Purpose
To determine the effectiveness of dysphagia interventions compared to standard care in improving oral intake and reducing aspiration for adults in acute and critical care.
Methods
We searched ...electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published.
Results
We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake (
n
= 33, MD (days) − 4.5, 95% CI − 10.6 to 1.6, 1 study,
P
= 0.15) (very low certainty) or in aspiration following treatment (
n
= 113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies,
I
2
= 0%,
P
= 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (
n
= 719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies,
I
2
= 15%,
P
= 0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (
n
= 239, MD − 11.38, 95% CI − 23.83 to 1.08, I
2
= 78%,
P
= 0.07) (very low certainty).
Conclusion
There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient-centred outcomes are needed.
IntroductionCurrent clinical trials on swallowing disorders (dysphagia) in Parkinson’s disease (PD) apply a high variety of outcomes and different outcome measures making comparative effectiveness ...research challenging. Furthermore, views of patients and dysphagia clinicians when selecting trial outcomes have not been considered in the past, thus study results may have little importance to them. This study aims to develop an agreed standardised Core Outcome Set for Dysphagia Interventions in Parkinson’s disease (COS-DIP), systematically measured and reported as a minimum for all clinical trials. It will also comprise guidance on outcome definitions, outcome measures and time points of measurement.Methods and analysisThe COS-DIP development will comprise five stages following established methodology: (1) a recent scoping review on all applied outcomes, their definitions, methods and time points of measurement in clinical trials in dysphagia in PD, (2) online surveys and focus groups with clinicians, patients, caregivers and family members to identify outcomes that are important to them, (3) an identified list of outcomes based on results of stage 1 and 2, (4) three round online Delphi survey with up to 200 key stakeholders to determine core outcomes and (5) two online consensus meetings with up to 40 representative key stakeholders to agree on all outcomes, definitions, methods and time points of measurement in the final COS-DIP.Ethics and disseminationFull ethical approval was obtained from the Research Ethics Committee, School of Linguistic, Speech and Communication Sciences, Trinity College Dublin, on 15 May 2023 (HT27). Dissemination of the COS-DIP will be enhanced through presentations at (inter-) national conferences and through peer-reviewed, open access publications of related manuscripts. Lay and professional information sheets and infographics will be circulated through relevant patient and professional organisations and networks.Trial registration numberThe COS-DIP study was registered prospectively with the Core Outcome Measures in Effectiveness Trials (COMET) database on 24 September 2021 (www.comet-initiative.org/Studies/Details/1942).
Numerous guidelines on responsible reporting of suicide are available to journalists globally, offering advice on best practice regarding approaches and suitability of content. Whilst their advice is ...compelling and legitimate, their use is uneven at best. With a suicide death every 40 seconds worldwide, it is imperative journalists understand and recognise the best ethical practices in order to report suicide responsibly. To address these shortcomings, the authors present a model for responsible suicide reporting (RSR) that is grounded in news-work and embeds media reporting guidelines within journalistic storytelling practices. The RSR model consists of a typology of suicide narratives and ‘othering’, ethical rules and a standard of moderation. Methodologically, these typologies emerged from analysis of 159 suicide news stories published in 2018–19, with particular focus on adherence and non-adherence to global media reporting guidelines. We posit through the process of producing stories using the RSR model, journalists should interact more effectively with critical risk factors for example, stigmatisation, copycat effects, harmful speculation, highlighted by media reporting guidelines.
Oropharyngeal dysphagia or swallowing difficulties are common in acute care and critical care, affecting 47% of hospitalised frail elderly, 50% of acute stroke patients and approximately 62% of ...critically ill patients who have been intubated and mechanically ventilated for prolonged periods. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, increased length of hospital stay and re-admission to hospital. To date, most dysphagia interventions in acute care have been tested with acute stroke populations. While intervention studies in critical care have been emerging since 2015, they are limited and so there is much to learn about the type, the delivery and the intensity of treatments in this setting to inform future clinical trials. The aim of this systematic review is to summarise the evidence regarding the relationship between dysphagia interventions and clinically important patient outcomes in acute and critical care settings.
