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Publications

Publications by Paulo Teles

2017

Arteriovenous access banding revisited

Authors
Teixeira, G; Almeida, P; Sousa, CN; Teles, P; De Sousa, P; Loureiro, L; Teixeira, S; Rego, D; Almeida, R; de Matos, AN;

Publication
JOURNAL OF VASCULAR ACCESS

Abstract
Purpose: The aim of this study is to validate the current applicability of arteriovenous access banding in high flow access (HFA) and/or haemodialysis access-induced distal ischaemia (HAIDI). Methods: This retrospective study was conducted at the GEV (Grupo de Estudos Vasculares) vascular access centre. The clinical records of consecutive patients undergoing banding for HAIDI and HFA symptoms, between June 2011 and January 2015, were reviewed until April 2015. All vascular access patients' consultation records and surgical notes were reviewed. We analysed and compared patients' age, gender, comorbidities, symptoms and intraoperative ultrasound control. We defined technical failure as recurrence of symptoms, requiring new banding. Excessive banding, access thrombosis, rupture and false aneurysm development were registered as complications. Primary clinical success was defined as improvement of symptoms or effective flow reduction after banding, with no need for reintervention. If one reintervention was necessary, we have defined it as secondary clinical success. Results: Overall, 119 patients underwent banding: 64 (54%) with HAIDI and 55 (46%) with HFA. The HAIDI group was significantly older (65 +/- 13 years compared with 56 +/- 22 years, p = 0.001) and had significantly greater number of patients with diabetes (56% vs 24%, p = 0.004). Primary success was achieved in 85 patients (71.4%) and the secondary success rate was 84.9%. Older age (p = 0.016) and intraoperative ultrasound control (p = 0.012) were significantly associated with primary success. Conclusions: Our results do not corroborate the high incidence of thrombosis previously reported as associated with AV access banding and suggest that ultrasound control is crucial for preventing technical failure. The procedure was effective on both compared groups.

2014

Physical examination of arteriovenous fistula: The influence of professional experience in the detection of complications

Authors
Sousa, CN; Teles, P; Ferreira Dias, VFF; Alves Apostolo, JLA; Jesus Silva Figueiredo, MHJS; Martins, MM;

Publication
HEMODIALYSIS INTERNATIONAL

Abstract
Vascular access is one of the leading causes of mobilization of financial resources in health systems for people with chronic kidney disease on hemodialysis. Physical examination of the arteriovenous fistula (AVF) has demonstrated its effectiveness in identifying complications. We decided to evaluate the influence of nurses' professional experience in the detection of complications of the AVF (venous stenosis and steal syndrome). The study took place in eight hemodialysis centers between May and September of 2011 in the north of Portugal. Sample was constituted by registered nurses. The nurses involved in the experiment were divided in two groups: those who had more than 5 years of experience and those who had less than 5 years of experience. Ninety-two nurses participated in the study: 34 nurses had less than 5 years of professional experience and 58 had more than 5 years of professional experience. In the practices considered by nurses in the detection of venous stenosis, there were no differences observed between the groups (P > 0.05). In steal syndrome, there were no differences observed between the groups in the practices of the nurses in the detection of this complication of the AVF (P > 0.05). We concluded that professional experience does not influence the detection of venous stenosis and steal syndrome.

2018

The effect of temporal aggregation on the estimation accuracy of ARMA models

Authors
Teles, P; Sousa, PSA;

Publication
COMMUNICATIONS IN STATISTICS-SIMULATION AND COMPUTATION

Abstract
Autoregressive Moving Average (ARMA) time series model fitting is a procedure often based on aggregate data, where parameter estimation plays a key role. Therefore, we analyze the effect of temporal aggregation on the accuracy of parameter estimation of mixed ARMA and MA models. We derive the expressions required to compute the parameter values of the aggregate models as functions of the basic model parameters in order to compare their estimation accuracy. To this end, a simulation experiment shows that aggregation causes a severe accuracy loss that increases with the order of aggregation, leading to poor accuracy.

