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Background\ud Stroke can affect people’s ability to swallow, resulting in passage of some food and drink into the airway. This can cause choking, chest infection, malnutrition and dehydration, reduced rehabilitation, increased risk of anxiety and depression, longer hospital stay, increased likelihood of discharge to a care home, and increased risk of death. Early identification and management of disordered swallowing reduces risk of these difficulties.\ud \ud Objectives\ud Primary objective\ud \ud • To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke\ud \ud Secondary objectives\ud \ud • To assess the influence of the following sources of heterogeneity on the diagnostic accuracy of bedside screening tools for dysphagia\ud \ud ‐ Patient demographics (e.g. age, gender)\ud \ud ‐ Time post stroke that the study was conducted (from admission to 48 hours) to ensure only hyperacute and acute stroke swallow screening tools are identified\ud \ud ‐ Definition of dysphagia used by the study\ud \ud ‐ Level of training of nursing staff (both grade and training in the screening tool)\ud \ud ‐ Low‐quality studies identified from the methodological quality checklist\ud \ud ‐ Type and threshold of index test\ud \ud ‐ Type of reference test\ud \ud Search methods\ud In June 2017 and December 2019, we searched CENTRAL, MEDLINE, Embase, CINAHL, and the Health Technology Assessment (HTA) database via the Centre for Reviews and Dissemination; the reference lists of included studies; and grey literature sources. We contacted experts in the field to identify any ongoing studies and those potentially missed by the search strategy.\ud \ud Selection criteria\ud We included studies that were single‐gate or two‐gate studies comparing a bedside screening tool administered by nurses or other healthcare professionals (HCPs) with expert or instrumental assessment for detection of aspiration associated with dysphagia in adults with acute stroke admitted to hospital.\ud \ud Data collection and analysis\ud Two review authors independently screened each study using the eligibility criteria and then extracted data, including the sensitivity and specificity of each index test against the reference test. A third review author was available at each stage to settle disagreements. The methodological quality of each study was assessed using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS‐2) tool. We identified insufficient studies for each index test, so we performed no meta‐analysis. Diagnostic accuracy data were presented as sensitivities and specificities for the index tests.\ud \ud Main results\ud Overall, we included 25 studies in the review, four of which we included as narratives (with no accuracy statistics reported). The included studies involved 3953 participants and 37 screening tests. Of these, 24 screening tests used water only, six used water and other consistencies, and seven used other methods. For index tests using water only, sensitivity and specificity ranged from 46% to 100% and from 43% to 100%, respectively; for those using water and other consistencies, sensitivity and specificity ranged from 75% to 100% and from 69% to 90%, respectively; and for those using other methods, sensitivity and specificity ranged from 29% to 100% and from 39% to 86%, respectively. Twenty screening tests used expert assessment or the Mann Assessment of Swallowing Ability (MASA) as the reference, six used fibreoptic endoscopic evaluation of swallowing (FEES), and 11 used videofluoroscopy (VF). Fifteen screening tools had an outcome of aspiration risk, 20 screening tools had an outcome of dysphagia, and two narrative papers did not report the outcome. Twenty‐one screening tests were carried out by nurses, and 16 were carried out by other HCPs (not including speech and language therapists (SLTs)).\ud \ud We assessed a total of six studies as low risk across all four QUADAS‐2 risk of bias domains, and we rated 15 studies as low concern across all three applicability domains.\ud \ud No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing combined water swallow and instrumental tool was the Bedside Aspiration test (n = 50), the best performing water plus other consistencies tool was the Gugging Swallowing Screen (GUSS; n = 30), and the best water only swallow screening tool was the Toronto Bedside Swallowing Screening Test (TOR‐BSST; n = 24). All tools demonstrated combined highest sensitivity and specificity and low risk of bias for all domains. However, clinicians should be cautious in their interpretation of these findings, as these tests are based on single studies with small sample sizes, which limits the estimates of reliability of screening tests.\ud \ud Authors' conclusions\ud We were unable to identify a single swallow screening tool with high and precisely estimated sensitivity and specificity based on at least one trial with low risk of bias. However, we were able to offer recommendations for further high‐quality studies that are needed to improve the accuracy and clinical utility of bedside screening tools.

OBJECTIVE The purpose of this scoping review is to identify the extent of research exploring the health and well-being harms experienced by adult victims of different types of interpersonal violence. INTRODUCTION Interpersonal violence is defined as violence between individuals. It can take many forms and may be physical, sexual, psychological, coercive, or deprivational in nature. Health and well-being harms from being subject to interpersonal violence are common and often endure. Interpersonal violence may cause physical injury, often has mental health impacts, and is associated with greater risk for long-term medical conditions. Though a substantial body of research of health and well-being harms of different types of interpersonal violence exists, to date this has not been collated and mapped; this scoping review will address this gap. INCLUSION CRITERIA Peer-reviewed primary and secondary research studies, from 2000 to 2019 (in English) that address the negative effects of interpersonal violence on the health and well-being of adult victims will be included. Studies of group violence, military veterans, and violence as acts of war will be excluded. METHODS Six electronic databases (MEDLINE, CINAHL Complete, Embase, PsycINFO, SocINDEX and Cochrane Library) and web sources of specialist gray literature will be searched. Screening and data extraction will be assessed by independent researcher verification processes. Relevant studies and their characteristics will be summarized using a pre-designed data extraction form. Further data synthesis will be undertaken to produce a coherent and comprehensive map of research in the field, identify gaps, and inform priorities for future directions of research and innovation.

