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Young VN, Ma Y, Rosen CA, Schneider SL. Medicare Restriction of Telehealth Speech Services Negatively Impacts Patient Care. Otolaryngol Head Neck Surg 2024; 171:425-430. [PMID: 38613195 DOI: 10.1002/ohn.779] [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: 11/10/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Ample literature shows voice and swallowing therapy, in-person or virtual, to be essential for Otolaryngology and Speech-Language Pathology care. In March 2023, Medicare announced discontinuing teletherapy reimbursement in hospital-based outpatient departments, effective May 2023. This decision was subsequently reversed; however, the uncertain interval period provided the opportunity to study the impact of eliminating teletherapy. STUDY DESIGN Prospective cohort. SETTING Tertiary laryngology center. METHODS Affected Medicare patients were contacted via mailed letter, phone, and secure patient portal and offered to change appointments to in-person, teletherapy with cash self-payment ($165-282/session) or cancellation. Demographics and responses were collected. Statistical analyses conducted using Student's t test. RESULTS Fifty-three patients (28 female; mean age 66.8 ± 14.2 years) were impacted. 64% (n = 34) changed to in-person appointment, 28% (n = 15) canceled, 8% (n = 4) did not respond. No patients opted to self-pay. 67% of patients that canceled telehealth care cited distance from in-person care location. The mean distance for canceled versus rescheduled patients was 92.3 ± 93.0 versus 32.8 ± 57.4 miles, P = .034. Mean age, gender, and number of sessions were not different between groups. Mean time to third next available therapy appointment was 96 ± 46 versus 46 ± 12 days before and after rule change, P = .007. Upon Medicare's reversal, this trend rebounded to nearly baseline (mean 77 ± 12 days, P = .12). CONCLUSION Medicare's discontinuation of reimbursement for teletherapy services caused nearly 30% of patients to cancel voice and swallowing therapy, primarily due to distance. These cancellations led to decreased access to care for Medicare patients with voice/swallowing diagnoses, which affect function, quality of life, and potentially even mortality risk.
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Affiliation(s)
- VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, USA
| | - Yue Ma
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, USA
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, USA
| | - Sarah L Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, USA
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Kang Y, Firn J, Tiner M, Neevel A, Hogikyan ND. Trust Development Between Speech-Language Pathologists and Laryngologists: A Thematic Analysis. J Voice 2024:S0892-1997(24)00170-X. [PMID: 38981739 DOI: 10.1016/j.jvoice.2024.05.019] [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: 03/23/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES Speech-language pathologists (SLPs) and laryngologists often work closely in interdisciplinary settings evaluating and treating patients with voice, swallowing, and airway disorders. This collaboration is integral to providing optimum patient care. We theorize that trust is an essential component of this relationship and contributes to effective patient care and professional satisfaction. There is currently no literature that explores the development and role of trust in this unique interprofessional relationship. We aim to explore the SLP and laryngologist interprofessional relationship and the development and role of trust in that relationship. STUDY DESIGN Qualitative Realist Thematic Analysis. METHODS Thematic analysis of semistructured qualitative interviews was performed to explore the relationship between SLPs and laryngologists. Through purposive sampling from November 2022-January 2023, we recruited SLPs (n = 10) and laryngologists (n = 10) from 12 centers with varying years of practice, practice setting (academic or private), geographic location, and team structures. RESULTS Trust between SLPs and laryngologists is comprised of confidence in (1) ability (clinical judgment, technical skill), (2) benevolence, and (3) integrity. Trust formation is enhanced by frequency and quality of communication, physical proximity, and reduction of practical barriers (scheduling, billing, departmental structure). Role negotiation was not identified as a factor. The presence of all three components of trust contributes to job satisfaction, perceptions of patient experience and care outcomes, and the willingness to collaborate in academic areas beyond clinical care. CONCLUSIONS All three elements (ability, benevolence, integrity) must be present for trust in an interprofessional relationship between SLPs and laryngologists, and formation of trust is facilitated by robust communication, physical proximity, and reduction of practical barriers to collaboration. The lack of these elements and lack of trust between the two professions can negatively impact collaboration, job satisfaction, and patient care outcomes, contributing to inefficiencies in patient care.
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Affiliation(s)
- Yena Kang
- University of Michigan Medical School, Ann Arbor, MI
| | - Janice Firn
- University of Michigan Medical School, Ann Arbor, MI; University of Michigan Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI; University of Michigan Department of Learning Health Sciences, Ann Arbor, MI
| | - Margaret Tiner
- Michigan Medicine Speech Language Pathology Program, Ann Arbor, MI
| | - Andrew Neevel
- University of Michigan Department of Otolaryngology, Ann Arbor, MI
| | - Norman D Hogikyan
- University of Michigan Medical School, Ann Arbor, MI; University of Michigan Department of Otolaryngology, Ann Arbor, MI; University of Michigan Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI.
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Grillo EU, Corej B, Wolfberg J. Normative Values of Client-Reported Outcome Measures and Self-Ratings of Six Voice Parameters via the VoiceEvalU8 App. J Voice 2024; 38:964.e17-964.e27. [PMID: 34895987 PMCID: PMC9177899 DOI: 10.1016/j.jvoice.2021.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Ecological momentary assessments (EMA) and interventions (EMI) have the potential to assess and offer interventions repeatedly within the client's daily life through mobile app technology. Considering the development of the EMA VoiceEvalU8, the current work provided normative data by comparing traditional (i.e., paper and pencil) and electronic (i.e., VoiceEvalU8 app) administration modalities of client-reported outcome measures and client self-ratings of six voice parameters twice a day in their functional environment. METHODS In Experiment 1, 50 vocally healthy cisgender women and men completed the Voice Handicap Index (VHI)-30, VHI-10, and Vocal Fatigue Index (VFI) with paper and pencil and the VoiceEvalU8 app. The order of administration modality and perceptual scales was randomized for each participant. In Experiment 2, 104 vocally healthy cisgender women and men used the VoiceEvalU8 app across five days in the morning before talking all day and in the evening after talking all day to self-rate six voice parameters (i.e., overall quality, roughness, breathiness, strain, pitch, and loudness) on a scale from 0 - 100. Mann Whitney U tests were run for all measures. Means and standard deviations are reported for descriptive analysis and normative values. RESULTS In Experiment 1, results showed no significant differences between paper and pencil and VoiceEValU8 app administration for the VHI-30, VHI-10, and VFI for vocally healthy adults. Normative values in the current study were consistent with previous literature for the VHI-10 and VFI factor 1 and 2, but slightly higher for the VHI-30 and slightly lower for the VFI factor 3. In Experiment 2, results demonstrated significant differences for all six voice parameters between the morning and evening log sessions. Normative values demonstrated higher self-ratings in the morning as compared to the evening. CONCLUSIONS For vocally healthy adults, completing the VHI-30, VHI-10, and VFI via paper and pencil and the VoiceEvalU8 app yielded the same results. Client self-ratings of six voice parameters on a scale from 0 - 100 twice a day demonstrated that vocally healthy adults perceived voice to be worse in the morning before talking all day as compared to the evening after talking all day. The results from the current work are promising for EMA via the VoiceEvalU8 app and support the need for continued investigations with clients with voice differences, problems, and/or disorders.
