Language Intervention for Late Talkers: The Experiences of Speech-Language Pathologists in Malaysia (Intervensi Bahasa untuk Kanak-kanak Lambat Bercakap: Pengalaman Terapis Pertuturan-Bahasa di Malaysia) / Jurnal Sains Kesihatan Malaysia

@#A few studies have investigated the practise patterns of Malaysian speech-language pathologists (SLPs) when working with children with speech and language problems whose language intervention is necessary. However, these studies did not provide in-depth information about the SLPs' experiences as the studies were conducted quantitatively. Moreover, none of the studies focus on late-talkers (LTs), in which intervention for them can vary along a continuum from a wait/ watch-and-see approach to direct intervention. Thus, this study aimed to explore SLPs’ experiences in managing LTs in Malaysia. Twelve SLPs participated in individual, semi-structured phone interviews. They were asked about their experiences in managing LTs. The interviews were recorded, transcribed, and a content analysis was performed. Two themes were identified; a) practises of SLPs and b) challenges faced by SLPs in managing LT cases. The practises of SLPs included conducting assessments, developing intervention plans, providing intervention, sharing information, giving homework, providing support, and managing appointments. The challenges faced were related to parents, other individuals close to LTs, LTs themselves, and resources. Although the SLPs’ practises aligned with the international standard of speech-language pathology service delivery, there is room for improvement, especially in collaborating with parents, as one-to-one direct interventions for LTs might not be suitable due to the challenges related to resources. In addition, a few suggestions related to centred-based care and trusted social media pages can be provided to parents to assist them outside therapy sessions besides initiating the development of awareness programs and information resources for parents and other caregivers.

Malay-Translated Version and Content Validation of Parent Goals for Shared Reading Questionnaire (Versi Terjemahan Bahasa Melayu dan Pengesahan Kandungan bagi Parent Goals for Shared Reading Questionnaire) / Jurnal Sains Kesihatan Malaysia

@#The interaction between adults and children during shared reading contributes to the conversation and reading in hand and makes the activity interactive. It is, therefore, imperative to understand parents’ goals for shared reading with their children as it will influence their behaviour and, in turn, affect their children’s development of language and literacy skills. In Malaysia, no local psychometric instrument identifying parent goals for shared reading is available. This study aims to translate the English version of the Parent Goals for Shared Reading Questionnaire (PGSRQ) into Malay and validate the translated questionnaire. Four qualified translators carried out the translation processes, and a panel of eight experts subsequently validated the Malay-translated version of PGSRQ. Of 33 items, the validation assessment revealed that 17 items had a content validity ratio (CVR) value of 1.0, while 12 items had a CVR value of 0.8. Only four items had a CVR value lower than 0.78 and were retranslated and modified. The findings of this study can pave the way for more research efforts in the field of shared reading in Malaysia. The questionnaire can also assist a speech therapist in assessing the goals that parents have on shared reading to come up with better designs for shared book reading intervention.

Investimentos do Sistema Único de Saúde do Brasil em vocologia no período de 2008 a 2022 / Investments of the Brazilian Unified Health System in vocology in the period from 2008 to 2022

RESUMO Objetivo Analisar os investimentos do Sistema Único de Saúde do Brasil destinados à vocologia. Métodos Estudo ecológico, de caráter quantitativo com dados públicos, secundários, disponibilizados na plataforma digital DataSUS/TABNet. Os dados referem-se à quantidade e aos valores dos procedimentos da vocologia, apresentados e aprovados durante o período de 2008 a 2022 no Brasil. Após a coleta e análise descritiva dos dados, foram adotados os valores absolutos, relativos, taxas de crescimento e déficit. Resultados No período analisado foram realizados 4.6 milhões de procedimentos realizados a um custo total de R$18.350 milhões. Destes, 2.4 milhões de procedimentos foram aprovados a receberem o pagamento pelas secretarias de saúde dos estados e municípios a um custo total de R$ 10.617 milhões aos cofres públicos. Estes valores repassados representaram uma taxa de crescimento nos investimentos destinados aos procedimentos da vocologia em até 491%, se comparado ao ano de 2008, porém acumulou-se uma taxa de déficit financeiro de até 360% em todo o período estudado. Conclusão Constatou-se que os investimentos públicos destinados à vocologia passaram por crescimento significativo em todos os índices analisados, apesar de não terem sido repassados a totalidade dos valores referentes aos procedimentos realizados.

