INVESTIGATING THE EFFECTS OF OROPHARYNGEAL SENSORY STIMULATION ON SWALLOWING

This series of studies examined the effects of oropharyngeal air-pulse stimulation on saliva swallowing. The first study sought to determine whether air-pulse trains delivered to the peritonsillar area facilitate swallowing in healthy young adult subjects. Trains of unilateral, or bilateral, air pulses were delivered to the peritonsillar area while swallows were simultaneously identified from their associated laryngeal and respiratory movements. Results in four subjects indicated that oropharyngeal air-pulse stimulation evoked an irrepressible urge to swallow, followed by an overt swallow as verified by laryngeal and respiratory movements. In addition, air-pulse stimulation was associated with a significant increase in saliva swallowing frequency. The second experiment examined the effects of oropharyngeal air-pulse stimulation on saliva swallowing in healthy older adults. Saliva swallowing rates were monitored across six conditions: baseline without mouthpiece, baseline with mouthpiece in situ, unilateral right oropharyngeal stimulation, unilateral left oropharyngeal stimulation, bilateral oropharyngeal stimulation, and sham stimulation. Results indicated that the bilateral oropharyngeal air-pulse stimulation condition was associated with a statistically significant increase in mean saliva swallowing rate compared to the baseline without mouthpiece, baseline with mouthpiece in situ, and sham stimulation conditions. In contrast to the perception by young adults of an irrepressible urge to swallow in response to oropharyngeal air-pulse delivery, the older adults did not perceive the air­ pulse stimulation as being associated with swallowing or other percept. These findings suggest that the facilitatory effect of oropharyngeal air-pulse stimulation on saliva swallowing may be robust across the adult age span. iii The third study evaluated the effects of oropharyngeal air-pulse stimulation on saliva swallowing frequency in hemispheric stroke using a single-subject research design. Visual analysis indicated that four of the eight subjects demonstrated increased saliva swallowing rates in association with bilateral oropharyngeal stimulation compared to baseline saliva swallowing rates. Descriptive analysis of subject demographics was conducted to identify participant and stroke-related features related to various air-pulse response patterns. Future research is required to elucidate the swallowing impairment profiles for which oropharyngeal air-pulse stimulation affects swallowing, and to determine whether oropharyngeal air-pulse stimulation can enhance recovery of swallowing function secondary to hemispheric stroke

Exploring Practice-Based Clinical–Research Partnerships in Speech-Language Pathology: A Scoping Review

Collaborative partnerships between speech-language pathologists and researchers present an opportunity for practice-based research. For practice-based research to become more widely used in speech-language pathology, a crucial step is outlining the potential purposes and outcomes of these partnership projects. The current article is two-fold. First, we describe a model for practice-based partnerships between researchers and speech-language pathologists. The practice-based research cocreation model developed for this project includes three distinct partnership outcomes: (a) creating practice, (b) capturing current practice, and (c) changing practice. Then, informed by our model, we completed a scoping review to explore the extent and type of practice-based research in the field of speech-language pathology to date. A literature database search identified 3510 articles meeting our inclusion criteria. Two independent readers reviewed abstracts and titles to determine articles for further review. Fifty-three articles were reviewed in full and 18 of these were excluded. Data were extracted from the remaining 35 articles. Level of partnership (creating, capturing, or changing) and type of partnership (collaborative or consultative) were coded. A thematic analysis revealed that three of the 35 articles involved creating practice, 19 captured current practice, and 13 were aimed at changing practice. Of the 27 articles in which details were provided about the partnerships between researchers and clinicians, 18 partnerships were collaborative and 9 were consultative. This review offers an initial step in examining the use of practice-based research in speech-language pathology, thereby demonstrating to researchers and clinicians how they can support each other to cocreate clinically relevant researc

Lessons learned in practice-based research: Studying preschool language interventions in the real world

