Stress Velopharyngeal Incompetence: Prevalence, Treatment, and Management Practices

2007 ◽  
Vol 44 (4) ◽  
pp. 424-433 ◽  
Author(s):  
Deonne Malick ◽  
Jerry Moon ◽  
John Canady
Keyword(s):  
Management Practices ◽  
Demographic Data ◽  
Posterior Wall ◽  
Fat Injection ◽  
Speech Language Pathologist ◽  
Velopharyngeal Incompetence ◽  
Management Techniques ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty ◽  
Typical Treatment

Objective: Stress velopharyngeal incompetence is the unwanted coupling of the oral and nasal cavities while brass and woodwind musicians play their instruments. This study investigated both (1) the prevalence of stress velopharyngeal incompetence in college musicians, delineating symptoms and situations possibly associated with the condition; and (2) physicians’ experiences with musicians exhibiting stress velopharyngeal incompetence, including typical treatment and management techniques. Methods: Questionnaires were distributed to 297 brass or woodwind student musicians at three public universities and to 998 plastic surgeons and otolaryngologists. The musician questionnaire focused on demographic data and identification of symptoms that might indicate the presence of stress velopharyngeal incompetence. The physician questionnaire addressed demographics of the physician and his or her practice, familiarity and experience with stress velopharyngeal incompetence, and treatment and management suggestions for individuals experiencing the condition. Results: Thirty-four percent of the responding musicians reported symptoms of stress velopharyngeal incompetence, most often after 30 minutes of playing. Forty-five percent of the responding physicians reported being familiar with the term stress velopharyngeal incompetence, although only 27% reported ever having seen a patient with the condition. The seven most frequently reported intervention strategies were referral to a speech language pathologist (47.50%), sphincter pharyngoplasty (30.00%), pharyngeal flap (26.88%), referral to a cleft palate team (24.38%), watch and wait (18.75%), posterior wall fat injection (12.50%), and palatal lift (10.00%). Conclusions: Stress velopharyngeal incompetence is a potentially career-ending (or career-preventing) problem that currently may be undertreated and that is in need of more systematic study both in terms of its physiologic underpinnings and its management.

Surgical Considerations and Choices in the Management of Velopharyngeal Dysfunction

2015 ◽  
Vol 25 (2) ◽  
pp. 54-65 ◽  
Author(s):  
John Jensen ◽  
Michael VanLue
Keyword(s):  
Surgical Technique ◽  
Cleft Palate ◽  
Comprehensive Evaluation ◽  
Surgical Techniques ◽  
Speech Language Pathologist ◽  
Imaging Results ◽  
History Of ◽  
Pharyngeal Flap ◽  
Sphincter Pharyngoplasty ◽  
Velopharyngeal Function

Determining the type of secondary surgical management to treat velopharyngeal dysfunction requires the incorporation of surgical indications and principles to the perceptual, acoustic/airflow, and imaging results of a comprehensive evaluation by a speech-language pathologist. In addition, how the specific type of surgical technique (primary and/or secondary) may affect velopharyngeal function also should be considered. The purpose of this paper is to consider three standard techniques commonly employed in speech surgery—Pharyngeal Flap; Sphincter Pharyngoplasty; and Furlow Double Opposing Z-Plasty—and provide examples of the specific imaging parameters that support the choice of surgical technique. In addition, information is provided regarding the characteristics of different primary surgical techniques for cleft palate which can influence velopharyngeal closure, given that the most common cause of velopharyngeal dysfunction seen in the clinic is a patient with a history of repaired cleft palate.

Impression management and legitimacy strategies: The BP case

2013 ◽  
pp. 35-64 ◽  
Author(s):  
Giovanna Michelon
Keyword(s):  
Impression Management ◽  
Management Practices ◽  
Legitimacy Theory ◽  
British Petroleum ◽  
Wide Range ◽  
Management Techniques ◽  
Disclosure Tone ◽  
The Empirical Analysis ◽  
A Company ◽  
Texas City

