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. Multivariable Cox regression models were used to assess the association between cohort allocation and the two major clinical outcomes. RESULTS: Data of 114 and 141 patients were analyzed respectively from Cohorts 1 (historical data) and 2 (with AVF tracking). After adjustment of covariates in the multivariable analysis, the AVFs created in Cohort 2 were more likely to be cannulated earlier (adjusted HR: 2.82; 95% CI: 1.97-4.05; p < 0.001), compared to those in Cohort 1. Similarly, the AVFs of Cohort 2 patients had significantly higher probability of functional maturation (adjusted HR: 1.81; 95% CI: 1.31-2.48; p < 0.001) than fistulas in Cohort 1. Cannulation was commenced for half of the AVFs by 4.1 months post-creation in the historical cohort (Cohort 1), whereas in the post-tracking cohort, 50% of the AVFs were cannulated by 2.3 months after creation (p < 0.001). It took 5.5 and 4.3 months for 50% of the AVFs created in Cohort 1 and Cohort 2 patients to achieve catheter-free functional maturation, respectively (p = 0.06). CONCLUSION: An AVF tracking program with maturation target for the access surgeons, together with a standardized tracking, feedback, and clinical strategy adjustment system is able to improve the AVF functional maturation rate.

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. The outcome variables were the length of stay per admission; inpatient and outpatient bill per admission; and, if they had an Emergency Department visit. Cost outcomes were reported in Singapore dollars (S$). A total of 1682 patients were included, and the mean age was 69.9 years (±13.0). An average patient incurred a length of stay of 38.7 days, 7.9 inpatient dressing sessions, an inpatient bill of S$33 096, 11.3 outpatient dressing sessions, and an outpatient bill of S$8780. Inpatient services per patient cost 73.5% higher than outpatient services. NIU patients with multiple (>3) comorbid conditions, peripheral artery disease, or chronic kidney disease incurred longer hospitalisation and higher inpatient bill. Patients with diabetes mellitus and coronary artery disease had higher odds of incurring an ED visit. Patients with coronary artery disease, hyperlipidaemia, kidney complications, or obesity incurred higher outpatient bills. NIU treatment imposes a significant economic burden, especially with inpatient services.

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. Data were extracted from a tertiary hospital registry in Singapore, between 2013 and 2017. The outcome variables were length of stay per admission; inpatient and outpatient bill per admission; whether a patient underwent a surgical treatment of the venous system; and, whether they visited the emergency department. Cost outcomes were reported in Singapore dollars (S$). A total of 162 VLU patients were included with a mean age of 67.5 (±14.4). For the inpatient setting the mean length of stay was 8.1 days and the mean inpatient bill was S$7886. For outpatients, the mean number of dressings was 29.4, and mean outpatient bill was S$6962. Heart disease patients incurred longer hospital stays and larger inpatient bills per admission and females had greater odds of undergoing a surgical procedure on the venous system. Certain VLU patient groups were found to be associated with larger cost outcomes.

In situ Raman enhancement strategy for highly sensitive and quantitative lateral flow assay.

As a paper-based analytical platform, lateral flow assay (LFA) gets benefit from the rapid analysis, low cost, high selectivity, good stability, and user-friendliness, and thus has been widely used in rapid screening or assisted diagnosis. Nevertheless, LFA still suffers from low detection sensitivity via the naked eye, limiting its applications to qualitative and semi-quantitative tests. To enhance the signal readout, various nanoparticle signal tags have been employed to replace traditional colloidal gold nanoparticles (AuNPs), such as fluorescent nanoparticles (FNPs), magnetic nanoparticles (MNPs), and Raman reporter-labeled nanoparticles. In particular, Raman reporter-labeled nanoparticles are extremely sensitive due to remarkable signal enhancement effect on metal surface. However, the application of LFA is still hampered by the poor stability of Raman reporter-labeled nanoparticles. Herein, we developed an in situ Raman enhancement strategy to create a surface-enhanced Raman scattering (SERS) signal on the AuNPs, shortened as "i-SERS," which not only preserves the original advantages of the colloidal gold strip (AuNPs-LFA), but also realizes highly sensitive and quantitative detection. We applied the i-SERS for procalcitonin (PCT) detection. The experimental process takes only 16 min, and the limit of detection (LOD) is 0.03 ng mL-1, far below the value using AuNPs-LFA. These results indicate that i-SERS assay was highly sensitive and suitable for the rapid detection of PCT.

Surface-enhanced coherent anti-Stokes Raman scattering based on coupled nanohole-slit arrays.

