The development of a new rating scale for the perceptual assessment of tracheoesophageal voice quality outcome following total laryngectomy

PhD ThesisPerceptual assessment of voice in people with surgical voice restoration (SVR) is essential to evaluate surgical and other interventions aimed at delivering optimal voice quality. Currently there are no tools to measure this that do not have issues of validity and reliability. This work describes the development and trialling of investigatory versions of three scales to address this situation: a) the Sunderland Tracheoesophageal Perceptual Scale (SToPS) for professional raters, b) the Naïve Rater Scale for non-specialist raters and c) the Patient and Carer Scale. In the final testing of the pilot version 55 speakers using tracheoesophageal voice were evaluated by twelve Speech and Language Therapists (SLT’s) and ten Ear, Nose and Throat (ENT) surgeons, divided into experienced or not at assessing voice. Ten naïve raters assessed the voice stimuli within a test-retest design. Forty tracheoesophageal speakers and thirty-seven carers attended an interview to rate their own or their relative’s voice. Inter rater agreement was then calculated between SLT, ENT, naïve, patient and carer groups with weighted kappa co-efficients Strength of agreement values (Landis and Koch 1977) were compared to profession and expertise. Expert SLT’s achieved “good” agreement for nine of fourteen parameters. Naïve judges attained “good” levels of inter and intra-rater agreement for the parameters Overall Grade and Social Acceptability. The greatest inter group consensus was for patients and carers, with “good” agreement for Intelligibility, Volume and Wetness. The only other “good” agreement was between naïve/ENT and naïve/ SLT groups for Overall Grade. The scales are ready for clinical use with the proviso that future work will determine whether it is possible to enhance agreement so less experienced judges can achieve “good” levels of agreement for more parameters and examine which perceptual parameters might be more prominent or vital for outcomes for different groups.City Hospitals Sunderland NHS Foundation Trust

Dissecting Jack-the-Ripper : An Anatomy of Murder in the Metropolis

Jack-the-Ripper has been an historical prism for international studies of crime, history and societies. This article re-examines the infamous violent homicides from a new medical perspective. In a cold case review, original evidence of a secret trade in the dead poor is presented, neglected in crime historiography. Trafficking in bodies and body parts to teach human anatomy to medical students was the norm in the East End of London in 1888. The business of anatomy – peopled by body dealers and their accomplices – had the medical infrastructure to provide a deadly disguise for the serial killings. Those that fell from relative to absolute poverty, in death, supplied dissection tables in major teaching hospitals across London. Its social wallpaper could conceivably have camouflaged homicide in the Metropolis.Au plan international, la figure de Jack-L’éventreur a servi de prisme historique pour l’histoire sociale du crime. Cet article ré-examine ces homicides abominables et violents d’un point de vue médical nouveau. À partir d’une étude des affaires classées, l’article présente des preuves inédites d’un commerce secret de cadavres de pauvres, jusqu’ici négligé par l’historiographie. Le traffic des cadavres et de portions de ceux-ci destinés à l’enseignement de l’anatomie humaine pour les étudiants en médécine était la norme dans l’East End londonien en 1888. Le commerce anatomique, contrôlé par des trafiquants de cadavres et leurs complices, disposait de l’infrastructure médicale nécessaire pour camoufler les meurtres en série en morts naturelles. Ceux qui passaient de la pauvreté relative à la misère absolue, alimentaient après leur mort les tables de dissection des principaux hopitaux universitaires londoniens et il est fort possible que cette pratique ait permis d’occulter des homicides dans la métropole londonienne

Chapter Abbreviations

Those convicted of homicide were hanged on the public gallows before being dissected under the Murder Act in Georgian England. Yet, from 1752, whether criminals actually died on the hanging tree or in the dissection room remained a medical mystery in early modern society. Dissecting the Criminal Corpse takes issue with the historical cliché of corpses dangling from the hangman’s rope in crime studies. Some convicted murderers did survive execution in early modern England. Establishing medical death in the heart-lungs-brain was a physical enigma. Criminals had large bull-necks, strong willpowers, and hearty survival instincts. Extreme hypothermia often disguised coma in a prisoner hanged in the winter cold. The youngest and fittest were capable of reviving on the dissection table. Many died under the lancet. Capital legislation disguised a complex medical choreography that surgeons staged. They broke the Hippocratic Oath by executing the Dangerous Dead across England from 1752 until 1832

