Predictors of compassion satisfaction and compassion fatigue in health care workers providing health and rehabilitation services in rural and remote locations: A scoping review.

INTRODUCTION: A better understanding of the predictors of compassion satisfaction and compassion fatigue in health care workers in rural and remote communities is needed to inform preventative interventions for this sector of the health workforce. OBJECTIVE: To identify predictors of compassion satisfaction and compassion fatigue in health care workers providing health and rehabilitation services in rural and remote locations. DESIGN: A scoping review informed by Arksey and O'Malley's five-stage framework and the scoping review protocol of the PRISMA-ScR statement. FINDINGS: The search yielded 946 articles, and 34 full texts were screened for eligibility, leaving 12 studies meeting the inclusion criteria. No studies on workers providing rehabilitation services were identified. Three studies assessed possible predictors of compassion satisfaction and compassion fatigue in health care workers, and all studies evaluated burnout. The most studied predictor variables were age, gender, profession and workload. DISCUSSION: This study identified potential risk and protective factors for health care workers that are likely relevant to those providing rehabilitation services in rural locations. Little is known about possible predictors of compassion satisfaction and compassion fatigue in professionals working in rural and remote areas outside of medicine and nursing or health care workers in rural community-based settings. CONCLUSION: Research examining predictors of compassion satisfaction and compassion fatigue in rehabilitation health care workers working in rural and remote locations is scant. Research that identifies risk and protective factors in this rapidly growing sector of the health care workforce is needed to inform the development of interventions that promote professional quality of life.

Cognitive-communication and psychosocial functioning 12 months after severe traumatic brain injury.

OBJECTIVE: Cognitive-communication deficits after severe Traumatic Brain Injury (TBI) may contribute to poor psychosocial functioning, however, the possible nature of this relationship remains unclear and warrants investigation. The current study explored the variance and correlations of a measure of cognitive-communication with a measure of psychosocial outcome in adults 12 months following TBI. METHOD: 36 adults with severe TBI evaluated at 12 months post-injury. Cognitive-communication skills were evaluated with the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES), Sydney Psychosocial Reintegration Scale-2 (SPRS-2) Form A - Informant version assessed psychosocial functioning. Multiple regression analyses were used to investigate association between cognitive-communication and psychosocial outcomes. RESULTS: Two measures of cognitive-communication assessment (Accuracy and Rationale of the FAVRES) contributed significantly to total psychosocial outcome (SPRS-2). Multiple regression analyses revealed these variables accounted for 29.1% of the variance. Cognitive-communication variables accounted for 24.0% and 28.6% of the Work/Leisure and Relationship domains of the SPRS-2. CONCLUSION: Cognitive-communication ability was significantly related to psychosocial functioning at 12 months post-TBI. Findings suggested continued speech pathology involvement in the post-acute stages of recovery may improve social, vocational and overall psychosocial functioning. The FAVRES is a promising cognitive-communication assessment for identification of treatable factors impacting psychosocial outcomes.

The Lidcombe Program and child language development: Long-term assessment.

This study was driven by the need to understand the mechanisms underlying Lidcombe Program treatment efficacy. The aim of the present study was to extend existing data exploring whether stuttering reductions observed when children successfully treated with the Lidcombe Program are associated with restricted language development. Audio recordings of 10-min parent-child conversations at home were transcribed verbatim for 11 pre-school-age children with various stuttering severities. Language samples from three assessments-pre-treatment, 9 and 18 months after beginning treatment-were analysed using SALT software for lexical diversity, utterance length and sentence complexity. At 18 months posttreatment commencement, the children had attained and maintained statistically significant stuttering reductions. During that period, there was no evidence that Lidcombe Program treatment was associated with restricted language development. The continued search for the mechanisms underlying this successful treatment needs to focus on other domains.

Exploring the relationship between cognition and functional verbal reasoning in adults with severe traumatic brain injury at six months post injury.