The aim of this paper is to study if and how impression management varies during different phases of the legitimation process, in particular during the legitimacy building and legitimacy repairing phases (Suchman, 1995). We aim at understanding whether and how the disclosure tone adopted by a company in the two different moments is diverse and thus functional to the intrinsic objective of the each phase. The empirical analysis focuses on the case of British Petroleum Plc. We investigated the impression management practices undertaken by the company both during the preparation of the rebranding operation, i.e. a situation in which the company is trying to build legitimacy; and during the happenings of two legitimacy crises, like the explosion of the refinery in Texas City and the oil spill in the Gulf of Mexico. The evidence appears in line with the theoretical prediction of legitimacy theory. Results show that while the company tends to privilege image enhancement techniques during the legitimacy-building phase, it uses more obfuscation techniques when managing a legitimacy-repairing process. Moreover, the analysis suggests that the company makes more extensive use of impression management techniques in the disclosures addressed to shareholders, investors and other market operators than in the disclosures addressed to the wide range of other stakeholders.

scholarly journals Patients perspectives on drug shortages in six European hospital settings – a cross sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Darija Kuruc Poje ◽  
Domagoj Kifer ◽  
Isabelle Huys ◽  
Joao Miranda ◽  
Helena Jenzer ◽  
...  
Keyword(s):  
Management Practices ◽  
Healthcare Professionals ◽  
Demographic Data ◽  
General Information ◽  
Basic Knowledge ◽  
Drug Shortage ◽  
Cross Sectional ◽  
Drug Shortages ◽  
Good Communication ◽  
Information Preferences

Abstract Background It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages. Methods A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3). Results 6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p < 0.001) while the fewest patients were in H-SE (1 %, N = 1/100, p = 0.001). In addition, 82.5 %, (N = 501/607) of respondents wanted to be informed of alternative treatment options if there was a drug shortage without a generic substitute available. Majority of these patients (66.4 %, N = 386/501) prefer to be informed by a healthcare professional. Conclusions Although drug shortages led to serious medical consequences, our findings show that most of the patients did not perceive shortages as a problem. One possible interpretation is that good hospital management practices by healthcare professionals helped to mitigate the perceived impact of shortages. Our study highlights the importance of a good communication especially between patients and healthcare professionals in whom our patients have the greatest trust.

scholarly journals Integrated Management of Downy Mildew on Slicing Cucumber With Fungicides and Host Resistance But Not Trellising

Plant Disease ◽  
2019 ◽  
Vol 103 (10) ◽  
pp. 2592-2598
Author(s):  
Anthony P. Keinath
Keyword(s):  
Downy Mildew ◽  
Host Resistance ◽  
Management Practices ◽  
Integrated Management ◽  
Cultivar Resistance ◽  
Fall Season ◽  
Fungicide Treatment ◽  
Progress Curve ◽  
Management Techniques ◽  
The Mean

The objective of this study was to evaluate fungicide applications, host resistance, and trellising, alone and in combination, as management practices for downy mildew on slicing cucumber. A split-split plot experimental design was used with three and four replications in spring and fall 2017, respectively. The whole-plot treatment was fungicide, four applications of chlorothalonil (Bravo Weather Stik 6SC) alternated with three applications of cyazofamid (Ranman 400SC), or water. Split plots were nontrellised or trellised with four strings supported by stakes. Split-split plots were cultivar Bristol, which is intermediately resistant to downy mildew, or cultivar Speedway, which is susceptible to downy mildew with similar parentage as Bristol. In both seasons, area under the disease progress curve (AUDPC) values were lower with fungicides than water for both cultivars. In the spring, AUDPC for Bristol was lower than for Speedway regardless of fungicide treatment. In the fall, Bristol had a lower AUDPC than Speedway with fungicides, but the AUDPC did not differ between the two cultivars with water. The mean AUDPC for trellised plants (376.2) was lower than for nontrellised plants (434.0; P = 0.007). Fungicide applications increased marketable and total fruit weights in both seasons (P ≤ 0.0002). Marketable weight with fungicides was almost double (93% greater) the marketable weight with water. Marketable weight was 55% greater for Bristol than for Speedway in spring, but yields did not differ between cultivars in fall (season-by-cultivar interaction, P ≤ 0.0003). Because trellising had no effect on marketable yields (P = 0.11), trellising is not recommended for managing downy mildew on slicing cucumber. Of the three management techniques examined, fungicides had the largest effects on disease and yields, followed by cultivar resistance.

