Objectives/Hypothesis
To evaluate the voice and speech outcomes after tubed supraglottic laryngeal closure (TSLC) surgery to treat chronic aspiration after radiotherapy for head and neck cancer.
...Study Design
A retrospective case‐control study.
Methods
The data of patients who underwent radiotherapy for head and neck cancer and who later required total laryngectomy or TSLC for chronic aspiration between 2004 and 2017 were retrieved from a dysphagia clinic. Preoperative and postoperative voice and speech were assessed by the GRBAS and INFVo rating scales. Control subjects who underwent radiotherapy alone or total laryngectomy with a tracheoesophageal prosthesis for other indications were recruited for comparison.
Results
Of 15 patients who underwent a TSLC with a mean age of 57.3 years (45–75 years), 13 were male and 2 female. All patients had a history of nasopharyngeal carcinoma. The success rate of speech production using their own larynx following an intact TSLC was 64%. There was no statistically significant difference in voice and speech ratings between preoperative and TSLC subjects on the GRBAS (P = .32) and INFVo scales (P = .57), although the quality of voice appeared to deteriorate after TSLC. However, the INFVo scale for impression, intelligibility and unsteadiness of the voice after TSLC was statistically significantly better than for laryngectomy with tracheoesophageal speech.
Conclusions
A tubed supraglottic laryngeal closure controls chronic aspiration while preserving the larynx for phonation, and results in a better voice and speech quality than a laryngectomy with a voice prosthesis.
Level of Evidence
4 Laryngoscope, 131:E1616–E1623, 2021
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
This edited collection explores the topic of disclosure of evidence and information in the criminal justice process.
The book critically analyses the major issues driving the long-standing problem of ...dysfunctional disclosure practice, with contributions from academics, lawyers, former police officers and current police policymakers. The ultimate objective is to review the key problems at the investigative, trial and post-conviction stages of criminal proceedings and to suggest a way forward through potential routes of reform, both legal and cultural. The collection represents a significant and novel contribution to the policy debate regarding disclosure and advances thought on resolving this issue in a fair and sustainable manner.
The book provides a valuable resource for academics, practitioners and policymakers working on this vital aspect of criminal procedure.
Background
Exercise‐based swallowing training (EBST) and transcutaneous neuromuscular electrical stimulation (TNMES) are common modalities used to treat late dysphagia after radiotherapy for ...nasopharyngeal carcinoma (NPC). We aimed to investigate and compare the efficacies of EBST and TNMES as proactive treatments administered early after radiotherapy.
Methods
Patients with early post‐radiotherapy NPC (n = 120) underwent either TNMES or EBST. Flexible endoscopic evaluation of swallowing (FEES), quality of life (QOL), and swallowing function questionnaires were completed before the intervention as well as immediately, 6, and 12 months after the intervention. Outcome measures included the scores for the swallowing function score (SFS), penetration and aspiration scale (PAS), dynamic imaging grade of swallowing toxicity (DIGEST), functional oral intake scale (FOIS), swallowing performance status scale (SPSS), pharyngeal motor impairment (PMI), pharyngeal function impairment (PFI), and functional assessment after cancer therapy–nasopharyngeal (FACT‐NP) questionnaire.
Results
Three months after radiotherapy, 31 and 34 patients underwent TNMES and EBST, respectively, and completed swallowing assessments at all four assessment timepoints. All patients showed post‐radiotherapy impairments in the SFS, PAS, DIGEST, PMI, and PFI. Compared with the EBST group, the TNMES group showed significant improvements in the PFI and PMI scores, with small‐to‐medium effect sizes. Additionally, compared with the EBST group, the TNMES group demonstrated a trend toward slightly better improvements in the PAS, DIGEST, FOIS, and SPSS scores immediately and 6 months after the intervention. The SFS scores improved from baseline in both groups; however, the TNMES group showed an earlier improvement. Finally, the TNMES group showed better QOL according to the FACT‐NP than the EBST group.
Conclusion
Proactive TMNES and EBST are safe and feasible modalities for improving swallowing in patients with NPC when administered early after radiotherapy. Although TNMES showed better results than EBST, these results should be interpreted with caution given the study limitations.
Level of evidence
1B.
This study investigated the outcomes of proactive swallowing training by electric neuromuscular stimulation and swallowing exercise in early post irradiated patients with nasopharyngeal carcinoma and results shows neuromuscular stimulation and swallowing exercise are feasible to improve swallowing in 12 months follow up assessment. Electrical neuromuscular stimulation is better than swallowing exercise in some aspect of swallowing function.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective
To demonstrate that oro‐pharyngo‐esophageal radionuclide scintigraphy (OPERS) not only detects tracheobronchial aspiration after swallowing, but also quantifies the amount of aspiration and ...subsequent clearance.
Methods
Data collected between 2014 and 2019 were reviewed for aspiration pneumonia at 12 and 24‐months after OPERS. The predictive value for aspiration pneumonia on flexible endoscopic evaluation of swallowing (FEES), videofluoroscopic swallowing study (VFSS), and OPERS, and the overall survival of patients with or without aspiration were determined.
