scholarly journals Changes in the Daily Phonotrauma Index Following the Use of Voice Therapy as the Sole Treatment for Phonotraumatic Vocal Hyperfunction in Females

2021 ◽  
Vol 64 (9) ◽  
pp. 3446-3455
Author(s):  
Jarrad H. Van Stan ◽  
Andrew J. Ortiz ◽  
Katherine L. Marks ◽  
Laura E. Toles ◽  
Daryush D. Mehta ◽  
...  
Keyword(s):  
Patient Group ◽  
Second Harmonic ◽  
Vocal Folds ◽  
Theoretical Framework ◽  
Voice Therapy ◽  
Control Group ◽  
Group Data ◽  
Vocal Hyperfunction ◽  
The Impact ◽  
Voice Use

Purpose The aim of this study was to use the Daily Phonotrauma Index (DPI) to quantify group-based changes in the daily voice use of patients with phonotraumatic vocal hyperfunction (PVH) after receiving voice therapy as the sole treatment. This is part of an ongoing effort to validate an updated theoretical framework for PVH. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and posttreatment data from 52 female patients with PVH. Normative weeklong data were also obtained from 52 matched controls. Each week was represented by the DPI, which is a combination of neck-surface acceleration magnitude skewness and the standard deviation of the difference between the first and second harmonic magnitudes. Results Compared to pretreatment, the DPI statistically decreased towards normal in the patient group after treatment (Cohen's d = −0.25). The posttreatment patient group's DPI was still significantly higher than the control group ( d = 0.68). Conclusions The DPI showed the pattern of improved ambulatory voice use in a group of patients with PVH following voice therapy that was predicted by the updated theoretical framework. Per the prediction, voice therapy was associated with a decreased potential for phonotrauma in daily voice use, but the posttreatment patient group data were still significantly different from the normative control group data. This posttreatment difference is interpreted as reflecting the impact on voice use of the persistence of phonotrauma-induced structural changes to the vocal folds. Further validation of the DPI is needed to better understand its potential clinical use.

scholarly journals Changes in a Daily Phonotrauma Index After Laryngeal Surgery and Voice Therapy: Implications for the Role of Daily Voice Use in the Etiology and Pathophysiology of Phonotraumatic Vocal Hyperfunction

2020 ◽  
Vol 63 (12) ◽  
pp. 3934-3944
Author(s):  
Jarrad H. Van Stan ◽  
Daryush D. Mehta ◽  
Andrew J. Ortiz ◽  
James A. Burns ◽  
Katherine L. Marks ◽  
...  
Keyword(s):  
Patient Group ◽  
Vocal Fold ◽  
Second Harmonic ◽  
Voice Therapy ◽  
Laryngeal Surgery ◽  
Vocal Hyperfunction ◽  
The Difference ◽  
Two Parameters ◽  
Voice Use

Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls. Each week was represented by the DPI, standard deviation of the difference between the first and second harmonic amplitudes (H1–H2). Results Compared to pretreatment, the DPI significantly decreased in the patient group after surgery (Cohen's d effect size = −0.86) and voice therapy ( d = −1.06). The patient group DPI only normalized after voice therapy. Conclusions The DPI produced the expected pattern of improved ambulatory voice use across laryngeal surgery and postsurgical voice therapy in a group of patients with PVH. The results were interpreted as providing new objective information about the role of daily voice use in the etiology and pathophysiology of PVH. The DPI is viewed as an estimate of potential vocal fold trauma that relies on combining the long-term distributional characteristics of two parameters representing the magnitude of phonatory forces (neck-surface acceleration magnitude) and vocal fold closure dynamics (H1–H2). Further validation of the DPI is needed to better understand its potential clinical use.

scholarly journals Differences in Daily Voice Use Measures Between Female Patients With Nonphonotraumatic Vocal Hyperfunction and Matched Controls

