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Erensoy İ, Yaşar Ö, Aydınlı FE, Kemal Ö, Terzi M. The discriminant ability of the Eating Assessment tool-10 to detect swallowing efficiency in neurogenic dysphagia. LOGOP PHONIATR VOCO 2024:1-9. [PMID: 39126364 DOI: 10.1080/14015439.2024.2388894] [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: 11/20/2023] [Revised: 07/10/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Neurogenic dysphagia causes complications such as malnutrition, dehydration, and aspiration pneumonia. Therefore, early detection with clinically valid tools is essential. This study aimed to investigate the Eating Assessment Tool-10 (EAT-10) ability to detect swallowing efficiency at three different consistencies in neurogenic dysphagia. METHODS One hundred twelve patients with neurogenic dysphagia (74 males and 38 females, mean ± SD age 61.83 ± 9.72 years) were included in the study. A Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed in the clinic following EAT-10 to assess swallowing efficacy at International Dysphagia Diet Standardization Initiative (IDDSI) consistencies of 0, 3, and 7. The swallowing efficiency of the patients was assessed using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Area under the curve, sensitivity, and specificity values were calculated to evaluate the ability of EAT-10 to discriminate between participants with and without residue and between participants with and without moderate-to-severe residue. RESULTS The EAT-10 significantly detected participants with and without residues for three IDDSI consistent: for IDDSI 0 residue in the vallecula and pyriform sinus (cutoff score ≥ 14, p < 0.001), for IDDSI 3 residue in the vallecula and pyriform sinus (cutoff score ≥ 13, p < 0.001), for IDDSI 7 residue in the vallecula and pyriform sinus (respectively, cutoff score ≥ 13, cutoff score ≥ 14, p < 0.001). Additionally, the EAT-10 significantly detected those with and without moderate-to-severe residue. CONCLUSIONS The EAT-10, frequently used in swallowing clinics, can determine swallowing efficiency in individuals with neurogenic dysphagia. Additionally, it has the power to detect moderate-to-severe pharyngeal residue.
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Affiliation(s)
- İbrahim Erensoy
- Department of Speech and Language Therapy, Ondokuz Mayıs University, Samsun, Turkey
- Department of Speech and Language Therapy, Hacettepe University, Ankara, Turkey
| | - Özlem Yaşar
- Department of Speech and Language Therapy, Ondokuz Mayıs University, Samsun, Turkey
| | - Fatma Esen Aydınlı
- Department of Speech and Language Therapy, Hacettepe University, Ankara, Turkey
| | - Özgür Kemal
- Department of Ear Nose Throat, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Murat Terzi
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Legget E, Wernick M, Jardine DL. Hypercalcaemia causing acute oropharyngeal dysphagia in a patient with multiple myeloma. Intern Med J 2024; 54:1233-1234. [PMID: 39013776 DOI: 10.1111/imj.16447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/05/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Emelia Legget
- Department of General Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Maya Wernick
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - David L Jardine
- Department of General Medicine, Christchurch Hospital, Christchurch, New Zealand
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Slovik Y, Kaminer BM, Revital G, Ron A, Harris M, Ziv O, Loutati A, Cohen O. A Modified Fiberoptic Endoscopic Evaluation of Swallowing Evaluating Esophageal Dysphagia by a Capsule: A Pilot Study. Dysphagia 2024:10.1007/s00455-024-10724-z. [PMID: 38872056 DOI: 10.1007/s00455-024-10724-z] [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: 11/13/2023] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
While functional endoscopic evaluation of swallowing (FEES) is the most useful diagnostic test for the evaluation of dysphagia, it cannot evaluate the esophageal phase of swallowing. To evaluate if a modification for the FEES exam by swallowing an empty capsule and screening of the upper esophagus could be used for early detection of esophageal dysphagia. A prospective, single-center, pilot study. At the end of a standard FEES exam, the patients were asked to swallow an empty capsule. Fifteen seconds later, the endoscope was inserted into the upper esophagus. A pathological capsule test was defined when the capsule was seen in the esophagus. In such cases, the patient was advised to undergo a gastroscopy, MBS, or esophageal manometry, which were compared to the results of the capsule test. The capsule test was utilized in 109 patients. A pathological capsule test was found in 55 patients (57.8%). In 48 patients (87.3%), an isolated or combined esophageal dysphagia was seen. The accuracy value of the capsule test compared to gastroenterology tests was 83.3%, sensitivity 88.46%, specificity 75%, PPV 85%, and NPV 80%. A modification of the standard FEES exam by including an empty capsule swallow test with an upper esophagus examination may provide a useful screening tool for esophageal dysphagia.
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Affiliation(s)
- Youval Slovik
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, POB 151, Beer-Sheva, Israel.
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Benyamin Meir Kaminer
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, POB 151, Beer-Sheva, Israel
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Gorali Revital
- Hearing & Speech Institute, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alona Ron
- Department of Rehabilation, Soroka University Medical Center, Beer-Sheva, Israel
- Department of Brain and Cognitive Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Mai Harris
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
- Medical School for International Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Oren Ziv
- Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, POB 151, Beer-Sheva, Israel
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ayelet Loutati
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Oded Cohen
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel
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Krekeler BN, Howell RJ. Cricopharyngeus muscle dysfunction: a poorly defined disorder from diagnosis to treatment. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08644-7. [PMID: 38714548 DOI: 10.1007/s00405-024-08644-7] [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: 01/17/2024] [Accepted: 03/26/2024] [Indexed: 05/10/2024]
Abstract
PURPOSE Cricopharyngeus muscle dysfunction (CPMD) is a common clinical occurrence with very few clear diagnostic criteria and multiple pathways for treatment. Incidence of CPMD is not known, but some data suggest around 25% of people with dysphagia experience some degree of CPMD, which negatively impacts swallowing safety and efficiency. Workup and treatment of CPMD can require multidisciplinary collaboration across laryngologists, speech-language pathologists with training in dysphagia management, and gastroenterologists. The purpose of this paper is to review what is known about CPMD and identify areas of future research in CPMD diagnosis and treatment. METHODS An overview of CPMD, relative treatments and disorders, and a discussion of future areas of research needed to improve clinical care of CPMD. RESULTS Details regarding historical background, pathophysiology and treatment practiced for CPMD are included. CONCLUSION In summary, CPMD is a poorly defined disease due to a lack of understanding of its pathophysiology and the lack of consensus diagnostic criteria. Well-designed, prospective clinical trials are necessary to develop a better understanding of clinical incidence of CPMD, impact of the disorder on oropharyngeal swallowing, and how to approach treatment of the disorder surgically or in conjunction with therapy directed by a specialized speech-language pathologist.
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Affiliation(s)
- Brittany N Krekeler
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, USA
- Department of Communication Sciences and Disorders, University of Cincinnati College of Allied Health Sciences, Cincinnati, USA
| | - Rebecca J Howell
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, USA.
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Ribeiro M, Miquilussi PA, Gonçalves FM, Taveira KVM, Stechman-Neto J, Nascimento WV, de Araujo CM, Schroder AGD, Massi G, Santos RS. The Prevalence of Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-analysis. Dysphagia 2024; 39:163-176. [PMID: 37610669 DOI: 10.1007/s00455-023-10608-8] [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: 08/30/2022] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
To determine the global prevalence of oropharyngeal dysphagia (OD) in adults. Six electronic databases (Embase, LILACS, LIVIVO, PubMed/Medline, Scopus, and Web of Science) were searched, in addition to gray literature (ASHA, Google Scholar, ProQuest Dissertation, and Theses). A random-effects model for meta-analysis of proportions was conducted, and heterogeneity was evaluated according to the moderator variable through subgroup analysis and meta-regression. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the certainty of the evidence was assessed using the GRADE tool. Thirty papers were included for qualitative and quantitative synthesis. The combined prevalence estimate was 60% [CI 95% = 50%-70%; I2 = 95%], accounting for different baseline conditions. However, the wide variation that exists between the different baseline conditions (underlying disease or risk factor) tended to overestimate this prevalence when considering the general population. Only one study evaluated healthy individuals, which showed a prevalence of 31% [CI95% = 27%-36%]. The risk of bias was considered low for all studies. None of the variables were considered predictors for the observed variance between the effect sizes of the included studies. For the prevalence of OD, the GRADE rating was considered very low. Despite the high prevalence observed, with over half of the individuals affected, the evidence regarding this outcome remains uncertain due to an overestimation of the generated estimates caused by the baseline condition of the sample.
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Affiliation(s)
- Marcos Ribeiro
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil.
- , Avenida Diederichsen, 864. Apt: 172, Vila Guarani - South Zone, São Paulo, SP, 04310-000, Brazil.
| | - Paloma Alves Miquilussi
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | - Flávio Magno Gonçalves
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | - Karinna Veríssimo Meira Taveira
- Department of Morphology- Center of Biosciences, University of Notre Dame, 100 Galvin Life Science Center, Notre Dame, USA
- Postgraduate Program in Speech, Language and Hearing Sciences, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - José Stechman-Neto
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | - Weslania Viviane Nascimento
- Department of Dentistry, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Curitiba, Brazil
| | - Cristiano Miranda de Araujo
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | | | - Giselle Massi
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders, Center for Advanced Studies in Systematic Review and Meta-Analysis - NARSM, Tuiuti University of Paraná, Curitiba, Brazil
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Nakajima Y, Tsujimura T, Tsuji K, Magara J, Inoue M. Continuous electrical stimulation of superior laryngeal nerve inhibits initiation of swallowing in anesthetized rats. Neurosci Lett 2024; 825:137672. [PMID: 38360144 DOI: 10.1016/j.neulet.2024.137672] [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: 12/21/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
Pharyngeal electrical stimulation (PES) applies electrical stimulation to pharyngeal mucosa (PhM) and represents a useful approach to improve swallowing function in patients with dysphagia. To determine the optimal PES modality to treat dysphagia, the mechanism underlying the effects of PES on swallowing function must be elucidated. In this study, we evaluated how PES and electrical stimulation of the superior laryngeal nerve (SLN) modulate the initiation of swallowing in anesthetized rats. A swallow was evoked by electrical stimulation of the PhM, SLN, and nucleus of the solitary tract (nTS) and pharyngeal mechanical stimulation using a von Frey filament. A swallow was identified by electromyographic bursts in mylohyoid and thyrohyoid muscles. Bilateral SLN transection abolished the swallows evoked by PhM electrical stimulation. PhM and SLN electrical stimulation decreased swallowing frequency in a similar time-dependent manner. Intravenous administration of the GABAA receptor antagonist bicuculine did not affect the time-dependent change in swallowing frequency during SLN electrical stimulation. Continuous SLN electrical stimulation significantly inhibited pharyngeal mechanically and nTS-electrically evoked swallows compared with before and 5 min after stimulation. The present findings suggest that the SLN plays a primary role in PES-evoked swallows. Additionally, continuous SLN electrical stimulation inhibits the initiation of swallowing, and the modulation of central network associated with swallowing might be partially involved in this inhibition.
