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Aim: The aim was to study criterion validity of the Czech version of the Eating Assessment Tool (EAT-10) by comparing it with the Nursing Dysphagia Screening Tool (NDST). Moreover, the aim was to compare three items of the EAT-10 that focused on swallowing liquids (EAT3) and solids (EAT4) and on cough while eating (EAT9) with one item of the NDST, the swallow test (NDST8). Design: The design was cross-sectional. Methods: The sample included 57 hospitalized patients with a neurological condition. Their swallowing function was assessed using the EAT-10 and NDST. The relationship between the dichotomized EAT-10 and NDST and the selected items of both tools was expressed using the association coefficient phi (ϕ). Results: For all the studied EAT-10 cut-off scores, the relationship between the EAT-10 and NDST was negative; it was the strongest for a cut-off score of 15 (phi = -0.795; p < 0.001). In all but one case, the relationship between the three items of the EAT-10 and the NDST8 was negative; it was the strongest for EAT3 (cut-off score of 3; phi = -0.701; p < 0.001). Conclusion: The results do not provide evidence for criterion validity of the EAT-10 using the NDST. Further research is recommended.

Background The aim of this study was to compare spontaneous swallow frequency analysis (SFA) with clinical screening protocols for identification of dysphagia in acute stroke. Methods In all, 62 patients with acute stroke were evaluated for spontaneous swallow frequency rates using a validated acoustic analysis technique. Independent of SFA, these same patients received a routine nurse-administered clinical dysphagia screening as part of standard stroke care. Both screening tools were compared against a validated clinical assessment of dysphagia for acute stroke. In addition, psychometric properties of SFA were compared against published, validated clinical screening protocols. Results Spontaneous SFA differentiates patients with versus without dysphagia after acute stroke. Using a previously identified cut point based on swallows per minute, spontaneous SFA demonstrated superior ability to identify dysphagia cases compared with a nurse-administered clinical screening tool. In addition, spontaneous SFA demonstrated equal or superior psychometric properties to 4 validated, published clinical dysphagia screening tools. Conclusions Spontaneous SFA has high potential to identify dysphagia in acute stroke with psychometric properties equal or superior to clinical screening protocols.

Dysphagia screening often includes administration of water. This study assessed the accuracy in identifying dysphagia with each additional teaspoon of water. The original research of the TOR-BSST(©) permitted this assessment. Trained nurses from acute and rehabilitation facilities prospectively administered the TOR-BSST(©) to 311 eligible stroke inpatients. A sensitivity analysis was conducted for the water item using 10 teaspoons plus a sip as the standard. The proportion of positive screenings was 59.2% in acute and 38.5% in rehabilitation. Of all four items that form the TOR-BSST(©), the water swallow item contributed to the identification of dysphagia in 42.7% in acute and 29.0% in rehabilitation patients. Across all patients, dysphagia accuracy was that five teaspoons resulted in a sensitivity of 79% (95% confidence interval [CI] = 70-86), eight a sensitivity of 92% (95% CI = 85-96) and 10 a sensitivity of 96% (95% CI = 90-99). Although a primary contributor, the water swallow item alone does not identify all patients with dysphagia. For a water swallow to accurately identify dysphagia, it is critical to administer 10 teaspoons. The TOR-BSST(©) water swallow item contributes largely to the total TOR-BSST(©)'s screening score and in making the test highly accurate and reliable.

