Axillary to common iliac arteriovenous graft for hemodialysis access: Case report and review of 'exotic' axillary-based grafts.

A 58-year-old Caucasian male with end-stage renal disease and peripheral arterial disease was referred to us for management of his complex vascular access. His vascular access history included a left wrist primary fistula, a left upper arm access graft, a left leg loop graft, and multiple PermCaths in his jugular veins with recurrent infections. Magnetic resonance venography (MRV) of his chest revealed extensive bilateral venous occlusions due to numerous past hemodialysis access catheters. The patient was scheduled for right lower extremity arteriovenous graft placement, but intraoperatively was found to have severe peripheral arterial disease and a thromboendarterectomy was performed instead. Lower body venous imaging demonstrated patent iliac veins. Based on these anatomic considerations a right axillary artery to right common iliac vein polytetrafluoroethylene (PTFE) graft was placed. The graft required revision twice--once for graft ultrafiltration at the arterial end of the graft and once for needle stick infection--but continues to serve as sufficient access after 15 months. Grafts based off the axillary artery have become increasingly popular in recent years and several venous outflow options have been considered, each with distinct advantages. The common iliac vein offers a central location with high flow rate and low probability of infection. Axillary artery to iliac vein arteriovenous grafting may have a place in the vascular surgeon's armamentarium for complex vascular access cases.

The role of sulphydryl groups in efflux of taurine and GABA from cerebral cortical cells.

1. Effluxes of taurine and GABA from pre-loaded cells in slices of rat cerebral cortex in isosmotic media is enhanced by the -SH reagent p-chloromercuriphenylsulphonic acid (pCMPS) (100 microM) accompanied by moderate swelling. Those effects were more pronounced with GABA than with taurine. N-ethylmaleimide (NEM) (100 microM) had only slight affects on these variables. 2. The acceleration of effluxes that occurs when medium osmolality is reduced from 315 to 265 mosmol/kg is blocked by NEM and by pCMPS, with pronounced cell swelling. 3. The inhibitory effects of these reagents on efflux is abolished when cell swelling is prevented by the addition of 25 mM sucrose to hyposmotic incubation media (with equimolar reduction in NaCl concentration). 4. Pre-exposure of slices to dithiothreitol (DTT) (100 microM) blocks the effects of NEM and pCMPS on GABA efflux in hyposmotic media, but has no effect on taurine efflux. 5. The cell membrane and cytoskeletal responses which may underlie these effects are briefly discussed.

Managers' perceptions of customers' satisfactions with their hospital cafeteria services.

It is important that hospital cafeterias deliver products that create customer satisfaction so that financial objectives are met. An exploratory descriptive survey of 12 selected hospital cafeterias used a self-administered questionnaire to determine how satisfied customers were with services provided. It also asked cafeteria managers to give their perceptions of their customers' relative satisfaction/dissatisfaction with the service. Principal components analysis, followed by varimax rotation, identified four underlying constructs of the 15 pre-selected foodservice characteristics used to measure relative satisfaction. A multiple regression model, controlling for country, hospital size and customer demographics, in which the dependent variable was overall rating, found that the independent variables, the underlying rating constructs--food and service--made a much greater impact on overall rating than environment and accessibility. Most cafeteria managers' predictions about their customers' satisfaction were within two standard deviations of their customers' mean scores of satisfaction. While the managers' close association with their service may have accounted for this, it does not necessarily follow that they have the power to implement policy and product improvements.

Labour productivity in hospital foodservice.

The objective of this research was to examine the relationship between quantitative labour productivity in hospital foodservice departments and variations in selected factors such as number of beds, staff turnover and the use of convenience foods. Thirty such factors were tested for their value in predicting labour productivity in the foodservice departments of a sample of public general hospitals in Ontario with rated capacities of 90 or more beds. In this research the outputs of hospital foodservice departments were separated into the two components, goods and services, and then evaluated against the labour required to produce them, given the variations in selected factors. Four of 20 variables tested against the output of goods (mealdays) collectively explained 48% of the variation in number of mealdays produced per labour hour. The four variables were: unionized staff, number of beds, percent patient mealdays of total mealdays, and percent part-time hours of total hours worked. None of 10 variables tested against the output of services (clinical counselling) showed any reliability in explaining the variation in number of patients seen per clinical labour hour.

