Annual Report
April 2021 – March 2022
Introduction
This past year has brought much change to our team at Bristol Speech and Language Therapy Research Unit (BSLTRU) in terms of plans, partnerships and people.
As a grant funded unit, bidding for research funding is in our DNA and part and parcel of our everyday activity. Our plans for the future are reliant on which grants are successful – and sometimes this does not coincide with what our patient community or clinical partners feel is of most value. This year however we are thrilled to announce our success with an application to The Underwood Trust Legacy fund. This substantial award will not only enable us to continue with the important work we do with The Cleft Collective Cohort studies and the University of Bristol but will also enable us to employ a Senior Research Fellow to join the team in a tenure track post. This will be vital to the future of BSLTRU as we plan our work through this decade and into the next.
Research is a team activity and we have always worked with a wide range of collaborators from health, education and industry backgrounds. This year, we are extremely pleased to announce a new partnership with Cardiff Metropolitan University’s School of Sport and Health Sciences. This is the first time that BSLTRU has been linked to a speech and language therapy training institution. We are looking forward to the research we do being incorporated into training of the next generation of SLTs but also working with the existing Speech, Hearing and Communication Research Group at the school with a new theme of Clinical Research.
BSLTRU has always had has its mission a desire to improve the lives of those living with and affected by communication impairment through robust and patient informed research. BSLTRU is also a team of people, working together to effect change and create impact, using our combined and complementary skills and strengths. Like any well-functioning team, every individual is valued and plays an important role in all we do. It is in this context that we waved goodbye to Fay Smith, our dedicated administrator who has been our constant over nearly 25 years. We miss you Fay but are excited for your new adventures in retirement and look forward to hearing about them.
And of course, with each challenge, there are new opportunities, and we are so pleased to welcome Dominika Kruszynska to the team as our new administrator. With many of us still working remotely for at least some of the week, it can be a challenge, but Dominika has settled in quickly and become a critical member of BSLTRU.
We hope you enjoy reading this summary of our activity over the last year. We are excited about the year ahead, the work we can do with The Underwood Trust funding to create impact, and the opportunities that arise in our partnership with Cardiff Metropolitan University. Thank you for your support and interest, not only at annual report time, but throughout the year.
Best wishes
Yvonne
Dr Yvonne Wren Director, BSLTRU
Contents
1 BSLTRU People
51.1 BSLTRU staff 5
1.2 Honorary staff 6
1.3 Postgraduate students, placements and internships 7
1.4 Steering Group 8
1.5 Measures of esteem 8
2 Funding and Grant Applications
93 Project Updates
10Active Projects in 2021/22 (those marked with * are led by holders of NIHR clinical academic fellowships or internships)
3.1 The Cleft Collective Speech and Language Study 10
*3.2
3.3
3.4 3.5
A randomised controlled trial of the effectiveness of parent-based models of speech and language therapy intervention for 2- to 3-year-old children with primary
language impairment in areas of social disadvantage
The effect of infant feeding and non-nutritive sucking on speech sound development at age 5 years
The CHATTER Study: Children’s Activities and Talk in their Everyday Routines The Language Explorer Study
11
12
12 13 3.6 Understanding the impact of wearing facemasks and using virtual meeting platforms
for individuals who stammer 13
3.7
3.8
Can technology optimise Speech and Language Therapy services to meet the National Institute for Health and Care Excellence (NICE) guidelines for people with aphasia following a stroke in Northern Ireland?
Maximising the Impact of Speech and Language Therapy for children with Speech Sound Disorder (The MISLToe_SSD study)
14
15
3.11
3.12 3.13
3.14
Evidence Review of Universal, Population and Targeted Interventions which support Speech, Language and Communication Development in the Early Years
Softly non-spoken: soft robotics as non-verbal communication aids
Understanding the impact of the Covid-19 pandemic on surgery and speech and language therapy for children born with cleft palate
Optimising outcomes for young people with cleft lip and/or palate in adolescence
16
17 17
18
Hosted Student Projects 18
*3.15 Unspoken Voices: What are the perspectives of people who use alternative and augmentative communication (AAC) on the impact and effectiveness of AAC equipment?
18
4 Research Outputs and Engagement
204.1
Publications
204.2 Presentations and conferences 23
4.3 Public and patient involvement 28
4.4 Website 29
4.5 Social Media 29
Glossary
30
1. BSLTRU People
BSLTRU consists of a core workforce of research and support staff who work in partnership with our honorary staff, students, clinical interns and volunteers.
1.1 BSLTRU staff
Dr Yvonne Wren, Director of BSLTRU, was funded by the Underwood Trust until January when she started her role as Reader of Speech and Language Therapy at Cardiff Metropolitan University. She also continues in her post as Associate Professor of Speech and Communication at the University of Bristol Dental School. Our core research team consists of Dr Sam Harding (Research Fellow), Dr Lydia Morgan (Research Associate), Dr Jen Chesters, Dr Lucy Southby and Sam Burr (Senior Research Associates). Both Sam H and Lydia have been with the unit for many years and also have complementary roles with the Research and Innovation Office and the clinical SLT team at North Bristol NHS Trust respectively. Jen and Lucy joined us in November 2020 to work on the NIHR funded Language Explorer Study and the Cleft Collective respectively. Sam B joined us in February 2022 to work on the NIHR funded MISLToe-SSD study.
We are fortunate to also have a number of bank staff join us to work on short term projects over this past year including Miriam Seifert who has worked with us on a number of studies over the past few years, Jenny Short, Sharon Baker, Debbie Mason, Elaine Davidson and Julie Davies. Two of our PhD students, Caitlin Holme and Kath Broomfield, have also worked with us on a bank capacity alongside their doctoral studies.
We continued to be well-supported by Fay Smith, our administrator for many years
prior to her retirement in March and are pleased to have welcomed Dominika
Kruszynska to the team as Fay’s replacement.
