ORCID Profile
0000-0001-9604-4558
Current Organisations
Edith Cowan University
,
University of Melbourne
,
Fiona Stanley Hospital
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Publisher: SAGE Publications
Date: 08-2018
Publisher: S. Karger AG
Date: 2014
DOI: 10.1159/000366423
Abstract: b i Background: /i /b Dysphagia occurs in approximately half of the stroke patients and is associated with respiratory infections however, it is unclear what other factors contribute to an increased risk. This study aimed to provide evidence on factors associated with respiratory infections in the very acute stroke period. b i Methods: /i /b Retrospective review of 536 stroke patients admitted to Australian Hospitals in 2010. Data were collected on 37 clinical and demographic parameters. Univariable and multivariable logistic regression was performed. b i Results: /i /b The overall incidence of respiratory infection was 11%. On admission, requiring full assistance with mobility [OR 6.48, 95% CI 1.35, 31.16] and urinary incontinence [OR 3.21, 95% CI 1.16, 8.87] were associated with respiratory infections. During the first week post stroke nasogastric tubes (NGT) [OR 3.91, 95% CI 1.73, 8.80] and Nil By Mouth (NBM) [OR 5.62, 95% CI 1.54, 20.46] were associated with respiratory infections. Impaired GCS, ischaemic stroke and significantly impaired mobility were associated with swallowing difficulties. b i Conclusion: /i /b This study of a large cohort of acute stroke patients supports research indicating aspiration pneumonia is multifactorial in nature. NGT were associated with increased risk of respiratory infections and may contribute to infections by promoting oropharyngeal colonisation. Patients with severely impaired mobility were also at very high risk of respiratory infection.
Publisher: Informa UK Limited
Date: 06-07-2023
Publisher: Elsevier BV
Date: 05-2023
Publisher: SAGE Publications
Date: 09-03-2023
DOI: 10.1177/17474930231161454
Abstract: Aphasia is a common consequence of stroke, and people who live with this condition experience poor outcomes. Adherence to clinical practice guidelines can promote high-quality service delivery and optimize patient outcomes. However, there are currently no high-quality guidelines specific to post-stroke aphasia management. To identify and evaluate recommendations from high-quality stroke guidelines that can inform aphasia management. We conducted an updated systematic review in accordance with PRISMA guidelines to identify high-quality clinical guidelines published between January 2015 and October 2022. Primary searches were performed using electronic databases: PubMed, EMBASE, CINAHL, and Web of Science. Gray literature searches were conducted using Google Scholar, guideline databases, and stroke websites. Clinical practice guidelines were evaluated using the Appraisal of Guidelines and Research and Evaluation (AGREE II) tool. Recommendations were extracted from high-quality guidelines (scored 66.7% on Domain 3: “Rigor of Development”), classified as aphasia-specific or aphasia-related, and categorized into clinical practice areas. Evidence ratings and source citations were assessed, and similar recommendations were grouped. Twenty-three stroke clinical practice guidelines were identified and 9 (39%) met our criteria for rigor of development. From these guidelines, 82 recommendations for aphasia management were extracted: 31 were aphasia-specific, 51 aphasia-related, 67 evidence-based, and 15 consensus-based. More than half of stroke clinical practice guidelines identified did not meet our criteria for rigorous development. We identified 9 high-quality guidelines and 82 recommendations to inform aphasia management. Most recommendations were aphasia-related aphasia-specific recommendation gaps were identified in three clinical practice areas: “accessing community supports,” “return to work, leisure, driving,” and “interprofessional practice.”