Results
Thirty‐seven patients treated with radiotherapy for nasopharyngeal carcinoma (NPC) were reviewed. The incidence of aspiration detected on FEES, VFSS, and OPERS was 78.4%, 66.7%, and 44.4%, respectively. Using VFSS as a gold standard, the sensitivity and specificity of OPERS for aspiration was 73.7% and 100%. The positive and negative predictive values for aspiration were 100% and 66.7%, respectively, with an overall accuracy of 82.8%. A history of aspiration pneumonia was one factor associated with a higher chance of subsequent aspiration pneumonia within 12 months (odds ratio: 15.5, 95% CI 1.67–145.8, p < .05) and 24 months (odds ratio: 23.8, 95% CI 3.69–152.89, p < .01) of the swallowing assessment. Aspiration detected by OPERS was a significant risk factor for future aspiration pneumonia at 12 and 24 months respectively. Significantly, better survival was associated with an absence of aspiration on OPERS only, but not on FEES or VFSS.
Conclusion
OPERS predicts the safety of swallowing, the incidence of subsequent aspiration pneumonia, and the survival prognosis in post‐irradiated NPC dysphagia patients.
Level of Evidence
3.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
This paper describes the application of state-of-the-art automatic speech recognition (ASR) systems to objective assessment of voice and speech disorders. Acoustical analysis of speech has long been ...considered a promising approach to non-invasive and objective assessment of people. In the past the types and amount of speech materials used for acoustical assessment were very limited. With the ASR technology, we are able to perform acoustical and linguistic analyses with a large amount of natural speech from impaired speakers. The present study is focused on Cantonese, which is a major Chinese dialect. Two representative disorders of speech production are investigated: dysphonia and aphasia. ASR experiments are carried out with continuous and spontaneous speech utterances from Cantonese-speaking patients. The results confirm the feasibility and potential of using natural speech for acoustical assessment of voice and speech disorders, and reveal the challenging issues in acoustic modeling and language modeling of pathological speech.
Objective. To evaluate the effectiveness and safety of acupuncture treatment for dysphagia as a complication of stroke. Methods and Design. This is a multicenter, pragmatic, nonrandomized, ...self-controlled clinical trial. A total of 39 patients were recruited from several Chinese medicine outpatient clinics and hospital-affiliated speech therapy outpatient clinics in Hong Kong. 26 patients completed all the 24 sessions of acupuncture treatment within two months, and only 12 of them were used as self-control. For the self-control group, the retrospective clinical data was taken from the electronic patient records with patient consent. The descriptive swallowing function data were converted into the quantitative Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS) scores by two registered speech therapists through a validation process. And the data were validated by reaching consensus between the two speech therapists. All subjects underwent a baseline assessment before commencement of treatment, and outcome assessments were conducted upon the completion of treatment. The primary outcome measure is the RBHOMS score, which is a swallowing disability rating scale for monitoring difficulties in daily swallowing function. Secondary outcome measures include the Chinese version of the Swallow Quality-of-Life Questionnaire and adverse events. All the primary and secondary outcomes were assessed at baseline as well as at the end of acupuncture treatment (month 2). Results. A total of 39 participants aged 46 to 89 years were enrolled in the study, and the male-to-female ratio was 15 : 11. The mean baseline RBHOMS score of all 39 participants was 5.92 ± 2.23. The mean retrospective RBHOMS score of the 12 subjects who were used as self-control was 5.67 ± 1.72 before enrollment, while the mean RBHOMS score of the 26 participants who completed all the 24 sessions of treatment was 6.92 ± 2.07. There were statistically significant differences between the RBHOMS score at the completion of treatment and baseline (p=0.006), and retrospective data (p=0.042). Moreover, a significant difference was also found in terms of swallow quality-of-life score before and after acupuncture treatment (p<0.01). Conclusions. This pilot study provides preliminary evidence for the effectiveness of acupuncture for poststroke dysphagia. The findings from this trial can be used as a foundation for future full-scale randomized controlled clinical trials to assess the efficacy and safety of acupuncture for poststroke dysphagia. Ethics and Dissemination. The ethical approval of the clinical research study was granted by the Research Ethics Committee of both New Territories East and West Cluster of Hong Kong. Written informed consent was obtained from all participants, and the study was undertaken according to the ICH-GCP Guidelines. Trial Registration. This trial is registered with ChiCTR-TRC-12002621 and the registration date is 2012-10-26.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
To study the demographic characteristics of ocular trauma in Central Sarawak and identify the determinant factors of poor visual outcome.
A retrospective study of ocular trauma cases presenting at ...the referral hospital in 2013.
Patients were identified and recruited from hospital records. Those presenting for follow-up review were excluded. Case records were retrieved and reviewed after recruitment.
