Pathologists Of Australia Research Articles

Speech and swallowing intervention following oral cancer treatment: A survey of speech-language pathologists in Australia and New Zealand

Purpose Treatment for oral cancer has debilitating effects on speech and swallowing, however, little is known about current speech-language pathology practice. Method An online survey of speech-language pathologists (SLPs) was disseminated via emails to speech pathology departments, social media platforms, and professional online forums. Survey questions captured demographics, service delivery, type and timing of speech and swallowing interventions, and influences and barriers to practice. Result Forty-three SLPs working in Australia (n = 41) and New Zealand (n = 2) completed the survey. SLPs recommended speech and swallowing compensatory strategies significantly more frequently than active intervention. Swallowing outcomes measures were either instrumental (n = 31, 94%) or performance ratings (n = 25, 76%), whereas speech was measured informally with judgements of intelligibility (n = 30, 91%). SLPs used a range of supports for their decision making, particularly expert opinion (n = 81, 38.2%). They reported time and staffing limitations (n = 55, 55%) and a lack of relevant evidence (n = 35, 35%) as the largest barriers to evidence-based service delivery. Conclusion There is variability amongst SLPs in Australia and New Zealand regarding rehabilitation of speech and swallowing for people with oral cancer. This study highlights the need for evidence-based guidelines outlining best practice for screening processes, active rehabilitation protocols, and valid outcome measures with this population.

Speaking of Online Learning: Alternative Practice-Based Learning Experiences for Speech Pathologists in Australia, Ghana and Hong Kong

Speech Pathology programs usually send students to workplaces to learn clinical skills necessary for practice. During COVID-19, programs needed to respond quickly to ensure that students continued to gain the necessary experiences and skills required to progress through their program and graduate as clinicians, while simultaneously complying with COVID-19 requirements. Case studies from seven different universities in Australia, Ghana and Hong Kong described the diverse ways in which placements were adapted to be COVID-safe, taking into account local needs. Some practices which had been included in placement education prior to the pandemic, such as telepractice and simulation-based learning, were extended and developed during this time. Educators, students, clinicians and clients responded to the rapidly changing needs of the time with flexibility and innovation, utilising a variety of technologies and tools to support case-based and virtual learning opportunities. Feedback from these diverse stakeholders about the experiences was positive, despite inevitable limitations and less-than-ideal circumstances. The positive findings provided insights for consideration in the future: could strategies implemented in response to the pandemic continue to be incorporated into placement experiences, enhancing current practices and maintaining student performance outcomes? Exceptional circumstances prompted exceptional responses; flexibility and innovation were accelerated in response to the pandemic and may transform future placement-based learning opportunities.

Lidcombe Program translation to community clinics in Australia and England.

Early intervention is essential healthcare for stuttering, and the translation of research findings to community settings is a potential roadblock to it. This study was designed to replicate and extend the Lidcombe Program community translation findings of O'Brian etal. (2013) but with larger participant numbers, incorporating clinicians (speech pathologists/speech anlanguage therapists) and their clients from Australia and England. Participants were 51 clinicians working in public and private clinics across Australia (n = 36) and England (n = 15), and 121 of their young stuttering clients and their families. Outcome measures were percentage of syllables stuttered (%SS), parent severity ratings at 9 months post-recruitment, number of clinic visits to complete Stage 1 of the Lidcombe Program, and therapist drift. Community clinicians in both countries achieved similar outcomes to those from randomized controlled trials. Therapist drift emerged as an issue with community translation. Speech and language therapists in England attained outcomes 1.0%SS above the speech pathologists in Australia, although their scores were within the range attained in randomized trials. Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice. The long-term impact of therapist drift in community clinical practice with the Lidcombe Program has yet to be determined. What is already known on the subject The Lidcombe Program is an efficacious early stuttering intervention. Translation to clinical communities has been studied with one Australian cohort. What this paper adds to existing knowledge A larger translation cohort is studied, comprising community clinicians and children in Australia and England. What are the potential or actual clinical implications of this work? Community clinicians from Australia and England can attain Lidcombe Program outcome benchmarks established in randomized trials. This finding is reassuring in light of the controlled conditions in clinical trials of the Lidcombe Program compared with its conduct in community practice.

