Healthcare providers' perceived acceptability of a warning signs intervention for rural hospital-to-home transitional care: A cross-sectional study.

INTRODUCTION: There is a pressing need for transitional care that prepares rural dwelling medical patients to identify and respond to the signs of worsening health conditions. An evidence-based warning signs intervention has the potential to address this need. While the intervention is predominantly delivered by nurses, other healthcare providers may be required to deliver it in rural communities where human health resources are typically limited. Understanding the perspectives of other healthcare providers likely to be involved in delivering the intervention is a necessary first step to avert consequences of low acceptability, such as poor intervention implementation, uptake, and effectiveness. This study examined and compared nurses' and other healthcare providers' perceived acceptability of an evidence-based warning signs intervention proposed for rural transitional care. METHODS: A cross-sectional design was used. The convenience sample included 45 nurses and 32 other healthcare providers (e.g., physical and occupational therapists, physicians) who self-identified as delivering transitional care to patients in rural Ontario, Canada. In an online survey, participants were presented with a description of the warning signs intervention and completed established measures of intervention acceptability. The measures captured 10 intervention acceptability attributes (effectiveness, appropriateness, risk, convenience, relevance, applicability, usefulness, frequency of current use, likelihood of future use, and confidence in ability to deliver the intervention). Ratings ≥ 2 indicated acceptability. Data analysis included descriptive statistics, independent samples t-tests, as well as effect sizes to quantify the magnitude of any differences in acceptability ratings between nurses and other healthcare providers. RESULTS: Nurses and other healthcare providers rated all intervention attributes > 2, except the attributes of convenience and frequency of current use. Differences between the two groups were found for only three attributes: nurses' ratings were significantly higher than other healthcare providers on perceived applicability, frequency of current use, and the likelihood of future use of the intervention (all p's < .007; effect sizes .58 - .68, respectively). DISCUSSION: The results indicate that both participant groups had positive perspectives of the intervention on most of the attributes and suggest that initiatives to enhance the convenience of the intervention's implementation are warranted to support its widespread adoption in rural transitional care. However, the results also suggest that other healthcare providers may be less receptive to the intervention in practice. Future research is needed to explore and mitigate the possible reasons for low ratings on perceived convenience and frequency of current use of the intervention, as well as the between group differences on perceived applicability, frequency of current use, and the likelihood of future use of the intervention. CONCLUSIONS: The intervention represents a tenable option for rural transitional care in Ontario, Canada, and possibly other jurisdictions emphasizing transitional care.

Knowledge flow and exchange in interdisciplinary primary health care teams (PHCTs): an exploratory study.

OBJECTIVE: Improving the process of evidence-based practice in primary health care requires an understanding of information exchange among colleagues. This study explored how clinically oriented research knowledge flows through multidisciplinary primary health care teams (PHCTs) and influences clinical decisions. METHODS: This was an exploratory mixed-methods study with members of six PHCTs in Ontario, Canada. Quantitative data were collected using a questionnaire and analyzed with social network analysis (SNA) using UCINet. Qualitative data were collected using semi-structured interviews and analyzed with content analysis procedures using NVivo8. RESULTS: It was found that obtaining research knowledge was perceived to be a shared responsibility among team members, whereas its application in patient care was seen as the responsibility of the team leader, usually the senior physician. PHCT members acknowledged the need for resources for information access, synthesis, interpretation, or management. CONCLUSION: Information sharing in interdisciplinary teams is a complex and multifaceted process. Specific interventions need to be improved such as formalizing modes of communication, better organizing knowledge-sharing activities, and improving the active use of allied health professionals. Despite movement toward team-based models, senior physicians are often gatekeepers of uptake of new evidence and changes in practice.

Collaborative Development of an Older Adult Experience Survey for Specialized Geriatric Services.

