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1.
Rev. neurol. (Ed. impr.) ; 71(6): 213-220, 16 sept., 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195514

RESUMO

INTRODUCCIÓN: Los problemas nutricionales son frecuentes en niños con enfermedades neurológicas, sobre todo si tienen una importante afectación motora. La disfagia orofaríngea es muy prevalente en estos pacientes y puede contribuir a empeorar el estado nutricional y a que se produzcan aspiraciones pulmonares. OBJETIVO: Evaluar de forma longitudinal el estado nutricional de una muestra de pacientes pediátricos con enfermedad neurológica moderada-grave y establecer la prevalencia de disfagia orofaríngea en dicha muestra. PACIENTES Y MÉTODOS: Estudio multicéntrico prospectivo observacional. Se incluyó a niños menores de 16 años controlados en cuatro centros hospitalarios. Se recogieron datos clínicos y antropométricos durante un año. Se realizaron preguntas dirigidas a realizar un cribado sistemático de disfagia orofaríngea. RESULTADOS: Se seleccionó a 68 pacientes, y el diagnóstico más frecuente fue la parálisis cerebral infantil. En la valoración antropométrica, 42 pacientes (62%) presentaron puntuaciones z de peso inferiores a 2, y 29 (43%), talla con puntuaciones z inferiores a 2, pero con un índice de masa corporal, un perímetro braquial y unos pliegues cutáneos mucho menos alterados. La prevalencia de disfagia orofaríngea fue del 73,5%, que aumentó a mayor afectación motora. CONCLUSIONES: Estos pacientes presentan un tamaño corporal menor que la población de su misma edad y sexo sin patología. Sin embargo, con un correcto seguimiento nutricional, mantienen estable su composición corporal. Es importante investigar de forma proactiva la presencia de disfagia orofaríngea, sobre todo en los que tienen mayor afectación motora, pues se presenta con mucha frecuencia y un adecuado diagnóstico puede mejorar la evolución clínica y prevenir complicaciones


INTRODUCTION: Nutritional problems are common in children with neurological diseases, especially if they have significant motor impairment. Oropharyngeal dysphagia is very prevalent in these patients, and can contribute to worsening nutritional status and produce pulmonary aspirations. AIM: Longitudinal assessment of the nutritional status of a sample of pediatric patients with moderate-severe neurological disease and establish the prevalence of oropharyngeal dysphagia in that sample. PATIENTS AND METHODS: An observational multicenter prospective study was conducted. We included children under 16 years of age with moderate-to-severe neurological impairment from four hospitals, with clinical and anthropometric monitoring for one year. Questions were asked to conduct oropharyngeal dysphagia screening. RESULTS: Sixty-eight children were included, the main diagnosis obtained was cerebral palsy. In the anthropometric assessment, 42 patients (62%) showed weight z scores below 2, and 29 (43%) height z scores below 2, while body mass index, mid upper arm circumference and triceps and subscapular skinfolds remained less affected. We found an oropharyngeal dysphagia prevalence of 73.5% in our sample, increasing with greater motor impairment. CONCLUSIONS: These patients showed lower weight and height than children without neurological impairment. However, with a correct follow-up they remain stable with an adequate body composition. It is important to proactively investigate the presence of oropharyngeal dysphagia, especially in those with greater motor impairment, as it occurs very frequently and an adequate diagnosis can improve clinical evolution and prevent complications


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Estado Nutricional/fisiologia , Transtornos de Deglutição/complicações , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/dietoterapia , Estudos Prospectivos , Antropometria/métodos , Transtornos de Deglutição/prevenção & controle , Gastrostomia
2.
Intellect Dev Disabil ; 58(2): 111-125, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32240050

RESUMO

Dysphagia is common in individuals with developmental disabilities. Little research exists on the impact of trainings aimed at improving Direct Care Staff's (DCS) use of safe eating and drinking practices. This article presents two studies using pre-and postexperimental design, evaluating online training to improve DCSs' knowledge and ability to identify nonadherence to diet orders. A pilot study (n = 18) informed improvements to the intervention. The follow-up study (n = 64) compared those receiving training with those receiving training plus supervisor feedback. There was no significant difference between groups after training. Both groups increased in knowledge and identification of nonadherence to diet orders. Online training may be an effective tool for training DCS in safe eating and drinking practices.


