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Cimoli M, Gibney J, Lim M, Castles J, Dammert P. Nil per os in the management of oropharyngeal dysphagia-exploring the unintended consequences. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1410023. [PMID: 38957683 PMCID: PMC11217566 DOI: 10.3389/fresc.2024.1410023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/04/2024] [Indexed: 07/04/2024]
Abstract
Nil per os (NPO), also referred to as Nil by Mouth (NBM), is a health-related intervention of withholding food and fluids. When implemented in the context of a person with dysphagia, NPO aims to mitigate risks of aspiration. However, evidence demonstrating that NPO is beneficial as an intervention for people with dysphagia is lacking. This paper explores the theoretical and empirical evidence relating to the potential benefits and adverse effects of NPO and asserts that NPO is not a benign intervention. This paper argues for applying an ethics framework when making decisions relating to the use of NPO as an intervention for dysphagia, in particular addressing informed consent and a person's right to self-determination.
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Affiliation(s)
- Michelle Cimoli
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Jennifer Gibney
- Speech Pathology Department, Nepean Hospital, Penrith, NSW, Australia
| | - Mathew Lim
- Dental Services, Alfred Health, Prahran, VIC, Australia
- Melbourne Dental School, University of Melbourne, Carlton, VIC, Australia
| | - Jo Castles
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Pedro Dammert
- Pulmonary and Critical Care Department, Scripps Mercy Hospital Chula Vista, Chula Vista, CA, United States
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Ismael-Mohammed K, Bolívar-Prados M, Laguna L, Nuñez Lara A, Clavé P. Exploring Texture and Biomechanics of Food Oral Processing in Fork-Mashable Dishes for Patients with Mastication or Swallowing Impairments. Foods 2024; 13:1807. [PMID: 38928749 PMCID: PMC11202756 DOI: 10.3390/foods13121807] [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: 04/23/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Texture-modified diets (TMDs) are a primary compensatory treatment for hospitalized older patients with swallowing and mastication disorders. Nevertheless, the lack of a protocol for evaluating their objective textural properties hampers their industrialization and optimal patient care. OBJECTIVES This study aimed (a) to evaluate the textural properties (maximum force, cohesiveness, and adhesiveness) and biomechanics of food oral processing (mastication cycles, time, and frequency) of ten fork-mashable dishes (Texture E BDA/IDDSI level 6), (b) to explore the impact of oral processing on texture, and (c) to measure the properties of the ready-to-swallow bolus (RSB) in healthy adults. METHODS The textural properties (maximum force, cohesiveness, and adhesiveness) of ten dishes were analyzed with a texture analyzer before and after oral processing (RSB) in five healthy adults (30 ± 3.9, 3 women). Surface electromyography was used to measure mastication cycles, time, and frequency. RESULTS The pre-mastication Texture Profile Analysis (TPA)-averaged values of maximum force ranged from 0.65 to 2.73 N, cohesiveness was 0.49-0.87, and adhesiveness was 0.01-0.95 N·s. Masticatory Cycles (46.87-19.13 MC) and time (36.73-15.80 S) from whole samples to RSB greatly and significantly differed among dishes, although frequency did not (1.68-1.11 MC/T). Post-mastication RSB TPA-averaged values of maximum force ranged from 0.70 to 2.24 N; cohesiveness, 0.49-0.73; and adhesiveness, 0.01-1.14 N·s. CONCLUSIONS Despite all dishes being classified by the same qualitative descriptor (BDA level E/IDDSI level 6), there was a large and significant variation in their textural properties (maximum force, cohesiveness, and adhesiveness) when measured in SI units. In addition, in healthy adults, the masticatory cycles and time to achieve RSB greatly differed, whereas masticatory frequency remained quite constant.
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Affiliation(s)
- Kovan Ismael-Mohammed
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
- Institute of Agrochemistry and Food Technology (IATA, CISC), 46980 Valencia, Spain
| | - Mireia Bolívar-Prados
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08304 Barcelona, Spain
| | - Laura Laguna
- Institute of Agrochemistry and Food Technology (IATA, CISC), 46980 Valencia, Spain
| | - Adrian Nuñez Lara
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08304 Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08304 Barcelona, Spain
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Stradling EJ, Barnhart MK, Robinson RA, Mogg PJ, Ward EC, Smee RI. Implementing flexible endoscopic evaluation of swallow screening within annual cancer surveillance appointments to monitor for late-stage radiation-induced dysphagia: A feasibility study. Head Neck 2024; 46:615-626. [PMID: 38151916 DOI: 10.1002/hed.27615] [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: 06/06/2023] [Revised: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Late-stage progressive decline of swallowing function after radiotherapy for head and neck cancer (HNC) is often difficult to monitor. This study examined the feasibility and clinical outcomes of speech-language pathology implementing flexible endoscopic evaluation of swallow (FEES) screening during annual cancer surveillance visits to monitor late-stage swallowing function. METHODS Patients >2 years post treatment who attended routine oncological visits underwent FEES screening. Feasibility (service data, stakeholder survey) and swallowing outcomes (oral intake, secretions, internal lymphedema, penetration-aspiration, and residue) were collected. RESULTS Screening was completed with 70% (50/71) of eligible patients. Medical staff and speech-language pathologists indicated the protocol was worthwhile and achievable to incorporate into practice. Almost all patients were willing to complete the protocol annually. FEES outcomes identified 84% with dysphagia versus only 26% self-reported dysphagia. CONCLUSION Findings indicate FEES screening incorporated into annual oncological reviews is feasible and effective at monitoring late-stage swallowing function following HNC.
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Affiliation(s)
- Emma J Stradling
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Comprehensive Cancer Centre, POWH, Randwick, New South Wales, Australia
| | - Molly K Barnhart
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Comprehensive Cancer Centre, POWH, Randwick, New South Wales, Australia
| | - Rachelle A Robinson
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - Penny J Mogg
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Robert I Smee
- Department of Radiation Oncology, Comprehensive Cancer Centre, POWH, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia
- The Clinical Teaching School, University New South Wales, Kensington, New South Wales, Australia
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Chandrashekaraiah B, N S, Belliappa MS. Cross-Cultural Adaptation, Translation and Validation of Kannada Version of the Swallowing Quality of Life Questionnaire (KSWAL-QOL). Indian J Otolaryngol Head Neck Surg 2024; 76:351-357. [PMID: 38440609 PMCID: PMC10908923 DOI: 10.1007/s12070-023-04162-w] [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: 07/07/2023] [Accepted: 08/19/2023] [Indexed: 03/06/2024] Open
Abstract
The swallowing quality of life (SWAL-QOL) questionnaire is a commonly used tool to assess the impact of dysphagia on quality of life. SWAL-QOL has been translated and validated in many languages. There is no valid dysphagia-specific quality of life tool in Indian languages. Hence, the current study aimed at cultural adaptation, translation, and validation of SWAL-QOL in Kannada (KSWAL-QOL), a south Indian Dravidian language. The original SWAL-QOL was translated into Kannada using the standard translation procedure. A group of 55 participants with oro-pharyngeal dysphagia (clinical group) and 55 participants with normal swallowing abilities (control group) were recruited for the current study to assess the validity and reliability of KSWAL-QOL. Dysphagia Handicap Index- Kannada version (DHI-K) and Life Satisfaction Questionnaire (LISAT) were used to check for the convergent validity of the KSWAL-QOL. The KSWAL-QOL demonstrated excellent discriminant validity and distinguished clinical from the control group across all domains (p = 0.00). Internal consistency for all the nine domains of KSWAL-QOL measured using Cronbach's α ranged from 0.89 to 0.92, demonstrating excellent reliability. Test-retest measures were exceptional, with Intraclass Correlation Coefficient (ICC) ranging between 0.92 and 0.98 and Spearman's rho values between 0.91 and 0.97. A very strong negative correlation was obtained between KSWAL-QOL and DHI-K, and a strong positive correlation was seen between KSWAL-QOL and LISAT. The KSWAL-QOL is a reliable and valid tool with excellent psychometric properties to evaluate the quality of life associated with swallowing in individuals with oropharyngeal dysphagia. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04162-w.
