Clarity and contradictions: speech and language therapists' insights regarding thickened liquids for post-stroke aspiration

2020 ◽  
Vol 27 (6) ◽  
pp. 1-15
Author(s):  
Arlene McCurtin ◽  
Ronan Brady ◽  
Katherine Coffey ◽  
Anne O'Connor
Keyword(s):  
Clinical Decision Making ◽  
Treatment Effectiveness ◽  
Oropharyngeal Dysphagia ◽  
Empirical Support ◽  
Clinical Decision ◽  
Thickened Liquids ◽  
Speech And Language ◽  
Post Stroke ◽  
Treatment Use ◽  
Safety First

Background/Aims Oropharyngeal dysphagia is a common condition following stroke, with adverse consequences including aspiration pneumonia. Internationally, aspiration risk is typically managed using thickened liquids, an intervention with limited empirical support and associated treatment adherence issues. This study explores speech and language therapists' perceptions of and reasons for employing this intervention. Methods A total of 22 speech and language therapists working with people with dysphagia post-stroke in hospital settings participated in three focus groups. Participants were recruited through gatekeeper managers and data were analysed using inductive thematic analysis. Results Three themes were identified: primary justifications for treatment use, acute implementation issues, and having doubts. Use of thickened liquids is pivoted on safety-first reasoning, employed as a first step on the treatment ladder and in the context of limited perceived alternatives. Both clarity and contradictions are revealed by therapists, who acknowledge multiple factors that impact treatment effectiveness, including hospital, patient and product issues. Conclusions The findings from this study provide a basis for understanding clinical decision making for a widely-used gateway treatment that requires further empirical support. The data suggest that, similar to other professions, safety-first reasoning is paramount for speech and language therapists. The dominance of thickened liquids in treating aspiration is reflected internationally and warrants ongoing discussion.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

scholarly journals Complexity of Clinical Decision Making: Consent, Capacity, and Ethics

2019 ◽  
Vol 40 (03) ◽  
pp. 162-169 ◽  
Author(s):  
Annette Askren ◽  
Paula Leslie
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Negative Charge ◽  
Clinical Decision ◽  
Informed Consent Process ◽  
Thickened Liquids ◽  
Medical Decisions ◽  
Social Media Platforms ◽  
The Right ◽  
Right To Refuse

AbstractSpeech–language pathologists (SLPs), and really their patients, are often faced with challenging clinical decisions to be made. Patients may decline interventions recommended by the SLP and are often inappropriately labeled “noncompliant.” The inappropriateness of this label extends beyond the negative charge; the patient's right to refuse is, in fact, protected by law. Anecdotal exchanges, social media platforms, and American Speech-Language-Hearing Association forums have recently revealed that many SLPs are struggling with the patient's right to decline. Many are not comfortable with the informed consent process and what entails patients' capacity to make their own medical decisions. Here, we discuss the basics of clinical decision-making ethics with intent to minimize the clinician's discomfort with the right to refuse those thickened liquids and eliminate the practice of defensive medicine.

The State of the Science in Patient-Reported Outcomes for Patients with Lung Cancer

2020 ◽  
Vol 41 (03) ◽  
pp. 377-385
Author(s):  
Canhua Xiao ◽  
Newton Hurst ◽  
Benjamin Movsas
Keyword(s):  
Lung Cancer ◽  
Clinical Trials ◽  
Clinical Decision Making ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Patient Reported Outcome ◽  
Cancer Clinical Trials ◽  
Cancer Type ◽  
Patient Reported ◽  
State Of The Science

AbstractTraditionally, clinicians have assumed the primary responsibility for evaluating disease- and treatment-related outcomes. In the past few decades, however, a series of recommendations and standards promulgated by professional societies and regulatory agencies have resulted in increased use of patient-reported outcome (PRO) measures in cancer clinical trials. PROs, such as quality of life (QOL) measures, are important in establishing overall treatment effectiveness in cancer clinical trials, and they can inform clinical decision making. This article discusses the current state of the science in PRO research for patients with lung cancer, the cancer type with the highest incidence rate and the lowest survival rate worldwide. The discussion focuses on (1) PRO and survival; (2) electronic PRO reporting and interventions; (3) PROs and immunotherapy; (4) PRO, biomarkers, and precision health; (5) key issues in applying PROs in clinical trials; and (6) future directions for research.

