title: Physicians' opinions regarding the criteria for resuming oral intake after aspiration pneumonia: A questionnaire survey and cluster analysis of hospitals across Japan.
abstract: OBJECTIVE
  To investigate the items that are considered by physicians when making decisions regarding the resumption of oral intake among patients with aspiration pneumonia who have undergone short-term fasting.
  
  
  METHODS
  We surveyed 2490 Japanese hospitals that had internal medicine and respiratory medicine departments. We mailed questionnaires that contained 24 items related to oral intake resumption after aspiration pneumonia to the head of the department at each hospital. Cronbach statistics, principal component analysis and cluster analysis were used to analyze the results.
  
  
  RESULTS
  We received responses from 350 hospitals; 89.7% of the respondents answered that they "Strongly agree" that "level of consciousness" is a useful criterion for resuming oral intake. Furthermore, 66%, 66%, 63.4%, 58.5% and 51% of the respondents answered that they "strongly agree" regarding the use of SpO2, the discretion of the attending physician, body temperature, swallowing function test results, mental state and respiratory rate, respectively. In the cluster analysis, level of consciousness, body temperature, SpO2, respiratory rate, mental state and the discretion of the attending physician belonged to the first cluster. The second cluster consisted of the patient's request, the family's request, the opinions of the medical staff and non-physician healthcare providers, and performance status.
  
  
  CONCLUSIONS
  Physicians consider several criteria during decision-making regarding oral intake resumption, which can be assigned to two clusters. Future studies are required to develop generalizable and objective criteria. Geriatr Gerontol Int 2017; 17: 810-818.
authors.affiliation: Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan.|Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
authors.forename: Tsuneaki
authors.initials: T
authors.lastname: Kenzaka
authors.affiliation: Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Kumabe
authors.affiliation: Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Kosami
authors.affiliation: Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.|Department of General Medicine, National Health Insurance Ooma Hospital, Ooma, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Matsuoka
authors.affiliation: Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Minami
authors.affiliation: Satellite Center of Community Medicine, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ninomiya
authors.affiliation: Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Noda
authors.affiliation: Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Okayama
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D003243:Consciousness / Q000502:physiology*; D003430:Cross-Sectional Studies; D003657:Decision Making; D003679:Deglutition; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D010820:Physicians / Q000592:standards*; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires
keywords: aspiration pneumonia; consciousness; decision-making; fasting; resumption of oral intake