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Nishizawa K, Honda I, Doi T. Content validation of the defining characteristics of the nursing diagnosis "impaired swallowing" using the Delphi technique: A study with dysphagia nursing experts in Japan. Int J Nurs Knowl 2024. [PMID: 38764211 DOI: 10.1111/2047-3095.12471] [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: 03/15/2024] [Accepted: 05/02/2024] [Indexed: 05/21/2024]
Abstract
PURPOSE Nurses' clinical reasoning skills regarding impaired swallowing can help prevent patient complications and maintain quality of life. Clinical reasoning skills need content-validated defining characteristics (DCs). We aimed to validate the content of these DCs for nursing diagnosis "impaired swallowing." METHODS Content validation of the DCs was performed by 275 dysphagia nursing experts in Japan, using 3 rounds of the Delphi technique and Fehring's Diagnostic Content Validation (DCV) model. Three rounds of questionnaires on 84 DCs were completed via printed mail. FINDINGS The valid response rates for each round were as follows: round 1, 90.2%; round 2, 77.8%; and round 3, 71.3%. Of the 84 DCs, 77 that met the consensus criteria were categorized as major (n = 18), minor (n = 45), and excluded (n = 14). There were four minor DCs other than the oral, pharyngeal, and esophageal phases. DCs listed from outside NANDA-I included 12 major, 16 minor, and 3 excluded characteristics. Of the NANDA-I DCs, 5 were no consensus and 11 were excluded. The total DCV score for the 63 major and minor DCs was 0.8. CONCLUSIONS Our results recommend the addition of 28 DCs and the exclusion of 11 for the NANDA-I nursing diagnosis "impaired swallowing" (00103). Major DCs were prominent indicators of impaired swallowing and signs of aspiration or pharyngeal residuals. Minor DCs included not only the three phases but also other signs necessary for a comprehensive understanding of impaired swallowing. IMPLICATIONS FOR NURSING PRACTICE This validation study strengthens the clinical usefulness of the DCs for impaired swallowing, which can improve nurses' clinical reasoning skills. Major and minor DCs can increase the awareness of impaired swallowing and enable accurate intervention, thereby preventing patient complications and maintaining quality of life.
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Affiliation(s)
- Kazuyoshi Nishizawa
- Department of Nursing, School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
- Department of Nursing Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ikumi Honda
- Department of Nursing Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Doi
- Faculty of Nursing, Nagoya University of Arts and Sciences, Nagoya, Japan
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Xiong S, Zhou Y, He W, Zhu J, He W, Ding M, Si D. Study on predictive models for swallowing risk in patients with AECOPD. BMC Pulm Med 2024; 24:95. [PMID: 38395811 PMCID: PMC10893668 DOI: 10.1186/s12890-024-02908-y] [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: 09/27/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Dysphagia is considered a complication in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, AECOPD may have risk factors for dysphagia. METHODS Through a cross-sectional study, which included 100 patients with AECOPD. General information, Pulmonary function, COPD assessment test (CAT) and modified Medical Research Council (mMRC) were collected by questionnaire. The questionnaires were administered by uniform-trained investigators using standard and neutral language, and swallowing risk was assessed by using a water swallow test (WST) on the day of patient admission. RESULTS Among the 100 included patients, 50(50%) were at risk of swallowing. Multivariate analysis using logistic regression analysis showed that age ≥ 74 years old, mMRC ≥ level 2, hospitalization days ≥ 7 days and the use of BIPAP assisted ventilation were important influencing factors for swallowing risk in patients with AECOPD. CONCLUSION Patients with AECOPD are at risk for dysphagia, assessing age, mMRC, hospitalization days and the use of BIPAP assisted ventilation can be used to screen for swallowing risk, thus contributing to the implementation of early prevention measures.
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Affiliation(s)
- Shuyun Xiong
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - You Zhou
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Wenfeng He
- Guangzhou Red Cross Hospital, 510000, Guangzhou, Guangdong, China
| | - Jinling Zhu
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Wenfang He
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Meizhu Ding
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Dongxu Si
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China.
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Li W, Mao S, Mahoney AS, Coyle JL, Sejdić E. Automatic Tracking of Hyoid Bone Displacement and Rotation Relative to Cervical Vertebrae in Videofluoroscopic Swallow Studies Using Deep Learning. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01039-4. [PMID: 38383805 DOI: 10.1007/s10278-024-01039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
The hyoid bone displacement and rotation are critical kinematic events of the swallowing process in the assessment of videofluoroscopic swallow studies (VFSS). However, the quantitative analysis of such events requires frame-by-frame manual annotation, which is labor-intensive and time-consuming. Our work aims to develop a method of automatically tracking hyoid bone displacement and rotation in VFSS. We proposed a full high-resolution network, a deep learning architecture, to detect the anterior and posterior of the hyoid bone to identify its location and rotation. Meanwhile, the anterior-inferior corners of the C2 and C4 vertebrae were detected simultaneously to automatically establish a new coordinate system and eliminate the effect of posture change. The proposed model was developed by 59,468 VFSS frames collected from 1488 swallowing samples, and it achieved an average landmark localization error of 2.38 pixels (around 0.5% of the image with 448 × 448 pixels) and an average angle prediction error of 0.065 radians in predicting C2-C4 and hyoid bone angles. In addition, the displacement of the hyoid bone center was automatically tracked on a frame-by-frame analysis, achieving an average mean absolute error of 2.22 pixels and 2.78 pixels in the x-axis and y-axis, respectively. The results of this study support the effectiveness and accuracy of the proposed method in detecting hyoid bone displacement and rotation. Our study provided an automatic method of analyzing hyoid bone kinematics during VFSS, which could contribute to early diagnosis and effective disease management.
