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Stoelben E. [Functional, Radiological and Endoscopic Diagnostic of Tracheal Diseases]. Zentralbl Chir 2024; 149:253-259. [PMID: 38056500 DOI: 10.1055/a-2210-3636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Diseases of the trachea are rare, while other diseases associated with shortness of breath and pulmonary symptoms are common, which is why the necessary diagnosis and therapy are regularly delayed. At the same time, diseases range from simple scarring stenosis to extensive tumour disease. Patients may be otherwise healthy, suffer from autoimmune disease, or have severe general illnesses, as in tracheotomised patients. Therefore, history and clinical examination provide very important clues to a disease of the trachea. Subsequent diagnostics should be ordered in a reasonable manner and lead to the correct diagnosis and subsequent therapy in a timely manner. Functional, radiological and endoscopic examinations, each with a special focus in experienced hands, avoid duplicate examinations or misinterpretations. Patients are grateful because diseases of the trachea - a central airway that cannot be bypassed - are experienced as life-threatening or at least as severely limiting the quality of life.
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Affiliation(s)
- Erich Stoelben
- Thoraxchirurgie, Thoraxklinik Köln, St. Hildegardis Krankenhaus, Köln, Deutschland
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2
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Rao SJ, Nickel JC, Navarro NI, Madden LL. Readability Analysis of Spanish Language Patient-Reported Outcome Measures in Laryngology. J Voice 2024; 38:487-491. [PMID: 34742617 DOI: 10.1016/j.jvoice.2021.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laryngologists use patient-reported outcome measures (PROM) to determine the efficacy of an intervention or to evaluate a patient's symptomatology. PROMs should be developed for a diverse target audience, including patients of all literacy levels. The American Medical Association (AMA) recommends that PROMs are written at or below the sixth- grade level. In recent studies, readability scores for otolaryngology PROMs in English were above the recommended reading level. To date, there is limited data regarding the readability of Spanish PROMs. Thus, this study aims to report the readability of Spanish language PROMs in laryngology. METHODS This study analyzed nine Spanish language laryngology PROMs. The authors queried PROMs from PubMed and Google scholar based upon English language laryngology PROM systematic reviews. Common categories included voice, airway, dysphagia, and other laryngology PROMs. Only nine laryngology PROMs were translated and validated in the Spanish language and publicly available. The readability of Spanish PROMs was determined using a multi-lingual readability software by two readability indices: Fernández Huerta and INFLESZ. RESULTS The mean and standard deviation (SD) Fernández-Huerta was 75.25 (27.12) and INFLESZ was 71.25 (26.98). The average readability score per PROM in Spanish was: DI (84.19), EAT-10 (11.54), MDADI (64.92), RSI (57.22), SWAL-QoL (70.98), TVQ (87.64), VFI (99.46), VHI-10 (95.04), and VRQoL (88.28). CONCLUSION The mean readability of Spanish language laryngology PROMs was above the recommended reading level. Patient readability should be considered when developing laryngology PROMs translations and validations. Robust development and testing of novel PROMs are important to address the persistent, pervasive risks for Spanish speaking patients.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Joseph C Nickel
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Noel I Navarro
- Bilingual/Bicultural Kato Verified Translator, Biomedical Quality Engineer, Fung Institute for Engineering Leadership, University of California, Berkeley, Berkeley, California, USA
| | - Lyndsay L Madden
- Department of Otolaryngology - Head & Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina USA.
