Ultrasound guided percutaneous sharp recanalization for restoring patency from peripheral chronic total occlusions of hemodialysis accesses.

Objective: Resistant chronic total occlusion (CTO) lesions present an ongoing challenge for conventional endovascular interventions to restore functional hemodialysis (HD) access. This study endeavors to present a novel endovascular approach utilizing ultrasound (USG)-guided percutaneous sharp recanalization to cross the resistant occlusions and evaluates its effectiveness.

Methods: This is a multi-center retrospective review of consecutive patients received USG guided sharp recanalization for the treatment of resistant CTO lesions of their HD access between 1st January 2019 and 31st July 2023.

Evaluating the carbon footprint of sedation practices in intensive care.

Background: Healthcare's carbon footprint contributes to 4.4% of global net emissions and intensive care units (ICUs) are very resource intensive. Existing studies on environmental sustainability in ICUs focused on carbon footprint generated from energy and electricity consumption, use of medical consumables and equipment, but few studies quantified carbon footprint generated from pharmaceuticals used in ICUs.

A systematic review of prediction models on arteriovenous fistula: Risk scores and machine learning approaches.

Objective: Failure-to-mature and early stenosis remains the Achille's heel of hemodialysis arteriovenous fistula (AVF) creation. The maturation and patency of an AVF can be influenced by a variety of demographic, comorbidity, and anatomical factors. This study aims to review the prediction models of AVF maturation and patency with various risk scores and machine learning models.

One-staged brachial-basilic vein transposition versus arm straight arteriovenous graft for hemodialysis.

Objectives: After forearm and arm cephalic veins are no longer available as options, the choices of arm vascular access between one-staged brachial-basilic vein transposition (BBAVF) and arm straight arteriovenous graft (AS-AVG) for hemodialysis are controversial. This study aims to compare outcomes between groups.

Methods: All one-staged BBAVF and AS-AVG from August 2014 to December 2019 were reviewed.

A portable optical pulsatile flowmetry demonstrates strong clinical relevance for diabetic foot perfusion assessment.

We present a robust, cost-effective (<2000 USD), and portable optical diffuse speckle pulsatile flowmetry (DSPF) device with a flexible handheld probe for deep tissue blood flow measurement in the human foot as well as a first-in-man observational clinical study using the proposed optical device for tissue ischemia assessment and peripheral artery disease (PAD) diagnosis. Blood flow in tissue is inherently pulsatile in nature. However, most conventional methods cannot measure deep tissue-level pulsatile blood flow noninvasively.

Dialysis nurses' knowledge, attitude, practices, and self-efficacy regarding vascular access care: A multicenter cross-sectional survey in Singapore.

Background: Dialysis nurses play a pivotal role in the management of vascular access (VA), physician-patient liaison, and patient education for hemodialysis patients. This multicenter study aims to review the dialysis nurses' knowledge, attitude, practice, and self-efficacy toward providing care for patients' VA.

Methods: A multi-centered study was conducted using a self-administered survey.

Effectiveness of a native vein arteriovenous fistula tracking system.

Objective: This study aims to evaluate the effectiveness of a tracking program on the functional maturation rate of arteriovenous fistula (AVF).

Methods: Two major clinical outcomes (commencement of cannulation and functional maturation) of created AVFs were compared between two cohorts. (i) Cohort 1: historical cohort; (ii) Cohort 2: AVFs created after implementation of the tracking project.

Polymer-coated paclitaxel-eluting stents for the treatment of stenosed native arteriovenous fistulas: Long-term results from the ELUDIA study.

Background: Percutaneous transluminal angioplasty is the preferred treatment of stenosed failing arteriovenous fistulas (AVF) but is hampered by increasing rates of vascular restenosis because of development of myointimal hyperplasia.

Methods: This multicenter observational study of polymer-coated low-dose paclitaxel-eluting stents (ELUvia stents by Boston Scientific) in stenosed AVF undergoing hemoDIAlysis (ELUDIA) was jointly conducted in three tertiary hospitals from Greece and Singapore. Failure of AVF was defined according to K-DOQI criteria and significant fistula stenosis (>50%DS by visual estimate) was determined with subtraction angiography.

