Inequalities in birth before arrival at hospital in South West England: a multimethods study of neonatal hypothermia and emergency medical services call-handler advice.

OBJECTIVES: To examine inequalities in birth before arrival (BBA) at hospitals in South West England, understand which groups are most likely to experience BBA and how this relates to hypothermia and outcomes (phase A). To investigate opportunities to improve temperature management advice given by emergency medical services (EMS) call-handlers during emergency calls regarding BBA in the UK (phase B). DESIGN: A two-phase multimethod study. Phase A analysed anonymised data from hospital neonatal records between January 2018 and January 2021. Phase B analysed anonymised EMS call transcripts, followed by focus groups with National Health Service (NHS) staff and patients. SETTING: Six Hospital Trusts in South West England and two EMS providers (ambulance services) in South West and North East England. PARTICIPANTS: 18 multidisciplinary NHS staff and 22 members of the public who had experienced BBA in the UK. RESULTS: 35% (64/184) of babies conveyed to hospital were hypothermic on arrival. When compared with national data on all births in the South West, we found higher percentages of women with documented safeguarding concerns at booking, previous live births and 'late bookers' (booking their pregnancy >13 weeks gestation). These women may, therefore, be more likely to experience BBA. Preterm babies, babies to first-time mothers and babies born to mothers with disability or safeguarding concerns at booking were more likely to be hypothermic following BBA. Five main themes emerged from qualitative data on call-handler advice: (1) importance placed on neonatal temperature; (2) advice on where the baby should be placed following birth; (3) advice on how to keep the baby warm; (4) timing of temperature management advice and (5) clarity and priority of instructions. CONCLUSIONS: Findings identified factors associated with BBA and neonatal hypothermia following BBA. Improvements to EMS call-handler advice could reduce the number of babies arriving at hospital hypothermic.

A Markov Chain Model for Mental Health Interventions.

Poor mental health affects nearly one billion people worldwide and can end in suicide if not treated. Unfortunately, stigma and a lack of mental healthcare providers are barriers to receiving needed care. We developed a Markov chain model to determine whether decreasing stigma or increasing available resources improves mental health outcomes. We mapped potential steps in the mental health care continuum with two discrete outcomes: getting better or committing suicide. Using a Markov chain model, we calculated probabilities of each outcome based on projected increases in seeking help or availability of professional resources. Modeling for a 12% increase in awareness of mental health concerns yielded a 0.39% reduction in suicide. A 12% increase in access to professional help yielded a 0.47% reduction in suicide rate. Our results show that expanding access to professional services has a higher impact on reducing suicide rates than creating awareness. Any intervention towards awareness or access positively impacts reducing suicide rates. However, increased access results in a higher reduction in suicide rates. We have made progress in increasing awareness. Awareness campaigns help to increase recognition of mental health needs. However, focusing efforts on increasing access to care may have a higher impact on reducing suicide rates.

Perceptual Assessment of Tracheoesophageal Voice Quality With the SToPS: The Development of a Reliable and Valid Tool.

Perceptual assessment of tracheoesophageal voice quality following total laryngectomy with surgical voice restoration is essential to investigate functional outcomes in relation to surgical procedure and rehabilitation regimes. There is no current tool with established reliability and validity to fulfill this purpose. This study describes the development of a set of new perceptual scales, in relation to core validity and reliability issues. These were investigated using voice stimuli from 55 voice prosthesis speakers and evaluated by 22 judges-12 speech and language therapists (SLTs), 10 Ear, Nose, and Throat surgeons-classified into experienced or not at assessing voice. SLT judges rated more parameters reliably than Ear, Nose, and Throat raters, and SLTs with specialist experience in laryngectomy and laryngeal voice attained the most parameters at an acceptable level of agreement. These scales are ready for clinical use, with the most optimal assessors being expert SLTs. Future studies are needed to ascertain precisely how reliability may relate to training, experience, voice stimuli type, and scale format.

A survey of speech-language therapy provision for people with post-stroke dysarthria in the UK.