Staff Job Title Funding
Dr Yvonne Wren Director The Underwood Trust/Cardiff Metropolitan University/Welsh Government/NIHR
Dr Sam Harding Research Fellow Welsh Government/NIHR Dr Lydia Morgan Research Associate NIHR
Dr Jennifer Chesters Senior Research Associate NIHR/The Underwood Trust
Dr Lucy Southby Senior Research Associate UHBW/Bristol Health Research Charity Sam Burr Senior Research Associate NIHR
Jenny Short Research Associate (Bank) The Underwood Trust/Welsh Government
Debbie Mason Research Associate (Bank) The Underwood Trust Miriam Seifert Research Associate (Bank) NIHR/HEE
Sharon Baker Research Associate (Bank) Welsh Government Julie Davies Research Associate (Bank) UHBW
Elaine Davidson Research Associate (Bank) UHBW Caitlin Holme PhD student/Research
Associate Welsh Government
Kath Broomfield PhD student/Research
Associate EPSRC
Fay Smith Research Administrator The Underwood Trust Dominika Kruszynska Research Administrator The Underwood Trust Table 1. Staffing at the BSLTRU 2021/22
1.2 Honorary Staff
We continue to benefit from the input of experienced colleagues who have previously worked at the unit and are now involved on an honorary basis. In particular, our work in the fields of stammering (Dr Rosemarie Hayhow), aphasia and technology (Dr Brian Petheram) and primary speech and language impairment (Professor Sue Roulstone) is growing as a result of this team work.
We are also extremely grateful for the advice and guidance from Professor Pam Enderby OBE and for her ongoing connection with The Underwood Trust.
Staff Job Title Funding
Dr Rosemarie
Hayhow Associate BSLTRU member Grants and consultancy work Dr Brian Petheram Associate BSLTRU member Grants and consultancy work Prof Sue Roulstone Emeritus Professor UWE Grants and consultancy work Prof Pam Enderby Emeritus Professor
University of Sheffield The Underwood Trust (travel expenses)
Table 2. Honorary Associate staff at the BSLTRU 2021/2022
1.3 Postgraduate students, placements and internships
BSLTRU continues to support clinical speech and language therapists who are keen to embark on a clinical academic career through the NIHR Integrated Clinical Academic (ICA) pathway. We continue to support Sam Burr and host Kath Broomfield, who are both in their final year of the same scheme and Caitlin Holme who is in the second year of her funded PhD studentship from the Heather van der Lely Foundation.
We have also supported Hannah Lane and Lucy Rogers in their NIHR ICA Predoctoral Clinical Academic Fellowships and Janine Andrews with a HEE Internship.
Student Award Scheme Academic Institution Supervised by Sam Burr,
Solent HEE/NIHR Clinical Doctoral Research Fellowship
University of the West
of England Yvonne Wren & Toity Deave (University of the West of England) Caitlin Holme PhD - funded by the
Heather van der Lely Foundation
University of Bristol Yvonne Wren, Sam Harding & Patricia Lucas (University of Bristol) Table 2. Supervision at BSLTRU in 2020/2021.
Student Award Scheme Academic Institution Supervised by Katherine
Broomfield, Gloucestershire
HEE/NIHR Clinical Doctoral Research Fellowship
Manchester
Metropolitan University Karen Sage (Manchester Metropolitan University) Georgina Jones (Leeds Beckett University), Prof. Deborah James (MMU), Simon Judge (clinical supervisor)
Table 4. Hosted students at BSLTRU in 2021/2022.
Intern Award Scheme NHS Institution Supervised by Hannah
Lane HEE/NIHR Predoctoral Clinical Academic Fellowship
Doncaster and
Bassetlaw Yvonne Wren Lucy
Rodgers HEE/NIHR Predoctoral Clinical Academic Fellowship
Sussex Community Sam Harding/Yvonne Wren
Janine
Andrews HEE Predoctoral Bridging
Funding Dorset County
Hospital NHS Foundation Trust
Yvonne Wren
Charlie
Moran HEE North Internship
Scheme Barnsley Hospital
NHS Foundation Trust Katherine Broomfield
1.4 Steering Group
BSLTRU continues to be well supported by the BSLTRU Steering Group who maintain oversight and governance of the BSLTRU for the achievement of the unit objectives.
Name Title
Prof Sue Roulstone (Chair) Emeritus Professor University of the West of England Prof Pam Enderby Emeritus Professor University of Sheffield
Prof David Wynick Director of Research, UHBristol and North Bristol NHS Trust Prof Juliet Goldbart Professor of Developmental Disabilities, Manchester
Metropolitan University
Prof Tim Peters Research Director, Faculty of Health Sciences, University of Bristol
Dr Toity Deave Associate Professor, UWE
Alison Williams Pennaeth therapi Llederydd ac Iaith, Head of Speech and Language therapy Bwrdd Iechyd Prifysgol Aneurin Bevan/Aneurin Bevan University Health Board
Andy Clark Divisional Operational Director for Neurological and Musculoskeletal Sciences, North Bristol NHS Trust Table 6. BSLTRU Steering Group members 2021/2022.
1.5 Measures of esteem
Members of the BSLTRU team have been invited to participate in a variety of activities in recognition of the work we carry out to understand the nature of speech, language and communication impairments and what we can do to help.
Members of BSLTRU have been invited to give talks on topics related to the research we carry out:
1. Wren, Y. (May 2021, virtual) Invitation to give keynote speech at NAPLIC Conference, Sheffield, UK.
2. Broomfield, K. (August 2021) Invited presentation: The Unspoken Voices Project:
Developing a Patient-Reported Outcome Measure (PROM) for AAC. International Society for AAC (ISAAC) conference
3. Wren, Y (September 2021) Invitation to give keynote speech at the annual conference of the Portuguese Association of Speech and Language Therapists. Lisbon, Portugal 4. Wren, Y. (October 2021) Keynote speaker at South African Speech Language and
Hearing Association National Conference. Title: Speech sound disorder in the post- Covid era – who should we treat and how?
5. Broomfield, K. (October 2021) Invited to give a keynote on service user involvement;
RCSLT Virtual Conference
6. Southby, L. (February 2022) IALP Child Speech Committee Online Panel Series:
SSD and cleft palate – How differences in anatomy and physiology affect the way we label and describe SSD in children?
7. Roulstone, S. (April 2022) Invited as a key speaker at 6th Congress of Croatian Speech and Language Therapists – “Challenges of Modern Speech and Language Pathology“ Split, Croatia.
8. Wren, Y. (July 2022) Invitation to be keynote speaker at International Cleft and Craniofacial Congress.
2. Funding and grant applications
BSLTRU, together with our collaborators, has been successful in grant applications for new funding totalling near £2million over the past year. Additional funds from supervision, hosting and consultancy fees enable us to continue to develop our research programme .
