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Gag Reflex

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21. Reducing gagging during dental treatment – insufficient evidence for any intervention

reflex during dental treatment. More well-designed and well-reported trials evaluating different interventions are needed. Comments Despite a wide-ranging search for studies, as is typical with Cochrane reviews, only a single small study of acupuncture was identified, which was not sufficient to demonstrate clear results. The review does highlight the wide range of interventions that have been suggested for patients for gagging problems but no high quality evidence is available at present to assess (...) was October 6, 2015 Reducing gagging during dental treatment Insufficient evidence for interventions to reduce gagging during dental treatment Managing gag reflex during dental treatment-little evidence Reducing gagging during dental treatment – insufficient evidence for interventions Don’t miss – Reducing gagging during dental treatment We can help you: 1 Keep up to date with the latest research 2 Connect with experts and colleagues 3 Contribute to your professional development Free email newsletter

2015 The Dental Elf

22. Sexual correlates of gagging and dental anxiety. (Abstract)

, who applied for sex therapy at the Sexual Medicine Center, Sheba Medical Center, Tel-Hashomer, Israel, completed the following sexual and dental functioning questionnaires: International Index of Erectile Function (men only), Female Sexual Function Index and difficulties with sexual penetration (women only), dental anxiety, gagging reflex and dentist preference (entire population).Higher gagging reflex was associated with problems in sexual penetration and history of sexual abuse in women (...) (especially one that included vaginal penetration). It was also associated with dental anxiety and higher preference for dentist of the same gender for both genders.The study shows that gagging reflex can bear sexual connotations, especially in women.

2012 Community dental health

23. Management of exaggerated gagging in prosthodontic patients using glossopharyngeal nerve block Full Text available with Trip Pro

Management of exaggerated gagging in prosthodontic patients using glossopharyngeal nerve block When gag reflex becomes abnormally active, it poses difficulty for the prosthodontists, as it hinders the process of fixed partial denture construction beginning with tooth preparation till impression making. In this case-report, the authors used a nerve block technique which is popular among anaesthetist and otolaryngologist, but is being applied in the field of prosthodontics for the first time

2011 BMJ case reports

24. What is the relationship between the Glasgow Coma Scale and airway protective reflexes in the Chinese population? (Abstract)

What is the relationship between the Glasgow Coma Scale and airway protective reflexes in the Chinese population? To describe the relationship of gag and cough reflexes to Glasgow coma score (GCS) in Chinese adults requiring critical care.Prospective observational study of adult patients requiring treatment in the trauma or resuscitation rooms of the Emergency Department, Prince of Wales Hospital, Hong Kong. A long cotton bud to stimulate the posterior pharyngeal wall (gag reflex) and a soft (...) tracheal suction catheter were introduced through the mouth to stimulate the laryngopharynx and elicit the cough reflex. Reflexes were classified as normal, attenuated or absent.A total of 208 patients were recruited. Reduced gag and cough reflexes were found to be significantly related to reduced GCS (p=0.014 and 0.002, respectively). Of 33 patients with a GCS≤8, 12 (36.4%) had normal gag reflexes and 8 (24.2%) had normal cough reflexes. 23/62 (37.1%) patients with a GCS of 9-14 had absent gag

2011 Resuscitation

26. Outpatient biopsy for diagnosis of suspicious lesions of the larynx pharynx and tongue base

are not able to sit for a prolonged time, have a strong gag reflex or have respiratory distress or poor cardiopulmonary function. Context (includes organisational issues) ? In NHS Greater Glasgow and Clyde (NHS GG&C), the ENT department performs over 700 general anaesthetic operating theatre biopsies each year. ? Based on an NHS GG&C departmental audit, 20-30% of patients who have head and neck cancer will be offered treatment with palliative intent at diagnosis. ? The availability of the outpatient biopsy

2019 Evidence Notes from Healthcare Improvement Scotland

27. The Prevention, Assessment and Management of in-Hospital Newborn Falls and Drops

than usual ability and / or spontaneous irritable cry. Less than usual spontaneous grimace or infant has a spontaneous irritable cry which is consolable. 3 Abnormal high pitch inconsolable cry. Infant has an abnormal cry and cannot be consoled. 2 Weak cry, moans or grunts to pain. Infant moans or grunts or has weak cry in response to pain. 1 None. There is no vocal or grimace response to pain. Motor Response 5 Infant has normal spontaneous movements and normal primitive reflexes. Includes suck, gag (...) (NEWTT+ The Prevention, Assessment and Management of in-Hospital Newborn Falls and Drops A BAPM Framework for Practice 13 ©BAPM2020 Modified GCS) (Appendix -3). Check anterior fontanelle and sutures, pupil size, symmetry and response to light, tone, power, primitive reflexes, measure head circumference and plot 4,516,17,22 . c. Decisions about severity of brain injury, management or prognosis should not be based on Modified GCS scoring alone. d. If any non-accidental injury (NAI) suspected, ensure