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Affiliation(s)
- Yuta Nakajima
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata 951-8514, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata 951-8514, Japan.
| | - Kojun Tsuji
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata 951-8514, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata 951-8514, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata 951-8514, Japan
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Alayón LF, Salas BS, Diaz-Saavedra RC, Ortiz AR, Martin JZ, Jimenez PCL, Sáez-Bravo ML. Screening oropharyngeal dysphagia in patients with head and neck cancer in a radiation oncology department. Rep Pract Oncol Radiother 2024; 28:756-763. [PMID: 38515827 PMCID: PMC10954268 DOI: 10.5603/rpor.98732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/04/2023] [Indexed: 03/23/2024] Open
Abstract
Background Oropharyngeal dysphagia (OD) occurs in up to 40% of head and neck cancer (HNC) patients before treatment and remains a common symptom (23-60%) after oncological treatments, leading to several consequences. Early detection is essential for effective swallowing-rehabilitation and nutritional-support. The increased radiosensitivity of tumors associated with human papillomavirus (HPV) and advances in imaging techniques have stimulated research into deintensified strategies to minimize radiotherapy (RT) side effects. The purposes of the study are to establish the percentage of patients with HNC who are candidates to RT who are at risk of dysphagia [Eating Assessment Tool (EAT) score ≥ 3], determine if tumor location and previous surgery were related to a higher risk of dysphagia and if patients suffering severe toxicity during cancer therapy are at greater risk of posttreatment-dysphagia. Materials and methods Patients diagnosed of HNC who were referred to RT treatment at our Radiation Oncology Department were prospectively included. Questionnaire EAT-10 was filled in the first assessment used as a screening tool and repeated one month after treatment. Treatment toxicity was established according to common toxicity criteria adverse effects (CTCAE4.03). Results From November 2019 to January 2021, 72 patients were included. All completed pretreatment EAT-10 questionnaire. The mean (SD) score of the pretreatment EAT-10 was 7.26 ± 11.19 and 43.1% were at dysphagia risk. Patients with tumors located in the oral cavity, oropharynx and those that had received surgery prior to RT had higher risk than the rest of locations or those who had not previous surgery (p = 0.001 and p = 0.002, respectively). After oncological treatment 95.83% completed EAT-10 post-treatment and 45,6% showed positive EAT-10 score. Conclusions Patients with tumors in the oral cavity or oropharynx, presenting in advanced stage, and who previously received surgery are at higher risk of developing dysphagia. The EAT-10 is a simple tool that can help us identify those patients and refer them for an intensive evaluation to reduce dysphagia-consequences.
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Affiliation(s)
- Laura Ferrera Alayón
- Department of Radiation Oncology, Universitary Hospital Dr Negrín Las Palmas de Gran Canaria, Spain
- Las Palmas de Gran Canaria University (ULPGC), Las Palmas de Gran Canaria, Spain
| | - Barbara Salas Salas
- Department of Radiation Oncology, Universitary Hospital Dr Negrín Las Palmas de Gran Canaria, Spain
| | | | - Anais Ramos Ortiz
- Department of Radiation Oncology, Universitary Hospital Dr Negrín Las Palmas de Gran Canaria, Spain
| | - Juan Zafra Martin
- Department of Radiation Oncology, Universitary Hospital Dr Negrín Las Palmas de Gran Canaria, Spain
| | - Pedro Carlos Lara Jimenez
- Department of Radiation Oncology, Universitary Hospital San Roque, Las Palmas de Gran Canaria, Spain
- Fernando Pessoa Canarias University, Las Palmas de Gran Canaria, Spain
| | - Marta Lloret Sáez-Bravo
- Department of Radiation Oncology, Universitary Hospital Dr Negrín Las Palmas de Gran Canaria, Spain
- Las Palmas de Gran Canaria University (ULPGC), Las Palmas de Gran Canaria, Spain
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8
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Jeong SY, Kim JM, Park JE, Baek SJ, Yang SN. Application of deep learning technology for temporal analysis of videofluoroscopic swallowing studies. Sci Rep 2023; 13:17522. [PMID: 37845272 PMCID: PMC10579219 DOI: 10.1038/s41598-023-44802-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023] Open
Abstract
Temporal parameters during swallowing are analyzed for objective and quantitative evaluation of videofluoroscopic swallowing studies (VFSS). Manual analysis by clinicians is time-consuming, complicated and prone to human error during interpretation; therefore, automated analysis using deep learning has been attempted. We aimed to develop a model for the automatic measurement of various temporal parameters of swallowing using deep learning. Overall, 547 VFSS video clips were included. Seven temporal parameters were manually measured by two physiatrists as ground-truth data: oral phase duration, pharyngeal delay time, pharyngeal response time, pharyngeal transit time, laryngeal vestibule closure reaction time, laryngeal vestibule closure duration, and upper esophageal sphincter opening duration. ResNet3D was selected as the base model for the deep learning of temporal parameters. The performances of ResNet3D variants were compared with those of the VGG and I3D models used previously. The average accuracy of the proposed ResNet3D variants was from 0.901 to 0.981. The F1 scores and average precision were 0.794 to 0.941 and 0.714 to 0.899, respectively. Compared to the VGG and I3D models, our model achieved the best results in terms of accuracy, F1 score, and average precision values. Through the clinical application of this automatic model, temporal analysis of VFSS will be easier and more accurate.
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Affiliation(s)
- Seong Yun Jeong
- Department of Computer Science and Engineering, Korea University, 145 Anam-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Jeong Min Kim
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Ji Eun Park
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Seung Jun Baek
- Department of Computer Science and Engineering, Korea University, 145 Anam-ro Seongbuk-gu, Seoul, 02841, Korea.
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
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Wang JY, Yang YW, Liu CH, Chang KC, Lin YT, Liu CC. Emergency department visits and associated factors among people with dementia residing in nursing homes in Taiwan: a one-year cohort study. BMC Geriatr 2023; 23:503. [PMID: 37605133 PMCID: PMC10441757 DOI: 10.1186/s12877-023-04221-5] [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] [Received: 02/20/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Residing in a nursing home (NH) may increase emergency department (ED) utilization in patients with dementia; however, evidence regarding the status of and predictors for ED utilization of NH residents with dementia remains unclear, especially in Asia. This study aimed to assess the incidence density of ED visits and associated factors for the risk of ED utilization among NH residents with dementia. METHODS This one-year cohort study followed 6595 NH residents with dementia aged ≧ 40 years from Taiwan's National Health Insurance Research Database between 2012 and 2014. The Andersen-Gill extension of Cox regression analysis with death as a competing risk was applied to investigate the association of the risk of all causes and the most common causes of ED utilization with the predisposing, enabling, and need factors as defined by the Andersen model. RESULTS All participants encountered 9254 emergency visits in the 5371.49 person-years observed, representing incidence densities of ED visits of 1722.80 per 1000 person-years. Among them, respiratory disease was the most common cause of ED visits. The significant predictors for the risk of all-cause and respiratory-cause ED visits included: (1) predisposing factors (i.e., age and gender); (2) enabling factors (i.e., regional variables); and (3) need factors (i.e., prolonged ventilator dependence and comorbidity status). CONCLUSIONS Predisposing, enabling, and need factors could influence ED visits among studies patients. NH providers should consider these factors to develop strategies for reducing ED utilization.
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Affiliation(s)
- Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Wan Yang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Hui Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Division of Emergency Medical Service, New Taipei City Fire Department, New Taipei, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
| | - Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan.
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10
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Lal PB, Wishart LR, Ward EC, Schwarz M, Seabrook M, Coccetti A. Understanding barriers and facilitators to speech-language pathology service delivery in the emergency department. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:509-522. [PMID: 35579003 DOI: 10.1080/17549507.2022.2071465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Timely speech-language pathology (SLP) involvement with dysphagic patients in the Emergency Department (ED) may improve patient outcomes. This study utilised qualitative interviews to understand current models and explore factors which have influenced establishment and current dysphagia service provision in Australian EDs. METHOD Semi-structured interviews were conducted with representatives from 12 acute hospital facilities with a SLP ED service. Interview transcripts were analysed using plain content analysis to identify key themes. Sub-analysis using the Consolidated Framework for Implementation Research (CFIR) model was undertaken for facilities with more "expanded" models (n = 4). RESULT SLP ED service models ranged from referral-only services, to models with referral-only and proactive SLP-led screening procedures (classified as "expanded"). Patient-related factors, the ED setting, SLP service factors and perceptions of dysphagia management were key themes reported to impact service delivery. With expanded models, 14 CFIR constructs (innovation source, external policy and incentives, networks and communications, stakeholders and relative priority) were identified as facilitators, while four constructs (adaptability, cost, compatibility, available resources) were barriers to services. CONCLUSION There are service-specific issues with providing SLP care within the ED. Factors related to the unique ED environment must be considered by SLP departments when establishing/optimising dysphagia management within the ED.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Maria Schwarz
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Anne Coccetti
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
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11
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El Halabi M, Arwani R, Parkman HP. Dysphagia in Neurological Disorders. Semin Neurol 2023; 43:530-539. [PMID: 37579785 DOI: 10.1055/s-0043-1771458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Dysphagia is a common symptom in many neurologic disorders. Patients with oropharyngeal dysphagia present with difficulties when they start to swallow, often with coughing and choking; whereas patients with esophageal dysphagia describe the feeling that swallowed food stops in the chest. Chronic neurologic diseases such stroke, Parkinson's disease, or dementia often have dysphagia as a symptom, particularly oropharyngeal dysphagia, and the term "neurogenic dysphagia" is often used. A disruption of the sophisticated, integrated sensorimotor swallowing system is usually the main reason behind dysphagia. Dysphagia can be associated with aspiration leading to aspiration pneumonia, and chronic dysphagia can lead to weight loss and malnutrition. Patients with dysphagia, when accurately and promptly diagnosed through medical history, physical examination, and diagnostic tests, often can be treated and experience improved quality of life. The pathophysiological mechanisms behind dysphagia, its diagnosis, and potential treatments are discussed in this manuscript.
