The Impact of Cervical Spinal Disease on Pharyngeal Swallowing Function.

PURPOSE: Spinal pathology is very common with advancing age and can cause dysphagia; however, it is unclear how frequently these pathologies affect swallowing function. This study evaluates how cervical spinal pathology may impact swallowing function in dysphagic individuals observed during videofluoroscopic swallowing studies (VFSSs). METHOD: A retrospective case-control study was performed on 100 individuals with dysphagia as well as age-/gender-matched healthy controls (HCs) with available VFSS. Spinal anatomy of patients was classified into two predetermined categories, and a consensus decision of whether spinal pathology influenced swallowing physiology was made. Validated swallow metrics, including Modified Barium Swallow Impairment Profile (MBSImP) component scores, Penetration-Aspiration Scale (PAS) maximum scores, and 10-item Eating Assessment Tool (EAT-10) scores, were compared between the spine-associated dysphagia (SAD), non-SAD (NSAD), and HC groups using Kruskal-Wallis one-way analysis of variance. RESULTS: Most patients with dysphagia had spinal pathology. Spinal pathology was judged to be the primary etiology of dysphagia in 16.9% of patients with abnormal spine pathology. Median EAT-10 scores were statistically different among the three groups, with the NSAD group scoring the highest and the HC group scoring the lowest. Similarly, median PAS scores were significantly different between dysphagic groups and HCs. Median MBSImP Oral Total scores were significantly different only between the NSAD group and HCs, whereas Pharyngeal Total score was not significantly different among the groups. CONCLUSIONS: Spinal pathology is commonly observed during VFSS and can contribute to dysphagia, resulting in worse swallowing-related outcomes when compared with HCs. Patients judged to have SAD tended to have better outcomes than patients with dysphagia from other etiologies, perhaps due to the progressive nature of spinal disease that allows for compensatory swallowing physiology over time.

The impact of nurse staffing on falls performance within a health care system: A descriptive study.

AIM: The purpose of this study was to examine the impact of nurse staffing on inpatient falls performance across a multi-hospital system. BACKGROUND: Evidence to support which staffing variables influence fall performance so that health care organizations can better allocate resources is lacking. METHOD: A descriptive study design was used to analyse the impact of nurse staffing and falls performance, with units dichotomized as either high or low performing based on national benchmarking data. The impact was evaluated using 10 nurse staffing variables. RESULTS: A total of nine units were included (five high and four low performing). Higher performing units showed less use of sitters and travellers, had fewer overtime hours worked by nurses, and employed more expert-level clinical nurses and combined nursing assistant/health unit coordinator positions, than lower performing units. CONCLUSION: Findings provide evidence of how staffing variables affect a unit's falls performance. While significant relationships were found, further evaluation is needed to explore the relationship of staffing variables and quality outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers may consider trying to reduce use of sitters and travellers, and utilize innovative staffing models, such as using combined nursing assistant/health unit coordinator positions, to help improve their falls performance.

A Systematic Review of Voice Therapy: What "Effectiveness" Really Implies.

INTRODUCTION: Behavioral voice therapy guided by a speech-language pathologist is recommended as the main treatment approach for many kinds of voice disorders. Encouraging evidence regard of good outcomes from voice therapy has been found in two previous reviews on broad patient populations. However, no definitive conclusion on the effectiveness of direct voice therapy can be drawn from these reviews due to limitations of the included studies. AIMS: To review recent literature on voice therapy; to provide clinicians with a list of evidence-based voice therapy techniques; to incorporate the therapy components in a physiologically based model; to assess the limitations and progress achieved in the recent research on voice therapy. METHODS: A literature search was conducted using three electronic databases: PubMed, Scopus, and CINAHL. A similar strategy was used in all three databases to highlight the concepts of "therapy" and "voice disorders." Only randomized controlled trials were included in the review. RESULTS: Fifteen papers met the inclusion criteria, covering five categories of voice disorders (functional, Parkinson induced, GERD induced, presbyphonia, unilateral vocal fold paresis) and seven specific behavioral voice therapy approaches. Statistically significant improvements were found postintervention on at least one outcome variable in all but one study. Clinical significance of the results was rarely discussed. Discrepancies in reported outcome measures were found across studies, making comparisons between interventions challenging. CONCLUSION: Behavioral voice therapy generally leads to significant improvements in voice outcomes, but further research considering clinical meaningfulness of the results are needed to establish what is really meant by the term "effectiveness" when it comes to voice therapy.

