Communicating Risks and Food Procedures through a Visual Poster for Caregivers of Patients with Dysphagia in Inpatient Care: Usability and Impact.

Food-related procedures are a part of rehabilitation interventions for dysphagia. However, studies show that professional-caregiver communication is often lacking in dysphagia, risking caregivers' knowledge, understanding, and practice of those procedures, with negative consequences for patient safety and rehabilitation. The aim of this study was to evaluate caregivers' perspectives about the utility of a poster designed to communicate dysphagia-related risks and food procedures for caregivers of patients in inpatient care. The impact of caregivers' exposure to the poster on patients' dysphagia-related health was additionally explored. The poster was placed by the beds of a randomly assigned group of patients (n = 21). Their caregivers responded to a questionnaire about the poster's utility. In addition, to explore whether the caregiver exposure to the poster could already have some effect on patient dysphagia-related health, patient risk of aspiration, food swallowing capacity, nutritional status, and oral cavity health were assessed before and one month after placement of the poster, and the poster-exposed group was compared with a (randomly-assigned) non-exposed group (n = 21). Data were analyzed with descriptive statistics and generalized linear models based on analyses of covariance. All caregivers across various education levels reported noticing, reading, and understanding the poster (100%). Nearly all reported that the poster added new information to their knowledge (17 out of 21). In the additional analysis, the patients in the poster-exposed group showed greater improvements in the health outcomes, compared with the non-exposed group, although the effects were statistically non-significant within this study's one-month period. A poster with pictorial information was effective in increasing awareness about dysphagia-specific information among caregivers of patients in inpatient care and can be used as an augmentative means of information, with potential benefits for patient safety and rehabilitation.

Recommendations of good practice to prevent aspiration pneumonia in older adults at risk of oropharyngeal dysphagia living in nursing homes: A modified e-Delphi study protocol.

BACKGROUND: Aspiration pneumonia (AP) is a subset of pneumonia caused by the aspiration of food and fluids to the lungs and is highly prevalent in the older population. Oropharyngeal dysphagia (OD) is one of the risk factors for AP and it is also associated with malnutrition, dehydration and poor functional outcomes. As pneumonia is the second most common infection in nursing homes (NHs) and OD represents a major concern to NH staff, good practices for the prevention of AP in older adults at risk of OD are needed. PURPOSE: The aim of this modified e-Delphi study is to build consensus among a panel of experts regarding a set of recommendations for NH staff on good practices to prevent AP in older adults at risk of OD living in NHs. The objective of this paper is to establish the methodology inherent to the Delphi study. METHODS: An online modified Delphi study will be developed in three rounds. Criteria for the Delphi panel participants include holding a master's or doctoral degree in OD or speech and language therapy; or having 10 or more years of experience in OD; or having at least one scientific publication related to OD. A previously described modified Delphi methodology will be used to achieve consensus (75% agreement). An additional round will be performed to collect the experts' perspectives regarding the priority for application of each recommendation previously validated. DISCUSSION: This protocol aimed to describe the methodology of a future Delphi study on the prevention of AP, seeking to fulfil the gap in the literature regarding this topic. The modified Delphi technique is a widely used method for collecting experts' opinion in health sciences, but the absence of standardised guidelines allows some heterogeneity between studies with the same aim. WHAT THIS PAPER ADDS: What is already known on the subject Aspiration pneumonia (AP) is related to three main risk factors: impaired safety of swallow, impaired nutritional status and poor oral health. It is known that being dependent for feeding is one of the main risk factors for AP and around 50% of nursing home (NH) residents need feeding assistance. Thus, it is important to promote specialised intervention and care by the NH staff for preventing AP. What this paper adds to existing knowledge It is hypothesised that increasing the knowledge of NH staff regarding the best practices for preventing AP in older adults at risk of oropharyngeal dysphagia (OD) will improve outcomes such as quality of life, incidence of AP and mortality. What are the potential or actual clinical implications of this work? The recommendations resulting from this study will address a current gap in healthcare practice of NH staff regarding older adults at increased risk for OD and, consequently, for AP.

Quality Standard for Rehabilitation of Young Deaf Children Receiving Cochlear Implants.

