Reliability, validity and normative data of a quick repetition test for Italian children

OBJECTIVES

A quick repetition test can be useful as a screening or preliminary investigation to select children who need to be assessed with a more specific articulation test. Schindler's repetition test lasts about 2 min and requires the repetition of a 30 words list, each word targeting a specific phoneme or cluster. The aims of the study are: to assess reliability of Schindler's repetition test; to establish normative data for speech development in Italian-speaking children; to analyse validity of this instrument.

METHODS

Six-hundred-two Italian children, aged range between 3;0 and 10;8 years, were included in the study: 557 without clinical sign of speech impairment and 45 had a speech sound disorder. Reliability. One-hundred-five children were tested the same day by two examiners (inter-rater reliability); the administration of the repetition test to 45 children was audio-recorded (intra-rater reliability); 105 children underwent the repetition test twice, with a 2 weeks interval (test-retest reliability). Data were compared through Intraclass Correlation Coefficient (ICC). Normative data. Percentages of children without clinical sign of speech impairment in each age group who repeated correctly, omitted or produced distorted target phonemes of Schindler's repetition test were reported.

VALIDITY

To assess the ability of the test to record improvement in mean values with age (construct validity), the proportion of correct repetitions obtained by children from different age groups were compared through logistic regression. The speech abilities of 45 children were also analysed through a more comprehensive articulation test (concurrent validity). Scores were compared through Bland-Altman plot.

RESULTS

Reliability. All ICC were superior to 0.9. Normative data. Despite language-specific pattern of acquisition emerged, data showed many similarities to data reported in international studies on speech sound development.

VALIDITY

Logistic regression demonstrated a significant effect of age groups. Bland-Altman plot showed relatively narrow limits of agreement between Schindler's repetition and Rossi's articulation test.

CONCLUSIONS

Schindler's repetition test can be considered a reliable and valid instrument for preliminary assessment of speech abilities in Italian-speaking children aged from 3 to 6 years old. Application of Schindler's repetition test is recommended in clinical practice, as a screening test or as a first clinical assessment instrument.

[The role of colloids in intensive care medicine. Evidence instead of emotions]

BACKGROUND

Besides albumin, which is gained from human donors, synthetic colloids have been playing a dominant role in treating patients in shock and are standard therapy in intensive care units (ICU). Since the publication of large randomized controlled trials indicating negative effects on renal function, their use has been questioned, especially for hydroxyethyl starch products. The preliminary assumption that these side effects are only existent in first or secondary generation starch fluids was proven incorrect. In fact, the use of hydroxyethyl starch products in critically ill patients is prohibited by the European Medicines Agency.

CURRENT DISCUSSION AND INDICATIONS

Several methodological limitations exist in each of these trials that limit the evidence value of these investigations, although they served as the basis for the negative judgment of the European Medicines Agency. In addition, a large randomized controlled trial on the efficacy of gelatin is lacking. The use of colloids in ICU patients is indicated in cases where crystalloid volume therapy is inadequate.

CONCLUSION

Especially during the first 6 h of sepsis, when aggressive volume therapy is decisive for patient outcome, colloids may be relevant to increase patient survival. The latest guideline on treatment with colloids has been published in the German S3 guideline "Intravascular volume therapy in adults."

Transcranial direct current stimulation enhances sucking of a liquid bolus in healthy humans

BACKGROUND

Transcranial direct current stimulation (tDCS) is a non-invasive technique used for modulating cortical excitability in vivo in humans. Here we evaluated the effect of tDCS on behavioral and electrophysiological aspects of physiological sucking and swallowing.

METHODS

Twelve healthy subjects underwent three tDCS sessions (anodal, cathodal and sham stimulation) on separate days in a double-blind randomized order. The active electrode was placed over the right swallowing motor cortex. Repeated sucking and swallowing acts were performed at baseline and at 15 and 60 min after each tDCS session and the mean liquid bolus volume ingested at each time point was measured. We also calculated average values of the following electrophysiological parameters: 1) area and 2) duration of the rectified EMG signal from the suprahyoid/submental muscles related to the sucking and swallowing phases; 3) EMG peak amplitude for the sucking and swallowing phases; 4) area and peak amplitude of the laryngeal-pharyngeal mechanogram; 5) oropharyngeal delay.

RESULTS

The volume of the ingested bolus significantly increased (by an average of about 30% compared with the baseline value) both at 15 and at 60 min after the end of anodal tDCS. The electrophysiological evaluation after anodal tDCS showed a significant increase in area and duration of the sucking phase-related EMG signal.

CONCLUSIONS

Anodal tDCS leads to stronger sucking of a liquid bolus in healthy subjects, likely by increasing recruitment of cortical areas of the swallowing network. This finding might open up interesting perspectives for the treatment of patients suffering from dysphagia due to various pathological conditions.