OBJECTIVE(S): This study aims to determine the association between cognitive impairment and functional verbal reasoning in adults with severe traumatic brain injury (TBI), at six months post-injury. METHOD(S): 38 participants with severe TBI were assessed using the four tasks on the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) [1] and a battery of neuropsychological tests at 6 months post injury in a cross-sectional observational study. RESULTS: Overall performance on the FAVRES [1] was strongly associated with overall performance on the neuropsychological battery (rho = 0.60). FAVRES Task 2 and FAVRES Task 4 had the most significant positive associations with the cognitive indices of Attention and speed of processing, Memory and Executive functions. There was one weak significant association between the Task 1 Accuracy score and the Total Cognitive index (rho = 0.46). CONCLUSIONS: Performance on the FAVRES [1] is positively associated with cognitive processes. Participants with stronger verbal reasoning skills which may be required for activities in work, home and social contexts also had higher scores on tests of cognitive functioning. These findings may inform clinical practices for speech pathologists and other health professionals, in the assessment and treatment of cognitive communication disorders during early stages of recovery in people with severe TBI.

The Monosyllable Imitation Test for Toddlers: influence of stimulus characteristics on imitation, compliance and diagnostic accuracy.

BACKGROUND: Although verbal imitation can provide a valuable window into the developing language abilities of toddlers, some toddlers find verbal imitation challenging and will not comply with tests that involve elicited verbal imitation. The characteristics of stimuli that are offered to toddlers for imitation may influence how easy or hard it is for them to imitate. This study presents a new test of elicited imitation-the Monosyllable Imitation Test for Toddlers (MITT)-comprising stimuli of varying characteristics and test features designed to optimize compliance. AIMS: To investigate whether the stimulus characteristics of neighbourhood density and consonant complexity have independent and/or convergent influences on imitation accuracy; and to examine non-compliance rates and diagnostic accuracy of the MITT and an existing test, the Test of Early Nonword Repetition (TENR) (Stokes and Klee 2009a). METHODS & PROCEDURES: Fifty-two toddlers (25-35 months) participated. Twenty-six had typically developing language (TDs) and 26 were defined as late talkers (LTs) based on parent-reported vocabulary. The MITT stimuli were created by manipulating both neighbourhood density (dense or sparse) and consonant complexity (early- or late-developing initial consonant). The MITT was designed to maximize compliance by: (1) using eight monosyllabic stimuli, (2) providing three exposures to stimuli and (3) embedding imitation in a motivating context: a computer animation with reasons for imitation. OUTCOMES & RESULTS: Stimulus characteristics influenced imitation accuracy in TDs and LTs. For TDs, neighbourhood density had an independent influence, whereas for LTs consonant complexity had an independent influence. These characteristics also had convergent influences. For TDs, stimuli were all equally easy to imitate, except those that were both sparse and contained a late-developing consonant which were harder to imitate. For LTs, stimuli that were both dense and contained an early-developing consonant were easier to imitate than any other stimuli. Two LTs and no TDs were non-compliant with the MITT. With the TENR, five LTs and two TDs were non-compliant. The MITT and TENR yielded similar levels of diagnostic sensitivity, but the TENR offered higher specificity rates. Subsets of stimuli from the MITT and the TENR also showed diagnostic promise when explored post-hoc. CONCLUSIONS & IMPLICATIONS: Stimulus characteristics converge to influence imitation accuracy in both TD and LT toddlers and therefore should be considered when designing stimuli. The MITT resulted in better compliance than the TENR, but the TENR offered higher specificity. Insights about late talking, elicited imitation and speech production capabilities are discussed.

Screening mammography: test set data can reasonably describe actual clinical reporting.

PURPOSE: To establish the extent to which test set reading can represent actual clinical reporting in screening mammography. MATERIALS AND METHODS: Institutional ethics approval was granted, and informed consent was obtained from each participating screen reader. The need for informed consent with respect to the use of patient materials was waived. Two hundred mammographic examinations were selected from examinations reported by 10 individual expert screen readers, resulting in 10 reader-specific test sets. Data generated from actual clinical reports were compared with three test set conditions: clinical test set reading with prior images, laboratory test set reading with prior images, and laboratory test set reading without prior images. A further set of five expert screen readers was asked to interpret a common set of images in two identical test set conditions to establish a baseline for intraobserver variability. Confidence scores (from 1 to 4) were assigned to the respective decisions made by readers. Region-of-interest (ROI) figures of merit (FOMs) and side-specific sensitivity and specificity were described for the actual clinical reporting of each reader-specific test set and were compared with those for the three test set conditions. Agreement between pairs of readings was performed by using the Kendall coefficient of concordance. RESULTS: Moderate or acceptable levels of agreement were evident (W = 0.69-0.73, P < .01) when describing group performance between actual clinical reporting and test set conditions that were reasonably close to the established baseline (W = 0.77, P < .01) and were lowest when prior images were excluded. Higher median values for ROI FOMs were demonstrated for the test set conditions than for the actual clinical reporting values; this was possibly linked to changes in sensitivity. CONCLUSION: Reasonable levels of agreement between actual clinical reporting and test set conditions can be achieved, although inflated sensitivity may be evident with test set conditions.

