Reducing day 3 baseline monitoring bloodwork and ultrasound for patients undergoing timed intercourse and intrauterine insemination treatment cycles

Abstract Background In the current context of a global pandemic it is imperative for fertility clinics to consider the necessity of individual tests and eliminate those that have limited utility and may impose unnecessary risk of exposure. The purpose of this study was to implement and evaluate a multi-modal quality improvement (QI) strategy to promote resource stewardship by reducing routine day 3 (d3) bloodwork and transvaginal ultrasound (TVUS) for patients undergoing intrauterine insemination (IUI) and timed intercourse (IC) treatment cycles. Methods After literature review, clinic stakeholders at an academic fertility centre met to discuss d3 testing utility and factors contributing to d3 bloodwork/TVUS in IC/IUI treatment cycles. Consensus was reached that it was unnecessary in patients taking oral/no medications. The primary intervention changed the default setting on the electronic order set to exclude d3 testing for IC/IUI cycles with oral/no medications. Exceptions required active test selection. Protocols were updated and education sessions were held. The main outcome measure was the proportion of cycles receiving d3 bloodwork/TVUS during the 8-week post-intervention period compared with the 8-week pre-intervention period. Balancing measures included provider satisfaction, pregnancy rates, and incidence of cycle cancellation. Results A significant reduction in the proportion of cycles receiving d3 TVUS (57.2% vs 20.8%, p < 0.001) and ≥ 1 blood test (58.6% vs 22.8%, p < 0.001) was observed post-intervention. There was no significant difference in cycle cancellation or pregnancy rates pre- and post-intervention (p = 0.86). Treatment with medications, cyst history, prescribing physician, and treatment centre were associated with receiving d3 bloodwork/TVUS. 74% of providers were satisfied with the intervention. Conclusion A significant reduction in IC/IUI treatment cycles that received d3 bloodwork/TVUS was achieved without measured negative treatment impacts. During a pandemic, eliminating routine d3 bloodwork/TVUS represents a safe way to reduce monitoring appointments and exposure.

Download Full-text

Improving Care Delivery for Young Adults With Type 1 Diabetes via a Multi-Faceted Quality Improvement Interdisciplinary Intervention

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.938 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A459-A460

Author(s):

Alvita Justine Chan ◽

Stephanie Gomer ◽

Eleni V Dimaraki ◽

Lorraine Lucille Lipscombe ◽

Geetha Mukerji

Keyword(s):

Type 1 Diabetes ◽

Care Delivery ◽

Severe Hypoglycemia ◽

Intervention Period ◽

Post Intervention ◽

Virtual Care ◽

Significant Difference ◽

Ed Visits

Abstract Background: The transition from pediatric to adult type 1 diabetes (TID) care represents a vulnerable period for young adults (YA), and many are eventually lost to follow up. This can result in lost opportunities for patient education, worsened glycemic control and increased rates of acute diabetes complications. To address this, a multi-faceted quality improvement (QI) intervention was implemented at a YA T1D program with the goal of improving patient attendance and care delivery amongst YA with T1D. Methods: The intervention consisted of three main components: a transitional navigator, an interdisciplinary diabetes assessment flowsheet and virtual care via phone or video conference. These components were implemented at the YA T1D program using a stepwise approach beginning in 2019. The attendance of all patients seen between January 2017 and August 2020 were tracked monthly on a run chart to identify any shifts after each component was implemented. A pre-post analysis was also performed in new patients with a minimum follow up period of 12 months to compare secondary outcomes including A1c reduction at 12 months, incidence of diabetes-related ED visits/hospitalizations, incidence of severe hypoglycemia and psychosocial counselling rates. Results: A total of 2240 scheduled appointments was included in the primary analysis. Patient attendance improved from 59% to 79% (p<0.01) with virtual care, demonstrated by a shift in attendance sustained over 6 months after its implementation. Virtual care was utilized in 81.3% of appointments in the post-intervention period. Subgroup analysis showed the improvement in attendance was significant in follow up appointments (80% vs 59%, p<0.01), but there was no difference in attendance for initial consultations (67% vs 58%, p=0.45). Forty-two patients were included in the pre-post analysis (n=27 in the pre-intervention and n=15 in the post-intervention period). There were with no significant difference in baseline characteristics of the two groups. Mean patient age was 20.2±2.9 years. Males comprised of 28.5% of the study population. Mean duration of diabetes was 11.1±5.3 years, and baseline average A1c was 8.6±1.7%. Preliminary analysis demonstrated there was significant improvement in preconception counselling rate (76% vs 100%, p=0.048) following the intervention. There was no significant difference in A1c reduction at 12 months, incidence of diabetes-related ED visits/hospitalizations or incidence of severe hypoglycemia. Conclusion: Virtual care was effective in improving attendance for follow up appointments at a YA T1D clinic. Further data analysis for patients assessed in September to December 2020 is currently underway.

