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Sample records for successful stent implementation

  1. Clinical outcomes and prognosis of patients with stent fracture after successful drug-eluting stent implantation

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    Kim, In Soo [Cadiovascular center, Chonnam National University Hospital, Gwangju (Korea, Republic of); Han, Jae Bok; Jang, Seong Joo [Dept. of Radiology, Dongshin University, Naju (Korea, Republic of)

    2014-06-15

    Many studies have suggested that in the era of Drug Eluting Stents (DES) are one of the causes of In-Stent Restenosis (ISR) of Stent Fracture (SF). The present study sought to evaluate clinical characteristics of patients with stent fracture after successful DES implantation. The 4,701 patients were selected for analysis who underwent a follow-up coronary angiography irrespective of ischemic symptoms. The overall incidence of SF was 32 patients(male:female=19:13, Av. age 62.44±9.8 year, 0.68%). Fractures of Sirolimus-Eluting Stents (SES), Paclitaxel-Eluting Stents (PES), Biolimus A9-Eluting Stents (BES), Everolimus-Eluting Etents (EES), Endothelial Progenitor Cell Capture Stent (EPC) and Zotarolimus-Eluting Stents (ZES) are accounted for 19 (59.4%), 9 (28.1%), 2 (6.3%), 1 (3.1%), 1 (3.1%) and 0 (0%) respectively. SF developed in the left Anterior Dscending (LAD) artery in 16 patients (50%) and in complex(type B2, C) lesions in 25 patients (69.4%). Ten patients were treated with heterogenous DES, the rest being treated with either homogenous DES (3 patients), plain old balloon angioplasty (3 patients), or conservative medical treatment (17 patients). None of the patients with SF suffered from cardiac death during a follow-up period of 32.9±12.4 months. The overall rate of DES fracture over up to 3.7 years of follow-up was 0.68% with higher incidence in SES than in PES. SF frequently occurred in the LAD artery and in complex lesions. Of the patients with SF, coronary intervention was performed only when the binary restenosis lesion was significant. During the follow-up, patients with SF have continued on combination antiplatelet therapy. There is a very low rate of major adverse cardiac events(post-detection of SF), especially cardiac death associated with SF.

  2. Characteristics of duplex sonographic parameters over time after successful carotid artery stenting.

    Science.gov (United States)

    Kim, Esther S H; Sun, Zhiyuan; Kapadia, Samir; Bajzer, Christopher; Arrigain, Susana; Gornik, Heather L

    2012-08-01

    Carotid duplex sonography is the primary tool for surveillance after carotid artery stenting, but the course of sonographic velocities over time after successful stenting is unclear. The purpose of this study was to describe carotid duplex sonographic velocity parameters after successful carotid artery stenting and to determine the predictors of poststent sonographic velocities. We queried institutional carotid stent and noninvasive vascular laboratory databases for internal carotid artery stents placed between January 2004 and June 2007. We included patients with stenosis of 20% or less on completion angiograms who had carotid duplex sonography within 30 days before and 7 days after stenting. The prestent peak systolic velocity (PSV), end-diastolic velocity (EDV), internal-to-common carotid artery PSV ratio, contralateral internal carotid artery velocities, stent type, open- versus closed-cell stent design, and days of follow-up were tested as potential predictors of poststent velocities. Eighty-two of 498 patients met inclusion criteria. The mean PSV and PSV ratio decreased from 423.6 cm/s and 7.1 before stenting to 98.5 cm/s and 1.3 after stenting (both P PSV, EDV, and PSV ratio) were dependent on prestent ipsilateral and contralateral velocities. The poststent EDV was dependent on the type of stent. The upper range for 0% to 20% stenosis in the stented internal carotid artery was a PSV of 141 cm/s, an EDV of 42 cm/s, and a PSV ratio of 2.1 or lower. With a median follow-up of 1 year, the PSV and PSV ratio remained stable over time in successfully stented carotid arteries. Deviations in sonographic parameters after initial poststent carotid duplex sonography should prompt an investigation for possible in-stent restenosis.

  3. Auditing Marketing Strategy Implementation Success

    OpenAIRE

    Herhausen, Dennis; Egger, Thomas; Oral, Cansu

    2014-01-01

    What makes a marketing strategy implementation successful and how can managers measure this success? To answer these questions, we developed a two-step audit approach. First, managers should measure the implementation success regarding effectiveness, efficiency, performance outcomes, and strategic embeddedness. Second, they should explore the reasons that have led to success or failure by regarding managerial, leadership, and environmental traps. Doing so will also provide corrective action p...

  4. Successful Treatment of Stent Knot in the Proximal Ureter Using Ureteroscopy and Holmium Laser

    Directory of Open Access Journals (Sweden)

    Masters M. Richards

    2011-01-01

    Full Text Available Knotted ureteral stent is rare yet tedious complication that might represent a treatment challenge to the endourologist. Only twelve cases of knotted stent have been reported. Different management options have been reported, including simple traction, ureteroscopy, percutaneous removal, and open surgery. In this paper, we present the successful untying of the knot using ureteroscopy with holmium laser.

  5. MIGS: therapeutic success of combined Xen Gel Stent implantation with cataract surgery.

    Science.gov (United States)

    Hohberger, Bettina; Welge-Lüßen, Ulrich-Christoph; Lämmer, Robert

    2018-01-15

    Glaucoma, a common disease in the elderly population, is frequently coexistent with cataract. While the combination of filtration surgery and cataract surgery is a challenging topic with limited success, minimal invasive glaucoma surgery (MIGS), such as Xen Gel Stents, seems to provide promising results. The aim of this study was to investigate the complete and qualified therapeutic success of Xen Gel Stent implantation with (XenPhaco) and without cataract surgery. One hundred and eleven open-angle glaucoma eyes underwent implantation of Xen45 Gel Stent (AqueSys, Inc.) with or without cataract operation. Complete therapeutic success was defined as target intraocular pressure (IOP) success was defined as target IOP success was achieved in 46.9% of single Xen Gel Stent implantation, whereas 53.3% was reached with combined XenPhaco. Qualified success was seen in 2.5% in the eyes of the single Xen Gel Stent implantation group and in 3.3% of the combined surgery group. Therapeutic failure rate was 49.4% in the stand-alone group vs 46.7% in the combined group. Data were not significantly different for group and subgroup analyses. Complete and qualified therapeutic success is similar for the combination of Xen Gel Stent implantation with and without cataract surgery in open-angle glaucoma patients. MIGS using Xen Gel Stent can be recommended in situations if glaucoma surgery is indicated besides coexisting cataract.

  6. Portal vein stent placement for the treatment of postoperative portal vein stenosis: long-term success and factor associated with stent failure.

    Science.gov (United States)

    Kato, Atsushi; Shimizu, Hiroaki; Ohtsuka, Masayuki; Yoshitomi, Hideyuki; Furukawa, Katsunori; Miyazaki, Masaru

    2017-02-01

    Portal vein stenosis develops due to different causes including postoperative inflammation and oncological processes. However, limited effective therapy is available for portal vein stenosis. The objectives of this study were to evaluate the efficacy of a portal vein stent for portal vein stenosis after hepatobiliary pancreatic surgery and to determine the factors associated with stent patency. From December 2003 to December 2015, portal vein stents were implanted in 29 patients who had portal vein stenosis after hepatobiliary pancreatic surgery. We conducted a retrospective analysis to evaluate the efficacy and safety of portal vein stent placement. Twelve clinical variables were analyzed for their role in stent patency. The symptoms before portal vein stent placements included nine patients with hepatic encephalopathy, six patients with gastrointestinal bleeding, four patients with ascites, and four patients with hyperbilirubinemia. Portal vein thrombosis due to postoperative portal stenosis was found in four patients. Portal vein stent were successfully implanted without any major complications. Of the 21 patients with symptoms, 17 showed improvement, and stent patency was maintained in 22 (76%) patients. The presence of a collateral vein is the only variable related to the development of an occlusion after portal stenting. Portal vein stent were implanted safely and had good long-term patency. This procedure is useful to relieve portal hypertension-related symptoms and to improve the quality of life. Our data strongly suggest that embolization to block blood flow in a collateral vein during portal vein stent placement will improve the patency of the stent.

  7. Successful removal of an internal pancreatic stent that migrated into the bile duct using double-balloon enteroscopy after pancreaticoduodenectomy.

    Science.gov (United States)

    Hirono, Seiko; Kawai, Manabu; Yamashita, Yasunobu; Okada, Ken-Ichi; Miyazawa, Motoki; Ueno, Masaki; Maeda, Yoshimasa; Itonaga, Masahiro; Kitano, Masayuki; Yamaue, Hiroki

    2017-07-08

    Internal stents used during pancreaticoduodenectomy (PD) are generally spontaneously passed through the rectum by defecation. However, we encountered six patients with internal stents that migrated into the bile duct after PD. We herein report the outcomes of these six patients and the usefulness of double-balloon enteroscopy (DBE) for removal of such stents from the bile duct. An internal stent was placed across pancreaticojejunostomy in 416 (68.8%) of 605 consecutive patients undergoing PD between 2005 and 2015. This study evaluated the characteristics and outcomes of the six patients whose internal stent migrated into the bile duct. Migration of an internal stent into the bile duct was found during follow-up computed tomography (CT) in 6 (1.4%) of 416 patients who had an internal stent placed during PD. Three patients developed stent-induced cholangitis, and two had bile duct stones. Excluding one patient whose internal stent spontaneously slipped out and disappeared from the bile duct, all patients underwent successful removal of a stent from the bile duct by a single instance of biliary intervention involving DBE. Removal of a stent from the bile duct using DBE is a feasible and useful procedure that should be considered if an internal stent is detected during follow-up CT after PD.

  8. A severe case of median arcuate ligament syndrome with successful angioplasty and stenting.

    Science.gov (United States)

    Hongsakul, Keerati; Rookkapan, Sorracha; Sungsiri, Jitpreedee; Tubtawee, Teeravut

    2012-01-01

    Median arcuate ligament syndrome (MAL) or celiac axis compression syndrome (CACS) is a rare etiology of chronic abdominal pain. Traditional treatment of this syndrome is surgery. We report a case of median arcuate ligament syndrome with a severe compression of the celiac trunk, which was successfully treated by angioplasty with stenting.

  9. A Severe Case of Median Arcuate Ligament Syndrome with Successful Angioplasty and Stenting

    OpenAIRE

    Keerati Hongsakul; Sorracha Rookkapan; Jitpreedee Sungsiri; Teeravut Tubtawee

    2012-01-01

    Median arcuate ligament syndrome (MAL) or celiac axis compression syndrome (CACS) is a rare etiology of chronic abdominal pain. Traditional treatment of this syndrome is surgery. We report a case of median arcuate ligament syndrome with a severe compression of the celiac trunk, which was successfully treated by angioplasty with stenting.

  10. A Severe Case of Median Arcuate Ligament Syndrome with Successful Angioplasty and Stenting

    Directory of Open Access Journals (Sweden)

    Keerati Hongsakul

    2012-01-01

    Full Text Available Median arcuate ligament syndrome (MAL or celiac axis compression syndrome (CACS is a rare etiology of chronic abdominal pain. Traditional treatment of this syndrome is surgery. We report a case of median arcuate ligament syndrome with a severe compression of the celiac trunk, which was successfully treated by angioplasty with stenting.

  11. Carotid Artery Stenting Successfully Prevents Progressive Stroke Due to Mobile Plaque

    Directory of Open Access Journals (Sweden)

    Masahiro Oomura

    2015-05-01

    Full Text Available We report a case of progressive ischemic stroke due to a mobile plaque, in which carotid artery stenting successfully prevented further infarctions. A 78-year-old man developed acute multiple infarcts in the right hemisphere, and a duplex ultrasound showed a mobile plaque involving the bifurcation of the left common carotid artery. Maximal medical therapy failed to prevent further infarcts, and the number of infarcts increased with his neurological deterioration. Our present case suggests that the deployment of a closed-cell stent is effective to prevent the progression of the ischemic stroke due to the mobile plaque.

  12. Critical success factors in ERP implementation

    Directory of Open Access Journals (Sweden)

    Blerta Abazi Chaushi

    2016-11-01

    Full Text Available This study conducts state of the art literature review of critical success factors for enterprise resource planning systems implementation success. Since research on critical success factors for ERP implementation success is very rare and fragmented, this study provides a more comprehensive list of ten factors that companies that have adopted and struggle with the implementation, as well as companies who are in the process of considering implementation of ERP system can easily adopt and follow. The main contribution of this paper is that these ten new critical success factors are identifi ed through a thorough analysis of 22 selected research papers and is more comprehensive and straightforwardly employable for use.

  13. Successful endovascular treatment of a hemodialysis graft pseudoaneurysm by covered stent and direct percutaneous thrombin injection.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-07-25

    Vascular access for hemodialysis remains a challenge for nephrologists, vascular surgeons, and interventional radiologists alike. Arteriovenous fistula and synthetic grafts remain the access of choice for long-term hemodialysis; however, they are subject to complications from infection and repeated needle cannulation. Pseudoaneurysms are an increasingly recognized adverse event. At present, there are many minimally invasive methods to repair these wall defects. We present a graft pseudoaneurysm, which required a combination of endovascular stent graft placement and percutaneous thrombin injection for successful occlusion.

  14. Safety and Technical Success of Percutaneous Left Main Coronary Artery Stenting

    Science.gov (United States)

    Ali, Liaqat; Malik, Shahid Nawaz; Khalid, Abdullah Bin; Sultan, Mehboob; Sadiq, Nadeem

    2014-01-01

    Objective: Critical stenosis of left main coronary artery (LMCA) has always remained a challenge for interventional cardiologists. Conventionally Coronary Artery Bypass Grafting (CABG) is done for these patients but recently Percutaneous Coronary Intervention (PCI) is also being tried more frequently, but data of PCI is scarce in this regard. Our objective was to determine the safety and technical success rate of percutaneous left main coronary artery stenting. Methods: This was 12 month follow up study conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad from 11th Jan 2012 to 11th Jan 2013. All symptomatic patients who underwent coronary angiogram at PIMS and were found to have either isolated LMCA disease or coexisting osteal Left Anterior Descending (LAD) artery disease were potentially eligible for the study. Patients who had previous surgical treatment for coronary artery disease and those with renal dysfunction requiring dialysis were excluded. Patients were counselled in detail regarding the pros and cons of PCI versus CABG.Those who opted for PCI were included in the study. All these patients were treated with percutaneous left main coronary artery stenting with or without osteal LAD stenting. Results: Seventy two patients had LMCA disease during angiogram. Fifteen patients opted for CABG. Four patients did not meet the inclusion criteria, whereas 53 patients were finally enrolled. Mean age of patients were 55.45±10.275 years. Twenty nine patients were with acute coronary syndrome and 22 presented with unstable angina.PCI with stenting was technically successful in all patients. One patient died three months after PCI, there was no other mortality. Conclusion: Our study showed that Percutaneous Coronary Intervention (PCI) to LMS has good technical success rate; the safety of the procedure is also acceptable. PMID:25097507

  15. Successful Enterprise System Re-Implementation

    DEFF Research Database (Denmark)

    Svejvig, Per

    2017-01-01

    Achieving success in enterprise systems (ES) implementations is challenging. The success rate is not high in view of the sums invested by many organizations in these companywide systems. The literature is charged with reasons for unsuccessful implementations, such as a lack of top management...

  16. Successful Coronary Stent Retrieval from the Saphenous Vein Graft to Right Coronary Artery

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    Mustafa Aydin

    2009-01-01

    Full Text Available Stent dislodgement and migration is a rare but serious complication of stent usage. For extraction of unexpanded stents different techniques have been described previously. We describe a case which used small baloon catheter for retrieval of a stent from the SVG-RCA.

  17. Ureteral stenting can be a negative predictor for successful outcome following shock wave lithotripsy in patients with ureteral stones

    Directory of Open Access Journals (Sweden)

    Dong Hyuk Kang

    2016-11-01

    Full Text Available Purpose: To evaluate ureteral stenting as a negative predictive factor influencing ureteral stone clearance and to estimate the probability of one-session success in shock wave lithotripsy (SWL patients with a ureteral stone. Materials and Methods: We retrospectively reviewed the medical records of 1,651 patients who underwent their first SWL. Among these patients, 680 had a ureteral stone measuring 4–20 mm and were thus eligible for our study. The 57 patients who underwent ureteral stenting during SWL were identified. Maximal stone length (MSL, mean stone density (MSD, skin-to-stone distance (SSD, and stone heterogeneity index (SHI were determined by pre-SWL noncontrast computed tomography. Results: After propensity score matching, 399 patients were extracted from the total patient cohort. There were no significant differences between stenting and stentless groups after matching, except for a higher one-session success rate in the stentless group (78.6% vs. 49.1%, p=0.026. In multivariate analysis, shorter MSL, lower MSD, higher SHI, and absence of a stent were positive predictors for one-session success in patients who underwent SWL. Using cutoff values of MSL and MSD obtained from receiver operator curve analysis, in patients with a lower MSD (≤784 HU, the success rate was lower in those with a stent (61.1% than in those without (83.5% (p=0.001. However, in patients with a higher MSL (>10 mm, the success rate was lower in those with a stent (23.6% than in those without (52.2% (p=0.002. Conclusions: Ureteral stenting during SWL was a negative predictor of one-session success in patients with a ureteral stone.

  18. Successful outcome of sphincterotomy and 7 French pigtail stent insertion in the management of post-cholecystectomy bile leaks.

    LENUS (Irish Health Repository)

    Donnellan, Fergal

    2009-06-01

    BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used to manage post-cholecystectomy bile leaks. However, the best endoscopic intervention remains controversial. We investigated the success of a 7 French double pigtail stent following sphincterotomy in the management of such bile leaks. METHODS: Between July 1998 and June 2008, 48 patients were referred for ERCP for presumed post-cholecystectomy bile leaks. Leaks were confirmed at ERCP and managed by a combination of sphincterotomy and stent insertion unless contraindicated. RESULTS: Bile duct cannulation was successful in 44 (91.7%) patients. A leak of the cystic duct was demonstrated in 19 (43.2%) patients, the duct of Luschka in 11 (25.0%), and the common hepatic duct in 5 (11.4%). Complete transection of the common bile duct occurred in 4 patients. The remaining patients had no cholangiographic evidence of a leak. Sphincterotomy was performed in 34 patients. A 7 French double pigtail plastic stent was placed in all 35 patients with cholangiographic evidence of a bile leak. No bile leaks were demonstrated at a follow-up of 8-16 weeks and all stents were removed successfully. CONCLUSION: The combination of sphincterotomy and insertion of a 7 French double pigtail stent results in excellent outcomes in the management of post-cholecystectomy bile leaks.

  19. Successful Implementation of Clinical Information Technology

    Science.gov (United States)

    Hill, V.; Bruner, K.; Maciaz, G.; Saucedo, L.; Catzoela, L.; Ramirez, R.; Jacobs, W.J.; Nguyen, P.; Patel, L.; Webster, S.L.

    2015-01-01

    Summary Objectives To identify and describe the most critical strategic and operational contributors to the successful implementation of clinical information technologies, as deployed within a moderate sized system of U.S. community hospitals. Background and Setting CHRISTUS Health is a multi-state system comprised of more than 350 services and 60 hospitals with over 9 000 physicians. The Santa Rosa region of CHRISTUS Health, located in greater San Antonio, Texas is comprised of three adult community hospital facilities and one Children’s hospital each with bed capacities of 142–180. Computerized Patient Order Entry (CPOE) was first implemented in 2012 within a complex market environment. The Santa Rosa region has 2 417 credentialed physicians and 263 mid-level allied health professionals. Methods This report focuses on the seven most valuable strategies deployed by the Health Informatics team in a large four hospital CHRISTUS region to achieve strong CPOE adoption and critical success lessons learned. The findings are placed within the context of the literature describing best practices in health information technology implementation. Results While the elements described involved discrete de novo process generation to support implementation and operations, collectively they represent the creation of a new customer-centric service culture in our Health Informatics team, which has served as a foundation for ensuring strong clinical information technology adoption beyond CPOE. Conclusion The seven success factors described are not limited in their value to and impact on CPOE adoption, but generalize to – and can advance success in – varied other clinical information technology implementations across diverse hospitals. A number of these factors are supported by reports in the literature of other institutions’ successful implementations of CPOE and other clinical information technologies, and while not prescriptive to other settings, may be adapted to yield

  20. Formulation: Implementing Successful Public Montessori Programs.

    Science.gov (United States)

    Epstein, Paul

    1994-01-01

    Draws on the experiences of the OEkos Foundation for Education in implementing successful Montessori programs in 12 public school districts to present essential elements and key decisions needed for establishing such programs. Includes a schematic for the Decision Tree developed by the foundation. (ETB)

  1. Barriers To Successful Implementation of STEM Education

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    James A. Ejiwale

    2013-05-01

    Full Text Available The implementation of STEM education in schools across the globe is to prepare the future workforce with strong scientific and mathematical backgrounds to enhance skills development across STEM disciplines. However, for STEM education to achieve its goals and objectives, addressing the barriers to STEM education should start by fixing the problems at the elementary, junior and senior high school levels; the grassroots and potential feeders to colleges and universities. Since many nations including the United States of America is in dire need of the workforce with adequate preparation in science and mathematics to help address the nation’s economy that is in shambles, the barriers to its successful implementation should be identified and addressed. In this paper, (a the definition of STEM education and (b some barriers to successful implementation of STEM education are discussed and elaborated.

  2. Clinical pharmacogenetics implementation: approaches, successes, and challenges.

    Science.gov (United States)

    Weitzel, Kristin W; Elsey, Amanda R; Langaee, Taimour Y; Burkley, Benjamin; Nessl, David R; Obeng, Aniwaa Owusu; Staley, Benjamin J; Dong, Hui-Jia; Allan, Robert W; Liu, J Felix; Cooper-Dehoff, Rhonda M; Anderson, R David; Conlon, Michael; Clare-Salzler, Michael J; Nelson, David R; Johnson, Julie A

    2014-03-01

    Current challenges exist to widespread clinical implementation of genomic medicine and pharmacogenetics. The University of Florida (UF) Health Personalized Medicine Program (PMP) is a pharmacist-led, multidisciplinary initiative created in 2011 within the UF Clinical Translational Science Institute. Initial efforts focused on pharmacogenetics, with long-term goals to include expansion to disease-risk prediction and disease stratification. Herein we describe the processes for development of the program, the challenges that were encountered and the clinical acceptance by clinicians of the genomic medicine implementation. The initial clinical implementation of the UF PMP began in June 2012 and targeted clopidogrel use and the CYP2C19 genotype in patients undergoing left heart catheterization and percutaneous-coronary intervention (PCI). After 1 year, 1,097 patients undergoing left heart catheterization were genotyped preemptively, and 291 of those underwent subsequent PCI. Genotype results were reported to the medical record for 100% of genotyped patients. Eighty patients who underwent PCI had an actionable genotype, with drug therapy changes implemented in 56 individuals. Average turnaround time from blood draw to genotype result entry in the medical record was 3.5 business days. Seven different third party payors, including Medicare, reimbursed for the test during the first month of billing, with an 85% reimbursement rate for outpatient claims that were submitted in the first month. These data highlight multiple levels of success in clinical implementation of genomic medicine. © 2014 Wiley Periodicals, Inc.

  3. Endolymphatic Thoracic Duct Stent-Graft Reconstruction for Chylothorax: Approach, Technical Success, Safety, and Short-term Outcomes.

    Science.gov (United States)

    Srinivasa, Rajiv N; Chick, Jeffrey Forris Beecham; Hage, Anthony N; Gemmete, Joseph J; Murrey, Douglas C; Srinivasa, Ravi N

    2017-12-05

    To report approach, technical success, safety, and short-term outcomes of thoracic duct stent-graft reconstruction for the treatment of chylothorax. Two patients, 1 (50%) male and 1 (50%) female, with mean age of 38 years (range: 16-59 years) underwent endolymphatic thoracic duct stent-graft reconstruction between September 2016 and July 2017. Patients had radiographic left-sided chylothoraces (n = 2) from idiopathic causes (n = 1) and heart transplantation (n = 1). In both (100%) patients, antegrade lymphatic access was used to opacify the thoracic duct after which retrograde access was used for thoracic duct stent-graft placement. Pelvic lymphangiography technical success, antegrade cisterna chyli cannulation technical success, thoracic duct opacification technical success, retrograde thoracic duct access technical success, thoracic duct stent-graft reconstruction technical success, ethiodized oil volume, contrast volume, estimated blood loss, procedure time, fluoroscopy time, radiation dose, clinical success, complications, deaths, and follow-up were recorded. Pelvic lymphangiography, antegrade cisterna chyli cannulation, thoracic duct opacification, retrograde thoracic duct access, and thoracic duct stent-graft reconstruction were technically successful in both (100%) patients. Mean ethiodized oil volume was 8 mL (range: 5-10 mL). Mean contrast volume was 13 mL (range: 5-20 mL). Mean estimated blood loss was 13 mL (range: 10-15 mL). Mean fluoroscopy time was 50.4 min (range: 31.2-69.7 min). Mean dose area product and reference air kerma were 954.4 μGmy 2 (range: 701-1,208 μGmy 2 ) and 83.5 mGy (range: 59-108 mGy), respectively. Chylothorax resolved in both (100%) patients. There were no minor or major complications directly related to the procedure. Thoracic duct stent-graft reconstruction may be a technically successful and safe alternative to thoracic duct embolization, disruption, and surgical ligation for the treatment of chylothorax

  4. Successful Endobronchial stenting for bronchial compression from a massive thoracic aortic aneurysm

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    David Comer

    2010-06-01

    Full Text Available A case of bronchial occlusion caused by a thoracic aortic aneurysm and the relief of this obstruction by the implantation of expandable metallic stents is described. Stent deployment provided an immediate improvement in lung ventilation and chest radiograph appearances. Stent insertion was uncomplicated, but weaning from mechanical ventilation was unsuccessful and the patient died from a ventilator-associated pneumonia, unrelated to the procedure. Endobronchial stenting should be considered as a non-invasive therapy for the treatment of bronchial obstruction, with respiratory compromise, caused by a thoracic aortic aneurysm when vascular surgery is not an option. The medium to long term survival of this patient group is poor. This can be attributed to complications related to the stent and also to the poor performance status of these patients.

  5. Success rate of placement of a bicanalicular stent for partial nasolacrimal obstruction in adults under local, monitored anesthesia care and general anesthesia

    Directory of Open Access Journals (Sweden)

    David I. Silbert, MD, FAAP

    2017-07-01

    Conclusion: Silicone intubation of the NLD in adults is rarely done due to need for general anesthesia. The Lacriflow stent can be successfully placed in the office under local anesthesia offering a new approach for tearing in adults.

  6. Success Factors of Business Process Management Systems Implementation

    NARCIS (Netherlands)

    J.P.P. Ravesteijn; Johan Versendaal

    2007-01-01

    In this research (critical) success factors for Business Process Management Systems implementation are identified and qualitatively validated. Furthermore a list of critical success factors is constructed. Based on the identified factors a BPMS implementation approach is suggested. Future research

  7. Critical Success Factors for IFRS Implementation

    DEFF Research Database (Denmark)

    Lønne, Henrik; Holm, Claus; Schøler, Finn

    n this paper we compare the implementation process to integrate IFRS in Ireland, Denmark and New Zealand and derive the critical succesfactors in capability to implement IFRS. The implementation phase is divided into three phases before, during and after the implementation process. The description...... is based of five basic elements that can be affected. For developing countries - but also more developed countries, e.g. the new countries in the EU - a description of these above mentioned elements is valuable information, if they are going to implement the IFRS standards. We find that every country has...... different challenges and problems to be aware of. Covering those characteristics is therefore a vital part of the planning process before the IFRS implementation. It is also beneficial to have companies as early adopters before the implementation. As well before as during the implementation process...

  8. Stenting in the treatment of chronic mesenteric ischemia. Technical and clinical success rates; Chronische mesenteriale Ischaemie. Technische und klinische Erfolgsrate der perkutanen Stentangioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Heiss, P.; Zorger, N.; Kaempfe, I.; Jung, E.M.; Paetzel, C.; Feuerbach, S.; Herold, T. [Inst. fuer Roentgendiagnostik, Univ. Regensburg (Germany); Pfister, K. [Klinik und Poliklinik fuer Chirurgie, Univ. Regensburg (Germany)

    2008-10-15

    Purpose: to evaluate the technical and clinical success rates of percutaneous stent revascularization in the treatment of chronic mesenteric ischemia (CMI). Patients and methods: 17 patients (12 female) with typical symptoms of CMI were treated by percutaneous stent placement for stenoses of the splanchnic arteries (celiac trunk; superior mesenteric artery, SMA; inferior mesenteric artery, IMA). The primary and secondary technical success, primary and secondary clinical success, and the long-term clinical outcome were determined. Results: a total of 24 stents were implanted in 21 splanchnic arteries (12 stents in the celiac trunk, 11 in the SMA and 1 in the IMA). The primary technical success rate was 91% (19/21 arteries), the secondary technical success rate was 95% (21/22 arteries). Clinical follow-up was available for 16 patients. The primary clinical success rate was 81% (13/16 patients). Following two secondary interventions, the secondary clinical success rate was 94% (15/16 patients). Long-term clinical success was achieved in 15 of 16 patients (94%) with a mean follow-up of 26 months. One patient died within 30 days of the intervention and two patients demonstrated major complications (1 dissection, 1 stent dislocation). None of the patients required surgical revascularization and none of the patients died due to recurrent mesenteric ischemia. (orig.)

  9. Implementing Successful Geoscience Education and Outreach Efforts

    Science.gov (United States)

    Braile, L. W.

    2004-12-01

    Successful geoscience Education and Outreach (E&O) efforts associated with a research program benefit from effective planning and a commitment by scientists/researchers to become more knowledgeable about and involved in education. Several suggested strategies have evolved based on experience in Earth science E&O with K-16 educators and students during the past 10 years. E&O programs and materials should be developed at appropriate levels ("start from where they're at") and utilize information, skills and topics that are most relevant to students and teachers. Hands-on and inquiry-based activities that teach or reinforce fundamental science understanding and skills, while introducing new topics, results and discoveries, are particularly effective. It is useful to design materials that can provide for a range of time commitment, level of technical skills, and effort, so that introductory to in-depth curriculum units can be implemented. Use of the Internet and working with teachers can be effective methods for dissemination and taking advantage of a "multiplying factor". Obtaining feedback and evaluation of the programs and developed materials, and connecting the materials to national or state education standards are also highly recommended. Most importantly, scientists should become more involved in the science education community. Attending and presenting papers at appropriate science education sessions or workshops, or state or national science teacher meetings (the annual National Science Teachers Association convention is an excellent place to start) can be a significant educational experience for the scientist/researcher. Effective geoscience E&O programs have significant potential for enhancing K-16 education and scientific literacy, and can help attract students to the sciences. Perhaps surprisingly, these efforts have substantial positive impact on the scientist/researcher as well.

  10. Decentralisation in developing countries: preconditions for successful implementation

    Directory of Open Access Journals (Sweden)

    Yasin Olum

    2014-07-01

    Full Text Available Decentralisation has been implemented and is being implemented in many developing countries without much success. Although several unique factors inhibit the implementation of decentralisation in individual countries, the paper argues that there are six pre-conditions that these countries should fulfill before decentralisation can be successfully implemented. These preconditions are: institutional mechanisms; creation of spaces for participation; political will and civil will; capacity development at the local level; careful implementation; and democratic governance.

  11. Implementing successful strategic plans: a simple formula.

    Science.gov (United States)

    Blondeau, Whitney; Blondeau, Benoit

    2015-01-01

    Strategic planning is a process. One way to think of strategic planning is to envision its development and design as a framework that will help your hospital navigate through internal and external changing environments over time. Although the process of strategic planning can feel daunting, following a simple formula involving five steps using the mnemonic B.E.G.I.N. (Begin, Evaluate, Goals & Objectives, Integration, and Next steps) will help the planning process feel more manageable, and lead you to greater success.

  12. Model of key success factors for Business Intelligence implementation

    Directory of Open Access Journals (Sweden)

    Peter Mesaros

    2016-07-01

    Full Text Available New progressive technologies recorded growth in every area. Information-communication technologies facilitate the exchange of information and it facilitates management of everyday activities in enterprises. Specific modules (such as Business Intelligence facilitate decision-making. Several studies have demonstrated the positive impact of Business Intelligence to decision-making. The first step is to put in place the enterprise. The implementation process is influenced by many factors. This article discusses the issue of key success factors affecting to successful implementation of Business Intelligence. The article describes the key success factors for successful implementation and use of Business Intelligence based on multiple studies. The main objective of this study is to verify the effects and dependence of selected factors and proposes a model of key success factors for successful implementation of Business Intelligence. Key success factors and the proposed model are studied in Slovak enterprises.

  13. The Road of ERP Success: A Framework Model for Successful ERP Implementation

    Directory of Open Access Journals (Sweden)

    Sevenpri Candra

    2011-11-01

    Full Text Available To compete with nowadays business is to implement technology and align it into their business strategy. One of technology that commonly implement is Enterprise Resource Planning (ERP. This research will examined what are critical success factor of ERP and the impact of their business outcomes. A framework model for ERP Implementation success is constructs from several research or previous study in Implementation ERP. This study will extends in the research field of successful implementation ERP and implication factor for business practice to have more knowledge in term of implementation ERP and their business strategy. 

  14. Stenting of bifurcation lesions: a rational approach.

    Science.gov (United States)

    Lefèvre, T; Louvard, Y; Morice, M C; Loubeyre, C; Piéchaud, J F; Dumas, P

    2001-12-01

    The occurrence of stenosis in or next to coronary bifurcations is relatively frequent and generally underestimated. In our experience, such lesions account for 15%-18% of all percutaneous coronary intervention > (PCI). The main reasons for this are (1) the coronary arteries are like the branches of a tree with many ramifications and (2) because of axial plaque redistribution, especially after stent implantation, PCI of lesions located next to a coronary bifurcation almost inevitably cause plaque shifting in the side branches. PCI treatment of coronary bifurcation lesions remains challenging. Balloon dilatation treatment used to be associated with less than satisfactory immediate results, a high complication rate, and an unacceptable restenosis rate. The kissing balloon technique resulted in improved, though suboptimal, outcomes. Several approaches were then suggested, like rotative or directional atherectomy, but these techniques did not translate into significantly enhanced results. With the advent of second generation stents, in 1996, the authors decided to set up an observational study on coronary bifurcation stenting combined with a bench test of the various stents available. Over the last 5 years, techniques, strategies, and stent design have improved. As a result, the authors have been able to define a rational approach to coronary bifurcation stenting. This bench study analyzed the behavior of stents and allowed stents to be discarded that are not compatible with the treatment of coronary bifurcations. Most importantly, this study revealed that stent deformation due to the opening of a strut is a constant phenomenon that must be corrected by kissing balloon inflation. Moreover, it was observed that the opening of a stent strut into a side branch could permit the stenting, at least partly, of the side branch ostium. This resulted in the provocative concept of "stenting both branches with a single stent." Therefore, a simple approach is currently implemented

  15. Preparing for successful surgery: an implementation study.

    Science.gov (United States)

    Diaz, Manuel; Larsen, Brad

    2005-01-01

    To evaluate the implementation of a mind-body program for surgical patients in a community hospital, assessing patient participation, patient perception, and program impact on anxiety, pain, and quality of sleep during the perioperative period. Two hundred thirty patients having total hip replacement, total knee replacement, hysterectomy, or colectomy participated in this investigation. One hundred fifteen patients were assigned to the control group before the start of the mind-body program and received routine care. The subsequent 115 patients were assigned to the intervention group and were given an audio CD (containing guided imagery, affirmations, and relaxation music) and a brochure three to seven days before surgery. The brochure recommended that patients listen to the CD twice a day before and after surgery. Anxiety, pain at rest, pain with movement, quality of sleep, and program participation were assessed for the first two postoperative days, and patient perception of the program was assessed at the end of the two days. Anxiety scores were lower in the intervention group on the evening of surgery. Despite a trend toward lower pain scores in the intervention group, no difference between the intervention and control groups reached statistical significance, including quality of sleep. Of patients in the intervention group, 74% listened to the CD at least once after surgery, and 37% listened to the program three or more times. Most patients who used the CD at least once rated it as helpful, and 87% said they would use it for future operations. Patient response to a perioperative mind-body program was favorable. Most patients listened to the program CD at least once, and a third used the CD repeatedly, as recommended. The majority of patients who used the CD felt it had been helpful and would use it again. Program participants experienced less anxiety on the night of surgery.

  16. Implementing E-Government in Ireland: A Roadmap for Success

    OpenAIRE

    William Golden; Martin Hughes; Murray Scott

    2003-01-01

    E-government provides unparalleled opportunities for governments to streamline processes and improve customer service. As a result, achieving successful citizen centric e-government has become a key concern for many governments. This paper analyses the Irish Government’s evolutionary path to the provision of successful e-Government. The success factors and stages of evolution of e-government are identified and a detailed examination of how the Irish Government successfully implemented its e...

  17. Successful Implantation of a Coronary Stent Graft in a Peripheral Vessel

    Directory of Open Access Journals (Sweden)

    Alexander Hess

    2015-01-01

    Full Text Available Peripheral artery disease (PAD is a complex, often underdiagnosed illness with rising prevalence in western world countries. During the past decade there has been a rapid advance especially in the field of endovascular treatment of PAD. Here we present for the first time a case reporting on the placement of coronary stent graft in a peripheral vessel for the management of a peripheral side branch perforation. Interventional angiologists or radiologists may consider such an option for complication management after injury of smaller vessels during peripheral percutaneous interventions. Further specialization and novel options of complication management as described in our case may shift the treatment from surgical to even more endovascular treatment procedures in the future.

  18. Implementing a Dynamic Street-Children's Program: Successes and ...

    African Journals Online (AJOL)

    Implementing a Dynamic Street-Children's Program: Successes and Challenges. ... the influence that early childhood dynamics of parentchild, parent-parent and ... they can influence the child's behaviour in both positive and negative ways.

  19. Advanced Manufacturing Technology Implementation Process in SME: Critical Success Factors

    Directory of Open Access Journals (Sweden)

    Jani Rahardjo

    2010-01-01

    Full Text Available The aim of this paper is to present critical factors that constitute a successful implementation of the Advanced Manufacturing Technologies (AMT in Small Medium Enterprise (SME. Many large companies have applied AMT and the applications have shown significant results in this global market era. Conveniently, these phenomenons are also engaged to Small Medium Enterprises (SME that of high demands on performing high quality product, fast delivery, reliable and more flexible. The implementation of AMT follow several processes namely pre installation, installation, improvement and mature. In order to guarantee the succesfull of running these processes, one should consider the Critical Success Factors (CSF. We conducted a survey to 125 SMEs that have implemented AMT, and found that the CSF for each process are moderately different. Good leadership is the main critical success factor for preparing and installation of the AMT. Once the AMT started or installed and arrived at growth stage, the financial availability factor turns into a critical success factor in the AMT implementation. In, mature stage, the support and commitment of top management becomes an important factor for gaining successful implementation. By means of factor analysis, we could point out that strategic factors are the main factors in pre-installation and installation stage. Finally, in the growth stage and mature stage, both tactical and strategic factors are the important factors in the successful of AMT implementation

  20. Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience

    Science.gov (United States)

    Salsamendi, Jason; Pereira, Keith; Baker, Reginald; Bhatia, Shivank S; Narayanan, Govindarajan

    2015-01-01

    Transplant renal artery stenosis (TRAS) is a vascular complication frequently seen because of increase in the number of renal transplantations. Early diagnosis and management is essential to optimize a proper graft function. Currently, the endovascular treatment of TRAS using angioplasty and/or stenting is considered the treatment of choice with the advantage that it does not preclude subsequent surgical correction. Treatment of TRAS with the use of stents, particularly in tortuous transplant renal anatomy presents a unique challenge to an interventional radiologist. In this study, we present three cases from our practice highlighting the use of a balloon-expandable Multi-Link RX Ultra coronary stent system (Abbott Laboratories, Abbott Park, Illinois, USA) for treating high grade focal stenosis along very tortuous renal arterial segments. Cobalt–Chromium alloy stent scaffold provides excellent radial force, whereas the flexible stent design conforms to the vessel course allowing for optimal stent alignment. PMID:26629289

  1. Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience.

    Science.gov (United States)

    Salsamendi, Jason; Pereira, Keith; Baker, Reginald; Bhatia, Shivank S; Narayanan, Govindarajan

    2015-10-01

    Transplant renal artery stenosis (TRAS) is a vascular complication frequently seen because of increase in the number of renal transplantations. Early diagnosis and management is essential to optimize a proper graft function. Currently, the endovascular treatment of TRAS using angioplasty and/or stenting is considered the treatment of choice with the advantage that it does not preclude subsequent surgical correction. Treatment of TRAS with the use of stents, particularly in tortuous transplant renal anatomy presents a unique challenge to an interventional radiologist. In this study, we present three cases from our practice highlighting the use of a balloon-expandable Multi-Link RX Ultra coronary stent system (Abbott Laboratories, Abbott Park, Illinois, USA) for treating high grade focal stenosis along very tortuous renal arterial segments. Cobalt-Chromium alloy stent scaffold provides excellent radial force, whereas the flexible stent design conforms to the vessel course allowing for optimal stent alignment.

  2. Surveying the critical success factors of BPM-systems implementation.

    NARCIS (Netherlands)

    Ravesteyn, P.; Batenburg, R.

    2010-01-01

    Purpose – The purpose of this paper is to explore if there is a common ground for the definition of business process management (BPM) and BPM-systems, as well as the critical success factors (CSFs) for BPM-system implementation. A BPM-system implementation framework is validated that classifies the

  3. Implementation of Balanced Scorecard and the Successful of Implementation Strategy: a Review

    OpenAIRE

    Ellitan, Lena; Anatan, Lina

    2008-01-01

    The balanced scorecard is a formal management technique for development, implementation and management of business strategy. It is difficult to ascertain the success of the technique as most of the literature on its implementation is put out by those with a vested interest in its success as a commercial product. Much has been written about barriers to strategy implementation but not specifically to the implementation of balanced scorecard. This paper presents a review of the factors that cont...

  4. Successful iliac vein and inferior vena cava stenting ameliorates venous claudication and improves venous outflow, calf muscle pump function, and clinical status in post-thrombotic syndrome.

    Science.gov (United States)

    Delis, Konstantinos T; Bjarnason, Haraldur; Wennberg, Paul W; Rooke, Thom W; Gloviczki, Peter

    2007-01-01

    Stent therapy has been proposed as an effective treatment of chronic iliofemoral (I-F) and inferior vena cava (IVC) thrombosis. The purpose of this study was to determine the effects of technically successful stenting in consecutive patients with advanced CVD (CEAP3-6 +/- venous claudication) for chronic obliteration of the I-F (+/-IVC) trunks, on the venous hemodynamics of the limb, the walking capacity, and the clinical status of CVD. These patients had previously failed to improve with conservative treatment entailing compression and/or wound care for at least 12 months. The presence of venous claudication was assessed by > or =3 independent examiners. The CEAP clinical classification was used to determine the severity of CVD. Outflow obstruction [Outflow Fraction at 1- and 4-second (OF1 and OF4) in %], venous reflux [Venous Filling Index (VFI) in mL/100 mL/s], calf muscle pump function [Ejection Fraction (EF) in %] and hypertension [Residual Venous Fraction (RVF) in %], were examined before and after successful venous stenting in 16 patients (23 limbs), 6 females, 10 males, median age 42 years; range, 31-77 yearas, left/right limbs 14/9, using strain gauge plethysmography; 7/16 of these had thrombosis extending to the IVC. Contralateral limbs to those stented without prior I-F +/- IVC thrombosis, nor infrainguinal clots on duplex, were used as control limbs (n = 9). Excluded were patients with stent occlusion or stenoses, peripheral arterial disease (ABI calf muscle pump function (EF), worse CEAP clinical class, and increased RVF (all, P calf muscle pump function (EF) had both improved (P calf muscle pump function (EF), and RVF of the stented limbs did not differ significantly from those of the control; significantly worse (P calf muscle pump function, compounded by a significant clinical improvement of CVD. The significant increase in the amount of venous reflux of the stented limbs indicates that elastic or inelastic compression support of the successfully

  5. Implementation of critical success factors in construction research ...

    African Journals Online (AJOL)

    Construction research and development (R&D) process has a number of issues that affect its success. These issues imply that Critical Success Factors (CSFs) of construction R&D process are not properly addressed. Not knowing CSFs could lead to not implementing them and not paying proper attention for them. The study ...

  6. Successful Implementation of New Technology Using an Interdepartmental Collaborative Approach.

    Science.gov (United States)

    Tetef, Sue

    2017-06-01

    The implementation of new technology is vital to the success of health care organizations. New technology provides health care organizations an opportunity to obtain new patients, increase revenue, and stay competitive. In 2014, a union hospital in Southern California successfully implemented a bronchial thermoplasty program. To implement this new technology, the administration created a strategy, identified financial risks and benefits, created an implementation model, established a plan based on Lewin's change model and Roger's diffusion of innovations theory, and recognized adult learning needs through an interdepartmental, open communication, and collaborative approach. In addition, the implementation of the bronchial thermoplasty program allowed the organization to meet the goals, mission, and vision of the organization, which is key to remaining viable and marketable. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  7. Cobalt chromium stents versus stainless steel stents in diabetic patients

    Directory of Open Access Journals (Sweden)

    Mahmoud Ahmed Tantawy

    2014-03-01

    Conclusions: We concluded that no significant statistical difference was found between the two stents (cobalt-chromium alloy bare metal stent versus conventional bare metal stainless steel stent in diabetic patients regarding (initial procedural success, in-hospital complications, the incidence of ISR at follow up, event-free survival at follow up.

  8. Early angiographic changes of intra-aneurysmal flow after flow-diverter stent treatment are not predictive of therapeutic success.

    Science.gov (United States)

    Labeyrie, Paul-Emile; Gory, Benjamin; Sadeh-Gonike, Udi; Huguet, Nazyed; Sivan-Hoffmann, Rotem; Riva, Roberto; Courthéoux, Patrick; Turjman, Francis

    2016-12-01

    Flow-diverter stents (FDS) are new devices for the endovascular treatment of intracranial aneurysms (IAs) promoting progressive aneurysmal thrombosis. To date, the delay of aneurysmal exclusion remains unclear. We evaluated the correlation between angiographic changes in the first 24 hours and 12-month occlusion in aneurysms treated with FDS. We retrospectively analyzed the intra-aneurysmal flow by evaluating the in-flow and out-flow delays on preoperative, immediate postoperative, 24-hour and 12-month follow-up angiography. Dichotomy of in-flow and out-flow within the aneurysm was considered as the time of contrast filling and time of contrast washing relatively to the parent artery. The delay times were compared and correlated with the therapeutic success of FDS at 12 months of follow-up. Out of 14 treated IAs, in 13 consecutive patients, n = 10 (71%) aneurysms showed complete occlusion at 12 months. Between immediate postoperative and 24-hour control, 10 aneurysms (71%) demonstrated in-flow modification, with eight increasing, two decreasing and four having no change. There were no statistical differences in therapeutic success in relation to the different flow-related profiles of intra-aneurysmal flux.Out-flow modifications were found in 11 aneurysms (79%) between immediate postoperative and 24-hour control, with five increasing, six decreasing and three having no change. Similar to the in-flow changes, there were no statistical differences in therapeutic success relative to the flow-related profiles. Early angiographic changes after FDS placement are very frequent, but are not correlated with the 12-month technical success of flow-diversion techniques. © The Author(s) 2016.

  9. Successful Treatment of Iatrogenic External Iliac Artery Perforation With Covered Stent: Case Report and Review of the Literature.

    Science.gov (United States)

    Awan, Muhammad Umer; Omar, Bassam; Qureshi, Ghazanfar; Awan, Ghulam Mustafa

    2017-10-01

    Retroperitoneal hemorrhage from iliac artery injury is a potentially serious complication of vascular interventional procedures leading to hemorrhagic shock and death if not diagnosed early and treated promptly. We report a 70-year-old male admitted to our facility with non-ST-elevation myocardial infarction, whose heart catheterization revealed left anterior descending artery (LAD) with 80% proximal, 95% mid and 100% distal disease. The left circumflex and right coronary arteries were 100% occluded proximally and received collaterals from the LAD. The patient declined coronary artery bypass surgery; therefore, the decision was made to perform high-risk percutaneous coronary intervention (PCI) of the LAD with Impella left ventricular assist device support. Left femoral artery angiogram revealed severely tortuous and calcified aorta, left external iliac and left common iliac arteries, and was accessed with 14-inch Impella sheath. He developed groin pain with mild hypotension thought to be due to sedation, which responded to intravenous fluids and dopamine. He underwent successful rotational atherectomy of the proximal and mid LAD with deployment of drug-eluting stents. Following PCI, he suffered acute profound hypotension necessitating intravenous fluids and vasopressor support with epinephrine. Emergency transthoracic echocardiogram did not reveal any pericardial effusion, and showed normal left ventricle and right ventricle systolic function. The Impella device was removed and selective left common iliac angiogram from the right femoral access revealed a vascular injury site with shift of the bladder to the right indicative of retroperitoneal hematoma. A digital subtraction angiogram revealed extravasation of blood at the vascular injury site. An 8.0 × 59 mm iCAST covered stent was deployed to the left external iliac artery with successful sealing of the perforation. The Impella device site was closed with two Perclose devices. The patient required 4 units of

  10. Electronic health records: critical success factors in implementation.

    Science.gov (United States)

    Safdari, Reza; Ghazisaeidi, Marjan; Jebraeily, Mohamad

    2015-04-01

    EHR implementation results in the improved quality of care, customer-orientation and timely access to complete information. Despite the potential benefits of EHR, its implementation is a difficult and complex task whose success depends on many factors. The purpose of this research is indeed to identify the key success factors of EHR. This is a cross-sectional survey conducted with participation of 340 work forces from different types of job from Hospitals of TUMS in 2014. Data were collected using a self-structured questionnaire which was estimated as both reliable and valid. The data were analyzed by SPSS software descriptive statistics and analytical statistics. 58.2% of respondents were female and their mean age and work experience were 37.7 and 11.2 years, respectively and most respondents (52.5%) was bachelor. In terms of job, the maximum rate was related to nursing (33 %) and physician (21 %). the main category of critical success factors in Implementation EHRs, the highest rate related to Project Management (4.62) and lowest related to Organizational factors (3.98). success in implementation EHRs requirement more centralization to project management and human factors. Therefore must be Creating to EHR roadmap implementation, establishment teamwork to participation of end-users and select prepare leadership, users obtains sufficient training to use of system and also prepare support from maintain and promotion system.

  11. Critical success factors for implementing healthcare e-Learning.

    Science.gov (United States)

    Lee, Te-Shu; Kuo, Mu-Hsing; Borycki, Elizabeth M; Yunyong, David

    2011-01-01

    The use of e-Learning in educational institutes has rapidly increased along with the development of information and communication technology (ICT). In healthcare, more medical educators are using e-Learning to support their curriculum design, delivery and evaluation. However, no systematic work exists on characterizing a collective set of Critical Success Factors (CSFs) for implementing e-Learning in the healthcare education institutions. The aim of this paper is to study the CSFs of implementing healthcare e-Learning.

  12. Seven Elements Important to Successful Implementation of Early Literacy Intervention

    Science.gov (United States)

    Foorman, Barbara; Dombek, Jennifer; Smith, Kevin

    2016-01-01

    The objective of this article is to describe seven elements important to successful implementation of early literacy intervention. The seven elements are drawn from research as well as from the authors' recent randomized controlled trial of effective early literacy interventions in kindergarten through second grade in 55 schools across Florida.…

  13. Effect of leadership styles on successful implementation of a ...

    African Journals Online (AJOL)

    Effective leadership in the organisation could be critical in the successful implementation of performance management. However, empirical investigation of this relationship is lacking. The objectives of this study were: (1) To assess the effect of transactional and transformational leadership on the adoption of a performance ...

  14. Principles of Successful Implementation of Lecture Recordings in Higher Education

    Science.gov (United States)

    Ollermann, Frank; Rolf, Rüdiger; Greweling, Christian; Klaßen, André

    2017-01-01

    Purpose: This paper aims to describe the principles underlying the successful implementation of a lecture recording service in higher education. Design/methodology/approach: The paper qualitatively reviews the practices and experiences of several years of automated lecture recording at a medium-sized university in Germany. Findings: The paper…

  15. Successful Implementation of Technological Innovations in Health Care Organizations

    NARCIS (Netherlands)

    MD E.J.M. Wouters; T.C.M. Weijers; T.L. Finch

    2015-01-01

    In order to accept and implement technology in a successful manner, not only determinants (acceptance barriers or facilitators) related to individual persons, for instance, health care providers as well as health care recipients, are important. Also interpersonal relationships on the work floor as

  16. Paving the Road to Success: A Framework for Implementing the Success Tutoring Approach

    Directory of Open Access Journals (Sweden)

    Spark Linda

    2017-12-01

    Full Text Available The exponential growth of higher education enrolment in South Africa has resulted in increased diversity of the student body, leading to a proliferation of factors that affect student performance and success. Various initiatives have been adopted by tertiary institutions to mitigate the negative impact these factors may have on student success, and it is suggested that interventions that include aspects of social integration are the most successful. This paper outlines an approach called Success Tutoring (a non-academic tutorial approach used as part of a student success and support programme in the Faculty of Commerce, Law, and Management at the University of the Witwatersrand, which is underscored by empirical evidence drawn from evaluation data collected during Success Tutor symposia. The authors draw conclusions and make recommendations based on a thematic analysis of the dataset, and ultimately provide readers with a framework for implementing Success Tutoring at their tertiary institutions.

  17. Successful Management of Repetitive Urinary Obstruction and Anuria Caused by Double J Stent Calculi Formation after Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Zongyao Hao

    2014-01-01

    Full Text Available This report firstly describes an extremely rare case of repetitive double J stent calculi formation after renal transplantation caused by the antihyperparathyroidism (HPT drug calcitriol. In 2012, a woman initially presented to our hospital for anuria with lower abdominal pain. She was diagnosed with allograft hydronephrosis and double J stents obstruction by calculi formation after transplantation and treated with triplicate stents replacements in another hospital without clinical manifestations improvements. Through detailed exploration of medical history, we conclude that the abnormal calculi formation is due to the calcitriol (1,25-dihydroxyvitamin D3 administration, a drug which can increase renal tubular reabsorption of calcium for treating posttransplant HPT bone disease. After discontinuing calcitriol, the patient was stone-free and had a good recovery without severe complications during the 9-month follow-up. Our novel findings may provide an important clue and approach to managing formidable repetitive double J stent calculi formation in the clinical trial.

  18. Successful management of repetitive urinary obstruction and anuria caused by double j stent calculi formation after renal transplantation.

    Science.gov (United States)

    Hao, Zongyao; Zhang, Li; Zhou, Jun; Zhang, Xiansheng; Shi, Haoqiang; Zhang, Yifei; Wei, Pengfei; Liang, Chaozhao

    2014-01-01

    This report firstly describes an extremely rare case of repetitive double J stent calculi formation after renal transplantation caused by the antihyperparathyroidism (HPT) drug calcitriol. In 2012, a woman initially presented to our hospital for anuria with lower abdominal pain. She was diagnosed with allograft hydronephrosis and double J stents obstruction by calculi formation after transplantation and treated with triplicate stents replacements in another hospital without clinical manifestations improvements. Through detailed exploration of medical history, we conclude that the abnormal calculi formation is due to the calcitriol (1,25-dihydroxyvitamin D3) administration, a drug which can increase renal tubular reabsorption of calcium for treating posttransplant HPT bone disease. After discontinuing calcitriol, the patient was stone-free and had a good recovery without severe complications during the 9-month follow-up. Our novel findings may provide an important clue and approach to managing formidable repetitive double J stent calculi formation in the clinical trial.

  19. Impact of critical success factors on successful technology implementation in Consumer Packaged Goods (CPG supply chain

    Directory of Open Access Journals (Sweden)

    Ranjan Arora

    2017-05-01

    Full Text Available The purpose of this study is to identify and analyze the impact of critical success factors (CSFs impacting technology implementation in Consumer Packaged Goods (CPG supply chain. The study has used existing literature to identify CSFs and then questionnaire-based survey and Ex-ploratory Factor Analysis (EFA to group CSFs. The paper has revealed that “Inter-Organizational”, “Organizational”, “CPG Sector Specific”, “Human” and “Program Manage-ment” CSFs impact successful technology implementation in CPG supply chain. The paper fills the gap in existing literature by studying the impact of CSFs on successful technology imple-mentation in CPG supply chain and providing guidance to practitioners working in CPG sector.

  20. Implementation evaluation of the Telephone Lifestyle Coaching (TLC) program: organizational factors associated with successful implementation.

    Science.gov (United States)

    Damschroder, Laura J; Reardon, Caitlin M; Sperber, Nina; Robinson, Claire H; Fickel, Jacqueline J; Oddone, Eugene Z

    2017-06-01

    The Telephone Lifestyle Coaching (TLC) program provided telephone-based coaching for six lifestyle behaviors to 5321 Veterans at 24 Veterans Health Administration (VHA) medical facilities. The purpose of the study was to conduct an evaluation of the TLC program to identify factors associated with successful implementation. A mixed-methods study design was used. Quantitative measures of organizational readiness for implementation and facility complexity were used to purposively select a subset of facilities for in-depth evaluation. Context assessments were conducted using interview transcripts. The Consolidated Framework for Implementation Research (CFIR) was used to guide qualitative data collection and analysis. Factors most strongly correlated with referral rates included having a skilled implementation leader who used effective multi-component strategies to engage primary care clinicians as well as general clinic structures that supported implementation. Evaluation findings pointed to recommendations for local and national leaders to help anticipate and mitigate potential barriers to successful implementation.

  1. Balloon Angioplasty for In-Stent Restenosis Resulting in Carotid Stent Fracture: Literature Review of Stent-in-Stent Technique as a Viable Therapeutic Option.

    Science.gov (United States)

    Naeem, Abdul-Haseeb; Al-Rumaihi, Ghaya; Namavarian, Amirpouyan; Sharma, Manas; Boulton, Melfort

    2017-05-01

    Carotid stent fractures are rare, and multiple etiologies have been proposed to explain their occurrence. We describe a patient with an internal carotid artery (ICA) stent who developed in-stent restenosis. We performed balloon angioplasty to address in-stent restenosis, but he developed a carotid stent fracture after the procedure. To our knowledge, balloon angioplasty has not been reported to cause stent fractures. A 72-year-old man underwent stent placement for symptomatic left ICA stenosis with residual stenosis of 55% after stent placement. He presented with transient ischemic attacks 2 months later, and work-up revealed in-stent restenosis of the left ICA. Given prior complete occlusion of right ICA and right vertebral artery and narrowing of left vertebral artery ostium, satisfactory balloon (5 × 40 mm) angioplasty was carried out. After balloon angioplasty, x-ray showed a new stent fracture, which was initially missed on immediate postoperative imaging. He presented 9 months later with symptoms of compromised cerebral perfusion. Work-up revealed the previously missed stent fracture causing blood flow changes. Peak systolic velocity in the left ICA was 383 cm/second. He underwent left ICA repeat stent placement via a stent-in-stent technique for symptomatic severe left ICA stenosis of 70% with 40% residual stenosis after new stent deployment. Balloon angioplasty to address in-stent restenosis can secondarily cause stent fractures. We provide evidence of successful management of stent fracture with recurrent in-stent stenosis by repeat stent placement via a stent-in-stent technique. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Renal frame count: a measure of renal flow that predicts success of renal artery stenting in hypertensive patients.

    Science.gov (United States)

    Naghi, Jesse; Palakodeti, Samhita; Ang, Lawrence; Reeves, Ryan; Patel, Mitul; Mahmud, Ehtisham

    2015-08-01

    Renal artery (RA) stenting can improve control of hypertension yet predicting clinical response remains difficult. We sought to determine the role of the renal frame count (RFC) (number of angiographic frames for contrast to reach distal renal parenchyma after initial RA opacification) as a predictor of improvement in blood pressure (BP) after RA stenting. Renal flow was quantified in 68 consecutive patients (age 72.5 ± 9.1 years, 72% male) undergoing RA stenting for refractory hypertension (BP ≥ 140/90 mm Hg despite treatment with two or more antihypertensive medications) by measuring RFC pre-RA stenting. Significant renal artery stenosis (RAS) was defined as a stenosis ≥ 70% by visual estimation on angiography. Baseline and 6-month follow-up BP was recorded. Clinical response was defined by a drop in systolic blood pressure (SBP) >10 mm Hg on the same or fewer number of anti-hypertensive medications. Patients with RFC > 30 had SBP reduction (43.2 ± 25.7 mm Hg vs. 30.1 ± 31.3 mm Hg, P = 0.067), diastolic blood pressure reduction (9.1 ± 19.0 vs. -0.2 ± 13.4 mm Hg, P = 0.02), and mean arterial pressure reduction (23.8 ± 19.4 vs. 11.8 ± 16.1 mm Hg, P 30 was associated with a higher rate of clinical response to RA stenting (93.5% vs. 73%, P = 0.027). RFC can be used as a clinical predictor of response to RA stenting. RFC > 30 was associated with reduction in BP after RA stenting and was predictive of clinical response. RFC provides a useful intraprocedural tool in assessing the severity of RAS and predicts the likelihood of clinical response following RA stenting. © 2015 Wiley Periodicals, Inc.

