Bone Conduction Stimulated VEMP Using the B250 Transducer

Objective: Bone conduction (BC) stimulation is rarely used for clinical testing of vestibular evoked myogenic potentials (VEMPs) due to the limitations of conventional stimulation alternatives. The aim of this study is to compare VEMP using the new B250 transducer with the Minishaker and air conduction (AC) stimulation.Methods: Thirty normal subjects between 20 and 37 years old and equal gender distribution were recruited, 15 for ocular VEMP and 15 for cervical VEMP. Four stimulation conditions were compared: B250 on the mastoid (FM); Minishaker and B250 on the forehead (FZ); and AC stimulation using an insert earphone.Results: It was found that B250 at FM required a statistically significant lower hearing level than with AC stimulation, in average 41 dB and 35 dB lower for ocular VEMP and cervical VEMP, respectively, but gave longer n10 (1.1 ms) and n23 (1.6 ms). No statistical difference was found between B250 at FM and Minishaker at FZ.Conclusion: VEMP stimulated with B250 at FM gave similar response as the Minishaker at FZ and for a much lower hearing level than AC stimulation using insert earphones

Long-term follow-up and review of the Bone Conduction Implant

Active transcutaneous bone conduction devices are a type of bone conduction device developed to keep the skin intact and provide direct bone conduction stimulation. The Bone Conduction Implant (BCI) is such a device and has been implanted in 16 patients. The objective of this paper is to give a broad overview of the BCI development to the final results of 13 patients at 5-year follow-up. Follow-up of these patients included audiological performance investigations, questionnaires, as well as safety evaluation and objective functionality testing of the device. Among those audiological measure-ments were sound field warble tone thresholds, speech recognition threshold (SRT), speech recognition score (SRS) and signal to noise ratio threshold (SNR-threshold).The accumulated implant time for all 16 patients was 113 years in February 2022. During this time, no serious adverse events have occurred. The functional improvement for the 13 patients reported in this paper was on average 29.5 dB (average over 0.5, 1, 2 and 4 kHz), while the corresponding effective gain was-12.4 dB. The SRT improvement was 24.5 dB and the SRS improvement was 38.1%, while the aided SNR-threshold was on average -6.4 dB.It was found that the BCI can give effective and safe hearing rehabilitation for patients with conduc-tive and mild-to-moderate mixed hearing loss

Three-Year Follow-Up with the Bone Conduction Implant

Background: The bone conduction implant (BCI) is an active transcutaneous bone conduction device where the transducer has direct contact to the bone, and the skin is intact. Sixteen patients have been implanted with the BCI with a planned follow-up of 5 years. This study reports on hearing, quality of life, and objective measures up to 36 months of follow-up in 10 patients. Method: Repeated measures were performed at fitting and after 1, 3, 6, 12, and 36 months including sound field warble tone thresholds, speech recognition thresholds in quiet, speech recognition score in noise, and speech-to-noise thresholds for 50% correct words with adaptive noise. Three quality of life questionnaires were used to capture the benefit from the intervention, appreciation from different listening situations, and the ability to interact with other people when using the BCI. The results were compared to the unaided situation and a Ponto Pro Power on a soft band. The implant functionality was measured by nasal sound pressure, and the retention force from the audio processor against the skin was measured using a specially designed audio processor and a force gauge. Results: Audiometry and quality of life questionnaires using the BCI or the Ponto Pro Power on a soft band were significantly improved compared to the unaided situation and the results were statistically supported. There was generally no significant difference between the two devices. The nasal sound pressure remained stable over the study period and the force on the skin from the audio processor was 0.71 \ub1 0.22 N (mean \ub1 1 SD). Conclusion: The BCI improves the hearing ability for tones and speech perception in quiet and in noise for the indicated patients. The results are stable over a 3-year period, and the patients subjectively report a beneficial experience from using the BCI. The transducer performance and contact to the bone is unchanged over time, and the skin area under the audio processor remains without complications during the 3-year follow-up

The bone conduction implant - a review and 1-year follow-up

Objective: The objective of this study is to evaluate its safety and effectiveness of the bone conduction implant (BCI) having an implanted transducer and to review similar bone conduction devices. Design: This is a consecutive prospective case series study where the patients were evaluated after 1, 3, 6 and 12 months. Outcome measures were focussed on intraoperative and postoperative safety, the effectiveness of the device in terms of audiological performance and patient\u27s experience. Study sample: Sixteen patients with average age of 40.2 (range 18-74) years have been included. Thirteen patients were operated in Gothenburg and three in Stockholm. Results: It was found that the procedure for installing the BCI is safe and the transmission condition was stable over the follow-up time. No serious adverse events or severe adverse device effects occurred. The hearing sensitivity, speech in noise and the self-assessment as compared with the unaided condition improved significantly with the BCI. These patients also performed similar or better than with a conventional bone conduction reference device on a softband. Conclusions: In summary, it was found that the BCI can provide a safe and effective hearing rehabilitation alternative for patients with mild-to-moderate conductive or mixed hearing impairments

