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Harding S, Burr S, Cleland J, Stringer H, Wren Y. Outcome measures for children with speech sound disorder: an umbrella review. BMJ Open 2024; 14:e081446. [PMID: 38684261 PMCID: PMC11086453 DOI: 10.1136/bmjopen-2023-081446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/12/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE Speech sound disorder (SSD) describes a 'persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication'. There is a need to establish which care pathways are most effective and efficient for children with SSD. Comparison of care pathways requires clearly defined, evidence-based, interventions and agreement on how to measure the outcomes. At present, no definitive list of assessments, interventions or outcomes exists. The objective of this umbrella review paper is to provide a rigorous and detailed list of assessments, interventions and outcomes which target SSD in children. DESIGN In December 2022, a systematic search of Ovid Medline, OVID Embase, CINAHL, PsycInfo and Cochrane and a number of grey literature platforms were undertaken. 18 reviews were included, and subsequently 415 primary research articles were assessed for data related to assessments, interventions or outcomes. The AMSTAR (Assessing the Methodological Quality of Systematic Reviews) framework was used to assess the quality of the retained reviews. SETTING Reviews were retained which took place in any setting. PARTICIPANTS The population is children of any age with a diagnosis of SSD of unknown origin. PRIMARY AND SECONDARY OUTCOME MEASURES Reviews reporting outcomes, assessment and interventions for children with SSD. RESULTS Extraction and analysis identified 37 assessments, 46 interventions and 30 outcome measures used in research reporting of SSD. Not all of the listed outcomes were linked to specific outcome measurement tools, but these were measurable through the use of one or more of the assessments extracted from the retained reviews. CONCLUSIONS The findings of this review will be used to develop a Core Outcome Set for children with SSD. The findings are part of a rigorous process essential for advancing healthcare research and practice in the specific area of speech and language therapy for children with SSD. PROSPERO REGISTRATION NUMBER CRD42022316284.
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Affiliation(s)
- Sam Harding
- Southmead Hospital, Bristol, UK
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | - Sam Burr
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | - Joanne Cleland
- Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Helen Stringer
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Westbury on Trym, UK
- Bristol Dental School, University of Bristol, Bristol, UK
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Stringer H, Cleland J, Wren Y, Rees R, Williams P. Speech sound disorder or DLD (phonology)? Towards a consensus agreement on terminology. Int J Lang Commun Disord 2023. [PMID: 38059693 DOI: 10.1111/1460-6984.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 11/15/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The publication of phase 2 of the CATALISE project in 2017 clarified terminology for children with developmental language disorder (DLD) or delay but unintentionally muddied the water for children with unintelligible speech. A diagnostic label of DLD (phonology) indicates poor prognosis and phonological disorder that persists into middle childhood. However, in contrast to other diagnostic labels that fall under the overarching term of speech sound disorder (SSD), DLD (phonology) does not elucidate the characteristics of the child's speech nor does it point us in the direction of appropriate intervention. AIMS The aim of this paper is to discuss terminology in SSD leading to an evidence-based model which builds on the model of DLD developed in CATALISE, supports descriptive diagnosis and signposts intervention. METHODS Following a focused review of literature proposing or describing terminology for SSD, an expert group of researchers in developmental SSD proposed a revised model of existing terminology. Groups of UK speech and language therapists (SLTs) who provide services for children with SSD were asked to comment on its acceptability and feasibility. DISCUSSION A three-level terminology model was developed. This comprised an overarching Level 1 term; Level 2 terms that differentiated SSD of unknown origin from SSD with associated or underlying conditions; and specific diagnostic terms at Level 3 to support further assessment and intervention decisions. Consulted SLTs generally expressed agreement with the proposed terminology and a willingness to adopt it in practice. CONCLUSIONS Existing terminology for childhood SSD provides a good basis for clinical decision-making. A modified version of Dodd's (2005) terminology was found to be acceptable to UK SLTs. There is an evident overlap of SSD with CATALISE terminology. However more detailed and specialist terminology than 'DLD (phonology)' is required to support clinical decision-making. It is proposed that endorsement by the UK Royal College of Speech and Language Therapists would obviate the need for a Delphi process. WHAT THIS PAPER ADDS What is already known on this subject Over nearly a hundred years, as our knowledge and understanding of speech sound disorder (SSD) has increased, so has the terminology that is used to describe those disorders. Current terminology not only describes subtypes of SSD but can also signpost us to effective interventions. With the publication, in 2017, of phase 2 of CATALISE a new term of 'developmental language disorder (DLD) (phonology)' was introduced with the unintentional consequence of challenging more specific descriptive terms for SSD. What this paper adds In the context of CATALISE and DLD (phonology), the history and nature of SSD terminology are reappraised. Building on the model of DLD developed in CATALISE, a tiered model that supports descriptive diagnosis and signposts intervention is proposed for discussion. Clinical implications of this study The proposed model of terminology for SSD provides descriptive and detailed labels that will support accuracy in differential diagnosis of developmental SSD by speech and language therapists. Furthermore, a decision-making tree for SSD demonstrates the pathway from diagnostic use of the terminology to the selection of evidence-based, effective interventions.
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Affiliation(s)
- Helen Stringer
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
- Bristol University, Bristol, UK
- Cardiff University, Cardiff, Wales, UK
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Cleland J, Blitz J, Cleutjens KBJM, Oude Egbrink MGA, Schreurs S, Patterson F. Robust, defensible, and fair: The AMEE guide to selection into medical school: AMEE Guide No. 153. Med Teach 2023; 45:1071-1084. [PMID: 36708606 DOI: 10.1080/0142159x.2023.2168529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Selection is the first assessment of medical education and training. Medical schools must select from a pool of academically successful applicants and ensure that the way in which they choose future clinicians is robust, defensible, fair to all who apply and cost-effective. However, there is no comprehensive and evidence-informed guide to help those tasked with setting up or rejuvenating their local selection process. To address this gap, our guide draws on the latest research, international case studies and consideration of common dilemmas to provide practical guidance for designing, implementing and evaluating an effective medical school selection system. We draw on a model from the field of instructional design to frame the many different activities involved in doing so: the ADDIE model. ADDIE provides a systematic framework of Analysis (of the outcomes to be achieved by the selection process, and the barriers and facilitators to achieving these), Design (what tools and content are needed so the goals of selection are achieved), Development (what materials and resources are needed and available), Implementation (plan [including piloting], do study and adjust) and Evaluation (quality assurance is embedded throughout but the last step involves extensive evaluation of the entire process and its outcomes).HIGHLIGHTSRobust, defensible and fair selection into medical school is essential. This guide systematically covers the processes required to achieve this, from needs analysis through design, development and implementation, to evaluation of the success of a selection process.
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Affiliation(s)
- J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - J Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - K B J M Cleutjens
- School of Health Professions Education, Maastricht University, the Netherlands
| | - M G A Oude Egbrink
- School of Health Professions Education, Maastricht University, the Netherlands
| | - S Schreurs
- School of Health Professions Education, Maastricht University, the Netherlands
- Centrum for Evidence Based Education, University of Utrecht, the Netherlands
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Cleland J. Ultrasound Tongue Imaging in Research and Practice with People with Cleft Palate ± Cleft Lip. Cleft Palate Craniofac J 2023:10556656231202448. [PMID: 37715630 DOI: 10.1177/10556656231202448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Ultrasound tongue imaging is becoming popular as a tool for both phonetic research and biofeedback for treating speech sound disorders. Despite this, it has not yet been adopted into cleft palate ± cleft lip care. This paper explores why this might be the case by highlighting recent research in this area and exploring the advantages and disadvantages of using ultrasound in cleft palate ± cleft lip care. Research suggests that technological advances have largely overcome some of the difficulties of employing ultrasound with this population and we predict a future increase in the clinical application of the tool.
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Affiliation(s)
- Joanne Cleland
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Patrick K, Fricke S, Rutter B, Cleland J. Clinical application of usage-based phonology: Treatment of cleft palate speech using usage-based electropalotography. Int J Speech Lang Pathol 2023:1-16. [PMID: 37652151 DOI: 10.1080/17549507.2023.2238924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
PURPOSE To investigate whether a novel electropalatography (EPG) therapy, underpinned by usage-based phonology theory, can improve the accuracy of target speech sounds for school-aged children and adults with persistent speech sound disorder (SSD) secondary to cleft palate +/- lip. METHOD Six consecutively treated participants (7-27 years) with long-standing speech disorders associated with cleft palate enrolled in a multiple baseline (ABA) within-participant case series. The usage-based EPG therapy technique involved high-volume production of words. Speech was assessed on three baselines prior to therapy, during weekly therapy, at completion of therapy, and 3 months post-therapy. Percent correct of target phonemes in untreated words and continuously connected speech were assessed through acoustic phonetic transcription. Intra- and inter-transcriber agreement was determined. RESULT Large to medium treatment effect sizes were shown for all participants following therapy (15-33 sessions). Percentage of targets correct for untreated words improved from near 0% pre-therapy, to near 100% for most target sounds post-therapy. Generalisation of target sounds to spontaneous connected speech occurred for all participants and ranged from 78.95-100% (M = 90.66; SD = 10.14) 3 months post-therapy. CONCLUSION Clinically significant speech change occurred for all participants following therapy. Response to the novel therapeutic technique is encouraging and further research is indicated.
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Affiliation(s)
- Kathryn Patrick
- Regional Cleft Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Silke Fricke
- Division of Human Communication Sciences, The University of Sheffield, Sheffield, UK and
| | - Ben Rutter
- Division of Human Communication Sciences, The University of Sheffield, Sheffield, UK and
| | - Joanne Cleland
- School of Psychological Sciences and Health, The University of Strathclyde, Glasgow, UK
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Dokovova M, Sugden E, Cartney G, Schaeffler S, Cleland J. Tongue Shape Complexity in Children With and Without Speech Sound Disorders. J Speech Lang Hear Res 2023; 66:2164-2183. [PMID: 37267440 DOI: 10.1044/2023_jslhr-22-00472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE This study investigates the hypothesis that younger speakers and speakers with more severe speech sound disorders are more likely to use simpler (undifferentiated) tongue gestures due to difficulties with, or immaturity of, lingual motor control. METHOD The hypothesis is tested using cross-sectional secondary data analysis of synchronous audio and high-speed ultrasound recordings from children with idiopathic speech sound disorders (n = 30, aged 5;0-12;11 [years;months]) and typically developing children (n = 29, aged 5;8-12;10), producing /a/, /t/, /ɹ/, /l/, /s/, and /ʃ/ in an intervocalic /aCa/ environment. Tongue shape complexity is measured using NINFL (Number of INFLections) and modified curvature index (MCI) from splines fitted to ultrasound images at the point of maximal lingual gesture. Age, perceived accuracy, and consonant are used as predictors. RESULTS The results suggest that as age increases, children with speech sound disorders have lower MCI compared to typically developing children. Increase in age also led to decrease of MCI for the typically developing group. In the group of children with speech sound disorders, perceptually incorrect /ɹ/ productions have lower MCI than correct productions, relative to /a/. CONCLUSIONS There is some evidence of systematic tongue shape complexity differences between typically developing children and children with speech sound disorders when accounting for increase in age. Among children with speech sound disorders, increase in age and perceptually incorrect consonant realizations are associated with decreasing tongue shape complexity.
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Affiliation(s)
- Marie Dokovova
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Ellie Sugden
- School of Health Sciences, Western Sydney University, Richmond, New South Wales, Australia
| | - Gemma Cartney
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Sonja Schaeffler
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
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Mirihagalla Kankanamalage I, Cleland J, Cohen W. Translation and validation of the Intelligibility in Context Scale into Sinhala for adolescents in Sri Lanka with cleft lip and palate. Clin Linguist Phon 2023; 37:398-414. [PMID: 36093956 DOI: 10.1080/02699206.2022.2120417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 05/20/2023]
Abstract
The Intelligibility in Context Scale (ICS) is a parent-report screening tool used to measure parents' perceptions of children's functional intelligibility. This tool has been translated into over 60 languages and found to have a good reliability and validity. The purpose of the current study was to translate the ICS into Sinhala (the ICS-SIN), the main language spoken by the Sinhalese people in Sri Lanka, and to validate it with both typically developing (TD) children and children with repaired cleft lip and/or palate (CLP). The translation process followed the forward-backward-forward method. A total of 88 parents of TD children and children with CLP aged 12-15 years old (TD n = 50, CLP n = 38) completed the ICS-SIN questionnaire. Parents of TD and CLP children reported their children's speech as most intelligible to parents and least intelligible to strangers. The ICS-SIN had high internal consistency for both groups (TD α = 0.87, p < 0.05, CLP α = 0.97, p < 0.05). The ICS-SIN total scores and item scores showed significant correlations, indicating a good construct validity. TD participant group's ICS-SIN average mean scores (M = 4.88, SD = 0.29) were significantly higher compared to the CLP ICS-SIN average mean scores (M = 4.64, SD = 0.67) and varied according to gender in both groups, suggesting good discriminant validity. The ICS-SIN has overall good psychometric properties. Therefore, this tool has the potential to be used as a valid parent-rating screening tool for clinical and research purposes in Sri Lanka.
