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At least 325 records · Page 18Linked to original sources

PubMed1998

Physical therapists' opinions and practices regarding direct access.

BACKGROUND AND PURPOSE: This study examined whether differences exist about physical therapists' opinions and practices regarding the use of direct access between therapists practicing in Massachusetts, a direct-access state, and therapists practicing in Connecticut, a state that allows only evaluation without referral. A second purpose was to examine direct-access practices of therapists in Massachusetts. SUBJECTS: A sample of 329 therapists in Massachusetts and 179 therapists in Connecticut were surveyed. METHODS: A cover letter, questionnaire, and return-reply envelope were mailed to each therapist. Independent group t tests and chi-square analyses were used to determine whether therapists' opinions about direct access differed between states. Frequencies were calculated to examine direct-access practices of therapists in Massachusetts. RESULTS: Adjusted response rates were 65.5% in Massachusetts and 57.9% in Connecticut. Therapists in both states were equally supportive of direct access (74.9%). Therapists in Connecticut were more supportive of three stipulations regulating direct access than therapists in Massachusetts were. In Massachusetts, 34.0% of the respondents stated that they practiced using direct access, and 8.8% of the patients seen by the therapists sampled were treated without physicians' referrals. The therapists indicated that the most common reasons for limited use of direct access were employer policies and lack of insurance reimbursement. CONCLUSION AND DISCUSSION: Therapists in Connecticut favored more stipulation regulating direct access than therapists in Massachusetts did. Although therapists in both states appear to be supportive of direct access, the number of patients in Massachusetts seen through this mode of care appears to be limited because of practice and financial restraints.

Adult↗

PubMedDate not supplied

Variable flow Doppler for hemodialysis access evaluation: theory and clinical feasibility.

Access thrombosis remains an enormous problem for patients on hemodialysis. Current evidence suggests that decreasing access blood flow rate is an important predictor of future access thrombosis and failure. This article describes a method for determining access volume flow and detecting access pathology. The Doppler ultrasound signal downstream from the arterial needle as a function of the variable hemodialysis blood pump flow rate, is used to determine access blood flow. By using this variable flow (VF) Doppler technique compared with duplex volume flow estimates measured in 18 accesses (16 patients with 12 polytetrafluorethylene [PTFE] grafts and 6 autogenous fistulas), the results showed a correlation of 0.83 (p < 0.0001) between these methods. In grafts with lower blood flow rates, aberrant flow patterns were observed, including stagnant or reversed flow during diastole while forward flow was maintained during systole. When reversed diastolic flow was severe, it was accompanied by access recirculation. In conclusion, we report the theory and clinical feasibility of determining access blood flow by using a VF Doppler technique. Measurements are made without the need to determine the access cross sectional area required for duplex volume flow calculations and without the need to reverse the lines required for various indicator dilution techniques. Important information is also obtained about aberrant flow patterns in patients at risk of access failure.

Blood Flow Velocity↗

PubMedDate not supplied

Statewide evaluation of youth access ordinances in practice: effects of the implementation of community-level regulations in Massachusetts.

The objectives of the study described in this article were to test whether community-level youth access ordinances reduce adolescents' perceived access to tobacco, purchase attempts, and tobacco use. A telephone survey was performed of a random sample of 3,831 Massachusetts adolescents linked to a database of all town-level youth access ordinances in the state. Respondents' perceived ease of access to tobacco, attempts to purchase tobacco, and tobacco use (ever smoking and current [past 30-day] smoking) were assessed. The association of these outcomes with the characteristics of youth access ordinances in the respondents' town of residence (n = 314) was tested in multilevel analyses that included town-level clustering, controlled for multiple individual and environmental characteristics, including a measure of community-level anti-smoking sentiment. Community-level youth access ordinances were not associated with adolescents' perceived access to tobacco, purchase attempts, or tobacco use, with two exceptions: (1) banning free-standing displays was associated with a 40% reduction in perceived access to tobacco (OR = 0.6; 95% CI, 0.4-0.9) and (2) a vending machine ban was associated a 30% higher report of perceived access to tobacco (OR = 1.3; 95% CI, 1.1-1.5). This study found no consistent associations between community-level youth access ordinances and adolescents' perceived access to tobacco, purchase attempts, or smoking prevalence.

