The Role of Telemedicine in Voice Therapy.

Introduction: During the COVID-19 pandemic, our institution adopted telemedicine for voice therapy (VT) as an alternative to in-person sessions, which has been integrated into our routine practice following the pandemic. This study aims to explore factors influencing completion rates among the 2 methods. Method: A retrospective chart review at a single tertiary care institution between 2019 and 2021 was conducted. Patient zip codes were used to determine Neighborhood Atlas® Area Deprivation Index (ADI) scores and travel distance to our institution. Demographic data, Voice Handicap Index (VHI) scores, and completion status were extracted. Results: Between 2019 and 2021, 521 patients were referred to VT at our institution, with 29% opting for telemedicine VT (TVT) sessions and 71% choosing in-person sessions. Seventy-four percent was female, and average age was 57.1 years (range:10-89 years old). No statistically significant differences were observed between the 2 groups regarding sex, age, employment status, or insurance type. Participants in the TVT group demonstrated notably higher completion rates compared to the in-person group [70.0% vs 31.6% (P < .001)]. The TVT group also comprised of a higher percentage of white patients, reported longer travel distances and times to reach therapy, but had comparable ADI scores to the in-person group. Moreover, there were no significant differences in pretreatment VHI scores between the 2 groups or between those who completed therapy versus those who did not (P = .501). Conclusion: Our findings indicate that patients utilizing the telemedicine platform had significantly higher VT completion rates compared to patients appearing in person. These results highlight the importance of being able to offer telemedicine-based options in the management of voice patients.

Dysphagia in the Aging Population.

Older adults are projected to outnumber children aged under 18 years for the first time in United States history by 2034, according to Census Bureau projections. This will lead to significant increase in age-related disorders. One of the most important disorders that will increase in prevalence is dysphagia, as it leads to malnutrition, dehydration, aspiration pneumonia, and death. In this article, the physiology of dysphagia in the elderly, as well as the management options is discussed.

The effect of physical and psychological symptoms on spiritual well-being and emotional distress in inpatient cancer patients.

PURPOSE: This study was conducted to examine the effects of physical and psychological symptoms seen in inpatient cancer patients on spiritual well-being and emotional distress. METHOD: This descriptive and cross-sectional study was conducted with 98 cancer patients treated in oncology, haematology, and stem cell services at a university hospital between April and June 2022. Socio-demographic characteristic form, Karnofsky performance scale, Nightingale Symptom Assessment Scale, Hospital Anxiety and Depression Scale, distress thermometer and spiritual well-being scale were used to collect data. Statistical analyses were made by taking the descriptive features of the data. RESULTS: It was determined that 55.1% of the patients were diagnosed with cancer for more than one year, 53.1% receiving treatment for more than one year, 61.2% were diagnosed with haematological cancer, and 62.2% were treated only with chemotherapy. Cancer type (p<0.01), treatment (p<0.05) and Karnofsky scores (p<0.01) had an effect on the spiritual well-being and distress scores. It was determined that 39.8% of the patients were in the yellow zone of the distress thermometer, could not manage their stress well and needed psychological support. As the psychological symptoms of the patients increased, their spiritual well-being declined (r=-0.447, p<0.01), and as their physical (r=0.222, p<0.05) and psychological (r=0.311, p<0.01) symptoms increased, their distress scores increased. CONCLUSION: It is anticipated that identifying the problems that patients have and making interventions to solve those problems by oncology nurses would significantly contribute to the patient's spiritual well-being and emotional distress.

Psychometric Properties of the Turkish Version of the Nurse Spiritual Therapeutic Scale for Oncology Patients and Caregivers.

This study evaluated the Turkish version of the Nurse Spiritual Therapeutic Scale for assessing oncology patients' and caregivers' needs. It involved 200 participants from July 2022 to May 2023. The scale demonstrated high validity (content validity index = 0.97) and good internal consistency (Cronbach's alpha = 0.879). Factor analysis revealed a 20-item single-factor structure with satisfactory representation (factor loadings: 0.29-0.89). Item-total score correlations indicated moderate to strong relationships (0.236-0.761). The model showed a good fit (goodness-of-fit indices > 0.90). The Turkish version of the scale is valid and reliable for assessing oncology patients' and caregivers' spiritual care needs.

