Assess patients' perspectives on the severity, time course, and relative importance of swallowing deficit before and after (chemo)radiotherapy for head and neck cancer.
Before-and-after cohort study.
...Head and neck cancer UK multidisciplinary clinic.
A total of 167 patients with a primary cancer, mostly laryngopharyngeal, completed the MD Anderson Dysphagia Index (MDADI) and the University of Washington Quality of Life Questionnaire (UWQOL) before treatment and at 3, 6, and 12 months. Pretreatment swallowing, age, gender, and tumor site and stage were assessed. Statistical methods used were Mann-Whitney, analysis of variance, and logistic regression.
There was a sharp deterioration in swallowing on average by 18%, from before treatment to 3 months post treatment (mean difference in MDADI score = 14.5; P < .001). Treatment schedule, pretreatment score, and age accounted for 37% of the variance in 3-month posttreatment MDADI scores. There was then little improvement from 3 to 12 months. Patients treated with only 50-Gy radiotherapy reported significantly less dysphagia at 1 year than patients receiving higher doses or combined chemoradiation (P < .001). Swallowing was the most commonly prioritized of the 12 UWQOL domains both before and after therapy. The MDADI and UWQOL scores were strongly correlated: ρ > 0.69.
Swallowing is a top priority before and after treatment for the vast majority of patients with head and neck cancer. Swallowing deteriorates significantly posttreatment (P < .001). Treatment intensity, younger age, and lower pretreatment scores predict long-term dysphagia. After chemoradiation, there is little improvement from 3 to 12 months.
Summary The aims of this study were to examine vowel and gender effects on jitter and shimmer in a typical clinical voice task while correcting for the confounding effects of voice sound pressure ...level (SPL) and fundamental frequency ( F0 ). Furthermore the relative effect sizes of vowel, gender, voice SPL, and F0 were assessed, and recommendations for clinical measurements were derived. With this cross-sectional single cohort study, 57 healthy adults (28 women, 29 men) aged 20–40 years were investigated. Three phonations of /a/, /o/, and /i/ at “normal” voice loudness were analyzed using Praat (software). The effects of vowel, gender, voice SPL, and F0 on jitter and shimmer were assessed using descriptive and inferential (analysis of covariance) statistics. The effect sizes were determined with the eta-squared statistic. Vowels, gender, voice SPL, and F0 , each had significant effects either on jitter or on shimmer, or both. Voice SPL was the most important factor, whereas vowel, gender, and F0 effects were comparatively small. Because men had systematically higher voice SPL, the gender effects on jitter and shimmer were smaller when correcting for SPL and F0 . Surprisingly, in clinical assessments, voice SPL has the single biggest impact on jitter and shimmer. Vowel and gender effects were clinically important, whereas fundamental frequency had a relatively small influence. Phonations at a predefined voice SPL (80 dB minimum) and vowel (/a/) would enhance measurement reliability. Furthermore, gender-specific thresholds applying these guidelines should be established. However, the efficiency of these measures should be verified and tested with patients.
Vocal nodules management Birchall, Martin A.; Carding, Paul
Clinical otolaryngology,
July 2019, Letnik:
44, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Vocal fold nodules present the voice clinic team with a number of clinical dilemmas which are not as simple as previously thought. The definition, aetiology, prevalence and diagnosis are all poorly ...understood. Furthermore, treatment evidence for both behavioural and surgical approaches is weak. This paper reviews the published evidence pertaining to all of these aspects. Specific areas of uncertainty that remain include poorly defined nomenclature, the natural history of paediatric vocal nodules, the establishment of criteria to measure successful treatment, optimal configuration of speech therapy regimens and the rationale for surgical intervention. The authors suggest the development of evidence‐based guidelines for UK practice.
The unprecedented rapid re-deployment of healthcare workers from different care pathways into newly created and fluid COVID-19 teams provides a unique opportunity to examine the interaction of many ...of the established non-technical factors for successful delivery of clinical care and teamwork in healthcare settings. This research paper therefore aims to address these gaps by qualitatively exploring the impact of COVID work throughout the pandemic on permanent and deployed personnel's experiences, their ability to effectively work together, and the effect of social dynamics (e.g., cohesion, social support) on teamwork and mental health.