2020 British Association of Perinatal Medicine

28. Covid-19 Guidance for Return to Practice for Otolaryngology-Head and Neck Surgery: Part One

to be aerosol generating procedures (AGPs): open suctioning of airways, endotracheal intubation and extubation, non-invasive, ventilation (e.g., BiPAP, CPAP), bronchoscopy, manual ventilation, and nebulizer administration. The CDC list is not inclusive of all otolaryngology procedures. Nasal endoscopy and flexible nasal laryngoscopy in and of itself are presumably not AGPs. However, they may potentially increase the likelihood of cough, gag, and sneeze, with possible subsequent aerosolization, and therefore (...) is appropriate. This recommendation can be adjusted based on availability and quality of COVID-19 testing and/or current local incidence of COVID-19. • If available, a video system rather than direct visualization through the endoscope can be considered to keep the examiners face further away from the patient. • Ear canal and mastoid instrumentation can elicit coughing due to stimulation of Arnold’s nerve cough reflex with resultant aerosolization. It is also theoretically possible that aerosolization could

2020 American Academy of Otolaryngology - Head and Neck Surgery

29. Foreign body ingestion

male sex (adults) gastrointestinal tract narrowing mechanical disorders of the gastrointestinal tract chemical dependence intellectual disability mental illness inmates or people engaged in criminal activities dental disorders hurried eating impaired gag reflex history of underlying oesophageal disease, surgery, or procedure seizure disorder Diagnostic investigations x-rays of neck, chest, abdomen FBC urea and electrolytes prothrombin time/INR PTT oxygen saturation faecal occult blood testing hand (...) the gastrointestinal tract. History and exam presence of risk factors dysphagia non-specific abdominal pain stridor and wheezing drooling gagging, nausea/vomiting, neck/throat pain atypical chest pain or non-cardiac chest pain choking signs of upper gastrointestinal obstruction lower gastrointestinal bleeding odynophagia fever, poor feeding, failure to thrive, and irritability (in children) acute or chronic asthma-like symptoms or recurrent pneumonia signs of sepsis sign of acute drug intoxication age <15 years

2018 BMJ Best Practice

30. Scoliosis

scoliometer measurement of >5° at paraspinal prominence symmetric abdominal reflexes shoulder asymmetry waist-line asymmetry thoracic wall or breast asymmetry normal gag reflex truncal decompensation positive FHx peak adolescent growth spurt Diagnostic investigations clinical exam standing PA x-rays of cervical, thoracic, and lumbar spine, and pelvis standing lateral x-rays of cervical, thoracic, and lumbar spine, and pelvis MRI of cervical, thoracic, lumbar, and sacral spine, and brainstem Treatment

2018 BMJ Best Practice

31. Acute respiratory failure

cyanosis loss of airway/gag reflex anxiety headache hypoventilation cardiac rhythm disturbances underlying neuromuscular disorder drug use seizure coma asterixis papilloedema cigarette smoking young age elderly age pulmonary infection chronic lung disease upper airway obstruction lower airway obstruction alveolar abnormalities perfusion abnormalities cardiac failure peripheral nerve abnormalities muscle system abnormalities opiate and sedative medicines toxic fumes and gases traumatic spinal injury

2018 BMJ Best Practice

32. Lung abscess

. Mansharamani NG, Koziel H. Chronic lung sepsis: lung abscess, bronchiectasis, and empyema. Curr Opin Pulm Med. 2003 May;9(3):181-5. http://www.ncbi.nlm.nih.gov/pubmed/12682562?tool=bestpractice.com History and exam presence of risk factors fever productive cough cardiac murmur cavernous (amphoric) breath sounds pleuritic chest pain constitutional symptoms cachexia pallor gingival disease halitosis absence of gag reflex dyspnoea haemoptysis rigors weakness arthralgia haemorrhagic lesions inspiratory

2018 BMJ Best Practice

33. Assessment of cranial nerve mononeuropathy

in the evaluation of glossopharyngeal, vagal, and spinal accessory neuropathy. Semin Ultrasound CT MR. 1987;8:284-300. Nerve testing The gag reflex is absent if a nerve palsy is present, as the afferent impulse is carried by the glossopharyngeal nerve. Vagus (X) Anatomy The vagus nerve exits the brainstem just below the glossopharyngeal nerve, at the pontomedullary junction, traverses the cerebellopontine angle, and exits the cranium through the jugular foramen. The first main branch of the vagus nerve (...) droop and deviation of the uvula to the contralateral side. Lesions distal to pharyngeal branches, or a lesion of the recurrent laryngeal nerve itself, present with isolated hoarseness. The gag reflex is absent, as the efferent limb is formed by the vagus nerve. Accessory (XI) Anatomy The cranial part of the accessory nerve originates from the nucleus ambiguus of the medulla and emerges from the lateral aspect of the medulla. On reaching the jugular foramen, these fibres join the vagus nerve