Adolescent↗

PubMed2003

Analysis of accessible surface of residues in proteins.

We analyzed the total, hydrophobic, and hydrophilic accessible surfaces (ASAs) of residues from a nonredundant bank of 587 3D structure proteins. In an extended fold, residues are classified into three families with respect to their hydrophobicity balance. As expected, residues lose part of their solvent-accessible surface with folding but the three groups remain. The decrease of accessibility is more pronounced for hydrophobic than hydrophilic residues. Amazingly, Lysine is the residue with the largest hydrophobic accessible surface in folded structures. Our analysis points out a clear difference between the mean (other studies) and median (this study) ASA values of hydrophobic residues, which should be taken into consideration for future investigations on a protein-accessible surface, in order to improve predictions requiring ASA values. The different secondary structures correspond to different accessibility of residues. Random coils, turns, and beta-structures (outside beta-sheets) are the most accessible folds, with an average of 30% accessibility. The helical residues are about 20% accessible, and the difference between the hydrophobic and the hydrophilic residues illustrates the amphipathy of many helices. Residues from beta-sheets are the most inaccessible to solvent (10% accessible). Hence, beta-sheets are the most appropriate structures to shield the hydrophobic parts of residues from water. We also show that there is an equal balance between the hydrophobic and the hydrophilic accessible surfaces of the 3D protein surfaces irrespective of the protein size. This results in a patchwork surface of hydrophobic and hydrophilic areas, which could be important for protein interactions and/or activity.

Amino Acids↗

PubMedDate not supplied

A randomized prospective study of comparison of reservoir ports versus conventional vascular access in advanced-stage ovarian carcinoma cases treated with chemotherapy.

Vascular access ports were developed to overcome many of the problems associated with limited peripheral access, combined with the need for frequent venipuncture, in oncology patients receiving long-term intensive therapy. In this study, we compared the effectivity and acceptability of vascular access port with conventional needle application together with complication rates in ovarian cancer patients. Advanced-stage ovarian carcinoma cases under chemotherapy treatment were equally randomized into two groups, implantable vascular access ports applied to one group (22 cases) and conventional vascular access applied to the other (38 cases) as a control group. Anteroposterior thoracic X-rays of implantable port-applied cases were taken before and after the application. Vortex reservoir ports (Horizon Medical Products, Inc., Manchester, GA) were used in the application to the subclavian vein. Classic peripheral venipuncture method (Medikit), Mediflon(trade mark) IV cannula with PTFE radiopaque catheter and injection valve, Eastern Medikit Ltd, Gurgaon, Haryana, India) was used in the control group. Vascular accesses of all cases were controlled just after the application, 12 h after the application, and during each drug or intravenous fluid application. Mean port insertion time was 26.3 min. Total port occlusion was observed in two of the port-applied cases (11.7%) and partial port occlusion was observed in five of the port-applied cases (29%). Heparin and saline combination was used in order to open the port tip, in five cases, two with total occlusion and three with partial occlusion. Infection was observed in only one case (5%) to whom appropriate therapy was given, and the port was taken out. Ports of two cases were also taken out because of skin dehiscence. No change in port tip position was observed in any of the cases. Total occlusion was observed in 16 of the 38 cases (42.1%) with conventional vascular access. In 12 cases (31.5%), a need arose to change the conventional vascular access. No vascular access was found in 13 of the 38 cases (34.2%). Application of reservoir ports especially to cases with advanced-stage carcinomas, under chemotherapeutic drug treatment, leads to minimal anxiety for the patient and his/her family and minimal risk of physical trauma to the patient with only one vascular access. Reservoir ports occlude or cause infection to a lesser extent than classic vascular access methods. Occlusion or infection rates of reservoir ports are statistically significant, lower than those of classic venipuncture.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Vascular access: a role for a renal nurse clinician.

