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Handa N, Ishizaki T, Mitsutake S, Ono K, Akishita M. Safety profile of hypnotics or sedatives on community-dwelling older adults aged 75 or older in Japan: A retrospective propensity-matched cohort study. Int J Geriatr Psychiatry 2024; 39:e6085. [PMID: 38622754 DOI: 10.1002/gps.6085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE The purpose of the study is to assess if daily use of hypnotics increases mortality, aspiration pneumonia and hip fracture among relatively healthy individuals aged 75 years or older who lead independent lives in the community. METHOD AND PATIENTS Of the adults aged 75 years or older residing in Hokkaido prefecture of Japan (n = 705,538), those who did not meet several exclusion criteria were eligible for generating propensity score-matched cohorts (n = 214,723). Exclusion criteria included co-prescribed medications acting on the central nervous system, diagnoses of malignant neoplasm, dementia, depression, etc. We compared 33,095 participants who were prescribed hypnotics for daily use (hypnotic group) with a propensity score-matched cohort without a prescription (control group). Participants were followed for more than 42 months. RESULTS During the 42-month follow-up period, the incidence of the three outcome measures in the hypnotics group was significantly higher than that in the control group (aspiration pneumonia p < 0.001, hip fracture p = 0.007, and all-cause mortality p < 0.001). Sensitivity analyses utilizing inverse probability weighting demonstrated hazard ratios of 1.083 [1.023-1.146] for mortality, 1.117 [1.014-1.230] for aspiration pneumonia, and 1.720 [1.559-1.897] for hip fracture. Meanwhile, the attribute risk differences were 2.7, 1.5, and 1.0 per 1000 patient-years, respectively. CONCLUSIONS Although daily use of hypnotics increased the risk of three events, their attribute risk differences were fewer than 3.0 per 1000 patient-years. The results will help provide guidance on whether it is reasonable to prescribe hypnotics to geriatric population aged 75 or older leading independent lives in the community. CLINICAL TRIAL REGISTRATION UMIN-CTR UMIN000048398.
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Affiliation(s)
- Nobuhiro Handa
- Department of Digital Therapeutics, Juntendo University, Graduate School of Medicine, Tokyo, Japan
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Kino-Medic Clinic, Ichigao, Yokohama, Japan
- Medical Technology Innovation Center, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | | | | | - Koki Ono
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Department of Social Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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2
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Affiliation(s)
- Vincent Girard
- Département de médecine (Girard); Division d'infectiologie (Bai), Département de médecine, Université Queen's, Kingston, Ont
| | - Anthony D Bai
- Département de médecine (Girard); Division d'infectiologie (Bai), Département de médecine, Université Queen's, Kingston, Ont.
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Tamamura Y, Matsuura M, Shiba S, Nishikimi T. Effect of comorbid heart failure assessed by plasma B-type natriuretic peptide level on the activities of daily living in patients with hospitalization-associated disability after aspiration pneumonia. Eur Geriatr Med 2024; 15:67-72. [PMID: 38150127 DOI: 10.1007/s41999-023-00907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE We investigated the effects of comorbid heart failure on rehabilitation outcomes in patients with hospitalization-associated disability after aspiration pneumonia (AP). METHODS This study included 134 patients with hospitalization-associated disability after AP. Patients were classified into heart failure (B-type natriuretic peptide (BNP) ≧100 pg/ml, n = 39) and non-heart failure (BNP < 100 pg/ml, n = 95) groups, and the rehabilitation outcomes of both groups were compared. RESULTS Rehabilitation effectiveness was lower in heart failure group than in non-heart failure group (21.1 ± 22.6% vs 36.2 ± 30.8, p < 0.01). The rate of independent walking at discharge in heart failure group (28.2%) was significantly lower than in non-heart failure group (53.7%). Multiple linear regression analysis revealed that age, male, handgrip strength, quadriceps strength, functional oral intake scale, Mini Nutritional Assessment Short Form, and BNP were significantly associated with rehabilitation effectiveness. DISCUSSION Results suggest that comorbid heart failure has a negative impact on rehabilitation outcomes in patients with hospital-associated disability after AP.
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Affiliation(s)
- Yusuke Tamamura
- Department of Rehabilitation, Wakakusa-Tatsuma Rehabilitation Hospital, 1580 Ooaza Tatsuma, Daito City, Osaka, 574-0012, Japan
| | - Michiko Matsuura
- Department of Rehabilitation, Wakakusa-Tatsuma Rehabilitation Hospital, 1580 Ooaza Tatsuma, Daito City, Osaka, 574-0012, Japan
| | - Sumiko Shiba
- Department of Physical Therapy, Konan Women's University, 6-2-23 Morikita-Cho, Higashinada-Ku, Kobe City, Hyogo, Japan
| | - Toshio Nishikimi
- Department of Medicine, Wakakusa-Tatsuma Rehabilitation Hospital, 1580 Ooaza Tatsuma, Daito City, Osaka, 574-0012, Japan.
- Department of Internal Medicine, Wakakusa-Tatsuma Rehabilitation Hospital, 1580 Ooaza Tatsuma, Daito City, Osaka, 574-0012, Japan.
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4
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Disma N, Frykholm P. Clear rules for clear fluids fasting in children. Br J Anaesth 2024; 132:18-20. [PMID: 37996274 DOI: 10.1016/j.bja.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023] Open
Abstract
Preoperative fasting guidelines published in 2022 by the European Society of Anaesthesiology and Intensive Care represent a paradigm shift in the preoperative preparation of children undergoing general anaesthesia. Schmitz and colleagues report the results from a multi-institutional prospective cohort study to determine if application of the recent guidelines increased the risk of regurgitation and pulmonary aspiration. This study provides support for the concept of reducing real fasting times by allowing clear fluids until 1 h before induction of anaesthesia. Although the study cohort was large, further prospective multicentre studies with even greater sample sizes are warranted to provide definitive evidence for the safety of the new fasting rules.
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Affiliation(s)
- Nicola Disma
- Unit for Research in Anaesthesia, Department of Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Peter Frykholm
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
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Schmitz A, Kuhn F, Hofmann J, Habre W, Erb T, Preuss M, Wendel-Garcia PD, Weiss M, Schmidt AR. Incidence of adverse respiratory events after adjustment of clear fluid fasting recommendations to 1 h: a prospective, observational, multi-institutional cohort study. Br J Anaesth 2024; 132:66-75. [PMID: 37953199 DOI: 10.1016/j.bja.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/22/2023] [Accepted: 10/07/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Preoperative fasting reduces the risk of pulmonary aspiration during anaesthesia, and 2-h fasting for clear fluids has commonly been recommended. Based on recent evidence of shorter fasting times being safe, the Swiss Society of Paediatric Anaesthesia began recommending 1-h fasting for clear fluids in 2018. This prospective, observational, multi-institutional cohort study aimed to investigate the incidence of adverse respiratory events after implementing the new national recommendation. METHODS Eleven Swiss anaesthesia institutions joined this cohort study and included patients aged 0-15 yr undergoing anaesthesia for elective procedures after implementation of the 1-h fasting instruction. The primary outcome was the perioperative (defined as the time from anaesthesia induction to emergence) incidence of pulmonary aspiration, gastric regurgitation, and vomiting. Data are presented as median (inter-quartile range; minimum-maximum) or count (percentage). RESULTS From June 2019 to July 2021, 22 766 anaesthetics were recorded with pulmonary aspiration occurring in 25 (0.11%), gastric regurgitation in 34 (0.15%), and vomiting in 85 (0.37%) cases. No major morbidity or mortality was associated with pulmonary aspiration. Subgroup analysis by effective fasting times (<2 h [n=7306] vs ≥2 h [n=14 660]) showed no significant difference for pulmonary aspiration between these two groups (9 [0.12%] vs 16 [0.11%], P=0.678). Median effective fasting time for clear fluids was 157 [104-314; 2-2385] min. CONCLUSIONS Implementing a national recommendation of 1-h clear fluid fasting was not associated with a higher incidence of pulmonary aspiration compared with previously reported data.
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Affiliation(s)
- Achim Schmitz
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabian Kuhn
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Hofmann
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Walid Habre
- Unit for Anaesthesiological Investigation, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas Erb
- Department of Anaesthesia, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Preuss
- General Secretary of Association of Swiss Office Based Anaesthesiologists (ASOBA), Joint Office for Outpatient Anesthesia (AGPA) Baden-Dättwil, Switzerland
| | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander R Schmidt
- Department of Anaesthesia, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University - School of Medicine, Stanford, CA, USA.