Factors in rehospitalisation for severe pressure ulcer care in spinal cord injury/disorders

OBJECTIVE

Repeated hospital admissions (RHA) for ongoing pressure ulcer (PU) care remains a significant challenge in the clinical management of the spinal cord injury/disorders (SCI/D) population. The current study investigated the significance of risk factors for PU treatment and RHA.

METHOD

A retrospective chart review of veterans admitted to the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC) Spinal Cord Injury (SCI) unit for Category III or IV PUs was carried out. A random sample of 105 individuals with SCI/D, evaluated by the Wound Care Team (WCT) from 2006 to 2009 was assessed. Multiple PU development risk factors were extracted from the electronic health record system using standardised data collection forms and entered into the Spinal Cord Injury Pressure Ulcer Database (SCIPUD). Potential associations with RHA were analysed.

RESULTS

Twenty variables were initially identified as potentially related to PU development. Descriptive statistics and statistically significant associations between risk factors and RHA were determined. Demographic factors showed no significant association with RHA. Duration of injury, power wheelchair use and sub-optimally managed spasticity (SMS) were significantly associated with higher RHA. Sub-optimally managed neurogenic bowel (SMNB) at admission was significantly associated with reduced RHA.

CONCLUSION

Factors previously found to be predictive of initial PU development may not, in fact, be predictive of RHA. Some protective trends were observed, such as polypharmacy and marital status, but these did not reach statistical significance in this preliminary study of admission characteristics, warranting further research.

DECLARATION OF INTEREST

There were no external sources of funding for this study. The authors have no conflicts of interests to declare.

Swallowing, voice, and quality of life after supratracheal laryngectomy: preliminary long-term results

BACKGROUND

The purpose of this study was to report preliminary long-term outcomes after supratracheal laryngectomy (STL).

METHODS

Twenty-two male patients who underwent STL were involved in this study. Swallowing skills, neoglottis motility, and vibrations were videoendoscopically assessed. Aerodynamic measures, spectrogram analysis, aspiration pneumonia, body weight variations, and voice perceptual assessment were performed. Generic, voice-related, and swallowing-related quality of life (QOL) were assessed.

RESULTS

Aspiration was found in 10, 2, and 5 patients, respectively, for liquids, semisolids, and solids. Neoglottis motility was generally preserved, whereas vibration was impaired. Aerodynamic measures showed a poor performance. Perceptual assessment revealed highly dysphonic voices. In only 8 patients, a harmonic structure was visible in the spectrograms. Aspiration pneumonia occurred in 2 patients. Preoperative weight was maintained in 16 patients. Generic, voice-related, and swallowing-related QOL revealed satisfied patients.

CONCLUSION

After STL, swallowing was sufficiently restored and QOL was satisfactory, whereas the voice was severely impaired even if oral communication was well preserved.

Reliability and validity of the Italian Eating Assessment Tool

OBJECTIVES

We sought to evaluate the reliability and validity of the Italian EAT-10 (Italian Eating Assessment Tool; I-EAT-10).

METHODS

The study consisted of 4 phases: item generation, internal consistency and reliability analysis, normative data generation, and validity analysis. Discussion of the EAT-10 with 30 patients and its back-translation were accomplished. The recruited population included 172 patients (40 with dysphonia and 132 with dysphagia) and 269 asymptomatic subjects for testing of internal consistency, and 94 patients with dysphagia and 158 asymptomatic subjects for test-retest reliability analysis. Normative data were gathered from the 269 subjects. The scores of patients and asymptomatic subjects were compared. The I-EAT-10 and flexible endoscopic evaluation of swallowing (FEES) scores in 94 patients were correlated. The I-EAT-10 scores made before and after successful swallowing rehabilitation in 38 patients were compared.

RESULTS

Excellent internal consistency (Cronbach's alpha values of 0.90 and 0.93) and strong test-retest reliability (intraclass correlation coefficients of 0.95 and 0.98) were found in patients and asymptomatic subjects. The I-EAT-10 mean (+/- SD) score of the normal cohort was 0.6 +/- 1.1. The asymptomatic subjects and dysphonic patients scored lower than the dysphagic patients on the Kruskal-Wallis test (p = 0.001). The I-EAT-10 and FEES scores were mildly correlated. The mean I-EAT-10 score improved from 9.8 +/- 10.3 to 5.8 +/- 6.7 after swallowing rehabilitation (p = 0.04).

CONCLUSIONS

The I-EAT-10 is a reliable, valid, symptom-specific outcome tool.

Upper esophageal sphincter dysfunction: diverticula-globus pharyngeus

The following discussion of upper esophageal sphincter dysfunction includes commentaries on the role of the cricopharyngeus muscle in reflux disease; the etiology and treatment of Zenker diverticulum; the use of videofluoroscopy in patients with dysphagia, suspicion of aspiration, or globus; the role of pH-impedance monitoring in globus evaluation; and treatment for reflux-associated globus.

