Telephone Quality Research Articles

Cancer care and management during COVID-19: A comparison of in-person, video and telephone consultations

In Australia, the COVID-19 pandemic has resulted in the exponential growth in the delivery of telehealth services. Medicare data indicates that the majority of telehealth consultations have used the telephone, despite the known benefits of using video. The aim of this study was to understand the perceived quality and effectiveness of in-person, telephone and videoconsultations for cancer care. Data was collected via online surveys with consumers (n = 1162) and health professionals (n = 59), followed by semi-structured interviews with telehealth experienced health professionals (n = 22) and consumers (n = 18). Data were analysed using descriptive statistics and significance was tested using the chi-square test. A framework analysis and thematic analysis were used for qualitative data. Results indicate telehealth is suitable for use across the cancer care pathway. However, consumers and health professionals perceived videoconsultations facilitated visual communication and improved patients’ quality of care. The telephone was appropriate for short transactional consultations such as repeat prescriptions. Consumers were rarely given the choice of consultation modality. The choice of modality depended on a range of factors such as the type of consultation and stage of cancer care. Hybrid models of care utilising in-person, video and telephone should be developed and requires further guidance to promote the adoption of telehealth in cancer care.

Dysarthric speech detection from telephone quality speech using epoch-based pitch perturbation features

Dysarthric speech detection from telephone quality speech using epoch-based pitch perturbation features

Analysis of Instantaneous Frequency Components of Speech Signals for Epoch Extraction

The major impulse-like excitation in the speech signal is due to abrupt closure of the vocal folds, which takes place at the glottal closure instant (GCI) or epoch in each cycle. GCIs are used in many areas of speech science and technology, such as in prosody modification, voice source analysis, formant extraction and speech synthesis. It is difficult to observe these discontinuities (corresponding to GCIs) in the speech signal because of the superimposed time-varying response of the vocal tract system. This paper examines the phase part of different frequency components of the speech signal to extract epochs. Three analysis methods to decompose the speech signal into different frequency components are considered. These methods are the short-time Fourier transform (STFT), narrow bandpass filtering (NBPF), and single frequency filtering (SFF). The locations of the discontinuities in the speech signal are obtained from the instantaneous frequency (IF) (i.e., the time derivative of the phase) of each of the frequency components. A method for automatic detection of epochs using the amplitude weighted IF is proposed. Performance of the proposed epoch detection method is compared with four state-of-the-art methods in clean and telephone quality speech. The performance of the proposed method is comparable with the performance of the existing epoch detection methods for clean speech but better for telephone quality speech.

Variables Associated with Coronavirus Disease 2019 Vaccine Hesitancy Amongst Patients with Neurological Disorders.

Introduction: Given that the success of vaccines against coronavirus disease 2019 (COVID-19) relies on herd immunity, identifying patients at risk for vaccine hesitancy is imperative—particularly for those at high risk for severe COVID-19 (i.e., minorities and patients with neurological disorders). Methods: Among patients from a large neuroscience institute in Hawaii, vaccine hesitancy was investigated in relation to over 30 sociodemographic variables and medical comorbidities, via a telephone quality improvement survey conducted between 23 January 2021 and 13 February 2021. Results: Vaccine willingness (n = 363) was 81.3%. Univariate analysis identified that the odds of vaccine acceptance reduced for patients who do not regard COVID-19 as a severe illness, are of younger age, have a lower Charlson Comorbidity Index, use illicit drugs, or carry Medicaid insurance. Multivariable logistic regression identified the best predictors of vaccine hesitancy to be: social media use to obtain COVID-19 information, concerns regarding vaccine safety, self-perception of a preexisting medical condition contraindicated with vaccination, not having received the annual influenza vaccine, having some high school education only, being a current smoker, and not having a prior cerebrovascular accident. Unique amongst males, a conservative political view strongly predicted vaccine hesitancy. Specifically for Asians, a higher body mass index, while for Native Hawaiians and other Pacific Islanders (NHPI), a positive depression screen, both reduced the odds of vaccine acceptance. Conclusion: Upon identifying the variables associated with vaccine hesitancy amongst patients with neurological disorders, our clinic is now able to efficiently provide ancillary COVID-19 education to sub-populations at risk for vaccine hesitancy. While our results may be limited to the sub-population of patients with neurological disorders, the findings nonetheless provide valuable insight to understanding vaccine hesitancy.

