Primary Access Research Articles

ENVIRONMENTAL CONFLICTS IN TIMIȘOARA. CASE STUDY: GAS STATIONS

The increase in the number of motor vehicles has led to a significant demand for fuel consumption, which has led to a need for more gas stations in urban areas. However, operating a gas station requires obtaining various permits, as they have the potential to negatively affect the natural or built environment or individuals residing or working nearby. Additionally, specific regulations must be followed when selecting a location to construct a gas station, including maintaining minimum distances from certain surrounding functional buildings. Gas stations in urban areas are often a source of environmental conflicts due to their flammable and explosive nature and the handling of hazardous substances on-site, mainly as they are usually situated close to residential, commercial, or office areas. To identify environmental conflicts related to gas stations and residential areas, a study was conducted on sixty operational and non-operational gas stations in the Timișoara area in 2023, most of them being located on the primary access routes into the city. The study revealed that 9.62% of the total gas stations in use did not comply with the minimum distance requirements from nearby urban functions as mandated by law. This non-compliance poses a potential risk to individuals residing or working near the gas station. Furthermore, a survey was conducted to identify the perceptions and attitudes of Timișoara inhabitants towards the acceptability of gas stations. A total of 141 questionnaires were completed to determine the awareness of the existence of a potentially conflicting association.

AI-Powered Real-time Accessibility Enhancement: A Solution for Web Content Accessibility Issues

The web accessibility landscape is a significant challenge, with 96.3% of home pages displaying issues with Web Content Accessibility Guidelines (WCAG). This paper addresses the primary accessibility issues, such as missing Accessible Rich Internet Applications (ARIA) landmarks, ill-formed headings, low contrast text, and inadequate form labeling. The dynamic nature of modern web and cloud applications presents challenges, such as developers' limited awareness of accessibility implications, potential code bugs, and API failures. To address these issues, an AI-enabled system is proposed to dynamically enhance web accessibility. The system uses machine learning algorithms to identify and rectify accessibility issues in real-time, integrating with existing development workflows. Empirical evaluation and case studies demonstrate the efficacy of this solution in improving web accessibility across diverse scenarios.

Antibiotic lock solutions as adjunct therapy for catheter-related blood stream infections in pediatric hemodialysis patients.

The predominant use of intravenous catheters as primary access type in the pediatric hemodialysis population is associated with an increased risk of catheter related blood stream infections. While strict adherence to catheter placement and long-term care guidelines have helped to decrease the incidence of these infections, blood stream infections remain an infection burden in pediatric patients with long term hemodialysis catheters. The formation of biofilms on the surfaces of these catheters has been shown to be a source of microbes causing blood stream infections. One of the strategies for preventing bacterial colonization, inhibiting microbial multiplication, and suppressing the seeding of these microbes from biofilms upon maturation, has been the use of antibiotic-based lock solutions in-between dialysis treatments. Although clinical guidelines for the use of antibiotic lock solutions are yet to be developed, available evidence suggests a beneficial role of antibiotic lock solutions in the management of catheter related blood stream infections. Additionally, a clear understanding of how biofilms are formed and their role in the pathogenesis of catheter related bloodstream infection will facilitate the development of solutions that can prevent biofilm formation and inhibit their multiplication, maturation and seeding into the bloodstream.

Disparities in Access to a Regular Primary Care Physician Among First-Generation Migrants with Early Psychosis in Ontario, Canada.

Disparities in primary care utilization among migrants with early psychosis may be related to lack of access to a regular primary care physician. This study aimed to investigate access to a regular primary care physician among first-generation migrants with early psychosis. People aged 14-35 years with first onset non-affective psychotic disorder in Ontario, Canada were identified in health administrative data (N = 39,440). Access to a regular primary care physician through enrollment in the year prior to diagnosis was compared between first-generation migrants (categorized by country of birth) and the general population using modified Poisson regression. Most migrant groups had a lower prevalence of regular primary care physician access relative to the general population, particularly migrants from Africa (African migrants: 81% vs. non-migrants: 89%). Adjustment for sociodemographic and clinical factors attenuated these differences, although the disparities for migrants from Africa remained (PR = 0.96, 95%CI = 0.94-0.99). Interventions aimed at improving primary care physician access in migrant groups may facilitate help-seeking and improve pathways to care in early psychosis.

Transpancreatic Sphincterotomy After Double Guidewire Technique Was Noninferior to Primary Transpancreatic Sphincterotomy in Difficult Biliary Cannulation.

When unintentional pancreatic duct access occurs during difficult biliary cannulation, the double guidewire (DGW) or transpancreatic sphincterotomy (TPS) may be utilized. DGW can be easily switched to TPS due to the existing guidewire in the pancreatic duct. However, the efficacy of TPS after DGW, named sequential DGW-TPS technique, versus primary TPS has not been assessed. Our aim was to compare the benefits and adverse events of sequential DGW-TPS technique and primary TPS. We performed a comparative retrospective cohort study that enrolled a total of 117 patients with native papillae. The patients were divided into one of 2 groups according to the primary bile duct access technique (sequential DGW-TPS or primary TPS), both with pancreatic stenting. Between November 2017 and May 2023, a total of 84 patients were grouped into sequential DGW-TPS and 33 into primary TPS. The overall post-ERCP pancreatitis (PEP) rate was 4.3% in the entire cohort, with no statistical differences were observed between the groups in terms of PEP rates (P = 0.927), PEP severity (P = 1.000), first biliary cannulation success (P = 0.621), overall cannulation success (P = 1.000), hyperamylasemia incidence (P = 0.241), elevated amylase levels (P = 0.881), and postoperative hospital stay (P = 0.185). Furthermore, these results remained consistent in multivariable regression analysis. The sequential DGW-TPS technique showed a comparable safety and biliary cannulation success rate to primary TPS in difficult biliary cannulation. Given the potential long-term complications associated with TPS, DGW should be first if inadvertent pancreatic access occurs, with TPS serving as second only if DGW fails.

Vascular access surgery training in the United Kingdom is currently perceived (by trainees) to be inadequate.

Vascular access surgery (VAS) involves the creation and maintenance of arteriovenous access to facilitate haemodialysis. The prevalence of haemodialysis is rising despite increases in kidney transplants on a yearly basis. There is currently only one access surgery fellowship accredited by the Royal College of Surgeons of England. We aimed to establish the experience and perceived competence in access surgery of senior vascular surgery trainees. A short questionnaire (SurveyMonkey) was used to survey all senior (ST6-ST8) vascular surgery trainees in Health Education England (HEE) vascular surgery training programmes. The short survey asked trainees to report their: (1) training grade; (2) training deanery; (3) experience of access surgery; and (4) whether senior trainees thought they would be able to independently undertake primary access surgery post-completion of training (post Certificate of Completion of Training). The survey was circulated via HEE deaneries and the vascular surgery trainees' society: the Rouleaux Club. Twenty-eight senior (ST6-ST8) vascular surgery trainees responded to the survey: 29.6% were ST6 level, 33.3% were ST7 and 37.1% were ST8. Deanery respondence was evenly spread, although London was overrepresented (37.1%). In total, 28.6% had been involved in fewer than 10 cases, 35.7% in 10-25 cases, and 35.7% in more than 25 cases. Almost 54% of senior vascular surgery trainees believed they would not be able to undertake independent access surgery once they had completed training. Competence in access surgery is an increasing requirement of a consultant vascular surgeon. More formalised training is required to adequately train the next generation of vascular surgeons.

Vascular access surgery training in the United Kingdom is currently perceived (by trainees) to be inadequate.