Vomer aplasia in a patient carrying a de novo mutation of the TP63 gene (3q27)

The congenital vomer defect (CVD) is a rare and still partially unknown condition. Only few cases have been reported in the international literature and the large majority of them appeared to be isolated. We report a case of CVD detected in a 7-year-old girl affected by ectodermal dysplasia clefting syndrome caused by a mutation of the TP63 gene.

CTA for screening of complicated atherosclerotic carotid plaque--American Heart Association type VI lesions as defined by MRI

BACKGROUND AND PURPOSE

High-resolution carotid MR imaging can accurately identify complicated American Heart Association lesion type VI plaques, which are characterized by thrombus, hemorrhage, or a ruptured fibrous cap. The purpose of this study is to evaluate whether CTA can be used as screening tool to predict the presence or absence of American Heart Association lesion type VI plaques as defined by high-resolution MR imaging.

METHODS

Fifty-one patients with suspected ischemic stroke or TIA with carotid CTA and carotid MR imaging performed within 14 days of the event/admission from April 2008 to December 2010 were reviewed. Vessels with stents or occlusion were excluded (n = 2). Each carotid artery was assigned an American Heart Association lesion type classification by MR imaging. The maximum wall thickness, maximum soft plaque component thickness, maximum calcified component thickness, and its attenuation (if the soft plaque component thickness was >2 mm) were obtained from the CTA.

RESULTS

The maximum soft plaque component thickness proved the best discriminating factor to predict a complicated plaque by MR imaging, with a receiver operating characteristic area under the curve of 0.89. The optimal sensitivity and specificity for detection of complicated plaque by MR imaging was achieved with a soft plaque component thickness threshold of 4.4 mm (sensitivity, 0.65; specificity, 0.94; positive predictive value, 0.75; and negative predictive value, 0.9). No complicated plaque had a soft tissue plaque thickness <2.2 mm (negative predictive value, 1) and no simple (noncomplicated) plaque had a thickness >5.6 mm (positive predictive value, 1).

CONCLUSIONS

Maximum soft plaque component thickness as measured by carotid CTA is a reliable indicator of a complicated plaque, with a threshold of 2.2 mm representing little to no probability of a complicated American Heart Association lesion type VI plaque.

Reliability and validity of the Italian nose obstruction symptom evaluation (I-NOSE) scale

The NOSE scale is a questionnaire assessing QOL related with nasal obstruction. The aim of this study was to culturally adapt the NOSE scale into Italian (I-NOSE). Prospective instrument validation study. Cross-cultural adaptation and validation were accomplished. Cronbach α was used to test internal consistency in 116 patients complaining nasal obstruction and 232 asymptomatic subjects. Pearson and ICC tests were used for test-retest reliability analysis. Normative data were gathered from the 232 asymptomatic subjects. Mann-Whitney test was used to compare the I-NOSE scores in patients and asymptomatic subjects and in 40 patients before and after septoplasty. I-NOSE scores obtained in 60 patients were correlated with rhinomanometric results and with the score of a visual analog scale (VAS) measuring the subjective sensation of nasal obstruction. Good internal consistency and good test-retest reliability were found. I-NOSE mean score of the normal cohort was 12.1 ± 13.2. Asymptomatic subjects scored lower than patients with nasal obstruction (p = 0.001). Positive correlations between I-NOSE scores and VAS and rhinomanometric results were found. The mean I-NOSE score improved from 64.4 ± 23.6 to 22.1 ± 13.5 after septoplasty (p < 0.001). The I-NOSE scale is a reliable, valid, self-administered, symptom-specific questionnaire; its application is recommended.

Liquid-chromatographic profiling of Saponinum album (Merck)

Saponinum album (Merck) is a complex composite of triterpene saponins. It was shown that Saponinum album (Merck) dramatically enhances the toxicity of the N-glycosylase saporin from the seeds of Saponaria officinalis L. as well as the toxicity of a saporin based anti-tumor toxin. This study was intended to chromatographically profile the saponins present in Saponinum album (Merck) in order to identify saponins that determine the cytotoxicity enhancing properties of Saponinum album (Merck) on saporin. For this purpose a liquid-chromatographic profiling (HPLC) followed by ESI-TOF-MS analysis and evaluation of cytotoxicity enhancer effects of saponins from Saponinum album (Merck) was performed. This is the first study describing a liquid-chromatographic profiling of saponins from Saponinum album (Merck). Ten different saponins were isolated. There was a lot of variation observed in the cytotoxicity enhancing properties of different isolated saponins, 8 out of 10 isolated saponins showed an enhancer effect on the toxicity of saporin. Based on these results it was concluded that the cytotoxicity enhancer effect of Saponinum album (Merck) is not attributable to a single, activity determining saponin.