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Akhtar RN, Behn N, Morgan S. Understanding Dysphagia Care in Pakistan: A Survey of Current Speech Language Therapy Practice. Dysphagia 2024; 39:484-494. [PMID: 38006420 PMCID: PMC11127846 DOI: 10.1007/s00455-023-10633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/19/2023] [Indexed: 11/27/2023]
Abstract
Dysphagia affects individuals across all ages and has pervasive and potentially life-threatening consequences. Individuals with dysphagia are assessed and treated by speech and language therapists (SLTs), however, little attention has been paid to their practices in Pakistan. This study aimed to explore SLTs practices for dysphagia assessment, signs and symptoms observed during evaluation, and management strategies, alongside barriers and facilitators to service delivery in Pakistan. A 45-item survey was distributed to SLTs online. Responses were received from 101 participants and analyzed descriptively, and open-text responses were analyzed using content analysis. Results revealed that 65.3% SLTs worked across the lifespan, and most (79.4%) had dysphagia-related experience of five years or less. SLTs were an active workforce engaged with varying ages, disorders, and settings, yet dysphagia contributed to a small caseload percentage for most. Analyses found informal clinical exams were more frequently used than instrumental assessments. A variety of service provision facilitators were described, such as supportive teams and accessible resources, and responses about barriers revealed gaps in awareness, education, and guidance. This exploratory study presents novel and unexplored data which provides a deeper understanding of dysphagia-related care in Pakistan.
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Affiliation(s)
- Rohma N Akhtar
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK.
- City University of London, London, UK.
| | - Nicholas Behn
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK
- City University of London, London, UK
| | - Sally Morgan
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK
- City University of London, London, UK
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2
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Volkert D, Beck AM, Faxén-Irving G, Frühwald T, Hooper L, Keller H, Porter J, Rothenberg E, Suominen M, Wirth R, Chourdakis M. ESPEN guideline on nutrition and hydration in dementia - Update 2024. Clin Nutr 2024; 43:1599-1626. [PMID: 38772068 DOI: 10.1016/j.clnu.2024.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND & AIMS Dementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes. METHODS The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process. RESULTS 40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points. CONCLUSION Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Gerd Faxén-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frühwald
- Department of Geriatric Acute Care, Hietzing Municipal Hospital, Vienna, Austria
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Heather Keller
- Department of Kinesiology & Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Judi Porter
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Elisabet Rothenberg
- Department of Nursing and Integrated Health Sciences, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Matsumura E, Nohara K, Fukatsu H, Tanaka N, Fujii N, Sakai T. Effects of Thickening Agents on the Mucociliary Transport Function: Comparison by the Type of Thickening Agents and the Viscosity of Thickened Water. Dysphagia 2024:10.1007/s00455-024-10704-3. [PMID: 38777870 DOI: 10.1007/s00455-024-10704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/26/2024] [Indexed: 05/25/2024]
Abstract
Thickening agents effectively prevent liquid aspiration, but their impact on the ease of discharging aspirated liquids from the trachea remains unclear due to alterations in the physical properties of liquids. This study clarifies the effects of thickening agents, comprising various raw materials, on mucociliary transport function, focusing on the viscosities of thickened waters. The subjects were 23 healthy adults. Five types of saccharin solution were prepared: a solution without a thickening agent, a starch-based nectar-like solution, a starch-based honey-like solution, a xanthan-gum-based nectar-like solution, and a xanthan-gum-based honey-like solution. Using these five types of saccharin solutions randomly, each subject underwent five trials of the saccharine dye test to evaluate the mucociliary transport function of the respiratory tract. The saccharin time was defined as the time from the placement of the saccharin solution on the nasal vestibule of the subject to when the subject reported that they became aware of the sweetness. The saccharin transit times for all samples of thickened water were longer compared to those of water without a thickening agent (p < 0.01). A comparison between thickened water samples with different viscosities showed that the saccharin transit time was longer when thickened water samples with high viscosity were prepared using the same thickening agent (p < 0.01). This suggests that while thickening reduces aspiration, the use of thickening agents may increase the difficulty in discharging aspirated fluids from the trachea.
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Affiliation(s)
- Erika Matsumura
- Division for Oral-Facial Disorders, Osaka University Dental Hospital, Osaka, Japan
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kanji Nohara
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hikari Fukatsu
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Fukatsu Dental Clinic, Mie, Japan
| | - Nobukazu Tanaka
- Division for Oral-Facial Disorders, Osaka University Dental Hospital, Osaka, Japan
| | - Nami Fujii
- Division for Oral-Facial Disorders, Osaka University Dental Hospital, Osaka, Japan
| | - Takayoshi Sakai
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Decker SRDR, Tomanchieviez M, Lauxen LJ, Teixeira C, Rosa RG. Swallowing interventions for older in-hospital patients: have we appropriately selected the desired outcomes? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231403. [PMID: 38716948 PMCID: PMC11068373 DOI: 10.1590/1806-9282.20231403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/29/2023] [Indexed: 05/12/2024]
Affiliation(s)
| | - Maiara Tomanchieviez
- Hospital Moinhos de Vento, Internal Medicine Service – Porto Alegre (RS), Brazil
| | | | - Cassiano Teixeira
- Hospital Moinhos de Vento, Internal Medicine Service – Porto Alegre (RS), Brazil
| | - Regis Goulart Rosa
- Hospital Moinhos de Vento, Internal Medicine Service – Porto Alegre (RS), Brazil
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Davies V, Taylor M. Nutritional and hydration interventions for people with dysphagia. Nurs Stand 2024; 39:77-81. [PMID: 38544435 DOI: 10.7748/ns.2024.e12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
Dysphagia (swallowing difficulties) is particularly common in older people and is associated with various health conditions. Dysphagia affects an individual's ability to eat and drink, and can have a significant effect on their clinical outcomes and quality of life. This article explores ways in which nurses can support people with dysphagia to minimise the effects of the condition and enhance their quality of life. The authors examine the role of commonly used strategies such as dietary texture modification and thickened fluids that aim to optimise nutrition and hydration. However, some of the management options for dysphagia do not have a strong evidence base, so nurses should consider whether any dietary restrictions are proportionate and ensure that their benefits outweigh the risks.
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Affiliation(s)
- Vicky Davies
- Faculty of Social and Life Sciences, Wrexham University, Wrexham, Wales
| | - Melanie Taylor
- The Walton Centre NHS Foundation Trust, Liverpool, England
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Kocica J, Lasotova N, Kolcava J, Svobodova M, Hladikova M, Stourac P, Bednařík J, Vlckova E. Screening for dysphagia in patients with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2024; 83:105418. [PMID: 38262330 DOI: 10.1016/j.msard.2023.105418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND In multiple sclerosis (MS), dysphagia is an important and common clinical symptom. Although often overlooked and underdiagnosed, it can have a significant impact on a patient's life, including social integration, and it can lead to malnutrition, aspiration pneumonia, and suffocation, i.e., life-threatening complications. Early detection of dysphagia is essential to prevent these risks. However, the optimal screening method and the inter-relationship between different methods used for dysphagia screening are not clear. The aim of this study was to compare the diagnostic performance of a simple question about swallowing problems, the DYsphagia in MUltiple Sclerosis (DYMUS) swallowing questionnaire, and the Timed Water Swallowing Test (TWST) to detect dysphagia in people with relapsing-remitting MS (RRMS). METHODS Patients with MS were asked about subjective swallowing difficulties and, regardless of their response, completed the DYMUS questionnaire and underwent the TWST at their routine follow-up visit. Patients with at least one positive screening method were offered an objective assessment of swallowing function using the Fiberoptic Endoscopic Evaluation of Swallowing (FEES). The results were statistically analyzed and correlated with demographic and MS-related parameters. RESULTS Of the 304 people with RRMS enrolled in the study, 46 (15.1 %) reported having subjective difficulty swallowing when asked a simple question. The DYMUS questionnaire was positive in 59 (19.4 %) of the 304 patients; 51 (16.8 %) had an abnormality on the TWST. A clear correlation (r = 0.351, p < 0.01) was found between the DYMUS and TWST results, but a significant proportion of patients (about half) had an abnormality on only one of these tests. The positivity of at least one of the screening methods used (DYMUS or TWST) had a better chance of identifying a patient with dysphagia than a simple question (p < 0.001). Of the patients with a positive result for difficulty swallowing, 37 underwent FEES, which confirmed dysphagia in 94.6% of this subgroup. Patients with higher Expanded Disability Status Scale (EDSS) scores, female gender, and older age were at higher risk of developing dysphagia. CONCLUSION The DYMUS questionnaire and TWST had a confirmed potential to identify more patients with dysphagia than a simple question about swallowing problems. However, our study found only a partial overlap between DYMUS and TWST; a combination of these two methods was more sensitive in identifying patients with MS at risk of dysphagia. Furthermore, the screening showed excellent specificity: almost 95 % of the positively screened patients had dysphagia confirmed by objective methods. Age, female gender, and a higher EDSS score appear to be potential risk factors for dysphagia in patients with MS.
