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PubMed1998

The utility of the Hartmann procedure.

BACKGROUND: In 1923 the French surgeon Henri Hartmann described an operation for rectosigmoid cancer as an alternative to abdomino-perineal resection for high-risk patients. In the subsequent years, the indications for performing the Hartmann procedure have broadened to include complicated diverticulitis, ischemic bowel, iatrogenic perforations, volvulus, and colitis. METHODS: We have retrospectively reviewed our experience in 185 patients who underwent the Hartmann procedure from January 1981 to December 1995. Charts were reviewed for indications, morbidity, and mortality and to determine the outcome of patients who underwent the Hartmann procedure. RESULTS: The main indications for performing the Hartmann procedure were complicated diverticulitis (including perforation, obstruction, and abscesses) in 108 patients, rectosigmoid cancer in 31 patients, and other indications in 46 patients. There were a total of 27 deaths for an in-hospital mortality of 14%. All complications occurred at a rate of less than 9%. Of the 158 surviving patients, 90 (57%) eventually underwent the second stage of the operation to restore bowel continuity. The average length of time between initial resection and reanastomosis was 149 days. There were no deaths associated with the second stage of the procedure and complications occurred at a rate less than 4%. CONCLUSIONS: This is the largest reviewed series of the Hartmann procedure. Mortality is lower than in other reported series, and morbidity is low. Our data demonstrate that the second stage of the procedure, in properly selected individuals, is a procedure that can be performed with minimal morbidity and no mortality. This is different from other published reports. We conclude that the Hartmann procedure is a safe and efficacious option for the surgeon confronted with the complex pathology of the rectosigmoid area, with acceptable morbidity and mortality.

Aged↗
PubMed1998

Modified Konno-Rastan procedure for subaortic stenosis: indications, operative techniques, and results.

BACKGROUND: Diffuse or unresectable subaortic stenosis (SAS) necessitates an aggressive surgical approach for the elimination of left ventricular outflow tract obstruction. In this article we report our experience with the modified Konno-Rastan procedure, with inherent preservation of the native aortic valve and annulus, in the treatment of diffuse or unresectable SAS. METHODS: Sixteen children (age range, 21 months to 18 years) underwent the modified Konno-Rastan procedure through either a transventricular (n = 12) or a transatrial approach (n = 4) to the conal septum. Indications for operation were recurrent SAS (n = 3), hypertrophic obstructive cardiomyopathy (n = 3), tunnel stenosis (n = 2), SAS related to a canal (n = 3), and SAS after ventricular septal defect closure (n = 5). Eleven patients had undergone previous procedures and 5 underwent the modified Konno-Rastan procedure as their primary operation. RESULTS: The mean preoperative left ventricular outflow tract gradient of 50 +/- 17 mm Hg was reduced to 3 +/- 7 mm Hg (p < 0.001) after surgical repair. Postoperative complications included sternal infection (n = 1), heart block (n = 2), mediastinal bleeding (n = 1), and renal and cerebral ischemia (n = 1). There was 1 late postoperative death caused by pneumonia 2 years after operation (6.2% mortality rate). The mean follow-up period was 62 +/- 39 months and all patients had complete relief of preoperative symptoms and were in New York Heart Association class I. One patient underwent a successful redo modified Konno-Rastan procedure 7 years after the first operation for residual left ventricular outflow tract obstruction immediately below the aortic valve. One patient is awaiting reoperation for aortic incompetence unrelated to conal enlargement 1.5 years after the first procedure. CONCLUSIONS: The modified Konno-Rastan procedure represents an excellent therapy for diffuse or unresectable SAS in patients with a normal aortic valve. In addition, it produces excellent results in a limited number of patients with hypertrophic obstructive cardiomyopathy, in whom the Morrow procedure traditionally has been performed. Although it usually is performed through a transventricular approach, the modified Konno-Rastan procedure also can be performed through a transatrial approach; this is particularly useful in patients who have had previous ventricular septal defect closure associated with SAS occurring proximal to the prosthetic patch.

Adolescent↗
PubMed2002

Coping with the stress of a painful medical procedure.

