Development of clinical items to identify dysphagia in patients with dementia-An e-Delphi study.

AIM: To identify clinical observable items that can be used to identify dysphagia while observing a typical eating situation. DESIGN: A three-round e-Delphi survey. METHODS: An expert panel consisting of five nurses, eight speech language therapists and five physicians participated in this three-round e-Delphi survey from November 2022 to January 2023. Round 1 presented the results of a literature research conducted in September 2022 and an open question to the participants. The answers were analysed using the content analysis method. In the following rounds, the results were presented back to the participants with a request to rate them for usefulness. Means, standard deviations, ANOVA and Fisher's exact test were used to demonstrate the panel's opinion, level of agreement, demographic characteristics of the participants as well as differences between the professional groups in regard of the rating of the items. Methods and results are reported in accordance with the 'Guidance on Conducting and Reporting Delphi Studies' (CREDES). RESULTS: The content analysis initially generated 36 items suggested by the expert panel. Seven additional items were incorporated from the literature review. In rounds 2 and 3, a 4-point Likert scale was used to rate each item and to calculate the level of agreement. The predetermined level of agreement exceeded 70% for 23 items. CONCLUSION: Based on the expert opinions, it is possible for nurses to identify dysphagia in patients with dementia by using the determined 23 items while observing a typical eating situation. PATIENT OR PUBLIC CONTRIBUTIONS: The expert panel contributed to the creation of this study by participating in the Delphi rounds. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The 23 items determined in this e-Delphi study enable nurses to make dietary adjustments or consult other members of the multidisciplinary team based on available evidence, enabling complications to be avoided. IMPACT: What problem did the study address? This study provides evidence regarding the identification of dysphagia in patients with dementia by nurses. What were the main findings? Twenty-three items were determined by an expert panel that can be used by nurses to identify dysphagia in patients with dementia while observing a typical eating situation. Where and on whom will the research have an impact? This research will have an impact on patients with dementia and the nurses caring for them. REPORTING METHOD: Methods and results are reported in accordance with the 'Guidance on Conducting and Reporting Delphi Studies' (CREDES) (Jünger et al., 2017), which promotes consistency and quality in conducting Delphi studies.

Adaptation of Clinical Practice Guideline Recommendations in Hospitals for People Living With Dementia and Their Caregivers.

BACKGROUND: Dementia is common in older people in general hospitals. To improve the quality of their care, the use of nonpharmacological interventions based on the best evidence from clinical guidelines is recommended. Many international clinical guidelines exist, but their recommendations are often not used because they do not fit the local setting or the country. AIM: The aim of this study was to adapt the international clinical guidelines and their recommendations to the Austrian context regarding nonpharmacological interventions for people with dementia living in the general hospital setting. METHODS: The ADAPTE process was chosen as a method for the adaptation. A search for international clinical guidelines was conducted in seven databases within this process. The guidelines which met the inclusion and quality criteria were assessed with the AGREE II instrument by two independent reviewers. The recommendations of the guidelines were extracted. Those that did not fit the Austrian context were excluded, and recommendations with similar statements were summarized. The selected and modified recommendations were translated into German. RESULTS: Out of 206 guidelines, three met the inclusion criteria and two, the quality criteria. One hundred and fifty-two recommendations were extracted from these two guidelines, 42 of which were suitable for the Austrian setting and 20 of which had similar statements and could be summarized. Finally, 32 recommendations were identified that were applicable to the general hospital setting in Austria. LINKING EVIDENCE TO ACTION: The adaptation of clinical guidelines with the ADAPTE process generated seven topics with 32 recommendations. Many international guidelines exist, but they cannot be applied verbatim in every country due to the fact that some recommendations are not applicable with respect to the national and local context. Creating an adaption of international guidelines is an effective way to provide and link evidence from research to national nursing practice.

Modulation of the glyoxalase system in the aging model Podospora anserina: effects on growth and lifespan.

The eukaryotic glyoxalase system consists of two enzymatic components, glyoxalase I (lactoylglutathione lyase) and glyoxalase II (hydroxyacylglutathione hydrolase). These enzymes are dedicated to the removal of toxic α-oxoaldehydes like methylglyoxal (MG). MG is formed as a by-product of glycolysis and MG toxicity results from its damaging capability leading to modifications of proteins, lipids and nucleic acids. An efficient removal of MG appears to be essential to ensure cellular functionality and viability. Here we study the effects of the genetic modulation of genes encoding the components of the glyoxalase system in the filamentous ascomycete and aging modelPodospora anserina. Overexpression of PaGlo1 leads to a lifespan reduction on glucose rich medium, probably due to depletion of reduced glutathione. Deletion of PaGlo1 leads to hypersensitivity against MG added to the growth medium. A beneficial effect on lifespan is observed when both PaGlo1 and PaGlo2 are overexpressed and the corresponding strains are grown on media containing increased glucose concentrations. Notably, the double mutant has a 'healthy' phenotype without physiological impairments. Moreover, PaGlo1/PaGlo2_OEx strains are not long-lived on media containing standard glucose concentrations suggesting a tight correlation between the efficiency and capacity to remove MG within the cell, the level of available glucose and lifespan. Overall, our results identify the up-regulation of both components of the glyoxalase system as an effective intervention to increase lifespan in P. anserina.