Recent Submissions

  • Effects of pharyngeal electrical stimulation on swallow timings, clearance and safety in post-stroke dysphagia: Analysis from the Swallowing Treatment Using Electrical Pharyngeal Stimulation (STEPS) trial

    Everton, Lisa F. (2021)
    Swallowing impairment (dysphagia) post-stroke results in poorer outcomes. Pharyngeal electrical stimulation (PES) is a potential treatment for post-stroke dysphagia. In a post hoc analysis, we investigated PES using videofluoroscopy swallow studies (VFSS) from the STEPS trial incorporating multiple measures of safety (penetration aspiration scale-PAS), speed and duration (timing), and efficiency (clearance), as opposed to the original trial which only measured PAS scores. 81 randomised participants (PES (N = 43) versus sham (N = 38)) were analysed at baseline and 2 weeks. Participants swallowed up to 6 x 5 ml and 1 x 50 ml of thin liquid barium at 40% w/v, images at ≥25 fps. Based on PAS, the 5 ml mode bolus (most frequently occurring PAS from 6 x 5 ml) and the worst 50 ml bolus were chosen for further analysis. Eight timing measures were performed, including stage transition duration (STD) and pharyngeal transit time (PTT). Clearance measures comprised oral and pharyngeal residue and swallows to clear. Comparisons of change of scoring outcomes between PES and sham were done at 2 weeks. Wilcoxon Signed Ranks Test was also used to evaluate longitudinal changes from both groups’ combined results at two weeks. Between-group analysis showed no statistically significant differences. Issues with suboptimal image quality and frame rate acquisition affected final numbers. At two weeks, both groups demonstrated a significant improvement in most safety scores (PAS) and STD, possibly due to spontaneous recovery or a combination of spontaneous recovery and swallowing treatment and usual care. A nonsignificant trend for improvement was seen in other timing measures, including PTT. This study, which conducted additional measurements of kinematic and residue analysis on the STEPS data did not detect “missed” improvements in swallowing function that the PAS is not designed to measure. However, more studies with greater numbers are required.
  • Validating the dysphagia severity rating scale: A prospective and retrospective study

    Everton, Lisa F. (2020)
    Outcome measures used in dysphagia rehabilitation should be validated and clinically meaningful. The Dysphagia Severity Rating Scale (DSRS) is a clinician-rated scale of oral intake, with three ordinal subscales (fluids, diet, and supervision). This research describes validation of the DSRS and establishes the Minimal Clinically Important Difference (MCID) of this scale.
  • Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients

    Everton, Lisa F. (2020)
    Post stroke dysphagia (PSD) is common and associated with poor outcome. The Dysphagia Severity Rating Scale (DSRS), which grades how severe dysphagia is based on fluid and diet modification and supervision requirements for feeding, is used for clinical research but has limited published validation information. Multiple approaches were taken to validate the DSRS, including concurrent- and predictive criterion validity, internal consistency, inter- and intra-rater reliability and sensitivity to change. This was done using data from four studies involving pharyngeal electrical stimulation in acute stroke patients with dysphagia, an individual patient data meta-analysis and unpublished studies (NCT03499574, NCT03700853). In addition, consensual- and content validity and the Minimal Clinically Important Difference (MCID) were assessed using anonymous surveys sent to UK-based Speech and Language Therapists (SLTs). Scores for consensual validity were mostly moderate (62.5-78%) to high or excellent (89-100%) for most scenarios. All but two assessments of content validity were excellent. In concurrent criterion validity assessments, DSRS was most closely associated with measures of radiological aspiration (penetration aspiration scale, Spearman rank rs = 0.49, p < 0.001) and swallowing (functional oral intake scale, FOIS, rs = -0.96, p < 0.001); weaker but statistically significant associations were seen with impairment, disability and dependency. A similar pattern of relationships was seen for predictive criterion validity. Internal consistency (Cronbach's alpha) was either "good" or "excellent". Intra and inter-rater reliability were largely "excellent" (intraclass correlation >0.90). DSRS was sensitive to positive change during recovery (medians: 7, 4 and 1 at baseline and 2 and 13 weeks respectively) and in response to an intervention, pharyngeal electrical stimulation, in a published meta-analysis. The MCID was 1.0 and DSRS and FOIS scores may be estimated from each other. The DSRS appears to be a valid tool for grading the severity of swallowing impairment in patients with post stroke dysphagia and is appropriate for use in clinical research and clinical service delivery.
  • Dementia and hearing loss: A narrative review