Assuntos
Transtornos de Deglutição/prevenção & controle , Deficiências do Desenvolvimento/complicações , Comportamento de Ingestão de Líquido , Comportamento Alimentar , Educação de Pacientes como Assunto , Segurança , Transtornos de Deglutição/etiologia , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internet , Masculino , Projetos Piloto , Resultado do Tratamento
3.
Einstein (Sao Paulo) ; 18: eAO4952, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31939524

RESUMO

OBJECTIVE: To define physician´s behavior in the face of a mentally capable elderly dysphagic patients at risk of pulmonary aspiration, who do not accept oral restriction. METHODS: Observational, cross-sectional study, presenting a clinical case of an independent elderly with clinical complaints of dysphagia and laryngotracheal aspiration by flexible endoscopic evaluation of swallowing who rejected the proposal to restrict oral diet. A questionnaire about the patient's decision-making process was used to assess whether the physician was sympathetic and justify their answer, and if they are aware of hierarchy of ethical principles (recognition of the person´s value, autonomy, beneficence, nonmaleficence and justice), in the decision-making process, and which was the main principle that guided their decision. RESULTS: One hundred participants were classified by time since graduation as Group I (less than 10 years) and Group II (more than 10 years). Of them, 60% agreed with the patient's decision, with no difference between the groups. The main reason was autonomy of patients, in both groups. Among those who were not sympathetic, the main argument was beneficence and nonmaleficence, considering the risk between benefit and harm. As to awareness about the hierarchy of principles, we did not find differences between the groups. Autonomy was the principle that guided those who were sympathetic with the patient's decision, and justice among those who didnot agree. CONCLUSION: Physicians were sympathetic with the patient's decision regarding autonomy, despite the balance between risks of beneficence and nonmaleficence, including death. We propose to formalize a non-compliance term.


Assuntos
Transtornos de Deglutição/complicações , Padrões de Prática Médica/estatística & dados numéricos , Aspiração Respiratória/etiologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Estudos Transversais , Transtornos de Deglutição/prevenção & controle , Gastroscopia/métodos , Gastrostomia/métodos , Humanos , Intubação Gastrointestinal/métodos , Masculino , Autonomia Pessoal , Relações Médico-Paciente , Aspiração Respiratória/prevenção & controle , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo
4.
Br J Radiol ; 93(1107): 20190955, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31971818

RESUMO

Patients with squamous cell carcinoma of the oropharynx are generally treated with (chemo) radiation. Patients with oropharyngeal cancer have better survival than patients with squamous cell carcinoma of other head and neck subsites, especially when related to human papillomavirus. However, radiotherapy results in a substantial percentage of survivors suffering from significant treatment-related side-effects. Late radiation-induced side-effects are mostly irreversible and may even be progressive, and particularly xerostomia and dysphagia affect health-related quality of life. As the risk of radiation-induced side-effects highly depends on dose to healthy normal tissues, prevention of radiation-induced xerostomia and dysphagia and subsequent improvement of health-relatedquality of life can be obtained by applying proton therapy, which offers the opportunity to reduce the dose to both the salivary glands and anatomic structures involved in swallowing.This review describes the results of the first cohort studies demonstrating that proton therapy results in lower dose levels in multiple organs at risk, which translates into reduced acute toxicity (i.e. up to 3 months after radiotherapy), while preserving tumour control. Next to reducing mucositis, tube feeding, xerostomia and distortion of the sense of taste, protons can improve general well-being by decreasing fatigue and nausea. Proton therapy results in decreased rates of tube feeding dependency and severe weight loss up to 1 year after radiotherapy, and may decrease the risk of radionecrosis of the mandible. Also, the model-based approach for selecting patients for proton therapy in the Netherlands is described in this review and future perspectives are discussed.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Transtornos de Deglutição/prevenção & controle , Neoplasias Orofaríngeas/radioterapia , Terapia com Prótons/métodos , Lesões por Radiação/prevenção & controle , Xerostomia/prevenção & controle , Idoso , Transtornos de Deglutição/etiologia , Nutrição Enteral/estatística & dados numéricos , Humanos , Mandíbula/efeitos da radiação , Pessoa de Meia-Idade , Países Baixos , Órgãos em Risco/efeitos da radiação , Qualidade de Vida , Glândulas Salivares/efeitos da radiação , Xerostomia/etiologia
5.
J Voice ; 34(1): 121-126, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30340927

