The South African dysphagia screening tool (SADS): A screening tool for a developing context

Background: Notwithstanding its value, there are challenges and limitations to implementing a dysphagia screening tool from a developed contexts in a developing context. The need for a reliable and valid screening tool for dysphagia that considers context, systemic rules and resources was identified to prevent further medical compromise, optimise dysphagia prognosis and ultimately hasten patients’ return to home or work.Methodology: To establish the validity and reliability of the South African dysphagia screening tool (SADS) for acute stroke patients accessing government hospital services. The study was a quantitative, non-experimental, correlational cross-sectional design with a retrospective component. Convenient sampling was used to recruit 18 speech-language therapists and 63 acute stroke patients from three South African government hospitals. The SADS consists of 20 test items and was administered by speech-language therapists. Screening was followed by a diagnostic dysphagia assessment. The administrator of the tool was not involved in completing the diagnostic assessment, to eliminate bias and prevent contamination of results from screener to diagnostic assessment. Sensitivity, validity and efficacy of the screening tool were evaluated against the results of the diagnostic dysphagia assessment. Cohen’s kappa measures determined inter-rater agreement between the results of the SADS and the diagnostic assessment.Results and conclusion: The SADS was proven to be valid and reliable. Cohen’s kappa indicated a high inter-rater reliability and showed high sensitivity and adequate specificity in detecting dysphagia amongst acute stroke patients who were at risk for dysphagia. The SADS was characterised by concurrent, content and face validity. As a first step in establishing contextual appropriateness, the SADS is a valid and reliable screening tool that is sensitive in identifying stroke patients at risk for dysphagia within government hospitals in South Africa.

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Incorporation of relative cerebral blood flow into CT perfusion maps reduces false ’at risk' penumbra

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013268 ◽

2017 ◽

Vol 10 (7) ◽

pp. 657-662 ◽

Cited By ~ 2

Author(s):

Shlomi Peretz ◽

David Orion ◽

David Last ◽

Yael Mardor ◽

Yotam Kimmel ◽

...

Keyword(s):

At Risk ◽

Acute Stroke ◽

Ct Perfusion ◽

False Negative ◽

Stroke Patients ◽

True Negative ◽

True Negative Rate ◽

Negative Rate ◽

Perfusion Maps

PurposeThe region defined as ‘at risk’ penumbra by current CT perfusion (CTP) maps is largely overestimated. We aimed to quantitate the portion of true ‘at risk’ tissue within CTP penumbra and to determine the parameter and threshold that would optimally distinguish it from false ‘at risk’ tissue, that is, benign oligaemia.MethodsAmong acute stroke patients evaluated by multimodal CT (NCCT/CTA/CTP) we identified those that had not undergone endovascular/thrombolytic treatment and had follow-up NCCT. Maps of absolute and relative CBF, CBV, MTT, TTP and Tmax as well as summary maps depicting infarcted and penumbral regions were generated using the Intellispace Portal (Philips Healthcare, Best, Netherlands). Follow-up CT was automatically co-registered to the CTP scan and the final infarct region was manually outlined. Perfusion parameters were systematically analysed – the parameter that resulted in the highest true-negative-rate (ie, proportion of benign oligaemia correctly identified) at a fixed, clinically relevant false-negative-rate (ie, proportion of ‘missed’ infarct) of 15%, was chosen as optimal. It was then re-applied to the CTP data to produce corrected perfusion maps.ResultsForty seven acute stroke patients met selection criteria. Average portion of infarcted tissue within CTP penumbra was 15%±2.2%. Relative CBF at a threshold of 0.65 yielded the highest average true-negative-rate (48%), enabling reduction of the false ‘at risk’ penumbral region by ~half.ConclusionsApplying a relative CBF threshold on relative MTT-based CTP maps can significantly reduce false ‘at risk’ penumbra. This step may help to avoid unnecessary endovascular interventions.

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Adult ADHD in the South African workplace: the usefulness of a self-report screening measure and preliminary prevalence estimates

South African Journal of Psychology ◽

10.1177/0081246319870780 ◽

2019 ◽

Vol 50 (2) ◽

pp. 262-273

Author(s):

Charles H Van Wijk

Keyword(s):

