Audiology and Speech Pathology - Research Publications
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ItemNo Preview AvailableInterventions to Mitigate Bias in Social Work Decision-Making: A Systematic Review(SAGE Publications, 2019)Purpose: This systematic review synthesized evidence supporting interventions aimed at mitigating cognitive bias associated with the decision-making of social work professionals. Methods: A systematic search was conducted within 10 social services and health-care databases. Review authors independently screened studies in duplicate against prespecified inclusion criteria, and two review authors undertook data extraction and quality assessment. Results: Four relevant studies were identified. Because these studies were too heterogeneous to conduct meta-analyses, results are reported narratively. Three studies focused on diagnostic decisions within mental health and one considered family reunification decisions. Two strategies were reportedly effective in mitigating error: a nomogram tool and a specially designed online training course. One study assessing a consider-the-opposite approach reported no effect on decision outcomes. Conclusions: Cognitive bias can impact the accuracy of clinical reasoning. This review highlights the need for research into cognitive bias mitigation within the context of social work practice decision-making.
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ItemSpeech Detection in Noise for Young Bilaterally Implanted Children: Is There Evidence of Binaural Benefit Over the Shadowed Ear Alone?(LIPPINCOTT WILLIAMS & WILKINS, 2017)OBJECTIVES: To measure binaural benefit over the shadowed ear alone for young bilateral cochlear implant (CI) users. It was hypothesized that children who received bilateral CIs at a young age (<4 years), and had significant bilateral experience, would demonstrate lower detection thresholds for speech sounds in background noise in the bilateral CI over the unilateral CI condition when the added CI was ipsilateral to the noise source. DESIGN: Children receiving bilateral CIs at the Eye and Ear Hospital Clinic in Melbourne were invited to participate in a wider research project evaluating outcomes; those participating in the wider project who were bilaterally implanted by 4 years and were approximately 2 years postoperative were included in the present study. For 20 participants, detection signal to noise ratios (SNRs) were measured for speech presented from in front and noise from 90° in at least 3 of 4 device/noise conditions, namely left CI/noise right and right CI/noise left, plus bilateral CIs/noise right and bilateral CIs/noise left. RESULTS: As some participants could only complete testing in 3 conditions within the 1 test block, the unilateral versus bilateral comparison was performed for 1 CI (i.e., 1 noise direction) for 15 participants and for both CIs (i.e., noise left and noise right) for 5 participants. Group analysis indicated no significant difference in detection SNR between the unilateral and bilateral CI conditions when adding the left CI or right CI (for the overall group) or when adding the first or second CI (for the 15 participants with sequential bilateral CIs). Separate analyses indicated no significant difference in detection SNR between the unilateral and bilateral CI conditions for the majority of individuals; this occurred irrespective of whether the analysis indicated that the CI added in the bilateral condition was poorer-performing, better-performing, or not significantly different compared with the other CI. Four individuals demonstrated a significant improvement in the bilateral condition when the CI added in the bilateral condition was a better-performing (n = 1), poorer-performing (n = 2), or not significantly different CI (n = 1). There was no relationship between the detection SNR difference between each CI and the detection SNR difference between the unilateral and bilateral conditions. CONCLUSIONS: The hypothesis of a lower detection SNR in the bilateral condition was not supported by the group results or by the results for the majority of individuals. For the 4 participants who did demonstrate benefit over the shadowed ear alone, that benefit cannot be separated from the potential benefit gained as a result of the CI added in the bilateral condition being the better-performing CI for 1 of the 4. Variation in outcomes could not be related to demographic factors for this group, which was relatively homogeneous for age at bilateral CI and experience; an older, more experienced group may demonstrate greater binaural benefit in these conditions. These results can be used during counseling for families regarding postoperative expectations for young children, especially in the first 2 years.
