Analysis of 855 Upper Extremity Fistulas Created Using a Standard Protocol: The Role of Graft Extension to Achieve Functional Status

2013 ◽  
Vol 79 (6) ◽  
pp. 625-629
Author(s):  
Bassan J. Allan ◽  
Enrique R. Perez ◽  
Marwan Tabbara
Keyword(s):  
Upper Extremity ◽  
Chronic Hemodialysis ◽  
Standard Protocol ◽  
Hemodialysis Access ◽  
Arteriovenous Fistulas ◽  
Excellent Method ◽  
The Creation ◽  
National Programs ◽  
Current Guidelines

The Fistula First Breakthrough Initiative (FFBI) has been one of the most important national programs to help achieve considerable improvements in the care of patients on chronic hemodialysis. FFBI has helped place guidelines to push practitioners to reduce the use of tunneled central venous catheters and to increase the rate of arteriovenous fistula use in patients requiring chronic hemodialysis access. However, despite current guidelines, no specific protocols exist for the creation and management of autogenous arteriovenous fistulas and outcomes at most centers are below national benchmarks. In this study, we examine the effectiveness of a standard protocol used at our institution for the creation of autogenous upper extremity fistulas for hemodialysis access in achieving early cannulation and early removal of tunneled dialysis catheters. Our review encompasses 855 consecutive autogenous fistulas created over a 10-year period. Our findings suggest that the use of a standard protocol for creation and management of autogenous fistulas can help increase the rate of functional accesses over national benchmarks. Additionally, extension/conversion of malfunctioning fistulas to grafts appears to be an excellent method to expedite removal of a tunneled dialysis catheter with concomitant preservation of a fistula.

scholarly journals The role of Doppler ultrasonography in vascular access surveillance—controversies continue

2021 ◽  
pp. 112972982092817
Author(s):  
Jan Malik ◽  
Carlo Lomonte ◽  
Mario Meola ◽  
Cora de Bont ◽  
Robert Shahverdyan ◽  
...  
Keyword(s):  
Doppler Ultrasonography ◽  
Blood Stream ◽  
Chronic Hemodialysis ◽  
Arteriovenous Fistulas ◽  
Duplex Doppler ◽  
Current Guidelines ◽  
Time Diagnosis ◽  
Lower Morbidity ◽  
Ultrasound Surveillance

Chronic hemodialysis therapy required regular entry into the patient’s blood stream with adequate flow. The use of arteriovenous fistulas and grafts is linked with lower morbidity and mortality than the use of catheters. However, these types of accesses are frequently affected by stenoses, which decrease the flow and lead to both inadequate dialysis and access thrombosis. The idea of duplex Doppler ultrasound surveillance is based on the presumption that in-time diagnosis of an asymptomatic significant stenosis and its treatment prolongs access patency. Details of performed trials are conflicting, and current guidelines do not support ultrasound surveillance. This review article summarizes the trials performed and focuses on the reasons of conflicting results. We stress the need of precise standardized criteria of significant access stenosis and the weakness of the metaanalyses performed.

Comparing Outcomes of Upper Extremity Brachiobasilic Arteriovenous Fistulas and Arteriovenous Grafts: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 112972982097078
Author(s):  
David J. Haddad ◽  
Venkata Sai Jasty ◽  
Babu Mohan ◽  
Chiu-Hsieh Hsu ◽  
Chyi Chyi Chong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Primary Patency ◽  
Secondary Patency ◽  
Random Effects Model ◽  
Hemodialysis Access ◽  
Basilic Vein ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

Objective: It is unclear what the optimal upper extremity hemodialysis access is for patients without a suitable cephalic vein for arteriovenous fistulas (AVFs). The objective of this systematic review and meta-analysis was to compare the outcomes for upper extremity transposed brachiobasilic AVFs (BBAVFs) and prosthetic arteriovenous grafts (AVGs). Methods: A systematic review was performed to identify all English publications and abstracts comparing the patency outcomes of upper extremity BBAVFs and AVGs (January 1st, 1994 to April 1st, 2020). The outcomes assessed were 1-year and 2-year primary and secondary patency rates. Pooled odds ratios (OR) were calculated using the random-effects model, and I2 statistic was used to assess between-study variability. Results: Twenty-three studies examining 2799 patients were identified and included in the study. The 1-year primary patency rates (OR = 1.68, 95% CI 1.24–2.28, p = 0.001, I2 = 69.40%) and 2-year primary patency rates (OR = 2.33, 95% CI 1.59–3.43, p < 0.001, I2 = 68.26%) were significantly better for BBAVFs than AVGs. Compared to AVGs, the 1-year secondary patency rates (OR = 1.45, 95% CI 1.05–1.98, p = 0.022, I2 = 56.64%) and 2-year secondary patency rates (OR = 1.93, 95% CI 1.39–2.68, p < 0.001, I2 = 57.61%) were also significantly higher for BBAVFs. Conclusion: The outcomes for upper extremity BBAVFs appear to be consistently superior to prosthetic hemodialysis access. This analysis supports the preferential placement of BBAVFs over AVGs in patients with a suitable upper extremity basilic vein.

The role of affect in feelings of obligation

2020 ◽  
Vol 43 ◽  
Author(s):  
Stefen Beeler-Duden ◽  
Meltem Yucel ◽  
Amrisha Vaish
Keyword(s):  
Positive Emotions ◽  
The Creation ◽  
Sense Of Obligation

Abstract Tomasello offers a compelling account of the emergence of humans’ sense of obligation. We suggest that more needs to be said about the role of affect in the creation of obligations. We also argue that positive emotions such as gratitude evolved to encourage individuals to fulfill cooperative obligations without the negative quality that Tomasello proposes is inherent in obligations.

