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Babbitt, Edna M., Patrick Semik, Allen Heinemann, and Leora R. Cherney. "Does type of aphasia impact change on the Communication Confidence Rating Scale for Aphasia (CCRSA)?" Aphasiology 32, sup1 (July 26, 2018): 9–10. http://dx.doi.org/10.1080/02687038.2018.1487925.
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Cherney, Leora R., Edna M. Babbitt, Patrick Semik, and Allen W. Heinemann. "Psychometric Properties of the Communication Confidence Rating Scale for Aphasia (CCRSA): Phase 1." Topics in Stroke Rehabilitation 18, no. 4 (July 2011): 352–60. http://dx.doi.org/10.1310/tsr1804-352.
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Babbitt, Edna M., Allen W. Heinemann, Patrick Semik, and Leora R. Cherney. "Psychometric properties of the Communication Confidence Rating Scale for Aphasia (CCRSA): Phase 2." Aphasiology 25, no. 6-7 (January 10, 2011): 727–35. http://dx.doi.org/10.1080/02687038.2010.537347.
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Steele, Richard D., Allison Baird, Denise McCall, and Lisa Haynes. "Combining Teletherapy and On-line Language Exercises in the Treatment of Chronic Aphasia: An Outcome Study." International Journal of Telerehabilitation 6, no. 2 (January 29, 2015): 3–20. http://dx.doi.org/10.5195/ijt.2014.6157.
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We report a 12-week outcome study in which nine persons with long-term chronic aphasia received individual and group speech-language teletherapy services, and also used on-line language exercises to practice from home between therapy sessions. Participants were assessed at study initiation and completion using the Western Aphasia Battery, a portion of the Communicative Effectiveness Index, ASHA National Outcome Measurement System, and RIC Communication Confidence Rating Scale for Aphasia; additionally participants were polled regarding satisfaction at discharge. Pre-treatment and post-treatment means were calculated and compared, and matched t-tests were used to determine significance of improvements following treatment, with patterns of independent on-line activity analyzed. Analysis of scores shows that means improved on most measures following treatment, generally significantly: the WAB AQ improved +3.5 (p = .057); the CETI Overall (of items administered) — +17.8 (p = .01), and CCRSA Overall — + 10.4 (p = .0004). Independent work increased with time, and user satisfaction following participation was high.
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de Jong-Hagelstein, Marjolein, Lieke Kros, Hester F. Lingsma, Diederik W. J. Dippel, Peter J. Koudstaal, and Evy G. Visch-Brink. "Expert Versus Proxy Rating of Verbal Communicative Ability of People with Aphasia after Stroke." Journal of the International Neuropsychological Society 18, no. 6 (November 2012): 1064–70. http://dx.doi.org/10.1017/s1355617712000811.
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AbstractIn randomized clinical trials of aphasia treatment, a functional outcome measure like the Amsterdam-Nijmegen Everyday Language Test (ANELT), administered by speech-language therapists, is often used. However, the agreement between this expert rating and the judgment of the proxy about the quality of the daily life communication of the person with aphasia is largely unknown. We examined the association between ANELT scores by speech-language therapists and proxy judgments on the Partner Communication Questionnaire both at 3 and 6 months in 39 people with aphasia after stroke. We also determined which factors affected the level of agreement between expert and proxy judgment of the communicative ability at 6 months in 53 people with aphasia. We found moderate agreement (at 3 months r = .662; p = < .0001 and at 6 months r = .565; p = .0001), with proxies rating slightly higher than experts. Less severe aphasia, measured with the Aphasia Severity Rating Scale, was associated with better agreement. In conclusion, although proxies were slightly more positive than experts, we found moderate agreement between expert and proxy rating of verbal communicative ability of people with aphasia after stroke, especially in milder cases. (JINS, 2012, 18, 1064–1070)
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Wilssens, Ineke, Dorien Vandenborre, Kim van Dun, Jo Verhoeven, Evy Visch-Brink, and Peter Mariën. "Constraint-Induced Aphasia Therapy Versus Intensive Semantic Treatment in Fluent Aphasia." American Journal of Speech-Language Pathology 24, no. 2 (May 2015): 281–94. http://dx.doi.org/10.1044/2015_ajslp-14-0018.
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Objective The authors compared the effectiveness of 2 intensive therapy methods: Constraint-Induced Aphasia Therapy (CIAT; Pulvermüller et al., 2001) and semantic therapy (BOX; Visch-Brink & Bajema, 2001). Method Nine patients with chronic fluent aphasia participated in a therapy program to establish behavioral treatment outcomes. Participants were randomly assigned to one of two groups (CIAT or BOX). Results Intensive therapy significantly improved verbal communication. However, BOX treatment showed a more pronounced improvement on two communication—namely, a standardized assessment for verbal communication, the Amsterdam Nijmegen Everyday Language Test (Blomert, Koster, & Kean, 1995), and a subjective rating scale, the Communicative Effectiveness Index (Lomas et al., 1989). All participants significantly improved on one (or more) subtests of the Aachen Aphasia Test (Graetz, de Bleser, & Willmes, 1992), an impairment-focused assessment. There was a treatment-specific effect. BOX treatment had a significant effect on language comprehension and semantics, whereas CIAT treatment affected language production and phonology. Conclusion The findings indicate that in patients with fluent aphasia, (a) intensive treatment has a significant effect on language and verbal communication, (b) intensive therapy results in selective treatment effects, and (c) an intensive semantic treatment shows a more striking mean improvement on verbal communication in comparison with communication-based CIAT treatment.
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Xin, Jiawei, Xuanyu Huang, Xiaodong Pan, Lin Lin, Mingyao Sun, Chen Liu, and Qinyong Ye. "Risk Factors for Aphasia in Cerebral Small Vessel Diseases." Current Neurovascular Research 16, no. 2 (July 10, 2019): 107–14. http://dx.doi.org/10.2174/1567202616666190227202638.
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Background: Lacunes and white matter hyperintensities (WMH) are two common findings seen on neuroimaging in patients with cerebral small vessel disease (cSVD). Clinically we observed that some patients with cSVD have aphasia through the language assessment scale. Our study aimed to explore the underlying risk factors for aphasia in cSVD patients. Methods: This study retrospectively analyzed 38 patients, with and without aphasia, aged 50 or over, Chinese Han population, diagnosed as cSVD with lacunes and/or WMH. We collected demographic characteristics and vascular risk factors. The severity of WMH was assessed by the age related white matter changes (ARWMC) rating scale. Results: Risk factors associated with aphasia were: lower education (p = 0.029), higher total cholesterol (TC) levels (p = 0.023), and higher low-density lipoprotein cholesterol (LDL-C) levels (p = 0.027). After controlling for age and sex, levels of TC (odds ratios, 1.96; 95% confidence interval, 1.06-3.62; p = 0.032) remained associated with aphasia independently. Conclusion: High level of TC was significantly associated with a higher risk of aphasia in clinically silent cSVD patients. Early interventions including lipid-lowering treatment, cranial magnetic resonance imaging (MRI) and ARWMC rating scale should be performed. Further studies are needed to explore proper methods of prevention and treatment for aphasia in clinically silent cSVD patients, in addition to understanding the pathophysiological mechanism.
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Ryan, Brooke, Kyla Hudson, Linda Worrall, Nina Simmons-Mackie, Emma Thomas, Emma Finch, Kathy Clark, and Jennifer Lethlean. "The Aphasia Action, Success, and Knowledge Programme: Results from an Australian Phase I Trial of a Speech-Pathology-Led Intervention for People with Aphasia Early Post Stroke." Brain Impairment 18, no. 3 (March 30, 2017): 284–98. http://dx.doi.org/10.1017/brimp.2017.5.