The Underwood Trust has been a long-term supporter of BSLTRU and this has continued through 2021/2022 with funds to support the core administration and management function of the unit. Following submission of a new application to the Underwood Trust’s Legacy funding scheme, we are delighted to have been awarded a substantial grant of £1.5million which will have a transformative impact on the work we can do to further understanding and impact for people with communication impairment. We are very grateful for the support of the Underwood Trust for their support for our work.
In addition to the Underwood Trust Legacy grant, we have led 13 other grant applications to a variety of charity, UKRI and NIHR funding streams. We have had a successful outcome for 10 of these, with a total value of £1,867,909 and are awaiting the outcome of a 11
th. These include personal fellowships as well as project grant awards.
3. Project updates
Over the past year, five projects have been completed and seven new studies have begun. Our ongoing work includes grant funded research, doctoral and masters fellowship studies and collaborative work with other institutions. A summary of each study is provided below.
3.1 The Cleft Collective Speech and Language Study
Investigator: Yvonne Wren, Sam Harding and Lucy Southby Timescale: Dec 2014 to March 2023. (To be extended to 2027) Funder: Scar Free Foundation, The Underwood Trust
University of Bristol
The Cleft Collective Cohort Studies investigate the biological and environmental causes of cleft lip and/or palate, the best treatments for cleft and the impact of cleft on those affected and their families. With the help of every cleft team in the UK, children and their families are being recruited into the studies. Families are asked to contribute biological samples (such as saliva) and complete a number of questionnaires at important time points during their child’s development. This information can be used by researchers including clinicians to answer important questions about the causes and treatments for cleft lip and/or palate and the wellbeing of children and adults born with a cleft and their families There are three cohorts: the birth cohort, the five-year cohort, the antenatal cohort and the Speech and Language study (CC-SL) which is a nested study within the main birth cohort and hosted by the BSLTRU. The CC-SL study is collecting data on a range of potential risk factors for speech outcomes in children born with cleft palate including parent-child interaction, infant vocalisations, the audio environment, SLT assessments at 24 and 36 months and hearing assessment data.
For more information about The Cleft Collective cohort studies, please see: http://www.bristol.ac.uk/cleft-collective/ and https://www.nbt.nhs.uk/bristol-
speech-language-therapy-research-unit/bsltru-research/cleft-speech-language-study
3.2 A randomised controlled trial of the effectiveness of parent- based models of speech and language therapy intervention for 2- to 3-year-old children with primary language impairment in areas of social disadvantage
Investigators:
Deb Gibbard (Solent NHS Trust), Chris Markham (University of Portsmouth), Claire Smith (Solent NHS Trust), Sue Roulstone, Sam Harding, Lydia Morgan
Timescale: 2017-2021 (extended for 12 months) Funder: Nuffield Foundation
A multicentre clustered blind randomised controlled trial was used to evaluate the effect of parent-based group interventions to improve early language development with children (mean age 27.5 months) in more socially disadvantaged areas. Participants received one of two interventions (1) Standard Care: indirect group parent-based intervention - PBI (2) Enhanced Care: indirect group enhanced parent-based intervention - EPBI. 155 participants were randomised at baseline. Children in both groups made improvements in outcome on sentence length, from pre intervention to both post intervention and six months post intervention. Changes in vocabulary and expressive language skills, however, were more equivocal, showing wide variation in confidence intervals. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention.
This project has now been completed and the team are working together to produce a
series of peer-review journal articles. The report prepared for Nuffield, the funders,
can be downloaded from https://www.nuffieldfoundation.org/project/rct-of-parent-
based-models-of-speech-and-language-therapy.
3.3 The effect of infant feeding and non-nutritive sucking on speech sound development at age 5 years
Investigator: Samantha Burr
Timescale: June 2017- January 2022
(including 8 months maternity leave)
Funder: HEE/NIHR Clinical Doctoral Fellowship
This study has examined the relationship between the different ways babies are fed, their early sucking habits and how they develop their speech sounds in early childhood.
The results of this study are currently being analysed and written up for publication.
The findings suggest that different patterns of speech development at age 2 years are observed for children who were fed in different ways as babies (e.g., breast fed versus bottle fed). Differences in speech development at age 5 years are also observed depending on whether children sucked a dummy at age 2 years.
3.4 The CHATTER Study: Children’s Activities and Talk in their Everyday Routines
Investigator: Caitlin Holme
Timescale: June 2020 – June 2024
Funder: Heather van der Lely Foundation
This study is being conducted by Caitlin Holme as part of her PhD at the University of Bristol and is funded by the Heather van der Lely foundation. The goal of this qualitative study is to build a rich description of different family experiences and communication environments and use this information to consider how parent-child interaction approaches can work best for the wide range of families that SLTs serve. In the past year we have published the findings of a scoping review conducted as part of the study.
Recruitment of families and data collection began in autumn 2021 and will conclude in summer 2022.
For more information about the study see the website: https://www.nbt.nhs.uk/bristol- speech-language-therapy-research-unit/bsltru-research/chatter-study
You can watch a Youtube video of Caitlin talking about the study here:
https://www.youtube.com/watch?v=DzOKphACBOw
3.5 The Language Explorer Study
Investigators:
Yvonne Wren, Miriam Seifert, Sam Harding, Lydia Morgan, Jen Chesters, Rebecca Bright, Swapnil Gadgil (Therapy Box), Cristina McKean (University of Newcastle), Geraldine Bates (Sirona Care)
Timescale: 01/11/2019 – 30/04/22 Funder: NIHR i4i Scheme
We are now in the final year of the Language Explorer study, where we are developing and assessing a new app to semi-automate language transcription and analysis. The app will assist speech and language therapists with clinical decision making for children with developmental language disorder (DLD).
BSLTRU are leading the clinical evaluation of the app, which has involved co- ordinating the assessment of children with DLD across clinical sites in Bristol, Hackney in East London, and Newcastle. We are currently using the data from these assessments to compare how children with DLD perform on the Language Explorer app, with data from 600 children with typically developing language collected in an earlier phase of the study. Our clinical evaluation report will be completed in May 2022.
3.6 Understanding the impact of wearing facemasks and using virtual meeting platforms for individuals who stammer
Investigators: Yvonne Wren, Jen Chesters, Rosemarie Hayhow, Deborah Mason,
Anna Prince, Jennifer Short.
Timescale: 01/03/2021 – 31/05/21 Funder: The Underwood Trust
to STAMMA support services changed during COVID-19 and 3) an analysis of SLT outcomes during the pandemic, compared to the pre-pandemic period.
