Development of an internet version of the Lidcombe Program of early stuttering intervention: A trial of Part 1

Purpose: There is evidence that access to treatment for early stuttering is not available for all who need it. An internet version of the Lidcombe Program for early stuttering (Internet-LP) has been developed to deal with this shortfall. The LP is suitable for such development because it is delivered by parents in the child’s everyday environment, with training by a speech-language pathologist. A Phase I trial of Internet-LP Part 1, comprising parent training, is reported here.

Method: Eight parents of pre-schoolers who stutter were recruited and six completed the trial.

Result: Post-trial assessment indicated that the parents scored well for identifying and measuring stuttering and for knowledge about conducting practice sessions, including how to present verbal contingencies during practice sessions.

Conclusion: The results prompted minor adjustments to Part 1 and guided the construction of Part 2, which instructs parents during the remainder of the treatment process.     

Case file audit of Lidcombe program outcomes in a student-led stuttering clinic

Purpose: The current study aimed to benchmark clinical outcomes for preschool-aged clients (2;0–5;11 years old) that attended a student-led clinic and undertook the Lidcombe Program.

Method: A case file audit was undertaken for all preschool clients who attended the clinic between February 2008 and February 2013 and commenced the Lidcombe Program. Clients were grouped according to Stage 1 completion. A mixed ANOVA was used to test for differences between the groups in initial and final percentage syllables stuttered (%SS). Associations between case variable factors and treatment duration were investigated using Pearson correlations.

Result: Clients who completed Stage 1 had final %SS and severity rating (SR) scores comparable to the literature; however, the median Stage 1 duration was greater. Over half of the clients (57%) withdrew prior to completing Stage 1. These clients had a significantly higher %SS at final treatment session than their completing peers. Initial %SS and SR scores were the only case variables associated with treatment duration.

Conclusion: Students can achieve the same short-term treatment outcomes for children who stutter using the Lidcombe Program as the current published literature; however, treatment duration is greater and may impact completion. Implications of this for clinical education are discussed.     

Investigating optimal intervention intensity with the Lidcombe Program of early stuttering intervention

Abstract

This paper addresses optimal intervention intensity in stuttering with reference to the Lidcombe Program of early stuttering intervention. This is an operant program in which the parent provides the actual treatment, for proscribed periods each day, in the child's everyday environment. The parent learns how to do this during weekly visits with the child to the speech-language pathologist. This program was chosen because it is supported by considerable research evidence. This evidence includes randomized controlled trials and file audits. Individual children vary in the time taken to reach the program criteria, with children with milder stuttering taking less time than children whose stuttering is more severe. Hence, the dose depends largely on stuttering severity. Other service delivery models for the Lidcombe Program have been investigated, including telehealth (distance delivery) and group delivery. While telehealth delivery was as efficacious as face-to-face delivery, 3-times more clinician hours were needed to achieve this. Group delivery of the program was also as efficacious as face-to-face delivery but required 30% less clinician time. The fact that treatment is delivered by parents but is directed by the speech-language pathologist raises interesting issues about what constitutes dose.     

Investigating optimal intervention intensity with the Lidcombe Program of early stuttering intervention

Abstract This paper addresses optimal intervention intensity in stuttering with reference to the Lidcombe Program of early stuttering intervention. This is an operant program in which the parent provides the actual treatment, for proscribed periods each day, in the child's everyday environment. The parent learns how to do this during weekly visits with the child to the speech-language pathologist. This program was chosen because it is supported by considerable research evidence. This evidence includes randomized controlled trials and file audits. Individual children vary in the time taken to reach the program criteria, with children with milder stuttering taking less time than children whose stuttering is more severe. Hence, the dose depends largely on stuttering severity. Other service delivery models for the Lidcombe Program have been investigated, including telehealth (distance delivery) and group delivery. While telehealth delivery was as efficacious as face-to-face delivery, 3-times more clinician hours were needed to achieve this. Group delivery of the program was also as efficacious as face-to-face delivery but required 30% less clinician time. The fact that treatment is delivered by parents but is directed by the speech-language pathologist raises interesting issues about what constitutes dose.     

A survey of Australian adult users of altered auditory feedback devices for stuttering: Use patterns,perceived effectiveness and satisfaction

Purpose. Small portable devices that provide delayed auditory feedback (DAF) and/or frequency altered feedback (FAF) have been developed and marketed to clinicians and people who stutter as fluency enhancing aids for use in everyday speaking situations. The literature contains many laboratory-based reports about the impact of altered auditory feedback (AAF) on the speech of people who stutter but few reports about its use in everyday speaking situations. This paper investigates use patterns and perceptions of the effectiveness and satisfaction with AAF devices.