Seventy-five interviews were conducted across the UK between March and December 2021 during wave 2 and 3 of COVID-19 with 75 healthcare workers who were either permanent staff on Intensive Care/High Dependency Units used as COVID wards, had been rapidly deployed to such a ward, or had managed such wards. Work Life Balance was measured using the WLB Scale. Interview transcripts were qualitatively coded and thematic codes were compared using network graph modeling.
Using thematic network analysis, four overarching thematic clusters were found, (1) teamwork, (2) organizational support and management, (3) cohesion and social support, and (4) psychological strain. The study has three main findings. First, the importance of social factors for teamwork and mental health, whereby team identity may influence perceptions of preparedness, collaboration and communication, and impact on the collective appraisal of stressful events and work stressors. Secondly, it demonstrates the positive and negative impact of professional roles and skills on the development of teamwork and team identity. Lastly the study identifies the more pronounced negative impact of COVID work on deployed personnel's workload, mental health, and career intentions, exacerbated by reduced levels of social support during, and after, their deployment.
The thematic network analysis was able to highlight that many of the traditional factors associated with the successful delivery of patient care were impeded by pandemic constraints, markedly influencing personnel's ability to work together and cope with pandemic work stressors. In this environment teamwork, delivery of care and staff well-being appear to depend on relational and organizational context, social group membership, and psycho-social skills related to managing team identity. While results hold lessons for personnel selection, training, co-location, and organizational support during and after a pandemic, further research is needed into the differential impact of pandemic deployment on HCWs mental health and teamwork.
There is only very limited information on the prevalence of voice disorders, particularly for the pediatric population. This study examined the prevalence of dysphonia in a large cohort of children ...(n = 7389) at 8 years of age. Data were collected within a large prospective epidemiological study and included a formal assessment by one of five research speech and language therapists as well as a parental report of their child's voice. Common risk factors that were also analyzed included sex, sibling numbers, asthma, regular conductive hearing loss, and frequent upper respiratory infection. The research clinicians identified a dysphonia prevalence of 6% compared with a parental report of 11%. Both measures suggested a significant risk of dysphonia for children with older siblings. Other measures were not in agreement between clinician and parental reports. The clinician judgments also suggested significant risk factors for sex (male) but not for any common respiratory or otolaryngological conditions that were analyzed. Parental report suggested significant risk factors with respect to asthma and tonsillectomy. These results are discussed in detail.
The rapid increase of acute and intensive care capacities in hospitals needed during the response to COVID-19 created an urgent demand for skilled healthcare staff across the globe. To upscale ...capacity, many hospitals chose to increase their teams in these departments with rapidly re-deployed inter-professional healthcare personnel, many of whom had no prior experience of working in a high-risk environment and were neither prepared nor trained for work on such wards. This systematic review of reviews examines the current evidence base for successful teamwork in rapidly deployed interprofessional teams in intensive and acute care settings, by assessing systematic reviews of empirical studies to inform future deployments and support of rapidly formed clinical teams. This study identified 18 systematic reviews for further analysis. Utilising an integrative narrative synthesis process supported by thematic coding and graphical network analysis, 13 themes were found to dominate the literature on teams and teamwork in inter-professional and inter-disciplinary teams. This approach was chosen to make the selection process more transparent and enable the thematic clusters in the reviewed papers to be presented visually and codifying four factors that structure the literature on inter-professional teams (i.e., team-internal procedures and dynamics, communicative processes, organisational and team extrinsic influences on teams, and lastly patient and staff outcomes). Practically, the findings suggest that managers and team leaders in fluid and ad-hoc inter-professional healthcare teams in an intensive care environment need to pay attention to reducing pre-existing occupational identities and power-dynamics by emphasizing skill mix, establishing combined workspaces and break areas, clarifying roles and responsibilities, facilitating formal information exchange and developing informal opportunities for communication. The results may guide the further analysis of factors that affect the performance of inter-professional teams in emergency and crisis deployment.