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ItemEveryday Listening Performance of Children Before and After Receiving a Second Cochlear Implant: Results Using the Parent Version of the Speech, Spatial, and Qualities of Hearing Scale(LIPPINCOTT WILLIAMS & WILKINS, 2016)OBJECTIVES: To evaluate change in individual children's performance in general areas of everyday listening following sequential bilateral implantation, and to identify the specific types of listening scenarios in which performance change occurred. The first hypothesis was that parent performance ratings for their child would be higher in the bilateral versus unilateral implant condition for each section of the speech, spatial and qualities of hearing scale for parents, viz.: speech perception, spatial hearing, and qualities of hearing. The second hypothesis was that the rating for the participant group would be higher in the bilateral condition for speech perception items involving group conversation or background noise, spatial hearing items, and qualities of hearing items focused on sound segregation or listening effort. DESIGN: Children receiving sequential bilateral implants at the Royal Victorian Eye and Ear Hospital and fulfilling selection criteria (primarily no significant cognitive or developmental delays, and oral English language skills of child and parent sufficient for completing assessments) were invited to participate in a wider project evaluating outcomes. The assessment protocol for older children included the speech, spatial, and qualities of hearing scale for parents. All children (n = 20; ages 4 to 15 years) whose parents completed the scale preoperatively and at 24-months postoperatively were included in this study. Ratings obtained preoperatively in the unilateral implant condition (or unilateral implant plus hearing aid for 4 participants) were compared with those obtained postoperatively in the bilateral implant condition. RESULTS: Bilateral ratings were significantly higher than unilateral ratings on the speech section for 12 children (W ≥ 7.0; p ≤ 0.03), on the spatial section for 13 children (W ≥ 15.0; p ≤ 0.03), and on the qualities of hearing section for 9 children (W ≥ 15.0; p ≤ 0.047). The difference between conditions was unrelated to time between implants or age at bilateral implantation (r ≤ 0.4; p ≥ 0.082). The median bilateral ratings for the participant group were higher for all eight speech perception items, including, as predicted, those involving group conversation and/or background noise (W ≥ 37.5; p ≤ 0.043). Also, as predicted, the median bilateral ratings for the participant group were higher for all six spatial hearing items (W ≥ 88.0; p ≤ 0.014), and for qualities of hearing items related to sound segregation (W ≥ 94.0; p ≤ 0.029), but not for those related to listening effort (W ≤ 92.0; p ≥ 0.112). CONCLUSIONS: Seventy-five percentage of parents perceived change in their child's daily listening performance postoperatively, and 25% perceived change across all three listening areas. For the overall participant group, the parents perceived a change in performance in the majority of specific listening scenarios, although change was limited in the qualities of hearing section, including no change in listening effort. Previous research suggests postoperative change was likely due to the headshadow effect and improved spatial hearing. Additional contributions may have been made by binaural summation, redundancy, and unmasking. For these participants, differences between device conditions may have been limited by their relatively old age at implantation, delay between implants, and limited bilateral experience. These results will provide valuable information to families during preoperative counseling and postoperative discussions about expected progress and evident benefit.
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ItemBilateral cochlear implants in children(Georg Thieme Verlag KG, 2011-02-28)
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ItemPlanned simultaneous bilateral cochlear implant operations: How often do children receive only one implant?(ELSEVIER IRELAND LTD, 2012-03)OBJECTIVE: The aim of this study was to determine the proportion of planned simultaneous cochlear implant operations that do not result in simultaneous cochlear implants on the day of surgery. The frequency with which this occurs has not been reported in the literature, and such information is important for parents' pre-operative decision making. METHODS: A retrospective review was conducted of pediatric cochlear implant operations performed in the period January 2007-July 2010 at the Melbourne Cochlear Implant Clinic. The number of planned simultaneous cochlear implant procedures and the results of these surgeries were catalogued. Reasons for not proceeding with simultaneous cochlear implants as planned were also identified. RESULTS: In the time period examined, there were a total of 50 planned simultaneous cochlear implant operations. Of these planned simultaneous operations, 22% did not result in bilateral cochlear implants on the day of surgery, with all children involved receiving a first-side cochlear implant only. In the majority of cases, the reason for a first-side cochlear implant only was otitis media. CONCLUSION: In the time period examined, a considerable proportion of planned simultaneous cochlear implant operations did not result in simultaneous bilateral implantation on the day of surgery. It is important that the likelihood of this outcome is discussed with families during pre-operative counseling as it may influence their decision making.
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ItemCan adolescents and young adults with prelingual hearing loss benefit from a second, sequential cochlear implant?(TAYLOR & FRANCIS LTD, 2010-05)This study aimed to determine if adolescents/young adults gained additional perceptual benefit from sequential bilateral cochlear implants within 12 months, and to document adaptation to the second implant. Assessments comprised a pediatric version of The Speech, Spatial and Qualities of Hearing Scale (SSQ), anecdotal reports of device use and daily listening, and the Adaptive Spondee Discrimination Test (AdSpon). All nine participants achieved full-time use of, a preference for, and superior daily listening with, bilateral implants. Eight participants were comfortable using the second implant alone, and two achieved similar daily listening with either implant alone. SSQ ratings were higher post-operatively for the majority of participants. AdSpon performance was superior bilaterally for five participants with noise ipsilateral to the first implant, but not contralateral. Unilateral performance with either implant was similar for one participant. A second implant may provide additional benefit up to 19 years of age, even with congenital hearing loss and >16 years between implants. Families and clinicians should understand the aspects of second-implant candidacy and post-operative use that are unique to adolescents/young adults.
