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Aii S, Fujishima I, Shigematsu T, Ohno T, Kunieda K, Yamawaki M. Sliced Jelly Whole Swallowing Reduces Deglutition Risk: A Novel Feeding Method for Patients with Dysphagia. Dysphagia 2024:10.1007/s00455-024-10674-6. [PMID: 38568345 DOI: 10.1007/s00455-024-10674-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/18/2024] [Indexed: 04/24/2024]
Abstract
Texture modification in the form of gels or jellies is used for patients with dysphagia. For over 20 years, our group has been using gelatin jellies, a type of gel, as a starting diet for patients with dysphagia. Gelatin jellies are served in a small-sliced form and swallowed whole. In sliced jelly whole swallowing (SJWS), sliced gelatin jelly (SGJ) passes through the pharynx in one lump without collapsing. This study aimed to examine the usefulness of SJWS. We analyzed the images of videofluoroscopic swallowing studies performed using the normalized residue ratio scale (NRRSv: vallecula, NRRSp: pyriform sinus), the penetration-aspiration scale (PAS), and pharyngeal transit time (PTT) in 50 patients with dysphagia and compared the results in a prospective study. SJWS had significantly less residue in both NRRSv and NRRSp than in moderately thickened liquid swallowing. No significant differences in PAS scores were found between SGJ and moderately thickened liquid. Additionally, no significant differences in PTT scores were noted between the two. This study demonstrated the usefulness of SJWS in improving swallowing safety in patients with dysphagia. Further studies are needed to evaluate the reproducibility of the test, the comparison of SGJ with other thickened liquids, and the safety of SJWS for different diseases.
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Affiliation(s)
- Seijiro Aii
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan.
- Department of Medical Education Research and Development, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu City, Shizuoka, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masanaga Yamawaki
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Medical Education Research and Development, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
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2
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Yang H, Chou LY, Hua CC. Effects of Calcium and pH on Rheological Thermal Resistance of Composite Xanthan Gum and High-Methoxyl Apple Pectin Matrices Featuring Dysphagia-Friendly Consistency. Foods 2023; 13:90. [PMID: 38201118 PMCID: PMC10778284 DOI: 10.3390/foods13010090] [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: 12/11/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
High-methoxyl apple pectin (AP) derived from apple was employed as the main ingredient facilitating rheological modification features in developing dysphagia-friendly fluidized alimentary matrices. Xanthan gum (XG) was also included as a composite counterpart to modify the viscoelastic properties of the thickened system under different thermal processes. The results indicate that AP is extremely sensitive to thermal processing, and the viscosity is greatly depleted under a neutral pH level. Moreover, the inclusion of calcium ions echoed the modification effect on the rheological properties of AP, and both the elastic property and viscosity value were promoted after thermal processing. The modification effect of viscoelastic properties (G' and G″) was observed whne XG was incorporated into the composite formula. Increasing the XG ratio from 7:3 to 6:4 (AP:XG) triggers the rheological transformation from a liquid-like form to a solid-like state, and the viscosity value shows that the AP-XG composite system exhibits better thermal stability after thermal processing. The ambient modifiers of pH (pH < 4) and calcium chloride concentration (7.5%) with an optimal AP-XG ratio of 7:3 led to weak-gel-like behavior (G″ < G'), helping to maintain the texture properties of dysphagia-friendly features similar to those prior to the thermal processing.
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Affiliation(s)
- Huaiwen Yang
- Department of Food Science, National Chiayi University, Chiayi City 60004, Taiwan
| | - Liang-Yu Chou
- Department of Food Science, National Chiayi University, Chiayi City 60004, Taiwan
| | - Chi-Chung Hua
- Department of Chemical Engineering, National Chung Cheng University, Chiayi City 621301, Taiwan
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3
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Silva DCGD, Cunha MDSBD, Santana ADO, Alves AMDS, Santos MP. Nutritional interventions in children and adolescents with cerebral palsy: systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2022107. [PMID: 37436239 DOI: 10.1590/1984-0462/2024/42/2022107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/05/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). DATA SOURCE This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde - Lilacs, Embase, United States National Library of Medicine - PubMed, Scientific Electronic Library Online - SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: "children" OR "childhood" AND "nutritional therapy" OR "nutritional intervention" OR "nutrition" OR "nutritional support" OR "diet" AND "cerebral palsy" OR "cerebral injury". Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. DATA SYNTHESIS Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. CONCLUSIONS Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.
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Gallegos C, Turcanu M, Assegehegn G, Brito-de la Fuente E. Rheological Issues on Oropharyngeal Dysphagia. Dysphagia 2023; 38:558-585. [PMID: 34216239 DOI: 10.1007/s00455-021-10337-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
There is an increasing proof of the relevance of rheology on the design of fluids for the diagnosis and management of dysphagia. In this sense, different authors have reported clinical evidence that support the conclusion that an increase in bolus viscosity reduces the risks of airway penetration during swallowing. However, this clinical evidence has not been associated yet to the definition of objective viscosity levels that may help to predict a safe swallowing process. In addition, more recent reports highlight the potential contribution of bolus extensional viscosity, as elongational flows also develops during the swallowing process. Based on this background, the aim of this review paper is to introduce the lecturer (experts in Dysphagia) into the relevance of Rheology for the diagnosis and management of oropharyngeal dysphagia (OD). In this sense, this paper starts with the definition of some basic concepts on Rheology, complemented by a more extended vision on the concepts of shear viscosity and elongational viscosity. This is followed by a short overview of shear and elongational rheometrical techniques relevant for the characterization of dysphagia-oriented fluids, and, finally, an in-depth analysis of the current knowledge concerning the role of shear and elongational viscosities in the diagnosis and management of OD (shear and elongational behaviors of different categories of dysphagia-oriented products and contrast fluids for dysphagia assessment, as well as the relevance of saliva influence on bolus rheological behavior during the swallowing process).
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Affiliation(s)
- Crispulo Gallegos
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany.
| | - Mihaela Turcanu
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
| | - Getachew Assegehegn
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
| | - Edmundo Brito-de la Fuente
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
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Dahlström S, Henning I, McGreevy J, Bergström L. How Valid and Reliable Is the International Dysphagia Diet Standardisation Initiative (IDDSI) When Translated into Another Language? Dysphagia 2023; 38:667-675. [PMID: 35996035 PMCID: PMC9395848 DOI: 10.1007/s00455-022-10498-2] [Citation(s) in RCA: 1] [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: 01/20/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022]
Abstract
Swallowing difficulties are estimated to affect 590 million people worldwide and the modification of food and fluids is considered the cornerstone of dysphagia management. Contemporary practice uses the International Dysphagia Diet Standardisation Initiative (IDDSI), however, the validity and reliability of IDDSI when translated into another language has not been investigated. This study describes the translation process and confirms the validity and reliability of IDDSI when translated into another language (Swedish). The translation used a 12-step process based on the World Health Organization recommendations. Validity was tested using Content Validity Index (CVI) based on three ratings by a panel of 10-12 experts (Dietitians and Speech-Language Pathologists [SLPs]). The translation was rated for linguistic correlation as well as understandability and applicability in a Swedish context. Inter-rater reliability was calculated using Intraclass Correlation Coefficient (ICC) from 20 SLP assessments of 10 previously published patient cases. Significant improvement (p < 0.05) of CVI between Expert Panel assessments was shown for linguistic correlation (improvement from 0.74-0.98) and understandability/applicability (improvement from 0.79-0.93 across ratings). Excellent validity (Item-CVI > 0.78 and Scale-CVI/Average > 0.8) and very high inter-rater reliability (ICC > 0.9) were demonstrated. Results show that, when using a multi-step translation process, a translated version of IDDSI (into Swedish) demonstrates high validity and reliability. This further contributes to the evidence for use of IDDSI.
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Affiliation(s)
- Sara Dahlström
- Department of Health and Rehabilitation, Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Regional Habilitation Center, Region Kalmar, Oskarshamn, Sweden
| | - Ida Henning
- Department of Health and Rehabilitation, Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jenny McGreevy
- Department of Dietetics, Nyköping Hospital, 611 39 Nyköping, Sweden
- Centre for Clinical Research Region Sörmland, Eskilstuna, Sweden
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Liza Bergström
- Department of Health and Rehabilitation, Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Remeo Stockholm, Torsten Levenstams väg 8, SE-128 64 Stockholm, Sweden
- Division of Neurology, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, SE-182 88 Stockholm, Sweden
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6
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Sari DW, Aurizki GE, Indarwati R, Farapti F, Rekawati E, Takaoka M. The Provision of Texture-Modified Foods in Long-term Care Facilities by Health Professionals: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e44201. [PMID: 36930183 PMCID: PMC10131749 DOI: 10.2196/44201] [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: 12/11/2022] [Revised: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Malnutrition among older adults with dysphagia is common. Texture-modified foods (TMFs) are an essential part of dysphagia management. In long-term care (LTC) facilities, health professionals have implemented TMFs, but their application has not been fully elucidated, making them heterogeneous. OBJECTIVE We aim to explore the implementation of TMFs in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMFs (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes). METHODS A scoping review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodological approach will be performed. A comprehensive search for published literature will be systematically performed in PubMed, CINAHL, MEDLINE, ProQuest, PsycINFO, and Science Citation Index (Web of Science). Data screening and extraction will be performed by 2 reviewers independently. The studies included will be synthesized, summarized, and reported, following the preferred reporting items of the Mixed Methods Appraisal Tool. Our review will consider the following study designs: mixed methods, quantitative, and qualitative. Studies with patients who are not older adults will be excluded. RESULTS Data extraction will be completed by February 2023. Data presentation and analyses will be completed by April 2023, and the final outcomes will be completed by June 2023. The study findings will be published in a peer-reviewed journal. CONCLUSIONS Our scoping review will consider studies related to TMF interventions for older adults in LTC residential facilities, with no exclusion restrictions based on country, gender, or comorbidities. Studies on interventions that address TMF-related issues, such as deciding the type of food, preparing and giving the food, and evaluating the outcomes, are qualified for inclusion. TRIAL REGISTRATION OSF Registries 79AFZ; https://osf.io/79afz. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44201.
