Publications by authors named "Jacqueline Allen"

32 Publications

Effects of corticosteroids vs halofuginone on vocal fold wound healing in an ovine model.

Authors:
Jacqueline Allen

Laryngoscope Investig Otolaryngol 2021 Aug 10;6(4):786-793. Epub 2021 Jun 10.

Department of Surgery University of Auckland Auckland New Zealand.

Objectives: To evaluate antifibrotic effects of corticosteroids and halofuginone, a small molecule inhibitor of Smad3, in an ovine model of vocal fold (VF) injury.

Methods: Thirty sheep, using a paired study design, underwent controlled right VF injury by biopsy and then were treated with either no treatment, oral dexamethasone, intralesional triamcinolone, or oral halofuginone. Larynges were evaluated for histological evidence of fibrosis, immunohistochemical presence of Smad3, and vibratory parameters. Outcomes were compared across treatment groups.

Results: Following injury, VF collagen density decreased in both halofuginone-treated and dexamethasone-treated sheep but not in triamcinolone treated sheep. A significant difference was noted between halofuginone and triamcinolone treated sheep (27.8% vs 37%,  = .017). Elastin was preserved postinjury by halofuginone treatment in contrast with all steroid treated animals where significant loss of elastin was noted ( <.05). Smad3 staining was up-regulated at all injury sites compared to normal left VFs however halofuginone and dexamethasone treatment reduced Smad3 activity significantly whereas triamcinolone treatment did not ( <.05). Ex-vivo stroboscopic evaluation demonstrated mucosal wave in all excised larynges with a normalized glottal gap less than 3, suggesting adequate glottal closure.

Conclusions: VF injury in an ovine model results in a wound response able to be modified by Smad3 inhibitor, halofuginone, with benefit to vibratory function. Halofuginone treated sheep demonstrated reduced collagenization of lamina propria with greater elastin density after injury, than sheep treated with either steroid medication. These data support this pathway as a suitable target for manipulation to prevent or reverse fibrosis in the glottis and restore voice quality.Level of Evidence: NA.
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http://dx.doi.org/10.1002/lio2.602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356862PMC
August 2021

Improving Readiness to Manage Intimate Partner Violence in Family Medicine Clinics by Collaboration With a Community Organization.

PRiMER 2021 18;5:20. Epub 2021 Jun 18.

University of Texas Southwestern Medical Center - Department of Community and Family Medicine.

Background And Objectives: Primary care clinicians are in a unique position to address intimate partner violence (IPV) in routine clinical practice. The purpose of this study was to improve clinician readiness to identify and manage IPV in four family medicine residency practice sites on the west side of Chicago by partnering with a local domestic violence organization.

Methods: Practice sites included three federally qualified health centers and one hospital-based office. Eligible clinicians included resident and faculty physicians, nurse practitioners, and certified nurse midwives. We assessed readiness using the validated Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS). We used initial survey results (n=53, 73%) to develop a targeted clinician educational intervention by a community organization. We administered the PREMIS tool postintervention at 1 and 6 months, measuring perceived and actual knowledge, preparedness, and practice issues. We performed comparison statistics to assess aggregate change.

Results: PREMIS response rates were n=53 (72%), n=32 (47%), and n=36 (49%), for preintervention, 1, and 6 months postintervention, respectively. Mean clinician preparedness score improved significantly at 1 and 6 months (<.001, <.009). Mean self-perceived knowledge score improved significantly at 1 month (<.001) and trended toward improvement at 6 months (=.07). Actual knowledge trended toward improvement at 1 month (=.07) and after 6 months (=.05). Mean practice issues scores did not improve significantly.

Conclusions: Participation in a 45-minute targeted educational intervention improved clinician readiness to manage IPV. Collaborating with a community partner builds a relationship for further referrals and advocacy for patients.
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http://dx.doi.org/10.22454/PRiMER.2021.717020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284494PMC
June 2021

Impact of subspecialty training on management of laryngopharyngeal reflux: results of a worldwide survey.

Eur Arch Otorhinolaryngol 2021 Jun 27;278(6):1933-1943. Epub 2021 Feb 27.

Division of Laryngology and the Professional Voice Department of Otolaryngology, Communication Science Medical College of Wisconsin, Milwaukee, WI, USA.

Objective: To study the management of laryngopharyngeal reflux (LPR) among the subspecialties of practicing otolaryngology-head and neck surgeons and their trainees.

Methods: A survey was sent to over 8000 otolaryngologists (OTOHNS) over 65 countries, utilizing membership lists of participating otolaryngological societies. The outcomes were answers to questions regarding LPR knowledge and practice patterns, and included queries about its definition, prevalence, clinical presentation, diagnosis, and treatment.

Results: Of the 824 respondents, 658 practiced in one specific otolaryngologic subspecialty. The symptoms and findings thought to be the most related to LPR varied significantly between subspecialists. Extra-laryngeal findings were considered less by laryngologists while more experienced OTOHNS did not often consider digestive complaints. Compared with colleagues, otologists, rhinologists and laryngologists were less aware of the involvement of LPR in otological, rhinological and laryngological disorders, respectively. Irrespective of subspecialty, OTOHNS consider symptoms and signs and a positive response to empirical therapeutic trial to establish a LPR diagnosis. Awareness regarding the usefulness of impedance pH-studies is low in all groups. The therapeutic approach significantly varies between groups, although all were in agreement for the treatment duration. The management of non-responder patients demonstrated significant differences among laryngologists who performed additional examinations. The majority of participants (37.1%) admitted to being less than knowledgeable about LPR management.

Conclusions: LPR knowledge and management vary significantly across otolaryngology subspecialties. International guidelines on LPR management appear necessary to improve knowledge and management of LPR across all subspecialties of otolaryngology.
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http://dx.doi.org/10.1007/s00405-021-06710-yDOI Listing
June 2021

High prevalence of malnutrition and frailty among older adults at admission to residential aged care.

J Prim Health Care 2020 12;12(4):305-317

College of Health, Massey University, Turitea Placem Albany, Auckland, New Zealand.

