Dysphagia after Stroke: An Unmet Antibiotic Stewardship Opportunity

Finniss, Mathew C.; Myers, James W.; Wilson, Jackie R.; Wilson, Vera C.; Lewis, Paul O.

doi:10.1007/s00455-021-10269-5

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…Relevant studies (30,31) have shown that dysphagia and malnutrition often coexist in stroke patients. Dysphagia is the strong predictor of malnutrition in stroke patients during rehabilitation period (32). Swallowing disorders in patients with cerebrovascular disease are mainly in the oral and pharyngeal phases (33).…”

Section: Discussionmentioning

confidence: 99%

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Wu¹,

Zhu²,

Zhou³

et al. 2021

Ann Palliat Med

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Background: Nutrition supports is essential to the prognosis of stroke patients with dysphagia. It's necessary to evaluate the effects and safety of intermittent tube feeding for stroke patients with dysphagia, to provide evidence for the management of dysphagia.Methods: Cochrane Library et al. databases were searched for randomized controlled trials (RCTs) on the intermittent tube feeding for stroke patients with dysphagia up to Feb 15, 2021. Bias risk assessment tool recommended by Cochrane was used for quality assessment, and Revman5.3 software was used for data analysis.Results: A total of 11 RCTs involving 762 stroke patients with dysphagia were included. Meta-analysis indicated that intermittent tube feeding could significantly increase the rate of dysphagia function

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Section: Discussionmentioning

confidence: 99%

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Wu¹,

Zhu²,

Zhou³

et al. 2021

Ann Palliat Med

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“…Dysphagia and lung infection are mutual risk factors for post-stroke complications, with pulmonary infections also being the greatest hidden danger of dysphagia after a stroke ( Martino et al, 2005 ). Patients with dysphagia after a stroke are more likely to be administered antibiotics, although our scientific understanding and effective use of antibiotics in these cases remain poor ( Finniss et al, 2021 ). Future research should therefore focus on the use of standardized antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Acupuncture Reduces the Risk of Dysphagia in Stroke Patients: A Propensity Score-Matched Cohort Study

et al. 2022

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Background: Post-stroke dysphagia (PSD) affects the quality of life in stroke patients, impairs their rehabilitation ability, and causes other complications following stroke. Currently, there is currently some understanding of PSD risk factors, but its protective factors remain largely unknown.Objective: To analyze the effects of acupuncture (AP) on dysphagia in stroke patients and explore its potential as a preventive therapy.Methods: Patients with a diagnosis of stroke from 2010 to 2019 were selected and followed until 2020, utilizing factors such as age, gender, stroke location, stroke type, and baseline comorbidity. To compare the incidence of dysphagia, equal numbers of stroke patients treated with and without AP (n = 1,809) were matched by 1:1 propensity scoring. The Cox proportional hazards model and Kaplan-Meier method were used to assess the risk of dysphagia as an outcome measure.Results: The stroke patients treated with AP had a lower risk of dysphagia after adjusting for age, gender, stroke location, stroke type, and baseline comorbidity [adjusted hazard ratio (AHR) = 0.43, 95% confidence interval = 0.37–0.49] compared with those in the non-AP cohort. AP also decreased the risk of PSD among different gender groups. The risk ratios were AHR = 0.45 and AHR = 0.33 for males and females, respectively. AP also reduced the risk for PSD among different age groups. The risk ratios were AHR = 0.20, AHR = 0.37, AHR = 0.41, and AHR = 0.45 for the 18–39, 40–59, 60–79, and >80 years-old groups. Regarding stroke types (ischemic, hemorrhagic, and mixed type), patients treated with AP had a lower risk (AHR = 0.47, 0.28 and 0.17, respectively). With respect to stroke location, the risk of PSD in AP-treated patients was decreased regardless of location: brain stem (AHR = 0.41), diencephalon (AHR = 0.13), or multiple lesions (AHR = 0.40), the risk of PSD in AP-treated patients was decreased. For all baseline comorbidities, AP attenuated the risk of dysphagia. The cumulative incidence of dysphagia was remarkably lower in the AP group than in the non-AP group (log-rank test, P = 0.000).Limitations: First, this was a single-center clinical retrospective study. Second, we did not classify the severity of stroke and dysphagia. Third, all data were extracted manually. Lastly, the sample size was relatively small. Thus, future studies with larger sample sizes are warranted to verify our findings.Conclusion: Acupuncture treatment attenuates the risk of dysphagia in stroke patients. Future research should increase the sample size and elaborate further on the details of the AP protocol.

