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Narasimhan SV, Divyashree D. Adaptation and Validation of the Sydney Swallow Questionnaire into Kannada (KSSQ). Dysphagia 2025; 40:454-463. [PMID: 39249512 DOI: 10.1007/s00455-024-10748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/06/2024] [Indexed: 09/10/2024]
Abstract
Self-rating questionnaires are necessary to quantify the impairment and the impact of impairment on the quality of life, provided that these questionnaires are delivered in the patient's native language. There are no questionnaires to assess the symptom severity of oropharyngeal dysphagia in Kannada-speaking individuals. The Sydney Swallow Questionnaire (SSQ) is one such explicit tool to assess the symptoms of dysphagia, especially among patients with oropharyngeal dysphagia. The SSQ is a simple and easy-to-understand questionnaire. Therefore, the present study aimed to adapt and validate the SSQ in Kannada. English version of the SSQ was translated to Kannada and was administered to two groups of native Kannada-speaking participants - Group 1 included 53 participants (66.49 + 12.65 years) diagnosed with oropharyngeal dysphagia, and Group 2 included 53 age and gender-matched native Kannada speakers with normal swallowing ability with no history and symptoms of swallowing disorders. Cronbach's alpha was used to assess the test-retest reliability. Internal consistency was assessed using the split-half correlation. The concurrent validity of the Kannada version of SSQ (KSSQ) was measured by determining the correlation between the total scores of KSSQ and the Kannada version of Dysphagia Handicap Index (DHI). The discriminant validity was assessed by comparing the KSSQ scores between the participants of both groups. The results indicated that the KSSQ had excellent test-retest reliability, strong internal consistency, and good concurrent and discriminant validity. Therefore, it was inferred that the KSSQ is a valid and reliable tool for assessing the symptoms of dysphagia, especially among Kannada-speaking patients with oropharyngeal dysphagia.
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Affiliation(s)
| | - Dhanashekar Divyashree
- Department of Speech & Language Pathology, JSS Institute of Speech & Hearing, Mysore, Karnataka, India
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Dall'Oglio GP, De Lima Alvarenga EH, Haddad L, Aires MM, Abrahão M. Profile of oropharyngeal swallowing in healthy Brazilian adults and older adults. Braz J Otorhinolaryngol 2025; 91:101494. [PMID: 39307053 PMCID: PMC11447311 DOI: 10.1016/j.bjorl.2024.101494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/12/2024] [Accepted: 08/03/2024] [Indexed: 10/06/2024] Open
Abstract
OBJECTIVES To describe the findings of Fiberoptic Endoscopic Examination of Swallowing (FEES) in asymptomatic young and older adults, comparing results across different age groups. Additionally, this study aims to test the Eating Assessment Tool (EAT-10) as an instrument to identify dysphagia risk. METHODS A prospective cross-sectional observational analysis was conducted on a sample of individuals aged 20 and above, asymptomatic for dysphagia, stratified by age groups. The EAT-10 questionnaire was completed, and the FEES was employed to assess oropharyngeal swallowing function. Various parameters, including salivary stasis, swallowing reflex trigger, swallowing sequence, residue, penetration, and aspiration were blindly analyzed by two otolaryngologists. RESULTS A total of 184 participants were included, with a mean age of 44.7 ± 18.5 years. There was good to excellent agreement between examiners for FEES parameters. The EAT-10 score ≥3 suggested dysphagia risk in 7.6% (n = 14) of the sample, with no association with age or any FEES parameter. Individuals aged ≥80 years presented more residue (50%; n = 5/10) compared to younger individuals (11.5%; n = 20/174; p = 0.039). Salivary stasis was found exclusively in individuals aged ≥60 years (n = 5/39; 12.8%; p = 0.027). Age did not influence on the swallowing reflex trigger, swallowing sequence, penetration, and aspiration. Penetration was observed in 4.9% (n = 9) of subjects and aspiration occurred in 0.5% (n = 1) of subjects, with no statistical significance in age groups. CONCLUSION Age does not have a linear influence on swallowing in healthy adults and elderly people. However, individuals aged ≥80 years showed a higher prevalence of residue, and individuals aged ≥60 years showed a higher prevalence of salivary stasis, suggesting an increased risk or presence of dysphagia. Other FEES parameters were not influenced by age. These findings provide valuable insights into the nuanced dynamics of swallowing across different age groups, emphasizing the importance of age-specific considerations in dysphagia assessment. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Giovana Piovesan Dall'Oglio
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
| | - Eliézia Helena De Lima Alvarenga
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Leonardo Haddad
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Mateus Morais Aires
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade de Pernambuco (UPE), Faculdade de Ciências Médicas, Recife, PE, Brazil; Universidade Federal de Pernambuco (UFPE), Hospital das Clínicas, Recife, PE, Brazil
| | - Márcio Abrahão
- Universidade Federal de São Paulo (UNIFESP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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Alaei S, Wang Y, Liu Y, Schiele J, Deng R, Shiller D, Marroum P, Menon R, Salem AH. Venetoclax Clinical Pharmacokinetics After Administration of Crushed, Ground or Whole Tablets. Clin Ther 2024; 46:752-758. [PMID: 38782609 DOI: 10.1016/j.clinthera.2024.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Venetoclax is a potent, orally bioavailable BCL-2 inhibitor used in the treatment of some hematological malignancies. Crushing tablets may be necessary to help with the administration of venetoclax to patients with swallowing difficulties or patients requiring nasogastric tube feeding. The study was conducted to assess the bioavailability of crushed and finely ground venetoclax tablets relative to whole tablets. METHODS An open-label, randomized, 3-way, crossover study in 15 healthy adult females was conducted. Venetoclax tablets were administered orally in a crushed, ground or intact form on Day 1 of each period with water following a high-fat breakfast. Pharmacokinetic samples were collected up to 72 hours postdosing. FINDINGS The crushed and ground tablets met the bioequivalence criteria (0.80-1.25) relative to the intact tablets with respect to area under the concentration-time curve to time of the last measurable concentration (AUCt) and to infinite time (AUCinf) but exhibited a slightly lower maximum plasma concentration (Cmax). This was not considered clinically significant as only venetoclax overall exposure (AUC) has been shown to correlate with clinical efficacy. There was no change in the physical appearance and the evaluated physicochemical properties of crushed and ground venetoclax tablets after 72 hours of storage at 25°C/60% relative humidity. IMPLICATIONS Crushing or grinding venetoclax tablets before administration could be considered as a viable alternative method of administration for patients who have difficulty swallowing whole venetoclax tablets or patients requiring nasogastric tube feeding. CLINICALTRIALS GOV IDENTIFIERS NCT05909553, registered June 12, 2023.
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Affiliation(s)
| | | | | | | | - Rong Deng
- Genentech Inc., South San Francisco, California
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Narasimhan SV, Panarath A. An Evaluation of Psychometric Properties of EAT-10: A Malayalam Version. Dysphagia 2024; 39:586-592. [PMID: 38032481 DOI: 10.1007/s00455-023-10639-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023]
Abstract
The Eating Assessment Tool (EAT-10) is a 10-item self-administered questionnaire that assesses the severity of dysphagia symptoms, the impact of dysphagia on quality of life and treatment efficacy. EAT-10 has been adapted into several languages, including Malayalam. However, the information on the psychometric properties of EAT-10 MALAYALAM is not known. Therefore, the study aimed to evaluate the psychometric properties of the EAT-10 MALAYALAM. EAT-10 MALAYALAM questionnaire was administered to two groups of native Malayalam-speaking participants. Group 1 consisted of a total of 110 participants (76 males and 34 females) with a mean age of 52.9 ± 13.5 years diagnosed with oropharyngeal dysphagia. Group 2 consisted of 110 age and gender-matched healthy participants with normal swallow function and no history and symptoms of swallowing disorders. The test-retest reliability was assessed using Spearman's rank correlation coefficient between the test and the retest scores; internal consistency was assessed using Cronbach's alpha, and Known groups validity was evaluated by comparing the EAT-10 MALAYALAM scores between the participants of both groups. The results of Spearman's correlation coefficient showed 0.99, indicating that the EAT-10-MALAYALAM has excellent test-retest reliability. The Cronbach's alpha was 0.94, indicating strong internal consistency. Mann-Whitney U test showed significant differences in the scores of EAT-10-MALAYALAM between the participants of both groups. Therefore, it was inferred that EAT-10-MALAYALAM had good known groups validity. The EAT-10-MALAYALAM is a valid and reliable tool for screening Malayalam-speaking dysphagia patients.
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Affiliation(s)
| | - Afna Panarath
- JSS Institute of Speech & Hearing, Mysore, Karnataka, India
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Verma H, Kumar S, Sharma A, Mishra R, Nagamani B. Swallowing dysfunction between the community-living older adults with and without comorbid conditions using Patient-Reported Outcome Measures (PROM). Geriatr Nurs 2024; 56:64-73. [PMID: 38301436 DOI: 10.1016/j.gerinurse.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The present study aimed to investigate older adults' perspective on their swallowing physiology using a PROM tool. The study further explored the swallowing issues among older adults with and without comorbid conditions. METHOD One hundred twenty-two (122) participants participated in the e-survey. A questionnaire was developed to assess the swallowing deficits among older adults, and Eating Assessment Tool-10 (EAT-10) was administered to assess the PROM. RESULTS The results revealed that 40% of older adults with comorbid conditions had EAT-10 scores greater than 3, suggesting swallowing deficits. A significant difference was observed between the two groups with respect to swallowing deficits, as reported on EAT-10. CONCLUSION Based on the results, it can be delineated that swallowing deficits emerge with aging. More of older adults with comorbid conditions reported swallowing deficits in comparison to those without comorbid conditions. Hence, their nutritional and health status gets compromised, leading to poor quality of life.
