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Good evening everyone! Thanks for the opportunity to listen and learn from you! :)
I'm having a hard time hearing you and my volume is up to max
the sound is good on my end
Volume is working alright on my end
I figured it out.
i am not hearing!!
will the recorded version be accessible for a later watch?
if N95's are not available, are KN95's considered an adequate substitute?
Once the negative COVID test results are confirmed for inpts, does ASHA still recommend N-95 masks for all AGPs.
Yes - the recording will be available later.
Are any of the speakers doing FEES with COVID positive patients?
In my outpatient clinic, our company has just issued guidelines in the past 2 weeks that, in addition to the N95 and other PPE, we also are required to close off the room for 2 hours after any dysphagia treatment/evaluation (COVID positive or not due to unknown status). This is theoretically to allow the aerosolized particles to settle. This has been extremely difficult with regards to scheduling in a small outpatient clinic with only 2 rooms available. Would you think this 2 hour window is necessary?
I have heard one hour in some settings too.
We have been told it is dependent on the rate at which the HVAC system circulates the air
Would the panelists consider a LSVT or Speak Out! session to be an AGP?
What about doing EMST with a COVID negative pt?
what about children with tube feeding? how we can help them?
We've actually been using EMST with COVID recovered patients due to their new SOB impacting speech. It's been a population we've found really benefits from it
What about IOPI?
Was curious if anyone had opinions on diet recommendations (in the acute setting) for specifically patients who have had poor O2 Sats, and a high level O2 requirement. They may be at risk for aspiration due to the level of O2, not necessarily an oral or pharyngeal Dysphagia at baseline. It felt very subjective at times?
To what extent have covid symptoms impacted diet recommendations?
when needed we complete an MBS but our infection control restricts us from FEES with Covid +
despite the appropriate PPE available
please comment on tests used that are validated for use via tmannerelepractice or how you have made recommendations in a non-standardized
Can somebody comment on the safety aspects of doing a bedside clinical swallow eval via telehealth? Has anybody instructed patients to take foods/liquids trials during a telehealth session?
use via telepractice
I would love to hear the panelists (or attendees) thoughts/ideas/barriers faced related to training SLP students in dysphagia assesment and management during the pandemic.
Thanks for the purdue link
how long of a time is a rest?
what about continuous PPE for all covid patients? is that recommended or frowned upon?
I work at a CIRH/LTACH (HIH) so the host hospital provides our MBSS. The issue I am running into now is they are still requiring 2 negative covid swabs before they will test. As you all know patients will test negative and then positive or indeterminate before we can get 2 negatives and I find it is delaying their progress. I have made the clinical decision to advance some of their diets without the modified...
Can you comment Luis???
what about FEES in a SNF setting?
yes, I would definitely agree with that!!
when we had push back from radiology for covid +mbs we linked hospitalist to radiologist for peer to peer discussion
I believe you can definitely do more during the clinical bedside evaluation that we realize.
Kevin Kent I would love to hear about opinions of the panel of mobile FEES in a SNF setting ............
cervical auscultation, done correctly, is very valuable right now
Where can we find this reference list? Will it be sent out?
I agree Susan Browning.
where can we find some resourses about manners how we can work with patients with disphagia ?
References available in the SLP Health Care Library. You will need to login to your account.https://community.asha.org/viewdocument/dysphagia-management-during-covid-1?CommunityKey=f1b028b3-5098-4091-b854-2bdee3dec2b7&tab=librarydocuments&LibraryFolderKey=&DefaultView=folder
speaking of oral care- I’ve seen patients that were proned for days with terrible labial, facial and lingual wounds. how are you managing that in terms of oral care and and swallowing?
We all know oral care doesn't really exist in a SNF setting
That question came up today - how is oral care getting done in the prone position? We have seen patients with pressure sores on their face from being prone.
