Background: The perceptual assessment is generally performed by the voice specialist. The objective evaluation is performed in a voice laboratory. Research in voice laboratories has generated a variety of different objective tests and parameters. The perceptual evaluation is one of the most controversial topics in voice research. Review of literature reveals a wide variety of rating scales and reliability data fluctuating from study to study. Unfortunately, there is no widely accepted valid method for classifying voice disorders and assessing outcome after voice treatment. Objectives: The goals of this research were to identify important objective acoustic parameters of vocal quality, and to establish an objective and quantitative correlate of the perceived vocal quality. Materials and Methods : We evaluated the voice analyzed data from 122 dysphonic patients and 20 normal volunteers. A computerized speech lab. 4300B(CSL) was used to carry out the analysis of each voice sample. Results: Three dysphonia severity indices(DSI) were created using discriminant analysis. DSI is based on the weighted combination of the following selected set of acoustic parameters: absolute jitter(Jita in us), smoothed pitch period perturbation (sPPQ in %), amplitude perturbation quotient(APQ in %), soft phonation index(SPI), average fundamental frequency(Fo in Hz), lowest fundamental frequency(Flo in Hz), and smoothed amplitude perturbation quotient(sAPQ in %). The DSI, being the discriminating rule calculated by the logistic regression, consists of three equation based on statistically significant acoustic parameters. Three DSI were created to reflects best the degree of hoarseness as expressed by G from the GRBAS scale. The more positive this DSI is for a patient, the worse the vocal quality. The more it is negative, the better it is. The effect of sex is included implicitly in the DSI-1 and DSI-2, so that a separate DSI-1 and DSI-2 for males and females need not be used. The DSI is objective because no perceptual input is required for its calculation. Conculsion : This research demonstrates that the voice function values calculated from three different multivariate objective dysphonia severity indices are significantly associated with subjective voice assessments. These multivariate objective dysphonia severity indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.
Choi, Seong-Hee;Jiang, Jack J.;Yun, Bo-Ram;Lee, Ji-Yeoun;Lim, Sung-Eun;Choi, Hong-Shik
말소리와 음성과학
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제2권3호
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pp.157-164
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2010
This study investigated the characteristics of two aerodynamic indices, PTP (Phonation threshold pressure) and PTF (Phonation threshold flow) in patients with ADSD (adductor spasmodic dysphonia) and to see if two new aerodynamic indices can differentiate between normal and ADSD group. Additionally, PTP and PTF values were compared in terms of overall severity of ADSD in the patient group. The severity of ADSD was rated on a 7-point rating scale by two experienced speech language pathologists. The Kay Elemetrics Phonatory Aerodynamic System (PAS) (Kay Elemetrics Corp., Lincoln Park, NJ) was used to collect PTP and PTF measurements from 16 female normal subjects, 31 female patients with ADSD. Significantly lower PTF values (P< 0.05) were observed in ADSD when compared to those of normal control. Also, significantly lower PTF values in severe ADSD patients (P<.001). However, PTP could not distinguish patients with ADSD from control groups (P=0.119) and among the ADSD groups according to the severity (P=0.177). Consequently, PTF was more sensitive than PTP which might differentiate between normal speakers and ADSD and among different levels of severity within ADSD, suggesting that PTF could be a useful diagnostic parameter to measure the aerodynamic function of ADSD and provide the neurolaryngeal dysfunction in patients with ADSD.
Subjective scoring by different groups on different status of morbidity are compared to objective data obtained from legal awards. A power law is tested between subjective and objective scores. Regression analysis by means of a power function provides a measure of consistency in its regression coefficient. Power functions fitting also leads to a justified use of geometric averaging of individual scores into group scores.
44 Temporomandibular Disorders(TMDs) patients with non-trauma and non-iatrogenic origin pressented at Wonkwang University Dental Hospital. They were grouped into experimental subjects and 85 persons without TMSDs were classified into control groups. The objectives of this study was to investigate the effects of recent life changes on the symptom severity and treatment course of TMDs. For that purpose, the author used several scales and indices, namely, Social Readjustment Rating Scale(SRRS) devised by Holmes and Rahe, SRRS-Korean revision by Hong and Jeong, Helkimos Anamnestic index, Clinical Dysfunction index, and Visual Analogue Scale treatment index(VAS Ti) transformed from VAS by the author. Data resulted from the investigation were collected by scale or index and processed with SPSS. The obtained results were as follows : 1. Life change units(LCU) and values of indices of experimental group were higher than those of control group. 2. Life change units recorded with SRRS-Korean revision were higher than those with original SRRS in all cases and significant positive correlations existed, between he two Therefore, clinical use of original SRRS in Korea is reliable and valid. 3. In experimental group, LCU were positively correlated with Helkimos Clinical Dysfunction index and VAS treatment index, but in control group LCU were not correlated with any items. From this, increase of life changes in patient with TMDs is likely to aggravate TMJ dysfunction and more likely to complicate treatment course.