A Pilot Randomized Control Trial of Motor-Based Treatments for Childhood Apraxia of Speech: Rapid Syllable Transition Treatment and Ultrasound Biofeedback.

PURPOSE: Both Rapid Syllable Transition Treatment (ReST) and ultrasound biofeedback are effective approaches to treating childhood apraxia of speech (CAS). The purpose of the study was to compare outcomes from these two motor-based treatment approaches for school-age children with CAS. METHOD: In a single site, single blind randomized control trial, 14 children with CAS ages 6-13 years were randomly assigned to 12 sessions over 6 weeks of either of ultrasound biofeedback treatment (with a speech motor chaining practice structure) or ReST. Treatment was delivered at The University of Sydney by students trained and supervised by certified speech-language pathologists. Transcriptions from blinded assessors were used to compare the two groups on speech sound accuracy (percent phonemes correct) and prosodic severity (lexical stress errors and syllable segregation) in untreated words and sentences at three time points: pretreatment, immediately posttreatment, and 1-month posttreatment (i.e., retention). RESULTS: Both groups showed significant improvement on treated items indicating a treatment effect. At no time was there a difference between groups. Both groups showed a significant improvement in speech sound accuracy on untreated words and sentences from pre to post and neither group showed an improvement in prosody pre-post. Changes to speech sound accuracy were retained by both groups at 1-month follow-up. Significant improvement in prosodic accuracy was reported at the 1-month follow-up. CONCLUSIONS: ReST and ultrasound biofeedback were equally effective. Either ReST or ultrasound biofeedback may be viable treatment options for school-age children with CAS. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22114661.

Identifying Clinical Behaviors Using the Motor Learning Classification Framework: A Pilot Study.

CONTEXT: Although differences in clinical interactions with patients between students and experienced clinicians are well described, differences in therapeutic training behaviors have not been explored, especially in relation to motor learning principles. AIMS: This pilot study compared clinical behaviors between speech language pathology (SLP) students and experienced SLPs in a voice therapy task, using prepractice variables in the Motor Learning Classification Framework (MLCF). METHODS: Using a quasi-experimental design, five final-year undergraduate SLP students and four experienced SLPs with a voice therapy caseload taught a standardized patient to produce a vocal siren. Two trained raters categorized the clinicians' behaviors using the MLCF. RESULTS: High intrarater reliability (91.9%, 92.3%) and interrater reliability (89.6%, 82.1%) were shown across both raters. Both clinician groups used the same percentage of behaviors classified as verbal information but differed in the subtypes of these behaviors. Experienced clinicians used behaviors categorized as problem-solving and only experienced clinicians used repeated behavior sequences that included perceptual training. Both groups used significantly more talking behaviors than doing behaviors. CONCLUSIONS: The MLCF can be reliably used to identify prepractice behaviors during client interactions in voice therapy. Students and experienced clinicians showed similarities in behaviors, but experienced clinicians used more problem solving and perceptual training behaviors than students. These differences have implications for student training. The greater use of talking behaviors than doing behaviors warrants further investigation into whether this impacts the subsequent quality of practice engaged by the client and ultimately treatment effectiveness.

Functionally significant differences in expression of disease-associated IL-7 receptor alpha haplotypes in CD4 T cells and dendritic cells.

