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Lindberg NE, Kynø NM, Billaud Feragen K, Pripp AH, Tønseth KA. Early Follow-up of Parents by a Specialized Cleft Nurse After the Birth of an Infant with Cleft lip and/or Palate. Cleft Palate Craniofac J 2024; 61:1369-1382. [PMID: 37151047 PMCID: PMC11308288 DOI: 10.1177/10556656231171750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVE To document the impact of early follow-up by specialized cleft nurses (SCNs) to families of infants with cleft lip and/or cleft palate (CL/P). DESIGN Prospective inclusion of a control group, which received standard care alone, followed by an intervention group, which in addition received early SCN follow-up. SETTING The cleft lip and palate team at a University hospital. PARTICIPANTS 70 families (69 mothers and 57 fathers); control group (n = 38); intervention group (n = 32). INTERVENTION SCNs offered a consultation at the maternity ward and follow-ups by phone or face-to-face at one, three, eight weeks and six months after birth. OUTCOME MEASURES Use of Internet-Questionnaire, Quality of discharge teaching scale (QDTS), Post discharge coping difficulty scale (PDCDS), Response on follow-up by health professionals. RESULTS Infants in the intervention group were admitted less frequently to a Neonatal Intensive Care unit (NICU); 21.9% vs 51.4%, P = .012. Parents in the intervention group used internet for cleft-related reasons less frequently (74.6% vs 85.9%), P = .112 and the mothers benefitted less from cleft-related activity on the internet (P = .013). The intervention group reported higher mean score for satisfaction with total cleft care (P = .001). There were no significant group differences regarding mean total score for discharge teaching (P = .315) and coping difficulties (P = .919). CONCLUSION Early follow-up by a SCN with expertise in cleft care is highly valued by parents. Closer cooperation between the cleft team and health professionals at birth hospitals and Child health centers is necessary for optimal follow-up.
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Affiliation(s)
- Nina Ellefsen Lindberg
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nina Margrete Kynø
- Department of Nursing and Health Promotion, Acute and Critical illness, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Stock NM, Costa B, Parnell J, Johns AL, Crerand CE, Billaud Feragen K, Stueckle LP, Mills A, Magee L, Hotton M, Tumblin M, Schefer A, Drake AF, Heike CL. A Conceptual Thematic Framework of Psychological Adjustment in Caregivers of Children with Craniofacial Microsomia. Cleft Palate Craniofac J 2024:10556656241245284. [PMID: 38584503 DOI: 10.1177/10556656241245284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE Children with craniofacial microsomia (CFM) have complex healthcare needs, resulting in evaluations and interventions from infancy onward. Yet, little is understood about families' treatment experiences or the impact of CFM on caregivers' well-being. To address this gap, the NIH-funded 'Craniofacial microsomia: Accelerating Research and Education (CARE)' program sought to develop a conceptual thematic framework of caregiver adjustment to CFM. DESIGN Caregivers reported on their child's medical and surgical history. Narrative interviews were conducted with US caregivers (n = 62) of children aged 3-17 years with CFM. Transcripts were inductively coded and final themes and subthemes were identified. RESULTS Components of the framework included: 1) Diagnostic Experiences, including pregnancy and birth, initial emotional responses, communication about the diagnosis by healthcare providers, and information-seeking behaviors; 2) Child Health and Healthcare Experiences, including feeding, the child's physical health, burden of care, medical decision-making, surgical experiences, and the perceived quality of care; 3) Child Development, including cognition and behavior, educational provision, social experiences, and emotional well-being; and 4) Family Functioning, including parental well-being, relationships, coping strategies, and personal growth. Participants also identified a series of "high" and "low" points throughout their journey and shared their priorities for future research. CONCLUSIONS Narrative interviews provided rich insight into caregivers' experiences of having a child with CFM and enabled the development of a conceptual thematic framework to guide clinical care and future research. Information gathered from this study demonstrates the need to incorporate evidence-based psychological support for families into the CFM pathway from birth onward.
