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Cahill PT, Ferro MA, Ng S, Turkstra LS, Campbell WN. Core outcomes for speech-language services in Ontario schools: a group concept mapping study and guiding framework. BMC Health Serv Res 2024; 24:347. [PMID: 38491356 PMCID: PMC10943816 DOI: 10.1186/s12913-024-10821-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Establishing the most important outcomes for school-based speech-language therapy is essential to guide future research and program evaluation for these services. Many health disciplines have developed core outcomes sets (COS) for this purpose. A COS encompasses the most important outcomes for particular health services as identified by appropriate interested parties. These interested parties usually represent health care providers and those with the health condition. In this paper, we report the development of a guiding framework for a COS for speech-language therapy services in schools in a Canadian context. METHODS Using a group concept mapping method, we identified the outcomes for inclusion in the COS guiding framework through the elicited opinions of key interested parties: speech-language therapists, teachers, and family members of children with speech, language, and communication needs. We extracted 103 statements (potential outcomes) from a previous data set of interview transcripts. We then asked participants to sort the statements into conceptually similar groups, which were aggregated and transformed into a cluster map using multidimensional scaling followed by hierarchical cluster analysis. Participants also rated each statement on 5-point scales for importance and feasibility. We calculated mean ratings for individual statements and for all statements in a cluster, for all participants and for participant groups separately. RESULTS We identified seven core outcomes for school-based speech-language services in Ontario, Canada. These included: classroom-based services, a holistic approach, support for teachers, care coordination, accessible services, family supports, and student success. All outcomes were rated highly for importance. Feasibility ratings were consistently below importance ratings. All participant groups concurred that a holistic approach was the most important outcome and accessible services was the least feasible outcome to achieve. CONCLUSIONS The seven outcomes identified in this study are recommended to guide the development of a full COS to direct future research and program evaluation for school-based speech-language services. These outcomes have not been widely included in previous research and should be incorporated into future research alongside specific intervention outcomes. Data for some outcomes may be available from non-traditional sources such as administrative data sets. Consequently, their use for program evaluations should be accompanied by appropriate institutional support to allow speech-language therapists to make meaningful use of appropriate outcomes data.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Mark A Ferro
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Stella Ng
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, Canada
| | - Lyn S Turkstra
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
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Cahill PT, Ng S, Turkstra LS, Ferro MA, Campbell WN. Exploring the valued outcomes of school-based speech-language therapy services: a sequential iterative design. Front Rehabil Sci 2024; 5:1290800. [PMID: 38313699 PMCID: PMC10834652 DOI: 10.3389/fresc.2024.1290800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024]
Abstract
Background Achieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools. Methods A sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members' perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison. Results Structural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services. Conclusions Outcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development.
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Affiliation(s)
- Peter T. Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Stella Ng
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, ON, Canada
| | - Lyn S. Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Mark A. Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Wenonah N. Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
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Cahill PT, Ng S, Dix L, Ferro MA, Turkstra L, Campbell WN. Outcomes management practices in tiered school-based speech-language therapy: A Canadian example. Int J Lang Commun Disord 2023; 58:786-801. [PMID: 36426768 DOI: 10.1111/1460-6984.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/28/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service-delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. AIMS The first aim was to explore how school-based speech-language therapists approached outcomes management as their clinical programmes transitioned to tiered service-delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. METHODS & PROCEDURES A secondary deductive-inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. FINDINGS & RESULTS Participants reported measuring and qualitatively assessing seven key outcomes for school-based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy-in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. CONCLUSIONS & IMPLICATIONS School-based speech-language therapists measure, assess and manage multiple outcomes relevant to school-based practice in tiered service-delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service-delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical-research collaboration and knowledge exchange is recommended. WHAT THIS PAPER ADDS What is already known on the subject Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech-language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school-based practice. What are the potential or actual clinical implications of this work? Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school-based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Stella Ng
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, ON, Canada
| | - Leah Dix
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Mark A Ferro
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lyn Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
