Rianne de Wit

Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review

AIM This paper is a report of a systematic review conducted to determine the effectiveness and feasibility of bedside screening methods for detecting dysphagia in patients with neurological disorders. BACKGROUND Dyspaghia affects 22-65% of patients with neurological conditions. Although there is a large variety of bedside tests to detect dysphagia, it is unknown which have the best psychometric properties and are feasible for nurses to use. DATA SOURCES AND REVIEW METHODS An electronic database search was carried out using Medline (PubMed), Embase, CINAHL, and PsychLit, including all hits up to July 2008. The search terms were dysphagia, sensitivity, specificity, diagnosis, and screening. The methodological quality of included studies was assessed. RESULTS Thirty-five out of 407 studies were included in the review. Eleven studies with sufficient methodological quality revealed that trial swallow tests using water had sensitivities between 27% and 85% and specificities between 63% and 88%. Trial swallow tests with different viscosities led to sensitivities ranging from 41% to 100% and specificities of 57% to 82%. Combining water tests with oxygen desaturation led to sensitivities between 73% and 98% and specificities between 63% and 76%. Single clinical features, such as abnormal gag, generally had low sensitivity and specificity. CONCLUSION A water test combined with pulse oximetry using coughing, choking and voice alteration as endpoints is currently the best method to screen patients with neurological disorders for dysphagia. Further research is needed to establish the most effective standardized administration procedure for such a water test, and to assess the value of pulse oximetry, in addition to a trial swallow to detect silent aspiration.

Observation scales for pain assessment in older adults with cognitive impairments or communication difficulties

Background: Several pain observation scales have been developed to accurately assess and manage pain in older adults with severe cognitive impairments, communication difficulties, or both. Objective: To review relevant pain observation scales and the psychometric qualities of these scales. Methods: The literature was searched for articles reporting the use of a pain observation scale in an empirical study and describing psychometric properties in older adults with cognitive impairments, communication difficulties, or both. Results: Thirteen pain observation scales were included. Scales differed in numbers of items, types of categories, and psychometric properties. Facial expression, vocalization, motor behavior, and social behavior or mood are categories present in most of the scales. In terms of reliability and validity, however, most studies are too limited or incomplete to allow definite conclusions to be drawn about usefulness in daily practice. Discussion: As different methods of evaluating reliability and validity were used, and different aims (e.g., type of pain) were pursued, the available scales cannot be compared easily. Nevertheless, a few are promising, given preliminary results. These should be examined further on psychometric properties and usefulness in different populations because optimal pain assessment is necessary for efficient and effective pain treatment.

Pain prevalence and characteristics in three Dutch residential homes

Background: In Anglo‐Saxon countries, high prevalence rates of pain have been reported for elderly living in nursing homes, residential homes and for community‐dwelling elderly. No information on pain prevalence is available for elderly living in Dutch residential homes.

Pressure ulcer guideline development and dissemination in Europe

AIMS AND OBJECTIVES To explore the current state of pressure ulcer guideline development and dissemination, from national to local level (i.e. nursing homes) in six European countries: England, Germany, Italy, the Netherlands, Portugal and Sweden. BACKGROUND Pressure ulcers are a persistent problem in healthcare institutions. Their prevalence is influenced by many factors, one of them being the development and dissemination of pressure ulcer guidelines. These are difficult and complex processes and it is not clear whether they differ between European countries. DESIGN Literature review and semi-structured interviews. METHOD Interviews were conducted in six countries at national and nursing home level. RESULTS Four countries had national pressure ulcer prevention and treatment guidelines. Portugal had no national guidelines and Sweden had shifted the responsibility to regional level. All participating nursing homes had pressure ulcer guidelines except those in Portugal. Control and monitoring of guideline dissemination was carried out only in Sweden and England. CONCLUSIONS All countries studied have national or regional pressure ulcer prevention and treatment guidelines, except Portugal. Portugal is also the only country where none of the nursing homes included had pressure ulcer guidelines. Because the dissemination of such guidelines does not imply actual implementation, further research should focus on the implementation process. RELEVANCE TO CLINICAL PRACTICE Clinical guidelines, like pressure ulcer guidelines, are important tools in guiding the care processes in healthcare institutions. Successful dissemination of guidelines from national level to individual healthcare institutions is a first and necessary step in actually applying them. Monitoring of the guideline dissemination process is therefore essential.

Evaluation of the dissemination and implementation of pressure ulcer guidelines in Dutch nursing homes

RATIONALE, AIMS AND OBJECTIVES Annual national prevalence surveys have been conducted in the Netherlands over the past 10 years and have revealed high prevalence rates in Dutch nursing homes. Pressure ulcer guideline implementation is one of the factors that can influence prevalence rates. Previous research has shown that these guidelines are often only partly implemented in Dutch nursing homes. Reasons for this lack of pressure ulcer guideline implementation are not known. Therefore, the aim of this study is to investigate the current situation regarding pressure ulcer guideline dissemination and implementation in Dutch nursing homes. METHODS Semi-structured interviews were conducted in eight nursing homes in the Netherlands from January till December 2008. In each nursing home, interviews were held with eight persons. RESULTS The implementation of pressure ulcer guidelines was lacking in some of the nursing homes. Risk assessment scales were often not used in practice, repositioning schemes were not always available and, when they were, they were often not used in practice. Knowledge about guideline recommendations was also lacking and pressure ulcer education was inadequate. Barriers to applying guideline recommendations in practice were mostly related to personnel and communication. CONCLUSIONS The implementation of pressure ulcer guidelines does not seem to be successful in all nursing homes and needs more attention. Barriers mentioned by the interviewees in applying guideline recommendations need to be addressed. Providing adequate education for nursing home staff and increasing attention for pressure ulcer care can be the first steps in improving the implementation of pressure ulcer guidelines.

899 INTRODUCING THE RELIABLE AND VALID ROTTERDAM ELDERLY PAIN OBSERVATION SCALE (REPOS)

presence or absence of the behaviour before and after antalgic treatment. A similar procedure was also leaded in a group of communicative old patients with using pain self assessment tools (VAS or NRS or VDS). Results: The behaviours more frequently associated to pain were: frowning, grimacing, changes in mobility, points out to sore area, verbalisation “complaint”/onomatopoeia, imploring crying look, wrikling, clenching teeth, groaning, guarding/avoiding reaction. Analysis of relationships according to communication status and others scores confirm the relevance of these items. Conclusion: The last study has to access the Psychometric properties of Algoplus 10. Acknowledgments: Supported by CNP foundation and Grünenthal Group.

491 NURSES' COMPLIANCE WITH PAIN REGISTRATION IN DUTCH NURSING HOMES

previous pain exposure). Findings were compared with age and gender matched controls without previous hospital experiences. Results: Former patients were significantly less sensitive to cold and warmth perception at the heel (p< 0.05), and for warmth on the hand. Conversely, former patients were significantly more sensitive to heat and cold pain at the heel (p< 0.05); pain thresholds on the hand did not differ with controls. Preterm-born neonates were more hypoand hypersensitive than term born patients. Conclusions: Eight years following NICU admission, alterations in pain processing at the area of previous tissue damage are still measurable. In accordance to experimental findings in animals, these long-term consequences are more prominent in preterm born neonates, confirming the existence of a developmental window.

498 PERCEPTIONS OF PAIN IN A GERIATRIC IN‐HOSPITAL POPULATION

Background and Aims: It has been well documented that up to 80% of nursing home residents suffer from pain. We aimed to study prevalences and characteristics of pain in hospitalized elderly patients. Methods:We included patients admitted to a geriatric ward of an academic hospital in the Netherlands over a 4-month period. After written consent, patients were administered a questionnaire on pain and other related issues. We asked them to rate present pain, pain last week and tolerable pain on a Numeric Rating Scale from 0 (no pain) to 10 (worst pain). In this study we assumed scores 4 and higher to indicate substantial pain. Results: The 60 patients (41 female) admitted during the study period had mean age 83 years (60–98). Mean stay in hospital was 16 days (1–50). We administered the questionnaire to 38 patients, as 11 patients showed cognitive limitation and 11 were admitted too short. Twenty (53%) reported pain (median 5.0). Duration of pain varied from days (n = 4), weeks (n = 4), months (n = 4) to years (n = 8). Five (13%) patients reported intolerable pain. Pain in most patients was caused by circulatory or musculoskeletal problems. Seventeen patients received analgesics on routine basis and 3 received only as needed. Nineteen received no analgesics at all, of whom seven reported pain (median 4.0). Conclusion: More than half of hospitalized elderly reported pain, yet less than half received pain medication. We recommend a special focus on chronic pain treatment in the hospitalized elderly using validated pain scores and a treatment algorithm.

438 ASSOCIATION BETWEEN PSYCHOLOGICAL CHARACTERISTICS AND THE DEVELOPMENT OF COMPLEX REGIONAL PAIN SYNDROME (CRPS1) - PRELIMINARY RESULTS OF A PROSPECTIVE MULTICENTER STUDY

A. Beerthuizen1 °, A. van ’t Spijker2, F.J.P.M. Huygen3, J. Klein4, J. Passchier2, D.L. Stronks1, R. de Wit5,6. 1Pain Expertise Center, Erasmus MC, Rotterdam; 2Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam; 3Pain Treatment Center, Erasmus MC, Rotterdam; 4Department of Anesthesiology, Erasmus MC, Rotterdam; 5Department of Nursing Research, Faculty of Health Sciences, University of Maastricht; 6University Hospital Maastricht, The Netherlands