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Purpose: The early identification of oropharyngeal dysphagia (OD) in patients after an acute stroke using non-invasive and easily administered instruments can minimize its consequences and reduce comorbidity and mortality. The Volume-Viscosity Swallow Test (V-VST) is a screening test that makes it possible. The goal of this study is to contribute to the validation of the V-VST European Portuguese (V-VST: EP) version and study the prevalence of safety and efficacy signs in acute stroke patients. Method: The V-VST: EP, its instructions manual and algorithm, was presented to a panel of experts, to assess its content validity. It was applied to 33 acute stroke patients, with signs of OD, to analyze its psychometric properties. Finally, the prevalence of impaired signs of safety and efficacy was analyzed. Results: The V-VST: EP and its instruction manual (content) demonstrate very good agreement values. Most of the results for inter and intra-evaluator reliability presented Cohen’s kappa values higher than 0.60 or 0.80 (75.0%). The concurrent validity (against the 3 OZ wst) presented a sensitivity of 100% and a specificity of 57.1%. For evaluator 1, the results presented are for the nectar, liquid and pudding consistencies, the prevalence values for the 5 ml, 10 ml and 20ml volume capacity was: impaired lip closure (36%, 39%, 18%), piecemeal deglutition (50%, 50%, 50%), oral residue (7%, 0%, 9%), pharyngeal residue (25%, 17%, 9%) and safe swallowing (89%, 33%, 94%), respectively. Propósito: La identificación temprana de la disfagia orofaríngea (DO) en pacientes después de un accidente cerebrovascular, utilizando instrumentos no invasivos y de fácil administración, puede minimizar sus consecuencias y reducirla comorbilidad y la mortalidad. El examen VolumeViscosity Swallow Test (V-VST) es una prueba de detección que lo hace posible. El objetivo de este estudio es contribuir para la validación del V-VST Versión en portugués europeo (V-VST: EP) y estudio de prevalencia de signos de seguridad y eficacia en pacientes con ictus agudo. Método: Se presentó el V-VST: EP, su manual de instrucciones y algoritmo, a un panel de expertos, para evaluar su validez de contenido. Se aplicó a 33 pacientes con ictus agudo, con signos de DO, para analizar sus propiedades psicométricas. Finalmentese analizó la prevalencia de senales ˜ de deterioro de seguridad y eficacia. Resultados: El V-VST: EP y su manual de instrucciones (contenido) demuestran valores demuy buenaconcordancia. La mayoría de los resultados de confiabilidad inter e intra evaluador presentaron valoreskappa de Cohen superiores a 0,60 o 0,80 (75,0%). La validez concurrente (contra el peso de 3 OZ) presentada una sensibilidad del 100% y una especificidad del 57,1%. Para el evaluador 1, los resultados presentados son para las consistencias de néctar, líquido y budín, los valores de prevalencia para los 5 ml, 10 ml y 20 ml capacidad de volumen fue: deterioro del cierre de los labios (36%, 39%, 18%), deglución fragmentaria (50%, 50%, 50%), residuo oral (7%, 0%, 9%), residuo faríngeo (25%, 17%, 9%) y deglución segura (89%, 33%, 94%), respectivamente. published

The Timed Water Swallow Test (TWST) and the Test of Mastication of Solids (TOMASS) are dysphagia screening procedures that have been shown to be reliably assessed from video. The reliability of the procedures performed over telemedicine has not previously been assessed. TWST and TOMASS outcomes in two situations (both face-to-face and over telemedicine) were compared for 48 participants (aged 60–90; 27 with clinical conditions and 21 older persons). Both testing situation and test performed order were randomized, and all assessment procedures were performed within 3 h of each other. The results indicated a high level of agreement between face-to-face and telemedicine screening outcomes for TWST and TOMASS, respectively. The assessments indicated an 83% and 76% agreement in classifications of individual participants as within or outside normal limits for the TWST and TOMASS for the two test situations. The TWST showed a balanced distribution in differing classification in telemedicine (0.16–0.19 error rates). The TOMASS procedure classified more participants as outside normal limits over telemedicine compared to face-to-face administration. Agreement in the observed number of swallows was substantially lower than other outcome measures, which is attributed to increased difficulty in observing this property over video. Most participants (60%) reported that they would prefer telemedicine over face-to-face assessments, and 90% viewed the procedure as more accessible than expected. All participants were satisfied with the telemedicine procedures. The results suggest that clinical assessment of dysphagia over telemedicine using the TWST and TOMASS are viable alternatives to face-to-face administration of the procedures.

There is growing enthusiasm to develop inexpensive, non-invasive, and portable methods that accurately assess swallowing and provide biofeedback during dysphagia treatment. High-resolution cervical auscultation (HRCA), which uses acoustic and vibratory signals from non-invasive sensors attached to the anterior laryngeal framework during swallowing, is a novel method for quantifying swallowing physiology via advanced signal processing and machine learning techniques. HRCA has demonstrated potential as a dysphagia screening method and diagnostic adjunct to VFSSs by determining swallowing safety, annotating swallow kinematic events, and classifying swallows between healthy participants and patients with a high degree of accuracy. However, its feasibility as a non-invasive biofeedback system has not been explored. This study investigated 1. Whether HRCA can accurately differentiate between non-effortful and effortful swallows; 2. Whether differences exist in Modified Barium Swallow Impairment Profile (MBSImP) scores (#9, #11, #14) between non-effortful and effortful swallows. We hypothesized that HRCA would accurately classify non-effortful and effortful swallows and that differences in MBSImP scores would exist between the types of swallows. We analyzed 247 thin liquid 3 mL command swallows (71 effortful) to minimize variation from 36 healthy adults who underwent standardized VFSSs with concurrent HRCA. Results revealed differences (p

Introduction: During the COVID-19 epidemic in Singapore, there was an urgent demand to train more nurses within a short timeframe to perform the Water Swallow Test (WST). The previous training model involved training with actual patients and was time-consuming. Hence, the model was revamped and standardised patients (SPs) were engaged for nurses' training. This study further investigated nurses' feedback about the new training model and compared the efficiency and learner-reported outcomes of the previous and new models. Methods: Nurses who completed WST training from January 2018 to July 2020 were enrolled. Training records were accessed to determine the number of nurses trained under the previous and new models. Nurses were invited to complete post-training evaluation forms and their responses were analysed. Descriptive statistics and the Mann-Whitney U test were used for data analysis. Results: Under the previous model, 52 nurses were trained over 2 years, whereas under the new model, 112 nurses were trained over two months. From the evaluation form responses, the majority of nurses trained under the new model agreed that they achieved the learning objectives and were confident in performing the WST. There was also no significant difference (p>0.05) found between learner-reported outcomes for both training models. Conclusion: Our findings demonstrated that the new model that engaged SPs was more efficient in training more nurses. Nurses were also satisfied with the new training model, which achieved similar learner-reported outcomes as the previous model. [ABSTRACT FROM AUTHOR] Copyright of Asia Pacific Scholar is the property of Centre for Medical Education (CenMed) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

Objective/Hypothesis:The 10-item Eating-Assessment Tool (EAT-10) is a dysphagia screening test. In HNC patients, screening and diagnosis of dysphagia are not well-established. To determine the metrological properties of the EAT-10 compared with videofluoroscopy in non-surgical HNC-patients and to assess the relationship between EAT-10 scores and patients’ self-reported symptoms.Study Design:Prospective cohort study.Methods:Forty-six HNC-patients recently diagnosed and referred to chemoradiotherapy (CRT). Main outcome was evidence of dysphagia according to EAT-10 score, self-perception on a Visual Analog Scale (VAS) of impaired swallowing, severity on the Penetration-Aspiration Scale (PAS), and the Functional Oral Intake Scale (FOIS). Patients were assessed at baseline, before-CRT, after-CRT, and at 3-month follow-up.Results:A strong baseline correlation between EAT-10, VAS, and FOIS was observed. All 3 values decreased in weeks 6 to 9 after CRT initiation; a poor correlation of EAT-10 with VAS was observed at 3-month follow-up. A receiver operating characteristic curve determined new cut-off points (sensitivity/specificity) for safe swallowing: baseline 3 (86%, 77%); post-CRT, 15 (62.5%, 80%); and 3-month follow-up, 4 (83%, 75%).Conclusions:New safe-swallow EAT-10-points are suggested for this population during screening and the oncological follow-up. A poor correlation between EAT10-score and patient self-reported symptoms was observed at the end-RT and at 3-month follow-up, highlighting the need for an objective evaluation instrument.