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Affiliation(s)
- Maan El Halabi
- Section of Gastroenterology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Remy Arwani
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Henry P Parkman
- GI Motility Laboratory, Section of Gastroenterology, Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
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12
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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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Kwon S, Cha S, Kim J, Han K, Paik NJ, Kim WS. Trends in the incidence and prevalence of dysphagia requiring medical attention among adults in South Korea, 2006-2016: A nationwide population study. PLoS One 2023; 18:e0287512. [PMID: 37379287 DOI: 10.1371/journal.pone.0287512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/07/2023] [Indexed: 06/30/2023] Open
Abstract
The prevalence of dysphagia is increasing, resulting in socioeconomic burden, but previous reports have only been based on a limited populations. Therefore, we aimed to investigate the nationwide incidence and prevalence of dysphagia requiring medical attention to provide adequate information for healthcare planning and resource allocation. In this nationwide retrospective cohort study, the data of adults aged ≥20 years recorded from 2006 to 2016 were sourced from the Korean National Health Insurance Service database. Medical claim codes based on ICD-10-CM were used to define dysphagia and possible causes. The annual incidence and prevalence of dysphagia were calculated. Cox regression was used to estimate dysphagia risk in people with possible dysphagia etiology. Survival analysis was performed to estimate the mortality and hazard ratio of dysphagia. The crude annual incidence of dysphagia increased continuously from 7.14 in 2006 to 15.64 in 2016. The crude annual prevalence of dysphagia in 2006 was 0.09% and increased annually to 0.25% in 2016. Stroke (odds ratio [OR]: 7.86, 95% confidence interval [CI]: 5.76-6.68), neurodegenerative disease (OR: 6.20, 95% CI: 5.76-6.68), cancer (OR: 5.59, 95% CI: 5.17-6.06), and chronic obstructive pulmonary disease (OR: 2.94, 95% CI: 2.71-3.18) were associated with a high risk of dysphagia. The mortality in the dysphagia group was 3.12 times higher than that in the non-dysphagia group (hazard ratio: 3.12, 95% CI: 3.03-3.23). The incidence and prevalence of dysphagia requiring medical attention are increasing annually. The increasing trend was conspicuous in the geriatric population. The presence of stroke, neurodegenerative disease, cancer, and chronic obstructive pulmonary disease is associated with a high risk of dysphagia. Therefore, adequate screening, diagnosis, and management of dysphagia in the older population must be emphasized in geriatric healthcare.
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Affiliation(s)
- SuYeon Kwon
- Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, School of Medicine, Seoul, Republic of Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Junsik Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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Gölaç H, Atalık G, Gülaçtı A, Şansal E, Ceylan BT, Esen Aydınlı F, Yılmaz M. The discriminant ability of the eating assessment tool-10 questionnaire to detect residue and aspiration in patients with mixed etiology of dysphagia. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07987-x. [PMID: 37097466 DOI: 10.1007/s00405-023-07987-x] [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: 03/09/2023] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To investigate the discriminant ability of the eating assessment tool-10 (EAT-10) to detect postswallow residue and aspiration for different consistencies. METHODS Seventy-two consecutive patients with mixed etiology of dysphagia (42 males and 30 females, mean ± sd age of 60.42 ± 15.82) were included. After completing the EAT-10, Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed to assess the efficiency and safety of swallowing for the following consistencies: thin liquid, nectar thick, yogurt, and solid. While swallowing efficiency was evaluated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the Penetration-Aspiration Scale (PAS) was used to evaluate swallowing safety. RESULTS The EAT-10 questionnaire significantly identified the patients with residue from those without residue for the following consistencies and anatomic locations: thin liquid residue in the pyriform sinus (cutoff score ≥ 10, p = 0.009), nectar thick residue in the vallecula (cutoff score ≥ 15, p = 0.001), yogurt residue in the vallecula (cutoff score ≥ 15, p = 0.009), yogurt residue in the pyriform sinus (cutoff score ≥ 9, p = 0.015), and solid residue in the vallecula (cutoff score ≥ 13, p = 0.016). However, the same discriminant ability of EAT-10 was not found for detecting aspiration in any consistency. CONCLUSIONS The EAT-10 questionnaire can be used as an assessment tool to judge swallowing efficiency in patients with mixed etiology of dysphagia, but the same is not evident for swallowing safety.
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Affiliation(s)
- Hakan Gölaç
- Department of Speech and Language Therapy, Faculty of Health Sciences, Gazi University, Emek Mah. Bişkek Cad. 6. Cad. (Eski 81. Sokak) No: 2 Çankaya, 06490, Ankara, Turkey.
| | - Güzide Atalık
- Department of Speech and Language Therapy, Faculty of Health Sciences, Gazi University, Emek Mah. Bişkek Cad. 6. Cad. (Eski 81. Sokak) No: 2 Çankaya, 06490, Ankara, Turkey
| | - Adnan Gülaçtı
- Department of Speech and Language Therapy, Faculty of Health Sciences, Gazi University, Emek Mah. Bişkek Cad. 6. Cad. (Eski 81. Sokak) No: 2 Çankaya, 06490, Ankara, Turkey
| | - Ebru Şansal
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Banu Tijen Ceylan
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fatma Esen Aydınlı
- Department of Speech and Language Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Metin Yılmaz
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Denk-Linnert DM, Farneti D, Nawka T, am Zehnhoff-Dinnesen A, Moerman M, Zorowka P, Farahat M, Schindler A, Geneid A. Position Statement of the Union of European Phoniatricians (UEP): Fees and Phoniatricians' Role in Multidisciplinary and Multiprofessional Dysphagia Management Team. Dysphagia 2023; 38:711-718. [PMID: 35972695 PMCID: PMC9379897 DOI: 10.1007/s00455-022-10502-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/15/2022] [Indexed: 11/03/2022]
Abstract
The need for multidisciplinary and multiprofessional management of dysphagia is constantly increasing and creating a major challenge for healthcare professionals and society, especially in terms of professional expertise and human resources. The distribution of tasks among the dysphagia team members, which includes phoniatricians, otolaryngologists, and speech-language therapists, is flexible and overlapping. For assessing dysphagia, the (fibreoptic) flexible endoscopic evaluation of swallowing (FEES), with or without videofluoroscopy, is a pivotal diagnostic tool. This position paper aims to illustrate the phoniatrician's role in performing a FEES, which is an indispensable component of the diagnostic workup of patients suffering from oropharyngeal dysphagia. It is based on the current collaborative expert view of the Swallowing Committee of the Union of European Phoniatricians and a literature review. A FEES is one of the core competences of phoniatricians due to their endoscopic expertise and experience in the field of dysphagia and diseases of the upper aerodigestive tract. Therefore, the phoniatrician is an important member of the dysphagia team, for the medical diagnostics of the aerodigestive tract and dysphagia as well as for FEES. Phoniatric competence is especially important for head and neck cancer patients, infants, and complex cases.
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Affiliation(s)
- Doris-Maria Denk-Linnert
- grid.411904.90000 0004 0520 9719Division of Phoniatrics and Speech-Language Therapy, Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, University Hospital Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Daniele Farneti
- Audiology and Phoniatrics Department - Romagna Health Service, Rimini Hospital, Rimini, Italy
| | - Tadeus Nawka
- grid.6363.00000 0001 2218 4662Department of Audiology and Phoniatrics, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | - Patrick Zorowka
- grid.5361.10000 0000 8853 2677Department of Hearing, Speech and Voice Disorders, Medical University, Innsbruck, Austria
| | - Mohamed Farahat
- grid.56302.320000 0004 1773 5396Department of Otolaryngology, Research Chair of Voice, Swallowing and Communication Disorders, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Antonio Schindler
- grid.4708.b0000 0004 1757 2822Department of Biomedical and Clinical Sciences, L. Sacco, Phoniatric Unit, University of Milan, Milan, Italy
| | - Ahmed Geneid
- grid.7737.40000 0004 0410 2071Department of Otorhinolaryngology and Phoniatrics-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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16
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Bosch G, Comas M, Domingo L, Guillen-Sola A, Duarte E, Castells X, Sala M. Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality. Eur J Clin Invest 2023; 53:e13930. [PMID: 36477740 DOI: 10.1111/eci.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia can be highly concerning in hospitalized patients, increasing morbidity and mortality, making its early identification essential. We aimed to characterize dysphagia and its association with aspiration pneumonia and mortality in a tertiary hospital in Barcelona, Spain. METHODS Using data from all hospital discharges during the period 2018-2021, we identified the characteristics of patients with dysphagia and their distribution among hospital departments through the minimum data set, which codifies patients' diagnoses according to the International Classification of Diseases 10th Revision (ICD-10). We used logistic regression models to assess the association between dysphagia, aspiration pneumonia and mortality. RESULTS Dysphagia was present in 2.4% of all hospital discharges and was more frequent in older patients and in men. The diagnoses most frequently associated with dysphagia were aspiration pneumonia (48.2%) and stroke (14%). Higher prevalence of dysphagia was found in the acute geriatric unit (10.3%), neurology (7.6%) and internal medicine (7.5%) wards. Dysphagia was associated with aspiration pneumonia, aOR = 8.04 (95%CI, 6.31-10.25), and independently increased the odds of death among hospitalized patients, aOR = 1.43 (95%CI, 1.19-1.73). CONCLUSIONS We conclude that dysphagia is a prevalent and transversal condition, increasing the risk of mortality in all patients, and efforts should be intensified to increase its early detection and correct management.
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Affiliation(s)
- Guillermo Bosch
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB (Parc de Salut Mar - Pompeu Fabra University - Agència de Salut Pública de Barcelona), Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Anna Guillen-Sola
- Department of Physical Medicine and Rehabilitation, PSMAR, Barcelona. Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, PSMAR, Barcelona. Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
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17
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O'Donovan A, Duncan JC, Li KY, Del-Nevo L, Gill A, Peak M, Alhnan MA. The Use of Special-Order Products in England between 2012-2020: An Insight into The Need for Point-of-Care Manufacturing. Int J Pharm 2023; 637:122801. [PMID: 36878418 DOI: 10.1016/j.ijpharm.2023.122801] [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: 10/31/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
Point-of-care manufacturing such as 3D printing has recently received significant attention from regulatory bodies and the pharmaceutical industry. However, little information is available on the quantity of the most prescribed patient-specific items, their dosage form, and why they were required to be dispensed. In England, 'Specials' are unlicensed medicines formulated to meet the requirements of a specific prescription, prescribed if no suitable licensed alternative exists. This work aims to quantify and examine trends in the prescribing of 'Specials' in England during 2012-2020, using the NHS Business Services Authority (NHSBSA) database. Quarterly prescription data from NHSBSA for the top 500 'Specials' by quantity from 2012-2020 were compiled yearly. The changes in net ingredient cost, the number of items, British National Formulary (BNF) drug category, dosage form, and a potential reason for requiring a 'Special' were identified. In addition, the cost-per-unit was calculated for each category. The total spending on 'Specials' decreased by 62% from £109.2M in 2012 to £41.4M in 2020, primarily due to a 55.1% reduction in the number of 'Specials' items issued. The most frequently prescribed dosage form type of 'Special' was oral dosage forms (59.6% of all items in 2020) particularly oral liquids. The most common reason for prescribing a 'Special' was an inappropriate dosage form (74% of all 'Specials' in 2020). The total number of items dropped over the 8 years as commonly prescribed 'Specials' such as melatonin and cholecalciferol became licensed. In conclusion, the total spending on 'Specials' dropped from 2012-2020 primarily due to a reduction in the number of 'Specials' items issued and pricing change in the Drug tariff. Based on the current demand for 'special order' products, these findings are instrumental for formulation scientists to identify 'Special' formulations to design the next generation of extemporaneous medicine to be produced at the point of care.
