Developing an App-Based Voice Clinical Decision Support Tool to Augment the Sensitivity of the Bedside Swallow Evaluation in Older Adults

开发基于应用程序的语音临床决策支持工具，以提高老年人床边吞咽评估的灵敏度

• 批准号: 10522784
• 负责人: Anais Rameau
• 金额: $ 24.29万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-04 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10522784
• 关键词: Acoustics; Address; Adult; Advocacy; Affect; Aging; Alzheimer' s disease related dementia; Aspiration Pneumonia; Barium swallow; Behavioral Research; Biological Markers; Caring; Cause of Death; Cellular Phone; Characteristics; Clinical; Clinical Management; Collaborations; Coughing; Data; Deglutition; Deglutition Disorders; Dehydration; Dental Hygiene; Detection; Elderly; Environment; Evaluation; Evidence based treatment; Exercise; Fellowship; Food; Foundations; Functional disorder; Funding; Geriatrics; Goals; Grant; Head and Neck Surgery; Health Care Costs; Human; Individual; Language; Lead; Leadership; Length of Stay; Lung; Machine Learning; Malnutrition; Mentors; Mentorship; Methods; Morbidity - disease rate; Nurses; Nursing Assessment; Nursing Homes; Oral; Otolaryngologist; Otolaryngology; Pathologist; Patients; Perception; Performance; Pharyngeal structure; Pilot Projects; Protocols documentation; Research; Research Personnel; Risk; Site; Specialist; Speech; Standardization; Techniques; Technology; Testing; Time; United States National Institutes of Health; Vision; Voice; base; canine model; career; career development; clinical decision support; cohort; cost; curriculum development; dietary; digital; experience; flexibility; frailty; high risk; human old age (65+); improved; improved outcome; interdisciplinary collaboration; interest; medical schools; mobile application; mortality risk; novel strategies; prospective; skills; smartphone Application; sound; support tools; tool; treatment strategy; vibration; vocal cord

PROJECT SUMMARY/ABSTRACT The over-arching goals of Dr, Rameau's Beeson application are (1) to develop an easy-to-use, highly accurate bedside clinical decision support tool to identify swallowing dysfunction in older adults using analysis of features of their recorded voice, cough and speech, and (2) to become a leader in the nascent field of geriatric otolaryngology with a focus on management of speech and swallowing issues in older adults with Alzheimer's disease and related dementias (AD/ADRD). Candidate: The applicant, Dr. Anaïs Rameau, is an otolaryngologist at Weill Cornell Medical College (WCMC) who has demonstrated significant research ability and clinical interest in geriatric otolaryngology, especially in the care of older adults with dysphagia. Dr. Rameau's long-term career goal is to become an independent researcher and academic leader in geriatric dysphagia. She already laid significant foundations towards this goal, developing close mentorship relationships, gaining broad research, clinical, management and leadership skills, and experience as PI on multiple institutional and foundation grants. Mentors: To achieve her objectives, Dr. Rameau has engaged an exceptional, transdisciplinary team of mentors, who are highly successful, NIH-funded investigators and well-recognized leaders and experts in their respective fields. Her mentorship team includes Dr. Mark Lachs, Co-Director of the WCMC Division of Geriatrics, Dr. Michael Stewart, Chair of the WCM Department of Otolaryngology – Head & Neck Surgery, and Dr. Sara Czaja, Director of the Center on Aging and Behavioral Research at WCM. Research: In collaboration with bio-acousticians at the Cornell Lab of Ornithology, our research, both in an excised canine model and a human pilot study, has suggested that conventional acoustic metrics of voice and cough sound differ in important ways between patients with and without aspiration risk. These characteristics may serve as biomarkers of dysphagia, and acoustic analysis of the patient's digitally recorded voice and cough has the potential to effectively differentiate between normal and abnormal swallowing. Including multiple characteristics, such as those specifically evaluating oral frailty, and combining the results may increase accuracy of swallowing dysfunction identification, especially in older adults with AD/ADRD who are more prone to silent aspiration. Adding non-linear methods and machine learning to conventional acoustic analysis may also improve accuracy. Dr. Rameau proposes to use these techniques to develop a clinical decision support tool that incorporates analysis of multiple characteristics of a patient's recorded voice and cough to determine their aspiration risk. To increase the potential for use of this tool at the bedside, she will modify it for recordings on a smartphone as part of a mobile application. Upon completion of this research, she plans to submit an R01 to prospectively examine the performance of the clinical decision support tool in a multi-site RCT in large, diverse cohort of older adults.

项目概要/摘要 Rameau 博士的 Beeson 应用程序的总体目标是 (1) 开发一种易于使用、高度集成的 准确的床边临床决策支持工具，通过分析识别老年人的吞咽功能障碍 他们录制的声音、咳嗽和言语的特征，以及（2）成为新兴领域的领导者 老年耳鼻喉科，重点关注老年人言语和吞咽问题的管理 阿尔茨海默病和相关痴呆症 (AD/ADRD)。 候选人： 申请人Anaïs Rameau博士，是威尔康奈尔医学院（WCMC）的耳鼻喉科医生 他在老年耳鼻喉科方面表现出了显着的研究能力和临床兴趣，特别是在 Rameau 博士的长期职业目标是成为一名独立的患者。 她是老年吞咽困难领域的研究员和学术带头人，她已经为此奠定了重要的基础。 目标，发展密切的指导关系，获得广泛的研究、临床、管理和领导力 作为多个机构和基金会资助的 PI 的技能和经验。 导师：为了实现她的目标，拉莫博士聘请了一支杰出的跨学科团队 导师，他们是非常成功的、由 NIH 资助的研究人员以及其领域内公认的领导者和专家 她的导师团队包括 WCMC 部门联合主任 Mark Lachs 博士。 老年病学、WCM 耳鼻喉科 - 头颈外科系主任 Michael Stewart 博士，以及 Sara Czaja 博士，WCM 老龄化和行为研究中心主任。 研究：我们与康奈尔大学鸟类学实验室的生物声学专家合作，进行了 切除的犬科动物模型和人类试点研究表明，声音和声音的传统声学指标 有误吸风险的患者和无误吸风险的患者之间的咳嗽声音存在重要差异。 可以作为吞咽困难的生物标志物，并对患者的数字记录的声音进行声学分析 咳嗽有可能有效区分正常和异常吞咽，包括多次吞咽。 特征，例如专门评估口腔脆弱的特征，并将结果结合起来可能会增加 吞咽功能障碍识别的准确性，尤其是患有 AD/ADRD 的老年人，他们更容易发生这种情况 将非线性方法和机器学习添加到传统的声学分析中可能会实现无声的愿望。 Rameau 博士建议使用这些技术来开发临床决策支持。 该工具结合了对患者录制的声音和咳嗽的多种特征的分析，以确定 为了增加在床边使用该工具的可能性，她将对其进行修改以进行记录。 在智能手机上作为移动应用程序的一部分完成这项研究后，她计划提交 R01。 前瞻性地检验临床决策支持工具在大型多中心随机对照试验中的性能， 不同的老年人群体。