ABSTRACT Purpose To analyze the investments of the Unified Health System in Brazil destined to vocology. Methods Ecological, quantitative study with public, secondary data, available on the DataSUS/TABNet digital platform. The data refer to the quantity and values of the vocology procedures, presented and approved during the period from 2008 to 2021 in Brazil. After data collection and descriptive analysis, absolute and relative values, growth rates and deficit were adopted. Results In the analyzed period, 4,6 million procedures were carried out at a total cost of R$18,350 million. Of these, 2,4 million procedures were approved to be paid by state and municipal health departments at a total cost of R$10,617 million to public coffers. These transferred values represented a growth rate in investments destined to vocology procedures of up to 491%, if compared to 2008, however, a financial deficit rate of up to 360% was accumulated throughout the studied period. Conclusion It was verified that the public investments destined to vocology had a significant growth in all the indices analyzed, despite not having been passed on the totality of the values referring to the procedures carried out.

Validação de conteúdo de protocolo de decanulação de pacientes adultos traqueostomizados / Content validation of the decannulation protocol for adult tracheostomized patients

RESUMO Objetivo Realizar a validação de conteúdo de um protocolo de decanulação de pacientes adultos traqueostomizados. Método Para a validação de conteúdo do protocolo elaborado por fonoaudiólogas foi utilizada a técnica Delphi. Os 11 itens do protocolo foram julgados por peritos, por meio de rodadas via e-mail e foram classificados como adequados, parcialmente adequados ou inadequados, além de fornecerem comentários e sugestões sobre cada item. Foram convidados 30 fonoaudiólogos, 30 fisioterapeutas respiratórios e 30 médicos responsáveis pelo procedimento de traqueostomia e decanulação. O percentual de concordância adotado foi ≥ 80% e o processo foi interrompido quando obtido esse percentual em todos os itens. Resultados Ao final do processo, 24 profissionais participaram da terceira rodada, sendo 46% fonoaudiólogos, 29% fisioterapeutas e 25% médicos. Após as sugestões e comentários dos peritos, dois itens foram mantidos como estavam no protocolo inicial, sete foram reformulados, seis incluídos e dois excluídos. A versão final do protocolo incluiu: identificação, ausência de secreções abundantes, características da secreção, tosse eficaz, capacidade para remover secreções, tolera o balonete desinsuflado, aptidão no processo de decanulação, nível de consciência, troca de cânula para menor calibre, ausência de infecção vigente/ ativa, deglutição espontânea e eficaz de saliva, uso de válvula de fala, aptidão à oclusão da cânula, avaliação da aptidão para decanulação e exames objetivos. Conclusão Por meio da Técnica Delphi houve a validação do conteúdo do instrumento, ocorrendo mudanças substanciais. A próxima etapa de validação do instrumento é a obtenção de evidências de validade em relação a estrutura interna.

ABSTRACT Purpose Perform content validation of a decannulation protocol for tracheostomized adult patients. Methods To validate the content of the protocol developed by speech therapists, the Delphi technique was used. The 11 items of the protocol were judged by experts through rounds via e-mail and were classified as adequate, partially adequate or inadequate, in addition to providing comments and suggestions on each item. 30 speech therapists, 30 respiratory physiotherapists and 30 physicians responsible for the tracheostomy and decannulation procedure were invited. The percentage of agreement adopted was ≥ 80% and the process was interrupted when this percentage was obtained in all items. Results At the end of the process, 24 professionals participated in the third round, being 46% speech therapists, 29% physiotherapists and 25% physicians. After the experts' suggestions and comments, two items were kept as they were in the initial protocol, seven were reformulated, six were included and two were excluded. The final version of the protocol included: identification, absence of abundant secretions, characteristics of the secretion, effective cough, ability to remove secretions, tolerate the deflated cuff, aptitude in the decannulation process, level of consciousness, change of cannula to a smaller caliber, absence of current/active infection, spontaneous and effective swallowing of saliva, use of a speech valve, aptitude for occlusion of the cannula, assessment of aptitude for decannulation and objective examinations. Conclusion Through the Delphi Technique, the content of the instrument was validated, with substantial changes occurring. The next stage of instrument validation is obtaining evidence of validity in relation to the internal structure.

