Geen bedrijf ontkomt eraan om in zijn processen gebruik te maken van ICT en dan met name van webtoepassingen. WIe dat niet doet - van notaris tot grootgrutter en telecombedrijf - raakt onherroepelijk klanten kwijt. Het succes waarmee in een continu verbeteringsproces ingespeeld wordt op klantwensen en gelijktijdig transactiekosten worden verlaagd, is bepalend voor sneven of overleven. De feitelijke toepassingen en onderliggende technieken ontwikkelen zich zo snel, dat verstard management een organisatie al bij voorbaat op fatale achterstand zet. De eisen aan het management lijken welhaast met elkaar in tegenspraak, klantgericht, flexibel, gestructureerd, innovatief en kostenbewust. In dit artikel passeren benaderingen de revue die het management vat geven op de bedrijfsprestatie. En hoe daarover te communiceren. Zeker is dat niets zonder zwaarwegende rededen kan blijven zoals het was.
DOCUMENT
From the introduction: "There are two variants of fronto-temporal dementia: a behavioral variant (behavioral FTD, bvFTD, Neary et al. (1998)), which causes changes in behavior and personality but leaves syntax, phonology and semantics relatively intact, and a variant that causes impairments in the language processing system (Primary Progessive Aphasia, PPA (Gorno-Tempini et al., 2004). PPA can be subdivided into subtypes fluent (fluent but empty speech, comprehension of word meaning is affected / `semantic dementia') and non-fluent (agrammatism, hesitant or labored speech, word finding problems). Some identify logopenic aphasia as a FTD-variant: fluent aphasia with anomia but intact object recognition and underlying word meaning."
MULTIFILE
Pauses in speech may be categorized on the basis of their length. Some authors claim that there are two categories (short and long pauses) (Baken & Orlikoff, 2000), others claim that there are three (Campione & Véronis, 2002), or even more. Pause lengths may be affected in speakers with aphasia. Individuals with dementia probably caused by Alzheimer’s disease (AD) or Parkinson’s disease (PD) interrupt speech longer and more frequently. One infrequent form of dementia, non-fluent primary progressive aphasia (PPA-NF), is even defined as causing speech with an unusual interruption pattern (”hesitant and labored speech”). Although human listeners can often easily distinguish pathological speech from healthy speech, it is unclear yet how software can detect the relevant patterns. The research question in this study is: how can software measure the statistical parameters that characterize the disfluent speech of PPA-NF/AD/PD patients in connected conversational speech?
DOCUMENT
From the article: "Individuals with dementia often experience a decline in their ability to use language. Language problems have been reported in individuals with dementia caused by Alzheimer’s disease, Parkinson’s disease or degeneration of the fronto-temporal area. Acoustic properties are relatively easy to measure with software, which promises a cost-effective way to analyze larger discourses. We study the usefulness of acoustic features to distinguish the speech of German-speaking controls and patients with dementia caused by (a) Alzheimer’s disease, (b) Parkinson’s disease or (c) PPA/FTD. Previous studies have shown that each of these types affects speech parameters such as prosody, voice quality and fluency (Schulz 2002; Ma, Whitehill, and Cheung 2010; Rusz et al. 2016; Kato et al. 2013; Peintner et al. 2008). Prior work on the characteristics of the speech of individuals with dementia is usually based on samples from clinical tests, such as the Western Aphasia Battery or the Wechsler Logical Memory task. Spontaneous day-to-day speech may be different, because participants may show less of their vocal abilities in casual speech than in specifically designed test scenarios. It is unclear to what extent the previously reported speech characteristics are still detectable in casual conversations by software. The research question in this study is: how useful for classification are acoustic properties measured in spontaneous speech."
MULTIFILE
Analysis of spontaneous speech is an important tool for clinical linguists to diagnose various types of neurodegenerative disease that affect the language processing areas. Prosody, fluency and voice quality may be affected in individuals with Parkinson's disease (PD, degradation of voice quality, unstable pitch), Alzheimer's disease (AD, monotonic pitch), and the non-fluent type of Primary Progressive Aphasia (PPA-NF, hesitant, non-fluent speech). In this study, the performance of a SVM classifier is evaluated that is trained on acoustic features only. The goal is to distinguish different types of brain damage based on recorded speech. Results show that the classifier can distinguish some dementia types (PPA-NF, AD), but not others (PD).
