1
|
Yli-Hukka J, Lignell J, Eriksson K, Bergström L. Dysphagia terminology for texture modified fluid and food: a national survey of speech-language pathologists' practice. LOGOP PHONIATR VOCO 2024; 49:47-57. [PMID: 36067123 DOI: 10.1080/14015439.2022.2117844] [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: 11/01/2021] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate: (a) Swedish Speech-Language Pathologists (SLPs) dysphagia management with TMC, including terminology, inter-professional collaboration, and knowledge of standard TMC guides; and (b) the current TMC terminology/guides used within university hospitals, in Sweden. METHOD Part One surveyed SLPs from 19/21 regions. Recruitment occurred via regional SLP/department managers, the national SLP association and email lists. Non-parametric statistics were employed. Part Two explored TMC guides within the seven university hospitals. RESULT The initial survey identified 78 Swedish TMC terms. Overlap of both TMC terms and descriptions occurred. Different terms to describe same/similar textures were used by 70% of the SLPs. Knowledge of established guides was high (>90%), though TMC was often (60%) based on locally developed documents. Collaboration with other professions was reported by 97% of SLPs, however almost half perceived collaboration to be inadequate, citing difficulties with transfer of TMC recommendations. Variance in TMC terms/guides within/across the university hospitals occurred. CONCLUSION Variable TMC terminology is used in Sweden, impacting optimal dysphagia management. Future research should focus upon implementation of standardised TMC terminology.
Collapse
Affiliation(s)
- Julia Yli-Hukka
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Neurology and Rehabilitation Medicine, Region Västra Götaland, Södra Älvsborg Hospital, Borås, Sweden
| | - Joanna Lignell
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Allied Health, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - Karin Eriksson
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Pulmonary Disease, Allergology and Palliative Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Liza Bergström
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- REMEO Stockholm, Torsten Levenstams väg 8, Stockholm, Sweden
- Division of Neurology, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Gallegos C, Turcanu M, Assegehegn G, Brito-de la Fuente E. Rheological Issues on Oropharyngeal Dysphagia. Dysphagia 2023; 38:558-585. [PMID: 34216239 DOI: 10.1007/s00455-021-10337-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
There is an increasing proof of the relevance of rheology on the design of fluids for the diagnosis and management of dysphagia. In this sense, different authors have reported clinical evidence that support the conclusion that an increase in bolus viscosity reduces the risks of airway penetration during swallowing. However, this clinical evidence has not been associated yet to the definition of objective viscosity levels that may help to predict a safe swallowing process. In addition, more recent reports highlight the potential contribution of bolus extensional viscosity, as elongational flows also develops during the swallowing process. Based on this background, the aim of this review paper is to introduce the lecturer (experts in Dysphagia) into the relevance of Rheology for the diagnosis and management of oropharyngeal dysphagia (OD). In this sense, this paper starts with the definition of some basic concepts on Rheology, complemented by a more extended vision on the concepts of shear viscosity and elongational viscosity. This is followed by a short overview of shear and elongational rheometrical techniques relevant for the characterization of dysphagia-oriented fluids, and, finally, an in-depth analysis of the current knowledge concerning the role of shear and elongational viscosities in the diagnosis and management of OD (shear and elongational behaviors of different categories of dysphagia-oriented products and contrast fluids for dysphagia assessment, as well as the relevance of saliva influence on bolus rheological behavior during the swallowing process).
Collapse
Affiliation(s)
- Crispulo Gallegos
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany.
| | - Mihaela Turcanu
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
| | - Getachew Assegehegn
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
| | - Edmundo Brito-de la Fuente
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
| |
Collapse
|
3
|
Matsuo H, Sakuma K. Pathophysiology of Cachexia and Characteristics of Dysphagia in Chronic Diseases. Asia Pac J Oncol Nurs 2022; 9:100120. [PMID: 36118624 PMCID: PMC9471339 DOI: 10.1016/j.apjon.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Haruyo Matsuo
- Departments of Nursing, Kagoshima Medical Association Hospital, Kagoshima, Japan
| | - Kunihiro Sakuma
- Institute for Liberal Arts, Environment and Society, Tokyo Institute of Technology, Tokyo, Japan
- Corresponding author.
