scholarly journals Association between Improvement of Oral Health, Swallowing Function, and Nutritional Intake Method in Acute Stroke Patients

2021 ◽  
Vol 18 (21) ◽  
pp. 11379
Author(s):  
Michiyo Aoyagi ◽  
Junichi Furuya ◽  
Chiaki Matsubara ◽  
Kanako Yoshimi ◽  
Ayako Nakane ◽  
...  
Keyword(s):  
Oral Health ◽  
Acute Care ◽  
Assessment Tool ◽  
Tube Feeding ◽  
Nutritional Intake ◽  
University Hospital ◽  
Stroke Patients ◽  
Oral Ingestion ◽  
Swallowing Function ◽  
Oral Nutrition

Stroke and poor oral health are common in older people, and the brain injuries associated with stroke are often accompanied by a decline in oral function. In this study, we investigated the characteristics of stroke patients who could not recover oral ingestion until discharge and the association between improved oral health, swallowing function, and nutritional intake methods in acute care. The subjects were 216 consecutive stroke patients who were admitted to Tokyo Medical and Dental University hospital and received oral health management. Nutritional intake, dysphagia, and oral health were evaluated using the Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), and Oral Health Assessment Tool (OHAT), respectively. Patients in the tube feeding group (FOIS level 1–2, N = 68) tended to have a worse general condition, fewer functional teeth, and a worse DSS level than those in the oral nutrition group (FOIS level 3–7, N = 148). Multiple analysis with improvement in FOIS score as the dependent variable showed that number of functional teeth (odds ratio [OR]: 1.08, p = 0.04) and improved DSS (OR: 7.44, p < 0.001) and OHAT values (OR: 1.23, p = 0.048) were associated with improvement in nutritional intake methods in acute care. Therefore, recovery of swallowing function and oral health might be important for stroke patients to recover oral ingestion in acute care.

scholarly journals Factors Related to Oral Intake of Food by Hospitalized Patients with Malnutrition under the Care of a Nutrition Support Team

2021 ◽  
Vol 18 (21) ◽  
pp. 11725
Author(s):  
Junichi Furuya ◽  
Hiroyuki Suzuki ◽  
Rena Hidaka ◽  
Kazuharu Nakagawa ◽  
Kanako Yoshimi ◽  
...  
Keyword(s):  
Health Status ◽  
Oral Health ◽  
General Condition ◽  
Assessment Tool ◽  
Oral Intake ◽  
Oral Health Status ◽  
Nutrition Support ◽  
Care Hospital ◽  
Oral Nutrition ◽  
Support Team

This study aimed to evaluate the role of the general condition and oral health status in determining the primary nutritional route and suitable food form for oral ingestion among malnourished inpatients. This cross-sectional study included 255 inpatients referred to a nutrition support team (NST), which included dental professionals, at an acute care hospital. We assessed the participants’ basic information, and Dysphagia Severity Scale (DSS) and Oral Health Assessment Tool (OHAT) scores. The nutritional intake mode was evaluated based on the Functional Oral Intake Scale scores at the initial NST consultation (FOIS-I), and then revised by the NST based on the participants’ general condition and oral health (FOIS-R). There was a divergence between FOIS-I and FOIS-R, with FOIS-R being significantly higher than FOIS-I (p < 0.001). Logistic regression analysis of FOIS-R identified that consciousness level (odds ratio (OR): 0.448; 95% confidence interval (CI): 0.214–0.935) and DSS (OR: 3.521; 95% CI: 2.574–4.815) significantly affected the oral nutrition intake. Among participants who could ingest orally (FOIS-R ≥ 3; n = 126), FOIS score had significant negative and positive associations with the OHAT and DSS scores, respectively. These findings suggest that appropriate assessment of oral health status, including swallowing function, might contribute to high-quality nutrition management.

scholarly journals Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia

2020 ◽  
Vol 44 (1) ◽  
pp. 1-10
Author(s):  
Ji Soo Choi ◽  
Hyun Bang ◽  
Goo Joo Lee ◽  
Han Gil Seo ◽  
Byung-Mo Oh ◽  
...  
Keyword(s):  
Tube Feeding ◽  
Oral Feeding ◽  
Stroke Patients ◽  
Swallowing Function ◽  
Follow Up Study ◽  
Key Indicator ◽  
Subacute Stroke ◽  
Function Recovery ◽  
Multiple Structures