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Affiliation(s)
- Jan Kocica
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, The University Hospital Brno, Czech Republic
| | - Nadezda Lasotova
- Department of Neurology, The University Hospital Brno, Czech Republic; Faculty of Education, Department of Special and Inclusive Education, Masaryk University, Brno, Czech Republic
| | - Jan Kolcava
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, The University Hospital Brno, Czech Republic.
| | - Monika Svobodova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, The University Hospital Brno, Czech Republic
| | - Magdalena Hladikova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, The University Hospital Brno, Czech Republic
| | - Pavel Stourac
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, The University Hospital Brno, Czech Republic
| | - Josef Bednařík
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, The University Hospital Brno, Czech Republic
| | - Eva Vlckova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, The University Hospital Brno, Czech Republic
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Kokush EM, Patel R, Boardingham CE, Rothman BF, Ward J, McKay OA, Yonclas P, Glass NE. Assessing Knowledge, Usage, and Perceptions of the Frazier Free Water Protocol: A Pilot Study. J Surg Res 2024; 293:381-388. [PMID: 37806225 DOI: 10.1016/j.jss.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/04/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Dysphagia is very common among hospitalized patients and is associated with increased length of hospital stay, morbidity, and mortality. Diet restrictions for dysphagia cause dehydration and discontent. The Frazier Free Water Protocol (FFWP) was developed to improve hydration and quality of life in dysphagia patients by establishing the safety of allowing sips of water between meals. Despite these potential benefits, we hypothesized that the FFWP is not widely utilized. We sought to determine barriers to utilization by assessing the familiarity, usage, and perceptions of the FFWP among health-care providers at our institution. METHODS We distributed an anonymous questionnaire to a convenience sample of nurses in the hospital during daily huddles. The questionnaire was adapted from a validated framework to assess provider acceptability of health-care interventions. RESULTS Of the 66 surveys distributed, we had 58 completed (88%). Only 10 nurses (17%) had heard of the "FFWP" by name. For those that were familiar with the indications, benefits, and risks of giving free water to patients with dysphagia (n = 18), less than half (39%) reported doing so. No nurses that had less than 10 y of patient care experience gave water to dysphagia patients, even if they knew the indications, benefits, and risks. Similarly, less than a fifth (19%) of all nurses surveyed were comfortable giving water to dysphagia patients, but comfort increased for some if the protocol was recommended by a speech-language pathologist (33%) or physician (13%). Nursing experience of >10 y or in intensive care settings did not yield significant differences in knowledge, usage, or comfort level than those with less years or nonintensive care experience, respectively. CONCLUSIONS Nurses are essential to the implementation of the FFWP, yet many are unfamiliar and uncomfortable with utilizing it. Education about the protocol is necessary to improve patient outcomes and quality of life. We plan to provide targeted education about the FFWP as well as assess other members of the health-care team, in an attempt to increase utilization of the protocol and improve dysphagia management.
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Affiliation(s)
- Emily M Kokush
- Division of Trauma and Surgical Critical Care, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Radhika Patel
- Division of Trauma and Surgical Critical Care, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Brooke F Rothman
- Speech-Language Pathology, University Hospital, Newark, New Jersey
| | - Jan Ward
- Speech-Language Pathology, University Hospital, Newark, New Jersey
| | - Ondrea A McKay
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Peter Yonclas
- Division of Trauma and Surgical Critical Care, Rutgers New Jersey Medical School, Newark, New Jersey; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nina E Glass
- Division of Trauma and Surgical Critical Care, Rutgers New Jersey Medical School, Newark, New Jersey.
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8
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Twichell M. Inpatient Rehabilitation Following Burn Injury. Phys Med Rehabil Clin N Am 2023; 34:755-765. [PMID: 37806695 DOI: 10.1016/j.pmr.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Inpatient rehabilitation confers excellent benefit to burn survivors and should be considered as a potential destination during discharge planning. Consulting physiatrists identify and manage complications within the inpatient rehabilitation setting. Interventions can be taken to address medical sequelae of injury, including pain, itch, neuropathy, psychological coping and mood, and nutritional needs. Physiatrists also oversee and direct a rehabilitation program focusing on scar management, contracture prevention, dysphagia treatment, and evaluation and treatment of cognitive impairments. Aerobic and resistive exercise are key components of an inpatient rehabilitation program to reduce the systemic impact of a burn injury and improve quality of life.
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Affiliation(s)
- Maria Twichell
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Suite 910, Pittsburgh, PA 15213, USA.
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Ball L, Meteyard L, Powell RJ. Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists. Eur Arch Otorhinolaryngol 2023; 280:5101-5114. [PMID: 37543958 DOI: 10.1007/s00405-023-08153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The contributing factors of aspiration pneumonia have been well documented. However, there are gaps in the literature regarding identifying the weight associated with each factor and the relationship between factors. METHOD In this study, 20 potential predictors of aspiration pneumonia (with four additional variables) have been applied to historic Speech and Language Therapy records to greater understand the significance of each contributor of aspiration pneumonia. 152 cases with an oropharyngeal dysphagia, and a Speech and Language Therapy recommendation of eating and drinking with known aspiration and the associated potential risk of developing an aspiration pneumonia, were included in the data. These were inpatients and outpatients, and had various diagnoses but all had had a videofluoroscopy. RESULTS Logistic regression analysis found seven factors that were individually significant in predicting the development of aspiration pneumonia with 84.93% sensitivity and 91.03% specificity DISCUSSION: Logistic regression and random forest analyses led to the proposal of a new matrix of predictors of aspiration pneumonia with respective scoring weights for individual and cumulative contributors (a direction for future research).
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Affiliation(s)
- Laura Ball
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
| | - Lotte Meteyard
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Roy J Powell
- NIHR Research Design Service-SW, Exeter, UK
- University of Exeter Medical School, Exeter, UK
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Werden Abrams S, Gandhi P, Namasivayam-MacDonald A. The Adverse Effects and Events of Thickened Liquid Use in Adults: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2331-2350. [PMID: 37437527 DOI: 10.1044/2023_ajslp-22-00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
PURPOSE Practice pattern studies suggest that liquid modification is currently a primary strategy used by speech-language pathologists to manage dysphagia; however, the breadth of negative consequences associated with their use is not well understood. The purpose of this review was to summarize the evidence on adverse events and effects of thickened liquid (TL) use in adults. METHOD Six databases were searched in February 2022: EMBASE, MEDLINE (PubMed), Speechbite, AMED, AgeLine, and CINAHL. Articles were included if they compared adults receiving different TL viscosities and discussed at least one adverse event or effect of consuming TLs. Articles were excluded if they were review articles, rehabilitation studies, rheological analyses, not in English, or not peer reviewed. Screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using Cochrane tools. RESULTS Thirty-three studies (N = 4,990 participants across all studies) were eligible for inclusion (2,405 unique records screened). Reported adverse events included dehydration (n = 5), pneumonia (n = 4), death (n = 2), urinary tract infection (n = 1), and hospitalization (n = 1); adverse effects included reduced quality of life (n = 18), aspiration (n = 12), reduced intake (n = 8), increased residue (n = 4), and reduced medication bioavailability (n = 2). Results were mapped on to codes and domains of the International Classification of Functioning, Disability and Health. CONCLUSIONS A range of adverse outcomes associated with TL use were identified. Adverse outcomes should be monitored and reported in dysphagia research. Given current research evidence, it is vital for clinicians to weigh the risks and benefits of TL use to mitigate potential adverse outcomes.
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Affiliation(s)
- Sophia Werden Abrams
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
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Le KHN, Low EE, Yadlapati R. Evaluation of Esophageal Dysphagia in Elderly Patients. Curr Gastroenterol Rep 2023; 25:146-159. [PMID: 37312002 PMCID: PMC10726678 DOI: 10.1007/s11894-023-00876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence. RECENT FINDINGS In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.
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Affiliation(s)
| | - Eric E Low
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA
| | - Rena Yadlapati
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA.
- , La Jolla, CA, USA.
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Soto AP, Meyer SL. Oral Implications of Polypharmacy in Older Adults. Clin Geriatr Med 2023; 39:273-293. [PMID: 37045533 DOI: 10.1016/j.cger.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Over the next several decades, rates of aged populations will increase rapidly. These populations are susceptible to multimorbidities and polypharmacy (concurrently, prescribed 5 or more medications). Many medications have side effects that manifest orally. Therefore, it essential to possess current pharmacologic knowledge to diagnose and treat oral implications of commonly prescribed medications. This article details common medication-induced oral lesions and patient assessment of risk factors for polypharmacy and provides a template to integrate medication reconciliation into dental clinical practice.
