Day-to-day Variability of Stuttering

Variability has long been known to be a primary feature of the disorder of stuttering (Bloodstein & Bernstein Ratner, 2008; Costello & Ingham, 1984; Yaruss, 1997a, 1997b). Many factors that affect variability have been investigated (Brown, 1937; Johnson & Brown, 1935; Quarrington, Conway, & Siegel, 1962) yet the typical range of variability experienced by speakers remains unknown. This study will examine the speech of six adult speakers in three spontaneous speaking situations and two reading tasks. The frequency, duration, and types of stuttered events that occur on the tasks will be compared within and between speakers. The focus will be on describing variability in stuttering frequency and duration within speakers and attempting to detect consistent patterns between speakers

What does Diabetes have to do with Cognition and Swallowing?

Speech-language pathologists working with adults in medical settings are likely to encounter patients with a diagnosis of diabetes mellitus on a regular basis (NCD Risk Factor Collaboration, 2016). The current literature supports an association between diabetes and mild cognitive impairment (Moreira, Soldera, Cury, Meireles, & Kupfer, 2015; Vincent & Hall, 2015). Mild impairments in executive functioning are of particular relevance in this population. Even within the range of normal cognitive abilities, reduced executive functioning can negatively impact patients’ self-management of their diabetes (and potentially adherence to therapy programs and strategies) and therefore their overall health. Mild cognitive deficits in this population are therefore clinically relevant and may warrant intervention (Vincent & Hall, 2015). Diabetic complications may also impact digestion, indirectly impacting patients’ intake and tolerance of food and drink (Borgnakke, Anderson, Shannon, & Jivanescu, 2015; Gatopoulou, Papanas, & Maltezos, 2012; Hüppe et al., 1992; Sandberg, Sundberg, Fjellstrom, & Wikblad, 2000)

Complexity of Clinical Decision Making: Consent, Capacity, and Ethics

Speech–language pathologists (SLPs), and really their patients, are often faced with challenging clinical decisions to be made. Patients may decline interventions recommended by the SLP and are often inappropriately labeled “noncompliant.” The inappropriateness of this label extends beyond the negative charge; the patient's right to refuse is, in fact, protected by law. Anecdotal exchanges, social media platforms, and American Speech-Language-Hearing Association forums have recently revealed that many SLPs are struggling with the patient's right to decline. Many are not comfortable with the informed consent process and what entails patients' capacity to make their own medical decisions. Here, we discuss the basics of clinical decision-making ethics with intent to minimize the clinician's discomfort with the right to refuse those thickened liquids and eliminate the practice of defensive medicine

A Case of Lance-Adams Syndrome: The Clinical Process of the Evidence-Based Clinician

Evidence-based practice (EBP) has become a hallmark of modern medicine. Diving into the literature is an essential part of clinical decision-making. The management of rare disorders and disease almost always prompts a search, but the answers to important clinical questions can be challenging and rarely straightforward. The majority of us have endured the “EBP Class” of our academic careers, drilling the hierarchy of research evidence and whether strict inclusion/exclusion criteria were considered, etc. We frequently see our medical colleagues turn to high powered trials and meta-analyses, but such works are few and far between. Single-subject design, case studies, case series, and reviews of such cannot be discredited, especially within a profession that is relatively new in the broad scheme of medicine. The following case study details a clinician’s process through the identification, appraisal, and application of relevant literature in the management of a rare disorder: Lance-Adams syndrome. Proposed assessment considerations are intended to help the reader’s approach to diagnosis and intervention

Eligibility and enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)--27 states and New York City, 2007-2008.

The national Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition education, growth monitoring, breastfeeding promotion and support, and food to low-income pregnant or postpartum women, infants, and children aged <5 years. Several studies have linked WIC services with improved maternal and infant health outcomes. Most population-based studies have lacked information needed to identify eligible women who are not receiving WIC services and might be at risk for poor health outcomes. This report uses multistate, population-based 2007-2008 survey data from CDC's Pregnancy Risk Assessment Monitoring System (PRAMS) and California's Maternal and Infant Health Assessment (MIHA) to estimate how many women were eligible but not enrolled in WIC during pregnancy and to describe their characteristics and their prevalence of markers of risk for poor maternal or infant health outcomes. Approximately 17% of all women surveyed were eligible but not enrolled in WIC during pregnancy. The proportion of women eligible for WIC and WIC participation rates varied by state. WIC participants had higher prevalences of markers of risk for poor maternal or infant health outcomes than eligible nonparticipants, but both groups had higher prevalences of risk markers than ineligible women, suggesting that many eligible women and their children might benefit from WIC services. The results of this analysis can help identify the scope of WIC outreach needed to include more eligible nonparticipants in WIC and whom to target