Objective To evaluate the longitudinal changes of swallowing kinematics based on videofluoroscopic swallowing studies (VFSSs) in subacute stroke patients grouped according to the method of dietary intake.Methods Sixty-nine subacute stroke patients who had taken at least 2 successive VFSSs were included. Subjects were allocated into 3 groups according to the degree of swallowing function recovery—not improved group (tube feeding recommended to patients at both studies), improved group (tube feedings recommended initially to patients and oral feeding recommended at follow-up study), and well-maintained group (oral feeding at both studies recommended to patients). Initial VFSS was performed during the subacute stage of stroke, 1 to 12 weeks after the onset of stroke, and follow-up VFSS was performed at least once. Kinematic variables were calculated by two-dimensional motion analysis of multiple structures, including the hyoid bone, epiglottis, and vocal cord. Changes of kinematic variables were analyzed in serial VFSSs.Results At the initial VFSS, the well-maintained group showed significantly larger angles of epiglottic folding than the not improved group, while at the follow-up VFSS, the improved and the well-maintained groups showed significantly larger epiglottic folding angles than the not improved group. The distribution of epiglottic folding angles was in a dichotomous pattern, and each cluster was related to the swallowing function.Conclusion This study showed that improved epiglottic folding angles are associated with the recovery of the swallowing process and suitability for oral feeding among various kinematic variables in subacute stroke patients.

scholarly journals Impact of nasogastric tube feeding on swallowing function in patients with dysphagia: a pilot study

2021 ◽  
Vol 26 (4) ◽  
pp. 809-815
Author(s):  
Yu Sang Jung ◽  
MinYoung Kim ◽  
Kyunghoon Min ◽  
Jong Moon Kim ◽  
Eun Young Han ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Tube Feeding ◽  
University Hospital ◽  
Diagnostic Significance ◽  
Swallowing Function ◽  
Videofluoroscopic Swallowing Study ◽  
Swallowing Therapy ◽  
Swallowing Dysfunction ◽  
Nasogastric Tube Feeding

During dysphagia treatment, direct oral swallowing therapy is applied to some patients temporarily fed via nasogastric tube. However, the risk of aspiration in oral swallowing while nasogastric tube in situ may be disregarded in a standard videofluoroscopic swallowing study performed without a nasogastric tube. To evaluate the diagnostic significance of nasogastric tube in situ videofluoroscopic swallowing study of nectar and pureed diet compared to the standard videofluoroscopic swallowing study without nasogastric tube. Videofluoroscopic swallowing study records of dysphagia patients conducted between June and August 2017 in a university hospital were collected for review. Rosenbek’s penetration-aspiration scale, diagnostic criteria of aspiration were used to define aspiration. videofluoroscopic dysphagia scale for videofluoroscopic swallowing study with or without nasogastric tube were compared for nectar and pureed diet swallowing. Patients had various duration of nasogastric tube feeding. Paired T-test comparing the videofluoroscopic dysphagia scales for videofluoroscopic swallowing study with or without nasogastric tube revealed significant aggravation of swallowing dysfunction in nectar drinking while nasogastric tube in situ. This aggravation was noted in 19% (n=4) of patients who suffered from stroke regardless of nasogastric tube duration. Nasogastric tube in situ videofluoroscopic swallowing study, at least of nectar drinking could be beneficial in selecting a safe candidate for direct oral swallowing therapy in conjunction with the conventional nasogastric tube removed videofluoroscopic swallowing study.

scholarly journals Decreased Maximal Tongue Protrusion Length May Predict the Presence of Dysphagia in Stroke Patients

2021 ◽  
Vol 45 (6) ◽  
pp. 440-449
Author(s):  
Hyunchul Cho ◽  
Jeong Se Noh ◽  
Junwon Park ◽  
Changwook Park ◽  
No Dam Park ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Oral Intake ◽  
Stroke Patients ◽  
Tongue Protrusion ◽  
Swallowing Function ◽  
Transparent Plastic ◽  
Post Stroke ◽  
Tongue Length ◽  
Functional Oral Intake Scale ◽  
The Relationship

Objective To investigate the relationship between maximal tongue protrusion length (MTPL) and dysphagia in post-stroke patients.Methods Free tongue length (FTL) was measured using the quick tongue-tie assessment tool and MTPL was measured using a transparent plastic ruler in 47 post-stroke patients. The MTPL-to-FTL (RMF) ratio was calculated. Swallowing function in all patients was evaluated via videofluoroscopic swallowing study (VFSS), PenetrationAspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Videofluoroscopic Dysphagia Scale (VDS).Results The MTPL and RMF values were significantly higher in the non-aspirator group than in the aspirator group (MTPL, p=0.0049; RMF, p<0.001). MTPL and RMF showed significant correlations with PAS, FOIS and VDS scores. The cut-off value in RMF for the prediction of aspiration was 1.56, with a sensitivity of 84% and a specificity of 86%.Conclusion There is a relationship between MTPL and dysphagia in post-stroke patients. MTPL and RMF can be useful for detecting aspiration in post-stroke patients.