Abstract Background and aims: Practice-based research holds potential as a promising solution to closing the research-practice gap, because it addresses research questions based on problems that arise in clinical practice and tests whether systems and interventions are effective and sustainable in a clinical setting. One type of practice-based research involves capturing practice by collecting evidence within clinical settings to evaluate the effectiveness of current practices. Here, we describe our collaboration between researchers and clinicians that sought to answer clinician-driven questions about community-based language interventions for young children (Are our interventions effective? What predicts response to our interventions?) and to address questions about the characteristics, strengths, and challenges of engaging in practice-based research. Methods: We performed a retrospective chart review of 59 young children who had participated in three group language interventions at one publicly funded community clinic between 2012 and 2017. Change on the Focus on the Outcomes of Communication Under Six (FOCUS), a government mandated communicative participation measure, was extracted as the main outcome measure. Potential predictors of growth during intervention were also extracted from the charts, including type of intervention received, attendance, age at the start of intervention, functional communication ability pre-intervention, and time between pre- and post-intervention FOCUS scores. Results: Overall, 49% of children demonstrated meaningful clinical change on the FOCUS after their participation in the language groups. Only 3% of participants showed possibly meaningful clinical change, while the remaining 46% of participants demonstrated not likely meaningful clinical change. There were no significant predictors of communicative participation growth during intervention. Conclusions: Using a practice-based research approach aimed at capturing current practice, we were able to answer questions about the effectiveness of interventions delivered in real-world settings and learn about factors that do not appear to influence growth during these interventions. We also learned about benefits associated with engaging in practice-based research, including high clinical motivation, high external validity, and minimal time/cost investment. Challenges identified were helpful in informing our future efforts to examine other possible predictors through development of a new, clinically feasible checklist, and to pursue methods for improving collection of outcome data in the clinical setting. Implications: Clinicians and researchers can successfully collaborate to answer clinically informed research questions while considering realistic clinical practice and using research-informed methods and principles. Practice-based research partnerships between researchers and clinicians are both valuable and feasible

Lessons learned in practice-based research: Studying language interventions for young children in the real world

© The Author(s) 2020. Background and aims: Practice-based research holds potential as a promising solution to closing the research-practice gap, because it addresses research questions based on problems that arise in clinical practice and tests whether systems and interventions are effective and sustainable in a clinical setting. One type of practice-based research involves capturing practice by collecting evidence within clinical settings to evaluate the effectiveness of current practices. Here, we describe our collaboration between researchers and clinicians that sought to answer clinician-driven questions about community-based language interventions for young children (Are our interventions effective? What predicts response to our interventions?) and to address questions about the characteristics, strengths, and challenges of engaging in practice-based research. Methods: We performed a retrospective chart review of 59 young children who had participated in three group language interventions at one publicly funded community clinic between 2012 and 2017. Change on the Focus on the Outcomes of Communication Under Six (FOCUS), a government mandated communicative participation measure, was extracted as the main outcome measure. Potential predictors of growth during intervention were also extracted from the charts, including type of intervention received, attendance, age at the start of intervention, functional communication ability pre-intervention, and time between pre- and post-intervention FOCUS scores. Results: Overall, 49% of children demonstrated meaningful clinical change on the FOCUS after their participation in the language groups. Only 3% of participants showed possibly meaningful clinical change, while the remaining 46% of participants demonstrated not likely meaningful clinical change. There were no significant predictors of communicative participation growth during intervention. Conclusions: Using a practice-based research approach aimed at capturing current practice, we were able to answer questions about the effectiveness of interventions delivered in real-world settings and learn about factors that do not appear to influence growth during these interventions. We also learned about benefits associated with engaging in practice-based research, including high clinical motivation, high external validity, and minimal time/cost investment. Challenges identified were helpful in informing our future efforts to examine other possible predictors through development of a new, clinically feasible checklist, and to pursue methods for improving collection of outcome data in the clinical setting. Implications: Clinicians and researchers can successfully collaborate to answer clinically informed research questions while considering realistic clinical practice and using research-informed methods and principles. Practice-based research partnerships between researchers and clinicians are both valuable and feasible

The impact of seasonal operating room closures on wait times for oral cancer surgery