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“…Oropharyngeal dysfunction (OD) is the most common complication of stroke[ 1 ]. It has been reported that the incidence of OD after stroke is 30%–65%[ 2 ]. Although some stroke patients can recover within a few weeks after stroke onset, between 11% and 50% of patients still experience OD after 6 months[ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…From the perspective of modern medicine, OD is believed to be caused by cerebral ischemia and hypoxia, leading to damage to the cortex, cortical bulbar tract, intracranial nerve, and glossopharyngeal nerve, and resulting in the loss of normal innervation of muscle groups and effectors by upper motor neurons[ 2 , 4 ]. The main clinical manifestations include obstruction during swallowing, inability to chew, difficulty in swallowing, coughing, aspiration, and food reflux.…”

Section: Introductionmentioning

confidence: 99%

Effect of a systemic intervention combined with a psychological intervention in stroke patients with oropharyngeal dysfunction

Song,

Wang,

Chen

et al. 2024

World J Psychiatry

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BACKGROUND Stroke frequently results in oropharyngeal dysfunction (OD), leading to difficulties in swallowing and eating, as well as triggering negative emotions, malnutrition, and aspiration pneumonia, which can be detrimental to patients. However, routine nursing interventions often fail to address these issues adequately. Systemic and psychological interventions can improve dysphagia symptoms, relieve negative emotions, and improve quality of life. However, there are few clinical reports of systemic interventions combined with psychological interventions for stroke patients with OD. AIM To explore the effects of combining systemic and psychological interventions in stroke patients with OD. METHODS This retrospective study included 90 stroke patients with OD, admitted to the Second Affiliated Hospital of Qiqihar Medical College (January 2022–December 2023), who were divided into two groups: regular and coalition. Swallowing function grading (using a water swallow test), swallowing function [using the standardized swallowing assessment (SSA)], negative emotions [using the self-rating anxiety scale (SAS) and self-rating depression scale (SDS)], and quality of life (SWAL-QOL) were compared between groups before and after the intervention; aspiration pneumonia incidence was recorded. RESULTS Post-intervention, the coalition group had a greater number of patients with grade 1 swallowing function compared to the regular group, while the number of patients with grade 5 swallowing function was lower than that in the regular group (P < 0.05). Post-intervention, the SSA, SAS, and SDS scores of both groups decreased, with a more significant decrease observed in the coalition group (P < 0.05). Additionally, the total SWAL-QOL score in both groups increased, with a more significant increase observed in the coalition group (P < 0.05). During the intervention period, the total incidence of aspiration and aspiration pneumonia in the coalition group was lower than that in the control group (4.44% vs 20.00%; P < 0.05). CONCLUSION Systemic intervention combined with psychological intervention can improve dysphagia symptoms, alleviate negative emotions, enhance quality of life, and reduce the incidence of aspiration pneumonia in patients with OD.

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Dysphagia after Stroke: An Unmet Antibiotic Stewardship Opportunity

Cited by 4 publications

References 22 publications

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Intermittent tube feeding for stroke patients with dysphagia: a meta-analysis and systematic review

Acupuncture Reduces the Risk of Dysphagia in Stroke Patients: A Propensity Score-Matched Cohort Study

Effect of a systemic intervention combined with a psychological intervention in stroke patients with oropharyngeal dysfunction

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