Common genetic variants of IL-7 receptor alpha (IL-7Ralpha) have recently been shown to affect susceptibility to multiple sclerosis (MS) and type 1 diabetes, and survival following bone marrow transplantation. Transcription of the gene produces two dominant isoforms, with or without exon 6, which code for membrane-bound or soluble IL-7Ralpha, respectively. The haplotypes produce different isoform ratios. We have tested IL-7Ralpha mRNA expression in cell subsets and in models of T cell homeostasis, activation, tolerance, and differentiation into regulatory T cell/Th1/Th2/Th17, memory, and dendritic cells (DCs) under the hypothesis that the conditions in which haplotype differences are maximal are those likely to be the basis for their association with disease pathogenesis. Maximal differences between haplotypes were found in DCs, where the ligand is mainly thymic stromal lymphopoietin (TSLP). The MS-protective haplotype produces a much lower ratio of soluble to membrane-bound receptor, and so potentially, DCs of this haplotype are more responsive to TSLP. The TSLP/IL-7Ralpha interaction on DCs is known to be critical for production of thymic regulatory T cells, and reduced production of these cells in MS susceptibility haplotypes may be a basis for its association with this disease. IL-7Ralpha mRNA expression varies greatly through cell differentiation so that it may be a useful marker for cell states. We also show that serum levels of soluble receptor are much higher for the MS susceptibility haplotype (p = 4 x 10(-13)). Because signaling through IL-7Ralpha controls T cell regulation, this haplotype difference is likely to affect the immunophenotype and disease pathogenesis.

Evaluating communication training for paid carers of people with traumatic brain injury.

PRIMARY OBJECTIVE: To evaluate the effectiveness of a communication training programme for paid carers to improve their conversational interactions with people with TBI. RESEARCH DESIGN: Single blinded randomized controlled study. METHODS AND PROCEDURES: Ten paid carers were randomly selected from a post-acute residential rehabilitation programme and allocated to either a training or control group. Training comprised a 17-hour programme (across 8 weeks) with conversational interactions (i.e. structured and casual) between paid carers and people with TBI videotaped pre-training, post-training and at 6-months follow-up. Interactions were rated on the Adapted Measure of Support in Conversation (MSC), Adapted Measure of Participation in Conversation (MPC) and Global Impression Scales of conversation. MAIN OUTCOMES AND RESULTS: Trained paid carers were more able to acknowledge and reveal the competence of people with TBI. Conversations were perceived as more appropriate, interesting and rewarding compared to the control group. Improvements were confined to the structured conversation and were maintained for 6 months. CONCLUSIONS: Training paid carers has a positive effect on improving conversational interactions with people with TBI in a long-term care facility. These improvements can help to foster increased independence for the person with TBI in the home and community.

Predicting Treatment Outcomes in Rapid Syllable Transition Treatment: An Individual Participant Data Meta-Analysis.

PURPOSE: The purpose of this study is to identify predictors of treatment outcomes in Rapid Syllable Transition Treatment (ReST) for childhood apraxia of speech through an individual participant data meta-analysis. METHOD: A systematic literature search identified nine ReST studies for inclusion. Individual participant data were obtained, and studies were coded for methodological design, baseline participant characteristics, service delivery factors, and treatment outcomes. Bivariate analyses were conducted to identify potential predictor variables. Multiple linear regressions were then performed to identify predictors of treatment outcomes. RESULTS: Data for 36 participants from seven studies were included in the statistical analyses. In multivariate modeling, better performance on treated pseudowords posttreatment was predicted by higher baseline expressive language and Goldman-Fristoe Test of Articulation scores, lower speech inconsistency and percentage of vowels correct, and higher pretreatment accuracy on pseudoword targets. Better performance on untreated real words posttreatment was predicted by higher pretreatment accuracy on real words. Gains in performance and retention of gains were not significantly predicted by any individual variable or combination of variables. CONCLUSIONS: Baseline speech and expressive language skills and accuracy on pseudowords and real words were significant predictors of absolute posttreatment performance. Regardless of baseline characteristics, all children were statistically as likely to achieve gains during ReST and retain these gains for up to 4 weeks posttreatment. Large-scale prospective research is required to further examine the effects of dose frequency and co-occurring language impairments on treatment outcomes and the complex co-effects of percentage of vowels correct with other potential predictors. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19611714.

Understanding mammographic breast density profile in China: A Sino-Australian comparative study of breast density using real-world data from cancer screening programs.

