Efficiency and Cutoff Values of Self-Assessment Instruments on the Impact of a Voice Problem.

OBJECTIVES: To evaluate the efficiency of four self-assessment questionnaires that rate the impact of a voice problem on the individual's life: Voice-Related Quality of Life (V-RQOL), the original and reduced versions of the Voice Handicap Index (VHI) and VHI-10, Vocal Performance Questionnaire (VPQ), and Voice Symptom Scale (VoiSS). METHODS: Data from 975 subjects, 486 with a diagnosis of dysphonia and 489 vocally healthy individuals, were submitted to the receiver operating characteristic (ROC) curve analysis to obtain the cutoff values that determine the discriminating power of these instruments (presence of dysphonia vs healthy voice). RESULTS: The ROC curve analysis showed that the most efficient questionnaires were the VoiSS and the VHI. Results showed that they presented as a perfect classification based on their efficiency, specificity, and sensitivity values (all three of them = 1). The VHI-10 and the V-RQOL showed excellent classification (VHI-10: efficiency = 0.991; specificity = 1; sensitivity = 0.981; V-RQOL: efficiency = 0.914; specificity = 0.860; sensitivity = 0.967). Finally, the VPQ showed a good level of classification (efficiency = 0.828; specificity = 0.824; sensitivity = 0.831). The cutoff values for the instruments are as follows: VoiSS = 16 points, VHI = 19 points, VHI-10 = 7.5 points, V-RQOL = 91.25, and VPQ = 20.5 points. These values are important for screening large populations as well as for helping in the decision-making process of clinical management. The cutoff values for maximum sensitivity and specificity of the instruments that did not produce perfect classification are as follows: VHI-10: sensitivity = 5; specificity = 7.5, V-RQOL: sensitivity = 86.25; specificity = 98.75, and VPQ: sensitivity = 15.5; specificity = 31.5. CONCLUSIONS: Both the VoiSS and the VHI are perfect classifiers. The VHI-10 and the V-RQOL are excellent classifiers, and the VPQ is good at discriminating individuals with dysphonia from the ones without dysphonia.

Mastigação, deglutição e suas adaptações na paralisia facial periférica / Mastication, deglutition and its adaptations in facial peripheral paralysis

OBJETIVO: caracterizar mastigação, fase oral da deglutição e possíveis adaptações funcionais observadas nos portadores de Paralisia Facial Periférica. MÉTODO: participaram desta pesquisa 30 indivíduos com Paralisia Facial Periférica grau IV, com história de até 30 dias, sem distinção de etiologia e divididos em três grupos, os que apresentavam a paralisia em até 10 dias, de 11 a 20 e de 20 a 30 dias. As funções mastigação e fase oral da deglutição foram avaliadas tanto com alimento sólido e como com água natural. Os indivíduos responderam questões relacionadas às dificuldades imediatamente após a instalação da paralisia. Os dados foram analisados estatisticamente pelo Teste da Razão de Verossimilhança e pelo Teste Exato de Fisher. RESULTADOS: foram constatadas alterações nas funções de mastigação e fase oral da deglutição pela diminuição do tônus no músculo orbicular dos lábios e do músculo bucinador, que diminuindo a pressão intra-oral, favorece o escape de alimento e líquido. À observação da Fonoaudióloga a variável "derrama líquido enquanto bebe" apresentou dados estatisticamente significante (p=0,003) nos três grupos estudados. A variável "acúmulo de alimento entre os dentes e a gengiva no lado paralisado" foi estatisticamente significante nos grupos de 11 a 20 dias (p= 0,002). CONCLUSÃO: os indivíduos da amostra mastigam no lado paralisado com dificuldade, mediante ciclos mastigatórios lentos e inconsistentes. Ocorre um incremento nos movimentos de língua para limpeza de resíduos retidos no vestíbulo oral no lado paralisado. Este é o sintoma que mais incomoda o paciente. Apresentam dificuldade no beber de forma contínua. Desenvolvem adaptações para compensar suas dificuldades funcionais.

