scholarly journals The role of the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke (GLOBE-3S) in the prevention of stroke-associated pneumonia (SAP)

2021 ◽  
Author(s):  
T. B. Jannini ◽  
M. Ruggiero ◽  
A. Viganò ◽  
A. Comanducci ◽  
I. Maestrini ◽  
...  
Keyword(s):  
Screening Tool ◽  
Function Analysis ◽  
Screening Method ◽  
Screening Tools ◽  
Stroke Patients ◽  
Silent Aspiration ◽  
Highly Sensitive ◽  
Dysphagic Patients ◽  
Swallowing Screening

Abstract Background and purpose Stroke-associated pneumonia (SAP) affects 10 to 38% of patients in the acute phase of stroke. Stroke patients diagnosed with dysphagia have an 11-fold higher risk of developing SAP. Thus, identifying dysphagic patients through a highly accurate screening tool might be crucial in reducing the incidence of SAP. We present a case–control study designed to evaluate efficacy in reducing the risk of SAP between two swallowing screening tools, the classic water swallow test (WST) and a recently validated tool such as the GLOBE-3S (the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke), which is a highly sensitive swallowing screening tool particularly accurate in detecting silent aspiration as well. Methods We analyzed the occurrence of dysphagia in 100 acute stroke patients distributed in two groups: half were screened with WST and the other half with GLOBE-3S. Results Dysphagia was diagnosed in 28 patients. The main result is that, among patients who passed the dysphagia screenings, none of those screened with the GLOBE-3S method developed pneumonia compared to 31.82% in the WST group. Discriminant function analysis (DFA) showed that NIH Stroke Scale (NIHSS) score and the dysphagia screening method (i.e., GLOBE-3S vs. WST) were the two main factors in the SAP’s predicting model and the only significant ones per se. Conclusions The new GLOBE-3S screening test can reduce the risk of SAP compared to WST.

scholarly journals Perioperative Nutritional Screening Tools Are Not Associated with Poor Outcomes After Musculoskeletal Trauma

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1136-1136
Author(s):  
Aspen Miller ◽  
John Davison ◽  
Nathan Hendrickson ◽  
Erin Wilson ◽  
Natalie Glass ◽  
...  
Keyword(s):  
Screening Tool ◽  
Screening Method ◽  
Screening Tools ◽  
Nutritional Deficiencies ◽  
Screening Methods ◽  
Complication Rates ◽  
Nutritional Screening ◽  
Patient Reported ◽  
Poor Outcomes ◽  
Musculoskeletal Trauma

Abstract Objectives Malnutrition is predictive of poor outcomes after trauma. Side effects of both pain and narcotics often limit postoperative dietary intake increasing nutritional deficiencies and limiting wound healing. The purpose of this study was to compare the predictive ability of a dietician nutritional evaluation and a patient reported nutritional screening tool for post-operative complications after musculoskeletal trauma. Methods Adults with operative pelvis or long bone fractures were prospectively enrolled in a single-blinded RCT and included in this analysis. Subjects were evaluated with the Patient Generated Subjective Global Assessment (PG-SGA) survey at baseline. Dietician Nutritional Assessment Screening (NAS) was performed for patients ≥65 years with low Albumin or Vitamin D, or admitted to the ICU. Complication analysis included subjects having minimum 6-month follow-up and/or ≥1 complication within six months. Spearman's Correlation was used to evaluate agreement between screening methods. Comparison using X analysis was done of complications between pre-operative assignment of malnutrition for each screening tool. Results Agreement of NAS and self-reported PG-SGA for 265 subjects demonstrated a weak correlation of rho = 0.23, P = 0.0002. Neither screening method had significant correlation for rates of non-union, mortality, medical, or surgical complications between designations of malnutrition (all P > .05). Among study subjects, incidence of those having a medical or surgical complication not screened by a dietician was 31.3% and 37.7% respectively. Conclusions Results indicate inconsistency in methods for assigning malnutrition in trauma population. Additionally, designation of malnutrition by either method was not associated with post-operative complication rates. The high incidence of those with a complication who were not evaluated by a dietician during initial hospitalization (1/3rd) support the need to develop better methods for screening malnutrition after trauma. Funding Sources American Academy of Orthopaedic Surgeons, Board of Specialty Societies Quality and Patient Safety Action Fund.

