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One in 10 independently living adults aged 65 years old and older is considered frail, and frailty is associated with poor postoperative outcomes. This systematic review aimed to examine the association between frailty assessments and postoperative outcomes in patients with vascular disease. Electronic databases – MEDLINE, Embase, and the Cochrane Library – were searched from inception until January 2022, resulting in 648 articles reviewed for potential inclusion and 16 studies selected. Demographic data, surgery type, frailty measure, and postoperative outcomes predicted by frailty were extracted from the selected studies. The risk of bias was assessed using the Newcastle–Ottawa Scale. The selected studies (mean age: 56.1–76.3 years) had low-to-moderate risk of bias and included 16 vascular (elective and nonelective) surgeries and eight frailty measures. Significant associations ( p < 0.05) were established between mortality (30-day, 90-day, 1-year, 5-year), 30-day morbidity, nonhome discharge, adverse events, failure to rescue, patient requiring care after discharge, and amputation following critical limb ischaemia. The strongest evidence was found between 30-day mortality and frailty. Composite 30-day morbidity and mortality, functional status at discharge, length of stay, spinal cord deficit, and access site complications were found to be nonsignificantly associated with frailty. With frailty being significantly associated with several adverse postoperative outcomes, preoperative frailty assessments can potentially be clinically useful in helping practitioners predict and guide the pre-, peri-, and postoperative management of frail with vascular disease.

Projects are becoming increasingly more complex at work. This applies to the information technology (IT) field as well. In this technology manager notebook article, we provide a brief review and comparison of management principles from the latest editions of two commonly referenced frameworks in the field of IT: the IT Infrastructure Library and Project Management Book of Knowledge. This is followed by sharing some practical observations and considerations to better manage projects from an IT project management perspective. IEEE

Objectives We performed a systematic review and meta-analysis of outcomes of lobectomy versus sublobar resection in elderly patients (≥65) with stage 1 nonsmall cell lung carcinoma (NSCLC). Methods We searched for relevant articles using a set of inclusion and exclusion criteria. Meta-analytic techniques were applied. Results Twelve studies (n = 5834) were chosen. Our results indicate that in the elderly, lobectomy for stage 1 NSCLC confers a survival advantage over sublobar resection. Lobectomy patients had a lower risk of death within 5 years and lower odds of local cancer recurrence. Our results show that lobectomy had a better 5-year cancer-specific survival and 5-year disease-free survival that trended toward significance. The sublobar resection group showed better 30-day operative mortality that trended toward significance. Subgroup analysis of stage 1A cancer demonstrated no difference in 5-year overall survival rates. However, for stage 1B tumors 5-year overall survival favored lobectomy. Conclusion Lobectomy for stage 1 NSCLC in elderly patients is superior to sublobar resection in terms of survival and cancer recurrence and should be afforded where possible. For stage 1A tumors, sublobar resection is noninferior and may be considered. Further randomized controlled trials in this topic is required.

We performed a systematic review and meta-analysis to analyze the efficacy and safety of sirolimus-eluting stents (SESs) in the treatment of below-the-knee (BTK) arterial disease.An electronic literature search was conducted from inception to July 24, 2021. Retrospective, prospective, and randomized studies that had used SESs to treat BTK arterial disease and had reported the primary patency, technical success, target lesion revascularization, and/or mortality were included. Meta-analyses of the proportions were conducted to derive pooled summary statistics of the outcomes. Where Kaplan-Meier curves were provided for primary patency, a meta-analysis of the individual patient data was conducted via a graphic reconstruction tool to estimate primary patency at various follow-up points. For studies comparing SESs and bare metal stents (BMSs), a two-stage meta-analysis was performed to compare the 6-month primary patency of SESs vs BMSs.Ten studies across 13 publications, including 995 patients, were retrieved for analysis. In the meta-analysis of proportions, across six studies (n = 339 patients), the pooled 6-month primary patency was 87.3% (95% confidence interval [CI], 81.6%-92.1%). Across seven studies (n = 283 patients), the pooled 6-month mortality was 5.4% (95% CI, 1.4%-11.2%). An individual patient data analysis of three studies (n = 282 patients) yielded a primary patency rate of 95.2% (95% CI, 92.7%-97.8%), 82.8% (95% CI, 78.3%-87.6%), 79.8% (95% CI, 75.0%-85.0%), and 79.8% (95% CI, 75.0%-85.0%) at 6, 12, 18, and 24 months, respectively. The 12-month target lesion revascularization rate across four studies (n = 324 patients) was 9.6% (95% CI, 6.4%-13.4%). In the two-stage meta-analysis of 6-month primary patency across three studies (n = 168 patients), the use of SESs was significantly favored over BMSs (risk ratio, 1.28; 95% CI, 1.12-1.46; P .001).The overall evidence suggests that the use of SESs appears to be safe and offers favorable outcomes for BTK arterial disease compared with BMSs.