| |
Collapse
|
4
|
Wu XS, Miles A, Braakhuis A. An Evaluation of Texture-Modified Diets Compliant with the International Dysphagia Diet Standardization Initiative in Aged-Care Facilities Using the Consolidated Framework for Implementation Research. Dysphagia 2022; 37:1314-1325. [PMID: 34993611 DOI: 10.1007/s00455-021-10393-2] [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: 05/27/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
Texture-modified diets (TMDs) are commonly prescribed for older adults with swallowing difficulties to improve swallowing safety. The International Dysphagia Diet Standardization Initiative (IDDSI) provides a framework for terminology, definitions and testing of TMDs. This observational mixed-method study used the consolidated framework for implementation research (CFIR) to establish the barriers and enablers to IDDSI adoption in aged-care facilities (ACFs). Five New Zealand ACFs who had adopted IDDSI > 12 months previously were recruited. Evaluation tools were developed based on CFIR constructs, integrating data from (i) mealtime observations; (ii) manager interviews and (iii) staff (nursing, carers and kitchen) self-administrated surveys. All facility and kitchen managers were IDDSI aware and had access to online resources. Three sites had changed to commercially compliant products post-IDDSI adoption, which had cost implications. Awareness of IDDSI amongst staff ranged from 5 to 79% and < 50% of staff surveyed felt sufficiently trained. Awareness was greater in large sites and where IDDSI was mandated by head office. Managers had not mandated auditing and they felt this had led to reduced perceived importance. Managers felt staff required more training and staff wanted more training, believing it would improve food safety and quality of care. Lack of a dedicated project leader and no speech pathologist on-site were perceived barriers. Collaboration between healthcare assistants, kitchen staff and allied health assisted implementation. ACF staff were aware of IDDSI but staff awareness was low. Using the CFIR, site specific and generic barriers and enablers were identified to improve future implementation effectiveness. Managers and staff want access to regular training. Multidisciplinary collaboration and improving communication are essential. ACFs should consider TMD auditing regularly. Successful implementation of IDDSI allows improvement of quality of care and patient safety but requires a systematic, site-specific implementation plan.
Collapse
Affiliation(s)
- Xiaojing Sharon Wu
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142, New Zealand.
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Andrea Braakhuis
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142, New Zealand
| |
Collapse
|
5
|
Improving Accuracy of Texture-Modified Diets and Thickened Fluids Provision in the Hospital: Evidence in Action. Dysphagia 2021; 37:488-500. [PMID: 33891191 DOI: 10.1007/s00455-021-10294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
Ensuring inpatients with dysphagia receive and consume the correct texture-modified diet and thickened fluid prescriptions is challenging, and errors can result in significant complications for patients and increased costs to hospitals. The aim of this study was to investigate underlying factors that help or hinder receipt and consumption of correct dietary prescriptions for people with dysphagia in the hospital setting then implement and evaluate a range of strategies to address identified issues. A mixed-methods study design, using an integrated knowledge translation approach, was conducted in three phases. In Phase 1, clinical incident data (i.e., documented incidents of diet/fluid errors, with errors defined as the provision or consumption of any food/fluid not appropriate for a patient's dietary prescription) were analyzed, and staff, patients, and family members were interviewed using the Theoretical Domains Framework to identify factors contributing to errors. In Phase 2, health professionals assisted with the development and implementation of interventions targeted at micro (patient/family), meso (staff), and macro (organizational) levels to address factors identified in Phase 1. In Phase 3, outcomes including the change in number of dietary clinical incidents pre- to post-intervention, meal accuracy error rates from mealtime audits post-intervention, and follow-up interviews were evaluated using quantitative and qualitative measures. Post-intervention, there was a 50% reduction in clinical incidents, and a 2.3% meal accuracy error rate was observed. Staff reported most interventions were acceptable and feasible within their workload, although some interventions were not well embedded in everyday practice. This study highlights the value in using an integrated knowledge translation approach to inform tailored interventions targeting improved dietary accuracy in the hospital setting.
