ORCID Profile
0000-0002-6268-4378
Current Organisation
Monash University
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Publisher: Informa UK Limited
Date: 30-03-2021
Publisher: MDPI AG
Date: 23-02-2023
Abstract: There has been increasing adoption and implementation of virtual healthcare in recent years, especially with COVID-19 impacting the world. As a result, virtual care initiatives may not undergo stringent quality control processes to ensure that they are appropriate to their context and meet sector needs. The two objectives of this study were to identify virtual care initiatives for older adults currently in use in Victoria and virtual care challenges that could be prioritised for further investigation and scale-up and to understand why certain virtual care initiatives and challenges are prioritised over others for investigation and scale-up. Methods: This project used an Emerging Design approach. A survey of public health services in the state of Victoria in Australia was first carried out, followed by the co-production of research and healthcare priorities with key stakeholders in the areas of primary care, hospital care, consumer representation, research, and government. The survey was used to gather existing virtual care initiatives for older adults and any associated challenges. Co-production processes consisted of in idual ratings of initiatives and group-based discussions to identify priority virtual care initiatives and challenges to be addressed for future scale-up. Stakeholders nominated their top three virtual initiatives following discussions. Results: Telehealth was nominated as the highest priority initiative type for scaling up, with virtual emergency department models of care nominated as the highest priority within this category. Remote monitoring was voted as a top priority for further investigations. The top virtual care challenge was data sharing across services and settings, and the user-friendliness of virtual care platforms was nominated as the top priority for further investigation. Conclusions: Stakeholders prioritised public health virtual care initiatives that are easy to adopt and address needs that are perceived to be more immediate (acute more so than chronic care). Virtual care initiatives that incorporate more technology and integrated elements are valued, but more information is needed to inform their potential scale-up.
Publisher: Public Library of Science (PLoS)
Date: 30-12-2021
DOI: 10.1371/JOURNAL.PONE.0261793
Abstract: Disinvestment is the removal or reduction of previously provided practices or services, and has typically been undertaken where a practice or service has been clearly shown to be ineffective, inefficient and/or harmful. However, practices and services that have uncertain evidence of effectiveness, efficiency and safety can also be considered as candidates for disinvestment. Disinvestment from these practices and services is risky as they may yet prove to be beneficial if further evidence becomes available. A novel research approach has previously been described for this situation, allowing disinvestment to take place while simultaneously generating evidence previously missing from consideration. In this paper, we describe how this approach can be expanded to situations where three or more conditions are of relevance, and describe the protocol for a trial examining the reduction and elimination of use of mobilisation alarms on hospital wards to prevent patient falls. Our approach utilises a 3-group, concurrent, non-inferiority, stepped wedge, randomised design with an embedded parallel, cluster randomised design. Eighteen hospital wards with high rates of alarm use (≥3%) will be paired within their health service and randomly allocated to a calendar month when they will transition to a “Reduced” ( %) or “Eliminated” (0%) mobilisation alarm condition. Dynamic randomisation will be used to determine which ward in each pair will be allocated to either the reduced or eliminated condition to promote equivalence between wards for the embedded parallel, cluster randomised component of the design. A project governance committee will set non-inferiority margins. The primary outcome will be rates of falls. Secondary clinical, process, safety, and economic outcomes will be collected and a concurrent economic evaluation undertaken.
Publisher: Wiley
Date: 02-01-2022
DOI: 10.1002/HPJA.565
Abstract: Consumer engagement in healthcare research presents with challenges, one of which is ensuring that the consumers have comprehended the often complex concepts in scientific research. This study aimed to compare how well older adult consumers understood video-based versus written and verbal description approaches to provision of information. Twenty adults in the community aged 60 years and older were recruited for this study half were randomised to receive the information via a digital story, and the other half received the same information from a written brief. Both mediums were presented via video teleconferencing. An interviewer was present to ask questions and address queries. Participants who viewed the digital story requested for clarifications less frequently compared to those who received the written brief. Difficulty in understanding the information rose with complexity, but providing concrete ex les aided comprehension of the information. Complex concepts benefit from the provision of concrete ex les to facilitate understanding. Video-based approaches to provision of information are acceptable forms of participant engagement in research and require less human resources to successfully convey key information and facilitate understanding of the information. Research procedures that employ large amounts of data collection and/or asynchronous methods should consider the use of video-based approaches, such as digital stories, to increase cost-effectiveness.