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Affiliation(s)
- Dianis Wulan Sari
- Department of Advanced Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.,Research Group for Community Health, Family, and Geriatric Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Gading Ekapuja Aurizki
- Research Group for Community Health, Family, and Geriatric Nursing, Universitas Airlangga, Surabaya, Indonesia.,Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Retno Indarwati
- Department of Advanced Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.,Research Group for Community Health, Family, and Geriatric Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Farapti Farapti
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Etty Rekawati
- Department of Community and Geriatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Manami Takaoka
- Department of Gerontological Home Care and Long-Term Care Nursing, The University of Tokyo, Tokyo, Japan
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7
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Blake CL, Brown TE, Pelecanos A, Moroney LB, Helios J, Hughes BGM, Chua B, Kenny LM. Enteral nutrition support and treatment toxicities in patients with head and neck cancer receiving definitive or adjuvant helical intensity-modulated radiotherapy with concurrent chemotherapy. Head Neck 2023; 45:417-430. [PMID: 36433667 DOI: 10.1002/hed.27249] [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: 01/24/2021] [Revised: 09/10/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Enteral nutrition (EN) is often required in patients with head and neck cancer (HNSCC); however, initiation criteria is limited or inconsistent. This study aimed to describe the relationship of treatment toxicities and requirement for EN and investigate toxicity and baseline characteristics association with EN duration. METHODS Acute toxicities and baseline characteristics were collected from patients with HNSCC (n = 110) undergoing H-IMRT. Percentage EN contributing to estimated requirements and EN duration were measured. RESULTS The threshold for patients needing ≥50% of estimated requirements via EN increased from week 3 to 4 for grade ≥2 oral/pharyngeal mucositis, dysgeusia, thick saliva and nausea, and for grade 3 dysphagia. Patients with grade 2-3 dysphagia had a reduced risk of ceasing EN compared to those with grade 0-1 dysphagia. CONCLUSIONS Using acute toxicities in clinical practice may be a useful tool to inform prompt initiation of EN prior to decline in nutritional status and anticipate EN duration.
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Affiliation(s)
- Claire L Blake
- Department of Nutrition and Dietetics, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Teresa E Brown
- Department of Nutrition and Dietetics, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Laura B Moroney
- Department of Speech Pathology and Audiology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Jennifer Helios
- Department of Speech Pathology and Audiology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Brett G M Hughes
- Cancer Care Services, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Benjamin Chua
- Cancer Care Services, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lizbeth M Kenny
- Cancer Care Services, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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8
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Marshall J, Buttsworth J, Grandt HDS, Raatz M, Signorini A, Fernando S, Clarke S. Testing and Development of Slightly Thick Infant Formula Recipes for Dysphagia Management: An Australian Perspective. Dysphagia 2023:10.1007/s00455-022-10550-1. [PMID: 36637506 DOI: 10.1007/s00455-022-10550-1] [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: 09/15/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023]
Abstract
Thickened feeds may be useful in supporting improved suck-swallow-breath coordination and airway protection in infants with dysphagia. Unfortunately, the stability of thickened feeds for infant formulas is unpredictable, which makes use of this strategy challenging. This study aimed to propose a set of Level 1 (slightly thick) recipes for Australian infant formulas/thickeners. A secondary aim was to test whether formula could be batch prepared. A set of powdered, ready-to-feed, and specialized formulas were mixed with two thickening products (Aptamil Feed Thickener® and Supercol®) and tested at 5-, 10-, 15-, 20-, 25-, 30-, and 45-min intervals using the International Dysphagia Diet Standardization Initiative (IDDSI) Flow Test. Formula/thickener samples were mixed following manufacturer instructions, but recipes were adapted to determine an ideal recipe for Level 1 (slightly thick) consistency that would be maintained over a feed. Samples were refrigerated, reheated after 12 h, and retested. Each combination was tested six times. Overall, 1,353 IDDSI Flow Tests were conducted using 14 formula/thickener combinations. In all combinations, recipe alterations were made using metric spoon measurements as opposed to the manufacturer-provided scoop. All samples were most variable at the 5-min timepoint. Formulas thickened with Supercol® generally reached a more stable consistency by 10 min, whereas formulas thickened with Aptamil Feed Thickener® were more stable by 15 min. Samples tested after 12 h were more variable with Aptamil Feed Thickener®. This study provides practical recommendations for clinicians working with infants requiring thickened feeds for dysphagia management. Further study under controlled laboratory conditions is required.
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Affiliation(s)
- Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Jordyn Buttsworth
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Hannah D S Grandt
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Annabelle Signorini
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Shenali Fernando
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Sally Clarke
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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Khan A, Malik S, Ahmad F, Sadiq N. The importance of human factors in therapeutic dietary errors of a hospital: A mixed-methods study. PLoS One 2022; 17:e0273728. [PMID: 36006996 PMCID: PMC9409594 DOI: 10.1371/journal.pone.0273728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
An accurate therapeutic diet can help people improve their medical condition. Any discrepancy in this regard could jeopardize a patient’s clinical condition. This study was aimed to determine prevalence of dietary errors among in-patients at an international private hospital’s food department, and to explore causes of error to suggest strategies to reduce such errors in the future. Thus, a sequential explanatory mixed-methods study was carried out. For the quantitative part, secondary data were collected on a daily basis over one-month. For qualitative data, errors arising during the meal flow process were traced to the source on the same day of error followed by qualitative interviews with person responsible. Quantitative data were analyzed in SPSS v.25 as percentages. Qualitative data were analyzed by deductive-inductive thematic analysis. Out of a total of 7041 diets, we found that only 17 had errors. Of these, almost two-thirds were critical. Majority of these errors took place during diet card preparation (52.94%), by dietitians (70.59%), during weekdays (82.35%), breakfasts (47.06%), and in the cardiac care ward (47.06%). The causes identified through interviews were lack of backup or accessory food staff, and employee’s personal and domestic issues. It was concluded that even though the prevalence of dietary errors was low in this study, critical errors formed majority of these errors. Adopting organizational behavior strategies in the hospital may not only reduce dietary errors, but improve patients’ well-being, and employee satisfaction in a long run.
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Affiliation(s)
- Amanullah Khan
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Sidra Malik
- Riphah International University, Islamabad, Pakistan
| | - Fayaz Ahmad
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Naveed Sadiq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan
- * E-mail:
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Taira K, Watanabe Y, Okada K, Kondo M, Takeda M, Ito K, Nakajima J, Iwasaki M, Itoda M, Inohara K, Sasaki R, Nishi Y, Furuya J, Watanabe Y, Umemoto G, Kishima M, Tohara T, Sato Y, Yoshida M, Yamazaki Y. Association between denture use and food form in older adults requiring long-term care: A multicenter cross-sectional study. J Prosthodont Res 2022. [PMID: 35989265 DOI: 10.2186/jpr.jpr_d_21_00161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to determine whether denture use contributes to maintaining and improving food forms in long-term care facility (LTCFs) residents. METHODS In 888 residents of 37 LTCFs in Japan, the following were investigated: nutritional intake status, food forms, age, sex, Barthel index (BI), clinical dementia rating (CDR), number of teeth present, number of occlusal supports, swallowing function, and use of dentures. Among all residents, those who were well-nourished and had ≤9 occlusal supports were analyzed. Based on standardized criteria, the food forms consumed by the subjects were divided into two groups: dysphagia and normal diet, which were further classified into four levels. Analysis was performed using a generalized estimation equation with the four levels of food forms as dependent variables and age, sex, BI, CDR, presence of dysphagia, number of teeth present, and use of dentures as independent variables. RESULTS The final analysis included 622 (70.0%) residents. Of these, 380 (61.1%) used dentures. The analyses revealed that food form was significantly associated with age (adjusted odds ratio [OR], 0.98), BI (OR, 1.04), number of teeth present (OR, 1.03), presence of dysphagia (OR, 0.44), and use of dentures (OR, 2.82). CONCLUSION Denture use was associated with food forms among Japanese LTCF residents. This indicates that the use of dentures is related to the maintenance of food forms, even in the elderly who participate in few activities of daily living, have reduced cognitive function, and require long-term care.
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Affiliation(s)
- Kenshu Taira
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Kazutaka Okada
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Miyako Kondo
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Maaya Takeda
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Kayoko Ito
- Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba, Japan
| | | | - Masataka Itoda
- Department of Oral Rehabilitation Osaka Dental University Hospital, Osaka, Japan
| | - Ken Inohara
- Inohara Dental and Rehabilitation Clinic, Hiroshima, Japan.,Ota Memorial Hospital, Hiroshima, Japan
| | - Rikimaru Sasaki
- Rehabilitation Clinic for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo, Japan
| | - Yasuhiro Nishi
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo, Japan
| | | | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Takashi Tohara
- The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo, Japan
| | - Yuji Sato
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo, Japan
| | - Mitsuyohi Yoshida
- Department of Dentistry & Oral-Maxillofacial Surgery Fujita Health University, Aichi, Japan
| | - Yutaka Yamazaki
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido, Japan
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Hadde EK, Prakash S, Chen W, Chen J. Instrumental texture assessment of IDDSI texture levels for dysphagia management. Part 1: Thickened fluids. J Texture Stud 2022; 53:609-616. [PMID: 35717604 DOI: 10.1111/jtxs.12707] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Abstract
Thickened fluids are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia). International Dysphagia Diet Standardization Initiative (IDDSI) developed a standardized terminology and description for texture-modified foods and thickened fluids to allow dysphagia patients to receive the correct consistency of food/drink. Syringe flow test and fork drip test are suggested by IDDSI to identify the drink category (IDDSI Levels 1-4). These practical methods are widely welcomed by carers and patients because of their simplicity. However, these methods are not most feasible for industrial applications, where objective measurements are required for industry for the purpose of quality control of such products. Therefore, our aim in this work was to develop quantitative and objective measurements that best describe IDDSI level category for use as an objective framework. Two measuring techniques, syringe flow test and fork drip test, recommended by IDDSI were evaluated in two different sets of experiment. Participants were recruited to categorize fluid samples of known texture parameters using syringe flow test and fork drip test techniques. The apparent stress measured from Ball-Back Extrusion (BBE) technique for each of the fluid category (IDDSI Levels 1-4) was calculated. Bands of apparent stress for each of the fluid category were developed from two measuring techniques, syringe flow test and fork drip test. An inconsistency was observed between these two measuring techniques for IDDSI Level 3 fluid due to different dominating factors in the two tests. However, we proposed to combine the results from the two experiments to develop a quantitative range for each IDDSI Level as objective complements to the IDDSI Framework. Thickened fluid manufacturers are encouraged to follow the proposed guidelines presented once they are clinically validated and use them fine-tune their products, thus enhancing the safety of individuals with dysphagia.
