Effect of auditory deprivation on adaptive locomotion: Interaction with lower visual field occlusion.

Auditory stimuli have been suggested to play a role in adequately controlling movement; however, their influence is not fully understood, particularly regarding dynamic behaviors, such as adaptive locomotion. This study aimed to investigate whether auditory deprivation affects adaptive locomotion. In particular, we aimed to elucidate the role of the auditory sense in obstacle avoidance by manipulating the visual field, which provides crucial sensory information for movement control. Sixteen participants approached a 15-cm obstacle located 6 m away and stepped over it under four different conditions that combined two factors: the hearing condition controlled by wearing earmuffs with and without holes, and the lower visual field condition controlled by carrying opaque white and transparent boards. Spatiotemporal variables during the approach to the obstacle were measured using an electronic walkway, whereas foot clearance over the obstacle was assessed using a motion-capture system. Participants who experienced auditory deprivation and lower visual field occlusion demonstrated greater variability in step length when approaching the obstacle compared with the other conditions. The leading and trailing foot clearances were higher under lower visual field occlusion conditions. Furthermore, when participants were under conditions of auditory deprivation, greater variability was observed in the clearance of the leading foot. These results suggest that auditory information contributes to movement stabilization during adaptive locomotion. Our findings provide evidence that auditory and visual senses complement each other during motor actions, indicating that adaptive locomotion can be influenced by the integration of multiple sensory inputs.

Identification of Antioxidative Hydrolyzable Tannins in Water Chestnut.

Despite the various biological activities exhibited by water chestnut (the fruit of the Trapa genus), the phenolic compounds present in its extract require comprehensive characterization. Accordingly, we analyzed a 80% methanol extract of commercially available water chestnut and identified a new hydrolyzable tannin dimer termed trapadin A. Additionally, 22 known compounds, including 10 hydrolyzable tannin monomers and 2 dimers, were also detected in the extract. Spectroscopic and chemical methods were used to elucidate the structure of trapadin A, revealing it to be a hydrolyzable tannin dimer formed from units of tellimagrandin II and 1,2,3,6-tetra-O-galloyl-ß-d-glucose. Moreover, the 1,1-diphenyl-2-picrylhydrazyl radical scavenging activity assay used to determine the half-maximal effective concentration values for the 23 compounds isolated from water chestnut indicated significant radical scavenging activity associated with hydrolyzable tannins. Notably, trapadin A, the new hydrolyzable tannin dimer, exhibited the highest activity value among the tested compounds.

Shape of an obstacle affects the mediolateral trajectory of the lower limb during the crossing process.

In previous studies involving obstacle crossing, vertical foot clearance has been used as an indicator of the risk of contact. Under normal circumstances, individuals do not always cross over obstacles with the same height on both sides, and depending on the shape of the obstacle, the risk of contact may differ depending on the foot elevation position. Therefore, we investigated whether task-related control of the mediolateral foot position is adapted to the shape of the obstacle. Sixteen healthy young adults performed a task in which they crossed over two obstacles with different shapes while walking: a trapezoidal obstacle and a rectangular obstacle, as viewed from the frontal plane. It was shown that when crossing over a trapezoidal obstacle, the participants maintained foot clearance by controlling the mediolateral direction, which chose the height that needed to be cleared. The results of this study suggest that the lower limb movements that occur during obstacle crossing are controlled not only in the vertical direction but also in the mediolateral direction by adjusting the foot trajectory to reduce the risk of contact. It was demonstrated that control was not only based on the height of the obstacle directly under the foot but also in the foot mediolateral direction, considering the shape of the entire obstacle, including the opposite limb.

Estrous Cycle Mediates Midbrain Neuron Excitability Altering Social Behavior upon Stress.