Publisher: MDPI AG
Date: 05-11-2021
DOI: 10.3390/GERIATRICS6040108
Abstract: Purees are often recommended for older adults in residential aged care facilities (RACFs) to target swallowing difficulties and nutrition. However, they lack appeal and may have negative impacts on nutritional intake. This study investigated the subjective experiences and objective swallowing function and safety of older adults in response to a modified puree. Twenty-eight residents from three RACFs whose regular diets consisted of purees were recruited. Purees were modified to improve visual appeal by adding a commercial enzyme gellant. Each participant was observed during three puree and three modified puree meals, and completed a brief questionnaire after each meal. A videofluoroscopic swallowing study (VFSS) was performed with 16 of the participants. Compared to purees, modified purees were observed to be easier for oral processing and intake amount was higher, but participants required assistance more often and mealtimes were longer. Participants did not show preference for either type of puree. VFSS showed similar swallowing responses between the two puree types however, a distinction was observed for modified pureed meat compared to other ingredients. Modifying puree meals in RACFs is a feasible approach to improve nutritional intake while maintaining swallowing safety, but their appeal to consumers is not definitive.
Publisher: Wiley
Date: 09-02-2023
Abstract: Swallowing function can become impaired due to primary medical conditions or age‐related presbyphagia, resulting in swallowing disorders, known as dysphagia. Specific manoeuvres that target different musculature have been innovated and researched, but whole‐body exercises (WBE) that target multiple large groups of body systems and muscles have been rarely considered in dysphagia management, despite the causes of dysphagia being often systemic. To identify intervention studies that have used or incorporated WBE to target swallowing function in humans, and report on their findings. A scoping review was conducted given the paucity and novelty of this topic in research and practice. Key search terms were used to search five major databases on for all human studies published before 28 November 2022. Studies that were not interventional or used animal models were excluded. All swallowing and oromotor‐related outcomes were extracted from the studies. Two researchers independently reviewed all search results following the PRISMA‐ScR guideline before meeting to resolve any disagreements. Final analysis was conducted on 11 papers that described 10 studies, with 10 papers (9 studies) reporting positive findings for swallowing or oromotor function‐related outcomes. Studies ranged from randomised controlled trials to case studies in design. The study design and populations were heterogeneous, with outcome measures for swallowing and oromotor function ranging from subjective questionnaires to instrumental assessments. Dysphagia rehabilitation that incorporates WBE as part of a comprehensive programme appears to be more beneficial than either WBE or swallowing‐related interventions alone. This review is an initial attempt to systematically examine the evidence on this topic. There is a need for future research to study how WBE can be used, either alone or combined with traditional swallowing exercises, to influence swallowing function in different healthy and clinical populations. Dysphagia rehabilitation usually focuses only on the swallowing muscles and structures of the head, neck, and respiratory system. Whole‐body exercise (WBE) and fitness are associated with stronger performance of the tongue muscles, there may be transference potential of WBE to swallowing function. This review found 10 studies conducted in the last decade that investigated the inclusion of WBE in programmes intended to improve swallowing and/or oromotor‐related outcomes. The studies varied widely in design and methodology, but most reported evidence in support of the inclusion of WBE to improve or maintain swallowing and/or oromotor‐related functions. There is potential for WBE to have a synergistic effect on swallowing function when combined with traditional swallowing exercises. Future clinical research should compare different rehabilitation approaches with controls. Clinicians should enlist allied health professionals who can provide whole‐body rehabilitation when managing dysphagia.
Publisher: American Speech Language Hearing Association
Date: 18-09-2017
DOI: 10.1044/2017_JSLHR-S-17-0028
Abstract: The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly in iduals in aged care facilities. A total of 878 in iduals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating Assessment Tool score, oral motor assessment score, Mini-Mental State Examination, medical history, and various functional status ratings. Binomial logistic regression was used to identify independent variables associated with dysphagia in this cohort. Two statistical models were constructed. Model 1 used variables from case files without the need for hands-on assessment, and Model 2 used variables that could be obtained from hands-on assessment. Variables positively associated with dysphagia identified in Model 1 were male gender, total dependence for activities of daily living, need for feeding assistance, mobility, requiring assistance walking or using a wheelchair, and history of pneumonia. Variables positively associated with dysphagia identified in Model 2 were Mini-Mental State Examination score, edentulousness, and oral motor assessments score. Cognitive function, dentition, and oral motor function are significant indicators associated with the presence of swallowing in the elderly. When assessing the frail elderly, case file information can help clinicians identify frail elderly in iduals who may be suffering from dysphagia.