We have now completed the analysis of 97 survey responses, 1912 contacts to STAMMA support services and 105 episodes of care from the RCSLT Online Outcome Tool, which has given us a comprehensive overview of the experiences of people who stammer during the COVID-19 pandemic. In consultation with people who stammer, and professionals working with them, we have produced a report with guidance and recommendations to better support people who stammer following the COVID-19 pandemic, and during future similar events. We have also produced a short animation to summarise our findings. The report will be launched at the end of May 2022, and will be available on our project page.
3.7 Can technology optimise Speech and Language Therapy services to meet the National Institute for Health and Care
Excellence (NICE) guidelines for people with aphasia following a stroke in Northern Ireland?
Investigators: Jane Mortley and Sam Harding Timescale:
01/10/2020 – 28/02/2022
SPONSOR: Steps Consulting Ltd
FUNDERS: Small Business Research Initiative (SBRI)
This project has just ended, and the final dataset is being analysed. Given the
challenges the services have faced over the time frame of this project it is a great to
say that we were able to meet recruitment targets and gain some valuable insights into
the acceptability of the developed tool and its ability to positively effect change in our
target population.
3.8 Maximising the Impact of Speech and Language Therapy for children with Speech Sound Disorder (The MISLToe_SSD study)
Investigators: Yvonne Wren, Sam Harding and Sam Burr Timescale: March 2022- August 2023
Funder: NIHR Research for Patient Benefit (RfPB) Tier 3
This study aims to maximise the impact of speech and language therapy (SLT) for children with speech sound disorder by developing a Core Outcome Set (COS) and minimum dataset to be used by SLT services. This study comprises three workstreams, this first of which is an umbrella review to collect data to serve as content for the COS and minimum dataset. Workstream two will bring together SSD specialist SLTs from five NHS sites and PPI members in a participatory workshop to discuss and agree a diagnostic pathway for children with SSD. Consensus will be achieved through online survey and card sorting activity. The final workstream will present the COS and minimum dataset, populated by the umbrella review, to an expert panel, including PPI members, to reach final consensus on these. The planned follow-on study for this work will involve rolling the COS and minimum dataset out to ten NHS sites across the UK for data collection.
3.9 Chin Tuck Against Resistance with Feedback: Swallowing Rehabilitation in Frail Older People (CTAR-SwiFt) - A feasibility study a Research for Patient Benefit
Investigators: Lydia Morgan, Aiofe Stone-Ghariani, Ian Swaine, Dharine Hansjee,
Alberto Gambaruto, David Smithard
Timescale: September 2021- May 2023 Funder: NIHR Research for Patient Benefit
This is a feasibility randomised controlled study of two types of rehabilitation exercises
using Chin Tuck against resistance to improve swallowing, eating and drinking, funded
3.10 Wales Early Language Screening Review
Investigators: Sharon Baker, Sam Harding, Caitlin Holme, Rhonwen Lewis,
Miriam Seifert, Yvonne Wren
Timescale: July 2021 - Jan 2022 Funder: Welsh Government
This study is funded by Welsh Government and fulfils one of the objectives of the Talk with Me: Speech, Language and Communication Delivery Plan (Welsh Government, 2020). The aim of the project is to review the evidence for early language screening and provide a set of recommendations about whether screening should take place at all in Wales, and if so, at what age and by whom. The project will encompass a review of the early language screening tools which are currently available and will consider the capacity of these to be used effectively in the Welsh context given differences related to language use in Wales.
For more information about the Welsh Government, Talk with Me: Speech, Language and Communication Delivery Plan see the website: https://gov.wales/talk-me-speech- language-and-communication-slc-delivery-plan
3.11 Evidence Review of Universal, Population and Targeted Interventions which support Speech, Language and
Communication Development in the Early Years
Investigators: Sharon Baker, Sam Harding, Jennifer Short, Yvonne Wren Timescale: Dec 2021 - Apr 2022
Funder: Welsh Government
This study is also funded by Welsh Government and contributes to the objectives of
the Talk with Me: Speech, Language and Communication Delivery Plan (Welsh
Government, 2020). The project consists of three scoping reviews to identify the
speech, language and communication (SLC) elements of perinatal/mental health
interventions; SLC elements of parenting interventions and the SLC interventions that
are available at Universal, Population and Targeted levels. The study will critique the
evidence for the effectiveness of the interventions and consider how they could be
implemented in the Welsh context.
For more information about the Welsh Government, Talk with Me: Speech, Language and Communication Delivery Plan see the website: https://gov.wales/talk-me-speech-
language-and-communication-slc-delivery-plan3.12 Softly non-spoken: soft robotics as non-verbal communication aids
Investigator: Katherine Broomfield, Hemma Philamore, Alice Haynes, Richard
Sewell, Alison Oldfield
Timescale: Oct 2021 - March 2022
Funder: EPSRC Impact Accelerator award
This project is concerned with exploring whether soft robotics can be used as augmentative and alternative communication (AAC) to support non-verbal communication. It is being carried out as a collaboration between with partners at University of Bristol, The Bristol Robotics Lab, BSLTRU and Airgiants (an industry partner). Katherine Broomfield is supporting this project by providing expertise in AAC and co-design with people who have communication difficulties.
3.13 Understanding the impact of the Covid-19 pandemic on surgery and speech and language therapy for children born with cleft palate
Investigator: Yvonne Wren and Lucy Southby Timescale: April 2021 - October 2021
Funder: Bristol Health Research Charity
This work aimed to determine the degree to which surgery and SLT services for
children with CP+/-L were delayed and/or changed as a result of the Covid-19
pandemic and how this varied across the country. It also aimed to determine the impact
that these delays and disruption to surgery and SLT services had on children with
3.14 Optimising outcomes for young people with cleft lip and/or palate in adolescence
Investigator::
Yvonne Wren, Lucy Southby, Peter Fowler, Alistair Cobb, Shaheel Chummun
Timescale: July 2021 - March 2022
Funder: Above and Beyond and University Hospitals Bristol and Weston NIHR
Research Capability Funding
In this project, we worked with clinicians from cleft care centres across the UK and young people affected by cleft to determine what information needs to be collected in a dedicated clinic for young people aged 15-17 years born with clefts. We also aimed to determine how we should collect the data and the logistics of running such a clinic.