PURPOSE: to describe mastication, swallowing oral phase and possible functional adaptations observed in Facial Peripheral Paralysis subjects. METHOD: there were 30 subjects with grade IV Facial Peripheral Paralysis, with at the most 30 days paralysis history and no etiology differentiation. They were separated in three groups, 1 to 10 days paralysis, 11 to 20 days and 21 to 30 days. Mastication and swallowing oral phase functions were assessed with both solid food and water. Participants answered questions related to the difficulties right after the paralysis. Data were statistically analyzed using the Likelihood Ratio Test and Fisher Exact Test. RESULTS: changes were observed in mastication and swallowing oral phase due to the lowering of lips tonus, orbicular muscle and buccinator muscle that allows the escaping of food and liquid by decreasing intra-oral pressure. To the speech therapist's observation "spill liquid while drinking" presented statistically significant data (p=0,003) in the three observed groups. Variable "accumulate food between teeth and gums" was statistically significant in groups of 11 to 20 days (p= 0,002). CONCLUSION: sample subjects chew with difficulty in the paralyzed side, showing slow and inconsistent mastication cycles. There is an increased tongue movements for cleaning the residues kept in oral vestibule in the paralyzed side. This is the most annoying symptom according to the patients. They develop adaptation strategies to compensate their functional difficulties.

Medical adverse events in elderly hospitalized patients: a prospective study

OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e.g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score Il). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events, the patients with medical adverse events had a significantly longer hospital stay (21.41 ± 15.08 days versus 10.91 ± 7.21 days) and a higher mortality rate (39 deaths [41.5%] versus 17 deaths [22.1%]). Mortality was significantly predicted by the Simplified Acute Physiology Score II score (odds ratio [OR] = 1.13, confidence interval [CI] 95%, 1.07 to 1.20), the Katz score (OR=1.47, CI 95%, 1.18 to 1.83), and medical adverse events (OR = 3.59, CI 95%, 1.55 to 8.30). CONCLUSION: Medical adverse events should be monitored in every elderly hospitalized patient because there is no risk profile for susceptible patients, and the consequences of adverse events are serious, sometimes leading to longer hospital stays or even death.

Abordagem não-paramétrica para cálculo do tamanho da amostra com base em questionários ou escalas de avaliação na área de saúde / Non-parametric approach for calculation of sample size based on questionnaires or scales of assessment in the health care

Este texto sugere sobre como calcular um tamanho de amostra com base no uso de um instrumento de coleta de dados formado por itens categóricos. Os argumentos para esta sugestão estão embasados nas teorias da Combinatória e da Paraconsistência. O propósito é sugerir um procedimento de cálculo simples e prático para obter um tamanho de amostra aceitável para coletar informações, organizá-las e analisar dados de uma aplicação de um instrumento de coleta de dados médicos baseado, exclusivamente, em itens discretos (itens categóricos), ou seja, cada item do instrumento é considerado como uma variável não-paramétrica com um número finito de categorias. Na Área de Saúde, é muito comum usar instrumentos para levantamento com base nesse tipo de itens: protocolos clínicos, registros hospitalares, questionários, escalas e outras ferramentas para inquirição consideram uma sequência organizada de itens categóricos. Uma fórmula para o cálculo do tamanho da amostra foi proposta para tamanhos de população desconhecidos e um ajuste dessa fórmula foi proposto para populações de tamanho conhecido. Pôde-se verificar, com exemplos práticos, a possibilidade de uso de ambas as fórmulas, o que permitiu considerar a praticidade de uso nos casos em que se tem disponível pouca ou nenhuma informação sobre a população de onde a amostra será coletada.

This text suggests how to calculate a sample size based on the use of a data collection instrument consisting of categorical items. The arguments for this suggestion are based on theories of Combinatorics and Paraconsistency. The purpose is to suggest a practical and simple calculation procedure to obtain an acceptable sample size to collect information, organize it and analyze data from an application of an instrument for collecting medical data, based exclusively on discrete items (categorical items), i.e., each item of the instrument is considered as a non-parametric variable with finite number of categories. In the health care it is very common to use survey instruments on the basis of such items: clinical protocols, hospital registers, questionnaires, scales and other tools for hearing consider a sequence of items organized categorically. A formula for calculating the sample size was proposed for a population of unknown size, and an adjusted formula has been proposed for population of known size. It was seen, with practical examples, the possibility of using both formulas, allowing to consider the practicality of the use in cases that have little or no information available about the population from which the sample is collected.