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1.
Enferm. intensiva (Ed. impr.) ; 30(4): 154-162, oct.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184479

RESUMO

Objetivo: Analizar el manejo intraquirúrgico y los resultados posquirúrgicos asociados a la extubación temprana en los pacientes sometidos a cirugía reparadora de tetralogía de Fallot en un hospital público argentino. Métodos: Se realizó una revisión retrospectiva de los expedientes clínicos de los pacientes a quienes se les practicó cirugía para corrección de tetralogía de Fallot. Se incluyeron en el análisis un total de 38 expedientes que cumplieron con los criterios de inclusión establecidos en el protocolo para la revisión retrospectiva. Resultados: El 16% fue extubado de manera temprana. Milrinona fue la única droga que mostró diferencias en los pacientes a quienes se extubó de manera temprana (p = 0,01). El tiempo de circulación extracorpórea, el de clampaje aórtico, la transfusión con crioprecipitados, la saturación de la presión de oxígeno, y el hematocrito al finalizar el procedimiento quirúrgico no evidenciaron diferencias (p > 0,05). En el período posquirúrgico, la estadía en UTI fue más corta en los pacientes que fueron extubados de manera temprana (p = 0,0007), pero no hubo diferencias en la estadía hospitalaria total (p = 0,26). Conclusiones: La extubación temprana en la institución si bien resultó de baja frecuencia ha demostrado ser una alternativa segura y eficaz para disminuir la estancia en UTI de estos pacientes


Objective: To assess surgical management and postoperative results associated with early extubation in patients undergoing tetralogy of Fallot corrective surgery at a public hospital in Argentina. Methods: A retrospective review was made from clinical records from patients who underwent corrective surgery for tetralogy of Fallot. A total of 38 clinical records that met the inclusion criteria for the retrospective review were included in the analysis. Results: 16% were extubated early. Milrinone was the only drug that showed differences in patients who were extubated early (p = 0.01). Extracorporeal circulation time, aortic clamping time, transfusion with cryoprecipitates, saturation of oxygen pressure, and haematocrit at the end of the surgical procedure showed no differences (p > .05). In the postoperative period, the ICU stay was shorter for the patients who were extubated early (p = 0.0007), but there were no differences in the total hospital stay (p = 0.26). Conclusions: Early extubation in the institution, although found to be low frequency, has proved as a safe and effective alternative to shorten these patients’ stay in ICU


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Extubação/instrumentação , Extubação/tendências , Tetralogia de Fallot/cirurgia , Cuidados Pós-Operatórios/enfermagem , Monitorização Intraoperatória/enfermagem , Hospitais Públicos , Argentina , Estudos Retrospectivos , Circulação Extracorpórea/enfermagem , Tempo de Internação , Serviço Hospitalar de Anestesia/organização & administração , Anestesia Endotraqueal/enfermagem , Manuseio das Vias Aéreas/enfermagem , Transtornos de Deglutição/prevenção & controle
2.
Medicine (Baltimore) ; 98(40): e17304, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577721

RESUMO

BACKGROUND: Tongue strengthening exercise (TSE) is a remedial method for the training of swallowing-related muscles in the oropharyngeal phase. However, clinical evidence of its effectiveness is insufficient. METHODS: To investigate the effect of TSE on the oropharyngeal muscles associated with swallowing in older adults, in this study, 40 elder adults living in the community were recruited and assigned to 2 groups. The experimental group performed a TSE with a 1-repetition maximum resistance level of 70%. The exercise was divided into an isometric and isotonic part. The control group did not perform an exercise. We measured the muscle strength and thickness of the tongue and suprahyoid muscles using an Iowa Oral Performance Instrument and ultrasonography. RESULTS: The experimental group showed a statistically significant increase in tongue muscle strength and thickness in the oral phase (P = .001 and <.001, respectively). In the pharyngeal phase, the experimental group showed a statistically significant increase in the mylohyoid and digastric muscles (suprahyoid muscles) (P = .045 and .019, respectively). The control group showed no statistically significant changes. CONCLUSION: TSE is effective in increasing the strength and thickness of the oropharyngeal muscles of elder adults and is recommended for those who are vulnerable to swallowing difficulties.