2021 ◽  
pp. 1-14
Author(s):  
Jarrad H. Van Stan ◽  
Andrew J. Ortiz ◽  
Juan P. Cortes ◽  
Katherine L. Marks ◽  
Laura E. Toles ◽  
...  
Keyword(s):  
Matched Control ◽  
Second Harmonic ◽  
Characteristic Curve ◽  
Classification Model ◽  
Control Group ◽  
Matched Control Group ◽  
Unseen Data ◽  
Vocal Hyperfunction ◽  
The Difference ◽  
Voice Use

Purpose The purpose of this study was to obtain a more comprehensive understanding of the pathophysiology and impact on daily voice use of nonphonotraumatic vocal hyperfunction (NPVH). Method An ambulatory voice monitor collected 1 week of data from 36 patients with NPVH and 36 vocally healthy matched controls. A subset of 11 patients with NPVH were monitored after voice therapy. Daily voice use measures included neck-skin acceleration magnitude, fundamental frequency ( f o ), cepstral peak prominence (CPP), and the difference between the first and second harmonic magnitudes (H1–H2). Additional comparisons included 118 patients with phonotraumatic vocal hyperfunction (PVH) and 89 additional vocally healthy controls. Results The NPVH group, compared to the matched control group, exhibited increased f o (Cohen's d = 0.6), reduced CPP ( d = −0.9), and less positive H1–H2 skewness ( d = −1.1). Classifiers used CPP mean and H1–H2 mode to maximally differentiate the NPVH and matched control groups (area under the receiver operating characteristic curve of 0.78). Classifiers performed well on unseen data: the logit decreased in patients with NPVH after therapy; ≥ 85% of the control and PVH groups were identified as “normal” or “not NPVH,” respectively. Conclusions The NPVH group's daily voice use is less periodic (CPP), is higher pitched ( f o ), and has less abrupt vocal fold closure (H1–H2 skew) compared to the matched control group. The combination of CPP mean and H1–H2 mode appears to reflect a pathophysiological continuum in NPVH patients of inefficient phonation with minimal potential for phonotrauma. Further validation of the classification model is needed to better understand potential clinical uses. Supplemental Material https://doi.org/10.23641/asha.14390771

scholarly journals Differences in Weeklong Ambulatory Vocal Behavior Between Female Patients With Phonotraumatic Lesions and Matched Controls

2020 ◽  
Vol 63 (2) ◽  
pp. 372-384 ◽  
Author(s):  
Jarrad H. Van Stan ◽  
Daryush D. Mehta ◽  
Andrew J. Ortiz ◽  
James A. Burns ◽  
Laura E. Toles ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Second Harmonic ◽  
Characteristic Curve ◽  
Vocal Behavior ◽  
Adult Women ◽  
Glottal Closure ◽  
Vocal Hyperfunction ◽  
The Difference ◽  
Voice Data ◽  
Voice Use

Purpose Previous work using ambulatory voice recordings has shown no differences in average vocal behavior between patients with phonotraumatic vocal hyperfunction and matched controls. This study used larger groups to replicate these results and expanded the analysis to include distributional characteristics of ambulatory voice use and measures indicative of glottal closure. Method Subjects included 180 adult women: 90 diagnosed with vocal fold nodules or polyps and 90 age-, sex-, and occupation-matched controls with no history of voice disorders. Weeklong summary statistics (average, variability, skewness, kurtosis) of voice use were computed from neck-surface acceleration recorded using an ambulatory voice monitor. Voice measures included estimates of sound pressure level (SPL), fundamental frequency ( f o ), cepstral peak prominence, and the difference between the first and second harmonic magnitudes (H1–H2). Results Statistical comparisons resulted in medium–large differences (Cohen's d ≥ 0.5) between groups for SPL skewness, f o variability, and H1–H2 variability. Two logistic regressions (theory-based and stepwise) found SPL skewness and H1–H2 variability to classify patients and controls based on their weekly voice data, with an area under the receiver operating characteristic curve of 0.85 and 0.82 on training and test sets, respectively. Conclusion Compared to controls, the weekly voice use of patients with phonotraumatic vocal hyperfunction reflected higher SPL tendencies (negatively skewed SPL) with more abrupt glottal closure (reduced H1–H2 variability, especially toward higher values). Further work could examine posttreatment data (e.g., after surgery and/or therapy) to determine the extent to which these differences are associated with the etiology and pathophysiology of phonotraumatic vocal fold lesions.