Publisher: Elsevier BV
Date: 09-2020
Publisher: American Speech Language Hearing Association
Date: 14-01-2021
DOI: 10.1044/2020_JSLHR-19-00190
Abstract: This study aims to investigate the effects of dysphonic voice on speech intelligibility in Cantonese-speaking adults. Speech recordings from three speakers with dysphonia secondary to phonotrauma and three speakers with healthy voices were presented to 30 healthy listeners (15 men and 15 women M age = 22.7 years) under six noise conditions (signal-to-noise ratio [SNR] −10, SNR −5, SNR 0, SNR +5, SNR +10) and quiet conditions. The speech recordings were composed of sentences with five different lengths: five syllables, eight syllables, 10 syllables, 12 syllables, and 15 syllables. The effects of speaker's voice quality, background noise condition, and sentence length on speech intelligibility were examined. Speech intelligibility scores were calculated based on the listener's correct judgment of the number of syllables heard as a percentage of the total syllables in each stimulus. Dysphonic voices, as compared to healthy voices, were significantly more affected by background noise. Speech presented with dysphonic voices was significantly less intelligible than speech presented with healthy voices under unfavorable SNR conditions (SNR −10, SNR −5, and SNR 0 conditions). However, there was no sufficient evidence to suggest effects of sentence length on intelligibility, regardless of the speaker's voice quality or the level of background noise. This study provides empirical data on the impacts of dysphonic voice on speech intelligibility in Cantonese speakers. The findings highlight the importance of educating the public about the impacts of voice quality and background noise on speech intelligibility and the potential of compensatory strategies that specifically address these barriers. 0.23641/asha.13335926
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.JVOICE.2017.09.015
Abstract: The purpose of this study was to evaluate the reliability and validity of the Mandarin (simplified) Chinese version of Voice Activity and Participation Profile (MC-VAPP) in mainland China. This study enrolled 786 subjects from February 2015 to March 2017, including 456 in iduals with voice disorders (dysphonic group) and 330 vocally healthy in iduals (nondysphonic group). The internal consistency (Cronbach alpha coefficient), test-retest reliability (intraclass correlation coefficient [ICC]), and differences in the MC-VAPP scores were compared between the two groups. Exploratory factor analysis was performed. The receiver operating characteristic curve and cutoff point were calculated. The MC-VAPP had a high internal consistency. Cronbach alpha coefficients for the subsection scores were from 0.86 and 0.96, with 0.98 for the total score. Test-retest reliability was high for the total score (ICC = 0.98). The four factors' cumulative contribution was determined to be 74.68%. The dysphonic participants displayed significantly higher total score and subsection scores than the nondysphonic participants (P < 0.001). There were significant differences in total activity limitation scores and the total participation restriction scores between the two groups (P < 0.001). The cutoff point for screening between the two groups was 36.5, with a sensitivity of 76.80% and specificity of 80.30%. The MC-VAPP is a reliable and valid instrument for the evaluation of voice-related quality of life in Chinese-speaking in iduals. It is also recommended that the MC-VAPP would be a useful tool for screening in iduals with and without voice disorders based on the cutoff value of 36.5.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 28-04-2021
DOI: 10.1007/S00455-021-10311-6
Abstract: This study aimed to investigate the relationship between intensity-modulated radiation therapy (IMRT) dosimetry and swallowing kinematic and timing measures. Thirteen kinematic and timing measures of swallowing from videofluoroscopic analysis were used as outcome measures to reflect swallowing function. IMRT dosimetry was accessed for thirteen swallowing-related structures. A cohort of 44 nasopharyngeal carcinoma (NPC) survivors at least 3 years post-IMRT were recruited. The cohort had a mean age of 53.2 ± 11.9 years, 77.3% of whom were male. There was an average of 68.24 ± 14.15 months since end of IMRT 41 (93.2%) had undergone concurrent chemotherapy. For displacement measures, female sex and higher doses to the cricopharyngeus, glottic larynx, and base of tongue were associated with reduced hyolaryngeal excursion and pharyngeal constriction, and more residue. For timing measures, higher dose to the genioglossus was associated with reduced processing time at all stages of the swallow. The inferior pharyngeal constrictor emerged with a distinctly different pattern of association with mean radiation dosage compared to other structures. Greater changes to swallowing kinematics and timing were observed for pudding thick consistency than thin liquid. Increasing radiation dosage to swallowing-related structures is associated with reduced swallowing kinematics. However, not all structures are affected the same way, therefore organ sparing during treatment planning for IMRT needs to consider function rather than focusing on select muscles. Dose-response relationships should be investigated with a comprehensive set of swallowing structures to capture the holistic process of swallowing.