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Affiliation(s)
- Elizabeth U Grillo
- Department of Communication Sciences and Disorders, West Chester University, West Chester, Pennsylvania, USA.
| | - Brigit Corej
- Department of Communication Sciences and Disorders, West Chester University, West Chester, Pennsylvania, USA
| | - Jeremy Wolfberg
- Massachusetts General Hospital Institute of Health Professions, Speech-Language Pathology Master's Program, Boston, Massachusetts, USA
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Liu H, Hao G, Chen S, Ouyoung L, Liu Y, Li J, Duan H, Li Z, Liu Y, Zhong J, Liu B, Jiang J. Effectiveness and Feasibility of Telepractice on Voice Therapy for Female Teachers in Elementary Schools with Self-Reported Voice Disorders. J Voice 2024; 38:244.e1-244.e13. [PMID: 34583880 DOI: 10.1016/j.jvoice.2021.07.015] [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: 05/02/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study is to explore the effectiveness of telepractice in voice intervention for female teachers in elementary schools with self-reported voice disorders. METHODS Thirty-five female elementary school teachers with self-reported voice disorders volunteered to participate in the study. They were divided into a telepractice voice intervention group (experimental group N=18) and a face-to-face voice intervention group (control group N=17) based on their employment setting. The exact same treatment protocol was applied to both groups of subjects, except that the intervention group was seen through telepractice, and the control group was seen face-to-face. The treatment protocol includes vocal hygiene education and resonant voice therapy twice a week for a total of eight sessions. Auditory perceptual analysis, acoustic assessment, aerodynamic assessment and self-assessment protocol were conducted before the intervention and one week after the last intervention, and the differences before and after interventions within each group and between groups were compared. RESULTS There was no significant difference in baseline data including age, working years, and voice symptoms between the two groups. Both groups showed significant improvement (P<0.05) in all voice assessment before and after the treatment sessions, except for the Voice Handicap Index-10 (VHI-10) assessment. No statistical difference was found in other pre- and post-intervention voice assessment changes between the two study groups. The control group presented higher improvement in the total score, and the two subdomain assessments of physiology and emotion. CONCLUSIONS Telepractice voice intervention can effectively improve the voice quality of female teachers in elementary schools, and telepractice therapy can be an effective alternative to face-to-face voice intervention.
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Affiliation(s)
| | | | | | | | | | - Jinrang Li
- the Sixth Medical Center of PLA General Hospital
| | | | | | - Yang Liu
- The Sixth Medical Center of PLA General Hospital
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Anil Kumar Vaidhyam S, Huang KT. Social Determinants of Health and Patients' Technology Acceptance of Telehealth During the COVID-19 Pandemic: Pilot Survey. JMIR Hum Factors 2023; 10:e47982. [PMID: 37934556 PMCID: PMC10631497 DOI: 10.2196/47982] [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: 04/06/2023] [Revised: 09/05/2023] [Accepted: 09/23/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Telehealth has been widely adopted by patients during the COVID-19 pandemic. Many social determinants of health influence the adoption. OBJECTIVE This pilot study aimed to understand the social determinants of patients' adoption of telehealth in the context of the pandemic. METHODS A survey methodology was used to capture data from 215 participants using Amazon Mechanical Turk. The study was guided by the technology acceptance model and the social determinants of health framework. The questionnaire included technology acceptance model variables (eg, perceived usefulness [PU] and perceived ease of use [PEOU]), social determinants (eg, access to health care, socioeconomic status, education, and health literacy), and demographic information (eg, age, sex, race, and ethnicity). A series of ordinary least squares regressions were conducted to analyze the data using SPSS Statistics (IBM Corp). RESULTS The results showed that social determinant factors-safe neighborhood and built environment (P=.01) and economic stability (P=.05)-are predictors of the PEOU of telehealth adoption at a statistically significant or marginally statistically significant level. Furthermore, a moderated mediation model (PROCESS model 85) was used to analyze the effects of COVID-19 on the neighborhood, built environment, and economic stability. PEOU and PU significantly positively affected users' intention to use technology for both variables. CONCLUSIONS This study draws attention to 2 research frameworks that address unequal access to health technologies. It also adds empirical evidence to telehealth research on the adoption of patient technology. Finally, regarding practical implications, this study will provide government agencies, health care organizations, and health care companies with a better perspective of patients' digital health use. This will further guide them in designing better technology by considering factors such as social determinants of health.
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Affiliation(s)
- Sneha Anil Kumar Vaidhyam
- Department of Information Culture and Data Stewardship, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kuo-Ting Huang
- Department of Information Culture and Data Stewardship, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
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Guglani I, Sanskriti S, Joshi SH, Anjankar A. Speech-Language Therapy Through Telepractice During COVID-19 and Its Way Forward: A Scoping Review. Cureus 2023; 15:e44808. [PMID: 37809138 PMCID: PMC10560081 DOI: 10.7759/cureus.44808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
The overall burden of voice disorders is vast, and speech-language therapy has been in use for long to prevent, assess, diagnose, and treat different speech and language disorders. Due to the COVID-19 outbreak, these services are not readily accessible because of various precautionary measures that have been laid down by the government to check the blowout of infection; as a solution to this, there has been a rise in telepractice. The purpose of this review article is to study the usefulness of telepractice for speech-language therapy during the COVID-19 pandemic and its way forward. Search was performed in the PubMed database. A total of 102 articles were found, out of which 32 articles were included through a comprehensive inclusion and exclusion criteria. This study analyzes various papers on the use of telepractice during COVID-19 for speech-language therapy. The satisfaction was greater among women as compared to men because women could get the appointment done at home and they could easily manage their household chores. It has been recognized as an "attend anywhere" web-based platform that provides us with the 5 C's, namely, easy-to-access care, increased comfort, increased convenience, reduced cost, and higher confidentiality. Patients look for such sessions in the future, even when the pandemic is over. Telepractice has now been accepted as the new healthcare delivery model with multiple advantages and disadvantages. However, more research needs to be done on the moral and environmental aspects related to its use.
