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S 24 Parellel sesion

S 24 Open Forum
Saal 1, 28th September 2015, 14:00 – 15:30

Programme of the session:

GS: Giovanni Strippoli (Italy)
Summarising evidence: the  role of systematic reviews and the Cochrane Renal Group

O 62
A survey of nephrology nurses’ oral health knowledge and oral care practices

Tai Mooi Ho (Spain)

O 63
Clinical praxis for assessment of dry weight in Sweden and Denmark: a mixed-methods study

Jenny Stenberg (Sweden)

O 64
Nurses Role in HD follow-up during the successul pregnancies of the Diabetes Mellitus patients

Zubeyde Mazman (Turkey)

O 65
Adherence of healthcare workers to hand hygiene: Clinical reality

Susana Dinis (Portugal)


Summarising evidence: the role of systematic reviews and the Cochrane Renal Group

G. Strippoli1, 2
1Cochrane Kidney Transplant, University of Sydney, Australia; 2Diaverum Academy, Lund, Sweden

There is an overwhelming increase in the number of scientific studies published yearly in all disciplines of internal medicine.  Clinicians are no longer able to stay up to date with such data and it is essential that they are summarized for their fruition.  Systematic reviews are a way to summarize the best available unbiased evidence for intervention questions, prognostic questions and diagnostic test accuracy questions.  In this presentation, we will review the methods to identify and summarize existing evidence, with particular focus on systematic reviews of randomized controlled trials.  We will review how these are done and used in clinical practice.  We will review how they are used to inform policy, based on the methods of the Cochrane Collaboration.


O 62
A survey of nephrology nurses’ oral health knowledge and oral care practices

T.M. Ho1, R. Castillo1, E. Junyent, M.C. Picart
1Department of Nephrology, Hospital del Mar - Parc de Salut Mar, Barcelona, Spain

Background: Mouth care is part of basic nursing activity. Studies have identified important interactions between oral health and chronic kidney disease (CKD) that can affect the well-being of patients with renal disease. Oral care has been reported to occupy low-priority in clinical practice.   
Objectives: This survey aims to gain an insight into our nurses' knowledge about oral complications associated with CKD and oral care practices.
Methods: A descriptive cross-sectional study was conducted. We designed a self-administered questionnaire with 21 items. This tool covers four sections: demographic data, oral hygiene training, oral complications related to CKD and prevailing practices. All nursing staff in our Nephrology Department were invited to participate on a voluntary and anonymous basis. Data obtained were analysed by using descriptive statistics.
Results: 29 (69%) staff nurses and 13 (31%) auxiliary nurses participated in the study. 83% of the respondents identified that oral health is very important but knowledge of oral health in CKD was inadequate. 51% stated that oral care was learnt during basic nursing training and 15% reported a self-taught experience. 100% of these participants responded that this topic was not addressed at renal conferences attended. Regarding practices, the results indicated that patients’ oral health was not always dealt with.
Conclusion/Application to practice: This survey reveals that our nephrology nurses lacked adequate knowledge about the impact of CKD on oral health and care was often overlooked. The findings served to raise awareness of the importance of CKD patients’ oral health and the need to adopt measures to increase knowledge in order to improve care.

Disclosure: No conflict of interest declared

O 63
Clinical praxis for assessment of dry weight in Sweden and Denmark: a mixed-methods study

J. Stenberg1, M. Lindberg2, 3, H. Furuland1
1Department of Medical Sciences, University Hospital, Uppsala, Sweden; 2Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; 3Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

Background: Overhydration is an independent predictor of mortality in hemodialysis (HD) patients, and more than 30% of all HD patients may be overhydrated. Insufficient volume control has actuated development of objective tools, e.g. bioimpedance spectroscopy (BIS), for assessment of hydration status.
Objectives: The aim was to investigate clinical praxis, local guidelines and routines for assessment of dry weight (DW) in Swedish and Danish HD units, and to compare differences in routines with levels of blood pressure (BP).
Methods: In this cross-sectional study a questionnaire was used to collect information about clinical praxis, routines and guidelines; qualitative and quantitative data were analyzed convergent with statistical analysis of retrospective treatment related data of 99 stratified patients, in a mixed methods design.
Results: Written local guidelines concerning DW existed in 54% of the units, and 52% had a BIS-device, but few used it on regular basis. HD nurses (HDN) were prime initiators of utilization of BIS. The frequency of DW adjustment was 1.6 times higher and systolic BP pre HD 8 mmHg lower if HDN were authorized to adjust DW.
Conclusion/Application to practice: There is wide variation in routines for DW assessment in Swedish and Danish HD units, and implementation of BIS may have been delayed by uncertainty of how to manage the device and interpret measurements. There may be a correlation between more frequent DW adjustments, authorization of HDN to adjust DW and lower BP. Adequate hydration status is fundamental in HD, thus better methods and guidelines for assessment of DW and utilization of BIS need to be developed.