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Affiliation(s)
- Bilvashree Chandrashekaraiah
- Department of Speech-Language Pathology and Centre for Swallowing Disorders, All India Institute of Speech and Hearing, Naimisham Campus, Manasagangothri, Mysuru, Karnataka 570006 India
| | - Swapna N
- Centre for Swallowing Disorders, All India Institute of Speech and Hearing, Mysuru, Karnataka India
| | - M. Sonam Belliappa
- Department of Speech-Language Pathology, All India Institute of Speech and Hearing, Mysuru, Karnataka India
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Mascarenhas A, Mendo R, O'Neill C, Franco AR, Mendes R, Simão I, Rodrigues JP. Current Approach to Dysphagia: A Review Focusing on Esophageal Motility Disorders and Their Treatment. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:403-413. [PMID: 38476159 PMCID: PMC10928869 DOI: 10.1159/000529428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/13/2023] [Indexed: 03/14/2024]
Abstract
Background Dysphagia is a prevalent condition which may severely impact the patient's quality of life. However, there are still lacking standardized therapeutic options for esophageal motility disorders. Summary Dysphagia is defined as a subjective sensation of difficulty swallowing which can result from oropharyngeal or esophageal etiologies. Regarding esophageal dysphagia, after excluding structural causes and esophageal mucosal lesions, high-resolution manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM has not only improved the sensitivity for detecting achalasia but has also expanded our understanding of spastic and hypomotility disorders of the esophageal body. The Chicago Classification v4.0 uses a hierarchical approach and provides a standardized diagnosis of esophageal motility disorders, allowing a tailored therapeutic approach. Dysphagia is often a long-term health problem that broadly impacts health and well-being and leads to physical and psychosocial disability, namely, malnutrition and aspiration pneumonia, as well as social isolation, depression, and anxiety. Apart from achalasia, most esophageal motility disorders tend to have a benign long-term course with symptoms of dysphagia and noncardiac chest pain that can improve significantly over time. Patient-reported outcomes (PROs) are self-assessment tools that capture the patients' illness experience and help providers better understand symptoms from the patients' perspective. Therefore, PROs have a critical role in providing patient-centered care. Key Messages Motility disorders should be ruled out in the presence of nonobstructive esophageal dysphagia, and treatment options should be considered according to the severity of symptoms reported by the patient.
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Affiliation(s)
- André Mascarenhas
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Rui Mendo
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Catarina O'Neill
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Ana Rita Franco
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Raquel Mendes
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Inês Simão
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - José Pedro Rodrigues
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Pathophysiology Autonomous Disciplinary Area, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Ismael-Mohammed K, Bolivar-Prados M, Laguna L, Clavé P. Measuring the Rheological and Textural Properties of Thick Purees Used to Manage Patients with Swallowing Disorders. Nutrients 2023; 15:3767. [PMID: 37686799 PMCID: PMC10490504 DOI: 10.3390/nu15173767] [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: 07/13/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Texture-modified diets are the first-line compensatory strategy for older patients with swallowing and mastication disorders. However, the absence of a common protocol to assess textural properties inhibits their standardization and quality control and, thus, patient safety. This study aimed to (a) assess the rheological and textural properties of ten thick purees (Texture C, British Dietetic Association), (b) understand the effect of oral processing, and (c) measure the properties of the ready-to-swallow bolus after oral processing in healthy adults. Shear viscosity at 50 s-1 and 300 s-1 and textural properties (maximum force, cohesiveness, and adhesiveness) of boluses of ten thick purees were analyzed with a rheometer and a texture analyzer before and after oral processing (ready-to-swallow) in five healthy volunteers. Viscosity varied by 81.78% at 50 s-1 (900-4800 mPa·s) among purees before oral processing. Maximum force varied by 60% (0.47-1.2 N); cohesiveness, 18% (0.66-0.82), and adhesiveness, 32% (0.74-1.1 N·s). The high variability of viscosity was also present in ready-to-swallow boluses, 70.32% among purees. Oral processing significantly reduced viscosity in most purees (French omelet, zucchini omelet, turkey stew, red lentils, noodles, and hake fish) and also significantly reduced maximum force (7-36%) and adhesiveness (17-51%) but hardly affected cohesiveness (<5%). All thick purees met the qualitative textural descriptors for Level C texture. However, all ten purees showed significant differences in all parameters measured instrumentally and were affected differently by oral processing. This study demonstrates the need to use instrumental quality control using standardized protocols and SI units to narrow the variability and provide the optimal values for patients with dysphagia who require texture-modified diets.
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Affiliation(s)
- Kovan Ismael-Mohammed
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataro, Spain (M.B.-P.)
- Institute of Agrochemistry and Food Technology (IATA-CISC), 46980 Valencia, Spain;
| | - Mireia Bolivar-Prados
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataro, Spain (M.B.-P.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08304 Barcelona, Spain
| | - Laura Laguna
- Institute of Agrochemistry and Food Technology (IATA-CISC), 46980 Valencia, Spain;
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataro, Spain (M.B.-P.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08304 Barcelona, Spain
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Achalu S, Berry R, Zhuo J, Bredenoord AJ, Clarke JO, Fass R, Gyawali CP, Kahrilas PJ, Katzka DA, Massey BT, Penagini R, Roman S, Savarino E, Vela MF, Kamal AN. Development and modification of a dysphagia question prompt list to improve patient-physician communication: Incorporating both esophageal expert and patient perspectives. Neurogastroenterol Motil 2023:e14600. [PMID: 37122123 DOI: 10.1111/nmo.14600] [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: 12/13/2022] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Question prompt lists (QPLs) are structured sets of disease-specific questions, intended to encourage question-asking by patients and enhance patient-physician communication. To date, a dysphagia-specific QPL has not been developed for patients with esophageal dysphagia symptoms. We aim to develop a dysphagia-specific QPL incorporating both esophageal expert and patient perspectives, applying rigorous methodology. METHODS The QPL content was generated applying a two-round modified Delphi (RAND/UCLA) method among 11 experts. In round one, experts provided five answers to the prompts: "What general questions should patients ask when being seen for dysphagia?" and "What questions do I not hear patients asking but, given my experience, I believe they should be asking?" In round two, experts rated proposed questions on a 5-point Likert scale. Responses rated as "essential" or "important", determined by an a priori median threshold of ≥4.0, were accepted for inclusion. Subsequently, 20 patients from Stanford Health Care were enrolled to modify the preliminary QPL, to incorporate their perspectives and opinions. Patients independently rated questions applying the same 5-point Likert scale. At the end, patients were encouraged to propose additional questions to incorporate into the QPL by open-endedly asking "Are there questions we didn't ask, that you think we should?" KEY RESULTS Eleven experts participated in both voting rounds. Of 85 questions generated from round one, 60 (70.6%) were accepted for inclusion, meeting a median value of ≥4.0. Questions were combined to reduce redundancy, narrowing down to 44 questions. Questions were categorized into the following six themes: 1. "What is causing my dysphagia?"; 2. "Associated symptoms"; 3. "Testing for dysphagia"; 4. "Lifestyle modifications"; 5. "Treatment for dysphagia"; and 6. "Prognosis". The largest number of questions covered "What is causing my dysphagia" (27.3%). Twenty patients participated and modified the QPL. Of the 44 questions experts agreed were important, only 30 questions (68.2%) were accepted for inclusion. Six patients proposed 10 additional questions and after incorporating the suggested questions, the final dysphagia-specific QPL created by esophageal experts and modified by patients consisted of 40 questions. CONCLUSIONS & INFERENCES Incorporating expert and patient perspectives, we developed a dysphagia-specific QPL to enhance patient-physician communication. Our study highlights importance of incorporating patient perspective when developing such a communication tool. Further studies will measure the impact of this communication tool on patient engagement.
