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Per una gestione Lean degli Accessi Vascolari
Get PDFVascular access (VA) is the key point to obtain an efficient dialysis, since VA dysfunction can hinder efficacy by increasing costs and hospitalization time, and by worsening quality of life. Costs of VA are increasing, due to the development of new grafts, catheters, and stents, and the increasing number of old patients.
A global strategy to contain costs in this field requires a solid and consistent strategy of process management. The Toyota Production System could offer a method to analyze VA from a patient-oriented point of view, by means of identifying wastes and value stream during the process.
Vascular burden of at-risk patients (chronic disease, frequent hospital stay) must be protected by skilled nurses. Late referral must be constrained to low figures by controlling the territory and allowing the planning of internal native VA. Residual CVC must be evaluated for AVF conversion, and a hierarchy among AVF, AVG and CVC must be established and respected. Finally, angioplasty and stents must be used in selected cases.
CVC appear to be the main waste, while AV fistula is the access with maximum added value.
Such a complex activity, involving many professionals, fits very well with a low volume/high quality industry model, and is based on the empowerment of each professional along the production chain.
The multi-professional model requires a coordinator able to guide the patient along a pathway composed by the classical steps of planning, monitoring, clinical discussion, and corrective measures. It is our opinion that a senior nurse could be the right professional to do this job, as suggested by the model implemented in organ transplantation
sj-docx-1-jva-10.1177_11297298231217318 – Supplemental material for Vascular access for hemodialysis in Italy: What a national survey reveals
No full textSupplemental material, sj-docx-1-jva-10.1177_11297298231217318 for Vascular access for hemodialysis in Italy: What a national survey reveals by Marcello Napoli, Francesco Guzzi, Walter Morale, Carlo Lomonte, Franco Galli, Massimo Lodi, Giuseppe Bonforte, Decenzio Bonucchi, Giuliano Brunori, Laura Buzzi, Giacomo Forneris, Maurizio Gallieni, Mario Meola, Nicola Pirozzi, Concetto Sessa, Monica Spina and Luigi Tazza in The Journal of Vascular Access</p
Everolimus, Cyclosporine, and Thrombotic Microangiopathy: Clinical Role and Preventive Tools in Renal Transplantation
No full textINTRODUCTION:
Thrombotic microangiopathy (TMA) is characterized by endothelial cell injury and formation of fibrin thrombi within capillary and arterioles. In renal allograft recipients, TMA mainly presents as hemolytic uremic syndrome. Its occurrence is rare, and diagnosis requires a high degree of suspicion. Drug toxicity, in particular from calcineurin inhibitors (CNIs) and mTOR inhibitors (mTORi), is the most common cause posttransplant and has recently been emphasized in the setting of lung transplantation.
OBJECTIVE:
The goal of this study was to investigate the role of mTORi as an added risk factor in the development of TMA to propose strategies for modulation of immunosuppressive (IS) therapy.
PATIENTS AND METHODS:
From a database of 496 renal graft recipients, we analyzed 350 renal graft biopsy specimens gathered at our center from 1998 to 2012. In patients undergoing combined therapy with mTORi and CNI, we compared drugs levels in TMA-affected and TMA-free groups, using mTORi and CNI TLC and the summation of [everolimus TLC+(cyclosporine C2/100)] (Σ) as a surrogate marker of combined exposition to 2 drugs. Receiver-operating characteristic analysis of association of EVL TLC+(C2/100) was performed for patients exposed to mTORi.
RESULTS:
Histologic features of TMA were found in 36 patients (prevalence of 7.3%). The caseload was divided into 2 groups: not drug-related TMA (n=19) and drug-related TMA (n=17). Despite the prevalence of TMA in patients exposed to mTORi being greater (8 of 153; prevalence, 5.3%) compared with therapies without mTORi (9 of 324; prevalence, 2.8%), statistical difference was not reached. Patients treated with mTORi who developed de novo drug-related TMA had higher blood levels of IS drugs compared with those who did not develop TMA. Receiver-operating characteristic analysis found a significant threshold of 12.5 ng/mL (area under the curve, 0.803; P=.006).
CONCLUSIONS:
Results confirm the pivotal role of IS drugs in the onset of de novo TMA. On the basis of literature, we could speculate a sequence of endothelial damage by CNI, on which everolimus fits hindering the repair of endothelial injury. Therefore, high blood levels of CNI and mTORi seem to predispose patients to posttransplant TMA. Combined monitoring of these 2 drugs might be used to prevent the complication. Σ [everolimus TLC + (cyclosporine C2/100)]>12.5 ng/mL should be avoided as a surrogate risk factor for adverse effects
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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