Benefits and losses: a qualitative study exploring healthcare staff perceptions of teamworking

ABSTRACT Objectives: To examine staff perceptions of teamworking practice in the field of stroke care. Design: Qualitative interview study. Setting: Three teams providing care to patients with stroke across a typical care pathway of acute hospital ward, specialist stroke unit, and community rehabilitation. Participants: 37 staff members from a range of professions. Main outcome measures: Healthcare staff perceptions of teamworking. Results: Through detailed coding and analysis of the transcripts, five perceptions regarding the impact of teamworking on staff and patients were identified. These were: (1) mutual staff support, (2) knowledge and skills sharing, (3) timely intervention/discharge, (4) reduced individual decision-making and responsibility and (5) impact on patient contact time. Conclusions: Teamworking practice may be associated with a number of perceived benefits for staff and patient care; however, the potential for losses resulting from reduced patient contact time and ill-defined responsibility needs further investigation

Automatic recognition of children’s read speech for stuttering application

Stuttering is a common speech disfluency that may persist into adulthood if not treated in its early stages. Techniques from spoken language understanding may be applied to provide auto-mated diagnoses of stuttering from voice recordings; however,there are several difficulties, including the lack of training data involving young children and the high dimensionality of these data. This study investigates how automatic speech recognition(ASR) could help clinicians by providing a tool that automatically recognises stuttering events and provides a useful written transcription of what was said. In addition, to enhance the performance of ASR and to alleviate the lack of stuttering data, this study examines the effect of augmenting the language model with artificially generated data. The performance of the ASR tool with and without language model augmentation is com-pared. Following language model augmentation, the ASR tool’s performance improved recall from 38% to 62.2% and precision from 56.58% to 71%. When mis-recognised events are more coarsely classified as stuttering/ non-stuttering events, the performance improves up to 73% in recall and 84% in precision.Although the obtained results are not perfect, they map to fairly robust stutter/ non-stutter decision boundaries

Detecting stuttering events in transcripts of children’s speech

Stuttering is a common problem in childhood that may persist into adulthood if not treated in early stages. Techniques from spoken language understanding may be applied to provide automated diagnosis of stuttering from children speech. The main challenges however lie in the lack of training data and the high dimensionality of this data. This study investigates the applicability of machine learning approaches for detecting stuttering events in transcripts. Two machine learning approaches were applied, namely HELM and CRF. The performance of these two approaches are compared, and the effect of data augmentation is examined in both approaches. Experimental results show that CRF outperforms HELM by 2.2% in the baseline experiments. Data augmentation helps improve systems performance, especially for rarely available events. In addition to the annotated augmented data, this study also adds annotated human transcriptions from real stuttered children’s speech to help expand the research in this field

The state of the art in non-pharmacological interventions for developmental stuttering. Part 2: qualitative evidence synthesis of views and experiences.

BACKGROUND: A range of interventions have been developed to treat stuttering in recent years. The effectiveness of these interventions has largely been assessed in studies focusing on the impact of specific types of therapy on patient outcomes. Relatively little is known about the factors that influence how the delivery and impact of different types of intervention may be experienced from the perspective of both people who deliver as well as those who receive interventions. AIMS: To synthesize the available evidence in relation to factors that might enhance or mitigate against successful outcomes following interventions for stuttering by identifying and synthesizing relevant qualitative research that explored the experiences of people delivering and receiving interventions that aim to improve fluency. METHODS & PROCEDURES: We carried out a systematic review including research that had used in-depth interviews and focus groups and conducted a substantive qualitative analysis of the data collected. Included study populations were either adults or children affected by a diagnosed stutter and/or providers of therapy for stuttering. An iterative approach was used to search for published qualitative evidence in relevant databases from 1990 to 2014. Retrieved citations were sifted for relevance and the data from articles that met the inclusion criteria were extracted. Each included paper was assessed for quality and a thematic analysis and synthesis of findings was carried out. MAIN CONTRIBUTION: Synthesized qualitative evidence highlights the changing experiences for people who stutter both historically and, for individuals, over the life course. Barriers and facilitators to the implementation of interventions for stuttering are encountered at the individual, intervention, interpersonal and social levels. Interventions may be particularly pertinent at certain transition points in the life course. Attention to emotional as well as practical aspects of stuttering is valued by people receiving therapy. The client-therapist relationship and support from others are also key factors in achieving successful outcomes. CONCLUSIONS & IMPLICATIONS: A synthesis of qualitative findings from published papers has added to the effectiveness data reported in an accompanying paper in understanding how stuttering impacts on people across the life course. Evidence suggests that a client-centred and individually tailored approach enhances the likelihood of successful intervention outcomes through attention to emotional, situational and practical needs

