4 resultados para Oroantral Fistula
em Deakin Research Online - Australia
Resumo:
Postauricular cutaneous mastoid fistula is a rare condition. The cutaneous mastoid fistula is a very rare complication of chronic suppurative otitis media. The fistula tracts are typically difficult to manage because of the surrounding necrotic skin edges. We describe an unusual case of a postauricular cutaneous mastoid fistula and outline the surgical technique used for closure.
Resumo:
Background
Renal access coordinators contribute specifically to dialysis access care for people with chronic and end stage renal disease. Since the introduction of renal access coordinators into Australia in the early 2000s, there have been anecdotal examples of associated improvements in patient outcomes and service delivery; however scant published quantitative evidence exists. Thus, the impact of the implementation of renal access coordinators has not undergone a rigorous review to date.
Objective
The objective of this systematic review was to critically appraise and synthesize the best available evidence related to the impact of renal access coordinators on dialysis patient outcomes and associated service delivery.
INCLUSION CRITERIA
Types of participants
This review considered studies that included renal access coordinators (noting variations of the titles) and adult hemodialysis patients (aged 18 years and over).
Types of intervention(s)
This review considered studies that evaluated the effectiveness of the renal access coordinator. This role typically consists of clinical and administration duties such as providing pre dialysis access coordination, access surveillance patient education and nurse education.
Types of studies
The types of studies considered within this review included experimental and epidemiological study designs. Thus randomized controlled trials (RCT), non-randomized controlled trials, and quasi-experimental, before and after studies, prospective and retrospective cohort studies were considered as were case control studies, analytical cross sectional studies and descriptive cross sectional studies.
Types of outcomes
Patient outcomes considered included: days to first vascular access complication (such as stenosis or thrombosis) and/or primary intervention (such as angioplasty or surgical intervention); percentage of central line insertions (negative); rate of arteriovenous fistula (AVF)/arteriovenous graft (AVG)/central venous catheter (CVC) at start of dialysis (incidence); prevalent rate of AVF/AVG/CVC; time to occlusion of AVF and time from referral to surgery. Service outcomes included: knowledge/up skilling of renal nurses; cannulation skills, ultrasound skills, knowledge of anatomy and physiology and other access related knowledge.
Search strategy
The search strategy aimed to locate published and unpublished studies, utilizing a three-step searching approach. Studies published in English from 1990 to October 2013 were considered for inclusion in this review.
Methodological quality
The studies were assessed by two independent reviewers using the appropriate standardized critical appraisal instruments from the Joanna Briggs Institute.
Data collection
Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute, namely JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).
Data synthesis
This review aimed to conduct meta-analyses of the findings: however, because of the limitations of the data found, this was not possible and so the findings are presented in a narrative format.
Results
Five studies were identified for inclusion in the review. No RCTs were found, therefore four of the five studies were pre-post intervention cohort studies and one was a prospective quality assurance report. Data were heterogeneous and thus did not allow for meta-analysis. All studies included multidisciplinary teams with variable emphasis on the renal access coordinator role. The pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the hemodialysis population and the quality assurance report measured the difference in patency rates between AVF and AVG. All discussed the role of central coordination as a contributor to the success of vascular access care.
Conclusions
This review found insufficient data to make firm conclusions about the impact that renal access coordinators have on patient outcomes. The results of this review suggest an association between renal access coordinators and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs.
Resumo:
ABSTRACT
Background:
Aim:
To undertake a randomised controlled pilot study comparing the efficacy of Arnica and Hirudoid creams in treating bruising and pain following post-needling infiltration.
Methods:
One dialysis centre of 40 patients over a 12-month period. Following infiltration, and at the five subsequent dialysis treatments, pain was measured using the Abbey pain scale and size of the bruise was recorded.
Results:
Eleven cases of infiltration were recorded consisting of seven males (64%) and four females (36%) who had a mean age of 78 years (SD=9). Access for eight patients was via arteriovenous fistula and for three patients via arteriovenous graft. Eight patients experienced bruising and two patients reported mild pain post-infiltration but there were no differences found between the effect of Arnica or Hirudoid in treating either symptom.
Conclusion:
This pilot study was unable to detect any differences in the effect of Arnica and Hirudoid on pain or bruising. The study demonstrated that a larger, multicentre trial would be required to power a study and that a non-interventional control group should be added.
Resumo:
Background: The risk of venous thromboembolism (VTE) may be reduced if a vein of appropriate diameter is used forperipherally inserted central catheter (PICC) insertion. However, clinicians may have predilections to cannulate certainvein types and use particular insertion sites (eg, right or left arm) and therefore do not necessarily assess all veinsavailable to determine the most optimal vessel to introduce a catheter. It is important that clinicians have anunderstanding of the diameter of veins used for PICC insertion and the effect of patient factors such as hand dominanceon vein size to determine whether their clinical practice is appropriate.
Methods: A scoping review of published literature was performed to determine existing knowledge regarding thediameters of veins used for PICC insertion and the influence of patient factors such as hand dominance and laterality(left or right arm) on vein size.
Results: There was limited published research about the diameters of the basilic, brachial, and cephalic veins at themidupper arm, with only 6 studies identified. Three of the 6 selected articles focused on vein diameter measurement toinform arteriovenous fistula development. Only 1 study included participants undergoing PICC insertion. Scant researchexamined the effect of laterality on vein diameter and 1 study was identified that reported the influence of handdominance or vein type on the diameter of veins used for PICC insertion.
Conclusions: This review found that there is a paucity of studies that have examined the veins used for PICC insertion.Nevertheless, it appears that the basilic vein has the largest diameter (with smaller brachial and cephalic veins),although this is not always the case. Laterality and hand dominance does not seem to influence vein diameter. Furtherresearch about the vasculature used for PICC insertion is needed to inform clinical practice.
