Standardization of infection control practices through a course is a cost-effective way to decrease related adverse outcomes. If these findings can be reproduced, this approach may serve as a model for physicians-in-training.
Buttonhole cannulation is a method of cannulation of native arteriovenous fistulae traditionally practiced by self-cannulators. At St Michael's Hospital, this method has been modified to allow its use in problematic fistulae by multiple cannulators. In a busy dialysis unit, the need for a few specific cannulators to establish the tunnel tracks in combination with the variable dialysis schedules creates logistical challenges. A new method of creating tunnel tracks with the use of the BioHole™ device was evaluated. Buttonhole tracks were created in 12 patients using a peg of polycarbonated material with a holder (BioHole™ kit). The peg was inserted into the path left by the hemodialysis sharp needle following the index cannulation. Four of the 12 patients had an alternate access. Buttonhole tracks were successfully created in all the patients, albeit in 2 patients, the initial attempt to establish buttonhole tracks was aborted due to complications and the procedure was rescheduled. Compared with the modified buttonhole technique, pain on cannulation following track creation was significantly less in the BioHole™ group (P < 0.001). Ease of cannulation was significantly improved in the BioHole™ group (P<0.05) when compared with that in thrice-weekly patients using the modified buttonhole technique. Hemostasis postdialysis did not differ between the study groups. The use of the BioHole™ device is effective in the creation of tunnel tracks for buttonhole cannulation, is associated with less pain, and simplifies the logistics of arranging patient and nurses' schedules.
La definición del Síndrome de Alienación Parental, también conocido por su acrónimo SAP 1 , fue publicada por primera vez por Richard Gardner. La difusión 2 y defensa del SAP fue la principal actividad intelectual de este autor. Su principal actividad pública fue como psiquiatra contratado en litigios por la custodia de los hijos. Gardner sigue siendo, aún después de su muerte en 2003, el principal referente teórico del término.El SAP se ha introducido y aplicado en los juzgados de nuestro medio bajo el argumento de tratarse de un nuevo trastorno clínico. Dicha aparición, al igual que la describió Gardner en el contexto de los EE.UU. en 1985 3 , coincide con la promulgación de la custodia compartida (Ley 15/2005).Salvo dos elementos añadidos posteriormente a la primera formulación -ser considerado trastorno infantil e inaplicable en caso de maltrato/abuso sexual-su estructura ha permanecido inalterada: «El síndrome de alienación parental (SAP) es un trastorno infantil que surge casi exclusivamente en el contexto de disputas por la custodia de los niños. Su manifestación primaria es la campaña de denigración del niño contra un padre, una campaña que no tiene justificación. Ello resulta de la combinación de una pro-RESUMEN: Concluimos que el SAP fue construido por medio de falacias y que puede ser usado como una amenaza para disuadir a las mujeres de abandonar a su pareja cuando hay violencia de género. PALABRAS CLAVE: Síndrome de alineación parental (SAP), alienación parental, análisis del contenido, terapia de la amenaza.SUMMARY: We conclude that the PAS was built through fallacies. The PAS could be used as a threat for dissuade to women from left her couple when there is gender violence.
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