PEN eNews 13(3) March 2023 - Nephrology - All Kinds of Updates!
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® eNews is a monthly e-newsletter shared with the global PEN Community and created to help dietitians position themselves as leaders in evidence-based nutrition practice. In addition, users of the PEN System will find articles on the new evidence, resources and features available and how to maximize one's use of PEN.
What is the Latest on Dysphagia?
The Question
Among individuals with dysphagia, is the use of thickened liquids versus thin liquids associated with better clinical outcomes (lower risks of aspiration, pneumonia, death), hydration and quality of life?
Recommendation
Dementia and/or Parkinson's Disease
In individuals with dementia and/or Parkinson’s disease who have swallowing disorders/dysphagia, the effects of thickened liquids are uncertain. This is based on limited evidence, which suggests that thickened liquids compared to regular fluids (given in chin-down head posture) may have an immediate effect on decreasing the risk of aspiration; however, greater adverse effects (e.g. dehydration, urinary tract infection, fever and possibly pneumonia) and increased dissatisfaction with thickened fluids have been reported over three months.
Post-Stroke
In individuals with post-stroke dysphagia, limited evidence suggests no difference in the risk of pneumonia when individuals consume thin liquids, using safe swallowing strategies (such as proper positioning of the body, head or neck; oral care; intake of thin water between meals) compared with those consuming thickened liquids only. There is insufficient evidence to draw conclusions on whether the long-term use of thickened liquid is related to a higher incidence of dehydration or poorer quality of life (QoL) in this population.
Maxillary Carcinoma
In individuals with maxillary carcinoma who underwent total maxillectomy, limited evidence suggests that xanthan gum-based thickened liquid, compared to regular liquids, can improve hydration status and dysphagia-related QoL.
Additional research is required to establish a stronger quality of evidence for the risks and benefits of the use of thickened liquids for different patient populations with dysphagia.
Country-specific Guidelines
A 2022 guideline from the Danish Centre for Clinical Guidelines for oropharyngeal dysphagia provides a weak recommendation against the use of textured modified liquids based on no difference between thickened and thin fluids on the risk of pneumonia or death and reduced QoL.
The 2018 ESPEN guidelines on clinical nutrition in neurology suggests that texture-modified diets and thickened liquids may reduce aspiration in individuals with stroke and dysphagia and may lead to reduced energy and fluid intake. The guidelines acknowledge a lack of evidence on positive and adverse effects of texture-modified diets in stroke patients with dysphagia.
To see the full practice question, including the Evidence Summary, Evidence Statements, Remarks, Comments, Rationale and References, click here.
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How Do I … Sort Through the PEN® System to Find Tools and Resources?
Here’s how to sort to find the tools and resources in the PEN System:
Go to any Knowledge Pathway of interest (example: Irritable Bowel Disease) and click on Related Tools and Resources on the right-hand side of the screen.
You can click on one or all three of the orange boxes (audience, country, language) to sort through the results and find the tools and resources you need:
Available options you can sort by:
- Audience: consumer or professional
- Country: Australia, Canada, Europe, Japan, Ireland, New Zealand, South Africa, United Kingdom, United States
- Language: English, French, Chinese, Gujarati, Hindi, Indigenous Australian languages, Japanese, NA Aboriginal native languages, NZ Maori, Pacific Island languages, Punjabi, South Asian, Spanish, Tamil, Urdu, Vietnamese, Welsh
You can also access all PEN-created consumer handouts through the PEN Handout Collection on the PEN home page:
After clicking on the handout collection icon you will be directed to a variety of collections. Each contains PEN-developed client handouts in English with most translated into French, and some are also available in other translations and cultural adaptations.
Here's an example of handouts available for Reactive Hypoglycemia under the 'Health Condition' collection:
En - English Fr - French Sp - Spanish Pun - Punjabi Ch - Chinese Vi - Vietnamese
As always, we welcome your feedback.
PEN® Resource Manager:
Jane Bellman MEd, RD
jane.bellman@dietitians.ca
Reposted from a previous eNews Article.
PEN® Summary of Recommendations and Evidence: Where Evidence and Practice Guidance Meet
Short on time, but need a quick and comprehensive overview of the evidence on a topic area? The Summary of Recommendations and Evidence (SRE) is your new favourite tool. The SRE organizes all the questions in a knowledge pathway by topic. It is your one-stop shop to find the key practice points (including recommendations and graded evidence) for the topics covered in the knowledge pathway. The SRE replaces the Evidence Summary, which was a synthesis of just the evidence part of the key practice points, organized by evidence grade level. The SRE is a stand-alone tool and is mirrored in the Practice Guidance Toolkit, replacing the Key Findings and Recommendations section.
There are now more than 200 Knowledge Pathways in the PEN System, which means that we have many SREs to create! So far, we have created more than 90! The remainder of SREs will be in the former Evidence Summary format until content in those KPs are updated or new content is added.
Here are the latest new or updated Summaries of Recommendations and Evidence:
PEN eNews
March 2023 Volume
13 (3)
A Publication of the PEN® System Global Partners,
a collaborative partnership between International Dietetic Associations.
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