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Affiliation(s)
- Sudharshan Achalu
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Rani Berry
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Justin Zhuo
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Albert J Bredenoord
- Division of Neurogastroenterology and Motility, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - John O Clarke
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, MetroHealth, Cleveland, Ohio, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Peter J Kahrilas
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - David A Katzka
- Division of Gastroenterology, Columbia University, New York, New York, USA
| | - Benson T Massey
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Roberto Penagini
- Division of Gastroenterology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
| | - Sabine Roman
- Division of Digestive Physiology, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | | | - Marcelo F Vela
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Afrin N Kamal
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, California, USA
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Hepper EC, Patterson JM. Healthcare Professionals' Perceptions of Stabilized Edible Foam with Adults with Severe Dysphagia; an exploratory study: Use of stabilized edible foam with adults with dysphagia: Use of stabilized edible foam with adults with dysphagia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:226-240. [PMID: 36040239 DOI: 10.1111/1460-6984.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Improving the quality of life for individuals with severe dysphagia is a priority when considering new areas of dysphagia management, especially if this increases opportunities to participate in social activities associated with eating and drinking. Edible foam is widely researched and available in the food industry; however, the use of edible foam within the field of dysphagia remains unexplored. Despite no research published on effectiveness and safety, a commercial product currently on the market is widely distributed across both Europe and the UK, including 28 NHS Trusts, suggesting that it is increasingly being used in clinical practice. AIMS To explore the perceptions and experiences of healthcare professionals on the use of stabilized edible foam (SEF) with adults with severe dysphagia in order to inform areas for future research in this novel dysphagia intervention. METHODS & PROCEDURES Healthcare professionals were recruited using purposeful sampling and snowballing technique. A total of 56 healthcare professionals were initially approached, of which 10 completed the semi-structured interviews. Interview questions were developed from a topic guide and a pilot questionnaire. OUTCOMES & RESULTS Thematic analysis was used to identify three themes: potential impact, consideration of risk and perceived experiences. Overarching each of these themes was the element of the unknown. CONCLUSIONS & IMPLICATIONS Use of SEF with adults with dysphagia is in its infancy. Whilst results indicate that some clinicians are embracing this novel approach, others express concerns. Therefore, further research is needed, particularly in relation of direct experience of individuals and contra-indications. WHAT THIS PAPER ADDS What is already known on the subject The use of SEF with individuals with swallowing problems is a relatively novel area of dysphagia intervention in the UK. There are currently no published studies on its effectiveness and safety profile. What this paper adds to existing knowledge This study provides valuable preliminary work into the area of SEF and adults with severe dysphagia, capturing the experience and perceptions of healthcare professions who have an awareness of SEF. What are the potential or actual clinical implications of this work? Increasing clinicians and researcher's awareness of this novel area of dysphagia management.
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Affiliation(s)
- Elizabeth C Hepper
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Joanne M Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre University of Liverpool, Liverpool, UK
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Maeda M, Kadokura M, Aoki R, Komatsu N, Kawakami M, Koyama Y, Watanabe K, Nishiyama M. A Fiber-Optic Non-Invasive Swallowing Assessment Device Based on a Wearable Pressure Sensor. SENSORS (BASEL, SWITZERLAND) 2023; 23:2355. [PMID: 36850956 PMCID: PMC9963261 DOI: 10.3390/s23042355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
We developed a wearable swallowing assessment device using a hetero-core fiber-optic pressure sensor for the detection of laryngeal movement during swallowing. The proposed pressure sensor (comfortably attached to the skin of the neck) demonstrated a high sensitivity of 0.592 dB/kPa and a linearity of R2 = 0.995 within a 14 kPa pressure band, which is a suitable pressure for the detection of laryngeal movement. In addition, since the fabricated hetero-core fiber-optic pressure sensor maintains appreciable sensitivity over the surface of the sensor, the proposed wearable swallowing assessment device can accurately track the subtle pressure changes induced by laryngeal movements during the swallowing process. Sixteen male subjects and one female subject were evaluated in a variety of age groups ranging from 30 to 60 years old. For all subjects, characteristic swallowing waveforms (with two valleys based on laryngeal movements consisting of upward, forward, backward, and downward displacements) were acquired using the proposed wearable swallowing assessment device. Since the denoted time of the first valley in the acquired waveform determines the "aging effect", significant differences in swallowing functions among the different age groups were ultimately determined based on the time of the first valley. Additionally, by analyzing each age group using the proposed device, due to p-values being consistently less than 0.05, swallowing times were found to exhibit statistically significant differences within the same groups.
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Affiliation(s)
- Masanori Maeda
- Information Systems Science Major, Graduate of Science and Engineering, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Miyuki Kadokura
- Information Systems Science Major, Graduate of Science and Engineering, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Ryoko Aoki
- Faculty of Nursing, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Noriko Komatsu
- Faculty of Nursing, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Masaru Kawakami
- School of Nursing, Jichi Medical University, 3311-159 Yakushiji, Shimotsuke, Tochigi 329-0431, Japan
| | - Yuya Koyama
- Department of Electrical and Electronic Engineering, Chiba Institute of Technology, 2-17-1 Tsudanuma, Narashino, Chiba 275-0016, Japan
| | - Kazuhiro Watanabe
- Department of Science and Engineering for Sustainable Innovation, Faculty of Science and Engineering, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
| | - Michiko Nishiyama
- Department of Science and Engineering for Sustainable Innovation, Faculty of Science and Engineering, Soka University, 1-236 Tangi-Machi, Hachioji, Tokyo 192-8577, Japan
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George RG, Jagtap M. Impact of Swallowing Impairment on Quality of Life of Individuals with Dysphagia. Indian J Otolaryngol Head Neck Surg 2022; 74:5473-5477. [PMID: 36742852 PMCID: PMC9895758 DOI: 10.1007/s12070-021-02798-0] [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: 06/19/2021] [Accepted: 08/01/2021] [Indexed: 02/07/2023] Open
Abstract
To explore oral intake and quality of life measures among individuals with dysphagia. This cross-sectional study with purposive sampling included 15 individuals with dysphagia. Functional oral intake scale (FOIS) and Dysphagia Quality of Life questionnaire in Marathi (DQOL-QM) were administered on individuals with dysphagia to evaluate oral intake levels and swallow related quality of life respectively. Data was collected using the interview method via tele-mode. Statistical analysis using Spearman's rank correlation revealed significant negative correlation (ρ = - 0.87) between oral intake and overall quality of life of the individuals with dysphagia. This negative impact was observed across all the domains of their quality of life. A considerable negative impact on quality of life was observed with declining oral intake of the individual with dysphagia. As oral intake plays an important role in the quality of life, decisions regarding the mode of feeding must be guided by the preferences of the individual and their family. strategies that enhance oral intake improves quality of life of dysphagic individual.