scholarly journals The effect of ERAS management in gastric cancer: assessment from the IMIGASTRIC study

2020 ◽  
Vol 2 (4) ◽  
pp. First
Author(s):  
Francesco Giovanardi ◽  
Francesco Falbo ◽  
Chiara Celano ◽  
Michele Casella ◽  
Marco Palisi
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Total Sample ◽  
Control Group ◽  
Group Data ◽  
Complications Rate ◽  
And Control ◽  
The Impact

Background: Establish protocols to enhance the surgical management (ERAS) can improve outcomes, shortening hospital stay and save resources. Several studies have carried out for colorectal surgery, while a lack of evidence for gastrectomy remains.This study aims to evaluate the impact of ERAS strategies in a large series of patients underwent gastric cancer surgery. Methods: This is a propensity score-matched case-control study, comparing an ERAS group with a control group. Data were recorded through a tailored and protected web-based system. Primary outcomes: hospital stay, complications rate. Among the secondary outcomes, there are: POD of mobilization, POD of starting liquid diet and soft solid diet. Results: Patients in the ERAS and control groups were 1:1 matched by the closest propensity score on the logit scale and with a Caliber = 0.2. The successful matching resulted in a total sample of 440 patients. The two groups showed no differences in all baseline patients characteristics, type of surgery (P=0.31) and stage of the disease (P=0.61). A benefit in favor of the ERAS management was found in the length of hospital stay (P=0.0004) and complications rate (P=0.001). Conclusion: An ERAS program can safely be established in referral centers for gastric cancer, enabling to significantly improve the main clinical outcomes.

scholarly journals Study of transcranial Doppler ultrasound and endothelin-1 in children with sickle cell anemia: a single-center study

2021 ◽  
Vol 20 (3) ◽  
pp. 31-35
Author(s):  
S. Ragab ◽  
E. Badr ◽  
H. El-Kholy ◽  
M. El-Hawy
Keyword(s):  
High Risk ◽  
Patient Group ◽  
Sickle Cell ◽  
Serum Ferritin ◽  
Sickle Cell Anemia ◽  
Transcranial Doppler ◽  
Control Group ◽  
Healthy Children ◽  
Endothelin 1 ◽  
The Impact

To assess the impact of our transcranial Doppler (TCD) screening program on the incidence of a first stroke in children with sickle cell anemia and to study the role of elevated serum endothelin-1 (an inflammatory mediator) in these children. Background: stroke is a major complication of sickle cell disease (SCD), even in very young children. About 11% of children with homozygous sickle cell anemia (SS) develop stroke by the end of the second decade of life. The underlying etiology in most cases is an ischemic stroke caused by large-vessel stenosis or occlusion. Transcranial Doppler (TCD) recommended as a routine screening test to identify children at high risk of developing a stroke, measures flow velocities within large intracranial arteries. TCD should be routinely performed in children between 2 and 16 years as this age group is at the highest risk of sickle cerebral vasculopathy. We carried out a prospective case-control study which included 2 groups: a patient group consisted of 30 children with sickle cell anemia and sickle thalassemia and a group of 30 healthy children of matched age and sex. Each group included 11 males (36.5%) and 19 females (63.5%); the age range was 2 to 17 years. Both groups underwent a thorough clinical examination and laboratory tests (CBC, liver and renal function, serum ferritin and endothelin-1). Additionally, TCD was performed in all children included in the patient group. According to the results of TCD, time-averaged mean of the maximum velocity (TAMMX) was < 170 cm/s (normal), 170–200 cm/s (conditional), ≥ 200 cm/s (high risk) in 20 (66.7%), 4 (13.3%) 6 (20%) patients, respectively. The level of endothelin-1 was significantly higher in the patients (57.1 ± 91.3) than in the controls (21.9 ± 14.8). Hemoglobin concentration was significantly lower in the patient group than in the control group, but the levels of reticulocytes, WBCs and serum ferritin were significantly higher in the patients than in the healthy controls. Serum Endotheline-1 level was higher in patients with sickle cell anemia than control group.