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Affiliation(s)
- Himanshu Verma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabh Kumar
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Sharma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshani Mishra
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Banumathy Nagamani
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Lindgren U, Hedberg-Oldfors C, Pullerits R, Lindberg C, Oldfors A. Inclusion body myositis with early onset: a population-based study. J Neurol 2023; 270:5483-5492. [PMID: 37498322 PMCID: PMC10576680 DOI: 10.1007/s00415-023-11878-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Inclusion body myositis (IBM), an inflammatory myopathy with progressive weakness without efficient treatment, typically presents after 45 years of age and younger patients are sparsely studied. METHODS In a population-based study during a 33-year period, 142 patients with IBM were identified in western Sweden. Six patients fell outside the European Neuromuscular Centre 2011 criteria for IBM due to young age at symptom onset, verified by a muscle biopsy < 50 years of age. These were defined as early-onset IBM and included in this study. Medical records, muscle strength, comorbidities, muscle biopsies, and nuclear- and mitochondrial DNA were examined and compared with patients with IBM and age matched controls from the same population. RESULTS The median age at symptom onset was 36 (range 34-45) years and at diagnosis 43 (range 38-58) years. Four patients were deceased at a median age of 59 (range 50-75) years. The median survival from diagnosis was 14 (range 10-18) years. The prevalence December 31 2017 was 1.2 per million inhabitants and the mean incidence 0.12 patients per million inhabitants and year. The mean decline in quadriceps strength ± 1 standard deviation was 1.21 ± 0.2 Newton or 0.91 ± 0.2% per month and correlated to time from diagnosis (p < 0.001). Five patients had swallowing difficulties. All patients displayed mitochondrial changes in muscle including cytochrome c oxidase deficiency and the mitochondrial DNA mutation load was high. CONCLUSIONS Early-onset IBM is a severe disease, causing progressive muscle weakness, high muscle mitochondrial DNA mutation load and a reduced cumulative survival in young and middle-aged individuals.
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Affiliation(s)
- Ulrika Lindgren
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Neuromuscular Center, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Carola Hedberg-Oldfors
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rille Pullerits
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christopher Lindberg
- Neuromuscular Center, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Oldfors
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Law T, Wei Y, Wong KHY, Hu Y, Tong MCF, Lee KYS. Feasibility and self-perceived effectiveness of an online training program on dysphagia in residential aged care homes in mainland China. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1903-1911. [PMID: 37066521 DOI: 10.1111/1460-6984.12878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND With a rapidly aging population in mainland China, dysphagia has become one of the common geriatric disorders which creates a huge demand on speech and language therapists (SLTs). The major challenge is the shortage of SLTs in China. In addition, frontline practitioners in mainland China may not be well equipped with the knowledge and practical skills in dysphagia management due to lack of systematic training and the work nature. AIMS This study evaluates the self-perceived effectiveness and feasibility of an online training program that aims to enhance the self-assessed knowledge and skills of SLTs providing dysphagia care in residential aged care homes. METHODS AND PROCEDURES Sixteen SLTs working in a residential aged care homes in mainland China attended a three-hour pilot online training program which consists of didactic lecture and practical skills activity components. A total of 10 participants completed an online questionnaire one month after the training to evaluate the feasibility and effectiveness of this online training program. OUTCOMES AND RESULTS The preliminary results demonstrated participants' self-perception of high training effectiveness in theoretical knowledge and practical skills. A majority of the participants perceived that the training enhanced their theoretical knowledge and all of them perceived that they acquired practical skills. All respondents were satisfied with the online training approach. They also highlighted the advantage and challenges of the online training approach. CONCLUSIONS AND IMPLICATIONS Online training is an effective and feasible approach for theoretical knowledge and practical skills transfer in SLT training and could ultimately benefit the delivery of services for individuals with dysphagia in mainland China. WHAT THIS PAPER ADDS What is already known on the subject Previous studies have shown that online training approach is as effective as face-to-face training in increasing professional knowledge. Online training programs may be more cost efficient and time efficient when compared with face-to-face training. What this study adds The present study provided preliminary evidence to support the feasibility and effectiveness of using online training on dysphagia for speech and language therapists working in residential aged care homes in mainland China. What are the clinical implications of this work? From the participants' perception, online training approach is effective and feasible in delivering theoretical knowledge and practical skills. It may be a better training approach for mainland China considering the lack of expertise and accessibility to training.
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Affiliation(s)
- Thomas Law
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yifeng Wei
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kay H Y Wong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yunyi Hu
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michael C F Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kathy Y S Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- The Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong SAR, China
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Abstract
Dysphagia is an important clinical symptom that increases in prevalence with age. Both oropharyngeal and esophageal processes can contribute to dysphagia, and these can be differentiated with a careful history. Neuromuscular processes are more prevalent than structural causes in oropharyngeal dysphagia, therefore, investigation should start with a modified barium swallow. In contrast, structural processes dominate in esophageal dysphagia, and endoscopy can offer biopsy and therapy by way of dilation. Manometry is performed for esophageal dysphagia when no structural etiology is found. Specific management of dysphagia is dependent on the etiology and mechanism of dysphagia.
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Affiliation(s)
- Edward Hurtte
- Division of Gastroenterology, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Jocelyn Young
- United Health Services Hospitals, Johnson City, NY, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Khayyat YM, Abdul Wahab RA, Natto NK, Al Wafi AA, Al Zahrani AA. Impact of anxiety and depression on the swallowing process among patients with neurological disorders and head and neck neoplasia: systemic review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023; 59:75. [DOI: 10.1186/s41983-023-00674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/23/2023] [Indexed: 09/25/2023] Open
Abstract
Abstract
Background
Dysphagia is associated with depression and anxiety due to the severity, impact of symptoms itself or secondary to the underlying cause. This is more recognizable to brain diseases that has consequences common to the neural supply of the swallowing act and the cognition and behavior. Limited data are available to explore, quantitate and monitor these neurological outcomes. Our aim of this research to review the literature pertinent to depressive disorders, anxiety, and/or the quality of life (QoL) and psychological well-being. Search of Medline and Google Scholar databases for relevant articles had revealed a total of 1568 citations; 30 articles met the inclusion and exclusion criteria.
Results
Data about the direct effect of dysphagia on psychiatric aspects are limited. Studies of the relationship between severity of dysphagia and depressive symptoms demonstrated that several evaluation tools are available for objective and subjective assessment. The severity and progression of dysphagia was significantly associated with increased depressive symptoms.
Conclusion
Dysphagia is associated with and positively correlated to depression and anxiety scores observed in Parkinson disease (PD), multiple sclerosis (MS) and stroke. Similar association is observed in patients with head and neck cancer, tongue cancer and oral cancer. A bidirectional positive correlation exists with a vicious circle that loops between dysphagia and psychological disease. Moreover, the severity of dysphagia shows correlation with depression and/or anxiety scores (Fig. 1, Graphical abstract).
Graphical Abstract
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Lin CW, Chiang TY, Chen WC, Chiu LW, Su YC, Lin HC, Chang CT. Is Postextubation Dysphagia Underestimated in the Era of COVID-19? A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:935-943. [PMID: 36842159 DOI: 10.1002/ohn.168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To investigate the incidence rate of postextubation dysphagia (PED) in patients with COVID-19, as well as relative factors potentially influencing the clinical course of dysphagia. DATA SOURCES Six databases including PubMed, MEDLINE, Embase, ScienceDirect, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched with no restriction on the language. REVIEW METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted and cross-examined among 3 of the authors. The random-effects model was adopted for the statistical synthesis. The percentage and 95% confidence interval (CI) were adopted as the effect measurements of the PED incidence rate. Subgroup analyses, sensitivity analyses, and metaregression were also performed to identify the heterogeneity among the studies. RESULTS A total of 594 patients were enrolled and analyzed from the 10 eligible studies. The weighted incidence of PED in patients with COVID-19 was 66.5% (95% CI: 49.7%-79.9%). Age was the potential factor influencing the incidence rate after heterogeneity was adjusted by the metaregression analysis. CONCLUSION Compared to the current evidence reporting only 41% of the non-COVID patients experienced PED, our study further disclosed that a higher 66.5% of COVID-19 patients suffered from PED, which deserves global physicians' attention. With the association between COVID-19 and dysphagia having been more clearly understood, future clinicians are suggested to identify intubated patients' risk factors earlier to strengthen PED care programs in the era of COVID-19.
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Affiliation(s)
- Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ting-Yi Chiang
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Ching Chen
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Wen Chiu
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yung-Chung Su
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Division of Laryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Sleep Center, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chun-Tuan Chang
- Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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Thu Hien NT, Thong TH, Tung LT, Khoi VH, Thu Hoai DT, Tinh TT, Van Huy N, Kien VD. Dysphagia and associated factors among patients with acute ischemic stroke in Vietnam. Ann Med Surg (Lond) 2022; 84:104887. [DOI: 10.1016/j.amsu.2022.104887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
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McSweeney MD, Stewart I, Richardson Z, Kang H, Park Y, Kim C, Tiruthani K, Wolf W, Schaefer A, Kumar P, Aurora H, Hutchins J, Cho JM, Hickey AJ, Lee SY, Lai SK. Stable nebulization and muco-trapping properties of regdanvimab/IN-006 support its development as a potent, dose-saving inhaled therapy for COVID-19. Bioeng Transl Med 2022; 8:e10391. [PMID: 36248234 PMCID: PMC9537933 DOI: 10.1002/btm2.10391] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/16/2022] [Accepted: 07/27/2022] [Indexed: 01/21/2023] Open
Abstract
The respiratory tract represents the key target for antiviral delivery in early interventions to prevent severe COVID-19. While neutralizing monoclonal antibodies (mAb) possess considerable efficacy, their current reliance on parenteral dosing necessitates very large doses and places a substantial burden on the healthcare system. In contrast, direct inhaled delivery of mAb therapeutics offers the convenience of self-dosing at home, as well as much more efficient mAb delivery to the respiratory tract. Here, building on our previous discovery of Fc-mucin interactions crosslinking viruses to mucins, we showed that regdanvimab, a potent neutralizing mAb already approved for COVID-19 in several countries, can effectively trap SARS-CoV-2 virus-like particles in fresh human airway mucus. IN-006, a reformulation of regdanvimab, was stably nebulized across a wide range of concentrations, with no loss of activity and no formation of aggregates. Finally, nebulized delivery of IN-006 resulted in 100-fold greater mAb levels in the lungs of rats compared to serum, in marked contrast to intravenously dosed mAbs. These results not only support our current efforts to evaluate the safety and efficacy of IN-006 in clinical trials, but more broadly substantiate nebulized delivery of human antiviral mAbs as a new paradigm in treating SARS-CoV-2 and other respiratory pathologies.