This article aims to examine some popular project management certifications relevant to the Information Technology (IT) industry as well as to share and help readers to decide if it is worthwhile to seek project management certifications.

Introduction: Central venous occlusive disease (CVOD) is a complication that can occur in patients with end-stage renal disease who are receiving hemodialysis. When CVOD develops, patients often require multiple re-interventions to maintain their dialysis access. CVOD can be treated by various strategies such as balloon angioplasty, stenting, lower limb or extra-anatomical grafts, hybrid grafts or surgical bypasses such as right atrial (RA). In this systematic review, we aim to evaluate the indications, technical aspects, and outcomes after RA bypass grafting for the treatment of CVOD in hemodialysis patients. Methods: A systematic and comprehensive literature search was conducted using various electronic databases. We included articles that reported described and reported outcomes of RA bypass grafting for the treatment of CVOD in hemodialysis patients. A narrative review of the indications and technical aspects of RA bypass grafting was performed. We also pooled and reported the primary patency, secondary patency, postoperative complications, and 30-day mortality of RA bypass grafting. Results: A total of 21 studies with 55 patients who underwent RA bypass grafting were included in our systematic review. Follow-up period ranged from 0.5 to 84 months. The mean pooled primary patency and secondary patency of RA bypass grafting were 8.1 ± 4.9 and 21.7 ± 20.1 months, respectively. The incidence of early postoperative complications such as surgical site infection, bleeding, and access thrombosis was 0%, 4%, and 4%, respectively. The overall 30-day mortality was 4%. Conclusions: This systematic review summarizes the patient characteristics, technical features and outcomes of RA bypass grafting in the treatment of hemodialysis-related CVOD. RA bypass grafting may be a viable last-resort option when less invasive or conventional treatment options have been exhausted.

Background A longitudinal or a transverse incision is routinely used for common femoral artery (CFA) exposure. Some believe a transverse incision is associated with a lower incidence of postoperative complications. We performed a systematic review and meta-analysis to evaluate the risk of postoperative surgical site infection, lymphatic complications, wound dehiscence and haematoma formation when using a longitudinal or transverse incision for CFA exposure. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were adhered to. We searched various databases such as MEDLINE via PubMed and Embase for relevant studies from inception till 31 May 2020. Relevant search terms such as 'longitudinal', 'transverse', 'vertical', 'horizontal', 'femoral', 'incision' were used. We included both randomized controlled trials and case-controlled studies, and extracted data related to study characteristics and postoperative complications. We assessed risk of bias using the Cochrane risk of bias tool and the Newcastle-Ottawa scale. A random-effects meta-analysis was performed to obtain the pooled proportions and risk ratios (RR) for our study outcomes. Results We included seven studies with a total of 5922 groin incisions. A longitudinal incision was associated with a significantly higher incidence of wound infection (RR 2.93, 95% confidence interval (CI) 1.12-7.70, P = 0.03) and wound dehiscence (RR 2.87, 95% CI 1.06-7.77, P = 0.04). The risk of lymphatic complications (RR 1.09, 95% CI 0.39-3.05, P = 0.87) and wound haematoma (RR 2.85, 95% CI 0.88-9.21, P = 0.08) were similar. Conclusions A longitudinal incision may be associated with a higher incidence of wound infection and wound dehiscence, as compared to using a transverse incision for CFA exposure.

