March 2019

  • Events across the globe
  • Why Temperature is so important
  • Updates on Syringe Codes
  • Upcoming changes to our Website
  • University of Michigan recordings available
  • Resources update
  • IDDSI Translations
  • 2018 All-Star Winner
  • IDDSI on the Move
Community-based rehabilitation in South Africa and IDDSI: an opportunity for greater inter-professional education and practice in the UK?

On April 11, 2019, Dr. Mershen Pillay, IDDSI Board member from South Africa (SA) and partners, Dr Julie Marshall and Dr Mark Jayes from the Manchester Metropolitan University (MMU) in the UK will be meeting to address this question.  They will meet with clinicians involved with dysphagia to look at implementing IDDSI for different groups of individuals with a focus on vulnerable populations groups where food security is a major factor.  The meeting will address a variety of cultural and low-middle income contexts in both the UK and SA. A goal of the meeting in MMU is to develop/frame methods to address diet modifications to match IDDSI levels along with specific strategies dysphagia practitioners may consider in their work to meaningfully address a variety of economic, social, geographic, dietary, cultural and linguistic settings. 

For more information and booking, click here .

This meeting is an extension of Dr Pillay’s collaborations with colleagues in various countries where food security issues are a factor that must be considered in IDDSI implementation.  This includes South Africa, other African countries (e.g., Ghana) and Asian (e.g., India, Sri Lanka), Middle Eastern (e.g. United Arab Emirates) and some European contexts like Portugal.
Australia May 1, 2019: Ready, Set Launch….IDDSI

Australia is set to implement the IDDSI Framework from 1 May 2019. On Wednesday 13 March, the Queensland and New South Wales Branch of the Institute of Hospitality in HealthCare (IHHC) held a pre-launch IDDSI Breakfast and welcomed more than 100 people from healthcare, food service and industry. Dr. Julie Cichero (Co-Chair) of IDDSI had the opportunity to welcome the group and share updates about the new IDDSI consumer handouts and posters. There was a presentation on a Room Service Systems model at Mater Health. With the help of dietetic students, the group was able to audit 177 menu items over 5 days, with learnings about why items were not compliant and how to change them. They also shared the success of tiered huddles to spread the word through their teams. There was also a presentation from Statewide Food Services across Queensland Health that covers 15 hospitals and health services. Under this model local champions worked together in working groups that included food service, dietetics, speech pathology and nursing staff. The breakfast was a resounding success with congratulations to IHHC. The date also coincided with Swallowing Awareness day in Australia.
IDDSI at the Dysphagia Research Society (DRS)

IDDSI Board members were in attendance at DRS in March 2019 to share information at IDDSI in the exhibitor area. IDDSI was featured in several presentations during the conference. Two presentations by Dr Kate Hutcheson(MD Anderson Cancer Centre, Houston TX) included the use of the Functional Diet Scale and the IDDSI framework in research of head and neck cancer patients.  In addition Dr. Catriona Steele presented a talk on reference measures for swallowing from videofluoroscopy featuring the IDDSI and Dr. Teresa Valenzano, who used IDDSI to look at swallowing physiology in spinal cord patients.

To Dr Jianshe Chen, member of the IDDSI Board of Directors and his colleague, Dr. Woroud Alsanei of King Abdulaziz University in Saudi Arabiawhohave just completed a chapter " Food structure development for specific population groups " for a book "Handbook of Food Structure Development" edited by Fotis Spyropoulos, Aris Lazidis & Ian T. Norton, School of Chemical Engineering, University of Birmingham, UK. The book will be published by Royal Society of Chemistry later this year. 
Too thick, too thin or just right – why temperature is so important
Thick liquids change thickness levels depending on their temperature
It has always been the case that the thickness of liquids change depending on their temperature. Generally speaking, a thick liquid that is served cold/chilled will be thicker than if it is served at room temperature, or heated. We see this effect in our daily lives as well. Think about a tube of toothpaste. During winter, more force is needed to push the toothpaste out of the tube, as the toothpaste is firmer. During the summer months, it is very easy to push the toothpaste out of the tube as it flows more easily due to the ambient heat. Think now also of a rich pumpkin soup. Served warm it behaves more like a liquid, but when it cools off, it becomes thicker. This is physics at work. Thick liquids have always behaved this way – thicker when cool, and thinner when warm. In research this is why it is critical to include the temperature for testing because the effect is well known. 
How does this affect individuals with swallowing difficulties?
Thickened milk is typically served warm to babies. The teat/nipple needs to be carefully selected so that the thick milk will flow through it when the infant sucks. If the baby is fussy, the thick milk cools over time and the thick milk becomes thicker and harder for the infant to suck through the teat/nipple. This can cause the baby to fatigue more quickly as they become inefficient with their feeding.
How can the IDDSI flow test help?
The IDDSI Flow Test can be used to accurately capture the change in thickness level as the fluid cools.  temperature.

