139 5 General Discussion limiting factor in delaying or preventing BCHD provision to children [21] resulting in up to half of appropriate patients not receiving a BAHD, underpinning the importance of appropriately and timely assessments. Conversely caregivers may be motivated to over report improvements in children based on previous experiences and expectations. When making our assessment of the impact of hearing devices, the BWCH team built a relationship with each family offering a direct contact system for any concerns. As a result of this, the BWCH team worked on the foundation that patients or caregivers would report concerns to medical professionals and request urgent review if necessary. The lack of attendance for routine follow-up appointments is therefore interpreted as a lack of complications or concerns. This is only possible due to the ease of the open communication streams between patients and our program team to allow for direct review if requested. To improve these factors in the future, we continually strive to reduce barriers to attendance, offering telephone consultations, email contact, App based questionnaires and video consultations. In recent years following the impact of the Covid 19 pandemic, remote consultations have become increasingly more common in practice as the infrastructure and IT platforms to support them have become readily available. In addition, patient understanding of these alternative methods of review has become more acceptable to patient groups. Although video consultation is in its infancy in the Birmingham program, this has potential and is likely to improve response rates and compliance in future studies. Core Principle 3 – Wider fixtures and better Abutment geometry. It is now well established that the wider diameter implant improves spontaneous implant losses as compared to the previous narrow implants. This in combination with surface modulation and optimisation in fixture design have improved osteointegration. Abutment shape and surface coating developments have improved skin infection, irritation, and overgrowth rates. In 2018, the use of the Cochlear BAI300 implant system demonstrated the impact of abutment and fixture design on clinical outcomes. The wider fixture was more stable with less fixture failures, however the abutment design was problematic resulting in increased peri abutment skin issues [22]. The combination of these factors leads to less medical or surgical interventions following implantation. Core Principle 4 – Processor Design capable of withstanding the paediatric population. As discussed earlier in the introduction chapter, there has been dramatic improvement in size, shape, and interconnectivity of BCHD processors. The reduction in the overall footprint, weight and increased mounting options makes the sound processor more cosmetically acceptable. This combined with increased inter-connectivity options to help in classroom setting with
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