Base de dados : MEDLINE
Pesquisa : E07.132.750 [Categoria DeCS]
Referências encontradas : 1245 [refinar]
Mostrando: 1 .. 10   no formato [Detalhado]

página 1 de 125 ir para página                         

  1 / 1245 MEDLINE  
              next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29189249
[Au] Autor:Reeves T; Morrison D; Altmiller G
[Ad] Endereço:Turena Reeves is a quality management coordinator and Dolores Morrison is a clinical nurse specialist at Einstein Medical Center Philadelphia. Gerry Altmiller is an associate professor of nursing at the College of New Jersey, Ewing, and a consultant for Einstein Medical Center Philadelphia. Contact author: Dolores Morrison, morrisod@einstein.edu. Reeves and Morrison received an in-house grant from the Albert Einstein Society to implement this quality improvement project. The authors have disclosed no potential conflicts of interest, financial or otherwise.
[Ti] Título:A Nurse-Led Ultrasound-Enhanced Vascular Access Preservation Program.
[So] Source:Am J Nurs;117(12):56-64, 2017 Dec.
[Is] ISSN:1538-7488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:: Insertion of peripheral iv catheters is a common practice in medical-surgical care settings. The frequency with which attempts are made to insert catheters causes rapid peripheral vessel depletion (a reduction in the number of usable veins), leading to the overuse of unnecessary central line catheters. Reducing central line-associated bloodstream infections is a national health care priority. In this quality improvement report, the authors describe the implementation of a nurse-led vascular access preservation program using ultrasound technology as a method to reduce the use of nonessential peripherally inserted central catheters.
[Mh] Termos MeSH primário: Cateterismo Venoso Central/enfermagem
Cateterismo Periférico/enfermagem
Melhoria de Qualidade
Ultrassonografia de Intervenção
[Mh] Termos MeSH secundário: Seres Humanos
Papel do Profissional de Enfermagem
Sistemas Automatizados de Assistência Junto ao Leito
Padrões de Prática em Enfermagem
Dispositivos de Acesso Vascular
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1097/01.NAJ.0000527490.24610.51


  2 / 1245 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29029713
[Au] Autor:Bhatt A; Al-Hakim R; Benenati JF
[Ad] Endereço:Miami Cardiac and Vascular Institute, Miami, FL. Electronic address: alokbbhatt@gmail.com.
[Ti] Título:Techniques and Devices for Catheter-Directed Therapy in Pulmonary Embolism.
[So] Source:Tech Vasc Interv Radiol;20(3):185-192, 2017 Sep.
[Is] ISSN:1557-9808
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The clinical presentation of a patient with acute pulmonary embolism (PE) can be classified into 3 categories: low-risk, submassive (presence of right heart strain), and massive (hemodynamic compromise). Massive PE is associated with high morbidity or mortality and typically treated with systemic intravenous thrombolysis. Over the last 2 decades, however, catheter-directed techniques have become an increasingly popular treatment modality for patients with a contraindication to systemic thrombolysis or without clinical improvement after systemic thrombolysis. Furthermore, endovascular treatment for patients with submassive PE has been of great interest due to the significantly increased mortality associated with right heart strain, and prospective clinical trials have demonstrated catheter-directed thrombolysis to decrease right heart strain earlier than systemic anticoagulation alone. This article describes available devices and endovascular techniques used to treat patients with massive and submassive acute PE.
[Mh] Termos MeSH primário: Procedimentos Endovasculares/instrumentação
Fibrinolíticos/administração & dosagem
Embolia Pulmonar/terapia
Trombectomia/instrumentação
Terapia Trombolítica/instrumentação
Dispositivos de Acesso Vascular
[Mh] Termos MeSH secundário: Adulto
Angiografia por Tomografia Computadorizada
Procedimentos Endovasculares/efeitos adversos
Procedimentos Endovasculares/mortalidade
Desenho de Equipamento
Feminino
Fibrinolíticos/efeitos adversos
Hemodinâmica
Seres Humanos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Embolia Pulmonar/diagnóstico por imagem
Embolia Pulmonar/mortalidade
Embolia Pulmonar/fisiopatologia
Medição de Risco
Fatores de Risco
Trombectomia/efeitos adversos
Trombectomia/mortalidade
Terapia Trombolítica/efeitos adversos
Terapia Trombolítica/mortalidade
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Fibrinolytic Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171015
[St] Status:MEDLINE