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Affiliation(s)
- Anna O'Donovan
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, Kings College, London, SE1 9NH
| | - Jennifer C Duncan
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP
| | - Kuan-Yin Li
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, Kings College, London, SE1 9NH
| | - Lucy Del-Nevo
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, Kings College, London, SE1 9NH
| | - Andrea Gill
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP
| | - Matthew Peak
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP
| | - Mohamed A Alhnan
- Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, Kings College, London, SE1 9NH.
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Elbl J, Veselý M, Blaháčková D, Ondruš J, Kulich P, Mašková E, Mašek J, Gajdziok J. Development of 3D Printed Multi-Layered Orodispersible Films with Porous Structure Applicable as a Substrate for Inkjet Printing. Pharmaceutics 2023; 15:pharmaceutics15020714. [PMID: 36840036 PMCID: PMC9961792 DOI: 10.3390/pharmaceutics15020714] [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: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
The direct tailoring of the size, composition, or number of layers belongs to the advantages of 3D printing employment in producing orodispersible films (ODFs) compared to the frequently utilized solvent casting method. This study aimed to produce porous ODFs as a substrate for medicated ink deposited by a 2D printer. The innovative semi-solid extrusion 3D printing method was employed to produce multilayered ODFs, where the bottom layer assures the mechanical properties. In contrast, the top layer provides a porous structure for ink entrapment. Hydroxypropyl methylcellulose and polyvinyl alcohol were utilized as film-forming polymers, glycerol as a plasticizer, and sodium starch glycolate as a disintegrant in the bottom matrix. Several porogen agents (Aeroperl® 300, Fujisil®, Syloid® 244 FP, Syloid® XDP 3050, Neusilin® S2, Neusilin® US2, and Neusilin® UFL2) acted as porosity enhancers in the two types of top layer. ODFs with satisfactory disintegration time were prepared. The correlation between the porogen content and the mechanical properties was proved. A porous ODF structure was detected in most samples and linked to the porogen content. SSE 3D printing represents a promising preparation method for the production of porous ODFs as substrates for subsequent drug deposition by 2D printing, avoiding the difficulties arising in casting or printing medicated ODFs directly.
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Affiliation(s)
- Jan Elbl
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Masaryk University Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Martin Veselý
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Masaryk University Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Dagmar Blaháčková
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Masaryk University Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
| | - Jaroslav Ondruš
- Department of Pharmacology and Toxicology, Veterinary Research Institute, Hudcova 70, 621 00 Brno, Czech Republic
| | - Pavel Kulich
- Department of Pharmacology and Toxicology, Veterinary Research Institute, Hudcova 70, 621 00 Brno, Czech Republic
| | - Eliška Mašková
- Department of Pharmacology and Toxicology, Veterinary Research Institute, Hudcova 70, 621 00 Brno, Czech Republic
| | - Josef Mašek
- Department of Pharmacology and Toxicology, Veterinary Research Institute, Hudcova 70, 621 00 Brno, Czech Republic
| | - Jan Gajdziok
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Masaryk University Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic
- Correspondence:
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Pu D, Yao TJ. The use and effects of whole-body exercises on swallowing function: A scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023. [PMID: 36759960 DOI: 10.1111/1460-6984.12858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Swallowing function can become impaired due to primary medical conditions or age-related presbyphagia, resulting in swallowing disorders, known as dysphagia. Specific manoeuvres that target different musculature have been innovated and researched, but whole-body exercises (WBE) that target multiple large groups of body systems and muscles have been rarely considered in dysphagia management, despite the causes of dysphagia being often systemic. AIMS To identify intervention studies that have used or incorporated WBE to target swallowing function in humans, and report on their findings. METHODS & PROCEDURES A scoping review was conducted given the paucity and novelty of this topic in research and practice. Key search terms were used to search five major databases on for all human studies published before 28 November 2022. Studies that were not interventional or used animal models were excluded. All swallowing and oromotor-related outcomes were extracted from the studies. Two researchers independently reviewed all search results following the PRISMA-ScR guideline before meeting to resolve any disagreements. MAIN CONTRIBUTION Final analysis was conducted on 11 papers that described 10 studies, with 10 papers (9 studies) reporting positive findings for swallowing or oromotor function-related outcomes. Studies ranged from randomised controlled trials to case studies in design. The study design and populations were heterogeneous, with outcome measures for swallowing and oromotor function ranging from subjective questionnaires to instrumental assessments. CONCLUSIONS & IMPLICATIONS Dysphagia rehabilitation that incorporates WBE as part of a comprehensive programme appears to be more beneficial than either WBE or swallowing-related interventions alone. This review is an initial attempt to systematically examine the evidence on this topic. There is a need for future research to study how WBE can be used, either alone or combined with traditional swallowing exercises, to influence swallowing function in different healthy and clinical populations. WHAT THIS PAPER ADDS What is already known on this subject Dysphagia rehabilitation usually focuses only on the swallowing muscles and structures of the head, neck, and respiratory system. Whole-body exercise (WBE) and fitness are associated with stronger performance of the tongue muscles, there may be transference potential of WBE to swallowing function. What this paper adds to existing knowledge This review found 10 studies conducted in the last decade that investigated the inclusion of WBE in programmes intended to improve swallowing and/or oromotor-related outcomes. The studies varied widely in design and methodology, but most reported evidence in support of the inclusion of WBE to improve or maintain swallowing and/or oromotor-related functions. What are the potential or actual clinical implications of this work? There is potential for WBE to have a synergistic effect on swallowing function when combined with traditional swallowing exercises. Future clinical research should compare different rehabilitation approaches with controls. Clinicians should enlist allied health professionals who can provide whole-body rehabilitation when managing dysphagia.
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Affiliation(s)
- Dai Pu
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Theresa Jingyun Yao
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, CA, USA
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Slim N, Williamson JM. Achalasia: investigation and management. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 36708337 DOI: 10.12968/hmed.2022.0437] [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: 01/25/2023]
Abstract
Achalasia, characterised by the absence of peristalsis and failure of relaxation of the lower oesophageal sphincter, is an uncommon degenerative condition that results in dysphagia. If left untreated it can lead to aspiration, oesophageal perforation, oesophagitis and malnutrition. It has a range of immune, allergic, viral and genetic aetiological causes. Successful diagnosis relies on the use of oesophagogastroduodenoscopy, barium swallow and oesophageal manometry to characterise the severity of the disease and to rule out underlying malignancy. Although no treatment can reverse the degenerative process, therapeutic strategies including lifestyle modification, medication, endoscopic and operative intervention can help to reduce symptoms. This article reviews the latest methods used to investigate and manage achalasia.
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Affiliation(s)
- Naim Slim
- Department of General Surgery, The Great Western Hospital, Swindon, UK
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Schindler A, de Fátima Lago Alvite M, Robles-Rodriguez WG, Barcons N, Clavé P. History and Science behind the Eating Assessment Tool-10 (Eat-10): Lessons Learned. J Nutr Health Aging 2023; 27:597-606. [PMID: 37702330 DOI: 10.1007/s12603-023-1950-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/31/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Oropharyngeal dysphagia (OD) is an underdiagnosed medical condition with a high prevalence in populations such as patients with frailty, neurological disease, or head and neck pathology. Potential barriers to its diagnosis include lack of (or low) awareness of the existence and severity of the condition, the hidden nature of the condition within the 'normal ageing' process, clinical limitations, and socioeconomic reasons. Consequently, an effective treatment is not systematically offered in a timely manner, and complications, such as dehydration and respiratory infections or aspiration pneumonia, can arise. To overcome this issue, the early use of screening questionnaires to identify people at risk of swallowing disorders represents the cornerstone of preventive medicine. Several screening tools have been created but few are widely used in clinical practice. The Eating Assessment Tool-10 (EAT-10) was developed as a quick, easy-to-understand, and self-administered screening tool for OD. METHODS A literature review was conducted in five databases with no restrictions on the language, date of publication, or design of the study to identify aspects of the validation, applicability, and usefulness of EAT-10. RESULTS AND CONCLUSIONS Transcultural adaptation and translation studies, as well as studies involving various types of patients with dysphagia in different settings have shown the validity and reliability of EAT-10 in relation to the gold standard and other validation tools. The use of this standardised screening tool could be used as a primary screening instrument of dysphagia in routine clinical practice across a wide range of diseases and settings and thereby increase the likelihood of early diagnosis and management of a condition that lead to serious complications and impaired quality of life.
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Affiliation(s)
- A Schindler
- William Gildardo Robles-Rodriguez FUCS: Fundacion Universitaria de Ciencias de la Salud, Colombia,
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22
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Shen Z, Hou Y, Huerman A, Ma A. Patients with dysphagia: How to supply nutrition through non-tube feeding. Front Nutr 2022; 9:1060630. [PMID: 36532550 PMCID: PMC9757495 DOI: 10.3389/fnut.2022.1060630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/17/2022] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Dysphagia has become one of the important factors that cause malnutrition in the whole age group. At present, tube feeding is still the mainstream means to solve the problem of dysphagia. However, tube feeding has physical and mental harm to people, and the ways of non-tube feeding are relatively diversified. The significance of the thickening mechanism described in some articles to solve the problem of dysphagia is not clear. SETTING AND PARTICIPANTS All patients with dysphagia worldwide, including oropharyngeal dysphagia (OD) and non-oropharyngeal dysphagia. METHODS We searched the literature in Pubmed, Web of Science and Cochrane Library and initially browsed the titles and abstracts. We reviewed the full text of the articles that met our topic, and the language of the article was limited to English. RESULTS We found that food thickening to a certain degree (350-1,750 cP) can reduce the complications of choking, aspiration, reflux, and other complications in patients with dysphagia, and reduce the social disorder, anxiety, and other psychological problems caused by catheterization and surgery. Significantly, food science engineers should invite clinicians to intervene in the development of specialty foods from different perspectives such as clinical pathophysiology and fluid mechanics. CONCLUSION AND IMPLICATIONS It is necessary to develop special foods for patients with dysphagia, which requires scientists from different disciplines to work together.
