***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This paper addresses the development and effectiveness of a home education program . The program , design ed for hearing-impaired elders and their significant others ( SO ) , deals with communication strategies and speech reading . Participants were r and omly assigned to a training group ( hearing aid fitting + home education program ) or a control group ( hearing aid fitting ) . The training group included 24 hearing-impaired subjects and 24 SO 's . Controls were 24 affected individuals and 22 SO 's . Question naires addressing emotional response , communication strategies and the IOI-HA , IOI-AI and IOI-SO were used . A repeated measures analysis of variance was applied to test group differences between pre , post , and 6-months follow-up measures . Increased awareness of benefits of speech reading and improved interaction with the SO were observed in the training group only ( p < 0.05 ) . No group difference on ‘ emotional response ’ was found . IOI-AI and IOI-SO demonstrated favorable attitudes towards the program . Follow-up measures showed improved quality of life and satisfaction in the training group , while a decrease was observed among the controls ( p < 0.05 ) . Some effects differed between first-time and experienced hearing aid users . Addition of services to amplification and involvement of the SO are relevant in aural rehabilitation BACKGROUND Audiologic rehabilitation aims to improve communication for people with hearing impairment . Education is widely regarded as an integral part of rehabilitation , but the effect of the delivery method of an educational program on the experience of hearing problems has rarely been investigated in controlled trials . PURPOSE The purpose of this study was to examine the short-term effects of complementing an educational program for hearing aid users with telephone consultations , delivered through weekly discussion s with the subjects about information obtained from a book on hearing and hearing aids . RESEARCH DESIGN This study used a r and omized , controlled design . STUDY SAMPLE In total , 69 hearing aid users were r and omly assigned to an intervention group ( n = 33 ) or a control group ( n = 36 ) . INTERVENTION The intervention group had access to a book and received weekly topic-based reading instructions related to the different chapters of the book . Five telephone calls were made to the members of the intervention group . During the calls , an audiologist discussed new information with the participant as needed . The control participants also read the book , but they did not discuss the contents of the book with a professional . DATA COLLECTION AND ANALYSIS The Hearing H and icap Inventory for the Elderly ( HHIE ) , the Hospital Anxiety and Depression Scale ( HADS ) , and the International Outcome Inventory for Hearing Aids ( IOI-HA ) were used to measure the outcomes of this study . RESULTS Participants in the intervention group had a reduction in self-reported hearing h and icap , while there were no significant changes in the control group . In the intervention group , 45 % of the participants showed an improvement of ≥36 % on the HHIE , while only 17 % of the control group showed an improvement of ≥36 % . There were also improvements on the HADS total and the depression subscale for the intervention group . No changes occurred on the IOI-HA . CONCLUSIONS Reading about hearing and hearing aids can reduce the hearing h and icap and reported anxiety in hearing aid users . In this study , discussing the content of the book that was provided with a professional during weekly telephone consultations and having weekly home assignments further improved emotional well-being , as demonstrated by the HHIE ( emotional scale ) and HADS ( depression scale ) , but these activities had no effect on hearing aid outcomes as measured by the IOI-HA Results of this study demonstrate the advantages of both pre- and postfitting hearing aid orientation ( HAO ) sessions . This study demonstrated that HAO counseling is helpful in expediting hearing aid benefit and satisfaction through the education of our clients and that this benefit and satisfaction is age dependent as measured by the Glasgow Hearing Aid Benefit Profile ( GHABP ) ( Gatehouse , 1997 ) . Patients with greater initial disability  , as identified by item 1 of the GHABP , receive significant benefit from prefitting and /or postfitting counseling as compared to patients receiving no counseling . Implication s of these findings are discussed OBJECTIVE To determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease ( AD ) . DESIGN Prospect i ve study of 639 individuals who underwent audiometric testing and were dementia free in 1990 to 1994 . Hearing loss was defined by a pure-tone average of hearing thresholds at 0.5 , 1 , 2 , and 4 kHz in the better-hearing ear ( normal , < 25 dB [ n = 455 ] ; mild loss , 25 - 40 dB [ n = 125 ] ; moderate loss , 41 - 70 dB [ n = 53 ] ; and severe loss , > 70 dB [ n = 6 ] ) . Diagnosis of incident dementia was made by consensus diagnostic conference . Cox proportional hazards models were used to model time to incident dementia according to severity of hearing loss and were adjusted for age , sex , race , education , diabetes mellitus , smoking , and hypertension . SETTING Baltimore Longitudinal Study of Aging . PARTICIPANTS Six hundred thirty-nine individuals aged 36 to 90 years . MAIN OUTCOME MEASURE Incident cases of all-cause dementia and AD until May 31 , 2008 . RESULTS During a median follow-up of 11.9 years , 58 cases of incident all-cause dementia were diagnosed , of which 37 cases were AD . The risk of incident all-cause dementia increased log linearly with the severity of baseline hearing loss ( 1.27 per 10-dB loss ; 95 % confidence interval , 1.06 - 1.50 ) . Compared with normal hearing , the hazard ratio ( 95 % confidence interval ) for incident all-cause dementia was 1.89 ( 1.00 - 3.58 ) for mild hearing loss , 3.00 ( 1.43 - 6.30 ) for moderate hearing loss , and 4.94 ( 1.09 - 22.40 ) for severe hearing loss . The risk of incident AD also increased with baseline hearing loss ( 1.20 per 10 dB of hearing loss ) but with a wider confidence interval ( 0.94 - 1.53 ) . CONCLUSIONS Hearing loss is independently associated with incident all-cause dementia . Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study Background Hearing impairment is the most common body system disability in veterans . In 2008 , nearly 520,000 veterans had a disability for hearing loss through the Department of Veterans Affairs ( VA ) . Changes in eligibility for hearing aid services , along with the aging population , contributed to a greater than 300 % increase in the number of hearing aids dispensed from 1996 to 2006 . In 2006 , the VA committed to having no wait times for patient visits while providing quality clinical ly-appropriate care . One approach to achieving this goal is the use of group visits as an alternative to individual visits . We sought to determine : 1 ) if group hearing aid fitting and follow-up visits were at least as effective as individual visits , and 2 ) whether group visits lead to cost savings through the six month period after the hearing aid fitting . We describe the rationale , design , and characteristics of the baseline cohort of the first r and omized clinical trial to study the impact of group versus individual hearing aid fitting and follow-up visits . Methods Participants were recruited from the VA Puget Sound Health Care System Audiology Clinic . Eligible patients had no previous hearing aid use and monaural or binaural air-conduction hearing aids were ordered at the evaluation visit . Participants were r and omized to receive the hearing aid fitting and the hearing aid follow-up in an individual or group visit . The primary outcomes were hearing-related function , measured with the first module of the Effectiveness of Aural Rehabilitation ( Inner EAR ) , and hearing aid adherence . We tracked the total cost of planned and unplanned audiology visits over the 6-month interval after the hearing aid fitting . Discussion A cohort of 659 participants was r and omized to receive group or individual hearing aid fitting and follow-up visits . Baseline demographic and self-reported health status and hearing-related measures were evenly distributed across the treatment arms . Outcomes after the 6-month follow-up period are needed to determine if group visits were as least as good as those for individual visits and will be reported in subsequent publication . Trial Registration UNLABELLED It is of paramount importance to install hearing rehabilitation programs for the elderly . AIM To check the efficacy of a forma auditory training program for elderly patients fitted with hearing aids for at least three months , by means of speech recognition tests and self- assessment question naires . METHODS Longitudinal contemporary cohort study . We selected 13 elderly hearing aid users , using intra-canal hearing aids in both ears , from both genders , with average age of 65.3 years . This group was r and omly divided in Experiment Group and Control Group . The Experiment Group underwent seven formal auditory training sessions , aim ing at stimulating their hearing skills for hearing closing , memory , attention , background figure and binaural integration . The participants were assessed by three behavioral tests and one self assessment question naire . RESULTS The elderly from the Experiment Group had significantly better performance in the assessment s after auditory training in comparison to the Control Group . CONCLUSION The formal auditory training program in a soundproof booth , associated with the use of hearing aids , improves speech recognition performance and reduces the perception of auditory h and icap for the elderly who use intra-canal hearing aids The purpose of this study was to determine whether periodic clinician-initiated telephone contact would reduce the number of unresolved complaints and increase satisfaction , use , and perceived benefit at 4 mo postfitting . Thirty subjects were contacted at 6 , 9 , and 12 wk postfitting to address questions and to