  3 / 1245 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29023551
[Au] Autor:Radakovic D; Reboredo J; Helm M; Weigel T; Schürlein S; Kupczyk E; Leyh RG; Walles H; Hansmann J
[Ad] Endereço:Department of Thoracic and Cardiovascular Surgery, University Hospital Wuerzburg, Josef-Schneider-Straße 2, Wuerzburg, Germany.
[Ti] Título:A multilayered electrospun graft as vascular access for hemodialysis.
[So] Source:PLoS One;12(10):e0185916, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Despite medical achievements, the number of patients with end-stage kidney disease keeps steadily raising, thereby entailing a high number of surgical and interventional procedures to establish and maintain arteriovenous vascular access for hemodialysis. Due to vascular disease, aneurysms or infection, the preferred access-an autogenous arteriovenous fistula-is not always available and appropriate. Moreover, when replacing small diameter blood vessels, synthetic vascular grafts possess well-known disadvantages. A continuous multilayered gradient electrospinning was used to produce vascular grafts made of collagen type I nanofibers on luminal and adventitial graft side, and poly-É›-caprolactone as medial layer. Therefore, a custom-made electrospinner with robust environmental control was developed. The morphology of electrospun grafts was characterized by scanning electron microscopy and measurement of mechanical properties. Human microvascular endothelial cells were cultured in the graft under static culture conditions and compared to cultures obtained from dynamic continuous flow bioreactors. Immunofluorescent analysis showed that endothelial cells form a continuous luminal layer and functional characteristics were confirmed by uptake of acetylated low-density-lipoprotein. Incorporation of vancomycin and gentamicin to the medial graft layer allowed antimicrobial inhibition without exhibiting an adverse impact on cell viability. Most striking a physiological hemocompatibility was achieved for the multilayered grafts.
[Mh] Termos MeSH primário: Prótese Vascular
Células Endoteliais/metabolismo
Teste de Materiais
Diálise Renal/instrumentação
Dispositivos de Acesso Vascular
[Mh] Termos MeSH secundário: Colágeno Tipo I/química
Células Endoteliais/citologia
Seres Humanos
Nanofibras/química
Poliésteres/química
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Collagen Type I); 0 (Polyesters); 24980-41-4 (polycaprolactone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171022
[Lr] Data última revisão:
171022
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171013
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185916


  4 / 1245 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28987428
[Au] Autor:Simon EM; Summers SM
[Ad] Endereço:Emergency Department, San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, SAMMC, MCHE-EMR, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234-6200, USA. Electronic address: emsimon85@gmail.com.
[Ti] Título:Vascular Access Complications: An Emergency Medicine Approach.
[So] Source:Emerg Med Clin North Am;35(4):771-788, 2017 Nov.
[Is] ISSN:1558-0539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Millions of central venous and arterial catheters are placed across the United States annually as mechanisms of obtaining advanced hemodynamic monitoring and facilitating acute resuscitation. Although presumably life saving or sustaining in many circumstances, current literature identifies the preprocedural and postprocedural complications of infection, thrombosis, embolism, and iatrogenic injury as resulting in patient morbidity and mortality. Today, through the application of aseptic technique, performance of operator training, and the utilization of ultrasound, emergency physicians may limit vascular access complications and improve patient outcomes.
[Mh] Termos MeSH primário: Cateterismo Periférico/efeitos adversos
Medicina de Emergência/métodos
Dispositivos de Acesso Vascular/efeitos adversos
[Mh] Termos MeSH secundário: Cateterismo Periférico/instrumentação
Falha de Equipamento
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171009
[St] Status:MEDLINE


  5 / 1245 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28873444
[Au] Autor:Han Y; Choo SJ; Kwon H; Lee JW; Chung CH; Kim H; Kwon TW; Cho YP
[Ad] Endereço:Department of and Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
[Ti] Título:Effects of upper-extremity vascular access creation on cardiac events in patients undergoing coronary artery bypass grafting.
[So] Source:PLoS One;12(9):e0184168, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The present study was conducted to investigate whether upper-extremity vascular access (VA) creation increases the risk for major adverse cardiac events (MACE) and death in patients undergoing coronary artery bypass grafting (CABG) with an in situ left internal thoracic artery (ITA) graft. A total of 111 patients with CABG with a left ITA graft who underwent upper-extremity VA creation were analyzed retrospectively; 93 patients received left VA creation (83.8%, ipsilateral group) and 18 patients received right VA creation (16.2%, contralateral group). The primary outcome was the occurrence of MACE, and the secondary outcome was the composite of MACE or late death. There were no significant differences in the incidence of primary (P = 0.30) or secondary (P = 0.09) outcomes between the two groups. Multivariate regression analysis indicated that prior cerebrovascular accidents (hazard ratio [HR] 3.30; 95% confidence interval [CI] 1.37-7.97; P = 0.01) and type of VA (HR 3.44; 95% CI 1.34-8.82; P = 0.01) were independently associated with MACE; prior peripheral arterial occlusive disease (HR 4.22; 95% CI 1.62-10.98; P<0.01) and type of VA (arteriovenous fistula vs. prosthetic arteriovenous grafting) (HR 3.06; 95% CI, 1.42-6.61; P<0.01) were associated with the composite of MACE or death. The side and location of VA were not associated with MACE or death. Our study showed no definite evidence that ipsilateral VA creation affects the subsequent occurrence of MACE or late death from any cause. The type of VA (a prosthetic arteriovenous grafting) is a significant predictor of the subsequent occurrence of MACE or late death.
[Mh] Termos MeSH primário: Ponte de Artéria Coronária
Extremidade Superior/irrigação sanguínea
Dispositivos de Acesso Vascular
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184168