The aim of this study was to evaluate the validity of a dysphagia screening test (DST) in patients who have undergone resection for head and neck cancer (HNC). In addition, we examined whether or not combined effects of DSTs improve the detection accuracy of penetration/aspiration. Thirty-six HNC patients were participated. The DST consisted of the repetitive saliva swallowing test (RSST), the water swallowing test (WST), the modified water swallowing test (MWST), the food test (FT), and tongue pressure. A videofluoroscopic swallowing study was conducted, and the penetration–aspiration scale was used for scoring. For statistical analyses, we used the receiver operating characteristic (ROC) analysis. Furthermore, the accuracy of the determination of penetration/aspiration was evaluated by combining two or three DSTs. The penetration/aspiration could be predicted with moderate accuracy based on MWST and FT. The area under the ROC curve (AUC) values of the MWST and FT were 0.76 (p = 0.03) and 0.80 (p = 0.050), and the sensitivity/specificity was 0.9/0.61 (MWST) and 0.8/0.8 (FT), respectively. As a result of combining 2 or 3 DSTs, the combination of “MWST and FT” was the most accurate, with an AUC of 0.87 (p = 0.02). The combination of three tests had lower accuracy than the combination of two tests. Based on our results, it is recommended that MWST or FT be used when only one type of DST is performed. In addition, the combination of two DSTs may detect aspiration patients more accurately than one alone.

Introduction Nurses and other nonspecialists in dysphagia are often trained to screen swallowing poststroke. There are many basic tools that test water only, they are usually conservative, and patients that fail the test remain nil by mouth until a speech and language therapy assessment. More comprehensive tests also allow nonspecialists to recommend modified oral intake. Little is known about the accuracy, clinical utility and cost‐effectiveness of these tests. Methods Following PRISMA guidelines, a systematic review was conducted to describe comprehensive swallowing tests that are available for use in acute stroke by nurses or other nonspecialists in dysphagia. A meta‐analysis was performed to evaluate accuracy and the clinical utility of the tests was considered. Searches and analyses, conducted by two reviewers, included MEDLINE, Embase, trial registries and grey literature up to December 2018. Validated studies were assessed for quality and risk of bias using QUADAS‐2. Results Twenty studies were included, describing five different tests, three of which had undergone validation. The tests varied in content, recommendations and use. There was no test superior in accuracy and clinical utility. Three studies validating the Gugging Swallow Screen provided sufficient data for meta‐analysis, demonstrating high sensitivity; 96% (95% CI 0.90–0.99), but low specificity, 65% (95% CI 0.47–0.79), in line with many water swallow tests. Results should be interpreted with caution as study quality and applicability to the acute stroke population was poor. Conclusions There is no comprehensive nurse dysphagia assessment tool that has robustly demonstrated good accuracy, clinical utility and cost‐effectiveness in acute stroke. Relevance to Clinical Practice Nurses and other clinicians can develop competencies in screening swallowing and assessing for safe oral intake in those with poststroke dysphagia. It is important to use a validated assessment tool that demonstrates good accuracy, clinical utility and cost‐effectiveness.

Zusammenfassung Hintergrund Die oropharyngeale Dysphagie ist bei geriatrischen Patienten weit verbreitet und fast immer multikausal bedingt. Sie führt zu schwerwiegenden Komplikationen und wird oft unzureichend detektiert. Alle bekannten und etablierten Screeningmaßnahmen fokussieren sich auf Patienten mit neurologischer Grunderkrankung, insbesondere nach Schlaganfall. Material und Methoden In der Arbeitsgruppe „Dysphagie“ der Deutschen Gesellschaft für Geriatrie (DGG), in der Ärzte, Logopäden und Schlucktherapeuten zusammengeschlossenen sind, erfolgte eine selektive Literaturrecherche zum Dysphagiescreening. Basierend auf Ergebnissen der Literaturrecherche und eigenen Erfahrungen wurde durch eine Konsensgruppe ein neues Screeninginstrument für geriatrische Patienten entwickelt und konsentiert. Ergebnisse Das Screeninginstrument zur Erfassung einer oropharyngealen Dysphagie bei geriatrischen Patienten gliedert sich in 3 Teile: 1. Vigilanz und Sitzposition, 2. Speichelschluck, Zungenbeweglichkeit und Hustenstoß sowie 3. Wasserschlucktest. Das Screeninginstrument kann durch geschultes medizinisches Personal angewendet werden und ist einfach in den Arbeitsalltag zu integrieren. Diskussion Das neu entwickelte Screeninginstrument ist speziell für die Anwendung bei geriatrischen Patienten vorgesehen. Es hat Vorteile gegenüber bisher empfohlenen Screeningtests. Bisherige Erfahrungen zeigen eine gute Praktikabilität und Akzeptanz im geriatrischen Team. Weitere Studien müssen die Validität des Instruments prüfen.

Our aim was to validate a Finnish version of the Eating Assessment Tool (F-EAT-10) for clinical use and to test its reliability and validity in a multicenter nationwide study. Normative data were acquired from 180 non-dysphagic participants (median age 57.0 years, 62.2% female). Dysphagia patients (n = 117, median age 69.7 years, 53.0% female) referred to fiberoptic endoscopic evaluation of swallowing (FEES) completed F-EAT-10 before the examination and after 2 weeks. Patients underwent the 100-ml water swallow test (WST) and FEES was evaluated using the following three scales: the Yale Pharyngeal Residue Severity Rating Scale, Penetration-Aspiration Scale, and the Dysphagia Outcome Severity Scale. An operative cohort of 19 patients (median age 75.8 years, 57.9% female) underwent an endoscopic operation on Zenker’s diverticulum, tight cricopharyngeal muscle diagnosed in videofluorography, or both. Patients completed the F-EAT-10 preoperatively and 3 months postoperatively. The cut-off score for controls was p

BACKGROUND Dysphagia is a common complication seen in acute ischemic stroke patients, and can lead to morbidity and mortality. As such, quality measures have been instituted to track adherence to dysphagia screening in all stroke patients. In our 217-bed community hospital, we were faced with a low rate in successfully screening for dysphagia. METHODS Quality control interventions were implemented after an analysis of the reasons for dysphagia screening failures was performed. Interventions included online educational sessions for nurses, face-to-face sessions with medical residents, distribution of educational laminated cards, changing the method of documenting the dysphagia screen in our electronic record and others. RESULTS There was an increase of rates of screening for dysphagia from 67% to 91%. CONCLUSION We conclude that failure analysis, implementation of quality control measures to address the cause of failures and re-evaluating success rates periodically was effective to address this problem.

OBJECTIVE: Hospital-acquired aspiration pneumonia remains a rare but potentially devastating problem. The best means by which to prevent aspiration in a cancer hospital population has not been evaluated. The aim of this study was to evaluate the impact of dysphagia screening on aspiration pneumonia rates in an acute care oncology hospital. METHODS: A prospective single-institution quality-improvement dysphagia screening protocol at a comprehensive cancer center. Effect of dysphagia screening implemented in 2016 on hospital acquired aspiration pneumonia rates coded “aspiration pneumonitis due to food/vomitus” were compared with rates from 2014-15, prior to implementation. Screening compliance, screening outcomes, patient demographics, and medical data were reviewed as part of a post hoc analysis. RESULTS: Of 12,392 admissions in 2014-16, 97 patients developed aspiration pneumonia during their hospitalization. No significant change in aspiration pneumonia rate was seen during the dysphagia screening year when compared to prior years (baseline- 7.36 and screening year- 8.78 per 1000 discharges p=0.33). Sixty-eight of the cases (66%) were associated with emesis/gastrointestinal obstruction or perioperative aspiration and only 15 (15%) with oropharyngeal dysphagia. Multivariate analysis found that patients admitted to GI surgery had an aspiration risk equivalent to patients admitted to head and neck, thoracic and pulmonary services (OR 0.65, p= 0.2). DISCUSSION: Nursing-initiated dysphagia screening did not decrease aspiration pneumonia rates. The causes of aspiration-associated pneumonia were heterogeneous. Aspiration of intestinal contents is a more common source of hospital-acquired pneumonia than oropharyngeal dysphagia.