    Ray, Manisha; Dening, Tom (2019)
    Dementia and hearing loss are both common among older people. The co-occurrence of the two conditions increases complexities in all aspects of an individual's care and management plan. There has been increasing research interest in the relationship between dementia and hearing loss in recent years. In this review we discuss the relationship between hearing loss and dementia, including hearing loss as a risk factor for dementia; the effects of dementia with hearing loss on affected persons' quality of life and the care they receive; screening and available interventions; and opportunities for prevention. We also discuss dementia and hearing loss in the care home setting, as the majority of residents have either, or indeed both, dementia and/or hearing loss. Several mechanisms have been suggested for how hearing loss and dementia may be related but the evidence for how these may operate together is still unclear. Similarly, although it is to be hoped that the active identification and management of hearing problems may help to reduce the future development of cognitive impairment, evidence for this is still lacking.<br/>Copyright &#xa9; 2019 Elsevier B.V.
  • Dementia and hearing loss: A narrative review

    Ray, Manisha; Dening, Tom (2019)
    Dementia and hearing loss are both common among older people. The co-occurrence of the two conditions increases complexities in all aspects of an individual's care and management plan. There has been increasing research interest in the relationship between dementia and hearing loss in recent years. In this review we discuss the relationship between hearing loss and dementia, including hearing loss as a risk factor for dementia; the effects of dementia with hearing loss on affected persons' quality of life and the care they receive; screening and available interventions; and opportunities for prevention. We also discuss dementia and hearing loss in the care home setting, as the majority of residents have either, or indeed both, dementia and/or hearing loss. Several mechanisms have been suggested for how hearing loss and dementia may be related but the evidence for how these may operate together is still unclear. Similarly, although it is to be hoped that the active identification and management of hearing problems may help to reduce the future development of cognitive impairment, evidence for this is still lacking.<br/>Copyright &#xa9; 2019 Elsevier B.V.
  • Patients' and clinicians' views of the psychological components of tinnitus treatment that could inform audiologists' usual care: A delphi survey

    McMurran, Mary (2018)
    Objectives: The aim of this study was to determine which components of psychological therapies are most important and appropriate to inform audiologists' usual care for people with tinnitus.Design: A 39-member panel of patients, audiologists, hearing therapists, and psychologists completed a three-round Delphi survey to reach consensus on essential components of audiologist-delivered psychologically informed care for tinnitus.Results: Consensus (≥80% agreement) was reached on including 76 of 160 components. No components reached consensus for exclusion. The components reaching consensus were predominantly common therapeutic skills such as Socratic questioning and active listening, rather than specific techniques, for example, graded exposure therapy or cognitive restructuring. Consensus on educational components to include largely concerned psychological models of tinnitus rather than neurophysiological information.Conclusions: The results of this Delphi survey provide a tool to develop audiologists' usual tinnitus care using components that both patients and clinicians agree are important and appropriate to be delivered by an audiologist for adults with tinnitus-related distress. Research is now necessary to test the added effects of these components when delivered by audiologists.
  • Psychiatric emergencies in deaf people

    Gahir, Manjit; Gibbon, Simon D. (2015)
  • Deaf offenders with mental health needs