The estrous cycle is a potent modulator of neuron physiology. In rodents, in vivo ventral tegmental area (VTA) dopamine (DA) activity has been shown to fluctuate across the estrous cycle. Although the behavioral effect of fluctuating sex steroids on the reward circuit is well studied in response to drugs of abuse, few studies have focused on the molecular adaptations in the context of stress and motivated social behaviors. We hypothesized that estradiol fluctuations across the estrous cycle acts on the dopaminergic activity of the VTA to alter excitability and stress response. We used whole-cell slice electrophysiology of VTA DA neurons in naturally cycling, adult female C57BL/6J mice to characterize the effects of the estrous cycle and the role of 17ß-estradiol on neuronal activity. We show that the estrous phase alters the effect of 17ß-estradiol on excitability in the VTA. Behaviorally, the estrous phase during a series of acute variable social stressors modulates subsequent reward-related behaviors. Pharmacological inhibition of estrogen receptors in the VTA before stress during diestrus mimics the stress susceptibility found during estrus, whereas increased potassium channel activity in the VTA before stress reverses stress susceptibility found during estrus as assessed by social interaction behavior. This study identifies one possible potassium channel mechanism underlying the increased DA activity during estrus and reveals estrogen-dependent changes in neuronal function. Our findings demonstrate that the estrous cycle and estrogen signaling changes the physiology of DA neurons resulting in behavioral differences when the reward circuit is challenged with stress.SIGNIFICANCE STATEMENT The activity of the ventral tegmental area encodes signals of stress and reward. Dopaminergic activity has been found to be regulated by both local synaptic inputs as well as inputs from other brain regions. Here, we provide evidence that cycling sex steroids also play a role in modulating stress sensitivity of dopaminergic reward behavior. Specifically, we reveal a correlation of ionic activity with estrous phase, which influences the behavioral response to stress. These findings shed new light on how estrous cycle may influence dopaminergic activity primarily during times of stress perturbation.

Japanese clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care.

AIM: This clinical practice guideline aims to provide and recommend methods of assessing aspiration and pharyngeal residue during eating and swallowing and methods of selecting and implementing nursing care for adults to prevent the development of aspiration pneumonia through early and appropriate management of oropharyngeal dysphagia. METHODS: In April 2018, the Japan Academy of Nursing Science established the Supervisory Committee in Nursing Care Development/Standardization Committee to develop clinical practice guidelines for aspiration and pharyngeal residual assessment during eating and swallowing for nursing care. This clinical practice guideline was developed according to the Minds Manual for Guideline Development 2017, with the aim of providing a specific pathway for nurses to determine the policy for selecting management for oropharyngeal dysphagia based on research evidence and multifaceted factors including the balance of benefits and harms and patients' values. RESULTS: Based on the 10 clinical questions related to assessment by physical assessment, the Repetitive Saliva Swallowing Test, Modified Water Swallowing Test, Food Test, cervical auscultation, observation using an ultrasound diagnostic device, and an endoscope, 10 recommendations have been developed. Eight recommendations have been evaluated as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) 2C, and the other two have been evaluated as no GRADE. CONCLUSION: The first reliable clinical practice guideline has been produced from an academic nursing organization that focuses on assessment for nursing care and incorporates the latest findings.

Electrophysiologically distinct bed nucleus of the stria terminalis projections to the ventral tegmental area in mice.

The bed nucleus of the stria terminalis (BNST) is a highly heterogeneous limbic forebrain structure that serves as a relay connecting autonomic, neuroendocrine and behavioral function. It can be divided into over 16 individual subregions with distinct neuronal subpopulations based on receptors, transmitters, and neuropeptides. Specifically, the BNST projection to the ventral tegmental area (VTA), the dopamine hub of the brain, has been shown to have a crucial role in the stress response. However, in mice there is a lack of unbiased data on the functional diversity of this sub-population which serves as an upstream input to the VTA. The dopaminergic neurons in the VTA modify their ion channel activity and intrinsic membrane properties to adapt to stress in part from inputs from BNST projections. Therefore, we aimed to perform a multi-component characterization of the functional diversity of the BNST-VTA pathway. We studied the passive and active electrophysiological properties of virally identified population of BNST neurons that project to the VTA. We used a comprehensive series of in vitro recordings of electrophysiological variables and performed hierarchical clustering to determine the functional diversity of the projection neurons in the BNST-VTA pathway. Our study revealed four subpopulations in the BNST-VTA pathway, all of which differ in their activation profiles and likely have distinct inputs and function in the VTA. Our results will help resolve the discord in interpretation of the various roles of this electrophysiologically diverse projection and builds a foundation for understanding how the different neuronal types integrate signals.