The team approach to the delivery of healthcare is important and has become more so since the boundaries between professional groups have become blurred. Renal replacement therapy requires that patients have adequate access. This could be in the form of an arterio-venous fistula, a graft, or a vascular catheter. Doctors have historically always provided access for patients. Placement of vascular access is a lengthy process often causing long delays and anxiety. Due to the reduction in junior doctors hours and the further demands on senior medical staff, a nurse was nominated and developed the role of vascular access specialist and clinician. Before the development of the nurse clinicians' role, the situation in this centre regarding venous access for haemodialysis was based on an ad hoc arrangement between junior doctors. Historically surgeons and medical staff have always provided vascular access for haemodialysis. However, it was felt that a suitably educated renal nurse would be more suitable to develop this role, and a relevant course, (MSc in Advanced Nursing Practice) had been developed at a nearby university. The access role included the insertion of both short and long-term vascular access catheters. An access referral pathway is now in place, giving a streamlined service. A designated access specialist nurse now inserts vascular access, providing focused individualised care specifically targeted at the renal patients' needs. Because of the success of this role, four more nurses are being supported to undertake the clinical MSc. The aim is to develop other areas of renal provision and to provide a nurse led specialist individualised service in line with the future National Service Framework. The role has also provided scope for nursing career development, giving motivation to experienced clinical nurses who wish to remain clinically involved, improve the care for patients and progress their career.

Arteriovenous Shunt, Surgical↗

PubMed1996

The effect of endodontic access cavity preparation and subsequent restorative procedures on molar crown retention.

Preparation of an endodontic access cavity through a full crown may affect its retention. This study was undertaken to investigate the effects on molar crown retention of endodontic access cavities and their subsequent restoration. Thirty human molars were mounted in resin, crown preparations were cut and their surface areas were determined. Vented metal copings were cemented with zinc phosphate and the forces required to displace each coping were measured using a tensile-testing machine. The copings were recemented, access cavities were cut and their surface areas determined prior to the displacement forces being re-measured. The copings were recemented, assigned to two groups, and the access cavities were restored--Group 1 with amalgam; Group 2 with glass ionomer (GIC). Displacement forces were re-measured and the copings were recemented. The occlusal margins of the access cavities were bevelled and restored again prior to displacement forces being remeasured. Mean displacement forces were - Group 1: Original (kg force), 37.86 +/- 3.97; After access cavity, 29.28 +/- 3.22; Amalgam, 50.21 +/- 4.71; Amalgam + bevel, 46.45 +/- 6.21. Group 2: Original, 42.77 +/- 4.49; After access cavity, 39.25 +/- 5.91; GIC, 48.11 +/- 3.55; GIC + bevel, 39.63 +/- 5.31. Statistical analyses with paired t tests showed that retentive values with access cavities were significantly lower than with intact crowns. Amalgam or GIC restorations increased retention beyond original values, significantly with amalgam. Bevelled occlusal margins decreased retention of crowns with restored access cavities but this was not significantly different from the original values. A significant relationship existed between total surface areas of the crown preparations, areas of the occlusal tables, and retentive values for crowns without access cavities. The access cavity area, as a proportion of the total area of the preparation, was related to the decrease in retention.

Cementation↗

PubMed2006

Vascular access: comparison of US guidance with the sonic flashlight and conventional US in phantoms.

PURPOSE: To prospectively evaluate whether ultrasonography (US)-guided vascular access can be learned and performed faster with the sonic flashlight than with conventional US and to demonstrate sonic flashlight-guided vascular access in a cadaver. MATERIALS AND METHODS: Institutional review board approval and oral and written informed consent were obtained. The sonic flashlight replaces the standard US monitor with a real-time US image that appears to float beneath the skin and is displayed where it is scanned. In studies 1 and 2, participants performed sonic flashlight-guided needle insertion tasks in vascular phantoms. In study 1, 16 participants (nine women, seven men) with no US experience performed 60 simulated vascular access trials with sonic flashlight or conventional US guidance. With analysis of variance (ANOVA) and power-curve fitting, improvement with practice rate and mean differences between techniques and tasks were examined. In study 2, 14 female nurses (mean age, 50.1 years) proficient with conventional US performed simulated vascular access trials on three tasks with the sonic flashlight and conventional US. With random assignment, half the participants used the sonic flashlight first and half used conventional US first. Mean performance with each technique and that with each task were compared by using ANOVA. In study 3, feasibility of sonic flashlight guidance for access to internal jugular and basilic veins was demonstrated in a cadaver. RESULTS: For study 1, learning rates (ie, decrease in access time over trials) did not differ for vascular access with sonic flashlight and conventional US. Overall, participants achieved faster vascular access times with sonic flashlight guidance (P < .007). In study 2, participants performed procedures faster overall with the sonic flashlight (P < .02) and found the sonic flashlight easier to use. In study 3, sonic flashlight-guided vascular access was gained in the cadaver. CONCLUSION: Learning and performance of vascular access were significantly faster with the sonic flashlight than with conventional US, and vascular access could be gained in a cadaver; the sonic flashlight is ready for clinical trials.

