Biomedical subjects

Rosemary Martino

Publications and source records attributed to Rosemary Martino.

4 recordsLinked to original sources

PubMed2005

Dysphagia after stroke: incidence, diagnosis, and pulmonary complications.

OBJECTIVE: To determine the incidence of dysphagia and associated pulmonary compromise in stroke patients through a systematic review of the published literature. METHODS: Databases were searched (1966 through May 2005) using terms "cerebrovascular disorders," "deglutition disorders," and limited to "humans" for original articles addressing the frequency of dysphagia or pneumonia. Data sources included Medline, Embase, Pascal, relevant Internet addresses, and extensive hand searching of bibliographies of identified articles. Selected articles were reviewed for quality, diagnostic methods, and patient characteristics. Comparisons were made of reported dysphagia and pneumonia frequencies. The relative risks (RRs) of developing pneumonia were calculated in patients with dysphagia and confirmed aspiration. RESULTS: Of the 277 sources identified, 104 were original, peer-reviewed articles that focused on adult stroke patients with dysphagia. Of these, 24 articles met inclusion criteria and were evaluated. The reported incidence of dysphagia was lowest using cursory screening techniques (37% to 45%), higher using clinical testing (51% to 55%), and highest using instrumental testing (64% to 78%). Dysphagia tends to be lower after hemispheric stroke and remains prominent in the rehabilitation brain stem stroke. There is increased risk for pneumonia in patients with dysphagia (RR, 3.17; 95% CI, 2.07, 4.87) and an even greater risk in patients with aspiration (RR, 11.56; 95% CI, 3.36, 39.77). CONCLUSIONS: The high incidence for dysphagia and pneumonia is a consistent finding with stroke patients. The pneumonia risk is greatest in stroke patients with aspiration. These findings will be valuable in the design of future dysphagia research.

Adult↗

PubMed2005

A measure of disease-specific health-related quality of life for achalasia.

OBJECTIVES: To develop a measure of disease-specific health-related quality of life for achalasia for use as an outcome measure in clinical trials. METHODS: We generated a list of potential items for a measure of disease-specific health-related quality of life for achalasia by semistructured interviews with seven persons with achalasia, and by expert opinion. We then used factor analysis and item response theory methods for item reduction, using responses on the long-form questionnaire from 70 persons with achalasia. The severity measure underlying the item responses was constructed using a Rasch model. RESULTS: We developed a 10-item measure of disease-specific health-related quality of life that sampled the concepts of food tolerance, dysphagia-related behavior modifications, pain, heartburn, distress, lifestyle limitation, and satisfaction. The measure was reliable (person separation reliability 0.79, Cronbach's alpha 0.83), showed evidence of construct validity and good data-to-model fit (mean infit and outfit statistics for items, 1.00 and 0.98, respectively), and had a wide effective measurement range (able to discriminate between 87% of subjects with achalasia). The measure was recalibrated onto a 0-100 interval-level scale. CONCLUSIONS: We describe a reliable measure of achalasia disease-specific health-related quality of life that has a broad effective measurement range, interval-level properties, and evidence of construct validity. This measure is appropriate for use as an outcome measure in clinical trials and other evaluative studies on the effectiveness of treatment for achalasia.

Activities of Daily Living↗

PubMed2004

Oropharyngeal dysphagia: surveying practice patterns of the speech-language pathologist.

The present study was designed to obtain a comprehensive view of the dysphagia assessment practice patterns of speech-language pathologists and their opinion on the importance of these practices using survey methods and taking into consideration clinician, patient, and practice-setting variables. A self-administered mail questionnaire was developed following established methodology to maximize response rates. Eight dysphagia experts independently rated the new survey for content validity. Test-retest reliability was assessed with a random sample of 23 participants. The survey was sent to 50 speech-language pathologists randomly selected from the Canadian professional association database of members who practice in dysphagia. Surveys were mailed according to the Dillman Total Design Method and included an incentive offer. High survey (64%) and item response (95%) rates were achieved and clinicians were reliable reporters of their practice behaviors (ICC>0.60). Of all the clinical assessment items, 36% were reported with high (>80%) utilization and 24% with low (<20%) utilization, the former pertaining to tongue motion and vocal quality after food/fluid intake and the latter to testing of oral sensation without food. One-third (33%) of instrumental assessment items were highly utilized and included assessment of bolus movement and laryngeal response to bolus misdirection. Overall, clinician experience and teaching institutions influenced greater utilization. Opinions of importance were similar to utilization behaviors (r = 0.947, p = 0.01). Of all patients referred for dysphagia assessment, full clinical assessments were administered to 71% of patients but instrumental assessments to only 36%. A hierarchical model of practice behavior is proposed to explain this pattern of progressively decreasing item utilization.

Attitude of Health Personnel↗

PubMed2002

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Cerebrovascular Disorders↗