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The satisfaction of clients and caregivers with telehealth speech-language pathology services
Get PDFObjectives
To investigate the satisfaction of service users with different aspects related to telehealth speech-language pathology (SLP) services, and examine the influence of client's demographics, medical diagnosis, and type of clinical services on the level of satisfaction with telehealth services.
Methods
A questionnaire was developed and validated to measure the satisfaction of clients and caregivers with telehealth services. Phone survey was used to collect data from clients and caregivers of clients who received telehealth SLP services.
Results
302 clients and caregivers completed the survey. Most of the respondents were strongly satisfied with different aspects related to telehealth, including their whole telehealth experience (82.12%), the perceived benefits from telehealth (69.21%), and the perceived quality of healthcare received through telehealth (87.75%). The levels of satisfaction with these aspects were not related to age or gender, but they were significantly influenced by the SLP diagnosis ( p < 0.001). The results also showed high levels of satisfaction across all types of clinical services, including screening, assessment, therapy, and monitoring. There were no significant relationships between the types of clinical services and the levels of satisfaction with telehealth.
Conclusions
Most clients and caregivers were satisfied with SLP services received via telehealth irrespective of the type of clinical service, client's age, or gender. However, satisfaction with SLP telehealth and patient experience varied according to the client's diagnosis. These factors must be considered by policy makers and funding bodies while planning the implementation or expansion of telehealth SLP services
Safe in Leicester Town? Law's reach to those working for less than the National Minimum Wage
Get PDFThis article examines the origins of paragraph 2.42 of the guidance issued under the Modern Slavery Act 2015, which concerns identification. It traces the origins of this paragraph to a divergence of legal approach between the Supreme Court of India (SCI) and the International Labour Organisation on a presumption of economic coercion amongst those working for less than the legally mandated minimum wage. The approach of the ILO has since evolved, but its position in 2005–6 is reflected in paragraph 2.42. That which of the two approaches is taken matters can be seen in the response to wage conditions amongst garment workers in Leicester. The difference had two aspects: first, the characterisation of freedom or otherwise of those working for less than the minimum wage and second, responsibilities in law. It will be argued that the reasoning of the SCI provides a sounder starting point. The article will first consider relevant economic theories. Next, it will examine whether the guidance can legitimately prevent human rights law from drawing on breaches of labour law and how this affects responsibilities for fundamental labour rights. Following, UK national minimum wage law will be considered. Finally, amendment to the guidance is recommended, with practical illustrations
What’s ‘Natural’ About Disasters? Practice Theory as an Emancipatory Lens for Reconceptualising the Social Construction of Disasters
Get PDFPractice theory constitutes an emancipatory lens for reconceptualising the social construction of disaster. Framing extreme weather disasters, such as floods, fires and tropical storms as natural, places them beyond human action. By contrast, a practice lens places their consequences firmly within the realm of human action. Drawing on practice theory, we explain why framing disasters as natural exacerbates their prevalence. We note that the practices of everyday life and striving to resume those practices after disaster often take precedence over alleviating the sources of disaster. Furthermore, these practices are distributed across time and space in patterns of social order that perpetuate the tendency for disaster to disproportionately affect the most vulnerable. We conclude by issuing a call to arms to embrace the emancipatory potential of practice scholarship by exposing the disastrous consequences of mundane practice, critiquing the dominant ways of knowing that contribute to existing constructions of disaster and using social science to advocate for fundamental change
Designing a digital intervention for children with developmental language disorder: Aligning theory, research and clinical practice
Get PDFIntroduction
Developmental language disorder (DLD) is a neurodevelopmental condition characterised by persistent and pervasive challenges in daily communication. This paper describes the process of designing a digital word-learning intervention for this population that aligns with routine clinical practice, is evidence-based, and has strong theoretical rationale.
Method
The intervention design process involved research collaboration between academics, clinicians and software professionals.
