exudates and Deglutition-Disorders

Dysphagia is the most common problem among head and neck cancer patients. It can occur before, during, and/or after cancer treatment due to cancer growth or side effects from cancer treatment. To date, the data on the prevalence of dysphagia in Malaysia is very limited. Therefore, the present study aimed to examine the prevalence and contributing factors of dysphagia.. A total of 240 patients (mean age 53.1, 167 males and 73 females) from Hospital Kuala Lumpur and the National Cancer Institute were enrolled in this research. All patients were interviewed individually in which they completed a thorough case history and swallowing screening test, including the water swallow test.. The results revealed that 43.3% of patients had dysphagia. In multivariate logistic regression, occupation of the patients was found to be associated with dysphagia, i.e., working in service and sales sector (adjusted Odds Ratio, aOR=0.36, 95% Confidence Interval, 95%CI: 0.13, 0.99). Compared to patients without treatment, those who had chemoradiotherapy (aOR=4.45; 95%CI: 1.10, 17.99) were at an increased odd of developing dysphagia.. This study showed that occupation, cancer stage, and type of treatment received by the head and neck cancer patients were crucial factors associated with the development of dysphagia. These findings guide the clinicians in identifying head and neck cancer patients who are at greater risks of developing dysphagia.

Topics: Deglutition Disorders; Female; Head and Neck Neoplasms; Hospitals, Public; Humans; Malaysia; Male; Prevalence

To evaluate the clinical outcomes and satisfaction of patients following laparoscopic Heller myotomy for achalasia cardia in four tertiary centers.. Fifty-five patients with achalasia cardia who underwent laparoscopic Heller myotomy between 2010 and 2019 were enrolled. The adverse events and clinical outcomes were analyzed. Overall patient satisfaction was also reviewed.. The mean operative time was 144.1 ± 38.33 min with no conversions to open surgery in this series. Intraoperative adverse events occurred in 7 (12.7%) patients including oesophageal mucosal perforation (n = 4), superficial liver injury (n = 1), minor bleeding from gastro-oesophageal fat pad (n = 1) & aspiration during induction requiring bronchoscopy (n = 1). Mean time to normal diet intake was 3.2 ± 2.20 days. Mean postoperative stay was 4.9 ± 4.30 days and majority of patients (n = 46; 83.6%) returned to normal daily activities within 2 weeks after surgery. The mean follow-up duration was 18.8 ± 13.56 months. Overall, clinical success (Eckardt ≤ 3) was achieved in all 55 (100%) patients, with significant improvements observed in all elements of the Eckardt score. Thirty-seven (67.3%) patients had complete resolution of dysphagia while the remaining 18 (32.7%) patients had some occasional dysphagia that was tolerable and did not require re-intervention. Nevertheless, all patients reported either very satisfied or satisfied and would recommend the procedure to another person.. Laparoscopic Heller myotomy and anterior Dor is both safe and effective as a definitive treatment for treating achalasia cardia. It does have a low rate of oesophageal perforation but overall has a high degree of patient satisfaction with minimal complications.

Topics: Adult; Aged; Deglutition Disorders; Esophageal Achalasia; Esophageal Perforation; Female; Follow-Up Studies; Heller Myotomy; Humans; Intraoperative Complications; Laparoscopy; Malaysia; Male; Middle Aged; Patient Satisfaction; Safety; Tertiary Care Centers; Time Factors; Treatment Outcome

To explore the perceptions of healthcare professionals' (HCPs) in a South East Asian nation towards percutaneous endoscopic gastrostomy (PEG) feeding.. Semi-structured, qualitative interviews.. A teaching hospital in Kuala Lumpur, Malaysia.. A total of 17 healthcare professionals aged 23-43 years, 82% women.. Thematic analysis revealed five themes that represent HCPs' perceptions in relation to the usage of PEG feeding: 1) knowledge of HCPs, 2) communication, 3) understanding among patients, and 4) financial and affordability.. The rationale for reluctance towards PEG feeding observed in this regions was explained by lack of education, knowledge, communication, team work, and financial support. Future studies should assess the effects of educational programmes among HCPs and changes in policies to promote affordability on the utilization of PEG feeding in this region.