Background Most large-volume centres use left heart bypass (LHB) as their preferred organ protection strategy during repair of descending thoracic aortic (DTA) and thoracoabdominal aortic (TAA) pathologies. We investigate the use of hypothermic circulatory arrest (HCA) for similar pathologies and compare the outcomes of both. Methods A PubMed, Embase and Scopus search for studies in English on LHB versus HCA for repair of DTA and TAA pathologies published from inception till February 2020 was performed. Our analysis excluded studies without direct comparison of the two organ protection strategies. Clinical endpoints that were studied were 30-day mortality, post-operative stroke, spinal cord deficit, renal failure and respiratory failure. Random effects meta-analyses of the effect of the two strategies across all clinical endpoints were conducted. Results HCA is non-inferior to LHB across all clinical endpoints. In terms of 30-day mortality (odds ratio (OR) 1.19, 95% confidence interval (CI) 0.31-4.59, P = 0.14, I2 = 49%), stroke (OR 0.41, 95% CI 0.12-1.39, P = 0.97, I2 = 0%), spinal cord deficit (OR 0.56, 95% CI 0.22-1.45, P = 0.78, I2 = 0%), renal failure (OR 1.33, 95% CI 0.37-4.76, P = 0.98, I2 = 0%) and respiratory failure (OR 0.86, 95% CI 0.37-1.97, P = 0.16, I2 = 46%), there was no statistically significant difference between the two cohorts. Conclusion Evidence is limited, but suggests that HCA alone provides adequate organ protection during repair of DTA and TAA pathologies, and has equivalent outcomes when compared to LHB.

Inveterbral disc degeneration is a significant musculoskeletal disease that brings huge burden of pain, disability, psychological and social consequences to the affected population worldwide with treatments that only alleviate the pain but does not address the underlying biological problems. For the past decades, tissue engineering of the disc has been investigated with annulus fibrosus (AF) been one of the complicated disc component to be engineered. With the limited source of annulus cells, bone marrow stromal cells (BMSCs) have been frequently investigated as a potental cell candidate to develop an AF-like tissue which often require a multi-disciplinary effort to achieve. The extracellular matrix of AF is largely make up of collagen and proteoglycan which is still unclear how these matrix proteins could influence the BMSCs towards constructing a AF-like tissue. In this study, we adopted a coiled hydrogel microfiber that resembles the micro-architecture of the native AF tissue to encapsulate BMSCs and incorporated collagen type 1 and hyaluronic acid which later demonstrated that the co-presence of hyaluronic acid and collagen could potentially regulated AF-associated biomarkers and protease expression which are critical for later development of an engineered AF tissue construct.

ObjectivesMore patients are being diagnosed with exertional rhabdomyolysis secondary to indoor spinning. We conducted a systematic review to characterize the clinical characteristics of this new clinical entity.MethodsWe conducted a thorough literature search on PubMed, Embase, Web of Science, Scopus and The Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published from inception till 23rd June 2021 were considered for inclusion. A two-stage article selection process was performed. Articles that reported clinical characteristics and outcomes for patients with SIER were included. Quality assessment was performed using the Joanna Briggs Institute checklists.ResultsThere was a total of 22 articles and 97 patients with SIER. Most patients were healthy females who had attended their first spinning session. The average time to clinical presentation was 3.1 ± 1.5 days. The most common presenting symptoms were myalgia, dark urine and muscle weakness involving the thigh. Seven patients (7.2%) developed acute kidney injury, and two patients (2.1%) required temporary inpatient haemodialysis. Four patients (4.1%) developed thigh compartment syndrome and required fasciotomies. There were no long-term sequelae or mortality observed. The average length of stay was 5.6 ± 2.9 days.ConclusionsHealthcare professionals must have a high index of suspicion of SIER if any patient presents with myalgia, dark urine or weakness after a recent episode of indoor spinning. Fitness centre owners, spinning instructors and participants should also be better educated about the clinical characteristics and manifestations of SIER.

