2,259 results on '"Swallowing disorders"'
Search Results
2. Screening for dysphagia in older people with dementia: Evidence of validity based on internal structure and reliability of the Caregiver Questionnaire – RaDID-QC
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de Oliveira, Grazielle Duarte, Vicente, Laélia Cristina Caseiro, Mourão, Aline Mansueto, dos Santos, Sayuri Hiasmym Guimarães Pereira, Silva, Uriel Moreira, Friche, Amélia Augusta de Lima, and Bicalho, Maria Aparecida Camargos
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- 2024
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3. Screening for dysphagia in older people: A validation study of the psychometric properties of the Danish 4 Question Test (4QT‐DK)
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Staal, Sabina Mette, Christensen, Karl Bang, Smithard, David, Westergren, Albert, and Melgaard, Dorte
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OLDER people , *CONFIRMATORY factor analysis , *PSYCHOMETRICS , *RASCH models , *STRUCTURAL reliability - Abstract
Aim Methods Results Conclusion The four‐item questionnaire test (4QT) is a simple screening measure of dysphagia for older people. A positive answer to any item indicates the need for further assessment. The 4QT is fast, simple to apply and requires no training beforehand. However, it is not translated to Danish, and the psychometric properties in an older Danish population are unknown. The aim was to translate the 4QT to Danish, determine criterion validity according to the existing measures, the Minimal Eating Observation Form‐II (MEOF‐II) and Volume‐Viscosity Swallow Test (V‐VST), and determine construct and structural validity and reliability by exploring whether 4QT fits the assumptions of the Rasch model.The 4QT was translated and back‐translated. A total of 73 participants aged ≥65 years were included and screened with the 4QT‐DK, and assessed using the V‐VST and MEOF‐II. Criterion validity was assessed compared with the V‐VST and MEOF‐II according to sensitivity, specificity and predictive values. Construct and structural validity were examined using confirmatory factor analysis and Rasch model analysis investigating item and person fit, differential item functioning for sex, age, primary disease and local dependency. Reliability was assessed using Cronbach's coefficient alpha.For criterion validity, the 4QT‐DK showed high sensitivity (84% and 90% with the V‐VST and MEOF‐II, respectively). As expected, specificity was lower (36%, and 42%). Analyses confirmed the psychometric validity of the 4QT‐DK. Reliability was low (Cronbach's alpha = 0.58) due to the number of items.The 4QT‐DK is a valid and sensitive measure for screening older people for dysphagia. Further studies are required to assess the psychometric properties and confirm findings in a larger Danish sample.
Geriatr Gerontol Int 2025; ••: ••–•• . [ABSTRACT FROM AUTHOR]- Published
- 2025
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4. Impact of early swallowing rehabilitation on oral feeding in patients with dysphagia following traumatic brain injury.
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Kalhori Boroujerdi, Sara, Ghoreishi, Zahra Sadat, Ghorbani, Mohammad, Mohammadpour, Arezoo, and Kenarangi, Taiebe
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REHABILITATION for brain injury patients , *EARLY medical intervention , *THERAPEUTICS , *PATIENT safety , *CONSCIOUSNESS , *CLINICAL trials , *TREATMENT effectiveness , *SEVERITY of illness index , *GLASGOW Coma Scale , *ARTIFICIAL feeding , *DEGLUTITION , *LENGTH of stay in hospitals , *DEGLUTITION disorders , *COGNITION , *MECHANICAL ventilators - Abstract
Objective: This study aimed to evaluate the effects of early swallowing rehabilitation on safe oral feeding in dysphagia patients following traumatic brain injury. Methods: Sixty-nine patients were divided into intervention and control groups, with the intervention group receiving swallowing rehabilitation therapy. The severity of swallowing disorders, cognitive function, and level of consciousness were assessed using the Mann Assessment of Swallowing Ability (MASA), Rancho Los Amigos (RLA), and Glasgow Coma Scale (GCS) before and after the intervention. Additionally, data on ventilator use duration and hospital stay length were collected. Result: The intervention group exhibited a significant improvement in MASA scores (68.58) compared to the control group (38.10). No significant differences were observed in GCS and RLA scores post-intervention, indicating similar levels of consciousness and cognitive function between groups. While the duration of ventilator use was comparable, the intervention group achieved safe oral swallowing 12.12 days earlier than the control group. Discussion: The findings demonstrate that early swallowing rehabilitation significantly enhances recovery dysphagia post-brain injury, as evidenced by improved MASA scores and earlier achievement of safe oral feeding, despite no notable changes in cognition or consciousness. This underscores the importance of implementing early rehabilitation strategies in clinical practice. [ABSTRACT FROM AUTHOR]
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- 2025
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5. Intensive care unit-acquired dysphagia – change in feeding route after a standardized dysphagia assessment in neurocritical care patients.
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Reitz, Sarah Christina, Marly, Joanna, Neef, Vanessa, Konczalla, Jürgen, Czabanka, Marcus, Grefkes-Hermann, Christian, Foerch, Christian, and Lapa, Sriramya
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Background: Dysphagia is a frequent finding on intensive care units (ICUs) and is associated with increased reintubation rates, pneumonia, and prolonged ICU-stay. Only a limited numbers of ICUs have access to a Speech and Language Pathologist (SLP). Hence, it falls upon the critical care team to estimate dysphagia risk and define the safest feeding route. Therefore, the aim of this study was to evaluate if the feeding route established by the ICU-team is changed after a standardized dysphagia assessment (DA) by an SLP. Furthermore, we tried to identify predictors for the need of a SLP assessment looking at the change in feeding route (CIFR) after DA. Methods: We performed a retrospective analysis of patients consecutively admitted for at least 48 h in 2018, to the ICU of the Department of Neurology and Neurosurgery. Following variables were assessed: Referral to an SLP, feeding route before and after DA by an SLP, main diagnosis, and ventilation parameters. Results: From 497 included patients (65 years, IQR 51–77), 148 received a DA, confirming dysphagia in 125 subjects. DA by the SLP resulted in a significant CIFR, with 32 (21.6%) subjects receiving stricter diets, and in 29 (19.6%) cases a reduction of dietary recommendations. 50 patients lacked readiness for oral intake due to severely affected oral phase or reduced consciousness. Conclusion: Dysphagia is a frequent finding in the Neuro-ICU. Assessment of dysphagia-risk and safest feeding route differ significantly between the SLP and the critical care team. Besides implementation of standardized operating procedures for DA, the presence of ICU-specific trained SLP should be mandatory. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Aspiration after Critical Illness: Role of Endotracheal Tube, Tracheostomy, and Swallowing Disorders.
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Osorio, Benedict, Krakora, Rebecca, Epping, Geraldine, Wright, Drew, and Rajwani, Kapil
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RESPIRATORY aspiration , *VOCAL cords , *INTENSIVE care units , *ASPIRATION pneumonia , *RESPIRATORY obstructions , *CRITICALLY ill patient care , *DEGLUTITION disorders ,MORTALITY risk factors - Abstract
Swallowing is a complex process that involves over 50 muscles and nerves and has two critical roles: passing food from the oral cavity through the pharynx and into the esophagus and preventing contents from entering the airway. If a patient's swallowing physiology or airway protective mechanisms are disturbed, the airways and the lungs have innate defense systems to protect against injury and infection. However, critically ill patients are more likely to develop dysphagia, which is an impairment or malfunction in any aspect of the swallowing mechanism, due to the numerous interventions they undergo. When airway reflexes fail, commonly in the presence of dysphagia, aspiration can occur, which is the entry of a fluid or solid below the level of the true vocal cords. If left unmanaged, dysphagia has been associated with aspiration pneumonia, pneumonitis, airway obstruction, delayed enteral nutrition, prolonged length of intensive care unit (ICU) and hospital stay, reduced quality of life, and even death; in some cases, dysphagia is an independent risk factor for mortality. It is important to routinely assess dysphagia in all critically ill patients using a multimodal approach, including systematic assessments, scoring indices, trained specialists, and ICU nurses. Several interventions are crucial for preventing and managing dysphagia and its associated problems. Further research is necessary to help determine the best ways to prevent and manage pulmonary aspiration in critically ill patients. Several interventions are essential in preventing and managing dysphagia and the sequelae of swallowing dysfunction. Further research is needed to help elucidate the best way to avoid and manage pulmonary aspiration in critically ill patients. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Swallowing and Aspiration: How to Evaluate and Treat Swallowing Disorders Associated with Aspiration Pneumonia in Older Persons.
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Ortega, Omar, Guidotti, Lucilla, Yoshimatsu, Yuki, Sitges, Claudia, Martos, Josep, Miró, Jaume, Martín, Alberto, Amadó, Cristina, and Clavé, Pere
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MEDICAL personnel , *ASPIRATION pneumonia , *OLDER people , *ORAL hygiene , *COMMUNITY-acquired pneumonia , *OLDER patients - Abstract
Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. We performed a narrative review, including our experience with prior studies at Hospital de Mataró, on the diagnosis and treatment of AP. AP refers to pneumonia occurring in patients with swallowing disorders, frequently coinciding with poor oral health and vulnerability. Its main risk factors include oropharyngeal aspiration, impaired health status, malnutrition, frailty, immune dysfunction, and oral colonization by respiratory pathogens. Incidence is estimated at between 5 and 15% of cases of CAP, but it is highly underdiagnosed. Diagnostic criteria for AP have not been standardized but should include its main pathophysiological element, oropharyngeal aspiration. Recently, a clinical algorithm was proposed, based on the recommendations of the Japanese Respiratory Society, that includes aspiration risk factors and clinical evaluation of OD. To facilitate the task for health care professionals, new artificial intelligence (AI)-based screening tools for OD combined with validated clinical methods such as the volume–viscosity swallowing test (V-VST) for the detection of AP are being validated. Prevention and treatment of AP require multimodal interventions aimed to cover the main risk factors: textural adaptation of fluids and diets to avoid oropharyngeal aspiration; nutritional support to avoid malnutrition; and oral hygiene to reduce oral bacterial load. The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection of AP. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Dysphagia Screening in Brazilian Older Adults with Dementia: Content Development and Validation of a Questionnaire for Caregivers – RaDID-QC.