Aim
To review the evidence for behavioural interventions to reduce drooling in children with neurodisability.
Method
A detailed search in eight databases sought studies that: (1) included ...participants aged 0 to 18 years with neurodisability and drooling; (2) provided behavioural interventions targeting drooling or a drooling‐related behaviour; and (3) used experimental designs. Two reviewers extracted data from full‐text papers independently. Results were tabulated for comparison. The Risk of Bias assessment in N‐of‐1 Trials scale for single case experimental designs (SCEDs) and the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs) were applied.
Results
Of an initial yield of 763, seven SCEDs and one RCT were included. Behavioural interventions included the use of reinforcement, prompting, self‐management, instruction, extinction, overcorrection, and fading. Each assessed body functions or structures’ outcomes (drooling frequency and severity); three included activity outcomes (mouth drying, head control, eye contact, and vocalizations) and none assessed participation or quality of life. While each study reported positive effects of intervention, risk of bias was high.
Interpretation
Low‐level evidence suggests behavioural interventions may be useful for treatment of drooling in children with neurodisability. Well‐designed intervention studies are urgently needed to determine effectiveness.
What this paper adds
Behavioural interventions used to treat drooling included reinforcement, prompting, self‐management, extinction, overcorrection, instruction, and fading.
Interventions targeted body structures and function‐level outcomes and activity‐level outcomes.
Low‐level evidence supports the use of behavioural intervention to treat drooling.
Resumen
Intervenciones conductuales para tratar el babeo en niños con discapacidad neurológica: una revisión sistemática
Objetivo
Revisar la evidencia de intervenciones conductuales a fin de reducir el babeo en niños con discapacidad neurológica.
Metodo
Una búsqueda detallada de ocho bases de datos donde se buscaron estudios que 1) incluyeron participantes de 0 a 18 años de edad con discapacidad neurológica y babeo 2) proporcionaron intervenciones conductuales dirigidas al babeo o conductas relacionadas con el babeo 3) utilizaron diseños experimentales. Dos revisores extrajeron datos de artículos de texto completo en forma independiente. Los resultados fueron tabulados para la comparación. Fueron aplicados la evaluación de riesgo de sesgo en N‐1 para ensayos de diseños experimentales de un solo caso (SCEDS) y la evaluación de riesgo de sesgo Cochrane para ensayos controlados aleatorios (RCT).
Resultado
De un rendimiento inicial de 763 artículos, se incluyeron siete SCEDS y un RCT. Las intervenciones conductuales incluyeron: el uso de refuerzo, desencadenamiento‐ Estimulación, sobre corrección de autogestión y desvanecimiento. Cada uno evaluo resultados relacionados a funciones o estructuras corporales (frecuencia y severidad del babeo); tres incluyeron actividad (secado de boca, control cefálico, contacto visual y vocalizaciones) y ninguno evaluó la participación o la calidad de vida. Mientras que cada estudio informó efectos positivos de la intervención el riesgo de sesgo fue alto.
Interpretacion
La evidencia de bajo nivel sugiere que las intervenciones conductuales podrían ser útiles en el tratamiento del babeo de los niños con discapacidad neurología. Se necesitan en forma urgente estudios de intervención bien diseñados para determinar la efectividad de las intervenciones conductuales.
Resumo
Intervenções comportamentais para tratar sialorréia em crianças com neuroincapacidades: uma revisão sistemática
Objetivo
Revisar a evidência de intervenções comportamentais para reduzir a sialorréia em crianças com neuroincapacidades.
Método
Uma busca detalhada em oito bases de dados buscou estudos que 1) incluíram participantes com idades entre 0 e 18 anos com neuroincapacidades e sialorréia; 2) ofereceram intervenções comportamentais voltadas para a sialorréia ou comportamento relacionado a ela; e 3) usaram desenhos experimentais. Dois revisores extraíram dados dos artigos completos independentemente. Os resultados foram tabulados para comparação. A Escala de Avaliação do Risco de Viés em estudos com N‐de 1 para estudos com desenhos experimentais de caso único (DECUs) e a Avaliação Cochrane para Risco de Viés em estudos clínicos randomizados (ECRs) foram aplicadas.
