Patients with dysphagia suffer from various degrees of difficulty in eating or swallowing. To improve their oral intake, meals must be provided with due consideration given to individual patient's eating ability. In this study, we examined a newly developed grading system of oral nutrition, which comprised 5 grades (I-V) based on the degree of difficulty in swallowing each formula. Grades I-III are meals suitable for swallowing training, grade IV represents meals that were enough to meet nutritional requirements, and grade V meals for the preparatory stage leading up to the changeover from liquid to solid foods.
  To assess the 5-step grading system of oral nutrition, we worked out average ingestion rates in 23 patients with dysphagia. The ingestion rate was 75±21% for patients on grade IV oral nutrition, and 74±19% for those on grade V, with a combined rate of 74±20%. This was higher than the average ingestion rate in a previous study conducted before our introduction of the grading system for oral nutrition (Journal of the Japanese Association of Rural Medicine 57: 83-88, 2008). We considered the surveillance data showed tendency to support the 5-step grading system, and in a case with dysphagia, this system actually brought about a remarkable improvement in ingestion. It has been introduced in our hospital since July 2008.

To prevent protein-energy malnutrition in elderly inpatients with dysphagia, weexamined the current meals for them in detail. The thickeners seemed to be a ploblem. Changes of viscosity over time and temperature were reduced when a starch thickener was changed to a xanthan gum thickener. When a gelatinizer was added to soft meals to allow cutting into shape, etc., the meals looked better were less sticky, more cohesive, and easier to eat. Thus, the smooth texture required of meals for dysphagia patients was obtained. When conventional mixed meals were changed to soft meals, there was an improvement of appearance and the meals became more palatable.The change of food intake after these improvements was investigated in five inpatients who had difficulty in swallowing. Food intake was increased in four of these five patients after these improvements, suggesting that their appetite might have been increased by improvement of the appearance and palatability of their meals. We will continue making improvements of these meals in hopes that patients can eat solid food again as early as possible.
Deglutition Disorders ; Eating ; Energy, Physics ; Solid ; Malnutrition

  Dietary management during chemotherapy for cancer can improve a patient's nutritional status through an adequate dietary intake, and increase the therapeutic effect.  In this study, we performed a questionnaire survey of inpatients in chemotherapy about their dietary preferences and changes in their senses of taste and smell, with the aim of producing a ‘chemotherapy menu’, utilizing recipes and foodstuffs to produce a palatable menu for those patients with their appetite diminished. We received responses from 102 out of 109 in patients surveyed (94%). Of the respondents, 66% rerealed that they had a decrease in appetite during chemotherapy, of whom 85% complained of extremely poor appetite. The smell of fish dishes disturbed 29% of the respondents, of whom 62% reported a stronger aversion to hot dishes. The foods easy to eat were found to be fruits, noodles, and soups. Meat and fish dishes, white rice, and stews were difficult to eat. Seasoning with tomato sauce made food difficult to eat for 44% of the respondents, whereas soy sauce was shunned by only 6%. The survey also found that 38% liked the use of Furikake (dried seasoning sprinkles), because it could make the meals palatable.  Based on the survey results, we devised an 8-day ‘chemotherapy menu’. It includes a Japanese style breakfast, with bread as an option, and many foods easy to eat, such as flavoured rice, sushi, noodles, sandwiches, and fruits. We have offered this menu to 47 inpatients, with average eating rates of greater than 70% for both rice and dishes. We will further conduct surveys with a view to producing a ‘chemotherapy menu’ palatable for as many patients as possible.

Background: and Purpose To assess the long-term outcomes of intracranial dural arteriovenous fistula (DAVF) treated with stereotactic radiosurgery (SRS) alone or embolization and SRS (Emb-SRS) and to develop a grading system for predicting DAVF obliteration. Methods: This multi-institutional retrospective study included 200 patients with DAVF treated with SRS or Emb-SRS. We investigated the long-term obliteration rate and obliteration-associated factors. We developed a new grading system to estimate the obliteration rate. Additionally, we compared the outcomes of SRS and Emb-SRS by using propensity score matching. Results: The 3- and 4-year obliteration rates were 66.3% and 78.8%, respectively. The post-SRS hemorrhage rate was 2%. In the matched cohort, the SRS and Emb-SRS groups did not differ in the rates of obliteration (P=0.54) or post-SRS hemorrhage (P=0.50). In multivariable analysis, DAVF location and cortical venous reflux (CVR) were independently associated with obliteration. The new grading system assigned 2, 1, and 0 points to DAVFs in the anterior skull base or middle fossa, DAVFs with CVR or DAVFs in the superior sagittal sinus or tentorium, and DAVFs without these factors, respectively. Using the total points, patients were stratified into the highest (0 points), intermediate (1 point), or lowest (≥2 points) obliteration rate groups that exhibited 4-year obliteration rates of 94.4%, 71.3%, and 60.4%, respectively (P<0.01). Conclusions SRS-based therapy achieved DAVF obliteration in more than three-quarters of the patients at 4 years of age. Our grading system can stratify the obliteration rate and may guide physicians in treatment selection.