This work will inform a follow-on study where we will collect data which we can use to determine which young people born with cleft do well and why. The ultimate aim of this work is to provide information for services to plan services and care that will maximise outcomes for this at-risk population and ensure fewer children born with clefts are disadvantaged in adolescence and adult life.
Hosted Projects
In addition to the speech and language therapists who are fellowship or internship awardees and supervised directly by BSLTRU staff, we also host a therapist/NIHR Clinical Doctoral Fellow who is local to the area but registered at a distant institution.
The hosting arrangement means that we do not provide supervision but instead provide a research environment and networks with local clinical academics.
*3.15 Unspoken Voices: What are the perspectives of people who use alternative and augmentative communication (AAC) on the impact and effectiveness of AAC equipment?
Investigator: Katherine Broomfield (Manchester Metropolitan University) Timeline: April 2017-September 2022 Funder: HEE/NIHR Clinical Doctoral Fellowship
This project is concerned with people who use augmentative and alternative
communication (AAC) because they cannot speak clearly, or cannot speak at all. AAC
refers to a set of strategies such as pointing to pictures, words or letters as well as the use of special equipment that can speak out messages entered into or stored within it.
The aim of this research project is to understand more about people’s experience of using AAC to communicate to inform the development of clinical tool that will evaluate AAC interventions from the perspective of the patient. Katherine has completed a systematic literature review of patient-reported outcome measures (PROMs) currently used in AAC, and a narrative review of qualitative literature about the experiences of people who use AAC to communicate. She has conducted over 40 interviews with people who have communication difficulties to understand more about their expectations and experience of AAC to understand what outcomes are important to them.
Katherine is working with an expert group of people who use AAC in the delivery of
this project and has developed expertise in supporting patient and public involvement
creatively to enable the involvement of hard to engage with groups in research. She
has published information about the creative methods she has used and co-edited a
book with contributions from colleagues at BSLTRU.
4. Research outputs
4.1 Publications
The unit has maintained a strong record of publishing both as lead and co-authors this year with 28 publications in respected peer-reviewed journals for the field and two in non-peer reviewed publications and grey literature.
Published- peer reviewed
1. Broomfield. K., Craig, C., Smith, S., Jones, G. L., Judge, S., and Sage. K. Creativity in public involvement: Supporting authentic collaboration and inclusive research with seldom heard voices. Research Involvement and Engagement. 7, 17 (2021).
https://doi.org/10.1186/s40900-021-00260-7
2. Jensen de López, K., Lyons, R., Novogrodsky, R., Baena, S., Feilberg, J., Harding, S.
et al. (in press) Exploring Parental Perspectives of Childhood Speech and Language Disorders Across 10 Countries: A Pilot Qualitative Study .Journal of Speech, Language and Hearing Research (online April 2021 Open access) https://pubs.asha.org/doi/10.1044/2020_JSLHR-20-00415
3. Jensen de López, K.M., Feilberg, J., Baena, S., Lyons, R., Harding, S., Kelić, M., et al (in press) “So, I told him to look for friends!” Barriers and protecting factors that may facilitate inclusion for children with Developmental Language Disorder in everyday social settings: cross-cultural qualitative interviews with parents. Research in Developmental Disabilities
4. Cler, G.J., Krishnan, S., Papp, D., Wiltshire, C.E.E., Chesters, J. & Watkins, K.E.
(Sept, 2021). Elevated iron concentration in putamen and cortical speech motor network in developmental stuttering. Brain: a journal of Neurology.
5. Davies, A., Davies, A., Wren, Y., Deacon, S., Chummun, S. (in press) Exploring the relationship between palatal cleft type and width with the use of relieving incisions in primary repair. Cleft Palate and Craniofacial Journal.
6. Southby, L., Harding, S., Phillips, V., Wren, Y. and Joinson, C., 2021. Speech input processing in children born with cleft palate: A systematic literature review with narrative synthesis. International Journal of Language & Communication Disorders, 56(4), pp.668-693.
7. Patterson J.M., Lu, L., Watson, L-J., Harding, S., Ness, A.R, Thomas, S. et al (in press) Trends in, and predictors of, swallowing and social eating outcomes in head and neck cancer survivors: a longitudinal analysis within the Head and Neck Cancer 5000 cohort.
Oral Oncology
8. Stein, C., Iyengar, S., Bencheck, P., Lewis, B., Miller, G., Taylor, G. & Wren, Y. (in press) Association between genes regulating neural pathways for quantitative traits of speech and language disorders. npj Genomic Medicine.
9. Baker, S., Zhao, F. & Wren, Y. (in press) Exploring the relationship between conductive hearing loss and cleft speech characteristics. International Journal of Pediatric Otorhinolaryngology.
10. Baker, J., Bullimore, C., Cavalli, L., Dixon, L., Dietrich, M., Duffy, J. R., Elias, A., Fraser, D. E., Freeburn, J. L., Gregory, C., McKenzie, K., Miller, N., Patterson, J., Roth, C., Roy, N., Short, J., Utianski, R. L., Van Mersbergen, M., Vertigan, A., Carson, A., Stone, J., McWhirter, L. Management of Functional Communication, Swallowing, Cough, and Related Disorders: Consensus Recommendations for Speech and Language Therapy. Journal of Neurology, Neurosurgery, and Psychiatry
11. Morgan, L., Bates, S.,Titterington, J. & Wren, Y. Making the case for collection of a minimal dataset in clinical speech and language therapy" International Journal of Language & Communication Disorders
12. Stephanie van Eeden, S., Wren, Y., McKean, C., & Stringer, H. (2021). Early Communication Behaviors in Infants With Cleft Palate With and Without Robin Sequence: A Preliminary Study. Cleft Palate-Craniofacial Journal.
https://doi.org/10.1177/10556656211031877 (Accepted for publication)
13. Tran, C., Crawford, A. A., Hamilton, A. J., French, C. E., Wren, Y. E., Sandy, J. R., &
Sharp, G.C. (2021). Maternal stressful life events during the periconceptional period and orofacial clefts: a systematic review and meta-analysis. The Cleft Palate- Craniofacial Journal. (accepted for publication)
14. Molyneaux, C., Sherriff, M., Wren, Y., Ireland, A., & Sandy, J. (2021). Changes in the Transverse Dimension of the Maxillary Arch of 5-Year-Olds Born With UCLP Since the Introduction of Nationwide Guidance. The Cleft Palate-Craniofacial Journal.
https://doi.org/10.1177/10556656211028511(accepted for publication)
15. Wiltshire, C.E.E., Chiew, M., Chesters, J., Healy, M.P. & Watkins, K.E. (July, 2021).
Speech Movement Variability in People Who Stutter: A Vocal Tract Magnetic Resonance Imaging Study. Journal of Speech, Language, and Hearing Research, 64(7):2438-2452.