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Background: Speech pathologists work to optimise communication and reduce the emotional and social impact of communication disability in patients with aphasia but need evidence-based interventions to effectively do so.Objective: This phase 1 study aims to evaluate an Australian speech-pathology-led intervention called the Aphasia Action, Success, and Knowledge (Aphasia ASK) programme for patients with aphasia early post stroke.Methods: A convergent parallel mixed-methods design was utilised. The intervention included up to six individual face-to-face sessions with seven participants with aphasia and their nominated family member(s). Quantitative outcomes assessing mood, quality of life, and communication confidence were conducted for the participants with aphasia. Follow-up interviews were conducted with both participants with aphasia and family members to determine their perceptions of the programme.Results: Significant improvements were found in communication confidence and mood after treatment and the gains were maintained at 3-month follow-up. Participants with aphasia and their family members reported a good level of satisfaction with the programme.Conclusions: Findings suggest the Aphasia ASK programme is a suitable intervention with positive initial outcomes for people with aphasia. A larger scale evaluation with a greater variety of participants is now required. An Australian cluster randomised control trial is planned.
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El Hachioui, Hanane, Evy G. Visch-Brink, Hester F. Lingsma, Mieke W. M. E. van de Sandt-Koenderman, Diederik W. J. Dippel, Peter J. Koudstaal, and Huub A. M. Middelkoop. "Nonlinguistic Cognitive Impairment in Poststroke Aphasia." Neurorehabilitation and Neural Repair 28, no. 3 (November 8, 2013): 273–81. http://dx.doi.org/10.1177/1545968313508467.
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Background and objectives. Information on cognitive impairment in aphasic patients is limited. Our aim was to investigate the prevalence and course of nonlinguistic cognitive impairments in the first year after stroke and their association with aphasia and functional outcome. Methods. We included 147 patients with acute aphasia. At 3 months and 1 year, we assessed cognition with a nonlinguistic cognitive examination including abstract reasoning, visual memory, visual perception and construction, and executive functioning. We assessed language with a verbal communication rating (Aphasia Severity Rating Scale), the ScreeLing (a linguistic-level screening test), and the Token Test. We evaluated functional outcome with the modified Rankin scale and registered the use of antidepressants. Results. In total, 107 (88%) patients had impairments in at least one nonlinguistic cognitive domain at 3 months and 91 (80%) at 1 year. The most frequently observed impairment concerned visual memory (83% at 3 months; 78% at 1 year) and the least frequent visual perception and construction (19% at 3 months; 14% at 1 year). There was improvement on all cognitive domains including language, except for abstract reasoning. Patients with persisting aphasia had lower cognitive domain scores, worse functional outcome, and were more often depressed than patients who had recovered from aphasia. Conclusions. Standard nonlinguistic cognitive examination is recommended in aphasic stroke patients. Nonlinguistic cognitive impairments are common and associated with poor functional outcome and depression, especially in patients with persisting aphasia.
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Fox, Lynn E. "AAC Collaboration Using the Self-Anchored Rating Scales (SARS): An Aphasia Case Study." Perspectives on Augmentative and Alternative Communication 21, no. 4 (December 2012): 136–43. http://dx.doi.org/10.1044/aac21.4.136.
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Abstract The self-anchored rating scale (SARS) is a technique that augments collaboration between Augmentative and Alternative Communication (AAC) interventionists, their clients, and their clients' support networks. SARS is a technique used in Solution-Focused Brief Therapy, a branch of systemic family counseling. It has been applied to treating speech and language disorders across the life span, and recent case studies show it has promise for promoting adoption and long-term use of high and low tech AAC. I will describe 2 key principles of solution-focused therapy and present 7 steps in the SARS process that illustrate how clinicians can use the SARS to involve a person with aphasia and his or her family in all aspects of the therapeutic process. I will use a case study to illustrate the SARS process and present outcomes for one individual living with aphasia.
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Godecke, Erin, Elizabeth A. Armstrong, Tapan Rai, Sandy Middleton, Natalie Ciccone, Anne Whitworth, Miranda Rose, et al. "A randomized controlled trial of very early rehabilitation in speech after stroke." International Journal of Stroke 11, no. 5 (May 5, 2016): 586–92. http://dx.doi.org/10.1177/1747493016641116.
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Rationale The efficacy of rehabilitation therapy for aphasia caused by stroke is uncertain. Aims and hypothesis The Very Early Rehabilitation of Speech (VERSE) trial aims to determine if intensive prescribed aphasia therapy (VERSE) is more effective and cost saving than non-prescribed, intensive (usual care-plus) and non-intensive usual care (UC) therapy when started within 15 days of stroke onset and continued daily over four weeks. We hypothesize that aphasia therapy when started very early after stroke and delivered daily could enhance recovery of communication compared with UC. Sample size estimates A total of 246 participants (82 per arm) will provide 80% power to detect a 4.4% improvement on aphasia quotient between VERSE and UC plus at a significance level of α = 0.05. Setting Acute-care hospitals and accompanying rehabilitation services throughout Australia, 2014–2017. Design Three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment (PROBE) trial. Participants Acute stroke in previous 14 days and aphasia diagnosed by aphasia quotient (AQ) of the Western Aphasia Battery (WAB). Randomization Computer-generated blocked randomization procedure stratified by aphasia severity according to Western Aphasia Battery, to one of three arms. Intervention All participants receive UC—usual ward-based aphasia therapy. Arm 1: UC—no additional therapy; Arm 2: UC-plus usual ward-based therapy; Arm 3: VERSE therapy—a prescribed and structured aphasia therapy program. Arms 2 and 3 receive a total of 20 additional sessions (45–60 min, provided daily) of aphasia therapy. The additional intervention must be provided before day 50 post stroke. Study outcome measures The aphasia quotient of Western Aphasia Battery at 12 weeks post stroke. Secondary outcomes include discourse measures, the Stroke and Aphasia Quality of Life Scale-39 and the Aphasia Depression Rating Scale at 12 and 26 weeks. Economic evaluation Incremental cost-effectiveness ratios at 26 weeks will be reported. Discussion This trial is designed to test whether the intensive and prescribed VERSE intervention is effective in promoting maximum recovery and preventing costly health complications in a vulnerable population of survivors of stroke. It will also provide novel, prospective, aphasia specific cost-effectiveness data to guide future policy development for this population.
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Hedberg, Berith, Dan Malm, Jan-Erik Karlsson, Kristofer Årestedt, and Anders Broström. "Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation." European Journal of Cardiovascular Nursing 17, no. 5 (November 14, 2017): 446–55. http://dx.doi.org/10.1177/1474515117741891.
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Background: Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making. Aim: The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms. Methods: A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data. Results: Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication. Conclusion: Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.
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Knapik-Szweda, Sara. "The effectiveness and influence of Vocal and Instrumental Improvisation in Music Therapy on children diagnosed with autism. Pilot Study." Journal of Education Culture and Society 6, no. 1 (January 5, 2020): 153–66. http://dx.doi.org/10.15503/jecs20151.153.166.