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Affiliation(s)
- Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Jade Parnell
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Laura P Stueckle
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angela Mills
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Leanne Magee
- Buerger Center for Advanced Pediatric Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Hotton
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, England
| | - Melissa Tumblin
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amy Schefer
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel School of Medicine, Chapel Hill, NC, USA
| | - Carrie L Heike
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
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Influence of Self-Practice Oriented Teaching plus Psychological Intervention on Blood Glucose Level and Psychological State in Patients with Type 2 Diabetes Mellitus on Insulin Therapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5606697. [PMID: 35978998 PMCID: PMC9377873 DOI: 10.1155/2022/5606697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Background. The study aimed to examine the effect of self-practice oriented teaching plus psychological intervention on blood glucose level and psychological status of type 2 diabetic patients on first insulin therapy. Methods. A total of 80 patients with type 2 diabetes admitted from April 2020 to November 2020 were assessed for eligibility and included. They were then assigned to a control group and an observation group via the random number table method, with 40 cases in each group. In addition to insulin injection treatment in both groups prior to intervention, the control group received health education and psychological intervention, whereas the observation group adopted a self-practice oriented teaching strategy plus psychological intervention. Insulin injections, nursing satisfaction, blood glucose level, and disease awareness were compared between the two groups. The Exercise of Self-Care Agency (ESCA) scale was used to assess the patients’ self-care ability, the Generic Quality of Life Inventory-74 (GQOLI-74) scale was used to assess their quality of life, and the emotional state of patients was evaluated by the Hospital Anxiety and Depression (HAD) scale. Results. Patients in the observation group outperformed the control group in terms of insulin injection after intervention (
). Significantly higher nursing satisfaction and ESCA scores were observed after intervention (
). Self-practice oriented teaching plus psychological intervention resulted in remarkably lower postintervention glycemic indexes (
). Markedly higher disease knowledge scores and GQOLI-74 scores were witnessed in the observation group in contrast to those of the control group (
). The observation group patients showed lower HAD scores than those of the control group (
). Conclusion. Self-practice oriented teaching plus psychological intervention could effectively alleviate the negative emotions of type 2 diabetic patients on first insulin therapy, stabilize glycemic indexes, and improve quality of life, demonstrating good potential for clinical promotion.
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A Booklet to Promote Psychological Health in New Families Affected by Craniosynostosis. J Craniofac Surg 2021; 33:1670-1673. [PMID: 34974462 DOI: 10.1097/scs.0000000000008454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Recent research indicates that parents of children with craniosynostosis may be at risk of emotional distress. Yet, parents may not be accessing the support they need to cope with common challenges. The aim of this project was to develop a research-informed booklet to promote psychological health in new families, and to assess acceptability of the booklet within the craniosynostosis community. The first draft was designed in close collaboration with leading UK charity Headlines Craniofacial Support 5 parent representatives, and 3 specialist clinical psychologists via online focus groups. The draft booklet, attached to an online acceptability survey, was distributed to a broader group of parents and multidisciplinary specialists working in craniofacial teams in England for feedback. A total of 44 complete responses to the online acceptability survey were received. Acceptability (measured by the number of respondents who would recommend the booklet) was 100%. All respondents reported they "agreed" or "strongly agreed" with the UK-wide distribution of the booklet. Evidence for psychological intervention in the craniofacial field remains scarce, and specialist teams may be under-resourced to effectively screen and support parents. It is hoped this booklet will begin to address the gap in psychological support for new families affected by craniosynostosis.
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Parental Reports of Intervention Services and Prevalence of Teasing in a Multinational Craniofacial Microsomia Pediatric Study. J Craniofac Surg 2021; 32:2687-2691. [PMID: 34727472 DOI: 10.1097/scs.0000000000007999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT Children with craniofacial microsomia (CFM) are at increased risk for educational and social concerns. This study describes intervention services and frequency of teasing in a multinational population of children with CFM. Caregivers of children with CFM ages 3 to 18 years in the US and South America were administered a questionnaire. Additional information was gathered from medical charts and photographs. Participants (N = 169) had an average age of 10.1 ± 6.2 years, were primarily male (60%), and from the US (46%) or Colombia (32%). Most participants had microtia and mandibular hypoplasia (70%). They often had unilateral (71%) or bilateral (19%) hearing loss and 53% used a hearing aid. In the US, special education services were provided for 48% of participants enrolled in school; however, similar services were rare (4%) in South America and reflect differences in education systems. Access to any intervention service was higher in the US (80%) than in South America (48%). Caregivers reported children showed diagnosis awareness by an average age of 4.4 ± 1.9 years. Current or past teasing was reported in 41% of the children, starting at a mean age of 6.0 ± 2.4 years, and most often took place at school (86%). As half of the US participants received developmental and academic interventions, providers should screen for needs and facilitate access to services. Given diagnosis awareness at age 4 and teasing at age 6, providers are encouraged to assess for psychosocial concerns and link to resources early in treatment.
