Comparing In Vivo versus Simulation Training for Transnasal Endoscopy Skills

Fiberoptic endoscopic evaluations of swallowing (FEES) is as important of a swallowing evaluation as the videoflouroscopic swallow study, but far fewer speech-language pathologists are competent in its use (Ambika, Datta, Manjula, Warawantkar, & Thomas, 2019; Brady & Donzelli, 2013; Pisegna & Langmore, 2016). One hurdle in FEES training is the necessity of practicing transnasal endoscopy on volunteers. The primary aim of this study was to compare the learning effectiveness of practicing transnasal endoscopy via simulation with practice in vivo for a student’s first passes of the endoscope. The end goal of this study was to determine the most cost-effective and feasible means of teaching transnasal endoscopy to graduate clinicians. Twenty-one graduate students practiced transnasal endoscopy in one of three conditions: in vivo, high-fidelity lifelike simulation, low-fidelity non-lifelike simulation. The learning outcomes assessed were speed of endoscopy, student confidence, and simulated patients’ comfort and perception of student skill. There were no significant differences between conditions found for any of these measures. Students in all conditions became more confident after practicing endoscopy, and that confidence was predictive of procedure time. The results of this study indicate that practice with simulation may be an important first step in teaching endoscopy

The Utility of Peer-to-Peer Practice for Teaching Speech-Language Pathology Students Transnasal Endoscopy

Introduction: Transnasal flexible endoscopy (TNFE) is necessary for multiple assessments in speech-language pathology (SLP), but it is generally considered an advanced practice technique to be learned during clinical practice. As such, there is no standardized way that it is taught in training programs, leading to a substantial knowledge gap for new graduates. Though peer-to-peer practice has been discussed as an important step in training, it is not clear whether it confers additional benefits above and beyond simulation. This study sought to answer that question in the areas of student confidence, endoscopy speed, and motivation to pursue further TNFE experiences. Methods: Thirty-six SLP graduate students completed TNFE training and one of two practice conditions: simulation only or simulation with additional peer-to-peer practice. Outcome measures included confidence and comfort surveys, intrinsic motivation to complete an additional TNFE experience, and speed of TNFE. Results: No significant differences were found between the two groups for any measure, and consistently low effect sizes indicated there was little difference between groups. Conclusions: These results indicate that teaching TNFE through simulation may provide similar outcomes to peer-to-peer practice during the initial training that an SLP graduate program can provide. This adds to the literature indicating that TNFE simulation is a worthwhile addition to SLP programs

Clinical Education Outcomes and Research Directions in Speech-Language Pathology: A Scoping Review

Purpose: To describe what researchers are investigating and how they are measuring the constructs of their investigations within the speech-language pathology (SLP) clinical education literature. Method: A scoping review methodology (Arksey & O’Malley, 2005) was employed to develop a picture of clinical education articles which reported a measured outcome. Articles that met criteria were categorized by the purpose of the investigation and the outcome measures reported. Result: 124 articles met inclusion criteria. Analysis of study purposes revealed a wide breadth of foci that were grouped into four broad clusters: Outcome Measures, Student Perspectives, Educational Contexts, and Teaching Methods. Most of the studies in the corpus relied only on student self-report measures. In addition, any specific outcome measure was typically used only once and not found in subsequent studies. Trends indicate a variety of constructs are being studied at an exploratory level with limited in-depth investigation. Conclusion: Given the inconsistency of outcome measures and reliance on self-report measures, more research is needed to validate recommendations of best practices in clinical education. Areas of need include developing and implementing validated outcomes, more frequent investigation of clinical education using measures other than student self-reports, and testing theories found in other fields

Reimagining Clinical Education Practices for Autism through the Multi-client Multilevel Mentorship Model

Speech-language pathology students require comprehensive graduate education to address the needs of their future autistic clients. Despite this need, survey research suggests that students receive limited didactic and clinical graduate training that sufficiently prepares them to work with autistic clients. Contemporary research into clinical education for autism includes several features, such as more support and group-based services, that do not align with traditional clinical education in the field (Anderson, 1988; Dudding et al., 2017). The purpose of this study is to describe feasibility (by acceptability and implementation) of a new clinical education protocol, the Multi-client Multilevel Mentorship (M3) model. The M3 model is a collaborative clinical education model that emphasizes in-the-room clinical supervision of group-based service delivery for a team of students. Two cohorts of student clinicians (N = 9) participated in two ten-week rotations where they provided (a) and a literacy intervention (b) an intervention targeting executive function for two groups of clients with mixed diagnoses including autism spectrum disorder. Two clinical educators supervised the sessions with additional support by peer mentors. Survey feedback from participants showed that they rated the clinical education experience highly, suggesting adequate acceptability of the M3 model. Participants demonstrated strong fidelity to one protocol and fair fidelity to the other, which was a positive indicator of implementation. Overall, student participants appear to benefit from the M3 model during an adapted group intervention protocol designed for autistic clients. Further testing of the M3 model’s effectiveness is warranted given the positive feasibility indicators

Chromosome Xq23 is associated with lower atherogenic lipid concentrations and favorable cardiometabolic indices

AbstractAutosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10−72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10−4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10−5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids.Abstract Autosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10−72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10−4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10−5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2–4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

GWAS of thyroid stimulating hormone highlights pleiotropic effects and inverse association with thyroid cancer

Thyroid stimulating hormone (TSH) is critical for normal development and metabolism. To better understand the genetic contribution to TSH levels, we conduct a GWAS meta-analysis at 22.4 million genetic markers in up to 119,715 individuals and identify 74 genome-wide significant loci for TSH, of which 28 are previously unreported. Functional experiments show that the thyroglobulin protein-altering variants P118L and G67S impact thyroglobulin secretion. Phenome-wide association analysis in the UK Biobank demonstrates the pleiotropic effects of TSH-associated variants and a polygenic score for higher TSH levels is associated with a reduced risk of thyroid cancer in the UK Biobank and three other independent studies. Two-sample Mendelian randomization using TSH index variants as instrumental variables suggests a protective effect of higher TSH levels (indicating lower thyroid function) on risk of thyroid cancer and goiter. Our findings highlight the pleiotropic effects of TSH-associated variants on thyroid function and growth of malignant and benign thyroid tumors