Search

Objective: Gaps and complexities exist in cancer referral and diagnosis in Australia, leading to delays in cancer treatments. Developing evidence-based referral pathways is important for promoting better and more timely cancer diagnosis and care. Type of program or service: This paper describes a toolkit endorsed by the Cancer Institute NSW as a guide for promoting best practice in localising cancer referral and diagnosis pathways in line with the national Optimal Care Pathways. Use of toolkit: Employing methods in the toolkit yielded an increased understanding of cancer care pathways, strengthened collaboration between tertiary and primary sector stakeholders, and enhanced the project skills of Cancer System Innovation Managers. The toolkit has become a valuable guide for consolidating referral pathways for various cancers in the NSW local health districts and could apply to cancer services in other jurisdictions., Lessons Learnt: The pilot project showed that the toolkit is useful in developing referral pathways and reflects best stakeholder engagement practices. Local evidence should be generated to support systematic change and should include the perspectives of cancer patients and clinicians. NSW local health districts continue to use the toolkit methods to optimise care to improve outcomes for people living with cancer., Competing Interests: None declared.

Purpose: Team-based learning (TBL) has gained popularity across the health professions, including in interprofessional contexts. The authors conducted this systematic review to summarize the published evidence regarding the extent, design, and practice of interprofessional TBL within health professions (including medical) degree programs to inform interprofessional education (IPE) educators and curricula designers., Method: In June 2020, the authors searched PubMed Central, CINAHL, Web of Science, and ERIC for original research articles describing TBL programs with student representation from multiple health professions degree programs that were published between January 2010 and June 2020. Included articles underwent data extraction for study characteristics (e.g., country of origin, topics covered, class descriptors) and the 7 core design elements of TBL: team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the 4 Ss (significant problem, same problem, specific choice, and simultaneous reporting), incentive structure, and peer review., Results: Twelve articles were included. Significant variability was noted in the application and reporting of the 7 core design elements of TBL, which highlighted challenges to the implementation of interprofessional TBL., Conclusions: Although the structured format of TBL provides a suitable pedagogy for IPE, this review identified challenges associated with the effective integration of IPE into TBL, including: the unequal distribution of students to teams as a result of there being multiple disciplines from different programs; varied levels of student experience with the pedagogy of TBL; a lack of resources required for large groups of students; timetabling requirements for multiple disciplines from different programs; inability to provide more than 1 TBL session; design of patient cases that suit multiple disciplines; alignment of topics within the curricula of multiple disciplines, programs, and universities; inequities in grading for different students within the same TBL program; and limited opportunity for peer review., (Copyright © 2021 by the Association of American Medical Colleges.)

Objectives: A single case study is reported of a child who underwent several surgical procedures as result of congenital grade III subglottic stenosis. The anterior aspect of the right vocal cord was damaged and underwent atrophy during one of these procedures. Now, an active 10-year-old, the patient has become increasingly aware of his vocal limitations on functional activities. Injection of hyaluronic acid into the vocal folds has been known to provide improved voice quality in adults although there are no known cases reported of this procedure in children., Methods: This article reports voice outcomes after injection of hyaluronic acid into the Reinke's space in a single case study. Voice recordings were made before, after, and 1 month after injection. The voice recordings were subject to acoustic and perceptual analysis., Results: Post and follow-up voice recordings demonstrate decreased jitter, shimmer, and harmonics-to-noise ratio. Perceptual evaluation indicates improved voice quality., Conclusion: Injection of hyaluronic acid in children who require voice augmentation is possible and may contribute to increased vocal function and improved voice outcomes., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: When assessing pediatric dysphonia, there are different approaches that can be taken in gathering a subjective view of the impact voice difficulties have on a child. Most valid questionnaires require parent-proxy reporting, although it has become increasingly important to gather the views of children themselves. This study reports a pilot study of an adaptation to the Pediatric Voice-Related Quality-of-Life Questionnaire (PVRQoL)., Methods: A total of 24 parent and child dyads were recruited from a tertiary pediatric voice clinic. Children were aged between 3 years and 8 months and 15 years and 3 months. Parents completed the existing PVRQoL questionnaire, whereas their children were given a child-adapted version. Follow-up completion of the child questionnaire was conducted after a 2-week period., Results: There was a good correlation between the two time periods when children completed the adapted PVRQoL and also between parent and child responses. Of particular interest, however, was the different ratings on individual items by parents and their children with parents tending to overestimate the extent to which their children may be emotionally affected by their voice disorder., Conclusions: This study shows that children have much to tell about their own voice-related quality of life, so our conclusion is that they should also be self-assessed. The PVRQoL when adapted for use with children offers an additional insight that can be gathered in a relatively short timeframe and be considered with other assessments of vocal function., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: Team-based learning (TBL), a structured form of small-group learning, has gained popularity in medical education in recent years. A growing number of medical schools have adopted TBL in a variety of combinations and permutations across a diversity of settings, learners, and content areas. The authors conducted this systematic review to establish the extent, design, and practice of TBL programs within medical schools to inform curriculum planners and education designers., Method: The authors searched the MEDLINE, PubMed, Web of Knowledge, and ERIC databases for articles on TBL in undergraduate medical education published between 2002 and 2012. They selected and reviewed articles that included original research on TBL programs and assessed the articles according to the seven core TBL design elements (team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the four S's [significant problem, same problem, specific choice, and simultaneous reporting], incentive structure, and peer review) described in established guidelines., Results: The authors identified 20 articles that satisfied the inclusion criteria. They found significant variability across the articles in terms of the application of the seven core design elements and the depth with which they were described. The majority of the articles, however, reported that TBL provided a positive learning experience for students., Conclusions: In the future, faculty should adhere to a standardized TBL framework to better understand the impact and relative merits of each feature of their program.

The European Laryngological Society (ELS) recommend that functional assessment of voice disorder in adults requires evaluation of a number of different parameters. These include perceptual evaluation of voice, videostroboscopic imaging of vocal fold movement, acoustic analysis of specific voicing aspects, aerodynamic support for voicing, and a subjective rating of voice impact. No specific guidelines are available for children, but a similar range of parameters is needed to guide intervention and measure outcomes. The development of subjective voice measures for adults and their adaptations for the paediatric population are reviewed and compared to the research comparing these to evaluation of vocal function. The need for further refinement of child assessment measures, and a proposal of how these might be developed, is discussed.

The European Laryngological Society (ELS) recommend that functional assessment of voice disorder in adults requires evaluation of a number of different parameters. The current paper presents a discussion of four of the five parameters highlighted in the ELS protocol: perceptual evaluation of voice, videostroboscopic examination, evaluation of aerodynamic performance in voice, and acoustic analysis. Subjective rating of voice in children is explored in a companion paper. These parameters have been extensively evaluated in adults, and a review of the literature pertaining to the paediatric population is presented.

Identification of patients with specific nutritional needs requires the use of appropriate weighing systems. The introduction of the Non-Automated Weighing Instruments Directive for equipment requiring an operator (Directive 2009/23/EC of the European Parliament) in hospitals in the UK has provided a framework for standardisation of measurement accuracy in weighing equipment. This article outlines the recommendations of the directive. Clinical areas in which weight measurements are especially relevant are identified. A summary of checks for local verification of weighing equipment and practice is provided. In addition, the importance of accurate height measurement to reduce error in derived values of body mass index is outlined.

Research has shown that the positioning of syringe pumps can have a significant effect on the amount of drug delivered t opatients. This article explains the effects of raising and lowering syringe pumps in relation to the entry site, and its impact on drug delivery. It also discusses drugs which are particularly associated with risks to patients when the device height is changed, and measures to reduce the clinical impact of height elevation and depression of infusion lines, including training.

Objective: The purpose of this article is to use the steps described by Genson and Chun for implementation of electronic health records to determine the plausibility of implementation in a small private practice in northern Michigan., Discussion: A step by step approach was applied as described by Genson and Chun, which included discovery, planning, procurement, implementation, and support. Several challenges and obstacles were identified., Conclusion: Electronic health records will eventually be a necessity, but they may not have matured enough to easily replace paper charts or to justify the expense for a single-doctor practice at this time. Each doctor should evaluate the needs of his or her practice for implementing electronic health records and weigh benefits and drawbacks prior to considering implementation.

Objective: To identify factors contributing to unplanned tracheostomy following cardiac surgery in children under 12 months without prior airway support., Methods: Case series with chart review., Results: Eleven patients were identified (eight male, three female). Eight were term, three preterm. Four had syndromes associated with cardiac disease. Age at cardiac surgery was 2.2 (0.1-5.2) months. Time between surgery and tracheostomy was 1.2 (0-3) months. Two groups were identified. The first had tracheobronchomalacia as the primary diagnosis (n = 9). Time post-surgery for tracheostomy was 1.2 (0.5-3) months. The second had bilateral vocal fold paralysis (n = 2). Both children had cardiac procedures that have recognized risk to the left recurrent laryngeal nerve (RLN). Both had cannulation of the right internal jugular vein at the time of surgery. Tracheostomy occurred within three days of the cardiac procedure., Conclusion: Investigations for tracheobronchomalacia should occur if a child continues to fail ventilator weaning or extubation following cardiac surgery. Risk of right RLN injury due to right vascular instrumentation should be minimized in left RLN prone procedures.