Simulation-based Learning Experiences in Stuttering Management Delivered Online: What Do Students, Clinical Educators and Simulated Patients Think?

Speech pathology students are required to demonstrate competency across a range of practice areas. There are, however, limited opportunities for students to access clinical placements in the area of stuttering. Simulation-based learning (SBL) activities have proven to be effective in increasing students’ clinical experience in this area. Due to the COVID-19 pandemic, the delivery of in-person SBL programs was not feasible, resulting in a shift to online provision. The aim of this study was to investigate the perceptions of students, clinical educators and simulated patients who participated in an online adult stuttering SBL experience. Ten first-year graduate entry Masters program speech pathology students participated in the study alongside four clinical educators and four simulated patients. The experience involved two online SBL sessions and one online tutorial via videoconferencing from separate locations. Each participant group engaged in focus group interviews exploring their perceptions of the online SBL activity. Thematic network analysis of the focus group interview data was conducted. Overall interpretation of the data from the perspectives of students, clinical educators and simulated patients revealed an overarching global theme that online SBL offers a positive, comfortable and comparable experience to enable students to build client-centred, clinical and telepractice skills. The positive outcomes of this study suggest that together with in-person clinical experiences, online SBL has an important role in the education of speech pathology students.

Surveillance study of apparent life-threatening events (ALTE) in the Netherlands

SIDS and ALTE are different entities that somehow show some similarities. Both constitute heterogeneous conditions. The Netherlands is a low-incidence country for SIDS. To study whether the same would hold for ALTE, we studied the incidence, etiology, and current treatment of ALTE in The Netherlands. Using the Dutch Pediatric Surveillance Unit, pediatricians working in second- and third-level hospitals in the Netherlands were asked to report any case of ALTE presented in their hospital from January 2002 to January 2003. A questionnaire was subsequently sent to collect personal data, data on pregnancy and birth, condition preceding the incident, the incident itself, condition after the incident, investigations performed, monitoring or treatment initiated during admission, any diagnosis made at discharge, and treatment or parental support offered after discharge. A total of 115 cases of ALTE were reported, of which 110 questionnaires were filled in and returned (response rate 97%). Based on the national birth rate of 200,000, the incidence of ALTE amounted 0.58/1,000 live born infants. No deaths occurred. Clinical diagnoses could be assessed in 58.2%. Most frequent diagnoses were (percentages of the total of 110 cases) gastro-esophageal reflux and respiratory tract infection (37.3% and 8.2%, respectively); main symptoms were change of color and muscle tone, choking, and gagging. The differences in diagnoses are heterogeneous. In 34%, parents shook their infants, which is alarmingly high. Pre- and postmature infants were overrepresented in this survey (29.5% and 8.2%, respectively). Ten percent had recurrent ALTE. In total, 15.5% of the infants were discharged with a home monitor. In conclusion, ALTE has a low incidence in second- and third-level hospitals in the Netherlands. Parents should be systematically informed about the possible devastating effects of shaking an infant. Careful history taking and targeted additional investigations are of utmost importance

Physical activity and health-related quality of life among physiotherapists: a cross sectional survey in an Australian hospital and health service

Background Physiotherapists are a professional group with a high rate of attrition and at high risk of musculoskeletal disorders. The purpose of this investigation was to examine the physical activity levels and health-related quality of life of physiotherapists working in metropolitan clinical settings in an Australian hospital and health service. It was hypothesized that practicing physiotherapists would report excellent health-related quality of life and would already be physically active. Such a finding would add weight to a claim that general physical activity conditioning strategies may not be useful for preventing musculoskeletal disorders among active healthy physiotherapists, but rather, future investigations should focus on the development and evaluation of role specific conditioning strategies. Methods A questionnaire was completed by 44 physiotherapists from three inpatient units and three ambulatory clinics (63.7% response rate). Physical activity levels were reported using the Active Australia Survey. Health-related quality of life was examined using the EQ-5D instrument. Physical activity and EQ-5D data were examined using conventional descriptive statistics; with domain responses for the EQ-5D presented in a frequency histogram. Results The majority of physiotherapists in this sample were younger than 30 years of age (n = 25, 56.8%) consistent with the presence of a high attrition rate. Almost all respondents exceeded minimum recommended physical activity guidelines (n = 40, 90.9%). Overall the respondents engaged in more vigorous physical activity (median = 180 minutes) and walking (median = 135 minutes) than moderate exercise (median = 35 minutes) each week. Thirty-seven (84.1%) participants reported no pain or discomfort impacting their health-related quality of life, with most (n = 35,79.5%) being in full health. Conclusions Physical-conditioning based interventions for the prevention of musculoskeletal disorders among practicing physiotherapists may be better targeted to role or task specific conditioning rather than general physical conditioning among this physically active population. It is plausible that an inherent attrition of physiotherapists may occur among those not as active or healthy as therapists who cope with the physical demands of clinical practice. Extrapolation of findings from this study may be limited due to the sample characteristics. However, this investigation addressed the study objectives and has provided a foundation for larger scale longitudinal investigations in this field