Toward Improving the Performance of Epoch Extraction from Telephonic Speech

Epoch is an abrupt closure event within a glottal cycle at which significant excitation to the vocal-tract system happens during the production of voiced speech. The state-of-the-art zero frequency filtering technique is a simple and efficient method that shows robustness in extracting the epochs from clean speech. However, this method has shown poor performance for telephonic quality speech, due to the presence of spurious zero crossings in epoch evidence, which leads to a high false alarm rate. Recently, zero-phase zero frequency resonator (ZP-ZFR) an alternative to zero frequency filter is proposed for stable implementation of zero frequency filtering technique. In this study, higher-order ZP-ZFR is investigated to improve the performance of zero frequency filtering for epoch extraction from telephonic speech. The performance of the proposed ZP-ZFR method is quantitatively evaluated on telephonic speech simulated using six standard databases having simultaneous electroglottograph recordings as ground truth. Experimental results suggest that the performance of the proposed method is significantly better than the state-of-the-art methods in terms of identification rate and false alarm rate.

Quality of telephone nursing services for adults with cancer and related non-emergent visits to the emergency department.

A quality improvement project was conducted to determine the quality of telephone nursing for patients with cancer symptoms. Eligible patients were ones who telephoned the nurse about cancer symptom(s) within four weeks prior to an emergency department (ED) visit not requiring hospital admission. Experienced oncology nurses extracting data indicated appropriateness of ED visits and opportunities for improvement. The Symptom Management Analysis Tool was used to analyze nurse documentation. For 77 patients, 87% ED visits occurred within four days of calls about symptoms (e.g., pain, breathlessness, constipation, diarrhea, nausea/vomiting) and 91% could have been managed by more complete telephone assessment and/or an urgent clinic visit. Quality of nurse documentation revealed few patients were assessed adequately (38%), received any symptom-specific medication review (49%), or were guided in self-care strategies (17%). There was low-quality telephone symptom management by nurses and a need for alternative options for patients requiring urgent face-to-face assessments. Our findings highlight a gap in use of guidelines for informing telephone symptom management.

Quality of telephone nursing services for adults with cancer and related non-emergent visits to the emergency department

Un projet d’amélioration de la qualité a été mené afin de mesurer la qualité des interventions téléphoniques des infirmières auprès des patients présentant des symptômes associés au cancer. Les patients admissibles au projet avaient téléphoné à une infirmière pour signaler des symptômes dans les 4 semaines précédant une visite aux urgences qui n’avait pas requis d’hospitalisation. Les infirmières spécialisées en oncologie qui ont extrait les données évaluaient la pertinence des visites aux urgences et les points à améliorer. Nous avons eu recours à un outil d’analyse de la gestion des symptômes pour analyser la documentation du personnel infirmier. Sur 77 patients, 87 % des visites aux urgences ont eu lieu durant les 4 jours suivant un appel téléphonique justifié par la présence de symptômes (douleur, dyspnée, constipation, diarrhée, nausées ou vomissements, etc.). Dans 91 % des cas, une évaluation téléphonique plus exhaustive ou une consultation dans une clinique de soins d’urgence aurait suffi. Selon la documentation laissée par les infirmières, peu de patients ont été évalués adéquatement (38 %), ont bénéficié d’une révision de la médication traitant leurs symptômes (49 %) ou ont reçu des conseils sur les stratégies de soins autoadministrés (17 %). La qualité de la prise en charge des symptômes effectuée au téléphone par les infirmières laissait à désirer et il aurait fallu trouver des solutions de rechange pour les patients nécessitant une évaluation d’urgence en personne. Ces constats font ressortir des lacunes dans l’utilisation des directives sur la gestion téléphonique des symptômes.