Assuntos
Transtornos de Deglutição/prevenção & controle , Deglutição/fisiologia , Terapia por Exercício/métodos , Força Muscular/fisiologia , Treinamento de Resistência/métodos , Língua/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia
3.
Pediatr Cardiol ; 40(6): 1296-1303, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31342114

RESUMO

Dysphagia and vocal cord dysfunction are frequent complications after congenital heart surgery. Both are risk factors for aspiration, which can lead to pneumonia, progressive lung disease, and respiratory arrest. A protocol was implemented to promote early detection of aspiration in a high-risk cohort of patients. Retrospective data were collected on all patients under 120 days old who underwent the Norwood procedure, aortic arch repair, Blalock-Taussig shunt placement, or cervical cannulation for extracorporeal membrane oxygenation from 10/2012 to 05/2016 at a single institution. Patients underwent an assessment of symptoms, fiberoptic endoscopic evaluation of swallowing (FEES), and modified barium swallow (MBS) study in the postoperative period prior to initiating oral feeds. Patients with and without aspiration were compared. Of the 96 patients included in the study, one-third (33%) of patients had evidence of vocal cord dysfunction by FEES and just over half (51%) had evidence of aspiration by FEES or MBS. Most (73%) of the patients with aspiration were asymptomatic and a majority (53%) of patients with aspiration had normal vocal cord function. Aspiration is common after congenital heart surgery, and an assessment of vocal cord or swallow function in isolation may lead to underdiagnosis. A comprehensive protocol including MBS and FEES is necessary for the early detection of vocal cord dysfunction and aspiration and may prevent adverse outcomes in high-risk postoperative patients.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/diagnóstico , Aspiração Respiratória/diagnóstico , Estudos de Casos e Controles , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Diagnóstico Precoce , Feminino , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Aspiração Respiratória/epidemiologia , Aspiração Respiratória/etiologia , Estudos Retrospectivos , Fatores de Risco , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia
5.
Cancer Radiother ; 23(5): 439-448, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31358445

RESUMO

Intensity-modulated radiation therapy (IMRT) is presently the recommended technique for the treatment of locally advanced head and neck carcinomas. Proton therapy would allow to reduce the volume of irradiated normal tissue and, thus, to decrease the risk of late dysphagia, xerostomia, dysgeusia and hypothyroidism. An exhaustive research was performed with the search engine PubMed by focusing on the papers about the physical difficulties that slow down use of proton therapy for head and neck carcinomas. Range uncertainties in proton therapy (±3 %) paradoxically limit the use of the steep dose gradient in distality. Calibration uncertainties can be important in the treatment of head and neck cancer in the presence of materials of uncertain stoichiometric composition (such as with metal implants, dental filling, etc.) and complex heterogeneities. Dental management for example may be different with IMRT or proton therapy. Some uncertainties can be somewhat minimized at the time of optimization. Inter- and intrafractional variations and uncertainties in Hounsfield units/stopping power can be integrated in a robust optimization process. Additional changes in patient's anatomy (tumour shrinkage, changes in skin folds in the beam patch, large weight loss or gain) require rescanning. Dosimetric and small clinical studies comparing photon and proton therapy have well shown the interest of proton therapy for head and neck cancers. Intensity-modulated proton therapy is a promising treatment as it can reduce the substantial toxicity burden of patients with head and neck squamous cell carcinoma compared to IMRT. Robust optimization will allow to perform an optimal treatment and to use proton therapy in current clinical practice.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Física Sanitária , Terapia com Prótons , Lesões por Radiação/prevenção & controle , Radioterapia (Especialidade) , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Pesquisa Médica Translacional , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Disgeusia/etiologia , Disgeusia/prevenção & controle , Humanos , Hipotireoidismo/etiologia , Hipotireoidismo/prevenção & controle , Modelos Teóricos , Órgãos em Risco , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada/efeitos adversos , Incerteza , Xerostomia/etiologia , Xerostomia/prevenção & controle
6.
Crit Care Nurse ; 39(3): e9-e17, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154338