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ItemPerformance of Toddlers, Children and Young Adults Using Unilateral or Bilateral Cochlear Implants on a Left versus Right Loudspeaker Identification Task(KARGER, 2011)Thirty-six participants with bilateral cochlear implants aged 1–19 years completed a left versus right loudspeaker identification task. The majority performed at chance in the unilateral condition (n = 24) and significantly above chance in the bilateral condition (n = 28). Cluster analysis identified three groups; one group performed above chance in both conditions and was older at second implant and older at testing, with longer delay between implants. There were no such differences between the group performing at chance in both conditions and the group which scored highly in the bilateral condition only, thus demonstrating a bilateral benefit. Unilateral, but not bilateral, scores were correlated with age at second and at first implant, time between implants, and age at testing. Bilateral benefit was negatively correlated with age at second implant, time between implants and age at testing. Co-linearity made it difficult to isolate the relationships with demographic factors, though age at testing may have had the most influence on unilateral scores. Spatial hearing skills with bilateral implants cannot be predicted for individuals.
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ItemAdapting to bilateral cochlear implants: early post-operative device use by children receiving sequential or simultaneous implants at or before 3.5 years.(Informa UK Limited, 2012-05)OBJECTIVE: To classify adaptation difficulties, or lack thereof, experienced by a clinical population of young bilateral cochlear implant recipients. METHOD: Forty-six of the first 48 children sequentially or simultaneously implanted at ≤3.5 years at the Melbourne Clinic participated. Classification into categories was based on daily use of both implants at 2 months post-switch-on, with follow-up information obtained at 12 months. RESULTS: The 37 Category 1 children wore both implants full time at 2 months, and 35 still did so at 12 months. The two Category 2 children used both implants 4 hours daily at 2 months, but achieved full-time use within 12 months. The five Category 3 children used both implants for ≤1 hour, with only three achieving full-time use within 12 months. The two Category 4 children did not use two implants at 2 months, and one still did not wear both implants at 12 months. There were weak/modest but significant relationships between category and each of time between implants and age at bilateral implantation. DISCUSSION: Ninety-five percent of simultaneously and 70% of sequentially implanted children demonstrated full-time use within 2 months, and nearly all continued to do so at 12 months. Full-time use maximizes opportunities to develop listening skills. Monitoring device use is necessary for all children, especially when significant change occurs. For those experiencing difficulty in adapting, bilateral implant use usually increased over 12 months. Pre-operative counselling must include discussion of possible adaptation difficulties and raise the potential negative influence of age at bilateral implantation and time between implants.
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ItemAdaptation of the speech, spatial, and qualities of hearing scale for use with children, parents, and teachers.(Informa UK Limited, 2013-06)Subjective assessment of hearing ability in everyday life complements more objective forms of evaluation. A broad evaluation of the additional benefit provided to children by a second bilateral cochlear implant required such an assessment. As no paediatric tool provided detailed evaluation of performance in the areas of daily listening in which benefit was likely to be demonstrated, an adult questionnaire was adapted. Items of the Speech, Spatial and Qualities of Hearing Scale (SSQ) focused mainly, although not exclusively, on hearing functions requiring the binaural system. The adapted child, parent, and teacher versions of the SSQ retained the structure of rating listening performance in everyday scenarios across the domains of speech perception, spatial hearing, and other qualities of hearing. Modifications were minimized, although deletion of some items and wording changes were required, and some subdomains could not be included. Observation periods were introduced so that parents and teachers observe performance prior to providing ratings. The suggested minimum age is 11 years for the child version and 5 years for the parent and teacher versions. Instructions indicate interview-style administration in which interpretation of the described listening scenarios can be clarified and use of the ruler-style response format demonstrated. Researchers applying the SSQ for parents have reported higher performance ratings for bilateral over unilateral cochlear implants, particularly in the spatial hearing domain. Further research should provide evidence for the target age range, compare child and parent responses, and evaluate modifications for use with younger children.