  6 / 1245 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28842077
[Au] Autor:Schneider PA
[Ad] Endereço:Division of Vascular Therapy, Kaiser Foundation Hospital, Honolulu, Hawaii. Electronic address: peterschneidermd@aol.com.
[Ti] Título:Evolution and current use of technology for superficial femoral and popliteal artery interventions for claudication.
[So] Source:J Vasc Surg;66(3):916-923, 2017 Sep.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:An important facet in caring for patients with claudication is the development of a plan for managing the technology available for superficial femoral artery (SFA) and popliteal artery interventions. Although this is a field in evolution, clinical experience and data are emerging that assist the clinician in making informed choices as to the best method of endovascular treatment. Algorithms for SFA and popliteal artery interventions are developing. Methods for assessing a wide range of technologies are discussed. This article reviews the evolution of technology for SFA and popliteal artery interventions, describes the recent developments in data and clinical experiences, and discusses some potential methods of device assessment and incorporation into clinical practice.
[Mh] Termos MeSH primário: Angioplastia com Balão
Implante de Prótese Vascular
Artéria Femoral/cirurgia
Claudicação Intermitente/terapia
Doença Arterial Periférica/terapia
Artéria Poplítea/cirurgia
[Mh] Termos MeSH secundário: Algoritmos
Angioplastia com Balão/efeitos adversos
Angioplastia com Balão/instrumentação
Prótese Vascular
Implante de Prótese Vascular/efeitos adversos
Implante de Prótese Vascular/instrumentação
Procedimentos Clínicos
Técnicas de Apoio para a Decisão
Artéria Femoral/fisiopatologia
Seres Humanos
Claudicação Intermitente/diagnóstico
Claudicação Intermitente/fisiopatologia
Seleção de Pacientes
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/fisiopatologia
Artéria Poplítea/fisiopatologia
Desenho de Prótese
Fatores de Risco
Stents
Resultado do Tratamento
Dispositivos de Acesso Vascular
Grau de Desobstrução Vascular
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170827
[St] Status:MEDLINE