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Affiliation(s)
- Morgan D. McSweeney
- Inhalon Biopharma IncResearch Triangle ParkNorth CarolinaUSA
- Mucommune LLCResearch Triangle ParkNorth CarolinaUSA
| | - Ian Stewart
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Zach Richardson
- Inhalon Biopharma IncResearch Triangle ParkNorth CarolinaUSA
- Mucommune LLCResearch Triangle ParkNorth CarolinaUSA
| | - Hyunah Kang
- Biotechnology Research InstituteCelltrion IncIncheonRepublic of Korea
| | - Yoona Park
- Biotechnology Research InstituteCelltrion IncIncheonRepublic of Korea
| | - Cheolmin Kim
- Biotechnology Research InstituteCelltrion IncIncheonRepublic of Korea
| | - Karthik Tiruthani
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Whitney Wolf
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Alison Schaefer
- UNC/NCSU Joint Department of Biomedical EngineeringUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
| | - Priya Kumar
- Department of Anesthesiology, School of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Harendra Aurora
- Department of Anesthesiology, School of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Jeff Hutchins
- Inhalon Biopharma IncResearch Triangle ParkNorth CarolinaUSA
| | - Jong Moon Cho
- Biotechnology Research InstituteCelltrion IncIncheonRepublic of Korea
| | | | - Soo Young Lee
- Biotechnology Research InstituteCelltrion IncIncheonRepublic of Korea
| | - Samuel K. Lai
- Inhalon Biopharma IncResearch Triangle ParkNorth CarolinaUSA
- Mucommune LLCResearch Triangle ParkNorth CarolinaUSA
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of PharmacyUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
- UNC/NCSU Joint Department of Biomedical EngineeringUniversity of North Carolina‐Chapel HillChapel HillNorth CarolinaUSA
- Department of Microbiology and Immunology, School of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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13
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Yamada M, Ishikawa A, Muramatsu S, Furuishi T, Onuki Y, Fukuzawa K, Yonemochi E. Study of Orally Disintegrating Tablets Using Erythritol as an Excipient Produced by Moisture-Activated Dry Granulation (MADG). Pharmaceuticals (Basel) 2022; 15:ph15081004. [PMID: 36015152 PMCID: PMC9415806 DOI: 10.3390/ph15081004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Moisture-activated dry granulation (MADG) is an eco-friendly granulation method that uses a small amount of water and insoluble excipients to absorb moisture. MADG is expected to improve productivity and reduce costs. Erythritol, an excipient used for preparing orally disintegrating tablets (ODTs), has poor tabletability and is difficult to form into tablets by conventional methods, such as high-shear granulation (HSG) and direct compression. In this study, we optimized the manufacturing conditions for ODTs to improve the tabletability of erythritol using MADG. The disintegration time of tablets made using the MADG method was approximately one-tenth that of those made using the HSG method, and the hardness was approximately 1.4 times higher. Moreover, MADG could delay disintegration and improve tabletability. We further attempted to optimize the manufacturing conditions using MADG, particularly in terms of the amount of water used. The disintegration time increased as the amount of added water increased. Moreover, water absorption tests revealed that capillary wetting decreased as the amount of water added increased, but the initial wetting did not change. These results suggested that the disintegration time was prolonged because of the increase in granule density and decrease in capillary wetting with the increase in the amount of added water. The hardness of the tablets increased because of the easy deformation of the granules after the addition of up to 3% water; however, when more than 3% water was added, the hardness decreased because of the aggregation of the granules with the excess water. Finally, two-dimensional maps of the effect of the amount of added water and water activity indicated that tablets with a hardness of ≥80 N and a disintegration time of ≤15 s could be produced by adjusting the amount of added water to within the range of 2.2–3.3% and water activity to 0.3–0.53. These results indicate that MADG can improve the tabletability of erythritol and be used for the granulation of ODTs. Tablets with appropriate hardness and disintegration properties can be produced by adjusting the water content to approximately 2.7% and the water activity to approximately 0.4 when producing ODTs with MADG.
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Affiliation(s)
- Mizuki Yamada
- Department of Physical Chemistry, School of Pharmacy and Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku 142-8501, Tokyo, Japan
| | - Agata Ishikawa
- Department of Physical Chemistry, School of Pharmacy and Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku 142-8501, Tokyo, Japan
| | - Shun Muramatsu
- Department of Physical Chemistry, School of Pharmacy and Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku 142-8501, Tokyo, Japan
| | - Takayuki Furuishi
- Department of Physical Chemistry, School of Pharmacy and Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku 142-8501, Tokyo, Japan
- Correspondence: (T.F.); (E.Y.)
| | - Yoshinori Onuki
- Laboratory of Pharmaceutical Technology, School of Pharmacy and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama-shi 930-0194, Toyama, Japan
| | - Kaori Fukuzawa
- Department of Physical Chemistry, School of Pharmacy and Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku 142-8501, Tokyo, Japan
- Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita 565-0871, Osaka, Japan
| | - Etsuo Yonemochi
- Department of Physical Chemistry, School of Pharmacy and Pharmaceutical Sciences, Hoshi University, 2-4-41 Ebara, Shinagawa-ku 142-8501, Tokyo, Japan
- Correspondence: (T.F.); (E.Y.)
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14
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Casey V, Perry A, Conway R. Intraoral Swallow Pressure Profiles: General Features and Aids to Categorization. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00682-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose
The primary goal of this study was to establish a normative data set representing intraoral time series swallow pressure profiles for healthy adults using a novel wearable intraoral pressure sensing system, OroPress, developed to help with dysphagia (swallow disorder) clinical screening.
Methods
Swallow intraoral pressure-time profiles for 35 healthy adults (17 male, 18 female) swallowing water ($$3 \times 5\, {\text{cm}^3}$$
3
×
5
cm
3
; $$3 \times 10\, {\text{cm}^3}$$
3
×
10
cm
3
) and custard ($$3 \times 5\, {\text{cm}^3}$$
3
×
5
cm
3
) boluses ($$N=9 \times 35 = 315$$
N
=
9
×
35
=
315
) were recorded using OroPress.
Results
General swallow profile traits are identified to characterise an effective, efficient swallow. A profile-specific swallow envelope function is devised which in combination with profile metrics, provides a simple means of categorizing swallows as effective or impaired.
Conclusion
The swallow profile data trace with superimposed and colour coded peaks, envelope function and related swallow metrics provides a simple human readable graphic to aid the real-time instrumented identification of subjects warranting more in-depth clinical assessment. It may also prove useful in the selection of training set profiles for machine learning and other analysis tools which could improve the discriminatory capabilities of intraoral pressure measurement in dysphagia diagnostics.
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15
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Abstract
Background: Among patients seen by palliative care, dysphagia is prevalent and can lead to disturbing symptoms and challenges in medical decisions for patients and families. Case: Our patient, AP, an 88-year-old woman with a history of thyroid cancer and esophageal dysmotility, was nearing end of life. She wanted nothing more than to eat her chocolate cake in peace. This shocked her family and also presented multiple ethical and logistical issues for the medical team caring for her during an acute admission for hypoxia. Discussion: This case presents an opportunity to: review strategies for evaluating and diagnosing dysphagia; appraise evidenced based approach to the palliative management of dysphagia; and promote the education of families and staff regarding palliative options for care. Conclusion: Palliative care professionals can be instrumental in educating patients, families, other clinicians, including swallowing therapists, on how to enhance comfort and quality of life among patients with dysphagia.
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Affiliation(s)
- Amanda Warren
- Department of Communication Sciences and Disorders, Emerson College, Boston, Massachusetts, USA
| | - Mary K Buss
- Department of Ambulatory Palliative Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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16
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Swallowing difficulty in the older adults: presbyphagia or dysphagia with sarcopenia? Int J Rehabil Res 2021; 44:336-342. [PMID: 34545853 DOI: 10.1097/mrr.0000000000000494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Oropharyngeal dysphagia is an important cause of mortality and morbidity in older adults. It has been reported in the literature that 11-68% of older adults experience swallowing difficulties. This study aimed to investigate the presence of dysphagia in older adults, whether this dysphagia is related to age (presbyphagia) or sarcopenia by comparing it with adults. Two hundred twenty-five patients were included in this cross-sectional study. The participants were divided into two groups by age as 'adults' and 'older adults'. Sarcopenia, dysphagia and malnutrition evaluations were performed. Older adult and adult groups were compared in terms of malnutrition, dysphagia and sarcopenia. The number of patients with dysphagia was significantly higher (P = 0.007) in the older adults. In older adults, all sarcopenic evaluation parameters were found significantly lower than adults (P < 0.05). The number of older adults with malnutrition was significantly lower in patients with normal swallowing (P < 0.05). The swallowing difficulty can be detected in older adults even if it does not cause any complaint. While most swallowing disorders may be due to age-related changes, about a third may be accompanied by sarcopenia.