The unknown impact of multiple myeloma: assessing the impact of financial well-being on quality of life of caregivers.

PURPOSE: Patients with multiple myeloma and their caregivers are financially burdened, and their quality of life is significantly affected by treatment costs and care expenses. The aim of our study is to examine the impact of financial well-being of the caregiver on the life quality of patients with multiple myeloma. METHODS: The study included 113 patients with multiple myeloma and 113 caregivers in two hospitals located in Western Turkey. This study evaluated the demographic characteristics of patients and their caregivers, financial status, financial well-being, and quality of life of caregivers. Simple linear regression analyses were used to examine the impact of financial well-being on caregiver quality of life. RESULTS: The average age of multiple myeloma patients and caregivers is 64.00 ± 11.05 and 48.02 ± 11.4, respectively. Of patients, 50.4% and 62.8% of their caregivers were female. It is determined that 51.3% of the patients were diagnosed in 1-5 years, 85% received chemotherapy, and 80.5% had an ECOG performance status between 0 and 1. Caregivers' quality of life and financial well-being were found to be low. On one hand, while caregivers' financial well-being (ß = - 1.003; t = - 3.831; p = .000) negatively affected the quality of their lives, their financial satisfaction (ß = 2.507; t = 3.820; p = .000) positively affected the quality of their lives, on the other hand. CONCLUSIONS: Caregivers' quality of life declined as their financial well-being got worse. Decreased quality of life of caregivers may affect the quality of care they provide to patients with MM. Hence, this study recommends the following. First, nurses who care for patients with MM should always assess the financial situation of patients and caregivers. Second, patient navigators, hospital billing specialists, and social workers should provide financial guidance to multiple myeloma patients and caregivers and provide help in solving their financial problems. Finally, policies that support the financial situation of patients and caregivers should be developed.

Early postoperative complications following tracheotomy: Does suturing technique influence outcomes?

Introduction: Tracheotomy is one of the most commonly performed procedure by otolaryngologists, but no consensus exists on the effect of suturing techniques on postoperative complications. Stay sutures and Bjork flaps are utilized frequently for securing the tracheal incision to the neck skin in order to create a tract for recannulation. Methods: Retrospective cohort study of tracheotomies performed by Otolaryngology-Head and Neck Surgery providers (May 2014 to August 2020) was conducted to determine the effect of suturing technique on postoperative complications and patient outcomes. Patient demographics, medical comorbidities, indication for tracheostomy, and postoperative complications were analyzed with a statistical alpha set of .05. Results: Out of 1395 total tracheostomies performed at our institution during the study period, 518 met inclusion criteria for this study. Three hundred and seventeen tracheostomies were secured by utilizing a Bjork flap, while 201 were secured with up and down stay sutures. Neither technique was noted to be more commonly associated with tracheal bleeding, infection, mucus plugging, pneumothorax, or false passage of the tracheostomy tube. One mortality was noted following decannulation during the study period. Conclusion: Though various techniques exist; adverse outcomes are not associated with the manner in which a new tracheostomy stoma is secured. Medical comorbidities and the indications for tracheostomy likely play a more significant role in postoperative outcomes and complications. Level of evidence: Level 3.

A randomized controlled trial of the effects of flow phonation voice treatment for primary muscle tension dysphonia.