We will search MEDLINE, EMBASE, CENTRAL, Web of Science, CINAHL and clinical trial registries from inception to the present. We will include studies conducted with adults in acute care settings such as acute hospital wards or units or intensive care units and critical care settings. Studies will be restricted to randomised controlled trials and quasi-randomised controlled trials comparing a new dysphagia intervention with usual care or another intervention. The main outcomes that will be collected include length of time taken to return to oral intake, change in incidence of aspiration and pneumonia, nutritional status, length of hospital stay and quality of life. Key intervention components such as delivery, intensity, acceptability, fidelity and adverse events associated with such interventions will be collected to inform future clinical trials. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. A meta-analysis will be conducted as appropriate.
No systematic review has attempted to summarise the evidence for oropharyngeal dysphagia interventions in acute and critical care. Results of the proposed systematic review will inform practice and the design of future clinical trials.
PROSPERO CRD 42018116849 (http://www.crd.york.ac.uk/PROSPERO/).
ObjectiveIdentify prevalence of self-reported swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19.DesignMulticentre prospective observational cohort study ...using questionnaire data at visit 1 (2–7 months post discharge) and visit 2 (10–14 months post discharge) from hospitalised patients in the UK. Lasso logistic regression analysis was undertaken to identify associations.Setting64 UK acute hospital Trusts.ParticipantsAdults aged >18 years, discharged from an admissions unit or ward at a UK hospital with COVID-19.Main outcome measuresSelf-reported swallow, communication, voice and cognitive compromise.ResultsCompromised swallowing post intensive care unit (post-ICU) admission was reported in 20% (188/955); 60% with swallow problems received invasive mechanical ventilation and were more likely to have undergone proning (p=0.039). Voice problems were reported in 34% (319/946) post-ICU admission who were more likely to have received invasive (p<0.001) or non-invasive ventilation (p=0.001) and to have been proned (p<0.001). Communication compromise was reported in 23% (527/2275) univariable analysis identified associations with younger age (p<0.001), female sex (p<0.001), social deprivation (p<0.001) and being a healthcare worker (p=0.010). Cognitive issues were reported by 70% (1598/2275), consistent at both visits, at visit 1 respondents were more likely to have higher baseline comorbidities and at visit 2 were associated with greater social deprivation (p<0.001).ConclusionSwallow, communication, voice and cognitive problems were prevalent post hospitalisation for COVID-19, alongside whole system compromise including reduced mobility and overall health scores. Research and testing of rehabilitation interventions are required at pace to explore these issues.
This article examines the manner in which journalists write news stories based on the ‘death knock’ interview where they gather reaction from the recently bereaved about their loss. The death knock ...news story with its emphasis on the first-hand testimony of the bereaved in certain respects can be perceived as a personal narrative of grief. This research studies the types of narratives used to tell these personal stories and applies Labov and Waletzky’s personal narrative model in order to determine what the bereaved tell us about grief and how the journalist interprets it. Statements from the bereaved contained in such stories are examined to identify emergent grief themes across the genre. The research found that, despite the adoption of a more positive mood in the later stages of reporting a family’s grief, the coherent narrative was one of unyielding anguish, emptiness and continuing loss.