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3
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Ntouniadakis E, Sundh J, Magnuson A, von Beckerath M. Balloon dilatation is superior to CO 2 laser excision in the treatment of subglottic stenosis. Eur Arch Otorhinolaryngol 2023; 280:3303-3311. [PMID: 36964409 PMCID: PMC10038384 DOI: 10.1007/s00405-023-07926-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Endoscopic treatment of subglottic stenosis (SGS) is regarded as a safe procedure with rare complications and less morbidity than open surgery yet related with a high risk of recurrence. The abundance of techniques and adjuvant therapies complicates a comparison of the different surgical approaches. The primary aim of this study was to investigate disease recurrence after CO2 laser excisions and balloon dilatation in patients with SGS and to identify potential confounding factors. MATERIALS AND METHODS In a tertiary referral center, two cohorts of previously undiagnosed patients treated for SGS were retrospectively reviewed and followed for 3 years. The CO2 laser cohort (CLC) was recruited between 2006 and 2011, and the balloon dilatation cohort (BDC) between 2014 and 2019. Kaplan‒Meier and multivariable Cox regression analyzed time to repeated surgery and estimated hazard ratios (HRs) for different variables. RESULTS Nineteen patients were included in the CLC, and 31 in the BDC. The 1-year cumulative recurrence risk was 63.2% for the CLC compared with 12.9% for the BDC (HR 33.0, 95% CI 6.57-166, p < 0.001), and the 3-year recurrence risk was 73.7% for the CLC compared with 51.6% for the BDC (HR 8.02, 95% CI 2.39-26.9, p < 0.001). Recurrence was independently associated with overweight (HR 3.45, 95% CI 1.16-10.19, p = 0.025), obesity (HR 7.11, 95% CI 2.19-23.04, p = 0.001), and younger age at diagnosis (HR 8.18, 95% CI 1.43-46.82, p = 0.018). CONCLUSION CO2 laser treatment is associated with an elevated risk for recurrence of SGS compared with balloon dilatation. Other risk factors include overweight, obesity, and a younger age at diagnosis.
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Affiliation(s)
- Eleftherios Ntouniadakis
- Department of Ear Nose and Throat, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden.
- Ear Nose and Throat Department, Örebro University Hospital, Södra Grev Rosengatan, 701 85, Örebro, Sweden.
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden
| | - Mathias von Beckerath
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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4
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de Bataille C, Bernard D, Dumoncel J, Vaysse F, Cussat-Blanc S, Telmon N, Maret D, Monsarrat P. Machine Learning Analysis of the Anatomical Parameters of the Upper Airway Morphology: A Retrospective Study from Cone-Beam CT Examinations in a French Population. J Clin Med 2022; 12:84. [PMID: 36614885 PMCID: PMC9820916 DOI: 10.3390/jcm12010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
The objective of this study is to assess, using cone-beam CT (CBCT) examinations, the correlation between hard and soft anatomical parameters and their impact on the characteristics of the upper airway using symbolic regression as a machine learning strategy. Methods: On each CBCT, the upper airway was segmented, and 24 anatomical landmarks were positioned to obtain six angles and 19 distances. Some anatomical landmarks were related to soft tissues and others were related to hard tissues. To explore which variables were the most influential to explain the morphology of the upper airway, principal component and symbolic regression analyses were conducted. Results: In total, 60 CBCT were analyzed from subjects with a mean age of 39.5 ± 13.5 years. The intra-observer reproducibility for each variable was between good and excellent. The horizontal soft palate measure mostly contributed to the reduction of the airway volume and minimal section area with a variable importance of around 50%. The tongue and the position of the hyoid bone were also linked to the upper airway morphology. For hard anatomical structures, the anteroposterior position of the mandible and the maxilla had some influence. Conclusions: Although the volume of the airway is not accessible on all CBCT scans performed by dental practitioners, this study demonstrates that a small number of anatomical elements may be markers of the reduction of the upper airway with, potentially, an increased risk of obstructive sleep apnea. This could help the dentist refer the patient to a suitable physician.
