Search

While oropharyngeal cancer treatment regimens, including surgical resection, irradiation, and chemotherapy, are effective at removing tumors, they lead to muscle atrophy, denervation, and fibrosis, contributing to the pathogenesis of oropharyngeal dysphagia - difficulty swallowing. Current standard of care of rehabilitative tongue strengthening and swallowing exercises is ineffective. Here, we evaluate an alternative approach utilizing an acellular and injectable biomaterial to preserve muscle content and reduce fibrosis of the tongue after injury. Skeletal muscle extracellular matrix (SKM) hydrogel is fabricated from decellularized porcine skeletal muscle tissue. A partial glossectomy injury in the rat is used to induce tongue fibrosis, and SKM hydrogels along with saline controls are injected into the site of scarring two weeks after injury. Tissues are harvested at 3 and 7 days post-injection for gene expression and immunohistochemical analyses, and at 4 weeks post-injection to evaluate histomorphological properties. SKM hydrogel reduces scar formation and improves muscle regeneration at the site of injury compared to saline. SKM additionally modulates the immune response towards an anti-inflammatory phenotype. This study demonstrates the immunomodulatory and tissue-regenerative capacity of an acellular and minimally invasive ECM hydrogel in a rodent model of tongue injury.

Rice (Oryza sativa L.) is the extensively consumed primary food with a main source of energy, vitamins, minerals, fiber, and biomolecules. It is not only a dietary cornerstone but also has an array of bioactive compounds with significant health benefits. The use of rice ingredients in dietary supplements, culinary additives, pharmacological adjuvants, and nutritional products is growing. Therefore, this review article summarized the rice biomolecules, its utilization in various diets and food products, and therapeutic properties of rice. The article concluded that rice grain emerges as a potential source of phytochemicals like oryzanol, phenolics, anthocyanins, flavonoids, carotenoids, Saponins, vitamin E, and other components with multiple health effects. The article gives information on the application of rice in various food products including bread, cake, vermicelli, pasta, noodles, probiotic beverages, and many more, which are considered to be beneficial for health. Moreover, rice and its bioactive compounds have numerous health benefits like hepatoprotective, anti-inflammatory, neuroprotective, hypolipidemic, hypocholestrolemic, metabolic regulatory effects, protection from cardiovascular diseases, and obesity. Also, the utilization of rice in food and pharmaceutical industry will be increase due to its role in healthy product development, and disease prevention. [ABSTRACT FROM AUTHOR]

This study evaluated food preferences and eating behaviors of individuals with Dravet syndrome. Patients diagnosed with Dravet syndrome were recruited, as well as a control group composed of siblings of patients with epilepsy (any form). The Food Preference Questionnaire and the Child Eating Behavior Questionnaire were completed by caregivers along with two open‐ended questions regarding eating challenges. Seventy‐eight participants (45 with Dravet syndrome and 33 controls) were included. Compared to controls, mean scores for food preference were lower for fruits (p = .000099), meats and fish (p = .00094), and snacks (p = .000027) in Dravet syndrome. People with Dravet syndrome also had less emotional overeating (p = .0085) and food enjoyment (p = .0012), but more slowness in eating (p = .00021) and food fussiness (p = .0064). In a subgroup analysis of only pediatric (age <18 years) patients, similar results were observed for both food preferences and eating habits. In qualitative data, caregivers most commonly reported difficulties with fixation on specific foods. This study demonstrates specific food preferences and challenging eating behaviors in individuals with Dravet syndrome. These data provide potential avenues for nutritional interventions and behavioral therapies to increase the quality of life of patients and their families. [ABSTRACT FROM AUTHOR]

Background: Antiadhesion products are essential for postoperative care in patients after thyroidectomy by providing a physical barrier to cover the exposed tissue and thus preventing abnormal adhesion of adjacent tissues. Since thyroidectomy may result in swallowing difficulties arising from damage or inflammation of the surrounding tissues, the use of antiadhesion agents such as MegaShield® or Guardix-SG® will help reduce scar formation. This may thus improve postoperative swallowing function in patients. Methods: Patients were enrolled and followed up between October 4, 2018, and March 26, 2020. Patients during the postoperative follow-up sessions were randomly allocated to the standard care with Guardix-SG® and clinical trial medical device application group with MegaShield® (test group) in a 1:1 ratio by the permuted block randomization method. Patient performance on penetration aspiration scale (PAS), National Institutes of Health-Swallow Safety Scale (NIH-SSS), videofluoroscopic dysphagia scale (VDS), Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) based on Videofluoroscopic swallowing study (VFSS) were collected. Nonadhesion-reducing agent patient data were used as a control group. Results: No statistical significance was shown (P >.05) between the 2 groups of MegaShield® and Guardix-SG® in various phases from thick semisolid, thin semisolid to liquid for both PAS and NIH-SSS. Several statistical significances were reported in the results comparing various criteria of PAS, NIH-SSS, VDS at different oral and pharyngeal phases, and DIGEST in all 3 stages among MegaShield®, Guardix-SG®, and nonadhesion-reducing agent group. Conclusions: These results prove the noninferiority of MegaShield® compared with Guardix-SG® as an antiadhesion agent in postthyroidectomy care. [ABSTRACT FROM AUTHOR]

Compensatory strategies used to treat dysphagia, like the chin-down and chin-up positions, are often employed by speech-language pathologists to enhance swallowing safety. However, their effects on cortical neural responses remain unclear. This study aimed to investigate the cortical hemodynamic responses to swallowing across three head positions —chin-down, chin-neutral, and chin-up — using functional near-infrared spectroscopy (fNIRS) in the bilateral precentral and postcentral gyrus regions of interest. Twenty-six healthy adults completed 32 swallows of 5 ml water in each head position. Results revealed short-term cortical activation increases for chin-up swallows compared to both chin-neutral (mean difference = 1.2, SE = 0.18, p =.048) and chin-down swallows (mean difference = 0.76, SE = 0.18, p =.009). These findings suggest that postural changes during swallowing induce immediate neural adaptations in people without swallowing difficulty. These modifications likely reflect the necessary sensory and neuromuscular adaptations required for safe swallowing in different head positions, with less hyolaryngeal movement needed for a chin-down swallow and more movement needed for a chin-up swallow. While challenging swallow conditions, like the chin-up, may offer promising therapeutic potential, caution is warranted considering the associated safety risk, and further investigation is needed. This study provides insights into the immediate effects of head positions on cortical activity during swallowing and highlights avenues for future research in dysphagia rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is a potential complication following anti-gastroesophageal reflux surgery (ARS), with challenging management. Endoscopic balloon dilation is recommended for patients with significant dysphagia from tight wraps or strictures. We aim to evaluate factors associated with the need for post-ARS dilation and the outcomes of balloon dilation. Additionally, we assessed the predictors of sustained clinical failure after dilation. Methods: A retrospective analysis was conducted on patients who underwent robotic or laparoscopic ARS between January 2012 and April 2023. Patients were divided based on whether they received balloon dilation using a through-the-scope wire-guided dilator. Excluded were those with pre-existing achalasia, other dilation devices, or inadequate follow-up. Results: Of 1002 patients, 69 underwent 94 postoperative dilations, and the remainder were controls. The dilation cohort was older (63.78 vs. 56.14 years, P = 0.032) and had more magnetic sphincter augmentations (MSA) (P = 0.004), a prior history of ARS (P = 0.039), and a higher rate of laparoscopic surgery (P = 0.009) compared to controls. Of all dilations, 54 (57.5%) patients reported immediate dysphagia improvement, and 39 (41.5%) had sustained improvement. Sixteen (23.2%) patients required reoperation, primarily for hiatal hernia recurrence or slipped wrap. Multivariable logistic regression showed that MSA (OR 0.04, 95% CI 0.01–0.46, P = 0.031) and requiring multiple dilations (OR 0.16, CI 0.03–0.68) predicted sustained dilation failure. Conclusions: Factors including older age, history of prior ARS, and MSA are correlated with higher post-ARS dilation rates. Although dilation improves symptoms in approximately half of patients initially, one-fourth may eventually require reoperation, mostly due to a slipped wrap or hernia recurrence. Thus, in cases of persistent dysphagia, consideration for surgical failure is important, and further imaging and workup are warranted. Patients who undergo MSA and those who have more than one dilation are more likely to experience dilation failure. [ABSTRACT FROM AUTHOR]

Respiratory–swallowing coordination (RSC) is well established as an essential airway‐protective mechanism. Previous studies have used nasal airflow and/or kinematic rib cage and abdominal measures to assess respiration surrounding swallowing, meaning that the direct influence of oral respiration on RSC remains unknown. This study used a partitioned oronasal facemask to compare respiratory phase patterns measured using isolated nasal airflow with those measured using combined oronasal airflow during non‐ingestive and ingestive swallowing tasks. Twenty‐four healthy individuals with no respiratory or swallowing disorders were assessed at rest and during cued dry, 10 mL water, continuous drinking and cracker swallowing tasks. Respiratory phase patterns were determined for discrete swallows using the nasal and combined oronasal channels separately. There was variable agreement between respiratory phase patterns according to the nasal and oronasal channels across swallowing conditions. The frequency of exhale–swallow–exhale, inhale–swallow–exhale and exhale–swallow–inhale patterns increased by 2%–3% each with the addition of oral flow data to nasal data, whereas the prevalence of inhale–swallow–inhale and ambiguous patterns decreased. This suggests that estimates of respiratory phase patterns are altered minimally by inclusion of oral respiratory estimates in a healthy sample. There were several additional findings of note, including lower within‐participant, within‐session trial consistency (test–retest reliability) than expected, suggesting high variability in respiratory phase patterns across trials. Additionally, data showed evidence of swallowing non‐respiratory flow at the beginning and end of the respiratory–swallowing pause, moving in both inward and outward directions, potentially expanding current understanding of swallowing non‐respiratory flow. Further in‐depth physiological investigations are required to improve understanding of these findings. What is the central question of this study?What is the impact of mouth breathing on the frequency of respiratory phase patterns for respiratory–swallowing coordination?What is the main finding and its importance?Added oral flow appeared to alter respiratory phase patterns minimally in healthy individuals. This was probably attributed to increased clarity of the respiratory flow signal, aiding interpretation of respiratory data. This suggests that mouth breathing might impact measurement of respiratory phase patterns. These findings might have implications for the methods used to assess respiratory phase patterns and broader respiratory–swallowing coordination, particularly in patient populations prone to mouth breathing. [ABSTRACT FROM AUTHOR]

