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Background: Liquid nutrition delivered through a tube is often used amid difficulty swallowing. Tube feeding has been shown to have a relationship to pneumonia and mortality. Aim: Researchers investigated the relationship of feeding route (oral or tube) to patient outcomes. Design: Data were collected on outcomes (pneumonia, depression, mortality), feeding route, presence/absence of dysphagia, and covariates (chronic obstructive pulmonary disease [COPD], stroke, mortality risk, illness severity, sex, age). Researchers collected data over a 45-month period to ensure an adequate sample size for matching. The method of sampling was retrospective, archival data analysis. Propensity score analysis resulted in 94 matched, balanced pairs. Covariates were isolated from the treatment effect. Participants: The records of 2,180 inpatients treated by Palliative Medicine were considered, and 292 met the inclusion criteria. Results: Results revealed 10.14 times greater odds of pneumonia (OR = 10.14; p <.001) with tube feeding compared to oral feeding in patients with dysphagia and end-stage COPD or end-stage stroke. Results also revealed increased odds of depression (OR = 2.79; p =.01) and mortality (OR = 3.02; p <.01) with tube feeding compared to oral feeding. Conclusion: Study findings should encourage consideration of oral nutrition at the end of life. [ABSTRACT FROM AUTHOR]

Communication is fundamental to mental health services for every patient, caregiver and clinician interaction. Without adequate communication skills, the aspiration to inclusion, engagement and recovery is likely to fail. Speech and language therapists provide specialist knowledge directly with patients, and indirectly via clinicians and caregivers. The objective of this study was to explore current UK provision and practice of speech and language therapists supporting working age adults with mental health conditions. A ten question online survey was shared on social media and sent to a network of speech and language therapists interested in mental health services in September 2019. Responses were analysed using descriptive statistics supported by free text survey responses. From survey closing in March 2020, 96 responses were received from across the four UK nations describing widely varying services. Respondents reported concerning gaps in SLT provision, other professions not understanding the SLT role, but over 75% of respondents reported multidisciplinary ways of working. Risks associated with communication impairment are often overlooked. The understanding of mental health professionals about the role of speech and language therapists is patchy. Highlighting awareness amongst the mental health workforce about communication impairment will improve access to treatment and care for all patients. [ABSTRACT FROM AUTHOR]

Aspiration and pneumonia are common in people with eating, drinking and swallowing difficulties. Thickened liquids are often used as a first-line measure by speech-language pathologists and other health and social care professionals to reduce aspiration and pneumonia in people with eating, drinking and swallowing difficulties. This approach, and the relative lack of evidence of benefit, has come under increased criticism in recent years. This aim of this review is to examine alternatives—or complementary approaches—that might be considered by SLPs and other professionals treating people with eating, drinking and swallowing difficulties. We examined the current research evidence and will discuss medical factors, bolus modification approaches, rehabilitation approaches, hygiene and residue reduction interventions, physical and postural interventions, common sense strategies, and other issues to consider when using thickened liquids. We conclude that there are many options available to health and social care professionals who are supporting people with eating, drinking and swallowing difficulties, some of which have a less, equal or more supportive evidence base than thickened liquids. A broad multidisciplinary and multifactorial approach is beneficial, and more acceptable to, people with eating, drinking and swallowing difficulties. [ABSTRACT FROM AUTHOR]

Purpose: The intervention of thickened liquids (TL) is commonly used to reduce aspiration in people with dysphagia. Speech-language pathologists (SLPs) have traditionally believed it is an effective intervention. Recent articles highlight limited evidence, poor acceptance, and a variety of unintended consequences. This study explores if current debates have been reflected in SLP practices and perspectives. Method: An e-survey was developed. Participants were recruited via professional associations in Australia, New Zealand, Ireland, the United Kingdom, and the United States. Descriptive and inferential statistics were used to explore the data. Principal component analysis was used to summarize SLP practices and perspectives. Results: The 370 respondents represented mainly experienced, confident, hospital-based clinicians. While 20% of respondents frequently recommend TL, 61% believe it to be a burdensome treatment. "Best treatment" and "It works" beliefs continue to underpin decision making. Those who recommend TL most often are most influenced by penetration, coughing, and their own clinical experience. They are more likely to believe TL is evidence based and effective, reduces aspiration, and improves hydration. Person-centeredness is important among all respondents, although significant numbers would implement TL against patient wishes. Improvements in aspiration status and quality of life rank highly as reasons to discontinue TL. Conclusions: The results of this study suggest that fewer respondents are regularly using TL. Divergent groups are evident with those frequently employing and believing in the efficacy of TL and those who do not. While current debates are influencing practice, there clearly remains a significant number of SLPs continuing to recommend TL. This study's findings highlight both alterations and preservations in the discipline's approach to TL and calls for SLPs to reframe our thinking regarding this intervention as well as consider alternative options in this treatment space. [ABSTRACT FROM AUTHOR]