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Affiliation(s)
- Caroline de Bataille
- Laboratoire Centre d’Anthropobiologie et de Génomique de Toulouse, Université Paul Sabatier, 31073 Toulouse, France
- School of Dental Medicine and CHU de Toulouse—Toulouse Institute of Oral Medicine and Science, 31062 Toulouse, France
| | - David Bernard
- Institute of Research in Informatics (IRIT) of Toulouse, CNRS—UMR5505, 31062 Toulouse, France
- RESTORE Research Center, Department of Oral Medicine, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse University Hospital (CHU), Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Jean Dumoncel
- Laboratoire Centre d’Anthropobiologie et de Génomique de Toulouse, Université Paul Sabatier, 31073 Toulouse, France
| | - Frédéric Vaysse
- Laboratoire Centre d’Anthropobiologie et de Génomique de Toulouse, Université Paul Sabatier, 31073 Toulouse, France
- School of Dental Medicine and CHU de Toulouse—Toulouse Institute of Oral Medicine and Science, 31062 Toulouse, France
| | - Sylvain Cussat-Blanc
- Institute of Research in Informatics (IRIT) of Toulouse, CNRS—UMR5505, 31062 Toulouse, France
- Artificial and Natural Intelligence Toulouse Institute ANITI, 31013 Toulouse, France
| | - Norbert Telmon
- Laboratoire Centre d’Anthropobiologie et de Génomique de Toulouse, Université Paul Sabatier, 31073 Toulouse, France
- Service de Médecine Légale, Centre Hospitalier Universitaire Rangueil, Avenue du Professeur Jean Poulhès, CEDEX 9, 31059 Toulouse, France
| | - Delphine Maret
- Laboratoire Centre d’Anthropobiologie et de Génomique de Toulouse, Université Paul Sabatier, 31073 Toulouse, France
- School of Dental Medicine and CHU de Toulouse—Toulouse Institute of Oral Medicine and Science, 31062 Toulouse, France
| | - Paul Monsarrat
- School of Dental Medicine and CHU de Toulouse—Toulouse Institute of Oral Medicine and Science, 31062 Toulouse, France
- RESTORE Research Center, Department of Oral Medicine, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Université P. Sabatier, Toulouse University Hospital (CHU), Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
- Artificial and Natural Intelligence Toulouse Institute ANITI, 31013 Toulouse, France
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Kristensen JK, Nielsen C, Haloob N. Patient reported outcome measures (PROMS) for body image in dermatology: A systematic review. SKIN HEALTH AND DISEASE 2022; 2:e167. [PMID: 36479261 PMCID: PMC9720198 DOI: 10.1002/ski2.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION It is widely acknowledged that negative body image perception is linked to anxiety, depression, and body dysmorphic disorder. However, there is no gold standard, body image related patient reported outcome measure in use, specific for dermatologic disease, despite evidence to suggest a high prevalence of mental health problems relating to body image in this group of patients. AIM The aim of this study was to perform a review of body image Patient Reported Outcome Measures (PROMs) used in dermatology and to evaluate their effectiveness. METHODS Searches were performed in the major databases. Two investigators independently performed full text evaluation by applying an established checklist to evaluate the conceptual model, content validity, reliability, construct validity, scoring and interpretability and respondent burden. RESULTS Six different PROMs were identified of which only one was fully validated. There was a significant lack of patient involvement in the development of PROMs in this context. CONCLUSIONS We therefore encourage further research in this field to improve the quality of evidence to better understand the relationship between mental health and dermatologic disease.
