265 research outputs found

    Adductor focal laryngeal Dystonia: correlation between clinicians’ ratings and subjects’ perception of Dysphonia

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    Background Although considerable research has focused on the etiology and symptomology of adductor focal laryngeal dystonia (AD-FLD), little is known about the correlation between clinicians’ ratings and patients’ perception of this voice disturbance. This study has five objectives: first, to determine if there is a relationship between subjects’ symptom-severity and its impact on their quality of life; to compare clinicians’ ratings with subjects’ perception of the individual characteristics and severity of AD-FLD; to document the subjects’ perception of changes in dysphonia since diagnosis; to record the frequency of voice arrest during connected speech; and, finally, to calculate inter-clinician reliability based on results from the Unified Spasmodic Dysphonia Rating Scale (USDRS) (Stewart et al, J Voice 1195-10, 1997). Methods Sixty subjects with AD-FLD who were receiving ongoing injections of BoNT participated in this study. Subjects’ mean age was 60.78 years and their mean duration of symptoms was 16.1 years. Subjects completed the Disease Symptom Questionnaire (DSQ) (specifically designed for this study) and the Voice Handicap Index-10 (VHI-10) (Jacobson et al, Am J Speech Lang Pathol 6:66–70, 1997) to measure the symptoms of their dysphonia and the impact of the disease on their quality of life. Two speech-language pathologists and two laryngologists used the Voice Arrest Measure (VAM) (specifically designed for this study) and the USDRS to independently rate voice recordings of 56/60 subjects. Results The mean VHI-10 score was 21.3 which is clinically significant. The results of the DSQ and the USDRS were highly correlated. The most severe symptoms identified by both subjects and clinicians were roughness, strain-strangled voice quality, and increased expiratory effort. Voice arrest, aphonia, and tremor were uncommon. Subjects rated their current voice quality at the time of reinjection (i.e., at the time of the study) as significantly better than at the time of their initial AD-FLD diagnosis (p < 0.0001). Inter-clinician reliability on the USDRS was significant at the 0.001 level. Conclusions The findings from the VHI-10 suggest that AD-FLD has a profound impact on quality of life. The results of the DSQ and the USDRS suggest that there is a strong correlation between subjects’ perception and clinicians’ assessment of the individual symptoms and the severity of the dysphonia. The findings from the VAM suggest that voice arrests are infrequent in subjects with AD-FLD who are receiving ongoing BoNT injections. The strong inter-clinician reliability on the USDRS suggests that it is an appropriate measure for identifying symptoms and severity of AD-FLD

    A cost effectiveness study of integrated care in health services delivery: a diabetes program in Australia

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    BACKGROUND: Type 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general practitioners (GPs) with diabetes management. This approach uses a centralized database of clinical data of an Australian Division of General Practice (a network of GPs) to co-ordinate care according to national guidelines. METHODS: Long term outcomes for patients in the program were derived using clinical parameters after 5 years of program participation, and the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model, to project outcomes for 40 years from the time of diagnosis and from 5 years postdiagnosis. Cost information was obtained from a range of sources. While program costs are directly available, and costs of complications can be estimated from the UKPDS model, other costs are estimated by comparing costs in the Division with average costs across the state or the nation. The outcome and cost measures are used derive incremental cost-effectiveness ratios. RESULTS: The clinical data show that the program is effective in the short term, with improvement or no statistical difference in most clinical measures over 5 years. Average HbA1c levels increased by less than expected over the 5 year period. While the program is estimated to generate treatment cost savings, overall net costs are positive. However, the program led to projected improvements in expected life years and Quality Adjusted Life Expectancy (QALE), with incremental cost effectiveness ratios of A8,106perlife−yearsavedandA8,106 per life-year saved and A9,730 per year of QALE gained. CONCLUSIONS: The combination of an established model of diabetes progression and generally available data has provided an opportunity to establish robust methods of testing the cost effectiveness of a program for which a formal control group was not available. Based on this methodology, integrated health care delivery provided by a network of GPs improved health outcomes of type 2 diabetics with acceptable cost effectiveness, which suggests that similar outcomes may be obtained elsewhere

    Teaching strategies for enhancing employability skills in learners

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    This twenty-minute presentation will outline an Ako Aotearoa Regional Hub funded collaborative research project undertaken by a dozen educational developers from seven Institutes of Technology and Polytechnics (ITPs). The project team sought to identify ‘where and how’ excellent teachers in their ITPs currently enhance their learners’ skills for employability, life-long learning and contributing to society. The Tertiary Education Commission (TEC) and other stakeholders seek evidence of the effectiveness of programmes of study in preparing graduates for industry. Inspired by Australian research on university preparation for employability, the project team wondered how it might assist teachers in New Zealand ITPs to design teaching and learning strategies for embedding skills that enhance employability

    The Ursinus Weekly, April 25, 1949

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    Cancer drive opens on Ursinus campus to fill urgent need • Cub and Key receives seven juniors • Club 49 announces re-opening April 29 with Louie manager • Annual tapping honors campus leaders at butterfly ball • British labor man to address forum on labor movement • Men\u27s government okays concessions in student business • Thespians to depict individualists\u27 life in May production • Steele to consider scripture reliability • Warren takes lead in May Day frolic • ICG delegates to visit capital, observe legislature in action • Relax, reflect in record room • What would you demand of your ideal woman? • Darkie ensemble whams fellow students in deluge of cracks and various routines • Adair blanks bruin nine; Explorers explode at bat • Spring inaugurates interdorm softball • Baseballers break losing jinx; Russ Binder sets new record • Quay pitches brilliantly in relief role; Leander leads batsmen with four hits • Sprint star runs \u27100\u27 in 9.8 seconds as bruins bow to Haverford 79-47 • Softballers win 11-0 in exhibition game with Garnet coeds • Coach Dennis hopes to rejuvenate golf for \u2749 campaign • Muddy courts delay opening of season with Elizabethtown • Belated tennis season begins; Meet Bryn Mawr on Wednesday • Juniors crown Neill queen of evening at \u2749 butterfly ballhttps://digitalcommons.ursinus.edu/weekly/1615/thumbnail.jp
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