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Cahill PT, Reitzel M, Anaby DR, Camden C, Phoenix M, Romoff S, Campbell WN. Supporting rehabilitation stakeholders in making service delivery decisions: a rapid review of multi-criteria decision analysis methods. Disabil Rehabil 2022:1-14. [PMID: 35649688 DOI: 10.1080/09638288.2022.2080285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This review aimed to synthesize knowledge about multi-criteria decision analysis methods for supporting rehabilitation service design and delivery decisions, including: (1) describing the use of these methods within rehabilitation, (2) identifying decision types that can be supported by these methods, (3) describing client and family involvement, and (4) identifying implementation considerations. METHODS We conducted a rapid review in collaboration with a knowledge partner, searching four databases for peer-reviewed articles reporting primary research. We extracted relevant data from included studies and synthesized it descriptively and with conventional content analysis. RESULTS We identified 717 records, of which 54 met inclusion criteria. Multi-criteria decision analysis methods were primarily used to understand the strength of clients' and clinicians' preferences (n = 44), and five focused on supporting decision making. Shared decision making with stakeholders was evident in only two studies. Clients and families were mostly engaged in data collection and sometimes in selecting the relevant criteria. Good practices for supporting external validity were inconsistently reported. Implementation considerations included managing cognitive complexity and offering authentic choices. CONCLUSIONS Multi-criteria decision analysis methods are promising for better understanding client and family preferences and priorities across rehabilitation professions, contexts, and caseloads. Further work is required to use these methods in shared decision making, for which increased use of qualitative methods and stakeholder engagement is recommended. IMPLICATIONS FOR REHABILITATIONMulti-criteria decision analysis methods are promising for evidence-based, shared decision making for rehabilitation.However, most studies to date have focused on estimating stakeholder preferences, not supporting shared decision making.Cognitive complexity and modelling authentic and realistic decision choices are major barriers to implementation.Stakeholder-engagement and qualitative methods are recommended to address these barriers.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Meaghan Reitzel
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Dana R Anaby
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada.,CanChild Centre for Child Disability Research, Hamilton, Canada
| | - Chantal Camden
- CanChild Centre for Child Disability Research, Hamilton, Canada.,School of Rehabilitation, University of Sherbrooke, Sherbrooke, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,CanChild Centre for Child Disability Research, Hamilton, Canada
| | - Shelley Romoff
- Empowered Kids Ontario-Enfants Avenir Ontario, Toronto, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,CanChild Centre for Child Disability Research, Hamilton, Canada
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Cahill PT, Ferro MA, Campbell WN, Ronen GM. Self-esteem mediates mental health outcomes in young people with epilepsy. Epilepsia 2021; 62:2072-2081. [PMID: 34275131 DOI: 10.1111/epi.17006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the extent to which self-esteem mediates the impacts of epilepsy-specific and environmental factors on mental health outcomes in young people with epilepsy. METHODS A prospective cohort of 480 young people with epilepsy and their families participated in five visits over 28 months. We collected data on clinical seizure burden, cognitive comorbidity, peer and parental support, self-esteem, and self-reported mental health symptoms. We used structural equation modeling to specify and test relationships among these constructs simultaneously. Direct, indirect, and total effects were estimated with confidence intervals constructed through bias-corrected bootstrapping. RESULTS Self-esteem mediated the effects of clinical seizure burden ( β = 0.23, 95% confidence interval [0.05, 0.42]) and peer support ( β = -0.15, 95% CI [-0.28, -0.03]) on mental health. There were no mediating effects of parental support ( β = -0.07, 95% CI [-0.14, 0.00]) or cognitive comorbidity ( β = -0.01, 95% CI [-0.02, 0.01]) on mental health. SIGNIFICANCE We found evidence that self-esteem mediates the impact that both clinical seizure burden and peer support have on mental health outcomes, indicating that assessment of and interventions targeting self-esteem may be appropriate for young people with epilepsy. Supporting self-esteem could mitigate negative influences on mental health, whether from resistant epilepsy or low peer support.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Gabriel M Ronen
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada.,Department of Paediatrics (Neurology), McMaster University, Hamilton, ON, Canada
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Kennedy JN, Missiuna CA, Pollock NA, Sahagian Whalen S, Dix L, Campbell WN. Making connections between school and home: Exploring therapists’ perceptions of their relationships with families in partnering for change. Br J Occup Ther 2019. [DOI: 10.1177/0308022619876560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction A recently developed service delivery model, called Partnering for Change, encourages collaboration between occupational therapists, educators and families, and aims to improve children’s participation across school, home and community settings. Partnering for Change has been successful in facilitating equitable access to services and eliminating wait lists; however, it could have a more significant impact through improved capacity-building with families. The purpose of this study is to describe the factors that therapists view as influencing the development of family–therapist relationships in Partnering for Change, and to explore their ideas to improve relationship-building. Methods Focus groups were completed with 15 occupational therapists who provided Partnering for Change school-based services. Qualitative description methodology and directed content analysis were utilized. Results Several factors were identified that influenced the development of family–therapist relationships including competing demands; consistency and availability; awareness, readiness and commitment; relationships with schools and educators; and sociodemographic characteristics. Increasing in-person interactions and awareness of occupational therapy services were suggested to improve relationship-building. Conclusions Therapists should consider innovative ways of overcoming competing demands, utilizing relationships with schools and educators, and participating in mentorship and communities of practice to address the current barriers of family–therapist relationships, and create better opportunities for collaboration.
