Arteriovenous access practices in Australian and New Zealand dialysis units

2019 ◽  
Vol 20 (6) ◽  
pp. 740-745 ◽  
Author(s):  
Brendan Smyth ◽  
Sradha Kotwal ◽  
Martin Gallagher ◽  
Nicholas A Gray ◽  
Kevan R Polkinghorne
Keyword(s):  
New Zealand ◽  
Vascular Access ◽  
Flow Measurement ◽  
Online Survey ◽  
Descriptive Analysis ◽  
Graft Function ◽  
Peritoneal Dialysis Catheter ◽  
Flow Rate Measurement ◽  
Unit Management ◽  
Arteriovenous Access

Background: The creation and maintenance of dialysis vascular access is associated with significant morbidity. Structured management pathways can reduce this morbidity, yet practice patterns in Australia and New Zealand are not known. We aimed to describe the arteriovenous access practices in dialysis units in Australia and New Zealand. Methods: An online survey comprising 51 questions was completed by representatives from dialysis units from both countries. In addition to descriptive analysis, responses were compared between units inside and outside of major cities. Results: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 38% of dialysis units in Australia and New Zealand. While 94% of units provided pre-dialysis education, only 60% reported a structured pre-dialysis pathway and 69% had a dedicated vascular access nurse. Most units routinely monitored fistula/graft function using flow rate measurement (73%) or recirculation studies (63%). A minority used routine ultrasound (35%). Thrombectomy, fistuloplasty and peritoneal dialysis catheter insertion were rarely performed by nephrologists (4%, 4% and 17% of units, respectively). Units outside of a major city were less likely to have access to a local vascular access surgeon (6/13 (46%) vs 35/35 (100%), P < 0.001). There were no other significant differences between units on the basis of location. Conclusion: Much variation exists in unit management of arteriovenous access. Structured pre-dialysis pathways and dedicated vascular access nurses may be underutilised in Australia and New Zealand. The use of regular access blood flow measurement and ultrasound is common in both countries despite a lack of data supporting its effectiveness. There is room for both practice improvement and a need for further evidence to ensure optimal arteriovenous access care.

scholarly journals Role of Doppler ultrasonography in the evaluation of hemodialysis arteriovenous access maturation and influencing factors

2021 ◽  
pp. 112972982096506
Author(s):  
Eva Chytilova ◽  
Tamara Jemcov ◽  
Jan Malik ◽  
Jernej Pajek ◽  
Branko Fila ◽  
...  
Keyword(s):  
Vascular Access ◽  
Doppler Ultrasonography ◽  
Arteriovenous Graft ◽  
Central Venous ◽  
Preoperative Mapping ◽  
High Incidence ◽  
Arteriovenous Access ◽  
Ultrasound Parameters ◽  
Fistula Maturation

The goal of vascular access creation is to achieve a functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG). An autologous fistula has been shown to be superior to AVG or to central venous catheters (CVCs) with lowest rate of re-intervention, but vessel obstruction or immaturity accounts for 20 % to 54% of cases with primary failure of AVF. This review is focused on the factors influencing maturation; indication and timing of preoperative mapping/creation of vascular access; ultrasound parameters for creation AVF/AVG; early postoperative complications following creation of a vascular access; ultrasound determinants of fistula maturation and endovascular intervention in vascular access with maturation failure. However, vascular accesses that fail to develop, have a high incidence of correctable abnormalities, and these need to be promptly recognized by ultrasonography and managed effectively if a high success rate is to be expected. We review approaches to promoting fistula maturation and duplex ultrasonography (DUS) of evaluating vascular access maturation.

scholarly journals A survey of clinicians on the use of artificial intelligence in ophthalmology, dermatology, radiology and radiation oncology

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jane Scheetz ◽  
Philip Rothschild ◽  
Myra McGuinness ◽  
Xavier Hadoux ◽  
H. Peter Soyer ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
New Zealand ◽  
Radiation Oncology ◽  
Online Survey ◽  
New Technology ◽  
Medical Liability ◽  
Healthcare Outcomes ◽  
Medical Workforce ◽  
Artificial Intelligence Technology ◽  
Workforce Needs