AIM: This study aims at understanding mammographic density profile in China by comparing the density between women in China and Australia. METHODS: Data of 3250 women aged 45-69 were obtained from the Cancer Screening Program in Urban China and data of 1384 Australian counterparts at same age range were gathered from the Lifepool project. Demographic and reproductive details and mammograms for each cohort were collected. Mammographic density was assessed using AutoDensity, and two metrics, percentage density (PD) and dense area (DA), were applied. T-tests were used to compare the means of mammographic density between two populations of all, premenopausal, and postmenopausal women. Two-way ANOVA was conducted to examine interactions of population (Chinese/Australian) and each variable of interest upon mammographic density. RESULTS: Chinese women had 9.61%, 8.20%, and 9.28% higher PD than their Australian counterparts in all, premenopausal, and postmenopausal women, respectively (all p < 0.001). The mean differences in DA between two population were 1.81 cm2 (p < 0.001), 0.55 cm2 (p = 0.472), and 1.76 cm2 (p = 0.003) for all, premenopausal, and postmenopausal women, respectively. There were significant interactions between population and age (F[4, 4624] = 4.12, p = 0.003), BMI (F[2, 4628] = 3.92, p = 0.020), age at first birth (F[1, 4250] = 11.69, p < 0.001), breastfeeding history (F[1, 4479] = 17.79, p < 0.001), and breastfeeding duration (F[1, 3526] = 66.90, p < 0.001) upon PD. Interaction was only found for breastfeeding history (F[1, 4479] = 4.79, p = 0.029) and breastfeeding duration (F[1, 3526] = 17.72, p < 0.001) for DA. CONCLUSIONS: Both PD and DA were found to be higher in Chinese women compared to Australian women. The density difference by menopause status was shown and breastfeeding history affected breast density differently in both populations.

Variables Associated with Self-reported Language Impairment in Multiple Sclerosis: A Regression Analysis.

BACKGROUND: Persons with multiple sclerosis (MS) can experience language-related symptoms such as difficulty with word finding, understanding verbal information, and structuring discourse. These symptoms have negative psychological and interpersonal consequences. Studies exploring characteristics of language impairment in MS are limited. The aim of this study was to investigate what symptom-related (eg, fatigue), demographic (eg, age), clinical (eg, MS type), social network, and quality of life (QOL) variables are associated with language impairment in MS. METHODS: Participants were recruited internationally to complete an online questionnaire. A forward stepwise regression analysis was run with the dependent variable being a language impairment index from the Communication and Language Assessment questionnaire for persons with Multiple Sclerosis (CLAMS). Nineteen independent variables were entered into the regression. RESULTS: Two hundred and two participants completed the questionnaire. The CLAMS language impairment score was significantly associated with self-reported cognitive impairment, speech and voice impairment, yes/no response to a binary question on presence of language impairment, group membership and participation, and QOL. The adjusted R2 value was 0.717 (P < .001). CONCLUSIONS: Self-reported language impairment in MS is significantly associated with several symptom-related, social network, and QOL variables. These results provide an early model of language impairment in MS to guide future studies of treatment approaches and causative relationships between variables.

Clinical Trials of Adult Stuttering Treatment: Comparison of Percentage Syllables Stuttered With Self-Reported Stuttering Severity as Primary Outcomes.

Purpose In a companion paper, we found no statistical reason to favor percentage syllables stuttered (%SS) over parent-reported stuttering severity as a primary outcome measure for clinical trials of early stuttering. Hence, considering the logistical advantages of the latter measure, we recommended parent-reported stuttering severity for use as an outcome measure. The present report extends the prior analysis to a comparison of %SS with self-reported stuttering severity (SRSS) for use as an outcome measure in clinical trials of stuttering treatments for adults. Method We analyzed data from four randomized clinical trials for adults that incorporated %SS and SRSS data at prerandomization and at 6 months post randomization. We analyzed the distributions associated with the two measures, their agreement, and their estimates of effect sizes. Results The positively skewed distribution of %SS warrants much reservation about its value as a clinical trial outcome measure. This skew causes inherent instability because of spurious data associated with low scores, which occur commonly at the low end of such a distribution. This inherent instability is compounded by inherent problems with absolute reliability of %SS measures. These problems are reduced with the much more normal distribution of SRSS. Conclusions The logistical arguments in favor of SRSS apply similarly to adults as they do when parents report the stuttering severity of their children. However, there are statistical reasons to favor SRSS over %SS measures as a primary outcome of clinical trials with adult participants: SRSS has acceptable discriminant validity and a normal distribution, and it is less error prone than %SS. We recommend SRSS as a primary outcome for clinical trials of adults with stuttering.

