Evaluation of Swallowing Function in Relation to Oropharyngeal Dysphagia in Patients with Operated Unilateral Cleft Lip and Palate.

OBJECTIVE: To determine the occurrence of oropharyngeal dysphagia (OD) signs and symptoms in patients with operated unilateral cleft lip and palate (CLP). MATERIALS AND METHODS: This prospective study was conducted on 15 adolescents with operated unilateral CLP (CLP group) and 15 non-cleft volunteers (control group). Initially, the Eating Assessment Tool-10 (EAT-10) questionnaire was administered to subjects. OD signs and symptoms such as coughing, the sensation of choking, globus sensation, the need to clear the throat, nasal regurgitation, difficulties of bolus control multiple swallowing were evaluated by patient complaints and physical examination of swallowing function. Also, the Functional Outcome Swallowing Scale was used to determine the severity of the OD. Fiberoptic endoscopic evaluation of swallowing (FEES) with water, yogurt, and crackers was performed. RESULTS: The prevalence of OD signs and symptoms based on patient complaints and physical examination of swallowing was low (range, 6.7 to 26.7%), and nonsignificant differences were observed between the groups for these parameters as well as for EAT-10 scores. According to the Functional Outcome Swallowing Scale findings, 11 of 15 patients with CLP were asymptomatic. Fiberoptic endoscopic evaluation of swallowing indicated that post-swallow pharyngeal wall residues with yogurt were significant in the CLP group with a prevalence of 53% ( P < 0.05), whereas differences between the groups in terms of cracker and water residues were nonsignificant ( P > 0.05). CONCLUSION: OD in patients with repaired CLP was manifested mainly in the form of pharyngeal residue. However, it did not appear to cause significant increases in patient complaints compared with healthy individuals.

Development of the Breast Cancer Related Lymphedema Self-Care Scale.

The purpose of study was to develop the Breast Cancer Related Lymphedema Self-Care Scale to evaluate the self-care practices of women with breast cancer-related lymphedema (BRCL); and to examine the psycholinguistic and psychometric characteristics of this scale. The item pool of the scale was created based on the literature in this descriptive study. Content validity, explanatory and confirmatory factor analyses used in evaluation of the validity; and item analyzes, the Cronbach's Alpha and Split Half analyzes were made for reliability in the study. The content validity index was found to be above 0.80. In the Explanatory Factor Analysis, a four-factor structure was obtained. In Confirmatory Factor Analysis, fit indices were found to be acceptable. Cronbach's Alpha coefficients of the sub-dimensions of the scale varied between 0.62 and 0.86. It was determined the Breast Cancer Related Lymphedema Self-Care Scale was a valid and reliable scale for women with BRCL.

Fiberoptic endoscopic evaluation of swallowing (FEES) study: the first report in children to evaluate the oropharyngeal dysphagia after esophageal atresia repair.

BACKGROUND: The aim of this study was to evaluate the swallowing problems by fiberoptic endoscopic evaluation of swallowing (FEES) study in both short- and long-gap patients after esophageal atresia (EA) repair. METHODS: Hospital records of patients who had undergone surgery for EA were reviewed retrospectively. Patients were divided into two groups as short-gap (SG) group (n:16) and long-gap (LG) group (n:10) to compare the swallowing problems. FEES study was performed, and the results were discussed in detail. RESULTS: There were twenty-six (16 M/10 F) patients with a mean age at evaluation was 7.52 ∓ 3.68 years. Mean follow-up period was 75.35 ∓ 44.48 months. In FEES study, pharyngeal phase abnormalities were detected in 10 patients (38.4%). Pharyngeal phase abnormalities were detected significantly higher in LG group (p:0.015). Laryngeal penetration/aspiration was seen in four patients on FEES study (15.3%). All of them was in LG group (40%). Laryngeal penetration/aspiration was seen significantly higher in LG group (p:0.014). CONCLUSION: This is the first study to conduct FEES study in children after esophageal atresia repair to evaluate their swallowing conditions. Even though our sample is small, swallowing problems are more common than expected in the cases of LG when compared to SG.

Self-care practices, patient education in women with breast cancer-related lymphedema.