Vascular access surgery (VAS) involves the creation and maintenance of arteriovenous access to facilitate haemodialysis. The prevalence of haemodialysis is rising despite increases in kidney transplants on a yearly basis. There is currently only one access surgery fellowship accredited by the Royal College of Surgeons of England. We aimed to establish the experience and perceived competence in access surgery of senior vascular surgery trainees. A short questionnaire (SurveyMonkey) was used to survey all senior (ST6-ST8) vascular surgery trainees in Health Education England (HEE) vascular surgery training programmes. The short survey asked trainees to report their: (1) training grade; (2) training deanery; (3) experience of access surgery; and (4) whether senior trainees thought they would be able to independently undertake primary access surgery post-completion of training (post Certificate of Completion of Training). The survey was circulated via HEE deaneries and the vascular surgery trainees' society: the Rouleaux Club. Twenty-eight senior (ST6-ST8) vascular surgery trainees responded to the survey: 29.6% were ST6 level, 33.3% were ST7 and 37.1% were ST8. Deanery respondence was evenly spread, although London was overrepresented (37.1%). In total, 28.6% had been involved in fewer than 10 cases, 35.7% in 10-25 cases, and 35.7% in more than 25 cases. Almost 54% of senior vascular surgery trainees believed they would not be able to undertake independent access surgery once they had completed training. Competence in access surgery is an increasing requirement of a consultant vascular surgeon. More formalised training is required to adequately train the next generation of vascular surgeons.

Retrograde Access for Revascularization of Difficult Peripheral Artery Lesions in Patients with Chronic Limb-threatening Ischemia: A Periprocedural Outcome Analysis of a Single-center Case Series

Abstract Background: Endovascular interventions are a standard treatment approach for patients suffering chronic limb threatening ischemia. This approach however can be complicated in some cases owing to difficult anatomy of the lesion that hinders successful crossing and recanalization of the diseased artery. Hence retrograde access and recanalization technique was described and used. Aims and Objectives: The aim of this study was to assess the procedural success, periprocedural complications and evaluate the safety of retrograde popliteal access for SFA and iliac lesions and tibial and pedal access for difficult tibial lesions. Materials and Methods: This is a case series of 60 patients who underwent percutaneous retrograde access (SFA, popliteal, tibial, pedal) for the recanalization of difficult lesions (aorto-iliac, SFA, tibial) between November 2018 to December 2022. We analyzed the technical success and number of periprocedural complications following successful revascularization through a prospective, nonrandomized, single–center, observational study conducted at Jain Institute of Vascular Sciences, Bengaluru, Karnataka, India. We have also analyzed safety of retrograde access and hemodynamic success (based on post-operative ABI improvement) following revascularization. Results: Of the 60 cases, retrograde access was successfully performed in all 60 patients, SFA in 3.3% (n=2), popliteal in 30% (n=18) (3 were primary PA retrograde access and remaining 15 were secondary), ATA was utilized in 35% (n=21), PTA in 20% (n=12), DPA in 6.7% (n=4) and peroneal in 5% (n=3). Technical success was achieved in 92% (n=55). Hemodynamic success was achieved in 75% (n=45). The recorded complication rate was 8.3% which included perforation of artery in 3% (n=2), iatrogenic AV fistula in 1.7% (n=1), arterial thrombosis in 1.7% (n=1) and peri-operative death in 1.7% (n=1). Conclusions: Hence, we recommend that retrograde access angioplasty is a safe and effective approach for revascularization when antegrade access fails and should be considered after proper anatomic evaluation, under US or fluoroscopic guidance.

Intraoperative Pedal Pressure Changes Offers Another Quantitative Assessment for Revascularization