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Affiliation(s)
- Wuqi Li
- Edward S. Rogers Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Shitong Mao
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda S Mahoney
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ervin Sejdić
- Edward S. Rogers Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada.
- North York General Hospital, Toronto, ON, Canada.
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Starace E, De Pasquale G, Morenghi E, Crippa C, Matteucci S, Pieri G, Soekeland F, Gibbi SM, Lo Cricchio G, Reggiani F, Calatroni M, Pastore M, Mazzoleni B, Mancin S. Hospital Malnutrition in the Medicine and Neurology Departments: A Complex Challenge. Nutrients 2023; 15:5061. [PMID: 38140320 PMCID: PMC10745339 DOI: 10.3390/nu15245061] [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: 11/22/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Hospital malnutrition is especially common among elderly patients with neurological deficits or dementia. These conditions can be exacerbated by unpalatable diets and issues such as dysphagia and presbyphagia. Our study aimed to investigate the prevalence of malnutrition in patients on a homogenized diet and to identify potential correlations with specific clinical variables. We conducted a retrospective observational study in compliance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. The study encompassed 82 patients, mainly elderly and diagnosed with neurodegenerative diseases. Upon initial assessment, 46.34% of the sample displayed a risk of malnutrition based on the Malnutrition Universal Screening Tool (MUST), and 62.20% were classified as malnourished based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Only 45.12% retained autonomy in food intake. Weight loss identified prior to the study was closely tied to malnutrition and influenced BMI. Moreover, autonomy in food intake was strongly associated with a prolonged hospital stay (LOS), and a similar trend was observed for water intake. Our findings emphasize the importance of promptly recognizing patients at risk of malnutrition, especially within such a vulnerable population. Autonomy in food intake and hydration emerge as critical indicators in the clinical management of hospitalized patients.
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Affiliation(s)
- Erica Starace
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Giulia De Pasquale
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Camilla Crippa
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Sofia Matteucci
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Gabriella Pieri
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Fanny Soekeland
- School of Health Professions, University of Applied Sciences, 3008 Bern, Switzerland;
| | - Stefano Maria Gibbi
- Department of Drug Science, School of Pharmacy, University of Pavia, 27100 Pavia, Italy;
| | - Giuliana Lo Cricchio
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Francesco Reggiani
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Marta Calatroni
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Manuela Pastore
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
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Nagano A, Onaka M, Maeda K, Ueshima J, Shimizu A, Ishida Y, Nagami S, Miyahara S, Nishihara K, Yasuda A, Satake S, Mori N. Prevalence and Characteristics of the Course of Dysphagia in Hospitalized Older Adults. Nutrients 2023; 15:4371. [PMID: 37892446 PMCID: PMC10609669 DOI: 10.3390/nu15204371] [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: 09/08/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Sarcopenic dysphagia (SD) is an emerging concern in geriatric medicine. This study aimed to identify the prevalence, progression, and distinct attributes of SD in patients in the Department of Geriatric Medicine. Older adult patients admitted between 2021 and 2022 were enrolled. The department conducts a comprehensive geriatric assessment (CGA) combined with a multidisciplinary team-based intervention, setting the standard for medical care. We diligently assessed the occurrence and development of dysphagia at both the admission and discharge phases. Of the 180 patients analyzed (38.9% male, mean age 86.0 ± 6.6 years), 22.8% were diagnosed with SD at admission, thrice the rate of other dysphagia variants. Only one patient had new-onset dysphagia during hospitalization, attributed to SD. Patients with SD showed a better recovery rate (18.9%) than those with other dysphagia types. Patients with diminished swallowing capacity had compromised nutritional profiles, diminished energy and protein consumption, and extended fasting durations. Although sarcopenia is a prevalent inducer of dysphagia in older adults, an integrated approach in geriatric medicine involving rehabilitation, nutrition, and dentistry is pivotal. Strategies rooted in CGA promise potential for addressing dysphagia.
