Factors that influence development of speech pathology skills required for videofluoroscopic swallowing studies.

BACKGROUND: Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees. AIMS: This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts' VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self-efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts' skill development. METHODS & PROCEDURES: Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected-the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing-Adults, self-reported the number of dysphagia cases they managed on placement, and self-rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis. OUTCOMES & RESULTS: Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images. CONCLUSIONS & IMPLICATIONS: Novice analysts vary in the acquisition of beginner-level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development. WHAT THIS PAPER ADDS: What is already known on the subject The existing literature suggests that no vice Video fluoroscopic Swallowing Study (VFSS) analysts training may be influenced by their personal characteristics and experience. What this study adds This study found that student clinicians, clinical exposure to dysphagia cases and their ability to identify anatomical landmarks relevant to swallowing on still radiographic images prior to training best predicted their ability to identify swallowing impairments after training. What are the clinical implications of this work? Given the expense of training health professionals, further research is required into the factors that successfully prepare clinicians for VFSS training, including clinical exposure, foundational knowledge of anatomy relevant to swallowing and the ability to identify the anatomical landmarks on still radiographic images.

Videofluoroscopic swallow study training for radiologists-in-training: a survey of practice and training needs.

BACKGROUND: There is a lack of formal, published videofluoroscopic swallow study (VFSS) training targeting radiologists, yet radiology senior medical officers and resident medical officers (i.e., radiologists-in-training, known in Australia as "registrars") are expected to be involved in VFSS interpretation of anatomical anomalies and reporting. This study investigated whether VFSS training is delivered to registrars during their specialist radiology training, whether it is a perceived need and, if so, to determine the desired content for inclusion in a targeted training package. METHODS: A cross-sectional, mixed methods study design was used. An internet-based survey was circulated via convenience and snowball sampling to radiologists (both senior medical officers and registrars) and speech-language pathologists across Australia in October-November 2017. Surveys also were distributed to practitioners based in New Zealand and the United Kingdom, as they practised within similar health systems, and it was anticipated they may have similar VFSS training practices. The radiology survey contained 36 questions and the speech-language pathology survey contained 44 questions. Participants were asked the following: (1) Report their current VFSS radiology registrar training environment; (2) Advise whether radiology registrars need VFSS training; (3) Recommend the content, format, training intensity, and evaluation methods for an effective radiology registrar training package. Demographic data were analysed descriptively, and open-ended responses were analysed using qualitative content analysis. RESULTS: 21 radiology senior medical officers and registrars and 150 speech-language pathologists predominantly based at Australian tertiary hospital settings completed the survey. Most respondents (90.6%) identified that VFSS training is needed for radiology registrars. Only one speech-language pathologist respondent reported that they deliver VFSS training for radiology registrars. Specific content and teaching modalities for a VFSS training package, including diagnosing anatomical anomalies associated with dysphagia were recommended. CONCLUSION: While most of the radiologists and speech-language pathologists surveyed did not deliver VFSS training to radiology registrars, they identified that targeted training is needed to improve radiology registrars' effectiveness and engagement in VFSS clinics. The training package content, format and evaluation methods recommended by participants will inform the development of a VFSS training package targeting radiology registrars to be piloted at an Australian tertiary hospital.

Facilitating interprofessional affective learning in health professional students through digital client documentation: a comparison of simulation modes.

Digital Interprofessional Learning Client Documentation (D-IPL Client Docs) is an initiative designed to develop student interprofessional communication skills through electronic record writing and a virtual simulation (VS) or live virtual simulation (LVS) case conference. The aims of the study were to (a) identify whether D-IPL Client Docs supports student learning in the affective domain and (b) compare the learning outcomes for students participating in the VS versus the LVS case conference. Data were drawn from 83 Bachelor of Social Work students who had participated with other health professional students in the D-IPL Client Docs activities. The reflective journals submitted by this cohort of social work students were analyzed qualitatively and quantitatively using the Griffith University Affective Learning Scale. Qualitative analyses revealed that the activities enabled students in both groups to learn about themselves, their roles, and the roles of others, and the benefits of interprofessional collaboration in optimizing client outcomes. Quantitatively, the VS mode appeared to be more effective in supporting students to develop higher order affective learning; however, the effect size was small. Future studies should involve a larger sample size and include students from various professions to ascertain the transferability of findings.

