Impact of speech rate and speaker-modulated vocal effort on laryngeal kinematics in people with Parkinson’s disease

PURPOSE: Communication difficulties in Parkinson’s Disease (PD) are multifactorial. Observing cardinal motor symptoms may be insufficient in qualifying speech dysfunction in people with Parkinson’s Disease (PwPD). This study aimed to use high-speed video (HSV) endoscopy to explore the use of three measures of laryngeal kinematics – spatiotemporal index, asymmetry index, and kinematic stiffness ratio – as a novel means of examining vocal motor control in PD, to better understand the pathophysiology of PwPD within the phonatory subsystem. METHOD: 24 PwPD and 24 age- and sex-matched controls were trained to produce repetitions of a VCV target, /ifi/, while varying their speech rate and vocal effort during simultaneous HSV nasoendoscopic and acoustic recordings. Kinematic measures were calculated from HSV recordings during vocal fold adduction using both manual glottal angle tracking and a semi-automated algorithm. Six separate repeated measures analyses of variance (ANOVAs) were completed to determine the spatiotemporal index, asymmetry index and kinematic stiffness ratio, with main effects of group and condition (fast rate, regular rate, slow rate, mild effort, moderate effort, maximum effort). Alpha levels < .05 were considered statistically significant. Effect sizes of significant differences were calculated by using partial eta squared. RESULTS: The repeated ANOVAs showed a statistically significant effect of group on spatiotemporal index values across both rate (p < .01) and effort (p <.05) and on asymmetry index values across rate (p < .01). No statistically significant main effect of rate or effort or interaction effects between group × rate or group × effort were observed for all kinematic measures. CONCLUSION: This study determined that spatiotemporal index, a measure of variability in movement, and asymmetry index, a measure of movement efficiency, are significantly higher for PwPD compared to controls. These findings are consistent with increased variability and reduced efficiency observed in other speech subsystems in PwPD. Further research is recommended to explore the use of laryngeal kinematics in characterizing the pathophysiology of the laryngeal subsystem in PwPD

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London