RESUMO

BACKGROUND: Free water protocols allow patients who aspirate thin liquids and meet eligibility criteria to have access to water or ice according to specific guidelines. Limited research is available concerning free water protocols in acute care settings. OBJECTIVES: To compare rates of positive clinical outcomes and negative clinical indicators of a free water protocol in the acute care setting and to continue monitoring participants discharged into the hospital system's rehabilitation setting. Positive clinical outcomes were diet upgrade, fewer days to diet upgrade, and fewer days in the study. Negative clinical indicators were pneumonia, intubation, and diet downgrade. METHODS: A multidisciplinary team developed and implemented a free water protocol. All eligible stroke and trauma patients (n = 104) treated over a 3-year period were randomly assigned to an experimental group with access to water and ice or a control group without such access. Trained study staff recorded data on positive outcomes and negative indicators; statistical analyses were conducted with blinding. RESULTS: No significant group differences in positive outcomes were found (all P values were > .40). Negative clinical indicators were too infrequent to allow for statistical comparison of the 2 groups. Statistical analyses could not be conducted on the small number (n = 15) of patients followed into rehabilitation, but no negative clinical indicators occurred in these patients. CONCLUSIONS: Larger-scale studies are needed to reach decisive conclusions on the positive outcomes and negative indicators of a free water protocol in the acute care setting.


Assuntos
Transtornos de Deglutição/prevenção & controle , Ingestão de Líquidos , Acidente Vascular Cerebral/terapia , Ferimentos e Lesões/terapia , Idoso , Enfermagem de Cuidados Críticos/métodos , Estado Terminal/enfermagem , Estado Terminal/terapia , Feminino , Guias como Assunto , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente , Valores de Referência , Método Simples-Cego , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/enfermagem , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/enfermagem
7.
Injury ; 50(4): 908-912, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30952496

RESUMO

BACKGROUND: Postoperative dysphagia is one major concern in the treatment for patients with cervical spine spondylosis by using anterior cervical discectomy and fusion (ACDF) with plating and cage system. PURPOSE: To evaluate the influence of two types of surgery for multilevel cervical spondylotic myelopathy (CSM) on postoperative dysphagia, namely ACDF with cage alone (ACDF-CA) using Fidji cervical cages and ACDF with cage and plate fixation (ACDF-CP). METHODS: A retrospective study was performed in 62 consecutive patients with multilevel CSM, including 32 underwent ACDF-CA (group A) and 30 underwent ACDF-CP (group B). All enrolled patients were followed up at 48 h, 2 months and 6 months postoperatively, when the dysphagia rate, Swallowing-Quality of Life (SWAL-QOL) score and the thickness of prevertebral soft tissue were recorded. RESULTS: At 48 h and 2 months, the dysphagia rate and thickness of prevertebral soft tissue were both significantly lower in group A than in group B, while the SWAL-QOL score of group A was significantly higher than that of group B. No significant difference was observed at 6 months. CONCLUSION: Fidji cervical cages could relieve postoperative dysphagia in the treatment of multilevel CSM with ACDF, especially at the first several months postoperatively.


