South of the UES: Improving the ability of speech-language pathologists to detect oesophageal abnormalities during videofluoroscopy swallowing studies.

PURPOSE: With two-thirds of adults presenting for a videofluoroscopy swallow study (VFSS) with oesophageal abnormalities, it seems prudent to include visualisation of the oesophagus, in the context of the entire swallow process, to provide further information to the diagnostic team. This study aims to evaluate the ability of speech-language pathologists (SLPs) to interpret oesophageal sweep on VFSS and the relative improvement in that ability with additional training. METHOD: One hundred SLPs attended training in oesophageal visualisation during VFSS, based on a previous study. Ten oesophageal sweep videos (five normal, five abnormal) with one 20 ml thin fluid barium bolus (19% w/v) were presented at baseline and following training. Raters were blinded to patient information other than age. Binary ratings were collected for oesophageal transit time (OTT), presence of stasis, redirection, and referral to other specialists. RESULT: Inter-rater reliability as measured by Fleiss' kappa improved for all parameters, reaching statistical significance for OTT (pre-test kappa = 0.34, post-test kappa = 0.73; p < 0.01) and redirection (pre-test kappa = 0.38, post-test kappa = 0.49; p < 0.05). Overall agreement improved significantly (p < 0.001) for all parameters except stasis, where improvement was only slight. Interaction between pre-post and type of video (normal/abnormal) was statistically significant (p < 0.001) for redirection, with a large pre-post increase in positive accuracy compared with a slight pre-post decrease in negative accuracy. CONCLUSION: Findings indicate that SLPs require training to accurately interpret an oesophageal sweep on VFSS. This supports the inclusion of education and training on both normal and abnormal oesophageal sweep patterns, and the use of standardised protocols for clinicians using oesophageal visualisation as part of the VFSS protocol.

Evaluation of the implementation of a Tracheostomy Review Services (TRS): an observational cohort study.

It has been suggested that interprofessional tracheostomy teams improve safety, enhance outcomes and promote excellence. This study evaluated the effect of a Tracheostomy Review Service (TRS) on patient outcomes and staff attitudes. The TRS reviewed patients with a tracheostomy tube (TT) in situ on our wards. Data was collected via medical record audit. Two years of retrospective data (n = 39) was compared with 12 months of prospective data (n = 28) for: length of cannulation (LOC); length of ward-based cannulation (LOWBC); length of stay (LOS); ICU LOS (ICU-length of stay); the frequency and time to trial one way valve (PMV); and tracheostomy-related adverse events (AE). Staff were also surveyed regarding their knowledge and confidence in tracheostomy management. No significant difference was seen in LOC, LOWBC, LOS, ICU-LOS, and AE. A significant increase was seen in the frequency of PMV use (pre-TRS 74%; post-TRS 100%). Staff reported an improvement in knowledge and confidence in more complex areas of tracheostomy management. Limited measureable improvements in patient outcomes were seen following the implementation of a TRS. Limitations of this study include a small sample size and heterogeneous patient characteristics.

The use of virtual reality and physical tools in the development and validation of ease of entry and exit in passenger vehicles.

Ease of entry and exit is important for creating a positive first impression of a car and increasing customer satisfaction. Several methods are used within vehicle development to optimise ease of entry and exit, including CAD reviews, benchmarking and buck trials. However, there is an industry trend towards digital methods to reduce the costs and time associated with developing physical prototypes. This paper reports on a study of entry strategy in three properties (buck, car, CAVE) in which inconsistencies were demonstrated by people entering a vehicle representation in the CAVE. In a second study industry practitioners rated the CAVE as worse than physical methods for identifying entry and exit issues, and having lower perceived validity and reliability. However, the resource issues associated with building bucks were recognised. Recommendations are made for developing the CAVE and for combinations of methods for use at different stages of a vehicle's development.

