Safety and Efficacy of Specially Designed Texture-Modified Foods for Patients with Dysphagia Due to Brain Disorders: A Prospective Study

Providing texture-modified food for patients with dysphagia is a cornerstone of dysphagia treatment. This study aimed to evaluate the safety and efficacy of a specially designed texture-modified food that can be easily swallowed while maintaining the unique taste by adjusting hardness and adhesiveness in patients with brain disorders using a videofluoroscopic swallowing study. We included 101 patients with oropharyngeal dysphagia due to brain disorders who were referred to the rehabilitation department. To evaluate the safety and efficacy of a specially designed texture-modified food, rice gruel was compared with a regular instant rice porridge, and bulgogi mousse was compared with ground bulgogi, which normally serves as a texture-modified diet for patients with dysphagia in our hospital during the videofluoroscopic swallowing study. The Penetration–Aspiration Scale score, oropharyngeal transit time, number of swallows required to maximally eliminate food materials from the oropharyngeal space, and vallecular and pyriform sinus residue after swallowing scale score were compared. Rice gruel required a shorter oropharyngeal transit time and fewer number of swallowing per the given amount of food than regular instant rice porridge; however, no statistical difference was found in the vallecular and pyriform sinus residue after swallowing scale scores and the Penetration–Aspiration Scale scores. Bulgogi mousse required more swallowing and had lower Penetration–Aspiration Scale scores than ground bulgogi; however, no significant difference was found in the oropharyngeal transit time and the vallecular and pyriform sinus residue after swallowing scale scores. The study foods were safe and efficacious compared to control foods usually provided for patients with dysphagia from various brain disorders.

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The efficacy comparison of citalopram, fluoxetine, and placebo on motor recovery after ischemic stroke: a double-blind placebo-controlled randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215518777791 ◽

2018 ◽

Vol 32 (8) ◽

pp. 1069-1075 ◽

Cited By ~ 7

Author(s):

Marjan Asadollahi ◽

Mahtab Ramezani ◽

Ziba Khanmoradi ◽

Ehsan Karimialavijeh

Keyword(s):

Ischemic Stroke ◽

Placebo Group ◽

Scale Score ◽

Motor Recovery ◽

Controlled Clinical Trial ◽

Double Blind ◽

Double Blind Placebo ◽

Post Stroke ◽

Significant Difference ◽

Scale Scores

Objective: The present study aimed to assess the effectiveness of oral citalopram, compared with fluoxetine and a placebo, in patients with post-stroke motor disabilities. Design: A randomized double-blind placebo-controlled clinical trial was conducted between January 2015 and January 2016. Setting: The neurology department of a university-affiliated urban hospital in Tehran, Iran. Subjects: Ninety adult patients with acute ischemic stroke, hemiplegia, or hemiparesis and a Fugl-Meyer Motor Scale score of below 55 were included. Interventions: Participants were randomly allocated to one of three groups: Group A received 20 mg PO of fluoxetine daily, Group B received 20 mg PO of citalopram daily, and Group C received a placebo PO The duration of the therapy was 90 days. In addition to the medications, all of the participants received physiotherapy. Main measures: Functional status at 90 days, which was measured by the Fugl-Meyer Motor Scale score. Results: The initial mean (SD) Fugl-Meyer Motor Scale scores for the placebo, fluoxetine, and citalopram groups were 18.2 (11.42), 20.08 (14.53), and 17.07 (14.92), respectively. After 90 days, the scores were 27.96 (18.71) for the placebo group, 52.42 (26.24) for the fluoxetine group, and 50.89 (27.17) for the citalopram group. Compared with the placebo group, the mean Fugl-Meyer Motor Scale scores showed significant increases in the fluoxetine and citalopram groups ( P = 0.001). Conclusion: There was no significant difference between citalopram and fluoxetine in facilitating post-stroke motor recovery in ischemic stroke patients. However, compared with a placebo, both drugs improved post-stroke motor function.

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Mixed Consistencies in Dysphagic Patients: A Myth to Dispel

Dysphagia ◽

10.1007/s00455-021-10255-x ◽

2021 ◽

Author(s):

Mozzanica Francesco ◽

Pizzorni Nicole ◽

Scarponi Letizia ◽

Bazzotti Claudia ◽

Ginocchio Daniela ◽

...

