Rina Matala

Rina Matala

I am a Lecturer at the University of East Anglia and a Community Pharmacist. I am the Dysphagia MOOC co-ordinator.

Location University of East Anglia Norwich UK


  • @CarolineIwegbu You need to upgrade to get a certificate but you do get confirmation of completing the course.

  • Welcome Maryann. We hope you enjoy the course!

  • You are Welcome Elizabeth. You are certainly not alone. Enjoy the course.

  • Hello Abigail. As you progress through the course you will be able to identify the best ways in which to administer medicines to people who have swallowing difficulties and what you need to consider when doing so.

  • Hello Isatu, thanks for your question. This all depends on what the medication is and whether is has any special release properties or coatings on the tablet. Its best to check for each medication with the relevant medicines information sources.

  • @CK Hi, You are on the right lines. Sometimes existing licensed medicinal products are not appropriate to meet patient need therefore unlicensed medicines may be used. This may be the case if patients cannot swallow tablets of a certain licensed medication but a liquid version is not made by the manufacturer. Also for the paediatric population who may require...

  • @JoannaCharles Dysphagia can be a symptom of esophageal stricture, which is the abnormal narrowing of the esophagus.

  • When you're actively eating and swallowing, you don't trigger the sensory nerves in the back and sides of the throat that cause the gag reflex. BUT if you are eating a large mouthful of something unchewed or viscous (like pudding) or are putting something that isn't food deeply into your mouth, it can activate those sensory nerves to initiate the gag reflex....

  • Hi Pallavi,
    It is more often difficult to swallow thin liquids as it is more difficult to control and manipulate in the mouth and during the swallow process and the risk of it being aspirated into the lungs is high.

    Thanks for the question

  • Hi Wendy
    Epiglottic dysfunction is usually from a traumatic (e.g intubation, lesions) or neuromuscular cause. If you are experiencing these symptoms or are concerned I suggest you speak to your doctor for investigation.

  • Very often colours are selected by the manufacturer because they are more attractive to the consumer, however sometimes specific colours are also used for their binding properties that hold the tablet together e.g cobalt. :)

  • Hi Helen,
    Historically, excluding women in clinical trials has been due to a lack of knowledge about the biological differences between men and women and fluctuating hormones could complicate the design of the study and the interpretation of the results.
    Women are better represented in today's field of clinical studies. :)

  • Hi Helen, this would in the medical field mean most efficient and least expensive approaches. :)

  • national foundations of swallowing disorders :)

  • Hi Michael, you can find a glossary of terms in step 1.15 :) I hopee that helps!

  • Hi Karen, you may find this source useful, it looks into the types of dysphagia and the most common causes. http://www.spg.pt/wp-content/uploads/2015/11/2014-dysphagia.pdf I hope this helps.

  • Hi Karen, you may find more information here https://www.retainedneonatalreflexes.com.au/test-at-hom/
    I hope this helps.

  • Thank you for the feedback Andrea, I will get that fixed :)

  • These are all valid questions that you would need to consider when providing care to this patient. Well done.

  • Hi Christina, usually the desiccant is hidden well. Some medicines have them in the blister pack as a larger tablet shape, some have the desiccant in little plastic canisters or bags similar to what you would find in a new handbag. Others have them incorporated into the lid of the medicine, therefore it is important to keep the medicine in the original...

  • Hi Alexandra,
    I am no expert on Anorexia and dysphagia, but you may find this an interesting read http://www.gaudianiclinic.com/gaudiani-clinic-blog/2016/1/11/dysphagia-why-difficulty-swallowing-is-a-serious-red-flag-in-anorexia-nervosa I hope this helps

  • Hi Samantha, yes risk of airborne particles is present for all crushing methods particularly using a pestle and mortar. The 'NEWT Guidelines for the administration of medication to patients with enteral feeding tubes or swallowing difficulties' states that administrators should prepare a tablet by crushing it with a pestle and mortar, a tablet crusher, or...

  • Thank you Linda! Yes I am sure Harry Potter is familiar with the NEWT guidelines! I am glad you are enjoying the course. Thanks for your feedback. Rina

  • Hi Nicola, its precisely that, the long term is largely unknown. The safety outcome past 10-20 years is not known at this stage studies have been conducted looking into the safety within 5 years of procedure. No additional objective safety and efficacy evidence has been published. Intensive post-marketing surveillance, device registries, and long-term clinical...

