scholarly journals Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Chung-Pei Wu ◽  
Yu-Juan Xu ◽  
Tyng-Guey Wang ◽  
Shih-Chi Ku ◽  
Ding-Cheng Chan ◽  
...  

Abstract Background For patients who survive a critical illness and have their oral endotracheal tube removed, dysphagia is highly prevalent, and without intervention, it may persist far beyond hospital discharge. This pre- and post-intervention study with historical controls tested the effects of a swallowing and oral care (SOC) intervention on patients’ time to resume oral intake and salivary flow following endotracheal extubation. Methods The sample comprised intensive care unit patients (≥ 50 years) successfully extubated after ≥ 48 h endotracheal intubation. Participants who received usual care (controls, n = 117) were recruited before 2015, and those who received usual care plus the intervention (n = 54) were enrolled after 2015. After extubation, all participants were assessed by a blinded nurse for daily intake status (21 days) and whole-mouth unstimulated salivary flow (2, 7, 14 days). The intervention group received the nurse-administered SOC intervention, comprising toothbrushing/salivary gland massage, oral motor exercise, and safe-swallowing education daily for 14 days or until hospital discharge. Results The intervention group received 8.3 ± 4.2 days of SOC intervention, taking 15.4 min daily with no reported adverse event (coughing, wet voice, or decreased oxygen saturation) during and immediately after intervention. Participants who received the intervention were significantly more likely than controls to resume total oral intake after extubation (aHR 1.77, 95% CI 1.08–2.91). Stratified by age group, older participants (≥ 65 years) in the SOC group were 2.47-fold more likely than their younger counterparts to resume total oral intake (aHR 2.47, 95% CI 1.31–4.67). The SOC group also had significantly higher salivary flows 14 days following extubation (β = 0.67, 95% CI 0.29–1.06). Conclusions The nurse-administered SOC is safe and effective, with greater odds of patients’ resuming total oral intake and increased salivary flows 14 days following endotracheal extubation. Age matters with SOC; it more effectively helped participants ≥ 65 years old resume total oral intake postextubation. Trial registration NCT02334774, registered on January 08, 2015

2021 ◽  
Author(s):  
Sehj Kashyap ◽  
Amanda F Spielman ◽  
Nikhil Ramnarayan ◽  
Sahana SD ◽  
Rashmi Pant ◽  
...  

Background and Objectives: Globally, 2.5 million newborns die within the first month of life annually. The majority of deaths occur in low- and middle-income countries (LMICs), and many of these deaths happen at home. The study assessed if the Care Companion Program (CCP) an in-hospital, skills-based training given to families improves post-discharge maternal and neonatal health outcomes. Methods: This quasi-experimental pre-post intervention study design compared self-reported behavior and health outcomes among families before and after the CCP intervention. Intention to treat analysis included families regardless of their exposure to the intervention. Mixed effects logistic regression model, adjusted for confounders, was fit for all observations. Effects were expressed as Relative Risks (RR) with 95% Confidence Intervals (CI). Results: At 2-weeks post-delivery, telephone surveys were conducted in the pre (n = 3510) and post-intervention (n = 1474) groups from 11 district hospitals in the states of Karnataka and Punjab. The practice of dry cord care improved significantly by 4%, (RR = 1.04, 95%CI [1.04,1.06]) and skin to skin care by 78% (RR=1.78, 95%CI [1.37,2.27]) in the post-intervention group as compared to pre-intervention group. Furthermore, newborn complications reduced by 16% (RR=0.84, 95%CI [0.76,0.91]), mother complications by 12% (RR=0.88, 95%CI [0.79,0.97]) and newborn readmissions by 56% (RR=0.44, 95%CI [0.31,0.61]). Outpatient visits increased by 27% (RR=1.27, 95%CI [1.10,1.46]). However, outcomes of breastfeeding, mothers diet, hand-hygiene, and process indicator of being instructed on warning signs were not different. Conclusion: Postnatal care should incorporate pre-discharge multi-pronged training of families to improve essential maternal and newborn care practices. The CCP model runs on a public-private partnership and is integrated into existing health systems. Our findings demonstrate that it is possible to improve outcomes through a family-centered approach in India. The CCP model can be integrated into formalised hospital processes to relieve overburdened healthcare systems in LMIC settings.