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17
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Jowhar D, Farooq U, Acharya A, Kouanda A, Imam Z, Ahmed N, Henry C, Saleem N, Munroe C, Howden CW. Efficacy of empiric esophageal dilation in patients with non-obstructive dysphagia: systematic review and meta-analysis. Scand J Gastroenterol 2021; 56:1490-1495. [PMID: 34477033 DOI: 10.1080/00365521.2021.1971288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Empiric esophageal dilation is frequently performed for non-obstructive dysphagia. Studies evaluating its efficacy have reported conflicting results. In this meta-analysis, we have evaluated the efficacy of esophageal dilation in the management of non-obstructive dysphagia. METHODS We reviewed several databases from inception to 26 May 2021 to identify randomized controlled trials (RCTs) and observational studies that evaluated the role of empiric esophageal dilation for non-obstructive dysphagia. Our outcomes of interest were clinical success (improvement in dysphagia after dilation) and difference in post-operative dysphagia score between groups. For categorical variables, we calculated pooled odds ratios (OR) with 95% confidence intervals (CI); for continuous variables, we calculated standardized mean difference (SMD) with 95% CI. Data were analyzed using a random effects model. We used GRADE framework to ascertain the quality of evidence. RESULTS We included 4 studies (3 RCTs and one observational) with 243 patients; there were 133 treated with empiric dilation and 110 controls. We found no significant difference in clinical success (OR (95% CI) 1.91 (0.89, 4.08)) or post-procedure dysphagia score between groups (SMD (95% CI) 0.38 (-0.37, 1.14)). Our findings remained consistent on subgroup analysis including RCTs only. Quality of evidence ranged from low to very low based on GRADE framework. CONCLUSIONS Our meta-analysis does not support the use of empiric esophageal dilation in patients with non-obstructive dysphagia. More studies are required to confirm these findings.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Muhammad Ali Khan
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wade Lee-Smith
- Mulford Health Sciences Library, University of Toledo, Toledo, OH, USA
| | - Sachit Sharma
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Dawit Jowhar
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Umer Farooq
- Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, IL, USA
| | - Ashu Acharya
- Department of Medicine, University of Toledo, Toledo, OH, USA
| | - Abdul Kouanda
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Zaid Imam
- Division of Gastroenterology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Nazneen Ahmed
- Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Collin Henry
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nasir Saleem
- Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Craig Munroe
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Colin W Howden
- Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, USA
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18
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Järvenpää P, Kuuskoski J, Pietarinen P, Markkanen-Leppänen M, Freiberg H, Ruuskanen M, Rekola J, Ilmarinen T, Kinnari TJ, Autio TJ, Penttilä E, Muttilainen MS, Laaksonen A, Oksanen L, Geneid A, Aaltonen LM. Finnish Version of the Eating Assessment Tool (F-EAT-10): A Valid and Reliable Patient-reported Outcome Measure for Dysphagia Evaluation. Dysphagia 2021; 37:995-1007. [PMID: 34518933 PMCID: PMC9345834 DOI: 10.1007/s00455-021-10362-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022]
Abstract
Our aim was to validate a Finnish version of the Eating Assessment Tool (F-EAT-10) for clinical use and to test its reliability and validity in a multicenter nationwide study. Normative data were acquired from 180 non-dysphagic participants (median age 57.0 years, 62.2% female). Dysphagia patients (n = 117, median age 69.7 years, 53.0% female) referred to fiberoptic endoscopic evaluation of swallowing (FEES) completed F-EAT-10 before the examination and after 2 weeks. Patients underwent the 100-ml water swallow test (WST) and FEES was evaluated using the following three scales: the Yale Pharyngeal Residue Severity Rating Scale, Penetration-Aspiration Scale, and the Dysphagia Outcome Severity Scale. An operative cohort of 19 patients (median age 75.8 years, 57.9% female) underwent an endoscopic operation on Zenker's diverticulum, tight cricopharyngeal muscle diagnosed in videofluorography, or both. Patients completed the F-EAT-10 preoperatively and 3 months postoperatively. The cut-off score for controls was < 3 (sensitivity 94.0%, specificity 96.1%) suggesting that ≥ 3 is abnormal. Re-questionnaires for test-retest reliability analysis were available from 92 FEES patients and 123 controls. The intraclass correlation coefficient was excellent for the total F-EAT-10 score (0.93, 95% confidence interval 0.91-0.95). Pearson correlation coefficients were strong (p < 0.001) for each of the questions and the total score. Internal consistency as assessed by Cronbach's alpha was excellent (0.95). Some correlations between findings in FEES and 100-ml WST with F-EAT-10 were observed. The change in subjective symptoms of operative patients paralleled the change in F-EAT-10. F-EAT-10 is a reliable, valid, and symptom-specific patient-reported outcome measure for assessing dysphagia among Finnish speakers.
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Affiliation(s)
- Pia Järvenpää
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, P.O. Box 263, FI-00029, Finland.
| | - Jonna Kuuskoski
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Petra Pietarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, P.O. Box 263, FI-00029, Finland
| | - Mari Markkanen-Leppänen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, P.O. Box 263, FI-00029, Finland
| | - Hanna Freiberg
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Miia Ruuskanen
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Jami Rekola
- Department of Otorhinolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Taru Ilmarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, P.O. Box 263, FI-00029, Finland
| | - Teemu J Kinnari
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, P.O. Box 263, FI-00029, Finland
| | - Timo J Autio
- Department of Otorhinolaryngology - Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
| | - Elina Penttilä
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Marika S Muttilainen
- Department of Rehabilitation and Psychosocial Support, Tampere University Hospital and Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Annika Laaksonen
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University, Hospital and University of Helsinki, Helsinki, Finland
| | - Lotta Oksanen
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University, Hospital and University of Helsinki, Helsinki, Finland
| | - Ahmed Geneid
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University, Hospital and University of Helsinki, Helsinki, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, P.O. Box 263, FI-00029, Finland
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19
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Björkman K, Pietarinen P, Mäkitie A, Markkanen-Leppänen M. Fibre-optic endoscopic evaluation of swallowing as a second-stage diagnostic tool in 117 patients with dysphagia. Clin Otolaryngol 2021; 46:1106-1109. [PMID: 33787059 DOI: 10.1111/coa.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/07/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kajsa Björkman
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petra Pietarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mari Markkanen-Leppänen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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20
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SEREL ARSLAN S, DEMIR N, KARADUMAN AA. Deglutition disorders from the perspective of healthcare professionals in Turkey. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.812290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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21
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Cisternas D, Taft T, Carlson DA, Glasinovic E, Monrroy H, Rey P, Hani A, Ardila-Hani A, Leguizamo AM, Bilder C, Ditaranto A, Varela A, Agotegaray J, Remes-Troche JM, Ruiz de León A, Pérez de la Serna J, Marin I, Serra J. Validation and psychometric evaluation of the Spanish version of Brief Esophageal Dysphagia Questionnaire (BEDQ): Results of a multicentric study. Neurogastroenterol Motil 2021; 33:e14025. [PMID: 33169488 DOI: 10.1111/nmo.14025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The recently developed Brief Esophageal Dysphagia Questionnaire (BEDQ) evaluates esophageal obstructive symptoms. Its initial evaluation showed strong psychometric properties. The aims of this study were to (a) translate and validate an international Spanish version of BEDQ and (b) evaluate its psychometric properties in a large Hispano-American sample of symptomatic individuals. METHODS A Spanish BEDQ version was performed by Hispano-American experts using a Delphi process and reverse translation. Patients were prospectively recruited from seven centers in Spain and Latin America among individuals referred for high-resolution manometry (HRM). Patients completed several scores: Hospital Anxiety & Depression Scale (HADS), Eckardt score (ES), Gastroesophageal Reflux Questionnaire (GERDQ), and the BEDQ. Standardized psychometric analyses were performed. KEY RESULTS A total of 426 patients were recruited. Spanish BEDQ showed excellent reliability (Cronbach's alpha = 0.91). Factor analysis confirmed its unidimensional character. Moderate significant correlations between BEDQ and other symptomatic scores were found, suggesting sufficient convergent validity. Patients with abnormal or obstructive HRM findings scored significantly higher when compared to normal or non-obstructive findings, respectively. Using a cutoff of 10, BEDQ showed a sensitivity of 65.38% and a specificity of 66.21% and an area under the curve of 0.71 for obstructive or major manometric diagnosis. CONCLUSIONS AND INFERENCES A widely usable Spanish BEDQ version has been validated. We confirm its excellent psychometric properties in our patients, confirming the appropriateness of its use in different populations.
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Affiliation(s)
- Daniel Cisternas
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile
| | - Tiffany Taft
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dustin A Carlson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Esteban Glasinovic
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile
| | - Hugo Monrroy
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Rey
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Albis Hani
- San Ignacio Hospital, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Andres Ardila-Hani
- San Ignacio Hospital, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Claudio Bilder
- Escuela de Medicina, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | - Andres Ditaranto
- Escuela de Medicina, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | - Amanda Varela
- Escuela de Medicina, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | - Joaquin Agotegaray
- Escuela de Medicina, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | | | | | | | - Ingrid Marin
- Motility and Functional Gut Disorders Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University Hospital Germans Trias i Pujol, Badalona, Spain.,Universitat Autonoma de Barcelona, Badalona, Spain
| | - Jordi Serra
- Motility and Functional Gut Disorders Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University Hospital Germans Trias i Pujol, Badalona, Spain.,Universitat Autonoma de Barcelona, Badalona, Spain
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22
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Madhavan A. Preclinical Dysphagia in Community Dwelling Older Adults: What Should We Look For? AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:833-843. [PMID: 33684295 DOI: 10.1044/2020_ajslp-20-00014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Purpose Traditionally, etiology of dysphagia is thought to be related to multiple medical diagnoses including stroke, head and neck cancer, degenerative neurological conditions, and so forth. However, community dwelling older adults (CDOA) can present with dysphagia in the absence of any specific etiology. The purpose of this research was to develop a multidimensional framework to help identify those CDOA at risk for dysphagia of nonspecific etiology. Method Pertinent literature was examined to identify support for the proposed framework and to explain how the various elements support the model. Results Several factors that are not traditionally thought to be associated with dysphagia can both initiate and exacerbate symptoms of swallowing difficulties. Swallowing difficulties may be subtle and underreported. Monitoring for symptoms related to preclinical dysphagia may be helpful for early identification. Conclusions Dysphagia in CDOA is complex and multidimensional. Clinicians working with older adults will benefit from considering elements described in this multidimensional framework to better understand the etiology of swallowing deficits and improve management. Supplemental Material https://doi.org/10.23641/asha.14150078.