Background: Dysphagia, as a geriatric syndrome, is prevalent in the intensive care unit (ICU). Malnutrition resulting from swallowing disorders is likely to correlate with adverse ICU outcomes, including delirium, thereby escalating the costs of care and hospitalization. However, malnutrition has not received the attention it deserves in ICU clinical nursing practice. As two preventable and correctable conditions—malnutrition and delirium—the advantages of early identification and intervention are substantial. Exploring the relationship between malnutrition and delirium, starting from the high‐risk group of elderly patients with swallowing difficulties in the ICU, will aid us in managing patients promptly and effectively. Aim: To investigate the relationship between malnutrition and the incidence of delirium in elderly patients with dysphagia in the ICU. Study Design: This is a retrospective study. Data for this study were obtained from the Medical Information Mart for Intensive Care‐IV. All 2273 patients included were dysphagia older patients over 65 years of age admitted to the ICU, and logistic regression was used to explore the relationship between malnutrition and delirium. We also used propensity score matching (PSM) for sensitivity analysis. Results: Among the included patients with swallowing difficulties, 13% individuals (297/2273) exhibited malnutrition, with a delirium incidence rate of 55.9% (166/297). In the non‐malnutrition group (1976/2273), the delirium incidence rate is 35.6% (704/1976). After adjusting for 31 covariates, multifactorial logistic regression showed that malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) = 1.47–2.62). The results remained stable after analysis by PSM. Conclusion: Malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU. Malnutrition should be given adequate attention in the ICU. Relevance to Clinical Practice: ICU nurses should pay particular attention to malnutrition, especially among the high‐prevalence group of patients with dysphagia. Early identification and nutritional intervention for these patients may help reduce the costs of care and health care expenditures. [ABSTRACT FROM AUTHOR]

Background: Post‐extubation dysphagia (PED) is a common post‐extubation complication that may lead to serious problems, such as malnutrition and longer hospital and intensive care unit (ICU) stays. Aim: To explore factors associated with the readiness for oral intake in post‐extubated critically ill adult patients. Study Design: This prospective observational study involved 125 extubated patients. Readiness for oral intake was assessed using the Gugging Swallowing Screen (GUSS), and regression analysis was used to determine its predictors. Results: The median age of the participants was 40.0 years, and 51.2% were female. The median GUSS score was 12.0 (possible range, 0–20), and 35.2% of the studied patients had severe dysphagia (scored 0–9). Bivariate regression analysis showed that older age, male, higher APACHE II score, body mass index (BMI) ≥30, smoking history, longer ICU stay, muscle relaxants use, large‐bore endotracheal and orogastric tubes and frequent intubation attempts were associated with lower GUSS score (p‐value <.05). Multivariate regression analysis showed that age, BMI and smoking history predicted 37.2% of the variability in the GUSS score (F = 23.865, p‐value <.001). Adding the ICU length of stay, muscle relaxants use, size of the endotracheal tube, size of the orogastric tube and frequency of intubation attempts to the regression model raised the predictability to 86.0% (F = 88.809, p‐value <.001). Conclusions: More than one‐third of extubated patients have severe PED with a high risk of aspiration. Several modifiable factors, such as muscle relaxant use and endotracheal and orogastric tube size, predict post‐extubation readiness for oral intake. Relevance to Clinical Practice: Using endotracheal and orogastric tubes of appropriate sizes, careful assessment of patients with a high risk for difficult intubation, and minimal use of muscle relaxants may help increase patients' readiness for post‐extubation oral intake. [ABSTRACT FROM AUTHOR]

Introduction: Tracheal resection anastomosis has been established as the definitive surgery for high grade postintubation subglottic stenosis. To achieve a relaxed tension-free anastomosis, various laryngeal release techniques were discussed in literature with potential effect on postoperative swallowing dysfunction. This study aims to compare the difference in swallowing outcomes following two methods of infrahyoid laryngeal release: with and without fracture of the superior thyroid horns. Methods: A retrospective cohort study was carried out at our tertiary referral hospitals including cases with grade III and IV subglottic stenosis treated by partial crico-tracheal resection with thyro-tracheal anastomosis. The patients were divided into two groups according to the method used in laryngeal release; mini infrahyoid release (group A) or infrahyoid full release (group B) where full means with fracture of the superior thyroid horn bilaterally while mini means their preservation. Swallowing assessment preoperatively and postoperatively was done by comparing swallowing dysfunction symptoms, Gugging swallowing screen (GUSS) score and fiberoptic endoscopic evaluation of swallowing (FEES) according to penetration aspiration scale (PAS). Results: A total of 71 patients were included; 46 in Group A and 25 in Group B. Clinical swallowing evaluation one week postoperatively showed statistically significant difference between the two groups being affected in 80.04% and 100% of patients in group A and B, respectively. The mean postoperative GUSS were 18 ± 1.32 in group A patients in comparison to 8.84 ± 5.18 in group B (p-value < 0.001). With FEES assessment, group A had full improvement of their swallowing abilities one month after the surgery while patients in group B had significantly lower PAS scores. Unfavourable scores for both the GUSS test and PAS were associated with increasing patients' age in group B. Conclusion: In this retrospective cohort study, cases with mini infrahyoid laryngeal release had significantly better swallowing outcomes and full resolution of dysphagia in comparison to full laryngeal release. Also, full laryngeal release is associated with delayed resolution of swallowing difficulty in older patients. This point should be considered during preoperative patient selection and counselling. [ABSTRACT FROM AUTHOR]

Purpose: Swallowing disorders are highly interrelated with increased morbidity and mortality rates; therefore, early detection is crucial. Most screening tools rely on subjective observation, thus making objective assessment tools more vital. Timed Water Swallowing Test (TWST) is a screening tool used in the field providing quantitative data. This study aimed to investigate the swallowing parameters in a wide age range by using TWST and to expand the already existing normative data pool accordingly. It is also aimed to examine the reliability of the TWST and assess its validity in stroke survivors. Materials and methods: This study had a cross-sectional design. TWST carried out simultaneously along with surface EMG and laryngeal sensor on 196 healthy subjects aged 10 to 80 for normative data. Also, TWST carried out 30 patients having a history of recent stroke. Test-retest and inter-rater scoring analysis were used for reliability purposes, while Gugging Swallowing Screen (GUSS) test was used for validity purposes. Additionally, the correlations between the participants' TWST scores and GUSS scores were examined using the Spearman correlation coefficient. Results: The normative TWST data of healthy participants are tabulated and presented and their average swallowing capacity was found 13.73 ml/s. Furthermore, the mean swallowing capacity of stroke survivors was found 4.61 ml/s. As a result of validity analyses, a statistically strong and significant relationship was found between GUSS and TWST parameters (r = 0.775, p < 0.001). Intraclass correlation coefficient (ICC) and correlation values were found between moderate to good agreement between test-retest measurement (ICC = 0.563 to 0.891, p < 0.05). Also, the agreement between the raters was found to be significant (ICC = 0.949 to 0.995, p < 0.05). Conclusion: TWST is a valid and reliable screening tool to evaluate dysphagia on given population. Although the test's performance on healthy individuals is adequate, more research is still needed to confirm that it can be used as a screening tool for stroke. [ABSTRACT FROM AUTHOR]

Background: Head and neck cancer (HNC) patients often have dysphagia following surgical and/or chemoradiation treatment, which can lead to reduced quality of life. Some patients suffer from decreased tongue strength and mobility that may cause discomfort and difficulty with swallowing. Our group has developed a patented genioglossus muscle strength trainer (GMST) to increase tongue protrusive force that has been used in patients with sleep apnea. We hypothesized that the GMST device would increase tongue strength in the HNC population. Methods: We conducted an IRB approved, non-randomized, interventional clinical trial of HNC patients with dysphagia to determine the effect of GMST on tongue strength. Our secondary objective was to assess dysphagia quality of life, as determined by questionnaires. Genioglossus muscle strength measurements (measured in Newtons, N) and dysphagia quality of life scores (SWAL-QoL questionnaire) were obtained from enrolled patients at baseline and following 4 weeks of intervention. Treatment was at-home GMST exercise regimen 3 times daily, 5 days per week. Compliance was assessed via review of training logs. Two-sided paired t -tests at significance level α =.05 were performed to assess difference in mean GG muscle strength pre- and post-treatment. Results: Out of 10 patients initially enrolled, 7 patients completed the trial. Eighty-six percent were male and the average age was 60. About 5 patients had surgery plus adjuvant radiation and 2 patients had primary radiation. All patients had baseline dysphagia as determined by patient complaint and/or objective measurement (prior modified barium swallow). No adverse events were reported. We observed a statistically significant increase in genioglossus muscle strength (mean change: 4.0 N, 95% CI 1.1-6.9, P =.015) after 4 weeks of treatment. Patients reported reduced swallowing burden and feeling of stigma around eating based on SWAL-QoL results. Conclusions: Our data suggest that protrusive tongue-training exercises utilizing a novel tongue trainer device is well-tolerated and increases genioglossus muscle strength in treated HNC patients complaining of dysphagia. Patient-reported outcomes based on the SWAL-QoL survey indicate improvements in quality-of-life post-treatment, although our results are limited by small sample size. Larger studies are needed to see if this device could have clinically meaningful results for this difficult-to-treat patient population. [ABSTRACT FROM AUTHOR]

Early retrospective data identify that dysphagia is common in older persons with burn injury, suggesting a rate of 47 %, and that it is associated with medical, burn, and nutritional outcomes. To prospectively (1) explore the incidence, (2) describe associations, and (3) evaluate risk factors for dysphagia in patients ≥ 75 years old hospitalised with burn injury. All patients > 75 years old admitted to Concord-Repatriation-General-Hospital with burn injury over 4 years (2019–2023) were assessed for dysphagia on presentation and were continually monitored throughout their admission. Burn injury, demographic, and nutritional data were prospectively captured and analysed for association with dysphagia. Sixty-two patients (33 male) aged 75–95 years (median=83 years) were recruited. Dysphagia was identified in 50 %. Dysphagia was associated with burn size (p = 0.002), pre-existing cognitive impairment (p = 0.000), hospital length of stay (p = 0.001), in-hospital complications (p = 0.000), feeding dependence (p = 0.002), nutritional status (p = 0.013) and enteral feeding duration (p = 0.030). Cognitive impairment was the most sensitive predictor for dysphagia at 100 % (specificity=29 %, NPV=100 %, PPV=59 %). Development of secondary comorbidities was less sensitive at 52 % (NPV 65 %), but was associated with high specificity (90 %) and PPV (84 %). One in every two patients ≥ 75 years admitted with burn injury will demonstrate dysphagia during their hospital admission. Those with pre-existing cognitive impairment are most at risk. • Dysphagia incidence in the older person with burn injury is confirmed to be high. • Dysphagia in the older person with burn injury is confirmed to be associated with increased morbidity and mortality. • Those with pre-existing cognitive impairment are most at risk for dysphagia. [ABSTRACT FROM AUTHOR]

Background: Treating oral problems with dentist intervention during hospitalisation may improve patients' food intake status. Objectives: This study aimed to clarify whether convalescent rehabilitation ward inpatients in a hospital with hospital dentistry (HHD) had a better diet at discharge than those in a hospital without hospital dentistry (HNHD). Methods: Retrospective observational study including inpatients with dental involvement in a HHD with dentists and dental hygienists and HNHD with dental hygienist and visiting dental service between 1 March and 31 August 2022. Data included age, sex, body mass index (BMI), Functional Independent Measure (FIM) motor and cognitive, Oral Health Assessment Tool (OHAT) score, Food Intake LEVEL Scale (FILS), whether the FILS ≥8 (indicating that patient eats also a non‐texture‐modified diet), remained and functional tooth numbers and speech language hearing therapist (SLHT) and dentist interventions. Comparisons between the two hospitals and factors that affected the FILS ≥8 were examined. Results: A total of 333 and 89 inpatients were included in the HHD and HNHD groups, respectively. After propensity score matching, the HHD group had a significantly higher rate of FILS ≥8, functional tooth numbers at discharge, and SLHT and dentist intervention rates. The multivariable logistic regression analysis for propensity score matching participants showed that the significant independent variables for FILS ≥8 were age, BMI, FILS, FIM motor (all at admission) and SLHT and dentist interventions. Odds ratio for dentist intervention was 14.46 (95% CI: 4.36–48.01). Conclusions: Dentists are necessary to improve patients' food intake status in convalescent rehabilitation wards. [ABSTRACT FROM AUTHOR]

Background: Tongue‐strengthening exercises may be used at home to strengthen swallowing‐related oropharyngeal muscles in community‐dwelling older adults with sarcopenic dysphagia; however, evidence of their effectiveness remains unclear. Objective: This study aimed to investigate the effects of a home‐based tongue‐strengthening exercise (hTSE) using portable tool on swallowing‐related oropharyngeal muscles in community‐dwelling older adults with sarcopenic dysphagia. Methods: Forth community‐dwelling older adults with sarcopenic dysphagia were enrolled in the study. The participants were randomly assigned to the experimental and control groups. 1‐Repetition Maximum (1‐RM) of tongue muscle was measured in the experimental group using the Iowa Oral Performance Instrument, and hTSE was performed using a portable tool with an intensity corresponding to approximately 70%–80% of the range based on the 1‐RM value (90 times/day, 5 days/week, for 8 weeks). The control group did not perform any tongue exercises. The primary outcome measures were tongue strength and thickness. The secondary outcome measure was suprahyoid muscle strength (digastric and mylohyoid muscles). Results: The experimental group showed significantly greater increases in suprahyoid muscle (mylohyoid and digastric) thickness (p =.01 and.011, d = 1.0 and.55), as well as tongue strength and thickness (p <.001 and.029, d = 2.2 and.6) than the control group. Conclusion: This study confirmed that hTSE using a portable tool is effective in increasing swallowing‐related oropharyngeal muscle activity in older adults with sarcopenic dysphagia. Therefore, hTSE is recommended as an inexpensive, safe, and easy‐to‐use therapy for sarcopenic dysphagia in older adults. [ABSTRACT FROM AUTHOR]

Background: Cervical auscultation (CA) involves listening to swallowing and respiratory sounds and/or vibrations to detect oropharyngeal aspiration (OPA). CA has shown promising diagnostic test accuracy when used with the clinical swallowing examination and is gaining popularity in clinical practise. There has not been a review to date analysing the accuracy of CA in paediatric and adult populations with meta‐analyses. Objectives: To determine the accuracy of CA in detecting OPA in paediatric and adult populations, when compared to instrumental assessments. Search Methods: Databases searched included MEDLINE, PubMed, Embase, CINAHL, AustHealth, Cochrane and Web of Science. The search was restricted between 01 October 2012 and 01 October 2022. Selection Criteria: Inclusion criteria included (a) all clinical populations of all ages, (b) who have had an instrumental assessment and (c) CA. All study types were included. Data Collection and Analysis: Studies were reviewed independently by two authors. The methodological quality of the studies was analysed using the QUADAS‐2. Main Results: Ten studies met the inclusion criteria for this review and meta‐analyses. The pooled diagnostic performance of CA in detecting OPA was 0.91 for sensitivity and 0.79 for specificity. The area under the curve summary receiver operating curve (sROC) was estimated to be 0.86, thereby indicating good discrimination of OPA. Most studies scored high for risk of bias in at least one domain in the QUADAS‐2, likely attributed to a lack of high‐quality prospectively designed studies. Conclusions: There are promising diagnostic test accuracies for the use of CA in detection of OPA. Future research could include using CA in specific clinical populations and settings, and identifying standardised criteria for CA. [ABSTRACT FROM AUTHOR]

Introduction: As patients nowadays tend to have multiple diseases and complex medical histories, our aim was to identify high‐quality, non‐instrumental dysphagia screening tools used for the detection of adult dysphagia cases in all disease categories in acute‐care settings. Method: A literature search was conducted in five databases from each database's earliest inception to 31 July 2021 and guided by five keywords: 'dysphagia', 'deglutition', 'screening', 'test' and 'measure'. Without limiting the search in any specific disease category, reviewers assessed original studies and identified tools if they had been validated against instrumental evaluations and if they had been designed as a pass–fail procedure to screen whether dysphagia is absent or present. We further excluded any tool if it was (1) for pediatric focus, or (2) a patient self‐report questionnaire. All final tool candidates underwent a methodological quality appraisal using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2). Result: Out of 195 studies with 165 tools identified, 20 tool candidates underwent QUADAS‐2 review. We found six high‐quality, non‐instrumental screening tools for detecting adult dysphagia cases in acute‐care settings, including the Yale Swallow Protocol, Gugging Swallowing Screen, Toronto Bedside Swallowing Screening Test (both English and Portuguese versions), Sapienza Global Bedside Evaluation of Swallowing and Two‐Step Thickened Water Test. These high‐quality tools were developed primarily for patients with stroke. Only Yale Swallow Protocol was originally tested for heterogeneous populations with stroke, multiple sclerosis, traumatic brain injury, oesophageal surgery, neurosurgery and head‐and‐neck cancer. Conclusions: The results highlight the gap in the unavailability of high‐quality dysphagia screening tool in several emerged high‐risk populations including elderly inpatients, or patients following endotracheal extubation. Further research is needed to determine whether these six tools can be effectively applied across different high‐risk populations in acute‐care settings to screen for cases finding. [ABSTRACT FROM AUTHOR]