Background Mycotic vascular complications after liver transplantation are rare but can be pose a serious threat to the liver graft and the patient’s life. Mycotic complications can present as an incidental finding on routine imaging, or as haemorrhagic shock. Traditionally, these mycotic vascular complications were managed with open surgery. Method/results In this case report, we describe a patient who had developed multiple sequential mycotic aneurysms after liver transplantation which were managed successfully using endovascular and percutaneous techniques. Conclusion An endovascular approach is minimally invasive and will be the way forward in managing these mycotic vascular complications.

Background Percutaneous transluminal angioplasty is the current standard treatment for arteriovenous fistula (AVF) stenosis. The mid- and long-term patency with plain balloon angioplasty (PBA) is however far from satisfactory. While paclitaxel-coated balloon angioplasty has been shown to be superior to PBA, concern over its safety profile has recently arisen after a reported possible increased mortality risk with a meta-analysis of large lower limb studies. An angioplasty balloon with a new type of drug coating, the sirolimus-coated balloon (SCB), has been proven to improve patency in the coronary arteries. However, its effect on AV access has yet to be studied. Methods/design This is an investigator-initiated, prospective, multicenter, double-blinded, randomized controlled clinical trial to assess the effectiveness of SCB compared to PBA in improving the patency of AVF after angioplasty. A total of 170 patients with mature AVF that requires PTA due to AVF dysfunction will be randomly assigned to treatment with a SCB or PBA at a 1:1 ratio, stratified by location of AVF and followed up for up to 1 year. The inclusion criteria include [1] adult patient aged 21 to 85 years who requires balloon angioplasty for dysfunctional arteriovenous fistula [2]; matured AVF, defined as being in use for at least 1 month prior to the angioplasty; and [3] successful angioplasty of the underlying stenosis with PBA, defined as less than 30% residual stenosis on digital subtraction angiography (DSA) and restoration of thrill in the AVF on clinical examination. The exclusion criteria include thrombosed or partially thrombosed access circuit at the time of treatment, presence of symptomatic or angiographically significant central vein stenosis that requires treatment with more than 30% residual stenosis post angioplasty, and existing stent placement within the AVF circuit. The primary endpoint of the study is access circuit primary patency at 6 months. The secondary endpoints are target lesion primary patency; access circuit-assisted primary patency; access circuit secondary patency at 3, 6, and 12 months; target lesion restenosis rate at 6 months; total number of interventions; complication rate; and cost-effectiveness. The trial is supported by Concept Medical. Discussion This study will evaluate the clinical efficacy and safety of SCB compared to PBA in the treatment of AVF stenosis in hemodialysis patients. Trial registration ClinicalTrials.govNCT04409912. Registered on 1 June 2020

This dataset supports the findings of the vascular e-Learning during the COVID-19 pandemic survey (the EL-COVID survey). The General Data Protection Regulation (GDPR) of the European Union was taken into consideration in all steps of data handling. The survey was approved by the institutional ethics committee of the Primary Investigator and an online English survey consisting of 18 questions was developed ad-hoc. A bilingual English-Mandarin version of the questionnaire was developed according to the instructions of the Chinese Medical Association in order to be used in mainland People's Republic of China. Differences between the two questionnaires were minor and did affect the process of data collection. Both questionnaires were hosted online. The EL-COVID survey was advertised through major social media. All national and regional contributors contacted their respective colleagues through direct messaging on social media or by email. Eight national societies or groups supported the dissemination of the EL-COVID survey. The data provided demographics information of the EL-COVID participants and an insight on the level of difficulty in accessing or citing previously attended online activities and whether participants were keen on citing these activities in their Curricula Vitae. A categorization of additional comments made by the participants are also based on the data. The survey responses were filtered, anonymized and submitted to descriptive analysis of percentage.