Collapse
|
6
|
Fennelly O, Grogan L, Reed A, Hardiker NR. Use of standardized terminologies in clinical practice: A scoping review. Int J Med Inform 2021; 149:104431. [PMID: 33713915 DOI: 10.1016/j.ijmedinf.2021.104431] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
AIM To explore the use and impact of standardized terminologies (STs) within nursing and midwifery practice. INTRODUCTION The standardization of clinical documentation creates a potential to optimize patient care and safety. Nurses and midwives, who represent the largest proportion of the healthcare workforce worldwide, have been using nursing-specific and multidisciplinary STs within electronic health records (EHRs) for decades. However, little is known regarding ST use and impact within clinical practice. METHODS A scoping review of the literature was conducted (2019) across PubMed, CINAHL, Embase and CENTRAL in collaboration with the Five Country Nursing and Midwifery Digital Leadership Group (DLG). Identified studies (n = 3547) were reviewed against a number of agreed criterion, and data were extracted from included studies. Studies were categorized and findings were reviewed by the DLG. RESULTS One hundred and eighty three studies met the inclusion criteria. These were conducted across 25 different countries and in various healthcare settings, utilising mainly nursing-specific (most commonly NANDA-I, NIC, NOC and the Omaha System) and less frequently local, multidisciplinary or medical STs (e.g., ICD). Within the studies, STs were evaluated in terms of Measurement properties, Usability, Documentation quality, Patient care, Knowledge generation, and Education (pre and post registration). As well as the ST content, the impact of the ST on practice depended on the healthcare setting, patient cohort, nursing experience, provision of education and support in using the ST, and usability of EHRs. CONCLUSION Employment of STs in clinical practice has the capability to improve communication, quality of care and interoperability, as well as facilitate value-based healthcare and knowledge generation. However, employment of several different STs and study heterogeneity renders it difficult to aggregate and generalize findings.
Collapse
Affiliation(s)
- Orna Fennelly
- Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive (HSE), Ireland.
| | - Angela Reed
- Northern Ireland Practice & Education Council for Nursing and Midwifery, Northern Ireland.
| | | |
Collapse
|
7
|
Xie Y, Zhao W, Yu W, Lin X, Tao S, Prakash S, Dong X. Validating the textural characteristics of soft fish-based paste through International Dysphagia Diet Standardisation Initiative recommended tests. J Texture Stud 2020; 52:240-250. [PMID: 33315243 DOI: 10.1111/jtxs.12578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/05/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
One in every twelve people worldwide suffers from dysphagia that affects the swallowing mechanism and some patients require a special texture-modified food for their sustenance. Fish is a great source of nutrients and proteins, however the commercially dysphagia diet made from fish is limited. This study investigated the textural characteristics of a soft fish paste produced from steamed grass carp fillet with different the water addition, grinding cycles and ratio of starch with the mixture of steamed fillet and water, following International Dysphagia Diet Standardisation Initiative (IDDSI) guidelines and other instruments. The water addition and particle size affected the physical properties, and the starch had a certain masking effect on fishy odor. The mixture of steamed fish fillets and water (91:9 wt/wt) was ground in a colloid mill for 3 cycles. The fish paste was then sterilized by adding sugar, salt, and starch in the mixture (ratios of 0.5:100, 0.5:100, and 0.6:100, wt/wt, respectively) and mixing well. The paste conformed to Level 4-pureed and extremely thick of IDDSI framework. The fish paste product had a light fishy odor that was acceptable to sensory specialists.
