The health service perspective on determinants of success in allied health student research project collaborations: a qualitative study guided by the Consolidated Framework for Implementation Research.

BACKGROUND: A research culture in health care organisations is associated with improved healthcare performance. Allied health (AH) students undertake research training as part of their professional degree qualifications. This may include participation in research projects, sometimes undertaken in association with health services. Co-supervision of these projects by health service staff provides research capacity building opportunities and staff-centred outcomes for the individuals involved, as well as improvements in clinical knowledge and practice within the local area. Also, publications from these projects contribute to the wider evidence base. Identification of barriers and facilitators to engagement in, and conduct of, these projects may optimise systems for improved health service outcomes. METHODS: This formative evaluation used the Consolidated Framework for Implementation Research (CFIR) to guide analysis of qualitative data obtained from semi-structured interviews with health service-employed allied health professionals, including clinicians and research fellows, who had supervised students on clinical-related research placements within the previous five years. RESULTS: Eleven AH clinicians described 18 collaborative projects with 24 students from five AH disciplines across four universities. Three health service-employed AH research fellows described their involvement in these and other student research projects. Twenty key determinant constructs were identified and mapped across all five CFIR domains. Facilitators included health service cosmopolitanism, project adaptability and implementation climate (compatibility). Health service-employed research fellows provided readiness for implementation and a facilitator for project execution. The main barriers identified were cost to staff in workload and personal time and aspects related to project complexity. Differing student characteristics affected the relative advantage of collaborative projects in positive and negative manners. CONCLUSIONS: This study describes the facilitators and barriers to the conduct of collaborative AH student research projects. Addressing these determinants when establishing each new project may enable health services to optimise communication, role delineation and project success, and thus ultimately, healthcare performance and patient care.

Investigating the impact of autistic children's feeding difficulties on caregivers.

AIM: The aim of this study was to investigate the influence of children's autism characteristics, sensory profiles and feeding difficulties on caregiver-reported impact at mealtimes. BACKGROUND: Caregivers of children (5-12 years) with a diagnosis of Autism Spectrum Disorder completed an online survey examining (a) demographic characteristics, (b) children's autism characteristics (Social Communication Questionnaire), (c) sensory profiles (Sensory Profile 2-short form), (d) feeding difficulties (Behavioural Paediatrics Feeding Assessment Scale, BPFAS) and (c) caregiver-reported impact of feeding difficulties (Feeding-Swallowing Impact Survey, FS-IS). RESULTS: Seventy-eight caregivers completed surveys for 80 children. Children with clinically significant feeding difficulties on the BPFAS (n = 55, 68.8%) had higher levels of caregiver-reported impact on daily activities, worry and feeding difficulties compared to children without clinically significant feeding difficulties (FS-IS; U = 257.000, z = -4.471, p < 0.01). Spearman's rank correlation showed a statistically significant, moderate correlation between BPFAS total frequency score and FS-IS Daily activities score, rs (98) = 0.56, p < 0.01, indicating that as the frequency of feeding difficulties increased, the impact of these feeding difficulties on caregivers also increased. Using multiple regression, a model comprising of the three factors was statistically significant (F[1, 78] = 87.75, p < 0.001, adj. R2 = 0.52), with children's frequency of feeding difficulties the strongest predictor of caregiver-reported impact with a moderate effect size (r = 0.49). CONCLUSION: Autistic children's feeding difficulties had a greater impact on caregivers than autism or sensory profiles, with the frequency of feeding difficulties and the caregiver impact of these feeding difficulties positively correlated. The findings demonstrate that efforts to understand and address feeding difficulties in autistic children must extend beyond the children to include their families.

Cervical Auscultation for Detecting Oropharyngeal Aspiration in Paediatric and Adult Populations: A Systematic Review and Meta-Analysis.

BACKGROUND: Cervical auscultation (CA) involves listening to swallowing and respiratory sounds and/or vibrations to detect oropharyngeal aspiration (OPA). CA has shown promising diagnostic test accuracy when used with the clinical swallowing examination and is gaining popularity in clinical practise. There has not been a review to date analysing the accuracy of CA in paediatric and adult populations with meta-analyses. OBJECTIVES: To determine the accuracy of CA in detecting OPA in paediatric and adult populations, when compared to instrumental assessments. SEARCH METHODS: Databases searched included MEDLINE, PubMed, Embase, CINAHL, AustHealth, Cochrane and Web of Science. The search was restricted between 01 October 2012 and 01 October 2022. SELECTION CRITERIA: Inclusion criteria included (a) all clinical populations of all ages, (b) who have had an instrumental assessment and (c) CA. All study types were included. DATA COLLECTION AND ANALYSIS: Studies were reviewed independently by two authors. The methodological quality of the studies was analysed using the QUADAS-2. MAIN RESULTS: Ten studies met the inclusion criteria for this review and meta-analyses. The pooled diagnostic performance of CA in detecting OPA was 0.91 for sensitivity and 0.79 for specificity. The area under the curve summary receiver operating curve (sROC) was estimated to be 0.86, thereby indicating good discrimination of OPA. Most studies scored high for risk of bias in at least one domain in the QUADAS-2, likely attributed to a lack of high-quality prospectively designed studies. CONCLUSIONS: There are promising diagnostic test accuracies for the use of CA in detection of OPA. Future research could include using CA in specific clinical populations and settings, and identifying standardised criteria for CA.