  3. Factors influencing successful implementation of enhanced oil recovery projects

    Directory of Open Access Journals (Sweden)

    Karović-Maričić Vesna

    2014-01-01

    Full Text Available Tertiary methods in oil production process called 'Enhanced Oil recovery methods' (EOR are mostly applied in mature oil fields with declining production trend after primary and secondary recovery methods or immediately after primary production phase. These 'Enhanced Oil Recovery' methods implies injection of gases or fluids to mobilize residual oil captured in reservoir rock due to presence of strong viscous and capillary forces and high value of interfacial tension between fluid and rock. Depending on the type of injected fluid, production mechanism, as well as an approach to implementation, EOR methods are divided into thermal methods, chemical methods, miscible/immiscible gas injection methods and other methods that so far have an experimental application. The paper analyzes the key factors influencing the successful implementation of EOR projects: phases of EOR project implementation, the price of crude oil at the world market as a criterion for the beginning and the justification for EOR process application and development of new technologies for more efficient process realization.

  4. Late Silent Stent Abscess.

    Science.gov (United States)

    Zateyshchikov, Dmitry; Fattakhova, Elvira; Demchinsky, Vladimir; Baklanova, Tatiana; Serebruany, Victor

    2015-01-01

    Coronary stent infections in general and stent abscesses (SAs) in particular are rare but often deadly complications. Most SAs manifest with fever and chest pain within 30 days after intervention and require antibiotics and stent removal. A 45-year-old man with second ST elevated myocardial infarction and cardiogenic shock was admitted to a hospital that had no cardiac catheterization laboratory. The patient underwent fibrinolytic therapy with alteplase but died 1 h later. His medical history revealed posterior myocardial infarction 7 years before, which had been successfully treated with a bare metal stent of the right coronary artery. The post-discharge observation had been unremarkable with no evidence of ischaemia or infection but gross non-compliance. Autopsy revealed complete closure of the left main coronary artery and a surprise additional finding, namely SA; the stented portion of the artery was enveloped by an abscess, and purulent material completely occluded the stent, which was floating in pus. Impressions: Since coronary angioplasty is so common, the incidence of late silent SA is probably higher than expected, especially considering that there is often a lack of clinical manifestations. Clinicians should be cognizant of this complication. More attention may be required to assess the condition of existing stents during repeated interventions. Gross non-compliance and/or early withdrawal from dual anti-platelet therapy may be directly responsible for the development of silent delayed SA.

  5. Task-selective memory effects for successfully implemented encoding strategies.

    Directory of Open Access Journals (Sweden)

    Eric D Leshikar

    Full Text Available Previous behavioral evidence suggests that instructed strategy use benefits associative memory formation in paired associate tasks. Two such effective encoding strategies--visual imagery and sentence generation--facilitate memory through the production of different types of mediators (e.g., mental images and sentences. Neuroimaging evidence suggests that regions of the brain support memory reflecting the mental operations engaged at the time of study. That work, however, has not taken into account self-reported encoding task success (i.e., whether participants successfully generated a mediator. It is unknown, therefore, whether task-selective memory effects specific to each strategy might be found when encoding strategies are successfully implemented. In this experiment, participants studied pairs of abstract nouns under either visual imagery or sentence generation encoding instructions. At the time of study, participants reported their success at generating a mediator. Outside of the scanner, participants further reported the quality of the generated mediator (e.g., images, sentences for each word pair. We observed task-selective memory effects for visual imagery in the left middle occipital gyrus, the left precuneus, and the lingual gyrus. No such task-selective effects were observed for sentence generation. Intriguingly, activity at the time of study in the left precuneus was modulated by the self-reported quality (vividness of the generated mental images with greater activity for trials given higher ratings of quality. These data suggest that regions of the brain support memory in accord with the encoding operations engaged at the time of study.

  6. Retrograde placement of ureteral stent and ureteropelvic anastomosis with two running sutures in transperitoneal laparoscopic pyeloplasty: tips of success in our learning curve.

    Science.gov (United States)

    Papalia, Rocco; Simone, Giuseppe; Leonardo, Costantino; Guaglianone, Salvatore; Forestiere, Ester; Buscarini, Maurizio; Gallucci, Michele

    2009-05-01

    We report our experience of transperitoneal laparoscopic dismembered pyeloplasties describing our step-by-step surgical technique, and we retrospectively analyze the impact on operative times of technical modifications that were introduced during the learning curve. From November 2002 to May 2008, 84 consecutive patients with ureteropelvic junction (UPJ) obstruction were selected for laparoscopic pyeloplasty (LP). The main steps of the surgical procedure are described. In the initial 14 patients who underwent LP, we performed intraoperative antegrade stenting, and we configured the ureteropelvic anastomosis with interrupted sutures; in the 25 following patients, anastomosis was performed with running sutures. In the latest 45 patients, the ureteral stent was positioned retrograde, and ureteropelvic anastomosis was performed with two running sutures. We evaluated the impact of technical modifications on the operative times, dividing patients into three groups (group A, first 14 patients; group B, following 25 patients; and group C, last 45 patients). Median operative times of each group were compared with the Student t test. No major complications occurred, while postoperative urinary leakage was seen in three patients at bladder catheter removal (two in group A and one in group B). Mean operative blood loss was 70 mL, and mean hospital stay was 1.6 days. Median operative time was 115 min (range 110-125 min) for group A, 100 min (range 95-115 min) for group B, and 85 min (range 65-95 min) for group C; differences between operative times of groups A and B and between groups B and C were statistically significant (both P < 0.001). At a median follow-up of 38 months, recurrent symptoms developed in three patients. Overall, the success rate of the procedure was 96.5%. In a retrospective analysis of our series, the retrograde placement of the ureteral stent and the ureteropelvic anastomosis with two running sutures seemed to be tips of success in reducing operative times.

  7. Vascular biliopathy as a cause of common bile duct obstruction successfully treated by mesocaval shunt and endoscopic retrograde cholangiopancreatography biliary stent placement.

    Science.gov (United States)

    Rosenthal, Martin D; White, Geoffrey H; Stephen, Michael S; Gallagher, James J; Sandroussi, Charbel

    2008-01-01

    Common bile duct stenosis owing to extrahepatic portal varices is termed "portal hypertensive biliopathy" (PHB) and is a rare occurrence. We report a case of PHB owing to portal vein thrombosis with cavernous transformation successfully managed by mesocaval shunt and endoscopic retrograde cholangiopancreatography (ERCP) biliary stent placement. A 44-year-old male, who presented with hematemesis, melena, jaundice, and abdominal pain, underwent gastroscopy, which revealed bleeding gastric varices. Computed tomography with arterial and venous imaging demonstrated portal vein thrombosis with cavernous transformation and extensive extrahepatic varices within the porta hepatis causing common bile duct obstruction from extrinsic compression. Biliary decompression was achieved with ERCP, and a small common bile duct stone was retrieved. A mesocaval shunt with a 16 mm Dacron graft successfully treated the portal hypertension. PHB is rare. We report a case successfully treated by mesocaval shunt and ERCP.

  8. Bronchial stents

    Directory of Open Access Journals (Sweden)

    Ibrahim Emad

    2006-01-01

    Full Text Available Bronchial stents are mostly used as a Palliative relief of symptoms often caused by airway obstruction, It is also used for sealing of stump fistulas after pneumonectomy and dehiscence after bronchoplastic operations. Advances in airway prosthetics have provided a variety of silicone stents, expandable metal stents, and pneumatic dilators, enabling the correction of increasingly complex anatomical problems. Several series have been published describing the application and results of these techniques. This manuscript reviews the historical development of stents, types, indication, outcome, and complications. Alternative therapies for tracheobronchial stenting were also reviewed

  9. Childhood acute basilar artery thrombosis successfully treated with mechanical thrombectomy using stent retrievers: case report and review of the literature.

    Science.gov (United States)

    Nicosia, Giancarlo; Cicala, Domenico; Mirone, Giuseppe; Spennato, Pietro; Trischitta, Vincenzo; Ruggiero, Claudio; Guarneri, Gianluigi; Muto, Mario; Cinalli, Giuseppe

    2017-02-01

    Acute basilar artery occlusion (ABAO) is an infrequent but potentially fatal cause of strokes in both adults and children, and it is usually due to vertebral artery dissection (VAD). VAD has been found to be usually a consequence of traumatic vertebral artery injury. ABAO usually presents with symptoms of acute ischemic stroke (AIS) of the posterior circulation or transient ischemic attack (TIA). It may lead to death or long-term disability if not promptly recanalized. Basilar artery recanalization in children can be achieved safely and with excellent clinical outcome using endovascular thrombectomy with the new generation self-expanding and retrievable stents. We report the case of a 23-month old baby that came to the emergency room of our hospital for progressive impairment of consciousness associated with widespread stiffness and plaintive cry, appeared after accidental fall from stroller. An emergency brain CT scan was obtained showing multiple infarction lesions in the brainstem and left cerebellum suggestive of acute stroke in posterior circulation territories. An MR scan with angiography and diffusion-weighted sequences confirmed the multiple infarction lesions and demonstrated poor representation of the flow signal at the V3 segment of the left vertebral artery and absent representation of the flow signal at the distal segment of the basilar artery suggestive of acute thrombotic occlusion. The patient was immediately referred to interventional neuroradiology unit, and digital subtraction angiography showed complete basilar artery occlusion and left vertebral artery dissection at extracranial V2-V3 segment. The patient underwent intra-arterial thrombectomy using stent retrievers and occlusion of the V2-V3 segment of the left vertebral artery. The patient survived and long-term outcome was excellent. To our knowledge, only nine cases of ABAO in children treated with intra-arterial thrombectomy have been previously reported in the literature. In only three

  10. Strong advocacy led to successful implementation of smokefree Mexico City

    Science.gov (United States)

    Crosbie, Eric; Sebrié, Ernesto M; Glantz, Stanton A

    2011-01-01

    Objective To describe the approval process and implementation of the 100% smokefree law in Mexico City and a competing federal law between 2007 and 2010. Methods Reviewed smokefree legislation, published newspaper articles and interviewed key informants. Results Strong efforts by tobacco control advocacy groups and key policymakers in Mexico City in 2008 prompted the approval of a 100% smokefree law following the WHO FCTC. As elsewhere, the tobacco industry utilised the hospitality sector to block smokefree legislation, challenged the City law before the Supreme Court and promoted the passage of a federal law that required designated smoking areas. These tactics disrupted implementation of the City law by causing confusion over which law applied in Mexico City. Despite interference, the City law increased public support for 100% smokefree policies and decreased the social acceptability of smoking. In September 2009, the Supreme Court ruled in favour of the City law, giving it the authority to go beyond the federal law to protect the fundamental right of health for all citizens. Conclusions Early education and enforcement efforts by tobacco control advocates promoted the City law in 2008 but advocates should still anticipate continuing opposition from the tobacco industry, which will require continued pressure on the government. Advocates should utilise the Supreme Court’s ruling to promote 100% smokefree policies outside Mexico City. Strong advocacy for the City law could be used as a model of success throughout Mexico and other Latin American countries. PMID:21059606

  11. Manejo exitoso con stent en un prematuro con síndrome de vena cava superior: Reporte de caso Successful management with stent in a premature infant with superior vena cava syndrome: A case report

    Directory of Open Access Journals (Sweden)

    Jhon J Gómez

    2012-08-01

    Full Text Available El síndrome de vena cava superior en la infancia es una complicación inusual al uso de catéter venoso central en la unidad de cuidados intensivos neonatales. Otras causas en niños son la cirugía para enfermedades congénitas del corazón la cual ocupa la mayoría de los casos, y los linfomas, que constituyen la segunda causa más frecuente de obstrucción. Se describe el caso de un recién nacido prematuro de 25 semanas, con síndrome de vena cava superior secundario al uso de catéter venoso central para manejo de sepsis. Se destaca la importancia de un diagnóstico y tratamiento precoz. Así mismo, se reporta el manejo exitoso con stent para el síndrome de vena cava superior.Superior vena cava syndrome in infancy is an unusual complication of the use of central venous catheters in neonatal intensive care unit. Other causes of this syndrome in children are surgery for congenital heart disease which accounts for most of the cases, and lymphomas, that constitute the second most common cause of obstruction. We describe the case of a premature infant born at 25 weeks with superior vena cava syndrome secondary to a central venous catheter for management of sepsis. The importance of early diagnosis and treatment is highlighted. We also report the successful management with stenting for superior vena cava syndrome.

  12. Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Knežević Božidarka

    2008-01-01

    Full Text Available Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.

  13. Impact of stent platform on longitudinal stent deformation: an in vivo frequency domain optical coherence tomography study.

    Science.gov (United States)

    Yamada, Ryotaro; Okura, Hiroyuki; Kume, Teruyoshi; Fukuhara, Kenzo; Koyama, Terumasa; Higa, Tomitaka; Neishi, Yoji; Yoshida, Kiyoshi; Uemura, Shiro

    2017-07-01

    Recently, longitudinal coronary stent deformation has been highlighted as a possible cause of drug-eluting stent failure. Although bench tests and in vivo studies have demonstrated difference in longitudinal stent strength among the stents with different platforms, its clinical impact is still unknown. Furthermore, it is unknown if modified stent platform favorably affect the incidence of stent deformation. The aim of this study was to investigate the longitudinal deformation of the everolimus-eluting stents (EES) with different stent platforms by using frequency domain optical coherence tomography (FD-OCT). Seventy-eight lesions treated with EES (Xience Prime: n = 26, Promus element: n = 29, Promus premier: n = 23) were studied. After successful stent implantation, FD-OCT was performed and stent length was measured using three-dimensional reconstruction of the images in vivo. Percent longitudinal stent shortening (%SS) was defined as the in vivo stent length divided by nominal stent length. Longitudinal stent deformation was defined as  %SS > 10 %. Patients' and procedural characteristics were similar among 3 EESs. There was no difference in mean  %SS between Xience Prime, Promus Element and Promus Premier (1.0 ± 5.8, 2.9 ± 6.7 and 0.8 ± 3.7 %, p = 0.322). Incidence of the longitudinal stent deformation was significantly higher in Promus Element than the other stents (0, 13.8 and 0 %, p = 0.028). Incidence of longitudinal stent deformation was different between EESs with different stent platforms. Stent material, stent design and/or stent delivery balloon may affect longitudinal stent deformation.

  14. Coronary artery stent (image)

    Science.gov (United States)

    ... blocked. The stent is inserted along with a balloon catheter and expands when the balloon is inflated. The stent is ... blocked. The stent is inserted along with a balloon catheter and expands when the balloon is inflated. The stent is ...

  15. How does interorganisational implementation behaviour challenge the success of Football Fitness?

    DEFF Research Database (Denmark)

    Bennike, Søren; Ottesen, Laila

    2016-01-01

    three crucial interconnected factors influencing interorganisational implementation behaviour and representing complications for the successful implementation of Football Fitness: (1) The implementation is being carried out by multiple actors with different implementation tasks. These actors operate......This article explores the role of the interorganisational implementation behaviour of the relevant actors in the implementation of Football Fitness, a Danish football-based, health-related activity. Football Fitness was designed by the Danish Football Association in 2010 and introduced in several...

  16. Bosnia: Crime and Corruption Threaten Successful Implementation of the Dayton Peace Agreement

    National Research Council Canada - National Science Library

    Johnson, Harold

    2000-01-01

    Endemic crime and corruption in Bosnia are threatening the successful implementation of the Dayton Peace Agreement and until the situation is satisfactorily addressed the conditions for the complete...

  17. Applying grounded theory to create a unified critical success factors model for ERP implementations

    OpenAIRE

    Pastor Collado, Juan Antonio; Esteves, José

    2000-01-01

    Despite the benefits that can be achieved from a successful ERP system implement ation, there is already evidence of high failure risks in ERP implementation pro jects. Too often, project managers focus mainly on the technical and financial a spects of the implementation project, while neglecting or putting less effort on the nontechnical issues. Therefore, one of the major research issues in ERP sys tems today is the study of ERP implementation success. Some authors have show...

  18. Can groundwater be successfully implemented as a bulk water ...

    African Journals Online (AJOL)

    Groundwater is a strategic water resource in rural Limpopo Province and it accounts for almost 70% of rural domestic water supply. The resource is ... Keywords: groundwater, GRIP, bulk water supply, information variability, borehole productivity, conjunctive ..... Based on phased implementation, the model was created to.

  19. Key factors influencing the implementation success of home telecare application.

    NARCIS (Netherlands)

    Postema, T.R.F.; Peeters, J.M.; Friele, R.D.

    2012-01-01

    Rationale: The introduction of home telecare in healthcare organizations has shown mixed results in practice. The aim of this study is to arrive at a set of key factors that can be used in further implementation of video communication. We argue that key factors are mainly found in the organizational

  20. Can groundwater be successfully implemented as a bulk water ...

    African Journals Online (AJOL)

    While most water service authorities in the Province have been randomly developing new boreholes with limited success rates, the analysis of datasets in the newly established groundwater data repository, the Limpopo Groundwater Resource Information Project (GRIP) demonstrates that large quantities of groundwater ...

  1. Searching for Student Success: Implementing Immediacy in Online Courses

    Science.gov (United States)

    Jennings, Amy B.

    2013-01-01

    Growing demand for higher education has contributed to the popularity of online education. While online courses can be effective in terms of student learning and success, and there are many potential benefits, there are also still areas that can be improved. There is evidence that students can experience online courses as impersonal and lacking…

  2. Information System Design and Implementation: Strategies for Success.

    Science.gov (United States)

    Pollack, Gail R.

    This paper describes strategies for successful management information system (MIS) development, and an application of these strategies to the Benjamin Rose Institute, a community agency serving the frail elderly in Cleveland, Ohio. A definition of MIS is followed by a list of symptoms of systems which indicate a need to review current methods of…

  3. New techniques for intracranial stent navigation in patients with tortuous arteries

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hyun Wook; Koo, Young Baek; Lee, Tae Hong; Kim, Hak Jin; Lee, Jun Woo; Kim, Chang Won; Kim, Suk; Choo, Ki Seok; Jeong, Yeon Joo; Lee, Suk Hong [Pusan National University Hospital, Pusan (Korea, Republic of)

    2005-07-15

    We wanted to describe several new techniques of intracranial stenting that are helpful for navigating the stent delivery system in the tortuous carotid or vertebral arteries. Between May 1998 and June 2004, 65 patients with 73 symptomatic, stenotic intracranial arteries (more than 50%) were successfully treated with stent-assisted angioplasty. In eleven of the total cases, the standard technique failed to navigate the stent delivery system into the objective lesion because of the tortuous path of the carotid or vertebral arteries. In these cases, several new techniques were used to overcome the vessels' tortuous path. The several new techniques were 1) the waiting method (20-30 minutes) after advancement of microwire across the lesion; 2) the double wires technique using an additional microwire; and 3) the coaxial double guiding catheters technique using an additional smaller guiding catheter. Five lesions were located in the middle cerebral arteries, four were in the supraclinoid internal carotid arteries, and two were in the distal vertebral arteries. In all difficult cases, intracranial artery stenting was performed successfully by using the several new techniques. The waiting method made smooth stent navigation possible in 5 cases, the double wire technique was successful in 4 cases and the coaxial double guiding catheter technique was successful in 2 case. There was no complication related to the new techniques. In difficult cases where the standard technique failed to navigate the stent delivery system into the objective lesion because of the vessels' tortuous path, these new techniques for intracranial stent navigation were usefully implemented.

  4. Cloud Computing Implementation Organizational Success in the Department of Defense

    Science.gov (United States)

    2014-03-27

    models is not apparent, understanding the theory is germane to the research. As Pfeffer (1982) postulates, an individual "achieves membership and...and implement powerful guidance/standards to force the issue. Despite numerous senior leader decrees, directives and orders, organizations still think... Understanding this research and its ramifications, if the models are executed, inevitably leads an organization to investigate the "best practices" for

  5. KPI Building Blocks For Successful Green Transport Corridor Implementation

    Directory of Open Access Journals (Sweden)

    Prause Gunnar

    2015-12-01

    Full Text Available The green transport corridor concept represents a cornerstone in the development of integrated and sustainable transport solutions. Important properties of green corridors are their transnational character and their high involvement of large numbers of public and private stakeholders, including political level, requiring sophisticated approaches for implementation, management and governance. The current scientific discussion focusses on Key Performance Indicators (KPI for monitoring and management of green transport corridor performance emphasizing the operational aspects.

  6. Evaluating Stent Optimisation Technique (StentBoost®) in a Dedicated Bifurcation Stent (the Tryton™)

    Energy Technology Data Exchange (ETDEWEB)

    Fysal, Zamil; Hyde, Thomas; Barnes, Edward; McCrea, William; Ramcharitar, Steve, E-mail: steve.ramcharitar@chem.ox.ac.uk

    2014-03-15

    Background/Purpose: To evaluate the use of StentBoost® in the Tryton™ dedicated SideBranch Stent. Methods and Results: The Tryton™ SideBranch Stent has been effectively used to manage complex bifurcations. However, the paucity of scaffolding in the proximal part of the stent makes it often difficult to visualise under standard radiographic imaging. We set out to evaluate whether by using an augmented radiographic imaging technique it was possible to aid visualisation of the stent. In particular the so call 'wedding ring' band which is crucial to the procedural success. We further evaluated whether it was possible to determine the apposition of the stent at the carina, its coverage and the ability to aid recrossing of the struts closest to the carina as well as the added radiation exposure. Conclusions: StentBoost® was found to be invaluable to the procedural success of the Tryton™ deployment without adding any extra cost to the procedure and with only a 3.7% increase in radiation to the patient. It allowed enhanced visualisation in all cases to aid apposition, recrossing and coverage.

  7. Evaluating stent optimisation technique (StentBoost®) in a dedicated bifurcation stent (the Tryton™).

    Science.gov (United States)

    Fysal, Zamil; Hyde, Thomas; Barnes, Edward; McCrea, William; Ramcharitar, Steve

    2014-03-01

    To evaluate the use of StentBoost® in the Tryton™ dedicated SideBranch Stent. The Tryton™ SideBranch Stent has been effectively used to manage complex bifurcations. However, the paucity of scaffolding in the proximal part of the stent makes it often difficult to visualise under standard radiographic imaging. We set out to evaluate whether by using an augmented radiographic imaging technique it was possible to aid visualisation of the stent. In particular the so call 'wedding ring' band which is crucial to the procedural success. We further evaluated whether it was possible to determine the apposition of the stent at the carina, its coverage and the ability to aid recrossing of the struts closest to the carina as well as the added radiation exposure. StentBoost® was found to be invaluable to the procedural success of the Tryton™ deployment without adding any extra cost to the procedure and with only a 3.7% increase in radiation to the patient. It allowed enhanced visualisation in all cases to aid apposition, recrossing and coverage. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Freescale Semiconductor Successfully Implements an Energy Management System

    Energy Technology Data Exchange (ETDEWEB)

    None

    2011-06-30

    Through the Superior Energy Performance (SEP) plant certification program, Freescale Semiconductor implemented projects at the company's Oak Hill Fab plant that reduced annual energy consumption by 28 million kilowatt hours (kWh) of electricity and 26,000 million British thermal units (Btu) of natural gas between 2006 and 2009, saving more than $2 million each year. The plant is now certified at the SEP silver level, and has a management system in place to proactively manage the facility's energy resources in the future.

  9. Understanding a Successful Implementation of Organizational Social Media: A Multi-Site Case Study

    Science.gov (United States)

    Lahman, Caroline D.

    2017-01-01

    The purpose of this dissertation was to examine the successful implementation of social media strategies in multiple organizations. Examining the factors an organization used to implement social media can provide the understanding of the benefits and risks associated with this technology. Some businesses are considered successful using social…

  10. Towards a framework of critical success factors for implementing supply-chain information systems

    NARCIS (Netherlands)

    Denolf, J.M.; Wognum, P.M.; Trienekens, J.H.; Vorst, van der J.G.A.J.; Omta, S.W.F.

    2015-01-01

    Supply chain information systems (SCISs) have emerged as the core of successful management in supply chains. However, the difficulties of SCIS implementations have been widely cited in the literature. Research on the critical success factors (CSFs) for SCIS implementation is rather scarce and

  11. The Effects of Organizational Characteristics on Enterprise Resource Planning Implementation Success and Perceived Organizational Performance

    Directory of Open Access Journals (Sweden)

    Yaşar AKÇA

    2014-06-01

    Full Text Available The aim of this study is to demonstrate the effects of organizational characteristics on Enterprise Resource Planning (ERP system implementation success and organizational performance. For this purpose, data obtained from 236 firms through surveys were analyzed using correlation, factor and regression analysis. The results were as follows; (1 While top management support had a statistically significant and positive effect on ERP implementation success, it had no significant effect on perceived organizational performance. (2 Organizational consensus had a statistically significant effect on neither ERP implementation success nor organizational performance. (3 The effect of training on ERP implementation success and organizational performance was positive. (4 Although information intensity didn’t have an effect on ERP implementation success, it had a statistically significant and positive effect on organizational performance

  12. Removal of retrievable self-expandable urethral stents: experience in 58 stents

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon; Song, Ho-Young; Kim, Jin Hyoung; Ko, Heung-Kyu; Kim, Yong Jae; Woo, Chul-Woong; Kim, Tae-Hyung; Ko, Gi-Young; Yoon, Hyun-Ki; Sung, Kyu-Bo [Asan Medical Center, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul (Korea); Park, Hyungkeun [Asan Medical Center, Department of Urology, University of Ulsan College of Medicine, Seoul (Korea)

    2006-09-15

    The purpose of this study was to retrospectively evaluate the safety and efficacy of removing retrievable self-expandable urethral stents using a retrieval hook wire. Under fluoroscopic guidance, the removal of 58 polyurethane or PTFE (polytetrafluoroethylene)-covered stents was attempted in 33 patients using a retrieval hook wire. Indications for removal were elective removal (n=21), stent migration (n=19), formation of tissue hyperplasia around or inside of the stent (n=14), stent deformity (n=3), and severe pain (n=1). The mean time the stents remained in place was 64.8{+-}42.9 days (range, 1-177 days). Fifty-six (97%) of the 58 stents were successfully removed using the retrieval hook wire despite the following difficulties; hook wire disconnection (n=2), untied drawstrings (n=3), and polyurethane membrane disruption/separation (n=4). The removal procedure using a retrieval hook wire failed in two stents (3%) which had migrated into the urinary bladder. One of the two stents with migration into the urinary bladder was removed using a snare through the cystostomy route. The overall complication rate was 14% (seven hematuria cases and one urethral tear case), and all were minor and spontaneously resolved without further treatment. In conclusion, removal of retrievable urethral stents using a retrieval hook wire was safe and effective despite some technical difficulties. It is a useful method for allowing temporary stent placement and solving various complications of stent use. (orig.)

  13. Comparison of uncovered stent with covered stent for treatment of malignant colorectal obstruction.

    Science.gov (United States)

    Lee, Kee Myung; Shin, Sung Jae; Hwang, Jae Chul; Cheong, Jae Youn; Yoo, Byung Moo; Lee, Kwang Jae; Hahm, Ki Baik; Kim, Jin Hong; Cho, Sung Won

    2007-11-01

    Insertion of self-expandable metallic stents (SEMS) can provide rapid relief of malignant colorectal obstruction and can be used as a palliative treatment or as a bridge to surgery. A SEMS can be classified as an uncovered or covered stent. Both types of stents have their own merits and demerits. The objectives of this study were to compare success rates, durability, and complication rates of uncovered and covered stent groups of malignant colorectal obstruction. DESIGNS AND SETTING: A nonrandomized prospective, single-center study. We studied 80 patients with malignant colorectal obstruction: colon cancer in 70 patients, metastatic lesion of advanced gastric cancer in 8 patients, and cervix cancer in 2 patients. Insertion of uncovered stents was attempted in 39 patients (before surgery in 20, palliative in 19), and covered stents were used in 41 (before surgery in 23, palliative in 18). The stent was inserted into the obstructive sites for preoperative or palliative purposes by using the through-the-scope method. After stent insertion, the patients had regular follow-ups, either as clinical checkups or telephone interviews. Insertion success rate, durability, and complication rate according to stent type. Technical and clinical success rates of uncovered and covered stents were not different (100%; 95.1%, P > .05, 100%; 97.4%, P > .05). The early stent migration rate was not different in both groups. The late stent migration was more common in the covered stent group than the uncovered stent group (0% vs 40%, respectively, P = .005). Loss of stent function during the long-term follow-up period was more frequent in the covered stent group than in the uncovered stent group (18.8% vs 60%, respectively, P = .018). This was a small-sized, nonrandomized, prospective, single-center study. Confirmation of large-scale, multicenter, randomized, prospective outcome is required. Insertion of either an uncovered or covered stent is similarly an effective treatment modality of

  14. Air vehicle integration issues and considerations for CLAS successful implementation

    Science.gov (United States)

    Lockyer, Allen J.; Alt, Kevin H.; Kudva, Jayanth N.; Tuss, James

    2001-06-01

    Over the last decade, Northrop Grumman Corporation under internal and DoD funding, and others, have been working on integration of RF antennas into load-bearing aircraft structures. This multidisciplinary effort, collectively referred to as Conformal Load-bearing Antenna Structures (CLAS), requires concurrent consideration of structural and antenna performance issues and has involved a team consisting of avionics, structures, material, and manufacturing expertise. From the published articles to date it could be argued that the technology has had some spectacular success in its initial stages but not much has been published about the issues raised by CLAS that would still need to be addressed and solved for final technology inclusion in an operational air-vehicle. Presented are some key results from the Air Force Research Laboratory's (AFRL) Smart Skins Structures Technology Demonstrator (S3TD) program that while funded from the Air Vehicles Directorate looked at the total picture of integration from a multidisciplilnary standpoint. Issues related to airframe integration are also discussed that need further study and evaluation before CLAS can be sanctioned as a viable future DoD technology. Such topics, in no particular order of priority are 1) airframe CLAS panel location, 2) airframe configuration issues, 3) EMI/lightning issues, and 4) repair issues and supportability, 5) panel design enhancement, risks, and issues.

  15. Successful treatment of a ruptured aneurysm at the vertebral artery-posterior inferior cerebellar artery junction and simultaneous treatment of the stenotic vertebral artery with a single flow-diverting stent: a case report.

    Science.gov (United States)

    Borota, Ljubisa; Gál, Gyula; Jonasson, Per; Ridderheim, Per-Åke

    2014-05-30

    This is the first report on the simultaneous successful treatment of a large ruptured saccular aneurysm and stenotic parent artery with a single flow-diverting stent. We report the case of a 68-year-old Caucasian man with occlusion of the right vertebral artery and a ruptured aneurysm at the junction of the left posterior inferior cerebellar artery-left vertebral artery that was successfully treated by the deployment of a single flow-diverting stent in the stenotic left vertebral artery. Stent deployment was complicated by thrombotic occlusion of the basilar artery, which was successfully reopened. The patient recovered completely, and follow-up angiography at 4 months and 1 year showed patent vertebral artery with gradual shrinkage of the aneurysm. This report contributes to the literature on treatment of large ruptured aneurysms localized in stenotic arteries and in areas of the endocranium where a mass of embolic material in the aneurysm (coils) might compromise the circulation in the parent blood vessel or compress vital brain structures.

  16. Stent malapposition, as a potential mechanism of very late stent thrombosis after bare-metal stent implantation: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Higuma, Takumi, E-mail: higuma@cc.hirosaki-u.ac.jp; Abe, Naoki; Hanada, Kenji; Yokoyama, Hiroaki; Tomita, Hirofumi; Okumura, Ken

    2014-04-15

    A 90-year-old man was admitted to our hospital with acute ST-segment elevation myocardial infarction. He had a history of post-infarction angina pectoris 79 months ago and had a bare-metal stent (BMS) implanted in the proximal left anterior descending artery at our hospital. Emergent coronary angiography demonstrated thrombotic occlusion in the previously stented segment. After catheter thrombectomy, antegrade flow was restored, but 90% stenosis with haziness persisted in the proximal and distal portions of the previously stented segment. Intravascular ultrasound imaging showed interstrut cavities or stent malapposition at the proximal and distal sites of stented segment. In close proximity to the sites, residual thrombi were also observed. Optical coherence tomography (OCT) demonstrated neither lipid-laden neointimal tissue nor rupture but clearly demonstrated residual thrombus adjacent to the malapposed region in addition to the stent malapposition. PCI with balloon was successfully performed and stent apposition was confirmed by OCT. Stent malapposition is an unusual mechanism of very late stent thrombosis after BMS implantation. OCT can clearly reveal the etiology of stent thrombosis.

  17. Evaluation of the Influence of Selected Factors on a Successful ERP Software Implementation

    Directory of Open Access Journals (Sweden)

    Grażyna Hołodnik-Janczura

    2010-01-01

    Full Text Available Based on a pilot study, a list of critical success factors for an IT project was developed. These factors were subjected to statistical analysis on the basis of the results of a questionnaire. Two samples of projects, called "success" and "failure" respectively, were analysed. The groups were distinguished in order to evaluate the influence of selected factors on the success of an implementation project. Furthermore, a non-parametric test was applied, in order to conduct statistical data analysis, which confirmed the influence of the majority of the selected factors on the success of an implementation project. (original abstract

  18. ERP implementation - Seeing through a lens : A comparative literature review regarding the factors that influence a successful ERP system implementation.

    OpenAIRE

    Rashidzadeh Azar, Soran; Chaudhry, Muhammad Irfan

    2010-01-01

    Purpose: The purpose of this thesis is to describe and analyse the factors that contribute to the successful ERP system implementation, the stakeholders of ERP system and how these stakeholders are related to CSFs of ERP system implementation. Design/ methodology/ approach: The research methodology approach chosen for this research is based on reality and clear research which includes qualitative and quantitative method for collecting and analysing data. Data for this research consists of sec...

  19. Exploring the success, failure and factors influencing M-government implementation in developing countries

    CSIR Research Space (South Africa)

    Ogunleye, OS

    2014-05-01

    Full Text Available and to provide better services to citizens, businesses, and government agencies through using mobile technology. This research reviews the success, failures and factors influencing m-Government development and implementation in developing countries...

  20. Problems Affecting Successful Implementation of Blended Learning in Higher Education: the Teacher Perspective

    National Research Council Canada - National Science Library

    Mozelius, Peter

    2017-01-01

    .... There are less studies on the teacher view of blended learning environments. This study had the aim to explore, analyse and discuss teachers' perceived problems and barriers to a successful implementation of blended learning at university...

  1. Predictors of stent dysfunction after self-expandable metal stent placement for malignant gastric outlet obstruction: tumor ingrowth in uncovered stents and migration of covered stents.

    Science.gov (United States)

    Hori, Yasuki; Naitoh, Itaru; Hayashi, Kazuki; Ban, Tesshin; Natsume, Makoto; Okumura, Fumihiro; Nakazawa, Takahiro; Takada, Hiroki; Hirano, Atsuyuki; Jinno, Naruomi; Togawa, Shozo; Ando, Tomoaki; Kataoka, Hiromi; Joh, Takashi

    2017-10-01

    Endoscopic metallic stenting is widely accepted as a palliation therapy for malignant gastric outlet obstruction (GOO). However, the predictors of stent dysfunction have not been clarified. We aimed to evaluate the predictors, especially tumor ingrowth in uncovered self-expandable metallic stents (U-SEMS) and migration of covered self-expandable metallic stents (C-SEMS), which are the main causes related to the stent characteristics. In this multicenter retrospective study, we compared patients with U-SEMS and C-SEMS in terms of clinical outcomes, and predictors of stent dysfunction. In total, 252 patients (126 with U-SEMS and 126 with C-SEMS) were enrolled. There were no significant differences in technical success, clinical success, GOO score, or time to stent dysfunction. Tumor ingrowth was significantly more frequent in U-SEMS (U-SEMS, 11.90% vs. C-SEMS, 0.79%; p = 0.002), and stent migration was significantly more frequent for C-SEMS (C-SEMS, 8.73% vs. U-SEMS, 0.79%; p = 0.005). Karnofsky performance status (p = 0.04), no presence of ascites (p = 0.02), and insufficient (migration. Both U-SEMS and C-SEMS are effective with comparable patencies. Tumor ingrowth and stent migration are the main causes of stent dysfunction for U-SEMS and C-SEMS, respectively. With regard to stent dysfunction, U-SEMS might be a good option for patients receiving chemotherapy, while C-SEMS with longer stents for patients in good condition. (Clinical trial registration number: UMIN000024059).

  2. The impact of middle manager affective commitment on perceived improvement program implementation success.

    Science.gov (United States)

    Fryer, Ashley-Kay; Tucker, Anita L; Singer, Sara J

    2017-07-03

    Recent literature suggests that middle manager affective commitment (emotional attachment, identification, and involvement) to an improvement program may influence implementation success. However, less is known about the interplay between middle manager affective commitment and frontline worker commitment, another important driver of implementation success. We contribute to this research by surveying middle managers who directly manage frontline workers on nursing units. We assess how middle manager affective commitment is related to their perceptions of implementation success and whether their perceptions of frontline worker support mediate this relationship. We also test whether a set of organizational support factors foster middle manager affective commitment. We adapt survey measures of manager affective commitment to our research context of hospitals. We surveyed 67 nurse managers from 19 U.S. hospitals. We use hierarchical linear regression to assess relationships among middle manager affective commitment to their units' falls reduction program and their perceptions of three constructs related to the program: frontline worker support, organizational support, and implementation success. Middle manager affective commitment to their unit's falls reduction program is positively associated with their perception of implementation success. This relationship is mediated by their perception of frontline worker support for the falls program. Moreover, middle managers' affective commitment to their unit's falls program mediates the relationship between perceived organizational support for the program and perceived implementation success. We, through this research, offer an important contribution by providing empirical support of factors that may influence successful implementation of an improvement program: middle manager affective commitment, frontline worker support, and organizational support for an improvement program. Increasing levels of middle manager affective

  3. Implementing Human Resource Management Successfully: A First-Line Management Challenge

    NARCIS (Netherlands)

    Bos-Nehles, Anna Christina; van Riemsdijk, Maarten; Looise, Jan C.

    2006-01-01

    In this paper we will address the success of Human Resource Management (HRM) implementation, concentrating not on the HR function but on first-line managers. First-line managers find implementing HR practices at the operational level difficult and show reluctance with their HR responsibilities.

  4. Upper Gastrointestinal Stent

    OpenAIRE

    Kim, Sang Gyun; Yang, Chang-Hun

    2012-01-01

    Gastrointestinal (GI) stent has been developed for palliation of obstructive symptoms in various diseases causing obstruction of GI tract. Self-expanding metal stent (SEMS) has replaced old type of plastic stent, and endoscopic insertion of stent has replaced fluoroscopy-guided insertion. Nowadays, newly-designed SEMSs have been developed for prevention of complications such as stent migration and re-obstruction, and indications of stent recently have been widened into benign conditions as we...

  5. Defining critical success factors in TOD implementation using rough set analysis

    NARCIS (Netherlands)

    Thomas, R.; Bertolini, L.

    2017-01-01

    This paper defines critical success conditions in transit-oriented development (TOD), evaluating the impact of practices, policies, and governance models on implementation. As part of a meta-analysis of 11 international case studies, 16 critical success factors were developed and validated using

  6. From Project Management Capabilities to ERP Implementation Success: The Mediating Effect of IT Executives' Capabilities

    Science.gov (United States)

    Touir, Maatallah

    2016-01-01

    Enterprise resource planning project implementation success is necessary for organizations to enhance productivity and achieve operational efficiency; however, the failure rates of ERP projects remain high, ranging between 10% and 90%, and costing organizations $500,000 to $300 million. The problem addressed in this study was the low success rate…

  7. Light rail implementation : Success and failure aspects of Dutch light rail projects

    NARCIS (Netherlands)

    Van Oort, N.; Van der Bijl, R.; Roeske, R.

    2015-01-01

    Light rail has been successfully implemented in many urban regions worldwide. Although light rail has been a proven transport concept in many cities, there is much debate on the (societal) cost-benefit ratio of these systems. In addition to the success stories, several light rail projects were not

  8. Examining Success Factors Related to ERP Implementations in Higher Education Shared Services Projects

    Science.gov (United States)

    Stoyanoff, Dawn Galadriel Pfeiffer

    2012-01-01

    This study examined the enterprise resource planning (ERP) implementations that utilized a shared services model in higher education. The purpose of this research was to examine the critical success factors which were perceived to contribute to project success. This research employed a quantitative non-experimental correlational design and the…

  9. Relevance of Kotter’s Model for Change in Successfully Implementing Lean

    OpenAIRE

    Mishra, Shovan

    2013-01-01

    Part IV: ICT and Emerging Technologies; International audience; Though lean consists of numerous tools and techniques that are applicable to entire value stream, there are not many guidelines on how to implement lean from the managerial perspective. Lean implementation has succeeded and failed in many different organizations. This paper attempts to map success factors of lean implementation as suggested by some studies with Kotter’s eight steps model for change.

  10. Implementation of success factors in new product development: The missing link

    DEFF Research Database (Denmark)

    Jensen, Bjarne; Harmsen, Hanne

    2001-01-01

    This paper addresses companies' lack of implementation of success factors in new product development. Drawing on theory in the competence perspective and an exploratory empirical study, the paper points to two major areas that have not been covered by previous studies on new product development...... success factors. The two areas are knowledge and skills of individual employees, values and norms and it is suggested that increased understanding of these two areas hold potential in making identified success factors more accessible to companies....

  11. Symptomatic stent cast.

    LENUS (Irish Health Repository)

    Keohane, John

    2012-02-03

    Biliary stent occlusion is a major complication of endoscopic stent insertion and results in repeat procedures. Various theories as to the etiology have been proposed, the most frequently studied is the attachment of gram negative bacteria within the stent. Several studies have shown prolongation of stent patency with antibiotic prophylaxis. We report the case of stent occlusion from a cast of a previously inserted straight biliary stent; a "stent cast" in an 86-year-old woman with obstructive jaundice. This was retrieved with the lithotrypter and she made an uneventful recovery. This is the first reported case of a biliary stent cast.

  12. A successful enterprise system re-implementation against all odds – A multisourcing case study

    DEFF Research Database (Denmark)

    Svejvig, Per

    2011-01-01

    Achieving success in enterprise systems (ES) implementations is challenging. The success rate is not high in view of the sums invested by many organizations in these companywide systems. The literature is charged with reasons for unsuccessful implementations, such as a lack of top management...... support and insufficient change management. Contrary to this research, empirical data from an ES re-implementation in a Scandinavian high-tech company shows successful implementation despite many problematic shifts in outsourcing partners. Therefore, it is natural to ask: why was the re...... shows an equivocal result: four fulfilled, three partially fulfilled and three not fulfilled. Even the two top CSFs, top management support and change management, are either not fulfilled or only partial fulfilled. However, the institutional analysis provides additional explanations, such as a few...

  13. Implementing IT processes the main 17 IT processes and directions for a successful implementation

    CERN Document Server

    Pilorget, Lionel

    2015-01-01

    Information Technology plays a major role in our society. Due to system integration and process automation, a company has to rely on performant information systems. To achieve this objective, it is important to have relevant IT processes in place on the one hand to ensure current operation and on the other hand to enable the successful introduction of new technologies. Once IT processes are defined and described, interrelations become visible, which allow to gain an appropriate level of maturity.

  14. What are the requirements of a successful ERP implementation in SMEs? Special focus on Southern Africa

    Directory of Open Access Journals (Sweden)

    Victoria Hasheela-Mufeti

    2017-01-01

    Full Text Available Many international Enterprise Resource Planning (ERP systems were developed based on the best practices of organizations in which they were developed. These organizations are usually large, and in developed countries. However, small organizations in other parts of the world are also implementing ERP. Implementing a system based on different practices that differ from yours is certainly bound to come with issues. The objective of the study is to identify challenges experienced by SMEs when implementing ERP systems, and to suggest requirements of achieving successful implementations in SMEs in Southern Africa. A thematic analysis methodology was used to explore identified challenges from fourteen SMEs and to identify themes within the data. The study suggested that a successful ERP implementation requires sufficient and appropriate training, reliable internet connection, involvement of end-users, change management, as well as sufficient demonstration of the prospective ERP system.

  15. Sequential structural and fluid dynamic numerical simulations of a stented bifurcated coronary artery.

    Science.gov (United States)

    Morlacchi, Stefano; Chiastra, Claudio; Gastaldi, Dario; Pennati, Giancarlo; Dubini, Gabriele; Migliavacca, Francesco

    2011-12-01

    Despite their success, stenting procedures are still associated to some clinical problems like sub-acute thrombosis and in-stent restenosis. Several clinical studies associate these phenomena to a combination of both structural and hemodynamic alterations caused by stent implantation. Recently, numerical models have been widely used in the literature to investigate stenting procedures but always from either a purely structural or fluid dynamic point of view. The aim of this work is the implementation of sequential structural and fluid dynamic numerical models to provide a better understanding of stenting procedures in coronary bifurcations. In particular, the realistic geometrical configurations obtained with structural simulations were used to create the fluid domains employed within transient fluid dynamic analyses. This sequential approach was applied to investigate the final kissing balloon (FKB) inflation during the provisional side branch technique. Mechanical stresses in the arterial wall and the stent as well as wall shear stresses along the arterial wall were examined before and after the FKB deployment. FKB provoked average mechanical stresses in the arterial wall almost 2.5 times higher with respect to those induced by inflation of the stent in the main branch only. Results also enlightened FKB benefits in terms of improved local blood flow pattern for the side branch access. As a drawback, the FKB generates a larger region of low wall shear stress. In particular, after FKB the percentage of area characterized by wall shear stresses lower than 0.5 Pa was 79.0%, while before the FKB it was 62.3%. For these reasons, a new tapered balloon dedicated to bifurcations was proposed. The inclusion of the modified balloon has reduced the mechanical stresses in the proximal arterial vessel to 40% and the low wall shear stress coverage area to 71.3%. In conclusion, these results show the relevance of the adopted sequential approach to study the wall mechanics and

  16. Very late stent thrombosis of bare-metal coronary stent nine years after primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Đurić Predrag

    2016-01-01

    Full Text Available Introduction. Stent thrombosis (ST in clinical practice can be classified according to time of onset as early (0–30 days after stent implantation, which is further divided into acute ( 30 days and very late (> 12 months. Myocardial reinfaction due to very late ST in a patient receiving antithrombotic therapy is very rare, and potentially fatal. The procedure alone and related mechanical factors seem to be associated with acute/subacute ST. On the other hand, in-stent neoathero-sclerosis, inflammation, premature cessation of antiplatelet therapy, as well as stent fracture, stent malapposition, un-covered stent struts may play role in late/very late ST. Some findings implicate that the etiology of very late ST of bare-metal stent (BMS is quite different from those following drug-eluting stent (DES implantation. Case report. We presented a 56-year old male with acute inferoposterior ST segment elevation myocardial infarction (STEMI related to very late stent thrombosis, 9 years after BMS implantation, despite antithrombotic therapy. Thrombus aspiration was successfully performed followed by percutaneous coronary intervention (PCI with implantation of DES into the pre-viously implanted two stents to solve the in-stent restenosis. Conclusion. Very late stent thrombosis, although fortu-nately very rare, not completely understood, might cause myocardial reinfaction, but could be successfully treated with thrombus aspiration followed by primary PCI. Very late ST in the presented patient might be connected with neointimal plaque rupture, followed by thrombotic events.

  17. Coil Migration through a Neuroform 3 Stent during Endovascular Coiling. A Case Report.

    LENUS (Irish Health Repository)

    O'Hare, A

    2009-07-29

    Summary: A 43-year-old woman attended for stent assisted coiling. A Neuroform 30 x 4.5 mm stent had been successfully placed over the left periophthalmic aneurysm. During the coiling the first coil migrated through the crowns in the stent, lodging at the MCA bifurcation. We believe that the coil herniated through the overlying stent due to the carotid siphon curvature and the open cell design. Furthermore the distal markers of the stent impeded coil extraction with a MERCI device.

  18. Drug-eluting stents in renal artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Zaehringer, M. [Marienhospital Stuttgart, Department of Radiology, Stuttgart (Germany); Pattynama, P.M.T. [Erasmus MC-University Medical Center Rotterdam, Rotterdam (Netherlands); Talen, A. [genae associates nv, Antwerp (Belgium); Sapoval, M. [Hopital Europeen Georges Pompidou, Service de Radiologie Cardio-Vasculaire, Paris (France); Inserm U 780 epidemiologie Cardio Vasculaire, Paris (France)

    2008-04-15

    Because of higher acute and long-term success rates compared with balloon angioplasty alone, percutaneous stent implantation has become an accepted therapy for the treatment of atherosclerotic renal artery stenosis. Restenosis rates after successful renal stent placement vary from 6 up to 40%, depending on the definition of restenosis, the diameter of the treated vessel segment and comorbidities. The safety and efficacy of drug-eluting stents for the treatment of renal-artery stenosis is poorly defined. The recently published GREAT study is the only prospective study, comparing bare-metal and sirolimus-coated low profile stent systems in renal artery stenosis, showing a relative risk reduction of angiographic binary in-stent restenosis by 50%. This is an opinion paper on indications, current treatment options and restenosis rates following renal artery stenting and the potential use of drug-eluting stents for this indication. (orig.)

  19. Supporting successful implementation of public health interventions: protocol for a realist synthesis.

    Science.gov (United States)

    MacDonald, Marjorie; Pauly, Bernadette; Wong, Geoff; Schick-Makaroff, Kara; van Roode, Thea; Strosher, Heather Wilson; Kothari, Anita; Valaitis, Ruta; Manson, Heather; O'Briain, Warren; Carroll, Simon; Lee, Victoria; Tong, Samantha; Smith, Karen Dickenson; Ward, Megan

    2016-04-07

    There is a growing emphasis in public health on the importance of evidence-based interventions to improve population health and reduce health inequities. Equally important is the need for knowledge about how to implement these interventions successfully. Yet, a gap remains between the development of evidence-based public health interventions and their successful implementation. Conventional systematic reviews have been conducted on effective implementation in health care, but few in public health, so their relevance to public health is unclear. In most reviews, stringent inclusion criteria have excluded entire bodies of evidence that may be relevant for policy makers, program planners, and practitioners to understand implementation in the unique public health context. Realist synthesis is a theory-driven methodology that draws on diverse data from different study designs to explain how and why observed outcomes occur in different contexts and thus may be more appropriate for public health. This paper presents a realist review protocol to answer the research question: Why are some public health interventions successfully implemented and others not? Based on a review of implementation theories and frameworks, we developed an initial program theory, adapted for public health from the Consolidated Framework for Implementation Research, to explain the implementation outcomes of public health interventions within particular contexts. This will guide us through the review process, which comprises eight iterative steps based on established realist review guidelines and quality standards. We aim to refine this initial theory into a 'final' realist program theory that explains important context-mechanism-outcome configurations in the successful implementation of public health interventions. Developing new public health interventions is costly and policy windows that support their implementation can be short lived. Ineffective implementation wastes scarce resources and is

  20. BPR implementation process: an analysis of key success and failure factors

    Directory of Open Access Journals (Sweden)

    Mohamad Reza Khoshlafz

    2016-08-01

    Full Text Available This paper investigates the effects of different factors influencing on the successful implementation of the business process re-engineering (BPR in Iran. The study selects 386 experts randomly and using some statistical tests examines the effects of four groups of factors including strategic, organizational, methodologic and technological & educational issues on the success of the BPR implementation in Iran. The study designs a questionnaire in Likert scale and distributes it among some experts where Cronbach alpha was calculated as 0.71. The implementation of Pearson correlation ratio has confirmed that technological and educational factors marinated the highest effects (r = 0.523, Sig. = 0.000 followed by strategic (r = 0.505, Sig. = 0.000, organizational (r = 0.352, Sig. = 0.000 and methodologic issues (r = 0.267, Sig. = 0.000. In addition, the implementation of Stepwise regression has confirmed that technological & educational, strategic and methodologic factors influence on BPR in Iran.

  1. Critical success factors in implementing an e-rostering system in a healthcare organisation.

    Science.gov (United States)

    Soomro, Zahoor A; Ahmed, Javed; Muhammad, Raza; Hayes, Dawn; Shah, Mahmood H

    2017-01-01

    Effective and efficient staff scheduling has always been a challenging issue, especially in health service organisations. Both the extremes of staff shortage and overage have an adverse impact on the performance of healthcare organisations. In this case, an electronic and systematic staff scheduling (e-rostering) system is the often seen as the best solution. Unless an organisation has an effective implementation of such a system, possible cost savings, efficiency, and benefits could be minimal. This study is aimed to research key success factors for the successful effective implementation of an electronic rostering system, especially at healthcare organisations. A case study research method was used to evaluate critical success factors for effectively implementing an e-rostering system. The data were collected through interviews and observations. The findings indicate that technical support, an effective policy, leadership, clear goals and objectives, gradual change, evidence of the advantages of the new system, senior management support, and effective communication are the critical success factors in implementing an e-rostering system in healthcare organisations. Prior to this study, no such factors were grounded in the current context, so this research would help in bridging the gap towards effective implementation of an e-rostering system in the healthcare sector. This research also suggests future studies in different cultures and contexts.

  2. Implementing Moodle for e-learning for a successful knowledge management strategy

    OpenAIRE

    Dana Tessier; Kimiz Dalkir

    2016-01-01

    A knowledge management strategy was implemented in a call centre organization. Part of this strategy included an e-learning tool ‘Moodle’ to support employee training and knowledge management (KM) initiatives. The research looked at the ways in which the e-learning tool could be used to help successfully implement the knowledge management strategy – specifically, to improve knowledge transfer between employees, improve individual and organizational performance and have a better understanding ...

  3. Critical success factors for implementing supply chain information systems : insights from the pork industry

    OpenAIRE

    Denolf, J.M.

    2014-01-01

    Critical success factors for implementing supply chain information systems – Janne M. Denolf Due to intensified competition, companies realize that they should closely collaborate with their supply-chain partners to further cut costs and stay competitive. To do so, supply-chain partners should intensify information sharing, which is often facilitated through supply chain information systems (SCIS). Implementation of such a system is a complex undertaking due to the umpteen technical and...

  4. A Strategic Analysis for Successful Implementation of Social Media for SFU Business

    OpenAIRE

    Leung, Eric Yuk Wai

    2010-01-01

    Universities and other educational institutions are increasingly looking to leverage the power of social media to recruit new student, communicate with student, improve student services and collect feedback. Understanding social media is an important first step to ensure a successful implementation of social media as a communication strategy. This paper introduces social media and provides social media implementation strategies for SFU Business by focusing on the communication objectives of t...

  5. The Factors Influencing Successful Implementation of E-Commerce within SMEs Businesses

    OpenAIRE

    Supattra Kanchanopast

    2014-01-01

    The purpose of this research was to identify factors that influenced the success of e-commerce implementation within SMEs businesses. In order to achieve the objectives of this research, the researcher collected data from random firms in Thailand, both the users and those who are not using the e-commerce. The data was comprised of the results of 310 questionnaires, as well as 10 interviews with owner/managers of businesses who are currently using e-commerce successfully. ...

  6. Critical success factors for offshoring of enterprise resource planning (ERP implementations

    Directory of Open Access Journals (Sweden)

    Rajneesh Chauhan

    2012-01-01

    Full Text Available Background: In recent years, offshoring enterprise resource planning (ERP implementation has been an emerging trend in the field of offshoring information technology (IT. However, both ERP implementations and IT offshoring are fraught with risks, and when both ERP implementation and IT offshoring happen together, the risks become even more pronounced. Therefore, it is important to understand and identify the issues of ERP implementation in an offshoring situation. Objectives: The purpose of this paper is to highlight the key factors that enable successful offshoring ERP implementation from the client and the vendor perspective. Methods/Approach: The paper uses literature as a basis for identifying a critical success factor, data collected through semi-structured interviews with ERP managers at various levels of the subject organizations, and eventually their analysis. Results: The findings of the paper reveal that various factors are critical while implementing offshoring ERP. They include: offshoring partnership, project management, project team composition, people issues, communications and compliance of the onsite team composition. It is also noticed that ten factors are grouped into three categories: the client side, the vendor side, and both. Conclusions: Organizations are currently undertaking or considering the offshoring ERP implementation particularly from India. This paper will enable them to understand the possible challenges and areas of offshoring the ERP implementation program. The value and originality of the paper comes from the fact that up to now, ERP implementation in offshoring has not been comprehensively explored. This research provides a complete understanding of the critical success factors from the client, the vendor or both the client and the vendor perspective. It also enables researchers to analyse ili rethink ili review offshoring in different service areas.

  7. Determinants of successful implementation of population-based cancer screening programmes

    DEFF Research Database (Denmark)

    Lynge, Elsebeth; Törnberg, Sven; von Karsa, Lawrence

    2012-01-01

    consider when planning, implementing and running population based cancer screening programmes. The list is general and is applicable to breast, cervical and colorectal cancer screening. It is based on evidence presented in the three European Union guidelines on quality assurance in cancer screening......) piloting or trial implementation, (5) scaling up from pilot to service, (6) running of full-scale programme, and (7) sustainability. For each phase, a substantial number of specified conditions have to be met. Successful implementation of a cancer screening programme requires societal acceptance and local...

  8. Magnetizable stent-grafts enable endothelial cell capture

    Energy Technology Data Exchange (ETDEWEB)

    Tefft, Brandon J. [Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States); Uthamaraj, Susheil [Division of Engineering, Mayo Clinic, Rochester, MN (United States); Harburn, J. Jonathan [School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees (United Kingdom); Hlinomaz, Ota [Department of Cardioangiology, St. Anne' s University Hospital, Brno (Czech Republic); Lerman, Amir [Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States); Dragomir-Daescu, Dan [Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN (United States); Sandhu, Gurpreet S., E-mail: sandhu.gurpreet@mayo.edu [Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States)

    2017-04-01

    Emerging nanotechnologies have enabled the use of magnetic forces to guide the movement of magnetically-labeled cells, drugs, and other therapeutic agents. Endothelial cells labeled with superparamagnetic iron oxide nanoparticles (SPION) have previously been captured on the surface of magnetizable 2205 duplex stainless steel stents in a porcine coronary implantation model. Recently, we have coated these stents with electrospun polyurethane nanofibers to fabricate prototype stent-grafts. Facilitated endothelialization may help improve the healing of arteries treated with stent-grafts, reduce the risk of thrombosis and restenosis, and enable small-caliber applications. When placed in a SPION-labeled endothelial cell suspension in the presence of an external magnetic field, magnetized stent-grafts successfully captured cells to the surface regions adjacent to the stent struts. Implantation within the coronary circulation of pigs (n=13) followed immediately by SPION-labeled autologous endothelial cell delivery resulted in widely patent devices with a thin, uniform neointima and no signs of thrombosis or inflammation at 7 days. Furthermore, the magnetized stent-grafts successfully captured and retained SPION-labeled endothelial cells to select regions adjacent to stent struts and between stent struts, whereas the non-magnetized control stent-grafts did not. Early results with these prototype devices are encouraging and further refinements will be necessary in order to achieve more uniform cell capture and complete endothelialization. Once optimized, this approach may lead to more rapid and complete healing of vascular stent-grafts with a concomitant improvement in long-term device performance. - Highlights: • Magnetic stent-grafts were made from 2205 steel stents and polyurethane nanofibers. • Stent-grafts remained patent and formed a thin and uniform neointima when implanted. • Stent-grafts captured endothelial cells labeled with magnetic nanoparticles.

  9. Successful Implementation of Clinical Information Technology: Seven Key Lessons from CPOE.

    Science.gov (United States)

    Gellert, G A; Hill, V; Bruner, K; Maciaz, G; Saucedo, L; Catzoela, L; Ramirez, R; Jacobs, W J; Nguyen, P; Patel, L; Webster, S L

    2015-01-01

    To identify and describe the most critical strategic and operational contributors to the successful implementation of clinical information technologies, as deployed within a moderate sized system of U.S. community hospitals. CHRISTUS Health is a multi-state system comprised of more than 350 services and 60 hospitals with over 9 000 physicians. The Santa Rosa region of CHRISTUS Health, located in greater San Antonio, Texas is comprised of three adult community hospital facilities and one Children's hospital each with bed capacities of 142-180. Computerized Patient Order Entry (CPOE) was first implemented in 2012 within a complex market environment. The Santa Rosa region has 2 417 credentialed physicians and 263 mid-level allied health professionals. This report focuses on the seven most valuable strategies deployed by the Health Informatics team in a large four hospital CHRISTUS region to achieve strong CPOE adoption and critical success lessons learned. The findings are placed within the context of the literature describing best practices in health information technology implementation. While the elements described involved discrete de novo process generation to support implementation and operations, collectively they represent the creation of a new customer-centric service culture in our Health Informatics team, which has served as a foundation for ensuring strong clinical information technology adoption beyond CPOE. The seven success factors described are not limited in their value to and impact on CPOE adoption, but generalize to - and can advance success in - varied other clinical information technology implementations across diverse hospitals. A number of these factors are supported by reports in the literature of other institutions' successful implementations of CPOE and other clinical information technologies, and while not prescriptive to other settings, may be adapted to yield value elsewhere.

  10. Critical success factors simplified implementing the powerful drivers of dramatic business improvement

    CERN Document Server

    Howell, Marvin T

    2010-01-01

    Critical-to-success factors (CSFs) have become essential elements to strategic planning and no business can achieve consistent success without effectively adopting them. To take full advantage of CSFs, however, an organization must first understand what they are and how they can be used to drive organizational initiatives and processes. Critical Success Factors Simplified: Implementing the Powerful Drivers of Dramatic Business Improvement provides a concise manual on CSFs that will teach you how to identify and select the right CSFs, measure their impact, and adjust them as needed to reach your goals.