Methods. The current study surveys 14 Australian AAF users.

Results. The survey responses revealed varied opinions about AAF devices and their use and effectiveness in everyday speaking situations. Opinions were somewhat related to the type of device used.

Conclusions. The results of this study provide some important directions for future research. In particular there is need to investigate the effectiveness of AAF devices when used in conjunction with other traditional treatments.     

A survey of Australian adult users of altered auditory feedback devices for stuttering: use patterns, perceived effectiveness and satisfaction

Purpose. Small portable devices that provide delayed auditory feedback (DAF) and/or frequency altered feedback (FAF) have been developed and marketed to clinicians and people who stutter as fluency enhancing aids for use in everyday speaking situations. The literature contains many laboratory-based reports about the impact of altered auditory feedback (AAF) on the speech of people who stutter but few reports about its use in everyday speaking situations. This paper investigates use patterns and perceptions of the effectiveness and satisfaction with AAF devices.

Methods. The current study surveys 14 Australian AAF users.

Results. The survey responses revealed varied opinions about AAF devices and their use and effectiveness in everyday speaking situations. Opinions were somewhat related to the type of device used.

Conclusions. The results of this study provide some important directions for future research. In particular there is need to investigate the effectiveness of AAF devices when used in conjunction with other traditional treatments.     

Identification of cluttering and stuttering by the public in four countries

The investigators sought to explore and compare the identification of cluttering vs stuttering in four different country samples. After reading lay definitions of the two fluency disorders in their own language, convenience samples of 60–90 adult respondents from Turkey, Bulgaria, Russia, and the US identified 51–119 children or adults who either cluttered, stuttered, or both. They also indicated whether or not they, themselves, cluttered or stuttered. The majority of respondents in all four samples identified at least one person who cluttered, stuttered, or cluttered and stuttered. The average respondent identified one person with a fluency disorder, most likely a stutterer, less likely a clutterer, and least likely a clutterer-stutterer. Both similarities and differences characterized those identified in the three groups, e.g., the sex ratios were not the same. As with stuttering, the public apparently is aware of cluttering individuals and can identify such persons.     

Prevalence of stuttering in primary school children in Cairo-Egypt

Abstract

Purpose: To determine the prevalence of stuttering among primary school children in Cairo.

Method: A cross-sectional design was employed. Using a multi-stage random sample from 10 schools in Cairo, a total of 8765 primary school students were enrolled in the study. The teacher referring method was initially used to detect stuttering students, which was then confirmed by a Speech Language Pathologist (SLP) using Diagnostic and Statistical Manual for Mental Disorders–Fourth Edition (DSM-IV) criteria. Personal data were collected for all students and separate questionnaires were administered to the parents of each stuttering child, inquiring about consanguinity, family history, presence of other disorders and family attitudes towards the child.

Result: Prevalence of stuttering among primary school children in Cairo was 1.03%. The prevalence of stuttering showed a declining trend in the older age group. Stuttering was 7-fold more prevalent among left-handed students. Males had a higher prevalence of stuttering, but didn't reach statistical significance. Anxiety was expressed in 25% of the families of affected children. Positive family history was found in 28% of cases, mainly among first-degree relatives.

Conclusion: The current study showed a prevalence of stuttering comparable to other areas of the world with some evidence of hereditary background, although lower than that reported by other studies.     

Getting out of Procrustes' bed: The needs and benefits of qualitative research in stuttering

Qualitative research has a vast potential for understanding complex issues such as stuttering, and is becoming more common in that research field. The purpose of this article is to highlight the potential benefits of qualitative research in stuttering through exploration of four different research paradigms and their knowledge claims. Through this explanation, a case is built for the benefits of applying qualitative methods to stuttering research. Questions such as “how” a certain behavior or process take places, rather than just “if” a certain behavior or process takes place, are possible within the qualitative paradigm. It is concluded that future knowledge about stuttering and its treatment will be well served by applying the most appropriate investigative methods to it rather than by attempting to establish information with a restricted set of quantitative approaches.     