Collapse
Affiliation(s)
- Yisha Xie
- National Engineering Research Center of Seafood, Collaborative Innovation Center of Provincial and Ministerial Co-construction for Seafood Deep Processing, Liaoning Province Collaborative Innovation Center for Marine Food Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian, People's Republic of China
| | - Wenyu Zhao
- National Engineering Research Center of Seafood, Collaborative Innovation Center of Provincial and Ministerial Co-construction for Seafood Deep Processing, Liaoning Province Collaborative Innovation Center for Marine Food Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian, People's Republic of China
| | - Wanying Yu
- National Engineering Research Center of Seafood, Collaborative Innovation Center of Provincial and Ministerial Co-construction for Seafood Deep Processing, Liaoning Province Collaborative Innovation Center for Marine Food Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian, People's Republic of China
| | - Xiaoyu Lin
- National Engineering Research Center of Seafood, Collaborative Innovation Center of Provincial and Ministerial Co-construction for Seafood Deep Processing, Liaoning Province Collaborative Innovation Center for Marine Food Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian, People's Republic of China
| | - Shuaifei Tao
- National Engineering Research Center of Seafood, Collaborative Innovation Center of Provincial and Ministerial Co-construction for Seafood Deep Processing, Liaoning Province Collaborative Innovation Center for Marine Food Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian, People's Republic of China
| | - Sangeeta Prakash
- School of Agriculture and Food Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Xiuping Dong
- National Engineering Research Center of Seafood, Collaborative Innovation Center of Provincial and Ministerial Co-construction for Seafood Deep Processing, Liaoning Province Collaborative Innovation Center for Marine Food Deep Processing, School of Food Science and Technology, Dalian Polytechnic University, Dalian, People's Republic of China
| |
Collapse
|
8
|
Are Medication Swallowing Lubricants Suitable for Use in Dysphagia? Consistency, Viscosity, Texture, and Application of the International Dysphagia Diet Standardization Initiative (IDDSI) Framework. Pharmaceutics 2020; 12:pharmaceutics12100924. [PMID: 32998301 PMCID: PMC7601516 DOI: 10.3390/pharmaceutics12100924] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 12/03/2022] Open
Abstract
Medication lubricants are thick liquids or gels that are designed to aid swallowing of solid oral dosage forms. Tablets and capsules are placed within a spoonful of the product for swallowing. The aim of this study was to describe and compare commercially available medication lubricants in terms of textural suitability for patients with dysphagia. Twelve medication lubricants were characterised according to the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. Apparent viscosity, yield stress, thickness consistency, and various texture features were compared. Gloup Forte was the only medication lubricant classified as IDDSI level 4 (pureed/extremely thick) at room (24 °C) temperature. Four other Gloup products were IDDSI level 3 (liquidised/moderately thick) at room temperature but testing at 4 °C or pouring from the container instead of using the pump dispenser resulted in classification as IDDSI level 4. The IDDSI Flow test would have classified MediSpend and Slo Tablets as IDDSI level 3, but their very low yield stress led to these fluids flowing too quickly through the prongs of a fork and so these were classified as <3. Severo was IDDSI level 2. Heyaxon and the two versions of Magic Jelly tested contained lumps, and Swallow Aid had exceptionally high viscosity, hardness, adhesiveness, and gumminess, classifying them as IDDSI Level 7 (“regular textures”) and therefore as unsuitable for people with dysphagia according to IDDSI. This study provides valuable information to help with the selection of a safe medication lubricant with appropriate thickness level suited to each individual with dysphagia.
Collapse
|
9
|
Controlling the rheological properties of wheat starch gels using Lepidium perfoliatum seed gum in steady and dynamic shear. Int J Biol Macromol 2020; 143:928-936. [DOI: 10.1016/j.ijbiomac.2019.09.153] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/24/2019] [Accepted: 09/22/2019] [Indexed: 12/24/2022]
|
10
|
Hadde EK, Nicholson TM, Cichero JAY. Evaluation of Thickened Fluids Used in Dysphagia Management Using Extensional Rheology. Dysphagia 2019; 35:242-252. [PMID: 31115661 DOI: 10.1007/s00455-019-10012-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
Recent studies show that understanding the rheological properties of thickened fluids, such as viscosity and yield stress, is advantageous in designing optimal thickened fluids for the treatment of dysphagia. To date, these studies have focused on the rheological behavior of thickened fluids in shear deformation, while limited information is available on the surface tension of thickened fluids or their rheological behavior in extensional deformation. Knowledge of the extensional properties of thickened fluids (extensional viscosity and cohesiveness) is important to fully understand the behavior of such fluids while swallowing. Our aim in this work, therefore, was to characterize water and skim milk thickened with a commercial thickener (xanthan gum based) to determine extensional deformation and surface tension properties. It was observed that the surface tension decreases as the thickener concentration increases due to the accumulation of the biopolymer at the surface of the fluid when it dissolves in water. In addition, the extensional viscosity of the fluid increased over time as the filament thinned (i.e., as the Hencky strain increased) until it reached a plateau. It was observed that the maximum extensional viscosity, which is related to the cohesiveness of the fluid, increases with the higher concentrations of thickener. However, the cohesiveness of thickened skim milk was lower than that of the thickened water at a given thickener concentration due to lower surface tension. This study confirms that by increasing the concentration of thickener, it will not only increase the shear viscosity (i.e., bolus thickness) of the fluid, but also the extensional viscosity (i.e., bolus cohesiveness).