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Affiliation(s)
- Rebecca. Grace. George
- School of Audiology and Speech Language Pathology, Bharati Vidyapeeth (Deemed To Be University), Pune, Maharashtra India
| | - Mansi. Jagtap
- School of Audiology and Speech Language Pathology, Bharati Vidyapeeth (Deemed To Be University), Pune, Maharashtra India
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Fang WJ, Zheng F, Zhang LZ, Wang WH, Yu CC, Shao J, Wu YJ. Research progress of clinical intervention and nursing for patients with post-stroke dysphagia. Neurol Sci 2022; 43:5875-5884. [PMID: 35661279 PMCID: PMC9166186 DOI: 10.1007/s10072-022-06191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Post-stroke dysphagia (PSD) is a common and costly complication of stroke and is associated with increased mortality, morbidity, and hospitalization. Although most patients can spontaneously resume swallowing, there are still many patients who do not recover and even die. Despite multiple advances in the acute treatment and secondary prevention of stroke, the effective treatment of PSD remains a neglected area. Studies have shown that repair mechanisms of neurostimulation techniques and increased cortical activity play an important role in the treatment of PSD. In addition, nutritional interventions are also crucial for the treatment of malnutrition in PSD patients. Therefore, this article reviews the effects of the current main clinical treatment methods and nutritional interventions on the treatment and rehabilitation of PSD patients. It also emphasized the necessity of developing an individualized care plan for PSD patients, which is of great significance to promote the clinical treatment, nutritional status, prognosis, and quality of life of PSD patients.
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Affiliation(s)
- Wen-Juan Fang
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Fei Zheng
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Lin-Zhi Zhang
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Wen-Hui Wang
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Cheng-Chen Yu
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Juan Shao
- Department of Neurology, The Second People's Hospital of Hefei, Heifei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, China
| | - Yi-Jin Wu
- The Second Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui, China.
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12
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Steadman KJ, Weng M, Malouh MA, Symons K, Cichero JAY. Swallowing safety of oral liquid medications: assessment using the International Dysphagia Diet Standardisation Initiative framework. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Min‐Tz Weng
- School of Pharmacy The University of Queensland Brisbane Australia
| | - Marwa A. Malouh
- School of Pharmacy The University of Queensland Brisbane Australia
| | - Keli Symons
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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Ghaddar Z, Matar N, Noujaim J, Diep AN, Tohmé A, Pétré B. Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study. Patient Prefer Adherence 2022; 16:1511-1524. [PMID: 35769338 PMCID: PMC9236548 DOI: 10.2147/ppa.s364520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the absence of literature allowing for an evidence-based approach to therapeutic patient education (TPE) in Oropharyngeal Dysphagia (OD), this study aims to reach a consensus of experts on the content of a competency framework of an educational program for OD patients and their informal caregivers (ICGs). METHODS We used the Delphi consensus-building method. Four categories of experts were recruited: 12 patients, 17 ICGs, 46 healthcare professionals (HCP) (experienced in OD, not necessarily certified in TPE), and 19 experts in TPE (trained individuals to set up and run TPE programs not necessarily HCPs). The content of the questionnaire of the first round (R) was established according to the result of a scoping review and the opinion of an expert committee. We carried out three rounds. In R1 and R2, we collected the opinions on the relevance (7-point Likert-type scale) and on comprehensiveness (YES/No question and asking participants to propose additional content). Participants were also invited to leave comments on each objective. In R3, we asked the participants to give their opinion about the relevance of the objectives again and asked them to rank the themes from highest to lowest priority. RESULTS Objectives were considered relevant for all participants if they reached consensus when the interquartile (IQR) ≤ 1, and if the median indicated agreement (Mdn ≥ 6) (6= appropriate, 7 = totally appropriate). Following three rounds, the final content of the educational program is composed of 23 educational objectives organized in 13 themes with an agreement about relevance amongst all participants (Mdn ≥ 6; IQR ≤ 1). The comprehensiveness criterion received also a consensus (IQR ≤ 1). The participants ranked the theme "normal swallowing vs difficulty swallowing" as the highest priority. CONCLUSION This Delphi study resulted in a consensus, on the content of a competency framework of an educational program for OD patients and their ICGs. Further steps are needed to construct learning activities based on these objectives before testing their feasibility and efficacy.
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Affiliation(s)
- Zahya Ghaddar
- Department of Public Health, University of Liège, Liege, Belgium
- Doctoral School of Sciences and Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
- Correspondence: Zahya Ghaddar, Department of Public Health, University of Liège, Place du XX août 7, Liege, 4000, Belgium, Tel +961 3554813, Email ;
| | - Nayla Matar
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Center Hotel-Dieu de France, Affiliated to Saint-Joseph University, Beirut, Lebanon
| | - Joyce Noujaim
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Anh Nguyet Diep
- Department of Public Health, University of Liège, Liege, Belgium
| | - Aline Tohmé
- Department of Internal Medicine and Clinical Immunology, University Hospital Center Hotel-Dieu de France, Affiliated to Saint-Joseph University, Beirut, Lebanon
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liege, Belgium
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Dysphagic disorder in a cohort of COVID-19 patients: Evaluation and evolution. Ann Med Surg (Lond) 2021; 69:102837. [PMID: 34512968 PMCID: PMC8423675 DOI: 10.1016/j.amsu.2021.102837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 is a multisystem disease complicated by respiratory failure requiring sustanined mechanical ventilation (MV). Prolongued oro-tracheal intubation is associated to an increased risk of dysphagia and bronchial aspiration. Purpose of this study was to investigate swallowing disorders in critically ill COVID-19 patients. Material and methods This was a retrospective study analysing a consecutive cohort of COVID-19 patients admitted to the Intensive Care Unit (ICU) of our hospital. Data concerning dysphagia were collected according to the Gugging Swallowing Screen (GUSS) and related to demographic characteristics, clinical data, ICU Length-Of-Stay (LOS) and MV parameters. Results From March 2 to April 30, 2020, 31 consecutive critically ill COVID-19 patients admitted to ICU were evaluated by speech and language therapists (SLT). Twenty-five of them were on MV (61% through endotracheal tube and 19% through tracheostomy); median MV length was 11 days. Seventeen (54.8%) patients presented dysphagia; a correlation was found between first GUSS severity stratification and MV days (p < 0.001), ICU LOS (p < 0.001), age (p = 0.03) and tracheostomy (p = 0.042). No other correlations were found. At 16 days, 90% of patients had fully recovered; a significant improvement was registered especially during the first week (p < 0.001). Conclusion Compared to non-COVID-19 patiens, a higher rate of dysphagia was reported in COVID-19 patients, with a more rapid and complete recovery. A systematic early SLT evaluation of COVID-19 patients on MV may thus be useful to prevent dysphagia-related complications.