AbstractArtificial intelligence technology has advanced rapidly in recent years and has the potential to improve healthcare outcomes. However, technology uptake will be largely driven by clinicians, and there is a paucity of data regarding the attitude that clinicians have to this new technology. In June–August 2019 we conducted an online survey of fellows and trainees of three specialty colleges (ophthalmology, radiology/radiation oncology, dermatology) in Australia and New Zealand on artificial intelligence. There were 632 complete responses (n = 305, 230, and 97, respectively), equating to a response rate of 20.4%, 5.1%, and 13.2% for the above colleges, respectively. The majority (n = 449, 71.0%) believed artificial intelligence would improve their field of medicine, and that medical workforce needs would be impacted by the technology within the next decade (n = 542, 85.8%). Improved disease screening and streamlining of monotonous tasks were identified as key benefits of artificial intelligence. The divestment of healthcare to technology companies and medical liability implications were the greatest concerns. Education was identified as a priority to prepare clinicians for the implementation of artificial intelligence in healthcare. This survey highlights parallels between the perceptions of different clinician groups in Australia and New Zealand about artificial intelligence in medicine. Artificial intelligence was recognized as valuable technology that will have wide-ranging impacts on healthcare.

A retrospective descriptive analysis of race‐day injuries of greyhounds in New Zealand

2021 ◽  
Author(s):  
AL Palmer ◽  
CW Rogers ◽  
KJ Stafford ◽  
A Gal ◽  
CF Bolwell
Keyword(s):  
New Zealand ◽  
Descriptive Analysis

Invariant method for measuring wet gas flow rate

2021 ◽  
pp. 13-19
Author(s):  
Zhanat А. Dayev ◽  
Gulzhan E. Shopanova ◽  
Bakytgul А. Toksanbaeva
Keyword(s):  
Flow Rate ◽  
Measurement System ◽  
Flow Measurement ◽  
Gas Flow ◽  
Test Results ◽  
Invariant System ◽  
Rate Measurement ◽  
Gas Flow Rate ◽  
Flow Rate Measurement ◽  
Wet Gas

The article deals with one of the important tasks of modern flow measurement, which is related to the measurement of the flow rate and the amount of wet gas. This task becomes especially important when it becomes necessary to obtain information about the separate amount of the dry part of the gas that is contained in the form of a mixture in the wet gas stream. The paper presents the principle of operation and structure of the invariant system for measuring the flow rate of wet gas, which is based on the combined use of differential pressure flowmeters and Coriolis flowmeters. The operation of the invariant wet gas flow rate measurement system is based on the simultaneous application of the multichannel principle and the partial flow measurement method. Coriolis flowmeters and the differential pressure flowmeter are used as the main elements of the system. The proposed measurement system does not offer applications for gases with abundant drip humidity. The article provides information about the test results of the proposed invariant system. The estimation of the metrological characteristics of the invariant system when measuring the flow rate of wet gas is given. The obtained test results of the invariant wet gas flow rate measurement system are relevant for natural gas production, transportation, and storage facilities.

scholarly journals What do Australian & New Zealand caregivers know about children’s ibuprofen? The results of an online survey?

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Judy Mullan ◽  
Pippa Burns ◽  
Kathryn Weston ◽  
Shelley Crowther ◽  
Robyn Dixon ◽  
...  
Keyword(s):  
New Zealand ◽  
Online Survey

scholarly journals Profilaxia Pré-Exposição para o Vírus da Imunodeficiência Humana no Currículo Médico em Portugal: Uma Análise Transversal

2022 ◽  
Vol 35 (13) ◽  
Author(s):  
Francisco Duarte ◽  
Nuno Rua ◽  
David Gomes ◽  
Vasco Ricoca Peixoto ◽  
Daniela Azevedo ◽  
...  
Keyword(s):  
Medical Students ◽  
Online Survey ◽  
Descriptive Analysis ◽  
Medical Schools ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
School Year ◽  
Exposure Prophylaxis

Introduction: Pre-exposure prophylaxis (PrEP) has gained relevance as a method of prevention for HIV in certain people and settings. Following the publication of the guideline on PrEP prescribing in Portugal, we aimed to assess the knowledge of Portuguese Medical Students about PrEP.Material and Methods: An online survey was sent to Medical students of Portuguese Medical Schools. We conducted a descriptive analysis of the results and an analytic cross-sectional study to identify factors associated with “knowing about PrEP”, “having had one class about PrEP” and “identifying eligible groups correctly”.Results: Of the 796 students that responded to the survey, 64.6% were aware of what PrEP is. Of these, 34.44% acquired this knowledge during their training. Out of the total amount of respondents, 4.77% could identify correctly and completely the eligible groups for PrEP. As the training years went by, the probability of being aware of PrEP, having had one class about PrEP, and identifying the eligible groups correctly, increased. Of the sixth-year students, 43.48% had had one class about PrEP and among the students that were aware of PrEP, 28% identified what the eligible groups were. After adjusting for the school year, we found differences between Medical Schools regarding the outcomes. The association between the different ways of learning about PrEP and the ability to correctly identify eligible groups for PrEP was not statistically significant.Conclusion: The differences between Medical Schools could be harmonized through changes in the medical curricula that would allow this topic to be addressed more often.

