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Yi Q, Mao L, Li W, Shen F, Liao Z, Huang H, Li L. The perceptions and experiences of caregivers of patients with dysphagia: A qualitative meta-synthesis. Nurs Open 2024; 11:e2223. [PMID: 39219148 PMCID: PMC11366769 DOI: 10.1002/nop2.2223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 10/27/2023] [Accepted: 06/11/2024] [Indexed: 09/04/2024] Open
Abstract
AIMS To understand the perceptions and experiences of family caregivers of adult patients with dysphagia. BACKGROUND Dysphagia is a common symptom and burdens caregivers greatly. There is a growing body of studies concentrating on caregivers and caregiving experiences. However, no qualitative meta-synthesis has been conducted to explore the perceptions and experiences of family caregivers. DESIGN A qualitative meta-ethnography. METHODS A search was conducted for relevant articles in six electronic databases (PubMed, Web of Science, CINAHL, Ovid, Cochrane Library, ProQuest) and two Chinese databases (CNKI, Wanfang Data) from inception to February 2023. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to evaluate study quality. The meta-ethnographic method was used to synthesize data from qualitative studies. The study was reported according to EQUATOR guidelines. RESULTS Eleven studies were included and three themes emerged: (1) emotion and perception, (2) change and challenge (3) adaption and coping. CONCLUSION This review highlighted the challenges and positive coping experienced by caregivers. Findings directly inform the development and implementation of supportive interventions to reduce caregivers' stress and promote adaptive coping. RELEVANCE TO CLINICAL PRACTICE Pay attention to the needs of family caregivers of dysphagia. Family caregivers' perceived severity of dysphagia requires assessment. Caregivers need knowledge, support, and guidance to reduce their burden and fulfill their role.
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Affiliation(s)
- QiaoLi Yi
- Neurology Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- School of Nursing, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - LiYe Mao
- Neurology Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- School of Nursing, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - WenYao Li
- Neurology Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- School of Nursing, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Fan Shen
- Neurology Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- School of Nursing, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - ZongFeng Liao
- Neurology Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - HaiShan Huang
- Neurology Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Ling Li
- Neurology Department, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Werden Abrams S, Kurosu A, Namasivayam-Macdonald A. Participant Characteristics for Dysphagia Research: A Proposed Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-11. [PMID: 39151056 DOI: 10.1044/2024_ajslp-22-00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE Participant characteristics are underreported; however, they impact swallowing impairments and subsequent access to assessment and intervention. Standards for rigorous and transparent reporting of dysphagia research are required. The Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS) offers a critical appraisal tool for dysphagia research. This article outlines questions for participant characteristics in dysphagia research as part of the larger FRONTIERS tool. METHOD An exploratory literature review was conducted to determine how participant characteristics, eligibility criteria, and definitions of health and dysphagia are reported in the literature. Findings were cross-referenced with other relevant critical appraisal tools. A list of questions was generated and refined iteratively with the entire FRONTIERS collaborative until consensus was met. RESULTS The participant characteristics portion of the FRONTIERS tool includes eight questions and 16 possible subquestions. Examples for how the tool might be used, as well as rationales for inclusion of all questions, are included. CONCLUSIONS Including detailed characteristics of research participants may support understanding of how best to serve marginalized and underrepresented populations more effectively. Critical appraisal tools, such as FRONTIERS, may help to improve the rigor and transparency in dysphagia research, ultimately improving patient care.
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Affiliation(s)
| | - Atsuko Kurosu
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
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Pinho J, Meyer T, Schumann‐Werner B, Becker J, Tauber S, Nikoubashman O, Wiesmann M, Schulz JB, Werner CJ, Reich A. Swallowing muscle mass contributes to post-stroke dysphagia in ischemic stroke patients undergoing mechanical thrombectomy. J Cachexia Sarcopenia Muscle 2024; 15:1539-1548. [PMID: 38890004 PMCID: PMC11294029 DOI: 10.1002/jcsm.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/13/2024] [Accepted: 05/15/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Neurogenic dysphagia is a frequent complication of stroke and is associated with aspiration pneumonia and poor outcomes. Although ischaemic lesion location and size are major determinants of the presence and severity of post-stroke dysphagia, little is known about the contribution of other acute stroke-unrelated factors. We aimed to analyse the impact of swallowing and non-swallowing muscles measurements on swallowing function after large vessel occlusion stroke. METHODS This retrospective study was based on a prospective registry of consecutive ischaemic stroke patients. Patients who underwent mechanical thrombectomy between July 2021 and June 2022 and received a flexible endoscopic evaluation of swallowing (FEES) within 5 days after admission were included. Demographic, anthropometric, clinical, and imaging data were collected from the registry. The cross-sectional areas (CSA) of selected swallowing muscles (as a surrogate marker for swallowing muscle mass) and of cervical non-swallowing muscles were measured in computed tomography. Skeletal muscle index (SMI) was calculated and used as a surrogate marker for whole body muscle mass. FEES parameters, namely, Functional Oral Intake Scale (FOIS, as a surrogate marker for dysphagia presence and severity), penetration aspiration scale, and the presence of moderate-to-severe pharyngeal residues were collected from the clinical records. Univariate and multivariate ordinal and logistic regression analyses were performed to analyse if total CSA of swallowing muscles and SMI were associated with FEES parameters. RESULTS The final study population consisted of 137 patients, 59 were female (43.1%), median age was 74 years (interquartile range 62-83), median baseline National Institutes of Health Stroke Scale score was 12 (interquartile range 7-16), 16 patients had a vertebrobasilar occlusion (11.7%), and successful recanalization was achieved in 127 patients (92.7%). Both total CSA of swallowing muscles and SMI were significantly correlated with age (rho = -0.391, P < 0.001 and rho = -0.525, P < 0.001, respectively). Total CSA of the swallowing muscles was independently associated with FOIS (common adjusted odds ratio = 1.08, 95% confidence interval = 1.01-1.16, P = 0.029), and with the presence of moderate-to-severe pharyngeal residues for puree consistencies (adjusted odds ratio = 0.90, 95% confidence interval = 0.81-0.99, P = 0.036). We found no independent association of SMI with any of the FEES parameters. CONCLUSIONS Baseline swallowing muscle mass contributes to the pathophysiology of post-stroke dysphagia. Decreasing swallowing muscle mass is independently associated with increasing severity of early post-stroke dysphagia and with increased likelihood of moderate-to-severe pharyngeal residues.
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Affiliation(s)
- João Pinho
- Department of NeurologyUniversity Hospital RWTHAachenGermany
| | - Tareq Meyer
- Department of NeurologyUniversity Hospital RWTHAachenGermany
| | - Beate Schumann‐Werner
- Department of Neurology and GeriatricsJohanniter Hospital Stendal GmbHStendalGermany
- Institute of Cognitive Neurology and Dementia ResearchOtto Von Guericke UniversityMagdeburgGermany
| | - Johanna Becker
- Department of NeurologyUniversity Hospital RWTHAachenGermany
| | - Simone Tauber
- Department of NeurologyUniversity Hospital RWTHAachenGermany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital RWTHAachenGermany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital RWTHAachenGermany
| | - Jörg B. Schulz
- Department of NeurologyUniversity Hospital RWTHAachenGermany
- JARA‐BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany
| | - Cornelius J. Werner
- Department of NeurologyUniversity Hospital RWTHAachenGermany
- Department of Neurology and GeriatricsJohanniter Hospital Stendal GmbHStendalGermany
| | - Arno Reich
- Department of NeurologyUniversity Hospital RWTHAachenGermany
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Kuroiwa R, Shibuya K, Inagaki T, Nara T, Nemoto M, Doi Y, Yasuda M, Uzawa A, Shiko Y, Murata A, Yamanaka Y, Kuwabara S. Reliability and validity of cough peak flow measurements in myasthenia gravis. Neuromuscul Disord 2024; 41:29-34. [PMID: 38870650 DOI: 10.1016/j.nmd.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/16/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
Decreased cough strength in myasthenia gravis (MG) leads to aspiration and increases the risk of MG crisis. The aim of this study was to clarify the reliability and validity of cough peak flow (CPF) measurements in MG. A total of 26 patients with MG who underwent CPF measurements using the peak flow meter by themselves were included. MG symptoms were evaluated by pulmonary function tests and clinical MG assessment scales before and after immune-treatments. The relationship between CPF and pulmonary function tests and MG comprehensive were assessed. The cut-off value of CPF for aspiration risk was determined and the area under the curve (AUC) was calculated. The intraclass correlation coefficient was more than 0.95 for pre-and post-treatment. Positive correlations were found between CPF and almost all spirometric values as well as between the differences of pre-and post-treatment in CPF and quantitative myasthenia gravis score. The CPF for identifying the aspiration risk was used to calculate the CPF cut-off value of 205 L/min with a sensitivity of 0.77, specificity of 0.90, and AUC of 0.85. The CPF, a convenient measure by patients themselves, has a high reliability in patients with MG, and is a useful biomarker reflecting MG symptoms.
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Affiliation(s)
- Ryota Kuroiwa
- Division of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan; Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Inagaki
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Science, Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Takeru Nara
- Division of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan; Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Marie Nemoto
- Division of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan
| | - Yuka Doi
- Department of Rehabilitation Therapy, Chiba Rehabilitation Center, Chiba, Japan
| | - Manato Yasuda
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Department of Biostatistics Section, Chiba University Hospital, Clinical Research Center, Chiba, Japan
| | - Atsushi Murata
- Division of Rehabilitation Medicine, Chiba University Hospital, Chiba, Japan
| | - Yoshitaka Yamanaka
- Urayasu Rehabilitation Education Center, Chiba University Hospital, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Niessen AC, Zang J, Tinat F, Nienstedt JC, Müller F, Flügel T, Glinzer J, Pflug C. The effect of underlying diseases on pneumonia risk in patients with neurogenic or tumor-related dysphagia: a retrospective cohort study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08815-6. [PMID: 38992194 DOI: 10.1007/s00405-024-08815-6] [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: 05/02/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To analyze the association of neurological disorders (ND) and head and neck cancer (HNC) with dysphagia severity and aspiration pneumonia occurrence. METHOD Retrospective cohort study conducted at a university dysphagia center) for two consecutive years. Patients with ND or HNC were included if they had undergone a flexible endoscopic swallowing evaluation (FEES) at the dysphagia center, and at least one food consistency had been sampled and recorded. Outcomes of interest were swallowing safety, highest penetration-aspiration-score (PASmax), way of food intake, presence of a tracheal tube, and occurrence of pneumonia within the past two years. RESULTS Of 257 consecutive patients, 199 were enrolled in the study and classified according to their underlying diagnosis into ND (120 patients) or HNC (79 patients). Forty-three HNC patients (54.4%) and 54 ND patients (45%) showed critical dysphagia in FEES (PAS ≥ 6). Binary logistic regression comparing both groups showed patients with ND to be 2.31 times more likely to develop pneumonia. However, if the 32 stroke patients were excluded from the calculation, PASmax remains the only significant variable affecting pneumonia risk in both groups. Liquids were the main challenge for ND patients, while aspirating HNC patients struggled with all consistencies. CONCLUSIONS The study shows that patients with HNC and ND differ in pneumonia risk only if stroke patients are included in the ND group. If they are excluded, the PAS score is the only remaining risk factor for pneumonia. Thickening liquids may not be suitable for all dysphagic patients; individually tailored measures might be more helpful, especially for HNC patients.
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Affiliation(s)
- Almut C Niessen
- Universitätsklinikum Hamburg-Eppendorf, Martinistr 48-52, Hamburg, 20246, Germany.
| | - Jana Zang
- Universitätsklinikum Hamburg-Eppendorf, Martinistr 48-52, Hamburg, 20246, Germany
| | - Ferkhunda Tinat
- Universitätsklinikum Hamburg-Eppendorf, Martinistr 48-52, Hamburg, 20246, Germany
| | - Julie C Nienstedt
- Universitätsklinikum Hamburg-Eppendorf, Martinistr 48-52, Hamburg, 20246, Germany
| | - Frank Müller
- Universitätsklinikum Hamburg-Eppendorf, Martinistr 48-52, Hamburg, 20246, Germany
| | - Till Flügel
- Universitätsklinikum Hamburg-Eppendorf, Martinistr 48-52, Hamburg, 20246, Germany
| | - Julia Glinzer
- Universitätsklinikum Hamburg-Eppendorf, Martinistr 48-52, Hamburg, 20246, Germany
| | - Christina Pflug
- Universitätsklinikum Hamburg-Eppendorf, Martinistr 48-52, Hamburg, 20246, Germany
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Hong I, Bae S, Lee HK, Bonilha HS. Prevalence of Dysphonia and Dysphagia Among Adults in the United States in 2012 and 2022. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1868-1879. [PMID: 38713813 DOI: 10.1044/2024_ajslp-23-00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
PURPOSE The purpose of this study was to compare the prevalence of dysphonia and dysphagia among adults in the United States between 2012 and 2022. METHOD A retrospective and cross-sectional design with national surveys was used. The 2012 and 2022 National Health Interview Surveys were utilized to estimate the number of adults reporting dysphonia and dysphagia in the past 12 months. Multivariate logistic regression models were used to examine associations between the survey year (2022 vs. 2012) and the prevalence rate of dysphonia and dysphagia while accounting for demographics and clinical characteristics. RESULTS The population-estimated mean age was 46.63 years in 2012, which increased to 48.12 years in 2022. In 2012, adults reporting dysphonia and dysphagia were 17.89 million (7.62%) and 9.44 million (4.02%), respectively. In 2022, these estimates increased to 29.92 million adults (11.71%) and 15.10 million adults (5.91%), respectively. Adults in 2022 had significantly higher odds for reporting dysphonia (odds ratio [OR] = 1.602, 95% confidence intervals [CIs] [1.486, 1.726], p < .0001) and dysphagia (OR = 1.461, 95% CI [1.328, 1.606], p < .0001) in the past 12 months compared to adults in 2012. CONCLUSIONS The population-estimates indicated that in 2022, dysphonia affected one in 8.5 adults and dysphagia affected one in 17 adults. The increase in prevalence of these disorders should serve as a call-to-action to improve access to care and research for voice and swallowing disorders.
