scholarly journals TP10.2.4Access surgery for dialysis patients during COVID-19

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Kaifeng Liang ◽  
Ben Lindsey ◽  
Ismail Mohammed ◽  
Mohammed Khurram ◽  
Cinzia Sammartino ◽  
...  
Keyword(s):  
Fistula Formation ◽  
Dialysis Access ◽  
Peritoneal Catheter ◽  
Postoperative Complication Rate ◽  
Arteriovenous Grafts ◽  
Patient Refusal ◽  
The Uk ◽  
Surgical Pathway ◽  
Second Wave ◽  
Access Surgery

Abstract Aims To describe the organisation of a triage system and COVID-19-free surgical pathway, and to assess the outcomes after its implementation for planned dialysis access surgery for patients during the first wave of the COVID-19 pandemic in the UK. Methods In response to the suspension of elective operations due to SARS-CoV-2 outbreak, we devised a COVID-19 free surgical pathway performed in NHS and an independent hospital. We audited the outcomes of its application in patients requiring access surgery between 17 April and 15 September 2020. The data was collated, analysed, and presented at clinical governess. We are looking to re-audit for the second wave in the coming months. Results A total of 235 cases were listed, and 203 procedures were performed. Thirty-two cases were cancelled and the top reason for cancellation was patient refusal. Of the procedures carried out, 47% (n = 96) were arteriovenous fistula formation, 42% (n = 84) were peritoneal catheter procedures, and 11% (n = 23) were arteriovenous grafts. The postoperative complication rate by day 7 was 13.3% (n = 27), by day 30 was 6.9% (n = 14) and they are similar to pre-COVID outcomes. By performing a definitive dialysis access, we avoided the significant morbidity and mortality associated with tunnel-line based dialysis. No patients acquired COVID-19 or died from its related illnesses in 30 days. Conclusion Our results confirmed that our pathway was effective in delivering dialysis access in a timely manner and COVID safe. Our model is safe, easy to replicate COVID-19-free pathway and can be used during similar challenges in the future.

scholarly journals The potential dangers of not understanding COVID-19 public health restrictions in dementia: “It’s a groundhog day – every single day she does not understand why she can’t go out for a walk”

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clarissa Giebel ◽  
Kerry Hanna ◽  
Manoj Rajagopal ◽  
Aravind Komuravelli ◽  
Jacqueline Cannon ◽  
...  
Keyword(s):  
Public Health ◽  
Cognitive Deficits ◽  
Third Sector ◽  
Cognitive Capacity ◽  
The Public ◽  
Health Measures ◽  
Third Sector Organisations ◽  
The Uk ◽  
Second Wave

Abstract Background Sudden public health restrictions can be difficult to comprehend for people with cognitive deficits. However, these are even more important for them to adhere to due to their increased levels of vulnerability, particularly to COVID-19. With a lack of previous evidence, we explored the understanding and changes in adherence to COVID-19 public health restrictions over time in people living with dementia (PLWD). Methods Unpaid carers and PLWD were interviewed over the phone in April 2020, shortly after the nationwide UK lockdown, with a proportion followed up from 24th June to 10th July. Participants were recruited via social care and third sector organisations across the UK, and via social media. Findings A total of 70 interviews (50 baseline, 20 follow-up) were completed with unpaid carers and PLWD. Five themes emerged: Confusion and limited comprehension; Frustration and burden; Putting oneself in danger; Adherence to restrictions in wider society; (Un) changed perceptions. Most carers reported limited to no understanding of the public health measures in PLWD, causing distress and frustration for both the carer and the PLWD. Due to the lack of understanding, some PLWD put themselves in dangerous situations without adhering to the restrictions. PLWD with cognitive capacity who participated understood the measures and adhered to these. Discussion In light of the new second wave of the pandemic, public health measures need to be simpler for PLWD to avoid unwilful non-adherence. Society also needs to be more adaptive to the needs of people with cognitive disabilities more widely, as blanket rules cause distress to the lives of those affected by dementia.

scholarly journals “At Least until the Second Wave Comes…”: A Twitter Analysis of the NHS and COVID-19 between March and June 2020

2021 ◽  
Vol 18 (8) ◽  
pp. 3943
Author(s):  
Kathy McKay ◽  
Sarah Wayland ◽  
David Ferguson ◽  
Jane Petty ◽  
Eilis Kennedy
Keyword(s):  
Health Care ◽  
Social Media ◽  
Content Analysis ◽  
Well Being ◽  
Profound Impact ◽  
Time Period ◽  
Twitter Analysis ◽  
The Uk ◽  
Media Narratives ◽  
Second Wave

