Evaluation of the uptake of the Australian standardized terminology and definitions for texture modified foods and fluids

Abstract

This paper discusses the uptake of standardized terminology and definitions for texture modified foods and fluids. The Australian dietetic and speech-language pathology associations endorsed national standards in 2007. This project sought to determine the barriers and enablers for use of the national standards in clinical practice. Cross-sectional online surveys were developed, including open- and closed-response questions. The surveys targeted different professional groups in Australia including speech-language pathologists, dietitians, nurses, and food service personnel. Australian accredited universities were contacted to determine penetration of the standards. A total of 574 surveys were received. Sixty-five per cent of respondents indicated full implementation, 23% partial implementation, and 10% no implementation of the standards in their workplace. Speech-language pathologists and dietitians were most likely to have championed implementation of the standards. Barriers to implementation included: lack of knowledge about the standards, time, and resistance to change. Enablers included: encouragement to use the standards and 'buy-in' from stakeholders. Benefits of implementation included: consistent terminology and perceived improvements in patient safety. It was concluded that the standards have been successfully implemented in a majority of facilities and Australian universities. This study provides insight into the complexity of introducing and managing change in healthcare environments.

Understanding the mechanism of drug delivery from thickened fluids to aid swallowing of medications

“…Furthermore, the thickeners based on xanthan gum also affected dissolution when used at the intermediate thickness, level 400. Other countries may use even thicker consistencies, for example in the USA the thickest level is 'spoon thick' which is ƞ50 >1750 cP (Jukes et al, 2012), which may be expected to retard drug release to an even greater extent than that observed here. The Biopharmaceutical Classification Scheme (BCS) classifies drugs according to two major physicochemical properties, solubility and permeability, that contribute to bioavailability upon oral administration (Amidon et al, 1995).…”

“…Atenolol was also chosen for its high solubility in water and for the presence of a chromophore within the chemical structure to enable analysis using UV spectroscopy. Six commercial food thickening agents (Easythick, Easythick Advanced, Janbak F, Karicare, Nutilis, Viscaid) were selected as a vehicles for drug delivery (Table 2-2) and prepared as directed by the manufacturer at three thickness levels indicated for dysphagic patients (Jukes et al, 2012); mildly thick (level 150), moderately thick (level 400) and extremely thick (level 900). Spoon measurements of the powder were converted to weight (Table 2-2) and added into water to reach the desired percentage (% w/v).…”

“…This commonly involves crushing tablets or opening capsules and mixing the contents into food or fluids such as apple sauce, jam, custard, yoghurt, honey or juice (Nissen et al, 2009, Lee et al, 1996, Gidal et al, 1998, McLean et al, 2001, Fay et al, 2005, Jann et al, 1986, Damle et al, 2002. Patients suffering from dysphagia often have their fluid and dietary intake managed by the use of thickening agents in order to ensure safe swallowing and avoid aspiration into the airway (Jukes et al, 2012).…”

“…There are generally three thickness levels used, with the viscosity prescribed often increasing with severity of dysphagia (Jukes et al, 2012).…”

“…There are three concentration levels that relate to polymer-polymer and polymersolvent interactions, including a critical concentration for entanglement (c*) (Lapasin and Pricl, 1995). Stock solutions of xanthan gum 2.2% w/v, guar gum 1.4% w/v and maltodextrin 70% w/w, which correspond to the concentration of the thickener al level 900 according to the Australian standardize terminology for thickened fluids (Jukes et al, 2012). They were prepared by weighing their corresponding amounts of the polysaccharides and deionized water (i.e.…”