Background Early identification of dysphagia aims to mitigate the risk of health consequences in adults poststroke; however, the evidence from experimental trials alone is inconclusive. This meta‐analysis assessed dysphagia screening benefit from both trial and observational data. Methods and Results Seven electronic databases were searched to December 2019. Unique abstracts and full articles were screened for eligibility by 2 independent blinded raters using a priori criteria and discrepancies resolved by consensus. Included studies were summarized descriptively and assessed for methodological quality using Cochrane Risk of Bias Tool. Across studies, pooled estimates of health benefit were derived for homogeneous data using Review Manger 5.3. From the yield of 8860 citations, 30 unique articles were selected: 24 observational and 6 randomized trials. Across studies, comparisons varied: no screening versus screening, late versus earlier screening, informal versus formal screening, pre‐ versus postscreening, and pre‐ versus poststroke guidelines that included screening. Pooled estimates across comparisons favored experimental groups for pneumonia odds ratio (OR), 0.57 (95% CI, 0.45–0.72), mortality OR, 0.52 (95% CI, 0.35–0.77), dependency OR, 0.54 (95% CI, 0.35–0.85), and length of stay standardized mean difference, −0.62 (95% CI, −1.05 to −0.20). Conclusions Combining evidence from experimental and observational studies derived a significant protective health benefit of dysphagia screening following adult acute stroke for pneumonia, mortality, dependency, and length of stay.

Background: Nearly two-thirds of acute stroke patients have dysphagia. Dysphagia is difficulty to swallow food or liquids. Early detection of dysphagia is crucial in stroke patients as a result of increased morbidity and mortality due to malnutrition and respiratory tract infections. Aim: Our purpose was to conduct a literature review of dysphagia screening for stroke patient. Methods: We used the bolean operator to search articles of “or” and “and” with the key words were "Dysphagia" or “Screening”, AND "Stroke" or Acute Stroke” AND "Nursing". Data based used were Scopus, Proquest and Science Direct with inclusion criteria using full text in English which published from 2019 to 2021. We obtained 240 articles and then we screened by reading the main focus of articles with paying attention to the topics and the suitability of article content.Result: Twenty five publications relating to dysphagia screening met the inclusion criteria. There are five methods of dysphagia screening performed by nurses or other health workers: 1) a simple Questionnaire Test (4QT) method; 2) Water Swallow Test (WST) method; 3) Bed Side Screening Tool for Dysphagia (BSTD) method; 4) Volume Viscosity Swallow Test (V-VST) method; 5) EAT-10 method.Conclusion: screening is the first step in the identification of swallowing impairment or dysphagia of stroke patient. Dysphagia is an independent predictor of poor patient outcome and prolonged recovery time. Nurse has an important role to conduct a screening and must ensure that the selected tools has high reliability and concurrent validity. Key Words: Dysphagia, Nursing, Screening, Stroke

Introduction: This article summarizes the medical experience in establishing stroke units and systemic thrombolysis in Georgia, which, like many other post-Soviet countries, still faces problems in organizing stroke care even after 30 years of independence. Patients and Methods: We created an example of treating acute stroke with systemic thrombolysis and introduced stroke units in several hospitals in the country, including standardization of the diagnostic and treatment process, consistent evaluation, and monthly feedback to the stroke unit staff. Results: Systemic thrombolysis has become a clinical routine in some large hospitals and is meanwhile reimbursed by the state insurance. The data of consecutive 1,707 stroke patients in 4 major cities demonstrated significant time lost at the prehospital level, due to failure in identifying stroke symptoms, delay in notification, or transportation. The consequent quality reports resulted in a dramatic increase in adherence to the European and national guidelines. A mandatory dysphagia screening and subsequent treatment led to a decrease in pneumonia rates. Discussion: We discuss our experience and suggestions on how to overcome clinical, financial, and ethical problems in establishing a stroke services in a developing country. Conclusion: The Georgian example might be useful for doctors in other post-Soviet countries or other parts of the world.

Introduction: Dysphagia occurs in up to two thirds of stroke patients and can lead to serious complications such as aspiration pneumonia, which is also linked to increased morbidity and mortality. Evidence-based guidelines recommend a bedside dysphagia assessment before oral intake in stroke patients regardless of initial stroke severity. Several studies have described registered nurses’ competency in terms of knowledge and skills regarding dysphagia screening. We aimed to examine the rate of aspiration pneumonia compared to the rate of dysphagia screening. Methods: A retrospective analysis of prospectively collected data at a single tertiary stroke center was carried out between January 2017 and June 2020. Data comparison was completed utilizing ICD-10 diagnosis codes to identify aspiration pneumonia in ischemic and hemorrhagic stroke patients. The data was reviewed to compare the compliance of a completed dysphagia screen prior to any oral intake to rate of aspiration pneumonia. Chi square tests were used to assess proportion differences in completed dysphagia screen and proportion of aspiration pneumonia diagnosis in the ischemic and hemorrhagic stroke patients. Results: We identified 3320 patient that met inclusion criteria. 67% were ischemic strokes, 22% were intracerebral hemorrhages and 11% were subarachnoid hemorrhages. Compliance with dysphagia screening decreased from 94.2% (n=1555/1650) in 2017-2018 to 74.0% (n=1236/1670) in 2019-2020, OR=0.17 (95%CI 0.14 - 0.22), p < 0.0001. Aspiration pneumonias increased from 58 (3.5%) in 2017-2018 to 77 (4.6%) in 2019-2020, but this difference was not statistically significant, OR=0.75 (95%CI 0.53 - 1.07), p = 0.11. Conclusion: We noted that the decrease in compliance with completing a dysphagia screen in patients with acute stroke prior to any oral intake was associated with a higher trend of aspiration pneumonia.

Introduction: Dysphagia is a common comorbidity after stroke linked to increased morbidity and mortality. Evidence-based guidelines recommend a bedside dysphagia screen before oral intake to reduce the risk of aspiration pneumonia in stroke patients. Prior studies have reviewed barriers to dysphagia screens being completed or documented timely on stroke patients before giving oral intake. Through Lean A3 process, we aimed to improve overall nursing documentation, including dysphagia screen, for stroke patients in the Emergency Department (ED) at an established Primary Stroke Center. Methods: The ED Charge Nurses and the Stroke Coordinator began an A3 project in May 2019 which focused on ED nurse documentation for stroke patients. Data included was 7 months prior to A3 implementation and 8 months post-implementation using Get With The Guidelines quality “Dysphagia Screen” measure. Lean A3 process involved changes to the computer system and re-education of nursing staff in July 2019 by the charge nurses and Stroke Coordinator. The post-A3 measurement period was between August 2019 and March 2020. Chi square tests were used to assess proportion differences in completed dysphagia screen and proportion of meeting or exceeding goal before and after the A3. Results: Overall compliance of patients screened for dysphagia was 87.3% (n = 379/434). After the A3 project, compliance for dysphagia screening was significantly higher than prior to the A3 implementation ((91.9% (n = 228/248) vs. 81.2% (n = 151/186), OR = 2.64 [95%CI 1.47-4.75], p < 0.001). In addition, the 90% goal for dysphagia screen compliance was achieved only 1 month of 7 (14.3%) prior to A3, but was achieved in 6 months of 8 post-A3 (75%), p = 0.04. Conclusion: In conclusion, we found that dysphagia screening documentation by ED nurses improved due to the Lean A3 process improvement project conducted in the ED.

The aim of this study was to determine healthcare providers’ knowledge and practices about dysphagia. A descriptive cross-sectional study was carried out based on a self-administered and anonymous questionnaire addressed to healthcare providers in Spain. A total of 396 healthcare providers participated in the study. Of these, 62.3% knew the definition of dysphagia as a swallowing disorder. In addition, up to 39.2% of the participants reported that they did not know whether the EatingAssessmentTool (EAT-10) dysphagia screening test was usedin their own clinical settings. Similarly, up to 49.1% of them did not know the ClinicalExaminationVolume-Viscosity (MECV-V) method. Nearly all participants (98.8%) reported that thickeners must be used forall liquids administered to patients. A higher percentage of respondents based the choice of texture on patient’s tolerance (78.2%) rather than on the MECV-V result (17.3%). In addition,76.4% of the professionals had witnessed a bronchoaspiration, after it, 44.4% (n = 175) of them reported the appearance of pneumonia, and 14.5% (n = 57) the death of the patient (p = 0.005). The participants revealeda moderate/low knowledge ofthe definition, diagnosis, and clinical management of liquid dysphagia, which indicates some room for improvements.

