Advances in the Treatment of Dysphagia in Neurological Disorders: A Review of Current Evidence and Future Considerations.

Dysphagia, which refers to difficult and/or disordered swallowing, is a common problem associated with various neurological diseases such as stroke, motor neuron diseases and neurodegenerative diseases. Traditionally, dysphagia treatments are either compensatory, which includes modifications of bolus texture or feeding posture, or rehabilitative, which includes behavioral exercises and sensory stimulation. Despite being widely adopted in clinical practice, recent views have challenged the clinical efficacy of these treatments due to the low level of evidence supported by mainly non-controlled studies. As such, with advancements in technology and scientific research methods, recent times have seen a surge in the development of novel dysphagia treatments and an increasing number of robust randomized controlled clinical trials. In this review, we will review the clinical evidence of several newly introduced treatments for dysphagia in the last two decades, including rehabilitative exercises, biofeedback, pharmacological treatments, neuromodulation treatments and soft robotics. Despite the recent improvements in the quality of evidence for the efficacy of dysphagia treatments, several critical issues, including heterogeneity in treatment regimens, long-term treatment effects, underlying mechanisms of some neuromodulation treatments, and the effects of these techniques in non-stroke dysphagia, remain to be addressed in future clinical trials.

A review of the clinical assistant workforce at a district general hospital during the COVID-19 pandemic.

INTRODUCTION: In April 2020, a new workforce of clinical assistants (CAs), comprising predominantly of medical students, began work at Northampton General Hospital. Clinical-years students had a role similar to final-year student assistants; pre-clinical students were offered a healthcare assistant role. This research aimed to evaluate both CAs' and clinicians' perceptions of this programme. METHODS: Separate questionnaires were developed for CAs and clinicians, assessing the scheme's successes and failures. Data analysis was carried out using MS Excel and SPSS. RESULTS AND DISCUSSION: Forty-nine CAs and 60 clinicians responded. CAs of all years were completing the higher-level role. They were perceived to improve continuity of care (74% CA agreement; 88% clinician agreement), reduce clinician workload (90% clinician agreement) and felt significantly more confident with practical and administrative tasks. Sixty-eight per cent of CAs and 72% of clinicians believed the role should be available to students before their final year.

Fissurectomy with posterior midline sphincterotomy for management of chronic anal fissure.

OBJECTIVE: To determine the efficacy and safety of fissurectomy with posterior midline sphincterotomy in the management of chronic anal fissure in terms of symptomatic relief, complications and recurrence. STUDY DESIGN: Observational case-series. PLACE AND DURATION OF STUDY: Department of Surgery, Liaquat University Hospital, Jamshoro/Hyderabad, for a period of 3 years from January 2005 to December 2007. METHODOLOGY: A total of 136 patients with chronic anal fissure were recruited for this study. All subjects underwent elective fissurectomy and posterior sphincterotomy. Surgery was performed either under spinal or general anaesthesia. Symptomatic relief and early postoperative complications were recorded. The patients were followed for 18 months. Follow-up included assessment for complications such as pain, incontinence, keyhole deformity, and recurrence. RESULTS: All patients presented with pain during and after defaecation. Forty (29.4%) patients presented with bleeding per rectum. One hundred and sixteen (85%) patients complained of perianal swelling while 8 (5.9%) patients complained of perianal itching. Retention of urine was the most common postoperative complication, seen in 10 (7.4%) cases. It occurred within the first 24 hours after operation and all cases required catheterization. Six (4.4%) patients complained of moderate to severe postoperative pain in the first 24 hours, requiring narcotic analgesics. Transient incontinence of flatus and faeces occurred in 5 (3.7%) and 3 (2.2%) cases respectively. One patient presented with a recurrent anal fissure after 8 months but responded to conservative treatment. CONCLUSION: Given the low rate of complications and almost negligible rate of recurrence, fissurectomy with posterior midline sphincterotomy is still a treatment of choice for the management of chronic anal fissure.

A systematic review and meta-analysis of probiotics for the management of radiation induced bowel disease.

BACKGROUND & AIMS: A meta-analysis to estimate the efficacy of probiotics in prevention of radiation-induced bowel disease after pelvic radiotherapy has been performed. Previous attempts have arguably failed to provide a comprehensive analysis of clinical trials and their outcomes. METHODS: We searched for studies indexed in Medline, EMBASE, Cochrane Library, and on-line clinical trials registers. There was no language or time limit. Each study was evaluated for methodological quality and outcomes. We identified four outcomes on which to perform meta-analysis: incidence of diarrhoea, loperamide use, watery, and soft stools (Bristol Stool Chart). Odds ratio (OR) was used to compare efficacy, and the pooled OR was estimated using a random effects model; heterogeneity was assessed with Cochran's Q and Higgins I(2) test. Analyses were performed using Review Manager 5.2. RESULTS: Ten studies were included in our systematic review, of which six were subjected to meta-analysis to compare probiotics against placebo. Quality assessment showed an unclear risk due to incomplete outcome data and lack of performance of intention-to-treat analysis, while blinding and randomization issues were present in certain studies. Pooled results showed heterogeneity (Cochran's Q: p < 0.05; I(2): high). However the pooled OR for the incidence of diarrhoea, synthesized from 6 studies, significantly favoured the use of probiotics over control (OR = 0.44, 95% CI 0.21-0.92). Numerically, but not statistically, probiotics seem to decrease loperamide use (OR = 0.29, 95% CI 0.01-6.80) and the incidence of watery stools (OR = 0.36, 95% CI 0.05-2.81). CONCLUSIONS: In conclusion, probiotic supplementation shows a probable beneficial effect in the prevention, and possible benefit in the treatment, of radiation-induced diarrhoea.