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Affiliation(s)
| | | | - Nora Haloob
- Imperial College HealthcareNHS TrustLondonUK
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6
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Alrabiah A, Aldriweesh B, Almujaiwel N, Alasqah MI, Alduraywish SA, Alammar A. The Reliability of the Arabic Version of the Dyspnea Index Questionnaire for Upper Airway-Related Dyspnea. Cureus 2022; 14:e29656. [PMID: 36320950 PMCID: PMC9612267 DOI: 10.7759/cureus.29656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives This study aimed to translate the Dyspnea Index (DI) questionnaire into the Arabic language and determine whether this version is valid and reliable for Arabic-speaking patients with upper airway-related dyspnea. Methods A cross-sectional study was conducted at the King Saud University Medical City otolaryngology clinics in Riyadh, Saudi Arabia. The DI questionnaire was translated into Arabic and then back-translated into the English language. Inclusion criteria were preoperative patients presenting to the otolaryngology clinic with upper airway-related dyspnea between November and December 2020. The results of internal consistency and factor analysis among the items were compared to the original DI development results to assess the reliability of the questionnaire. Results Among a total of 57 recruited patients, 50 questionnaires were completed with an 88% response rate. The mean age of the included patients was 38 ±14 years. Women constituted 58% of the patients. The most common diagnosis was subglottic stenosis (72%). Principle component extraction in factor analysis revealed a single underlying factor for all the questions. Factor loading ranged from 0.69 to 0.85. Reliability statistics showed a high value of internal consistency among the items. The mean inter-item correlation was 0.58. Conclusion Based on our findings, the Arabic version of the DI questionnaire is a reliable instrument for evaluating upper airway dyspnea.
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Fernandes-Taylor S, Damico-Smith C, Arroyo N, Wichmann M, Zhao J, Feurer ID, Francis DO. Multicenter Development and Validation of the Vocal Cord Paralysis Experience (CoPE), a Patient-Reported Outcome Measure for Unilateral Vocal Fold Paralysis-Specific Disability. JAMA Otolaryngol Head Neck Surg 2022; 148:756-763. [PMID: 35797026 DOI: 10.1001/jamaoto.2022.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Unilateral vocal fold paralysis (UVFP) is a common and life-changing complication of cancer, trauma, and an estimated 500 000 head, neck, and chest surgeries performed annually in the US, among other causes (eg, idiopathic). Consequent disabilities are profound and often permanent and can include severe voice, swallowing, and breathing dysfunction and concomitant anxiety, isolation, and fear. Physiological measures often correlate poorly with patient-reported disability. The measure described herein was designed to be a comprehensive, psychometrically sound UVFP-specific patient-reported outcome measure (PROM) for use in clinical trials or at point of care. Objective To evaluate the reliability and validity of the CoPE (vocal Cord Paralysis Experience) PROM in a nationally representative sample for both clinical and research use. Design, Setting, and Participants This survey validation study was performed at 34 tertiary care centers across the US and included English-speaking adults with unilateral vocal fold immobility confirmed via laryngoscopy. Main Outcomes and Measures Reliability (internal consistency, alternate form, and test-retest) and validity (convergent and known-group). Results In total, 613 patients (mean [SD] age, 58 [15.3] years; 394 [64.5%] women) were recruited, and 555 (92.3%) completed surveys for all time points. Internal consistency was high in the overall 22-item PROM and psychosocial, swallow, and voice subscales (Cronbach α > 0.91). Intraclass correlations for individuals between the baseline and 2-week administrations were moderate for the overall score and subscales (intraclass correlations range, 0.66-0.80). There were significant differences between the online and 2-week paper administrations for the overall score and voice and psychosocial subscales (overall scale mean: 54.4 [95% CI, 49.7-59.1] vs 48.9 [95% CI, 43.7-54.0] at 2 weeks). The confirmatory model was found to be suitably fitted based on average r2 values 0.5 or greater for subscale and overall scores. Correlations between subscales and existing PROMs (Voice-Related Quality of Life, Eating Assessment Tool, and Communication Participation Item Bank) were all greater than 0.69, and mean PROM subscale scores were significantly different across known quartiles of existing PROMs. Conclusions and Relevance The findings of this survey validation study suggest that the CoPE PROM could serve as a psychometrically sound, comprehensive measure of UVFP-attributed disability suitable for use in clinical and research settings to assess within-person changes. The results will inform a user manual to facilitate use in clinical trials comparing the effectiveness and durability of treatments including behavioral (speech therapy), temporary (eg, injection augmentation), and permanent surgical treatments for UVFP.