Background and objectives: More and more children with severe-to-profound hearing loss are receiving cochlear implants (CIs) at an early age to improve their hearing and listening abilities, speech recognition, speech intelligibility, and other aspects of spoken language development. Despite this, the rehabilitation outcomes can be very heterogeneous in this population, not only because of issues related to surgery and fitting or the specific characteristics of the child with his/her additional disabilities but also because of huge differences in the quality of the support and rehabilitation offered by the therapist and the family. These quality standards for the rehabilitation of young deaf children receiving CIs are developed within the European KA202 Erasmus+ project "VOICE"-vocational education and training for speech and language therapists and parents for the rehabilitation of children with CIs, Ref. No.: 2020-1-RO01-KA202-080059. Material and methods: To develop these quality standards, we used the input from the face-to-face interviews of 11 local rehabilitation experts in CIs from the four partner countries of the project and the outcomes of the bibliographic analysis of 848 publications retrieved from six databases: Pub Med, Psych Info, CINAHL, Scopus, Eric, and Cochrane. Based on all this information, we created a first set of 32 quality standards over four domains: general, fitting, rehabilitation, and for professionals. Further on, the Delphi method was used by 18 international rehabilitation experts to discuss and agree on these standards. Results: The results from the literature analysis and the interviews show us that more than 90% of the consulted international experts agreed on 29 quality standards. They focus on different aspects of rehabilitation: the multidisciplinary team, their expertise and knowledge, important rehabilitation topics to focus on, and programming issues related to rehabilitation. Conclusions: These quality standards aim to optimize the activity of speech rehabilitation specialists so that they reach the optimal level of expertise. Also presented is the necessary equipment for the IC team to carry out the rehabilitation sessions in good conditions. This set of quality standards can be useful to ensure the appropriate postoperative care of these children. As a result, the rehabilitation process will be more relaxed, and therapists will have the opportunity to focus more on the specific needs of each child, with the provision of quality services, which will result in better results. This theme is particularly complex and dependent on multifactorial aspects of medicine, education, speech therapy, social work, and psychology that are very intricate and interdependent.

Development of the European Portuguese version of the oral health assessment tool: Content validity and reliability study in an elderly population.

AIMS: Poor oral health is a risk factor for aspiration pneumonia (AP), especially in elderly patients at risk of oropharyngeal dysphagia (OD). In Portugal, available tools to screen oral problems in nursing homes are scarce. The oral health assessment tool (OHAT) is a screening tool that assesses elderly residents' oral health. This study aims to translate and validate the tool for the European Portuguese (EP) context. METHODS: The original version was translated into EP throughout a forward-backward translation process. An instruction manual was created. Content of both documents were assessed by a panel of eight experts. The content validity Index was calculated. A reliability study was conducted in three nursing homes by two speech and language therapists in two different moments, separated by 48 h. RESULTS: A sample of 30 institutionalized elderly with a mean age of 77 years was analyzed. The EP version and its instruction manual presented a content validity Index greater than 0.88 in all its items. Total scores showed excellent inter-rater and good intra-rater results. CONCLUSION: The EP version showed to be a reliable and valid tool for the screening of oral health conditions of institutionalized older adults at risk of OD.

Interventions to Prevent Aspiration Pneumonia in Older Adults: An Updated Systematic Review.

Purpose The aim of the study was to provide an updated systematic review of randomized controlled trials that studied the effectiveness of pharmacological and nonpharmacological interventions to prevent aspiration pneumonia in older adults at risk for aspiration. Method The search was conducted in MEDLINE (PubMed), Scopus, and Web of Science databases and the Cochrane Central Register of Controlled Trials, using a protocol registered on PROSPERO (CRD42019139973). Randomized controlled trials of interventions to reduce the incidence of aspiration pneumonia in individuals older than 65 years at risk for aspiration, published between January 2002 and July 2019 and written in English, were included. Two reviewers independently evaluated the methodological quality of studies using the revised Cochrane risk-of-bias tool. Results Thirteen out of 703 articles identified met the eligibility criteria and were included. Six studies focused on pharmacological interventions, three studies focused on dietary interventions and compensatory strategies, one study focused on oral care, two studies focused on multidisciplinary interventions, and one study assessed a screening method. Four studies showed positive and statistically significant effect in reducing aspiration pneumonia but were considered to have unclear or high risk of bias. Three studies showed promising results on the preventive effect of pharmacological interventions. Conclusions The most recent evidence on the prevention of aspiration pneumonia in older adults revealed modest to poor methodological quality. Given the burden of aspiration pneumonia on patients and on the health care systems, the development of larger well-designed trials on this topic is of undoubted importance.

