Objective: In this research, two types (comprehensive evaluation methods and single evaluation methods) of dysphagia screening test were compared effectiveness to confirm more appropriate as the screening test.
Methods: Video recordings were made of 3 patients with dysphagia who underwent single evaluation methods (RSST and MWST) or comprehensive evaluation methods (SSA and TOR-BSST) in dysphagia screening tests. These recordings were then used to create a teaching video movie, which was shown to 65 speech therapists with clinical experience (mean years of experience, 5.2±3.6 years); these therapists were then administered a questionnaire. This questionnaire consisted of 10 items, which covered the following aspects of the dysphagia screening tests: simplicity of the tests, confirmation or inference of the site of dysphagia, their safety, severity evaluation, determination of the food types, determination of their usefulness for assessment of swallowing training, evaluation of the effect of swallowing training, evaluation of the changes in swallowing functions over a period of time, ability to diagnose dysphagia, and usefulness of the tests. A 5-point scale was used to answer each question, and the subjective evaluations of the practitioners who used the 4 tests were analyzed. The Kruskal-Wallis test was used for analysis of the results and a value less than 5% was considered to be significant.
Results: As a result of questionnaire survey, it has become apparent that comprehensive evaluation methods were more appropriate than single evaluation methods as dysphagia screening tests.
Conclusion: The result of this study suggested that effectiveness of comprehensive evaluation methods in dysphagia screening test. It might be contribute for the dysphasic patients to introduce the comprehensive evaluation methods in Japan.
Background and objectives: In terms of the fundamental requirements for food appropriate for dysphagia, the greatest importance is placed on safe physical properties. In 2009, with the aim of safer oral intake, the relationships between the physical properties of food and the physical properties appropriate for dysphagia were clarified by the System for Food for Specified Health Uses of the Japanese Ministry of Health, Labour and Welfare (MHLW), in a document titled “Criteria for acceptability of foods for dysphagia”. In order to achieve the appropriate physical properties, thickening polysaccharides, that is, dietary polysaccharides with the properties of thickening agents, gelling agents, etc. are frequently used. In the case of foods appropriate for dysphagia, the objective of the present study was to replicate physical properties effectively within the range of the criteria for acceptability, using typical thickening polysaccharides, starch-degrading enzyme, and gelling promoter, and to elucidate methods that are readily applicable to the clinical environment.
Materials: The food used was polished rice. The following six types of thickening polysaccharide were used: glucomannan, κ- and ι-carrageenan, xanthan gum, gellan gum, and locust-bean gum. The starchdegrading enzyme used was amylase. The gelling promoter used was non-fat milk powder.
Methods: Dissolved polysaccharides and kayu were mixed together by stirring. A Petri dish was then filled with the mixture, and left undisturbed for 30 min with the temperature within the material maintained at 20±2℃, after which the hardness, adhesivity and cohesiveness were measured using a rheometer, in accordance with the test methods stipulated by the Ministry of Health, Labour and Welfare, and the water separation rate was measured together.
Results: When polysaccharide was used alone, the glucomannan, locust-bean gum, and xanthan gum did not gel. Gellan gum and κ- and ι-carrageenan decreased in cohesiveness with gelation, and were within the reference range, but did not satisfy licensing standard I because the hardness and adhesion increased rapidly and exceeded the upper limits of the reference value. The gellan gum separated, but it was effective in combination with polysaccharide. We effectively formed a gel for the two combinations of xanthan gum and locust-bean gum, and xanthan gum and glucomannan.
Conclusions: Appropriate material properties to utilize the characteristic of polysaccharides and to satisfy the licensing standard, were provided. Starch chain degradation by an enzyme, amylase, is effective for reducing the increase in adhesive property. Bridge formation by supplying cations by non-fat milk powder promotes gelling. Gelling is achieved by combining several polysaccharides that do not gel when added singly, and combining polysaccharides also makes it possible to prevent dehydration. A combination using polysaccharide was effective for reducing water separation.
Introduction: Daily fluid restriction and aging-related atrophy of saliva glands might cause dry mouth in older hemodialysis patients. We hypothesized that greater saliva secretion is needed to relieve dry mouth and that this could be achieved by providing oral functional training to patients. The aim of this study was to investigate changes in resting saliva secretion after performing oral functional training for older hemodialysis patients with mild dry mouth.
Materials and Methods: Hemodialysis patients with mild dry mouth at Kawashima Hospital gave informed consent to participate in the study. They were then randomly divided into an intervention group (n＝31) and a control group (n＝30). The intervention group was provided oral functional training by a dental hygienist, including saliva gland massage for 30 s and tongue lateral movement for 12 weeks during dialysis treatment. The control group did not receive the training. Overall, 54 participants completed the experiment. Oral wetness was measured using a KISO-WeT Tester, and the amount of resting saliva secreted in 30 s was collected in a cotton roll and weighed. Measurements were implemented at baseline and at 2, 4, 8, and 12 weeks after starting the regimen.
Results and Discussion: In the intervention group, oral wetness at 4, 8, and 12 weeks was significantly higher than that at baseline (p＜0.05, p＜0.001, p＜0.05, respectively). No statistically significant differences were found in the control group. In the intervention group, the amounts of saliva secreted at 4, 8, and 12 weeks were significantly greater than that at baseline (p＜0.05, p＜0.001, p＜0.001, respectively). In the control group, the amount of saliva secreted at 12 weeks was significantly more than that at 2 and 4 weeks (p＜0.05, p＜0.05, respectively).
Conclusion: We concluded that performing oral functional training, which included salivary gland massage and tongue movement training for 4 or more weeks, could increase the amount of resting saliva secretion in older hemodialysis patients with mild dry mouth.
Objective: “The guideline about decision-making process for the introduction of artificial hydration and nutrition in elderly patients with dysphagia” (“the guidelines”) were published in 2012 as a project sponsored by the Ministry of Health, Labour and Welfare. In fiscal 2014, a series of revisions were made to further require the promotion of rehabilitation (rehab) for the transition from tube feeding to oral intake. We investigated the changes in the number of patients who transitioned to oral intake and who underwent percutaneous endoscopic gastrostomy (PEG). Additionally, we examined how the guidelines and the revision of the medical payment system affected the outcomes of patients in convalescent rehab wards.
Methods: We retrospectively reviewed medical records of inpatients consuming 3 meals a day via tube (36–45 patients/year) in the convalescent rehab wards of our hospital from 2010 to 2014.
Results: The number of patients who regained oral intake ability gradually increased from 2010 onward (from 8 patients [19%] in 2010 to 17 patients [38%] in 2014). According to the year of hospital admission, the patients were divided into the 2010–2011 group and 2012–2014 group. The number of patients who regained oral intake ability was significantly increased in the 2012–2014 group; in contrast, the number of PGE patients decreased significantly from 34 (79%) in the 2010–2011 group to 19 (42%) in the 2012–2014 group.
Discussion: The FIM (functional independence measure) score gain during hospitalization in the same period improved by about 5 points, possibly explaining the marked increase in the number of patients who transitioned to oral intake. The number of patients with PEG has shown a consistent decline since 2010, and this trend is not probably affected by the medical payment system revision. It may be affected by the fact that newspapers and books have begun to address the ethical issues pertaining to PEG often after the guidelines were published.