WWW.DISSERTATION.XLIBX.INFO
FREE ELECTRONIC LIBRARY - Dissertations, online materials
 
<< HOME
CONTACTS



Pages:   || 2 | 3 | 4 | 5 |   ...   | 6 |

«Taste and Smell Examination Component Manual January 2013 TABLE OF CONTENTS Chapter Page 1 OVERVIEW OF TASTE AND SMELL COMPONENT 1.1 Background of ...»

-- [ Page 1 ] --

Taste and Smell

Examination Component

Manual

January 2013

TABLE OF CONTENTS

Chapter Page

1 OVERVIEW OF TASTE AND SMELL COMPONENT

1.1 Background of Taste and Smell Perception

1.2 Basic Principles of Taste and Smell

1.2.1 The Sense of Smell

1.2.2 The Sense of Taste

1.3 Medical Disorders of the Chemosenses

1.3.1 Disorders of Smell

1.3.2 Disorders of Taste

1.4 Importance of Taste and Smell Data

1.4.1 Public Health Goals of the NHANES Study

1.5 Overview of the Taste and Smell Examination

References

2 EQUIPMENT AND SUPPLIES

2.1 Equipment

2.2 Supplies

2.3 Equipment Care and Maintenance

2.3.1 Start of Stand and Start of Session

2.3.2 Equipment Care and Maintenance between SP’s................ 2-8 2.3.3 End of Session

2.3.4 Daily

2.4Equipment Malfunctions

–  –  –

2.5 Setup Procedures

2.5.1 Porto-Dent II

2.5.2 Supplies

–  –  –

2.6 Teardown Procedure

2.6.1 Porto-Dent II

2.6.2 Supplies

3 Examination Protocol

3.1 Eligibility Criteria

3.2 Pre-Examination Procedures

–  –  –

5 Quality Control

5.1 Introduction to Quality Control

5.2 Training

5.3 Monitoring Equipment and Equipment Repair

–  –  –

Appendix A EXAM FLOW

B TALKING POINTS

C REPORT OF FINDINGS

–  –  –

Figure 1-1 Maps of the nasal lining

2-1 Sensory Perception Light Box

2-2 Portable Lux Meter

2-3 Porto-Dent II Suction Machine (front view)

2-4 Porto-Dent II Suction Machine (back view)

2-5 Porto-Dent II Suction Machine – cabinet view

–  –  –

2-10 Gooseneck microphone stand with slip-on clip

2-11 Dry oral evacuation funnel

2-12 High-volume evacuation valve

2-13 Low-volume vacuum line plug

2-14 gLMS and dry erase marker

–  –  –

Vacuum line connector

2-18 2-19 Overflow shut-off mechanism

2-20 Canister lid alignment indicator markings

2-21 HVE with lever in the open position “Down”

2-22 Motor and canister assembly inside cabinet

3-1 General Labeled Magnitude Scale (gLMS)

3-2 The tongue tip taste test

–  –  –

Exhibit 4-1 Logon SP screen

4-2 ISIS screen characteristics

4-3 Screening questions

–  –  –

4-5 gLMS Introduction and Practice Screen

4-6 gLMS Light Standards Testing Screen

4-7 Tongue Tip Taste Test screen

–  –  –

4-10 Odor Identification screen – item 1

4-11 Odor Identification screen – item 2

4-12 Odor Identification screen – item 3

4-13 Odor Identification screen – item 4

4-14 Odor Identification screen – item 5

4-15 Odor Identification screen – item 6

4-16 Odor Identification screen – item 7

4-17 Odor Identification screen – item 8

4-18 Replicate Whole Mouth Taste Test “A”

4-19 Replicate Whole Mouth Taste Test “B”