Influence of frame rate in detecting oropharyngeal aspiration in paediatric videofluoroscopic swallow studies - An observational study.

OBJECTIVES: The videofluoroscopic swallow study (VFSS), currently the gold standard for assessing aspiration in children, incurs radiation. Adhering to the ALARA principle is crucial in minimising radiation dose whilst obtaining accurate diagnostic information in children. International adult VFSS guidelines recommend a capture rate of 30 frames per second (fps). Higher capture rates increase radiation yet there is limited evidence on best practice VFSS capture rates in children, particularly on thin fluid consistency-the fastest viscosity with the highest potential for missed aspiration on slower capture rates. We aimed to determine if image acquisition at 30fps versus 15fps alters the accuracy of detecting aspiration when assessing thin fluids during paediatric VFSS. MATERIALS & METHODS: Seventeen speech language pathologists (SLPs) blindly rated a total of 2,356 swallow loops for the presence/absence of aspiration from VFSS recordings of 13 infants/children drinking thin fluids. 76 swallow loops were randomly presented at 15 versus 30fps, on two occasions. Area under receiver operating curve (aROCs) was used to compare the accuracy of aspiration ratings at 15 versus 30fps compared to a comparison set. The intraclass correlation coefficient (ICC) was used to examine rater reliability. RESULTS: Accuracy for detecting aspiration was near-identical at 15fps (aROC:0.97; 95%CI:0.96-0.97) and 30fps (0.96; 95%CI 0.96-0.97). Good inter-rater (ICC:0.82; 95%CI:0.72-0.89) and intra-rater reliability among the raters (ICC:0.89; 95%CI:0.82-0.93) was found. CONCLUSION: Using 15fps in paediatric VFSS when assessing thin fluid consistency aspiration provides a similar detection rate to using 30fps. As 15fps would have a lower radiation dose than 30fps, we recommend using 15fps when undertaking VFSS in children. CLINICAL RELEVANCE STATEMENT: Adhering to the ALARA principles, a capture rate of 15fps should be used in paediatric VFSS for assessment on thin fluids.

Exploring barriers and solutions to consumer involvement in health service research using a nominal group technique.

BACKGROUND: Consumer involvement in health research is when patients, their families and caregivers work with researchers on research projects. Despite the growing expectation for health services to facilitate the involvement of consumers in research, the practical integration of this approach is an ongoing process, with limited research conducted into how Australian health services can support this practice. This study explored consumer perspectives on the barriers and solutions to enabling consumer involvement in research within an Australian tertiary hospital and health service, and staff perspectives on the solutions to facilitating consumer involvement. A prior survey had identified barriers to consumer involvement from the staff perspective. The broad aim was to inform the development of a framework to help promote consumer involvement in research within the health service. METHODS: A Nominal Group Technique (NGT) was utilised with groups comprised of health service consumers and staff. Three health consumers were co-researchers in the full life-cycle of this study and are included as authors. RESULTS: Ten consumers and 14 staff participated across three sessions ranging from one to three hours. For consumers, barriers to their involvement were grouped into seven domains: (1) lack of connection with researchers/research projects, (2) low research literacy, (3) structural barriers, (4) lack of acknowledgement, (5) implementation challenges, (6) inadequate information provision, and (7) representation concerns. Solutions to enabling involvement were grouped into five domains: (1) support to connect with researchers/research projects, (2) adequate information provision, (3) incentive for involvement, (4) acknowledgement, and (5) balanced representation. Staff ideas for solutions were grouped into five domains: (1) support to connect with consumers, (2) support to involve consumers, (3) access to funds to remunerate consumers, (4) more time to involve consumers, and (5) staff training. CONCLUSION: Through an NGT methodology, this study delivered a nuanced comprehension of perspectives on involving consumers in research from both health service consumers and staff. These findings serve as a foundation for identifying strategies that foster enhanced and refined relationships between consumers and researchers, advancing the collaborative landscape in health research. The findings from this project offer valuable strategies for researchers to better engage consumers in research and for consumer groups to enhance their involvement. Additionally, these insights could be used by other health services to advocate for essential resources.

Consumer involvement in health research is when patients, their families, and caregivers work with researchers on research projects. While there is a growing expectation for health services to promote the involvement of consumers in health service research, it is still a work in progress, especially in Australia, where there hasn't been much research done on this topic. This study looked at what consumers and staff at an Australian hospital thought would hinder or help consumers to become involved in health research. The study used a method called the Nominal Group Technique (NGT), where groups of staff and consumers met for sessions ranging from one to three hours to share and prioritise their ideas. Consumers thought that barriers to their involvement included difficulty connecting with researchers or projects, not knowing much about research, and personal barriers to involvement (such as lack of childcare). They believed that better connection with researchers, information, incentives for involvement, and ensuring everyone's voices are heard were possible solutions. Staff also had ideas for solutions, like providing support to connect with consumers and more time for research activities. Overall, this study describes what consumers and staff think about working together on research. These findings can help develop strategies for building relationships between consumers and researchers, advancing collaborative efforts in health research.