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Affiliation(s)
- Zhean Shen
- College of Food Science and Engineering, Xinjiang Institute of Technology, Aksu, China
- Nutritional Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
| | - Yingze Hou
- Sanquan College, Xinxiang Medical University, Xinxiang, China
| | - Ayideng Huerman
- College of Food Science and Engineering, Xinjiang Institute of Technology, Aksu, China
| | - Aiqin Ma
- Nutritional Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
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Ghelichi L, Hashemian M, Nakhostin Ansari N, Tarameshlu M. Cross-cultural Adaption, Validation and Factor Analysis of the Persian Version of the Eating Assessment Tool: EAT-10. Dysphagia 2022; 37:1511-1518. [PMID: 35132473 DOI: 10.1007/s00455-021-10405-1] [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: 10/02/2021] [Accepted: 12/28/2021] [Indexed: 02/05/2023]
Abstract
The eating assessment tool (EAT-10) is a self-reported questionnaire to assess the patient's perception of swallowing difficulties. The aim of this study was to cross-culturally adapt and determine validity and reliability of the Persian version of the EAT-10 (P-EAT-10) in patients with oropharyngeal dysphagia. The EAT-10 was translated into Persian language and cross-culturally adapted. One hundred patients with dysphagia (mean age ± SD = 44.44 ± 14.69 years) participated. The test-retest reliability (time interval = 7 days) was assessed in 50 patients. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were analyzed. The Persian version of functional oral intake scale (FOIS-P) was also recorded to assess construct validity. One hundred healthy subjects completed the P-EAT-10 for clinical validity. Factor analysis was performed to determine the P-EAT-10 structure. There were no missing responses and floor or ceiling effects. Internal consistency was high (Cronbach's α 0.91). Item-total correlations exceeded acceptable standard of 0.3 for the all items (0.62-0.83). The test-retest reliability was excellent [(ICC)agreement 0.96]. The SEM and SDC were 2.61 and 7.23, respectively. Construct validity was confirmed by a significant correlation between the P-EAT-10 and FOIS-P scores (r = 0.84). Clinical validity was supported by a significant discrimination between patients and healthy subjects (t = 29.97, P < 0.001). Factor analysis indicated 2 components for the P-EAT-10. The P-EAT-10 is a valid and reliable tool and can be used in clinic and research for the assessment of oropharyngeal dysphagia in Persian-speaking patients.
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Affiliation(s)
- Leila Ghelichi
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Hashemian
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tarameshlu
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Miles A, McRae J, Clunie G, Gillivan-Murphy P, Inamoto Y, Kalf H, Pillay M, Pownall S, Ratcliffe P, Richard T, Robinson U, Wallace S, Brodsky MB. An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic. Dysphagia 2022; 37:1349-1374. [PMID: 34981255 PMCID: PMC8723823 DOI: 10.1007/s00455-021-10396-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022]
Abstract
COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers' health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.
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Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Grafton Campus, Private Bag 92019, Auckland, New Zealand.
| | - Jackie McRae
- Centre for Allied Health, St George's, University of London/University College London Hospitals NHS Foundation Trust, London, UK
| | - Gemma Clunie
- Imperial College London & Clinical Specialist SLT (Airways/ENT), Imperial College Healthcare NHS Trust, London, UK
| | - Patricia Gillivan-Murphy
- Clinical Specialist SLT, Voice & Swallowing Clinic, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Yoko Inamoto
- SLHT, Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hanneke Kalf
- Division of Speech Pathology, Department of Rehabilitation, Radboud University Medical Centre / Donders Centre for Neuroscience, Nijmegen, The Netherlands
| | - Mershen Pillay
- Speech-Language Therapy, University of KwaZulu-Natal, Durban, South Africa
| | - Susan Pownall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Philippa Ratcliffe
- Consultant SLT Royal National ENT and EDH University College London Hospitals NHS Foundation Trust, London, UK
| | - Theresa Richard
- Mobile Dysphagia Diagnostics, Medical SLP Collective, Buffalo, USA
| | - Ursula Robinson
- SLT, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - Sarah Wallace
- Consultant SLT, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martin B Brodsky
- Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
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25
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Bobin F, Lechien JR. The role of pH-impedance monitoring in swallowing disorders. Curr Opin Otolaryngol Head Neck Surg 2022; 30:406-416. [PMID: 36004789 DOI: 10.1097/moo.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the current evidence about the usefulness and the place of pH study in the management of patients with swallowing disorders. RECENT FINDINGS Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are found in approximately 30% of patients with esophageal or oropharyngeal dysphagia. Patients with suspected GERD may benefit from gastrointestinal endoscopy and proton pump inhibitors according to guidelines. The diagnosis of LPR in patients with oropharyngeal dysphagia is more controversial because there are no gold standard and diagnostic guidelines. The clinical diagnosis based on empirical therapeutic trial is a reasonable first-line strategy, but many dysphagic patients should not respond to treatment. These patients require hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH), which is the most effective examination providing important information on GERD and LPR features. At the HEMII-pH, GERD patients often report upright (daytime) and supine (nighttime) liquid acid esophageal events with significant esophageal distal acid exposure time. LPR patients have more frequently upright (daytime) gaseous weakly acid or nonacid pharyngeal reflux events without distal esophageal acid exposure abnormalities in many times. The features of reflux at the HEMII-pH may indicate a personalized treatment for dysphagic patients combining proton pump inhibitors, alginate/magaldrate or gastroprokinetic in cases of esophageal dysmotility. SUMMARY GERD and LPR are prevalent causes of dysphagia. The large number of reflux patients who do not respond to empirical treatment makes important the awareness of otolaryngologists about pH-impedance monitoring indication, features, and interpretation.
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Affiliation(s)
- Francois Bobin
- Polyclinic of Poitiers, Elsan Hospital, Poitiers, France
| | - Jerome R Lechien
- Polyclinic of Poitiers, Elsan Hospital, Poitiers, France
- Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons
- Department of Otolaryngology-Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
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26
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Hou WH, Moo CC, Kuo TL, Kuo CL, Chu SY, Wu KF, Chen LW, Li CY. Schizophrenia, but not depression or bipolar affective disorder, adds additional risk of aspiration pneumonia among stroke survivors: A national cohort study in Taiwan. J Psychosom Res 2022; 162:111033. [PMID: 36115193 DOI: 10.1016/j.jpsychores.2022.111033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Few studies have assessed the sex-specific and age-specific risk of aspiration pneumonia (AP) in patients with stroke and evaluated whether mental disorders may increase this risk. In this population-based cohort study, we investigated the sex-specific and age-specific risk of AP in association with stroke and the joint effects of stroke and mental disorders on the risk of AP. METHODS We included 23,288 patients with incident stroke admitted between 2005 and 2017 and 68,675 matched nonstroke controls. Information on mental disorders was obtained from medical claims data within the 3 years before the stroke incidence. Cox proportional hazards models considering death as a competing risk event were constructed to estimate the hazard ratio of AP incidence by the end of 2018 associated with stroke and selected mental disorders. RESULTS After ≤14 years of follow-up, AP incidence was higher in the patients with stroke than in the controls (11.30/1000 vs. 1.51/1000 person-years), representing a covariate-adjusted subdistribution hazard ratio (sHR) of 3.64, with no significant sex difference. The sHR significantly decreased with increasing age in both sexes. Stratified analyses indicated schizophrenia but not depression or bipolar affective disorder increased the risk of AP in the patients with stroke. CONCLUSION Compared with their corresponding counterparts, the patients with schizophrenia only, stroke only, and both stroke and schizophrenia had a significantly higher sHR of 4.01, 5.16, and 8.01, respectively. The risk of AP was higher in younger stroke patients than those older than 60 years. Moreover, schizophrenia was found to increase the risk of AP in patients with stroke.
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Affiliation(s)
- Wen-Hsuan Hou
- College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cherl Cy Moo
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Teng-Lung Kuo
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Lun Kuo
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ke-Fei Wu
- Department of Business Management, National Taichung University of Science and Technology, Taichung, Taiwan; Department of Accounting Information, Chihlee University of Technology, New Taipei City, Taiwan
| | - Liang-Wu Chen
- Department of Chest, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Effects of Food and Liquid Properties on Swallowing Physiology and Function in Adults. Dysphagia 2022; 38:785-817. [PMID: 36266521 DOI: 10.1007/s00455-022-10525-2] [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: 02/14/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
Foods and liquids have properties that are often modified as part of clinical dysphagia management to promote safe and efficient swallowing. However, recent studies have questioned whether this practice is supported by the evidence. To address this, a scoping review was conducted to answer the question: "Can properties of food and liquids modify swallowing physiology and function in adults?" Online search in six databases yielded a set of 4235 non-duplicate articles. Using COVIDENCE software, two independent reviewers screened the articles by title and abstract, and 229 full-text articles were selected for full-text review. One-hundred eleven studies met the inclusion criteria for qualitative synthesis and assessment of risk of bias. Three randomized controlled trials and 108 non-randomized studies were analyzed. Large amounts of variability in instrumental assessment, properties of food and liquids, and swallowing measures were found across studies. Sour, sweet, and salty taste, odor, carbonation, capsaicin, viscosity, hardness, adhesiveness, and cohesiveness were reported to modify the oral and pharyngeal phase of swallowing in both healthy participants and patients with dysphagia. Main swallow measures modified by properties of food and liquids were penetration/aspiration, oral transit time, lingual pressures, submental muscle contraction, oral and pharyngeal residue, hyoid and laryngeal movement, pharyngeal and upper esophageal sphincter pressures, and total swallow duration. The evidence pooled in this review supports the clinical practice of food texture and liquid consistency modification in the management of dysphagia with the caveat that all clinical endeavors must be undertaken with a clear rationale and patient-specific evidence that modifying food or liquid benefits swallow safety and efficiency while maintaining quality of life.
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28
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Rodríguez-Pombo L, Awad A, Basit AW, Alvarez-Lorenzo C, Goyanes A. Innovations in Chewable Formulations: The Novelty and Applications of 3D Printing in Drug Product Design. Pharmaceutics 2022; 14:pharmaceutics14081732. [PMID: 36015355 PMCID: PMC9412656 DOI: 10.3390/pharmaceutics14081732] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Since their introduction, chewable dosage forms have gained traction due to their ability to facilitate swallowing, especially in paediatric, geriatric and dysphagia patients. Their benefits stretch beyond human use to also include veterinary applications, improving administration and palatability in different animal species. Despite their advantages, current chewable formulations do not account for individualised dosing and palatability preferences. In light of this, three-dimensional (3D) printing, and in particular the semi-solid extrusion technology, has been suggested as a novel manufacturing method for producing customised chewable dosage forms. This advanced approach offers flexibility for selecting patient-specific doses, excipients, and organoleptic properties, which are critical for ensuring efficacy, safety and adherence to the treatment. This review provides an overview of the latest advancements in chewable dosage forms for human and veterinary use, highlighting the motivations behind their use and covering formulation considerations, as well as regulatory aspects.
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Affiliation(s)
- Lucía Rodríguez-Pombo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Atheer Awad
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - Abdul W. Basit
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
- FabRx Ltd., Henwood House, Henwood, Ashford, Kent TN24 8DH, UK
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Correspondence: (C.A.-L.); (A.G.)
| | - Alvaro Goyanes
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute iMATUS and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK
- FabRx Ltd., Henwood House, Henwood, Ashford, Kent TN24 8DH, UK
- Correspondence: (C.A.-L.); (A.G.)
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Ullal TV, Marks SL, Belafsky PC, Conklin JL, Pandolfino JE. A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans. Front Vet Sci 2022; 9:889331. [PMID: 35754550 PMCID: PMC9228035 DOI: 10.3389/fvets.2022.889331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.