BACKGROUND Simple water-swallowing screening tools are not predictive of aspiration and dysphagia in patients with Parkinson's Disease (PD). We investigated the diagnostic accuracy of a multi-texture screening tool, the Gugging Swallowing Screen (GUSS) to identify aspiration and dysphagia/penetration in PD patients compared to flexible endoscopic evaluation of swallowing (FEES). METHODS Swallowing function was evaluated in 51 PD participants in clinical 'on-medication' state with the GUSS and a FEES examination according to standardized protocols. Inter-rater reliability and convergent validity were determined and GUSS- and FEES-based diet recommendations were compared. KEY RESULTS Inter-rater reliability of GUSS ratings was high (rs = 0.8; p

Identification of elderly patients in risk of dysphagia as early as possible upon hospital admission seems warranted due to the risk of aspiration pneumonia, dehydration, length of stay, and increased mortality. This study aimed to evaluate the feasibility and outcome of dysphagia screening of elderly persons admitted to the emergency department (ED). Inclusion criteria were age &ge, 60 years. A nurse applied the Simple Water Swallow test within one hour of admission. Subsequent assessment was performed by an occupational therapist (OT) using Volume Viscosity Swallow Test and Minimal Eating Observation Form. Of 113 eligible participants (median age 78 years), 75 (66%) were screened in the ED by the nurse, and among those, 12 (16%) were detected with dysphagia. Twenty of the patients not screened in the ED due to critical illness were tested by the OT in the ward after clinical stabilization and 15 patients (75%) were identified with dysphagia. This study demonstrated that it is feasible to perform dysphagia screening of elderly persons by a nurse in the ED, but there are severe limitations according to screening patients with critical illness and patients fasting before surgery in the ED. These patients have a high prevalence of dysphagia and should be screened as early as possible after hospitalization, as it will rarely be possible in the ED.

Background & Aim: Formal dysphagia screening protocols are not yet implemented in some hospitals although there is growing evidence that early dysphagia screening reduces pneumonia rates in stroke patients. Trained professionals are not often available outside weekdays working hours in stroke units, meaning that early screening is usually performed by nurses that use informal detection to screen dysphagia in acute stroke patients. The purpose of this study was to identify which items stroke nurses prioritize in their clinical practice to screen dysphagia in acute stroke patients. Methods & Materials: A qualitative study was developed using a focus group technique in five stroke units with a total of 20 stroke nurses selected by purposive sampling in march 2019. Qualitative Data Analysis Software Miner Lite 4.0 was used to assist in content analysis. Results: Two categories emerged: clinical data and swallowing and non-swallowing signs, each with a set of dimensions. In the category clinical data, relevance was noted for the dimension Glasgow Coma Scale and sex, identified as the most and least relevant, respectively, for dysphagia screening. In the category swallowing and non-swallowing signs no relevance evolved for preferred items. However, in this category, data suggest that nurses find less relevant in clinical practice speech disorders for dysphagia screening. Conclusions: Results reinforce the importance of a standardized approach through the use of valid and reliable dysphagia screening protocols, arguing the need for clear guidance in acute stroke clinical pathways on procedures for dysphagia screening.

Актуальность. Проведение сравнительного анализа репрезентативных региональных данных по уровню диагностики на госпитальном этапе ведения инсульта за определенный период времени и между различными лечебными учреждениями позволяет корректно сформировать комплекс лечебно-профилактических мероприятий и разработать последовательные рекомендации по их улучшению. Цель исследования: оценить динамику показателей качества клинико-аппаратной диагностики инсульта за период 2017–2019 гг. и провести их сравнительный анализ между исследуемыми лечебно-профилактическими учреждениями. Материалы и методы. По данным историй болезни выполнен сравнительный анализ уровня организации клинико-аппаратной диагностики в коммунальном некоммерческом предприятии «Винницкая областная клиническая психоневрологическая больница им. акад. А.И. Ющенко Винницкого областного совета» (ВОКПНБ) и Винницкой городской клинической больнице скорой медицинской помощи (ВГКБСМП) в 2017–2019 гг. Статистическая обработка результатов выполнена с помощью статистического пакета «Statistica 5.5». Результаты. Установлены достоверные различия в процентной доле пациентов ВОКПНБ и ВГКБСМП, которым на госпитальном этапе проведены оценка степени тяжести инсульта по Шкале инсульта Национальных институтов здравоохранения США, нейровизуализация в первые часы заболевания, ультразвуковое исследование сосудов шеи, скрининг на предмет фибрилляции предсердий и дисфагии, консультация логопеда и физиотерапевта. В каждом медицинском учреждении отмечена положительная динамика за три года по факту проведения всех диагностических мероприятий и процедур. Выводы. Результаты исследования подтвердили адекватность изученных индикаторов качества и целесообразности дальнейшего внедрения метода госпитального регистра в других регионах Украины для оценки и контроля качества медицинской помощи, включая анализ эффективности новых технологий., Background. Carrying out comparative analysis of representative regional data on the level of diagnosis at the hospital stage of stroke management for a certain period of time and between different medical establishments allows us to form correctly a set of medical and preventive measures and to develop consistent recommendations for their improvement. The purpose: to assess the dynamics of quality indicators of clinical and hardware diagnosis of stroke for the period of 2017–2019 and to conduct a comparative analysis between the studied health care institutions. Materials and methods. According to the case histories, a comparative analysis was carried out on the level of organization of clinical and hardware diagnosis in the Municipal Non-Profit Enterprise “Academician O.I. Yushchenko Vinnytsia Regional Clinical Psychoneurological Hospital of Vinnytsia Regional Council” (VRCPNH) and Vinnytsia City Clinical Emergency Hospital (VCCEH) in 2017–2019. Statistical processing of the results was performed using Statistica 5.5 package. Results. Significant differences were found in the number of VRCPNH and VCCEH patients who underwent evaluation of stroke severity on the National Institutes of Health Stroke Scale at hospital stage, neuroimaging in the first hours of the disease, ultrasound of the neck vessels, atrial fibrillation and dysphagia screening, consultations of speech therapist and physiotherapist. In each hospital, there was a positive trend for three years after the completion of all diagnostic measures and procedures. Conclusions. The results of the study confirmed the adequacy of the studied quality indicators and the feasibility of further implementation of the hospital registry method in other regions of Ukraine to assess and control the quality of care, including the analysis of the effectiveness of new technologies., Актуальність. Проведення порівняльного аналізу репрезентативних регіональних даних стосовно рівня діагностики на госпітальному етапі ведення інсульту за певний період часу i між різними лікувальними закладами дозволяє коректно сформувати комплекс лікувально-профілактичних заходів та розробити послідовні рекомендації щодо їх поліпшення. Мета дослідження: оцінити динаміку показників якості клініко-апаратної діагностики інсульту за період 2017–2019 рр. та провести їх порівняльний аналіз між досліджуваними лікувально-профілактичними закладами. Матеріали та методи. За даними історій хвороби виконано порівняльний аналіз рівня організації клініко-апаратної діагностики в комунальному некомерційному підприємстві «Вінницька обласна клінічна психоневрологічна лікарня ім. акад. О.І. Ющенка Вінницької обласної ради» (ВОКПНЛ) i Вінницькій міській клінічній лікарні швидкої медичної допомоги (ВМКЛШМД) у 2017–2019 рр. Статистичну обробку результатів здійснено за допомогою статистичного пакета «Statistica 5.5». Результати. Встановлено вірогідні відмінності у відсотковій частці пацієнтів ВОКПНЛ i ВМКЛШМД, яким на госпітальному етапі проведено оцінку ступеня тяжкості інсульту за Шкалою інсульту Національних інститутiв охорони здоров’я США, нейровізуалізацію в перші години захворювання, ультразвукове дослiдження судин шиї, скринінг фібриляції передсердь та дисфагії, консультацію логопеда й фізіотерапевта. У кожному медичному закладі відмічено позитивну динаміку за три роки за фактом проведення всіх діагностичних заходів і процедур. Висновки. Результати дослідження підтвердили адекватність вивчених індикаторів якості і доцільності подальшого впровадження методу госпітального реєстру в інших регіонах України для оцінки і контролю якості медичної допомоги, включаючи аналіз ефективності нових технологій.

