Abordaje dietético de la disfagia orofaríngea en establecimientos de salud públicos y privados de la República Argentina, año 2021: Estudio Exploratorio.

I Introduction: Dysphagia refers to the alteration in the swallowing process; its treatment requires a multidisciplinary approach to ensure the safety and efficacy of feeding. The aim of this study was to describe the existence and characteristics of interdisciplinary teams in the treatment of oropharyngeal dysphagia (OPD) in adult and pediatric patients, and the use of typifications of oral diets adapted for this purpose, in health institutions with hospitalization in the Argentine Republic. Methodology: exploratory study. Non-random sampling. A self-designed questionnaire aimed at Registered Dietitians was applied. Data was processed with VCCStat – Beta3.0®. Descriptive statistics were calculated with CI 95%. Results: 100 health institutions were sampled, from 22 districts. 38% (IC 95% 28,6-48,3) had interdisciplinary teams for the treatment of OPD, and only 12% were well formed and fully operational. 75.8% (IC 95% 63,0-85,4) reported that the greatest difficulty in forming an interdisciplinary team was the lack of professionals linked to OPD treatment. 40% (IC 95% 30,5-50,3) did not have standardized diets designed for this group of patients. Only 11% and 6% of institutions used IDDSI nomenclature to describe consistency of food and beverages. Conclusions: in most cases there were no interdisciplinary teams for treatment of patients with OPD, neither standardized diets nor consensus regarding the nomenclature used to describe textures and consistencies. Training and specialization of health professionals and the will of each institution to promote interdisciplinary teams to treat OPD are urgently needed.Introducción: La disfagia hace referencia a la alteración en el proceso deglutorio; su tratamiento requiere un abordaje multidisciplinario para garantizar la seguridad y eficacia de la alimentación. El objetivo fue describir la existencia y características de equipos interdisciplinarios para el abordaje de la disfagia orofaríngea (DOF) en pacientes adultos y pediátricos, y el uso de tipificaciones de planes de alimentación adaptados a tal fin, en establecimientos de salud con internación de la República Argentina. Metodología: estudio exploratorio. Muestreo no aleatorio, por conveniencia. Se aplicó un cuestionario de diseño propio dirigido a Licenciados en Nutrición. Los datos fueron procesados con VCCStat – Beta3.0®. Se calcularon porcentajes, medidas de tendencia central y dispersión, e IC95%. Resultados: La muestra quedó conformada por 100 establecimientos de 22 provincias. Sólo el 38% (IC 95% 28,6-48,3) contaba con equipos interdisciplinarios para el abordaje de la DOF, y apenas el 12% estaba bien conformado y en pleno funcionamiento. En el 75,8% (IC 95% 63,0-85,4) de los casos la principal dificultad percibida para su conformación fue la falta de profesionales vinculados al abordaje de la DOF. El 40% (IC 95% 30,5-50,3) no contaba con listas de menú tipificadas para la alimentación oral adaptada de pacientes con DOF. Sólo un 11% y 6% de las instituciones utilizaban la nomenclatura propuesta por IDDSI para describir las consistencias de líquidos y alimentos, respectivamente. Conclusiones: En la mayoría de los casos no existían equipos interdisciplinarios para el abordaje de la DOF. Tampoco existían planes de alimentación de textura modificada tipificados ni consenso respecto a la nomenclatura para describirlos. La capacitación y especialización de los profesionales de la salud y la decisión de cada institución para fomentar la conformación de equipos interdisciplinarios son hoy una necesidad.

Surgical vs. transcatheter aortic valve replacement in patients over 75 years with aortic stenosis: sociodemographic profile, clinical characteristics, quality of life and functionality

Background Aortic valve stenosis (AVS) affects 25% of the population over 65 years. At present, there is no curative medical treatment for AVS and therefore the surgical approach, consisting of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR), is the treatment of choice. Methodology The aim of this study was to analyze the sociodemographic and clinical characteristics, quality of life and functionality of a sample of patients with AVS over 75 years of age, who underwent TAVR or SAVR, applying standard clinical practice. A prospective multicenter observational study was conducted in two hospitals of the Spanish National Health System. Data were collected at baseline, 1, 6 months and 1 year. Results In total, 227 participants were included, with a mean age of 80.6 [SD 4.1]. Statistically significant differences were found in terms of quality of life, which was higher at 1 year in patients who underwent SAVR. In terms of functionality, SAVR patients obtained a better score (p < 0.01). However, patients who underwent TAVR began with a worse baseline situation and managed to increase their quality of life and functionality after 1 year of follow-up. Conclusion The individualized choice of TAVR or SAVR in patients with AVS improves patients? quality of life and function. Moreover, the TAVR procedure in patients with a worse baseline situation and a high surgical risk achieved a similar increase in quality of life and functionality compared to patients undergoing SAVR with a better baseline situation.Funding. This work was supported by the Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL) (Next-Val Program). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript