Purpose: In videoendoscopic examination of swallowing (VE), the Hyodo score is used to predict oral food intake ability. For aspiration prevention and oral food intake ability, in addition to the Hyodo score evaluation indicator, voluntary coughing, instruction comprehension, and consciousness level are also considered important. However, no studies examining these three factors during VE have been reported. We examined how the Hyodo score and voluntary coughing, instruction comprehension, and level of cognitive awareness during VE measured at the same time are associated with oral food intake ability after recovering to the acute stage.

　Subjects and methods: This research design was a longitudinal study. The subjects were 231 patients (114 men, mean age 82.4±8.3 years) admitted to the acute care ward at our hospital during the period from May 2017 to April 2019 who received VE due to suspicion of dysphagia. With oral food intake ability at discharge from the acute hospital as the dependent variable, subjects were divided into a successful oral intake group if they were able to eat three meals a day of regular or soft food orally and a non-successful intake group if they could ingest a dysphagia diet, were tube fed while also ingesting a dysphagia diet, or were only tube fed. The independent variables were Hyodo score, ability to cough voluntarily, ability to understand instructions, and level of cognitive awareness at initial VE. Regression analysis was performed with age, duration of hospital stay, duration from hospital admission to receiving VE, illness leading to hospital admission, and medical history as control variables to find the cumulative incidence rate ratio (CIRR) and the 95% confidence interval (CI).

　Results: There were 84 patients (36.3%) in the successful oral intake group. Factors that were significantly associated with oral intake ability discharge from the acute hospital were Hyodo score (CIRR: 0.607, 95% CI: 0.373-0.988) and voluntary coughing (0.468, 0.289-0.757).

　Conclusion: In predicting oral food intake ability discharge from the acute hospital, the ability to cough voluntarily was an independent factor in addition to Hyodo score. This suggests that assessing the ability to cough voluntarily may be important in conjunction with the Hyodo score when predicting oral food intake ability.

　Background: MostGraph is a measurement device developed based on the forced oscillation technique (FOT), and can measure respiratory resistance and reactance. We found that in many cases with a history of aspiration pneumonia, respiratory resistance measured by MostGraph was increased after eating. We investigated the cause of this phenomenon using swallowing videoendoscopy (VE).

　Methods: We studied VE with oral intake in 23 patients with a history of aspiration pneumonia and 17 controls. In addition, we measured pre-VE and post-VE whole-breath respiratory system resistance (Rrs) and reactance (Xrs) using MostGraph.

　Results: The change in respiratory resistance (cmH₂O/L/s) at 5 Hz (DR5) was significantly higher in the patient group than in the control group [median 0.37 (min －0.46, max 1.13) vs. 0.29 (－1.64, 0.39), p＜0.001]. In the patient group, DR5 did not correlate with the mean value of the index of pharyngeal residuals (YPR-SRS) or the mean value of the laryngeal penetration and aspiration scale (PAS), but showed a significant positive correlation with the mean value of salivary PAS (S-PAS) (Spearman’s rank correlation coefficient ρ＝0.453, p＝0.030). In the patient group＋control group, DR5 showed a significant positive correlation with mean values of dysphagia indices: YPR-SRS (ρ＝0.527, p＜0.001), PAS (ρ＝0.502, p＜0.001) and S-PAS (ρ＝0.550, p＜0.001).

　Conclusion: Postprandial elevation of respiratory resistance using MostGraph may be useful in the assessment of dysphagia, especially laryngeal penetration and aspiration of saliva during eating.

　Background and Purpose: Traditionally, minced foods and soft foods have been offered to individuals with reduced occlusal force (OF). The purpose of this study was to compare the masticatory efficiency (ME) between minced and soft foods, and to clarify whether minced foods are effective in reduced OF.

　Methods: Carrot samples were prepared in the form of soft bites with artificial saliva, soft chunks with thickening liquid, uncooked chunks with artificial saliva, and uncooked chunks with thickening liquid. Using a simplified mock mastication device, each sample was masticated 30 times at a mastication speed of one time per second, with OF of 50, 100, 150, and 200 N. After mastication, each sample was sieved through a 1.7-mm mesh sieve, and each ME was calculated from the residual amount on the sieve. Finally, the values were compared statistically.

　Results: The ME of the soft bites was significantly higher than that of the uncooked chunks with artificial saliva, and uncooked chunks with thickening liquid (p＜0.001 for all). There was no significant difference in ME between the soft bites and soft chunks with thickening liquid at OF of 50 N and 100 N (p＝0.206 and p＝0.353, respectively). At OF of 150 N and 200 N , the ME of soft bites was significantly higher than that of soft chunks (p＝0.020, p＝0.014, respectively). There was no significant difference in ME between uncooked chunks with artificial saliva and with thickening liquid at all OF.