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Affiliation(s)
- Annetty P Soto
- Division of General Dentistry, Department of Restorative Dental Sciences, University of Florida College of Dentistry, 1395 Center Drive, PO Box 100415, Gainesville, FL 32610-0415, USA.
| | - Sarah L Meyer
- University of Florida Health Science Center Libraries, 1600 Southwest Archer Road, PO Box 100206, Gainesville, FL 32610, USA
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Khamis A, Badawi N, Morgan C, Novak I. Baby Intensive Early Active Treatment (babiEAT): A Pilot Randomised Controlled Trial of Feeding Therapy for Infants with Cerebral Palsy and Oropharyngeal Dysphagia. J Clin Med 2023; 12:jcm12072677. [PMID: 37048760 PMCID: PMC10095351 DOI: 10.3390/jcm12072677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/09/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
Cerebral palsy (CP), results in impairment of muscle function including the face, mouth, and throat, leading to oropharyngeal dysphagia (OPD), which affects 85% of children with CP. OPD increases risk of deficiencies in growth, neurological development, and aspiration pneumonia, a leading cause of death in CP. This pilot randomised controlled trial aimed to (i) assess feasibility and acceptability of a novel neuroplasticity and motor-learning feeding intervention program, Baby Intensive Early Active Treatment (babiEAT), and standard care, and (ii) explore preliminary efficacy of babiEAT on health and caregiver feeding-related quality of life (QoL). A total of 14 infants with both CP and OPD were randomly allocated to 12 weeks of babiEAT or standard care. Results indicate that babiEAT and standard care are equally feasible, and acceptable. Parents in the babiEAT group thought recommendations were significantly more effective than standard care parents, were more likely to recommend the program to a friend and reported higher QoL. babiEAT infants showed significantly greater efficiency in fluid intake, fewer compensatory strategies with cup drinking, consumption of more advanced food textures, and shorter mealtimes without impacting intake, aspiration risk, or weight. This small pilot study shows promise for babiEAT in infants with CP and OPD. Further research is needed to determine strength of its effects.
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Affiliation(s)
- Amanda Khamis
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
- The Children’s Hospital at Westmead, The Sydney Children’s Hospitals Network, Sydney, NSW 2145, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
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14
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Kuhn MA, Gillespie MB, Ishman SL, Ishii LE, Brody R, Cohen E, Dhar SI, Hutcheson K, Jefferson G, Johnson F, Rameau A, Sher D, Starmer H, Strohl M, Ulmer K, Vaitaitis V, Begum S, Batjargal M, Dhepyasuwan N. Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2023; 168:571-592. [PMID: 36965195 DOI: 10.1002/ohn.302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/16/2023] [Accepted: 02/01/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx. METHODS Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible. RESULTS The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus. CONCLUSION Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to dysphagia in HNC patients.
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Affiliation(s)
- Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stacey L Ishman
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa E Ishii
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA
| | - Rebecca Brody
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA
| | - Ezra Cohen
- Moores Cancer Center at UC San Diego Health, La Jolla, California, USA
| | | | - Kate Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Gina Jefferson
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Anais Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - David Sher
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Karen Ulmer
- Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA
| | - Vilija Vaitaitis
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA
| | - Sultana Begum
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Misheelt Batjargal
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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15
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Hepper EC, Patterson JM. Healthcare Professionals' Perceptions of Stabilized Edible Foam with Adults with Severe Dysphagia; an exploratory study: Use of stabilized edible foam with adults with dysphagia: Use of stabilized edible foam with adults with dysphagia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:226-240. [PMID: 36040239 DOI: 10.1111/1460-6984.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Improving the quality of life for individuals with severe dysphagia is a priority when considering new areas of dysphagia management, especially if this increases opportunities to participate in social activities associated with eating and drinking. Edible foam is widely researched and available in the food industry; however, the use of edible foam within the field of dysphagia remains unexplored. Despite no research published on effectiveness and safety, a commercial product currently on the market is widely distributed across both Europe and the UK, including 28 NHS Trusts, suggesting that it is increasingly being used in clinical practice. AIMS To explore the perceptions and experiences of healthcare professionals on the use of stabilized edible foam (SEF) with adults with severe dysphagia in order to inform areas for future research in this novel dysphagia intervention. METHODS & PROCEDURES Healthcare professionals were recruited using purposeful sampling and snowballing technique. A total of 56 healthcare professionals were initially approached, of which 10 completed the semi-structured interviews. Interview questions were developed from a topic guide and a pilot questionnaire. OUTCOMES & RESULTS Thematic analysis was used to identify three themes: potential impact, consideration of risk and perceived experiences. Overarching each of these themes was the element of the unknown. CONCLUSIONS & IMPLICATIONS Use of SEF with adults with dysphagia is in its infancy. Whilst results indicate that some clinicians are embracing this novel approach, others express concerns. Therefore, further research is needed, particularly in relation of direct experience of individuals and contra-indications. WHAT THIS PAPER ADDS What is already known on the subject The use of SEF with individuals with swallowing problems is a relatively novel area of dysphagia intervention in the UK. There are currently no published studies on its effectiveness and safety profile. What this paper adds to existing knowledge This study provides valuable preliminary work into the area of SEF and adults with severe dysphagia, capturing the experience and perceptions of healthcare professions who have an awareness of SEF. What are the potential or actual clinical implications of this work? Increasing clinicians and researcher's awareness of this novel area of dysphagia management.
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Affiliation(s)
- Elizabeth C Hepper
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Joanne M Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre University of Liverpool, Liverpool, UK
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16
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Implementation of a free water protocol at a long term acute care hospital. Sci Rep 2023; 13:2626. [PMID: 36823156 PMCID: PMC9950376 DOI: 10.1038/s41598-023-29448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
This feasibility study aimed to trial a Free Water Protocol (FWP) for patients with thin liquid dysphagia in the Long-Term Acute Care Hospital (LTACH) setting. Patients with dysphagia are often prescribed thickened liquids to avoid or mitigate aspiration. While this clinical intervention can minimize the risk of aspiration pneumonia (PNA), it is generally not well received by patients. As such, the goal of this study was to determine if patients who knowingly aspirate thin liquids can safely tolerate thin liquid water, and if so, to what degree of benefit. The study assessed for adverse events, fluid intake, hydration status, quality of life, and overall swallow function outcomes. These measurements were taken over a 7 day trial period using inventories, lab work, clinical judgment, and observation. Ten participants were enrolled in this study with 9 having sufficient data for analysis (n = 9). No adverse events related to the FWP were observed, and patients saw improved total fluid intake (P = 0.0074), swallow-related quality of life (P = 0.0273), and overall swallow function (P = 0.0002). The results in this feasibility study allowed for the hospital wide implementation of the FWP and laid out the groundwork for future studies looking at longitudinal effects of a FWP.
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17
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Hashida N, Tamiya H, Korematsu M, Fujii T. Does oral intake of thin fluids increase aspiration pneumonia for dysphagia after head and neck cancer surgery? A retrospective study for a total of 654 cases. Auris Nasus Larynx 2023:S0385-8146(23)00027-5. [PMID: 36775772 DOI: 10.1016/j.anl.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/24/2022] [Accepted: 01/11/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVE Head and neck cancer (HNC) treatment causes dysphagia, which may lead to aspiration pneumonia (AP). Thickened fluids are widely used to prevent aspiration in patients with dysphagia; however, there is little evidence that they can prevent AP. This study aimed to clarify the differences between restriction of oral intake of fluids (R), only thickened fluids (TF), and no restriction of fluids (NR) for AP in patients with dysphagia after HNC treatment. METHODS We retrospectively studied 654 patients with dysphagia after HNC surgery between 2012 and 2021. Of these, 255 had some restriction of fluids. The development of possible AP and administration of antibacterial drugs were used as outcomes. Multivariate linear regression and propensity score matching analyses were performed. RESULTS The mean patient age was 64 ± 13, 67 ± 11, and 68 ± 10 years, while the Dynamic Imaging Grade of Swallowing Toxicity score 3-4 was 2.8%, 27.5, and 53.3%% water in NR, TF, and R groups, respectively. AP was diagnosed or suspected after starting oral intake in 37 (9.3%), 11 patients (15.9%), and 45 (17.6%) and antibacterial drugs were administered in 11 (2.8%), 7 patients (10.1%), and 25 (9.8%) in NR, TF, and R groups, respectively. R and TF had significant negative impacts on AP. CONCLUSIONS Fluid restrictions may not reduce the risk of AP or affect the administration of antibacterial drugs. Medical staff should bear in mind that fluid restrictions do not necessarily prevent AP in patients with HNC.