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Affiliation(s)
- Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park
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23
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Choung RS, Saito YA, Schleck CD, Harmsen WS, Zinsmeister AR, Murray JA, Talley NJ. The Natural History of Chronic Unexplained Gastrointestinal Disorders and Gastroesophageal Reflux During 20 Years: A US Population-Based Study. Mayo Clin Proc 2021; 96:563-576. [PMID: 33673910 PMCID: PMC8127806 DOI: 10.1016/j.mayocp.2020.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/23/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To explore the natural history of chronic unexplained gastrointestinal (GI) symptoms and to determine the longitudinal trends of prevalence during a 20-year period in a single US community. METHODS Between January 1, 1990, and December 31, 2009, valid self-report questionnaires of GI symptoms were mailed to randomly selected cohorts of a community. The study used respondents who answered questions on 1 or more of 3 surveys (initial, 1990-1992; second, 2003-2004; and third, 2008-2009). The trends of prevalence of GI symptoms over time were analyzed in responders who completed 3 surveys, and the natural history or transition was evaluated. RESULTS The overall prevalence of major symptom groupings including gastroesophageal reflux disease was consistent among residents in a community on 3 survey time points (1990-1992, 2003-2004, and 2008-2009). The transitions of GI symptoms were common in 228 patients who responded to all 3 surveys; only 29% had the same symptom category in 3 surveys; otherwise, symptoms changed over time, resolving, recurring, or transitioning to another disorder. Observed proportions of symptom transitions were significantly different from expected during 20 years (P<.001). Higher non-GI somatic symptom scores were significantly associated with both symptom transitions (odds ratio, 3.9; 95% CI, 1.38 to 10.77) and having sustained symptoms (odds ratio, 12.7; 95% CI, 4.62 to 34.90). CONCLUSION The overall population prevalence of chronic unexplained GI symptoms is stable, but in individuals, transitions seem to be the rule. As these various GI syndromes appear to be so intimately interconnected, the common underlying pathogenesis may account for a major subgroup of chronic unexplained GI disorders.
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Affiliation(s)
- Rok Seon Choung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Yuri A Saito
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Cathy D Schleck
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - William S Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Alan R Zinsmeister
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, New Lambton, New South Wales, Australia.
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Mehraban-Far S, Alrassi J, Patel R, Ahmad V, Browne N, Lam W, Jiang Y, Barber N, Mortensen M. Dysphagia in the elderly population: A Videofluoroscopic study. Am J Otolaryngol 2021; 42:102854. [PMID: 33482586 DOI: 10.1016/j.amjoto.2020.102854] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/22/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the impact of age and underlying comorbid conditions on swallowing in elderly patients with dysphagia. METHODS Charts of consecutive patients aged >64 studied by Videofluoroscopic swallowing study (VFSS) between 2010 and 2018 at our institution were reviewed (n = 731). Patients were categorized based on age into young old (aged 65-74), older old (aged 75-84) and oldest old (aged 85+). The underlying comorbidities and VFSS results were compared between different age groups. RESULTS Dysphagia was more likely to be caused by presbyphagia (p < 0.01) and dementia (p < 0.0001) in the oldest old, whereas, head and neck cancers (p < 0.0001) were more common in the young old cohort. In the absence of organic disease (e.g. cancer, stroke, dementia), aging was associated with prolonged oral transit time (OTT) (p < 0.05) and aspiration after swallow (p < 0.05). Compared to those with presbyphagia, patients with organic disease were more likely to have delayed pharyngeal swallow response (p < 0.05) and aspiration during swallow (p < 0.005). CONCLUSION There are significant differences in the etiology of dysphagia between different age cohorts amongst the dysphagic elderly population. In addition, organic diseases affect swallowing differently than does mere aging. The rate of prolonged OTT and post-swallow aspiration increase with aging in patients with presbyphagia, likely due to age-related sarcopenia of the swallowing muscles. Whereas, those with organic diseases have a higher rate of delayed pharyngeal swallow response and aspiration during swallow, likely due to sensorineural impairment. Thus, it is important to view the elderly as a heterogeneous group when evaluating patients with dysphagia.
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Affiliation(s)
- Sina Mehraban-Far
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA.
| | - James Alrassi
- SUNY Downstate Health Sciences University, Department of Otolaryngology, Brooklyn, NY, USA
| | - Rushil Patel
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Verdah Ahmad
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Nicholas Browne
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Wai Lam
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Yujie Jiang
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Nathaniel Barber
- Stony Brook University Hospital, Department of Surgery, Stony Brook, NY, USA
| | - Melissa Mortensen
- Albany Medical College, Department of Otolaryngology, Albany, NY, USA
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Park MI. [Approach of Dysphagia]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:57-63. [PMID: 33632995 DOI: 10.4166/kjg.2021.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 11/03/2022]
Abstract
Dysphagia has been reported to be relatively common and seems to be increased in Korea. Dysphagia can be classified as oropharyngeal dysphagia or esophageal dysphagia. In patients with swallowing difficulties, it is important to determine whether the dysphagia is oropharyngeal or esophageal. Patients with orophayngeal dysphagia are likely to develop aspiration and aspiration pneumonia, so accurate diagnosis should be made in the early stages of complaining of swallowing difficulties. Patients with orophayngeal dysphagia complained difficulty initiating a swallow. Swallowing may be accompanied by coughing, choking, nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx. Patients with esophageal dysphagia complained difficulty swallowing several seconds after initiating a swallow and a sensation of food getting stuck in the esophagus. Esophageal dysphagia should be characterized by analyzing whether foods that cause swallowing difficulties are solid, liquids or both, whether symptoms are progressive or intermittent, how severe, and associated symptoms, such as weight loss, heartburn, or regurgitation. The approach to diagnostic testing to determine the cause of esophageal dysphagia is based upon the medical history. If esophageal motility disorder is suspected, barium esophagogram is performed first, and upper endoscopy is performed first if structural abnormalities are suspected. If an upper endoscopy shows normal findings, but the esophagus is still suspected of mechanical obstruction, a barium esophagogram is performed. Esophageal manometry should be performed in patients with swallowing difficulties who are suspected of esophageal motility disorder or have normal findings in upper endoscopy.
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Affiliation(s)
- Moo In Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Khalifa Y, Donohue C, Coyle JL, Sejdic E. Upper Esophageal Sphincter Opening Segmentation With Convolutional Recurrent Neural Networks in High Resolution Cervical Auscultation. IEEE J Biomed Health Inform 2021; 25:493-503. [PMID: 32750928 DOI: 10.1109/jbhi.2020.3000057] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Upper esophageal sphincter is an important anatomical landmark of the swallowing process commonly observed through the kinematic analysis of radiographic examinations that are vulnerable to subjectivity and clinical feasibility issues. Acting as the doorway of esophagus, upper esophageal sphincter allows the transition of ingested materials from pharyngeal into esophageal stages of swallowing and a reduced duration of opening can lead to penetration/aspiration and/or pharyngeal residue. Therefore, in this study we consider a non-invasive high resolution cervical auscultation-based screening tool to approximate the human ratings of upper esophageal sphincter opening and closure. Swallows were collected from 116 patients and a deep neural network was trained to produce a mask that demarcates the duration of upper esophageal sphincter opening. The proposed method achieved more than 90% accuracy and similar values of sensitivity and specificity when compared to human ratings even when tested over swallows from an independent clinical experiment. Moreover, the predicted opening and closure moments surprisingly fell within an inter-human comparable error of their human rated counterparts which demonstrates the clinical significance of high resolution cervical auscultation in replacing ionizing radiation-based evaluation of swallowing kinematics.
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Groher ME. Dysphagia Unplugged. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Elmoheen A, Haddad M, Bashir K, Salem WA. Subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum after upper gastrointestinal endoscopy. BMJ Case Rep 2020; 13:13/11/e236369. [PMID: 33148576 PMCID: PMC7640491 DOI: 10.1136/bcr-2020-236369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Upper gastrointestinal (GI) endoscopies are performed for several reasons. The overuse of endoscopy has negative effects on the quality of healthcare and pressurises endoscopy services. It also results in the complications. These complications include pneumoperitoneum, pneumomediastinum and subcutaneous pneumomediastinum. However, it is worth noting that these complications rarely occur during endoscopy of the upper GI tract. These complications, when they occur, indicate perforation of the retroperitoneal space or peritoneal cavity. In this article, we discuss a case of pneumoperitoneum, pneumomediastinum and subcutaneous emphysema after upper GI endoscopy.
