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1.
J Neurosci Nurs ; 41(4): 178-85; quiz 186-7, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19678503

ABSTRACT

The purpose of this retrospective study of aspiration and the lack of a protective cough reflex at the vocal folds (silent aspiration) was to increase the awareness of nursing staffs of the diagnostic pathology groups associated with silent aspiration. Of the 2,000 patients evaluated in this study, 51% aspirated on the video fluoroscopic evaluation. Of the patients who aspirated, 55% had no protective cough reflex (silent aspiration). The diagnostic pathology groups with the highest rates of silent aspiration were brain cancer, brainstem stroke, head-neck cancer, pneumonia, dementia/Alzheimer, chronic obstructive lung disease, seizures, myocardial infarcts, neurodegenerative pathologies, right hemisphere stroke, closed head injury, and left hemisphere stroke. It is of high concern that the diagnostic groups identified in this research as having the highest risk of silent aspiration be viewed as "red-flag" patients by the nursing staff caring for them. Early nursing dysphagia screens, with close attention to the clinical symptoms associated with silent aspiration, and early referral for formal dysphagia evaluation are stressed.


Subject(s)
Deglutition Disorders/diagnostic imaging , Deglutition Disorders/nursing , Fluoroscopy , Pneumonia, Aspiration/diagnostic imaging , Pneumonia, Aspiration/nursing , Adolescent , Adult , Aged , Aged, 80 and over , Cough , Deglutition , Education, Nursing, Continuing , Female , Humans , Male , Mass Screening , Middle Aged , Retrospective Studies , Young Adult
2.
Epilepsia ; 50(4): 917-22, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19054406

ABSTRACT

The American Epilepsy Society and the Epilepsy Foundation jointly convened a task force to assess the state of knowledge about sudden unexplained death in epilepsy (SUDEP). The task force had five charges: (1) develop a position statement describing if, when, what, and how SUDEP should be discussed with patients and their families and caregivers; (2) design methods by which the medical and lay communities become aware of the risk of SUDEP; (3) recommend research directions in SUDEP; (4) explore steps that organizations can take to perform large-scale, prospective studies of SUDEP to identify risk factors; and (5) identify possible preventive strategies for SUDEP. Some of the major task force recommendations include convening a multidisciplinary workshop to refine current lines of investigation and to identify additional areas of research for mechanisms underlying SUDEP; performing a survey of patients and their families and caregivers to identify effective means of education that will enhance participation in SUDEP research; conducting a campaign aimed at patients, families, caregivers, coroners, and medical examiners that emphasizes the need for complete autopsy examinations for patients with suspected SUDEP; and securing infrastructure grants to fund a consortium of centers that will conduct prospective clinical and basic research studies to identify preventable risk factors and mechanisms underlying SUDEP. For now, the principal effort in preventing SUDEP should be prompt and optimal control of seizures, especially generalized convulsive seizures.


Subject(s)
Death, Sudden/etiology , Death, Sudden/prevention & control , Epilepsy/complications , Advisory Committees/organization & administration , Death, Sudden/epidemiology , Epilepsy/epidemiology , Health Education , Humans , Research Design/standards , Risk Factors , United States , Voluntary Health Agencies
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