Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study

BACKGROUND: Communication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists’ implementation of stroke CPGs. This study aimed to describe speech pathologists’ experiences and current use of guidelines, and to identify what factors influence speech pathologists’ implementation of stroke CPGs. METHODS: Speech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data. RESULTS: 320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline “somewhat useful” or “very useful”. Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided. CONCLUSIONS: There are many different factors that can influence speech pathologists’ implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies

Public injecting and public amenity in an inner-city suburb of Melbourne, Australia

Background: Public drug markets and injecting impose significant burden on individuals and the community. This study aimed to document public injecting and amenity in North Richmond, an inner-city suburb of Melbourne, Australia. Methods: A rapid assessment methodology was employed. Data comprised: secondary data on drug use indicators, structured observations and interviews with key stakeholders. Primary data were collected from May to October 2012. Quantitative data are summarised using descriptive statistics. Basic content analysis was performed on interview transcripts. Results: An average of 1843 needle–syringes (NS) were collected per month from syringe disposal bins and street-sweeps in the period January–December 2012. Discarded NS and other injecting paraphernalia were observed in a variety of locations. Stakeholder interviews indicated substantial concerns over the presence of NS and witnessing injecting and overdose. Discussion: Public injecting is widespread, frequent, and highly visible in North Richmond and has a substantial negative effect on public amenity. The research identified two main priorities: (1) enhance access to harm reduction services and materials; and (2) improve public amenity. Among other responses, the study findings support the introduction of a supervised injecting facility (SIF) as a viable component of a comprehensive harm reduction response to illicit drug use in this area

Assessing the outcomes of a clinical trial: Primary outcome measures only tell part of the story

Identifying outcome measures that are sensitive to change and meaningful to participants is a challenge when designing clinical trials of complex communication interventions. Outcome measures encompassing participants’ perceptions of clinically meaningful change and their experience of the treatment process are frequently neglected. This paper presents an overview of the outcome measures used in a 3 arm clinical trial which aimed to investigate (i) social skills training for the person with TBI alone (which we have termed the TBI SOLO condition) and (ii) training communication partners to deal with difficult communication behaviors (the JOINT condition) compared to a delayed waitlist CONTROL condition. The paper asks two research questions: 1. What information did the self-report of perceived communication ability using the La Trobe Communication Questionnaire, and qualitative measures provide in addition to blinded ratings on the Adapted Kagan Scales, the primary outcome measure? 2.How did participants perceive the training experience as measured through post treatment interviews

Communication skills of people with severe traumatic brain injury can be improved by training everyday communication partners: Findings from a single-blind multi-centre clinical trial

This controlled group comparison study examined the effectiveness of everyday communication partner (ECP) training for people with TBI. 44 participants with severe TBI and their ECPs were allocated to a) TBI SOLO group where the person with TBI was trained; b) JOINT group where the communication partner was also trained; or c) a delayed CONTROL. Conversations were videotaped pre and post training and rated by two blind assessors on conversational skills. Training ECPs was more efficacious than training the person with TBI alone. Involving communication partners in treatment appears crucial for improved communication interactions for people with severe TBI

'The early exposure is really helpful' : students' views of participating in communication skills screening

Students commence university with many hopes and dreams for their future and for most, these are realised. Health professional students must succeed in both their academic and clinical experiences. Excellent communication with their patients and colleagues on placement is necessary and particularly so for speech pathology students. This qualitative, descriptive study investigates how first- and final-year students view the screening of their communication skills in which they participate. The focus groups took place within the speech pathology department of a major Australian metropolitan university. Data were transcribed and analysed thematically. Three main themes arose: professional development, students’ cognitive and emotional responses, and the organisation of the screener. Both groups of students felt the screener was both an important part of their professional development and a way of identifying and supporting speech pathology students with communication difficulties. They valued the student-led nature of the process. Implications for the value of using a student-led communication screener to identify students with weaker communication skills early in their program and for the support of such students are discussed

Inter-rater reliability of the Measure of Support in Conversation and Measure of Participation in Conversation (Kagan et al., 2004) adapted for people with Traumatic Brain Injury (TBI) and their communication partners