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6
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Lu L, Yakupu A, Wu Y, Li X, Zhang P, Aihaiti G, Xu H. Quality of Life in Patients With Velopharyngeal Insufficiency in West China. Cleft Palate Craniofac J 2021; 59:1024-1029. [PMID: 34460333 DOI: 10.1177/10556656211034107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the quality of life (QOL) of patients with cleft lip and palate and velopharyngeal insufficiency (VPI) in relation to sex, age, age at initial cleft lip surgery, and age at initial cleft palate surgery. DESIGN This is a cross-sectional study. SETTING The study was conducted in a tertiary medical center. PARTICIPANTS The participants were caregivers of 72 patients with cleft lip and palate and VPI aged 4 to 20 years. MAIN OUTCOME MEASURE(S) Participants completed the Chinese version of the caregiver report of the VPI Effects on Life Outcomes (VELO) questionnaire. The Mann-Whitney U test was used to evaluate the patients' sex, age, age at initial cleft lip repair, and age at initial cleft palate repair in relation to VELO total score and domains. Spearman correlation analysis was completed including all study variables. Associations between the study variables and the VELO total score were tested using a generalized linear mixed model. RESULTS In the univariate analysis, patients' age and age at initial cleft palate surgery influenced the QOL of patients with VPI. There were no differences in the VELO total score or domains based on sex or age at first cleft lip surgery. In the generalized linear mixed model, patients older than 8 years had higher VELO total scores. CONCLUSIONS By caregiver report, the QOL of patients under age 8 years with VPI was lower than older patients. In addition, the caregiver impact domain was higher for parents of children who had their initial cleft palate surgery at age 2 years or younger.
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Affiliation(s)
- Lidan Lu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Aipiziguli Yakupu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Yanhui Wu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Xiangnan Li
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Pengxin Zhang
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Guliziba Aihaiti
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Postgraduate College of Xinjiang Medical University, Urumqi, China
| | - Hui Xu
- Department of Oral and Maxillofacial Surgery, 159426People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.,Stomatology School of Xinjiang Medical University, Urumqi, China
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7
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Klassen AF, Rae C, Wong Riff KW, Bulstrode N, Denadai R, Goldstein J, Hol ML, Murray DJ, Bracken S, Courtemanche DJ, O'Hara J, Butler D, Tassi A, Malic CC, Ganske IM, Phua YS, Marucci DD, Johnson D, Swan MC, Breuning EE, Goodacre TE, Pusic AL, Cano S. FACE-Q Craniofacial Module: Part 1 validation of CLEFT-Q scales for use in children and young adults with facial conditions. J Plast Reconstr Aesthet Surg 2021; 74:2319-2329. [PMID: 34274246 DOI: 10.1016/j.bjps.2021.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/09/2021] [Accepted: 05/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The CLEFT-Q includes 12 independently functioning scales that measure appearance (face, nose, nostrils, teeth, lips, jaws), health-related quality of life (psychological, social, school, speech distress), and speech function, and an eating/drinking checklist. Previous qualitative research revealed that the CLEFT-Q has content validity in noncleft craniofacial conditions. This study aimed to examine the psychometric performance of the CLEFT-Q in an international sample of patients with a broad range of facial conditions. METHODS Data were collected between October 2016 and December 2019 from 2132 patients aged 8 to 29 years with noncleft facial conditions. Rasch measurement theory (RMT) analysis was used to examine Differential Item Function (DIF) by comparing the original CLEFT-Q sample and the new FACE-Q craniofacial sample. Reliability and validity of the scales in a combined cleft and craniofacial sample (n=4743) were examined. RESULTS DIF was found for 23 CLEFT-Q items when the datasets for the two samples were compared. When items with DIF were split by sample, correlations between the original and split person locations showed that DIF had negligible impact on scale scoring (correlations ≥0.995). In the combined sample, RMT analysis led to the retention of original content for ten CLEFT-Q scales, modification of the Teeth scale, and the addition of an Eating/Drinking scale. Data obtained fit with the Rasch model for 11 scales (exception School, p=0.04). Person Separation Index and Cronbach alpha values met the criteria. CONCLUSION The scales described in this study can be used to measure outcomes in children and young adults with cleft and noncleft craniofacial conditions.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Karen Wy Wong Riff
- Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Neil Bulstrode
- Division of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, UK.