We studied 168 patients with 179 ocular injuries, of which 44% were work related. Compared with non-work-related cases, work-related cases were more likely to be male odds ratio (OR), 19.7; 95% confidence interval (CI), 2.6-150.9 and foreign (OR, 18.0; 95% CI, 2.3-142.0). Open globe injuries constituted a higher percentage of impaired visual acuity (VA) during the first visit: 84.6% compared with 18.1% for closed globe injuries (OR, 25.0; 95% CI, 5.3-118.4; P < 0.001). Of the open globe injuries, 61.5% worsened or showed no improvement in VA after 3 months compared with closed globe injuries (28.9%) (OR, 3.9; 95% CI, 1.2-12.7; P = 0.015). Of cases presenting 7 or more days after trauma, 76.9% worsened or showed no improvement in VA after 3 months compared with those presenting in less than 7 days (27.7%) (OR, 8.7; 95% CI, 2.3-33.0; P < 0.001). Among those with work-related injuries, 23.1% had used eye protective devices (EPDs).
Ocular injuries in Central Sarawak were predominantly work related, occurring at industrial premises, and involving males and foreigners. Both open globe injuries and a delay in seeking treatment resulted in significantly poorer visual outcomes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Small business owners who lack effective strategies to incorporate telecommuting may be unable to retain teleworking employees, create a flexible working environment, or improve workforce morale, ...negatively impacting company productivity and profitability. Grounded in transformational leadership theory and sociotechnical systems theory, the purpose of this qualitative multiple case study was to explore strategies small business owners use to incorporate telecommuting to retain teleworking employees. Data were collected from five small business owners in Texas with at least 1 year of management experience and created and maintained remote working strategies. Data collection included semistructured interviews and company documents. Three themes emerged from coding analysis: connection between employee engagement and actors, employee engagement and tasks, and individual consideration and tasks. A key recommendation is for small business owners to provide team-building events for managers and employees. The implications for positive social change include the opportunity to recruit employees from a larger pool of applicants, reduce company expenses, and hire employees who cannot leave their homes because of disabilities or other physical concerns. Additionally, employees may experience improved work–life balance, which may allow them more time to volunteer in their local community, manage personal life concerns, and continue their education.
Background: Multilingualism can bring about various positive outcomes to typically developing children. Its effect on children with language difficulties is not yet clear.
Aim: The aim of this study ...was to examine the effects of multilingual learning as a medium of instruction (MOI) on first language (L1) acquisition of children with language disorders (LD).
Methods & Procedures: Nineteen Cantonese‐speaking students aged 5;8–6;8 who were diagnosed with LD were recruited from a school that used Putonghua (an alternative Chinese dialect) as the MOI when learning Chinese language and were compared with 18 age‐and‐gender‐matched Cantonese‐speaking students with LD from a school that used Cantonese as the MOI when learning Chinese language. All the students also learned English (L2) as a subject at school. Proficiency in Cantonese was tested at the beginning and the end of the semester in Grade One in terms of: (1) grammar, (2) expressive vocabulary, (3) auditory textual comprehension, (4) word definition and (5) narration.
Outcomes & Results: Mixed‐model ANOVAs revealed an effect of time on language proficiency indicating positive gains in both groups. Interaction effects between time and group were not significant. There was a trend that children learning Putonghua showed slightly more improvement in auditory textual comprehension.
Conclusions & Implications: Proficiency gains were similar across groups. The study found no evidence that a multilingual learning environment hinders the language proficiency in L1 in students who have LD.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Purpose: The speech of some children does not follow a typical normalization trajectory, and they develop speech sound disorders (SSD). This study investigated predictive correlates of speech sound ...normalization in children who were at risk of SSD. Method: A prospective population cohort study of 845 Cantonese-speaking preschoolers was conducted over 2.5 years to examine: (1) children who resolved nonadult realizations of consonants (normalized); and (2) those who had persisting speech sound difficulties (did not normalize). From these 845, a sample of 82 participants characterized as having SSD (1.25 SDs below the mean in a standardized speech assessment, with a delay in initial consonant acquisition or with one or more atypical errors) was followed for 2 years at 6-month intervals or until the completion of their initial consonant inventory. Data from 43 children who did not receive speech-language pathology services were analyzed with survival analysis to model time to normalization while controlling for covariates. The target event (outcome) was the completion of their initial consonant inventory. Results: Under the no-intervention condition, the estimated median time to normalization was 6.59 years of age. Children who were more likely to normalize or normalized in a shorter time were stimulable to all errors and more intelligible as rated by caregivers using the Intelligibility in Context Scale. Those who showed atypical error patterns did not necessarily take longer to normalize. Similarly, expressive language ability was not significantly associated with speech normalization. Conclusions: Stimulability and intelligibility were more useful prognostic factors of speech normalization when compared to (a)typicality of error patterns and expressive language ability. Children with low intelligibility and poor stimulability should be prioritized for speech-language pathology services given that their speech errors are less likely to resolve naturally.
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DOBA, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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