1,720,976 research outputs found
Correlations between bedside and instrumental endoscopic parameters in determining severity of dysphagia: An integrated clinical evaluation of safety and efficiency
Full text linkInteraction between bedside and endoscopic parameters is of great interest in the management of patients with swallowing disorders. Our aim is to document if and how bedside parameters correlate with severity using endoscopic assessment. 556 consecutive patients (318 M/238 F, mean age 65.56 ± 10.36 years, range 18-91), were evaluated in our Swallowing Centre during 2008. All underwent bedside evaluation and fiberoptic endoscopic evaluation of swallowing (FEES), considering the pooling score (p-score) and the pooling sensation, collaboration and age score (p-SCA score) to express criteria of clinical severity of dysphagia. The correlation between the two tests (Spearman correlation coefficient) and their agreement to classify severity (Cohen’s kappa) was defined. After dichotomisation (cut-off: no risk/any kind of risk of aspiration), values of sensitivity and specificity were obtained after comparison with FEES results (gold standard). A close and significant correlation between the p-score and p-SCA score was found (rho = 0.88; p < 0.001). The agreement among scores in attributing the categories of risk is moderate (Cohen’s Kappa = 0.46; p < 0.001).The p-score had a sensitivity of 96% and specificity of 60%, while the p-SCA score has a sensitivity of 98% and specificity of 40%. Our results suggest that including even a few parameter from bedside evaluation to an endoscopic score, the level of severity expressed by the latter, decreases. The evaluation of patients with swallowing disorders should consider as many elements as possible, deriving from non-instrumental and instrumental evaluation (integrated clinical evaluation)
The endoscopic evaluation of the oesophageal phase of swallowing (E-FEES): perspective in a audiological-phoniatric setting
No full textDuring a fiberoptic endoscopic evaluation of swallowing (FEES) the study of the oesophagus, complete with tests with bolus (oesophageal FEES, E-FEES) is a procedure rarely used in a phoniatric setting, with patients complaining of swallowing and voice alterations. This extension of FEES toward the oesophagus by a transnasal approach is a procedure used for decades in the instrumental evaluation of patients with ENT complaints. E-FEES is used on out-patients without premedication or local anaesthesia. The patient is sitting upright and a 70 cm flexible endoscope, 3.5 cm diameter, is used. During the procedure the patients undergo tests with bolus. 20 patients (13M/7F, range 19–78 years, mean age 50, 51 years), taken from 437 consecutive outpatients seen in our Department from August to December 2011, underwent E-FEES (retrospective analysis). Patients were selected based on a reflux finding index (RFI) > 13, Reflux finding score (RFS) > 7 and FEES alterations (penetration/aspiration, spillage, residues). E-FEES findings were: 10 esophagitis, 1 gastroesophageal junction incontinence, 2 hiatal hernia, 4 motility alterations, 2 diverticula, 1 carcinoma. oesophageal alterations are not rare in patients with deglutition and voice disorders. E-FEES is a safe, reliable and cost-effective technique, worthy of being implemented in a phoniatric setting. The main steps and characteristic of the procedure are proposed
The endoscopic evaluation of the oral phase of swallowing (Oral-FEES, O-FEES): a pilot study of the clinical use of a new procedure.