RESUMO

Vocal fold movement impairment may significantly compromise postoperative recovery and quality of life of patients following thoracic or cardiothoracic surgery or prolonged intubation. The literature is limited and there is no standard screening protocol for the optimal postoperative swallowing and aspiration evaluations. We performed retrospective review of adult patients undergoing early vocal fold (VF) injection laryngoplasty for acute postoperative Vocal fold movement impairment (<30 days) that had both pre- and postinjection speech language pathologist (SLP) performed swallowing/aspiration evaluations. Records were reviewed for demographics, clinical characteristics, procedural details, and short-term outcome measures of oral intake. In total, 30 patients were included, and had data on swallowing/aspiration studies before and after the VF injection laryngoplasty. Most of the patients were injected within 5 days following the laryngologist evaluation and within 14 days following the iatrogenic recurrent laryngeal nerve injury (23/30, 76.7%). The majority of patients were injected at the bedside by awake transcutaneous injection (22/30, 73.3%), six patients were injected in the operating room under general anesthesia, and two at the outpatient clinic. Pre- and postinjection SLP evaluations included clinical bedside assessment or instrumental evaluation. Following VF injection laryngoplasty, oral diet advancement was noted in 81.8% of the patients that were nil per os before the injection (18/22). No complications were noted. In conclusions, acute VFMI following surgery requires immediate diagnosis and therapeutic strategy to minimize postoperative complications and to overcome impairments in the voice, swallow, and cough. Otolaryngology-SLP interdisciplinary aspiration and swallowing assessment protocol is proposed based on our experience and an extensive literature review.


Assuntos
Transtornos de Deglutição/prevenção & controle , Deglutição , Laringoplastia , Complicações Pós-Operatórias/cirurgia , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Aspiração Respiratória/prevenção & controle , Distúrbios da Voz/cirurgia , Qualidade da Voz , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Recuperação de Função Fisiológica , Traumatismos do Nervo Laríngeo Recorrente/diagnóstico , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/etiologia , Aspiração Respiratória/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/etiologia , Distúrbios da Voz/fisiopatologia , Adulto Jovem
6.
Support Care Cancer ; 28(2): 739-745, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31139929

