L6 Screening Flashcards
Define Symptom:
An observation felt or described by the patient
Define Sign:
An observation made by an examiner.
Define Complication:
Signs and symptoms that result due to treatments
If a patient says they have trouble chewing this is an example of a ________
symptom
Abnormalities seen on clinical or VF exams are an example of a ______
sign
_______ predicts the presence of a disease. It is defined by CASLPO as a process where a member applies certain measures that are designed to
identify patients who may have a disorder[s], for the sole purpose of determining the patient’s need for a speech language pathology assessment.
Screening
________ is an example of a screening test
Burke Screening Test
_________ predicts the presence or absence of a non-observable disease or determines the presence of an observable disease.
Clincial evaluation
________ is used to determine the presence of oral, pharyngeal and upper esophageal dysphagia.
Instrumental Evaluation
How does CASLPO define Screening:
a process where a member applies certain measures that are designed to identify patients who may have a disorder[s], for the sole purpose of determining the patient’s need for a speech language pathology assessment
T or F: Inadvertently noticing an issue with swallowing is the same as a screening
False
List 7 characteristics of a screening:
1) Informal
2) Administration by a team member
3) Non invasive
4) Non technical
5) Results quickly interpretable
6) Reliable
7) Accurate
What are the two questions answered by a screening?
1) High likelihood for dysphagia (including
aspiration) ?
2) Is patient candidate for further testing?
Who selects a dysphagia screening tool?
SLP
When selecting the screening tool the SLP asks themself:
- purpose
- target population
- who designed it and when
- validated
- sample size
- population validated for
- Sensitivity, Specificity and Likelihood Ratio scores and how does it compare to other screening tools
- reliability?
- country designed in?
- extent of training required and by whom?
- Positives and negatives of tool.
- Level of evidence of tool.. (1, 2, 3)
Describe the three levels of evidence:
Level 1 - at least one prospective, randomized controlled study has found the intervention to be effective.
Level 2 - one non-randomized cohort comparison, multicentre case-study series, or chronological series has found the intervention to be effective. Evidence may also be part of extraordinary results from randomized clinical trials.
Level 3 - Canadian professional association guidelines, standard practice in other jurisdictions, descriptive studies, reports of an expert committee, collective experience of a consensus panel, or expert
opinion have judged the intervention to be effective.”
What is the best level of evidence?
Level 1
On the Burke Dysphagia Screening test, if any one of which 7 features is present the result is a fail:
1) Bilateral hemispheric stroke
2) Brainstem stroke
3) History of Pneumonia during the acute stroke phase
4) Coughing associated with feeding or during a 3 oz water swallow test
5) failure to consume on half of meals
6) Prolonged time required for feeding
7) Non-oral feeding program in place
Describe the 50 ml test:
Abnormal if:
The patient drinks 50 ml in 5ml aliquots ie. 10 tsp
Abnormal if choking, coughing, altered voice and test was not discontinued
T or F: We give the patient 10 tbsp in the 50 ml Test
False - TSP not TBSP
Describe the 3 oz test:
Abnormal if:
The patient is given a cup with three oz of water and has to drink it without interruption. The patient must be seated upright and be alert enough to hold the cup and drink.
Abnormal if cough within one minute
T or F: The 50 ml test is a better test
True - equal sensitivity, better specificity and better likelihood ratio
_______ is the probability that the presence of dysphagia screening test is positive
sensitivity
______ is the probability that the absence of dysphagia screening test is negative.
specificity
_______ is the odds that dysphagia is actually present with a positive finding.
likelihood ratio
The likelihood ratio of the 50ml test is ____ vs ____ for the 3 oz test
5.7 vs 1.7
The 50 ml test is also called _______
Kidd Water Test
List clinical indicators predicting aspiration:
- dysphonia/ aphonia
- wet phonation
- harsh phonation
- breathy phonation
- abnormal/ absent laryngeal elevation
- wet spontaneous cough
- some or no swallowing secretions
- reclining posture
What is the TOR-BSST?
A screening tool to train nurses in the administration of a dysphagia screening in the acute or rehabilitative setting. The nurses are trained by an SLP.
T or F: The TOR-BSST is over ___% accurate and is ____ reliable
90%
0.92
T or F: There is emergin evidence that screening has a positive effect on health by reducing Aspiration pneumonia, mortality and PEG dependency
True
T or F: Screenings allow for earlier diagnostic work ups
True
T or F: All patients with a stroke should have their swallowing assessed
False -all patients should have their swallowing screened, patients with features indicating dysphagia should have an assessment
Patients should have swallowing ability screened using a _____________ as part of their initial assessment, and before_____________
simple, valid, reliable bedside testing protocol
initiating oral intake of medications, fluids or food.
Patients who are not alert within the first 24 hours should be monitored and dysphagia screening performed when _________.
clinically appropriate
T or F: Patients presenting with features indicating dysphagia should receive a full clinical assessment of their swallowing ability by a speech–language pathologist who should advise on safety of swallowing ability and consistency of diet and fluids.
True
Stroke patients with ___________and ________, including dysphagia, should be referred to a dietitian.
suspected nutritional and/or hydration deficits
T or F: Only stroke patients with specific indicators should have an oral/dental assessment, which includes screening for obvious signs of dental disease, level of oral care and appliances, upon or soon after admission
False - All stroke patients
T of F: If a patient passes the TOR-BSST they are good to go and there is no need for anyone to watch their swallowing
False- The swallowing team member (eg. nurses) should monitor swallowing
Currently, in Canada, screening is completed on ___% of all newly admitted stroke patients.
50%
T or F: In Ontario, screening practice increased from 47.9% in (2002) of all patients, to 62.3% (2008). There was a corresponding decline in the inpatient pneumonia rate across all hospital designations.
True
The CNST is a _______ screening tool
nutritional
A patient would fail a nutritional screening if one of these 7 things are present:
-Many texture restrictions (especially liquid)
-Unintentional weight loss (more than 10% drop from ‘usual’ body weight)
-Previous history of dietary involvement
-Tube feeding (enteral or parenteral)
-Food allergies and sensitivities may restrict
nutritional intake
-Needs a special therapeutic diet (renal, low
sodium etc) plus a texture modification
-Wounds present
T or F: Patients at nutritional risk need an assessment to confirm malnutrition. This is done by the SLP
False - dietician
