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Biomedical subjects

B C Smith

Publications and source records attributed to B C Smith.

61 records · Page 4Linked to original sources
PubMedDate not supplied

The relationship of health locus of control to patients with end-stage renal disease.

Twenty-eight patients with end-stage renal disease receiving dialysis at the University of Utah Medical Center were the subjects of a nonequivalent control group study. This study was designed to measure the impact of a preventive aerobic exercise/educational intervention on the patients' locus of control. A creative incentive plan was utilized to motivate patients to accept responsibility for acquire cardiovascular fitness. There were no statistically significant differences before and after the intervention, as measured by the Multidimensional Locus of Control scale. The absence of change was partly attributed to an unusual internal orientation at the pretest level. Of the four factors examined that might account for this finding, the one that emerged with a statistically significantly high correlation was the duration on dialysis.

Cardiovascular Diseases↗
PubMedDate not supplied

AV fistula rates: changing the culture of vascular access.

PURPOSE: Data from the United States Renal Data System show about 30% of prevailing hemodialysis (HD) patients use arteriovenous fistulae (AVF), which falls far short of the Kidney Disease Outcomes Quality Initiative (K/DOQI) goals of 40-50%. Recent initiatives to increase the use of AVF in HD patients have been criticized as unachievable under realistic practice conditions. METHODS: A multidisciplinary effort to increase AVF use was undertaken at an outpatient HD center beginning in 1998. Strategies focused on education and recruitment of patients in both inpatient and outpatient settings, preservation of veins, pre-operative vein mapping, and education of staff. RESULTS: AVF rates increased from 32%, to 72% over 6 years. The percentage of prosthetic grafts decreased from 40% to 13%. Central venous catheters fell from 28% to 15%. Among residual patients with catheters, 77% had maturing fistulae, as well. Infection rates in the dialysis unit decreased by 39%. Bacteremia declined by 47%. These improvements have been sustainable over the past 12 months. CONCLUSIONS: Adherence to a strategic program similar to the Fistula First Initiative can increase fistula rates under ordinary practice conditions. High fistula rates can be achieved in male and female patients. Unanimous commitment among all members of the health care team is needed. Reduction in the risks of infection, bacteremia, endocarditis, and death may be derived from achievable changes in practice.

Journal Article↗
PubMedDate not supplied

Long-term outcomes of a fistula initiative: sustaining "fistula culture".

From 1998 to 2003, a low cost fistula initiative at Allegheny General Hospital increased the rate of AV fistulas from 32% to 72%. We present an additional 25 months of vascular access data, with stratification of results by gender and long-term patient survival data. These data show the self-sustaining nature of 'fistula culture' in an urban hemodialysis unit, and the survival benefits that result from increased fistula rates.

Arteriovenous Shunt, Surgical↗