scholarly journals Factors affecting the oral health of inpatients with advanced cancer in palliative care

2021 ◽  
Author(s):  
Junichi Furuya ◽  
Hiroyuki Suzuki ◽  
Rena Hidaka ◽  
Nei Koshitani ◽  
Yuko Motomatsu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Oral Health ◽  
Assessment Tool ◽  
Oral Care ◽  
Terminal Cancer ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Terminal Stage ◽  
Removable Denture

Abstract Purpose Patients with terminal cancer undergoing multidisciplinary palliative care often have oral health problems, but these details are still unclear. This cross-sectional study aimed to elucidate the oral health of patients with terminal-stage cancer who are inpatient recipients of acute-phase palliative care, and to unveil the factors affecting their oral health. Methods Participants were 121 patients with terminal-stage cancer (68 males, 53 females, mean age: 73.6 ± 11.1 years) and oral health complaints. They received palliative care at Tokyo Medical and Dental University Medical Hospital between April 2017 and August 2019. Their demographic and medical details were extracted, retrospectively, from their medical records, and their oral health status, such as the number of natural teeth, removable denture usage, Oral Health Assessment Tool (OHAT), and Dysphagia Severity Scale, were evaluated. All outcomes were assessed by a dentist from the palliative care team. Results The problems with soft tissue, saliva, and oral cleanliness were observed. The absence of posterior occlusal support was common, and the use of removable dentures was often inadequate. In contrast, swallowing function was relatively well-conserved and 46.3% of the participants were capable of nutrition intake solely by mouth. Multiple regression analysis revealed a significant association between total OHAT score and age, consciousness level, prognostic level, and method of nutritional intake. Conclusion The results revealed that the oral health of terminal cancer patients under palliative care declined despite receiving routine oral care from nurses, and suggest the importance of including dental professionals in multidisciplinary palliative care.

Abstract WP341: Is it Safe to Treat Patients With Acute Minor Stroke and Tia as Outpatients?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sidsel Hastrup ◽  
Soren Paaske Johnsen ◽  
Martin Jensen ◽  
Paul von Weitzel-Mudersbach ◽  
Claus Ziegler Simonsen ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Outpatient Clinic ◽  
Assessment Tool ◽  
Recurrent Stroke ◽  
University Hospital ◽  
Minor Stroke ◽  
Stroke Patients ◽  
Set Up ◽  
Ischemic Attack ◽  
Historic Cohort

Objective: To evaluate the effects of an acute 7-day outpatient clinic for minor stroke or transient ischemic attack (TIA). Methods: We performed a prospective cohort-study using all patients from an outpatient clinic for patient with suspected minor stroke and TIA between September 2013 and August 2014. The clinic opened in May 2012 as part of centralization of the stroke services in Central Region Denmark. For comparison, we used a matched historic cohort from the same hospital between May 2011 and April 2012 (before the outpatient clinic) and a contemporary cohort from a comparable university hospital from the Capital Region without an outpatient clinic. A risk-assessment tool was used in the outpatient clinic to determine the risk of recurrent stroke and hence a need for a hospital admission. Results: The outpatient clinic cohort (OCC) consisted of 1076 patients and we confirmed a neurovascular diagnosis in 510 of the patients (47.4%). Of these, 215 had a stroke and 94 (43.7%) were discharged direct from the outpatient clinic. TIA was confirmed in 171 patients and of these 121 (70.8%) were handled without a hospitalization. In the stroke patients from the OCC there was a shorter length of acute hospital stay (median 1 day) compared to the matched historic cohort (median 3 days); adjusted length of stay ratio of 0.49 (0.33-0.71). Furthermore these stroke patients had a 30-day readmission rate on 3.2 % (0.6-5.7) compared to 11.6 % (6.99-16.2) in the historic cohort; adjusted hazard ratio of 0.23 (0.09-0.59) and increased quality of care captured in 10 process performance measures. We found similar results in comparison with the contemporary cohort. Furthermore, we saw a similar pattern when we compared TIA patients from the OCC to a matched contemporary cohort. According to the risk-assessment, 170 stroke or TIA patients had a ‘low risk’ and were treated without being admitted as inpatients. Only one of these patients experienced a stroke within 7 days (0.59%). Conclusions: Overall, the results showed the outpatient set up for minor stroke and TIA was safe and may be an advance compared to hospitalization in stroke units despite use of less bed days. Furthermore, the risk assessment used to select patients in need of an inpatient course seems useful.