scholarly journals Homoprejudiced violence among Chinese men who have sex with men: A cross-sectional analysis in Guangzhou, China

2020 ◽  
Author(s):  
Dan Wu ◽  
Eileen Yang ◽  
Wenting Huang ◽  
Weiming Tang ◽  
Huifang Xu ◽  
...  
Keyword(s):  
Sexual Orientation ◽  
Online Survey ◽  
Descriptive Analysis ◽  
Strong Association ◽  
Public Health Issue ◽  
Marriage Education ◽  
Cross Sectional ◽  
Cyber Aggression ◽  
Sex With Men ◽  
Sectional Analysis

Abstract Background Homoprejudiced violence, defined as physical, verbal, psychological and cyber aggression against others because of their actual or perceived sexual orientation, is an important public health issue. Most homoprejudiced violence research has been conducted in high-income countries. This study aimed to examine the experience and perpetration of homoprejudiced violence among men who have sex with men (MSM) in Guangzhou, China. Methods MSM in a large Chinese city, Guangzhou, completed an online survey instrument that was distributed through community-based organizations. Descriptive analysis was conducted to describe the sample characteristics. Multivariable logistic regression analyses, controlling for age, residence, occupation, heterosexual marriage, education and income, were carried out to explore associated factors. Results A total of 777 responses were analyzed and most (64.9%) were under the age of 30. Three-hundred-ninety-nine (51.4%) reported experiencing homoprejudiced violence, while 205 (25.9%) reported initiating homoprejudiced violence against others. Compared to respondents who self-identified as gay, respondents who were heterosexual were 0.6 times (AOR=0.6, 95% CI: 0.4-0.9) as likely to have experienced homoprejudiced violence, whereas those who were unsure about their sexual orientation were 2.6 times (AOR=2.6, 95% CI: 1.2-5.5) more likely to have experienced homoprejudiced violence before. Furthermore, a strong association (AOR=2,4. 95% CI: 1.6-3.5) was identified between experiencing homoprejudiced violence and initiating violence. MSM who had disclosed their sexual orientation to people other than their partners were more likely to have experienced homoprejudiced violence (AOR=1.8, 95% CI:1.3-2.5). Conclusions These findings suggest the importance of research and the implementation of interventions focused on preventing and mitigating the effects of homoprejudiced violence affecting MSM in China.

scholarly journals Vascular Access Perspectives in Patients After Kidney Transplantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Krzysztof Letachowicz ◽  
Mirosław Banasik ◽  
Anna Królicka ◽  
Oktawia Mazanowska ◽  
Tomasz Gołębiowski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Kidney Transplantation ◽  
Vascular Access ◽  
Graft Function ◽  
Protective Measure ◽  
Study Group ◽  
Renal Transplant Recipients ◽  
Upper Arm ◽  
Surgical Closure ◽  
Proximal Forearm