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Affiliation(s)
- Ishita Guglani
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sanskriti Sanskriti
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shiv H Joshi
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Anjankar
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Liu B, Hao G, Cui Y, Fang J, Ji M, Wu J, Jiang J, Shao J, Liu H. Introduction of Voice Type Component (VTC) as an Effective Acoustic Voice Analysis Method in Tele-evaluation. J Voice 2023:S0892-1997(23)00215-1. [PMID: 37544815 DOI: 10.1016/j.jvoice.2023.07.005] [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: 05/11/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Telepractice in voice health care and evaluation services has attracted much attention in recent years. Multiple studies have proven the effectiveness of voice therapy with telepractice. However, voice evaluations are still mostly conducted in person due to the lack of sensitive acoustic analysis methods. METHODS This study examined various acoustic analysis methods for voice evaluation in telepractice. Eighteen female elementary school teachers with self-reported voice disorders volunteered to participate in the study. Speech samples were collected before and after the interventions using two voice sampling methods concurrently. One set of data was collected using the traditional voice sample collection method by the therapist in person. The second set of data was collected on the same speech samples using the clients' own smartphones, and the collected voice samples were later sent to the researcher for further acoustic analysis. The voice type component (VTC) measurement represented the proportion of different VTCs in a voice by measuring the chaos and intrinsic dimension. RESULTS Voice analyses were conducted on both sets of data, and the correlation between the two sampling procedures was analyzed. It appears that the VTC could be a more reliable method for producing acoustic analysis results with voice samples collected from smartphones compared to other objective voice assessment procedures. This reliability has been demonstrated via statistical analysis, including correlation coefficient, pairwise t test, d-prime, and area under the curve. The results of this study highlighted the VTC as an effective and accurate acoustic analysis method in tele-evaluation. CONCLUSIONS This feasible voice sampling method, which utilizes participants' own smartphones, will reduce barriers to accessing limited voice specialists due to distance and will decrease the cost of care by minimizing expenses associated with travel and additional equipment for voice sampling. Ultimately, this approach will enhance the effectiveness of voice care delivered through telepractice to patients in remote and underserved areas.
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Affiliation(s)
- Boquan Liu
- School of Humanities, Shanghai Jiao Tong University, Shanghai, China
| | - Grace Hao
- Department of Communication Sciences and Disorders, North Carolina Central University, North Carolina, USA
| | - Ying Cui
- School of Journalism and Communication, Shanghai University of Sport, Shanghai, China
| | - Jin Fang
- School of Humanities, Shanghai Jiao Tong University, Shanghai, China
| | - Mingjun Ji
- School of Humanities, Shanghai Jiao Tong University, Shanghai, China
| | - Jianfeng Wu
- International Cultural Exchange School, Fudan University, Shanghai, China
| | - Jack Jiang
- Department of Surgery-Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA
| | - Jing Shao
- Department of English Language and Literature, Hong Kong Baptist University, Hong Kong, China
| | - Hengxin Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, Beijing, China
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8
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Gherson S, Tripp R, Goudelias D, Johnson AM. Rapid Implementation of Teletherapy for Voice Disorders: Challenges and Opportunities for Speech-Language Pathologists. J Voice 2023:S0892-1997(23)00206-0. [PMID: 37537109 DOI: 10.1016/j.jvoice.2023.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The COVID-19 pandemic necessitated a rapid restructuring of the clinical management of voice and upper airway disorders by speech-language pathologists (SLPs). As in-person therapy sessions were suspended, voice-specialized SLPs across healthcare settings shifted to online teletherapy. In this survey study, we queried voice therapists on their experiences with and opinions regarding the adoption of teletherapy into routine clinical practice. METHODS Voice-specialized SLPs were recruited nationwide to complete an online survey which included questions about the usability of software and hardware, patient management, the effectiveness of therapy, overall satisfaction, and suggestions for improvement. RESULTS 48 participants completed the survey. The majority of respondents reported frequent technical difficulties and poor access to or understanding of appropriate equipment. Overall, participants endorsed better patient access, attendance, and compliance, as well as increased scheduling flexibility. While 95% of the respondents stated they would recommend teletherapy to another SLP, only 20% supported a shift to exclusively virtual sessions. Forty percent of respondents endorsed a hybrid model consisting of initial in-person sessions followed by virtual ones. DISCUSSION Incorporating teletherapy into clinical voice practice has, for the most part, followed Carl May's normalization process theory framework, in that clinicians have invested understanding, training, time and effort, and appraisal into its implementation. However, the unusually rapid pace of change necessitated by the pandemic has presented its own set of challenges. Given the inherent conveniences of virtual therapy, the online modality is likely here to stay. It is critical that we understand the facilitators and barriers to its successful adoption.
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Affiliation(s)
- Shirley Gherson
- Department of Otolaryngology, New York University Grossman School of Medicine, New York, NY
| | - Raquel Tripp
- Department of Communicative Sciences and Disorders, New York University, New York, NY
| | - Deanna Goudelias
- Department of Communicative Sciences and Disorders, New York University, New York, NY
| | - Aaron M Johnson
- Department of Otolaryngology, New York University Grossman School of Medicine, New York, NY.
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9
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Song X, Liu X, Dong R, Kummer KA, Wang C. Implementation of Tele-Intensive Care Unit Services During the COVID-19 Pandemic: A Systematic Literature Review and Updated Experience from Shandong Province. Telemed J E Health 2023; 29:646-656. [PMID: 36251955 DOI: 10.1089/tmj.2022.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Background: While the use of telemedicine had been expanding before the initial outbreak of COVID-19, the pandemic has dramatically accelerated its implementation and expanded its usage in many hospitals. Tele-intensive care unit (ICU) is a specialized type of telemedicine that adapts available technologies to the unique needs of critically ill patients. We published an editorial in 2020 describing our initial experiences of Tele-ICU application in Shandong Province. Here, we update our insights gained over the past 2 years, and we provide a systematic review of the literature to compare our perspectives with those from other institutions. Methods: We performed a systematic literature review of publications describing the use of telemedicine in an ICU setting during COVID-19. The PubMed database was searched for studies published after January 1, 2020, which offered detailed descriptions of tele-ICU usage. Extracted data included details regarding tele-ICU technologies, descriptions of the institution, usage cases, assessments of tele-ICU effectiveness, and site-reported opinions (e.g., advantages, disadvantages). Results: We screened 162 studies resulting from the PubMed literature search, along with one expert recommendation. Of the 112 full-text articles retrieved, 11 were selected for inclusion in this qualitative summary. All were retrospective descriptions of tele-ICU experiences at a single site. Some pairs of included articles reported results from the same institution, with seven unique sites being described. Three sites employed centralized models of tele-ICU, while four allowed staff to participate from distant locations. Five sites collected user-reported feedback regarding tele-ICU. While the advantages and disadvantages described rarely overlapped directly between sites, many reported positive opinions of tele-ICU use overall. Conclusions: The potential applications of tele-ICU technologies vary widely, making them highly adaptable to the needs of individual institutions. Tele-ICU has proven invaluable to some hospitals during COVID-19 due to its effectiveness at aiding patient care while mitigating risk to health care workers.