Background National guidelines recommend dysphagia screening (DS) before oral intake in stroke patients to reduce hospital-acquired pneumonia (HAP). We examined the relationship between DS and HAP after ischemic stroke. Methods Get with the Guidelines–Stroke defines HAP as postadmission diagnosis of pneumonia requiring antibiotics, and DS as the use of bedside swallow screening prior to oral intake. Univariable and multivariable analyses examined the relationship between DS and HAP. Results Among 314,007 ischemic stroke patients at 1244 Get with the Guidelines–Stroke hospitals from 2003-2009 who were eligible for DS and had completed HAP data, a total of 216,372 (68.9%) underwent DS and a total of 17,906 (5.7%) developed HAP. When compared with patients without HAP, patients with HAP were older, had admission National Institutes of Health Stroke Scale (NIHSS) score (median NIHSS score: 10 versus 4), were more likely to undergo DS (75.5% versus 68.5%), and had increased length of stay and in-hospital mortality (12.4% versus 2.3%). In multivariable analyses, factors independently associated with a lower risk of HAP were female gender (odds ratio [OR] 0.84), dyslipidemia (OR 0.84), and hypertension (OR 0.94). DS was associated with a higher adjusted OR for HAP (OR 1.40), but the OR was greatly attenuated after adding NIHSS score to the model (OR 1.10). Conclusions HAP occurs in 1 of 17 hospitalized stroke patients and is associated with a greater than 5-fold increase in mortality. DS did not occur in 31.1% of eligible patients, with increased screening among those with more severe strokes and those who developed HAP. The attenuation of the relationship between DS and HAP risk when controlling for NIHSS score suggests the association between screening and pneumonia is confounded by severity. Controlled trials are needed to determine DS effectiveness.

Early detection of dysphagia is critical in stroke as it improves health care outcomes. Administering a swallowing screening tool (SST) in the emergency department (ED) appears most logical as it is the first point of patient contact. However, feasibility of an ED nurse-administered SST, particularly one involving trial water swallow administration, is unknown. The aims of this pilot study were to (1) implement an SST with a water swallow component in the ED and track nurses’ adherence, (2) identify barriers and facilitators to administering the SST through interviews, and (3) develop and implement a process improvement plan to address barriers. Two hundred seventy-eight individuals with stroke symptoms were screened from October 2009 to June 2010. The percentage of patients screened increased from 22.6 in October 2009 to a high of 80.8 in March 2010, followed by a decrease to 61.9% in June (Cochran-Armitage testz=-5.1042, P<0.0001). The odds of being screened were 4.0 times higher after implementation compared to two months before implementation. Results suggest that it is feasible for ED nurses to administer an SST with a water swallow component. Findings should facilitate improved quality of care for patients with suspected stroke and improve multidisciplinary collaboration in swallowing screening.

Swallowing accelerometry has been recently investigated as a potential non-invasive tool for dysphagia screening. This method is based on the translation of vibrations recorded from the upper aerodigestive tract structure during swallowing into a voltage signal. Some studies hypothesize the hyoid bone movement during swallowing as the source of swallow vibrations, as it is an essential component of swallowing function that contributes to protection of the airway during the swallow. However, there is still an open question about the physiological source of swallowing vibrations. In this paper, we investigate the correlation between the swallowing vibrations recorded by the tri-axial accelerometer and hyoid bone kinetics observed in video-fluoroscopic swallow imaging studies. Further, this is a first of its kind study investigating this correlation with vibration signals measured in the medial-lateral plane of accelerometry. Our hypothesis is that there exists a correlation between the recorded swallowing vibrations in three axes and hyoid bone kinetics in videofluoroscopic images.Copyright © 2016 by ASME

Background Although many dysphagia screening tools exist, none has high sensitivity and reliability or can be administered quickly with minimal training. Objective To design and validate a swallowing screening tool to be used by health care professionals who are not speech language pathologists to identify dysphagia and aspiration risk in acute stroke patients. Methods In a prospective study of 300 patients admitted to the stroke service at an urban tertiary care hospital, interrater and test-retest reliabilities of a new tool (the Acute Stroke Dysphagia Screen) were established. The tool was administered by nursing staff when patients were admitted to the stroke unit. A speech language pathologist blinded to the results with the new tool administered the Mann Assessment of Swallowing Ability, a clinical bedside evaluation, with dysphagia operationally defined by a score less than 178. Results The mean time from admission to screening with the new tool was 8 hours. The mean time between administration of the new tool and the clinical bedside evaluation was 32 hours. For the new tool, interrater reliability was 93.6% and test-retest reliability was 92.5%. The new tool had a sensitivity of 91% and a specificity of 74% for detecting dysphagia and a sensitivity of 95% and a specificity of 68% for detecting aspiration risk. Conclusions The Acute Stroke Dysphagia Screen is an easily administered and reliable tool that has sufficient sensitivity to detect both dysphagia and aspiration risk in acute stroke patients.