Adult↗

PubMed2005

Vascular access education, planning and percutaneous interventions by nephrologists.

To optimize vascular access care of patients with end stage renal disease, nephrologists themselves are taking a keen interest in the management of vascular access-related issues. Because of their unique clinical perspective on dialysis access and better understanding of the intricacies of renal replacement therapy, nephrologists are ideally suited for this activity. Two areas are the main focus of attention by these specialists: vascular access education and access-related percutaneous interventions. Vascular access-related procedures commonly performed by nephrologists include percutaneous balloon angioplasty for vascular access stenosis, thrombectomy procedure for a thrombosed arteriovenous access, tunneled hemodialysis catheter-related procedures and vascular mapping to determine the patient's optimal vascular access. While the performance of these procedures by nephrologists offers many advantages, appropriate training in order to develop the necessary procedural skills is critical. Recent data have emphasized that a nephrologist can be successfully trained to become a competent interventionalist. In addition to documenting excellent outcome data, multiple reports have demonstrated safety and success when these procedures are performed by nephrologists. This chapter focuses on vascular access education and hemodialysis access-related procedures performed by nephrologist and calls for a proactive approach in optimizing this aspect of patients care.

Angioplasty, Balloon↗

PubMed2006

Open access publishing and author-pays business models: a survey of authors' knowledge and perceptions.

OBJECTIVES: We aimed to assess journal authors' current knowledge and perceptions of open access and author-pays publishing. DESIGN: An electronic survey. SETTING: Authors of research papers submitted to BMJ, Archives of Disease in Childhood, and Journal of Medical Genetics in 2004. MAIN OUTCOME MEASURES: Familiarity with and perceptions of open access and author-pays publishing. RESULTS: 468/1113 (42%) responded. Prior to definitions being provided, 47% (222/468) and 38% (176/468) reported they were familiar with the terms "open access" and "author-pays" publishing, respectively. Some who did not at first recognize the terms, did claim to recognize them when they were defined. Only 10% (49/468) had submitted to an author-pays journal. Compared with non-open access subscription-based journals, 35% agreed that open access author-pays journals have a greater capacity to publish more content making it easier to get published, 27% thought they had lower impact factors, 31% thought they had faster and more timely publications, and 46% agreed that people will think anyone can pay to get published. 55% (256/468) thought they would not continue to submit to their respective journal if it became open access and charged, largely because of the reputation of the journals. Half (54%, 255/468) said open access has "no impact" or was "low priority" in their submission decisions. Two-thirds (66%, 308/468) said they would prefer to submit to a non-open access subscription-based journal than an open access author-pays journal. Over half thought they would have to make a contribution or pay the full cost of an author charge (56%, 262/468). CONCLUSIONS: The survey yielded useful information about respondents' knowledge and perceptions of these publishing models. Authors have limited familiarity with the concept of open-access publishing and surrounding issues. Currently, open access policies have little impact on authors' decision of where to submit papers.

Adult↗

PubMed2002

Approach to vascular access for hemodialysis: experiences from the Republic of Macedonia.