[Aphasia Rapid Test: Translation, Adaptation and Validation Studies for the Portuguese Population]. / Aphasia Rapid Test: Estudos de Tradução, Adaptação e Validação para a População Portuguesa.

INTRODUCTION: Classical aphasia evaluation scales are too long to use in the context of acute stroke or as a monitoring tool. The Aphasia Rapid Test is a 26-point scale developed as a bedside assessment to rate aphasia severity in acute stroke patients in less than 3 minutes. We aimed to adapt and validate this scale for European Portuguese. MATERIAL AND METHODS: We evaluated 56 acute stroke patients in the first and in the seventh days post-stroke. In the seventh day, patients were evaluated by two independent raters, to evaluate inter-rater agreement. To study concurrent validity, the Lisbon Aphasia Examination Battery was applied to a subset of 20 patients. The predictive ability of the Aphasia Rapid Test was assessed at six months, by the aphasia subscale of the National Institutes of Health Stroke Scale. RESULTS: Translation to European Portuguese was based in the French and English versions, considering the words' utilization frequency. The Chronbach's alpha was 0.796. The concordance coefficient between the two raters was excellent (0.985). Correlation between Aphasia Rapid Test and the Lisbon Aphasia Examination Battery was strong (r = -0.958, p < 0.001). The study through Bland-Altman graphs corroborated the good inter-rater agreement and concurrent validity of the test. The Aphasia Rapid Test score in the first day is an independent predictor of long-term outcome. DISCUSSION: This study provides reliable results for European Portuguese, with adequate internal consistency, inter-rater agreement and concurrent validity. CONCLUSION: The Aphasia Rapid Test is a good tool for the evaluation and monitoring of aphasia in stroke patients.

Introdução: As baterias clássicas de caracterização de afasia são demasiado longas para serem utilizadas no contexto do acidente vascular cerebral agudo ou como ferramenta de monitorização. O Aphasia Rapid Test é uma escala de 26 pontos desenvolvida como teste de cabeceira para avaliar a gravidade da afasia num doente com acidente vascular cerebral em menos de três minutos. O objetivo do estudo é adaptar e validar a escala para o português europeu. Material e Métodos: Foram avaliados 56 doentes com acidente vascular cerebral no primeiro e sétimo dia pós-acidente vascular cerebral. Ao sétimo dia, foram avaliados por dois avaliadores independentes para avaliar o acordo interavaliadores. Para estudar a validade concorrente, a 20 doentes foi aplicada também a Bateria de Avaliação de Afasias de Lisboa. A capacidade preditiva do Aphasia Rapid Test foi avaliada aos seis meses, através do valor da subescala de afasia do National Institutes of Health Stroke Scale. Resultados: A tradução para o português europeu baseou-se nas versões francesa e inglesa, respeitando a frequência de utilização das palavras. O α de Cronbach foi de 0,796. O coeficiente de concordância entre examinadores foi excelente (0,985). A correlação entre o Aphasia Rapid Test e a Bateria de Avaliação de Afasias de Lisboa é forte (r = -0,958, p < 0,001). Os gráficos de Bland-Altman corroboram as boas concordâncias interavaliadores e validade concorrente. O Aphasia Rapid Test no primeiro dia é preditor independente do resultado a longo prazo. Discussão: Este estudo apresenta resultados confiáveis para o português europeu, com valores de consistência interna, concordância interavaliadores e validade concorrente adequados. Conclusão: O Aphasia Rapid Test é um bom instrumento para avaliação e monitorização da afasia em doentes com acidente vascular cerebral.