IntroductionLower extremity angiography is one of the most prevalent vascular procedures performed, generally via the contralateral common femoral artery. The use of retrograde pedal artery access to perform angiography has long been reserved as a “bail-out” technique to help cross chronic total occlusions that were not amenable from an antegrade approach. Recently, there has been reports and discussion involving increased utilization of pedal access for primary revascularization. The purpose of this study is to describe the outcomes of pedal access as a primary approach and to propose a novel evaluation of distal perfusion changes associated with interventions using direct pressure measurements. MethodsA retrospective observational study evaluating all patients who underwent lower extremity angiography via retrograde pedal access between December 1st 2020 and June 30th 2021 within a single healthcare system spanning 3 hospitals was performed. Demographics, comorbidities, procedural indications, and details were all recorded. Hemodynamic measurements were obtained and recorded upon initial pedal access and post intervention with a pressure transducer connected directly to the access sheath. Outcomes were analyzed with a paired t-test. ResultsTwenty-eight angiograms using primary pedal access for endovascular intervention were performed during the study period. Most patients were African American (75%) females (57.1%) with hypertension (89.3%), hyperlipidemia (78.6%), diabetes (85.7%), coronary artery disease (64.3%), and current tobacco user (57.1%). The most prevalent indication for angiography was nonhealing wounds (67.9%). Pedal access was mostly achieved via the anterior tibial artery (79%). Sixty-three vessels were treated during the 28 angiograms (averaging 2.3 vessels per angiogram), most commonly the superficial femoral (27%), anterior tibial (25%), and popliteal (22%) arteries. Balloon angioplasty with or without stenting (98.5%) was predominately performed with an overall technical success rate of 94%. The mean pre- and post-intervention pressures were 36.5mmHg (standard deviation 25.7) and 83.4mmHg (standard deviation 19.5), respectively. The mean change in pressure after intervention was 46.9mmHg (standard deviation 23.3) (Table 3). There was a statistically significant difference detected between pre-intervention and post-intervention pressure (p<0.00) (Figure 1). There were no major amputations or adverse cardiovascular events at a mean first follow-up duration of 89 days. Six of the total 28 patients (21.4%) underwent repeat endovascular intervention on the ipsilateral extremity within a median of 45 (IQR 22.5-62.3) days. ConclusionPrimary pedal access is a viable option for performing lower extremity angiographic interventions. A significant increase in pedal artery pressure can be observed after angiographic intervention from retrograde pedal artery access. Further studies are necessary to define the clinical prognostic importance of these findings in relation to wound healing rates.

Suprapubic and Transurethral Bladder Access for Voiding Cystourethrography in Pediatric Male Patients.

To compare suprapubic access (SPA) and transurethral catheterization (TUC) in voiding cystourethrogram (VCUG). Retrospective single-center evaluation of 311 VCUG performed in male patients under 12 years of age. Two study groups were built based on the bladder access method. TUC was performed in 213 patients, whereas 98 received SPA. The groups were compared regarding the procedural switch rate, the complication rate, radiation parameters, the amount of contrast media applied and the examination quality. Complications were graded in minor (contrast leakage, premature termination of the examination) and major (fever, urinary tract infection, bladder perforation). Fluoroscopy time and radiation parameters were compared. Examination quality was assessed based on the satisfactory acquisition of fluoroscopic images using a four-point Likert scale. In 9% of the SPA examinations a method switch to TUC was necessary. The minor complication rate was 1.9% for TUC and 35.7% for SPA (p < 0.001). The major complication rate was 0.9% for TUC and 2% for SPA (p > 0.05). Mean fluoroscopy time and radiation dose were significantly lower in TUC (TUC, 26 ± 19 s, 0.6 ± 1.2 µGy·m2; SPA, 38 ± 33 s, 1.7 ± 2.9 µGy·m2; p = 0.01/0.001). There was no significant difference regarding the amount of contrast media applied (TUC, 62 ± 40 mL; SPA, 66 ± 41 mL; p > 0.05) and the examination quality with full diagnostic quality achieved in 88% of TUC and 89% of SPA examinations (p > 0.05). As TUC provides significantly lower radiation exposure and less periprocedural complications, it should be the primary bladder access route for VCUG in pediatric male patients.

"Closed books": restrictions to primary healthcare access in Aotearoa New Zealand-reporting results from a survey across general practices.

In Aotearoa New Zealand, primary care is organised by enrolling patients with a primary care provider. However, the benefits of this arrangement are frustrated when providers "close their books" due to insufficient capacity for new patients. We investigated the extent, evolution and impact of this situation on health access and equity in access to primary healthcare. We distributed a survey for general practice personnel in 2022, yielding 227 valid responses. We examined responses across respondents' practice characteristics, including practice size, rural-urban setting, average co-payments, region and ethnic composition of the catchment population. Most general practices are selectively enrolling their patients. In 2022, only 28% of respondents freely enrolled new people. Since 2019, most respondents (79%) had "closed books" or limited enrolments at some point. The situation worsened between 2019 and 2022, compromising equal opportunity and access in healthcare. Restricted enrolment poses a widespread barrier to health access and equity, and it worsened since the beginning of the COVID-19 pandemic. Addressing closed books and limited enrolments in general practice could significantly improve health services' access and equity. The study aims to inform ongoing health reforms.