Characteristics of Mammographic Breast Density and Associated Factors for Chinese Women: Results from an Automated Measurement.

BACKGROUND: Characteristics of mammographic density for Chinese women are understudied. This study aims to identify factors associated with mammographic density in China using a quantitative method. METHODS: Mammographic density was measured for a total of 1071 (84 with and 987 without breast cancer) women using an automatic algorithm AutoDensity. Pearson tests examined relationships between density and continuous variables and t-tests compared differences of mean density values between groupings of categorical variables. Linear models were built using multiple regression. RESULTS: Percentage density and dense area were positively associated with each other for cancer-free (r=0.487, p<0.001) and cancer groups (r=0.446, p<0.001), respectively. For women without breast cancer, weight and BMI (p<0.001) were found to be negatively associated (r=-0.237, r=-0.272) with percentage density whereas they were found to be positively associated (r=0.110, r=0.099) with dense area; age at mammography was found to be associated with percentage density (r=-0.202, p<0.001) and dense area (r=-0.086, p<0.001) but did not add any prediction within multivariate models; lower percentage density was found within women with secondary education background or below compared to women with tertiary education. For women with breast cancer, percentage density demonstrated similar relationships with that of cancer-free women whilst breast area was the only factor associated with dense area (r=0.739, p<0.001). CONCLUSION: This is the first time that mammographic density was measured by a quantitative method for women in China and identified associations should be useful to health policy makers who are responsible for introducing effective models of breast cancer prevention and diagnosis.

Changes in semantic fluency across childhood: Normative data from Australian-English speakers.

PURPOSE: Verbal fluency tests are often used as part of an assessment battery to investigate children's lexical knowledge as well as executive function skills. To date, however, issues surrounding consistency of measurement cloud comparisons across studies, with the developmental performance of Australian-English speaking children also currently lacking. This study tracked verbal fluency development as measured by two semantic fluency tasks that included coding of fluency, clustering and switching type responses. METHOD: Participants included 355 typically developing Australian-English speaking children (4-10 years) and 46 young adults. Total fluency was determined by the number of words produced for each category (Animals or Food), minus repetitions and rule violations. Semantic clusters (words generated within a subcategory) were coded while switches between single words or subcategories were differentiated and coded as either hard or cluster switches. RESULT: Fluency showed consistent improvement over age. Cluster Switches and Hard Switches showed some evidence of a plateau in performance relative to fluency, but in opposite direction. Other measures showed no strong trends over age. Results were similar for both semantic categories. CONCLUSION: Our results highlight the rich information available within a semantic fluency task and the importance of differentiating hard and cluster switches in paediatric samples.

Safety Behaviors and Stuttering.

Purpose: Those who are socially anxious may use safety behaviors during feared social interactions to prevent negative outcomes. Safety behaviors are associated with anxiety maintenance and poorer treatment outcomes because they prevent fear extinction. Social anxiety disorder is often comorbid with stuttering. Speech pathologists reported in a recent publication (Helgadottir, Menzies, Onslow, Packman, & O'Brian, 2014a) that they often recommended procedures for clients that could be safety behaviors. This study investigated the self-reported use of safety behaviors by adults who stutter. Method: Participants were 133 adults who stutter enrolled in an online cognitive-behavior therapy program. Participants completed a questionnaire about their use of potential safety behaviors when anxious during social encounters. Correlations were computed between safety behaviors and pretreatment scores on measures of fear of negative evaluation and negative cognitions. Results: Of 133 participants, 132 reported that they used safety behaviors. Many of the safety behaviors correlated with higher scores for fear of negative evaluation and negative cognitions. Conclusions: Adults who stutter report using safety behaviors, and their use is associated with pretreatment fear of negative evaluation and unhelpful thoughts about stuttering. These results suggest that the negative effects of safety behaviors may extend to those who stutter, and further research is needed.