Keyword(s):

Rating Scale ◽

Pyriform Sinus ◽

Endoscopic Evaluation ◽

Pharyngeal Residue ◽

Food Residue ◽

Severity Rating ◽

Vegetable Soup ◽

Laryngeal Vestibule ◽

Dysphagic Patients ◽

Penetration Aspiration Scale

AbstractOnly limited and inconsistent information about the effect of mixed consistencies on swallowing are available. The aim of this study was to evaluate the location of the head of the bolus at the swallow onset, the risk of penetration/aspiration, and the severity of post-swallow pharyngeal residue in patients with dysphagia when consuming mixed consistencies. 20 dysphagic patients underwent a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) testing five different textures: liquid, semisolid, solid, biscuits-with-milk and vegetable-soup. The location of the head of the bolus at the onset of swallowing was rated using a five-points scale ranging from zero (the bolus is behind the tongue) to four (the bolus falls into the laryngeal vestibule), the severity of penetration/aspiration was rated using the Penetration Aspiration Scale (PAS), the amount of pharyngeal residue after the swallow was rated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in the vallecula and pyriform sinus. When consuming biscuits-with-milk and liquid the swallow onset occurred more often when the boluses were located in the laryngeal vestibule. Penetration was more frequent with biscuits-with-milk, while aspiration was more frequent with Liquid, followed by biscuits-with-milk and vegetable-soup, Semisolid and Solid. In particular, no differences in penetration and aspiration between liquids and biscuits-with-milk were found as well as among vegetable-soup, semisolid and solid. No significant differences in the amount of food residue after swallowing were demonstrated. The risk of penetration-aspiration for biscuits-with-milk and liquid is similar, while the risk of penetration-aspiration is lower for vegetable-soup than for liquid.

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The Effect of Loneliness on Death Anxiety in the Elderly During the COVID-19 Pandemic

OMEGA - Journal of Death and Dying ◽

10.1177/00302228211010587 ◽

2021 ◽

pp. 003022282110105

Author(s):

Türkan Akyol Guner ◽

Zeynep Erdogan ◽

Isa Demir

Keyword(s):

Death Anxiety ◽

The Elderly ◽

Average Score ◽

City Center ◽

Cross Sectional ◽

North West ◽

Significant Difference ◽

Scale Scores ◽

Education Status ◽

At Home

The aim of the study is to determine the effect on death anxiety of loneliness in the elderly during the COVID-19 pandemic. The population of this study that is descriptive and cross-sectional type consist of 354 elderly who meet the inclusion criteria from three different associations operating for charitable purposes in a city center located in north-west Turkey. The average score of Loneliness Scale of Elderly (LSE) of the elderly was determined as 11.39 ± 5.31, and the average score of Death Anxiety Scale (DAS) of the elderly was determined as 8.54 ± 4.82. According to these results, it was found that the elderly experienced acceptable levels of loneliness and moderate death anxiety. A statistically significant difference was found in the LSE and DAS scores of the elderly according to their age, marital status, education status, chronic illness status and living at home with relatives. In addition, during the COVID-19 epidemic, the scale scores of the elderly who have increased worries, who have a hobby at home, and who communicate with their relatives via social media/mobile phones were found to be statistically significant (p < 0.05).

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551. Convalescent plasma early in disease course improves survival in COVID-19

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.745 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S341-S342

Author(s):

Varidhi Nauriyal ◽

Anita Shallal ◽

Amit T Vahia ◽

Linoj Samuel ◽

Robert Tibbetts ◽

...