Evaluation of a Point-of-Care Ultrasound Educational Program for Nurse Educators.

BACKGROUND: The effectiveness of point-of-care ultrasound (POCUS) for nurses has been demonstrated; however, only a limited number of nurses have been trained to perform POCUS. This article reports on a POCUS train-the-trainer program for nurse educators that targets lower urinary track dysfunction. METHOD: Nurse educators (n = 38) were invited to participate in a POCUS train-the-trainer program, which comprised an e-learning module and a hands-on seminar. Acquisition of knowledge and skills were assessed after the module and seminar, respectively. RESULTS: Questions from the "Basic Knowledge of Ultrasonography" test were answered correctly at a rate of 93.0% (SD, 8.5%). Measured values of bladder urinary volume using ultrasonography were in close agreement with actual values. All of the participants indicated that the program covered the content necessary to use in practice. CONCLUSION: The POCUS train-the-trainer program equips nurse educators with the knowledge and skills needed for training nurses at their institutions. [J Contin Educ Nurs. 2021;52(8):375-381.].

Foot clearance when crossing obstacles of different heights with the lead and trail limbs.

BACKGROUND: In order to predict and prevent falls and fall-related injuries, it is crucial to understand the motor control for crossing obstacles. In real life, since obstacles do not always take regular shapes like rectangles, the lead and trail limbs sometimes need to negotiate different obstacle heights. The interlimb interaction in this process has remained unknown, since obstacle crossing studies commonly use a single-obstacle paradigm in which the obstacle height is the same for the lead and trail limbs. RESEARCH QUESTION: We used a dual-obstacle paradigm to test whether the foot clearance over one obstacle was influenced by the contralateral obstacle's height. METHODS: Sixteen healthy young male and female participants (age: 22.5 ± 1.9 years) crossed over two obstacles placed side by side. Four obstacle conditions were made by combining obstacles of two heights (low, L, 9.0 cm; high, H, 22.5 cm) of the obstacles.In the LL condition, both obstacles were low, and in the LH condition, there was a low obstacle for the lead limb and a high one for the trail limb. Similarly, we also arranged HL and HH conditions. Each subject performed 20 trials per condition. We compared the vertical foot clearance, prestep distance, and poststep distance between the conditions. RESULT: The foot trajectory to step over the obstacles were affected by the contralateral obstacle's height. The vertical foot clearance of the trail limb was greater in the HL condition than in the LL condition. The vertical foot clearance of the lead limb was greater in the LH condition than in the LL condition. SIGNIFICANCE: The results suggest that the foot trajectory was not determined exclusively by the obstacle to be crossed. Instead, comprehensive information, including the height of the obstacle for the other limb, might be used for motor control during obstacle crossing.

Au(I) Catalyzed Synthesis of Densely Substituted Pyrazolines and Dihydropyridines via Sequential Aza-Enyne Metathesis/6π-Electrocyclization.

A gold(I) autotandem catalysis protocol is reported for the de novo synthesis of densely substituted pyrazolines and dihydropyridines from the corresponding imine derivatives in a highly regioselective fashion via a one-pot aza-enyne metathesis/6π-electrocyclization sequence. The substituents on the nitrogen atom of the imine perfectly control the reaction pathways from the pivotal 1-azabutadiene intermediate; thus, carbazates were converted into pyrazolines via 6π-electrocyclization of α,ß-unsaturated hydrazones, while aryl imines provided dihydropyridines via 6π-electrocyclization of 3-azahexatrienes.

Diagnostic accuracy of ultrasound examination in detecting aspiration and pharyngeal residue in patients with dysphagia: A systematic review and meta-analysis.