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Wang P, Wang J, Wang L, Lv J, Shao Y, He D. High throughput sequencing technology reveals alteration of lower respiratory tract microbiome in severe aspiration pneumonia and its association with inflammation. Infect Genet Evol 2023; 116:105533. [PMID: 37995886 DOI: 10.1016/j.meegid.2023.105533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/18/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Aspiration pneumonia is a common and severe clinical condition. The microbiome present in the lower respiratory tract plays a crucial role in regulating human inflammatory response. However, the relationship between the altered lower respiratory tract microbiome and inflammation in aspiration pneumonia remains inadequately explored. PURPOSE To investigate the alteration of the lower respiratory tract microbiome in severe aspiration pneumonia patients and explore the potential correlation between microbiome components and inflammatory response. METHOD Patients in the severe aspiration pneumonia group and control group were enrolled from the intensive care unit of Jinshan Hospital, Fudan University between December 31, 2020 and August 19, 2021. Sputum specimens were collected from all participants and subsequently subjected to 16S rDNA high throughput sequencing technology. The concentration of inflammatory cytokines in serum was measured using enzyme-linked immunosorbent assay (ELISA) kits, and collected data including patients' demographic information, clinical data, and laboratory examination results were recorded for further analysis. RESULTS Alteration in the lower respiratory tract microbiome was observed in severe aspiration pneumonia. Compared to the control group, a significant decrease in the relative abundance of Firmicutes was found at the phylum level (P < 0.01). At the family level, the relative abundance of Corynebacteriaceae, Enterobacteriaceae and Enterococcaceae increased significantly (P < 0.001, P < 0.05, P < 0.01). There were no significant differences in community diversity of the lower respiratory tract between the two groups. Patients in the severe aspiration pneumonia group exhibited significantly higher levels of inflammation compared to those in the control group. Correlation analysis showed that the relative abundance of Corynebacteriaceae was positively correlated with the expression level of IL-1β and IL-18 (P = 0.002, P = 0.02); the relative abundance of Enterobacteriaceae was negatively correlated with IL-4 (P = 0.011); no other significant correlations have been identified between microbiome and inflammatory indicators thus far (P > 0.05). CONCLUSIONS Alteration of the lower respiratory tract microbiome is critically involved in inflammation and disease progression in severe cases of aspiration pneumonia. The potential inflammation regulation properties of the microbiome hold promising value for developing novel therapeutic approaches aimed at mitigating the severity of the disease.
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Affiliation(s)
- Pengfei Wang
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China; Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai 201508, China; Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai 201508, China
| | - Junming Wang
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China; Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai 201508, China; Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai 201508, China
| | - Lina Wang
- Department of General Practice, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Jiang Lv
- Department of General Practice, Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Yiru Shao
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China; Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai 201508, China; Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai 201508, China
| | - Daikun He
- Department of General Practice, Jinshan Hospital, Fudan University, Shanghai 201508, China; Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai 201508, China; Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai 201508, China; Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai 201508, China.
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Sakurai Y, Kato Y, Momosaki R. Strategies to Facilitate Early Oral Intake After Aspiration Pneumonia. J Am Med Dir Assoc 2023; 24:2017. [PMID: 37633315 DOI: 10.1016/j.jamda.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Yuya Sakurai
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Yuki Kato
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
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8
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Shimoda M, Tanaka Y, Morimoto K, Nomura S, Yoshimori K, Ohta K. Comparison of the thickness of the erector spinae muscles between aspiration pneumonia and bacterial pneumonia patients. Aging Clin Exp Res 2023; 35:2657-2665. [PMID: 37676430 DOI: 10.1007/s40520-023-02542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND AIMS Aspiration pneumonia is generally associated with deterioration of skeletal muscle mass, which is usually evaluated by the erector spinae muscle cross-sectional area (ESMCSA); however, no report has assessed ESMCSA in patients with aspiration pneumonia. Furthermore, erector spinae muscle thickness (ESMT) was developed to be easier to measure than ESMCSA. Therefore, this study investigated the relationship between ESMT and ESMCSA in aspiration pneumonia patients compared to bacterial pneumonia patients. METHODS We retrospectively collected data for 164 patients with aspiration pneumonia and 480 patients with bacterial pneumonia who were hospitalized at Fukujuji Hospital between September 2018 and May 2022. We assessed the correlations between ESMCSA and ESMT and compared the data between the two groups. RESULTS ESMT had a strong, proportional relationship with ESMCSA in all patients (r = 0.908, p < 0.001) and those with aspiration pneumonia (r = 0.896, p < 0.001). ESMCSA (median 671.8 mm2 [range 164.0-1636.7] vs. median 1057.0 mm2 [range 161.3-2412.5], p < 0.001) and ESMT (median 17.1 mm [range 6.95-34.4] vs. median 23.8 mm [range 6.95-43.7], p < 0.001) were significantly lower in patients with aspiration pneumonia. A multivariate analysis of aspiration pneumonia diagnosis showed significant independent differences from bacterial pneumonia in ESMCSA (odds ratio 0.998 [95% CI: 0.996-0.999], p = 0.001) and ESMT (odds ratio 0.90 [95% CI: 0.84-0.96], p = 0.002). CONCLUSION This study demonstrates a strong correlation between ESMCSA and ESMT. ESMT can be more easily used to evaluate skeletal muscle mass and can help in diagnosing aspiration pneumonia.
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Affiliation(s)
- Masafumi Shimoda
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose City, Tokyo, 204-8522, Japan.
| | - Yoshiaki Tanaka
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose City, Tokyo, 204-8522, Japan
| | - Kozo Morimoto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose City, Tokyo, 204-8522, Japan
| | - Sakika Nomura
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose City, Tokyo, 204-8522, Japan
| | - Kozo Yoshimori
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose City, Tokyo, 204-8522, Japan
| | - Ken Ohta
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association (JATA), 3-1-24 Mastuyama, Kiyose City, Tokyo, 204-8522, Japan
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9
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Marusiak MJ, Paulden M, Ohinmaa A. Professional oral health care prevents mouth-lung infection in long-term care homes: a systematic review. Can J Dent Hyg 2023; 57:180-190. [PMID: 38020079 PMCID: PMC10662425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/30/2022] [Accepted: 06/26/2023] [Indexed: 12/01/2023]
Abstract
Background Nursing home-acquired pneumonia (NHAP) is the leading cause of mortality among residents in long-term care (LTC) homes. Aspiration pneumonia (AP) is one cause of NHAP. Professional oral health care (POHC) and daily mouth care can be effective in decreasing AP risk. Aim To identify, appraise, synthesize, analyze, and interpret results on the effectiveness of onsite POHC interventions/programs delivered to LTC home residents in reducing oral disease and NHAP. To summarize the findings and provide recommendations for clinical work and future research. Methods The PICO question addressed was, "In LTC home residents with oral health needs (P), is onsite POHC (I), compared to usual care (C), clinically effective in reducing dental disease and pneumonia/AP (O)?" Databases searched were PubMed, EMBASE (Ovid), CINAHL (Ebsco), Cochrane Library (Wiley), Web of Science, and the databases of the Centre for Reviews and Dissemination. Included were randomized controlled trials (RCTs), non-RCTs, and cross-sectional studies. PRISMA guidelines were followed and GRADE was used to assess the quality of studies. Results Thirteen clinical effectiveness studies were included: 10 RCTs, 1 non-RCT, and 2 cross-sectional studies. Discussion Better oral health and respiratory infection outcomes were found in the experimental groups who received an onsite POHC intervention compared to the control groups. Conclusion There is moderate-to-strong evidence that onsite POHC in LTC homes, provided mostly by dental hygienists, is effective in preventing bacterial mouth infection, pneumonia, and AP.