Ausculta cervical en el paciente pediátrico con parálisis cerebral Revision narrativa / Cervical auscultation in pediatric patient with cerebral palsy Narrative review

Dentro de la atención clínica, el profesional de la fonoaudiología cuenta con recursos evaluativos para describir la biomecánica secuencial de la ingesta; uno de los recursos utilizados es la Auscultación Cervical (AC). (Dudik et al., 2016) Teniendo en cuenta la descripción de la importancia de la intervención oportuna y efectiva de los procesos de alimentación en los niños con parálisis cerebral, se considera necesario resolver aspectos relevantes alrededor de la relación de las características clínicas de estos niños en su proceso de deglución y los registros del perfil espectrográfico en su fase faríngea de la deglución a partir de la aplicación de la AC. La organización de la revisión establece la búsqueda de artículos científicos en la utilización de la AC en la evaluación clínica de la deglución en sujetos pediátricos y diagnosticados con Parálisis Cerebral. La información encontrada muestra cómo en ausencia de procesos instrumentales de evaluación deglutoria, la AC aporta como beneficio la accesibilidad del procedimiento, además de características de temporalidad en la secuencia de los sonidos deglutorio, sin ningún tipo de factor adverso para su realización. Es por ello que la auscultación es un recurso importante en la evaluación clínica y se puede establecer como un primer paso en el análisis de los aspectos fisiológicos de la fase faríngea de la deglución, pone a la auscultación en una posición privilegiada, pero que debe ser estandarizada por los estudiosos y teóricos del tema.

In the clinical care, the speech language pathologist has evaluative resources to describe the biomechanics of swallowing; one of the resources used is Cervical Auscultation (CA). (Dudik et al., 2016) Taking into account the description of the importance of the timely and effective intervention of the swallowing processes in children with cerebral palsy, it is considered necessary to solve relevant aspects around the relationship of the clinical characteristics of these children in their swallowing process and the records of the spectrographic profile in their pharyngeal phase of swallowing from the application of CA. In the absence of instrumental swallowing evaluation processes, CA provides the accessibility of the procedure as a benefit, in addition to temporality characteristics in the sequence of swallowing sounds, without any type of adverse factor for its performance. The CA is an important resource in clinical evaluation, it establishes a first step in the physiological analysis of swallowing with the physiological aspects of the pharyngeal phase. This puts auscultation in a privileged position, but it must be standardized by cientifics and theorists on the subject.

Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: an epidemiological study

Abstract Background Malocclusions are highly prevalent in childhood and adolescence, being considered a public health problem worldwide, in addition to be considered an important predictor in the tongue position and speech disorders. Objective Evaluate the association of malocclusions with tongue position and speech distortion in mixed-dentition schoolchildren from the south of Brazil. Methodology This cross-sectional study was performed using a database of an epidemiological survey realized in the southern of Brazil, in 2015, for evaluating the dental and myofunctional condition of the mixed-dentition from 7-13 years' schoolchildren. The outcome variables were tongue position and speech distortion, evaluated by a trained and calibrated examiner. Characteristics regarding sociodemographic and oral health measures (Angle's classification of the malocclusion, overjet, overbite, posterior crossbite and respiratory mode) were also assessed. Poisson regression models with adjusted robust variance were used to evaluate the association among predictors variables in the outcomes. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI). Results A total of 547 children were evaluated. Schoolchildren who presented anterior open bite (PR 2.36 95%CI 1.59-3.49) and having oral/oral-nasal breathing (RP 2.51 95%CI 1.70-3.71) are more likely to have altered position of the tongue. Both deep bite and being male represent protection factors for the abnormal tongue position. Regarding speech distortion, deep overbite presents a protective relationship to speech distortion (PR 0.41; 95%CI 0.24-0.71), whereas schoolchildren with posterior crossbite were more likely to present this problem (PR 1.77; 95%CI 1.09-2.88). Conclusion Anterior open bite and posterior crossbite were the malocclusions related to speech distortion and/or altered tongue position. Oral/oral-nasal breathing was also related to myofunctional changes. Deep bite malocclusion was a protective factor for both speech problems and altered tongue position when compared to a normal overbite.

Características de profesores que consultan por queja vocal en IST Viña del Mar entre los años 2012 y 2017 / Characteristics of teachers who consult for vocal complaint at IST Viña del Mar between 2012 and 2017

Introducción: el docente es un profesional que presenta riesgo para el desarrollo de patologías vocales consideradas enfermedades laborales. En Viña del Mar, el Ins-tituto de seguridad del trabajo (IST) es un centro de referencia para las atenciones médicas de enfermedades laborales. El objetivo del estudio consiste en establecer la incidencia y prevalencia de profesores de Viña del Mar, Chile, que concurrieron al IST con quejas vocales entre 2012 y 2017. Metodología: se adoptó un enfoque cuantitativo, retrospectivo, descriptivo, corre-lacional y de diseño no experimental. La muestra estuvo conformada por 186 profe-sores que presentaron quejas vocales relacionadas con su desempeño laboral. Resultados: 167 docentes mujeres y 19 docentes hombres consultaron por pro-blemas vocales; 64.5% docentes de la muestra realizan clases en educación básica. Ningún docente universitario accedió al IST con este tipo de queja. El diagnóstico más recurrente fue de disfonías orgánico-funcionales (75,8%), de las cuales 69,5% fueron dirigidas a terapia vocal en el IST. 14,1% de los docentes fueron diagnostica-dos con disfonía funcional (también fueron enviados a terapia); sin embargo, 9,4% de los casos, al no cumplir con las características de origen exclusivamente laboral, no recibieron terapia fonoaudiológica en el IST. Conclusión: el docente chileno en la V Región presenta un bajo nivel de consulta por patologías vocales. Los docentes de educación básica son los que más buscan te-rapia profesional para su voz y la mayor cantidad de afecciones se relacionan con un deficiente conocimiento de técnicas y/o hábitos vocales inadecuados. Es necesaria una inversión mayor en promoción y prevención vocal para este grupo profesional.