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Affiliation(s)
- Ickpyo Hong
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Suyeong Bae
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Republic of Korea
| | - Ho Kyung Lee
- Department of Occupational Therapy, Graduate School, Yonsei University, Wonju, Republic of Korea
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Salgado TT, Oliveira CMDS, Gatti M, Silva RGD, Honório HM, Berretin-Felix G. Degree of swallowing impairment in the elderly: clinical and instrumental assessment. Braz J Otorhinolaryngol 2024; 90:101426. [PMID: 38608636 PMCID: PMC11016858 DOI: 10.1016/j.bjorl.2024.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/11/2023] [Accepted: 02/27/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE To classifying the degree of swallowing impairment in the elderly, comparing clinical and instrumental assessment. METHODS This is a cross-sectional study with quantitative and qualitative analysis of clinical and instrumental assessment of 37 elderly, aged 60-82 years, of both genders without neurological, oncological or systemic diseases, participated in this study. All participants were submitted to clinical evaluation and their results compared through fiberoptic endoscopic evaluation of swallowing considering liquid, pudding and solid food consistencies. Data were analyzed descriptively and statistically using the analysis of variance test (two-way ANOVA) and Tukey's post hoc test (p < 0.05). RESULTS In the clinical evaluation there was a higher occurrence of moderate swallowing impairment, followed by functional swallowing, while in fiberoptic endoscopic evaluation of swallowing the severity of the impairment was greater for moderate and mild degrees. There was no statistical difference between the clinical and instrumental evaluation methods. However, there was a significant interaction between the variables, with a difference for liquid consistency in the instrumental evaluation method. CONCLUSION Healthy elderly have different degree of swallowing impairment according to food consistency. The clinical assessment using a scale that considers the physiological changes of the elderly, presented results similar to those found in the instrumental examination. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | - Marina Gatti
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, SP, Brazil
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Taniguchi Y, Ono J, Haraguchi M, Tabuchi M, Hisamatsu N, Takahata H, Kondo H, Yamaguchi N, Kumai Y, Nakao K. Impact of low pharyngeal/esophageal pressure associated with sarcopenia on postendoscopic submucosal dissection pneumonia in patients with superficial esophageal cancer. Dig Endosc 2024; 36:801-810. [PMID: 37908188 DOI: 10.1111/den.14715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/29/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES The aging population, including patients with superficial esophageal cancer, encounters critical dysphagia- and postoperative pneumonia-related issues. Although endoscopic submucosal dissection (ESD) provides advantages over other modalities, older patients are at higher risk of postoperative pneumonia. Furthermore, the etiologies of pneumonia are complex and include patient- (such as sarcopenia) and treatment- (including ESD) related factors. Therefore, this study evaluated swallowing function in patients with superficial esophageal cancer and identified post-ESD pneumonia-associated factors. METHODS Comprehensive swallowing function and sarcopenia were evaluated in patients pre-ESD and 2 months post-ESD using high-resolution manometry and several swallowing studies by multiple experts. The effects of mucosal resection and sarcopenia on swallowing function changes post-ESD, the relationship between preoperative swallowing function and sarcopenia, and the factors influencing postoperative pneumonia were investigated. RESULTS Twenty patients were included in the study. Patients with preoperative sarcopenia had significantly lower pharyngeal/upper esophageal sphincter and tongue pressures than those without sarcopenia. However, ESD did not worsen pharyngeal or upper esophageal pressure. Post-ESD pneumonia incidence tended to be higher in patients with sarcopenia than in those without sarcopenia. The lower upper esophageal sphincter-integrated relaxation pressure (UES-IRP) was a significant factor in pneumonia development. Furthermore, the receiver operating characteristic curve for UES-IRP in pneumonia yielded an area under the curve of 0.82. CONCLUSIONS Sarcopenia is associated with preoperative dysphagia, which increases post-ESD pneumonia risk. Therefore, postoperative pneumonia incidence is expected to increase with an aging population, making preoperative sarcopenia and swallowing function evaluation crucial.
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Affiliation(s)
- Yasuhiro Taniguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Junki Ono
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masafumi Haraguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Maiko Tabuchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriko Hisamatsu
- Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hideaki Takahata
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hisayoshi Kondo
- Biostatistics Section, Division of Scientific Data Registry, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Naoyuki Yamaguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Komiya K, Yamatani I, Kadota JI. Treatment strategy for older patients with pneumonia independent of the risk of drug resistance in the world's top country for longevity. Respir Investig 2024; 62:710-716. [PMID: 38823190 DOI: 10.1016/j.resinv.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/05/2024] [Accepted: 05/26/2024] [Indexed: 06/03/2024]
Abstract
The number of older people with impaired swallowing function increases with aging population. Aspiration pneumonia is one of the most cases of pneumonia developing among older people. As aspiration pneumonia may develop as a result of age-related deterioration, it is crucial to consider it as an unavoidable event with aging. While pneumonia is diagnosed based on respiratory symptoms and radiological features, the lung involvement of aspiration pneumonia may be undetectable via a frontal chest radiograph in some cases. Bacterial profiles show the predominance of drug-resistant bacteria, such as Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), but isolated bacteria from respiratory samples do not necessarily indicate causative pathogens. Furthermore, there is no evidence regarding treatment superiority using broad-spectrum antibiotics compared with narrow-spectrum antibiotics. Even if isolated pathogens are a causative factor for pneumonia among older patients, the use of broad-spectrum antibiotics covering the bacteria may not improve their outcomes. Therefore, we propose a treatment strategy independent of the risk of drug resistance focusing on the discrimination of patients who are unlikely to respond to broad-spectrum antibiotics. An aspiration risk is associated with increased in-hospital mortality in patients with pneumonia, which could also lead to a greater risk of poor long-term outcomes with increased 1-year mortality. Advance care planning is now recognized as a process for communication and medical decision-making across the life course. This approach would be widely recommended for older people with aspiration risk.
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Affiliation(s)
- Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan; Research Center for Global and Local Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Izumi Yamatani
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan; Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan.
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
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McGuire MR, Mostofa A, Shon J, Frost M, Kim MJ, Li K. Designs of clinical swallowability assessments of solid oral dosage forms in regulatory submissions. Int J Pharm 2024; 659:124229. [PMID: 38762166 DOI: 10.1016/j.ijpharm.2024.124229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/06/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
The swallowability of solid oral dosage forms (SODFs) is crucial for medication safety and adherence. Both regulatory agencies and sponsors are concerned with bringing swallowable SODFs to patients. However, no best practices are available for assessing swallowability. Therefore, we conducted a comparative analysis of clinical swallowability assessments (CSAs) for SODFs in regulatory submissions to identify current study design practices. CSAs were identified from a "swallowability" keyword search of a Food and Drug Administration database. Notable design trends among the 17 CSAs were not assessing swallowability as a primary endpoint (76 %); enrolling pediatric patients (76 %); administering assessments post-screening (76 %); and utilizing questionnaires (100 %). A design trend with near equal frequency (∼50 %) was single- or multiple-doses of product administration. Study subjects were the primary questionnaire respondents (82 %), usually using a Likert scale (92 %, 12/13). CSAs generally dichotomized the responses for analysis (65 %) without pre-specified threshold values (59 %). Overall, while study designs exhibited trends, methodology variations may impact swallowability measurements affecting the interpretation of results. Thus, developing robust and valid assessment tools for swallowability is imperative to produce clinically relevant data and inform regulatory decision-making. Collaboration between regulatory agencies and sponsors is warranted to create best practices and ensure high quality swallowability data.
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Affiliation(s)
- Meredith R McGuire
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Agm Mostofa
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Jihong Shon
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Mitchell Frost
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Myong-Jin Kim
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Karen Li
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
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Bai L, Cheng H, Hu P, Wang Q, Shilin Z, Shen Z, Xu F, Su X, Zhang Y. Effect of acupuncture on post-stroke dysphagia: a randomized controlled trial. Front Neurol 2024; 15:1391226. [PMID: 38974687 PMCID: PMC11224290 DOI: 10.3389/fneur.2024.1391226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Post-stroke dysphagia (PSD) is associated with various complications that increase morbidity and mortality rates. Acupuncture has been used extensively in China to treat these complications; however, its therapeutic efficacy remains uncertain. We therefore aimed to study the clinical effects of acupuncture on PSD. Methods Patients (n = 101) were randomly divided into acupuncture (n = 50) and rehabilitation training control (n = 51) groups based on the treatment used. Both groups were treated once daily, 6 days a week, for a total of 4 weeks. Pulse oxygen saturation (SpO2) and standardized swallowing assessment (SSA) were performed before the intervention, 2 weeks into treatment, after the intervention (4 weeks post-intervention), and at a 6-month follow-up (28 weeks). The levels of hemoglobin (Hb) and albumin (ALB), and 5-hydroxytryptamine (5-HT) and dopamine (DA) were measured before the intervention, 2 weeks into treatment, and after the intervention (4 weeks), as nutrition and swallowing function indices, respectively. Results Following the intervention, significant differences were observed between the acupuncture and control groups. The acupuncture group exhibited considerably superior enhancements in SpO2 and SSA scores at 4 weeks (p < 0.001). Moreover, this group demonstrated significantly greater improvements in Hb, ALB, 5-HT, and DA values 4 weeks post-treatment (p < 0.001). However, sex-based differences were not observed (P > 0.005). Conclusion Acupuncture treatment can improve the swallowing function and nutritional status of patients with PSD, and increase the levels of 5-HT and DA. These findings strongly support the efficacy of acupuncture as a therapeutic intervention in patients with PSD.Clinical trial registration: identifier, ChiCTR2100052201. (https://www.chictr.org.cn/).
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Affiliation(s)
- Lin Bai
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Hongliang Cheng
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Peijia Hu
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Qingqing Wang
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Zhang Shilin
- Fuyang City Sixth People's Hospital, Fuyang, China
| | - Zhiqiang Shen
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Fangyuan Xu
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Xingxing Su
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Yiting Zhang
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
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Fogarty MJ. Dendritic morphology of motor neurons and interneurons within the compact, semicompact, and loose formations of the rat nucleus ambiguus. Front Cell Neurosci 2024; 18:1409974. [PMID: 38933178 PMCID: PMC11199410 DOI: 10.3389/fncel.2024.1409974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Motor neurons (MNs) within the nucleus ambiguus innervate the skeletal muscles of the larynx, pharynx, and oesophagus. These muscles are activated during vocalisation and swallowing and must be coordinated with several respiratory and other behaviours. Despite many studies evaluating the projections and orientation of MNs within the nucleus ambiguus, there is no quantitative information regarding the dendritic arbours of MNs residing in the compact, and semicompact/loose formations of the nucleus ambiguus.. Methods In female and male Fischer 344 rats, we evaluated MN number using Nissl staining, and MN and non-MN dendritic morphology using Golgi-Cox impregnation Brightfield imaging of transverse Nissl sections (15 μm) were taken to stereologically assess the number of nucleus ambiguus MNs within the compact and semicompact/loose formations. Pseudo-confocal imaging of Golgi-impregnated neurons within the nucleus ambiguus (sectioned transversely at 180 μm) was traced in 3D to determine dendritic arbourisation. Results We found a greater abundance of MNs within the compact than the semicompact/loose formations. Dendritic lengths, complexity, and convex hull surface areas were greatest in MNs of the semicompact/loose formation, with compact formation MNs being smaller. MNs from both regions were larger than non-MNs reconstructed within the nucleus ambiguus. Conclusion Adding HBLS to the diet could be a potentially effective strategy to improve horses' health.
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Affiliation(s)
- Matthew J. Fogarty
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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Turkovic E, Vasiljevic I, Parojcic J. A comprehensive assessment of machine learning algorithms for enhanced characterization and prediction in orodispersible film development. Int J Pharm 2024; 658:124188. [PMID: 38705248 DOI: 10.1016/j.ijpharm.2024.124188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
Orodispersible films (ODFs) have emerged as innovative pharmaceutical dosage forms, offering patient-specific treatment through adjustable dosing and the combination of diverse active ingredients. This expanding field generates vast datasets, requiring advanced analytical techniques for deeper understanding of data itself. Machine learning is becoming an important tool in the rapidly changing field of pharmaceutical research, particularly in drug preformulation studies. This work aims to explore into the application of machine learning methods for the analysis of experimental data obtained by ODF characterization in order to obtain an insight into the factors governing ODF performance and use it as guidance in pharmaceutical development. Using a dataset derived from extensive experimental studies, various machine learning algorithms were employed to cluster and predict critical properties of ODFs. Our results demonstrate that machine learning models, including Support vector machine, Random forest and Deep learning, exhibit high accuracy in predicting the mechanical properties of ODFs, such as flexibility and rigidity. The predictive models offered insights into the complex interaction of formulation variables. This research is a pilot study that highlights the potential of machine learning as a transformative approach in the pharmaceutical field, paving the way for more efficient and informed drug development processes.