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de Oliveira, Grazielle Duarte, Vicente, Laélia Cristina Caseiro, Mourão, Aline Mansueto, dos Santos, Sayuri Hiasmym Guimarães Pereira, de Lima Friche, Amélia Augusta, and Bicalho, Maria Aparecida Camargos
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ALZHEIMER'S disease , *VASCULAR dementia , *INTRACLASS correlation , *OLDER people , *PORTUGUESE language , *CAREGIVERS - Abstract
This study aims to develop and validate the content and response processes of a questionnaire intended for caregivers to screen for dysphagia in Brazilian older adults with dementia due to Alzheimer's disease and/or vascular dementia. The instrument items were developed in Brazilian Portuguese language based on the theoretical framework. A committee of speech-language-hearing therapists analyzed the relevance, objectivity, clarity, and understandability of the items with the Delphi method. The content validity index cutoff agreement score for experts' answers to validate each item in the questionnaire was 0.78; in the intraclass correlation coefficient, it was 0.75 for all items. For response process validity evidence, the questionnaire was applied to 30 caregivers of older adults with dementia, who judged the clarity and understandability of the items. Each item was validated when understood by at least 95% of participants. The first version of the instrument had 29 items. After two expert assessments, the last version had 24 items. The intraclass correlation coefficient was 0.85. Only one item needed semantic adjustments in the pre-test. The dysphagia screening instrument applied to caregivers of older adults with dementia was developed with adequate content and response process validity evidence, enabling adjustments in its construct. Future studies will analyze the remaining evidence of validity and reliability. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Cognitive Impairment and Mild to Moderate Dysphagia in Elderly Patients: A Retrospective Controlled Study.
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Maniaci, Antonino, Lechien, Jérome R, La Mantia, Ignazio, Iannella, Giannicola, Ferlito, Salvatore, Albanese, Gianluca, Magliulo, Giuseppe, Pace, Annalisa, Cammaroto, Giovanni, Di Mauro, Paola, Vicini, Claudio, and Cocuzza, Salvatore
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NEUROLOGIC examination , *QUESTIONNAIRES , *SEVERITY of illness index , *ENDOSCOPIC surgery , *DESCRIPTIVE statistics , *AGE distribution , *RETROSPECTIVE studies , *FIBER optics , *COGNITION disorders , *ANALYSIS of variance , *DEGLUTITION , *ENDOSCOPY , *DEGLUTITION disorders , *EVALUATION , *DISEASE risk factors , *OLD age - Abstract
Background : To investigate whether cognitive impairment in elderly patients could correlate with the severity of swallowing disorders detectable through the endoscopic fiber optic evaluation. Methods : Elderly patients (≥65 years) performing a swallowing evaluation were included and divided according to the Dysphagia outcome and severity scale (DOSS). Neurological evaluation and Mini-Mental test examination (MMET) were administered to detect cognitive impairment. Results : Significantly worse swallowing function was reported in the cognitive impairment group than the control one (40% vs 19%; P =.001). A different significant distribution of swallowing performance was detected according to the patient's MMET score (P <.001; P <.001; P =.01). At the ANOVA test among dependent variables assessed, only age>65 and MMET<10 were significantly correlated with swallowing function (F = 3.862, P =.028; F = 17.49, P =.000). Conclusions: The elderly patient has an increased risk for unrecognized swallowing disorders, with a prevalence of mild to moderate forms. Assessment of cognitive performance could facilitate the identification of swallowing disorders by providing a higher level of suspicion for silent aspiration in subjects with poor MMET scores. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Tracheotomie: Indikation und Durchführung.
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Oppert, Michael, Jungehülsing, Markus, and Nibbe, Lutz
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CRITICALLY ill patient care ,CANCER patient care ,HEAD & neck cancer ,OPERATIVE surgery ,CRITICAL care medicine ,TRACHEOTOMY - Abstract
Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature 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.)
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- 2024
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11. Long-Term Assessment of Speech and Swallowing Function in Laryngopharyngeal Cancer Patients After J-Flap Reconstruction
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Yi-An Lu, Chung-Kan Tsao, Li-Jen Hsin, Hsiu-Feng Chuang, and Tuan-Jen Fang
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laryngopharyngeal neoplasms ,surgical flaps ,speech disorders ,swallowing disorders ,quality of life ,laryngectomy ,reconstructive surgical procedures ,Medicine ,Otorhinolaryngology ,RF1-547 - Abstract
Objectives. A novel J-shaped anterolateral thigh (ALT) flap reconstruction technique was developed to simultaneously restore swallowing and speech functions in patients following total laryngopharyngectomy. This study aimed to assess the outcomes and surgical complications in patients who underwent J-flap reconstruction over time. Methods. Patients who underwent J-shaped ALT flap phonatory tube reconstruction were enrolled. Surgical morbidities and outcomes were evaluated every 3 months post-surgery for a period of 12 months or until death. Results. Of the 36 patients, 13 underwent circumferential pharyngeal wall resection (circumferential defect [CD] group), and 23 underwent partial resection (partial defect [PD] group). After 12 months, 97% of the patients were able to resume oral intake without the need for a nasogastric tube, and 50% achieved fluent speech using the reconstructed phonatory tube. The CD group experienced a higher rate of delayed healing than the PD group (30.8% vs. 0%, p=0.012). Additionally, the PD group showed significantly higher percentages of individuals consuming solid food at both the 3- and 12-month intervals than the CD group (81.0% vs. 23.1% and 78.9% vs. 40%, respectively). Conclusions. This study investigated the progression of speech and swallowing functions over time after reconstruction of the voice tube with a J-flap. Using a J-shaped ALT flap phonatory tube effectively restored both speech and swallowing functions, providing long-term benefits, regardless of whether the defect was circumferential or partial.
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- 2024
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12. Qualifications, professional roles and service practices of nurses, occupational therapists and speech-language pathologists in the management of adults with oropharyngeal dysphagia: a Nordic survey.
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Rivelsrud, Maribeth Caya, Hartelius, Lena, Speyer, Renée, and Løvstad, Marianne
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SPEECH therapists , *CROSS-sectional method , *SELF-evaluation , *PEARSON correlation (Statistics) , *WORK , *THERAPEUTICS , *OCCUPATIONAL roles , *PROFESSIONAL practice , *HEALTH attitudes , *RESEARCH funding , *OCCUPATIONAL therapists , *QUESTIONNAIRES , *PILOT projects , *STATISTICAL sampling , *WORK environment , *DESCRIPTIVE statistics , *CHI-squared test , *PROFESSIONS , *CLINICAL competence , *ATTITUDES of medical personnel , *NURSES' attitudes , *DEGLUTITION , *COMPARATIVE studies , *DATA analysis software , *DEGLUTITION disorders , *PSYCHOSOCIAL factors , *PSYCHOLOGY of nurses , *EXPERIENTIAL learning , *ADULTS - Abstract
Purpose: To identify the qualifications, professional roles and service practices of nurses, occupational therapists (OTs) and speech-language pathologists (SLPs) in the management of adults with oropharyngeal dysphagia (OD) in the Nordic countries. Methods: A web-based survey was developed that consisted of 50 questions on respondent demographics, education, experience, roles and service practices provided for adults with OD. The survey was distributed to practicing nurses, OTs, and SLPs in five Nordic countries via professional associations, social media, online networks and snowballing. Results: Data from 396 nurses, OTs and SLPs whom provided services for adults with OD revealed that the majority of respondents worked in acute care and inpatient rehabilitation facilities. Most respondents had minimal undergraduate education and practical clinical training in OD. Notable variances in roles and service practices in OD between professions and countries were found. OTs were the primary service provider for OD management in Denmark, while SLPs had this role in the other Nordic countries. Nurses were mainly involved in screening and some compensatory treatments in most Nordic countries. Limited use of evidence-based screening, non-instrumental or instrumental clinical assessments and rehabilitative therapeutic methods was evident. Conclusions: Study results highlight challenges in education and training of professionals responsible for the management of adults with OD in the Nordic countries. Increased use of evidence-based assessment and exercise-based treatments to improve swallowing are warranted. Adherence to European and international clinical practice guidelines for the management of adults with OD is recommended. [ABSTRACT FROM AUTHOR]
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- 2024
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13. The effect of hyperbaric oxygen therapy in head and neck cancer patients with radiation induced dysphagia—a systematic review.
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Philipsen, Bahareh Bakhshaie, Korsholm, Malene, Rohde, Max, Wessel, Irene, Forner, Lone, Johansen, Jørgen, and Godballe, Christian
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Purpose: The aim of this systematic review was to assess the role of hyperbaric oxygen therapy (HBOT) in patients with dysphagia after radiation therapy for head and neck cancer. Method: A systematic search was conducted in the electronic databases Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials for relevant studies until March 14, 2023. No restriction on language or publication date. The criteria for inclusion: patients with HNC who had received both radiation therapy and HBOT as 1) a preventive treatment against swallowing difficulties, 2) to preserve swallowing function, or 3) to promote swallowing difficulties. Results: We identified 1396 records. After removal of 31 duplicates, 1365 records were accessible for title and abstract screening. This yielded 53 studies for full text assessment. Six studies met the eligibility criteria and were included for qualitative analysis. Conclusion: Evidence of HBOT benefits in patients with dysphagia after radiation therapy for head and neck cancer is inconsistent. Well-designed studies using validated outcome measures and long-term follow-up are warranted. [ABSTRACT FROM AUTHOR]
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- 2024
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14. 不同频次经颅直流电刺激治疗对脑卒中后吞咽障碍的临床疗效研究.