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Affiliation(s)
- Jennifer N Kennedy
- CanChild, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Cheryl A Missiuna
- CanChild, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Nancy A Pollock
- CanChild, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | | | - Leah Dix
- CanChild, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Wenonah N Campbell
- CanChild, McMaster University, Hamilton, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Anaby DR, Campbell WN, Missiuna C, Shaw SR, Bennett S, Khan S, Tremblay S, Kalubi-Lukusa JC, Camden C. Recommended practices to organize and deliver school-based services for children with disabilities: A scoping review. Child Care Health Dev 2019; 45:15-27. [PMID: 30264437 DOI: 10.1111/cch.12621] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inclusive educational environments can have a positive effect on the general health and well-being of children with disabilities. However, their level of academic success and participation remains limited. Considering scarce resources and high needs, identifying efficient methods for providing interdisciplinary services is critical. This scoping review, therefore, aims to (a) synthesize current evidence about principles for organizing and delivering interdisciplinary school-based support services for students with disabilities and (b) ascertain useful strategies for implementation of principles in the school setting. METHODS Scholarly and grey literature in rehabilitation and education were reviewed collaboratively with school-based stakeholders. A search of five databases identified 13,141 references and resulted in 56 relevant articles published from 1998 to 2017. Information (e.g., principles to organize services and strategies for implementation) was extracted, and thematic analysis was used to summarize findings. RESULTS Within the documents retained, 65% were scientific and 35% were grey. Services primarily targeted students with behavioral issues, followed by those with cognitive and learning disabilities with a focus on improving social-emotional functioning and academic performance. Thematic analysis revealed 10 common principles to guide service organization (e.g., collaborative interventions and support for teachers) and seven implementation strategies (e.g., training and coordination) for employing these principles. CONCLUSIONS Findings can guide rehabilitation professionals, educators, and policy makers in restructuring well-coordinated collaborative services involving training and capacity-building of school-based service providers. Such knowledge can contribute to the improved provision of care and, consequently, promote children's school participation and inclusion.
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Affiliation(s)
- Dana R Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Missiuna
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Steven R Shaw
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Sheila Bennett
- Faculty of Education, Brock University, St. Catharines, Ontario, Canada
| | - Sitara Khan
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Stephanie Tremblay
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | | | - Chantal Camden
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Campbell WN, Douglas NF. Supporting evidence-based practice in speech-language pathology: A review of implementation strategies for promoting health professional behavior change. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17489539.2017.1370215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wenonah N. Campbell
- School of Rehabilitation Science, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Natalie F. Douglas
- Department of Communication Disorders, Central Michigan University, Mount Pleasant, Michigan
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Pollock NA, Dix L, Whalen SS, Campbell WN, Missiuna CA. Supporting occupational therapists implementing a capacity-building model in schools. Can J Occup Ther 2017. [DOI: 10.1177/0008417417709483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Douglas NF, Campbell WN, Hinckley JJ. Implementation Science: Buzzword or Game Changer? J Speech Lang Hear Res 2015; 58:S1827-36. [PMID: 26502033 DOI: 10.1044/2015_jslhr-l-15-0302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/01/2015] [Indexed: 05/14/2023]
Abstract
PURPOSE The purpose of this supplement article is to provide a resource of pertinent information concerning implementation science for immediate research application in communication sciences and disorders. METHOD Key terminology related to implementation science is reviewed. Practical suggestions for the application of implementation science theories and methodologies are provided, including an overview of hybrid research designs that simultaneously investigate clinical effectiveness and implementation as well as an introduction to approaches for engaging stakeholders in the research process. A detailed example from education is shared to show how implementation science was utilized to move an intervention program for autism into routine practice in the public school system. In particular, the example highlights the value of strong partnership among researchers, policy makers, and frontline practitioners in implementing and sustaining new evidence-based practices. CONCLUSIONS Implementation science is not just a buzzword. This is a new field of study that can make a substantive contribution in communication sciences and disorders by informing research agendas, reducing health and education disparities, improving accountability and quality control, increasing clinician satisfaction and competence, and improving client outcomes.