Palate in the United Kingdom—Parent/Caregiver Perspectives and Experiences. Perspectives of the ASHA Special Interest Groups, 6(6), pp.1809-1819.
18. Southby, L., Harding, S., Davies, A., Lane, H., Chandler, H. and Wren, Y., 2022.
Parent/Caregiver Views of the Effectiveness of Speech-Language Pathology for Children Born With Cleft Palate Delivered via Telemedicine During COVID- 19. Language, speech, and hearing services in schools, pp.1-10. (This paper was chosen by the ASHA Journals as one of their 'Research Tuesday' social media campaign papers where the paper is promoted on social media platforms and made freely available by the journal for two weeks)
19. Patterson, J. M., Lu, L., Watson, L-J., Harding, S., Ness, A. R., Thomas, S., Waylen, A., Pring, M., Waterboer, T. & Sharp, L. (in press). Associations between markers of social functioning and depression and quality of life in survivors of head and neck cancer: findings from the Head and Neck Cancer 5000 study. Psycho-Oncology.
20. Fell, M., Dack, K., Chummun, S., Wren, Y., Sandy, J & Lewis, S. (Sept 2021). Maternal cigarette smoking and cleft lip and palate: A systematic review and meta-analysis. The Cleft Palate-Craniofacial Journal https://doi.org/10.1177/10556656211040015 Published Sept 2021
21. Lane, H., Harding, S. & Wren, Y. A Systematic Review of Early Speech and Language Therapy Interventions for Children with Cleft Palate. International Journal of Language and Communication Disorders Revisions. DOI: 10.1111/1460-6984.12683
22. Holme, C., Harding, S., Roulstone, S Lucas, P.J. & Wren, Y (2022) Mapping the literature on parent-child language across activity contexts: a scoping review.
International Journal of Early Years Education, 30(1), DOI:
10.1080/09669760.2021.2002135
23. Prince, A., Marsden, J., Wren, Y., Hayhow, R., Harding, S. (in press) The Fluency Trust Residential Course for Young People who Stutter: A Pragmatic Feasibility Study.
Journal of Communication Disorders
24. McKean, C., Watson, R., Charlton, J., Roulstone, S., Holme, C., Gilroy, V. and Law, J. (2022) ‘Making the most of together-time’: Development of a Health Visitor led intervention to support children’s early language and communication development at the 2-2½ year-old review. BMC Pilot and Feasibility Studies, 8(35), DOI:
10.1186/s40814-022-00978-5
25. Fell, M., Davies, A., Davies, A., Chummun, S., Cobb, A., Moar, K., Wren, Y. (in press) Current surgical practice for children born with a cleft lip and/or palate in the United Kingdom. Cleft Palate and Craniofacial Journal.
26. Rogders, L., Harding, S., Rees, R. & Clarke, M.T. (in press). Interventions for Pre- school Children with Co-occurring Phonological Speech Sound Disorder and
Expressive Language Difficulties; A Scoping Review. International Journal of Language and Communication Disorders Revisions.
27. Clay, P. & Broomfield, K. (2022) Masking care: A qualitative investigation of the impact of face masks on the experience of stroke rehabilitation from the perspective of staff and service users with communication difficulties. International Journal of Language and Communication Disorders. https://doi.org/10.1111/1460-6984.12711 28. Davies, A., Humphries, K., Sharp, G., Southby, L. and Wren, Y. 2022. Policy Briefing:
The impact of COVID-19 on children born with cleft lip and palate. http://www.bristol.ac.uk/policybristol/policy-briefings/cleft-care-covid-19/
Published - non peer reviewed
1. Berman, S., Sharp, G., Lewis, S., Blakey, R., Davies, A., Humphries, K., Wren, Y., Sandy, J., Stergiakouli, E. (2021) Prevalence and Factors Associated with Behavioural Problems in 5-year-old Children Born with Cleft Lip and/or Palate from the Cleft
Collective. medRxiv 2021.08.04.21261594; doi:
https://doi.org/10.1101/2021.08.04.21261594
2. Yue, Z., Barker, J., Christensen, H., McKean, C., Ashton, E., Wren, Y., Gadgil, S., Bright, R. (2021) Parental Spoken Scaffolding and Narrative Skills in Crowd-Sourced Storytelling Samples of Young Children. Proc. Interspeech 2021, 2946-2950, doi:
10.21437/Interspeech.2021-1297
4.2 Presentations and conferences
Members of BSLTRU have been invited to present at a number of national and international events as detailed above under measures of esteem. We have also had one panel and 40 abstracts accepted for presentation at conferences, both national and international.
Panel presentations
Paper Presentations
1. Williams, C., Harding, S. & Wren, Y. (April 2021, virtual). Cleft Collective Speech and Language Study: Using focus groups to explore intervention provision.
Craniofacial Society of Great Britain and Ireland annual conference, Cardiff, UK.
Postponed to April 2021
2. Lane, H., Harding, S. & Wren, Y. (April 2021, virtual) A Systematic Review of Early Speech and Language Therapy Interventions for Children with Cleft Palate.
Craniofacial Society of Great Britain and Ireland annual conference, Cardiff, UK.
Postponed to April 2021Southby, L., Wren, Y., Joinson, C. (April 2021, virtual) Speech input processing in children born with cleft palate. American Cleft Palate and Craniofacial Association Annual Conference
3. Wren, Y., Seifert, M., Davies, A., McLeod, S. (April 2021, virtual) Intelligibility in 3-year-olds with cleft lip and/or palate using the Intelligibility in Context Scale:
Findings from the Cleft Collective Cohort Study. American Cleft Palate and Craniofacial Association Annual Conference
4. Wren, Y., Davies, A., Sandy, J., Humphries, K., Sharp, G., Stergiakouli, E., Lewis, S., Southby, L. (April 2021, virtual) The Cleft Collective Cohort Study - a resource for the international research community to investigate the biological and environmental causes of cleft, the best treatments for cleft and the impact of cleft on those affected. American Cleft Palate and Craniofacial Association Annual Conference
5. Davies, A., Harding, S., Sandy, J., Humphries, K., Yang, Q., Sharp, G., Stergiakouli, E., Lewis, S., Southby, L., Wren, Y., (April 2021, virtual) The impact of Covid-19 on children born with a cleft in the UK. American Cleft Palate and Craniofacial Association Annual Conference
6. Seifert, M., Morgan, L., Gibbin, S. & Wren, Y. (June 2021, virtual) An Alternative Approach to Measuring Reliability of Transcription in Children’s Speech Samples:
Extending the Concept of Near Functional Equivalence. International Clinical Phonetics and Linguistics Association Conference, University of Strathclyde, Glasgow, Scotland.