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Affiliation(s)
- Tarini V Ullal
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Peter C Belafsky
- Department of Otolaryngology, Center for Voice and Swallowing, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jeffrey L Conklin
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, UCLA Robert G. Kardashian Center for Esophageal Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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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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Hsu CY, Lai JN, Kung WM, Hung CH, Yip HT, Chang YC, Wei CY. Nationwide Prevalence and Outcomes of Long-Term Nasogastric Tube Placement in Adults. Nutrients 2022; 14:nu14091748. [PMID: 35565713 PMCID: PMC9102306 DOI: 10.3390/nu14091748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/05/2023] Open
Abstract
Tube feeding (TF) is commonly used for patients with severe swallowing disturbance, and patients with chronic dysphagia are often provided with a long-term nasogastric tube (NGT). However, nationwide epidemiological data on long-term NGT placement are limited. The present study identified the prevalence and outcomes of patients with long-term NGT placement in Taiwan. Data were obtained from the Longitudinal Health Insurance Database. Patients with NGT placement for more than 3 months between 2000 and 2012 were enrolled in this cohort study. An NGT cohort of 2754 patients was compared with 11,016 controls matched for age, sex, residential area, and comorbidities. The prevalence rate of long-term NGT reached 0.063% in 2005 and then remained stable at 0.05-0.06%. The major causes of NGT placement were stroke (44%), cancer (16%), head injury (14%), and dementia (12%). Men (63%) were more likely to have long-term NGT placement than women (37%). The adjusted hazard ratios were 28.1 (95% CI = 26.0, 30.3) for acute and chronic respiratory infections; 26.8 (95% CI = 24.1, 29.8) for pneumonia, 8.84 (95% CI = 7.87, 9.93) for diseases of the esophagus, stomach, and duodenum; and 7.5 (95% CI = 14.7, 20.8) for mortality. Patients with NGT placement for more than 6 months had a higher odds ratio (1.58, 95% CI = 1.13, 2.20) of pneumonia than those with NGT placement for less than 6 months. Only 13% and 0.62% of the patients underwent rehabilitation therapy and percutaneous endoscopic gastrostomy, respectively. Long-term NGT use was associated with a higher risk of comorbidities and mortality. Stroke was the main illness contributing to long-term NGT use. Further interventions are necessary to improve the negative effects of long-term TF.
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Affiliation(s)
- Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40402, Taiwan;
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan;
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan;
| | - Chao-Hsien Hung
- Department of Neurology, Feng Yuan Hospital, Taichung 42055, Taiwan;
| | - Hei-Tung Yip
- Management Office for Health Data, Clinical Trial Center, China Medical University Hospital, Taichung 40447, Taiwan;
- College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yu-Chen Chang
- Show Chwan International Dementia and Movement Disorder Center, Chang Bing Show Chwan Memorial Hospital, Changhua County 50544, Taiwan;
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan;
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua County 50544, Taiwan
- Correspondence: ; Tel.: +886-04-7813888
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The global prevalence of oropharyngeal dysphagia in different populations: a systematic review and meta-analysis. J Transl Med 2022; 20:175. [PMID: 35410274 PMCID: PMC9003990 DOI: 10.1186/s12967-022-03380-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/04/2022] [Indexed: 01/21/2023] Open
Abstract
Background Oropharyngeal dysphagia (OD) refers to any abnormality in the physiology of swallowing in the upper gastrointestinal tract, which leads to the related clinical complications, such as malnutrition, dehydration, and sever complication, such as aspiration pneumonia, suffocation, and eventually, premature death. The previous studies indicated a various range of prevalence of OD. The present systematic review and meta-analysis aimed to standardize the global prevalence of OD in different populations. Methods A systematic literature review was conducted using Embase, Scopus, PubMed, Web of Science (WoS) databases, and Google Scholar motor engine using related MeSH/Emtree and Free Text words, with no time limitation until November 2021. The heterogeneity among studies was quantified using I2 index and the random effects model was used, due to the high heterogeneity among the results of studies included in the meta-analysis. Results The systematic literature search retrieved 2092 studies. After excluding the irrelevant studies, ultimately 27 articles with a sample size of 9841 were included in the meta-analysis. After combining the studies, the overall estimate of the global prevalence rate of OD was 43.8% (95% CI 33.3–54.9%) and the highest prevalence rate was estimated in Africa with 64.2% (95% CI 53.2–73.9%). Given the subgroup analysis based on the study population, the highest prevalence of OD was related to Dementia with 72.4% (95% CI 26.7–95.0%). The results of meta-regression indicated that the prevalence of OD has an increasing trend with the enhancement of year of publication and mean age. Conclusion The results of the present systematic review and meta-analysis revealed that the prevalence of OD is high in different populations and its trend has been increasing in recent years. Therefore, the appropriate strategies should be applied to reduce the prevalence of OD by finding its causation and monitoring at all levels, as well as providing feedback to hospitals.
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Lin TH, Yang CW, Chang WK. Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia. Front Immunol 2022; 12:800029. [PMID: 35185865 PMCID: PMC8847226 DOI: 10.3389/fimmu.2021.800029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are widely used techniques to feed older patients with oropharyngeal dysphagia. Aspiration pneumonia is the most common cause of death in these patients. This study aimed to evaluate the role of oropharyngeal dysphagia in older patients on long-term enteral feeding for risk stratification of pneumonia requiring hospitalization. Methods We performed modified flexible endoscopic evaluation of swallowing to evaluate oropharyngeal dysphagia in older patients and conducted prospective follow-up for pneumonia requiring hospitalization. A total of 664 oral-feeding patients and 155 tube-feeding patients were enrolled. Multivariate Cox analysis was performed to identify risk factors of pneumonia requiring hospitalization. Results Multivariate analyses showed that the risk of pneumonia requiring hospitalization significantly increased in older patients and in patients with neurological disorders, tube feeding, and oropharyngeal dysphagia. Subgroup analysis revealed that the risk of pneumonia requiring hospitalization was significantly lower in patients with PEG than in those with NGT among the patients with oropharyngeal dysphagia (adjusted hazard ratio 0.26, 95% confidence interval: 0.11–0.63, P = 0.003). Conclusions For older patients with oropharyngeal dysphagia requiring long-term enteral tube feeding, PEG is a better choice than NGT. Further research is needed to elucidate the role of oropharyngeal dysphagia in enteral feeding in older patients.
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Affiliation(s)
- Tai-Han Lin
- Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Yu L, Li Y, Zhang D, Huang W, Li R, Zhu J, Li R, Zhao J, Wang J. A risk prediction model for dysphagia in older patients: a single-center prospective study. Geriatr Nurs 2022; 44:24-29. [PMID: 35007867 DOI: 10.1016/j.gerinurse.2021.12.013] [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: 10/18/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
Surveys based on western populations have identified many risk factors for dysphagia in older people, but the potential risk factors consistent with the demographic characteristics of older, hospitalized Chinese patients require further study. This single-center prospective study aimed to determine the incidence of dysphagia in western China, and to develop and validate a model to predict the risk of dysphagia among older patients. A total of 343 inpatients (aged ≥ 65 years without dysphagia and cognitive impairment) were included. A score ≥ 2 on the Eating Assessment Tool-10 was defined as dysphagia. After a six-month follow-up, 70 (20.4%) patients were found to have dysphagia. The final model included age, wearing dentures, activities of daily living, cerebral vascular disease, coronary heart disease, and malignancy. The developed model has high predictive accuracy and can be easily implemented in daily practice.
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Affiliation(s)
- Lili Yu
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China; School of Nursing, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | | | - Dongyun Zhang
- School of Nursing, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Wanyun Huang
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Runping Li
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Junxia Zhu
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Rongxiu Li
- Dianjiang Traditional Chinese Medical Hospital, Chongqing, China
| | - Jun Zhao
- Center for Environment and Health in Water Source Area of South-to-North Water Diversion, Hubei University of Medicine, Shiyan, Hubei, China.
| | - Jing Wang
- Center for Environment and Health in Water Source Area of South-to-North Water Diversion, Hubei University of Medicine, Shiyan, Hubei, China.
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Hollinghurst J, Smithard DG. Identifying Dysphagia and Demographic Associations in Older Adults Using Electronic Health Records: A National Longitudinal Observational Study in Wales (United Kingdom) 2008-2018. Dysphagia 2022; 37:1612-1622. [PMID: 35212847 PMCID: PMC9643178 DOI: 10.1007/s00455-022-10425-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Dysphagia is increasingly being recognised as a geriatric syndrome (giant). There is limited research on the prevalence of dysphagia using electronic health records. To investigate associations between dysphagia, as recorded in electronic health records and age, frailty using the electronic frailty index, gender and deprivation (Welsh index of multiple deprivation). A Cross-sectional longitudinal cohort study in over 400,000 older adults was undertaken (65 +) in Wales (United Kingdom) per year from 2008 to 2018. We used the secure anonymised information linkage databank to identify dysphagia diagnoses in primary and secondary care. We used chi-squared tests and multivariate logistic regression to investigate associations between dysphagia diagnosis and age, frailty (using the electronic Frailty index), gender and deprivation. Data indicated < 1% of individuals were recorded as having a dysphagia diagnosis per year. We found dysphagia to be statistically significantly associated with older age, more severe frailty and individuals from more deprived areas. Multivariate analyses indicated increased odds ratios [OR (95% confidence intervals)] for a dysphagia diagnosis with increased age [reference 65-74: aged 75-84 OR 1.09 (1.07, 1.12), 85 + OR 1.23 (1.20, 1.27)], frailty (reference fit: mild frailty 2.45 (2.38, 2.53), moderate frailty 4.64 (4.49, 4.79) and severe frailty 7.87 (7.55, 8.21)] and individuals from most deprived areas [reference 5. Least deprived, 1. Most deprived: 1.10 (1.06, 1.14)]. The study has identified that prevalence of diagnosed dysphagia is lower than previously reported. This study has confirmed the association of dysphagia with increasing age and frailty. A previously unreported association with deprivation has been identified. Deprivation is a multifactorial problem that is known to affect health outcomes, and the association with dysphagia should not be a surprise. Research in to this relationship is indicated.
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Affiliation(s)
| | - David G. Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Road, Woolwich, London, SE18 4QH UK ,University of Greenwich, Avery Hill Campus, Bexley Rd, London, SE9 2PQ UK
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Masuda Y, Kumagi T, Miyaue N, Hosokawa Y, Yabe H. The Eldest Female Case of Myasthenia Gravis with an Unusual Presentation: Aspiration Pneumonia as the Initial Manifestation. Cureus 2021; 13:e19268. [PMID: 34900462 PMCID: PMC8648139 DOI: 10.7759/cureus.19268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/05/2022] Open
Abstract
We report the eldest female case of myasthenia gravis (MG) that initially presented with aspiration pneumonia. A 91-year-old female with a high-grade fever and general malaise who had suffered from expectoration for several years was diagnosed with aspiration pneumonia. Thorough medical history taking and physical examination suggested the possibility of MG as a cause of aspiration pneumonia. Positive acetylcholine receptor antibody and waning phenomenon on a nerve conduction study confirmed the diagnosis. Treatment with intravenous immunoglobulin, prednisolone, and pyridostigmine resulted in a rapid improvement. Physicians should always consider the etiology of aspiration pneumonia to prevent further negative events.