Eight thousand eight hundred and forty nine different vascular hemodialysis accesses were performed in the period from 1976 until 1999 at the Department of Nephrology, Skopje: 3,114 native arterial-venous fistula (AVF), 715 arterial-venous shunts (AVS), 4,964 temporary or permanent catheters (4,411/88.86% femoral, 410/8.26% subclavian, 143/2.88% jugular) and 56 PTFE vascular grafts. Femoral catheterization (4,312/86.86%) is the favoured solution if a temporary vascular dialysis access is taken into consideration. The most popular chronic dialysis angio-access in our country is native AVF (90.5% of 3,440 permanent dialytic vascular accesses). The tunneled subcutaneously positioned catheters as a permanent dialytic angio-access were present in 270 cases (7.9%): 99 in femoral veins (our original method), 123 in subclavian veins and 48 catheters in jugular veins. The synthetic vascular grafts-PTFE (polytetrafluoro-ethylene) represent only 1.6% of all dialysis angio-accesses. The number of preventive AVFs created in patients with preterminal end-stage renal disease eventually increased; from 14% in the eighties, 20.8% after 10 years and 31.50% in 1999. Most of the preventive AVFs are done in outpatients 71.8% in 1999. This year 44.4% of all chronic vascular access were created in the same way. We prefer femoral catheters for both temporary and permanent access because our results show that femoral catheterization has a lower rate of early complications when compared to the subclavian catheterization group; the rate of late complications (thrombosis, stenosis, infections) is lower or the same; infections in femoral catheterizations are less frequent, compared to subclavian and jugular ones. Our contributions in the field of vascular access surgery are the three original methods which are constantly used at the Department: 1. Combination of temporary (AVS) and permanent vascular access (AVF) using the same blood vessels, performed in one surgical act; 2. Tunneled femoral catheter as a permanent vascular access for hemodialysis (2 types: on the abdominal wall and on the infrainguinal region - thigh); 3. Reduction of hyper-flow in AVF without the operation of "banding", with ligation of the artery before arteriovenous anastomosis.

Adolescent↗

PubMed2005

Effect of access to anticoagulation management services on warfarin use in patients with atrial fibrillation.

STUDY OBJECTIVE: To determine the effect of access to ambulatory anticoagulation management services (AMS) on the rate of warfarin use in patients with atrial fibrillation. DESIGN: Retrospective medical record review. SETTING: Two ambulatory care clinics in the same managed care system: one with and one without access to pharmacist-managed AMS. PATIENTS: One hundred seventy-eight patients with atrial fibrillation diagnosed between June 2000 and June 2001. MEASUREMENTS AND MAIN RESULTS: Warfarin use was assessed overall and by contraindications and risk factors for stroke. Independent predictors of therapy were identified. The overall rate of warfarin use in atrial fibrillation was higher in the clinic with access to AMS than in the clinic without access (77.9% vs 61.7%, p=0.03). In patients with no known contraindications, warfarin use increased by 20.2% with access to AMS versus no access (80.2% vs 60.0%, p=0.023). Patients aged 65 years or older with one or more risk factors for stroke and no contraindications were more likely to receive warfarin in the clinic with access to AMS than in the clinic without access (85.1% vs 53.8%, p=0.001). Access to AMS was an independent predictor of warfarin use (odds ratio 2.19, 95% confidence interval [CI] 1.05-4.56). Female sex was an independent negative predictor of warfarin use (odds ratio 0.48, 95% CI 0.24-0.96). CONCLUSION: In the managed care setting, use of warfarin for stroke prophylaxis in patients with atrial fibrillation was higher in the ambulatory care clinic with access to pharmacist-managed AMS than in the clinic without access.

Age Factors↗

PubMedDate not supplied

Access control based on attribute certificates for medical intranet applications.

BACKGROUND: Clinical information systems frequently use intranet and Internet technologies. However these technologies have emphasized sharing and not security, despite the sensitive and private nature of much health information. Digital certificates (electronic documents which recognize an entity or its attributes) can be used to control access in clinical intranet applications. OBJECTIVES: To outline the need for access control in distributed clinical database systems, to describe the use of digital certificates and security policies, and to propose the architecture for a system using digital certificates, cryptography and security policy to control access to clinical intranet applications. METHODS: We have previously developed a security policy, DIMEDAC (Distributed Medical Database Access Control), which is compatible with emerging public key and privilege management infrastructure. In our implementation approach we propose the use of digital certificates, to be used in conjunction with DIMEDAC. RESULTS: Our proposed access control system consists of two phases: the ways users gain their security credentials; and how these credentials are used to access medical data. Three types of digital certificates are used: identity certificates for authentication; attribute certificates for authorization; and access-rule certificates for propagation of access control policy. Once a user is identified and authenticated, subsequent access decisions are based on a combination of identity and attribute certificates, with access-rule certificates providing the policy framework. CONCLUSIONS: Access control in clinical intranet applications can be successfully and securely managed through the use of digital certificates and the DIMEDAC security policy.