The Effect of Residence Time of No-tunneled Hemodialysis Catheters on Infection and Thrombosis Outcome. Identification of CVC’s Time Cut-off

Introduction: Permanent vascular access (arteriovenous fistula (AVF), arteriovenous graft (AVG)) is susceptible to acute events that reduce patency. The temporary central venous catheter (CVC) constitutes bridging therapy for primary vascular access dysfunction. The impact of “residence time” on the rate of dysfunction/thrombosis or infection remains to be explored. AIM: 1) To evaluate the impact of CVC residence time on outcomes (infection or Thrombosis/dysfunction) in consecutive temporary CVCs adjusted for the insertion site (upper site vs. lower site). 2) To establish a cut-off resident time. Patients and methods: Seventeen prevalent hemodialysis patients with three consecutive CVCs are followed up prospectively in an observational study for a period equivalent to the permanence of the CVCs. The data is recorded at the beginning of the CVC time. The diagnosis of catheter-related bloodstream infection and thrombosis/dysfunction is made following the K-Doqi 2019 guidelines. Statistical analysis: Seventeen hemodialysis patients (51 CVCs) were included. The ‘CVC resident time’ of each individual patient ((i.e. βcoefficient (log-transformed)*AUC)) was determined using LMM and then inserted into multivariate Cox models to assess infection and dysfunction/thrombosis outcomes (Joint Models). The AUC was calculated at various baseline levels of CVC time (10th……50th percentile). The cut-off point for thrombosis in CVC time corresponds to the mean of the CVC time at the 30th percentile of all CVCs. Results: The CVC time is different for CVC’s site insertion and sequence. From the analysis of multivariate joint models, CVC resident time appears not to be significant for infection, but heterogenicity for the insertion site (ref3-4=upper site) is significant for the outcome of thrombosis/dysfunction. From the study of survival analysis, the free survival from outcomes by CVC site insertion appears to be significant for thrombosis/dysfunction. The average time of CVCs’ calculation at the 30th percentile is 14 days (cut-off). Conclusion: No tunneled hemodialysis Catheter (NTHC) residence time is considered not to be a risk factor for infection, but it represents a risk factor for lower access thrombosis. After the cut-off time of 14 days, the advantage of the higher NTHCs is lost.

A systematic algorithm for large-bore arterial access closure after TAVI: the TAVI-MultiCLOSE study.

Despite transcatheter aortic valve implantation (TAVI) having become a routine procedure, access site bleeding and vascular complications are still a concern which contribute to procedure-related morbidity and mortality. The TAVI-MultiCLOSE study aimed to assess the safety and efficacy of a new vascular closure algorithm for percutaneous large-bore arterial access closure following transfemoral (TF)-TAVI. All consecutive TF-TAVI cases in which the MultiCLOSE vascular closure algorithm was used were prospectively included in a multicentre, observational study. This stepwise algorithm entails the reinsertion of a 6-8 Fr sheath (primary access) following the initial preclosure with one or two suture-based vascular closure devices (VCDs). This provides the operator with the opportunity to perform a quick and easy angiographic control and tailor the final vascular closure with either an additional suture- or plug-based VCD, or neither of these. Among 630 patients who underwent TF-TAVI utilising the MultiCLOSE algorithm, complete arterial haemostasis was achieved in 616 patients (98%). VCD failure occurred in 14 patients (2%), treated with either balloon inflation (N=1), covered stent (N=12) or surgical repair (N=1). Overall, this vascular closure approach resulted in a minor and major vascular complication rate of 2.2% and 0.6%, respectively. At 30 days, only one new minor vascular complication (0.2%) was noted. In-hospital and 30-day all-cause mortality rates were 0.2% and 1.0%, respectively. Use of the MultiCLOSE vascular closure algorithm was demonstrated to contribute to an easy, safe, efficacious and durable vascular closure after TF-TAVI, resulting in a major vascular complication rate of less than 1%.