Assuntos
Vértebras Cervicais/cirurgia , Transtornos de Deglutição/prevenção & controle , Discotomia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Fusão Vertebral/efeitos adversos , Espondilose/cirurgia , Idoso , Vértebras Cervicais/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Discotomia/instrumentação , Feminino , Humanos , Incidência , Fixadores Internos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Qualidade de Vida , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Espondilose/diagnóstico por imagem , Espondilose/fisiopatologia , Resultado do Tratamento
8.
Indian J Dent Res ; 30(1): 133-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30900673

RESUMO

Total maxillectomy for patients with malignant lesions will often incapacitate the patient both functionally and aesthetically. An immediate surgical obturator prosthesis would be of utmost importance for patients in these critical situations to aid in deglutition, phonetics, respiration and effectively avoiding various post-surgical complications. This article emphasizes on utilizing circum-zygomatic wiring for retention of the immediate surgical obturator in cases of total maxillectomy or edentulous patients.


Assuntos
Maxila/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Obturadores Palatinos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fios Ortopédicos , Transtornos de Deglutição/prevenção & controle , Humanos , Boca Edêntula/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Transtornos Respiratórios/prevenção & controle , Transtorno Fonológico/prevenção & controle
9.
Curr Opin Otolaryngol Head Neck Surg ; 27(3): 157-161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30893132

RESUMO

PURPOSE OF REVIEW: The purpose of this study is to provide an overview on the methodologies, outcomes and clinical implications of studies that have investigated swallowing outcomes after head and neck cancer (HNC) treatment when reducing radiotherapy dose to specific dysphagia/aspiration-related structures (DARS). RECENT FINDINGS: Overall, there is limited recent evidence, with a lack of high-quality studies, which examine the outcomes of DARS-optimized radiotherapy treatment. Large variations exist in the methodology of these studies in regards to which DARS are delineated and how swallowing outcomes are measured. Consequently, there is a wide range of dose limits recommended to a variety of DARS structures. Despite these limitations, there appears to be a general consensus that optimizing dose to the DARS will result in some reduction of dysphagia after radiotherapy without compromising on treatment to the tumour. SUMMARY: More rigorous study must be completed to determine the true extent of clinical benefit from this practice. Institutions must take into consideration the limitations of the evidence as well as logistical costs of implementing this technique into practice. However, optimizing dose to the DARS appears to be a well-tolerated practice that may have substantial positive benefits for patients' swallowing function and quality of life after HNC treatment.


Assuntos
Transtornos de Deglutição/prevenção & controle , Neoplasias de Cabeça e Pescoço/radioterapia , Laringe/efeitos da radiação , Faringe/efeitos da radiação , Pneumonia Aspirativa/prevenção & controle , Lesões por Radiação/prevenção & controle , Dosagem Radioterapêutica/normas , Transtornos de Deglutição/etiologia , Relação Dose-Resposta à Radiação , Humanos , Pneumonia Aspirativa/etiologia , Lesões por Radiação/etiologia
10.
Intellect Dev Disabil ; 57(1): 14-25, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30716006

RESUMO

With the increasing survival rate of people with developmental disabilities into adulthood and later life, nutritional support and feeding of these individuals frequently becomes a critical problem which must be addressed by their caregivers and healthcare providers. Problems surrounding mealtimes include difficulty with the mechanisms of feeding as well as medical complications including aspiration and gastrointestinal dysmotility. No comprehensive guidelines exist to aid caregivers and healthcare providers regarding the issues in feeding and nutrition in this population. We offer an algorithmic approach to the nutrition-related problems of aspiration, laborious meals and mealtime refusal, choosing the best route for tube feeding, and when to return patients with developmental disabilities back to oral feeding.