Keyword(s):

Scale Score ◽

Medical Records ◽

Clinical Status ◽

Ordinal Scale ◽

Optimal Timing ◽

Care Hospital ◽

Future Studies ◽

Patient Gender ◽

Significant Difference ◽

Pcr Test

Abstract Background Convalescent plasma (CP) has been described as a potential therapy for coronavirus disease 2019 (COVID-19). Given paucity of data, we sought to describe characteristics of CP recipients in survivors and non-survivors. Methods We conducted retrospective review of electronic medical records which included any patient with a positive SARS-CoV-2 PCR test who received CP at an 890-bed quaternary care hospital in Southeast Michigan between March-May 2020. Data collected included: demographics, co-morbidities, mSOFA score on admission, laboratory values, and treatment. Outcomes assessed included inflammatory markers and clinical status based on an 8-point ordinal scalea. These values were recorded on admission, the date of CP (day 1), day 3, 7, and day 30 post-CP. Patient outcomes were stratified by ordinal scale score and compared using Mann-Whitney U tests to examine differences in clinical characteristics: scale of 1–4 (“meaningful survivor”), 5–7 (“survivor”), and 8 (“non-survivor”). Results Results of our study are summarized in Table 1 and 2. Non-survivors were older than survivors (62 vs 71 years; p=0.026). There was no statistically significant difference between patient gender, race, number of days from positive PCR test to CP, treatments, and co-morbidities. There was a trend toward higher mSOFA score on admission in non-survivors (p=0.056). A lower ordinal scale score on the date of receiving CP was significantly associated with meaningful survivorship (6 vs 7, p=0.005). Comparisons of Characteristics Based on Ordinal Scale at Day 30 Comparisons of Outcomes Based on Ordinal Scale at Day 30 Conclusion Patients who have a lower ordinal scale score on the date of CP administration are most likely to have meaningful survivorship at day 30. Future studies should evaluate optimal timing and outcomes for CP therapy in COVID-19. Disclosures All Authors: No reported disclosures

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Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

Anaesthesia and Intensive Care ◽

10.1177/0310057x20962113 ◽

2021 ◽

Vol 49 (1) ◽

pp. 23-34

Author(s):

Katherine P Hooper ◽

Matthew H Anstey ◽

Edward Litton

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Meta Analysis ◽

Diagnostic Testing ◽

Intervention Group ◽

Cochrane Central Register ◽

Safety And Efficacy ◽

Significant Difference

Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%–72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

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Safety and efficacy of iron isomaltoside 1000/ferric derisomaltose versus iron sucrose in patients with chronic kidney disease: the FERWON-NEPHRO randomized, open-label, comparative trial

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa011 ◽

2020 ◽

Vol 36 (1) ◽

pp. 111-120 ◽

Cited By ~ 14

Author(s):

Sunil Bhandari ◽

Philip A Kalra ◽

Mario Berkowitz ◽

Diogo Belo ◽

Lars L Thomsen ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Single Dose ◽

Kidney Disease ◽

Iron Deficiency ◽

Iron Sucrose ◽

Hypersensitivity Reactions ◽

Open Label ◽

Pronounced Increase ◽

Safety And Efficacy ◽

Significant Difference

Abstract Background The optimal intravenous (IV) iron would allow safe correction of iron deficiency at a single infusion over a short time. The FERWON-NEPHRO trial evaluated the safety and efficacy of iron isomaltoside 1000/ferric derisomaltose (IIM) in patients with non-dialysis-dependent chronic kidney disease and iron deficiency anaemia. Methods In this randomized, open-label and multi-centre trial conducted in the USA, patients were randomized 2:1 to a single dose of 1000 mg IIM or iron sucrose (IS) administered as 200 mg IV injections up to five times within a 2-week period. The co-primary endpoints were serious or severe hypersensitivity reactions and change in haemoglobin (Hb) from baseline to Week 8. Secondary endpoints included incidence of composite cardiovascular adverse events (AEs). Results A total of 1538 patients were enrolled (mean estimated glomerular filtration rate 35.5 mL/min/1.73 m2). The co-primary safety objective was met based on no significant difference in the incidence of serious or severe hypersensitivity reactions in the IIM and IS groups [0.3% versus 0%; risk difference: 0.29% (95% confidence interval: –0.19; 0.77; P > 0.05)]. Incidence of composite cardiovascular AEs was significantly lower in the IIM versus IS group (4.1% versus 6.9%; P = 0.025). Compared with IS, IIM led to a more pronounced increase in Hb during the first 4 weeks (P ≤ 0.021), and change in Hb to Week 8 showed non-inferiority, confirming that the co-primary efficacy objective was met. Conclusions Compared with multiple doses of IS, a single dose of IIM induced a non-inferior 8-week haematological response, comparably low rates of hypersensitivity reactions, and a significantly lower incidence of composite cardiovascular AEs.

