BackgroundHealthcare systems internationally are under an ever-increasing demand for services that must be delivered in an efficient, effective and affordable manner. Several patient-related and organisational factors influence health-care expenditure and utilisation, including oropharyngeal dysphagia. Here, we present a systematic review of the literature and meta-analyses investigating how oropharyngeal dysphagia influences healthcare utilisation through length of stay (LOS) and cost.MethodsUsing a standardised approach, eight databases were systematically searched for relevant articles reporting on oropharyngeal dysphagia attributable inpatient LOS and healthcare costs through June 2016. Study methodologies were critically appraised and where appropriate, extracted LOS data were analysed in an overall summary statistic.ResultsEleven studies reported on cost data, and 23 studies were included reporting on LOS data. Descriptively, the presence of dysphagia added 40.36% to health care costs across studies. Meta-analysis of all-cause admission data from 13 cohort studies revealed an increased LOS of 2.99 days (95% CI, 2.7, 3.3). A subgroup analysis revealed that admission for stroke resulted in higher and more variable LOS of 4.73 days (95% CI, 2.7, 7.2). Presence of dysphagia across all causes was also statistically significantly different regardless of geographical location: Europe (8.42 days; 95% CI, 4.3; 12.5), North America (3.91 days; 95% CI, 3.3, 4.5). No studies included in meta-analysis were conducted in Asia.ConclusionsThis systematic review demonstrated that the presence of oropharyngeal dysphagia significantly increases healthcare utilisation and cost, highlighting the need to recognise oropharyngeal dysphagia as an important contributor to pressure on healthcare systems.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3376-3) contains supplementary material, which is available to authorized users.

BackgroundHealth professional education programs attract students from around the world and clinical supervisors frequently report that international students find learning in clinical placement contexts particularly challenging. In existing literature clinical supervisors, who support international students on placement have identified concerns about their communication and interactions within clinical environments.However, clinical supervisors’ perspectives about their experiences with international students on placement and the strategies they utilise to facilitate international student learning have not been described. As a result we have little insight into the nature of these concerns and what clinical supervisors do to support international students’ competency development.MethodsFive focus group interviews were conducted with twenty Speech-Language Pathology clinical supervisors, recruited from 2 Australian universities. Interview data were analysed thematically. Themes identified were interpreted using cognitive load and sociocultural learning theories to enhance understanding of the findings.ResultsFour themes were identified: ‘Complex teaching and learning relationships’, ‘Conceptions of students as learners’; Student communication skills for professional practice’, and ‘Positive mutual learning relationships’.ConclusionsFindings indicated that clinical supervisors felt positive about supporting international students in clinical placements and experienced mutual learning benefits. However, they also identified factors inherent to international students and the placement environment that added to workload, and made facilitating student learning complex. Clinical supervisors described strategies they used to support international students’ cultural adjustment and learning, but communication skills were reported to be difficult to facilitate within the constraints of placements. Future research should address the urgent need to develop and test strategies for improving international students’ learning in clinical settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0702-5) contains supplementary material, which is available to authorized users.

The findings of this study suggest that international students experience additional communication, cultural and contextual demands on clinical placement, which may increase their learning requirements. Clinical education practices must be responsive to the learning needs of diverse student populations. Strategies are suggested to assist all students to adjust to the professional and learning expectations of clinical education placements.

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Background: As the need for health care services rise, alternative service delivery models such as student-led health interventions become attractive alternatives to alleviate the burden on healthcare. Predominantly, studentled health interventions were free clinics servicing socially disadvantaged communities in the USA. A 2015 systematic review identified that students value these student-run clinics and reported skill and knowledge attainment from participating. Previous research has reported on patient satisfaction outcomes, but less frequently about the clinical outcomes patients accrue from these student-delivered services. As cardiovascular disease is the leading cause of death worldwide, this review aimed to explore the effectiveness of student-led health interventions through examining their impact on objective clinical outcomes, using the case of patients at risk of, or with, cardiovascular disease. Methods: A systematic literature search was conducted in eight electronic databases to identify student-led health interventions conducted on adults with a cardiovascular disease risk factor or established cardiovascular disease, and a clinical outcome of interest. Through double-blinded screening and data extraction, sixteen studies were identified for synthesis. Results: The majority of student-led health interventions for patients at risk of cardiovascular disease demonstrated a positive impact on patient health. Statistically significant changes amongst patients at risk of cardiovascular disease appeared to be associated with student-led individualised intervention or group-based interventions amongst patients with diabetes or those who are overweight or obese. The evidence was of moderate quality, as included studies lacked a control group for comparison and detail to enable the intervention to be replicated. Conclusions: Future research applying a student-led health intervention through a randomised control trial, with rigorous reporting of both student and patient interventions and outcomes, are required to further understand the effectiveness of this alternative service delivery model.

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Placements provide opportunities for students to develop practice skills in professional settings. Learning in placements may be challenging for culturally and linguistically diverse (CALD) students, international students, or those without sufficient English proficiency for professional practice. This study investigated whether these factors, which are hypothesized to influence acculturation, predict poor placement outcome. Placement outcome data were collected for 854 students who completed 2747 placements. Placement outcome was categorized into ‘Pass’ or ‘At risk’ categories. Multilevel binomial regression analysis was used to determine whether being CALD, an international student, speaking ‘English as an additional language’, or a ‘Language other than English at home’ predicted placement outcome. In multiple multilevel analysis speaking English as an additional language and being an international student were significant predictors of ‘at risk’ placements, but other variables tested were not. Effect sizes were small indicating untested factors also influenced placement outcome. These results suggest that students’ English as an additional language or international student status influences success in placements. The extent of acculturation may explain the differences in placement outcome for the groups tested. This suggests that learning needs for placement may differ for students undertaking more acculturative adjustments. Further research is needed to understand this and to identify placement support strategies.

Professional development can provide opportunities to develop new skills and knowledge, and to apply them to practice in a sustainable way. However, delivery of professional development needs to consider the philosophies and pedagogies of training recipients, and activities should be tailored to meet their needs. This article reports on an exploratory study of an embedded, service-based model of professional development for early childhood educators (educators), targeting children's speech, language, and communication skill development. This innovative model, conducted by speech and language therapy (SLT) students and a SLT professional practice educator, utilized co-teaching strategies to facilitate the professional learning of educators and SLTs in this context. A qualitative research design was employed and data gathered through focus group interviews with educators and individual semi-structured interviews with centre directors. The data were triangulated with some observational data of educators' practices with young children several months post program completion to explore their application of skills and knowledge that had been covered in the professional development program. The data contained four main themes: Communication, relationships, environment, and translating knowledge into practice. Observational data lent further depth and validation to the results by confirming the presence or absence of expressed practice values and experiences in the educators' everyday interactions with children. The observational data supported the themes relationships and translating knowledge into practice. The results contribute to our understanding of educators' and childcare centre directors' perspectives on their knowledge, skills, and practice in response to this embedded professional development program. This model of professional development may be appropriate to facilitate knowledge and skill development about children's speech, language, and communication skills for educators working with young children in a childcare setting. Benefits