Collapse
Affiliation(s)
- E K Hadde
- School of Chemical Engineering, The University of Queensland, St Lucia, QLD, 4072, Australia.,School of Food Science and Engineering, Zhejiang Gongshang University, Hangzhou, 310018, Zhejiang, China
| | - T M Nicholson
- School of Chemical Engineering, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - J A Y Cichero
- School of Pharmacy, The University of Queensland, St Lucia, QLD, 4072, Australia
| |
Collapse
|
11
|
Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev 2018; 135:75-84. [PMID: 29660383 DOI: 10.1016/j.addr.2018.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 02/15/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.
Collapse
Affiliation(s)
- Esther T L Lau
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Julie A Y Cichero
- School of Pharmacy, The University of Queensland, Brisbane, QLD 4102, Australia.
| | - Lisa M Nissen
- School of Clinical Sciences, QUT (Queensland University of Technology), Gardens Point Campus, 2 George St, Brisbane, QLD 4000, Australia.
| |
Collapse
|
12
|
Cichero JAY, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M, Riquelme L, Stanschus S. Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework. Dysphagia 2017; 32:293-314. [PMID: 27913916 PMCID: PMC5380696 DOI: 10.1007/s00455-016-9758-y] [Citation(s) in RCA: 462] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/08/2016] [Indexed: 12/20/2022]
Abstract
Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3-4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0-7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.
Collapse
Affiliation(s)
- Julie A Y Cichero
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia.
- School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, 20 Cornwall St, Brisbane, QLD, 4102, Australia.
| | - Peter Lam
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
- Peter Lam Consulting, Vancouver, BC, Canada
| | - Catriona M Steele
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ben Hanson
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Department of Mechanical Engineering, University College London, London, UK
| | - Jianshe Chen
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Zhejiang Gongshang University, Hangzhou, China
| | - Roberto O Dantas
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Janice Duivestein
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Access Community Therapists, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jun Kayashita
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Department of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Caroline Lecko
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- National Health Service Improvement, London, UK
| | - Joseph Murray
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Ann Arbor Veterans Affairs, Ann Arbor, MI, USA
| | - Mershen Pillay
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Speech Pathology, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
- Manchester Metropolitan University, Manchester, UK
| | - Luis Riquelme
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Department of Speech-Language Pathology, New York Medical College, Valhalla, NY, USA
- Barrique Speech-Language Pathology at Center for Swallowing & Speech-Language Pathology, New York Methodist Hospital, Brooklyn, NY, USA
| | - Soenke Stanschus
- International Dysphagia Diet Standardisation Initiative (IDDSI) Working Committee, Brisbane, QLD, Australia
- Swallowing and Speech Pathology, Hospital zum Heiligen Geist, Kempen, Germany
| |
Collapse
|
13
|
Karsten Hadde E, Ann Yvette Cichero J, Michael Nicholson T. Viscosity of thickened fluids that relate to the Australian National Standards. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:402-410. [PMID: 27063673 DOI: 10.3109/17549507.2015.1081289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/22/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE In 2007, Australia published standardized terminology and definitions for three levels of thickened fluids used in the management of dysphagia. This study examined the thickness of the current Australian National Fluid Standards rheologically (i.e. viscosity, yield stress) and correlated these results with the "fork test", as described in the national standards. METHOD Clinicians who prescribe or work with thickened liquids and laypersons were recruited to categorize 15 different thickened fluids of known viscosities using the fork test. The mean apparent viscosity and the yield stress for each fluid category were calculated. RESULT Clear responses were obtained by both clinicians and laypersons for very thin fluids (< 90 mPa.s) and very thick fluids (> 1150 mPa.s), but large variations of responses were seen for intermediate viscosities. Measures of viscosity and yield stress were important in allocating liquids to different categories. CONCLUSION Three bands of fluid viscosity with distinct intermediate band gaps and associated yield stress measures were clearly identifiable and are proposed as objective complements to the Australian National Standards. The "fork test" provides rudimentary information about both viscosity and yield stress, but is an inexact measure of both variables.