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Affiliation(s)
| | | | | | | | - Jiwei Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison
| | - Irene D Feurer
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David O Francis
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison.,Endoscopy and Laryngology Section Editor, JAMA Otolaryngology-Head & Neck Surgery
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Williams MT, Lewthwaite H, Paquet C, Johnston K, Olsson M, Belo LF, Pitta F, Morelot-Panzini C, Ekström M. Dyspnoea-12 and Multidimensional Dyspnea Profile: Systematic Review of Use and Properties. J Pain Symptom Manage 2022; 63:e75-e87. [PMID: 34273524 DOI: 10.1016/j.jpainsymman.2021.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 12/13/2022]
Abstract
CONTEXT The Dyspnoea-12 (D-12) and Multidimensional Dyspnea Profile (MDP) were specifically developed for assessment of multiple sensations of breathlessness. OBJECTIVES This systematic review aimed to identify the use and measurement properties of the D-12 and MDP across populations, settings and languages. METHODS Electronic databases were searched for primary studies (2008-2020) reporting use of the D-12 or MDP in adults. Two independent reviewers completed screening and data extraction. Study and participant characteristics, instrument use, reported scores and minimal clinical important differences (MCID) were evaluated. Data on internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation coefficient, ICC) were pooled using random effects models between settings and languages. RESULTS A total 75 publications reported use of D-12 (n = 35), MDP (n = 37) or both (n = 3), reflecting 16 chronic conditions. Synthesis confirmed two factor structure, internal consistency (Cronbach's α mean, 95% CI: D-12 Total = 0.93, 0.91-0.94; MDP Immediate Perception [IP] = 0.88, 0.85-0.90; MDP Emotional Response [ER] = 0.86, 0.82-0.89) and 14 day test-rest reliability (ICC: D-12 Total = 0.91, 0.88-0.94; MDP IP = 0.85, 0.70-0.93; MDP ER = 0.84, 0.73-0.90) across settings and languages. MCID estimates for clinical interventions ranged between -3 and -6 points (D-12 Total) with small variability in scores over 2 weeks (D-12 Total 2.8 (95% CI: 2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1) and six months (D-12 Total 2.9 (2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1)). CONCLUSION D-12 and MDP are widely used, reliable, valid and responsive across various chronic conditions, settings and languages, and could be considered standard instruments for measuring dimensions of breathlessness in international trials.
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Affiliation(s)
- Marie T Williams
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Hayley Lewthwaite
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada; College of Engineering, Science and Environment, School of Environmental & Life Sciences, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Catherine Paquet
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Faculté des Sciences de l'Administration, Université Laval, Québec (Québec) , Canada
| | - Kylie Johnston
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Max Olsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden
| | - Letícia Fernandes Belo
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Capucine Morelot-Panzini
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Groupe Hospitalo-Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Département R3S, Paris, France
| | - Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden
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Ntouniadakis E, Sundh J, von Beckerath M. Monitoring Adult Subglottic Stenosis With Spirometry and Dyspnea Index: A Novel Approach. Otolaryngol Head Neck Surg 2021; 167:517-523. [PMID: 34813409 PMCID: PMC9442627 DOI: 10.1177/01945998211060817] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective The aim was to examine the correlations among the anatomic Cotton-Myer classification, pulmonary function tests (PFTs), and patient-perceived dyspnea or dysphonia in patients with subglottic stenosis and identify measurements accurately reflecting treatment effects. Study Design Prospective cohort study. Setting Tertiary referral center. Method Fifty-two adults receiving endoscopic treatment for isolated subglottic stenosis were consecutively included. Correlations were calculated among the preoperative Cotton-Myer scale, PFTs, the Dyspnea Index (DI), and the Voice Handicap Index. Receiver operating characteristic curves were determined for PFT, DI, and Voice Handicap Index pre- and postoperative measurements. Results The Cotton-Myer classification correlated weakly with peak expiratory flow (r = −0.35, P = .012), expiratory disproportion index (r = 0.32, P = .022), peak inspiratory flow (r = −0.32, P = .022), and total peak flow (r = −0.36, P = .01). The DI showed an excellent area under the curve (0.99, P < .001), and among PFTs, the expiratory disproportion index demonstrated the best area under the curve (0.89, P < .001), followed by total peak flow (0.88, P < .001), peak expiratory flow (0.87, P < .001), and peak inspiratory flow (0.84, P < .001). Patients treated endoscopically with balloon dilatation showed a 53% decrease in expiratory disproportion index (95% CI, 41%-66%; P < .001) and a 37% improvement in peak expiratory flow (95% CI, 31%-43%; P < .001). Conclusion Expiratory disproportion index or peak expiratory flow combined with DI was a feasible measurement for the monitoring of adult subglottic stenosis. The percentage deterioration of peak expiratory flow and increase in expiratory disproportion index correlated significantly with a proportional percentage increase in DI.