BACKGROUND: While generic, site, and disease-specific patient experience surveys exist, such surveys have limited relevance to frail, medically complex older adults attending appointment-based specialized geriatric services (SGS). The study objective was to develop and evaluate a patient experience survey specific to this population. METHODS: Using established survey research methods, this study was conducted collaboratively with older adults (patients and family members/friends) at three Ontario sites offering SGS. The study was done in three phases: Phase One-literature review, evidence alignment, and operationalization of core survey items; Phase Two-cognitive interviews and refinement; and Phase Three-pilot testing, survey item analysis, and refinement. RESULTS: Based on an evidence-informed framework, the "Older Adult Experience Survey" includes 12 core items, two global rating items, two open-ended questions, and two demographic questions. The summed 12 core items demonstrated acceptable internal consistency (Cronbach's alpha: 0.83), and the correlation between the summed score and a global question was 0.59, providing evidence of construct validity. The survey also demonstrated face and content validity. CONCLUSION: This open access, collaboratively developed, psychometrically sound patient experience survey can be used to assess, then improve, the clinical experience and quality of care of older adults attending appointment-based SGS clinics/programs.

Longitudinal variations of laryngeal overpressure and voice-related quality of life in spasmodic dysphonia.

OBJECTIVES/HYPOTHESIS: Adductor spasmodic dysphonia (AdSD) is a voice disorder characterized by variable symptom severity and voice disability. Those with the disorder experience a wide spectrum of symptom severity over time, resulting in varied degrees of perceived voice disability. This study investigated the longitudinal variability of AdSD, with a focus on auditory-perceptual judgments of a dimension termed laryngeal overpressure (LO) and patient self-assessments of voice-related quality of life (V-RQOL). STUDY DESIGN: Longitudinal, correlational study. METHODS: Ten adults with AdSD were followed over three time periods. At each, both voice samples and self-ratings of V-RQOL were gathered prior to their scheduled Botox injection. Voice recordings subsequently were perceptually evaluated by eight listeners for LO using a visual analog scale. RESULTS: LO ratings for all-voiced and Rainbow Passage sentence stimuli were found to be highly correlated. However, only the LO ratings obtained from judgments of AV stimuli were found to correlate moderately with self-ratings of voice disability for both the physical functioning and social-emotional subscores, as well as the total V-RQOL score. Based on perceptual judgments, LO appears to provide a reliable means of quantifying the severity of voice abnormalities in AdSD. CONCLUSIONS: Variability in self-ratings of the V-RQOL suggest that perceived disability related to AdSD should be actively monitored. Further, auditory-perceptual judgments may provide an accurate index of the potential impact of the disorder on the speaker. Similarly, LO was supported as a simple clinical measure that serves as a reliable index of voice change over time.

Exploring use of the ICF in health education.

PURPOSE: Currently, little is known regarding use of the International Classification of Functioning, Disability and Health (ICF) in health education applications. Therefore, this review sought to examine the scope of work that has been conducted regarding the application of the ICF in health education. METHODS: A review of the current literature related to use of the ICF in health education programs was conducted. Twelve electronic databases were searched in accordance with a search protocol developed by a health sciences librarian. In total, 17,878 records were reviewed, and 18 articles met the criteria for inclusion in this review. RESULTS: Current evidence regarding use of the ICF in healthcare education revealed that program and participant properties can be essential facilitators or barriers to successful education programs. In addition, gaps in comprehensive outcome measurement were revealed as areas for future attention. Educational applications of the ICF are very much a work in progress as might be expected given the ICF's existence for only a little over a decade. CONCLUSIONS: To advance use of the ICF in education, it is important to incorporate the measurement of both knowledge acquisition and behavior change related to ICF-based programs. Ultimately, widespread implementation of the ICF represents not only a substantial opportunity but also poses a significant challenge.

Examining the construct validity of the V-RQOL in speakers who use alaryngeal voice.