Assuntos
Deficiências do Desenvolvimento/complicações , Comportamento Alimentar , Transtornos Nutricionais/prevenção & controle , Algoritmos , Transtornos de Deglutição/complicações , Transtornos de Deglutição/prevenção & controle , Ingestão de Alimentos , Humanos , Transtornos Nutricionais/complicações
11.
Asian Pac J Cancer Prev ; 20(1): 91-96, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30678386

RESUMO

Objective: To evaluate the effect of induction chemotherapy on swallowing and swallowing-related quality of life of patients with oropharyngeal, laryngeal and hypopharyngeal cancer. Study design: Prospective study of 33 patients with locally advanced tumors who were eligible for treatment with neoadjuvant chemotherapy followed by radiotherapy and concurrent chemotherapy. A multidimensional assessment of swallowing was performed using the following tools: (1) Clinical analysis, numerical scale for general pain and painful swallowing, American Speech and Hearing Association (ASHA) Functional Communication Measures (FCM) swallowing assessment scales, (2) assessment of Swallowing-Related Quality of Life (The MD Anderson Dysphagia Inventory - MDADI), and (3) swallowing videofluoroscopy. Results: There was a reduction in general pain scale (p=0.021), and quality of life (emotional, functional and physical) improved from average limitation (score of 61-80) to minimal limitation (81-100) after induction chemotherapy. According to the swallowing videofluoroscopy results, 26 (78.7%) of the patients had some degree of dysphagia pre-treatment, which decreased to 21 (63.6%) after induction. Conclusion: Our results suggest that induction chemotherapy improves numerous aspects of swallowing and has a positive impact on the quality of life of pre-chemoradiotherapy patients.


Assuntos
Quimiorradioterapia/efeitos adversos , Transtornos de Deglutição/prevenção & controle , Neoplasias de Cabeça e Pescoço/terapia , Quimioterapia de Indução , Qualidade de Vida , Transtornos de Deglutição/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Inquéritos e Questionários
12.
Acta Oncol ; 58(5): 658-664, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30698049

RESUMO

Background: In recent years, preventive swallowing exercises have been investigated as a means to limit dysphagia in head and neck cancer patients. However, adherence to exercise regimes has been poorly documented limiting the conclusions drawn on the effects of the interventions. We investigated adherence to a preventive swallowing exercise program and identified possible associations between adherence and four selected baseline factors: HPV status, partner status, concomitant chemotherapy and tumor site and between adherence to swallowing exercises and attendance to supervised training sessions. Material and methods: Forming part of an ongoing RCT (clinicaltrials.gov NCT02385929) adherence to intervention was based on participant provided training-logs. The exercise program consisted of 3 weekly supervised sessions of 30 min each and a home-based exercise program to be performed three times daily. Adherence was calculated as percentage of prescribed exercises completed and dichotomously as high (≥80%∼median) and low (<80%∼median) adherence. Associations between adherence and clinical/demographic factors (HPV, partner status, chemotherapy, tumor site or attendance level) were explored by logistic regression analyses. Results: Full adherence data were available from 45 (76%) participants. The total cohort median adherence to exercises was 78%. No association was found between any of the tested factors and adherence. Discussion: The study found a high adherence to preventive swallowing exercises in HNC patients undergoing (chemo)radiotherapy, both in home-based exercises and in supervised sessions, when compared to other studies, although median adherence to home-based exercises was below the defined 80% threshold. We acknowledge, that adherence in an RCT may be higher than in the everyday clinical situation due to surveillance bias. However, we find it reassuring that HNC patients comply with a preventive swallowing program, which requires some time investment from the patients.


Assuntos
Quimiorradioterapia/efeitos adversos , Transtornos de Deglutição/prevenção & controle , Terapia por Exercício/métodos , Neoplasias de Cabeça e Pescoço/terapia , Cooperação do Paciente , Adulto , Idoso , Deglutição/fisiologia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
13.
Endoscopy ; 51(2): 169-173, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30005444