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Affiliation(s)
| | - Joanne Cleland
- Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Wendy Cohen
- Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Aakko I, Kauramäki J, Cleland J, Lee A, Vainio M, Saalasti S. Auditory-perceptual evaluation with visual analogue scale: feasibility and preliminary evidence of ultrasound visual feedback treatment of Finnish [r]. Clin Linguist Phon 2023; 37:345-362. [PMID: 36106455 DOI: 10.1080/02699206.2022.2118079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/30/2022] [Accepted: 06/02/2022] [Indexed: 05/20/2023]
Abstract
Accumulating evidence suggests that ultrasound visual feedback increases the treatment efficacy for persistent speech sound errors. However, the available evidence is mostly from English. This is a feasibility study of ultrasound visual feedback for treating distortion of Finnish [r]. We developed a web-based application for auditory-perceptual judgement. We investigated the impact of listener's experience on perceptual judgement and the intra-rater reliability of listeners. Four boys (10-11 years) with distortion of [r], otherwise typical development, partook in eight ultrasound treatment sessions. In total, 117 [r] samples collected at pre- and post-intervention were judged with visual analogue scale (VAS) by two listener groups: five speech and language therapists (SLTs) and six SLT students. We constructed a linear mixed-effects model with fixed effects for time and listener group and several random effects. Our findings indicate that measurement time had a significant main effect on judgement results, χ2 = 78.82, p < 0.001. Effect of listener group was non-significant, but a significant main effect of interaction of group × time, χ2 = 6.33, p < 0.012 was observed. We further explored the effect of group with nested models, and results revealed a non-significant effect of group. The average intra-rater correlation of the 11 listeners was 0.83 for the pre-intervention samples and 0.92 for post-intervention showing a good or excellent degree of agreement. Finnish [r] sound can be evaluated with VAS and ultrasound visual feedback is a feasible and promising method in treatment for distortion of [r], and its efficacy should be further assessed.
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Affiliation(s)
- Iida Aakko
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jaakko Kauramäki
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
| | - Alice Lee
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Martti Vainio
- Department of Digital Humanities, University of Helsinki, Helsinki, Finland
| | - Satu Saalasti
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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Cleland J, Dokovova M, Crampin L, Campbell L. An Ultrasound Investigation of Tongue Dorsum Raising in Children with Cleft Palate +/- Cleft Lip. Cleft Palate Craniofac J 2023:10556656231158965. [PMID: 36843478 DOI: 10.1177/10556656231158965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVE This study aimed to determine whether increased raising of the back of the tongue is evident in children with repaired cleft palate with or without cleft lip (CP+/-CL). We hypothesized that children with CP+/-CL would show increased raising of the tongue dorsum, a compensatory pattern. METHOD Secondary data analysis of mid-sagittal ultrasound tongue imaging data from 31 children with CP+/-CL and 29 typically developing children were used. We annotated the consonants /ʃ, t, s, k/ at the point of maximum constriction in an /aCa/ environment. Children with CP+/-CL said the tokens 10 times, typically developing children said them once. We automatically fitted splines to the tongue contour and extracted the Dorsum Excursion Index (DEI) for each consonant. This metric measures the relative use of the tongue dorsum, with more posterior consonants having higher values. We compared DEI values across groups and consonants using a linear mixed effects model. DEI was predicted by the interaction of consonant (baseline: /ʃ/) and speaker type (baseline: TD), including by-speaker random slopes for consonant and random intercepts for speaker. RESULTS Overall DEI was not higher in children with CP+/-CL compared to typically developing children. Between groups the only significant difference was the position of /k/ relative to /ʃ/, where the difference between these two consonants was smaller in the children with CP+/-CL. CONCLUSIONS There was no support for the hypothesis that increased raising of the tongue dorsum is a common characteristic in children with repaired CP+/-CL. However, individual children may present with this pattern.
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Affiliation(s)
- Joanne Cleland
- 150865School of Psychological Sciences and Health, University of Strathclyde Glasgow, Glasgow G1 1XQ, UK
| | - Marie Dokovova
- 150865School of Psychological Sciences and Health, University of Strathclyde Glasgow, Glasgow G1 1XQ, UK
| | - Lisa Crampin
- Speech and Language Therapy, Children's Hospital, Glasgow, G51 4TF, UK
| | - Linsay Campbell
- Speech and Language Therapy, Children's Hospital, Glasgow, G51 4TF, UK
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Harding S, Burr S, Cleland J, Stringer H, Wren Y. Outcome measures for children with speech sound disorder: an umbrella review protocol. BMJ Open 2023; 13:e068945. [PMID: 36797019 PMCID: PMC9936291 DOI: 10.1136/bmjopen-2022-068945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Speech sound disorder (SSD) describes a 'persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication'. There is a need to establish which care pathways are most effective and efficient for children with SSD. Comparison of care pathways requires clearly defined, evidence-based interventions and agreement on how to measure the outcomes. At present, no list of assessments, interventions or outcomes exists.The objective of this paper is to provide a rigorous and detailed protocol for an umbrella review of assessments, interventions and outcomes that target SSD in children. The protocol details the development of a search strategy and trial of an extraction tool. METHODS AND ANALYSES The umbrella review has been registered with PROSPERO (CRD42022316284). Papers included can use a review methodology of any sort but must include children of any age, with an SSD of unknown origin. In accordance with the Joanna Briggs Institute scoping review methods guidelines, an initial search of the Ovid Emcare and Ovid Medline databases was conducted. Following this, a final search strategy for these databases were produced. A draft extraction form was developed. ETHICS AND DISSEMINATION Ethical approval is not needed for an umbrella review protocol. Following the systematic development of an initial search strategy and extraction form, an umbrella review of this topic can take place. Dissemination of findings will be through peer-reviewed publications, social media, and patient and public engagement.
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Affiliation(s)
- Sam Harding
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Westbury on Trym, UK
- Department of Research and Innoviation, North Bristol NHS Trust, Westbury on Trym, UK
| | - Sam Burr
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | - Joanne Cleland
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Helen Stringer
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Westbury on Trym, UK
- Bristol Dental School, University of Bristol, Bristol, UK
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Sugden E, Cleland J. Using ultrasound tongue imaging to support the phonetic transcription of childhood speech sound disorders. Clin Linguist Phon 2022; 36:1047-1066. [PMID: 34605343 DOI: 10.1080/02699206.2021.1966101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
This study aims to determine whether adding an additional modality (ultrasound tongue imaging) improves the inter-rater reliability of phonetic transcription in childhood speech sound disorders (SSDs) and whether it enables the identification of different or additional errors in children's speech. Twenty-three English speaking children aged 5-13 years with SSDs of unknown origin were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio and ultrasound. Two types of transcriptions were undertaken off-line: (1) ultrasound-aided transcription by two ultrasound-trained speech-language pathologists (SLPs) and (2) traditional phonetic transcription from audio recordings, completed by the same two SLPs and additionally by two different SSD specialist SLPs. We classified transcriptions and errors into ten different subcategories and compared: the number of consonants identified as in error by each transcriber; the inter-rater reliability; and the relative frequencies of error types identified by the different types of transcriber. Results showed that error-detection rates were different across the transcription types, with the ultrasound-aided transcribers identifying more errors than were identified using traditional audio-only transcription. Analysis revealed that these additional errors were identified on the dynamic ultrasound image despite being transcribed as correct, suggestive of subtle motor speech differences. Interrater reliability for classifying the type of error was substantial (κ = 0.72) for the ultrasound-aided transcribers and ranged from fair to moderate for the audio-only transcribers (κ = 0.38 to 0.52). Ultrasound-aided transcribers identified more instances of increased variability and abnormal timing errors than the audio-only transcribers.
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Affiliation(s)
- Eleanor Sugden
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Khadka J, Hutchinson C, Milte R, Cleland J, Muller A, Bowes N, Ratcliffe J. Assessing feasibility, construct validity, and reliability of a new aged care-specific preference-based quality of life instrument: evidence from older Australians in residential aged care. Health Qual Life Outcomes 2022; 20:159. [PMID: 36456953 PMCID: PMC9713096 DOI: 10.1186/s12955-022-02065-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Quality of Life-Aged Care Consumers (QOL-ACC) is a new older-person-specific quality of life instrument designed for application in quality assessment and economic evaluation in aged care. The QOL-ACC was designed from its inception with older people receiving aged care services ensuring its strong content validity. Given that the QOL-ACC has already been validated in home care settings and a preference-weighted value set developed, we aimed to assess feasibility, construct validity and reliability of the QOL-ACC in residential aged care settings. METHODS: Individuals living in residential aged care facilities participated in an interviewer-facilitated survey. The survey included the QOL-ACC, QCE-ACC (quality of aged care experience measure) and two other preference-based quality of life instruments (ASCOT and EQ-5D-5L). Feasibility was assessed using missing data and ceiling/floor effects. Construct validity was assessed by exploring the relationship between the QOL-ACC and other instruments (convergent validity) and the QOL-ACC's ability to discriminate varying levels of self-rated health and quality of life. Internal consistency reliability was assessed using Cronbach's alpha (α). RESULTS Of the 200 residents (mean age, 85 ± 7.7 years) who completed the survey, 60% were female and 69% were born in Australia. One in three participating residents self-rated their health as fair/poor. The QOL-ACC had no missing data but had small floor effects (0.5%) and acceptable ceiling effects (7.5%). It demonstrated moderate correlation with ASCOT (r = 0.51, p < 0.001) and EQ-5D-5L (r = 0.52, p < 0.001) and a stronger correlation with the QCE-ACC (r = 0.57, p < 0.001). Residents with poor self-rated health and quality of life had significantly lower scores on the QOL-ACC. The internal consistency reliability of the QOL-ACC and its dimensions was good (α = 0.70-0.77). CONCLUSIONS The QOL-ACC demonstrated good feasibility, construct validity and internal consistency reliability to assess aged care-related quality of life. Moderate correlations of the QOL-ACC and other instruments provide evidence of its construct validity and signifies that the QOL-ACC adds non-redundant and non-interchangeable information beyond the existing instruments. A stronger correlation with the QCE-ACC than other instruments may indicate that quality of life is more intimately connected with the care experience than either health- or social-related quality of life in residential aged care settings.
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Affiliation(s)
- J Khadka
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia ,grid.430453.50000 0004 0565 2606Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia Australia
| | - C Hutchinson
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - R Milte
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - J Cleland
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - A Muller
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia Australia
| | - N Bowes
- Uniting AgeWell, Melbourne, VIC Australia
| | - J Ratcliffe
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
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McMillan FJ, Bond C, Inch J, Cleland J. Does the Scottish pharmacist post-registration foundation programme change self-reported competence? A before and after questionnaire study. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac089.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Abstract
Introduction
The two-year Post-registration Foundation Programme for pharmacists in Scotland1, is based on an eight-element framework, and supports early career pharmacists to develop core competences relevant to all sectors of practice. Pharmacists have 6 monthly appraisals and are assessed by an online portfolio and a summative OSCE.
Aim
The aim of this paper is to describe the changes in pharmacists’ self-reported competence at the end-of-programme compared to baseline.
Methods
Eligible participants were pharmacists from any sector registering for the programme in September 2017/February 2018. They were invited by email to complete an online questionnaire at baseline and exit to assess their self-reported level of competence with 19 statements linked to the framework using a ten-point Likert scale (1 not at all confident ,10 very confident). Additional questions on expectations (baseline only) and experiences (end-of-programme only: resources used, general views on the programme and suggestions for improvement (open text) were included. No reminders were sent. Questionnaires were hosted on a Qualtrics platform. Data was collated in Excel then exported to an SPSS version 27 database. Analyses were based on the sub-sample who completed both questionnaires; frequencies and means/SD are reported and changes from baseline to end-of-programme compared using paired t test. Open-text responses were subjected to content analysis. Ethical approval was not required for this evaluation.