PURPOSE: The construct validity of the Voice-Related Quality of Life (V-RQOL; Hogikyan & Sethuraman, 1999) measure was evaluated in a sample of 109 individuals who have undergone total laryngectomy. METHOD: A principal components factor analysis was performed on participant responses to the 10-question V-RQOL measure. RESULTS: Factor analysis of the V-RQOL in our alaryngeal sample confirmed the presence of two factors (physical and social-emotional), which is consistent with the identified domains in the current V-RQOL. However, the current data indicate that some of the questions proposed by the original authors of the V-RQOL (Questions 7 and 9) do not align with their proposed domains in this postlaryngectomy sample. CONCLUSION: The results indicate that some V-RQOL questions do not align with their proposed domains. Consequently, an alternative scoring algorithm may be warranted for alaryngeal populations, and the authors make suggestions for this change that are simple and efficient. Based on the findings of the present factor analysis, use of this modified scoring procedure may serve to increase the sensitivity of the V-RQOL for those who are laryngectomized and use alaryngeal methods of voice and speech. Consequently, the value and application of the V-RQOL may be expanded in the clinical setting.

Auditory-perceptual speech outcomes and quality of life after total laryngectomy.

OBJECTIVE: (1) To determine potential relationships between speech intelligibility, acceptability, and self-reported quality of life (QOL) after total laryngectomy and (2) to determine whether relationships are stronger when QOL is measured by a head and neck cancer-specific or discipline-specific QOL scale. STUDY DESIGN: Cross-sectional. SETTING: University-based laboratory and speech clinic. SUBJECTS AND METHODS: Twenty-five laryngectomized individuals completed disease-specific (University of Washington Quality of Life; UW-QOL) and discipline-specific (Voice Handicap Index-10; VHI-10) QOL scales. They also provided audio recordings that included the Sentence Intelligibility Test (SIT) and a reading passage. Thirty-three listeners transcribed the SIT sentences to yield intelligibility scores. Fifteen additional listeners judged speech acceptability of the reading passage using rating scales. RESULTS: The QOL scores were moderate across the UW-QOL physical (mean = 77.63) and social-emotional (mean = 78.02) subscales and the VHI-10 (mean = 17.91). Speech acceptability and intelligibility varied across the samples, with acceptability only moderately related to intelligibility (r = 0.41, P < .05). Relationships were weak between ratings of intelligibility and self-reported QOL (range, r = 0.00-0.22) and weak to moderate between acceptability with QOL (range, r = 0.01-0.46). The only statistically significant, but moderate, relationship was found between speech acceptability with the UW-QOL speech subscore (r = 0.46, P < .05). CONCLUSION: Listeners' ratings of speech acceptability and intelligibility were not strongly predictive of disease-specific or voice-related QOL, suggesting that listener-rated and patient-reported outcomes are complementary.

Nature and the natural environment as health facilitators: the need to reconceptualize the ICF environmental factors.

PURPOSE: This work examines the environmental factors component of the International Classification of Functioning, Disability, and Health (ICF) relative to current health-facilitating evidence about natural environmental factors. We argue that the environmental factors component warrants reconceptualization in order to offer an extended and more systematic framework for identifying and measuring health-facilitating natural environmental factors. METHOD: Current evidence highlighting the potential health-facilitating benefits of natural environmental factors is synthesized and considered in the context of the ICF framework and its coding system. RESULTS: In its current form, the ICF's conceptual framework and coding system are inadequate for identifying and measuring natural environmental factors in individuals and groups with and/or without health conditions. CONCLUSION: The ICF provides an advanced framework for health and disability that reflects contemporary conceptualizations about health. However, given the scope of emerging evidence highlighting positive health and well-being outcomes associated with natural environmental factors, we believe the environmental factors component requires further advancement to reflect this current knowledge. Reconceptualizing the environmental factors component supports a more holistic interpretation of the continuum of environmental factors as both facilitators and barriers. In doing so, it strengthens the ICF's utility in identifying and measuring health-facilitating natural environmental factors.

