What are the voice and swallowing concerns and outcomes of adults with laryngotracheal stenosis who undergo reconstructive surgery?

Acquired laryngotracheal stenosis (LTS) is a rare condition causing narrowing of the upper airway leading to a range of laryngological symptoms. This thesis seeks to identify and evaluate the existing evidence base for the voice and swallowing difficulties of adult patients with LTS who undergo airway reconstruction; and identify voice and swallowing concerns and outcomes. Four studies were included: 1) a systematic review of the voice and swallowing outcomes in adults with LTS following reconstructive surgery, 2) a qualitative study focusing on voice and swallowing concerns, 3) a survey study exploring the impact of mucus and cough, 4) an observational study exploring voice and swallowing outcomes before and after airway reconstruction. The systematic review identifed no consistent reporting of outcomes and provided minimal information to guide clinical practice. The qualitative study indentified voice and swallowing concerns that were grouped into three themes; The Medical Journey which included information provision and staff expertise versus complacency; the Physical Journey which considered symptoms and treatment; the Emotional Journey encompassing identity, support networks and living with a chronic condition. Mucus and cough were raised in the qualitative research leading to a survey to investigate the issue further. They were noted to impact all aspects of health and were related to voice and swallowing issues. There was no consistent treatment advice or management, supporting the need for clearer guidance. The observational study highlighted the heterogeneity of voice and swallowing outcomes which could indicate a need for personalised assessment and management. In conclusion, adults with LTS present with a range of voice and swallowing concerns and outcomes. Clinical care should be personalised according to individuals, including pre-treatment information provision, and support beyond airway reconstruction. There is a need to develop a core outcome set for the assessment of voice and swallowing in adults with LTS.Open Acces

What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and meta-synthesis

© 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license: https://creativecommons.org/licenses/by/4.0/Purpose: Tracheostomy is a common surgical procedure in ICU. Whilst often a life-saving procedure, it can have important impacts on patients. Much of the literature on tracheostomy focuses on timing and technique of insertion, risk factors and complications. More knowledge of patient experience of tracheostomy in ICU is needed to support person-centred care. Materials and Methods: Qualitative systematic review and metasynthesis of the literature on adult experience of tracheostomy in ICU. Comprehensive search of four bibliographic databases and grey literature. Title and abstract screening and full text eligibility was completed independently by two reviewers. Metasynthesis was achieved using thematic synthesis, supported by a conceptual framework of humanised care. Results: 2971 search returns were screened on title and abstract and 127 full texts assessed for eligibility. Thirteen articles were included for analysis. Five descriptive and three analytical themes were revealed. The over-arching theme was ‘To be seen and heard as a whole person’. Patients wanted to be treated as a human, and having a voice made this easier. Conclusions: Voice restoration should be given high priority in the management of adults with a tracheostomy in ICU. Staff training should focus on both technical skills and compassionate care to improve person-centred outcomes. Keywords: tracheostomy, voice, qualitative, systematic review, metasynthesis, humanisationPeer reviewe

Current Concepts and Considerations in Measuring Dysphagia-Related Quality of Life for People with Head and Neck Disease

Kate Toft - ORCID: 0000-0002-0129-9329 https://orcid.org/0000-0002-0129-9329Purpose of Review To provide an overview of current concepts and considerations in the measurement of dysphagia-related quality of life (QoL) for people with head and neck disease. We describe key psychometric and other tool properties that are important to consider when deciding which dysphagia QoL tool to use in practice. The review seeks to establish which tool/s best meet the required properties. Recent Findings Currently, no single dysphagia QoL tool meets all criteria. However, a few (SWAL QoL, MDADI, SOAL) meet several parameters and we highlight the current evidence base for these assessments. Summary QoL is essential to providing holistic clinical care and could also be an important outcome in research when evaluating interventions. Existing tools may benefit from re-validation studies which take account of progress made in the fields of instrument development, cross-cultural validity and patient centredness. It is also crucial to recognise that the value of capturing QoL in clinical practice is only realised by subsequent follow-up with the individual patient.https://doi.org/10.1007/s40136-023-00450-9pubpu

COVID-19 and ENT SLT services, workforce and research in the UK: A discussion paper

Background. The COVID‐19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high‐risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims. To discuss the threats and opportunities from the COVID‐19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures. The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple‐group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution. The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID‐19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non‐instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face‐to‐face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications. The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post‐COVID era to re‐evaluate current practice, embrace opportunities and evaluate new ways of working

Utility of ultrasound in the assessment of swallowing and laryngeal function: A rapid review and critical appraisal of the literature

BACKGROUND: Ultrasound (US) is not widely used as part of the speech and language therapy (SLT) clinical toolkit. The COVID-19 pandemic has intensified interest in US as an alternative to SLT instrumental tools such as the videofluoroscopic swallowing study (VFSS), fibreoptic endoscopic evaluation of swallowing (FEES) and endoscopic evaluation of the larynx (EEL) as a non-invasive, non-aerosol-generating procedure that can be delivered at the bedside to assess swallowing and/or laryngeal function. To establish the appropriacy of routine US use, and in response to a national professional body request for a position statement, a group of expert SLTs conducted a rapid review of the literature. AIM: To explore critically the clinical utility of US as an assessment tool for swallowing and laryngeal function in adults. METHODS & PROCEDURES: A rapid review of four databases was completed to identify articles using US to assess swallowing and/or laryngeal function in adults compared with reference tests (VFSS/FEES/EEL/validated outcome measure). Screening was completed according to predefined inclusion/exclusion criteria and 10% of abstracts were rescreened to assess reliability. Data were extracted from full texts using a predeveloped form. The QUADAS-2 tool was used for quality ratings. Information from included studies was summarized using narrative synthesis and visual illustration. OUTCOMES & RESULTS: Ten papers used US to assess swallowing, and 13 to assess laryngeal function. All were peer-reviewed primary studies across a range of clinical populations and with a wide geographical spread. Four papers had an overall low risk of bias, but the remaining 19 had at least one domain where risk of bias was judged as high or unclear. Applicability concerns were identified in all papers. The papers that used US to assess swallowing varied widely in terms of the anatomical structures assessed and methodology employed. The papers assessing laryngeal function were more homogenous in their methodology. Sensitivity and specificity data were provided for 12 of the laryngeal function papers with ranges of 64.3–100% and 48.5–100%, respectively. CONCLUSIONS & IMPLICATIONS: There is burgeoning evidence to support the use of US as an adjunct to SLT clinical assessment of swallowing and laryngeal function. However, the current literature does not support its use as a tool in isolation. Further research is required to establish reliability in US assessment as well as clear SLT-driven protocols and training

