Blood temperature monitoring–guided vascular access intervention improved dialysis adequacy

2020 ◽  
pp. 112972982094903
Author(s):  
Seung Don Baek ◽  
Soomin Jeung ◽  
Jin Go ◽  
Jae-Young Kang
Keyword(s):  
Vascular Access ◽  
Reference Point ◽  
Temperature Monitoring ◽  
Artificial Kidney ◽  
Dialysis Adequacy ◽  
Vascular Intervention ◽  
Flow Rates ◽  
Blood Temperature ◽  
Before And After ◽  
The Mean

Objectives: The aim of this study was to investigate whether blood temperature monitoring–guided vascular access intervention could improve dialysis adequacy. Methods: We retrospectively evaluated all patients who received outpatient-based prevalent hemodialysis patients ( n = 84) in our artificial kidney room between January 2019 and October 2019. Through blood temperature monitoring, access blood flow was calculated every month and Kt/ V was calculated every 3 months. The reference point was set at the time of vascular intervention in the patients ( n = 27) who underwent intervention or at the middle of the study period in patients ( n = 57) who did not undergo intervention. The mean blood temperature monitoring–estimated access flow and Kt/ V before and after the reference point were calculated and compared. Results: Among 84 patients, 30 (35.7%) showed access flow rates of <500 mL/min, calculated by blood temperature monitoring during the study period. Twenty-seven patients (32.1%) underwent vascular intervention, of whom 24 (28.6%) showed access flow rates of <500 mL/min, 2 (2.4%) showed weak bruit or thrill incapable of needling, and 1 (1.2%) presented acute occlusion. Six patients (7.1%) whose access flow rates were <500 mL/min refused to undergo intervention. All angiographies in the patients whose access flow rates were <500 mL/min who underwent intervention showed a significant stenosis. The mean change in blood temperature monitoring–estimated access flow and Kt/ V before and after vascular intervention was 483.3 ± 490.6 and 0.19 ± 0.21, respectively, which showed significant differences (all p < 0.05). A weak positive correlation between the mean change in blood temperature monitoring–estimated access flow and Kt/ V was shown in all study patients by Pearson’s correlation analysis ( r = 0.234, p = 0.033). Conclusion: Access flow estimation by blood temperature monitoring might identify candidates who require vascular intervention. Blood temperature monitoring–guided vascular intervention significantly improved access flow and dialysis adequacy.

scholarly journals Stima della portata della fistola artero-venosa mediante termodiluizione nei pazienti in emodialisi cronica: esperienza monocentrica.

2020 ◽  
Vol 32 (1) ◽  
pp. 30-35
Author(s):  
Enrico Varricchio ◽  
Alessandro Puntoni ◽  
Domenico Giannese ◽  
Claudia Mannucci ◽  
Piera Serio ◽  
...  
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Color Doppler ◽  
Chronic Hemodialysis ◽  
Blood Temperature ◽  
Doppler Data ◽  
Important Challenge ◽  
Native Fistula ◽  
Temperature Monitor ◽  
The Mean

Purpose: Vascular access surveillance in hemodialysis is today an important challenge for nephrologist.  Low blood flow is a risk factor for development of thrombosis of native fistula or graft. The aim of the study is to evaluate the correspondence between flow measurement by thermodilution and Color Doppler, and to identify flow rate values using the Blood temperature monitor (BTM) method in the case of stenosis. Methods: We evaluated 29 patients on chronic hemodialysis. The evaluation of blood flow with BTM were performed during the first hour of the hemodialysis session. All patients underwent a color doppler of vascular access within 10 days from the BTM measurements. Results: The mean vascular access flow calculated with BTM resulted 1142 ± 700 ml/min and there was a correlation with color doppler data 1199 ± 644 ml/min (p=0,0001 r=0,829). The flow of patients with hemodynamically significant stenosis was 332 ± 92 ml/min with a minimum value of 270 ml/min and a maximum value of 440 ml/min. Conclusion: the correspondence between thermodilution and color doppler support the implementation of intradialitic evaluation of the vascular access blood flow with the BTM method. Thermodilution allows to identify earlier patients with high risk of vascular access failure and the need for further diagnostic and therapeutic investigations.

scholarly journals Prediction of vascular access stenosis: Blood temperature monitoring with the Twister versus static intra-access pressure ratio