OBJECTIVE: The purpose of the study was to investigate the effects of flow phonation voice therapy on laryngeal physiology and vocal quality in persons with primary Muscle Tension Dysphonia (MTD1). METHODS: Seventeen participants with a diagnosis of MTD1 completed the study. Participants were randomized to two groups. Group 1 (9 participants) received flow phonation treatment and individualized vocal hygiene education for 12 sessions over six weeks. Group 2 (8 participants) received vocal hygiene education only for three weeks (6 sessions), followed by another three weeks (6 sessions) of both vocal hygiene instruction and flow phonation therapy. Treatment consisted of cup-bubble blowing, gargling, and stretch and flow exercises. Visual-perceptual. auditory-perceptual, acoustic, aerodynamic and voice-related quality-of-life measures were obtained at three time points: before treatment, three weeks after initiation of treatment and after completion of treatment. RESULTS: Voice quality was perceived to be significantly improved in both groups. Voice related quality-of-life trended toward improvement for both groups across time points. Changes in aerodynamic and acoustic measures did not reach statistical significance compared to baseline for both groups. Visual comparisons of laryngeal closure patterns demonstrated comparably better outcomes for Group 1. CONCLUSIONS: Results of this study indicate flow phonation exercises can potentially be favorably employed for individuals with MTD1. In particular, it appears that the exercises aid in alleviating vocal hyperfunction, as evidenced by visual perceptual stroboscopic analysis, and clinically improved auditory-perceptual measures.

Home care practices of cancer caregivers and the effect of perceived social support on care burden.

INTRODUCTION: Caregivers have to manage tasks at home such as providing management of the patient's follow-up. Social support is known to have protective effects, especially for caregivers for cancer patients. The aim of this study is to examine the effect of home care practices and perceived social support level of caregivers of cancer patients on the burden of care. METHODS: A descriptive and cross-sectional study. A total of 222 caregivers were included in the study. In this study, Caregiver and Patient Identification Form, Caregiver's Home Care Practices Questionnaire Form, Zarit Caregiver Burden Scale, Multidimensional Scale of Perceived Social Support, and Karnofsky Performance Scales were used. RESULTS: Of the caregivers included in the study, it was found that 47.3% were in the 40-61 age group, and 64.4% were women. The total score of caregivers from MSPSS was 61.29 ± 17.27, the total score they received from the Home Care Practices Questionnaire was 28.88 ± 7.72, and the total score they got from the ZBI was 29.11 ± 14.58. It was found that there was a weak and negative correlation between the perceived social support total scores and caregiver burden scores of caregivers (p < .01). In particular, in the regression analysis, a significant correlation was found between the total score of home care practices and personal sub-dimension scores (r: .91, p < .001, tolerance value: .158, VIF: 6.311). CONCLUSIONS: It has been determined that the increase in home care practices of caregivers of cancer patients and the low level of perceived social support increase the burden of care.

Examining the relationship between symptoms watched in lung cancer patients and illness perception.

OBJECTIVE: To examine the relationship between the symptom experience of lung cancer patients and their illness perception of the disease. METHODS: The descriptive and cross-sectional study was conducted from April to September 2015 at the Chemotherapy Treatment Centre of the Medicine Chest Diseases Clinic at the Ege University, Izmir, Turkey, and comprised lung cancer patients of either gender aged >18 years. Data was collected using a predesigned Patient Questionnaire as well as the standard Lung Cancer Symptom Scale, Illness Perception Questionnaire and Karnofsky Performance Scale. The patients' sociodemographic characteristics and data on their illness, the symptoms they experienced and the numerical and percentage distribution of the items on the illness perception scale, mean and standard deviation values were examined. Pearson Correlation analysis was used to examine the correlation between illness perception and Karnofsky Performance Scale scores and other variables. RESULTS: Of the 105 patients, 86(81.9%) were males, 86(81.9%) were married, 49(46.7%) were elementary school graduates, 101(96.2%) were unemployed, and 95(90.5%) were receiving chemotherapy. The overall mean age of the sample was 61.43±8.24 years, the period since diagnosis was 11.38±17.84 months, and the duration of chemotherapy was 4.28±2.37 months. The mean symptom burden score was 22.75±10.85 and the Lung Cancer Symptom Scale score was 22.75±10.85. The mean score of the type of illness domain was 5.53±2.12. The overall mean global quality of life score was 64.30±12.60. CONCLUSIONS: As the symptom burden experienced by the lung cancer patients increased, their perception of the illness became more negative, and the longer the cyclical periods and the period of diagnosis, the patients' control over their illness decreased.

