Screening for Dysphagia in Adult Patients with Stroke: Assessing the Accuracy of Informal Detection

This study assessed the accuracy of informal dysphagia detection prior to implementation of a formal screening protocol. We conducted a secondary analysis of data captured between 2003 and 2008 from a sample of 250 adult stroke survivors admitted to a tertiary care centre. Using a priori criteria, patient medical records were reviewed for notation about dysphagia; if present, the date/time of notation, writer ’s profession, and suggestion of dysphagia presence. To assess accuracy of notations indicating dysphagia presence, we used speech language pathology (SLP) assessments as the criterion reference. There were 221 patient medical records available for review. Patients were male (56%), averaged 68 ye ars (SD = 15.0), with a mean Canadian Neurological Scale score of 8.1 (SD = 3.0). First notations of swallowing by SLP were excluded. Of the remaining 170 patients, 147 (87%) had first notations (104 by nurses; 40 by physicians) within a median of 24.3 h from admission. Accuracy of detecting dy sphagia from informal notations was low, with a sensitivity of 36.7% [95% CI, 24.9, 50.1], but specificity was high (94.2% [95% CI, 86.5, 97.9]). Informal identification methods, although timely, are suboptimal in their accuracy to detect dysphagia and leave patients with stroke at risk for poor hea lth outcomes. Given these findings, we encourage the use of psychometrically validated formal screening protocols to identify dysphagia.
Source: Dysphagia - Category: Speech-Language Pathology Source Type: research

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CONCLUSION: In stroke inpatients over sixty years of age, it is necessary to distinguish the patients with multiple previous cerebral infarctions, high NIHSS score, masticatory muscle paralysis, abolition of gag reflex for early detection and rehabilitation of dysphagia. PMID: 30223382 [PubMed - as supplied by publisher]
Source: Journal of Back and Musculoskeletal Rehabilitation - Category: Orthopaedics Tags: J Back Musculoskelet Rehabil Source Type: research
AbstractWhile percutaneous catheter closure proves an effective treatment for secundum atrial septal defect (ASD2), some child patients require surgical closure. We assessed the risks associated with isolated surgical ASD2 closure by reviewing the outcomes of 120 children operated on between 1999 and 2011 (mean age 4.6  ± 3.9 years, mean weight 17 ± 12 kg). Direct sutures were performed in 4% and patch closures in 96%. The mean cardiopulmonary bypass duration was 38 ± 14 min, aortic cross-clamp time 19 ± 9 min, intensive...
Source: Pediatric Cardiology - Category: Cardiology Source Type: research
This study aimed to investigate the efficacy of bedside respiratory muscle training on pulmonary function and stroke-related disabilities in stroke rehabilitation. Design Patients with stroke (N = 40) in a rehabilitation unit were randomly assigned to either the intervention group (n1 = 20) or the control group (n2 = 20). Both groups participated in a conventional stroke rehabilitation program. During the study period, the intervention group received bedside respiratory muscle training twice a day for 3 wks. The respiratory muscle training consisted of (1) a breath stacking exercise, (2) inspiratory muscle training, and...
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Original Research Articles CME Article . 2018 Series . Number 10 Source Type: research
CONCLUSIONS: General anesthesia and conscious sedation are both safe alternatives for anesthetic management of patients submitted to endovascular thrombectomy. No anesthetic management is universally recommended and hopefully the ongoing randomized clinical trials will shed some light on the best approach; meanwhile, the choice of anesthesia should be based on the patient's individual characteristics. Regarding neuroprotection, hemodynamic stability is currently the most important strategy, as no pharmacological method has been proven effective in humans. PMID: 30195628 [PubMed - as supplied by publisher]
Source: Revista Brasileira de Anestesiologia - Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research
Background: Patients with dysphagia are at an increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed during the acute phase. The aim of this review was to identify the methods of assessment and management in acute stroke that influence the risk of stroke-associated pneumonia. Studies of stroke patients that reported dysphagia screening, assessment or management and occurrence of pneumonia during acute phase stroke were screened for inclusion after electronic searches of multiple databases from inception to November 2016. The primary outcome was association with ...
Source: Cerebrovascular Diseases - Category: Neurology Source Type: research
Abstract Objective Acute limb ischemia is a common vascular emergency requiring immediate intervention. Thrombolysis has been widely utilized for acute limb ischemia; the purpose of this study is to analyze contemporary trends, outcomes and complications of thrombolysis for acute limb ischemia. Methods Patients were identified from the Nationwide Inpatient Sample (2003-2013) using ICD-9. Patients undergoing emergency thrombolysis for acute limb ischemia were evaluated. Three groups were analyzed: thrombolysis alone, thrombolysis and endovascular procedure (T+ENDO), and failed thrombolysis requiring open surgery (T...
Source: Vascular - Category: Surgery Authors: Tags: Vascular Source Type: research
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Source: Aging Clinical and Experimental Research - Category: Geriatrics Authors: Tags: Aging Clin Exp Res Source Type: research
Authors: Aziz KT, Best MJ, Naseer Z, Skolasky RL, Ponnusamy KE, Sterling RS, Khanuja HS Abstract Background: Our goal was to determine whether postoperative delirium is associated with inpatient complication rates after primary elective total hip arthroplasty (THA). Methods: Using the National Inpatient Sample, we analyzed records of patients who underwent primary elective THA from 2000 through 2009 to identify patients with delirium (n = 13,551) and without delirium (n = 1,992,971) and to assess major perioperative complications (acute renal failure, death, myocardial infarction, pneumonia, pulmonary embolism,...
Source: Clinics in Orthopedic Surgery - Category: Orthopaedics Tags: Clin Orthop Surg Source Type: research
Authors: Takasaki M, Momosaki R, Wakabayashi H, Nishioka S Abstract Nutritional complications frequently occur among patients undergoing rehabilitation, and the importance of nutrition in these patients has been emphasized. However, there is not enough evidence available on rehabilitation nutrition. The Japan Rehabilitation Nutrition Database was set up to reflect the real-world clinical practice of rehabilitation nutrition. This paper describes the construction and quality evaluation of the registry database. We constructed a large-scale database that can be used for the clinical research of nutrition for rehabili...
Source: Journal of Nutritional Science and Vitaminology - Category: Nutrition Tags: J Nutr Sci Vitaminol (Tokyo) Source Type: research
Publication date: Available online 1 September 2018Source: Journal of Hospital InfectionAuthor(s): Nasrinsadat Mirtalaei, Aliasghar Farazi, Mohsen Ebrahimi Monfared, Abolfazl JokarAbstractVentilator-associated pneumonia (VAP) is one of the most important problems of intensive care units. 84 neurologic patients with acute stroke (Glasgow Coma Score ≤ 8) were entered into a double-blind clinical trial. Patients in the intervention group received piperacillin-tazobactam 4g/0.5g at the time of intubation and 12 hours later. The incidences of early-onset (within 4 days of intubation) and late-onset VAP were 9.2 and 26.9 epis...
Source: Journal of Hospital Infection - Category: Infectious Diseases Source Type: research
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