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Autism is a developmental disorder which is difficult to recognize and diagnose. The present study examines the effectiveness of music therapy intervention based on improvisational techniques with the elements of Creative Music Therapy by Paul Nordoff and Clive Robbins and improvisational techniques by Tony Wigram (such as imitating, frameworking, dialogues, holding) on developmentl of children with Autism (two boys diagnosed with autism - case 1. and case 2), especially in verbal and nonverbal communication, disturbance behavior patterns, cognitive and social-emotional areas. The results indicate a positive outcome in two music therapy observing tools: Scale I Child – Therapist Relationship in Coactive Musical Experience Rating Form and Scale II Musical Communicativeness Rating Form. The tables indicate the intensity of interaction between the therapist and the subject during the music therapy process (including communication skills, cognitive skills and behavior patterns). The results of case 1 are indicated in Scale I and Scale II and show a significant effect of improvisational music therapy. The important findings from the analysis of behavior in the sessions were Stability and confidence in interpersonal musical relationship, Activity relationship developing, (scale 1.). The results of the case 2. show small changes in musical behavior when it comes to Stability and confidence in interpersonal musical relationship, but in Activity relationship developing the indicators show a lot of changes between sessions. The results of the research indicate that music therapy intervention has a positive outcome and may be an effective method to increase functioning of children with autism.
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Correia, Sheilla de Medeiros, Lilian Schafirovits Morillo, Wilson Jacob Filho, and Leticia Lessa Mansur. "Swallowing in moderate and severe phases of Alzheimer's disease." Arquivos de Neuro-Psiquiatria 68, no. 6 (December 2010): 855–61. http://dx.doi.org/10.1590/s0004-282x2010000600005.
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OBJECTIVE: To characterize the problems of feeding and swallowing in individuals with moderate and severe Alzheimer´s disease (AD) and to correlate these with functional aspects. METHOD: Fifty patients with AD and their caregivers participated in this study. The instruments used were: Clinical Dementia Rating (CDR), Mini-Mental State Examination, Index of Activities of Daily Living, Assessment of Feeding and Swallowing Difficulties in Dementia, Functional Outcome Questionnaire for Aphasia, and Swallowing Rating Scale. RESULTS: Problems with passivity, distraction and refusal to eat were encountered in the CDR2 group. Distraction, passivity and inappropriate feeding velocity were predominant in the CDR3 group. The problems were correlated with communication, swallowing severity of AD individuals and caregiver schooling. CONCLUSION: Given the inexorable functional alterations during the course of the disease, it is vital to observe these in patients with a compromised feeding and swallowing mechanism. The present study supplies the instruments to orient caregivers and professionals.
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Cera, Maysa Luchesi, Karin Zazo Ortiz, Paulo Henrique Ferreira Bertolucci, and Thaís Soares Cianciarullo Minett. "Speech and orofacial apraxias in Alzheimer's disease." International Psychogeriatrics 25, no. 10 (June 7, 2013): 1679–85. http://dx.doi.org/10.1017/s1041610213000781.
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ABSTRACTBackground:Alzheimer's disease (AD) affects not only memory but also other cognitive functions, such as orientation, language, praxis, attention, visual perception, or executive function. Most studies on oral communication in AD focus on aphasia; however, speech and orofacial apraxias are also present in these patients. The aim of this study was to investigate the presence of speech and orofacial apraxias in patients with AD with the hypothesis that apraxia severity is strongly correlated with disease severity.Methods:Ninety participants in different stages of AD (mild, moderate, and severe) underwent the following assessments: Clinical Dementia Rating, Mini-Mental State Examination, Lawton Instrumental Activities of Daily Living, a specific speech and orofacial praxis assessment, and the oral agility subtest of the Boston diagnostic aphasia examination.Results:The mean age was 80.2±7.2 years and 73% were women. Patients with AD had significantly lower scores than normal controls for speech praxis (mean difference=−2.9, 95% confidence interval (CI)=−3.3 to −2.4) and orofacial praxis (mean difference=−4.9, 95% CI=−5.4 to −4.3). Dementia severity was significantly associated with orofacial apraxia severity (moderate AD: β=−19.63, p=0.011; and severe AD: β=−51.68, p < 0.001) and speech apraxia severity (moderate AD: β=7.07, p = 0.001; and severe AD: β= 8.16, p < 0.001).Conclusion:Speech and orofacial apraxias were evident in patients with AD and became more pronounced with disease progression.
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Yao, Dongning, Liang Jiang, Yuankai Huang, Lei Chen, Yitao Wang, and Xiaoyu Xi. "Assessment of Factors Influencing Communication in Clinical Pharmacy." Evaluation & the Health Professions 42, no. 4 (February 20, 2018): 422–49. http://dx.doi.org/10.1177/0163278717751028.
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This study aimed to identify and assess the factors that influence communication quality between clinical pharmacists and patients using a structural equation model based on the predisposing, reinforcing, and enabling constructs in educational/environmental diagnosis and evaluation–policy, regulatory, and organizational constructs in educational and ecological development model to identify the most effective path to increase their communication quality. A survey was conducted at 253 Class-A tertiary hospitals in China from March to December 2016. During on-site observations, verbal communications between clinical pharmacists ( n = 752) and patients were audio recorded, and communication quality was rated by an expert panel on an 8-item Quality of Communication Rating Scale. Clinical pharmacists completed questionnaires that examined the predisposing, enabling, and reinforcing factors that influenced communication quality. Finally, AMOS was employed to examine the relationships between the three factors and communication quality. The results indicated that all three factors positively affected communication quality, with correlation coefficients of .26, .13, and .17, respectively. The most influential predisposing factor was attitude (.77), the most influential enabling factors were self-efficacy (.71) and confidence (.72), and the most influential reinforcing factor was rewards (.74). The findings suggest that pharmacists’ attitudes toward, perceived knowledge of, and skill and confidence in communication, and the rewards offered by pharmacy management are the most influential factors that influence communication quality.
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Farrand, Paul, Henry Clover, and Iain L. Hutchison. "GDPs’ Self-perceived Confidence and Anxiety in Their Clinical and Communication Skills Used When Screening for Oral Cancer: UK Variations." Primary Dental Care os10, no. 3 (July 2003): 81–86. http://dx.doi.org/10.1308/135576103322497048.
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Objective To compare anxieties of general dental practitioners (GDPs) across the UK in communicating with patients about oral cancer and confidence in clinical skills required to perform soft tissue screening for oral cancer. Design A questionnaire was sent to 2200 randomly selected GDPs from across the UK. Responses to the questionnaires were analysed using 95% confidence intervals. Setting Dental practitioners in general practice within England, Northern Ireland, Scotland and Wales. Results The response rate varied between 57% in England and 65% in Northern Ireland. A high percentage of dental practitioners across all UK regions reported performing soft tissue examinations (range 78% to 88%). The number of soft tissue examinations per month varied between 129 (95% CI 109, 148) and 162 (95% CI 154, 170) indicating criteria when selecting patients for screening. Using a nine-point rating scale (1 = not at all, 9 = extremely), confidence in the clinical skills required during oral cancer screening was generally good (ratings varying between 5.4 and 6.7). With the exception of reporting positive findings to patients (rating 4.5 to 5.2), anxiety in communication skills used during oral cancer screening was generally low (ratings varying between 1.8 and 3.9). Conclusion While concerns over generalising the results exist, the situation with respect to the clinical and communication skills required by GDPs during oral cancer screening is generally encouraging. An area of concern is discussing positive findings with patients. This may be overcome by developing specialist courses on breaking bad news within undergraduate dental curricula and programmes of continuing professional development.
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Haro-Martínez, Ana M., Genny Lubrini, Rosario Madero-Jarabo, Exuperio Díez-Tejedor, and Blanca Fuentes. "Melodic intonation therapy in post-stroke nonfluent aphasia: a randomized pilot trial." Clinical Rehabilitation 33, no. 1 (July 30, 2018): 44–53. http://dx.doi.org/10.1177/0269215518791004.