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The effect of resistant starch on colon function in humans

British Journal Of Nutrition ◽

10.1079/bjn19900058 ◽

1990 ◽

Vol 64 (2) ◽

pp. 589-595 ◽

Cited By ~ 48

Author(s):

J. Tomlin ◽

N. W. Read

Keyword(s):

Transit Time ◽

Resistant Starch ◽

Bacterial Flora ◽

Random Order ◽

Observable Effect ◽

Total Carbohydrate ◽

Diet Supplements ◽

Significant Difference ◽

Dietary Period ◽

The Difference

Starch that is resistant to human amylases forms during the cooking and subsequent cooling of some foods, and may therefore be a substrate for the bacterial flora of the colon. It is thus possible that resistant starch (RS) will affect colon function in a similar manner to non-starch polysaccharides. To test this theory, a group of eight volunteers took two diet supplements for 1 week each in a random order with a 1 week separation. One supplement comprised mainly 350 g Cornflakes/d and the other 380 g Rice Krispies/d, providing 10.33 and 0.86 g RS/.d respectively. The amounts of amylase-digestible starch, non-starch polysaccharides, total carbohydrate, energy, protein and fat were balanced between the two periods by giving small amounts of Casilan, wheat bran, butter and boiled sweets. The volunteers made faecal collections during day 3 to day 7 of each period. Whole-gut transit time was calculated using the continuous method. Stool consistency and ease of defaecation were assessed by the volunteers. All episodes of flatulence noticed were recorded in a diary, along with food intake. Serial breath hydrogen measurements were made at 15 min intervals for 8 h on day 1 of each supplement. Questionnaires regarding colon function were completed at the end of each dietary period. There were no significant differences in the stool mass, frequency or consistency, ease of defaecations, transit time or flatulence experienced during the two supplements (P > 0.05). Significantly more H2 (area under curve) was produced while eating Cornflakes than Rice Krispies (P < 0.05). The difference of 9.47 g RS/d between the two diets was over three times the calculated normal daily RS intake of 2.76 g/d. As the only significant difference observed was in the breath H2 excretion on day 1, we suggest that either RS is rapidly and completely fermented to end-products including H2 gas, which is subsequently excreted via the lungs and has little influence on colon function, or that bacterial adaptation removed any observable effect on faecal mass and transit time by day 3.

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Safety and efficacy of directly acting antivirals (sofosbuvir and daclatasvir) in treatment of chronic HCV in HIV-HCV co-infected Egyptian patients

Egyptian Liver Journal ◽

10.1186/s43066-021-00089-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Inas E L-Khedr Mohamed ◽

Kadry Mohamed EL-Saeed ◽

Mahmoud Hassan Al-Sadik ◽

Christina Alphonse Anwar

Keyword(s):

Complete Blood Count ◽

Virologic Response ◽

Safety And Efficacy ◽

Treatment Regimens ◽

End Of Treatment ◽

Increased Risk ◽

Significant Difference ◽

Egyptian Patients ◽

Infected Adult ◽

Chronic Hcv

Abstract Background Cure of chronic hepatitis C (HCV) in HIV/HCV co-infected patients is a priority due to their increased risk of complications. Daclatasvir and sofosbuvir treatment regimens with or without ribavirin are considered an important chance for better HCV treatment in patients with HIV/HCV co-infection. This study aimed at the assessment of safety and efficacy of sofosbuvir-daclatasvir treatment regimens in HIV/HCV co-infected Egyptian patients. Results Thirty HIV/HCV co-infected adult patients were included. All patients completed the study duration without major problems or drug interactions, HCV PCR was negative for all patients at the end of treatment, yet 12 weeks after ending treatment, only one patient (3.33%) had HCV relapse. Liver enzymes showed a significant decrease by the end of treatment and 12 weeks after end of treatment in comparison with their values before treatment (P-value = 0.0001). CD4 counts as well showed significant increase. There was non-significant change in serum albumin, total bilirubin, alfa fetoprotein, complete blood count (CBC), coagulation profile, random blood sugar, or serum creatinine. Ultrasonographic findings did not show significant difference. Conclusion Combination of daclatasvir and sofosbuvir have showed 96.67% sustained virologic response at 12 weeks after treatment (SVR 12) among HIV/HCV co-infected patients, with a good safety profile. Moreover, the treated patients showed a significant increase in CD4 lymphocytic count.