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Affiliation(s)
- Amr Elmoheen
- Emergency Department, Hamad Medical Corporation, Doha, Qatar .,QU Health, College of Medicine, Qatar University, Doha, Qatar
| | - Mahmoud Haddad
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Bashir
- Emergency Department, Hamad Medical Corporation, Doha, Qatar.,QU Health, College of Medicine, Qatar University, Doha, Qatar
| | - Waleed Awad Salem
- Emergency Department, Hamad Medical Corporation, Doha, Qatar.,QU Health, College of Medicine, Qatar University, Doha, Qatar
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Riboldazzi G, Spinazza G, Beccarelli L, Prato P, Grecchi B, D'Abrosca F, Nicolini A. Effectiveness of expiratory flow acceleration in patients with Parkinson's disease and swallowing deficiency: A preliminary study. Clin Neurol Neurosurg 2020; 199:106249. [PMID: 33039853 DOI: 10.1016/j.clineuro.2020.106249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) causes dysfunction both to swallowing and to the cough mechanism. Oropharyngeal dysphagia is the main cause of pneumonia, due to silent aspiration of food and saliva. Pneumonia is the leading cause of death in PD. Different strategies exist to reduce the risk of inhalation and associated lung infections, but evidence of their efficacy is still unclear. The aim of this preliminary study was to investigate if adding an expiratory flow acceleration (EFA®) technique to standard therapy (ST) for dysphagia can reduce the incidence of bronchopulmonary infections and improve quality of life, respiratory function parameters, cough, and airways encumbrance perception. MATERIALS AND METHODS Twenty-five patients with PD were randomized to two groups: ST vs. ST + EFA. Patients were re-assessed at 30, 180 and 360 days from start of treatment. The primary outcome was the incidence of respiratory exacerbations together with quality of life score (PDQ-39). Secondary outcomes were changes in respiratory function tests, cough capacity (CPEF), perceived health status (Euro-QOL-VAS), cough, and upper airways encumbrance perception evaluated by visual numeric scale (VNS). RESULTS Twenty patients concluded the study (10 each group). Albeit the difference was not significant, less respiratory infections, symptoms, hospital admissions and medical visits were found in the study group. Furthermore, there was a significant difference in cough effectiveness measured with the peak cough expiratory flow (PCEF) and other spirometry parameters (FEV1, FVC), and also in specific and generic health-related quality of life measures (PDQ-39, Euro-QoL-VAS). CONCLUSION The results of this preliminary study support the use of EFA® technology in Parkinson's patients with dysphagia to reduce the risk of respiratory complications. Nevertheless, further studies are needed in a larger, more representative sample to definitively confirm the usefulness of this technique in PD patients.
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Affiliation(s)
- Giulio Riboldazzi
- Parkinson's Disease Unit, Gaetano and Piera Borghi Foundation, Brebbia, Italy
| | - Giada Spinazza
- Neurology Rehabilitation Department, Hospital of Cuasso al Monte, Italy
| | - Laura Beccarelli
- Pulmonary Rehabilitation Unit, General Hospital, Sestri Levante, Italy
| | - Paola Prato
- Pulmonary Rehabilitation Unit, General Hospital, Sestri Levante, Italy
| | - Bruna Grecchi
- Physical Medicine and Rehabilitation Department, General Hospital, Sestri Levante, Italy
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Advanced flow cell design for in vitro release testing of mucoadhesive buccal films. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2020; 70:359-371. [PMID: 32074072 DOI: 10.2478/acph-2020-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2019] [Indexed: 01/19/2023]
Abstract
Films for buccal application are a slowly emerging new platform for drug delivery. There remains a lack of analytical techniques for the determination of in vitro active pharmaceutical ingredient release. The aim here was to develop an alternative method to the commonly used United States Pharmacopoeia (USP) 2 method, based on the flow-through cell. This system extends the release time and enables more detailed sample discrimination according to formulation. It could be used as a tool for in vivo prediction of drug release rates from buccal film formulations. The flow cell contains two chambers separated by a membrane through which the released active pharmaceutical ingredient is measured. Vital system variables and their effects on the release rate of the model active pharmaceutical ingredient are presented for formulations based on sodium alginate polymer. The method reflects the differences between films and is shown to be discriminatory for evaluation of buccal formulations.
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A prospective study for evaluation of structural and clinical validity of the Eating Assessment Tool. BMC Geriatr 2020; 20:269. [PMID: 32758137 PMCID: PMC7405447 DOI: 10.1186/s12877-020-01654-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Eating Assessment Tool is a self-rating questionnaire developed to assess symptom severity and treatment efficacy in swallowing disorders. The aim of this study was to investigate the structural validity of the Eating Assessment Tool and whether individual item scores differed between dysphagia secondary to neurological and structural/esophageal disorders, respectively. METHODS This is a prospective cross-sectional questionnaire study. In total, 200 community-dwelling adults with suspected dysphagia referred for fiberoptic endoscopic examination of swallowing at Karolinska University Hospital, Stockholm, Sweden, completed the S-EAT-10. Patients' medical charts were reviewed in order to establish the type of dysphagia. Principal axis factoring was conducted to examine structural validity, and Mann-Whitney U tests were used to study differences in the S-EAT-10 score patterns between different types of dysphagia. RESULTS One single factor explained 54% of the total variance in EAT-10 item scores. All ten items loaded substantially or strongly on this factor, supporting the single-factor solution (Cronbach's alpha = 0.90). Structural/esophageal dysphagia was associated with higher scores on six items and with a higher total EAT-10 score. CONCLUSIONS The EAT-10 yields a unidimensional index of symptom severity in patients with dysphagia. Individual item scores reflect typical symptoms in neurogenic and structural/esophageal dysphagia, supporting its clinical relevance.
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Matta A, Elenizi K, Carrié D, Roncalli J. Dysphagia as an early sign of cardiac decompensation in elderly: case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32974472 PMCID: PMC7501929 DOI: 10.1093/ehjcr/ytaa149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/17/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Several clinical entities may be misdiagnosed in elderly if we consider dysphagia as a normal aging process in our daily practice. On top of usual aetiologies like motor dysfunction, investigations may uncover serious underlying conditions. CASE SUMMARY We report an unusual case where dysphagia was the warning sign for acute heart failure in a 76-year-old patient known to have dilated cardiomyopathy with reduced ejection fraction. It was due to an external oesophageal compression by the left atrium. A transthoracic echocardiography, an enhanced thoracic computed tomography-scan and esophagogastroduodenoscopy were used for the diagnosis. Diuretics were the cornerstone treatment with symptomatic improvement. DISCUSSION Despite the fact that cardiovascular dysphagia is an uncommon medical entity, but it remains a potential differential diagnosis, especially in elderlies with high risk for atrial enlargement.
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Affiliation(s)
- Anthony Matta
- Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon
- Department of Cardiology, Institute CARDIOMET, Rangueil Hospital, Toulouse, France
| | - Khaled Elenizi
- Department of Cardiology, Institute CARDIOMET, Rangueil Hospital, Toulouse, France
- Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Didier Carrié
- Department of Cardiology, Institute CARDIOMET, Rangueil Hospital, Toulouse, France
| | - Jerome Roncalli
- Department of Cardiology, Institute CARDIOMET, Rangueil Hospital, Toulouse, France
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Yüksel A, Kulan CA, Akçiçek F. The investigation of asymptomatic swallowing disorder through surface electromyography in the geriatric population. Aging Clin Exp Res 2020; 32:1567-1576. [PMID: 31538319 DOI: 10.1007/s40520-019-01349-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
AIM Swallowing is a vital activity. The difficulty while swallowing, referred to as swallowing disorder, is strongly associated with serious health problems in the elderly. The aim of this study is to enable early recognition of the swallowing function developing as an asymptomatic condition. METHOD Our study was conducted on elderly populations aged 65 years and over who met the exclusion criteria. Firstly, to be able to reach the number of sampling, "EAT-10 questionnaire", which also has a Turkish validation, was used to eliminate those with symptomatic swallowing disorders. The number of patients we reached was 320, but 7 dropped out of the study and therefore the study was carried out with a total of 313 [reached as 97.8% (up 95% G-power)]. RESULT We used validated sEMG test in the quantitative (objective) detection of asymptomatic swallowing disorder. In this method, asymptomatic swallowing disorder was detected in 39 cases (12.4%). CONCLUSION Swallowing disorder without symptoms is frequent and the sEMG test is useful in detecting it in the elderly population.
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Affiliation(s)
- Arif Yüksel
- Department of Internal Medicine, Izmir Bozyaka Health Research and Application Center, University of Health Sciences, Izmir, Turkey.
- SBU Izmir Bozyaka Eğitim ve Araştırma Hastanesi, Saim Cıkrıkcı Cad., No:59 Karabaglar, Izmir, Turkey.
| | - Can Ahmet Kulan
- Department of Neurology, Izmir Bozyaka Health Research and Application Center, University of Health Sciences, Izmir, Turkey
| | - Fehmi Akçiçek
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
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Gupta MS, Kumar TP. Characterization of Orodispersible Films: An Overview of Methods and Introduction to a New Disintegration Test Apparatus Using LDR - LED Sensors. J Pharm Sci 2020; 109:2925-2942. [PMID: 32565356 DOI: 10.1016/j.xphs.2020.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Orodispersible Film (ODF) is a promising and progressive dosage form that offers exceptional drug delivery benefits to patients. Indeed, they are the most transformational alternatives to traditional/conventional dosage forms such as tablets and capsules. ODFs are portable and highly comfortable for self-administration by patients with swallowing problems. The key to gain end-user acceptance is to have an ODF with outstanding quality. Poor quality may lead to choking or spitting, accordingly leading to a lack of compliance. It is vital to employ suitable experimental methodologies that facilitate characterization or determination of the quality of ODF. Nonetheless, there are no standard techniques prescribed in official compendia of any country. But, there is a consensus in the thin-film research community about the characterization techniques that one relies on deciding the quality of an ODF. We review various experimental techniques and highlight its importance in determining the performance and quality of an ODF. We provide a relatively novel and inventive disintegration test apparatus, which works using 'Light Dependent Resistor (LDR) and Light Emitting Diode (LED) sensors' for clear and accurate determination of start and end disintegration time of an ODF.