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Objective: To collect data to estimate the sample size of a definitive randomized controlled trial to evaluate the effects of Melodic Intonation Therapy in post-stroke nonfluent aphasia. Design: A randomized, crossover, interventional pilot trial. Setting: Departments of Neurology and Rehabilitation from a university general hospital. Participants: Stroke survivors with post-stroke nonfluent aphasia. Interventions: Patients randomized to group 1 had treatment with Melodic Intonation Therapy first (12 sessions over six weeks) followed by no treatment; the patients in group 2 started active treatment between three and six months after their inclusion in the study, serving as waiting list controls for the first phase. Main measures: The Communicative Activity Log (CAL) questionnaire and the Boston Diagnostic Aphasia Examination (BDAE) were evaluated at baseline, and at six and 12 weeks. Results: Twenty patients were included. Four of the patients allocated to group 2 crossed over to group 1, receiving the treatment at first. Intention-to-treat analysis: after adjustment for baseline scores, the mean difference in the CAL evaluation from baseline in the treated group was 8.5 points (95% confidence interval (CI), 0.11–17.0; P = .043), with no significant change in any of the BDAE sections. Per-protocol analysis showed similar results with a clear treatment effect ( P = .043) on the CAL. Conclusion: Melodic Intonation Therapy might have a positive effect on the communication skills of stroke survivors with nonfluent aphasia as measured by the CAL questionnaire. A full-scale trial with at least 27 patients per group is necessary to confirm these results.
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Palmer, Rebecca, Munyaradzi Dimairo, Nicholas Latimer, Elizabeth Cross, Marian Brady, Pam Enderby, Audrey Bowen, et al. "Computerised speech and language therapy or attention control added to usual care for people with long-term post-stroke aphasia: the Big CACTUS three-arm RCT." Health Technology Assessment 24, no. 19 (April 2020): 1–176. http://dx.doi.org/10.3310/hta24190.
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Background People with aphasia may improve their communication with speech and language therapy many months/years after stroke. However, NHS speech and language therapy reduces in availability over time post stroke. Objective This trial evaluated the clinical effectiveness and cost-effectiveness of self-managed computerised speech and language therapy to provide additional therapy. Design A pragmatic, superiority, single-blind, parallel-group, individually randomised (stratified block randomisation, stratified by word-finding severity and site) adjunct trial. Setting Twenty-one UK NHS speech and language therapy departments. Participants People with post-stroke aphasia (diagnosed by a speech and language therapist) with long-standing (> 4 months) word-finding difficulties. Interventions The groups were (1) usual care; (2) daily self-managed computerised word-finding therapy tailored by speech and language therapists and supported by volunteers/speech and language therapy assistants for 6 months plus usual care (computerised speech and language therapy); and (3) activity/attention control (completion of puzzles and receipt of telephone calls from a researcher for 6 months) plus usual care. Main outcome measures Co-primary outcomes – change in ability to find treated words of personal relevance in a bespoke naming test (impairment) and change in functional communication in conversation rated on the activity scale of the Therapy Outcome Measures (activity) 6 months after randomisation. A key secondary outcome was participant-rated perception of communication and quality of life using the Communication Outcomes After Stroke questionnaire at 6 months. Outcomes were assessed by speech and language therapists using standardised procedures. Cost-effectiveness was estimated using treatment costs and an accessible EuroQol-5 Dimensions, five-level version, measuring quality-adjusted life-years. Results A total of 818 patients were assessed for eligibility and 278 participants were randomised between October 2014 and August 2016. A total of 240 participants (86 usual care, 83 computerised speech and language therapy, 71 attention control) contributed to modified intention-to-treat analysis at 6 months. The mean improvements in word-finding were 1.1% (standard deviation 11.2%) for usual care, 16.4% (standard deviation 15.3%) for computerised speech and language therapy and 2.4% (standard deviation 8.8%) for attention control. Computerised speech and language therapy improved word-finding 16.2% more than usual care did (95% confidence interval 12.7% to 19.6%; p < 0.0001) and 14.4% more than attention control did (95% confidence interval 10.8% to 18.1%). Most of this effect was maintained at 12 months (n = 219); the mean differences in change in word-finding score were 12.7% (95% confidence interval 8.7% to 16.7%) higher in the computerised speech and language therapy group (n = 74) than in the usual-care group (n = 84) and 9.3% (95% confidence interval 4.8% to 13.7%) higher in the computerised speech and language therapy group than in the attention control group (n = 61). Computerised speech and language therapy did not show significant improvements on the Therapy Outcome Measures or Communication Outcomes After Stroke scale compared with usual care or attention control. Primary cost-effectiveness analysis estimated an incremental cost per participant of £732.73 (95% credible interval £674.23 to £798.05). The incremental quality-adjusted life-year gain was 0.017 for computerised speech and language therapy compared with usual care, but its direction was uncertain (95% credible interval –0.05 to 0.10), resulting in an incremental cost-effectiveness ratio of £42,686 per quality-adjusted life-year gained. For mild and moderate word-finding difficulty subgroups, incremental cost-effectiveness ratios were £22,371 and £28,898 per quality-adjusted life-year gained, respectively, for computerised speech and language therapy compared with usual care. Limitations This trial excluded non-English-language speakers, the accessible EuroQol-5 Dimensions, five-level version, was not validated and the measurement of attention control fidelity was limited. Conclusions Computerised speech and language therapy enabled additional self-managed speech and language therapy, contributing to significant improvement in finding personally relevant words (as specifically targeted by computerised speech and language therapy) long term post stroke. Gains did not lead to improvements in conversation or quality of life. Cost-effectiveness is uncertain owing to uncertainty around the quality-adjusted life-year gain, but computerised speech and language therapy may be more cost-effective for participants with mild and moderate word-finding difficulties. Exploring ways of helping people with aphasia to use new words in functional communication contexts is a priority. Trial registration Current Controlled Trials ISRCTN68798818. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 19. See the NIHR Journals Library website for further project information. The Tavistock Trust for Aphasia provided additional support to enable people in the control groups to experience the intervention after the trial had ended.
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Frerich, Gerrit, Vanessa Romotzky, Maren Galushko, Stefanie Hamacher, Klaus Maria Perrar, Axel Doll, Thomas Montag, et al. "Communication about the desire to die: Development and evaluation of a first needs-oriented training concept — A pilot study." Palliative and Supportive Care 18, no. 5 (March 5, 2020): 528–36. http://dx.doi.org/10.1017/s1478951520000097.
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AbstractObjectivePatients’ desire to die (DD) is rarely discussed in palliative care (PC) due to health professionals’ (HPs) feeling of uncertainty. The aim of the study was to develop and evaluate a training to increase HPs’ self-confidence in responding professionally to patient's DD and to assess the feasibility of this approach.MethodsThe training course was developed via focus groups and relevant literature and refined with an advisory board. An evaluation design was developed to evaluate training outcomes and to examine feasibility. To assess self-confidence, knowledge, skills, and attitudes: (1) standardized surveys were applied at T1 (before training), T2 (directly after), and T3 (3 months later), and were analyzed by descriptive and non-parametric statistics; and (2) participants’ open feedback was summarized by content.ResultsA two-day multi-disciplinary training was developed to improve self-confidence via diverse teaching methods. Twenty-four HPs from general and specialized PC were participated. Via self-rating on Likert scales at three time points, improvements were seen at T1, T2, and partly remained at T3, especially in the overall item of self-confidence in communicating with patients about their DD (means: 4.3. at T1, 5.7 at T2, and 5.9 at T3; on a 7-point scale with 1 = lowest value and 7 = highest value). Fewer improvements were found in skills (using different approaches) and attitudes (feeling less helplessness). Open feedback revealed a high appreciation for the training, especially the composition of participants, the role-play, and the overall increase of awareness of the topic.Significance of resultsThe developed training on addressing DD meets a need and was perceived by the participants to be of added value. Future research should measure training effects with a validated instrument, including more participants, diverse participant groups, and a control group. Effects on patients should be assessed.