Publisher: Wiley
Date: 27-09-2023
DOI: 10.1111/JEP.13769
Abstract: Low‐value care in public health can be addressed via disinvestment with the support of disinvestment research generated evidence. Consumers' views of disinvestment have rarely been explored despite the potential effects of this process on the care they will receive and the importance of consumer participation in decision‐making in public healthcare. This study aimed to understand consumer concerns, perceptions and attitudes towards disinvestment processes, with the goal of providing recommendations to health service researchers and managers to more effectively engage consumers in shared decision‐making in public healthcare. We conducted semistructured interviews using four scenarios describing the principles of disinvestment, how and why it could be undertaken, and a fifth scenario that described a real‐life application of these principles. These scenarios were presented to participants in a written word document or a digital story during semistructured interviews. Participants were 18 community‐dwelling older adults who were recruited via convenience s ling. Questions were addressed to the participants regarding their feelings and concerns towards disinvestment, their participation as consumers in disinvestment processes, as well as their preference for communicating information about disinvestment to patients and families. Four major themes emerged around the negative perception of disinvestment and positive perception of research. Participants were concerned that the removal of a clinical activity was mainly the result of financial constraints in hospital systems. At times, participants indicated that disinvestment and its justifications were not easily understood. Participants expressed a need for consumer advocacy not always through themselves, but via others with more expertize a single consumer is insufficient in representing the broader consumer perspective. Participants stressed the importance of transparency in relation to research evidence and decision‐making outcomes. Face‐to‐face dissemination of information by expert staff was preferred, which could be supplemented with clear and concise written materials. Consumers' main perception of disinvestment processes was that the removal of a clinical care activity depended on financial imperatives from hospital administration and political agendas. This tended to cause suspicion about reasons behind the removal of care, which overshadowed comprehension of the ineffective/inconclusive evidence that were key to disinvestment.
Publisher: Association Babylonia Switzerland
Date: 25-08-2021
DOI: 10.55393/BABYLONIA.V2I.57
Abstract: Children who exhibit severe difficulties in the expression and/or comprehension of language are considered to have a developmental language disorder (DLD). The language of children with DLD is characterized by numerous errors, demonstrated most frequently and severely in the areas of phonology and morphosyntax. Recently, it has been revealed that aspects of language not directly related to grammar, such as the social use of language, i.e., communicative skills, may pose difficulties as well. Therefore, the assessment of pragmatic and social emotional skills in these children is a rather recent and highly intriguing field of study that needs further investigation. In the present article, we discuss the necessity of assessing pragmatic and social emotional skills in children (especially with DLD). Moreover, we advocate for the consideration of in idual differences in the social use of language in affected children and suggest that, primarily, skills that require the active use of language, e.g., the various aspects of turn taking and topic selection/maintenance/change, seem to be most challenging. Last, we discuss how teachers, parents, and peers can help prevent and overcome socioemotional needs of children with DLD.
Publisher: Wiley
Date: 04-10-2018
DOI: 10.1002/LARY.27501
Abstract: The objectives of the study were to develop a mealtime experience self-assessment questionnaire that was head and neck cancer (HNC) survivors-driven and based on the International Classification of Functioning, Disability and Health (ICF) framework, and to identify common mealtime issues reported by HNC survivors. Outcomes research. Mealtime issues reported by HNC survivors in prior research was synthesized and classified using the ICF framework to develop the content and structure of the Head and Neck Cancer Survivors' Assessment of Mealtimes (HNSAM). A total of 122 HNC survivors completed both HNSAM and M.D. Anderson Dysphagia Inventory (MDADI) to assess for concurrent validity, whereas 51% of participants completed a second HNSAM for test-retest reliability. The HNSAM scores were significantly correlated with the MDADI scores. Dysphagic participants (n = 45) had significantly higher HNSAM scores than the nondysphagic participants (n = 77). Principal component analysis revealed three factors that matched with the HNSAM subscales. Good internal consistency (Cronbach's α = 0.72-0.96) and test-retest reliability (intraclass correlation = 0.76-0.91) were found. Both dysphagic and nondysphagic participants reported difficulties with saliva-related issues and were not able to enjoy food/drinks that they previously enjoyed. HNC survivors experience mealtime changes after cancer treatment. These initial validity data support the potential for the HNSAM to help HNC survivors' identify changes to the mealtime experience. Validation of the English version of the tool is now required. 2c Laryngoscope, 129:1572-1578, 2019.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
No related grants have been discovered for Dai Pu.