What about thickener products? 
Due to the known and scientifically proven variation in thickness with temperature, IDDSI is aware that a liquid that tests ‘in range’ at ‘room temperature’, may be considered too thick when chilled, or too thin when heated. We have asked manufacturers to state what temperature their products should be served at. For people with swallowing problems, we need the thick fluid to be the correct thickness at the time they are drinking it. So, if the person needs Level 2 Mildly Thick, then the drink should be that thickness level when they drink it (warm, chilled or room temperature). Because the same thick fluid is very unlikely to be ‘in range’ at all three temperatures, we ask manufacturers to nominate the temperature for optimal serving. This then is the temperature that ‘audits’ should be conducted at. If clinicians or patients choose to use the drink at other temperature, then they do this at their own risk or ‘off label’. 

The concept of ‘off label’ use is well understood in the pharmaceutical industry. For example, pills and solid dose forms are designed to be taken ‘whole’. Some people cut or crush the pills; however, the pharmaceutical company does not warrant its use under those conditions, only when it is ‘taken as directed’. Thick fluid companies may wish to conduct IDDSI testing for their liquids to give the IDDSI level for other temperatures as well as the optimal serving temperature, however, the product only needs to be ‘in range’ for what the company chooses to be the optimal serving temperature. IDDSI is working with clinicians to help them understand that the variability has always existed, and to understand that it is highly unlikely that manufacturers could produce thick liquids that will be ‘in range’ for temperatures spanning chilled to heated.  Clinicians need to audit thick fluids at the intended serving temperature
IMPORTANT UPDATE: Syringe Code for North America
It has come to our attention that some IDDSI documentation had outdated code number as some changes were made by BD

303134 is the correct code number for North America syringes that meet the requirements to perform the IDDSI flow test.

The 0-10 ml markings measure 61.5 mm.
Resources Update
We continue to work on updating documents on our website to align with the recent addition of Level 7 Easy to Chew.
Find the updated Print and Post posters on our website under the resources tab:

  • What is IDDSI
  • The IDDSI Flow Test 
Updating our Website

Just a reminder, we are working on updating our current Framework, Descriptor and Testing Method documents on the IDDSI website to align with some of our new resources and the new Level 7 Regular Easy to Chew.  

We will keep you posted in our e-bites about the status of these updates. Resource development and updates are completed by the volunteer members of the IDDSI Board of Directors so we appreciate your patience.
If you missed the very popular webinar ( Implementation in an Academic Hospital setting:University of Michigan, presented by Kit Warner RD and Sarah Russell SLP ),  you can still watch the recorded version.

Stay tuned for upcoming webinars.
IDDSI Translations
Looking for a translated version of the IDDSI Framework, Descriptors or Testing Methods?
Check our completed translations tab on the IDDSI website for the following:
Chinese (simplified), Farsi, French (Canada), French (France), Italian, Norwegian, Portuguese (Brazil), Spanish and Swahili.

Languages currently up for review include:     
Arabic, Dutch, German, Greek, Japanese, Russian, Slovenian and Vietnamese.  Are you fluent in any of these languages?  If so, please consider reviewing these documents and adding any comments or suggestions for the translation before final posting.
Languages in progress:
Thai, Turkish, Hindi, Hebrew, Urdu, Zulu, Portuguese (Portugal), and Marathi.

Do you speak a language not currently under translation? Would you be willing to provide a translation? We want to hear from you.

We now have an easier online-based translation feedback form.

Check out our Translations tab.
2018 All Star Award Winner
For a second year in a row, IDDSI has been named a 2018 All Star Award winner by  Constant Contact . The annual award recognizes the most successful 10 percent of Constant Contact’s customer base, based on their significant achievements using email marketing to engage their customer base and drive results for their organization during the prior year.

We’re happy to be recognized by Constant Contact for achieving strong marketing results and engaging with our customers.

We couldn't do this without the thousands of people who have continue to champion IDDSI across the globe. Thank you!
IDDSI on the Move
  • March 2019 - Dysphagia Research Society Conference, San Diego, CA, USA
  • April 2019 - Manchester Metropolitan University, Manchester, UK
  • May 2019 - Canadian Society of Nutrition Management Conference, Calgary, AB, Canada
  • June 2019 - Dietitians of Canada Conference, Ottawa, ON, Canada
  • June 2019 - Association of Nutrition & Foodservice Professionals Conference, St. Louis, MO, USA
  • June 2019 - Speech Pathology Australia and New Zealand Speech-Language Therapists’ Association Joint Conference, Brisbane, Australia

Please let us know what you are doing in your part of the world. We would be happy to share it with the rest of the world.
Connect with us on social media & let us know your thoughts!