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Missiuna C, Pollock N, Campbell WN, Bennett S, Hecimovich C, Gaines R, DeCola C, Cairney J, Russell D, Molinaro E. Use of the Medical Research Council Framework to develop a complex intervention in pediatric occupational therapy: Assessing feasibility. Res Dev Disabil 2012; 33:1443-1452. [PMID: 22522203 DOI: 10.1016/j.ridd.2012.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 05/31/2023]
Abstract
The United Kingdom Medical Research Council recommends use of a conceptual framework for designing and testing complex therapeutic interventions. Partnering for Change (P4C) is an innovative school-based intervention for children with Developmental Coordination Disorder (DCD) that was developed by an interdisciplinary team who were guided by this framework. The goals of P4C are to facilitate earlier identification, build capacity of educators and parents to manage DCD, and improve children's participation in school and at home. Eight occupational therapists worked in school settings during the 2009-2010 school year. Their mandate was to build capacity through collaboration and coaching with the school becoming the "client", rather than any individual student. Over 2600 students and 160 teachers in 11 elementary schools received service during the project. Results from questionnaires and individual interviews indicated that this model was highly successful in increasing knowledge and capacity. P4C intervention holds promise for transforming service delivery in schools.
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Affiliation(s)
- Cheryl Missiuna
- CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main Street West, IAHS 408 Hamilton, Ontario, Canada L8S 1C7.
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Campbell WN, Missiuna C, Vaillancourt T. Peer victimization and depression in children with and without motor coordination difficulties. Psychol Schs 2012. [DOI: 10.1002/pits.21600] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Missiuna CA, Pollock NA, Levac DE, Campbell WN, Whalen SDS, Bennett SM, Hecimovich CA, Gaines BR, Cairney J, Russell DJ. Partnering for Change: An Innovative School-Based Occupational Therapy Service Delivery Model for Children with Developmental Coordination Disorder. Can J Occup Ther 2012; 79:41-50. [DOI: 10.2182/cjot.2012.79.1.6] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background. Developmental coordination disorder (DCD) is a common, chronic health condition that is poorly recognized and understood in school settings. Without appropriate support, children with DCD are at increased risk of depression, decreased fitness, and obesity. Evidence shows that occupational therapy intervention needs to shift from remediation of impairment to chronic disease management. Purpose. This paper describes Partnering for Change (P4C), an innovative, empirically derived school health service delivery model for children with DCD. Key Issues. The model emphasizes the partnership of the occupational therapist with educators and parents to change the life and daily environment of a child. The P4C partnership focuses on capacity building through collaboration and coaching in context. The model uses a tiered approach which includes whole class instruction, dynamic performance analysis, and monitoring response to intervention. Implications. P4C is a model that responds to the needs of this population, addresses issues identified in research, and provides a continuum of services designed to build capacity.
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Affiliation(s)
| | | | - Danielle E. Levac
- Danielle E. Levac, MSc., is Doctoral Candidate, McMaster University, School of Rehabilitation Science, 1400 Main Street West, IAHS 408, Hamilton, ON, L8S 1C7
| | | | | | - Sheila M. Bennett
- Sheila M. Bennett, PhD., is Professor, Brock University, Faculty of Education, Department of Teacher Education, 500 Glenridge Avenue, St. Catharines, ON, L2S 3A1
| | - Catherine A. Hecimovich
- Catherine A. Hecimovich, M.Ed., is Chief Executive Officer, Central West Community Care Access Centre, 199 County Court Boulevard, Brampton, ON., L6W 4P3
| | | | | | - Dianne J. Russell
- Dianne J. Russell, Ph.D., is Knowledge Exchange Specialist, McMaster University, CanChild Centre for Childhood Disability Research, 1400 Main Street West, IAHS 408, Hamilton, ON, L8S 1C7
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Campbell WN, Missiuna CA, Rivard LM, Pollock NA. “Support for Everyone”: Experiences of Occupational Therapists Delivering a New Model of School-Based Service. Can J Occup Ther 2012; 79:51-9. [DOI: 10.2182/cjot.2012.79.1.7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background. Occupational therapists working in school health have recognized the need to move away from a one-to-one direct service delivery model towards a more collaborative, classroom-based approach. Partnering for Change (P4C) is an innovative service delivery model that may enhance school-based collaborative care. Purpose. To capture the experiences of occupational therapists implementing P4C and to elicit their perspectives about how this model differs from the direct service approach. Methods. Semi-structured, face-to-face interviews were conducted with seven therapists who had delivered P4C in 10 Ontario schools. Thematic analysis was utilized with themes verified through member checking. Findings. Five themes (a year of growth, becoming a community, the key ingredients of P4C, a balancing act, and providing services that make an impact) reflected therapists' personal and professional growth, aspects of the model they believed were key, challenges they encountered, and the impact they felt they had made. Implications. Partnering for Change has the potential to transform school-based occupational therapy and overcome existing barriers to collaboration. This model also may better address the needs of children with motor coordination difficulties.