Aim: Dysphagia often develops after esophagectomy. The geniohyoid muscle is involved in swallowing movements, but its significance in esophagectomy patients remains unclear. We investigated the relationship of preoperative geniohyoid muscle mass with post‐esophagectomy swallowing function. Method s : We retrospectively analyzed 114 patients who underwent esophagectomy and gastric conduit reconstruction for esophageal malignancy. We evaluated preoperative geniohyoid muscle sagittal cross‐sectional areas (cm2) using computed tomography. Median values for each sex were considered as cutoff values. Dysphagia severity was assessed using the Penetration–Aspiration Scale (PAS) during video‐fluoroscopic swallowing studies performed 7–10 days postoperatively. Results: The cross‐sectional area was significantly larger in males than in females (3.2 ± 0.7 vs. 2.4 ± 0.5, p < 0.01: median in males: 3.2 cm2, and in females: 2.3 cm2). These values were used to define high and low cross‐sectional area groups. The cross‐sectional area correlated positively with grip strength (correlation coefficient (CC) = 0.530) and skeletal muscle index (CC = 0.541). Transthyretin levels (22.4 ± 6.8 vs. 25.4 ± 5.5, p = 0.03) and cross‐sectional area (2.6 ± 0.7 vs. 3.2 ± 0.8, p < 0.01) were significantly lower in patients with (PAS score ≥6; 20%) than in those without aspiration during fluoroscopic swallowing studies. Recurrent laryngeal nerve palsy was significantly more frequent in those with than in those without aspiration during fluoroscopic studies (22% vs. 5%, p = 0.03). In the multivariate analysis, low cross‐sectional area and recurrent laryngeal nerve palsy were both independent risk factors for aspiration during swallowing studies (odds ratio = 3.6, p = 0.03 and odds ratio = 6.6, p = 0.02, respectively). Conclusion: Preoperative geniohyoid muscle mass, evaluated using neck computed tomography, can predict dysphagia after esophagectomy. [ABSTRACT FROM AUTHOR]

Objective: The modified 5‐item frailty index (mFI‐5) is a comorbidity‐based risk stratification tool previously validated in patients undergoing several surgical procedures. This study investigates the association between mFI‐5 score and cricopharyngeal myotomy (CM) complications. Study Design: Retrospective database review. Setting: US hospitals. Methods: The National Surgical Quality Improvement Program database was queried for patients who underwent CM between 2005 and 2018. mFI‐5 score was determined by assigning 1 point for comorbidities including: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent health status. Univariate and multivariable analyses were conducted to determine associations between mFI‐5 score and postoperative complications. Results: A total of 1075 patients undergoing CMs were queried and stratified into the following groups: mFI = 0 (n = 412 [38.3%]), mFI = 1 (n = 452 [42.0%]), and mFI ≥ 2 (n = 211 [19.6%]). Univariate analysis showed association between higher mFI‐5 scores with older age, higher American Society of Anesthesiologists Classification class, obesity, smoking, dyspnea, and systemic sepsis. Higher mFI‐5 was associated with a greater proportion of cumulative surgical complications, cumulative medical complications, pneumonia, myocardial infarction, cumulative morbidity, readmissions, unplanned readmissions, and reoperations. Multivariable analyses found associations between greater mFI‐5 score and cumulative morbidity (odds ratio [OR] = 1.95, confidence interval [CI]: 1.29‐2.96, P =.002), any surgical complication (OR = 1.80, CI: 1.15‐2.79, P =.010), readmission (OR = 1.81, CI: 1.01‐3.26, P =.047), and reoperations (OR = 1.96, CI: 1.04‐3.68, P =.037). Conclusion: Evaluating mFI‐5 can help assess the risk of postoperative complications for patients undergoing CM. Level of Evidence: Level 4. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Background Design Data Sources Methods Results Conclusions To select and obtain relevant evidence for the management of dysphagia after anterior cervical spine surgery both domestically and internationally, clinical quality evaluation indicators were developed based on evidence‐based nursing practices, and obstacles and promoting factors in evidence‐based nursing practices were analysed. This research was aimed to provide a basis for evidence‐based nursing practices to promote standardized management of dysphagia after anterior cervical surgery.Dysphagia is the most common complication following anterior cervical surgery, but there is a lack of standard protocols and guidelines to direct clinical practice.Mixed methods were employed for the translational research to support evidence‐based practice.This study was based on the JBI evidence‐based health care model. According to the ‘6S Evidence Resource Pyramid Model’, we searched from top to bottom.This study is guided by the knowledge to action (KTA) evidence‐based practice model. Utilizing a comprehensive evidence‐based approach and following the 6S evidence resource pyramid model, relevant evidence on the management of swallowing disorders after cervical anterior surgery was selected from both domestic and international sources. Based on the best available evidence, the Delphi expert consultation method was used to establish a management plan for swallowing disorders post‐cervical anterior surgery. Semi‐structured interviews were then conducted to identify barriers to clinical implementation, and clinical quality evaluation indicators, as well as promoting factors, were subsequently developed.Based on the 31 best evidence points, 12 evaluation indicators were developed. The baseline results of these indicators reveal that, apart from evaluation indicator 8, which has a compliance rate of 72.2%, the compliance rates for most of the other indicators are relatively low. Based on the results of the clinical quality review, the following main obstacles were analysed: negative behaviours and attributes, lack of professional knowledge, and lack of standardized management.Effective management of swallowing disorders after cervical spine surgery is crucial for enhancing treatment outcomes, reducing complications, shortening hospital stays and improving patient quality of life. This study identified the best evidence for managing dysphagia post‐anterior cervical surgery and developed corresponding solutions. The next step involves applying these measures in clinical practice to improve patient prognosis and elevate the quality of care. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of hydrogel ingestion training intervention based on empowerment education model in stroke patients with dysphagia. Methods A total of 100 cases of stroke patients with dysphagia admitted to the hospital from January 2022 to October 2023 were selected and divided into the reference group and the intervention group using the randomized number table method, with 50 cases in each group, and 2 cases were dislodged from each of the 2 groups, resulting in a final number of cases of 48 cases in each group. The reference group used conventional education and ingestion training intervention, and the intervention group used hydrogel ingestion training intervention based on empowerment education model on the basis of the reference group and the intervention time of both groups was 1 month. The self-efficacy, self-care ability, leakage-aspiration, swallowing function and quality of life of the patients in the 2 groups were observed before and 1 month after the intervention. Results After inter vention, the General Self-Efficacy Scale (GSES) and Self-Care Competency Assessment (ESCA) scores of the patients in both groups were higher than those before intervention, and the intervention group was higher than that of the reference group.with statistically significant differences (P<0.05); the Rosenbek Leakage-Misaspiration Scale (PAS) scores of the two groups were lower than that before intervention, and the intervention group was lower than that of the reference group, with statistically significant differences (P<0.05); the Functional Oral Intake Scale (FOIS) score and the Dysphagia Quality of Life Scale (EDQOL) scores except for economic status were higher than those before intervention in both groups.and the intervention group's score was higher than that of the reference group, with statistically significant differences (P<0.05). Conclusion Hydrogel ingestion training intervention based on empowerment education model improves self-efficacy and self-care ability of stroke patients with dysphagia, reduces the degree of leakage-misaspiration, and helps to promote the recovery of swallowing function and improve their quality of life. [ABSTRACT FROM AUTHOR]

Background: Relationship between dysphagia and dehydration has not been studied widely. The aim of this study is to determine the frequency of dysphagia and dehydration in geriatric outpatient clinic, to evaluate the relationship between these two conditions. Methods: The cross-sectional study included 1345 patients. Plasma osmolarity (Posm) was calculated using the following formula: [1.86 x (Na + K) + 1.15 x glucose + urea + 14]. Overt dehydration was defined as a calculated Posm of > 300 mmol/L. Eating Assessment Tool (EAT-10) score of ≥ 3 was accepted as dysphagia. Associations between dehydration and dysphagia was evaluated. Results: Mean age was 78 ± 8 years, and 71% were females. Dysphagia was observed in 27% of patients. Dysphagia was associated with a higher number of drug exposure, dependency on basic activities of daily living and geriatric depression (p < 0.05). Overt dehydration was found in 29% of patients with dysphagia, and 21% of patients with no dysphagia (p = 0.002); and dysphagia was significantly associated with overt dehydration mmol/L (OR 1.49, 95% CI 1.13–1.96, p = 0.005) after adjustments for age and sex. In another model, EAT-10 score was found as one of the independent predictors of overt dehydration (OR1.03, 95% CI 1.00-1.06, p = 0.38), along with diabetes mellitus (OR 2.32, 95% CI 1.72–3.15, p < 0.001), chronic kidney disease (OR 3.05, 95% CI 2.24–4.15, p < 0.001), and MNA score (OR 0.97, 95% CI 0.94-1.00, p = 0.031). Conclusion: EAT-10 scale was independently associated with overt dehydration among older adults, as MNA score was. Correction of both dysphagia and malnutrition might improve overt dehydration to a better extent than correction either of these factors alone. Future studies are needed to test cause and effect relationships. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultConclusionTo evaluate current oral care practices in an acute aged care hospital setting, and staff perceptions of the barriers and enablers to delivery of evidence-based oral care practices.A mixed method study comprised of retrospective file audit and cross-sectional survey was conducted within a single acute aged care unit. Medical records of patients aged ≥ 65 years admitted over a 6 month period were retrospectively audited. A clinician survey was used to explore barriers to and enablers of the delivery of oral care practices using the Capability, Opportunity, Motivation, Behaviour (COM-B) questionnaire. Result were analysed using descriptive statistics.Patient file audits (n = 206) found 13.6% (n = 28) of patients had oral care completed, despite 23% (n = 47) of patients being recommended by a speech language pathologist to receive oral care. Staff survey respondents (n = 31) reported they do not have the physical or social opportunities to provide oral care (i.e. adequate resources, time, and social support), however, they were motivated and reported they have the required knowledge and skills to provide oral care.There is a need for implementation strategies to enable an interprofessional response to improve the delivery of evidence-based oral care practices and optimise patient outcomes. [ABSTRACT FROM AUTHOR]