全髋置换术后早期系统康复的疗效观察

目的：观察全髋置换术后早期系统康复治疗对下肢功能的影响.方法：全髋关节置换术患者50例,随机分为2组各25例,对照组术后由骨科医护人员给予指导,观察组由康复专业人员进行系统康复干预.分别于术前、干预2周后采用Harris髋关节等级评分、术后下地天数、术后行走天数及患髋屈曲活动度进行评估.结果：术后2周,2组患者Harris评分及髋关节屈曲活动度均较治疗前显著提高（P＜0.05）,且观察组更高于对照组（P＜0.05）.术后2周,观察组术后开始下地时间及行走时间均明显早于对照组（均P＜0.05）.结论：全髋置换术后早期系统康复可以促进下肢功能的恢复.     

Evaluation of a community mental health carepath for early psychosis

PURPOSE: To implement a carepath for early psychosis across all community mental health centres through the Early Psychosis Intervention Programme in the Fraser South Area of British Columbia, Canada. METHODS: Prior to developing the carepath, chart reviews and interviews were performed to assess for adherence to published guidelines for early psychosis intervention. This assessment revealed the inadequacies of narrative recording and that core psychosocial interventions were inconsistently provided. The carepath developed included prompts for interventions and standardized assessments and ultimately replaced the charting system used in the mental health centres for early psychosis clients. RESULTS AND CONCLUSIONS: One-year evaluation revealed some improvements in clinical practice but also identified other areas that require further improvement. This project demonstrated that it is possible to successfully implement a carepath in community mental health and that doing so provides a standardized method for ongoing improvements in care.     

Validation of the 25-Item Stanford Faculty Development Program Tool on Clinical Teaching Effectiveness

Construct: The 25-item Stanford Faculty Development Program Tool on Clinical Teaching Effectiveness assesses clinical teaching effectiveness. Background: Valid and reliable rating of teaching effectiveness is helpful for providing faculty with feedback. The 25-item Stanford Faculty Development Program Tool on Clinical Teaching Effectiveness was intended to evaluate seven dimensions of clinical teaching. Confirmation of the structure of this tool has not been previously performed. Approach: This study sought to validate this tool using a confirmatory factor analysis, testing a 7-factor model and compared its goodness of fit with a modified model. Acceptability of the use of the tool was assessed using a 6-item survey, completed by final year medical students (N = 119 of 156 students; 76%). Results: The testing of the goodness of fit indicated that the 7-factor model performed poorly, χ²(254) = 457.4, p < .001 (root mean square error of approximation [RMSEA] = 0.08, comparative fit index [CFI] = 0.91, non-normed fit index [NNFI] = 0.89). Only standardized root mean square residual (SRMR) indicated acceptable fit (0.06). Further exploratory analysis identified 10 items that cross-loaded on 2 factors. The remainder of the items loaded on factors as originally intended. By removing these 10 items, repeat confirmatory factor analysis on the modified 15-item, 5-factor model demonstrated a better fit than the original model: SRMR = 0.075, NNFI = 0.91, χ²(80) = 150.1, p < .001; RMSEA = 0.09; CFI = 0.93. Although 75% of the participants stated they were willing to fill the tool on their preceptors on a biweekly basis, only 25% were willing to do so on a weekly basis. Conclusions: Our study failed to confirm factor structure of the 25-item tool. A modified tool with fewer, more conceptually distinct items was best fit by a 5-factor model. Further, the acceptability of use for the 25-item tool may be poor for rotations with a new preceptor weekly. The abbreviated tool may be preferable in that setting.     

Faculty Development: How to Evaluate the Effectiveness of a Faculty Development Program in Emergency Medicine

Evaluation of the effectiveness of any faculty development program (FDP) is crucial to provide assessment of existing programs and to yield valid recommendations for designing future programs that better address the needs of individual faculty members and the sponsoring institutions. The author chose the validated Kirkpatrick's model with four levels of program outcomes (satisfaction data, learning data, performing data, and career change) to evaluate the effectiveness of an FDP in emergency medicine. Assessment of the effectiveness of this FDP can be performed by sponsoring organizations or by independent evaluators experienced in the field for better objectivity.     

Effectiveness of nurse-led clinics in the early discharge period after percutaneous coronary intervention: A systematic review