Swallow accelerometry is an emerging tool for noninvasive dysphagia screening. However, the automatic detection of a swallowing event is challenging due to contaminant vibrations arising from head motion, speech and coughing. In this paper, we consider the acceleration signal as a stochastic diffusion where movement is associated with drift and swallowing with volatility. Using this model, we develop a volatility-based swallow event detector that operates on the raw acceleration signal in an online fashion. With data from healthy participants and patients with dysphagia, the proposed detector achieves performance comparable to previously proposed swallow segmentation algorithms, with the added benefit of online detection and no signal pre-processing. The volatility-based detector may be useful for event identification in other biomechanical applications that rely on accelerometry signals.

The Massachusetts General Hospital-Swallow Screening Tool (MGH-SST) is a two-part dysphagia screening tool for use by trained staff working with acute neuroscience patients. It was developed in 2004 for use on our neuroscience inpatient units using factors sensitive to aspiration risk. The MGH-SST provides early detection of those at risk for aspiration, guides the decision whether a patient can safely eat or drink, and acts as a trigger for appropriate speech--language pathology (SLP) consult for a comprehensive swallow evaluation. A staff education module was developed including a training video with clinical examples to simulate disordered clinical features, as well as a competency assessment. The MGH-SST was validated using trained nurses with patients with a broad range of neurological and neurosurgical injuries, comparing the MGH-SST results to an instrumental dysphagia assessment, fiberoptic endoscopic evaluation of swallowing (FEES). It was found to be a valid and effective screening to identify patients at risk for dysphagia. Elements critical to the success of a dysphagia screening program include multi-disciplinary collaboration, administrative support, comprehensive training to ensure reliable and consistent administration, and continuous performance measurements.

Screening of acute stroke patients for signs of dysphagia (swallowing impairment) is recommended within 24hours of hospitalization owing to increased risk of morbidity and mortality. Speech and language therapists (SLTs) are the lead health professionals responsible for assessment of dysphagia. However, increasing demand for assessment and the relative dearth of SLTs in the NHS has resulted in delays in assessment of up to 6days. Subsequently there is a drive for nurses to perform this screening process using a validated screening method and tool. This paper centres on the exploratory phase of a three-stage programme of research, designed to develop and evaluate a bedside dysphagia screening tool for use by registered nurses. Here the authors focus on a review of the salient professional literature and the findings of a survey of current dysphagia screening practices employed by nurses across 52 NHS trusts in England and Wales.

Purpose: The purpose of this study was to evaluate the psychometric quality and feasibility of measurements for screening dysphagia in older adults to identify the ‘right tool’ for nurses to use in nursing homes. Methods: A systematic review was done. Electronic databases were searched for studies related to dysphagia screening measurements. A checklist was used to evaluate the psychometric quality and applicability. Tools were evaluated for feasible incorporation into routine care by nurses. Results: 29 tools from 31 studies were identified. Dysphagia screening tools with an acceptable validity and reliability had sensitivity between 68% and 100% and specificity between 52% and 100%. The Gugging Swallowing Screen (GUSS) and the Standardized Swallowing Assessment (SSA) were the tools with high psychometric quality, especially with high sensitivity, that nurses could perform feasibly to identify the risk and to grade the severity of dysphagia and aspiration of nursing home residents. Conclusion: Results show that GUSS and SSA are reliable and sensitive tools for screening dysphagia which nurses can use in nursing homes. Further research is needed to examine feasibility of screening with identified tools, and also, to establish effective and standardized protocols for these tools so they can be effectively incorporated into routine care.