7. Burr, S., Harding, S., Wren, Y. & Deave, T. (June 2021, virtual). The relationship between feeding and non-nutritive sucking behaviours and speech development:
A systematic review. International Clinical Phonetics and Linguistics Association Conference, University of Strathclyde, Glasgow, Scotland, UK
8. Harding, S. & Roulstone, S. (June 2021, virtual) Obtaining the views of preschool children with language impairment: Thinking about more than speech
samples. International Clinical Phonetics and Linguistics Association Conference, University of Strathclyde, Glasgow, Scotland, UK
9. Seifert, M., Davies, A., Harding, S., McLeod, S. & Wren, Y. (June 2021, virtual) Parents’ ratings of intelligibility in 3-year-olds with cleft lip and/or palate using the Intelligibility in Context Scale: Findings from the Cleft Collective Cohort Studies;
International Clinical Phonetics and Linguistics Association Conference, University of Strathclyde, Glasgow, Scotland.
10. Southby, L., Joinson, C. & Wren, Y. (June 2021, virtual) Speech input processing skills in children born with cleft palate at age 5 years and their association with the presence of Cleft Speech Characteristics (CSCs). International Clinical Phonetics and Linguistics Association Conference, University of Strathclyde, Glasgow, Scotland.
11. Burr, S. (June 2021, virtual). Speech sound development and feeding patterns at ages 2 and years in a normative sample. International Clinical Phonetics and Linguistics Association Conference, University of Strathclyde, Glasgow, Scotland, UK
12. Jensen de Lopez, K., Lyons, R. & Harding, S. (June 2021, virtual) Pilot Study:
Cross-cultural exploration of how parents construe language disorder and their experiences of accessing services. International Clinical Phonetics and Linguistics Association Conference, University of Strathclyde, Glasgow, Scotland.
13. Jensen de Lopez, K., Lyons, R. & Harding, S. (June 2021, virtual) Methodological revelations from a pilot cross-cultural exploration of how parents construe language disorder and their experiences of accessing services. International Clinical Phonetics and Linguistics Association Conference, University of Strathclyde, Glasgow, Scotland.
14. Broomfield, K. (Online 13th-17th August. Pre-recorded presentation) The Unspoken Voices Project: What are the experiences and expectations of people who have been referred to AAC services? Communication Matters conference.
15. Wren, Y., Grewal, S., Ponduri, S., Leary, S., Ireland, A., Ness, A. & Sandy, J. (Sept 2021, virtual) Educational attainment of children born with unilateral cleft lip and palate: Findings from Cleft Care UK. Craniofacial Society of Great Britain and
(CSCs) in children born with cleft palate +/- lip at age 5 years. Craniofacial Society of Great Britain and Ireland annual conference Cardiff, UK.
18. Berman, S., Davies, A., Humphries, K., Wren, Y., Sandy, J., Lewis, A., Sharp, G.
& Stergiakouli, E., (Sept 2021, virtual) Behavioural outcomes in children born with cleft lip and/or palate from the Cleft Collective. Craniofacial Society of Great Britain and Ireland annual conference, Cardiff, UK.
19. Holme, C., Harding, S., Roulstone, S., Lucas, P. & Wren, Y. (September 2021, virtual) How do activity contexts affect parent-child interaction? Reporting results from a scoping review and implications for PCI intervention. International Developmental Language Disorder Research Conference – IDLD
20. Holme, C., Roulstone, S., McKean, C., Charlton, J. and Law, J. (September 2021, virtual) Exploring the acceptability of speech and language screening for preschool children from parents’ perspectives. International Developmental Language Disorder Research Conference – IDLD
21. McKean, C. Watson, R. Charlton, J. Roulstone, S. Holme, C. Gilroy, V. Rush, R.
Wilson, P. and Law, J. (September 2021, virtual) ‘Making the most of together- time’: Development of a Health Visitor led intervention to support children’s early language and communication development at the 2-2½ year-old review’.
International Developmental Language Disorder Research Conference – IDLD 22. Morgan, L., Harding, S., Roulstone, S. & Gibbard, D (September 2021). An
exploration of parent activation in parents attending parent-based intervention.
International Developmental Language Disorder Research Conference – IDLD 23. Holme, C., Roulstone, S., McKean, C., Gilroy, V., Charlton, J. and Law, J.
(October 2021, virtual) Exploring the acceptability for parents of preschool children of the language component in the 24-30 month review in England’s Healthy Child programme. RCSLT Virtual Conference
24. McKean, C., Watson, R., Roulstone, S., Holme, C., Charlton, J. and Law, J.
(October 2021, virtual) The Co-design of an intervention for parents following the ELIM at the 24-30 month review in England’s Healthy Child programme. RCSLT Virtual Conference
25. Chesters, J., Hayhow, R., Mason, D., Prince, A.,Short, J. & Wren, Y. (October 2021) Understanding the impact of wearing facemasks and using virtual meeting platforms for individuals who stammer. RCSLT Virtual Conference
26. Wren, Y., Pagnamenta, E. (October 2021, virtual) Will my child be ok? Answering parents’ questions about educational and well-being outcomes in children with persistent speech disorder. RCSLT Virtual Conference
27. Hesketh, E. & Roulstone, S. (October 2021) Outcomes from a community speech and language therapy service treatment waiting list: The natural history of 527 children with identified speech and language needs Oral presentation at RCSLT Virtual conference
28. Broomfield, K (Online 5th-7th October) In dialogue: Qualitative research with people who use augmentative and alternative communication. Poster RCSLT conference
29. McAllister, J., Wren, Y.E., Hayhow, R., Heron, J., & Skinner, J. (October 2021) Atypical speech development and adolescent self-harm. Royal College of Speech and Language Therapists’ Conference, virtual
30. Wren, Y.E., Siefert, M., Davies, A., & McLeod, S. (November 2021) Intelligibility in 3-year-olds with Cleft Lip and/or Palate: Findings from the Cleft Collective Study. American Speech-Language and Hearing Association Annual Convention, Washington DC.