Recent developments in low-cost screening and assessment of childhood disabilities in Jamaica. Part 2: Assessment

This paper summarise the requirements and criteria for assessment of childhood disabilities. It reviews recent research carried out in Jamaica and outlines procedures for medical and psychological assessment used in the International Epidemiological Study of Childhood and Disability as well as local experience in community-based rehabilitation. While the medical assessment procedures were considered to be validated, there is an urgent need for local research and development in psychological assessment. These approaches, while not perfect as yet, bring the possibility of local community capability closer. They will require changes in professional attitudes, training of health and educational personnel, and changes in the service systems, so that screening and assessment can be integrated into existing services. However, although this will obviate the need for new, specialised administrations, improved linkages and lines of referral will be necessary. (AU)

Recent developments in low-cost screening and assessment of childhood disabilities in Jamaica. Part 2: Assessment

This paper summarise the requirements and criteria for assessment of childhood disabilities. It reviews recent research carried out in Jamaica and outlines procedures for medical and psychological assessment used in the International Epidemiological Study of Childhood and Disability as well as local experience in community-based rehabilitation. While the medical assessment procedures were considered to be validated, there is an urgent need for local research and development in psychological assessment. These approaches, while not perfect as yet, bring the possibility of local community capability closer. They will require changes in professional attitudes, training of health and educational personnel, and changes in the service systems, so that screening and assessment can be integrated into existing services. However, although this will obviate the need for new, specialised administrations, improved linkages and lines of referral will be necessary.

Identification of childhood disability in Jamaica: the ten question screen

This is the first in a series of papers that report the testing of two instruments for the identification and assessment of childhood disability by community workers (CWs) in Third World countries. It is part of the International Epidemiological Study on Childhood Disability. The Ten Question Screen (TQ) was used as the main instrument to identify disability in a two stage population-based survey of 5478 children aged 2-9 years in Clarendon, Jamaica. In the second stage, TQ positive and 8 percent of the screen negative controls were professionally assessed by a doctor and a psychologist using standard criteria on the main classification system of the ICIDH. Sensitivity of the TQ as a whole varies in different strata of the group and amongst different disabilities, from perfect in girls under 6 years, fits and motor disabilities and for serious disability in all groups except boys over 5 years with a cognitive disability. Specificity was good but the false positive rate was unacceptably high at 74 percent. It was concluded, firstly, that the validation of a simple questionnaire of perceptions of behaviour against objective measurments of impairments was perhaps not fair to the TQ. In spite of this, the TQ would be a very useful instrument in collection disability data for identifying people in need of rehabilitation help, if a way of reducing false positive could be found. (AU)

Use of the key informant method and the community survey method in the rapid identification and assessment of childhood disability in Jamaica - abstract

An international collaborative study has as its main objective the development of a methodology for the rapid identification of children with disabilities in the age group 2-9 years. It focuses on a simple screening instrument, the ten question screen with probes (TQP), which will provide a tool for the measurement of this health problem. In addition to this objective, the project also compared the effectiveness of two screening approaches for the identification of disability; the use of "key informants" (persons with knowledge about the child population in their area) with the community survey method, in which a house-to-house survey was carried out by primary health care workers. In both cases, children identified as being disabled and a control group were referred to a doctor and psychologist for professional assessment of their disabilities and handicaps. Approximately 120 key informants were exposed to a two-day workshop designed to give them information about the project and distribute questionnaires for the referral of children in their communities. Six months later, they were reminded of the survey and further referrals were solicited. Eight community workers, completed a house-to-house survey of all families in two areas in Clarendon and administered the TQP on 5,400 2-9 year-olds during a one-year period in 1987 and 1988. Seventeen referrals were made by the key informants. Of these, two were seen by the professional team and found to be disabled. The community workers referred over 200 children who were TQP positive (i.e., disabled according to the criteria). It is concluded that, in Jamaica, considerable groundwork and preparation of key informants would have to be done if such persons were to be relied upon for referrals of disabled children (AU)