Metal nanohole arrays show excellent performance when applied for sensing, optical fibers, and surface-enhanced spectroscopy, but they are not ideal candidates for surface-enhanced coherent anti-Stokes Raman scattering (SECARS) because of their low enhancement factor (EF). Here, the finite element method was used to study the dependence of the period, width, and thickness of nanoslits on the EF of SECARS and optical transmission in Au nanohole-slit arrays. Nanoslits across the nanoholes significantly modulated the SECARS signal, and we observed an ∼106 improvement in the EF of SECARS compared with the nanohole-only structure. Uniform and stable 2D hotspots at the open surface of plasmonic nanohole-slit structures provided a huge SECARS EF as high as 18 orders of magnitude. Directional SECARS emission revealed strong forward and backscattering with high directionality, showing a smaller divergence angle of 14° on the reflective side of the nanohole-slit array. These results provide a fundamental understanding of SECARS in coupled nanohole-slit arrays and are useful for designing a SECARS platform with high sensitivity.

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. Patients' major limb amputation and mortality were assessed using Cox regression models. Cumulative survival and amputation-free survival among the three classified groups were calculated using Kaplan-Meier analysis. Compared with patients with only DM, those in the PAD group and the DM-PAD group had higher risk of major limb amputation (adjusted hazard ratio: 2.47, 95% CI: 1.65-3.70; adjusted hazard ratio: 2.01, 95% CI: 1.53-2.65 respectively) and mortality (adjusted hazard ratio: 2.36, 95% CI: 1.57-3.55; adjusted hazard ratio: 2.46, 95% CI: 1.86-3.26 respectively). The 3-year survival and amputation-free survival were lowest in the DM-PAD group (52.1% and 41.5% respectively), followed by the PAD group (53.3% and 44.6% respectively) and the DM group (74.2% and 68.5% respectively). Lower extremity NIU patients with PAD or DM-PAD were found to have poorer clinical prognosis than those with DM only.

Surface and coherent contributions of plasmon fields to ultraviolet tip-enhanced coherent anti-Stokes Raman scattering.

Design of plasmonic substrates is of immense importance for high sensitivity and spatial resolution in plasmon-enhanced spectroscopy. In this study, the enhancement factors (EFs) of tip-enhanced coherent anti-Stokes Raman scattering (TECARS) contributed by surface and quantum coherent effects in the ultraviolet region are theoretically analyzed using three-dimensional finite-difference time-domain (3D-FDTD) method. In the multi-resonant TECARS configuration, surface and coherent EFs of 1018 and 109, respectively, can be achieved by considering the synthetic effect of surface and coherent enhancement mechanisms, providing the total TECARS EF of 1027 and sub-5 nm spatial resolution. Our theoretical results not only provide a deeper understanding of ultraviolet (UV)-TECARS but also can be used as a highly efficient reference for the experimental design of TECARS platform.

Deep ultraviolet tip-enhanced fluorescence.

Theoretical calculations were performed for the deep ultraviolet (DUV) tip-enhanced fluorescence (TEF) using Al@Al2O3 core-shell tips. Fluorescence enhancement, spatial resolution and surface plasmon coupled emission (SPCE) of DUV-TEF were quantitatively studied by finite-difference time-domain (FDTD) method. FDTD results demonstrate that the enhancement factor (EF) of TEF can be as high as 3 orders of magnitudes in the optimal TEF geometry. At the DUV excitation wavelength of 244 nm, the spatial resolution and SPCE angles are 6 nm and ±23°, respectively, showing maximum EF of 7.4 × 102. Our results not only help understanding the underlying physical mechanism for developing high-sensitivity and high-resolution DUV-TEF platform, but also contribute to expanding TEF technology from visible to UV range.

Plasmon-Enhanced Second-Harmonic Generation Nanorulers with Ultrahigh Sensitivities.

Attainment of spatial resolutions far below diffraction limits by means of optical methods constitutes a challenging task. Here, we design nonlinear nanorulers that are capable of accomplishing approximately 1 nm resolutions by utilizing the mechanism of plasmon-enhanced second-harmonic generation (PESHG). Through introducing Au@SiO2 (core@shell) shell-isolated nanoparticles, we strive to maneuver electric-field-related gap modes such that a reliable relationship between PESHG responses and gap sizes, represented by "PESHG nanoruler equation", can be obtained. Additionally validated by both experiments and simulations, we have transferred "hot spots" to the film-nanoparticle-gap region, ensuring that retrieved PESHG emissions nearly exclusively originate from this region and are significantly amplified. The PESHG nanoruler can be potentially developed as an ultrasensitive optical method for measuring nanoscale distances with higher spectral accuracies and signal-to-noise ratios.