Results
Ninety-six pharmacists registered for the programme: 14 males; 11 Health Boards. To date 56 have completed the programme (5 community, 34 hospital, 15 hospital/primary-care and 2 primary-care). Baseline and end-of-programme questionnaires were completed by 73/96 pharmacists (76% response) and 54/87 (50 completers and 4 early exiters) (62.1% response) respectively. 37 pharmacists completed both questionnaires. At the end-of-programme there was improvement in self-reported competence across all statements compared to baseline. Based on a paired t-test changes were significant for all competencies at p<0.001, apart from demonstrating a non-discriminatory attitude which was significant at p<0.05 and was the competency at baseline with the highest self-reported competence (9.36, SD 1.16 cf 9.89, SD 0.32). Regular meetings with tutors/NES staff and support from colleagues and healthcare professionals were the resources rated most highly. Around 50% of participants rated the NES resource booklets, guidance documents and the assessment handbook essential/very useful. 15% found NES personnel input essential and 45% rated peer sessions essential/very useful. FPs commented that undertaking the training had; increased confidence, improved clinical skills, increased ability to reflect, furthered their career prospects and enabled progression to independent prescribing. It had also improved: knowledge and skills, patient care, ability to support other health care professionals. Suggestions for improvement related to the online portfolio, support, and the final assessment.
Discussion/Conclusion
Limitations include small numbers and programme delivery limited to Scotland. Overall, there was a marked improvement in all competency and practice statements at programme exit. Resources provided were generally rated useful and had been utilised. The training programme had also had a positive impact on confidence, reflective practice, and enabled progress to Independent Prescribing courses.
References
1. Post- registration Foundation Programme for Newly Qualified Pharmacists in Scotland https://nes.scot.nhs.uk/our-work/post-registration-foundation-programme-for-newly-qualified-pharmacists-in-scotland-autumn-2021-onwards/ Accessed October 12th, 2021
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Affiliation(s)
| | - C Bond
- Institute of Applied Health Sciences, University of Aberdeen , Aberdeen, Scotland
| | - J Inch
- Institute of Applied Health Sciences, University of Aberdeen , Aberdeen, Scotland
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University , Singapore
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McMillan FJ, Bond C, Inch J, Cleland J. Foundation pharmacists’ experiences of personal development whilst undertaking the nes post-registration foundation programme: a qualitative study (Scotland). International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac089.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Abstract
Introduction
The NES post-registration Foundation Programme1 for pharmacists introduced in 1989, has recently been extended to primary-care and community sectors. The programme, approximately two years in duration, is based on a competency framework (six core elements & 2 sector specific). Foundation pharmacists (FPs) are assigned a tutor, have 6 monthly appraisals, and are assessed by an e-portfolio and OSCE.
Aim
The aim of this paper is to describe FPs’ experiences and personal development when undertaking the Programme. This study is part of larger mixed methods evaluation of the Programme.
Methods
Eligible participants were pharmacists registering with the programme in September 2017/February 2018. NES staff sent emails inviting them to take part in either a focus group or interview (face-to-face or virtual) at baseline, mid-point, and-programme completion, to explore their expectations and experiences of the programme. Proceedings were digitally recorded, transcribed, and managed using NVivo. Analysis was inductive and thematic2 and synthesised in relation to Bandura’s Social Cognitive theory3 (SCT) which posits that learning and knowledge enhancement are related to interaction between environmental, person/cognitive, and behavioural factors. Facilitators and barriers to undertaking the Programme were identified. IRAS advised ethical approval was not required; NHS Research & Development approval was given.
Results
Ninety-six pharmacists registered for the Programme. In total 22 participated in 7 baseline focus groups, 7 in 2 midway focus group/3 in interviews, and 4 in end-of-programme interviews. At baseline environmental factors predominated in motivation to undertake the Programme such as the structured approach and robust support network (tutors, peers & NES). These also contributed to the perceived facilitators for programme completion. Conversely environmental factors linked to the external working environment could also be barriers. Person/cognitive factors were other motivators to undertaking the Programme because of perceived improved employability, and benefits of increased confidence. Finally, the behavioural domain also contributed to motivation with perceptions of benefits in both transferable and clinical skills. At midway, pharmacists confirmed their improvements in both the personal/cognitive domain (confidence, resilience, reflective practice) and the behavioural domain of clinical and transferable skills. Facilitators (support & resources) and barriers (lack of support, time, and feedback) were almost exclusively environmental. Comments around professional identity also emerged inextricably linked to FPs’ relationships with and recognition by other members of the HCP team. At programme end the views from the midway point remain unchanged. Perceived skills had increased largely in the behavioural domain but also in the person/cognitive domain with understanding the value of reflective practice emerging as a key area of improvement and being reported as influencing professional identity. Facilitators were solely reported in terms of environmental factors relating to extensive support networks and barriers again related to environmental factors which included lack of support, resources, and external influences. Views of the programme overall were very positive
Discussion/Conclusion
All three SCT factors influenced the learning and development of the FPs, but environmental influences dominated the barriers. As a qualitative study these results cannot be generalised, but they highlight areas to explore in more details for future programme delivery.
References
1. Post-registration Foundation Programme for Newly Qualified Pharmacists in Scotland. Available from: https://nes.scot.nhs.uk/our-work/post-registration-foundation-programme-for-newly-qualified-pharmacists-in-scotland-autumn-2021-onwards/ Accessed July 25, 2022
2. Braun, V., Clarke, V. Using thematic analysis in psychology. Qualitative Research in Psychology, 2006;3(2):77-101. ISSN 1478-0887. Available from: http://eprints.uwe.ac.uk/11735 Accessed October 12, 2021
3. Bandura, A. Social learning theory. Englewood Cliffs, N.J.: Prentice Hall; 1977.
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Affiliation(s)
| | - C Bond
- Institute of Applied Health Sciences, University of Aberdeen , Aberdeen, Scotland
| | - J Inch
- Institute of Applied Health Sciences, University of Aberdeen , Aberdeen, Scotland
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University , Singapore
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Cleland J, Bill V, Williams E, Shelton C. Retained desflurane in decommissioned vaporisers: a national problem? Anaesthesia 2022; 78:651-652. [PMID: 36437774 DOI: 10.1111/anae.15930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- J Cleland
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - V Bill
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - E Williams
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Shelton
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Allen JE, Cleland J, Smith M. An initial framework for use of ultrasound by speech and language therapists in the UK: Scope of practice, education and governance. Ultrasound 2022; 31:92-103. [PMID: 37144231 PMCID: PMC10152317 DOI: 10.1177/1742271x221122562] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/07/2022] [Indexed: 11/05/2022]
Abstract
Background: There is growing evidence to support the use of ultrasound as a tool for the assessment and treatment of speech, voice and swallowing disorders across the Speech and Language Therapy profession. Research has shown that development of training competencies, engagement with employers and the professional body are vital to progressing ultrasound into practice. Methods: We present a framework to support translation of ultrasound into Speech and Language Therapy. The framework comprises three elements: (1) scope of practice, (2) education and competency and (3) governance. These elements align to provide a foundation for sustainable and high-quality ultrasound application across the profession. Results: Scope of practice includes the tissues to be imaged, the clinical and sonographic differentials and subsequent clinical decision-making. Defining this provides transformational clarity to Speech and Language Therapists, other imaging professionals and those designing care pathways. Education and competency are explicitly aligned with the scope of practice and include requisite training content and mechanisms for supervision/support from an appropriately trained individual in this area. Governance elements include legal, professional and insurance considerations. Quality assurance recommendations include data protection, storage of images, testing of ultrasound devices as well as continuous professional development and access to a second opinion. Conclusion: The framework provides an adaptable model for supporting expansion of ultrasound across a range of Speech and Language Therapy specialities. By taking an integrated approach, this multifaceted solution provides the foundation for those with speech, voice and swallowing disorders to benefit from advances in imaging-informed healthcare.
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Affiliation(s)
- Jodi Elizabeth Allen
- The National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Mike Smith
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Cleland J, Crampin L, Campbell L, Dokovova M. Protocol for SonoSpeech Cleft Pilot: a mixed-methods pilot randomized control trial of ultrasound visual biofeedback versus standard intervention for children with cleft lip and palate. Pilot Feasibility Stud 2022; 8:93. [PMID: 35477444 PMCID: PMC9043876 DOI: 10.1186/s40814-022-01051-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Children with cleft lip and palate can continue to have problems producing clear speech after surgery. This can lead to social, emotional, and educational challenges. Typical treatment involves teaching children the correct tongue movements to produce speech sounds. This is known as articulation intervention. However, this intervention is challenging because the tongue is hidden from view and movements are difficult to see and describe. This pilot randomized control trial will try a new treatment, ultrasound visual biofeedback (U-VBF) versus standard articulatory intervention for children with cleft lip and palate, as comparison. Feasibility outcomes will be determined. Methods/design The Sonospeech project will enroll up to 40 children with cleft lip and palate aged 4;6 to 16 in a mixed-methods randomized controlled trial with blinded assessors. Children will receive either six sessions of U-VBF or articulation intervention. The primary goals of this pilot are to assess the feasibility and inform the design of a full-scale RCT of U-VBF for children with cleft speech characteristics. This will be achieved by determining the following outcome measures: recruitment/attrition rates; measures of pre-post follow-up completion; and acceptability of the randomization and interventions to families. Discussion Larger trials of speech interventions for children with cleft lip and palate are needed. This pilot/feasibility study will determine whether a larger randomized control trial comparing ultrasound and articulation interventions is feasible. Trial registration ISRCTN, ISRCTN17441953. Registered 22 March 2021. See Table 2 in Appendix 1 for all items.
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Affiliation(s)
| | - Lisa Crampin
- NHS Greater Glasgow and Clyde, Glasgow, Scotland
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18
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McMillan FJ, Bond C, Inch J, Bartlett S, Bullock A, Cleland J. Is the post-registration foundation programme fit for purpose for community pharmacists? An exploration of pharmacist experiences. International Journal of Pharmacy Practice 2022. [PMCID: PMC9383647 DOI: 10.1093/ijpp/riac021.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction The two-year, NHS Education for Scotland (NES) post-registration foundation programme supports early career pharmacists in patient-facing sectors of practice. The experiential programme, based on an eight-element competency framework, also includes webinars, online resources, and tutor support. Learners complete an online evidence portfolio and undertake a summative OSCE. Aim The aim of this paper is to report the experiences of the community-pharmacist participants, with a focus on the ‘fitness-for-purpose’ of the programme. Methods This was a longitudinal mixed-methods study theoretically underpinned by Miller’s triangle and social cognitive theory. Eligible participants were all pharmacists registering for the programme in Scotland in September 2017 and February 2018, all participating Welsh community-pharmacists, and all tutors. Invitation packs were emailed by NES/HEIW staff with names forwarded to researchers following signed consent. Focus groups/interviews (face-to-face or virtual according to participant preference) were undertaken at start, mid-point and exit of programme, to explore expectations (benefits, social gains, professional identify), experiences (challenges, facilitators, meeting of learners’ needs) and barriers. Proceedings were digitally recorded, transcribed verbatim and managed using NVivo. Thematic analysis (1) was based on social cognitive theory (transferable behavioural skills and professional attitudes). An inductive analysis additionally identified emergent themes. Participants in Scotland were invited to complete an on-line base-line questionnaire to describe their self-assessed competence against the NES Foundation framework (personal and professional practice, membership of healthcare team, communication, patient centred approach to practice). Data was analysed in SPSS using descriptive statistics. Themes from qualitative and quantitative data were integrated. IRAS ethical approval was not required; NHS Research & Development approval was given. Results 96 pharmacists registered for the programme: 18 community-pharmacists in Scotland (11 health boards); 14 community pharmacists in Wales. In Scotland 15 community-pharmacists completed questionnaires: 9 expected an ‘increase in confidence’ and 11 to provide ‘better patient care’. Self-assessed competence against the framework was generally high. Across Scotland and Wales, 12 focus-groups (involving 19 community-pharmacists), 12 community-pharmacist interviews, 10 tutor focus-groups (8 community-pharmacist tutors) and 3 community-pharmacist tutor interviews were conducted. At midpoint and exit pharmacists and tutors reported increased confidence, the ability to reflect and pride in their achievement. Barriers: included lack of protected time; workload; and lack of support (tutor and employer). There were also programme issues (practicalities of portfolio; workplace-based assessment, no access to medical records); and cultural issues in community-pharmacy (‘speed & safety’; lack of recognition). Reasons for dropping out of the programme included: moved geographical area; too experienced; workload pressures; no incentive; no employer support. Four community-pharmacists in Scotland and none in Wales completed the programme. Conclusion Study limitations include the small numbers, programme delivery limited to Scotland and Wales, and limited response rate to focus-groups/interviews, exacerbated by COVID19. Overall community pharmacist expectations were met, and they perceived the programme was fit-for-purpose and worthwhile. However, barriers particularly related to the community pharmacy context, may have led to the high drop-out rate. These findings should be considered as the new UK-wide RPS curriculum for foundation pharmacists (2) is implemented in Scotland, to optimise its successful delivery. References (1) Braun, V. and Clarke, V. Using thematic analysis in psychology. Qualitative Research in Psychology. [Internet]. 2006; 3 (2): 77-101. ISSN 1478-0887 Available from: http://eprints.uwe.ac.uk/11735 (2) Post- registration Foundation Programme for Newly Qualified Pharmacists in Scotland [Internet] https://nes.scot.nhs.uk/our-work/post-registration-foundation-programme-for-newly-qualified-pharmacists-in-scotland-autumn-2021-onwards Accessed October 12, 2021.