The Medical Research Council's framework for developing complex interventions provided preliminary guidance; greater design depth was introduced by adding recommended elements from a synthesis of intervention design literature. The resulting intervention design was refined with focus group feedback from speech and language therapists, which underwent reflexive thematic analysis.
Results
Intervention design features were generated by aligning word-learning traits characteristic of the disorder with evidence-based vocabulary intervention strategies and clinician requirements for embedding digital practice in routine service-delivery.
Mock ups for a mobile intervention app were developed from the design features and shared for refinement with practicing speech and language therapists who had day-to-day experience of supporting children with DLD.
Conclusion
This paper outlines the process of defining the therapeutic components of a digital intervention, guided by empirical literature and clinician insights. These initial findings will serve as a foundation for co-designing with children with DLD to shape the final design, particularly in terms of motivation and engagement features.
Investing at the design stage in the determinants of successful translation of research into practice, increases the likelihood that the resulting intervention will demonstrate both research effectiveness and clinical uptake
Quantisations of exactly solvable ghostly models
No full textWe investigate an exactly solvable two-dimensional Lorentzian coupled quantum system that in a certain parameter regime can be transformed to a higher time derivative theory (HTDT) with preserved symplectic structure. By transforming the system's Lagrangian, we explicitly map it onto the standard Pais-Uhlenbeck formulation, revealing a direct correspondence in their dynamical and Poisson bracket structures. We quantise the model in two alternative ways. First we derive the eigensystem of the Hamiltonian by solving the Schr"odinger equation through an Ansatz that leads to a set of coupled three-term recurrence relations, that we solve exactly, identifying normalisable wavefunctions and their associated energy spectra. We compare our results with a Fock space construction, finding exact agreement. On the basis of the exact solutions we report several specific physical properties of the ghost model investigated with a focus on the localisation properties of the system
Expiratory Muscle Strength Training to Improve Voice and Respiratory Outcomes After Laryngectomy: A Feasibility Study
Get PDFBACKGROUND: People with laryngectomy who use a tracheoesophageal voice prosthesis for communication experience changes to respiratory function resulting in reduced breath support and increased secretions. This impacts tracheoesophageal voice quality and volume. Expiratory muscle strength training (EMST) is an effective treatment for cough management, voice and respiratory function in other clinical populations, such as neurodegenerative conditions and benign voice disorders. There is limited evidence for the use of EMST in people with laryngectomy. This study explores EMST feasibility and preliminary efficacy with tracheoesophageal speakers. It is hypothesised that, like in other disorders, EMST can improve respiratory parameters and thus tracheoesophageal voice quality.
AIMS: (1) To investigate the feasibility and acceptability of EMST after laryngectomy. (2) To determine the impact of EMST on respiratory function; participant-reported outcome measures (PROMS) of cough and secretion burden, voice-related quality of life and experiences of communication; objective and perceptual measures of tracheoesophageal voice quality.
METHODS AND PROCEDURES: This was a before-after study with time (double baseline) providing experimental control. Participants completed a 5-week EMST protocol and 6-week maintenance period. Assessments were taken at two baselines, post-EMST and at 6-week follow-up: respiratory: maximum expiratory pressure (MEP), peak flow, forced expiratory volume (FEV1); PROMS: CASA-Q, SECEL, V-RQOL; voice: voice recording for perceptual (clinician-rated) analysis, maximum phonation time, decibels. One-way repeated measures ANOVA or Friedman tests were used as appropriate to explore the pattern of change. Effect sizes were reported.
OUTCOMES AND RESULTS: Ten participants (eight male and two female) completed EMST. Participants found EMST acceptable and beneficial, reporting subjective changes in breathing and exercise tolerance. There were no significant differences in any measures between the two baselines. Significant increase from baseline was found in peak flow, FEV1 and decibels post-EMST training and post 6-week maintenance period, respectively. MEP increased significantly from baseline to post-EMST training only. PROMS showed a reduction in cough impact, sputum symptoms and reduced self-evaluation of communication impairment post-EMST. There was a non-significant reduction in maximum phonation time and no significant differences in clinician-rated voice quality post-EMST training and maintenance periods. Participants required device modifications to enable safe usage of the device and to achieve an airtight connection at the neck stoma.