INTRODUCTION Malnutrition is an under-recognised and under-treated problem often affecting older adults. AIM The aim of this study was to evaluate the prevalence of and factors associated with malnutrition and frailty among older adults at early admission to residential aged care. METHODS A cross-sectional study was undertaken among eligible older adults within the first week of admission to residential aged care. Participants were assessed for malnutrition risk using the Mini Nutritional Assessment Short Form, frailty using the Fried phenotype criterion, muscle strength using a grip strength dynamometer and gait speed using a 2.4-m walk test. A Cox regression analysis was conducted to identify factors associated with malnutrition risk and frailty status. RESULTS Of 174 participants (mean age 85.5 years, 61% women), two-thirds (66%) were admitted to residential aged care from the community. Most (93%) were either malnourished (48%) or at risk of malnutrition (45%). A total of 76% of participants were frail and 24% were pre-frail. Forty-three percent were both malnourished and frail. Low risk of malnutrition was associated with increases in muscle strength [0.96 (0.93-0.99)], gait speed [0.27 (0.10-0.73)] and pre-frailty status [0.32 (0.12-0.83)]. DISCUSSION This study provides preliminary evidence for high prevalence of malnutrition and frailty at admission to residential aged care. Almost all participants were malnourished or at nutrition risk. Findings highlight the need for strategies to prevent, detect and treat malnutrition in community health care and support nutrition screening at admission to residential aged care.
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http://dx.doi.org/10.1071/HC20042DOI Listing
December 2020

Management of Laryngopharyngeal Reflux Around the World: An International Study.

Laryngoscope 2021 05 17;131(5):E1589-E1597. Epub 2020 Nov 17.

Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.

Objective: To investigate worldwide practices of otolaryngologists in the management of laryngopharyngeal reflux (LPR).

Methods: An online survey was sent on the management of LPR to members of many otolaryngological societies. The following aspects were evaluated: LPR definition, prevalence, clinical presentation, diagnosis, and treatment.

Results: A total of 824 otolaryngologists participated, spread over 65 countries. The symptoms most usually attributed to LPR are cough after lying down/meal, throat clearing and globus sensation while LPR-related findings are arytenoid erythema and posterior commissure hypertrophy. Irrespective to geography, otolaryngologists indicate lack of familiarity with impedance pH monitoring, which they attribute to lack of knowledge in result interpretation. The most common therapeutic regimens significantly vary between world regions, with a higher use of H2 blocker in North America and a lower use of alginate in South America. The duration of treatment also significantly varies between different regions, with West Asia/Africa and East Asia/Oceania otolaryngologists prescribing medication for a shorter period than the others. Only 21.1% of respondents are aware about the existence of nonacid LPR. Overall, only 43.2% of otolaryngologists believe themselves sufficiently knowledgeable about LPR.

Conclusions: LPR knowledge and management significantly vary across the world. International guidelines on LPR definition, diagnosis, and treatment are needed to improve knowledge and management around the world.

Level Of Evidence: N.A. Laryngoscope, 131:E1589-E1597, 2021.
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http://dx.doi.org/10.1002/lary.29270DOI Listing
May 2021

Aspects of the assessment and management of pharyngoesophageal dysphagia.

Ann N Y Acad Sci 2020 12 13;1482(1):5-15. Epub 2020 Aug 13.

Division of Gastroenterology and Hepatology, Johns Hopkins Medical School, Baltimore, Maryland.

Swallowing complaints are common and may have significant consequences for nutrition and pulmonary health. Etiology varies and different aspects of the deglutitive system may be affected. A thorough assessment from the oral cavity to the stomach will provide physiologic information that enables specific targeted management plans to be devised. Although the swallow trajectory bridges anatomic areas, there has previously been a tendency to compartmentalize assessment and treatment by arbitrary anatomic boundaries. It is now clear that this approach fails to appreciate the complexity of swallow mechanics and that systems (oral, pharyngeal, esophageal, and pulmonary) are intertwined and codependent. Swallowing specialists from different backgrounds and with complementary skill sets form a multidisciplinary team that can provide insight and address multiple areas of management. With the advent of new tools for instrumental evaluation, such as manometry, targeted rehabilitative strategies can be informed by physiology, increased in precision and breadth, and assessed quantitatively. Surgical approaches have evolved toward endoscopic techniques, and food technology is expanding options in dietary management. The multidisciplinary team is core to managing this varied and often neglected patient population. This review is for clinicians treating swallowing disorders and will explore the selected aspects of the assessment and management of pharyngoesophageal swallowing disorders.
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http://dx.doi.org/10.1111/nyas.14456DOI Listing
December 2020

SoGut: A Soft Robotic Gastric Simulator.

Soft Robot 2021 Jun 19;8(3):273-283. Epub 2020 Jun 19.

Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand.

The human stomach breaks down and transports food by coordinated radial contractions of the gastric walls. The radial contractions periodically propagate through the stomach and constitute the peristaltic contractions, also called the gastric motility. The force, amplitude, and frequency of peristaltic contractions are relevant to massaging and transporting the food contents in the gastric lumen. However, existing gastric simulators have not faithfully replicated gastric motility. Herein, we report a soft robotic gastric simulator (SoGut) that emulates peristaltic contractions in an anatomically realistic way. SoGut incorporates an array of circular air chambers that generate radial contractions. The design and fabrication of SoGut leverages principles from the soft robotics field, which features compliance and adaptability. We studied the force and amplitude of the contractions when the lumen of SoGut was empty or filled with contents of different viscosity. We examined the contracting force using manometry. SoGut exhibited a similar range of contracting force as the human stomach reported in the literature. Besides, we investigated the amplitude of the contractions through videofluoroscopy where the contraction ratio was derived. The contraction ratio as a function of inflation pressure is found to match the observations of situations. We demonstrated that SoGut can achieve peristaltic contractions by coordinating the inflation sequence of multiple air chambers. It exhibited the functions to massage and transport the food contents. SoGut can simulate the physiological motions of the human stomach to advance research of digestion.
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http://dx.doi.org/10.1089/soro.2019.0136DOI Listing
June 2021

Proximal reflux: biochemical mediators, markers, therapeutic targets, and clinical correlations.