In the UK, tweets around COVID-19 and health care have primarily focused on the NHS. Recent research has identified that the psychological well-being of NHS staff has been adversely impacted as a result of the COVID-19 pandemic. The aim of this study was to investigate narratives relating to the NHS and COVID-19 during the first lockdown (26 March–4 July 2020). A total of 123,880 tweets were collated and downloaded bound to the time period of the first lockdown in order to analyse the real-time discourse around COVID-19 and the NHS. Content analysis was undertaken and tweets were coded to positive and negative sentiments. Five main themes were identified: (1) the dichotomies of ‘clap for carers’; (2) problems with PPE and testing; (3) peaks of anger; (4) issues around hero worship; and (5) hints of a normality. Further research exploring and documenting social media narratives around COVID-19 and the NHS, in this and subsequent lockdowns, should help in tailoring suitable support for staff in the future and acknowledging the profound impact that the pandemic has had.

scholarly journals An OSCE as part of the first-year SpR assessmentinent in ENT

2006 ◽  
Vol 88 (9) ◽  
pp. 310-312 ◽  
Author(s):  
A Drake-Lee ◽  
D Skinner ◽  
A Reid
Keyword(s):  
First Year ◽  
European Law ◽  
Senior Registrar ◽  
The Uk ◽  
Second Wave

The structure of postgraduate hospital training in the UK has changed in the last 20 years: the Calman report brought training in line with European law and the SpR post was created out of the registrar and senior registrar posts. Implementation of the new training was staggered across specialties. ENT was included in the second wave of implementation in October 1995. At the same time, consultant expansion was envisaged.

Effectiveness and safety of repeated percutaneous intervention in an office-based endovascular center in maintaining hemodialysis access

Vascular ◽  
2021 ◽  
pp. 170853812110043
Author(s):  
Jay Patel ◽  
Stephanie Chang ◽  
Shaan Manawar ◽  
John Munn ◽  
Mark C Rummel ◽  
...  
Keyword(s):  
Percutaneous Intervention ◽  
Dialysis Access ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Upper Arm ◽  
Access Site ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

scholarly journals Exploring the Relationship Between Palatal Cleft Type and Width With the Use of Relieving Incisions in Primary Repair

2021 ◽  
pp. 105566562110196
Author(s):  
Alex Davies ◽  
Amy Davies ◽  
Yvonne Wren ◽  
Scott Deacon ◽  
Alistair R.M. Cobb ◽  
...  
Keyword(s):  
Oral Mucosa ◽  
Primary Repair ◽  
Fistula Formation ◽  
The United Kingdom ◽  
Using Data ◽  
The Uk ◽  
The Relationship ◽  
Soft Edge ◽  
Intravelar Veloplasty ◽  
Pierre Robin

Objective: The mainstay of palatal repair in the United Kingdom is the intravelar veloplasty (IVVP). It is not always possible to align the oral mucosa in the midline to achieve tension-free repair. The addition of lateral relieving incisions may aid transposition of the oral mucosa to allow closure. The aim of this study was to explore cleft features that may predispose to a requirement for relieving incisions in order to allow palate closure. Design: We performed a national multiinstitutional retrospective study using data from the UK Cleft Collective cohort study. Patients: The study sample consisted of 474 patients who had undergone IVVP at the time of palatal closure across all 16 of the UK cleft units. Results: We found strong evidence for the requirement for relieving incisions in patients with an increased degree of clefting per the Veau classification ( P < .001), increasing palatal soft-edge width ( P < .001) and moderate evidence of an associated use in patients with Pierre Robin sequence ( P = .015). Insufficient data were available to explore the relationship between intertuberosity distance and the presence of fistula formation with the use of relieving incisions. Conclusions: The results of this study identify cleft features that increase the likelihood for requiring lateral relieving incisions to allow palatal closure. The degree to which the addition of relieving incisions to IVVP affects maxillary growth and speech outcomes is unknown. Further study is required to answer this important question.

The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

2020 ◽  
pp. 112972982095474
Author(s):  
Sung-Joon Park ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
Sung Beom Cho ◽  
Tae-Seok Seo ◽  
...  
Keyword(s):  
Clinical Success ◽  
Primary Patency ◽  
Interventional Treatment ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Purse String Suture ◽  
Purse String ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

The Regional Consequences of the Japanese Second Wave: A Case Study

1995 ◽  
Vol 10 (1) ◽  
pp. 4-20 ◽  
Author(s):  
Max Munday
Keyword(s):  
Local Economy ◽  
The Uk ◽  
Second Wave

Outline This paper examines the Japanese “second wave” sector in the local economy. Following an examination of the development of the second wave Japanese-owned supplier sector in the UK, the paper assesses the role of this sector in the local economy, and questions the policy rationale of attracting this particular type of inward investment.