Introduction: being a teacher presents a risk for the development of vocal patho-logies, considered occupational diseases. In Viña del Mar, the Work Safety Institute (known by the acronym IST) is a reference center for medical care for occupational diseases. The objective of this study is to establish the incidence and prevalence of teachers from Viña del Mar, Chile, who attended the IST with vocal complaints be-tween 2012 and 2017. Methods: a quantitative, retrospective, descriptive, correlational and non-experi-mental design approach was adopted. The sample was made up of 186 teachers who presented vocal complaints related to their job performance. Results: 167 female and 19 male teachers consulted with vocal problems; 64.5% teachers of the sample worked in primary school while there were no reports of university professors who accessed the IST with vocal problems. The most recurrent diagnosis was organic-functional dysphonia (75.8%), of which 69.5% was referred to vocal therapy at the IST. 14.1% Of the teachers were diagnosed with functional dysphonia, (and were also sent to vocal therapy). However, 9.4% of the cases did not meet the characteristics of being exclusively work related, for this reason they did not receive vocal therapy at the IST.Conclusion: Chilean teachers from V Region have a low level of consultation for vocal pathologies. Primary school teachers are the ones who seek most professional therapy for their voice and the greatest number of conditions are related to poor knowledge about voice techniques and/or vocal habits. A greater investment in pro-motion and vocal prevention is necessary for this professional group

Study on Assessment and Treatment Patterns of Speech-Language Pathologists in Pediatric Vocal Problem Through Multicenter Survey

BACKGROUND AND OBJECTIVES: Pediatric vocal health problems are relatively common. However, it is not yet well studied whether uniform diagnosis and treatment is done properly in South Korea. The purpose of this study was to investigate the methods that the Korean speech therapists use to diagnose and treat pediatric voice problem. MATERIALS AND METHOD: An anonymous online questionnaire was administered to 32 speech language therapists registered at the Korean laryngeal speech linguistics society detailing demographics, employment institution, general management of pediatric patients with vocal problem including assessment and treatment procedures. RESULTS: Current practice patterns were analyzed on 32 speech language therapists providing services in South Korea mostly working at tertiary university hospital. One third of pediatric patients were assessed without proceeding to treatment. One fifth of patients were treated without assessment. Perceptual assessment was the main pre-treatment assessment methods used. Treatment was done in the following order : Voice rest, SOVT, yawn-sigh and resonant voice. Post-treatment evaluation was used in the following order : Instrumental assessment, clinical judgment, and recording comparison. CONCLUSION: Speech language therapists practice in South Korea mostly follows the ASHA practice guidelines. However, there are still great amount of cases in which only the evaluation was done without appropriate treatment. Further research is needed to make SPLs more systematic and efficient for evaluating and treating pediatric vocal patients.

Reading comprehension assessment: effect of order of task application / Avaliação da compreensão leitora: efeito da ordem de aplicação das tarefas

ABSTRACT Purpose To investigate the influence of order of reading tasks application on the reading comprehension performance by students with and without reading difficulties. Methods 40 students (4th and 5th grade) were classified according to the presence (Research Group-RG) or absence (Control Group-CG) of reading difficulties. RG-r and CG-r - 20 students (10 for each group) who retold the read text and responded to open-ended questions; RG-q and CG-q - 20 students (10 for each group) who responded to open-ended questions and then retold the read text. The analysis quantified the main idea, details and inferences retold, causal links and retelling reference standard (3-0) was also established from the best to the worst performance. Open-ended questions received one point for each correct answer. Results Open-ended questions influenced only the retelling performance of good readers. A better performance of CG-q was noted for the number of second level links retold (U=50.50, p=0.155), total of links retold (U=23,00, p=0.038) and retelling reference standard (U=24.50, p=0.039). Reading-monitoring strategies are laborious and tend to be less used by students with reading difficulties. This is because these compete directly with low-level skills (decoding and microstructure processing), losing efficiency or being abandoned in the very course of reading. Conclusion There was improvement on the retelling performance of students without reading difficulties when this task was preceded by the open-ended questions, possibly because of the use of monitoring strategies that allowed a better understanding of the link between the retained ideas, improving links and retelling reference standard.