“Self-management has to be the way of the future”: Exploring the perspectives of speech-language pathologists who work with people with aphasia

Purpose: Healthcare models have incorporated self-management approaches to facilitate increased patient responsibility for chronic condition management. As aphasia is a chronic condition, self-management may be beneficial for people with aphasia; however, the possible impacts of the language disorder on self-management must be acknowledged and addressed. Speech-language pathologists would likely be principal providers of self-management support; therefore, their perspectives should be sought when considering development of aphasia self-management approaches. This study aims to explore speech-language pathologist perspectives of aphasia self-management. Method: In-depth, semi-structured interviews conducted with 15 speech-language pathologists in Australia. Interview data analysed using qualitative content analysis. Result: Aphasia self-management was viewed as a person- and family-centred approach enabling comprehensive long-term care for people with aphasia and promoting control, responsibility, and independence. Speech-language pathologists were seen to have a substantial role providing self-management support and consultation, and training was required to expand this role. Communication partners and peer support were highly valued. Personal and environmental factors may influence successful aphasia self-management. Differences between aphasia self-management and chronic condition self-management were considered. Conclusion: Self-management could facilitate long-term sustainable aphasia management. Aphasia self-management approaches should factor in how to maximise communication partner and peer support. Aphasia-friendly self-management resources are necessary.

An investigation of changing forensic pathology workloads in the coronial jurisdictions of Australia

The workload of forensic pathologists involves performing autopsies for the coroner. Over the period 2006–2016 it was expected to see a change in autopsy workload of forensic pathologists in Australia due to the increasing number of deaths per year. This study investigated if trends in Australian coronial autopsy workload are related to changes in Coroners Acts. Analysis was performed using data from the National Coronial Information System (NCIS), which was compared with the death data from the Australian Bureau of Statistics (ABS) and Coroners Acts between 2006–2016. In every jurisdiction, the number of deaths per year increased during the study period, but not all jurisdictions observed an increase number of autopsies per year. In three of the eight coronial jurisdictions of Australia, changes in autopsy numbers coincided with changes in Coroners Acts. However, changes in autopsy numbers per year were also observed in without modifications to Coroners Acts. The findings suggest that forensic pathology autopsy workload can be influenced by changes in Coroners Acts and by changes relating to operating polices within individual jurisdictions.

Use of Transcription when Assessing Children’s Speech: Australian Speech-Language Pathologists’ Practices, Challenges, and Facilitators

Objective: There is currently limited knowledge on the useof transcription in the management of children with speech sound disorders (SSD) by speech-language pathologists in Australia. This study explored the use of transcription, the facilitators, and challenges of transcription use, and differences in the use of detailed transcription with various client groups. Method and Participants: Eighty-four participants (speech-language pathologists working in Australia) completed an online exploratory survey which included closed and open-ended questions. Results: 95% of participants reported using transcription. The three most commonly reported strategies/resources were transcription charts (81%), self-practice (68%), and websites (42%). Transcription challenges included the use of two vowel notation systems, reduced proficiency in transcription, service delivery issues, sampling/recording issues, and issues with using transcription to communicate. Finally, results from this survey found that participants use detailed transcription more often when recording the speech of children with childhood apraxia of speech and craniofacial impairment compared to using transcription to document the speech of children who have SSD of unknown origin. Most participants (91%) had not attended transcription professional development. Conclusions: These findings have implications for the university training of speech-language pathologists and for the establishment of professional development courses for practising speech-language pathologists in Australia.