Publisher: SAGE Publications
Date: 09-2019
Publisher: Springer Science and Business Media LLC
Date: 21-11-2012
DOI: 10.1007/S00787-012-0346-X
Abstract: Attention-deficit hyperactivity disorder (ADHD) has a significant impact on children's classroom behaviour, daily functioning and experience of school life. However, the effects of drug treatment for ADHD on learning and academic achievement are not fully understood. This review was undertaken to describe the effects of methylphenidate, dexamfetamine, mixed amfetamine salts and atomoxetine on children's on-task behaviour and their academic performance, and to perform a meta-analysis to quantify these effects. Nine electronic databases were systematically searched for randomized controlled trials comparing drug treatment for ADHD against (i) no drug treatment, (ii) baseline (in crossover trials), or (iii) placebo reporting outcomes encompassing measures of educational achievement within the classroom environment. Forty-three studies involving a pooled total of 2,110 participants were identified for inclusion. Drug treatment benefited children in the amount of school work that they completed, by up to 15%, and less consistently improved children's accuracy in specific types of academic assignments, such as arithmetic. Similar improvements were seen in classroom behaviour, with up to 14% more of children's time spent "on task". Methylphenidate, dexamfetamine and mixed amfetamine formulations all showed beneficial effects on children's on-task behaviour and academic work completion. Atomoxetine was examined in two studies, and was found to have no significant effect. These review findings suggest that medication for ADHD has the potential to improve children's learning and academic achievement.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.JOCN.2014.05.035
Abstract: Post stroke infections are a significant clinical problem. Dysphagia occurs in approximately half of stroke patients and is associated with respiratory infections however it is unclear what other factors contribute to an increased risk. This study aimed to determine which factors are most strongly predictive of infections in the first 7 days post stroke admission. A retrospective review of 536 stroke patients admitted to Australian hospitals in 2010 was conducted. Data were collected on 37 clinical and demographic parameters. Univariate and multivariate logistic regression analysis was performed. The overall incidence of infection was 21%. Full assistance with mobility and incontinence on admission were associated with increased odds of general infection. Nil by mouth and presence of a nasogastric tube were significantly associated with patients developing respiratory infections. Urinary incontinence was a significant predictor for a urinary tract infection. Incidence of infection was highest on day two post admission. This study found enteral feeding, requiring full assistance with mobility and incontinence were significantly associated with developing infections in acute stroke. It contributes valuable new data from a large cohort of stroke patients demonstrating a period of susceptibility to infection in the very acute post stroke period.
Publisher: Frontiers Media SA
Date: 2018
Publisher: Informa UK Limited
Date: 04-07-2022
DOI: 10.1080/10749357.2022.2095087
Abstract: People with communication disabilities post-stroke have poor quality-of-life. We aimed to explore the association of self-reported communication disabilities with different dimensions of quality-of-life between 90 and 180 days post-stroke. Cross-sectional survey data were obtained between 90 and 180 days post-stroke from registrants in the Australian Stroke Clinical Registry recruited from three hospitals in Queensland. The usual follow-up survey included the EQ5D-3L. Responses to the Hospital Anxiety and Depression Scale, and extra questions (e.g. communication disabilities) were also collected. We used χ Overall, 244/647 survivors completed the survey. Respondents with communication disabilities (n = 72) more often reported moderate to extreme problems in all EQ5D-3L dimensions, than those without communication disabilities (n = 172): anxiety or depression (74% vs 40%, p < .001), pain or discomfort (58% vs 39%, p = .006), self-care (46% vs 18%, p < .001), usual activities (77% vs 49%, p < .001), and mobility (68% vs 35%, p < .001). Respondents with communication disabilities reported less fatigue (66% vs 89%, p < .001), poorer cognitive skills (thinking) (16% vs 1%, p < .001) and lower social participation (31% vs 6%, p < .001) than those without communication disabilities. Survivors of stroke with communication disabilities are more negatively impacted across different dimensions of quality-of-life (as reported between 90 and 180 days post-stroke) compared to those without communication disabilities. This highlights the need for timely and on-going comprehensive multidisciplinary person-centered support.
Publisher: Informa UK Limited
Date: 14-06-2020
Publisher: Coventry University, Lanchester Library
Date: 13-10-2022
DOI: 10.18552/IJPBLHSC.V10I1.735
Abstract: Speech Pathology programs usually send students to workplaces to learn clinical skills necessary for practice. During COVID-19, programs needed to respond quickly to ensure that students continued to gain the necessary experiences and skills required to progress through their program and graduate as clinicians, while simultaneously complying with COVID-19 requirements. Case studies from seven different universities in Australia, Ghana and Hong Kong described the erse ways in which placements were adapted to be COVID-safe, taking into account local needs. Some practices which had been included in placement education prior to the pandemic, such as telepractice and simulation-based learning, were extended and developed during this time. Educators, students, clinicians and clients responded to the rapidly changing needs of the time with flexibility and innovation, utilising a variety of technologies and tools to support case-based and virtual learning opportunities. Feedback from these erse stakeholders about the experiences was positive, despite inevitable limitations and less-than-ideal circumstances. The positive findings provided insights for consideration in the future: could strategies implemented in response to the pandemic continue to be incorporated into placement experiences, enhancing current practices and maintaining student performance outcomes? Exceptional circumstances prompted exceptional responses flexibility and innovation were accelerated in response to the pandemic and may transform future placement-based learning opportunities.