Background and Purpose: Screening patients admitted with stroke symptoms for risk of dysphagia is often the responsibility of registered nurses (RNs). Simulation technology has become a widely used evidence-based form of training for healthcare professionals. Simulation mannequins allow for training in a controlled environment, eliminating the need for practice of skills with live patients. The purpose of this pilot study was to compare effectiveness of in-service training to a comprehensive training method utilizing a medical simulation mannequin as a main component to teach administration of swallowing screening items. Methods: RNs (N=32) were randomly assigned to one of two training groups. Both groups received a 20 minute didactic training in administration and interpretation of non-swallow (dysarthria, wet voice, abnormal volitional cough) and water swallow (cough, throat clear, wet voice) screening components. The control group (n=16) received only didactic training. The experimental group (n=16) received didactic training plus additional training with a medical mannequin programmed to simulate auditory elements of acute stroke patients, e.g., dysarthria, cough after swallow. Acquisition of skills was evaluated for both groups using the medical mannequin simulated with various stroke patient profiles. Fisher’s Exact Test was used to assess the association between type of training and acquisition of skills. Results: No significant association was evident for acquisition of interpretation or procedural skills between groups. Raw data revealed that the experimental group achieved accurate interpretation and procedural skills in fewer trials than the control group. This was particularly evident for procedural skills in which 69% in the experimental group achieved accurate administration within one trial while only 31% in the control group demonstrated accuracy. Conclusion: Results indicate that simulation training is a feasible method to teach and evaluate obtainment of skills necessary to accurately complete dysphagia screenings in acute stroke patients. Further research should focus on retention of skills learned and translation of skills from the simulated patient to live patients admitted with stroke symptoms.

Background and Purpose: Registered nurses (RNs) are critical to the rapid completion of dysphagia screening as individuals presenting with stroke symptoms must have swallowing screened prior to oral intake including aspiration. With many swallowing screening tools, RNs are required to make judgments routinely performed by speech-language pathologists (SLP). We hypothesized that RNs could obtain and sustain high inter-rater reliability in completing dysphagia screening. Methods: RNs routinely working with stroke admissions at the Michael E. DeBakey VA Medical Center were recruited (N=15). They underwent a 20 minute didactic training concerning stroke and dysphagia which included observation of a video recording showing execution and interpretation of the screening items (lethargy, dysarthria, wet voice, abnormal volitional cough, and response to water swallow: cough, throat clear, wet voice). Following this, the RN was required to demonstrate correct administration and interpretation of the screening items using study staff and video clips of dysphagia screenings prior to screening patients. To establish RN inter-rater reliability, a randomly selected RN from the cohort of trained nurses and an SLP made simultaneous independent judgments of the same observations obtained from the screening of a stroke participant. Results: Between October 2012 and June 2014, 199 dysphagia screenings were completed. Overall, substantial reliability was identified between the RNs and the SLPs (k[SE] = .79[.02]) and was comparable to SLP inter-rater reliability (.83[.03]). Completion of 20 screenings (n = 5) yielded almost perfect reliability (.83[.02]). RNs with at least 20 screenings showed consistent improvement in reliability over time with an average increase of 19% (range 6.2% to 40.2%) when comparing earlier screenings to later screenings. Conclusions: RNs are reliable in obtaining and sustaining reliability in accurately completing dysphagia screening. Practice improves performance with high levels of sustained reliability achieved with completion of 20 screenings.

155 Background: In Ontario, Canada, longitudinal patient self-reporting of 9 common cancer symptoms and a global health scale (Edmonton Symptom Assessment System, ESAS) is mandated and used clinically as a screening tool for multidisciplinary precision care (chemo/rads/surg). However, a common GI symptom, dysphagia, is not assessed in the same setting. Methods: Mostly gastro-esophageal cancer outpatients (some head and neck and lung cancer patients undergoing radiation were also included for generalizability) received one of two versions (V1, V2) of the dysphagia screening tool based on PRO-CTCAE-derived language. The tool included two screening questions, which when answered affirmatively, led to more comprehensive dysphagia/odynophagia questioning. The survey was introduced on iPads with V1. An assessment of acceptability through patient survey was additionally included in V2, and the duration of survey completion was recorded. Exploratory in-depth interviews were conducted with oncologists to assess usability in the clinic setting. Results: Of 101 approached and eligible, 79 consented, and 66 completed the survey. Median completion time was 2.12 ± 0.80 min. 95% were happy to complete survey on a touchscreen tablet, 88% did not find completion of survey time-consuming, and 91% found completion of survey useful in order to tell the clinician how they feel physically and emotionally. The prevalence of dysphagia based on screening question #1 (“difficulty upon swallowing?”) was 38% (25/66), while for screening question #2 (“pain upon swallowing?”) prevalence was 18% (12/66). Five interviewed physicians found the survey to be clinically informative, not burdensome in terms of time consumption, and felt it would be a valuable addition to outpatient clinics. One recurring suggestion was to combine the two screening questions into one. Results were similar across GI, head and neck, and lung cancer sites. Conclusions: The e-PRO dysphagia screening tool is acceptable and feasible for patients, and useful for clinicians. Next, a modified one-question dysphagia tool will be assessed in the multidisciplinary care of gastro-esophageal cancer patients.