RESUMO

BACKGROUND: Recent studies have highlighted that people diagnosed with head and neck cancer (HNC) have complex information needs. They are subject to multiple clinical appointments with numerous healthcare professionals in preparation for their treatment. Speech and language therapists (SLTs) are core members of the HNC multidisciplinary team, providing assessment, prehabilitation and counselling regarding potential treatment effects on the critical functions, including swallowing and communication. We believed the purpose of the pre-treatment speech-language therapy (SLT) consultation within this pathway is not well understood by patients. Whilst the benefits of prophylactic swallowing exercise prescriptions continue to be explored, adherence is a frequently cited challenge in clinical trials. We sought to enhance pre-treatment dysphagia services for patients with head and neck cancer (HNC) undergoing chemoradiation. METHODS: A participatory action research approach called experience-based co-design (EBCD) was undertaken at a tertiary cancer hospital in the UK. People who had previous radical radiation treatment for head and neck cancer and staff members within the head and neck unit were recruited to take part in in-depth, one-to-one interviews about their experiences of the pre-treatment SLT head and neck radiation clinic. Patient interviews were video-recorded, analysed and edited down to a 30 min 'trigger' film. At a subsequent patient feedback event, the film was shown and an 'emotional mapping' exercise was undertaken. Through facilitated discussion, patient priorities for change were agreed and recorded. At a staff feedback event, key themes from the staff interviews were discussed and priority areas for change identified. The project culminated in a joint patient and staff event where the film was viewed, experiences shared and joint priorities for change agreed. Task and finish groups were developed to implement these changes. RESULTS: Seven patients and seven staff members participated. All seven patients had undergone radical (chemo-) radiation for HNC. At least 2 months had elapsed since their final treatment date and all participants were within 9 months of their definitive treatment. Staff members comprised a radiation oncologist, two clinical nurse specialists, two head and neck dietitians and two speech-language therapists. Patients reported that overall, their experience of the pre-treatment clinic is positive. Patients value experienced staff, consistency of staff and the messages they provide and a team approach. Patients highlighted the need for different information methods including online/digital information resources and further information regarding the longer-term effects of treatment. Patients valued the purposes of prophylactic exercises and again advocated for supporting resources to be available in a range of online/digital media. Staff members raised the need for flexibility in appointment times and clearer messaging as to the rationale for a pre-treatment SLT appointment, including a rebranding of the SLT service. Seven key areas for improvement were identified jointly by patients and staff members including revision of patient and carer information, development of a patient experience video, information on timelines for recovery, a buddy system for patients before, during and after treatment, flexibility of appointment scheduling, seamless transfer of care between settings and SLT department rebranding. Joint patient and staff task and finish groups were initiated to work on these seven priority areas. CONCLUSIONS: We have worked in partnership with patients to co-design pre-treatment dysphagia services which are accessible and meet the individuals' needs. Task and finish groups are ongoing with staff and patients are working together to address priority areas for change. This work provides a good example for other centres who may wish to engage in similar activities.


Assuntos
Transtornos de Deglutição/prevenção & controle , Transtornos de Deglutição/terapia , Deglutição/fisiologia , Terapia por Exercício/métodos , Neoplasias de Cabeça e Pescoço/terapia , Adulto , Cuidadores , Quimiorradioterapia , Feminino , Educação em Saúde/métodos , Pessoal de Saúde , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta
7.
Spine J ; 20(2): 261-265, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31505302

RESUMO

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is considered the gold standard surgical intervention for cervical myelopathy and radiculopathy. Obtaining a solid fusion is an important goal of ACDF, and doing so has correlated with favorable clinical outcomes. A common complication after surgery is postoperative dysphagia. Multiple techniques have been utilized in attempt to prevent and treat dysphagia, including use of retropharygeal steroids. PURPOSE: To examine the effects of retropharyngeal steroids on fusion rate in ACDF. STUDY DESIGN: Case control METHODS: Forty-two patients who received local retropharyngeal steroids during ACDF surgery were the sample patient population. The control group consisted of matched cases based on number of spinal levels treated and age at approximately 1:2 case to control ratio. Data were collected on demographic variables, as well as operative and postoperative courses. Radiographic data were collected and fusion determined by <2 mm motion on flexion/extension views and bridging bone. Data were compared between case and control populations. Continuous variables were compared using Student's t test and nominal/ordinal values were compared using Z-test. Fusion status was assessed using Pearson chi-squared test. RESULTS: A total of 121 patients were reviewed based on matching status and sufficient follow-up. The case and control groups were successfully matched based on age, spinal levels treated, and smoking status. The case group had an overall fusion rate of 64.7%, whereas the control group had a fusion rate of 91%. When analyzed at each level of attempted fusion, the case group had a fusion rate of 81% compared to 93% in the control group. There was a single patient in the case group that developed esophageal rupture and retropharygeal abscess requiring surgical intervention with irrigation, debridement and repair at 8 months after index operation. CONCLUSIONS: The use of retropharyngeal steroids to mitigate postoperative dysphagia is associated with a decreased rate of radiographic fusion in ACDF surgery.