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Affiliation(s)
- Erna Turkovic
- Department of Pharmaceutical Technology and Cosmetology, University of Belgrade - Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia.
| | - Ivana Vasiljevic
- Department of Pharmaceutical Technology and Cosmetology, University of Belgrade - Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Jelena Parojcic
- Department of Pharmaceutical Technology and Cosmetology, University of Belgrade - Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia
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Burdick R, Peña-Chávez R, Namasivayam-MacDonald A, Rogus-Pulia N. Deglutologist Practices and Perceptions of the Penetration-Aspiration Scale: A Survey Study. Dysphagia 2024; 39:522-533. [PMID: 38267756 DOI: 10.1007/s00455-023-10637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/26/2023] [Indexed: 01/26/2024]
Abstract
Successful dysphagia management requires accurate, succinct diagnosis and characterization of swallowing safety impairments. However, the Penetration-Aspiration Scale (PAS) remains the only available tool developed exclusively for assessment of airway protection. To best support efforts to advance the field's understanding of swallowing safety, it is crucial to understand current clinician practice patterns, perceptions, and accuracy regarding the PAS. A 46-item survey was developed and distributed to deglutologists internationally examining: (1) Demographics; (2) Scale Practices; (3) Swallowing Safety Priorities; (4) Scale Perceptions; and (5) Accuracy. The first four sections consisted of questionnaires. In the optional fifth section, respondents were asked to score five videos of swallows collected via videofluoroscopy and previously PAS-scored by two trained raters. In total, 335 responses were analyzed. The majority of respondents self-reported PAS training (84%); 90% of untrained respondents were receptive to training. Respondents reported using the PAS "always" (40%) or "frequently" (29%), and that the PAS carries "a great deal of" weight in assessment (40%). Reported application of the PAS was heterogeneous, with the most common approach being "single worst score per unique presentation" (45%). Most respondents (64%) prioritized a parameter not captured by the PAS. Untrained respondents were significantly more confident with PAS ratings than trained respondents (X2 = 7.47; p = 0.006). Of 1460 PAS ratings provided, 364 of them were accurate (25%) when compared to ratings by trained lab members. Results of this survey reflect ubiquitous use of the PAS, unmet needs for assessment of swallowing safety, low accuracy despite generally high confidence, and heterogenous training that does not correspond to confidence. This emphasizes the need for additional training in clinical application of the PAS as well as development of novel metrics to optimize assessments of swallowing safety.
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Affiliation(s)
- Ryan Burdick
- Department of Medicine, Division of Geriatrics and Gerontology, Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705-2281, USA
- Geriatric Research Education and Clinical Center (GRECC), William S Middleton Veterans Hospital, Madison, USA
| | - Rodolfo Peña-Chávez
- Department of Medicine, Division of Geriatrics and Gerontology, Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705-2281, USA
- Geriatric Research Education and Clinical Center (GRECC), William S Middleton Veterans Hospital, Madison, USA
- Facultad de Ciencias de La Salud y de los Alimentos, Departamento de Ciencias de La Rehabilitacion en Salud, Universidad del Bío-Bío, Concepción, Chile
| | - Ashwini Namasivayam-MacDonald
- Department of Communication Sciences and Disorders, McMaster University, Togo Salmon Hall 331, 1280 Main Street West, Hamilton, Ontario, Canada
| | - Nicole Rogus-Pulia
- Department of Medicine, Division of Geriatrics and Gerontology, Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705-2281, USA.
- Geriatric Research Education and Clinical Center (GRECC), William S Middleton Veterans Hospital, Madison, USA.
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Baqué J, Huret O, Rayneau P, Schleich M, Morinière S. Acoustic Analysis of Swallowing of an Experimental Meal of Three Food Textures: A Comparative Aging Study. Dysphagia 2024; 39:452-458. [PMID: 37979004 PMCID: PMC11127804 DOI: 10.1007/s00455-023-10629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
Swallowing disorders in the elderly represent a public health problem, their detections are a medico-economic issue. The acoustic analysis of swallowing has the advantages of being non-invasive with no radiation, compared to videofluoroscopy or fiberoptic swallowing assessments. Acoustic analysis of swallowing has been tested in many studies but only on small food boluses. The aim of this study was to compare the acoustic swallowing parameters of two groups of healthy subjects, before and after 70 years old, during the intake of a series of 3 food textures. A laryngophone was used to record the pharyngeal phase of swallowing. The experimental meal was composed of 100 ml of mashed potatoes, 100 ml of water, and 100 ml of yogurt. Group 1 (50-70 years old) comprised 21 subjects and group 2 (over 70 years old) 23 subjects. Acoustic parameters analyzed were the number of swallows, average duration of swallowing, average duration of inter-swallowing, meal duration, and the average frequency of swallowing per minute. These parameters for groups 1 and 2 were compared. The average duration of inter-swallowing and the meal duration were significantly higher in the older group (p < 0.001), with a mean duration of inter-swallowing that was 2.4 s longer than the younger group. The average swallowing frequency per minute was higher in the younger group (11.3 vs 7.9; p < 0.001). This study demonstrated that acoustic analysis of an experimental meal of three food textures generated usable data on swallowing. In the over 70 age group, there was a decrease in swallowing frequency, indicating a slowdown in food intake. A reduced swallowing frequency could become a criteria to assess presbyphagia.
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Affiliation(s)
- Jean Baqué
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France.
| | - Océane Huret
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Pierre Rayneau
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Marianne Schleich
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
| | - Sylvain Morinière
- ENT and Head and Neck Surgery, University Hospital of Tours, 2 Boulevard Tonnelé , 37044, Tours, France
- Francois-Rabelais University of Tours, University Hospital of Tours, 10 Boulevard Tonnelé, 37032, Tours, France
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Estácio JC, Cera ML, Mangilli LD. Swallowing performance of elderly people and sociodemographic, cognitive and language factors. Codas 2024; 36:e20220319. [PMID: 38836826 PMCID: PMC11189153 DOI: 10.1590/2317-1782/20242022319pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/15/2023] [Indexed: 06/06/2024] Open
Abstract
PURPOSE To analyze the correlation between swallowing, language and cognition performance and describe the sociodemographic data of elderly people without previous neurological disorders. METHODS Analytical cross-sectional study, with non-probabilistic sample for convenience and data collection by telecall. The aspiration screening test (Yale Swallow Protocol) was used to identify and exclude elderly people at risk of aspiration. Then, sociodemographic data were collected, and instruments were applied: activity of daily living (IADLs), risk of dysphagia (EAT-10), cognitive screening (Mini Mental State Examination - MMSE) and language (Montreal-Toulouse Language Battery - MTL-Brazil). RESULTS The sample consisted of 32 elderly people from the Federal District, with a mean age of 69.00±7.73 years and schooling of 10.00±5.60 years. The scores on the EAT-10, MMSE and MTL Battery instruments were altered in four, 22 and 26 elderly, respectively, indicating, in this case, risk of dysphagia, suggestion of cognitive alteration and language alteration. Regarding food, of the total sample, 13 seniors (40%) complained of needing modified food, as well as 10 of these also obtained MMSE scores suggestive of cognitive alteration. When comparing the groups with and without complaints and/or risk of dysphagia, there was no statistically significant difference in relation to sociodemographic, cognitive and language variables. Binary logistic regression models also showed no statistically significant results. CONCLUSION The present study, when correlating the swallowing, language and cognition findings, did not obtain statistically significant results. It was observed that the elderly with swallowing complaints also showed results suggestive of cognitive and language changes in the tests performed, but there was no statistically significant difference in relation to the elderly without complaints or swallowing changes.
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Affiliation(s)
- Jaqueline Cardoso Estácio
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade de Brasília – UnB - Brasília (DF), Brasil.
| | - Maysa Luchesi Cera
- Curso de Fonoaudiologia, Faculdade de Ceilândia, Universidade de Brasília – UnB - Brasília (DF), Brasil.
| | - Laura Davison Mangilli
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade de Brasília – UnB - Brasília (DF), Brasil.
- Curso de Fonoaudiologia, Faculdade de Ceilândia, Universidade de Brasília – UnB - Brasília (DF), Brasil.
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Iwai K, Azuma T, Yonenaga T, Sasai Y, Komatsu Y, Tabata K, Nomura T, Sugiura I, Inagawa Y, Matsumoto Y, Nakashima S, Abe Y, Tomofuji T. Predictive Factors Associated with Future Decline in Swallowing Function among Japanese Older People Aged ≥ 75 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:674. [PMID: 38928921 PMCID: PMC11203831 DOI: 10.3390/ijerph21060674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
Predictive factors associated with a decline in swallowing function after 2 years were examined in 3409 Japanese older people aged ≥ 75 years who had undergone a dental checkup in Gifu Prefecture, Japan. Participants with normal swallowing function in a baseline survey in April 2018 were followed for 2 years. Swallowing function was assessed using a repetitive saliva swallowing test. In our study, 429 participants (13%) who were swallowing less than three times in 30 s based on a repetitive saliva swallowing test after 2 years were diagnosed as those with decline in swallowing function. Multivariate logistic regression analyses showed the decline in swallowing function after 2 years was associated with the male gender (odds ratio [ORs]: 0.772; 95% confidence interval [CIs]: 0.615-0.969), age ≥ 81 years (presence; ORs: 1.523; 95% CIs: 1.224-1.895), support/care-need certification (presence; ORs: 1.815; 95% CIs: 1.361-2.394), periodontal pocket depth (PPD) ≥ 4 mm (presence; ORs: 1.469; 95% CIs: 1.163-1.856), difficulty in biting hard food (yes; ORs: 1.439; 95% CIs: 1.145-1.808), choking on tea and water (yes; ORs: 2.543; 95% CIs: 2.025-3.193), and dry mouth (yes; ORs: 1.316; 95% CIs: 1.052-1.646) at baseline. Therefore, the dental checkup items associated with a decline in swallowing function after 2 years were a PPD ≥ 4 mm, difficulty in biting hard food, choking on tea and water, and dry mouth. PPD status and confirming to the self-administered questionnaire about biting, choking, and dry mouth may be useful in predicting future decline in swallowing function.
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Affiliation(s)
- Komei Iwai
- Department of Community Oral Health, School of Dentistry, Asahi University, 1-1851 Hozumi, Mizuho 501-0296, Gifu, Japan; (K.I.); (T.A.); (T.Y.); (Y.S.); (Y.K.); (K.T.)
| | - Tetsuji Azuma
- Department of Community Oral Health, School of Dentistry, Asahi University, 1-1851 Hozumi, Mizuho 501-0296, Gifu, Japan; (K.I.); (T.A.); (T.Y.); (Y.S.); (Y.K.); (K.T.)
| | - Takatoshi Yonenaga
- Department of Community Oral Health, School of Dentistry, Asahi University, 1-1851 Hozumi, Mizuho 501-0296, Gifu, Japan; (K.I.); (T.A.); (T.Y.); (Y.S.); (Y.K.); (K.T.)
| | - Yasuyuki Sasai
- Department of Community Oral Health, School of Dentistry, Asahi University, 1-1851 Hozumi, Mizuho 501-0296, Gifu, Japan; (K.I.); (T.A.); (T.Y.); (Y.S.); (Y.K.); (K.T.)
| | - Yoshinari Komatsu
- Department of Community Oral Health, School of Dentistry, Asahi University, 1-1851 Hozumi, Mizuho 501-0296, Gifu, Japan; (K.I.); (T.A.); (T.Y.); (Y.S.); (Y.K.); (K.T.)
| | - Koichiro Tabata
- Department of Community Oral Health, School of Dentistry, Asahi University, 1-1851 Hozumi, Mizuho 501-0296, Gifu, Japan; (K.I.); (T.A.); (T.Y.); (Y.S.); (Y.K.); (K.T.)
| | - Taketsugu Nomura
- Gifu Dental Association, 1-18 Minamidori, Kano-cho, Gifu 500-8486, Gifu, Japan; (T.N.); (I.S.); (Y.I.); (Y.M.); (S.N.); (Y.A.)
| | - Iwane Sugiura
- Gifu Dental Association, 1-18 Minamidori, Kano-cho, Gifu 500-8486, Gifu, Japan; (T.N.); (I.S.); (Y.I.); (Y.M.); (S.N.); (Y.A.)
| | - Yujo Inagawa
- Gifu Dental Association, 1-18 Minamidori, Kano-cho, Gifu 500-8486, Gifu, Japan; (T.N.); (I.S.); (Y.I.); (Y.M.); (S.N.); (Y.A.)
| | - Yusuke Matsumoto
- Gifu Dental Association, 1-18 Minamidori, Kano-cho, Gifu 500-8486, Gifu, Japan; (T.N.); (I.S.); (Y.I.); (Y.M.); (S.N.); (Y.A.)
| | - Seiji Nakashima
- Gifu Dental Association, 1-18 Minamidori, Kano-cho, Gifu 500-8486, Gifu, Japan; (T.N.); (I.S.); (Y.I.); (Y.M.); (S.N.); (Y.A.)
| | - Yoshikazu Abe
- Gifu Dental Association, 1-18 Minamidori, Kano-cho, Gifu 500-8486, Gifu, Japan; (T.N.); (I.S.); (Y.I.); (Y.M.); (S.N.); (Y.A.)
| | - Takaaki Tomofuji
- Department of Community Oral Health, School of Dentistry, Asahi University, 1-1851 Hozumi, Mizuho 501-0296, Gifu, Japan; (K.I.); (T.A.); (T.Y.); (Y.S.); (Y.K.); (K.T.)