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Affiliation(s)
- Xuan Song
- ICU, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | | | | | | | - Chunting Wang
- ICU, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
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10
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Liu AQ, Ji Y, Hu A. Do patients regret having in-office vocal fold injections for glottic insufficiency? J Otolaryngol Head Neck Surg 2023; 52:33. [PMID: 37098608 PMCID: PMC10129306 DOI: 10.1186/s40463-023-00643-8] [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: 08/25/2021] [Accepted: 04/15/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND In-office vocal fold injections (VFI) are an effective treatment for glottic insufficiency. The primary objective of this study was to assess if patients reported decisional regret after VFI. Secondary objectives included determining if variables were associated with lower decisional regret. METHODS Case-control study of patients who underwent in-office VFIs for glottic insufficiency from August 2017 to December 2019 at a tertiary laryngology clinic. Participants completed the validated Decision Regret Scale (DRS). Demographic data, clinician's perceptual analysis with GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain), and patient's self-reported Voice Handicap Index-10 (VHI-10) were analyzed. Nonparametric tests as well as univariate and multiple logistics regression were performed. RESULTS Of patients eligible, 75% (136/182) completed the DRS (mean age 65.4 years (SD 13.9), 58.1% male). Eighty-three (61.0%) reported no decisional regret, thirty-three (24.3%) reported mild decisional regret, and twenty (14.7%) reported moderate to strong decisional regret. Improvement in most recent VHI-10 (Kendall correlation coefficient tau = 0.156, p = 0.029), Grade of voice (tau = 0.236, p value = 0.002) and Breathiness of voice (tau = 0.150, p = 0.044) were associated with lower DRS. Multivariate logistics regression results showed that the change in Grade of voice (OR 9.9, p < 0.01), Roughness (OR 0.2, p < 0.01) and Breathiness (OR 0.2, p < 0.03) were significantly associated with DRS. CONCLUSION The majority of patients had no or mild decisional regret after in-office VFI for glottic insufficiency. Both patients who reported less vocal handicap after VFI and clinician-noted improvements in perceptual evaluation of voice after VFI were associated with significantly lower decisional regret.
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Affiliation(s)
- Alice Q Liu
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Yunqi Ji
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Amanda Hu
- Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
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11
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Flock L, King SR, Williams J, Finlay E, Smikle H, Benito M, Benton-Stace F, Brown J, Mann-Daraz AJ, Hart L, Mclean K, Prucnal Z, Barry L, Lynes R, Toy M, Valentine K, Slattery S, Aldridge-Waddon L. Working Together to Find a Voice: Recommendations for Voice Healthcare Based on Expert-By-Experience and Practitioner Consensus. J Voice 2023:S0892-1997(23)00083-8. [PMID: 36959052 DOI: 10.1016/j.jvoice.2023.02.023] [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: 01/31/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVES Voice care services aim to provide effective and meaningful voice care. Current practice guidance recommends a multidisciplinary voice care approach, supported by the evidence-base and practitioner experience. However, unlike other areas of physical and mental health, current voice care guidance does not explicitly include the voices of experts-by-experience, meaning those who have lived experience of voice difficulties. The perspectives of those working within nonclinical voice professions, such as vocal coaches, are also often omitted. There is therefore a need for updated practice guidance which prioritizes expert-by-experience and nonclinical perspectives. METHODS Vocal Health Education hosted a consensus meeting in London, UK. The meeting was coproduced with experts-by-experience, and attendees included those with lived experience of voice difficulties and practitioners across a range of disciplines within voice care. The content of the meeting was synthesized into themes and associated recommendations were drafted and agreed to by all attendees. RESULTS The consensus statement offers practical advice to those working in voice care. Recommendations are offered for multidisciplinary and biopsychosocial voice care, with a focus on person-centered practice and the valuing of lived experience. Through discussion, consensus was reached regarding recommendations for voice care assessment and treatment, practitioner approach, psychosocial considerations, and service design. The need for greater expert-by-experience involvement, coproduction, and co-construction was emphasized throughout. CONCLUSIONS This report emphasizes the voices of those with lived experience. It highlights ways of updating or improving current care, with the aim of informing clinical practice as well as research and service development. The consensus statement is the first in voice care to include experts-by-experience at the center of its recommendations, underlining the need for more coproduced and co-constructed research and practice within voice healthcare.
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Affiliation(s)
- Lydia Flock
- Vocal Manual Therapy, Oxford Vocal Massage, Oxford, UK; Voice Care Centre, Voice Care Centre, London, UK
| | - Stephen R King
- Voice Care Centre, Voice Care Centre, London, UK; Vocal Health Education, Vocal Health Education, London, UK
| | - Jenevora Williams
- Voice Care Centre, Voice Care Centre, London, UK; Vocal Health Education, Vocal Health Education, London, UK
| | - Emma Finlay
- Independent Researcher, VHE Meeting, London, UK
| | - Hannah Smikle
- Vocal Coaching, Hannah Smikle-Vocal Performance Coaching, Stockport, UK
| | | | | | - Jenna Brown
- Voice Study Centre, Voice Study Centre, Suffolk, UK
| | | | - Lydia Hart
- Voice Care Centre, Voice Care Centre, London, UK; Speech and Language Therapy, Frimley Health NHS Foundation Trust, Berkshire, UK
| | - Keesha Mclean
- Cairns Voice Studio and Cairns Voice Care, Cairns Voice Studio and Cairns Voice Care, Cairns, Australia
| | | | | | | | - Mel Toy
- Mel Toy Music, Mel Toy Music, London, UK
| | - Kate Valentine
- Voice Care Centre, Voice Care Centre, London, UK; Valentine Voice Care, Valentine Voice Care, Seaford/Glasgow/London, UK
| | - Sam Slattery
- Grace Bay Medical, Grace Bay Medical, Grace Bay, Turks and Caicos Islands
| | - Luke Aldridge-Waddon
- Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford, UK.
