Integrated oral health care for stroke patients – a scoping review

Aims and objectives: To identify current evidence on the role of nurses and allied health professionals in the oral health management of stroke patients, detailing their current knowledge, attitudes and practices and the potential benefits of an integrated oral care programme. Background: Stroke has disabling oral health effects, such as dysphagia and hindered brushing due to upper limb hemiparesis. Together, these can increase bacterial load, increasing risk of pneumonia. In general management of stroke, nurses play a key role in early identification, assessment and referral, while occupational therapists, dieticians and speech pathologists are important in rehabilitation. While this should logically apply to the oral care of stroke patients, there is currently limited information, especially in Australia. Design: Scoping review. Method: A literature search was conducted using multiple databases regarding the oral health management of stroke patients by nondental professionals, and 26 articles were reviewed. Results: The Australian National Clinical Guidelines for Stroke accentuate the need for oral care following stroke and suggest how hospital staff need to be involved. Currently, there are no Australian studies. However, international literature suggests that lack of oral health knowledge by nurses and poor patient attitude are reflected in infrequent assistance with stroke patient oral hygiene. There is limited information regarding the benefits of nursing-driven oral hygiene programme in reducing pneumonia incidence, and only few studies show that involving nurses in assisted oral care reduces plaque. There are some suggestions that involving nurses and speech pathologists in oral rehabilitation can improve dysphagia outcomes. Conclusion: Managing oral health poststroke is vital, and there is a need for an appropriate integrated oral care service in Australia. Relevance to clinical practice: Nondental professionals, especially nurses, can play a key role in the poststroke oral health management of stroke patients to reduce complications, especially pneumonia

The learning curves for transradial and ultrasound-guided arterial access : an analysis of the SURF trial

Introduction: Historically, coronary angiography and percutaneous coronary intervention involved accessing the femoral artery via palpation. However, recently there has been a trend towards using a transradial approach and ultrasound guidance for arterial access. Studies have shown that these techniques respectively improve major bleeding rates and access outcomes. There have been no studies conducted that assess the time it takes to train operators to attain proficiency. This sub-analysis of the Standard versus Ultrasound-guided Radial and Femoral access in coronary angiography and intervention (SURF) trial aims to assess the number of procedures required to attain proficiency in ultrasound-guided transradial and transfemoral access. Methods: The SURF trial randomised 1,388 patients undergoing coronary angiography and/or percutaneous coronary intervention into standard or ultrasound-guidance and radial or femoral access in a 2Ã2 factorial design. Operators who participated in this trial were required to have performed at least 50 standard and 10 ultrasound-guided punctures for each of transradial and transfemoral access. Cases were then chronologically ordered and stratified into groups of five, from which the primary endpoint measured was a progression in mean access time and first-pass success rates. Results: Across all operators, there was a reduction in mean access time between procedures one to five and six to 10 with ultrasound-guided femoral punctures (60.5 secs–51.5 secs, p=0.029) and between procedures 11 to 15 and 16 to 20 ultrasound-guided radial punctures (74s to 62.5 secs, p=0.082). This trend was more obvious in trainees, with significant reductions in mean access time between procedures one to five and six to 10 from 73.5 to 53.5 seconds (p<0.001) for ultrasound-guided femoral access and from 99.5 seconds to 60 seconds (p=0.024) for ultrasound-guided radial access. There were no trends with standard transradial access. Conclusion: The numbers required to attain competency in ultrasound-guided femoral and radial access are 15 and 25 punctures, respectively. Fifty (50) punctures appear adequate for proficiency in a standard transradial approach. These numbers are useful in incorporating into training program for advanced trainees and interventionalists

Integrated oral care for stroke patients

Background and Rationale: Stroke has disabling oral health (OH) effects, such as dysphagia and hindered brushing due to upper limb hemiparesis. Together, these can increase bacterial load, leading to pneumonia (Kwok et al, 2015). Since the National Clinical Guidelines (National Stroke Foundation, 2010) mention the need for post-stroke oral care, this review aims to identify OH attitudes and practices of nursing and allied health professionals and the benefits of integrating them into a post-stroke oral care program. Methods: A literature search was conducted using multiple databases (MEDLINE, EMBASE etc.) and combinations of medical, nursing and AH staff and OH terms were searched. Results: Currently, no studies have been conducted in Australia. However, studies in Malaysia suggest that nurses have inadequate oral health knowledge, reflected in their infrequent assistance with stroke patient brushing and mouthwash (Malik et al, 2015). There is limited information regarding the benefits of an integrated oral care program, with only a couple of trials indicating that involving nurses in assisted oral care can reduce plaque score (Lam et al, 2013), and reduce NPO status and stroke patient length of stay (Talley et al, 2015). Another questionnaire study suggests that involving nurses and speech pathologists in oral rehabilitation can improve dysphagia outcomes (Zheng et al, 2014). Conclusion: This scoping review highlights the need for further studies to be conducted, especially in Australia, to assess the role of non-dental professionals in an integrated oral care program for stroke patients. The debilitating oral health effects of stroke make future studies vital, potentially leading to a pathway between non-dental staff and oral health professionals, improving overall stroke outcomes