  11. Health information exchange implementation: lessons learned and critical success factors from a case study.

    Science.gov (United States)

    Feldman, Sue S; Schooley, Benjamin L; Bhavsar, Grishma P

    2014-08-15

    Much attention has been given to the proposition that the exchange of health information as an act, and health information exchange (HIE), as an entity, are critical components of a framework for health care change, yet little has been studied to understand the value proposition of implementing HIE with a statewide HIE. Such an organization facilitates the exchange of health information across disparate systems, thus following patients as they move across different care settings and encounters, whether or not they share an organizational affiliation. A sociotechnical systems approach and an interorganizational systems framework were used to examine implementation of a health system electronic medical record (EMR) system onto a statewide HIE, under a cooperative agreement with the Office of the National Coordinator for Health Information Technology, and its collaborating organizations. The objective of the study was to focus on the implementation of a health system onto a statewide HIE; provide insight into the technical, organizational, and governance aspects of a large private health system and the Virginia statewide HIE (organizations with the shared goal of exchanging health information); and to understand the organizational motivations and value propositions apparent during HIE implementation. We used a formative evaluation methodology to investigate the first implementation of a health system onto the statewide HIE. Qualitative methods (direct observation, 36 hours), informal information gathering, semistructured interviews (N=12), and document analysis were used to gather data between August 12, 2012 and June 24, 2013. Derived from sociotechnical concepts, a Blended Value Collaboration Enactment Framework guided the data gathering and analysis to understand organizational stakeholders' perspectives across technical, organizational, and governance dimensions. Several challenges, successes, and lessons learned during the implementation of a health system to the

  12. Health Information Exchange Implementation: Lessons Learned and Critical Success Factors From a Case Study

    Science.gov (United States)

    2014-01-01

    Background Much attention has been given to the proposition that the exchange of health information as an act, and health information exchange (HIE), as an entity, are critical components of a framework for health care change, yet little has been studied to understand the value proposition of implementing HIE with a statewide HIE. Such an organization facilitates the exchange of health information across disparate systems, thus following patients as they move across different care settings and encounters, whether or not they share an organizational affiliation. A sociotechnical systems approach and an interorganizational systems framework were used to examine implementation of a health system electronic medical record (EMR) system onto a statewide HIE, under a cooperative agreement with the Office of the National Coordinator for Health Information Technology, and its collaborating organizations. Objective The objective of the study was to focus on the implementation of a health system onto a statewide HIE; provide insight into the technical, organizational, and governance aspects of a large private health system and the Virginia statewide HIE (organizations with the shared goal of exchanging health information); and to understand the organizational motivations and value propositions apparent during HIE implementation. Methods We used a formative evaluation methodology to investigate the first implementation of a health system onto the statewide HIE. Qualitative methods (direct observation, 36 hours), informal information gathering, semistructured interviews (N=12), and document analysis were used to gather data between August 12, 2012 and June 24, 2013. Derived from sociotechnical concepts, a Blended Value Collaboration Enactment Framework guided the data gathering and analysis to understand organizational stakeholders’ perspectives across technical, organizational, and governance dimensions. Results Several challenges, successes, and lessons learned during the

  13. How organizational escalation prevention potential affects success of implementation of innovations: Electronic medical records in hospitals

    NARCIS (Netherlands)

    M.S. Lambooij (Mattijs); F. Koster (Ferry)

    2016-01-01

    textabstractBackground: Escalation of commitment is the tendency that (innovation) projects continue, even if it is clear that they will not be successful and/or become extremely costly. Escalation prevention potential (EPP), the capability of an organization to stop or steer implementation

  14. Critical success factors for implementing supply chain information systems : insights from the pork industry

    NARCIS (Netherlands)

    Denolf, J.M.

    2014-01-01

    Critical success factors for implementing supply chain information systems – Janne M. Denolf Due to intensified competition, companies realize that they should closely collaborate with their supply-chain partners to further cut costs and stay competitive. To do so,

  15. Lessons for Implementation from the World's Most Successful Programme: The Global Eradication of Smallpox.

    Science.gov (United States)

    Pratt, David

    1999-01-01

    Focuses on lessons educators might learn from the Intensified Campaign for the Global Eradication of Smallpox. Outlines the history of smallpox eradication. Discusses the eradication effort's obstacles, campaign, and costs and benefits. Considers five factors relevant to the successful implementation of educational programs. (CMK)

  16. How to successfully implement E-learning for both students and teachers.

    NARCIS (Netherlands)

    Gotthardt, M.; Siegert, M.J.; Schlieck, A.; Schneider, S.; Kohnert, A.; Gross, M.W.; Schafer, C.; Wagner, R.; Hormann, S.; Behr, T.M.; Engenhart-Cabillic, R.; Klose, K.J.; Jungclas, H.; Glowalla, U.

    2006-01-01

    RATIONALE AND OBJECTIVES: Electronic learning (e-learning) may provide a means to enhance learning efficacy. However, introduction of e-learning often fails. We describe a strategy of how an e-learning curriculum was successfully implemented. MATERIALS AND METHODS:The curriculum was designed based

  17. KM Critical Success Factors: A Comparison of Perceived Importance Versus Implementation in Malaysian ICT Companies

    Science.gov (United States)

    Chong, Siong Choy

    2006-01-01

    Purpose: This research examines the level of perception and implementation of 11 identified knowledge management (KM) success factors and their differences among the information and communication technology (ICT) companies operating in Malaysia. Design/methodology/approach: The survey data was obtained from a study of 427 middle managers from 194…

  18. Implementing the KPMG Value Explorer: Critical success factors for applying IC measurement tools

    NARCIS (Netherlands)

    Dr. Daan Andriessen

    2005-01-01

    Purpose This paper describes the result of an empirical study into the critical success factors for implementing an intellectual capital valuation method, the KPMG Value Explorer®. Methodology/Approach For this study the design approach was used as research methodology. Findings The research shows

  19. School Culture Benchmarks: Bridges and Barriers to Successful Bullying Prevention Program Implementation

    Science.gov (United States)

    Coyle, H. Elizabeth

    2008-01-01

    A substantial body of research indicates that positive school culture benchmarks are integrally tied to the success of school reform and change in general. Additionally, an emerging body of research suggests a similar role for school culture in effective implementation of school violence prevention and intervention efforts. However, little…

  20. Leadership, Control, Communication and Comprehension: Key Factors in Successful Implementation of SBDM.

    Science.gov (United States)

    Etheridge, Carol Plata; And Others

    This study examines the effects of principal leadership styles on the development of the working styles of seven local school councils in Memphis (Tennessee) during their first 15 months of operation. The successful implementation of a school-based decision making (SBDM) management model depends upon the ability of the local school council to…

  1. Steps to Ensure a Successful Implementation of Occupational Health and Safety Interventions at an Organizational Level

    Science.gov (United States)

    Herrera-Sánchez, Isabel M.; León-Pérez, José M.; León-Rubio, José M.

    2017-01-01

    There is increasing meta-analytic evidence that addresses the positive impact of evidence-based occupational health and safety interventions on employee health and well-being. However, such evidence is less clear when interventions are approached at an organizational level and are aimed at changing organizational policies and processes. Given that occupational health and safety interventions are usually tailored to specific organizational contexts, generalizing and transferring such interventions to other organizations is a complex endeavor. In response, several authors have argued that an evaluation of the implementation process is crucial for assessing the intervention’s effectiveness and for understanding how and why the intervention has been (un)successful. Thus, this paper focuses on the implementation process and attempts to move this field forward by identifying the main factors that contribute toward ensuring a greater success of occupational health and safety interventions conducted at the organizational level. In doing so, we propose some steps that can guide a successful implementation. These implementation steps are illustrated using examples of evidence-based best practices reported in the literature that have described and systematically evaluated the implementation process behind their interventions during the last decade. PMID:29375413

  2. Prioritizing critical success factors for reverse logistics implementation using fuzzy-TOPSIS methodology

    Science.gov (United States)

    Agrawal, Saurabh; Singh, Rajesh K.; Murtaza, Qasim

    2016-11-01

    Electronics industry is one of the fastest growing industries in the world. In India also, there are high turnovers and growing demand of electronics product especially after post liberalization in early nineties. These products generate e-waste which has become big environmental issue. Industries can handle these e-waste and product returns efficiently by developing reverse logistics (RL) system. A thorough study of critical success factors (CSFs) and their ordered implementation is essential for successful RL implementation. The aim of the study is to review the CSFs, and to prioritize them for RL implementation in Indian electronics industry. Twelve CSFs were identified through literature review, and discussion with the experts from the Indian electronics industry. Fuzzy-Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) approach is proposed for prioritizing these CSFs. Perusal of literature indicates that fuzzy-TOPSIS has not been applied earlier for prioritization of CSFs in Indian electronics industry. Five Indian electronics companies were selected for evaluation of this methodology. Results indicate that most of the identified factors are crucial for the RL implementation. Top management awareness, resource management, economic factors, and contracts terms and conditions are top four prioritized factor, and process capabilities and skilled workers is the least prioritized factor. The findings will be useful for successful RL implementation in Indian electronics industry.

  3. Enablers of the successful implementation of CIM in small and medium enterprises: an empirical analysis

    Science.gov (United States)

    Marri, H. B.; Gunasekaran, Angappa

    2001-10-01

    Small and Medium Enterprises (SMEs) play an important role in the national economy. Since manufacturing has become global, the competition is high among manufacturing/service industries to provide quality goods and services at competitive prices. Computer Integrated Manufacturing (CIM) is a generic term for a group of manufacturing technologies that combine both scope and scale capabilities that are making fundamental changes to manufacturing industry. The enablers of CIM play an important role in the implementation of CIM by SMEs to compete in the global market. Considering the importance of enablers of the successful implementation of CIM, the critical success factors for the implementation of CIM in SMEs have been identified with the help of an empirical study conducted with British SMEs.

  4. EXPLORING CRITICAL FACTORS FOR SUCCESSFULLY IMPLEMENTING LEAN MANUFACTURING AT MANUFACTURING COMPANIES IN VIETNAM

    Directory of Open Access Journals (Sweden)

    Nguyen Thi Duc Nguyen

    2017-06-01

    Full Text Available This study focuses on exploring the factors that influence the success of the Lean Manufacturing implementation at manufacturing companies in Vietnam. The mix-research methods are applied, including: reviewing previous studies, in-depth interviewing with experts in manufacturing field and case study-researching at two typical manufacturing companies in Vietnam. The results show that the significant issues, such as: leadership, communication at work, firm's financial capacity, employee's skills and expertise, organizational culture, customer and supplier management are the critical factors leading to the success of Lean Manufacturing implementation at manufacturing companies in Vietnam. Overall, this study provides the suggestions to business managers, especially Vietnamese managers, orienting toward utilizing resource on core activities to efficiently achieve Lean Manufacturing implementation.

  5. A Method to Evaluate Critical Factors for Successful Implementation of Clinical Pathways.

    Science.gov (United States)

    Dong, W; Huang, Z

    2015-01-01

    Clinical pathways (CPs) have been viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Despite widespread enthusiasm for CPs, research has shown that many CP initiatives are unsuccessful. To this end, this study provides a methodology to evaluate critical success factors (CSFs) that can aid healthcare organizations to achieve successful CP implementation. This study presents a new approach to evaluate CP implementation CSFs, with the aims being: (1) to identify CSFs for implementation of CPs through a comprehensive literature review and interviews with collaborative experts; (2) to use a filed study data with a robust fuzzy DEMATEL (the decision making trial and evaluation laboratory) approach to visualize the structure of complicated causal relationships between CSFs and obtain the influence level of these factors. The filed study data is provided by ten clinical experts of a Chinese hospital. 23 identified CSF factors which are initially identified through a review of the literature and interviews with collaborative experts. Then, a number of direct and indirect relationships are derived from the data such that different perceptions can be integrated into a compromised cause and effect model of CP implementation. The results indicate that the proposed approach can systematically evaluate CSFs and realize the importance of each factor such that the most common causes of failure of CP implementation could be eliminated or avoided. Therefore, the tool proposed would help healthcare organizations to manage CP implementation in a more effective and proactive way.

  6. The Key Success and Strategic Role of Accrual Based Accounting Implementation

    Directory of Open Access Journals (Sweden)

    Surepno Surepno

    2015-09-01

    Full Text Available Central Government policy to adopt accrual-based accounting system providing consequences for local governments to apply accrual accounting in the financial statements. Empirical evidence shows that the readiness of the local government in Indonesia in the process of implementation of accrual accounting is still relatively low. This study aimed to analyze the success of Semarang Government in implementing accrual accounting. This study also analyzes the offender's response to the implementation of the strategic role of accrual accounting in transparency and accountability. Furthermore, the method used in this study is a qualitative approach to perform a case study at the Department of Finance and Asset Management Area (DPKAD Semarang by means of interviewing the key actors of implementation. The results showed that the successful implementation of accrual accounting Semarang government is supported by four main strategies, namely management commitment, regulatory development, information systems development and human resource development. Furthermore, based on the conclusions of the implementers shows that accrual accounting has a strategic role in increasing transparency and accountability through financial reporting.

  7. Critical success factors for implementing risk management systems in developing countries

    Directory of Open Access Journals (Sweden)

    M.Reza Hosseini

    2016-03-01

    Full Text Available A review of published studies on risk management in developing countries reveals that critical success factors for implementing risk management has remained an under-researched area of investigation. This paper is aimed at investigating the perceptions of construction professionals concerning the critical success factors (CSFs for implementation of risk management systems (IRMS. Survey data was collected from 87 construction professionals from the Iranian construction industry as a developing country. The results indicate that four factors are regarded as highly critical: ‘support from managers’, ‘inclusion of risk management in construction education and training courses for construction practitioners’, ‘attempting to deliver projects systematically’, and ‘awareness and knowledge of the process for implementing risk management’. Assessing the associations among CSFs also highlighted the crucial role of enhancing the effectiveness of knowledge management practices in construction organisations. Study also revealed that parties involved in projects do not agree on the level of importance of CSFs for implementing risk management in developing countries. This study contributes to practice and research in several ways. For practice, it increases understanding of how closely knowledge management is associated with the implementation of risk management systems in developing countries. For research, the findings would encourage construction practitioners to support effective knowledge management as a precursor to higher levels of risk management implementation on construction projects.

  8. Developing and validating a model to predict the success of an IHCS implementation: the Readiness for Implementation Model

    Science.gov (United States)

    Gustafson, David H; Hawkins, Robert P; Brennan, Patricia F; Dinauer, Susan; Johnson, Pauley R; Siegler, Tracy

    2010-01-01

    Objective To develop and validate the Readiness for Implementation Model (RIM). This model predicts a healthcare organization's potential for success in implementing an interactive health communication system (IHCS). The model consists of seven weighted factors, with each factor containing five to seven elements. Design Two decision-analytic approaches, self-explicated and conjoint analysis, were used to measure the weights of the RIM with a sample of 410 experts. The RIM model with weights was then validated in a prospective study of 25 IHCS implementation cases. Measurements Orthogonal main effects design was used to develop 700 conjoint-analysis profiles, which varied on seven factors. Each of the 410 experts rated the importance and desirability of the factors and their levels, as well as a set of 10 different profiles. For the prospective 25-case validation, three time-repeated measures of the RIM scores were collected for comparison with the implementation outcomes. Results Two of the seven factors, ‘organizational motivation’ and ‘meeting user needs,’ were found to be most important in predicting implementation readiness. No statistically significant difference was found in the predictive validity of the two approaches (self-explicated and conjoint analysis). The RIM was a better predictor for the 1-year implementation outcome than the half-year outcome. Limitations The expert sample, the order of the survey tasks, the additive model, and basing the RIM cut-off score on experience are possible limitations of the study. Conclusion The RIM needs to be empirically evaluated in institutions adopting IHCS and sustaining the system in the long term. PMID:20962135

  9. Partnerships for successful enterprise transformation of forest industry companies implementing the forest biorefinery

    Energy Technology Data Exchange (ETDEWEB)

    Chambost, V.; Stuart, P.R. [Natural Sciences and Engineering Research Council of Canada, Ottawa, ON (Canada); Ecole Polytechnique, Montreal, PQ (Canada). Dept. de Genie Chimique, Environmental Design Engineering Chair; McNutt, J. [Georgia Institute of Technology, Inst. of Paper Science and Technology, Atlanta, GA (United States). Center for Paper Business and Industry Studies

    2009-05-15

    Forest product companies can diversify their revenues and improve their profitability through the implementation of the forest biorefinery. Although there are many possible biorefinery routes that may be feasible for a company, only a few options will bring sustainable competitive advantages. Forestry companies that limit their consideration of the biorefinery as an investment in projects that yield interesting returns in the short term, such as pellet mills or biofuels, may or may not be successful at transforming the business models of their companies in the long term. The recommended approach is to identify new added-value biorefinery products to be manufactured over the longer term, the new supply chain mechanisms needed for their efficient delivery, and the quality partners needed to be successful in this objective. This paper considered the overall approach that forestry companies might consider for the implementation of the forest biorefinery, the enterprise transformations implicated, as well as the partnerships that must be created in order to mitigate risk and enhance the potential for success of biorefinery implementation. The main purpose of the paper was to demonstrate the importance of developing a long-term, sustainable biorefinery vision, as opposed to considering only short-term cash flow objectives, and the linkage of this with partnership selection. The paper provided examples of strategic partnerships for biofuels/bio-products development as well as examples of potential biorefinery partners for a forest company considering implementation of the forest biorefinery. Other illustrations that were offered included a strategic phased implementation of the forest biorefinery and an example of an evolved product portfolio for a forestry company implementing the biorefinery. It was concluded that in implementing the forest biorefinery, forest product companies must understand the linkage of markets, products, and processes with partnerships and

  10. Malignant duodenal obstructions: palliative treatment with covered expandable nitinol stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Chul; Jung, Gyoo Sik; Lee, Sang Hee; Kim, Sung Min; Oh, Kyung Seung; Huh, Jin Do; Cho, Young Duk [College of Medicine, Kosin Univ, Pusan (Korea, Republic of); Song, Ho Young [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-04-01

    To evaluate the feasibility and clinical effectiveness of using a polyurethane-covered expandable nitinol stent in the palliative treatment of malignant duodenal obstruction. Under fluoroscopic guidance, a polyurethane-covered expandable nitinol stent was placed in 12 consecutive patients with malignant duodenal obstructions. All presented with severe nausea and recurrent vomiting. The underlying causes of obstruction were duodenal carcinoma (n=4), pancreatic carcinoma (n=4), gall bladder carcinoma (n=2), distal CBD carcinoma (n=1), and uterine cervical carcinoma (n=1). The sites of obstruction were part I (n=1), part II (n=8), and III (n=3). Due to pre-existing jaundice, eight patients with part II obstructions underwent biliary decompression prior to stent placement. An introducer sheath with a 6-mm outer diameter and stents 16 mm in diameter were employed, and to place the stent, and after-loading technique was used. Stent placement was technically successful in ten patients, and no procedural complications occuured. In one of two patients in whom there was technical failure, and in whom the obstructions were located in part III, the stent was placed transgastrically. Stent migration occurred in one patient four days after the procedure, and treatment involved the palcement of a second, uncovered, nitinol stent. After stent placement, symptoms improved in all patients. During follow-up, obstructive symptoms due to stent stenosis (n=1), colonic obstruction (n=1), and multiple small bowel obstruction (n=1) recurred in three patients. Two of these were treated by placing additional stents in the duodenum and colon, respectively. One of the eight patients in whom a stent was placed in the second portion of the duodenum developed jaundice. The patients died a mean 14 (median, 9) weeks after stent placement. The placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible, safe and effective for the palliative treatment of malignant

  11. Biodegradable stents for the treatment of bowel strictures in Crohn's disease

    DEFF Research Database (Denmark)

    Karstensen, John Gásdal; Risager Christensen, Katrine; Brynskov, Jørn

    2016-01-01

    success of biodegradable stents for treatment of inflamed Crohn's strictures refractory to endoscopic balloon dilatation. PATIENTS AND METHODS: Consecutive patients treated with biodegradable stents due to Crohn's disease and inflamed bowel strictures refractory to endoscopic balloon dilatation were...

  12. Key factors in the successful implementation of enterprise resource planning system

    Directory of Open Access Journals (Sweden)

    Farajollah Rahnavard

    2014-04-01

    Full Text Available Enterprise Resource Planning Systems (ERP are considered as the newest and most effective tools of enterprise resource planning and include an interconnected information, management and engineering system that meets all the needs of an organization. ERP implementation is costly and time-consuming and makes fundamental change in the process, if not implemented correctly it will cause challenges in most parts of the organization and will certainly fail. Therefore, the identification of key success factors in implementing ERP helps organizations avoid the loss of the project. This research aims to identify key success factors for ERP by examining 185 managers, professionals, experts of the Information and Communication Technology Institute associated with the Ministry of Communications and Information Technology of Iran. A questionnaire was used to collect data. Findings from exploratory factor analysis indicate that five factors: 1 user friendliness, flexible and consistency 2 establishment of project management; 3 alignment with user needs; 4 Management of organizational changes, and 5 observing the principles of successful implementation of ERP affect the institute and the corresponding suggestions are proposed consistent with these findings.

  13. Improving Knowledge Management in the Health Service: Re-Engineering Approach Towards Successful Implementation

    Science.gov (United States)

    Gyampoh-Vidogah, Regina; Moreton, Robert

    Changes to business practices involve risks. There has always been an attempt to develop various concepts for successful restructuring of business processes to enable technology adoption. This is due to the fact that the success of any business depends as much on how it is structured, as well as its ability to adopt new technology. As a consequence, the great success stories of the global economy emanate from those organisations most capable of adopting new technology, which invariably includes information technology (IT). This chapter examines how business process re-engineering (BPR) can be used to improve knowledge management (KM) in health services by (i) assessing the effectiveness and usefulness of BPR; (ii) present a critical review of approaches to BPR; and (iii) describe a framework for using BPR for KM based on empirical research. The aim is to provide a sound strategic and tactical management approach for successful implementation of knowledge management systems (KMS) to improve health-care service project administration.

  14. Computational Modeling to Predict Fatigue Behavior of NiTi Stents: What Do We Need?

    Directory of Open Access Journals (Sweden)

    Elena Dordoni

    2015-05-01

    Full Text Available NiTi (nickel-titanium stents are nowadays commonly used for the percutaneous treatment of peripheral arterial disease. However, their effectiveness is still debated in the clinical field. In fact a peculiar cyclic biomechanical environment is created before and after stent implantation, with the risk of device fatigue failure. An accurate study of the device fatigue behavior is of primary importance to ensure a successful stenting procedure. Regulatory authorities recognize the possibility of performing computational analyses instead of experimental tests for the assessment of medical devices. However, confidence in numerical methods is only possible after verification and validation of the models used. For the case of NiTi stents, mechanical properties are strongly dependent on the device dimensions and the whole treatments undergone during manufacturing process. Hence, special attention should be paid to the accuracy of the description of the device geometry and the material properties implementation into the numerical code, as well as to the definition of the fatigue limit. In this paper, a path for setting up an effective numerical model for NiTi stent fatigue assessment is proposed and the results of its application in a specific case study are illustrated.

  15. Effect of PlA1/A2 glycoprotein IIIa gene polymorphism on the long-term outcome after successful coronary stenting

    Directory of Open Access Journals (Sweden)

    Riddell John

    2007-11-01

    Full Text Available Abstract Aim To prospectively determine the role of platelet glycoprotein IIIa (GP IIIa gene PlA1/PlA2 polymorphism on the long-term clinical outcome in patients with coronary artery disease undergoing coronary stenting. Design and setting Prospective observational study in the University Hospital of Caen (France. Patients and methods 1 111 symptomatic consecutive Caucasian patients treated with percutaneous coronary intervention including stent implantation underwent genotyping for GP IIIa PlA1/A2. Main outcome measures Long-term clinical outcome in terms of the rate of major adverse cardiac events (MACE, ie death from any cause, non-fatal Q wave or non Q wave myocardial infarction, and need for coronary revascularisation was obtained and subsequently stratified according to the GP IIIa PlA1/A2 polymorphism. Results Three groups of patients were determined according to the GP IIIa PlA1/A2 polymorphism (71.6% had the A1/A1, 25.8% had the A1/A2 and 2.6% had the A2/A2 genotype. These three groups were comparable for all clinical characteristics including sex ratio, mean age, vascular risk factors, previous coronary events, baseline angiographic exam, indication for the percutaneous coronary intervention and drug therapy. The incidence of MACE was similar in these 3 groups of patients during a mean follow-up period of 654+/-152 days. Independent risk factors for MACE were a left ventricular ejection fraction Conclusion The GP IIIa PlA1/A2 polymorphism does not influence the clinical long-term outcome in patients with symptomatic coronary disease undergoing percutaneous coronary intervention with stent implantation.

  16. Two Stage Analysis of Successful Change Implementation of Knowledge Management Strategies in Energy Companies from Romania

    Directory of Open Access Journals (Sweden)

    Eduard Gabriel Ceptureanu

    2017-11-01

    Full Text Available The purpose of this paper is to emphasize the effects of knowledge management strategies toward organizational change in Romanian companies from the energy sector. This study explored a new vision to implement these types of organizational changes successfully in companies from the Romanian sector of energy and obtain their early benefits by using knowledge management strategies and also reveal the mediating effect of organizational learning and readiness for change. The results highlighted how energy companies can implement an Enterprise Resource Planning (ERP-based change effectively through KM strategies. The results are equally valuable for all Romanian organizations that are currently changing their working environment.

  17. Positive School and Classroom Environment: Precursors of Successful Implementation of Positive Youth Development Programs

    Directory of Open Access Journals (Sweden)

    Rachel C. F. Sun

    2008-01-01

    Full Text Available This case study was based on a school where the Tier 1 Program of the Project P.A.T.H.S. was integrated into the formal curriculum. In this case study, an interview with the school principal, vice-principal, and social worker was conducted in order to understand their perceptions of administrative arrangements and issues in the school, implementation characteristics, program effectiveness, program success, and overall impression. Results showed that several positive school and classroom attributes were conducive to program success, including positive school culture and belief in students' potentials, an inviting school environment, an encouraging classroom environment, high involvement of school administrative personnel, and systematic program arrangement.

  18. A Primary Human Critical Success Factors Model for the ERP System Implementation

    Directory of Open Access Journals (Sweden)

    Jenko Aleksander

    2016-08-01

    Full Text Available Background and Purpose: Many researchers have investigated various Critical success factors (CSFs and the different causes of ERP implementation project failures. Despite a detailed literature preview, we were unable to find an appropriate research with a comprehensive overview of the true causes behind CSFs, observed from a human factors perspective. The objective of this research was therefore to develop and evaluate the Primary human factors (PHFs model and to confirm the significant impact of PHFs on traditional CSFs and on the project success.

  19. Treatment of malignant gastroduodenal obstruction with using a newly designed complex expandable nitinol stent: initial experiences

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Mi Hee; Ko, Ji Ho; Lee, Eun Jung; Oh, Kyeng Seung; Huh, Jin Do; Cho, Young Duk; Park, Seun Ja [College of Medicine, Kosin University, Busan (Korea, Republic of); Jung, Gyoo Sik [Ulsan Hospital, Ulsan (Korea, Republic of)

    2005-12-15

    We wanted to evaluate the usefulness of a new type of a complex expandable nitinol stent that was designed to reduce the stent's propensity to migration during the treatment of malignant gastroduodenal obstructions. Two types of expandable nitinol stent were constructed by weaving a single thread of 0.2mm nitinol wire in a tubular configuration: an uncovered stent 18mm in diameter and a covered stent 16mm in diameter. Both ends of the covered stent were fabricated by coaxially inserting the covered stent into the tubular uncovered stent and then attaching the two stents together with using nylon monofilament. Under fluoroscopic guidance, the stent was placed in 29 consecutive patients (20 men and 9 women, mean age: 65 years) who were suffering with malignant gastric outlet obstruction (n=20), duodenal obstruction (n=6) or combined obstruction (n=3). Clinical improvement was assessed by comparing the food intake capacity before and after the procedure. The complications were investigated during the follow up period. Stent placement was successful in all the patients. After stent placement, the symptoms improved in all but one patient. During the follow up, stent migration occurred in one patient (3%) at 34 days after the procedure. Despite the stent migration, the patient was able to resume a soft diet. Six patients developed recurrent symptoms of obstruction with tumor overgrowth at a mean of 145 days after the procedure; all the patients underwent coaxial placement of an additional stent with good results. One patient showed recurrence of obstruction due to tumor in-growth, and this was treated by placement of a second stent. Two patients with stent placement in the duodenum suffered from jaundice 26 days and 65 days, respectively, after their procedures. Placement of the newly designed complex expandable nitinol stent seems to be effective for the palliative treatment of malignant gastroduodenal obstructions. The new stent also seems to help overcome the

  20. Successful language dialogue project implementation; Erfolgreiche Planung und Durchfuehrung von Sprachausgabesystemen

    Energy Technology Data Exchange (ETDEWEB)

    Reber, M.; Lehmann, E.; Rohr, N. [Svox AG, Zuerich (Switzerland)

    2006-11-15

    Text-to-Speech (TTS) based multilingual voice output systems have become a standard in the automotive industry. The increasingly complex challenges within the automated voice output market can be masterfully managed through careful adherence to a few important ground rules. The bulk of this article from the Svox AG is devoted to explaining how to optimize project implementation, based on the long-standing collaborative success with OEM and Tier-1 partners. (orig.)

  1. Nursing first. Smart CIOs are partnering with nurse executives for IT implementation success.

    Science.gov (United States)

    Hagland, Mark

    2008-11-01

    CIO/CNO partnership is critical to system implementation success. Focusing on mutual/organization-wide goals, such as clinical transformation and improved patient safety, can help provide a shared understanding of what will be needed for projects to work. A key position emerging in many organizations is that of vice president or director of clinical informatics, usually with a team reporting to him/her.

  2. EXPLORING CRITICAL FACTORS FOR SUCCESSFULLY IMPLEMENTING LEAN MANUFACTURING AT MANUFACTURING COMPANIES IN VIETNAM

    OpenAIRE

    Nguyen Thi Duc Nguyen; Nguyen Quoc Chinh

    2017-01-01

    This study focuses on exploring the factors that influence the success of the Lean Manufacturing implementation at manufacturing companies in Vietnam. The mix-research methods are applied, including: reviewing previous studies, in-depth interviewing with experts in manufacturing field and case study-researching at two typical manufacturing companies in Vietnam. The results show that the significant issues, such as: leadership, communication at work, firm's financial capacity, employee's skill...

  3. Assessment of contrast flow modification in aneurysms treated with closed-cell self-deploying asymmetric vascular stents (SAVS)

    Science.gov (United States)

    Ionita, Ciprian N.; Wang, Weiyuan; Bednarek, Daniel R.; Rudin, Stephen

    2010-03-01

    The Asymmetric Vascular Stent (AVS) for intracranial aneurysm (IA) treatment is an experimental device, specially designed for intra-aneurysmal blood flow diversion and thrombosis promotion. The stent has a low-porous patch to cover only the aneurysm neck while the rest of the stent is very porous to avoid blockage of adjacent branches. The latest AVS design is similar to state-of-art, closed-cell, self-expanding, neurovascular stent. The stents were used to treat sixteen rabbit-elastase aneurysm models. The treatment effect was analyzed using normalized-time-density-curves (NTDC) measured by pixel-value integration over a region-of-interest containing the aneurysm. Normalization constant was the total bolus injection determined angiographically. Based on NTDC measurement, five quantities were derived to describe the contrast flow. Two are related to the amount of contrast entering the aneurysm: NTDC peak and NTDC input slope. The other three are related to contrast presence in the aneurysmal dome: time-to-peak (TTP), wash-out-time (WOT) and mean-transit-time (MTT). Flow modification descriptions using the contrast related quantities were expressed as a pre-/post-stented NTDC parameter ratio, while the time related quantities were expressed as a post-/prestented ratio, so that ratios smaller than one indicate a desired effect. Thirteen aneurysms were treated successfully and achieved significant aneurysm occlusion. For these cases, the resulting average parameters were: peak-ratio=0.17+0.21; input-slope-ratio=0.19+/-0.24, TTP-ratio=0.17+0.21, WOT-ratio=0.58+/-0.73 and MTT-ratio=0.65+/-0.97). All the quantities revealed decreased aneurysmal flow due to blood flow diversion using the new self-expanding asymmetrical vascular stent (SAVS). Treatment outcome results and angiographic analysis indicate that the new self-deploying stent design has great potential for clinical implementation.

  4. Fire fighters as basic life support responders: A study of successful implementation

    Directory of Open Access Journals (Sweden)

    Christensen Erika

    2009-04-01

    Full Text Available Abstract Background First responders are recommended as a supplement to the Emergency Medical Services (EMS in order to achieve early defibrillation. Practical and organisational aspects are essential when trying to implement new parts in the "Chain of Survival"; areas to address include minimizing dispatch time, ensuring efficient and quick communication, and choosing areas with appropriate driving distances. The aim of this study was to implement a system using Basic Life Support (BLS responders equipped with an automatic external defibrillator in an area with relatively short emergency medical services' response times. Success criteria for implementation was defined as arrival of the BLS responders before the EMS, attachment (and use of the AED, and successful defibrillation. Methods This was a prospective observational study from September 1, 2005 to December 31, 2007 (28 months in the city of Aarhus, Denmark. The BLS responder system was implemented in an area up to three kilometres (driving distance from the central fire station, encompassing approximately 81,500 inhabitants. The team trained on each shift and response times were reduced by choice of area and by sending the alarm directly to the fire brigade dispatcher. Results The BLS responders had 1076 patient contacts. The median response time was 3.5 minutes (25th percentile 2.75, 75th percentile 4.25. The BLS responders arrived before EMS in 789 of the 1076 patient contacts (73%. Cardiac arrest was diagnosed in 53 cases, the AED was attached in 29 cases, and a shockable rhythm was detected in nine cases. Eight were defibrillated using an AED. Seven of the eight obtained return of spontaneous circulation (ROSC. Six of the seven obtaining ROSC survived more than 30 days. Conclusion In this study, the implementation of BLS responders may have resulted in successful resuscitations. On basis of the close corporation between all participants in the chain of survival this project

  5. A retrievable nitinol endobronchial stent : an experimental study in dog

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Sang Jin; Park, Sang Soo; Yoon, Hyun Ki; Sung, Kyu Bo; Song, Ho Young [Asan Medical Center, Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Kang, Sung Gwon [Inha Univ. College of Medicine, Inchon (Korea, Republic of)

    1999-06-01

    The purpose of this study was to evaluate the safety and the retrievability of a new covered retrievable nitinol tracheobronchial stent. Stents were knitted from 0.2mm nitinol wire, covered with polyurethane, and were 20-22mm in diameter and 2cm in length. Under fluoroscopic guidance, a stent was placed in the normal right bronchus intermedius of ten dogs. Using a retrieval hook, stent retrieval was attempted after 1 month(N=5) or 2 months(N=5). After removal, the dogs were sacrificed and their their tracheobronchial trees were examined grossly and histologically. Eleven stents were successfully placed in ten dogs. Migration and expectoration occurred in four of ten stents in nine dogs(40%). Five stents were successfully removed from six dogs(83%). Without significant difference between the two groups, mild to moderate mucosal hyperplasia was noted at the sites of stents as well as above and below them. On microscopy, three of five dogs showed pneumonia in the right middle lobes, but none of the stents was covered with epithelium. Temporary placement of a covered expandable nitinol stent in the tracheobronchial tree is feasible, but to establish its efficacy, further experimental studies are needed.

  6. Successes and challenges from formation to implementation of eleven broad-extent conservation programs.

    Science.gov (United States)

    Beever, Erik A; Mattsson, Brady J; Germino, Matthew J; Burg, Max Post Van Der; Bradford, John B; Brunson, Mark W

    2014-04-01

    Integration of conservation partnerships across geographic, biological, and administrative boundaries is increasingly relevant because drivers of change, such as climate shifts, transcend these boundaries. We explored successes and challenges of established conservation programs that span multiple watersheds and consider both social and ecological concerns. We asked representatives from a diverse set of 11 broad-extent conservation partnerships in 29 countries 17 questions that pertained to launching and maintaining partnerships for broad-extent conservation, specifying ultimate management objectives, and implementation and learning. Partnerships invested more funds in implementing conservation actions than any other aspect of conservation, and a program's context (geographic extent, United States vs. other countries, developed vs. developing nation) appeared to substantially affect program approach. Despite early successes of these organizations and benefits of broad-extent conservation, specific challenges related to uncertainties in scaling up information and to coordination in the face of diverse partner governance structures, conflicting objectives, and vast uncertainties regarding future system dynamics hindered long-term success, as demonstrated by the focal organizations. Engaging stakeholders, developing conservation measures, and implementing adaptive management were dominant challenges. To inform future research on broad-extent conservation, we considered several challenges when we developed detailed questions, such as what qualities of broad-extent partnerships ensure they complement, integrate, and strengthen, rather than replace, local conservation efforts and which adaptive management processes yield actionable conservation strategies that account explicitly for dynamics and uncertainties regarding multiscale governance, environmental conditions, and knowledge of the system? © 2014 Society for Conservation Biology.

  7. Successes and challenges from formation to implementation of eleven broad-extent conservation programs

    Science.gov (United States)

    Beever, Erik A.; Bradford, John B.; Germino, Matthew J.; Mattsson, Brady J.; Post van der Burg, Max; Brunson, Mark

    2014-01-01

    Integration of conservation partnerships across geographic, biological, and administrative boundaries is increasingly relevant because drivers of change, such as climate shifts, transcend these boundaries. We explored successes and challenges of established conservation programs that span multiple watersheds and consider both social and ecological concerns. We asked representatives from a diverse set of 11 broadextent conservation partnerships in 29 countries 17 questions that pertained to launching and maintaining partnerships for broad-extent conservation, specifying ultimate management objectives, and implementation and learning. Partnerships invested more funds in implementing conservation actions than any other aspect of conservation, and a program’s context (geographic extent, United States vs. other countries, developed vs. developing nation) appeared to substantially affect program approach. Despite early successes of these organizations and benefits of broad-extent conservation, specific challenges related to uncertainties in scaling up information and to coordination in the face of diverse partner governance structures, conflicting objectives, and vast uncertainties regarding future system dynamics hindered long-term success, as demonstrated by the focal organizations. Engaging stakeholders, developing conservation measures, and implementing adaptive management were dominant challenges. To inform future research on broad-extent conservation, we considered several challenges when we developed detailed questions, such as what qualities of broad-extent partnerships ensure they complement, integrate, and strengthen, rather than replace, local conservation efforts and which adaptive management processes yield actionable conservation strategies that account explicitly for dynamics and uncertainties regarding multiscale governance, environmental conditions, and knowledge of the system?

  8. Using the "customer service framework" to successfully implement patient- and family-centered care.

    Science.gov (United States)

    Rangachari, Pavani; Bhat, Anita; Seol, Yoon-Ho

    2011-01-01

    Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.

  9. Transformational and Transactional Factors for the Successful Implementation of Enterprise Architecture in Public Sector

    Directory of Open Access Journals (Sweden)

    Seogjun Lee

    2016-05-01

    Full Text Available Enterprise architecture (EA is one of the most important and effective tools for delivering high-quality e-government services to citizens. In this study, we used organizational performance and change theory to determine factors that contribute to the successful implementation of EA. We classified these factors as one of two types: transformation change (TFC and transactional change (TSC. To identify these factors, we collected survey data from Korean public sectors that have implemented EA for years. Results show that while EA management systems (EAMS and EA guidelines directly affect EA performance, laws and regulations, and EA organization exert an indirect effect. Further, top management support had both direct and indirect effect on EA performance. Ultimately, the findings produced by this study have implications for government institutions that plan to implement EA.

  10. Key success factors for implementing Taiwan TrainQuali System (TTQS in Taiwanese enterprises

    Directory of Open Access Journals (Sweden)

    Tzong-Ru (Jiun-Shen Lee

    2015-01-01

    Full Text Available Facing the change of economic environment and the need of enhancing competitive advantages, small and medium-sized enterprises in Taiwan utilize ‘Taiwan TrainQuali System (TTQS’ on training talents. In order to maximize the benefits of TTQS implementation and increase the training efficiency, this paper aims to use ‘grey relational analysis (GRA’ to extract key success factors (KSFs from 46 factors, which influence the implementation of TTQS. Moreover, this study also verifies the KSFs with nine case companies which have won gold medals in TTQS evaluation and sum up 12 concrete practices as references for other enterprises in order to show how to implement the TTQS training quality system better in the future, and in turn enhance the quality and performance of human resource training.

  11. The factors affecting Nigeria's success toward implementation of global public health priorities.

    Science.gov (United States)

    Echebiri, Vitalis C

    2015-06-01

    This paper examines the challenges facing the Nigerian government toward the implementation of global public health priories. The Nigerian government recognizes the need to implement these priorities by putting in place the necessary policy framework, but political instability, poor infrastructural development and inadequate funding have remained barriers toward the achievement of success in implementing these priorities. The rest of the paper elucidates the fact that despite leadership and influence from the World Health Organization and other United Nations agencies, and some responses from the Nigerian government, tackling these public health problems requires much more fundamental reform to primary health services and a reduction in poverty. Although the government has shown enough political will to tackle these problems, it is expected that a better result will be achieved through injecting more funds into the Nigerian health sector, and deploying astute health administrators to manage the sector rather than pure health professionals without managerial acumen. © The Author(s) 2014.

  12. Implementing Indigenous Education Policy Directives in Ontario Public Schools: Experiences, Challenges and Successful Practices

    Directory of Open Access Journals (Sweden)

    Emily Milne

    2017-08-01

    Full Text Available The Ontario Ministry of Education has declared a commitment to Indigenous student success and has advanced a policy framework that articulates inclusion of Indigenous content in schooling curriculum (Ontario Ministry of Education, 2007. What are the perceptions among educators and parents regarding the implementation of policy directives, and what is seen to encourage or limit meaningful implementation? To answer these questions, this article draws on interviews with 100 Indigenous (mainly Haudenosaunee, Anishinaabe, and Métis and non-Indigenous parents and educators from Ontario Canada. Policy directives are seen to benefit Indigenous and non-Indigenous students. Interviews also reveal challenges to implementing Indigenous curricular policy, such as unawareness and intimidation among non-Indigenous educators regarding how to teach material. Policy implications are considered.

  13. CRITICAL SUCCESS FACTORS FOR IMPLEMENTING LEAN PRACTICES IN IT SUPPORT SERVICES

    Directory of Open Access Journals (Sweden)

    Goutam Kundu

    2012-12-01

    Full Text Available Many studies have been done to identify the critical success factors (CSFs in for successful lean implementation in the manufacturing firms. But, till date, no systematic study has been done to identify the CSFs from the perspective of lean implementation in IT support service sector. This paper aims to address this area. A detailed literature review was undertaken to identify CSFs for lean implementation in manufacturing and services context and to consider their applicability to the IT support services sector. This paper is based on a conceptual discussion of CSFs as applied to the IT support services sector. The authors proposed a set of CSFs which is believed to be suitable for IT support service enterpri ses. The relevance of CSFs will need to be tested and qualitative research is needed to inform further work. The proposed CSFs are aimed at being useful to IT support services sector as a guideline, so as to ensure a positive outcome of the lean implementation process in IT support services sector.

  14. Strategy and governance for successful implementation of an enterprise-wide ambulatory EMR.

    Science.gov (United States)

    Kraatz, Andrew S; Lyons, Colleen M; Tomkinson, Julie

    2010-01-01

    Coordinating the implementation of an enterprise-wide ambulatory EMR has its challenges both from an IT technology perspective as well as from a clinical workflow perspective. Add to it the complexities of integrating a wide variety of legacy systems, the desire for electronic prescription processes, the need for remote access for doctors and patients, along with the number of physicians from diverse specialties that want to qualify for the federal stimulus funding and you have a summary of the Continuum Health Partners, Inc. (CHP) ongoing Ambulatory EMR project. This article will provide a detailed description of the key benefits to implementing an EMR, typical challenges, key strategies and techniques for managing an implementation, and critical success drivers to be monitored. Using a case study of a healthcare provider that leveraged strategic planning and these techniques, the article will show how an organization can maneuver successfully through the challenges in implementing an EMR and how the initiative can serve as a catalyst for change.

  15. Implementing system-wide risk stratification approaches: A review of critical success and failure factors.

    Science.gov (United States)

    Huckel Schneider, Carmen; Gillespie, James A; Wilson, Andrew

    2017-05-01

    Risk stratification has become a widely used tool for linking people identified at risk of health deterioration to the most appropriate evidence-based care. This article systematically reviews recent literature to determine key factors that have been identified as critical enablers and/or barriers to successful implementation of risk stratification tools at a system level. A systematic search found 23 articles and four promising protocols for inclusion in the review, covering the use to 20 different risk stratification tools. These articles reported on only a small fraction of the risk stratification tools used in health systems; suggesting that while the development and statistical validation of risk stratification algorithms is widely reported, there has been little published evaluation of how they are implemented in real-world settings. Controlled studies provided some evidence that the use of risk stratification tools in combination with a care management plan offer patient benefits and that the use of a risk stratification tool to determine components of a care management plan may contribute to reductions in hospital readmissions, patient satisfaction and improved patient outcomes. Studies with the strongest focus on implementation used qualitative and case study methods. Among these, the literature converged on four key areas of implementation that were found to be critical for overcoming barriers to success: the engagement of clinicians and safeguarding equity, both of which address barriers of acceptance; the health system context to address administrative, political and system design barriers; and data management and integration to address logistical barriers.

  16. Critical success factors model developing for sustainable Kaizen implementation in manufactur-ing industry in Ethiopia

    Directory of Open Access Journals (Sweden)

    Haftu Hailu

    2017-12-01

    Full Text Available The purpose of the research is to identify critical success factors and model developing for sustaining kaizen implementation. Peacock shoe is one of the manufacturing industries in Ethiopia facing challenges on sustaining. The methodology followed is factor analysis and empirically testing hypothesis. A database was designed using SPSS version 20. The survey was validated using statistical validation using the Cronbach alpha index; the result is 0.908. The KMO index value was obtained for the 32 items and had a value of 0.642 with Bartlett's Test of Sphericity Approx. Chi-Square 4503.007, degree of freedom 496 and significance value 0.000. A factor analysis by principal components and varimax rotation was applied for finding the critical success factors. Finding designates that 32 items were merged into eight critical success factors. All the eight factors together explain for 76.941 % of the variance. Multiple regression model analysis has indicated that some of the critical success factors had relationship with success indicators. Due to constraint of time, the researcher focused only at peacock shoe manufacturing industry. Other limitation also includes the absence of any local research that shows the critical success factors at the moment.

  17. CRITICAL SUCCESS FACTORS FOR SIX SIGMA IMPLEMENTATION IN LARGE-SCALE TURKISH CONSTRUCTION COMPANIES

    Directory of Open Access Journals (Sweden)

    Mehmet Tolga Taner

    2013-10-01

    Full Text Available This paper aims to investigate the Critical Success Factors (CSFs for the successful introduction of Six Sigma in large-scale Turkish construction companies. A survey-based approach is used in order to identify and understand the current quality practices. CSFs and impeding factors are identified and analysed. Involvement and commitment of top management, linking quality initiatives to customer and linking quality initiatives to supplier are found to be the most important CSFs to the construction companies. Leadership and commitment of top management, cross-functional teamwork and commitment of middle managers are found to be the most CSFs for successful introduction of Six Sigma, whereas lack of knowledge of the system to initiate and complacency are found to be hindering its implementation. High costs and high amount of waste are found to lower the performance of Turkish construction companies.

  18. Flow Characteristics Near to Stent Strut Configurations on Femoropopliteal Artery

    Science.gov (United States)

    Paisal, Muhammad Sufyan Amir; Fadhil Syed Adnan, Syed; Taib, Ishkrizat; Ismail, Al Emran; Kamil Abdullah, Mohammad; Nordin, Normayati; Seri, Suzairin Md; Darlis, Nofrizalidris

    2017-08-01

    Femoropopiteal artery stenting is a common procedure suggested by medical expert especially for patient who is diagnosed with severe stenosis. Many researchers reported that the growth of stenosis is significantly related to the geometry of stent strut configuration. The different shapes of stent geometry are presenting the different flow pattern and re-circulation in stented femoropopliteal artery. The blood flow characteristics near to the stent geometry are predicted for the possibility of thrombosis and atherosclerosis to be formed as well as increase the growth of stenosis. Thus, this study aims to determine the flow characteristic near to stent strut configuration based on different hemodynamic parameters. Three dimensional models of stent and simplified femoropopliteal artery are modelled using computer aided design (CAD) software. Three different models of stent shapes; hexagon, circle and rectangle are simulated using computational fluid dynamic (CFD) method. Then, parametric study is implemented to predict the performance of stent due to hemodynamic differences. The hemodynamic parameters considered are pressure, velocity, low wall shear stress (WSSlow) and wall shear stress (WSS). From the observation, flow re-circulation has been formed for all simulated stent models which the proximal region shown the severe vortices. However, rectangular shape of stent strut (Type P3) shows the lowest WSSlow and the highest WSS between the range of 4 dyne/cm2 and 70 dyne/cm2. Stent Type P3 also shows the best hemodynamic stent performance as compare to others. In conclusion, Type P3 has a favourable result in hemodynamic stent performance that predicted less probability of thrombosis and atherosclerosis to be formed as well as reduces the growth of restenosis.

  19. Survey and Explain the role of Sensemaking in Successful Strategy Implementation in Iran’s Automotive Companies

    Directory of Open Access Journals (Sweden)

    Seyed Farhad Hosseini

    2016-09-01

    Full Text Available There is not a dominant model that could explain key factors of sensemaking of strategy implementation and interactions between them. The purpose of this study is designing and explaining the role of sensemaking in successful strategy implementation along with a combination of factors which influence implementation sensemaking. This study surveyed the factors influencing sensemaking of successful strategy implementation in top Iran’s automotive companies. This is a qualitative research that uses grounded theory to obtain insight about the role of sensemaking in successful implementation through in-depth interviews with 22 individuals (Managers, Assistant Directors and Academic Professors and used gathered data to design a model of sensemaking in successful strategy implementation. Based on open and axial coding, 21 effective variables were conceptualized and classified in seven major categories then final model was designed. This theory explains factors that affect the sensemaking of successful strategy implementation and how these factors interact with each other. Sensemaking in Successful implementation of strategies depends on Sensemaking Context, Key Executers, Discourse Context, Intervening Conditions and Collective Sensemaking. Sensemaking Context cause sensemaking and sensegiving of key executers and key executers itself along with Discourse Context and Intervening Conditions lead to collective sensemaking. The consequence of model is sensemaking of successful strategy implementation that consists of maintaining and recording the meaning and its strengthening, collective effort, continuous strategy implementation and operational excellence of the organization.

  20. Community-Level Successes and Challenges to Implementing Adolescent Sex Education Programs

    Science.gov (United States)

    Rouse, Maura; Resseguie, Jamie; Smith, Hannah; Woodcox, Stephanie

    2010-01-01

    Best practices for adolescent sex education recommend science-based approaches. However, little is known about the capacity and needs of organizations who implement sex education programs on the local level. The purpose of this research was to describe successes and challenges of community organizations in implementing science-based sex education. Using qualitative methods, we interviewed program directors and educators in 17 state-funded adolescent pregnancy prevention/sex education programs as part of a larger mixed methods evaluation. Semi-structured interviews focused on success and challenges faced in implementing science-based approaches to program design, implementation and evaluation. Interviews were audio-recorded, transcribed and analyzed using a thematic approach. Grantees included a range of programs, from short programs on puberty and HIV for late elementary students, to skills-based curricular sex education programs for high schools, to year-long youth development programs. Key aspects of curricular choice included meeting the needs of the population, and working within time constraints of schools and other community partners. Populations presenting specific challenges included rural youth, youth in juvenile justice facilities, and working with Indiana's growing Latino population. Programs self-developing curricula described challenges related to assessment and evaluation of impact. Programs using commercial curricula described challenges related to curricular selection and adaptation, in particularly shortening curricula, and adapting to different cultural or social groups. A remarkable degree of innovation was observed. The use of qualitative methods permitted the identification of key challenges and successes in a state-sponsored small grants program. Information can be used to enhance program capacity and quality. PMID:20180004

  1. Success criteria for electronic medical record implementations in low-resource settings: a systematic review.

    Science.gov (United States)

    Fritz, Fleur; Tilahun, Binyam; Dugas, Martin

    2015-03-01

    Electronic medical record (EMR) systems have the potential of supporting clinical work by providing the right information at the right time to the right people and thus make efficient use of resources. This is especially important in low-resource settings where reliable data are also needed to support public health and local supporting organizations. In this systematic literature review, our objectives are to identify and collect literature about success criteria of EMR implementations in low-resource settings and to summarize them into recommendations. Our search strategy relied on PubMed queries and manual bibliography reviews. Studies were included if EMR implementations in low-resource settings were described. The extracted success criteria and measurements were summarized into 7 categories: ethical, financial, functionality, organizational, political, technical, and training. We collected 381 success criteria with 229 measurements from 47 articles out of 223 articles. Most papers were evaluations or lessons learned from African countries, published from 1999 to 2013. Almost half of the EMR systems served a specific disease area like human immunodeficiency virus (HIV). The majority of criteria that were reported dealt with the functionality, followed by organizational issues, and technical infrastructures. Sufficient training and skilled personnel were mentioned in roughly 10%. Political, ethical, and financial considerations did not play a predominant role. More evaluations based on reliable frameworks are needed. Highly reliable data handling methods, human resources and effective project management, as well as technical architecture and infrastructure are all key factors for successful EMR implementation. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation.

    Science.gov (United States)

    Yen, Po-Yin; McAlearney, Ann Scheck; Sieck, Cynthia J; Hefner, Jennifer L; Huerta, Timothy R

    2017-09-07

    In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer. ©Po-Yin Yen, Ann Scheck McAlearney, Cynthia J Sieck, Jennifer L Hefner, Timothy R Huerta. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 07.09.2017.

  3. Percutaneous nephrostomy and antegrade ureteral stenting: technique - indications - complications

    Energy Technology Data Exchange (ETDEWEB)

    Hausegger, Klaus A. [Klagenfurt General Hospital, Department of Radiology, Klagenfurt (Austria); Portugaller, Horst R. [University Hospital of Graz, Department of Radiology, Graz (Austria)

    2006-09-15

    In this review the technique, indication for and complications of percutaneous nephrostomy (PCN) and antegrade ureter stent insertion are described. In the majority of the cases PCN is performed to relieve urinary obstruction, which can be of benign or malignant nature. Another indication for PCN is for treatment of urinary fistulas. PCN can be performed under ultrasound and/or fluoroscopic guidance, with a success rate of more than 90%. The complication rate is approximately 10% for major and minor complications together and 4-5% for major complications only. Percutaneous antegrade double-J stent insertion usually is performed if retrograde ureter stenting has not been successful. However, especially in malignant obstructions, the success rate for antegrade stenting is higher than for retrograde transvesical double-J stent insertion. In the case of severe infection and bleeding after PCN JJ-stent insertion may be contraindicated so long as there is no sufficient concomitant drainage via a PCN. Lower urinary tract dysfunction should be excluded before stent placement. The complication rate is 2-4%. Consequent stent surveillance with regular stent exchange is mandatory. (orig.)

  4. Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks.

    Science.gov (United States)

    van Boeckel, Petra G A; Dua, Kulwinder S; Weusten, Bas L A M; Schmits, Ruben J H; Surapaneni, Naveen; Timmer, Robin; Vleggaar, Frank P; Siersema, Peter D

    2012-02-29

    Benign esophageal ruptures and anastomotic leaks are life-threatening conditions that are often treated surgically. Recently, placement of partially and fully covered metal or plastic stents has emerged as a minimally invasive treatment option. We aimed to determine the clinical effectiveness of covered stent placement for the treatment of esophageal ruptures and anastomotic leaks with special emphasis on different stent designs. Consecutive patients who underwent placement of a fully covered self-expandable metal stent (FSEMS), a partially covered SEMS (PSEMS) or a self-expanding plastic stent (SEPS) for a benign esophageal rupture or anastomotic leak after upper gastrointestinal surgery in the period 2007-2010 were included. Data on patient demographics, type of lesion, stent placement and removal, clinical success and complications were collected A total of 52 patients received 83 esophageal stents (61 PSEMS, 15 FSEMS, 7 SEPS) for an anastomotic leak (n=32), iatrogenic rupture (n=13), Boerhaave's syndrome (n=4) or other cause (n=3). Endoscopic stent removal was successful in all but eight patients treated with a PSEMS due to tissue ingrowth. Clinical success was achieved in 34 (76%, intention-to-treat: 65%) patients (PSEMS: 73%, FSEMS: 83%, SEPS: 83%) after a median of 1 (range 1-5) stent and a median stenting time of 39 (range 7-120) days. In total, 33 complications in 24 (46%) patients occurred (tissue in- or overgrowth (n=8), stent migration (n=10), ruptured stent cover (all Ultraflex; n=6), food obstruction (n=3), severe pain (n=2), esophageal rupture (n=2), hemorrhage (n=2)). One (2%) patient died of a stent-related cause. Covered stents placed for a period of 5-6 weeks may well be an alternative to surgery for treating benign esophageal ruptures or anastomotic leaks. As efficacy between PSEMS, FSEMS and SEPS is not different, stent choice should depend on expected risks of stent migration (SEPS and FSEMS) and tissue in- or overgrowth (PSEMS).

  5. Influence of Organizational Characteristics on Success in Implementing Process Improvement Goals in Correctional Treatment Settings.

    Science.gov (United States)

    Prendergast, Michael; Welsh, Wayne N; Stein, Lynda; Lehman, Wayne; Melnick, Gerald; Warda, Umme; Shafer, Michael; Ulaszek, Wendy; Rodis, Eleni; Abdel-Salam, Sami; Duvall, Jamieson

    2017-10-01

    Although research indicates that organizational characteristics substantially influence the adoption and use of evidence-based practices (EBPs), there has been little empirical research on organizational factors most likely to influence successful implementation of EBPs, particularly in criminal justice settings. This study examined organizational characteristics related to the success of change teams in achieving improvements in assessment and case-planning procedures for persons leaving correctional settings and receiving community services. In this evaluation of the Organizational Process Improvement Intervention (OPII), part of the National Institute on Drug Abuse's (NIDA's) Criminal Justice Drug Abuse Treatment Studies (CJDATS) cooperative, 21 sites were randomized to an early-start or a delayed-start condition. For this analysis, data from both conditions were combined. Agencies with fewer program needs, good communication, adequate staffing levels, good supervision, positive attitude toward rehabilitation, and higher institutional capacity for change were better able to implement planned changes in assessment and case-planning procedures. Such agencies may be better candidates for implementation improvement strategies, whereas other agencies could benefit from pre-intervention efforts aimed at strengthening these characteristics before attempting to improve assessment procedures.

  6. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings.

    Science.gov (United States)

    Lorenzi, Nancy M; Kouroubali, Angelina; Detmer, Don E; Bloomrosen, Meryl

    2009-02-23

    Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process. The EHR

  7. How to successfully select and implement electronic health records (EHR in small ambulatory practice settings

    Directory of Open Access Journals (Sweden)

    Detmer Don E

    2009-02-01

    Full Text Available Abstract Background Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. Discussion The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff

  8. Implementation of computerized physician order entry in National Guard Hospitals: assessment of critical success factors.

    Science.gov (United States)

    Altuwaijri, Majid M; Bahanshal, Abdullah; Almehaid, Mona

    2011-09-01

    The purpose of this study is to describe the needs, process and experience of implementing a computerized physician order entry (CPOE) system in a leading healthcare organization in Saudi Arabia. The National Guard Health Affairs (NGHA) deployed the CPOE in a pilot department, which was the intensive care unit (ICU) in order to assess its benefits and risks and to test the system. After the CPOE was implemented in the ICU area, a survey was sent to the ICU clinicians to assess their perception on the importance of 32 critical success factors (CSFs) that was acquired from the literature. The project team also had several meetings to gather lessons learned from the pilot project in order to utilize them for the expansion of the project to other NGHA clinics and hospitals. The results of the survey indicated that the selected CSFs, even though they were developed with regard to international settings, are very much applicable for the pilot area. The top three CSFs rated by the survey respondents were: The "before go-live training", the adequate clinical resources during implementation, and the ordering time. After the assessment of the survey and the lessons learned from the pilot project, NGHA decided that the potential benefits of the CPOE are expected to be greater the risks expected. The project was then expanded to cover all NGHA clinics and hospitals in a phased approach. Currently, the project is in its final stages and expected to be completed by the end of 2011. The role of CPOE systems is very important in hospitals in order to reduce medication errors and to improve the quality of care. In spite of their great benefits, many studies suggest that a high percentage of these projects fail. In order to increase the chances of success and due to the fact that CPOE is a clinical system, NGHA implemented the system first in a pilot area in order to test the system without putting patients at risk and to learn from mistakes before expanding the system to other

  9. Multi-center randomized trial on the impact of “CONFIDENCE” communication program aimed at evaluating therapy adherence of patients with registered myocardial infarction who underwent successful revascularization by stenting or thrombolysis after discharg

    Directory of Open Access Journals (Sweden)

    А. Р. Таркова

    2017-04-01

    Full Text Available Aim. The article looks at the effect of the program "Confidence" to increase the proportion of patients’ therapy in patients with coronary heart disease for two years after successful revascularization using thrombolytic or stenting of the coronary arteries on the myocardial infarction.Methods. This is a prospective, randomized, controlled, parallel-group trial including 4.000 patients. They will be divided into two groups: patients receiving standard outpatient observation (n=2000 and those enrolled for the program "Confidence" (n=2000. The total duration is 24 months. The trial will take place in two stages. In the first stage (0-12 months the impact of the program "Confidence" on therapy adherence and outcomes of cardiovascular diseases will be assessed. In the second stage (after the change of groups in 12 months, 12-24 months the effect of changing the way to remind patients of therapy adherence will be evaluated.Conclusion. The trial was designed in such a way as to show that the proposed program "Confidence" increases the proportion of patients who adhere to therapy in the cohort of those with coronary heart disease for two years after successful revascularization by using thrombolytic or stenting of the coronary arteries against the background of myocardial infarction.Received 13 February 2017. Accepted 9 March 2017.Financing: KRKA company’s grant. Sponsorship had no effect on data acquisition, analysis and interpretation.Conflict of interest: Kretov E.I. served as executive editor of “Endovascular surgery” section. All other authors declare no conflict of interest.Author contributionsStudy conception and design: Kretov E.I., Grazhdankin I.O., Baystrukov V.I., Zubarev D.D. Statistical data processing: Krestyaninov O.V., Kozyr K.V., Obedinskiy A.A., Prokhorikhin A.A.Drafting the article: Tarkova A.R., Anisimova V.D.Critical revision: Tarkova A.R., Anisimova V.D., Kretov E.I.