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Morishita S, Ohara Y, Iwasaki M, Edahiro A, Motokawa K, Shirobe M, Furuya J, Watanabe Y, Suga T, Kanehisa Y, Ohuchi A, Hirano H. Relationship between Mortality and Oral Function of Older People Requiring Long-Term Care in Rural Areas of Japan: A Four-Year Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041723. [PMID: 33579046 PMCID: PMC7916757 DOI: 10.3390/ijerph18041723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022]
Abstract
Oral ingestion influences the life sustenance, quality of life, and dignity of older adults. Thus, it is an important issue in medical care and the welfare of older adults. The purpose of this four-year prospective cohort study was to investigate the relationship between mortality and oral function among older adults who required long-term care and were living in different settings in a rural area of Japan. This study included 289 participants aged 65 and older who required long-term care and lived in the former Omorimachi area in Yokote City, Akita Prefecture, located in northern Japan. Following the baseline survey, mortality data were collected over four years; 102 participants (35.3%) died during that time. A significant difference was noted in the overall survival rates between the groups with good and deterioration of oral function such as oral dryness, rinsing ability, swallowing function, and articulation, based on Log-rank test results. After adjusting for various potential confounders using Cox proportional-hazards regression, oral dryness (HR: 1.83, 95% confidence interval: 1.12−3.00) was significantly associated with mortality within four years. This study revealed that oral dryness influences the life prognosis of older adults who receive long-term care in different settings.
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Affiliation(s)
- Shiho Morishita
- Department of Oral Health Sciences, School of Health Sciences, Meikai University, 1 Akemi, Urayasu-City, Chiba 279-8550, Japan; (S.M.); (Y.K.)
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo 173-0015, Japan; (M.I.); (A.E.); (K.M.); (M.S.); (H.H.)
- Division of Welfare, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-746 Asahimachi-Dori, Chuo-Ku, Niigata 951-8518, Japan;
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo 173-0015, Japan; (M.I.); (A.E.); (K.M.); (M.S.); (H.H.)
- Correspondence: ; Tel.: +81-33-964-3241 (ext. 4211); Fax: +81-33-964-2316
| | - Masanori Iwasaki
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo 173-0015, Japan; (M.I.); (A.E.); (K.M.); (M.S.); (H.H.)
| | - Ayako Edahiro
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo 173-0015, Japan; (M.I.); (A.E.); (K.M.); (M.S.); (H.H.)
| | - Keiko Motokawa
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo 173-0015, Japan; (M.I.); (A.E.); (K.M.); (M.S.); (H.H.)
| | - Maki Shirobe
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo 173-0015, Japan; (M.I.); (A.E.); (K.M.); (M.S.); (H.H.)
| | - Junichi Furuya
- Department of Geriatric Dentistry, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ohta-Ku, Tokyo 145-8515, Japan;
| | - Yutaka Watanabe
- Gerodontology, Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Nishi-7, Kita-13, Kita-ku, Sapporo 060-8586, Japan;
| | - Takeo Suga
- Department of Geriatric Dentistry, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Yokohama 230-8501, Japan;
| | - Yayoi Kanehisa
- Department of Oral Health Sciences, School of Health Sciences, Meikai University, 1 Akemi, Urayasu-City, Chiba 279-8550, Japan; (S.M.); (Y.K.)
| | - Akitugu Ohuchi
- Division of Welfare, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-746 Asahimachi-Dori, Chuo-Ku, Niigata 951-8518, Japan;
| | - Hirohiko Hirano
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-Cho, Itabashi-Ku, Tokyo 173-0015, Japan; (M.I.); (A.E.); (K.M.); (M.S.); (H.H.)
- Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan
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Effectiveness of Conventional Swallowing Therapy in Acute Stroke Patients with Dysphagia. Rehabil Res Pract 2020; 2020:2907293. [PMID: 33083059 PMCID: PMC7556095 DOI: 10.1155/2020/2907293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/17/2020] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Dysphagia is a common problem in acute stroke patient. Aspiration pneumonia increases in this group. Swallowing therapy is immediately conducted in a stable stroke patient. An effectiveness of our program has not been determined. Objective To determine an effectiveness of conventional swallowing therapy in acute stroke patients with dysphagia. Methods We retrospectively reviewed data from medical records of acute stroke patients with dysphagia who participated a swallowing therapy from January 2017 to June 2017. Fifty-seven acute stroke patients with dysphagia (26 males and 31 females) were participating in a conventional swallowing therapy (50 minutes a day for 3 days per week). A functional oral intake scale (FOIS) and swallow function scoring system (SFSS) were used to determine an effectiveness of the swallowing therapy. FOIS and SFSS scores before the first therapy session and after the last therapy session were compared using a paired t-test. Results The mean age of the patient was 69.5 ± 15.35 years. The period from stroke onset to the first swallowing therapy session was 7.5 ± 6.69 days. The number of therapy was 5.6 ± 2.83 sessions. Participants showed a significant improvement of the FOIS (mean score increased from 1.74 to 3.30 points, P = 0.001) and SFSS (mean score increased from 2.51 to 3.68 points, P = 0.001). Forty-two percent of patients with tube dependent change to total oral intake. Conclusion Conventional swallowing therapy is an effective treatment in acute stroke with dysphagia.
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Radford C, Marshall J, Herbert A, Irving H, Weir K. Risk Feeding: An Australian Pediatric Palliative Care Perspective. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-19-00032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
This article explores the challenges of risk feeding from an Australian Paediatric Palliative Care perspective. There is currently limited evidence to guide risk feeding in pediatric clinical practice. Therefore, this article uses evidence from the adult palliative and end-of-life care context (extrapolating to pediatric application), in addition to the authors' clinical experience in supporting children and their families with risk feeding. Recommendations for the clinical management of pediatric risk feeding are discussed, including the suggested focus for families and the interprofessional team along the different phases of the palliative care continuum.
Conclusion
There is currently limited information to guide decision making regarding risk feeding in pediatrics. Overall, in the absence of evidence-based practice guidelines, it is the authors' recommendation that a risk feeding plan is developed in consultation and collaboration with the family, treating physician, and interprofessional team. Further research is required to support guidance for clinicians working in this area.
