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Development of Pyriform Sinus Suctioning Programs for Aspiration Pneumonia Prevention During the Acute Stroke

AbstractAspiration due to dysphagia is a factor associated with pneumonia during acute stroke. In such cases, it is likely that secretions in the pyriform sinuses enter the laryngeal inlet. The present study was based on the idea that it is possible to reduce aspiration pneumonia by periodically suctioning and removing such secretions (pyriform sinus suctioning), a study was conducted in a single facility. The incidence of pneumonia as a dependent variable was compared between before (control) and after (intervention group) intervention with pyriform sinus suctioning as an independent variable. With a view of unifying the quality and frequency of intervention, two programs to: initially confirm the safety of such suctioning; subsequently enhance/evaluate knowledge and skills related to the procedure (educational); and specify conditions for the implementation and criteria for determining its appropriateness (practical), were developed. The study involved 33 (mean age: 74.6  ± 12.4) and 30 (80.0 ± 8.8) control and intervention group members, respectively, 25 (83.3%) of the latter were treated with pyriform sinus suctioning for 5 days after a stroke. Pneumonia developed in 7 (21.2%) and 2 (6.7%) of the former and latter, respectively. As individuals with a Japan Coma Scale (JCS) score of III or a midline shift on head CT tend to develop pharyngeal dysphagia, the patients were also divided into 2 groups to compare the incidence of pneumonia...
Source: Dysphagia - Category: Speech-Language Pathology Source Type: research

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This study aimed to assess the effects of SAI on patient mortality and functional outcome at 3  months after stroke onset. We retrospectively analyzed 809 consecutive patients with acute stroke (517 men and 292 women; median age, 72 years) who were admitted to our department between September 2014 and June 2016. SAI was defined as an infection diagnosed during the hospitalization period. Po or outcome was defined as a modified Rankin Scale (mRS) score of 3–5 or death (mRS score of 6). The effect of SAI on functional outcome was evaluated using a multivariate logistic regression analysis. SAI occurred in 169...
Source: Journal of Neurology - Category: Neurology Source Type: research
We examined trends in resource use and patient characteristics over the study period. RESULTS: There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median ...
Source: cmaj - Category: General Medicine Authors: Tags: CMAJ Open Source Type: research
Objective: To compare clinical features and short term hospital outcome in COPD patients with and without heart failure.Methods: This was a prospective cohort study among COPD patients admitted to tertiary care hospital with and without heart failure (HF), who were followed till their hospital outcome. Comparison of presenting clinical features and outcome were documented on a structured proforma. Patients with chronic kidney or liver disease, cancer, pace- maker, pneumothorax, pneumonia, Implantable- defibrillator, stroke, dementia were excluded to eliminate bias.Results: Total of 60 COPD patients with HF ( group 1) and 8...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Monitoring Airway Disease Source Type: research
In this study, the authors introduce the new national, multicenter, randomized, controlled trial "FRAGILE", to be developed in the main cardiac surgery centers of Brazil, to clarify the potential benefit of off-pump CABG in frail patients. Methods: FRAGILE is a two-arm, parallel-group, multicentre, individually randomized (1:1) controlled trial which will enroll 630 patients with blinded outcome assessment (at 30 days, 6 months, 1 year, 2 years and 3 years), which aims to compare adverse cardiac and cerebrovascular events after off-pump versus on-pump CABG in pre-frail and frail patients. Primary outcomes will be...
Source: Revista Brasileira de Cirurgia Cardiovascular - Category: Cardiovascular & Thoracic Surgery Source Type: research
CONCLUSIONS: TMV implantation using the SAPIEN 3 aortic prosthesis in patients with heavy annular calcification is feasible and represents a reasonable bailout option for inoperable patients. However, several limitations need to be considered in this special patient population. PMID: 28760473 [PubMed - indexed for MEDLINE]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Authors: Levine RS, Salemi JL, Mejia de Grubb MC, Gittner LS, Langston MA, Husaini BA, Rust G, Hennekens CH Abstract OBJECTIVE: Describe trends in non-Hispanic black infant mortality (IM) in the New York City (NYC) counties of Bronx, Kings, Queens, and Manhattan and correlations with gun-related assault mortality. METHODS: Linked Birth/Infant Death data (1999-2013) and Compressed Mortality data at ages 1 to ≥85 years (1999-2013). NYC and United States (US) Census data for income inequality and poverty. Pearson coefficients were used to describe correlations of IM with gun-related assault mortality and other ...
Source: Journal of the National Medical Association - Category: General Medicine Tags: J Natl Med Assoc Source Type: research
AbstractThe frequency of spontaneous swallowing is useful for screening of dysphagia in acute stroke. Low levels of substance P (SP) in saliva attenuate the swallowing reflex. The aim of this study was to determine the relationship between the frequency of spontaneous swallowing and salivary SP levels. In 40 subjects, saliva was collected within 72  h after stroke onset and salivary SP levels were measured using ELISA kit at a later date. The frequency of spontaneous swallowing was measured over 1 h using a microphone placed on the neck. Pneumonia was diagnosed by the presence of pyrexia and at least two respirat...
Source: Dysphagia - Category: Speech-Language Pathology Source Type: research
On February 3, 2016, an 85-year-old woman was brought to the emergency department (ED) because of mental confusion and intolerance of the sitting position, which had begun suddenly 2 days before. She had been wheelchair-bound for the past 9 years after a stroke that had left her with mild left-sided hemiparesis but without cognitive impairment. According to her medical records at the ED, she was initially found hypoxemic (SO2  = 75% in room air) and disoriented. She was diagnosed with pneumonia, and because there was major improvement regarding her oxygenation after hydration (SO2 = 94% in room air), she was disc...
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Tags: Letter to the Editor Source Type: research
By KIP SULLIVAN Managed care advocates see quality problems everywhere and resource shortages nowhere. If the Leapfrog Group, the Medicare Payment Advisory Commission, or some other managed care advocate were in charge of explaining why a high school football team lost to the New England Patriots, their explanation would be “poor quality.” If a man armed with a knife lost a fight to a man with a gun, ditto: “Poor quality.” And their solution would be more measurement of the “quality,” followed by punishment of the losers for getting low grades on the “quality” report card and...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized CMS Kip Sullivan value-based care Source Type: blogs
We examined associations between mortality and accelerometer-measured PA using age-relevant intensity cutpoints in older women of various ethnicities. The results support the hypothesis that higher levels of accelerometer-measured PA, even when below the moderate-intensity threshold recommended in current guidelines, are associated with lower all-cause and CVD mortality in women aged 63 to 99. Our findings expand on previous studies showing that higher self-reported PA reduces mortality in adults aged 60 and older, specifically in older women, and at less than recommended amounts. Moreover, our findings challenge th...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
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