scholarly journals THE “LINKED EVIDENCE APPROACH” TO ASSESS MEDICAL TESTS: A CRITICAL ANALYSIS

2013 ◽  
Vol 29 (3) ◽  
pp. 343-350 ◽  
Author(s):  
Tracy Merlin ◽  
Samuel Lehman ◽  
Janet E. Hiller ◽  
Philip Ryan
Keyword(s):  
Clinical Decision Making ◽  
Treatment Effectiveness ◽  
Treatment Options ◽  
Clinical Decision ◽  
Evidence Base ◽  
Test Accuracy ◽  
Decision Framework ◽  
Medical Test ◽  
Medical Tests ◽  
Linked Evidence

Objectives: A linked evidence approach (LEA) is the synthesis of systematically acquired evidence on the accuracy of a medical test, its impact on clinical decision making and the effectiveness of consequent treatment options. We aimed to assess the practical utility of this methodology and to develop a decision framework to guide its use.Methods: As Australia has lengthy experience with LEA, we reviewed health technology assessment (HTA) reports informing reimbursement decisions by the Medical Services Advisory Committee (August 2005 to March 2012). Eligibility was determined according to predetermined criteria and data were extracted on test characteristics, evaluation methodologies, and reported difficulties. Fifty percent of the evidence-base was independently analyzed by a second reviewer.Results: Evaluations of medical tests for diagnostic (62 percent), staging (27 percent), and screening (6 percent) purposes were available for eighty-nine different clinical indications. Ninety-six percent of the evaluations used either the full LEA methodology or an abridged version (where evidence is linked through to management changes but not patient outcomes). Sixty-one percent had the full evidence linkage. Twenty-five percent of test evaluations were considered problematic; all involving LEA (n = 22). Problems included: determining test accuracy with an imperfect reference standard (41 percent); assessing likely treatment effectiveness in test positive patients when the new test is more accurate than the comparator (18 percent); and determining probable health benefits in those symptomatic patients ruled out using the test (13 percent). A decision framework was formulated to address these problems.Conclusions: LEA is useful for evaluating medical tests but a stepped approach should be followed to determine what evidence is required for the synthesis.

Application of Data Mining Techniques in Clinical Decision Making

2017 ◽  
pp. 257-295
Author(s):  
Hakimeh Ameri ◽  
Somayeh Alizadeh ◽  
Elham Akhond Zadeh Noughabi
Keyword(s):  
Data Mining ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Treatment Effectiveness ◽  
Average Length ◽  
Clinical Decision ◽  
Drug Dosage ◽  
Classification Model ◽  
Data Mining Techniques ◽  
Average Length Of Stay

Data mining techniques are increasingly used in clinical decision making and help the physicians to make more accurate and effective decisions. In this chapter, a classification of data mining applications in clinical decision making is presented through a systematic review. The applications of data mining techniques in clinical decision making are divided into two main categories: diagnosis and treatment. Early prediction of medical conditions, detecting multi-morbidity and complications of diseases, identifying and predicting the chronic diseases and medical imaging are the subcategories which are defined in the diagnosis part. The Treatment category is composed of treatment effectiveness and predicting the average length of stay in hospital. The majority of the reviewed articles are related to diagnosis and there is only one article which discusses the determination of drug dosage in successful treatment. The classification model is the most commonly practical model in the clinical decision making.

scholarly journals Exercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic

2021 ◽  
pp. 154596832110541
Author(s):  
Kevin Moncion ◽  
Lynden Rodrigues ◽  
Marilyn MacKay-Lyons ◽  
Janice J. Eng ◽  
Sandra A. Billinger ◽  
...  
Keyword(s):  
Stroke Rehabilitation ◽  
Clinical Decision Making ◽  
Exercise Physiology ◽  
Disease Outbreaks ◽  
Clinical Decision ◽  
Respiratory Syndrome Virus ◽  
Exercise Rehabilitation ◽  
Post Stroke ◽  
Rehabilitation Programs ◽  
Clinical Considerations

Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.

Sign in / Sign up

Export Citation Format

Share Document