AIM: To estimate diagnostic accuracy of ultrasonography for detecting aspiration and pharyngeal residue in patients with dysphagia. METHODS: A systematic search was conducted in MEDLINE (via PubMed), CINAHL, EMBASE, Ichushi-Web, and Cochrane Library databases to identify articles that showed diagnostic accuracy of ultrasonography for detecting aspiration and residue published in English and Japanese until August 2019. Cross-sectional studies, case-control studies, and cohort studies were included. The diagnostic accuracy results were extracted and the pooled estimated sensitivity and specificity were calculated. The risk of bias of the studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies 2. The certainty of the evidence was assessed using the Grades of Recommendation Assessment, Development, and Evaluation methodology. RESULTS: Five studies were included in this review. The pooled estimated sensitivity and specificity for detecting aspiration were 0.82 (95% CI: 0.72-0.89) and 0.87 (95% CI: 0.81-0.92), respectively. One study was included that evaluated ultrasound assessments of pharyngeal residue. The sensitivity and specificity were 0.62 (95% CI: 0.32-0.86) and 0.67 (95% CI: 0.22-0.96), respectively. The certainty of the evidence was low and very low for the diagnostic accuracy of aspiration and pharyngeal residue, respectively. CONCLUSION: Ultrasound is a non-invasive method with good sensitivity and specificity in detecting aspiration as well as reference standards. While risk of bias and small number of studies limited the strength of this systematic review, our results suggested that ultrasound examination was useful as a bedside screening tool for detecting aspiration.

Evaluation of bowel preparation before colonoscopy by ultrasonographic monitoring of colonic fecal retention: a case series.

AIMS: While bowel preparation for colonoscopy is the key to successful examination, taking laxatives and showing stools to others causes both physical and mental distress to the patient. Thus, an alternative method to evaluation bowel preparation is necessary. In the current study, we studied the colonic fecal retention by ultrasonography (US) and examined the US finding which reflected completion of BP. MATERIAL AND METHODS: The subjects were outpatients who underwent colonoscopy. This report summarizes the ultrasonographic images of patients who underwent multiple US examinations for all five sites of the colon just before, during, and immediately after bowel preparation. According to the standard protocol, the patients took 2 L of polyethylene glycol-ascorbic acid as a laxative, which was discontinued when the nurse visually judged the stool to be clear. RESULTS: Seven patients in their 50s-80s, none of whom were unable to complete a colonoscopy due to residual feces were included in study. Following bowel preparation, the US images showed anechoic areas with haustration in four or all five areas of the colon. Three of the seven patients received low-dose laxatives (1.1-1.2 L); all three had watery stools in three or more colon areas and none of them were constipated at the time of taking 1 L of laxatives. CONCLUSIONS: Completion of bowel preparation can be assessed by the observation of anechoic areas with haustration in multiple colonic sites by ultrasonography.

Feasibility of the constipation point-of-care ultrasound educational program in observing fecal retention in the colorectum: A descriptive study.

AIM: Nurses have difficulty assessing the type of constipation by ordinal assessment methods and may therefore struggle to select an appropriate defecation care. Although previous studies described the safety and effectiveness of defecation care based on ultrasonographic observations in the colorectum, no standardized educational program has been established. This study aimed to determine the feasibility of the constipation point-of-care ultrasound (POCUS) educational program regarding the use of ultrasonography as an assessment tool to determine different types of constipation. METHODS: This descriptive study was conducted for visiting nurses working in Japan. The constipation POCUS educational program that nurses can learn in as short as 7 days comprised four elements: E-learning, a hands-on seminar, self-learning, and objective structured clinical examinations (OSCEs). The nurses were asked to complete a questionnaire regarding the education materials. OSCEs were used to assess the participants' skills in assessing patients based on the use of ultrasound observation in the colorectum. RESULTS: Of the 44 participants who enrolled, 40 were able to complete the program. All the 40 participants (100.0%) who took the OSCEs were able to pass at the first attempt. Moreover, 94.9% of the trainees indicated that this program was able to cover the content necessary to use ultrasonography in home care settings. CONCLUSIONS: The results of this study suggest that the 7-day constipation POCUS educational program provided trainees with a foundational knowledge and skills to observe fecal retention in the colorectum. Thus, further educational program enhancements and clinical skill evaluations are needed to maximize the program's effectiveness in the future.