Anatomically and biologically relevant vascular models are critical to progress our understanding of cardiovascular diseases (CVDs) that can lead to effective therapies. Despite advances in 3D bioprinting, recapitulating complex architectures (i.e., freestanding, branching, multilayered, perfusable) of a cell-laden vascular construct remains technically challenging, and the development of new techniques that can recapitulate both anatomical and biological features of blood vessels is of paramount importance. In this work, we introduce a unique, microfluidics-enabled molding technique that allows us to fabricate anatomically-relevant, cell-laden hydrogel vascular models. Our approach employed 3D-printed porous molds of poly(ethylene glycol) diacrylate (PEGDA) as templates to cast alginate-containing bioinks. Due to the porous and aqueous nature of the PEGDA mold, the calcium ion (Ca2+) was diffusively released to crosslink the bioinks to create hollow structures. Applying this technique, multiscale, multilayered vascular constructs that were freestanding and perfusable were readily fabricated using cell-compatible bioinks (i.e., alginate and gelatin methacryloyl (GelMA)). The bioinks were also readily customizable to either improve the compatibility with specific vascular cells or tune the mechanical modulus to mimic native blood vessels. Importantly, we successfully integrated smooth muscle cells and endothelial cells in a biomimetic organization within our vessel constructs and demonstrated a significant increase in monocyte adhesion upon stimulation with an inflammatory cytokine, tumor necrosis factor-alpha (TNF-α). We also demonstrated that the fabricated vessels were amenable for testing percutaneous coronary interventions (i.e., drug-eluting balloons and stents) under physiologically-relevant mechanical states, such as vessel stretching and bending. Overall, we introduce a versatile fabrication technique with multi-faceted possibilities of generating biomimetic vascular models that can benefit future research in mechanistic understanding of CVD progression and the development of therapeutic interventions.

Background The corona virus disease (COVID-19) pandemic has radically changed the possibilities for vascular surgeons and trainees to exchange knowledge and experience. The aim of the present survey is to inventorize the e-learning needs of vascular surgeons and trainees as well as the strengths and weaknesses of vascular e-Learning. Methods An online survey consisting of 18 questions was created in English, with a separate bilingual English-Mandarin version. The survey was dispersed to vascular surgeons and trainees worldwide through social media and via direct messaging from June 15, 2020 to October 15, 2020. Results Eight hundred and fifty-six records from 84 different countries could be included. Most participants attended several online activities (>4: n = 461, 54%; 2–4: n = 300, 35%; 1: n = 95, 11%) and evaluated online activities as positive or very positive (84.7%). In deciding upon participation, the topic of the activity was most important (n = 440, 51.4%), followed by the reputation of the presenter or the panel (n = 178, 20.8%), but not necessarily receiving accreditation or certification (n = 52, 6.1%). The survey identified several shortcomings in vascular e-Learning during the pandemic: limited possibility to attend due to lack of time and increased workload (n = 432, 50.5%), no protected/allocated time (n = 488, 57%) and no accreditation or certification, while technical shortcomings were only a minor problem (n = 25, 2.9%). Conclusions During the COVID-19 pandemic vascular e-Learning has been used frequently and was appreciated by vascular professionals from around the globe. The survey identified strengths and weaknesses in current e-Learning that can be used to further improve online learning in vascular surgery.

Objective : The COVID-19 pandemic has had a profound effect on the delivery of vascular surgery to patients around the world. In order to conserve resources and reduce the risk of COVID-19 infection, many institutions have postponed or cancelled surgeries. In this scoping review, we aim to review current literature and recapitulate the significant changes in elective and emergency vascular surgery during the COVID-19 pandemic. Methods : We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. We included all articles that had reported the effects of the COVID-19 pandemic on elective or emergency vascular surgery. Results : A total of 28 articles were included in this scoping review. We identified eight distinct themes that were relevant to our study topic. We report global, regional and local data on vascular surgical cases. We also discuss the adoption of vascular surgery triage systems, emergence of global collaborative vascular surgery research groups, increased use of endovascular techniques and locoregional anaesthesia, delayed presentation of vascular surgery conditions and poorer outcomes of patients with chronic limb-threatening ischaemia. Conclusions : This scoping review provides a snapshot of the impact of the COVID-19 pandemic on elective and emergency vascular surgery.