I agree with Susan Browning too! In some circumstances, observation and the clinical bedside gives us more information than the MBSS, which only gives us a snapshot in time (especially with very frail /elderly clients). Many of us are under-confident in our clinical evaluation ability
Published 7/27/2020, was the validation of the Yale Swallow Protocol for post-acute care. This can help u make decisions for instrumentals or not with a well done Yale Swallow Protocol. We heard from author, Matt Ward, on Ed Bice’s Journal club on facebook last night. article Validation of the Yale Swallow Protocol in Post Acute Care: A Prospective Doubleblind, Multirater Study. This is great news for SLPs who work outside of the acute setting! The article can be found at this link: https://pubs.asha.org/doi/10.1044/2020_AJSLP-19-00147?fbclid=IwAR26NTcyjFL7EnrnhltVm2ewLStdC_6GbXvotiB_XEV83Ixt70fMwDaz8R4
I have worked in post acute/snf since 2001. My experience has been a long standing history of limited instrumental studies available. this conversation is fabulous!
I agree with you too Isabel!
Kudos Dr. Riquelme for your emphasis on quality of life and focusing on humanity/treating the person! God bless common sense - not so common. Thank you for recommending holding off on intubation and using then smaller cannulas. Now, if we can only convince the medical staff.
Our facility does not allow MBS for COVID+ patients.
well said Susan
I agree with Susan W too!!!
Thank you! One for all and all for one. Speech must advocate for those who cannot do so for themselves. Frankly, it's scary how little other disciplines know about swallow function.
Mobile FEES thoughts in LTC ?
In home care in AZ, I’m seeing patients whose families received minimal info about the acute care dysphagia assmt tx, making collaboration more important than ever. I’ve had great response from acute SLPs, thanks!
our endoscopists aren't allowed in the building to perform the fees currently
We allow them in for most states with screening.
It's happening ............
AZ has mobile FEES
We are trying to re-start out FEES program in acute care with restrictions
Any input on COVID proning and laryngeal trauma?
anyone doing VitalStim and seeing the increased need for that?
I have seen pressure sores
I have heard Dysphagia Management Systems is doing it in some areas when allowed
We are assessing the clinical need and allowing it on a case by case basis.
Yes, very common. Nursing will typically take care of the pressure sores. Eventually with time it heals.
wound care sees them at my facility
what about abnormal oral mech exams after proning?
without neurological changes
Good perspectives, Luis! Thank you!
Great paper! Never before in the history of medicine has the need for collaborative care been more pronounced.
Thank you to the moderator and panelists for giving so generously of your time and knowledge.
we are doing out patient FEES after Covid test with negative results
Yeah Rinki! thanks
Thank you all so very much! As weird as this all is, we are going to be a stronger profession for navigating through this together. :)
Where can I get a copy of the Reference list?
thank you all!!
Great presentation Thank you !!!
Thank you! Thank You!
References available in the SLP Health Care Community Library. You will need to login to your account.https://community.asha.org/viewdocument/dysphagia-management-during-covid-1?CommunityKey=f1b028b3-5098-4091-b854-2bdee3dec2b7&tab=librarydocuments&LibraryFolderKey=&DefaultView=folder
yes, an excellent discussion!
Thank you panelists for your time!!
Thank you all so much. This discussion has been so useful :)
+Just a big thank you. Quick question…What face shield do you like? Ive been disappointed in all trials so far
Thank you, everyone. This was very helpful!
Thank you to the panelists and moderator for giving us their time to discuss such an important topic!
ASHA - thanks for link! here it is again: References available in the SLP Health Care Library. You will need to login to your account.https://community.asha.org/viewdocument/dysphagia-management-during-covid-1?CommunityKey=f1b028b3-5098-4091-b854-2bdee3dec2b7&tab=librarydocuments&LibraryFolderKey=&DefaultView=folder
Thank you so much for your time and knowledge.
Thank you so much for your time and information!
Thank you everyone!
Final comment: no matter what the dx/how grave the diagnosis/how critical the situation, important to remember that we are treating PEOPLE.
Thank you so much!
yes, we are treating family and friends! so important to remember this.
Luis, yes! Opportunities to promote, support. Well said.
thank you stay safe and healthy
Thank you! This was very informative!
Many thanks to all speakers….we need to continue these….
Thank you to all the panelists for hosting this!
Thank you so much everyone, it was wonderful hearing from you all!!!
thanks again everyone!
This was very informative! Thank you!
Wonderful! Thank you!
Appreciate the time and information!
wonderful presenters, thank you!