Certification↗

PubMed1999

Temporary vascular access for first dialysis is common, undesirable and usually avoidable.

BACKGROUND: When technically feasible, patients with end-stage renal failure should commence regular dialysis treatment with permanent access to the circulation (by arteriovenous fistula) or peritoneum (by soft peritoneal catheter) in situ, thus avoiding the need for initial hemodialysis employing temporary vascular access. We have examined the frequency, consequences and avoidability of temporary access in such patients. METHODS: 178 patients commencing regular dialysis between August 1993 and April 1995 were analysed retrospectively using case notes. Patients were divided into those who had permanent dialysis access in situ when they commenced dialysis and those who required temporary access. If temporary access was required, the patients were further analysed into those who had been first seen by a nephrologist at least 12 weeks before the first dialysis, and those who had been referred "late". It was assumed that 12 weeks was sufficient time for permanent access to be instituted. Mortality within the first 90 days of commencing dialysis was recorded. RESULTS: Seventy-four of 82 patients opting for regular hemodialysis and 53 of 96 opting for peritoneal dialysis required temporary vascular access. Late referral accounted for 47 and delays within the renal service for 35 of such patients. Late presentation to the medical profession or indecisiveness on the part of the patient accounted for the remainder. Twenty-five of 127 patients requiring temporary access but only one or 51 patients not requiring it died within 90 days of commencement of treatment. CONCLUSION: Late presentation to a renal unit prior to first dialysis is associated with increased mortality. Late referral or late presentation are associated with an increased need for temporary vascular access for first dialysis. Many patients who require temporary access for first dialysis could have been better managed.

Adult↗

PubMed1999

Ultrasound-fluoroscopy guided access to the intrarenal excretory system.

The access to the collecting system can be performed under fluoroscopy computerized tomography, ultrasonographic, mixed ultrasonographic and fluoroscopic guidance. In this paper the creation of a percutaneous transparenchymal ultrasound-fluoroscopy guided access to the intrarenal collecting system completely performed by urologist for different purposes is presented. In five years 297 patients underwent 330 percutaneous kidney accesses to perform derivative nephrostomies (217 pts), percutaneous nephrolithotomies (37 pts), antegrade ureteral manoeuvres (34 pts), antegrade endopyelotomies (7 pts), transitional cell carcinoma of the upper tract resection (2 pts). 11 patients out of these had a percutaneous kidney access in a transplanted kidney. The percutaneous access was successful in 98% of the attemps. A posterior calyx of the lower group (74%), of the medium group (25%) or of the upper group (1%) was accessed. In 73 accesses the mean target calyx diameter was 12.8 mm (range 5-45 mm), the mean operative time 5.4 minutes and the mean fluoroscopy time 5.1 seconds. In 84.5% of the patients the access was performed under local anesthesia when a dilation of the tract was not required. Gross haematuria was observed in 3.9% of the accesses and an arterial lesion treated by embolization in 0.9% of the accesses. Blood transfusion was required in 0.3% of the patients. The ultrasound-fluoroscopy guided access is at least as precise as the fluoroscopy guided one moreover it makes the procedure less invasive and it makes more precise the surgical planning.

Fluoroscopy↗

PubMed1993

Access problems plague both peritoneal dialysis and hemodialysis.

Both chronic peritoneal dialysis and center hemodialysis require a transcutaneous access. Costs of maintaining access to the bloodstream and the costs of maintaining access to the peritoneal cavity are substantial for both therapies. Complication rates for blood access clotting and exit site infection may be similar. Exit site infections can often be treated on an outpatient basis. Clotted blood access devices frequently need surgical revision. Peritonitis can in some instances be related to access (excluding internal sources for peritonitis), but with newer devices these rates can be as low as 0.5 episodes per patient year or lower. Thus, the sum of exit site infection rates and peritonitis rates may give totals approaching one episode per patient year. If clotted access incident rates are near half of this, as the recently quoted study suggests, then overall access complications may be more common in peritoneal dialysis. However, the outpatient treatment of most episodes of peritonitis and the outpatient treatment of many if not most episodes of exit site infection implies a lower level of severity than a clotted access device requiring hospitalization and surgical revision. Also of note, bacteremia is a rare complication of exit site infection and peritonitis. In contract, bacteremia and sepsis occur in a high percentage of patients with an infected blood access. Thus, both chronic peritoneal dialysis and chronic hemodialysis continue to be plagued by access problems. Efforts to decrease these problems if successful can result in increased acceptability and safety of both therapies.