Determination of glottal closure instants from clean and telephone quality speech signals using single frequency filtering

A new approach for determining the glottal activity from speech signals is presented in this paper. The approach is based on the use of single frequency filtering (SFF), proposed recently for voice activity detection. The variance (across frequency) of the spectral envelopes at each sampling instant is derived using the SFF of speech signal. The variance plot shows discontinuities corresponding to the impulse-like excitation within each glottal cycle. The proposed method uses filtering, thus avoiding the window effects of block processing, but the temporal resolution of the frequencies is still determined by the filtering process. The method also does not assume any knowledge of the average pitch period to derive the glottal activity features, such as the locations of the glottal closure instants (GCIs). The proposed GCI detection method is evaluated on five databases and compared with four existing methods on clean speech and telephone quality speech. From the experiments, it is observed that the performance of the proposed method is comparable to the existing methods on clean speech and significantly better on telephone quality speech.

Cognitive survey of telephone cardiopulmonary resuscitation among emergency personnel

Objectives To investigate the cognition of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) among emergency medical system(EMS) personnel and compare the cognition of TCPR among EMS personnel in different economic status, and to understand the current situation of TCPR cognition of EMS personnel in China. Methods This study is a multicenter cross-sectional survey. The method of multi-level convenient sampling was adopted, and the test reliability and split half reliability of the questionnaire was tested. Questionnaire survey and data collection were conducted from December 2018 to June 2019. The ethical approval number is M2018264. SPSS 20.0 was used for analysis. χ2 test was used to analyze the differences between groups. Results A total of 1 191 electronic questionnaires were collected. Of them, 80.94% respondents knew TCPR, 97.82% respondents thought that TCPR should be implemented in cardiac arrest, 36.62% respondents thought that bystander cardiopulmonary resuscitation quality monitoring was needed in TCPR, and TCPR training courses were set up in the emergency department which recruited 25.83% respondents. Emergency personnel in developed areas had a better understanding of the criteria for judging patients' breathlessness (11.69% vs 7.89%, P=0.048), of TCPR need ncluding guidance of chest compression (92.45% vs 87.49%, P=0.012) and of bystander cardiopulmonary resuscitation (BCPR) quality monitoring including the frequency of artificial respiration (84.42% vs 74.87%, P=0.029) than those in underdeveloped areas, but there was no significant difference in other indicators (P>0.05). Conclusions TCPR knowledge of EMS personnel in China is unsatisfactory. Further training is needed to improve their understanding of the criteria for judging cardiac arrest in out-of-hospital cardiac arrest patients via telephone, TCPR content and bystander cardiopulmonary resuscitation quality monitoring. There is difference in TCPR knowledge between the EMS personnel in developed and undeveloped areas in China. Key words: Emergency medical services; Telephone guidance; Cardiopulmonary resuscitation; Bystander; Out-of-hospital cardiac arrest; Cognition; Economic status; Cross-sectional survey

CWT-Based Approach for Epoch Extraction From Telephone Quality Speech

Epochs are the instants of significant excitation to vocal tract system. Existing methods can extract epochs accurately from clean speech signals. However, identification of epoch locations from band-limited telephonic speech is challenging due to the attenuation of fundamental frequency component and degradation caused by channel effect. This letter proposes an epoch extraction method that can accurately extract epochs from clean as well as telephonic speech signals. In the proposed method, the significant impulse-like discontinuities are extracted directly from the speech signal using continuous wavelet transform. The performance of the proposed method is evaluated using three speakers, namely, SLT, BDL, and JMK from CMU Arctic database. The clean speech is simulated using G.191 software tools to obtain telephonic speech. Experimental results show that the epoch identification rate of proposed method is significantly better than the state-of-the-art methods for the telephone quality speech.