Good long-term patency: 10-year follow-up using the mid-thigh adductor loop arteriovenous graft

2018 ◽  
Vol 20 (3) ◽  
pp. 313-320 ◽  
Author(s):  
Samantha J McEwan ◽  
Hannah Maple ◽  
Paul J Gibbs
Keyword(s):  
Venous Access ◽  
Fistula Formation ◽  
Published Data ◽  
Arteriovenous Graft ◽  
Patient Journey ◽  
Graft Thrombosis ◽  
Arteriovenous Grafts ◽  
Good Patency

Introduction: Definitive access in patients requiring renal replacement therapy is an ever-increasing challenge. For those where autogenous venous access is no longer a viable option, arteriovenous grafts can be considered. This article describes long-term follow-up, complications and patency rates of the mid-thigh ‘adductor loop’ arteriovenous graft. Methods: 50 mid-thigh loop arteriovenous grafts have been inserted into 48 patients in our unit over the past 11 years. A prospective database was collected on patients receiving an arteriovenous graft at our unit by the senior author. All remained under the care of our unit ensuring accurate follow-up data collection and database was updated at regular intervals. Results: Death-only censored primary patency at 1, 3 and 5 years was 76%, 44% and 23%, respectively. Patients receiving transplants were not censored as follow-up of the arteriovenous grafts was possible. Secondary patency at 1, 3 and 5 years was 95%, 63% and 45%. These rates are higher than previous studies looking at lower limb arteriovenous grafts. Graft thrombosis occurred in 14 patients (28%). Six patients were treated for an infection (12%) but only four grafts were excised; much lower than documented in previous studies. Conclusion: Autogenous venous access remains the perceived gold standard for patients requiring dialysis for end stage renal failure, despite some published data reporting poor outcomes. We have shown that adductor loop arteriovenous grafts can be a reliable, safe and long-term alternative in those whom fistula formation is not possible and may have a role earlier in the patient journey than previously thought, as a result of good patency and lower complications.

Dialysis Access Surgery

1991 ◽  
pp. 775-789
Author(s):  
George P. Noon ◽  
H. David Short
Keyword(s):  
Dialysis Access ◽  
Access Surgery

scholarly journals Psychological distress associated with the second COVID-19 wave: Prospective evidence from the UK Household Longitudinal Study

2021 ◽  
Author(s):  
Michael Daly ◽  
Eric Robinson
Keyword(s):  
Psychological Distress ◽  
Longitudinal Study ◽  
Fixed Effects ◽  
General Health Questionnaire ◽  
School Age Children ◽  
Clinically Significant ◽  
Fixed Effects Regression ◽  
The Uk ◽  
Second Wave ◽  
Pandemic Wave

BackgroundIn late 2020 a second wave of COVID-19 infections occurred in many countries and resulted in a national lockdown in the UK including stay at home orders and school closures. This study aimed to compare the prevalence of psychological distress before and during the second COVID-19 wave in the UK. MethodsThis study drew on data from 10,657 participants from the nationally representative probability-based UK Household Longitudinal Study (UKHLS). The 12-item General Health Questionnaire (GHQ-12) assessment measure was used to detect the proportion of UK adults experiencing clinically significant psychological distress. Changes in distress levels associated with the second pandemic wave were examined between September 2020 and January 2021 using logistic regression and linear fixed-effects regression models. ResultsLongitudinal analyses showed that the prevalence of clinically significant distress rose by 5.8% (95% CI:4.4-7.2) from 21.3% in September 2020 to 27.1% in January 2021, compared with a 2019 pre-pandemic estimate of 21% in this cohort. Fixed effects analyses confirmed that the second COVID-19 wave was associated with a significant within-person increase in distress (d =0.15, p&lt;.001). Increases were particularly pronounced among those with school-age children in the home. LimitationsA non-specific measure of mental health symptoms was utilized and it was not possible to separate the potential impact of the pandemic from other changes occurring in tandem within the study period. ConclusionClinically significant distress rose during the second wave of the COVID-19 pandemic and reached levels similar to those observed in the immediate aftermath of the first pandemic wave.

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