Ultrasonic assessment of subclinical radial artery stenosis after transradial angiography

This pilot study aims to investigate for subclinical endothelial injury following transradial coronary angiography (CA) and percutaneous coronary intervention (PCI)

Outcomes in femoral access patients with large abdominal circumference

One of the predictors of vascular complications in patients undergoing coronary angiography and percutaneous coronary intervention via transfemoral artery access (TFA), is obesity. Fat distribution may have a technical impact on accessing the femoral artery and control of bleeding afterward. We examined the outcomes of patients with abdominal circumference (AC) ≥100 cm in diameter from the Standard Versus Ultrasound-Guided (US) Radial and Femoral Access (SURF) Trial

Ultrasound-guided femoral access in patients with large thigh circumference : analysis from the Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) trial

Palpation and fluoroscopy are currently the ‘standard’ for transfemoral artery access (TFA). However, it can be challenging in patients with large thigh circumferences. Previous small-scale studies have suggested that the use of ultrasound (US)-guidance in patients with thigh circumference greater than 60 cm may reduce puncture attempts required for successful catheterisation. The aim of this analysis was to assess the effect of US-guided femoral access in patients with thigh circumference ≥ 60 cm

Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis

RATIONALE & OBJECTIVE: Coronavirus disease 2019 (COVID-19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID-19 in people with CKD. STUDY DESIGN: Systematic review and meta-analysis by searching MEDLINE, EMBASE, and PubMed through February 2021. SETTING & STUDY POPULATIONS: People with CKD with or without COVID-19. SELECTION CRITERIA FOR STUDIES: Cohort and case-control studies. DATA EXTRACTION: Incidence of COVID-19, death, respiratory failure, dyspnea, recovery, intensive care admission, hospital admission, need for supplemental oxygen, hospital discharge, sepsis, short-term dialysis, acute kidney injury, and fatigue. ANALYTICAL APPROACH: Random-effects meta-analysis and evidence certainty adjudicated using an adapted version of GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS: 348 studies (382,407 participants with COVID-19 and CKD; 1,139,979 total participants with CKD) were included. Based on low-certainty evidence, the incidence of COVID-19 was higher in people with CKD treated with dialysis (105 per 10,000 person-weeks; 95% CI, 91-120; 95% prediction interval [PrI], 25-235; 59 studies; 468,233 participants) than CKD not requiring kidney replacement therapy (16 per 10,000 person-weeks; 95% CI, 4-33; 95% PrI, 0-92; 5 studies; 70,683 participants) and kidney or pancreas-kidney transplant recipients (23 per 10,000 person-weeks; 95% CI, 18-30; 95% PrI, 2-67; 29 studies; 120,281 participants). Based on low-certainty evidence, the incidence of death in people with CKD and COVID-19 was 32 per 1000 person-weeks (95% CI, 30-35; 95% PrI, 4-81; 229 studies; 70,922 participants), which may be higher compared to people with CKD without COVID-19 (incidence rate ratio, 10.26; 95% CI, 6.78-15.53; 95% PrI, 2.62-40.15; 4 studies; 18,347 participants). LIMITATIONS: Analyses were generally based on low-certainty evidence. Few studies reported outcomes in people with CKD without COVID-19 to calculate the excess risk attributable to COVID-19 and potential confounders were not adjusted for in most studies. CONCLUSIONS: The incidence of COVID-19 may be higher in people receiving maintenance dialysis compared to those with CKD not requiring kidney replacement therapy or those who are kidney or pancreas-kidney transplant recipients. People with CKD and COVID-19 may have a higher incidence of death than people with CKD without COVID-19

Procedural success rates from the Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) trial

Ultrasound (US) guidance has been shown to improve vascular access. We examined access time, attempts, venipuncture, difficult and first-pass successes as secondary outcomes from the SURF trial

Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) : a randomised controlled trial

This study compared outcomes in unselectedpatients undergoing cardiac catheterisation via transradial(TRA) and transfemoral access (TFA) and also standard (SD)versus ultrasound (US) guidance