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Affiliation(s)
- Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1, Imazuyamanaka-cho, Nishinomiya 663-8211, Japan;
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
| | - Masami Onaka
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
- Nutrition Therapy Support Center, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute 480-1195, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
- Department of Nutritional Service, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano 380-8525, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
- Department of Nutrition, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute 480-1195, Japan
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki 701-0193, Japan;
| | - Shuzo Miyahara
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Keiji Nishihara
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Akiyuki Yasuda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Shosuke Satake
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.O.); (S.M.); (K.N.); (A.Y.); (S.S.)
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1, Yazakokarimata, Nagakute 480-1195, Japan; (J.U.); (A.S.); (N.M.)
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Zugasti Murillo A, Gonzalo Montesinos I, Cancer Minchot E, Botella Romero F. Hospital management of the patient with dysphagia. Survey and recommendations of SEEN nutrition area. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:1-9. [PMID: 37468415 DOI: 10.1016/j.endien.2023.07.002] [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: 03/16/2022] [Accepted: 04/03/2022] [Indexed: 07/21/2023]
Abstract
INTRODUCTION The prevalence of dysphagia in hospitalized patients is extraordinarily high and little known. The goal of care should be to assess the efficacy and safety of swallowing, to indicate personalized nutritional therapy. The development of Dysphagia Units, as a multidisciplinary team, facilitates comprehensive care for this type of patient. MATERIAL AND METHODS A observational, cross-sectional, web-based survey-type study, focused on Spanish Society of Endocrinology and Nutrition department heads, was conducted in September-October 2021. The following data were analyzed: size and type of center, existence of a dysphagia unit, dysphagia screening, dietary and nutritional therapy, education and training of professionals and patients, codification, and quality of life evaluation. RESULTS 65 responses (39% of the total Endocrinology and Nutrition departments). 37% of hospitals have a Dysphagia Unit and 25% are developing it. 75.4% perform screening, with MECV-V in 80.6%, and VED (61.4%) and VFS (54.4%) are performed as main complementary tests. The centers have different models of oral diet, thickeners and nutritional oral supplements adapted to dysphagia. In 40% of the centers, no information is offered on dysphagia, nor on the use of thickeners, dysphagia is coded in 81%, 52.3% have specific nursing protocols and only 8% have scales for quality-of-life evaluation. CONCLUSIONS The high prevalence and the risk of serious complications require early and multidisciplinary management at the hospital level. The information received by the patient and caregiver about the dietary adaptations they need, is essential to minimize risks and improve quality of life.
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Affiliation(s)
- Ana Zugasti Murillo
- Sección de Nutrición Clínica, Servicio Endocrinología y Nutrición, Hospital Universitario de Navarra, Pamplona, Navarra, Spain.
| | | | - Emilia Cancer Minchot
- Sección de Endocrinología y Nutrición, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Francisco Botella Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete Área de Nutrición de la SEEN, Albacete, Spain
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Le KHN, Low EE, Yadlapati R. Evaluation of Esophageal Dysphagia in Elderly Patients. Curr Gastroenterol Rep 2023; 25:146-159. [PMID: 37312002 PMCID: PMC10726678 DOI: 10.1007/s11894-023-00876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence. RECENT FINDINGS In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.
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Affiliation(s)
| | - Eric E Low
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA
| | - Rena Yadlapati
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA.
- , La Jolla, CA, USA.
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Bosch G, Comas M, Domingo L, Guillen-Sola A, Duarte E, Castells X, Sala M. Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality. Eur J Clin Invest 2023; 53:e13930. [PMID: 36477740 DOI: 10.1111/eci.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia can be highly concerning in hospitalized patients, increasing morbidity and mortality, making its early identification essential. We aimed to characterize dysphagia and its association with aspiration pneumonia and mortality in a tertiary hospital in Barcelona, Spain. METHODS Using data from all hospital discharges during the period 2018-2021, we identified the characteristics of patients with dysphagia and their distribution among hospital departments through the minimum data set, which codifies patients' diagnoses according to the International Classification of Diseases 10th Revision (ICD-10). We used logistic regression models to assess the association between dysphagia, aspiration pneumonia and mortality. RESULTS Dysphagia was present in 2.4% of all hospital discharges and was more frequent in older patients and in men. The diagnoses most frequently associated with dysphagia were aspiration pneumonia (48.2%) and stroke (14%). Higher prevalence of dysphagia was found in the acute geriatric unit (10.3%), neurology (7.6%) and internal medicine (7.5%) wards. Dysphagia was associated with aspiration pneumonia, aOR = 8.04 (95%CI, 6.31-10.25), and independently increased the odds of death among hospitalized patients, aOR = 1.43 (95%CI, 1.19-1.73). CONCLUSIONS We conclude that dysphagia is a prevalent and transversal condition, increasing the risk of mortality in all patients, and efforts should be intensified to increase its early detection and correct management.