1997 ◽  
Vol 27 (4) ◽  
pp. 199-202 ◽  
Author(s):  
Mubina Agboatwalla ◽  
Dure Samin Akram

A prospective community-based intervention study was conducted in a slum area of Karachi, Pakistan, with the objective of evaluating the impact of health education on the knowledge of mothers. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The post intervention knowledge scores of the mothers showed a significant difference of P < 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group ( P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group ( P < 0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 ( P > 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 ( P < 0.05).


2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
A Cano ◽  
C Diago ◽  
R Domingo ◽  
M Niebla ◽  
J Marginet ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pocket hematoma is one of the most frequent complications (10%) of the cardiac devices implant. To reduce the risk of bleeding, once the wound is sutured and isolated with a sterile dressing, the nurse performs a compression bandage over the area of the generator pocket. The choice of the type of bandage on the wound of the generator pocket is the responsibility of the nurse and there are several methods that vary according to the center. The vasocontrictive property of ice is known but its applicability is not demonstrated in these types of wounds. Objective Evaluate the efficacy of the hypothermic compression bandage versus conventional compression bandage, for the prevention of surgical wound post cardiac device implant hematoma in chronic oral anticoagulant and / or platelet antiaggregant treatment. Methodology This is a randomized prospective study. The protocol was accepted by ethical committee. The team of nurses from the arrhythmia laboratory recruited 310 patients (sample size with statistical calculation) who were going to undergo an implant or replacement of a pacemaker or internal defibrillator. Those patients who were under treatment with oral anticoagulant and/or platelet antiaggregants were selected. Through a list of random numbers two therapeutic branches were created: the intervention group was applied a compressive bandage with ice and the usual group lacked the conventional compressive bandage. Both bandages placed just at the end of wound closure and for 6 hours post-implant. Skin status was stratified between healthy, ecchymosis, mild hematoma and severe hematoma. The assessment of the state of the skin was performed by a blinded nurse, in the control of the wound at 7 days post intervention. The primary endpoint was the appearance of hematoma. The secundary endpoint was the appearance of severe hematoma, defined as bleeding with vital commitment that required drainage or rehospitalization. Results 310 patients participated in the study. 156 patients were randomized to the intervention group and 153 to usual care. The mean age of the sample was 73.77 ± 10.68 years and 74.8% were men. There were no significant differences between the intervention and usual care groups on any baseline demographic or clinical characteristics. A total of 13 patients presented hematoma and 36 patients presented ecchymosis. In the intervention group, 5.88% (n = 18) of ecchymosis and 1.3% (n = 4) of mild hematoma were observed. In the usual care group, 5.88% (n = 18) of ecchymosis and 2.9% (n = 9) of mild hematoma were observed. No patient in neither groups had severe hematoma. No significant differences were observed between the two types of bandage in any of the 3 levels of hematomas. There were also no significant differences between hematoma and the type of platelet antiaggregants or oral anticoagulant. Conclusion After this study it is observed that there is no difference between applying a compression bandage with or without cold.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zeenat Fatima Chatha ◽  
Usman Rashid ◽  
Sharon Olsen ◽  
Fakhar ud Din ◽  
Amjad Khan ◽  
...  

Abstract Background Pakistan is facing a growing population of people living with human immunodeficiency (HIV). In this randomized controlled trial, we investigate if a pharmacist-led intervention can increase adherence to antiretroviral therapy (ART) for people living with HIV (PLWH). Methods Adults with HIV, who have been taking ART for more than 3 months were randomly assigned to receive either a pharmacist-led intervention or their usual care. Measures of adherence were collected at 1) baseline 2) just prior to delivery of intervention and 3) 8 weeks later. The primary outcomes were CD4 cell count and self-reported adherence measured with the AIDS Clinical Trial Group (ACTG) questionnaire. Results Post-intervention, the intervention group showed a statistically significant increase in CD4 cell counts as compared to the usual care group (p = 0.0054). In addition, adherence improved in the intervention group, with participants being 5.96 times more likely to report having not missed their medication for longer periods of time (p = 0.0086) while participants in the intervention group were 7.74 times more likely to report missing their ART less frequently (p < 0.0001). Conclusions The findings support the improvement in ART adherence and HIV management. Trial registration The trial is registered with Australian New Zealand Clinical Trials Registry (ACTRN12618001882213). Registered 20 November 2018.