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12
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Quar TK, Rashid MFN, Rosdi MYM, Ishak WS, Chong FY. Impact of the COVID-19 Pandemic on Individuals With Hearing Loss and Audiology Practice in a Developing Country. Am J Audiol 2023; 32:59-69. [PMID: 36446036 DOI: 10.1044/2022_aja-22-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to determine the challenges faced by individuals with hearing loss at a time when many nations were attempting to move from the COVID-19 pandemic to endemic. DESIGN A cross-sectional survey was conducted on Malaysian adults with hearing loss to determine the impact of the COVID-19 crisis on hearing aid management, communication difficulties, psychosocial challenges, and access to audiological services. STUDY SAMPLE One hundred forty-six individuals aged 18 years old and above with hearing loss were recruited from hearing health care centers to participate in the survey. RESULTS Many of the participants (54.2%) reported significant difficulties communicating with people wearing face masks. For hearing aid management, repairing (36.3%) and fine-tuning devices (30.2%) were considered more challenging than obtaining a battery (21.3%). The COVID-19 pandemic had a serious psychosocial impact on a small portion of the individuals surveyed. Remote services were rarely offered by the audiologists, and most participants preferred in-person treatment. However, the majority perceived that creating awareness and training on telehealth was important. CONCLUSIONS Effective management for people with hearing loss needs to consider the challenges faced by them, as the world prepares to live with the coronavirus. Clinical protocols should consider providing a service that is helpful for the clients as well as safe and sustainable in future pandemics.
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Affiliation(s)
- Tian Kar Quar
- Audiology Programme, Center for Rehabilitation & Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Bangi
| | | | - Muhd Yusran Mohd Rosdi
- Audiology Programme, Center for Rehabilitation & Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Bangi
| | - Wan Syafira Ishak
- Audiology Programme, Center for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Bangi
| | - Foong Yen Chong
- Audiology Programme, Center for Rehabilitation & Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Bangi
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13
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Tele-rehabilitation in voice disorders during the pandemic: a consensus paper from the French Society of Phoniatrics and Laryngology. Eur Arch Otorhinolaryngol 2022; 280:2411-2419. [PMID: 36525078 PMCID: PMC9756705 DOI: 10.1007/s00405-022-07779-9] [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: 09/20/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To establish a consensus protocol for telerehabilitation in speech therapy for voice disorders. METHODS The study was conducted according to a modified Delphi method. Twenty speech therapist or laryngologist experts of the French Society of Phoniatrics and Laryngology assessed 24 statements of voice telerehabilitation with a 10-point visual analog scale ranging from 1 (totally disagree) to 10 (totally agree). The statements were accepted if more than 80% of the experts rated the item with a score of ≥ 8/10. The statements with ≥ 8/10 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. RESULTS The French Society of Phoniatrics and Laryngology experts validated 10, 6, and 2 statements after the first, second and third voting round, respectively. Seven statements did not reach agreement threshold and were rejected. The validated statements included recommendations for setting (N = 4), medical/speech history (N = 2), subjective voice evaluations (N = 3), objective voice quality measurements (N = 3), and voice rehabilitation (N = 5). The experts agreed for a follow-up consisting of combined telerehabilitation and in-office rehabilitation. The final protocol may be applied in context of pandemic but could be assessed out of pandemic period for patients located in rural regions. CONCLUSIONS This Delphi study established the first telerehabilitation protocol of the French Society of Phoniatrics and Laryngology for patients with voice disorders. Future controlled studies are needed to assess its feasibility, reliability, and the patient perception about telerehabilitation versus in-office rehabilitation.
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14
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Campbell KR, Wilhelm JL, Pettigrew NC, Scanlan KT, Chesnutt JC, King LA. Implementation and Adoption of Telerehabilitation for Treating Mild Traumatic Brain Injury. J Neurol Phys Ther 2022; 46:E1-E10. [PMID: 35666882 DOI: 10.1097/npt.0000000000000409] [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: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Multimodal physical therapy for mild traumatic brain injury (mTBI) has been shown to improve recovery. Due to the coronavirus disease-2019 (COVID-19) pandemic, a clinical trial assessing the timing of multimodal intervention was adapted for telerehabilitation. This pilot study explored feasibility and adoption of an in-person rehabilitation program for subacute mTBI delivered through telerehabilitation. METHODS Fifty-six in-person participants-9 males; mean (SD) age 34.3 (12.2); 67 (31) days post-injury-and 17 telerehabilitation participants-8 males; age 38.3 (12.7); 61 (37) days post-injury-with subacute mTBI (between 2 and 12 weeks from injury) were enrolled. Intervention included 8, 60-minute visits over 6 weeks and included subcategories that targeted cervical spine, cardiovascular, static balance, and dynamic balance impairments. Telerehabilitation was modified to be safely performed at home with minimal equipment. Outcome measures included feasibility (the number that withdrew from the study, session attendance, home exercise program adherence, adverse events, telerehabilitation satisfaction, and progression of exercises performed), and changes in mTBI symptoms pre- and post-rehabilitation were estimated with Hedges' g effect sizes. RESULTS In-person and telerehabilitation had a similar study withdrawal rate (13% vs 12%), high session attendance (92% vs 97%), and no adverse events. The telerehabilitation group found the program easy to use (4.2/5), were satisfied with care (4.7/5), and thought it helped recovery (4.7/5). The telerehabilitation intervention was adapted by removing manual therapy and cardiovascular portions and decreasing dynamic balance exercises compared with the in-person group. The in-person group had a large effect size (-0.94) in decreases in symptoms following rehabilitation, while the telerehabilitation group had a moderate effect size (-0.73). DISCUSSION AND CONCLUSIONS Telerehabilitation may be feasible for subacute mTBI. Limited ability to address cervical spine, cardiovascular, and dynamic balance domains along with underdosage of exercise progression may explain group differences in symptom resolution.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A392 ).