　Discussion and Conclusions: The ME of chopped hard foods was significantly lower than that of soft bites. The ME of the soft chunks was the same or lower than that of the soft bites, and there was no effect of chopping on the ME. There was no significant difference between the ME of chopped hard foods with or without thickening liquid, suggesting that thickening has no effect on the decreased OF. Therefore, soft and easy-to-chew food is more suitable for people with decreased OF who do not have dysphagia than minced food.

　Objective: In the present study, we sought to identify the characteristic nursing practices of Certified Nurses in Dysphagia Nursing (CNDNs) for preventing aspiration pneumonia (AP) relapse among dysphagia patients in Japan’s community healthcare support hospitals.

　Methods: We conducted semi-structured interviews with six CNDNs and performed qualitative retraction analysis on their responses.

　Results: From a total of 37 subcategories, we selected eight core categories including: “Observing typical symptoms of AP, and repeatedly considering assessments and nursing plans”; “Determine feasibility based on the subject’s background and dialogue, and explain dietary assistance and training methods, as well as measures to prevent recurrent aspiration pneumonia”; “Assessing the vicious cycle of deterioration of the subject’s general condition and provide support while seeking nursing care that respects the subject’s wishes”; “Practicing nursing care while devising methods to identify patients with AP and patients at risk in each ward, hospital, and community”; “Establishing a system for accepting consultations to deal with difficult cases of AP in hospitals”; “Educating ward nurses who are most closely involved with patients and their families in order to improve their practical skills in clinical dysphagia patients nursing”; “Visualizing nursing practice to ensure its continuity in response to changes in patients over time”; and “Adjusting the environment so that the various professions involved with patients and their families can continuously demonstrate their expertise to each other.” In addition, the eight categories became three core categories.

　Conclusion: Three core categories were identified as characteristics of nursing care practiced by CNDNs working at a community healthcare support hospital in Japan to prevent recurrence of AP in patients with dysphagia: Nursing practice that uses specialized knowledge and skills to deal with individuality, Nursing practice as management of nursing services focusing on the organization, and Nursing practice for continuity of nursing of dysphagia patients.

　Swallowing auxiliary products are useful for people with aphagia to enable them to drink, eat, and take their medicines. However, inappropriate usage of the products causes disintegration-delay and non-disintegration of the tablets, reducing drug efficacy. Sometimes, magnesium oxide tablets used as an antacid or laxative are taken with the help of swallowing auxiliary products. Detection of a non-disintegrated tablet in the stool of a patient who took the tablet using a thickening agent has been reported. In this study, we investigated how immersion of magnesium oxide tablets of various sizes (diameter: 7.5 mm, 8 mm, 9 mm, 10.5 mm) with three different swallowing auxiliary products (xanthan gum, guar gum food thickener, and swallowing aid jelly) affected their disintegration and dissolution. In the xanthan gum food thickener and swallowing aid jelly, the disintegration time of the tablets was similar to that of non-immersed tablets. In the guar gum food thickener, the disintegration time of the tablets (7.5 and 8 mm) was longer than that of the other tablets. The most significant effect was observed in the 7.5-mm tablets, and the dissolution rate was the lowest. Thus, the results showed that small-size magnesium oxide tablets are easily affected by guar gum food thickeners.

　Aspiration pneumonia is caused by the aspiration of food due to dysphagia as well as saliva aspiration during the night. As a countermeasure for saliva aspiration, low-pressure continuous salivary suction using a suction tube is used. However, this method has some shortcomings, including accidental swallowing or ingestion of the suction tube by biting and difficulty holding the suction tube within the oral cavity. There- fore, this method may be difficult to use in patients who move excessively or overnight while the patients are sleep. To solve these problems, we developed a simple method to fabricate a mouthpiece for continu- ous salivary suction by integrating a suction tube and a mouthpiece. In this report, we describe its clinical application in two patients with dysphagia.

　Case 1: The patient was a man in his 70s. He had dysphagia and left hemiplegia due to a right frontal lobe infarction. He started dysphagia rehabilitation after being transferred to a convalescent hospital. Saliva aspiration was confirmed using a fiberoptic endoscopic evaluation of swallowing. The patient had increased phlegm production at night due to saliva aspiration. A continuous saliva suction mouthpiece was fabricated to suction this overnight phlegm. The frequency of sputum suction at night (midnight to 6:00 am) decreased from eight times per night on average during the two weeks prior to beginning the use of the mouthpiece to zero during the two weeks while the mouthpiece was used.

　Case 2: The patient was a man in his 60s. Due to bulbar palsy caused by amyotrophic lateral sclerosis, saliva was retained in his oral cavity, and his family had difficulty suctioning his phlegm while he slept. A saliva continuous suction mouthpiece was fabricated and worn while the patient slept, and suctioning decreased from an average of three times per night to zero with the use of our mouthpiece.

　Discussion: Saliva aspiration not only causes aspiration pneumonia but also increases the care burden as frequent phlegm suctioning is required. Our saliva continuous suction mouthpiece is simple to fabricate and can help reduce the burden on caregivers. Further interventional study is needed to clarify the effects of saliva suction using this device to promote its widespread use.