CONCLUSIONS AND IMPLICATIONS: EMST is an acceptable treatment for tracheoesophageal speakers; however, device modifications are required to support usage and minimise airway safety risks. Preliminary efficacy data demonstrate that EMST may improve parameters of respiratory function, volume and self-perception of communication in PWL. A larger-scale randomised trial is required to increase the robustness of findings. It is recommended that device manufacturers develop adapters to facilitate airtight connection to neck stomas and to increase device safety in the laryngectomy population.
WHAT THIS PAPER ADDS: What is already known on this subject According to existing evidence, EMST is an effective treatment for improving cough strength and respiratory function. However, knowledge on the use of EMST after laryngectomy is limited, with only one existing study in evidence (Van Sluis et al. 2020). What this paper adds to existing knowledge This innovative feasibility study provides evidence on the feasibility and acceptability of EMST with people with laryngectomy and preliminary data on its impact on perceptual and objective measures of tracheoesophageal voice, cough and secretion clearance. What are the potential or actual clinical implications of this work? Subject to further testing, EMST may be an appropriate treatment to consider improving respiratory function, secretion clearance, vocal loudness and self-perception of communication for tracheoesophageal speakers
Somatosensory coding of visual self-identity
Get PDFHow does the brain process our bodily identity? This question has long fascinated scientists because of its potential implications for the study of self-awareness. Here, to test the idea that the somatosensory system is directly involved in coding bodily self-identity even when conveyed through vision, we probed the somatosensory system with tactile stimuli while participants observed hand images, either belonging to them (self-hand) or to another person (other-hand). In three psychophysical experiments (discovery, replicating and control samples), we found faster reaction times to tactile stimuli when paired with the self- than the other-hand image. To explore the neural basis of this effect, we conducted two electrophysiological experiments (discovery and replicating samples), and we observed that visual activity did not vary as a function of bodily identity, whereas the activity of the primary (at around 40 ms) and secondary (from 100 ms) somatosensory cortices did vary, as revealed by significantly higher somatosensory responses to tactile probes when presenting the self- than the other-hand image. We propose that this somatosensory coding of visual self-identity may be the result of associative learning mechanisms, through which individuals learn that the association between visual and somatosensory input only pertains to the own body, thus representing a possible prerequisite for establishing self-awareness
Setting the Research Priorities for Pregnancy Scanning: A Nationally co-produced vision with expectant women, the public and healthcare professionals
Get PDFObjectives
Despite sonography studies being integral to routine high quality antenatal care, clinical research in this field is less commonly initiated or led by sonography professionals. It is also unclear what the research priorities are for service users within the UK’s sonography screening and diagnostic pathway.
Methods
Here, we present a national priority setting partnership project, which included two surveys which were co-produced with the oversight of a stakeholder PSP group comprising service users and healthcare professionals, n = 12.
Results
From the surveys, there were 348 individual responses and 616 validated research questions/uncertainties submitted. The top-ranked 26 indicative questions were discussed at a final joint stakeholder meeting (n = 17) and the top 10 research priorities for pregnancy scanning research were voted for and agreed by consensus. These fell into six main themes: 1. Maternal and parental experience; 2. Emerging technology; 3, Screening, prediction, and diagnosis, 4, Role of pregnancy MRI, 5, Continued professional development, training and education; and, 6. Service delivery and workforce.
Conclusions
We envisage this PSP will support teams of researchers and clinicians with important and achievable targets to move the field of pregnancy scanning forward.
Advances in Knowledge
This is the first co-produced antenatal scanning priority setting partnership highlighting real world issues and lines of enquiry as proposed by service users and health care professionals
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