[Dysphagia] Cited reference

[lobsterpam at aol.com (lobsterpam@aol.com)]

It was done in the US, in Pennsylvania.  It was snail mailed to health 
care facilities within an identified region of ZIP/postal codes.  I 
know that some people use email/web surveys, but a representative 
sampling of "typical" practitioners isn't obtained that way.  There is 
far from universal participation in email lists.  I believe Garcia 
reported it at 30%?  Those data are available from ASHA for the Div. 13 
list.  We wanted to tap the typical therapist working in a health care 
setting.

I do per diem in nursing homes, and so I often cover for therapists who 
have sent patients out for videos.  Anecdotally, I'd see them come back 
with a report showing aspiration and a recommendation for thick 
liquids.  When I didn't change a diet, an astonished nurse invariabley 
said, "But we always change the diet when that recommendation comes 
back from a video."  I don't know how many nurses I've had to cajole 
because I was giving patients regular water at the bedside. The 
repeated anecdotes prompted me to do the survey.

The exact wording of the question was to provide a level of agreement 
(from 1 - 5)  to the statement "VFSS/MBS is used to confirm the 
presence/absence of aspiration."  That should not be why we use VFSS. 
It's used to examine the physiology of the swallow.  When paired with 
the responses about liquid consistency manipulation, a picture of the 
overall decision making pattern emerges.  The attempt was made to word 
the questions to avoid biasing respondents in any one direction.

ps



-----Original Message-----
From: Deanna Rolfe <DRolfe@nsccahs.health.nsw.gov.au>
To: lobsterpam@aol.com; dysphagia@b9.com
Sent: Fri, 13 Jan 2006 14:29:01 +1100
Subject: Re: [Dysphagia] Cited reference

    Given this information, I'm glad to know that our service here uses 
VFSS for
many more purposes than just identifying aspiration...and we are 
educating
referring doctors on the uses of the assessment too.
I'm also glad to know that our girls here take into account everything 
else
going on with the patient (i.e. the whole picture), and discuss with 
the medical
teams before decisions re. NBM or thickened fluids are made...and if 
the patient
is cognitively able to make their own decisions, they are given that
opportunity.

I'm sure there are many others out there who use VFSS for more than 
just
aspiration identification. I personally think it would be a huge waste 
of time
and energy just to get a person down to radiology, to then only look at 
whether
they aspirated or not. With all the other information it can provide, 
would
people really only do that?

I don't know what the wording of the question was for the survey talked 
about
below, but if it said that VFSS was "ONLY" used for identification of
aspiration, then I would be appalled at afifure of 80% believing that.
But if it didn't specify the "ONLY" then I can understand the figure of 
80% (and
am wondering why not higher)...as you can identify aspiration via MBS 
(although
granted it is only a snapshot, so you may not see it on that occasion).

What country was the survey done in? (for interest sake)

Deanna

>>> <lobsterpam@aol.com> 13/01/2006 1:52:37 PM >>>
Ali.Kutner@healthsouth.com wrote:

[[ I feel most SLP's utilize the VFSS to do exactly that - identify
abnormalities
of swallowing physiology so we may make an appropriate plan.  If we all
had the
"misguided tendancy" to simply ID aspiration, we would have one line
reports:
yes no  (check one)]]

I have survey data that refute this... over 80% of the SLPs who
responded to a survey in 2004 either "agreed" or "strongly agreed" that
the VFSS is used to confirm the presence or absence of aspiration.
Close to 75% either "agreed" or "strongly agreed" that patients who
aspirated thin liquids on VFSS should be recommended to receive thick
liquids.  Over 70%  either "agreed" or "strongly agreed" that patients
who aspirated thin liquids on VFSS should not receive regular
consistency water.

For nurses, the agreement for the liquid recommendations is even
higher, probably because SLPs have inserviced them about it.

These data suggest a reliance on the VFSS to answer the aspiration
question, and suggest  a reliance on that single piece of information
to make recommendations.

My speculation is that our field has developed standards of care before
there was empirical evidence to support those standards.  There IS
evidence from the medical literature that prandial aspiration and
pneumonia do not have a direct cause-effect relationship.  But in order
to implement evidence based practice(using the medical evidence), SLPs
find themselves having to "violate standards of care."

Pam Smith
_______________________________________________
Dysphagia mailing list
Dysphagia@b9.com
http://lists.b9.com/mailman/listinfo/dysphagia

Please note: Northern Sydney Central Coast Health E-Mail addresses have 
changed
from @doh.health.nsw.gov.au to @nsccahs.health.nsw.gov.au
Please make this change in your address books for my contact details.

Disclaimer: This message is intended for the addressee named and may
contain confidential information. If you are not the intended
recipient, please delete it and notify the sender. Views
expressed in this message are those of the individual sender,
and are not necessarily the views of Northern Sydney Central Coast 
Health.
<<<< GWAVASIG >>>>