    Gibbon, Simon D. (2017)
    There are approximately 10 million deaf and hard of hearing people in the United Kingdom, of whom 3.7 million are of working age.1 Deafness is more than an audiological measurement that defines an individual’s degree of hearing loss. Deaf people form a heterogeneous group, and the age of onset of their deafness and degree of hearing impairment have a significant effect upon the individual’s communication preference and cultural identity.2 Those who become deaf in early childhood, before the development of full spoken language (prelingual deafness), are more likely to use sign language such as British Sign Language (BSL), and belong to the Deaf * community and share its associated values and belief system. They are proud to be Deaf and share a unique set of defining life experiences with other members of the Deaf community. In the United Kingdom, 800,000 people are either severely or profoundly deaf, of which approximately 70,000 are BSL users.1 These individuals are probably most likely to refer to themselves as being Deaf.
  • Hearing impairment and incident dementia: Findings from the English longitudinal study of ageing

    Orrell, Martin (2017)
    Objectives: To determine whether hearing loss is associated with incident physician-diagnosed dementia in a representative sample. Design: Retrospective cohort study. Setting: English Longitudinal Study of Ageing. Participants: Adults aged 50 and older. Measurements: Cross-sectional associations between self-reported (n = 7,865) and objective hearing measures (n = 6,902) and dementia were examined using multinomial-logistic regression. The longitudinal association between self-reported hearing at Wave 2 (2004/05) and cumulative physician-diagnosed dementia up to Wave 7 (2014/15) was modelled using Cox proportional hazards regression. Results: After adjustment for potential confounders, in cross-sectional analysis, participants who had self-reported or objective moderate and poor hearing were more likely to have a dementia diagnosis than those with normal hearing (self-reported: odds ratio OR = 1.6, 95% CI = 1.1–2.4 moderate hearing; OR = 2.6, 95% CI = 1.7–3.9 poor hearing, objective: OR = 1.6, 95% CI = 1.0–2.8 moderate hearing; OR = 4.4, 95% CI = 1.9–9.9 poor hearing). Longitudinally, the hazard of developing dementia was 1.4 (95% CI = 1.0–1.9) times as high in individuals who reported moderate hearing and 1.6 (95% CI = 1.1–2.0) times as high in those who reported poor hearing. Conclusion: Older adults with hearing loss are at greater risk of dementia than those with normal hearing. These findings are consistent with the rationale that correction of hearing loss could help delay the onset of dementia, or that hearing loss itself could serve as a risk indicator for cognitive decline. © 2017, The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.
  • The psychological treatment needs of deaf mental health patients in high-secure settings: A review of the literature

    Mitchell, Thomas R.; Braham, Louise G. (2011)
    A review of the literature relating to the psychological treatment needs of deaf mentally disordered offenders residing in high secure settings was conducted. Four literature searches were conducted relating to offending, mental illness, assessment and treatment with the deaf. The literature regarding these areas was found to be highly limited. Despite this, evidence suggests that deaf people are over represented in high secure facilities. It is also suggested that deaf offenders show higher levels of violent and sexual offences than their hearing counterparts. Most theories accounting for this difference in offending relate to the insufficient acquirement of social understanding however the finding may be an artefact of biases in the criminal justice system. Overall deaf people appear to experience similar levels of mental illness but greater levels of learning disability than hearing people. There are numerous sources of error when conducting assessments with deaf people. Similarly there are a number of challenges when delivering interventions with deaf people. These issues are discussed in terms of their implications for the psychological treatment needs of deaf mentally disordered offenders. Suggestions for future research include making use of systematic case studies to avoid some of the methodological challenges of researching this population. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Assessing adaptive behaviour with pre-lingually deaf people with an intellectual disability who use sign language

    Baker, Kevin L. (2015)
    Objectives: To determine whether the traditional assessment of adaptive behaviour is valid with deaf people who use sign language. Some Deaf people with a mild intellectual disability often struggle to gain fluency in sign language and hence experience high levels of exclusion from both hearing and deaf communities and support services. They can struggle to find ways of solving many of the difficulties of modern life and can struggle to develop some adaptive behaviours. Without an appreciation of the linguistic and cultural context of a Deaf person, assessment is difficult. There is a question whether comparisons should be made with Deaf people without ID or to hearing people with and without an ID. Methods: A small sample of deaf people with an intellectual disability was assessed about their adaptive behaviour in their first language of British Sign Language using the ABAS-III. This was triangulated with the views of their support staff who were also deaf and sign language users. Each participant and their adaptive behaviour were discussed in BSL. Results: For each participant, the responses to each item of the ABAS-III was systematically analysed for construct validity and discussed with Deaf support workers. Items which were difficult to adapt or appeared inappropriate or inaccurate were identified. Comparisons to the age norms were made. Conclusions: Findings suggests that formal assessment of adaptive behaviour of Deaf people with ID should be used with caution. Recommendations for a valid assessment of adaptive behaviour are made based on the findings of this study.
  • Application of therapeutic community principles to a high secure deaf service