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Affiliation(s)
- Eleftherios Ntouniadakis
- Department of Ear Nose and Throat, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Josefin Sundh
- Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mathias von Beckerath
- Department of Ear Nose and Throat, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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10
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Rao SJ, Nickel JC, Kiell EP, Madden LL. Readability of Commonly Used Patient-Reported Outcome Measures in Laryngology. Laryngoscope 2021; 132:1069-1074. [PMID: 34498753 DOI: 10.1002/lary.29849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are used to evaluate patients' symptoms and clinical improvement after an intervention. Advocacy efforts and increased provider awareness regarding health literacy have helped to improve the readability of PROMs. Recent studies in otolaryngology in rhinology, pediatric otolaryngology, and head and neck reported PROM readability scores above the sixth-grade level. However, there is limited data regarding the readability of laryngology PROMs. Thus, this study aims to report the readability levels of PROMs in laryngology by assessing different readability indices and describing the relationship of readability levels to equitable healthcare. METHODS This is a bibliometric study that received approval from institutional review board (IRB) review as a nonhuman subject research study. Recent and widely utilized laryngology PROMs were selected from a publicly available literature search by reviewing laryngology systematic reviews, PubMed, and Google Scholar. Laryngology PROMs were selected from voice, dysphagia, airway, and other PROMs including voice questionnaires administered to patients seeking gender affirming voice care from systematic reviews and expert opinion. There were 37 PROMs included in this study. PROMs were analyzed via Gunning Fog, Simple Measure of Gobbledygook (SMOG), FORCAST, and Flesch Reading Ease Score. RESULTS All laryngology PROMs had readabilities above the recommended sixth-grade level. The mean and standard deviation (SD) of Gunning Fog was 7.30 (2.59), SMOG was 8.70 (1.51), FORCAST was 10.05 (1.51), and Flesch Reading Ease Score was 8.08 (2.76). CONCLUSION Laryngology PROMs are above the recommended middle school reading level. To further promote health equity, readability should be considered when developing future PROMs. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Joseph C Nickel
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Eleanor P Kiell
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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11
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Ntouniadakis E, Brus O, von Beckerath M. Dyspnea Index: An upper airway obstruction instrument; translation and validation in Swedish. Clin Otolaryngol 2021; 46:380-387. [PMID: 33277799 PMCID: PMC7986702 DOI: 10.1111/coa.13682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/14/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Upper airway dyspnoea is a challenging condition in which assessing the discomfort experienced by the patient is essential. There are three patient-reported outcome (PRO) instruments developed particularly for this patient group, none of which is available in Swedish. The aim of this study was to translate the Dyspnea Index (DI) into Swedish and validate the instrument for use in the Swedish-speaking population by investigating its basic psychometric properties. DESIGN A prospective instrument validation study. SETTING Tertiary referral centre. PARTICIPANTS Fifty-three (n = 53) patients with upper airway dyspnoea and 19 healthy controls. MAIN OUTCOME MEASURES The questionnaire was translated into Swedish (swDI) with a forward-backward method. Reliability, repeatability, responsiveness and construct validity were assessed by asking the subjects to complete the swDI, a visual analog scale (VAS) at exertion and at rest and the Voice Handicap Index (VHI). RESULTS The swDI showed excellent internal consistency (Cronbach's α: 0.85) and repeatability (interclass correlation coefficient: 0.87 and Pearson's r: .89) in the patient group. No ceiling effect was observed (maximum score achieved was 39; 85% of the patients scored ≤ 36). SwDI scores moderately correlated with VAS at exertion (r: .59) and at rest (r: .42), yet poorly with the VHI (r: .36). The effect size (ES) was 3.8. CONCLUSIONS The swDI is a valid, robust and reliable questionnaire for self-assessment in Swedish-speaking patients with upper airway obstruction. A future anchor-based longitudinal study is needed to assess the smallest detectable change (SDC) and minimal important change (MIC) that were not estimated in our study.