Information technology (IT) management requires maintaining IT services for customers and clients. This requirement is amplified in the defense and security industry. In this technology manager notebook article, we share some practical observations and considerations for better efficiency in IT operations management especially with respect to security and vulnerabilities. We are providing our insight to better prepare for future pandemic outbreaks and other crises from an IT management perspective.

This article begins with a common and popular definition of “Project Management.” The objective is to remind the reader that project management is a process – a series of steps (involving experience and knowledge in applying tools or techniques) undertaken to deliver a product or service in order to achieve a specific outcome. Not only do project managers need to deliver projects on time, on schedule, and within budget, they also need to ensure quality and user satisfaction for the work delivered. Project managers need to continually find ways to do this better. Using and applying the 80/20 principle thinking as a tool can aid in this aspect. We share how applying the 80/20 principle can help improve the management of an Information Technology (IT) project's data archival work activities.

This paper aims to understand the evolution of project management trends over the years by analysing publications related to project management trends. A narrative approach of the qualitative research method was adopted to connect ideas together through an identification of a sequence of events that happened from these publications so as to understand the evolution of project management trends. This method would be appropriate as the study aims to share key fi ndings and insights from past publications largely from scholars in the academic field, that will be useful and beneficial to practitioners from the industries as well.

Acute appendicitis is a common condition in the pediatric population. In patients with uncomplicated appendicitis, laparoscopic appendectomy (LA) is preferred as compared to open appendectomy (OA). However, in patients with complicated appendicitis (CA), as defined as suppurative, gangrenous or perforated appendicitis, or appendicitis with periappendicular abscess formation, the decision to perform OA or LA remains unclear. The PRISMA guidelines were adhered to. An electronic database search from 1997 to 2017 was performed using the Cochrane, Medline, PubMed, Scopus, Ovid, Embase, and Web of Knowledge databases. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Assessment of methodological and statistical heterogeneity, as well as publication bias of the included studies, was performed. Six randomized-control trials (296 LA versus 373 OA) and 33 case–control trials (3106 LA versus 4149 OA) were analyzed. Compared to OA, LA has a shorter length of stay (WMD = − 0.96, 95% CI − 1.47 to − 0.45) and a lower rate of surgical site infection (OR 0.37, 95% CI 0.25–0.54), although the rates of intraabdominal abscess formation were similar (OR 1.01, 95% CI 0.71–1.43). LA was also shown to have lower readmission rates, lower incidences of postoperative ileus or intestinal obstruction, lower incidence of reoperation, as well as a shorter time taken to oral intake. Operative time for OA was shorter than LA (WMD = 12.44, 95% CI 2.00–22.87). While studies in the past have associated LA with higher rates of intraabdominal abscess in patients with CA, our meta-analysis has shown that they were similar. Considering this, together with other improved postoperative outcomes, LA should be the procedure of choice in pediatric patients presenting with CA.

ObjectivesCoronavirus disease 2019 (COVID-19) infection is associated with a prothrombotic state. We performed a meta-analysis of proportions to estimate the weighted average incidence of pulmonary thromboembolism (PTE) in COVID-19 patients who were admitted to the intensive care unit (ICU).MethodsWe searched various medical databases for relevant studies from 31 December 2019 till 30 September 2020. We included observational studies that reported the incidence of PTE in COVID-19 patients admitted to the ICU. We extracted data related to study characteristics, patient demographics, and the incidence of PTE. Risk of bias was assessed by using the ROBINS-I tool. Statistical analysis was performed with R 3.6.3.ResultsWe included 14 studies with a total of 1182 patients in this study. Almost all patients in this meta-analysis received at least prophylactic anticoagulation. The weighted average incidence of PTE was 11.1% (95% CI 7.7% to 15.7%,I2= 78%, Cochran’sQtestP< 0.01). We performed univariate and multivariate meta-regression, which identified the proportion of males as a significant source of heterogeneity (P= 0.03, 95% CI 0.00 to − 0.09)ConclusionThe weighted average incidence of PTE remains high even after prophylactic anticoagulation. PTE is a significant complication of COVID-19 especially in critically ill patients in the ICU.