Patient and practitioner perspectives on the design of a simulated affective touch device to reduce procedural anxiety associated with radiotherapy: a qualitative study

Objective: The aim of this study was to elicit the views of relevant stakeholders on the design of a device using simulated affective touch to reduce procedural anxiety surrounding radiotherapy and imaging. Design: This qualitative study collected data from focus groups which were then analysed using inductive thematic analysis in line with Braun and Clarke's methods. Participants and setting: Twenty patients and carers were recruited, as well as 10 healthcare practitioners involved in either delivering radiotherapy or imaging procedures. Results: Patients, carers and healthcare practitioners agreed on some aspects of the device design, such as ensuring the device is warm and flexible in where it can be used on the body. However, patient and healthcare practitioner cohorts had at times differing viewpoints. For example, healthcare practitioners provided professional perspectives and required easy cleaning of the device. Meanwhile patients focused on anxiety-relieving factors, such as the tactile sensation of the device being either a vibration or pulsation. There was no consensus on who should control the device. Conclusions: The desired features of a simulated affective touch device have been investigated. Different priorities of patients and their carers and healthcare practitioners were evident. Any design must incorporate such features as to appease both groups. Areas where no consensus was reached could be further explored, alongside including further patient and public involvement in the form of a project advisory group

Not as simple as "fear of the unknown": A qualitative study exploring anxiety in the radiotherapy department

Objective Little is understood about the anxiety experienced by cancer patients undergoing radiotherapy or investigative imaging. Our aim was to identify sources of anxiety, the points along the cancer journey where anxiety occurred and methods to alleviate it. Methods Six focus groups were conducted with cancer patients (n = 17), caregivers (n = 3) and healthcare practitioners (HCPs; n = 10) in the radiotherapy department. Patients described specific elements in the care pathway which induced anxiety, while HCPs focused on their perception of the patient experience. Thematic analysis was used to analyse data. Results Three broad themes emerged: The Environment, The Individual and The Unknown. The physical environment of the hospital, inside the scanner for example, emerged as a key source of anxiety. The impact of cancer on patients' individual lives was significant, with many feeling isolated. The majority of participants described anxiety associated with the unknown. HCPs reported difficulty in identifying the anxious patient. Conclusions Anxiety is experienced throughout the cancer pathway. Common sources include the physical environment and the uncertainty associated with having cancer. Identifying both anxiety-inducing factors, and the anxious patients themselves, is crucial to enable targeted interventions to alleviate anxiety

COVID-19 and ENT SLT/laryngology services, workforce and research in the UK: A discussion paper

Background. The COVID‐19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high‐risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims. To discuss the threats and opportunities from the COVID‐19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures. The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple‐group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution. The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID‐19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non‐instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face‐to‐face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications. The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post‐COVID era to re‐evaluate current practice, embrace opportunities and evaluate new ways of working

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

From Springer Nature via Jisc Publications RouterHistory: received 2021-11-09, accepted 2022-01-19, registration 2022-01-20, pub-electronic 2022-02-24, online 2022-02-24, pub-print 2022-12Acknowledgements: Acknowledgements: The authors would like to thank the members of the international ultrasound group who participated in this project: Jemma Haines (UK), Becca Hammond (NZ), Lisa Hayward (UK), Professor Maggie-Lee Huckabee (New Zealand), Marloes Lagarde (Netherlands), Corinne Mossey-Gaston (UK), Claire Slinger (UK) and Sarah Wallace (UK).Publication status: PublishedFunder: Research Trainees Coordinating Centre; doi: http://dx.doi.org/10.13039/501100000659; Grant(s): Pre-Clinical Academic Fellowship, Clinical Doctoral Research Fellowship, Development and Skills AwardFunder: National Institutes of Health; doi: http://dx.doi.org/10.13039/100000002; Grant(s): Research Enhancement Award (R15)Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1–13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field

Translating ultrasound into clinical practice for the assessment of swallowing and laryngeal function: A speech and language pathology-led consensus study

Joan Ma - ORCID: 0000-0003-2051-8360 https://orcid.org/0000-0003-2051-8360Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1–13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.Jodi Allen receives part-funding from the National Institute of Health Research (NIHR) Pre-Clinical Academic Fellowship Award. Gemma Clunie receives funding from the National Institute for Health Research (NIHR) Integrated Clinical Academic Clinical Doctoral Fellowship Programme and acknowledges the support and infrastructure provided by the NIHR Imperial Biomedical Research Centre. Anna Volkmer receives funding from the NIHR via a Development and Skills Award. Soren Lowell receives funding from the National Institute of Health (NIH) Research Enhancement Award (R15).https://doi.org/10.1007/s00455-022-10413-9aheadofprintaheadofprin