The Effects of Self-Esteem, Coping, and Voice-Related Quality of Life on Communicative Participation Before and After BOTOX® Treatment for Spasmodic Dysphonia.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to (1) investigate the percent change in communicative participation in individuals with spasmodic dysphonia (SD) pre- and post-BOTOX® treatment; and (2) to investigate if percent change in communicative participation is predicted by change in self-esteem, coping, and/or Voice-Related Quality of Life (V-RQOL) pre- and post-BOTOX® treatment. STUDY DESIGN/METHODS: A cross-sectional study of 49 patients was conducted across three clinics, with each participant completing the Rosenberg Self-Esteem Scale, the Voice Disability Coping Questionnaire (VDCQ), the V-RQOL instrument, and the Communication Participation Item Bank (CPIB) before BOTOX® treatment and 10-14 days following BOTOX® treatment. DATA ANALYSIS: For Research Question 1, a paired t test was applied to test the equality of means for CPIB and to test the pre-post changes among other composite measurements before and after the BOTOX® treatment. For Research Question 2, a multivariable linear regression model was applied with percent change in CPIB as a main outcome, and change in Rosenberg Self-Esteem Scale, VDCQ, and the V-RQOL as independent variables (or covariates) in order to test the associations. RESULTS: The results indicated that pre- and post-BOTOX® measures of communicative participation are not statistically significantly different among the participants with SD. There was a strong positive correlation between change in coping and voice-related QOL. CONCLUSIONS: A better understanding of the relationship between communicative participation and voice-related QOL is warranted. Item analysis of the V-RQOL and the VDCQ may illustrate coping strategies and functional impairments and provide further information regarding highly variable communicative participation among individuals with SD.

What Does It Mean To Be Pemphigus Patient? A Qualitative Study.

This study aims to provide a closer examination of the problems experienced by individuals with pemphigus vulgaris with their eyes and experiences. This is a phenomenological study. The study population was completed with eight people with pemphigus vulgaris who applied to the dermatology clinic of a university hospital in a metropolis between September 2019 and March 2020. The interviews were transcribed and analyzed using phenomenological methods. Three main themes emerged and nine supporting sub-themes were identified. The main themes are (a) the physical problems they are experiencing now, (b) the psychological difficulties they are feeling now, and (c) intense future anxiety about the process and the future. This study will increase the understanding of the lived experiences of pemphigus vulgaris patients, increase the awareness of each nurse about these patients and will be able to provide better quality care to individuals with pemphigus vulgaris.

An Investigation of the Relationship between Adherence to Voice Therapy for Muscle Tension Dysphonia and Employment, Social Support, and Life Satisfaction.

PURPOSE: The purpose of this study was to investigate whether a relationship exists between employment status, perception of life quality (ie, vocal impairment, health, life satisfaction, and social support), and adherence to voice therapy for persons with muscle tension dysphonia (MTD). This study extends recent work as it evaluates investigating the impact of social support and life satisfaction on adherence to voice therapy for MTD. METHOD: A cross-sectional study of 45 individuals diagnosed with MTD who participated in voice therapy between January 2014 and December 2015 at the University of Arkansas for Medical Science's Voice and Swallowing Center in Little Rock, Arkansas participated in this study. Participants provided information regarding employment status and completed the Satisfaction with Life Scale and the Quality of Relationships Inventory. RESULT: Sixty percent of participants completed voice therapy. Patients who completed voice therapy were more likely to report gainful employment (P = 0.038) or less confidence in a specific and significant personal relationship (P = 0.004). CONCLUSION: This study discovered a moderate effect between employment status and adherence to voice therapy for MTD as well as relationship confidence and adherence.

Factors affecting knowledge levels of oncology nurses about skin cancer and sun protection.