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Affiliation(s)
- Kody R Campbell
- Departments of Neurology (K.R.C., J.L.W., N.C.P., K.T.S., L.A.K.) and Family Medicine, Neurology, and Orthopedics and Rehabilitation (J.C.C.), Oregon Health and Science University, Portland; Veterans Affairs Portland Health Care System, Portland, Oregon (K.R.C., J.L.W., N.C.P., K.T.S., J.C.C., L.A.K.); and Center for Regenerative Medicine, Oregon Health and Science University, Portland
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15
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Kim ME, Sund LT, Morton M, Kim J, Choi JS, Castro ME. Provider and Patient Satisfaction with Telemedicine Voice Therapy During the COVID-19 Pandemic. J Voice 2022:S0892-1997(22)00211-9. [PMID: 36038478 PMCID: PMC9289043 DOI: 10.1016/j.jvoice.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The COVID-19 pandemic expanded the use of telemedicine, but there is no literature exploring both patient and provider satisfaction specifically in the provision of voice therapy. This study aims to investigate patient and provider satisfaction with virtual voice therapy, its associated factors, and any correlation between the two. METHODS Cross-sectional study. Participants included 226 adults who underwent voice therapy delivered via telepractice at the USC Voice Center between April and October 2020. Patients and providers self-reported their level of satisfaction on a visual analog scale (VAS; range 0-100). Patient satisfaction was additionally measured using a previously validated Telemedicine Satisfaction Questionnaire (TSQ; range 1-5), and a binary question about their desire to choose telemedicine over in-person therapy in the future. Three speech-language pathologists rated provider satisfaction for all 226 patients. Patient satisfaction survey was completed by 55 patients. Multivariable linear regression analyses and linear mixed-effects models were used to assess the results. RESULTS Patient and provider mean (SD) VAS satisfaction scores were 86.8 (18.6) and 80.6 (19.7), respectively. The mean (SD) TSQ score was 4.4 (0.6). In a multivariable model, patient satisfaction levels were significantly higher for hypofunctional than for hyperfunctional dysphonia diagnoses. Forty-four (73%) patients reported they would prefer telemedicine voice therapy over in-person appointments, which was significantly correlated with internet reliability (P = 0.04). For providers, satisfaction was significantly lower for patients whose diagnosis had changed after initiation of voice therapy (Δ = -16.0 [95% CI: -28.7 to -3.2]) and for encounters with Asian patients compared to White patients (Δ = -11.6 [95% CI: -18.9 to -4.2]). Patient and provider satisfaction scores were weakly correlated (r = 0.19). CONCLUSIONS Our findings suggest that virtual voice therapy is not simply an alternative to in-person service, but rather an effective method useful beyond the current pandemic with proper diagnosis and technical support.
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Affiliation(s)
- Mary E Kim
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, University of Southern California Caruso, Los Angeles, California.
| | - Lauren Timmons Sund
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, University of Southern California Caruso, Los Angeles, California
| | - Mariah Morton
- Auburn University School of Kinesiology, Auburn, Albama
| | - James Kim
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, University of Southern California Caruso, Los Angeles, California
| | - Janet S Choi
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota
| | - M Eugenia Castro
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, University of Southern California Caruso, Los Angeles, California
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16
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Gray R, Michael D, Hoffmeister J, Lunos S, Zach S, Butcher L, Weinstein D, Misono S. Patient Satisfaction with Virtual vs In-Person Voice Therapy. J Voice 2022:S0892-1997(22)00081-9. [PMID: 35410780 DOI: 10.1016/j.jvoice.2022.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether there is a difference in patient satisfaction between in-person and virtual voice therapy. METHODS Patient satisfaction answers to the National Research Corporation (NRC) Health patient survey were retrieved for two separate 11 month periods. The first was for an in-person cohort, from April 2019 to February 2020. The second was for a virtual cohort between April 2020 and February 2021. Two group t tests or Wilcoxon rank sum tests were used to compare responses between the in-person and virtual cohorts. The effect of modality of therapy by gender, age, and race was examined by testing interactions with separate ANOVA models. RESULTS Responses were compared between 224 patient satisfaction surveys for the virtual cohort and 309 patient satisfaction surveys for the in-person cohort. Overall, responses were highly favorable in all categories. There were no differences between the in-person and virtual cohorts' responses with respect to three main categories: likelihood of future referral of clinic or provider; communication with provider; and comprehension of the treatment plan. The interaction between modality of therapy delivery and age was significant for the question, "Did you know what to do after your visit," with 18-44 year olds in the in-person group reporting a better understanding of the treatment plan compared to the 18-44 year olds in the virtual therapy cohort (P = 0.004). There were no interactions between modality of therapy and gender, or race. CONCLUSION Virtual delivery of voice therapy was associated with comparable visit satisfaction scores to in-person delivery, with both delivery modalities demonstrating very high satisfaction. Future studies are needed to identify which patients and conditions are most suited for virtual versus in-person delivery of speech-language pathology services in voice clinics.
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Affiliation(s)
- Raluca Gray
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota.
| | - Deirdre Michael
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Jesse Hoffmeister
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Scott Lunos
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Sarah Zach
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Lisa Butcher
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Dan Weinstein
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
| | - Stephanie Misono
- Department of Otolaryngology, Lions Voice Clinic, University of Minnesota, Minneapolis, Minnesota
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17
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Reverberi C, Gottardo G, Battel I, Castagnetti E. The neurogenic dysphagia management via telemedicine: a systematic review. Eur J Phys Rehabil Med 2022; 58:179-189. [PMID: 34605620 PMCID: PMC9980496 DOI: 10.23736/s1973-9087.21.06921-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Telerehabilitation is the provision of rehabilitation remotely through Information and Communication Technologies (ICT). Recently, there has been an increase of interest in its application thanks to increasing a new technology. The aim of this systematic review was to examine the evidence of the literature regarding the management of neurogenic dysphagia via telerehabilitation, compared to face-to-face rehabilitation treatment. The secondary aim was to create recommendations on telerehabilitation sessions for patients diagnosed with neurogenic dysphagia. EVIDENCE ACQUISITION The databases were: Medline, Embase, CINAHL, Scopus. A total of 235 records emerged from bibliographic research, manual search of full text and from gray literature, published until January 2021. Two blinded authors carried out titles and abstract screening and followed by full-text analysis. Sixteen articles were included in the systematic review and assessed through critical appraisal tools. EVIDENCE SYNTHESIS The research shows that the majority of the studies on neurogenic dysphagia involved the Clinical Swallow Examination via telerehabilitation, compared with the in-person modality. Significant levels of agreement and high satisfaction from clinicians and patients are reported to support the use of telerehabilitation. Based on the results of this systematic review and qualitative analysis, the authors developed practical recommendations for the management of telerehabilitation sessions for patients with neurogenic dysphagia. CONCLUSIONS Despite the presence of barriers, telerehabilitation allowed healthcare provision and increasing access to care and services with specialized professionals, remote rehabilitation can be a valid resource during the health emergency due to COVID-19.
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Affiliation(s)
- Cristina Reverberi
- Department of Health Professions, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Irene Battel
- Department of Physical and Medical Rehabilitation, San Giovanni e Paolo Civil Hospital, Azienda ULSS3 Serenissima, Venice, Italy -
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18
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Shahrul AI, Abd Rahman ANA. Telemedicine as an Alternative Way to Provide Multidisciplinary Cleft Care During the COVID-19 Pandemic. Open Dent J 2021. [DOI: 10.2174/1874210602115010446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The current coronavirus pandemic is changing the way healthcare professionals provide services to patients. Healthcare professionals are required to provide quality care while reducing the risk of viral transmission. This pandemic has disrupted the timely multidisciplinary team care for patients with clefts across the globe. Thus, telemedicine has been recognized and accepted by various medical and dental specialists as a viable alternative to face-to-face consultation. In addition, telemedicine incorporating a digital workflow in cleft management will further reduce the risk of viral transmission and enhance the quality of treatment being provided to these patients.