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Affiliation(s)
- Michelle J Marusiak
- Alumna, School of Public Health, University of Alberta, Edmonton, AB, Canada. This literature review was written in partial fulfillment of the requirements for the Master of Science (Health Policy Research Specialization) program at the University of Alberta.
| | - Michael Paulden
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Endo M, Fukuda Y, Okada K, Ogawa K, Nakamura M, Takahashi S, Murakami E, Shibayama C, Kawahara M, Akahane K, Onaga R, Nagatomo T, Kanazawa T, Nishino H, Mori H, Shirai K. Clinical Outcomes of Radiotherapy for Stage 1 Glottic Carcinoma: Comparing Accelerated Hyperfractionation and Once-daily Fractionation. In Vivo 2023; 37:2320-2326. [PMID: 37652523 PMCID: PMC10500519 DOI: 10.21873/invivo.13335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM Accelerated hyperfractionation (AHF) is used in head and neck cancer to improve the local control (LC) rate, but reports of outcomes for early-stage GC are limited. The outcomes of radiotherapy (RT) for stage 1 glottic carcinoma (GC) were retrospectively analyzed, comparing AHF and once-daily fractionation (ODF) using 2.0-2.4 Gy. PATIENTS AND METHODS A total of 102 patients with stage 1 GC underwent RT alone between 2007 and 2021, with 43 in the AHF group and 59 in the ODF group. A p-value less than 0.05 was considered to indicate a significant difference. RESULTS The 5-year LC rate was 98% in the AHF group and 91% in the ODF group (p=0.19). During RT, significantly more patients in the AHF group required opioids due to mucositis than in the ODF group (74% vs. 25%, p<0.001), and the rate of aspiration pneumonia tended to be higher in the AHF group than in the ODF group (7% vs. 0%, p=0.072). CONCLUSION There was no difference in the LC rate between AHF and ODF for stage 1 GC. Moreover, the AHF group required opioids at a higher rate and tended to have a higher risk of developing aspiration pneumonia.
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Affiliation(s)
- Masashi Endo
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan;
| | - Yukiko Fukuda
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Kohei Okada
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Kazunari Ogawa
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Michiko Nakamura
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Satoru Takahashi
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Eri Murakami
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan
- Department of Radiology, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Chiaki Shibayama
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan
- Department of Radiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Masahiro Kawahara
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Keiko Akahane
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Ryutaro Onaga
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University Hospital, Shimotsuke, Japan
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takafumi Nagatomo
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Takeharu Kanazawa
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Hiroshi Nishino
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Harushi Mori
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Katsuyuki Shirai
- Department of Radiology, Jichi Medical University Hospital, Shimotsuke, Japan
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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11
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Takimoto T, Yanagisawa A, Arai T, Inoue Y. Vocal cord paralysis associated with pleuroparenchymal fibroelastosis: A case report and literature review. Respir Investig 2023; 61:548-552. [PMID: 37331124 DOI: 10.1016/j.resinv.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023]
Abstract
Here, we report a case of idiopathic pleuroparenchymal fibroelastosis (PPFE) that progressed to pulmonary aspergilloma, aspiration pneumonia, and left vocal cord paralysis (VCP). To date, five cases of PPFE with VCP have been reported, including the present case. Aspiration pneumonia occurred in three cases, leading to death in two cases. Four cases had left-sided paralysis, in two of which, the paralysis occurred on side opposite to the predominant side (right side) of PPFE. Structural mechanisms underlying the recurrent laryngeal nerve could be involved. This report may further highlight the existence of hoarseness and dysphagia in PPFE.
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Affiliation(s)
| | | | - Toru Arai
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8555, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8555, Japan
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12
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Kato Y, Hori S, Ushida K, Shimizu M, Shirai Y, Momosaki R. Association between the amount of rehabilitation and the outcomes in patients with aspiration pneumonia. Int J Rehabil Res 2023; 46:216-220. [PMID: 37039603 DOI: 10.1097/mrr.0000000000000581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The appropriate amount of rehabilitation for aspiration pneumonia remains unknown. We conducted a historical cohort study to investigate the association between the amount of rehabilitation provided and the outcome of patients with aspiration pneumonia. A total of 4148 patients with aspiration pneumonia recruited from a database created by JMDC were categorized into three groups based on daily rehabilitation units: none or <1 unit (low-volume group), 1-2 units (medium-volume group), and more than 2 units (high-volume group). The main outcome measures were death in the hospital, discharge home, and length of hospital stay. The results showed that the middle-volume and high-volume groups had significantly fewer in-hospital deaths [middle-volume group, odds ratio (OR) 0.62; 95% confidence interval (CI), 0.46-0.83; high-volume group, OR 0.66; 95% CI, 0.45-0.97], more patients were discharged home (middle-volume group, OR 1.29; 95% CI, 1.03-1.62; high-volume group, OR 2.00; 95% CI, 1.48-2.71), and shorter hospital stay (middle-volume group, coefficient -3.30; 95% CI, -6.42 to -0.19; high-volume group, coefficient -4.54; 95% CI, -8.69 to -0.40) compared with the low-volume group. In conclusion, higher rehabilitation units per day provided to patients with aspiration pneumonia were associated with fewer deaths, more home discharges, and shorter hospital stays.
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Affiliation(s)
- Yuki Kato
- Department of Rehabilitation, Mie University Hospital
| | - Shinsuke Hori
- Department of Rehabilitation, Mie University Hospital
| | - Kenta Ushida
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Edobashi Tsu
| | - Miho Shimizu
- Department of Rehabilitation, Mie University Hospital
| | - Yuka Shirai
- Department of Clinical Nutrition Unit, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Edobashi Tsu
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13
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de Klerk ES, de Grunt MN, Hollmann MW, Preckel B, Hermanides J, van Stijn MFM. Incidence of excessive preoperative fasting: a prospective observational study. Br J Anaesth 2023; 130:e440-e442. [PMID: 36670008 DOI: 10.1016/j.bja.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Eline S de Klerk
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Midas N de Grunt
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mireille F M van Stijn
- Department of Anaesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
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14
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Inoue K, Abe S, Fukunaga T. Current state of cause of death determinations in Japan and the need to list the precise underlying cause of death. Med Sci Law 2023; 63:114-119. [PMID: 35585706 DOI: 10.1177/00258024221102203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
When death is caused by a disease, the precise cause of the death must be determined to promote health and contribute to prevention efforts. The circumstances of death should also be clarified so that measures can be taken to prevent the recurrence. Statistics regarding the cause of death must be accurate, and such statistics are shaped by the determination of the cause of death. We examined the annual cause of death rankings and the mortality rate in Japan during the 25-year period 1993-2017. We identified improvements that are needed to provide more precision in the cause of death statistics, with a focus on variations in the rankings, and we describe the peculiar and vulnerable aspects of the Vital Statistics system in Japan; for example, at one time the national government advised physicians to not list "heart failure" as the terminal stage of a condition on a death certificate, and the "heart disease" mortality rate thus tended to decline in that period. The ranking of "heart disease" as a cause of death decreased, but its mortality rate subsequently increased again. In addition, the "pneumonia" mortality rate has remained high over the past few years, but it abruptly decreased in 2017, when "aspiration pneumonia" was separated as a cause from other pneumonias. The "senility" mortality rate has increased annually, and it is a leading cause of death. It is important that physicians understand the underlying causes of death and provide that without being influenced by the reporting customs of the times.
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Affiliation(s)
- Ken Inoue
- Research and Education Faculty, Medical Sciences Cluster, Health Service Center, 12888Kochi University, Kochi, Japan
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Marsman M, Kappen TH, Vernooij LM, van der Hout EC, van Waes JA, van Klei WA. Association of a Liberal Fasting Policy of Clear Fluids Before Surgery With Fasting Duration and Patient Well-being and Safety. JAMA Surg 2023; 158:254-263. [PMID: 36598762 PMCID: PMC9857800 DOI: 10.1001/jamasurg.2022.5867] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/16/2022] [Indexed: 01/05/2023]
Abstract
Importance Current fasting guidelines for procedures under anesthesia are poorly implemented, leading to negative metabolic sequelae. Recent studies in children showed support of liberal clear fluid intake; adult physiology can support clear fluid intake, but implementation studies are lacking. Objective To evaluate the successfulness of implementation of a liberal clear fluid policy with regard to fasting duration, well-being, and safety in adults scheduled for anesthesia. Design, Setting, and Participants This was a quality improvement study conducted from January 2016 to July 2021 at a tertiary referral hospital in the Netherlands. Adults scheduled for nonemergency procedures under anesthesia were included in the study. Patients undergoing obstetrics procedures or those who were intubated preoperatively were excluded. Interventions Stepwise introduction of a liberal fluid fasting policy, allowing for ingestion of clear fluids until arrival at the operating room. Main Outcomes and Measures The primary outcome was change in fasting duration. Secondary outcomes were patient well-being, measured as preoperative thirst, amount of fluid ingested, postoperative nausea and vomiting (PONV), and administration of antiemetics. Safety was measured as incidence of regurgitation and aspiration (pneumonia). Results Of the 76 451 patients (mean [SD] age, 56 [17] years; 39 530 male individuals [52%] 36 921) included in the study, 59 036 (78%) followed the standard policy, and 16 815 (22%) followed the liberal policy. Time series analysis showed an estimated fasting duration decrease of 3:07 hours (IQR, 1:36-7:22; P < .001) after implementation of the liberal policy. Postimplementation median (IQR) fasting duration was 1:20 (0:48-2:24) hours. The incidence of regurgitation changed from 18 (95% CI, 14-21) to 24 (95% CI, 17-32) in 10 000 patients, and the incidence of aspiration changed from 1.7 (95% CI, 0.6-2.7) to 2.4 (95% CI, 0.5-4.7) in 10 000 patients. In the liberal policy, thirst feelings decreased (37% [4982 of 8615] vs 46% [3373 of 7362]; P < .001). PONV incidence decreased from 10.6% (6339 of 59 636) to 9.4% (1587 of 16 815; P < .001) and antiemetic administration decreased from 11.0% (6538 of 59 636) to 9.5% (1592 of 16 815; P < .001). Conclusions and Relevance Results of this quality improvement study suggest that a liberal fasting policy was associated with a clinically relevant reduction in fasting duration and improved patient well-being with regard to preoperative thirst and PONV. Although a slightly higher incidence of regurgitation could not be ruled out, wider implementation of such a policy may be advocated as results are still within the clinically accepted risks margins. Results suggest that surgical procedures in patients who drink clear fluids within 2 hours before anticipated anesthesia should not be postponed or canceled.