OBJECTIVES: This study aims to evaluate self-care practices, sociodemographic and clinical factors that affect self-care and patient education among women with breast cancer-related lymphedema (BCRL). PATIENTS AND METHODS: This descriptive, cross-sectional study included a total of 102 women with BCRL (median age: 59 years; range, 35 to 80 years) who received lymphedema (LE) treatment at least once between July 2014 and May 2016. A Sociodemographic and Clinical Characteristics Form and the Lymphedema Self-care Survey were used to collect data via face-to-face interviews. RESULTS: The median LE self-care practices score for women was 10 (range, 5 to 14). A total of 39.1% of the women implemented regular self-care. A statistically significant relationship was found between the score for perceived benefit of LE self-care and the score for self-care practice. No statistically significant difference was found among the self-care scores of the women with LE in terms of sociodemographic and clinical factors, except for education status. A total of 90.2% of the women with LE received self-care education, mostly from a physical therapy specialist and a physiotherapist. There was a statistically significant difference among self-care scores between patients who were educated and uneducated about LE. CONCLUSION: It is recommended that healthcare professionals should educate patients diagnosed with breast cancer to reduce LE risk and promote the implementation of self-care practices following the breast cancer surgery. Interventions should be made to increase the perceived benefits and reduce the perceived barriers and burden towards self-care behaviors to prevent and manage LE.

The effects of complex decongestive therapy on kinesthetic sense of hands, upper extremity function, and quality of life in patients with breast cancer-related lymphedema.

OBJECTIVES: This study aims to investigate the effect of complex decongestive therapy (CDT) on the kinesthetic sense of hands, upper extremity function, and the quality of life in patients with breast cancer-related lymphedema (BCRL). PATIENTS AND METHODS: Between August 2018 and August 2019, total of 50 women with BCRL (mean age: 56.5±9.6 years; range, 36 to 71 years) were included in the study. Kinesthetic sense of the hand, upper extremity function (Disabilities of the Arm, Shoulder and Hand [DASH]), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire [EORTC QLQ-C30]), and arm volume of all patients were evaluated before and after the treatment. All patients received CDT for 20 sessions for 1 h over a total of four weeks. RESULTS: A statistically significant decrease in the volume of the involved extremity was observed after the treatment (p<0.001). There was a significant decrease in the symptom score (p<0.001) and a significant improvement in the general health status and functional scales of the EORTC QLQ-C30 (p<0.001 and p=0.012, respectively). The DASH scores and visual and kinesthetic sense scores of the patients significantly improved after the treatment (p=0.016, p=0.008, and p<0.001, respectively). CONCLUSION: Our study results show that BCRL is a serious complication which may lead to impairment in the kinesthetic sense of hand and upper extremity function with the increased arm volume. The CDT is an effective and safe method not only to achieve significant volume reduction in the extremities, but also to achieve favorable results in managing these problems.

Effects of Yoga on Phase Angle and Quality of Life in Patients with Breast Cancer: A Randomized, Single-Blind, Controlled Trial.

INTRODUCTION: Phase angle (PA), a parameter that is obtained from body composition analysis, is an indicator of cellular health status. A lower PA in cancer patients can lead to a decrease in functional status and quality of life (QoL) and increased mortality. Studies have shown that physical activity increases PA. In this study, we aimed to examine the effects of Hatha yoga on PA, body composition, and QoL in patients with breast cancer. METHODS: Thirty-one patients were randomized into the yoga (group 1, n = 15) and the control group (group 2, n = 16). Hatha yoga was practiced twice a week for 10 weeks in the intervention group. The PA of the patients was assessed using a body analysis instrument, and QoL was evaluated with an EORTC QLQ questionnaire both before treatment and at week 10. RESULTS: Group 1 had significant improvements in the posttreatment EORTC QLQ functional and global scores (p < 0.05). In group 2, a significant improvement was observed in the EORTC QLQ symptom subscale (p = 0.035). PA values did not show any improvements in both groups (p > 0.05). Comparison of the 2 groups revealed no differences. CONCLUSION: Yoga may have beneficial effects on QoL in patients with breast cancer but does not have a significant effect on PA. There is a need for further studies to make a definitive statement.

Adaptation of Quality of Life Measure for Limb Lymphedema-Arm in Turkish Women With Breast Cancer-Related Lymphedema.

BACKGROUND: Quality-of-life measures are needed for clinicians and researchers to identify quality of women's life with breast cancer-related lymphedema (BCRL). OBJECTIVE: To adapt Quality of Life Measure for Limb Lymphedema-Arm into Turkish (TR) and to test its validity and reliability. METHODS: This is a methodological and cross-sectional study and was conducted in the lymphedema outpatient clinic of a university hospital. The study included 109 women with BCRL. After linguistic validity of the scale was achieved, confirmatory factor analyses and known group validity were used to test its construct validity. Reliability of the scale was tested with Cronbach's α, item-total correlations, and Spearman-Brown coefficient. RESULTS: After linguistic validity was achieved, opinions requested from 5 experts specializing in lymphedema showed that item and content validity indexes of the scale were 1. Fit indexes of confirmatory factor analysis were as follows: χ/df = 1.86, root mean square error of approximation = 0.089, standardized root mean square residual = 0.09, and comparative fit index = 0.81. Known group validity analysis showed a significant difference in the mean scores for the subscales of Quality of Life Measure for Limb Lymphedema-Arm-TR, symptom, function, and body image/appearance in terms of lymphedema stages (P < .05). The internal reliability coefficients for the subscales ranged from 0.78 and 0.86. The item-total correlation coefficients ranged between 0.36 and 0.73. CONCLUSION: Quality of Life Measure for Limb Lymphedema-Arm-TR was found to be valid and reliable in the TR population. It could be used in research to evaluate the quality of life in patients with BCRL. IMPLICATIONS FOR PRACTICE: The scale can be used to evaluate effectiveness of nursing interventions directed toward patients developing breast cancer-related lymphedema in clinical settings and studies.