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Affiliation(s)
- Guillermo Bosch
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB (Parc de Salut Mar - Pompeu Fabra University - Agència de Salut Pública de Barcelona), Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Anna Guillen-Sola
- Department of Physical Medicine and Rehabilitation, PSMAR, Barcelona. Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, PSMAR, Barcelona. Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Parc de Salut MAR (PSMAR), Barcelona, Spain.,Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
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Smith C, Bhattacharya D, Scott S. Understanding how primary care practitioners can be supported to recognise, screen and initially diagnose oropharyngeal dysphagia: protocol for a behavioural science realist review. BMJ Open 2023; 13:e065121. [PMID: 36806074 PMCID: PMC9944651 DOI: 10.1136/bmjopen-2022-065121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia (OD) affects around 15% of older people; however, it is often unrecognised and underdiagnosed until patients are hospitalised. Screening is an important process which aims to facilitate proactive assessment, diagnosis and management of health conditions. Healthcare systems do not routinely screen for OD in older people, and healthcare professionals (HCPs) are largely unaware of the need to screen. This realist review aims to identify relevant literature and develop programme theories to understand what works, for whom, under what circumstances and how, to facilitate primary care HCPs to recognise, screen and initially diagnose OD. METHODS AND ANALYSIS We will follow five steps for undertaking a realist review: (1) clarify the scope, (2) literature search, (3) appraise and extract data, (4) evidence synthesis and (5) evaluation. Initial programme theories (IPTs) will be constructed after the preliminary literature search, informed by the Theoretical Domains Framework and with input from a stakeholder group. We will search Medline, Google Scholar, PubMed, EMBASE, CINAHL, AMED, Scopus and PsycINFO databases. We will obtain additional evidence through grey literature, snowball sampling, lateral searching and consulting the stakeholder group. Literature will be screened, evaluated and synthesised in Covidence. Evidence will be assessed for quality by evaluating its relevance and rigour. Data will be extracted and synthesised according to their relation to IPTs. We will follow the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication standards to report study results. ETHICS AND DISSEMINATION Formal ethical approval is not required for this review. We will disseminate this research through publication in a peer-reviewed journal, written pieces targeted to diverse groups of HCPs on selected online platforms and public engagement events. PROSPERO REGISTRATION NUMBER CRD42022320327.
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Affiliation(s)
- Caroline Smith
- School of Healthcare, University of Leicester, College of Life Sciences, Leicester, Leicestershire, UK
| | - Debi Bhattacharya
- School of Healthcare, University of Leicester, College of Life Sciences, Leicester, Leicestershire, UK
| | - Sion Scott
- School of Healthcare, University of Leicester, College of Life Sciences, Leicester, Leicestershire, UK
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Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia 2023; 38:76-121. [PMID: 35639156 PMCID: PMC9873728 DOI: 10.1007/s00455-022-10465-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/29/2022] [Indexed: 01/28/2023]
Abstract
Oropharyngeal dysphagia (OD) is prevalent in the elderly and persons with complex medical conditions, resulting in considerable medical and psychosocial consequences and reduced quality of life. Many prevalence studies regard OD in relation to age or diagnosis. Knowledge on the prevalence of OD in different healthcare settings is lacking. This systematic review aimed to estimate the prevalence of OD in adults admitted to hospitals, rehabilitation facilities, nursing homes, and palliative care facilities through meta-analyses. A systematic literature search was completed including all dates up to March 30, 2021. The methodology and reporting were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Forty-four out of 1,956 screened articles were deemed eligible. Considerable heterogeneity in definitions of OD and type and quality of selected outcome measures were observed. Overall within-group pooled prevalence estimates for OD determined by meta-analysis were 36.5% (95% CI 29.9 - 43.6) in the hospital setting, 42.5% (95% CI 35.8 - 49.5) in the rehabilitation setting, and 50.2% (95% CI 33.3-67.2) in nursing homes. No OD prevalence data were identified for palliative care facilities. Results for between-group analyses of OD prevalence estimates in the hospital setting were non-significant for type of assessment method, diagnostic group, and type of hospital ward, but indicated significantly higher prevalence estimates in nursing homes when using screening compared to patient-report. Future research should provide OD prevalence data for palliative care, achieve consensus in OD-related terminology when performing prevalence studies, and use screening and assessments with optimal diagnostic performance and psychometric properties.
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Affiliation(s)
| | - Lena Hartelius
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Skaraborgs Hospital, Skövde, Sweden
| | - Liza Bergström
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Speech Pathology, Division of Neurology, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- REMEO Stockholm, Stockholm, Sweden
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Renée Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, the Netherlands
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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11
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Calles-Sánchez F, Pardal-Refoyo JL. Prevalencia de la disfagia orofaríngea en pacientes adultos. Revisión sistemática y metanálisis. REVISTA ORL 2023. [DOI: 10.14201/orl.29490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introducción y objetivo: La disfagia orofaríngea es un síntoma clínico de alta prevalencia, caracterizado por la dificultad en la deglución, que presenta diversos factores etiológicos. Su tratamiento se realiza de manera multidisciplinar, incluyendo diversos profesionales de ciencias de la salud. El objetivo es conocer la prevalencia de la disfagia orofaríngea en pacientes adultos.