Background Aims Methods and Procedures Outcomes and Results Conclusions and Implications WHAT THIS PAPER ADDS What is already known on this subject What this study adds to existing knowledge What are the clinical implications of this work? Dysphagia services have only recently been formalised within Chinese health services. There has been no comprehensive evaluation of all aspects of dysphagia services practice in China.To provide a profile for the dysphagia practice in China by assessing various facets of dysphagia services.This is a survey study carried out from December 2022 to May 2023 online in China. One hundred fifty‐nine respondents comprising doctors, nurses or therapists involved in the field of dysphagia rehabilitation completed a questionnaire via Sojump. The questionnaire included dichotomous (e.g., yes/no) and multiple‐choice questions related to participants' general information and their provision of dysphagia management services. Results were analysed descriptively and the differences among different levels of hospitals were analysed.Approximately two‐thirds of hospitals (67.9%) started dysphagia services within the last 5 years. A significant difference in the initiation of dysphagia rehabilitation was observed across different hospital levels (χ2  = 32.70;p < 0.001). Routine dysphagia screening was a standard practice in most hospitals (71.7%), with the most frequently employed screening method being the water swallow test (95.6%). Clinical swallowing evaluation emerged as the preferred initial assessment method (80.5%) and the most utilised assessment method (91.8%). Video fluoroscopic swallow study and flexible endoscopic evaluation swallowing were used by 22.7% and 12.6% of respondents. A significant difference was observed in the choice of assessment methods across hospitals of different levels (χ2 = 43.397; p < 0.001). The majority of respondents (53.5%) primarily employed rehabilitation as the main intervention method (76%–100%). Most respondents indicated that they would reevaluate patients after treatment (74.8%) and reported routine follow‐up with patients (60.4%).Despite the relatively recent development of dysphagia management in China, the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. However, the use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. There is a need for policy and resource support in the field of dysphagia rehabilitation in China. Assessment and treatment methods for dysphagia are various across different patients, medical facilities and settings. There has been no comprehensive evaluation of all aspects of dysphagia rehabilitation practice in China. The study assessed various facets of dysphagia rehabilitation in China through an online survey. We found that the relatively recent development of dysphagia management in China, but the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. Variations in practice patterns between hospitals of different levels may be attributed to resource constraints and patient needs. Besides, while rehabilitation exercises are the primary intervention method for dysphagia in China, the assessment largely centres on clinical swallowing evaluation. The use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. The study assessed various facets of dysphagia rehabilitation in China, and the results indicate that the use of instrumental assessments needs to be improved and there is a need for policy and resource support in the field of dysphagia rehabilitation in China. [ABSTRACT FROM AUTHOR]

Several studies support the benefits of biofeedback and Functional Electrical Stimulation (FES) in dysphagia therapy. Most commonly, adhesive electrodes are placed on the submental region of the neck to conduct Electromyography (EMG) measurements for controlling gamified biofeedback and functional electrical stimulation. Due to the diverse origin of EMG activity at the neck, it can be assumed that EMG measurements alone do not accurately reflect the onset of the pharyngeal swallowing phase (onset of swallowing). To date, no study has addressed the timing and detection performance of swallow onsets on a comprehensive database including dysphagia patients. This study includes EMG and BioImpedance (BI) measurements of 41 dysphagia patients to compare the timing and performance in the Detection of Swallow Onsets (DoSO) using EMG alone versus combined BI and EMG measurements. The latter approach employs a BI-based data segmentation of potential swallow onsets and a machine-learning-based classifier to distinguish swallow onsets from non-swallow events. Swallow onsets labeled by an expert serve as a reference. In addition to the F1 score, the mean and standard deviation of the detection delay regarding reference events have been determined. The EMG-based DoSO achieved an F1 score of 0.289 with a detection delay of 0.018 s ± 0.203 s. In comparison, the BI/EMG-based DoSO achieved an F1 score of 0.546 with a detection delay of 0.033 s ± 0.1 s. Therefore, the BI/EMG-based DoSO has better timing and detection performance compared to the EMG-based DoSO and potentially improves biofeedback and FES in dysphagia therapy. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implication for the Profession and Patient Care Patient or Public Contribution This study aimed to establish a comprehensive set of nursing‐sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the ‘structure‐process‐outcome’ model.A Delphi survey.The research utilised a mixed‐methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts.The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90–5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first‐level indicators, 23 second‐level indicators and 52 third‐level indicators.The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes.This study develops targeted NSQIs to improve dysphagia management in ABI patients’ posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training.Expert‐driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient‐centred care. [ABSTRACT FROM AUTHOR]

Background: Achalasia is characterized as an esophageal motility disorder with incomplete relaxation of the lower esophageal sphincter. Achalasia can be associated with abnormal peristalsis and symptoms of dysphagia, acid reflux, and chest pain. The exact pathophysiology of achalasia remains unclear, but it is hypothesized to be due to degeneration of the myenteric plexus. Case presentation: In this case, a 46-year-old Hispanic man presented to the emergency room with a 12-year history of progressive discomfort with swallowing solids and liquids. Due to many years of incomplete follow-up care and lack of understanding of the course of his disease, this patient's symptoms escalated to complete intolerance of oral intake and significant weight loss. He was diagnosed with achalasia during his hospital stay and treated successfully with laparoscopic Heller myotomy. Conclusions: This case discussion illustrates the importance of follow-up care and patient education so that diagnosis and treatment of achalasia are not delayed. [ABSTRACT FROM AUTHOR]

Background: The present study analyzed the relationship between oral motor and cognitive functions in community-dwelling older Korean adults. Methods: Study participants included 113 community-dwelling older adults with a mean age of 73.84 years. Subjects' cognition was assessed using the Korean version of the Montreal Cognitive Assessment, and tongue, cheek, and lip pressures were assessed using the Iowa Oral Performance Instrument. Tongue and masseter thicknesses were measured using an ultrasound device (Sonon, Healcerion, Roseville, CA, USA). The occlusal force was measured using a specialized device (Innobyte, Kube Innovation, Montreal, QC, Canada), and the number of lost teeth was directly verified by a dental hygienist. Results: Results of analysis of cognitive function according to demographic characteristics of older community-dwelling adults revealed a significant difference in cognitive function according to education level and employment status. Cognitive function demonstrated a positive correlation with oral motor function, including pressure on the cheek, lips, and tongue, thickness of the masseter and tongue, occlusal force, number of lost teeth, and age. Hierarchical regression analysis revealed that demographic characteristics and cheek, lip, tongue, and masseter functions did not affect cognition, whereas occlusal force and number of lost teeth significantly affected cognition. In this study, oral motor function, excluding occlusal force and number of lost teeth, did not affect cognition. Conclusions: Future studies, however, are required to analyze the relationship between oral motor function and cognition in older adults with a wider range of such functions. [ABSTRACT FROM AUTHOR]

Esophageal dysphagia is most commonly caused by motility disorders and intrinsic mechanical obstruction. However, extrinsic obstruction, such as pericardial effusion, is rare causes of dysphagia. We present an 89-year-old male with history of Waldenstrom macroglobulinemia, Charcot-Marie-Tooth syndrome, and basal cell carcinoma presenting with generalized weakness, productive cough, shortness of breath, and dysphagia to both solids and liquids. A chest X-ray obtained showed cardiomegaly with suggested central vascular congestion and pulmonary edema. Further imaging with computed tomography (CT) abdomen and pelvis showed a moderate-to-large pericardial effusion. Patient later developed signs and symptoms of cardiac tamponade, requiring urgent pericardiocentesis with removal of 1 L of sanguineous fluid. Up to today, only 6 cases of dysphagia due to pericardial effusion have been described. This case displays another rare case and highlights the importance of recognizing dysphagia as a critical symptom as well as non-gastrointestinal (GI) causes of dysphagia. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions The purpose of this work is to synthesize the latest developments in diagnosis and management of acute and late dysphagia and dysphonia in oral cavity cancer.A literature search was conducted using PubMed, Web of Science, Embase and Google Scholar in May 2024 of articles published between 2021 and 2024. Keywords in the search terms included oral cavity cancer, dysphagia, dysphonia, deglutition, swallowing, voice, oral cavity cancer treatment, oral cavity radiation, chemotherapy, dysgeusia, xerostomia, swallow preservation.Twenty‐seven pertinent studies fit the inclusion criteria. The most common dysphagic complaints following head and neck cancer are trismus, xerostomia, mucositis and dysphagia. Dysphonia, change in voice is reported by half of head and neck cancer survivors. Fibrosis and neuropathy following radiation therapy to the oral cavity, tongue, oropharynx and its surrounding structures is the most common etiology of post‐treatment dysphonia.Oral cavity cancers cause speech and swallowing dysfunction due to both anatomic and post‐treatment changes. These sequalae can be detrimental to the quality of life of the head and neck cancer survivor. For both dysphagia and dysphonia after head and neck cancer early speech and swallow therapy with a Speech Language Pathologist are essential to restoring and maintaining function. [ABSTRACT FROM AUTHOR]

Background: Lateral Medullary Syndrome (LMS) is a posterior circulation stroke (PCS) that has a broad array of manifestations but most classically presents with Horner's syndrome, ipsilateral ataxia, and ipsilateral hyperalgesia. Although dysphagia is also common, isolated and single presentation of this alone is rare and there are only a few case reports of this in the literature. This presentation can bias a clinician's differential diagnosis and delay diagnosis. Case presentation: A previously healthy 53-year-old-male presented with a complaint of dysphagia. He had no PCS symptoms, a National Institute of Health Stroke Scale (NIHSS) of zero, and an otherwise unremarkable neurological exam. Stroke imaging including non-contrast computed tomography (NCCT) scan of his head and computed tomography angiography (CTA) scan of his head and neck revealed no acute abnormalities. He was found to be positive for Influenza A, but otherwise all other etiologies for his dysphagia were worked up, including consultation with other specialty services, without resolve. Two days later, the patient subsequently developed new right sided sensory deficits and left sided Horner's syndrome, in which a magnetic resonance imaging (MRI) scan of his head revealed an acute infarct of the left lateral medulla with likely thrombus in the left posterior inferior cerebellar artery (PICA). Conclusions: PCS is frequently missed due to the often-vague symptoms and reassuring negative imaging. This case highlights the variability of presentations that ED physicians may encounter. Nonetheless, a high index of suspicion for PCS should be maintained even in young patients without risk factors. Lastly, dysphagia is never normal, and this case demonstrates the need to reconsider neurogenic origin when other causes have been ruled out. [ABSTRACT FROM AUTHOR]

