ABSTRACT
Objective : The 2014 Medical Treatment Reward Revision in Japan newly defines the oral intake recovery rate and requires a change of more than 35% to calculate various additions and subtractions. We calculated the recovery rate in various diseases and clarified some inherent problems. Methods : From April 2012 to March 2014, we retrospectively investigated the age, sex, removal rate from nasal nutrition or gastric fistula, oral intake recovery rate and days until removal of 286 inpatients with nasal nutrition or gastric fistula for dysphagia. Results : The removal rates for stroke, brain injury, oral and laryngopharyngeal cancer and other diseases were nearly always more than 50% because the disease did not cause dysphagia directly or the rehabilitation was effective for treating the remaining dysphagia. But the removal rates for neurodegenerative disease, complications due to stroke and brain injury in the chronic phase and respiratory disease did not reach 35% because the previous dysphagia progressed or actualized. Almost all oral intake recovery rates did not extend to 35% for exclusion of oral intake recovery within one month. Conclusion : The criteria of oral intake recovery rate needs to be reviewed in respect to setting goals to match the patient's underlying disease and to evaluate the possibility for early rehabilitation.
ABSTRACT
Objective : To examine the relation between psychoactive drugs and the outcome of dysphagia in patients with psychiatric disorders. Methods : We examined 53 inpatients who were prescribed speech therapy in the psychiatry ward of our hospital from January 2011 to April 2012. We categorized the patients into a poor outcome group and a good outcome group by the necessity for alternative nutrition at discharge and analyzed the number and kind of typical antipsychotic, atypical antipsychotic, hypnotic, antidepressant and mood stabilizer, total amount of typical antipsychotic, atypical antipsychotic used at admission and at discharge, sex, psychiatric disorder, central nervous system disease, aspiration pneumonia, duration of hospitalization, psychiatric disorder disease period, speech therapy intervention period and GAF scale at admission. Results : The outcome of dysphagia had a significant relation with the number and kind of antipsychotic used, especially typical antipsychotic used at admission. The good outcome group had a higher total amount of antipsychotic use, especially atypical antipsychotics. Conclusion : Long-term practical oral intake should not comprise antipsychotic polypharmacy, especially typical antipsychotics before onset of dysphagia, but should instead consist of a monopharmacy approach with atypical antipsychotics.
ABSTRACT
The purpose of this study was to investigate the occurrence of gastrointestinal complications and intestinal stasis after a videofluoroscopic examination of swallowing. Of 121 inpatients who underwent videofluoroscopic examinations from October 2008 to March 2009 and September to October 2009, we analyzed 33 patients who underwent abdominal X-ray four days after their videofluoroscopic examination. Six of 33 patients (18.2%) suffered gastrointestinal symptoms. Three patients had diarrhea, two had vomiting, and one had abdominal distention. The incidence of gastrointestinal complications after videofluoroscopic examination was estimated to be two of 33 patients (6.1%) because we assumed that two of the six patients' condition was related to their videofluoroscopic examination and that the other four were related to other factors. One of two patients with a poor general condition developed pneumonia after vomiting. There was no relationship between the incidence of gastrointestinal complications and the patient's background. Intestinal stasis as detected by X-ray was identified in 25 of 33 patients (75.8%). There was more barium sulfate intake in the patients who had intestinal stasis than the patients who had no intestinal stasis. There was no relationship between intestinal stasis and the incidence of gastrointestinal complications. Our findings suggest that the risk of gastrointestinal complications after videofluoroscopic examination is low except in patients with a poor general condition.