Hemodialysis patients' experience with and attitudes toward the buttonhole technique for arteriovenous fistula cannulation.

BACKGROUND: the buttonhole technique for arteriovenous fistula cannulation has been recommended as an alternative to the rope ladder technique. AIM: we compared patients' experiences and hypothesized that patients would prefer the buttonhole technique. METHODS: in an observational cross-sectional study using a 23-item questionnaire, we surveyed hemodialysis patients at 3 dialysis centers who had previously used the rope ladder technique and were presently using the buttonhole technique for their experiences with and attitudes toward the two techniques. Twelve months later, patients' attitudes were reassessed. RESULTS: 26 patients met inclusion criteria. On a scale of 0 (not at all satisfied) to 10 (very satisfied), patients reported a mean satisfaction with the buttonhole technique of 8.5 ± 1.9. 96% of patients said they would recommend it, and 83% reported that the buttonhole technique was easier for the nurses to use. Fewer patients reported fistula infiltration with the buttonhole technique (12% vs. 59%, p = 0.008). Twelve months later, 18 of 23 patients (78%) still dialyzing in the study units remained satisfied with the buttonhole technique. CONCLUSIONS: patients reported a high level of satisfaction, fewer complications, and a positive attitude about suggesting the buttonhole technique to other patients. Our findings support the recommendation for its more widespread use.

Prevalence of depression in patients with coronary artery disease in a tertiary care hospital in Pakistan.

OBJECTIVE: To determine the prevalence of depression in patients with coronary artery disease (CAD) in a tertiary care hospital setting in Pakistan. METHODS: One hundred and fifty four patients of CAD (115 males and 39 females) were randomly selected from the outpatient department and wards of the National Institute of Cardiovascular Diseases, Karachi and were scored for depression via the Hospital Anxiety and Depression Scale. Basic demographic data and disease variables were also collected. RESULTS: The point prevalence of depression in the sample was 37% (31.3% males and 53.8% females). Female sex, income level below Rs. 5000 per month, low education level, outpatient, single earning family member and hypertension were few variables associated positively with depression (p < 0.05). Only one patient was receiving treatment for depression by his cardiologist. CONCLUSION: Depression is prevalent in CAD patients in Pakistan. Economic conditions may pose an additional threat on these patients. Treating physicians (especially cardiologists) need to be aware of this co-morbidity so as to be able to diagnose and adequately manage such patients.