OBJECTIVES Dysphagia is common in patients with acute ischemic stroke patients (AIS) and it increases the risk of aspiration pneumonia after AIS. The volume-viscosity swallow test (V-VST) is a useful dysphagia screening tool. Therefore, we aim to explore the association between dysphagia (using the modified V-VST) and aspiration pneumonia in acute ischemic stroke patients. PATIENTS AND METHODS All patients with acute ischemic stroke (AIS) admitted during 1 January 2018 and 31 December 2018 were screened in this study by completing the modified V-VST within 24 hours after admission. The information of aspiration pneumonia was obtained from electronic medical system (EMS) and discharge notes. RESULTS Among 624 AIS patient, there were 152(24.36%) patients who suffered from aspiration pneumonia (95% CI, 20.65% - 27.35%) during hospitalization. Among all of them, patients with both impaired safety and impaired efficacy (HR, 7.53, 95%CI, 3.42-16.58, P < 0.001)) had a higher risk of aspiration pneumonia than those with only safety impaired (HR, 2.38, 95%CI, 1.40-4.04, P < 0.001) or only efficacy impaired (HR, 2.47, 95%CI, 1.33-4.57, P = 0.004). The risk of aspiration pneumonia was also associated with their completed volume at each viscosity. The patients with all impairment of three viscosities were also found to be related to the higher risk of developing aspiration pneumonia (P = 0.029). CONCLUSIONS The Modified V-VST is an easy-hand on, reliable screening tool for dysphagia among patients with AIS. Patient subgroup analyses based on the modified V-VST might be able to predict the risk of aspiration pneumonia during hospitalization.

Background and Issues: A common symptom of stroke, dysphagia leaves patients vulnerable to aspiration pneumonia and at risk for poor outcomes, mortality, and increased length of stay and healthcare costs. Evidence-based practice indicates early detection of dysphagia is fundamental in decreasing the risk of aspiration, yet often the opportunity is missed in the process of providing emergent care. Stroke patients should be screened for dysphagia and aspiration risk upon ED arrival using a standardized tool before receiving oral intake. Purpose: The goal was to emphasize early dysphagia screening with a standardized screening tool, achieving ≥ 85% compliance in this high-risk population. Methods: Cause-and-effect analysis was used throughout the improvement initiative. Focus was applied to staff recognition of stroke patients as high risk for dysphagia and associated complications. A standardized screening tool was adopted. Missed screening opportunities were identified, revealing frequent association with time-sensitive medication administration of antithrombotics in the ED. A six month pilot was conducted in the ED; an alert was programmed into the medication dispensing station to query the user regarding patient dysphagia risk when specific antithrombotics were dispensed. Control charts were used to measure compliance. Results: Screening compliance significantly improved more than 23% from 1Q2016 to 1Q2019. The standardized screening tool supported inter-rater reliability. The ED pilot improved compliance to 88%, revealing opportunities to improve screening compliance in acute care units. Conclusions: A standardized screening tool and medication alert in the ED improved dysphagia screen compliance, suggesting similar outcomes if implemented on acute care units. Further data will be valuable to hypothesize a negative correlation between sustained dysphagia screening compliance and decreased incidence of healthcare-associated aspiration pneumonia.

Background: The dysphagia screening in acute ischemic stroke plays an important role in patients with risk of dysphagia. The aim of this hospital-based case-control study is to explore if V-VST, as a new nurse-driven dysphagia screening tool for AIS patients, might help to reduce the rate of post-stroke pneumonia and early withdraw of feeding tube. Methods: 1598 acute ischemic stroke patients were enrolled in this study. The standard protocol in AIS patients were assessed by WST (before intervention and plus with V-VST after intervention). The V-VST assessment were be trained in two senior nurses and all AIS patients were assessed by V-VST during July 1and Dec 30 th , 2017. Among 299 AIS patients with suspected, all clinical data were analyzed. The comparison of their rate of pneumonia in hospital and withdraw rate of tubefeeding before discharge were performed between patients post-intervention (January 1, 2018-June 30, 2019)and those admitted before the intervention (January 1, 2016-June 30, 2017). Results: The baseline characteristics of the pre- and post- intervention AIS groups were similar in age, gender, NIHSS. The implementation of V-VST have a statistically significant reducing the risk of pneumonia with an adjusted HR (0.60, 95% CI 0.43-0.84, P=0.003). Additionally, follow-up V-VST were likely to be associated the withdraw rate of tube-feeding at discharge (29/168 vs 38/131 P=0.016).There is also a trend of length of tube-feeding decreasing (8.32±12.27 vs 6.84±8.61 P=0.241). Conclusion: In our study, the V-VST is a feasible bedside tool. The implemental might be associated with the reduction of post-stroke pneumonia. Therefore, it meets the requirements of a clinical screening test for dysphagia in acute stroke patients at bedside. Large prospective interventional study is needed to confirm our findings. V-VST: Volume-viscosity Swallow Test WST: Water Swallow Test AIS: Acute Ischemic Stroke HR: hazard ratio

Intro: Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many patients with mild presentation fail initial screening. We sought to evaluate the rates and predictors of dysphagia screening failure in mild acute ischemic stroke patients (NIHSS < 5). Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in the Northeast, South and West, we analyzed 8,687 stroke admissions from 06/2008 - 12/2018. Patients with mild stroke (NIHSS Results: Of the 8,687 patients, 3,614 (41%) had NIHSS < 5. Dysphagia screening failure was seen in 30.2% in the entire cohort while only 10.3% (373/3,614) in patients with NIHSS < 5. Mild stroke patients who failed dysphagia screening were older, more often had stroke risk factors of hypertension, hyperlipidemia, CAD/MI. They had higher median NIHSS and more often had language disturbance on presentation. Patients who failed dysphagia screening were less likely to be discharged home. On MV analysis, age (1.01, 95% 1.00, 1.02), hypertension (1.45, 95% 1.10, 1.91), NIHSS (1.62 95% 1.48, 1.77) and language disturbance at presentation (1.89 95% 1.13, 2.32) were significantly associated with initial dysphagia. Conclusion: Dysphagia screen failure rates are significantly less frequent in patients with mild symptoms and even lower for those with NIHSS of 0-1 at presentation. Factors associated with failure - older age, higher NIHSS and language disturbance at presentation may help focus efforts to avoid complications in these patients who might otherwise do well. This focused approach of screening patients all patients but targeting mild patients with dysphagia may hold potential for improved outcomes.

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.

summary: Background: Dysphagia is relatively common in patients with acute stroke and can lead to aspiration pneumonia and malnutrition. We evaluate the usefulness of dysphagia test using high-resolution impedance manometry during acute stroke. Methods: Consecutive patients with acute stroke were enrolled, and all patients were stratified into three aspiration risk groups. High-resolution impedance-manometry (HRiM) was performed in patients with an intermediate aspiration risk. The diet plan was determined based on the results of evaluations and clinical outcome was determined by improved diet program and pulmonary complications. Results: A total of 293 patients with acute stroke were enrolled. Among 91 patients with intermediate-risk, 36 revealed an impaired swallowing pattern in HRiM. Fifty-five patients with a preserved swallowing pattern and 169 with low-risk were started with a general diet and tolerated it well. Thirty-six patients with an impaired swallowing pattern were recommended for swallowing rehabilitation and a stepwise dysphagia diet of which 97.2% successfully adapted to the general diet. High-risk group patients received nasogastric tube feeding immediately. During admission, no patients with low- and intermediate-risk developed aspiration pneumonia. However, aspiration pneumonia frequently occurred in high-risk group patients. Conclusions: Our assessment program was safe and effective for assessing swallowing function and for determining the appropriate diet plan. Keywords: acute stroke, diet, dysphagia, high-resolution impedance manometry

The topic of dysphagia screening has garnered substantial attention in the research literature, in conference proceedings, and on various professional forums, including the SIG 13 Community page. A...