"Smart" Ag Nanostructures for Plasmon-Enhanced Spectroscopies.

Silver is an ideal candidate for surface plasmon resonance (SPR)-based applications because of its great optical cross-section in the visible region. However, the uses of Ag in plasmon-enhanced spectroscopies have been limited due to their interference via direct contact with analytes, the poor chemical stability, and the Ag(+) release phenomenon. Herein, we report a facile chemical method to prepare shell-isolated Ag nanoparticle/tip. The as-prepared nanostructures exhibit an excellent chemical stability and plasmonic property in plasmon-enhanced spectroscopies for more than one year. It also features an alternative plasmon-mediated photocatalysis pathway by smartly blocking "hot" electrons. Astonishingly, the shell-isolated Ag nanoparticles (Ag SHINs), as "smart plasmonic dusts", reveal a ∼1000-fold ensemble enhancement of rhodamine isothiocyanate (RITC) on a quartz substrate in surface-enhanced fluorescence. The presented "smart" Ag nanostructures offer a unique way for the promotion of ultrahigh sensitivity and reliability in plasmon-enhanced spectroscopies.

Electrochemical Tip-Enhanced Raman Spectroscopy.

Interfacial properties are highly important to the performance of some energy-related systems. The in-depth understanding of the interface requires highly sensitive in situ techniques that can provide fingerprint molecular information at nanometer resolution. We developed an electrochemical tip-enhanced Raman spectroscopy (EC-TERS) by introduction of the light horizontally to the EC-STM cell to minimize the optical distortion and to keep the TERS measurement under a well-controlled condition. We obtained potential-dependent EC-TERS from the adsorbed aromatic molecule on a Au(111) surface and observed a substantial change in the molecule configuration with potential as a result of the protonation and deprotonation of the molecule. Such a change was not observable in EC-SERS (surface-enhanced), indicating EC-TERS can more faithfully reflect the fine interfacial structure than EC-SERS. This work will open a new era for using EC-TERS as an important nanospectroscopy tool for the molecular level and nanoscale analysis of some important electrochemical systems including solar cells, lithium ion batteries, fuel cells, and corrosion.

Gold-coated AFM tips for tip-enhanced Raman spectroscopy: theoretical calculation and experimental demonstration.

The optimal gold-coated atomic force microscopy (AFM) tip-substrate system for tip-enhanced Raman spectroscopy (TERS) was designed theoretically and demonstrated experimentally. By optimizing the tip, excitation laser, and the substrate, the TERS enhancement factor can be tuned to as high as 9 orders of magnitude, and the spatial resolution could be down to 5 nm. Preliminary experimental results for AFM tips coated with gold layer of different thicknesses reveal that the maximum enhancement can be achieved when the thickness is about 60-80 nm, which is in good agreement with the theoretical prediction. Our results not only provide a deep understanding of the underlying physical mechanism of AFM tip-based TERS, but also guide the rational construction of a working AFM-TERS system with a high efficiency.

Three-dimensional and time-ordered surface-enhanced Raman scattering hotspot matrix.

The "fixed" or "flexible" design of plasmonic hotspots is a frontier area of research in the field of surface-enhanced Raman scattering (SERS). Most reported SERS hotspots have been shown to exist in zero-dimensional point-like, one-dimensional linear, or two-dimensional planar geometries. Here, we demonstrate a novel three-dimensional (3D) hotspot matrix that can hold hotspots between every two adjacent particles in 3D space, simply achieved by evaporating a droplet of citrate-Ag sols on a fluorosilylated silicon wafer. In situ synchrotron-radiation small-angle X-ray scattering (SR-SAXS), combined with dark-field microscopy and in situ micro-UV, was employed to explore the evolution of the 3D geometry and plasmonic properties of Ag nanoparticles in a single droplet. In such a droplet, there is a distinct 3D geometry with minimal polydispersity of particle size and maximal uniformity of interparticle distance, significantly different from the dry state. According to theoretical simulations, the liquid adhesive force promotes a closely packed assembly of particles, and the interparticle distance is not fixed but can be balanced in a small range by the interplay of the van der Waals attraction and electrostatic repulsion experienced by a particle. The "trapping well" for immobilizing particles in 3D space can result in a large number of hotspots in a 3D geometry. Both theoretical and experimental results demonstrate that the 3D hotspots are predictable and time-ordered in the absence of any sample manipulation. Use of the matrix not only produces giant Raman enhancement at least 2 orders of magnitude larger than that of dried substrates, but also provides the structural basis for trapping molecules. Even a single molecule of resonant dye can generate a large SERS signal. With a portable Raman spectrometer, the detection capability is also greatly improved for various analytes with different natures, including pesticides and drugs. This 3D hotspot matrix overcomes the long-standing limitations of SERS for the ultrasensitive characterization of various substrates and analytes and promises to transform SERS into a practical analytical technique.

