Evidence-based paediatric hearing services
Saturday May 14th 2005, 11:40am — 12:05pm
Prof. Adrian Davis BSc, MSc, PhD, FFPHM, FSS
Over the last ten years there have been a radical changes in the services for hearing impaired children and their families. Some of these have been based on evidence, some on good practice and some on good common sense (wisdom of the years!). Of course we would like all services to be based on the best evidence, but sometimes that is too expensive, too difficult or just unacceptable to stakeholders. I will try to address four major changes that have taken place.
The first change has been in terms of newborn hearing screening, that started out as an evidence based change. But not everyone agrees on what the evidence is to the extent that they implement different programmes. Some programmes that are based on the same evidence, look and feel very different and have different results. In the striving for individual clinical responsibility in the implementation of the screen great variation is created again. How should we address this issue – is it in the hands of parents?
The second change has been in the ready availability of cochlear implants. These are now a very real choice for children identified by newborn hearing screening who have a severe-profound deafness. Evidence abounds but there is not yet agreement on how early, whether there should be two or one implant and what the long term holds. What evidence do we need, to change what we do?
The third change has been that there has been a huge change in how we address children who are deaf in terms of DSP hearing aids, event related potential and tone pip ABR. Should there be national protocols for children’s patient journeys, should there be packages of care rather than hearing aids. These are questions on which we have relatively little evidence.
Finally there is the concept of family friendly hearing services. Is this a platitude? How do we address the concept, is there evidence that it is useful? Do we need evidence? There is a huge priority for services to take heed of newborn deaf children’s parents needs, to give true multi-agency support, to give integrated support to parents so that they can enable their families to take advantage of Early Support packages that are being developed and implemented.
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