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- Dysphagia is highly prevalent in patients with chronic neurological disorders and can increase the risk for comorbidities such as aspiration pneumonia and malnutrition. Treatment includes timely access to interdisciplinary health care teams with specialized skills in dysphagia management. A retrospective chart review (n=99 of 125 charts screened) was conducted to evaluate the effectiveness of referral criteria to identify and triage patients with suspected dysphagia to an ambulatory dysphagia clinic. Variables collected included demographic information (age), anthropometric information (body mass index [BMI], each patient’s sex), reason for referral, primary medical diagnosis, symptomatology (e.g., pneumonia, chest congestion), nutrition and swallowing interventions, clinic wait times, missed/cancelled appointments, and referring health care professional. The mean age and mean BMI ± standard deviation of patients reviewed were 68.7 years ± 18.4 years and 25.2 kg/m2 ± 6.7 kg/m2, respectively. Average clinic wait times were 158 days (13 to 368 days) for routine and 52 days (0 to 344 days) for urgent assessments (p<0.001). The most common reason(s) for referral was/were related to dysphagia (n=83), surgery (n=50), and/or gastrointestinal symptomatology (n=28); 80% to 90% of patients received varying diagnostic and treatment services for dysphagia. Development of effective referral criteria is critical to ensure that clients with dysphagia receive timely diagnostic, treatment, and nutrition interventions by interdisciplinary health care teams specializing in dysphagia.
- To assess relationships among food intake, anthropometrics, and wound severity, we studied 31 home care clients with pressure ulcers (PUs) or venous stasis ulcers (VSUs). Anthropometric variables (weight, height, waist circumference [WC]) were measured according to standard methodologies. Risk for PU development was assessed using the Braden Pressure Ulcer Risk Assessment score and wound severity according to the National Pressure Ulcer Advisory Panel. Three-day food records were analyzed to assess dietary adequacy. Adults with VSUs (65.8 ± 18.4 years) had a higher body mass index (48.1 vs. 25.9), WC (146.6 vs. 98.4 cm), and Braden score (20.2 vs. 17.5) than did those with PUs (67.8 ± 17.9 years) (p <0.05). Energy, protein, and zinc intake by diet alone did not meet estimated requirements in 41%, 32%, and 54.5% of clients, respectively. Intake by diet alone met the Estimated Average Requirement/ Adequate Intake for all nutrients except fibre, vitamin D, vitamin E, vitamin K, folate, calcium, magnesium, and potassium. Nutrient supplementation resolved this for all nutrients except fibre, vitamin K, and potassium. In multivariate analysis, increasing wound severity was associated with decreased intakes of vitamin A, vitamin K, magnesium, and protein (r2=0.90, p<0.001). Optimizing nutrient intake may be an important strategy to promote wound healing and decrease wound severity in home care clients with chronic wounds.