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黄 畅, 徐 伟, 佘灿芳, 郭晨曦, 向入平, and 马银琳
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TRANSCRANIAL direct current stimulation , *STROKE , *NUTRITIONAL status , *DRINKING water , *WATER testing - Abstract
Objective: To explore the efficacy of different frequencies of Transcranial direct current stimulation (tDCS) treatment on swallowing disorders after stroke, to provide clinical guidance for the treatment of swallowing disorders after stroke. Methods: A total of 96 patients with swallowing disorders after stroke from January 2022 to June 2023 who were admitted in our hospital were selected, and divided into the low intensity group (n = 32) the moderate intensity group (n = 32), and the high intensity group (n = 32) by random number table method. The low intensity group was received 1.0 mA tDCS treatment, the moderate intensity group was received 1.5 mA tDCS treatment, and the high intensity group was received 2.0 mA tDCS treatment. The changes in wada drinking water test rating, swallowing ability and feeding ability, nutritional status, and quality of life in three groups were compared. Results: After treatment, the wada drinking water test rating in three groups were improved (P < 0.05) and compared with the low and moderate intensity group, the high intensity group was better (P < 0.05), while no significant difference in the low and moderate intensity group (P > 0.05) After treatment, the standardized swallowing assessment (SSA) scores in three groups were decreased (P < 0.05), the Functional Oral Intake Scale (FOIS) scores were increased (P < 0.05) in comparision of the low and moderate intensity group, the SSA score in the high intensity group was lower (P<0.05), and the FOIS score was higher (P < 0.05) while no significant difference in the low and moderate intensity group P > 0.05 ). After treatment, Hemoglobin (HGB), Parvalbumin (PA), Total protein (TP), and Transferrin (TFN) levels in three groups were increased (P < 0.05) in comparison of the low and moderate intensity group, the high intensity group was higher (P < 0.05), while no significant difference in the low and moderate intensity group (P > 0.05) After treatment, Activity of Daily Living Scale (ADL) and Swallowing Quality of Life (SWAL-QOL) scores in three groups were improved (P < 0.05) and compared with the low and moderate intensity group, the high intensity group was higher(P<0.05), while no significant difference in the low and medium intensity group (P > 0.05) Conclusion: High intensity tDCS has good therapeutic effect on swallowing disorders after stroke, which can promote improvement of swallowing function, enhance swallowing and feeding abilities, improve nutritional status, and improve quality of life [ABSTRACT FROM AUTHOR]
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- 2024
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15. 神经肌肉电刺激在颅脑损伤吞咽障碍患者中的应用效果.
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王瑞华, 张竞文, and 何秋果
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Objective To explore the application effect of neuromuscular electrical stimulation combined with early swallowing function training in patients with swallowing disorders after craniocerebral injury. Methods A total of 184 patients with swallowing disorders caused by craniocerebral injury admitted to the hospital from April 2021 to April 2023 were selected and randomly divided into the control group and the observation group by the random number table method, with 92 cases in each group. Patients in the control group were given routine rehabilitation intervention, while the patients in the observation group were given neuromuscular electrical stimulation combined with early swallowing function training on the basis of routine rehabilitation intervention. The intervention time of both groups was two months. The rehabilitation effects of the two groups were compared. Results The scores of standard swallowing function scale, the national institutes of health stroke scale and swallowing quality of life scale in the observation group were higher than those in the control group, and the differences were statistically significant(P<0. 05). The incidence of complications such as aspiration pneumonia, aspiration and malnutrition in the observation group was lower than that in the control group, and the differences were statistically significant(P<0. 05). Conclusion The combination of neuromuscular electrical stimulation and early swallowing function training intervention in patients with swallowing disorders after craniocerebral injury can improve swallowing and neurological function in the patients, reduce the risk of complications, and further enhance their quality of life. [ABSTRACT FROM AUTHOR]
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- 2024
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16. Tongue pressure is a strong predictor of recommendation for gastrostomy in amyotrophic lateral sclerosis.
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Mendes, Amanda E., Silva, Guilherme D., Jorge, Frederico M. H., and Callegaro, Dagoberto
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Introduction/Aims: Objective and practical biomarkers to determine the need for gastrostomy in patients with amyotrophic lateral sclerosis (ALS) are lacking. Tongue pressure (TP) is a promising biomarker because it is associated with bulbar dysfunction. The aims of this study were to evaluate the association of TP with the need for gastrostomy, and to determine its optimal cut‐off value. Methods: This prospective observational study included participants with ALS taking nutrition orally. TP was evaluated using the Iowa Oral Performance Instrument. Need for gastrostomy as determined by a multidisciplinary team during a 12‐month follow up period was recorded. Associations between TP and need for gastrostomy placement were performed. ROC curve analysis determined the optimal cut‐off value of TP to predict gastrostomy. Results: Of 208 screened participants, 119 were included. Gastrostomy was indicated in 45% (53), in a 12‐month follow up period. TP of ≤20 kPA was a strong predictor of gastrostomy indication (OR 11.8, CI 95% [4.61, 34.7], p <.001). The association persisted even after adjustment for weight loss, pneumonia, prolonged feeding duration, Revised ALS Functional Rating Scale score, and American Speech‐Language‐Hearing Association scale score (OR 4.51, CI 95% [1.50, 14.9], p =.009). By receiver operating characteristic curve analysis, 20 kPA represented the optimal cut‐off value (sensitivity 0.75, specificity 0.89). Discussion: TP is a strong independent predictor of gastrostomy indication in the subsequent 12 months in patients with ALS, with good sensitivity and specificity at a cutoff value of ≤20 kPA, suggesting that it may be a promising biomarker in clinical practice. [ABSTRACT FROM AUTHOR]
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- 2024
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17. Implementation of a swallow screening protocol in a tertiary adult intensive care unit: A quality improvement project.
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Wedemire, Courtney, Sas, Lara, and Russell, Sarah
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HUMAN services programs ,EVALUATION of human services programs ,FISHER exact test ,TERTIARY care ,PHYSICIANS' attitudes ,DESCRIPTIVE statistics ,CHI-squared test ,MANN Whitney U Test ,INTENSIVE care units ,COLLEGE teacher attitudes ,NURSES' attitudes ,STATISTICS ,ARTIFICIAL respiration ,MEDICAL screening ,QUALITY assurance ,EXTUBATION ,DATA analysis software ,DEGLUTITION disorders ,CRITICAL care nurses ,ADULTS - Abstract
Background: Post-extubation dysphagia occurs in 3% to 62% of adults who have received invasive mechanical ventilation in an intensive care unit (ICU). A stepwise approach to identify dysphagia includes a routine swallow screening in patients who are recently extubated followed by a formal assessment by a Speech and Language Pathologist (SLP), in the event of a failed swallow screen, has been suggested. This quality improvement project aimed to implement and evaluate a new post-extubation swallow screening process. Methods: Using the Model for Improvement framework, a new process that included the Yale Swallow Protocol (YSP) was developed, implemented, and evaluated between July and December 2022 in a 20-bed tertiary ICU. All patients with at least four hours post-extubation were included in the project. Process development included a literature review and feedback from ICU educators, nurses, physicians, SLPs, and Registered Dietitians (RDs). Education was provided to critical care nurses prior to implementation. Data on patient characteristics, process indicators, and outcomes were collected between September and December 2022 to evaluate the project implementation. Descriptive statistics were used to describe the data and bivariate analyses were used to compare data between patients who passed and failed the YSP. Results: Fifty-four patients were extubated and evaluated using the new swallow screening process. Post-extubation dysphagia was diagnosed by an SLP in 30.0% of patients. Dysphagia was diagnosed in 90.0% of patients who failed, compared with 8.6% of patients who passed the YSP (P<0.001). Conclusion: A swallow screening process using the YSP was successfully adopted in a tertiary ICU. [ABSTRACT FROM AUTHOR]
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- 2024
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18. Rol del kinesiólogo en la atención del paciente con trastornos de la deglución y disfagia en la Unidad de Cuidados Intensivos.
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Eugenia Catini, María, Cámpora, Horacio, Falduti, Alejandra, Castaño, Rubén, Cuiña, Marcela, and Rosendo, Néstor
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OCCUPATIONAL roles ,THERAPEUTICS ,CRITICALLY ill ,PATIENTS ,MALNUTRITION ,KINESIOLOGY ,TRACHEOTOMY equipment ,INTENSIVE care units ,QUALITY of life ,DEGLUTITION ,LENGTH of stay in hospitals ,EXTUBATION ,DEGLUTITION disorders ,CRITICAL care medicine ,DEHYDRATION - Abstract
Copyright of Revista Argentina de Terapia Intensiva is the property of Sociedad Argentina de Terapia Intensiva (SATI) 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.)
- Published
- 2024
19. Factors associated with oropharyngeal dysphagia in individuals with cardiovascular disease and COVID-19.
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Magalhães de Almeida, Tatiana, Gama Fernandes, Raquel, Rovere Binhardi, Vitor Della, Dias França, João Italo, Magnoni, Daniel, and Gonçalves da Silva, Roberta
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- 2024
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20. Advancing stroke patient care: a network meta-analysis of dysphagia screening efficacy and personalization.
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Youli Jiang, Yue Chi, Rongjia Pan, Dongqi Zhang, Suzhen Huang, Hao Ju, and Yanfeng Li
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MEDICAL screening ,CINAHL database ,STROKE patients ,STROKE ,PUBLICATION bias ,DEGLUTITION disorders - Abstract
Introduction: The increasing incidence of stroke globally has led to dysphagia becoming one of the most common complications in stroke patients, with significant impacts on patient outcomes. Accurate early screening for dysphagia is crucial to avoid complications and improve patient quality of life. Methods: Included studies involved stroke-diagnosed patients assessed for dysphagia using bedside screening tools. Data was sourced from Embase, PubMed, Web of Science, Scopus, and CINAHL, including publications up to 10 December 2023. The study employed both fixed-effect and randomeffects models to analyze sensitivity, specificity, positive predictive value (PPV), and Negative Predictive Value (NPV), each with 95% confidence intervals. The random-effects model was particularly utilized due to observed heterogeneity in study data. Results: From 6,979 records, 21 studies met the inclusion criteria, involving 3,314 participants from 10 countries. The analysis included six assessment tools: GUSS, MASA, V-VST, BSST, WST, and DNTA, compared against gold-standard methods VFSS and FEES. GUSS, MASA, and V-VST showed the highest reliability, with sensitivity and specificity rates of 92% and 85% for GUSS, 89% and 83% for MASA, respectively. Heterogeneity among studies was minimal, and publication bias was low, enhancing the credibility of the findings. Conclusion: Our network meta-analysis underscores the effectiveness of GUSS, MASA, and V-VST in dysphagia screening for stroke patients, with high sensitivity and specificity making them suitable for diverse clinical settings. BSST and WST, with lower diagnostic accuracy, require more selective use. Future research should integrate patient-specific outcomes and standardize methodologies to enhance dysphagia screening tools, ultimately improving patient care and reducing complications. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Pharyngeal Cavity Electrical Stimulation-Assisted Swallowing for Post-stroke Dysphagia: A Systematic Review and Meta-analysis of Randomized Controlled Studies.
