Construction And Implementation Of The Management Program Of Stroke Patients With Dysphagia Based Evidence

ObjectiveIn order to acquire dysphagia' s experience and requirements and the dysphagia patients's current situation of management.this research combined evidence searching,qualitative interview,expert meeting and clinical empirical research to build the intervention in stroke patients with dysphagia.Scientific,normative and persistent intervention measures are expected to promote outcomes of the stroke patients.Methods1 In order to understand the dysphagia patients's current situation of management,Doctors and nurses of neurology department were selected as objects of the study with the approach of semi-structured interview of qualitative research in the idea of purposive sampling;Dysphagis patients' requirements were got with the same way;Medical expels and nursing specialists's knowledge about dysphagia were acquired using a self-designed questionnaire.This research was attempted to make proper supplements and lay a foundation of developing the management program.2 In addition to evidence based guidelines and systematic review of management of dysphagia patients,Meta analysis were conducted to find whether intermittence oro-esophageal tube feeding and ice/sour massage were useful for dysphagia patients.3 Depend on Joanna Briggs Institute Reviewers'Manual and Grade System Classification of Quality of evidence and strength of recommendation(2010),evidence was integrated and graft of the management program was formed.A panel meeting including medical expels and nursing specialists of neurology department,rehabilitation specialists and nutrition specialist was organized to make amendments and form text of the management program.4 A non-randomized controlled trial was conducted to assess clinical effectiveness of the management program.Objects of the study were eligible patients who underwent Neurology department in one grade-? general hospital from January 2017 to January 2018.Patients were divided into two groups.Patients who underwent Neurology department from January 2017 to June 2017 were assigned to the controlled group which received usual care,while patients from August 2017 to January 2018 to the intervention group.We compared baseline information,screen rate of the dysphagia,knowledge of the staff,incidence of stroke-associated pneumonia,length of hospital stay and hospitalization expense and other indicators of the two groups.IBM SPSS Statistics Version 17.0 was used to perform statistical analysis,when a p-value of<0.05 was considered statistically significant.The data were analyzed with methods as descriptive statistic or non-parametric test;Chi-square test was used for comparison of constituent ratio or rate.Results1 Qualitative research of the neurology staff was extracted four related topics while patietns's requirement five related topics,respectively.Semi-structured interview found that 84.22%of the doctors and nurses had poor knowledge of dysphagia,34.22%of the staff had poor behavior.2 According to the evidence researching,9 clinical guidelines and 31 systematic review were got.8 randomized controlled trials and 17 randomized controlled trials were included separately in the meta analysis about the intermittence oro-esophageal tube feeding and ice/sour massage for dysphagia patients.3 Management program for stroke patients with dysphagia had been developed with expels meeting in structure and contents.This program included screening,evaluation,treatment,complication prevention,education and training,also with tools and flows.4 The comparison between intervention group and control group showed the effect of intervention group is more notable in screening rate of dysphagia and nutrition risk,knowledge of the staff,incidence of stroke-associated pneumonia,length of hospital stay and hospitalization expense and other indicators of the two groups(p<0.05).Conclusion1 According to 9 clinical guidelines,31 overview of the systematic reviews,2 meta analysis and supplements of qualitative research,this research had formed a scientific and normative management program for stroke patients with dysphagia with approaches of evidence searching,qualitative interview and expert meeting.2 The feasibility and validity of this management program for stroke patients with dysphagia was testified under quasi-experiment,proving that the outcomes of patients can be greatly improved with significant effects.It serves as an instruction for clinical intervention.