Impact of a Structured Duplex Ultrasound Hemodialysis Access Surveillance Program on Access Intervention Rates
Bibliographic record
Abstract
Purpose —To assess the impact of a structured duplex ultrasound hemodialysis access surveillance program on the frequency of diagnostic fistulograms and endovascular interventions. Methods —A structured ultrasound hemodialysis access surveillance program was implemented at our institution on March 1, 2010. The access ultrasound comprised the measurement of vessel diameter, velocity, and flow in the feeding artery, anastomosis, and at specific points along the outflow vein (2.5, 5.0, 7.5, and 10 cm beyond anastomosis) along with a waveform pattern in the ipsilateral axillary and internal jugular vein. In this retrospective multicenter study, we compared the frequency of diagnostic contrast fistulograms and endovascular interventions (angioplasty) performed from March 2010 to February 2011 (12 months) by using the implemented ultrasound access surveillance program (postsurveillance) to the preceding 12 month period (March 2009 to February 2010) where no ultrasound access surveillance program was used (pre-surveillance). Results —Within our hemodialysis program, there was an average of 119 active fistulae during the presurveillance period versus 141 in the postsurveillance period. There were no significant demographic differences in our study populations across the two time frames ( p > 0.05). In the presurveillance period, 59 diagnostic contrast fistulograms were performed, whereas 47 diagnostic contrast fistulograms were performed during the post surveillance period. Using a two-sample test for equality of proportions, we found there was a significant decrease in the proportion of diagnostic contrast fistulograms after implementation of an access ultrasound surveillance program ( p = 0.0114). Similarly, 81 endovascular interventions were performed during the presurveillance period, whereas a significantly decreased number of endovascular interventions (n = 50) were performed postsurveillance ( p < 0.0001). Conclusions —There was a significant decrease in the number of invasive diagnostic contrast fistulograms and endovascular interventions upon implementation of an ultrasound access surveillance program. Such a structured surveillance program has the potential to provide significant reduction in patient discomfort and to minimize unnecessary invasive endovascular procedures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".