Personalised long-term follow-up of cochlear implant patients using remote care, compared with those on the standard care pathway: study protocol for a feasibility randomised controlled trial

Introduction: Many resources are required to provide postoperative care to patients who receive a cochlear implant. The implant service commits to lifetime follow-up. The patient commits to regular adjustment and rehabilitation appointments in the first year and annual follow-up appointments thereafter. Offering remote follow-up may result in more stable hearing, reduced patient travel expense, time and disruption, more empowered patients, greater equality in service delivery and more freedom to optimise the allocation of clinic resources. Methods and analysis: This will be a two-arm feasibility randomised controlled trial (RCT) involving 60 adults using cochlear implants with at least 6 months device experience in a 6-month clinical trial of remote care. This project will design, implement and evaluate a person-centred long-term follow-up pathway for people using cochlear implants offering a triple approach of remote and self-monitoring, self-adjustment of device and a personalised online support tool for home speech recognition testing, information, self-rehabilitation, advice, equipment training and troubleshooting. The main outcome measure is patient activation. Secondary outcomes are stability and quality of hearing, stability of quality of life, clinic resources, patient and clinician experience, and any adverse events associated with remote care. We will examine the acceptability of remote care to service users and clinicians, the willingness of participants to be randomised, and attrition rates. We will estimate numbers required to plan a fully powered RCT. Ethics and dissemination: Ethical approval was received from North West—Greater Manchester South Research Ethics Committee (15/NW/0860) and the University of Southampton Research Governance Office (ERGO 15329). Results: Results will be disseminated in the clinical and scientific communities and also to the patient population via peer-reviewed research publications both online and in print, conference and meeting presentations, posters, newsletter articles, website reports and social media. Trial registration number: ISRCTN14644286; Pre-results

Neuro-electronic technology in medicine and beyond

This dissertation looks at the technology and social issues involved with interfacing electronics directly to the human nervous system, in particular the methods for both reading and stimulating nerves. The development and use of cochlea implants is discussed, and is compared with recent developments in artificial vision. The final sections consider a future for non-medicinal applications of neuro-electronic technology. Social attitudes towards use for both medicinal and non-medicinal purposes are discussed, and the viability of use in the latter case assessed

Improving audio training for Cochlear Implant users

A Cochlear Implant(CI) is an implant that replaces the functionality of the inner ear with an electronic prosthesis. The prosthesis stimulates the auditory nerves within the cochlea so that people with auditory disabilities regain hearing. While the medical process of inserting the implant is relatively straightforward, learning how to use the implant may be difficult. This thesis proposes a digital training platform that can aid with the learning process for CI users and lighten the transition into the audible realm. Providing efficient training tools available at home without assistance from third parties can increase independence for CI users, as it becomes easier to conduct audio training. The results from a questionnaire performed during the thesis with CI users as participants found that participants spent, on average, one hour traveling to and from training centers or audio therapists. Introducing home-based training tools tailored toward post-lingually deafened CI users can help free up patients' time and alleviate the learning process. Therefore, a digital training platform was developed, tailored towards the needs of post-lingually deafened CI users. CI users were involved via questionnaires and semi-structured interviews throughout the development process, and their feedback was gathered to inform the design and increase usability and effectiveness. The participants' feedback and the findings from a literature review based on related research crafted the requirements specification for the proposed digital training platform. Throughout the thesis, the main goal was to create something that could be deployed and maintained, accessible and reachable for those who may use it. Therefore, a cost analysis of different cloud computing services was carried out to find the cheapest deployment options to avoid adding a monetary barrier to entry. Linode Kubernetes Engine (LKE) was an affordable and efficient option. Along with LKE, the efficacy of deployment through single board computers was investigated. The data gathered through performance testing done during the thesis indicates that the current generation of the Raspberry Pi platform could be used to provide a cheap alternative to deployment if the number of expected users is relatively low. However, a side effect of using single-board computers is that it puts the responsibility to provide the availability and reliability requirements on the developer. As a result, you can not rely on the monetary incentives of a cloud provider. Since the availability and reliability requirements of the proposed digital training platform could not be ensured when utilizing single-board computers, the final deployment utilizes LKE and is accessible through: www.lyttetrening.n

A Review of Current Pediatric Tele-Audiology eHealth Platforms

Purpose: The purpose of this study was to identify current pediatric tele-audiology hearing technology platforms for young children with hearing loss and their families. Method: An exploratory, descriptive design was used to evaluate features of available pediatric tele-audiology platforms for parents and audiologists to implement for young children. The study explored internet resources including hearing industry websites, for information related to specific eHealth platform features designed to support pediatric hearing devices currently available to audiologists and families. Results: Of the websites reviewed, only four major technology companies were found to have pediatric tele-audiology ready platforms designed to support young children and their families. Conclusions: Tele-audiology technology platforms for young children are available but limited in comparison to what may be available to older children and adults. A need for more consistency across platforms was identified based on the inconsistent features observed in the available platforms that could be hinderance to pediatric recipients of tele-audiology services. Future research directions to move eHealth applications forward and determine efficacy are discussed

Have cochlear implant, won’t have to travel: introducing telemedicine to people using cochlear implants

Purpose: This paper describes a planned project to design, implement, and evaluate remote care for adults using cochlear implants and compare their outcomes with those following the standard care pathway.Method: Sixty people with cochlear implants will be recruited and randomized to either the remote care group or a control group. The remote care group will use new tools for 6 months: remote and self-monitoring, self-adjustment of device, and a personalized online support tool. The main outcome measure is patient empowerment, with secondary outcomes of hearing and quality of life stability, patient and clinician preference, and use of clinic resources.Conclusion: The clinical trial ends in summer 2016. Remote care may offer a viable method of follow-up for some adults with cochlear implants

Focal Spot, Spring 2002

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