Perceived needs of Canadian dietitians for continuing education in management.

The purpose of this research was to assess the perceived needs of Canadian dietitians for continuing education in management both currently and as they plan for advancement, career change and development. A self-assessment questionnaire was mailed in January 1985 to 1000 members of the Canadian Dietetic Association (CDA) selected by a systematic randomized technique. Analysis of 450 anonymous questionnaires from employed CDA members showed that 77% were employed full-time and 23% part time. The analysis indicated a profession with a young membership of an eight-year mean and a six-year median in full time practice. A ranked ordering of the types of positions to which dietitians aspired was chief administrative dietitian, consultant, positions in other administration, and then private practice. Personnel and financial management were very important areas for current positions and were expected to be even more so in future. Respondents cited salient factors regarding continuing education programs and prioritized their need for several management topics. These topics were further analyzed according to the present positions of the respondents. This research supports the need for high quality continuing education programs in management for practising dietitians.

Dietetics in Australia and New Zealand, May 1983: expanding professional horizons.

This is a report on the author's activities and impressions of the dietetic profession in Australia and New Zealand, during a professional visit in May 1983. Activities included presenting the Abbott Lecture to the Third Annual Conference of the Australian Association of Dietitians, speaking at several state dietetic association meetings, and presenting some seminars. Foodservice systems in several hospitals were observed. Impressions related to the diverse educational backgrounds of dietitians, the focus on clinical practice, and the extreme youthfulness of the profession in some states. The author also modified a post-graduate program at the University of New South Wales to assist dietitians to gain more knowledge in foodservice administration.

Computer use and undergraduate education for computer use in Canadian health care foodservices.

Surveys were conducted to assess the computer use in 50 selected Canadian health care foodservice facilities and to determine the educational preparation for computer use in seven selected Canadian post-secondary education institutions which educate potential foodservice personnel. Both the foodservices and post-secondary educational institutions selected were represented at two workshops on computer-assisted foodservice management held in June 1980 and in May 1981. Only seven facilities used a computer for foodservice functions; nine foodservices planned to use a computer within the next two years. A list of applications in use, being planned and of future interest showed the priority areas for these foodservices. Only one post-secondary educational institution actually had an educational foodservice application for student use. The other six educational foodservice facilities covered the subject matter content by readings, lectures and discussions.

Computer use and educational needs in selected Canadian health care food services.

A survey was conducted to assess the computer use in 27 selected Canadian health care food service facilities and the educational needs in computerization of the corresponding foodservice administrators. The foodservices selected were represented by foodservice administrators at a workshop on computer-assisted foodservice managements held in June 1980. Only three facilities used a computer for foodservice functions: seven foodservices planned to use a computer within the next two years. A list of applications in use, being planned and of future interest showed the priority areas for these foodservices. The foodservice administrators identified their educational needs in computerization and demonstrated that a one to two day workshop was their preferred educational program format.

Convenience food use in eight hospitals in Ontario.

A ten point Conventional Convenience Rating Scale (CCRS) was developed to classify and analyze differences in use of convenience food for menu items of selective regular and diabetic diets for seven days in eight active treatment hospitals. Statistical analysis showed that the CCRS score detected differences between six meal components, three meals and four areas of production within each diet type. The convenience hospital had generally highest CCRS scores for all meal components; dessert CCRS scores were primarily dependent on the presence or absence of a bakeshop on the premises. Breakfast had the highest mean meal CCRS scores and lunch the lowest. CCRS scores were lowest for menu items which were prepared in the chef's area and in the salad and sandwich area. There was a significant inverse relationship (r = 0.895) between mean hospital CCRS score and aggregate skill level of food production employees. No correlation was found between the mean hospital CCRS score and 1) meal-days per food production labour minute, 2) total food cost per meal-day and 3) food production labour cost per meal-day. Among other recommendations, this research suggests that further investigation be made to assess the adequacy of the standards of performance used in this study and commonly used as indicators of institutional foodservice efficiency.