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Affiliation(s)
- F J McMillan
- Pharmacy, NHS Education for Scotland, Glasgow, Scotland
| | - C Bond
- Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - J Inch
- Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | | | - A Bullock
- CUREMeDE, University of Cardiff, Wales
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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19
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Roxburgh Z, Cleland J, Scobbie JM, Wood SE. Quantifying changes in ultrasound tongue-shape pre- and post-intervention in speakers with submucous cleft palate: an illustrative case study. Clin Linguist Phon 2022; 36:146-164. [PMID: 34496688 DOI: 10.1080/02699206.2021.1973566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 08/02/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
Ultrasound Tongue Imaging is increasingly used during assessment and treatment of speech sound disorders. Recent literature has shown that ultrasound is also useful for the quantitative analysis of a wide range of speech errors. So far, the compensatory articulations of speakers with cleft palate have only been analysed qualitatively. This study provides a pilot quantitative ultrasound analysis, drawing on longitudinal intervention data from a child with submucous cleft palate. Two key ultrasound metrics were used: 1. articulatory t-tests were used to compare tongue-shapes for perceptually collapsed phonemes on a radial measurement grid and 2. the Mean Radial Difference was reported to quantify the extent to which the two tongue shapes differ, overall. This articulatory analysis supplemented impressionistic phonetic transcriptions and identified covert contrasts. Articulatory errors identified in this study using ultrasound were in line with errors identified in the speech of children with cleft palate in previous literature. While compensatory error patterns commonly found in speakers with cleft palate have been argued to facilitate functional phonological development, the nature of our findings suggest that the compensatory articulations uncovered are articulatory in nature.
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Affiliation(s)
- Z Roxburgh
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, Scotland
| | - J Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
| | - J M Scobbie
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, Scotland
| | - S E Wood
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, Scotland
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McKeever L, Cleland J, Delafield-Butt J. Using ultrasound tongue imaging to analyse maximum performance tasks in children with Autism: a pilot study. Clin Linguist Phon 2022; 36:127-145. [PMID: 34060400 DOI: 10.1080/02699206.2021.1933186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 06/12/2023]
Abstract
This study proposes a protocol for assessing speech motor control in children using maximum performance tasks with simultaneous acoustic and ultrasound recording. The protocol was piloted on eight children with autism spectrum disorders and nine typically developing children. Diadochokinesis rate, accuracy, and consistency were elicited using an imitation paradigm where speakers repeat mono-, bi-, and tri-syllabic stimuli at increasing rates. Both traditional measures of rate, accuracy and consistency and an ultrasound tongue-shape analysis of slow versus fast productions were undertaken. Preliminary results suggest that the protocol is feasible with children with communication disorders. Instrumental measures suggest greater variability in tongue movements in the children with autism that is not detected using perceptual measures of accuracy. A subgroup of children with autism showed some evidence of differences in speech motor control. Ultrasound tongue imaging appears to be a useful method for gaining additional insight into speech motor control.
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Affiliation(s)
- Louise McKeever
- Psychological Science and Health, University of Strathclyde, Glasgow, UK
| | - Joanne Cleland
- Psychological Science and Health, University of Strathclyde, Glasgow, UK
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Jones Y, Cleland J, Li C, Pellicori P, Friday J. Inter operator variability of machine learning researchers predicting all-cause mortality in patients admitted to intensive care unit. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The number of publications using machine learning (ML) to predict cardiovascular outcomes and identify clusters of patients at greater risk has risen dramatically in recent years. However, research papers which use ML often fail to provide sufficient information about their algorithms to enable results to be replicated by others in the same or different datasets.
Aim
To test the reproducibility of results from ML algorithms given three different levels of information commonly found in publications: model type alone, a description of the model, and complete algorithm.
Methods
MIMIC-III is a healthcare dataset comprising detailed information from over 60,000 intensive care unit (ICU) admissions from the Beth Israel Deaconess Medical Centre between 2001 and 2012. Access is available to everyone pending approval and completion of a short training course.
Using this dataset, three models for predicting all-cause in-hospital mortality were created, two from a PhD student working in ML, and one from an existing research paper which used the same dataset and provided complete model information. A second researcher (a PhD student in ML and cardiology) was given the same dataset and was tasked with reproducing their results. Initially, this second researcher was told what type of model was created in each case, followed by a brief description of the algorithms. Finally, the complete algorithms from each participant were provided. In all three scenarios, recreated models were compared to original models using Area Under the Receiver Operating Characteristic Curve (AUC).
Results
After excluding those younger than 18 years and events with missing or invalid entries, 21,139 ICU admissions remained from 18,094 patients between 2001 and 2012, including 2,797 in-hospital deaths. Three models were produced: two Recurrent Neural Networks (RNNs) which differed significantly in internal weights and variables, and a Boosted Tree Classifier (BTC). The AUC of the first reproduced RNN matched that of the original RNN (Figure 1), however the second RNN and the BTC could not be reproduced given model type alone. As more information was provided about these algorithms, the results from the reproduced models matched the original results more closely.
Conclusions
In order to create clinically useful ML tools with results that are reproducible and consistent, it is vital that researchers share enough detail about their models. Model type alone is not enough to guarantee reproducibility. Although some models can be recreated with limited information, this is not always the case, and the best results are found when the complete algorithm is shared. These findings have huge relevance when trying to apply ML in clinical practice.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Jones
- University of Glasgow, Glasgow, United Kingdom
| | - J Cleland
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - C Li
- University of Glasgow, Glasgow, United Kingdom
| | - P Pellicori
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - J Friday
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
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Ellis R, Scrimgeour D, Cleland J, Lee A, Brennan P. 50 A Cross-Sectional Study Examining the Association Between MRCS Performance and Surgeons Receiving Fitness to Practice Sanctions. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Fitness to practice (FtP) investigations by the General Medical Council (GMC) can be one of the most stressful experiences in a surgeon’s career. Demographic factors are known to alter the likelihood of GMC investigation. Despite this there are no studies assessing risk factors in surgeons for FtP sanctions. Thus, we used the newly created Intercollegiate Membership of Royal College of Surgeons (MRCS) examination database to identify risk factors for and the prevalence of GMC sanctions in early-career surgeons.
Method
FtP sanction data contained in the GMC list of registered medical practitioners (LRMP) database was linked at person-level to all UK graduates who had attempted MRCS Part A or Part B between September 2007 and January 2020. Data were anonymised by the Royal College of Surgeons of England prior to analysis.
Results
f 11,660 candidates who had attempted the MRCS within the study period only 31 (0.3%) candidates had GMC FtP sanctions within the last two years. Of these, 12 had active conditions on their registration, 7 had active undertakings and 14 had warnings. Candidate demographics were similar between cohorts and there were no significant differences between MRCS performance identified.
Conclusions
In this, the largest study of MRCS candidates to date, the prevalence of active FtP sanctions in early-career surgeons was 0.3%, significantly lower than the prevalence of sanctions across more experienced UK surgeons (0.9%). These data highlight early-career surgeons as a low-risk group for disciplinary action and should reassure patients and medical professionals of the rarity of FtP sanctions.
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Affiliation(s)
- R Ellis
- Urology Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - D Scrimgeour
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, United Kingdom
| | - A Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
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Falconer R, Semple C, Cleland J, Walker K, Watson A. 751 Improving Engagement with Home-Based Surgical Skills Simulation. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Surgical simulation has been repeatedly shown to facilitate technical skill acquisition. However, trainee engagement with self-directed practice remains variable, despite access to resources. Understanding the motivators and barriers to participation is crucial to develop modules which can effectively meet the learning needs of current, and future, surgical trainees. The aim of this qualitative study was to examine factors which influence trainee engagement with home-based surgical skills simulation.
Method
A series of one-to-one semi-structured interviews were conducted remotely with ST3 vascular trainees who had previously consented to take part in a national programme of home-based technical skills simulation. Interview data was transcribed and thematically analysed.
Results
12 trainees were interviewed during a 4-week period. Overall, trainees valued simulation but found it difficult to balance against clinical commitments and mandatory training requirements, particularly if there were limited opportunities for skill transfer to the real-world environment. Although simulation was acknowledged to be a safe environment for experiential learning, trainees alluded to an underlying culture of perfection which limited willingness to learn from mistakes, even within a simulated setting. In addition, traditional attitudes about the apprenticeship model of surgical training prevail, with simulation often viewed as inferior to learning “on the job” in theatre.
Conclusions
Trainee engagement with home-based surgical skills simulation may be influenced by a range of systemic factors. In future, formal certification of simulation modules, mandating simulated competencies and curricular integration may help improve participation, as well as supporting cultural shift towards recognition of simulation as a vital component of modern surgical training.
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Affiliation(s)
- R Falconer
- Centre for Health Science, Inverness, United Kingdom
| | - C Semple
- Department of Vascular Surgery, Victoria Hospital, Kirkcaldy, United Kingdom
| | - J Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - K Walker
- Centre for Health Science, Inverness, United Kingdom
- Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom
| | - A Watson
- Centre for Health Science, Inverness, United Kingdom
- Department of General Surgery, Raigmore Hospital, Inverness, United Kingdom
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24
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Ellis R, Scrimgeour D, Cleland J, Lee A, Brennan P. 238 MRCS Performance Predicts Surgical Career Outcomes. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Successful completion of the MRCS examination is mandatory for progression into higher surgical (registrar) training in the UK. National selection for training programmes is a highly competitive process. Despite this, the ranking of applicants does not currently include MRCS performance scores. This offers a unique opportunity to compare two independent assessments of surgical trainees to establish whether MRCS performance can predict future surgical career outcomes and competitiveness in training.
Method
All UK candidates who attempted MRCS between 2007-2020 were matched to career outcome data using the GMC list of registered medical practitioners and anonymised (n = 2910). Chi-squared tests determined associations with first attempt MRCS pass/fail outcomes. Multinomial regression models were developed to establish the predictive power of success at MRCS in determining surgical specialty and training deanery choices.
Results
There was statistically significant variability in MRCS Part A pass rates, ranging from 55.1%-76.7% between surgical specialties (P=0.001) but no significant variability in Part B pass rates (P=0.655). There was significant variability in Part A and Part B pass rates between training deaneries (P=0.010 and P=0.036 respectively). Pass rates ranged from 59.9%-77.7% for Part A and 70.1%-85.0% for Part B between training deaneries. Those in more competitive specialties and training deaneries performed better in MRCS in terms of first attempt pass rate, scores and number of attempts taken to pass.
Conclusions
MRCS performance is an early predictor of surgical career choice and competitiveness. Trainees who perform well at MRCS are more likely to enter competitive surgical specialties and training deaneries.
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Affiliation(s)
- R Ellis
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - D Scrimgeour
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, Aberdeen, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - A Lee
- Department of Medical Statistics, University of Aberdeen., Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
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25
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Shah AP, Cleland J. 1253 Unlocking Growth Options in Surgical Education and Training During the Pandemic. Br J Surg 2021. [PMCID: PMC8524564 DOI: 10.1093/bjs/znab259.901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction The COVID-19 pandemic brought widespread disruption to structured surgical education and training. The knee-jerk reaction is often pessimism about surgical training’s future, particularly in the Improved Surgical Training (IST) pilot’s context. However, Einstein famously once said, “In the midst of every crises lies great opportunity”. Unlocking growth during periods of high uncertainty is a premise of real options theory; one utilised by supply chain managers and decision scientists, but novel to medical education. This study explores the growth options that have resulted from new operational models during the pandemic. Method Using a qualitative case study approach, data were obtained from interviews with core surgical trainees across Scotland. Data coding and inductive thematic analysis were undertaken. Results Forty-six trainees participated. Analysis from trainees’ perspective revealed: unexpected fulfilment from redeployment to non-surgical specialties, benefits to personal development from the unintended broad-based training across surgical specialties, improved collaborative teamworking between specialties and allied healthcare professionals, and enhanced supervised learning opportunities. Institutional growth options reported by trainees included: rapid uptake of telemedicine and digital technology, implementation of single hospital episode encounters for minor conditions, streamlined processes in theatre and acute admissions, and changes in working culture towards rationalising and teamworking. Conclusions Growth options have been deliberately and unintentionally unlocked due to individual and institutional adaptions and innovations in response to the exogenous disruption. While some changes may be temporary, hopefully structured reflection on these changes and responders to them will drive surgical education and training into a new sustainable and resilient post-pandemic era.