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Affiliation(s)
- Marije Marsman
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Teus H. Kappen
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Information Technology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisette M. Vernooij
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Judith A. van Waes
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilton A. van Klei
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
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16
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Hirota Y, Shin JH, Sasaki N, Kunisawa S, Fushimi K, Imanaka Y. Development and validation of prediction models for the discharge destination of elderly patients with aspiration pneumonia. PLoS One 2023; 18:e0282272. [PMID: 36827320 PMCID: PMC9955922 DOI: 10.1371/journal.pone.0282272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Discharge planning enhances the safe and timely transfer of inpatients between facilities. Predicting the discharge destination of inpatients with aspiration pneumonia is important for discharge planning. We aimed to develop and validate prediction models for the discharge destination of elderly patients with aspiration pneumonia. METHODS Using a nationwide inpatient database, we identified aspiration pneumonia cases for patients aged ≥65 years who had been admitted to hospital from their home or from a nursing home between April 2020 and March 2021. We divided the cases into derivation and validation cohorts according to the location of the admitting hospital. We developed two prediction models by dividing the cases based on the patient's place of residence prior to admission, one model to predict the home discharge of cases admitted from home and the other to predict the home or to a nursing home discharge of cases admitted from a nursing home. The models were internally validated with bootstrapping and internal-externally validated using a validation cohort. Nomograms that could be used easily in clinical practice were also created. RESULTS The derivation cohort included 19,746 cases admitted from home and 14,359 cases admitted from a nursing home. Of the former, 10,760 (54.5%) cases were discharged home; from the latter, 7,071 (49.2%) were discharged to either home or a nursing home. The validation cohort included 6,262 cases admitted from home and 6,352 cases admitted from a nursing home. In the internal-external validation, the C-statistics of the final model for the cases admitted from home and the cases admitted from a nursing home were 0.71 and 0.67, respectively. CONCLUSIONS We developed and validated new prediction models for the discharge of elderly patients with aspiration pneumonia either to home or to a nursing home. Our models and nomograms could facilitate the early implementation of discharge planning.
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Affiliation(s)
- Yoshito Hirota
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jung-ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- * E-mail:
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牛飼 純, 桑波田 聡, 窪田 唯, 佐田 千, 手塚 綾, 岩谷 徳, 竹中 俊, 大石 充. [An elderly male patient with dementia who showed repeated episodes of pneumonia due to chronic oral intake of kerosene]. Nihon Ronen Igakkai Zasshi 2023; 60:448-450. [PMID: 38171763 DOI: 10.3143/geriatrics.60.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
| | | | | | | | | | | | | | - 充 大石
- 鹿児島大学大学院医歯学総合研究科心臓血管・高血圧内科学
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18
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Tabaoka H. [Relationship between aspiration pneumonia and oral health assessment tool (OHAT)]. Nihon Ronen Igakkai Zasshi 2023; 60:400-405. [PMID: 38171757 DOI: 10.3143/geriatrics.60.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
AIM This study clarified the relationship between aspiration pneumonia and the oral health status. METHODS A total of 809 users from Kounankai were targeted. The Oral Health Assessment Tool (OHAT) includes eight items: lip, tongue, gingiva/mucosa, saliva, remaining teeth, dentures, oral cleaning, and toothache. Information on aspiration pneumonia was collected from each facility. A binomial logistic regression analysis was performed, with aspiration pneumonia as the objective variable and the OHAT items as explanatory variables. The analysis was performed using the R software program, version 4.0. 2, with a significance level of < 5%. RESULTS No significant association was found between the development of aspiration pneumonia and the OHAT score. The proportion of males was significantly higher in the aspiration pneumonia group than in the group without pneumonia. CONCLUSION No association was found between the development of aspiration pneumonia and the OHAT score.
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Takeshita Y, To Y, Kurosawa Y, Kinouchi T, Tsuya K, Tada Y, Tsushima K. Relationship between Anti-SARS-CoV-2 S Abs and IFN-λ3 Levels in the Administration of Oxygen following COVID-19 Vaccination. Immunohorizons 2023; 7:97-105. [PMID: 36645852 PMCID: PMC10563441 DOI: 10.4049/immunohorizons.2200093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023] Open
Abstract
Although the effectiveness of vaccination at preventing hospitalization and severe coronavirus disease (COVID-19) has been reported in numerous studies, the detailed mechanism of innate immunity occurring in host cells by breakthrough infection is unclear. One hundred forty-six patients were included in this study. To determine the effects of vaccination and past infection on innate immunity following SARS-CoV-2 infection, we analyzed the relationship between anti-SARS-CoV-2 S Abs and biomarkers associated with the deterioration of COVID-19 (IFN-λ3, C-reactive protein, lactate dehydrogenase, ferritin, procalcitonin, and D-dimer). Anti-S Abs were classified into two groups according to titer: high titer (≥250 U/ml) and low titer (<250 U/ml). A negative correlation was observed between anti-SARS-CoV-2 S Abs and IFN-λ3 levels (r = -0.437, p < 0.001). A low titer of anti-SARS-CoV-2 S Abs showed a significant association with oxygen demand in patients, excluding aspiration pneumonia. Finally, in a multivariate analysis, a low titer of anti-SARS-CoV-2 S Abs was an independent risk factor for oxygen demand, even after adjusting for age, sex, body mass index, aspiration pneumonia, and IFN-λ3 levels. In summary, measuring anti-SARS-CoV-2 S Abs and IFN-λ3 may have clinical significance for patients with COVID-19. To predict the oxygen demand of patients with COVID-19 after hospitalization, it is important to evaluate the computed tomography findings to determine whether the pneumonia is the result of COVID-19 or aspiration pneumonia.
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Affiliation(s)
- Yuichiro Takeshita
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Yasuo To
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Yusuke Kurosawa
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashiku, Tokyo, Japan; and
| | - Toru Kinouchi
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Kota Tsuya
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashiku, Tokyo, Japan; and
| | - Yuji Tada
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
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20
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Hrubovčák J, Tulinský U, Ihnát P, Jelínek P, Slívová I, Mitták M, Roman J, Stránský J. Is abdominal pain after an injury just an injury? Case report of rare aspiration pneumonia with lung gangrene and peritoneal response in a 5-year-old child. Cas Lek Cesk 2023; 162:160-163. [PMID: 37734942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Although pneumonia presents a relatively common diagnosis, it does not always present with classic clinical symptoms, nor does it follow a regular course without complications. The presented case describes a rare case of aspiration necrotizing pneumonia, which despite intensive therapy, progressed to lung gangrene and required a lung lobectomy. Another peculiarity is that the correct diagnosis was established only after the onset of abdominal pain, surprisingly by a trauma surgeon. This case emphasizes the necessity of a thorough general examination and draws attention to a rare, but conservatively intractable necrotizing pneumonia complicated by lung gangrene.
