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9. Ethical Issues and Dysphagia

Author

Smithard, David G., Kauczor, Hans-Ulrich, Series Editor, Parizel, Paul M., Series Editor, Peh, Wilfred C. G., Series Editor, Brady, Luther W, Series Editor, Lu, Jiade J., Series Editor, and Ekberg, Olle, editor

Published
2019
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11. The predictive value of anticholinergic drug exposure and the outcome of pneumonia: a Danish database study.

Author

Yoshimatsu, Yuki, Kragholm, Kristian, Clemmensen, Silas Zacharias, Melgaard, Dorte, Torp-Pedersen, Christian, Smithard, David G, and Riis, Johannes

Subjects
PNEUMONIA, INTENSIVE care units, LENGTH of stay in hospitals, PARASYMPATHOMIMETIC agents, POLYPHARMACY, TREATMENT effectiveness, HOSPITAL mortality, ARTIFICIAL respiration, HOSPITAL care, RESEARCH funding, DRUG side effects, INSTITUTIONAL care, DATA analysis software, COMMUNITY-acquired pneumonia
Abstract

Introduction Older adults are susceptible to anticholinergic effects. Dysphagia and pneumonia are associated with anticholinergic usage, though a definitive causative relationship has not been established. There is no effective way to predict the prognosis of older adults with pneumonia; therefore, this study investigates the predictive value of anticholinergic burden. Methods Patients aged 65 years and above admitted for community-acquired pneumonia from 2011 to 2018 in Denmark were included through Danish registries. We calculated anticholinergic drug exposure using the CRIDECO Anticholinergic Load Scale (CALS). The primary outcome was in-hospital mortality, and other outcomes included intensive care unit admission, ventilator usage, length of stay, 30-day/90-day/1-year mortality, institutionalisation, home care utilisation and readmission. Results 186,735 patients were included in the in-hospital outcome analyses, 165,181 in the readmission analysis, 150,791 in the institutionalisation analysis, and 95,197 and 73,461 patients in the home care analysis at follow-up. Higher CALS score was associated with higher in-hospital mortality, with a mean risk increasing from 9.9% (CALS 0) to 16.4% (CALS >10), though the risk plateaued above a CALS score of 8. A higher CALS score was also associated with greater mortality after discharge, more home health care, more institutionalizations and higher readmission rates. Conclusions High anticholinergic burden levels were associated with poor patient outcomes including short-/long-term mortality, dependence and readmission. It may be useful to calculate the CALS score on admission of older patients with pneumonia to predict their prognosis. This also highlights the importance of avoiding the use of drugs with a high anticholinergic burden in older patients. [ABSTRACT FROM AUTHOR]

Published
2024
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14. Route of Feeding as a Proxy for Dysphagia After Stroke and the Effect of Transdermal Glyceryl Trinitrate: Data from the Efficacy of Nitric Oxide in Stroke Randomised Controlled Trial

Author

Woodhouse, Lisa J, Scutt, Polly, Hamdy, Shaheen, Smithard, David G, Cohen, David L, Roffe, Christine, Bereczki, Daniel, Berge, Eivind, Bladin, Christopher F, Caso, Valeria, Christensen, Hanne K, Collins, Rónán, Czlonkowska, Anna, de Silva, Asita, Etribi, Anwar, Laska, Ann-Charlotte, Ntaios, George, Ozturk, Serefnur, Phillips, Stephen J, Prasad, Kameshwar, Szatmari, Szabolcs, Sprigg, Nikola, and Bath, Philip M

Published
2018
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23. Additional file 1 of Chin tuck against resistance exercise with feedback to improve swallowing, eating and drinking in frail older people admitted to hospital with pneumonia: protocol for a feasibility randomised controlled study

Author

Smithard, David G., Swaine, Ian, Ayis, Salma, Gambaruto, Alberto, Stone-Ghariani, Aoife, Hansjee, Dharinee, Kulnik, Stefan T., Kyberd, Peter, Lloyd-Dehler, Elizabeth, and Oliff, William

Abstract

Additional file 1. SPIRIT Checklist.