RESUMO

BACKGROUND: Proximal esophageal stents are poorly tolerated and have a high risk of complications. We report our experience using fully covered, biliary, self-expandable metal stents (B-SEMS) and narrow-diameter, esophageal, self-expandable metal stents (NDE-SEMS) for this group of patients. METHODS: 24 patients underwent placement of B-SEMS or NDE-SEMS for proximal esophageal lesions between 1 January 2011 and 31 July 2016. The outcomes included improvement of dysphagia, healing of fistulas, and adverse events. RESULTS: 10 patients received B-SEMS and 14 had NDE-SEMS. Median follow-up time was 11.5 months (range 0.5 - 62 months). In both cohorts, stents were left in place for a mean of 6 weeks. The dysphagia score decreased in 7 (70 %) and 10 (71.4 %) patients, and fistulas resolved in 3/5 (60.0 %) and 5/8 (62.5 %) patients with B-SEMS and NDE-SEMS, respectively. Stent migration occurred in three patients (30.0 %) with B-SEMS and five patients (35.7 %) with NDE-SEMS. CONCLUSIONS: Both stents were well tolerated and resulted in overall improvement of dysphagia in 70.8 % of patients. B-SEMS appeared to be more favorable for cervical esophageal lesions with narrower diameters, while NDE-SEMS may be better for more distal lesions.


Assuntos
Transtornos de Deglutição/prevenção & controle , Estenose Esofágica/cirurgia , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Tomada de Decisões , Transtornos de Deglutição/etiologia , Remoção de Dispositivo , Estenose Esofágica/complicações , Feminino , Florida , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Implantação de Prótese , Estudos Retrospectivos
14.
Nursing ; 48(12): 42-46, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30461710

RESUMO

Collaboration between nurses and speech language pathologists is vital to the screening and management of dysphagia in acute care settings. This article examines each discipline's role in caring for patients with dysphagia.


Assuntos
Transtornos de Deglutição/prevenção & controle , Papel Profissional , Patologia da Fala e Linguagem , Comportamento Cooperativo , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/enfermagem , Humanos , Programas de Rastreamento/enfermagem , Papel do Profissional de Enfermagem , Enfermeiras e Enfermeiros/psicologia , Avaliação em Enfermagem , Risco
16.
J Bone Joint Surg Am ; 100(17): 1461-1472, 2018 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-30180054

RESUMO

BACKGROUND: Dysphagia and dysphonia are the most common postoperative complications following anterior cervical discectomy and fusion (ACDF). Although most postoperative dysphagia is mild and transient, severe dysphagia can have profound effects on overall patient health and on surgical outcomes. The purpose of this study was to compare the efficacy of local to intravenous (IV) steroid administration during ACDF on postoperative dysphagia and dysphonia. METHODS: This was a single-blinded, prospective, randomized clinical trial. Seventy-five patients undergoing ACDF with cervical plating were randomized into 3 groups: control (no steroid), IV steroid (10 mg of IV dexamethasone at the time of closure), or local steroid (40 mg of local triamcinolone). Patient-reported outcome measures (PROMs) were collected for dysphagia, dysphonia, and neck pain postoperatively for 1 year. RESULTS: Patient demographics were similar. Postoperative day 1 PROMs showed significantly lower scores for dysphonia (p = 0.015) and neck pain (p = 0.034) in the local steroid group. At 2 weeks postoperatively, the local steroid cohort showed significantly decreased prevalence of severe dysphagia (Eating Assessment Tool-10 [EAT-10], severe dysphagia, p = 0.027) compared with the control and IV steroid groups. Both steroid groups had significantly less severe dysphagia when compared with the control group at the 6-week and 3-month time points. At 1 year postoperatively, both steroid groups had significantly reduced dysphagia rates (p = 0.014) compared with the control group. CONCLUSIONS: Both local and IV steroid administration after cervical plating in ACDF yielded better PROMs for dysphagia compared with a control group. This finding is particularly evident in the reduced number of patients who reported severe dysphagia symptoms following ACDF with local steroid application within the first 2 postoperative weeks. Future studies should attempt to stratify dysphagia severity when reporting outcomes related to anterior cervical spine surgery. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Vértebras Cervicais/cirurgia , Transtornos de Deglutição/prevenção & controle , Discotomia/efeitos adversos , Disfonia/prevenção & controle , Glucocorticoides/administração & dosagem , Fusão Vertebral/efeitos adversos , Dexametasona/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Método Simples-Cego , Triancinolona/administração & dosagem
17.
J Bodyw Mov Ther ; 22(3): 810-816, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30100317