Author(s):  
Namita Patel ◽  
Subitha Lakshminarayanan ◽  
Jeby Jose Olickal

AbstractObjectivesWorld Health Organization (WHO) suggests intake of five servings (400 g) of fruits and vegetables (F&V) per day to ensure an adequate dietary fibre and to reduce the risk of non-communicable diseases. Risk factor survey of Non-Communicable Diseases (2007–08), reports that only 1% population in Tamil Nadu, South India consumed more than five servings a day. So we aimed to assess the effectiveness of nutrition education in improving the daily intake of fruit and vegetable servings and stage of behaviour change among college students.MethodsA pre-post intervention study was conducted among undergraduate students from two selected women’s colleges in urban Puducherry, South India during September–October 2019. The two English departments were randomly allocated into intervention group (IG), control group (CG) and 75 students in each group were chosen by systematic random sampling. IG received 30 min of nutrition education programme; which includes importance and minimum daily intake of fruits & vegetables, local availability, cost and awareness about myths and misconceptions. CG received pamphlets regarding healthy dietary intake. Knowledge regarding portion sizes, average daily servings of fruit & vegetable intake and stage of behaviour change were assessed at baseline and after one month of intervention.ResultsThere was a significant increase in knowledge regarding portion sizes (28– 64%) after intervention in IG (p<0.001) compared to CG (24– 40%). The knowledge regarding the required number of servings of fruits (27–56%) and vegetables (15–58%) also increased significantly (p<0.001) in the IG. Intake of fruits, vegetables and juices in the last 24 h were significantly increased in IG compared to CG (p<0.001). There was a significant increase (p=0.002) in contemplation and preparation stage (13–34%) in IG after intervention.ConclusionsA well designed nutrition education programme is an effective tool in promoting healthy eating habits among adolescents. It enabled a significant increase in knowledge regarding portion sizes of F&V and daily intake of fruits and vegetables.


2020 ◽  
Author(s):  
Robert J. Arnold ◽  
Nina Bausek

AbstractBackgroundDysphagia is prevalent with cerebrovascular accidents and contributes to the burden of disease and mortality. Strengthening of the dysfunctional swallow muscles through respiratory muscle training (RMT) has proven effective in improving swallow effectiveness and safety. However, approaches to strengthen only the expiratory muscle groups (EMST) dominate the clinical study literature, with variable outcomes. This study investigated the effect of a simultaneous inspiratory and expiratory muscle strengthening strategy to improve swallowing function in stroke patients.MethodsTwenty post-stroke patients were randomly assigned to either intervention group (IG) or control group (CG). The intervention group was treated with three 5-minute sessions of resistive respiratory muscle training every day for 28 days, while the control group received no RMT. Respiratory and swallow outcomes were assessed pre- and post-intervention and included Mann Assessment of Swallowing Ability (MASA), Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with Penetration/Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), patient visual analogue scale (VAS), and peak expiratory flow (PEF).ResultsAfter 28 days, the intervention group demonstrated greater improvements (pVal < 0.05) in PEF (IG: 168.03% vs CG: 17.47%), VAS (IG: 103.85% vs CG: 27.54%), MASA (IG: 37.28% vs CG: 6.92%), PAS (IG: 69.84% vs CG: 12.12%), and FOIS (IG: 93.75% vs CG: 21.21%).ConclusionCombined resistive inspiratory and expiratory muscle training is a feasible and effective method to improve signs and symptoms of dysphagia in stroke patients.


2019 ◽  
Author(s):  
Stephanie Schoeppe ◽  
Jo Salmon ◽  
Susan L. Williams ◽  
Deborah Power ◽  
Stephanie Alley ◽  
...  