scholarly journals Measurement of Oxygen Desaturation Is Not Useful for the Detection of Aspiration in Dysphagic Stroke Patients

2017 ◽  
Vol 7 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Thomas Marian ◽  
Jens Schröder ◽  
Paul Muhle ◽  
Inga Claus ◽  
Stephan Oelenberg ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Screening Tool ◽  
Oxygen Desaturation ◽  
Screening Tools ◽  
Endoscopic Evaluation ◽  
National Guidelines ◽  
Stroke Patients ◽  
Severe Dysphagia ◽  
A Minor ◽  
Swallowing Assessment

Background: Dysphagia is one of the most dangerous symptoms of acute stroke. Various screening tools have been suggested for the early detection of this condition. In spite of conflicting results, measurement of oxygen saturation (SpO2) during clinical swallowing assessment is still recommended by different national guidelines as a screening tool with a decline in SpO2 ≥2% usually being regarded as a marker of aspiration. This paper assesses the sensitivity of SpO2 measurements for the evaluation of aspiration risk in acute stroke patients. Methods: Fifty acute stroke patients with moderate to severe dysphagia were included in this study. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardised protocol. Blinded to the results of FEES, SpO2 was monitored simultaneously. The degree of desaturation during/after swallows with aspiration was compared to the degree of desaturation during/after swallows without aspiration in a swallow-to-swallow analysis of each patient. To minimise potential confounders, every patient served as their control. Results: In each subject, a swallow with and a swallow without aspiration were analysed. Overall, aspiration seen in FEES was related to a minor decline in SpO2 (mean SpO2 without aspiration 95.54 ± 2.7% vs. mean SpO2 with aspiration 95.28 ± 2.7%). However, a significant desaturation ≥2% occurred only in 5 patients during/after aspiration. There was no correlation between aspiration/dysphagia severity or the amount of aspirated material and SpO2 levels. Conclusions: According to this study, measurement of oxygen desaturation is not a suitable screening tool for the detection of aspiration in stroke patients.

The Predictive Role of Maternal Parenting and Stress on Pupils’ Bullying involvement

2016 ◽  
Vol 34 (17) ◽  
pp. 3691-3710 ◽  
Author(s):  
Fatemeh Alizadeh Maralani ◽  
Mirmahmoud Mirnasab ◽  
Touraj Hashemi
Keyword(s):  
Parenting Style ◽  
Parenting Styles ◽  
Parental Stress ◽  
Maternal Stress ◽  
Function Analysis ◽  
Short Form ◽  
Screening Method ◽  
Stress Index ◽  
Cluster Sampling

The link between inappropriate parenting style and both bullying and victimization is well documented. However, it is not clear as to which kind of parenting style is associated with victimization. Furthermore, no studies have yet been conducted regarding the role of parental stress in bullying and victimization. This study aimed to examine the role of parenting styles and maternal stress in pupils’ bullying and victimization. A total of 300 primary school pupils, enrolled in fourth and fifth grades, participated in the study. Initially, 100 noninvolved pupils were randomly selected using a multistage cluster sampling method. Then using a screening method, 100 bully pupils and 100 victimized peers were selected. Olweus Bullying Scale and teacher nomination were administered for screening these pupils. Baumrind Parenting Style Questionnaire and revised version of Abidin Parental Stress Index (short form) were also applied to all pupils in the study. Data were analyzed using discriminant function analysis. The findings showed that (a) with regard to parenting styles, significant differences were found among groups. Authoritarian parenting style could significantly predict pupils’ bullying behavior, whereas victimization was predictable in families with permissive parenting style. In addition, noninvolved pupils were predicted to have authoritative parenting style. (b) Considering maternal stress, significant differences were observed across groups. Parents of bullies and victims were predicted to have higher maternal stress than noninvolved pupils. The implications of the study in relation to the role of mothers in bullying and victimization are discussed.

