Voice quality of prepubescent children with quiescent recurrent respiratory papillomatosis.

OBJECTIVE: The purpose of this study was to assess the long-term impact of recurrent respiratory papillomatosis (RRP) and its treatment on voice quality in prepubescent children. STUDY DESIGN: Case-control study. METHODS: Prepubescent children with RRP in remission for at least 12 [according to MM section] months were asked to participate. Remission was documented by absence of papillomas on fiberoptic flexible laryngoscopy. An age- and sex-matched control was selected for each patient enrolled. Voice was evaluated using the voice-related quality of life (V-RQOL) questionnaire, perceptual evaluations of voice quality by speech-language pathologists using the GRBAS (grade of hoarseness, roughness, breathiness, asthenia, strain) scale, and acoustic analysis (fundamental frequency, maximal phonation time, and relative average perturbation) using the Visi-Pitch II 3300. RESULTS: Medical records of 84 patients were reviewed and 15 met study criteria. Five agreed to participate but one was excluded due to the presence of papillomas. The four study patients and four matched controls were between 9- and 11-years old. On the V-RQOL questionnaire, each control rated V-RQOL as normal (10/50) and the average patient group score was within the normal range (11.5/50). On perceptual evaluations, the patient's voices were more hoarse, breathy, and rough compared to controls'. Acoustic analysis showed that patients' voices had a lower average fundamental frequency (F(0)) (200 Hz compared to 243 Hz for controls) and a higher relative average perturbation (RAP) (1.10 compared to 0.77), although only one patient's voice actually had elevated RAP (2.89), which had a large impact on raising the average score for the patient group. The average maximal phonation times were similar for the two groups (7.8s for patients and 7.4s for controls) but lower than average normal scores reported in the literature. CONCLUSIONS: Although children with RRP do not perceive their voice quality to have a negative impact on V-RQOL, speech-language pathologist evaluations and acoustic measurements show objective differences between the voices of children with quiescent RRP and those of normal, healthy controls.

Decision tree model describing alternate health care choices made by oncology patients.

What common sense decision strategies do patients with cancer use when they are making health care choices that include alternate therapies? Existing research indicates that oncology patients are making alternate choices while associated with biomedicine. Often patients' decision strategies are exploited by the alternate system to promote and market alternate products. Although some of these practices are benign, others are dangerous or may interfere or delay successful treatment in biomedicine. Therefore, it seems important for biomedical professionals to understand patients' common sense decision patterns. A decision tree model, outlining patients' decision strategies, has recently been developed through intensive interviews with 300 patients who were diagnosed with cancer of the respiratory and digestive systems. The two-phase methodology included, first, a context sensitive approach to develop the model, followed by a predictive approach testing the model developed in the first phase on a separate yet similar random sample of patients. The discussion in this article focuses on the research, the patterns of the decision tree model, and the implications and adaptability of this model to nursing practice.