Perception and clinical practice regarding mucus clearance devices with chronic obstructive pulmonary disease: a cross-sectional study of healthcare providers in Saudi Arabia

OBJECTIVES: Clearing secretions from the airway can be difficult for people with chronic obstructive pulmonary disease (COPD). Mucus clearance devices (MCDs) are an option in disease management to help with this, but healthcare provider awareness and knowledge about them as well as current clinical practice in Saudi Arabia are not known. DESIGN: A cross-sectional online survey consisting of four themes; demographics, awareness, recommendations and clinical practice, for MCDs with COPD patients. SETTING: Saudi Arabia. PARTICIPANTS: 1188 healthcare providers including general practitioners, family physicians, pulmonologists, nursing staff, respiratory therapists and physiotherapists. PRIMARY OUTCOME MEASURES: Healthcare providers' level of awareness about MCDs, and the identification of current clinical practices of COPD care in Saudi Arabia. RESULTS: 1188 healthcare providers (44.4% female) completed the survey. Regarding devices, 54.2% were aware of the Flutter, 23.8% the Acapella and 5.4% the positive expiratory pressure mask. 40.7% of the respondents identified the Acapella, and 22.3% the Flutter as first choice for COPD management. 75% would usually or always consider their use in COPD patients reporting daily difficulty clearing mucus, whereas 55.9% would sometimes or usually consider the use of MCDs with COPD patients who produced and were able to clear mucus with cough. In clinical practice, 380 (32%) of the respondents would prescribe MCDs, 378 (31.8%) would give MCDs without prescriptions, 314 (26.4%) would not provide them at all and 116 (9.8%) would only advise patients about them. CONCLUSION: Healthcare providers are aware of the existence of MCDs and their benefits for sputum clearance and believe that MCDs are beneficial for sputum clearance in some COPD patients. TRIAL REGISTRATION NUMBER: ISRCTN44651852

Algorithmic Salvage Techniques in Non-Maturing Radiocephalic Arteriovenous Fistulae with Their Long-Term Patency

Introduction: The aim of this study is to examine the role of five different operative salvage techniques with their long-term primary patency (PP) in an algorithmic manner in gaining primary functional maturation (FM) in radio cephalic arteriovenous fistulae (RCAVF) formation following their impairment. Methods: A prospective consecutive data collection on 195 patients undergoing only autogenous RCAVF formation from July 2013 to December 2015 was conducted. Each non-maturing fistula was then exposed to a salvage technique by an algorithmic methodology and their FM and PP was prospectively recorded. Results: Forty-two patients were exposed to five different salvages techniques, with a median age of 67 years (IQR, 27-90), cephalic vein diameter of 2 mm (IQR, 1.5-4 mm) and radial artery diameter of 1.8 mm (IQR, 1.2-2.1 mm), demonstrated 63.1% FM and cumulative primary patency of 15.2 months (95% CI, 12.5-17.9) over a 21-month follow-up period. Conclusions: Operative salvage techniques play an important role in achieving assisted functional maturation and long-term patency in RCAVF as an alternative and/or in conjunction with other minimally invasive procedures. These procedures can maximize access outcome, minimize bridging procedures, decrease complications and optimize patient anatomical resources for longer access provisions in an era of aging population