RESUMEN
OBJECTIVES/HYPOTHESIS: To identify risk factors for pneumonia incidence in patients with dysphagia undergoing a videofluoroscopic swallow study (VFSS) in an outpatient tertiary-care center. STUDY DESIGN: Historical cohort study. METHODS: All individuals undergoing a VFSS between 10/02/13 and 07/30/15 were identified and followed historically for 2 years. Demographic information, medical history, and fluoroscopic data were collected. The 2-year incidence of pneumonia was obtained from the medical records and telephone interview. The incidence of pneumonia and death were calculated and risk factors for pneumonia and mortality were ascertained. RESULTS: 689 patients were followed for 2 years. The mean age (±standard deviation) of the cohort was 65 (±15.5) years. 49% (338/689) were female. The most common causes of dysphagia were cricopharyngeus muscle dysfunction (270/689), head and neck cancer (175/689), and neurodegenerative disease (56/689). The incidence of pneumonia was 22% (153/689). The incidence of death was 11%. Multivariable logistic regression revealed that chronic obstructive pulmonary disorder [COPD] (odds ratio [OR] = 2.36, 95% confidence interval [CI]: 1.33-4.19), hypertension (OR = 1.82, 95% CI: 1.23-2.73), tracheotomy status (OR = 2.96, 95% CI: 1.09-7.99), and vallecular residue (OR = 1.88, 95% CI: 1.24-2.85) were all significantly associated with an elevated risk of pneumonia. Kidney disease (OR = 1.27, 95% CI: 1.02-9.9), COPD (OR = 3.27, 95% CI: 1.65-6.49), vallecular residue (OR = 2.35, 95% CI: 1.35-4.1), male gender (OR = 2.21, 95% CI: 1.25-3.92), and low body mass index (OR: 1.12, 95% CI: 1.06-1.19) were independent adjusted risk factors for death. CONCLUSIONS: The incidence of aspiration pneumonia (22%) and death (11%) within 2-years of a VFSS was high. The greatest adjusted risk factors for incident pneumonia were tracheotomy (OR = 3.0), COPD (OR = 2.4) and vallecular residue (OR = 1.9). The greatest adjusted risk factors for death were COPD (OR = 3.3), vallecular residue (OR = 2.3), and male gender (OR = 2.2). LEVEL OF EVIDENCE: 4 Laryngoscope, 132:1172-1176, 2022.
Asunto(s)
Trastornos de Deglución , Enfermedades Neurodegenerativas , Neumonía por Aspiración , Neumonía , Enfermedad Pulmonar Obstructiva Crónica , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Deglución/fisiología , Trastornos de Deglución/complicaciones , Trastornos de Deglución/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía/epidemiología , Neumonía por Aspiración/complicaciones , Neumonía por Aspiración/etiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Estudios RetrospectivosRESUMEN
Introduction: Service learning can teach medical students about the social determinants of health and prepare them to better serve marginalized populations, while people in the sex trade can serve as effective educators for their peers and health professions trainees. However, service-learning projects involving medical students and people in the sex trade are currently rare. Methods: We modified a curriculum from an author's prior institution to provide a unique service-learning experience for medical students and peer health education for women in the sex trade in a new city and new context. Medical students partnered with a local community organization to implement a 10-week course on physical and mental health for women in the sex trade. Coled by a medical student and a woman who had utilized the community partner's services, the course's instructional methods included in-class demonstrations, group discussion, games, and worksheets. Results: Ten women participated in the course, and six medical students facilitated its implementation. The participants demonstrated increased knowledge in physical and mental health topics and reported being more comfortable speaking with health care providers. The coleaders developed skills and confidence to pursue additional leadership opportunities. The medical student coleader gained a better understanding of addiction and was more prepared to work with patients with substance use disorders. Discussion: This mutual learning experience was a valuable health education opportunity for a local underserved community and helped medical students understand the barriers women in the sex trade face when seeking health care and how physicians can better meet their needs.
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Educación de Pregrado en Medicina , Estudiantes de Medicina , Curriculum , Femenino , Humanos , Liderazgo , AprendizajeRESUMEN
BACKGROUND: Current medication and transcranial magnetic stimulation (TMS) treatments for depression bring only approximately one-third of patients to remission. Newer TMS techniques such as bilateral treatment, neuronavigation, and theta burst stimulation (TBS) show promise in improving remission rates. However, it is unclear whether newer off-label techniques improve outcomes enough to justify widespread implementation. METHODS: An IRB approved retrospective chart review examined 58 primarily treatment-resistant (79%) depressed patients who received bilateral neuronavigated TBS-20Hz in a private outpatient clinic. RESULTS: 72% (42/58) of patients remitted (Beck Depression Inventory-II (BDI-II)â¯<â¯13) with an 81% decrease in BDI-II scores. 83% (48/58) of patients responded (BDI-IIâ¯≤â¯50%). Average time to remission was 7.3 treatment weeks (SDâ¯=â¯4.5, Range 0.6-21.2). Overall, 40% (17/42) of remitters also successfully discontinued one or more pretreatment medications. CONCLUSIONS: Bilateral Neuronavigated TBS-20Hz TMS brought more than two-thirds of treatment refractory depressed patients to remission. TBS-20Hz may be critical for obtaining higher remission rates. Controlled trials are warranted.