Abstract:
:Physical examination (PE) is an excellent means of predicting arteriovenous fistula (AVF) dysfunction. Although quick and inexpensive, PE is seldom used as a tool to assess stenosis by general nephrologists, dialysis nurses, and dialysis technicians. Previous studies have demonstrated that PE can be taught to interventional specialists, but the perception remains that it is too complex to be performed by other health care professionals. We hypothesized that the physical exam can be taught to a nonmedical professional, and that, with time, it would be comparable to the physical exam performed by a full-time interventional specialist. An undergraduate student and an interventional specialist (MD) examined AVF for dysfunction in a tertiary care hospital over a 6-month period. PE was performed on patients who were suspected of having dialysis access dysfunction and were referred for angiography and intervention (n = 49). Physical exam findings were categorized blindly by each examiner into four categories of lesion location: inflow, outflow, both, or neither. Data were privately recorded and compared to the gold standard of angiographic results. Potential confounding variables, including age, gender, diabetic status, and location of AVF were recorded. Weighted Cohen's kappa value was used as a measurement of the level of agreement beyond chance between the diagnoses made by physical exam and angiography. The full-time interventional specialist demonstrated correct prediction of lesion location of 89.8% (kappa = 0.850), while the undergraduate student had a correct prediction of 77.6% (kappa = 0.625). The student's performance, however, differed significantly over time. The student correctly predicted the location of the lesion in 6 (42.9%) of the first 14 patients (kappa = 0.082), compared to 32 (91.4%) of the last 35 patients (kappa = 0.855). We suggest that physical exam of AVF can be taught to a nonmedical professional in a short duration of time and the predictive value of the exam can be similar to that of an interventional specialist.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
Rosenberg JE,Yevzlin AS,Chan MR,Valliant AM,Astor BCdoi
10.1111/sdi.12361subject
Has Abstractpub_date
2015-09-01 00:00:00pages
544-7issue
5eissn
0894-0959issn
1525-139Xjournal_volume
28pub_type
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
pub_type: 社论
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journal_title:Seminars in dialysis
pub_type: 社论
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
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更新日期:2014-03-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2006.00212.x
更新日期:2006-11-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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更新日期:2001-11-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2007.00333.x
更新日期:2008-01-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
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更新日期:2020-03-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12907
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journal_title:Seminars in dialysis
pub_type: 社论
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journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12027
更新日期:2012-11-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12045
更新日期:2013-07-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12503
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2008.00550.x
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2006.00117.x
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12841
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journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1046/j.1525-139x.2002.00076.x
更新日期:2002-09-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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