Publisher: SAGE Publications
Date: 10-2018
Publisher: BMJ
Date: 19-05-2014
DOI: 10.1136/ARCHDISCHILD-2013-305532
Abstract: Children born very preterm (VP <32 weeks) are at risk for attention deficit/hyperactivity disorders (ADHD). ADHD in VP children have a different clinical presentation to ADHD in the general population, and therefore VP children with difficulties may not come to the teacher's attention in school. We have assessed ADHD symptoms to determine whether VP children's difficulties may go undetected in the classroom. Parents and teachers of 117 VP and 77 term-born children completed the Strengths and Difficulties Questionnaire to assess hyperactivity/inattention, emotional, conduct and peer problems, and the Du Paul ADHD Rating Scale-IV to assess inattention and hyperactivity/impulsivity symptoms. Special Educational Needs (SEN) were assessed using teacher report. Group differences in outcomes were adjusted for socio-economic deprivation. Parents and teachers rated VP children with significantly higher mean Strengths and Difficulties Questionnaire hyperactivity/inattention scores, and parents rated them with more clinically significant hyperactivity/inattention difficulties than term-born controls (Relative Risk (RR) 4.0 95% CI 1.4 to 11.4). Examining ADHD dimensions, parents and teachers rated VP children with significantly more inattention symptoms than controls, and parents rated them with more clinically significant inattention (RR 4.8 95% CI 1.4 to 16.0) in contrast, there was no excess of hyperactivity/impulsivity. After excluding children with SEN, VP children still had significantly higher inattention scores than controls but there was no excess of hyperactivity/impulsivity. VP children are at greater risk for symptoms of inattention than hyperactivity/impulsivity. Inattention was significantly increased among VP children without identified SEN suggesting that these problems may be difficult to detect in school. Raising teachers' awareness of inattention problems may be advantageous in enabling them to identify VP children who may benefit from intervention.
Publisher: Springer Science and Business Media LLC
Date: 21-01-2014
DOI: 10.1007/S00455-013-9514-5
Abstract: Swallowing problems occur in 37-78 % of stroke patients. Evidence points to multiple factors contributing to the development of pneumonia in the first week post stroke, of which the presence of dysphagia is one. A heightened understanding of the very acute phase (first 7 days post stroke) is required to improve management of this population. We conducted a retrospective review of 536 stroke patients admitted to Australian hospitals in 2010. Data were collected on 37 clinical and demographic parameters. Descriptive statistics and univariate and multivariate logistic regression analyses were performed. Dysphagia was present in 58.5 % of admissions. For those patients remaining in the study for the full week there was a recovery rate from dysphagia of 30.5 %. Overall incidence of respiratory infection was 11 %. Respiratory infections developed in 17 % of patients with dysphagia. Impaired Glasgow Coma Scale, ischemic stroke, and significantly impaired mobility were associated with swallowing difficulties. Being nil by mouth and insertion of a nasogastric tube were significant predictors for respiratory infections. This study of a large cohort of acute stroke patients supports research indicating that aspiration pneumonia is multifactorial in nature and the incidence of respiratory infection is significant in the very acute stroke period.
Publisher: Informa UK Limited
Date: 18-05-2020
Publisher: Informa UK Limited
Date: 06-02-2019
Publisher: Springer Science and Business Media LLC
Date: 16-06-2022
DOI: 10.1186/S13063-022-06433-3
Abstract: Treatment fidelity is inconsistently reported in aphasia research, contributing to uncertainty about the effectiveness of types of aphasia therapy following stroke. We outline the processes and outcomes of treatment fidelity monitoring in a pre-specified secondary analysis of the VERSE trial. VERSE was a 3-arm, single-blinded RCT with a 12-week primary endpoint comparing Usual Care (UC) to two higher intensity treatments: Usual Care-Plus (UC-Plus) and VERSE, a prescribed intervention. Primary outcome results were previously reported. This secondary analysis focused on treatment fidelity. Video-recorded treatment sessions in the higher intensity study arms were evaluated for treatment adherence and treatment differentiation. Treatment components were evaluated using a pre-determined fidelity checklist. Primary outcome: prescribed amount of therapy time (minutes) secondary outcomes: (i) adherence to therapy protocol (%) and (ii) treatment differentiation between control and high intensity groups. Two hundred forty-six participants were randomised to Usual Care ( n =81), Usual Care-Plus ( n =82), and VERSE ( n =83). One hundred thirty-five (82%) participants in higher intensity intervention arms received the minimum prescribed therapy minutes. From 10,805 (UC 7787 UC-Plus 1450 VERSE 1568) service events, 431 treatment protocol deviations were noted in 114 participants. Four hundred thirty-seven videos were evaluated. The VERSE therapists achieved over 84% adherence to key protocol elements. Higher stroke and aphasia severity, older age, and being in the UC-Plus group predicted more treatment deviations. We found high levels of treatment adherence and differentiation between the intervention arms, providing greater confidence interpreting our results. The comprehensive systems for intervention fidelity monitoring and reporting in this trial make an important contribution to aphasia research and, we argue, should set a new standard for future aphasia studies. ACTRN 12613000776707
Publisher: Informa UK Limited
Date: 29-10-2021
Publisher: SAGE Publications
Date: 21-08-2012
No related grants have been discovered for Emily Brogan.