Increasing Hearing Readiness Using Boothless Audiometry.

INTRODUCTION: U.S. Army regulations require all soldiers to undergo annual audiometric testing to maintain hearing readiness. The standard method of monitoring hearing in the DoD is via multi-person testing in sound-treated booths using the Defense Occupational and Environmental Health Readiness System-Hearing Conservation. COVID-19 significantly hindered the standard method, resulting in alarming declines in hearing readiness. In response, the Army Hearing Program initiated a pilot program to use boothless audiometers to supplement standard methods to increase hearing readiness. MATERIALS AND METHODS: Funding from the Coronavirus Aid, Relief, and Economic Security Act was used to purchase 169 boothless audiometers and increase staffing at dozens of Army Hearing Program clinics. Standard operating procedures were established for audiometric testing outside the booth using a process matching standard test parameters (i.e., test frequencies, tone characteristics, and interstimulus intervals). Additional capabilities developed to leverage this new technology during the annual hearing exam include the administration of automated contralateral masking, enhanced tinnitus screening, and hearing health education and training. RESULTS: Monitoring audiometry using boothless audiometers has been conducted for nearly 12,000 service members worldwide. Thresholds obtained via boothless audiometers are comparable to follow-up thresholds obtained from the standard test methods in the booth (mean difference 95% CI, -1.2, 0.9), and hearing readiness has returned to pre-pandemic levels at installations where this novel technology is being used regularly. CONCLUSIONS: Significant reductions in patient encounters as a direct result of the COVID-19 pandemic have led to innovative solutions leveraging boothless audiometers. While this has aided the primary mission to maintain a medically ready force, innovations from this endeavor highlight several additional improvements relative to current standards of care that should be considered for permanent inclusion in DoD Hearing Conservation Programs.

Challenges and improvements associated with transitions between hospitals and care homes during the COVID-19 pandemic: a qualitative study with care home and healthcare staff in England.

BACKGROUND: Care home residents transitioning from hospital are at risk of receiving poor-quality care with their safety being challenged by the SARS-CoV-2 virus (COVID-19) pandemic. Little is known about how care home staff worked with hospital staff and other healthcare professionals to address these challenges and make improvements to increase patient safety. OBJECTIVE: To gain insight into how the COVID-19 pandemic influenced the safety of transitions between hospital and care home. METHOD: Semi-structured interviews were conducted with care home staff and healthcare professionals involved in hospital to care home transitions including doctors, nurses, paramedics, pharmacists, social workers, and occupational therapists. Commonalities and patterns in the data were identified using thematic analysis. RESULTS: Seventy participants were interviewed. Three themes were developed, first, 'new challenges', described care homes were pressurised to receive hospital patients amidst issues with COVID-19 testing, changes to working practices and contentious media attention, which all impacted staff negatively. Second, 'dehumanisation' described how care home residents were treated, being isolated from others amounted to feelings of being imprisoned, caused fear and engendered negative reactions from families. Third, 'better ways of working' described how health and social care workers developed relationships that improved integration and confidence and benefited care provision. CONCLUSION: The COVID-19 pandemic contributed to and compounded high-risk hospital-to-care home discharges. Government policy failed to support care homes. Rapid discharge objectives exposed a myriad of infection control issues causing inhumane conditions for care home residents. However, staff involved in transitions continued to provide and improve upon care provision.

Residents transitioning between hospital and care homes: protocol for codesigning a systems-level response to safety issues (SafeST study).

INTRODUCTION: The aim of this study is to develop a better understanding of incident reporting in relation to transitions in care between hospital and care home, and to codesign a systems-level response to safety issues for patients transitioning between hospital and care home. METHODS AND ANALYSIS: Two workstreams (W) will run in parallel. W1 will aim to develop a taxonomy of incident reporting in care homes, underpinned by structured interviews (N=150) with care home representatives, scoping review of care home incident reporting systems, and a review of incident reporting policy related to care homes. The taxonomy will be developed using a standardised approach to taxonomy development. W2 will be structured in three phases (P). P1a will consist of ≤40 interviews with care home staff to develop a better understanding of their specific internal systems for reporting incidents, and P1b will include ≤30 interviews with others involved in transitions between hospital and care home. P1a and P1b will also examine the impact of the SARS-CoV-2 pandemic on safe transitions. P2 will consist of a retrospective documentary analysis of care home data relating to resident transitions, with data size and sampling determined based on data sources identified in P1a. A validated data extraction form will be adapted before use. P3 will consist of four validation and codesign workshops to develop a service specification using National Health Service Improvement's service specification framework, which will then be mapped against existing systems and recommendations produced. Framework analysis informed by the heuristic of systemic risk factors will be the primary mode of analysis, with content analysis used for analysing incident reports. ETHICS AND DISSEMINATION: The study has received university ethical approval and Health Research Authority approval. Findings will be disseminated to commissioners, providers and regulators who will be able to use the codesigned service specification to improve integrated care.

Report on the conference on ageing: maturing at a healthy pace: appreciating the older years, March 31-April 1, 1999, Eric Williams' Medical Sciences Complex, Mt. Hope

The conference organizers, ... had the following as the main conference objectives: (i) the formulation of strategies which would positively influence the main factors impacting on the life of older persons (ii) the dissemination of information about positive ways in which the needs of the elderly are being approached (iii) the creation of a policy on ageing which would embrace a gender-sensitive approach to the delivery of services (Executive Summary)

Report on the conference on ageing: maturing at a healthy pace: appreciating the older years, March 31-April 1, 1999, Eric Williams' Medical Sciences Complex, Mt. Hope

The conference organizers, ... had the following as the main conference objectives: (i) the formulation of strategies which would positively influence the main factors impacting on the life of older persons (ii) the dissemination of information about positive ways in which the needs of the elderly are being approached (iii) the creation of a policy on ageing which would embrace a gender-sensitive approach to the delivery of services (Executive Summary)