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo , Brazil.
| | - Jesse Goldstein
- Department of Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Marinka Lf Hol
- Department of Otolaryngocoloy and Head and Neck Surgery, University Medical Center Utrecht, Prinses Maxima Center for Childhood oncology, Utrecht, The Netherlands.
| | - Dylan J Murray
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | - Shirley Bracken
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | | | - Justine O'Hara
- Division of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, UK.
| | - Daniel Butler
- Division of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, UK.
| | - Ali Tassi
- Division of Graduate Orthodontics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Claudia C Malic
- Department of Surgery, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
| | - Ingrid M Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
| | - Yun S Phua
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, Brisbane, Australia.
| | - Damian D Marucci
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia.
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Marc C Swan
- Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Eleonore E Breuning
- Department of Plastic Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom.
| | - Tim Ee Goodacre
- Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Stefan Cano
- Modus Outcomes, Letchworth Garden City, United Kingdom.
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8
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Smith F, Fowler P, Ellis P. Long-term treatment outcomes from a patient's perspective with Treacher Collins syndrome. BMJ Case Rep 2021; 14:14/5/e241351. [PMID: 34045198 DOI: 10.1136/bcr-2020-241351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The management of patients with Treacher Collins Syndrome (TCS) is complex and involves many different specialists within multidisciplinary teams (MDT). The treatment pathway extends from birth well into adulthood and is associated with a heavy burden of care. Due to the extensive nature of the interaction with these patients, MDT members have opportunities to provide enhanced patient-centred care and support.This case report provides an overview of the current knowledge of the aetiology of TCS, the management of these patients and provides a unique perspective from one of the coauthors who has TCS and reports on his treatment experiences and long-term treatment outcomes. By having a better understanding of the impact of TCS and treatment provided, MDT members can not only provide improved clinical treatment but also offer improved patient experiences for those with craniofacial anomalies in particular an increased awareness of the psychosocial challenges they endure.
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Affiliation(s)
- Francis Smith
- University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Peter Fowler
- Orthodontic Department, University of Bristol School of Oral and Dental Sciences, Bristol, UK
| | - Pamela Ellis
- Orthodontic Department, Dorset County Hospital NHS Foundation Trust, Dorchester, Dorset, UK
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9
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Klassen AF, Rae C, Riff W, Denadai R, Murray DJ, Bracken S, Courtemanche DJ, Bulstrode N, O'Hara J, Butler D, Goldstein J, Tassi A, Hol ML, Johnson D, Ganske IM, Kölby L, Benitez S, Breuning EE, Malic CC, Allen GC, Pusic AL, Cano S. FACE-Q craniofacial module: Part 2 Psychometric properties of newly developed scales for children and young adults with facial conditions. J Plast Reconstr Aesthet Surg 2021; 74:2330-2340. [PMID: 34172403 DOI: 10.1016/j.bjps.2021.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/09/2021] [Accepted: 03/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The FACE-Q Craniofacial Module is a patient-reported outcome measure designed for patients aged 8 to 29 years with conditions associated with a facial difference. In part 1, we describe the psychometric findings for the original CLEFT-Q scales tested in patients with cleft and noncleft facial conditions. The aim of this study was to examine psychometric performance of new FACE-Q Craniofacial Module scales. METHODS Data were collected between December 2016 and December 2019 from patients aged 8 to 29 years with conditions associated with a visible or functional facial difference. Rasch measurement theory (RMT) analysis was used to examine psychometric properties of each scale. Scores were transformed from 0 (worst) to 100 (best) for tests of construct validity. RESULTS 1495 participants were recruited with a broad range of conditions (e.g., birthmarks, facial paralysis, craniosynostosis, craniofacial microsomia, etc.) RMT analysis resulted in the refinement of 7 appearance scales (Birthmark, Cheeks, Chin, Eyes, Forehead, Head Shape, Smile), two function scales (Breathing, Facial), and an Appearance Distress scale. Person separation index and Cronbach alpha values met criteria. Three checklists were also formed (Eye Function, and Eye and Face Adverse Effects). Significantly lower scores on eight of nine scales were reported by participants whose appearance or functional difference was rated as a major rather than minor or no difference. Higher appearance distress correlated with lower appearance scale scores. CONCLUSION The FACE-Q Craniofacial Module scales can be used to collect and compare patient reported outcomes data in children and young adults with a facial condition.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Wong Riff
- Department of Surgery, Hospital for Sick Children, ON Canada.
