Objective: The aim of this study was to develop quality indicators that Certified Nurses in Dysphagia Nursing (CNs) can utilize in a transdisciplinary team approach in hospitals.

　Methods: The draft quality indicators were developed based on literature and other sources, focusing on the process aspect of healthcare quality assessment. They were categorized into two domains: technical (A) and interpersonal (B). They comprised 21 items grouped under four concepts in aspect A (e.g., screening) and 39 items under ten concepts in aspect B (e.g., organizational culture), totaling 60 items. To assess content validity and face validity, a questionnaire survey and expert panel review were conducted with CNs. Additionally, to further examine content validity among the multidisciplinary team members, a questionnaire survey was administered to council members of the Japanese Society of Dysphagia Rehabilitation. Known-group validity, construct validity, and reliability were assessed through a web-based survey of CNs working in hospitals regarding the frequency of implementation of the quality indicators, followed by statistical analysis. The significance level was set at 5%.

　Results: Nine CNs evaluated the validity, importance, appropriateness, and feasibility of the indicators using a nine-point scale, resulting in median values (Mdn) ranging from 5 to 9. Items with Mdn values of 5 or 6 were reviewed and revised by the expert panel.

　Among 45 council members surveyed, 59 items received Mdn values between 7 and 9. One item with an Mdn of 6 remained unchanged, and a new item, “Coordination with Other Teams,” was added, increasing the total indicators to 61.

　Among 200 CNs surveyed (valid response rate: 24.4%), a ceiling effect was observed in five items under aspect B. The item.total correlation, excluding two items with commonality below .16, ranged from r＝.37 to .60 for aspect A and from r＝.55 to .81 for aspect B. Good.poor analysis indicated significantly higher scores in the upper group for 58 items. The total scores for aspects A and B were significantly higher in known groups where CNs were part of a team, teams had five or more professional roles and at least nine members, on-the-job training frequency was high, and team-based reimbursement was applied. Exploratory factor analysis revealed five factors for aspect A and four factors for aspect B, with interpretable item structures. Cronbach’s α was .875 for aspect A and .980 for aspect B.

　Conclusion: The 61 developed quality indicators demonstrated acceptable validity and reliability.

　Background: Videofluoroscopic swallowing examination (VF) is recognized as the gold standard for evaluating swallowing physiology. Although standardized VF samples have been established for liquids and semi-solids, an agreed preparation protocol for rice―the primary staple food in Japan―has not been defined. The powder-mixing method enables barium incorporation without altering grain morphology, yet evidence to determine an appropriate concentration range remains insufficient.

　Objective: To clarify how barium concentration affects the textural and mixing characteristics of rice samples prepared for VF evaluation using the powder-mixing method and to propose a practical concentration range.

　Methods: Cooked rice (100 g) was mixed with pre-hydrated barium sulfate to achieve concentrations of 15%, 20%, or 25% (w/w). Rice-based VF samples were maintained at 45℃ and evaluated using a texture analyzer for hardness, adhesiveness, and cohesiveness (n＝8 per group). Mixability was visually assessed based on grain uniformity, separation, and aggregation.

　Results: One-way ANOVA demonstrated significant differences in hardness (p＝0.003), adhesiveness (p＜0.001), and cohesiveness (p＜0.001) among concentrations. For hardness, significant differences were observed among concentrations, and the 15% condition exhibited intermediate values between the 0% and 20–25% conditions. For adhesiveness, significant differences were observed between 0% and ≥15%, whereas no significant differences were found among the 15–25% conditions. For cohesiveness, significant differences were observed between 0% and 20–25%; however, no significant differences were found between 0% and 15% or among the 15–25% conditions. Mixability was most favorable at 15–20%, whereas the 25% condition resulted in grain scattering and early aggregation.

　Conclusion: A barium concentration of 15–20% appears most practical for preparing rice-based VF samples using the powder-mixing method, with 15% offering the best balance of uniformity, workability, and reproducibility. These findings provide foundational evidence for the standardization of rice-based VF samples, supporting more consistent and clinically relevant swallowing assessments.

　In patients admitted with worsening respiratory conditions due to aspiration related lung disease, we investigated whether there were differences in swallowing function at the time of admission and the ability to regain oral intake depending on the type of disease. The subjects were 135 patients (mean age 84.9± 8.7 years) who were hospitalized with aspiration pulmonary disease accompanied by worsening respiratory status and in whom STs (speech language hearing therapists) performed early intervention. They were divided into two groups: 113 patients with aspiration pneumonia and 22 patients with aspiration pneumonitis, and compared retrospectively. As a result, the aspiration pneumonitis group showed significantly lower albumin levels at admission, MWST (modified water swallowing test), and FOIS (Functional Oral Intake Scale) at discharge and transfer compared to the aspiration pneumonia group (p＜0.05). This study suggests that in the acute phase, the aspiration pneumonia group had more difficulty regaining oral intake than the aspiration pneumonitis group, and that swallowing function was impaired.