Discovering the Benefits of Group Peer Review of Submitted Manuscripts.

Problem: Traditionally, journal editors expect individuals to complete peer reviews of submitted manuscripts on their own. Recently, a number of editors of health sciences journals have begun to support, and even espouse, the practice of group peer review (GPR). With GPR, multiple individuals work together to complete the review with permission from the journal editor. Motivated by the idea that GPR could provide a meaningful service learning experience for participants in an interprofessional educational scholarship course, we conducted three such reviews and subsequently reflected on our experience and the lessons we learned. We frame our reflections using guiding principles from the domains of peer review, professional development, and educational scholarship. Intervention: The course director arranged for manuscripts to review with the editors of three health sciences journals. Each GPR occurred during a separate weekly session of the course. Each GPR was completed using a similar set of steps, which included (a) gaining familiarity with review criteria, (b) reading aloud and discussing the manuscript's abstract as a class, (c) reading and critiquing assigned sections as individuals and then small groups, (d) building consensus and sharing notes, (e) having the course director synthesize notes into a single review for submission to the journal. Context: The course on educational scholarship involved 15 faculty representing faculty from the University of Utah's School of Medicine, College of Nursing, College of Pharmacy, College of Health, and School of Dentistry. The course director led three GPR sessions mid-way through the yearlong course. Impact: Participants' reflections indicate that GPR (a) conformed to principles of effective peer review; (b) resulted in a meaningful service learning experience within a formal professional development program, deepening understanding of core concepts of educational scholarship; and (c) represented an authentic example of engaging in educational scholarship (i.e., designing and evaluating an intervention while drawing upon and contributing to a body of shared understanding within a community of practice). Lessons Learned: Our principles-based approach to completing GPR within a professional development course on educational scholarship can serve as a model for others to follow. A rigorous, meaningful group review can occur in 1 hour using a combination of group and individual activities focused on matching review criteria to the submitted manuscript. As a result, we continue to include GPR in future offerings of this interprofessional course on educational scholarship, and we continue to study ways to optimize its value as a service learning experience.

A framework to support the development of quality simulation-based learning programmes in speech-language pathology.

BACKGROUND: Simulation-based learning provides students with a safe learning environment, guaranteed exposure to specific clinical scenarios and patients, time for reflection and repetition of tasks, and an opportunity to receive feedback from multiple sources. Research including studies specific to allied health training programmes have demonstrated that simulation-based learning also helps increase learners' confidence and reduces anxiety related to clinical environments, activities and skills. Such evidence, together with increasing challenges in provision of workplace clinical education, has supported an expansion of integrating simulation-based learning into university curricula. AIMS: To provide detailed information about the processes and considerations involved in the development of a simulation-based learning programme for speech-language pathology. METHODS & PROCEDURES: Through reflection on the development process of a 5-day simulation-based learning programme, and in light of existing research in simulation, this paper outlines the important steps and considerations required for the development of a simulation-based learning programme to support student competency development in adult speech pathology range of practice areas. MAIN CONTRIBUTION: A proposed framework for the development of future simulation-based learning programmes in speech-language pathology. CONCLUSIONS & IMPLICATIONS: The framework can be applied to simulation-based learning for university programmes and/or workplace training in speech-language pathology and across several other health disciplines.

Implementing Cough Reflex Testing in a Clinical Pathway for Acute Stroke: A Pragmatic Randomised Controlled Trial.