RESUMO Objetivo Estudar a influência da resposta a questões sobre o desempenho na tarefa de reconto após leitura realizada por escolares com e sem dificuldades de leitura. Método Foram agrupados 40 escolares do 4º e 5º ano do Ensino Fundamental segundo a presença (Grupo Pesquisa-GP) ou ausência (Grupo Controle-GC) de alteração na compreensão leitora: GP-r e GC-r - 20 escolares (10 de cada grupo) que responderam a questões abertas e depois recontaram oralmente o texto lido. A análise quantificou no reconto: total de ideias centrais, detalhe e inferências; enlaces e classificou o padrão de compreensão leitora (3-0) do melhor para o pior desempenho. As questões abertas computaram um ponto para cada acerto. Resultados Questões abertas favoreceram apenas o desempenho de bons leitores no reconto. Melhor desempenho foi identificado para GC-r quando considerados os enlaces de segundo nível (U=50.50, p=0.155); total de enlaces (U=23.00, p=0.038) e de padrão do reconto (U=24.50, p=0.039). Estratégias de monitoramento de leitura são laboriosas e tendem a ser menos utilizadas por escolares com dificuldades de leitura. Isso porque essas estratégias competem diretamente com as habilidades de baixa ordem na leitura (decodificação e processamento da microestrutura). Conclusão O desempenho de escolares sem queixas em tarefa de reconto após leitura melhorou quando precedida por respostas a questões abertas, possivelmente por causa das estratégias de automonitoramento da compreensão, que permitiram melhor entendimento das relações entre as ideias retidas.

Perfil profesional de los fonoaudiólogos colombianos que trabajan con adultos mayores / Professional profile of Colombian speech and language pathologists that work with elderly persons

El objetivo del estudio fue caracterizar el perfil profesional de fonoaudiólogos que trabajan con adultos mayores en Colombia. Metodología: La investigación fue de tipo descriptivo; los participantes fueron 30 fonoaudiólogos quienes se encargaron de responder una encuesta. La encuesta contenía ítems relacionados con el perfil sociodemográfico, el perfil profesional, el quehacer fonoaudiológico y las percepciones sobre la población adulta mayor. Resultados: El abordaje fonoaudiológico con esta población se caracteriza por estar centrado en el escenario salud, en su mayoría el rol es el asistencial, específicamente en los procesos de evaluación e intervención en las áreas de deglución, lenguaje y comunicación Conclusiones: Los resultados permitieron caracterizar el perfil profesional y el quehacer del fonoaudiólogo con la población adulta mayor. También evidencian la importancia de continuar el trabajo con este grupo etario en función de sus habilidades y bienestar comunicativo, y de allí la necesidad de plantear estudios que pueden servir para comprender la comunicación en población adulta con y sin desórdenes.

The aim of the study was to characterize the professional profile of speech therapists who work with elderly adults in Colombia. Methodology: The study was descriptive; participants were 30 speech and language pathologists who answered a survey including items related with sociodemographic profiles, professional profiles, speech and language pathology tasks, and perceptions about the elder adults. Results: The approach to speech and language pathology practice with this population is focused on the health setting, is mainly centered on assisting patients on areas such as swallowing, language, and communication. Conclusions: The results allowed characterizing the professional profile and the speech and language pathologist's practice with the elderly adult population. They also showed the importance of working with elderly persons based on their abilities and their communicative well-being. Also, it is necessary to conduct further studies to understand communication among elderly adults with and without disorders.

Correlación clínico-patológica: una simbiosis irremplazable entre internista y patólogo / Clinical-pathological correlation: an unreplaceable symbiosis between the internist and the pathologist

RESUMEN No existen dudas acerca de las dificultades que se presentan para lograr el diagnóstico de algunos pacientes, aún con el mejor uso de la clínica y de los recursos tecnológicos. Hay un porcentaje variable de diagnósticos de entidades nosológicas que por diversas complejidades o asociación de factores a veces requieren confirmación por la autopsia. Pueden citarse múltiples ejemplos de enfermedades descubiertas o esclarecidas, gracias a la autopsia, que tiene en la correlación clínico-patológica un basamento fundamental. Los índices de discrepancia y coincidencia de las causas de muerte entre el diagnóstico clínico y morfológico constituyen de forma indirecta un indicador de calidad de la atención médica prestada. Se estableció como objetivo de investigación describir los principales vínculos histórico-médicos de la correlación clínico-patológica y su vigencia actual. Sin lugar a dudas, a través del método anatomoclínico existe una unión muy necesaria entre internista y patólogo, y que de cuya relación los principales beneficiados siempre serán los pacientes, sus familiares y la sociedad en general (AU).

