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conversations.value: a description for a book titled The Encyclopedia of Elder Care about Bookviews.com, November with the genre: New, Used & Rental Textbooks, Medicine & Health Sciences
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conversations.value: "Just about any question one might have is answered in this book..." -- Bookviews.com, November 2004
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conversations.value: the first four paragraphs for this book
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conversations.value: The Encyclopedia of Elder Care
  Patient satisfaction has been widely used as a measure of quality of care. Satisfaction has traditionally been measured with a variety of instruments and methods, with little agreement or consistency regarding how to interpret findings, how to utilize them, or even what is being measured. Despite this, providers of health and health-related services have devoted considerable resources to collecting and analyzing satisfaction data. Satisfaction scores have been used to identify quality problems and target interventions to address them. Increasingly, patients' experiences with care have been utilized to address demands by payers, accrediting agencies, policy-makers, and consumers for greater levels of accountability for quality of care and more patient-centered care.
  Traditionally, a typical patient satisfaction survey included one or more general questions regarding the overall quality of care, often involving choices along a Likert-type scale. In addition, such survey instruments usually include questions regarding specific services (e.g., nursing, therapy) and may also include questions regarding specific elements of care such as the quality of communications with staff, timeliness, and other interpersonal aspects of care. Patient satisfaction surveys have generally been designed and distributed by one of several vendors.
  This traditional approach to patient satisfaction faced criticism for several reasons, including lack of rigor and a focus on items unrelated to quality of care (Cleary, 1999). Scores on satisfaction surveys that consist primarily of general, "global" satisfaction questions are typically high, with results often showing greater than 90% of respondents rating their care as "excellent" or "very good," or rating themselves as "very satisfied" or "satisfied" with their care. Such results do not necessarily preclude efforts to analyze and understand variance within those scores or to focus on outliers as a signal to investigate possible quality problems. For instance, if a home health agency's satisfaction surveys typically yield high scores but one team or field office is showing consistently lower scores, it will most likely be useful to find out why. Still, lack of variance limits the use of traditional patient satisfaction surveys as a quality improvement tool.
  Lack of standardization also presented a problem. Benchmarking was generally limited to providers using the same contractors. Satisfaction survey instruments and results were generally proprietary, further limiting reliable comparisons of providers' scores.
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conversations.value: three more paragraphs
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conversations.value: Swallowing disorders occur in all age groups and can be produced by a wide variety of pathologies (i.e., neurologic and medical problems or structural abnormalities). The resulting impairment may range from very mild to life threatening. It is, however, necessary to distinguish the effect of usual aging changes from the effects of specific diseases or degenerative changes. Indeed, non-dysphagic elderly may have altered function without impairment. With increasing age, several changes can be observed: increased stiffness of the upper esophageal sphincter, progressive lengthening of the duration of the hyoid movement, and shortening of the duration of the laryngeal closure, among others. These changes are congruent with a general impression that aging per se does not lead to pathology, but it puts the aging person at risk for swallowing problems if some pathology is present. As such, aspiration is likely to be the result of pathology and not due to normal aging.
  A patient who complains about difficulties swallowing certain foods or liquids may have a swallowing disorder. Globus sensation or a feeling of a lump in the throat is usually not related to swallowing and should not be confused with dysphagia. Regurgitation, or the return of undigested food or liquid, may have different causes; delayed regurgitation of undigested food is suggestive of a Zenker diverticulum. Odynophagia, or painful swallowing, is most commonly due to acute disorders such as a pharyngitis. Aspiration is defined as food (i.e., liquids or solids) entering the airway below the level of the true vocal cords (Logemann, 1998; Lundy et al., 1999). Coughing usually indicates that liquid or food has entered the airway, but some patients do not cough when they aspirate (i.e., "silent aspiration"). A gurgly voice quality after swallowing indicates that food remains in the larynx.
  Evaluation of a person who has a swallowing disorder requires a multidisciplinary approach. It should always start with a careful clinical evaluation, in collaboration with a speech-language pathologist.
conversations.from: human
conversations.value: Delete the first sentence.
conversations.from: assistant
conversations.value: e., neurologic and medical problems or structural abnormalities). The resulting impairment may range from very mild to life threatening. It is, however, necessary to distinguish the effect of usual aging changes from the effects of specific diseases or degenerative changes. Indeed, non-dysphagic elderly may have altered function without impairment. With increasing age, several changes can be observed: increased stiffness of the upper esophageal sphincter, progressive lengthening of the duration of the hyoid movement, and shortening of the duration of the laryngeal closure, among others. These changes are congruent with a general impression that aging per se does not lead to pathology, but it puts the aging person at risk for swallowing problems if some pathology is present. As such, aspiration is likely to be the result of pathology and not due to normal aging.
  A patient who complains about difficulties swallowing certain foods or liquids may have a swallowing disorder. Globus sensation or a feeling of a lump in the throat is usually not related to swallowing and should not be confused with dysphagia. Regurgitation, or the return of undigested food or liquid, may have different causes; delayed regurgitation of undigested food is suggestive of a Zenker diverticulum. Odynophagia, or painful swallowing, is most commonly due to acute disorders such as a pharyngitis. Aspiration is defined as food (i.e., liquids or solids) entering the airway below the level of the true vocal cords (Logemann, 1998; Lundy et al., 1999). Coughing usually indicates that liquid or food has entered the airway, but some patients do not cough when they aspirate (i.e., "silent aspiration"). A gurgly voice quality after swallowing indicates that food remains in the larynx.
  Evaluation of a person who has a swallowing disorder requires a multidisciplinary approach. It should always start with a careful clinical evaluation, in collaboration with a speech-language pathologist.
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conversations.value: the last four paragraphs
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conversations.value: A recently completed phase 1 clinical trial with adenoviral-mediated aquaporin-1 cDNA transfer to a single irradiated parotid gland was shown beneficial in treating patients with radiation-induced xerostomia (Baum et al., 2012).
  Salivary gland hypofunction is not reversible. However, preventive measures and conservative treatments can avoid or limit mucosal breakdown, infections, and permanent damage to teeth. Symptomatic relief may be obtained with local measures and systemic secretogues in many patients. As clinicians, we should establish clear diagnoses, make certain that patients understand the causes of their dry mouth, and deliver the most efficacious preventive and management techniques available.
  The presence of saliva impacts our daily activities. Saliva is required for support of the basic functions of the oral cavity—alimentation and communication. Management of symptoms and increasing saliva output may help patients feel more comfortable and improve the quality of their lives. Xerostomia may represent an adverse drug event and thus the patient's medication list should be critically reviewed.
  U.S. Department of Agriculture's terminology U.S. Department of Agriculture Economic Research Service,