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Wu Y, Guo K, Chu Y, Wang Z, Yang H, Zhang J. Advancements and Challenges in Non-Invasive Sensor Technologies for Swallowing Assessment: A Review. Bioengineering (Basel) 2024; 11:430. [PMID: 38790297 PMCID: PMC11118896 DOI: 10.3390/bioengineering11050430] [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: 04/02/2024] [Revised: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Dysphagia is a pervasive health issue that impacts diverse demographic groups worldwide, particularly the elderly, stroke survivors, and those suffering from neurological disorders. This condition poses substantial health risks, including malnutrition, respiratory complications, and increased mortality. Additionally, it exacerbates economic burdens by extending hospital stays and escalating healthcare costs. Given that this disorder is frequently underestimated in vulnerable populations, there is an urgent need for enhanced diagnostic and therapeutic strategies. Traditional diagnostic tools such as the videofluoroscopic swallowing study (VFSS) and flexible endoscopic evaluation of swallowing (FEES) require interpretation by clinical experts and may lead to complications. In contrast, non-invasive sensors offer a more comfortable and convenient approach for assessing swallowing function. This review systematically examines recent advancements in non-invasive swallowing function detection devices, focusing on the validation of the device designs and their implementation in clinical practice. Moreover, this review discusses the swallowing process and the associated biomechanics, providing a theoretical foundation for the technologies discussed. It is hoped that this comprehensive overview will facilitate a paradigm shift in swallowing assessments, steering the development of technologies towards more accessible and accurate diagnostic tools, thereby improving patient care and treatment outcomes.
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Affiliation(s)
- Yuwen Wu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Kai Guo
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Yuyi Chu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Zhisen Wang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Hongbo Yang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Juzhong Zhang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
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Kovalenko L, Kukuls K, Berga M, Mohylyuk V. Taste-Masked Pellets of Warfarin Sodium: Formulation towards the Dose Personalisation. Pharmaceutics 2024; 16:586. [PMID: 38794249 PMCID: PMC11124359 DOI: 10.3390/pharmaceutics16050586] [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: 04/02/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
The bitter drug, warfarin, has a narrow therapeutic index (NTI) and is used in paediatrics and geriatrics. The aim of this feasibility study was to formulate the taste-masked warfarin-containing pellets to be applicable for dose personalisation and to improve patient compliance, as well as to investigate the effect of the core type (PharSQ® Spheres M, CELPHERE™ CP-507, and NaCl) on the warfarin release from the Kollicoat® Smartseal taste-masking-coated pellets. The cores were successfully drug-loaded and coated in a fluid-bed coater with a Wurster insert. An increase in particle size and particle size distribution was observed by optical microscopy. In saliva-simulated pH, at the Kollicoat® Smartseal level of 2 mg/cm2, none of the pellets demonstrated drug release, confirming their efficient taste-masking. However, in a stomach-simulated pH, a faster drug release was observed from PharSQ® Spheres M- and CELPHERE™ CP-507-coated pellets in comparison with NaCl cores. Additional experiments allowed us to explain the slower drug release from NaCl-containing pellets because of the salting-out effect. Despite the successful taste masking, the drug release from pellets was relatively slow (not more than 91% per 60 min), allowing for further formulation improvements.
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Affiliation(s)
| | | | | | - Valentyn Mohylyuk
- Laboratory of Finished Dosage Forms, Faculty of Pharmacy, Riga Stradiņš University, LV-1007 Riga, Latvia
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Harnett A, Byrne S, O’Connor J, Burke E, South L, Lyons D, Sahm LJ. Point Prevalence Survey of Acute Hospital Patients with Difficulty Swallowing Solid Oral Dose Forms. Pharmaceutics 2024; 16:584. [PMID: 38794246 PMCID: PMC11125361 DOI: 10.3390/pharmaceutics16050584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024] Open
Abstract
The safe administration of solid oral dose forms in hospital inpatients with swallowing difficulties is challenging. The aim of this study was to establish the prevalence of difficulties in swallowing solid oral dose forms in acute hospital inpatients. A point prevalence study was completed at three time points. The following data were collected: the prevalence of swallowing difficulties, methods used to modify solid oral dose forms to facilitate administration, the appropriateness of the modification, and patient co-morbidities. The prevalence of acute hospital inpatients with swallowing difficulties was an average of 15.4% with a 95% CI [13.4, 17.6] across the three studies. On average, 9.6% of patients with swallowing difficulties had no enteral feeding tube in situ, with 6.0% of these patients receiving at least one modified medicine. The most common method of solid oral dose form modification was crushing, with an administration error rate of approximately 14.4%. The most common co-morbid condition in these patients was hypertension, with dysphagia appearing on the problem list of two (5.5%) acute hospital inpatients with swallowing difficulties. Inappropriate modifications to solid oral dose forms to facilitate administration can result in patient harm. A proactive approach, such as the use of a screening tool to identify acute hospital inpatients with swallowing difficulties, is required, to mitigate the risk of inappropriate modifications to medicines to overcome swallowing difficulties.
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Affiliation(s)
- Anne Harnett
- University Hospital Limerick, Dooradoyle, V94 F858 Limerick, Ireland; (L.S.); (D.L.)
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 YN60 Cork, Ireland; (S.B.); (J.O.); (E.B.)
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 YN60 Cork, Ireland; (S.B.); (J.O.); (E.B.)
| | - Jennifer O’Connor
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 YN60 Cork, Ireland; (S.B.); (J.O.); (E.B.)
| | - Eimear Burke
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 YN60 Cork, Ireland; (S.B.); (J.O.); (E.B.)
| | - Laura South
- University Hospital Limerick, Dooradoyle, V94 F858 Limerick, Ireland; (L.S.); (D.L.)
| | - Declan Lyons
- University Hospital Limerick, Dooradoyle, V94 F858 Limerick, Ireland; (L.S.); (D.L.)
| | - Laura J. Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 YN60 Cork, Ireland; (S.B.); (J.O.); (E.B.)
- Pharmacy Department, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
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21
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Davies V, Taylor M. Nutritional and hydration interventions for people with dysphagia. Nurs Stand 2024; 39:77-81. [PMID: 38544435 DOI: 10.7748/ns.2024.e12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
Dysphagia (swallowing difficulties) is particularly common in older people and is associated with various health conditions. Dysphagia affects an individual's ability to eat and drink, and can have a significant effect on their clinical outcomes and quality of life. This article explores ways in which nurses can support people with dysphagia to minimise the effects of the condition and enhance their quality of life. The authors examine the role of commonly used strategies such as dietary texture modification and thickened fluids that aim to optimise nutrition and hydration. However, some of the management options for dysphagia do not have a strong evidence base, so nurses should consider whether any dietary restrictions are proportionate and ensure that their benefits outweigh the risks.
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Affiliation(s)
- Vicky Davies
- Faculty of Social and Life Sciences, Wrexham University, Wrexham, Wales
| | - Melanie Taylor
- The Walton Centre NHS Foundation Trust, Liverpool, England
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22
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Tsai YT, Fang KH, Chen WC, De Vito A, Liao CT, Kang CJ, Hsu CM, Huang EI, Tsai MS, Chang GH, Lee YC, Lai CH. Survival-weighted quality of life profiles in patients treated for laryngeal and hypopharyngeal cancers. J Cancer 2024; 15:1805-1815. [PMID: 38434970 PMCID: PMC10905404 DOI: 10.7150/jca.92400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024] Open
Abstract
Objectives: This study assessed functional outcomes and quality of life (QoL) in the long term in individuals treated for laryngohypopharyngeal cancer (LHC) by estimating their life expectancy (LE), survival-weighted psychometric scores (SWPSs), and quality-adjusted LE (QALE). Materials and methods: To estimate survival outcomes, we retrospectively reviewed the data of 1576 patients treated for primary LHC between January 2010 and December 2018 and followed them until death or December 2020. We also prospectively collected QoL and functional data between October 2013 and November 2022 from 232 patients by administering the Taiwanese Chinese versions of the QoL Questionnaire Core 30, Head and Neck 35, and EQ-5D-3L. To estimate LE, we employed linear extrapolation of a logit-transformed curve. We calculated QALE and SWPSs by combining the QoL data with the LE results. Results: We estimated the LE of the patients with LHC to be 7.8 years and their loss of LE to be 15.7 years. The estimated QALE was 7.0 QALYs, with a loss of QALE of 16.5 QALYs. Lifetime impairment durations were estimated for cognitive (4.9 years), physical (4.2 years), emotional (3.4 years), social (3.4 years), and role functions (2.7 years). We estimated the durations of problems related to swallowing, speech, and teeth to be 6.2, 5.6, and 4.8 years, respectively. The patients were expected to be dependent on feeding tubes for 1.2 years. Conclusions: Patients with LHC experience significant reductions in both LE and QALE. SWPSs may constitute a valuable tool for obtaining subjective information regarding how LHC affects multifaceted QoL outcomes.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ku-Hao Fang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Cheng Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Andrea De Vito
- Ear Nose Throat (ENT) Unit, Department of Surgery, Forlì Hospital Health Local Agency of Romagna, Italy
| | - Chun-Ta Liao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Jan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ethan I. Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chan Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chia-Hsuan Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
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23
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Wang Y, Zhu K, Wang N, Chen X, Cai C, Zhu Y, Shi C. Development and Validation of a Risk Prediction Model to Predict Postextubation Dysphagia in Elderly Patients After Endotracheal Intubation Under General Anesthesia: A Single-Center Cross-Sectional Study. Dysphagia 2024; 39:63-76. [PMID: 37272948 DOI: 10.1007/s00455-023-10594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
At present, the incidence and risk factors for dysphagia after extubation in elderly inpatients are still unclear, and we aimed to develop and validate a risk prediction model that prospectively identifies high-risk patients to reduce the occurrence rate of dysphagia. The 469 patients recruited were randomly divided into modeling and validation groups in a 7:3 ratio. In the modeling group, the postextubation dysphagia (PED) risk factors were analyzed, and a risk prediction model was established. In the validation group, the model was validated and evaluated. The model was constructed based on the risk factors determined by a binary logistic regression analysis. The discrimination ability of the model was evaluated by the receiver operating characteristic (ROC) curve. The calibration curve and Hosmer‒Lemeshow test were performed to evaluate the model's calibration ability. The clinical utility of the risk prediction model was analyzed by decision curve analysis (DCA). The results showed that the incidence of PED was 15.99%, and age, duration of indwelling gastric tube, difficult endotracheal intubation, atomization after extubation, anesthesia risk level and frailty assessment were identified as important risk factors. The model was validated to have favorable discrimination, calibration ability and clinical utility. It has a certain extension value and clinical applicability, providing a feasible reference for preventing the occurrence of PED.
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Affiliation(s)
- Yixin Wang
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China
| | - Kaimei Zhu
- Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Nan Wang
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China
| | - Xiangrong Chen
- General Hospital of PLA Central Theater Command, Wuhan, Hubei, China
| | - Chan Cai
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China
| | - Yuxin Zhu
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China
| | - Chongqing Shi
- Institute of Nursing Research, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, 430065, China.
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24
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Mao L, Wang J, Li Y, Zheng J, Fan D, Wei S, Wu X, Yang X, Wang D. Risk factors for dysphagia in patients with acute and chronic ischemic stroke: A retrospective cohort study. Heliyon 2024; 10:e24582. [PMID: 38304775 PMCID: PMC10830548 DOI: 10.1016/j.heliyon.2024.e24582] [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: 06/05/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
Background Dysphagia is a common and clinically significant complication of ischemic stroke. The prevalence and risk factors for dysphagia may vary at different stages following an ischemic stroke. Methods This study included patients with acute and chronic ischemic stroke who were treated at the Department of Rehabilitation, First Affiliated Hospital, Zhejiang University School of Medicine from 2019 to 2022. Various demographic, clinical, and laboratory parameters were collected, and statistical analyses were performed to investigate their association with dysphagia. Results Among the 399 ischemic stroke patients included in the study, 165 (41.4 %) experienced dysphagia, with 72 (38.7 %) in the acute phase and 93 (43.7 %) in the chronic phase. Univariate analysis revealed significant associations (p < 0.05) between dysphagia and factors such as pulmonary infection, aphasia, NIHSS score, ADL score, NLR score, lower extremity Brunnstrom's stages, and sit-to-stand balance. Multiple logistic regression analysis, after adjusting for confounding factors, identified the ADL score as an independent predictor of dysphagia. These findings were consistent across three time-windows: the acute phase, the chronic phase, and 180 days after stroke onset. Additionally, the lymphocyte count and pulmonary infection were identified as potential independent indicators. Conclusions This study investigated the prevalence and risk factors for dysphagia in ischemic stroke patients at different time-windows. A low ADL score (<40) may serve as a valuable and reliable predictor for poststroke dysphagia in clinical settings.
