scholarly journals Adjusted cost analysis of video televisits for the care of people with amyotrophic lateral sclerosis

2019 ◽  
Vol 60 (2) ◽  
pp. 147-154 ◽  
Author(s):  
Sabrina Paganoni ◽  
Marc van de Rijn ◽  
Kristin Drake ◽  
Katherine Burke ◽  
Michael Doyle ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Cost Analysis ◽  
Adjusted Cost ◽  
Lateral Sclerosis

Continuing Non-Invasive Ventilation During Amyotrophic Lateral Sclerosis-Related Hospice Care Is Medically, Administratively, and Financially Feasible

2020 ◽  
pp. 104990912098229
Author(s):  
Philip J. Choi ◽  
Michael Murn ◽  
Roberta Turner ◽  
Richard Bedlack
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Length Of Stay ◽  
Cost Analysis ◽  
Rating Scale ◽  
Academic Medical Center ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Als Patients ◽  
Lateral Sclerosis

Background: Amyotrophic Lateral Sclerosis (ALS) is a terminal neuromuscular disease with patients dying within 3-5 years of diagnosis. Most patients choose to forego invasive life sustaining measures. Timing of hospice referral can be challenging given the advancement of non-invasive ventilation (NIV) technology. Objective: To describe the characteristics of patients enrolled in hospice from an ALS clinic at 1 academic medical center and to perform a cost analysis for patients who remained on ventilator support. Methods: Retrospective cross-sectional study of patients enrolled in hospice over a 2-year period. Clinical characteristics included ALS Functional Rating Scale Revised (ALSFRS-R) score, Forced Vital Capacity (FVC), use of NIV and mechanical insufflation-exsufflation (MIE), riluzole use, and length of stay in hospice. A cost analysis was performed for patients enrolled in Duke Home Care and Hospice. Results: 85 of 104 patients who died were enrolled in hospice. Median days enrolled in hospice was 84. Patients who continued on NIV had similar hospice length of stay as those on no respiratory support (88 versus 80 days, p = 0.83). Bulbar patients had a trend toward shorter length of stay in hospice than limb onset patients (71 versus 101 days, p = 0.49). Cost analysis showed that hospice maintained a mean net operating revenue of $3234.50 per patient who continued on NIV. Conclusions: Hospice referrals for ALS patients on NIV can be challenging. This study shows that even with continued NIV use, most ALS patients die within the expected 6 months on home hospice, and care remains cost effective for hospice agencies.

Automated Acoustic Analysis of Oral Diadochokinesis to Assess Bulbar Motor Involvement in Amyotrophic Lateral Sclerosis

2020 ◽  
Vol 63 (1) ◽  
pp. 59-73 ◽  
Author(s):  
Panying Rong
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Acoustic Analysis ◽  
Speaking Rate ◽  
Disease Stage ◽  
Healthy Controls ◽  
Tongue Movement ◽  
Major Barrier ◽  
Syllable Repetition ◽  
Oral Diadochokinesis ◽  
Lateral Sclerosis

Purpose The purpose of this article was to validate a novel acoustic analysis of oral diadochokinesis (DDK) in assessing bulbar motor involvement in amyotrophic lateral sclerosis (ALS). Method An automated acoustic DDK analysis was developed, which filtered out the voice features and extracted the envelope of the acoustic waveform reflecting the temporal pattern of syllable repetitions during an oral DDK task (i.e., repetitions of /tɑ/ at the maximum rate on 1 breath). Cycle-to-cycle temporal variability (cTV) of envelope fluctuations and syllable repetition rate (sylRate) were derived from the envelope and validated against 2 kinematic measures, which are tongue movement jitter (movJitter) and alternating tongue movement rate (AMR) during the DDK task, in 16 individuals with bulbar ALS and 18 healthy controls. After the validation, cTV, sylRate, movJitter, and AMR, along with an established clinical speech measure, that is, speaking rate (SR), were compared in their ability to (a) differentiate individuals with ALS from healthy controls and (b) detect early-stage bulbar declines in ALS. Results cTV and sylRate were significantly correlated with movJitter and AMR, respectively, across individuals with ALS and healthy controls, confirming the validity of the acoustic DDK analysis in extracting the temporal DDK pattern. Among all the acoustic and kinematic DDK measures, cTV showed the highest diagnostic accuracy (i.e., 0.87) with 80% sensitivity and 94% specificity in differentiating individuals with ALS from healthy controls, which outperformed the SR measure. Moreover, cTV showed a large increase during the early disease stage, which preceded the decline of SR. Conclusions This study provided preliminary validation of a novel automated acoustic DDK analysis in extracting a useful measure, namely, cTV, for early detection of bulbar ALS. This analysis overcame a major barrier in the existing acoustic DDK analysis, which is continuous voicing between syllables that interferes with syllable structures. This approach has potential clinical applications as a novel bulbar assessment.

Amyotrophic Lateral Sclerosis Assessment Questionnaire-5--Turkish Version

2019 ◽  
Author(s):  
Naile Alankaya ◽  
Zeliha Tülek ◽  
Aylin Özakgül ◽  
Alper Kaya ◽  
Aynur Dik
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Turkish Version ◽  
Assessment Questionnaire ◽  
Lateral Sclerosis

Amyotrophic Lateral Sclerosis Assessment Questionnaire-40--Turkish Version

2019 ◽  
Author(s):  
Naile Alankaya ◽  
Zeliha Tülek ◽  
Aylin Özakgül ◽  
Alper Kaya ◽  
Aynur Dik
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Turkish Version ◽  
Assessment Questionnaire ◽  
Lateral Sclerosis

Difference in cortical activity of lumbar- and bulbar-form of Amyotrophic lateral sclerosis: an fMRI study

2009 ◽  
Vol 40 (01) ◽  
Author(s):  
K Kollewe ◽  
K Krampfl ◽  
A Samii ◽  
R Dengler ◽  
T Münte ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Cortical Activity ◽  
Fmri Study ◽  
Lateral Sclerosis
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