BackgroundReadmission after percutaneous coronary intervention is common in the early postdischarge period, often linked to limited opportunity for education and preparation for self-care. Attending a nurse-led clinic within 30 d after discharge has the potential to enhance health outcomes.ObjectiveThe aim of the study was to synthesise the available literature on the effectiveness of nurse-led clinics, during early discharge (up to 30 d), for patients who have undergone percutaneous coronary intervention.Review method usedA systematic review of randomised and quasi-randomised controlled trials was undertaken.Data sourcesThe databases included PubMed, OVID, CINAHL, EMBASE, the Cochrane Library, SCOPUS, and ProQuest.Review methodsDatabases were searched up to November 2018. Two independent reviewers assessed studies using the Cochrane risk-of-bias tool.ResultsOf 2970 articles screened, only four studies, representing 244 participants, met the review inclusion criteria. Three of these studies had low to moderate risk of bias, with the other study unclear. Interventions comprised physical assessments and individualised education. Reported outcomes included quality of life, medication adherence, cardiac rehabilitation attendance, and psychological symptoms. Statistical pooling was not feasible owing to heterogeneity across interventions, outcome measures, and study reporting. Small improvements in quality of life and some self-management behaviours were reported, but these changes were not sustained over time.ConclusionsThis review has identified an important gap in the research examining the effectiveness of early postdischarge nurse-led support after percutaneous coronary intervention on outcomes for patients and health services. More robust research with sufficiently powered sample sizes and clearly defined interventions, comparison groups, and outcomes is recommended to determine effectiveness of nurse-led clinics in the early discharge period.     

Moving beyond policy rhetoric: building a moral community for early psychosis intervention

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An introduction to the knowledge-to-action strategic framework for disseminating evidence-based practice in autism spectrum disorder early intervention centers and its relevance to the National Disability Insurance Scheme

ABSTRACT

A knowledge-to-practice gap has been widely documented in autism spectrum disorder (ASD) early intervention, including nonuse of effective practices and use of ineffective and/or non-evidence-based practices (non-EBPs). We argue that it is critical to bridge this gap to ensure the best possible outcomes for children with ASD. In this paper, we draw from the implementation science field to describe a strategic framework for disseminating information, improving practice, and maintaining EBPs in ASD early intervention centers that encompasses the entire cycle of the knowledge-to-action (KTA) paradigm with stakeholder collaboration as a key element. We outline the potential for application of the KTA framework and for planning and implementing a strategy for professional development in ASD early intervention centers in an Australian context with reference to the National Disability Insurance Scheme (NDIS). We provide a model for future research in ASD to facilitate the translation of research to practice in a more timely and efficient manner, in order to improve practice and outcomes for children with ASD and their families.     

Effectiveness of adherence therapy in patients with early psychosis: A mirror image study

In patients with early psychosis, medication non‐adherence is associated with more frequent relapse. Observational studies have reported that up to 60% of patients fail to take medication as prescribed. This study aimed to establish the effectiveness of adherence therapy (AT) training for two multidisciplinary early intervention in psychosis (EIIP) teams in preventing relapse in their patients. This intervention involved six 1‐day team AT training sessions delivered monthly over a 6‐month period. Participants were patients with early psychosis who were on the caseload of the EIIP teams during the study period. A mirror‐image design was used, comparing clinician ratings of relapse in the year preceding training (year 0) and the subsequent year (year 1). Results showed that in year 0, the mean number of relapses was 0.96 (standard deviation (SD) = 1.10). During year 1, relapses reduced significantly (P < 0.01) to 0.34 (SD = 0.64). No unexpected effects of training were reported. A thematic analysis of staff views of training, and service users' views of their care received from EIIP teams, was also completed. Challenges in faithfully incorporating AT skills into practice were reported. In conclusion, AT training coincided with reductions in relapse rates in patients receiving services from an EIIP team, but no other changes in outcomes were detected.     

社区成年危重发热患者的早期预警技术研究

目的:建立社区成年发热患者病情严重度评分标准(adult fever state score,AFSS),形成社区成年危重发热患者的早期预警技术.方法:回顾性收集357例急性发热患者临床资料,通过Logistic回归筛选发热患者病情严重度的独立危险因素,并赋予各指标反映病情严重度的权重分值,据此建立AFSS.应用ROC曲线评价其诊断准确性,Kappa检验评估诊断可靠性,病情轻重的临界值为cutoff值.AFSS与住院率、住院病死率的相关性分析采用γ2检验,与住院时间相关性采用Kruskal-Wallis 检验.结果:筛选出年龄、发热病程、既往体健与否、体温、呼吸频率、心率、平均动脉压、白细胞计数为反映发热患者病情轻重的独立危险因素,每个指标根据其权重分别赋予0～3分,建立AFSS.AFSS的ROC曲线下面积为0.964,cutoff值为7分,Kappa值为0.801.随着AFSS评分的增加,患者病情加重,住院率、住院病死率及住院时间随之增加(P＜0.05),AFSS对预后的预测效能明显高于早期预警评分.结论:AFSS具有很高的诊断准确性和可靠性,利于急诊医师早期识别社区发热危重患者.