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Affiliation(s)
- Nao Hashida
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka City, Japan. 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan; Swallowing Center, Osaka University Hospital, Osaka City, Japan. 2-15, Yamadaoka, Suita city, Osaka, 554-0871, Japan.
| | - Hironari Tamiya
- Department of Rehabilitation, Osaka International Cancer Institute, Osaka City, Japan. 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan
| | - Mizuki Korematsu
- Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka City, Japan. 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka City, Japan. 3-1-69, Otemae, Chuo-ku, Osaka City, 541-8567, Japan
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Remijn L, Sanchez F, Heijnen BJ, Windsor C, Speyer R. Effects of Oral Health Interventions in People with Oropharyngeal Dysphagia: A Systematic Review. J Clin Med 2022; 11:jcm11123521. [PMID: 35743591 PMCID: PMC9225542 DOI: 10.3390/jcm11123521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
People with oropharyngeal dysphagia (OD) are at risk of developing aspiration pneumonia. However, there is no “best practice” for oral health interventions to improve swallowing-related outcomes, the incidence of aspiration pneumonia, and oral health in people with OD. Systematic literature searches were conducted for oral health interventions in OD in PubMed, Embase, CINAHL, and PsycINFO until July 2021. Original articles published in English and reporting pre- and post-intervention measurements were included. The methodology and reporting were guided by the PRISMA checklist. The methodological quality of the eight included studies was rated using the QualSyst critical appraisal tool. The oral health interventions in people with OD were diverse. This study shows little evidence that regular oral care and the free water protocol or oral disinfection reduced the incidence of aspiration pneumonia in people with OD. Oral cleaning, twice a day with an antibacterial toothpaste in combination with intraoral cleaning or the free water protocol, proved to be the most promising intervention to improve oral health. The effect of improved oral health status on swallowing-related outcomes could not be established. Increasing awareness of the importance of oral health and implementing practical oral care guidelines for people involved in the daily care of people with OD are recommended.
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Affiliation(s)
- Lianne Remijn
- Academy of Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-24-353-1500
| | - Fabiola Sanchez
- Pedagogical Professional Team District Frogner, 0201 Oslo, Norway;
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway; (C.W.); (R.S.)
| | - Bas J. Heijnen
- Department Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Catriona Windsor
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway; (C.W.); (R.S.)
| | - Renée Speyer
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway; (C.W.); (R.S.)
- Department Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
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Murray J, Maloney S, Underdown K, Doeltgen S. Patient suitability for free water protocols in acute stroke and general medicine: a qualitative study of clinician perceptions. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:630-644. [PMID: 35318783 DOI: 10.1111/1460-6984.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The free water protocol (FWP) is an alternate management strategy for patients with dysphagia, who would otherwise be nil by mouth or prescribed thickened fluids, allowing them to drink and potentially aspirate water under strict guidelines to minimize the risk of adverse consequences. The FWP is not widely implemented in acute settings, and it is unclear whether this is due to the complexity of patient presentations, clinician decision-making or barriers related to the setting. AIMS To explore the perceptions and decision-making process of clinicians about using FWPs to manage dysphagia for patients admitted to acute stroke and general medicine. METHODS & PROCEDURES A qualitative, critical realist approach was adopted to allow for in-depth exploration of the perspectives of four dietitians, seven medical officers, eight registered nurses and 17 speech and language pathologists (SLPs) from three hospitals in a capital city of Australia. Data from semi-structured interviews were analysed using the Situated Clinical Decision-Making Framework (CDF). OUTCOMES & RESULTS Participants were cautious about FWP for patients with neurological conditions, head and neck cancer, dementia, poor immunity, chronic or recurrent respiratory illness, and certain types of stroke. Medical status and the implications for aspiration were paramount, particularly respiratory status, oxygen supplementation, cognitive status, fatigue and mobility. Participants considered patient quality of life, preferences and choices for care, but indicated that factors influencing safety often outweighed patient preference for water. Indirect factors affecting decision-making included the roles of the multidisciplinary team, individual clinical experience and attitude to risk, and availability of supervision. CONCLUSIONS & IMPLICATIONS Despite the benefits of FWPs in other settings, in acute stroke and general medicine, clinicians erred on the side of safety and, in most cases, would not implement an FWP. Future clinical research is needed to systematically design high-quality and feasible clinical trials to determine the benefits and safety of FWPs for patients with dysphagia in these settings. This would lay the foundations for guidelines to support the complex clinical decision-making regarding patient suitability for FWPs. WHAT THIS PAPER ADDS What is already known on the subject FWPs are an alternate management strategy for patients with dysphagia, with systematic reviews recommending their use for adults in inpatient rehabilitation with a low risk of pneumonia. However, evidence from the acute setting is sparse, leaving clinicians unsure about which patients might benefit and which may inadvertently be exposed to increased risk by an FWP. What this paper adds to existing knowledge Participants from all interviewed disciplines agreed that SLPs lead the decision-making process and as such act as 'gatekeepers' for access to an FWP. The decision-making process is complex, and participants acknowledged that disease conditions and illnesses were often used as exclusionary criteria. Although participants reported favourably on the benefits of FWPs, their decision-making privileged risk aversion over patient preference in most settings, except for palliative care. Lack of clinical guidelines and research evidence in acute care settings, as well as the focus on risk aversion, appear to perpetually reinforce the avoidance of FWP in these settings. Of note, more senior clinicians acknowledged being more deliberately guided by patient preference; hence, leadership by senior clinicians appears critical for change in practice in this space. What are the potential or actual clinical implications of this work? If evidence about the safety of FWP in the acute settings is to be collected, a systematic approach to addressing the present barriers is warranted. This may allow rigorous clinical trials to proceed and potentially lead to best-practice guidelines for dysphagia management options for wider populations of patients.
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Affiliation(s)
- Joanne Murray
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Swallowing Neurorehabilitation Research Laboratory, Flinders University, Adelaide, SA, Australia
| | - Shannon Maloney
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Kaitlyn Underdown
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Sebastian Doeltgen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Swallowing Neurorehabilitation Research Laboratory, Flinders University, Adelaide, SA, Australia
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20
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Murray J, Walker C, Doeltgen S. Implementation of free water protocols in acute care: An observation of practice. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:111-121. [PMID: 34343448 DOI: 10.1080/17549507.2021.1955973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: Evidence supporting free water protocols (FWP) in acute settings is limited and the potential risks and benefits for acutely ill patients are not well understood. This study aimed to observe how and with whom FWPs are implemented in acute stroke and general medical units.Method: Mixed methods parallel case study design. Medical and nursing records were evaluated for information pertaining to the implementation of the FWP and outcomes for three patients. Semi-structured interviews conducted with three patient-nurse-speech-language pathologist triads focussed on clinical decision-making and barriers and enablers to FWP implementation. Data were analysed descriptively and triangulated across sources.Result: Patients identified as suitable for a FWP had markedly different presentations to those described in the evidence-base and FWP were consequently significantly adapted. Although patients were permitted water, they received and consumed very small amounts. Speech-language pathologists and nurses identified more barriers than enablers to FWP implementation; cognitive impairments, reliance on others and insufficient documentation were perceived as the key barriers, while clear verbal communication was identified as a facilitator.Conclusion: Overall the findings suggest FWP implementation in the acute care setting is hindered by a lack of standardised procedures and current evidence-base that would otherwise inform best practice.
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Affiliation(s)
- Joanne Murray
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Swallowing Neurorehabilitation Research Laboratory, Flinders University, Adelaide, Australia
| | - Chelsea Walker
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sebastian Doeltgen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Swallowing Neurorehabilitation Research Laboratory, Flinders University, Adelaide, Australia
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21
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Mushero N, Demers LB, Chippendale R. An Interactive Workshop on Managing Dysphagia in Older Adults With Dementia. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11223. [PMID: 35309254 PMCID: PMC8888763 DOI: 10.15766/mep_2374-8265.11223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Nearly six million American adults live with dementia, and dysphagia is a common comorbidity impacting their nutrition and quality of life. There is a shortfall in the number of geriatricians available to care for older adults. Thus, primary care physicians should be equipped with the knowledge to adequately care for the geriatric population. Modified diets are routinely prescribed for patients with dementia despite limited evidence that they protect patients from the sequelae of dysphagia and some suggestion of poor side-effect profiles. METHODS We created a onetime, interactive, case-based session to educate medical residents on how to evaluate and treat dementia-associated dysphagia and address the discrepancy between the limited evidence for dietary modifications and their routine use. The session had a mixture of small-group discussion and didactic learning as well as a participatory component during which learners were able to sample thickened liquids. RESULTS The session was implemented in an established primary care curriculum. Based on survey responses, which were obtained from 15 out of 17 participants, the session significantly improved participants' knowledge of dysphagia-associated dementia and increased their comfort with caring for patients with dysphagia. DISCUSSION Dementia-associated dysphagia, although an increasingly common clinical problem, remains an underexamined area of medicine. We successfully implemented a session on this topic for internal medicine residents on the primary care track. Limitations included generalizability due to the small number of residents in the course and inability to gather sufficient data to see if knowledge learned was sustained over time.
