Streptococcus bovis - Gundersen Lutheran Health System

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19. Joseph T, Johnson B, Battista RA, et al. Perception of fatigue during simulated competition. Med Sci Sports Exerc. 2008;40(2):381-386. 20. Faulkner J, Parfitt G, Eston R. The rating of perceived exertion during competitive running scales with time. Psychophysiology. 2008;45(6):977-985. 21. Amann M, Eldridge MW, Lovering AT, Stickland MK, Pegelow DF, Dempsey JA. Arterial oxygenation influences central motor output and exercise performance via effects on peripheral locomotor muscle fatigue in humans. J Physiol. 2006;575 (Pt 3):937-952. 22. Peltonen JE, Rantamaki J, Niittymaki SP, Sweins K, Viitasalo JT, Rusko HK. Effects of oxygen fraction in inspired air on rowing performance. Med Sci Sports Exerc. 1995;27(4):573-579. 23. Tucker R, Kayser B, Rae E, Raunch L, Bosch A, Noakes T. Hyperoxia improves 20 km cycling time trial performance by increasing muscle activation levels while perceived exertion stays the same. Eur J Appl Physiol. 2007;101(6):771-781. 24. Morgan WP, Pollock ML. Psychologic characterization of the elite distance runner. Ann N Y Acad Sci. 1977;301:382-403. 25. Foster C, Hendrickson K, Peyer K, et al. Pattern of developing the performance template [published online ahead of print January 5, 2009]. Br J Sports Med. doi:10.1136/bjsm.2008.054841. pLACebo effeCtS on exerCiSe perforMAnCe 26. Guyatt GH, Pugsley SO, Sullivan MJ, et al. Effect of encouragement on walking test performance. Thorax. 1984;39(11):818-822. 27. Havenetidis K, Cooke CB, Butterly R, King RF. Incorrect calculation of power outputs masks the ergogenic capacity of creatine supplementation. Appl Physiol Nutr Metab. 2006;31(5):635-642. 28. Reiser RF 2nd, Broker JP, Peterson ML. Inertial effects on mechanically braked Wingate power calculations. Med Sci Sports Exerc. 2000;32(9):1660-1664. 29. Mendez-Villanueva A, Hamer P, Bishop D. Fatigue in repeated-sprint exercise is related to muscle power factors and reduced neuromuscular activity. Eur J Appl Physiol. 2008;103(4):411-419. 30. Foster C, Pollock ML, Anholm JD, et al. Work capacity and left ventricular function during rehabilitation after myocardial revascularization surgery. Circulation. 1984;69(4):748-755. 31. Squires RW, Rod JL, Pollock ML, Foster C. Effects of propranolol on perceived exertion soon after myocardial revascularization surgery. Med Sci Sports Exerc. 1982;14(4):276-280. Zebra Family Jeff Hillesland Trauma & Emergency Center Gundersen Lutheran Medical Journal • Volume 6, Number 1, June 2009 7
Authors: David E. Hartman, PhD, BC-ANCDS(A) Speech Pathology, Department of Neurology Gundersen Lutheran Health System Melissa Hunter Department of Research Gundersen Lutheran Medical Foundation Richard D. Hutter, MD Department of Neurology Gundersen Lutheran Health System Claudia Schneller, RN Department of Nursing Gundersen Lutheran Health System Jake Gundrum, MS Department of Research Gundersen Lutheran Medical Foundation Address for correspondence: David E. Hartman, PhD, BC-ANCDS(A) Mail Stop EB3-005 Gundersen Lutheran Health System 1900 South Avenue La Crosse, WI 54601 Telephone: (608) 782-7300 Facsimile: (608) 791-6358 email: dehartma@gundluth.org Outcomes from a Screening Procedure for Oropharyngeal Dysphagia Following Acute Stroke AbStrACt Stroke is the third leading cause of death and number one cause of adult disability in the United States, affecting more than 700 000 Americans each year, including 160 000 deaths from stroke-related causes. 1 It is estimated that over 3 million Americans are permanently disabled from stroke. 2 In 1999, stroke cost the United States approximately 30 billion dollars in healthcare costs and lost productivity. 1 Given inflation, more sophisticated technology for evaluation and treatment, and the overall rise in the cost of healthcare, this figure has steadily increased over the years. Stroke is the most common etiology for dysphagia, with 30% or more of patients showing signs of aspiration by clinical examination or videofluorographic study of swallow (VFSS). 3-8 The likelihood of developing pneumonia is 7 times greater in stroke patients who aspirate than in those who do not, even though the typical course for dysphagia after stroke is gradual improvement over a 6-month period. 