Topics: Adult; Aged; Attitude of Health Personnel; Deglutition Disorders; Enteral Nutrition; Female; Gastrostomy; Health Knowledge, Attitudes, Practice; Health Personnel; Hospitals, Teaching; Humans; Malaysia; Male; Middle Aged; Perception; Surveys and Questionnaires; Young Adult

There are competency standards available in countries with established speech-language pathology services to guide basic dysphagia training with ongoing workplace mentoring for advanced skills development. Such training processes, however, are not as well established in countries where speech-language pathology training and practice is relatively new, such as Malaysia. The current study examines the extent of dysphagia training and workplace support available to speech-language pathologists (SLPs) in Malaysia and Queensland, Australia, and explores clinicians' perceptions of the training and support provided, and of their knowledge, skills, and confidence. Using a matched cohort cross-sectional design, a purpose-built survey was administered to 30 SLPs working in Malaysian government hospitals and 30 SLPs working in Queensland Health settings in Australia. Malaysian clinicians were found to have received significantly less university training, less mentoring in the workplace, and were lacking key infrastructure needed to support professional development in dysphagia management. Over 90% of Queensland clinicians were confident and felt they had adequate skills in dysphagia management; in contrast, significantly lower levels of knowledge, skills, and confidence were observed in the Malaysian cohort. The findings identify a need for improved university training and increased opportunities for workplace mentoring, training, and support for Malaysian SLPs.

Topics: Attitude of Health Personnel; Chi-Square Distribution; Clinical Competence; Cross-Sectional Studies; Curriculum; Deglutition Disorders; Education, Graduate; Education, Professional; Hospitals; Humans; Inservice Training; Malaysia; Mentors; Perception; Personal Satisfaction; Queensland; Social Support; Speech-Language Pathology; Surveys and Questionnaires; Time Factors; Training Support; Workplace

Gastrostomy feeding is superior to long-term nasogastric (NG) feeding in patients with dysphagic stroke, but this practice remains uncommon in Asia. We sought to examine the nutritional adequacy of patients on long term NG feeding and identify barriers to gastrostomy feeding in these patients.. A prospective comparison of subjective global assessment (SGA), and anthropometry (mid-arm muscle circumference, MAMC; triceps skinfold thickness, TST) between elderly stroke patients on long-term NG feeding and matched controls was performed. Selected clinicians and carers of patients were interviewed to assess their knowledge and attitudes to gastrostomy feeding.. 140 patients (70 NG, 70 oral) were recruited between September 2010 and February 2011. Nutritional status was poorer in the NG compared to the oral group (SGA grade C 38.6% NG vs 0% oral, p<0.001; TST males 10.7 + 3.7 mm NG vs 15.4 + 4.6 mm oral, p<0.001; MAMCmales 187.9 + 40.4 mm NG vs 228.7 + 31.8 mm oral, p<0.001). 45 (64.3%) patients on long-term NG feeding reported complications, mainly consisting of dislodgement (50.5%), aspiration of feed content (8.6%) and trauma from insertion (4.3%). Among 20 clinicians from relevant speciliaties who were interviewed, only 11 (55%) clinicians would routinely recommend a PEG. All neurologists (100%) would recommend a PEG, whilst the response was mixed among non-neurologists. Among carers, lack of information (47.1%) was the commonest reason stated for not choosing a PEG.. Elderly patients with stroke on long term NG feeding have a poor nutritional status. Lack of recommendation by clinicians appears to be a major barrier to PEG feeding in these patients.

Topics: Academic Medical Centers; Aged; Aged, 80 and over; Attitude of Health Personnel; Deglutition Disorders; Enteral Nutrition; Female; Gastrostomy; Health Knowledge, Attitudes, Practice; Humans; Intubation, Gastrointestinal; Malaysia; Male; Middle Aged; Neurology; Nutritional Status; Practice Patterns, Physicians'; Prospective Studies; Stroke; Time Factors; Workforce