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Relationship of “dose” of intracranial hypertension to outcome in severe traumatic brain injury

Journal of Neurosurgery ◽

10.3171/jns/2008/109/10/0678 ◽

2008 ◽

Vol 109 (4) ◽

pp. 678-684 ◽

Cited By ~ 127

Author(s):

Anne Vik ◽

Torbjørn Nag ◽

Oddrun Anita Fredriksli ◽

Toril Skandsen ◽

Kent Gøran Moen ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Hypertension ◽

Scale Score ◽

Severe Traumatic Brain Injury ◽

Injury Severity ◽

Area Under The Curve ◽

Term Outcome ◽

Long Term Outcome ◽

Scale Scores

Object It has recently been suggested that the degree of intracranial pressure (ICP) above the treatment goal can be estimated by the area under the curve (AUC) of ICP versus time in patients with severe traumatic brain injury (TBI). The objective of this study was to determine whether the calculated “ICP dose”—the ICP AUC—is related to mortality rate, outcome, and Marshall CT classification. Methods Of 135 patients (age range 1–82 years) with severe TBI treated during a 5-year period at the authors' institution, 113 patients underwent ICP monitoring (84%). Ninety-three patients with a monitoring time > 24 hours were included for analysis of ICP AUC calculated using the trapezoidal method. Computed tomography scans were assessed according to the Marshall TBI classification. Patients with Glasgow Outcome Scale scores at 6 months and > 3 years were separated into 2 groups based on outcome. Results Sixty patients (65%) had ICP values > 20 mm Hg, and 12 (13%) developed severe intracranial hypertension and died secondary to herniation. A multiple regression analysis adjusting for Glasgow Coma Scale score, age, pupillary abnormalities and Injury Severity Scale score demonstrated that the ICP AUC was a significant predictor of poor outcome at 6 months (p = 0.034) and of death (p = 0.035). However, it did not predict long-term outcome (p = 0.157). The ICP AUC was significantly higher in patients with Marshall head injury Categories 3 and 4 (24 patients) than in those with Category 2 (23 patients, p = 0.025) and Category 5 (46 patients, p = 0.021) TBIs using the worst CT scan obtained. Conclusions The authors found a significant relationship between the dose of ICP, the worst Marshall CT score, and patient outcome, suggesting that the AUC method may be useful in refining and improving the treatment of ICP in patients with TBI.

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Blowing Away Shot Pain: A Technique for Pain Management During Immunization During Immunization

PEDIATRICS ◽

10.1542/peds.93.3.384 ◽

1994 ◽

Vol 93 (3) ◽

pp. 384-388 ◽

Cited By ~ 1

Author(s):

Gina M. French ◽

Eileen C. Painter ◽

Daniel L. Coury

Keyword(s):

Public Health ◽

Health Department ◽

Controlled Study ◽

Public Health Department ◽

Painful Procedure ◽

Analog Scale ◽

Significant Difference ◽

Scale Scores ◽

Tetanus Immunization ◽

Active Distraction

Objective. To study the effect of an active distraction technique on pain in preschool children receiving diphtheria, pertussis, and tetanus immunization. Design. Randomized, unblinded controlled study. Setting. Columbus Public Health Department Immunization Clinics. Participants. One hundred forty-nine 4- to 7-year-old children. Intervention. Children were taught to blow out air repeatedly during the injection, as if they were blowing bubbles. Results. Children who were taught to blow out air during their shots had significantly fewer pain behaviors (P < .04) and demonstrated a trend toward lower subjectively reported pain (P = .06). There was no significant difference in the nurse or parent visual analog scale scores. Conclusions. A simple distraction technique can be effective in helping children cope with the pain of immunization. The use of such a technique to relieve the pain and distress associated with even a brief painful procedure should be encouraged.

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