Purpose: This hospital has operated a trauma system of the inclusive trauma system under the sponsorship of this hospital and with financial support from the government from 2011, and it has been designated as a specialized trauma center (candidate) since November 2008. Therefore, this emergency medical center evaluated the influence of the inclusive trauma system on the course of healing and on the results for trauma patients within the region. Methods: The medical records of all patients who were registered as trauma patients from among those who visited the emergency medical center of this hospital from April 2009 to May 2012 were retrospectively reviewed. The monthly and the annual averages of important indices, such as the time in the emergency room and preventable mortalities, were calculated, and patterns of change were sought. The preventable mortality rate was calculated by using the Trauma Injury Severity Score (TRISS) for each patient. Results: The total number of patients registered from April 2009 to May 2012 was 601, and male patients accounted for a larger proportion(432 males(71.88%) vs. 169 females(28.12%)). Their average age was 46.2 years, the average Revised Trauma Score (RTS) was 5.74 points, and the average Injury Severity Score (ISS) was 26.99 points. The preventable mortality rate during the entire period, which was calculated using the TRISS, appeared lower than the preventable mortality rates reported in past studies in the Republic of Korea. Conclusion: These results for the operation of a new trauma system are limited in that they are only for a local private university hospital. However, results show greater changes and developments in and out of the hospital due to multilateral endeavors by the trauma team and the hospital. These endeavors include increased communications among the departments and development of a complementary patient registration system.
Takuya Hino;Kyung Soo Lee;Joungho Han;Akinori Hata;Kousei Ishigami;Hiroto Hatabu
Korean Journal of Radiology
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제22권5호
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pp.811-828
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2021
Following the introduction of a novel pathological concept of usual interstitial pneumonia (UIP) by Liebow and Carrington in 1969, diffuse interstitial pneumonia has evolved into UIP, nonspecific interstitial pneumonia (NSIP), and interstitial lung abnormality (ILA); the histopathological and CT findings of these conditions reflect the required multidisciplinary team approach, involving pulmonologists, radiologists, and pathologists, for their diagnosis and management. Concomitantly, traction bronchiectasis and bronchiolectasis have been recognized as the most persistent and important indices of the severity and prognosis of fibrotic lung diseases. The traction bronchiectasis index (TBI) can stratify the prognoses of patients with ILAs. In this review, the evolutionary concepts of UIP, NSIP, and ILAs are summarized in tables and figures, with a demonstration of the correlation between CT findings and pathologic evaluation. The CT-based UIP score is being proposed to facilitate a better understanding of the spectrum of pulmonary fibrosis, from ILAs to UIP, with emphasis on traction bronchiectasis/bronchiolectasis.
Objectives : This study was designed to identify the possibility of aroma oils as the complementary medical goods specially for the effects of aromatheraphy on xerosis cutis. Materials and Methods : The participants were 23 adult patients and all participants of this study use aroma oils which is known to effect on xerosis cutis. The subjects consist of voluntary patients with xerosis cutis in Seong-So Hospital in Andong Kyoungbuk, Korea. From April 1st to April 30th, 2004 for 4 weeks, the subjects massaged aroma oils on itching parts or the whole body. Aroma oils were Lavender, Losemary, Jasmine and blended drop by drop per 10ml jojoba oil which used a carrier oil. Skin pH was measured with a skin pH meter(Model : HI98110, Se-Chang instruments, made in Portuga. After 4weeks using aroma oils, the participants answered questions about the feeling of satisfaction with aroma oils. Results : Changes in the physiological indices. The mean deviation of skin pH was $5.58{\pm}0.47$ points before using aroma oils and $5.53{\pm}0.45$ points after 2 weeks, no statistical significance was found(p=0.221). MD was $5.36{\pm}0.41$ points after 4 weeks using aroma oils, which was statistically significant decrease of 0.22 points(p=0.001) Changes on the Pruritus Score Scale. A modified scale of the Pruritus Score Scale(Duo, 1987) was used to measure the severity, location, frequency, and the inconveniences of daily life due to prurius. The maximum scale of severity was 4 points, the full marks of location was 2 points, the full marks of frequency was 3 points, the full marks of inconveniences of daily life due to pruritus was 3 points. The scores ranged from 0 to 12, with 12 indicating the most severe pruritus. There was no statistical difference in severity and frequency score at 4 weeks later(severity p=0.097, frequency p=0.633). A statistically significant difference was found in the score of location and the inconveniences of daily life due to pruritus(each p=0.003). Conclusion : Generally speaking, the patient suffering from renal itch is the higher than normal in skin pH levels. that means to show alkaline condition of skin surface. In some case in this study, skin pH levels was rather lower than normal levels when measured actually patients suffering from renal itch by skin pH meter. But in this study post-test skin pH levels decreased, showing the contribution of aromathrapy to acidic condition of skin surface in suffering from renal itch. It seems to be some help to cure a pruritus and also have no ill effects on aroma oils.