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Affiliation(s)
- Nicole Mushero
- Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine; Physician, Department of Geriatrics, Boston Medical Center
| | - Lindsay B. Demers
- Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine
| | - Ryan Chippendale
- Assistant Professor, Section of Geriatrics, Department of Medicine, Boston University School of Medicine; Physician, Department of Geriatrics, Boston Medical Center
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22
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Clunie GM, Bolton L, Lovell L, Bradley E, Bond C, Bennington S, Roe J. Considerations for speech and language therapy management of dysphagia in patients who are critically ill with COVID-19: a single centre case series. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Patients treated with intubation and tracheostomy for COVID-19 infection are at risk of increased incidence of laryngeal injury, dysphagia and dysphonia. Because of the novelty of the SARS-CoV-2 virus, little is known about the type of dysphagia patients experience as a result of infection and critical illness. The aim of this case series report was to progress understanding of COVID-19 and dysphagia following admission to an intensive care unit and to guide speech and language therapy clinical practice in the ongoing pandemic. Methods A retrospective case review was conducted of all patients at Imperial College Healthcare NHS Trust, London who underwent a tracheostomy because of COVID-19 and received an instrumental assessment of swallowing in the early stages of the pandemic. Results A total of 11 patients were identified, and descriptive statistics were used to present demographic data, with a narrative account of their dysphagia profile used to describe presentation. Causes and presentation of dysphagia were heterogenous, with each patient requiring individualised clinical management to maximise outcome. A positive trend was seen in terms of recovery trajectory and progressing to oral intake. Conclusions This study reports on early experience of the presentation of dysphagia in patients with COVID-19 and demonstrates the value of instrumental assessment. It indicates the need for further research to consolidate knowledge and guide clinical practice.
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Affiliation(s)
- Gemma M Clunie
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lee Bolton
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Lindsay Lovell
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth Bradley
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Cara Bond
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Bennington
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Roe
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Oliveira I, Couto G, Santos R, Campolargo A, Lima C, Ferreira P. Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022. [DOI: 10.1159/000520505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dysphagia is frequent after stroke, and it increases the risk of respiratory infection, dehydration and malnutrition, resulting in worse outcomes. Different clinical guidelines present recommendations for the assessment and management of dysphagia in stroke patients in a scattered way. These best practice recommendations address seven clinical questions on the assessment and management of dysphagia in stroke patients, gathering the best-updated evidence. A systematic literature review using the PICO strategy was performed. The recommendations draft was then appraised by a multidisciplinary panel of experts (nutritionists, physiatrists, speech-language pathologists and rehabilitation nurses) in a total of 3 Delphi rounds. A minimum of 80% consensus was established, and the final version offers a total of 21 recommendations for use in clinical practice for stroke patients. These clinical recommendations are an overview of the most recent evidence combined with experts’ consensus and translated into clinically relevant statements. In implementing recommendations at the local level, health professionals should identify facilitators and barriers to evidence-based practice within their contexts and determine the best strategies to address local needs. Where the change is needed, initial and continuing training on all recommendations is essential and relevant.
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Steele SJ, Ennis SL, Dobler CC. Treatment burden associated with the intake of thickened fluids. Breathe (Sheff) 2021; 17:210003. [PMID: 34295407 PMCID: PMC8291955 DOI: 10.1183/20734735.0003-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
The implementation of thickened fluids in patients with dysphagia is widely considered an effective strategy for safe and physiologically improved swallow. However, there is limited evidence to suggest that this intervention reduces the risk of dysphagia-related complications including aspiration pneumonia. In addition, there is growing evidence that this approach is associated with adverse clinical effects including dehydration, malnutrition and reduced health-related quality of life. This review summarises the rationale for thickened fluids, the evidence base (or lack thereof) underpinning their use, and current guideline recommendations. Educational aims To review the evidence base for thickened fluids in the management of dysphagia.To examine the evidence that thickened fluids reduce aspiration pneumonia.To provide an overview of the advantages and disadvantages of thickened fluids in the management of dysphagia.
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Affiliation(s)
- Simon J Steele
- Dept of General and Acute Care Medicine, Alfred Hospital, Melbourne, Australia
| | - Samantha L Ennis
- Dept of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, Australia
| | - Claudia C Dobler
- Dept of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Stewart A, Burr S. Thickened liquids: do they still have a place in the paediatric dysphagia toolkit? Curr Opin Otolaryngol Head Neck Surg 2021; 29:194-199. [PMID: 33797420 DOI: 10.1097/moo.0000000000000707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Use of thickened fluids has long been a cornerstone of dysphagia management. However, clinicians and researchers are increasingly questioning their effectiveness and highlighting potential harms. This review aims to present the current state of the evidence for use of thickened fluids in children. RECENT FINDINGS The relationship between aspiration and respiratory infection is complex. The role of thickened fluids in improving respiratory health is limited and contradictory. A high level of variability exists in all aspects of thickened fluid use. Little is known about patient and family perspectives on meaningful endpoints for intervention. SUMMARY Clinicians should be open and transparent in their decision making with patients and families, acknowledging the limited evidence and the need for individualised care. Further research is needed to establish the efficacy of thickened fluid use in children with regard to improvements in respiratory health, fluid intake and child and family wellbeing.
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Affiliation(s)
- Alexandra Stewart
- Great Ormond Street Hospital for Children NHS Foundation Trust
- Department of Psychology and Language Sciences, University College London, London
| | - Samantha Burr
- Solent NHS Trust, Hampshire
- Faculty of Health and Applied Sciences, the University of the West of England, Bristol, UK
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Kim E, Kast C, Afroz-Hossain A, Qiu M, Pappas K, Sinvani L. Bridging the Gap Between the Intensive Care Unit and the Acute Medical Care Unit. Am J Crit Care 2021; 30:193-200. [PMID: 34161979 DOI: 10.4037/ajcc2021591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite a growing cohort of intensive care unit (ICU) survivors, little is known about the early ICU aftercare period. OBJECTIVE To identify gaps in early ICU aftercare and factors associated with poor hospital outcomes. METHODS A multisite, retrospective study (January 1 to December 31, 2017) was conducted among randomly selected patients admitted to the medical ICU and subsequently transferred to acute medical care units. Records were reviewed for patient characteristics, ICU course, and early ICU aftercare practices and syndromes. Associations between practices and hospital outcomes were calculated with χ2 and Wilcoxon rank sum tests, followed by logistic regression. RESULTS One hundred fifty-one patients met inclusion criteria (mean [SD] age, 64.2 [19.1] years; 51.7% male; 44.4% White). The most frequent diagnoses were sepsis (35.8%) and respiratory failure (33.8%). During early ICU aftercare, 46.4% had dietary restrictions, 25.8% had bed rest orders, 25.0% had a bladder catheter, 26.5% had advance directive documentation, 33.8% had dysphagia, 34.3% had functional decline, and 23.2% had delirium. Higher Charlson Comorbidity Index (odds ratio, 1.6) and midodrine use on medical units (odds ratio, 7.5) were associated with in-hospital mortality; mechanical ventilation in the ICU was associated with rapid response on medical unit (odds ratio, 12.9); and bladder catheters were associated with ICU readmission (odds ratio, 5.2). CONCLUSIONS Delirium, debility, and dysphagia are frequently encountered in early ICU aftercare, yet bed rest, dietary restriction, and lack of advance directive documentation are common. Future studies are urgently needed to characterize and address early ICU aftercare.
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Affiliation(s)
- Eileen Kim
- Eileen Kim is assistant professor, Division of Hospital Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Charles Kast
- Charles Kast is assistant professor, Division of Hospital Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Anika Afroz-Hossain
- Anika Afroz-Hossain is assistant professor, Division of Hospital Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Michael Qiu
- Michael Qiu is a data analyst, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Karalyn Pappas
- Karalyn Pappas is a biostatistician, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Liron Sinvani
- Liron Sinvani is an associate professor, Division of Hospital Medicine, Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, and an assistant professor, Feinstein Institutes for Medical Research, Northwell Health
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Stösser S, Gotthardt M, Lindner-Pfleghar B, Jüttler E, Kassubek R, Neugebauer H. Severe Dysphagia Predicts Poststroke Fever. Stroke 2021; 52:2284-2291. [PMID: 33910366 DOI: 10.1161/strokeaha.120.033396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Sebastian Stösser
- Department of Neurology, University of Ulm, Germany (S.S., M.G., R.K., H.N.).,Department of Neurology, University Hospital Bonn, Germany (S.S.)
| | - Matthias Gotthardt
- Department of Neurology, University of Ulm, Germany (S.S., M.G., R.K., H.N.)
| | | | - Eric Jüttler
- Department of Neurology, Ostalb Hospital Aalen, Germany (E.J.)
| | - Rebecca Kassubek
- Department of Neurology, University of Ulm, Germany (S.S., M.G., R.K., H.N.)
| | - Hermann Neugebauer
- Department of Neurology, University of Ulm, Germany (S.S., M.G., R.K., H.N.).,Department of Neurology, University Hospital Würzburg, Germany (H.N.)