Background Objectives Method Results Conclusions When re‐learning a motor skill, practicing a variety of treatment targets promotes error processing and the exploration of motor control strategies, which initially disrupts accuracy during training (motor performance), but ultimately enhances generalization, retention, and transfer (motor learning). Cough skill training (CST) is feasible and efficacious to improve cough strength; however, previous studies have used the same practice target during training.Our goal was to examine the impact of CST with variable practice on motor performance, motor learning, and respiratory system adaptations.The study was a prospective three‐visit single group design. Twenty individuals with Parkinson's disease (PD) and concomitant dysphagia and dystussia completed two sessions of CST involving three randomized practice targets. Cough, lung volume, and airway clearance outcomes were assessed before and after treatment sessions with long‐term retention evaluated after 1 month.Peak expiratory flow rate improved after CST with variable practice for voluntary single (β = 0.35 L/s) and sequential (β = 0.22 L/s) cough, which were maintained after 1 month without treatment. The ability to expel material from the upper airway demonstrated a small magnitude of improvement (β = −1.87%). During CST, participants altered lung volume based on the treatment target and lung volume decreased during reflex cough after completing CST.Individuals with PD demonstrated improvements in several aspects of motor learning after two sessions of CST with variable practice. Increasing lung volume may not be an implicit strategy to upregulate voluntary cough strength in this treatment paradigm. The findings support the need for larger investigations exploring the potential benefits of this CST approach. [ABSTRACT FROM AUTHOR]

Background: Dysphagia, a common complication of acute stroke, is associated with increased mortality and morbidity. Acupuncture, a widely used swallowing therapy in China, has been suggested as an effective therapy for treating Post-Stroke Dysphagia (PSD) by recent meta-analyses and guidelines. The use of resting-state functional Magnetic Resonance Imaging (rs-fMRI) and Diffusion Tensor Imaging (DTI) could explore the change of regional spontaneous neural activity, functional relationships between brain regions, and white matter connectivity patterns after acupuncture intervention for PSD. This trial aims to evaluate the efficacy of acupuncture treatment for PSD and explore its central mechanism by neuroimaging. Methods/design: This randomized controlled trial will recruit 40 PSD patients. All patients will be randomized to either the Real Acupuncture (RA) or Sham Acupuncture (SA) group by a ratio of 1:1. All patients will receive immediate acupuncture treatment in the MRI scanning room, followed by four weeks of long-term acupuncture treatment. The primary outcomes are the rs-fMRI and DTI indicators, which will be evaluated after the immediate and long-term acupuncture treatment. The secondary outcomes are the scales that assess the efficacy, including the Functional Oral Intake Scale (FOIS), Water Swallowing Test (WST), Swallowing Quality Of Life Questionnaire (SWAL-QOL), and National Institute of Health Stroke Scale (NIHSS). The modified version of the Massachusetts General Hospital Acupuncture Sensation Scale (M-MASS) and fMRI sensation record table will also be evaluated. Discussion: This protocol presents the design of a randomized, single-blind trial that will evaluate the efficacy and explore the neural plasticity of acupuncture treatment for PSD. This trial will deepen our insight into the clinical value of acupuncture for PSD and initially probe into the time-dosage-effect mechanism of acupuncture. Trial registration numbers: Chinese Clinical Trial Registry (www.chictr.org.cn) ChiCTR2300067480. This study was registered on 9th January 2023. [ABSTRACT FROM AUTHOR]

The first-line management of cervical dystonia (CD) symptoms is intramuscular injection of botulinum toxin type A (BoNTA). However, a comparison of safety among BoNTAs is difficult because, per regulatory authorities, units of BoNTA activity are not interchangeable. Dysphagia and muscle weakness are widely considered two key adverse events to monitor closely in the treatment of CD. This integrated analysis compared the safety of BoNTAs approved for CD in the US by evaluating relationships between the incidence of dysphagia and muscle weakness in prescribing information and the core neurotoxin content. Coefficients The coefficients of determination (R2) and trendlines were estimated via regression-based lines of best fit. Adverse drug reaction (ADR) rates were strongly correlated with core neurotoxin amounts for conventional BoNTAs (slope coefficients: dysphagia = 0.048, R2 = 0.74; muscle weakness = 0.096, R2 = 0.82). The published ADR rates at approved doses for conventional BoNTAs were higher compared with DaxibotulinumtoxinA (DAXI; DAXXIFY®, Revance Therapeutics, Inc., Nashville, TN, USA) by core neurotoxin content. The use of a core neurotoxin amount was found to be an effective method for comparing the safety of BoNTA products. Current clinical trials suggest that DAXI, a novel BoNTA formulation, provides a potentially wider safety margin compared with other approved BoNTAs for CD. The lower amount of core neurotoxin administered at approved doses compared with conventional BoNTAs may explain low on-target ADRs like muscle weakness, whereas reduced diffusion from the injection site is thought to be responsible for low off-target ADRs like dysphagia. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify the temporal and spatial parameters of videofluoroscopic swallowing study (VFSS) that could predict the recovery of swallowing function in subacute stroke patients. Methods: We included 102 patients who were admitted to the Department of Rehabilitation Medicine between 2019 and 2022. Patients were classified into good and poor prognosis groups according to whether they had restored prestroke swallowing function or were able to consume sufficient nutrition via oral feeding to meet their body's needs. Univariate and multivariate regression analyses were used to identify the predictors. Calibration and discrimination were tested using the Hosmer–Lemeshow test and area under the curve (AUC), respectively. Results: Of the 102 included patients, 51 had a good prognosis for swallowing function within 6 months of onset. The final multivariate regression model included three significant factors: laryngeal closure duration (LCD) (OR: 0.998; 95% CI: 0.996–0.999; p < 0.05), maximum width of the upper esophageal sphincter opening (MWUESO) (OR: 1.251; 95% CI: 1.073–1.458; p < 0.05), and pharyngeal residual grade (PRG) (p < 0.05). The shorter LCD and larger MWUESO were positive predictors of good swallowing function outcomes, while higher PRG was a negative predictor of good outcomes. The AUC for PRG, MWUESO, and LCD were 0.767 (p < 0.05), 0.738 (p < 0.05), and 0.681 (p < 0.05), respectively. Conclusion: Identifying prognostic factors for the recovery of swallowing function in patients with poststroke dysphagia is essential for developing treatment strategies. The findings of this study may provide an important reference for developing appropriate therapeutic interventions to promote the recovery of swallowing function in stroke patients. [ABSTRACT FROM AUTHOR]

Purpose: One major consequence of lung transplantation is the development of oropharyngeal dysphagia. This systematic review aims to appraise and synthesize the available evidence of the use of instrumental assessments to outline the characteristics of post‐lung transplant dysphagia. Methods: Following the identification of appropriate search terms for the question, a literature search was conducted in PubMed, Scopus, and the Health and Medical Collection of Proquest Research Library and included records between inception and September 14, 2023. Search strategies included the use of text words and subject headings (e.g., MeSH and Index terms) related to (1) dysphagia or swallowing (swallow*, deglutition disorder*), (2) lung transplant (lung transplant*, post‐operative, post‐lung), and (3) complications (adverse effects, *complications, treatment outcome). Results: The literature search strategy yielded a total of 883 studies from the electronic database search, with no additional records identified through other sources. After the removal of duplicates (n = 96), a total of 787 studies were screened through title and abstracts which eliminated 775 studies. Six studies were ultimately included in the systematic review. The selected articles included patients who underwent lung transplantation and all but one study utilized a retrospective design. A lack of transparency regarding instrumental evaluation protocols (videofluoroscopic [VFSS] and Flexible Endoscopic Evaluation of Swallowing [FEES]) including the number and bolus types used during the instrumental evaluations appeared as a theme in the studies included. The Penetration‐Aspiration Scale (PAS) was systematically utilized to measure dysphagia safety outcome. Handling of the PAS scale was not consistent across studies, however penetration or aspiration ranged from 52.4% up to 100%. Additionally, silent aspiration rates ranged from 14.2% to 61.9%. Conclusions: This review sought to describe the post‐operative swallowing function and its physiological parameters following lung transplantation. We examined the results reported and the methods utilized in obtaining these results in the existing literature. Limited reporting practices for physiological parameters were found, however the airway invasion was reported in all studies with variation in degrees of swallowing safety related deficits, with PAS being the most widely used scale to describe airway invasion depth and response. Future studies exploring dysphagia outcomes post‐lung transplant should comment on the altered physiological mechanisms of the swallow to further expand on the physiological deficits observed following transplantation in this group and allow for treatment planning. Level of evidence: Level 1. [ABSTRACT FROM AUTHOR]