Método: Se realizó una búsqueda bibliográfica de estudios relativos a la prevalencia de disfagia orofaríngea en pacientes adultos. El cribado y la selección de estudios se realizó a través del método Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Se realizó un análisis estadístico de las variables consideradas relevantes para el estudio.
Resultados: Un total de 29 estudios fueron seleccionados. La prevalencia total de la disfagia se presentó con una probabilidad de p = 0.39, en un intervalo de confianza de (IC 95% 0.303 – 0.476).
Discusión: Existe asociación o correlación entre la disfagia y diversos estados clínicos o patologías del paciente. Se ha encontrado una relación directa entre la prevalencia de la disfagia y una edad avanzada.
Conclusiones: La disfagia orofaríngea se presentó con una alta prevalencia según los estudios seleccionados. Las enfermedades neurológicas, la malnutrición y la neumonía fueron los principales estados comórbidos en los pacientes con disfagia. La función de enfermería permanece prácticamente ausente en los estudios seleccionados.
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12
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Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey. Dysphagia 2022; 37:1451-1460. [PMID: 35092486 DOI: 10.1007/s00455-021-10389-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/31/2021] [Indexed: 12/16/2022]
Abstract
Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.
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Lin Y, Wan G, Wu H, Shi J, Zhang Y, Chen H, Wei X, Tang Z, Dai M, Dou Z, Wen H. The sensitivity and specificity of the modified volume-viscosity swallow test for dysphagia screening among neurological patients. Front Neurol 2022; 13:961893. [PMID: 36188363 PMCID: PMC9523084 DOI: 10.3389/fneur.2022.961893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022] Open
Abstract
Oropharyngeal dysphagia (OD) is a highly prevalent condition after stroke and other neurological diseases. The volume-viscosity swallow test (V-VST) is a screening tool for OD. Considering that the recommendations of volume and thickeners in the original V-VST limited the popularization and application of the test in the Chinese population, we provide the modified V-VST to detect OD among neurological patients. In addition, the accuracy of the modified V-VST to screen OD needs to be verified. We included 101 patients with neurological diseases. OD was evaluated by a modified V-VST and a videofluoroscopy swallowing study (VFSS) using 3 volumes (i.e., 3, 5, and 10 ml) and 4 viscosities (i.e., water, mildly thick, moderately thick, and extremely thick). In this study, to compare with the original V-VST results, a volume of 20 ml was also included. The discriminating ability of modified V-VST in detecting OD was assessed by the sensitivity and specificity values of clinical signs of impaired efficiency (impaired labial seal, piecemeal deglutition, and residue) and impaired safety of swallowing (cough, voice changes, and oxygen desaturation ≥3%) in comparison to the results of VFSS. The modified V-VST showed 96.6% sensitivity and 83.3% specificity for OD, 85.2% sensitivity and 70% specificity for impaired safety, and 90.9% sensitivity and 76.9% specificity for impaired efficacy. Our study suggests that the modified V-VST offers a high discriminating ability in detecting OD among neurological patients.
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14
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Manejo hospitalario del paciente con disfagia. Encuesta y recomendaciones del área de nutrición de la SEEN. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Xu L, Gu H, Zhang Y. Research Hotspots of the Rehabilitation Medicine Use of sEMG in Recent 12 Years: A Bibliometric Analysis. J Pain Res 2022; 15:1365-1377. [PMID: 35592819 PMCID: PMC9112527 DOI: 10.2147/jpr.s364977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Surface electromyography (sEMG) has been widely applied to rehabilitation medicine. However, the bibliometric analysis of the rehabilitation medicine use of sEMG is vastly unknown. Therefore, this research aimed to investigate the current trends of the rehabilitation medicine use of sEMG in the recent 12 years by using CiteSpace (5.8). Methods Literature relating to rehabilitation medicine use of sEMG from 2010 to 2021 was retrieved from the Web of Science. CiteSpace analyzed country, institution, cited journals, authors, cited references and keywords. An analysis of counts and centrality was used to reveal publication outputs, countries, institutions, core journals, active authors, foundation references, hot topics and frontiers. Results A total of 1949 publications were retrieved from 2010 to 2021. The total number of publications continually increased over the past 12 years, and the most active countries, institutions, journals and authors in rehabilitation medicine use of sEMG were identified. The most productive country and institution in this field were America (484) and the University of Sao Paulo (36). Andersen LL (28) was the most prolific author, and Dario Farina ranked first among the cited authors. Besides, there were three main frontiers in keywords for sEMG research, including “activation”, “exercise”, and “strength”. Conclusion The findings from this bibliometric study provide the current status and trends in clinical research of rehabilitation medicine use of sEMG over the past ten years, which may help researchers identify hot topics and explore new directions for future research in this field.