Deep learning-based classification of rectal fecal retention and analysis of fecal properties using ultrasound images in older adult patients.

AIM: The present study aimed to analyze the use of machine learning in ultrasound (US)-based fecal retention assessment. METHODS: The accuracy of deep learning techniques and conventional US methods for the evaluation of fecal properties was compared. The presence or absence of rectal feces was analyzed in 42 patients. Eleven patients without rectal fecal retention on US images were excluded from the analysis; thus, fecal properties were analyzed in 31 patients. Deep learning was used to classify the transverse US images into three types: absence of feces, hyperechoic area, and strong hyperechoic area in the rectum. RESULTS: Of the 42 patients, 31 tested positive for the presence of rectal feces, zero were false positive, zero were false negative, and 11 were negative, indicating a sensitivity of 100% and a specificity of 100% for the detection of rectal feces in the rectum. Of the 31 positive patients, 14 had hard stools and 17 had other types. Hard stool was detected by US findings in 100% of the patients (14/14), whereas deep learning-based classification detected hard stool in 85.7% of the patients (12/14). Other stool types were detected by US findings in 88.2% of the patients (15/17), while deep learning-based classification also detected other stool types in 88.2% of the patients (15/17). CONCLUSIONS: The results showed that US findings and deep learning-based classification can detect rectal fecal retention in older adult patients and distinguish between the types of fecal retention.

The association between jaw-opening strength, geniohyoid muscle thickness and echo intensity measured by ultrasound.

AIM: Jaw-opening strength is an indicator of swallowing function including hyoid bone elevation. Geniohyoid muscles play an important role during hyoid bone elevation. This study aimed to investigate whether geniohyoid muscle thickness and echo intensity measured by ultrasonography were related to jaw-opening strength. MATERIAL AND METHODS: Sixty-eight participants (39 men) with an average age of 77±7.7 years were recruited from a functional training health care facility. We measured muscle thickness and echo intensity of the geniohyoid muscle on transverse ultrasound images. RESULTS: Age, calf circumference, grip strength, muscle thickness and echo intensity were significantly associated with jaw-opening strength in univariate analyses. After adjusting for grip strength in multiple regression analysis, geniohyoid muscle thickness and echo intensity were significantly associated with jaw-opening strength (ß=0.29 for muscle thickness, ß=-0.26 for echo intensity). CONCLUSIONS: There was a positive correlation between geniohyoid muscle thickness and jaw-opening strength; echo intensity negatively correlated with jaw-opening strength. Ultrasound evaluation of geniohyoid muscle status provides important information about maintaining jaw-opening strength.

Effectiveness of Swallowing Care on Safe Oral Intake Using Ultrasound-Based Observation of Residues in the Epiglottis Valley: A Pragmatic, Quasi-Experimental Study.

The demand for methods to ensure safe oral consumption of food and liquids in order to prevent aspiration pneumonia has increased over the last decade. This study investigated the safety of swallowing care selected by adding ultrasound-based observation, evaluated its efficacy, and determined effective content of selected swallowing care. The study employed a pragmatic quasi-experimental research design. Participants were 12 community-dwelling adult patients (age: 44-91 years) who had experienced choking within 1 month prior to the study. After the control phase, in which conventional swallowing care was provided, trained nurses provided ultrasound observation-based swallowing care for a minimum period of 2 weeks. Outcome measurements were compared across three points, namely T1-beginning of the control phase, T2 and T3-before and end of the intervention phase. The mean durations of intervention were 30.8 days in the control phase and 36.5 days in the intervention phase. Pneumonia and suffocation did not occur in the control phase or the intervention phase. The safe intake food level and the food intake level score significantly improved during the intervention phase (p = 0.032 and 0.017, respectively) by adding eating training based on the ultrasound observation. However, there was no significant improvement in the strength of the muscle related to swallowing by the selected basic training. Our results suggest that swallowing care selected based on the ultrasound observation, especially eating training, safely improved safe oral intake among community-dwelling adults with swallowing dysfunction.