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Affiliation(s)
- A P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen., Aberdeen, United Kingdom
| | - J Cleland
- Medical Education Research and Scholarship Unit (MERSU), LKC School of Medicine, Singapore, Singapore
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26
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Ellis R, Scrimgeour D, Cleland J, Lee A, Brennan P. 51 The Impact of Disability on Performance in the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS). Br J Surg 2021. [DOI: 10.1093/bjs/znab258.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The number of clinicians with disabilities is increasing, however there is no data on the performance of doctors with registered disabilities in the postgraduate environment. If we are to ensure diversity and equality within the workforce, we must first identify whether attainment differences exist in markers of performance. To address this, we assessed the impact of disabilities on performance in the MRCS.
Method
All UK medical graduates who had attempted MRCS Part A (n = 9,597) and Part B (n = 4,562) between 2007-2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included. Univariate analysis identified associations with MRCS performance and logistic regression models identified independent predictors of success.
Results
Candidates with registered disabilities (n = 635) had lower MRCS Part A pass rates (46.3% vs 59.8% (p < 0.001)) but similar Part B pass rates (68.2% vs 70.9% (p = 0.339)). They were nearly twice as likely to fail Part A (odds ratio 0.55 [95% Confidence Interval 0.46-0.64]). When prior academic attainment (A-Levels and medical school performance) was accounted for, there was no statistically significant difference in the likelihood of MRCS success (p>0.05). Pass rates were similar for candidates with specific learning difficulties and those with other registered disabilities (p>0.05).
Conclusions
This is the first study to assess the impact of disability status and type on performance at a postgraduate medical examination. It appears that candidates with registered disabilities performed less well in formal, written examinations generally. Although our data indicate that current MRCS testing accommodations are fair, enabling performance unrestricted by disability.
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Affiliation(s)
- R Ellis
- Urology Department, Nottingham University Hospitals, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - D Scrimgeour
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - A Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, London, United Kingdom
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27
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Cleland J, Williams MAK. Anomalous diffusion driven by the redistribution of internal stresses. Phys Rev E 2021; 104:014123. [PMID: 34412333 DOI: 10.1103/physreve.104.014123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/21/2021] [Indexed: 11/07/2022]
Abstract
This article explores the mathematical description of anomalous diffusion, driven not by thermal fluctuations but by internal stresses. A continuous time random walk framework is outlined in which the waiting times between displacements (jumps), generated by the dynamics of internal stresses, are described by the generalized Γ distribution. The associated generalized diffusion equation is then identified. The solution to this equation is obtained as an integral over an infinite series of Fox H functions. The probability density function is identified as initially non-Gaussian, while at longer timescales Gaussianity is recovered. Likewise, the second moment displays a transient nature, shifting between subdiffusive and diffusive character. The potential application of this mathematical description to the quaking observed in several soft-matter systems is discussed briefly.
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Affiliation(s)
- J Cleland
- School of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand.,Riddet Institute, Palmerston North 4442, New Zealand
| | - M A K Williams
- School of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand.,Riddet Institute, Palmerston North 4442, New Zealand.,The MacDiarmid Institute for Advanced Materials and Nanotechnology, Wellington 6140, New Zealand
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28
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Ellis R, Cleland J, Scrimgeour D, Lee AJ, Brennan PA. The impact of disability on performance in a high-stakes postgraduate surgical examination: a retrospective cohort study. J R Soc Med 2021; 115:58-68. [PMID: 34269623 DOI: 10.1177/01410768211032573] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Despite rising numbers of doctors in the workforce with disabilities, little is known about the impact of disabilities on postgraduate performance. To ensure all groups are treated fairly in surgical training, it is essential to know whether any attainment differences exist in markers of surgical performance. To address this gap, we assessed the impact of disabilities on performance on the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS). DESIGN Retrospective cohort study. SETTING Secondary care. PARTICIPANTS All UK MRCS candidates attempting Part A (n = 9600) and Part B (n = 4560) between 2007 and 2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included. MAIN OUTCOME MEASURES Chi-square tests and correlation coefficients established univariate associations with MRCS performance, while multiple logistic regressions identified independent predictors of success. RESULTS Though MRCS Part B pass rates were similar (p = 0.339), candidates with registered disabilities had significantly lower first-attempt Part A pass rates (46.3% vs. 59.8%, p < 0.001). Candidates with disabilities also performed less well in examinations taken throughout school and medical school, and after adjusting for prior academic performance and sociodemographic predictors of success, logistic regression found that candidates with disabilities were no less likely to pass MRCS than their peers (odds ratio 1.04, 95% confidence interval 0.66 to 1.62). No significant variation was found in MRCS performance between type of disability or degree of limitations caused by disability (p > 0.05). CONCLUSION Although candidates with registered disabilities performed less well in formal, written examinations, our data indicate that they are as likely to pass MRCS at first attempt as their peers who achieved similar grades at high school and medical school. In order to enable equity in career progression, further work is needed to investigate the causes of attainment differences in early career assessments.
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Affiliation(s)
- R Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.,Urology Department, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - J Cleland
- 371018Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Dsg Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.,Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - A J Lee
- Department of Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, UK
| | - P A Brennan
- Department of Maxillo-Facial Surgery, 112006Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
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29
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Cleland J, Scobbie JM. The Dorsal Differentiation of Velar From Alveolar Stops in Typically Developing Children and Children With Persistent Velar Fronting. J Speech Lang Hear Res 2021; 64:2347-2362. [PMID: 33719530 DOI: 10.1044/2020_jslhr-20-00373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study has two key aims: first, to provide developmental articulatory norms for the alveolar-velar distinction in 30 English-speaking typically developing (TD) children; second, to illustrate the utility of the reported measures for classifying and quantifying the speech of children with a history of persistent velar fronting as they develop the contrast longitudinally. Method This study involved secondary data analysis of the UltraSuite corpus comprising ultrasound tongue imaging recordings of speech materials from 30 typical children and longitudinal data from five children with persistent velar fronting undergoing ultrasound visual biofeedback intervention. We present two new measures of coronal dorsal differentiation: KTMax and KT crescent area. These measures distinguish /k/ and /t/ by quantifying the magnitude of this distinction in absolute spatial terms (mm of linear dorsal difference). For the typical children, we report these measures in corner vowel contexts. We then compare these to dorsal productions by the children with speech disorders, before, during, and after intervention. Results Both measures reliably distinguished /k/ and /t/ in TD children. There was an effect of vowel, with larger KTmax and KT crescent area in /a/ and /o/ vowel contexts than in an /i/ context. The children with persistent velar fronting showed KTmax values near zero before intervention, showing a complete merger between /k/ and /t/. During intervention, they showed variable KTmax values. Post intervention, they showed values within the range of typical children. Conclusions This study provides articulatory norms derived from ultrasound tongue imaging for the dorsal differentiation in alveolar and velar stops in TD children. By applying these norms to children with persistent velar fronting as they acquire this contrast, we see that /k/ is acquired in an articulatorily gradient manner.
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Affiliation(s)
- Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - James M Scobbie
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Musselburgh, United Kingdom
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30
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Ellis R, Cleland J, Scrimgeour DSG, Lee AJ, Brennan PA. A cross-sectional study examining the association between MRCS performance and surgeons receiving sanctions against their medical registration. Surgeon 2021; 20:211-215. [PMID: 34030984 DOI: 10.1016/j.surge.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/20/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fitness to practice (FtP) investigations by the General Medical Council (GMC) safeguard patients and maintain the integrity of the medical profession. The likelihood of FtP sanctions is influenced by specialty and socio-demographic factors and can be predicted by performance at postgraduate examinations. This is the first study to characterise the prevalence of FtP sanctions in early-career surgeons and to examine the association with performance at the Membership of the Royal College of Surgeons (MRCS) examination. METHODS All UK graduates who attempted MRCS between September 2007-January 2020 were matched to the GMC list of registered medical practitioners. Clinicians who had active FtP sanctions between 28th August 2018 and 28th August 2020 were identified. Data were anonymised by RCS England prior to analysis. RESULTS Of 11,660 candidates who attempted MRCS within the study period, only 31 (0.3%) had FtP sanctions between 2018 and 2020. Of these, 12 had active conditions on registration, seven had undertakings and 14 had warnings. There was no statistically significant difference in MRCS performance in either Parts A or B of the examination for those with and those free from FtP sanctions (P > 0.05). CONCLUSIONS In this, the largest study of MRCS candidates to date, the prevalence of active FtP sanctions in early-career surgeons was 0.3%, significantly lower than the prevalence of sanctions across more experienced UK surgeons (0.9%). These data highlight early-career surgeons as a low-risk group for disciplinary action and should reassure patients and medical professionals of the rarity of FtP sanctions.
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Affiliation(s)
- R Ellis
- Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, United Kingdom; Urology Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - D S G Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, United Kingdom; Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, United Kingdom
| | - A J Lee
- Department of Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD, United Kingdom
| | - P A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, United Kingdom
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31
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Ellis R, Brennan P, Cleland J, A. Lee, D. Scrimgeour. 221 UK Medical School Selection Criteria Predicts Success in Part A of The Intercollegiate Membership of The Royal College of Surgeons (MRCS) Examination. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Selection into UK medical school typically involves a combination of three measures: prior academic attainment, selection tests (e.g., the University Clinical Aptitude Test (UCAT), Biomedical Admissions Test (BMAT), Graduate Medical School Admissions Test (GAMSAT)), and an interview. We investigated whether prior attainment and selection test scores can predict MRCS success.
Method
We used the UKMED database to analyse selection data for all UK graduates who attempted MRCS Part A (n = 9729) and Part B (n = 4644) between 2007-2017. Univariate analysis and Pearson correlation coefficients were used to examine the relationship between selection scores and first attempt MRCS success.
Results
Successful MRCS Part A candidates had better A-Levels and higher scores in UCAT, BMAT and GAMSAT examinations (p < 0.001) than their unsuccessful peers. No statistically significant difference was observed for MRCS Part B. A moderate positive correlation was found between Part A, BMAT (r = 0.315, p < 0.001) and GAMSAT scores (r = 0.346, p < 0.001). A weak positive correlation was found between Part A, A-Level (r = 0.144, p < 0.001) and UCAT scores (r = 0.246, p < 0.001).
Conclusions
A-level results and medical school selection tests predict success in the knowledge-based (Part A) MRCS examination.
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Affiliation(s)
- R Ellis
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, United Kingdom
- Urology Department, Nottingham University Hospitals, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - A. Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - D. Scrimgeour
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
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32
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Ellis R, Scrimgeour D, Brennan P, Lee A, Cleland J. 191 Performance at Medical School and Foundation Programme Selection Can Predict Success in The MRCS Examination. Br J Surg 2021. [DOI: 10.1093/bjs/znab135.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Identifying factors that predict success in the Membership of the Royal College of Surgeons (MRCS) examination can aid trainees’ exam preparation and help deaneries identify candidates likely to require additional support. We assessed whether performance at Medical School and UK Foundation Programme selection (Educational Performance Measurement (EPM) and Situational Judgement Test (SJT)) predicted MRCS success.
Method
We analysed data from the UKMED Database for UK graduates who had attempted MRCS Part A (n = 1,975) and Part B (n = 630) between 2013-2017. Univariate analysis examined the relationship between performance and the likelihood of passing MRCS at first attempt. Logistic regression identified independent predictors of MRCS success.
Results
Each additional EPM decile increased the chances of passing MRCS by 52% for Part A (odds ratio 1.52 [95% confidence interval 1.46-1.60]) and 27% for Part B (1.27 [1.18-1.38]). Each EPM point awarded for degrees increased the likelihood of passing Part A by 29% (1.29 [1.12-1.48]). SJT score was not a statistically significant independent predictor of MRCS success (P>0.05).
Conclusions
This is the first study to investigate the relationship between UK medical school performance and postgraduate surgical exam success. Higher ranked students are more likely to succeed in the MRCS compared to their lower ranked peers.
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Affiliation(s)
- R Ellis
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, United Kingdom
- Urology Department, Nottingham University Hospitals, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, Royal Colleges of Surgeons, United Kingdom
| | - D Scrimgeour
- Intercollegiate Committee for Basic Surgical Examinations, Royal Colleges of Surgeons, United Kingdom
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, Royal Colleges of Surgeons, United Kingdom
| | - A Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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33
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Ellis R, Scrimgeour D, Cleland J, Lee A, Brennan P. 220 Choice of UK Medical School Predicts Success in The Intercollegiate Membership of The Royal College of Surgeons (MRCS) Examination. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
UK medical schools vary in terms of factors such as mission, specific curricula and pedagogy. As relatively little is understood about the impact of these differences at a post-graduate level, we examined the relationship between medical school and MRCS success.
Method
Using the UKMED database we analysed data on UK medical graduates who attempted MRCS Part A (n = 9729) and MRCS Part B (n = 4644) between 2007-2017. Univariate analysis characterised the relationship between medical school and first attempt MRCS success. Logistic regression modelling identified independent predictors of MRCS success.