  10. Effects of people-centred factors on enterprise resource planning implementation project success: empirical evidence from Sri Lanka

    Science.gov (United States)

    Wickramasinghe, Vathsala; Gunawardena, Vathsala

    2010-08-01

    Extant literature suggests people-centred factors as one of the major areas influencing enterprise resource planning (ERP) implementation project success. Yet, to date, few empirical studies attempted to validate the link between people-centred factors and ERP implementation project success. The purpose of this study is to empirically identify people-centred factors that are critical to ERP implementation projects in Sri Lanka. The study develops and empirically validates a framework for people-centred factors that influence the success of ERP implementation projects. Survey research methodology was used and collected data from 74 ERP implementation projects in Sri Lanka. The people-centred factors of 'project team competence', 'rewards' and 'communication and change' were found to predict significantly the ERP implementation project success.

  11. RESISTANCE TO CHANGE AND ERP IMPLEMENTATION SUCCESS: THE MODERATING ROLE OF CHANGE MANAGEMENT INITIATIVES

    Directory of Open Access Journals (Sweden)

    Zafar U. Ahmed

    2006-01-01

    Full Text Available Enterprise Resource Planning (ERP is a useful tool that builds strong capabilities, improves performance, supports better decision making, and provides competitive advantage for businesses. ERP aims to help the management by setting better business practices and equipping them with the right information to take timely decision. In any new technology implementation, one of the issues that need to be addressed is the resistance to change. Many implementations have failed due to strong resistance from the end users. Thus, the main purpose of this paper is to test the impact of resistance to change on ERP's implementation success and how change management initiatives acts in the capacity of a moderating role. Using data collected from 69 manufacturing organizations through a mail survey, it was found that resistance to change is negatively related to achievement of predetermined goals (b = –0.930, p < 0.01 and usersatisfaction (b = –0.952, p < 0.01. Further, change management initiatives did not moderate the relationship between resistance and predetermined goals but it moderated the relationship between resistance and user satisfaction. In addition, change management initiatives have a direct positive impact on user satisfaction. This research concludes that the human factor is very important in ERP's implementation.

  12. From histology and imaging data to models for in-stent restenosis

    NARCIS (Netherlands)

    Amatruda, C.M.; Bona Casas, C.; Keller, B.K.; Tahir, H.; Dubini, G.; Hoekstra, A.; Hose, D.R.; Lawford, P.; Migliavacca, F.; Narracott, A.J.; Gunn, J.

    2014-01-01

    The implantation of stents has been used to treat coronary artery stenosis for several decades. Although stenting is successful in restoring the vessel lumen and is a minimally invasive approach, the long-term outcomes are often compromised by in-stent restenosis (ISR). Animal models have provided

  13. Successful implementation of intelligent infusion technology in a multihospital setting: nursing perspective.

    Science.gov (United States)

    Longshore, Lisa; Smith, Timothy; Weist, Michelle

    2010-01-01

    Complexities of today's medications and greater use of high-risk medications place the patient at an increased risk for nursing errors. The purpose of this case report is to present, from a nursing perspective, the successful experience of a multihospital healthcare system's quest to decrease or eliminate medication administration errors through implementation of intelligent pumps. This case report focuses on the vital role that nursing services played, including the selection of pumps, development of the drug library, education of end users, and strategies employed to achieve a high compliance rate. Also described are the ongoing educational efforts, lessons learned, and specific results in intercepting significant medication administration errors.

  14. Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients

    Directory of Open Access Journals (Sweden)

    Liberato Manuel José

    2012-08-01

    Full Text Available Abstract Background Endoscopic biliary drainage of hilar cholangiocarcinoma is controversial with respect to the optimal types of stents and the extent of drainage. This study evaluated endoscopic palliation in patients with hilar cholangiocarcinoma using self-expandable metallic stents (SEMS and plastic stents (PS.We also compared unilateral and bilateral stent placement according to the Bismuth classification. Methods Data on 480 patients receiving endoscopic biliary drainage for hilar cholangiocarcinoma between September 1995 and December 2010 were retrospectively reviewed to evaluate the following outcome parameters: technical success (TS, functional success (FS, early and late complications, stent patency and survival. Patients were followed from stent insertion until death or stent occlusion. Patients were divided into 3 groups according to the Bismuth classification (Group 1, type I; Group 2, type II; Group 3, type > III. Results The initial stent insertion was successful in 450 (93.8% patients. TS was achieved in 204 (88.3% patients treated with PS and in 246 (98.8% patients palliated with SEMS (p P P  Conclusions SEMS insertion for the palliation of hilar cholangiocarcinoma offers higher technical and clinical success rates in the ITT analysis as well as lower complication rates and a superior cumulative stent patency when compared with PS placement in all Bismuth classifications. The cumulative patency of bilateral SEMS or PS stents was significantly higher than that of unilateral SEMS or PS stents, with lower occlusion rates in Bismuth II patients.

  15. Percutaneous antegrade ureteric stent removal using a rigid alligator forceps.

    LENUS (Irish Health Repository)

    Given, M F

    2008-12-01

    To evaluate the safety and efficacy of percutaneous antegrade ureteric stent removal using a rigid alligator forceps. Twenty patients were included in our study. Indications for ureteric stent insertion included stone disease (n = 7), malignancy (n = 8) and transplant anastomotic strictures (n = 5). Stent retrieval was carried out for proximal stent placement\\/migration in seven patients and encrustation in the remaining 13. Twenty-two stents were successfully retrieved in 20 patients. There was one technical failure (5%). There were no major complications. We had four minor complications, which included nephrostomy site pain (n = 2), periprocedural sepsis (n = 1) and a small urinoma (n = 1). All patients settled with conservative management. Percutaneous radiologically guided antegrade ureteric stent removal with an alligator forceps is safe and effective, particularly when initial surgical removal has failed.

  16. Endovascular treatment of superficial femoral artery occlusive disease with stents coated with diamond-like carbon

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, O. E-mail: schaefer@mrs1.ukl.uni-freiburg.de; Lohrmann, C.; Winterer, J.; Kotter, E.; Langer, M

    2004-12-01

    A major consideration in the reduction of early stent thrombosis and in-stent restenosis is the improvement of biocompatibility of the devices. Diamond-like carbon is a novel material for coating stent surfaces in order to increase biocompatibility. The authors report on the endovascular treatment of two individuals with superficial femoral artery occlusions, using stents coated with diamond-like carbon. Technical and clinical success was achieved in both cases, with primary patency rates of 100% 12 months after intervention.

  17. Percutaneous transhepatic self-expanding metal stents for palliation ...

    African Journals Online (AJOL)

    Cancers of the pancreas, gallbladder and bile ducts are the commonest causes of malignant biliary obstruction. .... markers on the delivery catheter allow fluoroscopic control of stent release after positioning across the .... percutaneous biliary transhepatic self-expanding metal stent insertion was technically successful in all ...

  18. Implementation of clinical governance in hospitals: challenges and the keys for success.

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Hadi Mousavi

    2014-07-01

    Full Text Available There is a number of models and strategies for improving the quality of care such as total quality management, continuous quality improvement and clinical governance. The policy of clinical governance is part of the governments overall strategy for monitoring, assuring and improving in the national health services organization. Clinical governance has been introduced as a bridge between managerial and clinical approaches to quality. For successful implementing of clinical governance, it is necessary to pay attention to firm foundations of the structure, including equipment, staffing arrangement, supporting specialties, and staff training. Therefore, as clinical governance improves safety and quality in health care services, the current situation in hospitals should be evaluated before any intervention while barriers and blocks on structure and process should be determined to select a method for changing them. Considering these points could guarantee success in implementation of clinical governance; otherwise there would be a little chance to achieve the desired results despite consumption of plenty of time and huge paper works.

  19. Biodegradable and bioabsorbable stents.

    Science.gov (United States)

    Waksman, Ron; Pakala, Rajbabu

    2010-01-01

    Angioplasty of the coronary arteries has made significant headway in the past 20 years as a treatment for atherosclerotic vascular disease. Though drug-eluting stents are effective, they appear to invoke a thrombogenic response. Biodegradable stents are a promising alternative to permanent stents and may eventually be used to solve the lingering problem of in-stent restenosis. Additionally, fully degradable stents have the ability to deliver more drugs to the target site than a thin coating of drug on metallic stents. A variety of degradable materials have been studied for stent design, including polyesters, polycarbonates, bacterial-derived polymers, and corrodible metals. The ideal biodegradable stent would be reliably deployable under fluoroscopic guidance and situate into the target lesion with minimal endovascular trauma. The stent should degrade into nontoxic byproducts and invoke a minimal degree of inflammation at the target site. Finally, the stent itself should disappear within months (to years) without significant displacement from the deployment site. Although initial data from clinical trials have been sufficient to bring biodegradable materials into the realm of feasibility, future research is undoubtedly necessary to resolve the critical issues of inflammation and mechanical stability.

  20. What it Takes to Successfully Implement Technology for Aging in Place: Focus Groups With Stakeholders.

    Science.gov (United States)

    Peek, Sebastiaan Theodorus Michaël; Wouters, Eveline J M; Luijkx, Katrien G; Vrijhoef, Hubertus J M

    2016-05-03

    There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by the fact that multiple stakeholder groups are involved. Goals and motives of stakeholders may not always be transparent or aligned, yet research on convergent and divergent positions of stakeholders is scarce. To provide insight into the positions of stakeholder groups involved in the implementation of technology for aging in place by answering the following questions: What kind of technology do stakeholders see as relevant? What do stakeholders aim to achieve by implementing technology? What is needed to achieve successful implementations? Mono-disciplinary focus groups were conducted with participants (n=29) representing five groups of stakeholders: older adults (6/29, 21%), care professionals (7/29, 24%), managers within home care or social work organizations (5/29, 17%), technology designers and suppliers (6/29, 21%), and policy makers (5/29, 17%). Transcripts were analyzed using thematic analysis. Stakeholders considered 26 different types of technologies to be relevant for enabling independent living. Only 6 out of 26 (23%) types of technology were mentioned by all stakeholder groups. Care professionals mentioned fewer different types of technology than other groups. All stakeholder groups felt that the implementation of technology for aging in place can be considered a success when (1) older adults' needs and wishes are prioritized during development and deployment of the technology, (2) the technology is accepted by older adults, (3) the technology provides benefits to older adults, and (4) favorable prerequisites for the use of technology by older adults exist. While stakeholders seemed to have identical aims, several underlying differences emerged, for example, with regard

  1. Indicators of successful implementation of programs to promote healthy weight among women.

    Science.gov (United States)

    Drayton, V L C; Walker, D K; Mikolowsky, K

    2015-03-01

    Obesity rates have steadily increased over the past two decades. To address the epidemic in women, the Health Resources and Services Administration's Maternal and Child Health Bureau, Division of Healthy Start and Perinatal Services (HRSA/MCHB/DHSPS) awarded 14 demonstration grants to community health centers, health departments, universities and community-based organizations in 12 states to develop innovative approaches aimed at reducing the prevalence of overweight and obesity, specifically in women of childbearing age. Grantees implemented modified or existing evidence-based programs (EBP) or promising practices tailored to the geographic locations, cultures and traditional values of the communities. A review of the 15 programs implemented from 2004 to 2007 was conducted using the methodology outlined in the Transparent Reporting of Evaluations with Nonrandomized Designs Statement to identify indicators of successful program implementation. The six indicators identified were: (1) supportive organizational culture with adequate resources and appropriate staff; (2) attention to the needs of the service population; (3) a referral system that links participants to appropriate services; (4) flexible schedules; (5) support for child care and transportation; and (6) formal and informal support systems to keep participants engaged and motivated. Two of the programs that reported improved participant outcomes are available for replication: La Vida Sana, La Vida Feliz in Illinois was designated as a promising practice by the Association of Maternal and Child Health Programs and Sisters in Action in Michigan was rated as a moderate evidence-based program by the Agency for Healthcare Research and Quality.

  2. Refinement of a thrombectomy technique to treat acute ischemic stroke: Technical note on microcatheter advance during retrieving self expandable stent

    Energy Technology Data Exchange (ETDEWEB)

    Youn, Sung Won; Kim, Ho Kyun [Catholic Univ. of Daegu School of Medicine, Daegu (Korea, Republic of)

    2012-07-15

    Temporary stenting and thrombectomy by use of the Solitaire stent (ev3, Irvine, CA, USA) has shown prompt and successful recanalization of the acutely occluded major cerebral artery. However, even if rarely reported, inadvertent stent detachment may occur as an innate drawback and full deployment of the stent was considered to increase the risk. In our patients, the Solitaire stent did not fully unfold to prevent inadvertent detachment. Before retrieval of the stent, the tip of the microcatheter was advanced forward carefully under fluoroscopic observation until it met the presumed thrombus segment and a subtle sense of resistance was felt in the fingers guiding the stent. After retrieval, complete recanalization was achieved, and the thrombus was trapped between the tip of the microcatheter and the stent strut. We present 2 cases of successful thrombi captures by advancing a microcatheter during Solitaire stent retrieval, and we suggest that advancing the microcatheter can be a useful refinement to the thrombectomy technique for acute ischemic stroke.

  3. Regional media coverage influences the public's negative attitudes to policy implementation success in Sweden.

    Science.gov (United States)

    Fredriksson, Mio; Tiainen, Anne; Hanning, Marianne

    2015-12-01

    One central aspect of health literacy is knowledge of patients' rights. Being an important source of information about health and health care, the media may influence health literacy and act as a policy implementer. To investigate whether regional news media coverage in Sweden is linked to (i) the public's awareness and knowledge of a patient's rights policy, the waiting-time guarantee and (ii) the public's attitudes to how the guarantee's time limits are met, that is, implementation success. Three types of data are used. First, a national telephone survey of the public's awareness, knowledge and attitudes; second, media coverage information from digital media monitoring; and third, official waiting-time statistics. Bivariate and multivariate regression analyses are performed with the 21 Swedish county councils/regions as a base. In the county councils/regions, non-awareness ranged from 1 to 15% and knowledge from 47 to 67%. There are relatively large differences between population groups. The amount of regional media coverage shows no significant correlation to the level of awareness and knowledge. There is, however, a significant correlation to both positive and negative attitudes; the latter remains after controlling for actual waiting times. At the national level, the media function as a policy implementer, being the primary source of information. At the regional level, the media are part of the political communication, reporting more extensively in county councils/regions where the population holds negative views towards the achievement in implementing the guarantee. We conclude that Swedish authorities should develop its communication strategies to bridge health literacy inequalities. © 2014 John Wiley & Sons Ltd.

  4. The role of cognitive and learning theories in supporting successful EHR system implementation training: a qualitative study.

    Science.gov (United States)

    McAlearney, Ann Scheck; Robbins, Julie; Kowalczyk, Nina; Chisolm, Deena J; Song, Paula H

    2012-06-01

    Given persistent barriers to effective electronic health record (EHR) system implementation and use, the authors investigated implementation training practices in six organizations reputed to have ambulatory care EHR system implementation "best practices." Using the lenses of social cognitive and adult learning theories, they explored themes related to EHR implementation training using qualitative data collected through 43 key informant interviews and 6 physician focus groups conducted between February 2009 and December 2010. The authors found consistent evidence that training practices across the six organizations known for exemplary implementations were congruent with the tenets of these theoretical frameworks and highlight seven best practices for training. The authors' analyses suggest that effective training programs must move beyond technical approaches and incorporate social and cultural factors to make a difference in implementation success. Taking these findings into account may increase the likelihood of successful EHR implementation, thereby helping organizations meet "meaningful use" requirements for EHR systems.

  5. Eight critical factors in creating and implementing a successful simulation program.

    Science.gov (United States)

    Lazzara, Elizabeth H; Benishek, Lauren E; Dietz, Aaron S; Salas, Eduardo; Adriansen, David J

    2014-01-01

    Recognizing the need to minimize human error and adverse events, clinicians, researchers, administrators, and educators have strived to enhance clinicians' knowledge, skills, and attitudes through training. Given the risks inherent in learning new skills or advancing underdeveloped skills on actual patients, simulation-based training (SBT) has become an invaluable tool across the medical education spectrum. The large simulation, training, and learning literature was used to provide a synthesized yet innovative and "memorable" heuristic of the important facets of simulation program creation and implementation, as represented by eight critical "S" factors-science, staff, supplies, space, support, systems, success, and sustainability. These critical factors advance earlier work that primarily focused on the science of SBT success, to also include more practical, perhaps even seemingly obvious but significantly challenging components of SBT, such as resources, space, and supplies. SYSTEMS: One of the eight critical factors-systems-refers to the need to match fidelity requirements to training needs and ensure that technological infrastructure is in place. The type of learning objectives that the training is intended to address should determine these requirements. For example, some simulators emphasize physical fidelity to enable clinicians to practice technical and nontechnical skills in a safe environment that mirrors real-world conditions. Such simulators are most appropriate when trainees are learning how to use specific equipment or conduct specific procedures. The eight factors-science, staff, supplies, space, support, systems, success, and sustainability-represent a synthesis of the most critical elements necessary for successful simulation programs. The order of the factors does not represent a deliberate prioritization or sequence, and the factors' relative importance may change as the program evolves.

  6. Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment.

    Science.gov (United States)

    Mohr, David C; Lyon, Aaron R; Lattie, Emily G; Reddy, Madhu; Schueller, Stephen M

    2017-05-10

    Mental health problems are common and pose a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people experience barriers that prevent access to treatment, aggravated by a lack of mental health specialists. Digital mental health is potentially useful in meeting the treatment needs of large numbers of people. A growing number of efficacy trials have shown strong outcomes for digital mental health treatments. Yet despite their positive findings, there are very few examples of successful implementations and many failures. Although the research-to-practice gap is not unique to digital mental health, the inclusion of technology poses unique challenges. We outline some of the reasons for this gap and propose a collection of methods that can result in sustainable digital mental health interventions. These methods draw from human-computer interaction and implementation science and are integrated into an Accelerated Creation-to-Sustainment (ACTS) model. The ACTS model uses an iterative process that includes 2 basic functions (design and evaluate) across 3 general phases (Create, Trial, and Sustain). The ultimate goal in using the ACTS model is to produce a functioning technology-enabled service (TES) that is sustainable in a real-world treatment setting. We emphasize the importance of the service component because evidence from both research and practice has suggested that human touch is a critical ingredient in the most efficacious and used digital mental health treatments. The Create phase results in at least a minimally viable TES and an implementation blueprint. The Trial phase requires evaluation of both effectiveness and implementation while allowing optimization and continuous quality improvement of the TES and implementation plan. Finally, the Sustainment phase involves the withdrawal of research or donor support, while leaving a functioning, continuously improving TES in place. The ACTS model is a step

  7. Applying value stream mapping techniques to eliminate non-value-added waste for the procurement of endovascular stents.

    Science.gov (United States)

    Teichgräber, Ulf K; de Bucourt, Maximilian

    2012-01-01

    OJECTIVES: To eliminate non-value-adding (NVA) waste for the procurement of endovascular stents in interventional radiology services by applying value stream mapping (VSM). The Lean manufacturing technique was used to analyze the process of material and information flow currently required to direct endovascular stents from external suppliers to patients. Based on a decision point analysis for the procurement of stents in the hospital, a present state VSM was drawn. After assessment of the current status VSM and progressive elimination of unnecessary NVA waste, a future state VSM was drawn. The current state VSM demonstrated that out of 13 processes for the procurement of stents only 2 processes were value-adding. Out of the NVA processes 5 processes were unnecessary NVA activities, which could be eliminated. The decision point analysis demonstrated that the procurement of stents was mainly a forecast driven push system. The future state VSM applies a pull inventory control system to trigger the movement of a unit after withdrawal by using a consignment stock. VSM is a visualization tool for the supply chain and value stream, based on the Toyota Production System and greatly assists in successfully implementing a Lean system. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  8. Comparison of Efficacy of Self-Expandable Metallic Stent Placement in the Unresectable Esophageal Cancer Patients.

    Science.gov (United States)

    Uesato, Masaya; Akutsu, Yasunori; Murakami, Kentarou; Muto, Yorihiko; Kagaya, Akiko; Nakano, Akira; Aikawa, Mizuho; Tamachi, Tomohide; Arasawa, Takahiro; Amagai, Hiroyuki; Muto, Yasuhide; Matsubara, Hisahiro

    2017-01-01

    This is a retrospective study to evaluate the prevention of complications of metallic stent placement in patients with unresectable advanced esophageal cancer. A total of 87 patients were treated with 4 types of metal stents in the esophagus over a period of 18 years. Stent placement was technically successful. The most common prior treatment was chemoradiotherapy. There were no significant differences in the rate of patients with no complications among the prior treatments. Approximately, 30% of patients had the most common chest pain in complications. Stent placement within one month after the completion of chemoradiotherapy should be avoided for the prevention of the chest pain. There was no significant difference in the rate of patients with no complications by lesion location. The rate of no complications was higher for the Niti-S stent than the Gianturco Z-stent or Ultraflex stent. Of note, no complications were noted for the Niti-S ultrathin stent at all. Among cases of stent-related death, the most common type of complication was respiratory disorder caused by the stent that seems to be thick and hard. Therefore, the stent with thin and flexible characteristics like the Niti-S ultrathin stent will solve the various problems of esophageal stent placement.

  9. Telehealth: seven strategies to successfully implement disruptive technology and transform health care.

    Science.gov (United States)

    Schwamm, Lee H

    2014-02-01

    "Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.

  10. Human resource management in Lean Production adoption and implementation processes: Success factors in the aeronautics industry

    Directory of Open Access Journals (Sweden)

    Pedro José Martínez-Jurado

    2014-01-01

    Full Text Available The purpose of this paper is to identify success factors in human resource management during the transition process to Lean Production. Using case study research in the aeronautics industry, the results show a series of explanatory factors that are then grouped into main factors depending on the phase of the transition process. Thus, in the pre-adoption phase, the setting up of joint management-trade unions committees is the main factor. Five main factors are found in the other three phases of the adoption and implementation process: training, communication, rewards, job design, and work organization. Moreover, a variety of explanatory elements are identified in each of the main factors found in each phase of the transition process to Lean Production. Finally, a model is developed to understand the sequence that leads to the cultural change associated with Lean Production.

  11. Successful implementation of inquiry-based physiology laboratories in undergraduate major and nonmajor courses.

    Science.gov (United States)

    Casotti, G; Rieser-Danner, L; Knabb, M T

    2008-12-01

    Recent evidence has demonstrated that inquiry-based physiology laboratories improve students' critical- and analytical-thinking skills. We implemented inquiry-based learning into three physiology courses: Comparative Vertebrate Physiology (majors), Human Physiology (majors), and Human Anatomy and Physiology (nonmajors). The aims of our curricular modifications were to improve the teaching of physiological concepts, teach students the scientific approach, and promote creative and critical thinking. We assessed our modifications using formative (laboratory exams, oral presentations, and laboratory reports) and summative evaluations (surveys, laboratory notebook, and an end of semester project). Students appreciated the freedom offered by the new curriculum and the opportunity to engage in the inquiry process. Results from both forms of evaluation showed a marked improvement due to the curricular revisions. Our analyses indicate an increased confidence in students' ability to formulate questions and hypotheses, design experiments, collect and analyze data, and make conclusions. Thus, we have successfully incorporated inquiry-based laboratories in both major and nonmajor courses.

  12. Potential Success and Barrier Factors for Implementation of the Transition to Independence (TIP Model

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    Christopher M. Kalinyak

    2017-01-01

    Full Text Available In this qualitative study, 28 key stakeholders who work with transition-aged youth participated in focus group discussions addressing success and barrier factors regarding implementation of a transition to independence process (TIP program for youth, ages 14–29, in three Midwestern cities. All participants had prior knowledge of TIP. The paradigm shift to client-oriented goals and services was acknowledged by respondents as the prime benefit of TIP; youth are more motivated to follow through on self-determined goals. Barrier factors for providers involved collaboration with agencies adhering to provider-oriented interventions, provision of TIP methods training, and reallocation of time and money. Barrier factors for youth involved mistrust of service providers, overcoming maturational deficits, and acquiring and maintaining relationships, reputations, and social supports.

  13. The nature and pattern of coronary stent recalls.

    Science.gov (United States)

    Kumar, Sanjay; Innasimuthu, Antony L; Marmur, Jonathan D

    2014-09-01

    Each year, over 1 million percutaneous coronary interventions (PCIs) are performed in the United States. Coronary stents have been shown to reduce restenosis or abrupt vessel closure and therefore have improved the success of PCI. Rarely, manufacturers recall stents due to unanticipated problems. We sought to study the extent and pattern of stent recall. To determine the number and rate of stent recall and safety alerts, to identify trends in the rates, and to identify the nature of stent recalls. The Food and Drug Administration (FDA; http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRES/res.cfm) and Healthcare Recall Management websites (RASMAS; https://alerts.rasmas.noblis.org/rasmas/c/selectViewAlertList.do) were searched. The search terms for recall were, "coronary stent" or "stent." Dates were searched between November 2002 and June 2013. There were 17 coronary stent recalls involving almost 500,000 units; 12 recalls (71%) were before 2006 and 5 recalls (29%) were after. Thirteen recalls (76%) consisted of class II recalls (moderate hazard); the remaining 4 were equally split between class I (severe hazard) and class III (mild hazard; 12% each). The common reasons for recall were concerns with sterility (29%) followed by wrong labeling/packaging (23%) and impaired delivery of stent (18%). In terms of units involved with recalls, 98% (472,189/481,131) were related to wrong labeling/ packaging or misbranding, while 0.1% (542/481,131) were related to potential for broken struts or crack in inflation port hub or sterility. However, approximately 2% of units were related to the potentially lethal problem of impaired balloon inflation. Recalls involved multiple manufacturers with various stent types. The overall incidence of coronary stent recall is low and has declined over the years. The majority of stent recalls are of moderate hazard. However, due to the possibility of serious injury, clinicians should be aware of recalls.

  14. Colorectal stenting for colonic obstruction: The indications, complications, effectiveness and outcome-5-Year review

    Energy Technology Data Exchange (ETDEWEB)

    Athreya, S. [Department of Radiology, Gartnavel General Hospital, Great Western Road, Glasgow (United Kingdom)]. E-mail: harshavbs@yahoo.com; Moss, J. [Department of Radiology, Gartnavel General Hospital, Great Western Road, Glasgow (United Kingdom)]. E-mail: j.moss@clinmed.gla.ac.uk; Urquhart, G. [Department of Radiology, Southern General Hospital, Glasgow (United Kingdom); Edwards, R. [Department of Radiology, Gartnavel General Hospital, Great Western Road, Glasgow (United Kingdom); Downie, A. [Department of Radiology, Victoria Infirmary, Glasgow (United Kingdom); Poon, F.W. [Department of Radiology, Royal Infirmary, Glasgow (United Kingdom)

    2006-10-15

    Introduction: Currently self-expanding metallic stents are being used for palliation and acute decompression of colonic obstruction. The aim of this study is to review our experience of using these metallic stents over a 5-year period. Materials and methods: Case records of 102 patients who had colorectal stenting between 1998 and 2004 were reviewed retrospectively. The indications for colorectal stenting, efficacy of the procedure in relieving the obstruction, complications and clinical outcome were analysed. Results: Ninety-nine patients had malignant disease and in three patients a benign cause of obstruction was demonstrated. All procedures were performed during normal working hours. Stenting was technically successful in 87 patients (85%). A single stent was placed in 80 patients. Seven patients required two stents. Of the successful cases, 67 had stents placed by fluoroscopy alone and 20 by a combined fluoroscopy/endoscopy procedure. Four percent had early complications (within 30 days) which included four perforations. There were late complications (over 30 days) in 9% which included five stent migrations, two blocked stents and one colovesical fistula. Ninety percent (n = 76) of the successful patients needed no further radiological or surgical intervention later. Survival ranged from 14 days to 2 years. Conclusion: Colorectal stenting when technically successful is an effective procedure for both preoperative and palliative decompression of colonic obstruction.

  15. Critical success factors for implementation of supply chain management in Indian small and medium enterprises and their impact on performance

    OpenAIRE

    Kumar, Ravinder; Rajesh K. Singh; Shankar, Ravi

    2015-01-01

    Globalization of the economy, e-business, and introduction of new technologies pose new challenges to all organizations especially for small and medium enterprises (SMEs). In this scenario, successful implementation of supply chain management (SCM) can give SMEs an edge over their competitors. However, SMEs in India and other developing countries face problems in SCM implementation due to lack of resources and direction. Against this backdrop, this paper identified 13 critical success factors...

  16. From Plan to Action: Successful Data Management Plan Implementation in a Multidisciplinary Project

    Directory of Open Access Journals (Sweden)

    Margaret H. Burnette

    2016-09-01

    Full Text Available Objective and Setting: While data management planning becomes more commonplace, moving from planning into implementation remains a hurdle for many researchers. With little specific guidance from funding agencies and libraries in the early stages of developing services to assist researchers, insights into what contributes to successful data management are sorely needed. The objective of this study was to document how a multidisciplinary research team, after consultation with the University of Illinois Library, took steps to implement a data management plan. Design and Methods: A case study was designed to gather insights from the research group through semi-structured interviews. Questions focused on which of the recommended data management strategies were adopted and how those strategies affected the project in terms of cost, time, effectiveness, and long-term data use. Results: From these interviews five major themes emerged as important: intentional staffing, addressing essential data management elements, iterative improvement, training and mentorship, and increased efficiency and peace of mind. Conclusions: Despite the initial investment that data management requires, researchers report significant benefits.

  17. From national air carriers to low-cost companies: Effects of successful marketing strategy implementation

    Directory of Open Access Journals (Sweden)

    Aćimović Slobodan

    2009-01-01

    Full Text Available Huge changes in marketing strategies and, more generally - in business philosophies are not so often. During the last 20 years global and/or national companies have already defined their general approaches of marketing instruments implementation. Therefore, when a contemporary company changes something in its marketing approach, it usually only refers to 'subtle adjustment' of the already determined strategy. Another reason for changes in a particular segment of marketing is a crisis of some kind that forces firms to implement innovations, especially regarding the elements such as costs - price - or service quality. A global enterprise segment consisting of low tariff airline companies is here identified as the one that has dramatically changed its marketing approach within the last 20 years, which continually resulted in its improved market position and business results. Changes in marketing strategies of low-cost companies have truly been revolutionary and are completely the consequence of recognizing the real needs of clients who use services of air transport. The success of low-cost airline companies is forcing the traditional, classic, air carriers to adapt their marketing instruments to this new model of business management. This paper also identifies one very significant assumption of the low-cost carriers phenomenon and their marketing approach - the liberalization of the global air transport market.

  18. Identifying critical success factors (CSFs) of implementing building information modeling (BIM) in Malaysian construction industry

    Science.gov (United States)

    Yaakob, Mazri; Ali, Wan Nur Athirah Wan; Radzuan, Kamaruddin

    2016-08-01

    Building Information Modeling (BIM) is defined as existing from the earliest concept to demolition and it involves creating and using an intelligent 3D model to inform and communicate project decisions. This research aims to identify the critical success factors (CSFs) of BIM implementation in Malaysian construction industry. A literature review was done to explore previous BIM studies on definitions and history of BIM, construction issues, application of BIM in construction projects as well as benefits of BIM. A series of interviews with multidisciplinary Malaysian construction experts will be conducted purposely for data collection process guided by the research design and methodology approach of this study. The analysis of qualitative data from the process will be combined with criteria identified in the literature review in order to identify the CSFs. Finally, the CSFs of BIM implementation will be validated by further Malaysian industrialists during a workshop. The validated CSFs can be used as a term of reference for both Malaysian practitioners and academics towards measuring BIM effectiveness level in their organizations.

  19. Concocting that Magic Elixir: Successful Grant Application Writing in Dissemination and Implementation Research.

    Science.gov (United States)

    Brownson, Ross C; Colditz, Graham A; Dobbins, Maureen; Emmons, Karen M; Kerner, Jon F; Padek, Margaret; Proctor, Enola K; Stange, Kurt C

    2015-12-01

    This paper reports core competencies for dissemination and implementation (D&I) grant application writing and provides tips for writing a successful proposal. Two related phases were used to collect the data: a card sorting process among D&I researchers and an expert review among a smaller set of researchers. Card sorting was completed by 123 respondents. In the second phase, a series of grant application writing tips were developed based on the combined 170 years of grant review experience of the writing team. The card sorting resulted in 12 core competencies for D&I grant application writing that covered the main sections in a grant application to the US National Institutes of Health: (a) specific aims that provide clear rationale, objectives, and an overview of the research plan; (b) significance that frames and justifies the importance of a D&I question; (c) innovation that articulates novel products and new knowledge; and (d) approach that uses a relevant D&I model, addresses measurement and the D&I context, and includes an analysis plan well-tied to the aims and measures. Writing a successful D&I grant application is a skill that can be learned with experience and attention to the core competencies articulated in this paper. © 2015 Wiley Periodicals, Inc.

  20. Successful implementation effect of insurance services in money and capital financial markets

    Directory of Open Access Journals (Sweden)

    Nemat Tahmasebi

    2016-11-01

    Full Text Available One of the most important sectors of the economy of each country is capital market. Economic growth can lead to the development and prosperity of the capital market. On the other hand to achieve the desired economic development, without existence of effective financial institutions and appropriate equipment of financial resources, it is impossible. In this regard, efficient financial systems through seeking information about investment opportunities, integrate and mobilize savings, monitoring investments and exert corporate governance can facilitate the exchange of goods and services, distribution and risk management, reducing transaction costs and data analysis may lead to better allocation of resources and ultimately economic growth. Insurance companies and generally insurance industry in each country is the most important and active financial institutions operating in the financial market especially capital markets in addition to securing economic activity could have basic role in mobility of financial markets and providing funds to invest in the economic activity through the provision of insurance services. In this study, successful financial services of insurance and investment funds in insurance companies such as Dana, Alborz, and Asia have been studied in Tehran. According to the hypothesis, there is a significant correlation between successful implementation of insurance services and money and capital financial markets. There is a significant correlation between different types of insurance services (institution-building, instrument making, and general insurance policies and money and capital financial markets.

  1. Reduction of seclusion on a hospital-wide level: successful implementation of a less restrictive policy.

    Science.gov (United States)

    Jungfer, Hermann-Alexander; Schneeberger, Andres R; Borgwardt, Stefan; Walter, Marc; Vogel, Marc; Gairing, Stefanie K; Lang, Undine E; Huber, Christian G

    2014-07-01

    Change of treatment policy from closed to open ward settings has been shown to reduce coercive measures. The aim of the current study was to examine the effects of the change from closed to open wards on the frequency of seclusion and forced medication in a hospital-wide setting. 2-year, longitudinal observational study with 2838 inpatient cases. On a hospital-wide level, the percentage of patients with at least one seclusion was decreased significantly (χ(2)(1) = 5.8; p = .016), while there was no significant change in forced medication (χ(2)(1) = .08; p = .775). The frequency of seclusions and forced medication decreased significantly on newly opened wards, and there were no significant changes regarding seclusion on permanently closed or open wards, while the number of forced medications increased significantly on closed wards. The decrease in seclusions on newly opened wards remained statistically significant after controlling for diagnoses and severity of illness. Our results indicate that a reduction of overall seclusion can be successfully attained, and that, in particular, the frequency of seclusion and forced medication on newly opened wards was decreased significantly. These changes were not accompanied by a significant increase in seclusion on other wards. Open ward treatment was successfully implemented and was associated with a significant decrease of coercive measures in our study. It might therefore provide a good care model, strengthening the patient's right to autonomy and leading to a reduction of coercive measures. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Concocting that Magic Elixir: Successful Grant Application Writing in Dissemination and Implementation Research

    Science.gov (United States)

    Colditz, Graham A.; Dobbins, Maureen; Emmons, Karen M.; Kerner, Jon F.; Padek, Margaret; Proctor, Enola K.; Stange, Kurt C.

    2015-01-01

    Abstract Background This paper reports core competencies for dissemination and implementation (D&I) grant application writing and provides tips for writing a successful proposal. Methods Two related phases were used to collect the data: a card sorting process among D&I researchers and an expert review among a smaller set of researchers. Card sorting was completed by 123 respondents. In the second phase, a series of grant application writing tips were developed based on the combined 170 years of grant review experience of the writing team. Results The card sorting resulted in 12 core competencies for D&I grant application writing that covered the main sections in a grant application to the US National Institutes of Health: (a) specific aims that provide clear rationale, objectives, and an overview of the research plan; (b) significance that frames and justifies the importance of a D&I question; (c) innovation that articulates novel products and new knowledge; and (d) approach that uses a relevant D&I model, addresses measurement and the D&I context, and includes an analysis plan well‐tied to the aims and measures. Conclusions Writing a successful D&I grant application is a skill that can be learned with experience and attention to the core competencies articulated in this paper. PMID:26577630

  3. Designing and Implementation of a Course on Successful Dental Practice for Dentists

    Directory of Open Access Journals (Sweden)

    Yaser Safi

    2015-11-01

    Full Text Available Objectives: We aimed to design, implement and evaluate the efficacy of a comprehensive course on non-clinical competencies that dentists must possess for a successful dental practice.Materials and Methods: In this interventional before-after study an expert panel of five academic staff members and five general practitioners derived the topics for a course on successful dental practice, and aggregated them in the form of a two-day course. It was held for 46 randomly selected dentists in January 2010, at the School of Dentistry, Tehran University of Medical Sciences. The participants completed an anonymous questionnaire asking about their self-perceived need to receive training in each of the proposed topics and their self-assessed knowledge about each topic before and after attending the course.Results: Participants gave a higher priority to the necessity of training on “ergonomics and professional health” and communication skills in post-test compared to pre-test (P<0.05. The self-assessed knowledge of dentists improved significantly after attending the course in seven domains: ergonomics and occupational health, workplace design, documentation principles and IT applications in dentistry, national rules and regulations of dental practice, medical emergencies, dental ethics and communication skills (P<0.05. More than 70% of the participants were completely satisfied or satisfied with practical implication of the course, conformity of the contents with the title and course settings.Conclusion: The designed course seemed to be successful in revealing the need of participants for further education. Considering the high satisfaction rate of the attendants, this course can serve as a model for continuing education purposes.

  4. Magnetizable stent-grafts enable endothelial cell capture

    Science.gov (United States)

    Tefft, Brandon J.; Uthamaraj, Susheil; Harburn, J. Jonathan; Hlinomaz, Ota; Lerman, Amir; Dragomir-Daescu, Dan; Sandhu, Gurpreet S.

    2017-04-01

    Emerging nanotechnologies have enabled the use of magnetic forces to guide the movement of magnetically-labeled cells, drugs, and other therapeutic agents. Endothelial cells labeled with superparamagnetic iron oxide nanoparticles (SPION) have previously been captured on the surface of magnetizable 2205 duplex stainless steel stents in a porcine coronary implantation model. Recently, we have coated these stents with electrospun polyurethane nanofibers to fabricate prototype stent-grafts. Facilitated endothelialization may help improve the healing of arteries treated with stent-grafts, reduce the risk of thrombosis and restenosis, and enable small-caliber applications. When placed in a SPION-labeled endothelial cell suspension in the presence of an external magnetic field, magnetized stent-grafts successfully captured cells to the surface regions adjacent to the stent struts. Implantation within the coronary circulation of pigs (n=13) followed immediately by SPION-labeled autologous endothelial cell delivery resulted in widely patent devices with a thin, uniform neointima and no signs of thrombosis or inflammation at 7 days. Furthermore, the magnetized stent-grafts successfully captured and retained SPION-labeled endothelial cells to select regions adjacent to stent struts and between stent struts, whereas the non-magnetized control stent-grafts did not. Early results with these prototype devices are encouraging and further refinements will be necessary in order to achieve more uniform cell capture and complete endothelialization. Once optimized, this approach may lead to more rapid and complete healing of vascular stent-grafts with a concomitant improvement in long-term device performance.

  5. [Very late drug-eluting stent thrombosis by stent fracture].

    Science.gov (United States)

    Cheaito, R; Tritar, A; Scemama, A; Ferrag, W; Goy, P; Haziza, F; Benamer, H

    2015-12-01

    The superiority of drug-eluting stents in reducing the risk of in-stent restenosis compared to bare-metal stents is no longer challenged. Nevertheless, the drug-eluting stents may carry long-term risk of late and very late stent thrombosis. The promoting factors of this complication are usually divided into three chapters depending on the patient, the procedure and the stent. Indeed, the literature has reported several parameters related to the stent itself, such as its length, the malapposition, its diameter, but also more rarely the occurrence of stent fracture. We present the case of a patient admitted for myocardial infarction after a very late thrombosis of Cypher drug-eluting stent four years after its implantation and related to stent fracture. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  6. Government-to-private sector energy programs: Identification of common elements leading to successful implementation

    Science.gov (United States)

    Stockton, Keith M.

    This dissertation examines six distinct government energy programs implemented in the United States during the last three decades. A common element within these programs is an attempt by government to drive commercialization of energy technologies leading to changes in energy production or consumptive behavior. We seek to understand the factors that lead to success or failure of these programs with two goals in mind. The first is theoretical in that we test a hypothesis that market-based energy programs have substantially higher success rates than command-and-control programs. The second goal is operational in nature, in which we desire to identify common factors within energy programs that lead either to program success or to failure. We investigate and evaluate three market-based and three command-and-control energy programs. The market-based programs include the federal Corporate Average Fuel Economy and Sulfur Dioxide Emissions Control programs as well as Colorado's Amendment 37. The command-and-control programs include the federal Synthetic Fuels Corporation and Corn Based Ethanol programs as well as Colorado's Solar Electric Power program. We conduct the analysis of each program based on composite methodology derived from leading academics within the Policy Sciences. From our research findings, we conclude that both market-based and command-and-control programs can achieve their legislative goals and objectives, resulting in permanent changes in energy production or consumptive behavior. However, we also find that the economic efficiency is the differentiator between market-based and command-and-control programs. Market-based programs, because of the inherent flexibility, allow participants to react to changing economic and/or technical conditions. In contrast, command-and-control programs lack such flexibility and often result in economic inefficiency when economic conditions change. The financial incentives incorporated in the three command

  7. Biocompatibility of Coronary Stents

    Directory of Open Access Journals (Sweden)

    Thamarasee M. Jeewandara

    2014-01-01

    Full Text Available Cardiovascular disease is the dominant cause of mortality in developed countries, with coronary artery disease (CAD a predominant contributor. The development of stents to treat CAD was a significant innovation, facilitating effective percutaneous coronary revascularization. Coronary stents have evolved from bare metal compositions, to incorporate advances in pharmacological therapy in what are now known as drug eluting stents (DES. Deployment of a stent overcomes some limitations of balloon angioplasty alone, but provides an acute stimulus for thrombus formation and promotes neointimal hyperplasia. First generation DES effectively reduced in-stent restenosis, but profoundly delay healing and are susceptible to late stent thrombosis, leading to significant clinical complications in the long term. This review characterizes the development of coronary stents, detailing the incremental improvements, which aim to attenuate the major clinical complications of thrombosis and restenosis. Despite these enhancements, coronary stents remain fundamentally incompatible with the vasculature, an issue which has largely gone unaddressed. We highlight the latest modifications and research directions that promise to more holistically design coronary implants that are truly biocompatible.

  8. [Esophageal stenting complications].

    Science.gov (United States)

    Smoliar, A N; Radchenko, Iu A; Nefedova, G A; Abakumov, M M

    2014-01-01

    The aim of the study was to analyze esophageal stenting complications in case of cancer and benign diseases. It was investigated complications in 8 patients in terms from 7 days to 1 year after intervention. In 4 patients esophageal stenting was performed for constrictive esophageal cancer and compression with pulmonary cancer metastases into mediastinal lymphatic nodes. 2 patients had esophageal stenting for post-tracheostomy tracheo-esophageal fistula, 1 patient - for spontaneous esophageal rupture, 1 patient - for post-burn scar narrowing of esophagus and output part of the stomach. Severe patients' condition with tumor was determined by intensive esophageal bleeding in 2 cases, bilateral abscessed aspiration pneumonia, tumor bleeding, blood aspiration (1 case), posterior mediastinitis (1 case). Severe patients' condition with benign disease was associated with decompensated esophageal narrowing about proximal part of stent (1 case), increase of tracheo-esophageal fistula size complicated by aspiration pneumonia (1 case), stent migration into stomach with recurrence of esophago-mediastino-pleural fistula and pleural empyema (1 case), decompensated narrowing of esophagus and output part of the stomach (1 case). Patients with cancer died. And patients with benign diseases underwent multi-stage surgical treatment and recovered. Stenting is palliative method for patients with esophageal cancer. Patients after stenting should be under outpatient observation for early diagnosis of possible complications. Esophageal stenting in patients with benign diseases should be performed only by life-saving indications, in case of inability of other treatment and for the minimum necessary period.

  9. ANALYSIS OF INFORMATION SYSTEM IMPLEMENTATION IN BINUS UNIVERSITY USING DELONE AND MCLEAN INFORMATION SYSTEM SUCCESS MODEL AND COBIT FRAMEWORK

    Directory of Open Access Journals (Sweden)

    Johan Muliadi Kerta

    2013-05-01

    Full Text Available The success of implementation of information system in an organization will supportthe organization in the process of achieving goals. Successful information system will support theorganization's day-to-day operations, so that problem can be resolved more quickly and easily. Theinformation system which has been developed and implemented is also necessary to measure thematurity level. Therefore, it can determine whether the implementation of information systemsmade in accordance with the goals of the organization. Measuring the success of informationsystems used the DeLone and McLean IS success model. To measure the maturity level ofinformation systems used COBIT (Control Objectives for Information and related Technologyframeworks that provides best practices for IT governance and control. The results of this analysiswill assist and support the IT team in order to develop and build information systems that better fitthe needs and goals of the organization.

  10. Efficacy of retrievable metallic stent with fixation string for benign stricture after upper gastrointestinal surgery

    Energy Technology Data Exchange (ETDEWEB)

    KIm, Jeong Eun; KIm, Hyo Cheol; Lee, Myung Su; Hur, Sae Beom; KIm, Minuk; Lee, Sang Hwan; Cho, Soo Buem; KIm, Chan Sun; Han, Joon Koo [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2016-11-15

    To determine the efficacy of retrievable metallic stent with fixation string for benign anastomotic stricture after upper gastrointestinal (UGI) surgery. From June 2009 to May 2015, a total of 56 retrievable metallic stents with fixation string were placed under fluoroscopy guidance in 42 patients who were diagnosed with benign anastomotic stricture after UGI surgery. Clinical success was defined as achieving normal regular diet (NRD). The clinical success rate after the first stent placement was 57.1% (24/42). After repeated stent placement and/or balloon dilation, the clinical success rate was increased to 83.3% (35/42). Six (14.3%) patients required surgical revision to achieve NRD. One (2.4%) patient failed to achieve NRD. Stent migration occurred in 60.7% (34/56) of patients. Successful rate of removing the stent using fixation string and angiocatheter was 94.6% (53/56). Distal migration occurred in 12 stents. Of the 12 stents, 10 (83.3%) were successfully removed whereas 2 could not be removed. No complication occurred regarding distal migration. Using retrievable metallic stent with a fixation string is a feasible option for managing early benign anastomotic stricture after UGI surgery. It can reduce complications caused by distal migration of the stent.

  11. Combination therapy of temporary tracheal stenting and radiofrequency ablation for multinodular thyroid goiter with airway compression

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon; Beak, Jung Hwan; Oh, Yeon Mok; Ha, Eun Ju; Lee, Jeong Hyun [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2013-10-15

    We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.

  12. Recanalization of an Occluded Intrahepatic Portosystemic Covered Stent via the Percutaneous Transhepatic Approach

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Chih Yang; Liang, Po Chin [National Taiwan University Hospital, Taipei (China)

    2010-08-15

    A 41-year-old woman with liver cirrhosis had recurrent portal hypertension and bleeding from esophageal varices due to complete occlusion of a previously inserted transjugular intrahepatic portosystemic shunt stent. Because recanalization of the stent by the transjugular approach was unsuccessful, ultrasound-guided entry to the splenic vein and portal vein was used. After catheter-directed intrathrombus thrombolysis, successful opening of the stent was achieved and a stent was placed. We herein report a rare case in which thrombolysis and recanalization of a TIPS stent were performed via a percutaneous transhepatic approach

  13. Oesphageal Stenting for palliation of malignant mesothelioma

    Directory of Open Access Journals (Sweden)

    Rahamim Joseph

    2008-01-01

    Full Text Available Abstract Dyspahgia in patients with malignant mesothelioma is usually due to direct infiltration of the eosophagus by the tumour. It can be distressing for the patient and challenging for the physician to treat. We describe three cases in which this condition has been successfully palliated with self expanding esophageal stents.

  14. Late Thrombosis of Sirolimus-Eluting Stent: A Multifactorial Problem

    Directory of Open Access Journals (Sweden)

    Igor Kranjec

    2009-01-01

    Full Text Available We report a case of a young patient in whom a sirolimus-eluting stent was implanted on the culprit left anterior descending coronary artery at primary percutaneous coronary intervention (PCI for acute myocardial infarction. Nine months later she suffered from a reinfarction due to the late stent thrombosis despite a continuous antiplatelet therapy with aspirin and clopidogrel. A cluster of factors that might have contributed to the development of the stent thrombosis were identified: suboptimal PCI technique, complete stent fracture, and clopidogrel resistance. The obstructed stent was successfully reopened by repeat PCI, while the clopidogrel maintenance dosage was doubled to 150 mg daily for the following year. The further long-term clinical course was uneventful.

  15. On the successful integration of the implemented principles into the fiscal legislation

    Directory of Open Access Journals (Sweden)

    Valerijs JAKUŠEVS

    2013-12-01

    Full Text Available The study is carried out within the boundaries of the research “Taxation policy of the Republic of Latvia within the context of the principle of equity”. The objective of the study is to prepare a theoretical basis for the successful implementation of the state taxation policy considering the presently widespread usage of electronic means of data processing, transfer and storage, as well as to develop the legislative principles of self-regulation for the fiscal legislation in order to prepare it for working with quantum physics-based data processing hardware. The study is based on the legislative practice of the Republic of Latvia, with special regard to the period of economic recovery following the economic recession of 2009-2012. The study relies on legal literature, judicial practice, state planning documents and the researches ordered by the government and carried out by private contractors, as well as on statistics. The data collection does not confine itself to the research of phenomena and the systematization of the new knowledge and the knowledge acquired before, but mostly uses the empiric scientific method – observations, surveys. The study also employs the theoretical scientific method by analyzing the aforementioned documents and literature and using these as a basis for developing the theory and suggesting hypotheses, as well as through scientific (conceptual modeling. Relying on the acquired data, the author verifies the forecasting power in order to achieve the objective of the study.

  16. Stent intussusception after thromboaspiration through a platinum chrome stent: a particular case of longitudinal stent deformation.

    Science.gov (United States)

    Mila, Rafael; Vignolo, Gustavo; Trujillo, Pedro

    2015-04-01

    The need to improve stent deliverability has led to the development of thinner and more flexible stents. However, there is concern about decreased longitudinal strength. The number of longitudinal stent deformation reports has dramatically increased. We report a case of stent longitudinal deformation after thromboaspiration through a new generation platinum chrome bare metal stent. Images show an "intussusception effect," an extreme form of the previously described "concertina deformation," as the mechanism of shortening. Since stent technology is constantly evolving, newer devices will probably be designed to have less susceptibility to longitudinal stent deformation.

  17. Facilitators and barriers to the successful implementation of a protocol to detect child abuse based on parental characteristics.

    Science.gov (United States)

    Diderich, Hester M; Dechesne, Mark; Fekkes, Minne; Verkerk, Paul H; Pannebakker, Fieke D; Klein Velderman, Mariska; Sorensen, Peggy J G; Buitendijk, Simone E; Oudesluys-Murphy, Anne Marie

    2014-11-01

    To determine the critical facilitating and impeding factors underlying successful implementation of a method to detect child abuse based on parental rather than child characteristics known as the Hague Protocol. The original implementation region of the protocol (The Hague) was compared to a new implementation region (Friesland), using analysis of referrals, focus group interviews (n=6) at the Emergency departments (ED) and at the Reporting Centers for Child abuse and Neglect (RCCAN) as well as questionnaires (n=76) at the EDs. Implementation of the Hague Protocol substantially increased the number of referrals to the RCCAN in both regions. In Friesland, the new implementation region, the number of referrals increased from 2 out of 92,464 patients (three per 100,000) to 108 out of 167,037 patients (62 per 100,000). However in Friesland, child abuse was confirmed in a substantially lower percentage of cases relative to the initial implementation region (62% vs. 91%, respectively). Follow-up analyses suggest that this lower positive predictive value may be due to the lack of training for RCCAN professionals concerning the Hague Protocol. The focus group interviews and questionnaires point to time limitations as the main impediment for implementation, whereas an implementation coach has been mentioned as the most important facilitating factor for success. The Hague Protocol can be used to detect child abuse beyond the initial implementation region. However, training is essential in order to assure a consistent evaluation by the RCCAN. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Characteristics and critical success factors for implementing problem-based learning in a human resource-constrained country.

    Science.gov (United States)

    Giva, Karen R N; Duma, Sinegugu E

    2015-08-31

    Problem-based learning (PBL) was introduced in Malawi in 2002 in order to improve the nursing education system and respond to the acute nursing human resources shortage. However, its implementation has been very slow throughout the country. The objectives of the study were to explore and describe the goals that were identified by the college to facilitate the implementation of PBL, the resources of the organisation that facilitated the implementation of PBL, the factors related to sources of students that facilitated the implementation of PBL, and the influence of the external system of the organisation on facilitating the implementation of PBL, and to identify critical success factors that could guide the implementation of PBL in nursing education in Malawi. This is an ethnographic, exploratory and descriptive qualitative case study. Purposive sampling was employed to select the nursing college, participants and documents for review.Three data collection methods, including semi-structured interviews, participant observation and document reviews, were used to collect data. The four steps of thematic analysis were used to analyse data from all three sources. Four themes and related subthemes emerged from the triangulated data sources. The first three themes and their subthemes are related to the characteristics related to successful implementation of PBL in a human resource-constrained nursing college, whilst the last theme is related to critical success factors that contribute to successful implementation of PBL in a human resource-constrained country like Malawi. This article shows that implementation of PBL is possible in a human resource-constrained country if there is political commitment and support.

  19. Percutaneous Biliary Drainage Using Open Cell Stents for Malignant Biliary Hilar Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Sun Jun; Bae, Jae Ik; Han, Tae Sun; Won, Je Hwan; Kim, Ji Dae; Kwack, Kyu Sung; Lee, Jae Hee; Kim, Young Chul [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2012-11-15

    To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.

  20. Late thrombosis of coronary bare-metal stent: Case report

    Directory of Open Access Journals (Sweden)

    Apostolović Svetlana

    2006-01-01

    Full Text Available Stent thrombosis remains the primary cause of death after percutaneous coronary interventions (PCI. Despite modern concepts of PCI, stent thrombosis occurs in 0.5% -2% of elective procedures and even 6% of patients with the acute coronary syndrome (ACS. Stent thrombosis most often develops within the first 48 hours after the PCI, and rarely after a week of stent implantation. Angiographically documented late (>6 months thrombosis of coronary bare-metal stent (BMS is rare, because the stent endothelialization is considered to be completed after four weeks of the intervention. Our patient is a 41 year old male and he had BMS thrombosis 345 days after the implantation, which was clinically manifested as an acute myocardial infarction in the inferoposterolateral localization. Stent Clinical Centre of Serbia, Belgrade thrombosis occurred despite a long term dual antiplatelet therapy and control of known risk factors. Thrombolytic therapy (Streptokinase in a dose of 1 500 000 IU was not successful in reopening the occluded vessel, so the flow through the coronary artery was achieved by rescue balloon angioplasty, followed by implantation of drug eluting stent in order to prevent restenosis.

  1. Method of evaluating the impact of ERP implementation critical success factors - a case study in oil and gas industries

    Science.gov (United States)

    Gajic, Gordana; Stankovski, Stevan; Ostojic, Gordana; Tesic, Zdravko; Miladinovic, Ljubomir

    2014-01-01

    The so far implemented enterprise resource planning (ERP) systems have in many cases failed to meet the requirements regarding the business process control, decrease of business costs and increase of company profit margin. Therefore, there is a real need for an evaluation of the influence of ERP on the company's performance indicators. Proposed in this article is an advanced model for the evaluation of the success of ERP implementation on organisational and operational performance indicators in oil-gas companies. The recommended method establishes a correlation between a process-based method, a scorecard model and ERP critical success factors. The method was verified and tested on two case studies in oil-gas companies using the following procedure: the model was developed, tested and implemented in a pilot gas-oil company, while the results were implemented and verified in another gas-oil company.

  2. Controlling Neglected Tropical Diseases (NTDs in Haiti: Implementation Strategies and Evidence of Their Success.

    Directory of Open Access Journals (Sweden)

    Jean Frantz Lemoine

    2016-10-01

    Full Text Available Lymphatic filariasis (LF and soil-transmitted helminths (STH have been targeted since 2000 in Haiti, with a strong mass drug administration (MDA program led by the Ministry of Public Health and Population and its collaborating international partners. By 2012, Haiti's neglected tropical disease (NTD program had reached full national scale, and with such consistently good epidemiological coverage that it is now able to stop treatment for LF throughout almost all of the country. Essential to this success have been in the detail of how MDAs were implemented. These key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign facilitated by voluntary drug distributors; strengthening community trust of the drug distributors by ensuring that respected community members were recruited and received appropriate training, supervision, identification, and motivation; enforcing a "directly observed treatment" strategy; providing easy access to treatment though numerous distribution posts and a strong drug supply chain; and ensuring quality data collection that was used to guide and inform MDA strategies. The evidence that these strategies were effective lies in both the high treatment coverage obtained- 100% geographical coverage reached in 2012, with almost all districts consistently achieving well above the epidemiological coverage targets of 65% for LF and 75% for STH-and the significant reduction in burden of infection- 45 communes having reached the target threshold for stopping treatment for LF. By taking advantage of sustained international financial and technical support, especially during the past eight years, Haiti's very successful MDA campaign resulted in steady progress toward LF elimination and development of a strong foundation for ongoing STH control. These efforts, as described, have not only helped establish the global portfolio of "best practices" for

  3. Controlling Neglected Tropical Diseases (NTDs) in Haiti: Implementation Strategies and Evidence of Their Success.

    Science.gov (United States)

    Lemoine, Jean Frantz; Desormeaux, Anne Marie; Monestime, Franck; Fayette, Carl Renad; Desir, Luccene; Direny, Abdel Nasser; Carciunoiu, Sarah; Miller, Lior; Knipes, Alaine; Lammie, Patrick; Smith, Penelope; Stockton, Melissa; Trofimovich, Lily; Bhandari, Kalpana; Reithinger, Richard; Crowley, Kathryn; Ottesen, Eric; Baker, Margaret

    2016-10-01

    Lymphatic filariasis (LF) and soil-transmitted helminths (STH) have been targeted since 2000 in Haiti, with a strong mass drug administration (MDA) program led by the Ministry of Public Health and Population and its collaborating international partners. By 2012, Haiti's neglected tropical disease (NTD) program had reached full national scale, and with such consistently good epidemiological coverage that it is now able to stop treatment for LF throughout almost all of the country. Essential to this success have been in the detail of how MDAs were implemented. These key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign facilitated by voluntary drug distributors; strengthening community trust of the drug distributors by ensuring that respected community members were recruited and received appropriate training, supervision, identification, and motivation; enforcing a "directly observed treatment" strategy; providing easy access to treatment though numerous distribution posts and a strong drug supply chain; and ensuring quality data collection that was used to guide and inform MDA strategies. The evidence that these strategies were effective lies in both the high treatment coverage obtained- 100% geographical coverage reached in 2012, with almost all districts consistently achieving well above the epidemiological coverage targets of 65% for LF and 75% for STH-and the significant reduction in burden of infection- 45 communes having reached the target threshold for stopping treatment for LF. By taking advantage of sustained international financial and technical support, especially during the past eight years, Haiti's very successful MDA campaign resulted in steady progress toward LF elimination and development of a strong foundation for ongoing STH control. These efforts, as described, have not only helped establish the global portfolio of "best practices" for NTD control but

  4. Analysis of Success Factors to Implement Sustainable Supply Chain Management Using Interpretive Structural Modeling Technique: A Real Case Perspective

    Directory of Open Access Journals (Sweden)

    Mengke Yang

    2017-01-01

    Full Text Available Sustainability draws increased supply chain management (SCM attention. This article analyzes critical success to the assessment, evaluation, and attainment of sustainable supply chain management (SSCM, assessed through critical-success identification and qualitative data analysis. Namely, a literature review selected of 188 articles, published between January 1994 and November 2016, helps identify the most influential success factors. The qualitative data analysis pertains to fifteen such successes, identified in the literature review and through our collaboration with other academic researchers and industrial specialists. Notably, the study’s qualitative data analysis, interpretive structural modeling (ISM, unconceals the mutual impact among the most prominent SSCM success factors. The economic benefits and environmental awareness of suppliers are recognized as the most significant success factors, which could allow business enterprises and other organizations to implement a SSCM framework, with intentionality and the sustainability in their business. The article concludes with suggestions for future research directions.