  7 / 1245 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28826727
[Au] Autor:Jongsma H; van Mierlo-van den Broek P; Imani F; van den Heuvel D; de Vries JPM; Fioole B
[Ad] Endereço:Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands. Electronic address: jongsmah@maasstadziekenhuis.nl.
[Ti] Título:Randomized comparison of femoropopliteal artery drug-eluting balloons and drug-eluting stents (FOREST trial): Study protocol for a randomized controlled trial.
[So] Source:J Vasc Surg;66(4):1293-1298, 2017 Oct.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The optimal endovascular treatment for femoropopliteal arterial occlusive disease has yet to be assessed. Patency rates after uncoated balloon angioplasty are disappointing. Although stents have better outcomes, they also have limitations. Intra-arterial stenting may lead to stent thrombosis and flow pattern disruption, which may result in stent fracture or in-stent restenosis. In the past decade, drug-eluting balloons (DEBs) and drug-eluting stents (DESs) have been introduced, and both have been proven to possess antirestenotic features compared with conventional techniques. The objective of this study is to perform a noninferiority analysis of DEBs with provisional bare-metal stenting and primary stenting with DESs in the treatment of femoropopliteal arterial occlusive disease. If DEB with provisional bare-metal stenting proves to be noninferior to primary stenting with DESs, DEBs may be the favorable technique because the postoperative long-term limitations of stents will be restricted. This is a prospective, randomized, controlled, single-blind, multicenter trial. The study population consists of volunteers aged ≥18 years, with chronic, symptomatic peripheral arterial occlusive disease (Rutherford-Baker classification 2 to 5) caused by de novo stenotic or occlusive atherosclerotic lesions of the superficial femoral artery or of the popliteal artery (only segment P1). Subjects will be treated with a DEB and provisional bare-metal stenting (if a stenosis >30% or a flow-limiting dissection persists after prolonged inflation with an uncoated balloon) or with primary stenting with a DES. The study will include 254 patients (ratio 1:1). The primary end point is 2-year freedom from binary restenosis, defined as a lumen diameter reduction of <50% assessed by duplex ultrasound imaging (peak systolic velocity ratio <2.5). Secondary end points are technical success, target lesion revascularization, target vessel revascularization, improvement in ankle-brachial index, improvement in Rutherford classification, amputation rate, and mortality rate.
[Mh] Termos MeSH primário: Angioplastia com Balão/instrumentação
Fármacos Cardiovasculares/administração & dosagem
Materiais Revestidos Biocompatíveis
Stents Farmacológicos
Artéria Femoral
Doença Arterial Periférica/terapia
Dispositivos de Acesso Vascular
[Mh] Termos MeSH secundário: Angioplastia com Balão/efeitos adversos
Índice Tornozelo-Braço
Protocolos Clínicos
Constrição Patológica
Intervalo Livre de Doença
Artéria Femoral/diagnóstico por imagem
Artéria Femoral/fisiopatologia
Seres Humanos
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/fisiopatologia
Desenho de Prótese
Recuperação de Função Fisiológica
Recidiva
Projetos de Pesquisa
Fatores de Tempo
Resultado do Tratamento
Ultrassonografia Doppler Dupla
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Cardiovascular Agents); 0 (Coated Materials, Biocompatible)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170823
[St] Status:MEDLINE


  8 / 1245 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28787431
[Au] Autor:Lin WY; Lin CP; Hsu CH; Lee YH; Lin YT; Hsu MC; Shao YY
[Ad] Endereço:Department of Anesthesiology, National Taiwan University Hospital, 7, Chung-Shan S Rd, Taipei City 10002, Taiwan.
[Ti] Título:Right or left? Side selection for a totally implantable vascular access device: a randomised observational study.
[So] Source:Br J Cancer;117(7):932-937, 2017 Sep 26.
[Is] ISSN:1532-1827
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Totally implantable vascular access device (TIVAD)-related complications interfere in the anticancer treatment and increase medical expenses. We examined whether the implantation side of central line TIVADs is associated with the occurrence of thrombotic or occlusion events. METHODS: We enrolled patients with cancer who required central line TIVADs and randomised them to receive the TIVAD implantation on either the left or right side. The primary endpoint was the occurrence of catheter-related thrombotic or occlusion events. RESULTS: We randomised 240 patients, of which 235 received TIVAD implantation according to the protocol. In the per-protocol cohort, 117 and 118 patients received implantation on the left and right sides, respectively. Catheter-related thrombotic or occlusion events occurred in 9 (4%) patients, accounting for 0.065 events per 1000 catheter-days. Between the patients with left- and right-sided implantations, the occurrence rates (P=0.333) and the time from catheter implantation to the occurrence of thrombotic or occlusion events (P=0.328) were both similar. In the multivariate analysis, the side of implantation remained unassociated with the occurrence of thrombotic or occlusion events. CONCLUSIONS: The side of central line TIVAD implantation was not associated with the occurrence of catheter-related thrombotic or occlusion events in patients with cancer.
[Mh] Termos MeSH primário: Obstrução do Cateter/etiologia
Infecções Relacionadas a Cateter/etiologia
Cateterismo Periférico/métodos
Neoplasias/tratamento farmacológico
Dispositivos de Acesso Vascular/efeitos adversos
Trombose Venosa/etiologia
[Mh] Termos MeSH secundário: Idoso
Antineoplásicos/administração & dosagem
Falha de Equipamento
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antineoplastic Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171005
[Lr] Data última revisão:
171005
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170809
[St] Status:MEDLINE
[do] DOI:10.1038/bjc.2017.264