4-20 SP’s understanding of the test screen

4-21 Component status screen – Complete

4-22 Component status screen – Partial

4-23 Component status screen – Not Done

4-24 Soft Edit Warning

–  –  –

4-25 Soft Edit Description of Taste

4-26 Soft Edit Label Preference

4-27 Hard Edit Exclusion Questions

4-28 Hard Edit Screening Questions

4-29 Hard Edit gLMS

5-1 Quality Control Checks

5-2 Start of Stand QC Checks

5-3 Start of Session QC Checks

5-4 Daily QC Checks

5-5 End of Session QC Checks

5-6 End of Stand QC Checks

5-7 Quality Control Checks – Not Done QC

–  –  –

1.1 Background of Taste and Smell Perception The vast majority of people with smell and taste disorders have problems with smell, not taste. Smell plays the most important role in appreciating flavors in eating. Common “tastes” such as chocolate, coffee, strawberry, apple, peach, pizza, steak sauce, and chicken actually reflect smellmediated sensations: odors from chewing food are released and propelled upwards towards the olfactory receptors via the posterior nasal pharynx. Taste buds, located mainly on the tongue surface, palate, and oropharynx, are primarily responsible for mediating sweet, sour, bitter, salty, and metallic sensations. The roles of the taste system include: (1) triggering digestive reflex systems that alter secretions of saliva, stomach acid, and pancreatic juices; (2) enhancing the feelings of pleasure and satiety when eating; and (3) enabling the determination of the quality of sampled foodstuffs and distinguishing nutrients, which usually taste “good” (e.g., sweet) from potential toxins, which usually taste “bad” (e.g., bitter). Although not usually appreciated, taste dysfunction can alter food choices and patterns of consumption, producing weight loss, malnutrition, and in some cases impaired immunity and even death. In someone who is hypertensive or diabetic, taste loss can lead to a dangerous tendency to overcompensate for the loss of a sense of taste by adding additional salt or sugar to the food.





–  –  –

The sense of smell is mediated by specialized smell receptor cells of the nasal cavity. These smell receptors, unlike the receptors of most sensory systems, are directly exposed to the outside environment, except for a thin protective layer of mucus, making them relatively susceptible to damage from such exogenous agents as viruses, bacteria, pollutants, and airborne toxins. A number of factors influence the function of smell in “normal” individuals. These include age, gender, and smoking habits, among others. Of these three, aging is by far the most important. Medical treatments and the use of medications and drugs have also been shown to profoundly affect the sense of smell.

1-1 1.2.1.1 Olfactory (Smell) System The olfactory system is able to recognize a great variety of odors or substances and discriminate subtle differences between chemicals. The primary olfactory receiving center of the brain is the “olfactory bulb.” After processing in the olfactory bulb, physiological signals for smell are delivered directly to the olfactory areas in the brain.

The nasal passages are complex, dynamic channels for breathing and smell detection. The inside of the nasal passages are covered with mucus membranes.2 The location of the smell receptors in the nasal passages is shown in Figure 1-1. This illustration shows maps of the nasal lining illustrated with plus (+) signs of the location where biopsy specimens contained olfactory epithelium or fasicles of the olfactory nerve indicate the location of olfactory mucosa smell receptors. The minus (-) signs indicate that no olfactory epithelium or nerve was found.

–  –  –

The numbers and the distribution of smell receptors in the nasal passages are known to vary within and between individuals. Factors such as chemical exposure, bacterial and viral infection, and head trauma may affect the distribution and it has been shown that the olfactory epithelium decreases with age.

1-2 1.2.2 The Sense of Taste Taste or gustation is one of the two main chemical senses. Humans detect taste with taste receptor cells. These are clustered in taste buds which are not visible to the naked eye. Most of them are buried in specialized structures called papillae on specific parts of the tongue. These papillae give the tongue its bumpy appearance. Most of the bumps are filiform papillae but there are other types of papillae. The papillae on the tongue have no taste function. Filiform papillae come in different shapes. In the cat, they are shaped like tiny spoons with sharp edges. They help the cat lap up liquids. The filiform papillae on our tongues do not have these sharp edges. Thus, if we try to lap fluids from a dish, we will find it to be a tiring task. The taste buds themselves are distributed in a line across the roof of the mouth and in papillae distributed in an oval on the surface of the tongue. Normally we have no subjective awareness of this distribution of taste buds.

Taste cells have a limited life span. After a few days they die and are replaced by new cells.

This constant renewal allows the taste system to recover from a variety of sources of damage and explains why our taste systems tend to remain robust even into old age.

1.2.2.1 Transduction and the Four Basic Tastes The first event in the sensation of taste is the contact between a substance to be tasted (the “tastant”) and a site on the microvillus that extends from the taste receptor cell. The signal that is generated by this contact is called a “transduction.” Transduction mechanisms are very different for different tastes. We can divide the transduction mechanisms into two groups: salty and sour acids versus bitter and sweet. Salts and sour acids are made up of charged particles; bitter and sweet stimuli have particular molecular shapes that fit complementary shapes on the microvilli of the taste cells.

There are four “basic tastes” (sweet, salty, bitter, and sour). Sweet is the taste of the sugars that are biologically useful to us (sucrose, fructose, and glucose); the sweet taste of mother’s milk may serve to produce suckling immediately after birth before an infant has had time to learn the consequences of ingesting milk. Salty is the taste of sodium, a mineral that must be available in relatively large quantities to maintain nerve and muscle function; loss of body sodium leads to a swift death. Bitter is the taste of many poisons. Sour is the taste of acid that in high enough concentrations can damage tissue.

1-3 When we consider the functions that taste performs, we can see how important that coding is. If taste mixtures behaved as do color mixtures, we would have a problem. For example, pure salt is not often found in nature. The ability to analyze a mixture to detect the presence of salt is critical to survival.