ABSTRACT There are no doubts on the difficulties arising for arriving to the diagnosis of several patients, even with the best usage of the clinic and the technological resources. There it is a variable percent of diagnoses of hospital entities that, because of diverse complexities or factors association, sometimes require confirmation by autopsy. Multiple examples of diseases discovered or elucidated due to the autopsy could be cited, having a main basement in the clinical-pathological correlation. The indexes of discrepancy and coincidence of death causes between the clinical and morphological diagnoses are, in an indirect way, an indicator of the given medical care. The established research objective was describing the main historic-medical bonds of the clinical-pathological correlation and its current force. Without doubts, there is a very necessary relation between the internist and the pathologist through the anatomoclinical method, and as a result of it, the main benefitted would be always the patients, their relatives and all the society (AU).

The Metabolic Clinic: Challenges in a Developing Country

The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “The Metabolic Clinic: Challenges in a Developing Country”. No formal abstract is available. Readers are requested to read the full article.

Implementation of toxicologic pathology peer review based on the new edition of China Good Laboratory Practice / 国际药学研究杂志

The Chinese Food and Drug Administration issued the new Good Laboratory Practice(GLP)for nonclinical safety studies in September 2017,which emphasizes the peer review during the pathology practice.Pathology peer review could verify and im?prove the accuracy and quality of pathology diagnoses and interpretations in discussion.Pathology peer review is recommended when important risk assessment or business decisions are based on nonclinical studies.The objectives of this review are to provide a unified interpretation of the new regulation and recommend compliant processes for organizations to implement.

Evaluation of a Professional Development Model for Enhancing Knowledge, Skill and Confidence in Dysphagia Management / Jurnal Sains Kesihatan Malaysia

There were critical limitations to dysphagia services in Malaysia with speech-language pathologists’ (SLPs) reported lacking skills and confidence in managing the disorder. This study examined the impact of providing professional development training in dysphagia management. Aims were to determine if: (1) delivery of a training series enhances SLPs knowledge in dysphagia management, (2) knowledge translated into improved clinical skills and (3) clinicians’ perception of their knowledge, skills and confidence improved post-training. The study used a single cohort pre- and post-test research design and involved nine Malaysian SLPs. Participants underwent assessment at pre- and immediately post-training and again at one month post-training. At each assessment level, knowledge and skills were assessed via a written examination and observational assessment of clinical performance respectively. Visual analogue scales were used to measure clinician’s perceptions of knowledge, skills and confidence. The training model involved four consecutive; 4-hour week-end workshops with opportunity to apply new knowledge and develop networking in clinical practice in the weekdays between each session. Significant (p < 0.05) improvements in knowledge and clinical skills were observed immediately post- and at one month after training. Clinician’s perceptions of knowledge, skills and confidence were also significantly higher immediately post- and at one month post-training. The current 4-week structured professional development model was found to be effective in enhancing SLPs’ knowledge and skills in dysphagia management and improving their perceptions and confidence. The findings highlight the benefits that can be achieved through well designed professional development programs.

Effects of meticulousness of pathologists on lymph node harvest after neoadjuvant chemoradiotherapy combined radical resection of patients with rectal cancer / 第二军医大学学报

Objective To investigate the effect of meticulousness of pathologists on the lymph node harvest after radical resection of invasive rectal carcinoma in paients following neoadjuvant chemoradiotherapy. Methods The clinical data of 191 patients with rectal cancer (stage I to III) undergoing radical excision after neoadjuvant chemoradiotherapy in Department of ColorectalSurgery, Changhai Hospital, Second Military Medical University from Jan. 2005 to Dec. 2014 were retrospectively analyzed. Since Jan. 2009 when multidisciplinary cooperation was carried out, pathologists and surgeons suggested that no less than 15 lymph nodes in single rectal specimen should be found by meticulousness of pathologists, according to which patients were divided into routine sampling group (n=46) and meticulousness group (n=145). The harvest number and positive rate of postoperative lymphnodes were compared between the two groups. Results The lymph node retrieval in the meticulousness group was significantly more than that in the routine sampling group (13.1 ± 4.9 vs 9.6 ± 4.0, P<0.01), and the percentage of patients with the lymph node harvest equaling or more than 12 was significantly increased (69.7% vs 33.3%, P<0.01). There were no significant differences in the positive node harvest number (1.8 ± 2.9 vs 1.9 ± 3.8, P=0.334) or positive rate of lymph nodes (50.0% vs 38.6%, P=0.172) between the two groups. The positive rate of tymph nodes of patients in T0, T1, T2, T3, and T4 stages in the two groups were 25. 0% (1/4) and 22.7% (5/22), 0.0% (0/1) and 33.3% (1/3), 9.1% (1/11) and 25. 0%(8/32), 70.0%(21/30) and 47.1%(40/85), and 0.0%(0/0) and 66. 7%(2/3), respectively. There were no significant differences in T stages between the two groups (X2=4.55, P=0.209). Conclusion The lymph node harvest number is increased by meticulousness of pathologists after multidisciplinary cooperation, while the positive node harvest number and positive rate of tymph nodes are not increased, suggesting that supplementary measures should be taken to obtainmore accurate lymph node status of patients with rectat cancer after neoadjuvant chemoradiotherapy.