  9 / 1245 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28764608
[Au] Autor:Sharma A; Kumar S; Devarajan SLJ; Agarwal H
[Ad] Endereço:1 Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
[Ti] Título:Rare Post-Tonsillectomy Internal Carotid Artery Pseudoaneurysm: Management by Parent Artery Occlusion Using Detachable Balloons.
[So] Source:Vasc Endovascular Surg;51(7):506-508, 2017 Oct.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Iatrogenic cervical internal carotid artery pseudoaneurysm is a rare and potentially lethal complication following tonsillectomy. It can be complicated by thromboembolism, mass effect and eventually may rupture leading to death. Various endovascular treatment options are available for the management of these pseudoaneurysms, including coil embolization, detachable balloon occlusion, or stent graft placement. Parent artery occlusion using detachable balloons can be a therapeutic option in a subset of patients. However, evaluation of cross circulation with preprocedure balloon test occlusion is imperative in such cases.
[Mh] Termos MeSH primário: Falso Aneurisma/terapia
Oclusão com Balão/instrumentação
Lesões das Artérias Carótidas/terapia
Doença Iatrogênica
Tonsilectomia/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Falso Aneurisma/diagnóstico por imagem
Falso Aneurisma/etiologia
Lesões das Artérias Carótidas/diagnóstico por imagem
Lesões das Artérias Carótidas/etiologia
Artéria Carótida Interna/diagnóstico por imagem
Angiografia por Tomografia Computadorizada
Desenho de Equipamento
Seres Humanos
Masculino
Resultado do Tratamento
Dispositivos de Acesso Vascular
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417723154


  10 / 1245 MEDLINE  
              first record previous record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28599902
[Au] Autor:Shechter SM; Chandler T; Skandari MR; Zalunardo N
[Ad] Endereço:Sauder School of Business, University of British Columbia, Vancouver, BC, Canada.
[Ti] Título:Cost-effectiveness Analysis of Vascular Access Referral Policies in CKD.
[So] Source:Am J Kidney Dis;70(3):368-376, 2017 Sep.
[Is] ISSN:1523-6838
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The optimal timing of vascular access referral for patients with chronic kidney disease who may need hemodialysis (HD) is a pressing question in nephrology. Current referral policies have not been rigorously compared with respect to costs and benefits and do not consider patient-specific factors such as age. STUDY DESIGN: Monte Carlo simulation model. SETTING & POPULATION: Patients with chronic kidney disease, referred to a multidisciplinary kidney clinic in a universal health care system. MODEL, PERSPECTIVE, & TIMEFRAME: Cost-effectiveness analysis, payer perspective, lifetime horizon. INTERVENTION: The following vascular access referral policies are considered: central venous catheter (CVC) only, arteriovenous fistula (AVF) or graft (AVG) referral upon HD initiation, AVF (or AVG) referral when HD is forecast to begin within 12 (or 3 for AVG) months, AVF (or AVG) referral when estimated glomerular filtration rate is <15 (or <10 for AVG) mL/min/1.73m . OUTCOMES: Incremental cost-effectiveness ratios (ICERs, in 2014 US dollars per quality-adjusted life-year [QALY] gained). RESULTS: The ICER of AVF (AVG) referral within 12 (3) months of forecasted HD initiation, compared to using only a CVC, is ∼$105k/QALY ($101k/QALY) at a population level (HD costs included). Pre-HD AVF or AVG referral dominates delaying referral until HD initiation. The ICER of pre-HD referral increases with patient age. Results are most sensitive to erythropoietin costs, ongoing HD costs, and patients' utilities for HD. When ongoing HD costs are excluded from the analysis, pre-HD AVF dominates both pre-HD AVG and CVC-only policies. LIMITATIONS: Literature-based estimates for HD, AVF, and AVG utilities are limited. CONCLUSIONS: The cost-effectiveness of vascular access referral is largely driven by the annual costs of HD, erythropoietin costs, and access-specific utilities. Further research is needed in the field of dialysis-related quality of life to inform decision making regarding vascular access referral.
[Mh] Termos MeSH primário: Derivação Arteriovenosa Cirúrgica
Falência Renal Crônica
Encaminhamento e Consulta
Diálise Renal
[Mh] Termos MeSH secundário: Derivação Arteriovenosa Cirúrgica/instrumentação
Derivação Arteriovenosa Cirúrgica/métodos
Derivação Arteriovenosa Cirúrgica/psicologia
Análise Custo-Benefício
Seres Humanos
Falência Renal Crônica/economia
Falência Renal Crônica/psicologia
Falência Renal Crônica/terapia
Método de Monte Carlo
Anos de Vida Ajustados por Qualidade de Vida
Encaminhamento e Consulta/economia
Encaminhamento e Consulta/organização & administração
Diálise Renal/economia
Diálise Renal/instrumentação
Diálise Renal/métodos
Estados Unidos
Dispositivos de Acesso Vascular/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170611
[St] Status:MEDLINE



página 1 de 125 ir para página                         
   


Refinar a pesquisa
  Base de dados : MEDLINE Formulário avançado   

    Pesquisar no campo  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde