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Objectives
Dysphagia is a frequent finding in nursing home residents. The aim of this study is to evaluate the association of dysphagia and mortality in nursing home residents and identify further risk factors for mortality in residents with dysphagia.Design
One-day, annually repeated cross-sectional study, evaluating the nutritional situation of nursing home residents with 6-month mortality as outcome.Setting
191 nursing homes from 14 countries in Europe and the United States participating in the nutritionDay study between 2007 and 2012.Participants
Data of all nursing home residents in the nutritionDay study aged 65 years or older with available information about dysphagia and outcome were analyzed.Measurements
Residents’ characteristics and mortality rate were calculated by group comparison, and mortality risk was calculated by multivariate regression analysis with adjustment for potential confounding factors.Results
10,185 residents (78% female) with a mean age of 85 ± 8.1 years were included in the analysis. Dysphagia was reported in 15.4% of residents. The 6-month mortality of residents with dysphagia was significantly higher than of those without dysphagia (24.7% vs 11.9%; P < .001). The multivariate regression analysis revealed dysphagia [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.24-1.68, P < .001] along with body mass index <20 (OR 1.78, 95% CI 1.55-2.03, P < .001) and weight loss >5 kg (OR 1.61, 95% CI 1.37-1.88, P < .001) as independent and significant risk factors for mortality. Because of significant interaction, a disproportionately high mortality of 38.9% was found in residents with dysphagia accompanied by previous weight loss >5 kg (OR for interaction 1.44; 95% CI 1.03-2.01; P = .032). Tube feeding was reported in 14.6% of residents with dysphagia. The mortality rate of dysphagic residents receiving tube feeding vs those who were not was not significantly different (21.4% vs 25.3%; P = .244).Conclusion
In this nutritionDay study, dysphagia was identified as an independent risk factor for mortality in nursing home residents. Residents with dysphagia accompanied by weight loss are at a particularly high risk of mortality and should therefore receive special attention. 相似文献During monitoring of motor evoked potentials (MEP) elicited by transcranial electrical stimulation (TES) for prognostication of postoperative motor deficit, significant MEP changes without postoperative deterioration of motor function represent false-positive results. We aimed to investigate this phenomenon in a large series of patients who underwent resection of supratentorial lesions. TES was applied in 264 patients during resection of motor-eloquent supratentorial lesions. MEP were recorded bilaterally from arm, leg, and/ or facial muscles. The threshold criterion was applied assessing percentage increase in threshold level, which was considered significant if being?>?20% higher on affected side than on the unaffected side. Subcortical stimulation was additionally applied to estimate the distance to corticospinal tract. Motor function was evaluated at 24 h after surgery and at 3-month follow-up. Patients with false-positive results were analyzed regarding tumor location, tumor volume, and characteristics of the monitoring. MEP were recorded from 399 muscles (264 arm muscles, 75 leg muscles, and 60 facial muscles). Motor function was unchanged postoperatively in 359 muscles in 228 patients. Among these cases, the threshold level did not change significantly in 354 muscles in 224 patients, while it increased significantly in the remaining 5 muscles in 4 patients (abductor pollicis brevis in all four patients and orbicularis oris in one patient), leading to a false-positive rate of 1.1%. Tumor volume, opening the ventricle, and negative subcortical stimulation did not significantly correlate with false-positive results, while the tumor location in the parietal lobe dorsal to the postcentral gyrus correlated significantly (p?=?0.012, odds ratio 11.2, 95% CI 1.8 to 69.8). False-negative results took place in 1.1% of cases in a large series of TES-MEP monitoring using the threshold criterion. Tumor location in the parietal lobe dorsal to the postcentral gyrus was the only predictor of false-positive results.
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