Assuntos
Vértebras Cervicais/cirurgia , Transtornos de Deglutição/epidemiologia , Discotomia/métodos , Complicações Pós-Operatórias/epidemiologia , Radiculopatia/cirurgia , Fusão Vertebral/métodos , Esteroides/uso terapêutico , Adulto , Idoso , Estudos de Casos e Controles , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/prevenção & controle , Discotomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Fusão Vertebral/efeitos adversos
8.
Brachytherapy ; 19(1): 104-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31636025

RESUMO

PURPOSE: The aim of this review was to examine efficacy of palliative interventional radiotherapy (IRT) in esophageal cancer compared with other treatment in terms of dysphagia-free survival (DyFS) and safety. METHODS AND MATERIAL: A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles evaluating the efficacy of IRT as palliation in patients with esophageal cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. We analyzed only clinical study as full text of patients with symptomatic esophageal cancer treated with IRT alone or in combination with other treatment. Conference paper, survey, letter, editorial, book chapter, and review were excluded. Time restriction (1990-2018) as concerns the years of the publication was considered. The primary outcome was the duration of dysphagia relief (DyFS) after brachytherapy vs. other treatment (external-beam radiotherapy, photodynamic therapy, argon plasma coagulation, stent, and laser) during followup. Secondary outcomes included overall survival and adverse event rates. RESULTS: The literature search resulted in 554 articles. Sixty-six articles were assessed via full text for eligibility. Of these, 59 articles were excluded for various reasons, leaving seven randomized studies. The number of evaluated patients was 905 patients, and median age was 70.5 years. In the IRT group, the median DyFS was 99 days, the most relevant G3-G4 toxicity were fistula development and stenosis reported, respectively, in 8.3% and 12.2%; the overall median survival was 175.5 days. CONCLUSION: In conclusion, we provided evidence-based support that IRT is an effective and safe treatment option; therefore, its underuse is no longer justified.


Assuntos
Braquiterapia , Transtornos de Deglutição/prevenção & controle , Fístula Esofágica/etiologia , Neoplasias Esofágicas/radioterapia , Cuidados Paliativos/métodos , Braquiterapia/efeitos adversos , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/complicações , Estenose Esofágica/etiologia , Humanos , Lesões por Radiação/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents/efeitos adversos , Taxa de Sobrevida
9.
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
10.
J Bone Joint Surg Am ; 101(22): 2007-2014, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31764363

RESUMO

BACKGROUND: Dysphagia is one of the most common complications of surgical procedures in the anterior cervical spine, and can persist up to 2 years postoperatively. Corticosteroids are relatively safe and inexpensive for treating various inflammatory conditions. Perioperative corticosteroid administration for anterior cervical spine procedures may effectively minimize postoperative dysphagia, potentially leading to better outcomes, decreased readmission rates, and improved patient satisfaction. The purpose of this study was to determine the efficacy of perioperative corticosteroids in decreasing the severity and duration of dysphagia following single-level and multilevel anterior cervical spine procedures. METHODS: Seventy-four patients undergoing elective anterior cervical surgical procedures for degenerative conditions were recruited. Patients with prior cervical procedures; with a diagnosis of fracture, malignancy, or infection; or requiring combined anterior-posterior procedures were excluded. Patients were randomized to perioperative intravenous dexamethasone or saline solution. Doses were administered before incision and at 8 and 16 hours postoperatively. Investigators and patients were blinded to the treatment throughout the study. Dysphagia outcomes were assessed with use of the Bazaz dysphagia scale and the Dysphagia Short Questionnaire (DSQ) at 1 day, 2 days, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 12 months postoperatively. Statistical analysis was performed comparing means and standard deviations; significance was set at p < 0.05. Clinical outcomes were measured with use of the Quality of Life-12 and Neck Disability Index. RESULTS: Sixty-four patients were included in the analysis. There were 49 anterior cervical discectomies and fusions, 8 corpectomies, 1 hybrid procedure (corpectomy and adjacent discectomy), and 6 single-level arthroplasties. Patients who received corticosteroids had significantly better dysphagia scores on both the Bazaz scale and DSQ at most time points up to 6 months postoperatively (p < 0.05). On subgroup analysis, patients with multilevel (≥2-level) fusion benefited significantly from corticosteroids on both scales, whereas those with single-level procedures did not. There were no short-term wound complications or infections, and length of stay and fusion rates were comparable. CONCLUSIONS: Perioperative administration of corticosteroids can reduce dysphagia symptoms following multilevel anterior cervical procedures. Benefit was noted immediately and up to 6 months postoperatively. There was no significant effect on short-term wound-healing, infection rates, length of stay, or fusion rates. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Corticosteroides/administração & dosagem , Vértebras Cervicais/cirurgia , Transtornos de Deglutição/prevenção & controle , Dexametasona/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Discotomia/efeitos adversos , Discotomia/estatística & dados numéricos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Estudos Prospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Resultado do Tratamento
11.
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
12.
Trials ; 20(1): 503, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412947