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Affiliation(s)
- Enrico Karsten Hadde
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Sangeeta Prakash
- School of Agricultural and Food Science, The University of Queensland, Brisbane, Australia
| | - Wei Chen
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Jianshe Chen
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
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12
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Hadde EK, Prakash S, Chen W, Chen J. Instrumental texture assessment of IDDSI texture levels for dysphagia management. Part 2: Texture modified foods. J Texture Stud 2022; 53:617-628. [PMID: 35708507 DOI: 10.1111/jtxs.12706] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 12/01/2022]
Abstract
Texture-modified foods and thickened fluids play a major role in clinical treatment for individuals who suffer from swallowing difficulties (known as dysphagia). International Dysphagia Diet Standardization Initiative (IDDSI) developed a standardized terminology and description for texture-modified foods and thickened fluids to allow dysphagia patients to receive the correct consistency of food/drink. While the IDDSI framework provides a consistent texture description (Levels 0-7) and is widely accepted as an international standard, testing and assessment of IDDSI texture level are qualitative in nature and subjective in manner. These methods were proposed primarily for use by frontline carers, but are not most ideal for industrial purposes of quality control of such products. Therefore, the main aim of this work was to develop a quantitative instrumental method that best describes IDDSI levels as an objective framework. A set of test samples, including commercially available instant mashed potato, baby rice cereal, and cooked potato cubes of varying texture, were prepared. Two IDDSI measuring techniques, fork pressure test and spoon tilt test, were used to evaluate texture grades of these samples. Puncture and compression tests based on texture analyzer were used to assess cohesiveness, adhesiveness, firmness, and hardness for each food category (Levels 4-7). Thresholds of cohesiveness and adhesiveness, as well as bands of acceptable firmness and hardness for each food category were clearly identified and are proposed as objective complements to the IDDSI framework.
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Affiliation(s)
- Enrico Karsten Hadde
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Sangeeta Prakash
- School of Agricultural and Food Science, The University of Queensland, Brisbane, Australia
| | - Wei Chen
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Jianshe Chen
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
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13
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Takeda M, Watanabe Y, Matsushita T, Taira K, Miura K, Ohara Y, Iwasaki M, Ito K, Nakajima J, Iwasa Y, Itoda M, Nishi Y, Furuya J, Watanabe Y, Umemoto G, Kishima M, Hirano H, Sato Y, Yoshida M, Yamazaki Y. Observational Variables for Considering a Switch from a Normal to a Dysphagia Diet among Older Adults Requiring Long-Term Care: A One-Year Multicenter Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116586. [PMID: 35682168 PMCID: PMC9180175 DOI: 10.3390/ijerph19116586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
This one-year multicenter longitudinal study aimed to assess whether older adult residents of long-term care facilities should switch from a normal to a dysphagia diet. Using the results of our previous cross-sectional study as baseline, older adults were subdivided into those who maintained a normal diet and those who switched to a dysphagia diet. The explanatory variables were age, sex, body mass index (BMI), Barthel Index, clinical dementia rating (CDR), and 13 simple and 5 objective oral assessments (remaining teeth, functional teeth, oral diadochokinesis, modified water swallowing test, and repetitive saliva swallowing test), which were used in binomial logistic regression analysis. Between-group comparison showed a significantly different BMI, Barthel Index, and CDR. Significant differences were also observed in simple assessments for language, drooling, tongue movement, perioral muscle function, and rinsing and in objective assessments. In multi-level analysis, switching from a normal to a dysphagia diet was significantly associated with simple assessments of tongue movement, perioral muscle function, and rinsing and with the objective assessment of the number of functional teeth. The results suggest that simple assessments can be performed regularly to screen for early signs of discrepancies between food form and eating/swallowing functions, which could lead to the provision of more appropriate food forms.
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Affiliation(s)
- Maaya Takeda
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
- Correspondence: ; Tel.: +81-11-706-4582
| | - Takae Matsushita
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
| | - Kenshu Taira
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
| | - Kazuhito Miura
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Masanori Iwasaki
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Kayoko Ito
- Oral Rehabilitation, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan;
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Tokyo 272-8513, Japan;
| | - Yasuyuki Iwasa
- Department of Dentistry, Haradoi Hospital, Fukuoka 813-8588, Japan;
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka 573-1144, Japan;
| | - Yasuhiro Nishi
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan;
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Yoshihiko Watanabe
- Department of Healthcare Management, Tohoku Fukushi University, Sendai 981-8522, Japan;
| | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Masako Kishima
- Wakakusa-Tatsuma Rehabilitation Hospital, Daito 574-0012, Japan;
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Yuji Sato
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Mitsuyoshi Yoshida
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Dengakugakubo, 1-98, Kutsukake-cho, Toyoake 470-1192, Japan;
| | - Yutaka Yamazaki
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan; (M.T.); (T.M.); (K.T.); (K.M.); (Y.Y.)
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Hill C, Clapham RP, Buccheri A, Field M, Wong Shee A, Alston L. Assessing adherence and exploring barriers to provision of prescribed texture modifications for dysphagia in a residential aged care facility in rural Australia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:67-76. [PMID: 34420459 DOI: 10.1080/17549507.2021.1953144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Purpose: Between 55-65% of residents living in residential aged care facilities (RACFs) experience dysphagia and are prescribed texture-modified diets by a speech-language pathologist (SLP). The aim of this study was to assess current adherence to prescribed texture modification for people with dysphagia; and explore barriers to implementation in a rural aged care setting. METHOD Method: Meal texture audits (N = 42) were completed with residents with dysphagia in a rural RACF who were prescribed texture-modified diets or fluids by a SLP. Semi-structured focus groups were conducted with nursing and food preparation staff (N = 11) to identify barriers to implementation. RESULT Result: Mealtime texture audits identified that 54.8% (n = 23) of residents' food modification requirements were incorrectly documented in the manual entry database (kitchen form) and 64.3% (n = 27) of meal trays contained foods that did not meet residents' dysphagia management plans. Focus group data revealed seven main themes impacting on the ability of staff to implement prescribed texture-modified diets. Complicated processes and communication between nursing, food services and SLP staff were identified as major barriers. These were complicated further by time pressures experienced by staff as well as staffing issues, resourcing of the kitchen, accommodating individual dietary preferences and the variety/presentation of dietary options at the aged care facility.Conclusion: There was low adherence to SLP prescribed texture-modified diets and fluids in the participating rural RACF. This study identified major barriers to implementing SLP prescribed texture-modified diets including complicated processes, communication breakdowns, time pressures and limited staffing. Implementation of an online menu management system and regular dysphagia-specific training may address barriers to communication and complicated paper-based menu systems and should be a priority for health services to ensure adequate dysphagia management.
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Affiliation(s)
- C Hill
- Speech Pathology, Colac Area Health, Colac, Australia
| | - R P Clapham
- Primary and Community Care, Ballarat Health Services, Ballarat, Australia
- Deakin Rural Health, Deakin University, Geelong, Australia
| | - A Buccheri
- Speech Pathology, Colac Area Health, Colac, Australia
| | - M Field
- Research Unit, Colac Area Health, Colac, Australia
| | - A Wong Shee
- Primary and Community Care, Ballarat Health Services, Ballarat, Australia
- Deakin Rural Health, Deakin University, Geelong, Australia
| | - L Alston
- Deakin Rural Health, Deakin University, Geelong, Australia
- The Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
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15
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Frydrych AM, Banerjee C, Mansoor K, Kujan O. Factors influencing the cariogenic potential of oral nutritional supplements indicated for use in adults with or at risk of malnutrition. SPECIAL CARE IN DENTISTRY 2022; 42:390-397. [PMID: 34990016 DOI: 10.1111/scd.12693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Malnutrition can be a significant problem among older adults and the medically compromised individuals, contributing to morbidity and mortality. Causes of malnutrition are complex and varied. Oral nutritional supplements (ONS) are often prescribed to individuals with or at risk of malnutrition. Although beneficial, concerns have been raised about their cariogenic potential. The purpose of this study is to report on the currently available ONS in Australia, focusing on factors that impact their cariogenicity. METHODS A list of ONS was compiled based on their availability in Australia and indication for use in adults with or at risk of malnutrition. Data concerning composition, clinical indications and the recommended daily consumption was ascertained from product labels, company websites and customer services. Measurements of pH and viscosity were obtained for all ONS. RESULTS A total of 33 ONS were identified, which were noted to vary in their cariogenic potential. CONCLUSIONS Recognition of the possible caries risk associated with the use of ONS is important. Awareness facilitates the making of informed decisions when ONS are chosen. When the need arises to use ONS in individuals where the associated caries risk is considered significant, caries preventive protocols should be implemented by the prescriber.
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Affiliation(s)
- Agnieszka M Frydrych
- Oral Diagnostics and Surgical Sciences Division, UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Chandrama Banerjee
- Oral Diagnostics and Surgical Sciences Division, UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Khadija Mansoor
- Oral Diagnostics and Surgical Sciences Division, UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Omar Kujan
- Oral Diagnostics and Surgical Sciences Division, UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
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Minchell E, Rumbach A, Finch E. The effects of endovascular clot retrieval and thrombolysis on dysphagia in an Australian quaternary hospital: A retrospective review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:128-137. [PMID: 34767286 DOI: 10.1111/1460-6984.12681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED Dysphagia (impaired swallowing) is known to contribute to decreased quality of life, and increased length of hospital stay and mortality post-stroke. Despite the advancements in stroke treatment with the introduction of thrombolysis and endovascular clot retrieval (ECR), patients continue to present with high rates of dysphagia. Speech and language therapists and stroke teams should consider the presence of haemorrhagic transformation, success of reperfusion and presence of communication deficits as risk factors for dysphagia post-ECR and/or thrombolysis. PURPOSE To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. METHOD A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. RESULTS Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech-language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. CONCLUSION This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence-base for SLPs and the wider medical team and to inform clinical practice guidelines. WHAT THIS PAPER ADDS What is already known on the subject Stroke is one of the leading causes of disability and death internationally. Dysphagia (impaired swallowing), a common sequalae of stroke, is known to contribute to decreased quality of life, increased length of hospital stay and mortality. With advancements in technology, treatments for acute ischaemic stroke (endovascular clot retrieval and thrombolysis) are increasing in popularity. However, limited research exists exploring the impact of these therapies on dysphagia. What this paper adds Despite the advancements in stroke treatment, patients continue to present with high rates of dysphagia. Dysphagia following thrombolysis and/or ECR was found to be significantly correlated to the presence of aphasia, haemorrhagic transformation, and the success of reperfusion (regardless of treatment type). Additionally, increased rates of enteral feeding were found amongst this patient population compared to figures reported in the literature for patients following traditional stroke management. Clinical implications of this study Speech-language pathologists and the wider medical team should consider dysphagia as an ongoing consequence of stroke following reperfusion therapies, with consideration for success of reperfusion and adverse outcomes i.e., haemorrhagic transformation. Further research is required to provide an evidence-base and specific guidelines for the management of dysphagia post reperfusion therapies, including use of enteral feeding.