Ann N Y Acad Sci 2020 12 13;1481(1):127-138. Epub 2020 May 13.

Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin.

Airway reflux is implicated in the pathophysiology of a wide range of adult and pediatric upper and lower airway diseases. However, the diagnosis of proximal reflux-associated disease remains challenging due to evolving clinical criteria and institutional and regional variances in diagnostic practices. Evidence suggests that nonacidic contents of reflux may serve as both pathologic mediators of and biomarkers for reflux in the upper airway. Furthermore, they offer potential pharmaceutical and surgical intervention targets and are the focus of novel clinical diagnostic tools currently under investigation.
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http://dx.doi.org/10.1111/nyas.14366DOI Listing
December 2020

Self-reported Swallowing and Nutrition Status in Community-Living Older Adults.

Dysphagia 2021 04 8;36(2):198-206. Epub 2020 May 8.

Department of Surgery, University of Auckland, Auckland, 1142, New Zealand.

More New Zealanders are forecast to grow older in the community, ranging in levels of abilities and needs. Many health conditions can affect swallowing function or nutrition status in older age. However, older adults may not be aware of risk factors and when to seek help. A nationwide survey was conducted of self-reported swallowing ability and nutrition status in community-living New Zealanders aged 65 years and older to assess whether undisclosed swallowing and nutrition problems exist. Respondents completed an amalgamated questionnaire including two validated screening tools: Eating Assessment Tool (EAT-10) and Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). A convenience sample of 1020 adults aged 65-96 years old was obtained. Mean EAT-10 score was 2.15 (SD = 4.3); 22.1% scored above the normative score (3 or more). Mean SCREEN-II score was 48.50 (SD = 6.5); 46.9% scored below normal (< 50 for adults under 85 years old, < 49 for adults over 84 years old). EAT-10 scores significantly correlated with SCREEN-II scores (p < 0.001). Scores did not correlate with age or differ between age groups. Significantly more respondents with medical history associated with dysphagia disclosed swallowing and nutrition problems (p < 0.001). This data suggest increased prevalence of swallowing difficulties in older age is attributed to health conditions and medications, rather than ageing itself. Swallowing complaints from community-living older adults should not be ignored or attributed to the normal ageing process. This study supports routine nutrition screening in older adults.
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http://dx.doi.org/10.1007/s00455-020-10125-yDOI Listing
April 2021

Communication and Coordination Processes Supporting Integrated Transitional Care: Australian Healthcare Practitioners' Perspectives.

Int J Integr Care 2020 Apr 16;20(2). Epub 2020 Apr 16.

School of Nursing and Midwifery, Deakin University, Geelong, Vic, AU.

Introduction: Although a large body of research has identified effective models of transitional care, questions remain about the optimal translation of this knowledge into practice. In Australia, the introduction of a model of consumer-directed care uniquely challenges the practice of integrated care transitions for older adults. This study aimed to identify strengths and weaknesses in transitional care for older adults in an Australian setting by describing healthcare practitioners' experiences of care provision.

Methods: The study used a qualitative design in two phases: 1) semi-structured interviews, 2) one focus group. The setting comprised one public health network and five community services in urban Australia. In Phase 1, health practitioners across settings were interviewed about their experience of transitional care. Phase 2 sought feedback about the Phase 1 findings from different practitioners. All data were thematically analysed.

Findings: In Phase 1), 48 healthcare practitioners were interviewed across multiple settings. Few participants were aware of the introduction of consumer-directed care in community aged care. Four main themes were identified: 'Rapid and safe care transition', 'Discussing as a team', 'Questioning the discharge', and 'Engaging patients and carers'. In Phase 2), seven participants from different settings reviewed and endorsed the findings from Phase 1.

Discussion And Conclusions: Findings indicate that healthcare practitioners use a range of communication and coordination processes in optimising integrated transitional care. Although participants involved their patients in transitional care planning, most participants were unaware of the recent implementation of consumer-directed care. In contexts of community-based care shaped by multidisciplinary, sub-acute and CDC models, care integration must focus on improved communication with patients and carers to ascertain their needs and to support their increased responsibility in their care transitions.
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http://dx.doi.org/10.5334/ijic.4685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164380PMC
April 2020

Evaluation of the TRANSITION tool to improve communication during older patients' care transitions: Healthcare practitioners' perspectives.

J Clin Nurs 2020 Jul 31;29(13-14):2275-2284. Epub 2020 Mar 31.

Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Vic., Australia.

Aims: To evaluate healthcare practitioners' perceptions of the feasibility and acceptability of a communication tool, entitled the TRANSITION tool, to communicate with older patients during transition from acute care to a community setting.

Background: Transitional care for older patients is challenging due to their complex care needs and rapid care transitions. Research has identified effective models of transitional care. However, optimal communication between healthcare practitioners and older patients remains under-investigated.

Design: Exploratory descriptive qualitative design.

Methods: The methods are reported using the Consolidated Criteria for Reporting Qualitative Studies checklist. The setting comprised two acute medical wards in an urban hospital in Australia. Twenty-two nursing and allied healthcare practitioners used the TRANSITION tool to guide communication about transitional care with an older patient and then participated in an interview about their experience of using the tool. All data were thematically analysed.

Findings: Healthcare practitioners reported their perceptions that the TRANSITION tool was feasible and acceptable, and that they perceived the tool supported them to know what to ask and to find out information regarding their patient's transitional care needs. Some ward-based nurses reported their perception that transitional care was not their role.

Conclusions: Findings emphasise transitional care as a continuing care process that requires effective communication between nurses and older patients in acute medical wards.

