Exploring Reliable and Identifiable Quantitative Anatomical, Timing, and Displacement Measures in the VFS of Speech.

AIM: Videofluroscopy studies of speech are a recognized assessment of velopharyngeal insufficiency (VPI). Yet, this method is subjective and has low inter-rater reliability. Quantitative measures of timing, distance, and area in videofluoroscopic studies of swallowing have been shown to be valid and reliable, but quantitative measures are not routinely used in videofluroscopy studies for VPI. This study explored the use of quantitative measures in patients with VPI in terms of feasibility and reliability. METHODS: Forty patients of mixed etiology diagnosed with VPI through perceptual speech assessment underwent videofluroscopy. Anatomical landmarks and timing, distance, and area measurements were taken of the velopharyngeal port at rest and during speech tasks using specialized Swallowtail software. 50% of measures were double-blind rated to test inter-rater reliability. Raters reported on the time they took to complete each assessment and the challenges they had. Associations between measures were explored. RESULTS: Ten timing, line, and area measures were developed based on 3 landmarks. Measures had moderate-substantial inter-rater reliability (intraclass coefficient: 0.69-0.91) except for time to lift (secs), which only achieved fair agreement (intraclass coefficient: 0.56). Measures demonstrated internal consistency ( R >0.60). Raters took, on average, 15 mins per patient and reported some challenges with image resolution, especially in timing measures where structures were blurred by movement. CONCLUSION: Quantitative measures are reliable and have the potential to add novel information regarding VPI to support multidisciplinary decision-making. Further research with larger patient cohorts is needed to clarify how quantitative measures can support tailored decisions about surgical and therapeutic interventions in order to maximize outcomes for individuals.

Speech Outcomes of a National Cohort of Children with Orofacial Cleft at 5 and 10 Years of age.

OBJECTIVE: To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft. DESIGN: Prospective study. PARTICIPANTS: Children born with orofacial cleft and having primary surgery in New Zealand. Speech samples were available for 151 five-year-old, and 163 ten-year-old children. MAIN OUTCOME MEASURES: Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention. RESULTS: A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP. CONCLUSIONS: A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for individuals born with cleft to improve speech outcomes and interdisciplinary care.

The underreporting of medication errors: A retrospective and comparative root cause analysis in an acute mental health unit over a 3-year period.

Medication errors remain a commonly reported clinical incident in health care as highlighted by the World Health Organization's focus to reduce medication-related harm. This retrospective quantitative analysis examined medication errors reported by staff using an electronic Clinical Incident Management System (CIMS) during a 3-year period from April 2014 to April 2017 at a metropolitan mental health ward in Western Australia. The aim of the project was to identify types of medication errors and the context in which they occur and to consider recourse so that medication errors can be reduced. Data were retrieved from the Clinical Incident Management System database and concerned medication incidents from categorized tiers within the system. Areas requiring improvement were identified, and the quality of the documented data captured in the database was reviewed for themes pertaining to medication errors. Content analysis provided insight into the following issues: (i) frequency of problem, (ii) when the problem was detected, and (iii) characteristics of the error (classification of drug/s, where the error occurred, what time the error occurred, what day of the week it occurred, and patient outcome). Data were compared to the state-wide results published in the Your Safety in Our Hands (2016) report. Results indicated several areas upon which quality improvement activities could be focused. These include the following: structural changes; changes to policy and practice; changes to individual responsibilities; improving workplace culture to counteract underreporting of medication errors; and improvement in safety and quality administration of medications within a mental health setting.