Clinical management of childhood apraxia of speech: A survey of speech-language pathologists in Australia and New Zealand

Purpose: A number of studies have been published that have investigated the practices of speech-language pathologists in relation to speech sound disorder intervention; however, specific research about the treatment of childhood apraxia of speech is not available. This study aimed to describe the treatment approaches being used by speech-language pathologists, explore their perspectives of evidence-based practice and identify perceived barriers to implementing empirical research recommendations.Method: An online survey was distributed to speech-language pathologists in Australia and New Zealand. In total, 109 valid surveys were completed by participants who answered a series of multiple choice, yes/no, short answer and Likert-scaled questions.Result: Speech-language pathologists demonstrated a strong preference for eclectic interventions to treat childhood apraxia of speech. When asked to identify the primary treatment approach they used (whether as a stand-alone; or as the primary approach within an eclectic intervention), the most frequently used intervention was the Nuffield Dyspraxia Programme. Many speech-language pathologists reported valuing empirical research evidence, despite identifying a range of barriers that impact their ability to implement evidence-based practice in childhood apraxia of speech treatment.Conclusion: Although many speech-language pathologists use the Nuffield Dyspraxia Programme as their primary intervention, most clinicians use it as part of an eclectic/hybrid intervention. The effectiveness of eclectic interventions for childhood apraxia of speech has not been empirically evaluated.

Stroke communication partner training: a national survey of 122 clinicians on current practice patterns and perceived implementation barriers and facilitators.

Communication partners (CPs) find it challenging to communicate with people with communication disorders post-stroke. Stroke communication partner training (CPT) can enhance CPs' ability to support the communication and participation of people post-stroke. While evidence for the efficacy of aphasia-based CPT is strong, implementation in healthcare settings is unclear. To investigate Australian speech pathologists' current stroke CPT practices, factors influencing the implementation of CPT and how reported practice compares with the research evidence. Speech pathologists in Australia who had worked with people post-stroke were invited to complete a 99-item online survey. The survey was informed by a comprehensive review of the literature review, the Template for Intervention Description and Replication (TIDieR) intervention taxonomy, and the theoretical domains framework. data were analyzed using descriptive statistics and content analysis. A total of 122 clinicians were surveyed. Most participants reported providing CPT to treat a range of post-stroke communication disorders. While 98.3% reported training familiar CPs, only 66.1% reported training unfamiliar CPs. Current stroke CPT practice is characterized by one to two < 1 h sessions of informal face-to-face education and skills training. Only 13.3% and 10.0% of participants used evidence-based published programmes with unfamiliar and familiar CPs respectively. The main barriers included the perceived lack of behavioural regulation, skills, reinforcement, beliefs about consequences, positive social influences and resources. The main facilitators included clinicians' intentions to provide CPT, perception of CPT as part of their role and perceived compatibility of CPT with clinical practice. A significant evidence-practice gap exists. Research exploring the implementation of stroke CPT in healthcare settings, expanding evidence to support CPT for the range of post-stroke communication disorders, developing freely accessible step-by-step CPT programmes that consider restrictions in current practice and providing explicit instructions of CPT best practice are warranted. A supportive workplace culture and freely accessible formal training opportunities are also needed.

Genital injury? Clinical forensic medicine and forensic pathology collaboration distinguishes artefact from suspicious injury

Sexual assault homicide cases are not commonly encountered by forensic pathologists in Australia. Hence, experience in the examination of sexual assault victims is generally limited. In Western Australia a collaborative approach has been established between forensic pathology and the Sexual Assault Resource Centre (SARC); more so since the formation of the Faculty of Clinical Forensic Medicine. Where sexual assault is suspected, SARC may assist in the forensic examination to determine the presence or absence of potentially suspicious injuries. We present the case of an elderly lady who was found deceased at her home unexpectedly. She resided by herself and was found naked. At initial post-mortem inspection potentially suspicious features were noted in the ano-genital region. SARC doctors assisted with the post-mortem examination and following careful examination it could be established that the findings were non-suspicious, comprising a combination of age-related variation, old scarring from previous child birth and post-mortem change. This case report aims to educate fellow forensic practitioners on how post-mortem artefact and pre-existing genital abnormalities might disguise themselves as suspicious injuries in a post-mortem setting and highlights the advantages of collaboration between forensic pathology and clinical forensic medicine.