Aspiration pneumonia from dysphagia following stroke presents significant morbidity and mortality in that population. Dysphagia screening before oral intake has been a standard of care for years, but there is a lack of consensus on the best screening tool. The Gugging Swallowing Screen (GUSS) is presented as a potentially better alternative to other dysphagia screens due to its safer progression of oral intake, more thorough evaluation of swallowing, and ability to enable earlier nutrition. J Contin Educ Nurs. 2015;46(3):103–104.

Keypoints Many systemic diseases have associated oral manifestations Systemic inflammatory processes are associated with oral inflammatory disease Dysphagia may occur due to locoregional diseases, vascular, neurologic, and autoimmune diseases and medical management An interprofessional approach is important for dysphagia screening and management The preservation of periodontal health is a key component of oral and overall health

Dysphagia screening is a recurring topic of discussion in stroke care and other acute and chronic conditions that can affect swallowing. Many would agree with Wolf and Rudd that “[s]wallowing screening is so obviously important that a trial is not needed, but the hard evidence that screening saves lives is absent.”1 Paradoxically, the 2010 Joint Commission retired the dysphagia screening performance standard for acute stroke because the National Quality Forum could not endorse it, stating that there are no standards for what constitutes a valid dysphagia screening tool, and no clinical trials have been completed that identify the optimal swallow screening.2 Consequently, dysphagia screening was removed from the “Get With The Guidelines” stroke guidelines. This has led to concern among multidisciplinary stroke professionals that dysphagia screening will be entirely omitted from stroke care, leading to worsening outcomes among stroke patients at risk for swallowing problems. An invitational symposium was held January 31, 2012, at the State-of-the-Art Nursing Symposium in New Orleans, LA, to explore the issues and state of the science in dysphagia screening. The present report serves as a conference proceeding that aims to (1) educate multidisciplinary stroke professionals about the important issues related to identifying valid and reliable dysphagia screening tools, (2) identify the strengths and limitations of currently available dysphagia screenings, (3) describe how facilities may make cogent decisions about dysphagia screening selection, based on their specific needs, and (4) provide an example for establishing a dysphagia screening in a stroke care unit. As part of the discussion during the symposium, several expert recommendations were made regarding dysphagia screening in stroke care, which are also presented here. We will begin the report, as we will end, with this caveat: Because dysphagia screening is not a “one size fits all” process, neither the symposium nor the …

Background: Dysphagia is a devastating complication of stroke and can lead to malnutrition, immobility, aspiration pneumonia, and death. Guidelines advocate screening all patients with acute stroke for swallowing impairment. However, previous research suggests only 60% are screened, and it is unclear what factors contribute to receiving dysphagia screening. Methods: We used the Ontario Stroke Registry to identify patients who were admitted to Regional Stroke Centres from 2010-2013. We used multivariable regression to identify predictors of receiving a dysphagia screen within 72 hours. Results: Among 7172 patients with acute ischemic stroke, 1705 patients (23.8%) did not undergo screening. Factors increasing the odds of being tested were: Stroke unit admission (adjusted odds ratio aOR 6.5), presenting with speech deficits (aOR 1.9) or weakness (aOR 1.5), or receiving thrombolysis (aOR 1.9). Seizure (aOR 0.49) and mild stroke (aOR 0.59 vs moderate stroke) decreased the odds of being tested. Among those with mild strokes who received a swallowing screen, 33% failed. *All pConclusions: Patients with mild stroke are at risk of not being screened for dysphagia, despite a significant fail rate among those tested. This may expose untested patients to a higher risk of complications from dysphagia, and suggests a gap in process of care that should be addressed.

