BackgroundEducational computer games are examples of computer-assisted learning objects, representing an educational strategy of growing interest. Given the changes in the digital world over the last decades, students of the current generation expect technology to be used in advancing their learning requiring a need to change traditional passive learning methodologies to an active multisensory experimental learning methodology. The objective of this study was to compare a computer game-based learning method with a traditional learning method, regarding learning gains and knowledge retention, as means of teaching head and neck Anatomy and Physiology to Speech-Language and Hearing pathology undergraduate students.MethodsStudents were randomized to participate to one of the learning methods and the data analyst was blinded to which method of learning the students had received. Students’ prior knowledge (i.e. before undergoing the learning method), short-term knowledge retention and long-term knowledge retention (i.e. six months after undergoing the learning method) were assessed with a multiple choice questionnaire. Students’ performance was compared considering the three moments of assessment for both for the mean total score and for separated mean scores for Anatomy questions and for Physiology questions.ResultsStudents that received the game-based method performed better in the pos-test assessment only when considering the Anatomy questions section. Students that received the traditional lecture performed better in both post-test and long-term post-test when considering the Anatomy and Physiology questions.ConclusionsThe game-based learning method is comparable to the traditional learning method in general and in short-term gains, while the traditional lecture still seems to be more effective to improve students’ short and long-term knowledge retention.

OBJECTIVES:To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation.METHODS:The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance.RESULTS:Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk.CONCLUSIONS:Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population.

OBJETIVO: Relatar os resultados da avaliação clínica completa da deglutição em pacientes críticos de um hospital de ensino de grande porte na cidade de São Paulo. MÉTODOS: Foi realizado um estudo prospectivo, descritivo, no período de setembro a novembro de 2009, em uma unidade de terapia intensiva de emergências clínicas de trinta leitos, de um hospital terciário de grande porte do Brasil. Foram encaminhados 35 pacientes para a avaliação fonoaudiológica clínica da deglutição. Para a avaliação clínica completa da deglutição na unidade de terapia intensiva, foram preconizados os seguintes protocolos: Protocolo de Avaliação Preliminar (PAP), Protocolo de Avaliação do Risco para Disfagia (PARD) e Protocolo de Introdução e Transição da Alimentação por Via Oral (PITA). RESULTADOS: Neste estudo, foi constatada uma prevalência de 63% de disfagia orofaríngea (DO) na UTI, sendo a maioria destas classificadas como moderada e moderada-grave (39%). Entre os pacientes encaminhados para avaliação da deglutição, 74% apresentaram intubação orotraqueal prévia. A análise estatística revelou as variáveis que poderiam classificar corretamente os pacientes como tendo ou não DO nos testes clínicos. Esses indicadores clínicos incluíram: força da tosse, coordenação pneumofonoarticulatória, gravidade da disfonia e elevação laríngea. Vinte e seis pacientes (74%) completaram todos os protocolos. Desse total, 38% retornaram à dieta regular. CONCLUSÃO: A prática com protocolos padronizados mostra-se como uma importante opção no gerenciamento da disfagia orofaríngea na unidade de terapia intensiva.

IntroductionThe development of postextubation swallowing dysfunction is well documented in the literature with high prevalence in most studies. However, there are relatively few studies with specific outcomes that focus on the follow-up of these patients until hospital discharge. The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI).MethodsWe conducted a retrospective, observational cohort study from 2010 to 2012 of all patients over 18 years of age admitted to a university hospital ICU who were submitted to prolonged OTI and subsequently received a bedside swallow evaluation (BSE) by a speech pathologist. The prognostic factors analyzed included dysphagia severity rate at the initial swallowing assessment and at hospital discharge, age, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubations, intubation time and length of hospital stay.ResultsAfter we excluded patients with neurologic diseases, tracheostomy, esophageal dysphagia and those who were submitted to surgical procedures involving the head and neck, our study sample size was 148 patients. The logistic regression model was used to examine the relationships between independent variables. In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes.ConclusionsStudies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder. Additionally, this study stresses the importance of the initial assessment ratings.

the results of the present study reinforce that the procedures used to determine the individual abilities and inabilities were useful in planning the intervention procedures.

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RESUMO Objetivo Realizar um levantamento bibliográfico a respeito da decanulação da traqueostomia para verificar os fatores e protocolos utilizados em estudos internacionais. Estratégia de pesquisa Estudo de revisão de literatura utilizando a base de dados PubMed com os descritores em língua inglesa “Tracheostomy”, “Weaning”, “Decannulation”, “Removal tube”, “Speech, Language and Hearing Sciences”, “Intensive Care Units”, “Dysphagia”, “Swallowing”, “Deglutition” e “Deglutition Disorders”. Critérios de seleção Estudos publicados nos últimos cinco anos (2012 a 2017), com população acima de 18 anos de idade; pesquisas realizadas somente com seres humanos; artigos publicados em língua inglesa; artigos com acesso completo irrestrito; pesquisas relacionadas aos objetivos do estudo. Análise dos dados foram analisados quanto aos seguintes itens: caracterização da amostra; profissionais envolvidos no processo da decanulação; etapas do processo de decanulação; tempo total em dias de uso da traqueostomia; tempo total em dias para concluir processo de decanulação; fatores de insucesso para conclusão do processo de decanulação. Resultados A maior parte da população estudada foi do gênero masculino e com alterações neurológicas. Dos profissionais envolvidos no processo de decanulação, participaram em ordem decrescente médicos, fonoaudiólogos, fisioterapeutas e enfermeiros. As etapas da decanulação mais citadas foram: avaliação da deglutição; treino de oclusão; avaliação da permeabilidade de passagem do ar; habilidade de manipulação de secreção e troca de cânula; desinsuflação do cuff e treino de tosse; uso de válvula de fala. Além disso, obtiveram-se dados a respeito do tempo total de traqueostomia e de decanulação. Conclusão A presença do fonoaudiólogo é extremamente importante no processo de decanulação, visto que a avaliação da deglutição foi a etapa mais citada nos estudos, sendo esse trabalho realizado em conjunto com médicos e fisioterapeutas.

Objective tests that quantify diseases are important in their diagnosis, treatment and prognosis.