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Affiliation(s)
- Lin Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Juehan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yubo Li
- Information and Electronic Engineering College, Zhejiang University School, Hangzhou, China
| | - JinJin Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Denghuang Fan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Wei
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaohong Wu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofeng Yang
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Daming Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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25
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Lee DS, Kim HE, Choi JS. Oral Health-Related Factors Associated with Dysphagia Risk among Older, Healthy, Community-Dwelling Korean Adults: A Pilot Study. Healthcare (Basel) 2024; 12:267. [PMID: 38275546 PMCID: PMC10815140 DOI: 10.3390/healthcare12020267] [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: 12/24/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Most previous studies addressing dysphagia examined individuals who already had diseases causing dysphagia and did not pay much attention to oral health conditions as a risk factor. This pilot study investigated 62 healthy adults aged 65 years or older who were living independently in the community, performed basic activities of daily living independently, and had no history of a causative disease of dysphagia to identify the factors associated with dysphagia risk, especially oral health. The Dysphagia Risk Assessment Scale was used to screen the patients for dysphagia. Hyposalivation was diagnosed by evaluating the unstimulated salivary flow rate, and orofacial muscle strength (anterior tongue elevation, buccinator muscle, and lip strength) was quantitatively measured using the Iowa Oral Performance Instrument. To analyze the factors associated with dysphagia risk, the Mann-Whitney test, Kruskal-Wallis test, and multiple logistic regression analyses were conducted. In the final regression model adjusted for sociodemographic characteristics, the oral health-related factors independently associated with dysphagia risk were buccinator muscle strength, hyposalivation, and subjective masticatory discomfort (p < 0.05). Therefore, our findings suggest that weak buccinator muscle strength, hyposalivation, and subjective masticatory discomfort are valuable indicators for the early detection of dysphagia in older, healthy, independent, community-dwelling adults.
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Affiliation(s)
- Da-Som Lee
- Department of Dental Hygiene, Graduate School, Gachon University, Incheon 21936, Republic of Korea;
| | - Hee-Eun Kim
- Department of Dental Hygiene, College of Medical Science, Gachon University, Incheon 21936, Republic of Korea;
| | - Jun-Seon Choi
- Department of Dental Hygiene, College of Medical Science, Gachon University, Incheon 21936, Republic of Korea;
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26
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Crepeau PK, Sutton W, Sahli Z, Fedorova T, Russell JO, Zeiger MA, Bandeen-Roche K, Walston JD, Morris-Wiseman LF, Mathur A. Prevalence and risk factors for dysphagia in older adults after thyroid and parathyroid surgery. Surgery 2024; 175:99-106. [PMID: 37945476 PMCID: PMC10841879 DOI: 10.1016/j.surg.2023.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/03/2023] [Accepted: 04/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND We aimed to determine the prevalence and risk factors for dysphagia in adults 65 years and older before and after thyroidectomy or parathyroidectomy. METHODS We performed a longitudinal prospective cohort study of older adults undergoing initial thyroidectomy or parathyroidectomy. We administered the Dysphagia Handicap Index questionnaire preoperatively and 1, 3, and 6 months postoperatively. We compared preoperative and postoperative total and domain-specific scores using paired t tests and identified risk factors for worse postoperative scores using multivariable logistic regression. RESULTS Of the 175 patients evaluated, the mean age was 71.1 years (range = 65-94), 73.7% were female, 40.6% underwent thyroidectomy, 57% underwent bilateral procedures, and 21.1% had malignant diagnoses. Preoperative swallowing dysfunction was reported by 77.7%, with the prevalence 22.4% greater in frail than robust patients (P = .013). Compared to preoperative scores, 43.4% and 49.1% had worse scores at 3 and 6 months postoperatively. Mean functional domain scores increased by 62.3% at 3 months postoperatively (P = .007). Preoperative swallowing dysfunction was associated with a 3.07-fold increased likelihood of worse functional scores at 3 months. Whereas frailty was associated with preoperative dysphagia, there was no association between worse postoperative score and age, sex, race, frailty, body mass index, smoking status, gastroesophageal reflux disease, comorbidity index, malignancy, surgical extent, or type of surgery. CONCLUSION Adults 65 years and older commonly report swallowing impairment preoperatively, which is associated with a 3.07-fold increased likelihood of worsened dysphagia after thyroid and parathyroid surgery that may persist up to 6 months postoperatively.
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Affiliation(s)
- Philip K Crepeau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Whitney Sutton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zeyad Sahli
- Department of Surgery, The University of Virginia Health System, Charlottesville, VA
| | - Tatiana Fedorova
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martha A Zeiger
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Karen Bandeen-Roche
- Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeremy D Walston
- Johns Hopkins Older Americans Independence Center and the Center on Aging and Health, Johns Hopkins University, Baltimore, MD; Division of Geriatrics and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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27
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Dyreborg L, Raunbak SM, Sørensen SS, Melgaard D, Westmark S. The Cost-Effectiveness of Chin Tuck Against Resistance Compared to Usual Care in Citizens with Oropharyngeal Dysphagia - An Economic Evaluation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:787-797. [PMID: 38143783 PMCID: PMC10749109 DOI: 10.2147/ceor.s431380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose This study aims to evaluate the cost-effectiveness of chin tuck against resistance (CTAR) for citizens suffering from dysphagia compared to the standard municipal treatment in Denmark. Patients and Methods A cost-utility analysis, employing a municipal perspective, was conducted using cost data collected alongside clinical data of a randomized controlled trial evaluating the effect of CTAR training for citizens with dysphagia. The composition of the clinical randomized controlled trial, which included citizens with different diagnoses, means that participants had different disease courses. Ninety-two citizens from seven different Danish municipalities were enrolled, of whom 43 received standard care, and 49 received CTAR in addition to standard care. The effect outcome of the economic evaluation was quality-adjusted life years (QALY), estimated using the EQ-5D-5L questionnaire. Individual resource consumption of each citizen was determined based on the use of home care, home nursing care, physio- and occupational therapy, dietitian guidance, and hospital admissions. The incremental costs and QALYs between the intervention group (CTAR in addition to standard care) and standard care group were estimated using regression analysis, and sensitivity analyses were performed to investigate the robustness of the results. Results The base case analysis showed that the intervention group was dominant compared to the standard care group, with a decrease in incremental costs of £542.38 and an increase in incremental QALYs of 0.0118. All sensitivity analyses demonstrated similar findings as the base case analysis, supporting the robustness of the results. Conclusion This study found that the intervention group was the dominant alternative, hence being more effective and cost-saving, compared to the standard care group in a Danish municipality perspective with a three-month time horizon. This study adds to the scarce evidence on the cost-effectiveness of CTAR in a Danish clinical setting, but further studies should focus on estimating long-term cost-effectiveness.
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Affiliation(s)
- Line Dyreborg
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Sabine Michelsen Raunbak
- Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Sabrina Storgaard Sørensen
- Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Dorte Melgaard
- North Denmark Regional Hospital, Hjørring, Denmark
- Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Mech-sense, Aalborg University Hospital, Aalborg, Denmark
| | - Signe Westmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
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28
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Shimizu A, Ohno T, Fujishima I, Kayashita J, Momosaki R, Nishioka S, Wakabayashi H. Impact of Poor Oral Health Status on Swallowing Function Improvement in Older Dysphagic Patients. Cureus 2023; 15:e51249. [PMID: 38288242 PMCID: PMC10823192 DOI: 10.7759/cureus.51249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
Background This study aimed to explore the relationship between poor oral health status and improvement in swallowing function in older patients with dysphagia across various clinical settings, including acute and post-acute care environments. Methods This retrospective cohort study encompassed patients aged 65 years and older with dysphagia. Oral health status was assessed using the oral health assessment tool (OHAT) or the revised oral assessment guide (ROAG). In this study, an OHAT score of ≥3 or an ROAG score of ≥13 indicated poor oral health status. The primary outcome measured was the change in the food intake level scale (FILS) score, which reflects swallowing function, during the observation period. The association between changes in FILS score and poor oral health status was analyzed using a multivariable linear regression model. Results The study included 361 older patients with dysphagia (mean age 82.7 ± 7.7 years; 47.3% male), of whom 82.5% had poor oral health. A negative association was found between poor oral health status and improvement in FILS score at the endpoint (partial regression coefficient: -0.523, 95% confidence interval: -0.99 to -0.06, P=0.026). Conclusions Our findings underscore the negative impact of poor oral health status on the improvement of swallowing function and emphasize the importance of oral health interventions for older patients. Further study on oral health interventions' effects on improving swallowing function in older patients with dysphagia is warranted.
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Affiliation(s)
- Akio Shimizu
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, JPN
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, JPN
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, JPN
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, JPN
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Shinjuku-ku, JPN
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29
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Wang J, Kumar P, Engelmann C. Comprehensive insights into the multifaceted roles of the transient receptor potential vanilloid 1 channel in the digestive system. Life Sci 2023; 334:122207. [PMID: 37883862 DOI: 10.1016/j.lfs.2023.122207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
The transient receptor potential vanilloid (TRPV) channel, a family of calcium transporters comprising six distinct members (TRPV1-6), takes on a paramount role in maintaining intracellular Ca2+ homeostasis in mammalian cells. Notably, TRPV1, among its counterparts, has emerged as the subject of extensive scrutiny, owing to its pervasive presence in diverse cellular, tissue, and organ settings. This ubiquitous distribution underscores its fundamental involvement in the genesis of pain, making it a central focus in pain-related research. However, recent investigations have unveiled that TRPV1's functional significance transcends the realm of pain modulation, extending its influence to encompass a wide spectrum of physiological and pathological processes. The ambit of TRPV1's influence encompasses not only pain responses but also embraces the intricate domains of nervous system disorders, cancer metastasis, as well as afflictions pertaining to the skin and heart. Moreover, compelling evidence now demonstrates that TRPV1 also wields substantial sway in the domain of digestive diseases, further highlighting its versatility and far-reaching impact on human health. Therefore, this comprehensive review endeavors to delve into the multifaceted roles played by TRPV1 in the various organs constituting the digestive system.
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Affiliation(s)
- Juan Wang
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Pavitra Kumar
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
| | - Cornelius Engelmann
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Berlin Institute of Health (BIH), 10178 Berlin, Germany.
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30
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Hsu WC, Tsai HH, Weng LC, Wang YW. The experience of eating for older nursing home residents with dysphagia: A qualitative descriptive study. Int J Older People Nurs 2023; 18:e12566. [PMID: 37583102 DOI: 10.1111/opn.12566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/17/2023] [Accepted: 07/23/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Understanding the experience of eating for nursing home residents with dysphagia is essential for developing effective and holistic compensatory intervention programmes for older adults with dysphagia. However, there is a lack of studies on the experience of eating for older adults with dysphagia, especially for individuals in Asian cultures. OBJECTIVES This study aimed to understand the experience of eating for older nursing home residents who have difficulty swallowing (dysphagia), which is often a problem for this population. METHODS This qualitative descriptive study recruited older nursing home residents with dysphagia from facilities in central Taiwan. Residents were recruited by purposive sampling. Data were collected through individual in-depth semistructured face-to-face interviews. Interviews were audio-recorded and transcribed interview data were analysed with content analysis. RESULTS A total of 20 residents participated in the study; the mean age was 78.7 years (standard deviation = 8.54 years); male and female residents were equally represented. The main core theme describing the experience of eating for nursing home residents with dysphagia was irregular coughing, which often occurred spontaneously. Three subthemes described how residents responded: making adjustments to eating and swallowing, receiving assistance from NH staff and fear of eating. CONCLUSIONS Our findings can serve as an evidence-based reference for clinical care aimed at nursing home residents with dysphagia. Support programmes that provide safe swallowing skills and emotional support for managing dysphagia are recommended. IMPLICATIONS FOR PRACTICE Nursing home residents with dysphagia should receive interventions focussed on self-supporting care, training in swallowing skills and emotional support.
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Affiliation(s)
- Wen-Ching Hsu
- Department of General Surgery, Cheng Hsin General Hospital, Taipei City, Taiwan
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Li-Cheng Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Wen Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Harnett A, Byrne S, O’Connor J, Lyons D, Sahm LJ. Adult Patients with Difficulty Swallowing Oral Dosage Forms: A Systematic Review of the Quantitative Literature. PHARMACY 2023; 11:167. [PMID: 37888511 PMCID: PMC10609855 DOI: 10.3390/pharmacy11050167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
The aim of this systematic review was to identify and critically appraise the available evidence regarding solid oral dosage forms (SODFs), e.g., tablets, and challenges regarding the oral administration of medicine to inpatients in a variety of healthcare settings such as (1) hospitals, (2) nursing homes and (3) long-term stay units (LTSUs). A literature search was undertaken in September 2021 and repeated in June 2023 in the following databases: PubMed, EMBASE, CINAHL, Scopus, Web of Science, The Cochrane Library, PsycINFO and ProQuest. A Microsoft Excel® spreadsheet was devised to collate the following data from each eligible study: study author and year, country, number of participants, title, duration (follow-up period), study design, inclusion and exclusion criteria, method and data collection, relevant outcomes, and key findings. A total of 3023 records were identified, with 12 articles being included in the final systematic review. Seven of the twelve studies reported on the prevalence of difficulties swallowing SODFs, which varied from 10-34.2%. Nine of the twelve studies reported the methods used to manipulate SODFs, with the most reported method being tablet crushing. Given the prevalence of swallowing difficulties and the subsequent crushing of medicines in response to this, it is evident that concerns should be raised regarding the potential for a medication administration error to occur.
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Affiliation(s)
- Anne Harnett
- University Hospital Limerick, V94 F858 Limerick, Ireland; (A.H.); (D.L.)
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland; (S.B.)