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Affiliation(s)
| | | | - Lisa M. Rivard
- Lisa M. Rivard, MSc, PT, is a Doctoral Student in the School of Rehabilitation Science, McMaster University, 1400 Main Street, West, IAHS 408, Hamilton, ON, L8S 1C7
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Campbell WN, Skarakis-Doyle E. The relationship between peer conflict resolution knowledge and peer victimization in school-age children across the language continuum. J Commun Disord 2011; 44:345-358. [PMID: 21367428 DOI: 10.1016/j.jcomdis.2011.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 12/20/2010] [Accepted: 01/20/2011] [Indexed: 05/30/2023]
Abstract
UNLABELLED Peer victimization, or bullying, has been identified as a significant child health priority and children with language impairment (LI) are among those who are vulnerable. Given the mandate of educators to provide support for all students who are bullied regardless of language status, research is needed that integrates the study of risk factors for peer victimization among children who are developing typically and children who have LI. Accordingly, this preliminary study explored the degree to which one potential risk factor, peer conflict resolution knowledge, was related to peer victimization in children across the language continuum, and considered whether or not individual differences in language ability influenced that relationship. Participants included 17 girls and 15 boys aged 9-12 years with a wide range of language abilities, six meeting criteria for LI. Participants completed a hypothetical peer conflict resolution task and a measure of peer victimization. Correlational analyses revealed very different patterns of relationships for boys and girls. Whereas boys' reports of peer victimization were meaningfully related to how they responded to hypothetical peer conflicts, girls' reports were most strongly associated with language ability. These preliminary findings suggest that it is important to consider gender when conceptualizing how factors such as peer conflict resolution knowledge might influence children's risk of being bullied. LEARNING OUTCOMES Readers will be able to: (1) provide a definition of peer victimization and give examples of different forms of peer victimization; (2) recognize that inadequate peer conflict resolution knowledge may be a risk factor for peer victimization; (3) describe the relationships between peer conflict resolution knowledge, language ability, and peer victimization in this study, and explain how these relationships differed for boys and girls; and (4) identify at least three opportunities for future research that would help to clarify risk factors for peer victimization in boys and girls.
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Affiliation(s)
- Wenonah N Campbell
- Doctoral Program in Rehabilitation Science, The University of Western Ontario, Canada.
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Campbell WN, Skarakis-Doyle E. Innovations in measuring peer conflict resolution knowledge in children with LI: exploring the accessibility of a visual analogue rating scale. J Commun Disord 2011; 44:207-217. [PMID: 21122876 DOI: 10.1016/j.jcomdis.2010.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 09/08/2010] [Accepted: 10/07/2010] [Indexed: 05/30/2023]
Abstract
UNLABELLED This preliminary study explored peer conflict resolution knowledge in children with and without language impairment (LI). Specifically, it evaluated the utility of a visual analogue scale (VAS) for measuring nuances in such knowledge. Children aged 9-12 years, 26 with typically developing language (TLD) and 6 with LI, completed a training protocol and hypothetical task in which they rated goals and strategies that could be pursued following peer conflict. Whereas participants with TLD provided graded judgments using the entire VAS, most children with LI relied solely on the scale anchors. These results suggest at least two possibilities. The less differentiated manner in which participants with LI utilized the VAS may have been influenced by how they viewed the peer conflict situations. Alternatively, additional training may be required to enable them to consistently use the whole scale. Further research is needed to establish whether ratings made by children with LI reflect differences in social perceptions or a need for further experience with the VAS. In either case, distinguishing between these alternatives will likely provide a better understanding of factors that impact the peer relationships of children with LI. LEARNING OUTCOMES Readers will be able to: (1) identify challenges associated with assessing peer conflict resolution knowledge in children with language impairments; (2) describe current methods for measuring children's peer conflict resolution knowledge; (3) describe a visual analogue rating (VAS) scale and explain the potential advantages of this scale format; and (4) describe similarities and differences in how children with and without LI used a VAS in a hypothetical peer conflict resolution task.
