Impact of thermo-tactile stimulation on the speed and efficiency of swallowing: a systematic review.

BACKGROUND: A delayed or absent swallow reflex is common in dysphagia and can have a significant impact on swallow safety. Recent clinical practice survey data have supported the fact that clinicians continue to use thermo-tactile stimulation (TTS) as a strategy to stimulate key nerve pathways and evoke a swallow reflex for patients with a delayed or absent swallow reflex. AIMS: To conduct a systematic review of the effectiveness of TTS as a compensatory and/or rehabilitative tool. METHODS & PROCEDURES: A search performed on CINAHL, Medline and Speech Bite identified 599 articles. After removing duplicates, the titles and abstracts of 458 articles were assessed for eligibility; 426 articles were deemed to be clearly ineligible and the remaining 32 full-text articles were further screened for inclusion. Ten of these studies were included in this review. MAIN CONTRIBUTION: The results of this review highlight the lack of available evidence in this area and give support to the view that there is only low-level evidence for use of TTS as a compensatory strategy immediately before a swallow. CONCLUSIONS & IMPLICATIONS: There is low-level evidence to support the use of TTS. Current best practice would be to use TTS on a case-by-case basis, following detailed instrumental assessment and evaluation of its efficacy for an individual.

Inpatient HbA1c testing: a prospective observational study.

OBJECTIVE: To use admission inpatient glycated hemoglobin (HbA1c) testing to help investigate the prevalence of unrecognized diabetes, the cumulative prevalence of unrecognized and known diabetes, and the prevalence of poor glycemic control in both. Moreover, we aimed to determine the 6-month outcomes for these patients. Finally, we aimed to assess the independent association of diabetes with these outcomes. RESEARCH DESIGN AND METHODS: Prospective observational cohort study conducted in a tertiary hospital in Melbourne, Australia. PATIENTS: A cohort of 5082 inpatients ≥54 years admitted between July 2013 and January 2014 underwent HbA1c measurement. A previous diagnosis of diabetes was obtained from the hospital medical record. Patient follow-up was extended to 6 months. RESULTS: The prevalence of diabetes (known and unrecognized) was 34%. In particular, we identified that unrecognized but HbA1c-confirmed diabetes in 271 (5%, 95% CI 4.7% to 6.0%) patients, previously known diabetes in 1452 (29%, 95% CI 27.3% to 29.8%) patients; no diabetes in 3359 (66%, 95% CI 64.8-67.4%) patients. Overall 17% (95% CI 15.3% to 18.9%) of patients with an HbA1c of >6.5% had an HbA1c ≥8.5%. After adjusting for age, gender, Charlson Index score, estimated glomerular filtration rate, and hemoglobin levels, with admission unit treated as a random effect, patients with previously known diabetes had lower 6-month mortality (OR 0.69, 95% CI 0.56 to 0.87, p=0.001). However, there were no significant differences in proportions of intensive care unit admission, mechanical ventilation or readmission within 6 months between the 3 groups. CONCLUSIONS: Approximately one-third of all inpatients ≥54 years of age admitted to hospital have diabetes of which about 1 in 6 was previously unrecognized. Moreover, poor glycemic control was common. Proportions of intensive care unit admission, mechanical ventilation, or readmission were similar between the groups. Finally, diabetes was independently associated with lower 6-month mortality.

Defolliculated (dfl): a dominant mouse mutation leading to poor sebaceous gland differentiation and total elimination of pelage follicles.

Defolliculated is a novel spontaneous mouse mutation that maps to chromosome 11 close to the type I keratin locus. Histology shows abnormal differentiation of the sebaceous gland, with the sebocytes producing little or no sebum and undergoing abnormal cornification. The hair follicles fail to regress during catagen leading to abnormally long follicles. In contrast the hair shafts are shorter than normal, suggesting altered differentiation or proliferation of matrix cells during anagen. The shafts emerge from the follicle with cornified material still attached. The dermis contains increased numbers of immune cells, including T cells (CD4-positive), macrophages, and mast cells, at all time points examined. Complete elimination of all pelage and tail follicles occurs after two to three hair cycles, apparently by necrosis. Defolliculated may be a useful model for determining further functions of the sebaceous gland, and for understanding the regulation of catagen and hair follicle immunology.

Physico-chemical properties, probiotic survivability, microstructure, and acceptability of a yogurt-like symbiotic oats-based product using pre-polymerized whey protein as a gelation agent.

Consumption of a food product containing prebiotics and probiotics has been recognized as an important factor in lowering risk of intestinal cancer and gastrointestinal diseases and risks associated with high cholesterol. An oats-based symbiotic yogurt-like food (Oagurt) was developed using oats and probiotics (Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium), with pre-polymerized whey protein (PWP) as a gelation agent. The product was also fortified with inulin to increase soluble fiber, minerals, and vitamins. Physico-chemical analyses and 9 wk shelf life for viability of probiotics and changes in pH and viscosity were carried out for formulations with (F) and without (C) fortification. Results of the shelf life study showed that both L. casei and Bifidobacterium remained at therapeutic levels: 4.8 x 10(6) CFU/g (F), 4.3 x 10(6) CFU/g (C) and 3.1 x 10(6) CFU/g (F), 3.17 x 10(6) CFU/g (C) after 9 wk. However L. acidophilus did not survive after 3 wk. Viscosity and pH decreased significantly during the study with the difference between formulations also significant for pH (P < 0.0001). Scanning electron microscopy of samples revealed that the pre-polymerized whey protein played a major role in the structure of the gel with an increased protein network structure visible at higher PWP levels. A consumer acceptability study showed that the product was "fair" for all organoleptic attributes.