Download Full-text

Effectiveness of Letrozole and Human Chorionic Gonadotropin Injection in Ovulation Induction: A Cohort Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/45786.15138 ◽

2021 ◽

Author(s):

Peter Chukwudi Udealor ◽

Eric Ezenwa Asimadu ◽

Emeka Iloghalu

Keyword(s):

Cohort Study ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Ovulation Induction ◽

Intrauterine Insemination ◽

Statistical Significance ◽

Pregnancy Rates ◽

Significant Difference ◽

Ovulation Stimulation ◽

Group A

Introduction: Ovulation stimulation followed by timed intercourse or Intrauterine Insemination (IUI) is widely used for treatment of anovulatory infertility. Aim: To compare the effectiveness of Letrozole (LE) alone versus LE and human chorionic gonadotropin injection in ovulation induction and pregnancy rates in women undergoing ovulation induction/follicular tracking in Enugu, Nigeria. Materials and Methods: The longitudinal cohort study was carried out in University of Nigeria Teaching Hospital and Livingston Specialist Gynaecological Hospital in Enugu, Nigeria. Study population were women coming for ovulation stimulation/follicular tracking. Ovulation was confirmed by ultrasound evidence of ovulation with a progesterone level of greater or equal to 25 nmol/L on day 21, positive pregnancy test/ultrasound detection of a gestational sac. Patients were consecutively assigned to group A or B. Group A received LE only for the induction while group B received 10000 IU of human chorionic gonadotropin injection in addition to LE. A total of 5 mg of LE was given daily from day 3 to day 7. The primary outcome measured was the number of ruptured/crenated follicles on either arm while the secondary outcomes were the number of Luteinised Unruptured Follicles (LUF) and pregnancy rates. The Statistical analysis was performed using the Statistical Package for the Social Sciences version 21.0 software (SPSS Inc., Chicago, IL, United States). Results: A total of 50 women were in each arm of the study. There was no significant difference in age and parity between the two arms. There was no significance difference between the period of infertility and the number of the previous cycles of ovulation stimulation. (p=0.444 and 0.526, respectively). Ovulation was significantly associated with HCG injection (p=0.001). However, there was no statistical significance between both arms regarding the number of LUF (p=0.216). HCG injection was significantly associated with pregnancy. Subjects who took HCG injection were over two times more likely to become pregnant than those without HCG injection (OR=2.488, 95% CI for OR=1.057-5.857, p=0.037). Conclusion: This study showed that both the ovulation rate and pregnancy rate are significantly improved when human chorionic gonadotrophin injection is given after ovarian stimulation.

Download Full-text

93. A Diagnostic Stewardship Intervention to Improve Utilization of 1,3-β-D-glucan Testing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.138 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S62-S62

Author(s):

Jonathan A Kendall ◽

Jordan Colson ◽

Lyla Saeed ◽

Masako Mizusawa ◽

Takeru Yamamoto

Keyword(s):