encourage them to return to the clinic to resolve hearing aid-related problems . A control group of 30 subjects was encouraged to contact the center if problems arose at the time of dispensing only . All subjects were interviewed at 4 mo following receipt of the aids , and were sent the Hearing H and icap Inventory for the Elderly at the same time as well as at the time of dispensing . Results revealed a significant reduction in perceived h and icap in general , but no significant difference between groups on measures of satisfaction , use , or benefit . There was no significant difference between groups in the number of unresolved complaints at the time of the interview ; however , a trend toward fewer complaints in the experimental group was noted . A significantly greater number of complaints were raised for the first time in the control group than in the experimental group at the time of the interview , indicating that more problems remained unaddressed in the absence of clinician-initiated intervention . Therefore , the continued investigation of aggressive , and efficient , postfitting management schemes is warranted PURPOSE To evaluate teleconsultation 's efficacy for hearing aid fitting . METHODS Fifty hearing impaired individuals with ages ranging from 39 to 88 years and mean audiometric thresholds between 30 and 68.75 dBHL participated in this study . Participants were divided into two groups ( stratified r and omization ) : control group ( n=25 ) , su bmi tted to face-to-face procedures , and experimental group ( n=25 ) , su bmi tted to synchronous teleconsultation with interactive video and remote applicative control . The hearing aids were programmed and verified ( with microphone probe ) , and the subjects received instructions regarding use and care for the device . Time taken for the procedures was measured . Following the consultations , an evaluator ( blind to the groups ) applied the Hearing in Noise Test ( HINT-Brazil ) . Approximately one month after consultations , the daily time of hearing aid use was verified , and the International Outcome Inventory for Hearing Aids ( IOI-HA ) was administered . RESULTS A greater time for programming and verification and a smaller time for orientation were observed for the experimental group . No difference was found between groups for the total consultation time . The real ear measures ' matching to their respective targets was similar for both groups . No difference was observed between groups for the HINT results ( silence and noise ) , the daily amount of use of hearing aids in hours , and the IOI-HA scores . CONCLUSION Teleconsultation is an efficient procedure for hearing aid programming , verification and fitting when face-to-face services are not available Nineteen elderly hearing impaired subjects participated in an experimental treatment study and received either behavioural hearing tactics or served as untreated controls . Treatment was supplied in the form of a self-help treatment manual supplied with telephone contacts during 4 consecutive weeks . The treatment manual included applied relaxation , communication strategies training , advice to relatives , information , and coping skills . Assessment s ( pre-post ) were conducted in a structured interview measuring coping behaviour . In order to evoke behavioural compensation small acoustic provocations were included in the interview . Pre-post assessment s also included question naires , daily registered hearing problems , and hours of daily hearing aid use . Results showed significant beneficial effects in favour of the treatment in terms of self-assessed problems and behaviour change BACKGROUND Reduced hearing in elderly people is important because it is disabling and potentially treatable . We aim ed to assess the prevalence of reduced hearing in elderly people and levels of ownership of hearing aids and use . METHODS We have done a cross-sectional survey of people aged at least 75 years in 106 family practice s in the UK . We obtained self-reported data on hearing difficulties for 32,656 people and gave 14,877 a whispered voice test ( response rate 78 % ) . FINDINGS 2537 ( 8 % ) of 32,656 participants reported a lot of difficulty hearing and 13,630 ( 42 % ) a little or a lot of difficulty . 3795 ( 2 
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The clinical significance of these statistical findings is uncertain but it is likely that the outcomes were clinical ly significant for some , but not all , participants .
Delivery system design interventions These interventions did not significantly affect adherence or daily hours of hearing aid use in the short to medium term , or adverse effects in the long term .
There was no evidence of a statistically or clinical ly significant effect on hearing h and icap , hearing aid benefit or the use of verbal communication strategies in the short to medium term .
There is some low to very low quality evidence to support the use of self management support and complex interventions combining self management support and delivery system design in adult auditory rehabilitation .