Singapore was one of the first countries to be affected by COVID-19, with the index patient diagnosed on 23 January 2020. For two 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. We also describe in detail, with relevant data, how our vascular surgery practice has changed due to these policies and COVID-19. We show that with a segregated team model, the vascular surgery unit can still function whilst reducing risk of cross-contamination. We explain the various strategies adopted to reduce outpatient and inpatient volume. We provide a detailed breakdown of the type of vascular surgical cases that were performed during the COVID-19 pandemic and compared it to preceding months. We discuss our operating room and personal protective equipment protocols when managing a COVID-19 patient and share how we continue surgical training amidst the pandemic. We also discuss the challenges we might face in the future as COVID-19 regresses.

Purpose Coronavirus disease 2019 (COVID-19) infection is known to be associated with a hypercoagulable and prothrombotic state, especially in critically ill patients. Several observational studies have reported the incidence of thromboembolic events such as pulmonary thromboembolism (PTE). We performed a meta-analysis to estimate the weighted average incidence of PTE in critically ill COVID-19 patients who are admitted to the intensive care unit.Methods We searched MEDLINE via PubMed, Embase and Web of Science for relevant studies from 31 December 2019 till 15 Aug 2020 onwards using the search terms “coronavirus”, “COVID-19”, “SARS-CoV-2”, “2019-nCoV”, “thrombus”, “thrombo*”, “embolus” and “emboli*”. We included prospective and retrospective observational studies that reported the incidence of PTE in critically ill COVID-19 patients who required treatment in the intensive care unit. We identified 14 studies after two phases of screening and extracted data related to study characteristics, patient demographics and the incidence of PTE. Risk of bias was assessed by using the ROBINS-I tool. Statistical analysis was performed with R 3.6.3.Results We included 14 studies with a total of 1182 patients in this study. Almost 100% of patients in this meta-analysis received at least prophylactic anticoagulation. The weighted average incidence of PTE was 11.09% (95% CI 7.72% to 15.69%, I2 = 78%, Cochran’s Q test P < 0.01). We performed univariate and multivariate meta-regression which identified the proportion of males as a significant source of heterogeneity (P = 0.03, 95% CI 0.00 to -0.09)Conclusion This is the only study that had specifically reported the weighted average incidence of PTE in critically ill COVID-19 patients using meta-analytic techniques. The weighted average incidence of PTE remains high even after prophylactic anticoagulation. This study is limited by incomplete data from included studies. More studies are needed to determine the optimal anticoagulation strategy in critically ill COVID-19 patients.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy and safety of the endovascular approach compared to conventional surgical endarterectomy for atherosclerotic lesions at the common femoral artery (CFA) bifurcation.

Graphical Abstract This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. Graphical Abstract One of the most affected specialties

This paper aims to review several project management frameworks that are widely used in the industries. Studies on how to adopt and adapt such frameworks remain limited. Three project management (PM) frameworks widely used in the information technology (IT) industry, such as PMBOK, PRINCE2, and ITIL, were analyzed and compared. The objectives of the review are twofold. First, to allow one to have a quick understanding of the widely used project management frameworks; and second, provide how these frameworks can be used together and complement each other at the different phases of a project lifecycle to address the specific needs of the industries managing IT products or services.

Intra-abdominal metastasis (IAM) of central nervous system (CNS) tumors through ventriculoperitoneal shunt (VPS) is rare but has been previously reported (e.g., germinomas and medulloblastomas). However, there has been no previous reports in literature involving meningiomas. A case of primary rhabdoid meningioma with widespread intra-abdominal carcinomatosis after placement of a VPS in a 36-year-old man is described. The patient underwent preoperative angioembolization of the tumor, craniotomy, and surgical excision, followed by postoperative gamma knife radiosurgery. Five months later, he underwent a decompressive craniectomy and surgical excision for tumor recurrence causing raised intracranial pressure and communicating hydrocephalus, necessitating placement of a VPS. One month after placement of the VPS, the patient developed abdominal distension and confusion. He was treated for a VPS infection and the shunt was explanted. He continued to deteriorate with high output from the peritoneal drain placed at the time of shunt explantation. An exploratory laparotomy revealed multiple diffuse peritoneal and omental nodules which had the same histopathological and immunohistochemical morphology as the primary tumor. We reviewed the current literature on IAM of primary CNS tumors through VPS, which revealed that patients belonging to the pediatric age group of the male gender and with a primary intracranial germinoma or medulloblastoma have a higher incidence of IAM. The majority of IAM occurred within 2 years of VPS placement, and patients most commonly present with abdominal distension and ascites. Treatment after diagnosis is varied, and the prognosis is poor, with more than half of the patients dying within a year. It is vital for clinicians to maintain a high index of suspicion for similar patients as early intervention could potentially improve patient outcomes and patient expectations managed more effectively.