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Affiliation(s)
- Ellie Minchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
- Speech Pathology Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
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17
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Endo A, Watanabe Y, Matsushita T, Okada K, Ohara Y, Iwasaki M, Ito K, Nakajima J, Iwasa Y, Itoda M, Sasaki R, Nishi Y, Furuya J, Watanabe Y, Umemoto G, Kishima M, Hirano H, Sato Y, Yoshida M, Yamazaki Y. Association between Weight Loss and Food Form in Older Individuals Residing in Long-Term Care Facilities: 1-Year Multicenter Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010776. [PMID: 34682525 PMCID: PMC8535238 DOI: 10.3390/ijerph182010776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022]
Abstract
Changing the food form for older adults requiring nursing care from a regular to dysphagia diet is thought to impact their nutritional status. We assessed the association between changes in food form and weight loss over 1 year in older adults. Older adults residing in long-term care facilities in Japan (n = 455) who participated in the baseline (2018) and follow-up (2019) surveys were divided into two groups (regular diet, n = 284; dysphagia diet, n = 171). The regular diet group was further divided into the weight loss (n = 80; weight loss ≥5% over 1 year) and weight maintenance (n = 204; weight loss <5%) groups. After 1 year, the Barthel Index significantly decreased, and the proportion of participants who switched from a regular diet to a dysphagia diet significantly increased in the weight loss group than in the weight maintenance group. Multivariate logistic regression analysis found that Barthel index variation (odds ratio (OR): 0.97, 95% confidence interval (CI): 0.94‒0.99), change from a regular diet to a dysphagia diet (OR: 4.41, 95% CI: 1.87‒10.41), and body weight at baseline (OR = 1.06, 95% CI: 1.01‒1.11) were significantly associated with weight loss. Our results suggest that maintaining the food form inhibits weight loss and improves health outcomes in older adults.
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Affiliation(s)
- Akemi Endo
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
- Correspondence: ; Tel./Fax: +81-11-706-4582
| | - Takae Matsushita
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Kazutaka Okada
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Masanori Iwasaki
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Kayoko Ito
- Oral Rehabilitation, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan;
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba 272-8513, Japan;
| | - Yasuyuki Iwasa
- Department of Dentistry, Haradoi Hospital, Fukuoka 813-8588, Japan;
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka 573-1144, Japan;
| | - Rikimaru Sasaki
- Rehabilitation Clinic for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo 102-8158, Japan;
| | - Yasuhiro Nishi
- Department of Oral and Maxillofacial Prosthodontics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan;
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Yoshihiko Watanabe
- Department of Healthcare Management, Tohoku Fukushi University, Miyagi 981-8522, Japan;
| | - George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Masako Kishima
- Wakakusa-Tatsuma Rehabilitation Hospital, Osaka 574-0012, Japan;
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan; (Y.O.); (M.I.); (H.H.)
| | - Yuji Sato
- Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan; (J.F.); sato-@dent.showa-u.ac.jp (Y.S.)
| | - Mitsuyoshi Yoshida
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima 734-8553, Japan;
| | - Yutaka Yamazaki
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Hokkaido 060-8586, Japan; (A.E.); (T.M.); (K.O.); (Y.Y.)
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Shelf life stability and quality study of texture-modified chicken rendang using xanthan gum as thickener for the consumption of the elderly with dysphagia. FOOD BIOSCI 2021. [DOI: 10.1016/j.fbio.2021.101054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Maieves HA, Teixeira GL. Assessment of tomato-based thick fluid diet for patients with dysphagia using a simple and cheap test. J Texture Stud 2021; 52:647-655. [PMID: 34101187 DOI: 10.1111/jtxs.12617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
Swallowing difficulty, also known as dysphagia, is a health condition that can be managed by different approaches, such as changing the viscosity of fluid foods with thickener agents. Tomato-based beverages such as "gazpacho" and "salmorejo" are common foods much appreciated by the populations that adopt a Mediterranean diet, mainly in Spain. These beverages usually present a low viscosity, challenging to include in diets for dysphagia patients. Thus, this work aimed at evaluating the flow properties of tomato-based beverages with or without the addition of thickener agents (based on maltodextrin or gum) using a simple and cheap method proposed by the International Dysphagia Diet Standardization Initiative (IDDSI) to verify the suitability of using those products in a diet of patients with dysphagia. The study also evaluated the differences in using BD-type syringes on the test. Results indicated that the type of thickener significantly (p < .05) affects the samples' flow properties, enhancing their rheological behavior. The type of syringe can also affect the results, as they present different Luer slip tips. The results revealed that tomato-based beverages may have their properties improved simply by using low amounts of thickener agents (1.2-3.0 g 200 ml-1 ) and that the IDDSI test can be an alternative, cheap and straightforward method for evaluating these types of foods in hospital environments. Including tomato-based beverages in the diet of patients with dysphagia may present many benefits as these products have a rich nutritional composition (fiber) in addition to biocompounds such as lycopene and phenolic compounds.
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Affiliation(s)
- Helayne Aparecida Maieves
- Faculty of Nutrition, Federal University of Pelotas, Pelotas, Brazil.,Dpto. Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Gerson Lopes Teixeira
- Department of Food Science and Technology, Federal University of Santa Catarina, Florianópolis, Brazil
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20
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Raheem D, Carrascosa C, Ramos F, Saraiva A, Raposo A. Texture-Modified Food for Dysphagic Patients: A Comprehensive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5125. [PMID: 34066024 PMCID: PMC8150365 DOI: 10.3390/ijerph18105125] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 12/16/2022]
Abstract
Food texture is a major food quality parameter. The physicochemical properties of food changes when processed in households or industries, resulting in modified textures. A better understanding of these properties is important for the sensory and textural characteristics of foods that target consumers of all ages, from children to the elderly, especially when food product development is considered for dysphagia. Texture modifications in foods suitable for dysphagic patients will grow as the numbers of elderly citizens increase. Dysphagia management should ensure that texture-modified (TM) food is nutritious and easy to swallow. This review addresses how texture and rheology can be assessed in the food industry by placing particular emphasis on dysphagia. It also discusses how the structure of TM food depends not only on food ingredients, such as hydrocolloids, emulsifiers, and thickening and gelling agents, but also on the applied processing methods, including microencapsulation, microgels as delivery systems, and 3D printing. In addition, we address how to modify texture for individuals with dysphagia in all age groups, and highlight different strategies to develop appropriate food products for dysphagic patients.
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Affiliation(s)
- Dele Raheem
- Northern Institute for Environmental and Minority Law (NIEM), Arctic Centre, University of Lapland, 96101 Rovaniemi, Finland;
| | - Conrado Carrascosa
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain;
| | - Fernando Ramos
- Pharmacy Faculty, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
- REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - Ariana Saraiva
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain;
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
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Guénard-Lampron V, Masson M, Blumenthal D. Critical review of sensory texture descriptors: From pureed to transitional foods for dysphagia patients. J Texture Stud 2021; 52:665-678. [PMID: 33905538 DOI: 10.1111/jtxs.12604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/06/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
Dysphagic people need to change their diet to avoid pain or risk of choking. For example, they can eat texture modified foods (including pureed and transitional foods, that is, food that start with one texture and change into another because of moisture or heating). Simple testing methods proposed by the IDDSI initiative can be performed to characterize texture modified food but these methods are not always relevant for understanding oral texture and mouthfeel properties. Sensory characterization is essential to develop or optimize a food product and to meet consumer's expectations and needs especially for dysphagic persons. However, sensory methods and texture descriptors are complex to target and evaluate for different severity of dysphagia. Sensory texture descriptors can be determined by different methods and assessed in different ways. This review is useful for listing the sensory methods used to generate sensory descriptors to characterize the oral texture of cereal and pureed foods. We found that 55% of the reviewed publications used specific oral texture descriptors and that 17 descriptors could be identified as the most used and relevant for all the products studied (sticky), for pureed (e.g., cohesiveness, floury, and soft) and for cereal-based foods (e.g., hard, fatty, and crispy). These results should be considered to facilitate the choice of sensory texture descriptors in future studies on pureed and transitional foods such as cereal-based foods according to the IDDSI level. This review also demonstrates that it is difficult to find a consensus between studies using different evaluation methods for the same descriptor.
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Affiliation(s)
| | - Marine Masson
- UMR Sayfood, AgroParisTech, INRAE, Université Paris-Saclay, Massy, France
| | - David Blumenthal
- UMR Sayfood, AgroParisTech, INRAE, Université Paris-Saclay, Massy, France
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Improving Accuracy of Texture-Modified Diets and Thickened Fluids Provision in the Hospital: Evidence in Action. Dysphagia 2021; 37:488-500. [PMID: 33891191 DOI: 10.1007/s00455-021-10294-4] [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: 08/26/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
Ensuring inpatients with dysphagia receive and consume the correct texture-modified diet and thickened fluid prescriptions is challenging, and errors can result in significant complications for patients and increased costs to hospitals. The aim of this study was to investigate underlying factors that help or hinder receipt and consumption of correct dietary prescriptions for people with dysphagia in the hospital setting then implement and evaluate a range of strategies to address identified issues. A mixed-methods study design, using an integrated knowledge translation approach, was conducted in three phases. In Phase 1, clinical incident data (i.e., documented incidents of diet/fluid errors, with errors defined as the provision or consumption of any food/fluid not appropriate for a patient's dietary prescription) were analyzed, and staff, patients, and family members were interviewed using the Theoretical Domains Framework to identify factors contributing to errors. In Phase 2, health professionals assisted with the development and implementation of interventions targeted at micro (patient/family), meso (staff), and macro (organizational) levels to address factors identified in Phase 1. In Phase 3, outcomes including the change in number of dietary clinical incidents pre- to post-intervention, meal accuracy error rates from mealtime audits post-intervention, and follow-up interviews were evaluated using quantitative and qualitative measures. Post-intervention, there was a 50% reduction in clinical incidents, and a 2.3% meal accuracy error rate was observed. Staff reported most interventions were acceptable and feasible within their workload, although some interventions were not well embedded in everyday practice. This study highlights the value in using an integrated knowledge translation approach to inform tailored interventions targeting improved dietary accuracy in the hospital setting.
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Carubbi F, Barbato A, Burlina AB, Francini F, Mignani R, Pegoraro E, Landini L, De Danieli G, Bruni S, Strazzullo P. Nutrition in adult patients with selected lysosomal storage diseases. Nutr Metab Cardiovasc Dis 2021; 31:733-744. [PMID: 33589321 DOI: 10.1016/j.numecd.2020.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
Lysosomal storage disorders (LSDs) are a group of clinically heterogeneous disorders affecting the function of lysosomes and are characterized by an accumulation of undigested substrates within several cell types. In recent years there have been substantial advances in supportive care and drug treatment for some LSDs, leading to improved patient survival, as seen in Gaucher, Pompe and Fabry disease and some Mucopolysaccharidoses; however, many symptoms still persist. Thus it is now even more important to improve patients' quality of life and reduce symptoms and comorbidities. One potential way of achieving this goal is through adjunct nutritional therapy, which is challenging as patients may be overweight with associated consequences, or malnourished, or underweight. Furthermore, drugs used to treat LSDs can modify the metabolic status and needs of patients. There are currently not enough data to make specific dietary recommendations for individual LSDs; however, suggestions can be made for managing clinical manifestations of the diseases, as well as treatment-associated adverse events. The metabolic and nutritional status of adult patients must be regularly assessed and individualized dietary plans may be created to cater to a patient's specific needs. Damage to the autophagic process is a common feature in LSDs that is potentially sensitive to dietary manipulation and needs to be assessed in clinical studies.
