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EBP Group Project

Presentation for NUR320 project: Nasal Saline Irrigation for the Symptoms of Chronic Rhinosinusitis. Julie Anderson, Kremena Bikov, Sharon Gallaher, Susannah Reed

Sharon Gallaher

on 2 November 2010

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Transcript of EBP Group Project

................1900.........................1925..............................1950.................................1975.............................2000..................... Psychological experiments Procedure for comparing groups (McCall) Statistical Advancement
e.g. Chi-square & significance of difference Campbell and Stanley identify 15 types of experimental designs 1963 Types of basic designs and threats elaborated upon 1979 Experimental Design Timeline More complex and sophistocated experiments, involving many variables hello Nasal Saline Irrigation for Symptoms of Chronic Rhinosinusitis Nasal irrigation is the personal hygiene practice in which the nasal cavity is washed to flush out excess mucus and debris from the nose and sinuses. In a neti pot, mix an isotonic or hypertonic solution using warm water, salt and baking soda. Tilt head to one side. Pour solution slowly into one nostril and let it run out of the other nostril. Tilt head the other direction and repeat with other nostril. What is it? How does it work? When do we use it? 1. 2. 3. 4. To treat a wide range of chronic sinus symptoms caused by rhinusinusitis or hay-fever and the common cold. CONCLUSION The objective of this review was to evaluate a systematic review conducted in 2006 by The Cochrane Collaboration on the use of nasal saline in the treatment of chronic rhinosinusitis symptoms, and to investigate two current primary literature sources germane to the topic, with the goal of determining whether recent evidence warrants recommendation for use in nursing practice. PICO Summary POPULATION OUTCOME INTERVENTION NUR320 EBP Group Project
Julie Anderson
Kremena Bikov
Sharon Gallaher
Susannah Reed OBJECTIVE OF THE REVIEW COMPARISON individuals with various rhinosinusitis pathologies nasal saline irrigation various improved mucociliary clearance PICO SUMMARY THE ARTICLES SIGNIFICANCE OF PROBLEM Over 35 million Americans suffer from rhinosinusitis Symptoms
sinus pressure
head, ear and jaw pain
nasal congestion and/or drainage (postnasal drip)
difficulty breathing
fatigue Population Intervention Comparison Outcome Hauptman, 2007: People with rhinosinusitis.

Ural, 2009: People with allergic rhinitis, acute sinusitis, and chronic sinusitis. Hauptman, 2007: Nasal spray with isotonic or hypertonic saline solution.

Ural, 2009: Nasal irrigation with isotonic or hypertonic saline solution. Strengths Weaknesses Search strategies Reviewer's Conclusions/
Recommendations Lessons Learned Challenges Medical interventions
oral and topical steroids
sinus surgery Non-medical interventions
nasal washes
increased fluid intake
alterations in HOB angle Existing evidence suggests that the benefits of nasal saline in reducing symptoms of rhinosinusitus outweigh any harms Shortcomings of existing evidence
Is there an outcome difference between hypertonic or isotonic saline solutions?
What frequency of treatment best treat symptoms?
What is the most effective method of administration? Contribution of new research
assesses impact of hypertonic versus isotonic solutions on nasal patency and mucociliary clearance Nursing practice implications
existing and current evidence supports the use of topical saline application in the reduction of nasal symptoms
due to the prevalence of the condition, nurses are likely to encounter patients with rhinosinusitis
use of nasal saline irrigation is cost effective and easy to teach 1. Use as an adjunct to other treatments. 2. choose type of solution based on physiological findings and on patient's subjective report of comfort. 1. Difficulty finding recent studies on the topic further research needed to address: 2. frequency and duration of treatment for optimal results 1. most effective method of administation Databases
(Clinical Guidelines + References) Primary sources
In vivo randomized controlled trials involving male and female adults or children with symptoms of chronic rhinosinusitis of unspecified pathology
Interventions involving the use of intranasal saline administered by douche, irrigation, pulsation, spray or nebulizer versus no saline, versus “placebo,” versus adjunct “standard” therapy, or versus active agent.
Interventions involving the use of intranasal hypertonic versus isotonic saline administered by douche, irrigation, pulsation, spray or nebulizer CINAHL
Ovid Medline
Wisconsin Medical Journal (Search Terms, Delimiters) = 5 ______________________________ ∑ f nasal irrigation, nasal lavage, chronic rhinosinusitis, saline solution, nasal saline, neti pot, sinus, symptoms, sinusitis, saline AND, OR, Full text, Humans, English, Publication year: 2007–2010 / These articles were selected for three main reasons: the double blinding of physicians and participants further decreased the risk of bias in outcomes the use of a widely accepted outcome assessor: the saccharine clearance test the contraindication of other oral and/or topical symptom-relieving measures during the trial period 1. 2. 3. No power
analysis conducted
to determine significant sample size. Only subjective evidence was used for inclusion criteria for
enrollment, which may not have produced reliable results.

A minimum score of 20 on the SNOT-20 test, however
there was poor correlation between subjective symptoms
assessed with SNOT-20 and the objective measures.

A period of only 10 minutes to compare outcomes.
Patency measurements in the hypertonic saline group may
have been compromised due to inflammation.

The timing of the second set of acoustic rhinometer
measurements was not taken uniformly among all subjects. Participants were not monitored for compliance.

Lack of discrete symptomatic assessment scale. Article 1 Article 2 Strict inclusion parameters, including objective testing of participants’ sinusitis.

Grouping participants based on type of sinus condition: allergic rhinitis, acute sinusitis, chronic sinusitis, and control. Insured balance among the two groups based on
demographic parameters and SNOT-20 scores.

Three separate measurements of patency were taken to
ensure reproducibility.

Both the investigator and subjects were under continual
observation. Article 2 Article 1 Double blind

One investigator

Saccharine clearance test The effect of saline solutions on nasal patency and mucociliary clearance in rhinosinusitis patients.
Hauptman G, Ryan MW. (2007)

Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study.
Ural A, et al. (2009) 1. 2. Hauptman, 2007 Ural, 2009 Hauptman, 2007:
Before vs. after treatment
Isotonic vs. hypertonic saline

Ural, 2009:
Before vs. after treatment
Isotonic vs. hypertonic saline
Affected individuals vs. healthy control group Hypertonic and isotonic solutions improved mucociliary clearance times
Both solutions imrpoved symptoms of nasal stuffiness and obstruction
Isotonic solutions improved symptoms of nasal patency.
Hypertonic solutions caused more burning and irritation. Hypertonic solution improved mucociliary clearance times in patients with chronic sinusitis.
Isotonic solution improved mucociliary clearance times in patients with acute sinusitis and allergic rhinitis.
There was no significant change in mucociliary clearance times for the healthy control group. Scope Hauptman, 2007 Ural, 2009 Hauptman, 2007 Ural, 2009 1. Do not edit Prezi at the same time. 2. Use only saline to irrigate your nasal passages. 2. Difficulty in finding studies that addressed our initial questions
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