Seed Security for Food Security: A Situation Analysis from the Rural Home Gardens

Seeds being a primary agricultural input, its availability, access, and affordability is directly linked to the agricultural production. Traditional home gardens, backyards, Kandyan forest gardens, and micro-agricultural systems rich in biodiversity and species, mix with the knowledge and skills of the community to manage sustainable food production systems. Therefore, the study targeted to identify the types of seed production and preservation systems available among the farming community, and to identify the impact of seed ownership on household resilience to food insecurity. Data were gathered using an initial transaction walk, and a series of focus group discussions with rural households of Imbulpe and Boralanda GN divisions of Rathnapura and Badulla districts, respectively. The study areas were selected given the diversity of the crops in the area. Sample profile included 30 farmers who were purposively selected from each GN division. Results were analyzed using descriptive statistics and it revealed the existence of two seed production and preservation systems: formal and informal. Formal seed systems included both private and public stakeholders in seed and planting material business. Farmers used these formal seed systems for commercial level cultivation of both up-country and low-country vegetables. Informal seed systems were characterized with the own production, selection, storage, and maintenance of seed banks, barter system, and community seed gifting/sharing, and purchasing locally produced seeds from the locality. Informal seed systems were identified mainly for cereals (traditional rice varieties), pulses, fruits, vegetables, and spices at home gardening level. This resulted in seed and planting material ownership retaining among the local farmers. Seed ownership is an intangible asset which empowers social and human capital status of the households. Locally bred varieties proved to be resilient to climate change and maintain the crop diversity in home gardens. Informally sourced seeds recorded comparatively low yield than the hybrid/improved seed varieties that are sourced from formal seed systems. In conclusion own seed supplies ensured food availability, minimized seasonal yield variations, and enhanced meal diversity.&#x0D; Keywords: Food security, Household resilience, Seed system

Needle puncture fistulotomy: a new technique for needle-knife fistulotomy as a primary biliary access method for biliary cannulation.

Needle puncture fistulotomy: a new technique for needle-knife fistulotomy as a primary biliary access method for biliary cannulation.

Pregnancy-related knowledge in women with epilepsy in childbearing age: A pilot questionnaire survey from China.

We aim to understand the knowledge of and attitudes toward pregnancy issues among women with epilepsy (WWE) and their caregivers and analyze the answers from the questionnaire to expose topics that require educational activities; thus, WWE experiences pregnancy better. WWE at their childbearing age and/or their caregivers who entered the Fourth Affiliated Hospital of Zhejiang University for treatment of their condition were invited to fill out a questionnaire between March 1 and November 31, 2022. A combined total of 205 WWE and 142 caregivers completed the questionnaires. Among the surveyed WWE, a majority (63.74%) reported experiencing at least one miscarriage or induced abortion. However, a significant proportion (84.62%) of these WWE were still able to successfully give birth to at least one child. Furthermore, the offspring of these WWE showed no significant differences compared to the offspring of women without epilepsy, as reported by 93.51% of the participants. The participants' knowledge regarding the impact of epilepsy on pregnancy was found to be comparable, with average scores of 7.74 and 7.84, respectively. The participants exhibited a limited comprehension of antiseizure medications (ASMs)-related knowledge, specifically pertaining to ASMs adjustment during pregnancy (17.56% vs. 16.90%) and offspring outcomes (30.24% vs. 26.06%). Statistical analysis revealed significant correlations between the overall score and education level (p<.001), as well as epilepsy duration (p=.008). Regarding the source of knowledge, participants acknowledged primarily relying on neurologists, who remained their preferred choice for consultation. In our study, the understanding of pregnancy-related knowledge did not differ from WWE and their caregivers, both are far from satisfactory in certain areas. It is urgent for WWE and their caregivers to improve their pregnancy-related knowledge of epilepsy. As their primary access is from knowledgeable health care professionals like neurologists, well-trained neurologists in epilepsy management during pregnancy are in need.

Comments on 'Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography'.

Comments on 'Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography'.