Relevance To Clinical Practice: Given shorter lengths of stay, complex care needs and slow recovery, ward-based nurses are vital in communicating with older patients about their transitional care needs. The TRANSITION tool may support communication between ward-based nurses and older patients to improve assessment and planning. Implementation of the tool will require a planned strategy to facilitate translation of the tool into routine practice of ward-based nurses to support their roles during older patients' care transitions.
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http://dx.doi.org/10.1111/jocn.15236DOI Listing
July 2020

Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently?

Laryngoscope 2020 10 8;130(10):E539-E547. Epub 2020 Jan 8.

Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.

Objective: To investigate current practices of laryngologists and non-laryngologists in management of Laryngopharyngeal Reflux (LPR).

Methods: An online survey was sent to members of otolaryngology societies about LPR, and subgroup analysis was performed between laryngologists and non-laryngologists. This survey was conducted by the LPR Study Group of Young Otolaryngologists of the International Federation of Otolaryngological Societies.

Results: A total of 535 otolaryngologists completed the survey. Among them, 127 were laryngologists and 408 were non-laryngologists. Collectively, symptoms most commonly attributed to LPR are cough after lying down/meal, throat clearing, and acid brash; most common findings are thought to be arytenoid erythema and posterior commissure hypertrophy. Respectively, 12.5% and 5% of non-laryngologists and laryngologists believe that ≥50% of LPR patients suffer from heartburn (P = .010). Non-laryngologists are more aware about some extra-laryngeal findings associated with LPR (eg, pharyngeal erythema) than laryngologists. Neither laryngologists nor non-laryngologists associated development of benign lesions of the vocal folds with reflux. The management of LPR substantially differs between groups, with laryngologists indicating increased awareness of (impedance)-pH monitoring as well as the prevalence and treatment of nonacid/mixed LPR. Conversely, non-laryngologists are much more likely to include gastroenterology referral in their management of presumed LPR. Respectively, 44.8% and 27.6% of non-laryngologists and laryngologists believe themselves not sufficiently knowledgeable about LPR.

Conclusions: Significant differences exist between laryngologists and non-laryngologists in diagnosis and treatment of LPR. Overall only one-third of responders believe themselves to be sufficiently educated about LPR.

Level Of Evidence: 4 Laryngoscope, 130:E539-E547, 2020.
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http://dx.doi.org/10.1002/lary.28484DOI Listing
October 2020

Editorial: Going with the flow.

Curr Opin Otolaryngol Head Neck Surg 2019 12;27(6):431-432

Department of Surgery University of Auckland New Zealand, New Zealand.

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http://dx.doi.org/10.1097/MOO.0000000000000592DOI Listing
December 2019

Safety of in-office laryngology procedures.

Curr Opin Otolaryngol Head Neck Surg 2019 Dec;27(6):433-438

Department of Surgery, University of Auckland.

Purpose Of Review: A wide range of diagnostic and therapeutic laryngology procedures are currently performed in an office setting. In-office laryngology procedures (IOLP) are increasingly seen as standard-of-care, and while generally considered safe, high-quality evidence supporting the latter statement is lacking. This review aims to summarize recent literature regarding the safety of IOLP.

Recent Findings: There is a paucity of guidelines and standardized protocols for IOLP. To date, there is one available safety protocol specific to in-office laser procedures. Haemodynamic changes during IOLP have been documented and the significance of these changes continues to be unclear. Therefore, monitoring of vital signs is recommended. Continuing antithrombotic therapy during IOLP also appears safe, and this decision may be left to surgeon discretion. A protocol for management of antithrombotic therapy prior to in-office laser procedures is available. Actual serum lidocaine levels following topical application of mixed lidocaine preparations falls well below reported toxic levels but persists for longer than previously reported.

Summary: IOLP are safer that suspension laryngoscopy under general anaesthetic. Although complication rates of IOLP are low, patient characteristics and potential complications of both the procedure and of topical anaesthetic use must be considered. One must be prepared and equipped to deal with these potential complications.
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http://dx.doi.org/10.1097/MOO.0000000000000585DOI Listing
December 2019

A Systematic Review of Physiological Changes in Swallowing in the Oldest Old.

Dysphagia 2020 06 5;35(3):509-532. Epub 2019 Sep 5.

Department of Surgery, University of Auckland, Auckland, 1142, New Zealand.

Age-related swallowing changes are well-researched in deglutology, usually distinguishing those over 60 years as older aged. World-wide, older adults are healthier and forecast to live longer: many over 85 years. It is necessary for clinicians to understand healthy swallowing changes in this 'oldest old' in order to appropriately manage swallowing complaints in older patients. This systematic review collated and critically appraised studies investigating swallowing changes in adults over 85 years using instrumental assessment. Criteria for inclusion were healthy subjects over 85 years. Exclusion criteria included studies focused on anatomy and oral processing. Studies published until December 2018 were retrieved from BIOSIS, CINAHL, Embase, Medline, and Scopus, totaling 2125 articles. During data screening, 64% of studies investigating age-related swallowing changes were excluded, as the oldest old were not recruited. After PRISMA screening, 44 articles met criteria. These were further reviewed for data extraction, bias and quality. Main quantitative age-related changes in swallowing included increases in delay in swallow onset, bolus transit times, duration of UES opening, pressure above the UES and UES relaxation pressure, and reduction in pressure at the UES. Few studies detected increased residue or airway compromise in the form of aspiration. Results were not easily comparable due to differences in age ranges, methods for deeming participants 'healthy', measures used to define swallowing physiology, and swallowing tasks. Age-related swallowing changes are identified that do not compromise safety. The oldest old are underrepresented in normative deglutition research. It is essential future studies plan accordingly to recruit those over 85 years.
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http://dx.doi.org/10.1007/s00455-019-10056-3DOI Listing
June 2020

Semistructured interviews regarding patients' perceptions of Choosing Wisely and shared decision-making: an Australian study.

BMJ Open 2019 08 28;9(8):e031831. Epub 2019 Aug 28.

School of Nursing and Midwifery; Centre for Quality and Patient Safety Monash Health Partnership, Monash Health, Deakin University, Geelong, Victoria, Australia.

Objectives: This study aimed to examine how patients perceive shared decision-making regarding CT scan referral and use of the five Choosing Wisely questions with their general practitioner (GP).

Design: This is a qualitative exploratory study using semistructured interviews.

Setting: This study was conducted in a large metropolitan public healthcare organisation in urban Australia.

Participants: Following purposive sampling, 20 patients and 2 carers participated. Patient participants aged 18 years or older were eligible if they were attending the healthcare organisation for a CT scan and referred by their GP. Carers/family were eligible to participate when they were in the role of an unpaid carer and were aged 18 years or older. Participants were required to speak English sufficiently to provide informed consent. Participants with cognitive impairment were excluded.

Findings: Eighteen interviews were conducted with the patient only. Two interviews were conducted with the patient and the patient's carer. Fourteen participants were female. Five themes resulted from the thematic analysis: (1) needing to know, (2) questioning doctors is not necessary, (3) discussing scans is not required, (4) uncertainty about questioning and (5) valuing the Choosing Wisely questions. Participants reported that they presented to their GP with a health problem that they needed to understand and address. Participants accepted their GPs decision to prescribe a CT scan to identify the nature of their problem. They reported ambivalence about engaging in shared decision-making with their doctor, although many participants reported valuing the Choosing Wisely questions.

Conclusions: Shared decision-making is an important principle underpinning Choosing Wisely. Practice implementation requires understanding patients' motivations to engage in shared decision-making with a focus on attitudes, beliefs, knowledge and emotions. Systems-level support and education for healthcare practitioners in effective communication is important. However, this needs to emphasise communication with patients who have varying degrees of motivation to engage in shared decision-making and Choosing Wisely.
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http://dx.doi.org/10.1136/bmjopen-2019-031831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6720255PMC
August 2019

Associations between nutrition risk status, body composition and physical performance among community-dwelling older adults.

Aust N Z J Public Health 2019 Feb 20;43(1):56-62. Epub 2018 Nov 20.

School of Sport, Exercise and Nutrition, College of Health, Massey University, New Zealand.

Objective: To investigate the associations between nutrition risk status, body composition and physical performance among community-dwelling older New Zealanders.

Methods: This cross-sectional study enrolled 257 community-dwelling older adults (median age 79 years). Assessments included the Mini Nutritional Assessment-Short Form (MNA®-SF) for nutrition risk; the Eating Assessment Tool-10 for dysphagia risk; bioimpedance analysis for body composition (free fat mass (FFM) and percentage body fat) and gait speed for physical performance. A multiple logistics regression analysis was conducted, to determine factors associated with lower odds [OR (95% CI)] for nutrition risk.

Results: Every yearly increase in age was associated with higher odds 1.09 (1.01-1.17) for nutrition risk. Additionally, nutrition risk was less likely to occur among participants of age <85 years 0.30 (0.11-0.79), with no dysphagia 0.29 (0.09-0.97) and those with a healthy gait speed 0.29 (0.09-0.97). Lower odds for nutrition risk were also found with increasing values of FFM index 0.51 (0.34-0.77), and percentage body fat 0.81 (0.72-0.90). Gait speed was positively correlated with FFM index (r=0.19 p<0.022), percentage body fat (r=0.23, p=0.006) and BMI (r=0.29, p<0.001).

Conclusion: Among these participants, associations between nutrition risk, body composition and physical performance were found. Implications for public health: Routine screening of nutrition risk and/or physical performance among vulnerable older adults is key towards identifying those in need of assessment and dietary intervention. Alongside strategies to encourage physical activity, this may help to slow losses of FFM and protect physical performance.
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http://dx.doi.org/10.1111/1753-6405.12848DOI Listing
February 2019

Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults athospital admission.

BMC Geriatr 2018 03 21;18(1):78. Epub 2018 Mar 21.

School of Food and Nutrition, Massey University, Auckland, New Zealand.

Background: Malnutrition in patients admitted to hospital may have detrimental effects on recovery and healing. Malnutrition is preceded by a state of malnutrition risk, yet malnutrition risk is often not detected during admission. The aim of the current study was to investigate the magnitude and potential predictors of malnutrition risk in older adults, at hospital admission.

Methods: A cross-sectional was study conducted in 234 older adults (age ≥ 65 or ≥ 55 for Māori or Pacific ethnicity) at admission to hospital in Auckland, New Zealand. Assessment of malnutrition risk status was performed using the Mini Nutritional Assessment Short-Form (MNA®-SF), dysphagia risk by the Eating Assessment Tool (EAT-10), muscle strength by hand grip strength and cognitive status by the Montreal Cognitive Assessment (MoCA) tool.

Results: Among 234 participants, mean age 83.6 ± 7.6 years, 46.6% were identified as at malnutrition risk and 26.9% malnourished. After adjusting for age, gender and ethnicity, the study identified [prevalence ratio (95% confidence interval)] high dysphagia risk [EAT-10 score: 0.98 (0.97-0.99)], low body mass index [kg/m: 1.02 (1.02-1.03)], low muscle strength [hand grip strength, kg: 1.01 (1.00-1.02)] and decline in cognition [MoCA score: 1.01 (1.00-1.02)] as significant predictors of malnutrition risk in older adults at hospital admission.

Conclusion: Among older adults recently admitted to the hospital, almost three-quarters were malnourished or at malnutrition risk. As the majority (88%) of participants were admitted from the community, this illustrates the need for routine nutrition screening both at hospital admission and in community-dwelling older adults. Factors such as dysphagia, unintentional weight loss, decline in muscle strength, and poor cognition may indicate increased risk of malnutrition.
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http://dx.doi.org/10.1186/s12877-018-0771-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863453PMC
March 2018

User experience and care for older people transitioning from hospital to home: Patients' and carers' perspectives.

Health Expect 2018 04 9;21(2):518-527. Epub 2017 Nov 9.

Faculty of Health & School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia.