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19
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Lohnberg JA, Salcido L, Frayne S, Mahtani N, Bates C, Hauser ME, Breland JY. Rapid conversion to virtual obesity care in COVID-19: Impact on patient care, interdisciplinary collaboration, and training. Obes Sci Pract 2021; 8:131-136. [PMID: 34540265 PMCID: PMC8441727 DOI: 10.1002/osp4.550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
Objective The COVID‐19 pandemic presents challenges to maintaining interdisciplinary collaboration while transitioning care to telehealth environments. This paper describes how an intensive weight management clinic rapidly transitioned from in‐person only to a telehealth environment. Method As a program evaluation project, changes to clinic procedures were tracked on a weekly basis. Patients were invited to complete phone surveys after clinic appointments from 1 May 2020 to 31 July 2020. The survey included 12 items rated on a 5‐point scale (“strongly disagree” to “strongly agree”). Results Adaptations included converting team meetings and clinical training to phone/video platforms and transferring a complex patient tracking system to an interactive virtual format. Fifty‐eight patients completed phone surveys (81% response rate). All “agreed” or “strongly agreed” that they were satisfied with telehealth care; 51% “agreed” or “strongly agreed” that telephone visits were as good as in‐person visits; and 53% preferred phone appointments even after pandemic restrictions are eased. Conclusions It is feasible to rapidly transition to a telehealth clinic when supported by infrastructure and resources of a national, integrated healthcare system. Patient preferences include access to both telehealth and in‐person services. A blended telehealth/in‐person model that maintains interdisciplinary collaboration and training is necessary even after the COVID‐19 pandemic.
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Affiliation(s)
- Jessica A Lohnberg
- Psychology Service Veterans Affairs Palo Alto Health Care System Palo Alto California USA.,Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford California USA
| | - Lianne Salcido
- Psychology Service Veterans Affairs Palo Alto Health Care System Palo Alto California USA
| | - Susan Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i) VA Palo Alto Health Care System Menlo Park California USA.,Division of Primary Care and Population Health Stanford University Stanford California USA
| | - Naina Mahtani
- Mental Health Service San Francisco VA Health Care System San Francisco California USA
| | - Cheryl Bates
- Medical Service Veterans Affairs Palo Alto Health Care System Palo Alto California USA
| | - Michelle E Hauser
- Division of Primary Care and Population Health Stanford University Stanford California USA.,Medical Service Veterans Affairs Palo Alto Health Care System Palo Alto California USA.,Minimally Invasive & Bariatric Surgery Division of General Surgery Department of Surgery Stanford University School of Medicine Stanford California USA.,Department of Medicine Adult Primary Care-Fair Oaks Health Center San Mateo County Health System Redwood City California USA
| | - Jessica Y Breland
- Department of Psychiatry & Behavioral Sciences Stanford University School of Medicine Stanford California USA.,VA HSR&D Center for Innovation to Implementation (Ci2i) VA Palo Alto Health Care System Menlo Park California USA
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20
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Becker DR, Gillespie AI. In the Zoom Where It Happened: Telepractice and the Voice Clinic in 2020. Semin Speech Lang 2021; 42:64-72. [PMID: 33596605 DOI: 10.1055/s-0040-1722750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Telemedicine-conveying medical information virtually for planning, diagnosis, or treatment-has been a part of the American medical system for over 100 years. A constantly evolving modality, telepractice was a supplemental care delivery system for most speech-language pathologists (SLPs) until March 2020 when the COVID-19 pandemic forced clinical operations to halt in-person activities and convert as much as possible to virtual platforms. The purpose of this article is to provide an overview of the need for telepractice prior to and beyond the current pandemic, the efficacy of telepractice for the voice-specialized SLP, limitations of telepractice, and best practices for providing care over telepractice with a specific focus on voice disorder diagnosis and treatment.
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Affiliation(s)
- Diana Rose Becker
- Emory Voice Center, Department of Otolaryngology, Emory Healthcare, Emory University Hospital Midtown, Atlanta, Georgia
| | - Amanda I Gillespie
- Emory Voice Center, Department of Otolaryngology, Emory Healthcare, Emory University Hospital Midtown, Atlanta, Georgia
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21
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Knickerbocker K, Bryan C, Ziegler A. Phonogenic Voice Problems among Speech-Language Pathologists in Synchronous Telepractice: An Overview and Recommendations. Semin Speech Lang 2021; 42:73-84. [PMID: 33596606 DOI: 10.1055/s-0040-1722754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Many speech-language pathologists (SLPs) recently adopted a live, synchronous online distribution of clinical services due to physical distancing measures aimed at bringing the coronavirus disease 2019 (COVID-19) outbreak under control. Few SLPs had received training in telepractice to prepare them for changes from an in-person service delivery model to synchronous telepractice. The new telepractice environment may alter vocal behaviors and communication interactions in such a way that negatively impacts voice production. Thus, delivering synchronous online clinical services may require that SLPs adopt novel prevention strategies for avoiding phonogenic voice problems. Guided by two complementary injury frameworks, the Haddon Matrix and the Haddon Countermeasures, this article provides an overview of potential factors associated with phonogenic voice problems among SLPs in telepractice and proposes possible prevention strategies to maintain optimal vocal health and function with synchronous modes of online clinical practice.
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Affiliation(s)
| | | | - Aaron Ziegler
- The Wellness Group for Voice, Speech, and Swallowing, LLC
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22
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Lechien JR, Radulesco T, Distinguin L, Chekkoury-Idrissi Y, Circiu MP, Afia FE, Michel J, Papon JF, Hans S. Patient and otolaryngologist perceptions of telemedicine during COVID-19 pandemic. Eur Arch Otorhinolaryngol 2021; 278:4101-4105. [PMID: 33523283 PMCID: PMC7848874 DOI: 10.1007/s00405-021-06624-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
Background The rapid spread of the coronavirus disease 2019 and the implementation of quarantine in many European countries led to a swift change in health care delivery. Telemedicine was implemented in many otolaryngological departments to ensure the continuous care. The purpose of this study is to report our experience about telemedicine in 86 patients consulting virtually in our departments. Methods A total of 86 patients benefited from telemedicine consultation from April to Mai May 2020. Patients and physicians were invited to fulfill a satisfaction survey over the 3 days after the consultation. Results Patients consulted in the following fields: laryngology, voice and swallowing (N=15; 17.4%), head and neck or plastic surgery (N=34; 39.5%), rhinology (N=31; 36.1%) and otology (N=6; 7.0%). Practitioners estimated that the clinical examination would not have changed the consultation issue in 73.2% of cases. The realization of delayed clinical examination was rapidly necessary in 9.3% of cases and useless in 33.7% of cases. Five percent of patients estimated that the consultation did not bring reliable conclusion. Although the majority of patient (87.7%) would recommend telemedicine consultation to friend/family in the context of pandemic, only 44.6% would accept to replace office- consultation by telemedicine consultation outside the pandemic. Conclusion Telemedicine appears to be an interesting alternative approach in situation of pandemic and lock-down. Because the patient motivation to further participate to telemedicine appears to be conditioned by the context, efforts are still required to understand the patient perception, satisfaction and fears in view of future implementation outside pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06624-9.