Background and purpose The Gugging Swallowing Screen (GUSS) is a tool to screen aspiration risk in acute stroke. We aimed to replicate its validity in a larger second cohort of patients with acute stroke, including the more severe with a National Institutes of Health Stroke Scale (NIHSS) ≥ 15. Methods In a prospective, double-blind design, the GUSS was validated with the Fiberoptic Endoscopic Evaluation of Swallowing scale. Patients were categorized into different stroke severities as assessed by the NIHSS, and the diagnostic properties were calculated separately for each subgroup. Results A total of 100 patients with acute stroke were evaluated consecutively at a mean 1.7 ± 2.2 days after stroke. With the GUSS cut-off value of 14 points, the GUSS screened aspiration risk with a 96.5% sensitivity and 55.8% specificity (area under the curve, 0.76; 95% CI, 0.67–0.84), which corresponded well with the original publication. In the NIHSS < 5 group, the sensitivity and specificity levels were 71.4% and 88.8%, respectively. In the NIHSS ≥ 15 group, these levels changed to 100% and 20%, respectively. The high failure rate in completing the first part of the GUSS in the latter group was related to the low specificity. Diet recommendations following the GUSS were more conservative than those after Fiberoptic Endoscopic Evaluation of Swallowing. In particular, the GUSS overestimated the need for nasogastric tube feeding. Conclusions This is the first time that a swallowing screening tool for patients with acute stroke has been revalidated in a larger population from another stroke center. The validity of a swallow screening test may vary according to different stroke severities.

The large majority of the available dysphagia screening tools has been developed for the stroke population. Only few screening tools are suitable for heterogeneous groups of patients admitted to a subacute care unit. The Royal Brisbane and Women's Hospital (RBWH) dysphagia screening tool is a nurse-administered, evidence-based swallow screening tool for generic acute hospital use that demonstrates excellent sensitivity and specificity. No Italian version of this tool is available to date. The aim of this study was to determine the reliability and screening accuracy of the Italian version of the RBWH (I-RBWH) dysphagia screening tool. A total of 105 patients consecutively admitted to a subacute care unit were enrolled. Using the I-RBWH tool, each patient was evaluated twice by trained nurses and once by a speech and language pathologist (SLP) blind to nurses' scores. The SLP also performed standardised clinical assessment of swallowing using the Mann assessment of swallowing ability (MASA). During the first and the second administration of the I-RBWH by nurses, 28 and 27 patients, respectively, were considered at risk of dysphagia, and 27 were considered at risk after SLP assessment. Intra- and inter-rater reliability was satisfactory. Comparison between nurse I-RBWH scores and MASA examination demonstrated a sensitivity and specificity of the I-RBWH dysphagia screening tool up to 93% and 96%, respectively; the positive and negative predictive values were 90% and 97%, respectively. Thus, the current findings support the reliability and accuracy of the I-RBWH tool for dysphagia screening of patients in subacute settings. Its application in clinical practice is recommended.La maggior parte dei test di screening per la disfagia è stato sviluppato per essere utilizzato in pazienti con stroke. Solo pochi strumenti risultano applicabili a popolazioni più eterogenee di pazienti, come quelli ricoverati nelle unità di cure per Sub-acuti. Tra questi, il Royal Brisbane and Women’s Hospital (RBWH) dysphagia screening tool è stato concepito per essere utilizzato da personale infermieristico e possiede un’eccellente sensibilità e specificità. Al momento non è disponibile una versione italiana di questo strumento. Scopo del lavoro è di analizzare l’affidabilità e l’accuratezza nello screening della versione italiana del RBWH (I-RBWH) dysphagia screening tool. A tal fine sono stati arruolati 105 pazienti, tutti ricoverati presso l’unità di cure Sub-acute. Ogni paziente è stato valutato con il I-RBWH dysphagia screening tool da personale infermieristico (per due volte) e da una logopedista. Quest’ultima, non solo era all’oscuro dei risultati ottenuti durante la valutazione infermieristica, ma ha anche eseguito una valutazione standardizzata delle abilità deglutitorie utilizzando il Mann Assessment of Swallowing ability (MASA). L’affidabilità intra- e inter-rater si sono rilevate soddisfacenti. Il confronto tra i risultati ottenuti dal personale infermieristico durante la somministrazione del I-RBWH e i punteggi del MASA hanno dimostrato un’eccellente sensibilità (93%), specificità (96%), valore predittivo positivo (90%) e valore predittivo negativo (97%). Questi dati supportano l’affidabilità e l’accuratezza del I-RBWH dysphagia screening tool nello screening della disfagia nei pazienti ricoverati nelle unità di cure per Sub-acuti. Il suo utilizzo in clinica è pertanto raccomandabile.

Background: Early identification of stroke-related oropharyngeal dysphagia (OPD) using screening by nurses can prevent adverse patient outcomes in lower middle-income countries. Nurses are essential in the OPD management team and should ideally be able to screen and prioritise dysphagia management in stroke patients. Objective: The aim of this research was to describe nurses’ practices related to identification and management of patients with stroke-related OPD. Methods: Qualified nurses from various healthcare levels in the Eastern Cape, South Africa were invited to complete a previously published hard copy survey on the signs and symptoms, complications and management of stroke-related OPD. A sample of 130 participants completed the survey. Results: The mean scores of correct responses for each section were: 8.7/13 (66.7%) for signs and symptoms, 4.7/10 (47.3%) for complications and 3.8/7 (54.2%) for management practices. Statistically, there were no differences between the levels of healthcare for the signs and symptoms section and the complications section. Regarding management of OPD, secondary-level (S) nurses demonstrated significantly better knowledge than primary-level (P) and tertiary-level (T) nurses (S–P: p = 0.022; S–T: p = 0.010). Secondary-level nurses also scored significantly higher across all three sections (S–P: p = 0.044; S–T: p = 0.025) than those at the other levels. Conclusions: The study found that nurses across all levels of healthcare had only moderate knowledge regarding identification and management of stroke-related OPD. Interdisciplinary collaboration between nurses and speech–language therapists may improve nurses’ knowledge in identification and management of stroke-related OPD in lower middle-income settings such as South Africa.

Background Dysphagia is associated with aspiration pneumonia after stroke. Data are limited on the influences of dysphagia screen and assessment in clinical practice. Aims To determine associations between a “brief” screen and “detailed” assessment of dysphagia on clinical outcomes in acute stroke patients. Methods A prospective cohort study analyzed retrospectively using data from a multicenter, cluster cross-over, randomized controlled trial (Head Positioning in Acute Stroke Trial [HeadPoST]) from 114 hospitals in nine countries. HeadPoST included 11,093 acute stroke patients randomized to lying-flat or sitting-up head positioning. Herein, we report predefined secondary analyses of the association of dysphagia screening and assessment and clinical outcomes of pneumonia and death or disability (modified Rankin scale 3–6) at 90 days. Results Overall, 8784 (79.2%) and 3917 (35.3%) patients were screened and assessed for dysphagia, respectively, but the frequency and timing for each varied widely across regions. Neither use of a screen nor an assessment for dysphagia was associated with the outcomes, but their results were compared to “screen-pass” patients, those who failed had higher risks of pneumonia (adjusted odds ratio [aOR] = 3.00, 95% confidence interval [CI] = 2.18–4.10) and death or disability (aOR = 1.66, 95% CI = 1.41–1.95). Similar results were evidence for the results of an assessment for dysphagia. Subsequent feeding restrictions were related to higher risk of pneumonia in patients failed dysphagia screen or assessment (aOR = 4.06, 95% CI = 1.72–9.54). Conclusions Failing a dysphagia screen is associated with increased risks of pneumonia and poor clinical outcome after acute stroke. Further studies concentrate on determining the effective subsequent feeding actions are needed to improve patient outcomes.

Three facilities, involved in introducing a model of Allied Health Assistant (AHA) delegated dysphagia screening, examined barriers and facilitators to service implementation. The 3 facilities varied in size, services and location. AHAs (n = 4) and speech-language therapists (SLTs; n = 4) directly involved in implementation at each site completed semi-structured interviews exploring the implementation experience. Analysis was guided by the Consolidated Framework for Implementation Research (CFIR). There was differential implementation across the sites. Facilitators to implementation fell within the CFIR Innovation Characteristic domain, with the “relative advantage” of the model and “design, quality and packaging” of the training and implementation resources being key facilitators. Barriers related to the Innovation Characteristic domain, regarding the tool’s “adaptability” in terms of screening tools selected and the implementation environment. Issues with the Inner Setting domain, specifically the “structural characteristics,” the “compatibility” of the model and the “relative priority” of the model’s implementation within other organizational priorities were also barriers. Although the service model was perceived to have relative advantage, compatibility with local work-flow priorities and service needs must be thoroughly considered if AHA delegated dysphagia screening is to be beneficial as a service model to address increasing dysphagia referral demands.IMPLICATIONS FOR REHABILITATIONDysphagia is a disabling condition which may result in medical, social and operational complications.The demands of screening, assessing, managing and providing rehabilitation for dysphagia are increasing, therefore alternative models of service delivery including delegation are increasingly being considered and implemented.This study provides evidence regarding the context and facilitators of successful AHA dysphagia screening model implementation.This evidence contributes to a growing knowledge base of delegation practices for the management of staffing resources and building of capacity for rehabilitation service delivery. Dysphagia is a disabling condition which may result in medical, social and operational complications. The demands of screening, assessing, managing and providing rehabilitation for dysphagia are increasing, therefore alternative models of service delivery including delegation are increasingly being considered and implemented. This study provides evidence regarding the context and facilitators of successful AHA dysphagia screening model implementation. This evidence contributes to a growing knowledge base of delegation practices for the management of staffing resources and building of capacity for rehabilitation service delivery.

Objectives: The purposes of this study are to determine whether there is a correlation between the Mann Assessment of Swallowing Ability (MASA) and modified MASA (mMASA) according to various cognitive status and to investigate whether the cognitive status of patients with brain damage affects the prediction of aspiration using the MASA.Methods: We retrospectively assessed 146 dysphagic patients with brain lesion due to various causes. Dysphagia was assessed using the MASA and mMASA. According to the videofluoroscopic swallowing study results, patients were divided into two groups: aspirators and non-aspirators. Patients were classified into four groups according to cognitive function according to the Korean version of Mini-mental State Examination scores: normal (>24), mild (21–24), moderate (10–20), and severe (

Background & Aim: There is a high incidence of dysphagia after stroke that, depending on the assessment, methodology and time elapsed, can range from 8.1% to 80%. Early and systemic dysphagia screening is associated with a decreased risk of aspiration pneumonia and prevents inadequate hydration/nutrition. The purpose of this systematic review was to identify dysphagia screening tools for acute stroke patients available for nurses validated against reference test. The research question was: which dysphagia screening tools for acute stroke patients available for nurses? Methods & Materials: Three electronic databases were searched from January 2007 to November 2017: on PubMed, Scielo and CINAHL Plus. Two independent reviewers screened all titles and abstracts, assessed methodological quality and extracted data. The methodological quality analysis and evaluation was guided according to four domains: patient selection, index test, reference standard and flow and timing. Divergences between reviewers in data extraction were consensualized through discussion. Results: From the 377 articles retrieved, only three articles met criteria for review: Barnes-Jewish Hospital-Stroke Dysphagia Screen; the Gugging Swallowing Screen and, The Toronto Bedside Swallowing Screening Test. None of the screening tools complies with all psychometric properties, which means that a still significant proportion of patients will be kept nil by mouth without being necessary or that some patients will “fall through the cracks” interrupting the diagnostic process. The tools identified are different from each other, making their comparison impracticable. Conclusion: Due to psychometric proprieties and dietary recommendations adjusted to dysphagia severity, of all available tools, GUSS is a suitable screening tool for nurses in clinical practice.

Introduction: Dysphagia occurs in roughly 30 to 67% of stroke patients and can lead to significant complications, including aspiration with subsequent pneumonia. There has been a lack of agreement on a single effective dysphagia screening tool. The tool used in our institution was developed internally based on extensive literature review, and includes dysphagia screening items followed by a water challenge. Hypothesis: We suspected this dysphagia screening tool was performing well based on low rates of aspiration pneumonia in our stroke patients. The purpose of this study was to validate the dysphagia screening tool against gold standard video fluoroscopy (VF). Methods: This was a prospective study to determine the sensitivity and specificity of the dysphagia screening tool. Our enrollment goal was 300 patients with suspected ischemic stroke between December 2016 and January 2018. The primary nurse completed the routine dysphagia screen, and the sub-investigator performed a blinded simultaneous screen, followed by VF evaluation. We used a group sequential design with interim analyses every 30 patients to allow for early stopping. The primary hypothesis was sensitivity >85%, evaluated using a one-sided test of proportion at a study alpha level of 0.025. Results: At the second interim analysis, 34/61 patients were positive for dysphagia on VF, while only 19 were positive on the screening tool. Estimated sensitivity was 55.9% (95% CI 39.5-71.1%), with a p-value below the second-stage threshold of 0.000002. Therefore, we terminated the study at this point. Estimated specificity was 51.9% (95% CI 34.0-69.3%), and the concordance between examiners for dysphagia screening as 91.8%. Conclusions: This is a routinely used screening tool across multiple hospitals within this organization. The tool did not show adequate sensitivity or specificity compared against the gold standard. Despite the results, we continue to have low rates of aspiration pneumonia. It is possible that VF may overestimate dysphagia, or that subjective interpretation of dysphagia criteria with VF may complicate the results. In conclusion, due to inadequate sensitivity and specificity of the dysphagia screening tool, we terminated the study and recommended modification of the tool.

Background and Issues: A hospital in a Chicago suburb struggled with inconsistent dysphagia screening and National Institute of Health Stroke Scale (NIHSS) assessment upon admission for patients coding out as a confirmed stroke patient. Percentage of compliance for dysphagia and NIHSS were, in 2014, 79% and 84%, respectively. Purpose: The purpose of this Quality Improvement (QI) Project Abstract was to increase the number of stroke patients assessed for dysphagia and NIHSS upon admission. Methods: A sample size of approximately 90 patients over a three month period was used to identify admission diagnoses of patients that were not assessed for dysphagia and NIHSS upon arrival but did code out for stroke. D izziness, A ltered mental status, a trial fibrillation, W eakness and S yncope were the five diagnoses consistently utilized. It was recognized that patients admitted with these diagnoses needed to be routinely assessed. To help staff remember these five diagnoses, an acronym ( DAaWS ) was developed. Communication to staff of the new DAaWS acronym and practice began in 2015 and consisted of visual learning tools, staff meeting discussions, just-in-time learning, rounding to influence and 1:1 education. Results: Data from 2013 showed an average NIHSS at 90% / dysphagia at 76%. 2014 showed an average NIHSS at 84% / dysphagia at 79%. Implementation year of DAaWS practice, 2015 showed an average NIHSS at 91% / dysphagia at 94%. 2016 showed an average NIHSS at 97% / dysphagia at 90%. 2017 showed an average NIHSS at 96% / dysphagia at 84%. Of note is the 15% improvement of dysphagia from year 2014 to 2015 when the DAaWS practice began. Implementation of DAaWS had less impact on the NIHSS compliance in the initial year of 2015 with an increase of 7%. Subsequent years of 2016/2017 have seen an average increase in compliance of 12.5% from the 2014 data. Conclusion: In conclusion, the study showed that implementing a catchy acronym, DAaWS, to assist the nurse with early identification of potential stroke patients significantly improved the compliance of the dysphagia screening & NIHSS assessment upon admission.

Background and Issues: Prior to this project, an internally created dysphagia screen had been used. A validated stroke dysphagia screen was needed. Knowledge deficits existed on who, when, and how to perform the screen. With record patient census, stroke patients got admitted wherever there was an open bed, so all units needed this education. Evidence also showed that swallowing issues were related to aspiration. Purpose: Evaluate the impact of expanded education and use of a validated stroke dysphagia screen on core measure compliance and hospital acquired pneumonia incidence on stoke/TIA patients. Methods: An interprofessional team selected the validated, stroke dysphagia screen. Education was provided via an online module, tipsheets, and live demonstrations. More resources and demonstration videos were made available on the internal stroke program website. All inpatient stroke/TIA patients were monitored for core measure compliance at least 4 days/week, with real time follow-up to involved nurses as needed. The stroke core measure of dysphagia screening compliance and documentation of hospital-acquired aspiration pneumonia was entered into a database for 100% of the coded stroke/TIA patients during the study periods (i.e. July-December over 2 years: Baseline= 2016 and Intervention=2017). Results: More than 2000 nurses attended the live presentations and/or completed the online module. Compliance and outcome findings were as follows: Conclusions: Though no direct cause and effect with the pneumonia results can be proven with this quality improvement effort, favorable findings occurred. The percentage of stroke/TIA patients being screened went up and the percentage of those patients developing hospital acquired pneumonia went down after the screening tool change, education, and monitoring process were put into place.