Published
2022
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24. Contributors

Author

Alfonsi, Enrico, Almirall, Jordi, Alvarez-Larruy, Marta, Arreola, Viridiana, Baixauli, Raquel, Barallat, Lucía, Bolívar-Prados, Mireia, Cabib, Christopher, Carrión, Silvia, Cereda, Emanuele, Cheng, Ivy, Clavé, Pere, Cunillera, Ramon, de Tapia, Beatriz, Dou, Zulin, Dziewas, Rainer, Escobar, Romina, Franco, José María, Fujishima, Ichiro, Gallegos, Críspulo, Gea, Montserrat, Hamdy, Shaheen, Han, Tai Ryoon, Inamoto, Yoko, Inzitari, Marco, Ismael-Mohammed, Kovan, Kaneoka, Asako, Labeit, Bendix, Laguna, Laura, Lewis, Jane, Macrae, Phoebe, Marin, Sergio, Martos, Josep, Martín, Alberto, Masiero, Stefano, Mateos-Nozal, Jesús, Matsuo, Koichiro, Melgaard, Dorte, Michou, Emilia, Milewska, Magdalena, Murray, Joanne, Nart, José, Nascimento, Weslania, Núñez, Adrián, Oh, Byung-Mo, Ortega, Omar, Padrós, Jaume, Paniagua, Blanca, Park, Jin-Woo, Pilz, Walmari, Pizzorni, Nicole, Regan, Julie, Riera, Stephanie, Rubinat, Esther, Saitoh, Eiichi, Sasegbon, Ayodele, Scannapieco, Frank A., Schindler, Antonio, Shaker, Reza, Smithard, David G., Suntrup-Krüger, Sonja, Tomsen, Noemí, Ton, Valeria, Vallés, Cristina, Vilarrasa, Javi, Viñas, Paula, Wakabayashi, Hidetaka, Walshe, Margaret, Warnecke, Tobias, Wirth, Rainer, and Yoshimatsu, Yuki

Published
2024
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40. Can bedside assessment reliably exclude aspiration following acute stroke?

Author

Smithard, David G., O'Neill, Paul A., Park, Clare, England, Ruth, Renwick, Deborah S., Wyatt, Rosemary, Morris, Julie, and Martin, Derick F.

Subjects
Aspiration and aspirators -- Research, Stroke patients -- Care and treatment -- Research, Health, Psychology and mental health, Seniors, Social sciences, Care and treatment, Research
Abstract

Introduction Stroke is a common disorder, affecting approximately 100000 new subjects in the U4K each year [1]. Many will have difficulty swallowing in the first few days or weeks and [...]

Published
1998

44. Is dysphagia under diagnosed or is normal swallowing more variable than we think? Reported swallowing problems in people aged 18 – 65 years.

Author

Leslie, Paula, Smithard, David G, Leslie, Paula, and Smithard, David G

Abstract

PURPOSE: Dysphagia prevalence in younger community dwelling adults and across nations is sparse. We investigated the prevalence of swallowing problems in an unselected cohort of people aged 18-65 years. METHODS: The EAT-10 Assessment Tool was converted into an anonymized online survey. Invitations were emailed to author contacts and onwards dispersal encouraged. Analysis was performed using non-parametric test for group comparison (Mann-Whitney U) and Spearman’s rho correlation. RESULTS: From March 2014 to October 2017: 2,054 responses (32 reported ages outside of 18-65 or undeclared) from Africa, Asia, Australasia/Oceania, Europe, and North and South America. Responses: 1,648 female, 364 male, (10 reported as both), median age 34, (range 18-65, mean 37.12, SD 12.40) years. Total EAT-10 scores: median 0 (range 0-36, mean 1.57, SD 3.49). EAT-10 score ≥3 (337) median 5 (range 3-36, mean 7.02 SD 5.91). Median age 36 (range 19-65, mean 37.81, SD 13.21) years. Declared sex was not statistically significantly associated with non-pathological vs. pathological EAT-10 score (p=.665). Female scores (median 0.00, mean 1.56, SD 3.338) were significantly higher than for males (median 0.00, mean 1.62, SD 4.161): U (Nfemale=1648, Nmale=364) = 275420.000, z=-2.677, p=.007. Age and EAT-10 score were not associated: females rs=-0.043, p=.079, N=1648, males rs=-0.003, p=.952, N=364. Considerable impact on people: “I take ages to eat a main course … This is embarrassing and I often leave food even though I am still hungry.” (no diagnosis, EAT-10=17). CONCLUSION: Concerns regarding swallowing exist in people undiagnosed with dysphagia, who may feel uncomfortable seeking professional help. Dysphagia may be under reported resulting in a hidden population. Subtle changes are currently seen as subtle markers of COVID-19. Further work is required to ensure that what is an essentially normal swallow does not become medicalized.

Published
2020

46. No gag, no food

Author

Smithard, David G. and Spriggs, David

Published
2003

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