31. Wren, Y., Davies, A., Humphries, K., Southby, L. Harding, S., Seifert, M., van Eeden, S., Baker, S., & Williams, C. ( May 2022) The Cleft Collective Cohort Studies – a novel approach using big data to advance practice, research and education. ESLA Congress 2022 (oral presentation)
32. Sharp, L., Patterson, J., Watson, L-J., Lu, L. Harding, S (May 2022) 'Prevalence and predictors of cancer-related fatigue in head and neck cancer: findings from HN5000' British Association of Head and Neck Oncologists 2022 (oral presentation)
33. Gibbard, D., Roulstone, S., Kandala, N.II., Markham, C., Morgan, L., Harding., S., Smith, C. (May 2022) An RCT into the impact of parent-based intervention on the language of socially disadvantaged two to three year old children. ESLA Congress 2022 (oral presentation)
34. Zajdó, K., Kelić, M., Ulfsdottir, T.S., Baena, S., Feilberg, J., Klatte, I., Lyons, R., Jensen de Lopez, K.M., Novogrodsky, R., Rodriguez-Ortiz, I.R. & Harding, S.
(May 2022) Rearing a child with DLD: Parents experiences with SLT services in 10 countries. ESLA Congress 2022 (in person oral presentation)
35. Southby, L., Harding, S., Davies, A., Wren, Y. and The Cleft Collective team.
perspectives and experiences of SLT provision for children born with cleft palate in the United Kingdom during the COVID-19 pandemic. International Cleft Congress, Edinburgh, July 2022
37. Southby, L. and Chesters, J. (Accepted as poster) Developing a theoretical model of speech processing for children born with cleft palate +/- cleft lip. International Cleft Congress, Edinburgh, July 2022
38. Seifert, M., Southby, L., Davies, A., Wren, Y., McLeod, S. (Accepted as oral presentation) Exploring the association between intelligibility and language skills in 3-year-old children born with cleft palate +/- lip. International Cleft Congress, Edinburgh, July 2022
39. Chandler, H., Southby, L., Davies, A., Wren Y. (Accepted as poster) Early language indicators and their relationship with Speech and Language Therapists ability to judge velopharyngeal function in children born with cleft palate at age 18-24 months. International Cleft Congress, Edinburgh, July 2022
40. Davies, J., Davidson., E., Harding, S., Southby, L., Wren Y. (Accepted as oral presentation) Identifying patient preferred outcomes for young people aged 15-20 years born with cleft lip and palate. International Cleft Congress, Edinburgh, July 2022
4.3 Public and Patient Involvement
BSLTRU continues to actively engage with members of the public and patients to ensure that our activities are relevant and meaningful to the people that matter.
In our work as partners with the Cleft Collective team at the University of Bristol, we lead the PPI group, CLAPA (Cleft Lip and Palate Association) Cleft Collective Patient Consultation group. This group meets remotely twice a year and once in person (when possible) at the Cleft Collective offices in Bristol. This work builds on many years of engagement with the support organisation CLAPA and the patient community. The group is attended by parents of children born with a cleft, adults who were born with a cleft and representatives from CLAPA. It is co-ordinated and facilitated by members of The Cleft Collective and BSLTRU teams including Yvonne Wren and Lucy Southby.
Members of the BSLTRU who have sought and received feedback from this group on projects in development or the findings of research in the last year: Lucy Southby, Jen Chesters, Hannah Lane, Matt Fell.
Kath Broomfield has co-edited a book on service user involvement with Dr Anna
Volkmer from University College London. The book, titled ‘Seldom Heard Voices in
Service User Involvement: The How and Why of Meaningful Collaboration’ is at thepre-publication stage and available to order from J&R Press. It includes chapters
from other members of BSLTRU and is the first book to explore how we involve
individuals with communication impairment and their families in agenda setting and design of research.
Kath was invited to give a keynote speech on this topic at the 2021 Royal College of Speech and Language Therapists Conference.
4.4 Website
We work with the web team at NBT to create an accessible, innovative web site for the unit which is managed through NBT but that the team can edit and create content.
The website homepage is www.nbt.nhs.uk/BSLTRU
4.5 Social Media
BSLTRU has several active social media platforms with a relatively small but targeted worldwide audience of key professionals, collaborators and colleagues as well as members of the public. These social media streams are an important way to help us stay connected with the speech and language therapy community world-wide, as well as providing a route of public engagement activities and recruiting to research studies.
Ways to engage with us on social media
https://www.facebook.com/BSLTRU/
@Bristol_SLTRU
Bristol Speech and Language Therapy Research http://bsltru.blogspot.co.uk/
https://www.linkedin.com/company/b
Glossary of Terms
AAC Alternative and Augmentative Communication ALSPAC Avon Longitudinal Study of Parents and Children BSLTRU Bristol Speech and Language Therapy Research Unit CBT Cognitive Behavioural Therapy
CC-SL Cleft Collective Speech and Language Study CDRF Clinical Doctoral Research Fellowship CLAPA Cleft Lip and Palate Association COCO90s Children of the Children of the 90s DLD Developmental Language Disorder EBCD Experience-based co-design methodology ELIM Early Language Identification Measure HEE Health Education England
ICA Integrated Clinical Academic i4i Innovation for Invention
LENA Language Environment Analysis MRC Medical Research Council NBT North Bristol NHS Trust NHS National Health Service
NICE National Institute for Health and Care Excellence NIHR National Institute for Health Research
PAM Patient Activation Measure PCIT Parent-child interaction therapy PhD Doctor of Philosophy
PHE Public Health England
PI Public Involvement
PPI Public and Patient Involvement PROMs Patient Reported Outcome Measures PSD Persistent Speech Disorder
RCPCH Royal College of Paediatrics and Child Health RCSLT Royal College of Speech and Language Therapists SRBI Small Business Research Initiative
SCL Steps Consulting Ltd
SLCN Speech, language and communication needs
SLT Speech and Language Therapy/ Speech and Language Therapists SSNAP Stroke Sentinel National Audit Programme
TTA Tavistock Trust for Aphasia
UK United Kingdom
UoB University of Bristol
UWE University of the West of England Published April 2022
©North Bristol NHS Trust 2022
Contact – [email protected]