Jitter Buffer Control Algorithm and Simulation Based on Network Traffic Prediction

The jitter buffer size is one of the important factors that affect the voice quality of Voice over Internet Protocol (VoIP). In order to reduce buffer delay and packet loss and improve the speech quality of VoIP, an adaptive jitter buffer control algorithm based on network traffic prediction is proposed. Among them, the particle swarm optimization algorithm is used to optimize the weight and threshold of Elman neural network so that it avoids falling into local minimum and improves the accuracy of network traffic prediction. According to the change law of network traffic, the jitter buffer control algorithm under the autoregressive model is proposed. Through the improved stochastic midpoint placement algorithm, a network business traffic prediction model with sudden and self-similarity is established. Then the buffer size is set according to the predicted value of network traffic, and it is continuously improved in use to improve the accuracy of the buffer setting. The simulation results show that the MOS value of the algorithm is high, which improves the voice quality of the network telephone.

The implementation of voice over internet protocol on private automatic branch exchange using analog telephone adapter

Voice over internet protocol is a technology that has offer to the telephone by Internet Protocol and has developed to be VoIP IP PBX which can be connected between VoIP and Private Automatic Branch eXchange, the use of technology VoIP IP PBX would be being easy more and emphasizing of the cost to the increasing extension telephone analog which is on the private automatic branch exchange without added Central Private Automatic Branch eXchange. To implemented that idea, so we make server VoIP by using elastix as IP PBX server which is installed to the PC, and then using analog telephone adapter as signal conversion analog to the digital to be connected to the private automatic branch exchange. Measuring is done by calling between client as much as 12 times in 5 minutes. And the value of quality of service Jitter is 2,004 ms, Delay is 91,562 ms, and Packet Loss is 3%, so it can be categorized that quality of internet telephone is well done, it is based on ITU-T G. 114.

The effect of three methods of follow-up (Short Message Service SMS , telephone and regular) on the quality of life in heart failure patients

Introduction Modern methods and telemonitoring manage care and control of chronic diseases has improved, meanwhile, the hospital use traditional methods to teach their patients. Aim: to compare the effectiveness of three methods of follow-up (SMS, telephone and regular follow up) on the quality of life in heart failure patients. methods In the randomized clinical trial, , patients with heart failure admitted to Emam Ali and Emam Reza hospitals were selected. The patients or dependent relatives of the patients had used mobile phones and text messages with a written consent participated in the study. With a convenience sampling the patients selected and patients randomly assigned to three groups of SMS, telephone and regular follow-up, respectively. Each patient was assessed before and 1, 2, 3 months after discharge respectively. To collect data, the Minnesota Living With Heart Failure Questionnaire was used. The data analyezed with software SPSS VER19 by paired t test, repeated measure ANOVA and curves. Finding Twenty five patients assigned to each group. there wasn’t statistically significant differences between the quality of life in the telephone follow up before and the first, second and third months, as well as in the regular follow-up (36±12.6, 41.7±14.4, 36.5±13.5 and 36±13.2 respectively) and also there wasn’t significant difference between before discharge and after 3 months in regular follow up (38±17 vs 39.7±17.7). in the follow up via SMS there was a significant difference between the quality of life before and the first, second and third months (49.6±21.5, 43.9±16.6, 39.1±13.8 and 38.4±12.6 respectively). Conclusion Because the heart failure patients need different education and follow up, the result of this study showed that SMS follow up can promote the patients’ quality of life, but telephone and usual follow up didn’t change the quality of change in heart failure patients. Hence, follow up by SMS may be considerd in these patients.

Asymptomatic congenital lung malformations: Is nonoperative management a viable alternative?