scholarly journals Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching

2021 ◽  
Vol 11 (2) ◽  
pp. 161
Author(s):  
Chong-Chi Chiu ◽  
Jhi-Joung Wang ◽  
Chao-Ming Hung ◽  
Hsiu-Fen Lin ◽  
Hong-Hsi Hsien ◽  
...  
Keyword(s):  
Propensity Score ◽  
Functional Status ◽  
Propensity Score Matching ◽  
Acute Care ◽  
Medical Cost ◽  
Economic Burden ◽  
Stroke Rehabilitation ◽  
Stroke Patients ◽  
The Impact ◽  
Post Acute Care

Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost–illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.

scholarly journals Improving the oral health of older people in care homes (TOPIC): a protocol for a feasibility study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Georgios Tsakos ◽  
Paul R. Brocklehurst ◽  
Sinead Watson ◽  
Anna Verey ◽  
Nia Goulden ◽  
...  
Keyword(s):  
Health Promotion ◽  
Oral Health ◽  
Complex Intervention ◽  
Assessment Tool ◽  
Care Home ◽  
Care Homes ◽  
Routine Practice ◽  
Oral Health Promotion ◽  
Nice Guideline ◽  
Care Home Staff

Abstract Background Evidence for interventions promoting oral health amongst care home residents is weak. The National Institute for Health and Care Excellence (NICE) guideline NG48 aims to maintain and improve the oral health of care home residents. A co-design process that worked with residents and care home staff to understand how the NG48 guideline could be best implemented in practice has been undertaken to refine a complex intervention. The aim of this study is to assess the feasibility of the intervention to inform a future larger scale definitive trial. Methods This is a protocol for a pragmatic cluster randomised controlled trial with a 12-month follow-up that will be undertaken in 12 care homes across two sites (six in London, six in Northern Ireland). Care homes randomised to the intervention arm (n = 6) will receive the complex intervention based on the NG48 guideline, whilst care homes randomised to the control arm (n = 6) will continue with routine practice. The intervention will include a training package for care home staff to promote knowledge and skills in oral health promotion, the use of the Oral Health Assessment Tool on residents by trained care home staff, and a ‘support worker assisted’ daily tooth-brushing regime with toothpaste containing 1500 ppm fluoride. An average of ten residents, aged 65 years or over who have at least one natural tooth, will be recruited in each care home resulting in a recruited sample of 120 participants. Assessments will be undertaken at baseline, 6 months and 12 months, and will include a dental examination and questionnaires on general health and oral health administered by a research assistant. A parallel process evaluation involving semi-structured interviews will be undertaken to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention, and intervention fidelity will also be recorded. A cost-consequence model will determine the relevance of different outcome measures in the decision-making context. Discussion The study will provide valuable information for trialists, policymakers, clinicians and care home staff on the feasibility and associated costs of oral health promotion in UK care homes. Trial registration ISRCTN10276613. Registered on 17th April 2020. http://www.isrctn.com/ISRCTN10276613.

scholarly journals Nasogastric Tube Feeding Practice and Associated Complication in stroke Patients in a Tertiary Care Hospital in Bangladesh

2018 ◽  
Vol 4 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Kazi Mohibur Rahman ◽  
Sharif Uddin Khan ◽  
ATM Hasibul Hasan ◽  
Sirajee Shafiqul Islam ◽  
Rajib Nayan Chowdhury ◽  
...  
Keyword(s):  
Aspiration Pneumonia ◽  
Nasogastric Tube ◽  
Tertiary Care ◽  
Tube Feeding ◽  
Electrolyte Imbalance ◽  
Feeding Practice ◽  
Care Hospital ◽  
Stroke Patients ◽  
Nasal Irritation ◽  
Nasogastric Tube Feeding

Background: Nasogastric tube feeding is an integral part of management of stroke patients with feeding difficulties.Objectives: The purpose of the present study was to evaluate the nasogastric tube feeding practice and its complication on stroke patients.Methodology: One hundred (100) adult patients aged ≥ 18 years with stroke were enrolled in the study. The diagnosis of stroke was established by the clinical presentation, neuroimaging. Patients requiring nasogastric tube feeding was included in the study. They were thoroughly examined for any complications from possible use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard preformed questionnaire regarding any complications as well. Results: A total number of 100 patients were recruited for this study. In this study population, 63.0% patients had ischaemic stroke; 26.0% had haemorrhagic stroke and 9.0% population had sub-arachnoid haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39.0%) followed by semi consciousness (26.0%), unconsciousness (22.0%), inability to maintain feed (10.0%). About 71.0% of the patients had complications from NG tube feeding such as nasal irritation (53.0%), electrolyte imbalance (43.0%), aspiration pneumonia (40.0%) and diarrhea (38.0%).Conclusion: Nasal irritation, aspiration pneumonia, electrolyte imbalance, diarrhea are common complications associated with NG tube feeding which in part may be related to faulty feeding technique.Journal of National Institute of Neurosciences Bangladesh, 2018;4(1): 23-27

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