Communication and Low Mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia

Objective: The aim was to evaluate behavioural therapy as a treatment for low mood in people with aphasia. Design: A randomized controlled trial comparing behavioural therapy plus usual care with a usual care control. Potential participants with aphasia after stroke were screened for the presence of low mood. Those who met the criteria and gave consent were randomly allocated. Setting: Participants were recruited from hospital wards, community rehabilitation, speech and language therapy services and stroke groups. Subjects: Of 511 people with aphasia identified, 105 had low mood and were recruited. Interventions: Behavioural therapy was offered for up to three months. Outcomes were assessed three and six months after random allocation. Main measures: Stroke Aphasic Depression Questionnaire, Visual Analog Mood Scales ‘sad’ item, and Visual Analogue Self-Esteem Scale. Results: Participants were aged 29 to 94 years (mean 67.0, SD 13.5) and 66 (63%) were men. Regression analysis showed that at three months, when baseline values and communication impairment were controlled for, group allocation was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), visual analogue ‘sad’ (P = 0.03), and Visual Analogue Self-Esteem Scale (P < 0.01). At six months, group alone was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), and remained significant when baseline values were controlled for (P = 0.02). Mean Stroke Aphasic Depression Questionnaire 10-item hospital version scores decreased from baseline to six months by six points in the intervention group as compared with an increase of 1.9 points in the control group. Conclusions: Behavioural therapy seemed to improve the mood of people with aphasia

Vancomycin sensitivity of Staphylococcus aureus isolates from hospital patients in Karachi, Pakistan

Methicillin-resistant Staphylococcus aureus (S. aureus) (MRSA), resistant to all antibiotics including Vancomycin, has been reported in Japan, USA, Canada and Brazil. Hence, the main objective of this study was to evaluate the possible presence of Vancomycin resistant or intermediate S.aureus in Karachi. A total of 850 clinical isolates were collected from two civil hospitals in the city between February 2006 and January 2007. They were identified using standard bacteriological methods.Sensitivity to recommended antibiotics was determined by disc diffusion, agar dilution, and E-test quantitative minimum inhibitory concentration (MIC). Susceptibility to natural or semi-natural products was determined by the agar dilution method. Out of 850 isolates, 250 were MRSA, of which 22% were resistant to 4 µg/ml Vancomycin, 24% to 8 µg/ml, 15.2% to 16 µg/ml, 10% to 20 µg/ml, and 13.2% to 30 µg/ml; the remaining 15.6% were sensitive to all used concentrations. Although we did not detect any Vancomycin-resistant S. aureus (VRSA), we found that 13% of the strains were intermediates (VISA), i.e. resistant to 30 µg/ml of Vancomycin. Because of the continuously increasing prevalence of VISA, it is imperative to minimize the use of Vancomycin. Indeed, the drug should only be prescribed for the treatment of documented, culture-proven infections with MRSA that are not susceptible to routine or alternative agents. This should help avoid the consequences of the development of Vancomycin resistant S. aureus (VRSA) in our environment

Sequence labeling to detect stuttering events in read speech

Stuttering is a speech disorder that, if treated during childhood, may be prevented from persisting into adolescence. A clinician must first determine the severity of stuttering, assessing a child during a conversational or reading task, recording each instance of disfluency, either in real time, or after transcribing the recorded session and analysing the transcript. The current study evaluates the ability of two machine learning approaches, namely conditional random fields (CRF) and bi-directional long-short-term memory (BLSTM), to detect stuttering events in transcriptions of stuttering speech. The two approaches are compared for their performance both on ideal hand-transcribed data and also on the output of automatic speech recognition (ASR). We also study the effect of data augmentation to improve performance. A corpus of 35 speakers’ read speech (13K words) was supplemented with a corpus of 63 speakers’ spontaneous speech (11K words) and an artificially-generated corpus (50K words). Experimental results show that, without feature engineering, BLSTM classifiers outperform CRF classifiers by 33.6%. However, adding features to support the CRF classifier yields performance improvements of 45% and 18% over the CRF baseline and BLSTM results, respectively. Moreover, adding more data to train the CRF and BLSTM classifiers consistently improves the results