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

2018 ◽  
Vol 45 (3-4) ◽  
pp. 101-108 ◽  
Author(s):  
Sonja Suntrup-Krueger ◽  
Jens Minnerup ◽  
Paul Muhle ◽  
Inga Claus ◽  
Jens Burchard Schröder ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Case Fatality ◽  
Stroke Patients ◽  
Treatment Practices ◽  
Order Of Magnitude ◽  
Dysphagic Patients ◽  
Swallowing Screening ◽  
The Impact ◽  
Over Time ◽  
Stroke Register

Background: Early dysphagia screening and appropriate management are recommended by current guidelines to reduce complications and case fatality in acute stroke. However, data on the potential benefit of changes in dysphagia care on patient outcome are limited. Our objective was to assess the degree of implementation of dysphagia guidelines and determine the impact of modifications in dysphagia screening and treatment practices on disease complications and outcome in stroke patients over time. Methods: In this prospective register-based study (“Stroke Register of Northwestern Germany”), all adult stroke patients admitted to 157 participating hospitals between January, 2008 and December, 2015 were included (n = 674,423). Dysphagia incidence upon admission, the proportion of patients receiving a standardized swallowing screening, and the percentage of dysphagic patients being referred to a speech language therapist (SLT) for treatment were obtained per year. Pneumonia rate, modified Rankin Scale (mRS) at discharge, and in-hospital mortality were compared between groups of dysphagic vs. non-dysphagic patients over time. Results: Screening proportions continuously increased from 47.2% in 2008 to 86.6% in 2015. But the proportion diagnosed with dysphagia remained stable with about 19%. The number of dysphagic patients receiving SLT treatment grew from 81.6 up to 87.0%. Pneumonia incidence was higher in dysphagic stroke cases (adjusted OR 5.4 [5.2–5.5], p < 0.001), accompanied by a worse mRS at discharge (adjusted OR for mRS ≥3: 3.1 [3.0–3.1], p < 0.001) and higher mortality (adjusted OR 3.1 [3.0–3.2], p < 0.001). The order of magnitude of these end points did not change over time. Conclusion: Although advances have been made in dysphagia care, prevalent screening and treatment practices remain insufficient to reduce pneumonia rate, improve functional outcome, and decrease case fatality in dysphagic stroke patients. More research is urgently needed to develop more effective swallowing therapies.

scholarly journals Correlation of admission labour admission test in low risk pregnancies with pregnancy outcome

2019 ◽  
Vol 8 (5) ◽  
pp. 1880
Author(s):  
Preeti Sharma ◽  
Nikita Gandotra ◽  
Deepti Rana ◽  
Sabia Rasheed ◽  
Anil Kumar Sharma
Keyword(s):  
Prospective Observational Study ◽  
Screening Tool ◽  
Stress Test ◽  
Mode Of Delivery ◽  
Screening Method ◽  
Low Risk ◽  
Age Group ◽  
Admission Test ◽  
Pathological Group

Background: Aim of the study was to evaluate the role of NST (labour admission test) as a screening method in management of low risk pregnancies and to study the correlation of NST with fetal outcome.Methods: A prospective observational study conducted over 500 patients managed at our centre after proper evaluation. Patients were evaluated for mode of delivery and neonatal outcome.Results: The maximum number 352 of patients belonged to 20-30 years age group, 113 patients belonged to 31-35 age group. 200 patients were of 37-40 weeks gestation and 185 were of 40-41 weeks gestation. There were 125 patients in the 41-42 weeks gestational period. Among the 500 pregnant mothers who were included in the study 82.6% had Normal NST, 11.6% had suspicious and 5.8% had pathological NST. Cesarean rate was 14.4% in normal NST group, 58.62% in suspicious group and 72.41% in pathological group study. 6.77% in Normal group had meconium stained liquor at delivery whereas 29.31% in suspicious group and 37.93% in pathological group had same.Conclusions: The non-stress test is an important screening tool to identity the fetus in jeopardy in utero. This enables an appropriate timely intervention to achieve the most favorable outcome.