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White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults. Dysphagia 2021; 37:333-349. [PMID: 33787994 PMCID: PMC8009935 DOI: 10.1007/s00455-021-10283-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023]
Abstract
This White Paper by the European Society for Swallowing Disorders (ESSD) reports on the current state of screening and non-instrumental assessment for dysphagia in adults. An overview is provided on the measures that are available, and how to select screening tools and assessments. Emphasis is placed on different types of screening, patient-reported measures, assessment of anatomy and physiology of the swallowing act, and clinical swallowing evaluation. Many screening and non-instrumental assessments are available for evaluating dysphagia in adults; however, their use may not be warranted due to poor diagnostic performance or lacking robust psychometric properties. This white paper provides recommendations on how to select best evidence-based screening tools and non-instrumental assessments for use in clinical practice targeting different constructs, target populations and respondents, based on criteria for diagnostic performance, psychometric properties (reliability, validity, and responsiveness), and feasibility. In addition, gaps in research that need to be addressed in future studies are discussed. The following recommendations are made: (1) discontinue the use of non-validated dysphagia screening tools and assessments; (2) implement screening using tools that have optimal diagnostic performance in selected populations that are at risk of dysphagia, such as stroke patients, frail older persons, patients with progressive neurological diseases, persons with cerebral palsy, and patients with head and neck cancer; (3) implement measures that demonstrate robust psychometric properties; and (4) provide quality training in dysphagia screening and assessment to all clinicians involved in the care and management of persons with dysphagia.
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Abstract
Over the next several decades, rates of aged populations will increase rapidly. These populations are susceptible to multimorbidities and polypharmacy (concurrently, prescribed 5 or more medications). Many medications have side effects that manifest orally. Therefore, it essential to possess current pharmacologic knowledge to diagnose and treat oral implications of commonly prescribed medications. This article details common medication-induced oral lesions and patient assessment of risk factors for polypharmacy and provides a template to integrate medication reconciliation into dental clinical practice.
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Thickened liquids: do they still have a place in the dysphagia toolkit? Curr Opin Otolaryngol Head Neck Surg 2021; 28:145-154. [PMID: 32332203 DOI: 10.1097/moo.0000000000000622] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The use of commercially or naturally thickened liquids is a well-established treatment for patients with dysphagia to fluids, the aim of which is to improve swallow safety by minimizing risk of aspiration. Although the most recent systematic reviews conclude that this treatment lacks evidential support and leads to patient-reported worsening health and quality of life, thickened liquids continue to be used with patients with dysphagia across clinical settings. This review briefly summarizes the evidence and considers potential reasons for the apparent mismatch between the evidence and clinical practice. RECENT FINDINGS Continuing practice with thickened liquids is influenced by a range of factors, including gaps in clinical knowledge, inadequate patient involvement, a culture of common practice and a reliance on invalid surrogate studies or research lacking a credible association between thickened liquids and clinically meaningful endpoints. SUMMARY While awaiting further research, clinical decision-making about thickened liquids can be improved by considering the evidence of clinically meaningful endpoints, promoting shared decision-making with patients and underpinning practice with knowledge about the complex relationship between dysphagia, aspiration and pneumonia.
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Thiyagalingam S, Kulinski AE, Thorsteinsdottir B, Shindelar KL, Takahashi PY. Dysphagia in Older Adults. Mayo Clin Proc 2021; 96:488-497. [PMID: 33549267 DOI: 10.1016/j.mayocp.2020.08.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/07/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022]
Abstract
Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can experience malnutrition, pneumonia, and dehydration. Patients can also experience increased rates of mortality and long-term care admission. Providers can identify the specific type of dysphagia for treatment in approximately 80% of patients by asking 5 questions in the patient's history: What happens when you try to swallow? Do you have trouble chewing? Do you have difficulty swallowing solids, liquids, or both? Describe the symptom onset, duration, and frequency? What are the associated symptoms? Providers can then request a videofluoroscopic swallow study or a fiberoptic endoscopic evaluation of swallowing for further evaluation of oropharyngeal dysphagia. If providers are diagnosing esophageal dysphagia, barium esophagraphy or esophagogastroduodenoscopy (EGD) can be used as part of the assessment. Patients can be treated for oropharyngeal dysphagia by using compensatory interventions, including behavioral changes, oral care, dietary modification, or rehabilitative interventions such as exercises and therapeutic oral trials. Providers often address treatment of esophageal dysphagia by managing the underlying etiology, which could include removal of caustic medications or using EGD as a therapeutic modality for esophageal rings. High-quality, large research studies are necessary to further manage the diagnosis and appropriate treatment of this growing geriatric syndrome.
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Affiliation(s)
- Shanojan Thiyagalingam
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Anne E Kulinski
- Department of Neurology-Speech-Language Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Bjorg Thorsteinsdottir
- Division of Community Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Katrina L Shindelar
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Paul Y Takahashi
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of Community Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
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Treatment for Adults. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Namasivayam-MacDonald AM, Riquelme LF. Speech-Language Pathology Management for Adults With COVID-19 in the Acute Hospital Setting: Initial Recommendations to Guide Clinical Practice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1850-1865. [PMID: 32692584 DOI: 10.1044/2020_ajslp-20-00096] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This document outlines initial recommendations for speech-language pathology management of adult patients with COVID-19 in the acute hospital setting. Method The authors initially developed these recommendations by adapting those developed for physical therapists working with patients with COVID-19 by Thomas et al. (2020). The recommendations then underwent review by 14 speech-language pathologists and rehabilitation-focused academics representing seven countries (Belgium, Brazil, Canada, Ireland, Japan, New Zealand, the United States). The authors consolidated and reviewed the feedback in order to decide what should be included or modified. Applicability to a global audience was intended throughout the document. Results The authors had 100% agreement on the elements of the recommendations that needed to be changed/modified or added. The final document includes recommendations for speech-language pathology workforce planning and preparation, caseload management, service delivery and documentation, as well as recommendations for the selection of appropriate personal protective equipment and augmentative and alternative communication equipment in the acute care hospital setting. Conclusions Speech-language pathologists play a critical role in the assessment, management, and treatment of patients with COVID-19. Several important considerations need to be made in order to meet the needs of this unique patient population. As more is learned about the impact of the virus on swallowing and communication, the role of the speech-language pathologist on interdisciplinary care teams will remain paramount.
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Affiliation(s)
| | - Luis F Riquelme
- School of Health Sciences and Practice, New York Medical College, Valhalla, NY
- Barrique Speech-Language Pathology, PC, Brooklyn, NY
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Levenson SA, Walker VL. It Is Time to Revamp Approaches to Managing Dysphagia in Nursing Homes. J Am Med Dir Assoc 2020; 20:952-955. [PMID: 31353044 DOI: 10.1016/j.jamda.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 01/18/2023]
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Dong Y, Hu B, Huang S, Ye T, Dong Q. The Modified Volume-Viscosity Swallow Test as a Predictor of Aspiration Pneumonia after Acute Ischemic Stroke. Clin Neurol Neurosurg 2020; 200:106351. [PMID: 33168332 DOI: 10.1016/j.clineuro.2020.106351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/03/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Dysphagia is common in patients with acute ischemic stroke patients (AIS) and it increases the risk of aspiration pneumonia after AIS. The volume-viscosity swallow test (V-VST) is a useful dysphagia screening tool. Therefore, we aim to explore the association between dysphagia (using the modified V-VST) and aspiration pneumonia in acute ischemic stroke patients. PATIENTS AND METHODS All patients with acute ischemic stroke (AIS) admitted during 1 January 2018 and 31 December 2018 were screened in this study by completing the modified V-VST within 24 hours after admission. The information of aspiration pneumonia was obtained from electronic medical system (EMS) and discharge notes. RESULTS Among 624 AIS patient, there were 152(24.36%) patients who suffered from aspiration pneumonia (95% CI, 20.65% - 27.35%) during hospitalization. Among all of them, patients with both impaired safety and impaired efficacy (HR, 7.53, 95%CI, 3.42-16.58, P < 0.001)) had a higher risk of aspiration pneumonia than those with only safety impaired (HR, 2.38, 95%CI, 1.40-4.04, P < 0.001) or only efficacy impaired (HR, 2.47, 95%CI, 1.33-4.57, P = 0.004). The risk of aspiration pneumonia was also associated with their completed volume at each viscosity. The patients with all impairment of three viscosities were also found to be related to the higher risk of developing aspiration pneumonia (P = 0.029). CONCLUSIONS The Modified V-VST is an easy-hand on, reliable screening tool for dysphagia among patients with AIS. Patient subgroup analyses based on the modified V-VST might be able to predict the risk of aspiration pneumonia during hospitalization.