Background and Purpose— Dysphagia screening (DS) before oral intake in patients with acute stroke is a hospital-level performance measure. We report outcomes of an initiative to improve compliance to this quality measure. Methods— The design was a pre- versus postintervention comparison study. The Intervention was an electronic medical record-based clinical DS system embedded within stroke admission orders. The clinical DS was designed to facilitate DS in patients with stroke. The primary outcome was compliance to a process measure in patients with ischemic stroke: performance of a swallow screen before oral intake. Results— DS measure compliance increased from 36% to 74% ( P =0.001). Chart audits found screened patients were more likely to have clinical DS-embedded admission orders initiated or stroke unit admission. Conclusion— The electronic medical record offers a ready platform for clinical DS implementation. DS is a difficult performance measure to improve. The described clinical DS has the potential for improving performance on this challenging care quality measure.

Background Swallowing accelerometry has been suggested as a potential non-invasive tool for bedside dysphagia screening. Various vibratory signal features and complementary measurement modalities have been put forth in the literature for the potential discrimination between safe and unsafe swallowing. To date, automatic classification of swallowing accelerometry has exclusively involved a single-axis of vibration although a second axis is known to contain additional information about the nature of the swallow. Furthermore, the only published attempt at automatic classification in adult patients has been based on a small sample of swallowing vibrations. Methods In this paper, a large corpus of dual-axis accelerometric signals were collected from 30 older adults (aged 65.47 ± 13.4 years, 15 male) referred to videofluoroscopic examination on the suspicion of dysphagia. We invoked a reputation-based classifier combination to automatically categorize the dual-axis accelerometric signals into safe and unsafe swallows, as labeled via videofluoroscopic review. From these participants, a total of 224 swallowing samples were obtained, 164 of which were labeled as unsafe swallows (swallows where the bolus entered the airway) and 60 as safe swallows. Three separate support vector machine (SVM) classifiers and eight different features were selected for classification. Results With selected time, frequency and information theoretic features, the reputation-based algorithm distinguished between safe and unsafe swallowing with promising accuracy (80.48 ± 5.0%), high sensitivity (97.1 ± 2%) and modest specificity (64 ± 8.8%). Interpretation of the most discriminatory features revealed that in general, unsafe swallows had lower mean vibration amplitude and faster autocorrelation decay, suggestive of decreased hyoid excursion and compromised coordination, respectively. Further, owing to its performance-based weighting of component classifiers, the static reputation-based algorithm outperformed the democratic majority voting algorithm on this clinical data set. Conclusion Given its computational efficiency and high sensitivity, reputation-based classification of dual-axis accelerometry ought to be considered in future developments of a point-of-care swallow assessment where clinical informatics are desired.

Dysphagia is a common problem that affects people with many health conditions and that can have serious complications. Various dysphagia screening tests exist; however, their creation was associated with certain weaknesses, e.g. none of them used “objective” instrumental tests (e.g., videofluoroscopy or flexible endoscopic examination of swallowing, FEES) in all patients to verify the results. In addition, most dysphagia screening tests were developed for stroke patients. The purpose of this study was to fill this gap. Our research included not only patients with stroke but also patients with other neurological and otorhinolaryngologic conditions. We tested 33 physical examination items in 44 patients and analyzed the results by comparing them to FEES results. Our study is the first one that performed this kind of comparison in all the patients enrolled in the study. Data mining was used to create a 13-item dysphagia screening test that has 88.2% sensitivity.

Objectives: The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10). Methods: The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses. Results: A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (±SD) EAT-10 score of the normal cohort was 0.40 ± 1.01. The mean EAT-10 score was 23.58 ± 13.18 for patients with esophageal dysphagia, 23.10 ± 12.22 for those with oropharyngeal dysphagia, 9.19 ± 12.60 for those with voice disorders, 22.42 ± 14.06 for those with head and neck cancer, and 11.71 ± 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p < 0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 ± 10.5 to 5.2 ± 7.4 after treatment (p < 0.001). Conclusions: The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.

This article discusses the findings of an audit to assess the improved outcomes of a systematic approach to training nurses working in an emergency assessment area (EAA) to conduct dysphagia screening for patients who have had a stroke. The investment in training has reduced the time patients wait for dysphagia screening from 35 hours to less than one hour. As a result of this audit dysphagia screening competencies have been established.

