Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature.

We conducted a systematic literature review and analysis of programs for evaluating swallowing in order to prevent aspiration pneumonia. This article derives from an evidence report on diagnosis and treatment of swallowing disorders (dysphagia) in acute-car stroke patients prepared by us as an Evidence-based Practice Center (EPC) under contract to the U.S. Agency for Healthcare Research and Quality (AHRQ). Available evidence on the diagnosis and treatment of dysphagia for preventing pneumonia is limited. We found reported pneumonia rates in one historical controlled study of a program using bedside exams (BSE) for acute stroke patients; one uncontrolled case series study of acute stroke patient-reporting of swallowing difficulty; one controlled case series study of videofluoroscopic study of swallowing (VFSS) for acute stroke patients; and one historical controlled study of fiberoptic endoscopic examination of swallowing (FEES) for patients referred for swallowing evaluation in rehabilitation centers. Comparing these results with historical controls indicates that implementation of dysphagia programs is accompanied by substantial reductions in pneumonia rates. While all these methods appeared effective, the small sizes of available studies did not allow determination of the relative efficacy of BSE, VFSS, or FEES.

Videotape assessment of changes in aberrant meal-time behaviors in anorexia nervosa after treatment.

This study compared meal-time behaviors in patients with anorexia nervosa to normal-weight controls and the effects of hospital treatment on these behaviors. Ten restricting-anorexics and six normal-weight controls were given a standard lunch and asked to eat the entire meal. Their behaviors were recorded via hidden camera. All participants were tested twice--anorexics before and after in-patient treatment, and controls at similar intervals. Videotapes of these sessions were analysed for occurrence and duration of eight categories of non-ingestive behaviors: food manipulation, food preparation, food moving, non-food manipulation, concealment, vigilance, passivity and physical activity. Food-ingestion patterns, including number of bites of food and switches between different kinds of food, were also recorded. Results indicated that anorexics spent significantly more time than controls in behaviors that were directly food-related, and exhibited more vigilance behavior. Pre-treatment anorexics spent significantly more time in these behaviors than did post-treatment anorexics. Few group differences or treatment effects were found in food-ingestion patterns, although there was an indication that both pre- and post-treatment anorexics avoided high-fat foods more than controls did. These results suggest that videotaping provides a useful technique for characterizing the behavior associated with eating disorders. Further studies should explore whether normalization of these behaviors is associated with a positive clinical outcome.