DOCUMENT
Aims: To detect differences in speech fluency in separate primaryprogressive aphasia syndromes (PPA) using automated analysistechniques. The resulting linguistic features are evaluated for theiruse in a predictive model to identify common patterns in speakerswith PPA. As fluency is observable in audio recordings, its quantifi-cation may provide a low-cost instrument that augments sponta-neous speech analyses in clinical practice.Methods and Procedures: Speech was recorded in 14 controls, 7nonfluent variant (nfvPPA) and 8 semantic variant (svPPA) speakers.The recordings were annotated for speech and non-speech withKaldi, a common toolkit for speech processing software. Variablesrelating to fluency (pause rate, number of pauses, length of pauses)were analyzed.Outcomes and Results: The best fitting distribution of pause dura-tion was a combination of two Gaussian distributions, correspond-ing with pause categories short vs. long.Group level differences were found in the rate of pauses andproportion of silence: nfvPPA speakers use more short pausesrelative to long pauses than control speakers, and the duration ofshort and long pauses is longer; svPPA speakers use more longerpauses relative to short pauses. Their short pauses are significantlyshorter than those from control speakers.Participants in both PPA groups pause more frequently. SvPPAspeakers are typically perceived as fluent. However, our analysisshows their fluency patterns to be distinct from control speakers, ifthe long-short distinction is observed.Conclusions: Automatic measurements of pause duration showmeaningful distinctions across the groups and might provide futureaid in clinical assessment.
MULTIFILE
This Article presents the PSO matrix as a tool for making choices in change projects – choices for simplicity or for complexity. A good process structure is essential for a simple organization, but it is the employees and the managers who are expected to take the lead in the changes and the improvement proposals. The PSO matrix is a useful and usable instrument that promotes simplicity and respects the intelligence that is already present in the organization, particularly that of the ordinary employees. The approach leads to drastic savings. Do as much nothing as possible.
MULTIFILE
Purpose (1) To investigate the differences in the course of participation up to one year after stroke between distinct movement behavior patterns identified directly after discharge to the home setting, and (2) to investigate the longitudinal association between the development of movement behavior patterns over time and participation after stroke. Materials and methods 200 individuals with a first-ever stroke were assessed directly after discharge to the home setting, at six months and at one year. The Participation domain of the Stroke Impact Scale 3.0 was used to measure participation. Movement behavior was objectified using accelerometry for 14 days. Participants were categorized into three distinct movement behavior patterns: sedentary exercisers, sedentary movers and sedentary prolongers. Generalized estimating equations (GEE) were performed. Results People who were classified as sedentary prolongers directly after discharge was associated with a worse course of participation up to one year after stroke. The development of sedentary prolongers over time was also associated with worse participation compared to sedentary exercisers. Conclusions The course of participation after stroke differs across distinct movement behavior patterns after discharge to the home setting. Highly sedentary and inactive people with stroke are at risk for restrictions in participation over time. Implications for rehabilitation The course of participation in people with a first-ever stroke up to one year after discharge to the home setting differed based on three distinct movement behavior patterns, i.e., sedentary exercisers, sedentary movers and sedentary prolongers. Early identification of highly sedentary and inactive people with stroke after discharge to the home setting is important, as sedentary prolongers are at risk for restrictions in participation over time. Supporting people with stroke to adapt and maintain a healthy movement behavior after discharge to the home setting could prevent potential long-term restrictions in participation.
MULTIFILE
Background: Patient participation in goal setting is important to deliver client-centered care. In daily practice, however, patient involvement in goal setting is not optimal. Patient-specific instruments, such as the Patient Specific Complaints (PSC) instrument, can support the goal-setting process because patients can identify and rate their own problems. The aim of this study is to explore patients’ experiences with the feasibility of the PSC, in the physiotherapy goal setting. Method: We performed a qualitative study. Data were collected by observations of physiotherapy sessions (n=23) and through interviews with patients (n=23) with chronic conditions in physiotherapy practices. Data were analyzed using directed content analysis. Results: The PSC was used at different moments and in different ways. Two feasibility themes were analyzed. First was the perceived ambiguity with the process of administration: patients perceived a broad range of experiences, such as emotional and supportive, as well as feeling a type of uncomfortableness. The second was the perceived usefulness: patients found the PSC useful for themselves – to increase awareness and motivation and to inform the physiotherapist – as well as being useful for the physiotherapist – to determine appropriate treatment for their personal needs. Some patients did not perceive any usefulness and were not aware of any relation with their treatment. Patients with a more positive attitude toward questionnaires, patients with an active role, and health-literate patients appreciated the PSC and felt facilitated by it. Patients who lacked these attributes did not fully understand the PSC’s process or purpose and let the physiotherapist take the lead. Conclusion: The PSC is a feasible tool to support patient participation in the physiotherapy goal setting. However, in the daily use of the PSC, patients are not always fully involved and informed. Patients reported varied experiences related to their personal attributes and modes of administration. This means that the PSC cannot be used in the same way in every patient. It is perfectly suited to use in a dialogue manner, which makes it very suitable to improve goal setting within client-centered care.
DOCUMENT
Abstract Background: Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. Methods: This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. Results: In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as “age-unfriendly structure,” “inefficient care,” and “frailty of older adults” could increase the risk of MNC. In addition, factors such as “support capabilities” and “ethical and legal requirements” will moderate MNC. Conclusions: Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.
DOCUMENT
