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Using Multivariate Statistics

/pdf/multiple-factor-analysis-1xkff91jny.pdf

Multiple factor analysis.

Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids for patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Disclaimer This clinical practice guideline is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and it may not provide the only appropriate approach to diagnosing and managing this problem. Differences from Prior Guideline (1) Incorporation of new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia.

https://journals.sagepub.com/doi/pdf/10.1177/0194599817751030

Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).

Adattamento Italiano del BRIEF-A Behavior Rating Inventory of Executive Function - Adult Version

The COVID-19 pandemic outbreak has forced online teaching and learning to be the primary instruction format in higher education globally. One of the worrying concerns about online learning is wheth...

https://journals.sagepub.com/doi/pdf/10.1177/22125868211007011

COVID-19 pandemic’s disruption on university teaching and learning and competence cultivation: Student evaluation of online learning experiences in Hong Kong

The mechanisms underlying working memory training remain unclear, but one possibility is that the typically limited transfer effects of this training reflect adoption of successful task-specific strategies. Our pre-registered randomized controlled trial (N = 116) studied the early effects of externally given vs. internally generated strategies in an updating task (n-back) over a 5-day period with a single 30-minute training session. Three groups were employed: n-back training with strategy instruction (n = 40), n-back training without strategy instruction (n = 37), and passive controls (n = 39). We found that both external and internal strategy use was associated with significantly higher posttest performance on the trained n-back task, and that training with n-back strategy instruction yielded positive transfer on untrained n-back tasks, resembling the transfer pattern typically seen after the ordinary uninstructed 4–6-week working memory training. In the uninstructed participants, the level of detail and type of internally generated n-back strategies at posttest was significantly related to their posttest n-back performance. Our results support the view that adoption of task-specific strategies plays an important role in working memory training outcomes, and that strategy-based effects are apparent right at the start of training.

/pdf/the-early-effects-of-external-and-internal-strategies-on-445m9lhnp4.pdf

The early effects of external and internal strategies on working memory updating training.

The role of strategy use in working memory training outcomes

Prevalence and Risk Factors for Voice Problems Among Soccer Coaches.

Frontostriatal dysfunction in Parkinson's disease (PD) increases the risk for working memory (WM) impairment and depression, calling for counteractive measures. Computerised cognitive rehabilitation is a promising option, but targeted training protocols are lacking and lab-based training can be demanding due to the repeated visits. This study tested the feasibility and efficacy of home-based computerised training targeting mainly WM updating in PD. Fifty-two cognitively well-preserved PD patients were randomised to a WM training group and an active control group for five weeks of training (three 30-min sessions per week). WM training included three computerised adaptive WM tasks (two updating, one maintenance). The outcomes were examined pre- and post-training with trained and untrained WM tasks, tasks tapping other cognitive domains, and self-ratings of executive functioning and depression. Home-based training was feasible for the patients. The training group improved particularly on the updating training tasks, and showed posttest improvement on untrained WM tasks structurally similar to the trained ones. Moreover, their depression scores decreased compared to the controls. Our study indicates that patients with mild-to-moderate PD can self-administer home-based computerised WM training, and that they yield a similar transfer pattern to untrained WM tasks as has been observed in healthy older adults.

Training working memory updating in Parkinson's disease: A randomised controlled trial.

Working memory (WM) training with the N-Back task has been argued to improve cognitive capacity and general cognitive abilities (the Capacity Hypothesis of training), although several studies have ...

/pdf/strategy-mediation-in-working-memory-training-in-younger-and-ptpif8wj5i.pdf

Daniel Fellman

Papers

The early effects of external and internal strategies on working memory updating training.

The role of strategy use in working memory training outcomes

Prevalence and Risk Factors for Voice Problems Among Soccer Coaches.

Training working memory updating in Parkinson's disease: A randomised controlled trial.

Strategy mediation in working memory training in younger and older adults