Evidence supports the need for a multiparametric voice assessment incorporating objective and subjective assessment types. European guidelines and the American Speech-Language-Hearing Association recommend a comprehensive voice assessment protocol; however, currently in Ireland no national standards exist. This study investigates voice assessment practices of speech and language therapists (SLTs) in Ireland, with a particular interest in the use of objective instrumentation. It further elucidates what may act as barriers to the use of instrumental techniques, which has not been addressed in earlier studies. An online questionnaire was distributed to SLTs who work with voice disordered clients, via social media outlets of the Irish Association of Speech and Language Therapy (IASLT) and the Voice Special Interest Group to obtain both qualitative and quantitative data. Forty-five questionnaires were returned; the results of thirty-three completed questionnaires are presented here. The results suggest that subjective measures (auditory assessment protocols) are more commonly used by SLTs in Ireland than instrumental techniques. Limited access to equipment, the cost of equipment and low prioritisation of voice clients in a large caseload were most frequently named as barriers to the use of instrumental assessment. The SLTs acknowledged the need for and expressed interest in more training on the use of instrumental techniques in the assessment of voice disorders. The results provoke discussion surrounding evidence-base practice in voice assessment and have implications for how instrumental techniques are incorporated in the curriculum of SLT training courses and in the continual professional development.

Purpose: Sedation and analgesia are administered to critically ill patients, which may result in physical dependence and subsequent iatrogenic withdrawal. The Withdrawal Assessment Tool-1 (WAT-1) was developed and validated as an objective measurement of pediatric iatrogenic withdrawal in intensive care units (ICUs), with a WAT-1 score ≥ 3 indicative of withdrawal. This study's objectives were to test interrater reliability and validity of the WAT-1 in pediatric cardiovascular patients in a non-ICU setting.Design and methods: This prospective observational cohort study was conducted on a pediatric cardiac inpatient unit. WAT-1 assessments were performed by the patient's nurse and a blinded expert nurse rater. Intra-class correlation coefficients were calculated, and Kappa statistics were estimated. A two-sample, one-sided test of proportions of weaning (n = 30) and nonweaning (n = 30) patients with a WAT-1 ≥3 were compared.Results: Interrater reliability was low (K = 0.132). The WAT-1 area under the receiver operating curve was 0.764 (95% confidence interval; ± 0.123). There was a significantly higher proportion (50%, p = 0.009) of weaning patients with WAT-1 scores ≥3 compared to the nonweaning patients (10%). The WAT-1 elements of moderate/severe uncoordinated/repetitive movement and loose, watery stools were significantly higher in the weaning population.Practice Implications: Methods to improve interrater reliability warrant further examination. The WAT-1 had good discrimination at identifying withdrawal in cardiovascular patients on an acute cardiac care unit. Frequent nurse re-education may increase accurate tool use. The WAT-1 tool may be used in the management of iatrogenic withdrawal in pediatric cardiovascular patients in a non-ICU setting.