Background: Use of modified texture diets—thickening of liquids and modifying the texture of foods—in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners. Main text: Valid informed consent requires provision of accurate and balanced information, and that agreement is given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients' communication difficulties but also poor communication—and no real attempt to obtain consent—by practitioners before people are 'put on' modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients' decisions is also questionable if they are told 'you must', when 'you might consider' is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information. Conclusion: Research is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the 'lens' of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people's preferences and values. [ABSTRACT FROM AUTHOR]

Background. Assessment referrals are increasing for unexpected dysphagia, particularly for older people. It is unclear if this is due to more impaired swallows or healthy age-related changes. Swallow respiration coordination prevents aspiration, and may deteriorate with age. Nonpathological features of the swallow in healthy aging and the factors that influence an individual's ability to eat and drink safely need greater understanding. Some changes might predispose an older person to dysphagic complications in the event of an insult such as a stroke. We investigated the effects of healthy aging on resting and swallow respiratory patterns. Methods. Fifty healthy volunteers (aged 20-78 years) were recruited to have swallow respiration patterns recorded on a computer. Bolus volume and consistency variations were studied: 5 and 20 ml of water and 5 ml of yogurt. Results. Measurable swallows significantly decreased with age for water boluses. Swallow apnea increased with age (5 ml of water r = 0.433, p = .002; 5 ml of yogurt r = 0.367, p .023). Independent of age were: breathing out (occurred after 98% of boluses); multiple swallowing (occurred with all bolus types); postswallow respiration reset pattern (more irregular after yogurt, Wilcoxon signed rank Z = -2.236, p = .025); and resting respiration. Conclusions. Subtle changes occur in swallow respiration coordination with age. These changes may be compensatory protective mechanisms rather than the result of decreased muscle mobility or reaction times, and not indicative of impairment. Misattributing healthy age-related changes to impairment affects patient care and the use of healthcare resources.

Purpose: Medications can produce side effects that negatively impact swallowing and cognition. Speech-language pathologists (SLPs) who know which medications their patients are taking are able to consider the potential impact of medication side effects on their patient's swallow function and progress in therapy. The goal of this investigation was to gain preliminary information on how often SLPs report that they review a patient's medications as part of their standard practice, as well as the most common reasons for not reviewing patient medications. Method: A 10-item online questionnaire was distributed to practicing SLPs to collect information regarding their clinical experience, patient caseload, and whether they routinely review patient medications. Logistic regression analysis was used to determine which variables were associated with medication review. Results: Responses were received from 205 SLPs. Approximately half reported "always" reviewing patient medications (n = 116). The most frequent reason given for not reviewing medications was lack of pharmacology training. The results indicated that SLPs with 15 years or more of experience were nearly 3 times more likely to review medications than SLPs with less experience. Not all Special Interest Groups participated in the distribution of the survey. Conclusions: Many SLPs reported that they did not consistently check patient medications as part of a patient evaluation. Of concern is the possibility that SLPs do not realize the importance of medication knowledge. Clinicians may gain familiarity with the medications and understanding of the impact that medications have on their patients as they accrue clinical experience. Future research should investigate the best ways to promote knowledge of this topic in new clinicians. [ABSTRACT FROM AUTHOR]

Purpose: Working with patients and families with different cultural backgrounds is now commonplace in all areas of speech-language pathology. This includes supporting those with eating, drinking, and swallowing problems. Becoming more culturally sensitive as clinicians requires us to think less of them versus us, and instead what matters to them, and how best for us to provide expert care. Our starting point for this important topic is not how we tweak our clinical recommendations to fit someone's "culture." Rather, let us examine what is culture and how should it factor into our professional work? We need to understand how our patients and families view health and well-being, or lack thereof, in general. This will enable us to frame our support and offer optimal care to all stakeholders. This leads naturally to a consideration of the concepts of autonomy, informed consent, and how these factor into person-centered care, and shared decision making. Conclusions: As well as gaining an understanding of the frameworks of health and illness, we consider how food and drink are much more than mere nutrition and hydration. Foods signal our individual and collective identities. Thus, to be a respectful and professional clinician, we need to appreciate our role as a cultural guest with all whom we serve. We propose that there is no such thing as being "culturally competent." Expert clinicians possess a respect for the patient and their expertise-by-experience of health and illness. Such respect is founded in the position of cultural humility, to be a guest of someone's world view, in the same way that we respect being a guest in a patient's physical home. [ABSTRACT FROM AUTHOR]