Role of Nail Fold Capillaroscopy as A Method of Early Detection of Atherosclerosis in Systemic Lupus Erythematosus Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hanan Mohamed Farouk ◽  
Rasha Mahmoud Mohamed ◽  
Fatma Mohammad Aboud ◽  
Huda Taha Hussein
Keyword(s):  
Cardiovascular Disease ◽  
Lupus Erythematosus ◽  
Screening Tool ◽  
Intima Media Thickness ◽  
Systemic Lupus Erythematosis ◽  
University Hospitals ◽  
Systemic Lupus ◽  
Highly Sensitive ◽  
Carotid Doppler

Abstract Background The development of atherosclerosis and cardiovascular disease as a consequence Systemic Lupus Erythematosis is a common and dangerous complication in patients with SLE. However, since the prevalence of atherosclerosis and cardiovascular disease is variable and increasing by time, universal screening would imply a large number of unnecessary carotid Doppler. Objective To study the early prediction of atherosclerosis and the cardiovascular risk in SLE patients by Nail fold capillaroscopy and the Intima media thickness of the Carotid artery. Patients and Methods All Patients were subjected to full history taking, full clinical examination, laboratory investigations, carotid Doppler and nail fold capillaroscopy. In this study, we prospectively collected data on 30 consecutive patients referred to Ain Shams University hospitals and The National Research Institute. Results However, nail fold changes was significantly higher in patients with IM thickness changes indicative of atherosclerosis with SLE: it was proved to be highly sensitive and adequately specific in predicting the atherosclerosis in those patients. Conclusion IM thickness and nail fold capillaroscopy could be used as a guiding noninvasive screening tool in patients with SLE to predict the atherosclerosis and CV risk. Nail fold changes is correlated to the atherosclerotic changes happening in SLE patients. These results may lead to a reduction in the number of SLE patients with undiagnosed atherosclerosis and CV risk. Nail fold capillarscopy may also help alleviate the financial and disinfection burdens of radiology units as well as the medical costs associated with atherosclerosis and CV risk. Nail fold capillaroscopy can be used as a screening tool before doing carotid Doppler.

scholarly journals Validation of a Dysphagia Screening Tool in Acute Stroke Patients

2010 ◽  
Vol 19 (4) ◽  
pp. 357-364 ◽  
Author(s):  
Jeff Edmiaston ◽  
Lisa Tabor Connor ◽  
Lynda Loehr ◽  
Abdullah Nassief
Keyword(s):  
Acute Stroke ◽  
Health Care Professionals ◽  
Screening Tool ◽  
Tertiary Care ◽  
Screening Tools ◽  
Care Hospital ◽  
Stroke Patients ◽  
Aspiration Risk ◽  
The Mean ◽  
Mean Time

Background Although many dysphagia screening tools exist, none has high sensitivity and reliability or can be administered quickly with minimal training. Objective To design and validate a swallowing screening tool to be used by health care professionals who are not speech language pathologists to identify dysphagia and aspiration risk in acute stroke patients. Methods In a prospective study of 300 patients admitted to the stroke service at an urban tertiary care hospital, interrater and test-retest reliabilities of a new tool (the Acute Stroke Dysphagia Screen) were established. The tool was administered by nursing staff when patients were admitted to the stroke unit. A speech language pathologist blinded to the results with the new tool administered the Mann Assessment of Swallowing Ability, a clinical bedside evaluation, with dysphagia operationally defined by a score less than 178. Results The mean time from admission to screening with the new tool was 8 hours. The mean time between administration of the new tool and the clinical bedside evaluation was 32 hours. For the new tool, interrater reliability was 93.6% and test-retest reliability was 92.5%. The new tool had a sensitivity of 91% and a specificity of 74% for detecting dysphagia and a sensitivity of 95% and a specificity of 68% for detecting aspiration risk. Conclusions The Acute Stroke Dysphagia Screen is an easily administered and reliable tool that has sufficient sensitivity to detect both dysphagia and aspiration risk in acute stroke patients.

scholarly journals Ground-Truthing Validation to Assess the Effect of Facility Locational Error on Cumulative Impacts Screening Tools