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0204630 ◽  
Author(s):  
Yoo Jin Choi ◽  
Young-Ki Lee ◽  
Hayne Cho Park ◽  
Eun Yi Kim ◽  
Ajin Cho ◽  
...  
Keyword(s):  
Vascular Access ◽  
Pressure Ratio ◽  
Temperature Monitoring ◽  
Blood Temperature ◽  
Vascular Access Stenosis

scholarly journals FP572PREDICTION OF VASCULAR ACCESS STENOSIS: BLOOD TEMPERATURE MONITORING WITH TWISTER VS STATIC INTRA-ACCESS PRESSURE RATIO

2018 ◽  
Vol 33 (suppl_1) ◽  
pp. i233-i233
Author(s):  
Yoo Jin Choi ◽  
Young-Ki Lee ◽  
Ajin Cho ◽  
Eun Yi Kim ◽  
Sun Ryoung Choi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Pressure Ratio ◽  
Temperature Monitoring ◽  
Blood Temperature ◽  
Vascular Access Stenosis

Comparison of urea recirculation and thermodilution for monitoring of vascular access in patients undergoing hemodialysis

2018 ◽  
Vol 19 (3) ◽  
pp. 283-290 ◽  
Author(s):  
Almudena Vega ◽  
Soraya Abad ◽  
Inés Aragoncillo ◽  
Isabel Galán ◽  
Nicolás Macías ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Vascular Access ◽  
Operating Characteristic ◽  
Temperature Monitoring ◽  
Hemodialysis Access ◽  
Receiver Operating Characteristic Curves ◽  
Blood Temperature ◽  
A Value ◽  
Kaplan Meier

Introduction It is important to monitor vascular access in patients with stage 5 chronic kidney disease receiving hemodialysis. Access recirculation can help to detect a need for intervention. Objectives: To compare urea recirculation with recirculation by thermodilution using blood temperature monitoring to predict a need for intervention of vascular access over a 6-month period. Methods: We analyzed urea recirculation and blood temperature monitoring simultaneously in 61 patients undergoing hemodialysis. During the 6-month follow-up, we recorded all cases of angioplasty or surgery (thrombectomy or reanastomosis). In line with previous studies, we considered a value to be positive when urea recirculation was >10% and blood temperature monitoring >15%. Receiver operating characteristic curves were constructed. Results: Mean urea recirculation was 9.5% ± 6.6% and mean blood temperature monitoring 12.9% ± 4.3% (p = 0.001). Urea recirculation >10% had a sensitivity of 80% and specificity of 78%. Blood temperature monitoring >15% had a sensitivity of 33% and specificity of 85%. During follow-up, 25% of patients developed need for intervention of vascular access. We found an association between vascular access dysfunction and urea recirculation. The Kaplan–Meier analysis confirmed an association between urea recirculation and risk of vascular access dysfunction (log rank = 17.2; p = 0.001). We were unable to confirm this association with blood temperature monitoring (log rank = 0.879; p = 0.656). Conclusion: Urea recirculation is better predictor of vascular access dysfunction than thermodilution.

scholarly journals The Effect of Dialysis Solution Temperature and Stepwise Ultrafiltration Profile on Dialysis Adequacy and Pruritus in Hemodialysis Patients: A Quasi-experimental Study

2021 ◽  
Vol 9 (4) ◽  
Author(s):  
Abdolhamid Jamshidzehi ◽  
Fatemeh Kiyani ◽  
Salahuddin Boya ◽  
Hasan Askari ◽  
Farshid Saeedinezhad
Keyword(s):  
Standard Deviation ◽  
Hemodialysis Patients ◽  
Solution Temperature ◽  
Dialysis Adequacy ◽  
Dialysis Solution ◽  
Increased Risk ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental ◽  
The Mean

Background: Patients with renal insufficiency who receive hemodialysis should be continuously monitored to avoid possible complications, as they are at increased risk of several problems, including pruritus, as one of the most annoying problems. It seems that dialysis adequacy affects the pruritus of hemodialysis patients. Objective: The current study aimed to investigate the effect of dialysis solution temperature and stepwise ultrafiltration profile on dialysis adequacy and pruritus of hemodialysis patients. Methods: Following a single group quasi-experimental design, 34 eligible hemodialysis patients admitted to the hemodialysis ward of Zahedan Medical Center (Iran) in 2020 were recruited using the convenience sampling technique. All patients attended three standard dialysis sessions (at a temperature of 37°C) and three cold dialysis sessions (36°C) with a stepwise dialysis ultrafiltration profile. Dialysis adequacy was measured at the end of each session, and Yosipovitch’s Pruritus Severity Scale (PSS) was filled before and after each dialysis session. Data were summarized using descriptive statistics (i.e., frequency, mean, and standard deviation). Mean scores before and after dialysis were paired by t-test using SPSS version 22. Statistical significance was considered when P-value < 0.05. Results: The mean and standard deviation of dialysis adequacy in both standard dialysis and cold dialysis techniques with stepwise ultrafiltration profile were 1.18 ± 0.36 and 1.44 ± 0.48, respectively, indicating that dialysis adequacy of the cold dialysis method with stepwise ultrafiltration profile was significantly higher (P = 0.001). Besides, the mean pruritus scores in the standard dialysis and cold dialysis methods with stepwise ultrafiltration profile were -0.73 ± 0.80 and -1.73 ± 1.16, respectively, showing a significant difference (P = 0.001). Conclusions: Cold hemodialysis with a stepwise ultrafiltration profile can be used as a simple and low-cost technique to improve both dialysis adequacy and relieve pruritus in hemodialysis patients.

