Qualitative study on influencing factors of refusal of gastric tube placement in stroke patients with dysphagia

Objective:To explore the influencing factors of patients with dysphagia after stroke who refuse to accept gastric tube implantation,and to provide intervention basis for improving the compliance of patients with gastric tube implantation.Methods:Asemi-structured interview method was used to conduct in-depth interviews with 11 patients who refused gastric tube placement,and the interview data were analyzed by Colaizzi analysis method.Results:The influencing factors of patients with dysphagia after stroke can be summarized into the following three themes:patient factors(patient's cognition of disease,patient's subjective pain perception and fear),family factors(patient's caregiver's cognition of disease,economic conditions)and medical factors(trust in medical staff,medical education methods).Conclusion:Medical staff should understand the influencing factors of dysphagia after stroke and take positive measures to improve the compliance of patients with gastric tube placement and ensure the treatment effect.

Delphi and Analytic hierarchy process for the construction of a risk assessment index system for post-stroke shoulder-hand syndrome

Background:Shoulder-hand syndrome(SHS)is one of the common complications after stroke,which is difficult to cure once it occurs.Early risk identification is an effective measure to prevent and treat SHS,but there is no effective tool to assess the risk assessment of SHS.Objective:To develop a validated tool to assess the risk of SHS occurrence after stroke.Methods:This was an observational study with a 3-step process:(1)Literature review to establish initial indicators;(2)Application of a modified Delphi method for two rounds of correspondence,with final indicators obtained by modifying each round based on expert opinion;(3)Application of hierarchical analysis to determine the weights of each indicator.Results:The initial literature review constructed4 primary indicators and 24 secondary indicators;after the first round of Delphi,a total of 10 secondary indicators were deleted and 6 secondary indicators were added,and the final indicators included 3 primary indicators and 15 secondary indicators,and in the second round,consensus was reached;by AHP analysis,the highest weight was given to existing risk factors(0.5584),followed by relevant medical history(0.3196);lastly,demographic factors(0.1220),and the scores of other secondary indicators met the requirements.Conclusion:This study establishes and constructs a post-stroke SHS risk assessment tool,which provides a basis for early identification of SHS and early intervention.Meanwhile,this study provides a methodological reference for the development of other indicatorssets.

Esophageal Functional Changes in Obstructive Sleep Apnea/Hypopnea Syndrome and Their Impact on Laryngopharyngeal Reflux Disease

Background：Obstructive sleep apnea/hypopnea syndrome （OSAHS） and laryngopharyngeal reflux （LPR） disease have a high comorbidity rate,but the potential causal relation between the two diseases remains unclear.Our objectives were to investigate the esophageal functional changes in OSAHS patients and determine whether OSAHS affects LPR by affecting esophageal functions.Methods：Thirty-six OSAHS patients and 10 healthy controls underwent 24-h double-probed combined esophageal multichannel intraluminal impedance and pH monitoring simultaneously with polysomnography.High-resolution impedance manometry was applied to obtain a detailed evaluation of pharyngeal and esophageal motility.Results：There were 13 OSAHS patients （36.1%） without LPR （OSAHS group） and 23 （63.9%） with both OSAHS and LPR （OSAHS and LPR group）.Significant differences were found in the onset velocity of liquid swallows （OVL,P =0.029） and the percent relaxation of the lower esophageal sphincter （LES） during viscous swallows （P =0.049） between the OSAHS and control groups.The percent relaxation of LES during viscous swallows was found to be negatively correlated with upright distal acid percent time （P =0.016,R =-0.507）,and OVL was found to be negatively correlated with recumbent distal acid percent time （P =0.006,R =-0.557） in the OSAHS and LPR group.Conclusions：OSAHS patients experience esophageal functional changes,and linear correlations were found between the changed esophageal functional parameters and reflux indicators,which might be the reason that LPR showed a high comorbidity with OSAHS and why the severity of the two diseases is correlated.