At Risk ◽

South African ◽

Predictive Validity ◽

Attention Deficit ◽

Adult Adhd ◽

Self Report ◽

The South ◽

Dsm 5 ◽

Prevalence Estimates ◽

Interpretation Systems

In the South African context, resource constraints often preclude the comprehensive assessment of large numbers of people for the likelihood of Adult Attention-Deficit/Hyperactivity Disorder (ADHD). Primary screening through a self-report measure may be useful to stream at-risk individuals towards diagnostic assessment services, as well as being useful in population and workplace based research. The present study set out, first, to investigate the usefulness of a self-report ADHD scale to identify at-risk individuals, and, second, to provide preliminary prevalence estimates for Adult ADHD, guided by Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria, in a South African workplace sample. Workers in full-time skilled employment ( N = 1,917), aged 18–44, completed a self-report Adult ADHD scale, and participated in an interview with a psychologist. Their scale data, using three different scoring and interpretation systems, were subjected to statistical analysis. Favourable internal reliability and positive predictive validity were found. Different interpretation systems provided different prevalence estimations: using DSM-5 criteria, a total prevalence estimate of 3.3 % was calculated (attention deficit subtype = 0.9%, hyperactivity-impulsivity subtype = 1.0%, and combined subtype = 1.4%). The positive predictive validity found with this sample suggests that this scale can be used constructively in research or screening contexts to identify at-risk individuals. Furthermore, preliminary prevalence estimates for Adult ADHD, guided by DSM-5 criteria, are now available for a South African workplace sample.

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Managing employee well-being: A qualitative study exploring job and personal resources of at-risk employees

SA Journal of Human Resource Management ◽

10.4102/sajhrm.v15i0.957 ◽

2017 ◽

Vol 1 (2) ◽

Author(s):

Cecile Gauche ◽

Leon T. De Beer ◽

Lizelle Brink

Keyword(s):

At Risk ◽

South African ◽

Financial Services ◽

Well Being ◽

Job Resources ◽

Personal Resources ◽

South African Context ◽

The South ◽

African Context ◽

The Impact

Orientation: Job and personal resources influence the well-being of employees. Currently, limited information exists in literature surrounding the experience of these resources in employees identified as at-risk of burnout.Research purpose: To investigate the experience of job and personal resources from the perspectives of employees identified as at-risk of burnout.Motivation for the study: Empirical evidence on the integrative role and influence of job and personal resources on the well-being of employees in the South African context is currently limited. Attaining a better understanding of the manner in which at-risk employees experience resources can empower organisations to actively work towards creating an environment that allows for optimal employee well-being.Research design, approach and method: A phenomenological approach was taken to conduct the study in a South African-based financial services organisation. A combination of purposive and convenience sampling was used, and 26 employees agreed to participate. Semi-structured interviews were used to collect data, and data analysis was performed through the use of thematic analysis.Main findings: Employees identified as at-risk of burnout acknowledged both job and personal resources as factors influencing their well-being. Participants in this study elaborated on received job resources as well as lacking job resources. Information was also shared by participants on personal resources through describing used personal resources as well as lacking personal resources.Practical/managerial implications: Knowledge gained from the study will contribute to empower organisations to better understand the impact of resources on the well-being of employees, and allow organisations to adapt workplace resources to ensure adequate and appropriate resources to facilitate optimal employee well-being.Contribution: This study contributes to the limited research available in the South African context regarding the experience of job and personal resources from the perspective of at-risk employees. The study may also enable organisations to create a workplace that is more supportive and empowering with appropriate resources to deliver on expected demands.

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Multinational tax avoidance: An application of controlled foreign companies and royalty payments in South African legislation

The Business and Management Review ◽

10.24052/bmr/v11nu02/art-13 ◽

2020 ◽

Vol 11 (02) ◽

pp. 109-117

Author(s):

Nicholas Brown ◽

◽

Shaun Parsons ◽

Riley Carpenter ◽

◽

...

Keyword(s):

At Risk ◽

South African ◽

Research Methodology ◽

Multinational Enterprises ◽

Tax Avoidance ◽

The South ◽

Tax Base ◽

Foreign Companies ◽

Tax Legislation

This paper seeks to determine whether South African tax legislation would limit the effectiveness of tax avoidance schemes used by multinational enterprises to avoid their tax liabilities. The paper reviews two commonly used multinational tax avoidance schemes, namely, disregarding controlled foreign companies (‘check box’ regulations) and royalty payments. Using a doctrinal research methodology, the paper considers the application of these schemes within the context of South African legislation. The findings indicate that the effectiveness of the schemes is somewhat curtailed. However, the South African tax base remains at risk, and efforts to combat base erosion are still necessary.

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Validation Study of Kaiser Permanente Bedside Dysphagia Screening Tool in Acute Stroke Patients

The Permanente Journal ◽

10.7812/tpp/19.230 ◽

2020 ◽

Vol 24 (5) ◽

Author(s):

Barbara Finnegan

Keyword(s):

Acute Stroke ◽

Validation Study ◽

Screening Tool ◽

Stroke Patients ◽

Kaiser Permanente

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Diagnostic Accuracy of a Bedside Screening Tool for Dysphagia (BSTD) in Acute Stroke Patients

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.105470 ◽

2021 ◽

Vol 30 (2) ◽

pp. 105470

Author(s):

Paolo Immovilli ◽

Eugenia Rota ◽

Nicola Morelli ◽

Elena Marchesi ◽

Chiara Terracciano ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Acute Stroke ◽

Screening Tool ◽

Stroke Patients

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Measurement of Oxygen Desaturation Is Not Useful for the Detection of Aspiration in Dysphagic Stroke Patients

Cerebrovascular Diseases Extra ◽

10.1159/000453083 ◽

2017 ◽

Vol 7 (1) ◽

pp. 44-50 ◽

Cited By ~ 3

Author(s):

Thomas Marian ◽

Jens Schröder ◽

Paul Muhle ◽

Inga Claus ◽

Stephan Oelenberg ◽

...