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Affiliation(s)
- Maram Suresh Gupta
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Sri Shivarathreeshwara Nagar, Mysore 570 015, India.
| | - Tegginamath Pramod Kumar
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Sri Shivarathreeshwara Nagar, Mysore 570 015, India
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Mitra T, Dixit VK, Shukla SK, Yadav DP, Thakur P, Thakur RK. Clinical profile of patients presenting with dysphagia - an experience from a tertiary care center in North India. JGH OPEN 2020; 4:472-476. [PMID: 32514456 PMCID: PMC7273703 DOI: 10.1002/jgh3.12284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/10/2019] [Indexed: 12/29/2022]
Abstract
Background and Aim Dysphagia can lead to substantial morbidity and mortality, especially in the elderly. It has both benign and malignant causes. Despite having a varied etiology, there have been few studies in India. Therefore, a study was undertaken to evaluate the clinical profile and various etiologies of dysphagia. Methods A prospective study was conducted on 220 patients with a complaint of dysphagia. Detailed history and examination, endoscopy and biopsies, and barium swallow were performed. Computed tomography and magnetic resonance imaging were performed wherever required. Patients who had an oropharyngeal or neurological cause of dysphagia were excluded. Results The mean age of patients was 57.2 years, with the male: female ratio being 1.7:1. Of the patients, 35% (78 patients) had malignant etiology, with a mean age of 65.2 years, and 65% (142 patients) had a benign etiology, with a mean age of 51 years. Among the patients with malignancy, 56 had squamous cell carcinoma of esophagus (71.7%), 20 had adenocarcinoma of esophagus (25.7%), and 2 had gastric cardia adenocarcinoma (2.6%). Malignancy was most commonly located in distal esophagus (48 patients), and among the cases, 18 had involvement of the gastroesophageal junction. The most common benign cause was esophagitis secondary to reflux in 25.5% (56 patients), followed by esophageal ulcer in 5.9%, achalasia in 5%, corrosive stricture in 4.5%, and peptic stricture in 3.6%. Conclusion Dysphagia has diverse etiology, and a majority can be diagnosed by endoscopy and barium swallow. Malignancy is an important cause of dysphagia in elderly. Esophageal squamous cell carcinoma remains the most common malignancy, but the incidence of gastroesophageal junctional adenocarcinoma is increasing.
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Affiliation(s)
- Tuhin Mitra
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences Banaras Hindu University Varanasi India
| | - Vinod K Dixit
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences Banaras Hindu University Varanasi India
| | - Sunit K Shukla
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences Banaras Hindu University Varanasi India
| | - Dawesh P Yadav
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences Banaras Hindu University Varanasi India
| | - Piyush Thakur
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences Banaras Hindu University Varanasi India
| | - Ravi K Thakur
- Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences Banaras Hindu University Varanasi India
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Self-reported Swallowing and Nutrition Status in Community-Living Older Adults. Dysphagia 2020; 36:198-206. [PMID: 32385694 DOI: 10.1007/s00455-020-10125-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
More New Zealanders are forecast to grow older in the community, ranging in levels of abilities and needs. Many health conditions can affect swallowing function or nutrition status in older age. However, older adults may not be aware of risk factors and when to seek help. A nationwide survey was conducted of self-reported swallowing ability and nutrition status in community-living New Zealanders aged 65 years and older to assess whether undisclosed swallowing and nutrition problems exist. Respondents completed an amalgamated questionnaire including two validated screening tools: Eating Assessment Tool (EAT-10) and Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). A convenience sample of 1020 adults aged 65-96 years old was obtained. Mean EAT-10 score was 2.15 (SD = 4.3); 22.1% scored above the normative score (3 or more). Mean SCREEN-II score was 48.50 (SD = 6.5); 46.9% scored below normal (< 50 for adults under 85 years old, < 49 for adults over 84 years old). EAT-10 scores significantly correlated with SCREEN-II scores (p < 0.001). Scores did not correlate with age or differ between age groups. Significantly more respondents with medical history associated with dysphagia disclosed swallowing and nutrition problems (p < 0.001). This data suggest increased prevalence of swallowing difficulties in older age is attributed to health conditions and medications, rather than ageing itself. Swallowing complaints from community-living older adults should not be ignored or attributed to the normal ageing process. This study supports routine nutrition screening in older adults.
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Marvin S, Thibeault S. Pharyngeal Versus Esophageal Stasis: Accuracy of Symptom Localization. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:664-672. [PMID: 32142366 DOI: 10.1044/2019_ajslp-19-00161] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The purpose of this article was to determine whether patients who complain of bolus stasis are accurate at localizing bolus stasis as measured by a videofluoroscopic swallowing study with an esophagram. Method This study used a prospective analysis of outcomes data from the University of Wisconsin-Madison Voice and Swallow Outcomes database in patients with complaints of bolus stasis who completed the combined videofluoroscopic swallowing study and esophagram to determine the accuracy of bolus stasis localization. Results Dysphagia evaluation was completed in 301 patients with complaints of bolus stasis. Patients with complaints of bolus stasis in the throat (i.e., pharynx and cervical esophagus) were less accurate at localizing bolus stasis than patients with complaints in the thoracic esophagus (p < .001). Esophageal stasis was the most common finding regardless of complaint location. Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. This work supports a comprehensive evaluation of both the pharynx and the esophagus for patients with complaints of bolus stasis in the throat. Future research should focus on identifying symptom profiles that could lead to targeted swallowing evaluations based on patient history and complaint.
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Affiliation(s)
- Stevie Marvin
- Voice & Swallow Clinics, Department of Surgery, University of Wisconsin-Madison
| | - Susan Thibeault
- Voice & Swallow Clinics, Department of Surgery, University of Wisconsin-Madison
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Abu-Ghanem S, Chen S, Amin MR. Oropharyngeal Dysphagia in the Elderly: Evaluation and Prevalence. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00258-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Nishida T, Yamabe K, Honda S. Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons. Gerodontology 2019; 37:185-190. [PMID: 31874118 DOI: 10.1111/ger.12455] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/15/2019] [Accepted: 12/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate which domains of frailty are associated with dysphagia in community-dwelling elderly persons. BACKGROUND Dysphagia is a common cause of aspiration pneumonia in frail elderly persons in Japan. Although frailty is considered to be multidimensional, it is unclear which domains of frailty affect dysphagia. METHODS The participants were 3475 independent Japanese elderly persons (≥65 years; 1555 men and 1920 women). A self-report questionnaire with a frailty checklist consisting of several domains (lifestyle, physical function, nutrition, oral function, homebound status, cognitive function and depressive mood) was used to determine the participants' characteristics. Dysphagia was defined as impaired swallowing in the oral function domain. To determine the associations between dysphagia and age, sex and the other domains on the frailty checklist, adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated using multiple logistic regression analysis. RESULTS The multiple logistic regression analysis showed that dysphagia was independently associated with female sex (AOR = 1.35; 95% CI = 1.08-1.68), chewing ability (AOR = 1.70; 95% CI = 1.32-2.18), oral dryness (AOR = 1.94; 95% CI = 1.48-2.54), physical function (AOR = 2.19; 95% CI = 1.66-2.90), cognitive function (AOR = 1.68; 95% CI = 1.34-2.12) and depressive mood (AOR = 1.82; 95% CI = 1.41-2.35). CONCLUSION Dysphagia was independently associated with oral, physical, cognitive and psychological frailty. These results suggest that frailty prevention strategy including swallowing training might be useful for community-dwelling independent elderly persons aged ≥65 years.
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Affiliation(s)
- Takahiro Nishida
- Sasebo-Yoshii Community Comprehensive Support Center, Sasebo, Japan.,Yamabe Dental Clinic, Sasebo, Japan.,Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Sumihisa Honda
- Department of Public Health Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Howells SR, Cornwell PL, Ward EC, Kuipers P. Dysphagia care for adults in the community setting commands a different approach: perspectives of speech-language therapists. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:971-981. [PMID: 31479197 DOI: 10.1111/1460-6984.12499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/11/2019] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Descriptions of community-based speech-language therapy (SLT) dysphagia practices and services are underrepresented in the research literature, despite the prevalence of dysphagia in the community. Owing to a globally ageing population and government drives to support people to remain living at home rather than in hospital or aged care, there is a growing need for SLT services to be responsive to the needs of clients living at home in the community, referred to in this study as 'community-based clients'. Exploration of current SLT services and dysphagia care practices for this population may identify ways services can be designed and enhanced to better meet the needs of clients and carers. AIMS To explore the nature (i.e., characteristics) of dysphagia services and SLT clinical practices for adults with dysphagia living at home in the community. METHODS & PROCEDURES Using a qualitative descriptive approach positioned within an explanatory sequential mixed methods design, this study explored SLT services and practices for adults with dysphagia living in the community to explain further and elaborate on findings from an earlier quantitative study. A total of 15 SLTs working with community-based clients with dysphagia were recruited using purposive representative sampling. Content analysis was used to explore the data. OUTCOMES & RESULTS The overarching theme of community commands a different approach and was illustrated by three subthemes that highlighted how and why a different approach to dysphagia care in the community setting was necessary: (1) skills and mindset require adaptation in the community context; (2) values and approaches are different in the community context; and (3) organizational influences impact service delivery in the community context. From the data, it is apparent that the work undertaken in the community setting differs from dysphagia care in other settings and requires adapted SLT skills, values and approaches that encompass holistic care, client autonomy and carer engagement. SLT practices are also informed by organizational influences such as policies and resourcing, which in some services were enablers, while for others these presented challenges. CONCLUSIONS & IMPLICATIONS Community-based SLT services must continue to foster flexible, responsive practices by SLTs to ensure the needs of clients and carers are met now and in future.