Resultados
De uma quantidade inicial de 763 estudos, sete DECUs e um ECR foram incluídos. Intervenções comportamentais incluíram o uso de reforço, comandos, dicas, auto‐manejo, super‐correção e diminuição progressiva. Todos avaliaram resultados relacionados a estruturas e funções do corpo (frequência e severidade da salivação); três incluíram resultados de atividades (secura da boca, controle de cabeça, contato visual, e vocalizações), e nenhum avaliou participação ou qualidade de vida. Embora todos os estudos tenham reportado efeitos positivos das intervenções, o risco de viés foi alto.
Interpretação
Evidências de baixo nível sugerem que intervenções comportamentais podem ser úteis para o tratamento da sialorréia em crianças com neuroincapacidades. Estudos com bom desenho são necessários com urgência para determinar a efetividade.
What this paper adds
Behavioural interventions used to treat drooling included reinforcement, prompting, self‐management, extinction, overcorrection, instruction, and fading.
Interventions targeted body structures and function‐level outcomes and activity‐level outcomes.
Low‐level evidence supports the use of behavioural intervention to treat drooling.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
Video Podcast: https://www.youtube.com/watch?v=D6Ji6J3mtQ8&feature=youtu.be
Paul N. Carding
Michael J. Drinnan
Freeman Hospital, Newcastle upon Tyne, Great Britain
Contact author: Meike Brockmann, Head of Speech Pathology Section, Clinic of Otorhinolaryngology, Head and Neck ...Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091 Zürich, Switzerland. E-mail: meike.brockmann{at}usz.ch .
Purpose: The aim of this study was to investigate voice loudness and gender effects on jitter and shimmer in healthy young adults because previous descriptions have been inconsistent.
Method: Fifty-seven healthy adults (28 women, 29 men) aged 20–40 years were included in this cross-sectional single-cohort study. Three phonations of /a/ at soft, medium, and loud individual loudness were recorded and analyzed using PRAAT software (P. Boersma & D. Weeninkk, 2006). Voice loudness and gender effects on measured sound pressure level, fundamental frequency, jitter, and shimmer were assessed through the use of descriptive and inferential (analysis of variance) statistics.
Results: Jitter and shimmer significantly increased with decreasing voice loudness, especially in phonations below 75 dB and 80 dB. In soft and medium phonation, men were generally louder and showed significantly less shimmer. However, men had higher jitter measures when phonating softly. Gender differences in jitter and shimmer at medium loudness may be mainly linked to different habitual voice loudness levels.
Conclusion: This pragmatic study shows significant voice loudness and gender effects on perturbation. In clinical assessment, requesting phonations above 80 dB at comparable loudness between genders would enhance measurement reliability. However, voice loudness and gender effects in other age groups, in disordered voices, or when a minimal loudness is requested should be further investigated.
KEY WORDS: voice loudness, gender, jitter, shimmer, acoustic assessment
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Purpose: In the absence of evidence-based guidelines, this study sought to understand current speech-language pathologists' (SLPs) practice when treating drooling in children with a neurodisability.
...Method: Descriptive research using cross-sectional survey methodology. Online survey methods were used to obtain specific information on Australian SLPs' self-reported assessment and treatment practices relative to working with children with neurodisability who drool. Questions focussed on level of expertise, treatment approaches and barriers to evidence-based practice (EBP) in this area. Participants were sourced through three targeted associations/organisations. Data were analysed using descriptive and non-parametric statistics.
Result: Participants were Australian SLPs who had recent experience working with children with neurodisability who drool (n = 68). They favoured informal rather than formal methods for assessment. Preferred treatment techniques included behavioural intervention methods (46-53%) and modifying positioning (43.3%). Client suitability dominated reasoning regarding treatment selection (60%) with 57% of SLPs reporting EBP barriers.
Conclusion: Drooling was perceived to be a complex practice area for which SLPs desire additional education. Despite availability, valid and reliable assessments of drooling were not commonly used. Clinicians have limited evidence to support their practice: further research is needed to establish evidence-based treatments for drooling.
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