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Affiliation(s)
- Francesca Carubbi
- U.O.C. Medicina metabolica AOU Modena, Metabolic Medicine Unit, Modena University Hospital, Modena, Italy.
| | - Antonio Barbato
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Alberto B Burlina
- U.O.C. Malattie Metaboliche Ereditarie, Major Operational Unit of Hereditary Metabolic Diseases, Azienda Ospedaliera di Padova, Padua, Italy
| | - Francesco Francini
- U.O. Nutrizione Clinica, Department of Medicine, Azienda Ospedaliera di Padova, Padua, Italy
| | - Renzo Mignani
- U.O. di Nefrologia e Dialisi dell'Ospedale Infermi di Rimini, Nephrology Operational Unit of the Infermi Hospital in Rimini, Rimini, Italy
| | - Elena Pegoraro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Linda Landini
- S.S.D. Dietetics and Clinical Nutrition ASL 4 Chiavarese Liguria - Sestri Levante Hospital, Italy
| | | | | | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
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Stading M. Physical properties of a model set of solid, texture-modified foods. J Texture Stud 2021; 52:578-586. [PMID: 33599283 DOI: 10.1111/jtxs.12592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 01/28/2023]
Abstract
Those suffering from swallowing disorders, or dysphagia, require texture-modified foods for safe swallowing. The texture is modified according to the severity of the disorder, as maintained by the guidelines outlining classes of texture-modified foods, ranging from viscous soups to soft, solid foods. As a basis for studies of bolus rheology and oral response of solid texture-modified foods, a set of well-defined, solid foods has been identified and characterized regarding texture and physical properties. Gelled food is compared to both the firmer timbale class and to the corresponding regular food. Foods eaten at room temperature were chosen to avoid temperature effects: bread, cheese, tomato, and the combination into a sandwich. All foods were tested as gel, timbale, and regular food. The texture was determined by compression and penetration tests, thereby showing a decrease in strength (compression stress), stiffness (modulus), and penetration force for increased degree of modification. The moisture content increased with increased degree of modification. The structural change from room to oral temperature was monitored by the complex shear modulus that showed a decrease with increasing temperature. Cheese and the gelatine-based tomato gel showed a distinct melting when the temperature was increased to 37°C. The texture-modified foods were softer and moister in all aspects as compared to the regular foods, which follows the intended modification. The classes for the texture-modified foods were qualitatively comparable to other national classification systems with regard to solid foods, but there is a lack of objective, physics-based classification of texture, especially for solid, texture-modified foods.
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Affiliation(s)
- Mats Stading
- RISE Research Institutes of Sweden, Gothenburg, Sweden.,Chalmers University of Technology, Gothenburg, Sweden
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González-Fernández M, Arbones-Mainar JM, Ferrer-Lahuerta E, Perez-Nogueras J, Serrano-Oliver A, Torres-Anoro E, Sanz-Paris A. Ultrasonographic Measurement of Masseter Muscle Thickness Associates with Oral Phase Dysphagia in Institutionalized Elderly Individuals. Dysphagia 2021; 36:1031-1039. [PMID: 33462765 DOI: 10.1007/s00455-020-10234-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Oral phase dysphagia is dependent on ability to chew. As people age, general muscle atrophy contributes to decreased masseter strength. The main objective of this study was to assess the relationship between the thickness of the masseter muscle measured by ultrasonography and the presence of dysphagia in a group of institutionalized elderly people. As a secondary objective, we aimed to establish cutoff points of masseters muscle thickness (MMT) to identify elderly individuals at risk of oral dysphagia. METHODS Cross-sectional study of all residents from 3 nursing homes. All individuals underwent ultrasonographic measurements of left and right MMT and were classified according to the presence of dysphagia assessed by both the EAT-10 screening questionnaire and the volume-viscosity swallow test (V-VST). RESULTS 469 patients (69% women, mean age 84.7 yrs) were recruited. Dysphagia was present in 41.6% and 26% of individuals according the EAT-10 and V-VST, respectively. Multivariate logistic regression showed that 1 mm increase in MMT reduced the risk of dysphagia by 21% according to the EAT-10 tool and by 30% using the V-VST after adjusting for age, sex, mini-nutritional assessment score, and body mass index. We used receiver operative characteristic (ROC) curves to identify cutoff points of MMT to detect dysphagic individuals according to either EAT-10 or V-VST. CONCLUSIONS The MMT measured by ultrasonography is reduced in elderly individuals with dysphagia. Based on MMT, clinicians may be better informed about the patients'´ ability to masticate solid foods and identify potential nutrient deficiencies in geriatric settings.
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Affiliation(s)
| | - Jose M Arbones-Mainar
- Instituto de Investigacion Sanitaria Aragon (IIS-Aragon), Zaragoza, Spain. .,Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, University Hospital Miguel Servet, Instituto Aragones de Ciencias de la Salud (IACS), 50009, Zaragoza, Spain. .,Centro de Investigacion Biomedica en Red Fisiopatología Obesidad Y Nutricion (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.
| | | | | | | | | | - Alejandro Sanz-Paris
- Department of Nutrition, University Hospital Miguel Servet, Zaragoza, Spain.,Instituto de Investigacion Sanitaria Aragon (IIS-Aragon), Zaragoza, Spain
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Hadde EK, Chen J. Texture and texture assessment of thickened fluids and texture-modified food for dysphagia management. J Texture Stud 2020; 52:4-15. [PMID: 33155674 DOI: 10.1111/jtxs.12567] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
Thickened fluids and texture-modified foods are commonly used in the medical management of individuals who suffer from swallowing difficulty (known as dysphagia). However, how to reliably assess texture properties of such food systems is still a big challenge both to industry and to academic researchers. This article aims to identify key physical parameters that are important for objective assessment of such properties by reviewing the significance of rheological or textural properties of thickened fluids and texture-modified foods for swallowing. Literature reviews have identified that dominating textural properties in relation to swallowing could be very different for thickened fluids and for texture-modified foods. Important parameters of thickened fluids are generally related with the flow of the bolus in the pharyngeal stage, while important parameters of texture-modified foods are generally related with the bolus preparation in the oral stage as well as the bolus flow in the pharyngeal stage. This review helps to identify key textural parameters of thickened fluids and texture-modified foods in relation to eating and swallowing and to develop objective measuring techniques for quality control of thickened fluids and texture-modified foods for dysphagia management.
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Affiliation(s)
- Enrico K Hadde
- Lab of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Zhejiang, Hangzhou, China
| | - Jianshe Chen
- Lab of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Zhejiang, Hangzhou, China
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Dunn K, Rumbach A, Finch E. Dysphagia following non-traumatic subarachnoid haemorrhage: A prospective pilot study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:702-711. [PMID: 32654291 DOI: 10.1111/1460-6984.12554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Whilst dysphagia is a commonly reported complication of stroke, it has received relatively little attention in the literature for patients following non-traumatic subarachnoid haemorrhage (SAH). AIMS To investigate dysphagia incidence, risk factors, clinical progression and recovery in patients following non-traumatic SAH. METHODS & PROCEDURES A prospective cohort study of 49 patients admitted to a tertiary neurosurgical referral unit with non-traumatic SAH over a 12-month period was conducted. Swallowing function was assessed by a speech-language pathologist within 72 h of medical stability and monitored throughout the acute inpatient admission. OUTCOMES & RESULTS Dysphagia incidence was 16.33% (n = 8/49). Risk factors associated with dysphagia included; Glasgow Coma Scale (GCS) score on admission, need for intensive care unit (ICU) admission, length of ICU stay, need for intubation and ventilation, and hydrocephalus. Participants with dysphagia were admitted to hospital 1.9 times longer than those without dysphagia (p < 0.05) and were more likely to be transferred to another inpatient facility for ongoing care (p < 0.05). Dysphagia remained present at hospital discharge for over half (62.5%) of participants who developed this complication. CONCLUSIONS & IMPLICATIONS Care pathways for patients admitted to hospital with non-traumatic SAH should include early screening for dysphagia risk. Further research using a larger prospective cohort is required to validate dysphagia incidence and risk factors in this patient cohort. What this paper adds What is already known on this subject Dysphagia is a negative complication following non-traumatic SAH, and can occur as a result of primary injury or secondary to treatment complications (e.g., intubation and ventilation, surgical intervention). However, limited evidence regarding its incidence, risk factors, clinical progression and recovery in a prospective cohort exists. What this paper adds to existing knowledge This study is the first to examine prospectively patients with non-traumatic SAH within 72 h of medical stability. It identifies dysphagia incidence, risk factors, clinical characteristics and recovery during the acute hospital admission for this patient cohort. What are the potential or actual clinical implications of this work? Early and regular screening for dysphagia in the presence of associated risk factors is essential for patients admitted with non-traumatic SAH. Speech-language pathologist resources in the neurocritical care context should be available to support the assessment and management of dysphagia in this cohort.
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Affiliation(s)
- Katrina Dunn
- Speech Pathology Department, West Moreton Health, Queensland Health, Ipswich, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, QLD, Australia
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Štreimikytė P, Keršienė M, Eisinaitė V, Jasutienė I, Lesauskaitė V, Damulevičienė G, Knašienė J, Leskauskaitė D. Formulating protein-based beverages for the dysphagia diets of the elderly: viscosity, protein quality, in vitro digestion, and consumers acceptability. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2020; 100:3895-3901. [PMID: 32323329 DOI: 10.1002/jsfa.10431] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/23/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Dysphagia is defined as a disorder of the swallowing mechanism. The most common management of dysphagia is diet modification by thickening food and beverages. This study aimed to obtain protein-based beverages for the dysphagia diets of the elderly, corresponding to the 'honey' (III) level of dysphagia fluids according to the National Dysphagia Diet classifications, and containing 100 g kg-1 of good-quality proteins with a high rate of hydrolysis during digestion. RESULTS Four protein formulations made from pea proteins, milk proteins, a mixture of milk and pea proteins, and milk proteins with added konjac glucomannan, were evaluated on the basis of rheological characterization and proteolysis kinetics during in vitro digestion. The mixture of milk proteins and pea proteins, and the mixture of milk proteins with added konjac glucomannan, showed typical yielding pseudoplastic fluid behavior with similar apparent viscosity but different structural characteristics. These differences were the reason for the differences in proteolysis kinetics during digestion. The mixture of milk and pea proteins showed viscous liquid behavior and was more rapidly hydrolyzed under gastrointestinal conditions than mixtures containing milk proteins and konjac glucomannan acting as a weak gel system. CONCLUSION We presume that geriatric consumers with swallowing difficulties may benefit from 'honey'-level viscosity, protein-based beverages containing pea and milk proteins through faster proteolysis and better bioaccessibility of amino acids during digestion. © 2020 Society of Chemical Industry.