3,6,9,10 Untreated or undiagnosed dysphagia can lead to malnutrition, while pneumonia increases the chance of mortality 3-fold, particularly in those institutions that do not have a screening protocol for dysphagia. 11,12 It has been the general consensus that in acute stroke, a bedside examination, even if supplemented by available dysphagia Oropharyngeal dysphagia and aspiration pneumonia are common sequelae to stroke. The purpose of the current investigation was to assess the effectiveness of a screening procedure for dysphagia and aspiration following acute stroke. Medical records of 753 patients who were seen through an acute stroke care pathway and screened for dysphagia and aspiration using the Gundersen Lutheran Acute Dysphagia Screen (GLADS) between 1998 and 2006 were reviewed. Dysphagia, pneumonia, nutritional outcomes, and neurologic characteristics of patients who passed GLADS were compared with those of patients who failed. Five hundred seventy-eight patients passed GLADS. Of these, 524 (91%) remained stable on an oral diet and free of pneumonia during their hospitalization; 18 (3%) developed pneumonia during the study. One hundred seventy-five patients failed GLADS and had further evaluation and treatment. Eighty-two of these patients (47%) remained stable on an oral diet and free of pneumonia during their hospitalization; 16 (9%) developed pneumonia during the study. Patients who passed GLADS had significantly lower rates of pneumonia than those who failed. Length of hospital stay and cost of hospitalization were considerably greater for patients failing GLADS. Premorbid stroke and dysphagia were not good predictors of a patient’s ability to maintain a safe oral diet. No significant association was found between site of lesion, communicative or cognitive deficits, and pneumonia. Communicative or cognitive deficits were not good predictors of a patient’s ability to maintain a safe oral diet after stroke. GLADS appears to be an effective screening tool for dysphagia and preventing pneumonia following acute stroke. screening tools, is inadequate for assessing deglutitory function and for predicting dysphagia or its ramifications, including aspiration, pneumonia, or malnutrition. 7,8,13-19 Recently, however, Trapl and colleagues 20 described a bedside screening protocol used for 50 acute-stroke patients that, with further investigation, may allow for institution of a safe oral diet without the need for further evaluation of swallowing function. Martino and colleagues 21 and Perry and Love 22 conducted comprehensive literature reviews that identified several articles that met strict research criteria for dysphagia screening following acute stroke. Their combined results indicated a need for both creation and validation of efficacious screening procedures for dysphagia after stroke. This issue was also stressed in the 1999 Agency for Health Care Policy and Research report for dysphagia, 23 and by the Joint Commission, 24 Smith and colleagues, 25 Teramoto and Fukuchi, 26 Mosheim, 27 and Swigert, 11 particularly as bedside screening procedures are used to detect aspiration. In 1997, professional staff at our institution representing neurology, speech-language pathology, physical medicine and rehabilitation, internal medicine, neurosurgery, and nursing developed a comprehensive care pathway—Acute Stroke Care 8 Gundersen Lutheran Medical Journal • Volume 6, Number 1, June 2009
Page 1 and 2: Th e Gundersen Lu T h e r a n M e d
Page 3 and 4: editor David E. Hartman, PhD, BC-AN
Page 5 and 6: through our online Scholarly Activi
Page 7 and 8: competition practice of each subjec
Page 9: effect. These data suggest that the
Page 13 and 14: discharge. Twelve patients (2%) dev
Page 15 and 16: pneumonia rates of 2.4%, versus 5.4
Page 17 and 18: Authors: Alexander D. Wade, MD Depa
Page 19 and 20: Since that report, other authors ha
Page 21 and 22: Authors: Abhishek Tandon, MD Depart
Page 23 and 24: cancer, duodenal ulcers, inflammato
Page 25 and 26: figure 1. Radiograph depicting a 4-
Page 27 and 28: Authors: Meghana Raghavendra, MB, B
Page 29 and 30: Authors: Ines H. Berger, MD, PhD De
Page 31 and 32: and nerve root avulsion. Simmel, in
Page 33 and 34: Authors: Brian E. Udermann, PhD, AT
Page 35 and 36: figure 2. Longtime LEHP member Don
Page 37 and 38: Summer Splendor Kelly Hodgson Kline

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