Dominio del fonoaudiólogo para la determinación del grado de viscosidad de alimentos líquidos / Speech pathologists proficiency for determining viscosity grade in liquid foods

La disfagia es una alteración del proceso deglutorio que afecta la seguridad, eficacia y calidad de la alimentación. Una de las estrategias más utilizadas para su intervención es la modificación de la viscosidad de los alimentos, sin embargo, la metodología empleada para determinarla es subjetiva y no está estandarizada. Esta investigación buscó establecer el dominio de los fonoaudiólogos para determinar el tipo de viscosidad. Se utilizaron 12 muestras de alimentos líquidos, cuyas viscosidades fueron determinadas objetivamente con un viscosímetro rotacional, clasificándolos bajo las categorías: fino, néctar, miel y pudín. Posteriormente, cuarenta fonoaudiólogos que se desempeñan en el área de los trastornos de la deglución en centros de salud de la Región Metropolitana en Santiago de Chile, evaluaron subjetivamente las 12 muestras. Con esta información se realizó un estudio comparativo objetivo/subjetivo para establecer el dominio de los profesionales. Los participantes lograron 66,87 por ciento de efectividad en la valoración del grado de viscosidad de las muestras, con un mejor rendimiento para aquellas viscosidades tipo fino y pudín. La repetibilidad intrasujeto fue superior a 75 por ciento para el 60 por ciento de la muestra. Existen además indicadores de que el tiempo de ejercicio profesional incidiría positivamente en estas capacidades, no así el nivel de perfeccionamiento. Por último, se establece que los fonoaudiólogos evaluados poseen un dominio regular para determinar el grado de viscosidad de alimentos líquidos, pero este no es homogéneo. Se hace necesario incentivar el conocimiento y manejo adecuado en este tema, en búsqueda de consensuar procedimientos y criterios que permitan una mayor estandarización al respecto.

Dysphagia is a disruption in the swallowing process which hinders movement of food, affecting the safety, efficiency and quality of feeding. Treatment includes different strategies, with viscosity modification being one of the most used strategies nowadays. However, the methodology used to determine food viscosity is subjective and not standardized. In this regard, this study seeks to establish the speech pathologists’ skills in determining the different types of food viscosity. Twelve samples of liquid foods were used, whose viscosities were determined objectively with a rotational viscometer. Then, the samples of liquid foods were classified into four categories: thin liquid, nectar, honey, and pudding. Forty speech pathologists working with patients diagnosed with dysphagia at health centers in the Metropolitan Region, Chile, subjectively evaluated the samples of liquid foods. Finally, an objective/subjective comparative study was performed to determine their competence in identifying the different types of food viscosity. Near 66,87 percent of the participants performed well in the task. Participants performed better in determining thin and pudding viscosities. Over 75 percent of intra-subject repeatability was obtained for 60 percent of the sample. Unlike postgraduate studies, it could be observed that professional experience has a positive impact on these skills. Finally, the results of this study indicate that the participants have intermediate skills in determining the degree of viscosity of liquid food. However, this is not homogeneous, and therefore, it is necessary to enhance our understanding and proper management of dysphagia. Agreement on standard procedures is also necessary.

