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1.
Lang Speech Hear Serv Sch ; 53(2): 233-236, 2022 Apr 11.
Article in English | MEDLINE | ID: covidwho-1788337

ABSTRACT

PURPOSE: This prologue introduces the LSHSS Forum: Speech and Language Tele-Intervention: The Future Is Now. The aims of the forum are (a) to report on the process of moving established in-person interventions to virtual delivery and (b) to provide speech-language pathologists (SLPs) with empirically based guidance on designing and implementing tele-interventions, in order to support academic success for school-age children with speech and language needs. The included articles explore the process, benefits, and challenges of providing intervention in speech, language, and literacy domains in a virtual environment with children. CONCLUSION: Although there are some logistical challenges, established treatments such as those targeting morphosyntax as well as communication partner training can be adapted for successful delivery online. In addition, the forum supports the delivery of an app-based articulation-focused intervention. SLPs report a number of challenges in relation to adapting and delivering interventions through telepractice, and parents express concerns in relation to SLPs' online evaluation of complex speech sound difficulties for children born with cleft lip and palate. Finally, using the principles of Minimal Intervention Needed for Change, a systematic approach to the adaptation of evidence-based interventions for online delivery, is outlined.


Subject(s)
Cleft Lip , Cleft Palate , Speech-Language Pathology , Child , Humans , Language , Speech
2.
J Craniofac Surg ; 33(2): 409-412, 2022.
Article in English | MEDLINE | ID: covidwho-1746165

ABSTRACT

ABSTRACT: Smile Train, the largest global cleft nonprofit organization, employs a model of establishing partnerships with treatment centers and medical professionals in low- and middle-income countries (LMICs). Having a presence in over 90 countries throughout its history, the organization provides support for cleft lip and palate repair as well as comprehensive cleft care (CCC) for patients with clefts. With the goal of reducing disparities in access to quality surgical, anesthesia, and medical care, Smile Train strengthens partners with training, education, equipment, and patient support grants. Furthermore, safety and quality protocols have been put in place as guidelines for each partner center, and partnerships with other nongovernmental agencies were created to increase safety in the operating rooms. The founder of Smile Train desired to apply technology wherever possible to build sustainability within the treatment centers and surgeons supporting their own community. Smile Train's model, aimed at increased sustainability, is supplemented by technological advancements to assist in the safety and quality of cleft care services provided in LMIC treatment centers. Examples include centralized online data record keeping for every patient, virtual simulations and training, and mobile applications to enhance care. Recently, Smile Train's focus is expanding CCC with nutrition, oral health, speech, and nursing care programs to improve functional and psychosocial outcomes for patients following their procedure. Despite the challenges imposed by the COVID-19 pandemic, Smile Train continues to provide safe, efficacious, and CCC alongside their partners in LMICs further investing tremendous efforts towards the livelihood of children with clefts globally.


Subject(s)
COVID-19 , Cleft Lip , Cleft Palate , COVID-19/epidemiology , Child , Cleft Lip/surgery , Cleft Palate/surgery , Humans , Pandemics , Speech
3.
Ann Glob Health ; 88(1): 9, 2022.
Article in English | MEDLINE | ID: covidwho-1667533

ABSTRACT

Coronavirus disease 2019 (COVID-19) has placed an unprecedented strain on healthcare systems worldwide, but while high-income countries (HICs) have been able to adapt, low- and middle-income countries (LMICs) have been much slower to do so due to a lack of funding, skilled healthcare providers, equipment, and facilities. The redistribution of resources to combat the pandemic in LMICs has resulted in decreased surgical volumes at local surgical centers as well as a dramatic reduction in the number of humanitarian aid missions. Despite recent global investment in improving the surgical capacities of LMICs, even in the pre-COVID-19 era there was a vast unmet surgical need. This deficit in surgical capacity has grown during the pandemic and it will be a significant struggle to overcome the resulting backlog of patients. A topic of particular concern to the authors is the effect that the pandemic will have on the delivery of time-sensitive surgical care to patients with cleft palate deformities as delay in providing care can have enormous physical and psychosocial consequences. This paper draws increased attention to the lasting impact that the COVID-19 pandemic may have on cleft palate patients in LMICs. SSRN Pre-print server link: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3898055.