2018 BMJ Best Practice

34. Aspiration pneumonia

of disease include lung abscess and empyema. Definition Aspiration pneumonia results from inhalation of oropharyngeal contents into the lower airways that leads to lung injury and resultant bacterial infection. It commonly occurs in patients with altered mental status who have an impaired gag or swallowing reflex. The bacteriology and presentation of aspiration pneumonia have changed over the past five decades. Older studies characterised an anaerobic pleuropulmonary syndrome, with necrotising pneumonia

2018 BMJ Best Practice

35. Foreign body ingestion

male sex (adults) gastrointestinal tract narrowing mechanical disorders of the gastrointestinal tract chemical dependence intellectual disability mental illness inmates or people engaged in criminal activities dental disorders hurried eating impaired gag reflex history of underlying oesophageal disease, surgery, or procedure seizure disorder Diagnostic investigations x-rays of neck, chest, abdomen FBC urea and electrolytes prothrombin time/INR PTT oxygen saturation faecal occult blood testing hand (...) the gastrointestinal tract. History and exam presence of risk factors dysphagia non-specific abdominal pain stridor and wheezing drooling gagging, nausea/vomiting, neck/throat pain atypical chest pain or non-cardiac chest pain choking signs of upper gastrointestinal obstruction lower gastrointestinal bleeding odynophagia fever, poor feeding, failure to thrive, and irritability (in children) acute or chronic asthma-like symptoms or recurrent pneumonia signs of sepsis sign of acute drug intoxication age <15 years

2018 BMJ Best Practice

36. Vestronidase alfa (Mepsevii) - Mucopolysaccharidosis VII

EU European Union FDA Food and Drug Administration FVC Forced vital capacity GAG Glycosaminoglycan GCP Good Clinical Practice GEE Generalized Estimating Equation GLP Good Laboratory Practice GMP Good Manufacturing Practice GUS Beta-glucuronidase HS Heparan sulfate HSCT Haematopoietic stem cell transplantation IAR Infusion associated reaction Assessment report EMA/480950/2018 Page 5/87 ICH International Conference on Harmonisation ICR Individualized clinical response IND Investigational New Drug (...) of action Vestronidase alfa is a recombinant form of human GUS and is intended to provide exogenous beta- glucuronidase for uptake into cellular lysosomes. Mannose-6-phosphate (M6P) residues on the oligosaccharide chains allow binding of the enzyme to cell surface receptors, leading to cellular internalization of the enzyme, targeting to lysosomes and subsequent catabolism of accumulated GAGs in affected tissues. Primary and Secondary pharmacology A summary of the effect of vestronidase alfa treatment

2018 European Medicines Agency - EPARs

37. Masitinib mesylate (Alsitek) - Amyotrophic Lateral Sclerosis

include spasticity and exaggerated reflexes (hyperreflexia) including an overactive gag reflex. An abnormal reflex commonly called Babinski’s sign (the large toe extends upward as the sole of the foot is stimulated in a certain way) also indicates upper motor neuron damage. Symptoms of lower motor neuron degeneration include muscle weakness and atrophy, muscle cramps, and fasciculations. To be diagnosed with ALS, people must have signs and symptoms of both upper and lower motor neuron damage

2018 European Medicines Agency - EPARs

39. Clostridium botulinum neurotoxin type A (Xeomin) - chronic sialorrhoea due to neurological disorders

toxin type A. 1 Summary of clinical effectiveness issues Sialorrhoea may result from excessive saliva production or excessive pooling due to poor swallowing: usually caused by neuromuscular dysfunction (for example, in Parkinson’s disease, stroke, traumatic brain injury, motor neurone disease and cerebral palsy), hypersecretion (adverse event of a medicine), or anatomic abnormalities. In patients with atypical parkinsonism it results from decreased swallowing reflexes, causing diminished frequency (...) and efficiency of swallowing of saliva. 6 Chronic sialorrhoea is associated with perioral dermatitis, facial skin maceration, eating and speaking difficulty, bad breath, sleep disturbance, dehydration and fatigue. Posterior loss of control of saliva is also associated with gagging, choking, coughing, aspiration pneumonia and chest infections. In turn, chronic sialorrhoea has a considerable psychosocial and emotional impact on patients and can have a detrimental effect on the quality of life of both patients

2019 Scottish Medicines Consortium

40. Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association

key brainstem areas such as the cranial nerve (Cn) III nucleus in the midbrain, resulting in the absence of pupillary light reflex, and the trigeminal nerve nucleus, injury to which leads to the loss of the corneal reflex. In preterm infants, the lack of pupillary reflexes may be developmental and should not be used for prognosis. In those with widespread cerebral cortical injury but with preservation of the brainstem, the patient may at best achieve an unresponsive wakefulness syndrome (formerly (...) known as the vegetative state). These patients remain unresponsive but with preserved brainstem reflexes. Patients with some injury to the cerebral cortex but with preservation of subcortical and brainstem areas may present with varying cognitive and motor deficits. In the very young, cortical plasticity is mediated by surviving subplate neurons, and injury to subcortical areas may inhibit recovery through plasticity and cortical reassignment. Neuroimaging is an evolving modality that may be able

2019 American Heart Association

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