To evaluate its effect on procedure-related distress, the focus of attention was manipulated by providing training to hospitalized acute burn patients (n=42). Participants were randomly assigned to attention focusing (i.e. attending to procedural sensations) or music distraction (i.e. attention diverting) coping interventions, or to usual care during the target dressing change. Coping behavior (i.e. distraction, focusing, and three confounding methods, ignoring, catastrophizing, reinterpreting), tension and intrusiveness were evaluated 24 h retrospectively (i.e. for the prior procedure), during the targeted procedure, and 30 min after the target procedure. When coping during the target procedure by ignoring, reinterpreting, and catastrophizing were covaried, the music distraction group experienced significantly fewer intrusions, and the attention focus group had more intrusions. Additionally, secondary analyses revealed that coping by ignoring during the prior day's procedure significantly predicted higher procedural tension during, and more intrusions following, the targeted procedure. Suppression-based forms of emotion-focused coping may be enhanced by training in the use of an explicit distractor.

Acute Disease↗
PubMed2003

Laparoscopic Swenson procedure--an optimal approach for both primary and secondary pull-through for Hirschsprung's disease.

BACKGROUND/PURPOSE: Several pull-through procedures are available for the surgical management of Hirschsprung's disease (HD) in children. The authors have adopted a laparoscopic approach since 1995, including laparoscopic Swenson procedure (LSw), both for one-stage primary and 2-stage secondary procedures. The aim of this study was to examine the role of LSw in children with HD in both primary and secondary procedures. METHODS: From January 1995 to December 2001, 42 children with biopsy-proven HD underwent laparoscopic pull-through procedure for HD. This group included 29 children who underwent LSw, a detailed analysis of which forms the basis of this report. RESULTS: Sixteen children underwent a single-stage neonatal LSw; the median weight of this group at the time of surgery was 3.2 kg and the median age was 5 days. Secondary LSw was performed in the remaining 13 children, which included 3 children with total colonic HD who underwent laparoscopic total colectomy and LSw. The median operating time was 105 minutes (range, 66 to 175 minutes). The median time to commence full diet was 48 hours (range, 24 to 86 hours), and median time to return to normal play and activity was 72 hours (range, 48 hours to 5 days). There was no difference in operating time between primary and secondary pull-through procedures. There were no intraoperative complications, and no patient required open conversion. Postoperative ileus was noted in 3 children and enterocolitis in 2. The median hospital stay was 4 days (range, 2 to 6 days). Follow-up was between 6 months to 7 years with a median follow-up of 2.2 years. At follow-up, 2 children required laparoscopic antegrade continence enema procedure. A satisfactory continence was noted in 15 of the 19 children who were older than 3 years at the time of last follow-up. CONCLUSIONS: LSw seems to be a suitable procedure for laparoscopic management of HD in children. LSw is safe and effective, both for primary and secondary type of pull-through procedures, with good short-term results.

Child, Preschool↗
PubMed2001

Development of a real-time PCR procedure including an internal control for the measurement of HCMV viral load.

Human cytomegalovirus (HCMV) infections are frequent in immuno-compromised patients. The recent development of real-time PCR procedures that allow the rapid quantification of genome load will be helpful for accurate monitoring of these infections. Two extraction procedures were evaluated using 30 blood samples that were processed pure and diluted (1/10). Repeatability and reproducibility of the quantitative PCR procedure using an internal control for amplification were analysed, and its sensitivity compared to a qualitative PCR procedure using 50 HCMV culture positive blood samples. The real-time PCR and qualitative PCR procedures were positive in 46 and 48 of the samples tested, respectively. Discrepancies were observed for samples with a low viral load. The sensitivity of the real-time PCR procedure was evaluated at 500 HCMV DNA copies per ml of sera. The use of an internal control concomitantly processed during the HCMV quantification did not alter the sensitivity of the procedure, and was relevant for the detection of putative PCR inhibitors that may interfere with the amplification process. This procedure was used to measure genome load in two bone marrow transplant patients with HCMV disease, confirming that this new PCR procedure should be used widely for diagnosing and monitoring HCMV infections in transplant patients.

Bone Marrow Transplantation↗
PubMed1996

Open thoracotomy procedural competency: validity study of teaching and assessment modalities.