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Liu, Zicai, Cheng, Jinling, Tan, Cheng, Liu, Huiyu, and Han, Dongmiao
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Stroke is the leading cause of death and disability among adults. The incidence of stroke per 100, 000 patient-years was 2875. As many as 37% to 78% of patients with acute strokes suffer dysphagia. Dysphagia can easily lead to inhalation pneumonia, dehydration, malnutrition, and other serious complications, affecting the quality of life of stroke patients and increasing their mortality. Effective prevention and treatment of post-stroke dysphagia are of great significance to improving the prognosis and quality of life of patients. Some studies have shown that Pharyngeal cavity electrical stimulation-assisted swallowing (PCES-assisted swallowing) has a positive effect on patients with post-stroke dysphagia. This study will evaluate the effects of PCES-assisted swallowing on post-stroke dysphagia, including swallowing function, withdrawal rate of nasal feeding tubes, duration of hospitalization, and so on. Randomized controlled trials (RCTs) of PCES-assisted swallowing in the treatment of post-stroke dysphagia were searched in eight databases, including Cochrane Library, Embase, PubMed, Web of Science, Chinese Biomedical Literature Database, VIP Information Resource System, CNKI, and Wanfang Medical Science. The retrieval time was from the database establishment to June 2022. Rayyan was used to screen the retrieved literature risk of bias for included studies and was calculated using ROB2.0. The RevMan 5.3 software was used for the meta-analysis with the standard mean difference (SMD) and 95% confidence interval (CI). The model type was a random effect model, The risk ratio (RR) was used as the effect size for the two categorical variables. The swallowing function scores, withdrawal rate of nasal feeding tubes, and Length of stay (LOS) of the intervention and control groups were extracted, and the results of the meta-analysis were presented using a forest plot. Six studies from 2010 to 2018 with a total of 341 people were included in the meta-analysis. All studies reported quantitative outcome measures for the severity of dysphagia, and some reported the withdrawal rate of nasal feeding tubes, LOS, and penetration-aspiration-scale (PAS). The overall swallowing function of the PCES group was better than that of the control group (SMD = − 0.20, 95%CI − 0.38 to − 0.03, P = 0.02). In terms of the severity of dysphagia, there was a statistically significant difference in the Dysphagia Severity Rating scale (DSRS) between the Pharyngeal cavity electrical stimulation (PCES) group and the control group (SMD = − 0.24, 95%CI − 0.48 to 0, P = 0.05). The PCES group nasal feeding withdrawal rate of nasal feeding tubes was higher than the control group (RR = 2.88, 95% CI 1.15 to 7.26, P = 0.02). There was no significant difference in the LOS between the PCES group and the control group (SMD = − 0.19, 95%CI − 0.44 to 0.07, P = 0.15). This systematic review and meta-analysis provide reasonably reliable evidence that PCES-assisted swallowing can improve nasogastric feeding swallowing function and the withdrawal rate of nasal feeding tubes in patients with post-stroke dysphagia. However, the evidence for reducing oral feeding, aspiration, and length of hospitalization stay is lacking, and further studies are needed. [ABSTRACT FROM AUTHOR]
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- 2024
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22. Severe aspiration pneumonia in the elderly
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Sebastian Ocrospoma and Marcos I. Restrepo
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Aspiration pneumonia ,Aged ,Critical illness ,Swallowing disorders ,Frailty ,Antibacterial agents ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
The global population is aging at an unprecedented rate, resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities. In this context, severe aspiration pneumonia, a condition that carries substantial morbidity, mortality, and financial burden, especially among elderly patients requiring admission to the intensive care unit, has attracted greater concern. Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology. Prior episodes of coughing on food or liquid intake, a history of relevant underlying conditions, abnormalities on videofluoroscopy or water swallowing, and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration. Patients with aspiration pneumonia tend to be elderly, frail, and suffering from more comorbidities than those without this condition. Here, we comprehensively address the epidemiology, clinical characteristics, diagnosis, treatment, prevention, and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic, enhance outcomes, and minimize the healthcare costs associated with this illness. Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.
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- 2024
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23. Exploring the diagnostic accuracy and applicability of the Gugging Swallowing Screen in children with feeding and/or swallowing disorders.
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Georgiou, Rafaella, Voniati, Louiza, Papaleontiou, Andri, Gryparis, Alexandros, Ziavra, Nafsika, and Tafiadis, Dionysios
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MEDICAL screening , *CHILD patients , *DEGLUTITION , *GREEK language , *STATISTICAL reliability - Abstract
Background: The Gugging Swallowing Screen (GUSS) is a bedside dysphagia screening tool that has been designed to determine the risk of aspiration in acute stroke patients. There is no evidence in the literature for the GUSS for the pediatric population. The present study aimed to determine the diagnostic accuracy of GUSS as a screening tool in the Greek language for children with dysphagia. Methods: Eighty‐Greek‐Cypriot children aged 3–12 years who had dysphagia participated in this retrospective study. The translated into Greek GUSS was administered twice (pre‐ and post‐therapy) to each patient throughout 24 sessions of dysphagia therapy. Key Results: The GUSS showed a high internal consistency (Cronbach's α = 0.826), good test–retest reliability (rs = 0.767), convergent validity compared to the Greek Pediatric Eating Assessment tool‐10 (PEDI‐EAT‐10) total score (rs = −0.365), and inter‐rater reliability (κ = 0.863). A total cutoff points equal to 13.00 was also calculated. Aspiration was identified by the GUSS with low sensitivity and high specificity (PPV 100%, NPV 57%, LR+ NA, LR− 0.79); dysphagia/penetration was identified with high sensitivity and low specificity (PPV 33%, NPV 100%, LR+ 0.102, LR− NA). Conclusions & Inferences: The pediatric version of GUSS has been found to be a valuable tool in identifying the risk of aspiration as that of adults. It proved to be used as a good screening guide for selecting and confirming the existence of dysphagia from instrumental assessments. This is the first study of the pediatric version of GUSS, and future studies on this topic are needed. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Clinical feeding assessment: An effective screening test to predict aspiration in children in low resource settings.
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Dahiya, Vijeyta, Picardo, Naina, Thejesh, Ramanadham, John, Mary, and Varghese, Ajoy Mathew
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RESPIRATORY aspiration , *ENDOSCOPIC surgery , *CEREBRAL palsy , *INFANT nutrition , *FIBER optics , *LONGITUDINAL method , *MEDICAL screening , *RESOURCE-limited settings , *DEGLUTITION , *COMPARATIVE studies , *DEGLUTITION disorders , *ENDOSCOPY - Abstract
OBJECTIVE: Diagnosis and management of swallowing problems in children is crucial for improvement of their health status and quality of life. This study aimed to determine the accuracy of clinical feeding assessment (CFA) as a screening test to detect aspiration in children using fibreoptic endoscopic evaluation of swallowing (FEES) as the gold standard. METHODS: A prospective study of 80 children aged below 16 years who were referred to a paediatric otolaryngology clinic for swallowing complaints was completed from 2019 to 2020. Swallowing was assessed by both CFA and FEES. Presence of any one of the following symptoms was considered positive for aspiration in CFA: cough, wet vocal quality, and respiratory distress. Aspiration on FEES was measured using the Penetration Aspiration Scale. The clinical predictors of aspiration were analysed. RESULTS: The majority of the children (78.8%) had an associated neurological condition, with cerebral palsy being the most common. CFA had a sensitivity ranging from 80% to 100% and a specificity ranging from 68% to 79% for predicting true aspiration for different food consistencies. The significant risk factors predicting aspiration (p value <0.05) were history of prior intubation (p = 0.009), history of nasal regurgitation (p = 0.002) and spasticity on examination (p = 0.043). CONCLUSION: This study showed that CFA can be used as a screening test in evaluation of paediatric dysphagia. In those with negative CFA, the chances of aspiration are less while those with positive CFA need further evaluation. In addition, the availability and cost-effectiveness of the test make it a good tool for screening aspiration in low-resource settings. [ABSTRACT FROM AUTHOR]
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- 2024
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25. Comparative analysis of videofluoroscopy and pulse oximetry for aspiration identification in patients with dysphagia after stroke and non-dysphagics.
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Bengisu, Serkan, Öge-Daşdöğen, Özlem, and Yıldız, Hatice Yelda
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PULSE oximetry , *STROKE , *VIDEOFLUOROSCOPY , *DEGLUTITION disorders , *LEVEL of aspiration - Abstract
Purpose: Dysphagia is a prevalent symptom observed in acute stroke. Several bedside screening tests are employed for the early detection of dysphagia. Pulse oximetry emerges as a practical and supportive method to augment the existing techniques utilized during bedside swallowing assessments. Desaturation levels, as measured by pulse oximetry, are acknowledged as indicative of aspiration by certain screening tests. However, the predictive capability of pulse oximetry in determining aspiration remains a subject of controversy. The objective of this study was to compare aspiration and oxygen desaturation levels by time and aspiration severity in dysphagic patients compared to healthy controls. It also aimed to evaluate the accuracy of pulse oximetry by comparing it with VFSS findings in detecting aspiration in both liquid (IDDSI-0) and semi-solid (IDDSI-4) consistencies. Materials and methods: Eighty subjects (40 healthy and 40 acute stroke patients) participated. Patients suspected of dysphagia underwent videofluoroscopy as part of the stroke unit's routine procedure. Baseline SpO2 was measured before VFSS, and stabilized values were recorded. Sequential IDDSI-0 and IDDSI-4 barium tests were conducted with 5 ml boluses. Stabilized SPO2 values were recorded during swallowing and 3-min post-feeding. Patients with non-dysphagia received equal bolus monitoring. Changes in SPO2 during, before, and after swallowing were analyzed for each consistency in both groups. Results: The study revealed a statistically significant difference in SPO2 between patients with dysphagia and controls for IDDSI-4 and IDSSI-0. In IDDSI-4, 20% of patients experienced SpO2 decrease compared to 2.5% in control group (p = 0.013). For IDDSI-0, 35% of patients showed SpO2 decrease, while none in the control group did (p = 0.0001). Aspiration rates were 2.5% in IDDSI-4 and 57.5% in IDDSI-0. In IDDSI-0, SpO2 decrease significantly correlated with aspiration (p = 0.0001). In IDDSI-4, 20.5% had SpO2 decrease without aspiration, and showing no significant difference (p = 0.613). Penetration-Aspiration Scale scores had no significant association with SpO2 decrease (p = 0.602). Pulse oximetry in IDDSI-4 had limited sensitivity (0%) and positive predictive value, (0%) while in IDDSI-0, it demonstrated acceptable sensitivity (60.9%) and specificity (100%) with good discrimination capability (AUC = 0.83). Conclusions: A decrease in SPO2 may indicate potential aspiration but is insufficient alone for detection. This study proposes pulse oximetry as a valuable complementary tool in assessing dysphagia but emphasizes that aspiration cannot be reliably predicted based solely on SpO2 decrease. [ABSTRACT FROM AUTHOR]
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- 2024
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26. Predicting the gravity-driven flow of power law fluids in a syringe: a rheological map for the IDDSI classification.