Purpose: This article discusses the complexities of caring for individuals with dementia with an interdisciplinary team approach. The overlap and potential conflict between speech-language pathologists (SLPs) and occupational therapists (OTs) are addressed. SLPs and OTs have potentially similar roles when caring for people with dementia, so it can be difficult to decipher whose job it is to implement similar therapy techniques. However, there are ways health care professionals can prepare themselves to work collaboratively and potentially avoid conflict among team members, such as overstepping their professional boundaries and scopes of practice. This article discusses three beneficial techniques for interprofessional collaboration: acquiring sufficient knowledge about the scopes of practice of both SLPs and OTs, developing effective communication skills, and identifying the intentions of each therapeutic technique. Conclusions: There is no straightforward or universal answer to the question "Whose job is it?" when considering SLPs and OTs in caring for people with dementia. Deciding whether an SLP or an OT should implement certain aspects of therapy depends on the roles of each professional and how they can benefit the patient. Interdisciplinary team members must work together to identify how their roles interact and overlap. SLPs and OTs must have a solid knowledge base about each other's scopes of practice, develop effective communication skills, and be able to identify the intentions of their therapy. Developing these skills allows SLPs and OTs to work harmoniously in interprofessional teams. [ABSTRACT FROM AUTHOR]

Traditional point-based grading is failing students entering a competency-based workforce: Employers require concrete skills and knowledge, not "high" grades. In the specifications approach, learning outcomes are explicitly linked to the grading system. The basic components of the approach include clear alignment of learning outcomes to certification standards, bundled sequences of assessments tied to basic and advanced competency/learning outcomes, pass/fail grading with no partial credit, opportunities to revise unacceptable work, and detailed expectations of performance on assessments. This article describes the specifications approach and provides examples highlighting how to (1) align course learning objectives with a grading system, (2) implement a pass/fail approach even for complex assessment, (3) define specifications, (4) create and sequence bundles of assessments, and (5) provide instructor support through feedback and tokens. [ABSTRACT FROM AUTHOR]

Dysphagia management is complex and requires balancing individuals' preferences, quality of life, and medical consequences. Ethical challenges are not uncommon given the complexity of dysphagia. Professionals must engage in ethical reflection and shared decision-making when managing dysphagia. Recognizing one's own presuppositions and beliefs may be fundamental to ensuring an ethical approach. The goal of this article is to apply principles of ethics using hypothetical case studies of dysphagia. To this end, we will describe the challenges of working with the disorder of dysphagia; the influence of culture on decision-making about eating and feeding; the importance of information disclosure and respect for individuals' refusal of recommendations; and the interplay of ethical reflection, evidence, and clinical judgment when making complex dysphagia management decisions. These concepts should be kept in mind to ensure compassionate and competent care of the person with eating, drinking, or swallowing problems and their family caregivers. [ABSTRACT FROM AUTHOR]

Interprofessional, collaborative health care is the ideal standard in geriatrics. Students' interprofessional practice skills are limited in typical siloed education. An experiential, team-based geriatrics course was designed to improve health professions (HP) students' knowledge, skills, and attitudes about interprofessional practice. Students (n=209) from dentistry, medicine, nursing, nutrition, occupational therapy, pharmacy, physician assistant, social work, and speech-language pathology were assigned to interprofessional (IP) and medical-student only teams. The Interprofessional Collaborative Competency Attainment Survey-Revised (ICCAS-R) was administered pre- and post-course, along with program evaluations. Seventy percent of students completed both pre- and post-surveys. ICCAS-R scores were analyzed comparing the impact of training for medical students (n=78) on IP teams and remaining HP students (n=58). Students rated themselves as improved on all six ICCAS-R subscales (paired t-tests, p < 0.05). Sixty-nine percent rated themselves as better able to collaborate interprofessionally. A competitive team-based learning exercise using gamification was rated as the most authentic skill-building interprofessional activity. Experiential learning where students worked with the same team helped to build interprofessional and teamwork skills. Findings will be used to improve authenticity of the clinical and teamwork content, increase the use of gamification as a teaching technique, and refine students' practice of IP teamwork competencies. [ABSTRACT FROM AUTHOR]

271 Book reviews and educational resourcesEthical Issues in Dementia Care: Making Difficult Decisions, by Julian C. Hughes and Clive Baldwin. London: Jessica Kingsley, 2006, pp. 160. ISBN-13: 978 1 84310 [...]