Background: Transitioning from hospital to home is challenging for many older people living with chronic health conditions. Transitional care facilitates safe and timely transfer of patients between levels of care and across care settings and includes communication between practitioners, assessment and planning, preparation, medication reconciliation, follow-up care and self-management education. To date, there is limited understanding of how to actively involve care recipient service users in transitional care.

Objective: This study was part of a larger research project. The objective of this article was to report the first study phase, in which we aimed to describe user experience pertaining to patients and carers.

Design, Setting And Participants: The study design was qualitative descriptive using interviews. Patients (n = 19) and carers (n = 7) participated in semi-structured interviews about their experience of transition from hospital to home in an urban Australian health-care setting. Interview data were analysed using thematic analysis.

Findings: All participants reported that they needed to become independent in transition. Participants perceived a range of social processes supported their independence at home: supportive relationships with carers, caring relationships with health-care practitioners, seeking information, discussing and negotiating the transitional care plan and learning to self-care.

Discussion: Findings contribute to our understanding that quality transitional care should focus on patients' need to regain independence. Social processes supporting the capacities of patients and carers should be emphasized in future initiatives.

Conclusion: Future transitional care interventions should emphasize strategies to enable negotiation for suitable supports and assist care recipients to overcome barriers identified in this study.
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http://dx.doi.org/10.1111/hex.12646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867324PMC
April 2018

High nutrition risk is associated with higher risk of dysphagia in advanced age adults newly admitted to hospital.

Nutr Diet 2018 02 15;75(1):52-58. Epub 2017 Sep 15.

School of Food and Nutrition, Massey University, Auckland, New Zealand.

Aim: To establish the prevalence of nutrition risk and associated risk factors among adults of advanced age newly admitted to hospital.

Methods: A cross-sectional study was undertaken in adults aged over 85 years admitted to one of two hospital wards in Auckland within the previous 5 days. An interviewer-administered questionnaire was used to establish participant's socio-demographic and health characteristics. Markers of body composition and muscle strength were collected. Nutrition risk was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), dysphagia risk using the 10-Item Eating Assessment Tool (EAT-10) and level of cognition using the Montreal Cognitive Assessment.

Results: A total of 88 participants with a mean age of 90.0 ± 3.7 years completed the assessments. A third (28.4%) of the participants were categorised by the MNA-SF as malnourished and 43.2% were classified at risk of malnutrition. A third (29.5%) were at risk of dysphagia as assessed by EAT-10. Malnourished participants were more likely to be at risk of dysphagia (P = 0.015). The MNA-SF score was positively correlated with body mass index (r = 0.484, P < 0.001) and grip strength (r = 0.250, P = 0.026) and negatively correlated with risk of dysphagia (r = -0.383, P < 0.001).

Conclusions: Among newly hospitalised adults of advanced age, over two thirds were malnourished or at risk of malnutrition, and a third were at risk of dysphagia. Nutrition risk was positively correlated with low BMI and grip strength and negatively correlated with dysphagia risk. Findings highlight the importance of screening for dysphagia risk, especially in those identified to be malnourished or at nutrition risk.
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http://dx.doi.org/10.1111/1747-0080.12385DOI Listing
February 2018

Response of an ovine laryngeal injury model to a novel fibrosis inhibitor.

Authors:
Jacqueline Allen

ANZ J Surg 2017 Apr 23;87(4):266-270. Epub 2016 Nov 23.

Faculty of Medical and Health Science, Department of Surgery, The University of Auckland, Auckland, New Zealand.

Background: Vocal fold injury results in severe voice alteration that limits occupational function and social interaction. An ovine model of laryngeal injury has been developed, validated and utilized to examine laryngeal wound healing and the effect of a novel collagen inhibitor (halofuginone) on surgical wound healing. The study design includes basic research and animal model.

Methods: An ovine laryngeal model was utilized to study controlled vocal fold injury and healing. Twenty-five sheep were divided into five groups. Sheep underwent right vocal fold injury preceded or followed by administration of halofuginone orally, topically or intralesionally. Biopsies were taken at commencement, 1 month and larynges explanted at 3 months. Specimens were examined for elastin and collagen density and epithelial changes. Pearson correlation statistics and Student's t-tests were used to assess inter-relationships.

Results: All sheep tolerated halofuginone. One sheep death occurred in an untreated sheep. Vocal fold tissue demonstrated a predictable histological response to injury. Elastin was significantly reduced post-injury in the glottis. Halofuginone administered orally for 10 weeks prevented elastin loss and demonstrated a trend of reducing collagen density post-injury.

Conclusion: In an ovine laryngeal injury model, administration of a fibrosis inhibitor resulted in altered elastin and collagen deposition after injury in the glottis. Further investigation is warranted to examine whether these tissue changes affect vocal fold dynamics.
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http://dx.doi.org/10.1111/ans.13852DOI Listing
April 2017

User Experience and Care Integration in Transitional Care for Older People From Hospital to Home: A Meta-Synthesis.

Qual Health Res 2017 Jan 28;27(1):24-36. Epub 2016 Jul 28.

Deakin University, Burwood, Victoria, Australia.

This meta-synthesis aimed to improve understanding of user experience of older people, carers, and health providers; and care integration in the care of older people transitioning from hospital to home. Following our systematic search, we identified and synthesized 20 studies, and constructed a comprehensive framework. We derived four themes: (1) 'Who is taking care of what? Trying to work together"; (2) 'Falling short of the mark'; (3) 'A proper discharge'; and (4) 'You adjust somehow.' The themes that emerged from the studies reflected users' experience of discharge and transitional care as a social process of 'negotiation and navigation of independence (older people/carers), or dependence (health providers).' Users engaged in negotiation and navigation through the interrogative strategies of questioning, discussion, information provision, information seeking, assessment, and translation. The derived themes reflected care integration that facilitated, or a lack of care integration that constrained, users' experiences of negotiation and navigation of independence/dependence.
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http://dx.doi.org/10.1177/1049732316658267DOI Listing
January 2017

Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review.

BMC Health Serv Res 2014 Aug 15;14:346. Epub 2014 Aug 15.

Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood 3125, Vic, Australia.

Background: Provision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice.

Methods: Eight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias.

Results: Twelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management.

Conclusions: Gaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed.
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http://dx.doi.org/10.1186/1472-6963-14-346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147161PMC
August 2014

Comparison of cough reflex test against instrumental assessment of aspiration.

Physiol Behav 2013 Jun 12;118:25-31. Epub 2013 May 12.

University of Canterbury, Christchurch, New Zealand; University of Auckland, Auckland, New Zealand.

Background: Silent aspiration is associated with pneumonia and mortality, and is poorly identified by traditional clinical swallowing evaluation (CSE). The aim of this study was to validate cough reflex testing (CRT) for identification of silent aspiration against aspiration confirmed by instrumental assessment.

Methods: Cough reflex threshold testing was completed on all patients using inhaled, nebulised citric acid. Within an hour, 80 patients underwent videofluoroscopic study of swallowing (VFSS) and 101 patients underwent fibreoptic endoscopic evaluation of swallowing (FEES). All tests were recorded and analysed by two researchers blinded to the result of the alternate test.

Results: Significant associations between CRT result and cough response to aspiration on VFSS (X(2) (2)=11.046, p=.003) and FEES (X(2) (2)=34.079, p<.001) were identified. Sensitivity and specificity were optimised at 0.6mol/L in patients undergoing VFSS (71%, 60% respectively) and at 0.4mol/L in patients undergoing FEES (69%, 71% respectively). A concentration of 0.8mol/L had the highest odds ratio (OR) for detecting silent aspiration (8 based on VFSS; 7 based on FEES).

Conclusion: CRT results are significantly associated with aspiration response on instrumental assessment. Lower concentrations of citric acid provide a better predictive measure of silent aspiration.
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http://dx.doi.org/10.1016/j.physbeh.2013.05.004DOI Listing
June 2013

Esophageal pathology in patients after treatment for head and neck cancer.

Otolaryngol Head Neck Surg 2010 Sep;143(3):375-8

Department of Otolaryngology-Head and Neck Surgery, University of California Davis School of Medicine, Sacramento, CA, USA.

Objective: To determine the prevalence of esophageal pathology following treatment for primary head and neck cancer (HNCA).

Study Design: Case series with planned data collection.

Setting: Academic medical practice.

Subjects And Methods: Subjects comprised HNCA survivors. Esophagoscopy was prospectively performed on 100 patients at least three months after treatment for HNCA. Patient demographics including cancer stage, cancer treatment, use of reflux medications, symptoms surveys, and esophageal findings were prospectively determined.

Results: The mean age of the cohort was 64 (+/- 10) years; 75 percent were male. The mean time between the end of treatment and endoscopy was 40 (+/- 51) months. Eighty-one percent of HNCA was advanced stage (3 or 4). The distribution of site of the primary HNCA was as follows: oropharynx (38%), larynx (33%), oral cavity (17%), unknown primary (10%), hypopharynx (1%), and nasopharynx (1%). Treatment modalities included surgery alone (15%), surgery with radiation (34%), radiation alone (6%), chemoradiation alone (24%), and chemoradiation with surgery (20%). The findings on esophagoscopy included peptic esophagitis (63%), stricture (23%), candidiasis (9%), Barrett metaplasia (8%), gastritis (4%), and carcinoma (4%). Only 13 percent had a normal esophagoscopy.

Conclusion: Esophageal pathology is extremely common in patients treated for HNCA. These findings support routine esophageal screening after HNCA treatment.
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http://dx.doi.org/10.1016/j.otohns.2010.05.006DOI Listing
September 2010

Pharyngeal dilation in cricopharyngeus muscle dysfunction and Zenker diverticulum.

Laryngoscope 2010 May;120(5):889-94

Center for Voice and Swallowing, University of California, Davis School of Medicine, Department of Otolaryngology/HNS, Sacramento, California, USA.

Objectives/hypothesis: Prolonged obstruction at the level of the lower esophageal sphincter is associated with a dilated, poorly contractile esophagus. The association between prolonged obstruction at the level of the upper esophageal sphincter (UES) and dilation and diminished contractility of the pharynx is uncertain. The purpose of this investigation was to evaluate the association between prolonged obstruction at the level of the UES and dilation and diminished contractility of the pharynx.

Study Design: Case-control study.

Methods: The fluoroscopic swallow studies of all persons with cricopharyngeus muscle dysfunction (CPD) diagnosed between January 1, 2006 and December 31, 2008 were retrospectively reviewed from a clinical database. Three categories of CPD were defined: nonobstructing cricopharyngeal bars (CPBs), obstructing CPBs, and Zenker diverticulum (ZD). The primary outcome measure was the pharyngeal constriction ratio (PCR), a surrogate measure of pharyngeal strength on fluoroscopy. Secondary outcome measures included pharyngeal area in the lateral fluoroscopic view and UES opening. The outcome measures were compared between groups and to a cohort of nondysphagic age- and gender-matched controls with the analysis of variance.

Results: A total of 100 fluoroscopic swallow studies were evaluated. The mean age (+ or -standard deviation) of the cohort was 70 years (+ or -10 years). Thirty-six percent were female. The mean PCR progressively increased, indicating diminishing pharyngeal strength, from the normal (0.08), to the nonobstructing CPB (0.13), to the obstructing CPB (0.22), to the ZD group (0.28) (P < .001 with trend for linearity). There was a linear increase in pharyngeal area from the normal (8.75 cm(2)) to the nonobstructing CPB (10.00 cm(2)), to the obstructing CPB (10.46 cm(2)), to the ZD group (11.82 cm(2)) (P < .01 with trend for linearity).

Conclusions: The data suggest that there is an association between cricopharyngeus muscle dysfunction and progressive dilation and weakness of the pharynx. Laryngoscope, 2010.
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http://dx.doi.org/10.1002/lary.20874DOI Listing
May 2010

Effects of Gold laser on the avian chorioallantoic membrane.