Silent aspiration is common after stroke and can lead to subsequent pneumonia. While standard bedside dysphagia assessments are ineffective at predicting silent aspiration, cough reflex testing (CRT) has shown promise for identifying patients at risk of silent aspiration. We investigated the impact of CRT on patient and service outcomes when embedded into a clinical pathway. 488 acute stoke patients were randomly allocated to receive either CRT or standard care (i.e. bedside assessment). Primary outcomes included confirmed pneumonia within 3 months post stroke and length of acute inpatient stay. Secondary outcomes related to the feasibility of implementing a CRT pathway and clinician and patient satisfaction. There was a non-significant reduction in pneumonia rates by 2.2% points in the CRT group (OR 0.32, 95% CI 0.06-1.62). There was a non-significant difference of 0.7 days (95% CI - 0.29 to 1.71 days) in length of stay between the standard care group and the CRT group. The CRT took on average 3 min longer to complete (p < 0.01) and resulted in a significant 6.7% increase in videofluoroscopic referrals (p = 0.02); however, these results are clinically insignificant. High patient and clinician satisfaction with CRT was found, with clinicians reporting additional knowledge and confidence in decision making for dysphagia management. Post hoc subgroup analyses according to stroke types were conducted and revealed no significant differences in pneumonia rates after adjustment for multiple comparisons. In conclusion, it was possible to implement a CRT pathway with minimal increases in clinician resources. While clinicians perceived CRT as beneficial in clinical decision making, the efficacy of CRT for reducing pneumonia rates in acute stroke remains to be established.Clinical Trial Registration-URL: http://www.anzctr.org.au . Unique identifier: ACTRN12616000724471.

The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study.

AIMS AND OBJECTIVES: To determine presence of clinical complications related to dysphagia and to explore their operational outcomes. BACKGROUND: Dysphagia is a common complication of stroke. The management of poststroke dysphagia is multidisciplinary with nurses playing a key role in screening for dysphagia risk, monitoring tolerance of food and fluids and checking for the development of complications such as fever, dehydration and change in medical status. Dysphagia often results in further complications including aspiration pneumonia and the need for nasogastric feeding. Dysphagia-related complications have been shown to have a significant impact on morbidity and mortality, length of stay and cost of admission. DESIGN: Retrospective cohort study. METHODS: A total of 110 patients presenting with an ischaemic stroke were chart-audited. RESULTS: Aspiration pneumonia poststroke was found to be significantly associated with increased overall length of stay, poorer functional outcomes poststroke as well as being associated with a high risk of mortality. The presence of a nasogastric tube was also associated with reduced functional outcomes poststroke and increased risk of death. CONCLUSION: High prevalence and cost of complications associated with stroke highlight the complexity of providing nursing and allied health care to this patient population. This provides a snapshot of dysphagia-related complications experienced by stroke patients. RELEVANCE TO CLINICAL PRACTICE: This paper highlights that poststroke complications can significantly impact on patient outcomes and operational factors such as cost of admission; therefore, poststroke care requires a multidisciplinary approach to management. Furthermore, preventing and managing complications poststroke is a key element of nursing care and has the potential to significantly reduce incidence of mortality, length of stay and cost of hospital admission.

Factors Influencing Occupational Therapists' Decision to Supervise Fieldwork Students.

The purpose of this study was to identify factors that influence the decision to supervise a Level II occupational therapy fieldwork student. A survey was sent to occupational therapists identified from licensure boards and alumni rosters, including those who have and have not supervised students (n = 548). The results identified both positive and negative influences along with predictive factors of supervising a student. While positive factors included continuing education units, education on fieldwork expectations, their own fieldwork experiences, shared supervision, and access to educational resources, negative influences consisted of: job responsibilities, caseload, productivity standards, working part-time, and fear of failing a student. The discussion focuses on how to address the needs of the clinician and facilitate fieldwork placement.

Developing novice analysts' videofluoroscopic swallowing study skills in speech-language pathology: A randomised control trial comparing blended and online training approaches.