Book reviews and educational resources 'Oh Good, Lunch is Coming': A Programme to Help Staff Encourage People with Dementia to Eat and DrinkWell, Dementia Services Development Centre, University of Stirling, [...]

'Oh Good, Lunch is Coming': A Programme to Help Staff Encourage People with Dementia to Eat and Drink Well, Dementia Services Development Centre, University of Stirling, 2002: The Cast Iron [...]

Billions of health care dollars go towards caring for older adults. Medicare per-person spending rises steadily with age and doubles between ages 70 and 95 (Neuman, Cubanski, Huang, & Damico, 2015). The baby boomers, born between 1946 and 1965, represent a large wave of older patients entering the United States health care system today. The boomer demographic is significant for its size and longevity, thereby adding pressure to an already strained health care system. Of critical importance to the boomers is where they expect to live until they die and how they expect to be cared for. Aging in place has become a common phrase and signals the boomers' overwhelming desire to remain at home until the end (Lai, 2008). According to the United Nations, by 2025 Japan will be the country with the highest proportion of individuals aged 75 or over, followed by Sweden and then Italy (Ogawa & Matsukura, 2007). What can we learn from Japan about graceful aging? This article discusses multiple factors responsible for longevity in Japan, ranging from perceptions of aging to government policy. [ABSTRACT FROM AUTHOR]

Purpose: Speech-language pathologists routinely assess physical tension during evaluation of those who stutter. If speakers experience tension that is not visible to clinicians, then judgments of severity may be inaccurate. This study addressed this potential discrepancy by comparing judgments of tension by people who stutter and expert clinicians to determine if clinicians could accurately identify the speakers’ experience of physical tension. Method: Ten adults who stutter were audio-video recorded in two speaking samples. Two board-certified specialists in fluency evaluated the samples using the Stuttering Severity Instrument-4 and a checklist adapted for this study. Speakers rated their tension using the same forms, and then discussed their experiences in a qualitative interview so that themes related to physical tension could be identified. Results: The degree of tension reported by speakers was higher than that observed by specialists. Tension in parts of the body that were less visible to the observer (chest, abdomen, throat) was reported more by speakers than by specialists. The thematic analysis revealed that speakers’ experience of tension changes over time and that these changes may be related to speakers’ acceptance of stuttering. Conclusion: The lack of agreement between speaker and specialist perceptions of tension suggests that using self-reports is a necessary component for supporting the accurate diagnosis of tension in stuttering. [ABSTRACT FROM AUTHOR]

Purpose: This study surveyed didactic and clinical education in fluency disorders at undergraduate and graduate institutions in the United States that provide education in speech-language pathology to determine whether a previously observed reduction in requirements has continued since prior surveys (Yaruss, 1999; Yaruss & Quesal, 2002). Method: The study involved a detailed questionnaire that was sent to 282 communication science and disorders departments. Questions examined didactic and clinical education, as well as faculty knowledge about fluency disorders. Results: Comparisons with prior surveys revealed several findings, including (a) on average, programs have increased academic coursework and incorporated more practical sessions and competency-based testing in the classroom; (b) the number of faculty who possess extensive clinical experience with fluency disorders has decreased; and (c) although an increase in clinical requirements in fluency disorders was detected, the number of programs providing minimal education about fluency disorders remains high. Conclusion: Given an expanding scope of practice, many programs have continued to try to provide adequate education about fluency disorders. Still, direct clinical experiences are limited, and faculty expertise in this area has continued to decrease. To raise students’ confidence and competence in fluency disorders, efforts beyond graduate work—or systemic changes in the profession— may be necessary. [ABSTRACT FROM AUTHOR]