Collapse
Affiliation(s)
- Enrico Karsten Hadde
- a School of Chemical Engineering, The University of Queensland , St Lucia , Australia and
| | | | | |
Collapse
|
14
|
Manrique YJ, Sparkes AM, Cichero JAY, Stokes JR, Nissen LM, Steadman KJ. Oral medication delivery in impaired swallowing: thickening liquid medications for safe swallowing alters dissolution characteristics. Drug Dev Ind Pharm 2016; 42:1537-44. [PMID: 26857812 DOI: 10.3109/03639045.2016.1151033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acetaminophen (paracetamol) is available in a wide range of oral formulations designed to meet the needs of the population across the age-spectrum, but for people with impaired swallowing, i.e. dysphagia, both solid and liquid medications can be difficult to swallow without modification. The effect of a commercial polysaccharide thickener, designed to be added to fluids to promote safe swallowing by dysphagic patients, on rheology and acetaminophen dissolution was tested using crushed immediate-release tablets in water, effervescent tablets in water, elixir and suspension. The inclusion of the thickener, comprised of xanthan gum and maltodextrin, had a considerable impact on dissolution; acetaminophen release from modified medications reached 12-50% in 30 min, which did not reflect the pharmacopeia specification for immediate release preparations. Flow curves reflect the high zero-shear viscosity and the apparent yield stress of the thickened products. The weak gel nature, in combination with high G' values compared to G'' (viscoelasticity) and high apparent yield stress, impact drug release. The restriction on drug release from these formulations is not influenced by the theoretical state of the drug (dissolved or dispersed), and the approach typically used in clinical practice (mixing crushed tablets into pre-prepared thickened fluid) cannot be improved by altering the order of incorporation or mixing method.
Collapse
Affiliation(s)
- Yady J Manrique
- a School of Pharmacy , The University of Queensland , Brisbane , Australia
| | - Arron M Sparkes
- a School of Pharmacy , The University of Queensland , Brisbane , Australia
| | - Julie A Y Cichero
- a School of Pharmacy , The University of Queensland , Brisbane , Australia
| | - Jason R Stokes
- b School of Chemical Engineering , The University of Queensland , Brisbane , Australia
| | - Lisa M Nissen
- c School of Clinical Sciences , Queensland University of Technology , Brisbane , Australia
| | - Kathryn J Steadman
- a School of Pharmacy , The University of Queensland , Brisbane , Australia
| |
Collapse
|
15
|
Ilhamto N, Anciado K, Keller HH, Duizer LM. In-house pureed food production in long-term care: perspectives of dietary staff and implications for improvement. J Nutr Gerontol Geriatr 2014; 33:210-228. [PMID: 25105716 DOI: 10.1080/21551197.2014.927306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Texture modification of foods to a pureed consistency is a common management approach for older adults with dysphagia. Long-term care (LTC) facilities commonly produce some pureed food in-house. This study investigated challenges and preferred practices associated with the production of pureed food in LTC facilities. Nutrition Managers (n = 27) and cooks (n = 26) from 25 Ontario LTC facilities were recruited for one-on-one, semistructured interviews. Interviews were digitally recorded, transcribed, and analyzed using inductive thematic analysis. Four themes arose from the data to exemplify challenges in production, including (a) difficulty in using standardized recipes, (b) varied interpretation of governmental guidelines, (c) lack of consistency in terminology and texture, and (d) wanting to improve the visual appeal. These challenges were reported to reduce the quality of in-house produced pureed food. Preferred practices to overcome these challenges were also provided by participants, such as involving cooks in pureed recipe improvements and tailoring to the specific needs of residents. Incorporation of these practices into pureed food production may help to shape and improve future practice and pureed food products.