Fungal Infections ◽

Medical Center ◽

Laboratory Data ◽

Intervention Period ◽

Candida Spp ◽

Post Intervention ◽

Significant Difference ◽

Test Order ◽

Group 2 ◽

Group 1

Abstract Background 1,3-β-D-glucan (BDG) is a cell wall component of fungi such as Aspergillus spp., Candida spp., and Pneumocystis jirovecii. BDG assay is used as a screening test to aid early diagnosis of invasive fungal infections (IFI) that are associated with significant morbidity and mortality in immunocompromised patients. The diagnostic performance varies depending on IFI risks among study populations, thus it is important to appropriately select patients with risk factors for IFI to optimize utilization of the BDG test. Figure 1. Figure 2. Methods An intervention to improve BDG test utilization was initiated at Truman Medical Center on November 28, 2018. The BDG test order was replaced by a BDG test request. The request was sent to the inbox of an on-call pathology team. Patient information was reviewed and the on-call pathology team called the ordering physician to discuss the case based on the approval algorithm chart. The criteria for BDG test approval were 1) immunocompromised or ICU patient, and 2) on empiric antifungal therapy, or inability to perform specific diagnostic tests such as bronchoscopy. If approved, a BDG test order was immediately processed. Retrospective chart review was conducted for 1 year pre- and post- intervention to obtain demographic, clinical, and laboratory data for 4 patient groups. Group 1 included patients who had BDG tests during pre-intervention period. Group 2 was composed of all patients who had BDG test requests during post-intervention period. Group 2a and 2b were the post-intervention patients with approved and rejected BDG test requests, respectively. Figure 3. Results The number of BDG tests performed per year decreased from 156 pre-intervention to 24 post-intervention. The number of test requests was 65 and 41 of them were rejected which led to $7,380 direct cost savings. There was no significant difference in age or the proportion of immunocompromised and ICU patients between Group 1 and 2. The test positivity rate was significantly higher in Group 2-a compared to Group 1 (45.8 % vs. 25.3%, p=0.038). There was no delay in IFI diagnosis or IFI-related mortality in patients for whom BDG test requests were rejected. Conclusion We successfully and safely implemented a diagnostic stewardship intervention for BDG testing and improved test utilization. Disclosures All Authors: No reported disclosures

Download Full-text

Reducing inappropriate empiric vancomycin use in neutropenic fever.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.290 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 290-290

Author(s):

Nina Kim ◽

Jessica Caro ◽

Samantha Jacobs ◽

Meenakshi Rana ◽

Cardinale B. Smith

Keyword(s):

Patient Outcomes ◽

Nurse Practitioners ◽

Neutropenic Fever ◽

High Morbidity ◽

Evidence Based ◽

Intervention Period ◽

Post Intervention ◽

Inappropriate Use ◽

Significant Difference ◽

The Impact

290 Background: Neutropenic fever is an oncologic emergency associated with high morbidity and mortality, requiring prompt antibiotic initiation. National infectious disease and oncology guidelines do not recommend vancomycin for standard empiric therapy, unless used for certain evidence-based indications. At our institution, we observed inappropriate use of vancomycin for neutropenic fever and implemented an intervention to educate providers regarding appropriate indications. Methods: We conducted a series of educational sessions focused on the evidence-based indications for vancomycin use in neutropenic fever with residents, nurse practitioners, fellows, and attending physicians. We also displayed educational posters in work rooms and patient units. We conducted a retrospective chart review to assess the impact on vancomycin prescribing practices and patient outcomes pre-intervention (9/1/17 - 2/28/18) and post-intervention (3/1/18 - 5/24/18). We used descriptive statistics and chi-square tests to assess differences. Results: Vancomycin was frequently prescribed without an appropriate indication in the pre-intervention period. Both the overall use and the inappropriate use of vancomycin decreased significantly in the post-intervention period (Table 1). There was no significant difference in mean duration of fever (2.7 vs 2.1 days, p = 0.06) or length of stay (30 vs 34 days, p = 0.58) between the pre- and post-intervention groups, respectively, despite the reduction in vancomycin use. Conclusions: Multidisciplinary educational sessions reduced unnecessary vancomycin use as empiric treatment for neutropenic fever without adverse patient outcomes. This is a low resource intervention that can be applied to other healthcare settings. Future work will evaluate the effect on cost.[Table: see text]

Download Full-text

81. Physicians’ Knowledge, Attitude, and Practice regarding Prolonged Antimicrobial Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.126 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S58-S58

Author(s):

Da Young Kim ◽

Dahye kim ◽

Eunjeong Heo ◽

Hyung-sook kim ◽

Ji Young Park ◽

...