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Affiliation(s)
- Eleftherios Ntouniadakis
- Department of Ear Nose and Throat, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ole Brus
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mathias von Beckerath
- Department of Ear Nose and Throat, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Naunheim MR, Dai JB, Rubinstein BJ, Goldberg L, Weinberg A, Courey MS. A visual analog scale for patient-reported voice outcomes: The VAS voice. Laryngoscope Investig Otolaryngol 2020; 5:90-95. [PMID: 32128435 PMCID: PMC7042645 DOI: 10.1002/lio2.333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Although patient-reported outcome measures (PROMs) can be useful for assessing quality of life, they can be complex and cognitively burdensome. In this study, we prospectively evaluated a simple patient-reported voice assessment measure on a visual analog scale (VAS voice) and compared it with the Voice Handicap Index (VHI-10). STUDY DESIGN Prospective survey. METHODS An abbreviated voice measure was designed by a team of otolaryngologists, speech pathologists, and patients that consisted of four VAS questions related to (a) a global question of voice disturbance, (b) physical function of voice, (c) functional issues, and (d) emotional handicap. All English-speaking patients presenting to an academic laryngology clinic for a voice complaint were included. Internal consistency and validity were assessed with comparison to the VHI-10. RESULTS A total of 209 patients were enrolled. Ninety-two percent of patients reported understanding the survey. The four-item VAS survey was highly correlated with VHI-10 score (Pearson correlation .81, P < .0001), and the Cronbach's alpha between all four VAS questions was .94. Age, gender, and diagnosis were not associated with either the global VAS or VHI-10 tool. CONCLUSION Reducing the complexity of instruments assessing voice-related quality of life is feasible, and the VAS voice correlated with existing measures. Simplified assessments may offer advantages compared to more cumbersome PROMs. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Matthew R. Naunheim
- Massachusetts Eye and EarBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | | | | | | | - Alan Weinberg
- Icahn School of Medicine at Mount SinaiNew YorkNew York
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Fernandes-Taylor S, Damico Smith C, Arroyo N, Bonnet K, Schlundt D, Wichmann M, Feurer I, Francis DO. Study protocol to develop a patient-reported outcome measuring disability associated with unilateral vocal fold paralysis: a mixed-methods approach with the CoPE collaborative. BMJ Open 2019; 9:e030151. [PMID: 31666263 PMCID: PMC6830693 DOI: 10.1136/bmjopen-2019-030151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Patient-reported outcome (PRO) measures are increasingly developed with multisite, representative patient populations so that they can serve as a primary endpoint in clinical trials and longitudinal studies. Creating multisite infrastructure during PRO measure development can facilitate future comparative effectiveness trials. We describe our protocol to simultaneously develop a PRO measure and create a collaborative of tertiary care centres to address the needs of patients with unilateral vocal fold paralysis (UVFP). We describe the stakeholder engagement, information technology and regulatory foundations for PRO measure development and how the process enables plans for multisite trials comparing treatments for this largely iatrogenic condition. METHODS AND ANALYSIS The study has three phases: systematic review, measure development and measure validation. Systematic reviews and qualitative interviews (n=75) will inform the development of a conceptual framework. Qualitative interviews with patients with UVFP will characterise the lived experience of the condition. Candidate PRO measure items will be derived verbatim from patient interviews and refined using cognitive interviews and expert input. The PRO measure will be administered to a large, multisite cohort of adult patients with UVFP via the CoPE (vocal Cord Paralysis Experience) Collaborative. We will establish CoPE to facilitate measure development