Efficacy of an education program for nurses that concerns the use of point-of-care ultrasound to monitor for aspiration and pharyngeal post-swallow residue: A prospective, descriptive study.

BACKGROUND: For nurses to provide swallowing care that is appropriate to individual patients' swallowing functions, techniques for using ultrasound to monitor for aspiration and pharyngeal post-swallow residue would be helpful. OBJECTIVES: This study seeks to clarify the effectiveness of an education program concerning the use of ultrasound to assess swallowing function (the "Swallowing Point-of-Care Ultrasound Education Program"). This assessment is based on a comparison of the observation skills of general nurses' and certified nurses in dysphagia nursing in this regard; both groups underwent the education program, but dysphagia nurses have greater knowledge of swallowing functions as a result of their training. METHODS: This prospective descriptive study was conducted as a post-graduate education program in two locations in Japan. The swallowing point-of-care ultrasound education program comprised four elements: e-learning, practical seminar, self-learning, and objective structured clinical examination. The objective structured clinical examination was used after the program to assess whether the participants had obtained the necessary skills. The general nurses were then asked to report the ease-of-use of the education materials. RESULTS: Of the 32 participants enrolled in the program, 22 general nurses and nine dysphagia nurses completed the program. In the objective structured clinical examination concerning monitoring for aspiration, the dysphagia-nurses group had a higher proportion of participants evaluated as "excellent" (p = 0.007); this group had a significantly higher ability to maintain adequate images during the swallowing process than did the general-nurse group (p = 0.034). However, there was no difference between the two groups regarding monitoring for post-swallowing residue. Further, over 70% of the nurses gave a positive evaluation of the user-friendliness of the e-learning and practical seminar. CONCLUSIONS: Our results suggest that the swallowing point-of-care ultrasound education program provides both general nurses and dysphagia nurses with sufficient knowledge and skill to monitor for aspiration and post-swallowing residue.

Safety and efficacy of a defecation care algorithm based on ultrasonographic bowel observation in Japanese home-care settings: a single-case, multiple-baseline study.

AIM: To verify the efficacy of defecation care based on handheld ultrasonographic observations for functional constipation by visiting nurses skilled in bowel ultrasonography. METHODS: Home-care patients with suspected functional constipation receiving nursing visits were recruited in this multiple-baseline, single-case experiment with intervention points shifted by 1 week. A total of 15 older adults were categorized into 3-, 4-, 5- or 6-week intervention phases. Ultrasonographic observations of fecal retention in the colorectum and defecation care based on observations during the ordinal physical assessment were reviewed. Tau-U was used for confirming the efficacy of the intervention by measuring the number of non-artificial and artificial defecations, as well as hard stools per week, and the amount of non-stimulant and stimulant laxatives, enemas and suppositories per week. For evaluating safety, adverse events, such as bowel obstruction and incontinence-associated dermatitis, were confirmed. RESULTS: No adverse events were observed. Statistical analysis showed that hard stools and artificial defecation reduced, and that their effect sizes were significant (Tau = -0.48, P < 0.01; Tau = -0.53, P < 0.01). Even the amounts of stimulant laxative and glycerin enema reduced, and their effect sizes were significant (Tau = -0.56, P < 0.01; Tau = -0.34, P = 0.04). CONCLUSIONS: Thus, defecation care based on ultrasonographic assessment by nurses in home-care settings is safe and effective for improving constipation symptoms and reducing laxative use. Geriatr Gerontol Int 2020; ••: ••-••.

Improvement of Constipation Symptoms in an Older Adult Patient by Defecation Care Based on Using a Handheld Ultrasound Device in Home Care Settings: A Case Report.