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Affiliation(s)
- Yi Dong
- Department of Neurology, Huashan Hospital, Fudan University, 12 UrimuqiMddle Road, Shanghai 200040, China
| | - Binbin Hu
- Department of Neurology, Huashan Hospital, Fudan University, 12 UrimuqiMddle Road, Shanghai 200040, China
| | - Shengyan Huang
- Department of Neurology, Huashan Hospital, Fudan University, 12 UrimuqiMddle Road, Shanghai 200040, China
| | - Ting Ye
- Department of Neurology, Huashan Hospital, Fudan University, 12 UrimuqiMddle Road, Shanghai 200040, China.
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, 12 UrimuqiMddle Road, Shanghai 200040, China; National clinical research center for aging and medicine, Huashan Hosiptial, Fudan University; State Key Laboratory of Medical Neurobiology, Fudan University, No. 12 UrumuqiMiddle Road, Shanghai 200040, China.
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Is IDDSI an Evidence-Based Framework? A Relevant Question for the Frail Older Population. Geriatrics (Basel) 2020; 5:geriatrics5040082. [PMID: 33096747 PMCID: PMC7709687 DOI: 10.3390/geriatrics5040082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
To delay impacts of aging, optimal nutritional status is essential. Several factors can reduce food intake, such as isolation, income, and cognitive/physical decline. Additionally, chewing and swallowing difficulties, or dysphagia, often disrupt the ability to consume life-long favorite dishes. Food and liquids could require modification of texture or consistency to ensure a comfortable or safe swallow. The food industry, foodservices facilities, and caregivers need quality control benchmarks to provide adequate nourishment and meet these new feeding challenges. The International Dysphagia Diet Standardisation Initiative (IDDSI) is proposing the IDDSI framework and testing methods to describe food used in nutritional care plans to circumvent dysphagia and improve communication among caregivers. This systematic review assesses the validity and reliability of the IDDSI testing methods using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Two publications presented content validity whereas 19 publications looked at construct validity or reliability for the IDDSI testing methods. One study was conducted in older adults presenting dysphagia. This review concludes that there is insufficient evidence to recommend the IDDSI testing methods. Further research, conducted with robust methodological design and reporting, is needed to develop and assess nutritious adapted food for frail older populations.
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McCurtin A, Brady R, Coffey K, O'Connor A. Clarity and contradictions: speech and language therapists' insights regarding thickened liquids for post-stroke aspiration. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Oropharyngeal dysphagia is a common condition following stroke, with adverse consequences including aspiration pneumonia. Internationally, aspiration risk is typically managed using thickened liquids, an intervention with limited empirical support and associated treatment adherence issues. This study explores speech and language therapists' perceptions of and reasons for employing this intervention. Methods A total of 22 speech and language therapists working with people with dysphagia post-stroke in hospital settings participated in three focus groups. Participants were recruited through gatekeeper managers and data were analysed using inductive thematic analysis. Results Three themes were identified: primary justifications for treatment use, acute implementation issues, and having doubts. Use of thickened liquids is pivoted on safety-first reasoning, employed as a first step on the treatment ladder and in the context of limited perceived alternatives. Both clarity and contradictions are revealed by therapists, who acknowledge multiple factors that impact treatment effectiveness, including hospital, patient and product issues. Conclusions The findings from this study provide a basis for understanding clinical decision making for a widely-used gateway treatment that requires further empirical support. The data suggest that, similar to other professions, safety-first reasoning is paramount for speech and language therapists. The dominance of thickened liquids in treating aspiration is reflected internationally and warrants ongoing discussion.
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Affiliation(s)
- Arlene McCurtin
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ronan Brady
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Katherine Coffey
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Anne O'Connor
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Legacy J, Herndon NE, Wheeler-Hegland K, Okun MS, Patel B. A comprehensive review of the diagnosis and treatment of Parkinson's disease dysphagia and aspiration. Expert Rev Gastroenterol Hepatol 2020; 14:411-424. [PMID: 32657208 PMCID: PMC10405619 DOI: 10.1080/17474124.2020.1769475] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/12/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Bulbar dysfunction is common in Parkinson's disease (PD) with more than 80% of affected individuals developing dysphagia during the course of the disease. Symptoms can begin in the preclinical stage and individuals may remain clinically asymptomatic for years. Furthermore, patients may be unaware of swallowing changes, which contributes to the difference between the prevalence of self-reported dysphagia and deficits identified during instrumental evaluations. Dysphagia is underrecognized and contributes to the development of aspiration pneumonia which is the leading cause of death in PD. Dysphagia in PD is complex and not completely understood. Both dopaminergic and nondopaminergic pathways likely underpin dysphagia. AREAS COVERED This comprehensive review will cover the epidemiology, pathophysiology, clinical evaluation, and expert management of dysphagia and aspiration in patients with PD. EXPERT OPINION A multidisciplinary team approach is important to properly identify and manage PD dysphagia. Regular clinical screenings with objective instrumental assessments are necessary for early detection of dysphagia. Studies are needed to better understand the mechanism(s) involved in PD dysphagia, establish markers for early detection and progression, and develop evidence-based treatment options.
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Affiliation(s)
- Joseph Legacy
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
| | - Nicole E. Herndon
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL
| | - Karen Wheeler-Hegland
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL
| | - Michael S. Okun
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
| | - Bhavana Patel
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
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Venegas M, Navia R, Fuentealba I, Medina MDD, Kunstmann P. MANEJO HOSPITALARIO DE LA PERSONA MAYOR CON DISFAGIA. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2019.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cook G, Hodgson P, Thompson J, Bainbridge L, Johnson A, Storey P. Hydration Interventions for older people living in residential and nursing care homes: overview of the literature. Br Med Bull 2019; 131:71-79. [PMID: 31556943 DOI: 10.1093/bmb/ldz027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/05/2019] [Accepted: 07/29/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Care home populations experiencing high levels of multi-morbidity and dementia require support from caregivers to meet their hydration requirements. This article provides an overview of literature related to hydration interventions and highlights gaps in knowledge. SOURCES OF DATA This paper draws on UK-focused literature from Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, Medline, Proquest Hospital Premium Collection, Cochrane Library and RCN databases on hydration interventions for older people living with multi-morbidity and dementia in care homes. AREAS OF AGREEMENT Fluid intake is too low in care home residents, and no single hydration intervention is effective in addressing the complex problems that older residents present. AREAS OF CONTROVERSY There is a lack of consensus about how much fluid an older person should consume daily for optimum health. There is also lack of agreement about what interventions are effective in supporting individuals with complex physical and cognitive problems to achieve daily fluid intake targets. GROWING POINTS To improve hydration care for residents, care home teams should be competent in the delivery of hydration care, and work closely with integrated multi-professional healthcare specialists to provide proactive case management. AREAS TIMELY FOR DEVELOPING RESEARCH There is a need for understanding of what hydration practices and processes are effective for care home residents and including these in multi-component interventions.
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Affiliation(s)
- Glenda Cook
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Philip Hodgson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Juliana Thompson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Lesley Bainbridge
- Nursing, Patient Safety and Quality, Newcastle Gateshead Clinical Commissioning Group, Riverside House, Goldcrest Way, Newburn , Newcastle upon Tyne, UK
| | - Amy Johnson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Paul Storey
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
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Motor Learning Feeding Interventions for Infants at Risk of Cerebral Palsy: A Systematic Review. Dysphagia 2019; 35:1-17. [DOI: 10.1007/s00455-019-10016-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/23/2019] [Indexed: 01/21/2023]
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McGinnis CM, Homan K, Solomon M, Taylor J, Staebell K, Erger D, Raut N. Dysphagia: Interprofessional Management, Impact, and Patient-Centered Care. Nutr Clin Pract 2018; 34:80-95. [DOI: 10.1002/ncp.10239] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Kimberly Homan
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Meghan Solomon
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Julia Taylor
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | | | - Denise Erger
- Sanford USD Medical Center; Sioux Falls South Dakota USA
| | - Namrata Raut
- Sanford USD Medical Center; Sioux Falls South Dakota USA
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Lee JM, Roy N, Dietrich M. Personality, Psychological Factors, and Behavioral Tendencies in Children With Vocal Nodules: A Systematic Review. J Voice 2018; 33:945.e1-945.e18. [PMID: 30529034 DOI: 10.1016/j.jvoice.2018.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This systematic review examined the evidence linking vocal nodule development in children to personality traits, psychological factors, and associated behavioral tendencies. METHODS Four electronic databases-PubMed, Scopus, ScienceDirect, EBSCO Host-as well as the reference lists from articles (including online sources) were searched. After screening for relevance, eight comparative, case-control studies were identified that met inclusion criteria. The quality of each study was evaluated by two raters using a modified, standardized checklist. RESULTS Four studies were rated as "good quality" and four were "fair". The questionnaires used to measure personality or psychological factors varied widely among the studies, and the results linking personality dispositions (and associated behavioral inclinations) to vocal nodule development in children were mixed. CONCLUSIONS Fair to good quality evidence exists to suggest that psychological factors or personality traits related to extraversion and impulsivity (and their related behavioral inclinations) might predispose children to vocal nodules and deserve further attention. Clinical implications, limitations of the current systematic review, and recommendations for future research are also discussed.