Chapter 1 The Condemned Body Leaving the Courtroom

Those convicted of homicide were hanged on the public gallows before being dissected under the Murder Act in Georgian England. Yet, from 1752, whether criminals actually died on the hanging tree or in the dissection room remained a medical mystery in early modern society. Dissecting the Criminal Corpse takes issue with the historical cliché of corpses dangling from the hangman’s rope in crime studies. Some convicted murderers did survive execution in early modern England. Establishing medical death in the heart-lungs-brain was a physical enigma. Criminals had large bull-necks, strong willpowers, and hearty survival instincts. Extreme hypothermia often disguised coma in a prisoner hanged in the winter cold. The youngest and fittest were capable of reviving on the dissection table. Many died under the lancet. Capital legislation disguised a complex medical choreography that surgeons staged. They broke the Hippocratic Oath by executing the Dangerous Dead across England from 1752 until 1832

In Bad Shape: Sensing the Criminal Corpse

Those convicted of homicide were hanged on the public gallows before being dissected under the Murder Act in Georgian England. Yet, from 1752, whether criminals actually died on the hanging tree or in the dissection room remained a medical mystery in early modern society. Dissecting the Criminal Corpse takes issue with the historical cliché of corpses dangling from the hangman’s rope in crime studies. Some convicted murderers did survive execution in early modern England. Establishing medical death in the heart-lungs-brain was a physical enigma. Criminals had large bull-necks, strong willpowers, and hearty survival instincts. Extreme hypothermia often disguised coma in a prisoner hanged in the winter cold. The youngest and fittest were capable of reviving on the dissection table. Many died under the lancet. Capital legislation disguised a complex medical choreography that surgeons staged. They broke the Hippocratic Oath by executing the Dangerous Dead across England from 1752 until 1832

Chapter 5 Mapping Punishment: Provincial Places to Dissect

Those convicted of homicide were hanged on the public gallows before being dissected under the Murder Act in Georgian England. Yet, from 1752, whether criminals actually died on the hanging tree or in the dissection room remained a medical mystery in early modern society. Dissecting the Criminal Corpse takes issue with the historical cliché of corpses dangling from the hangman’s rope in crime studies. Some convicted murderers did survive execution in early modern England. Establishing medical death in the heart-lungs-brain was a physical enigma. Criminals had large bull-necks, strong willpowers, and hearty survival instincts. Extreme hypothermia often disguised coma in a prisoner hanged in the winter cold. The youngest and fittest were capable of reviving on the dissection table. Many died under the lancet. Capital legislation disguised a complex medical choreography that surgeons staged. They broke the Hippocratic Oath by executing the Dangerous Dead across England from 1752 until 1832

Chapter 4 Delivering Post-Mortem Harm: Cutting the Corpse

Those convicted of homicide were hanged on the public gallows before being dissected under the Murder Act in Georgian England. Yet, from 1752, whether criminals actually died on the hanging tree or in the dissection room remained a medical mystery in early modern society. Dissecting the Criminal Corpse takes issue with the historical cliché of corpses dangling from the hangman’s rope in crime studies. Some convicted murderers did survive execution in early modern England. Establishing medical death in the heart-lungs-brain was a physical enigma. Criminals had large bull-necks, strong willpowers, and hearty survival instincts. Extreme hypothermia often disguised coma in a prisoner hanged in the winter cold. The youngest and fittest were capable of reviving on the dissection table. Many died under the lancet. Capital legislation disguised a complex medical choreography that surgeons staged. They broke the Hippocratic Oath by executing the Dangerous Dead across England from 1752 until 1832