Perbedaan Pengetahuan Siswa Tentang Penyakit Hepatitis A Sebelum Dan Sesudah Penyuluhan Di MTsN 02 Bondowoso Tahun 2015

2017 ◽  
Vol 4 (2) ◽  
pp. 14
Author(s):  
Putri Megasari
Keyword(s):  
Hepatitis A ◽  
Hepatitis Virus ◽  
Sampling Technique ◽  
Mean Value ◽  
Test Design ◽  
The World ◽  
Before And After ◽  
Post Test ◽  
The Mean ◽  
Paired T Test

Hepatitis has become a health problem in the world. The hepatitis virus infected many people. According to the teacher of MTsN 02 Bondowoso more than 20 students have hepatitis A viral infection. The purpose of this research was to know the differences of students' knowledge about hepatitis A before and after counseling in MTsN 02 Bondowoso 2015. This study used pre-experimental (pre-post test design). This study used stratified random sampling technique, 127 students from 270 sample involved this research,and 143 students was excluded. We used questionnaires to collect data. The results showed that the mean value of the students 'knowledge about hepatitis A before counseling in MTsN 02 Bondowoso 2015 was 83.96 with the lowest value of 37.5 and the highest value was 100. The mean value of the students' knowledge about hepatitis A after counseling in MTsN 02 Bondowoso 2015 was 93.21 with the lowest value waf 62.5 and the highest value was 100. Paired t test showed that t (-9.07) > t table (1.98), the null hypothesis (H0) was rejected. There was a difference between students' knowledge about hepatitis A before and after counseling in MTsN 02 Bondowoso 2015. This study showed that routine counseling by healthcare provider was important to prevent hepatitis A infection.; Keywords: counseling, knowledge of students, hepatitis

Quality of Life for Children with Persistent Sinonasal Symptoms

2003 ◽  
Vol 128 (1) ◽  
pp. 17-26 ◽  
Author(s):  
David J. Kay ◽  
Richard M. Rosenfeld
Keyword(s):  
Quality Of Life ◽  
Clinical Care ◽  
Longitudinal Change ◽  
Good Test ◽  
Routine Clinical Care ◽  
Before And After ◽  
The Mean ◽  
The Individual ◽  
Sinonasal Symptoms

OBJECTIVE: The goal was to validate the SN-5 survey as a measure of longitudinal change in health-related quality of life (HRQoL) for children with persistent sinonasal symptoms. DESIGN AND SETTING: We conducted a before and after study of 85 children aged 2 to 12 years in a metropolitan pediatric otolaryngology practice. Caregivers completed the SN-5 survey at entry and at least 4 weeks later. The survey included 5 symptom-cluster items covering the domains of sinus infection, nasal obstruction, allergy symptoms, emotional distress, and activity limitations. RESULTS: Good test-retest reliability ( R = 0.70) was obtained for the overall SN-5 score and the individual survey items ( R ≥ 0.58). The mean baseline SN-5 score was 3.8 (SD, 1.0) of a maximum of 7.0, with higher scores indicating poorer HRQoL. All SN-5 items had adequate correlation ( R ≥ 0.36) with external constructs. The mean change in SN-5 score after routine clinical care was 0.88 (SD, 1.19) with an effect size of 0.74 indicating good responsiveness to longitudinal change. The change scores correlated appropriately with changes in related external constructs ( R ≥ 0.42). CONCLUSIONS: The SN-5 is a valid, reliable, and responsive measure of HRQoL for children with persistent sinonasal symptoms, suitable for use in outcomes studies and routine clinical care.

scholarly journals Evaluation of pharmacy-led weight management service to minimise the risk of cardiovascular disease

