Recognizing dysphagia: implementation of an in-hospital screening protocol.

BACKGROUND: Dysphagia affects up to 30% of hospitalized patients, and it is associated with numerous complications. AIMS: Assess the impact of a 24/7 dysphagia screening protocol in an Internal Medicine Unit regarding respiratory complications (such as aspiration pneumonia) as the primary outcome. Length of stay and discharge destination were secondary outcomes. METHODS: Case-control hospital-based analysis comparing the outcomes before and after the implementation of the screening protocol. We analysed demographic data (such as age and gender) and clinical data (presence of dysphagia, vascular risk factors and other comorbidities, respiratory complications, in hospital length of stay and discharge destination). Patients with at least one of the following risk factors were included: COPD (chronic obstructive pulmonary disease), neurodegenerative disorders including dementia, acute stroke or chronic cerebrovascular disease, head and neck neoplasms/surgery or radiotherapy. Statistical analysis was performed with SPSS®. RESULTS: One hundred twenty-eight consecutive patient files were reviewed as the historical control, while 125 consecutive patients were evaluated after the screening protocol was implemented. Even though the second group had less evidence of dysphagia (33 vs 36), since it was detected earlier, respiratory complications were significantly lower (11.7% before vs 2.4%, p < 0.001), allowing more patients to be discharged home (65.6% vs 84%, p = 0.005) and less mortality (15.6% vs 4%, p = 0.005). CONCLUSIONS: Despite its limitations, this study demonstrates that dysphagia screening produces a significant impact on patients' lives, as well as healthcare professionals and resources. We hope that our results will encourage others to adopt a patient-centred multidisciplinary approach that includes a dysphagia screening protocol.

Prevalence of Vocal Problems in Portuguese Primary and Secondary School Level Teachers

This study compared the prevalence of vocal problems in two Portuguese groups: 73 teachers that use their voice as professional tool (teachers' group) and 73 non-voice professionals (control group). It also identified the risk factors that contributed to teachers' group voice problems. A questionnaire was applied to both goups in order to obtain information about vocal health, hygiene and behavior, profes-sional activity and general physical health. Statistical results revealed that the teachers' group presented a higher prevalence of vocal problems than the control group: 52% reported hoarseness, 46.6% vocal fatigue and 45.2% vocal discomfort compared with 31.5%, 20.5 % e 28.7%, respectively. Environmental factors (eg., smoke and cold temperatures), vocal abuse and upper respiratory pathologies (e.g., colds, laryngitis and pharyngitis) seemed to increase teachers' voice disorders (p-value < .05). In conclusion, the absence of vocal pedagogy in the curricular plan of teachers' higher education associated to poor working environmental conditions and professional voice demands explained the higher prevalence of vocal problems in teachers' group.

Este estudo avalia e compara a prevalência dos problemas vocais em dois grupos: 73 professores que usam a sua voz como ferramenta profissional (grupo experimental) e 73 sujeitos que não usam, profis-sionalmente, a voz (grupo de controlo). Foram também identificados os fatores de risco dos problemas vocais. Foi aplicado um questionário a ambos os grupos no sentido de obter informação sobre compor-tamento e higiene vocais, atividade profissional e saúde geral. Os resultados estatísticos revelaram que o grupo dos professores apresentou maior prevalência de problemas vocais que o grupo controle: 52% reportaram rouquidão, 46,6% fadiga vocal e 45,2% desconforto vocal, comparados com 31,5%, 20,5% e 28,7%, respectivamente. Fatores ambientais, tais como fumo e frio, abuso vocal e patologias do trato respiratório superior, tais como constipações, laringites ou faringites foram considerados como fatores de risco dos problemas vocais dos professores (p-value < 0.05). Concluí-se que a ausência de técnica vocal no plano curricular da formação acadêmica de professores, associada às fracas condições ambientais de trabalho e à exigência vocal da atividade profissional justificam a prevalência das perturbações vocais, entre os professores.

Este estudio evalua y compara la prevalencia de los problemas vocales en dos grupos: 73 profe-sores que usan su voz como herramienta profesional (grupo experimental) y 73 sujetos que no usan, profesionalmente, la voz (grupo de control). Han sido también identificados los factores de riesgo de los problemas vocales. Ha sido aplicada una encuesta a ambos grupos para obtener informaciones sobre comportamiento e higiene vocales, actividade profesional y salud general. Los resultados estadísticos han revelado que el grupo de los profesores ha presentado una mayor prevalencia de problemas vocales que el grupo de control: el 52% ha referido ronquera, el 46,6% fatiga vocal y el 45,2% malestar vocal, comparados con el 31,5%, el 20,5% y 28,7%, respectivamente. Factores ambientales, como humo y frio, abuso vocal y patologías del trato respiratorio superior, como constipaciones, laringitis o faringitis han sido considerados como factores de riesgo de los problemas vocales de los profesores (p-value < 0.05). Se concluye que, la ausencia de técnica vocal en el plan curricular de la formación académica de los profesores, asociada a las débiles condiciones ambientales de trabajo y a la exigencia vocal de la actividad profesional, justifican la prevalencia de las perturbaciones vocales, entre los profesores.