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21
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. The degree of recovery in swallowing ability in older inpatients with aspiration pneumonia is related to intramuscular adipose tissue of the quadriceps than to muscle mass. PLoS One 2022; 17:e0275810. [PMID: 36215269 PMCID: PMC9550090 DOI: 10.1371/journal.pone.0275810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND & AIM A recent study reported that the increase in intramuscular adipose tissue of the quadriceps in older inpatients is related to a decreasing degree of recovery in swallowing ability compared to the loss of muscle mass. However, whether the association remains true in case of aspiration pneumonia is unclear. Therefore, this study aimed to examine the relationship between the degree of recovery in swallowing ability and intramuscular adipose tissue in the quadriceps of older inpatients with aspiration pneumonia. METHODS This prospective study included 39 older patients with aspiration pneumonia. Swallowing ability was assessed using the Food Intake Level Scale (FILS). The indicators for the degree of recovery in swallowing ability were FILS at discharge and change in FILS. A greater change in FILS indicates a greater improvement in swallowing ability. Intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was used to determine whether the echo intensity of the quadriceps was independently and significantly related to FILS at discharge and the change in FILS. Independent variables were age, sex, days from disease onset, echo intensity and muscle thickness of the quadriceps, subcutaneous fat thickness of the thigh, FILS at admission, and number of units of rehabilitation therapy. RESULTS Echo intensity of the quadriceps (β = -0.363, p = 0.012) and FILS at admission (β = 0.556, p < 0.001) were independently and significantly associated with FILS at discharge (R2 = 0.760, f2 = 3.167, statistical power = 1.000). Similar variables (echo intensity of the quadriceps [β = -0.498, p = 0.012] and FILS at admission [β = -0.635, p < 0.001]) were independently and significantly related to change in FILS (R2 = 0.547, f2 = 1.208, statistical power = 0.998). Quadriceps muscle thickness was not independently and significantly related to FILS at discharge and change in FILS. CONCLUSION Our results indicate that intramuscular adipose tissue of the quadriceps in older inpatients with aspiration pneumonia is more strongly related to the degree of recovery in swallowing ability (that is, swallowing ability at discharge and change in swallowing ability) than muscle mass, and patients who have high intramuscular adipose tissue of the quadriceps at admission have a lower degree of recovery in swallowing ability.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
- * E-mail:
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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22
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Yamamoto T, Oishi K, Suizu J, Murakawa K, Hisamoto Y, Fujii T, Harada M, Chikumoto A, Kikuchi Y, Hamada K, Uehara S, Ohata S, Murata Y, Sakamoto K, Yamaji Y, Asami-Noyama M, Edakuni N, Kakugawa T, Hirano T, Matsunaga K. False-positive Elevation of Beta-D-glucan and Aspergillus Galactomannan Levels Due to Mendelson's Syndrome after Rice Aspiration. Intern Med 2022; 61:2935-2939. [PMID: 35314546 PMCID: PMC9593144 DOI: 10.2169/internalmedicine.8805-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Both 1,3-beta-D-glucan (BDG) and galactomannan (GM) are polysaccharide components of the fungal cell wall. Although elevated levels of serum BDG and Aspergillus GM suggest invasive fungal infection or Pneumocystis pneumonia and aspergillosis, respectively, it is also necessary to consider the possibility of false-positives. We herein report a 68-year-old man with marked elevation in serum BDG and GM levels accompanied by Mendelson's syndrome after rice aspiration. With the improvement of Mendelson's syndrome, his serum BDG and GM levels decreased. The false-positive serum BDG and GM findings may have been due to his aspiration of food containing them. It is important to take a detailed history of aspiration in addition to making a conventional differential diagnosis in patients with pneumonia with elevated serum BDG and GM levels.
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Affiliation(s)
- Tasuku Yamamoto
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Keiji Oishi
- Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Japan
| | - Junki Suizu
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Keita Murakawa
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Yukari Hisamoto
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Tetsuya Fujii
- Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Japan
| | - Misa Harada
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Ayumi Chikumoto
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Yujiro Kikuchi
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Kazuki Hamada
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Sho Uehara
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Syuichiro Ohata
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Yoriyuki Murata
- Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Japan
| | - Kenji Sakamoto
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Yoshikazu Yamaji
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Maki Asami-Noyama
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Nobutaka Edakuni
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Tomoyuki Kakugawa
- Department of Pulmonology and Gerontology, Graduate School of Medicine, Yamaguchi University, Japan
| | - Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
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23
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Taguchi E, Kobayashi Y, Tsuzuki H. [Effect of aspiration prevention surgery in three patients with multiple system atrophy who have been hospitalized for aspiration pneumonia]. Rinsho Shinkeigaku 2022; 62:621-626. [PMID: 35871564 DOI: 10.5692/clinicalneurol.cn-001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Three patients with multiple system atrophy (MSA) who have been hospitalized for aspiration pneumonia underwent aspiration prevention surgery. Laryngeal closure was performed in 2 cases, and laryngotracheal separation was performed in 1 case. Two patients were able to continue oral intake. No recurrence of aspiration pneumonia was observed in all cases after the operation for about two years, and the reduction in the number of aspirations at night improved the patient's QOL and reduced the burden on the caregiver. It was considered that the appropriate time for surgery was when communication in vocal language became difficult. It was a time when the loss of vocal function was well accepted in 3 cases. Aspiration prevention surgery may be a useful treatment option because it may contribute to prolonging the prognosis of life by reducing the complications of respiratory infections.
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Shiga Y, Nezu T, Shimomura R, Sato K, Himeno T, Terasawa Y, Aoki S, Hosomi N, Kohriyama T, Maruyama H. Various effects of nutritional status on clinical outcomes after intracerebral hemorrhage. Intern Emerg Med 2022; 17:1043-1052. [PMID: 34853991 DOI: 10.1007/s11739-021-02901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022]
Abstract
Although the assessment of nutrition is essential for stroke patients, detailed associations between nutritional status at admission, subsequent complications, and clinical outcomes in patients with acute intracerebral hemorrhage (ICH) are unclear. We aimed to elucidate these associations using the Controlling Nutritional Status (CONUT) score. Consecutive patients with acute ICH were investigated. Nutritional status was evaluated using the CONUT score, calculated from the serum albumin level, lymphocyte count, and total cholesterol level. Subsequent complications, such as hemorrhage expansion (HE) during the acute stage and aspiration pneumonia during hospitalization, were evaluated. Poor outcome was defined as a modified Rankin Scale score of ≥ 3 at 3 months. Of the 721 patients, 49 had HE, 111 had aspiration pneumonia, and 409 had poor outcomes. Patients with HE had significantly lower total cholesterol levels than those without HE. Patients with aspiration pneumonia had significantly lower albumin levels, lower lymphocyte counts, and higher CONUT scores than those without aspiration pneumonia. Patients with poor outcomes had significantly lower albumin levels, lower lymphocyte counts, lower total cholesterol levels, and higher CONUT scores than those with good outcomes. Multivariable logistic analysis showed that higher CONUT scores were independently associated with poor outcome (odds ratio, 1.28; 95% confidence interval, 1.09-1.49; P = 0.002) after adjusting for baseline characteristics, HE, and aspiration pneumonia. Each component of CONUT was a useful predictor of subsequent complications. Malnutrition, determined using the CONUT score, was independently associated with poor outcomes in patients with ICH after adjusting for these complications.