They think they find themselves: radical violence and narcissistic-identity suffering

2019 ◽  
Vol 1 (1) ◽  
pp. 21-31 ◽  
Author(s):  
Louis Brunet
Keyword(s):  
Lone Wolf ◽  
The Creation ◽  
Ideal Ego ◽  
Group Regression ◽  
The Ideal

This article proposes a model of individual violent radicalisation leading to acts of terrorism. After reviewing the role of group regression and the creation of group psychic apparatus, the article will examine how violent radicalisation, by the reversal of the importance of the superego and the ideal ego, serves to compensate the narcissistic identity suffering by “lone wolf” terrorists.

The Moving Cause of Artefacts: the role of techne in metaphysical explanation

2019 ◽  
Vol 1 (1) ◽  
pp. 64-83
Author(s):  
Margaret Cameron
Keyword(s):  
Alternative Theory ◽  
Metaphysical Explanation ◽  
Efficient Cause ◽  
The Creation

The essence of artefacts is typically taken to be their function: they are defined in terms of the goals or aims of the artisans that make them. In this paper, an alternative theory is proposed that emphasizes, via a reconstruction of Aristotle's various comments about the nature of artefacts, the role of the moving, or efficient, cause of artefacts. This account shifts the emphasis to the role played by the investment of expertise into the creation (and subsequent being) of artefacts. It turns out that expertise is prior in being and prior in explanation to the function of artefacts, and thus plays the most fundamental role in the explanation of the ontology of artefacts.

Telmisartan in High Cardiovascular Risk Patients

2012 ◽  
Vol 8 (1) ◽  
pp. 10 ◽  
Author(s):  
Roland Asmar ◽  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Ace Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
High Cardiovascular Risk ◽  
Raas Blockade ◽  
Risk Patients ◽  
Receptor Blockers ◽  
Current Guidelines

The worldwide morbidity and mortality burden of cardiovascular disease (CVD) is overwhelming and caused by increasing life expectancy and an epidemic of risk factors, including hypertension. Therapeutic options targeting different areas of the renin–angiotensin–aldosterone system (RAAS) to disrupt pathophysiological processes along the cardiovascular continuum are available. Angiotensin-converting enzyme (ACE) inhibitors are first-line treatments for CVD and angiotensin receptor blockers (ARBs) are suitable alternatives. Both ACE inhibitors and ARBs prevent CVD by lowering blood pressure (BP). Additionally, several studies have demonstrated that RAAS blockade can reduce cardiovascular risk beyond what might be expected from BP lowering alone. However, the ARBs are not all equally effective. Telmisartan is a long-lasting ARB that effectively controls BP over the full 24-hour period. Recently, the Ongoing telmisartan alone and in combination with ramipril global endpoint trial (ONTARGET) study showed that telmisartan reduces cardiovascular events in high cardiovascular risk patients similarly to the gold standard ACE inhibitor ramipril beyond BP lowering alone, but with a better tolerability. Based on the results of the ONTARGET and Telmisartan randomized assessment study in ACE intolerant subjects with cardiovascular disease (TRANSCEND) studies, telmisartan is indicated for the reduction of cardiovascular morbidity. This article aims to review current guidelines for the management of CVD and consider key data from clinical trials and clinical practice evaluating the role of telmisartan in CVD.

The Role of Evaluative Tools in the Creation of the Memorial Media Portrait of Jacques Chirac (1932—2019)

2020 ◽  
pp. 97-110
Author(s):  
E. N. Mikhailova ◽  
V. A. Telegina
Keyword(s):  
Print Media ◽  
Political Elite ◽  
Systematic Analysis ◽  
Research Material ◽  
Political Orientations ◽  
Different Types ◽  
The Media ◽  
The Creation ◽  
Entire Text

The article is devoted to the study of evaluative tools used in modern French media in order to form the media image of a representative of the political elite. The techniques used in the creation of a memorial media portrait of Jacques Chirac (1932—2019), President of France from 1995 to 2007 are considered. The research material was the most prestigious French print media of various political orientations, published in late September — early October 2019 in connection with the death of the ex-President of the French Republic. The relevance of the research topic is dictated by the close attention of modern linguistics to axiological phenomena, differently presented in different types of discursive practices. The novelty of the study is due to the appeal to the analysis of the complex of evaluation tools used in the French print media when characterizing the former leader of the state during the nation’s farewell period. The estimated potential of the title of the article and its influence on the formation of the estimated vector of the entire text of the publication are shown. A systematic analysis of the assessment expression means, reflected in the memorial media portrait of the politician, is given. The factors that influenced the peculiarities of their use in this type of media portrait are revealed.

MORPHOLOGICAL STRUCTURE OF AVIATION TERMS

2020 ◽  
Vol 1 (3) ◽  
pp. 206-210
Author(s):  
Ra`no Ergashova ◽  
◽  
Nilufar Yuldosheva
Keyword(s):  
Morphological Structure ◽  
The World ◽  
The Creation ◽  
Terminology System

The creation, regulation, lexical and grammatical research and interpretation of the system of terms in the field of aviation in the world linguistics terminology system are one of the specific directions of terminology. Research on specific features is an important factor in ensuring the development of the industry. This article discusses morphological structure of aviation terms. The purpose of the article is to analyze the role of aviation terms in the morphology of the Uzbek language and its definition.

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