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Affiliation(s)
- Liya Xu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing, People’s Republic of China
| | - Hongyi Gu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing, People’s Republic of China
| | - Yimin Zhang
- China Institute of sports and Health, Key Laboratory of sports and Physical Health Ministry of Education, Beijing Sports University, Beijing, People’s Republic of China
- Correspondence: Yimin Zhang, China Institute of sports and health, Key Laboratory of sports and physical health Ministry of Education, Beijing Sports University, Beijing, 100084, People’s Republic of China, Tel +86 13641108252, Email
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16
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Sommerville P, Hayton J, Soar N, Archer S, Fitzgerald A, Lang A, Birns J. Prognosis in dysphagic patients who are eating and drinking with acknowledged risk: results from the evaluation of the FORWARD project. Age Ageing 2022; 51:6530456. [PMID: 35180285 DOI: 10.1093/ageing/afac005] [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: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND patients with a permanently unsafe swallow may choose to eat and drink with acknowledged risk (EDAR). Informed decision-making and advance care planning depend on prognosis, but no data have yet been published on outcomes after EDAR decisions. METHODS the study was undertaken in 555 hospital inpatients' (mean [SD] age: 83 {12}) EDAR supported by the Feeding via the Oral Route with Acknowledged Risk of Deterioration care bundle between January 2015 and November 2019. Data were collected prospectively on clinical characteristics, dates of discharge, readmissions and death (where relevant). Kaplan-Meier survival functions and readmission risks per surviving patient per month were calculated. RESULTS mortality is 56% in the first 3 months after discharge but then mortality risk sharply decreases. The 3-month survival in EDAR patients was more likely in those <75 years of age, those with Parkinson's disease or a structural oral lesion as the dominating cause of dysphagia and those with mental capacity regarding EDAR decisions. Readmission risk in the 3 months post-discharge is 21% but reduces to 12% thereafter (P < 0.001). Thirty-eight percent of readmissions are secondary to EDAR-linked conditions such as chest infections and reduced oral intake. CONCLUSION there is a high mortality and readmission risk after an EDAR decision but much of this is frontloaded into the first 3 months, with a relatively favourable prognosis thereafter. This may be an appropriate time-point to reassess the plan for eating and drinking such that it continues to reflect the most appropriate balance of risk, comfort and nutrition.
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Affiliation(s)
- Peter Sommerville
- Department of Stroke Medicine, Guy’s and St Thomas’ NHS Trust, St. Thomas’ Hospital, London SE1 7EH, UK
| | - Jonathan Hayton
- Department of Stroke, Guy’s and St. Thomas' Hospital, London, SE1 7EH, UK
| | - Naomi Soar
- Department of Speech and Language, Guy’s and St Thomas' Hospital, London SE1 7EH, UK
| | - Sally Archer
- Department of Speech and Language, Guy’s and St Thomas' Hospital, London SE1 7EH, UK
| | - Adam Fitzgerald
- Integrated Local Services, Guy’s and St Thomas' Hospital, London, SE1 7EH, UK
| | - Alex Lang
- South West London Health and Care Partnership, NHS South West London CCG, London, SW19 1RH, UK
| | - Jonathan Birns
- Department of Stroke Medicine, Guy’s and St Thomas’ NHS Trust, St. Thomas’ Hospital, London SE1 7EH, UK
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Abstract
PURPOSE Historically, clinical reasoning has largely been considered from an empirical, biomedical standpoint. This epistemology, rooted in imperial rule, is influential in how healthcare practitioners practice. An empirical approach to healthcare often oversimplifies the complex nature of clinical reasoning by obscuring the influence of imperial ideologies on decision-making. This can perpetuate inequitable approaches to healthcare delivery which deepen social, political and economic divides globally. This paper aims to explore and challenge this standpoint by exploring how power, imperialism and performativity influences healthcare provision and decision-making amongst healthcare practitioners in dysphagia rehabilitation. METHODS Qualitative exploratory interviews were undertaken with seven South African trained SLPs with experience working in dysphagia. To allow for participation and collaboration from participants, three data collection tools were employed within the interviews: oral histories, cognitive mapping and arts-based tasks. An initial modified thematic analysis followed by a further ideological analysis were undertaken to analyse the data collected. RESULTS The results suggest that the participants felt influenced by several manifestations of power within healthcare. We argue that this demonstrates that imperial practices can influence knowledge, interaction and context and therefore affect how healthcare practitioners make decisions. CONCLUSION By acknowledging the impact of imperialism and power dynamics on healthcare provision and clinical reasoning we can potentially begin to transform the epistemology from which we approach healthcare provision in favour of one which is better suited to the current realities of healthcare to allow for equitable service provision.
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Affiliation(s)
- Thiani Pillay
- Speech Language Therapy, University of KwaZulu Natal, South Africa
| | - Mershen Pillay
- Speech Language Therapy, University of KwaZulu Natal, South Africa.,Massey University, Auckland, New Zealand.,Manchester Metropolitan University, Manchester, UK
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18
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Gonzalez Lindh M, Janson C, Koyi H. Swallowing dysfunction in patients hospitalised due to a COPD exacerbation. ERJ Open Res 2021; 7:00515-2021. [PMID: 34708116 PMCID: PMC8542964 DOI: 10.1183/23120541.00515-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/05/2022] Open
Abstract
Swallowing dysfunction is common in COPD patients with severe exacerbations but this kind of dysfunction is potentially correctable, at least in some patients. Further interventional studies on this topic are urgently needed. https://bit.ly/3mFKNq1.