Introduction: Oropharyngeal dysphagia or swallowing difficulties are common in critical care, affecting approximately 62% of critically ill patients who have been intubated and mechanically ...ventilated for prolonged periods. Cardiac surgery intensive care patients are one such group at risk of developing swallowing difficulties following prolonged intubation. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, increased length of hospital stay and readmission to hospital. This PhD aims to design a relevant, evidence based intervention for cardiac surgery intensive care patients that is acceptable for delivery and ready for testing in a trial with internationally accepted outcome measures. The project is underpinned by the Medical Research Council's framework for developing a complex intervention and includes three studies. Methods: Study 1 assessed the evidence by conducting the first systematic review of dysphagia intervention trials in acute and critical care settings. Studies were included if conducted with adults in acute care settings or intensive / critical care settings and were randomised or quasi-randomised controlled trials. The primary outcome was time taken to return to oral intake. Study 2 developed an intervention by discussing systematic review findings and a potential intervention with expert advisors and engaging with clinicians and ex-patients to further refine the proposed intervention. A live national survey was conducted with UK speech and language therapy clinicians working in critical care settings to gather their feedback on the proposed intervention. A focus group was conducted with ex-ICU patients to gather their views and feedback on the proposed intervention also. Study 3 developed the first international core outcome set for critical care dysphagia trials using Delphi consensus methodology. Ex-patients, critical care clinicians and researchers rated outcomes (identified from a number of information sources) in a 2-round online survey. Three consensus meetings were then conducted to discuss, agree and vote on definitions and measures for the core outcomes identified from the Delphi survey. Results: The systematic review identified 22 studies (19 stroke, 2 intensive care stroke and 1general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake (n = 33, MD (days) − 4.5, 95% CI − 10.6 to 1.6, 1 study, P = 0.15) (very low certainty). An intervention for intubated cardiac patients involving sensory electrical stimulation and tongue resistance exercises was designed and deemed acceptable following expert advisory discussion (n=7) and engagement with patients (n=4) and clinicians (n=64). One hundred and sixty participants (researchers, clinicians and ex-patients) from 22 countries (6 continents) completed a 2-round Delphi study. Six core outcomes were identified: aspiration; severity of aspiration; swallow function; efficiency of cough; pneumonia and mortality. Measures and time points were agreed for five of the six outcomes via consensus meetings. Conclusion: These three studies culminated in the development of a robust randomised controlled trial protocol with an appropriate intervention and outcome measures that can be taken forward for feasibility testing.
To identify all outcomes, their definitions, outcome measurement instruments (OMIs), timepoints and frequency of measurement applied in clinical trials in oropharyngeal dysphagia (OD) interventions ...in Parkinson's disease (PD). This scoping review is the first stage of a larger project establishing a core outcome set for dysphagia interventions in Parkinson's disease (COS-DIP).
Scoping review.
Six electronic databases and one trial registry were searched without language restrictions until March 2022. Bibliography lists of included studies were also reviewed. Study screening and data extraction were conducted independently by two reviewers using Covidence. The scoping review protocol is registered and published (http://hdl.handle.net/2262/97652).
19 studies with 134 outcomes were included. Trial outcomes were mapped to a recommended taxonomy for COSs and merged. 39 outcomes were identified. The most frequently measured were general swallowing-related outcomes, global quality-of-life outcomes and swallowing-related perceived health status outcomes. The applied outcomes, their definitions, OMIs, timepoints and frequency of measurement showed a high variability across all studies.
The high variability of outcomes emphasises the need for an agreed standardised COS. This will inform clinical trial design in OD in PD, increase the quality of OD trials in PD and facilitate synthesising and comparing study results to reach conclusion on the safety and effectiveness of OD interventions in PD. It will not prevent or restrict researchers from examining other outcomes.
The COS-DIP study, including the scoping review, was registered prospectively with the Core Outcome Measures in Effectiveness Trials Database on 24 September 2021 (www.comet-initiative.org, registration number: 1942).
To identify core practices for workforce management of communication and swallowing functions in coronavirus disease 2019 (COVID-19) positive patients within the intensive care unit (ICU).
A modified ...Delphi methodology was used, with 3 electronic voting rounds. AGREE II and an adapted COVID-19 survey framework from physiotherapy were used to develop survey statements. Sixty-six statements pertaining to workforce planning and management of communication and swallowing function in the ICU were included.
Electronic modified Delphi process.
Speech-language pathologists (SLPs) (N=35) from 6 continents representing 12 countries.
Not applicable.
The main outcome was consensus agreement, defined a priori as ≥70% of participants with a mean Likert score ≥7.0 (11-point scale: 0=strongly disagree, 10=strongly agree). Prioritization rank order of statements in a fourth round was also conducted.
SLPs with a median of 15 years of ICU experience, working primarily in clinical (54%), academic (29%), or managerial positions (17%), completed all voting rounds. After the third round, 64 statements (97%) met criteria. Rank ordering identified issues of high importance.
A set of global consensus statements to facilitate planning and delivery of rehabilitative care for patients admitted to the ICU during the COVID-19 pandemic were agreed by an international expert SLP group. Statements focused on considerations for workforce preparation, resourcing and training, and the management of communication and swallowing functions. These statements support and provide direction for all members of the rehabilitation team to use for patients admitted to the ICU during a global pandemic.
PDF