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
J. L. Sadd ◽  
E. S. Hall ◽  
M. Pastor ◽  
R. A. Morello-Frosch ◽  
D. Lowe-Liang ◽  
...  
Keyword(s):  
Screening Tool ◽  
Screening Method ◽  
Secondary Data ◽  
Ground Truth ◽  
Screening Tools ◽  
Cumulative Impacts ◽  
Cumulative Impact ◽  
Ground Truthing ◽  
Permitting Process ◽  
Locational Error

Researchers and government regulators have developed numerous tools to screen areas and populations for cumulative impacts and vulnerability to environmental hazards and risk. These tools all rely on secondary data maintained by government agencies as part of the regulatory and permitting process. Stakeholders interested in cumulative impacts screening results have consistently questioned the accuracy and completeness of some of these datasets. In this study, three cumulative impacts screening tools used in California were compared, and ground-truth validation was used to determine the effect database inaccuracy. Ground-truthing showed substantial locational inaccuracy and error in hazardous facility databases and statewide air toxics emission inventories of up to 10 kilometers. These errors resulted in significant differences in cumulative impact screening scores generated by one screening tool, the Environmental Justice Screening Method.

An integrated screening method for evaluating the pulmonary toxicity of inhaled particulates: Role of microscopic techniques in assessing pulmonary macrophage clearance functions

1990 ◽  
Vol 48 (3) ◽  
pp. 826-827
Author(s):  
David B. Warheit ◽  
Lena Achinko ◽  
Mark A. Hartsky
Keyword(s):  
Bronchoalveolar Lavage ◽  
Pulmonary Toxicity ◽  
Screening Method ◽  
Pulmonary Response ◽  
Inhaled Particles ◽  
Cytochemical Analysis ◽  
Pulmonary Macrophages ◽  
Integrated Screening

There is a great need for the development of a rapid and reliable bioassay to evaluate the pulmonary toxicity of inhaled particles. A number of methods have been proposed, including lung clearance studies, bronchoalveolar lavage analysis, and in vitro cytotoxicity tests. These methods are often limited in scope inasmuch as they measure only one dimension of the pulmonary response to inhaled, instilled or incubated dusts. Accordingly, a comprehensive approach to lung toxicity studies has been developed.To validate the method, rats were exposed for 6 hours or 3 days to various concentrations of either aerosolized alpha quartz silica (Si) or carbonyl iron (CI) particles. Cells and fluids from groups of sham and dust-exposed animals were recovered by bronchoalveolar lavage (BAL). Alkaline phosphatase, LDH and protein values were measured in BAL fluids at several time points postexposure. Cells were counted and evaluated for viability, as well as differential and cytochemical analysis. In addition, pulmonary macrophages (PM) were cultured and studied for morphology, chemotaxis, and phagocytosis by scanning electron microscopy.

The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective

Pflege ◽  
1999 ◽  
Vol 12 (1) ◽  
pp. 21-27
Author(s):  
Marit Kirkevold
Keyword(s):  
Acute Stroke ◽  
Theoretical Perspective ◽  
Stroke Patients ◽  
Role Of Nursing ◽  
Rolle Der Pflegenden

Eine Übersicht der bestehenden Literatur weist auf Unsicherheiten bezüglich der spezifischen Rolle der Pflegenden in der Rehabilitation von Hirnschlagpatientinnen und -patienten hin. Es existieren zwei unterschiedliche Begrifflichkeiten für die Rolle der Pflegenden, keine davon bezieht sich auf spezifische Rehabilitationsziele oder Patientenergebnisse. Ein anfänglicher theoretischer Beitrag der Rolle der Pflege in der Genesung vom Hirnschlag wird als Struktur unterbreitet, um die therapeutischen Aspekte der Pflege im Koordinieren, Erhalten und Üben zu vereinen. Bestehende Literatur untermauert diesen Beitrag. Weitere Forschung ist jedoch notwendig, um den spezifischen Inhalt und Fokus der Pflege in der Genesung bei Hirnschlag zu entwickeln.

Sign in / Sign up

Export Citation Format

Share Document