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Tong, Yongsheng, Kenneth R. Conner, Cuiling Wang, Yi Yin, Liting Zhao, Yuehua Wang, and Yue Liu. "Prospective study of association of characteristics of hotline psychological intervention in 778 high-risk callers with subsequent suicidal act." Australian & New Zealand Journal of Psychiatry 54, no. 12 (October 13, 2020): 1182–91. http://dx.doi.org/10.1177/0004867420963739.
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Objectives: This study aimed to assess the association of the quality scores of hotline psychological intervention and the reduction of subsequent suicidal acts among high suicidal risk callers. Methods: High-risk callers at a national crisis hotline service in China were recruited and prospectively followed for up to 3 months after receiving a hotline psychological intervention. The quality of the intervention was evaluated by supervisors who listened to the tape-recorded calls using the Counseling Skills Rating Scale for Psychological Support Hotlines, which assessed three counseling domains: process, attitude and communication skill. The primary outcome was the occurrence of suicidal acts during the follow-up period. Secondary outcomes were before versus after changes during the intake intervention call in hopefulness, psychological stress and suicide intention reported by the callers. Results: Over the 3-month follow-up, 45 of 778 high-risk callers reported 61 suicide attempts, and 3 other callers died by suicide. Subsequent suicidal act was significantly more common in callers classified as being at higher risk during the intake call. Higher scores on the quality of suicidality assessing of the Counseling Skills Rating Scale for Psychological Support Hotlines were associated with reduced risk of suicidal acts during follow-up (hazard ratio = 0.38, 95% confidence interval = [0.18, 0.85]). Higher scores on the communication skill domain were associated with increases in hopefulness (β = 0.09) after the intervention, and higher scores on the counseling process domain (β = −0.12) and higher suicidal risk scores (β = −0.12) were associated with decreased suicide intention after intervention. Conclusion: Several characteristics of a hotline intervention for suicide prevention were associated with decreased risk of suicidal acts during follow-up. Intervention skill training for hotline operators should emphasize these specific counseling skills.
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Armstrong, Kirk J., and Amanda J. Jarriel. "Standardized Patient Encounters Improved Athletic Training Students' Confidence in Clinical Evaluations." Athletic Training Education Journal 10, no. 2 (April 1, 2015): 113–21. http://dx.doi.org/10.4085/1002113.
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Context Researchers have reported that interacting with standardized patients (SPs) is a worthwhile and realistic experience for athletic training (AT) students. These encounters enhance students' interviewing skills, confidence as a clinician, clinical skill development, and interpersonal communication. Objective To determine how SP encounters impacted students' confidence in performing clinical evaluations. Design Pretest-posttest survey design. Setting Athletic training simulation lab. Patients or Other Participants Thirty-five students from the junior (n = 20) and senior (n = 15) AT cohorts from a public liberal arts institution in the Southeast. Intervention(s) Athletic training students completed 2 SP encounters per semester throughout an academic year in the AT program, totaling 4 SP encounters. Main Outcome Measure(s) Each student completed a 17-item Likert scale (1 = strongly disagree, 5 = strongly agree) that rated confidence levels immediately before and after each SP encounter. The confidence rating assessed students' confidence regarding how the SP encounter affected their confidence in completing patient evaluations (eg, identifying history questions, interpreting results of special tests). We computed descriptive statistics for all items Wilcoxon signed rank tests determined differences in pre-encounter and should be postencounter confidence ratings. Results Overall, students from both cohorts reported that the SP encounter improved confidence in completing clinical evaluations. Specifically, students reported a significant increase from pre-encounter to postencounter confidence ratings after nutrition-based (Z = −2.991, P = .004), knee (Z = −3.261, P = 0.001), concussion (Z = −3.294, P = .001), psychosocial intervention (Z = −3.062, P = .002), and general medical (Z = −3.524, P > .001) SP encounters. Conclusions The authenticity and fidelity of the SP encounter provided the AT students a real-time clinical evaluation in a nonthreatening environment. Students reported that their confidence improved after each encounter. By providing these experiences, AT students can become comfortable interacting with patients in clinical evaluations.
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Guiraud, Vincent, Thierry Gallarda, David Calvet, Guillaume Turc, Catherine Oppenheim, Frédéric Rouillon, and Jean-Louis Mas. "Depression predictors within six months of ischemic stroke: The DEPRESS Study." International Journal of Stroke 11, no. 5 (February 12, 2016): 519–25. http://dx.doi.org/10.1177/1747493016632257.
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Background Depression negatively affects rehabilitation and quality of life after stroke. Identifying in the acute phase patients at high risk for post-stroke depression would facilitate early detection of depressive symptoms. Methods The DEPRESS (Depression Predictors after Ischemic Stroke) study was a prospective cohort study designed to identify baseline predictors of depression occurring within six months after ischemic stroke and high-risk patients for post-stroke depression. All patients without aphasia were screened for depression by a neurologist using the Patient Health Questionnaire, and the diagnosis was confirmed by a psychiatrist with the Mini International Neuropsychiatric Interview. In severely aphasic patients, depression was diagnosed using the Aphasic Depression Rating Scale and the Visual Analog Mood Scale. Results Depression was present in 61 of 251 (24%) patients enrolled in the DEPRESS study. Female gender, prior history of depression, major physical disability, prior history of stroke, stressful life event exposure in the month preceding stroke onset, and pathologic crying were significant predictors of depression within six months after ischemic stroke. Depression was more frequent in patients with left caudate and/or lenticular nucleus lesion (OR = 2.4, 95% confidence interval, 0.97–5.91), but the difference was not significant. The presence of ≥2 predictors identified the largest proportion of depressed patients (62%) in the smallest proportion of the cohort (36%). Conclusion Female gender, prior history of depression, major physical disability, prior history of stroke, recent stressful life event exposure before stroke, and pathologic crying were significant predictors of post-stroke depression occurring within six months after stroke onset.
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Shrestha, Priyanka, Erica Husser, Diane Berish, Long Ngo, Marie Boltz, Sharon Inouye, Edward Marcantonio, and Donna Fick. "Clinicians’ Knowledge and Attitudes About Delirium Detection and Management." Innovation in Aging 4, Supplement_1 (December 1, 2020): 519–20. http://dx.doi.org/10.1093/geroni/igaa057.1676.
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Abstract Delirium is a serious and potentially life-threatening problem, but it remains clinically under-recognized. Various factors contribute to this under-recognition, including limited understanding of delirium, insufficient training and application of delirium assessments, potential stigma for the patient and increased workload for the clinician. As a part of an NIH funded study testing a rapid two-step delirium identification protocol at two hospitals in the U.S. (one urban and one rural), clinicians completed a 12-item survey to assess their knowledge and attitudes about delirium and their confidence in preventing and managing delirium. Survey response options followed a 5-point rating scale (strongly disagree, disagree, undecided, agree, strongly agree). The sample for this analysis included 399 clinicians (MDs=53; RNs=235; CNAs=111). Chi-square was used to test for group differences between clinician types. Less than half of the clinicians reported agreeing with the statement, “delirium is largely preventable” (MDs: 47%; RN: 44%; CNA: 41%, p-value=0.021). MDs and RNs indicated a high level of confidence in recognizing delirium while CNAs endorsed lower levels of confidence (MDs: 87%; RN: 81%; CNA: 65%, p-value=0.001). All types of clinicians reported lower confidence in managing delirium (MDs: 29%; RN: 36%; CNA: 44%, p-value=0.117). 47% of CNAs and 37% of RNs agreed there is a need for additional training in caring for persons with delirium while only 21% of MDs agreed (p = 0.031). Understanding how different types of clinicians think and feel about delirium will inform training and communication initiatives, clinical implementation, and research on best practices for delirium identification and management.