BACKGROUND Interventions using activity trackers and smartphone apps have demonstrated their ability to increase physical activity in children and adults. However, they have not been tested in entire families. Further, few family-centred interventions have actively involved both parents, and assessed intervention efficacy separately for children, mothers and fathers. OBJECTIVE This study aimed to examine the short-term efficacy of an activity tracker and app intervention to increase physical activity in the entire family (children, mothers and fathers). METHODS This was a pilot single-arm intervention study with pre-post measures. Between 2017-2018, 40 families (58 children aged 6-10 years, 39 mothers, 33 fathers) participated in the 6-week Step it Up Family program in Queensland, Australia. Using commercial activity trackers combined with apps (Garmin Vivofit Jr for children, Vivofit 3 for adults), the intervention included individual and family-level goal-setting, self-monitoring, performance feedback, family step challenges, family social support and modelling, weekly motivational text messages, and an introductory session delivered face-to-face or via telephone. Parent surveys were used to assess intervention efficacy measured as pre-post intervention changes in moderate-to-vigorous physical activity (MVPA) in children, mothers and fathers. RESULTS Thirty-eight families completed the post intervention survey (95% retention). At post intervention, MVPA had increased in children by 58 min/day (boys: 54 min/day, girls: 62 min/day; all P < .001). In mothers, MVPA increased by 27 min/day (P < .001), and in fathers, it increased by 31 min/day (P < .001). Furthermore, the percentage of children meeting Australia’s physical activity guidelines for children (≥60 MVPA min/day) increased from 34% to 89% (P < .001). The percentage of mothers and fathers meeting Australia’s physical activity guidelines for adults (≥150 MVPA min/week) increased from 8% to 57% (P < .001) in mothers, and from 21% to 68% (P < .001) in fathers. CONCLUSIONS Findings suggest that an activity tracker and app intervention is an efficacious approach to increasing physical activity in entire families to meet national physical activity guidelines. The Step it Up Family program warrants further testing in a larger, randomised controlled trial to determine its long-term impact. CLINICALTRIAL No trial registration as this is not an RCT. It is a pilot single-arm intervention study


2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Pyae Linn Aung ◽  
Tepanata Pumpaibool ◽  
Than Naing Soe ◽  
Jessica Burgess ◽  
Lynette J. Menezes ◽  
...  

Abstract Background Interventions to raise community awareness about malaria prevention and treatment have used various approaches with little evidence on their efficacy. This study aimed to determine the effectiveness of loudspeaker announcements regarding malaria care and prevention practices among people living in the malaria endemic villages of Banmauk Township, Sagaing Region, Myanmar. Methods Four villages among the most malaria-burdened areas were randomly selected: two villages were assigned as the intervention group, and two as the control. Prior to the peak transmission season of malaria in June 2018, a baseline questionnaire was administered to 270 participants from randomly selected households in the control and intervention villages. The loudspeaker announcements broadcasted health messages on malaria care and prevention practices regularly at 7:00 pm every other day. The same questionnaire was administered at 6-month post intervention to both groups. Descriptive statistics, Chi-square, and the t-test were utilized to assess differences between and within groups. Results Participants across the control and intervention groups showed similar socio-economic characteristics; the baseline knowledge, attitude and practice mean scores were not significantly different between the groups. Six months after the intervention, improvements in scores were observed at p-value < 0.001 in both groups, however; the increase was greater among the intervention group. The declining trend of malaria was also noticed during the study period. In addition, more than 75% of people expressed positive opinions of the intervention. Conclusions The loudspeaker intervention was found to be feasible and effective, as shown by the significant improvement in scores related to prevention and care-seeking practices for malaria as well as reduced malaria morbidity. Expanding the intervention to a larger population in this endemic region and evaluating its long-term effectiveness are essential in addition to replicating this in other low-resource malaria endemic regions.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 119-120
Author(s):  
N. Østerås ◽  
E. Aas ◽  
T. Moseng ◽  
L. Van Bodegom-Vos ◽  
K. Dziedzic ◽  
...  