Background and Purpose— Develop achievable benchmarks for 9 stroke performance measures (PM) and to identify organizational factors associated with adherence. Methods— Adherence rates and achievable benchmarks were determined for 9 PM within a study of patients (n=2294) admitted with acute ischemic stroke at 17 hospitals. Baseline information regarding hospital characteristics and stroke-specific processes of care were collected, and multi-level models were used to test the association of these factors with adherence. Results— Benchmarks were ≥90% for 8 of the 9 PM. After controlling for clustering, only use of standing orders was associated with adherence to PM, including: dysphagia screening, venous thrombosis prophylaxis, consideration of tPA, and provision of educational material. Conclusion— High levels of adherence are achievable for several acute stroke PM. Use of standing orders is associated with adherence to PM requiring immediate action on admission.

Initiating safe oral nutrition and hydration immediately following stroke had become a critical concern for health care professionals at our facility. The Examine Ability to Swallow (EATS) dysphagia screening protocol, administered by nurses, was developed to solve this clinical dilemma. The dysphagia screening process for the acute stroke patient has successfully met the facilities' needs and more importantly has increased patients' satisfaction. No formal data were collected. This proactive approach is beneficial to the patient's physiological status as a means of preventing adverse complications; which impacts the recovery time frame for the patient. In addition it promotes the emotional well being of patients, and is economically prudent. This is an asset in today's healthcare environment.

Background: While nutrition focused physical assessment (NFPA) is integral in the Nutrition Care Process, there are no clearly delineated Accreditation Council for Education in Nutrition andDietetics (ACEND) competencies requiringDietetic Internships andCoordinatedPrograms (DIs/CPs) to teach students and interns to performphysical assessment. Objective: To explore current NFPA teaching practices within DIs/CPs and perceived barriers and enablers to teachingNFPA skills. Design: Prospective,web-based survey. Subjects:Ninety-one (32.8%)ACENDaccredited DI/CP directors or their designee participated in the survey. Statistical Analysis: Descriptive statistics were used to report NFPA skills taught and barriers and enablers to teaching NFPA. Results: NFPA skills most frequently taught to be performed were related to anthropometrics: weight (82.0%), height (79.8%), waist circumference (64.0%), skinfold calipers use (55.1%), and bioelectrical impedance analysis (45.5%). Of non-anthropometric NFPA skills cited, skin assessmentwas themost frequently taught (64.4%), while dysphagia screening and cranial nerve screeningwere cited by 38.4% and 7.2% of respondents, respectively. Interest in teaching NFPA among program educators was cited as an enabler (46.6%) to teaching NFPA. Cited barriers to teaching NFPA skills included availability of educators trained in NFPA (56.2%), availability of multi-media resources (52.1%), and NFPA experience of supervised practice preceptors (50.7%). Conclusions: The results indicate that programs most frequently teach students to perform anthropometric measurements. Future research may address barriers including the need for comprehensive NFPA training, experienced preceptors in NFPA, and multi-media resources in order to increase frequency of NFPA skills taught to students and interns.

G A A b st ra ct s HRQoL and its association with clinical improvement were analyzed. Data are expressed as mean(SD). Results: Sixty-five patients were prospectively included in 8 hospitals in Spain. Thirty eight (58%) were men and the mean age was 49 years (+ 19 years). Of them, 47 were treated with pneumatic dilatation and 18 with laparoscopic Heller myotomy. Specific HRQoL were associated with severity of symptoms before therapy. After therapy, AE-18 global and subscales scores improved significantly (Table). All AE-18 scores, except PF, were lower after therapy with pneumatic dilatation than after myotomy. Improvement of AE-18 global score after therapy was significantly greater in patients showing an improvement in symptom severity score than in those without change or with deterioration in clinical status, and it was significantly associated with clinical improvement according to both patient (p= 0.001) and physician opinion (p= 0.002) Disease-specific HRQoL after therapy was significantly better in those patients who were asymptomatic (grade 0) or with mild symptoms (grade 1) than in those with moderate (grade 2) or severe symptoms (grade 3). Conclusion: Disease-specific HRQoL improves in patients with symptomatic achalasia after therapy with pneumatic dilatation or Heller myotomy. The degree of improvement of HRQoL depends on the degree of improvement of esophageal symptoms.