STUDY OBJECTIVES: To determine (1) reliability and validity estimates of three modalities used to assess open thoracotomy procedural competency and (2) the effect of computer practice on procedural performance as measured by the three assessment modalities. METHODS: An experimental, sequential assessment design with volunteer examinees completing all three assessment modalities (paper, computer, pig model) was implemented at the animal support facilities of a university medical school with an affiliated emergency medicine residency program. Level of physician training (student, resident, faculty) and type of computer practice (thoracotomy, cricothyrotomy) were independent variables. Procedural competency scores were determined for each modality; scores were defined in terms of performance time and performance accuracy for three thoracotomy procedures (opening the chest, pericardiotomy, and aortic cross-clamping). RESULTS: Thoracotomy performance on the pig reliably discriminated among examinees known to differ in level of training. However, computer simulation performance did not significantly differ among examinees with different levels of training. Computer simulation practice significantly improved later performance on the computer assessment (P < .05) but not on the pig assessment. The greatest predictor of procedural competency (time and accuracy) on the pig assessment was the ability to sequentially order procedural steps. CONCLUSION: This study establishes the pig model as superior to the paper and computer models as the criterion standard for open thoracotomy assessment. Psychometric properties support the pig model as the most reliable and valid model yet described for assessing thoracotomy procedural competency. Computer simulation practice using visual images (complex anatomy) and the sequential ordering of procedural steps through paper modeling show promise for teaching and assessment of prerequisite skills required to develop psychomotor procedural competency.

Animals↗
PubMed1997

Percutaneous injuries during oral and maxillofacial surgery procedures.

PURPOSE: This study estimated the frequency of percutaneous injuries (Pls) to dental health-care workers during oral and maxillofacial surgery and examined the circumstances surrounding the incidents. MATERIAL AND METHODS: A self-reported, prospective study was conducted to document Pls incurred during oral and maxillofacial surgery performed on outpatients and inpatients over 1-month and 6-month periods, respectively. Among the study variables examined were the numbers of patients treated, number and types of procedures performed, duration of treatment, numbers and types of health care workers at risk, treatment setting, and number of injuries. RESULTS: Four injuries were recorded during 362 operating room procedures on 236 inpatients, for a rate of 1.1 Pls per 100 procedures (95% confidence interval: 0.3 to 2.8) and 1.7 Pls per 100 patients (95% confidence interval: 0.5 to 4.6). These four injuries occurred during 1,665 person-procedures (mean number of workers present at each procedure times the total number of procedures) for a rate of 0.24 Pls per 100 person-procedures (95% confidence interval: 0.1 to 1.0). Three injuries took place during fracture reductions; two were caused by surgical wire and the third by a needlepoint Bovie tip. One injury occurred during orthognathic surgery and involved a Woodson elevator. Residents recorded no injuries while treating 521 outpatients (0 Pls per 100 patients; 95% confidence interval: 0 to 0.6). CONCLUSION: The results support previous findings that Pls rarely occur during outpatients oral and maxillofacial surgery procedures. However, the findings suggest that operating room procedures for oral and maxillofacial surgery that use wire or involve fracture reduction may be associated with an increased risk of injury. Strategies such as using a cork or sponge to cap sharp wires or instruments, and protecting hands and fingers by double gloving, may be used to decrease the risk of Pl.

Accidents, Occupational↗
PubMed2001

Long-term follow-up of atrial contraction after the maze procedure in patients with mitral valve disease.

OBJECTIVES: We sought to determine the effectiveness of the maze procedure for maintaining sinus rhythm and atrial contraction for a long period in patients with mitral valve disease. BACKGROUND: Although the maze procedure for atrial fibrillation (AF) has been effective in restoring sinus rhythm in patients with mitral valve disease, the long-term results of this procedure have not been determined. METHODS: We echocardiographically studied 94 consecutive patients with mitral valve disease before, as well as early (3.1 +/- 3.3 months) and late (2.2 +/- 0.9 years) after, the maze procedure. Peak velocity and the time-velocity integral of the left ventricular (LV) diastolic filling wave during atrial contraction (A wave), as well as the atrial filling fraction (calculated as the ratio of the time-velocity integral of the A wave to total diastolic filling), were obtained from transmitral flow recordings. Peak A wave velocity > or =10 cm/s was considered to indicate echocardiographic evidence of effective atrial contraction. RESULTS: Regular rhythm with P waves was restored in 70 patients (74%) in the early stage and in 59 patients (63%, p = 0.09) in the late stage after the maze procedure. Forty-seven patients (50%) in the early stage and 36 patients (38%, p = 0.14) in the late stage showed effective atrial contraction by Doppler echocardiography. Left atrial (LA) and LV end-diastolic diameters significantly decreased after the procedure (from 59 +/- 13 to 48 +/- 7 mm, p < 0.01; and from 54 +/- 9 to 47 +/- 5 mm, p < 0.01, respectively) and did not show significant changes during the follow-up period. Once atrial contraction was resumed, its degree did not change between the early and late stages after the maze procedure (17 +/- 6% vs. 17 +/- 6% for atrial filling fraction). CONCLUSIONS: Sinus rhythm and atrial contraction recovered early after the maze procedure in most patients and were maintained for more than two years. Once active atrial contraction was resumed, the degree of contraction did not change thereafter. These results demonstrate that the maze procedure is effective for a long period in patients with mitral valve disease.