Validity and reliability of the Turkish version of the lymphedema symptom intensity and distress survey.

OBJECTIVES: This study aims to adapt the Lymphedema Symptom Intensity and Distress Survey- Arm (LSIDS-Arm) into Turkish and to test its validity and reliability. PATIENTS AND METHODS: Between September 2017 and July 2018, this descriptive, methodological study included a total of 186 women (mean age: 55.4±10.2 years; range, 20 to 80 years) who were diagnosed with breast cancer-related lymphedema (BCRL) and followed in the lymphedema outpatient clinic. Data were collected using sociodemographic and clinical features form, LSIDS-Arm, and Functional Assessment of Cancer Treatment-Breast Cancer Scale+4 (FACT-B+4). After the linguistic and content validity of the scale was achieved, confirmatory factor analysis and known-groups validation were utilized to test the construct validity. Reliability of the survey was tested using the Cronbach alpha and Spearman Brown coefficient, item analysis, and parallel forms reliability. RESULTS: All patients completed the questionnaire. After achievement of linguistic and content validity, confirmatory factor analysis results were found to be higher than the accepted value. Known-groups validation revealed a significant difference in the mean scores for the intensity and distress scales between the patients with and without lymphedema. Cronbach alpha for the subscales ranged from 0.61 to 0.86. Parallel forms reliability showed a moderate, significant correlation between subscales of the intensity and distress scales of the survey and the subscales of FACT-B+4. CONCLUSION: The Turkish version of the survey is valid and reliable and can be used to evaluate symptoms, severity of symptoms, and distress caused by BCRL symptoms in the Turkish women.

Long-term swallowing outcomes of radiotherapy and transoral laser microsurgery for T1 glottic cancer treatment.

INTRODUCTION: Both CO2 transoral laser microsurgery (CO2 TOLMS) and radiotherapy (RT) are standard of care in early glottic carcinoma. However, previous studies focus on voice outcomes rather than swallowing outcomes. This study aimed to compare the late post-treatment effects of CO2 TOLMS and RT treatment on swallowing function in T1 glottic carcinoma. METHODS: Forty patients (20 CO2 TOLMS and 20 RT) with T1 glottic cancer between May 2015 and January 2019 were included. Certain types of foods triggering dysphagia, any difficulties in bolus control, need to clean the throat, the sensation of lumping in the throat, choking, cough and xerostomia were questioned. Also, functional oral intake scale (FOIS), functional outcome swallowing scale (FOSS), Eating Assessment Tool-10 test (EAT-10) and flexible fiberoptic endoscopic examination of swallowing (FEES) findings were assessed. RESULTS: CO2 TOLMS patients performed significantly better than the RT group regarding penetration and aspiration with 10 and 20 mL water according to the Penetration and Aspiration Scale (P < .05). The mean EAT-10 Score was found 0 in the CO2 TOLMS group, and 3.20 ± 3.24 in the RT group (P < .05) (lower score indicates a better outcome). According to the Yale Pharyngeal Residue Severity Scale for vallecula, there was no statistically significant difference in vallecular residue between the groups (P > .05). A significantly lesser residue in piriform sinus was detected in the CO2 TOLMS group compared to the RT group with 5 mL and 10 mL water, 5 mL and 20 mL honey consistency food and yogurt according to Yale Pharyngeal Residue Severity Scale (P < .05). CONCLUSION: It is suggested that in the long term, CO2 TOLMS is more advantageous regarding swallowing function in the treatment of T1 glottic cancer.

Polypharmacy, Physical and Nutritional Status, and Depression in the Elderly: Do Polypharmacy Deserve Some Credits in These Problems?