BACKGROUND: Although previous studies have demonstrated the ability of ultrasound to detect stool in the colon and rectum, the clinical utility of evaluating constipation via ultrasonic imaging by nurses has not been determined. In this case report, we observed fecal retention, assessed the presence of constipation, and performed defecation care in an older adult patient in a home care setting in a city near the metropolitan area in Japan. CASE: An 85-year-old male with advanced stage prostate cancer and multiple metastases was diagnosed with fecal impaction via digital rectal examination and evaluation of stool consistency. He was managed by regular digital evacuation of stool, but ultrasonic imaging indicated constipation with fecal retention in both the rectum and the colon despite this bowel evacuation program. When faced with this situation, we advocate a bowel management program that considers both intestinal elimination dysfunction and fecal transport dysfunction. Based on ultrasonic imaging, stool consistency was altered by promoting water intake, and we promoted self-defecation by asking the patient to attempt to move his bowels (regardless of cues to defecation) by sitting on the toilet every morning. As a result, the number of weekly enemas and digital dis-impaction episodes decreased while the number of spontaneous defecations increased. CONCLUSION: This case report demonstrated that ultrasonography improved bowel management in this patient with clinically severe chronic constipation.

Safety and the effectiveness of a new education program for nurses to assess swallowing function using fiberoptic endoscopic evaluation of swallowing (FEES).

AIM: Nurses have the potential to perform fiberoptic endoscopic evaluation of swallowing (FEES) in Japan, which can aid in their provision of swallowing care appropriate to individual patients' swallowing functions. We aimed to confirm the safety and effectiveness of a new nursing education program on FEES by examining its impact on autonomy in performing FEES and accuracy in observing bolus swallowing. METHODS: In this prospective descriptive study, we developed a FEES education program comprising three phases: (a) obtaining knowledge and skills through e-leaning and a practical workshop; (b) becoming proficient in skills for assessing healthy adults through self-learning; and (c) obtaining clinical competence through 30 cases of on-the-job training (OJT). The trends in autonomy and in accuracy of FEES were evaluated by the data during OJT. RESULTS: Of the three certified nurses in dysphagia nursing, a trainee completed 30 cases of OJT and the other two trainees experienced 20 cases and 10 cases, respectively without any adverse event. Autonomy in the four major FEES skills gradually increased over the OJT. The correct answer rate, sensitivity, and specificity of the penetration-aspiration scale and severity of residue in the pyriform sinus and epiglottis valley were above 95% at the first 10 cases of OJT among three trainees and they were 100% after the 11th case of OJT. CONCLUSIONS: Our results suggest that the developed education program helped nurses with experience being present at FEES obtain sufficient knowledge and skills to appropriately and safely perform FEES with 30 cases of OJT.

Food bolus-forming ability predicts incidence of aspiration pneumonia in nursing home older adults: A prospective observational study.

BACKGROUND: Food boluses in the pharynx without enough bolus formation sometimes cause aspiration among older adults; however, the relationship between food bolus-forming ability and incidence of aspiration pneumonia is unclear. OBJECTIVE: To investigate the relationship between food bolus-forming ability and incidence of aspiration pneumonia by evaluating the condition of chew-swallow managing food transported into the pharynx. METHODS: A prospective observational study conducted in a nursing home for the elderly between April 2016 and February 2018. Seventy-three residents who swallowed thickened liquids and consistent boluses without aspiration were included. Food boluses were graded into three categories in the pharynx using videoendoscopic evaluation. Boluses that retained their original shape were defined as Grade 1. A mixture of large and small boluses was defined as Grade 2. Boluses that had completely transformed into a paste were defined as Grade 3. The relationship between the bolus formation grade and incidence of aspiration pneumonia over 6-month follow-up was investigated. RESULTS: Seventeen residents developed aspiration pneumonia. The incidence rate of aspiration pneumonia was highest among residents with Grade 1 boluses, at an incidence rate of .187 cases per person-month (95% confidence interval (CI): 0.097-0.359). Cox regression showed residents with Grade 1 boluses had a hazard ratio of 4.548 (1.393-14.85) for incidence of aspiration pneumonia compared with residents who had Grade 2 or 3 boluses. CONCLUSION: Insufficient food bolus-forming ability predicted high incidence of aspiration pneumonia. Healthcare professionals should evaluate the food bolus-forming ability, as well as swallowing function, to prevent aspiration pneumonia.