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Affiliation(s)
- Yuya Masuda
- Postgraduate Medical Education Center, Ehime University Hospital, Toon, JPN.,Postgraduate Medical Education Center, Saiseikai Matsuyama Hospital, Matsuyama, JPN
| | - Teru Kumagi
- Postgraduate Medical Education Center, Ehime University Hospital, Toon, JPN
| | | | - Yuko Hosokawa
- Neurology, Saiseikai Matsuyama Hospital, Matsuyama, JPN
| | - Hayato Yabe
- Neurology, Saiseikai Matsuyama Hospital, Matsuyama, JPN
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Oropharyngeal Dysphagia as a Clinical Presentation of Lithium Intoxication: A Case Report. J Am Acad Child Adolesc Psychiatry 2021; 60:1443-1445. [PMID: 34273493 DOI: 10.1016/j.jaac.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/26/2021] [Accepted: 07/07/2021] [Indexed: 11/24/2022]
Abstract
Lithium is an effective treatment option for bipolar disorder in children and adolescents; however, the therapeutic window is narrow, and psychiatric, neurological, renal, gastrointestinal, dermatological, and endocrine side effects have been observed during lithium therapy.1 Iatrogenic dysphagia has been reported with psychotropic drugs, benzodiazepines, anti-inflammatory drugs, and some vasoactive drugs.2 However, oropharyngeal dysphagia due to lithium toxicity has not been reported in the literature.
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Randall DR, Chan R, Gomes D, Walker K. Natural History of Cricopharyngeus Muscle Dysfunction Symptomatology. Dysphagia 2021; 37:937-945. [PMID: 34495387 DOI: 10.1007/s00455-021-10355-8] [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: 12/28/2020] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
Cricopharyngeus muscle dysfunction (CPMD) is a common cause for progressive dysphagia and can lead to dietary restriction, reduced nutrition, weight loss, and pneumonia. There is a continuum between small, non-obstructive cricopharyngeus bars representing mild disease and severely obstructive bars or Zenker's diverticulum forming late-stage disease, but the natural history of untreated CPMD and the associated time course for progression is unknown. Retrospective longitudinal cohort study from a tertiary outpatient dysphagia centre. Patients diagnosed with CPMD by fluoroscopy and either awaiting surgical treatment or electing non-operative management were evaluated through prospectively collected Eating Assessment Tool-10 (EAT-10) and Functional Oral Intake Scale (FOIS). Review of available imaging identified degree of CPMD. We identified 174 patients with CPMD diagnosed between July 1, 2016, and June 30, 2020; 52 patients had serial Eating Assessment Tool (EAT-10) measures obtained at time of diagnosis and follow up appointment without operative treatment. Mean EAT-10 scores increased from 17.1 to 20.6 (3.5 ± 8.1 points, p = 0.002) points. This change was related to those with a Zenker's diverticulum rather than an isolated cricopharyngeus bar. Dietary outcomes measured by FOIS were stable. While some patients showed fluoroscopic progression of bar size, no patients developed a Zenker's diverticulum from a pre-existing bar in this population. Our data indicate patients with a cricopharyngeus bar do not decline in subjective dysphagia score or diet tolerance, however those with a Zenker's diverticulum worsen over time. This has implications for treatment timing and counselling patients but also reflects a need to understand the pathophysiology behind CPMD and the subset of patients who show progression.
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Affiliation(s)
- Derrick R Randall
- Section of Otolarynogology - Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Outpatient Dysphagia Clinic, Peter Lougheed Centre, Calgary, AB, Canada.
| | - Ryan Chan
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dayani Gomes
- Outpatient Dysphagia Clinic, Peter Lougheed Centre, Calgary, AB, Canada
- Speech Language Pathology, Department of Allied Health, Peter Lougheed Centre, Calgary, AB, Canada
| | - Kim Walker
- Outpatient Dysphagia Clinic, Peter Lougheed Centre, Calgary, AB, Canada
- Speech Language Pathology, Department of Allied Health, Peter Lougheed Centre, Calgary, AB, Canada
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Selvanderan S, Wong S, Holloway R, Kuo P. Dysphagia: clinical evaluation and management. Intern Med J 2021; 51:1021-1027. [PMID: 34278699 DOI: 10.1111/imj.15409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 12/19/2022]
Abstract
Dysphagia is a common problem affecting all ages. It is increasing in frequency particularly among the younger population due to the rising incidence of eosinophilic oesophagitis, a condition which often leads to acute presentation to hospital for the first time with food bolus obstruction requiring endoscopic removal. Careful history taking remains the first and most important step in evaluating dysphagia, and it is especially important to distinguish an oropharyngeal versus oesophageal origin, which helps to guide further investigation and therapy. The three main investigations for dysphagia remain endoscopy, barium study and manometry, with endoscopy also offering therapeutic potential. Management is largely determined by the eventual diagnosis, often in a multi-disciplinary setting.
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Affiliation(s)
- Shane Selvanderan
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephanie Wong
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Richard Holloway
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Paul Kuo
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Nutritional Supplements and Neuroprotective Diets and Their Potential Clinical Significance in Post-Stroke Rehabilitation. Nutrients 2021; 13:nu13082704. [PMID: 34444864 PMCID: PMC8399756 DOI: 10.3390/nu13082704] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
Nutrition and rehabilitation are crucial in post-stroke recovery, especially in the elderly. Since stroke is the leading cause of long-term disability, there is a need to promote special, individually tailored nutrition strategies targeting older patients with low motor ability. Chronic stroke survivors have higher risk of developing nutrition-related chronic diseases, such as sarcopenia, anemia, type 2 diabetes mellitus and osteoporosis. Moreover, reduced motor activity, cognitive impairment and depression might be aggravated by poor malnutrition status. Accumulated data suggest that nutritional supplements and neuroprotective diets can be associated with better effectiveness of post-stroke rehabilitation as well as brain recovery. Therefore, this review focuses on preventive strategies that can improve dietary intake and change dietary patterns. We highlight the importance of neuroprotective diets, the problem of dysphagia and the role of nutrition in rehabilitation. This article focuses on potential nutritional supplements and neuroprotective diets that may have an impact on functional recovery during and after rehabilitation. Moreover, a new approach to post-stroke neuroplasticity including the use of agents from marine sources such as fucoxanthin and tramiprosate as compounds that might be used as potential neuroprotectants with antioxidative and anti-inflammatory properties is introduced.
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Abudalou M, Malkowski M, Robles MR, Vega EA, Slama MCC. A Rare Presentation of a Rare Disease: Oropharyngeal Dysphagia as The Main Manifestation of Myasthenia Gravis. Cureus 2021; 13:e16880. [PMID: 34513455 PMCID: PMC8411993 DOI: 10.7759/cureus.16880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 12/02/2022] Open
Abstract
Oropharyngeal dysphagia is defined as the inability or difficulty to initiate swallowing. It has a wide array of etiologies including structural and neurologic diseases. Myasthenia gravis (MG) is a rare autoimmune condition caused by antibodies against the post-synaptic membranes of the neuromuscular junction, leading to fatigable weakness of skeletal muscles. Bulbar symptoms are less prevalent than ocular symptoms or limb weakness but can be particularly morbid. Non-neurologists are more likely to be the first providers to evaluate patients with dysphagia and should be familiar with MG. We report a unique case of newly diagnosed MG with the initial presentation of solid food and liquid dysphagia.
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Affiliation(s)
- Mohammad Abudalou
- Internal Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, USA
| | - Michael Malkowski
- Internal Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, USA
| | - Marcel R Robles
- Internal Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, USA
| | - Eduardo A Vega
- Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, USA
| | - Michael C C Slama
- Neurology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, USA
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Reyes-Torres CA, Castillo-Martínez L, Ramos-Vázquez AG, Chávez-Moreno DV, Serralde-Zúñiga AE. A low phase angle determined by bioelectrical impedance analysis is associated with oropharyngeal dysphagia among institutionalized older adults. Rev Assoc Med Bras (1992) 2021; 67:1161-1166. [DOI: 10.1590/1806-9282.20210578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 11/21/2022] Open
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Jafarov S, İsazade A, Köycü A, Beyazpınar G, Bahçecitapar M, Tüzüner A. Evaluation of Oropharyngeal Dysphagia in Elderly Patients with Pharyngeal Aberrant Internal Carotid Artery Using the Eating Assessment Tool-10 (EAT-10). Dysphagia 2021; 37:676-682. [PMID: 34226957 DOI: 10.1007/s00455-021-10318-z] [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: 11/15/2020] [Accepted: 05/13/2021] [Indexed: 10/20/2022]
Abstract
Pharyngeal aberrant internal carotid artery (PAICA) has been reported to be a cause of oropharyngeal dysphagia (OD) in case reports. However, as there have been no clinical studies, the relationship between PAICA and OD is not clear. The aim of this study was to investigate the perception of OD in elderly PAICA patients using the Eating Assessment Tool-10 (EAT-10). A study group (Group 1) was formed of patients diagnosed with PAICA from the visualization of a pulsatile mass in the pharynx in flexible fiberoptic endoscopic examination and carotid magnetic resonance angiography tests, and a control group (Group 2) was formed of age-matched healthy volunteers. The study group was subdivided as patients with unilateral PAICA (Group 1a) and patients with bilateral PAICA (Group 1b). The Turkish version of the EAT-10 was applied to all the participants. Total EAT-10 points of ≥ 3 were accepted as abnormal. Normal (< 3) and abnormal (≥ 3) total EAT-10 points were determined in 88.9% (24/27) and 11.1% (3/27), respectively, of the control group, in 55.2% (16/29) and 44.8% (13/29) of Group 1, in 70.6% (12/17) and 29.4% (5/17) of Group 1a, and in 33.3% (4/12) and 66.7% (8/12) of Group 1b. A statistically significant difference was determined between the control group and Group 1 and Group 1b in respect of abnormal (≥ 3) EAT-10 total points (p = 0.007, p = 0.001, respectively). No statistically significant difference was determined between the control group and Group 1a (p = 0.227). Problems (EAT point ≥ 1) in item 4 (swallowing solids takes extra effort) were experienced by 13 (44.8%) patients in Group 1, 9 (75%) patients in Group 1b, and 5 (18.5%) subjects in the control group (p < 0.05). These results demonstrated that unilateral PAICA does not significantly affect swallowing, whereas bilateral PAICA created a significant negative effect. These patients experience more problems when swallowing solid food.