IntroductionThe purpose of this study was to evaluate clinical outcomes in children with asymptomatic congenital lung malformations (CLM) who were initially managed nonoperatively. MethodsAn IRB-approved retrospective review was performed on all CLMs at a single tertiary care referral center (Jan 2006–Dec 2016, n=140). Asymptomatic cases that did not undergo elective resection were evaluated for subsequent CLM-related complications based on clinical records and a telephone quality of life survey. ResultsOut of 39 (27.9%) who were initially managed nonoperatively, 13 (33%) developed CLM-related symptoms and underwent surgical intervention at a median age of 6.8years (range, 0.7–19.8years). The most common indication for conversion to operative management was pneumonia (78%). Larger lesions, as measured by CT scan, were significantly associated with the need for subsequent surgical intervention (mean maximal diameter, 5.7 vs. 2.9cm; p=0.005). Based on survey data with a median follow up of 3.9years (range, 0.2–13.2years), 17% developed chronic pulmonary symptoms, including cough (11%) and asthma requiring bronchodilators (12%). ConclusionAlthough these data support nonoperative management as a viable alternative to surgical resection, at least one-third of CLM children eventually develop pneumonia or other pulmonary symptoms. Larger lesions are correlated with an increased risk for eventual surgical resection. Level of EvidenceLevel IV.

Development and testing of the KERNset: an instrument to assess the quality of telephone triage in out-of-hours primary care services

BackgroundTelephone triage is a core but vulnerable part of the care process at out-of-hours general practitioner (GP) cooperatives. In the Netherlands, different instruments have been used for assessing the quality of telephone triage. These instruments focussed mainly on communicational aspects, and less on the medical quality of triage decisions. Our aim was to develop and test a minimum set of items to assess the quality of telephone triage.MethodsA national survey among all GP cooperatives in the Netherlands was performed to examine the most important aspects of telephone triage. Next, corresponding items from existing instruments were searched on these topics. Subsequently, an expert panel judged these items on importance, completeness and formulation. The concept KERNset consisted of 24 items about the telephone conversation: 13 medical, ten communicational and one regarding both types. It was pilot tested on measurement characteristics, reliability, validity and variation between triagists. In this pilot study, 114 anonymous calls from four GP cooperatives spread across the Netherlands were judged by three out of eight raters, both internal and external raters.ResultsCronbach’s alpha was .94 for the medical items and .75 for the communicational items. Inter-rater reliability: complete agreement between the external raters was 45% and reasonable agreement 73% (difference of maximally one point on the five-point scale). Intra-rater reliability: complete agreement within raters was 55% and reasonable agreement 84%. There were hardly any differences between internal and external raters, but there were differences in strictness between individual raters. The construct validity was confirmed by the high correlation between the general impression of the call and the items of the KERNset. Of the differences within items 19% could be explained by differences between triage nurses, which means the KERNset is able to demonstrate differences between triage nurses.ConclusionsThe KERNset can be used to assess the quality of telephone triage. The validity is good and differences between calls and between triage nurses can be measured. A more intensive training for raters could improve the reliability.

‘Telephone interpreting should be used only as a last resort.’ Interpreters’ perceptions of the suitability, remuneration and quality of telephone interpreting

ABSTRACTThis article reports on selected findings from a survey of 465 telephone interpreters in Australia, focusing on their opinions about the suitability, remuneration and quality of telephone interpreting. Results of this study revealed serious problems, such as telephone interpreting being used in inappropriate situations, and interpreters’ dissatisfaction with the low remuneration for telephone interpreting. The majority of interpreters preferred on-site interpreting to telephone interpreting. However, interpreters’ views on the accuracy of telephone interpretation versus on-site interpretation varied considerably. The key finding is that interpreters proposed various measures that would enhance the quality of telephone interpreting, indicating that interpreters, clients and interpreter employers need to work together to achieve that goal. These findings have implications for developing national protocols for telephone interpreting.