A lightly supervised approach to detect stuttering in children's speech

© 2018 International Speech Communication Association. All rights reserved. In speech pathology, new assistive technologies using ASR and machine learning approaches are being developed for detecting speech disorder events. Classically-trained ASR model tends to remove disfluencies from spoken utterances, due to its focus on producing clean and readable text output. However, diagnostic systems need to be able to track speech disfluencies, such as stuttering events, in order to determine the severity level of stuttering. To achieve this, ASR systems must be adapted to recognise full verbatim utterances, including pseudo-words and non-meaningful part-words. This work proposes a training regime to address this problem, and preserve a full verbatim output of stuttering speech. We use a lightly-supervised approach using task-oriented lattices to recognise the stuttering speech of children performing a standard reading task. This approach improved the WER by 27.8% relative to a baseline that uses word-lattices generated from the original prompt. The improved results preserved 63% of stuttering events (including sound, word, part-word and phrase repetition, and revision). This work also proposes a separate correction layer on top of the ASR that detects prolongation events (which are poorly recog-nised by the ASR). This increases the percentage of preserved stuttering events to 70%

Supporting people with aphasia to ‘settle into a new way to be’: speech and language therapists’ views on providing psychosocial support

Background: People with aphasia are at risk of becoming depressed and isolated. On-line surveys have found that the majority of Speech and Language Therapists (SLTs) lack confidence in addressing the psychological needs of people with aphasia. Aims: To explore how SLTs conceptualise the scope of their role; barriers and facilitators to SLTs addressing psychosocial needs; and SLTs’ experiences of specialist training and support, and working with mental health professionals (MHPs). Methods and procedures: Focus groups conducted in stroke healthcare settings. Purposive sampling was used in selecting sites so as to capture a range of experiences. Results were analysed using Framework Analysis. Outcomes and Results: Twenty-three SLTs took part in six focus groups. Participants’ psychosocial work included counselling-type interactions, psychoeducation, working with families, facilitating peer support, and training other healthcare professionals. There was a lack of consensus on the scope of the SLT role. Many expressed a sense of conflict, both perceiving it as valuable to spend time addressing psychological well-being, while simultaneously feeling uneasy if they deviated from ‘direct SLT’ work. Barriers to addressing psychosocial wellbeing were: emotionally challenging nature of this work, particularly for those who felt unsupported; caseload and time pressures; attitude of senior managers and commissioners; difficulties measuring and documenting more ‘fluid’ psychosocial work; and the complexity of needs and backgrounds of some patients. Enabling factors were: specialist on-going support; peer support from colleagues; experience; support of management; and personal belief. Specialist training was valued. It changed how participants viewed the therapist-client relationship (more client-led); the assessment and goal setting process; and gave them more confidence to acknowledge client emotions. However, many felt that there was a need for on-going specialist advice, and to be able to see approaches modelled for this client group. In terms of mental health professionals (MHPs), a subset of stroke specialist clinical psychologists worked directly with people with marked aphasia and families, as well as supporting the multidisciplinary team to provide holistic care. However, a main theme was that participants perceived many MHPs did not consider people with aphasia as ‘appropriate candidates’ for psychological input. Conclusions and Implications: All participants cared about the emotional well-being of their clients; however, they identified a number of barriers to people with aphasia receiving appropriate psychological support. A cultural shift, whereby psychological care for people with aphasia is seen as valuable, feasible and necessary, delivered collaboratively by SLTs, MHPs and the wider team, may improve services

Autoimmune hepatitis triggered by nitrofurantoin: a case series

<p>Abstract</p> <p>Introduction</p> <p>Drugs can occasionally trigger the onset of autoimmune liver disease.</p> <p>Case presentation</p> <p>Three Caucasian women (aged 65, 42 and 74 years old) who were receiving long-term nitrofurantoin as prophylaxis against recurrent urinary tract infections developed hepatitic liver disease. Serological auto-antibody profiles and liver histology appearances were consistent with autoimmune hepatitis. Two of the patients presented with jaundice, and one required a prolonged hospital admission for liver failure. In all three patients nitrofurantoin was withdrawn, and long-term immunosuppressive therapy with prednisolone and azathioprine or mycophenolate was given. The patients responded well, with liver biochemistry returning to normal within a few months.</p> <p>Conclusions</p> <p>Although nitrofurantoin rarely causes autoimmune hepatitis, this antimicrobial is increasingly used as long-term prophylaxis against recurrent urinary tract infection. General practitioners and urologists who prescribe long-term nitrofurantoin therapy should be aware of this adverse effect.</p