Online Assessment and Treatment of Childhood Speech, Language, and Literacy Disorders

Telehealth, the provision of health services at a distance using information technology and telecommunications, is recognised as a valuable service delivery model in many health fields, including speech-language pathology. Its potential for providing more accessible services to rural and remote populations is particularly important. Validation of telehealth applications is necessary for it to become accepted by service providers and clinicians. Although preliminary evidence for telehealth applications for the assessment and treatment of childhood communication disorders is emerging, there is a need for more robust studies. Therefore, this thesis aimed to determine the validity and reliability of the assessment of childhood speech, language and literacy disorders via an Internet-based telehealth system, and to provide proof of concept for an online phonological awareness intervention. This research was conducted in two stages. The first phase aimed to validate the online assessment of speech, language and literacy in children by comparing assessment over the Internet with traditional, face-to-face (FTF) methods. This phase included 60 children aged between 4 and 13 years who had an identified or suspected speech, language or literacy disorder. Participants were placed in one or more of the following groups, depending on their communication difficulties: speech (n = 6 and 20), language (n = 25), and literacy (n = 20). The participants in each group were assessed on a battery of commonly used informal or standardised tests. The assessments were administered by either an online or a FTF speech-language pathologist (SLP), but were simultaneously rated by both SLPs. The online assessments utilised a custom-built telehealth system connected via the Internet over a 128 kbit/s. The online and FTF ratings were compared and the inter- and intra-rater reliability of both the online and FTF assessments was determined. An informal evaluation of the impact of technical, logistical, and child factors on the assessments was also undertaken. Phase two consisted of a proof of concept of an upgraded telehealth system for the treatment of children with literacy disorder using the Phonological Awareness for Literacy (PAL) program. Eight children aged between 8 and 10 years were treated via the system twice weekly for a period of 10 weeks. The online treatment was evaluated in terms of clinical outcomes (improvement in phonological awareness, reading and spelling), as well as participant and parent satisfaction. Overall, the results support the validity and reliability of the assessment of paediatric communication disorders via an Internet-based telehealth system. A high overall level of agreement was found between the online and FTF clinicians for the speech assessments (>80% agreement overall for transcription, stimulability, and phonological process analysis; >85% close [+/-1] agreement for severity, intelligibility and oromotor rating scales). The overall inter- and intra-rater reliability was also high for the online assessments (>85% for articulation and phonological assessment; >90% close agreement for severity, intelligibility and oromotor). Several parameters on the informal speech assessments, as well as the diagnosis of type of speech disorder failed to reach pre-determined clinically important levels of agreement. However, these discrepancies were largely due to difficulties inherent in the perceptual judgement of children’s speech that were not exclusive to the online environment. This finding was supported by similar levels of inter- and intra-rater reliability for the FTF assessment. The standardised language and literacy assessments were amenable to administration in the online environment, and yielded high overall levels of agreement between the online and FTF clinicians (κ = .93-> .99 for language and .92-1.00 for literacy), as well as very good overall inter- and intra-rater reliability (ICC = .84- 1.00 for language and .89-1.00 for literacy). Four individual parameters on the literacy assessments did not reach pre-determined clinically significant levels of agreement between the online and FTF raters. However this finding was largely attributed to differences in the raters’ subjective judgement, rather than system issues. The informal analysis of the technical capabilities of the telehealth system highlighted its many benefits, but also identified a small number of limitations (e.g., audio break-up), which largely affected the usability of the system, rather than the reliability of the scoring in the online condition. Participant factors, such as attention and behaviour, made both online and FTF assessments challenging at times. While only preliminary, the findings of the treatment study provided evidence of the feasibility of an Internet-based telehealth system for the treatment of children’s literacy using the PAL program. Although significant group effects were only found for nonword spelling and text reading accuracy, there were trends towards improvements on most other measures. There was also high participant and parent satisfaction. Further research in the form of a large scale randomised trial is needed to verify the results of this study. This thesis is the first comprehensive evaluation of telehealth applications for the assessment and treatment of childhood communication disorders. The results provide evidence that telehealth is a feasible alternate service delivery model for paediatric speech-language pathology. Future research including field trials, cost-benefit analyses, and studies investigating other technology, logistical and client factors would provide additional evidence to guide the widespread implementation of telehealth in paediatric speech-language pathology services