Keyword(s):

Antibiotic Treatment ◽

Neonatal Intensive Care ◽

Organizational Factors ◽

Prolonged Treatment ◽

Intervention Period ◽

Post Intervention ◽

Post Intervention Period ◽

Significant Difference ◽

Knowledge And Practice

Abstract Background To reduce unnecessary long-term antibiotic therapies, pharmacist-led intervention followed by the involvement of infectious diseases (ID) specialist was implemented. In addition, a survey for the prescribers was conducted to find the gaps for improvement. Methods The “less is better” intervention was implemented between August 1, 2018 and February 28, 2019, which was focused on those to whom antibiotics had been administered for over 15 days. However, the following patients were excluded: patients having hematologic diseases, patients in the neonatal intensive care units, and patients who were recommended to maintain antibiotics by ID specialist. Treatment duration according to the indications was compared between pre-intervention period (Aug to Sep 2017) and post-intervention period. A questionnaire based on clinical vignettes was distributed among 140 prescribers. Results Among 500 prescriptions assessed as a prolonged treatment, 475 (95%) were stopped after intervention. Over the pre- and post-intervention period, pneumonia was the most common indication of prolonged antibiotic use (43.8 versus 43.0%). The treatment durations decreased from 21.0 (interquartile range [IQR], 27.3-18.0) days pre-intervention to 16.0 (IQR, 20.0-15.0) days post-intervention (p=0.000). The survey response rate was 76.4% (107/140). Regarding community-acquired pneumonia, there was a significant difference between knowledge and practice, showing that 53% were aware of the standard duration, but 72% actually prescribed for a longer duration. There was a similar trend for the treatment of urinary tract infection (30% versus 83%, p=0.024). The reasons why the physicians prescribed antibiotics of a prolonged duration in spite of adequate knowledge were not only the lack of symptom alleviation in patients but also organizational factors. Conclusion The duration of long-term antibiotic treatment was shortened by active participation of pharmacist as well as ID specialists. However, gaps between the knowledge and practice on the duration of antibiotic treatment were also found. Therefore, it is necessary to implement appropriate feedback and education based on clinical scenario in order to improve the physicians’ antibiotic prescription. Disclosures All Authors: No reported disclosures

Download Full-text

Letrozole versus Clomiphene Citrate for Induction of Ovulation in Patients with Polycystic Ovarian Syndrome Undergoing Intrauterine Insemination

Clinical Medicine Insights Reproductive Health ◽

10.4137/cmrh.s6598 ◽

2011 ◽

Vol 5 ◽

pp. CMRH.S6598 ◽

Cited By ~ 3

Author(s):

Sherif F. Hendawy ◽

Hanan E. Samaha ◽

Mohamed F. Elkholy

Keyword(s):

Polycystic Ovary ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Transvaginal Ultrasound ◽

Clomiphene Citrate ◽

Randomized Study ◽

Multiple Pregnancy ◽

Reproductive Age ◽

Induction Of Ovulation ◽

Significant Difference

Background Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting women in the reproductive age group, and is one of the most common causes of hyperandrogenic anovulatory infertility. The aromatase inhibitor, letrozole, has been used for induction of ovulation. The purpose of this study was to compare the effects of letrozole and clomiphene citrate in induction of ovulation among patients with PCOS undergoing intrauterine insemination. Methods In a double-blind randomized study, 60 infertile patients with PCOS received standard doses of either clomiphene citrate or letrozole as an induction protocol prior to intrauterine insemination. A hormonal profile, pelvic ultrasound, hysterosalpingogram, and/ or laparoscopy were done for all patients. The patients were monitored for ovulation by translational ultrasonographic folliculometry, with measurement of number and size of the follicles, as well as endometrial thickness. Human chorionic gonadotrophin (HCG) was injected intramuscularly when at least one mature follicle > 18 mm diameter was detected, and intrauterine insemination was performed 32-36 hours later. Transvaginal ultrasound and β-HCG measurement were performed for confirmation of pregnancy. Results Letrozole and clomiphene citrate achieved follicle maturation within a mean ± standard deviation (SD) of 13.2 ± 1.53 and 14.1 ± 1.35 days, respectively, showing no significant difference (P > 0.05). The mean number of follicles reaching >18 mm on the day of HCG administration was significantly higher in patients who received clomiphene citrate (2.9 ± 1.77) than in those receiving letrozole (1.2 ± 0.9). Letrozole had a significantly greater effect than clomiphene citrate on endometrial thickness (9.16 ± 1.36 versus 4.46 ± 1.71). The number of pregnancies achieved in the letrozole group was significantly (P < 0.05) greater than in the clomiphene group. Conclusion Letrozole in patients with PCOS is as effective as clomiphene citrate in inducing ovulation, and although the number of follicles produced by induction with letrozole were less than those produced by clomiphene, letrozole had a significantly greater effect on endometrial thickness than clomiphene citrate, and the incidence of pregnancy after intrauterine insemination was significantly higher, with a lower incidence of multiple pregnancy.