The role of pathologists in multidisciplinary cancer care

In recent years there has been significant growth in multidisciplinary cancer treatment. In cancer patient management, multidisciplinary cancer treatment is essential for evaluation of treatment response and proper decision making. Multidisciplinary cancer treatment has some systematic problems in Korea; however, it is expected to be increasingly activated in tertiary medical institutions. Pathologists are core members of multidisciplinary cancer treatment teams. We reviewed the pathologist's role in multidisciplinary cancer treatment. The days of precision medicine have arrived with remarkable development in molecular pathology. Pathologists not only histologically confirm the cancer diagnosis and pathologic stage but also evaluate both prognostic factors and predictive factors determining targeted therapy. Pathologists' participation in multidisciplinary cancer treatment and explanation of pathologic results can draw good curative effect and improve patient satisfaction. The only caveat is that pathologists need to be brought down to the patient's level while describing pathologic findings. We suspect that pathologists' role will expand as pathologists participate in multidisciplinary cancer treatment in the era of precision medicine.

Demencia frontotemporal y esclerosis lateral amiotrófica: presentación de un caso clínico / Frontotemporal dementia and amyotrophic lateral sclerosis: a case report

For a long time amyotrophic lateral sclerosis was seen as an exclusively motor disease, however, a lot of investigations have proved the existence of cognitive symptoms similar to frontotemporal dementia that could precede, coexist or appear after the motor symptoms. We report the case of a 69 years old hispanic man who consults about progressive swallowing impairments. In the speech languagepathologist assessment, we detected cognitive impairments that made necessary to complete the workout with specific test. The results of the assessment, shown disturbance in swallowing with suggestive symptomatology of motor neuron disease, besides cognitive impairments in executive functions, visuospatial abilities, memory, language and behaviors and conductual abnormalities. A few months after speech language pathologist assessment, the diagnosis of amyotrophic lateral sclerosis was given. This case emphasize in the importance of a exhaustive anamnesis and clinical assessment, as well as early diagnosis focused on opportune interventions. Additionally, it’s important to note the need for professionals with update knowledge in neuropsychology, to support interventions.

Durante mucho tiempo se pensó que la esclerosis lateral amiotrófica era una enfermedad exclusivamente motora, sin embargo, diversos estudios han mostrado la existencia de síntomas cognitivos que pueden manifestarse antes, durante o después de los síntomas motores y que serían compatibles con una demencia frontotemporal. Se presenta un caso de un hombre de 69 años que consulta por dificultades de deglución de carácter progresivo. En la evaluación fonoaudiológica se pesquisan dificultades cognitivas, por lo cual se decide aplicar diversas pruebas con el objetivo de aclarar estas alteraciones. Los resultados de la evaluación revelan alteraciones a nivel de deglución, con sintomatologia sugerente de enfermedad de motoneurona, además de alteraciones cognitivas a nivel de funciones ejecutivas, habilidades visuoespaciales, memoria, lenguaje y alteraciones en conducta y comportamiento. En el transcurso de unos meses, posterior a la evaluación fonoaudiológica, se realiza el diagnóstico de esclerosis lateral amiotrófica. Se enfatiza en la importancia de la anamnesis y evaluación clínica, el diagnóstico precoz enfocado en la intervención oportuna y la relevancia de contar con profesionales competentes y capaces, con conocimientos sobre neuropsicología que puedan ser de apoyo para la intervención.

Work related musculoskeletal disorders among medical laboratory professionals: a narrative review.

Work related musculoskeletal disorders are common health problem and increasing cause of disability. Laboratory professionals are unique group of healthcare professionals who play an essential part in diagnosis and therapy planning and often their work is associated with potential health hazards. Objective of current study was to review literature on prevalence of work-related musculoskeletal disorders among medical laboratory professionals. Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. The searching strategy uncovered 13 reports. Total 7 studies were included for the review. A high degree of heterogeneity among studies was observed. The overall prevalence’s ranges from 40-60%. With neck being more prevalent 18-78%. However additional high quality studies are required in this area.

A survey of the current situation of pathologists and development of a consultation network using virtual slides / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : To grasp what kind of problems exists in order to solve the shortage of pathologists, we conducted a survey with special focus on the condition of facilities with single pathologists. We also considered whether the use of virtual slide technology is a viable option in mitigating the shortage of pathologists.<br><b>Methods</b> : The survey was conducted at the 58th Autumn Annual Meeting of the Japanese Society of Pathology using questionnaires. Interviews were also obtained with pathologists who use virtual slides<br><b>Results</b> : The percentage of facilities with single pathologists was approximately 30%, and these facilities had the highest rates of using virtual slides for remote pathology consultations. Regardless of the number of pathologist at a facility, outside consultation was often obtained with difficult cases. Although pathologists working alone expressed anxiety over diagnosing cancer, consulting other facilities appeared to be difficult.<br><b>Conclusion</b> : In order to reduce the anxiety of pathologists working alone and to raise the accuracy of cancer diagnoses, a mechanism by which pathologists can consult each other is required. Developing a network for pathologists for such consultations using virtual slides is felt to be important in primary care.