PURPOSE: This research investigates the relative effectiveness of independent online and blended learning approaches for novice analysts' development of videofluoroscopic swallowing study (VFSS) analytical skills. The secondary aims were to explore the impact of training on decision-making and to describe learners' perspectives of training outcomes. METHOD: Undergraduate speech-language pathology students (n = 74) who had completed the dysphagia academic curriculum in an undergraduate speech-language pathology program were recruited for a randomised control trial. The ability to identify swallowing impairments in adults was compared pre- and post-training across three conditions: independent online (n = 23), peer-supported (n = 23), and expert-facilitated training (n = 28). The training comprised online VFSS training and practice with a commercially available digital video disc (DVD). RESULT: The three training approaches were equal in improving novice analysts' identification of impairments on VFSS. Participants' analysis improved pre- to post-training (p = <.001), with no statistical difference amongst training conditions (p = .280). However, the expert facilitation condition resulted in better decision-making skill for novice analysts, as well as higher levels of confidence and greater engagement in the learning. CONCLUSION: Well-designed independent online methods are appropriate to prepare novice analysts for VFSS analytical training. Expert facilitation and peer-supported environments may have benefits for more advanced skill development and engagement, and should be investigated in future studies.

Effectiveness of Intensive Voice Therapy Versus Weekly Therapy for Muscle Tension Dysphonia: A Noninferiority Randomised Controlled Trial With Nested Focus Group.

OBJECTIVES: To investigate the noninferiority of intensive voice therapy and compare its effects with weekly voice therapy on multidimensional outcomes of voice and well-being, satisfaction, and attendance in people with muscle tension dysphonia (MTD). The study further aimed to explore clinician's perceptions of barriers and enablers to implementation of intensive therapy. STUDY DESIGN: Noninferiority randomised controlled trial with nested focus group. METHODS: Twenty adults with MTD were randomised to receive either weekly voice therapy (1 hour per week for 8 weeks) or intensive voice therapy (1 hour, 4 days per week for 2 weeks). Participants were assessed by a blinded assessor twice before treatment, once post treatment and once at 4 weeks follow up on the primary outcome measure VHI and a range of secondary auditory-perceptual, acoustic, and patient (i.e., VoiSS, satisfaction) and clinician reported outcome measures (i.e., AusTOMs, attendance rates). Five Speech Language Pathologists also participated in a focus group to explore barriers and enablers to implementing intensive therapy, with questions and analyses guided by the Theoretical Domains Framework. RESULTS: While noninferiority for the primary outcome measure VHI was not confirmed, secondary outcome measures revealed comparable within group clinically important improvements for VoiSS and the AusTOMs, as well as selected acoustic and auditory-perceptual measures for both groups. A trend of more improvements being maintained in the intensive group was identified. Comparably high satisfaction and attendance was also found between groups. Clinicians reported more enablers than barriers to providing intensive therapy which included beliefs that it led to greater progression and consolidation of patient learning, was supported by the local context and was associated with positive emotions. Barriers related to difficulties with booking and scheduling and the belief that intensive therapy was not for all patients. CONCLUSIONS: While the current study was likely underpowered to establish non-inferiority of intensive therapy, secondary outcomes suggested that intensive therapy may produce comparable benefits to voice, wellbeing, satisfaction and attendance compared to weekly therapy and may be a viable therapy option for individuals with MTD. When implementing intensive therapy, clinicians should consider patient's preferences and availability, as well as systems which allow for flexible booking and therapy provision for patients. Clear recommendations for future research including the use of a larger sample and telehealth are also provided.

The time-course of visual scanning behaviour of paramedicine students upon arrival at a simulated emergency call.

BACKGROUND: Limited knowledge exists regarding how paramedics acquire an understanding of the scene they encounter upon arrival, despite their need to quickly gather information for effective clinical decision-making. This study examined visual scanning behaviour during the early stages of simulated emergency calls. METHODS: Eye movements of 10 paramedicine students were recorded during simulated calls conducted in both a high-fidelity classroom setting and a full sensory immersion setting. RESULTS: Students focused on similar areas in both settings, with most time spent looking at the patient rather than distractors such as room features or other people. Analysis of gaze behaviour across the first five minutes revealed a more nuanced pattern: attention initially gravitated towards distractors but decreased as students became familiar with their surroundings and focused on the task at hand. This pattern was consistent across both simulation settings, indicating that information-seeking strategies may be independent of scene complexity. CONCLUSIONS: Expertise relies on the ability to differentiate between relevant and irrelevant information. Given the unpredictable nature of their work, paramedics must continuously adapt their understanding of a scene from the moment they enter it. Understanding how this skill develops may help identify expert strategies to inform training of novice paramedics.