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Lecanu, Rémi, Della Valle, Guy, Leverrier, Cassandre, and Ramaioli, Marco
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ELECTRICAL load , *NON-Newtonian fluids , *NEWTONIAN fluids , *PROPERTIES of fluids , *RHEOLOGY , *PSEUDOPLASTIC fluids - Abstract
Food rheology is key to manage the swallowing safety of people affected by swallowing disorders (dysphagia). Simple approaches to assess the flow properties of texture-modified drinks are widely used, but relatively poorly understood. This study focuses on the International Dysphagia Diet Standardisation Initiative (IDDSI) flow test, adopted by caregivers worldwide. This test considers the gravity-driven flow in a vertical syringe. Newtonian liquids and non-Newtonian fluids obtained using a commercial starch-based thickener were considered in this study. An accurate theoretical description of the flow is proposed for Newtonian and power-law fluids considering the effect of fluid properties and of the syringe geometry. A rheological map is proposed, based on the results of several thousand simulations, to capture quantitatively the effect of rheological properties and density on the IDDSI classification, highlighting the important effect of the fluid density which is usually ignored. The sensitivity of the IDDSI results with respect to the syringe outlet diameter is discussed, as well as the different average shear rates at which different IDDSI levels are tested. The rheological map also shows quantitatively that different combinations of the fluid rheological properties and density can result in the same IDDSI classification, suggesting interesting directions for future clinical research. [ABSTRACT FROM AUTHOR]
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- 2024
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27. Deglutologist Practices and Perceptions of the Penetration-Aspiration Scale: A Survey Study.
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Burdick, Ryan, Peña-Chávez, Rodolfo, Namasivayam-MacDonald, Ashwini, and Rogus-Pulia, Nicole
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Successful dysphagia management requires accurate, succinct diagnosis and characterization of swallowing safety impairments. However, the Penetration-Aspiration Scale (PAS) remains the only available tool developed exclusively for assessment of airway protection. To best support efforts to advance the field's understanding of swallowing safety, it is crucial to understand current clinician practice patterns, perceptions, and accuracy regarding the PAS. A 46-item survey was developed and distributed to deglutologists internationally examining: (1) Demographics; (2) Scale Practices; (3) Swallowing Safety Priorities; (4) Scale Perceptions; and (5) Accuracy. The first four sections consisted of questionnaires. In the optional fifth section, respondents were asked to score five videos of swallows collected via videofluoroscopy and previously PAS-scored by two trained raters. In total, 335 responses were analyzed. The majority of respondents self-reported PAS training (84%); 90% of untrained respondents were receptive to training. Respondents reported using the PAS "always" (40%) or "frequently" (29%), and that the PAS carries "a great deal of" weight in assessment (40%). Reported application of the PAS was heterogeneous, with the most common approach being "single worst score per unique presentation" (45%). Most respondents (64%) prioritized a parameter not captured by the PAS. Untrained respondents were significantly more confident with PAS ratings than trained respondents (X
2 = 7.47; p = 0.006). Of 1460 PAS ratings provided, 364 of them were accurate (25%) when compared to ratings by trained lab members. Results of this survey reflect ubiquitous use of the PAS, unmet needs for assessment of swallowing safety, low accuracy despite generally high confidence, and heterogenous training that does not correspond to confidence. This emphasizes the need for additional training in clinical application of the PAS as well as development of novel metrics to optimize assessments of swallowing safety. [ABSTRACT FROM AUTHOR]- Published
- 2024
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28. Understanding Dysphagia Care in Pakistan: A Survey of Current Speech Language Therapy Practice.
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Akhtar, Rohma N., Behn, Nicholas, and Morgan, Sally
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Dysphagia affects individuals across all ages and has pervasive and potentially life-threatening consequences. Individuals with dysphagia are assessed and treated by speech and language therapists (SLTs), however, little attention has been paid to their practices in Pakistan. This study aimed to explore SLTs practices for dysphagia assessment, signs and symptoms observed during evaluation, and management strategies, alongside barriers and facilitators to service delivery in Pakistan. A 45-item survey was distributed to SLTs online. Responses were received from 101 participants and analyzed descriptively, and open-text responses were analyzed using content analysis. Results revealed that 65.3% SLTs worked across the lifespan, and most (79.4%) had dysphagia-related experience of five years or less. SLTs were an active workforce engaged with varying ages, disorders, and settings, yet dysphagia contributed to a small caseload percentage for most. Analyses found informal clinical exams were more frequently used than instrumental assessments. A variety of service provision facilitators were described, such as supportive teams and accessible resources, and responses about barriers revealed gaps in awareness, education, and guidance. This exploratory study presents novel and unexplored data which provides a deeper understanding of dysphagia-related care in Pakistan. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Referral Patterns to Speech and Language Therapy in the UK before, during, and after the COVID-19 Pandemic: Dysphagia Compared with Communication Disorders.
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Yoshimatsu, Yuki, Enderby, Pamela Mary, Hansjee, Dharinee, and Smithard, David G.
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Acquired swallowing impairment is a major public health issue that often leads to increased morbidity and slower recovery. Speech and language therapists (SLTs) have taken the lead in the assessment and treatment of dysphagia, which is reflected in guidelines where early intervention is recommended. This is in addition to the central role that SLTs play in the management of acquired communication impairments since research indicates that patients with communication difficulties benefit from early and intensive therapy by SLTs. This increasing demand for SLTs is expected to cause conflicting pressures in their workload and, therefore, beneficial to consider workforce planning. The aim of this study was to examine real-world data in the UK to investigate this issue regarding changes in referral patterns of patients with dysphagia and/or communication disorders to SLTs over time, to assist with workforce planning.Introduction: We interrogated the Royal College of Speech and Language Therapists Online Outcome Tool, a national database, in this retrospective cohort study. We included patients evaluated between 2018 and 2022. We performed a subgroup analysis of patients aged ≥40 years who had a primary medical diagnosis of stroke. Data on age, primary diagnosis, time on caseload, primary Therapeutic Outcome Measure (TOM) scale and initial TOM score on impairment were examined.Methods: From the database of 44,444 referrals to speech and language therapy, 5,254 referrals were included in the stroke and overall subgroup analyses. Referrals were 55.1% male, with a median age of 71 years. More than half (56.1%) of these referrals were for dysphagia. Referrals decreased during the COVID-19 pandemic but began to recover from 2021 onwards. The time on the SLT caseload has increased over the years from a median of 14 days (interquartile range [IQR] 0–56) in 2018 to 20 days (IQR: 3–81) in 2022. While there were more referrals to SLT services for assessment and management of dysphagia than for communication in the overall population, in the stroke subgroup, referrals for communication disorders outnumbered referrals for dysphagia from 2020 onwards. Additionally, the severity of impairment on referral increased over the years.Results: Real-world data indicates that referrals to SLT services are changing over time to include more complex and severely impaired patients, with a demand for both swallowing and communication disorders. These findings should inform staff allocation and remodelling of education/training for SLTs to better meet clinical and public health needs. The retrospective nature of this study limits the strength and generalisability of these data, and this topic warrants further investigation. [ABSTRACT FROM AUTHOR]Conclusion: - Published
- 2024
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30. Factors associated with oropharyngeal dysphagia in individuals with cardiovascular disease and COVID-19
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Tatiana Magalhães de Almeida, Raquel Gama Fernandes, Vitor Della Rovere Binhardi, João Italo Dias França, Daniel Magnoni, and Roberta Gonçalves da Silva
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Cardiovascular Diseases ,Swallowing Disorders ,Intratracheal Intubation ,Coronavirus Infections ,Aging ,Philology. Linguistics ,P1-1091 ,Otorhinolaryngology ,RF1-547 - Abstract
ABSTRACT Purpose Oropharyngeal dysphagia (OD) is one of the possible outcomes in patients hospitalized with COVID-19 and also in the population hospitalized for the treatment of cardiovascular disease. Thus, knowing the predictive risk factors for OD may help with referral and early intervention. This study aimed to verify the association of different factors with OD in hospitalized individuals with cardiovascular disease and COVID-19. Methods Cross-sectional clinical study approved by the Research Ethics Committee (4,521,771). Clinical evaluation of swallowing was carried out in 72 adult patients with cardiovascular disease and COVID-19 hospitalized from April to September 2020. Individuals under 18 years of age and without previous cardiovascular disease were excluded. The presence of general clinical and/or neurological complications, pronation, stay in the intensive care unit (ICU), orotracheal intubation (OTI), tracheostomy tube, oxygen support and age were considered as predictive risk factors for oropharyngeal dysphagia. Fisher's exact test, Mann Whitney test and logistic regression model were used for analysis. Results General clinical complications (p=0.001), pronation (p=0.003), ICU stay (p=0.043), in addition to the need for oxygen supplementation (p=0.023) and age (p= 0 .037) were statistically significant factors associated. The pronation (0.013) and age (0.038) were independently associated with dysphagia. OTI (p=0.208), tracheostomy (p=0.707) and the presence of previous cerebrovascular accidents (p=0.493) were not statistically significant. Conclusion In this study, age and prone position were factors independently associated with oropharyngeal dysphagia, complications such as the need for oxygen supplementation, in addition to the need for ICU admission, were also associated factors in the population.