Dysphagia therapy post stroke: An exploration of the practices and clinical decision-making of speech-language pathologists in Australia

Purpose: A variety of dysphagia management options are available for the treatment of dysphagia following a stroke, however, it is unknown which of these approaches are most commonly utilised by Australian speech-language pathologists (SLPs) and whether particular factors influence decision-making.Method: The aim of this study was to investigate, through an online survey, the treatment practices of SLPs in Australia for the treatment of dysphagia post-stroke and identify the factors influencing treatment decisions.Result: A total of 118 SLPs completed the online survey. Descriptive statistics identified large variability in the dysphagia treatments utilised, with all 24 therapies listed in the online survey reported as being routinely used. Compensatory therapies were ranked as being utilised more frequently than rehabilitative approaches, with six of the seven highly utilised therapies being compensatory in nature. A client’s cognitive capacity was the most prominent factor influencing SLPs’ treatment decisions.Conclusion: This study provides insight into the practices of SLPs in Australia for the treatment of dysphagia following stroke and discusses potential for shifts in practice. It highlights the complexity involved in the decision-making process and that clinicians consider evidence, as well as client, clinician and service factors, when selecting between the range of options available.

Correlation between trans-rectal ultrasound guided (TRUS) biopsies reporting standards and multi-disciplinary team discussions, in the management of prostate cancer

<h3>Aim</h3> To investigate the reporting standards of TRUS biopsies and examine the effects on treatment decisions and related costs in low to intermediate-risk prostate cancer (PCa) <h3>Methods</h3> 675 patients undergoing TRUS biopsies at Monash Health from May 2010–2014 were retrospectively reviewed and stratified using the D'Amico risk classification, of which 218 fell into low and intermediate risk categories. Decisions to discuss patients at multi-disciplinary-team (MDT) meetings and further urological consultations were established by reviewing scanned medical and pathology reports. <h3>Results</h3> Of the 218 intermediate risk PCa, 144 (66.1%) were reported with a percentage of tumour involvement per biopsy core, 43 (19.7%) were reported with measurements of tumour involvement and 31 (14.2%) only included a positive finding for cancer. <h3>Conclusion and discussion</h3> Current international reporting guidelines are not being used by some pathologists in Australia. Variation in TRUS biopsy reporting may affect the management of patients. In addition, this may increase patient anxiety by delaying treatment. In the intermediate risk category, the pathology report plays an essential role in determining the need for MDT. As such we recommend a standardisation of TRUS biopsy reporting standards to aid in standardised treatment of patients.

Aphasia rehabilitation in Australia: Current practices, challenges and future directions

This study reports on current aphasia rehabilitation practices of speech-language pathologists in Australia. A 30-item web-based survey targeted approaches to aphasia rehabilitation, education, discharge, follow-up practices, counselling, interventions to improve communication access, community aphasia support services, and challenges to practice. One hundred and eighty-eight surveys were completed representing ˜ 33% of the potential target population, with 58.5% urban and 41.5% rural participants across all states and territories. Respondents reported embracing a wide variety of approaches to aphasia rehabilitation; however, significant challenges in providing aphasia management in acute and residential care were identified. Low levels of knowledge and confidence were reported for both culturally and linguistically diverse clients and discourse approaches. Group and intensive services were under-utilized and clinicians reported inflexible funding models as major barriers to implementation. Few clinicians work directly in the community to improve communicative access for people with aphasia. Despite the chronic nature of aphasia, follow-up practices are limited and client re-entry to services is restricted. Counselling is a high frequency practice in aphasia rehabilitation, but clinicians report being under-prepared for the role. Respondents repeatedly cited lack of resources (time, space, materials) as a major challenge to effective service provision. Collective advocacy is required to achieve system level changes.