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Affiliation(s)
- Claire Radford
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Jeanne Marshall
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anthony Herbert
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Helen Irving
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kelly Weir
- Gold Coast Hospital and Health Service, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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18
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Morley H, Panak V, Mulders WHAM, Goulios H, Martini A, Langdon C. Non-chewing diets and cerumen impaction in the external ear canal in a residential aged care population. Australas J Ageing 2019; 39:131-136. [PMID: 31691470 DOI: 10.1111/ajag.12736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/26/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine whether diets involving reduced chewing affect the degree of cerumen impaction in older people in residential care. METHODS A total of 51 people (53% male) over 65 years (80.5 ± 9.3) were recruited from two residential aged care facilities in Perth, Australia. Participants were classified as "chewers" (on unrestricted or soft food diets), or "non-chewers" (on pureed or nil by mouth diets), and completed a survey about predisposing factors for cerumen impaction. Otoscopy and tympanometry were used to assess cerumen impaction and ear canal occlusion. Participants with excess cerumen were referred for wax removal. RESULTS No significant difference in cerumen accumulation was found between groups. However, 57% of participants showed excess cerumen requiring removal. CONCLUSION Diets involving reduced chewing are not associated with increased cerumen in older people in residential care. The prevalence of cerumen impaction is high in this population, and improved cerumen screening and management is needed in residential aged care.
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Affiliation(s)
- Hannah Morley
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Vanessa Panak
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Wilhelmina H A M Mulders
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia.,Ear Science Institute Australia, Subiaco, WA, Australia
| | - Helen Goulios
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | | | - Claire Langdon
- School of Surgery, University of Western Australia, Crawley, WA, Australia
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19
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Kim JY, Lee YW, Kim HS, Lee EH. The mediating and moderating effects of meaning in life on the relationship between depression and quality of life in patients with dysphagia. J Clin Nurs 2019; 28:2782-2789. [PMID: 31067340 DOI: 10.1111/jocn.14907] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/06/2019] [Accepted: 04/16/2019] [Indexed: 12/13/2022]
Abstract
AIMS AND OBJECTIVES To identify whether meaning in life has moderating and mediating effects on the relationship between depression and quality of life in patients with dysphagia. BACKGROUND Dysphagic patients typically have multidimensional problems, such as depression, which can negatively influence their quality of life. Meaning in life, therefore, can be used as a psychological resource that may enhance quality of life for these patients. DESIGN A descriptive cross-sectional research design was used. METHODS Ninety patients with dysphagia were recruited for a survey from eight general and rehabilitation hospitals in Korea. The questionnaires, which included the Korean version of the Swallowing Quality of Life scale developed by Cha, the Center for Epidemiological Studies-Depression Scale developed by Radloff, and the Purpose in Life test developed by Crumbaugh and Maholick, were used for data collection. Descriptive statistics, Hayes' PROCESS macro and Cronbach's alpha were used for data analyses. RESULTS Meaning in life was found to mediate the relationship between depression and quality of life in patients with dysphagia. However, the index of moderation was not statistically significant, which mean that meaning in life did not moderate the relationship between the patients' depression and quality of life. CONCLUSIONS Meaning in life had a mediating effect on the relationship between depression and quality of life in patients with dysphagia. Thus, to improve the quality of life of patients with dysphagia, nurses should apply interventions to help them find meaning in life. RELEVANCE TO CLINICAL PRACTICE Meaning in life can be used as a nursing intervention strategy to improve the quality of life for patients living with dysphagia and depression.
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Affiliation(s)
- Ju-Yeun Kim
- Department of Nursing, Dongyang University, Yeongju, Korea
| | | | - Hwa-Soon Kim
- Department of Nursing, Inha University, Incheon, Korea
| | - Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, Korea
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20
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Abu-Snieneh HM, Saleh MYN. Registered Nurse's Competency To Screen Dysphagia Among Stroke Patients: Literature Review. Open Nurs J 2018; 12:184-194. [PMID: 30258508 PMCID: PMC6128015 DOI: 10.2174/1874434601812010184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/30/2018] [Accepted: 07/15/2018] [Indexed: 01/25/2023] Open
Abstract
Background An increased number of elderly people in the world may lead to an increase in the incidence of stroke, which creates a burden on the country's healthcare system. Dysphagia is the most common post stroke. Screening of dysphagia in stroke patients is serious to prevent complication linked to aspiration and inadequate hydration/nutrition. Objective This literature review aimed to discuss registered nurses' competency to screen dysphagia among stroke patients. Methods The keywords used were nurse's competency; dysphagia; dysphagia screening; and stroke. These keywords were entered into multiple electronic databases including CINAHL, Medline, Science Direct, Pro Quest, Pub Med, and Wiley Online Library. Aliterature search was conducted for the period2005 to 2016.Results:Seventeen studies were identified by a systematic search ofthe literature.Two parts created the body of this literature review. The first part covers the literature on the training nurses in screening dysphagia among stroke patients and benefits of screening. The second part covers nurse's competency in terms of knowledge and skills of screening dysphagia among stroke patients. Conclusion Because the nurses have more contact with the patient, they are most likely to observe dysphagia. It is important that formal dysphagia screening protocols are routine nursing care that requires special training to practice. Trained nurses should assess their competency in terms of knowledge and skills via well-developed tool.
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Affiliation(s)
| | - Mohammad Y N Saleh
- Clinical Nursing Department, The University of Jordan, Faculty of Nursing, Amman-Jordan
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21
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Jaffar S, Devadas M. Characterization of Self-Reported Dysphagia and Impact on Weight Outcomes After Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 28:3177-3185. [PMID: 29799107 DOI: 10.1007/s11695-018-3293-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION/AIMS There is paucity of literature examining dysphagia after laparoscopic sleeve gastrectomy (LSG). Moreover, there are few validated scoring systems for dysphagia that adequately assess its psychosocial impact. We aim to investigate dysphagia after LSG using a multidimensional scale that examines its functional and emotional impact. As secondary aims, we evaluated the impact of dysphagia on weight outcomes and its relationship with pre-operative gastro-esophageal reflux disease (GERD) and proton pump inhibitor (PPI) use. METHODS One hundred twenty-four patients 1 year or more post-LSG were administered the validated Dysphagia Handicap Index (DHI) questionnaire. To further delineate esophageal dysphagia, three additional questions were added. One hundred one patients (81.5%) responded. Physical, Emotional, Functional, and Esophageal scales were analyzed combined and individually using a multivariate model. RESULTS No patients reported dysphagia pre-operatively. The median DHI scale scores are the following: Physical-2 (0-20); Functional-4 (0-22); Emotional-2 (0-14); and Esophageal-2 (0-8). On multivariate analysis, DHI Emotional scores significantly correlated with reduced total weight loss (%TWL) (p = 0.001) and excess weight loss (%EWL) (p = 0.023). The physical symptoms of dysphagia did not affect weight outcomes. Post-operatively, PPI usage increased significantly (15.8 vs 19.8%, p = 0.01) and correlated with higher dysphagia scores. CONCLUSION A statistically validated dysphagia-specific questionnaire was utilized to evaluate the impact of LSG on dysphagia including its functional and emotional influences. The psychosocial handicap of dysphagia significantly reduced weight loss outcomes. A correlation between PPI use and dysphagia after LSG was found. The prevalence of dysphagia after LSG and the factors that contribute to its symptoms need to be further studied.