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- 2024
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31. Daily Challenges and Resources of Adults with Chronic Dysphagia: A Qualitative Investigation
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Ninfa, Aurora, Morandi, Giulia, Schindler, Antonio, and Delle Fave, Antonella
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- 2024
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32. A Psychometric Evaluation of the Dysphagia Handicap Index Using Rasch Analysis.
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Cordier, Reinie, Joosten, Annette Veronica, Heijnen, Bas J., and Speyer, Renée
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ITEM response theory , *DEGLUTITION disorders , *QUALITY of life , *PSYCHOMETRICS , *DISABILITIES - Abstract
Background/Objectives: The Dysphagia Handicap Index (DHI) is commonly used in oropharyngeal dysphagia (OD) research as a self-report measure of functional health status and health-related quality of life. The DHI was developed and validated using classic test theory. The aim of this study was to use item response theory (Rasch analysis) to evaluate the psychometric properties of the DHI. Methods: Prospective, consecutive patient data were collected at dysphagia or otorhinolaryngology clinics. The sample included 256 adults (53.1% male; mean age 65.2) at risk of OD. The measure's response scale, person and item fit characteristics, differential item functioning, and dimensionality were evaluated. Results: The rating scale was ordered but showed a potential gap in the rating category labels for the overall measure. The overall person (0.91) and item (0.97) reliability was excellent. The overall measure reliably separated persons into at least three distinct groups (person separation index = 3.23) based on swallowing abilities, but the subscales showed inadequate separation. All infit mean squares were in the acceptable range except for the underfitting for item 22 (F). More misfitting was evident in the Z-Standard statistics. Differential item functioning results indicated good performance at an item level for the overall measure; however, contrary to expectation, an OD diagnosis presented only with marginal DIF. The dimensionality of the DHI showed two dimensions in contrast to the three dimensions suggested by the original authors. Conclusions: The DHI failed to reproduce the original three subscales. Caution is needed using the DHI subscales; only the DHI total score should be used. A redevelopment of the DHI is needed; however, given the complexities involved in addressing these issues, the development of a new measure that ensures good content validity may be preferred. [ABSTRACT FROM AUTHOR]
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- 2024
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33. Swallowing Rehabilitation: Tracing the Evolution of Assessment and Intervention Approaches for Dysphagia over 30 Years.
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Vishak, M. S. and Ramasamy, Karthikeyan
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DEGLUTITION disorders , *DEGLUTITION , *LITERATURE reviews , *REHABILITATION , *NEUROLOGICAL disorders - Abstract
Dysphagia or difficulty in swallowing is a common condition affecting millions worldwide. It can occur due to structural problems, neurological disorders, cancer treatment, aging, etc. Swallowing rehabilitation aims to help patients regain safe and efficient swallowing function through compensatory strategies and exercises. This literature review examines the recent advancements in swallowing rehabilitation techniques over the past three decades, with a focus on innovations in diagnostics, personalized medicine, and patient care. [ABSTRACT FROM AUTHOR]
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- 2024
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34. The Impact of Frailty, Oropharyngeal Dysphagia and Malnutrition on Mortality in Older Patients Hospitalized for Covid-19.
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Martín-Martínez, Alberto, Viñas, Paula, Carrillo, Irene, Martos, Josep, Clavé, Pere, and Ortega, Omar
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HOSPITAL mortality , *MALNUTRITION , *EPIDEMIOLOGY - Abstract
COVID-19 hospital mortality is higher among older patients through as yet little-known factors. We aimed to assess the effect of frailty (FR), oropharyngeal dysphagia (OD) and malnutrition (MN) on mortality in hospitalized COVID-19 older patients. Prospective cohort study of older patients (>70 years) with COVID-19 admitted to a general hospital from April 2020 to January 2021. Patients were evaluated on admission, discharge and at 1- and 3-months follow up. FR was assessed with FRAIL-VIG, OD with Volume-Viscosity Swallowing Test and MN with GLIM criteria. Clinical characteristics and outcomes, including intra-hospital, 1- and 3-month mortality, were analyzed. 258 patients were included (82.5±7.6 years; 58.9% women); 66.7% had FR (mild 28.7%, moderate 27.1% and severe 10.9%); 65.4%, OD and 50.6%, MN. OD prevalence increased from non-FR patients through the severity levels of FR: mild, moderate and severe (29.8%, 71.6%, 90.0%, 96.2%; p<0.0001, respectively), but not that of MN (50.6%, 47.1%, 52.5%, 56.0%). Mortality over the whole study significantly increased across FR categories (9.3% non-FR; 23.0% mild; 35.7% moderate; 75.0% severe; p<.001). Functionality (Barthel pre-admission, HR=0.983, CI-95%:0.973-0.993; p=0.001), OD (HR=2.953, CI-95%:0.970-8.989; p=0.057) and MN (HR=4.279, CI-95%:1.658-11.049; p=0.003) were independent risk factors for intrahospital mortality. FR, OD and MN are highly prevalent conditions in older patients hospitalized with COVID-19. Functionality, OD and MN were independent risk factors for intra-hospital mortality. [ABSTRACT FROM AUTHOR]
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- 2024
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35. The Prevalence of Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-analysis.
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Ribeiro, Marcos, Miquilussi, Paloma Alves, Gonçalves, Flávio Magno, Taveira, Karinna Veríssimo Meira, Stechman-Neto, José, Nascimento, Weslania Viviane, de Araujo, Cristiano Miranda, Schroder, Angela Graciela Deliga, Massi, Giselle, and Santos, Rosane Sampaio
- Abstract
To determine the global prevalence of oropharyngeal dysphagia (OD) in adults. Six electronic databases (Embase, LILACS, LIVIVO, PubMed/Medline, Scopus, and Web of Science) were searched, in addition to gray literature (ASHA, Google Scholar, ProQuest Dissertation, and Theses). A random-effects model for meta-analysis of proportions was conducted, and heterogeneity was evaluated according to the moderator variable through subgroup analysis and meta-regression. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the certainty of the evidence was assessed using the GRADE tool. Thirty papers were included for qualitative and quantitative synthesis. The combined prevalence estimate was 60% [CI 95% = 50%–70%; I
2 = 95%], accounting for different baseline conditions. However, the wide variation that exists between the different baseline conditions (underlying disease or risk factor) tended to overestimate this prevalence when considering the general population. Only one study evaluated healthy individuals, which showed a prevalence of 31% [CI95% = 27%–36%]. The risk of bias was considered low for all studies. None of the variables were considered predictors for the observed variance between the effect sizes of the included studies. For the prevalence of OD, the GRADE rating was considered very low. Despite the high prevalence observed, with over half of the individuals affected, the evidence regarding this outcome remains uncertain due to an overestimation of the generated estimates caused by the baseline condition of the sample. [ABSTRACT FROM AUTHOR]- Published
- 2024
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36. Complications of oropharyngeal dysphagia in older individuals and patients with neurological disorders: insights from Mataró hospital, Catalonia, Spain.
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Karunaratne, Tennekoon B., Clavé, Pere, and Ortega, Omar
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OLDER people ,OLDER patients ,ASPIRATION pneumonia ,NEUROLOGICAL disorders ,DEGLUTITION disorders ,RESPIRATORY infections ,GERIATRIC assessment - Abstract
Background: Oropharyngeal dysphagia (OD) significantly impacts older individuals and neurologically compromised patients, hindering safe ingestion of food and liquids. Despite its prevalence, OD remains underdiagnosed and undertreated, leading to severe complications such as malnutrition, dehydration, respiratory infections, and aspiration pneumonia (AP), and increases hospital readmissions. Objectives: This study analyzes the intricate relationship between OD and various clinical complications in older individuals and patients with neurological disorders. Methods: Utilizing retrospective analysis and narrative review, our work consolidates findings from prior studies on Hospital de Mataro's dysphagia patient cohort. Revisiting OD's intricate association with clinical complications, it presents data via odds ratios (OR), incidence ratios (IR), and hazard ratios (HR) from univariate and multivariate analyses. Results: Five studies (2001-2014) involving 3,328 patients were scrutinized. OD exhibited independent and significant associations with various complications among older patients. Older individuals with OD faced heightened 1-month (ODDS 3.28) and 1-year (OR 3.42) mortality risks post-pneumonia diagnosis. OD correlated with a 2.72-fold risk of malnutrition, 2.39-fold risk of lower respiratory tract infections, 1.82-fold pneumonia readmissions (IR), and 5.07-fold AP readmissions (IR). Post-stroke OD is linked to neurological impairment (OR 3.38) and respiratory (OR 9.54) and urinary infections (OR 7.77), alongside extended hospital stays (beta coefficient 2.11). Conclusion: Oropharyngeal dysphagia causes and significantly exacerbates diverse clinical complications in older and post-stroke patients, emphasizing the urgent need for proactive identification, comprehensive assessment, and tailored management. Acknowledging OD's broader implications in general medical practice is pivotal to improving patient outcomes and healthcare quality. [ABSTRACT FROM AUTHOR]
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- 2024
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37. Association between sarcopenia and dysphagia among elderly.
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Mahgoub, Rewayda Walid, Sabry Elbedewy, Reem Mohamed, El Dein Hafez, Nirvana Gamal, Adly, Nermien Naim, and Mohamed, Mona Hegazy
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DEGLUTITION disorders , *OLDER people , *SARCOPENIA , *COMPULSIVE eating , *MEDICAL sciences , *SCIENTIFIC literature - Abstract
This document provides a list of references cited in a research article on sarcopenic dysphagia, a condition characterized by muscle loss and difficulty swallowing. The references cover topics such as the sensitivity and specificity of body mass index for diagnosing sarcopenic dysphagia, the relationship between malnutrition and dysphagia, the impact of dysphagia on daily activities and nutrition, and the prevalence of sarcopenia as a comorbid condition. Other references discuss the association between sarcopenia and physical disability, the link between thinness and swallowing function, and the use of assessment tools for dysphagia and nutritional status. [Extracted from the article]
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- 2024
38. PENERAPAN TEKNIK KOMPENSATORI POSTURAL CHIN-TUCK PADA LATIHAN MENELAN TERHADAP PENINGKATAN KEMAMPUAN MENELAN PADA PASIEN STROKE NON HEMORAGIK DENGAN GANGGUAN MENELAN.