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Affiliation(s)
- Paulina Štreimikytė
- Department of Food Science and Technology, Kaunas University of Technology, Kaunas, Lithuania
| | - Milda Keršienė
- Department of Food Science and Technology, Kaunas University of Technology, Kaunas, Lithuania
| | - Viktorija Eisinaitė
- Department of Food Science and Technology, Kaunas University of Technology, Kaunas, Lithuania
| | - Ina Jasutienė
- Department of Food Science and Technology, Kaunas University of Technology, Kaunas, Lithuania
| | - Vita Lesauskaitė
- Geriatric Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gytė Damulevičienė
- Geriatric Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jurgita Knašienė
- Geriatric Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Leskauskaitė
- Department of Food Science and Technology, Kaunas University of Technology, Kaunas, Lithuania
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Ranjan R, Lo SCY, Ly S, Krishnananthan V, Lim AK. Progression to Severe Hypernatremia in Hospitalized General Medicine Inpatients: An Observational Study of Hospital-Acquired Hypernatremia. ACTA ACUST UNITED AC 2020; 56:medicina56070358. [PMID: 32709029 PMCID: PMC7404557 DOI: 10.3390/medicina56070358] [Citation(s) in RCA: 6] [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: 07/04/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: Hypernatremia can be community or hospital-acquired, and there may be specific factors unique to the hospital environment, such as intravenous fluid treatment, which contribute to hypernatremia. The aim of this study was to determine the factors associated with the progression from moderate to severe hospital-acquired hypernatremia among patients admitted under general medicine. Materials and Methods: In this retrospective, single-center cohort study (2012 to 2017), we used ICD-10 coding and medical records to identify adult patients who developed moderate hypernatremia and followed them for progression to severe hypernatremia. We profiled the serum biochemistry and the volume and composition of prescribed intravenous fluids. We applied logistic regression to determine the factors associated with the progression to severe hypernatremia, using the patients with moderate hypernatremia as reference. Results: Of the 180 medical inpatients (median age of 81 years) with moderate hospital-acquired hypernatremia, 9.4% progressed to severe hypernatremia. Normal saline comprised 76% of intravenous fluid volume administered prior to onset of moderate hypernatremia. After the onset, 38% of fluid volume prescribed remained normal saline. The factors independently associated with progression to severe hypernatremia included chronic kidney disease stage (odds ratio 2.38, 95% CI: 1.26-4.50, P = 0.008) and serum creatinine increase (per 10 µmol/L, OR 1.29, 95% CI: 1.07-1.57, P = 0.009). Conclusions: Patients with chronic kidney disease and acute kidney injury may have an increased risk of severe hospital-acquired hypernatremia.
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Affiliation(s)
- Ramessh Ranjan
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
| | - Stacey C.-Y. Lo
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
| | - Stephanie Ly
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
| | - Visakan Krishnananthan
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
| | - Andy K.H. Lim
- Monash Health General Medicine, Dandenong Hospital, 135 David Street, Dandenong, VIC 3175, Australia; (R.R.); (S.C.-Y.L.); (S.L.); (V.K.)
- Department of Medicine, School of Clinical Sciences, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia
- Correspondence: or
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31
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Matsuyama S, Nakauma M, Funami T, Yamagata Y, Kayashita J. The influence of syringe geometry on the International Dysphagia Diet Standardisation Initiative flow test. Int J Food Sci Technol 2020. [DOI: 10.1111/ijfs.14559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Shingo Matsuyama
- San‐Ei Gen F.F.I., Inc. 1‐1‐11 Sanwa‐cho, Toyonaka Osaka 561‐8588 Japan
| | - Makoto Nakauma
- San‐Ei Gen F.F.I., Inc. 1‐1‐11 Sanwa‐cho, Toyonaka Osaka 561‐8588 Japan
| | - Takahiro Funami
- San‐Ei Gen F.F.I., Inc. 1‐1‐11 Sanwa‐cho, Toyonaka Osaka 561‐8588 Japan
| | - Yoshie Yamagata
- Department of Health Sciences Prefectural University of Hiroshima 1‐1‐71 Ujina‐higashi, Minami‐ku Hiroshima 734‐8558 Japan
| | - Jun Kayashita
- Department of Health Sciences Prefectural University of Hiroshima 1‐1‐71 Ujina‐higashi, Minami‐ku Hiroshima 734‐8558 Japan
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32
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A “mouthfeel wheel” terminology for communicating the mouthfeel attributes of medical nutrition products (MNP). Food Qual Prefer 2020. [DOI: 10.1016/j.foodqual.2019.103822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hamzaid NH, O’Connor HT, Flood VM. Observed Dietary Intake in Adults with Intellectual Disability Living in Group Homes. Nutrients 2019; 12:nu12010037. [PMID: 31877838 PMCID: PMC7020024 DOI: 10.3390/nu12010037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 12/31/2022] Open
Abstract
Background: There is limited information on the dietary intakes of people with intellectual disability (ID) living in group homes. Objective: To describe and evaluate dietary intake in people with ID. Method: Dietary intake was assessed in a convenience sample of people with ID living in group homes. Dietary assessment used three-day weighed food records and digital food photography. Intakes were compared to the Nutrient Reference Values (NRVs) and dietary recommendations. Results: A sample of 33 adults, (men (M): n = 14; women (W): n = 19), mean age 51 ± 14 years, was recruited from seven group homes. Mean daily energy intake was low (M: 7.4 MJ; W: 7.0 MJ; p = 0.46), similar to levels recommended for bed rest. Many participants had intakes below the estimated average requirements (EARs) for the nutrients, magnesium (M: 86%; W: 63%), calcium (M: 43%; W: 78%), iodine (M: 43%; W: 47%) and zinc (M: 43%). Less than half of the recommended daily servings were consumed for vegetables (men and women) and dairy foods (women). Conclusion: Nutrient intake and diet quality of the participants in the group homes studied was poor. Education and policy to support healthier diets is required to improve dietary intake of people with intellectual disability, living in group homes.
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Affiliation(s)
- Nur Hana Hamzaid
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Program of Dietetics, Kuala Lumpur 50300, Malaysia;
- Faculty of Health Sciences, The University of Sydney, Discipline of Exercise and Sport Science, Lidcombe 2141, NSW, Australia;
| | - Helen T. O’Connor
- Faculty of Health Sciences, The University of Sydney, Discipline of Exercise and Sport Science, Lidcombe 2141, NSW, Australia;
- Charles Perkins Centre, The University of Sydney, Camperdown 2006, NSW, Australia
| | - Victoria M. Flood
- Faculty of Health Sciences, The University of Sydney, Discipline of Exercise and Sport Science, Lidcombe 2141, NSW, Australia;
- Westmead Hospital, Western Sydney Local Health District, Westmead 2145, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown 2006, NSW, Australia
- Correspondence: ; Tel.: +61-412-118-977
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Relationships between shear rheology and sensory attributes of hydrocolloid-thickened fluids designed to compensate for impairments in oral manipulation and swallowing. J FOOD ENG 2019. [DOI: 10.1016/j.jfoodeng.2019.05.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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Hadde EK, Cichero JAY, Zhao S, Chen W, Chen J. The Importance of Extensional Rheology in Bolus Control during Swallowing. Sci Rep 2019; 9:16106. [PMID: 31695062 PMCID: PMC6834566 DOI: 10.1038/s41598-019-52269-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/10/2019] [Indexed: 11/16/2022] Open
Abstract
Thickened fluids are commonly used in the medical management of individuals who suffer swallowing difficulty (known as dysphagia). Previous studies have shown that the rheological properties of a liquid affect the flow behavior of the bolus in swallowing, such as pharyngeal transit time. While there is no doubt that shear rheology is a highly important factor for bolus flow, it is suspected that extensional properties of a liquid bolus also plays an important role in swallowing, due to elongation of the bolus as it flows through the oropharynx. Our aim in this work was to observe the effect of extensional viscosity on pharyngeal transit time and elongation of the bolus during swallowing. Eight samples of thickened liquid barium that were shear-controlled, but varied in extensional viscosity and two samples that were extensional-controlled, but varied in shear viscosity were swallowed by eight healthy individuals. Data were collected under lateral view of videofluoroscopy swallow study (VFSS); measures of pharyngeal transit time and the ratio of the length to the width of the bolus on the frame of Upper Esophageal Sphincter (UES) opening were taken from the VFSS recordings. It was observed that the pharyngeal transit time generally increases when the fluids are thickened to higher IDDSI consistency. Additionally, higher extensional viscosity fluids reduced the elongation of the bolus during swallowing, thus potentially reducing the risk of post-swallow residue due to bolus breakage. This study confirmed the relevance of the extensional viscosity of the bolus in swallowing.
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Affiliation(s)
- Enrico Karsten Hadde
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China.
| | | | - Shaofeng Zhao
- The 1st Affiliated Hospital of Soochow University, Suzhou, China
- The Eight Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wei Chen
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Jianshe Chen
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
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Impact of Multiple Texture-Modified Diets on Oral Intake and Nutritional Status in Older Patients with Pneumonia: A Retrospective Cohort Study. Dysphagia 2019; 35:574-582. [DOI: 10.1007/s00455-019-10063-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
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Makame J, Cronje T, Emmambux NM, De Kock H. Dynamic Oral Texture Properties of Selected Indigenous Complementary Porridges Used in African Communities. Foods 2019; 8:foods8060221. [PMID: 31234403 PMCID: PMC6617364 DOI: 10.3390/foods8060221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 02/03/2023] Open
Abstract
Child malnutrition remains a major public health problem in low-income African communities, caused by factors including the low nutritional value of indigenous/local complementary porridges (CP) fed to infants and young children. Most African children subsist on locally available starchy foods, whose oral texture is not well-characterized in relation to their sensorimotor readiness. The sensory quality of CP affects oral processing (OP) abilities in infants and young children. Unsuitable oral texture limits nutrient intake, leading to protein-energy malnutrition. The perception of the oral texture of selected African CPs (n = 13, Maize, Sorghum, Cassava, Orange-fleshed sweet potato (OFSP), Cowpea, and Bambara) was investigated by a trained temporal-check-all-that-apply (TCATA) panel (n = 10), alongside selected commercial porridges (n = 19). A simulated OP method (Up-Down mouth movements- munching) and a control method (lateral mouth movements- normal adult-like chewing) were used. TCATA results showed that Maize, Cassava, and Sorghum porridges were initially too thick, sticky, slimy, and pasty, and also at the end not easy to swallow even at low solids content—especially by the Up-Down method. These attributes make CPs difficult to ingest for infants given their limited OP abilities, thus, leading to limited nutrient intake, and this can contribute to malnutrition. Methods to improve the texture properties of indigenous CPs are needed to optimize infant nutrient intake.