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Affiliation(s)
- Jeong Min Lee
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah.
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah
| | - Maria Dietrich
- Department of Communication Science and Disorders, University of Missouri, Columbia, Missouri
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O'Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatr 2018; 18:167. [PMID: 30029632 PMCID: PMC6053717 DOI: 10.1186/s12877-018-0839-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/19/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although modifying diets, by thickening liquids and modifying the texture of foods, to reduce the risk of aspiration has become central to the current management of dysphagia, the effectiveness of this intervention has been questioned. This narrative review examines, and discusses possible reasons for, the apparent discrepancy between the widespread use of modified diets in current clinical practice and the limited evidence base regarding the benefits and risks of this approach. DISCUSSION There is no good evidence to date that thickening liquids reduces pneumonia in dysphagia and this intervention may be associated with reduced fluid intake. Texture-modified foods may contribute to undernutrition in those with dysphagia. Modified diets worsen the quality of life of those with dysphagia, and non-compliance is common. There is substantial variability in terminology and standards for modified diets, in the recommendations of individual therapists, and in the consistency of diets prepared by healthcare staff for consumption. Although use of modified diets might appear to have a rational pathophysiological basis in dysphagia, the relationship between aspiration and pneumonia is not clear-cut. Clinical experience may be a more important determinant of everyday practice than research evidence and patient preferences. There are situations in the management of dysphagia where common sense and the necessity of intervention will clearly outweigh any lack of evidence or when application of evidence-based principles can enable good decision making despite the absence of robust evidence. Nevertheless, there is a significant discrepancy between the paucity of the evidence base supporting use of modified diets and the beliefs and practices of practitioners. CONCLUSION The disconnect between the limited evidence base and the widespread use of modified diets suggests the need for more careful consideration as to when modified diets might be recommended to patients. Patients (or their representatives) have a choice whether or not to accept a modified diet and must receive adequate information, about the potential risks and impact on quality of life as well as the possible benefits, to make that choice. There is an urgent need for better quality evidence regarding this intervention.
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Affiliation(s)
- Shaun T O'Keeffe
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland.
- Unit 4, Merlin Park University Hospital, Galway, Ireland.
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Martín A, Ortega O, Roca M, Arús M, Clavé P. Effect of A Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study. J Nutr Health Aging 2018; 22:739-747. [PMID: 29806864 DOI: 10.1007/s12603-018-1043-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) is a newly defined geriatric syndrome that causes nutritional and respiratory complications in older hospitalized patients. Following hospital discharge, OD also causes hospital readmission and mortality in this population. OBJECTIVE Our aim was to assess the effect of a minimal-massive intervention (MMI) in reducing nutritional and respiratory complications in older hospitalized patients with OD. DESIGN AND PARTICIPANTS An open label trial was performed on 186 hospitalized older patients (>70y) with OD; 62 of these patients with OD were treated with the MMI and paired by sex, age, functionality, comorbidities and body mass index with two controls. INTERVENTION The MMI consisted of: a) fluid thickening and texture-modified foods, b) caloric and protein supplementation; and c) oral health and hygiene recommendations during hospitalization and following discharge. The control group followed the standard clinical practice without MMI. MEASUREMENTS Main study outcomes were hospital readmissions, respiratory infections, nutritional status and survival after 6 months follow up. RESULTS Both groups had similar advanced age (84.87±6.02MMI and 84.42±5.31 years), poor functionality (Barthel 59.51±26.76 MMI and 58.84±26.87), and high comorbidities (Charlson 3.00±1.60 MMI and 3.06±1.45). Main results showed that MMI improved nutritional status (MNA 9.84±2.05 pre-MMI vs. 11.31±2.21 post-MMI; p=0.0038) and functionality (Barthel 62.34±25.43 pre-MMI vs. 73.44±25.19 post-MMI; p=0.007). In addition MMI decreased hospital readmissions (68.8 readmissions/100 persons-year (28.1-109.38) MMI vs. 190.8 (156.0-225.7); p=0.001), respiratory infections (12.50 readmissions/100 persons-year (0-29.82) MMI vs. 74.68 (52.86-96.50); p=0.002), and increased 6-month survival (84.13% MMI vs. 70.96%; p=0.044). CONCLUSIONS Our results suggest that a MMI in hospitalized older patients with OD improves nutritional status and functionality and reduces hospital readmissions, respiratory infections and mortality. MMI might become a new simple and cost-effective strategy to avoid OD complications in the geriatric population admitted with an acute disease to a general hospital.
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Affiliation(s)
- A Martín
- Pere Clavé Civit, MD, PhD Surgeon. Principal Investigator. Associate Professor of Surgery Universitat Autònoma de Barcelona. +34 937417700 ext. 1046. Fax: +34 937417733. e-mail:
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Pisegna JM, Langmore SE. The Ice Chip Protocol: A Description of the Protocol and Case Reports. ACTA ACUST UNITED AC 2018. [DOI: 10.1044/persp3.sig13.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jessica M. Pisegna
- Department of Otolaryngology, Boston Medical Center
Boston, MA
- Speech-Language Pathology Sciences, Boston University School of Medicine
Boston, MA
| | - Susan E. Langmore
- Department of Otolaryngology-Head & Neck Surgery, Boston University Medical Center
Boston, MA
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Murray J, Scholten I. An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation. Gerodontology 2017; 35:18-24. [DOI: 10.1111/ger.12309] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Joanne Murray
- Speech Pathology; College of Nursing and Health Sciences; Flinders University; Adelaide SA Australia
| | - Ingrid Scholten
- Speech Pathology; College of Nursing and Health Sciences; Flinders University; Adelaide SA Australia
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Beck AM, Kjaersgaard A, Hansen T, Poulsen I. Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia - An updated clinical guideline. Clin Nutr 2017; 37:1980-1991. [PMID: 28939270 DOI: 10.1016/j.clnu.2017.09.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/24/2017] [Accepted: 09/02/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Oropharyngeal dysphagia (OD) has significant consequences for both the person with dysphagia and the society. An often-used treatment for OD is the recommendation of the texture of food and liquids. This recommendation seems to be based more on best practice than on evidence from a systematic review of existing scientific evidence. The aim of this paper was to report the result of an up-date of an original national guideline focussing on whether thickened liquids (review question 1) and modified foods (review question 2) are beneficial for adults above 17 years with OD in relation to three critical outcomes (aspiration, pneumonia and death) and seven important outcomes (dehydration, weight loss, mealtime performance, patient preferences, intervention adherence and quality of life). METHODS Three steps were used. First: An updated systematic literature search. Second: An assessment of the quality of the evidence for each review question by means of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Third: Development of clinical recommendations based on the evidence, assessment of the risk benefit ratio, and perceived patient preferences. RESULTS The body of evidence consisted of two RCTs for review question 1 both using nectar thickened liquids or honey-thickened liquids. No evidence was found for two important outcomes, mealtime performance and quality of life. With regard to risk of pneumonia, death, aspiration, dehydration, weight loss and intervention adherence no significant differences were found. The outcome addressing patient preferences, found a non-significant increased dissatisfaction with nectar thickened liquids (RR 1.11; 95% CI 0.95-1.30) and a significant increased dissatisfaction with honey thickened liquids compared to thin liquids/chin down (RR 1.18; 95% CI 1.01-1.37). No evidence was identified for review question 2. CONCLUSIONS Based on the quality of the evidence, assessment of the risk benefit ratio, and perceived patient preferences a weak recommendation against the use of texture modified liquids and good clinical practice pointing for the use of texture modified foods in patients with OD were made.
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Affiliation(s)
- Anne Marie Beck
- Division of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark; Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark.
| | - Annette Kjaersgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Denmark
| | - Tina Hansen
- Division of Physical and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Ingrid Poulsen
- RUBRIC (Research Unit on Brain Injury Rehabilitation Copenhagen), Department of Neurorehabilitation, TBI Unit, Copenhagen University Hospital, Denmark; Health, Arhus University, Denmark
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