OBJECTIVE: This is a descriptive, cross-sectional and observational study that determines the factors affecting the knowledge levels of oncology nurses for skin cancer and sun protection. MATERIALS & METHODS: This study was performed on the members of the Turkish Oncology Nursing Association and oncology nurses working in hospitals in Turkey between November 2019 and March 2020. Data were collected by using the Nurse Information Form and Skin Cancer and Sun Knowledge (SCSK) scale. For data analysis, average and percentage calculations and multiple linear regression analyses were used. The significance level was set at p < .05. RESULTS: We found those female nurses who were above 40 years of age and having darker skin tone due to excessive sun exposure, with a family history of skin cancer, and educated on skin cancer, performed better on the SCSK scale. We found a statistically significant difference between the mean scores of skin cancer and sun exposure. Using multiple regression analysis, a model was created based on the relationship between variables. In this model, the personality traits of oncology nurses are responsible for higher (91.1%) knowledge levels on skin cancer and sun exposure. CONCLUSION: In conclusion, it is important to consider factors that will influence an individual's behaviour while developing skin cancer and sun protection programmes.

Using Didactics and Simulation to Enhance Comfort, Knowledge, and Skills of Nonsurgical Trainees Caring for Patients With Tracheostomy and Laryngectomy.

INTRODUCTION: Management of tracheostomy and laryngectomy is an important skill for physicians who often care for patients with multiple, comorbid, chronic medical conditions. There is little published literature on training for tracheostomy and laryngectomy care during nonsurgical specialty residencies. This project was designed to assess and improve comfort with, knowledge of, proficiency in tracheostomy and laryngectomy care. METHODS: This prospective observational study comprised 122 physician trainees from internal medicine, emergency medicine, and anesthesia training programs at the University of Arkansas for Medical Sciences participating in a simulation-based curriculum from April 2016 to December 2016. The curriculum included didactic session, hands-on experience performing a tracheostomy change, and practicing emergency scenarios on interactive, high-fidelity simulation mannequins. Preintervention and postintervention assessments of self-perceived comfort, objective knowledge, and tracheostomy change proficiency were performed and results compared. RESULTS: Self-perceived comfort improved from a mean Likert score from 2.12 to 4.43 (P = 0.009). Knowledge mean scores improved from 57% to 82% (P < 0.001) on multiple-choice testing. Tracheostomy change proficiency mean scores improved from 41% to 84% (P < 0.001) of proficiencies correctly performed. Six-month follow-up assessment of comfort and knowledge showed statistically significant retention of comfort (P = 0.002) and knowledge (P = 0.026). CONCLUSIONS: Comprehensive tracheostomy and laryngectomy education, which combines enhancement of knowledge with simulation of both routine and emergent aspects of care, is an effective strategy in improving confidence with, knowledge of, proficiency in tracheostomy and laryngectomy care. Retention of confidence and knowledge was demonstrated 6 months later.

Adverse Events after Rigid and Flexible Endoscopic Repair of Zenker's Diverticula: A Systematic Review and Meta-analysis.

OBJECTIVE: To determine adverse events after endoscopic flexible vs endoscopic rigid cricopharyngeal myotomy for treatment of Zenker's diverticulum (ZD). DATA SOURCES: Systematic review of MEDLINE, Web of Science, CINAHL, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for all years according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional studies were identified from review citations and a by hand search of manuscripts referencing ZD. REVIEW METHODS: A structured literature search was conducted to identify studies for this systematic review. Methodological Index for Non-randomized Studies (MINORS) criteria were applied to assess study quality. For inclusion, each study had to provide data for at least 10 adult patients who had undergone endoscopic ZD repair reporting clear association with the postprocedure course in each case. Data extracted included all reported adverse events, recurrences, follow-up, and operative times. RESULTS: In total, 115 studies were included. All but 8 were retrospective case series. Sixty-one reported series of patients after rigid endoscopic stapler repair, 31 after rigid laser repair, and 13 with other rigid endoscopic instruments. Twenty-nine flexible endoscopic studies were included. Mortality, infection, and perforation were not significantly more likely in either the rigid or the flexible group, but bleeding and recurrence were more likely after flexible endoscopic techniques (20% vs <10% and 4% vs 0%, respectively). Dental injury and vocal fold palsy were reported rarely in the rigid endoscopic groups. CONCLUSIONS: Adverse events are rare after endoscopic Zenker's repair. The flexible approach minimizes exposure limitations and can be completed in some patients without general anesthesia. Transoral rigid approaches result in fewer revision surgeries compared with flexible diverticulotomy.