Anti-Bacterial Agents↗

PubMedDate not supplied

Hemodialysis access flow measurement. Comparison of ultrasound dilution and duplex ultrasonography.

Decreased hemodialysis access flow is associated with an increased risk of access thrombosis. Duplex ultrasonography can measure access flow and select a subset of patients at increased risk for access failure. With in-line techniques (ultrasound dilution), access flow can be measured during hemodialysis. This study attempted to determine if access flow measured by ultrasound dilution (QA-T) was comparable to that measured by duplex ultrasonography (QA-S). The authors performed 66 simultaneous measurements of hemodialysis access flow in 19 patients by ultrasound dilution and duplex ultrasound with time-domain correlation during 19 hemodialysis treatments. The mean access flow was 1,086 +/- 505 ml/min by ultrasound dilution and 1,026 +/- 513 ml/min with duplex ultrasonography (NS). Regression analysis revealed a linear relationship between the two techniques described by the equation QAT = 246.14 + 0.8104(QAS) (correlation coefficient of 0.83; p < 0.0001). Measurement of hemodialysis access flow by ultrasound dilution was essentially equivalent to that obtained by duplex ultrasound. Additional studies are needed to determine if regular in-line flow measurements can predict and prevent future access thrombosis and decreased the cost of access management.

Arteriovenous Shunt, Surgical↗

PubMed2005

Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial.

CONTEXT: It is estimated that half of unintended pregnancies could be averted if emergency contraception (EC) were easily accessible and used. OBJECTIVE: To evaluate the effect of direct access to EC through pharmacies and advance provision on reproductive health outcomes. DESIGN, SETTING, AND PARTICIPANTS: A randomized, single-blind, controlled trial (July 2001-June 2003) of 2117 women, ages 15 to 24 years, attending 4 California clinics providing family planning services, who were not desiring pregnancy, using long-term hormonal contraception or requesting EC. INTERVENTION: Participants were assigned to 1 of the following groups: (1) pharmacy access to EC; (2) advance provision of 3 packs of levonorgestrel EC; or (3) clinic access (control). MAIN OUTCOME MEASURES: Primary outcomes were use of EC, pregnancies, and sexually transmitted infections (STIs) assessed at 6 months; secondary outcomes were changes in contraceptive and condom use and sexual behavior. RESULTS: Women in the pharmacy access group were no more likely to use EC (24.2%) than controls (21.0%) (P = .25). Women in the advance provision group (37.4%) were almost twice as likely to use EC than controls (21.0%) (P<.001) even though the frequency of unprotected intercourse was similar (39.8% vs 41.0%, respectively, P = .46). Only half (46.7%) of study participants who had unprotected intercourse used EC over the study period. Eight percent of participants became pregnant and 12% acquired an STI; compared with controls, women in the pharmacy access and advance provision groups did not experience a significant reduction in pregnancy rate (pharmacy access group: adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.58-1.64; P = .93; advance provision group: OR, 1.10; 95% CI, 0.66-1.84, P = .71) or increase in STIs (pharmacy access group: adjusted OR, 1.08, 95% CI, 0.71-1.63, P = .73; advance provision group: OR, 0.94, 95% CI, 0.62-1.44, P = .79). There were no differences in patterns of contraceptive or condom use or sexual behaviors by study group. CONCLUSIONS: While removing the requirement to go through pharmacists or clinics to obtain EC increases use, the public health impact may be negligible because of high rates of unprotected intercourse and relative underutilization of the method. Given that there is clear evidence that neither pharmacy access nor advance provision compromises contraceptive or sexual behavior, it seems unreasonable to restrict access to EC to clinics.

Adolescent↗