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Affiliation(s)
- Wenonah N Campbell
- Doctoral Program in Rehabilitation Science, Elborn College, The University of Western Ontario, London, Ontario N6G 1H1, Canada.
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Allan CM, Campbell WN, Guptill CA, Stephenson FF, Campbell KE. A conceptual model for interprofessional education: The international classification of functioning, disability and health (ICF). J Interprof Care 2010; 20:235-45. [PMID: 16777791 DOI: 10.1080/13561820600718139] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A shared language and conceptual framework is essential to successful interprofessional collaboration. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a shared language and conceptual framework that transcends traditional disciplinary boundaries. This paper will familiarize readers with the ICF and describe the biopsychosocial perspective that is adopted in its conceptual framework and language. The presentation of a case study will illustrate how the ICF can enhance interprofessional learning by promoting a multidimensional perspective of an individual's health concerns. The case study will also highlight the value of the shared language and conceptual framework of the ICF for interprofessional collaboration. It is argued that a strong foundation in the principles exemplified by the ICF may serve to enhance interprofessional communication, and in so doing, encourage involvement in interprofessional collaboration and healthcare.
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Affiliation(s)
- Chris M Allan
- Doctoral Program in Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
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Campbell WN, Skarakis-Doyle E. School-aged children with SLI: the ICF as a framework for collaborative service delivery. J Commun Disord 2007; 40:513-35. [PMID: 17343872 DOI: 10.1016/j.jcomdis.2007.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Revised: 11/14/2006] [Accepted: 01/24/2007] [Indexed: 05/14/2023]
Abstract
UNLABELLED Reports of associated disabilities among children with specific language impairment (SLI) and children with other developmental disabilities are widespread. Clinicians require a broader definition of SLI that recognizes associated disabilities because it is their goal to impact children's everyday functioning. In this paper, we explore SLI from a broader perspective in which consideration is given to features known to be common across different developmental disabilities. The World Health Organization's (2001) International Classification of Functioning, Disability and Health (ICF) is utilized as an organizational and conceptual framework for considering how knowledge of commonalities across developmental disabilities may be used to promote collaborative service delivery in an educational setting. This framework can potentially provide a coherent and comprehensive approach to treating SLI and its associated disabilities without overburdening clinical services. LEARNING OUTCOMES As a result of this activity, the reader will be able to: (1) describe the potential role of the ICF in facilitating collaborative service delivery in the school setting; (2) identify and describe the commonalities among SLI and its associated disabilities; and (3) describe how knowledge of commonalities may inform approaches to service delivery.
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Affiliation(s)
- Wenonah N Campbell
- Doctoral Program in Rehabilitation Sciences, Elborn College, The University of Western Ontario, London, Ont. N6G 1H1, Canada.
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Abstract
BACKGROUND We routinely cultured native heart valves removed during valve replacement surgery even when infected carditis (IE) was not suspected. Several probable contaminated cultures prompted us to evaluate this practice. METHODS The medical records of all patients who had positive valve cultures from 1995 to 1997 were reviewed for admission diagnoses, operative surgery, pathology and microbiology report, postoperative infections, and antibiotic use. Cases were excluded only for incomplete medical records or preoperative suspicion of IE. Long-term outcome for the cases was obtained from review of outpatient records and phone contact with the patient or physician. RESULTS Thirty-two of 222 (14.4%) evaluable patients had positive valve cultures. Coagulase-negative Staphylococcus was the most common isolate. IE was not suggested in any of these cases based upon the surgical or the pathology report. Only 1 of 32 (3%) developed postoperative prosthetic valve endocarditis (PVE). Three patients died of unrelated causes, and the 28 surviving patients showed no sign of PVE, with a mean follow-up of 23 months. CONCLUSIONS The incidence of false-positive native valve cultures is high. Positive cultures did not predict the occurrence of PVE sufficiently to justify obtaining them. Treating patients who had positive native valve cultures would have been unwarranted and poses an unnecessary risk.
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Affiliation(s)
- W N Campbell
- Division of Infectious Diseases and Cardiovascular Surgery, The Union Memorial Hospital, Baltimore, Maryland 21218, USA
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Onuchic MH, Campbell WN, Shen CS. Acute human immunodeficiency virus infection with severe respiratory and renal failure. Clin Infect Dis 1998; 27:1537-8. [PMID: 9868679 DOI: 10.1086/517741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- M H Onuchic
- Department of Internal Medicine, Union Memorial Hospital, Baltimore, Maryland 21218, USA
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Campbell WN, Fitzpatrick M, Ding X, Jett M, Gemski P, Goldblum SE. SEB is cytotoxic and alters EC barrier function through protein tyrosine phosphorylation in vitro. Am J Physiol 1997; 273:L31-9. [PMID: 9252537 DOI: 10.1152/ajplung.1997.273.1.l31] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We studied whether Staphylococcal enterotoxin B (SEB) has direct effects on endothelial cells (EC) in the absence of effector cells or their products. Bovine or human pulmonary artery EC were grown to confluence on filters mounted in chemotaxis chambers. Barrier function was assessed by placing [14C]bovine serum albumin in the chamber and sampling the lower well for 14C activity. SEB exposures induced a significant (P < 0.001) dose- and time-dependent increase in albumin flux across both bovine and human EC monolayers. Albumin flux was temperature dependent, and cycloheximide pretreatment of the monolayers did not block the SEB-induced increase in permeability. Preincubation of SEB with trypsin or anti-SEB antibody significantly (P < 0.0001) reduced the effect, whereas pretreatment with polymyxin B did not. SEB at > or = 10 micrograms/ml significantly (P < 0.03) increased EC injury as measured by 51Cr release in a dose- and time-dependent manner. Herbimycin and genistein, inhibitors of protein tyrosine kinases, each protected against SEB-induced cytotoxicity, barrier dysfunction, and intercellular gap formation. We conclude that SEB perturbs endothelial barrier function and viability in the absence of effector cells or their mediators.
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Affiliation(s)
- W N Campbell
- Division of Infectious Diseases, R. A. Cowley Shock Trauma Center, Baltimore, Maryland, USA
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Campbell WN, Joshi M, Sileo D. Osteonecrosis following meningococcemia and disseminated intravascular coagulation in an adult: case report and review. Clin Infect Dis 1997; 24:452-5. [PMID: 9114199 DOI: 10.1093/clinids/24.3.452] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Meningococcemia and disseminated intravascular coagulation (DIC) have a known association, and they have been identified as a rare cause of osteonecrosis in children. To our knowledge, we report only the second case of an adult with DIC and Neisseria meningitidis infection whose condition was subsequently diagnosed as osteonecrosis. We also review the world medical literature that pertains to osteonecrosis as a sequelae of meningococcal infection associated with DIC.
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Affiliation(s)
- W N Campbell
- Division of Infectious Diseases, R. Adams Cowley Shock Trauma Center, Baltimore 21201, USA
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Campbell WN, Hendrix E, Cryz S, Cross AS. Immunogenicity of a 24-valent Klebsiella capsular polysaccharide vaccine and an eight-valent Pseudomonas O-polysaccharide conjugate vaccine administered to victims of acute trauma. Clin Infect Dis 1996; 23:179-81. [PMID: 8816151 DOI: 10.1093/clinids/23.1.179] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We measured the antibody response in 10 victims of acute blunt trauma and penetrating trauma who were immunized against Klebsiella pneumoniae and Pseudomonas species within 72 hours of injury. The two vaccines, which were previously shown to be safe and immunogenic in uninjured humans, were a 24-valent K. pneumoniae capsular polysaccharide vaccine and an eight-valent Pseudomonas O-polysaccharide-toxin A conjugate vaccine. The patients were between 18 and 44 years of age, had Injury Severity Scores that ranged between 9 and 34, and did not have chronic infections or malignancies. On days 14 and 28 after immunization, all patients had a response of greater than fourfold to at least six of the nine Pseudomonas vaccine antigens. Half of the patients responded to eight of the nine antigens. Nine patients responded to at least 18 of 24 Klebsiella antigens, and seven patients responded to 22 of the 24 antigens. No important side effects were attributed to the vaccines. The results of this preliminary study indicate that active immunization against potential pathogens is possible in victims of acute trauma.
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Affiliation(s)
- W N Campbell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
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Dickhoff P, Wallace CJ, MacRae ME, Campbell WN. Adenoid cystic carcinoma: an unusual sellar mass. Can Assoc Radiol J 1993; 44:393-5. [PMID: 8402242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Adenoid cystic carcinoma represents approximately 20% of tumours of the minor salivary glands. It can originate in the sphenoidal sinus and invade the sella turcica. The authors describe a patient in whom a tumour of this type was shown by computed tomography.
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Affiliation(s)
- P Dickhoff
- Department of Radiology, Foothills Hospital, Calgary, Alta
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Launois SH, Feroah TR, Campbell WN, Issa FG, Morrison D, Whitelaw WA, Isono S, Remmers JE. Site of pharyngeal narrowing predicts outcome of surgery for obstructive sleep apnea. Am Rev Respir Dis 1993; 147:182-9. [PMID: 8420415 DOI: 10.1164/ajrccm/147.1.182] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Uvulopalatopharyngoplasty (UPPP), an operation that enlarges the pharyngeal airway at the level of the soft palate, improves respiratory status during sleep in only 50% of patients with obstructive sleep apnea (OSA). This poor outcome suggests that narrowing of the pharyngeal airway at nonpalatal sites contributes to the obstructive process in many patients with OSA. We have used a novel endoscopic method to identify regions of the passive pharyngeal airway most susceptible to narrowing or complete closure. In order to test the hypothesis that narrowing of the passive airway at the nasopharynx predicts a favorable surgical outcome, we have preoperatively assessed the local mechanics of the passive pharyngeal airway in 18 patients with OSA undergoing UPPP. The patient population was prospectively divided into two groups: an exclusively nasopharyngeal (ENP) group, consisting of patients exhibiting narrowing only in the nasopharynx, and a not exclusively nasopharyngeal (NENP) group, consisting of patients having at least one site of narrowing outside the nasopharynx. The frequency of respiratory disturbances and arousals and the cumulative time in apnea-hypopnea were significantly reduced after surgery for the ENP group, but not for the NENP group. Improvement rate for the ENP group (86%) exceeded that for the NENP group (18%) (p < 0.01). These differences became even greater when selection criteria for the ENP group were made more restrictive (i.e., restricted to the velopharynx) or more liberal (i.e., including secondary narrowing of the oropharynx). Our results show that evaluation of passive pharyngeal mechanics identifies patients with OSA likely to improve after UPPP.
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Affiliation(s)
- S H Launois
- Department of Internal Medicine, University of Calgary, Faculty of Medicine, Alberta, Canada
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Abstract
Human recombinant interleukin-1 alpha (rIL-1 alpha) and -beta were studied to determine whether either could alter the permeability of bovine pulmonary artery endothelial cell monolayers. Endothelial cells were grown to confluence on filters mounted in chemotaxis chambers placed in wells. Barrier function of the monolayers was assessed by placing 14C-labeled bovine serum albumin ([14C]BSA) in the upper chamber and sampling the lower well for [14C]BSA. rIL-1 alpha induced a significant (P less than 0.01) dose- and time-dependent increase in transendothelial [14C]BSA flux. rIL-1 alpha exposures as brief as 30 min increased permeability, but the increased albumin transfer could not be demonstrated before 4 h after exposure. Exposures up to 6 h were reversible at 24 h. rIL-1 alpha induced significantly (P less than 0.01) greater increments in [14C]BSA flux than did equivalent exposures to rIL-1 beta. No important differences between bovine and human rIL-1 beta were demonstrated. Increased transendothelial flux could not be ascribed to either endothelial cytotoxicity or growth inhibition. There was no additive or synergistic relationship between rIL-1 alpha and human recombinant tumor necrosis factor-alpha. Our studies suggest that IL-1 alpha and -beta may play a role in the pathogenesis of pulmonary vascular leak.
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Affiliation(s)
- W N Campbell
- Division of Infectious Diseases, Maryland Institute for Emergency Medical Services Systems, Baltimore
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Antoniades K, Campbell WN, Hecksher RH, Kessler WB, McCarthy GE. Liver cell adenoma and oral contraceptives. Double tumor development. JAMA 1975; 234:628-9. [PMID: 170431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Campbell WN, Sokalchuk A. A Quick Method for Filling Curved Glass Apparatus With Liquids. Science 1947; 105:651. [PMID: 17820076 DOI: 10.1126/science.105.2738.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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