Similarly, poisonous plants contain components with a variety of tastes; if bitterness were to synthesize with those other tastes, we could not identify it and thus avoid the poison. The functions of the four tastes are well served by keeping them independent of one another.

Adaptation, a powerful phenomenon in taste also operates to maintain the separation of the four tastes. Perhaps one of the best demonstrations of taste adaptation is our own saliva. For example, if we rinse our mouths with distilled water and then taste a salt solution of the same salt content that saliva has, the solution tastes salty. But normally we are adapted to the same concentration of salt in our saliva so we do not taste it; we only taste saltiness from concentrations above that to which we are adapted.

1.2.2.2 Genetic Differences in the Ability to Taste

Part of the ability to detect bitter tastes is genetically determined. The best example of this is the ability to taste phenylthiocarbamide (PTC) which has been used for many years in taste studies. There is natural variation in the ability to taste PTC in the population – some people cannot taste it, some are average tasters, and some are extremely sensitive to it (“supertasters”). In modern taste testing studies, a chemical relative of PTC that was safer to test, 6-n-propylthiouracil (“PROP” or “PTU”) is used instead of PTC. Taste studies have shown that tasters may be more finicky eaters (they do not like bitter-tasting foods as much as nontasters) and there may be a relationship between taster status, obesity, and health.

Also, there is some research that links genetic variation in bitter taste preference to preferences for sweet and fat in foods.

1.3 Medical Disorders of the Chemosenses

Individuals with taste and smell impairments may be at increased risk of health and nutritional problems and also at risk of safety problems from fire and gas explosions. Many factors contribute to taste and smell impairments, such as medications/drugs, radiation therapy, unhealthy habits (cigarette smoking), head trauma, chronic sinusitis and rhinitis, and some toxic environmental exposures.

–  –  –

The most common causes of permanent smell loss are upper respiratory infections, head trauma or injury, and chronic rhinosinusitis. Although the data are limited, these causes account for the majority of patients who present to physicians with chemosensory problems. Other less common causes of smell loss include chronic alcoholism, epilepsy, and neurological disorders such as multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease. There is some literature to suggest that smell testing of persons who may be at risk for Alzheimer’s disease may be a predictor of who later will be clinically diagnosed with that disease.

Exposure to a number of toxic chemicals can induce smell loss. Olfactory loss can occur as a result of exposure to air pollution and to chemical exposures in the workplace. In addition to directly damaging the smell receptors, some chemicals may produce damage indirectly by inducing upper respiratory inflammatory responses or infections that, in turn, cause damage. The best scientifically documented examples of smell loss due to chemical exposures in humans are for acrylates, methacrylates, and cadmium. It should be noted that tobacco smoke is known to have a high amount of cadmium.

1.3.2 Disorders of Taste

The most debilitating taste disorders are those in which there is a persistent, chronic bad taste in the mouth, such as a bitter, salty, or “metallic” taste. The causes of this fall into two broad categories: (1) cases where an abnormal substance actually gains access to the mouth, and (2) “taste phantoms” that occur when there is nothing in the mouth. Taste phantoms originate in the brain itself.



Pages:   || 2 | 3 | 4 | 5 |   ...   | 6 |


Similar works:

«Anna: Picking up the pieces after infidelity. This is Stay Happily Married, episode number 250. Announcer: Welcome to Stay Happily Married, your source for weekly updates on the latest tips and advice to build a happy and healthy marriage. Anna: I'm Anna Riley, and I'm your host today. Welcome to the show. Is it really possible to truly forgive and forget when it comes to infidelity? Every human has needs. When it comes right down to it, greed can be one of those needs. More often than it...»

«Preface The third edition of the Norwegian National Influenza Pandemic Preparedness Plan is a revised and extended edition of the present preparedness plan which the Ministry of Health established in July 2003. The first Norwegian National Influenza Pandemic Preparedness Plan was, however, laid down as early as January 2001. The European Union as well as the World Health Organization recommend their membership countries to work out updated preparedness plans for influenza pandemics and that...»

«National Cancer Institute What You Need To Know About™ Thyroid Cancer U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer Institute Services This is only one of many free booklets for people with cancer. You may want more information for yourself, your family, and your doctor. NCI offers comprehensive research-based information for patients and their families, health professionals, cancer researchers, advocates, and the public. Call NCI’s Cancer...»

«What Can Colostrum Do for Me? What Is Colostrum Good For? Why Is It the Most Important Nutrient for the Prevention of Chronic Disease? Excerpts from the book: ‘Peptide Immunotherapy, COLOSTRUM, A physicians Reference Guide’ By Andrew M. Keech, PhD with contributions from Michail V. Borissenko BS, MS, Steven Bock, MD, Kenneth J. Frank, MD The first and foremost thing that must be understood about colostrum is what it isn’t, namely that colostrum is not a medication. Colostrum, our first...»