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland; (S.B.)
| | - Jennifer O’Connor
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland; (S.B.)
| | - Declan Lyons
- University Hospital Limerick, V94 F858 Limerick, Ireland; (A.H.); (D.L.)
| | - Laura J. Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland; (S.B.)
- Pharmacy Department, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland
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Brooks A. Dysphagia and aspiration during a Parkinson's hospitalization: a care partner's perspective and recommendations for improving standards of care. Front Aging Neurosci 2023; 15:1258979. [PMID: 37876878 PMCID: PMC10590889 DOI: 10.3389/fnagi.2023.1258979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/06/2023] [Indexed: 10/26/2023] Open
Abstract
People with Parkinson's disease have a significantly increased incidence and risk of aspiration pneumonia when compared to those without. Aspiration pneumonia associated with dysphagia (swallowing issues), which is the leading cause of death among people with Parkinson's disease, accounting for 25% of Parkinson's deaths. There is relatively limited evidence of the most effective strategies to balance the competing needs of each Parkinson's patient as providers aim to prevent, diagnose, and manage dysphagia. Exacerbated, and in part caused, by the intricacies of dysphagia and Parkinson's disease, there is still limited understanding among hospital providers and the Parkinson's community regarding the most appropriate measures to prevent and manage dysphagia in Parkinson's disease. The Parkinson's Foundation Hospital Care Recommendations identified the prevention and management of dysphagia as a care standard necessary to eliminate harm and attain higher reliability in care. This article discusses key components of dysphagia management in the hospital, provides a case example to demonstrate the challenges that people with PD and their care partners experience in the hospital related to dysphagia, and offers recommendations on how to better manage dysphagia and involve care partners in PD hospital care.
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Affiliation(s)
- Annie Brooks
- Strategic Initiatives, Parkinson's Foundation, New York, NY, United States
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Reina MA, Sala-Blanch X, Boezaart AP, Tubbs RS, Pérez-Rodríguez FJ, Riera-Pérez R, Sanromán Junquera M. The size, number, and distribution of nerve endings around and within the human epiglottis, focusing on tracheal intubation maneuvers. Clin Anat 2023; 36:1046-1063. [PMID: 37539624 DOI: 10.1002/ca.24101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023]
Abstract
The aim of this study was to examine the distribution of nerve endings in the mucosa, submucosa, and cartilage of the epiglottis and the vallecula area and to quantify them. The findings could inform the choice of laryngoscope blades for intubation procedures. Fourteen neck slices from seven unembalmed, cryopreserved human cadavers were analyzed. The slices were stained, and cross and longitudinal sections were obtained from each. The nerve endings and cartilage were identified. The primary metrics recorded were the number, area, and circumference of nerve endings located in the mucosa and submucosa of the pharyngeal and laryngeal sides of the epiglottis, epiglottis cartilage, and epiglottic vallecula zone. The length and thickness of the epiglottis and cartilage were also measured. The elastic cartilage of the epiglottis was primarily continuous; however, it contained several fragments. It was covered with dense collagen fibers and surrounded by adipose cells from the pharyngeal and laryngeal submucosa. Nerve endings were found within the submucosa of pharyngeal and laryngeal epiglottis and epiglottic vallecula. There were significantly more nerve endings on the posterior surface of the epiglottis than on the anterior surface. The epiglottic cartilage was twice the length of the epiglottis. The study demonstrated that the distribution of nerve endings in the epiglottis differed significantly between the posterior and anterior sides; there were considerably more in the former. The findings have implications for tracheal intubation and laryngoscope blade selection and design.
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Affiliation(s)
- Miguel Angel Reina
- School of Medicine, CEU-San-Pablo University, Madrid, Spain
- Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain
- Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Xavier Sala-Blanch
- Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
- Department of Anesthesiology, Hospital Clinic, Barcelona, Spain
| | - André P Boezaart
- Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Florida, USA
- Lumina Health, Surrey, UK
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Francisco José Pérez-Rodríguez
- School of Medicine, CEU-San-Pablo University, Madrid, Spain
- Department of Pathology, Madrid-Montepríncipe University Hospital, Madrid, Spain
| | | | - Margarita Sanromán Junquera
- Department of Signal Theory and Communications, Telematics, and Computing Systems, Rey Juan Carlos University, Madrid, Spain
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Kato G, Mitome H, Miyauchi Y, Takeda S, Toyota Y, Hidaka N, Tanaka M, Akira K. A study on the chemical stability of cholesterol-lowering drugs in concomitant simple suspensions with magnesium oxide. J Pharm Health Care Sci 2023; 9:32. [PMID: 37644559 PMCID: PMC10464426 DOI: 10.1186/s40780-023-00301-1] [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: 07/08/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Difficulty in taking solid medicines is a common issue particularly for the elderly because of a decline in swallowing function, also known as dysphagia. For patients with such a dysfunction, a simple suspension method, in which solid medicines are disintegrated and suspended using warm water, has been developed and widely used in Japanese clinical settings. However, there is little information on drug stability in the simple co-suspension of multiple formulations especially including acidic or alkaline ones. In this study, the chemical stability of typical cholesterol-lowering drugs was investigated in a simple co-suspension with alkaline magnesium oxide (MgO) which is frequently used as a laxative or antacid in Japan. METHODS A cholesterol-lowering drug (one tablet) was soaked with or without MgO in warm water (55°C), and the vessel was left at room temperature for 10 min or 5 h. The suspensions prepared were then analyzed by high-performance liquid chromatography. Degradation products were analyzed by nuclear magnetic resonance spectroscopy and mass spectrometry for the structural elucidation. RESULTS In the simple co-suspension with MgO, no significant degradation was observed for atorvastatin or pravastatin, while a significant decrease of the recovery from the co-suspension was observed for rosuvastatin after 5 h. On the other hand, simvastatin and ezetimibe co-suspended with MgO were partially degraded to simvastatin acid and a pyran compound, respectively. CONCLUSIONS A simple co-suspension with MgO is feasible for atorvastatin, pravastatin, and rosuvastatin, although the rosuvastatin tablet should not be left soaking for a long time. Further it is inadvisable to suspend simvastatin or ezetimibe together with MgO because of their partial degradation.
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Affiliation(s)
- Ginjiro Kato
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Hidemichi Mitome
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Yusura Miyauchi
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Syu Takeda
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Yoshito Toyota
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan
| | - Noriaki Hidaka
- Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mamoru Tanaka
- Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kazuki Akira
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-Cho, Matsuyama, Ehime, 790-8578, Japan.
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Yang LQ, Zhu L, Shi X, Miao CH, Yuan HB, Liu ZQ, Gu WD, Liu F, Hu XX, Shi DP, Duan HW, Wang CY, Weng H, Huang ZL, Li LZ, He ZZ, Li J, Hu YP, Lin L, Pan ST, Xu SH, Tang D, Sessler DI, Liu J, Irwin MG, Yu WF. Postoperative pulmonary complications in older patients undergoing elective surgery with a supraglottic airway device or tracheal intubation. Anaesthesia 2023; 78:953-962. [PMID: 37270923 DOI: 10.1111/anae.16030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 06/06/2023]
Abstract
The two most commonly used airway management techniques during general anaesthesia are supraglottic airway devices and tracheal tubes. In older patients undergoing elective non-cardiothoracic surgery under general anaesthesia with positive pressure ventilation, we hypothesised that a composite measure of in-hospital postoperative pulmonary complications would be less frequent when a supraglottic airway device was used compared with a tracheal tube. We studied patients aged ≥ 70 years in 17 clinical centres. Patients were allocated randomly to airway management with a supraglottic airway device or a tracheal tube. Between August 2016 and April 2020, 2900 patients were studied, of whom 2751 were included in the primary analysis (1387 with supraglottic airway device and 1364 with a tracheal tube). Pre-operatively, 2431 (88.4%) patients were estimated to have a postoperative pulmonary complication risk index of 1-2. Postoperative pulmonary complications, mostly coughing, occurred in 270 of 1387 patients (19.5%) allocated to a supraglottic airway device and 342 of 1364 patients (25.1%) assigned to a tracheal tube (absolute difference -5.6% (95%CI -8.7 to -2.5), risk ratio 0.78 (95%CI 0.67-0.89); p < 0.001). Among otherwise healthy older patients undergoing elective surgery under general anaesthesia with intra-operative positive pressure ventilation of their lungs, there were fewer postoperative pulmonary complications when the airway was managed with a supraglottic airway device compared with a tracheal tube.
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Affiliation(s)
- L Q Yang
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, Shanghai, China
| | - L Zhu
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, Shanghai, China
| | - X Shi
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - C H Miao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - H B Yuan
- Shanghai Changzheng Hospital, Shanghai, China
| | - Z Q Liu
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - W D Gu
- Huadong Hospital, Fudan University, Shanghai, China
| | - F Liu
- West China Hospital, Sichuan University, Chengdu, China
| | - X X Hu
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - D P Shi
- Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - H W Duan
- Shanghai Pudong Hospital Fudan University Pudong Medical Center, Shanghai, China
| | - C Y Wang
- Huangpu Branch of Ninth People's Hospital Affiliated to Medical College of Shanghai Jiao Tong University, Shanghai, China
| | - H Weng
- Shanghai Fengxian District Central Hospital, Shanghai, China
| | - Z L Huang
- Ren Ji Hospital (West) affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - L Z Li
- Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Z Z He
- Ren Ji Hospital (South) affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Li
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Y P Hu
- The Second Hospital of Wuxi affiliated to Nanjing Medical University, Wuxi, China
| | - L Lin
- The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - S T Pan
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - S H Xu
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - D Tang
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - J Liu
- West China Hospital, Sichuan University, Chengdu, China
| | - M G Irwin
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - W F Yu
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Key Laboratory of Anesthesiology (Shanghai Jiao Tong University), Ministry of Education, Shanghai, China
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Moreira VS, Chaves MLF, de Castilhos RM, Olchik MR. Caregiver burden related to feeding process in Alzheimer's disease. Dement Neuropsychol 2023; 17:e20220092. [PMID: 37533596 PMCID: PMC10392878 DOI: 10.1590/1980-5764-dn-2022-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/16/2023] [Accepted: 04/16/2023] [Indexed: 08/04/2023] Open
Abstract
Difficulties in the feeding process, such as aversive feeding behaviors and dysphagia, are common in patients with Alzheimer's disease (AD) and can often overload their caregivers. Although dysphagia is already established as a factor contributing to caregiver burden, the impact of aversive behaviors is less studied. Objectives Evaluate the relationship between the feeding process in individuals with AD and their caregiver's burden. Methods Dyads of individuals with AD and their caregivers were recruited for a cross-sectional study. The Edinburgh Feeding Evaluation in Dementia (EdFED) scale, the Zarit Burden Interview (ZBI), the mini-mental state examination (MMSE), the Functional Activities Questionnaire (FAQ), and the Functional Oral Intake scale (FOIS) were performed. Results We included 60 AD individuals-caregivers dyads. The median (IQR) age of caregivers was 57 (19-81) years, and the most were females (70%). The individuals with AD had a median MMSE of 12 (6-15), and the disease duration was 4 (2-6) years. The mean (SD) Zarit score was 20.95 (6.51). In the multivariate linear regression, the EdFED score (95% CI 0.368-1.465) and time as a caregiver (95% CI 0.133-1.355) were associated with the caregiver's burden. Conclusions Aversive behaviors were associated with the caregiver burden of individuals with AD, even with a short duration of the disease. These findings show the importance of education for caregivers regarding the feeding process, as these measures have great potential to minimize the caregiver's burden.
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Affiliation(s)
- Verônica Salazar Moreira
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina, Ciências Médicas, Porto Alegre RS, Brazil
| | - Márcia Lorena Fagundes Chaves
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina, Ciências Médicas, Porto Alegre RS, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Medicina Interna, Porto Alegre RS, Brazil
| | - Raphael Machado de Castilhos
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina, Ciências Médicas, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
| | - Maira Rozenfeld Olchik
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Medicina, Ciências Médicas, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Curso de Fonoaudiologia, Departamento de Cirurgia e Ortopedia, Porto Alegre RS, Brazil
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Salave S, Patel P, Desai N, Rana D, Benival D, Khunt D, Thanawuth K, Prajapati BG, Sriamornsak P. Recent advances in dosage form design for the elderly: a review. Expert Opin Drug Deliv 2023; 20:1553-1571. [PMID: 37978899 DOI: 10.1080/17425247.2023.2286368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/17/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION With the increase in the elderly population and the prevalence of multiple medical conditions, medication adherence, and efficacy have become crucial for the effective management of their health. The aging population faces unique challenges that need to be addressed through advancements in drug delivery systems and formulation technologies. AREAS COVERED The current review highlights the recent advances in dosage form design for older individuals, with consideration of their specific physiological and cognitive changes. Various dosage forms, such as modified-release tablets/capsules, chewable tablets, and transdermal patches, can be tailored to meet the specific needs of elderly patients. Advancements in drug delivery systems, such as nanotherapeutics, additive manufacturing (three-dimensional printing), and drug-food combinations, improve drug delivery and efficacy and overcome challenges, such as dysphagia and medication adherence. EXPERT OPINION Regulatory guidelines and considerations are crucial in ensuring the safe utilization of medications among older adults. Important factors to consider include geriatric-specific guidelines, safety considerations, labeling requirements, clinical trial considerations, and adherence and accessibility considerations.