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil
| | - Dylan J Murray
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | - Shirley Bracken
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | | | - Neil Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom.
| | - Justine O'Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom.
| | - Daniel Butler
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom.
| | - Jesse Goldstein
- Department of Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA United States.
| | - Ali Tassi
- Division of Graduate Orthodontics, Schulich School of Medicine and Dentistry, Western University, London ON, Canada.
| | - Marinka Lf Hol
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands AND Princess Maxima Center for Childhood oncology, Utrecht, Netherlands.
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Ingrid M Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA United States.
| | - Lars Kölby
- University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska, University Hospital, Gothenburg, Sweden.
| | - Susana Benitez
- Department of Plastic Surgery, Clinica Las Condes, Santiago, Chile
| | - Eleonore E Breuning
- Department of Plastic Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom.
| | - Claudia C Malic
- University of Ottawa, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - Gregory C Allen
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, United States.
| | - Stefan Cano
- Modus Outcomes, Letchworth Garden City, United Kingdom.
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10
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Kamran R, Longmire NM, Rae C, Riff KWYW, Forrest CR, O’Hara J, Bulstrode N, Klassen AF. Concepts Important to Patients With Facial Differences: A Qualitative Study Informing a New Module of the FACE-Q for Children and Young Adults. Cleft Palate Craniofac J 2020; 58:1020-1031. [DOI: 10.1177/1055665620969589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The concepts important to children and young adults who undergo treatments for facial differences are not well-defined. Measurement of treatment outcomes from the patient’s perspective is necessary to ensure goals of treatment are met. We aimed to identify concepts important to children and young adults with facial differences through a qualitative study. Design: An interpretive description qualitative approach was followed. Semistructured interviews were conducted, transcribed verbatim, and coded using a line-by-line approach. Qualitative analysis led to the development of a conceptual framework of outcomes important to patients. Setting: Interviews were conducted in Canada and the United Kingdom at home, by telephone, or in the hospital. Participants: Participants (N = 72) were recruited between May and June 2014 from craniofacial clinics at the Hospital for Sick Children (Toronto) and Great Ormond Street Hospital (London). Participants included anyone with a visible and/or functional facial difference aged 8 to 29 years and fluent in English, excluding patients with a cleft. The sample included 38 females and 34 males, with a mean age of 13.9 years, and included 28 facial conditions (11 facial paralysis, 18 ear anomalies, 26 skeletal conditions, and 17 soft tissue conditions). Results: Analysis led to identification of important concepts within 4 overarching domains: facial appearance, facial function, adverse effects of treatment, and health-related quality of life (psychological, social, and school function). Conclusions: Our study provides an understanding of concepts important to children and young adults with facial differences.
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Affiliation(s)
- Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen W. Y. Wong Riff
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher R. Forrest
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Justine O’Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Neil Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Saydam SZ, Çüçülayef D, Doğan TN, Crerand CE, Özek M. Social Experiences of Turkish Parents Raising a Child With Apert Syndrome: A Qualitative Study. Cleft Palate Craniofac J 2020; 58:354-361. [PMID: 32744062 DOI: 10.1177/1055665620944761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Apert syndrome is a rare and understudied craniofacial condition with regard to its psychosocial impact on children and their parents. Due to the lack of studies focusing solely on the social experiences of children and families with Apert syndrome, it is difficult to develop interventions and strategies to support well-being and positive adjustment for this particular population. This study addressed this gap by assessing the unique social experiences of parents who are raising their children with Apert syndrome including difficulties they face and strategies they use to cope with challenges. DESIGN Descriptive qualitative study using thematic analysis. PARTICIPANTS Participants included 21 parents of 12 children (aged 1-12 years) with Apert syndrome (9 couples, 2 fathers, and 1 mother) who were recruited from a pediatric neurosurgery unit in Turkey. RESULTS The qualitative analysis yielded four main themes describing the experiences of parents including (1) social challenges; (2) coping with negative reactions; (3) promoting socialization and independence; and (4) sources of strength. CONCLUSIONS Parents reported several challenges, including social stigmatization, and utilized a range of strategies to support both their own and their child's positive adaptation and resiliency, including the use of religion and reliance on their spouses for support. Results offer clinically relevant insights about the strengths and challenges of families coping with Apert syndrome.