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Blomberg, Ben A., Catherine Quintana, Jingwen Hua, Leslie Hargis-Fuller, Jeff Laux, and Margaret Drickamer. "ADVANCE CARE PLANNING COMMUNICATION: AN INTERACTIVE WORKSHOP WITH ROLE-PLAY FOR STUDENTS AND PRIMARY CLINICIANS." Innovation in Aging 3, Supplement_1 (November 2019): S846. http://dx.doi.org/10.1093/geroni/igz038.3113.
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Abstract There is a need for increased clinician training on advance care planning (ACP). Common barriers to ACP include perceived lack of confidence, skills, and knowledge necessary to engage in these discussions. Furthermore, many clinicians feel inadequately trained in prognostication. There is evidence that multimodality curricula are effective in teaching ACP, and may be simultaneously targeted to trainees and practicing clinicians with success. We developed a 3-hour workshop incorporating lecture, patient-oriented decision aids, prognostication tools, small group discussion, and case-based role-play to communicate a values-based approach to ACP. Cases included discussion of care goals a patient with severe COPD and one with mild cognitive impairment. The workshop was delivered to 4th year medical students, then adapted in two primary care clinics. In the clinics, we added an interprofessional case applying ACP to management of dental pain in advanced dementia. We evaluated the workshops using pre-post surveys. 34 medical students and 14 primary care providers participated. Self-reported knowledge and comfort with ACP significantly improved; attitudes toward ACP were strongly positive both before and after. The workshop was well received. On a seven-point Likert scale, (1=Unacceptable, 7=Outstanding), the median overall rating was 6 (“Excellent”). In conclusion, we developed an ACP workshop applicable to both students and primary clinicians. We saw improvements in self-reported knowledge and comfort with ACP, though long-term effects were not studied. Participants found the role-play especially valuable. Most modifications for primary care clinics focused on duration rather than content. Future directions include expanding the interprofessional workshop content.
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Jang, Sekwon, Vishal Navnitray Ranpura, Lynne Wood, Heller Stephanie, and Linda Self. "Effect of intervention on a quality measure of pain management at Medstar Washington Cancer Institute (MWCI)." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e20700-e20700. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e20700.
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e20700 Background: MWCI has participated in Quality Oncology Practice Initiative (QOPI) since 2008. Adherence to pain assessment and intensity documentation was high, but lower in plan of care for moderate/severe pain documentation (69%, compared to QOPI aggregate of 79%) during the Fall 2011 round. One potential explanation for the discrepancy was lack of communication between the nursing staff assessing the pain and the physician treating pain. We hypothesized that the use of pain card can improve the communication between nurses and doctors, as well as prompt physicians to document the plan of care for moderate/severe pain. Methods: MWCI created a team of physicians, nurses, quality resources and administrative staff in December 2011. We abstracted up to 10 patients charts per oncologist for those patientswho reported moderate to severe pain (pain score of more than 3 of 10 on numeric rating scale) each quarter during 2012.We used data for quarter 1 and 2 as a baseline. We implemented the use of pain card by nurses to report pain for these patients to the physician in quarter 3 and 4. Chi square test was used to compare documentation rate in the first two quarters and last two quarters. Results: The total number of charts evaluated, pain documentation as well as confidence intervals for each quarter are shown in the Table. Our results show significant improvement in pain documentation by physician in last two quarters compared to first two quarters (p =0.0007). Conclusions: Our study demonstrates pain card improved communication between nurse and physician resulting improved documentation of pain by physician. [Table: see text]
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Ranpura, Vishal Navnitray, Lynne Wood, Stephanie Heller, Linda Self, and Sekwon Jang. "Effect of intervention on a quality measure of pain management at Medstar Washington Cancer Institute." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 144. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.144.
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144 Background: Medstar Washington Cancer Institute (MWCI) has participated in Quality Oncology Practice Initiative (QOPI) since 2008. Adherence to pain assessment and intensity documentation was high, but lower in plan of care for moderate/severe pain documentation (69%, compared to QOPI aggregate of 79%) during the fall 2011 round. One potential explanation for the discrepancy was lack of communication between the nursing staff assessing the pain and the physician treating pain. We hypothesized that the use of pain card can improve the communication between nurses and doctors, as well as prompt physicians to document the plan of care for moderate/severe pain. Methods: MWCI created a team of physicians, nurses, quality resources, and administrative staff in December 2011. We abstracted up to 10 patients charts per oncologist for those patientswho reported moderate to severe pain (pain score of more than 3 of 10 on numeric rating scale) each quarter during 2012.We used data for quarter 1 and 2 as a baseline. We implemented the use of pain card by nurses to report pain for these patients to the physician in quarter 3 and 4. Chi square test was used to compare documentation rate in the first two quarters and last two quarters. Results: The total number of charts evaluated, pain documentation as well as confidence intervals for each quarter are shown in the table. Our results show significant improvement in pain documentation by physician in last two quarters compared to first two quarters ( p = 0.0007). Conclusions: Our study demonstrates pain card improved communication between nurse and physician resulting improved documentation of pain by physician. [Table: see text]
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Ramchandran, Kavitha, Lidia Schapira, David Spiegel, Stephanie Harman, Joshua Fronk, Manuela Kogon, Kay Kostopoulos, Erika L. Tribett, and Jonathan S. Berek. "Challenging conversations in oncology: A workshop for fellows." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 60. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.60.
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60 Background: Compassionate communication is critical to patient-centered cancer care. Conversations about sensitive topics are necessary to help patients make well-informed decisions. Still, many oncologists feel ill-equipped during these conversations and thus avoid them or approach them with a purely clinical perspective. Fortunately, empathic communication skills can be learned. This project, Challenging Conversations in Oncology (CCO), involves the development of an experiential workshop to help build skill and confidence communicating with cancer patients. The workshop is part of a movement to reimagine cancer care at Stanford. Methods: The first iteration of CCO was multi-day event with didactic lectures, self-awareness exercises and small group role-play. The faculty was multi-disciplinary, including clinicians in various subspecialties, communications experts and patients themselves. Activities were designed to build skills in interviewing, cultural humility, adapting communications, and dealing with patient and provider emotions. A post-workshop evaluation survey assessed overall effectiveness as well as self-reported learning and perceived enhancement of patient care as a result of participation. Results: The CCO workshop was implemented in Fall 2013. Participants included 17 physicians from various oncology subspecialties. Participants reported that the workshop was very valuable (rating at least 4 on a 5-point scale of overall effectiveness). Common themes included learning to “slow down” and do “less talking, more listening,” taking time to “let patients express themselves…cry, be silent.” Faculty reported enthusiasm watching trainee communication skills “evolve along with…the patient’s story.” Conclusions: This workshop was a significant educational opportunity for junior faculty at Stanford. Feedback suggests the experience was rewarding and influential. It encouraged cultivation of communication skills that will likely benefit doctors and their patients. This fall (Year 2), we will extend this workshop to senior faculty, staff, and administration. The course will continue to evolve to meet the needs of providers and align with comprehensive institutional enhancements in cancer care.
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Brown, William E., Gregg Margolis, and Roger Levine. "Peer Evaluation of the Professional Behaviors of Emergency Medical Technicians." Prehospital and Disaster Medicine 20, no. 2 (April 2005): 107–14. http://dx.doi.org/10.1017/s1049023x00002284.