Epoch Extraction From Telephone Quality Speech Using Single Pole Filter

Epoch extraction from speech involves the suppression of vocal tract resonances, either by linear prediction based inverse filtering or filtering at very low frequency. Degradations due to channel effect and significant attenuation of low frequency components ( $ 300 Hz) create challenges for the epoch extraction from telephone quality speech. An epoch extraction method is proposed that considers the vertical striations present in the time-frequency representation of voiced speech as the representative candidates for the epochs. Time-frequency representation with better localized vertical striations is estimated using single pole filter based filter bank. The time marginal of time-frequency representation is computed to locate the epochs. The proposed algorithm is evaluated on the database of five speakers, which provide simultaneous speech and electroglottographic recordings. Telephone quality speech is simulated using G.191 software tools. The identification rate of the state-of-the-art methods degrades substantially for the telephone quality speech whereas that of the proposed method remains the same, comparable to that of clean speech.

The Effect of the Korean Buffet Selection Attributes on Customer Satisfaction and Customer Loyalty

The purpose of this study is to research and analysis what the attributes that consumers choose the Korean buffet targeting consumers of Korean buffet recently trend, and then it is carried out to demonstrate that this Korean buffet selection attributes is a significant variable affecting the consumer satisfaction and consumer loyalty. As a result of this study, research model was verified that quality, price, Kindness and cleanness in Korean buffet selection attributes sub-factors had significant positive(+) effect on consumer satisfaction and consumer loyalty, I think that marketing strategy that provides a healthy and delicious Korean menu using good food materials at a resonable price are consistent with customer expectations and needs. it was verified that convenience and approach in Korean buffet selection attributes sub-factors had not significant effect on consumer satisfaction and consumer loyalty, I think that surveyed area Korean buffet had poor accessibility because of it was located in the multi-complex shopping mall of complicated structure or in new town, had poor convenience because of rack of internet and SNS network for reservation and consultation and poor quality of telephone answering service. To summarize the result of this study, creative companies to meet the interests and needs recently increases for health of that can survive in the Food service market and can develop and then this study was attempt to build an academic foundation can give a significant positive effect on food-service businesses and customer.

Telephone Transmission and Earwitnesses: Performance on Voice Parades Controlled for Voice Similarity

The effect of telephone transmission on a listener's ability to recognise a speaker in a voice parade is investigated. A hundred listeners (25 per condition) heard 1 of 5 ‘target' voices, then returned a week later for a voice parade. The 4 conditions were: target exposure and parade both at studio quality; exposure and parade both at telephone quality; studio exposure with telephone parade, and vice versa. Fewer correct identifications followed from telephone exposure and parade (64%) than from studio exposure and parade (76%). Fewer still resulted for studio exposure/telephone parade (60%) and, dramatically, only 32% for telephone exposure/studio parade. Certain speakers were identified more readily than others across all conditions. Confidence ratings reflected this effect of speaker, but not the effect of exposure/parade condition.

Detection of the closure-burst transitions of stops and affricates in continuous speech using the plosion index

Automatic and accurate detection of the closure-burst transition events of stops and affricates serves many applications in speech processing. A temporal measure named the plosion index is proposed to detect such events, which are characterized by an abrupt increase in energy. Using the maxima of the pitch-synchronous normalized cross correlation as an additional temporal feature, a rule-based algorithm is designed that aims at selecting only those events associated with the closure-burst transitions of stops and affricates. The performance of the algorithm, characterized by receiver operating characteristic curves and temporal accuracy, is evaluated using the labeled closure-burst transitions of stops and affricates of the entire TIMIT test and training databases. The robustness of the algorithm is studied with respect to global white and babble noise as well as local noise using the TIMIT test set and on telephone quality speech using the NTIMIT test set. For these experiments, the proposed algorithm, which does not require explicit statistical training and is based on two one-dimensional temporal measures, gives a performance comparable to or better than the state-of-the-art methods. In addition, to test the scalability, the algorithm is applied on the Buckeye conversational speech corpus and databases of two Indian languages.