A systematic review of noninvasive and invasive sialorrhoea management.

AIMS AND OBJECTIVES: To review published literature pertaining to the management of sialorrhoea while also highlighting the significance of the multidisciplinary approach. BACKGROUND: Sialorrhoea is a common and troublesome problem among certain neurological patients. It is distressing for patients and caregivers, and can be challenging for healthcare professionals. Various sialorrhoea management approaches have been documented. However, there is no clear consensus on best management practices. Therefore, it is necessary to systematically review and synthesise various approaches so as to provide an understanding of the efficacy of management approaches. DESIGN: Systematic literature review using PRISMA checklist (see Appendix S1). METHOD: Five databases (ScienceDirect, Wiley Online Library, CINAHL, Cochrane Library and PubMed) were searched (years 2001-2018) following inclusion criteria. Out of 1,294 identified records, 29 studies met the inclusion criteria. RESULTS: Various management approaches identified, ranging from noninvasive, such as speech therapy aiming to enhance swallowing behaviour, to invasive treatment including anticholinergic medication, botulinum toxin injection and surgical techniques. However, in the majority of cases, there is no scientific evidence-based management protocol leading to favourable results, and the evidence base for intervention effectiveness remains weak. CONCLUSIONS: The multifactor nature of sialorrhoea and its associated complications presents challenges for the medical care team. None of the management strategies stand alone as the best modality; therefore, it is proposed that management strategies follow a multidisciplinary approach to meet the diverse needs of patients. RELEVANCE TO CLINICAL PRACTICE: A comprehensive understanding of different sialorrhoea management approaches will enable healthcare professionals to identify the signs and symptoms regarding sialorrhoea, and to assist in effective management implementation. This will help to improve the management of sialorrhoea, hence, to improve quality of life of patients and provide formative scope to the development of an integrated care pathway.

Do newborn infants of Ethiopian origin spit up more than other newborn infants?

BACKGROUND: Ethnic differences in the incidence of spitting up have not been reported. The nursing team at our well-baby nursery observed that newborn infants of Ethiopian origin appeared to spit up more than the others. OBJECTIVE: To determine whether there are such ethnic differences and what, if anything, is their clinical relevance. METHODS: Of the 3663 enrolled infants born at the Hillel Yaffe Medical Center during the 12 month study period, 55 were of Ethiopian origin and their medical records were retrospectively surveyed. The retrieved data were compared with those of 167 randomly selected non-Ethiopian newborns (controls). Exclusion criteria were preterm delivery, admission to the neonatal intensive care unit, and congenital birth defects. RESULTS: Newborn infants of Ethiopian origin spit up 57% more than control infants. The difference in the number of spit ups was more obvious when only the infants who spit up were compared (2.3 +/- 1.7 Ethiopian newborns vs. 1.5 +/- 0.9 controls, P=0.002), although the percentage of infants who spit up was the same in the two groups. There was no difference in weight gain, days of hospitalization, bilirubin levels or nutrition type between the groups. CONCLUSIONS: Infants of Ethiopian origin spit up more than the control newborn infants of non-Ethiopian origin, while other clinical parameters were similar. In the absence of other pathological signs, spitting up is a non-relevant clinical condition.

Ptyalism in pregnant women.

Ptyalism affects few pregnant women. Those who suffer from it, however, find it to be a little-known, but major irritant. This article presents several possible etiologies and discusses some vexatious cases of ptyalism. Nursing interventions are also offered. More nursing research must be conducted so that nurses can better understand this problem.