Introduction: More attention has been paid to the influence of arteriovenous fistula (AVF) on the cardiovascular system. In renal transplant recipients, some beneficial effect of an elective vascular access (VA) ligation was observed in patients with a high AVF flow. However, this strategy is not widely accepted and is in contradiction to the rule of vasculature preservation for possible future access. The aim of our study is to elucidate the vascular access function and VA perspective in the kidney transplantation (KTx) population.Materials and Methods: KTx patients with a stable graft function were recruited to participate in this single center observational study (NCT04478968). The measurement of VA flow and vessel mapping for future vascular access was performed by a color Doppler ultrasound. The study group included 99 (63%) males and 58 (37%) females; the median age was 57 (IQR 48–64) years. The median time from the transplantation to the baseline visit was 94 (IQR 61–149) months. Median serum creatinine concentration was 1.36 (IQR 1.13–1.67) mg/dl.Results: Functioning VA was found in 83 out of 157 (52.9%) patients. The sites were as follows: snuffbox in six (7.2%), wrist in 41 (49.4%), distal forearm in 18 (21.7%), middle or proximal forearm in eight (9.6%), upper-arm AV graft in one (1.2%), and upper-arm AVFs in nine (10.8%) patients, respectively. Blood flow ranged from 248 to 7,830 ml/min; the median was 1,134 ml/min. From the transplantation to the study visit, 66 (44.6%) patients experienced access loss. Spontaneous thrombosis was the most common, and it occurred in 60 (90.9%) patients. The surgical closure of VA was performed only in six (4%) patients of the study group with a functioning VA at the time of transplantation. Access loss occurred within the 1st year after KTx in 33 (50%) patients. Majority (50 out of 83, 60.2%) of the patients with an active VA had options to create a snuffbox or wrist AVF on the contralateral extremity. In a group of 74 patients without a functioning VA, the creation of a snuffbox or wrist AVF on the non-dominant and dominant extremity was possible in seven (9.2%) and 40 (52.6%) patients, respectively. In 10 (13.1%) patients, the possibilities were limited only to the upper-arm or proximal forearm VA on both sides. Access ligation was considered by 15 out of 83 (18.1%) patients with a patent VA.Conclusions: In the majority of the patients, vascular access blood flow was below the threshold of the negative cardiovascular effect of vascular access. Creation of a distal AVF is a protective measure to avoid a high flow and preserve the vessels for future access. The approach to VA should be individualized and adjusted to the patient's profile.

scholarly journals The Determinants of International Student Demand in New Zealand and the OECD

2021 ◽  
Author(s):  
◽  
Logan Page
Keyword(s):  
New Zealand ◽  
International Students ◽  
Fixed Effects ◽  
International Student ◽  
Tertiary Education ◽  
Descriptive Analysis ◽  
University Education ◽  
Export Market ◽  
Student Demand ◽  
The Impact

<p>Tertiary education, once a purely domestic affair, has become an increasingly globalised industry over previous decades. Whilst the international sector has grown to being New Zealand's fourth largest export market (Ministry of Education, 2016), there is a lack of credible research on the demand of international students.    This thesis aims to provide a greater understanding of the determinants of international student demand, both in New Zealand and internationally. I firstly provide a descriptive analysis of the trends in the international student market for New Zealand and 27 OECD countries. Secondly, I use a fixed-effects approach to analyse the demand of international students within New Zealand, using fees data at the course-by-university level. Thirdly, I then generalise this approach to the international market to provide an analysis of the demand for international students travelling to the OECD.    The findings from these analyses imply that the demand for international university education is relatively inelastic. The impact of a marginal increase in fees decreases the number of EFTS/students at a proportion of less than one. Furthermore, this effect is generally not statistically distinguishable from zero.</p>

scholarly journals A precedence evaluation of demand and supply between vocational high school graduates and workforce requirement in Indonesia

2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Amat Jaedun ◽  
Muhd Khaizer Omar ◽  
Badrun Kartowagiran ◽  
Edi Istiyono
Keyword(s):  
Online Survey ◽  
High School Graduates ◽  
Supply And Demand ◽  
Descriptive Analysis ◽  
Industrial Sector ◽  
Academic Program ◽  
Academic Programs ◽  
Vocational High School ◽  
Workforce Skills ◽  
Research Population

The success in implementing the demand-driven approach in Vocational High Schools (VHS) can be realized by understanding the misalignment that occurs between graduate skill competency and workforce demand by the industry. This study aims at describing the precedence between the VHS graduates and the businesses/industrial sector (BS/IS) portraying from the regional potential perspectives. The research data was collected from documents and survey forms distributed to (BS/IS) within the research population. The document analysis was employed to collect information on programs offered at VHS, existing VHS students enrollment, and the value of Gross Regional Domestic Product (GRDP) in studied provinces. An online survey was distributed to all VHS graduates and BS/IS employers. The content validity was carried out prior actual study to ensure the validity of the instrument. A descriptive analysis was performed to gather information pertaining to developed research objectives. The precedence of the academic programs with the GRDP was determined based on 5% of criteria differences. The results found that there is a misalignment between the academic programs and the VHS students enrollment towards the region job potentials in each province in Indonesia. In addition, the research also found that the competency of VHS graduates related to the theoretical knowledge, the job characteristics, and the workforce skills were at moderate level. The implication of the study offers salient notion on minimizing the precedence that occurs between the supply and demand in the form of graduates supply to workforce and at the same time, fulfilling the workforce requirements demand by the industries. It is suggested on the capabilities of educational institutions in tweaking into demand-driven approach in making sure the academic program is relevant and sustainable.

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