Adult↗
PubMedDate not supplied

Quantification of procedures and resuscitations in an emergency medicine residency.

Currently, there are no data that govern the number of procedures that are necessary to promote competence during emergency medicine (EM) training. Nonetheless, the Residency Review Committee requires each program to report the average number of procedures and resuscitations performed by its residents. For 7 years, we have used a computer database to track resuscitation and procedure experience for 42 residents. We have documented resident experience both in our 36,000-visit Level I Trauma Center emergency department and during off-service rotations in our 400-bed university teaching hospital. We report data from four graduating classes (n = 24). We estimate that residents have recorded 60% of the actual procedures performed. The 24 residents documented 11,947 procedures, averaging 498 per resident (range 264-1055), and participated in 3432 resuscitations, or 143 per resident (range 64-379). Mean and standard deviations are reported for 20 specific EM procedures and 4 types of resuscitations. EM residents perform a large number of procedures, but there is wide inter-resident variability. There is no documentation that some residents perform even one of some rare but critical procedures. This tracking system suggests, then, that procedure simulations, or cadaver and animal models, must be developed and used to enhance experience. This program can be modified to track resident experience in any specialty, as well as to document supervision by faculty and support credentialling inquiries.

California↗
PubMedDate not supplied

Discrimination training: a comparison of two procedures for presenting multiple examples within a fading and non-fading paradigm.

When teaching discriminations, many researchers and practitioners recommend presenting multiple examples of both the correct and incorrect stimuli. To test this suggestion, we compared two procedures for presenting multiple examples. In one, multiple examples across trials (ME, Across), one correct (S+) and one incorrect (S-) stimulus were presented each trial; examples then changed across trials. In another procedure, multiple examples within trials (ME, Within), three stimuli (either 2 S+'s and 1 S-, or 1 S+ and 2 S-'s) were presented each trial; examples again changed across trials. Two experiments were conducted to test these procedures. The first procedure used a non-fading program to teach discrimination; the second used a fading procedure. In the first experiment, we taught 10 persons to identify words under these two procedures. The former procedure was superior in acquisition; the latter procedure, however, was better under generalization for most participants. In the second experiment, we presented the two procedures within a fading paradigm. The results replicated those in Experiment 1: ME, Across was better for acquisition, but ME, Within was better for generalization. Results were discussed and follow-up studies suggested.

Adolescent↗
PubMed1997

Rapid nodule evaluation computer-aided image analysis procedure for bone nodule quantification.

Using bone cell cultures, the effects of drugs on cell activities such as proliferation, differentiation, matrix formation, and mineralization can be explored. To quantify these parameters accurately and quickly, a kinetic reproducible computed image analysis procedure of culture dishes is proposed which could be conjointly used with biochemical analysis of the medium. In the present article, different mathematical procedures coupled either with or without histochemical staining are investigated and analyzed. Using serial cross sections and microradiographies of bone nodules, we demonstrated that the gray-level parameter is well correlated with bone mass and/or the mineralization status of the nodules. The procedure selected is a multistep procedure called rapid nodule evaluation (RNE), which uses a binary reconstruction program with different thresholds. To challenge this RNE procedure with the classical Von Kossa staining and quantification procedure, we cultured the cells in the presence of 10 nmol/L dexamethasone and compared the results using the two procedures. The RNE procedure appeared to be accurate and reproducible, and also has the advantage of speed and dynamic analysis over the classical Von Kossa quantification procedure.

Animals↗
PubMed2003

The effects of British and American trial procedures on the quality of juror decision-making.