A cost analysis of a 5-day simulation-based learning program for speech-language pathology student training.

Purpose: There is poor reporting of the cost of simulation and greater transparency is needed. The primary study aim was to conduct a financial analysis of the university/training institution costs associated with a 5-day simulation-based learning program for speech-language pathology students. The secondary aim was to consider the economic costs of the model.Method: Costs associated with the delivery of a 5-day simulation-based learning program for speech-language pathology students from six Australian universities were collected regarding: (a) pre-program training, (b) personnel, (c) room hire, (d) equipment, and (e) consumables. Both financial costs and economic costs (Australian dollar, at June 2017) were calculated per university site, and per student.Result: The simulation program was run 21 times involving 176 students. Average total financial cost per program ranged from $4717 to $11 425, with cost variation primarily attributed to local labour costs and various use of in-kind support. Average financial cost per student was $859 (range $683-$1087), however this was almost double ($1461 per student, range $857-$2019) in the economic cost calculation. Personnel was the largest contributing cost component accounting for 76.6% of financial costs. Personnel was also the highest contributing cost in the economic analysis, followed by room hire.Conclusion: This study provides clarity regarding financial and economic costing for a 5-day simulation-based learning program. These data can help universities consider potential up-front financial costs, and well as strategies for financial cost minimisation, when implementing simulation-based learning within the university context.

A systematic review of group intervention for acquired dysarthria in adults.

PURPOSE: This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication effectiveness and/or wellbeing. MATERIALS AND METHODS: A review protocol was prospectively published on PROSPERO. Fourteen electronic databases were searched to identify experimental studies investigating adults with acquired dysarthria participating in group intervention with outcomes related to communication and/or wellbeing. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) or the McMaster University's Critical Review Form, and the TIDieR template for intervention description and replication. RESULTS: 21 studies were identified involving 330 individuals with dysarthria, from mostly Parkinson's disease (PD) (97%; n = 321). Treatment approaches included singing therapy (n = 10), loudness therapy (n = 5) and multi-components therapy (including a combination of impairment and/or compensatory approaches) (n = 4). Studies varied in intensity and outcome measures used. Statistically significant improvements to speech production and/or wellbeing were reported following most approaches. CONCLUSION: There is some preliminary moderate-quality evidence to suggest that group therapy may improve speech production and in some cases communication effectiveness or wellbeing in people with dysarthria following PD, with more consistent improvements being found for loudness approaches. Singing approaches were frequently studied in PD with some improvements to intelligibility evident. Further well-designed controlled studies including individuals with non-progressive aetiologies is warranted to establish the effectiveness of group treatment.IMPLICATIONS FOR REHABILITATIONGroup therapy may be an effective means of improving speech production and/or wellbeing in individuals with dysarthria following Parkinson's disease.Studies' employing loudness-based group therapy for PD demonstrated more consistent improvements to intensity measures.Some controlled studies utilising singing group therapy resulted in improved intelligibility in PD.PROSPERO registration number: CRD42015029374.

Feasibility of a Telerehabilitation Adaptation of the Be Clear Speech Treatment Program for Non-Progressive Dysarthria.

This study evaluated the feasibility and outcomes of a telerehabilitation adaptation of the Be Clear speech treatment program for adults with non-progressive dysarthria to determine clinical delivery viability and future research directions. Treatment effects on speech clarity, intelligibility, communication effectiveness, and participation, as well as psychosocial outcomes in 15 participants with non-progressive dysarthria, were explored. Intervention involved daily 1-h online sessions (4 days per week for 4 weeks, totalling 16 sessions) and daily home practice. Outcome measures were obtained at baseline (PRE), post-treatment (POST), and 12 weeks following treatment (FUP). Feasibility measures targeting participant satisfaction, treatment adherence and fidelity, and technical viability were also employed. The programme was feasible concerning technical viability and implementation, treatment adherence and fidelity. High levels of participant satisfaction were reported. Increases in overall ratings of communication participation and effectiveness were identified at POST and FUP. Reductions in speech rate were identified at FUP. Improvements in aspects of lingual and laryngeal function were also noted after treatment. Over time, improvements relating to the negative impact of dysarthria were identified. Naïve listeners perceived negligible changes in speech clarity following treatment. Online delivery of the Be Clear speech treatment program was feasible, and some positive speech benefits were observed. Due to the small sample size included in this research, statistically significant findings related to speech outcomes must be interpreted with caution. An adequately powered randomised controlled trial of Be Clear online is warranted to evaluate treatment efficacy.

