Program Rules

The program rules page is where you can configure rules for shift/averaging calculations and assign them to projects. Shift reports and the auto-triage process rely on the correct configuration of these rules. Clicking on the icon will allow you to configure rule settings.

Note: the "Default" rule applies to all patients in projects without a shift rule assigned to them, and patients in "default project (unassigned)."

The two calculations you can configure in this section are the Shift Standard and Averaging Label. These calculations are automatically performed by your SHOEBOX app using a patient's audiogram results to provide you with specific values that you may be required to include in a patient's final test results.

Shift Standard

Shift standards are shift calculations or grading scales used to evaluate hearing changes. Here, you can set which calculations are used in your organization. These calculations are used for Patient Analysis, Summary Reports, and Automatic Triage.

Shift standards use the results of a patient's audiogram to automatically calculate things like recordable shifts in a patient's hearing ability, or measurable grades of hearing that are given to a patient based on their audiogram results.

During your testing, you may be required to use different Calculation Standards, based on your specific use case. Listed below are examples of the different calculation standards offered within SHOEBOX, and the industries they apply to.

Hearing Conservation Calculation Standards

OSHA (Occupational Safety and Health Administration)

As a part of the Department of Labor, OSHA is the regulatory and standard body for occupational health in the US. The specific standard that applies to occupational hearing conservation is 29 CFR 1910-95. Note that this is a national standard but that more than 25 states have their own state-specific OSHA guidelines in place for hearing conservation which take precedence over the national guidelines.

This calculation standard is used in compliance with OSHA to determine if there has been a measurable shift in a patient's hearing ability. While performing hearing conservation testing, you may be required to provide an indication of a recordable shift as a part of a patient's final test results.

OSHA With Age Adjustment

The same as above, with the addition of automatic adjustment to the calculation based on the patient's age. This variant of the OSHA calculation standard is not required, but optional in 48 states, and is not permitted at all in Oregon and Washington.

MSHA (Mining Safety and Health Administration)

Similar to OSHA and FRA but for the mining industry. MSHA works cooperatively with industry, labor, and other federal and state agencies to improve safety and health conditions for all miners in the United States.

A calculation standard used in compliance with MSHA to determine if there has been a measurable shift in a patient's hearing ability. While performing hearing conservation testing, you may be required to provide an indication of reportable shift as a part of a patient's final test results.

MSHA With Age Adjustment:

The same as above, with the addition of automatic adjustment to the calculation based on the patient's age. This variant of the OSHA calculation standard is not required, but optional in 48 states, and is not permitted at all in Oregon and Washington.

Note: SHOEBOX currently does not support calculation standards or test settings for FRA.

Clinical Calculation Standards

CTCAE

Common Terminology Criteria for Adverse Events (CTCAE) is commonly used as the standard classification and severity grading scale for adverse drug events in cancer therapy. Many clinical trials have adopted this 5 point grading scale.

Enable this if you would like to include a CTCAE grade on your patient's results.

Brock

The Brock grading scale is a 5-point scale and was specifically designed for pediatric oncology patients treated with cisplatin. This system is used to grade hearing loss progression from high to lower frequencies, taking into account the typical drug-induced configuration of high frequency loss. The grade is calculated for test frequencies from 1000 to 8000 Hz. Note that a grade of 0 does not necessarily indicate hearing within normal limits with this scale.

Enable this if you would like to include a Brock grade on your patient's results.

 

Averaging Label

During your testing, you may be required to calculate the PTA (Pure Tone Average) or AHL (Average Hearing Level). The Averaging Label determines which value (PTA/AHL) displays in the Analysis section of a patient's Summary Report, and can also be selected as an averaging model when building a report.

The frequencies that you select here will be used to calculate the average.

AHL (Average Hearing Level) is typically used in Hearing Conservation and is required for the following shift standards: OSHA, OSHA with Age Adjustment, MSHA, and MSHA with Age Adjustment. It is the average threshold across 2K Hz, 3K Hz and 4K Hz.

PTA (Pure Tone Average) is typically used in Audiology to determine hearing sensitivity in the speech frequencies. It is the average across your selected frequencies, most commonly 500 Hz, 1K Hz, 2K Hz, and 4K Hz.

Creating New Rules

You can create additional program rules with configurations that differ from the default rule and assign them to a specific project or projects. This is done if your organization is testing patients that require specific calculation standards to be in effect.

A good example of this is if you are performing occupational hearing testing on patients in Oregon or Washington state, where shift calculations without age adjustment are required by law. In this example, you would group all patients from these states into a separate project, create a new rule that uses the OSHA shift standard without age adjustment, and apply that rule to all patients contained within that project.

Note: the "Default" rule applies to all patients in projects without a shift rule assigned to them, and patients in "default project (unassigned)."

To create a new rule:

  1. Click on the "New" button in the top right corner of the page
  2. Give your new rule a title, assign it to a project(s), and select the shift standard and averaging label you would like the rule to use
  3. Click "Save" to save your new rule

Your new rule will then appear above the default rule. Rules can be edited at any time by clicking on the icon.

Last Updated: 2020-03-24

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