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Aliki Peletidi ◽  
Reem Kayyali
Keyword(s):  
Physical Activity ◽  
Weight Management ◽  
Activity Levels ◽  
Management Service ◽  
Initial Weight ◽  
Public Health Services ◽  
Clinical Role ◽  
Physical Activity Levels ◽  
Before And After ◽  
The Mean

Abstract Aims The primary aim of the programme was a minimum of a 5% weight reduction of the initial weight, while the secondary outcomes were a reduction in participants’ body mass index (BMI), waist circumference (WC), blood pressure (BP), AUDIT-C score and an increase in the Mediterranean diet (MD) score and an improvement in physical activity levels. Methods This 'before and after' study was a 10-week weight management (WM) programme and it was developed and delivered in community pharmacies in Patras chosen for convenience, thus consisting the first service of its type in Greece. The sample size was calculated (n = 96) based on the mean BMI for a Greek male and female individual, and the standard deviation (SD) of weight at baseline of 14 kg. Results Nearly every participant enrolled in the 20 participating pharmacies, 97.4% (n = 114/117), achieved the programme’s aim, losing at least 5% of their initial weight. The mean percentage of total weight loss of the 117 participants at the 10th week was 8.97% (SD 2.65), and the t-test showed statistically significant results (P-value < 0.001; 95% CI [8.48, 9.45]). A significant reduction in the waist-to-height ratio (WHtR) was observed in both male (P-value = 0.004) and female (P-value < 0.001) participants. The participants’ BP and AUDIT-C score and physical activity levels significantly improved (P-value < 0.001), as well as their MD score. Conclusion This study provides the first evidence that Greek pharmacists have the potential to play an important role within primary healthcare and that after training they are able to provide public health services for both the public’s benefit and their clinical role enhancement.

scholarly journals CT perfusion in peripheral arterial disease—hemodynamic differences before and after revascularisation

2021 ◽  
Author(s):  
Patrick Veit-Haibach ◽  
Martin W. Huellner ◽  
Martin Banyai ◽  
Sebastian Mafeld ◽  
Johannes Heverhagen ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Ct Perfusion ◽  
Arterial Disease ◽  
Lower Leg ◽  
Therapy Control ◽  
Non Invasive ◽  
Before And After ◽  
Invasive Method ◽  
The Mean ◽  
Peripheral Arterial

Abstract Objectives The purpose of this study was the assessment of volumetric CT perfusion (CTP) of the lower leg musculature in patients with symptomatic peripheral arterial disease (PAD) before and after interventional revascularisation. Methods Twenty-nine consecutive patients with symptomatic PAD of the lower extremities requiring interventional revascularisation were assessed prospectively. All patients underwent a CTP scan of the lower leg, and hemodynamic and angiographic assessment, before and after intervention. Ankle-brachial pressure index (ABI) was determined. CTP parameters were calculated with a perfusion software, acting on a no outflow assumption. A sequential two-compartment model was used. Differences in CTP parameters were assessed with non-parametric tests. Results The cohort consisted of 24 subjects with an occlusion, and five with a high-grade stenosis. The mean blood flow before/after (BFpre and BFpost, respectively) was 7.42 ± 2.66 and 10.95 ± 6.64 ml/100 ml*min−1. The mean blood volume before/after (BVpre and BVpost, respectively) was 0.71 ± 0.35 and 1.25 ± 1.07 ml/100 ml. BFpost and BVpost were significantly higher than BFpre and BVpre in the treated limb (p = 0.003 and 0.02, respectively), but not in the untreated limb (p = 0.641 and 0.719, respectively). Conclusions CTP seems feasible for assessing hemodynamic differences in calf muscles before and after revascularisation in patients with symptomatic PAD. We could show that CTP parameters BF and BV are significantly increased after revascularisation of the symptomatic limb. In the future, this quantitative method might serve as a non-invasive method for surveillance and therapy control of patients with peripheral arterial disease. Key Points • CTP imaging of the lower limb in patients with symptomatic PAD seems feasible for assessing hemodynamic differences before and after revascularisation in PAD patients. • This quantitative method might serve as a non-invasive method, for surveillance and therapy control of patients with PAD.

scholarly journals Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oriel Spierer ◽  
Abraham Spierer
Keyword(s):  
Young Children ◽  
Success Rate ◽  
Lateral Rectus ◽  
Intermittent Exotropia ◽  
Age At Surgery ◽  
Surgical Methods ◽  
Before And After ◽  
The Mean ◽  
Consecutive Esotropia

Abstract Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

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