That Won't Help The Meatballs: health care providers' perceptions of eating, drinking, and feeding as human experiences

BACKGROUND Eating, drinking, and feeding are individual acts signaling our values, our identity, our cultural alignment, and care giving. Humans need oxygen, a system to transport oxygen, and fuel (food and drink), but only with the last of these do we choose what, where and with whom. Swallowing difficulties (dysphagia) affect nine million adults in the United States. Health care providers report more discomfort with dysphagia decisions than other clinical interventions. Feeding is a unique form of clinical care because providers live in both worlds: eating, drinking and feeding as fundamentally and culturally part of 1) human experience and 2) clinical process. AIM To explore health care providers’ personal and professional attitudes to eating, drinking, and feeding focusing on the incongruities between the two perspectives. METHODS Two focus groups occurred with speech-language pathologists (total n=15) from rehabilitation settings and two groups with non-SLP front line providers (total n=15) from an urban health care network. Participants considered: 1) eating/drinking/feeding as a) a human experience, and b) a biomechanical task in dysphagia care, and 2) why health care providers may deviate from practice guidelines. Dialogue was audio recorded, transcribed and studied using Thematic Analysis. RESULTS A list of 33 codes gave rise to 8 themes: we eat and drink for health and life; meanings of food and feeding; nutrition/hydration versus food/drink; reasons for practice patterns; professional collaboration; patient control; economic concerns; improving things. Participants voiced concern that a) patients lose control over a highly meaningful life process, and b) health care providers do not recognize their role in this problem. Participants expressed inner turmoil with feeding interventions/decisions. BIOETHICAL SIGNIFICANCE Dysphagia intervention uniquely challenges and distresses people making decisions. Health care providers aim to do good but the definition of what “good” is should be broadened and addressed earlier in training. The telos (purpose) of eating and feeding is much more than the techne (doing) of medically framed nutrition. Addressing providers’ distress could reduce patient/family angst and support informed consent because more appropriate questions can be asked and clearer information provided, especially valuable in situations when caregivers have to make decisions

Using the Miracle Question in Community Engagement and Planning

Actively engaging community members in the revitalization of their neighborhoods is a goal of numerous planning initiatives. In this article, we provide a case example of how the solution-focused brief therapy's "miracle question" was used to engage members of a major metropolitan community in visualizing their dreams and planning strategies for change. Similar to outcomes with therapy clients, community members participated actively and were enthusiastic in communicating their outcomes. Dreams were realistic and important to participants, and suggested strategies were oriented toward first steps and recognized as involving effort by the community. Engagement and retention were sufficient to move forwward with immediate actions and longer-term preparation. Benefits and suggested modifications are offered for community practitioners and researchers employing this method.http://deepblue.lib.umich.edu/bitstream/2027.42/108577/1/UsingtheMiracleQuestion.pd

Provider Insight on Surmounting Specialty Practice Challenges to Improve Tdap Immunization Rates among Pregnant Women