RESUMO

Previous research suggests that aging-related deterioration of oral functions causes not only eating/swallowing disorders but also various conditions such as sleep disorders and higher-order brain dysfunction. The aim of the present study was to examine the effects of lip closure training on eating behavior, sleep, and brain function in elderly persons residing in an elder care facility. The 20 elderly subjects (mean age, 86.3 ± 1.0 years) were assigned to a control group or a lip closure training (LCT) group, in which an oral rehabilitation device was used for daily LCT sessions over a 4-week period. Before and after the 4-week intervention period, maximal lip closure force was measured, and prefrontal cortical hemodynamic activity (changes in oxygenated hemoglobin concentration) during lip closure movements was measured with (LCT group) or without (control group) use of the oral rehabilitation device. We also analyzed eating behavior and daytime sleep before and after the intervention period. Compared with the control group, the LCT group showed improved maximal lip closure force, shortened eating time, decreased food spill rates, and decreased daytime sleeping. Furthermore, compared with the control group, the LCT group showed a significant increase in prefrontal cortical activity during lip closure. In addition, the increase rate in the right dorsolateral prefrontal cortical activity after the intervention period was significantly correlated with the increase rate in the maximal lip closure force after the intervention period. These findings suggest that LCT is useful in elderly individuals with decreased eating/oral and cognitive functions without the risk of pulmonary aspiration during training.


Assuntos
Transtornos de Deglutição/prevenção & controle , Distúrbios do Sono por Sonolência Excessiva/prevenção & controle , Terapia por Exercício/métodos , Comportamento Alimentar , Lábio/fisiologia , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/complicações , Distúrbios do Sono por Sonolência Excessiva/complicações , Feminino , Hemodinâmica , Humanos , Masculino , Força Muscular/fisiologia , Resultado do Tratamento
18.
J Hum Nutr Diet ; 31(6): 742-746, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29992661

RESUMO

BACKGROUND: Texture-modified foods and thickened fluids are used as a strategy that aims to compensate for dysphagia and improve the safety and efficiency of swallowing. Currently, in Israel, there are no standardised terminologies and definitions for texture-modified diets. The inconsistent terminology adversely affects patient safety and the efficiency of communication between staff members both within and between health institutions. This present study describes a project of the Israeli Ministry of Health in which the labels and definitions of prevalent foods and fluids used in health institutions are mapped to develop a consensus on national standards. METHODS: A multidisciplinary committee of speech-language pathologists (SLPs) and registered dietitians (RDs) was appointed. A questionnaire was developed to identify the labels of texture-modified foods and fluids used in the Israeli healthcare system. The questionnaire included questions on knowledge, attitudes and barriers related to the need for a consistent national terminology for texture-modified diets. Questionnaires were sent to 120 institutions. The project was conducted between September 2016 and December 2017. RESULTS: Twenty-six SLPs and 42 RDs responded. The answers revealed that there were 50 labels in use for texture-modified foods. When asked to describe the texture of a particular food item, up to 17 different labels were used. There was broad support for a standardised terminology. CONCLUSIONS: The results of the present study confirm the lack of national standards in clinical practice and the need for a consistent terminology. A consensus was achieved between the committee members and the committee adopted the International Dysphagia Diet Standardization Initiative (IDDSI) recommendations and adapted the terminology to Hebrew.