Teachers' professional journey: Charting achievement recognition, career adaptability, and task performance.

The rapid technological advancement in higher education necessitates understanding the factors influencing university teachers' professional growth and task performance. This study investigates the relationships among Achievement Recognition, Career Adaptability, and Organizational Seniority, focusing on their impact on the task performance of Chinese university teachers. A longitudinal, time-lagged survey design was employed, collecting data from 1444 Chinese university teachers over three waves, each one month apart. The survey included Achievement Recognition, Career Adaptability, and Task Performance measures, with Organizational Seniority as a moderating variable. Achievement Recognition significantly predicted Career Adaptability. The interaction between career adaptability and organizational seniority was significant, indicating that the positive effect of career adaptability on task performance varied with levels of organizational seniority. Conditional Effects were substantial. Career Adaptability positively affected Work Performance for individuals with less than five years of seniority but had a weaker effect for those with 11-15 years and an adverse effect for those with >21 years of seniority. The indirect impact of Achievement Recognition on Work Performance through Career Adaptability was significant for newly employed workers but non-significant for experienced workers. The study underscores the importance of Achievement Recognition in enhancing Career Adaptability and, subsequently, Work Performance. The moderating role of Organizational Seniority suggests that interventions to boost Career Adaptability and Work Performance should be tailored to different career stages. Academic institutions should implement recognition programs, adaptability training, and mentorship schemes that consider faculty members' career stages to foster a high-performing, adaptable workforce.

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. DATA SOURCES AND REVIEW METHODS: Literature search was performed on PubMed, Scopus, and Embase to identify eligible articles. The quality of the studies was assessed using the Prediction model Risk Of Bias ASsessment (PROBAST) Tool. The performance (discrimination and calibration) of the included studies were extracted. RESULTS: Fourteen studies (seven studies used risk score approaches; seven studies used machine learning approaches) were included in the review. Among them, 12 studies were rated as high or unclear "risk of bias." Six studies were rated as high concern or unclear for "applicability." C-statistics (Model discrimination metric) was reported in five studies using risk score approach (0.70-0.886) and three utilized machine learning methods (0.80-0.85). Model calibration was reported in three studies. Failure-to-mature risk score developed by one of the studies has been externally validated in three different patient populations, however the model discrimination degraded significantly (C-statistics: 0.519-0.53). CONCLUSION: The performance of existing predictive models for AVF maturation/patency is underreported. They showed satisfactory performance in their own study population. However, there was high risk of bias in methodology used to build some of the models. The reviewed models also lack external validation or had reduced performance in external cohort.

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. Data encompassing patient demographics, access and lesion characteristics, procedural specifics, associated complications, immediate clinical outcomes, and outcomes during follow-up were collected. The procedural technical and clinical success, Kaplan-Meier estimated target lesion (TLPP), access circuit primary patency (ACPP), and index access secondary patency (SP) were reported. RESULTS: During the study period, 22 patients underwent USG-guided sharp recanalization procedures in the three participating centers with median follow-up of 14.5 months. Both the technical and clinical success were 100%. Only two patients experienced minor complications of localized hematoma over the access, with no instances of major complication. Kaplan-Meier estimated TLPP and ACPP at 3-, 6-, and 12 months were 90.9%, 68.2%, 56.8%, and 90.9%, 63.6%, 52.1% respectively. The SP rates were 100%, 95.5%, and 84.1% at 3-, 6-, and 12 months respectively. CONCLUSION: USG guided percutaneous sharp recanalization is an effective and safe endovascular approach to treat resistant CTO lesions of dysfunctional HD access.