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Affiliation(s)
- Sagar Salave
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Pranav Patel
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Nimeet Desai
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, India
| | - Dhwani Rana
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Derajram Benival
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, India
| | - Dignesh Khunt
- Graduate School of Pharmacy, Gujarat Technological University, Gandhinagar, Gujarat, India
| | | | - Bhupendra G Prajapati
- Shree S. K. Patel College of Pharmaceutical Education and Research, Ganpat University, Mehsana, India
| | - Pornsak Sriamornsak
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
- Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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Jiang W, Zou Y, Huang L, Zeng Y, Xiao LD, Chen Q, Zhang F. Gustatory stimulus interventions for older adults with dysphagia: a scoping review. Aging Clin Exp Res 2023:10.1007/s40520-023-02437-4. [PMID: 37209267 DOI: 10.1007/s40520-023-02437-4] [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: 12/07/2022] [Accepted: 05/07/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Gustatory stimulus interventions have been shown to improve swallowing function in older adults with dysphagia. However, the optimal intervention strategies as well as their effects and safety remain unclear. AIMS To explore current evidence regarding gustatory stimulus interventions for dysphagia in older adults. METHODS Nine electronic databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Sinomed) were searched from their inception to August 2022. RESULTS This review identified 263 articles, and 15 met the inclusion criteria. The types of gustatory stimulus interventions included spicy (n = 10), sour (n = 3), and mixed (sour-sweet) stimuli (n = 2), with most studies focusing on spicy stimuli. The most frequently reported spicy stimulus was capsaicin. Further, the most commonly reported intervention frequency was thrice a day before meals for 1-4 weeks. The stimuli concentrations and dosages could not be standardized due to the among-study heterogeneity. These studies reported 16 assessment tools and 42 outcomes, which mainly included videofluoroscopy and swallowing response time respectively. More than half of the included studies reported no adverse effects of gustatory stimulus interventions. CONCLUSION AND DISCUSSIONS Gustatory stimulus interventions improved swallowing function in older adults with dysphagia. However, assessment tools and outcomes for dysphagia should be standardized in the future, and explore personalized interventions based on different diseases and their stages, to determine the most cost-effective interventions, and to prevent its complications.
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Affiliation(s)
- Wenyi Jiang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Ying Zou
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Lei Huang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Yanli Zeng
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lily Dongxia Xiao
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Qian Chen
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Fengying Zhang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
- Nursing Key Laboratory of Sichuan Province, Chengdu, China.
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China.
- West China Hospital, Sichuan University, Chengdu, China.
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Feng HY, Zhang PP, Wang XW. Presbyphagia: Dysphagia in the elderly. World J Clin Cases 2023; 11:2363-2373. [PMID: 37123321 PMCID: PMC10131003 DOI: 10.12998/wjcc.v11.i11.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
Dysphagia has been classified as a “geriatric syndrome” and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide. A characteristic age-related change in swallowing is defined as “presbyphagia.” Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing. However, there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging. Our review provides an overview of presbyphagia, which has been a neglected health problem for a long time. Attention and awareness of dysphagia in the elderly population should be strengthened, and targeted intervention measures should be actively implemented.
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Affiliation(s)
- Hai-Yang Feng
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Ping-Ping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Weifang Medical University, Weifang 261021, Shandong Province, China
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Grossi E, Rocco C, Stilo L, Guarneri B, Inzitari M, Bellelli G, Gentile S, Morandi A. Dysphagia in older patients admitted to a rehabilitation setting after an acute hospitalization: the role of delirium. Eur Geriatr Med 2023:10.1007/s41999-023-00773-2. [PMID: 37052832 DOI: 10.1007/s41999-023-00773-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/22/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Dysphagia is a swallowing disorder that affects 8% of the world population. However, data are lacking on its prevalence in a heterogeneous group of older patients. The aim of this study is to evaluate the prevalence of dysphagia at admission and at discharge, and its related factors, in particular delirium, in older patients admitted to a rehabilitation setting. METHODS Retrospective cohort study of patients 65 years and older admitted to a rehabilitation ward after an acute hospitalization. The presence of dysphagia at admission was screened with the 3OZ Test and confirmed by a speech-therapist. The association between clinical factors and dysphagia was investigated with a multivariate logistic regression analysis. RESULTS We included 1040 patients, (65% females, mean age 81.9 ± 7.2 years). The prevalence of dysphagia at admission was 14.8% and 12.8% at discharge, while the prevalence of delirium among patients with dysphagia was of 31.2% vs 6.4% among patients without dysphagia. The severity of dysphagia was moderate. In the multivariate logistic regression, delirium was associated with dysphagia at admission (OR 2.06; Confidence Interval, CI 1.08-3.23) along with a pre-hospital impairment in the Instrumental-Activities-of-Daily-Living (OR-1.26; CI - 1.1; - 1.10), a change in Barthel Index from pre-hospital to hospital admission (OR-1.02; CI - 1.01 to 1.04), comorbidity (OR 1.12; CI 0.94;1.29) and the number of antibiotics (OR-1.63; CI - 1.01;2.62). CONCLUSION Delirium was the main factor associated with dysphagia at rehabilitation admission. The study underlines the importance of screening dysphagia in delirious patients and warrants future studies to determine the changes in dysphagia prevalence according to delirium resolution.
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Affiliation(s)
- Eleonora Grossi
- Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy
| | - Chiara Rocco
- Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy
| | - Leone Stilo
- Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy
| | - Barbara Guarneri
- Department of Rehabilitation, Fondazione Camplani Casa di Cura "Ancelle della Carità", Cremona, Italy
| | - Marco Inzitari
- REFiT Bcn Research Group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca and Acute Geriatric Unit IRCCS Foundation San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Simona Gentile
- Intermediate Care and Rehabilitation Unit, Azienda Speciale "Cremona Solidale", Via Zocco 21, 26100, Cremona, Italy
| | - Alessandro Morandi
- Intermediate Care and Rehabilitation Unit, Azienda Speciale "Cremona Solidale", Via Zocco 21, 26100, Cremona, Italy.
- REFiT Bcn Research Group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain.
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Cole CL, Yu VX, Perry S, Seenauth A, Lumpkin EA, Troche MS, Pitman MJ, Moayedi Y. Healthy Human Laryngopharyngeal Sensory Innervation Density Correlates with Age. Laryngoscope 2023; 133:773-784. [PMID: 35841384 DOI: 10.1002/lary.30287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Somatosensory feedback from upper airway structures is essential for swallowing and airway defense but little is known about the identities and distributions of human upper airway neurons. Furthermore, whether sensory innervation modifies with aging is unknown. In this study, we quantify neuronal and chemosensory cell density in upper airway structures and correlate with age. METHODS Participants underwent biopsies from base of tongue, lateral and midline pharyngeal wall, epiglottis, and arytenoids (N = 25 13 female/12 male; 20-80 years, mean 51.4 years without clinical diagnosis of dysphagia or clinical indication for biopsy). Tissue sections were labeled with antibodies for all neurons, myelinated neurons, and chemosensory cells. Densities of lamina propria innervation, epithelial innervation, solitary chemosensory cells, and taste buds were calculated and correlated with age. RESULTS Arytenoid had the highest density of innervation and chemosensory cells across all measures compared to other sites. Taste buds were frequently observed in arytenoid and epiglottis. Base of tongue, lateral pharynx, and midline posterior pharynx had minimal innervation and few chemosensory cells. Epithelial innervation was present primarily in close proximity to chemosensory cells and taste buds. Overall innervation and myelinated fibers in the arytenoid lamina propria decline with aging. CONCLUSION Findings establish the architecture of healthy adult sensory innervation and demonstrate the varied distribution of laryngopharyngeal innervation, necessary steps toward understanding the sensory basis for swallowing and airway defense. We also document age-related decline in arytenoid innervation density. These findings suggest that sensory afferent denervation of the upper airway may be a contributing factor to presbyphagia. LEVEL OF EVIDENCE NA Laryngoscope, 133:773-784, 2023.
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Affiliation(s)
- Caroline L Cole
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Victoria X Yu
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York, New York, USA
| | - Sarah Perry
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA.,Department of Medicine, University of Otago, Christchurch, New Zealand.,The University of Canterbury Rose Center for Stroke Recovery & Research at St. George's Medical Center, Christchurch, New Zealand
| | - Anisa Seenauth
- Department of Neurology, Columbia University, New York, New York, USA
| | - Ellen A Lumpkin
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Michael J Pitman
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York, New York, USA
| | - Yalda Moayedi
- Department of Otolaryngology-Head & Neck Surgery, Columbia University, New York, New York, USA.,Department of Neurology, Columbia University, New York, New York, USA.,Department of Physiology and Cellular Biophysics, Columbia University, New York, New York, USA
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Alentado VJ, Bisson EF, Potts EA. Dysphagia after cervical spine surgery: a review of risk factors and preventative measures. J Neurosurg Spine 2023; 38:382-388. [PMID: 36681963 DOI: 10.3171/2022.11.spine221247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
Dysphagia is a regular occurrence after cervical spine surgery, and the development of dysphagia postoperatively is associated with worsened quality of life for patients. Despite the frequency and negative implications of this adverse outcome, there is no clear consensus for defining dysphagia within the spinal literature. Numerous patient-reported outcomes questionnaires are currently used to elucidate the presence and severity of postoperative dysphagia, several of which are not validated instruments. This variability in reporting creates difficulty when trying to determine the prevalence of dysphagia and any potential mitigating factors. In the current review, the authors discuss the causes of postoperative dysphagia after cervical spine surgery, metrics for evaluating postoperative dysphagia, risk factors for the development of this adverse outcome, and strategies for preventing its development. Readers will be able to use this information to improve patient outcomes after cervical spine surgery.
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Affiliation(s)
- Vincent J Alentado
- 1Department of Neurosurgery, Indiana University, Indianapolis, Indiana
- 2Goodman Campbell Brain and Spine, Carmel, Indiana
| | - Erica F Bisson
- 3Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and
| | - Eric A Potts
- 2Goodman Campbell Brain and Spine, Carmel, Indiana
- 4St. Vincent Health, Indianapolis, Indiana
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Dehydration and hospital-associated disability in acute hospitalized older adults. Eur Geriatr Med 2023; 14:113-121. [PMID: 36445641 DOI: 10.1007/s41999-022-00722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Dehydration is highly prevalent in hospitalized older adults and has been linked to poor outcomes. It is considered a modifiable factor, so early identification and intervention may avoid adverse events and improve quality of life after discharge. Hospital-associated disability (HAD) is known to be a poor prognostic factor and can be categorized into mobility impairment and self-care impairment in setting goals for management. Few studies have directly examined the association between dehydration and HAD and therefore here we examined whether dehydration is a predictor of HAD categorized into mobility and self-care impairment among acute hospitalized older adults. METHODS Patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital were recruited for this prospective cohort study. Estimated serum osmolarity > 300 mOsm/kg was defined as current dehydration. HAD was assessed between baseline and discharge and at 3 months after discharge, and was evaluated separately for mobility and self-care impairments. RESULTS In total, 192 patients (mean age, 84.7 years; male, 41.1%; dehydration, 31.3%) were analyzed. The occurrence of HAD was significantly higher in the dehydrated group than in the non-dehydrated group (42.4% vs 26.5%) from baseline to 3 months after discharge. In multiple logistic regression analysis, dehydration was significantly associated with HAD in self-care from baseline to 3 months after discharge (odds ratio, 2.25; 95% confidence interval, 1.03-4.94). CONCLUSIONS Dehydration could predict the occurrence of HAD in acute hospitalized older adults. A multifaceted approach may be necessary to improve the management of dehydration in these patients.
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Robison R, (Focht) Garand KL, Affoo R, Yeh CK, Chin N, McArthur C, Pulia M, Rogus-Pulia N. New horizons in understanding oral health and swallowing function within the context of frailty. Age Ageing 2023; 52:afac276. [PMID: 36735843 PMCID: PMC9897303 DOI: 10.1093/ageing/afac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/15/2022] [Indexed: 02/05/2023] Open
Abstract
Frailty is a complex and multidimensional condition wherein declines in physiologic reserve and function place individuals in a state of heightened vulnerability and decreased resiliency. There has been growing interest in both research and clinical settings to understand how to best define, assess and characterise frailty in older adults. To this end, various models and clinical assessment tools have been used to define and measure frailty. While differences exist among these models and tools, a common unifying theme is a focus on physical function and activity. Notably absent across many available conceptual models and clinical tools are items directly related to oral and swallowing function. This is an important oversight as widespread changes to both oral and swallowing function are evident in older adults. Indeed, emerging evidence suggests many of the functional domains affected in frail older adults, such as nutrition and sarcopenia, have cyclical relationships with impairments in oral (oral hypofunction) and swallowing function (dysphagia) as well. The increasing appreciation for the interrelationships among oral hypofunction, dysphagia and frailty provides an opportunity for refinement of frailty assessment and characterisation in older adults to incorporate metrics specific to oral and swallowing function.
