Issues of Capacity and Decision-Making in the Context of Delirium

Decision-making capacity is a fundamental consideration in working with patients in a clinical setting. One of the most common conditions affecting decision-making capacity in patients in the inpatient or long-term care setting is a form of acute, transient cognitive change known as delirium. A thorough understanding of delirium — how it can present, its predisposing and precipitating factors, and how it can be managed — will improve a speech-language pathologist's (SLPs) ability to make treatment recommendations, and to advise the treatment team on issues related to communication and patient autonomy.

Swallowing and Feeding Services in the Schools: From Therapy to the Dinner Table

Addressing swallowing and feeding in a school system is a team effort. Working closely with parents is essential to the student's progress. This article profiles swallowing and feeding intervention by a school-based team with a 5-year-old Down's Syndrome student with dysphagia and behavioral feeding disorders. The team was able to work successfully with the parents which resulted in the student making significant progress both at school and in the home setting.

SIG 13 Perspectives Vol. 24, No. 4, October 2015

Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available until August 3, 2018.

A Retrospective Examination of Prandial Aspiration in Preterm Infants

Purpose We conducted this retrospective study to identify potential signs of aspiration in preterm infants based on crib-side nursing documentation. Study Design and Methods A total of 2,590 bottle-feedings were examined for signs of distress across 41 preterm infants who were referred for a swallowing evaluation. All infants underwent either a videofluoroscopic swallow study (VSS) or upper gastrointestinal study (GIS). Physiologic and behavioral warning signs were coded across feedings 10 days prior to the imaging study. Presence or absence of documented aspiration during VSS/GIS was coded for each infant. Results Distress signs were documented in seven percent of oral feeding attempts. Aspiration was more common when the crib-side nurse documented coughing (LR+, 8.77; 95% CI, .99–77.09), compromised oxygen saturation levels (LR+, 2.15; CI, .86–5.47), and tachypnea (LR+, 2.15; CI, .28–3.01) during bottle-feeding. Clinical Implications Evidence-based distress signs that signal increased suspicion for prandial aspiration will facilitate correct clinical judgments at crib-side. Early identification and prevention of prandial aspiration improves health outcomes for preterm infants.

Informed Consent in Clinical and Research Settings: What Do Patients and Families Need to Make Informed Decisions?

Informed consent requires that patients in clinical settings and participants in research voluntarily agree to a proposed plan based on their understanding of a clear and thorough explanation of purpose, risks, benefits, and alternatives. Although the need to obtain informed consent is well understood in clinical and research environments, the evidence suggests that patients, family members, and participants in research are often unclear about options, risks, and benefits even after providing “informed” consent. Individuals with communication or cognitive disorders are at particular risk for a suboptimal outcome of the informed consent process. There are many barriers to achieving true informed consent, but the use of appropriate strategies can minimize the impact of these barriers and allow clinicians and researchers to improve the process of achieving true informed consent.

SIG 13 Perspectives Vol. 24, No. 3, June 2015

Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available until May 4, 2018.

Revisiting Swallowing Function Following Contemporary Surgical Interventions for Oral/Oropharyngeal Cancer: Key Underlying Issues

There has been resurgence in surgical interventions for oral cavity and oropharyngeal cancer in tandem with technological advances in reconstructive and ablative procedures. This paper considers the mechanisms of impact of these surgical techniques on swallow function and patient outcomes especially in light of the shifting demographics of human papilloma virus (HPV) associated oropharyngeal cancer. We present a framework for considering physiologic impairment within the context of a holistic approach to patient care based on a series of key underlying considerations.