  • Hi Eddy,
    I am pleased you are finding the course useful. Unfortunately, I cannot direct you to a web page for Costa Rica. I can suggest you contact your pharmacist or equivelent medicines information department for a guide to use. Also look for nursing or speech and language therapy guides in Costa Rica. In the UK we have the NEWT guidelines and Handbook of...

  • Hi Carol,
    If a person has advanced cancer, they might not have the strength to fight off an infection, even with strong antibiotics. If they can't eat and drink, they are less able to cope with infections. Cancer cells can affect the bone marrow. Eventually, they might not have enough healthy bone marrow to make blood cells. A drop in white blood cells means...

  • Hi Brendan,
    Thanks for your comment. It is assessed on each individual case. It is important for patients especially those with dementia find pleasure in eating. This is something that carers are encouraged to explore with the patient and make sure their needs are being met.
    In advanced dementia, this can be more difficult. Feeding tubes are not regarded...

  • Hi Nicola, this is always a very difficult scenario in any case. Ultimately if the person is of sound mind, their wishes must be respected. The thing that cannot be refused is basic care such as personal care - washing etc...

  • Hi Puspa,
    There are issues of dissolution of certain medications, which can impede bioavailability and ability to reach a therapeutic plasma level. You can find more info on page 4 https://www.prescqipp.info/thickeners-for-dysphagia/send/169-thickeners-for-dysphagia/1939-bulletin-100-thickeners-for-dysphagia

  • Very well thought out Nicola.

  • Hi Zaki,
    Just to clarify, the swallowing difficulties are due to the stroke as this a common cause of dysphagia.

  • Good point Juliane. This is a big issue in the community. There is actually a new charter for care workers (UK) due to being launched. This directly impacts on the training care workers are required to have with regards to residents and swallowing difficulties. I will post more information when it comes out. I hope this helps.

  • Hi Dawn,
    Referrals can be made by the GP, district nurse, health visitor, or your child's nursery staff.
    You can also refer yourself to your local speech and language therapy service. You do not have to wait for someone else to refer you.

  • Hi Nicola. Dysphagia is the term used for swallowing difficulty - so a sign of an underlying problem. Thanks. Rina

  • Hi Nicola,
    In the UK, the recommendation is that, because of uncertainty over longer-term safety and inconclusive efficacy evidence, the procedure should only be used with special arrangements for clinical governance, consent and audit or research. This means in special circumstances for refractory reflux disease. I hope this helps. Rina

  • Hi Nicola, yes you are correct. It's usually severe reflux disease (not controlled by medication) which over time can lead to dysphagia. Thanks for your question. Rina

  • Hi Nicola, Stretta is a procedure used in reflux disease, in most cases, severe reflux over time leads to dysphagia. As not all dysphagia is caused by reflux this would not be offered as first line treatment. Also, the evidence, cost, risks and side effects of this procedure needs to be considered for all patients. Thanks for your comment. Rina

  • Hi Steven, there are varying degrees of dysphagia and sometimes it's something as simple as posture adjustment that can make a big difference. There are several options available depending on the severity of the swallowing difficulty before an NG tube is considered.

  • Hi Lorna,

    Yes there are. There is information about theses in this article.

    I hope this helps


  • Hi Lee,
    The GMC general medical council have published some guidelines on good practice in prescribing. here are a couple of points:
    1. You must make good use of the resources available to you.
    2. prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health, and are satisfied that the drugs or...

  • Individuals with religious or dietary restrictions forbid them from consuming gelatin capsules. Gelatin capsules are only suitable for use with powdered medications or supplements. Liquids and various other materials such as gels are not compatible with capsules made of gelatin. Cellulose based or vegetarian capsules are not made with animal...

  • Hi Linda,

    Young children (neonates) can't communicate whether pain is occurring or being reduced from pain relievers. Medical staff infer pain from facial and body expressions, which isn't always reliable. Parents seem to be becoming increasingly reluctant to enroll their children in basic research with no perceivable immediate benefit. As with adult...

  • Dear Gill, you can find the information about how thickeners affect drug bioavailability here: https://www.prescqipp.info/thickeners-for-dysphagia/send/169-thickeners-for-dysphagia/1939-bulletin-100-thickeners-for-dysphagia

    This also outlines the national guidance and how to use thickeners.

    I hope this helps.