Efficacy of Face-to-Face Delivered Cognitive Behavioral Therapy in Improving Health Status of Patients With Insomnia: A Meta-Analysis.

Background: Face-to-face cognitive behavioral therapy (CBT) is one of the most widely used non-pharmacological treatment approaches for insomnia. The aim of this study is to assess the efficacy of face-to-face delivered CBT on health outcomes and to evaluate the effect of CBT components as subgroup variables to explain the efficacy of face-to-face delivered CBT on health outcomes in adults over 18 years old with insomnia. Methods: Relevant randomized controlled trial studies published in the past 22 years were searched through the electronic databases. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the 31 included studies. The mean difference and standard deviation of outcome variables and subgroup variables were analyzed using random effect model, and the heterogeneity among the articles was assessed with the Q-test and I 2. Egger regression analysis was used to assess publication bias. Results: The meta-analysis showed a significant reduction in Insomnia Severity Index [standardized mean difference (SMD) = -2.56, 95% CI -3.81 to -1.30, p < 0.001], Pittsburgh Sleep Quality Index (SMD = -0.96, 95% CI -1.25 to -0.68, p < 0.001), sleep onset latency (SMD = -1.31, 95% CI -2.00 to -0.63, p < 0.001), wakening after sleep onset (SMD = -1.44, 95% CI -2.14 to -0.74, p < 0.001), number of awakenings (SMD = -1.18, 95% CI -2.10 to -0.26, p < 0.05), depression (SMD = -1.14, 95% CI -1.85 to -0.42, p < 0.01), and fatigue (SMD = -2.23, 95% CI -3.87 to -0.58, p < 0.01), and a significant increase in total sleep time (SMD = 0.63, 95% CI 0.28 to 0.98, p < 0.001), sleep efficiency (SMD = 1.61, 95% CI 0.92 to 2.29, p < 0.001), and physical health (SMD = 0.42, 95% CI 0.08 to 0.76, p < 0.05), in the CBT intervention group compared with the control group. There was no significant change in anxiety (SMD = -0.62, 95% CI -1.55 to 0.32, p > 0.05) and mental health (SMD = 1.09, 95% CI -0.59 to 2.77, p > 0.05) in CBT intervention group compared with control group. Group-delivered studies with larger number of intervention sessions and longer duration of single session provided a larger improvement in sleep quality. Conclusion: Face-to-face delivered CBT is effective in increasing total sleep time, sleep efficiency, and physical health, and reducing Insomnia Severity Index scores, Pittsburgh Sleep Quality Index scores, sleep onset latency, wakening after sleep onset, number of awakenings, depression, anxiety, and fatigue in patients with insomnia. Face-to-face delivered CBT is more effective when delivered through a larger number of sessions with longer duration of each session, and when delivered in groups. Face-to-face CBT is recommended to provide treatment to patients with insomnia in clinical settings. Systematic Review Registration: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200091, identifier: CRD4202020009.

Introducing Standardized Assessment and Management of Oral Cares in a Rehabilitation Unit: Patient Outcomes and Experiences.

PURPOSE: The aim of this study was to improve patient oral hygiene outcomes in a rehabilitation unit by implementing a nursing education package and oral hygiene assessment tool. DESIGN: A case-control design with 50 rehabilitation patients was performed. METHODS: Nursing staff received education and training in applying the Modified Oral Health Assessment Tool. Clinician assessment of patient oral hygiene occurred on admission and at days 5-7. Each patient reported their perceptions of oral hygiene and comfort prior to hospitalization, while in the hospital, and after transfer to the rehabilitation unit. FINDINGS: Oral hygiene rating scores improved significantly from admission to the rehabilitation unit to days 5-7 (p = .00). The mean score of patient perceived cleanliness improved from hospital admission to admission to the rehabilitation unit. CONCLUSION: Oral hygiene was improved following admission to a rehabilitation unit with a consistent and individualized approach to oral hygiene. CLINICAL RELEVANCE: The introduction of a consistent and individualized approach to oral hygiene demonstrates positive patient outcomes and high patient acceptance.