Dialysis nurses' knowledge, attitude, practice and self-efficacy regarding vascular access: A cross-sectional study in Singapore.

Introduction: Dialysis nurses play a paramount role in vascular access (VA) management. The aim of this study is to evaluate dialysis nurses' knowledge, attitude, practice and self-efficacy (KACP-SE) pertaining to VA cannulation and evaluation.

Method: An anonymous self-administered survey was administered to dialysis nurses from two tertiary hospitals (four dialysis units) and two community dialysis centres from April to May 2022.

Secondary analysis of electronic opt-out consent in pragmatic research: A study design method to diversify clinical trials?

We conducted a multi-center pragmatic trial of a low-risk intervention focused on medication adherence using an opt-out consent approach, where patients could opt out by letter and then electronically. We focus on the cohort after opt-out by mail. Here, we describe that 8% of patients opted out electronically, resulting in a 92% participation rate.

Crucial Business Model Elements for Medical Device Startup Companies in Emerging Markets.

Objectives: Medical devices that suit the needs and challenges of low- and middle-income countries are desperately needed. To provide sustainable access to such devices, business approaches must be developed to meet the demands of individual economic, healthcare, and innovation ecosystems. Currently, there is a gap in the literature regarding business models for medical devices in low- and middle-income countries.

Decision-making for early major amputation in selected diabetic foot ulcer patients with peripheral vascular disease.

Objective: To estimate the costs from delaying major amputation in patients with concurrent diabetic foot ulcer and peripheral vascular disease. We seek to model economic benefits from saved costs from promoting timely major amputations among these patients.

Methods: Retrospective modeling using data from National University Hospital, Singapore.

The burden of costs on health services from patients with venous leg ulcers in Singapore.

Healthcare costs arising from venous leg ulcers (VLU) are expected to increase due to an aging population and increased prevalence of comorbidities. We aim to estimate the healthcare resources incurred by VLU patients, and to quantify the extent to which predictors explain variation in cost-related outcomes. Retrospective patient-level cohort data for VLU patients were analysed using generalised linear regression models.

The burden of costs on health services by patients with neuro-ischaemic ulcers in Singapore.

The economic burden of neuro-ischaemic ulcers (NIU) is expected to increase because of rising prevalence of comorbidities in an aging population. We aim to estimate healthcare resources consumed by NIU patients, and to quantify the extent to which factors explain variation in cost-related outcomes. We analysed retrospective patient-level cohort data for NIU patients from a tertiary hospital registry in Singapore, from 2013 to 2017, using generalised linear regression models.

Vitamin B and folate decrease inflammation and fibrosis in NASH by preventing syntaxin 17 homocysteinylation.

Background & Aims: Several recent clinical studies have shown that serum homocysteine (Hcy) levels are positively correlated, while vitamin B (B) and folate levels are negative correlated, with non-alcoholic steatohepatitis (NASH) severity. However, it is not known whether hyperhomocysteinemia (HHcy) plays a pathogenic role in NASH.

Methods: We examined the effects of HHcy on NASH progression, metabolism, and autophagy in dietary and genetic mouse models, patients, and primates.

Effect of exercises on the maturation of newly created arteriovenous fistulas over distal and proximal upper limb: A systematic review and meta-analysis.

The aims of our review were: (i) to evaluate the effect of post-operative upper extremity exercise on maturation of AVFs, stratified by their locations. (ii) To evaluate the effect of pre-operative arm exercise on patients' superficial vein caliber of patients. Literature search was performed on PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and China National Knowledge Infrastructure (CNKI) to identify eligible articles.

The clinical journey and healthcare resources required for dialysis access of end-stage kidney disease patients during their first year of hemodialysis.