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Affiliation(s)
- Yuji Shiga
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Ryo Shimomura
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Kota Sato
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Takahiro Himeno
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Yuka Terasawa
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naohisa Hosomi
- Department of Neurology, Chikamori Hospital, Kochi, Japan
- Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Kohriyama
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Nicolardi ML, Oliva A, Masci GM, Ascoli V, Noccioli N, Mantovani S, Palange P. Lung on fire: a very severe case of fire-eater’s lung. Thorax 2022; 77:523-525. [PMID: 35165145 PMCID: PMC9016251 DOI: 10.1136/thoraxjnl-2021-218470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/20/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Maria Luisa Nicolardi
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Italy
| | - Giorgio Maria Masci
- Department of Radiological Oncological and Pathological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Valeria Ascoli
- Department of Radiological Oncological and Pathological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Niccolò Noccioli
- Department of Radiological Oncological and Pathological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Sara Mantovani
- Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Italy
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26
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Hwu YJ. [Regaining the Dignity of Eating]. Hu Li Za Zhi 2022; 69:4-5. [PMID: 35079991 DOI: 10.6224/jn.202202_69(1).01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Inserting a nasogastric tube is a common clinical management approach to treating patients with chewing and swallowing impairments and those with choking and aspiration issues. Although guidelines recommend that these tubes should not be indwelled for more than 4-6 weeks, they are in practice sometimes indwelled for periods exceeding 36 months (Wong et al., 2019). Long-term nasogastric tube indwelling may cause clients to gradually lose the ability to chew and swallow, resulting in a decrease in the stimulation received by the brain and an increase in the incidence of dementia (Liu et al., 2019). Japan's long-term care insurance payment regulations, amended in 2021, clearly point out that successfully improving enablement, oral training, nutrition, and cognition in clients results in relatively high payments for long-term care service units (Tamiya et al., 2020). This column advocates for using inter-disciplinary collaboration to "enhance physical fitness, improve nutrition status, take care of the mouth, and then smoothly remove the nasogastric tube" in line with the abovementioned philosophy. When people eat, they initially require the coordination of their lower limb and trunk (core) muscles to support their body weight and maintain posture stability, as the upper limb muscles are critical to sending the food into the mouth. Hence, strengthening physical fitness is of primary importance. Based on the results of the medical staff's assessment, even patients with indwelled nasogastric tubes should continue eating by mouth. Providing high-protein / high-calorie texture-modified foods that meet the chewing and swallowing functional needs of clients is essential to facilitating the repair of cellular tissues. In addition, it is necessary to manage the symptoms of chewing and swallowing impairments to prevent dehydration. Clients with chewing and swallowing impairments are prone to food debris / plaque accumulation in the mouth, resulting in significant levels of bacteria breeding. Moreover, during choking, bacteria is propelled by the cough mechanism into the trachea and may cause aspiration pneumonia. Aspiration pneumonia is often managed using a nasogastric tube. Gastric acid and bacteria may migrate upwards along indwelled nasogastric tubes into the pharynx, resulting in reinfection with aspiration pneumonia. Oral hygiene is thus critical to breaking this vicious cycle. The five topics of this column were derived using the above framework. Clients who are successfully liberated of their nasogastric tubes through inter-disciplinary collaboration regain the ability to eat independently and reduce medical care expenditures, while medical professionals experience the value of their own professional existence as part of an inter-disciplinary team (Bauer et al., 2019; Cochrane et al., 2016; Magne & Vilk, 2020).
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Affiliation(s)
- Yueh-Juen Hwu
- PhD, RN, Professor, Department of Nursing, Central Taiwan University of Science and Technology, Taiwan, ROC.
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Wang WH, Yu JL, Sung HC. [Three-Step Interdisciplinary Team Program for Nasogastric Tube Care]. Hu Li Za Zhi 2022; 69:33-40. [PMID: 35079996 DOI: 10.6224/jn.202202_69(1).06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patients with chewing disorders and dysphagia often take nutrition via nasogastric tube feeding. Patients with indwelling nasogastric tubes often experience discomfort, resulting in increased incidences of self-extubation and slippage. Frequent changes or misplacement of the nasogastric tube may also cause patient safety issues such as aspiration pneumonia, gastrointestinal trauma, and pneumothorax. Collaboration within the interdisciplinary team is needed to provide proper nasogastric tube care prior to placement, during the indwelling process, and during the removal of the nasogastric tube. Interdisciplinary teams should develop standardized procedures for nasogastric tube care, initiate swallow screening, oral care and training early, and develop a care plan for nasogastric tube removal. An evidence-based, practical example of nasogastric tube care implemented by an interdisciplinary team in a neurology unit is presented in this article. Interdisciplinary teams may assist patients to prepare to return to a normal tube-free life using individualized, safe, and dignified nasogastric tube care to improve quality of life.
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Affiliation(s)
- Wan-Hsiang Wang
- MSN, RN, Deputy Director, Department of Nursing, Hualien Tzu Chi Hospital; Adjunct lecturer, Department of Nursing, Tzu Chi University of Science and Technology; PhD Student, Department of Education and Potential Development, National Dong Hwa University, Taiwan, ROC
| | - Jia-Lun Yu
- BSN, RN, Head Nurse, Neurosurgery Ward, Hualien Tzu Chi Hospital, Taiwan, ROC
| | - Huei-Chuan Sung
- PhD, RN, Associate Professor, Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Taiwan, ROC.
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Wang CC, Hwu YJ, Huang CH. [Improve Physical Fitness and Reduce Nasogastric Tube Insertions: Working to Achieve a 'No Tube' Life]. Hu Li Za Zhi 2022; 69:6-11. [PMID: 35079992 DOI: 10.6224/jn.202202_69(1).00] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
It is common in clinical settings for patients to suffer from dysphagia-related malnutrition and coughing-related aspiration pneumonia because of reduced levels of food intake. Nasogastric tube feeding provides nutrition and water and prevents choking related to oral feeding. Although dysphagia is often treated using medical and surgical treatments, degenerative-disease-related dysphagia is currently widely treated using nutritional support and rehabilitation to enhance muscle strength and coordination and reduce the risk of nasogastric tube placement in the future. Generally, the focus of muscle strength training for dysphagia is on muscle training related to swallowing and breathing. However, the process of eating requires the coordinated operation of the muscles of the lower limbs and the trunk to support the body's physical weight and maintain stable posture. When consuming food, an individual must rely on the activities of the upper limb muscles. Therefore, training the relevant muscles may effectively reduce the eating difficulties caused by muscle strength loss. In this article, empirical literature evidence related to improving frailty is collected and principles and practical suggestions are provided for improving physical fitness programs, including breathing muscle strengthening training, sitting and balance training, upper limb muscle strength training, and lower limb muscle strength training. It is hoped that the findings will be used as a guide in clinical practice.
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Affiliation(s)
- Chun-Chieh Wang
- MD, Department of Internal Medicine, Puli Branch, Taichung Veterans General Hospital, and Lecturer, Department of Eldercare, Central Taiwan University of Science and Technology, Taiwan, ROC
| | - Yueh-Juen Hwu
- PhD, RN, Professor, Department of Nursing, Central Taiwan University of Science and Technology College of Nursing, Taiwan, ROC
| | - Chien-Hua Huang
- PhD, PT, Assistant Professor, Department of Eldercare, Central Taiwan University of Science and Technology, Taiwan, ROC.
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Miles A, Hunting A, Fletcher H, Allen JE. Current approaches to reporting pharyngo-laryngeal secretions. Curr Opin Otolaryngol Head Neck Surg 2021; 29:479-486. [PMID: 34320600 DOI: 10.1097/moo.0000000000000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Accumulated secretions in the pharynx and larynx are associated with dysphagia, aspiration and pneumonia, as well as increased social, health and economic burden. This article reviews developments in the instrumental reporting of pharyngo-laryngeal secretions over the last 2 years. RECENT FINDINGS Although the healthy pharynx and larynx is moist, accumulation of secretions is indicative of abnormality. Using standardized secretion scales allows early identification, quantification of risk in patients, and sensitive monitoring of patients over time. Nonstandardized and subjective secretion reporting is common in recently published research despite the validation of a number of publicly available tools. Research characterizing accumulated secretions has contributed to our understanding of pathophysiology associated with poor secretion management and may inform future treatment studies. SUMMARY Routine and standardized reporting of secretions is critical for patient assessment and should be reported in the most standardized way possible. Further research investigating the clinical relevance and treatment of accumulated secretions relies on quantitative pharyngolaryngeal secretions reporting.
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Affiliation(s)
- Anna Miles
- The University of Auckland, Auckland, New Zealand
| | - Alex Hunting
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | | - Jacqueline E Allen
- The University of Auckland, Auckland, New Zealand
- Auckland ENT Group, Auckland, New Zealand
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Sakai K, Gilmour S, Hoshino E, Nakayama E, Momosaki R, Sakata N, Yoneoka D. A Machine Learning-Based Screening Test for Sarcopenic Dysphagia Using Image Recognition. Nutrients 2021; 13:nu13114009. [PMID: 34836264 PMCID: PMC8622012 DOI: 10.3390/nu13114009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Sarcopenic dysphagia, a swallowing disorder caused by sarcopenia, is prevalent in older patients and can cause malnutrition and aspiration pneumonia. This study aimed to develop a simple screening test using image recognition with a low risk of droplet transmission for sarcopenic dysphagia. Methods: Older patients admitted to a post-acute care hospital were enrolled in this cross-sectional study. As a main variable for the development of a screening test, we photographed the anterior neck to analyze the image features of sarcopenic dysphagia. The studied image features included the pixel values and the number of feature points. We constructed screening models using the image features, age, sex, and body mass index. The prediction performance of each model was investigated. Results: A total of 308 patients participated, including 175 (56.82%) patients without dysphagia and 133 (43.18%) with sarcopenic dysphagia. The area under the receiver operating characteristic curve (ROC-AUC), sensitivity, specificity, positive predictive value, negative predictive value, and area under the precision-recall curve (PR-AUC) values of the best model were 0.877, 87.50%, 76.67%, 66.67%, 92.00%, and 0.838, respectively. The model with image features alone showed an ROC-AUC of 0.814 and PR-AUC of 0.726. Conclusions: The screening test for sarcopenic dysphagia using image recognition of neck appearance had high prediction performance.