Background Pertussis, or “whooping cough,” is an acute, contagious pulmonary disease that, despite being vaccine-preventable, has become an increasingly widespread problem in the United States. As a result, the Advisory Committee on Immunization Practices and American College of Obstetricians and Gynecologists updated recommendations stating clinicians should give a Tdap dose during every pregnancy, preferably at 27–36 weeks. Despite this recommendation, reported Tdap vaccine receipt rates during pregnancy vary from 16–61%, and previous studies have shown that clinician recommendation and vaccine administration are strongly associated with vaccine uptake among pregnant women. Methods Our aim was to inform new strategies to increase uptake of the Tdap vaccine among pregnant women and, ultimately, reduce pertussis-related morbidityand mortality in infants. We conducted interviewswith a sample of 24 ob-gyns. We subsequently performed grounded theory analyses of transcripts using deductive and inductive coding strategies followed by intercoder reliability assessment. Results All physicians interviewed were familiar with the most recent recommendation of giving the Tdap vaccine during the third trimester of every pregnancy, and the majority of physicians stated that they felt that the vaccine was important and effective due to the transfer of pertussis antibodies from the mother to the fetus. Most physicians indicated that they recommended the vaccine to patients during pregnancy, but not all reported administering it on site because it was not stocked at their practice. Implementation challenges for physicians included insurance reimbursement and other challenges (i.e., patient refusal). Tdap vaccinationduring pregnancy was a lower clinical priority for some physicians. Physicians recognized the benefits associated with Tdap vaccination during pregnancy. Conclusions Findings indicate while most ob-gyns recognize the benefits of Tdap and recommend vaccination during pregnancy, barriers such as insurance reimbursement and financial concerns for the practice can outweigh the perceived benefits. This resulted in some ob-gyns reporting choosing not to stock and administer the vaccine in their practice. Recommendations to address these concerns include 1) structural support for Tdap vaccine administration in ob-gyns practices; 2) Continuing medical education-equivalent educational interventions that address management techniques, vaccine coding, and other relevant information; and 3) interventions to assist physicians in communicating the importance of Tdap vaccination during pregnancy

Increasing the Engagement of Middle School Males Enrolled in a Foreign Language Class

This qualitative action research study investigated the engagement of middle school males in a foreign language class based in a British overseas territory. The data collection methods consisted of focus groups, observations, and surveys. The participants for this research included five students who are identified as males. The desired outcome of the research was to determine whether teaching strategies aligned with Howard Gardner’s theory of multiple intelligences (MI), the learner-centered approach, and Robert Gardner’s motivation theory with reference to integrative motivation, increased the engagement of middle school males in the foreign language classroom. The research questions included: RQ 1. How does an intervention model utilizing Howard Gardner’s theory of multiple intelligences, Robert Gardner’s integrative motivational strategies, and a learner-centered instructional approach impact the engagement of young men in a 6thgrade foreign language classroom?; and RQ 2. What are the perceptions of students identified as males whose first language is English in regard to the strategic learnercentered and motivational strategies employed in a Middle 1 (M1) foreign language course? The results from the focus groups audio transcripts demonstrated that the learning styles that were most common among the participants involved bodilykinesthetic, verbal-linguistic, and visual-spatial. The results from the data that included teacher-researcher’s observations revealed five main themes. The themes were that the participants had an appreciation for autonomy, student absences affected engagement, enthusiasm among participants increased when instruction incorporated culture,participants demonstrated ownership of learning, and increased awareness of content relevance among participants. Additionally, five themes emerged from the qualitative survey: 1. understanding the importance of language skills development; 2. independent learning as a vehicle for ownership; 3. understanding the importance of cultural awareness; 4. understanding the need for application of language skills; 5. positive emotions in regard to the target culture. Overall, the findings showed that tapping into the learning styles of learners as per the theory of multiple intelligences, using a learner-centered approach, and Robert Gardner’s integrative motivation positively impacted engagement

Obtaining and Using Copyrighted Research Journal Content—Convenience vs Ethics

Members of American Dietetic Association (ADA) or those credentialed by the Commission on Dietetic Registration agree to abide by the ADA/Commission on Dietetic Registration Code of Ethics for the dietetics profession (1). A fundamental principle within the Code is to conduct dietetics practice with honor, integrity, and fairness and to comply with all laws and regulations applicable or related to the profession. Dietetics practitioners read and apply the results of research published in professional journals and other publications to guide their evidence-based practice. Authors of research articles can, in some cases, make their work more accessible to practitioners by amendment of the copyright transfer agreements required by the publisher. And practitioners working in the United States must understand and abide by the US copyright laws that govern the fair use of these resources. In this digital age, inappropriate access to and distribution of copyrighted research content can occur. This article briefly describes the key requirements of current US copyright law, generalized to situations that a dietetics practitioner might encounter, through scenarios that illustrate implications for practitioners and suggests options for the retrieval and use of copyrighted research information while abiding by the Code of Ethics. The discovery, access, and use of freely available literature (“open access”) with proper attribution of authorship is also discussed