Results
MRCS pass rates differed significantly between medical schools (P < 0.001). Trainees from standard-entry 5-year programmes were more likely to pass MRCS at first attempt compared to those from extended (Gateway) courses ((Part A (Odds Ratio (OR) 3.72 [95% Confidence Interval (CI) 2.69-5.15]); Part B (OR 1.67 [1.02-2.76])). Non-graduates were more likely to pass Part A (OR 1.40 [1.19-1.64]) and Part B (OR 1.66 [1.24-2.24]). Russell Group graduates were more likely to pass MRCS Part A (OR 1.79 [1.56-2.05]) and Part B (OR 1.24 [1.03-1.49])).
Conclusions
Medical programme and medical school are associated with MRCS success. Further research is needed to tease out the relationship between individual factors, medical school and MRCS performance.
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Affiliation(s)
- R Ellis
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, United Kingdom
- Urology Department, Nottingham University Hospitals, Nottingham, United Kingdom
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
| | - D Scrimgeour
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - A Lee
- Department of Medical Statistics, University of Aberdeen, Aberdeen, United Kingdom
| | - P Brennan
- Intercollegiate Committee for Basic Surgical Examinations, RCS, United Kingdom
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34
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Uijl A, Vaartjes I, Denaxas S, Hemingway H, Shah A, Cleland J, Grobbee D, Hoes A, Asselbergs FW, Koudstaal S. Temporal trends in heart failure medication prescription in a population-based cohort study. BMJ Open 2021; 11:e043290. [PMID: 33653753 PMCID: PMC7929882 DOI: 10.1136/bmjopen-2020-043290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We examined temporal heart failure (HF) prescription patterns in a large representative sample of real-world patients in the UK, using electronic health records (EHR). METHODS From primary and secondary care EHR, we identified 85 732 patients with a HF diagnosis between 2002 and 2015. Almost 50% of patients with HF were women and the median age was 79.1 (IQR 70.2-85.7) years, with age at diagnosis increasing over time. RESULTS We found several trends in pharmacological HF management, including increased beta blocker prescriptions over time (29% in 2002-2005 and 54% in 2013-2015), which was not observed for mineralocorticoid receptor-antagonists (MR-antagonists) (18% in 2002-2005 and 18% in 2013-2015); higher prescription rates of loop diuretics in women and elderly patients together with lower prescription rates of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers, beta blockers or MR-antagonists in these patients; little change in medication prescription rates occurred after 6 months of HF diagnosis and, finally, patients hospitalised for HF who had no recorded follow-up in primary care had considerably lower prescription rates compared with patients with a HF diagnosis in primary care with or without HF hospitalisation. CONCLUSION In the general population, the use of MR-antagonists for HF remained low and did not change throughout 13 years of follow-up. For most patients, few changes were seen in pharmacological management of HF in the 6 months following diagnosis.
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Affiliation(s)
- Alicia Uijl
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - Ilonca Vaartjes
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
- Alan Turing Institute, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- Alan Turing Institute, London, UK
| | - Anoop Shah
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
| | - J Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Diederick Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arno Hoes
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Stefan Koudstaal
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Purcell C, Daw P, Kerr C, Cleland J, Cowie A, Dalal HM, Ibbotson T, Murphy C, Taylor R. Protocol for an implementation study of an evidence-based home cardiac rehabilitation programme for people with heart failure and their caregivers in Scotland (SCOT:REACH-HF). BMJ Open 2020; 10:e040771. [PMID: 33277287 PMCID: PMC7722379 DOI: 10.1136/bmjopen-2020-040771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Despite evidence that cardiac rehabilitation (CR) is an essential component of care for people with heart failure, uptake is low. A centre-based format is a known barrier, suggesting that home-based programmes might improve accessibility. The aim of SCOT: Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) is to assess the implementation of the REACH-HF home-based CR intervention in the context of the National Health Service (NHS) in Scotland.This paper presents the design and protocol for this observational implementation study. Specific objectives of SCOT:REACH-HF are to: (1) assess service-level facilitators and barriers to the implementation of REACH-HF; (2) compare real-world patient and caregiver outcomes to those seen in a prior clinical trial; and (3) estimate the economic (health and social) impact of implementing REACH-HF in Scotland. METHODS AND ANALYSIS The REACH-HF intervention will be delivered in partnership with four 'Beacon sites' across six NHS Scotland Health Boards, covering rural and urban areas. Health professionals from each site will be trained to facilitate delivery of the 12-week programme to 140 people with heart failure and their caregivers. Patient and caregiver outcomes will be assessed at baseline and 4-month follow-up. Assessments include the Minnesota Living with Heart Failure Questionnaire (MLHFQ), five-dimension EuroQol 5L, Hospital Anxiety and Depression Scale, and the Caregiver Burden Questionnaire. Qualitative interviews will be conducted with up to 20 health professionals involved in programme delivery (eg, cardiac nurses, physiotherapists). 65 facilitator-patient consultations will be audio recorded and assessed for fidelity. Integrative analysis will address key research questions on fidelity, context and CR participant-related outcomes. The SCOT:REACH-HF findings will inform the future potential roll-out of REACH-HF in Scotland. ETHICS AND DISSEMINATION The study has been given ethical approval by the West of Scotland Research Ethics Service (reference 20/WS/0038, approved 25 March 2020). Written informed consent will be obtained from all participants. The study is listed on the ISRCTN registry with study ID ISRCTN53784122. The research team will ensure that the study is conducted in accordance with both General Data Protection Regulations and the University of Glasgow's Research Governance Framework. Findings will be reported to the funder and shared with Beacon Sites, to facilitate service evaluation, planning and good practice. To broaden interest in, and understanding of REACH-HF, we will seek to publish in peer-reviewed scientific journals and present at stakeholder events, national and international conferences.
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Affiliation(s)
| | - Paulina Daw
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Claire Kerr
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - J Cleland
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Hasnain M Dalal
- Royal Cornwall Hospitals NHS Trust, Truro, UK
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Tracy Ibbotson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Clare Murphy
- Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rod Taylor
- MRC/CSO Social and Public Health Sciences Unit and Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Bisset CN, Dames N, Oliphant R, Alasadi A, Anderson D, Parson S, Cleland J, Moug SJ. Exploring shared surgical decision-making from the patient's perspective: is the personality of the surgeon important? Colorectal Dis 2020; 22:2214-2221. [PMID: 32628311 DOI: 10.1111/codi.15237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to determine the importance of a colorectal surgeon's personality to patients and its influence on their decision-making. METHODS We present a two-part mixed methods study using the Guidance for Reporting Involvement of Patients and the Public (GRIPP-2) long form. Part 1 was an online survey (25 questions) and Part 2 a face-to-face patient and public involvement exercise. Part 1 included patient demographics, details of surgery, overall patient satisfaction (net promoter score) and patient views on surgeon personality (Gosling 10 Item Personality Index). The thematic analysis of free-text responses generated four themes that were taken forward to Part 2. These themes were used to structure focus group discussions on surgeon-patient interactions. RESULTS Part 1 yielded 296 responses: 72% women, 75.3% UK-based and 55.1% aged 40-59 years. Inflammatory bowel disease (45.3%) and cancer (40.2%) were the main indications. 84.1% of respondents reported satisfaction with their surgical experience (net promoter score). Four key themes were generated from Part 1 and validated in Part 2: (i) surgeon personality stereotypes (media differed from patients' perspective); (ii) favourable and unfavourable surgical personality traits (openness, conscientiousness, emotional stability preferred over risk-taking and narcissism); (iii) patient-surgeon interaction (mutual respect and rapport valued); (iv) impact of surgeon personality on decision-making (majority unaware of second opinion option; management of postoperative complications). CONCLUSION Patients believe surgeon personality influences shared decision-making. Low levels of emotional stability and conscientiousness are perceived by patients to increase the likelihood of postoperative adverse events. Further work is required to explore the potential influence of surgeon personality on shared decision-making and postoperative outcomes.
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Affiliation(s)
- C N Bisset
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK.,University of Aberdeen, Aberdeen, UK
| | - N Dames
- ACPGBI Patient Liaison Group Member, Glasgow, UK
| | - R Oliphant
- University of Aberdeen, Aberdeen, UK.,Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - A Alasadi
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - D Anderson
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
| | - S Parson
- Suttie Centre, University of Aberdeen, Aberdeen, UK
| | - J Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - S J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK.,University of Glasgow, Glasgow, UK
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Rahimi K, Nazarzadeh M, Pinho-Gomes A, Woodward M, Salimi-Khorshidi G, Ohkuma T, Fitzpatrick R, Tarassenko L, Denis M, Cleland J. Technology-supported home monitoring in heart failure patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Digital health promises to enhance the prevailing episodic models of chronic heart failure (HF) care.
Purpose
We aimed to test the hypothesis that digital home monitoring with centralised specialist support for remote management of HF and major vascular comorbidities is more effective in optimising medical therapy and improving patients' quality of life than digital home monitoring alone.
Methods and results
In a two-armed partially blinded parallel randomised controlled trial, seven sites in the United Kingdom recruited a total of 202 adults with HF (71.3 years SD 11.1; mean left ventricular ejection fraction 32.9% SD 15.4). Participants were selected for being at high risk of adverse outcomes or high potential to benefit from remote management. Participants in both study arms were given an internet-enabled tablet computer, Bluetooth-enabled blood pressure monitor and weighing scales for health monitoring. After a run-in period, participants randomized to intervention received additional regular feedback to support self-management and their primary care doctors received instructions on blood investigations and pharmacological treatment. The primary outcome was the use of recommended medical therapy, for chronic HF and major comorbidities, measured as a composite opportunity score. Co-primary outcome was change in physical score of Minnesota Living with Heart failure questionnaire.
At the end of the trial, the weighted opportunity score was 0.54 (CI 95% 0.46, 0.62) in the control group and 0.61 (CI 95% 0.52, 0.70) in the intervention arm (p for mean difference=0.25). Physical well-being of participants did not differ significantly between the groups either (p=0.55).
Conclusions
Central provision of tailored specialist management in a multimorbid HF population was feasible. However, there was no strong evidence for improvement in use of evidence-based therapies nor health-related quality of life.
Figure 1
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) Health Services Research and Delivery; NIHR Career Development Fellowship
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Affiliation(s)
- K Rahimi
- University of Oxford, Clinical Trial Service Unit, Oxford, United Kingdom
| | - M Nazarzadeh
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - A.C Pinho-Gomes
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - M Woodward
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - G.H Salimi-Khorshidi
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - T Ohkuma
- University of New South Wales, Sydney, Australia
| | - R Fitzpatrick
- University of Oxford, Nuffield Department of Population Health, Oxford, United Kingdom
| | - L Tarassenko
- University of Oxford, Institute of Biomedical Engineering, Oxford, United Kingdom
| | - M Denis
- University of Oxford, Oxford Academic Health Science Network, Oxford, United Kingdom
| | - J Cleland
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
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Jones Y, Hillen N, Friday J, Pellicori P, Kean S, Murphy C, Cleland J. A comparison of machine learning models for predicting rehospitalisation and death after a first hospitalisation with heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Many machine learning models exist, including Multilayer Perceptron (MLP), Random Forest algorithm (RF), Support Vector Machine (SVM), and Gradient Boosted Machine (GBM), but their value for predicting outcome in patients with heart failure has not been compared.
Aim
To predict rehospitalisation (all-cause) and death (all-cause) at 1-, 3- and 12 months after discharge from a first hospitalisation for heart failure using four machine learning models.
Methods
The National Health Service Greater Glasgow and Clyde Health Board serves a population of ∼1.1 million. We obtained de-identified administrative data, including investigations, diagnosis and prescriptions, linked to hospital admissions and deaths for anyone with a diagnosis of vascular disease or heart failure or prescribed loop diuretics, statins or neuro-endocrine antagonists at any time between 1st January 2010 and 1st June 2018. Patients who were under 18 or had no prior hospitalisation for heart failure were excluded. Four ML algorithms using 46 variables were applied.
Results
Of 360,000 people who met the above criteria between 2010–2018, 6,372 had a hospitalisation for heart failure prior to 1st January 2010 and 8,304 had a first hospitalisation for heart failure thereafter. Between 2010 and 2018 there were 3,086 re-hospitalisations over 24 hours and 3,706 patients died, with 5,070 patients experiencing the composite outcome.
GBM and RF consistently outperformed MLP and SVM when comparing AUC, sensitivity and specificity combined, with GBM performing best in all scenarios. Since GBM and RF are both tree-based models, and with SVM and MLP regularly reporting very poor sensitivity or specificity despite a similar AUC to the others, this suggests that SVM and MLP may be suffering from overfitting and might perform better in larger data-sets.
Both GBM and RF work by ordering variables, so the final model can be used to determine the most important prediction variables. Age, number of times a blood sample was taken out of hospital, length of stay, social deprivation index and haemoglobin concentration consistently ranked amongst the most important variables. Models predicted all 1-month events better than later events.