RESUMO

BACKGROUND: Radiation-induced dysphagia is common in patients with head and neck cancer (HNC). Available evidence suggests that exercise therapy prior to oncological treatment could potentially improve deglutition and quality of life; however, a randomized clinical trial is needed to confirm this observation. METHODS/DESIGN: The Redyor study is a single-blind randomized clinical trial designed to compare the effect of prophylactic oropharyngeal exercises on quality of life and dysphagia of 52 patients with HNC referred to the Radiotherapy Department. The intervention will consist of respiratory muscle training (3 times/day, 5 days/week, 21 weeks) added to the standard swallow therapy. All patients will perform the same exercise intervention, but at different times: before chemoradiotherapy (CRT; early intervention group) or immediately after completing CRT (late intervention group). The main outcome will be change in dysphagia severity assessed with the Penetration-Aspiration Scale in videofluoroscopy study; quality of life will be assessed with the EORTC-QLQ-C30 and its Head and Neck Cancer Module (QLQ-H&N35) at 3, 6, and 12 months after completing CRT. DISCUSSION: This ongoing clinical trial, registered in 2016, is based on the hypothesis that undergoing a pre-radiotherapy rehabilitation (pre-habilitation) program will have greater benefits (less decrease in quality of life, less delay in swallowing parameters, and less severe dysphagia) compared to post-CRT rehabilitation. The main objective is to assess dysphagia severity in HNC patients; and secondly, to evaluate changes in dysphagia-related quality of life, and to determine the correlation between a clinical variable and instrumental parameters during this period. TRIAL REGISTRATION: NCT0209009911 .


Assuntos
Quimiorradioterapia , Transtornos de Deglutição/prevenção & controle , Deglutição , Terapia por Exercício/métodos , Neoplasias de Cabeça e Pescoço/radioterapia , Qualidade de Vida , Quimiorradioterapia/efeitos adversos , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Espanha , Fatores de Tempo , Resultado do Tratamento
13.
Ann Thorac Cardiovasc Surg ; 25(6): 318-325, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31316037

RESUMO

PURPOSE: This study aimed to assess whether hangekobokuto (HKT) can prevent aspiration pneumonia in patients undergoing cardiovascular surgery. METHODS: We performed a single-center, double-blinded, randomized, placebo-controlled study of HKT in patients undergoing cardiovascular surgery. JPS HKT extract granule (JPS-16) was used as HKT. The primary endpoint was defined as the prevention of postoperative aspiration pneumonia. The secondary endpoints included complete recovery from swallowing and coughing disorders. RESULTS: Between August 2014 and August 2015, a total of 34 patients were registered in this study. The rate of subjects with postoperative aspiration pneumonia was significantly lower in the HKT group than in the placebo group (p = 0.017). In high-risk patients for aspiration pneumonia, the rate was significantly lower in the HKT group than in the placebo group (p = 0.015). The rate of subjects with swallowing disorders tended to be lower in the HKT group than in the placebo group (p = 0.091), and in high-risk patients, the rate was significantly lower in the HKT group than in the placebo group (p = 0.038). CONCLUSIONS: HKT can prevent aspiration pneumonia in patients undergoing cardiovascular surgery. In high-risk patients for aspiration pneumonia, HKT can prevent aspiration pneumonia and improve swallowing disorders.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Transtornos de Deglutição/prevenção & controle , Deglutição/efeitos dos fármacos , Medicina Kampo , Extratos Vegetais/uso terapêutico , Pneumonia Aspirativa/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/efeitos adversos , Pneumonia Aspirativa/diagnóstico , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/fisiopatologia , Fatores de Risco , Fatores de Tempo , Tóquio , Resultado do Tratamento
15.
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
16.
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
17.
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
18.
J Speech Lang Hear Res ; 62(6): 1676-1684, 2019 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-31112668