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Affiliation(s)
- Raele Robison
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Kendrea L (Focht) Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL 36688, USA
| | - Rebecca Affoo
- School of Communication Sciences and Disorders, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Chih-Ko Yeh
- Geriatric Research, Education and Clinical Center (GRECC), South Texas Veterans Health Care System (STVHCS), San Antonio, TX 78229, USA
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio (UTHSA), San Antonio, TX 78229, USA
| | - Nathaniel Chin
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Caitlin McArthur
- School of Physiotherapy, Faculty Health, Dalhousie University, Halifax, NS
| | - Michael Pulia
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI 53703, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53726, USA
- Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI 53705, USA
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Nakagawa K, Yoshimi K, Yoshizawa A, Aritaki K, Yamaguchi K, Nakane A, Tohara H. The Safety of Oral Rehydration Solution Jelly for Water and Electrolyte Intake in Patients with Dysphagia. Ther Clin Risk Manag 2023; 19:219-227. [PMID: 36923730 PMCID: PMC10010143 DOI: 10.2147/tcrm.s398281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/05/2023] [Indexed: 03/11/2023] Open
Abstract
Purpose Oral rehydration solutions (ORSs) are effective in replacing fluids and electrolytes and are widely used. OS-1 Jelly (Otsuka Pharmaceutical Factory, Tokushima, Japan) is a jelly drink corresponding to code 2-1 of the 2021 Japanese Dysphagia Diet. Although jelly drinks are less likely to be aspirated than liquids, their physical properties vary depending on the product. Therefore, the severity of dysphagia may affect intake status. This study aimed to investigate the association between the intake status of ORS jelly and swallowing function. Patients and Methods Thirty-six patients with dysphagia who required videoendoscopic swallowing evaluation at our university hospital were enrolled. Videoendoscopic swallowing evaluation was performed, and each participant swallowed 5 mL of OS-1 Jelly or thickened water modified to International Dysphagia Diet Standardization Initiative (IDDSI) level 2 three times. Statistical analysis was performed to determine the difference in the number of swallows, time until the swallowing reflex, position for inducing the swallowing reflex, presence of pharyngeal residue, penetration, or aspiration between ORS jelly and thickened water. Results The time until the swallowing reflex was induced and the position of the swallowing reflex triggered were significantly earlier for ORS jelly (p=0.012, p=0.001). The incidence of pharyngeal residue was significantly lower with ORS jelly (p=0.002). The Penetration-Aspiration Scale score was similar for both samples (p=0.062), and no aspiration was observed in either sample. Conclusion Patients with dysphagia who can swallow thickened water modified to IDDSI level 2 can consume ORS jelly. ORS jelly, which requires no thickening and can be easily and safely consumed, is effective for water and electrolyte intake in patients with dysphagia.
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Affiliation(s)
- Kazuharu Nakagawa
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanako Yoshimi
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akira Yoshizawa
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kota Aritaki
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Yamaguchi
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Nakane
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruka Tohara
- Department of Dysphagia Rehabilitation, Division of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Sella‐Weiss O. The Test of Mastication and Swallowing Solids and the Timed Water Swallow Test: Reliability, associations, age and gender effects, and normative data. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:67-81. [PMID: 36036753 PMCID: PMC10087873 DOI: 10.1111/1460-6984.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Quantitative measures can increase precision in describing swallowing function, improve interrater and test-retest reliability, and advance clinical decision-making. The Test of Mastication and Swallowing Solids (TOMASS) and the Timed Water Swallow Test (TWST) are functional tests for swallowing that provide quantitative results. AIMS To explore the relationship between TOMASS and TWST; evaluate test-retest and interrater reliability; explore age and gender effects; and gather normative data. METHODS & PROCEDURES Healthy community dwelling participants (n = 298, ≥ 20 years old) were recruited. Of those, 126 were included in the reliability study. Participants completed the TWST and TOMASS. OUTCOMES & RESULTS Associations between TWST and TOMASS measures were found using Pearson's correlation coefficient. Age was positively associated with an increase in the number of bites (n = 292, r = 0.15, p = 0.009), masticatory cycles (n = 291, r = 0.33, p < 0.0001) and duration (n = 292, r = 0.32, p < 0.0001) for the TOMASS. For the TWST, age was positively associated with an increase in duration (n = 296, r = 0.23, p < 0.0001), and negatively associated with volume (n = 296, r = -0.205, p < 0.0001), and swallowing capacity (n = 296, r = -0.24, p < 0.0001). Females required more bites, masticatory cycles, swallows and longer time than males in TOMASS. In TWST, females required more swallows, longer time, and had lower volume per swallow and reduced swallowing capacity than males. Intraclass correlation coefficient (ICC) revealed good test-retest reliability and moderate to excellent interrater reliability. CONCLUSIONS & IMPLICATIONS This study provides support for the validity of the TOMASS and TWST. Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Extended chewing time and increased number of masticatory cycles might be compensatory behaviours for reduced oral processing abilities that are motor, sensory and/or mechanical. WHAT THIS PAPER ADDS The TOMASS and TWST are functional tests of swallowing that provide quantitative results. They are easy to incorporate as part of the clinical evaluation of swallowing due to low cost and quick administration. Age and gender effects were found for the TWST and TOMASS, but they were only tested on relative measures rather than absolute measures. Different types of crackers used for TOMASS led to differences in performance and in normative values. What is already known on the subject Associations between performance during TWST and TOMASS were found: time, number of swallows and time per swallow were correlated, meaning that need for more time and more swallows is reflected in both drinking and chewing. The study provides further support for age and gender effects in TWST and TOMASS, on both relative and also on absolute measures, which were not investigated previously. Longer durations in TOMASS and TWST with an increase in age, are likely to be the result of compensatory behaviours to allow safe swallowing. Normative data for a country-specific cracker are presented (Israel). What are the potential or actual clinical implications of this work? Reduced efficiency in one of the tests might indicate a need to evaluate performance in the other. Establishing country specific norms for commonly available crackers is necessary, since crackers size and ingredients, such as fat content and moisture, influence chewing and swallowing. There is a balancing act between safety and efficiency in older adults' swallowing behaviour. Reducing pace in eating and drinking probably supports safer swallowing.
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Affiliation(s)
- Oshrat Sella‐Weiss
- Department of Communication Sciences and DisordersUniversity of HaifaHaifaIsrael
- Department of Communication DisordersOno Academic CollageKiryat OnoIsrael
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Huang P, Hsu YC, Li CH, Hsieh SW, Lee KW, Wu KH, Chen WC, Lin CW, Chen CH. Videofluoroscopy dysphagia severity scale is predictive of subsequent remote pneumonia in dysphagia patients. Int J Med Sci 2023; 20:429-436. [PMID: 36860676 PMCID: PMC9969506 DOI: 10.7150/ijms.76448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/13/2023] [Indexed: 02/15/2023] Open
Abstract
Introduction: Dysphagia-associated pneumonia is a critical health issue especially in the elders and stroke patients which carries a poorer prognosis. Therefore, we aim to identify methods with the potentials to predict subsequent pneumonia in dysphagia patients, which will be of great value in the prevention and early management of pneumonia. Methods: One-hundred dysphagia patients were enrolled and measurements including Dysphagia Severity Scale (DSS), Functional Oral Intake Scale (FOIS), Ohkuma Questionnaire, and Eating Assessment Tool-10 (EAT-10) were assessed by either videofluoroscopy (VF), videoendoscopy (VE), or the study nurse. The patients were categorized into mild or severe groups based on each screening method. All the patients were assessed for pneumonia at 1, 3, 6, and 20 months after the examinations. Results: VF-DSS (p=0.001) is the only measurement being significantly associated with subsequent pneumonia with sensitivity and specificity of 0.857 and 0.486. The Kaplan-Meier curves revealed that significant differences between the mild/severe groups start to emerge 3 months after VF-DSS (p=0.013). Cox regression models used for adjusted hazard ratio of severe VF-DSS in association with subsequent pneumonia of different timepoints after controlling the important covariates showed the following results: 3 months, p=0.026, HR=5.341, 95%CI=1.219-23.405; 6 months, p=0.015, HR=4.557, 95%CI=1.338-15.522; 20 months, p=0.004, HR=4.832, 95%CI=1.670-13.984. Conclusions: Dysphagia severity evaluated by VE-DSS, VE-FOIS, VF-FOIS, Ohkuma Questionnaire, and EAT-10 is not associated with subsequent pneumonia. Only VF-DSS is associated with both short-term and long-term subsequent pneumonia. In patients with dysphagia, VF-DSS is predictive of subsequent pneumonia.
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Affiliation(s)
- Poyin Huang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Multidisciplinary Swallowing Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chiung Hsu
- Department of Biomedical Sciences and Engineering, National Central University, Chung-Li, Taoyuan City 320, Taiwan
| | - Chien-Hsun Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Integrated Center of Healthy and Long-term Care, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuo-Wei Lee
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kun-Han Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ching Chen
- Department of general medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Wei Lin
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Hung Chen
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Dysphagia Functional Reconstructive Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Multidisciplinary Swallowing Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Nutrition, Food and Diet in Health and Longevity: We Eat What We Are. Nutrients 2022; 14:nu14245376. [PMID: 36558535 PMCID: PMC9785741 DOI: 10.3390/nu14245376] [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: 11/16/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Nutrition generally refers to the macro- and micro-nutrients essential for survival, but we do not simply eat nutrition. Instead, we eat animal- and plant-based foods without always being conscious of its nutritional value. Furthermore, various cultural factors influence and shape our taste, preferences, taboos and practices towards preparing and consuming food as a meal and diet. Biogerontological understanding of ageing has identified food as one of the three foundational pillars of health and survival. Here we address the issues of nutrition, food and diet by analyzing the biological importance of macro- and micro-nutrients including hormetins, discussing the health claims for various types of food, and by reviewing the general principles of healthy dietary patterns, including meal timing, caloric restriction, and intermittent fasting. We also present our views about the need for refining our approaches and strategies for future research on nutrition, food and diet by incorporating the molecular, physiological, cultural and personal aspects of this crucial pillar of health, healthy ageing and longevity.
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Du G, Liu F, Ma X, Chen S, Dai M, Wei L, Liu Z. Comparison Between Percutaneous Endoscopic Gastrostomy and Nasogastric Feeding in 160 Patients with Swallowing Disturbances: A Two-Year Follow-Up Study. Clin Interv Aging 2022; 17:1803-1810. [PMID: 36506851 PMCID: PMC9733445 DOI: 10.2147/cia.s389891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose We retrospectively compared the complications, blood biochemical indexes and outcomes in patients with swallowing disturbances receiving nasogastric tube (NGT) feeding and percutaneous endoscopy gastrostomy (PEG). Methods Among 160 patients, 72 cases received PEG and 88 cases received NGT. All patients were followed up for two years. We collected their clinical data from the medical records. Indicators, such as body mass index (BMI), white blood cell (WBC), hemoglobin (HGB), complications, including recurrent aspiration pneumonia, gastrointestinal bleeding, reflux esophagitis, and outcomes (survival or death) were compared between the two groups semi-annually. Results SAt both six months and one year after receiving treatment, there was no statistical difference between the two groups in indicators, complications and outcomes, with all P >0.05. It can be seen that, when the patients were followed up for one and a half years18 months, ALB was lower in the NGT group (33.81±0.46) compared with the PEG group (36.14±0.50) (P <0.05). After two years of follow-up, differences between the NGT and PEG group could be seen in a variety of indicators, including BMI (20.08±0.27 vs 21.03±0.25), WBC (9.12±0.56 vs 7.08±0.29), ALB (33.11±0.43 vs 35.75±0.49), creatinine (55.07±1.83 vs 63.21±2.94), and the complications, such as aspiration pneumonia, gastrointestinal bleeding, reflux esophagitis, and electrolyte disorder, in the PEG group were significantly reduced compared to the NGT groupthan that in its counterpart, P <0.05. In the two-year follow-up period, there were 13 and 22 patients died in the PEG group and NGT group, respectively. Conclusion Both techniques are safe and effective in the short term. However, on a longer-term basis, PEG is shown to be superior to NGT feeding in improving nutrition and preventing common complications for patients with swallowing disturbances.
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Affiliation(s)
- Ge Du
- Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China
| | - Fangfang Liu
- Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China
| | - Xiaomin Ma
- Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China
| | - Shanshan Chen
- Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China
| | - Min Dai
- Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China
| | - Li Wei
- Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China,Correspondence: Li Wei; Zishuang Liu, Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, 100144, People’s Republic of China, Tel/Fax + 86-010-56981582, Email ;
| | - Zishuang Liu
- Department of Rehabilitation Center for Elderly, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, People’s Republic of China
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Buccal films: A review of therapeutic opportunities, formulations & relevant evaluation approaches. J Control Release 2022; 352:1071-1092. [PMID: 36351519 DOI: 10.1016/j.jconrel.2022.10.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022]
Abstract
The potential of the mucoadhesive film technology is hard to ignore, owing to perceived superior patient acceptability versus buccal tablets, and significant therapeutic opportunities compared to conventional oral drug delivery systems, especially for those who suffer from dysphagia. In spite of this, current translation from published literature into the commercial marketplace is virtually non-existent, with no authorised mucoadhesive buccal films available in the UK and very few available in the USA. This review seeks to provide an overview of the mucoadhesive buccal film technology and identify key areas upon which to focus scientific efforts to facilitate the wider adoption of this patient-centric dosage form. Several indications and opportunities for development were identified, while discussing the patient-related factors influencing the use of these dosage forms. In addition, an overview of the technologies behind the manufacturing of these films was provided, highlighting manufacturing methods like solvent casting, hot melt extrusion, inkjet printing and three-dimensional printing. Over thirty mucoadhesive polymers were identified as being used in film formulations, with details surrounding their mucoadhesive capabilities as well as their inclusion alongside other key formulation constituents provided. Lastly, the importance of physiologically relevant in vitro evaluation methodologies was emphasised, which seek to improve in vivo correlations, potentially leading to better translation of mucoadhesive buccal films from the literature into the commercial marketplace.
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