Background:To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international treatment recommendations. A previous analysis of a cluster RCT (cRCT) showed that compared to usual care, the intervention group reported higher quality of care and greater satisfaction with care. Also, more patients were treated according to international guidelines and fulfilled recommendations for physical activity at the 6-month follow-up.Objectives:To assess the cost-utility of a structured model for hip or knee OA care.Methods:A cRCT with stepped-wedge cohort design was conducted in 6 Norwegian municipalities (clusters) in 2015-17. The OA care model was implemented in one cluster at the time by switching from “usual care” to the structured model. The implementation of the model was facilitated by interactive workshops for general practitioners (GPs) and physiotherapists (PTs) with an update on OA treatment recommendations. The GPs explained the OA diagnosis and treatment alternatives, provided pharmacological treatment when appropriate, and suggested referral to physiotherapy. The PT-led patient OA education programme was group-based and lasted 3 hours followed by an 8–12-week individually tailored resistance exercise programme with twice weekly 1-hour supervised group sessions (5–10 patients per PT). An optional 10-hours Healthy Eating Program was available. Participants were ≥45 years with symptomatic hip or knee OA.Costs were measured from the healthcare perspective and collected from several sources. Patients self-reported visits in primary healthcare at 3, 6, 9 and 12 months. Secondary healthcare visits and joint surgery data were extracted from the Norwegian Patient Register. The health outcome, quality-adjusted life-year (QALY), was estimated based on the EQ-5D-5L scores at baseline, 3, 6, 9 and 12 months. The result of the cost-utility analysis was reported using the incremental cost-effectiveness ratio (ICER), defined as the incremental costs relative to incremental QALYs (QALYs gained). Based on Norwegian guidelines, the threshold is €27500. Sensitivity analyses were performed using bootstrapping to assess the robustness of reported results and presented in a cost-effectiveness plane (Figure 1).Results:The 393 patients’ mean age was 63 years (SD 9.6) and 74% were women. 109 patients were recruited during control periods (control group), and 284 patients were recruited during interventions periods (intervention group). Only the intervention group had a significant increase in EQ-5D-5L utility scores from baseline to 12 months follow-up (mean change 0.03; 95% CI 0.01, 0.05) with QALYs gained: 0.02 (95% CI -0.08, 0.12). The structured OA model cost approx. €301 p.p. with an additional €50 for the Healthy Eating Program. Total 12 months healthcare cost p.p. was €1281 in the intervention and €3147 in the control group, resulting in an incremental cost of -€1866 (95% CI -3147, -584) p.p. Costs related to surgical procedures had the largest impact on total healthcare costs in both groups. During the 12-months follow-up period, 5% (n=14) in the intervention compared to 12% (n=13) in the control group underwent joint surgery; resulting in a mean surgical procedure cost of €553 p.p. in the intervention as compared to €1624 p.p. in the control group. The ICER was -€93300, indicating that the OA care model resulted in QALYs gained and cost-savings. At a threshold of €27500, it is 99% likely that the OA care model is a cost-effective alternative.Conclusion:The results of the cost-utility analysis show that implementing a structured model for OA care in primary healthcare based on international guidelines is highly likely a cost-effective alternative compared to usual care for people with hip and knee OA. More studies are needed to confirm this finding, but this study results indicate that implementing structured OA care models in primary healthcare may be beneficial for the individual as well as for the society.Disclosure of Interests:None declared


2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Younes Lotfi ◽  
Mahdieh Hasanalifard ◽  
Abdollah Moossavi ◽  
Enayatollah Bakhshi ◽  
Mohammad Ajalloueyan

Abstract Background The objective of this study was to evaluate the effect of “Spatially separated speech in noise” auditory training on the ability of speech perception in noise among bimodal fitting users. The assumption was that the rehabilitation can enhance spatial hearing and hence speech in noise perception. This study was an interventional study, with a pre/post-design. Speech recognition ability was assessed with the specific tests. After performing the rehabilitation stages in the intervention group, the speech tests were again implemented, and by comparing the pre- and post-intervention data, the effect of auditory training on the speech abilities was assessed. Twenty-four children of 8–12 years who had undergone cochlear implantation and continuously used bimodal fitting were investigated in two groups of control and intervention. Results The results showed a significant difference between the groups in different speech tests after the intervention, which indicated that the intervention group have improved more than the control group. Conclusion It can be concluded that “Spatially separated speech in noise” auditory training can improve the speech perception in noise in bimodal fitting users. In general, this rehabilitation method is useful for enhancing the speech in noise perception ability.


Sign in / Sign up

Export Citation Format

Share Document