GISELE CHAGAS DE MEDEIROS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
- Clinical swallowing prognostic indicators in patients with acute ischemic stroke(2019) LEITE, Karoline Kussik de Almeida; SASSI, Fernando Chiarion; MEDEIROS, Gisele Chagas de; COMERLATTI, Luiz Roberto; ANDRADE, Claudia Regina Furquim deA swallowing disorder is present in more than 50% of patients with acute stroke. Objective: To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. Methods: Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) and the verification of demographic and clinical variables. Results: The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 - ASHA1 (n = 51); levels 3, 4 and 5 - ASHA2 (n = 96); levels 6 and 7 - ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age >= 70 years); had anterior circulation infarct: had lower scores on the Glasgow Coma Scale (GCS <= 14 points); took longer to initiate swallowing rehabilitation: had longer hospital stays; made more use of alternative feeding methods: needed more sessions of swallowing rehabilitation to remove alternate feeding methods: took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). Conclusion: Patients with acute ischemic stroke, admitted to the emergency room, aged >= 70 years. score on the GCS <= 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.
- Decannulation: a retrospective cohort study of clinical and swallowing indicators of success(2022) ESCUDERO, Carina; SASSI, Fernanda Chiarion; MEDEIROS, Gisele Chagas de; LIMA, Maira Santilli de; CARDOSO, Paulo Francisco Guerreiro; ANDRADE, Claudia Regina Furquim deObjective: To investigate the clinical and swallowing indicators related to a successful decannulation process during the hospital stay. Methods: A retrospective cohort clinical study. The study sample comprised a heterogeneous patient population who had submitted to a tracheostomy procedure in a tertiary hospital. Patients were divided into two groups (decannulated vs. non-decannulated) and compared not only in terms of demographic and clinical data but also the results of a swallowing assessment and intervention outcome. Results: Sixty-four patients were included in the present study: 25 (39%) who had been successfully decannulated, and 39 (61%) who could not be decannulated. Between-group comparisons indicated that both groups presented similar clinical and demographic characteristics. The groups also presented similar swallowing assessment results prior to intervention. However, significant differences were observed regarding the time to begin swallowing rehabilitation. The decannulated group was assessed nine days earlier than the non-decannulated group. Other significant differences included the removal of the alternate feeding method (72.0% of decannulated patients vs. 5.1% of non-decannulated patients) and the reintroduction of oral feeding (96.0% of decannulated patients vs. 41.0% of non-decannulated patients) and functional swallowing level at patient disclosure. The non-decannulated patient group presented higher death rates at disclosure. Conclusion: The results of the present study indicated that the following parameters were associated with a successful decannulation process: early swallowing assessment, swallowing rehabilitation, and improvement in the swallowing functional level during the hospital stay. The maintenance of low swallowing functional levels was found to be negatively associated with successful decannulation.
- Clinical dysphagia risk predictors after prolonged orotracheal intubation(2014) MEDEIROS, Gisele Chagas de; SASSI, Fernanda Chiarion; MANGILLI, Laura Davison; ZILBERSTEIN, Bruno; ANDRADE, Claudia Regina Furquim deOBJECTIVES: 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.
- Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration(2016) MEDEIROS, Gisele Chagas de; SASSI, Fernanda Chiarion; ZAMBOM, Lucas Santos; ANDRADE, Claudia Regina Furquim de
- Characterization of feeding skills and clinical markers of preterm newborns with gastroschisis in a neonatal therapy unit(2023) SASSI, Fernanda Chiarion; RITTO, Ana Paula; SASSI, Daniela Chiarion; ANSUINO, Ana Carla; MEDEIROS, Gisele Chagas de; JUSTE, Fabiola; BEFI-LOPES, Debora Maria; ANDRADE, Claudia Regina Furquim deObjective: To describe the clinical and feeding findings of premature infants with gastroschisis (GTQ) in a neonatal intensive care unit and compare them to preterm infants (NBs) without congenital anomalies. Methods: A retrospective case-control study was conducted with 50 premature NBs (25 with GTQ and 25 without comorbidities - control group). The NBs were compared regarding demographic and clinical data: risk of mortality and speechlanguage assessment (nonnutritive and nutritive sucking). Subsequently, a multiple logistic regression model was applied to determine the variables associated with the negative speech therapy outcome (speech therapy discharge after more than 7 days considering the first speech therapy evaluation). Results: The results of the first analysis indicated that there was a difference between the GTQ and the CG for the following variables: total time in days of hospitalization; use of mechanical ventilation (invasive x noninvasive); days of life on the date of the first speechlanguage assessment; use of alternative feeding route; and the GTQ group had worse results. The results of the multiple logistic regression indicated that the diagnosis of GTQ, the use of invasive mechanical ventilation, and the absence of adequate intraoral pressure during the first speech-language evaluation were risk factors for a negative speech-language outcome. Conclusion: The feeding skills of preterm infants with QTG are related to the severity of the condition (gastrointestinal tract complications), requiring longer hospitalization, use of invasive mechanical ventilation, prolonged use of alternative feeding route and requiring more speech therapy to start oral feeding.