Ambulatory Voice Biofeedback: Acquisition and Retention of Modified Daily Voice Use in Patients With Phonotraumatic Vocal Hyperfunction

2021 ◽  
pp. 1-10
Author(s):  
Jarrad H. Van Stan ◽  
Andrew J. Ortiz ◽  
Dagmar Sternad ◽  
Daryush D. Mehta ◽  
Chuanbing Huo ◽  
...  
Keyword(s):  
Term Retention ◽  
Vocal Hyperfunction ◽  
Short And Long Term ◽  
Long Term Retention ◽  
Future Work ◽  
The Impact ◽  
To Receive ◽  
Voice Use ◽  
Multiple Patients

Purpose: Voice ambulatory biofeedback (VAB) has potential to improve carryover of therapeutic voice use into daily life. Previous work in vocally healthy participants demonstrated that motor learning inspired variations to VAB produced expected differences in acquisition and retention of modified daily voice use. This proof-of-concept study was designed to evaluate whether these VAB variations have the same desired effects on acquisition and retention in patients with phonotraumatic vocal hyperfunction (PVH). Method: Seventeen female patients with PVH wore an ambulatory voice monitor for 6 days: three baseline days, one biofeedback day, one short-term retention day, and one long-term retention day. Short- and long-term retention were 1- and 7-days postbiofeedback, respectively. Patients were block-randomized to receive one of three types of VAB: 100%, 25%, and Summary. Performance was measured in terms of adherence time below a subject-specific vocal intensity threshold. Results: All three types of VAB produced a biofeedback effect with 13 out of 17 patients displaying an increase in adherence time compared to baseline days. Additionally, multiple patients from each VAB group increased their adherence time during short- and/or long-term retention monitoring compared to baseline. Conclusions: These findings show that VAB can be associated with acquisition and retention of desired voice use in patients with PVH. Specifically, all three feedback types improved multiple patients' performance and retention for up to 1 week after biofeedback removal. Future work can investigate the impact of incorporating VAB into voice therapy.

Evaluating the impact of accreditation and external peer review

2015 ◽  
Vol 28 (8) ◽  
pp. 757-777 ◽  
Author(s):  
Melvin Kilsdonk ◽  
Sabine Siesling ◽  
Renee Otter ◽  
Wim van Harten
Keyword(s):  
Quality Of Care ◽  
Peer Review ◽  
Theoretical Framework ◽  
Control Group ◽  
Original Research ◽  
Content Type ◽  
Research Framework ◽  
Methodological Research ◽  
The Impact

Purpose – Accreditation and external peer review play important roles in assessing and improving healthcare quality worldwide. Evidence on the impact on the quality of care remains indecisive because of programme features and methodological research challenges. The purpose of this paper is to create a general methodological research framework to design future studies in this field. Design/methodology/approach – A literature search on effects of external peer review and accreditation was conducted using PubMed/Medline, Embase and Web of Science. Three researchers independently screened the studies. Only original research papers that studied the impact on the quality of care were included. Studies were evaluated by their objectives and outcomes, study size and analysis entity (hospitals vs patients), theoretical framework, focus of the studied programme, heterogeneity of the study population and presence of a control group. Findings – After careful selection 50 articles were included out of an initial 2,025 retrieved references. Analysis showed a wide variation in methodological characteristics. Most studies are performed cross-sectionally and results are not linked to the programme by a theoretical framework. Originality/value – Based on the methodological characteristics of previous studies the authors propose a general research framework. This framework is intended to support the design of future research to evaluate the effects of accreditation and external peer review on the quality of care.

Evidence-based management of ectopic pregnancy

2001 ◽  
Vol 9 (1) ◽  
pp. 49-75 ◽  
Author(s):  
R Varma ◽  
L Mascarenhas
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Meta Analysis ◽  
Uterine Cavity ◽  
Control Group ◽  
Common Site ◽  
Group Data ◽  
Normal Site ◽  
Ectopic Pregnancies ◽  
The Impact

Ectopic pregnancy occurs when the conceptus implants outside the normal site within the uterine cavity. The most common site is within the Fallopian tube (98.3%), followed by abdominal (1.4%), ovarian (0.15%) and cervical (0.15%) implantation. Considering tubal ectopic pregnancies, 80% occur at the ampulla and 12% at the isthmus; 6% are fimbrial and 2% are interstitial. Approximately 5% to 5.7% of all clinical pregnancies from assisted reproductive technology (ART) in 1988–92 were ectopic; however, in 1995 the incidence was less at 2.8%. A meta-analysis of risk factors that predispose to ectopic pregnancy is depicted in Table 1. However, this meta-analysis does not control for the interplay of risk factors (multivariate analysis), including the impact of control group data and consequent problems of data collection (e.g. the incidence of pelvic inflammatory disease (PID) in the ectopic group is laparoscopically derived whereas it is derived from the history in the control group).

Update: Behavioral Management of Unilateral Vocal Fold Paralysis and Paresis

2019 ◽  
Vol 4 (3) ◽  
pp. 474-482
Author(s):  
Sarah L. Schneider
Keyword(s):  
Vocal Fold ◽  
Treatment Plan ◽  
Traumatic Injury ◽  
Voice Therapy ◽  
Valuable Insight ◽  
Behavioral Management ◽  
Use Patterns ◽  
Vocal Quality ◽  
And Function ◽  
Voice Use

PurposeVocal fold motion impairment (VFMI) can be the result of iatrogenic or traumatic injury or may be idiopathic in nature. It can result in glottic incompetence leading to changes in vocal quality and ease. Associated voice complaints may include breathiness, roughness, diplophonia, reduced vocal intensity, feeling out of breath with talking, and vocal fatigue with voice use. A comprehensive interprofessional voice evaluation includes auditory-perceptual voice evaluation, laryngeal examination including videostroboscopy, acoustic and aerodynamic voice measures. These components provide valuable insight into laryngeal structure and function and individual voice use patterns and, in conjunction with stimulability testing, help identify candidacy for voice therapy and choice of therapeutic techniques.ConclusionA comprehensive, interprofessional evaluation of patients with VFMI is necessary to assess the role of voice therapy and develop a treatment plan. Although there is no efficacy data to support specific voice therapy techniques for treating VFMI, considerations for various techniques are provided.

EEG Measurement of Emotion Processing in Children with Daytime Urinary Incontinence

2018 ◽  
Vol 46 (4) ◽  
pp. 336-341
Author(s):  
Justine Niemczyk ◽  
Monika Equit ◽  
Katja Rieck ◽  
Mathias Rubly ◽  
Catharina Wagner ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Patient Group ◽  
Imaging Techniques ◽  
Emotion Processing ◽  
Event Related Potentials ◽  
Oddball Paradigm ◽  
Control Group ◽  
Central Processing ◽  
Daytime Urinary Incontinence ◽  
Related Potentials

Abstract. Objective: Daytime urinary incontinence (DUI) is common in childhood. The aim of the study was to neurophysiologically analyse the central emotion processing in children with DUI. Method: In 20 children with DUI (mean age 8.1 years, 55 % male) and 20 controls (mean age 9.1 years, 75 % male) visual event-related potentials (ERPs) were recorded after presenting emotionally valent (80 neutral, 40 positive, and 40 negative) pictures from the International Affective Picture System (IAPS) as an oddball-paradigm. All children received a full organic and psychiatric assessment. Results: Children with DUI did not differ significantly from controls regarding responses to emotional pictures in the frontal, central, and parietal regions and in the time intervals 250–450 ms, 450–650 ms, and 650–850 ms after stimulus onset. The patient group had more psychological symptoms and psychiatric comorbidities than the control group. Conclusions: EEG responses to emotional stimuli are not altered in children with DUI. Central emotion processing does not play a major role in DUI. Further research, including a larger sample size, a more homogeneous patient group (regarding subtype of DUI) or brain imaging techniques, could reveal more about the central processing in DUI.

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