RESUMO

Purpose The aim of the study was to determine the effects of a 6-week progressive resistance tongue exercise protocol in mental practice form on tongue strength. Investigation begins in typically aging adults, a population susceptible to reduced tongue strength and dysphagia secondary to age-related changes in the swallowing mechanism. It was hypothesized that typically aging adults who perform a 6-week progressive resistance tongue exercise protocol in mental practice form would increase tongue strength. Method A prospective, case series intervention study was used. Six healthy women aged 53-78 years completed a 6-week mental practice tongue resistance exercise program utilizing motor imagery to imagine completion of tongue exercises. The main outcome was mean isometric maximum tongue pressures (tongue strength), which were collected at baseline and Weeks 2, 4, and 6 using the Iowa Oral Performance Instrument ( IOPI Medical, 2013 ). Results By Week 6 of the study, all participants had significantly increased their tongue strength compared to baseline. Conclusions The findings indicate that mental practice using motor imagery for tongue exercise may improve tongue strength in healthy individuals at risk for dysphagia and may thus represent a promising direction warranting further investigation in typically aging individuals and patients with dysphagia and decreased tongue strength.


Assuntos
Transtornos de Deglutição/prevenção & controle , Imagens, Psicoterapia/métodos , Treinamento de Resistência/métodos , Língua/fisiologia , Idoso , Estudos de Viabilidade , Feminino , Voluntários Saudáveis , Humanos , Pessoa de Meia-Idade , Força Muscular/fisiologia , Estudos Prospectivos , Desempenho Psicomotor
19.
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
20.
J Am Coll Surg ; 229(2): 210-216, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30998974

RESUMO

BACKGROUND: Attention has been focused on the amplitude of esophageal body contraction to avoid persistent dysphagia after a Nissen fundoplication. The current recommended level is a contraction amplitude in the distal third of esophagus above the fifth percentile. We hypothesized that a more physiologic approach is to measure outflow resistance imposed by a fundoplication, which needs to be overcome by the esophageal contraction amplitude. STUDY DESIGN: The esophageal outflow resistance, as reflected by the intra-bolus pressure (iBP) measured 5 cm above the lower esophageal sphincter (LES), was measured in 53 normal subjects and 37 reflux patients with normal esophageal contraction amplitude, before and after a standardized Nissen fundoplication. All were free of postoperative dysphagia. A test population of 100 patients who had a Nissen fundoplication was used to validate the threshold of outflow resistance to avoid persistent postoperative dysphagia. RESULTS: The mean (SD) amplitude of the iBP in normal subjects was 6.8 (3.7) mmHg and in patients before fundoplication was 3.6 (7.0) mmHg (p = 0.003). After Nissen fundoplication, the mean (SD) amplitude of the iBP increased to 12.0 (3.2) mmHg (p < 0.0001 vs normal subjects or preoperative values). The 95th percentile value for iBP after a Nissen fundoplication was 20.0 mmHg and was exceeded by esophageal contraction in all patients in the validation population, and 97% of these patients were free of persistent postoperative dysphagia at a median 50-month follow-up. CONCLUSIONS: Nissen fundoplication increases the outflow resistance of the esophagus and should be constructed to avoid an iBP > 20 mmHg. Patients whose distal third esophageal contraction amplitude is >20 mmHg have a minimal risk of dysphagia after a tension-free Nissen fundoplication.


Assuntos
Transtornos de Deglutição/prevenção & controle , Esôfago/fisiologia , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Estudos de Casos e Controles , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Esôfago/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
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