Compared to American trial procedures, British procedures provide a less distracting environment in which jurors can process trial evidence. Relying on theories of persuasion, it was predicted that jurors viewing British procedures would be less affected by extra-evidentiary cues and would be more sensitive to evidence strength variations than jurors in American trials. Participants (N = 245) viewed a mock trial in which trial procedure, judge's nonverbal behavior, and evidence strength were varied. Participants judged the British procedures to be more civil and fair than American procedures but were less likely to find for the plaintiff. Although jurors recalled more trial facts when they viewed British procedures, they were not more sensitive to variations in evidence strength. There was some evidence that British procedures may increase the influence of judge's nonverbal behavior on juror judgments. The relative benefits of different trial procedures are discussed.

Adolescent↗
PubMed1982

A comparison of two procedures to elicit verbal auxiliary and copula in normal kindergarten children.

Fourteen normal kindergarten children, all of whom spontaneously used verbal auxiliary and copular forms of BE (VACs) were studied. Two cloze procedures were designed to elicit all three forms of present tense VACs in uncontractible sentence positions. The syntactic elicitation (SE) procedure required the children to observe a syntactic constraint within a descriptive response; the emphatic elicitation (EE) procedure required observation of a stress constraint within a role-playing response. Personal pronouns were used as sentence subjects in both procedures. Results indicated that both procedures were effective in eliciting VACs approximately 75% of the time. The SE procedure was more effective than the EE procedure overall. The procedures did not differ in their ability to elicit auxiliary and copular forms. The effects of subject pronoun person and singular vs. plural verb form are discussed. The procedures have implications for supplementing spontaneous language samples in assessing expressive language.

Child↗
PubMed2002

The requirement for informed consent prior to nursing care procedures.

AIM OF THE PAPER: The aim of this paper is to examine the extent to which there is a requirement to obtain informed consent prior to nursing care procedures. RATIONALE: The requirement for nurses to obtain consent prior to nursing care procedures is addressed in various nursing policy documents. It is important that nurses understand the legal and ethical rationale behind the principles of informed consent so that the principles are applied appropriately to the particular context of nursing care. ARGUMENT: The ethical and legal rationale behind the concept of informed consent and its relevance to nursing practice are examined. In this paper, it is argued that the function of informed consent is to protect patient autonomy and to promote meaningful decision-making. Given the potential for nursing care procedures to infringe patient autonomy, consent is clearly a relevant concept in nursing. Furthermore, in law, any touching without consent is a potential battery. Informed consent is often associated as a rigid procedure, only relevant to surgical or research procedures. Consent should be obtained prior to nursing care procedures whenever patient autonomy is at stake. However, information-giving should be determined by the needs of the patient and approached in such a way as to facilitate meaningful decision-making. Given the individual nature of infringements to patient autonomy, it is difficult to predetermine all those care procedures that require consent; any list of procedures would fail to be comprehensive. CONCLUSIONS: The principles of informed consent should underpin our approach to nursing care procedures, which should not be mechanistic but determined by the needs of individual patients.

Ethics, Nursing↗
PubMed2003

Comparison of a rational and an empirical standard setting procedure for an OSCE. Objective structured clinical examinations.

PURPOSE: Earlier studies of absolute standard setting procedures for objective structured clinical examinations (OSCEs) show inconsistent results. This study compared a rational and an empirical standard setting procedure. Reliability and credibility were examined first. The impact of a reality check was then established. METHODS: The OSCE included 16 stations and was taken by trainees in their final year of postgraduate training in general practice and experienced general practitioners. A modified Angoff (independent judgements, no group discussion) with and without a reality check was used as a rational procedure. A method related to the borderline group procedure, the borderline regression (BR) method, was used as an empirical procedure. Reliability was assessed using generalisability theory. Credibility was assessed by comparing pass rates and by relating the passing scores to test difficulty. RESULTS: The passing scores were 73.4% for the Angoff procedure without reality check (Angoff I), 66.0% for the Angoff procedure with reality check (Angoff II) and 57.6% for the BR method. The reliabilities (expressed as root mean square errors) were 2.1% for Angoffs I and II, and 0.6% for the BR method. The pass rates of the trainees and GPs were 19% and 9% for Angoff I, 66% and 46% for Angoff II, and 95% and 80% for the BR method, respectively. The correlation between test difficulty and passing score was 0.69 for Angoff I, 0.88 for Angoff II and 0.86 for the BR method. CONCLUSION: The BR method provides a more credible and reliable standard for an OSCE than a modified Angoff procedure. A reality check improves the credibility of the Angoff procedure but does not improve its reliability.

Clinical Competence↗
PubMed2000

A correction procedure for the Minnesota Multiphasic Personality Inventory-2 for persons with spinal cord injury.

OBJECTIVE: To develop a procedure that adjusts scoring of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) for the items related to spinal cord injury (SCI) that skew interpretations with this population, and to assess the accuracy of interpretations resulting from this procedure, standard MMPI-2 scoring, and a previously offered procedure. DESIGN: A criterion study with masked comparisons. SETTING: Hospital inpatient physical medicine and rehabilitation unit. PATIENTS: Thirty-four SCI patients between the ages of 18 and 77 years, 19 with complete SCI and 15 with incomplete SCI. OTHER PARTICIPANTS: Twenty-one nurses, 23 physicians, and 17 psychologists. MAIN OUTCOME MEASURES: Masked MMPI-2 profiles, judged by clinicians for accuracy. Paired t tests comparing profile scales. RESULTS: A correction procedure was arrived at for the MMPI-2 and MMPI-A incorporating adjustments for physical complaints frequently arising from SCI. The new procedure was judged superior to both the standard procedure and the previously offered procedure. Paired t tests of MMPI-2 scales showed that differences from scoring procedures were significant with many scales measuring significance at the p < .0001 level. CONCLUSIONS: Statistically significant changes in MMPI-2 profiles occur when somatic complaints related to SCI are corrected for. Preliminary results suggest that the application of the new correction procedure increases clinical accuracy.

Adult↗
PubMed2002

[Signal detection theoretical aspects of various threshold detection procedures].

Psychoacoustic threshold detection measurements are widely used in clinical and research applications. A variety of procedures has been described to measure psychoacoustic thresholds. Each of these procedures has advantages and disadvantages. For clinical purposes procedures providing fast results may be preferred whereas for psychoacoustic research the threshold has to be determined as exactly as possible. Conventional procedures are based on a yes/no paradigm. Since these procedures are influenced by criterion shifts, n-alternative forced choice procedures were developed. Here the patient has to indicate the interval most likely to contain the signal. Additionally, it is possible to estimate the threshold based upon few data and comparing these to known psychometric functions. Following an overview outlining procedural aspects of threshold detection methods aspects of signal detection theory in relation to these procedures are discussed. Signal detection theory may help to explain why results obtained with various procedures may be quite different.

Audiometry, Pure-Tone↗
PubMed2001

Comparison of three procedures for initial fitting of compression hearing aids. I. Experienced users, fitted bilaterally.

We compared the effectiveness of three procedures for the initial fitting of hearing aids with multi-band compression: (1) CAMEQ, which aims to amplify speech so as to give equal loudness per critical band over the frequency range important for speech intelligibility, and to give similar overall loudness to 'normal': (2) CAMREST, which aims to amplify speech so as to restore 'normal' specific loudness patterns, over a wide range of speech levels; (3) DSL I/O, which aims to map the dynamic range of normally hearing people into the reduced dynamic range of hearing-impaired people, with 'full' restoration of audibility. Ten experienced hearing aid users with moderate sensorineural loss were fitted bilaterally with Danalogic 163D digital hearing aids, using each procedure in turn; the order was counterbalanced across subjects. The fitting required specification of gains for input levels of 55 and 80 dB SPL at six centre frequencies. Real-ear measurements were made to ensure that target gains were reached (+/-3 dB). Immediately after fitting with a given procedure, and one week after fitting, the gains were adjusted when required by the minimum amount necessary to achieve acceptable fittings. The amount of adjustment required provides one measure of the adequacy of the initial fitting. On average, the adjustments were smallest for the CAMEQ procedure. The gain changes were slightly larger for the CAMREST procedure and were largest of all for DSL I/O. For the latter, the gain changes were mostly negative, especially for high frequencies and the higher input level. This indicates that the DSL I/O procedure prescribes more high-frequency gain than is preferred by adult users. After these gain adjustments, users wore the aids for at least three weeks before filling out the APHAB questionnaire and taking part in laboratory measurements of the speech reception threshold (SRT) for sentences in quiet and in steady and fluctuating background noise at levels of 60 and 75 dB SPL. Following these tests, the hearing aids were re-fitted with the next procedure. The scores on the APHAB test and the SRTs did not differ significantly for the three procedures. We conclude that the CAMEQ and CAMREST procedures provide more appropriate initial fittings than DSL I/O.

Acoustic Stimulation↗