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Affiliation(s)
- Margareta Gonzalez Lindh
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | - Christer Janson
- Dept Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, Sweden
| | - Hirsch Koyi
- Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden.,Dept of Respiratory Medicine, Karolinska Institute, Stockholm, Sweden
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19
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Grilli GM, Giancaspro R, Del Colle A, Quarato CMI, Lacedonia D, Foschino Barbaro MP, Cassano M. Dysphagia in non-intubated patients affected by COVID-19 infection. Eur Arch Otorhinolaryngol 2021; 279:507-513. [PMID: 34468824 PMCID: PMC8408570 DOI: 10.1007/s00405-021-07062-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 01/17/2023]
Abstract
Purpose Patients affected by COVID-19 are assumed to be at high risk of developing swallowing disorders. However, to our best knowledge, data on the characteristics and incidence of dysphagia associated with COVID-19 are lacking, especially in non-intubated patients. Therefore, we investigated the onset of swallowing disorders in patients with laboratory-confirmed COVID-19 infection who have not been treated with invasive ventilation, in order to evaluate how the virus affected swallowing function regardless of orotracheal intubation. Methods We evaluated 41 patients admitted to the COVID department of our Hospital when they had already passed the acute phase of the disease and were therefore asymptomatic but still positive for SARS-CoV-2 RNA by RT-PCR. We examined patients’ clinical history and performed the Volume-Viscosity Swallow Test (VVST). Each patient also answered the Swallowing Disturbance Questionnaire (SDQ). After 6 months, we performed a follow-up in patients with swallowing disorders. Results Eight of 41 patients (20%) presented with dysphagia symptoms during hospitalization and 2 of them (25%) still presented a SDQ high score and swallowing disorders with liquid consistency after 6 months. Conclusion Non-intubated patients can experience various grades of swallowing impairment that probably directly related to pulmonary respiratory function alterations and viral direct neuronal lesive activity. Although these symptoms show natural tendency to spontaneous resolution, their impact on a general physical impaired situation should not be underestimated, since it can adversely affect patients’ recovery from COVID-19 worsening health outcomes.
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Affiliation(s)
- Gianluigi Mariano Grilli
- Department of Otolaryngology-Head and Neck Surgery, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
| | - Rossana Giancaspro
- Department of Otolaryngology-Head and Neck Surgery, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy.
| | - Anna Del Colle
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Carla Maria Irene Quarato
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Donato Lacedonia
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Michele Cassano
- Department of Otolaryngology-Head and Neck Surgery, University of Foggia, Via Luigi Pinto 1, 71122, Foggia, Italy
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20
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Riera SA, Marin S, Serra-Prat M, Tomsen N, Arreola V, Ortega O, Walshe M, Clavé P. A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia. Foods 2021; 10:1900. [PMID: 34441677 PMCID: PMC8391460 DOI: 10.3390/foods10081900] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023] Open
Abstract
(1) Background: The volume-viscosity swallow test (V-VST) is a clinical tool for screening and diagnosis of oropharyngeal dysphagia (OD). Our aims were to examine the clinical utility of the V-VST against videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallow (FEES) and to map the V-VST usage with patients at risk of OD across the years since it was described for the first time, carrying a systematic and a scoping review. (2) Methods: We performed both a systematic review (SR) including studies that look at the diagnostic test accuracy, and a scoping review (ScR) with articles published from September 2008 to May 2020. Searches were done in different databases, including PubMed and EMBASE from September 2008 until May 2020, and no language restrictions were applied. A meta-analysis was done in the SR to assess the psychometric properties of the V-VST. Quality of studies was assessed by Dutch Cochrane, QUADAS, GRADE (SR), and STROBE (ScR) criteria. The SR protocol was registered on PROSPERO (registration: CRD42020136252). (3) Results: For the diagnostic accuracy SR: four studies were included. V-VST had a diagnostic sensitivity for OD of 93.17%, 81.39% specificity, and an inter-rater reliability Kappa = 0.77. Likelihood ratios (LHR) for OD were 0.08 (LHR-) and 5.01 (LHR+), and the diagnostic odds ratio for OD was 51.18. Quality of studies in SR was graded as high with low risk of bias. In the ScR: 34 studies were retrieved. They indicated that V-VST has been used internationally to assess OD's prevalence and complications. (4) Conclusions: The V-VST has strong psychometric properties and valid endpoints for OD in different phenotypes of patients. Our results support its utility in the screening and clinical diagnosis and management of OD.