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Affiliation(s)
- Sukaina Jaffar
- Department of Upper Gastrointestinal Surgery and General Surgery, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia.
| | - Michael Devadas
- Department of Upper Gastrointestinal Surgery and General Surgery, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia.,Department of Bariatric Surgery and Upper Gastrointestinal Surgery, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia.,Centre for Bariatric and Metabolic Surgery, Circle of Care - Institute of Weight Control, Hospital for Specialist Surgery, Sydney, NSW, Australia.,Department of Upper Gastrointestinal Surgery and General Surgery, Nepean Private Hospital, Sydney, NSW, Australia.,Department of Upper Gastrointestinal Surgery and General Surgery, Norwest Private Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Zeng Y, Yip J, Cui H, Guan L, Zhu H, Zhang W, Du H, Geng X. Efficacy of neuromuscular electrical stimulation in improving the negative psychological state in patients with cerebral infarction and dysphagia. Neurol Res 2018; 40:473-479. [PMID: 29726748 DOI: 10.1080/01616412.2018.1451015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective To observe the improvement of negative affect disorders in patients with cerebral infarction and dysphagia by neuromuscular electrical stimulation. Methods One hundred and twelve patients with cerebral infarction and dysphagia were selected and randomized into treatment (n = 59) and control (n = 53) groups. Similar swallowing function was found in both groups before treatment: (1) Water-drinking test in the treatment group proved swallowing function Level III in 24 cases, Level IV in 22 cases and Level V in 13 cases; (2) in the control group, swallowing function was Level III in 21 cases, Level IV in 20 cases and Level V in 12 cases. Both groups received conventional drug therapy and swallowing training. The treatment group additionally received neuromuscular electrical stimulation. Both groups underwent water-drinking test evaluation, Hamilton Anxiety Scale test, and Hamilton Depression Scale test before and after treatment. Results After two courses of treatment, the rate of improvement in swallowing function was 88.1% in the treatment group while 69.8% in the control group. Somatic anxiety, psychogenic anxiety and total scores in the Hamilton Anxiety Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.01). Anxiety, cognitive disorder, psychomotor retardation and total scores in the Hamilton Depression Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.05). Conclusion Patients with cerebral infarction and dysphagia have varying degrees of anxiety, depression, and other negative affect disorders, which could be minimized by neuromuscular electrical stimulation in conjunction with conventional therapy.
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Affiliation(s)
- Yanfang Zeng
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - James Yip
- b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA
| | - Hongli Cui
- c Department of General Surgery , Beijing Chuiyangliu Hospital , Beijing , China
| | - Longfei Guan
- d China-America Institute of Neuroscience , Beijing Luhe Hospital , Beijing , China
| | - Haomeng Zhu
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Weidong Zhang
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Huishan Du
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China
| | - Xiaokun Geng
- a Department of Neurology , Beijing Luhe Hospital, Capital Medical University , Beijing , China.,b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA.,d China-America Institute of Neuroscience , Beijing Luhe Hospital , Beijing , China
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23
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Sun L, Zhao F, Zeng Y, Yi C. Risks and Benefits of Multimodal Esophageal Cancer Treatments: A Meta-Analysis. Med Sci Monit 2017; 23:889-910. [PMID: 28214903 PMCID: PMC5330207 DOI: 10.12659/msm.903328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal cancer has traditionally been associated with very poor outcomes. A number of therapies are available for the treatment and palliation of esophageal cancer, but little systematic evidence compares the efficacy of different treatment strategies. This meta-analysis aimed to investigate whether treatments in addition to radiotherapy could provide better efficacy and safety. MATERIAL AND METHODS We identified a total of 12 eligible studies with 18 study arms by searching PubMed, the Cochrane Library, EMBASE, and Clinical Trials.gov without time or language restrictions. The final search was conducted on 17 August 2016. We calculated mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) for continuous and dichotomous data, respectively. Heterogeneity was calculated and reported using Tau², Chi², and I² analyses. RESULTS Twelve studies with 18 study arms were included in the analysis. Addition of surgery to chemo-radiotherapy resulted in improved median survival time (p=0.009) compared with chemo-radiotherapy alone, but all other outcomes were unaffected. Strikingly, and in contrast with patients with squamous cell carcinomas, the subset of patients with adenocarcinoma who received therapies in addition to radiotherapy showed a significant improvement in median survival time (p<0.0001), disease-free survival (p=0.007), 2-year survival rates (p=0.002), and 3-year survival rates (p=0.01). The incidence of adverse effects increased substantially with additional therapies. CONCLUSIONS This meta-analysis reveals stark differences in outcomes in patients depending on the type of carcinoma. Patients with squamous cell carcinoma should be educated about the risks and benefits of undergoing multiple therapies.
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Affiliation(s)
- Lei Sun
- Department of Second Internal Medicine, No. 4 West China Teaching Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Fen Zhao
- Department of Medical Oncology, Chengdu First People's Hospital, Chengdu, Sichuan, China (mainland)
| | - Yan Zeng
- Department of Pathophysiology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Cheng Yi
- Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
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Dong Y, Zhang CJ, Shi J, Deng J, Lan CN. Clinical application of ICF key codes to evaluate patients with dysphagia following stroke. Medicine (Baltimore) 2016; 95:e4479. [PMID: 27661012 PMCID: PMC5044882 DOI: 10.1097/md.0000000000004479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study was aimed to identify and evaluate the International Classification of Functioning (ICF) key codes for dysphagia in stroke patients. Thirty patients with dysphagia after stroke were enrolled in our study. To evaluate the ICF dysphagia scale, 6 scales were used as comparisons, namely the Barthel Index (BI), Repetitive Saliva Swallowing Test (RSST), Kubota Water Swallowing Test (KWST), Frenchay Dysarthria Assessment, Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Multiple regression analysis was performed to quantitate the relationship between the ICF scale and the other 7 scales. In addition, 60 ICF scales were analyzed by the least absolute shrinkage and selection operator (LASSO) method. A total of 21 ICF codes were identified, which were closely related with the other scales. These included 13 codes from Body Function, 1 from Body Structure, 3 from Activities and Participation, and 4 from Environmental Factors. A topographic network map with 30 ICF key codes was also generated to visualize their relationships. The number of ICF codes identified is in line with other well-established evaluation methods. The network topographic map generated here could be used as an instruction tool in future evaluations. We also found that attention functions and biting were critical codes of these scales, and could be used as treatment targets.
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Affiliation(s)
- Yi Dong
- Mawangdui Hospital of Hunan Province
| | - Chang-Jie Zhang
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jie Shi
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Chun-Na Lan
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, China
- Correspondence: Chun-Na Lan, Department of Rehabilitation, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha 410011, China (e-mail: )
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25
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Miles A, Watt T, Wong WY, McHutchison L, Friary P. Complex Feeding Decisions: Perceptions of Staff, Patients, and Their Families in the Inpatient Hospital Setting. Gerontol Geriatr Med 2016; 2:2333721416665523. [PMID: 28680937 PMCID: PMC5486486 DOI: 10.1177/2333721416665523] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/19/2016] [Indexed: 11/18/2022] Open
Abstract
Objective: Where swallowing difficulties are chronic or progressive, or a patient is palliative, tube feeding is often not deemed appropriate. Instead, patients continue to eat and drink despite the risks of pneumonia and death. There is currently little evidence to guide clinical practice in this field often termed “risk feeding.” This qualitative study investigated staff, patient, and family member perceptions of risk feeding practices in one New Zealand hospital. Method: Twenty-nine staff members and six patients and/or their family were interviewed. Results: Thematic analysis revealed four global themes: supporting practice, communication, complexity of feeding decisions, and patient and family-centered care. Staff described limited education and organizational policy around risk feeding decisions. Communication was considered a major factor in the success. Conclusion: Feeding decisions are complex in the hospital environment. The themes identified in this study provide a foundation for hospital guideline development and implementation.