Conclusions
Some, but not all, ML models applied to this data-set predicted rehospitalisation and death with great accuracy for up to 3 months after a first hospitalisation for heart failure. The models identified several important prognostic variables that are currently seldom collected in clinical research registries but perhaps should be.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Medical Research Council
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Affiliation(s)
- Y Jones
- University of Glasgow, Glasgow, United Kingdom
| | - N Hillen
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - J Friday
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - P Pellicori
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - S Kean
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - C Murphy
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - J Cleland
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
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Abstract
Abstract
Background
The internet has a key role in sharing and expanding medical knowledge. Social networks offer health-care professionals the possibility to communicate, debate and learn from each other in real-time, thereby improving access to expertise and creating new knowledge. On Facebook, there are many groups that health-care professionals can join to discuss clinical cases. However, it is unknown if patient-privacy is respected and whether users are aware that they might be inadvertently involved in a criminal act for which they might be sued.
Methods
We identified the most popular Facebook group for cardiologists, “ECHO BOARD REVIEW forum” that has more than 47,000 users. We retrospectively evaluated all content posted by this group between February 6th and February 14th 2020. Information about the type of data posted, personal patient details, geographic location reported on images or videos, number of reactions and comments was collected. Privacy was considered fully violated when name and/or surname of the patient was identifiable. A comparison between the two cases (privacy preserved vs. privacy violated) was performed.
Results
Of 53 posts evaluated, 50 (94%) were echocardiograms; the remaining three cases were of an electrocardiogram, a cardiac magnetic resonance video and a coronary angiogram. The patient's identity was revealed in seven cases (13%). Compared to cases where identity was concealed, those revealing the patient's identify were more likely to report other important personal details including date of birth (n=0 (0%) vs 2 (29%)), age (n=14 (30%) vs 5 (71%)) and sex (n=15 (33%) vs 6 (86%)). The country (n=46, 87%), city (n=39, 74%), and hospital (n=34, 64%) where the cases were being evaluated were also frequently disclosed. Most cases were from Asia (n=23, 43%) or Africa (n=17, 32%). Of the 7 cases in which privacy was fully violated, 43% were from Africa, 27% were from South America and 14% were from Asia. In the majority of cases, the author of the post was seeking diagnostic help (n=33), less frequently a diagnosis was already made by the author (n=17). The median (interquartile range) number of comments/post was 12 (5–23), and of likes/post was 21 (12- 37), with no significant difference between cases in which privacy was violated or not.
Conclusion
Social media allows knowledge and expertise to be shared amongst health care professionals, but, alarmingly, violation of patient-confidentiality is common. In order to maintain patient-confidentiality and avoid breaking the law, strict rules should be applied to regulate the use of social media by health-care professionals.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Castrichini
- Azienda Sanitaria Universitaria Integrata di Trieste, Division of Cardiology, Cardiothoracovascular Department, Trieste, Italy
| | - V Nuzzi
- Azienda Sanitaria Universitaria Integrata di Trieste, Division of Cardiology, Cardiothoracovascular Department, Trieste, Italy
| | - G Sinagra
- Azienda Sanitaria Universitaria Integrata di Trieste, Division of Cardiology, Cardiothoracovascular Department, Trieste, Italy
| | - J Cleland
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
| | - P Pellicori
- Robertson Centre for Biostatistics, Glasgow, United Kingdom
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Scrimgeour DSG, Cleland J, Lee AJ, Brennan PA. Prediction of success at UK Specialty Board Examinations using the mandatory postgraduate UK surgical examination. BJS Open 2019; 3:865-871. [PMID: 31832594 PMCID: PMC6887704 DOI: 10.1002/bjs5.50212] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 06/26/2019] [Indexed: 11/09/2022] Open
Abstract
Background While performance in other mandatory examinations taken at the beginning of a doctor's career are predictive of final training outcomes, the influence early postgraduate surgical examinations might have on success at Specialty Board Exams in the UK is currently unknown. The aim was to investigate whether performance at the mandatory Membership of the Royal College of Surgeons (MRCS) examination, and other variables, are predictive of success at the Fellowship of the Royal College of Surgeons (FRCS) examination, thus potentially identifying those who may benefit from early academic intervention. Methods Pearson correlation coefficients examined the linear relationship between both examinations and logistic regression analysis identified potential independent predictors of FRCS success. All UK medical graduates who attempted either section of FRCS (Sections 1 and 2) between 2012 and 2018 were included. Results First attempt pass rates for Sections 1 and 2 FRCS were 87.4 per cent (n = 854) and 91.8 per cent (n = 797) respectively. In logistic regression analysis, sex (male: odds ratio (OR) 2.32, 95 per cent c.i 1.43 to 3.76), age (less than 29 years at graduation: OR 3.22, 1.88 to 5.51), Part B MRCS attempts (1 attempt: OR 1.77, 1.08 to 3.00), Part A score (OR 1.14, 1.09 to 1.89) and Part B score (OR 1.06, 1.03 to 1.09) were independent predictors of Section 1 FRCS success. Predictors of Section 2 FRCS success were age (less than 29 years at graduation: OR 3.55, 2.00 to 6.39), Part A score (OR 1.06, 1.02 to 1.11) and Section 1 FRCS score (OR 1.13, 1.07 to 1.18). Conclusion Part A and B MRCS performance were independent predictors of FRCS success, providing further evidence to support the predictive validity of this mandatory postgraduate exam. However, future research must explore the reasons between the attainment gaps observed for different groups of doctors.
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Affiliation(s)
- D S G Scrimgeour
- Centre for Healthcare Education Research and Innovation University of Aberdeen Aberdeen UK.,Department of Colorectal Surgery Aberdeen Royal Infirmary Aberdeen UK.,Intercollegiate Committee for Basic Surgical Examinations
| | - J Cleland
- Centre for Healthcare Education Research and Innovation University of Aberdeen Aberdeen UK
| | - A J Lee
- Department of Medical Statistics University of Aberdeen Aberdeen UK
| | - P A Brennan
- Intercollegiate Committee for Basic Surgical Examinations
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Sugden E, Lloyd S, Lam J, Cleland J. Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders. Int J Lang Commun Disord 2019; 54:705-728. [PMID: 31179581 DOI: 10.1111/1460-6984.12478] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/17/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND As cost and access barriers to ultrasound technology have decreased, interest in using ultrasound visual biofeedback (U-VBF) as a tool for remediating speech sound disorders (SSD) has increased. A growing body of research has investigated U-VBF in intervention for developmental SSD; however, diversity in study design, participant characteristics, clinical methods and outcomes complicate the interpretation of this literature. Thus, there is a need for a synthesis and review of the evidence base for using U-VBF in intervention for SSD. AIMS To synthesise and evaluate the research evidence for U-VBF in intervention for developmental SSD. METHODS A systematic review was conducted. Eight electronic databases were searched for peer-reviewed articles published before 2018. Details about study design, participants, intervention procedures, service delivery, intervention intensity and outcomes were extracted from each study that met the inclusion criteria. The included studies were rated using both a critical appraisal tool and for their reporting of intervention detail. MAIN CONTRIBUTIONS Twenty-eight papers, comprising 29 studies, met the inclusion criteria. The most common research design was single-case experimental design (44.8% of studies). The studies included between one and 13 participants (mean = 4.1) who had a mean age of approximately 11 years (range = 4;0-27 years). Within the research evidence, U-VBF intervention was typically provided as part of, or as an adjunct to, other articulatory-based therapy approaches. A range of lingual sounds were targeted in intervention, with 80.6% of participants across all reviewed studies receiving intervention targeting rhotics. Outcomes following therapy were generally positive with the majority of studies reporting that U-VBF facilitated acquisition of targets, with effect sizes ranging from no effect to a large effect. Difficulties with generalisation were observed for some participants. Most studies (79.3%) were categorised as efficacy rather than effectiveness studies and represented lower levels of evidence. Overall, the reviewed studies scored more highly on measures of external validity than internal validity. CONCLUSIONS The evidence base for U-VBF is developing; however, most studies used small sample sizes and lower strength designs. Current evidence indicates that U-VBF may be an effective adjunct to intervention for some individuals whose speech errors persist despite previous intervention. The results of this systematic review underscore the need for more high-quality and large-scale research exploring the use of this intervention in both controlled and community contexts.
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Affiliation(s)
- Eleanor Sugden
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Susan Lloyd
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
- Clinical Audiology, Speech & Language Research Centre, Queen Margaret University, Musselburgh, UK
| | - Jenny Lam
- Paediatric Speech and Language Therapy, NHS Lothian, Edinburgh, UK
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Cleland J, Lloyd S, Campbell L, Crampin L, Palo JP, Sugden E, Wrench A, Zharkova N. The Impact of Real-Time Articulatory Information on Phonetic Transcription: Ultrasound-Aided Transcription in Cleft Lip and Palate Speech. Folia Phoniatr Logop 2019; 72:120-130. [PMID: 31129664 DOI: 10.1159/000499753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study investigated whether adding an additional modality, namely ultrasound tongue imaging (UTI), to perception-based phonetic transcription impacted on the identification of compensatory articulations and on interrater reliability. PATIENTS AND METHODS Thirty-nine English-speaking children aged 3-12 years with cleft lip and palate (CLP) were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio recording and probe-stabilized ultrasound (US). Three types of transcriptions were performed: (1) descriptive observations from the live US by the clinician recording the data, (2) US-aided transcription (UA) by two US-trained clinicians, and (3) traditional phonetic transcription by two CLP specialists from audio recording. We compared the number of consonants identified as in error by each transcriber and then classified errors into eight different subcategories. RESULTS Both UA and traditional transcription yielded similar error detection rates; however, these were significantly higher than the observations recorded live in the clinic. Interrater reliability for the US transcribers was substantial (κ = 0.65) compared to moderate (κ = 0.47) for the traditional transcribers. US transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. CONCLUSION UTI is a useful complement to traditional phonetic transcription for CLP speech.
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Affiliation(s)
- Joanne Cleland
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, United Kingdom,
| | - Susan Lloyd
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, United Kingdom.,Speech and Hearing Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Linsay Campbell
- Dental Hospital and School, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Lisa Crampin
- Dental Hospital and School, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Juha-Pertti Palo
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, United Kingdom.,Speech and Hearing Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Eleanor Sugden
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, United Kingdom
| | - Alan Wrench
- Articulate Instruments Ltd., Edinburgh, United Kingdom
| | - Natalia Zharkova
- Speech and Language Sciences, Newcastle University, Newcastle, United Kingdom
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Maloney S, Cook DA, Golub R, Foo J, Cleland J, Rivers G, Tolsgaard MG, Evans D, Abdalla ME, Walsh K. AMEE Guide No. 123 - How to read studies of educational costs. Med Teach 2019; 41:497-504. [PMID: 30794756 DOI: 10.1080/0142159x.2018.1552784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Healthcare and health professions education share many of the same problems in decision making. In both cases, there is a finite amount of resources, and so choices need to be made between alternatives. To navigate the options available requires effective decision making. Choosing one option requires consideration of its opportunity cost - the benefit forgone of the other competing options. The purpose of this abridged AMEE guide is to introduce educational decision-makers to the economic concept of cost, and how to read studies about educational costs to inform effective cost-conscious decision-making. This guide leads with a brief review of study designs commonly utilized in this field of research, followed by an overview of how study findings are commonly presented. The tutorial will then offer a four-step model for appraising and considering the results of an economic evaluation. It asks the questions: (1) Can I trust the results? (2) What are the results telling me? (3) Could the results be transferred to my context? (4) Should I change my practice?