Aim: This study reports inter-rater reliability of the Adapted Measure of Support in Conversation (MSC) and Measure of Participation in Conversation (MPC) for TBI interactions. Method: The MSC and MPC were adapted to reflect theoretical models of cognitive-communication support for people with TBI. 10 casual and 10 purposeful TBI interactions were independently rated. Results: Strong inter-rater agreement was established on the MSC (ICC = 0.85-0.97) and the MPC (ICC = 0.85-0.97). All ratings scored within 0.5 on a 9 point scale. Conclusion: This is the first scale to measure the communication partner during TBI interactions. It shows promise in evaluating communication partner training programs

Increasing educational attainment and mortality reduction: a systematic review and taxonomy

Abstract Background Understanding the relationship between increasing educational attainment and mortality reduction has important policy and public health implications. This systematic review of the literature establishes a taxonomy to facilitate evaluation of the association between educational attainment and early mortality. Methods Following PRISMA guidelines, we searched Ovid Medline, Embase, PubMed and hand searches of references for English-language primary data analyses using education as an independent variable and mortality as a dependent variable. Initial searches were undertaken in February 2015 and updated in April 2016. Results One thousand, seven hundred and eleven unique articles were identified, 418 manuscripts were screened and 262 eligible studies were included in the review. After an iterative review process, the literature was divided into four study domains: (1) all-cause mortality (n = 68, 26.0%), (2) outcome-specific mortality (n = 89, 34.0%), (3) explanatory pathways (n = 51, 19.5%), and (4) trends over time (n = 54, 20.6%). These four domains comprise a novel taxonomy that can be implemented to better quantify the relationship between education and mortality. Conclusions We propose an organizational taxonomy for the education-mortality literature based upon study characteristics that will allow for a more in-depth understanding of this association. Our review suggests that studies that include mediators or subgroups can explain part, but not all, of the relationship between education and early mortality. Trial registration PROSPERO registration # CRD42015017182 .https://deepblue.lib.umich.edu/bitstream/2027.42/138128/1/12889_2017_Article_4754.pd

Development and validation of Australian aphasia rehabilitation best practice statements using the RAND/UCLA appropriateness method

Objectives: To develop and validate a national set of best practice statements for use in post-stroke aphasia rehabilitation. Design: Literature review and statement validation using the RAND/UCLA Appropriateness Method (RAM). Participants: A national Community of Practice of over 250 speech pathologists, researchers, consumers and policymakers developed a framework consisting of eight areas of care in aphasia rehabilitation. This framework provided the structure for the development of a care pathway containing aphasia rehabilitation best practice statements. Nine speech pathologists with expertise in aphasia rehabilitation participated in two rounds of RAND/UCLA appropriateness ratings of the statements. Panellists consisted of researchers, service managers, clinicians and policymakers. Main outcomes measures: Statements that achieved a high level of agreement and an overall median score of 7–9 on a nine-point scale were rated as ‘appropriate’. Results: 74 best practice statements were extracted from the literature and rated across eight areas of care (eg, receiving the right referrals, providing intervention). At the end of Round 1, 71 of the 74 statements were rated as appropriate, no statements were rated as inappropriate, and three statements were rated as uncertain. All 74 statements were then rated again in the face-to-face second round. 16 statements were added through splitting existing items or adding new statements. Seven statements were deleted leaving 83 statements. Agreement was reached for 82 of the final 83 statements. Conclusions: This national set of 82 best practice statements across eight care areas for the rehabilitation of people with aphasia is the first to be validated by an expert panel. These statements form a crucial component of the Australian Aphasia Rehabilitation Pathway (AARP) (http://www.aphasiapathway.com.au) and provide the basis for more consistent implementation of evidence-based practice in stroke rehabilitation

The 2014 BFA Graduating Class Department of Visual Arts

Congratulations on the opening of this, your graduate exhibition. Your presence in this catalogue not only celebrates your achievements while you’ve been with us, but also serves to signal your transition to the next chapter of your life and career. Whatever your goals, whatever your desire in life, it is my hope that your studies with the visual arts program serve you well, that you continue to explore, search, question, and, it is also my hope that you keep making art. The Division of Fine Arts is extremely proud of all its graduates and this catalogue, and your presence in it, will serve as a reminder over the years that you were here, and that you made a contribution and a difference to the visual arts program. All the very best and please keep in touch