Effectiveness of the corrective babbling speech treatment program for children with a history of cleft palate or velopharyngeal dysfunction.

OBJECTIVE: To investigate the effectiveness of a phonetic-based, parent-administered treatment to reduce cleft-related speech errors. DESIGN: Immediate treatment (IT) versus delayed treatment (DT) comparison followed by analysis of gains over approximately 4 months and again after a longer period of treatment for participants in both groups. PARTICIPANTS: Thirteen participants with a history of cleft palate or velopharyngeal dysfunction and speech disorder. INTERVENTION: After training, parents were instructed to conduct daily 10-minute sessions of phonetic drills with their children. MAIN OUTCOME MEASURES: Group differences in percent consonants correct (PCC) were compared between those who did and those who did not receive the treatment. Pre- and posttreatment PCC comparisons were made after approximately 4 months of treatment and after termination of treatment. RESULTS: Participants receiving Corrective Babbling therapy showed significant gains in PCC in limited contexts after 4 months of therapy. However, gains were not significantly greater for the IT versus DT group. Participants who continued with the treatment for longer than 4 months showed the greatest gains in PCC and had significant improvements in all speech contexts assessed. Parents reported satisfaction with the program. CONCLUSIONS: The results of this study indicate that this treatment shows promise for at least some children with a history of cleft palate and velopharyngeal dysfunction.

Drug-related bradycardia precipitating hospital admission in older adults: an ongoing problem.

BACKGROUND: Drug-related bradycardia (DRB) is a common clinical conundrum and can result in multiple hospital admissions as a result of the increased prescription of rate-limiting medications that can predispose to presyncopal or syncopal episodes. AIM: To evaluate the incidence of DRB in elderly hospital inpatients. METHODS: We conducted a retrospective analysis of all patients admitted to our acute medical unit between November 2018 and February 2019 and identified patients over the age of 70 with more than one diurnal bradycardic episode during their admission. We extracted patient demographics, presenting complaint, admission 12-lead ECG and medications from the hospital electronic database. RESULTS: We screened 2312 adults and identified 100 patients over the age of 70 years with two or more episodes of diurnal bradycardia during their hospital admission. This constituted 4.32% of total admissions. Beta blockers were the most commonly prescribed rate-limiting medication (n=54, 87.1%), of which bisoprolol was the most frequently prescribed (n=41) and sinus bradycardia was the most commonly identified rhythm disturbance in our cohort of patients (n=41, 41%). Syncope was the most common presenting symptom and occurred in 23 patients, 14 (60.9%) of which were diagnosed with a DRB. Atrial fibrillation was more common in those with DRB compared with those with bradycardia not caused by medications (35.5% vs 10.5%, p=0.006), and atrial fibrillation was a significant predictor of DRB (OR=10.2, 95% CI 3.3 to 31.6, p<0.001). CONCLUSION: Bradycardia is a significant cause of hospital admissions in older adults and can be avoided with pharmacovigilance. Caution should be exercised when initiating or changing the dose of rate-limiting agents in these patients; while those with atrial fibrillation should undergo regular review of their heart rate followed by appropriate medication dose adjustments.