[Dysphagia] Practice approaches

[gjackson at rochester.rr.com (gerriann jackson)]

I have been thinking about doing exactly that.  Right now, I can keep most
people that I place on thickened liquids in my head, but I think it would be
good idea to collect sufficient data along with the information about which
level liquid they are on, subsequent UTI's etc.

-----Original Message-----
From: Jai Gupta [mailto:Jai.Gupta at SESIAHS.HEALTH.NSW.GOV.AU]
Sent: Thursday, June 14, 2007 7:07 PM
To: Irene Campbell-Taylor; gerriann jackson; Vera Karger
Cc: dysphagia at b9.com
Subject: RE: [Dysphagia] Practice approaches



Hi,
Does any one audit their work or collect simple information about % of pt
who did not have pneumonia ? Asp i.e. have at least 3 of five cardinal
signs, develop pneumonia or pneumonitis when the pt is under speech
pathologist care. I would like to know if there is data in general or those
using Frazer protocol or those using thickened fluid. We have been working
on performance indicators and setting benchmark and in our preliminary data
collection got some interesting data for various sites for over 600 pts. If
there is some data out there I would like to compare with our benchmark.
Thanks


Jai Gupta.







-----Original Message-----
From: dysphagia-bounces at dysphagia.com
[mailto:dysphagia-bounces at dysphagia.com]On Behalf Of Irene
Campbell-Taylor
Sent: Thursday, 14 June 2007 9:36 PM
To: gerriann jackson; Vera Karger
Cc: dysphagia at b9.com
Subject: Re: [Dysphagia] Practice approaches




gerriann jackson <gjackson at rochester.rr.com> wrote:

I promote free water between meals, after oral care for my dysphagia
patients.

  *** Even the best oral care can never remove all pathogens from the mouth.
I cannot, however, ignore the many videos that I have performed
that demonstrate quite clearly a person aspirating on thin and tolerating
thickened liquids.
  *** You really must take these findings as what they are- not relevant to
real life. Logemann in her study on thickeners noted that the VFSS did not
match the real life situation - it never does.

  Nor can I ignore the patients who I follow over time
(LTC attached to hospital) who have experienced relief from chronic upper
respiratory symptoms, including repeated pneumonias after being placed on
thickened liquids.
  *** But you don't know all of the variables involved. They are,
undoubtedly, aspirating the thickened liquids as well. See Logemann et al.
Perhaps, for other reasons, their resistance is better. One cannot assume
that thickened liquids are not aspirated and we now know for certain that
they are.

Research and evidence based practice are important to my practice. However,
there is also evidence and knowledge to be gleaned from every patient that I
treat.
  *** Absolutely - but one must also know what changes, biochemical,
pharmaceutical, immunological, etc. are taking place before reaching
conclusions based on only one variable.

  Those patients and their outcomes tell me that although probably
overused, there is an appropriate place for thickened liquids in the LTC
setting.
  *** I, of course, would have to disagree, and, having never used them find
no reason to suggest that they do have any place - the recent study
supporting this conclusion.

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Dr I Campbell-Taylor
Clinical Neuroscientist
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