Background Operating room slowdowns occur at specific intervals in the year as a cost-saving measure. We aim to investigate the impact of these slowdowns on the care of oral cavity cancer patients at a Canadian tertiary care centre. Methods A total of 585 oral cavity cancer patients seen between 1999 and 2015 at the London Health Science Centre (lhsc) Head and Neck Multidisciplinary Clinic were included in this study. Operating room hours and patient load from 2006 to 2014 were calculated. Our primary endpoint was the wait time from consultation to definitive surgery. Exposure variables were defined according to wait time intervals occurring during time periods with reduced operating room hours. Results Overall case volume rose significantly from 2006 to 2014 (p \u3c 0.001), while operating room hours remained stable (p = 0.555). Patient wait times for surgery increased from 16.3 days prior to 2003 to 25.5 days in 2015 (p = 0.008). Significant variability in operating room hours was observed by month, with lowest reported for July and August (p = 0.002). The greater the exposure to these months, the more likely patients were to wait longer than 28 days for surgery (odds ratio per day [or]: 1.07, 95% confidence interval [ci]: 1.05 to 1.10, p \u3c 0.001). Individuals seen in consultation preceding a month with below average operating room hours had a higher risk of disease recurrence and/or death (hazard ratio [hr]: 1.59, 95% ci: 1.10 to 2.30, p = 0.014). Conclusions Scheduled reductions in available operating room hours contribute to prolonged wait times and higher disease recurrence. Further work is needed to identify strategies maximizing efficient use of health care resources without negatively affecting patient outcomes

The Grizzly, September 12, 1986

Patterns Passes Midpoint • Future of Dorms Fuzzy • Rutgers Rough For Lady Bears • Bomberger Organizes Itself • Pottstown Reich Cracks Down on Cruising • Ursinus\u27 Colors: A Long Tradition • Letter: Maples: The Place Just Ain\u27t the Same • Clean up Cans • The Private Eye • Infirmary Info • AXE: Fraternity With a Difference • Bodolus Bounces Back • Men\u27s and Women\u27s X-Country Off and Running • U.C. Does Dorneyhttps://digitalcommons.ursinus.edu/grizzlynews/1167/thumbnail.jp

The Grizzly, September 12, 1986

Patterns Passes Midpoint • Future of Dorms Fuzzy • Rutgers Rough For Lady Bears • Bomberger Organizes Itself • Pottstown Reich Cracks Down on Cruising • Ursinus\u27 Colors: A Long Tradition • Letter: Maples: The Place Just Ain\u27t the Same • Clean up Cans • The Private Eye • Infirmary Info • AXE: Fraternity With a Difference • Bodolus Bounces Back • Men\u27s and Women\u27s X-Country Off and Running • U.C. Does Dorneyhttps://digitalcommons.ursinus.edu/grizzlynews/1167/thumbnail.jp

Predictors of plate extrusion in oromandibular free flap reconstruction

Objectives Plate extrusions after free tissue transfer for mandibular reconstruction can be problematic and generally require revision surgery. Our objective was to assess the predictors of plate extrusion and compare outcomes between fibular free flaps (FFF), lateral border scapular flaps (LBSF), and scapular tip free flaps (STFF). Methods Retrospective review of consecutive patients who underwent osseous free tissue reconstruction of the mandible (2008‐2014) at Victoria Hospital, London, Ontario. Patient demographics and treatment‐related information were collected. Results We identified 134 procedures and 27 (20.2%) plate extrusions (21/61 FFF, 3/49 STFF, and 3/24 LBSF). Freedom from extrusion after 2 years was significantly associated with the use of FFF (P = .003, HR 6.09 1.82‐20.44), performing 1 osteotomy (P = .03, HR 2.61 1.08‐6.31), and anterior mandibular defects (P = .01, HR 2.66 1.25‐5.66) in the univariate model. FFF\u27s were employed more frequently in younger patients, with 2.4 mm plates, more anterior defects, and with a greater number of osteotomies (P \u3c .001). However, after controlling for these variables in multivariate analyses the use of a FFF was the only significant predictor of extrusion at 2 years (P = .006, HR 3.68 1.46‐9.28). Conclusions At our institution, use of the STFF predicts mandibular defects that are less prone to developing plate extrusion and FFF tended to be used more frequently in anterior defects with osteotomies. However, after controlling for these factors use of the FFF appeared to have higher rates of extrusion than scapular flaps. Further prospective studies controlling for defect variables are needed to elucidate the risk factors for plate extrusion

Development of a transoral robotic surgery program in Canada

Abstract Due to significant differences in healthcare structure between the United States and Canada, there are unique barriers to adopting new medical technology in Canada. In this article, we describe our experience developing a transoral robotic surgery (TORS) program at Western University. Specifically, we outline the steps that were necessary to obtain institutional and multidisciplinary team approval, financial support, as well as surgeon and allied healthcare personnel training. This experience can potentially be used as a roadmap for other Canadian institutions pursuing a TORS program