1. Darci Becker, PhD, CCC-SLP, BCS-S Katherine Locricchio, MS, CFY-SLP Carli Schieferdecker, MS, CCC-SLP

2.  2003-2005 An Oral Water Protocol in Rehabilitation Patients With Dysphagia for Liquids” Genesis Medical Center (Becker, Tews & Lemke) ◦ Randomized controlled trial investigating the risks and benefits of a water protocol in patients with dysphagia for liquids (thin liquid aspirators)  2010-2011 Dissertation: Patient Awareness of Dysphagia (Becker) ◦ Awareness of one’s dysphagia diagnosis and compliance with swallowing recommendations two days after modified barium swallow study (MBSS)

3.  2014 Exploring Oral Care Practices in a Regional Hospital (Schieferdecker, Tapper & Becker)  Many healthcare professionals use foam swabs as a primary method of oral care for some patient groups (Turk et al, 2012; Binkley et al., 2004; Grap et al., 2003)  Several studies have shown foam swabs provide mucosal stimulation, but alone are inadequate in the removal of dental plaque (Grap, Munro, Ashtiani, & Bryant (2003)  Oral care, particularly in those with dysphagia, is crucial to reducing risk of aspiration pneumonia (Langmore et al.,, 1998)  Goal: gather information on typical oral care practices at Genesis  Developed a survey for nurses and therapists on the Rehabilitation floor of Genesis West  Administered 71 surveys; received 55  Asked 29 questions regarding practices and attitudes surrounding oral care  One key finding: given a scenario with a patient who was NPO, had dysphagia and dependent for oral care…  70% selected foam swabs vs. 30% selected a toothbrush (manual, suction) as the method they would be most likely to use  This, and other findings, supported efforts to educate staff on the benefits of toothbrushes, for this population, given evidence in the literature

4.  2014 Are Patients With Silent Aspiration More Frequently Admitted/Readmitted With Pneumonia Than Those With Audible Signs of Aspiration, (Krull & Becker) ◦ Retrospective chart review of 50 Patients who had a MBSS at Genesis  20/50 patients (40%) aspirated  Of the 20 patients, 10/50 (50%) were readmitted to Genesis within a year  Of those who were readmitted, 3/10 (30%) were diagnosed with “aspiration pneumonia”  All 3 (100 %) were originally “silent” aspirators

5.  Article in Dysphagia (2013), Bonilha et al. “Radiation Exposure Time during MBSS: Influence of Swallowing Impairment Severity, Medical Diagnosis, Clinician Experience, and Standardized Protocol Use” ◦ Use radiation counter that appears on video image to measure exposure time (so no additional equipment needed!)  Genesis Speech and Hearing: Store 5 years (roughly 1750 DVDs) worth of recorded swallowing studies  Push for standardization ◦ We do not use a standardized MBSS protocol  Use anywhere from 0-3 solids ◦ My training= assessing ONE solid is adequate/preferred

6.  2014 “The Effect of Assessing Multiple Solids On Radiation Exposure Time During a Videofluoroscopic Swallowing Study,” (Locricchio & Becker)  Does average fluoroscopy time at Genesis exceed average times reported in the studies cited by Bonilha et al. (2013)?  How much, on average, does fluoroscopy time (for the entire swallowing study) increase with the addition of each subsequent solid?

7.  Reviewed 43 recorded MBSS studies (10 hours)  Are Genesis’ average MBSS fluoroscopy comparable to those reported other studies? Yes  Average exposure times reported in 3 studies by Bonilha (2013)=2.75-4.76 min; range: 30 sec.-18 min.  Genesis’ average exposure time= 3.39 min; range:1.17 - 7.82 min  How much, on average, does fluoroscopy time (for the entire swallowing study) increase with the addition of each subsequent solid? It didn’t!  No solids, average time: 3.47 min (8 studies)  One solid, average time: 4.58 min (3 studies)  Two solids, average time: 3.31 min (11 studies)  Three solids, average time: 3.23 min (21 studies)  Conclusions:  Assessment of all three solids occurs most often at Genesis  One SLP performs the majority of MBSSs  Other variables may impact radiation exposure time more than number of items assessed, e.g. swallowing severity  Future studies may explore the impact of these variables