The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.
Objective: Atopic dermatitis is the most common chronic inflammatory skin disease in childhood. Phellinus linteus, an orange color mushroom, has been used as a traditional herb medicine for years. Recent preliminary animal experiments suggest that Phellinus linteus grown on germinated brown rice is effective in chronic inflammatory disease. The aim of this study was to evaluate the efficacy of Phellinus linteus grown on germinated brown rice in the treatment of atopic dermatitis(AD). Methods: 35 patients, 2 to 14 years of age, with mild to moderate AD were treated with Phellinus linteus grown on germinated brown rice powder per oral, $6{\sim}12g$/day adjusted by the body weight, divided three for up to 12 weeks without other treatment. The mean age of patients was 7.3 years. The disease activity has been monitored by objective SCORAD index. The symptom score of the pruritus was measured by using a traditional visual analogue scale (VAS). In addition, the global assessments of clinical response were also monitored by patients or their parents. Results: After 12 weeks of the study, significant reductions in mean severity scores and mean symptom scores were observed. The mean objective SCORAD indices of 35 patients decreased from 25.31${\pm}$8.96 to 18.73${\pm}$13.89(p<0.05). And the mean symptom score of pruritus assessment decreased from 7.37${\pm}$1.33 to 4.6${\pm}$2.3(p<0.05). The patient's global assessment of clinical response were also improved through the period of treatment(p<0.05). Conclusions: Phellinus linteusgrown on germinated brown rice may play a role in the treatment of mild and moderate AD in Children.
It is important to evaluate nutritional status of elderly patients receiving dialysis, since wasting and malnutrition are their common problems. This study aims at assessing their nutritional status by the type and duration of dialysis. The nutritional status such as somatic fat and protein storage was evaluated with anthropometric measure including weight/height ratio, triceps skinfold thickness and midarm muscle circumference. It was also measured with albumin, transferrin, C3 and IGF-1 and calorie and protein intakes. The general clinical condition of patients was evaluated with the severity of uremia and metabolic acidosis. which were measured through the levels of serum urea, creatinine and bicarbonateion. The data were analyzed by using t-test, ANOVA, Wilcoxon-rank sums test, Scheffe test, Kruskal-Wallis test and Pearson correlation coefficients. The results are following : 1. There was no significant difference in the calorie and protein intakes by the type and duration of dialysis received. 2. As for the anthropometric measures, no significant difference was found by the type of dialysis in body mass index triceps skinfold thickness and midarm muscle circumference. Yet these anthropometric measures differed significantly by the duration of dialysis in those elderly patients receiving hemodialysis(HD group), but this finding was not found in those receiving continuous ambulatory peritoneal dialysis(CAPD). 3. Regarding the indicators of uremia and metabolic acidosis, blood urea nitrogen(BUN) and creatinine were lower in the CAPD group than in the HD group, whereas bicarbonate ion was higher in the CAPD group than in the HD group, with no statistical significance. In the HD group, creatinine increased significantly with the increase of the duration of dialysis. 4. Serum trasferrin and C3 were significantly higher in the CAPD group than in the HD group. However. each of biochemical indices did not show statistical significance by the duration of dialysis in both HD and CAPD groups. 5. Anthropometric measures were significantly associated with dietary intake. Significant correlations were observed between biocarbonate ion, BUN and creatinine. In addition, the correlations between serum protein and albumin and between transferrin and C3 were statistically significant. Yet, IGF-1 revealed no significant correlation with other nutritional indices. The above findings indicate that there were no difference in nutritional status measured with protein and calorie intakes between the type and duration of dialysis, but CAPD seems to benefit correcting uremia and metabolic acidosis than HD. Studies of dietary management for dialysis patients need to be pursued in order to improved the quality of aged patients receiving dialysis.
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