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Affiliation(s)
| | | | | | - Louise McHutchison
- The University of Auckland, New Zealand.,Hutt Valley District Health Board, Lower Hutt, New Zealand
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Shiao CC, Hsu HC, Chen IL, Weng CY, Chuang JC, Lin SC, Tsai FF, Chen ZY. Lower Barthel Index Is Associated with Higher Risk of Hospitalization-Requiring Pneumonia in Long-Term Care Facilities. TOHOKU J EXP MED 2016; 236:281-8. [PMID: 26250535 DOI: 10.1620/tjem.236.281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pneumonia is an important infectious entity that affects residents in long-term care facilities (LTCFs), whereas hospitalization-requiring pneumonia (HRP) represents a more critical patient condition with worse outcomes. The evidence addressing the association between Barthel index and risk of HRP among LTCF residents is lacking. A multicenter, retrospective cohort study was conducted in three LTCFs enrolling adult patients who resided for 3 months or more and ever underwent Barthel index evaluation within a study period of January 1 to December 31, 2010. The endpoint was HRP after enrollment. A total of 299 patients (169 women; age, 79.0 ± 12.2 years) were enrolled and categorized into HRP Group (n = 68; 36 women; age, 79.1 ± 11.3 years) and Non-HRP Group (n = 231; 133 women; age, 79.0 ± 12.4 years) by the endpoint. The patients in HRP Group had significantly lower Barthel index (8.6 versus 25.8 points, p < 0.001) but higher proportion of chronic obstructive pulmonary disease (13.2% versus 3.9%, p = 0.004). By the multivariate analysis of logistic regression, we found that lower Barthel index (odds ratio (OR), 0.967; p < 0.001), existence of chronic obstructive pulmonary disease (OR, 4.192; p = 0.015), and feeding route (percutaneous endoscopic gastrostomy comparing with oral feeding; OR, 0.177; p = 0.012) were independently associated with HRP. In conclusion, a lower Barthel index is significantly associated with the occurrence of pneumonia that requires hospitalization in long-term care residents. Barthel index is a useful and reliable tool for risk evaluation in this population.
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Mahmodlou R, Shateri K, Homayooni F, Hatami S. The effect of disc-shaped gastric resection of anastomosis site on reducing postoperative dysphagia and stricture after esophagogastric anastomosis in patients with esophageal cancer. Gastroenterol Rep (Oxf) 2016; 5:52-56. [PMID: 26893442 PMCID: PMC5444246 DOI: 10.1093/gastro/gow002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Esophagectomy remains the most reliable technique for managing esophageal cancer, but anastomotic complications including postoperative leak, ischemia and stricture negatively affect outcomes of this specific surgery. The aim of this study was to evaluate the effects of a novel method of esophagogastric anastomosis for reducing postoperative dysphagia and stricture formation. Methods: Eighty patients who were scheduled for esophagectomy due to esophageal cancer were randomly assigned into two groups: intervention and control (40 each). In the control group, the esophagogastric anastomosis was performed with a linear gastric incision, whilst in the intervention group a new method of disc-shaped gastric resection for anastomosis was applied. Postoperative outcomes were compared between the two groups. Results: The incidence of postoperative dysphagia and anastomotic stricture was significantly lower in the disc-shaped resection group (dysphagia 45% vs 75%, P = 0.02; stricture 12.5% vs 32.5%, P = 0.03), whilst the length of stay in an intensive care unit (ICU), anastomotic leakage and other complications were not significantly different between the two groups (all P > 0.05). Conclusion: Anastomotic complications can be reduced by improving surgical techniques. The decreased incidence of postoperative dysphagia and anastomotic stricture in our study may be partly due to providing the proper diameter for the site of anastomosis when using the disc-shaped gastric resection method. Hence, this new method can improve the clinical outcomes of patients who undergo esophagectomy with esophagogastric anastomosis.
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Affiliation(s)
- Rahim Mahmodlou
- Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Kamran Shateri
- Department of Gastroenterology, Urmia University of Medical Sciences, Urmia, Iran
| | - Faramarz Homayooni
- Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Sanaz Hatami
- Department of Surgery, Urmia University of Medical Sciences, Urmia, Iran Students' Research Committee, Urmia University of Medical Sciences, Urmia, Iran
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Abstract
Although people often refer to quality of life and there is a respectable research tradition to establish it, the meaning of the term is unclear. In this article we qualitatively study an intervention of which the quantitative effects are documented as indecisive. We do this in order to learn more about what the meaning of the term quality of life means when it is studied in daily life. With the help of these findings we reflect on the intricacies of objectifying and measuring quality of life using quantitative research designs. Our case is the feeding tube for patients suffering from ALS, a severe motor neuron disease that rapidly and progressively incapacitates patients. We studied how these patients, who lived in the Netherlands, anticipated and lived with a feeding tube in the course of their physical deterioration. Our analysis shows that the quality of life related to the feeding tube has to be understood as a process rather than as an outcome. The feeding tube becomes a different thing as patients move through the various phases of their illness, due to changes in their condition, living circumstances, and concerns and values. There are very different appreciations of the way the feeding tube changes the body's appearance and feel. Some patients refuse it because they feel it disfigures their body, whereas others are indifferent to its appearance. Our conclusion is that these differences are difficult to grasp with a quantitative study designs because 'matters of taste' and values are not distributed in a population in the same ways as physiological responses to medication. Effect studies assume physiological responses to be more or less the same for everyone, with only gradual differences. Our analysis of quality in daily life, however, shows that what a treatment comes to be and how it is valued shows shows generalities for subgroups rather than populations.
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Affiliation(s)
- Jeannette Pols
- Department of General Practice, Section of Medical Ethics, Academic Medical Centre, Postbus 22700, 1100 DE, Amsterdam, The Netherlands. .,Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Sarah Limburg
- Department of General Practice, Section of Medical Ethics, Academic Medical Centre, Postbus 22700, 1100 DE Amsterdam, The Netherlands
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Abstract
Integrative oncology uses non-pharmacological adjuncts to mainstream care to manage physical, emotional, and psychological symptoms experienced by cancer survivors. Depression, anxiety, fatigue and pain are among the common, often burdensome symptoms that can occur in clusters, deplete patient morale, interfere with treatment plans, and hamper recovery. Patients already seek various modalities on their own to address a broad range of problems. Legitimate complementary therapies offered at major cancer institutions improve quality of life, speed recovery, and optimize patient support. They also augment the benefits of psychiatric interventions, due to their ability to increase self-awareness and improve physical and psychological conditioning. Further, these integrated therapies provide lifelong tools and develop skills that patients use well after treatment to develop self-care regimens. The active referral of patients to integrative therapies achieves three important objectives: complementary care is received from therapists experienced in working with cancer patients, visits become part of the medical record, allowing treatment teams to guide individuals in maximizing benefit, and patients are diverted from useless or harmful 'alternatives.' We review the reciprocal physical and psychiatric benefits of exercise, mind-body practices, massage, acupuncture, and music therapy for cancer survivors, and suggest how their use can augment mainstream psychiatric interventions.
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Affiliation(s)
- Barrie R Cassileth
- Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center , New York , USA
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