  5. Critical Success Factors for Enterprise Resource Planning System Implementation: A Case Study in Malaysian SME

    OpenAIRE

    Feybi Ariani Goni; Abdoulmohammad Gholamzadeh Chofreh; Shahnorbanun Sahran

    2011-01-01

    Implementing Enterprise Resource Planning (ERP) system for Malaysian Small to Medium Enterprises (SMEs) is not just a technological challenge. It is a socio-technological endeavour which mandates modifying existing applications and redesigning business processes to facilitate ERP system implementation. Most Malaysian SMEs cannot afford to adopt an existing ERP system due to the extremely high cost and complex implementation. The ERP system implementation literature contains many case studies ...

  6. Investigation of how to implement successful KPIs for organizations – based on an empirical study at an international organization

    OpenAIRE

    Shen, Jing

    2013-01-01

    In the information age, KPIs (Key Performance Indicators) are commonly used for business performance measurement in organizations; however there’s no single best way about how to implement KPIs, which means that a company can select any arbitrary suitable KPIs. The thesis will do research and investigations based on existing academic theory and a case study in an international logistic company. The research was aiming at helping organizations to develop and implement successful KPIs that are ...

  7. [Successful implementation of the EFQM management model at the Department of Ophthalmology in Graz].

    Science.gov (United States)

    Langmann, G; Maier, R; Theisl, A; Bauer, H; Klug, U; Foussek, C; Hödl, R; Wedrich, A; Gliebe, W

    2011-04-01

    In the context of legal requirements and scarcer resources, the implementation of a quality management (QM) model will provide a competitive advantage or a site warranty for a hospital. For 3 years, the Department of Ophthalmology in Graz has been working with the EFQM model and has now accomplished the first level quality award, namely "Committed to Excellence (C2E)". The project work towards achieving this C2E-award is described below. EFQM stands for European Foundation for Quality Management, an organization that was founded in 1989 by the EU, together with 14 leading enterprises. In the EFQM model, the maturity of an organization in terms of quality is determined through the achievement of a number of quality awards. The C2E award is the first of these awards. At the beginning of our work for the C2E level, the strengths and weaknesses of the Department of Ophthalmology were determined by means of an EFQM questionnaire. Three improvement measures with the highest impact on the performance of the clinic were identified by the questionnaire: 1. The hospitalization of a cataract patient. 2. The lack of information between the various professional parties. 3. The lack of knowledge within the professional groups of the objectives and strategy of the Department of Ophthalmology. These areas requiring improvement were targeted, addressed and improved in a 6-months project work, structured by the EFQM model. The project work as a whole, the results obtained and the corresponding written documentation were evaluated positively in a 1-day assessment by Quality Austria. The EFQM model is a challenging quality management model. After the necessary training of project members or under the supervision of experienced quality managers, the EFQM model may be successfully applied to patient care, teaching and research in a department of ophthalmology.

  8. A successful nationwide implementation of the 'FIFA 11 for Health' programme in Brazilian elementary schools.

    Science.gov (United States)

    Fuller, Colin W; Thiele, Edilson S; Flores, Manoel; Junge, Astrid; Netto, Diogo; Dvorak, Jiri

    2015-05-01

    To deliver a nationwide implementation of the 'FIFA 11 for Health' programme in Brazil and to compare the outcomes with results obtained previously in Sub-Saharan Africa. A cohort study among 3694 Brazilian children aged 9-12 years within 128 elementary schools situated in 12 cities in the five Regions of Brazil. The 'FIFA 11 for Health' programme contains 11 90 min sessions: the first 45 min serve to encourage physical activity through the development of football skills (Play Football) and the second 45 min provide a vehicle for delivering 10 health messages (Play Fair). We measured preintervention and postintervention health knowledge (29-item questionnaire) and the children's evaluation of the programme (6-item questionnaire). Mean age of the children across the five Regions was 10.6 years (range 9.2-11.6). The mean preintervention health knowledge score for the five Regions was 60.2% (range 53.8-65.3%); the mean postintervention score was 78.6% (range 70.7-86.8%); thus the mean increase in health knowledge was 18.4% (range 13.6-29.1%). 91% of the children gave a positive evaluation for the programme (range across five Regions: 82.3-96.7%). The study showed that the 'FIFA 11 for Health' programme, which was originally developed in English and translated into another language, was delivered successfully with results equivalent to those previously obtained in Sub-Saharan Africa. The programme was effective across the five Regions of Brazil. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Biodegradable intestinal stents: A review

    Directory of Open Access Journals (Sweden)

    Zhanhui Wang

    2014-10-01

    Full Text Available Biodegradable stents are an attractive alternative to self-expanding metal stents in the treatment of intestinal strictures. Biodegradable stent can be made of biodegradable polymers and biodegradable metals (magnesium alloys. An overview on current biodegradable intestinal stents is presented. The future trends and perspectives in the development of biodegradable intestinal stents are proposed. For the biodegradable polymer intestinal stents, the clinical trials have shown promising results, although improved design of stents and reduced migration rate are expected. For the biodegradable magnesium intestinal stents, results of preliminary studies indicate magnesium alloys to have good biocompatibility. With many of the key fundamental and practical issues resolved and better methods for adjusting corrosion resistance and progressing biocompatibilities of magnesium alloys, it is possible to use biodegradable intestinal stents made of magnesium alloys in hospital in the not too distant future.

  10. A hybrid algorithm of BSC and QFD to determine the criteria affecting implementation of successful outsourcing

    OpenAIRE

    Mohammad Hemati; Azim Zarei; Hamidreza Karkehabadi

    2012-01-01

    Successful organizations share some identical factors that pave the way for their success. Among these factors, strategic management is the key to success for organizations to contribute more to the competitive world market of today. In this respect, the pivotal role of outsourcing cannot be denied. This research parallelizes the criteria affecting the outsourcing success as presented in Elmuti model with the Balanced score card method in the Tose'e Ta'avon Bank. In this research, questionnai...

  11. Key factors for the implementation of successful, stand-alone village electrification schemes in Peru

    Science.gov (United States)

    Sanchez-Campos, Teodoro

    The hypothesis of this work is that there are social, financial, technical, managerial institutional and political key factors that may either support or prevent the success of small stand alone energy systems in rural areas. This research work aims at contributing to the identification of such factors and study their relevance to the performance and sustainability of stand alone energy systems in rural areas; to meet its purpose, a wide range of literature was reviewed including rural electrification programmes and projects, research and development projects on access to electricity in rural areas, impact studies and others, and a field research survey was done the Andes and Upper Jungle regions in Peru. Nineteen possible critical factors were identified, thirteen with relevance at the local context (the community or village), and six with relevance at the national (or wider) context. From literature review it was found that the possible local critical factors were relevant only to four categories of factors instead of the six considered initially (i.e. social, financial, technological and managerial): the other two categories, political and institutional were found to be more relevant to the national context, therefore those were included in the group of possible critical factors of wider context. A series of questionnaires were designed to collect field data information, which was later used to analyse and establish the relation of each identified factor with the success of the systems studied. The survey research was implemented in 14 villages, 7 with small diesel sets and 7 with small hydropower schemes, all spread in the Andes and Upper Jungle of Peru, which were carefully selected to be representative of regions with isolated stand alone systems and with different socioeconomic background. Out of the 13 possible critical factors of local context, it was found that only 3 are really critical, the others are important but not critical; one of them (technical

  12. Identification of factors that support successful implementation of care bundles in the acute medical setting: a qualitative study.

    Science.gov (United States)

    Green, Stuart A; Bell, Derek; Mays, Nicholas

    2017-02-07

    Clinical guidelines offer an accessible synthesis of the best evidence of effectiveness of interventions, providing recommendations and standards for clinical practice. Many guidelines are relevant to the diagnosis and management of the acutely unwell patient during the first 24-48 h of admission. Care bundles are comprised of a small number of evidence-based interventions that when implemented together aim to achieve better outcomes than when implemented individually. Care bundles that are explicitly developed from guidelines to provide a set of related evidence-based actions have been shown to improve the care of many conditions in emergency, acute and critical care settings. This study aimed to review the implementation of two distinct care bundles in the acute medical setting and identify the factors that supported successful implementation. Two initiatives that had used a systematic approach to quality improvement to successfully implement care bundles within the acute medical setting were selected as case studies. Contemporaneous data generated during the initiatives included the review reports, review minutes and audio recordings of the review meetings at different time points. Data were subject to deductive analysis using three domains of the Consolidated Framework for Implementation Research to identify factors that were important in the implementation of the care bundles. Several factors were identified that directly influenced the implementation of the care bundles. Firstly, the availability of resources to support initiatives, which included training to develop quality improvement skills within the team and building capacity within the organisation more generally. Secondly, the perceived sustainability of changes by stakeholders influenced the embedding new care processes into existing clinical systems, maximising their chance of being sustained. Thirdly, senior leadership support was seen as critical not just in supporting implementation but also in

  13. What Is a Stent?

    Science.gov (United States)

    ... surgery or a fabric stent is used to repair an aneurysm in the abdominal aorta. These problems ... with clinical research. More Information Related Health Topics Aneurysm Carotid Artery Disease Coronary Heart Disease Percutaneous Coronary Intervention Peripheral Artery Disease ...

  14. Implementing healthier foodservice guidelines in hospital and federal worksite cafeterias: barriers, facilitators and keys to success.

    Science.gov (United States)

    Jilcott Pitts, S B; Graham, J; Mojica, A; Stewart, L; Walter, M; Schille, C; McGinty, J; Pearsall, M; Whitt, O; Mihas, P; Bradley, A; Simon, C

    2016-12-01

    Healthy foodservice guidelines are being implemented in worksites and healthcare facilities to increase access to healthy foods by employees and public populations. However, little is known about the barriers to and facilitators of implementation. The present study aimed to examine barriers to and facilitators of implementation of healthy foodservice guidelines in federal worksite and hospital cafeterias. Using a mixed-methods approach, including a quantitative survey followed by a qualitative, in-depth interview, we examined: (i) barriers to and facilitators of implementation; (ii) behavioural design strategies used to promote healthier foods and beverages; and (iii) how implementation of healthy foodservice guidelines influenced costs and profitability. We used a purposive sample of five hospital and four federal worksite foodservice operators who recently implemented one of two foodservice guidelines: the United States Department of Health and Human Services/General Services Administration Health and Sustainability Guidelines ('Guidelines') in federal worksites or the Partnership for a Healthier America Hospital Healthier Food Initiative ('Initiative') in hospitals. Descriptive statistics were used to analyse quantitative survey data. Qualitative data were analysed using a deductive approach. Implementation facilitators included leadership support, adequate vendor selections and having dietitians assist with implementation. Implementation barriers included inadequate selections from vendors, customer complaints and additional expertise required for menu labelling. Behavioural design strategies used most frequently included icons denoting healthier options, marketing using social media and placement of healthier options in prime locations. Lessons learned can guide subsequent steps for future healthy foodservice guideline implementation in similar settings. © 2016 The British Dietetic Association Ltd.

  15. Three case studies of three high school teachers' definitions, beliefs, and implementation practices of inquiry-based science method including barriers to and facilitators of successful implementation

    Science.gov (United States)

    Blackburn-Morrison, Kimberly D.

    This study involved three teachers in various stages of implementation of inquiry-based science method. The cases were chosen because one participant was a novice in using inquiry-based science method, one participant was in her second year of implementation, and the third participant was experienced with inquiry-based science method. The cases were set in a rural high school in three different science classrooms. One of the classrooms was a regular biology class. One of the classrooms was an honors oceanography class and another was an advanced placement environmental science classroom. Data sources included interviews, observations, and document collection. Interviews, observations, and document collection were used to triangulate data. Each classroom was observed five times. Interviews were conducted at the beginning of the semester with each participant and at the end of the semester. Follow-up interviews were conducted after each observation. Documents were collected such as each teacher's lesson plans, student work, and assignments. Data was initially organized according to the research areas of teacher's definition, teacher's beliefs, teacher's barriers to implementation, and teacher's enablers to implementation. Then, patterns emerging from each of these cases were organized. Lastly, patterns emerging across cases were compared in a cross-case analysis. Patterns shared between cases were: Participants related inquiry-based science method with hands-on learning activities. Participants saw students as the center of the learning process. Participants had positive beliefs about constructivist learning practices that were strengthened after implementation of inquiry-based teaching. Facilitators of successful implementation of inquiry-based science method were positive student motivation, students' retention of knowledge, and a positive experience for lower level students. Barriers to successful implementation were teachers not having complete control of the

  16. [How patient safety programmes can be successfully implemented - an example from Switzerland].

    Science.gov (United States)

    Kobler, Irene; Mascherek, Anna; Bezzola, Paula

    2015-01-01

    Internationally, the implementation of patient safety programmes poses a major challenge. In the first part, we will demonstrate that various measures have been found to be effective in the literature but that they often do not reach the patient because their implementation proves difficult. Difficulties arise from both the complexity of the interventions themselves and from different organisational settings in individual hospitals. The second part specifically describes the implementation of patient safety improvement programmes in Switzerland and discusses measures intended to bridge the gap between the theory and practice of implementation in Switzerland. Then, the national pilot programme to improve patient safety in surgery is presented, which was launched by the federal Swiss government and has been implemented by the patient safety foundation. Procedures, challenges and highlights in implementing the programme in Switzerland on a national level are outlined. Finally, first (preliminary) results are presented and critically discussed. Copyright © 2015. Published by Elsevier GmbH.

  17. Esophagojejunal anastomotic leak managed with self expandable metallic stent

    Directory of Open Access Journals (Sweden)

    Arvind Madurandagam Annapillai

    2013-01-01

    Full Text Available Esophagealjejunal anastomotic leak after gastrectomy is a serious surgical emergency with high mortality. This report describes a 57-year-old male with esophagojejunal anastomotic leak following total gastrectomy for gastric cancer and was managed successfully with self-expandable metallic stent. To our knowledge this is the first such report from India. This case report highlights the need of interdisciplinary coordination in managing this difficult clinical situation. Endotherapy with self-expandable metallic stent (SEM provided twin benefits of improving respiratory embarrassment and the joy of eating. Therapy of such difficult cases must be individualized; however, and SEM stent usage is a viable option

  18. Critical Success Factors for the Implementation of PeopleSoft Enterprise Resource Planning in a Public Organization

    Science.gov (United States)

    Mukkamala, Hemanth K.

    2013-01-01

    Organizations of different sizes are changing their information technology (IT) strategies in order to achieve efficiency and effectiveness in today's global economy and to integrate their internal and external information by implementing PeopleSoft Enterprise Resource Planning (ERP) systems. The literature has case studies of successful and…

  19. Success factors for the implementation of an intended brand personality : Conceptual framework and insights from the Swiss luxury industry

    NARCIS (Netherlands)

    Hoyer, Wayne D.; Krohmer, Harley; Lobschat, Lara

    2015-01-01

    The creation and implementation of an intended brand personality has become a prevailing topic, both for practitioners and researchers. Especially in luxury industry, where brands hold a strong symbolic meaning, marketers are faced with the challenge of successfully establishing an intended brand

  20. The Data Warehouse: Keeping It Simple. MIT Shares Valuable Lessons Learned from a Successful Data Warehouse Implementation.

    Science.gov (United States)

    Thorne, Scott

    2000-01-01

    Explains why the data warehouse is important to the Massachusetts Institute of Technology community, describing its basic functions and technical design points; sharing some non-technical aspects of the school's data warehouse implementation that have proved to be important; examining the importance of proper training in a successful warehouse…

  1. Challenges to Successful Total Quality Management Implementation in Public Secondary Schools: A Case Study of Kohat District, Pakistan

    Science.gov (United States)

    Suleman, Qaiser; Gul, Rizwana

    2015-01-01

    The current study explores the challenges faced by public secondary schools in successful implementation of total quality management (TQM) in Kohat District. A sample of 25 heads and 75 secondary school teachers selected from 25 public secondary schools through simple random sampling technique was used. Descriptive research designed was used and a…

  2. Stent Fracture after Everolimus-Eluting Stent Implantation

    Directory of Open Access Journals (Sweden)

    Ali S. Almasood

    2011-01-01

    Full Text Available Compared with bare-metal stents, drug-eluting stents (DES have greatly reduced the risk of in-stent restenosis (ISR by inhibiting neointimal growth. Nevertheless, DES are still prone to device failure, which may lead to cardiac events. Recently, stent fracture (SF has emerged as a potential mechanism of DES failure that is associated with ISR. Stent fracture is strongly related to stent type, and prior reports suggest that deployment of sirolimus eluting stents (SES may be associated with a higher risk of SF compared to other DES. Everolimus eluting stents (EESs represent a new generation of DES with promising results. The occurrence of SF with EES has not been well established. The present paper describes two cases of EES fracture associated with ISR.

  3. The Successful Implementation of NASA Orbital Debris Requirements for the Retirement of TDRS-1

    Science.gov (United States)

    Mirczak, Walter; Staich, Steve; Vaught, Lynn; Zaleski, Ronald

    2010-01-01

    TDRS-1 was decommissioned on October 28th 2009 following more than 26 years of operation. The Grand Old Dame of the TDRSS constellation wa s launched aboard the maiden voyage of the Space Shuttle Challenger ( STS-6) in April 1983. TDRS-1 survived a malfunction of the Inertial Upper Stage eventually utilizing its own propulsion system to success fully reach its assigned station in geosynchronous orbit. The anomalo us beginning of the TDRS-1 mission was not without lasting consequenc es as the primary reaction control system (A-side) was completely di sabled with an apparent propellant leak and the secondary system (B-s ide) suffered damage to its negative roll thruster rendering the thru ster inoperable. Following decommissioning the challenge to completin g a successful TDRS-1 end-of-mission (EOM) was the implementation of the stringent orbital debris requirements of NPR 8715.6 with a parti ally functioning spacecraft not originally designed to meet those req uirements. The TDRS-1 EOM had three key goals: 1) removal of the spac ecraft from geosynchronous orbit; 2) depletion of the remaining prope llant; and 3) passivation of all other sources of energy storage or generation. The TDRS-1 EOM approach was one of minimizing risks while accomplishing the goals above. The orbit raising portion of EOM was accomplished using deltavelocity operations already proven during pre vious stationchanging maneuvers. The propellant depletion approach wa s necessarily more aggressive as over 20 hours of burn time was requ ired to deplete the remaining fuel. A novel approach utilizing a spin ning, thrusting, passively controlled spacecraft configuration was ut ilized to achieve reasonable burn durations that met schedule constra ints. This nonstandard configuration required careful analysis of ele ctrical, thermal, and communication subsystems. The configuration wa s thoroughly simulated prior to the start of operations and carefully characterized during the initial spin period and

  4. [Implementation of computerized phisician order entry in a hospital setting: what are the keys to success?].

    Science.gov (United States)

    Garçous, R; Remy, G; Bary, M; Amant, F; Cauwe, F; De Beusscher, L; Bouzette, A; De Coster, P; Hecq, J-D

    2013-06-01

    A software of computerized physician order entry [CPOE] was developed by a data-processing company in collaboration with the Mont-Godinne University Hospital By 2006, parallel to the evolution of the software, the progressive implementation of CPOE was carried out, and currently covers 16 wards, the emergency room, the recovery rooms and the center of medical care [day hospital] as well as the day surgical center Complete computerization of the drug supply chain, including the regulation by the physician, the pharmaceutical validation, the delivery and the follow-up of stocks by pharmacy, the validation of the administration by the nurse and the tariffing of the drugs. In 2006, a working group was created in order to validate specifications allowing the development of a software of CPOE, Linked to the computerized medical record. A data-processing company was selected in order to develop this software. Two beds were computerized in the pneumology ward, in order to test and validate the software. From 2007 to 2009, 3 additional wards were computerized [geriatrics, neurosurgery, revalidation]. A steering committee of CPOE, composed of various members (direction, doctors, pharmacists, nurses, data processing specialistsl is created. This committee allows the installation of the means necessary to the deployment of CPOE in the Institution. Structured teams for the deployment are created: medical and nurse coaches. From 2009 to 2012, the deployment of the software is carried out, covering 16 wards, the emergency room, the recovery room and the day-hospitals. The computerization of the drug supply chain is a challenge which concerns the institutional level. The assets of our hospital and our project were: - a strong management committee, making of this project a priority entering the strategical planning of the institution; - a steering committee allowing each type of actor to express his needs, and of prioriser requests; - a closer medical coaching; - teams of nurses

  5. Direct comparison of Neuroform and Enterprise stents in the treatment of wide-necked intracranial aneurysms.

    Science.gov (United States)

    Durst, C R; Khan, P; Gaughen, J; Patrie, J; Starke, R M; Conant, P; Liu, K C; Jensen, M E; Evans, A J

    2014-12-01

    To compare the complications and outcomes of Neuroform and Enterprise stents in the treatment of unruptured wide-necked aneurysms. Under the auspices of the institutional review board, a review of a prospectively collected patient log identified 130 patients who underwent elective stent-assisted coil embolization of a wide-necked aneurysm, including 53 patients treated with an Enterprise stent and 77 patients treated with a Neuroform stent. Immediate and long-term clinical and radiographic outcomes were recorded for all patients. All patient data were handled in accordance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. The technical success rate was 94%. Overall morbidity was 15% with Enterprise stents and 3% with Neuroform stents (p = 0.020). However, the type of stent used was not predictive of clinical outcomes as measured by the modified Rankin scale. In a multivariate analysis, the use of a Neuroform stent was one of the predictors of retreatment (p = 0.034). Multivariate analyses identified the use of Neuroform stents as an independent predictor of the need for retreatment and the use of Enterprise stents as an independent predictor of morbidity. However, the type of stent was not predictive of clinical outcome as measured by the modified Rankin scale. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  6. Assessment of the adequacy of bronchial stenting by flow-volume loops

    Energy Technology Data Exchange (ETDEWEB)

    McLaren, Clare A.; Roebuck, Derek J. [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Pigott, Nick; Elliott, Martin J. [Great Ormond Street Hospital for Children, Cardiothoracic Unit, London (United Kingdom); Dunne, Catherine [Great Ormond Street Hospital for Children, Department of Physiotherapy, London (United Kingdom)

    2006-08-15

    Airway compression is a common problem in children with certain forms of congenital heart disease. Although various surgical approaches are available to overcome this form of airway obstruction, internal stenting is necessary in a minority of patients. It can be difficult to assess the success of stenting at the time of the procedure, and the interval to successful extubation is usually used as an outcome measure. Measurement of relevant parameters of respiratory physiology with flow-volume and volume-pressure loops permits immediate quantitative assessment of the adequacy of stenting. A 3-month-old infant who underwent bronchial stenting and physiological assessment at the time of the procedure is described. (orig.)

  7. Treatment of Endovascular Coil and Stent Migration Using the Merci Retriever: Report of Three Cases

    Directory of Open Access Journals (Sweden)

    David K. Kung

    2012-01-01

    Full Text Available Background. Coil and stent migration is a potentially catastrophic complication in endovascular neurosurgery, which may lead to cerebral thromboembolism. Techniques for removing migrated coil and stent are not well established. Methods and Results. We present three cases in which coil or stent migration occurred during endovascular embolization of a cerebral aneurysm. The Merci Retrievers were used successfully in all cases to remove the displaced foreign bodies. Technical details are described. Conclusion. The Merci Retriever device can be utilized successfully for removal of migrated coils and stents in endovascular neurosurgery.

  8. Critical success factors for implementation of supply chain management in Indian small and medium enterprises and their impact on performance

    Directory of Open Access Journals (Sweden)

    Ravinder Kumar

    2015-06-01

    Full Text Available Globalization of the economy, e-business, and introduction of new technologies pose new challenges to all organizations especially for small and medium enterprises (SMEs. In this scenario, successful implementation of supply chain management (SCM can give SMEs an edge over their competitors. However, SMEs in India and other developing countries face problems in SCM implementation due to lack of resources and direction. Against this backdrop, this paper identified 13 critical success factors (CSFs for implementation of SCM in SMEs and studied their impact on performance of Indian SMEs. Top management commitment, long–term vision, focus on core strengths, devoted resources for supply chain, and development of effective SCM strategy emerged as the most pertinent CSFs. To measure improvement in performance, the authors considered different measures related to customer service and satisfaction, innovation and growth, financial performance, and internal business. Results are analysed by testing research propositions using standard statistical tools.

  9. Percutaneous extraction of stented device leads.

    Science.gov (United States)

    Baranowski, Bryan; Wazni, Oussama; Chung, Roy; Martin, David O; Rickard, John; Tanaka-Esposito, Christine; Bassiouny, Mohammed; Wilkoff, Bruce L

    2012-05-01

    There are limited published data regarding the percutaneous extraction of device leads jailed by a venous stent. In this study we assessed the feasibility and safety of percutaneous extraction of stented device leads. We reviewed our experience percutaneously extracting 7 chronically implanted device leads jailed to the wall of the left innominate and/or subclavian veins by a previously placed stent. All leads were successfully extracted by using a percutaneous approach. Both pacing leads and defibrillator leads were extracted. The oldest pacing lead extracted was 14 years old. The oldest defibrillator lead extracted was 6 years old. Three of the leads were extracted with simple manual traction alone. The 4 remaining leads required a more complex, femoral extraction approach for successful removal. In our experience extracting 7 stented device leads, complete percutaneous removal was feasible 100% of the time using a combination of simple manual traction and a femoral approach. No major complications were associated with the extraction procedures. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  10. Professional Learning Communities: An Effective Mechanism for the Successful Implementation and Sustainability of Response to Intervention

    Science.gov (United States)

    Mundschenk, Nancy A.; Fuchs, Wendy W.

    2016-01-01

    Models of response to intervention (RtI) are being widely implemented in schools across the country in order to increase effective teaching and remove barriers to student learning. The implementation of RtI is greatly facilitated when teachers and staff see themselves as a professional learning community (PLC). This article begins with an…

  11. Implementing a new model for on-the-job training: critical success factors.

    NARCIS (Netherlands)

    van Zolingen, S.J.; Streumer, Jan; van der Klink, Marcel; de Jong, Rolinda

    2000-01-01

    Post Offices Inc. in The Netherlands has developed and implemented a new instruction model for the training of desk employees. The quality of the new instruction model was assessed by means of the evaluation model of Jacobs and Jones for on-the-job training. It is concluded that the implementation

  12. Examining Health Information Technology Implementation Success Factors in Critical Access Hospitals

    Science.gov (United States)

    Monkman, Blake D.

    2016-01-01

    As the role of information technology increases throughout the world, healthcare providers in the United States face industry and governmental pressures to implement health information technology (HIT) as a tool to improve healthcare costs, quality, and safety. The problem addressed in this study was the relatively low HIT implementation success…

  13. Evaluation of a national telemedicine initiative in the Veterans Health Administration: Factors associated with successful implementation.

    Science.gov (United States)

    Stevenson, Lauren; Ball, Sherry; Haverhals, Leah M; Aron, David C; Lowery, Julie

    2016-11-30

    The Consolidated Framework for Implementation Research was used to evaluate implementation facilitators and barriers of Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) within the Veterans Health Administration. SCAN-ECHO is a video teleconferencing-based programme where specialist teams train and mentor remotely-located primary care providers in providing routine speciality care for common chronic illnesses. The goal of SCAN-ECHO was to improve access to speciality care for Veterans. The aim of this study was to provide guidance and support for the implementation and spread of SCAN-ECHO. Semi-structured telephone interviews with 55 key informants (primary care providers, specialists and support staff) were conducted post-implementation with nine sites and analysed using Consolidated Framework for Implementation Research constructs. Data were analysed to distinguish sites based on level of implementation measured by the numbers of SCAN-ECHO sessions. Surveys with all SCAN-ECHO sites further explored implementation information. Analysis of the interviews revealed three of 14 Consolidated Framework for Implementation Research constructs that distinguished between low and high implementation sites: design quality and packaging; compatibility; and reflecting and evaluating. The survey data generally supported these findings, while also revealing a fourth distinguishing construct - leadership engagement. All sites expressed positive attitudes toward SCAN-ECHO, despite struggling with the complexity of programme implementation. Recommendations based on the findings include: (a) expend more effort in developing and distributing educational materials; (b) restructure the delivery process to improve programme compatibility; (c) establish an audit and feedback mechanism for monitoring and improving the programme; (d) engage in more upfront planning to reduce complexity; and (e) obtain local leadership support for providing primary care

  14. An Exploratory Study on the Critical Success Factors in the Implementation of Enterprise Resource Planning Systems in Venezuela

    Directory of Open Access Journals (Sweden)

    Leopoldo Colmenares

    2005-08-01

    Full Text Available This paper reports on an exploratory study, carried out in seven Venezuelan organizations who have successfully implemented an enterprise resource planning (ERP system. The data were collected by means of both a questionnaire and of conducted interviews to the seven project managers of the project of implementation of ERP systems in these enterprises. The purpose of the study was to know the perceptions the project managers, on aspects and activities of the process of implementing an ERP system and that are strongly correlated with the Critical Success Factors (FCE’s for this kind of projects. The FCE’s were identified in a deep revision of the literature. The questionnaire included, among others, questions on the top management support to the project, the process of selection of the system, team work implementation and the participation and training of the users. Additionally were identified the problems that organizations confronted during the implementation process. The study concludes that organizations must take care the elements that indicate the FCE’s, because them hit positively the project, additionally describe aspects, which must take into account the enterprises who are in the process to adopt an ERP system to facilitate its implementation.

  15. Similarities of lean manufacturing approaches implementation in SMEs towards the success: Case study in the automotive component industry

    Directory of Open Access Journals (Sweden)

    Rose A.N.M.

    2017-01-01

    Full Text Available Nowadays, manufacturing companies are striving for a better system like lean manufacturing (LM. The primary objective of LM is to identify and eliminate wastes. LM can be applied successfully in all industries providing a full understanding of lean ingredients i.e. concept, principles, and practices. There are a lot of practices which are necessary to be implemented in order to gain full benefits of LM. However, small and medium enterprises (SMEs are lack of knowledge in LM and facing difficulties to adopt all of the LM principles. Therefore, it is necessary to the researchers to come out with a simple guideline for LM implementation. The objective of this paper is to explore the journey of LM implementation including preliminary, in process and post of LM. This research was conducted through multi-case study research. There were four SMEs and two large companies. The gathered information shows that the preliminary stage of LM implementation is similar to each other including large companies. The result shows SMEs still have a potential to success in LM. This finding might give an opportunity to SMEs to prepare the basis for LM implementation effectively. As a result, SMEs able compete in the competitive global marketplace and strive for world class performance through implementation of LM.

  16. The Development and Implementation of Successful School-Community Partnerships in Public Elementary Education

    Science.gov (United States)

    Record, Vincent N.

    2012-01-01

    Purpose: The study aimed to define common characteristics of successful school-community partnerships supporting the improvement of academic achievement in public elementary schools. Based on the perceptions of elementary school administrators, this study identified important factors of, barriers to, and benefits of successful school-community…

  17. A Dual Expandable Stent for Treatment of Malignant Colorectal Obstruction: Long-Term Follow-Up Results

    Energy Technology Data Exchange (ETDEWEB)

    Son, Won Young; Kang, Hee; Jung, Gyoo Sik [Dept. of Radiology, Kosin University College of Medicine, Gospel Hospital, Busan (Korea, Republic of)

    2012-11-15

    To analyze the long-term results and to evaluate the efficacy of a dual expandable stent for the treatment of malignant colorectal strictures. Under the fluoroscopic guidance, stents were placed in 60 patients with malignant colorectal strictures. A dual stent consists of two stents, the outer stent was placed into the stricture which was followed by coaxial placement of the inner bare stent. Technical and clinical success rates, complications, patient survival and stent patency during the follow-up period were evaluated in this study. Stent placement was technically successful in 57 of 60 patients (95%). Of them, obstructive symptoms resolved within two days in 12/12 (100%) patients in the preoperative group and in 36/45 (80%) patients in the palliative group. Complications associated with this procedure were perforation (n = 5), migration (n = 3), and tumor overgrowth (n = 2). Each of the six patients in the preoperative group underwent conventional laparotomy and laparoscopic surgery, respectively. The mean interval between stent insertion and surgery was nine days. In the palliative group, the median survival was 159 days (mean; 235) and the median patency of stent was 116 days (mean; 185). 1-month, 3-month, 6-month, 12-month and 24-month stent patency were 75%, 60%, 27%, 13% and 7%, respectively. Insertion of a dual expandable nitinol stent into malignant colorectal obstruction is a safe and effective procedure for the palliative treatment of malignant colorectal obstruction. This procedure is also effective for preoperative decompression.

  18. Comparison of covered and uncovered self-expandable stents in the treatment of malignant biliary obstruction

    Directory of Open Access Journals (Sweden)

    Diana Yamel Flores-Carmona

    Full Text Available Background and objective: Drainage with metallic stents is the treatment of choice in malignant obstructive jaundice. Technical and clinical success with metallic stents is obtained in over 90% and 80% of cases, respectively. There are self-expandable metallic stents designed to increase permeability. The aim of this study was to describe the results obtained with totally covered self-expandable and uncovered self-expandable metallic stents in the palliative treatment of malignant biliary obstruction. Patients and methods: Sixty eight patients with malignant obstructive jaundice secondary to pancreatobiliary or metastatic disease not amenable to surgery were retrospectively included. Two groups were created: group A (covered self-expandable metallic stents (n = 22 and group B (uncovered self-expandable metallic stents (n = 46. Results: Serum total bilirubin, direct bilirubin, alkaline phosphatase and gamma glutamyl transferase levels decreased in both groups and no statistically significant difference was detected (p = 0.800, p = 0.190, p = 0.743, p = 0.521. Migration was greater with covered stents but it was not statistically significant either (p = 0.101. Obstruction was greater in the group with uncovered stents but it was not statistically significant either (p = 0.476. Conclusion: There are no differences when using covered self-expandable stents or uncovered self-expandable stents in terms of technical and clinical success or complications in the palliative treatment of malignant obstructive jaundice.

  19. Retrieval of proximally migrated double J ureteric stents in children using goose neck snare

    Directory of Open Access Journals (Sweden)

    Sivasankar Jayakumar

    2012-01-01

    Full Text Available Purpose: Proximal migration of the ureteric double J stent is a rare but known complication. We describe three cases where a minimally invasive technique for retrieval of displaced double J stents using Amplatz™ goose-neck snare was successful. Materials and Methods: A retrospective review of patients with displaced double J stent was carried out, in whom cystoscopy guided retrieval of double J stent was attempted with the help of Amplatz goose-neck snare under radiological control. Results: All three patients were under the age of 3 years. Two patients had migrated double J stent following pyeloplasty and in one patient the double J stent was displaced during a retrograde insertion of double J stent. In all cases, retrieval of displaced double J stent was successfully achieved using Amplatz goose-neck snare. There were no postoperative complications. Conclusion: Our method of retrieval of stent from renal pelvis is simple, safe and minimally invasive. This technique is a useful and safe alternative option for retrieval of proximally migrated double J stents in children.

  20. Design optimization of stent and its dilatation balloon using kriging surrogate model.

    Science.gov (United States)

    Li, Hongxia; Liu, Tao; Wang, Minjie; Zhao, Danyang; Qiao, Aike; Wang, Xue; Gu, Junfeng; Li, Zheng; Zhu, Bao

    2017-01-11

    Although stents have great success of treating cardiovascular disease, it actually undermined by the in-stent restenosis and their long-term fatigue failure. The geometry of stent affects its service performance and ultimately affects its fatigue life. Besides, improper length of balloon leads to transient mechanical injury to the vessel wall and in-stent restenosis. Conventional optimization method of stent and its dilatation balloon by comparing several designs and choosing the best one as the optimal design cannot find the global optimal design in the design space. In this study, an adaptive optimization method based on Kriging surrogate model was proposed to optimize the structure of stent and the length of stent dilatation balloon so as to prolong stent service life and improve the performance of stent. A finite element simulation based optimization method combing with Kriging surrogate model is proposed to optimize geometries of stent and length of stent dilatation balloon step by step. Kriging surrogate model coupled with design of experiment method is employed to construct the approximate functional relationship between optimization objectives and design variables. Modified rectangular grid is used to select initial training samples in the design space. Expected improvement function is used to balance the local and global searches to find the global optimal result. Finite element method is adopted to simulate the free expansion of balloon-expandable stent and the expansion of stent in stenotic artery. The well-known Goodman diagram was used for the fatigue life prediction of stent, while dogboning effect was used for stent expansion performance measurement. As the real design cases, diamond-shaped stent and sv-shaped stent were studied to demonstrate how the proposed method can be harnessed to design and refine stent fatigue life and expansion performance computationally. The fatigue life and expansion performance of both the diamond-shaped stent and sv

  1. A preliminary analysis of the effects of coaching feedback on teacher implementation fidelity of first step to success.

    Science.gov (United States)

    Rodriguez, Billie Jo; Loman, Sheldon L; Horner, Robert H

    2009-01-01

    First Step to Success (FSS) is a "manualized" intervention with documented effectiveness in reducing problem behaviors for young children at risk for school failure. This study is a preliminary analysis focusing on the role of performance feedback from FSS coaches on the fidelity with which teachers implemented FSS. Three typically developing students (2 kindergarten and 1 first grade) and their respective teachers served as participants. Student behavior and teacher implementation fidelity were assessed using a nonconcurrent multiple baseline design across student/teacher dyads, in which a no coaching baseline was followed by a performance feedback condition. The baseline phase showed modest levels of implementation fidelity and initial low levels of problem behavior followed by gradually increasing trends. A relation was demonstrated between coaching feedback and improved implementation fidelity. In addition, improved fidelity was associated with improvements in student problem behavior. Implications are drawn for clinical application of FSS and other "manualized" interventions.

  2. A Primary Human Critical Success Factors Model for the ERP System Implementation

    National Research Council Canada - National Science Library

    Aleksander Jenko; Matjaž Roblek

    2016-01-01

    ...) and the different causes of ERP implementation project failures. Despite a detailed literature preview, we were unable to find an appropriate research with a comprehensive overview of the true causes behind CSFs, observed from a human factors perspective...

  3. Comparison of early and late results of a Carbofilm-coated stent versus a pure high-grade stainless steel stent (the Carbostent-Trial).

    NARCIS (Netherlands)

    Sick, P.B.; Gelbrich, G.; Kalnins, U.; Erglis, A.; Bonan, R.; Aengevaeren, W.R.M.; Elsner, D.; Lauer, B.; Woinke, M.; Brosteanu, O.; Schuler, G.

    2004-01-01

    The long-term success of coronary interventions with stents is largely determined by the development of restenosis. The aim of this study was to compare a Carbofilm-coated and a pure stainless steel stent with regard to early and late adverse events. In this prospective, randomized trial, the

  4. Bare Metal Stenting for Endovascular Exclusion of Aortic Arch Thrombi

    Energy Technology Data Exchange (ETDEWEB)

    Mahnken, Andreas H., E-mail: mahnken@med.uni-marburg.de [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic Radiology (Germany); Hoffman, Andras; Autschbach, Ruediger; Damberg, Anneke L. M., E-mail: anneke.damberg@rwth-aachen.de [University Hospital RWTH Aachen, Department of Thoracic, Cardiac and Vascular Surgery (Germany)

    2013-08-01

    BackgroundAortic thrombi in the ascending aorta or aortic arch are rare but are associated with a relevant risk of major stroke or distal embolization. Although stent grafting is commonly used as a treatment option in the descending aorta, only a few case reports discuss stenting of the aortic arch for the treatment of a thrombus. The use of bare metal stents in this setting has not yet been described.MethodsWe report two cases of ascending and aortic arch thrombus that were treated by covering the thrombus with an uncovered stent. Both procedures were performed under local anesthesia via a femoral approach. A femoral cutdown was used in one case, and a total percutaneous insertion was possible in the second case.ResultsBoth procedures were successfully performed without any periprocedural complications. Postoperative recovery was uneventful. In both cases, no late complications or recurrent embolization occurred at midterm follow-up, and control CT angiography at 1 respectively 10 months revealed no stent migration, freely perfused supra-aortic branches, and no thrombus recurrence.ConclusionTreating symptomatic thrombi in the ascending aorta or aortic arch with a bare metal stent is feasible. This technique could constitute a minimally invasive alternative to a surgical intervention or complex endovascular therapy with fenestrated or branched stent grafts.

  5. Tracheal stent prediction using statistical deformable models of tubular shapes

    Science.gov (United States)

    Pinho, R.; Huysmans, T.; Vos, W.; Sijbers, J.

    2008-03-01

    Tracheal stenosis is a narrowing of the trachea that impedes normal breathing. Tracheotomy is one solution, but subjects patients to intubation. An alternative technique employs tracheal stents, which are tubular structures that push the walls of the stenotic areas to their original location. They are implanted with endoscopes, therefore reducing the surgical risk to the patient. Stents can also be used in tracheal reconstruction to aid the recovery of reconstructed areas. Correct preoperative stent length and diameter specification is crucial to successful treatment, otherwise stents might not cover the stenotic area nor push the walls as required. The level of stenosis is usually measured from inside the trachea, either with endoscopes or with image processing techniques that, eg compute the distance from the centre line to the walls of the trachea. These methods are not suited for the prediction of stent sizes because they can not trivially estimate the healthy calibre of the trachea at the stenotic region. We propose an automatic method that enables the estimation of stent dimensions with statistical shape models of the trachea. An average trachea obtained from a training set of CT scans of healthy tracheas is placed in a CT image of a diseased person. The shape deforms according to the statistical model to match the walls of the trachea, except at stenotic areas. Since the deformed shape gives an estimation of the healthy trachea, it is possible to predict the size and diameter of the stent to be implanted in that specific subject.

  6. Current status of metal stents for managing malignant ureteric obstruction.

    Science.gov (United States)

    Sountoulides, Petros; Kaplan, Adam; Kaufmann, Oskar Grau; Sofikitis, Nikolaos

    2010-04-01

    Obstruction of the ureters caused by extrinsic compression from a primary tumour or retroperitoneal lymph node masses is not unusual in the course of advanced pelvic malignancies. Most of the cases are of gynaecological or gastrointestinal origin, and the situation can be aggravated by peri-ureteric fibrosis, a long-term adverse event of previous chemotherapy or radiotherapy. Undoubtedly upper urinary tract decompression and maintenance of ureteric patency, even as a palliative measure, is important in managing these patients. Options for upper tract decompression include percutaneous nephrostomy, retrograde stenting and open urinary diversion. Plastic stents have long been used for managing malignant ureteric obstruction, but their overall success remains limited. Plastic stents often fail to be placed correctly, require regular exchange, and are faced with a high incidence of encrustation and migration. For these reasons plastic stents have been unsuccessful for long-term maintenance of ureteric patency. To overcome these limitations metal stents were introduced and recently developed in an effort to ensure better long-term patency of the obstructed ureter, fewer hospital admissions for stent change and better overall quality of life. In the present review the clinical applications of different types of metal stents are discussed, with a specific focus on the latest advances and the future options for managing malignant ureteric obstruction. © 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL.

  7. Have renal dietitians successfully implemented evidence-based guidelines into practice? A survey of dietitians across Australia and New Zealand.

    Science.gov (United States)

    Hall-McMahon, Emma J; Campbell, Katrina L

    2012-11-01

    Successful implementation of evidence-based practice (EBP) guidelines has been shown to improve the nutrition status of dialysis patients. This study aimed to establish use of EBP guidelines and implementation of key recommendations for nutrition assessment of dialysis patients, as well as to identify barriers and enablers associated with EBP guideline adherence. A survey of nutrition assessment practices and barriers to implementation of EBP guidelines was developed and piloted. The survey measured implementation of guidelines regarding frequency of nutrition assessment and use of the subjective global assessment (SGA) to diagnose malnutrition. Barriers to guideline implementation were measured using agreement with statements rated on a Likert scale. Data were summarized as counts and percentages and analyzed using chi-squared tests of association, with P nutrition assessment of dialysis patients (n = 36 of 65) and use of the SGA (n = 43 of 65), respectively. Barriers related to time, skills/self-efficacy, and an inefficient referral system were related to lower rates of guideline implementation. These findings indicate an evidence-practice gap in the nutritional management of dialysis patients. A standardized approach to EBP guideline implementation including structured 6-monthly nutrition assessment of dialysis patients and group training for use of the SGA tool may assist in closing this evidence-practice gap. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  8. Facilitators and Barriers for Successful Implementation of Interconception Care in Preventive Child Health Care Services in the Netherlands.

    Science.gov (United States)

    Sijpkens, Meertien K; Steegers, Eric A P; Rosman, Ageeth N

    2016-11-01

    Objectives Successful implementation of preconception and interconception care contributes to optimizing pregnancy outcomes. While interconception care to new mothers could potentially be provided by Preventive Child Health Care services, this care is currently not routinely available in the Netherlands. The purpose of this study was to identify facilitators and barriers for implementation of interconception care in Preventive Child Health Care services. Methods We organized four focus groups in which Preventive Child Health Care physicians and nurses, related health care professionals and policymakers participated. A semi-structured interview approach was used to guide the discussion. The transcribed discussions were analyzed. Results All four groups agreed that several facilitators are present, such as the unique position to reach women and the expertise in preventive health care. Identified barriers include unfamiliarity with interconception care among patients and health care providers, as well as lack of consensus about the concept of interconception care and how it should be organized. A broad educational campaign, local adaptation, and general agreement or a guideline for standard procedures were recognized as important for future implementation. Conclusions for practice This study identifies potentially important facilitators and barriers for the implementation of interconception care in Preventive Child Health Care services or comparable pediatric settings. These factors should be considered and strategies developed to achieve successful implementation of interconception care.

  9. Business process re-engineering in the logistics industry: a study of implementation, success factors, and performance

    Science.gov (United States)

    Shen, Chien-wen; Chou, Ching-Chih

    2010-02-01

    As business process re-engineering (BPR) is an important foundation to ensure the success of enterprise systems, this study would like to investigate the relationships among BPR implementation, BPR success factors, and business performance for logistics companies. Our empirical findings show that BPR companies outperformed non-BPR companies, not only on information processing, technology applications, organisational structure, and co-ordination, but also on all of the major logistics operations. Comparing the different perceptions of the success factors for BPR, non-BPR companies place greater emphasis on the importance of employee involvement while BPR companies are more concerned about the influence of risk management. Our findings also suggest that management attitude towards BPR success factors could affect performance with regard to technology applications and logistics operations. Logistics companies which have not yet implemented the BPR approach could refer to our findings to evaluate the advantages of such an undertaking and to take care of those BPR success factors affecting performance before conducting BPR projects.

  10. Mechanical Recanalization of Cerebral Artery Embolic Occlusion Using a Self-Expanding Stent: Experimental Analysis in Canine Model

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Kim, Snag Joon; Lee, Deok Hee; Suh, Dae Chul [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2011-07-15

    To evaluate the feasibility of a self-expanding stent for acute embolic occlusion, and recanalization mechanism by histologic examination. Five mongrel dogs were used as study subjects. Each vertebral artery was occluded, and a self-expanding stent was used for recanalization. We evaluated the technical success rate for the placement of the stent to the targeted vessel, the recanalization rate, and residual stenosis. We obtained two specimens of the stented vertebral arteries for histologic evaluation. One dog died of an unknown cause during the induction of anesthesia. In two dogs, only one side of the vertebral artery was used, whereas both vertebral arteries were used in the remaining dogs. A total of six vertebral arteries were successfully occluded. The technical success rate for stenting without complication was 66.7%. The immediate recanalization rate after stenting was 100%. The residual stenosis was 35.6 {+-} 18.6%. On microscopic examination, the stent concentrically displaced the clot and the clot was captured between the stent mesh and arterial wall. Self-expanding stents were effective in revascularizing the cerebrovascular embolic occlusion. The self-expanding stent seemed to achieve recanalization by pushing the clot to the arterial wall and capturing the clot between the stent mesh and arterial wall.

  11. Implementing Delirium Screening in the Intensive Care Unit: Secrets to Success

    Science.gov (United States)

    Brummel, Nathan E.; Vasilevskis, Eduard E.; Han, Jin Ho; Boehm, Leanne; Pun, Brenda T.; Ely, E. Wesley

    2013-01-01

    Objective To review delirium screening tools available for use in the adult and pediatric ICU, review evidence-based delirium screening implementation and to discuss common pitfalls encountered during delirium screening in the ICU. Data Sources Review of delirium screening literature and expert opinion. Results Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICUs settings. Keys to effective implementation include addressing barriers to routine screening, multi-faceted training such as lectures, case-based scenarios, one-on-one teaching and real-time feedback of delirium screening and interdisciplinary communication through discussion of a patient’s delirium status during bedside rounds and through documentation systems. If delirium is present clinicians should search for reversible or treatable causes since it is often multifactorial. Conclusion Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances. PMID:23896832

  12. Change Management as a Critical Success Factor in e-Government Implementation

    Directory of Open Access Journals (Sweden)

    Janja Nograšek

    2011-01-01

    Full Text Available Change management in e-government implementation is a very complex issue. E-government services are frequently distributed over different IT systems and organizations. There are also events from outside the public administration that cause changes such as government policies and legislation, public-private partnership, etc., and finally a huge resistance to change exists in public administration proverbial. Another problem is that the e-government is predominantly seen only as a technology mission and not as an organizational transformation issue. Those are probably the main reasons that the existing literature about change management in e-government is still missing at large. There are articles dealing with some aspects of changes affected by the new technology implementation, however, there is no comprehensive framework that would identify changes that have to be managed in e-government implementation. Therefore, the main aim of the paper is to identify a comprehensive set of changes that have to be considered in e-government implementation and the role of leadership in such processes. Finally, the paper proposes a conceptual model of change management in e-government implementation.

  13. Successful implementation of an alcohol-withdrawal pathway in a general hospital.

    Science.gov (United States)

    Repper-DeLisi, Jennifer; Stern, Theodore A; Mitchell, Monique; Lussier-Cushing, Mary; Lakatos, Barbara; Fricchione, Gregory L; Quinlan, Joan; Kane, Martha; Berube, Rhodes; Blais, Mark; Capasso, Virginia; Pathan, Firdosh; Karson, Andrew; Bierer, Michael

    2008-01-01

    Although alcohol use and abuse are common among general-hospital inpatients, many patients are inadequately assessed and treated for alcohol withdrawal. The purpose of this study was to determine whether the implementation of a clinical pathway for the treatment of alcohol withdrawal in medical inpatients would result in improvements in clinical practice and patient outcomes. Authors retrospectively reviewed 80 patient records (including 40 of those treated before the implementation of a pathway and 40 of those treated after pathway implementation). Assessment procedures and ordering patterns of physicians (medical house staff and staff physicians) shifted in a fashion consistent with the new treatment guidelines. Patient outcomes (e.g., length of stay and the incidence of delirium) improved for those patients who received benzodiazepines within the range of the pathway guidelines. Timely assessment and staff education can shift prescription patterns, increase patient monitoring, and reduce costs associated with alcohol withdrawal.

  14. A hybrid algorithm of BSC and QFD to determine the criteria affecting implementation of successful outsourcing

    Directory of Open Access Journals (Sweden)

    Mohammad Hemati

    2012-04-01

    Full Text Available Successful organizations share some identical factors that pave the way for their success. Among these factors, strategic management is the key to success for organizations to contribute more to the competitive world market of today. In this respect, the pivotal role of outsourcing cannot be denied. This research parallelizes the criteria affecting the outsourcing success as presented in Elmuti model with the Balanced score card method in the Tose'e Ta'avon Bank. In this research, questionnaires and interviews with experts helped determine the strategic goals at four perspectives of balanced score card method (at Tose'e Ta'avon Bank and the relative weights were computed for each of balance score card (BSC perspectives by using AHP method. As the next step, the indexes were prioritized by applying the quality function development(QFD technique and considering strategic goals at four perspectives in section "WHAT" and the outsourcing success criteria of Elmuti model in section "HOW". At the end of algorithm, the results are compared with the Elmuti method. Based on the results, the hybrid proposed technique seems to perform better than Elmuti.

  15. Critical Success Factors for Integrated Library System Implementation in Academic Libraries: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Shea-Tinn Yeh

    2016-09-01

    Full Text Available Integrated library system (ILS supports the entire business operations of an academic library from acquiring and processing library resources to making them available to user communities and preserving them for future use. As libraries’ needs evolve, there is a pressing demand for libraries to migrate from one generation of ILS to the next. This complex migration process is often the single largest investment in both budget and personnel involvement, but its success is by no means guaranteed. We draw upon enterprise resource planning (ERP and critical success factors (CSFs literature to identify the most salient CSFs for ILS migration success through a qualitative study with four cases. We identified that top management involvement, vendor support, user involvement, selection process, project team competence, project management and tracking, interdepartmental communication, data analysis and conversion, user education and training, and user emotion management are the CSFs that determine a migration project success.  Keywords: Integrated library systems, information systems, library automation, critical success factors, and academic libraries.

  16. The barriers perceived to prevent the successful implementation of evidence-based practice by speech and language therapists.

    Science.gov (United States)

    O'Connor, Siobhan; Pettigrew, Catharine M

    2009-01-01

    There is currently a paucity of research investigating what speech and language therapists, in particular, perceive are the greatest barriers to implementing evidence-based practice. The purpose of this study was to investigate the perceived barriers that are faced by speech and language therapists in southern Ireland when attempting to implement evidence-based practice. A 34-item questionnaire was sent to 39 therapists working in several counties in southern Ireland. The survey received an 82.1% (n = 32) response rate. The results of the study indicated that certain barriers are perceived to prevent evidence-based practice being implemented successfully. The most significant barrier affecting evidence-based practice implementation was reported to be a lack of time to read research (71.9%). Additional barriers that were found to be the most significant were the research having methodological inadequacies (62.5%) and insufficient time to implement new ideas (59.4%). Other important factors identified as being significant barriers to the implementation of evidence-based practice were those associated with the quality and presentation of the research, workplace setting, and lack of skills of the therapist. Associations between specific barriers and workplace setting or grade were also investigated. Some possible reasons for these barriers and the implications for clinical practice are also discussed. This small study suggests that therapists agreed that evidence-based practice is essential to the practice of speech and language therapy. There are, however, barriers in place that are perceived to prevent its successful implementation. It is hoped that because these barriers have been identified, individual clinicians and organizations can be proactive in aiming to provide an evidence-based service to their clients.

  17. Improved outcomes after successful implementation of a pediatric early warning system (PEWS) in a resource-limited pediatric oncology hospital.

    Science.gov (United States)

    Agulnik, Asya; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Doris Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos

    2017-08-01

    Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in resource-limited settings. Pediatric early warning systems (PEWS) aid in the early identification of clinical deterioration; however, there are limited data regarding their feasibility or impact in low-resource settings. This study describes the successful implementation of PEWS at the Unidad Nacional de Oncología Pediátrica (UNOP), a pediatric oncology hospital in Guatemala, resulting in improved inpatient outcomes. A modified PEWS was implemented at UNOP with systems to track errors, transfers to a higher level of care, and high scores. A retrospective cohort study was used to evaluate clinical deterioration events in the year before and after PEWS implementation. After PEWS implementation at UNOP, there was 100% compliance with PEWS documentation and an error rate of <10%. Implementation resulted in 5 high PEWS per week, with 30% of patients transferring to a higher level of care. Among patients requiring transfer to the pediatric intensive care unit (PICU), 93% had an abnormal PEWS before transfer. The rate of clinical deterioration events decreased after PEWS implementation (9.3 vs 6.5 per 1000-hospitalpatient-days, p = .003). Despite an 18% increase in total hospital patient-days, PICU utilization for inpatient transfers decreased from 1376 to 1088 PICU patient-days per year (21% decrease; P<.001). This study describes the successful implementation of PEWS in a pediatric oncology hospital in Guatemala, resulting in decreased inpatient clinical deterioration events and PICU utilization. This work demonstrates that PEWS is a feasible and effective quality improvement measure to improve hospital care for children with cancer in hospitals with limited resources. Cancer 2017;123:2965-74. © 2017 American Cancer Society. © 2017 American Cancer Society.

  18. Hepatocellular Carcinoma Complicated by Gastroduodenal Obstruction: Palliative Treatment with Metallic Stent Placement

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ye Jin; Kim, Jin Hyoung, E-mail: m1fenew@daum.net; Song, Ho-Young; Park, Jung-Hoon; Na, Han Kyu; Kim, Pyeong Hwa; Fan, Yong [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center (Korea, Republic of)

    2012-10-15

    Purpose: To evaluate the clinical effectiveness of self-expandable metallic stents in seven patients with malignant gastroduodenal obstruction caused by inoperable hepatocellular carcinoma (HCC). Methods: Seven patients with gastroduodenal obstruction caused by advanced HCC underwent metallic stent placement from 2003 to 2010. These patients had total dysphagia (n = 5) or were able to eat only liquids (n = 2) before stent placement. Patients had Eastern Cooperative Oncology Group performance scores of 2 or 3, and Child-Pugh classification B or C. Results: Stent placement was technically successful in all seven patients (100%) and clinically successful in six (86%). Five patients could eat a soft diet, and one patient tolerated regular diet after stent placement. Stent-related obstructive jaundice occurred in one patient. One patient had hematemesis 11 days after stent placement. Overall mean survival was 51 days (range, 10-119 days). Stent patency was preserved in six patients with clinical success until death. Conclusion: Placement of a covered self-expandable metallic stent may offer good palliation in patients with gastroduodenal obstruction due to advanced HCC.

  19. Synergy between direct coronary stenting technique and use of the novel thin strut cobalt chromium Skylor™ stent: the MACE in follow up patients treated with Skylor stent [MILES Study].

    Science.gov (United States)

    Giordano, Arturo; Polimeno, Michele; Corcione, Nicola; Fattore, Luciano; Di Lorenzo, Luigi; Biondi-Zoccai, Giuseppe; Ferraro, Paolo; Romano, Maria Fiammetta

    2012-02-01

    Despite significant improvements in stent platform, currently available bare-metal stents (BMS) are still associated with restenosis. Thin-strut design cobalt-chromium alloys hold the promise of improving results of BMS, especially when implanted with direct technique. We performed an observational study to appraise outcomes of the novel Skylor™ stent, stratifying outcomes according to stenting technique. We included all consecutive patients undergoing coronary stenting with Skylor™ at 2 centers between 2006 and 2009. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e. death, myocardial infarction (MI), coronary artery bypass grafting (CABG) or target vessel revascularization (TVR)). As pre-specified analysis, we compared patients undergoing direct stenting versus those stent implantation following predilation. A total of 1020 patients were included (1292 Skylor™ stents), with procedural success obtained in 99%. Comparing patients undergoing direct stenting (66%) versus pre-dilation (34%) at 16±7 months of follow-up, MACE had occurred in, respectively, 8% versus 14% (p=0.001), with death in 1% versus 2= (p=0.380), MI in 1% versus 2% (p=0.032), CABG in 0.2% versus 2% (p=0.012), and TVR in 6% versus 9% [p=0.071]. Even at multivariable analysis with propensity adjustment, direct stenting was associated with significantly fewer MACE [hazard ratio 0.60 [0.38-0.93], p=0.024]. This observational study suggests the presence of a beneficial synergy between direct coronary stenting technique and use of the novel thin-strut cobalt-chromium Skylor™ stent in real-world patients undergoing PCI.

  20. Incorporating the user perspective into a proposed model for assessing success of SHS implementations

    Directory of Open Access Journals (Sweden)

    Hans Holtorf

    2015-10-01

    Full Text Available Modern energy can contribute to development in multiple ways while approximately 20% of world's populations do not yet have access to electricity. Solar Home Systems (SHSs consists of a PV module, a charge controller and a battery supply in the range of 100 Wh/d in Sunbelt countries. The question addressed in this paper is how SHS users approach success of their systems and how these user's views can be integrated in to an existing model of success. Information was obtained on the user's approach to their SHSs by participatory observation, interviews with users and by self-observation undertaken by the lead author while residing under SHS electricity supply conditions. It was found that success of SHSs from the users' point of view is related to the ability of these systems to reduce the burdens of supplying energy services to homesteads. SHSs can alleviate some energy supply burdens, and they can improve living conditions by enabling communication on multiple levels and by addressing convenience and safety concerns. However, SHSs do not contribute to the energy services which are indispensable for survival, nor to the thermal energy services required and desired in dwellings of Sunbelt countries. The elements of three of the four components of our previously proposed model of success have been verified and found to be appropriate, namely the user's self-set goals, their importance and SHSs' success factors. The locally appropriate, and scientifically satisfactory, measurement of the level of achievement of self-set goals, the fourth component of our model of success, remains an interesting area for future research.

  1. The risk and prognostic impact of definite stent thrombosis or in-stent restenosis after coronary stent implantation

    DEFF Research Database (Denmark)

    Thayssen, Per; Jensen, Lisette Okkels; Lassen, Jens Flensted

    2012-01-01

    Aims: Data are limited on the prognostic impact of stent thrombosis and in-stent restenosis in patients treated with coronary stents. We examined the prognostic impact of stent thrombosis and in-stent restenosis in patients treated with percutaneous coronary intervention (PCI). Methods and result...

  2. Supporting the Evaluation and Implementation of Musculoskeletal Models of Care: A Globally Informed Framework for Judging Readiness and Success.