Assuntos
Comunicação , Transtornos de Deglutição/prevenção & controle , Deglutição , Rotulagem de Alimentos/normas , Terminologia como Assunto , Consenso , Dieta , Alimentos , Instalações de Saúde , Humanos , Israel , Padrões de Referência , Inquéritos e Questionários , Viscosidade
19.
Eur Rev Med Pharmacol Sci ; 22(13): 4288-4298, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30024619

RESUMO

Mitochondrial diseases are a group of rare multisystem disorders characterized by genetic heterogeneity and pleomorphic clinical manifestations. The clinical burden may be heavy for patients and their caregivers. There are no therapies of proven efficacy until now and a multidisciplinary supportive care is therefore necessary. Since the common pathogenic mechanism is the insufficient energy production by defective mitochondria, nutrition may play a crucial role. However, no guidelines are still available. The article reports the current evidence, highlighting nutrition both as support and as therapy. The estimate of nutritional status, energy needs and nutritional behaviors are firstly discussed. Then, we go in-depth on the scientific rationale and the clinical evidence of the use of anti-oxidants and enzyme-cofactors in the clinical practice. In particular, we analyze the role of Coenzyme Q10, Creatine monohydrate, α-lipoic acid, riboflavin, arginine and citrulline, folinic acid, carnitine, vitamin C, K, and E. Every attempt at nutritional intervention should be made knowing patient's disease and focusing on his/her energy and nutrients' requirements. For this reason, clinicians expert in mitochondrial medicine and clinical nutritionists should work together to ameliorate care in these fragile patients.


Assuntos
Doenças Mitocondriais/terapia , Apoio Nutricional , Arginina/administração & dosagem , Transtornos de Deglutição/prevenção & controle , Dieta Hiperlipídica , Metabolismo Energético , Humanos , Mitocôndrias/genética , Mitocôndrias/metabolismo , Ácido Tióctico/administração & dosagem , Ubiquinona/administração & dosagem , Ubiquinona/análogos & derivados
20.
Eur Arch Otorhinolaryngol ; 275(8): 2159-2167, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29978259

RESUMO

OBJECTIVES: Swallowing and voice dysfunctions are common side effects following head-and-neck squamous-cell carcinoma (HNSCC) treatment. Our aim was to analyze the relationships between quality of life, swallowing, and phonatory problems in patients with an advanced-stage HNSCC and to prospectively evaluate the effects of a prophylactic swallowing program. METHODS: First, we retrospectively studied 60 advanced HNSCC patients treated with exclusive or adjuvant radiotherapy/chemoradiotherapy (RT/CRT). Subjects were classified according to general and clinical-therapeutic features. Outcome measures included EORTC QLQ-C30, EORTC QLQ-H&N35, Dysphagia Handicap Index (DHI), M.D.Anderson Dysphagia Inventory (MDADI), and Voice Handicap Index (VHI). Then, we conducted a prospective evaluation of a prophylactic swallowing counselling in 12 consecutive advanced-stage HNSCC patients by a two-arm case-control analysis. These patients were treated with exclusive or adjuvant RT/CRT. RESULTS: 71% of the retrospective population studied reported swallowing dysfunction as a major side effect. No differences were detected in the severity of dysphagia or dysphonia according to type of treatment or staging of the primary tumour, while hypopharyngeal and laryngeal cancer patients showed significantly better swallowing ability and better QoL compared to oral cavity and oropharyngeal localisation (p < 0.05). In addition, a relevant correlation between swallowing and voice problems emerged (p < 0.05). In the prospective part, while no statistical correlation was evident before the start of RT/CRT in the experimental group compared to the control one, the former showed better performances at MDADI (p = 0.006) and DHI (p = 0.002) test 3 months after its end. CONCLUSION: Dysphagia is both an acute-and-long-term side effect which greatly affects QoL of HNSCC patients undergoing multimodality treatment. Our data show that a prophylactic swallowing program could actually produce a beneficial effect on patients' outcomes. LEVEL OF EVIDENCE: 1b and 2b.


Assuntos
Carcinoma de Células Escamosas/complicações , Transtornos de Deglutição/fisiopatologia , Deglutição/fisiologia , Neoplasias de Cabeça e Pescoço/complicações , Estadiamento de Neoplasias , Qualidade de Vida , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço
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