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Zabitha, Ridzka Ayyanun
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This research reveals that 27% of stroke patients experience acute swallowing disorders, increasing the risk of pneumonia due to silent aspiration. The chin-tuck technique can be applied as a compensatory intervention to enhance swallowing ability and prevent worsening clinical conditions. A case study involving three non-hemorrhagic stroke patients shows that chin-tuck intervention successfully improved swallowing ability from <60 to >70. The research also identifies physiological differences in swallowing between left and right hemisphere stroke patients, potentially causing dysphagia. Correlations between laryngeal elevation and disruptions in external and internal capsules were found. Stroke is recognized as a risk factor for swallowing disorders, with clinical manifestations such as communication impairment and facial paralysis. In conclusion, this study emphasizes the importance of understanding the relationship between stroke severity and swallowing physiology, highlighting the need for further research to comprehend contributing factors to dysphagia. Chin-tuck intervention can be independently implemented with twice-daily exercises, positively impacting the improvement of swallowing ability in non-hemorrhagic stroke patients with swallowing disorders. [ABSTRACT FROM AUTHOR]
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- 2024
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39. Comparing biomechanics and neurophysiology between different phenotypes of patients with oropharyngeal dysphagia.
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Tomsen, Noemí, Ortega, Omar, and Clavé, Pere
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BIOMECHANICS , *DEGLUTITION disorders , *ESOPHAGOGASTRIC junction , *NEUROPHYSIOLOGY , *PARKINSON'S disease , *PHENOTYPES - Abstract
The pathophysiology of oropharyngeal dysphagia (OD) across patient phenotypes may differ. The aim of this study was to compare the biomechanics and neurophysiology of swallowing between healthy volunteers (HVs) and patients with dysphagia as a consequence of aging (OOD), post‐stroke (PSOD), Parkinson's disease (POD), or dementia (DOD). A retrospective study including 35 HVs and 109 OOD, 195 PSOD, 78 POD, and 143 DOD patients was performed. Videofluoroscopic data of signs of impaired efficacy and safety, penetration–aspiration scale (PAS) score, and the biomechanics of laryngeal vestibule closure (LVC) and opening (LVO) and of upper esophageal sphincter opening (UESO) were collected. Neurophysiology was assessed with pharyngeal sensory evoked potentials and neurotopography maps. All OD phenotypes showed signs of impaired efficacy and safety of swallowing, increased PAS score (p < 0.001), and delayed time to LVC (p < 0.0001). OOD (p < 0.0001), PSOD (p < 0.0001), and POD (p = 0.0065) patients also had delayed time to LVO, and OOD (p = 0.0062) and DOD (p = 0.0016) patients to UESO. Regarding neurophysiology, all phenotypes presented impaired pharyngeal sensitivity, a significant reduction in cortical activation, and impaired sensory input integration. Additionally, only PSOD was associated with impaired conduction of sensory stimuli. In conclusion, we found common but also specific pathophysiological elements. These results improve our understanding of OD pathophysiology and may help pave the way for phenotype‐specific treatments. [ABSTRACT FROM AUTHOR]
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- 2024
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40. Swallowing dysfunction between the community-living older adults with and without comorbid conditions using Patient-Reported Outcome Measures (PROM).
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Verma, Himanshu, Kumar, Sourabh, Sharma, Atul, Mishra, Roshani, and Nagamani, Banumathy
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• To the best of our knowledge, this is the first study from India that compared the swallowing function in older adults with and without comorbid conditions, such as diabetes mellitus, hypertension, asthma, and others. • The swallowing issues increase with the aging, although the geriatric population may not strongly report those changes clinically. • Older adults generally do not show up any concern with respect to swallowing functions in their daily living, their nutritional & health status get compromised thereby leading to a poor quality of life. The present study aimed to investigate older adults' perspective on their swallowing physiology using a PROM tool. The study further explored the swallowing issues among older adults with and without comorbid conditions. One hundred twenty-two (122) participants participated in the e-survey. A questionnaire was developed to assess the swallowing deficits among older adults, and Eating Assessment Tool-10 (EAT-10) was administered to assess the PROM. The results revealed that 40% of older adults with comorbid conditions had EAT-10 scores greater than 3, suggesting swallowing deficits. A significant difference was observed between the two groups with respect to swallowing deficits, as reported on EAT-10. Based on the results, it can be delineated that swallowing deficits emerge with aging. More of older adults with comorbid conditions reported swallowing deficits in comparison to those without comorbid conditions. Hence, their nutritional and health status gets compromised, leading to poor quality of life. [ABSTRACT FROM AUTHOR]
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- 2024
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41. 多感官刺激联合间歇经口至食管管饲法在 老年脑卒中吞咽障碍的应用.
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刘丽, 何东梅, and 唐蓉
- Abstract
Objective To assess the effectiveness of multisensory stimulation combined with intermittent oroesophageal tube feeding in managing swallowing disorders among elderly stroke patients. Methods Stroke patients with swallowing disorders from February 2021 to October 2022 were randomly allocated into control group, observation group A, and observation group B. The control group received nasal gastric tube feeding on top of routine treatment; observation group A received intermittent oroesophageal tube feeding as an adjunct to routine treatment; observation group B, building upon observation group A, incorporated a multisensory stimulation protocol. The intervention duration for all three groups was 8 weeks. The study evaluated the Penetration- Aspiration Scale (PAS), Standard Swallowing Assessment (SSA), Swallowing Quality of Life Questionnaire (SWAL-QOL), body mass index (BMI), Nutritional Risk Screening 2002 (NRS2002), and laryngopharyngeal complex movement examination (hyoid bone elevation distance, thyroid cartilage elevation distance, hyoid bone anterior movement distance, thyroid cartilage anterior movement distance) before and after the intervention. Results After 8 weeks of intervention, except for the SWAL QOL score in the control group, the PAS score, SSA score, and SWAL-QOL score in the three groups showed improvement compared to preintervention levels (P<0.05). Observation group B demonstrated a significant difference in the PAS test and a lower SSA score compared to the other two groups (P<0.05), with a higher SWAL-QOL score than the control group (P<0.05), and no significant difference from observation group A (P>0.05). Regarding nutritional aspects, after 8 weeks of intervention, the BMI of all three groups increased compared to pre-intervention levels, and NRS2002 decreased (P<0.05). In the intergroup comparison, there was no significant difference in BMI among the three groups (P>0.05). Concerning NRS2002, observation group A and observation group B had lower scores than the control group (P<0.05), with no significant difference between observation group A and observation group B (P>0.05). In the laryngopharyngeal complex movement examination, after 8 weeks of intervention, except for the hyoid bone elevation distance in the control group, all other distances in the three groups increased compared to pre intervention levels (P<0.05). Observation group B had higher values than the other two groups in hyoid bone elevation distance and hyoid bone anterior movement distance (P<0.05), and only higher values than the control group in thyroid cartilage anterior movement distance and thyroid cartilage elevation distance, with no significant difference from observation group A (P>0.05). Conclusion The application of multisensory stimulation combined with intermittent oroesophageal tube feeding in stroke patients with swallowing disorders demonstrates improvements in swallowing function and enhances overall quality of life. Further research in this domain is warranted. [ABSTRACT FROM AUTHOR]
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- 2024
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42. A comparison of swallowing related quality of life in patients undergoing transoral endoscopic versus open thyroid surgery.
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Deshmukh, Parth, Shiva, Bharath, Yadav, Sanjay Kumar, Agarwal, Pawan, Sharma, Dhananjaya, and Johri, Goonj
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- *
THYROIDECTOMY , *DEGLUTITION , *QUALITY of life , *ENDOSCOPIC surgery , *HEMITHYROIDECTOMY , *VOCAL cords - Abstract
Introduction: It is important for the endoscopic thyroid surgeon to understand the pros and cons of trans‐oral endoscopic thyroidectomy‐vestibular approach (TOETVA) vis‐à‐vis, open conventional thyroidectomy (OTx) so he/she can help patients in making informed choices regarding the type of procedure to opt for. Swallowing related quality of life (SWAL‐QoL) has not been compared between the two approaches. Using a rigorous qualitative methodology and validated reliable tool, this study set out to compare the swallowing related quality of life in patients undergoing TOETVA versus OTx. Methods: Prospective study at 3 time points in patients planned for hemithyroidectomy (Preoperative, 1 week and 12 weeks). Data were collected on patients at a tertiary teaching institute in India. Participants ranged from age 18–60 years with a diagnosis of benign euthyroid nodule undergoing hemithyroidectomy. Exclusion criteria were—(1) pre‐existing vocal cord abnormalities, (2) undergoing surgery for recurrent nodules, and (3) any neuro‐muscular disease affecting swallowing ability. Main outcome measure was comparison of swallowing related quality of life domain scores between patients undergoing hemithyroidectomy via either endoscopic trans‐oral or open approach. Results: Of the 82 included patients, 40 underwent TOETVA and 42 OTx. Both the groups were comparable in terms of demographic and clinicopathological profile. The mean preoperative SWAL‐QOL scores were comparable in all domains. Mean SWAL‐QoL scores for all domains on postoperative day 7 were significantly better in TOETVA group with domains burden, eating desire, mental health and communication having medium effect sizes. Physical symptom domain was better in the OTx group but had a small effect size. The difference in SWAL‐QoL domains between the two groups persisted for 3 months also. Conclusion: Swallowing related quality of life after trans‐oral endoscopic thyroidectomy compared to conventional open surgery has not been reported in the literature. Our findings suggest that trans‐oral endoscopic thyroidectomy results in significant superior swallowing related quality of life in the majority of domains. Presentations: Part of this study was presented as oral presentation during World Congress of Endoscopic Surgery, September 2022, Busan, KoreaPart of this study was presented as oral presentation and was awarded Dr C Palanivelu Best Paper Award during annual meeting of the Association of Surgeons of India (ASICON), December 2022, Mumbai, IndiaPart of this study was presented as travel award presentation during annual meeting of the Korean Society of Endoscopic and Robotic Surgery, April 2023, Seoul, Korea [ABSTRACT FROM AUTHOR]
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- 2024
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43. Síntomas y problemas gastrointestinales en niños asistidos por equipos de cuidados paliativos pediátricos. Estudio observacional.