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AbstractIntroduction:Professional behavior is one of the cornerstones of effective emergency medical services (EMS) practice and is a required part of the National Standard Curricula for advanced levels of EMS education. However, peer rating of emergency medical technicians with respect to the 11 categories of professional behavior never has been quantified. This study uses a peer evaluation methodology to assess the affective competencies of practicing EMS providers.Methods:A professional behavior evaluation form was included as part of a survey that was sent to 2,443 randomly selected, nationally registered emergency medical technicians (EMTs). Participants were asked to rate the EMT partner with whom they worked most closely in the past year using 11 different categories of professional behavior using a Likert scale.Results:One thousand, five hundred, ten (61.8%) surveys were returned and analyzed. Both nationally registered EMTs at the Basic and Paramedic levels rated their partners with respect to 11 categories of professional behavior. The overall average score was 0.68 on a 0–1 scale, with one being the highest. The rating of each of the categories was: (1) integrity (0.77); (2) appearance/personal hygiene (0.74); (3) patient advocacy (0.73); (4) empathy (0.72); (5) self-confidence (0.70); (6) careful delivery of service (0.70); (7) respect (0.65); (8) communication skills (0.64); (9) time management skills (0.63); (10) teamwork/diplomacy skills (0.62); and (11) self-motivation (0.61). Overall, the NREMT-Paramedics rated their partners significantly lower than did the NREMT-Basics (p= 0.0156) and experienced EMT-Basics rated their partners significantly lower than did the newer EMT-Basics (p= 0.0002). Those EMTs who indicated high satisfaction with their current EMS assignment rated their partner more highly on professional behaviors than did those EMTs who were not as satisfied.Conclusion:Overall, EMTs peer evaluation of professional behavior was “good.” The behaviors most highly rated were integrity and appearance/personal hygiene. The behaviors rated lowest were self-motivation and team work/diplomacy. It appears that paramedics are more critical of their colleagues than are EMT-Basics, that experienced EMT-Basics are harsher critics than are newer EMT-Basics, and that there is a relationship between job satisfaction and peer evaluation.
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Miu, Michelle W., Andrew Martin, and Allan M. Cyna. "Postoperative pain and comfort scores: Do they correlate?" Anaesthesia and Intensive Care 47, no. 5 (August 9, 2019): 435–41. http://dx.doi.org/10.1177/0310057x19861985.
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Research on the nocebo effect has shown that some words can hurt. Pain is defined as ‘unpleasant’ and ‘associated with actual or potential tissue damage’. So, a sensation described as ‘pain’ may function as a negative suggestion or nocebo communication. This can lead to pain being experienced or exacerbated where it would not have been otherwise. The nocebo effect has also been implicated as adversely affecting the pain experience during the assessment of pain postoperatively. Words that avoid this potential nocebo effect such as ‘comfort’ may represent a more satisfactory alternative. We therefore aimed to determine whether ‘comfort’ and ‘pain’ scores correlate when assessing patients postoperatively at the same timepoint. Patients were questioned before routine post-anaesthesia rounds to rate their pain and comfort levels, with the sequence of questions randomised. Patients were asked to rate pain and comfort on a 0–10 verbal numerical rating scale, where 0 represents ‘no pain’ or ‘no comfort’ and 10 ‘worst pain’ or ‘most comfort’ imaginable, respectively. To provide a clinically relevant correlation of approximately 0.7 between pain and inverted comfort scores, a sample size of 100 would provide adequate precision (95% confidence interval (CI) 0.58–0.79). A P-value of <0.05 was considered significant. We recruited 100 patients. A positive correlation of 0.62 was found between pain and inverted comfort scores (95% CI 0.47–0.72; P<0.0001). The question sequence of asking about pain or comfort did not affect either score. Comfort and pain scores are moderately correlated. This finding represents a first step in validating comfort scores and suggests that they could be considered a suitable alternative to pain scores when assessing patients postoperatively. As comfort is not an exact antonym to pain, caution is required when using these measures interchangeably.
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White, Michelle C., Kirsten Randall, Vaonandianina A. Ravelojaona, Hery H. Andriamanjato, Vanessa Andean, James Callahan, Mark G. Shrime, Stephanie Russ, Andrew J. M. Leather, and Nick Sevdalis. "Sustainability of using the WHO surgical safety checklist: a mixed-methods longitudinal evaluation following a nationwide blended educational implementation strategy in Madagascar." BMJ Global Health 3, no. 6 (December 2018): e001104. http://dx.doi.org/10.1136/bmjgh-2018-001104.
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BackgroundThe WHO Surgical Safety Checklist reduces postoperative complications by up to 50% with the biggest gains in low-income and middle-income countries (LMICs). However in LMICs, checklist use is sporadic and widespread implementation has hitherto been unsuccessful. In 2015/2016, we partnered with the Madagascar Ministry of Health to undertake nationwide implementation of the checklist. We report a longitudinal evaluation of checklist use at 12–18 months postimplementation.MethodsHospitals were identified from the original cohort using purposive sampling. Using a concurrent triangulation mixed-methods design, the primary outcome was self-reported checklist use. Secondary outcomes included use of basic safety processes, assessment of team behaviour, predictors of checklist use, impact on individuals and organisational culture and identification of barriers. Data were collected during 1-day hospital visits using validated questionnaires, WHO Behaviourally Adjusted Rating Scale (WHOBARS) assessment tool and focus groups and analysed using descriptive statistics, multivariate linear regression and thematic analysis.Results175 individuals from 14 hospitals participated. 74% reported sustained checklist use after 15 months. Mean WHOBARS scores were high, indicating good team engagement. Sustained checklist use was associated with an improved overall understanding of patient safety but not with WHOBARS, hospital size or surgical volume. 87% reported improved understanding of patient safety and 83% increased job satisfaction. Thematic analysis identified improvements in hospital culture (teamwork and communication, preparation and organisation, trust and confidence) and hospital practice (pulse oximetry, timing of antibiotic prophylaxis, introduction of a surgical count). Lack of time in an emergency and obstructive leadership were the greatest implementation barriers.Conclusion74% of participants reported sustained checklist use 12–18 months following nationwide implementation in Madagascar, with associated improvements in job satisfaction, culture and compliance with safety procedures. Further work is required to examine this implementation model in other countries.
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Wallace, Sarah J., Linda Worrall, Tanya Rose, and Guylaine Le Dorze. "Core Outcomes in Aphasia Treatment Research: An e-Delphi Consensus Study of International Aphasia Researchers." American Journal of Speech-Language Pathology 25, no. 4S (December 2016). http://dx.doi.org/10.1044/2016_ajslp-15-0150.
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Purpose The purpose of this article is to identify outcome constructs that aphasia researchers consider essential to measure in all aphasia treatment research. Method Purposively sampled researchers were invited to participate in a 3-round e-Delphi exercise. In Round 1, an open-ended question was used to elicit important outcome constructs; responses were analyzed using inductive content analysis. In Rounds 2 and 3, participants rated the importance of each outcome using a 9-point rating scale. Outcomes reaching predefined consensus criteria were further analyzed using International Classification of Functioning, Disability and Health coding. Results Eighty researchers commenced Round 1, with 72 completing the entire survey. High response rates (≥ 85%) were achieved in subsequent rounds. Consensus was reached on 6 outcomes: (a) language functioning in modalities relevant to study aims, (b) impact of treatment from the perspective of the person with aphasia (PWA), (c) communication-related quality of life, (d) satisfaction with intervention from the perspective of the PWA, (e) satisfaction with ability to communicate from the perspective of the PWA, and (f) satisfaction with participation in activities from the perspective of the PWA. Conclusions Consensus was reached that it is essential to measure language function and specific patient-reported outcomes in all aphasia treatment research. These results will contribute to the development of a core outcome set.