Background: Creation and maintenance of dialysis vascular access (VA) is a major component of healthcare resource utilization and cost for patients newly started on hemodialysis (HD). Different VA format arises due to patient acceptance of anticipatory care versus late preparation, and clinical characteristics. This study reviews the clinical journey and resource utilization required for different VA formats in the first year of HD.

A novel coating method to reduce membrane infolding through pre-crimping of covered stents - Computational and experimental evaluation.

A covered stent has been used to treat carotid artery stenosis to reduce the chance of embolization, as it offers improved performance over bare-metal stents. However, membrane infolding of covered stents can affect efficiency and functionality for treating occlusive disease of first-order aortic branches. In order to mitigate the degree of infolding of the stent once it was re-expanded, we proposed a new coating method performed on the pre-crimped stent.

Nephrotoxic Medications and Risk Factors of Acute Kidney Injury in Medical Wards: A Single-Center Study.

Acute kidney injury (AKI) is a medical complication that can arise from various causes. This study aimed to determine the incidence of AKI and the predictors for the development of AKI in the medical wards of a tertiary hospital. A prospective cohort study was conducted on patients admitted to the medical wards from November 1 to December 31, 2017.

Major limb amputation and mortality in patients with neuro-ischaemic lower extremity wounds managed in a tertiary hospital: Focus on the differences among patients with diabetes, peripheral arterial disease and both.

A majority of lower extremities neuro-ischaemic wounds (NIU) are related to: (a) only diabetes (DM); (b) only peripheral artery disease (PAD); (c) co-existing diabetes and peripheral artery disease (DM-PAD). This study aims to characterise the major clinical outcomes of forementioned three groups of lower extremity wound patients in Singapore. Patients hospitalised for lower extremity NIU between January 2014 and October 2017 in a tertiary hospital in Singapore were analysed.

Health care professionals and care staff challenges and experiences of managing sexual expression among older adults ≥60 years in long-term care facilities: a qualitative review and meta-synthesis.

Long-term care (LTC) facilities, in which older adults are institutionalised, have the responsibility to address their residents' rights, privacy and comfort in expressing themselves sexually in an acceptable manner. However, many older adults have reported barriers in their sexual expression, which is often a result of the care staff's attitudes in the facilities. This review synthesis evidence from qualitative studies on the challenges faced by care staff when supporting sexual expression of older residents in LTC facilities.

Using a Web-Based Platform as an Alternative for Conducting International, Multidisciplinary Medical Conferences During the Novel COVID-19 Pandemic: Analysis of a Conference.

Background: The COVID-19 pandemic has stunted medical education activities, resulting in most conferences being cancelled or postponed. To continue professional education during this crisis, web-based conferences can be conducted via livestream and an audience interaction platform as an alternative.

Objective: The unprecedented COVID-19 pandemic has affected human connections worldwide.

Thoracic aorta stent grafts design in terms of biomechanical investigations into flexibility.

The present study aimed to design and optimize thoracic aorta stent grafts (SGs) based on the influence of geometric parameters on flexibility and durability. Five geometric parameters were selected, including strut height, strut number, strut radius, wire diameter, and graft thickness. Subsequently, 16 finite element (FE) models were established with an orthogonal design consisting of five factors and four levels.

Measurement of the Luminal Diameter of Peripheral Arterial Vasculature in Yorkshire × Landrace Swine by Using Ultrasonography and Angiography.

To select animals of appropriate size for preclinical studies of cardiovascular devices, reference knowledge of the cardio- vascular anatomy relative to body weight is crucial. We measured the luminal diameters of the arteries (carotid, femoral, and iliac arteries) that are the common access vessels for endovascular and vascular procedures in Yorkshire × Landrace swine. Measurements were performed by using both ultrasound and angiographic methods and were correlated with body weight.

Experience from a Singapore tertiary hospital with restructuring of a vascular surgery practice in response to national and institutional policies during the COVID-19 pandemic.

Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on January 23, 2020. For 2 weeks in February, we had the highest number of COVID-19 cases behind China. In this article, we summarize the key national and institutional policies that were implemented in response to COVID-19.