- Screening protocol for dysphagia in adults: comparison with videofluoroscopic findings(2017) SASSI, Fernanda C.; MEDEIROS, Gisele C.; ZILBERSTEIN, Bruno; JAYANTHI, Shri Krishna; ANDRADE, Claudia R. F. deOBJECTIVES: To compare the videofluoroscopic findings of patients with suspected oropharyngeal dysphagia with the results of a clinical screening protocol. METHODS: A retrospective observational cohort study was conducted on all consecutive patients with suspected oropharyngeal dysphagia between March 2015 and February 2016 who were assigned to receive a videofluoroscopic assessment of swallowing. All patients were first submitted to videofluoroscopy and then to the clinical assessment of swallowing. The clinical assessment was performed within the first 24 hours after videofluoroscopy. The videofluoroscopy results were analyzed regarding penetration/aspiration using an 8-point multidimensional perceptual scale. The accuracy of the clinical protocol was analyzed using the sensitivity, specificity, likelihood ratios and predictive values. RESULTS: The selected sample consisted of 50 patients. The clinical protocol presented a sensitivity of 50% and specificity of 95%, with an accuracy of 88%. ""Cough'' and ""wet-hoarse'' vocal quality after/during swallowing were clinical indicators that appeared to correctly identify the presence of penetration/aspiration risk. CONCLUSION: The clinical protocol used in the present study is a simple, rapid and reliable clinical assessment. Despite the absence of a completely satisfactory result, especially in terms of the sensitivity and positive predictive values, we suggest that lower rates of pneumonia can be achieved using a formal dysphagia screening method.
- Diagnostic precision for bronchopulmonary aspiration in a heterogeneous population(2020) LIMA, Maira Santilli de; SASSI, Fernanda Chiarion; MEDEIROS, Gisele Chagas de; JAYANTHI, Shri Krishna; ANDRADE, Claudia Regina Furquim dePurpose: The purpose of the present study was to assess the validity of a simple instrument for screening dysphagia used in a large public hospital in Brazil with heterogeneous adult population. Method: The Dysphagia Risk Evaluation Protocol (DREP) - screening version contains four items (altered cervical auscultation, altered vocal quality, coughing and choking before / during / after swallowing) that were previously indicated as independent risk factors associated to the presence of dysphagia in the swallowing test with water. Trained speech therapists administered and scored DREP - screening version to consecutive patients referred by hospital's medical team to perform Video Fluoroscopic for Swallowing Study (VFSS). Results: 211 patients received the swallowing screen (DREP): 99 failed and 112 passed. One in every five patients was randomized to receive a VFSS. The DREP screening version demonstrated excellent validity with sensitivity at 92.9%, specificity at 75.0%, negative predictive values at 95.5% and an accuracy of 80.9%. Conclusion: The DREP - screening version is a simple and accurate tool to identify the risk for penetration and / or aspiration in patients who are not tube-fed, who have a good level of alertness, have no history of recurrent pneumonia, are not on pneumonia, and that do not use a tracheostomy cannula.
- Oral transit time: a critical review of the literature(2015) SOARES, Thais Jacóe; MORAES, Danielle Pedroni; MEDEIROS, Gisele Chagas de; SASSI, Fernanda Chiarion; ZILBERSTEIN, Bruno; ANDRADE, Claudia Regina Furquim deINTRODUCTION: Oral transit time is one of the parameters observed during the clinical assessment of the swallowing function. The importance of this parameter is due to its impact on the total duration of a meal, whose consequence can be an unfavorable nutritional prognostic. OBJECTIVE: To document scientific papers that measure oral transit time in healthy subjects. METHOD: The review followed the steps proposed by the Cochrane Handbook. The search was done via the PubMed database through the use of descriptors related to the oral phase of swallowing, as well as to types of food consistency. RESULTS: The articles on the theme had different definitions for oral transit time, as well as heterogeneity of tested volumes, age and gender of the participants. The times found varied from 0.35 s to 1.54 s for liquids, from 0.39 s to 1.05 s for pasty foods and from 1 s to 12.8 s for solid foods. Also, regardless of volume or consistency, oral transit time in elderly people is significantly longer than in adults. CONCLUSION: There's no consensus in the literature about oral transit time in healthy subjects. However, this parameter should be valued during the assessment of the swallowing function due to its negative impact on the dynamics of swallowing, which can cause high energy expenditure during feeding.
- Preliminary results of a clinical study to evaluate the performance and safety of swallowing in critical patients with COVID-19(2020) LIMA, Maira Santilli de; SASSI, Fernanda Chiarion; MEDEIROS, Gisele C.; RITTO, Ana Paula; ANDRADE, Claudia Regina Furquim de
- USE OF SILICONE BRACELET TO SIGNAL RISK OF BRONCHOASPIRATION IN A HOSPITAL SETTING(2020) ANDRADE, C.; SASSI, F.; MEDEIROS, G.