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Affiliation(s)
- James Makame
- Department of Consumer and Food Sciences, University of Pretoria, Private Bag X20, Hatfield, Pretoria 0028, South Africa.
| | - Tanita Cronje
- Department of Statistics, University of Pretoria, Private Bag X20, Hatfield, Pretoria 0028, South Africa.
| | - Naushad M Emmambux
- Department of Consumer and Food Sciences, University of Pretoria, Private Bag X20, Hatfield, Pretoria 0028, South Africa.
| | - Henriette De Kock
- Department of Consumer and Food Sciences, University of Pretoria, Private Bag X20, Hatfield, Pretoria 0028, South Africa.
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Azzolino D, Damanti S, Bertagnoli L, Lucchi T, Cesari M. Sarcopenia and swallowing disorders in older people. Aging Clin Exp Res 2019; 31:799-805. [PMID: 30671866 DOI: 10.1007/s40520-019-01128-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 01/06/2023]
Abstract
Aging is accompanied by several changes which may affect swallowing function. The beginning of these changes, termed presbyphagia, still captures a preserved swallowing function, although burdened by the consequences of the physiological aging process. Several stressors (including diseases and medications) can easily trigger the disruption of this (increasingly weak) equilibrium and lead to overt dysphagia. It is noteworthy that the swallowing dysfunction may be aggravated by the sarcopenic process, characterizing the so-called "sarcopenic dysphagia", potentially responsible for several health-related negative outcomes. The assessment and management of sarcopenic dysphagia largely rely on the evaluation and integrated treatment of both constituting conditions (i.e., sarcopenia and dysphagia). The management of dysphagia requires a multidimensional approach and can be designed as either compensatory (aimed at producing immediate benefit for the patient through postural adjustments, swallowing maneuvers, and diet modifications) or rehabilitative. Interestingly, some evidence suggests that resistance training traditionally applied to tackle the lower extremity in sarcopenia may be simultaneously beneficial for sarcopenic dysphagia. If these preliminary results (discussed in the present review article) will be confirmed, the systemic beneficial effects of physical exercise will be indirectly demonstrated. This will also support the need of promoting healthy lifestyle in all sarcopenic individuals (thus potentially at risk of dysphagia).
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Affiliation(s)
- Domenico Azzolino
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Sarah Damanti
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Laura Bertagnoli
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Tiziano Lucchi
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Hadde EK, Nicholson TM, Cichero JAY. Evaluation of Thickened Fluids Used in Dysphagia Management Using Extensional Rheology. Dysphagia 2019; 35:242-252. [PMID: 31115661 DOI: 10.1007/s00455-019-10012-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
Recent studies show that understanding the rheological properties of thickened fluids, such as viscosity and yield stress, is advantageous in designing optimal thickened fluids for the treatment of dysphagia. To date, these studies have focused on the rheological behavior of thickened fluids in shear deformation, while limited information is available on the surface tension of thickened fluids or their rheological behavior in extensional deformation. Knowledge of the extensional properties of thickened fluids (extensional viscosity and cohesiveness) is important to fully understand the behavior of such fluids while swallowing. Our aim in this work, therefore, was to characterize water and skim milk thickened with a commercial thickener (xanthan gum based) to determine extensional deformation and surface tension properties. It was observed that the surface tension decreases as the thickener concentration increases due to the accumulation of the biopolymer at the surface of the fluid when it dissolves in water. In addition, the extensional viscosity of the fluid increased over time as the filament thinned (i.e., as the Hencky strain increased) until it reached a plateau. It was observed that the maximum extensional viscosity, which is related to the cohesiveness of the fluid, increases with the higher concentrations of thickener. However, the cohesiveness of thickened skim milk was lower than that of the thickened water at a given thickener concentration due to lower surface tension. This study confirms that by increasing the concentration of thickener, it will not only increase the shear viscosity (i.e., bolus thickness) of the fluid, but also the extensional viscosity (i.e., bolus cohesiveness).
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Affiliation(s)
- E K Hadde
- School of Chemical Engineering, The University of Queensland, St Lucia, QLD, 4072, Australia.,School of Food Science and Engineering, Zhejiang Gongshang University, Hangzhou, 310018, Zhejiang, China
| | - T M Nicholson
- School of Chemical Engineering, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - J A Y Cichero
- School of Pharmacy, The University of Queensland, St Lucia, QLD, 4072, Australia
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40
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Barbon CEA, Steele CM. Thickened Liquids for Dysphagia Management: a Current Review of the Measurement of Liquid Flow. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:220-226. [PMID: 32149018 PMCID: PMC7059648 DOI: 10.1007/s40141-018-0197-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW The use of thickened liquids has become one of the most common management strategies for individuals with dysphagia. The purpose of this paper is to review methods that can be used to measure the flow characteristics of liquids used in dysphagia management. We describe the measurement of apparent viscosity, measures of extensional flow, slump tests (specifically the line-spread test and Bostwick consistometry), gravity flow tests, and subjective methods. RECENT FINDINGS We discuss the relationship between different approaches to measuring flow, the 2002 American National Dysphagia Diet and the 2017 International Dysphagia Diet Standardisation Initiative (IDDSI) framework. A comparison of test results across four methods is provided. SUMMARY A consistent approach is needed for the measurement of flow for thickened liquids used in dysphagia management. This review highlights differences that can be expected across different flow testing methodologies. Adherence to a common method and measurement definitions will promote patient safety and facilitate future research regarding the effectiveness of texture modification as an intervention for dysphagia.
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Affiliation(s)
- Carly E. A. Barbon
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th floor, Toronto, ON M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute - University Health Network, 550 University Avenue, 12th floor, Toronto, ON M5G 2A2, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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41
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Abu Zarim N, Zainul Abidin S, Ariffin F. Rheological studies on the effect of different thickeners in texture-modified chicken rendang for individuals with dysphagia. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2018; 55:4522-4529. [PMID: 30333649 DOI: 10.1007/s13197-018-3386-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 04/13/2018] [Accepted: 08/07/2018] [Indexed: 11/25/2022]
Abstract
Texture-modified food has become an important strategy in managing dysphagia. Pureed food is proven to be the safest texture due to its high viscosity which can slow down the rate of the food bolus during swallowing. In this study, texture-modified chicken rendang was developed according to Texture C (smooth puree) as described by the Australian standard for texture-modified food. Samples were added with five different thickeners (sago starch, tapioca starch, modified corn starch, xanthan gum and carboxymethyl cellulose gum) at three different concentrations (10, 20 and 30% w/w). Their rheological effects were analyzed through dynamic and steady shear test. Results obtained reveals that samples contained xanthan gum have higher structure rigidity and shear thinning behaviour, while carboxymethyl cellulose gum provides the highest viscosity as well as yield stress than other samples. In terms of concentration, a strong dependence of structural rigidity and viscosity of all prepared samples with amount of thickeners added was observed. Overall, based on its rheological properties, the addition of carboxymethyl cellulose gum at 30% concentration was found to be the most suitable thickener, to be incorporated in the texture-modified chicken rendang. Selecting a suitable food thickener in developing food for individual with dysphagia plays an important role to ensure the right texture and consistency for their safe consumption.
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Affiliation(s)
- Nuraihan Abu Zarim
- Food Technology Division, School of Industrial Technology, Universiti Sains Malaysia, 11800 Gelugor, Penang Malaysia
| | - Syahariza Zainul Abidin
- Food Technology Division, School of Industrial Technology, Universiti Sains Malaysia, 11800 Gelugor, Penang Malaysia
| | - Fazilah Ariffin
- Food Technology Division, School of Industrial Technology, Universiti Sains Malaysia, 11800 Gelugor, Penang Malaysia
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Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev 2018; 135:75-84. [PMID: 29660383 DOI: 10.1016/j.addr.2018.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.
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Affiliation(s)
- Esther T L Lau
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Lisa M Nissen
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
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Flynn E, Smith CH, Walsh CD, Walshe M. Modifying the consistency of food and fluids for swallowing difficulties in dementia. Cochrane Database Syst Rev 2018; 9:CD011077. [PMID: 30251253 PMCID: PMC6513397 DOI: 10.1002/14651858.cd011077.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with dementia can have feeding and swallowing difficulties (dysphagia). Modification of the consistency of food or fluids, or both, is a common management strategy. However, diet modification can affect quality of life and may lead to dehydration and malnutrition. Evidence on the benefits and risks of modifying food and fluids is mandatory to improve the care of people with dementia and dysphagia. OBJECTIVES To determine the effectiveness and adverse effects associated with modifying the consistency of food and fluids in improving oral intake and eliminating aspiration in adults with dysphagia and dementia. SEARCH METHODS We searched ALOIS (the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group), the Cochrane Library, MEDLINE via Ovid SP, Embase via Ovid SP, PsycINFO via Ovid SP, CINAHL via EBSCOhost, LILACS via BIREME, ClinicalTrials.gov and the World Health Organization (WHO) Portal on 9 May 2018. We also checked the reference lists of relevant articles to identify any additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs published in any language that measured any of the outcomes of interest. We included trials with adults with a clinical diagnosis of dementia with symptoms and signs of dysphagia confirmed on instrumental assessment. We included participants with all types, stages and severities of dementia. Control groups received either no intervention or interventions not involving diet modification or modification to sensory properties of food. DATA COLLECTION AND ANALYSIS Two review authors independently assessed for inclusion all potential studies identified. Data were extracted independently along with assessment of methodological quality using standard Cochrane methods. We contacted study authors for additional unpublished information. MAIN RESULTS No trials on modification of food met the inclusion criteria. We included two studies that examined modification to fluids. Both were part of the same large multicentre trial and included people with dementia and people with or without dementia and Parkinson's disease. Participation in the second trial was determined by results from the first trial. With unpublished data supplied by study authors, we examined data from participants with dementia only. The first study, a cross-over trial, investigated the immediate effects on aspiration of two viscosities of liquids (nectar thick and honey thick) compared to regular liquids in 351 participants with dementia using videofluoroscopy. Regular liquids with a chin down head posture, as well as regular liquids without any intervention were also compared. The sequence of interventions during videofluoroscopy may have influenced response to intervention. The second study, a parallel designed RCT, compared the effect of nectar and honey thick liquids with a chin down head posture over a three-month period in a subgroup of 260 participants with dementia. Outcomes were pneumonia and adverse intervention effects. Honey thick liquids, which are more consistent with descriptors for 'spoon thick' or 'extremely thick' liquids, showed a more positive impact on immediate elimination of aspiration during videofluoroscopy, but this consistency showed more adverse effects in the second follow-up study. During the second three-month follow-up trial, there were a greater number of incidents of pneumonia in participants receiving honey thick liquids than those receiving nectar thick liquids or taking regular liquids with a chin down posture. There were no deaths classified as 'definitely related' to the type of fluids prescribed. Neither trial addressed quality of life. Risk of bias for both studies is high. The overall quality of evidence for outcomes in this review is low. AUTHORS' CONCLUSIONS We are uncertain about the immediate and long-term effects of modifying the consistency of fluid for swallowing difficulties in dementia as too few studies have been completed. There may be differences in outcomes depending on the grade of thickness of fluids and the sequence of interventions trialled in videofluoroscopy for people with dementia. Clinicians should be aware that while thickening fluids may have an immediate positive effect on swallowing, the long-term impact of thickened fluids on the health of the person with dementia should be considered. Further high-quality clinical trials are required.