  • Hi Lorna, you can find the information here: https://www.nice.org.uk/guidance/SC1/chapter/1-Recommendations#care-home-staff-giving-medicines-to-residents-without-their-knowledge-covert-administration.
    Chapter 1.15 has useful information about the covert administration of medicines.

    I hope this helps


  • Some patients may benefit from medications at a different time of day (consult Doctor and pharmacist).
    Some patients get distressed at the sight of all the pill bottles and boxes. Are there a lot of pills, and perhaps it is an overwhelming sight? If so, take the pills out of their bottles only when needed, and leave the bottles out of sight. Some caregivers...

  • It is important that people who have dementia feel reassured and supported while retaining some level of independence. Each person will have different needs so it's important to distinguish what would be a barrier for them in terms of adherence. When it is medication time, be sure there is a calm environment you are feeling calm. Resisting medications can be...

  • Individuals with religious or dietary restrictions forbid them from consuming gelatin capsules. Gelatin capsules are only suitable for use with powdered medications or supplements. Liquids and various other materials such as gels are not compatible with capsules made of gelatin. Cellulose based or vegetarian capsules are not made with animal...

  • Of course Ann you can continue. Rina

  • Hi Ann, Yes this is administration without the patient's knowledge - could be due to lack of capacity among other reasons.

  • Hi Patrick

    There are certain medication where blood levels or indicators are checked regularly e.g. warfarin and lithium however for antihypertensives the indicator is monitoring of blood pressure and pulse and is regularly reviewed if stable. If patients are suffering from hypotensive symptoms or if they have started on a new antihypertensive or have a...

  • Hi Peter,

    This works in occasional instances where the condition is stable for a long period of time, however where pain is concerned in most conditions there is usually a fluctuation of symptoms therefore individual ingredients would be more appropriate so the patient can tailor the dose as required. This is assuming the patient is well informed and...

  • Dear Beverley, there are lots of videos on youtube such as: https://www.youtube.com/playlist?list=PLxOoaF5jJoC7rQwSFjEPvk7ShcMaePNbD

  • Hi

    Metabolism is reduced in neonates, increases progressively during the first 6 months of life, exceeds adult rates by the first few years for some drugs, slows during adolescence, and usually attains adult rates by late puberty.

    I hope that clarifies the issue.

    Thank you

  • Hi Melissa
    There is no evidence that homeopathic remedies interfere with conventional medicines please see the document:

  • Massive Open Online Course :)

  • Hi Katie,

    This very much depends on the medicine. There are guides and information available to decide what the best course of action would be for each medicine. Each hospital has its own guidelines or there is the Handbook of Drug Administration via Enteral Feeding Tubes by R. White and The NEWT Guidelines for administration of medication to patients with...

  • Hi Beverley
    Paracetamol soluble is available as GSL in packs of up to 30 tablets in the UK. The idea of restricting pack size is to make it less easy for people to use too much.

  • Dear Joyce,
    I am not sure of the situation you are referring to, Nurses usually have doctors or pharmacists they can talk to / ring for advice. Using the medicines information number available in most countries or on call doctor or pharmacist at any time is an option. Also they may call their mentor or senior colleague. I think it is about good communication...

  • Hi Pamela

    You may find the information here useful http://adultspeechpathology.com/wp-content/uploads/2012/09/ASP-NewsletterSpring20122.pdf. It tells you how to use the thickener with Movicol sachets or there is the option to thicken Movicol liquid formulation but please seek advice from your own doctor and pharmacist to ensure this is appropriate for you.

  • Hi Joyce, if you click on the link in the text it will take you to the Amazon page. Or type the title into Amazon.


  • Hi Beverley

    Patents are granted anywhere along the development lifeline of a drug and last for 20 years. This patent ensures that other companies cannot steal or copy the claims made about the drug such as the invention, design, things you write, make or produce in relation to that drug.

  • Hi Beverley,
    This is all the information available to the public at this stage:
    Mar 15: Launch plan uncertain; no update on Special Products website
    Jun 14: Special Products anticipates approval of Epistatus
    Mar 14: No update available on the licence application for Epistatus
    Jun 13: Special Products submit a Marketing Authorisation Application for...

  • Hi Rachel, you can find the protocol here: http://journals.rcni.com/doi/pdfplus/10.7748/ns2002.
    I hope this helps.

  • Yes absolutely. Carers, Patient and Doctors can request that the Pharmacist de-blister and put into a bottle. That way the appropriate label can be placed on the medicines.

    Thanks Beverley