Objective Despite the high burden of vascular disease that is assessed, investigated, and managed by generalists, no specific medical school curriculum is in use for vascular surgery (VS). In the present scoping review, we aimed to map the available evidence on the provision of VS education in the medical school curriculum worldwide. Methods The present review was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analysis) extension for scoping reviews. The inclusion criterion was reported research studies on VS education in the medical curriculum. Results A total of 20 studies were included. Three main themes were identified. VS was perceived as an essential part of the general medical student curriculum by VS applicants. Exposure to VS varied considerably, and students generally expressed a need for an increase in VS coverage. The most important positive determinants when choosing VS as a career were having a VS mentor, the technical aspects of VS, and participation in a VS rotation. Frequently cited deterrents were the long training time and demanding lifestyle potentially compromising family life. Conclusions The present scoping review has provided a starting point to better understand the provision of VS education in medical schools across the world. Our review has demonstrated the variability in VS exposure at medical school and described students' sentiments toward VS. We have highlighted the need to determine whether the current curricula are adequate from the perspective of multiple stakeholders (eg, vascular surgeons, educators, general practitioners, a variety of specialists) with a crucial role in the treatment of patients with vascular conditions.

Objective Creation of good long-term arteriovenous access is essential in patients requiring hemodialysis for end-stage renal failure. However, arteriovenous grafts or fistulae can be complicated by infection that may require emergency surgery. For infections that involve the brachial artery anastomosis, or if total graft explantation is indicated, brachial artery repair or reconstruction is often required. An alternative management strategy would be brachial artery ligation (BAL). We performed a systematic review to evaluate the outcomes of BAL that has been performed for infected arteriovenous grafts or fistulae. Methods A thorough literature search was conducted using various electronic databases. We included articles that reported outcomes of BAL performed for infected arteriovenous grafts or fistulae. The primary outcome was the incidence of upper limb ischemia after BAL. Secondary outcomes were the need for urgent revascularization, need for upper limb amputation, and incidence of postoperative neurological deficit after BAL. Results A total of five studies with a total of 125 patients were included in our systematic review. BAL was performed for infected arteriovenous grafts or fistulae for all studies. Follow-up period ranged from 1 to 27 months. The incidence of upper limb ischemia after BAL was low. Only a single study reported three patients who developed upper limb ischemia. Two patients required urgent revascularization, and one patient required forearm amputation after proximal ligation. All studies reported clearance of infection with no recurrence. Conclusions Distal BAL may be performed safely for patients with infected arteriovenous fistulae or grafts with low risk of upper limb ischemia, postoperative neurological deficit, and recurrent infection.

Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed procedures for the treatment of obesity. Patients with obesity are more prone to experience opioid-related adverse events (ORAE). The objective of this study is to determine if a multimodal analgesia protocol (MAP) reduces ORAE and provides effective pain relief for patients after LSG. This study was conducted at University Hospital, Singapore. The MAP consists of mandatory pre-operative etoricoxib, intra-operative acetaminophen, and post-operative acetaminophen with optional post-operative tramadol. We identified and collected data for patients who underwent LSG between May 2010 and November 2015 and compared patients before and after the implementation of the MAP. One hundred fifty-eight patients were included and 68 patients were treated with the MAP. There were no differences in age, gender, body mass index, ethnicity, or comorbidities between the two groups except for the incidence of hypertension (p = 0.015). There was a significant reduction in the incidence of ORAE from 33.3 to 8.8% (p