Perceived barriers and facilitators to increasing physical activity among people with musculoskeletal disorders: a qualitative investigation to inform intervention development

Purpose Musculoskeletal conditions can impair people’s ability to undertake physical activity as they age. The purpose of this qualitative study was to investigate perceived barriers and facilitators to undertaking physical activity reported by patients accessing ambulatory hospital clinics for musculoskeletal disorders. Patients and methods A questionnaire with open-ended items was administered to patients (n=217, 73.3% of 296 eligible) from three clinics providing ambulatory services for nonsurgical treatment of musculoskeletal disorders. The survey included questions to capture the clinical and demographic characteristics of the sample. It also comprised two open-ended questions requiring qualitative responses. The first asked the participant to describe factors that made physical activity more difficult, and the second asked which factors made it easier for them to be physically active. Participants’ responses to the two open-ended questions were read, coded, and thematically analyzed independently by two researchers, with a third researcher available to arbitrate any unresolved disagreement. Results The mean (standard deviation) age of participants was 53 (15) years; n=113 (52.1%) were male. A total of 112 (51.6%) participants reported having three or more health conditions; n=140 (64.5%) were classified as overweight or obese. Five overarching themes describing perceived barriers for undertaking physical activity were "health conditions", "time restrictions", "poor physical condition", "emotional, social, and psychological barriers", and "access to exercise opportunities". Perceived physical activity facilitators were also aligned under five themes, namely "improved health state", "social, emotional, and behavioral supports", "access to exercise environment", "opportunities for physical activities", and "time availability". Conclusion It was clear from the breadth of the data that meaningful supports and interventions must be multidimensional. They should have the capacity to address a variety of physical, functional, social, psychological, motivational, environmental, lifestyle, and other perceived barriers. It would appear that for such interventions to be effective, they should be flexible enough to address a variety of specific concerns

Service providers' perceptions of working in residential aged care: a qualitative cross-sectional analysis

A number of professional disciplines employed internally and externally provide services in Residential Aged Care Facilities (RACFs). Literature has long highlighted numerous workplace issues in RACFs, yet little progress has been made in addressing these. As such there has been a call for greater understanding of shared issues among service providers. The aim of the current study is to explore and compare the perceptions of a cross-section of service providers regarding the challenges and motivators to working in RACFs. In-depth semi-structured interviews were conducted with 61 participants including: care managers, nurses, assistants in nursing, care, domestic and support staff, and speech pathologists. Analysis revealed few issues unique to any one service discipline, with four key themes identified: (a) working in RACFs is both personally rewarding and personally challenging; (b) relationships and philosophies of care directly impact service provision, staff morale and resident quality of life; (c) a perceived lack of service-specific education and professional support impacts service provision; and (d) service provision in RACFs should be seen as a specialist area. These data confirm there are key personal and professional issues common across providers. Providers must work collaboratively to address these issues and advocate for greater recognition of RACFs as a specialist service area. Acknowledging, accepting and communicating shared perceptions will reduce ongoing issues and enhance multi-disciplinary care

Cooperative Markets for Ideas: When does Technology Licensing Combine with R&D Partnerships?

The study departs from the traditional view of licensing as a spot market transaction and investigates license integration with R&D partnerships, introducing the concept of licensing combination. Drawing on licensing and R&D partnership literature and adopting the “transactional value” approach, we propose two types of antecedents – knowledge and dyad features – to investigate licensing combination. Using a dataset combining 441 original license agreements with firms’ patenting and market activity in the global biopharmaceutical industry, we find a substantial heterogeneity in the ways licensors and licensees jointly exploit markets for knowledge. The research highlights the specific role played by R&D collaboration and minority equity in inter-organizational exchange through licensing. Results show that licensing combination with R&D collaboration is likely when the licensed innovation is embryonic, the licensee is unfamiliar with the licensor’s technology and partners have different technological backgrounds. Instead, licensing of highly specific knowledge is likely to be supported by minority equity participation on the part of the licensee. Finally, licensing is combined with both forms of partnership in case of competence distance between partners. In the light of the empirical results, four types of licensing combination are proposed for future researc