The replacement of fluids (usually water), may be undertaken in one of three ways: * orally: People may drink it or it may be administered via an enteral tube; * intravenously where fluid is provided via a cannula into a vein; or * subcutaneously, where fluids are administered between the subcutaneous layer of the skin and fat. This is called hypodermoclysis. As speech-language pathologists (SLPs) monitor the ability to swallow, they are in an ideal position, particularly in community settings, to identify problems with hydration. People with dysphagia may require a modification to their diet. Fluids are frequently thickened, which then results in reduction of fluid (water) intake. When the amount of water drunk is exceeded by the amount of water lost (e.g., urine, feces, sweat, and breath) dehydration may result. Clinically, dehydration may present as agitation, dry skin and tongue (mouth), and reduced skin elasticity. Hypodermoclysis is a simple technique that can be used in the community with minimal training and can be used to supplement oral intake. The SLP is ideally placed to suggest this to the physician caring for the patient. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis The association between extraesophageal reflux (EER) and symptoms of gastroesophageal reflux disease (GERD) is inadequately understood. We used the Comprehensive Reflux Symptom Scale (CReSS) to evaluate EER and reflux-symptom prevalence in gastroenterology and otolaryngology outpatients and symptom awareness among UK gastroenterologists. Study Design Cross-sectional cohort survey. Methods Six hundred thirty-nine participants were surveyed: 103 controls, 359 patients undergoing esophagogastroduodenoscopy (EGD), and 177 otolaryngology clinic patients with throat symptoms. Participants completed the CReSS questionnaire. The study was undertaken in the Endoscopy Unit and the Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne, United Kingdom. Registered members of the British Gastroenterology Society were asked to rate how frequently reflux patients might complain of each CReSS item. Results The median CReSS total in volunteers (4) was significantly lower ( P < .002) than in ear, nose, and throat (ENT) patients (26) or EGD patients with (42) or without (32) esophageal inflammation. All items were scored as ≥1 by >15% of ENT patients and 28% of EGD patients. Three major, robust CReSS factors: esophageal, pharyngeal, and upper airway emerged. Of 259 gastroenterologists, >20% scored 8 of the 34 symptoms as never being reported by reflux patients. Conclusions Endorsement of each EER CReSS item by 28% to 58% of patients with endoscopic evidence of GERD supports the Montreal consensus on an EER-GERD continuum. Gastroenterologists vary considerably in their appreciation of EER symptom relevance. The advantages of CReSS include standardized, comprehensive capture of patient experience; discriminant validity of ENT and GERD patients from volunteers; and discrete esophageal, pharyngeal, and upper airway subscales. Level of Evidence 4 Laryngoscope, 125:424-430, 2015 [ABSTRACT FROM AUTHOR]

People with life-limiting disease are among the most vulnerable groups accessing healthcare. Given this vulnerability, polarized views have been expressed in the literature regarding such individuals' involvement in research studies. This is further compounded when the research is focused on rehabilitation, the concept of which is often misunderstood by patients, carers, and medical professionals. A number of factors can affect how we conduct research to elicit the needs of people with life-limiting disease, including social, historical, and cultural influences. Despite advances in palliative care research, challenges remain for those working across the specialism. In this review, we discuss the challenges of conducting rehabilitation research in this distinct clinical specialism and important considerations when involving patients and carers. We highlight the opportunities for understanding patient rehabilitation needs through mixed methods research design for studies involving those undergoing potentially complex rehabilitation interventions across settings. Note People with life-limiting disease will be referred to as 'patients' in the context of their being involved with the healthcare system and receiving care from a clinician. [ABSTRACT FROM AUTHOR]

This paper contributes to our understanding of participation in the Eucharist by examining the swallow. The paper begins with a thick description of the swallow as act, as phenomenon, and as symbol. This description reveals the swallow's interstitial nature, which is then examined for its implications on the meaning of participation in the sacrament. The paper then recommends approaches to the Eucharist for Catholics for whom swallowing is difficult or impossible. The paper finally incorporates these findings with the ex opere operato doctrine, demonstrating participation as efficacious interaction. [ABSTRACT FROM AUTHOR]

Health risks associated with dysphagia in adults with intellectual impairment are well documented. There is little research into compliance with dysphagia recommendations in environments where care is provided for adults with intellectual impairment. This is a pilot study into carer compliance with Speech-Language Pathology recommendations. We aimed to investigate the level of compliance with dysphagia recommendations in day centers and the factors that might affect compliance using a questionnaire. Twenty-seven clients were observed. Results showed an overall high level of compliance with recommendations (82%), with figures ranging from 64% compliance with appropriate utensils to 100% with direct support recommendations. Areas of noncompliance were evident, with level of dependence of clients and training of carers being key issues. Implications for practitioners are discussed. [ABSTRACT FROM AUTHOR]