    Science.gov (United States)

    Briggs, Andrew M; Jordan, Joanne E; Jennings, Matthew; Speerin, Robyn; Bragge, Peter; Chua, Jason; Woolf, Anthony D; Slater, Helen

    2017-04-01

    To develop a globally informed framework to evaluate readiness for implementation and success after implementation of musculoskeletal models of care (MOCs). Three phases were undertaken: 1) a qualitative study with 27 Australian subject matter experts (SMEs) to develop a draft framework; 2) an eDelphi study with an international panel of 93 SMEs across 30 nations to evaluate face validity, and refine and establish consensus on the framework components; and 3) translation of the framework into a user-focused resource and evaluation of its acceptability with the eDelphi panel. A comprehensive evaluation framework was developed for judging the readiness and success of musculoskeletal MOCs. The framework consists of 9 domains, with each domain containing a number of themes underpinned by detailed elements. In the first Delphi round, scores of "partly agree" or "completely agree" with the draft framework ranged 96.7%-100%. In the second round, "essential" scores ranged 58.6%-98.9%, resulting in 14 of 34 themes being classified as essential. SMEs strongly agreed or agreed that the final framework was useful (98.8%), usable (95.1%), credible (100%) and appealing (93.9%). Overall, 96.3% strongly supported or supported the final structure of the framework as it was presented, while 100%, 96.3%, and 100% strongly supported or supported the content within the readiness, initiating implementation, and success streams, respectively. An empirically derived framework to evaluate the readiness and success of musculoskeletal MOCs was strongly supported by an international panel of SMEs. The framework provides an important internationally applicable benchmark for the development, implementation, and evaluation of musculoskeletal MOCs. © 2016, American College of Rheumatology.

  3. Peer Mediation Services for Conflict Resolution in Schools: What Transformations in Activity Characterise Successful Implementation?

    Science.gov (United States)

    Sellman, Edward

    2011-01-01

    This article presents the findings from research conducted at nine schools (seven primary, two secondary) in England, which had previously implemented a peer mediation service for students experiencing interpersonal conflict. This analysis was informed by themes from a previous stage of research conducted at one additional primary school, where…

  4. The Successful Implementation of Electronic Health Records at Small Rural Hospitals

    Science.gov (United States)

    Richardson, Daniel

    2016-01-01

    Electronic health records (EHRs) have been in use since the 1960s. U.S. rural hospital leaders and administrators face significant pressure to implement health information technology because of the American Recovery and Reinvestment Act of 2009. However, some leaders and managers of small rural hospital lack strategies to develop and implement…

  5. Post-Implementation Success Factors for Enterprise Resource Planning Student Administration Systems in Higher Education Institutions

    Science.gov (United States)

    Sullivan, Linda; Bozeman, William

    2010-01-01

    Enterprise Resource Planning (ERP) systems can represent one of the largest investments of human and financial resources by a higher education institution. They also bring a significant process reengineering aspect to the institution and the associated implementation project through the integration of compiled industry best practices into the…

  6. What it takes to successfully implement technology for aging in place: focus groups with stakeholders

    NARCIS (Netherlands)

    Eveline J.M. Wouters; Katrien G. Luijkx; Hubertus J.M. Vrijhoef; Sebastiaan Theodorus Michaël Peek MSc

    2016-01-01

    BACKGROUND: There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by

  7. What it takes to successfully implement technology for aging in place : Focus groups with stakeholders

    NARCIS (Netherlands)

    Peek, S.T.M.; Wouters, E.J.M.; Luijkx, K.G.; Vrijhoef, H.J.M.

    2016-01-01

    BACKGROUND: There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by

  8. Key factors influencing the implementation success of a home telecare application.

    NARCIS (Netherlands)

    Postema, T.R.F.; Peeters, J.M.; Freide, R.D.

    2012-01-01

    Rationale The introduction of home telecare in healthcare organizations has shown mixed results in practice. The aim of this study is to arrive at a set of key factors that can be used in further implementation of video communication. We argue that key factors are mainly found in the organizational

  9. Implementation of a Personnel Management System "Beaufort": Successes and failures at a Dutch Hospital

    NARCIS (Netherlands)

    Bondarouk, Tatiana; Khosrow-Pour, M.

    2004-01-01

    This case describes a project concerning the implementation of a personnel management system - Beaufort - in Medinet, one of the larger regional general hospitals in The Netherlands. The project plan included two sequential phases: firstly, the introduction of Beaufort to the central personnel and

  10. Towards consistent modes of e-health implementation : structurational analysis of a telecare programmes limited success

    NARCIS (Netherlands)

    Boonstra, A.; van Offenbeek, M.A.G.

    2010-01-01

    Telecare is the use of information and communication systems to facilitate care delivery to individuals in their homes. Although the expectations of telecare are high, its implementation has proved complex. This case study demonstrates this complexity through a structurational analysis of a telecare

  11. Design and implementation of monitoring studies to evaluate the success of ecological restoration on wildlife

    Science.gov (United States)

    William M. Block; Alan B. Franklin; James P. Ward; Joseph L. Ganey; Gary C. White

    2001-01-01

    Restoration projects are often developed with little consideration for understanding their effects on wildlife. We contend, however, that monitoring treatment effects on wildlife should be an integral component of the design and execution of any management activity, including restoration. Thus, we provide a conceptual framework for the design and implementation of...

  12. Successful Implementation of Inquiry-Based Physiology Laboratories in Undergraduate Major and Nonmajor Courses

    Science.gov (United States)

    Casotti, G.; Rieser-Danner, L.; Knabb, M. T.

    2008-01-01

    Recent evidence has demonstrated that inquiry-based physiology laboratories improve students' critical- and analytical-thinking skills. We implemented inquiry-based learning into three physiology courses: Comparative Vertebrate Physiology (majors), Human Physiology (majors), and Human Anatomy and Physiology (nonmajors). The aims of our curricular…

  13. Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective.

    Science.gov (United States)

    Sidek, Yusof Haji; Martins, Jorge Tiago

    2017-11-01

    Electronic health records (EHR) make health care more efficient. They improve the quality of care by making patients' medical history more accessible. However, little is known about the factors contributing to the successful EHR implementation in dental clinics. This article aims to identify the perceived critical success factors of EHR system implementation in a dental clinic context. We used Grounded Theory to analyse data collected in the context of Brunei's national EHR - the Healthcare Information and Management System (Bru-HIMS). Data analysis followed the stages of open, axial and selective coding. Six perceived critical success factors emerged: usability of the system, emergent behaviours, requirements analysis, training, change management, and project organisation. The study identified a mismatch between end-users and product owner/vendor perspectives. Workflow changes were significant challenges to clinicians' confident use, particularly as the system offered limited modularity and configurability. Recommendations are made for all the parties involved in healthcare information systems implementation to manage the change process by agreeing system goals and functionalities through wider consensual debate, and participated supporting strategies realised through common commitment. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  14. Success with Sport Education at a Secondary Level: Implementation and Examples from a Basketball Season

    Science.gov (United States)

    Mercier, Kevin

    2010-01-01

    Based upon ten years of teaching and modifying the Sport Education Model at the high school level, this article summarizes how the author has had success in using the model to increase enthusiasm, student learning and quality participation in physical education. What started out as one teacher in the district testing the model with one class a…

  15. Successful Implementation of a Computer-Supported Collaborative Learning System in Teaching E-Commerce

    Science.gov (United States)

    Ngai, E. W. T.; Lam, S. S.; Poon, J. K. L.

    2013-01-01

    This paper describes the successful application of a computer-supported collaborative learning system in teaching e-commerce. The authors created a teaching and learning environment for 39 local secondary schools to introduce e-commerce using a computer-supported collaborative learning system. This system is designed to equip students with…

  16. The Implementation of a Structured Nursing Leadership Development Program for Succession Planning in a Health System.

    Science.gov (United States)

    Ramseur, Priscilla; Fuchs, Mary Ann; Edwards, Pamela; Humphreys, Janice

    2018-01-01

    Preparing future nursing leaders to be successful is important because many current leaders will retire in large numbers in the future. A structured nursing leadership development program utilizing the Essentials of Nurse Manager Orientation online program provided future nursing leaders with content aligned with nursing leadership competencies. Paired with assigned mentors and monthly leadership sessions, the participants increased their perception of leadership competence.

  17. Conditions, factors and criteria for successful project implementation: generalization of experience of project management

    Directory of Open Access Journals (Sweden)

    Feraru Galina Sergeevna

    2014-11-01

    Full Text Available The article addresses issues characterizing features of project management contributing to their competitive advantage; shows the factors and criteria of success of projects and the main reasons for their failures, making the failed efforts of developers to create projects.

  18. Embracing change: practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke

    Science.gov (United States)

    2012-01-01

    Background Rehabilitation technology for upper limb training of stroke patients may play an important role as therapy tool in future, in order to meet the increasing therapy demand. Currently, implementation of this technology in the clinic remains low. This study aimed at identifying criteria and conditions that people, involved in development of such technology, should take into account to achieve a (more) successful implementation of the technology in the clinic. Methods A literature search was performed in PubMed and IEEE databases, and semi-structured interviews with therapists in stroke rehabilitation were held, to identify criteria and conditions technology should meet to facilitate (implementation of) technology-assisted arm-hand skills training in rehabilitation therapy of stroke patients. In addition, an implementation strategy frequently applied in general health care was used to compose a stepwise guidance to facilitate successful implementation of this technology in therapy of stroke patients. Implementation-related criteria mentioned by therapists during the interviews were integrated in this guidance. Results Results indicate that, related to therapy content, technology should facilitate repetition of task-related movements, tailored to the patient and patient’s goals, in a meaningful context. Variability and increasing levels of difficulty in exercises should be on offer. Regarding hardware and software design of technology, the system should facilitate quick familiarisation and be easily adjustable to individual patients during therapy by therapists (and assistants). The system should facilitate adaptation to individual patients’ needs and their progression over time, should be adjustable as to various task-related variables, should be able to provide instructions and feedback, and should be able to document patient’s progression. The implementation process of technology in the clinic is provided as a stepwise guidance that consists of five

  19. Embracing change: practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke

    Directory of Open Access Journals (Sweden)

    Hochstenbach-Waelen Ananda

    2012-08-01

    Full Text Available Abstract Background Rehabilitation technology for upper limb training of stroke patients may play an important role as therapy tool in future, in order to meet the increasing therapy demand. Currently, implementation of this technology in the clinic remains low. This study aimed at identifying criteria and conditions that people, involved in development of such technology, should take into account to achieve a (more successful implementation of the technology in the clinic. Methods A literature search was performed in PubMed and IEEE databases, and semi-structured interviews with therapists in stroke rehabilitation were held, to identify criteria and conditions technology should meet to facilitate (implementation of technology-assisted arm-hand skills training in rehabilitation therapy of stroke patients. In addition, an implementation strategy frequently applied in general health care was used to compose a stepwise guidance to facilitate successful implementation of this technology in therapy of stroke patients. Implementation-related criteria mentioned by therapists during the interviews were integrated in this guidance. Results Results indicate that, related to therapy content, technology should facilitate repetition of task-related movements, tailored to the patient and patient’s goals, in a meaningful context. Variability and increasing levels of difficulty in exercises should be on offer. Regarding hardware and software design of technology, the system should facilitate quick familiarisation and be easily adjustable to individual patients during therapy by therapists (and assistants. The system should facilitate adaptation to individual patients’ needs and their progression over time, should be adjustable as to various task-related variables, should be able to provide instructions and feedback, and should be able to document patient’s progression. The implementation process of technology in the clinic is provided as a stepwise

  20. Assessing Cultural Readiness of Organization For Successful Implementation of Knowledge Managment, Appling FMCDM Approach: Case of Central Bank of Iran

    Directory of Open Access Journals (Sweden)

    Shaban Elahi

    2012-02-01

    Full Text Available Supportive organizational culture for knowledge management can vouch for successful implementation of knowledge management. In the case of lacking this kind of supportive culture, the organizational culture is one of the obstacles which can lead the implementation of knowledge management to full failure and waste of organizational assets. In this research, a framework based on FMCDM was utilized to assess the cultural readiness of organization as the knowledge management implementation prerequisite. This framework has been utilized to assess Central Bank of Iran’s cultural readiness. The methodology of research was descriptive and research data were gathered by questionnaire and were answered by experts and CBI executives. In this term, the cultural readiness of CBI was assessed and in accordance with this assessment, embarking on corrective action was proposed.

  1. FORMATION OF SIX SIGMA INFRASTRUCTURE FOR THE CORONARY STENTING PROCESS

    Directory of Open Access Journals (Sweden)

    Mehmet Tolga Taner

    2013-10-01

    Full Text Available The purpose of this study is to show how a tertiary care center in Turkey operating mainly in cardiology initiated Six Sigma principles to reduce the number of complications occuring during coronary stent insertion process. A Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC model for coronary stent insertion is suggested. Data were collected for 24-months. Twenty-two Critical-to-Quality (CTQ factors were identified for successful coronary stent insertion. The most frequent causes of complications in the process were found to be patients with previous bypass surgery or PCI, inexperience of staff members, highly damaged vessel structure, thin and/or long vessel diameter, inappropriate selection of stent type, inappropriate selection of balloon type and poor image quality.

  2. Transluminal endovascular stent-graft for the treatment of aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Do Yun; Chang, Byung Chul; Shim, Won Heum; Cho, Seung Yun; Chung, Nam Sik; Kwon, Hyuk Moon; Lee, Young Joon; Lee, Jong Tae [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1995-09-15

    The standard treatment for aortic aneurysms is surgical replacement with a prosthetic graft. Currently there is great interest in endoluminal intervention for treatment of aortic aneurysm. The purpose of this study was to evaluate the safety and effectiveness of endoluminally placed Stent-graft for the treatment of aortic aneurysms. Transluminal endovascular Stent-graft placements were attempted in 9 patients with infra-renal aortic aneurysms(n 6), thoracic aortic aneurysm(n = 1), and aortic dissection(n = 2). The endovascular Stent-grafts were custom-designed for each patient and were constructed of self-expandable modified Gianturco Stents covered with polytetrafluroethylene. The Stent-grafts were introduced through a 16-18 French sheath and expanded to 17-30 mm in diameter. The endovascular therapy was performed using a common femoral artery cutdown with local anesthesia. The endovascular Stent-graft deployment was achieved in 7 of 9 patients. Two cases failed deployment of the Stent-graft due to iliac artery stenosis and tortousity. There were complete thrombosis of the thoracic and infra-renal aortic aneurysm surround the Stent-graft in 3 patients, and persistent leak with partial thrombosis in 2. Two patients with aortic dissection were successfully treated by obliteration of entry tears. There were no major complication associated with Stent-graft placement. These preliminary results show that transluminal endovascular Stent-grafts offer great promise and good results. Further investigation is needed to establish its long-term safety and efficacy.

  3. Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS)

    DEFF Research Database (Denmark)

    Kosonen, Petteri; Vikman, Saila; Jensen, Lisette Okkels

    2012-01-01

    This prospective multicenter registry used intravascular ultrasound (IVUS) in patients with definite stent thrombosis (ST) to compare rates of incomplete stent apposition (ISA), stent fracture and stent expansion in patients treated with drug-eluting (DES) versus bare metal (BMS) stents. ST...

  4. Pathways to clean hands: highlights of successful hand hygiene implementation strategies in Europe.

    Science.gov (United States)

    Magiorakos, A P; Leens, E; Drouvot, V; May-Michelangeli, L; Reichardt, C; Gastmeier, P; Wilson, K; Tannahill, M; McFarlane, E; Simon, A

    2010-05-06

    Hand hygiene is the most effective way to stop the spread of microorganisms and to prevent healthcare-associated infections (HAI). The World Health Organization launched the First Global Patient Safety Challenge - Clean Care is Safer Care - in 2005 with the goal to prevent HAI globally. This year, on 5 May, the WHO s initiative SAVE LIVES: Clean Your Hands, which focuses on increasing awareness of and improving compliance with hand hygiene practices, celebrated its second global day. In this article, four Member States of the European Union describe strategies that were implemented as part of their national hand hygiene campaigns and were found to be noteworthy. The strategies were: governmental support, the use of indicators for hand hygiene benchmarking, developing national surveillance systems for auditing alcohol-based hand rub consumption, ensuring seamless coordination of processes between health regions in countries with regionalised healthcare systems, implementing the WHO's My Five Moments for Hand Hygiene, and auditing of hand hygiene compliance.

  5. Challenges to successful implementation of HIV and AIDS-related health policies in Cartagena, Colombia.

    Science.gov (United States)

    Djellouli, Nehla; Quevedo-Gómez, María Cristina

    2015-05-01

    The Caribbean region presents the highest prevalence of HIV/AIDS worldwide after sub-Saharan Africa; leading to serious social, economic and health consequences at the local scale but also at the regional and global levels. In Colombia, a national plan to tackle the epidemic was formulated with little evidence that its implementation in the local context is effective. This study focused on Cartagena - one of Colombia's largest cities and an international touristic hub - that presents one of the highest HIV prevalences in the country, to investigate whether the national plan accounts for local specificities and what are the barriers to local implementation. Based on the Contextual Interaction Theory (CIT), this qualitative research relied upon 27 interviews and 13 life stories of local inhabitants and stakeholders, collected in a first fieldwork in 2006-2007. A follow-up data collection took place in 2013 with 10 participants: key policymakers and implementers, NGO representatives and local inhabitants. Barriers identified by the participants included: local population's understandings and beliefs on condom use; stigma and discrimination; lack of collaboration from the Church, the education sector and local politicians; corruption; high staff turnover; frequent changes in leadership; lack of economic and human resources; and barriers to health care access. The findings suggest that global influences also have an impact on the CIT framework (e.g. international organisations as a major financier in HIV prevention). The participants put forward several feasible solutions to implementation barriers. We discuss how several of the proposed solutions have been applied in other Latin American and Caribbean countries and yielded positive results. However, further research is needed to find possible ways of overcoming certain barriers identified by this study such as corruption, the lack of collaboration of the Church and barriers to health care access. Copyright © 2015

  6. Barriers and Critical Success Factors for the Implementation of Cooperation Mechanisms

    DEFF Research Database (Denmark)

    Hansen, Lise-Lotte Pade; Klinge Jacobsen, Henrik

    This document reports activities and results of Task 3.1 of the Intelligent Energy Europe supported project RES4Less. This work is the initial analyses and survey of barriers for implementing cooperation mechanisms in the EU countries. This work builds on earlier Intelligent Energy Europe projects...... also shared and enriched by comments from other members of the RES4Less Team during internal meetings of the project....

  7. Arts Achieve, Impacting Student Success in the Arts: Preliminary Findings After One Year of Implementation

    OpenAIRE

    Mastrorilli, Tara M.; Harnett, Susanne; Zhu, Jing

    2014-01-01

    The Arts Achieve: Impacting Student Success in the Arts project involves a partnership between the New York City Department of Education (NYCDOE) and five of the city’s premier arts organizations. Arts Achieve provides intensive and targeted professional development to arts teachers over a three-year period. The goal of the project is to improve the quality of arts teachers’ instruction through in-service professional development on the use of balanced (formative and summative) assessment, le...

  8. A domestic model for successful implementation of enterprise resource planning (ERP systems in Iranian manufacturing enterprises

    Directory of Open Access Journals (Sweden)

    Mohammad Rahmani

    2012-01-01

    Full Text Available This research investigates the human-behavioral dimension of technology acceptance in enterprises. It is evident that accepting a technology depends on the underlying circumstances of the environment. We have approached this issue from two different angles of social and technological architecture. The research tries to explore proper enterprise architecture for ERP system acceptance. Social Architecture (SA is defined as the set of circumstances that makes people behave in a particular way. So behavior of persons (employees of an enterprise can be a function of SA. Hence acceptance of a system can be dictated by SA and manipulating SA can result in desirable success for a technology system. We have achieved various variables of social architecture and have examined their relevance to system acceptance and success in related enterprises (research domain beside technological architecture variables. The results have indicated that a special form of social and technological architecture can lead to success for ERP system in the enterprises of the research domain. This gave us a model of architecture.

  9. 3D printing guiding stent graft fenestration: A novel technique for fenestration in endovascular aneurysm repair.

    Science.gov (United States)

    Huang, Jianhua; Li, Gan; Wang, Wei; Wu, Keming; Le, Tianming

    2017-08-01

    Objective To describe a novel approach, 3D printing guiding stent graft fenestration, for fenestration during endovascular aneurysm repair for juxtarenal abdominal aortic aneurysm. Methods A 69-year-old male with juxtarenal abdominal aortic aneurysm underwent endovascular aneurysm repair with "off the label" fenestrated stent graft. To precisely locate the fenestration position, we reconstructed a 3D digital abdominal aortic aneurysm model and created a skin template covering this abdominal aortic aneurysm model. Then the skin template was physically printed and the position of the visceral vessel was hollowed out, thereby helping in locating the fenestration on stent graft. Results and conclusions With the help of this 3D printed skin template, we fenestrated the stent graft accurately and rebuilt the bilateral renal artery successfully. This is the first clinical case that used 3D printing guiding stent graft fenestration, which is a novel approach for precise fenestration on stent graft on the table during endovascular aneurysm repair.

  10. Impact analysis of critical success factors on the benefits from statistical process control implementation

    Directory of Open Access Journals (Sweden)

    Fabiano Rodrigues Soriano

    Full Text Available Abstract The Statistical Process Control - SPC is a set of statistical techniques focused on process control, monitoring and analyzing variation causes in the quality characteristics and/or in the parameters used to control and process improvements. Implementing SPC in organizations is a complex task. The reasons for its failure are related to organizational or social factors such as lack of top management commitment and little understanding about its potential benefits. Other aspects concern technical factors such as lack of training on and understanding about the statistical techniques. The main aim of the present article is to understand the interrelations between conditioning factors associated with top management commitment (Support, SPC Training and Application, as well as to understand the relationships between these factors and the benefits associated with the implementation of the program. The Partial Least Squares Structural Equation Modeling (PLS-SEM was used in the analysis since the main goal is to establish the causal relations. A cross-section survey was used as research method to collect information of samples from Brazilian auto-parts companies, which were selected according to guides from the auto-parts industry associations. A total of 170 companies were contacted by e-mail and by phone in order to be invited to participate in the survey. However, just 93 industries agreed on participating, and only 43 answered the questionnaire. The results showed that the senior management support considerably affects the way companies develop their training programs. In turn, these trainings affect the way companies apply the techniques. Thus, it will reflect on the benefits gotten from implementing the program. It was observed that the managerial and technical aspects are closely connected to each other and that they are represented by the ratio between top management and training support. The technical aspects observed through SPC

  11. Reducing surgical errors: implementing a three-hinge approach to success.

    Science.gov (United States)

    Landers, Ronda

    2015-06-01

    Surgical errors can have serious consequences including patient deaths, and recent reports suggest that surgical errors continue to occur at unacceptable rates. Studies indicate that causative factors for surgical error include human factors, OR interruptions, staffing issues, and error-reporting trends. A "three-hinge" approach can be used to implement a safety program that emphasizes use of a safe surgery checklist and the Centers for Medicare & Medicaid Services reporting requirements for ambulatory surgery centers. The three hinges are the assignment of a change agent, ideally an RN with a doctorate in nursing practice; team cohesiveness; and continuous quality monitoring. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  12. Didactical contract: An analytical concept to facilitate successful implementation of open-ended physics labs

    DEFF Research Database (Denmark)

    Jacobsen, Lærke Bang; Johannsen, Bjørn Friis; Rump, Camilla Østerberg

    outcomes of alternative laboratory work in secondary and tertiary physics education we decided to approach the underlying cause of the problem. Framed in the theory of Didactical Situations in mathematics we adapt the concept of the didactical contract to the physics education context to locate aspects...... contract permeates through secondary education into university physics education. Our results allow for a better renegotiation of didactical contracts and thus for avoiding typical problems related to the implementation of alternative tasks. One might expect physics students to be special in their explicit...... interest in physics and thus plan educational activities accordingly. Based on our results, however, we find this an ill-advised strategy....

  13. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar

    2014-01-01

    was obtained via laser cutting, and surface treatment was performed with acid pickling and electropolishing, followed by an annealing process. In vitro mechanical analysis was performed to analyze the mechanical performance of the auxetic coronary stent. Scanning electronic microscopy (SEM) was used...

  14. Isolated spontaneous dissection of the superior mesenteric artery: percutaneous stent placement in two patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Ho; Roh, Byung Suk; Lee, Young Hwan; Choi, See Sung; So, Byung Jun [Wonkwang University School of Medicine, Iksan (Korea, Republic of)

    2004-06-15

    Isolated spontaneous dissection of the superior mesenteric artery (SMA) is a rare cause of acute mesenteric ischemia. Two patients were successfully treated by percutaneous stent placement within the main trunk of the SMA. Emphasis is placed on the feasibility of nonsurgical management with percutaneous stent placement of isolated spontaneous dissection of the SMA.

  15. Repair of an Atherosclerotic Coronary Artery Aneurysm by Implantation of a Coronary Covered Stent

    Directory of Open Access Journals (Sweden)

    Antenor Portela

    2002-05-01

    Full Text Available An atherosclerotic aneurysm of the right coronary artery complicated by a recent myocardial infarction was successfully treated with coronary artery stenting, using a device consisting of 2 stents with a layer of expandable polytetrafluorethylene (PTFE placed between them. A follow-up angiograph 5 months after the procedure showed sustained initial results.

  16. Repair of an Atherosclerotic Coronary Artery Aneurysm by Implantation of a Coronary Covered Stent

    OpenAIRE

    Portela, Antenor; Bastos, Raldir; Costa, Itamar; Paiva, Jayro

    2002-01-01

    An atherosclerotic aneurysm of the right coronary artery complicated by a recent myocardial infarction was successfully treated with coronary artery stenting, using a device consisting of 2 stents with a layer of expandable polytetrafluorethylene (PTFE) placed between them. A follow-up angiograph 5 months after the procedure showed sustained initial results.

  17. Successful implementation and results of an HPV vaccination program in Geneva Canton, Switzerland.

    Science.gov (United States)

    Jeannot, Emilien; Petignat, Patrick; Sudre, Philippe

    2015-01-01

    We describe a human papillomavirus (HPV) vaccination program implemented since 2007 in Geneva Canton, Switzerland, that used school services, a public hospital, and private physicians as vaccination providers. We assessed program performance with the evolution of immunization coverage during the first four years of program implementation. We measured vaccination coverage of the target population using individual records of vaccination status collected by service providers and transmitted to the Geneva Canton Medical Office. The target population was 20,541 adolescent girls aged 11-19 years as of September 1, 2008, who resided in the canton when the program began. As of June 30, 2012, HPV vaccination coverage was 72.6% and 74.8% in targeted cohorts for three and two doses, respectively. The global coverage for three doses increased by 27 percentage points from December 2009 to June 2012. Coverage for girls aged 16-18 years at the beginning of the program reached 80% or more four years into the program. High coverage by this HPV vaccination program in Geneva was likely related to free vaccination and easy access to the vaccine using a combination of delivery services, including school health services, a public hospital, and private physicians, covering most eligible adolescent girls.

  18. The Use of Solitaire AB Stents in Coil Embolization of Wide-Necked Cerebral Aneurysms.

    Directory of Open Access Journals (Sweden)

    Teng-Fei Li

    Full Text Available The Solitaire AB stent is one of many assistant stents used for treating wide-necked cerebral aneurysm, and has been used since 2003. However, large sample studies on its safety and effectiveness are lacking. The objective of this study was to evaluate the effectiveness and safety of the Solitaire AB stent in the coil embolization of wide-necked cerebral aneurysms.Retrospective review of the clinical and image data of 116 patients with wide-necked cerebral aneurysms who had been enrolled at six interventional neuroradiology centers from February 2010 to February 2014 and had been treated by coil embolization; in total, 120 Solitaire AB stents were used. The degree of aneurysm occlusion was examined using digital subtraction angiography (DSA immediately after the procedure and during follow-up, and was graded using the modified Raymond classification. We also observed complications to evaluate the safety and effectiveness of this therapy.The 120 Solitaire AB stents (4 mm × 15 mm, four stents; 4 mm × 20 mm, 16 stents; 6 mm × 20 mm, 36 stents; 6 mm × 30 mm, 64 stents were inserted to treat 120 wide-necked cerebral aneurysms. All stents were inserted successfully. DSA immediately post-surgery revealed 55 cases of complete occlusion, 59 cases of neck remnant, and six cases of aneurysm remnant. Perioperatively, there were four cases of hemorrhage and four cases of stent thrombosis. The follow-up spanned 3-37 months; of 92 patients examined by DSA at the 6-month follow up, 12 had disease recurrence.The Solitaire AB stent is effective with a good technical success rate and short-term effect for assisting coil embolization of wide-necked cerebral aneurysms.

  19. How best can we plan & implement HIV prevention? A review of successful evidence based practices & research

    Directory of Open Access Journals (Sweden)

    Vijay Kumar Chattu

    2014-07-01

    Full Text Available Context: Around 2.5 million people become infected with HIV each year and its impact on human life and public health can only be tackled and reversed only by sound prevention strategies. Aim: This paper aims to provide the reader about different types of prevention strategies that are effective and practiced in various countries with special emphasis on evidence for success. It also highlights the importance of to the evidence based medicine& strategies. It describes about the importance of combination prevention, which encompasses complementary behavioral, biomedical and structural prevention strategies. Methods & Materials: Searches for peer reviewed journal articles was conducted using the search engines to gather the information from databases of medicine, health sciences and social sciences. Information for each strategy is organized & presented systematically with detailed discussion. Results: For a successful reduction in HIV transmission, there is a great need for combined effects of radical & sustainable behavioral changes among individuals who are potentially at risk. Second, combination prevention is essential for HIV prevention is neither simple nor simplistic. Reductions in HIV transmission need widespread and sustained efforts. A mix of communication channels are essential to disseminate messages to motivate people to engage in various methods of risk reduction. Conclusions: The effect of behavioral strategies could be increased by aiming for many goals that are achieved by use of multilevel approaches with populations both uninfected and infected with HIV. Combination prevention programs operate on different levels to address the specific, but diverse needs of the populations at risk of HIV infection.

  20. Implementing telehealth to support medical practice in rural/remote regions: what are the conditions for success?

    Directory of Open Access Journals (Sweden)

    Duplantie Julie

    2006-08-01

    Full Text Available Abstract Background Telehealth, as other information and communication technologies (ICTs introduced to support the delivery of health care services, is considered as a means to answer many of the imperatives currently challenging health care systems. In Canada, many telehealth projects are taking place, mostly targeting rural, remote or isolated populations. So far, various telehealth applications have been implemented and have shown promising outcomes. However, telehealth utilisation remains limited in many settings, despite increased availability of technology and telecommunication infrastructure. Methods A qualitative field study was conducted in four remote regions of Quebec (Canada to explore perceptions of physicians and managers regarding the impact of telehealth on clinical practice and the organisation of health care services, as well as the conditions for improving telehealth implementation. A total of 54 respondents were interviewed either individually or in small groups. Content analysis of interviews was performed and identified several effects of telehealth on remote medical practice as well as key conditions to ensure the success of telehealth implementation. Results According to physicians and managers, telehealth benefits include better access to specialised services in remote regions, improved continuity of care, and increased availability of information. Telehealth also improves physicians' practice by facilitating continuing medical education, contacts with peers, and access to a second opinion. At the hospital and health region levels, telehealth has the potential to support the development of regional reference centres, favour retention of local expertise, and save costs. Conditions for successful implementation of telehealth networks include the participation of clinicians in decision-making, the availability of dedicated human and material resources, and a planned diffusion strategy. Interviews with physicians and

  1. An Analytic Hierarchy Process-based Method to Rank the Critical Success Factors of Implementing a Pharmacy Barcode System.

    Science.gov (United States)

    Alharthi, Hana; Sultana, Nahid; Al-Amoudi, Amjaad; Basudan, Afrah

    2015-01-01

    Pharmacy barcode scanning is used to reduce errors during the medication dispensing process. However, this technology has rarely been used in hospital pharmacies in Saudi Arabia. This article describes the barriers to successful implementation of a barcode scanning system in Saudi Arabia. A literature review was conducted to identify the relevant critical success factors (CSFs) for a successful dispensing barcode system implementation. Twenty-eight pharmacists from a local hospital in Saudi Arabia were interviewed to obtain their perception of these CSFs. In this study, planning (process flow issues and training requirements), resistance (fear of change, communication issues, and negative perceptions about technology), and technology (software, hardware, and vendor support) were identified as the main barriers. The analytic hierarchy process (AHP), one of the most widely used tools for decision making in the presence of multiple criteria, was used to compare and rank these identified CSFs. The results of this study suggest that resistance barriers have a greater impact than planning and technology barriers. In particular, fear of change is the most critical factor, and training is the least critical factor.

  2. Barriers to the success of an electronic pharmacovigilance reporting system in Kenya: an evaluation three years post implementation.

    Science.gov (United States)

    Agoro, Oscar O; Kibira, Sarah W; Freeman, Jenny V; Fraser, Hamish S F

    2017-10-12

    Electronic pharmacovigilance reporting systems are being implemented in many developing countries in an effort to improve reporting rates. This study sought to establish the factors that acted as barriers to the success of an electronic pharmacovigilance reporting system in Kenya 3 years after its implementation. Factors that could act as barriers to using electronic reporting systems were identified in a review of literature and then used to develop a survey questionnaire that was administered to pharmacists working in government hospitals in 6 counties in Kenya. The survey was completed by 103 out of the 115 targeted pharmacists (89.5%) and included free-text comments. The key factors identified as barriers were: unavailable, unreliable, or expensive Internet access; challenges associated with a hybrid system of paper and electronic reporting tools; and system usability issues. Coordination challenges at the national pharmacovigilance center and changes in the structure of health management in the country also had an impact on the success of the electronic reporting system. Different personal, organizational, infrastructural, and reporting system factors affect the success of electronic reporting systems in different ways, depending on the context. Context-specific formative evaluations are useful in establishing the performance of electronic reporting systems to identify problems and ensure that they achieve the desired objectives. While several factors hindered the optimal use of the electronic pharmacovigilance reporting system in Kenya, all were considered modifiable. Effort should be directed toward tackling the identified issues in order to facilitate use and improve pharmacovigilance reporting rates.

  3. Histological analysis of cobalt-chromium stents with and without Camouflage® polymer coating: experimental porcine carotid artery model.

    Science.gov (United States)

    Grudtner, Marco Aurélio; de Lara Elesbão, Joao Luiz; Gutierrez, Paulo Sérgio; Meyer, Fabíola Schons; Pereira, Adamastor Humberto

    2011-04-01

    This study evaluated the arterial response to cobalt-chromium stents with and without polymer coating (Camouflage®, Hemoteq AG, Wuerselen, Germany) implanted in pigs. Cobalt-chromium balloon-expandable stents (4 × 16 mm) were implanted in the common carotid arteries of nine pigs. Histological analysis of endothelialization, inflammation and injury was performed one month later. All stents were successfully deployed, and all but one animal survived the 30 study days. All arteries were patent. Endothelialization was nearly complete in most sections of all carotid stents in both groups. There were mild inflammatory infiltrate and mild-to-moderate injury, which were associated with the stent shafts and not significantly different between groups. Our findings suggest that, in porcine carotid arteries, the histological response to balloon-expandable cobalt-chromium stents coated with polymer (Camouflage®, Hemoteq AG) is similar to the response to non-coated cobalt-chromium stents.

  4. Successful implementation of Virtual Environment for Radiotherapy Training (VERT) in Medical Physics education

    DEFF Research Database (Denmark)

    Jimenez, Yobelli A; Hansen, Christian Rønn; Juneja, Prabhjot

    2017-01-01

    This report outlines the University of Sydney's initial experience with the Virtual Environment for Radiotherapy Training (VERT) system in the Master of Medical Physics program. VERT is a commercially available system, simulating linear accelerators, patient computed tomography (CT) sets, plans...... and treatment delivery. It was purpose built for radiation therapy (RT) education and offers learners the opportunity to gain knowledge and skills within an interactive, risk-free environment. The integration of VERT into the RT physics module of the Master of Medical Physics program was intended to enhance...... student knowledge and skills relevant to the curriculum's learning objectives, and to alleviate some of the burden associated with student access to clinical equipment. Three VERT practical sessions were implemented: "RT treatment planning systems", "(CT) Anatomy for physicists" and "Linear accelerator...

  5. Case: A Second Victim Support Program in Pediatrics: Successes and Challenges to Implementation.

    Science.gov (United States)

    Dukhanin, Vadim; Edrees, Hanan H; Connors, Cheryl A; Kang, Eric; Norvell, Matt; Wu, Albert W

    2018-01-30

    While there is growing attention to making health care safer, there has been less emphasis on helping health care workers to cope with stressful patient related events (these workers are commonly referred to as second victims). We used the RISE (Resilience In Stressful Events) peer support program at the Johns Hopkins Hospital as a case study for evaluating effectiveness, and identifying barriers to addressing the needs of second victims. The study used a mixed-method approach that included: 1) quantitative analysis of surveys of health care workers in the Department of Pediatrics before RISE implementation and four years after, and 2) content analysis of open-ended commentaries about respondents' experience with seeking second victim support, as well as feedback on RISE. Survey response rates were 22.4% and 23.3% respectively. Quantitative analysis showed that respondents at the later time point were more likely to contact an organizational support structure, and had greater awareness of the availability of support. Respondents were very likely (93%) to recommend RISE to others. Content analysis identified barriers to using RISE: overcoming blame culture, need to promote the initiative, and need for more staff time to handle adverse events. Respondents reported varied preferences for the support format and specific support interventions. The mixed-method approach allowed a comprehensive evaluation of RISE and provided some evidence for its effectiveness in supporting pediatric health care workers. The findings suggest an important role of organizational culture in second victim support program implementation and evaluation. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. Late in-stent thrombosis following carotid angioplasty and stenting.

    Science.gov (United States)

    Buhk, Jan-Hendrik; Wellmer, Andreas; Knauth, Michael

    2006-05-23

    Acute in-stent thrombosis is a well-known complication of carotid angioplasty and stenting (CAS) and often due to resistance to or inadequate treatment with platelet-inhibiting agents. The authors report three cases of a delayed in-stent thrombosis after more than a week but less than 3 months after CAS. In all cases, the postprocedural antiplatelet regimen was discontinued to enable the treatment of a relevant comorbidity.

  7. Testing a systematic approach to identify and prioritise barriers to successful implementation of a complex healthcare intervention

    Directory of Open Access Journals (Sweden)

    Louise E. Craig

    2017-02-01

    Full Text Available Abstract Background Multiple barriers may inhibit the adoption of clinical interventions and impede successful implementation. Use of standardised methods to prioritise barriers to target when selecting implementation interventions is an understudied area of implementation research. The aim of this study was to describe a method to identify and prioritise barriers to the implementation of clinical practice elements which were used to inform the development of the T3 trial implementation intervention (Triage, Treatment [thrombolysis administration; monitoring and management of temperature, blood glucose levels, and swallowing difficulties] and Transfer of stroke patients from Emergency Departments [ED]. Methods A survey was developed based on a literature review and data from a complementary trial to identify the commonly reported barriers for the nine T3 clinical care elements. This was administered via a web-based questionnaire to a purposive sample of Australian multidisciplinary clinicians and managers in acute stroke care. The questionnaire addressed barriers to each of the nine T3 trial clinical care elements. Participants produced two ranked lists: on their perception of: firstly, how influential each barrier was in preventing clinicians from performing the clinical care element (influence attribute; and secondly how difficult the barrier was to overcome (difficulty attribute. The rankings for both influence and difficulty were combined to classify the barriers according to three categories (‘least desirable’, desirable’ or ‘most desirable’ to target to assist interpretation. Results All invited participants completed the survey; (n = 17; 35% medical, 35% nursing, 18% speech pathology, 12% bed managers. The barriers classified as most desirable to target and overcome were a ‘lack of protocols for the management of fever’ and ‘not enough blood glucose monitoring machines’. Conclusions A structured decision

  8. Factors associated with sustainability of 2 quality improvement programs after achieving early implementation success. A qualitative case study.

    Science.gov (United States)

    Ament, Stephanie M C; Gillissen, Freek; Moser, Albine; Maessen, José M C; Dirksen, Carmen D; von Meyenfeldt, Maarten F; van der Weijden, Trudy

    2017-12-01

    Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. The current study explored factors related to the sustainability of 2 multidisciplinary hospital-based programs 3 to 6 years after achieving early implementation success. An exploratory qualitative study was conducted into 2 implementation cases, an Enhanced Recovery After Surgery program for colorectal surgery and a short-stay program for breast cancer surgery. Semistructured interviews were held with key persons involved in the care process in 14 hospitals from both cases minimally 3 years after the implementation, between March 2012 and May 2013. The Consolidated Framework for Implementation Research was used to direct the development of the interview guide, during data collection and during analysis. A directed content analysis was performed. A total of 21 interviews with 26 individuals were held, 18 regarding the Enhanced Recovery After Surgery case and 8 regarding the short-stay program case. Respondents mentioned the following factors associated with sustainability of the programs: modification and adaptability of the program, cost-effectiveness, institutionalization into existing systems, short communication lines within the multidisciplinary team, an innovative culture, benefits for patients, cosmopolitanism, the existence of external policies and incentives, trust and belief in the program, and spread of the program to other settings. Two factors are not covered by the Consolidated Framework for Implementation Research, ie, modification of the program over the years and spread of the program to other contexts. The factors associated with sustainability put forward in both cases were largely the same. Leadership and the implementation project were not mentioned as having influenced the long-term sustainability of the benefits achieved. Sustainability of the innovations is influenced by determinants stemming from all ecological

  9. Primary angioplasty: Effect of deferred stenting on stent size.

    Science.gov (United States)

    Harbaoui, Brahim; Emsellem, Philippe; Cassar, Emmanuel; Besnard, Cyril; Dauphin, Raphael; Motreff, Pascal; Courand, Pierre-Yves; Lantelme, Pierre

    2017-04-01

    Primary angioplasty with immediate stenting (IS) is the gold standard for ST-segment elevation myocardial infarction (STEMI). Deferred stenting (DS) has been proposed to limit periprocedural complications, and may influence stent size because of thrombus and spasm alleviation. We sought to study the effect of DS on stent size. Over the study period, 258 patients underwent primary angioplasty for STEMI (DS, n=84; IS, n=174). An informative coronary angiogram run - i.e. allowing for proper lesion analysis - was selected and anonymized by an independent operator. Two experienced operators randomly analysed these runs, and proposed stent dimensions after having measured vessel diameter and lesion length by quantitative coronary analysis. The primary objective was the variation in stent size between the two coronary angiograms. The median delay between the two coronary angiograms was 2 days. Overall, the stent length was shorter (-1.64mm; P=0.030) and its diameter was larger (+0.13mm; P<0.001) during the second coronary angiogram, especially in the right coronary arteries. DS led to the implantation of a larger and shorter stent; this is probably because DS allows for more accurate assessment of the residual lesion after relief of spasm and thrombus, and may have clinical consequences in terms of stent thrombosis and restenosis. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

    Directory of Open Access Journals (Sweden)

    Elizabeth A. Martinez

    2011-01-01

    Full Text Available Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

  11. Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

    Science.gov (United States)

    Martinez, Elizabeth A.; Chavez-Valdez, Raul; Holt, Natalie F.; Grogan, Kelly L.; Khalifeh, Katherine W.; Slater, Tammy; Winner, Laura E.; Moyer, Jennifer; Lehmann, Christoph U.

    2011-01-01

    Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period. PMID:22091218

  12. Development and validation of an automated ventilator-associated event electronic surveillance system: A report of a successful implementation.

    Science.gov (United States)

    Hebert, Courtney; Flaherty, Jennifer; Smyer, Justin; Ding, Jing; Mangino, Julie E

    2017-11-10

    Surveillance is an important tool for infection control; however, this task can often be time-consuming and take away from infection prevention activities. With the increasing availability of comprehensive electronic health records, there is an opportunity to automate these surveillance activities. The objective of this article is to describe the implementation of an electronic algorithm for ventilator-associated events (VAEs) at a large academic medical center METHODS: This article reports on a 6-month manual validation of a dashboard for VAEs. We developed a computerized algorithm for automatically detecting VAEs and compared the output of this algorithm to the traditional, manual method of VAE surveillance. Manual surveillance by the infection preventionists identified 13 possible and 11 probable ventilator-associated pneumonias (VAPs), and the VAE dashboard identified 16 possible and 13 probable VAPs. The dashboard had 100% sensitivity and 100% accuracy when compared with manual surveillance for possible and probable VAP. We report on the successfully implemented VAE dashboard. Workflow of the infection preventionists was simplified after implementation of the dashboard with subjective time-savings reported. Implementing a computerized dashboard for VAE surveillance at a medical center with a comprehensive electronic health record is feasible; however, this required significant initial and ongoing work on the part of data analysts and infection preventionists. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Improving Emergency Department radiology transportation time: a successful implementation of lean methodology.

    Science.gov (United States)

    Hitti, Eveline A; El-Eid, Ghada R; Tamim, Hani; Saleh, Rana; Saliba, Miriam; Naffaa, Lena

    2017-09-05

    Emergency Department overcrowding has become a global problem and a growing safety and quality concern. Radiology and laboratory turnaround time, ED boarding and increased ED visits are some of the factors that contribute to ED overcrowding. Lean methods have been used in the ED to address multiple flow challenges from improving door-to-doctor time to reducing length of stay. The objective of this study is to determine the effectiveness of using Lean management methods on improving Emergency Department transportation times for plain radiography. We performed a before and after study at an academic urban Emergency Department with 49,000 annual visits after implementing a Lean driven intervention. The primary outcome was mean radiology transportation turnaround time (TAT). Secondary outcomes included overall study turnaround time from order processing to preliminary report time as well as ED length of stay. All ED patients undergoing plain radiography 6 months pre-intervention were compared to all ED patients undergoing plain radiography 6 months post-intervention after a 1 month washout period. Post intervention there was a statistically significant decrease in the mean transportation TAT (mean ± SD: 9.87 min ± 15.05 versus 22.89 min ± 22.05, respectively, p-value improving process reliability.

  14. Successes and Challenges in Implementation of Radon Control Activities in Iowa, 2010-2015.

    Science.gov (United States)

    Bain, Allison A; Abbott, Anne L; Miller, Laura L

    2016-04-14

    Radon gas has recently become more prominent in discussions of lung cancer prevention nationally and in Iowa. A review in 2013 of cancer plans in the National Comprehensive Cancer Control Program found that 42% of cancer plans, including Iowa's, had terminology on radon. Plans included awareness activities, home testing, remediation, policy, and policy evaluation. Iowa has the highest average radon concentrations in the United States; 70% of homes have radon concentrations above the Environmental Protection Agency's action levels. Radon control activities in Iowa are led by the Iowa Cancer Consortium, the Iowa Department of Public Health, and the Iowa Radon Coalition. A collaborative approach was used to increase levels of awareness, testing, and (if necessary) mitigation, and to introduce a comprehensive radon control policy in Iowa by engaging partners and stakeholders across the state. The multipronged approach and collaborative work in Iowa appears to have been successful in increasing awareness: the number of radon tests completed in Iowa increased by 20% from 19,600 in 2009 to 23,500 in 2014, and the number of mitigations completed by certified mitigators increased by 108% from 2,600 to more than 5,400. Through collaboration, Iowa communities are engaged in activities that led to increases in awareness, testing, mitigation, and policy. States interested in establishing a similar program should consider a multipronged approach involving multiple entities and stakeholders with different interests and abilities. Improvements in data collection and analysis are necessary to assess impact.

  15. [The world is free of pox - Implementation and success of a grandiose program].

    Science.gov (United States)

    Dittmann, S

    1980-12-15

    At the beginning of this century the compulsory vaccination and revaccination which was legally founded after the introduction of the vaccination by Jenner (1796) led to the removal of the smallpox in Europe and Northern America. However, up to the sixties in the developing countries of Asia, Africa as well as of Southern America and Middle America still fell ill and died of small-pox millions of people. Between 1953 and 1973 importations into countries of Europe and Northern America took place in 51 cases. In 1959 on the motion of the USSR the WHO decided performance of a world-wide eradication programme of small-pox which could be led to success with comprehensive personal, material and financial support of many countries. Flanking scientific, technological and methodical measures were of essential importance. In May 1980 the World Health Assembly in Geneva announced in solemn form the world-wide eradication of the small-pox and gave recommendations to the member countries for concluding measures concerning the small-pox vaccination, the foundation of vaccine reserves and the control of the epidemiological situation in the world. Also in the GDR the small-pox vaccination in childhood could be abolished.

  16. Successful implementation of a guideline program for the rational use of lipid-lowering drugs.

    Science.gov (United States)

    Stuart, M E; Handley, M A; Chamberlain, M A; Wallach, R W; Penna, P M; Stergachis, A

    1991-01-01

    Following the National Cholesterol Educational Program's (NCEP) 1988 screening and treatment recommendations, an educational and behavior-change program at Group Health Cooperative of Puget Sound (GHC) was developed to guide the use of lipid-lowering drugs within the larger context of cardiac risk reduction. The program has been successful in advancing a rational program to enhance care and manage costs of the use of lipid-lowering agents at GHC. Cost savings have been significant over the past two years. The educational design of the program includes training and ongoing education of a core group of "lipid gurus," who educate colleagues in area medical centers in a rational approach to hyperlipidemia. Patient education and patient participation in decision-making was emphasized. Program evaluation has demonstrated that physicians and patients are satisfied with the program, and inappropriate drug expenditures have been prevented. Key elements of the program include a critical review of outcome studies in the medical literature, use of information systems, algorithms and written materials organized into a well-designed, ongoing educational program, and development of a core group of physicians and pharmacists to administer the program at the clinic level.

  17. Posttuberculosis tracheobronchial stenosis: use of CT to optimize the time of silicone stent removal.

    Science.gov (United States)

    Verma, Akash; Park, Hye Yun; Lim, So Yeon; Um, Sang-Won; Koh, Won-Jung; Suh, Gee Young; Chung, Man Pyo; Kwon, O Jung; Kim, Hojoong

    2012-05-01

    To evaluate whether air pockets (tracheobronchial air columns in the space between the outer surface of the stent and the adjacent airway wall) discernible at computed tomography (CT) can help optimize the time of stent removal in patients with posttuberculosis tracheobronchial stenosis (PTTS). The study was approved by the institutional review board, and informed consent was obtained from all patients. Data from 41 patients (five men, 36 women) with a median age of 39 years (range, 21-64 years) who underwent silicone stent placement owing to PTTS, followed by CT and stent removal 6-12 months after clinical stabilization, were investigated retrospectively. Two radiologists determined whether the extent of air pockets on CT scans was associated with clinical success, which was defined as maintenance of a prosthesis-free airway for more than 2 years after stent removal. Radiologic features were compared for outcome by using a Wilcoxon two-sample test or Fisher exact test. Stents were removed successfully in 31 patients (76%). Air pockets longer than 1 cm or longer than 2 cm were associated with successful stent removal (P = .04 and P = .006, respectively). The sensitivity and specificity of air pocket length in the prediction of successful stent removal were 84% and 50%, respectively, for air pockets longer than 1 cm and 68% and 70% for air pockets longer than 2 cm. The extent of air pockets at chest CT shows correlation with the success of stent removal, indicates regression of stenosis, and may help guide the optimal time for stent removal.

  18. Implementation of a human papillomavirus vaccination demonstration project in Malawi: successes and challenges.

    Science.gov (United States)

    Msyamboza, Kelias Phiri; Mwagomba, Beatrice Matanje; Valle, Moussa; Chiumia, Hastings; Phiri, Twambilire

    2017-06-26

    Cervical cancer is a major public health problem in Malawi. The age-standardized incidence and mortality rates are estimated to be 75.9 and 49.8 per 100,000 population, respectively. The availability of the human papillomavirus (HPV) vaccine presents an opportunity to reduce the morbidity and mortality associated with cervical cancer. In 2013, the country introduced a school-class-based HPV vaccination pilot project in two districts. The aim of this study was to evaluate HPV vaccine coverage, lessons learnt and challenges identified during the first three years of implementation. This was an evaluation of the HPV vaccination project targeting adolescent girls aged 9-13 years conducted in Malawi from 2013 to 2016. We analysed programme data, supportive supervision reports and minutes of National HPV Task Force meetings to determine HPV vaccine coverage, reasons for partial or no vaccination and challenges. Administrative coverage was validated using a community-based coverage survey. A total of 26,766 in-school adolescent girls were fully vaccinated in the two pilot districts during the first three years of the programme. Of these; 2051 (7.7%) were under the age of 9 years, 884 (3.3%) were over the age of 13 years, and 23,831 (89.0%) were aged 9-13 years (the recommended age group). Of the 765 out-of-school adolescent girls aged 9-13 who were identified during the period, only 403 (52.7%) were fully vaccinated. In Zomba district, the coverage rates of fully vaccinated were 84.7%, 87.6% and 83.3% in year 1, year 2 and year 3 of the project, respectively. The overall coverage for the first three years was 82.7%, and the dropout rate was 7.7%. In Rumphi district, the rates of fully vaccinated coverage were 90.2% and 96.2% in year 1 and year 2, respectively, while the overall coverage was 91.3%, and the dropout rate was 4.9%. Administrative (facility-based) coverage for the first year was validated using a community-based cluster coverage survey. The majority of the

  19. The IGSN Experience: Successes and Challenges of Implementing Persistent Identifiers for Samples

    Science.gov (United States)

    Lehnert, Kerstin; Arko, Robert

    2016-04-01

    Physical samples collected and studied in the Earth sciences represent both a research resource and a research product in the Earth Sciences. As such they need to be properly managed, curated, documented, and cited to ensure re-usability and utility for future science, reproducibility of the data generated by their study, and credit for funding agencies and researchers who invested substantial resources and intellectual effort into their collection and curation. Use of persistent and unique identifiers and deposition of metadata in a persistent registry are therefore as important for physical samples as they are for digital data. The International Geo Sample Number (IGSN) is a persistent, globally unique identifier. Its adoption by individual investigators, repository curators, publishers, and data managers is rapidly growing world-wide. This presentation will provide an analysis of the development and implementation path of the IGSN and relevant insights and experiences gained along its way. Development of the IGSN started in 2004 as part of a US NSF-funded project to establish a registry for sample metadata, the System for Earth Sample Registration (SESAR). The initial system provided a centralized solution for users to submit information about their samples and obtain IGSNs and bar codes. Challenges encountered during this initial phase related to defining the scope of the registry, granularity of registered objects, responsibilities of relevant actors, and workflows, and designing the registry's metadata schema, its user interfaces, and the identifier itself, including its syntax. The most challenging task though was to make the IGSN an integral part of personal and institutional sample management, digital management of sample-based data, and data publication on a global scale. Besides convincing individual researchers, curators, editors and publishers, as well as data managers in US and non-US academia, state and federal agencies, the PIs of the SESAR project

  20. Assessing the Challenges in Successful Implementation and Adoption of Crop Insurance in Thailand

    Directory of Open Access Journals (Sweden)

    Shweta Sinha

    2016-12-01

    Full Text Available The purpose of this paper is to assess the gaps in the adoption of crop insurance in Thailand and suggest possible solutions relating to policy support and framework, implementation mechanisms, technology adoption, and awareness amongst farmers. The methodology includes a literature review, interaction with officials, rice experts and insurance experts, and discussion with farmers. A study was undertaken at province level to assess the impact of using rainfall index as a threshold. Additionally, focused group discussions (FGD were conducted with rice farmers at the village level. Key issues targeted in the FGD were to understand the behavior and practices during droughts, impact of drought on crop yield, methods already in use to reduce the impact, such as plantation of drought-resistant rice, and the adoption of crop insurance. Data availability is a challenge and has led to withdrawal of Weather Index Insurance (WII in 2015. WII have threshold levels based on historical rainfall. Adoption of coping mechanisms, such as drought-resistant rice and irrigation increases the chances of adverse selection. In absence of ground based weather data, a combination of satellite agriculture drought information can be used to make crop insurance more attractive as it would help in reducing basis risk and improving insurers and farmers’ confidence in the product. Discussion with farmers, insurance companies, and the Bank of Agriculture and Agricultural Cooperatives (BAAC in Thailand suggested low awareness among farmers about the potential benefits of weather index insurance products. Relatively low compensation is also an obstacle. Proper marketing and awareness raising campaigns should also accompany the introduction of index-based insurance products.

  1. Safety and efficacy of cobalt chromium alloy based sirolimus-eluting stent with bioabsorbable polymer in porcine model.

    Science.gov (United States)

    Wu, Yi-zhe; Shen, Li; Wang, Qi-bing; Hu, Xi; Xie, Jian; Qian, Ju-ying; Ge, Jun-bo

    2012-03-01

    First generation drug-eluting stents (DESs) were based on 316L stainless steel and coated with a permanent polymer. The vessel wall of these DESs was inflammatory and late in-stent thrombosis was reported. Hence, cobalt chromium based DES coated with a bioabsorbable polymer was an alternate choice. Cobalt chromium based DES with bioabsorbable polymer (Simrex stent) as well as control stents (Polymer stent and EXCEL(TM) stent) were implanted into porcine arteries. At a designated time, angiography, quantitative coronary angiography (QCA) analysis, histomorphometry, and electron-microscopical follow-up were performed. A total of 98 stents of all the three groups were harvested. At week 24, percent diameter stenosis (%DS), late loss (LL), and percent area stenosis (%AS) of Simrex was (12.9 ± 0.4)%, (0.35 ± 0.02) mm, and (24.5 ± 4.2)%, respectively, without significant difference in comparison to commercialized EXCEL(TM) stent. Slight inflammatory reaction was seen around the stent strut of Simrex, just as in the other two groups. Electron-microscopical follow-up suggested that it might take 4 - 12 weeks for Simrex to complete its re-endothelialization process. Cobalt chromium based, bioabsorbable polymer coated sirolimus-eluting stent showed excellent biocompatibility. During 24 weeks observation in porcine model, it was proved that this novel DES system successfully inhibited neointima hyperplasia and decreased in-stent stenosis. It is feasible to launch a clinical evaluation to improve the current prognosis of DES implantation.

  2. Delayed colonic perforation following stent placement for colorectal obstruction: a description of two cases with stent palliation.

    Directory of Open Access Journals (Sweden)

    Jalal Vahedian Ardakani

    2013-10-01

    Full Text Available Bowel stent insertion has a variety of complications one major of which is colonic perforation. The purpose of this article is to reveal two cases with delayed colonic perforation after stent placement to relieve bowel obstruction caused by rectal cancer. The first patient was a 55 year-old man who was a candidate for stent placement to avoid palliative surgery and relieve his bowel obstruction. Although the procedure resulted in complete relief of patient symptoms, but he returned with signs of peritonitis 10 days after the stent placement. A perforation was found at rectosigmoid junction on laparotomy. The second patient was a 60 year-old man who underwent a successful stent placement and returned 3 months later with a complaint of abdominal pain that showed up to be due to a rectal perforation on investigations. In conclusion, bowel perforation following stent placement can be a major complication, so close follow-up is necessary to detect it as soon as possible and prevent it from becoming an irreparable complication.

  3. Implementing specificity of HPV-DNA primary screening in a successful organised cervical cancer prevention programme.

    Science.gov (United States)

    Zappacosta, Roberta; Caraceni, Donatella; Ciccocioppo, Lucia; Rotondo, Tiziana; Capanna, Serena; Gatta, Daniela Maria Pia; D'Angelo, Chiara; Rosini, Sandra

    2013-03-01

    This two-arm longitudinal study was performed within a regional organized cervical-cancer-prevention program in which HPV-DNA test is used in primary screening. The aim was to analyze the diagnostic performances of p16INK4a/Ki-67 dual-test and E6/E7-mRNA test in identifying CIN2+ lesion among HPV-DNA positive (HPV-DNAve) women triaged for LSIL-or-worse liquid based cytology (LBC). Thirty-six thousand thirty-one women participated to HPV-DNA screening program pilot study. Three thousand six hundred forty-one resulted HPV-DNAve; among these, 43% were LSIL-or-worse (LSIL+). HPV-DNAve/LSIL+ patients were submitted to colposcopy and histological assessment of any visible lesions. Dual-test was performed on 794 residual LBC specimens. In 405 cases, dual-test result was related to histology, considering CIN2+ as endpoint. mRNA test has been carried out retrospectively, on a subset of 173 residual LBC specimens. Agreement between dual-test and histological diagnosis was 59%. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cytology-plus-dual-test approach were 62.3%, 76.8%, 63.1% and 84.2%, respectively. Dual-test improved specificity, PPV and NPV of cytological triage Agreement between mRNA testing and histology was 65%. Cytology-plus mRNA testing showing sensitivity, specificity, PPV and NPV reaching 32.1%, 94.9%, 75% and 50%, respectively; implemented specificity and PPV of cytology alone in triaging DNA-ve/LSIL+ patients (p<0.01). We provided promising data indicating the important role that p16(INK4)/Ki-67 dual-test, and mostly E6/E7 mRNA test, might have in triaging HPV-DNAve. These approaches would exclude the occurrence of cervical cancer and would avoid overtreatment, at the same time. Further longitudinal analysis has to be considered. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Aytekin, Cueneyt E-mail: cuneytaytekin@hotmail.com; Boyvat, Fatih; Yagmurdur, Mahmut Can; Moray, Goekhan; Haberal, Mehmet

    2004-01-01

    Objective: To evaluate the efficacy of stent placement for treating upper extremity central venous obstruction in chronic hemodialysis patients. Methods and Material: Between January 1999 and October 2001, we inserted metallic stents into the upper extremity central veins of 14 patients with shunt dysfunction and/or arm swelling. The indications for stent placement were stenosis or occlusion of the central vein in the upper extremity used for dialysis. Six of the individuals were diagnosed with subclavian vein stenosis, and 5 with brachiocephalic vein stenosis. Of the remaining 3 patients, 2 had subclavian vein occlusion, and 1 had left brachiocephalic vein occlusion. Results: All the stent placement procedures were technically successful, and there were no major complications. Follow-up ranged from 2 weeks to 29 months. The 1-, 3-, 6- and 12-month primary stent patency rates were 92.8, 85.7, 50 and 14.3%, respectively. Repeat interventions, including percutaneous transluminal angioplasty and additional stent placement, were required in 9 patients. The 3-, 6-, 12-month, and 2-year assisted primary stent patency rates were 100, 88.8, 55.5 and 33.3%, respectively. Conclusion: Endovascular stent placement is an effective alternative to surgery in patients with shunt dysfunction due to obstruction of an upper extremity central vein. Repeated interventions are usually required to prolong stent patency.