Pre-Hospital Management and Risk Factors in Children with Acute Diarrhoea Admitted to a Short-Stay Ward in an Urban South African hospital with a High HIV Burden

Background. Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are not well described.Objectives. To document pre-hospital home and primary care management of diarrhoea; and certain risk factors and complications of diarrhoea.Methods. We used a prospective descriptive convenience sample of children admitted to the short-stay ward at Tygerberg Hospital; Parow; Cape Town; between 1 February 2007 and 31 May 2008. Caregivers were interviewed; and demographic; clinical and laboratory variables were collected.Results. We recruited 142 children; median age 8.9 months. A third had moderate malnutrition. Twenty-four (16.9) were HIV-exposed; with 9 (6.3 HIV-infected. HIV-exposed children were significantly younger than unexposed children (p=0.03). Weight-for-age Z-scores (WAZ) were significantly lower in HIV-infected than in HIV-exposed; uninfected children (p=0.02). Eighty per cent of caregivers gave ORT and 35.2stopped feeds. Only 1 of 43 children aged under 6 months was exclusively breastfed. Advice at primary care level rarely complied with IMCI guidelines. Conclusions. Most caregivers do give ORT; but advice given at primary care level is often suboptimal. Many hospitalised children with diarrhoea are malnourished. Children with HIV infection are at increased risk of diarrhoeal disease and malnutrition; and HIV exposure appears to increase the risk of early presentation with diarrhoea. Ongoing strategies are needed to ensure optimal prevention policies; pre-hospital management and nutritional rehabilitation

The changing profile of pediatric meningitis at a referral centre in Cape Town, South Africa.

BACKGROUND: Pediatric meningitis remains a common cause of childhood morbidity and mortality in developing countries. Knowledge of the causative organisms in a region is of importance in guiding empiric antibiotic regimes and immunization schedules assisting decisions on primary health-care interventions. METHODS: This retrospective review of 557 meningitis cases represents a third pediatric survey conducted over a 3-year period (January 2007 to December 2009) at the same institution and after an interval of 14 years. Cases were identified using cerebrospinal fluid results. Demographic and laboratory variables were collected and meningitis was classified as aseptic/viral, bacterial, septic, tuberculous meningitis (TBM) or fungal. RESULTS: The commonest form of bacterial meningitis was TBM diagnosed in 22% (n = 126) of children. Streptococcus pneumoniae 4% (n = 23) and Klebsiella pneumoniae 3% (n = 17) were the next commonest causes of bacterial meningitis diagnosed. Haemophilus influenzae meningitis occurred in <1% (n = 3) of cases with a median age of 3 months. Aseptic meningitis remains the commonest category. Human immunodeficiency virus (HIV) testing was requested in 43% (n = 241) of cases; 8% (n = 46) were positive. CONCLUSION: TBM remains the commonest cause of pediatric bacterial meningitis in the Western Cape. It is concerning that the percentage of TBM cases out of the total study population has more than doubled compared with that in previous surveys. The low prevalence and young age of H. influenzae meningitis cases confirm the benefits derived from H. influenzae type b (Hib) vaccination.

Pediatric and adolescent imported malaria in Cape Town.

We reviewed 42 cases of pediatric and adolescent imported malaria in Cape Town. Patients were predominantly new and returned immigrants from other African countries. Rapid diagnosis occurred in most cases. Eleven of 42 (26%) had severe malaria. Management issues included delay to and inappropriate treatment, inadequate monitoring for hypoglycemia, and under notification to health authorities.