Assessment of Gender Differences in Perceptions of Work-Life Integration Among Head and Neck Surgeons.

IMPORTANCE: The factors that contribute to gender discrepancies among attending head and neck surgeons have yet to be fully characterized. OBJECTIVE: To evaluate the association of gender difference with the perceived quality of life of head and neck oncological surgeons. DESIGN, SETTING, AND PARTICIPANTS: Following approval from the American Head and Neck Society (AHNS) review board, a web-based survey study of 37 questions, mainly assessing daily lifestyle and quality of life, was sent to the entire membership. MAIN OUTCOMES AND MEASURES: The main outcome assessed was perceived quality of life among female and male surgeons. RESULTS: A total of 261 members (13.0%) responded, 71 women (27.2%) and 190 men (72.8%). In all, 66 female (92.5%) and 152 male (80%) surgeons worked at an academic institution. A greater percentage of women were at the associate professor level than men (20/64 [31%] vs 37/152 [24%]; difference, 6.9%; 95% CI, -5.6% to 20.5%) and a greater percentage of men were at the professor level than women (72/152 [47%] vs 18/64 [28%]; difference, 19%; 95% CI, 4.9% to 31.6%). This discrepancy was evident in administrative roles as well, with 4 female (6.2%) vs 23 male (17.6%) department chairs (difference, 11.3%; 95% CI, 0.9%-19.6%). Of the 71 women, 18 (25%) were not in a long-term relationship or were divorced, as opposed to 6 (3.2%) men (difference, 22%; 95% CI, 12.8%-33.5%). Women had a mean (median) 1.18 (1) children, whereas men had 2.29 (2) children. Mean age that participating women had their first child was 35.1 years, whereas the man age for men was 31.9 years. Overall, 117 men (61.9%) and 45 women (67.2%) found their family time limited compared with other otolaryngological subspecialties. Despite these results, 101 men (53.4%) vs 37 women (55.2%) stated that they had a good work-life balance. Six women vs 8 men indicated they would choose a different subspecialty if they could. CONCLUSIONS AND RELEVANCE: Despite improvements in work hours and gender balance in residency programs, discrepancy in the number of female surgeons with senior academic rankings continues. However, female and male head and neck surgeons appear equally content with their subspecialty choice.

A Mechanism-Based Approach to P2X7 Receptor Action.

The ligand-gated ion channel P2X7 receptor attracts special attention due to its widespread presence as well as its unusual responses. Besides relatively well-understood mechanisms such as intracellular Ca2+ increase and K+ depletion, the P2X7 receptor activates other peculiar responses whose mechanisms are not fully understood. The best known among these is the permeabilization of the cell membrane to large molecules. This permeabilization has been explained by the activation of a nonselective permeation pathway by the P2X7 receptor, a phenomenon called "pore formation." However, with the emergence of new data, it became apparent that large molecules enter the cell directly through the pore of the ion channel, similar to the smaller ions. This explanation seems to be true for cationic large molecules. On the other hand, there is still convincing evidence indicating that the P2X7 receptor activates a separate pathway that permeates anionic large molecules in some cell types. Furthermore, there exist functional data suggesting that the P2X7 receptor may also activate other intracellular signaling molecules or other ion channels. Interestingly and contrary to what is expected from a ligand-gated channel, these activations occur in a seemingly direct manner. Somewhat overshadowed by the pore formation hypothesis, these action mechanisms may lead to a better understanding of not only the P2X7 receptor itself but also some important physiologic functions such as the release of anionic autocoids/neurotransmitters in the central nervous system. This review discusses, assesses, and draws attention to the data concerning these neglected but potentially important points in the P2X7 receptor field.