SPHINCTER PHARYNGOPLASTY, FOR VELOPHARYNGEAL INCOMPETENCE

1992 ◽  
Vol 85 (Supplement) ◽  
pp. 3S-86
Author(s):  
L. Dwight Baker ◽  
R. P. Clay ◽  
Uldis Bite ◽  
I. T. Jackson
Keyword(s):  
Velopharyngeal Incompetence ◽  
Sphincter Pharyngoplasty

scholarly journals Routine veterinary anaesthetic management practices in South Africa

2000 ◽  
Vol 71 (3) ◽  
Author(s):  
K.E. Joubert
Keyword(s):  
South Africa ◽  
Mortality Rate ◽  
Continuing Education ◽  
Management Practices ◽  
Demographic Data ◽  
Anaesthetic Management ◽  
Practice Size ◽  
Induction Of Anaesthesia ◽  
Education Courses ◽  
Induction Agents

A survey of the routine anaesthetic management of dogs and cats during sterilisation by veterinarians in South Africa was conducted. This report describes the premedication, induction and maintenance agents most commonly used in dogs and cats. Information about monitoring of patients during the procedure and who is responsible for induction of anaesthesia and monitoring was obtained. Questionnaires were analysed with regard to demographic data, practice size, continuing education, the number of surgical procedures and sterilisations performed per week and an estimate of yearly mortality. Acetylpromazine is the most commonly used premedication in dogs and xylazine in cats. Thiopentone in dogs and alphaxalone/alphadolone in cats were the induction agents most commonly used. Alphaxalone/alphadolone in cats and halothane in dogs are the most commonly used maintenance agents. Records of anaesthesia are poorly kept and monitoring of patients is poorly performed. Respiratory rate is the parameter most commonly monitored (90.7 %), and in most cases is the sole parameter. On average 10.34 ± 8.25 cats were operated per week, of which 5.45 ±5.60 were sterilised; 17.79 ±11.61 dogs were operated per week, of which 8.65 ±7.10 were sterilised. In total, 190 patients died under anaesthesia, a mortality rate of 1:1243. Just over 50 % of practitioners had attended continuing education courses during their careers.

scholarly journals Children’s Nurses’ Knowledge and Attitudes on Paediatric Pain: A Descriptive Cross-Sectional Survey in a Developing Country

2020 ◽  
Vol 10 (3) ◽  
pp. 222-233
Author(s):  
Evans Oduro ◽  
Abigail Kusi-Amponsah Diji ◽  
Grace Kusi ◽  
Albert Amagyei ◽  
Joana Kyei-Dompim ◽  
...  
Keyword(s):  
Professional Education ◽  
Management Practices ◽  
Demographic Data ◽  
Pediatric Pain ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Knowledge And Attitudes ◽  
Hospital Facility ◽  
Pain Knowledge ◽  
Nurses Knowledge

Background: Children’s nurses’ knowledge of pain affects their pain management practices. Even though poor knowledge and attitudes have been reported in several studies, most were carried out in developed settings. However, little has been reported on the management of paediatric pain by nurses in resource-limited settings such as in sub-Saharan Africa.Purpose: This study sought to assess the knowledge and perceptions of children’s nurses regarding paediatric pain in a Ghanaian context.Methodology: A descriptive cross-sectional survey was carried out among 65 nurses at eight hospitals at various levels of healthcare in Ghana. Over three months, participants’ demographic data and responses on the Pediatric Nurses Knowledge and Attitude Survey Regarding Pain (PNKAS) instrument were collected. Data were analyzed and presented using descriptive and inferential statistics.Results: Participants’ average (SD) knowledge and attitudes regarding paeditric pain was 36.7% (6.9%) and ranged from 21.4% to 57.1%. Pediatric pain knowledge and attitudes (PPKA) of the nurses differed based on working years in the children’s unit and the hospital type they worked in (p<0.05). Nevertheless, the type of hospital facility was the only independent predictor of their PPKA (R2=0.181, p<0.001).Conclusion: Children nurses in this setting generally had insufficient knowledge and attitudes on paediatric pain. They should be motivated to undertake self-directed learning and regular continuing professional education to update their knowledge, attitude and skills on evidence-based pediatric pain assessment and management. 

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