Subject(s)
COVID-19 , Cleft Palate , Cleft Palate/epidemiology , Cleft Palate/surgery , Developing Countries , Humans , Pandemics , SARS-CoV-2
4.
Lang Speech Hear Serv Sch ; 53(2): 307-316, 2022 Apr 11.
Article in English | MEDLINE | ID: covidwho-1608038

ABSTRACT

PURPOSE: The purpose of this study was to describe and examine parent views of speech-language pathology (SLP) for children born with cleft palate delivered via telemedicine during the COVID-19 pandemic in the United Kingdom (UK). METHOD: Parents were asked whether they found this method of delivery "very effective," "somewhat effective," or "not at all effective." Free text was then invited. There were 212 responses. Ordinal chi-square, Kruskal-Wallis, or Fisher's exact tests examined associations between parent views of effectiveness and biological variables and socioeconomic status. Free text responses were analyzed using qualitative content analysis. RESULTS: One hundred and forty (66.0%) respondents reported that SLP delivered via telemedicine was "somewhat effective," 56 (26.4%) "very effective," and 16 (7.6%) "not at all effective." There was no evidence of an association between parent reported effectiveness and any of the explanatory variables. Parent-reported challenges impacting on effectiveness included technology issues and keeping their children engaged with sessions. Importantly, telemedicine was viewed as "better than nothing." CONCLUSIONS: Most parents reported that they felt SLP delivered via telemedicine during the first few months of the COVID-19 pandemic in the UK was at least "somewhat effective." It is important to interpret this in the context of there being no other method of service delivery during this time and that this study only represents families who were able to access SLP delivered via telemedicine. Further work is needed to identify which children with cleft palate might benefit from SLP delivered via telemedicine to inform postpandemic service provision.


Subject(s)
COVID-19 , Cleft Palate , Speech-Language Pathology , Telemedicine , Caregivers , Child , Cleft Palate/therapy , Humans , Pandemics , Parents
5.
Am J Otolaryngol ; 43(1): 103279, 2022.
Article in English | MEDLINE | ID: covidwho-1588364

ABSTRACT

PURPOSE: Coronavirus Disease-2019 (COVID-19) mitigation measures have led to a sustained reduction in tympanostomy tube (TT) placement in the general population. The present aim was to determine if TT placement has also decreased in children at risk for chronic otitis media with effusion (COME), such as those with cleft palate (CP). MATERIALS AND METHODS: A cohort study with medical record review was performed including consecutive children, ages 0-17 years, undergoing primary palatoplasty at a tertiary children's hospital February 2019-January 2020 (pre-COVID) or May 2020-April 2021 (COVID). Revision palatoplasty (n = 29) was excluded. Patient characteristics and middle ear status pre-operatively and at palatoplasty were compared between groups using logistic regression or Wilcoxon rank-sum. RESULTS: The pre-COVID and COVID cohorts included 73 and 87 patients, respectively. Seventy (44%) were female and median age at palatoplasty was 13.5 months for CP ± cleft lip (CP ± L) and 5.5 years for submucous cleft palate (SMCP). In patients with CP ± L, TT were placed or in place and patent at palatoplasty in 28/38 (74%) pre-COVID and 37/50 (74%) during COVID (P = 0.97). In patients with SMCP, these proportions were 5/35 (14%) and 6/37 (16%), respectively (P = 0.82). Examining only patients <2 years of age also revealed no difference in TT placement pre-COVID versus COVID (P = 0.99). Finally, the prevalence and type of effusion during COVID was similar to pre-COVID. CONCLUSIONS: Reduced infectious exposure has not decreased TT placement or effusion at palatoplasty. Future work could focus on non-infectious immunologic factors underlying the maintenance of COME in these children.


Subject(s)
COVID-19/epidemiology , Cleft Palate/surgery , Middle Ear Ventilation/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Pandemics , SARS-CoV-2
6.
J Dent ; 117: 103914, 2022 02.
Article in English | MEDLINE | ID: covidwho-1549905