Introduction\ud Videofluoroscopy (VFSS) is a frequently used radiological investigation for dysphagia and is conducted within a radiology setting by speech and language therapists (SLTs) working alongside imaging personnel (radiologists and/or radiographers). Previous surveys of SLT practice have reported variability in VFSS protocols and procedures. The aim of this study was to explore current clinical practice for VFSS from the perspective of imaging personnel engaged in VFSS within the United Kingdom.\ud \ud Methods\ud A comprehensive online survey enabled exploration of current practices of imaging professionals. Target participants were diagnostic imaging personnel (radiographers and radiologists) with experience of working in VFSS clinics. Descriptive statistics describe and summarise the data alongside inferential statistics where appropriate.\ud \ud Results\ud 54 survey participants represented 40 unique acute healthcare organisations in the UK, in addition to two respondents from the Republic of Ireland. The survey demonstrated high variance in clinical practice across all stages of the VFSS procedure. Clinicians were not always compliant with current UK guidelines and the roles and responsibilities of different professionals working within the clinics were often not clearly defined.\ud \ud Conclusion\ud Further research is required to develop new international, interprofessional VFSS guidelines to standardise service delivery for VFSS, improving diagnostic accuracy, efficiency and patient experience.\ud \ud Implications for practice\ud In the absence of VFSS guidelines for imaging personnel, practitioners should familiarise themselves with the UK Royal College of Speech and Language Therapists VFSS Position paper; IR (ME)R guidelines and DRLs for the client groups with which they work to guide clinics and improve practice. Clinicians should revisit protocols and clinical governance regarding safe practice in order to improve the quality of care within the VFSS clinic.

BackgroundGlobally, people with intellectual disabilities and/or autism experience health inequalities. Death occurs at a younger age and the prevalence of long-term morbidities is higher than in the general population. Despite this, their primary healthcare access rates are lower than the general population, their health needs are often unmet, and their views and experiences are frequently overlooked in research, policy, and practice.AimTo investigate the barriers and facilitators reported by individuals with intellectual disabilities, autism, or both, and/or their carers, to accessing and utilising primary health care for their physical and mental health needs.Design & settingAn integrative review was undertaken, which used systematic review methodology.MethodElectronic databases MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane were searched for relevant studies (all languages) using a search strategy. Two researchers independently screened the results and assessed the quality of the studies.ResultsSixty-three international studies were identified. Six main themes relating to barriers and facilitators emerged from an analysis of these studies. The main themes were: training; knowledge and awareness; communication; fear and embarrassment; involvement in healthcare decision-making; and time. All the themes were underpinned by the need for greater care, dignity, respect, collaborative relationships, and reasonable adjustments. Opposing barriers and facilitators were identified within each of the main themes.ConclusionAdolescents and adults with intellectual disabilities and/or autism experience several barriers to accessing and utilising primary health care. The findings highlight the reasonable adjustments and facilitators that can be implemented to ensure that these individuals are not excluded from primary health care.

Introduction: Clinical practice guidelines (CPGs) are expected to make evidence-based recommendations,\ud thus guiding practice and reducing unwarranted variation. CPGs are particularly helpful in guiding\ud complex procedures such as the Videofluoroscopic Swallowing Study (VFSS) for the assessment of\ud dysphagia, but there is a suspected high level of variability among them. To explore the extent of this\ud variation, this study aimed to systematically identify and appraise all VFSS CPGs available worldwide.\ud Methods: A systematic search of 3 academic databases and other sources was conducted to identify\ud relevant CPGs; independent reviews of each CPG were undertaken by a Speech and Language Therapist\ud and a Radiographer. Both reviewers completed a pre-determined checklist of expected professional\ud content for each CPG. CPGs were then assessed for quality using the Appraisal of Guidance for Research &\ud Evaluation II (AGREE II) instrument. Findings from the professional content review and the methodological\ud quality review were synthesised to inform an assessment of suitability of each CPG to inform\ud clinical practice.\ud Results: Seven VFSS CPGs were identified worldwide, none of which were co-designed by radiographers\ud or aimed at a radiographer audience. Each differs in their professional content, recommendations, underpinning\ud evidence base and professional focus. Average AGREE ll scores across the quality domains\ud vary considerably, ranging from 93 to 22%. No CPGs scored highly on all six AGREE II domains.\ud Conclusion: There is no standardisation between VFSS guidelines. Six CPGs are not recommended for\ud clinical use; only one of the seven identified CPGs is recommended for use following significant\ud modification.\ud Implications for practice: The lack of a comprehensive, evidence-based guideline encourages unwarranted\ud variation in clinical practice which potentially compromises clinical care. Further research is\ud needed to define VFSS best practice.

ObjectiveTo assess five physical signs to see whether they can assist in the screening of patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and potentially lead to quicker treatment.MethodsThis was a diagnostic accuracy study with inter-rater agreement assessment. Participants recruited from two National Health Service hospitals, local CFS/ME support groups and the community were examined by three practitioners on the same day in a randomised order. Two allied health professionals (AHPs) performed independent examinations of physical signs including: postural/mechanical disturbances of the thoracic spine, breast varicosities, tender Perrin’s point, tender coeliac plexus and dampened cranial flow. A physician conducted a standard clinical neurological and rheumatological assessment while looking for patterns of illness behaviour. Each examination lasted approximately 20 min.ResultsNinety-four participants were assessed, 52 patients with CFS/ME and 42 non-CFS/ME controls, aged 18–60. Cohen’s kappa revealed that agreement between the AHPs was substantial for presence of the tender coeliac plexus (κ=0.65, pConclusionsUsing the physical signs appears to improve the accuracy of identifying people with CFS/ME and shows agreement with current diagnostic techniques. However, the present study concludes that only two of these may be needed. Examining for physical signs is both quick and simple for the AHP and may be used as an efficient screening tool for CFS/ME. This is a small single-centre study, and therefore, further validation in other centres and larger populations is needed.