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Affiliation(s)
- Simone R Howells
- Menzies Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia
| | - Petrea L Cornwell
- Menzies Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, QLD, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia Campus, St Lucia, QLD, Australia
| | - Pim Kuipers
- Menzies Health Institute, Griffith University, Gold Coast Campus, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Buranda, QLD, Australia
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Prevalence of Dysphagia in Patients With Non-neoplastic Vocal Fold Pathology. J Voice 2019; 33:708-711. [DOI: 10.1016/j.jvoice.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/16/2018] [Indexed: 12/22/2022]
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An Open-Label Crossover Study of the Pharmacokinetics of the 60-mg Edoxaban Tablet Crushed and Administered Either by a Nasogastric Tube or in Apple Puree in Healthy Adults. Clin Pharmacokinet 2019; 57:221-228. [PMID: 28512699 PMCID: PMC5784001 DOI: 10.1007/s40262-017-0554-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Edoxaban is an orally active, direct factor Xa inhibitor indicated to reduce the risk of stroke and systemic embolism in non-valvular atrial fibrillation and for the treatment of venous thromboembolism. Objectives This study assessed the pharmacokinetics, safety, and tolerability of the edoxaban 60-mg tablet crushed and administered via a nasogastric tube in a water suspension or orally mixed in apple puree. Methods This phase 1, open-label, crossover study randomized 30 healthy adults to receive three edoxaban treatment regimens (oral 60-mg edoxaban tablet, or 60-mg edoxaban tablet crushed and administered via a nasogastric tube or orally in apple puree) in one of six treatment sequences. Results Total edoxaban exposure was similar between the intact and crushed tablet regimens (mean area under the plasma concentration–time curve from time zero to infinity: whole tablet, 2132 ng·h/mL; nasogastric tube, 2021 ng·h/mL; apple puree, 2076 ng·h/mL). Mean maximum plasma concentration, area under the plasma concentration–time curve from time zero to the time of the last measurable concentration, terminal half-life, and apparent total body clearance values were also similar. Time to maximum plasma concentration was significantly shorter for the nasogastric tube suspension and apple puree vs. the whole tablet [Hodges–Lehmann estimate of median difference (90% confidence interval): −0.75 (−1.25, −0.28); p = 0.0003 and −0.62 (−0.99, −0.26); p = 0.0024, respectively]. The maximum plasma concentation, area under the plasma concentration–time curve from time zero to infinity, and area under the plasma concentration–time curve from time zero to the time of the last measurable concentration were similar between treatment regimens; 90% confidence interval of the geometric least-squares means ratios were within the predefined 80–125% bioequivalence criterion. The safety and tolerability of edoxaban did not differ between treatment regimens. Conclusion The results support the use of edoxaban tablets crushed and administered either via a nasogastric tube or orally mixed in apple puree in patients who are unable to swallow solid oral dose formulations.
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Prevalence of dysphagia in patients with muscle tension dysphonia. The Journal of Laryngology & Otology 2019; 133:390-393. [DOI: 10.1017/s0022215119000513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundIt is hypothesised that patients with muscle tension dysphonia have a high prevalence of dysphagia in comparison to normative values reported in the literature.MethodsThis prospective study included 44 subjects diagnosed with muscle tension dysphonia, based on symptoms and laryngoscopic findings, and 25 control subjects with no history of dysphonia and normal laryngeal examination findings. Demographic data included age, gender and smoking history. The aetiology of muscle tension dysphonia was classified as primary or secondary. Evaluation involved the Eating Assessment Tool (‘EAT-10’) questionnaire.ResultsPatients’ mean age was 45.93 ± 14.95 years, with a female to male ratio of 1.2:1. Fourteen patients had primary muscle tension dysphonia, while 30 had secondary muscle tension dysphonia. Among patients with secondary muscle tension dysphonia, Reinke's oedema was the most common aetiology. There was a significant difference in the prevalence of dysphagia between the study group and the control group (40.9 per cent vs 8 per cent respectively, p < 0.05).ConclusionThis study demonstrates a higher prevalence of dysphagia in patients with the presenting symptom of dysphonia and diagnosed with muscle tension dysphonia in comparison to subjects with no dysphonia.
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Affiliation(s)
- Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Audag N, Goubau C, Danse E, Vandervelde L, Liistro G, Toussaint M, Reychler G. Validation and Reliability of the French Version of the Sydney Swallow Questionnaire. Dysphagia 2019; 34:556-566. [DOI: 10.1007/s00455-019-09978-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/18/2019] [Indexed: 01/05/2023]
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Howells SR, Cornwell PL, Ward EC, Kuipers P. Understanding Dysphagia Care in the Community Setting. Dysphagia 2019; 34:681-691. [DOI: 10.1007/s00455-018-09971-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/31/2018] [Indexed: 02/06/2023]
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Shapira-Galitz Y, Yousovich R, Halperin D, Wolf M, Lahav Y, Drendel M. Does the Hebrew Eating Assessment Tool-10 Correlate with Pharyngeal Residue, Penetration and Aspiration on Fiberoptic Endoscopic Examination of Swallowing? Dysphagia 2019; 34:372-381. [DOI: 10.1007/s00455-018-9964-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 11/14/2018] [Indexed: 12/12/2022]
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Madhavan A, Carnaby GD, Chhabria K, Crary MA. Preliminary Development of a Screening Tool for Pre-Clinical Dysphagia in Community Dwelling Older Adults. Geriatrics (Basel) 2018; 3:E90. [PMID: 31011125 PMCID: PMC6371185 DOI: 10.3390/geriatrics3040090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/30/2022] Open
Abstract
Evidence suggests that community dwelling older adults (CDOA) are at risk for dysphagia (swallowing difficulties). Dysphagia is often unidentified until related morbidities like under nutrition or pneumonia occur. These cases of unidentified dysphagia, prior to any clinical intervention, may be termed 'pre-clinical dysphagia'. Identifying pre-clinical dysphagia is challenged by the lack of validated tools appropriate for CDOA. This study addresses preliminary development of a novel patient reported outcome (PRO) screening tool for pre-clinical dysphagia. Initially, 34 questions were developed from literature review and expert opinion. Following pilot testing (n = 53), the questionnaire was revised and tested on 335 additional CDOA. Face validity, content validity, item analysis, reliability (internal consistency), and construct validity (exploratory factor analysis) measures were completed. Psychometric validation resulted in a 17-question PRO tool. Construct analysis identified a three-factor model that explained 67.345% of the variance. Emergent factors represented swallowing effort, physical function, and cognitive function. The results revealed strong construct validity and internal consistency (Cronbach's α = 0.90). A novel, simple PRO incorporating multiple function domains associated with aging demonstrated strong preliminary psychometric properties. This tool is more comprehensive and aging-focused than existing dysphagia screening tools. Inclusion of multiple domains may be key in early identification of pre-clinical dysphagia.
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Affiliation(s)
- Aarthi Madhavan
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Giselle D Carnaby
- Swallowing Research Laboratory, School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL 32816, USA.
| | - Karishma Chhabria
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Michael A Crary
- Swallowing Research Laboratory, School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL 32816, USA.
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Kamarunas E, Wong SM, Ludlow CL. Laryngeal Vibration Increases Spontaneous Swallowing Rates in Chronic Oropharyngeal Dysphagia: A Proof-of-Principle Pilot Study. Dysphagia 2018; 34:640-653. [PMID: 30488335 DOI: 10.1007/s00455-018-9962-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
Previously, vibratory stimulation increased spontaneous swallowing rates in healthy volunteers indicating that sensory stimulation excited the neural control of swallowing. Here, we studied patients with severe chronic dysphagia following brain injury or radiation for head and neck cancer to determine if sensory stimulation could excite an impaired swallowing system. We examined (1) if laryngeal vibratory stimulation increased spontaneous swallowing rates over sham (no stimulation); (2) the optimal rate of vibration, device contact pressure, and vibratory mode for increasing swallowing rates; and (3) if vibration altered participants' urge to swallow, neck comfort, and swallow initiation latency. Vibration was applied to the skin overlying the thyroid lamina bilaterally in thirteen participants to compare vibratory rates 30, 70, 110, 150, or 70 + 110 Hz, different devices to neck pressures (2, 4, or 6 kilopascals), and pulsed versus continuous vibration. Swallows were confirmed from recordings of laryngeal accelerometry and respiratory apneas and viewing neck movement. Participants' swallowing rates, urge to swallow, discomfort levels, and swallow initiation latencies were measured. Vibration at 70 Hz and at 110 Hz significantly increased swallowing rates over sham. All vibratory frequencies except 70 + 100 Hz increased participants' urge to swallow, while no pressures or modes were optimal for increasing urge to swallow. No conditions increased discomfort. Vibration did not reduce measures of swallow initiation latency using accelerometry. In conclusion, as non-invasive neck vibration overlying the larynx increased swallowing rates and the urge to swallow without discomfort in patients with chronic dysphagia, the potential for vibratory stimulation facilitating swallowing during dysphagia rehabilitation should be investigated.
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Affiliation(s)
- Erin Kamarunas
- Department of Communication Sciences and Disorders, James Madison University, 235 MLK Jr. Way, MSC 4304, Harrisonburg, VA, 22087, USA.
| | - Seng Mun Wong
- Department of Communication Sciences and Disorders, James Madison University, 235 MLK Jr. Way, MSC 4304, Harrisonburg, VA, 22087, USA
| | - Christy L Ludlow
- Department of Communication Sciences and Disorders, James Madison University, 235 MLK Jr. Way, MSC 4304, Harrisonburg, VA, 22087, USA
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Abstract
Globus is an area of interest for many medical specialists including otorhinolaryngologists, gastroenterologist, allergists, and psychiatrists. It may be caused by an organic disease, but it is not uncommon that an underlying etiology remains unidentified even after a full workup has been performed. Patients who suffer from globus usually visit several physicians from different specialties without finding a solution for their symptoms. Identifying the underlying cause of globus is not always a simple task; therefore, structural or functional abnormalities of the thyroid, larynx, pharynx, and esophagus should be investigated. Gastroesophageal reflux disease is commonly considered to be the underlying cause after being identified in an otorhinolarygeal (ear, nose, and throat) evaluation, which is usually the first diagnostic step. In the last few years, an inlet patch in the proximal esophagus has been shown to be associated with globus, and its elimination has resulted in symptom resolution in some patients. Finally, globus can be associated with psychiatric disorders as well as oropharyngeal hypersensitivity that could be either chemical or mechanical. Treatment is directed toward an identified organic cause; in those with a functional disorder, the mainstay of therapy includes neuromodulators and psychiatric/psychological interventions.
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