No full textOral FEES (O-FEES) is an endoscopic procedure conceived to directly visualise the oral phase of swallowing. In the perspective of clinical use, the feasibility, safety and acceptability of O-FEES has been evaluated. Subsequently, the procedure was compared with the radiological gold standard. The acceptability of O-FEES was compared to that of FEES using a 10 point questionnaire submitted to a sample of 52 outpatients complaining of swallowing disorders. Repeated measure analysis of variance (rm-ANOVA) models were used to test the mean difference of acceptability in the same subjects after FEES and O-FEES. Subsequently, another sample of 8 male outpatients underwent a simultaneous O-FEES and videofluoroscopic study (VFSS). The inter-rater reliability using 10 radiological landmarks, compared to O-FEES, was blindly determined between two raters. Inter-rater agreement between the two judges for O-FEES and VFSS scores was assessed with the single score intra-class correlation coefficient (ICC). Differences between FEES and O-FEES answers for each question and among all the items considered overall were statistically significant (rm-ANOVA; F-statistic p < 0.001). The inter-rater agreement concerning endoscopic and radiological evaluations between the two raters showed strong values of intra-class correlation coefficient (ICC) (95% confidence interval): 0.875 (0.373-0.979) and 0.921 (0.542-0.986), respectively. The Bland-Altman test showed a bias of -0.24 (95% limits of agreement; -1.77 to +1.19), which suggests that both methods produced almost identical results. In clinical practice and compared with FEES, O-FEES is a well tolerated and safe procedure. Compared with the radiological gold standard, O-FEES offers reliable information about oral preparation and oral propulsion of the bolu
Time as a factor during endoscopic assessment of swallowing: relevance in defining the score and severity of swallowing disorders
No full textResidue and clearing time: preliminary considerations in defining dysphagia severity in daily practice
No full textIntroduction and aim: In the consideration of swallowing, ‘time’ is a parameter of great interest. The pooling score (p-score), which considers the number of dry swallows needed to clear residue in the pharynx/larynx, can be made more complete by quantifying this parameter, attempting to give a more appropriate and functional criterion of the severity of an impaired swallow. The p-score, enhanced by the inclusion of the time needed to clear residue (timed p-score, tp-score) is put forward for use in clinical practice.
Matherial and methods: Two experienced raters blindly evaluated 35 short video clips of 5 cc pureed, 5 cc liquid and 1/4 cracker bolus transits, recorded during the endoscopic evaluations of 16 patients with dysphagia of different aetiologies. For each patient, the time needed to complete the clearing of the boluses (maximum 5 swallows, total time – TT), was determined together with the FOIS and DOSS scales.
Results: The average time necessary to clear residue for pureed, solid and liquid boluses was 22.5 s, 30.7 s and 16.6 s respectively. The inter-rater agreement between the 2 raters in applying the p-score was good (ICC > 0.800) for every consistency. A linear regression model documented a statistically significant correlation of the p-score total, the TT and the consistencies with the FOIS and the DOSS, respectively.
Discussion and conclusion: The p-score total and the TT are correlated with the severity of dysphagia and the functional activities of the patients, so the pt-score can be useful in clinical practice to define the severity of dysphagia
Aspiration: Diagnostic contributions from bedside swallowing evaluation and endoscopy
No full textThe aim of this study was to identify which characteristics, collected by bedside swallowing evaluation (BSE) and fiberoptic endoscopic evaluation of swallowing (FEES), are a risk or a protective factor for aspiration. This retrospective study included data on 1577 consecutive patients, collected by BSE and FEES. Bivariate analysis was performed to verify the association of each variable with aspiration (Chi-Square test). The variables associated with aspiration were entered into a multivariate logistic model to quantify this association. Several variables were significantly associated (p < 0.05) with aspiration; cooperation, sensation, laryngeal elevation and direct therapy were found to be protective factors against aspiration. The regression model identified the most variables related with aspiration, among which tracheotomy, material pooling and spillage. Patients able to perform dry swallows were 77% less likely to aspirate (protective factor). Several variables are involved in protection of airways during swallowing. Their interaction, in patients with swallowing disorders, offers the clinician the best means of interpreting BSE and FEES
Asymmetry of dendrites and alKaline phosphatase activity in preosteocytes and osteocytes of rabbit osteonic bone.
No full textAlkaline phosphatase activity in preosteocytes seem to progress in parallel with the asymmetry of their dendrogenesis, and in young osteocytes it appears polarized towards the osteoblastic lamina
Per un centro su L'Architettura dell'inganno
No full textAnalisi storico-critica degli studi svolti sul quadraturismo
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