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Affiliation(s)
- Kotomi Sakai
- Graduate School of Public Health, St. Luke’s International University, Tokyo 104-0044, Japan; (K.S.); (S.G.)
- Setagaya Memorial Hospital, Tokyo 158-0092, Japan;
- Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto 600-8815, Japan;
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke’s International University, Tokyo 104-0044, Japan; (K.S.); (S.G.)
| | - Eri Hoshino
- Comprehensive Unit for Health Economic Evidence Review and Decision Support (CHEERS), Research Organization of Science and Technology, Ritsumeikan University, Kyoto 600-8815, Japan;
| | - Enri Nakayama
- Department of Dysphagia Rehabilitation, Nihon University School of Dentistry, Tokyo 101-8310, Japan;
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu 514-8407, Japan;
| | - Nobuo Sakata
- Setagaya Memorial Hospital, Tokyo 158-0092, Japan;
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Daisuke Yoneoka
- Graduate School of Public Health, St. Luke’s International University, Tokyo 104-0044, Japan; (K.S.); (S.G.)
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo 106-8582, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- Tokyo Foundation for Policy Research, Tokyo 106-6234, Japan
- Correspondence: ; Tel.: +81-3-5550-4104
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Sumii Y, Baba T, Murakami T, Shibata T, Minamimura H. [Dysphagia and Aspiration Pneumonia Caused by Kommerell's Diverticulum and the Vascular Ring Associated with Right-sided Aortic Arch:Report of a Case]. Kyobu Geka 2021; 74:941-944. [PMID: 34601478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We report a case of an 80-year-old man complaining of dysphagia followed by aspiration pneumonia. Computed tomography of the chest revealed Kommerell's diverticulum associated with the right-sided aortic arch and the vascular ring which was formed by the aortic arch, the left subclavian artery, the ductus arteriosus, and the pulmonary artery around the esophagus and the trachea. Enlargement of the diverticulum was considered to be the cause of dysphagia. The surgery was performed at 20 ℃ under deep hypothermic circulatory arrest. We performed resection of the Kommerell's diverticulum, reconstruction of the left subclavian artery, and transection of the ductus arteriosus to relieve the compression by the esophagus and the trachea. The postoperative course was uneventful and dysphagia disappeared.
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Affiliation(s)
- Yosuke Sumii
- Department of Cardiovascular Surgery, Osaka City University, Osaka, Japan
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Yoshimatsu Y, Tobino K, Kawabata T, Noguchi N, Sato R, Motomura D, Sueyasu T, Yoshimine K, Nishizawa S, Natori Y. Hemorrhaging from an Intramedullary Cavernous Malformation Diagnosed Due to Recurrent Pneumonia and Diffuse Aspiration Bronchiolitis. Intern Med 2021; 60:1451-1456. [PMID: 33281156 PMCID: PMC8170235 DOI: 10.2169/internalmedicine.5752-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
While aspiration pneumonia constitutes the majority of pneumonia cases in the elderly, it remains highly underdiagnosed. We experienced a case of recurrent pneumonia and chronic cough that was later diagnosed as aspiration pneumonia and diffuse aspiration bronchiolitis (DAB) due to recurrent hemorrhaging from an intramedullary cavernous malformation. The patient was finally diagnosed when life-threatening respiratory depression caused emergency attention. This is the first report of hemorrhaging from an intramedullary cavernous malformation diagnosed due to aspiration pneumonia and DAB. These findings highlight the importance of considering aspiration in cases with recurrent pneumonia or chronic cough. The underlying cause may be a life-threatening condition.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Physiology, Hyogo College of Medicine, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | | | | | - Ryo Sato
- Department of Gastroenterology, Iizuka Hospital, Japan
| | | | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
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Vedamurthy A, Rajendran I, Manian F. Things We Do for No Reason™: Routine Coverage of Anaerobes in Aspiration Pneumonia. J Hosp Med 2020; 15:754-756. [PMID: 32966204 DOI: 10.12788/jhm.3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 03/25/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Amar Vedamurthy
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Iniya Rajendran
- Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Farrin Manian
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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34
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Kuramoto N, Ichimura K, Jayatilake D, Shimokakimoto T, Hidaka K, Suzuki K. Deep Learning-Based Swallowing Monitor for Realtime Detection of Swallow Duration. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:4365-4368. [PMID: 33018962 DOI: 10.1109/embc44109.2020.9176721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aspiration pneumonia is a life-threatening disease for the elderly. To prevent its risk, regular swallowing assessment is necessary; however, current screening tools for swallow assessment are not widely available and medical experts are insufficient. As a portable assessment tool, we have been developing a smartphone-based realtime monitoring device (GOKURI) which can evaluate swallowing ability based on swallow sounds. For better detection accuracy of the system, we integrated a deep learning model which was developed based on the swallowing anatomy. In this paper, we provide a detailed analysis to see how the swallow sounds detected by the deep learning-based monitor correspond to the actual swallow activities. Also, as an example of practical application of the system, we analyzed the changes of the swallow abilities over time by recording swallow sounds twice for the same participants at a nursing home. To minimize the risk of aspiration pneumonia, caregivers need to understand the disability levels of the patient's swallows so that safe feeding assistance can be provided. The result of this paper implies the possibility of using GOKURI as a daily swallowing monitor with minimum interventions.
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任 佳, 吕 丹, 刘 世. [Progress in evaluation of swallowing function after treatment of head and neck malignant tumors]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:861-864. [PMID: 33040517 PMCID: PMC10127740 DOI: 10.13201/j.issn.2096-7993.2020.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 04/30/2023]
Abstract
After treatment, patients with head and neckmalignant tumors may suffer from dysphagia, which may lead to aspiration pneumonia, cough and other complications, even threaten life, seriously affecting patients'quality of life. Through comprehensive evaluation of patients' swallowing function, clinicians can make corresponding rehabilitation plans to improve patients' quality of life.This paper summarizes a variety of subjective and objective evaluation methods for evaluating swallowing function of head and neck malignant tumors.
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Affiliation(s)
- 佳 任
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)
| | - 丹 吕
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)
| | - 世喜 刘
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)
- 刘世喜,
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36
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Russell CJ, White AA. Aspiring to Treat Wisely: Challenges in Diagnosing and Optimizing Antibiotic Therapy for Aspiration Pneumonia. J Hosp Med 2020; 15:445-446. [PMID: 32897854 DOI: 10.12788/jhm.3375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/26/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Christopher J Russell
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrew A White
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
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Jansen J, van der Maarel-Wierink CD, Dubois L. [Acute respiratory distress in a frail older patient: spontaneous tooth aspiration]. Ned Tijdschr Tandheelkd 2020; 127:282-285. [PMID: 32609098 DOI: 10.5177/ntvt.2020.05.19132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 68-year-old man presented at the emergency room with acute difficulty breathing. On account of recent subarachnoidal haemorrhage the patient was a resident of a care facility, and was also being treated for acute bronchitis there. Radiographic imaging of the lungs revealed a tooth with crown and pontic to have been inhaled. The tooth was surgically removed. After 3 weeks in the intensive care unit, the patient died of aspiration pneumonia. Spontaneous tooth aspiration is rare, yet it can have fatal consequences in vulnerable older patients. Aspiration of a foreign body may lead to injury and infection of the trachea and lungs. In order to determine the correct diagnosis in patients with acute respiratory distress, adequate and targeted diagnostics is essential; especially in older patients with multimorbidity and polypharmacy. Sarcopenia, dysphagia, a decrease in functional chewing units and decreased sensation of the palate increase the risk of choking in patients. In addition, dysphagia and poor oral health are known to be strongly associated with aspiration pneumonia. Healthcare providers should pay more attention to oral health in frail older patients.
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38
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Va A, Warrier R. Aspiration Pneumonitis. J Assoc Physicians India 2020; 68:50. [PMID: 32610867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Arun Va
- Asst. Professor, AFMC, Pune, Maharashtra
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39
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Ren JJ, Wang J, Zhao Y, He ZP. Could Aspiration Pepsin Be Used as a Marker of Gastric Reflux? Chest 2019; 153:1077. [PMID: 29626957 DOI: 10.1016/j.chest.2017.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jian-Jun Ren
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China; Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jing Wang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China.
| | - Zhao-Ping He
- Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
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Scannapieco FA, Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for the elderly. Periodontol 2000 2018; 72:153-75. [PMID: 27501498 DOI: 10.1111/prd.12129] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 12/12/2022]
Abstract
Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.