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. Nurses from 47 Singapore dialysis centers (five hospital-based and 42 community-based) providing hemodialysis were invited to participate on a voluntary and anonymous basis from April to November 2022. The survey consists of nurses' knowledge on VA (10 items), attitude on VA care (six items), usual practices (seven items), and self-efficacy in VA cannulation and management (six items). The total scores for the knowledge, attitude, and self-efficacy components were 50, 30, and 30 respectively. The instrument has been validated in a pilot study. RESULTS: In total, five hundred sixteen dialysis nurses participated the survey. The mean (±SD) knowledge score of the participants toward VA care was 30.0 (±8.1) over a total score of 50. The means (±SD) of their attitude and self-efficacy scores were 24.4 (±4.1) and 24.2 (±3.1) over 30 respectively. The majority of the nurses (84.1% in hospital-based centers and 98.9% in community-based centers) conducted patient education in some aspects of VA care. The percentage of nurses indicated need for referral to access specialists due to various abnormalities varied significantly between the hospital-based and community-based settings. In the multivariable linear regression analysis, longer working experience was a significant factor for higher knowledge score (B = 0.26; p = 0.001), attitude score (B = 0.08; p = 0.01), and self-efficacy score (B = 0.34; p < 0.001). CONCLUSION: Dialysis nurses in Singapore have satisfactory knowledge, practice, and self-efficacy on VA care. The majority of them expressed positive opinions toward the VA-related training they received, new technologies, and communications. The identified knowledge and practice gaps could be incorporated into the future training programs.

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. The proposed optical device can measure tissue-level pulsatile blood flow ∼6 mm underneath the skin surface. A new quantitative tissue perfusion index (TPIDSPF) based on frequency domain analysis of the pulsatile blood flow waveform is defined to assess tissue ischemia status. Through a clinical study involving 66 subjects, including healthy individuals and diabetes patients with and without PAD, TPIDSPF demonstrated strong correlations of 0.720 with transcutaneous tissue partial oxygen pressure (TcPO2) and 0.652 with toe-brachial index (TBI). Moreover, among the three methods, TPIDSPF demonstrated the highest area under the curve for PAD diagnosis among diabetes patients, with a notable value of 0.941. The promising clinical results suggest that the proposed optical method has the potential to be an effective clinical tool for identifying PAD among the diabetic cohort.

The regulatory mechanism and therapeutic potential of transcription factor EB in neurodegenerative diseases.

The autophagy-lysosomal pathway (ALP) is involved in the degradation of protein aggregates and damaged organelles. Transcription factor EB (TFEB), a major regulator of ALP, has emerged as a leading factor in addressing neurodegenerative disease pathology, including Alzheimer's disease (AD), Parkinson's disease (PD), PolyQ diseases, and Amyotrophic lateral sclerosis (ALS). In this review, we delineate the regulation of TFEB expression and its functions in ALP. Dysfunctions of TFEB and its role in the pathogenesis of several neurodegenerative diseases are reviewed. We summarize the protective effects and molecular mechanisms of some TFEB-targeted agonists in neurodegenerative diseases. We also offer our perspective on analyzing the pros and cons of these agonists in the treatment of neurodegenerative diseases from the perspective of drug development. More studies on the regulatory mechanisms of TFEB in other biological processes will aid our understanding of the application of TFEB-targeted therapy in neurodegeneration.

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. The 37-items survey consists of four dimensions of questions relating to VA cannulation and management: knowledge, attitude, practice and self-efficacy. The content validity and face validity of the survey was reviewed by three experienced VA professionals and five dialysis nurses respectively. The internal consistency and construct validity of the survey have been assessed with psychometric tests. RESULTS: There were 23 and 47 nurses, working in the participated community and tertiary hospital dialysis centres respectively, responded to the survey. The internal consistency coefficients indicated acceptable reliability of the instrument (KR-20 coefficient was 0.55 and 0.76 for knowledge and practice domains; Cronbach's α was 0.85 and 0.64 for self-efficacy and attitude domains). In the exploratory factor analysis for attitude and self-efficacy, the instrument could account for 64.0% and 53.0% of the total variance respectively. In the knowledge domain, five out of eight single-select multiple-choice questions were correctly answered by >70% of the participants. Overall, the mean (±SD) of participants' total self-efficacy score was 24.3 (±3.1) over total score of 30. The majority of the participants (82.4%) either agreed or strongly agreed that ultrasound guidance is useful for cannulation. CONCLUSION: This KAP-SE instrument can be used to evaluate knowledge, attitude, practice and self-efficacy of dialysis nurses toward VA management. The participants demonstrated acceptable knowledge level, but with some knowledge gaps identified. It also revealed nurses' good self-efficacy level and welcoming attitude towards adopting ultrasound in VA cannulation among the participants.