A Comparison of Voice and Psychotherapeutic Treatments for Adults With Functional Voice Disorders: A Systematic Review.

OBJECTIVE: To examine the effect of traditional voice therapy and cognitive therapy on the voice and client-wellbeing outcomes in adults with functional voice disorders (FVD). METHODS: A systematic review of English articles was conducted using Medline (Ovid), Embase (Elsevier), CINAHL (Ebsco), The Cochrane Central Register of Controlled Trials (CENTRAL), PsychInfo (Ebsco) and Speechbite from inception to current date. Additional studies were identified through bibliographies and authors were contacted when further information was required from an article. All study designs were included with pretest/posttest outcome measures related to voice. Independent extraction of studies was completed by three authors using predefined data fields and quality assessment tools. RESULTS: Outcomes of 23 studies (2 RCTs and 21 cohort or case studies) are summarised using a narrative style due to heterogeneity of interventions and outcome scales used. Overall research quality of included studies was low, with many cohort and case studies lacking controls, blinding and robust outcome measures. CONCLUSIONS: There are some benefits to pairing cognitive behavioural therapy (CBT) with traditional voice therapy for FVD including improved voice quality, psychosocial wellbeing and prevention of relapse. It is feasible to train speech-language pathologists (SLPs) in CBT-enhanced voice therapy. Further high-quality research is needed, however, to guide the clinical implementation of CBT for the management of FVD.

Simulation can replace part of speech-language pathology placement time: A randomised controlled trial.

PURPOSE: Simulation is increasingly used within speech-language pathology education. Research has primarily explored students' perceptions of learning in simulation. The aim of this study was to determine if speech-language pathology students achieved a statistically-equivalent level of competency when a mean of 20% of placement time was replaced with simulation compared to placements without a simulation component. METHOD: This non-inferiority randomised controlled trial involved students from six Australian universities. Students were randomised to either a simulation + traditional placement group attending 5 days of simulation prior to their traditional placement, or a traditional only placement group. Their end-placement clinical competency was assessed using Competency Assessment in Speech Pathology (COMPASS®). RESULT: Final data were available for 325 students: 150 students in traditional placements, 138 students in protocol-compliant simulation + traditional placements, and 37 students in non-protocol simulation + traditional placements. There were no statistically significant differences between groups (traditional vs protocol-compliant simulation + traditional Mann-Whitney-Wilcoxon z = 1.23, df = 286, p = 0.22; traditional vs intention-to-treat simulation + traditional Mann-Whitney-Wilcoxon z = 0.23, df = 323, p = 0.81). CONCLUSION: This research contributes to the evidence base which suggests that simulation can partially replace traditional placement time for speech-language pathology students without loss of competency, substantiating its value as an alternative placement model in speech-language pathology programmes.

Clinical decision-making for complex feeding decisions: A national survey of current approaches and perspectives.

OBJECTIVES: Decision-making around dysphagia management is becoming increasingly challenging due to the complexity of contexts associated with an ageing population. The current study explores current decision-making practices used by speech language therapists (SLTs) surrounding contexts related to palliative care, dementia, neuro-degenerative diseases, guardianship/family decisions, and other issues relevant to ongoing care of individuals with dysphagia. METHODS: An exploratory prospective electronic survey of SLTs was conducted. A total of 202 respondents were eligible for inclusion. RESULTS: Only 55% of respondents reported their workplace had a standard approach to documentation. Only 19% reported their service had a defined policy to support decision-making, with only 28% reporting the existence of patient information brochures. CONCLUSION: Limited formal guidance or practice standards exist in the setting of complex dysphagia management, which limits the consistency of practice and clinical efficiency. This insight into current practices and perspectives supports the development of clinical guidelines.