Ann Otol Rhinol Laryngol 2010 Jan;119(1):50-3

Department of Otolaryngology-Head and Neck Surgery, University of California Davis School of Medicine, Sacramento, California, USA.

Objectives: Office-based lasers have revolutionized the treatment of laryngeal disease. The 980-nm Gold laser is a device that may offer some practical advantages over other office lasers. The chick chorioallantoic membrane has been proposed as a model for predicting the effects of photoangiolytic lasers on vocal fold microvasculature. We sought to evaluate the effects of the Gold laser in this model.

Methods: Vascular reactions in first-order vessels were determined for the Gold laser with both 0 degree straight and 30 degrees angled laser fibers. Vessels were treated at 15 W and a 500-ms pulse interval, with a 1-mm working distance. Pulse widths of 300 ms and 500 ms were evaluated. All vessels were treated until selective coagulation or vessel rupture.

Results: We performed 60 trials on 30 embryos. The mean energy delivered was 33.7 J for the straight fiber and 51.2 J for the angled fiber. The laser achieved selective vessel coagulation without rupture in 100% (30 of 30) of straight fiber trials and in 100% (30 of 30) of angled fiber trials. In 6.7% (2 of 30) of straight fiber and 10% (3 of 30) of angled fiber trials, it caused minor injury to the surrounding albumin as indicated by white coagulum outside the vessel.

Conclusions: The Gold laser effectively coagulates small vessels without rupture at a working distance of 1 mm and settings of 15 W, 500-ms pulse interval, and 300- to 500-ms pulse width.
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http://dx.doi.org/10.1177/000348941011900110DOI Listing
January 2010

Endoscopic placement of a novel feeding tube.

Chest 2010 May 28;137(5):1028-32. Epub 2009 Dec 28.

Center for Voice and Swallowing, Department of Otolaryngology/HNS, University of California, Davis, 2521 Stockton Blvd, Ste 7200, Sacramento, CA 95817, USA.

Background: Complications of blind feeding tube (FT) placement include pneumothorax, pneumonia, empyema, and death. A safe and effective method of FT placement is desired. The Davis FT is a novel device that detachably couples to an ultrathin transnasal gastroscope. The objective of this study was to evaluate the safety and efficacy of Davis FT placement.

Methods: Fifty consecutive patients requiring transpyloric enteral tube feeding underwent placement of the Davis FT. Placement efficacy was evaluated with postplacement radiographs. Patient demographics, route of tube placement, use of sedation, and complications were abstracted.

Results: The Davis FT was placed successfully in 50 patients. The mean age of the cohort was 52 (+/- 18) years. Sixty-two percent (31/50) were men. The success rate of nonpulmonary placement was 100% (50/50), and the postpyloric success rate was 96% (48/50). IV sedation was used in 72% (36/50) of placements. Eighty-six percent (43/50) of tubes were placed transnasally. The majority (62%) of esophagogastroduodenoscopies and Davis FT placements was performed by a pulmonologist. Forty-four percent (22/50) of patients had an endotracheal tube, 20% (10/50) had a tracheotomy, and 36% (18/50) had no breathing tube at the time of Davis FT placement. There were no complications.

Conclusions: Transpyloric placement of the Davis FT is safe (100%) and effective (96%). The tube can be placed transorally or transnasally with or without sedation. The data suggest that postplacement radiographs are not necessary to confirm placement. Pulmonologists were successful in performing EGD and Davis FT placement.
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http://dx.doi.org/10.1378/chest.09-2229DOI Listing
May 2010

Validity and reliability of the Eating Assessment Tool (EAT-10).

Ann Otol Rhinol Laryngol 2008 Dec;117(12):919-24

Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95825, USA.

Objectives: The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10).

Methods: The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses.

Results: A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (+/- SD) EAT-10 score of the normal cohort was 0.40 +/- 1.01. The mean EAT-10 score was 23.58 +/- 13.18 for patients with esophageal dysphagia, 23.10 +/- 12.22 for those with oropharyngeal dysphagia, 9.19 +/- 12.60 for those with voice disorders, 22.42 +/- 14.06 for those with head and neck cancer, and 11.71 +/- 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p <0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 +/- 10.5 to 5.2 +/- 7.4 after treatment (p <0.001).

Conclusions: The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.
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http://dx.doi.org/10.1177/000348940811701210DOI Listing
December 2008

An evaluation of a community aged care nurse practitioner service.

J Clin Nurs 2005 Nov;14(10):1202-9

Royal District Nursing Service, Helen Macpherson Smith Institute of Community Health, St Kilda, Victoria, Australia.

Evaluation Aims: An evaluation is presented that aimed to augment current understandings of the nurse practitioner role by investigating potential outcomes of a community aged care nurse practitioner (ACNP) service on clients and the health care team.

Background: In Australia, the nurse practitioner role is being implemented in a variety of health care settings and is characterized by extended practice: prescribing of medications, requests for diagnostic investigations, referral to medical specialists and admitting clients to inpatient facilities.

Design: An exploratory qualitative evaluation method through data collection by interview and thematic analysis was undertaken.

Method: All clients referred to the ACNP service between June and August 2003, and a convenience sample of health professionals, were invited to participate in individual semi-structured interviews.

Results: Findings suggested that an ACNP could provide a high quality of holistic nursing care and positively affect clients' physical and psychological symptom management, enhance clients' quality of life, assist with supplies, provide health education and assist with advocacy. Health professionals commented on effective collaboration with the ACNP service during their partnerships in client care provision.

Conclusions: Overall, the positive effects of the ACNP service on clients and the health care team support the full implementation of the role within the community setting.

Relevance To Clinical Practice: Funding support for the nurse practitioner role is a vital addition to consideration in the development of international policy on advanced practice nursing. Without adequate funding, the full benefits of the nurse practitioner role in clinical practice, as suggested by the findings presented in this evaluation, will be compromised.
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http://dx.doi.org/10.1111/j.1365-2702.2005.01199.xDOI Listing
November 2005
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