Background: Older adults suffer from increased rates of dysphagia and dysphonia, both of which have a profound effect on quality of life and are often underdiagnosed. We sought to better understand the prevalence of these complaints and the potential utility of a patient‐reported screening program in a geriatrics clinic. Methods: Using an IRB‐approved cross‐sectional survey and retrospective cohort design, we recruited participants from a population of new patients seeking care at an academic geriatrics clinic. We used three validated questionnaires to assess self‐reported dysphagia, dysphonia, and pill dysphagia: the Eating‐Assessment Tool‐10 (EAT‐10), the Voice Handicap Index‐10 (VHI‐10), and the PILL‐5. Patients who screened positive on any questionnaire were offered referral to a laryngologist for additional evaluation. Patients who screened positive on the PILL‐5 were also offered referral to our geriatric pharmacist. Results: Among our 300 patients surveyed, the mean age was 76 (SD 8.46). A total of 82 (27.3%) patients screened positive (73 on EAT‐10, 10 on PILL‐5, 13 on VHI‐10) and were offered referral, of which 36 accepted. These positive screening patients took more prescription medications (p =.024) and had a higher GDS score (p <.001) when compared to the patients who screened negative. Conclusions: Many new patients seeking generalized care at our center screened positively for dysphagia and/or dysphonia on validated questionnaires. Geriatric patients may benefit from integrating screening for these disorders to identify the need of further evaluation. It is unknown if these survey tools are appropriate in a non‐otolaryngology clinic. Level of evidence: III. [ABSTRACT FROM AUTHOR]

An apparatus simulating the swallowing process of liquid foods was constructed using a flow channel. In the channel, a circular cylindrical obstruction was fixed to serve as an epiglottis in the mesopharynx. The apparatus was designed with an adjustable gate for flow control to represent the processes of healthy swallowing and dysphagia. The parameters considered were the holding time and flow resistance controlled by the gate, which were assumed to indicate the swallowing reflex and power, respectively. When a Newtonian liquid with relatively low viscosity was used, the flow experiment performed using the apparatus under conditions of shorter holding time and larger flow resistance successfully reproduced a phenomenon similar to aspiration in a patient with dysphagia. In addition to a Newtonian liquid with high viscosity, non-Newtonian liquids thickened to various concentrations using commercially available thickeners were used. In flow experiments with these test liquids, the efficacy for aspiration prevention was inferred based not only on the viscosity of the liquid but also its elasticity, depending on its viscosity. [ABSTRACT FROM AUTHOR]

Background: Severe dysphagia poses a significant challenge for clinicians regarding feeding tube choices, practices, and timing due to a lack of evidence‐based guidance. Objectives: To assess national clinical practices and opinions on gastrostomy use in patients with atypical parkinsonian syndromes (APS) across the UK. Methods: Online survey was administered to clinicians and allied health professionals regarding availability of services, current use, perceived advantages, and problems associated with gastrostomy insertion. Results: We received responses from 47 respondents across 12 UK centers, including 44 clinicians specialized in APS. Consensus was observed regarding primary indications for gastrostomy insertion and circumstances justifying avoidance of the procedure. Limitations in recommending gastrostomy due to insufficient evidence on safety and outcomes, survival and quality of life were identified. Widespread agreement on delays in gastrostomy discussions was highlighted as a challenge in optimizing patient care, together with variability in current practices and concerns over the lack of a standardized gastrostomy pathway, emphasizing the need for further research to address existing evidence gaps. Conclusion: This multi‐center survey highlights agreement among clinicians on key aspects of indication, challenges, and limitations such as delayed decision‐making and the absence of standardized pathways regarding the timing, method, and overall approach to gastrostomy insertion in APS. This study identified next steps to facilitate a more structured approach to future research toward a consensus on best practices for gastrostomy in APS. Addressing these challenges is crucial for enhancing patient outcomes and overall care quality in APS. [ABSTRACT FROM AUTHOR]

Objectives: Dysphagia, an impairment in swallowing, is a frequent and debilitating complication for patients undergoing anterior cervical discectomy and fusion (ACDF), a common surgical treatment for degenerative cervical myelopathy (DCM). This retrospective study aimed to assess the efficacy of modified tracheal traction exercise (MTTE) in alleviating postoperative dysphagia and improving clinical outcomes for these patients. Methods: A cohort of 143 patients underwent multilevel fusions, equally distributed between MTTE (n = 75) and traditional tracheal traction exercise (TTTE) (n = 68) groups. Demographic parity was observed in gender distribution, age averages (MTTE: 51.43 ± 11.25 years; TTTE: 52.35 ± 10.43 years), body mass index (BMI), comorbidities, fusion segments, and preoperative hospitalization days. Surgical duration differences were assessed. Clinical outcomes, dysphagia incidence, blood loss, postoperative complications, Cervical Japanese Orthopedic Association (c‐JOA) scores, and functional outcome swallowing scale evaluations were conducted. Univariate and multivariate logistic regression analyses were used to explore factors influencing dysphagia. Results: Modified tracheal traction exercise demonstrated advantages with a significantly lower dysphagia incidence (25.33% vs. 44.12%, p = 0.018), reduced blood loss (102.03 ± 17.04 vs. 113.46 ± 14.92, p < 0.001), shorter surgical durations (159.04 ± 9.82 vs. 164.41 ± 12.22 min, p = 0.004), and fewer postoperative complications (choking cough, cerebrospinal fluid leakage, and hoarseness). Postoperative c‐JOA scores at 2 and 6 weeks favored MTTE, but no significant differences were observed at 12 and 24 weeks. Functional outcome swallowing scale evaluations favored MTTE with significantly higher percentages of "normal" and lower incidences of "mild" and "moderate dysphagia" at various postoperative intervals compared to TTTE. Factors significantly associated with dysphagia included MTTE, age, and BMI according to logistic regression analyses. Conclusion: Modified tracheal traction exercise demonstrates superior short‐term outcomes in multilevel ACDF, showcasing reduced dysphagia incidence, blood loss, and specific postoperative complications. Notably, factors contributing to dysphagia, including operation technique and patient‐related variables, emphasize the significance of MTTE and patient characteristics in optimizing postoperative outcomes in multilevel ACDF procedures. [ABSTRACT FROM AUTHOR]

Introduction: RefluxStop is an implantable device for laparoscopic surgical treatment of gastroesophageal reflux disease (GERD) to restore and maintain lower esophageal sphincter and angle of His anatomy without encircling and putting pressure on the food passageway, thereby avoiding side effects such as dysphagia and bloating seen with traditional fundoplication. This study reports the clinical outcomes with RefluxStop at 4 years following implantation of the device. Methods: A prospective, single arm, multicenter clinical investigation analyzing safety and effectiveness of the RefluxStop device in 50 patients with chronic GERD. Results: Available data are presented for 44 patients at 4 years with the addition of three patients at 3 years carried forward. At 4 years, median GERD-HRQL score was 90% reduced compared to baseline. Two patients (2/44) used regular daily proton pump inhibitors (PPIs) despite subsequent 24-h pH monitoring off PPI therapy yielding normal results. There were no device-related adverse events (AEs), esophageal dilations, migrations, or explants during the entire study period. AEs reported between 1 and 4 years were as follows: one subject with heartburn and a pathologic pH result with device positioned too low at surgery; one subject with dysphagia, thus, 46/47 patients reported no dysphagia-related AEs between years 1 and 4. Two patients (2/47) were dissatisfied with treatment despite normal 24-h pH monitoring, of whom one had manometry-verified dysmotility at 6 months, indicating dissatisfaction for reasons other than acid reflux. Conclusion: These results confirm the excellent and already published 1-year results as stable in the long-term, supporting the safety and effectiveness of the RefluxStop device in treating GERD for over 4 years. GERD-HRQL score, pH testing, and PPI usage indicate treatment success without dysphagia or gas-bloating and only minimal incidence of other AEs. This favorably low rate of AEs is likely attributable to RefluxStop's dynamic physiologic interaction and non-encircling nature. [ABSTRACT FROM AUTHOR]

Background: Palliation to late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC) continues to be a challenge. Intermittent oro-esophageal tube feeding (IOE) is an emerging enteral nutrition mode that can address nutrition and quality of life issues related to nasogastric tube feeding (NGT). Objectives: This study aims to investigate the effect of IOE versus NGT in late dysphagia after radiotherapy for NPC. Methods: This randomized controlled study included 82 NPC survivors with late dysphagia after radiotherapy. The subjects were randomized divided into the IOE and NGT groups (n1 = n2 = 41). Both groups received standard-of-care rehabilitation. Enteral nutrition supports were administered through IOE or NGT accordingly. This study lasted 2 weeks for each participant. The primary outcome was nutritional status including albumin, hemoglobin, total serum protein, and body mass index. The secondary outcomes were (i) the functional oral intake scale (FOIS), (ii) the penetration-aspiration scale (PAS), (iii) oral transit time (OTT), (iv) hyoid pause time (HPT), (v) pharyngeal transport time (PTT), and (vi) swallowing-quality of life (SWAL-QoL). Results: Three cases quitted the study halfway and there were no significant baseline differences between the IOE (n = 40) and NGT (n = 39) groups. Both time and group effects were significant in all nutritional indicators. The time effect was significant in the FOIS levels, OTT and PTT, while the group effect was not. Either time or group effect were insignificant in the PAS levels and HPT. Both group and time effects were significant in the SWAL-QoL total scores (zGroup = 5.080, P < 0.001; zTime = 18.005, P < 0.001). The significance of time and group effects varied across different dimensions of the SWAL-QoL. Conclusions: Rehabilitation interventions can improve swallowing function among NPC survivors with late dysphagia after radiotherapy. In this population who received standard-of-care rehabilitation, IOE is more conducive to the improvement of nutritional status, and swallowing-related quality of life. Trial registration: ClinicalTrials.gov Identifier: NCT06301763. [ABSTRACT FROM AUTHOR]