Advances in winter pulse pathology research in Australia

Pulse crops in Australian broad-acre agriculture are a relatively small but essential component of present-day farming systems. Winter pulses, particularly the five accounted for in this review, dominate pulse area and production in this country. The Australian pulse industry has experienced devastating epidemics of diseases such as lupin anthracnose and chickpea ascochyta blight. In addition, many other diseases have appeared regionally. Research on various aspects was directed towards managing these diseases in individual regions, states and nationally. This review addresses advances in pathology related to bacterial, fungal and viral pathogens in lupins, chickpeas, field peas, lentils and faba beans. In addition to fundamental epidemiological and disease control studies, this paper includes molecular studies and quantitative epidemiology leading to disease modelling and disease forecasting. It also highlights the efforts undertaken recently by pulse pathologists in Australia to strengthen collaborative research nation-wide.

Turnover and intent to leave among speech pathologists

Sound, large scale and systematic research into why health professionals want to leave their jobs is needed. This study used psychometrically-sound tools and logistic regression analyses to determine why Australian speech pathologists were intending to leave their jobs or the profession. Based on data from 620 questionnaires, several variables were found to be significantly related to intent to leave. The speech pathologists intending to look for a new job were more likely to be under 34 years of age, and perceive low levels of job security and benefits of the profession. Those intending to leave the profession were more likely to spend greater than half their time at work on administrative duties, have a higher negative affect score, not have children under 18 years of age, and perceive that speech pathology did not offer benefits that met their professional needs. The findings of this study provide the first evidence regarding the reasons for turnover and attrition in the Australian speech pathology workforce, and can inform the development of strategies to retain a skilled and experienced allied health workforce.

Vowel transcription systems: An Australian perspective

Transcription is an essential clinical tool for speech-language pathologists as it provides a permanent written record of communicative behaviour and forms an important source of data for analysis, interpretation, decision making, and dissemination. One of the responsibilities in speech-language pathology is to faithfully capture the speech production characteristics of clinical populations so that informed management decisions may be made. Notation systems that are appropriately suited for this purpose are mandatory. In Australia today, the conventional phonemic transcription system was first described over 60 years ago. However, an alternative to this traditional system has more recently been proposed by Harrington, Cox and Evans (HCE). This paper details the HCE system and argues its advantage as a clinical tool for speech-language pathologists in Australia. This new system provides a more accurate phonetically oriented foundation against which atypical vowel production can be assessed. It is further argued that the HCE system can form the basis for narrower phonetic examination and has pedagogical value in the description of Standard Australian English.

Educating clinical educators: using a model of the experience of being a clinical educator

Background: Clinical educators are expected to prepare students to be competent beginning practitioners, ready to enter the workforce and meet the demands of competent practice. As part of ensuring the quality of clinical education, universities that provide these programs need to be involved in the education and support of clinical educators. In this paper we examine the preparation and professional development of clinical educators based on research into the experiences of being a clinical educator (McAllister 2001).Methods: The research approach involved a blend of hermeneutic phenomenology and narrative inquiry. In-depth interviews were conducted with five speech pathologists in Australia. Data were analysed using a phenomenological analysis process.Results: Recurrent themes in the research were represented by 12 themed stories to richly portray participants’ experiences of being clinical educators. An example is provided in this paper. The research produced a model of The Experience of Being a Clinical Educator. The six dimensions of this model are: a sense of self, of self-identity; a sense of relationship with others; a sense of being a clinical educator; a sense of agency or purposeful action; dynamic self-congruence; and the experience of growth and change.Conclusion: Becoming and being a clinical educator is a developmental process, mirroring in some ways the developmental process clinical educators strive to facilitate for their students. This journey of growth and development as a clinical educator requires active learning approaches coupled with reflection on one's practice as a clinical educator. The model can be used to educate clinical educators in speech pathology and other professions, given the commonalities in clinical educators’ roles across professions. Interactive and reflective strategies are presented in the paper for the development and support of clinical educators across the continuum from novice to professional artist.