2017

Radio-cephalic fistula recovered with drainage to forearm basilic vein

Authors
Norton De Matos, A; Sousa, CN; Almeida, P; Teles, P; Loureiro, L; Teixeira, G; Rego, D; Teixeira, S;

Publication
HEMODIALYSIS INTERNATIONAL

Abstract
Dysfunction problems with vascular access are a concern to patients and dialysis units. The vascular surgeon should analyse such dysfunction and perform a careful assessment of the vascular network in order to find new fistula layouts. We introduce and discuss the case of creation of a radiocephalic fistula with outflow into the forearm basilic vein through rotation of the forearm basilic vein toward the cephalic vein in the forearm of an 88-year-old hemodialysis male patient. This technique enables extending fistula patency and improves cost efficiency.

2015

Construction and validation of a scale of assessment of self-care behaviors with arteriovenous fistula in hemodialysis

Authors
Sousa, CN; Alves Apostolo, JLA; Jesus Silva Figueiredo, MHJS; Ferreira Dias, VFF; Teles, P; Martins, MM;

Publication
HEMODIALYSIS INTERNATIONAL

Abstract
Several guidelines recommend the importance of educating the patient about the care of vascular access. Nurses have a key role in promoting the development of self-care behaviors by providing the necessary knowledge to patients, so that they develop the necessary skills to take care of the arteriovenous fistula (AVF). This article describes the process of building a scale of assessment of self-care behaviors with arteriovenous fistula in hemodialysis (ASBHD-AVF). This is a cross-sectional study in which the development, construction, and validation process followed the directions of the authors Streiner and Norman. This is a convenience sample, sequential, and nonprobabilistic constituted by 218 patients. The study was conducted in two stages during 2012-2014. The first phase corresponds to the scale construction process, 64 patients participated, while the second corresponds to the evaluation of metric properties and 154 patients participated. The principal component analysis revealed a two-factor structure, with factorial weights between 0.805 and 0.511 and between 0.700 and 0.369, respectively, explaining 39.12% of the total variance of the responses. The Cronbach's alpha of the subscale management of signs and symptoms is 0.797 and from the subscale prevention of complications is 0.722. The ASBHD-AVF revealed properties that allow its use to assess the self-care behaviors in the maintenance and conservation of the AVF.

2015

Construction and validation of a scale of assessment of self-care behaviours anticipatory to creation of arteriovenous fistula

Authors
Sousa, CN; Figueiredo, MH; Dias, VF; Teles, P; Apostolo, JL;

Publication
JOURNAL OF CLINICAL NURSING

Abstract
Aims and objectives. We developed a scale to assess the self-care behaviours developed by patients with end-stage renal disease to preserve the vascular network prior to construction of arteriovenous fistula. Background. The possibility of creation of an arteriovenous fistula depends on the existence of an arterial and venous network in good condition, namely the size and elasticity of the vessels. It is essential to teach the person to develop self-care behaviours for the preservation of the vascular network, regardless of the modality of dialysis selected. Design. Methodological study. Methods. The scale was developed based on clinical experience and research conducted by the researcher in the area of the vascular access for haemodialysis. The content of the scale was judged by two panels of experts for content validity. The revised version of the scale was administered to a convenience sample of 90 patients with end-stage renal disease. In the statistical analysis, we used the Cronbach's alpha, the Kaiser-Meyer-Olkin and scree plot and the principal component analysis with varimax rotation. Results. A principal component analysis confirmed the univariate structure of the scale (KMO = 0.759, Bartlett's sphericity test-approximate chi(2) 142.201, p < 0.000). Cronbach's a is 0.831, varying between 0.711-0.879. Conclusion. This scale revealed properties that allow its use to assess the patients self-care behaviours regarding the preservation of the vascular network. Relevance to clinical practice. This scale can be used to evaluate educational programmes for the development of self-care behaviours in the preservation of vascular network. This scale can identify not only the patients that are able to take care of their vascular network but also the proportion of patients who are not able to do it, that need to be educated.

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