ABSTRACT

OBJECTIVES: To assess the patient experience of Remote Clinical Consultations (RCCs) for head and neck cancer and cleft lip and palate patients undergoing specialist restorative dentistry treatment in the context of a secondary care service. METHODS: An online survey was designed; all ninety three patients were invited to participate in its completion following a video or telephone remote clinical consultation with one restorative consultant in Addenbrooke's Hospital between August 2020 and April 2021. The video consultations were carried out via NHS England's Attend Anywhere platform. RESULTS: Sixty three responses were received. Over 70% of patients valued a video or telephone remote clinical consultation rather than an in-person attendance. Patients reported a good experience and would recommend a remote clinical consultation instead of an in-person attendance if no treatment would likely be required. Those who were less likely to recommend a remote clinical consultation were those who had difficulties logging-in to the remote platform or had technical issues. CONCLUSION: While a number of patients still would have preferred a face-to-face attendance, both telephone and video remote consultations were highly valued by patients, and the overall patient experience was that of acceptance. Benefits of remote consultations perceived by patients included having set time to discuss concerns and queries, becoming familiar with a clinician prior to any treatment, saving time, minimising travel and reducing expenses. Barriers to a positive experience included technical difficulties. This survey contributes to the evidence supporting remote clinical consultations as a practical way of delivering specialist consultations in restorative dentistry, it highlights this virtual process largely relates to the practicalities of service provision and highlights the use of remote consultations for specific appointments. CLINICAL SIGNIFICANCE: This study demonstrates patient feedback to a strategy implemented due to adaptations in working methods required as result of the Covid-19 pandemic. Patients were found to have a positive, accepting experience of both telephone and video remote clinical consultations. the study identifies a high patient acceptability and ability to overcome some of the disadvantages of an in-person attendance including saving time, travel and associated expenses while also contributing to a reduction in CO2 emissions and potentially improving clinical efficiency and capacity. These findings add to existing evidence and are indicative that remote consultations provide a practical way of delivering specialist communication in restorative dentistry as part of a unique patient pathway.


Subject(s)
COVID-19 , Cleft Lip , Cleft Palate , Remote Consultation , Dentistry , Humans , Pandemics , SARS-CoV-2
7.
Cleft Palate Craniofac J ; 58(12): 1547-1555, 2021 12.
Article in English | MEDLINE | ID: covidwho-1526569

ABSTRACT

BACKGROUND: Cleft lip and cleft palate (CLP) are among the world's most common congenital malformation and has a higher prevalence in developing nations due to environmental and genetic factors. Global efforts have been developed in order to prevent and treat the malformation. Telemedicine has been implemented in various humanitarian global missions with success and is currently the primary means of care due to COVID-19. OBJECTIVE: To assess the benefits and barriers of telehealth in the care of patients with CLP through a global approach. METHODS: Systematic review of the PubMed and Cochrane Review databases with relevant terms related to telemedicine in cleft lip and palate surgery. RESULTS: Eight articles fit the inclusion criteria and suggested benefits with the use of telemedicine in regard to education, preoperative, and postoperative care as well as increased access to underserved populations. Barriers included connectivity and accessibility concerns. CONCLUSION: Telehealth is a beneficial way to evaluate patients with CLP in developing countries with proper care and follow-up to reduce complications and to improve health outcomes.


Subject(s)
COVID-19 , Cleft Lip , Cleft Palate , Telemedicine , Cleft Lip/therapy , Cleft Palate/therapy , Humans , SARS-CoV-2
8.
Cleft Palate Craniofac J ; 59(5): 675-679, 2022 May.
Article in English | MEDLINE | ID: covidwho-1273208

ABSTRACT

BACKGROUND: As a result of the current global pandemic, the dental profession has utilized teledentistry to reduce footfall in the hospitals and clinics where possible. Pediatric dental consultants form a vital part of a multidisciplinary team and regularly monitor the dental growth and development of patients with cleft lip and palate. OBJECTIVE: To assess the effectiveness of the service provided by pediatric dental consultants in the South Thames Cleft Service at Evelina Children's Hospital during the COVID-19 pandemic through virtual clinics. DESIGN: Data were collected retrospectively and include all cleft patients contacted via the virtual clinic during May to July 2020. Patients were prioritized by the Red, Amber, Green (RAG) scale to highlight the urgency of their next face-to-face appointment. RESULTS: A total of 215 patients were contacted during this period with a 97% response rate. Patients given a RAG score of GREEN (86%) meant no urgent requirement for a face-to-face consultation and AMBER (8%) patients required treatment that was deemed nonurgent. However, 3% of patients received a RED rating as they required urgent input. CONCLUSION: Through these virtual clinics, the pediatric team was able to reach 208 patients and provided advice and reassurance. The need for face-to-face appointment was eliminated for 11% of patients who were discharged to their local dental practitioners, thereby reducing the risk of spreading COVID-19.


Subject(s)
COVID-19 , Cleft Lip , Cleft Palate , Child , Cleft Lip/epidemiology , Cleft Lip/therapy , Cleft Palate/epidemiology , Cleft Palate/therapy , Dentists , Humans , Outpatients , Pandemics , Professional Role , Retrospective Studies
9.
J Plast Reconstr Aesthet Surg ; 74(8): 1931-1971, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1252521

ABSTRACT

Maintaining an excellent level of service in a network Cleft Lip and Palate service in the UK has been an added challenge for both clinicians and patients throughout the COVID-19 pandemic. We describe the changes to our service, and report a high level of patient satisfaction with the changes. Some of the enforced changes may last beyond the duration of this pandemic.