Long-Term Care Residents' Perceptions of Integrated Care From Physio-Psycho-Social Perspectives: A Qualitative Inquiry.

In response to the aging population, an integrated care policy has been put forward and implemented in China. The key aspect of this policy is the reform of services within long-term care facilities, representing a significant shift and innovation. This study aims to explore the perceptions and experiences of integrated care among older residents living in long-term care facilities. A descriptive qualitative design was applied in our study. Utilizing a purposive sampling method, 18 older adults from 5 long-term care institutions in Shanghai, China were selected. Data were collected through semi-structured in-depth interviews from October 2022 to April 2023, continuing until data saturation was reached. Directed content analysis was applied to analyze the interview data, guided by the Fundamentals of Care (FoC) Framework. Five themes and 11 subthemes were identified, including (1) Policy level: positive attitude and negative feelings. (2) Physiological level: satisfied basic daily life, primary medical services accessibility and chronic care management enhancement needed. (3) Psychological level: need for psychological support and need for self-perception recognition. (4) Relationship level: enhancement of humanistic care and need for a family atmosphere. (5) Social level: interpersonal communication constrained by the times and inadequate social engagement. Strengthening the awareness and participation of older people in the integrated care policy, and fully meeting the diverse needs including advanced medical care, chronic disease management, personalized life care, psychological support, humanistic care and social engagement will contribute to the improvement of the policy, so as to better adapt the demographic shift.

Treatment of Hemodialysis Vascular Access Repeated Stenosis with Paclitaxel-Coated Balloon Angioplasty: A Retrospective Study

Introduction: The objective of this study was to report our experience of angioplasty with paclitaxel-coated balloon (PCB) versus common balloon (CB) for the treatment of repeated failing vascular access. Methods: Retrospective, single-center analysis consisting of 88 patients treated with percutaneous transluminal angioplasty in the period from October 2020 through December 2021. Patients were divided into two groups according to the type of treatment as PCB (n = 41) and CB (n = 47). We analyzed target lesion primary patency and vascular access primary patency for 6 months and the rate of complications. Results: There was no significant difference in the target lesion primary patency which was similar for 6 months between the two groups (PCB group vs. CB group at 1, 3, and 6 months; 95.12 vs. 89.36% (p = 0.55), 75.61 versus 74.47% (p = 0.90), 53.66% versus 63.83% (p = 0.33), respectively). Similarly, vascular access primary patency in the PCB group and CB group was 90.24 and 89.36% (p = 0.83), respectively, at 1 month, 65.85 and 68.09% (p = 0.82), respectively, at 3 months, 39.02 and 53.19% (p = 0.18), respectively, at 6 months. There were no major complications after endovascular treatment. Conclusion: Compared to CB angioplasty, PCB angioplasty has no short-term patency benefit in the treatment of vascular access repeated stenosis.

Access to routine health care and awareness of hypertension status among adults: Results from the National Health and Nutrition Examination Survey, 2011–2018

IntroductionHypertension is a growing pandemic affecting over 1 billion people worldwide; about 46% of people with hypertension are unaware. MethodData from the National Health and Nutrition Examination Survey (NHANES) 2011–2018 were analyzed to assess the relationship between access to a routine place of care and undiagnosed hypertension in adults aged 18 to 64 years old. We defined undiagnosed hypertension as those meeting the 2017 American Heart Association's guidelines for stage 1 or 2 hypertension who reported not being told by their healthcare provider that they had hypertension. We used a multivariable Poisson regression model to assess the relationship between access to a routine place of care and undiagnosed hypertension. ResultThe final analytic sample was 5345 hypertensive American adults, with 56% unaware of their status. The results indicate that lack of awareness of hypertension status was highest among those without a routine place of care [PR = 1.20, CI = (1.12–1.29), p < 0.001] compared to those with access to a routine place of care, after adjustment for sociodemographic and clinical characteristics. ConclusionAccess to a routine place of care in a non-emergency department setting is essential to reduce the rate of undiagnosed hypertension among American adults. Policymakers should implement policies to address the shortage of primary care providers and increase access to a routine place of care.