Survey of Australian paediatric speech pathologists, Part 1: demography

AbstractA survey of paediatric speech pathologists in Australia was undertaken to document: deinographic characteristics; enlploying bodies; caseload characteristics; and the nature of service provision. A total of 447 questionnaires were returned from practising Australian paediatric speech pathologists. This paper reports the age, years of experience, employing body, client group, venue for service provision and service delivery models of these respondents.

Temporal change in diagnostic criteria as a cause of the increase of malignant melanoma over time is unlikely

To assess whether the increase in malignant melanoma incidence could be due, at least in part, to changes in histological criteria of malignancy, pathologists in Australia, France, Italy, New Zealand, Norway, Sweden, the United Kingdom, the United States and the USSR reviewed diagnoses of 50 consecutive pigmented naevi (40 junctional and compound; 10 intradermal) and 20 consecutive malignant melanomas made in each participating centre around 1930, around 1955 and around 1980. Collaborating pathologists re-read the material, 2,665 cases in all, either from the original slide (82%) or from a recut block (17%), gave their diagnosis and indicated whether the lesion was benign (B), dubious benign (DB), dubious malignant (DM) or malignant (M). As the distribution of review diagnoses was much the same whether the original slide or one made from a recut block was read, the material was pooled. Overall, 2.8% of cases originally reported as B/DB were reviewed as DM/M, while 4.4% of the DM/M diagnoses were held to be B/DB. The shifts between categories were greatest around 1955 and least around 1980, suggesting increasing uniformity of interpretation. All available blocks were recut and sections sent to IARC for review: 1.7% (22) of 1293 B/DB diagnoses were considered to be DM/M and 3.3% (18) of 551 DM/M diagnoses were considered to have been B/DB. The consistently low frequency of shift in diagnostic category, whether the material was reviewed in the collaborating laboratories or by one pathologist at IARC, in a study designed to give maximum attention to those lesions--the junctional and compound naevi--in which a change in opinion as to malignancy would be most likely to arise, suggests that pathologists, irrespective of geographical location, are using common criteria. These findings argue against changes in histological interpretation as being responsible for more than a small portion of the continuous increase of some 3% to 8% per annum observed in malignant melanoma incidence. Other explanations, such as an increase in the frequency or potential for malignant transformation of precursor lesions, must be sought. The anatomical distribution of the malignant melanomas examined followed the usual site pattern by sex, and their thickness was observed to decrease over the period of the study in most centres.

Whither Prolonged Speech? The Disquieting Evolution of a Stuttering Therapy Procedure

The purpose of this paper is to draw attention to some disquieting trends in the management of stuttering by speech pathologists in Australia. These trends mainly relate to the growing exclusive use of prolonged speech, or its many variants, in stuttering therapy — especially in intensive therapy programmes for children. A range of problems and implications associated with this development are discussed, including a consideration of suitable alternative therapies.

Time Management and Clinic Management: Developing Efficiency and Flexibility in Delivering Communication Services

Many speech-language pathologists in Australia are experiencing increasing demands for communication services to an increasing number of clients in increasing numbers of settings and contexts. This paper discusses a number of strategies in time management which may assist the speech-language pathologist to cope with these demands. Issues in clinic management — waiting lists, intensive therapy, prioritization of caseloads, use of parents and aides — are discussed. The advantages and disadvantages of the various models of service delivery are examined and speech-language pathologists are encouraged to move away from the one-to-one service delivery model towards group models, consultation and integrated models. This paper is primarily addressed to speech-language pathologists working in community health or educational settings, although the issues raised are likely to be of concern to speech-language pathologists in all settings. Speech-language pathologists are challenged to develop flexibility and efficiency in service delivery to meet the challenges facing the profession and to ensure the vitality of individual speech-language pathologists.