    Izycky, Amy; Gibbon, Simon D.; Baker, Kevin L.; Gahir, Manjit (2007)
    Connaught Ward at Rampton Hospital provides the National High Secure Deaf Service for Men. Therapeutic Community (TC) principles have been used to inform the development and ongoing work of the service. This paper describes the work of the service and its particular difficulties. A discussion is then presented of the potential benefits and challenges that the use of TC principles has brought. © The Author(s).
  • The challenges of translating the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) Into British Sign Language

    Evans, Chris (2013)
    This article discusses translation issues arising during the production of a British Sign Language (BSL) version of the psychological outcome measure “Clinical Outcomes in Routine Evaluation–Outcome Measure” (CORE-OM). The process included forward translation, meeting with a team of translators, producing a second draft of the BSL version and back translating into English. Further modifications were made to the BSL version before piloting it with d/Deaf populations. Details of the translation process are addressed, including (a) the implications of translating between modalities (written text to visual language); (b) clarity of frequency anchors: analog versus digital encoding; (c) pronouns and the direction of signing; and (iv) the influence of the on-screen format. The discussion of item-specific issues encountered when producing a BSL version of the CORE-OM includes the expression of precise emotional states in a language that uses visual modifiers, problems associated with iconic signs, and the influence of Deaf world knowledge when interpreting specific statements. Finally, it addresses the extent to which lessons learned through this translation process are generalizable to other signed languages and spoken language translations of standardized instruments. Despite the challenges, a BSL version of the CORE-OM has been produced and found to be reliable.
  • Acellular pertussis vaccine efficacy: An updated systematic review and meta-analysis

    Shokraneh, Farhad (2016)
    Background: Recent studies indicate an increased incidence of pertussis disease in recent years. The aim of this study was to evaluate the efficacy of the acellular vaccine for children (as a replacement of current whole cell vaccine in the Expanded Program on Immunization) and for high-risk adults in Iran through updating current best available evidence. Methods: We performed a systematic literature review in relevant databases we focused on previously published systematic reviews to select those that address our questions. The AMSTAR (assessing the methodological quality of systematic reviews) tool was used for screening available reviews. Then search in databases was done until Feb 2014 to update the evidence. We pooled results using meta-analysis methods by Stata statistical package. Results: Eleven systematic review articles were included in the initial evaluation. In the end, two systematic reviews on acellular vaccine booster doses and the acellular vaccine in children were selected as the baseline evidence. In the update phase, new clinical trials were screened, and the results were updated. Overall pooled estimate of relative efficacy of acellular to whole cell was 0.68 (95% CI, 0.55-0.81) for children immunization Pooled estimates for the efficacy of acellular versus placebo were 0.70 (95% CI, 0.60-0.80). Overall pooled estimate of efficacy of booster dose of acellular was 0.87(95% CI, 0.85-0.88) compared to placebo. In addition pooled estimate of acellular vaccine efficacy based on response to antigen was 0.78(95% CI, 0.64-0.93) in highrisk group. Conclusion: The results show higher performance and safety of the acellular vaccine in the prevention of pertussis in children versus the whole cell vaccine. Moreover, the efficacy of the acellular vaccine in high-risk adult groups is acceptable. This study provides evidence in favor of the introduction of an acellular vaccine to the national program of immunization. Studies on cost effectiveness and aspects of policy analysis are recommended.
  • The prevalence of tinnitus and the relationship with neuroticism in a middle-aged UK population