Subject(s)
COVID-19 , Cleft Lip/surgery , Cleft Palate/surgery , Reconstructive Surgical Procedures , Humans
11.
J Craniofac Surg ; 32(2): e223-e226, 2021.
Article in English | MEDLINE | ID: covidwho-1216706

ABSTRACT

ABSTRACT: As Corona Virus Disease 2019 (COVID-19) has been gradually controlled domestically, various industries began to resume production in an orderly way. Attention should be paid to the disease and population characteristics of patients with cleft lip with/without palate during diagnosis and treatment. This article summarized and provided prevention and control recommendations on management strategies during hospitalization and protective measures of patients and healthcare workers, hoping to minimize the spread of disease and create a relatively safe environment for medical work.


Subject(s)
COVID-19 , Cleft Lip , Cleft Palate , China/epidemiology , Cleft Lip/epidemiology , Cleft Palate/epidemiology , Cleft Palate/surgery , Humans , Pandemics , SARS-CoV-2
12.
Int J Pediatr Otorhinolaryngol ; 144: 110700, 2021 May.
Article in English | MEDLINE | ID: covidwho-1163883

ABSTRACT

BACKGROUND: Due to the lockdown and quarantines caused by the COVID-19 pandemic, the need to study and use telepractice for providing speech pathology interventions for children with cleft palate has arisen. OBJECTIVE: To carry out a systematic review of the use of telepractice during the COVID-19 pandemic for providing speech pathology interventions for Spanish-speaking children with cleft palate. METHODS: In July and August 2020, the authors searched the electronic databases Medline, LILACS, SciELO, and the Cochrane Library using the following keywords in English (MeSH): Cleft palate combined with Early intervention, Speech therapy, Rehabilitation of speech and language disorders, Speech production measurement, Speech articulation tests and Telemedicine. Original articles were selected and analyzed, complemented by an analysis of flowcharts and recommendations by the GES Clinical Guide of Cleft Lip and Palate of Chile's Government and the authors' expert opinions. RESULTS: A total of 2680 articles were retrieved, of which 23 were critically analyzed and used to adapt the early stimulation, evaluation, and treatment of children with CP to speech therapy telepractice at the Gantz Foundation, a Hospital in Santiago de Chile. LIMITATIONS: Only three researchers carried out a quick review, which limited the depth of individual analysis of the studies included. Also, the suggestions and material presented should be evaluated in future investigations. CONCLUSION: This systematic review provides useful guidelines for providing speech pathology interventions through telepractice for children with cleft palate. Audiovisual materials seem to be extremely useful for families receiving the interventions. The use of interactive videos for Spanish-speaking children and educational videos for parents is manifest.


Subject(s)
COVID-19 , Cleft Lip , Cleft Palate , Speech-Language Pathology , Telemedicine/trends , Child , Chile , Cleft Lip/therapy , Cleft Palate/complications , Communicable Disease Control , Humans , Pandemics , Speech
13.
Cleft Palate Craniofac J ; 58(11): 1341-1347, 2021 11.
Article in English | MEDLINE | ID: covidwho-1112414

ABSTRACT

BACKGROUND: At the declaration of the global pandemic on March 11, 2020, many hospitals and institutions developed a tiered framework for the stratification and prioritization of elective surgery. Cleft lip and palate repair was classified as low acuity, and nasoalveolar molding (NAM) clinics were closed. Anticipating the consequences of delayed cleft care and the additional burden this would cause families, we reassessed our risk-stratification and perioperative algorithms. We hypothesized we could safely optimize nasolabial repair without burdening our care systems and without increasing COVID-19-related morbidity/mortality. METHODS: Our multidisciplinary cleft team reevaluated patient selection to maximize surgical impact. Perioperative protocols were adjusted, and COVID-19 preoperative testing was utilized before nasolabial repair and prior to suture removal under anesthesia. RESULTS: Early in the pandemic, unilateral cleft repair was prioritized and successfully completed on 9 patients. There were no complications related to COVID-19. Nasoalveolar molding clinic was reopened after total patient volume was significantly decreased. CONCLUSIONS: We offer an approach for surgical management of nasolabial clefts during a global pandemic. Although guidelines have suggested postponing all cleft care, we found that at our dedicated pediatric hospital with low burden of COVID-19 and adequate resources, we could follow a strategy to safely resume cleft care while decreasing burden on our patients' families and care delivery systems.