Disclosure: No conflict of interest declared

O 64
Abstract ID: 147

Nurses Role in HD follow-up during the successul pregnancies of the Diabetes Mellitus patients
Z. Mazman1, C. Kuralay1, D. Guç1, A. Nevcan1, S. Sevket1, Y. Asuman1
1Hemodialysis, RTS Antalya Dialysis Center, Antalya, Turkey

Background: This study presents the successful test-tube pregnancy of a 36-year-old  HD patient with a primary diagnosis of DM and related retinopathy and neuropathic wounds and the meticulous efforts of the dialysis team through to the follow-up of the first successful pregnancy, which will make it to the records in the global literature.
Objectives: Renal failure, presence of comorbidities and Type 1 Diabetes increases the risk of complication for the mother and the baby. Type 1 DM is related with a 3-to-5 times more increased risk of stillbirth during the pregnancy period.
Methods: As is the case with the other dialysis patients, our patient had psychological and social problems caused by her limited life expectancy as opposed to the normal population. When she discussed about her desire to give birth to a baby for her own and her husband’s happiness, our team explained her the problems and challenges related to her possible pregnancy.  On 2013, the embryo transfer was performed through in vitro fertilization (IVF).
Results: Pregnancy of the patient was confirmed with pelvic Ultra Sonographia(USG) and beta-hCG to be 8 weeks.
This would be the 1st IVF pregnancy in the global literature. The patient received 4 dialysis treatments a week during the 1st trimester; 5 treatments a week during the 2nd trimester; and 6 treatments a week during the 3rd trimester.
Upon start of contractions during the dialysis treatment in the 35th week of the pregnancy, the dialysis treatment was terminated.
Conclusion/Application to practice: Pregnancy is quite risky with the Type 1 DM patients receiving an ESRF long-term haemodialysis treatment; however, pregnancy could be optimized and improved through the efforts of a multidisciplinary team

Disclosure: No conflict of interest declared

O 65
Adherence of healthcare workers to hand hygiene: Clinical reality

J. Dias1, S. Dinis1, A. Reis1, C. Marchão1, J. Sequeira Andrade1, R. Peralta2, J. Fazendeiro Matos2
1NephroCare Entroncamento, Fresenius Medical Care, Entroncamento, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal

Background: Hand hygiene is a simple, low cost and extremely effective measure of infection and antimicrobial resistance control and prevention. Based on the World Health Organization (WHO) multimodal model "Clean Care is Safer Care” we perform hand hygiene audits to encourage adherence of health workers to this practice.
Objectives: To present the results of our audits and analyse the degree of adherence to hand hygiene by healthcare workers.
Methods: Biannual audits of hand hygiene of 7 physicians, 25 nurses, and 9 assistants.
Results: Comparing the results of the audit in 03/2012 vs 10/2014, we evaluated the following parameters:
• Percentages of employees adhering to hand hygiene
• Physicians: 25.5% vs 21.9%;
• Nurses: 42.2% vs 72.4%;
• Assistant: 11.7 vs 58.5%;
• Percentages of all participants complying with the “Five moments for hand hygiene” (WHO)
• Before contact with the patient: 29.6% vs 59.3%;
• Before aseptic procedures: 54.7% vs 69.1%;
• After risk of exposure to body fluids: 58.0% vs 83.9%;
• After contact with the patient: 37.5% vs 68.0%;
• After contact with the patient's surrounding environment: 21.9% vs 51.5%.
Conclusion/Application to practice: An  overall increase in the adherence to hand hygiene by healthcare workers was observed.
The highest rate of adherence was observed in the professional category of nurses followed by assistants and lastly the  physicians. With regard to the “Five moments…”, the highest adherence was observed after the risk of body fluids exposure, and the lowest after contact with patient environment. We conclude that the awareness for hand hygiene should be encouraged.

Disclosure: No conflict of interest declared