Voice Disorder Detection via an m-Health System: Design and Results of a Clinical Study to Evaluate Vox4Health.

OBJECTIVES: The current study presents a clinical evaluation of Vox4Health, an m-health system able to estimate the possible presence of a voice disorder by calculating and analyzing the main acoustic measures required for the acoustic analysis, namely, the Fundamental Frequency, jitter, shimmer, and Harmonic to Noise Ratio. The acoustic analysis is an objective, effective, and noninvasive tool used in clinical practice to perform a quantitative evaluation of voice quality. MATERIALS AND METHODS: A clinical study was carried out in collaboration with medical staff of the University of Naples Federico II. 208 volunteers were recruited (mean age, 44.2 ± 13.9 years), 58 healthy subjects (mean age, 36.7 ± 13.3 years) and 150 pathological ones (mean age, 47 ± 13.1 years). The evaluation of Vox4Health was made in terms of classification performance, i.e., sensitivity, specificity, and accuracy, by using a rule-based algorithm that considers the most characteristic acoustic parameters to classify if the voice is healthy or pathological. The performance has been compared with that achieved by using Praat, one of the most commonly used tools in clinical practice. RESULTS: Using a rule-based algorithm, the best accuracy in the detection of voice disorders, 72.6%, was obtained by using the jitter or shimmer value. Moreover, the best sensitivity is about 96% and it was always obtained by using jitter. Finally, the best specificity was achieved by using the Fundamental Frequency and it is equal to 56.9%. Additionally, in order to improve the classification accuracy of the next version of the Vox4Health app, an evaluation by using machine learning techniques was conducted. We performed some preliminary tests adopting different machine learning techniques able to classify the voice as healthy or pathological. The best accuracy (77.4%) was obtained by the Logistic Model Tree algorithm, while the best sensitivity (99.3%) was achieved using the Support Vector Machine. Finally, Instance-based Learning performed the best specificity (36.2%). CONCLUSIONS: Considering the achieved accuracy, Vox4Health has been considered by the medical experts as a "good screening tool" for the detection of voice disorders in its current version. However, this accuracy is improved when machine learning classifiers are considered rather than the rule-based algorithm.

Aerodynamic findings and Voice Handicap Index in Parkinson's disease.

OBJECTIVE: To verify possible relations between vocal disability and aerodynamic measures in selected Parkinson's disease (PD) patients with low/moderate-grade dysphonia. METHODS: Fifteen idiopathic dysphonic PD male patients were examined and compared with 15 euphonic subjects. Testing included the following measures: Voice Handicap Index (VHI), maximum phonation time (MPT), mean estimated subglottal pressure (MESGP), mean sound pressure level (MSPL), mean phonatory power (MPP), mean phonatory efficiency (MPE) and mean phonatory resistance (MPR). RESULTS: Statistical analysis showed: a significant reduction in MPR and MSPL in PD subjects compared to the healthy ones; a significant positive correlation between VHI score and MSPL, MPR, MPP, MESGP and a significant negative correlation between VHI and MTP within PD subjects. Test for multiple linear regression showed a significant correlation between VHI score, MPT, MPR and MSPL. CONCLUSIONS: A relationship between VHI and aerodynamic measures was shown in the present study. Compensatory mechanisms may aggravate vocal disability in PD subjects.

Medical liability, defensive medicine and professional insurance in otolaryngology.

BACKGROUND: This study aims at verifying relationships between the perception of medico-legal risks involved in the professional activity of Italian otolaryngologists, defensive medical behaviour and their understanding of professional liability insurance in matters of civil liability. One hundred specialists replied to a questionnaire pertaining to the psychological impact of medico-legal issues and to specific queries regarding insurance coverage, either privately stipulated or provided by the employer. Statistic analysis was carried out by χ(2) test and ANOVA multiple variance regression test, assuming P = 0.05 as the value of minimum statistical significance. RESULTS: It was found that in 50% of cases the behaviour of the doctor towards the patient had been decidedly influenced by concerns over medico-legal implications. In 29% of the sample these concerns had "often to always" influenced the choice of diagnostic procedures or treatment options, in order to safeguard themselves in case of legal dispute. The data obtained showed a statistically significant correlation between the level of concern (regarding potential medico-legal disputes) experienced by specialists on the one hand and variations in the doctor/patient relationship (P < 0.05) and the choice of defensive medical procedures (P < 0.05) on the other. Furthermore, the perception of the medico-legal problem was statistically related to the absence or poor knowledge of some insurance clauses, regarding posthumous coverage (72%), informed written consent (89%), and the coverage provided by the healthcare centre where the specialist is employed (32%) (P < 0.05). CONCLUSIONS: The results of this study indicate the necessity for a greater awareness of the actual guarantees provided by the insurance policy stipulated by specialists, to avoid inadequate coverage in the case of medico-legal disputes.

Quantitative evaluation of the clinical effects of S-adenosylmethionine on mood and behavior in Lesch-Nyhan patients.

UNLABELLED: BACKGROUND, RATIONALE, AND METHODS: Lesch-Nyhan disease is a rare, X-linked disorder due to hypoxanthine phosphoribosyltransferase deficiency. To evaluate reported benefit on mood and behavior obtained by the administration of S-adenosyl-L-methionine in this condition, we developed 2 quantitative evaluation tools, and used them to assess the effects of the drug in our population: the weekly questionnaire and the resistance to self-injurious behavior test. We performed an open-label, dose-escalation trial of the drug on 14 patients. RESULTS: Four patients tolerated the drug and reported beneficial effects. The majority experienced worsened behavior. The 2 assessment tools demonstrated effectiveness in quantitatively evaluating the self-injurious behavior.