    Middleton, Hugh (2014)
    Background: Previous research has suggested that a substantial proportion of the population are severely affected by tinnitus, however recent population data are lacking. Furthermore, there is growing evidence that the perception of severity is closely related to personality factors such as neuroticism.; Objective: In a subset (N=172,621) of a large population sample of >500,000 adults aged 40 to 69years, (from the UK Biobank dataset) we calculated the prevalence of tinnitus and that which is perceived as bothersome, and examined the association between tinnitus and a putative predisposing personality factor, neuroticism.; Method: Participants were recruited through National Health Service registers and aimed to be inclusive and as representative of the UK population as possible. The assessment included subjective questions concerning hearing and tinnitus. Neuroticism was self-rated on 13 questions from the Eysenck Personality Inventory. Associations between neuroticism and tinnitus were tested with logistic regression analyses.; Results: Prevalence of tinnitus was significantly higher for males, and increased with age, doubling between the youngest and oldest age groups (males 13% and 26%; females 9% and 19% respectively). Of those with tinnitus, females were more likely to report bothersome tinnitus. Neuroticism was associated with current tinnitus and bothersome tinnitus, with the items: 'loneliness', 'mood swings', 'worrier/anxious' and 'miserableness', as the strongest associations of bothersome tinnitus.; Conclusions: Neuroticism was identified as a novel association with tinnitus. Individuals with tinnitus and higher levels of neuroticism are more likely to experience bothersome tinnitus, possibly as a reflection of greater sensitivity to intrusive experiences.; © 2013. Published by Elsevier Inc. All rights reserved.
  • Hypocalcaemia following thyroidectomy unresponsive to oral therapy

    Schofield, Christopher (2014)
    Hypocalcaemia due to hypoparathyroidism following thyroidectomy is a relatively common occurrence. Standard treatment is with oral calcium and vitamin D replacement therapy; lack of response to oral therapy is rare. Herein we describe a case of hypoparathyroidism following thyroidectomy unresponsive to oral therapy in a patient with a complex medical history. We consider the potential causes in the context of calcium metabolism including: poor adherence, hungry bone syndrome, malabsorption, vitamin D resistance, bisphosphonate use and functional hypoparathyroidism secondary to magnesium deficiency. Malabsorption due to intestinal hurry was likely to be a contributory factor in this case and very large doses of oral therapy were required to avoid symptomatic hypocalcaemia.;
  • The reliability of British Sign Language and English versions of the Clinical Outcomes in Routine Evaluation - Outcome Measure with d/Deaf populations in the UK: An initial study

    Evans, Chris (2014)
    Previous research has argued that the mental well-being of d/Deaf people is poorer than that of hearing populations. However, there is a paucity of valid and reliable mental health instruments in sign language that have been normalised with d/Deaf populations. The aim of this study was to determine the reliability of the Clinical Outcomes in Routine Evaluation - Outcome Measure ( CORE- OM) with d/Deaf populations. A British Sign Language ( BSL) version was produced using a team approach to forward translation, and a back-translation check. The CORE- OM was incorporated into an online survey, to be completed in either BSL or English, as preferred by the participant. From December 2010 to March 2011, data were collected from 136 d/Deaf people. Cronbach's α was used to measure the internal consistency of items in the CORE- OM. Comparisons were made between versions, including comparisons with the non-clinical hearing population (not in receipt of mental health services) in a previous study. The reliability of the overall score, as well as the non-risk items in both the BSL and English versions, was satisfactory. The internal reliability of each domain in the BSL version was good (Cronbach's α > 0.70) and comparable to the English version in the hearing population. This was true for most domains of the CORE- OM in the English version completed by d/Deaf people, although the Functioning domain had a relatively low α of 0.79 and the Risk domain had an α of only 0.66 This raised the question whether it is advisable to use a mental health assessment with d/Deaf populations that has been standardised with hearing populations. Nevertheless, this study has shown that it is possible to collect data from d/Deaf populations in the UK via the web (both in BSL and English), and an online BSL version of the CORE- OM is recommended for use with Deaf populations in the community.