BACKGROUND: A large number of people who experience a stroke are affected by dysarthria. This may be in isolation or in association with aphasia and/or dysphagia. Despite evidence highlighting the psychological and social impact of having post-stroke dysarthria and a number of clinical guidelines that make recommendations for appropriate management, little is known currently about UK service delivery issues relating to speech and language therapy (SLT) assessment and treatment for this group. Such evidence is necessary in order to plan, develop and research services for people with post-stroke dysarthria. AIMS: To gain an overview of SLT practices in the management of people with dysarthria after stroke in the UK. METHODS & PROCEDURES: SLTs in the UK were asked to complete an online survey addressing referral patterns, caseload profiles, and their assessment and intervention methods for post-stroke dysarthria. In the absence of a national register of clinicians working with people with acquired dysarthria, a snowballing method was used to facilitate participant recruitment. Results were analysed using descriptive statistics. OUTCOMES & RESULTS: A total of 146 SLTs responded. The majority were employed by the National Health Service (NHS). Most patients were referred within 1 week post-stroke. Almost half the respondents did not regularly use formal assessments and the use of instrumentation was rare, including the use of video recording. The focus of therapy for mild, moderate and severe dysarthria did not differ significantly for clinicians. A little under half the respondents endorsed non-verbal oral exercises in rehabilitation. The survey demonstrated some appreciation of the centrality of regular intensive practice to effect change, but this was in a minority. CONCLUSIONS & IMPLICATIONS: Through this research it became clear that basic information regarding post-stroke dysarthria incidence, prevalence and core demographics is currently unavailable. More embedded NHS SLT reporting systems would make a significant contribution to this area. A more in-depth examination is required of the natural history of dysarthria over the months and years following stroke, of SLT practices in relation to post-stroke dysarthria, with investigations to understand more fully the choices SLTs make and how this relates to available evidence to support their clinical decision-making.

Assessment of speech in neurological disorders: development of a Swahili screening test.

Assessments for acquired motor-speech disorders that look at movements of the articulators would appear at first glance to be universal. This may be true for the most basic non-speech aspects of movement. We argue that assessments for speech motor control must be attuned to language-specific variables to be fully valid. We describe the rationale for, and development of a motor-speech-disorder screening test for Swahili speakers which includes impairment measures as well as measures of intelligibility and speech-voice naturalness. We further describe its initial validation in terms of content validity, feasibility of administration and scoring without requirements for lengthy training and technical expertise and application to groups of people with and without Parkinson's disease in Tanzania. Results indicate that the protocol is ready to use in so far as it is acceptable to users (clinicians, patients), is feasible to use, shows good interrater reliability, and is capable of differentiating performance in healthy speakers and those whose speech is disordered. We highlight needs for further development, including issues around training, development of local norms for healthy speakers and for speakers with a variety of neurological disturbances, and extension of the tool to cover culturally valid assessment of impact of communication disorders.

Survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: patients' and carers' perspectives.

BACKGROUND: Communication and swallowing changes are prominent in Parkinson's disease, but there remains a lack of information regarding the experiences and expectations of people with Parkinson's disease in respect of speech-language therapy (SLT) services. AIMS: To conduct a survey of people with Parkinson's disease and their carers in the United Kingdom to elicit their views concerning communication and swallowing changes in Parkinson's disease and the support they envisage in helping with these changes. METHODS & PROCEDURES: A national survey utilizing a questionnaire developed for the project, accessible by people with Parkinson's disease in web-based, e-mail or paper forms. OUTCOMES & RESULTS: A total of 168 people with Parkinson's disease (median = 7 years since diagnosis, range = 0.5-30) and 47 carers who provided their impression of the experience of the PwPD responded. Of these 215, 92 (43%) had no contact with SLT services. In general those who had seen an SLT found it a positive experience. Pointers for improvement centred around timing, intensity, duration and access to SLT as well as issues around transfer and maintenance of gains outside of clinic and (lack of) attention to psychosocial dimensions. Availability of ongoing support as the situation evolved and access to SLT when it was needed were two prominent features desired of a responsive service. CONCLUSIONS & IMPLICATIONS: Responses suggest that when SLT is available it offers positive support, but respondents felt (re)access when and where SLT is needed could improve, as well as what aspects of swallowing and communication were addressed in assessment and therapy. We reflect on possible recommendations to address the challenges for SLT services in considering organization and content of provision.