Current Opinion in Otolaryngology 2022-06-01

Editorial introductions

Publication date 01-06-2022


No abstract available

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Review of the effect of amylase-resistant dysphagia products on swallowing safety

Burnip, E.; Cichero, J.A.Y.

Publication date 01-06-2022


Purpose of review Thickened fluids are a widely utilised compensatory management strategy for people with impaired swallowing (dysphagia). Over recent years there has been a shift in practice to offer gum-based instead of starch-based products. A key marketing message has been that gum-based thickeners with amylase-resistant properties are superior in promoting ‘safer swallowing’. This review sought evidence to evaluate the effect of amylase-resistant products on swallowing safety.
Recent findings No studies directly compared the effect of amylase-resistant products with usual care or products without amylase resistance. Five studies cited amylase-resistant properties and compared gum-based to starch-based dysphagia products or thin fluids. Swallowing safety was frequently judged subjectively with rating scales. Swallowing biomechanics were not included and clinically meaningful outcomes, such as incidence of aspiration pneumonia, were not reported. A scoping review of the grey literature found little evidence that amylase-resistant properties of dysphagia products were of significant concern to clinicians or patients.
Summary Despite references to the ’importance’ of amylase-resistant properties of dysphagia products there is no evidence that this property improves swallowing safety. Further research is needed using objective and clinically meaningful outcome measures to allow clinicians and patients to make informed decisions for dysphagia management.

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An integrated care systems model approach for speech and language therapy head and neck cancer services in England: service development and re-design in Cheshire and Merseyside

Sheldrick, Heulwen; Houghton, Lisa; Fleming, Catriona; Crane, Julie

Publication date 01-06-2022


Purpose of review The incidence of head and neck cancer (HNC) is increasing globally and changes in treatment mean that patients are living longer with the condition. It is recognised that while there have been improvements at the diagnostic phase of the pathway, follow-up and on-going care can be fragmented and inequitable. Integrated care models (ICMs) are acknowledged as beneficial. The National Health Service in England is moving to a model whereby services are being re-organised to integrated care systems. This paper reviews the literature and discusses potential models of care to enhance speech and language therapy (SLT) provision for patients with HNC in line with the emerging ICS.
Recent findings The COVID-19 pandemic has provided an opportunity to review service provision and SLT teams quickly adapted to offering remote support. Discussions are currently on-going to explore the potential for patient initiated follow-up via the PETNECK 2 trial and the Buurtzorg ‘neighbourhood model’ holds promise.
Summary ICMs put the patient at the centre of care and have reported benefits for experience of care and clinical outcomes. Navigating organisational structures is complex. The Buurtzorg model provides a practical and theoretical framework to support organisational change.

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Ethical considerations in the care of people with eating, drinking and swallowing difficulties

Leslie, Paula; Lisiecka, Dominika

Publication date 01-06-2022


Purpose of review Eating, drinking and swallowing difficulties are low on the list of clinical headlines. Until something affects the process and then we see how pervasive and devastating such issues are. Recent guidelines have been published looking at national competencies to be structured into preregistration education. Professional bodies have addressed the topic from a risk perspective, which may be counter to the patient-centred approach of shared decision making. Our review places the literature in the wider, historical context of bioethics and our experience regarding ethical challenges as we strive to support our patients.
Recent findings Recent literature addressing ethical care for a person with eating, drinking and swallowing difficulties, highlights shared decision-making. This is guided by patient preference, professional roles and approaches, cultural context and informed consent. Studies highlight the importance of appropriate communication and documentation, and ethical decision-making steps.
Summary We hope to widen clinicians’ perspectives and reflection on factors influencing these challenges (including own biases), and how to address them so that the patient and the clinician are satisfied. Ethical approaches require skills and knowledge, and critically also time. Resources should be allocated at the service level to ensure a robust process of informed consent and decision making.

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Exploring research impact; why it matters?

Bhabra, Mandeep; Sparks, Freya

Publication date 01-06-2022


Purpose of review Making research impactful is becoming a vital part of research proposal development. Funding bodies now require evidence of clear dissemination strategies that demonstrate achievable broad impact from proposed studies. This review addresses what impact means in practice and how to achieve it.
Recent findings Research impact is defined as making real change in the real world. The review explores different kinds of impact, why it is important, the challenges faced, and planning for impact. Creative ways in which impact may be achieved, specifically through storytelling, utilizing infographics and animations are explored. The impact of social media platforms to maximize reach of potential research, alongside measuring impact is discussed.
Summary Researchers may need to develop new skills, to create impactful research outputs for global dissemination across several social media platforms. By utilizing methods that maximize engagement with target audiences, translating and implementing quality evidence into clinical practice may be achieved more rapidly.

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"Its not only swallowing: a clinician primer to adult food refusal beyond dysphagia"

Kershner, Marnie; Askren, Annette N.

Publication date 01-06-2022


Purpose of review Medical teams are frequently faced with challenging clinical scenarios when their patients exhibit reduced intake of food and drink. Speech-language pathologists, who serve as oropharyngeal swallowing specialists in medical settings, are frequently the first to be summoned with the referral, ‘Poor PO intake. Please evaluate and treat.’ As our practices have illuminated, many differentials other than oropharyngeal dysphagia are often at play.
Recent findings Changes to taste, salivary supply/dry mouth, hunger drive, and psychosocial circumstances will significantly impact intake per os – each scenario to be explored further in this paper. Consequences to diminished nutrition and hydration include medical complications, lengthier hospital stays, and diminished quality of life.
Summary In this review, two medical speech-language pathologists detail more common alternative diagnoses that explain reduced intake by mouth amongst adults with acute and chronic diseases. Ultimately, a multidisciplinary approach should be considered when evaluating such patients to ensure a comprehensive and effective care plan.

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Editorial: Otolaryngology training pathways in sub-Saharan Africa

Okerosi, S.N.; Diom, Evelyne; Mulwafu, Wakisa; Fagan, Johannes J.

Publication date 01-06-2022


No abstract available

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A training and implementation model for head and neck oncology service delivery in Mozambique

Chulam, Thiago C.; Bambo, Arquimedes Wamarremula Pedro; Machava, Pedro Rafael; Kowalski, Luiz P.

Publication date 01-06-2022


Purpose of review There is an extreme shortage of head and neck surgeons in Africa. In Mozambique prior to 2000, there were no surgeons with specific training in head and neck surgical oncology. Here, we introduce a training model and report our experience with implementation following the training of the first two head and neck surgeons from Mozambique.
Recent findings This training program, undertaken in Brazil, facilitated the formation of the first two head and neck surgeons from Mozambique. These surgeons received comprehensive training in head and neck surgical oncology and multidisciplinary care, allowing them to then treat their patients under continuous online mentorship collaboration. This model is expected to help in the local formation of new specialists and in the establishment of this specialty in Mozambique.
Summary The program started with remote training and support provided by the MD Anderson Cancer Center, in Texas, USA, as part of the Extension for Community Healthcare Outcomes program. Further training was then undertaken at an established fellowship program in Brazil as a focal point for 2 years, and the knowledge gained was replicated and disseminated locally.

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