Tracheostomy decannulation readiness: A cross sectional study comparing standardised evaluation for tacheostomy decannulation to flexible endoscopic evaluation of swallowing examination.

INTRODUCTION: Tracheostomy is a procedure commonly performed in neurocritical and mechanically ventilated patients in the intensive care unit. Dysphagia and impaired airway protection are the main causes for a delay in tracheostomy decannulation in patients with neurological disorders. Endoscopic evaluation is an objective examination of readiness for tracheostomy decannulation with flexible endoscopic evaluation of swallowing (FEES) as the most commonly used method, yet it requires special expertise and is heavily dependent on its operator in assessing the parameters. A relatively new method for assessing decannulation readiness in neurologic disorder, the Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation (SESETD) was introduced in 2013 by Warnecke, et al. This method includes stepwise evaluation of secretion management, spontaneous swallowing and laryngeal sensitivity. This study aims to find conformity between the SESETD and FEES in assessing readiness for tracheostomy decannulation in patients with neurologic disorders. MATERIALS AND METHODS: This study is a cross-sectional study conducted on 36 neurologic patients at Cipto Mangunkusumo General Hospital which was aimed to find the agreement between two modalities for tracheostomy decannulation readiness, FEES and SESETD based on parameters, standing secretion, spontaneous swallowing and laryngeal sensitivity. RESULT: A total of 36 subjects were examined and 22 of them underwent successful tracheostomy decannulation. The agreement between FEES and SESETD showed significant results with p-value <0.0001 and Kappa value = 0.47. CONCLUSION: There was conformity between FEES and SESETD in evaluating tracheostomy decannulation readiness based on three parameters: standing secretion, spontaneous swallowing and laryngeal sensitivity.

Relevance of mental health issues in university student dropouts.

BACKGROUND: A significant proportion of university students drop out of their courses, representing a significant loss of resources in terms of funds invested in them, as well as loss of revenue to universities. AIMS: To determine whether a history of recent or current mental health problems affected the likelihood of university students dropping out of their studies and, if so, whether additional supportive measures are needed. METHODS: We scrutinized the occupational health records of a cohort of students enrolled in 2005 to identify whether they had evidence of mental health problems at that time. Additionally, we identified all cohort members who had dropped out of their courses by 2011, thereby identifying students with a history of mental health problems among all those who dropped out. The dates in question were chosen to ensure that the permissible time limit for completing their studies had elapsed at the end of the follow-up period. RESULTS: In total, 1319 student records were surveyed. Of these, 181 students (14%) did not complete their studies. Further, 278 (21%) had evidence of mental health problems at enrolment but students dropping out of courses were not more likely to have had a recent or current mental health problem at the time of enrolling. CONCLUSIONS: The presence of mental health problems at the time of course enrolment was not a predictor for subsequently dropping out of the course in question. The findings suggest that existing supportive measures for this group may be adequate.