To validate the Manipal Bedside Swallowing Screening Test (MBSST) for assessing aspiration in individuals with tracheostomy using Video Fluoroscopic Swallow Study (VFSS). A total of 53 tracheostomized participants were screened for aspiration at bedside and VFSS across different consistencies. Penetration Aspiration Scale (PAS) was used to substantiate the severity of aspiration if present. The test demonstrated both high sensitivity (91%; 95% confidence interval = 70.8–98.9) and diagnostic accuracy (96%; 95% confidence interval = 87.0-99.5) for detecting aspiration in individuals with tracheostomy. The Manipal Bedside Swallowing Screening Test is an easy to administer tool that has sufficient sensitivity to detect aspiration in individuals with tracheostomy. The MBSST will be an easy to administer tool and will help in screening for aspiration at bedside without any instrumental examination. [ABSTRACT FROM AUTHOR]

Organophosphorus and carbamate Insectiside is common in Asia–Pacific region consisting of 63% of the Global death. Organophosphorus and Carbamate poisoning can lead into different complications in the respiratory,digestive,neurological aspects and maybe fatal in certain cases.Besides medical management of the same,early rehabilitation is also required to manage different kinds of neurological aspects caused due to Organophosphorus and carbamate poisoning. The study was done to introspect the early intervention in swallowing and speech therapy in organophosphorus and carbamate poisoning individual,as a part of management besides medical intervention. A 19 years old female reported to the hospital with history of consuming organophos and carbamate insecticide with the intention of self harming causing cardiac arrest and as diagnosed as Flaccid Dysarthria with Oro-Pharyngeal Dysphagia when assessed with diagnostic tools respectively. Early speech and swallowing intervention was provided and introspected using MASA which showed improvement in scores during the therapeutic intervention and was statistically analysed using linear regression analysis. The result showed the improvement in MASA scores (the slope of the best fit) and proved that MASA scores improved significantly (slope = 14.3, p < 0.05) over time as the therapy sessions proceeded. The regression model was also significant (p < 0.05). The motor-speech therapeutic intervention provided improvement in the kinematics of oro-motor skills along with improvement in intelligibility of speech. This study concludes that early intervention in managing speech and swallowing abilities in Dysarthria and Dysphagia is helpful besides medical intervention in such cases. [ABSTRACT FROM AUTHOR]

Paragangliomas are neoplasms of neural crest cells. They represent less than 1% of head and neck tumors. Laryngeal paragangliomas constitute a smaller fraction of head and neck paragangliomas. Malignant laryngeal paragangliomas with metastasis are extremely rare tumors. Definitive treatment includes complete surgical excision with maximum preservation of laryngeal function. Here, we report a rare case of a 55 year old woman who was diagnosed with recurrent laryngeal paraganglioma along with neck metastasis. A complete excision of mass with a lateral pharyngotomy approach along with neck dissection followed by chemotherapy was done. [ABSTRACT FROM AUTHOR]

High-resolution esophageal manometry [HRM] has become the gold standard for the evaluation of esophageal motility disorders. It is unclear whether there are HRM differences in diagnostic outcome based on regional or geographic distribution. The diagnostic outcome of HRM in a diverse geographical population of Mexico was compared and determined if there is variability in diagnostic results among referral centers. Consecutive patients referred for HRM during 2016–2020 were included. Four major referral centers in Mexico participated in the study: northeastern, southeastern, and central (Mexico City, two centers). All studies were interpreted by experienced investigators using Chicago Classification 3 and the same technology. A total of 2293 consecutive patients were included. More abnormal studies were found in the center (61.3%) versus south (45.8%) or north (45.2%) P  < 0.001. Higher prevalence of achalasia was noted in the south (21.5%) versus center (12.4%) versus north (9.5%) P  < 0.001. Hypercontractile disorders were more common in the north (11.0%) versus the south (5.2%) or the center (3.6%) P.001. A higher frequency of weak peristalsis occurred in the center (76.8%) versus the north (74.2%) or the south (69.2%) P  < 0.033. Gastroesophageal junction obstruction was diagnosed in (7.2%) in the center versus the (5.3%) in the north and (4.2%) in the south p.141 (ns). This is the first study to address the diagnostic outcome of HRM in diverse geographical regions of Mexico. We identified several significant diagnostic differences across geographical centers. Our study provides the basis for further analysis of the causes contributing to these differences. [ABSTRACT FROM AUTHOR]

The degenerative motor neuron disorder amyotrophic lateral sclerosis (ALS) frequently leads bulbar symptoms like dysarthria, dysphagia, and sialorrhea, in approximately one-third of cases being the initial symptom. Throughout the disease, more than two-thirds of ALS patients experience dysphagia, regardless of the region of onset. In this review, we aimed to offer an updated overview of dysphagia and sialorrhea in ALS, covering its diagnosis, monitoring, and treatment in clinical practice. Regular assessment of dysphagia and sialorrhea during each patient visit is essential and should be a standard aspect of ALS care. Early discussion of potential treatments such as high-calorie diets or percutaneous endoscopic gastrostomy (PEG) is crucial. Furthermore, this review highlights and discusses potential areas for improvement in both clinical practice and research. [ABSTRACT FROM AUTHOR]

Background: The prognostic impact of dysphagia in multiple system atrophy (MSA) remains controversial. This study aimed to investigate the relationship between dysphagia severity and survival in MSA and to elucidate whether this impact differs between MSA-cerebellar ataxia (MSA-C) and MSA-parkinsonism (MSA-P). Methods: This retrospective study included 297 patients with MSA: 251 met criteria for clinically established MSA and 46 for clinically probable MSA. Among them, 171 had MSA-C and 126 had MSA-P. We evaluated symptomatic dysphagia within 3 years of onset and quantified dysphagia severity using the Hyodo score (0 to 12) through fibreoptic endoscopic evaluation of swallowing (FEES) and clinical features, including autonomic dysfunction and vocal cord paralysis. Patients were followed up until death or tracheostomy, and survival factors were analysed using the log-rank test and multivariate Cox proportional hazards model. Results: Ninety patients developed symptomatic dysphagia within 3 years of onset, and 75 were evaluated for dysphagia severity using FEES. Survival from onset was shorter in patients with dysphagia within 3 years compared to those without (median: 4.2 years vs. 7.3 years; p < 0.001). Symptomatic dysphagia within 3 years of onset was an independent predictor of shorter survival in the multivariate Cox analysis. While the Hyodo score was higher in MSA-P than in MSA-C patients (p = 0.048), the Hyodo score was associated with survival in both MSA-C and MSA-P patients (log-rank p < 0.001 and p = 0.046, respectively). Conclusion: Symptomatic dysphagia within 3 years of onset predicts shorter survival in MSA-C and MSA-P patients. [ABSTRACT FROM AUTHOR]

Aim: Low body mass index (BMI) and poor oral health are prevalent among older stroke patients and associated with adverse outcomes. However, their combined impact on functional recovery after stroke remains unclear. This study investigated the synergistic effects of low BMI and poor oral health on activities of daily living (ADL) independence, swallowing function, and cognitive status in post‐stroke older patients. Methods: A retrospective cohort study was conducted on 708 hospitalized post‐stroke patients aged ≥70 years. Low BMI was defined as <20 kg/m2, and poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating oral problems. The primary outcome was ADL independence (Functional Independence Measure‐motor score >78) at discharge. Secondary outcomes included swallowing level (Food Intake Level Scale) and cognitive status (Functional Independence Measure‐cognition score). Multiple regression analyses were performed to examine the associations of low BMI, poor oral health, and their combination with outcomes of interest. Results: The coexistence of low BMI and poor oral health was independently associated with lower odds of achieving ADL independence (odds ratio 0.130, 95% confidence interval [CI] 0.023–0.718), worse swallowing level (B = −0.878, 95% CI −1.280 to −0.476), and poorer cognitive status (B = −1.872, 95% CI −2.960 to −0.784) at discharge, after adjusting for confounders. The combined impact was stronger than either condition alone. Conclusions: The coexistence of low BMI and poor oral health exerts a synergistic negative impact on functional recovery in older stroke inpatients. Comprehensive interventions integrating nutritional support, oral management, and rehabilitation are crucial to optimizing outcomes in this vulnerable population. Geriatr Gerontol Int 2024; 24: 1045–1052. [ABSTRACT FROM AUTHOR]

Omaveloxolone (SKYCLARYS®) is approved for the treatment of Friedreich ataxia (FA) in patients aged ≥16 years in the United States and European Union (EU). The recommended dosage is 150 mg administered orally once daily as three 50‐mg capsules. However, some patients with FA may have oropharyngeal dysphagia or difficulty swallowing whole capsules; therefore, alternate method(s) of administration are needed. A Phase 1 clinical study in 32 healthy volunteers evaluated the relative bioavailability, safety, and tolerability of a single dose of omaveloxolone when capsule contents were sprinkled on and mixed in applesauce compared to when taken as intact capsules. Palatability when sprinkled on and mixed in applesauce was assessed with a questionnaire. After a single 150‐mg dose, the peak and overall exposures of omaveloxolone were similar irrespective of administration method, with the 90% CIs of the geometric least squares mean ratio (%) for maximum plasma concentration (Cmax), AUC0‐t, and AUC0‐∞ within the 80% to 125% reference intervals. Omaveloxolone was absorbed more slowly as intact capsules (median tmax, 10 h) compared with sprinkled capsule contents over applesauce (median tmax, 6 h). With chronic daily administration of omaveloxolone to treat FA, the 4‐h difference in tmax is not considered clinically relevant. Sprinkled omaveloxolone capsule contents on applesauce were well tolerated, with acceptable palatability and no serious adverse events. Given the similar systemic exposure when capsules were swallowed whole, sprinkling omaveloxolone capsule contents on and mixing in applesauce is a feasible alternative method of administering omaveloxolone and has been included in both the United States and EU prescribing information. [ABSTRACT FROM AUTHOR]