Subject(s)
COVID-19 , Cleft Lip , Cleft Palate , Child , Cleft Lip/epidemiology , Cleft Lip/surgery , Cleft Palate/epidemiology , Cleft Palate/surgery , Humans , Nose , Pandemics , SARS-CoV-2
14.
Cleft Palate Craniofac J ; 58(10): 1331-1334, 2021 10.
Article in English | MEDLINE | ID: covidwho-983611
15.
Birth Defects Res ; 112(19): 1699-1719, 2020 11.
Article in English | MEDLINE | ID: covidwho-893203

ABSTRACT

BACKGROUND: There has been a longstanding debate about the role of folate in the etiology of orofacial clefts (OFCs). Studies of different measures of nutritional intake or folate status have been done to investigate the possible role of folate in the prevention of OFC. Only one knowledge synthesis has attempted to bring together different types of evidence. The aim of the present work was to update it. METHODS: Evidence for associations between OFC and dietary folate, supplement use, folic acid fortification, biomarkers of folate status, and variants of MTHFR (C677T and A1298C) were included. Potentially eligible articles were systematically identified from PubMed, Medline, Embase, and Web of Science (2007-2020) and combined using random-effects meta-analysis when appropriate. Quality assessments were conducted using the Newcastle-Ottawa scale and Cochrane's risk of bias tool. RESULTS: Sixty-four studies published since the previous knowledge synthesis were identified, with eight of these identified through a supplementary search from October, 2018 to August, 2020. There was an inverse association between folic acid-containing supplement use before or during pregnancy and cleft lip with or without cleft palate (CL/P) (OR 0.60, 95% CI 0.51-0.69), with considerable between-study heterogeneity. The prevalence of CL/P showed a small decline post-folic acid fortification in seven studies (OR 0.94, 95% CI 0.86-1.02). No association was found between OFC and genetic markers of folate status. The coronavirus-19 pandemic has threatened food availability globally and therefore there is a need to maintain and even enhance surveillance concerning maternal intake of folate and related vitamins. CONCLUSIONS: The risk of non-syndromic OFC was reduced among pregnant women with folic acid-containing supplements during the etiologically relevant period. However, high heterogeneity between included studies, incomplete reporting of population characteristics and variation in timing of exposure and supplement types mean that conclusions should be drawn with caution.


Subject(s)
Cleft Lip/drug therapy , Cleft Palate/drug therapy , Folic Acid/administration & dosage , Mouth Abnormalities/drug therapy , Biomarkers/metabolism , Cleft Lip/metabolism , Cleft Lip/pathology , Cleft Palate/metabolism , Cleft Palate/pathology , Dietary Supplements , Female , Humans , Mouth Abnormalities/metabolism , Mouth Abnormalities/pathology , Pregnancy
19.
Int J Pediatr Otorhinolaryngol ; 138: 110318, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-714003

ABSTRACT

OBJECTIVE: To study whether providing Speech and Language Pathology (SLP) interventions by telepractice (TP) could effectively improve speech performance in children with cleft palate (CCP). METHODS: Forty-three CCP were treated with TP intervention in 45 min sessions, 2 times per week for a period of one month. Children ages ranged 4-12 years (X = 7.04; SD = 2.59). All children presented with velopharyngeal insufficiency (VPI) and compensatory articulation (CA) after palatal repair. TP was provided in small groups (5-6 children) following the principles of the Whole Language Model (WLM). Severity of CA was evaluated by a standardized scale at the onset and at the end of the TP period. RESULTS: At the onset of the TP intervention period, 84% of the patients demonstrated severe CA. At the end of the TP period there was a significant improvement in severity of CA (p < 0.001). CONCLUSION: The results of this study suggests that TP can be a safe and reliable tool for improving CA. Considering that the COVID-19 pandemic will radically modify the delivery of Health Care services in the long term, alternate modes of service delivery should be studied and implemented.


Subject(s)
Betacoronavirus , Cleft Palate , Coronavirus Infections , Pandemics , Pneumonia, Viral , Speech Therapy , Speech-Language Pathology , COVID-19 , Child , Child, Preschool , Cleft Palate/complications , Humans , SARS-CoV-2 , Speech Therapy/methods , Speech-Language Pathology/methods , Velopharyngeal Insufficiency/etiology , Velopharyngeal Insufficiency/physiopathology
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