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Affiliation(s)
| | | | | | - Canice E Crerand
- Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, USA.,Department of Plastic Surgery, The Ohio State University School of Medicine, Columbus, OH, USA.,The Center for Biobehavioral Health, The Abigail Wexner Research Institute at 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Memet Özek
- Division of Pediatric Neurosurgery, Department of Neurosurgery, 162328Acıbadem University, Altunizade Mahallesi, Yurtcan Sokağı, Üsküdar/İstanbul, Turkey
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12
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Santoni C, Thaut M, Bressmann T. Immediate effects of voice focus adjustments on hypernasal speakers' nasalance scores. Int J Pediatr Otorhinolaryngol 2020; 135:110107. [PMID: 32480137 DOI: 10.1016/j.ijporl.2020.110107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore the immediate effects of voice focus adjustments on the oral-nasal balance of hypernasal speakers, measured with nasalance scores. METHODS Five hypernasal speakers (2 M, 3 F) aged 5-12 (SD 2.7) learned to speak with extreme forward and backward voice focus. Speakers repeated oral, nasal, and phonetically balanced stimuli. Nasalance scores were collected with the Nasometer 6450. RESULTS From the average baseline of 34.27% for the oral stimulus, nasalance increased to 46.07% in forward and decreased to 30.2% in backward focus. From the average baseline of 64.53% for the nasal stimulus, nasalance decreased to 64.13% in forward and decreased to 51.73% in backward focus. From the average baseline of 51.33% for the phonetically balanced stimulus, nasalance increased to 58.87% in forward and decreased to 46.2% in backward focus. CONCLUSIONS Forward voice focus resulted in higher and backward voice focus resulted in lower nasalance scores during speech for a group of hypernasal speakers. However, there was an exception: One male speaker showed decreased nasalance in forward voice focus. Future research should investigate the longer-term effectiveness of the intervention.
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Affiliation(s)
- Charlene Santoni
- Department of Music and Health Science, Faculty of Music, University of Toronto, Edward Johnson Building, 80 Queen's Park, Toronto, ON, M5S 2C5, Canada; Department of Speech-Language Pathology, University of Toronto, Rehabilitation Sciences Building, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Michael Thaut
- Department of Music and Health Science, Faculty of Music, University of Toronto, Edward Johnson Building, 80 Queen's Park, Toronto, ON, M5S 2C5, Canada.
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Rehabilitation Sciences Building, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
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13
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Stock NM, Hammond V, Hearst D, Owen T, Edwards Z, Ridley M, Rumsey N. Achieving Consensus in the Measurement of Psychological Adjustment to Cleft Lip and/or Palate at Age 8+ Years. Cleft Palate Craniofac J 2020; 57:746-752. [PMID: 31973561 DOI: 10.1177/1055665619898596] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Consensus regarding optimal outcome measurement has been identified as one of the most important, yet most challenging developments for the future of cleft lip and/or palate (CL/P) services. In 2011, a process began to adopt a shared conceptual framework and to identify a set of core outcome measures for the comprehensive assessment of psychological adjustment. OBJECTIVES The aim of the current article is to outline the collaborative process used to achieve consensus in the academic and clinical measurement of psychological adjustment to CL/P from the age of 8 years onward. RESULTS A conceptual framework and corresponding parent- and self-reported outcome measures for use at ages 8, 10, 12, 15, 18, 20, and 25 years have been agreed upon by clinicians, researchers, and patient and parent representatives. All measures have been evaluated according to their psychometric properties, clinical utility, ability to produce meaningful longitudinal data, and a range of pragmatic considerations. CONCLUSIONS Although the collaborative process has been challenging and has required ongoing dedication from multiple stakeholders, consistency in data collection over time will allow for key research questions in CL/P to be addressed, both in the United Kingdom (UK) and internationally. The process has also demonstrated the clinical utility of the measures and the potential for the gradual integration of the measures into clinical practice. UK progress has sparked global interest, and the adaptation of the framework and its corresponding measures for worldwide use is now a prominent focus.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Vanessa Hammond