Collapse
Affiliation(s)
- Nila Ilhamto
- a Elmira Pet Products , Elmira , Ontario , Canada
| | | | | | | |
Collapse
|
16
|
Cichero JAY, Steele C, Duivestein J, Clavé P, Chen J, Kayashita J, Dantas R, Lecko C, Speyer R, Lam P, Murray J. The Need for International Terminology and Definitions for Texture-Modified Foods and Thickened Liquids Used in Dysphagia Management: Foundations of a Global Initiative. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013; 1:280-291. [PMID: 24392282 PMCID: PMC3873065 DOI: 10.1007/s40141-013-0024-z] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Conservative estimates suggest that dysphagia (difficulty swallowing) affects approximately 8 % of the world's population. Dysphagia is associated with malnutrition, dehydration, chest infection and potentially death. While promising treatments are being developed to improve function, the modification of food texture and liquid thickness has become a cornerstone of dysphagia management. Foods are chopped, mashed or puréed to compensate for chewing difficulties or fatigue, improve swallowing safety and avoid asphyxiation. Liquids are typically thickened to slow their speed of transit through the oral and pharyngeal phases of swallowing, to avoid aspiration of material into the airway and improve transit to the esophagus. Food texture and liquid modification for dysphagia management occurs throughout the world. However, the names, the number of levels of modification and characteristics vary within and across countries. Multiple labels increase the risk to patient safety. National standardization of terminology and definitions has been promoted as a means to improve patient safety and inter-professional communication. This article documents the need for international standardized terminology and definitions for texture-modified foods and liquids for individuals with dysphagia. Furthermore, it documents the research plan and foundations of a global initiative dedicated to this purpose.
Collapse
Affiliation(s)
- Julie A. Y. Cichero
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Brisbane, QLD 4102 Australia
| | | | | | - Pere Clavé
- Unitat d’Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Mataró, Barcelona Spain
| | - Jianshe Chen
- Food Science, University of Leeds, West Yorkshire, UK
| | - Jun Kayashita
- Department of Health Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Roberto Dantas
- Departmento de Clinica Medica, Faculdade de Medecina de Ribeirao Preto, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Renee Speyer
- Speech Pathology Discipline, James Cook University, Townsville, QLD Australia
| | - Peter Lam
- Peter Lam Consulting, Vancouver, BC Canada
| | | |
Collapse
|
17
|
Cichero JAY. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J 2013; 12:54. [PMID: 23634758 PMCID: PMC3660277 DOI: 10.1186/1475-2891-12-54] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 04/24/2013] [Indexed: 01/19/2023] Open
Abstract
Dysphagia is the medical term for difficulty swallowing. Thickened liquids are often used in the management of dysphagia to improve bolus control and to help prevent aspiration. A range of starches and gums has historically been used to thicken liquids. Although thickened liquids improve swallow safety, they appear to have a great potential for unintended physiological consequences. Initial concerns were raised about the impact of thickeners on water binding due to the high prevalence of dehydration amongst individuals with dysphagia. Thankfully, regardless of thickening agent, thickeners do not affect water bioavailability. This effect holds true even for extremely thick fluids. However, bioavailability of medication is impaired with viscous substances. Liquids thickened to as little as 150 mPa.s retards drug release. In addition, feelings of satiety and thirst increase with increasingly viscous fluids. Flavour deteriorates with increasing thickness regardless of thickening agent. Therapeutically clinicians often prescribe small volumes of thickened liquids, consumed often. Yet small volumes of thick substances consumed with a long oral processing time, which is common for individuals with dysphagia, reduces the amount consumed. A combination of poor flavour, and increasing feelings of fullness result in little motivation and poor physiologic drive to consume thickened liquids. This review provides evidence from the dysphagia, pharmaceutical and food technology literature to show unintended side effects of thickened liquids that contribute to dehydration and potential sub-theraputic medication levels for individuals with dysphagia. The physical property of viscosity rather than a particular thickening agent appears to be key. Provision of “spoon-thick” or “extremely thick liquids” is particularly likely to contribute to dehydration and poor bioavailability of solid dose medication. Clinicians are encouraged to prescribe the minimal level of thickness needed for swallowing safety. Consultation with pharmacy and dietetic staff is essential for optimum management of individuals with dysphagia. Given the aged population forecasts for the year 2050, improved dysphagia management should be a high priority.
Collapse
|
18
|
McCormack J, O'Callaghan A. Diversity and development: selected papers from the Speech Pathology Australia National Conference (2011). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 14:187-188. [PMID: 22563894 DOI: 10.3109/17549507.2012.679314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|