Keyword(s):

Acute Stroke ◽

Screening Tool ◽

Oxygen Desaturation ◽

Screening Tools ◽

Endoscopic Evaluation ◽

National Guidelines ◽

Stroke Patients ◽

Severe Dysphagia ◽

A Minor ◽

Swallowing Assessment

Background: Dysphagia is one of the most dangerous symptoms of acute stroke. Various screening tools have been suggested for the early detection of this condition. In spite of conflicting results, measurement of oxygen saturation (SpO2) during clinical swallowing assessment is still recommended by different national guidelines as a screening tool with a decline in SpO2 ≥2% usually being regarded as a marker of aspiration. This paper assesses the sensitivity of SpO2 measurements for the evaluation of aspiration risk in acute stroke patients. Methods: Fifty acute stroke patients with moderate to severe dysphagia were included in this study. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardised protocol. Blinded to the results of FEES, SpO2 was monitored simultaneously. The degree of desaturation during/after swallows with aspiration was compared to the degree of desaturation during/after swallows without aspiration in a swallow-to-swallow analysis of each patient. To minimise potential confounders, every patient served as their control. Results: In each subject, a swallow with and a swallow without aspiration were analysed. Overall, aspiration seen in FEES was related to a minor decline in SpO2 (mean SpO2 without aspiration 95.54 ± 2.7% vs. mean SpO2 with aspiration 95.28 ± 2.7%). However, a significant desaturation ≥2% occurred only in 5 patients during/after aspiration. There was no correlation between aspiration/dysphagia severity or the amount of aspirated material and SpO2 levels. Conclusions: According to this study, measurement of oxygen desaturation is not a suitable screening tool for the detection of aspiration in stroke patients.

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Generalized Hyperbolic Distributions And Value-At-Risk Estimation For The South African Mining Index

International Business & Economics Research Journal (IBER) ◽

10.19030/iber.v13i2.8447 ◽

2014 ◽

Vol 13 (2) ◽

pp. 319 ◽

Cited By ~ 2

Author(s):

Chun-Kai Huang ◽

Knowledge Chinhamu ◽

Chun-Sung Huang ◽

Jahvaid Hammujuddy

Keyword(s):

At Risk ◽

South African ◽

Value At Risk ◽

Stock Exchange ◽

Risk Estimation ◽

Mining Industry ◽

Information Criterion ◽

The South ◽

Volatility Clustering ◽

T Distribution

South Africa is a cornucopia of mineral riches and the performance of its mining industry has significant impacts on the economy. Hence, an accurate distributional assumption of the underlying mining index returns is imperative for the forecasting and understanding of the financial market. In this paper, we propose three subclasses of the generalized hyperbolic distributions as appropriate models for the Johannesburg Stock Exchange (JSE) Mining Index returns. These models are shown to outperform the traditional assumption of normality and accommodate for a number of stylized features, such as excess kurtosis and volatility clustering, embedded within the financial data. The models are compared using the Akaike Information Criterion (AIC), the Bayesian Information Criterion (BIC) and log-likelihoods. In addition, Value-at-Risk (VaR) estimation and backtesting were also performed to test the extreme tails. The various criteria utilized suggest the generalized hyperbolic (GH) skew Students t-distribution as the most robust model for the South African Mining Index returns.

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Value at Risk in the South African equity market: a view from the tails

South African Journal of Economic and Management Sciences ◽

10.4102/sajems.v13i3.109 ◽

2010 ◽

Vol 13 (3) ◽

pp. 345-361 ◽

Cited By ~ 2

Author(s):

C Milwidsky ◽

Eben Mare

Keyword(s):

At Risk ◽

Monte Carlo Simulation ◽

Monte Carlo ◽

Normal Distribution ◽

South African ◽

Value At Risk ◽

Equity Market ◽

Financial Returns ◽

The South ◽

T Distribution

Traditional parametric Value at Risk (VaR) estimates assume normality in financial returns data. However, it is well known that this distribution, while convenient and simple to implement, underestimates the kurtosis demonstrated in most financial returns. Huisman, Koedijk and Pownall (1998) replace the normal distribution with the Student’s t distribution in modelling financial returns for calculation of VaR. In this paper we extend their approach to the Monte Carlo simulation of VaR on both linear and non-linear instruments with application to the South African equity market. We show, via backtesting, that the t-distribution produces superior results to the normal one.

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