- South Wales Cleft Service, Morriston Hospital, Swansea, United Kingdom
| | - Daniela Hearst
- Cleft Lip and Palate Service, Great Ormond Street Hospital, London, United Kingdom
| | - Tina Owen
- South West Cleft Service, University of Bristol Dental Hospital, Bristol, United Kingdom
| | - Zoe Edwards
- Cleft Lip and Palate Service, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Matthew Ridley
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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14
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Bous RM, Hazen RA, Baus I, Palomo JM, Kumar A, Valiathan M. Psychosocial Adjustments Among Adolescents With Craniofacial Conditions and the Influence of Social Factors: A Multi-Informant Study. Cleft Palate Craniofac J 2019; 57:624-636. [PMID: 31769310 DOI: 10.1177/1055665619888308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous studies have investigated psychosocial adjustments among adolescents with cleft lip and/or palate (CL/P), but our understanding of other craniofacial conditions remains limited. The objective of this study is to compare psychosocial adjustments among 3 groups of adolescents: craniofacial conditions other than cleft lip and/or palate (craniofacial anomaly [CFA]), CL/P, and controls (CON). Our secondary objective is to examine how social factors may predict the adjustments levels. DESIGN Cross-sectional, multi-informant, controlled survey study. PARTICIPANTS Aged 11- to 17-year olds. Craniofacial anomaly (n = 49), isolated CL/P (n = 42), and 55 CON. Total = 146. OUTCOME MEASURES The Strengths and Difficulties Questionnaire (self-report, parent report, and teacher report). RESULTS All 3 informant groups displayed similar patterns, where CFA reported the highest difficulties, followed by CL/P, while CON scored the lowest. Parent reports demonstrated significant differences among the 3 groups for most subscales and were emphasized for peer problems. Self-reports showed significant differences between CFA and CON for total scores and peer problems, while teacher reports showed significant differences for peer problems only. Craniofacial anomaly displayed the highest frequency of abnormal psychosocial adjustments, followed by CL/P. Experiencing bullying or teasing predicted increased difficulties, while having a good friend predicted decreased difficulties. CONCLUSIONS Adolescents with CFA, and to a lesser extent CL/P, may be at a higher risk of having psychosocial problems. Peer problems may constitute the biggest challenge that CFA and CL/P confront. Social factors, especially being bullied or having a good friend, may predict the psychosocial well-being of adolescents with craniofacial conditions.
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Affiliation(s)
- Rany M Bous
- Craniofacial, Surgical and Special Care Orthodontics Fellowship Program, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rebecca A Hazen
- Departments of Pediatrics and Psychology, Case Western Reserve University School of Medicine.,Division of Developmental/Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, University Hospital's Cleveland Medical Center, Cleveland, OH, USA
| | - Irene Baus
- Cleft and Craniofacial Center, Rainbow Babies and Children's Hospital, University Hospital's Cleveland Medical Center, Cleveland, OH, USA
| | - J Martin Palomo
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Anand Kumar
- Department of Pediatric Plastic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Plastic Surgery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Manish Valiathan
- Craniofacial, Surgical and Special Care Orthodontics Fellowship Program, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
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15
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Abstract
Clinicians use different diagnostic terms for patients with underdevelopment of facial features arising from the embryonic first and second pharyngeal arches, including first and second branchial arch syndrome, otomandibular dysostosis, oculoauriculovertebral syndrome, and hemifacial microsomia. Craniofacial microsomia has become the preferred term. Although no diagnostic criteria for craniofacial microsomia exist, most patients have a degree of underdevelopment of the mandible, maxilla, ear, orbit, facial soft tissue, and/or facial nerve. These anomalies can affect feeding, compromise the airway, alter facial movement, disrupt hearing, and alter facial appearance.
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Affiliation(s)
- Craig Birgfeld
- Pediatric Plastic and Craniofacial Surgery, Seattle Children's Hospital, 4800 Sand Point Way, M/S OB.9.520, PO Box 5371, Seattle, WA 98105, USA.
| | - Carrie Heike
- Craniofacial Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way, M/S OB.9.528, PO Box 5371, Seattle, WA 98105, USA
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