Introduction The Ohkuma questionnaire is a validated screening tool originally used to detect dysphagia among patients hospitalized in Japanese nursing facilities. Objective The purpose of this study is to evaluate the reliability and validity of the adapted Greek version of the Ohkuma questionnaire. Methods Following the steps for cross-cultural adaptation, we delivered the validated Ohkuma questionnaire to 70 patients (53 men, 17 women) who were either suffering from dysphagia or not. All of them completed the questionnaire a second time within a month. For all of them, we performed a bedside and VFSS study of dysphagia and asked participants to undergo a second VFSS screening, with the exception of nine individuals. Statistical analysis included measurement of internal consistency with Cronbach's α coefficient, reliability with Cohen's Kappa, Pearson's correlation coefficient and construct validity with categorical components, and One-Way Anova test. Results According to Cronbach's α coefficient (0.976) for total score, there was high internal consistency for the Ohkuma Dysphagia questionnaire. Test-retest reliability (Cohen's Kappa) ranged from 0.586 to 1.00, exhibiting acceptable stability. We also estimated the Pearson's correlation coefficient for the test-retest total score, which reached high levels (0.952; p = 0.000). The One-Way Anova test in the two measurement times showed statistically significant correlation in both measurements (p = 0.02 and p = 0.016). Conclusion The adapted Greek version of the questionnaire is valid and reliable and can be used for the screening of dysphagia in the Greek-speaking patients.

Introduction: During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Patients and methods: Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the stroke unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. Results: We examined 418 patients with acute stroke (G0 = 275, G1 = 143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs 29% in G1, P = .005) and median NIHSS score (4 points in G0 vs 7 points in G1, P = .003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs 25% in G1, P = .4), lower mortality (1.7% in G0 vs 0.7% in G1, P = .3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs 2.1% in G1, P = .05). Conclusions: Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients. Resumen: Introducción: En la fase aguda del ictus el 30% de los pacientes presentan disfagia, y de ellos, el 50% experimentarán broncoaspiración. Nuestro objetivo fue evaluar los resultados de mortalidad y broncoaspiración del test del agua comparado con el test 2 volúmenes/3 texturas controlado con pulsioximetría (2v/3t-P) en una unidad de ictus. Pacientes y métodos: Durante 5 años se analizaron de forma prospectiva y consecutiva todos los pacientes con infarto cerebral en la Unidad de Ictus. Del año 2008 al 2010 se utilizó el test del agua (grupo 0 o G0), y del 2011 al 2012, el test 2v/3t-P (grupo 1 o G1). Se recogieron las siguientes variables: demográficas, factores de riesgo vascular, gravedad neurológica con la escala NIHSS, subtipo etiológico según criterios TOAST, subtipo clínico según la clasificación Oxfordshire, prevalencia de disfagia, broncoaspiración y exitus. Resultados: Se analizaron 418 pacientes con infarto cerebral agudo (G0 = 275, G1 = 143). Se detectaron diferencias significativas entre ambos grupos en el porcentaje de pacientes con TACI (17% en G0 vs. 29% en G1, p = 0,005) y en la mediana de NIHSS (4 puntos en G0 vs. 7 puntos en G1, p = 0,003). Con el test 2v/3t-P se detectó un aumento no significativo en el porcentaje de disfagia (22% en G0 vs. 25% en G1, p = 0,4), una menor tasa de mortalidad (1,7% en G0 vs. 0,7% en G1, p = 0,3) y una reducción significativa de broncoaspiración (6,2% en G0 vs. 2,1% en G1, p = 0,05). Conclusiones: El nuevo test 2v/3t-P, comparado con el test del agua, mejoró significativamente los resultados de broncoaspiración en los pacientes con infarto cerebral agudo. Keywords: Acute ischaemic stroke, Dysphagia, Bronchoaspiration, Mortality, Palabras clave: Infarto cerebral, Disfagia, Broncoaspiración, Mortalidad

Aim: The aim of the study was to investigate the inter-rater agreement (IRA) of the 8-item Brief Bedside Dysphagia Screening Test-Revised (BBDST-R). Design: An observational IRA study was conducted. Methods: Forty-six patients with stroke were independently assessed by two nurse raters using the BBDST-R. Rater agreement was described and analysed using descriptive statistics, Cohen's kappa (κ), the proportion of observed agreement (Po), the prevalence index (pindex), and the bias index (bindex). Results: Kappa ranged from -0.046 (p = 0.641; 95% CI = -0.126-0.034) for item "ability to clench the teeth" to 0.784 (p < 0.001; 95% CI = 0.377-1.000) for "thick liquid: cough". For the overall BBDST-R result, κ was 0.241 (p = 0.114; 95% CI = 0.000-0.558). The Po was ≥ 0.80 for five items; the pindex was ≥ 0.80 for three items. The bindex ranged from 0.03-0.31. Conclusion: The IRA, as expressed by κ, was low for the overall result and variable for the individual items. However, for some items, κ may have misrepresented the IRA due to the high pindex and bindex. Several strategies are recommended to improve the IRA of the instrument. This should enhance the instrument's capacity to produce consistent results across raters.

Introduction: Dysphagia screening tools have been routinely used to assess for risk of aspiration in the stroke population. Despite a 30 to 40% prevalence rate of oropharyngeal dysphagia in older g...

Aim Dysphagia is a common and potentially serious problem in patients with neurological conditions. In many countries, dysphagia screening is used, which contributes to better patient outcomes. In Greece, the implementation of dysphagia screening has not yet been described. The aim was to examine the effectiveness of an educational session delivered to Greek masters-level nursing students and their faculty on the correct use of an 8-item nursing dysphagia screening instrument developed in the Czech Republic. Methods Fifteen students and nursing faculty members of the Technological Educational Institute of Athens were enrolled in this descriptive pilot study. They were educated on dysphagia in a session consisting of a theoretical and practical part and a discussion. The participants were asked to indicate their clinical experience with dysphagia and their opinion on the importance of nurses’ involvement in dysphagia assessment. Their knowledge of the screening procedure and interpretation and documentation of the result was tested using a hypothetical patient case. Results In this study, 4 (27%) participants had prior experience with patients with dysphagia. All of them thought that nurses’ involvement in dysphagia assessment was very important . Slightly more than half of the participants identified, interpreted, and documented all of the 8 item results correctly. Conclusion The participants were motivated to learn, however, complete mastery of the assessment technique was not achieved. The learning experience was affected by several issues that were unique to Greece, and the participants’ efforts focused on understanding how the new knowledge and skills could affect their daily practice. Direct ongoing support in the clinical setting could be beneficial.

Aim Dysphagia is common in dependent older adults. Thus, a method of evaluating eating and swallowing functions that can be used to diagnose and manage dysphagia in a simple and robust manner is required. In 2002, the Mann Assessment of Swallowing Ability (MASA) was introduced to identify dysphagia in acute-stage stroke patients. As the MASA enables easy screening, it might also be applicable to dependent older adults if appropriate MASA cut-off values and the most useful assessment items could be determined. In the present study, we attempted to determine suitable MASA cut-off values, and the most useful assessment items for predicting aspiration and pharyngeal retention in dependent older adults. Methods Using the MASA, we evaluated the eating and swallowing functions of 50 dependent older adults with dysphagia. All of the patients also underwent videoendoscopic-based swallowing evaluations to detect aspiration and pharyngeal retention. The participants' characteristics and the utility of each assessment item were compared between various groups. Using the patients' videoendoscopic findings as a reference, receiver operating characteristic curve analysis was carried out to determine appropriate cut-off values for predicting aspiration and pharyngeal retention in dependent older adults. Results The optimal MASA cut-off values for predicting aspiration and pharyngeal retention were 122 points and 151 points, respectively. A total of 17 of the 24 clinical items assessed by the MASA were found to be associated with aspiration in dependent older adults. Conclusions The MASA is a useful screening tool for evaluating eating and swallowing functions in dependent older adults. Geriatr Gerontol Int 2017; 17: 561-567.