  5. Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

    Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Raab, Udo, E-mail: udo.raab@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Lazarus, Friedrich, E-mail: friedrich.lazarus@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Nephrology (Germany); Ruppert, Volker, E-mail: volker.ruppert@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk, E-mail: dierk.vorwerk@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)

    2015-08-15

    PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft was the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

  6. Percutaneous transcholecystic approach for an experiment of biliary stent placement: an experimental study in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Tae Seok [Medical School of Gachon, Inchon (Korea, Republic of); Song, Ho Young; Lim, Jin Oh; Ko, Gi Young; Sung, Kyu Bo; Kim, Tae Hyung; Lee, Ho Jung [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-06-01

    To determine, in an experimental study of biliary stent placement, the usefulness and safety of the percutaneous transcholecystic approach and the patency of a newly designed biliary stent. A stent made of 0.15-mm-thick nitinol wire, and 10 mm in diameter and 2 cm in length, was loaded in an introducer with an 8-F outer diameter. The gallbladders of seven mongrel dogs were punctured with a 16-G angiocath needle under sonographic guidance, and cholangiography was performed. After anchoring the anterior wall of the gallbladder to the abdominal wall using a T-fastener, the gallbladder body was punctured again under fluoroscopic guidance. The cystic and common bile ducts were selected using a 0.035-inch guide wire and a cobra catheter, and the stent was placed in the common bile duct. Post-stenting cholangiography was undertaken, and an 8.5-F drainage tube was inserted in the gallbladder. Two dogs were followed-up and sacrificed at 2,4 and 8 weeks after stent placement, respectively, and the other expired 2 days after stent placement. Follow-up cholangiograms were obtained before aninmal was sacrified, and a pathologic examination was performed. Stent placement was technically successful in all cases. One dog expired 2 days after placement because of bile peritonitis due to migration of the drainage tube into the peritoneal cavity, but the other six remained healthy during the follow-up period. Cholangiography performed before the sacrifice of each dog showed that the stents were patent. Pathologic examination revealed the proliferation of granulation tissue at 2 weeks, and complete endothelialization over the stents by granulation tissue at 8 weeks. Percutaneous transcholecystic biliary stent placement appears to be safe, easy and useful. After placement, the stent was patent during the follow-period.

  7. Assessing DOE`s success in implementing the FFC Act: A federal and state partnership to develop treatment plans

    Energy Technology Data Exchange (ETDEWEB)

    Letourneau, M.J.; Bubar, P.M. [Dept. of Energy, Germantown, MD (United States)

    1995-12-31

    Implementation of the Federal Facility Compliance Act (FFCAct) required total cooperation among the Department of Energy (DOE), the involved States and interested stakeholders. Although the effort was time consuming, tedious and (at times) trying, the results obtained [Site Treatment Plans (STP)] were an unprecedented success. Through long-range planning, attention to details and organization of effort, a coordinated, cohesive, focused team was developed that included the DOE Headquarters, the Environmental Protection Agency (EPA), 40 DOE sites, 20 states and multiple interested stakeholders. The efforts of the FFCAct team resulted in the preparation of 37 STPs which outline the methods, locations and schedules for the treatment and disposal of DOE`s mixed wastes. The Plans provided a strong foundation upon which consent orders were prepared and approved. The FFCAct approach also resulted in the development of working relationships that will prove not only useful but vital to the planning and implementation necessary to the successful clean-up and disposal DOE`s mixed wastes.

  8. Trials at Sea: Successful Implementation of a Unique Two-Month Professional Development Program

    Science.gov (United States)

    Peart, L. W.; Orcutt, B. N.; Fisher, A. T.; Tsuji, T.; Petronotis, K. E.; Iodp Expedition 327 Participants

    2010-12-01

    During the summer of 2010, Integrated Ocean Drilling Program (IODP) Expedition 327 conducted coring and observatory installations on the Juan de Fuca Plate to characterize the hydrogeology of ridge-flank ocean crust. Due to the nature of the expedition, a smaller science party than usual was needed. IODP took this opportunity to expand education, outreach, and communication (EOC) activities with a previously untested model. Up to now, the IODP U.S. Implementing Organization had sailed either individual teachers on regular (2-month long) expeditions or groups of teachers and informal educators during short (2-week long) transits (School of Rock workshops). After two shipboard (Expeditions 312 and 321T) and two shore-based (Gulf Coast Repository) programs, we have recognized that sailing a group of educators is a beneficial model for IODP and the participants. What has been unavoidable is that these workshops took place outside typical expedition activities. Expedition 327 provided a unique opportunity to sail a diverse group of outreach officers on a regular expedition with a full range of scientific activities. The group included individuals with a wide variety of skills and backgrounds. US participants included a late-career high school physics teacher, a visualization graduate student, an undergraduate engineering student from an historically black university, and an artist. French participants included two middle and high school earth and life science teachers. This diversity made the group more dynamic but it also posed a challenge. Numerous scientific and technical staff also participated in EOC activity design and leadership, including development of dedicated web sites and blogs. After a seminar on constructivist and inquiry-based methods, we spent the first few weeks investigating earth science concepts so EOC participants could gain a basic understanding of the regional geology and the scientific objectives of the expedition. Close to the beginning of the

  9. Covered self-expandable metallic stent placement for a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Woon Ha; Jung, Gyoo Sik; Kim, Kyu Jong; Lee, Sang Ho [Gospel Hospital, College of Medicine, Kosin University, Busan (Korea, Republic of); Ko, Ji Ho [Masan Samsung Medical Center, Sungkyunkwan University School of University, Masan (Korea, Republic of); Jeong, Kyung Soon [University of Ulsan Colleg of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2007-09-15

    To evaluate the technical feasibility and clinical effectiveness of stent placement for the treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer. Under fluoroscopic guidance, one or two covered stents were placed in 20 consecutive patients (age range, 44-75 years) with an anastomotic stricture due to a recurrent gastric malignancy. Before stent placement, all patients had severe nausea and recurrent vomiting after ingestion. Stent placement was technically successful for all patients, and no procedural complications occurred. After stent placement, 18 of 20 (90.0%) patients were able to ingest at least a liquid diet and had a markedly decreased incidence of vomiting. During the follow-up of 2-116 weeks (mean, 25.5 weeks), stent migration occurred in two patients (10.0%) on one day after the procedure. All patients with stent migration were treated successfully by means of placing a second stent. Three patients showed a recurrence of the stricture due to tumor overgrowth; two of the patients were treated with coaxial placement of a second stent. Another patient refused additional management. Covered self-expandable metallic stent placement seems to be technically feasible and effective for palliative treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer.

  10. [Stent implantation for relief of pulmonary artery branch stenosis].

    Science.gov (United States)

    Guo, Ying; Yu, Zhiqing; Liu, Tingliang; Gao, Wei; Huang, Meirong; Li, Fen; Fu, Lijun; Zhao, Pengjun

    2014-05-01

    Branch pulmonary artery stenosis is one of the common congenital heart disease. Stent implantation to relieve branch pulmonary artery stenosis (BPAS) is an alternative to failed surgical or balloon angioplasty. The aim of this study was to explore the indication, methods and complications of using balloon expandable stent placement to treat branch pulmonary artery stenosis, and evaluate the results of stent implantation in the treatment of branch pulmonary artery stenosis. From August 2005 to December 2012, 19 patients underwent an attempt at stent implantation. The median age of those patients was 9.1 years (range 4.0-15.0 years). The median weight was 31.7 kg (range 17.0-60.5 kg); 14/19 patients underwent post surgical repair of tetralogy of Fallot, one patient received post surgical repair of pulmonary atresia with ventricular septal defect, one patient underwent post surgical repair of pulmonary atresia with intact septum, one with native left BPAS, and one was after surgical repair of aortopulmonary window and the other truncus arteriosus. CP stent and NuMED Balloon-in-Balloon catheter were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the inner balloon and outer balloon was inflated successively to expand the stent to desired diameter. Statistical analysis was performed with the unpaired Student t test. A total of 26 stents were implanted successfully in 19 patients. The systolic gradient across the stenosis fell from a median of (36.0 ± 18.3) to (3.8 ± 3.4) mmHg (P aortic pressure ratio fell from 0.68 to 0.49 (P children will require further dilation to keep up with normal somatic growth. Intermediate and long-term follow up studies have shown excellent results after further dilation over time.

  11. Development and implementation of an emergency medicine graduate training program at Addis Ababa University School of Medicine: challenges and successes.

    Science.gov (United States)

    Teklu, Sisay; Azazh, Aklilu; Seyoum, Nebyou; Woldetsadik, Assefu; Tupesis, Janis P; Wubben, Ryan; Hunchak, Cheryl; Meshkat, Nazanin; Tefera, Girma; Maskalyk, James

    2014-07-01

    Ethiopians experience high rates of acute illness and injury that have been sub-optimally addressed by the existing health care system. High rates of patient morbidity and mortality prompted the Federal Ministry of Health (FMOH) and the Addis Ababa University School of Medicine (AAU-SM) to prioritize the establishment of emergency medicine (EM) as a medical specialty in Ethiopia to meet this acute health system need. To review the EM residency training program developed and implemented at AAU-SM in partnership with the University of Wisconsin (UW), the University of Toronto (UT) and University of Cape Town (UCT) and to evaluate the progress and challenges to date. An EM Task Force (EMTF) at AAU-SM developed a context-specific three-year graduate EM curriculum with UW input. This curriculum has been co-implemented by faculty teachers from AAU-SM, UT and UW. The curriculum together with all documents (written, audio, video) are reviewed and used as a resource for this article. Seventeen residents are currently in full-time training. Five residents research projects are finalized and 100% of residents passed their year-end exams. A novel graduate EM training program has been successfully developed and implemented at AAU-SM. Interim results suggest that this curriculum and tri-institutional collaboration has been successful in addressing the emergency health needs of Ethiopians and bolstering the expertise of Ethiopian physicians. This program, at the forefront of EM education in Africa, may serve as an effective model for future EM training development throughout Africa.

  12. The Prediction of Successful Probability of CSR and Sustainable Development Strategy Implementation within "Rosia Montana Project" using Fuzzy Logic

    Directory of Open Access Journals (Sweden)

    Lucian SIRB

    2013-01-01

    Full Text Available This article aims to develop a methodology to forecast the probability of success regarding to the implementation of the concept of corporate social responsibility (CSR and of the strategy of sustainable development in a mining company of exploitation of mineral resources. It is well known that in the modern period we are witnessing ever more to increased demands in terms of corporate responsibility towards the environment, in the area which can include economic, social, cultural and ecological environment. As a consequence of this fact, it increases the uncertainty of decisions to be adopted by companies, uncertainty that may arise from several aspects such as incompleteness, inconsistencies or inaccuracies in information or simply due to the subjective nature of human reasoning which often is expressed in words, through linguistic values. Thus, for modeling this vagueness of decision or prediction process there is a particularly effective tool, represented by the fuzzy logic through triangular fuzzy numbers. By multiplying the importance weight of factors that influencing the adoption of CSR and sustainable development policy with values resulting from evaluation of the possibility of successful implementation of this policy with respect to each factor, there it results a probability that suggests us if the action of implementation of CSR and of sustainable development strategy will have the overall expected effect and in the case the result is not properly there it will require remedial measures. The proposed methodology is applied in a case study concerning the Romanian mining company Rosia Montana Gold Corporation (RMGC from Rosia Montana, Romania and also concerning the community in which it operates.

  13. Carotid stenting and endarterectomy.

    Science.gov (United States)

    Yip, Hon-Kan; Sung, Pei-Hsun; Wu, Chiung-Jen; Yu, Cheuk-Man

    2016-07-01

    Stroke, either ischemic or hemorrhagic, remains the second commonest cause of death worldwide in the last decade. Etiologies for ischemic stroke (IS) vary widely. Atherothrombotic occlusion is an essential cause to which carotid artery stenosis (CAS) is a major contributor. Administration of anti-platelet agent to patients with CAS has been shown to reduce incidence of long-term IS. In additional, in patients with symptomatic CAS, clinical trials have demonstrated that carotid endarterectomy (CEA) is superior to medical therapy for prevention of future CAS-related IS. However, CEA is not suitable for CAS post-radiotherapy or those located at higher level of the internal carotid artery; and major complications of this procedure including cranial nerve injuries have stimulated the interest of using percutaneous transfemoral carotid stenting as an alternative approach. Although transfemoral arterial approach of carotid stenting is not inferior to CEA in improving clinical outcomes, it has been reported to be associated with vascular complication and has its limitations in patients with athero-occlusive disease of abdominal aorta or bilateral iliac arteries, level II or III aortic arch, or bovine type carotid arterial anatomy. Therefore, transradial/transbrachial arterial approach has emerged as a novel method for carotid stenting. This article provides a critical review on interventional approaches for the treatment of CAS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Hemodynamics in Idealized Stented Coronary Arteries: Important Stent Design Considerations.

    Science.gov (United States)

    Beier, Susann; Ormiston, John; Webster, Mark; Cater, John; Norris, Stuart; Medrano-Gracia, Pau; Young, Alistair; Cowan, Brett

    2016-02-01

    Stent induced hemodynamic changes in the coronary arteries are associated with higher risk of adverse clinical outcome. The purpose of this study was to evaluate the impact of stent design on wall shear stress (WSS), time average WSS, and WSS gradient (WSSG), in idealized stent geometries using computational fluid dynamics. Strut spacing, thickness, luminal protrusion, and malapposition were systematically investigated and a comparison made between two commercially available stents (Omega and Biomatrix). Narrower strut spacing led to larger areas of adverse low WSS and high WSSG but these effects were mitigated when strut size was reduced, particularly for WSSG. Local hemodynamics worsened with luminal protrusion of the stent and with stent malapposition, adverse high WSS and WSSG were identified around peak flow and throughout the cardiac cycle respectively. For the Biomatrix stent, the adverse effect of thicker struts was mitigated by greater strut spacing, radial cell offset and flow-aligned struts. In conclusion, adverse hemodynamic effects of specific design features (such as strut size and narrow spacing) can be mitigated when combined with other hemodynamically beneficial design features but increased luminal protrusion can worsen the stent's hemodynamic profile significantly.

  15. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management.

    Science.gov (United States)

    Blackmon, Shanda H; Santora, Rachel; Schwarz, Peter; Barroso, Alberto; Dunkin, Brian J

    2010-03-01

    Esophageal or gastric leakage from anastomotic wound dehiscence, perforation, staple line dehiscence, or trauma can be a devastating event. Traditional therapy has often consisted of either surgical repair for rapidly diagnosed leaks or diversion for more complicated cases, commonly associated with a delayed diagnosis. This study summarizes our experience treating leaks or fistulas with novel, covered self-expanding metal stents (cSEMS). The primary objective of this study was to determine the efficacy and safety of covered self-expanding metal stents when used to treat complicated leaks and fistulas. Over 15 months, 25 patients with esophageal or gastric leaks were evaluated for stenting as primary treatment. A prospective database was used to collect data. Stents were placed endoscopically, with contrast evaluation used for leak evaluation. Patients who did not improve clinically after stenting or whose leak could not be sealed underwent operative management. During a mean follow-up of 15 months, 23 of the 25 patients with esophageal or gastric leaks during a 15-month period were managed with endoscopic stenting as primary treatment. Healing occurred in patients who were stented for anastomotic leakage after gastric bypass or sleeve gastrectomy (n = 10). One patient with three esophageal iatrogenic perforations healed with stenting. Eight patients successfully avoided esophageal diversion and healed with stenting and adjunctive therapy. Two of the 4 patients with tracheoesophageal fistulas sealed with the assistance of a new pexy technique to prevent stent migration; 1 additional patient had this same technique used to successfully heal an upper esophageal perforation. Esophageal leaks and fistulas can be effectively managed with cSEMS as a primary modality. The potential benefits of esophageal stenting are healing without diversion or reconstruction and early return to an oral diet. 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

  16. Success rate evaluation of clinical governance implementation in teaching hospitals in Kerman (Iran) based on nine steps of Karsh's model.

    Science.gov (United States)

    Vali, Leila; Mastaneh, Zahra; Mouseli, Ali; Kardanmoghadam, Vida; Kamali, Sodabeh

    2017-07-01

    One of the ways to improve the quality of services in the health system is through clinical governance. This method aims to create a framework for clinical services providers to be accountable in return for continuing improvement of quality and maintaining standards of services. To evaluate the success rate of clinical governance implementation in Kerman teaching hospitals based on 9 steps of Karsh's Model. This cross-sectional study was conducted in 2015 on 94 people including chief executive officers (CEOs), nursing managers, clinical governance managers and experts, head nurses and nurses. The required data were collected through a researcher-made questionnaire containing 38 questions with three-point Likert Scale (good, moderate, and weak). The Karsh's Model consists of nine steps including top management commitment to change, accountability for change, creating a structured approach for change, training, pilot implementation, communication, feedback, simulation, and end-user participation. Data analysis using descriptive statistics and Mann-Whitney-Wilcoxon test was done by SPSS software version 16. About 81.9 % of respondents were female and 74.5 have a Bachelor of Nursing (BN) degree. In general, the status of clinical governance implementation in studied hospitals based on 9 steps of the model was 44 % (moderate). A significant relationship was observed among accountability and organizational position (p=0.0012) and field of study (p=0.000). Also, there were significant relationships between structure-based approach and organizational position (p=0.007), communication and demographic characteristics (p=0.000), and end-user participation with organizational position (p=0.03). Clinical governance should be implemented by correct needs assessment and participation of all stakeholders, to ensure its enforcement in practice, and to enhance the quality of services.

  17. Percutaneous placement of self-expandable metallic stents in patients with obstructive janudice secondary to metastalic gastric cancer after gastrectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Seo, In Ho; Yu, Jung Rim; Mok, Young Jae; Oh, Joo Hyeong [Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kwon, Se Hwan [Dept. of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Kim, Sam Soo [Dept. of Radiology, Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Kim, Seung Kwon [Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis (United States)

    2013-10-15

    To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL ± 6.8 before stent insertion, decreased to 4.58 mg/dL ± 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 ± 99 days, and the median patient survival was 179 ± 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

  18. Development of a framework towards successful implementation of e-governance initiatives in health sector in India.

    Science.gov (United States)

    Ray, Subhasis; Mukherjee, Amitava

    2007-01-01

    The purpose of this paper is to explore the route map for employing efficient e-governance so that at least existing resource and infrastructure are better utilized and deficiencies are tracked for future planning. National health is one of the most important factors in a country's economic growth. India seems to be a victim of the vicious cycle around poor economy and poor health conditions. A detailed study was carried out to find out India's healthcare infrastructure and its standing in e-governance initiatives. After consolidating the fact that effective e-governance can enhance the quality of healthcare service even within limited resources, authors explored success and failure factors of many e-governance initiatives in India and abroad. Finally, an e-governance framework is suggested based on the above factors together with the authors' own experience of implementing e-governance projects in India and abroad. The suggested framework is based on a phased implementation approach. The first phase "Information Dissemination" is more geared towards breaking the "digital divide" across three dimensions: G2Business; G2Citizen; and G2Agent. The most advanced stage is aimed towards joining up healthcare information across the above three dimensions and drawing meaningful analytics out of it. The recommendations also include management of Policies, Scope, Process Reform, Infrastructure, Technology, Finance, Partnership and People for efficient implementation of such e-governance initiatives. The paper provides measures for continuous evaluation of systems as one passes through various stages of implementation. However, the framework can be tested on real or simulated environment to prove its worthiness. This paper can be a potential frame of reference for nation-wide e-healthcare projects not only in India but also in other developing countries. The paper also describes challenges that are most likely to be faced during implementation. Since the paper is practical in

  19. Clinical significance of balloon dilatation angiography during cerebral venous sinus stenosis stenting

    Directory of Open Access Journals (Sweden)

    Xiang-yu CAO

    2016-12-01

    Full Text Available Objective To explore the clinical significance of balloon dilatation angiography during cerebral venous sinus stenosis stenting to predict the reflux of perforator veins after operation. Methods A total of 93 patients (including 51 with cerebral venous sinus stenosis and intracranial hypertension and 42 with intractable pulsatile tinnitus caused by cerebral venous sinus stenosis who were treated by stent implantation were analyzed retrospectively. Among those patients, the diameter of transverse and sigmoid sinuses of 63 cases were measured based on angiography, and stent was selected according to the measurement result. The other 30 cases were given angiography on ipsilateral carotid artery or vertebral artery when the balloon was dilated in the venous sinus to confirm the reflux of perforator veins. If the venous reflux decreased in the angiography, stent with diameter 1-2 mm less than that of venous sinus could be selected.  Results The success rate of stenting was 100% (93/93. In 63 cases, 45 cases were planted 9 mm × 40 mm stents, 15 were planted 8 mm × 40 mm stents, 3 were planted 7 mm × 40 mm stents. The average diameter of stents was (8.67 ± 0.68 mm. There were 11 cases (17.46% with slow perforator venous reflux after operation. In the other 30 cases, 3 cases were planted 8 mm × 40 mm stents, 11 were planted 7 mm × 40 mm stents, and 16 were planted 6 mm × 40 mm stents. The average diameter of stents was (7.57 ± 0.67 mm. There was only one case (3.33% with slow perforator venous reflux after operation. The difference of stent diameter between 2 groups was statistically significant (t = 15.632, P = 0.001. The occurrence rate of perforator vein occlusion after operation between 2 groups was significantly different (adjusted χ 2 = 60.065, P = 0.001.  Conclusions Perforator vein occlusion after cerebral venous sinus stenting is common complication. Balloon dilatation angiography could predict the possibility of perforator vein

  20. Stents for malignant ureteral obstruction

    Directory of Open Access Journals (Sweden)

    Kristina Pavlovic

    2016-07-01

    Full Text Available Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician's ability to treat the underlying cancer. There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents (DJS, tandem DJS, nephrostomy tubes, and then more specialized products such as solid metal stents (e.g., Resonance Stent, Cook Medical and polyurethane stents reinforced with nickel-titanium (e.g., UVENTA stents, TaeWoong Medical. In patients who require long-term stenting, a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously. We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage. These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device. Factors that were identified to predict drainage failure included low serum albumin, bilateral hydronephrosis, elevated C-reactive protein, and the presence of pleural effusion. Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency. Discussions with the patient should take into consideration the frequency that exchanges will be needed, the need for externalized hardware (with nephrostomy tubes, or severe urinary symptoms in the case of internal DJS. This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.

  1. Direct coronary stenting versus stenting with balloon pre-dilation: incidence of enzyme release and follow-up results of a multicentre, prospective, randomized study. The CK and Troponin I Estimation in direct STenting (CK TEST) trial.

    Science.gov (United States)

    Balducelli, M; Varani, E; Vecchi, G; Paloscia, L; Manari, A; Santarelli, A; Cappi, B; Shoeib, A; Valenti, S; Maresta, A

    2007-06-01

    The aim of this study was to assess the safety of direct coronary stenting, its influence on costs, duration of the procedure, radiation exposure, clinical outcome and the incidence of periprocedural myocardial damage as assessed by enzyme release determination. We randomized 103 patients (109 lesions) to direct stent implant or stent implant following balloon predilatation. Patients with heavily calcified lesions, bifurcations, total occlusions, left main lesions and very tortuous vessels were excluded. Three samples of blood were drawn; before, 12 and 24 h after the procedure and total CK, CK MB mass and troponin I determination was carried out in a single centralized laboratory. Direct stenting was successful in 62/62 lesions (100%). No single loss or embolization of the stent occurred. All stents in the group with predilatation were effectively deployed. The immediate post procedure angiographic results were similar with both techniques. Contrast media consumption and procedural time were significantly lower in direct stenting (150+/-82 cc and 30+/-13 min) than in pre-dilated stenting (184+/-85 cc and 36+/-14 min) (P=0.04 and P=0.036 respectively) while fluoroscopy time was similar (9.1+/-12 vs 9.19+/-15 min, P=0.97). The incidence of enzyme release was similar in the groups with only three non Q MI all in the pre-dilated group (P=0.149). Any elevation of CK MB and troponin I occurred in 7% of direct stent vs 12% of pre-dilated group (P=0.66), isolated troponin I elevation in 21% of both groups. Major adverse cardiac events during hospitalization were 0 in direct and 3 in pre-dilated stenting (P=0.66), but there were no significant differences at follow-up at 1, 6 and 12 months between the 2 groups (target lesion revascularization at 12 months 11 vs 14% in the 2 groups respectively). Direct stenting is as safe as pre-dilated stenting in selected coronary lesions. Acute results and myocardial damage as assessed by enzyme release determination are similar, but

  2. Percutaneous bail-out treatment of vein graft rupture with a polytetrafluoroethylene-covered stent.

    Science.gov (United States)

    Pavlidis, Antonios N; Karamasis, Grigorios V; Clapp, Brian R

    2013-12-01

    Vessel perforation is an undesirable and life-threatening complication during vein graft angioplasty. We report on a case of vein graft rupture during angioplasty, which was successfully managed with deployment of a polytetrafluoroethylene-covered stent.

  3. Polymers for Cardiovascular Stent Coatings

    Directory of Open Access Journals (Sweden)

    Anne Strohbach

    2015-01-01

    Full Text Available Polymers have found widespread applications in cardiology, in particular in coronary vascular intervention as stent platforms (scaffolds and coating matrices for drug-eluting stents. Apart from permanent polymers, current research is focussing on biodegradable polymers. Since they degrade once their function is fulfilled, their use might contribute to the reduction of adverse events like in-stent restenosis, late stent-thrombosis, and hypersensitivity reactions. After reviewing current literature concerning polymers used for cardiovascular applications, this review deals with parameters of tissue and blood cell functions which should be considered to evaluate biocompatibility of stent polymers in order to enhance physiological appropriate properties. The properties of the substrate on which vascular cells are placed can have a large impact on cell morphology, differentiation, motility, and fate. Finally, methods to assess these parameters under physiological conditions will be summarized.

  4. Critical Elements for Successful Implementation and Adoption of Authentic Scientific Research Programs: Lessons Learned from NASA's Mars Student Imaging Project

    Science.gov (United States)

    Klug Boonstra, S.; Swann, J.; Boonstra, D.; Manfredi, L.; Christensen, P. R.

    2016-12-01

    Recent research identifies the most effective learning as active, engaged learning in which students interact with phenomena, other students, and the teacher/leader to derive meaning and construct understanding of their surroundings. "Similarly, an engaging and effective science education goes well beyond the low-level factual recall that is emphasized in many science classes. It must develop the skills that students need to solve complex problems, work in teams, make and recognize evidence-based arguments, and interpret and communicate complex information" (emphasis added). Authentic science research projects provide active, engaged learning in which students interact with authentic science data in an authentic problem-solving context to derive meaning and construct understanding of the world. In formal (and many informal) settings, the teacher/leader is effectively the gatekeeper who determines the learning experiences in which the students will participate. From our experience of nearly a decade and a half of authentic science programming for 5thgrade through early college students working with NASA Mars data, supporting and enabling the teacher is perhaps the most critical and foundational element for designing a successful authentic research experience. Yet, a major barrier to this type of learning are teacher/leaders who are too often not equipped or who lack confidence to succeed in facilitating authentic research projects. The Mars Student Imaging Project has implemented an iterative process of design, testing, and redesign that has identified and implemented critical teacher/leader-enabling elements that have led to increasingly successful adoptions within formal and informal educational settings - allowing more students to gain the benefits of immersive research experience.

  5. Focal point pricing: A challenge to the successful implementation of Section 10a (introduced by the Competition Amendment Act

    Directory of Open Access Journals (Sweden)

    Mike Holland

    2015-08-01

    Full Text Available The Competition Amendment Act introduced section 10A, which provides the Competition Commission with the powers to investigate complex monopoly conduct in a market and allows the Competition Tribunal, under certain conditions, to prohibit such behaviour. Although more than five years have elapsed since the Competition Amendment Act was promulgated, this provision has yet to come into force. However, when it eventually does so, it will mark a significant change in South African competition law, as it seeks to regulate firms’ consciously parallel conduct. This is coordinated conduct that occurs without communication or agreement, but results in the prevention or substantial lessening of competition. Examples of horizontal tacit coordination practices include price leadership and facilitating practices, such as information exchanges and price signaling. The successful implementation of the amendment poses problems for the competition authorities in assessing the competitive effects of complex monopoly conduct and in providing effective remedies. Oligopoly markets result in mutual interdependent decision-making by firms, which can lead to market outcomes similar to explicit collusion. However, a further and little noticed issue is that firms in oligopolistic markets have opportunities to use focal points to determine coordinated strategies. This paper explores the nature and role of focal point pricing, which can lead to prices that are above competitive levels. The South African banking industry is used as an example. We find that focal point pricing is difficult to control, making the successful implementation of section 10A even more problematic. Moreover, the proposed amendment provides scope for the imposition of structural remedies by the Competition Tribunal, a function that the Competition Tribunal is ill-suited to perform.

  6. Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients: a realist evaluation.

    Science.gov (United States)

    McConnell, Tracey; O'Halloran, Peter; Donnelly, Michael; Porter, Sam

    2015-03-01

    The Liverpool Care Pathway (LCP) for the dying patient was designed to improve end-of-life care in generalist healthcare settings. Controversy has led to its withdrawal in some jurisdictions. The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation. An organisational case study using realist evaluation in one health and social care trust in Northern Ireland. Two rounds of semistructured interviews were conducted with two policymakers and 22 participants with experience and/or involvement in management of the LCP during 2011 and 2012. Key resource inputs included facilitation with a view to maintaining LCP 'visibility', reducing anxiety among nurses and increasing their confidence regarding the delivery of end-of-life care; and nurse and medical education designed to increase professional self-efficacy, and reduce misuse and misunderstanding of the LCP. Key enabling contexts were consistent senior management support; ongoing education and training tailored to the needs of each professional group; and an organisational cultural change in the hospital setting that encompassed end-of-life care. There is a need to appreciate the organisationally complex nature of intervening to improve end-of-life care. Successful implementation of evidence-based interventions for end-of-life care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships, and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  7. Evaluating the effect of structural dimensions on the successful implementation of strategies in Payam-e-noor University of Iran

    Directory of Open Access Journals (Sweden)

    Hamidreza Shahhosseini

    2013-07-01

    Full Text Available This study aims to assess the relationship between structural dimensions of organization including centralization, complexity and formalization on one side and strategy effectiveness on the other side. Structural dimensions are determined based on Robbins theory, and each of them is considered as independent variables of research. Strategy effectiveness, which includes achieving strategic goals or successful implementation of strategies are the independent variable of the research, based on Noble’s strategy implementation model. One primary thesis and three secondary these are defined. This is a descriptive research of two variable correlation. The target population includes 600 senior managers of Payam-e-noor university around the country, including staff administrative managers, province and unit headmasters, of Iran at the time of data collection. Simple random sampling is used, with sample size of 120. Library resources are used for theoretical foundation data collection and note-taking. Questionnaires are used to collect data and evaluate research theses. Inferential Statistics and Pearson correlation coefficient are used to analyze the research theses. The first two theses are confirmed, at 95% and 99% respectively, but the third thesis is rejected based on the collected data. Therefore, based on this study, complexity and formalization have respectively inverse and direct effect on strategy effectiveness, but centralization does not affect strategy effectiveness in Payam-e-noor University.

  8. Successful implementation of Helping Babies Survive and Helping Mothers Survive programs-An Utstein formula for newborn and maternal survival.

    Directory of Open Access Journals (Sweden)

    Hege L Ersdal

    Full Text Available Globally, the burden of deaths and illness is still unacceptably high at the day of birth. Annually, approximately 300.000 women die related to childbirth, 2.7 million babies die within their first month of life, and 2.6 million babies are stillborn. Many of these fatalities could be avoided by basic, but prompt care, if birth attendants around the world had the necessary skills and competencies to manage life-threatening complications around the time of birth. Thus, the innovative Helping Babies Survive (HBS and Helping Mothers Survive (HMS programs emerged to meet the need for more practical, low-cost, and low-tech simulation-based training. This paper provides users of HBS and HMS programs a 10-point list of key implementation steps to create sustained impact, leading to increased survival of mothers and babies. The list evolved through an Utstein consensus process, involving a broad spectrum of international experts within the field, and can be used as a means to guide processes in low-resourced countries. Successful implementation of HBS and HMS training programs require country-led commitment, readiness, and follow-up to create local accountability and ownership. Each country has to identify its own gaps and define realistic service delivery standards and patient outcome goals depending on available financial resources for dissemination and sustainment.

  9. Percutaneous pancreatic stent placement for postoperative pancreaticojejunostomy stenosis: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Koo [Seoul National University College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2016-09-15

    Stenosis of the pancreatico-enteric anastomosis is one of the major complications of pancreaticoduodenectomy (PD). Endoscopic stent placement, has limited success rate as a nonsurgical treatment due to altered gastrointestinal anatomy. Percutaneous treatment is rarely attempted due to the technical difficulty in accessing the pancreatic duct. We reported a case of pancreaticojejunostomy stenosis after PD, in which a pancreatic stent was successfully placed using a rendezvous technique with a dual percutaneous approach.

  10. Percutaneous treatment of superior vena cava syndrome using metallic stents

    Energy Technology Data Exchange (ETDEWEB)

    De Gregorio Ariza, Miguel Angel; Gimeno, Maria Jose; Alfonso, Eduardo; Mainar, Antonio; Medrano, Joaquin; Lopez-Marin, Paloma [Department of Interventional Radiology, ' ' Lozano Blesa' ' University Hospital, Avda. San Juan Bosco 15, 50009 Zaragoza (Spain); Gamboa, Pablo [Division of Interventional Radiology, Ohio State University Hospital, Columbus, Ohio (United States); Tobio, Ricardo [Interventional Radiology, Clinica de la Zarzuela, Madrid (Spain); Herrera, Marcos [Division of Interventional Radiology, University of Minnesota, Minneapolis, Minnesota (United States)

    2003-04-01

    The purpose of this study was to evaluate the results of treatment of superior vena cava syndrome (SVCS) in patients with benign and malignant disease using expandable metallic stent. From January 1995 to April 2000, 87 expandable stents were implanted in 82 patients (59 men, 23 women; mean age 57.8 years, age range 39-79 years) for the treatment of SVCS. The SVCS was defined as symptomatic bilateral obstruction of venous drainage from head, neck and upper extremities. In 68 patients SVCS was due to malignant neoplasia, and in 14 cases it was due to benign aetiology. All patients were treated with expandable stent. We implanted 81 Wallstent prostheses and 6 Palmaz stents. Adjuvant thrombolysis was applied in 12 patients who required fibrinolysis. After recanalization, the stent was implanted in all cases in SVC (infra- or supra-azygos vein). All patients were treated with heparin of low molecular weight (HBPM) during 6 months. Patency was analyzed according to clinical symptoms and Doppler US or venograms exploration. Technical success was observed in all cases. Clinical success was reached in 78 of 82 patients (95.1%) (absence of symptoms in 2 or 3 days). Four patients suffered immediate thrombosis which required fibrinolitic treatment with a new prosthesis placement in 1 case. The follow-up for the malignant process was of 7.1 months (range 1-39 months) and in benign cases was 31.2 months (range 11-61 months). Sixty-two (91.1%) patients with malignancy died without SVCS symptomatology. All the patients with benign pathology are alive. Clinical primary patency in malignant cases was 87% with assisted patency of 96.2%. Endovascular therapy using metallic stent and thrombolysis is a successful method to treat SVCS due to benign or malignant aetiology. (orig.)

  11. Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person's Pathway.

    LENUS (Irish Health Repository)

    2018-01-25

    We addressed the research question "what factors enable the successful development and implementation of a frail older person\\'s pathway within the acute setting". A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles via database searches supplemented with 94 additional records including inputs from a twitter chat and a hospital site visit. Our final sample consisted of 18 documents. Following review and consensus by an expert panel we identified a conceptual model of context-mechanism-(resources)-outcomes. There was overall agreement frailty should be identified at the front door of the acute hospital. Significant challenges identified related to organisational boundaries both within the acute setting and externally, the need to shift outcomes to patient orientated ones, to support staff to sustain the pathway by providing ongoing education and by providing role clarity. RRRs can support research such as the systematic approach to improving care for frail older adults (SAFE) study by producing accounts of what works based on a wide range of sources and innovative engagement with stakeholders. It is evident from our provisional model that numerous factors need to combine and interact to enable and sustain a successful frail older person\\'s pathway.

  12. The evaluation of primary stenting of sirolimus-eluting versus bare-metal stents in the treatment of atherosclerotic lesions of crural arteries

    Energy Technology Data Exchange (ETDEWEB)

    Falkowski, Aleksander; Wilk, Grazyna [Pomeranian Medical University of Szczecin, Departament of General and Dental Diagnostic Imaging, Szczecin (Poland); Poncyljusz, Wojciech [Pomeranian Medical University of Szczecin, Departament of Diagnostic Imaging and Interventional Radiology, Szczecin (Poland); Szczerbo-Trojanowska, Malgorzata [Medical University of Lublin, Department of Interventional Radiology and Neuroradiology, Lublin (Poland)

    2009-04-15

    A comparison was made of sirolimus-eluting stents and bare stents as an effective means of treatment of stenosis in crural arteries. Patients were randomly divided into two groups: (1) patients treated with sirolimus-eluting stents and (2) patients treated with bare stents. Each group consisted of 25 patients, and every patient had one stent implanted. All patients showed symptoms of ischemia of the peripheral arteries, classified according to the Rutherford scale into categories 3, 4, and 5. All patients were examined 24 h before and 24 h and 6 months after the intervention. The results were analyzed according to clinical, hemodynamic, and angiographic criteria. Technically, the procedure was successful in 100% of cases, and both groups presented an equal improvement in clinical and hemodynamic parameters. The follow-up angiographic examination demonstrated a significantly lower rate of restenosis among the sirolimus-eluting stent group (4, 16%) versus the bare stent group (19, 76%) (p < 0.001), with lower target lesion revascularization in 3 (12%) versus 14 (56%) (p < 0.05), respectively. Quantitative angiography demonstrated that all variables used to assess restenosis were superior for sirolimus-eluting stents 6 months after intervention: late lumen loss 0.46 {+-} 0.72 versus 1.70 {+-} 0.94 (p < 0.001) and minimal lumen diameter 2.25 {+-} 0.82 versus 0.99 {+-} 1.08 (p < 0.001). Results of this study reveal that the use of sirolimus-eluting stents decreases the risk of restenosis in comparison to standard stents. (orig.)

  13. The evaluation of primary stenting of sirolimus-eluting versus bare-metal stents in the treatment of atherosclerotic lesions of crural arteries.

    Science.gov (United States)

    Falkowski, Aleksander; Poncyljusz, Wojciech; Wilk, Grazyna; Szczerbo-Trojanowska, Małgorzata

    2009-04-01

    A comparison was made of sirolimus-eluting stents and bare stents as an effective means of treatment of stenosis in crural arteries. Patients were randomly divided into two groups: (1) patients treated with sirolimus-eluting stents and (2) patients treated with bare stents. Each group consisted of 25 patients, and every patient had one stent implanted. All patients showed symptoms of ischemia of the peripheral arteries, classified according to the Rutherford scale into categories 3, 4, and 5. All patients were examined 24 h before and 24 h and 6 months after the intervention. The results were analyzed according to clinical, hemodynamic, and angiographic criteria. Technically, the procedure was successful in 100% of cases, and both groups presented an equal improvement in clinical and hemodynamic parameters. The follow-up angiographic examination demonstrated a significantly lower rate of restenosis among the sirolimus-eluting stent group (4, 16%) versus the bare stent group (19, 76%) (p < 0.001), with lower target lesion revascularization in 3 (12%) versus 14 (56%) (p < 0.05), respectively. Quantitative angiography demonstrated that all variables used to assess restenosis were superior for sirolimus-eluting stents 6 months after intervention: late lumen loss 0.46 +/- 0.72 versus 1.70 +/- 0.94 (p < 0.001) and minimal lumen diameter 2.25 +/- 0.82 versus 0.99 +/- 1.08 (p < 0.001). Results of this study reveal that the use of sirolimus-eluting stents decreases the risk of restenosis in comparison to standard stents.

  14. Preliminary Report of Carotid Artery Stenting Using a Tapered Stent

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Chang Woo; Kim, Dong Hyun; Hong, Seung; Jeong; Kim, Young Suk; Byun, Joo Nam; Oh, Jae Hee [Dept. of Radiology, Chosun University College of Medicine, Gwangju (Korea, Republic of); Ahn, Seong Hwan [Dept. of Neurology, Chosun University College of Medicine, Gwangju (Korea, Republic of)

    2011-10-15

    To analyze the results of carotid artery stenting using a tapered stent and to evaluate the effectiveness of the tapered stent compared to previously reported studies using non-tapered stents. From October 2008 to August 2010, elective carotid artery stenting using a tapered stent was attempted in 39 lesions from 36 consecutive patients. Post-procedural complications were evaluated by neurologic symptoms and magnetic resonance imaging. Restenosis or occlusion was evaluated by carotid Doppler ultrasound and computerized tomography with angiography. Newly developed neurologic symptoms were evaluated clinically. The self-expandable tapered stent was placed across the carotid artery stenosis. A total stroke was noted in 3 patients, while a major stroke was noted in 1 patient. On diffusion weighted imaging, new lesions were observed in 15 patients, but 13 patients were clinically silent. Follow-up imaging studies were performed in the 13 clinically silent lesions, and no evidence of restenosis or occlusion was found any of the 13 lesions. During clinical follow-up in 34 lesions from 31 patients, there were newly developed neurological symptoms in only 1 patient.

  15. In vitro hemocompatibility and cytocompatibility of dexamethasone-eluting PLGA stent coatings

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jiang; Liu, Yang; Luo, Rifang; Chen, Si; Li, Xin; Yuan, Shuheng; Wang, Jin, E-mail: jinxxwang@263.net; Huang, Nan

    2015-02-15

    Highlights: • Biodegradable dexamethasone-eluting PLGA stent coatings were developed. • Stent coatings can withstand the compressive and tensile strains without cracking. • Stent coatings presented favorable release kinetic for the lesion site. • Stent coatings can effectively inhibit the adhesion and activation of platelets. • Stent coatings can effectively inhibit the proliferation of SMC. - Abstract: Drug-eluting stents (DESs) have been an important breakthrough for interventional cardiology applications since 2002. Though successful in reducing restenosis, some adverse clinical problems still emerged, which were mostly caused by the bare-metal stents and non-biodegradable polymer coatings, associated with the delayed endothelialization process. In this study, dexamethasone-loaded poly (lactic-co-glycolic acid) (PLGA) coatings were developed to explore the potential application of dexamethasone-eluting stents. Dexamethasone-eluting PLGA stents were prepared using ultrasonic atomization spray method. For other tests like stability and cytocompatibility and hemocompatibility tests, dexamethasone loaded coatings were deposited on 316L SS wafers. Fourier transform-infrared spectroscopy (FT-IR) results demonstrated that there was no chemical reaction between PLGA and dexamethasone. The balloon expansion experiment and surface morphology observation suggested that the stent coatings were smooth and uniform, and could also withstand the compressive and tensile strains imparted without cracking after stent expansion. The drug release behavior in vitro indicated that dexamethasone existed burst release within 1 day, but it presented linear release characteristics after 6 days. In vitro platelets adhesion, activation test and APTT test were also done, which showed that after blending dexamethasone into PLGA, the hemocompatibility was improved. Besides, dexamethasone and dexamethasone-loaded PLGA coatings could significantly inhibit the attachment and

  16. The Use and Outcomes of Small, Medium and Large Premounted Stents in Pediatric and Congenital Heart Disease.

    Science.gov (United States)

    Boe, Brian A; Zampi, Jeffrey D; Schumacher, Kurt R; Yu, Sunkyung; Armstrong, Aimee K

    2016-12-01

    We sought to describe the use and outcomes of small, medium and large premounted stents in patients with congenital heart disease, including incidence of and risk factors for re-intervention and development of in-stent stenosis. Premounted stents offer several advantages over traditional manually crimped bare-metal stents, especially in small patients. There are no data describing the medium-term effectiveness and outcomes of premounted stents in congenital heart disease. We performed a single-center retrospective review of all small, medium and large premounted stents implanted over an 8-year period. Premounted stents were implanted in 71 vessels within 59 patients with a 97 % success rate. Regardless of implantation site, premounted stent implantation resulted in significant improvements in vessel size and pressure gradient (p congenital heart disease. Frequent follow-up is required, especially in smaller patients with expected somatic growth, and to evaluate for in-stent stenosis which occurs in nearly half of premounted stents.

  17. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Doros, Attila [Semmelweis University, Radiology Unit, Department of Transplantation and Surgery (Hungary); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom)

    2013-07-11

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.

  18. Budd-Chiari syndrome due to prothrombotic disorder: mid-term patency and efficacy of endovascular stents

    Energy Technology Data Exchange (ETDEWEB)

    Pelage, Jean-Pierre; Denys, Alban; Sibert, Annie; Menu, Yves [Department of Radiology, Hopital Beaujon, AP-HP, 100 Boulevard du General Leclerc, 92110 Clichy (France); Valla, Dominique [Department of Hepatology, Hopital Beaujon, AP-HP, 100 Boulevard du General Leclerc, 92110 Clichy (France); Sauvanet, Alain; Belghiti, Jacques [Department of Surgery, Hopital Beaujon, AP-HP, 100 Boulevard du General Leclerc, 92110 Clichy (France)

    2003-02-01

    Our objective was to evaluate efficacy and patency of metallic stent placement for symptomatic Budd-Chiari syndrome (BCS) due to prothrombotic disorders. Eleven patients with proved BCS due to prothrombotic disorders were referred for endovascular treatment because of refractory ascites (n=9), abdominal pain (n=8), jaundice (n=6), and/or gastrointestinal bleeding (n=4). Stents were inserted for stenosed hepatic vein (n=7), inferior vena cava (n=2), or mesenterico-caval shunt (n=2). Clinical efficacy and stent patency was evaluated by clinical and Doppler follow-up. After a mean follow-up of 21 months, 6 patients had fully patent stents without reintervention (primary stent patency: 55%). Two patients with hepatic vein stenosis had stent thrombosis and died 4 months after procedure. Restenosis occurred in 3 cases (2 hepatic vein and 1 mesenterico-caval shunt stenosis) and were successfully treated by balloon angioplasty (n=2) and addition of new stents (n=1) leading to a 82% secondary stent patency. Of 9 patients with patent stent, 7 were asymptomatic (77%) at the end of the study. Stent placement is a safe and effective procedure to control of symptomatic BCS. Prothrombotic disorder does not seem to jeopardize patency in anticoagulated patients. (orig.)

  19. Mechanical properties and in vivo performance of a novel sliding-lock bioabsorbable poly-p-dioxanone stent.

    Science.gov (United States)

    Feng, Qimao; Jiang, Wenbo; Sun, Kun; Sun, Kang; Chen, Sun; Zhao, Lijiao; Dai, Ke; Ma, Ning

    2011-10-01

    A bioabsorbable poly-p-dioxanone (PPDO) stent with a novel sliding-lock structure was fabricated to treat stenotic peripheral vessels. The sliding-lock PPDO stents have greater radial strength (107 kPa) than PPDO stents with conventional net-tube structure (32 kPa). The sliding-lock PPDO stents were implanted into the iliac arteries of pigs, and implantation success rate was 90% indicating the feasibility of this design. Additionally, we found that sliding-lock PPDO stents kept vessels patent, although by 3 and 6 months post implantation, luminal diameter decreased slightly due to intimal hyperplasia. At 1 month post implantation, the stents were sparsely covered with endothelial cells, and by 6 months, the stents were mostly absorbed and inflammatory reaction gradually decreased as the stents were absorbed. This study shows favorable mechanical strength, degradability and efficacy for the sliding-lock PPDO stents, and supports further research and development of this unique design of polymer stents for applications in vascular devices.

  20. A new Nitinol stent for use in superior vena cava syndrome

    DEFF Research Database (Denmark)

    Andersen, Poul Erik; Midtgaard, Annette; Brenøe, Anne-Sofie

    2015-01-01

    AIM: The aim of the study was to assess the early clinical experience with the Zilver Vena stent in treating patients with malignant superior vena cava syndrome. METHODS: Demographic, procedural, and follow-up data of 12 patients (seven women; mean age 69 years) treated for superior vena cava...... at the time of stent deployment. RESULTS: All patients had superior vena cava obstruction and clinical superior vena cava syndrome caused by malignant expansive mediastinal disease (eight patients non-small cell lung cancer and four small cell lung cancer). The technical success with deployment of the stents...... in the intended position was 75%. Good clinical effect with resolution of superior vena cava syndrome was achieved in 11 of the 12 patients (92%). CONCLUSION: The Zilver Vena stent appeared to be safe, easy to deploy, and showed good clinical outcome. The high radial force of the stent might be of advantage...

  1. Carotid artery stenting; Karotisangioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Fiehler, Jens [Universitaetsklinikum Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum

    2009-09-15

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  2. Endoscopic palliation of malignant obstructive jaundice in extremely elderly patients: plastic stent is enough.

    Science.gov (United States)

    Grönroos, Juha M; Gullichsen, Risto; Laine, Simo; Salminen, Paulina

    2010-04-01

    Although the price of biliary metal stents is manyfold higher when compared to plastic stents, the lower frequency of recurrent obstructions makes metal stents superior to plastic stents for endoscopic palliation of malignant biliary stricture in most patients. Is this the case in extremely elderly patients as well? A retrospective data review comprising prospective data collection and double-entry bookkeeping of therapeutic endoscopic retrograde cholangiopancreatographies (ERCP) with biliary strictures referring to malignancy in 14 patients aged 90 years or older at our institution in 1997-2007. Plastic stents were successfully inserted in 11 out of 14 patients, yielding a technical success rate of 79 %. In the remaining three patients, high biliary obstruction was relieved percutaneously in two cases while the general condition of one patient was so poor that terminal care decision was made in that case. There was no recurrent biliary obstruction in any of the patients with plastic stents prior to death which occurred after a mean of 2.8 months, giving a clinical success rate of 100 %. To be concluded, in extremely elderly patients with malignant obstructive jaundice, palliation with plastic stent is effective enough.

  3. Intracranial Stent Implantation for Drug Resistant Atherosclerotic Stenosis: Results of 52 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kuk Seon; Hwang, Dae Hyun; Ko, Young Hwan; Kang, Ik Won; Lee, Eil Seong; Han, You Mie [Dept. of Radiology, Hallym University Hospital Hangang Scared Heart Hospital, Seoul (Korea, Republic of); Kim, In Soo; Hur, Choon Woong [Dept. of Neurosurgery, Myungji St. Mari' s Hospital, Seoul (Korea, Republic of)

    2011-07-15

    We evaluated the usefulness of intracranial stent implantation for treatment of drug resistant atherosclerotic stenoses. Between March 2004 and July 2007, we tried intracranial stent implantation in 49 patients with 52 lesions (anterior circulation 48 cases, posterior circulation 4 cases) who had an ischemic stroke with more than 50% of major cerebral artery stenosis. We classified the lesions by their location and morphology, analyzed the results in terms of the success rate, complication rate, and restenosis rate during the follow-up period. Intracranial stent implantation was performed successfully in 43 cases (82.7%). In eight of the nine cases, the stent implantation failure was due to the tortuosity of the target vessel. There was no major periprocedural complication. One patient showed cerebellar infarction after the procedure. Mean residual stenoses decreased from 70.2% to 13.0%. Four cases (9.3%) demonstrated in-stent restenoses and more than 50% during the mean and 25.3/month after the follow-up period. Success rate of intracranial stent implantation may improve on developing technique and more experience. Low rate of complication and restenosis suggest that we can consider intracranial stent implantation for treatment of drug resistant atherosclerotic stenoses.

  4. [Company integration management in small and medium-sized companies. Legal requirements and prerequisites for successful implementation].

    Science.gov (United States)

    Ramm, D; Mahnke, C; Tauscher, A; Welti, F; Seider, H; Shafaei, R

    2012-01-01

    The article is based on the results of the project “Company integration management in small and medium-sized companies. Legal requirements and prerequisites for a successful implementation” (01 January 2009-31 August 2010). Since 2004 all employers have been legally bound to offer company integration management (BEM, Betriebliches Eingliederungsmanagement) for all employees who have been incapacitated for work for more than 6 weeks within a year (Section 84 SGB IX, Book 9 of the German Social Code). Objective of this law is to ensure ongoing employment. The aim of the study was to investigate the requirements companies, rehabilitation centres and services as well as social insurance institutions are faced with according to Section 84 SGB IX. Prerequisites for an effective implementation of BEM in small and medium-sized enterprises were analyzed. Protocol-based interviews with experts were adopted. A total of 38 interviews with experts were carried out. The experts interviewed were either willing to give information by interest (concernment) or were named by law as an initiator or co-operator in the process of integration. A substantial literature research was performed in advance of the interviews. The awareness level of BEM is still very low even 7 years after its introduction. Small and medium-sized enterprises do not have any significant experiential knowledge of long-term incapacity for work and, hence, about BEM. Due to a lack of workers representation in many small and medium companies, management does not receive initiatives or support in implementation of BEM from employees' side. Employers prefer a central contact point providing them with the information and help needed, the common service units, however, being widely unknown in this context. Cost comparisons suggest that a company integration management might be more cost-effective than dismissing employees who are incapacitated for some fields of work. These findings might even hold true for small

  5. Understanding the requirements of self-expandable stents for heart valve replacement: Radial force, hoop force and equilibrium.

    Science.gov (United States)

    Cabrera, María Sol; Oomens, Cees W J; Baaijens, Frank P T

    2017-04-01

    A proper interpretation of the forces developed during stent crimping and deployment is of paramount importance for a better understanding of the requirements for successful heart valve replacement. The present study combines experimental and computational methods to assess the performance of a nitinol stent for tissue-engineered heart valve implantation. To validate the stent model, the mechanical response to parallel plate compression and radial crimping was evaluated experimentally. Finite element simulations showed good agreement with the experimental findings. The computational models were further used to determine the hoop force on the stent and radial force on a rigid tool during crimping and self-expansion. In addition, stent deployment against ovine and human pulmonary arteries was simulated to determine the hoop force on the stent-artery system and the equilibrium diameter for different degrees of oversizing. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. The evolving impact of microfabrication and nanotechnology on stent design.

    Science.gov (United States)

    Caves, Jeffrey M; Chaikof, Elliot L

    2006-12-01

    Noncoronary atherosclerotic vascular disease, including symptomatic lower extremity peripheral arterial disease (PAD), promises to extract a steadily rising medical and economic toll over the coming decades. Although drug-eluting stents have led to substantial advances in the management of coronary atherosclerosis, endovascular treatment of noncoronary, peripheral arterial lesions continues to yield high restenosis rates and early clinical failures. In this report, we review recent developments in microfabrication and nanotechnology strategies that offer new opportunities for improving stent-based technology for the treatment of more extensive and complex lesions. In this regard, stents with microfabricated reservoirs for controlled temporal and spatial drug release have already been successfully applied to coronary lesions. Microfabricated needles to pierce lesions and deliver therapeutics deep within the vascular wall represent an additional microscale approach. At the nanoscale, investigators have primarily sought to alter the strut surface texture or coat the stent to enhance inductive or conductive schemes for endothelialization and host artery integration. Nanotechnology research that identifies promising strategies to limit restenosis through targeted drug delivery after angioplasty and stenting is also reviewed.

  7. Radiologic Placement of Uncovered Stents for the Treatment of Malignant Colonic Obstruction Proximal to the Descending Colon

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Jehong; Kwon, Se Hwan, E-mail: Kwon98@khu.ac.kr [Kyung Hee University, Department of Radiology, College of Medicine (Korea, Republic of); Lee, Chang-Kyun [Kyung Hee University, Department of Internal Medicine, College of Medicine (Korea, Republic of); Park, Sun Jin [Kyung Hee University, Department of Surgery, College of Medicine (Korea, Republic of); Oh, Ji Young [Kyung Hee University Hospital at Gangdong, Department of Radiology (Korea, Republic of); Oh, Joo Hyeong [Kyung Hee University, Department of Radiology, College of Medicine (Korea, Republic of)

    2017-01-15

    PurposeTo evaluate the safety, feasibility, and patency rates of radiologic placement of uncovered stents for the treatment of malignant colonic obstruction proximal to the descending colon.Materials and MethodsThis was a retrospective, single-center study. From May 2003 to March 2015, 53 image-guided placements of uncovered stents (44 initial placements, 9 secondary placements) were attempted in 44 patients (male:female = 23:21; mean age, 71.8 years). The technical and clinical success, complication rates, and patency rates of the stents were also evaluated. Technical success was defined as the successful deployment of the stent under fluoroscopic guidance alone and clinical success was defined as the relief of obstructive symptoms or signs within 48 h of stent deployment.ResultsIn total, 12 (27.3 %) patients underwent preoperative decompression, while 32 (72.7 %) underwent decompression with palliative intent. The technical success rate was 93.2 % (41/44) for initial placement and 88.9 % (8/9) for secondary placement. Secondary stent placement in the palliative group was required in nine patients after successful initial stent placement due to stent obstruction from tumor ingrowth (n = 7) and stent migration (n = 2). The symptoms of obstruction were relieved in all successful cases (100 %). In the palliative group, the patency rates were 94.4 % at 1 month, 84.0 % at 3 months, 64.8 % at 6 months, and 48.6 % at 12 months.ConclusionsThe radiologic placement of uncovered stents for the treatment of malignant obstruction proximal to the descending colon is feasible and safe, and provides acceptable clinical results.

  8. Development and characterization of a coronary polylactic acid stent prototype generated by selective laser melting.

    Science.gov (United States)

    Flege, Christian; Vogt, Felix; Höges, Simon; Jauer, Lucas; Borinski, Mauricio; Schulte, Vera A; Hoffmann, Rainer; Poprawe, Reinhart; Meiners, Wilhelm; Jobmann, Monika; Wissenbach, Konrad; Blindt, Rüdiger

    2013-01-01

    In-stent restenosis is still an important issue and stent thrombosis is an unresolved risk after coronary intervention. Biodegradable stents would provide initial scaffolding of the stenosed segment and disappear subsequently. The additive manufacturing technology Selective Laser Melting (SLM) enables rapid, parallel, and raw material saving generation of complex 3- dimensional structures with extensive geometric freedom and is currently in use in orthopedic or dental applications. Here, SLM process parameters were adapted for poly-L-lactid acid (PLLA) and PLLA-co-poly-ε-caprolactone (PCL) powders to generate degradable coronary stent prototypes. Biocompatibility of both polymers was evidenced by assessment of cell morphology and of metabolic and adhesive activity at direct and indirect contact with human coronary artery smooth muscle cells, umbilical vein endothelial cells, and endothelial progenitor cells. γ-sterilization was demonstrated to guarantee safety of SLM-processed parts. From PLLA and PCL, stent prototypes were successfully generated and post-processing by spray- and dip-coating proved to thoroughly smoothen stent surfaces. In conclusion, for the first time, biodegradable polymers and the SLM technique were combined for the manufacturing of customized biodegradable coronary artery stent prototypes. SLM is advocated for the development of biodegradable coronary PLLA and PCL stents, potentially optimized for future bifurcation applications.

  9. A novel electrical potential sensing method for in vitro stent fracture monitoring and detection.

    Science.gov (United States)

    Park, Chan-Hee; Tijing, Leonard D; Yun, Yeoheung; Kim, Cheol Sang

    2011-01-01

    This article describes a preliminary investigation and prototype fabrication of a novel potential sensing method to continuously monitor vascular stent fractures. A potential measurement system consisting of Wheatstone bridge circuit and signal conditioning circuit was designed for the cardiovascular stent durability and fatigue test. Each end of a bare and polyurethane-covered Nitinol vascular stent was electrically connected to the potential measurement system and then immersed either in simulated body fluid (SBF) media or distilled water at 36.4 ± 1 °C. When the stent experienced fracture (i.e., a cut), its electrical potential decreased with an increase in electrical resistance. This method successfully measured fractures in the stent regardless of location. Furthermore, the number of cycles at the onset of stent fracture was accurately detected and continuously monitored using this technique. Thus, the present fracture detection method, which to our knowledge is the first ever report to use electrical potential measurement for stent durability test, gives a fast, real-time, accurate and efficient detection of fractures in stent during in vitro fatigue and durability test.

  10. Recanalization of the lower leg. PTA or stent?; Rekanalisation am Unterschenkel. PTA oder Stent

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Huelsbeck, S. [Medizinischer Klinikverbund Flensburg, Ev.-Luth. Diakonissenanstalt zu Flensburg, Zentrum fuer Gesundheit und Diakonie, Abt. Diagnostische und Interventionelle Radiologie/Neuroradiologie, Flensburg (Germany)

    2010-01-15

    Percutaneous transluminal angioplasty (PTA) and stent placement are currently accepted methods for endovascular treatment of critical limb ischemia, if infragenual vessels are involved. Outcome results in high technical success and satisfactory clinical results for treatment of infrapopliteal lesions with regard to patency rates and amputation-free survival. These treatment modalities are also safe for the patients. The question whether PAT alone or additional stent placement is the better choice, is still unanswered due to limited data. (orig.) [German] Die perkutane transluminale Angioplastie (PTA) und die Stentimplantation stellen inzwischen akzeptierte Methoden zur Behandlung der kritischen Extremitaetenischaemie bei Beteiligung infragenualer Gefaesse dar. Diese Behandlungsmodalitaeten haben eine hohe technische Erfolgsrate, sind sicher fuer den Patienten und erbringen zufrieden stellende klinische Ergebnisse zur Therapie infrapoplitealer Laesionen hinsichtlich Offenheitsrate und amputationsfreiem Ueberleben. Die Frage, ob eine alleinige PTA oder die Stentimplantion besser ist, kann anhand der begrenzten derzeitigen Datenlage zur Zeit noch nicht hinreichend beantwortet werden. (orig.)