and to create preliminary infrastructure for future trials, including online data capture, stakeholder engagement, and the identification of barriers and facilitators to participation. Classical test theory psychometrics and grounded theory characterise our approach, and validation includes assessment of latent structure, reliability and validity. ETHICS AND DISSEMINATION Our study is approved by the University of Wisconsin Health Sciences Institutional Review Board. Findings from this project will be published in open-access journals and presented at international conferences. Subsequent use of the PRO measure will include comparative effectiveness trials of treatments for UVFP at CoPE Collaborative sites.
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Affiliation(s)
| | - Cara Damico Smith
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Natalia Arroyo
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Margarete Wichmann
- University of Wisconsin Survey Center, University of Wisconsin, Madison, Wisconsin, USA
| | - Irene Feurer
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - David O Francis
- Division of Otolaryngology, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
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Gray AJ, Huston M, Didericksen D, Meyer TK, Merati A, Brisebois S. The minimal clinically important difference of the dyspnea index in laryngotracheal stenosis. Laryngoscope 2019; 130:1775-1779. [PMID: 31593339 DOI: 10.1002/lary.28331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Dyspnea Index (DI) is a validated patient-reported outcome (PRO) instrument that has been used in the management of laryngotracheal stenosis (LTS). The minimal clinically important difference (MCID) is an established concept to help determine the change in a PRO instrument that reflects meaningful change for the patient. It is not known what change in the DI is of clinical significance in airway surgery. This study aims to determine the MCID for the DI in patients undergoing surgical treatment for LTS. METHODS This is a prospective cohort study in which 26 patients with LTS completed the DI (score range 0 to 40) before and 6 to 8 weeks postoperatively, in addition to a Global Ratings Change Questionnaire (GRCQ), scored from -7 to +7, at the postoperative interval. A hypothesis test was carried out to test the association between GRCQ and change in DI. The MCID for change in DI was determined using anchor-based analysis. RESULTS Overall mean change in DI was -11, and mean change in GRCQ was +5. Change in DI scores were significantly different among the improvement and no improvement groups (P value <0.002). Area under the receiver operating curve was 0.92, demonstrating high discriminatory ability of the change in DI score. A change of -4 was determined to be the threshold that discriminated between significant improvement and no improvement. CONCLUSION A decrease of 4 in the DI can be considered as the MCID for patients with LTS after surgical treatment. LEVEL OF EVIDENCE 2b Laryngoscope, 130:1775-1779, 2020.
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Affiliation(s)
- Alan J Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Molly Huston
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Devin Didericksen
- Department of Statistics, University of Washington, Seattle, Washington, U.S.A
| | - Tanya K Meyer
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Albert Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Simon Brisebois
- Department of Surgery, Otolaryngology-Head and Neck Division, University of Sherbrooke, Sherbrooke, Quebec, Canada
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Cramer JD, Graboyes EM, Brenner MJ. Mortality associated with tracheostomy complications in the United States: 2007-2016. Laryngoscope 2018; 129:619-626. [DOI: 10.1002/lary.27500] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 11/09/2022]
Affiliation(s)
- John D. Cramer
- Department of Otolaryngology-Head and Neck Surgery; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina
| | - Michael J. Brenner
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan; Ann Arbor Michigan U.S.A
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