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Affiliation(s)
- Stephanie A. Riera
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Department of Surgery and Morphological Sciences, University Autonomous of Barcelona, 08193 Cerdanyola del Vallès, Catalunya, Spain
| | - Sergio Marin
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Department of Pharmacy, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Catalunya, Spain
| | - Mateu Serra-Prat
- Research Unit, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain;
| | - Noemí Tomsen
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08304 Mataró, Catalunya, Spain
| | - Viridiana Arreola
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
| | - Omar Ortega
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08304 Mataró, Catalunya, Spain
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, 8PVW G5 Dublin, Ireland;
| | - Pere Clavé
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Department of Surgery and Morphological Sciences, University Autonomous of Barcelona, 08193 Cerdanyola del Vallès, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08304 Mataró, Catalunya, Spain
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21
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Gonzalez Lindh M, Janson C, Blom Johansson M, Jonsson M, Mälberg E, Allansson E, Holm C, Jennische M, Koyi H. Swallowing dysfunction in patients hospitalised due to a COPD exacerbation. ERJ Open Res 2021; 7:00173-2021. [PMID: 34109239 PMCID: PMC8181655 DOI: 10.1183/23120541.00173-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives This cross-sectional study aimed to investigate the prevalence of self-reported and clinically screened swallowing dysfunction (dysphagia) in COPD patients with severe exacerbations and to identify any associated factors. Findings were then compared to a control group. Methods Participants included 30 patients hospitalised due to a COPD exacerbation. The control group consisted of 30 adults hospitalised with acute cardiac symptoms. Data were derived from spirometry, the 150 mL timed water swallow test, a cookie swallow test and a dyspnoea questionnaire (modified Medical Research Council (mMRC)). Scores from the 10-item Eating Assessment Tool (EAT-10) were calculated to assess patient perception of swallowing dysfunction. Results Self-reported swallowing dysfunction and clinical signs thereof were more common in COPD patients than in the control group (67% versus 23% and 80% versus 37%, respectively; p≤0.001). Clinical signs of swallowing dysfunction in the group with acute exacerbation of COPD were associated with self-reported swallowing dysfunction (p=0.02) and xerostomia (p=0.04). Dyspnoea (mMRC ≥2) was more common among the COPD patients (90% versus 47%, p<0.001). There was a significant negative correlation between lung function and self-reported dysphagia (r=−0.39, p=0.03), but not between lung function and clinically screened dysphagia (r=−0.23, p=0.21). Conclusion COPD patients hospitalised with an acute exacerbation experienced significantly more self-reported and clinically screened swallowing dysfunction compared to a control group of patients with cardiac symptoms. Both patient groups experienced dyspnoea, but it was twice as common in the group with acute exacerbation of COPD. Both groups also experienced xerostomia. Patients hospitalised with #AECOPD experienced significantly more self-reported and clinically screened swallowing dysfunction compared to a control grouphttps://bit.ly/32awLkx
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Affiliation(s)
- Margareta Gonzalez Lindh
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | - Christer Janson
- Dept Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | - Mimmi Jonsson
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Emma Mälberg
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Cecilia Holm
- Dept of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Hirsch Koyi
- Centre for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden.,Dept of Respiratory Medicine, Karolinska Institute, Stockholm, Sweden
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Engh MCN, Speyer R. Management of Dysphagia in Nursing Homes: A National Survey. Dysphagia 2021; 37:266-276. [PMID: 33660070 PMCID: PMC8948132 DOI: 10.1007/s00455-021-10275-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/16/2021] [Indexed: 12/21/2022]
Abstract
The management of dysphagia may differ by country and clinical setting. The purpose of this study was to describe the management and care pathways for elderly people with dysphagia in nursing homes across Norway using an online survey. A national survey was developed that consisted of 23 questions covering various areas related to dysphagia care in nursing homes: background information of respondents, nursing homes, and residents and staff; screening and assessment of dysphagia including use of specialist consultation; management, practice patterns, and interventions targeting residents with dysphagia; training of staff; and perceived quality of current clinical practices in their nursing home. A total of 121 respondents completed the online survey, resulting in an overall response rate of 23.2%. Substantial discrepancies in dysphagia management were identified between nursing homes. In approximately 75% of nursing homes, residents were not routinely screened or assessed for swallowing problems. Although nursing homes used a broad range of strategies and routines for people with eating and swallowing difficulties, bolus modification seemed standard practice. Oral hygiene strategies were lacking in over 80% of nursing homes, and almost 50% did not have access to external experts, including speech therapists. Although nursing home staff rated the overall quality of care for people with eating and swallowing problems as high, their rating seemed mainly based on care for malnutrition and not directly aimed at dysphagia. The survey identified an evident need for training and upskilling staff in Norwegian nursing homes and raising awareness of the serious consequences and comorbidities that can result from dysphagia.
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Affiliation(s)
- Mina C N Engh
- Department Special Needs Education, University of Oslo, Oslo, Norway.,Indre Østfold Municipality, Askim, Norway
| | - Renée Speyer
- Department Special Needs Education, University of Oslo, Oslo, Norway. .,School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia. .,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
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