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Bernadá Scarrone, María Mercedes and Le Pera Garófalo, Valeria
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- 2024
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44. Multiple Einflussfaktoren bei Dysphagie: Erweiterte Aufgaben für das interprofessionelle Team auf der Intensivstation.
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Albrecht, Sindy and Nusser-Müller-Busch, Ricki
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INTENSIVE care units ,CRITICAL care medicine ,SPEECH therapists ,DEGLUTITION disorders ,MORTALITY - Abstract
Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature 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.)
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- 2024
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45. The Cost-Effectiveness of Chin Tuck Against Resistance Compared to Usual Care in Citizens with Oropharyngeal Dysphagia – An Economic Evaluation
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Dyreborg L, Raunbak SM, Sørensen SS, Melgaard D, and Westmark S
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cost-utility analysis ,exercise ,swallowing disorders ,municipality ,quality of life ,Medicine (General) ,R5-920 ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Line Dyreborg,1,2 Sabine Michelsen Raunbak,2 Sabrina Storgaard Sørensen,2 Dorte Melgaard,3– 5 Signe Westmark1 1Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; 2Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; 3North Denmark Regional Hospital, Hjørring, Denmark; 4Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; 5Mech-sense, Aalborg University Hospital, Aalborg, DenmarkCorrespondence: Signe Westmark, North Denmark Regional Hospital, Bispensgade 37, Hjørring, DK-9800, Denmark, Tel +45 2041 6541, Email s.westmark@rn.dkPurpose: This study aims to evaluate the cost-effectiveness of chin tuck against resistance (CTAR) for citizens suffering from dysphagia compared to the standard municipal treatment in Denmark.Patients and Methods: A cost-utility analysis, employing a municipal perspective, was conducted using cost data collected alongside clinical data of a randomized controlled trial evaluating the effect of CTAR training for citizens with dysphagia. The composition of the clinical randomized controlled trial, which included citizens with different diagnoses, means that participants had different disease courses. Ninety-two citizens from seven different Danish municipalities were enrolled, of whom 43 received standard care, and 49 received CTAR in addition to standard care. The effect outcome of the economic evaluation was quality-adjusted life years (QALY), estimated using the EQ-5D-5L questionnaire. Individual resource consumption of each citizen was determined based on the use of home care, home nursing care, physio- and occupational therapy, dietitian guidance, and hospital admissions. The incremental costs and QALYs between the intervention group (CTAR in addition to standard care) and standard care group were estimated using regression analysis, and sensitivity analyses were performed to investigate the robustness of the results.Results: The base case analysis showed that the intervention group was dominant compared to the standard care group, with a decrease in incremental costs of £ 542.38 and an increase in incremental QALYs of 0.0118. All sensitivity analyses demonstrated similar findings as the base case analysis, supporting the robustness of the results.Conclusion: This study found that the intervention group was the dominant alternative, hence being more effective and cost-saving, compared to the standard care group in a Danish municipality perspective with a three-month time horizon. This study adds to the scarce evidence on the cost-effectiveness of CTAR in a Danish clinical setting, but further studies should focus on estimating long-term cost-effectiveness.Keywords: cost-utility analysis, exercise, swallowing disorders, municipality, quality of life
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- 2023
46. Dysphagia Secondary to a Large Anterior Cervical Osteophyte: A Case Report
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Isam Sami Moghamis, Jawad Derbas, Nasser Mehrab Khan, Moh’d Ishaq Alamlih, Mutaz Awad Alhardallo, and Abdul Moeen Baco
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diffuse idiopathic skeletal hyperostosis ,dysphagia ,anterior cervical osteophytes ,swallowing disorders ,Medicine ,Orthopedic surgery ,RD701-811 - Abstract
Introduction: Diffuse idiopathic skeletal hyperostosis (DISH) is a common systemic condition that leads to ossification of the anterior spine longitudinal ligament with anterior marginal osteophyte formation. Generally, these osteophytes are asymptomatic, but when they are extremely large, their sizes may extend to the point that can lead to mechanical esophageal obstruction and dysphagia. Case Presentation: Sixty-three years old, male, presented with severe progressive dysphagia caused by a giant anterior cervical osteophyte, which was treated with surgical resection of the osteophyte and interbody fusion of the affected cervical segment. Conclusion: Cervical degenerative disc disease and DISH should be included in the differential diagnosis when evaluating an elderly patient for dysphagia. Early surgical intervention with osteophyte resection and interbody fusion is recommended to prevent recurrent osteophyte formation.
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- 2023
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47. Usefulness of a newly developed endoscope for the observation of the posterior tracheal wall
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Tomoe Tamai, Kanako Yoshimi, Kazuharu Nakagawa, Ryosuke Yanagida, Takuma Okumura, Kohei Yamaguchi, Miki Ishii, Yuki Nagasawa, and Haruka Tohara
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dysphagia ,swallowing disorders ,trachea ,videoendoscopy ,Otorhinolaryngology ,RF1-547 ,Surgery ,RD1-811 - Abstract
Abstract Objective Videoendoscopic evaluation of swallowing is an objective swallowing function evaluation method used in dysphagia rehabilitation. However, it is anatomically difficult to detect the entry of foreign substances through the posterior tracheal wall using a conventional endoscope (CE). In this study, we developed an endoscope that can observe the posterior tracheal wall and investigated its reliability and validity in healthy adults. Methods Twenty healthy adults were included. The trachea was observed from inside the larynx using a CE and a portable, flexible two‐step angulation endoscope (two‐AE) with a two‐step curved shaft tip. The visibility of the anterior and posterior walls was recorded. The time from the endoscope tip entering the larynx to the posterior tracheal wall was measured. Additionally, discomfort events were assessed after the examination. McNemar's test and a paired t‐test were used for statistical analysis. Kappa coefficients and concordance rates were calculated. Results The anterior tracheal wall was observed using both endoscopes. The posterior tracheal wall was significantly observed in 18 participants with the two‐AE (p
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- 2023
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48. Complications of oropharyngeal dysphagia in older individuals and patients with neurological disorders: insights from Mataró hospital, Catalonia, Spain
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Tennekoon B. Karunaratne, Pere Clavé, and Omar Ortega
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oropharyngeal dysphagia ,swallowing disorders ,aspiration pneumonia ,clinical complications ,post-stroke ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
BackgroundOropharyngeal dysphagia (OD) significantly impacts older individuals and neurologically compromised patients, hindering safe ingestion of food and liquids. Despite its prevalence, OD remains underdiagnosed and undertreated, leading to severe complications such as malnutrition, dehydration, respiratory infections, and aspiration pneumonia (AP), and increases hospital readmissions.ObjectivesThis study analyzes the intricate relationship between OD and various clinical complications in older individuals and patients with neurological disorders.MethodsUtilizing retrospective analysis and narrative review, our work consolidates findings from prior studies on Hospital de Mataro’s dysphagia patient cohort. Revisiting OD’s intricate association with clinical complications, it presents data via odds ratios (OR), incidence ratios (IR), and hazard ratios (HR) from univariate and multivariate analyses.ResultsFive studies (2001–2014) involving 3,328 patients were scrutinized. OD exhibited independent and significant associations with various complications among older patients. Older individuals with OD faced heightened 1-month (ODDS 3.28) and 1-year (OR 3.42) mortality risks post-pneumonia diagnosis. OD correlated with a 2.72-fold risk of malnutrition, 2.39-fold risk of lower respiratory tract infections, 1.82-fold pneumonia readmissions (IR), and 5.07-fold AP readmissions (IR). Post-stroke OD is linked to neurological impairment (OR 3.38) and respiratory (OR 9.54) and urinary infections (OR 7.77), alongside extended hospital stays (beta coefficient 2.11).ConclusionOropharyngeal dysphagia causes and significantly exacerbates diverse clinical complications in older and post-stroke patients, emphasizing the urgent need for proactive identification, comprehensive assessment, and tailored management. Acknowledging OD’s broader implications in general medical practice is pivotal to improving patient outcomes and healthcare quality.
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- 2024
- Full Text
- View/download PDF
49. Symptoms of oropharyngeal dysphagia, efficiency, and safety of swallowing in patients after treatment for head and neck cancer.
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Costa, Danila Rodrigues, Guedes, Renata Lígia Vieira, Mituuti, Cláudia Tiemi, Rubira, Cassia Maria Fischer, da Silva Santos, Paulo Sérgio, and Berretin-Felix, Giédre
- Abstract
Purpose: The aim of this study is to investigate the relation between symptoms and signs of oropharyngeal dysphagia after treatment for head and neck cancer. Methods: An observational analytical study with retrospective and prospective components was carried out including 25 adult and elderly patients with head and neck cancer who had completed the treatment at least 3 months before data collection. Data from the Eating Assessment Tool (EAT-10) protocol were analyzed, as well as from the videofluoroscopic swallowing exams. Based on videofluoroscopy, the degree of oropharyngeal dysphagia was classified, as well as the safety and efficiency grade using the DIGEST (Dynamic Imaging Grade of Swallowing Toxicity) scale. Pearson’s correlation test was applied, adopting a significance level of 5%. Results: There was a significant correlation between question 4 of the EAT-10 (swallowing solids takes extra effort) and the efficiency profile (p = 0.004), as well as between question 4 and the DIGEST score (p = 0.002). No significant relation was found between the DIGEST score and EAT-10 total score (p = 0.180) and not even between EAT-10 total score and efficiency (p = 0.129) or safety grade (p = 0.878). Conclusion: In conclusion, no relation was found between most of the dysphagia signs and symptoms investigated, demonstrating that the individual’s perception of the swallowing function may not be consistent with the findings of the instrumental evaluation after long-term treatment for head and neck cancer. [ABSTRACT FROM AUTHOR]
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- 2024
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50. Association between risk of dysphagia and signs suggestive of sarcopenia, nutritional status and frequency of oral hygiene in hospitalized elderly.
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Pinto Ferreira, Ronivaldo, Marsicano Alves, Luana, and Davison Mangilli, Laura
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- 2024
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