Dysphagia Profiles Among Inpatients with Dementia Referred for Swallow Evaluation.

BACKGROUND: Alzheimer's disease and related dementias (ADRD) patients who are hospitalized often develop oropharyngeal dysphagia, increasing risk for adverse outcomes, such as aspiration pneumonia. However, prevalence estimates of dysphagia are highly variable and often based on patient report or clinical testing rather than visualization of the swallow. OBJECTIVE: The aims of this study were to determine prevalence and severity of dysphagia among inpatients with ADRD referred for swallowing evaluation. METHODS: Electronic health record (EHR) abstraction of ADRD diagnosis and presence and severity of clinically-determined dysphagia on bedside swallow evaluation (BSE) and videofluoroscopic swallow study (VFSS). RESULTS: 16% (n = 268) had an ADRD diagnosis or were taking dementia-specific medication based on the EHR. 75% (n = 202) were diagnosed with dysphagia on the BSE. 60% subsequently underwent VFSS (n = 122) with dysphagia confirmation in 92% (n = 112). ADRD inpatients were significantly more likely to be diagnosed with dysphagia based on the BSE (p < 0.0001) than those without ADRD. Additionally, dysphagia on the VFSS was more severe in the ADRD group (p < 0.03). DISCUSSION: ADRD individuals may be vulnerable to developing or worsening dysphagia during hospitalization. Results underscore the importance of evaluating swallowing function in hospitalized patients with ADRD in order to facilitate targeted intervention.

Collaboration of nursing faculty and college administration in creating organizational change.

At schools of nursing nationwide, surging enrollments in the early 2000s necessitated changes in administrative structures and departmental organization. The authors describe a collaboration between faculty and administrators at their midwestern liberal arts college that aided a reorganization of the school of nursing. Kurt Lewin's 1951 change theory provided the framework for the restructuring, from the initial phases of data collection through implementation of the new administrative structure. The reorganization has resulted in a more efficient use of resources in the school of nursing.

Comorbid bulimia nervosa and schizophrenia.

OBJECTIVE: Despite literature citing the frequency of abnormal eating behavior in persons with schizophrenia, little attention has been paid to the comorbidity of eating disorders and schizophrenia. This case review explores the comorbidity of bulimia nervosa and schizophrenia and its possible clinical implications. METHOD: The authors present four case reports of women with rigorously diagnosed schizophrenia who have eating-disordered behavior. RESULTS: The first case describes a woman whose bulimia nervosa clearly preceded the onset of her schizophrenia. The second and third cases describe women who have many characteristics and risk factors for bulimia nervosa and whose bulimic symptoms significantly interact with psychotic symptoms. The fourth case describes a woman with bulimic behavior which is clearly responsive to psychosis. She does not have a history and behavioral profile of true bulimia nervosa. DISCUSSION: These case reports extend support to a model that schizophrenia and bulimia may coexist in a complex, interactive fashion with important clinical implications.

Dietary cholesterol and downregulation of cholesterol 7 alpha-hydroxylase and cholesterol absorption in African green monkeys.

In this study, hepatic production of bile acid was considered together with intestinal cholesterol absorption as potential regulatory sites responsive to dietary cholesterol. Sequential liver biopsies were taken from 45 feral African green monkeys studied during three different diet periods. Low-fat Monkey Chow was fed during the baseline period, a cholesterol and fat-enriched diet was then fed for 12 wk during period 2, and finally, after a washout period of 10 wk, three subgroups were fed low-, moderate-, and high-cholesterol diets for 12 mo during period 3. The percentage of cholesterol absorbed in the intestine was significantly lower when higher levels of cholesterol were fed; however, this percentage was significantly and positively correlated to plasma cholesterol concentration at each dietary cholesterol level. Hepatic free and esterified cholesterol content were significantly elevated by dietary cholesterol challenge and remained elevated even after 20 wk of low-cholesterol diets. Hepatic mRNA abundance for cholesterol 7 alpha-hydroxylase (C7H) was significantly lower (approximately 60%) when the high-cholesterol diet was fed, with the decrease being greater than that seen for low density lipoprotein (LDL) receptor mRNA. At the same time, hepatic mRNA abundance for apolipoprotein B and hepatic lipase were not diet sensitive. C7H activity was decreased to a similar extent by diet as was C7H mRNA, although the correlation between enzyme activity and mRNA abundance was only r = 0.5, suggesting that dietary regulation includes factors in addition to transcriptional regulation. Activity and mRNA abundance of C7H remained decreased when liver esterified cholesterol content was reduced to only a two- to three-fold elevation over baseline, at a time when plasma cholesterol and hepatic LDL receptor mRNA abundance had returned to baseline levels. These data on liver C7H, obtained in one of the few primate species predisposed to cholesterol gallstone formation, support the hypothesis that the liver may attempt to downregulate intestinal cholesterol absorption by decreasing bile acid production when increased amounts of absorbed dietary cholesterol reach the liver. Presumably this represents attempted downregulation of intestinal cholesterol absorption by limiting bile acid availability as a means to maintain hepatic cholesterol balance.