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Affiliation(s)
- Sabuhi Jafarov
- Department of Otorhinolaryngology, Baskent University Hospital, Fevzi Çakmak caddesi No 48, Çankaya, 06490, Ankara, Turkey.
| | - Artoghrul İsazade
- Department of Otorhinolaryngology, Baskent University Hospital, Fevzi Çakmak caddesi No 48, Çankaya, 06490, Ankara, Turkey
| | - Alper Köycü
- Department of Otorhinolaryngology, Baskent University Hospital, Fevzi Çakmak caddesi No 48, Çankaya, 06490, Ankara, Turkey
| | - Gülfem Beyazpınar
- Department of Otorhinolaryngology, Baskent University Hospital, Fevzi Çakmak caddesi No 48, Çankaya, 06490, Ankara, Turkey
| | | | - Arzu Tüzüner
- Department of Otorhinolaryngology, Baskent University Hospital, Fevzi Çakmak caddesi No 48, Çankaya, 06490, Ankara, Turkey
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44
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Dimer NA, Rech RS, Chiari BM, Goulart BNGD. Prevalence of speech-language and hearing disorders in elderly and younger adults according to sex and age: a population survey. Codas 2021; 33:e20200080. [PMID: 34133611 DOI: 10.1590/2317-1782/20202020080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To verify the distribution of self-reported speech-language and hearing disorders and their association to sex and age in a representative sample of the population in southern Brazil. METHODS Prevalence of speech-language and hearing disorders in elderly and younger adults according to sex and age: a population survey based on a household survey on Human Communication Disorders (DCH-POP Study). Standardized home interviews were conducted using a questionnaire with residents of the city of Porto Alegre between 2012 and 2014. The study outcome was self-reported "speech-language and hearing disorders", constituted from the variables: language, orofacial motricity, hearing, and balance. Analyses of absolute and relative frequencies were performed. Multivariable prevalence ratios were estimated in an adjusted analysis using Poisson Regression with robust variation and 95% confidence intervals. RESULTS Of the 1246 individuals interviewed, 918 participants were eligible for this study. Most of them were female (58.1%), and the average age was 48.9 (± 19.6) years. The outcome of speech-language and hearing disorders was found in 364 (39.4%) individuals, and the most affected age group was 60 years old or more (54.4%), with a higher prevalence in men (58.9%) than in women (51.9%). The multivariate analysis showed a significant prevalence ratio only in elderly individuals aged 60 years or older (PR 1.84; 95% CI 1.50-2.26). CONCLUSION In this study, we did not find significant differences between sexes in the prevalence of self-reported speech-language and hearing disorders in elderly and younger adults. However, elderly and younger adults presented a higher prevalence of these disorders.
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Affiliation(s)
- Nathalia Avila Dimer
- Curso de Fonoaudiologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Rafaela Soares Rech
- Curso de Fonoaudiologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Brasília Maria Chiari
- Programa de Pós-graduação em Distúrbios da Comunicação Humana, Universidade Federal de São Paulo - USP - São Paulo (SP), Brasil
| | - Bárbara Niegia Garcia de Goulart
- Curso de Fonoaudiologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil.,Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
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45
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Park JS, Frank E, Simental A, Perez HA, Park JJ, Filho PA, Murry T. Incidence of Dysphonia and Dysphagia Exceeds Recurrent Laryngeal Nerve Injury During Thyroid Surgery. J Voice 2021:S0892-1997(21)00093-X. [PMID: 34053823 DOI: 10.1016/j.jvoice.2021.02.030] [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: 12/21/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the prevalence of separate and combined voice and swallowing impairments before and after total thyroidectomy and to delineate risk factors for these symptoms. METHODS Retrospective review of 592 consecutive patients who underwent total thyroidectomy from July 2003 to August 2015. RESULTS Combined voice and swallowing problems occurred preoperatively in 4.7% (11/234), 3.3% (3/92), and 6.0% (16/266) of patients with malignancy, hyperthyroidism, and benign euthyroid disease, respectively. Postoperatively, prevalence was 5.1%, 2.2%, and 1.9%, respectively. Benign euthyroid disease (20.7%) had the greatest risk of preoperative dysphagia (P = 0.003) and the largest glands (P < 0.001). Comparing before and after surgery, the cancer and benign euthyroid groups had decreased dysphagia (cancer: 11.5% vs. 6.0%, P = 0.034; benign: 20.7% vs. 3.8%, P < 0.001) but increased dysphonia (cancer: 19.2% vs. 28.6%, P = 0.017; benign: 15.8% vs. 27.1%, P = 0.002). Overall, 23/592 (3.9%) developed new dysphagia and 122/592 (20.6%) developed new dysphonia after surgery. Intraoperative recurrent laryngeal nerve transection occurred in 12 cases (2.0%). CONCLUSIONS Total thyroidectomy resolved dysphagia but increased dysphonia in benign and malignant euthyroid patients. Voice and swallowing problems following thyroidectomy occurred more frequently than intraoperative recurrent laryngeal nerve transection, confirming symptoms often occur in the absence of suspected nerve injury.
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Affiliation(s)
- Joshua S Park
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California.
| | - Ethan Frank
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
| | - Alfred Simental
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
| | - Hector A Perez
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
| | - Jaimie J Park
- Loma Linda University School of Medicine, Loma Linda, California
| | - Pedro Andrade Filho
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
| | - Thomas Murry
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
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Liu X, Yang Z, He S, Wang G. Percutaneous endoscopic gastrostomy. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Xudong Liu
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengqiang Yang
- Department of Radiology Intervention, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shun He
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guiqi Wang
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Pizzorni N, Radovanovic D, Pecis M, Lorusso R, Annoni F, Bartorelli A, Rizzi M, Schindler A, Santus P. Dysphagia symptoms in obstructive sleep apnea: prevalence and clinical correlates. Respir Res 2021; 22:117. [PMID: 33882921 PMCID: PMC8061009 DOI: 10.1186/s12931-021-01702-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/31/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Epidemiology of dysphagia and its drivers in obstructive sleep apnea (OSA) are poorly understood. The study aims to investigate the prevalence of dysphagia symptoms and their association with demographic and clinical factors in patients with OSA. METHODS Patients with OSA referring to an Academic Sleep Outpatient Clinic were enrolled in a prospective study. Demographic, clinical characteristics, and OSA symptoms were collected. All patients underwent home sleep cardiorespiratory polygraphy and the Eating-Assessment Tool questionnaire (EAT-10) to investigate dysphagia symptoms. Patients with a positive EAT-10 were offered to undergo a fiberoptic endoscopic evaluation of swallowing (FEES) to confirm the presence of dysphagia. FEES findings were compared with a healthy control group. Univariate and multivariate analyses were performed to assess predictors of dysphagia. RESULTS 951 patients with OSA (70% males, age 62 IQR51-71) completed the EAT-10, and 141 (15%) reported symptoms of dysphagia. Female gender (OR = 2.31), excessive daily sleepiness (OR = 2.24), number of OSA symptoms (OR = 1.25), anxiety/depression (OR = 1.89), and symptoms of gastroesophageal reflux (OR = 2.75) were significantly (p < 0.05) associated with dysphagia symptoms. Dysphagia was confirmed in 34 out of 35 symptomatic patients that accepted to undergo FEES. Patients with OSA exhibited lower bolus location at swallow onset, greater pharyngeal residue, and higher frequency and severity of penetration and aspiration events than healthy subjects (p < 0.05). CONCLUSION A consistent number of patients with OSA show symptoms of dysphagia, which are increased in females and patients with a greater OSA symptomatology, anxiety and depression, and gastroesophageal reflux. The EAT-10 appears a useful tool to guide the selection of patients at high risk of dysphagia. In clinical practice, the integration of screening for dysphagia in patients with OSA appears advisable.
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Affiliation(s)
- Nicole Pizzorni
- Phoniatric Unit, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Via GB Grassi 74, 20154, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Marica Pecis
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Rosaria Lorusso
- Phoniatric Unit, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Via GB Grassi 74, 20154, Milan, Italy
| | - Federica Annoni
- Phoniatric Unit, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Via GB Grassi 74, 20154, Milan, Italy
| | - Alice Bartorelli
- Phoniatric Unit, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Via GB Grassi 74, 20154, Milan, Italy
| | - Maurizio Rizzi
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Antonio Schindler
- Phoniatric Unit, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Via GB Grassi 74, 20154, Milan, Italy.
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST-Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
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SEREL ARSLAN S, DEMIR N, KARADUMAN AA. Deglutition disorders from the perspective of healthcare professionals in Turkey. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.812290] [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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49
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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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Ershad AL, Rajabi-Siahboomi A, Missaghi S, Kirby D, Mohammed AR. Multi-Analytical Framework to Assess the In Vitro Swallowability of Solid Oral Dosage Forms Targeting Patient Acceptability and Adherence. Pharmaceutics 2021; 13:pharmaceutics13030411. [PMID: 33808875 PMCID: PMC8003620 DOI: 10.3390/pharmaceutics13030411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
A lack of effective intervention in addressing patient non-adherence and the acceptability of solid oral dosage forms combined with the clinical consequences of swallowing problems in an ageing world population highlight the need for developing methods to study the swallowability of tablets. Due to the absence of suitable techniques, this study developed various in vitro analytical tools to assess physical properties governing the swallowing process of tablets by mimicking static and dynamic stages of time-independent oral transitioning events. Non-anatomical models with oral mucosa-mimicking surfaces were developed to assess the swallowability of tablets; an SLA 3D printed in vitro oral apparatus derived the coefficient of sliding friction and a friction sledge for a modified tensometer measured the shear adhesion profile. Film coat hydration and in vitro wettability was evaluated using a high-speed recording camera that provided quantitative measurements of micro-thickness changes, simulating static in vivo tablet–mucosa oral processing stages with artificial saliva. In order to ascertain the discriminatory power and validate the multianalytical framework, a range of commonly available tablet coating solutions and new compositions developed in our lab were comparatively evaluated according to a quantitative swallowability index that describes the mathematical relationship between the critical physical forces governing swallowability. This study showed that the absence of a film coat significantly impeded the ease of tablet gliding properties and formed chalky residues caused by immediate tablet surface erosion. Novel gelatin- and λ-carrageenan-based film coats exhibited an enhanced lubricity, lesser resistance to tangential motion, and reduced stickiness than polyvinyl alcohol (PVA)–PEG graft copolymer, hydroxypropyl methylcellulose (HPMC), and PVA-coated tablets; however, Opadry® EZ possessed the lowest friction–adhesion profile at 1.53 a.u., with the lowest work of adhesion profile at 1.28 J/mm2. For the first time, the in vitro analytical framework in this study provides a fast, cost-effective, and repeatable swallowability ranking method to screen the in vitro swallowability of solid oral medicines in an effort to aid formulators and the pharmaceutical industry to develop easy-to-swallow formulations.
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Affiliation(s)
- Abdul Latif Ershad
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK; (A.L.E.); (D.K.)
| | | | | | - Daniel Kirby
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK; (A.L.E.); (D.K.)
| | - Afzal Rahman Mohammed
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK; (A.L.E.); (D.K.)
- Correspondence: ; Tel.: +44-(0)-121-204-4183
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