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Affiliation(s)
- Eadaoin Flynn
- Trinity College DublinClinical Speech and Language Studies7‐9 South Leinster Street2 DublinIreland
| | | | - Cathal D Walsh
- Department of Mathematics and StatisticsHealth Research Institute (HRI) and MACSIUniversity of LimerickIreland
| | - Margaret Walshe
- Trinity College DublinClinical Speech and Language Studies7‐9 South Leinster Street2 DublinIreland
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Sukkar SG, Maggi N, Travalca Cupillo B, Ruggiero C. Optimizing Texture Modified Foods for Oro-pharyngeal Dysphagia: A Difficult but Possible Target? Front Nutr 2018; 5:68. [PMID: 30131962 PMCID: PMC6090051 DOI: 10.3389/fnut.2018.00068] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/17/2018] [Indexed: 11/21/2022] Open
Abstract
Dysphagia is a swallowing disorder characterized by the difficulty in transferring solid foods and/or liquids from the oral cavity to the stomach, imparing autonomous, and safe oral feeding. The main problems deriving from dysphagia are tracheo-bronchial aspiration, aspiration pneumonia, malnutrition and dehydration. In order to overcome dysphagia-induced problems, over the years water and food thickening has been used, focusing specifically on viscosity increase, but limited results have been obtained. Elastic components and their effects on the cohesiveness on the bolus should be taken into account in the first place. We provide an analysis of dysphagia and suggest possible corrections to the protocols which are being used at present, taking into account rheological properties of food and the effect of saliva on the bolus. We reckon that considering such aspects in the dysphagia management market and healthcare catering would result in significant clinical risk reduction.
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Affiliation(s)
- Samir G Sukkar
- Clinical Nutrition Unit, IRCCS Ospedale Policlinico San Martino di Genova, Genova, Italy
| | - Norbert Maggi
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genova, Genova, Italy
| | | | - Carmelina Ruggiero
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genova, Genova, Italy
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Radiotherapy for cutaneous head and neck cancer and parotid tumours: a prospective investigation of treatment-related acute swallowing and toxicity patterns. Support Care Cancer 2018; 27:573-581. [PMID: 30019149 DOI: 10.1007/s00520-018-4352-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Reports of acute treatment-related dysphagia and toxicities for patients with parotid tumours or cutaneous head and neck cancer (HNC) are limited. This study aimed to describe the severity and timing of dysphagia and related toxicities experienced during radiotherapy for cutaneous HNC and parotid tumours, to inform the nature of future speech pathology (SP) service models required during treatment. METHODS Prospective study of 32 patients with parotid tumours and 36 with cutaneous HNC undergoing curative non-surgical management. Dysphagia and acute toxicity data was collected weekly during treatment and at 2, 4 and 12 weeks post-treatment using the Functional Oral Intake Scale, diet descriptors and CTCAE v4.0. RESULTS In both groups, minimal treatment toxicities (grades 0-1) were observed. Xerostomia and dysgeusia were the most frequently reported grade 2 toxicities. Only 3% of parotid patients and 6% with cutaneous HNC experienced grade 3 dysphagia. Full or soft texture diets were maintained by > 70% of patients in both groups. Symptoms peaked in the final week of treatment and rapidly improved thereafter. Apart from xerostomia < 10% of patients had any grade 2 toxicity at 12 weeks post-treatment. CONCLUSION Patients in these subgroups of HNC experienced minimal treatment-related toxicity during radiotherapy. As such, the need for supportive symptom management by SP is low. Models that involve interdisciplinary surveillance of symptoms with referral to SP only when required may be best suited for these individuals to ensure issues are identified whilst minimising patient burden created by unnecessary routine SP appointments.
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Martínez MP, Troncoso E, Robert P, Quezada C, Zúñiga RN. Time-Dependent Rheological Behavior of Starch-Based Thickeners and Herb Infusion Dispersions for Dysphagia Management. STARCH-STARKE 2018. [DOI: 10.1002/star.201700276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Macarena P. Martínez
- Department of Speech, Language and Hearing Sciences; Faculty of Medicine; Universidad de Chile; Independencia 1027 Independencia Santiago Chile
| | - Elizabeth Troncoso
- Department of Chemistry; Universidad Tecnológica Metropolitana; Las Palmeras 3360 Ñuñoa Santiago Chile
| | - Paz Robert
- Departament of Food Science and Chemical Technology; Universidad de Chile; Santos Dumont Nº 964 Independencia Santiago Chile
| | - Camilo Quezada
- Department of Speech, Language and Hearing Sciences; Faculty of Medicine; Universidad de Chile; Independencia 1027 Independencia Santiago Chile
| | - Rommy N. Zúñiga
- Programa Institucional de Fomento a la Investigación; Desarrollo e Innovación; Universidad Tecnológica Metropolitana; Ignacio Valdivieso 2409 San Joaquín Santiago Chile
- Department of Biotechnology; Universidad Tecnológica Metropolitana; Las Palmeras 3360 Ñuñoa Santiago Chile
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Moroney LB, Helios J, Ward EC, Crombie J, Pelecanos A, Burns CL, Spurgin AL, Blake C, Kenny L, Chua B, Hughes BGM. Helical intensity-modulated radiotherapy with concurrent chemotherapy for oropharyngeal squamous cell carcinoma: A prospective investigation of acute swallowing and toxicity patterns. Head Neck 2018; 40:1955-1966. [DOI: 10.1002/hed.25182] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/01/2018] [Accepted: 02/20/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Laura B. Moroney
- Department of Speech Pathology and Audiology; Royal Brisbane and Women's Hospital; Brisbane Australia
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Australia
| | - Jennifer Helios
- Department of Speech Pathology and Audiology; Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Elizabeth C. Ward
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Australia
- Centre for Functioning and Health Research; Metro South Hospital and Health Service; Brisbane Australia
| | - Jane Crombie
- Department of Speech Pathology and Audiology; Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute; Brisbane Australia
| | - Clare L. Burns
- Department of Speech Pathology and Audiology; Royal Brisbane and Women's Hospital; Brisbane Australia
- The University of Queensland; School of Health and Rehabilitation Sciences; Brisbane Australia
| | - Ann-Louise Spurgin
- Department of Speech Pathology and Audiology; Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Claire Blake
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Lizbeth Kenny
- Department of Speech Pathology and Audiology; Royal Brisbane and Women's Hospital; Brisbane Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane Australia
- The University of Queensland, School of Medicine; Brisbane Australia
| | - Benjamin Chua
- Department of Speech Pathology and Audiology; Royal Brisbane and Women's Hospital; Brisbane Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane Australia
- The University of Queensland, School of Medicine; Brisbane Australia
| | - Brett G. M. Hughes
- Department of Speech Pathology and Audiology; Royal Brisbane and Women's Hospital; Brisbane Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane Australia
- The University of Queensland, School of Medicine; Brisbane Australia
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48
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Tolerability and Product Properties of a Gum-Containing Thickener in Patients With Dysphagia. Rehabil Nurs 2018; 43:149-157. [DOI: 10.1097/rnj.0000000000000011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A review of diet standardization and bolus rheology in the management of dysphagia. Curr Opin Otolaryngol Head Neck Surg 2018; 24:183-90. [PMID: 26900822 DOI: 10.1097/moo.0000000000000251] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Texture modification is a widespread practice as a strategy for the management of dysphagia and can be very effective in individual cases. However, it is often performed in a qualitative, subjective manner and practices vary internationally according to multiple sets of national guidelines. This article aims to identify best practice by reviewing the theory and practice of texture modification, focussing on recent advances. RECENT FINDINGS Instrumental assessment of texture modification in vivo is challenging, and studies including rheology and perception have indicated that fluid viscosity is only one of many factors affecting texture modification in practice. Systematic reviews have identified a historical lack of high-quality clinical evidence, but recent controlled studies are beginning to identify positive and negative aspects of thickened fluids. Research and practice to date have been limited by the lack of control and standardization of foods and drinks. However in 2015 a not-for-profit organization, the International Dysphagia Diet Standardisation Initiative, has published a framework for texture modification from thin liquids to solid foods based on all the existing documentation and guidance, and the - limited - available clinical evidence. SUMMARY Rheology exists in the lab; however, normal practice is often subjective or lacking control and standardization. In the near future, cohesion of practice and the availability of practical standardization tools may increase awareness and use of rheology.
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Rumbach AF, Cremer R. Dysphagia and Speech-Language Pathology Involvement Following Chemical Ingestion Injury: A Review of 44 Cases Admitted to a Quaternary Australian Hospital (2008-2012). AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:1120-1128. [PMID: 28800373 DOI: 10.1044/2017_ajslp-16-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This study aimed to explore the clinical characteristics of an adult chemical ingestion population and examine the course of return to oral intake post injury and speech-language pathologist (SLP) involvement during the initial acute-care admission. METHOD A retrospective chart review of adults admitted to a quaternary hospital for the treatment of an acute chemical ingestion injury between 2008 and 2012 was conducted. RESULTS Forty-four adults (23 men, 21 women) were identified as receiving treatment for ingestion injury, of whom 18 (40.91%) required altered oral intake. Of those requiring altered oral intake, 50% were referred to SLPs. Individuals requiring altered oral intake were significantly (p < .05) older, more likely to be men, and present with more severe injuries requiring longer ICU and hospital admissions following intentional chemical ingestions than those who were able to commence a normal oral diet without any alteration or nonoral supplementation. By discharge, 15.91% (n = 7) of the total cohort had not resumed normal oral intake. CONCLUSIONS Return to oral intake post chemical ingestion injury can be protracted and complex. Referrals to SLPs were limited. These data may aid prognostic insight as well as provide (a) collateral information to assist discharge planning and follow-up and (b) background for evaluating the potential for SLP involvement.
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Affiliation(s)
- Anna F Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca Cremer
- Speech Pathology Department, Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Queensland Health, Brisbane. Australia
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