Background: To investigate the association of polypharmacy with physical function, nutritional status, and depression in the elderly. Method: The study included 675 people aged over 65 years from 8 centers in various geographical regions. The polypharmacy status was categorized as non-polypharmacy (0-4 drugs), polypharmacy (≥5 drugs). The subjects' physical function was assessed based on their "physical activity levels, Holden ambulation scores, gait speeds, and hand grip strengths"; their nutritional status based on the "Mini Nutritional Assessment (MNA)"; and their psychological status based on the "Center for Epidemiologic Studies Depression Scale -CES-D". Results: The presence of polypharmacy in this population was found to be 30% (n = 203). A statistically significant difference was found between the groups on the level of physical activity, Holden ambulation score, and nutrition status (p < .05). There was a statistically significant difference between the groups also on hand grip strength, MNA score, Charlson score (p < .05). Conclusion: Polypharmacy was observed to have a significant association with physical function, nutrition, and depression in the elderly aged ≥ 65 years.

Assessment of Muscle Strength and Volume Changes in Patients with Breast Cancer-Related Lymphedema.

INTRODUCTION: To determine whether complete decongestive therapy (CDT) used in breast cancer-related lymphedema affects muscle strength in the affected arm while assessing the efficacy of the therapy itself. MATERIAL AND METHODS: Seventy-four patients with breast cancer-related lymphedema were included in this study. The demographic and clinical history characteristics of the patients were taken. The patients were then evaluated with measurements of extremity volumes and handgrip strengths using a hand dynamometer before and after the CDT. Data were then assessed using relevant statistical methods. RESULTS: The mean CDT duration was 17.5 ± 8.93 days for the patients. Therapy resulted in significant improvement in the affected arm (p < 0.01). The difference between the arm with lymphedema and the other side was statistically significant, and this difference remained after the therapy (p < 0.01). The change in handgrip strength in the side with lymphedema was not found to be statistically significant after therapy (p > 0.05). Handgrip strength differences and volume differences before and after the treatment in the affected arm were not correlated (p > 0.05). CONCLUSION: Limbs affected with lymphedema were found to be weaker in handgrip strength and this weakness continued throughout the therapy. Strengthening exercises should be considered to be added into the treatment of patients undergoing CDT to gain better functional potential.

Kinesio taping and low-level laser therapy in breast cancer-related lymphedema in an arm with arteriovenous fistula for hemodialysis.

Secondary lymphedema mainly occurs as a result of impairment or obstruction of the lymphatic system. Although complex decongestive therapy is recognized as the best management technique of lymphedema, we encounter various patient profiles in our clinical practice and may need to apply alternative treatment options. In this article, we report a 57-year-old female patient with breast cancer-related lymphedema and arteriovenous (AV) fistula for hemodialysis in the same arm. We performed low-level laser therapy treatment for 12 sessions, kinesio taping, and remedial exercises to the patient as the compression part of complex decongestive therapy was contraindicated in the AV fistula. Self-manual lymphatic drainage training and skin care education were also given. The arm volume difference was decreased from 691 mL to 454 mL after the treatments. Low-level laser therapy and kinesio taping should be kept in mind as alternative techniques for appropriate cases in the treatment of lymphedema.

Objective analysis of swallowing and functional voice outcomes after thyroidectomy: A prospective cohort study.

BACKGROUND: Impairment in voice and swallowing functions are common after thyroidectomy. We aimed to evaluate the objective functional voice and swallowing outcomes in a series of patients undergoing thyroidectomy. METHODS: A total of 43 consenting patients who underwent thyroidectomy were prospectively recruited. Subjective evaluation of swallowing was assessed with 'Swallowing Impairment Score' and 'MD Anderson Dysphagia Inventory'. Fiberoptic endoscopic evaluation of swallowing (FEES) was applied for objective evaluation. Also, functional oral intake scale (FOIS) and functional outcome swallowing scale (FOSS) were used for swallowing assessment. Voice evaluation was assessed with videostrobolaryngoscopy (VSL) and 'The Multi-Dimensional Voice Program (MDVP)' was used for capturing and analyzing the voice samples. All evaluations were performed preoperatively and on 1st day, 2nd week and 6th months postoperatively. This study is registered with ClinicalTrials.gov, number NCT03436186. RESULTS: According to the objective analyses there was no difference between pre- and post-operative scores for the intake of fluid and thickened liquid food. There was a significant difference regarding light and moderate residual accumulation in solid food intake (p = 0.013). FOSS showed no difference, but FOIS revealed specific functional limitation (p = 0.034). Subjective data showed no correlation with objective findings (p > 0.05). Regarding voice evaluation, a significant increase was observed in standard deviation of average fundamental frequency and degree of subharmonics (p < 0.01). CONCLUSION: Even in the absence of recurrent laryngeal nerve injury, subjective and objective swallowing and voice alterations do occur after thyroidectomy.