Crawford McIntosh (creditkendo9)

Chronic kidney disease (CKD) is a major noncommunicable disorder and has become the 9th leading cause of death in the United States. Most patients with CKD in the United States choose hemodialysis as their treatment of choice. A functioning arteriovenous access is essential to reduce dependence on central venous catheters. An arteriovenous fistula (AVF), though the preferred access, has a major limitation with a high primary maturation failure rate. A functioning AVF requires well-preserved vessels, both arteries and veins, along with an acceptable cardiac pump function. Vessel preservation is crucial from a surgeon's perspective to create an AVF but is also relevant for maturation. More recently, concerns regarding the sequelae of transradial approach for percutaneous cardiac interventions have been raised. Educating and empowering the patient is the first step, but equally important is to educate all caregivers involved in providing care to a patient with advanced CKD. The current review evaluates the strategies used to preserve peripheral veins, central veins, and peripheral arteries.The new Kidney Disease Outcomes Quality Initiative Vascular Access Guidelines now focus on a more comprehensive overall patient strategy. The patient's vascular access needs are part of a dialysis access strategy, which itself is part of an End Stage Kidney Disease Life-Plan strategy that stems from a unique patient's individualized needs. The End Stage Kidney Disease Life-Plan is an individualized and comprehensive map for dialysis modalities and dialysis access for the lifetime of the patient. New targets are introduced that align with this patient-centered approach. The Guidelines made significant changes to the use of surveillance techniques to detect stenosis and found insufficient evidence to make a recommendation for routine arteriovenous fistula surveillance by measuring access blood flow, pressure monitoring, or imaging for stenosis that was in addition to routine clinical monitoring. Routine surveillance is not recommended in arteriovenous grafts. Similarly, pre-emptive angioplasty of arteriovenous fistulas or arteriovenous grafts with stenosis, not associated with clinical indicators, is not recommended. The Guidelines represent a rigorous review of the evidence; however, the available evidence to guide vascular access practice remains limited. There is a significant need and opportunity for new and ongoing high-quality research to inform best practice. Massage is commonly used by the Australian public and is often sought by expectant mothers. Despite its popularity there is no regulatory body to enforce minimum educational standards, guidelines or evidence-based best practice for massage therapists. The aim of this paper is to critically examine the views and practices of massage therapists who offer preconception, antenatal or postnatal massage. An online survey was administered to Australian massage therapists who provide massage in the preconception, antenatal or postnatal periods. Ninety-nine therapists completed the survey. The majority of respondents had received training in pregnancy massage (n=72; 72.7%) only. learn more The most confident respondents were those that had both training and experience. There are potential gaps in training for massage therapists including up-to-date curriculum and a fragmentation around industry training requirements for pregnancy massage, which may impact on the safety and benefits of pregnancy massage. There are potential gaps in training for massage therapists including up-to-date curriculum and a fragmentation around industry training requirements for pregnancy massage, which may impact on the safety and benefits of pregnancy massage. Student veterans are an at-risk population given the challenges of military experience, reintegration to civilian life, and attending college. Therefore, there is a need for innovative programs to suppor