Electronic medical records (EMRs) are the future of primary care. Transition to electronic records can have a significant impact on physicians, office staff, nursing staff and patients. There are no ...published EMR studies combining these four populations or studies that have evaluated the impact of EMR demonstrations. To better understand the impact of EMRs, an online survey was administered before and after EMR demonstrations.
A longitudinal cohort survey design was used to assess primary outcomes (attitudes, knowledge, skills and needs) related to EMRs in four populations that were divided into two groups--one of physicians and the other of nursing staff, office staff and patients. A total of 39 participants (19 physicians and 20 staff/patients) completed a pretest survey four weeks prior to and post-test surveys at four and ten weeks after EMR demonstrations. Mean composite scores for each primary outcome were calculated for each group and mean differences were calculated and compared within and between groups--from baseline to four weeks and four to ten weeks using paired t-tests and Student's t-tests, respectively.
Groups differed in several areas: physicians were younger, had more education and had fewer years of experience in a primary care office. There were no significant differences in gender or computer experience between groups. Staff/patients reported significant improvements in attitudes, knowledge and needs from baseline to four weeks (P<0.05, P<0.01 and P<0.05). Physician attitudes, knowledge and needs significantly increased at week four (P<0.05, P<0.01 and P<0.05). Attitudes, knowledge and needs were sustained in both groups from week four through to week ten.
EMR demonstrations improved attitudes, knowledge and needs of staff/patients and physicians. EMR demonstrations may be effective in favorably influencing healthcare personnel towards EMRs.
Electrical auditory brain stem responses (EABR) and electrical middle latency responses (EMLR) were recorded from patients who had received the Nucleus multichannel cochlear implant system. ...Twenty-five sequential patients had either intraoperative or outpatient EABR testing. We also recorded EMLRs from several outpatients. EABR results were consistent among all patients tested. Wave V mean latencies were the shortest (3.82 msec) for the most apical electrode (E20) and increased slightly for the medial (E12) and basal (E5) electrodes (3.94 and 4.20 msec, respectively). Absolute latencies for all EABR component waves were observed to be 1 to 1.5 msec shorter than typical acoustic auditory brain stem response (ABR) mean latencies. We have examined the relationships between patients' EABR/EMLR and their behavioral responses to electrical stimulation. Generally, the behavioral threshold and comfort current levels were lower than the predicted values based on EABR/EMLR findings. This observation may be due in part to psychophysical loudness differences noted for pulse rates of 10 to 500 pulses per second in some of the patients that we have studied in greater detail.
Consonant production was investigated in 29 children participating in the federal Food and Drug Administration's clinical trials of the Nucleus WSP-III cochlear implant. Speech samples were collected ...preimplant and 1 year postimplant. A significantly greater number of children produced stop, nasal, fricative, and glide consonants postimplant. Voiced stop consonants were used by more children than the voiceless cognates; however, voiceless fricatives were used more than voiced fricatives. Visible places of articulation were used more frequently than less visible places of articulation. Comparisons to Smith's data (J Speech Hear Res 1975;18:795-811) revealed qualitative similarities but postimplant, quantitative differences were observed. Post hoc analyses of the data revealed some sounds were influenced more by an implant than other sounds and suggest the role of an implant upon spontaneous speech is complex.
Results from 80 pediatric subjects with 12 months of experience wearing the Nucleus multichannel cochlear implant are presented. The data suggest that children demonstrate statistically and ...clinically significant benefit across a broad spectrum of abilities with the implant. Significant postoperative improvement was demonstrated by 66 percent (51 of 77), 63 percent (45 of 72), and 46 percent (27 of 59) of subjects tested on suprasegmental (prosodic), closed-set and open-set tests, respectively. Forty-nine percent of subjects tested improved when lipreading was combined with sound from the implant, compared with lipreading alone. Children who were deaf at an early age or who had longer duration deafness tended to demonstrate poorer performance on the more difficult perceptual tasks after 12 months of implant experience. However, preliminary evidence suggests that continued improvements by congenital and prelinguistic subjects over longer periods of time may reduce performance differences between subjects with early and later onset deafness.
Sixty-three postlinguistically deaf adults from four English-speaking countries participated in a 17-week field study of performance with a new speech coding strategy, Spectral Peak (SPEAK), and the ...most widely used strategy, Multipeak (MPEAK), both of which are implemented on wearable speech processors of the Nucleus 22 Channel Cochlear Implant System; MPEAK is a feature-extraction strategy, whereas SPEAK is a filterbank strategy. Subjects' performance was evaluated with an experimental design in which use of each strategy was reversed and replicated (ABAB). Average scores for speech tests presented sound-only at 70 dB SPL were higher with the SPEAK strategy than with the MPEAK strategy. For tests in quiet, mean scores for medial vowels were 74.8 percent versus 70.1 percent; for medial consonants, 68.6 percent versus 56.6 percent; for monosyllabic words, 33.8 percent versus 24.6 percent; and for sentences, 77.5 percent versus 67.4 percent. For tests in noise, mean scores for Four-Choice Spondees at +10 and +5 dB signal-to-noise ratio (S/N) were 88.5 percent versus 73.6 percent and 80.1 percent versus 62.3 percent, respectively; and for sentences at +15 dB, +10, and +5 dB S/N, 66.5 percent versus 43.4 percent, 61.5 percent versus 37.1 percent, and 60.4 percent versus 31.7 percent, respectively. Subjects showed marked improvement in recognition of sentences in noise with the new SPEAK filterbank strategy. These results agree closely with subjects' responses to a questionnaire on which approximately 80 percent reported they heard best with the SPEAK strategy for everyday listening situations.
The purpose of this study is to report on five speech production protocols collected as part of the Food and Drug Administration's Clinical Trials for the Nucleus multichannel cochlear implant. ...Sixty-one children, ranging in age from 2.4 years to 17.8 years, participated. Speech measures included nonsegmental and segmental portions of the Phonetic Level Speech Evaluation, the Phonologic Level Speech Evaluation, speech intelligibility, and an experimental condition examining speech produced with the device turned on versus off. Seventy-seven percent of the children improved on at least one-third of the speech production measures. Significant improvements in the ability to imitate prosodic characteristics were observed for 31.1 percent of the children. Improvements in the ability to imitate speech sounds were found for 66.7 percent of the children. Examination of phonologic skills acquired during spontaneous speaking improved for 55.6 percent of the children. Speech intelligibility improved in 62.9 percent of the children after implantation. More centralized second formant frequencies were observed in vowels produced with the speech processor turned off, as opposed to on, in all 13 of the children tested on this protocol. Data from this study suggest a multichannel cochlear implant may assist many children in developing better speech.
Seven postlinguistically deaf adults implanted with the Nucleus Multi-Electrode Cochlear Implant participated in an evaluation of speech perception performance with three speech processors: the ...Wearable Speech Process (WSP III), a prototype of the Mini Speech Processor, and the Mini Speech Processor. The first experiment was performed with the prototype and Wearable Speech Processor both programmed using the F0F1F2 speech coding strategy. The second experiment compared performance with the Mini Speech Processor programmed with the Multi-Peak speech coding strategy and the Wearable Speech Processor programmed with the F0F1F2 speech coding strategy. Performance was evaluated in the sound-only condition using recorded speech tests presented in quiet and in noise. Questionnaires and informal reports provided information about use in everyday life. In experiment I, there was no significant difference in performance using the Wearable Speech Processor and prototype on any of the tests. Nevertheless, six out of seven subjects preferred the prototype for use in everyday life. In experiment II, performance on open-set tests in quiet and noise was significantly higher with the Mini Speech Processor (Multi-Peak speech coding strategy) than with the Wearable Speech Processor. Subjects reported an increase in their ability to communicate with other people using the Mini Speech Processor (Multi-Peak speech coding strategy) compared with the Wearable Speech Processor in everyday life.
PDF
