Swallow screening at admission linked to less hospital-acquired aspiration pneumonia

The edition in brief

In 12,374 adults admitted to general wards at one Japanese hospital, patients who went through a nurse-led admission dysphagia screen (a symptom questionnaire, a saliva swallow test and mealtime observation) had less hospital-acquired aspiration pneumonia than those who did not, 0.8% against 2.1%, with an adjusted risk ratio of 0.42 (0.27–0.66). In 21,548 postmenopausal women from the Women's Health Initiative, five common cardiovascular risk models discriminated poorly in the 1,095 with CKD (C-statistics 0.57 to 0.67) and mostly underpredicted their risk. A Japanese case-control study of almost 22,000 heatstroke cases found that heat risk rose more steeply with each additional chronic or lifestyle condition. A JAMA Internal Medicine review sets out a stepwise approach to preoperative assessment by physicians, moving beyond clearance to risk reduction and shared decisions. The pearl covers the medication review at the heart of a preoperative visit.