Voice-related quality of life (V-RQOL) outcomes in laryngectomees.

BACKGROUND: Laryngeal cancer has a significant impact on patients. This study compared the Voice-Related Quality of Life (V-RQOL) outcomes specific to 3 different postlaryngectomy voice rehabilitation methods. METHODS: We conducted a retrospective review of 75 patients with laryngectomy from our V-RQOL questionnaire database. RESULTS: The database included 18 electrolaryngeal speech (ELS), 15 esophageal speech (ES), and 42 tracheoesophageal speech (TES) patients. Pairwise comparisons of V-RQOL outcomes showed that TES was perceived to be better than ELS (p < .001). ES was perceived as better than ELS, but this was driven by a difference in the total and social-emotional V-RQOL scores (p < .05). There was no difference between TES and ES groups. Only ELS showed a positive correlation with time after surgery and older age. CONCLUSIONS: Patients using TES had similar V-RQOL outcomes compared to ES and both performed significantly better than ELS. For ELS, the total V-RQOL score was better with longer time after surgery and older age.

Clinical approach to monitoring variability associated with adductor spasmodic dysphonia.

OBJECTIVES: Adductor spasmodic dysphonia (ADSD) is a voice disorder characterized by considerable intra- and intersubject variability. Although objective, acoustic measures of voice may provide a metric for ADSD, such measures can be inefficient in documenting such characteristics. This project integrated a simple auditory-perceptual measure termed "laryngeal overpressure" (LO) with measures of acoustic variability. METHODS: Ten adults diagnosed with ADSD were sequentially followed over a period of 3 to 6 months. Standard voice recordings were obtained at each point, and acoustic measures were gathered. Additionally, three experienced listeners then rated LO using a visual analogue scale, and acoustic variability was assessed relative to the measure of LO. RESULTS: Listener ratings of LO did not differ across the three-sentence stimuli and were highly correlated (r  =  .828 and .909 for naive and experienced listeners, respectively). A strong correlation was identified between the acoustic measure of harmonics to noise ratio and the all-voiced sentence stimuli (r  =  .710). CONCLUSION: LO appears to provide an easy clinical method of documenting voice change over time in those with ADSD. Although additional methods of voice monitoring may be used, the use of LO may provide the opportunity for a standard and reliable approach to the clinical monitoring of voice variability in those presenting with ADSD.

Assessing self-reported measures of voice disability in tracheoesophageal speakers.

OBJECTIVE: current instruments for evaluating quality of life in individuals treated for head and neck cancer often contain a speech-related item; however, none provide a dedicated measure of self-perceived voice-related quality of life. Therefore, this study sought to assess the utility of the Voice-Related Quality of Life (V-RQOL) instrument in a group of individuals who use tracheoesophageal (TE) speech following total laryngectomy for laryngeal cancer. DESIGN: this exploratory, retrospective study accessed individuals who used TE speech as their primary mode of communication. SETTING: Data were collected at a university centre. METHODS: fifteen male and 15 female TE speakers were age matched (± 3 years) and their V-RQOL scores were evaluated. MAIN OUTCOME MEASURES: the self-report V-RQOL was employed to evaluate participants' perceptions of their voice-related quality of life. The V-RQOL yields two subscales, social-emotional functioning and physical functioning, as well as a total score. RESULTS: analyses revealed no statistically significant differences across gender, thus permitting descriptive evaluation of group data. Data suggest that varied degrees of voice-related disability exist for both physical and social-emotional functioning, with participants generally reporting better social-emotional scores. CONCLUSIONS: based on these preliminary data, the V-RQOL may offer an easy and time-efficient clinical measure of postlaryngectomy voice disability for alaryngeal speakers. These findings suggest that the V-RQOL may be used with this clinical population and may serve to identify voice-related deficits that can be targeted for intervention as part of a patient's postlaryngectomy rehabilitation.