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Hashizume A, Banno H, Katsuno M, Hijikata Y, Yamada S, Inagaki T, Suzuki K, Sobue G. Quantitative Assessment of Swallowing Dysfunction in Patients with Spinal and Bulbar Muscular Atrophy. Intern Med 2017; 56:3159-3165. [PMID: 29021456 PMCID: PMC5742386 DOI: 10.2169/internalmedicine.8799-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to evaluate swallowing dysfunction in patients with spinal and bulbar muscular atrophy and to identify the most appropriate method of assessing swallowing dysfunction using a videofluoroscopic swallowing study. Methods In the videofluoroscopic swallowing study, patients were instructed to swallow 3 mL of 40% weight/volume barium sulfate twice, and the pharyngeal residue was measured. We used three different methods to quantify the pharyngeal barium residue and an eight-point scale to evaluate the laryngeal penetration leading to aspiration pneumoniae. Patients We assessed 111 patients with spinal and bulbar muscular atrophy who weren't undergoing disease-specific treatment. Results Our results showed that the pharyngeal barium residue after initial swallowing correlated better with the bulbar-related functional rating scales than that after multiple deglutition. This correlation was vague when the data from patients whose barium residue was >50% were eliminated. In addition, evaluating the pharyngeal residue after initial swallowing proved to be the most sensitive method with regard to laryngeal penetration. Conclusion This study showed that the pharyngeal barium residue after initial swallowing was the most appropriate parameter for quantitatively assessing the degree of dysphagia using a videofluoroscopic swallowing study and suggests that this method may predict laryngeal penetration and aspiration in patients with spinal and bulbar muscular atrophy.
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Affiliation(s)
- Atsushi Hashizume
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Haruhiko Banno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Yasuhiro Hijikata
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Shinichiro Yamada
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Tomonori Inagaki
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Keisuke Suzuki
- Department of Clinical Research, Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Japan
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Van de Putte P, Perlas A. What is the evidence that twenty-five millilitres of gastric fluid puts patients at risk of aspiration? Anaesth Intensive Care 2017; 45:127-128. [PMID: 28072948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Liu N, Zheng Z, Chen P, Hou P, Wang X, Li H, Chen R. [Detection of aspiration of nasopharyngeal secretion and the relationship between the aspiration of nasopharyngeal secretion and the incidence of pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi 2015; 38:511-515. [PMID: 26703017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To establish a method to detect aspiration of nasopharyngeal secretion and to explore the relationship between aspiration of nasopharyngeal secretion and pneumonia. METHOD Thirty-two patients with pulmonary infection [(30 males, 2 females; mean age (73 ± 8) years] were recruited from the First Affiliated Hospital of Guangzhou Medical University during the period between June 2014 and August 2014, and 9 age-matched healthy volunteers [(7 males, 2 females; mean age (73 ± 6) years] as the control group. A dose of 74.0 MBq ⁹⁹Tc(m)-sulfur colloid was diluted in 12 ml of saline, and then the mixture was dripped into the nasal pharynx of volunteers by 24 ml/h. Dynamic imaging from the mouth to the stomach was acquired by SPECT/CT. Two experienced physicians assessed all examination results and reached consensus for final diagnosis. Radioactivity detected at either the bronchi or within the lung fields was reported as positive for aspiration. RESULTS In the test group, 19 of 32 patients with pneumonia had a history of suffering from upper respiratory tract symptoms such as runny or blocked nose, and 21 of 32 patients were detected to have aspiration. However, none of the healthy people had aspiration (χ² = 9.624, P=0.002). In 21 patients with pneumonia, 14 showed respiratory aspirations in areas corresponding to the lesions, i.e. bilateral lungs, the right lung and the left lung in 6/10, 6/8, and 2/3 cases respectively (P=0.067). CONCLUSION ⁹⁹Tc(m)-sulfur colloid imaging is effective to detect the aspiration of nasopharyngeal secretions in the elderly people. Besides, the incidence rate of aspiration in the patients was higher than that in healthy people, which suggests that aspiration of nasopharyngeal secretion is the cause of pulmonary infection.
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Affiliation(s)
- Ni Liu
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
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Wang K, Li M, Wang X, Qin J, Wang Z, Zhao Z, Qin L, Hua Y. [Imaging origins and characteristics analysis of acute and chronic aspiration pneumonia]. Zhonghua Yi Xue Za Zhi 2014; 94:3244-3247. [PMID: 25604226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To discuss about the pathologic and imaging origins and characteristics of CT scaning and X-ray radiography for acute and chronic aspiration pneumonia. METHODS Imaging data from 30 patients with aspiration pneumonia were retrospectively analyzed, CT scaning was performed in 27 patients, which PMVR reconstruction was performed in 21 cases;3 exammed by X-ray with 2 used by esophagography. RESULTS Opaque bodies were detected in trachea by CT scaning in 12 patients.7 patients in acute phase rapidly developed into acute respiratory distress syndrome(ARDS). CT signs of 30 patients with acute and chronic aspiration pneumonia included: centrilobular nodules were detected in 2 cases with acute phase, 4 cases with subacute phase and 4 cases with chronic phase; the imaging of ground glass opacity were detected in 9 cases with acute phase, 2 cases with subacute phase and 3 cases with chronic phase; the imaging of bronchiectasis was detected in 8 cases with chronic phase, which mucilage embolism was detected in 3 of 8 cases; the imaging of atelectasis was detected in 6 cases with chronic phase; the imaging of sheeted consolidation was detected in 5 cases with chronic phase, 8 case with acute phase; the imaging of interstitial fibrosis was detected in 3 cases with chronic phase. Lesions of inferior lobe of right lung were detected in 9 cases with chronic phase, 4 cases with subacute phase, 11 case with acute phase;lesions of inferior lobe of left lung were detected in 6 cases with chronic phase and 3 cases with subacute group, 11 case with acute phase. CONCLUSION The imaging features of acute and chronic aspiration pneumonia overlap with GGO and centrilobular nodules in every group. While the imaging features of atelectasis, bronchiectasis or mucilage embolism are found in chronic phase. The chest CT scaning may accurately evaluate the dynamic change of aspiration pneumonia.
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Affiliation(s)
- Kang Wang
- Department of Radiology, Putuo Hospital, Affiliated to Shanghai China Traditional Medicine University, Shanghai 200061, China.
| | - Ming Li
- Department of Radiology, Putuo Hospital, Affiliated to Shanghai China Traditional Medicine University, Shanghai 200061, China
| | - Xiongbiao Wang
- Department of Radiology, Putuo Hospital, Affiliated to Shanghai China Traditional Medicine University, Shanghai 200061, China
| | - Jianmin Qin
- Department of Radiology, Putuo Hospital, Affiliated to Shanghai China Traditional Medicine University, Shanghai 200061, China
| | - Zhi Wang
- Department of Radiology, Putuo Hospital, Affiliated to Shanghai China Traditional Medicine University, Shanghai 200061, China
| | - Zehua Zhao
- Department of Radiology, Putuo Hospital, Affiliated to Shanghai China Traditional Medicine University, Shanghai 200061, China
| | - Le Qin
- Department of Radiology, Putuo Hospital, Affiliated to Shanghai China Traditional Medicine University, Shanghai 200061, China
| | - Yanqing Hua
- Department of Radiology, Putuo Hospital, Affiliated to Shanghai China Traditional Medicine University, Shanghai 200061, China
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Kadota JI. [Programs for continuing medical education: B session; 8. Progress in clinical management for pneumonia--present situation and future perspectives in Japanese elderly society]. Nihon Naika Gakkai Zasshi 2014; 103:724-728. [PMID: 24796143 DOI: 10.2169/naika.103.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Qu HZ, Zhang SY. [Biomarkers of aspiration syndromes]. Zhonghua Jie He He Hu Xi Za Zhi 2012; 35:355-357. [PMID: 22883995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Lee R. Ask the doctor. After being diagnosed with high blood pressure several years ago, I started taking diltiazem and Atacand. The results were good, giving me an average blood pressure of 110/65. I recently developed gastroenteritis and aspiration pneumonia. While I was in the hospital, my blood pressure got so low I was told to stop taking these medications. I have been off them since, and my blood pressure has remained normal, averaging 105/65. How can this be? Will high blood pressure return? Harv Heart Lett 2009; 19:7. [PMID: 19681209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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