　Even among patients without issues swallowing food, some have trouble swallowing pills (such as tablets, capsules, or powders). We therefore used barium capsules in videofluoroscopic (VF) examinations to compare the swallowing patterns of food versus capsules and investigate the differences.

　This study targeted patients undergoing VF examinations admitted to the recovery rehabilitation ward who were taking capsules and showed no laryngeal penetration when swallowing water or thickened liquids. The barium capsule was prepared by filling a size four capsule with 250 mg of barium sulfate powder and was taken with 20 mL of water or thickened water. Dysphagia was defined as a Functional Impairment Level of Swallowing (FILS) of 9 or below. Pill dysphagia was assessed based on swallowing status and transit time to the esophageal entrance. Sub-analyses examined associations with age, gender, cognitive function, jaw position (cervical-lower edge of the mandibular angle), number of medications, and anticholinergic drugs.

　Thirty-eight patients were included, with a mean age of 85.5 years [75.8, 87.3]; 18 patients experienced choking, eight had an upward positioned jaw, and 23 had cognitive impairment. Twenty-eight patients had dysphagia. Fourteen patients had pill dysphagia, requiring over 11 seconds for a capsule to pass, and among these, two patients were unable to swallow capsules. Among the 28 patients with dysphagia, 16 had no pill dysphagia, conversely, among the 10 patients without dysphagia, 2 had pill dysphagia (p＝0.269). Pill dysphagia was associated with cognitive impairment (p＝0.020) and jaw position during capsule intake (p＝0.034). Conversely, dysphagia was strongly associated with choking (p＜0.001) and age (p＝ 0.048).

　This suggests that the presence and factors of dysphagia and pill dysphagia may differ. All healthcare and care professionals should recognize the existence of pill dysphagia as distinct from dysphagia. Furthermore, we consider that pharmacists have a significant responsibility for the assessment and management of patients with pill dysphagia.

　Introduction: This study aimed to evaluate the feeding and swallowing function of tracheostomized patients under mechanical ventilation and to investigate the feasibility and safety of initiating direct swallowing training at an early stage.

　Materials and Methods: This was a retrospective observational study. The subjects were patients admitted to the intensive care unit (ICU) of Nagoya Ekisaikai Hospital between December 2022 and December 2023, who underwent tracheostomy, required mechanical ventilation for more than 48 hours, received intervention by a speech-language-hearing therapist (ST), and did not meet any exclusion criteria. Data were retrospectively collected from medical records, including patient demographics, hospitalization course, swallowing assessment parameters, and the occurrence of adverse events following swallowing assessment or the initiation of direct swallowing training. Swallowing assessments were initiated based on predefined criteria, including level of consciousness, absence of sedatives and vasopressors, and ventilator settings. The assessments were conducted over three consecutive days using a protocol based on the Modified Evan’s Blue Dye Test. If aspiration was suspected, the evaluation was repeated using constant-flow oxygen delivered through the subglottic suction port. When no signs of aspiration or changes in vital signs or respiratory patterns were observed, the assessment was considered passed, and direct swallowing training was initiated by the ST under the supervision of a physician or nurse. When constant-flow oxygen was required during assessment, it was also used during the training sessions.

　Results: A total of 10 patients were included (median age: 73 years; 4 males and 6 females). Direct swallowing training was completed without respiratory complications in nine patients. However, one patient developed pneumonia after the initiation of training, which hindered ventilator weaning.

　Conclusion: With clearly defined initiation criteria and appropriate risk management, direct swallowing training may be feasible, with careful monitoring, in tracheostomized patients requiring mechanical ventilation.

　A 37-year-old man was diagnosed with suspected Crohn’s disease based on clinical history, although a definitive pathological diagnosis could not be made. He was initially admitted to a local hospital due to postprandial vomiting and frequent diarrhea, and was later transferred to our hospital for further treatment. The patient also had a developmental disorder that made it difficult for him to comply with medical instructions, including fasting instructions during treatment. Consequently, the patient developed perforated peritonitis and underwent emergency surgery for stoma construction. Following extubation after surgery, his respiratory condition worsened due to aspiration pneumonia, requiring repeated reintubation and eventually tracheostomy. Postoperatively, he developed sarcopenic dysphagia, likely due to surgical stress, physical inactivity, and malnutrition. Videofluoroscopic swallowing examination revealed pharyngeal residues and aspiration. Conventional swallowing rehabilitation techniques―such as head-raising exercises, mouth-opening exercises, and tongue resistance training―were difficult to apply due to his strong behavioral rigidity, impaired comprehension, and low endurance associated with his developmental disorder. Therefore, we implemented a swallowing training program that incorporated neuromuscular electrical stimulation (NMES) to repeatedly trigger the swallowing reflex. This approach led to improved swallowing function, and the patient was eventually able to resume normal oral intake. This case suggests the potential effectiveness of NMES-assisted therapy for patients with sarcopenic dysphagia, particularly those with limited compliance. A brief literature review was conducted to support this study.