A novel method for objective in-situ measurement of audibility in bone conduction hearing devices–a pilot study using a skin drive BCD

Objective: Objective measurement of audibility (verification) using bone conduction devices (BCDs) has long remained an elusive problem for BCDs. For air conduction hearing aids there are well-defined and often used objective methods, and the aim of this study is to develop an objective method for BCDs. Design: In a novel setup for audibility measurements of bone-anchored hearing aid (BAHA) attached via a soft band, we used a skin microphone (SM) on the forehead measuring in-situ sound field thresholds, maximum power output (MPO) and international speech test signal (ISTS) responses. Study sample: Five normal-hearing persons. Result: Using the electrical output of SM it was possible to objectively measure the audibility of a skin drive BCD, presented as an eSPL-o-gram showing thresholds, MPO and ISTS response. Normalised eSPL-o-gram was verified against corresponding FL-o-grams (corresponding force levels from skull simulator and artificial mastoid (AM)). Conclusion: The proposed method with the SM can be used for objective measurements of the audibility of any BCDs based on thresholds, MPO and speech response allowing for direct comparisons of hearing and BCD output on the same graph using an eSPL-o-gram. After normalisation to hearing thresholds, the audibility can be assessed without the need for complicated calibration procedures

Närståendestöd och efterlevandestöd – under och efter vårdtid inom specialiserad Palliativ vård och ASIH i Skåne

Bakgrund: En av hörnstenarna i palliativ vård handlar om att ge stöd till alla närstående. Enligt lagstiftning har sjukvården även en skyldighet att speciellt beakta barns behov av information, råd och stöd om barnets föräldrar eller någon annan vuxen som barnet varaktigt bor tillsammans med har en livshotande sjukdom eller avlidit.Syfte: Alla närstående inom Palliativ vård och ASIH i Skåne ska erbjudas personcentrerad och jämlikt stöd under och efter vårdtiden.Metod: Uppdraget startades 2019 och beräknas vara klar under hösten 2022. All personal inom palliativ vård och ASIH i Skåne involverades genom att de fick göra nulägesanalys gällande närståendestöd. I nästa steg utfördes gapanalys för att identifiera likhet och olikhet kring närståendestöd. Vidare fick all personal ge förslag till att forma framtidens närståendestöd. Efter nulägesanalys och gapanalys bildades en multiprofessionell arbetsgrupp med representanter från alla verksamheterna i Skåne. Arbetsgruppens uppdrag var att framställa beslutsunderlag gällande närståendestöd under vårdtid och efterlevandestöd till närstående efter vårdtiden. Resultat: Nulägesanalys som utfördes 2019 visade att närstående med liknande behov har erbjudits olika professionella stöd. Gapanalys utfördes under 2020 för kartläggning av vilka former av stöd saknades/önskades samt var relevanta i nu tiden. Under 2021 arbetet har fortsatt med att definiera vad närståendestöd innefattar och under 2022 har arbete pågått med att ta fram beslutsunderlag för hur och vilka former av närståendestöd som ska erbjudas.Betydelse: Genom strukturerad arbetssätt identifiera närståendes förutsättningar, behov och önskemål ökar sannolikheten för att närstående erbjuds rätt stöd, i rätt tid och av rätt profession

Self assessment from one versus two hearing aids

Syfte Syftet med studien var att undersöka med frågeformulär om det finns någon skillnad i nytta i olika vardagssituationer för personer med sensorineural hörselnedsättning med hörapparat utprovad till ett öra respektive båda öronen. Material och Metod Deltagargruppen bestod av 71 personer. Metoden var en experimentell, randomiserad kontrollerad studie, med crossover för intern kontroll. Efter varje interventionsperiod skattade deltagarna nyttan utifrån frågeformulär. I studien definieras nyttan med hörapparat utifrån upplevelse i olika vardagssituationer. För att få svar på frågeställningen valdes frågeformulären SSQ och IOI-HA. I studien har även användarbok används. Resultat Med frågeformuläret SSQ skattade sig deltagarna signifikant bättre med två hörapparater jämfört med en när det gäller rumsuppfattning och riktningshörande samt när det gäller ett allmänt bättre hörande i mer bullriga miljöer. Med frågeformuläret IOI-HA finns ingen signifikant skillnad i deltagarnas skattning mellan en och två hörapparater. I användarboken skattar sig deltagarna överlag högre med två hörapparater än med en i upplevelse av hörandet och tillfredsställelse. Konklusion Två hörapparater visar på ett bättre resultat vid taluppfattning och rumsuppfattning samt ger en större tillfredsställelse än en hörapparat.Inge

Knowledge In The Decision-Making Process For Sustainable Renovation Of Multifamily Houses

Bakgrund: Renovering av flerfamiljshus är en utmanande process med flera krav från intressenter såsom hyresgäster, fastighetsägare, byggherrar, arkitekter och samhälle måste samordna. Som en del av större projekt som syftar till att utveckla en kravdriven modell för att stödja beslut om hållbar renovering av flerfamiljshus, är vårt fokus att analysera krav på kunskapsdelning hela renoveringsprocessen. Nya krav på grund av en förändring från nyproduktion till underhåll och specialiserade tjänster kräver ny kunskap, nya sätt att samarbete och förbättrad kunskapsdelning. Mål: Syftet är att studera hur och vem som kräver samarbete och kunskapsutbyte under renoveringsprocessen. Grunden för beslut inom en renoveringsprojekt riktar forskningsfrågor kring kriterier för val av fastighet att renovera, dokumentation av renoveringsbeslut och kunskapsutbyte i renoveringsprocessen - internt, externt och mellan projekt. Metod: I denna fältstudie har intervjuer med representanter från fastighetsbolag genomförts för att undersöka kriterier för att välja ut fastigheter för renovering och grunden för renoveringsbeslut. Genomförandekunskaper i beslutsprocessen analyseras också. Pågående renoveringsprocesser och motivation och incitament för kunskapsutbyte inom ett projekt mellan aktörer, från projekt till projekt inom ett fastighetsbolag och mellan fastighetsbolag analyseras. Resultat: Underlag för renoveringsbeslut varierar från okulär besiktning till användning av kalkylblad och avkastningsberäkningar. Även om behovet av kunskapsdelning nämns som mycket viktigt finns det brister i incitament för utveckling av strukturerade processer för kunskapsdelningBackground: Renovation of multifamily houses is a challenging process as a large number of requirements from stakeholders such as tenants, property owners, building contractors, architects and society has to be coordinated. As part of larger project aiming to develop a requirement driven model to support decisions for sustainable renovation of multifamily houses, our focus is on analysing requirements for knowledge sharing throughout the renovation process. New requirements due to a change from new production to maintenance and specialised services require new knowledge, new ways of collaboration and improved knowledge sharing. Objectives: The purpose is to study how and who requires cooperation and knowledge sharing during the renovation process. The basis for decisions within a renovation project is addressed research questions around Criteria for choice of which property to renovate, the Documentation of renovation decisions and Knowledge sharing in the renovation process – internally, externally and between projects. Methodology: This field study has used interviews with representatives from property companies to investigate criteria for choosing which properties to renovate and the basis for renovation decisions. The knowledge implementation in the decision-making process is also analysed. On-going renovation processes and motivation and incentives for knowledge sharing within a project between stakeholders, from project to project within a property company and between property companies are analysed. Results: Basis for renovation decisions varies from ocular inspection to intense use of spreadsheets and yield calculations. Though an outspoken need for knowledge sharing, neither incentives nor developed and structured processes for knowledge sharin

Palliativ vård : En litteraturöversikt av sjuksköterskors perspektiv

Background: It is part of nurses' professional role to meet patients and relatives in palliative care. Palliative care aims to relieve suffering before death, due to illness, injury or natural aging. Despite the importance of palliative care, patients and relatives describe in previous research that nurses saw them only as a disease and not as unique people. Patients and relatives value communication and support with a focus on existential needs, which means a great responsibility for nurses. Aim: To create an overview of palliative care from nurses' perspectives. Method: A literature review. A total of 12 caring science articles were included which were analyzed and summarized. Results: Nurses believed that communication is important to create trusting relationships with patients and relatives in palliative care. However, some nurses expressed that it is difficult and therefore avoided communicating. Many nurses state that they lack preparation and training for palliative care in basic education. Conclusion: Palliative care should be designed based on patients' individual needs, but in order for nurses to be able to fulfill individualized care, conditions such as time and resources are needed. Communication is also an important part of palliative care, where the conversation is important for both comfort and support. Keywords: Communication, Experience, Literature review, Nurses, Palliative car