To the Editor: Hinchey and the Stroke Practice Improvement Network Investigators1 are to be commended for managing a major multisite collaborative effort that has compiled a dataset demonstrating current practice in 15 institutions. However, this report is attended by all the usual limitations of this sort of study—dependence on routine documentation rather than evidence of actual practice, in some cases retrospective data extraction, pooling of data from diverse population groups, and an endeavor to identify significant factors among a host of variables which may potentially explain subgroup differences in outcomes. …

Background: Documentation of dysphagia assessment in nursing progress notes is often inconsistent and inconclusive. Despite receiving education on dysphagia screening, a formal tool to guide assessment and facilitate documentation was needed. Existing dysphagia screening tools have not been specifically designed or tested for use by nursing personnel. The nursing dysphagia screening form was developed in collaboration with the stroke service clinical manager and speech and language therapy (SLT) to provide a guideline for consistent assessment, thorough and timely documentation, and outline specific actions to be taken when there is evidence of dysphagia. Methods: All patients admitted to the Stroke Unit since July 2003 with a discharge diagnosis of stroke, excluded are stroke patients admitted to other units because of a lack of expertise, or patients with a pre-existing dysphagia. Within 24 hours of admission, all patients receive a nursing dysphagia screening. A SLT evaluation is then performed as soon as possible, blinded to the outcome of the initial nursing dysphagia screen. Percent agreement and Kappa statistics will be calculated to determine concordance of nursing and SLT evaluations. To determine concordance in acute findings, a stratified analysis is planned based on time intervals to nursing and SLT evaluation. Results: Preliminary results Nov. 2003 Conclusion: Pending.

Objective: To determine frequency of dysphagia risk and associated factors in hospitalized patients as well as to evaluate nutritional status by using different methods and correlate the status with scores of the Eating Assessment Tool (EAT-10). Methods: This was a cross-sectional study including 909 inpatients of a philanthropic hospital. For the diagnosis of dysphagia we used an adapted and validated Brazilian version of the Eating Assessment Tool (EAT-10). The nutritional status was evaluated through the subjective global assessment, and anthropometric measurements included weight, calf and arm circumference, and knee height. The Mann-Whitney test, associations using the Pearson’s χ2 and Spearman’s correlation were used to verify differences between the groups. Results: The prevalence of dysphagia risk was 10.5%, and aging was the associated factor with this condition. Patients at risk presented lower values of arm and calf circumference, variables that correlated inversely with the Eating Assessment Tool (EAT-10) score. Malnutrition was observed in 13.2% of patients based on the subjective global assessment and in 15.2% based on the Body Mass Index. Conclusion: Screening for dysphagia and malnutrition should be introduced in hospitals routine to avoid or minimize damages caused by dysphagia or malnutrition, especially among older people. RESUMO Objetivo: Verificar a prevalência do risco de disfagia e seus fatores associados em pacientes hospitalizados, bem como avaliar o estado nutricional por diferentes métodos e correlacioná-los à pontuação do Eating Assessment Tool (EAT-10). Métodos: Estudo de delineamento transversal, realizado com 909 pacientes internados em um hospital filantrópico. Para o rastreamento de disfagia, foi aplicado o Eating Assessment Tool (EAT-10) em sua versão adaptada para o Brasil. O diagnóstico nutricional foi realizado por meio da avaliação global subjetiva e pela aferição de medidas antropométicas. A diferença entre os grupos foi verificada pelo teste de Mann-Whitney e as associações, pelo χ2 de Pearson e correlação de Spearman. Resultados: A prevalência do risco de disfagia foi de 10,5%, sendo a faixa etária idosa um fator associado a esta condição. Pacientes em risco apresentaram valores inferiores de perímetro do braço e panturrilha, variáveis que se correlacionaram de forma inversa à pontuação do Eating Assessment Tool (EAT-10). A desnutrição foi identificada em 13,2% dos avaliados, segundo a avaliação global subjetiva, e em 15,2%, quando utilizado o índice de massa corporal. Conclusão: O rastreamento da disfagia e da desnutrição devem ser incorporados à rotina hospitalar, com o objetivo de evitar ou minimizar os prejuízos provocados por estas condições, especialmente nos idosos.