The PhINEST study - Pharyngeal ICU Novel Electrical Stimulation Therapy Study protocol of a prospective, multi-site, randomized, sham-controlled, single-blind (outcome assessor-blinded) study

Introduction: Post-extubation dysphagia is commonly observed in ICU patients and associated with increased aspiration rates, delayed resumption of oral intake/ malnutrition, prolonged ICU and hospital length of stay, decreased quality of life, and increased mortality. Conventional therapeutic approaches are limited. Pharyngeal electrical stimulation (PES) was previously shown to improve swallowing function and airway safety in severely dysphagic tracheostomised stroke patients. Methods: In a multi-center, single-blind, 1:1 randomized controlled study, up to 400 (360 evaluable) mixed emergency adult ICU patients with recent extubation following mechanical ventilation and confirmed oropharyngeal dysphagia will be enrolled at investigational academic ICUs. Primary objective is to evaluate the effectiveness of PES in reducing the severity of unsafe swallows. Patients will be randomized to receive PES (or sham) treatment on 3 consecutive days in addition to best supportive care. Primary endpoint is a composite of 2 endpoints with hierarchy based on clinical priorities: 1) Swallowing safety based on worst penetration-aspiration-scale (PAS) score in series of up to 4 boli using thin stimuli approx. From 24 to 60 hours after treatment completion, converted to a trichotomized ordinal response of safe (PAS 1-3), penetration (PAS 4-5), or aspiration (PAS 6-8). 2) Dysphagia Outcome and Severity Scale scores determined by bedside assessment 7 +/- 1 days after treatment completion. Oropharyngeal dysphagia will be assessed by Fiberoptic Endoscopic Evaluation of Swallowing by blinded study staff. Patients will be followed-up for a maximum of 90 days. Discussion: This study will evaluate the effects of PES on swallowing safety in critically ill ICU patients post mechanical ventilation with oropharyngeal dysphagia.Peer reviewe

Review of \u3ci\u3eTrans.Can.Lit.: Resituating the Study of Canadian Literature\u3c/i\u3e Edited by Smaro Kamboureli and Roy Miki

Encompassing an approach to the study of Canadian -literature that resulted in a conference held in Vancouver in 2005, this collection of a preface and thirteen chapters begins with Diana Brydon\u27s keynote address setting up the superordinates -Literature, Institutions, and Citizenship-to explore a discourse on Canadian literature\u27s future. That process leads toward our national literature in global contexts and in dialogue with Indigenous concerns. In effect, Trans.Can.Lit. means translation, transcontinental railroad, travel, trance, and globalization. Lee Maracle\u27s chapter on Salish thinkers and orators who help their people to see Ourselves Through Story vs. Western Models criticizes the Institutions of the diaspora that claim the right to establish dominion over other people\u27s educational and literary values. Dismissing the preponderance of global privilege, she claims the Salish are free to challenge the powerful by claiming their own narrative history which has created the body of knowledge of the nation and shaped the oral tradition, which then the listeners use to govern themselves. Thus, the past leads to the future