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Schumacher, Rahel, Stefanie Bruehl, Ajay D. Halai, and Matthew A. Lambon Ralph. "The verbal, non-verbal and structural bases of functional communication abilities in aphasia." Brain Communications 2, no. 2 (2020). http://dx.doi.org/10.1093/braincomms/fcaa118.
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Abstract The ability to communicate, functionally, after stroke or other types of acquired brain injury is crucial for the person involved and the people around them. Accordingly, assessment of functional communication is increasingly used in large-scale randomized controlled trials as the primary outcome measure. Despite the importance of functional communication abilities to everyday life and their centrality to the measured efficacy of aphasia interventions, there is little knowledge about how commonly used measures of functional communication relate to each other, whether they capture and grade the full range of patients’ remaining communication skills and how these abilities relate to the patients’ verbal and non-verbal impairments as well as the underpinning lesions. Going beyond language-only factors is essential given that non-verbal abilities can play a crucial role in an individual’s ability to communicate effectively. This study, based on a large sample of patients covering the full range and types of post-stroke aphasia, addressed these important, open questions. The investigation combined data from three established measures of functional communication with a thorough assessment of verbal and non-verbal cognition as well as structural neuroimaging. The key findings included: (i) due to floor or ceiling effects, the full range of patients’ functional communication abilities was not captured by a single assessment alone, limiting the utility of adopting individual tests as outcome measures in randomized controlled trials; (ii) phonological abilities were most strongly related to all measures of functional communication and (iii) non-verbal cognition was particularly crucial when language production was relatively impaired and other modes of communication were allowed, when patients rated their own communication abilities, and when carers rated patients’ basic communication abilities. Finally, in addition to lesion load being significantly related to all measures of functional communication, lesion analyses showed partially overlapping clusters in language regions for the functional communication tests. Moreover, mirroring the findings from the regression analyses, additional regions previously associated with non-verbal cognition emerged for the Scenario Test and for the Patient Communication Outcome after Stroke rating scale. In conclusion, our findings elucidated the cognitive and neural bases of functional communication abilities, which may inform future clinical practice regarding assessments and therapy. In particular, it is necessary to use more than one measure to capture the full range and multifaceted nature of patients’ functional communication abilities and a therapeutic focus on non-verbal cognition might have positive effects on this important aspect of activity and participation.
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Ballengee, Lindsay A., J. Kyle Covington, and Steven Z. George. "Introduction of a psychologically informed educational intervention for pre-licensure physical therapists in a classroom setting." BMC Medical Education 20, no. 1 (October 23, 2020). http://dx.doi.org/10.1186/s12909-020-02272-5.
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Abstract Background There is an increasing need for physical therapists to address psychosocial aspects of musculoskeletal pain. Psychologically informed practice is one way to deliver this type of care through the integration of biopsychosocial interventions into patient management. An important component of psychologically informed practice is patient centered communication. However, there is little research on how to effectively implement patient centered communication into pre-licensure training for physical therapists. Methods Thirty Doctor of Physical Therapy (DPT) students took part in an educational intervention that consisted of one 4-h didactic teaching session and three 1-h experiential learning sessions. Prior to the first session, students performed an examination of a standardized patient with chronic low back pain and were assessed on psychologically informed physical therapy (PIPT) adherent behaviors via a rating scale. Students also completed the Pain Attitudes and Beliefs Scale (PABS-PT). After the last experiential session, students evaluated another standardized patient and were reassessed on PIPT adherent behaviors. Students retook the PABS-PT and qualitative data was also collected. Results After the educational intervention, students had positive changes in their pain attitudes and belief scores indicating a stronger orientation toward a psychosocial approach to patient care (p < 0.05). Additionally, after the intervention, students showed improvements in their adherence to using PIPT behaviors in their simulated patient interactions (p < 0.05). Qualitatively, students reported a high acceptability of the educational intervention with common themes indicating improved confidence with treating and communicating with complex patients. Conclusion Students had attitudes and beliefs shift towards a more psychosocial orientation and demonstrated improved PIPT behaviors in simulated patient interactions after a brief educational intervention. Future research should investigate best practices for implementation of psychologically informed physical therapy for licensed clinicians.
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Moshina, Nataliia, Anders Skyrud Danielsen, Åsne Sørlien Hølen, Berit Hanestad, Elisabeth Stephansen, Ina Heggernes Pedersen, and Solveig Hofvind. "Self-reported Pain Associated With Screening With Digital Breast Tomosynthesis." Journal of Breast Imaging, December 21, 2020. http://dx.doi.org/10.1093/jbi/wbaa096.
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Abstract Objective We aimed to investigate self-reported pain during screening with digital breast tomosynthesis (DBT). Methods The study was approved by the Regional Committee for Medical and Health Research Ethics in the South East of Norway (2015/424). Women completed a questionnaire about experienced pain directly after the examination, August–November 2019. A numeric rating scale (NRS, 0–10) was used. Data on compression force (N), pressure (kPa), and compressed breast thickness (mm) were obtained from the Digital Imaging and Communication in Medicine header and density assessment software. Stepwise ordinary least-squares regression was used to estimate mean self-reported pain score with 95% confidence interval (CI) for values of compression force, pressure, and compressed breast thickness. Results The mean pain score was 1.9, whereof 19.3% (822/4266) of the women reported moderate or severe pain. The mean pain score of 2.6 (95% CI: 2.4–2.7) was observed at a compression force of 60 N, decreasing to 1.3 (95% CI: 1.2–1.4) at 130 N. The mean pain score of 1.3 (95% CI: 1.1–1.4) was at a compression pressure of 6 kPa, increasing to 2.9 (95% CI: 2.7–3.1) at 16 kPa. The mean pain score was 0.6 (95% CI: 0.4–0.6) at a compressed breast thickness of 20 mm, increasing to 2.9 (95% CI: 2.7–3.1) at 90 mm. Conclusion The mean pain score was low, 1.9 on NRS, for women screened with DBT. A compression force of 60–130 N and a pressure 6–16 kPa were associated with no or mild pain.
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Guttormsen, Linn Stokke, J. Scott Yaruss, and Kari-Anne Bottegård Næss. "Parents' Perceptions of the Overall Impact of Stuttering on Young Children." American Journal of Speech-Language Pathology, August 25, 2021, 1–13. http://dx.doi.org/10.1044/2021_ajslp-20-00113.
Full textAbstract:
Introduction Research has revealed the presence of emotional, behavioral, and cognitive reactions in young children who stutter; however, prior studies have not examined the overall impact of stuttering on young children's lives. Such information is necessary for improving understanding of how stuttering affects young children and for ensuring appropriate early intervention. Method This study employed an adaptation of the Overall Assessment of the Speaker's Experience of Stuttering for School-Age Children that was designed to ask parents about their perceptions of the impact of stuttering on their young children. Thirty-eight parents of young children who stutter (2–5 years of age) provided their perceptions of the impact of stuttering on their children. Parents rated how certain they were in their judgments using a 5-point scale to provide an indication of their confidence in proxy ratings of impact. Results Results indicated that, on average, parents perceived that stuttering affected their children negatively. Qualitatively, parents provided descriptions of the impact of stuttering on their children's quality of life, communication difficulties across people and situations, and reactions to stuttering; they also commented on their own feelings and strategies for handling impact. On average, parents perceived themselves to be certain in rating the impact of stuttering on their children. Conclusions Results indicated that parents identified adverse impact in their children's lives. Even though parents considered themselves to be certain in their impact ratings, clinicians and researchers should also assess the perspective of the children if appropriate. This is because present findings reveal that parents may not have insight into all aspects of impact, in particular, cognitive reactions to stuttering. Still, parents' perceptions of impact are important for clinicians to consider when giving recommendations for therapy, as they can provide important insight into the family's needs.