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Affiliation(s)
- S Maloney
- a Department of Physiotherapy , Monash University , Frankston , Australia
- d School of Primary and Allied Health Care , Monash University , Frankston , Australia
| | - D A Cook
- b Division of General Internal Medicine , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - R Golub
- c Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
| | - J Foo
- d School of Primary and Allied Health Care , Monash University , Frankston , Australia
| | - J Cleland
- e Division of Medical and Dental Education , University of Aberdeen , Aberdeen , United Kingdom of Great Britain and Northern Ireland
| | - G Rivers
- f Faculty of Business and Economics , Monash University , Melbourne , Australia
| | - M G Tolsgaard
- g Centre for clinical Education , Copenhagen , Denmark
| | - D Evans
- h Academic Division , University of Newcastle Australia , Newcastle , Australia
| | - M E Abdalla
- i College of Medicine , University of Sharjah , Sharjah , United Arab Emirates
| | - K Walsh
- j BMJ Learning and Quality , London , United Kingdom of Great Britain and Northern Ireland
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Griswold D, Wilhelm M, Donaldson M, Learman K, Cleland J. The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine-related painful conditions: a systematic review with meta-analysis. J Man Manip Ther 2019; 27:128-140. [PMID: 30935320 DOI: 10.1080/10669817.2019.1589030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective: The purpose of this systematic review was to evaluate the effects of deep versus superficial dry needling or acupuncture on pain and disability for spine-related painful conditions. A secondary purpose was to account for the differences of needling location in relation to the painful area. Methods: This PROSPERO (#CRD42018106237) registered review found 691 titles through a multi-database search. Following a comprehensive search, 12 manuscripts were included in the systematic review and 10 in the meta-analysis. Standardized mean differences (SMD) with 95% confidence intervals were calculated for pain and disability. Results: The included studies demonstrated an unclear to high risk of bias recommending a cautious interpretation of the results. A consistent effect supporting deep needling over superficial with an SMD of 0.585 [0.335, 0.835], p < 0.001 from 10 articles for pain but a non-significant effect of 0.197 [-0.066, 0.461], p = 0.14 from 2 studies for disability. A temporal examination was similar for effects on pain with an SMD of 0.450 [0.104, 0.796] immediately, 0.711 [0.375, 1.048] short-term (1 to 11 weeks), and 0.470 [0.135, 0.805] for time-points ≥12 weeks. Regionally, there was a greater effect needling the area of pain locally (SMD = 0.754) compared to remotely (SMD = 0.501). Discussion: Statistically significant between-group differences were observed favoring deep needling over superficial. Both superficial and deep needling resulted in clinically meaningful changes in pain scores over time. However, differences between groups may not be clinically meaningful. More high-quality trials are needed to better estimate the effect size of deep versus superficial needling while controlling for location and depth of the lesion. Level of evidence: 1a.
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Affiliation(s)
- D Griswold
- a Department of Physical Therapy , Youngstown State University , Youngstown , OH , USA
| | - M Wilhelm
- b Department of Physical Therapy , Walsh University , North Canton , OH , USA
| | - M Donaldson
- c Physical Therapy Program , Tufts University , Boston , MA , USA
| | - K Learman
- a Department of Physical Therapy , Youngstown State University , Youngstown , OH , USA
| | - J Cleland
- d Department of Physical Therapy , Franklin Pierce University , Manchester , NH , USA
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Wood SE, Timmins C, Wishart J, Hardcastle WJ, Cleland J. Use of electropalatography in the treatment of speech disorders in children with Down syndrome: a randomized controlled trial. Int J Lang Commun Disord 2019; 54:234-248. [PMID: 30039902 DOI: 10.1111/1460-6984.12407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/08/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Electropalatography (EPG) records details of the location and timing of tongue contacts with the hard palate during speech. It has been effective in treating articulation disorders that have failed to respond to conventional therapy approaches but, until now, its use with children and adolescents with intellectual/learning disabilities and speech disorders has been limited. AIMS To evaluate the usefulness of EPG in the treatment of speech production difficulties in children and adolescents with Down syndrome (DS) aged 8-18 years. METHODS & PROCEDURES A total of 27 children with DS were assessed on a range of cognitive and speech and language measures and underwent additional EPG assessment. Participants were randomly allocated to one of three age-matched groups receiving either EPG therapy, EPG-informed conventional therapy or 'treatment as usual' over a 12-week period. The speech of all children was assessed before therapy using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and reassessed immediately post- and 3 and 6 months post-intervention to measure percentage consonants correct (PCC). EPG recordings were made of the DEAP assessment items at all time points. Per cent intelligibility was also calculated using the Children's Speech Intelligibility Measure (CSIM). OUTCOMES & RESULTS Gains in accuracy of production immediately post-therapy, as measured by PCC, were seen for all groups. Reassessment at 3 and 6 months post-therapy revealed that those who had received therapy based directly on EPG visual feedback were more likely to maintain and improve on these gains compared with the other groups. Statistical testing showed significant differences between groups in DEAP scores across time points, although the majority did not survive post-hoc evaluation. Intelligibility across time points, as measured by CSIM, was also highly variable within and between the three groups, but despite significant correlations between DEAP and CSIM at all time points, no statistically significant group differences emerged. CONCLUSIONS & IMPLICATIONS EPG was an effective intervention tool for improving speech production in many participants. This may be because it capitalizes on the relative strength of visual over auditory processing in this client group. The findings would seem to warrant an increased focus on addressing speech production difficulties in current therapy.
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Affiliation(s)
- Sara E Wood
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, UK
| | - Claire Timmins
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Jennifer Wishart
- Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - William J Hardcastle
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, UK
| | - Joanne Cleland
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Cleland J, Scobbie JM, Roxburgh Z, Heyde C, Wrench A. Enabling New Articulatory Gestures in Children With Persistent Speech Sound Disorders Using Ultrasound Visual Biofeedback. J Speech Lang Hear Res 2019; 62:229-246. [PMID: 30950695 DOI: 10.1044/2018_jslhr-s-17-0360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose This study evaluated ultrasound visual biofeedback treatment for teaching new articulations to children with a wide variety of speech sound disorders. It was hypothesized that motor-based intervention incorporating ultrasound would lead to rapid acquisition of a range of target lingual gestures with generalization to untreated words. Method Twenty children aged 6-15 years with a range of mild to severe speech disorders affecting a variety of lingual targets enrolled in a case series with replication. Of these, 15 children completed the intervention. All of the children presented with a variety of errors. We therefore employed a target selection strategy to treat the most frequent lingual error. These individual speech targets were treated using ultrasound visual biofeedback as part of ten to twelve 1-hr intervention sessions. The primary outcome measure was percentage of target segments correct in untreated wordlists. Results Six children were treated for velar fronting; 3 children, for postalveolar fronting; 2 children, for backing alveolars to pharyngeal or glottal place; 1 child, for debuccalization (production of all onsets as [h]); 1 child, for vowel merger; and 2 children, for lateralized sibilants. Ten achieved the new articulation in the 1st or 2nd session of intervention, despite no children being readily stimulable for their target articulation before intervention. In terms of generalization, effect sizes for percentage of target segments correct ranged from no effect (5 children), small effect (1 child), medium effect (4 children), and large effect (5 children). Conclusions Ultrasound visual biofeedback can be used to treat a wide range of lingual errors in children with various speech sound disorders, from mild to severe. Visual feedback may be useful for establishing new articulations; however, generalization is more variable.
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Affiliation(s)
- Joanne Cleland
- Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - James M Scobbie
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, United Kingdom
| | - Zoe Roxburgh
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, United Kingdom
| | - Cornelia Heyde
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, United Kingdom
| | - Alan Wrench
- Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
- Articulate Instruments Ltd., Edinburgh, United Kingdom
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Scrimgeour D, Patel R, Patel N, Cleland J, Lee AJ, McKinley AJ, Smith F, Griffiths G, Brennan PA. The effects of human factor related issues on assessors during the recruitment process for general and vascular surgery in the UK. Ann R Coll Surg Engl 2019; 101:231-234. [PMID: 30773892 DOI: 10.1308/rcsann.2019.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Healthcare professionals increasingly recognise how human factors (HF) can contribute to medical error. An understanding of HF is also important during other high stakes activities such as summative assessments or examinations. National organisations hosting such events need to be aware of potential fatigue, boredom and stress that can occur in interviewers during these often repetitive activities. METHODS A previously validated questionnaire based around the well known HF analysis and classification system (HFACS) was used to evaluate four factors (care and support, asking questions about the role as an interviewer, working within the rules and boundaries, and stress and pressure) at the 2018 UK general and vascular surgery trainee national selection process. RESULTS A total of 92 questionnaires were completed and analysed (48% response rate). After recoding for negative phrased questions, no significant differences were found between years of experience in the selection process and mean scores obtained for all four factor items. Interviewers had a positive experience during national selection with mean factor scores ranging from 3.84 to 3.98 (out of a maximum satisfaction score of 5). CONCLUSIONS Organisations need to plan carefully and recognise the human element to ensure that their interviewers are cared for during any high stakes assessment such as national selection. Our work suggests that a positive assessor experience will further help contribute to a reliable and fair recruitment process.
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Affiliation(s)
| | - R Patel
- Portsmouth Hospitals NHS Trust , UK
| | - N Patel
- Portsmouth Hospitals NHS Trust , UK
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Patterson F, Roberts C, Hanson MD, Hampe W, Eva K, Ponnamperuma G, Magzoub M, Tekian A, Cleland J. 2018 Ottawa consensus statement: Selection and recruitment to the healthcare professions. Med Teach 2018; 40:1091-1101. [PMID: 30251906 DOI: 10.1080/0142159x.2018.1498589] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Selection and recruitment into healthcare education and practice is a key area of interest for educators with significant developments in research, policy, and practice in recent years. This updated consensus statement, developed through a multi-stage process, examines future opportunities and challenges in selection and recruitment. There is both a gap in the literature around and a compelling case for further theoretical and empirical literature to underpin the development of overall selection philosophes and policies and their enactment. More consistent evidence has emerged regarding the quality of different selection methods. Approaches to selection are context-dependent, requiring the consideration of an institution's philosophy regarding what they are trying to achieve, the communities it purports to serve, along with the system within which they are used. Diversity and globalization issues continue to be critically important topics. Further research is required to explore differential attainment and explain why there are substantial differences in culturally acceptable ways of approaching diversity and widening access. More sophisticated evaluation approaches using multi-disciplinary theoretical frameworks are required to address the issues. Following a discussion of these areas, 10 recommendations are presented to guide future research and practice and to encourage debate between colleagues across the globe.
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Affiliation(s)
- F Patterson
- a Work Psychology Group, Derby United Kingdom of Great Britain and Northern Ireland, UK
| | - C Roberts
- b Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - M D Hanson
- c Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - W Hampe
- d Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Eva
- e Centre for Health Education Scholarship and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - G Ponnamperuma
- f Centre for Medical Education, Yong Loo Lin School of Medicine, Singapore
| | - M Magzoub
- g Department of Medical Education, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A Tekian
- h Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - J Cleland
- i Centre for Healthcare Research and Innovation (CHERI), University of Aberdeen, UK
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Scrimgeour DSG, Brennan PA, Griffiths G, Lee AJ, Smith FCT, Cleland J. Does the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination predict 'on-the-job' performance during UK higher specialty surgical training? Ann R Coll Surg Engl 2018; 100:1-7. [PMID: 30286650 PMCID: PMC6204508 DOI: 10.1308/rcsann.2018.0153] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The Intercollegiate Membership of the Royal College of Surgeons (MRCS) is a mandatory examination to enter higher surgical specialty training in the UK. It is designed to help to ensure that successful candidates are competent to practice as higher surgical trainees. The annual review of competence progression (ARCP) assesses trainees' competence to progress to the next level of training and can be interpreted as a measure of 'on-the-job' performance. We investigated the relationship between MRCS performance and ARCP outcomes. MATERIALS AND METHODS All UK medical graduates who passed MRCS (Parts A and B) from 2007 to 2016 were included. MRCS scores, attempts and sociodemographics for each candidate were crosslinked with ARCP outcomes (satisfactory, unsatisfactory and insufficient evidence). Multinomial logistic regression was used to identify potential independent predictors of ARCP outcomes. RESULTS A total of 2570 trainees underwent 11,064 ARCPs; 1589 (61.8%) had only satisfactory outcomes recorded throughout training; 510 (19.9%) had at least one unsatisfactory outcome; and 471 (18.3%) supplied insufficient evidence. After adjusting for age, gender, first language and Part A performance, ethnicity (non-white vs white, OR 1.36, 95% CI 1.08 to 1.71), Part B passing score (OR 0.98, 95% CI 0.98 to 1.00) and number of attempts at Part B (two or more attempts vs one attempt, OR 1.50, 95% CI 1.16 to 1.94) were found to be independent predictors of an unsatisfactory ARCP outcome. CONCLUSIONS This is the first study to identify predictors of ARCP outcomes during higher surgical specialty training in the UK and provides further evidence of the predictive validity of the MRCS examination.
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Affiliation(s)
- DSG Scrimgeour
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, Scotland, UK
- Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
- Intercollegiate Committee for Basic Surgical Examinations, UK
| | - PA Brennan
- Intercollegiate Committee for Basic Surgical Examinations, UK
| | - G Griffiths
- Department of Vascular Surgery, Ninewells Hospital, Dundee, Scotland, UK
| | - AJ Lee
- Medical Statistics Team, University of Aberdeen, Aberdeen, Scotland, UK
| | - FCT Smith
- Intercollegiate Committee for Basic Surgical Examinations, UK
| | - J Cleland
- Centre for Healthcare Education Research and Innovation, University of Aberdeen, Aberdeen, Scotland, UK
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Scrimgeour D, Higgins J, Bucknall V, Arnett R, Featherstone C, Cleland J, Lee A, Brennan P. Do surgeon interviewers have human factor-related issues during the long day UK National Trauma and Orthopaedic specialty recruitment process? Surgeon 2018. [DOI: 10.1016/j.surge.2018.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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