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Affiliation(s)
- Jérôme R Lechien
- COVID-19 task force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France. .,Department of Human Anatomy and Experimental Oncology, School of Medicine, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium. .,Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Thomas Radulesco
- COVID-19 task force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology-Head & Neck Surgery, AP-HM, La Conception Hospital, Marseille, France
| | - Lea Distinguin
- COVID-19 task force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Younes Chekkoury-Idrissi
- COVID-19 task force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Marta P Circiu
- COVID-19 task force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Fahd El Afia
- COVID-19 task force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Justin Michel
- Department of Otorhinolaryngology-Head & Neck Surgery, AP-HM, La Conception Hospital, Marseille, France
| | - Jean-François Papon
- Department of Otorhinolaryngology-Head & Neck Surgery, Le Kremlin-Bicêtre Hospital, APHP, Paris Saclay University, Paris, France
| | - Stephane Hans
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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23
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Doll EJ, Braden MN, Thibeault SL. COVID-19 and Speech-Language Pathology Clinical Practice of Voice and Upper Airway Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:63-74. [PMID: 33332145 PMCID: PMC8740584 DOI: 10.1044/2020_ajslp-20-00228] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/20/2020] [Accepted: 10/14/2020] [Indexed: 05/31/2023]
Abstract
Purpose Evaluation and management of voice and upper airway disorders in adults and children, by speech-language pathologists worldwide, have been significantly altered by the COVID-19 pandemic. Secondary to the pathogenic nature of the virus in the respiratory tract and upper airway, it is essential that speech-language pathologists who specialize in these disorders are knowledgeable of current practices to provide evidence-based care while minimizing viral transmission. Understanding how and when SARS-CoV-2 spreads is critical to the development of effective infection prevention within clinical practices. Method We established an evidence-based clinical practice guide for clinicians working with voice and upper airway through a comprehensive evaluation of peer-reviewed journals, non-peer-reviewed manuscripts on preprint servers, national health guidelines, and published and online consensus statements and emerging data. Emphasis was placed on risk mitigation for viral transmission via safe clinical practices, including evaluative procedures, therapy including telehealth, personal protective equipment, room, staffing, and distancing considerations. Results/Conclusions While knowledge relevant to viral transmission of SARS-CoV-2 is rapidly evolving, there is a paucity of literature specific to the evaluation and treatment of voice and upper airway disorders. Within these confines and given the potentially significant high risk of infection secondary to the nature of COVID-19, we summarize current considerations and recommend best practices that maximize risk mitigation whereby ensuring patient and provider safety.
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Rule DW, Karia MK. Speech-Language Pathology and Audiology Care in the COVID-19 Era: Shared Experiences. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-20-00183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose
The COVID-19 pandemic has rapidly altered the global health-care system and stretched scarce resources to the limit. Resource limitations include personal protective equipment and medical devices; however, limited resources also include the more valuable health-care professional. Recent focus has been on the acute management of COVID-19. Still, there is a need to focus on the long-term rehabilitation of patients moving out of the acute treatment phase and into survivorship due to chronic respiratory concerns and other COVID-19 complications. Multidisciplinary, collaborative teams will support positive outcomes. Thus, speech-language pathologists too must carefully consider their role in patient care during a global pandemic. What makes the COVID-19 pandemic unique is the rapid minimally mitigated spread of the disease from close contact to most regions of the world. However, what appears to be true is a collective experience and common bond across regional borders.
Conclusions
Perhaps, this global pandemic may lead to a global partnership, a shared experience, and mutually dependent relationships. Global health is no longer “international service” or something that happens “over there”; global health is our reality.
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Affiliation(s)
- David W. Rule
- Department of Otolaryngology, College of Medicine, University of Cincinnati, OH
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Naunheim MR, Zhou AS, Puka E, Franco RA, Carroll TL, Teng SE, Mallur PS, Song PC. Laryngeal complications of COVID-19. Laryngoscope Investig Otolaryngol 2020; 5:1117-1124. [PMID: 33364402 PMCID: PMC7752067 DOI: 10.1002/lio2.484] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe and visually depict laryngeal complications in patients recovering from coronavirus disease 2019 (COVID-19) infection along with associated patient characteristics. STUDY DESIGN Prospective patient series. SETTING Tertiary laryngology care centers. SUBJECTS AND METHODS Twenty consecutive patients aged 18 years or older presenting with laryngological complaints following recent COVID-19 infection were included. Patient demographics, comorbid medical conditions, COVID-19 diagnosis dates, symptoms, intubation, and tracheostomy status, along with subsequent laryngological symptoms related to voice, airway, and swallowing were collected. Findings on laryngoscopy and stroboscopy were included, if performed. RESULTS Of the 20 patients enrolled, 65% had been intubated for an average duration of 21.8 days and 69.2% requiring prone-position mechanical ventilation. Voice-related complaints were the most common presenting symptom, followed by those related to swallowing and breathing. All patients who underwent flexible laryngoscopy demonstrated laryngeal abnormalities, most frequently in the glottis (93.8%), and those who underwent stroboscopy had abnormalities in mucosal wave (87.5%), periodicity (75%), closure (50%), and symmetry (50%). Unilateral vocal fold immobility was the most common diagnosis (40%), along with posterior glottic (15%) and subglottic (10%) stenoses. 45% of patients underwent further procedural intervention in the operating room or office. Many findings were suggestive of intubation-related injury. CONCLUSION Prolonged intubation with prone-positioning commonly employed in COVID-19 respiratory failure can lead to significant laryngeal complications with associated difficulties in voice, airway, and swallowing. The high percentage of glottic injuries underscores the importance of stroboscopic examination. Otolaryngologists must be prepared to manage these complications in patients recovering from COVID-19. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthew R. Naunheim
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Allen S. Zhou
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Elefteria Puka
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Ramon A. Franco
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Thomas L. Carroll
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Division of OtolaryngologyBrigham and Womens HospitalBostonMAUSA
| | - Stephanie E. Teng
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Division of OtolaryngologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Pavan S. Mallur
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Division of OtolaryngologyBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Phillip C. Song
- Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of Otolaryngology—Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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