«Robert Thirsk High School Complementary Registration Guide 2016 – 2017 (January 2016 Edition) Table of Contents Complementary Courses Health and Wellness Global Studies English Language Learners (ELL) International Students Recommended Course Sequence in Languages French as a Second Language Spanish Language and Culture Global Studies Courses Fine Arts Programs Acting for the Camera Art (Visual) Creative Writing and Publishing Dance Film Studies Music Technical Theatre / Performing Arts...»

«Illinois Association of Defense Trial Counsel Springfield, Illinois | www.iadtc.org | 800-232-0169 IDC Quarterly | Volume 24, Number 3 (24.3.12) Evidence and Practice Tips Joseph G. Feehan and Brad W. Keller Heyl, Royster, Voelker & Allen, P.C., Peoria Fraser v. Jackson: Second District Affirms Orders Barring Expert as Discovery Sanction and Awarding Fees Associated with Proving Reasonableness of Medical Bills In Fraser v. Jackson, 2014 IL App (2d) 130283, the Illinois Appellate Court, Second...»

«Letters of Recommendation    Carol C. Teitz, MD    Names of applicants, advisors, and schools have been changed for privacy.  EFFECTIVELY NEGATIVE LETTERS  “Damning with faint praise” The first letter contains negative words such as “mediocre”,“surprisingly low score”, “I feel comfortable recommending him”. The second mentions spotty attendance, frustration, position in the top 60% which would infer the 59th percentile rather than the 99th percentile. 1....»

«Health and Safety Executive Controlling fire and explosion risks in the workplace A brief guide to the Dangerous Substances and Explosive Atmospheres Regulations Introduction to DSEAR This leaflet provides a brief introduction to the requirements of the Dangerous Substances and Explosive Atmospheres Regulations 2002 – known as DSEAR.1,2 It explains what employers may need to do to protect their employees from fire and explosion risks. It will also be useful to employees and their...»

«PATHOBIOCHEMISTRY OF PANCREATIC SECRETORY TRYPSIN INHIBITOR (SPINK1) Extract of PhD dissertation Orsolya Király Semmelweis University School of PhD Studies in Molecular Medicine Program: Pathobiochemistry Thesis advisor: Dr. Miklós Sahin-Tóth Thesis committee: Dr. Péter Gál Dr. Attila Mócsai Head of exam committee: Dr. Péter Enyedi Exam committee: Dr. Beáta Vértessy Dr. Katalin Bartha Budapest 2007 I. INTRODUCTION Pancreatic secretory trypsin inhibitor (SPINK1) is secreted from...»

«Notes Introduction 2 My article received: Nina Teicholz, “Heart Breaker,” Gourmet, June 2004, 100–105. 4 “We were jumped on!”: David Kritchevsky, interview with author, May 31, 2005. 4 our fruits and vegetables by 17 percent, our grains by 29 percent: Calculated from data in US Department of Agriculture, “Profiling Food Consumption in America,” Agricultural Fact Book 2001–2002 (Washington, DC: US Government Printing Office, 2003) 18–19. 4 40 percent to 33 percent of calories:...»

«WARREN COUNTY BOARD SUPERVISORS OF COMMITTEE: HEALTH SERVICES DATE: NOVEMBER 4, 2009 COMMITTEE MEMBERS PRESENT: OTHERS PRESENT: SUPERVISORS SHEEHAN PAT AUER, DIRECTOR OF THE DEPARTMENT OF PUBLIC HEALTH THOMAS REPRESENTING WESTMOUNT HEALTH FACILITY: CHAMPAGNE BARBARA TAGGART, ADMINISTRATOR STRAINER BETSY HENKEL, COMPTROLLER PAUL DUSEK, COUNTY ATTORNEY COMMITTEE MEMBERS ABSENT: PATRICIA NENNINGER, SECOND ASSISTANT COUNTY ATTORNEY SUPERVISORS SOKOL JOAN SADY, CLERK OF THE BOARD O' CONNOR KEVIN...»

«Reviewing Short Stay Hospital Claims for Patient Status: Admissions On or After October 1, 2015 (Last Updated: 11/09/2015) Medical Review of Inpatient Hospital Claims Starting on October 1, 2015, the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations (QIOs) began conducting initial patient status reviews of acute care inpatient hospitals, long-term care hospitals, and inpatient psychiatric facilities to determine the appropriateness of Part A payment for short stay...»





 
<<  HOME   |    CONTACTS
2016 www.dissertation.xlibx.info - Dissertations, online materials

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.