Download Full-text

Lavender Aromatherapy to Reduce Anxiety During Intrauterine Insemination: A Randomized Controlled Trial

Global Advances in Health and Medicine ◽

10.1177/21649561211059074 ◽

2021 ◽

Vol 10 ◽

pp. 216495612110590

Author(s):

Tiffanny Jones ◽

MacKenzie Purdy ◽

Elizabeth A. Stewart ◽

Susanne M. Cutshall ◽

Matthew A. Hathcock ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Patient Satisfaction ◽

Intrauterine Insemination ◽

Controlled Trial ◽

Pregnancy Rates ◽

Public Health Issue ◽

Global Public Health ◽

Randomized Controlled ◽

Fertility Treatments ◽

Significant Difference

Background Infertility is a global public health issue. Therapies such as intrauterine insemination (IUI) are effective but may be associated with considerable anxiety. Preliminary data suggest that decreasing this anxiety might lead to improved outcomes. Objective To determine whether lavender aromatherapy (LA) reduces anxiety during an IUI procedure. Methods A randomized controlled trial of women undergoing IUI at a hospital-based fertility clinic. The intervention and comparison were the use of LA vs water. Measurements were the change in anxiety level during an IUI procedure, with secondary assessment of pain scores, patient satisfaction, and pregnancy rates. Results In total, 67 women were screened, and 62 women randomly assigned to either placebo (n = 31) or LA (n = 31). No differences were observed in baseline demographic characteristics or visual analog scores for anxiety before IUI (mean [95% CI], 33.9 [25.2 to 45.6] mm vs 41.0 [33.0 to 49.0] mm) in the LA and placebo groups. However, a statistically significant change in anxiety was observed after LA inhalation during the procedure (mean [95% CI], −11.2 [−19.1 to −3.2]) compared with placebo (mean [95% CI], 1.3 [−5.6 to 8.2]; P = .02). No significant difference was observed in pain during IUI in the LA group vs placebo group. Patient satisfaction was high, with 93% of respondents in the LA group satisfied with the aromatherapy during their procedure. Additionally, 76% of participants who received placebo reported that they would prefer to use LA during their IUI. No statistically significant difference was detected in pregnancy rates between the 2 groups: 19.4% with LA vs 9.7% with placebo ( P = .47). Conclusion LA reduced anxiety and was preferred by women during IUI fertility treatments.

Download Full-text

Study of endometrial thickness and pregnancy outcome following induction of ovulation and intrauterine insemination in primary infertility

Indian Journal of Medical Sciences ◽

10.25259/ijms_13_2020 ◽

2020 ◽

Vol 71 ◽

pp. 118-122

Author(s):

Sweta Nathani ◽

Pallab Kumar Mistri

Keyword(s):

Prospective Observational Study ◽

Primary Outcome ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Transvaginal Ultrasound ◽

Standard Procedure ◽

Clomiphene Citrate ◽

Significant Difference ◽

Group A ◽

Transvaginal Ultrasound Scan

Objective: Infertility affects approximately 10–15% of couples. Assessment of the endometrium with ultrasound has become a standard procedure during the diagnostic workup and treatment of infertility. Our study was designed to investigate whether endometrial thickness on the day of human chorionic gonadotropin administration is a predictor of intrauterine insemination (IUI) success as the primary outcome. Materials and Methods: In the prospective observational study, a serial transvaginal ultrasound scan was performed to measure endometrial thickness following ovulation induction with clomiphene citrate and IUI. One hundred and nine IUI cycles were chosen and the outcome was measured in terms of whether pregnancy occurred or not. Results: There was a statistically significant difference (P = 0.001) between the two groups with respect to mean endometrial thickness (mm). It was also seen significantly higher numbers of pregnancy in Group A (endometrial thickness ≥ 7 mm). Conclusion: The present study identified a statistically significant difference in mean endometrial thickness between cycles that resulted in pregnancy and those did not. Consequently, clinicians providing IUI for infertile couples must pay close attention to endometrial development.

Download Full-text

Using the Life Story Book With Mentally Alert Residents of Nursing Homes

Innovation in Aging ◽

10.1093/geroni/igaa057.1574 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 487-487

Author(s):

Theresa Chrisman

Keyword(s):

Depressive Symptoms ◽

Nursing Homes ◽

Meaning In Life ◽

Life Story ◽

Well Being ◽

Post Intervention ◽

Significant Difference ◽

Wilks Lambda ◽

Potential Benefits ◽

Hispanic White

Abstract Depression and lack of meaning in life (MIL) are common among residents of nursing homes (NHs) and contribute to a reduction in overall health and well-being. Life Story Book (LSB), a reminiscence intervention, is designed to provide a person with the opportunity to review their past and capture their life stories and photographs into a book. LSB has demonstrated positive outcomes for residents of NHs with dementia, yet little is known for residents without dementia. A switching replication design was used to examine the effects of LSB among 21 mentally alert residents from two NHs (NH-A and NH-B) in Houston, Texas. Participants in NH-A received three weeks of the LSB intervention, while NH-B received three weeks of care-as-usual; the intervention was then switched. The GDS-12R and the MIL questionnaire (MLQ) were used to measure depressive symptoms and MIL respectively. Participants from NH-A (n =11) and NH-B (n = 10) had a mean age of 75 years (SD =11.34); 81% female; 52% non-Hispanic white and 33% African American. Results from a one-way MANCOVA found no statistically significant difference on the GDS-12R and MLQ (F(3, 14) = 2.50, p = .102; Wilks’ Lambda = .652; η2 = .35). Further analyses comparing the pre-intervention and post-intervention scores for the entire sample (N =21) found a significant reduction in depressive symptoms (M = 2.67; SD = 2.52) and (M =1.67, SD = 2.29); (t (20) = 2.21, p = 0.039). The potential benefits of LSB for mentally alert residents of NHs warrants further research.

Download Full-text

Effect of “Spatially Separated Speech in Noise Training” on speech perception in noise in children with bimodal fitting

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00130-9 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Younes Lotfi ◽

Mahdieh Hasanalifard ◽

Abdollah Moossavi ◽

Enayatollah Bakhshi ◽

Mohammad Ajalloueyan

Keyword(s):

Speech Perception ◽

Intervention Group ◽

Auditory Training ◽

Control Group ◽

Interventional Study ◽

Post Intervention ◽

Speech Perception In Noise ◽

Speech In Noise ◽

Significant Difference ◽

Recognition Ability

Abstract Background The objective of this study was to evaluate the effect of “Spatially separated speech in noise” auditory training on the ability of speech perception in noise among bimodal fitting users. The assumption was that the rehabilitation can enhance spatial hearing and hence speech in noise perception. This study was an interventional study, with a pre/post-design. Speech recognition ability was assessed with the specific tests. After performing the rehabilitation stages in the intervention group, the speech tests were again implemented, and by comparing the pre- and post-intervention data, the effect of auditory training on the speech abilities was assessed. Twenty-four children of 8–12 years who had undergone cochlear implantation and continuously used bimodal fitting were investigated in two groups of control and intervention. Results The results showed a significant difference between the groups in different speech tests after the intervention, which indicated that the intervention group have improved more than the control group. Conclusion It can be concluded that “Spatially separated speech in noise” auditory training can improve the speech perception in noise in bimodal fitting users. In general, this rehabilitation method is useful for enhancing the speech in noise perception ability.

Download Full-text