohol use problems. Okinawa is a unique overseas environment that often challenges service members with separation from family and friends, limited resources and recreational activities, a high rate of deployment, and restrictive local laws. Single, young, male services members in the junior ranks are at increased risk for poor coping, particularly relying on alcohol use. Maladaptive alcohol use places them at increased risk for engaging in illegal behavior and other negative consequences that subsequently lead them to be referred for an evaluation for alcohol use problems. Alcohol use problems negatively affect health, safety, morale, and mission readiness. Findings from this study strongly suggest that prevention and wellness programs should target young service members in the junior ranks for training on responsible alcohol use, alcohol use problems, and basic coping for improved impact on health and mission readiness.