  11. Defining Success: Insights From a Random Assignment, Multisite Study of Implementing HIV Prevention, Testing, and Linkage to Care in U.S. Jails and Prisons.

    Science.gov (United States)

    Mitchell, Shannon Gwin; Willett, Jennifer; Swan, Holly; Monico, Laura B; Yang, Yang; Patterson, Yvonne O; Belenko, Steven; Schwartz, Robert P; Visher, Christy A

    2015-10-01

    In the emerging field of implementation science, measuring the extent to which a new or modified healthcare program or practice is successfully implemented following an intervention is a critical component in understanding how evidence-based treatments become part of regular practice. This paper is intended to expand our understanding of factors that influence the successful adoption of new or modified HIV services in correctional settings. The nine-site project developed and directed an organization-level intervention designed to implement improvements in preventing, detecting, and treating HIV for persons under correctional supervision. Using semi-structured interviews to elicit perceptions from Senior Researchers and Executive Sponsors at each of the nine sites, this paper presents their views and observations regarding the success of the experimental intervention in their criminal justice setting. Within the areas of focus for implementation (either HIV prevention, testing, or linkage to community treatment) the complexity of programmatic needs was very influential with regards to perceptions of success. An organization's pre-existing characteristics, staffing, funding, and interorganizational relationships contributed to either the ease or difficulty of programmatic implementation. Results are discussed pertaining to furthering our understanding of why new or modified healthcare interventions achieve success, including whether the intervention is a modification of existing practice or is a new intervention, and the choice of implementation strategy.

  12. Transjugular Intrahepatic Portosystemic Shunt Flow Reduction with Adjustable Polytetrafluoroethylene-Covered Balloon-Expandable Stents Using the "Sheath Control" Technique.

    Science.gov (United States)

    Blue, Robert C; Lo, Grace C; Kim, Edward; Patel, Rahul S; Scott Nowakowski, F; Lookstein, Robert A; Fischman, Aaron M

    2016-06-01

    A complication of transjugular intrahepatic portosystemic shunts (TIPS) placement is refractory portosystemic encephalopathy (PSE) often requiring TIPS reduction. We report the results of a "sheath control technique" utilizing constraining sheaths during deployment of polytetrafluoroethylene (PTFE)-covered balloon-expandable stents, minimizing stent migration, and providing additional procedural control. TIPS reduction was performed in 10 consecutive patients for PSE using Atrium iCast covered stents (Atrium Maquet Getinge Group, Germany). Within the indwelling TIPS stent, a 9 mm × 59 mm iCast stent was deployed with 2 cm exposed from the sheath's distal end and the majority of the stent within the sheath to create the distal hourglass shape. During balloon retraction, the stent was buttressed by the sheath. The proximal portion of the stent was angioplastied to complete the hourglass configuration, and the central portion of the stent was dilated to 5 mm. Demographics, pre- and post-procedure laboratory values, and outcomes were recorded. Ten patients underwent TIPS reduction with 100 % technical success. There was no stent migration during stent deployment. All patients experienced initial improvement of encephalopathy. One patient ultimately required complete TIPS occlusion for refractory PSE, and another developed TIPS occlusion 36 days post-procedure. There was no significant trend toward change in patients' MELD scores immediately post-procedure or at 30 days (p = 0.46, p = 0.47, respectively). TIPS reduction using Atrium iCast PTFE balloon-expandable stents using the "sheath control technique" is safe and effective, and minimizes the risk of stent migration.

  13. Microvascular Coronary Flow Comparison in Acute Myocardial Infarction Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare Metal Stent

    Energy Technology Data Exchange (ETDEWEB)

    Lindefjeld, Dante S., E-mail: dslindef@puc.cl [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Guarda, Eduardo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Méndez, Manuel [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Martínez, Alejandro [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Pérez, Osvaldo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Fajuri, Alejandro; Marchant, Eugenio [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Aninat, Mauricio; Torres, Humberto [Hospital Dr. Gustavo Fricke, Viña del Mar-Chile (Chile); Dussaillant, Gastón [Hospital Clínico Universidad de Chile, Santiago-Chile (Chile)

    2013-01-15

    Background: Distal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI). Objective: Assess the efficacy of a mesh covered stent (MGuard™ stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS). Methods: Forty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC). Results: At baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30 days follow up, but no clinical events at 6 months follow up. Conclusions: In this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.

  14. DJ stent - boon or curse?

    Directory of Open Access Journals (Sweden)

    AS Agrawal

    2014-04-01

    Full Text Available DJ stent is considered as a boon by the urologist but without proper knowledge it turns to be curse for the patient. We report a case of a 34 year old man who developed vesical calculus secondary to DJ stent in a short span of 6-8 months. He underwent cystolithotomy for removal of the vesical calculus along with the DJ stent. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-3, 55-59 DOI: http://dx.doi.org/10.3126/jcmsn.v9i3.10224  

  15. Biodegradable stents in gastrointestinal endoscopy.

    Science.gov (United States)

    Lorenzo-Zúñiga, Vicente; Moreno-de-Vega, Vicente; Marín, Ingrid; Boix, Jaume

    2014-03-07

    Biodegradable stents (BDSs) are an attractive option to avoid ongoing dilation or surgery in patients with benign stenoses of the small and large intestines. The experience with the currently the only BDS for endoscopic placement, made of Poly-dioxanone, have shown promising results. However some aspects should be improved as are the fact that BDSs lose their radial force over time due to the degradable material, and that can cause stent-induced mucosal or parenchymal injury. This complication rate and modest clinical efficacy has to be carefully considered in individual patients prior to placement of BDSs. Otherwise, the price of these stents therefore it is nowadays an important limitation.

  16. Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

    Energy Technology Data Exchange (ETDEWEB)

    Mehta, Vimal, E-mail: drvimalmehta@yahoo.co.in; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay [G.B. Pant Institute of Postgraduate Medical Education and Research (India)

    2016-01-15

    We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.

  17. Use of the Theoretical Domains Framework to evaluate factors driving successful implementation of the Accelerated Chest pain Risk Evaluation (ACRE) project.

    Science.gov (United States)

    Skoien, Wade; Page, Katie; Parsonage, William; Ashover, Sarah; Milburn, Tanya; Cullen, Louise

    2016-10-12

    The translation of healthcare research into practice is typically challenging and limited in effectiveness. The Theoretical Domains Framework (TDF) identifies 12 domains of behaviour determinants which can be used to understand the principles of behavioural change, a key factor influencing implementation. The Accelerated Chest pain Risk Evaluation (ACRE) project has successfully translated research into practice, by implementing an intervention to improve the assessment of low to intermediate risk patients presenting to emergency departments (EDs) with chest pain. The aims of this paper are to describe use of the TDF to determine which factors successfully influenced implementation and to describe use of the TDF as a tool to evaluate implementation efforts and which domains are most relevant to successful implementation. A 30-item questionnaire targeting clinicians was developed using the TDF as a guide. Questions encompassed ten of the domains of the TDF: Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Optimism; Beliefs about consequences; Intentions; Memory, attention and decision processes; Environmental context and resources; and Social influences. Sixty-three of 176 stakeholders (36 %) responded to the questionnaire. Responses for all scales showed that respondents were highly favourable to all aspects of the implementation. Scales with the highest mean responses were Intentions, Knowledge, and Optimism, suggesting that initial education and awareness strategies around the ACRE project were effective. Scales with the lowest mean responses were Environmental context and resources, and Social influences, perhaps highlighting that implementation planning could have benefitted from further consideration of the factors underlying these scales. The ACRE project was successful, and therefore, a perfect case study for understanding factors which drive implementation success. The overwhelmingly positive response suggests that it

  18. Renal artery stenting with noninvasive duplex ultrasound follow-up: 3-year results from the RENAISSANCE renal stent trial.

    Science.gov (United States)

    Rocha-Singh, Krishna; Jaff, Michael R; Lynne Kelley, E

    2008-11-15

    The multicenter, single-arm RENAISSANCE trial evaluated outcomes in patients with progressive atherosclerotic renal artery stenosis (ARAS) treated with the Express Renal Premounted Stent System (Boston Scientific, Natick, MA). Renal artery stenting may prevent the morbidity and mortality of surgical revascularization and high restenosis rates of percutaneous renal angioplasty (PTRA). Renal artery duplex ultrasonography (DUS) offers an alternative to traditional invasive poststenting angiographic surveillance, though concordance with angiography for in-stent restenosis has yet to be validated independently. RENAISSANCE enrolled 100 patients (117 lesions) with de novo or restenotic ostial atherosclerotic lesions or=4.0 and or=70%. The primary endpoint, 9-month binary restenosis, was compared to an objective performance criterion (OPC) of 40% for published PTRA results. Follow-up was conducted through 3 years. Technical and procedural success was both 99%. Follow-up angiography, triggered clinically or by ultrasonography, revealed 21.3% binary restenosis at 9 months, which was superior to the OPC (P RENAISSANCE demonstrates that renal artery stenting is superior to the prespecified OPC at 9 months, and also shows that DUS can accurately identify in-stent restenosis. (c) 2008 Wiley-Liss, Inc.

  19. Success Counteracting Tobacco Company Interference in Thailand: An Example of FCTC Implementation for Low- and Middle-income Countries

    Science.gov (United States)

    Charoenca, Naowarut; Mock, Jeremiah; Kungskulniti, Nipapun; Preechawong, Sunida; Kojetin, Nicholas; Hamann, Stephen L.

    2012-01-01

    Transnational tobacco companies (TTCs) interfere regularly in policymaking in low- and middle-income countries (LMICs). The WHO Framework Convention for Tobacco Control provides mechanisms and guidance for dealing with TTC interference, but many countries still face ‘how to’ challenges of implementation. For more than two decades, Thailand’s public health community has been developing a system for identifying and counteracting strategies TTCs use to derail, delay and undermine tobacco control policymaking. Consequently, Thailand has already implemented most of the FCTC guidelines for counteracting TTC interference. In this study, our aims are to describe strategies TTCs have used in Thailand to interfere in policymaking, and to examine how the public health community in Thailand has counteracted TTC interference. We analyzed information reported by three groups with a stake in tobacco control policies: Thai tobacco control advocates, TTCs, and international tobacco control experts. To identify TTC viewpoints and strategies, we also extracted information from internal tobacco industry documents. We synthesized these data and identified six core strategies TTCs use to interfere in tobacco control policymaking: (1) doing business with ‘two faces’, (2) seeking to influence people in high places, (3) ‘buying’ advocates in grassroots organizations, (4) putting up a deceptive front, (5) intimidation, and (6) undermining controls on tobacco advertising, promotion and sponsorship. We present three case examples showing where TTCs have employed multiple interference strategies simultaneously, and showing how Thai tobacco control advocates have successfully counteracted those strategies by: (1) conducting vigilant surveillance, (2) excluding tobacco companies from policymaking, (3) restricting tobacco company sales, (4) sustaining pressure, and (5) dedicating resources to the effective enforcement of regulations. Policy implications from this study are that

  20. Competency champions in the clinical competency committee: a successful strategy to implement milestone evaluations and competency coaching.

    Science.gov (United States)

    Ketteler, Erika R; Auyang, Edward D; Beard, Kathy E; McBride, Erica L; McKee, Rohini; Russell, John C; Szoka, Nova L; Nelson, M Timothy

    2014-01-01

    To create a clinical competency committee (CCC) that (1) centers on the competency-based milestones, (2) is simple to implement, (3) creates competency expertise, and (4) guides remediation and coaching of residents who are not progressing in milestone performance evaluations. We created a CCC that meets monthly and at each meeting reviews a resident class for milestone performance, a competency (by a faculty competency champion), a resident rotation service, and any other resident or issue of concern. University surgical residency program. The CCC members include the program director, associate program directors, director of surgical curriculum, competency champions, departmental chair, 2 at-large faculty members, and the administrative chief residents. Seven residents were placed on remediation (later renamed as coaching) during the academic year after falling behind on milestone progression in one or more competencies. An additional 4 residents voluntarily placed themselves on remediation for medical knowledge after receiving in-training examination scores that the residents (not the CCC membership) considered substandard. All but 2 of the remediated/coached residents successfully completed all area milestone performance but some chose to stay on the medical knowledge competency strategy. Monthly meetings of the CCC make milestone evaluation less burdensome. In addition, the expectations of the residents are clearer and more tangible. "Competency champions" who are familiar with the milestones allow effective coaching strategies and documentation of clear performance improvements in competencies for successful completion of residency training. Residents who do not reach appropriate milestone performance can then be placed in remediation for more formal performance evaluation. The function of our CCC has also allowed us opportunity to evaluate the required rotations to ensure that they offer experiences that help residents achieve competency performance necessary

  1. From global agenda-setting to domestic implementation: successes and challenges of the global health network on tobacco control.

    Science.gov (United States)

    Gneiting, Uwe

    2016-04-01

    Global policy attention to tobacco control has increased significantly since the 1990 s and culminated in the first international treaty negotiated under the auspices of the World Health Organization--the Framework Convention on Tobacco Control (FCTC). Although the political process that led to the creation of the FCTC has been extensively researched, the FCTC's progression from an aspirational treaty towards a global health governance framework with tangible policy effects within FCTC member countries has not been well-understood to date. This article analyses the role of the global health network of tobacco control advocates and scientists, which formed during the FCTC negotiations during the late 1990 s, in translating countries' commitment to the FCTC into domestic policy change. By comparing the network's influence around two central tobacco control interventions (smoke-free environments and taxation), the study identifies several scope conditions, which have shaped the network's effectiveness around the FCTC's implementation: the complexity of the policy issue and the relative importance of non-health expertise, the required scope of domestic political buy-in, the role of the general public as network allies, and the strength of policy opposition. These political factors had a greater influence on the network's success than the evidence base for the effectiveness of tobacco control interventions. The network's variable success points to a trade-off faced by global health networks between their need to maintain internal cohesion and their ability to form alliances with actors in their social environment. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

  2. Metal allergy to everolimus-eluting cobalt chromium stents confirmed by positive skin testing as a cause of recurrent multivessel in-stent restenosis.

    Science.gov (United States)

    Nakajima, Yoshifumi; Itoh, Tomonori; Morino, Yoshihiro

    2016-03-01

    A 54-year-old woman treated with cobalt-chromium everolimus eluting stents (CoCr-EES) for her left distal circumflex and diagonal branch lesions suffered from repeated in-stent restenosis in both lesions. Neointimal proliferation occurred rapidly and almost simultaneously in the two lesions. The cause was established to be metal allergy, as determined by patch tests which were strongly positive for bare metal stents and weakly positive for CoCr-EES. Following the third successive angioplasty, we initiated treatment with prednisolone (30 mg daily) and the anti-allergic and anti-proliferative drug tranilast (300 mg daily). An elective angiogram performed 3 months later showed no evidence of in-stent restenosis in any of the stented lesions. Furthermore, the patient has remained angina-free for 15 months. The unique features of this case include: (1) near-simultaneous repeated multivessel in-stent restenosis in a patient with skin test-documented metal allergy to cobalt-chromium stents; (2) adjunctive systemic medical therapy with prednisolone and tranilast appeared to terminate the malignant restenotic cycle. © 2015 Wiley Periodicals, Inc.

  3. Clinical testing of Belarusian aortic stent graft system

    Directory of Open Access Journals (Sweden)

    А. П. Шкет

    2016-12-01

    article.Conclusion. The Belarusian system of aortic stent graft successfully passed clinical testing and may be certified and used in clinical practice at a later time on the territory of Belarus.Received 21 June 2016. Accepted 11 November 2016.Funding: The research was financed by Ministry of Health Care of Republic of Belarus.Conflict of interest: The authors declare no conflict of interest.Author contributionsConceptualization and study design: Shket A.P.Material acquisition and analysis: Shket A.P., Nizhnikova O.G. Statistical data processing: Glybovskaya T.V.Article writing: Shket A.P., Krutov V.G.Review & editing: Ostrovskii Y.P.

  4. Initial use of endothelial progenitor cells capturing stents in paediatric congenital heart disease.

    Science.gov (United States)

    Cabanelas, Nuno; Martins, José D F; Pinto, Fátima

    2014-10-01

    Stenosis, mediated by neointimal hyperplasia and thrombosis, is a major limiting factor in successful stent implantation. The introduction of a stent, coated in its endoluminal surface by antihuman CD34 antibodies with endothelial progenitor cell-capturing properties, opens the possibility of promoting a rapid and normal functioning coverage by endothelium and thus avoids both an excessive cell proliferation within stent and the need for long-term dual antiplatelet therapy. These stents, developed for adult coronary artery disease, have not yet been implanted in children or in those with congenital heart disease. In this paper, we describe the implantation of Genous® stents in three children with cyanotic congenital heart disease and obstructed systemic-to-pulmonary shunts. We describe the use of this stent and address its potential feasibility in paediatric congenital heart disease. To maintain the patency of two modified Blalock-Taussig shunts and one ductus arteriosus, four Genous® stents were implanted in three infants with cyanotic heart disease. All procedures were immediately successful, with resolution of stenosis and improvement in transcutaneous oxygen saturation from 66% ± 3.6% to 92% ± 2.6%. In the follow-up, one stent had no occlusion; however, the remaining two had partial occlusion after 5 and 5.5 months, which were successfully managed with balloon dilatation preceding elective definitive surgical correction. In our preliminary experience, we demonstrated that Genous® stent implantation was feasible in infants with complex congenital heart disease. Additional studies with larger samples and longer follow-up are required to confirm the potential benefits of this technology in this clinical setting.

  5. Laboratory information system data demonstrate successful implementation of the prevention of mother-to-child transmission programme in South Africa.

    Science.gov (United States)

    Sherman, G G; Lilian, R R; Bhardwaj, S; Candy, S; Barron, P

    2014-03-01

    Monitoring the prevention of mother-to-child transmission (PMTCT) programme to identify gaps for early intervention is essential as South Africa progresses from prevention to elimination of HIV infection in children. Early infant diagnosis (EID) by an HIV polymerase chain reaction (PCR) test is recommended at 6 weeks of age for all HIV-exposed infants. The National Health Laboratory Service (NHLS) performs the PCR tests for the public health sector and stores test data in a corporate data warehouse (CDW). To demonstrate the utility of laboratory data for monitoring trends in EID coverage and early vertical transmission rates and to describe the scale-up of the EID component of the PMTCT programme. HIV PCR test data from 2003 to 2012 inclusive were extracted from the NHLS CDW by year, province, age of infant tested and test result and used to calculate EID coverage and early vertical transmission rates to provincial level. Rapid scale-up of EID over the first decade of the PMTCT programme was evident from the 100-fold increase in PCR tests to 350 000 by 2012. In 2012, 73% of the estimated 270 000 HIV-exposed infants requiring an early PCR were tested and the early vertical transmission rate had fallen to 2.4% as a result of successful implementation of the PMTCT programme. Laboratory data can provide real time, affordable monitoring of aspects of the PMTCT programme and assist in achieving virtual elimination of paediatric HIV infection in South Africa.

  6. Successful implementation of infection control strategies prevents P. aeruginosa transmission among cystic fibrosis patients inside the hospital

    Directory of Open Access Journals (Sweden)

    Matt, Benedikt

    2014-09-01

    Full Text Available [english] Background: The aim of this study was to characterise the epidemiology of isolated from cystic fibrosis (CF patients at the Vienna General Hospital (VGH by molecular genetic fingerprinting in order to understand transmission ways and to evaluate the established infection control protocols.Methods: The outpatient clinic for CF patients at the VGH cares for children and adolescents up to the age of 18 years. Among an average of 139 patients cared for at the clinic, 41 were tested positive for during the study period. Fifty isolates, obtained between August 2010 and March 2012 from routine examinations of CF patients, were subject to molecular characterization using the DiversiLab method.Results: 42 distinguishable molecular-biological patterns were identified, 7 of which were found multiple times. 40 out of 42 genotypes were retrieved from single patients only, while two patterns were present in two patients each.Nine patients presented with two or more phenotypically diverse isolates. In five of these cases the retrieved isolates belonged to the same genotype.Conclusion: The broad genetic heterogeneity of in the studied patient population suggests that the majority of CF patients cared for at the VGH acquire from environmental sources. It may be concluded that implemented infection control guidelines have been successful in preventing nosocomial transmission of among CF patients within the VGH and patient-to-patient transmission outside the hospital. Chronic polyclonal infection/colonization was rare in the study population.

  7. Factors Which Influenced the Success of the Implementation of the Regulation of the Minister of Home Affairs Number 59 of 2007 in North Sumatera Provincial Government

    Directory of Open Access Journals (Sweden)

    Amar Rinanda Lubis

    2016-06-01

    Full Text Available This study aimed to test empirically and analyze the influence of regulation, commitment, human resources and supporting devices to the successful implementation of the Regulation of the Minister of Home Affairs No.59 Year 2007. Population in this study is SKPD Officer of North Sumatra Province (108 people which was sampled for 93 people. Simultaneous F test and partial t test were used to studies effects of regulation, commitment, human resources and supporting facilities to the successful implementation of the Regulation of the Minister of Home Affairs No. 59, year 2007. These results prove that the regulation, commitment, human resources and supporting devices simultaneously influenced the successful implementation of the Regulation of the Minister of Home Affairs No. 59 Year 2007. In partial, regulation, commitment and human resources affected successful implementation of the Regulation of the Minister of Home Affairs No. 59 Year 2007, while the supporting facilities did not have an effect. These results showed that 48% variations of successful implementation of the Regulation of the Minister of Home Affairs No.59 Year 2007, depended on variable of regulation, commitment, human resources and supporting facilities and the remaining 52% depended on other uninvestigated variables.

  8. Stent Placement for Carotid Web.

    Science.gov (United States)

    Martinez-Perez, Rafael; Lownie, Stephen P; Pandey, Sachin K; Boulton, Mel R

    2017-02-01

    The carotid web is an intraluminal shelf-like projection arising from the posterior wall of the carotid bifurcation and an uncommon etiology of ischemic strokes. We describe the feasibility of endovascular stent placement to treat this condition. A 47-year-old woman presented with a sudden occlusion of the right middle cerebral artery. Computed tomography angiography and digital subtraction angiography showed a carotid web in the ipsilateral carotid bifurcation. Treatment included mechanical thrombectomy for the middle cerebral artery occlusion and carotid stent placement to prevent further ischemic episodes from the carotid web. At the 6-month follow-up, good apposition of the stent against the artery wall was noted, and the patient was free of neurologic symptoms. Carotid artery stent placement is a feasible option in the management of carotid webs. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Treatment of intracranial stenoses using the Neuroform stent system: initial experience in five cases

    Energy Technology Data Exchange (ETDEWEB)

    Haehnel, Stefan; Hartmann, Marius [University of Heidelberg Medical Center, Division of Neuroradiology, Department of Neurology, Heidelberg (Germany); Ringleb, Peter [University of Heidelberg Medical Center, Division of Neurology, Department of Neurology, Heidelberg (Germany)

    2006-07-15

    We assessed the technical feasibility of balloon-assisted angioplasty with consecutive stenting using a flexible, self-expanding neurovascular stent for the treatment of intracranial arteriosclerotic vascular stenoses. Five consecutive patients with symptomatic drug-resistant stenoses of the intracranial internal carotid artery (ICA) or the main stem of the middle cerebral artery (MCA) were treated by balloon-assisted angioplasty with consecutive stenting using the Neuroform stent system. Balloon dilatation of the stenoses and consecutive stent placement with complete coverage of the stenoses was feasible in all patients. One patient suffered acute thrombosis distally to the stented vessel segment which was successfully treated by fibrinolysis, and one patient suffered acute subarachnoid and parenchymal hemorrhage probably due to vessel perforation. In the other three patients, no complications occurred during or immediately after angioplasty. All patients were free of further ischemic events up to the 6-month follow-up. Our findings demonstrate that the Neuroform stent system can used successfully for the treatment of intracranial stenoses of the ICA and the main stem of the MCA. Although immediate angiographic results are promising, long-term angiographic and clinical follow-up is essential to demonstrate long-term outcome. (orig.)

  10. Biodegradable stents in gastrointestinal endoscopy

    OpenAIRE

    Lorenzo-Zúñiga, Vicente; Moreno-de-Vega, Vicente; Marín, Ingrid; Boix, Jaume

    2014-01-01

    Biodegradable stents (BDSs) are an attractive option to avoid ongoing dilation or surgery in patients with benign stenoses of the small and large intestines. The experience with the currently the only BDS for endoscopic placement, made of Poly-dioxanone, have shown promising results. However some aspects should be improved as are the fact that BDSs lose their radial force over time due to the degradable material, and that can cause stent-induced mucosal or parenchymal injury. This complicatio...

  11. Evaluation of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma.

    Science.gov (United States)

    Sugiyama, Gen; Okabe, Yoshinobu; Ishida, Yusuke; Saitou, Fumihiko; Kawahara, Ryuichi; Ishikawa, Hiroto; Horiuchi, Hiroyuki; Kinoshita, Hisafumi; Tsuruta, Osamu; Sata, Michio

    2014-06-14

    To review the usefulness of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma and identify problems that may need to be addressed. The study population consisted of 36 patients with obstructive jaundice caused by hepatocellular carcinoma (HCC) who underwent endoscopic biliary stenting (EBS) as the initial drainage procedure at our hospital. The EBS technical success rate and drainage success rate were assessed. Drainage was considered effective when the serum total bilirubin level decreased by 50% or more following the procedure compared to the pre-drainage value. Survival time after the procedure and patient background characteristics were assessed comparatively between the successful drainage group (group A) and the non-successful drainage group (group B). The EBS stent patency duration in the successful drainage group (group A) was also assessed. The technical success rate was 100% for both the initial endoscopic nasobiliary drainage and EBS in all patients. Single stenting was placed in 21 patients and multiple stenting in the remaining 15 patients. The drainage successful rate was 75% and the median interval to successful drainage was 40 d (2-295 d). The median survival time was 150 d in group A and 22 d in group B, with the difference between the two groups being statistically significant (P jaundice caused by HCC, as it appears to contribute to prolongation of survival time.

  12. Acceptance and introduction of disruptive technologies - simple steps to build a fully functional pulmonary valved stent.

    Science.gov (United States)

    Huber, Christoph H; Marty, Bettina; von Segesser, Ludwig K

    2007-08-01

    Valved stents are new land for cardiac surgeons even though they are being used more frequently by interventional disciplines. This paper presents simple steps to build a patient-specific pulmonary valved stent and its delivery device. The design concept was tested by random participants at a med-tech meeting. The valved stent is constructed by linking an endoprosthetic graft with a valved-jugular-vein. The delivery device is made from a modified 5-ml syringe. Of 72 participants, 66 (92%) built and 60 participants implanted the device successfully into the targeted pulmonary position via a trans-infundibular access.

  13. Cutting-balloon angioplasty of resistant ureteral stenosis as bridge to stent insertion

    Energy Technology Data Exchange (ETDEWEB)

    Iezzi, R., E-mail: iezzir@virgilio.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, ' A. Gemelli' Hospital - Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Di Stasi, C.; Simeone, A.; Bonomo, L. [Department of Bioimaging and Radiological Sciences, Institute of Radiology, ' A. Gemelli' Hospital - Catholic University, L.go A Gemelli 8, 00168 Rome (Italy)

    2011-07-15

    Ureteral stenting is a routine, minimally invasive procedure performed for relief of benign or malignant obstruction. In case of ureteral stenosis, to allow a correct insertion of the stent, a predilatation of the ureter stenosis with a conventional balloon catheter can be necessary. In exceptional cases, it can be difficult to advance an 7-8 Fr JJ-catheter over a tight resistant ureter stenosis following unsuccessful high-pressure balloon dilatation. In the present report, we describe two cases of resistant ureter stenosis successfully dilated by a cutting-balloon following the failure of high-pressure balloon dilatation, allowing a correct and uncomplicated antegrade stent insertion.

  14. Covered Stent and Coils Embolization of a Pulmonary Artery Pseudoaneurysm After Gunshot Wound

    Energy Technology Data Exchange (ETDEWEB)

    Huet, Nicolas, E-mail: nhuet@chu-grenoble.fr; Rodiere, Mathieu, E-mail: mrodiere@chu-grenoble.fr [Hôpital Universitaire de Grenoble and Université Grenoble Alpes, Department of Radiology and Medical Imaging (France); Badet, Michel, E-mail: michel.badet@ch-chambery.fr [Centre Hospitalier Métropôle Savoie, site de Chambéry, Intensive Care Unit (France); Michoud, Marie, E-mail: marie.michoud@ch-chambery.fr [Centre Hospitalier Métropôle Savoie, Site de Chambéry, Department of Radiology (France); Brichon, Pierre-Yves, E-mail: pybrichon@chu-grenoble.fr [Hôpital Universitaire de Grenoble and Université Grenoble Alpes, Department of Thoracic and Vascular Surgery (France); Ferretti, Gilbert, E-mail: gferretti@chu-grenoble.fr; Thony, Frédéric, E-mail: fthony@chu-grenoble.fr [Hôpital Universitaire de Grenoble and Université Grenoble Alpes, Department of Radiology and Medical Imaging (France)

    2016-05-15

    We report the first case of endovascular covered stent implantation for the treatment of a large pulmonary artery pseudoaneurysm (PAPA) following a right thoracic gunshot wound. After resuscitation and hemodynamic stabilization, a CT angiography was performed to analyze the neck size of the PAPA and its position relative to the branches of the parent artery. Covered stent implantation with additional coil embolization was successfully performed. At the 4-year follow-up, the stents remained patent and there was neither pseudoaneurysm recurrence nor treatment-related complication.

  15. The EBC TWO Study (European Bifurcation Coronary TWO): A Randomized Comparison of Provisional T-Stenting Versus a Systematic 2 Stent Culotte Strategy in Large Caliber True Bifurcations.

    Science.gov (United States)

    Hildick-Smith, David; Behan, Miles W; Lassen, Jens F; Chieffo, Alaide; Lefèvre, Thierry; Stankovic, Goran; Burzotta, Francesco; Pan, Manuel; Ferenc, Miroslaw; Bennett, Lorraine; Hovasse, Thomas; Spence, Mark J; Oldroyd, Keith; Brunel, Philippe; Carrie, Didier; Baumbach, Andreas; Maeng, Michael; Skipper, Nicola; Louvard, Yves

    2016-09-01

    For the treatment of coronary bifurcation lesions, a provisional strategy is superior to systematic 2-stent techniques for the most bifurcation lesions. However, complex anatomies with large side branches (SBs) with significant ostial disease length are considered by expert consensus to warrant a 2-stent technique upfront. This consensus view has not been scientifically assessed. Symptomatic patients with large caliber true bifurcation lesions (SB diameter ≥2.5 mm) and significant ostial disease length (≥5 mm) were randomized to either a provisional T-stent strategy or a dual stent culotte technique. Two hundred patients aged 64±10 years, 82% male, were randomized in 20 European centers. The clinical presentations were stable coronary disease (69%) and acute coronary syndromes (31%). SB stent diameter (2.67±0.27 mm) and length (20.30±5.89 mm) confirmed the extent of SB disease. Procedural success (provisional 97%, culotte 94%) and kissing balloon inflation (provisional 95%, culotte 98%) were high. Sixteen percent of patients in the provisional group underwent T-stenting. The primary end point (a composite of death, myocardial infarction, and target vessel revascularization at 12 months) occurred in 7.7% of the provisional T-stent group versus 10.3% of the culotte group (hazard ratio, 1.02; 95% confidence interval, 0.78-1.34; P=0.53). Procedure time, x-ray dose, and cost all favored the simpler procedure. When treating complex coronary bifurcation lesions with large stenosed SBs, there is no difference between a provisional T-stent strategy and a systematic 2-stent culotte strategy in a composite end point of death, myocardial infarction, and target vessel revascularization at 12 months. URL: http://www.clinicaltrials.gov. Unique identifier: NCT 01560455. © 2016 American Heart Association, Inc.

  16. Ab interno stenting procedures.

    Science.gov (United States)

    Radcliffe, Nathan M; Lynch, Mary G; Brown, Reay H

    2014-08-01

    Trabecular bypass was first used as a surgical treatment for glaucoma more than 100 years ago and aims to circumvent the trabecular meshwork, thought to be the main site of aqueous humor outflow resistance. The emerging field of microinvasive glaucoma surgery has brought a new ab interno trabecular microbypass stent through the U.S. Food and Drug Administration-approval process, and data from long-term randomized prospective trials have shown the safety and intraocular pressure-lowering value of trabecular microbypass. This review discusses the historical evolution of trabecular microbypass and describes new and forthcoming surgical options along with available clinical safety and efficacy data. Proprietary or commercial disclosures are listed after the references. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  17. A randomized multicenter comparison of hybrid sirolimus-eluting stents with bioresorbable polymer versus everolimus-eluting stents with durable polymer in total coronary occlusion: rationale and design of the Primary Stenting of Occluded Native Coronary Arteries IV study

    Directory of Open Access Journals (Sweden)

    Teeuwen Koen

    2012-12-01

    Full Text Available Abstract Background Percutaneous recanalization of total coronary occlusion (TCO was historically hampered by high rates of restenosis and reocclusions. The PRISON II trial demonstrated a significant restenosis reduction in patients treated with sirolimus-eluting stents compared with bare metal stents for TCO. Similar reductions in restenosis were observed with the second-generation zotarolimus-eluting stent and everolimus-eluting stent. Despite favorable anti-restenotic efficacy, safety concerns evolved after identifying an increased rate of very late stent thrombosis (VLST with drug-eluting stents (DES for the treatment of TCO. Late malapposition caused by hypersensitivity reactions and chronic inflammation was suggested as a probable cause of these VLST. New DES with bioresorbable polymer coatings were developed to address these safety concerns. No randomized trials have evaluated the efficacy and safety of the new-generation DES with bioresorbable polymers in patients treated for TCO. Methods/Design The prospective, randomized, single-blinded, multicenter, non-inferiority PRISON IV trial was designed to evaluate the safety, efficacy, and angiographic outcome of hybrid sirolimus-eluting stents with bioresorbable polymers (Orsiro; Biotronik, Berlin, Germany compared with everolimus-eluting stents with durable polymers (Xience Prime/Xpedition; Abbott Vascular, Santa Clara, CA, USA in patients with successfully recanalized TCOs. In total, 330 patients have been randomly allocated to each treatment arm. Patients are eligible with estimated duration of TCO ≥4 weeks with evidence of ischemia in the supply area of the TCO. The primary endpoint is in-segment late luminal loss at 9-month follow-up angiography. Secondary angiographic endpoints include in-stent late luminal loss, minimal luminal diameter, percentage of diameter stenosis, in-stent and in-segment binary restenosis and reocclusions at 9-month follow-up. Additionally, optical coherence

  18. A Newly Designed Stent for Management of Malignant Distal Duodenal Stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Wei-Zhong, E-mail: xmjbq007@163.com; Yang, Zheng-Qiang, E-mail: ntdoctoryang@hotmail.com; Liu, Sheng, E-mail: liusheng1137@sina.com; Zhou, Chun-Gao, E-mail: zhouchungao@aliyun.com; Xia, Jin-Guo, E-mail: docjinguoxia@hotmail.com; Zhao, Lin-Bo, E-mail: linberzhao@hotmail.com; Shi, Hai-Bin, E-mail: shihb@njmu.edu.cn [The First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology (China)

    2015-02-15

    PurposeTo evaluate the clinical effectiveness of a newly designed stent for the treatment of malignant distal duodenal stenosis.MethodsFrom March 2011 to May 2013, six patients with malignant duodenal stenosis underwent fluoroscopically guided placement of the new duodenal stent consisting of braided, nested stent wires, and a delivery system with a metallic mesh inner layer. Primary diseases were pancreatic cancer in three patients, gastric cancer in two patients, and endometrial stromal sarcoma in one patient. Duodenal obstructions were located in the horizontal part in two patients, the ascending part in two patients, and the duodenojejunal flexure in two patients. Technical success, defined as the successful stent deployment, clinical symptoms before and after the procedure, and complications were evaluated.ResultsTechnical success was achieved in all patients. No major complications were observed. Before treatment, two patients could not take any food and the gastric outlet obstruction scoring system (GOOSS) score was 0; the other four patients could take only liquids orally (GOOSS score = 1). After treatment, five patients could take soft food (GOOSS score = 2) and one patient could take a full diet (GOOSS score = 3). The mean duration of primary stent patency was 115.7 days.ConclusionsThe newly designed stent is associated with a high degree of technical success and good clinical outcome and may be clinically effective in the management of malignant distal duodenal obstruction.

  19. Primary stenting in the treatment of focal atherosclerotic abdominal aortic stenoses

    Energy Technology Data Exchange (ETDEWEB)

    Poncyljusz, W.; Falkowski, A.; Garncarek, J.; Karasek, M.; England, S.; Zawierucha, D

    2006-08-15

    Aim: To evaluate the results of primary stent placement in focal atherosclerotic aortic stenoses using balloon expandable stents. Materials and methods: Twenty-six primary balloon expandable stent placements in the abdominal aorta were performed and reviewed. All the aortic stenoses were atherosclerotic. Patients were followed up by ankle/brachial pressure indices (ABPI) and Doppler ultrasound (US) at 24 h after procedure and at 12 and 24 months. Follow-up angiograms were performed at 12 months. Results: Twenty-six stents in 26 patients were placed in the infrarenal aorta. All procedures were technically successful and immediate clinical success was obtained. The mean ABPI significantly improved from 0.52 {+-} 0.10 to 0.94 {+-} 0.09 within 24 h after procedure, and remained at 0.90 {+-} 0.12 between 12 and 24 months follow-up (mean 18 months). There was full haemodynamic success at hospital discharge and at 12 and 24 months after the procedure. Clinical success at 12 and 24 months (mean 18 months) was defined as an improvement in the Fontaine classification by at least one class compared with the pre-procedure class and was shown to be 100%. Conclusion: In summary, we report that primary stenting is a safe and effective alternative to surgery in cases of symptomatic stenosis of the infrarenal abdominal aorta. The excellent intermediate term results suggested that we would recommend primary stenting as the treatment of choice for focal atherosclerotic stenoses of the infrarenal aorta in selected patients.

  20. Primary stenting in the treatment of focal atherosclerotic abdominal aortic stenoses.

    Science.gov (United States)

    Poncyljusz, W; Falkowski, A; Garncarek, J; Karasek, M; England, S; Zawierucha, D

    2006-08-01

    To evaluate the results of primary stent placement in focal atherosclerotic aortic stenoses using balloon expandable stents. Twenty-six primary balloon expandable stent placements in the abdominal aorta were performed and reviewed. All the aortic stenoses were atherosclerotic. Patients were followed up by ankle/brachial pressure indices (ABPI) and Doppler ultrasound (US) at 24h after procedure and at 12 and 24 months. Follow-up angiograms were performed at 12 months. Twenty-six stents in 26 patients were placed in the infrarenal aorta. All procedures were technically successful and immediate clinical success was obtained. The mean ABPI significantly improved from 0.52+/-0.10 to 0.94+/-0.09 within 24h after procedure, and remained at 0.90+/-0.12 between 12 and 24 months follow-up (mean 18 months). There was full haemodynamic success at hospital discharge and at 12 and 24 months after the procedure. Clinical success at 12 and 24 months (mean 18 months) was defined as an improvement in the Fontaine classification by at least one class compared with the pre-procedure class and was shown to be 100%. In summary, we report that primary stenting is a safe and effective alternative to surgery in cases of symptomatic stenosis of the infrarenal abdominal aorta. The excellent intermediate term results suggested that we would recommend primary stenting as the treatment of choice for focal atherosclerotic stenoses of the infrarenal aorta in selected patients.

  1. Drug-eluting stents and bare metal stents in patients with NSTE-ACS

    DEFF Research Database (Denmark)

    Pedersen, Sune Haahr; Pfisterer, Matthias; Kaiser, Christoph

    2014-01-01

    the randomised BASKET-PROVE trial (sirolimus-eluting stent vs. everolimus-eluting stent vs. bare metal stent in large-vessel stenting). The primary endpoint was the combined two-year rate of cardiovascular death or non-fatal myocardial infarction (MI). Secondary endpoints were each component of the primary...

  2. The use of cold sprayed alloys for metallic stents

    Science.gov (United States)

    AL-Mangour, Bandar

    With the invention of the coronary stent, which is a wire metal mesh tube designed to keep the arteries open in the treatment of heart diseases, promising clinical outcomes were generated. However, the long term successes of stents have been delayed by significant in-stent restenosis (blockages) and stent fracture. In this research work, it has been proposed to use Cold Gas Dynamic Spraying (CGDS) coating material as an alternative choice to manufacture metallic stent. In CGDS, fine particles are accelerated to a high velocity and undergo solid-state plastic deformation upon impact on the substrate, which leads to particle-particle bonding. The feature of CGDS distinct from other thermal spray techniques is that the processing gas temperature is below the melting point of the feedstock. Therefore, unwanted effects of high temperatures, such as oxidation, grain growth and thermal stresses, are absent. In response to the fact that the majority of stents are made from stainless steel (316L) or Co-Cr alloy (L605), this study specifically addresses the development and characterization of 316L and 316L mixed with L605 coatings produced by the CGDS process. Scanning electron microscopy and electron backscatter diffraction were used to investigate the microstructural changes of these coatings before and after annealing. The effect of gas type on the microstructure of 316L coatings and the role of post-heat treatment in the microstructure and properties are also studied. Of particular interest are grain refinement, heat treatment, mechanical properties and corrosion behavior of the cold sprayed material.

  3. Restructuring Principal Preparation in Illinois: Perspectives on Implementation Successes, Challenges, and Future Outlook. IERC 2015-3

    Science.gov (United States)

    Klostermann, Brenda K.; Pareja, Amber Stitziel; Hart, Holly; White, Bradford R.; Huynh, Michelle Hanh

    2015-01-01

    The goals of the current mixed methods study--the Illinois Principal Preparation Implementation Review Project (I-PREP)--are to describe how the new policy is being implemented, learning which aspects of the implementation have been challenging and why they present challenges, and how programs are addressing challenges and realizing improvements…

  4. Restructuring Principal Preparation in Illinois: Perspectives on Implementation Successes, Challenges, and Future Outlook. Executive Summary. IERC 2015-3

    Science.gov (United States)

    Klostermann, Brenda K.; Pareja, Amber Stitziel; Hart, Holly; White, Bradford R.; Huynh, Michelle Hanh

    2015-01-01

    The goals of the current mixed methods study--the Illinois Principal Preparation Implementation Review Project (I-PREP)--are to describe how the new policy is being implemented, learning which aspects of the implementation have been challenging and why they present challenges, and how programs are addressing challenges and realizing improvements…

  5. Implementation of the forest expansion policy in the Netherlands in the period 1986-2007: Decline in success?

    NARCIS (Netherlands)

    Gossum, Van P.; Arts, B.J.M.; Laar, van J.N.; Verheyen, K.

    2010-01-01

    The current study explains why Dutch forest expansion policy is at risk of failure. To study the forest expansion implementation process we have chosen to further operationalize Matland's policy type implementation model to an extended and comprehensive typology of relevant implementation

  6. A successful nationwide implementation of the ‘FIFA 11 for Health’ programme in Brazilian elementary schools

    Science.gov (United States)

    Fuller, Colin W; Thiele, Edilson S; Flores, Manoel; Junge, Astrid; Netto, Diogo; Dvorak, Jiri

    2015-01-01

    Objectives To deliver a nationwide implementation of the ‘FIFA 11 for Health’ programme in Brazil and to compare the outcomes with results obtained previously in Sub-Saharan Africa. Method A cohort study among 3694 Brazilian children aged 9–12 years within 128 elementary schools situated in 12 cities in the five Regions of Brazil. The ‘FIFA 11 for Health’ programme contains 11 90 min sessions: the first 45 min serve to encourage physical activity through the development of football skills (Play Football) and the second 45 min provide a vehicle for delivering 10 health messages (Play Fair). We measured preintervention and postintervention health knowledge (29-item questionnaire) and the children's evaluation of the programme (6-item questionnaire). Results Mean age of the children across the five Regions was 10.6 years (range 9.2–11.6). The mean preintervention health knowledge score for the five Regions was 60.2% (range 53.8–65.3%); the mean postintervention score was 78.6% (range 70.7–86.8%); thus the mean increase in health knowledge was 18.4% (range 13.6–29.1%). 91% of the children gave a positive evaluation for the programme (range across five Regions: 82.3–96.7%). Summary The study showed that the ‘FIFA 11 for Health’ programme, which was originally developed in English and translated into another language, was delivered successfully with results equivalent to those previously obtained in Sub-Saharan Africa. The programme was effective across the five Regions of Brazil. PMID:25805807

  7. Hemodialysis shunts-related subclavian vein stenosis : treatment with self-expandable metallic stent

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Gyee; Lee, Young Chul; Shin, Sang Soo; Kim, Yun Hyeon; Kim, Jae Kyu; Kang, Heoung Keun; Jeong, Sang Young; Choi, Su Jin Na [Chonnam Univ. College of Medicine, Kwangju (Korea, Republic of)

    1999-04-01

    To evaluate the usefulness of placement of self-expandable stents in hemodialytic shunt-related subclavian vein stenosis. Self-expandable metallic stent was placed in nine patients with hemodialytic shunt-related subclavian vein stenosis. In seven cases, angioplasty was attempted before stent placement; in five, stents were placed immediately after failed angioplasty; and in two, due to restenosis after angioplasty. Procedures involved a 10mm diameter, 7-10cm length Wallstent in eight cases, and a 10mm diameter, 8cm length Hanaro stent in one. In all cases, clinical follow-up, which included physical examination and the measurement of venous resistance pressure during hemodialysis, was performed. The follow-up period was between 5 months and 1 year 7 months. Repeated intervention was performed if restenosis was detected. The stenotic sites were in eight cases the site of a previous subclavian venous line, and in one, the site of anatomic narrowing at the thoracic inlet of the subclavian vein. The technical success rate was 100%;a resulting complication was stent migration into the right atrium in one case in which a Hanaro stent had been used; this was removed by snaring. During follow-up of the eight patients in whon stent placement was successful, restenosis developed in three cases. This occurred during the 7th, 8th, and 15th month, respectively. Two such cases were treated by balloon dilatation. In hemodialytic shunt-related subclavian vein stenosis, treatment involving the use of a self-expandable metallic stent is useful, especially for treating a lesion which has not responded to angioplasty with a high patency rate.

  8. Six-Month Clinical and Angiographic Results of Paclitaxel Eluting Simpax Stent

    Directory of Open Access Journals (Sweden)

    Mehmet Muhsin Türkmen

    2012-08-01

    Full Text Available Introduction: We aimed to evaluate the safety and efficacy of the simpax stent in the treatmentof different patient groups.Patients and Methods: Forty-five patients were treated with the simpax stent. Of these patients,23 patients gave consent for six months of follow-up by quantitative coronary angiography (QSAand six patients were evaluated by exercise electrocardiographic test. Only the patients havinglesions with stenosis > 50% of diameter and lengths > 16 mm with reference diameters < 2.75mm were included.Results: The device success rate was 100% and procedure success rate was 97.7%. The meanstent length was 24.6 ± 7.3 mm and stent size was 2.54 ± 0.24 mm. The overall six months incidenceof major adverse cardiac events (MACE was 8.8%. MACE was consisted of two casesof non-Q wave myocardial infarction and two cases of repeated revascularization of the targetlesion. MACE rate was higher in chronic total occlusion (CTO group than non-CTO group (respectively33.3% and 5.1. Also when compared to stent size, MACE rate was 25% in < 2.5 mm,0% ≥ 2.5 mm. The QSA results at six months showed in-stent late lumen loss witha diameter of0.25 ± 0.15 mm in 17 patients.Conclusion: The six month results in this study demonsrated excellent procedural and devicesuccess. Simpax stent was associated with a low in-stent late lumen loss. Also this study showedsimpax stent was a safe and effective device in non-CTO group with stent size ≥ 2.5 mm.

  9. Angioplasty and stent placement - carotid artery

    Science.gov (United States)

    ... and stenting; CAS; Angioplasty - carotid artery; Carotid artery stenosis - angioplasty; ... Stenting versus endarterectomy for treatment of carotid-arery stenosis. N Engl J Med . 2010;363(1):11- ...

  10. Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures.

    Science.gov (United States)

    Little, M W; Oakley, T; Briggs, J H; Sutcliffe, J A; Allouni, A K; Makris, G; Bratby, M J; Tapping, C R; Patel, R; Wigham, A; Anthony, S; Phillips-Hughes, J; Uberoi, R

    2016-10-01

    To assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction. 268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28-98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %). Overall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week (p < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) (p < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) (p < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %. Lesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.

  11. Technical and Clinical Outcomes Following Colonic Stenting: A Seven-Year Analysis of 268 Procedures

    Energy Technology Data Exchange (ETDEWEB)

    Little, M. W.; Oakley, T.; Briggs, J. H.; Sutcliffe, J. A.; Allouni, A. K.; Makris, G.; Bratby, M. J.; Tapping, C. R.; Patel, R.; Wigham, A.; Anthony, S.; Phillips-Hughes, J.; Uberoi, R., E-mail: Raman.uberoi@ouh.nhs.uk [Oxford University Hospitals NHS Foundation Trust, Department of Interventional Radiology, John Radcliffe Hospital (United Kingdom)

    2016-10-15

    AimsTo assess the factors contributing to the technical and clinical success of colorectal stenting for large bowel obstruction.Methodology268 cases of colonic stenting for large bowel obstruction were performed in 249 patients of mean age of 72 years (28–98) between 2006 and 2013. The majority of strictures were due to malignant disease, 244/268 (91 %). Diverticular strictures accounted for 24/268 (9 %).ResultsOverall technical success rate was 81 % (217/268), with a clinical success rate of 65 % (174/268). Duration of symptoms ranged from 0 to 180 days (mean 8 days). Technical success rate was seen to decrease with increasing symptom duration. For symptom duration of less than 1 week, technical success was 85.4 % (181/212) versus 69.6 % (39/56) for those with symptoms of greater than a week (p < 0.05). Clinical success rates fell from 71.3 % (107/150) to 59.3 % (70/118) (p < 0.05) when attempting to stent lesions of greater than 5 cm. There was also a significant reduction in clinical success when stenting lesions on a bend rather than a straight segment of colon 75.7 % (109/144) versus 59.7 % (74/124) (p < 0.05). A total of 20 (7.46 %) perforations were identified during the study. Stent migration occurred in 6.6 % of cases. In-stent stenosis occurred in 3.3 %. The overall 30-day all cause mortality rate was 9 %.ConclusionLesion size, location and duration of obstructive symptoms are statistically significant determinants of patient outcome. These factors could be used to advise patient selection for colonic stenting or direct progression to surgical intervention.

  12. Paclitaxel and sirolimus eluting stents versus bare metal stents: long-term risk of stent thrombosis and other outcomes. From the Western Denmark Heart Registry

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Tilsted, Hans Henrik; Thayssen, Per

    2010-01-01

    AIMS: Stent thrombosis is a serious complication of percutaneous coronary intervention (PCI). We examined the incidence of stent thrombosis and other outcomes in patients treated with PCI and paclitaxeleluting stents (PES), sirolimus-eluting stents (SES) or bare-metal stents (BMS). METHODS AND RE...

  13. The use of coronary stent in hepatic artery stenosis after orthotopic liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Huang Mingsheng [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Shan Hong [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China)]. E-mail: gzshsums@public.guangzhou.gd.cn; Jiang Zaibo [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Li Zhengran [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Zhu Kangshun [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Guan Shouhai [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Qian Jiesheng [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Chen Guihua [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Lu Minqiang [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Yang Yang [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China)

    2006-12-15

    Purpose: This retrospective study was undertaken to evaluate the effectiveness of coronary stent placement in hepatic artery stenosis after orthotopic liver transplantation (OLT). Materials and methods: Of 430 consecutive adult orthotopic liver transplant recipients between November 2003 and September 2005, 17 had hepatic artery stenosis (HAS). Fourteen of them underwent coronary stent placement in the HAS. The technical results, complications, hepatic artery patency and clinical outcome were reviewed. Results: Technical and immediate success was 100%. After a mean follow-up of 159.4 days (range, 9-375 days), all patients obtained patent hepatic arteries except 2 patients occurred hepatic artery restenoses at 26 and 45 days after stent placement, respectively. Kaplan-Meier curve of patency showed cumulated stent patency at 3, 6, and 12 months of 78%, 58% and 45%, respectively. During the follow-up, 8 patients survived, 5 died of septic multiple-organ failure, 1 received retransplantation because of refractory biliary infection. Hepatic artery dissection induced by a guiding catheter occurred in one patient and was successfully treated with a coronary stent. Conclusion: Hepatic artery stenosis after OLT can be successfully treated with coronary stent placement with low complication rate and an acceptable 1-year hepatic artery patency rate.

  14. Simplified fistula dilation technique and modified stent deployment maneuver for EUS-guided hepaticogastrostomy

    Science.gov (United States)

    Paik, Woo Hyun; Park, Do Hyun; Choi, Jun-Ho; Choi, Joon Hyuk; Lee, Sang Soo; Seo, Dong Wan; Lee, Sung Koo; Kim, Myung-Hwan; Lee, Jung Bok

    2014-01-01

    AIM: To evaluate the success rates, procedural time and adverse event rates of the modified methods in endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS). METHODS: Twenty-eight patients in a prospective case series who underwent EUS-HGS (phase I). Forty-six patients in a matched case-control study (phase II). The simplified technique for fistula dilation was the primary use of a 4 mm balloon catheter with a stainless steel stylet. The stent deployment was modified by deploying the metal stent inside a bile duct (half of the stent) under EUS and fluoroscopic guidance and gently pulling the echoendoscope after full deployment of the stent inside the echoendoscope channel (remaining portion of the stent) under fluoroscopic guidance. This cohort was compared with a matched historical cohort. RESULTS: In phase I, the technical and clinical success with the modified method was 96% (27/28) and 89% (24/27 as per-protocol analysis). The overall adverse event rate was 7%. In phase II, there was no difference in technical and clinical success, stent patency and overall adverse events in each group. However, the procedural time (15.3 ± 5.2 min vs 22.3 ± 6.0 min, P time was shorter and early adverse events were less frequent with our simplified and modified technique. PMID:24803818

  15. Incidence and predictors of coronary stent thrombosis

    DEFF Research Database (Denmark)

    D'Ascenzo, Fabrizio; Bollati, Mario; Clementi, Fabrizio

    2013-01-01

    Stent thrombosis remains among the most feared complications of percutaneous coronary intervention (PCI) with stenting. However, data on its incidence and predictors are sparse and conflicting. We thus aimed to perform a collaborative systematic review on incidence and predictors of stent thrombo...

  16. Adjuvant revascularization of intracranial artery occlusion with angioplasty and/or stenting

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Choi, Byung Se; Kim, Jeoung Hyun; Hwang, Hae Jun; Kim, Sang Joon; Suh, Dae Chul [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea); Kim, Jae Kyun [Seoul Veterans Hospital, Department of Radiology, Seoul (Korea); Kim, Jong Sung [University of Ulsan College of Medicine, Department of Neurology, Asan Medical Center, Seoul (Korea)

    2009-01-15

    In conjunction with intravenous and/or intra-arterial thrombolysis, adjuvant revascularization of intracranial artery occlusion by angioplasty vs. stenting remains controversial. We evaluated outcome in patients with intracranial occlusion after angioplasty and/or stenting. Thirty-three patients who underwent angioplasty or stenting (17 stenting and 16 angioplasty) for intracranial arterial occlusion during the past 5 years were enrolled from prospective neurointerventional database. We compared recanalization rate [defined as thrombolysis in myocardial infarction (TIMI) grade II/III flow], adverse events, and clinical outcome [modified Rankin scale (mRS) at 1 and 6 months]. We also tried to determine independent variables associated with clinical outcome. Median initial National Institutes of Health Stroke Scale (NIHSS) was 13 and median time to treatment was 12 h from symptom onset. The successful recanalization rate was mean 79%. Symptomatic hemorrhage occurred in 15% (5/33). Events (27%, 9/33) at 1 month included four deaths, four major, and one minor stroke. Good outcome (mRS {<=} 2) was achieved in 17 patients (52%) at 6 months and was significantly related to age, initial NIHSS, TIMI flow, and stenting on bivariate analysis. On multivariable analysis, stenting was the only variable significantly associated with a 6-month, good clinical outcome (OR, 14.48; 95% CI, 1.76 to 118.93; p = 0.013) Intracranial revascularization with angioplasty and/or stenting may improve the clinical outcome in selected patients with intracranial occlusion. Multiple factors are related to favorable clinical outcome. (orig.)

  17. Endoscopic ultrasonography-guided placement of a transhepatic portal vein stent in a live porcine model.

    Science.gov (United States)

    Park, Tae Young; Seo, Dong Wan; Kang, Hyeon-Ji; Cho, Min Keun; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Lee, Sung Koo; Kim, Myung-Hwan

    2016-01-01

    Percutaneous portal vein (PV) stent placement is used to manage PV occlusion or stenosis caused by malignancy. The use of endoscopic ultrasonography (EUS) has expanded to include vascular interventions. The aim of this study was to examine the technical feasibility and safety of EUS-guided transhepatic PV stent placement in a live porcine model. EUS-guided transhepatic PV stent placement was performed in six male miniature pigs under general anesthesia using forward-viewing echoendoscope. Under EUS guidance, the left intrahepatic PV was punctured with a 19-gauge fine-needle aspiration (FNA) needle and a 0.025 inch guidewire inserted through the needle and into the main PV. The FNA needle was then withdrawn and a needle-knife inserted to dilate the tract. Under EUS and fluoroscopic guidance, a noncovered metal stent was inserted over the guidewire and released into the main PV. A PV stent was placed successfully in all six pigs with no technical problems or complications. The patency of the stent in the main PV was confirmed using color Doppler EUS and transhepatic portal venography. Necropsy of the first three animals revealed no evidence of bleeding and damage to intra-abdominal organs or vessels. No complications occurred in the remaining three animals during the 8 weeks observation period. EUS-guided transhepatic PV stent placement can be both technically feasible and safe in a live animal model.

  18. Endovascular treatment of wide-neck anterior communicating artery aneurysms using the LVIS Junior stent.

    Science.gov (United States)

    Feng, Zhengzhe; Zhang, Lei; Li, Qiang; Zhao, Rui; Xu, Yi; Hong, Bo; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

    2015-08-01

    We performed this retrospective study to assess the clinical safety and efficacy of the low-profile visualized intraluminal support junior (LVIS Jr.; MicroVention, Aliso Viejo, CA, USA) stent placement in anterior communicating artery (ACA) aneurysms. ACA aneurysms are some of the most common intracranial aneurysms. Stent placement is particularly difficult due to the complexity of the vascular anatomy and the small vessels of the ACA complex. From November 2013 and June 2014, LVIS Jr. stent-assisted coiling was performed in 11 patients with 12 wide-neck ACA aneurysms. Patient demographics, morphologic features of the aneurysm, clinical results and follow-up results are presented. Successful deployment of the LVIS Jr. stent in the targeted artery was achieved in all patients. Complete occlusion was achieved in seven patients, neck remnant in three, and partial occlusion in two. The angiographic follow-up of nine patients (mean 4.4 months) showed that all aneurysms remained stable or improved. There was no in-stent stenosis, recurrence or retreatment. The modified Rankin scale score at discharge was 0 in eight patients and 1 in three patients. The LVIS Jr. stent provided excellent trackability and deliverability and is safe and effective for the treatment of wide-necked ACA aneurysms. Further follow-up is needed to assess the long-term efficacy of LVIS Jr. stent placement in ACA. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19.  A Novel V- Silicone Vestibular Stent: Preventing Vestibular Stenosis andPreserving Nasal Valves

    Directory of Open Access Journals (Sweden)

    Rashid Al Abri

    2012-01-01

    Full Text Available  This report presents a novel style of placing nasal stents. Patientsundergoing surgical procedures in the region of nasal vestibuleand nasal valves are at risk of developing vestibular stenosis andlifelong problems with the external and internal nasal valves;sequels of the repair. The objective of the report is to demonstratea simple and successful method of an inverted V- Stent placementto prevent potential complication of vestibular stenosis and nasalvalve compromise later in life. Following a fall on a sharp edge ofa metallic bed, a sixteen month old child with a deep laceratednasal wound extending from the collumellar base toward thetip of the nose underwent surgical exploration and repair of thenasal vestibule and nasal cavity. A soft silicone stent fashioned asinverted V was placed bilaterally. The child made a remarkablerecovery with no evidence of vestibular stenosis or nasal valveabnormalities. In patients with nasal trauma involving the nasalvestibule and internal and external nasal valves stent placementavoids sequels, adhesions, contractures, synechia vestibularstenosis and fibrosis involving these anatomical structures.The advantages of the described V- stents over the traditionalreadymade ridged nasal stents, tubing’s and composite aural graftsare: a technical simplicity of use, b safety, c less morbidity, dmore comfortable, and e economical. To our knowledge, this isthe first report of such a stent for prevention of vestibular stenosisand preserving nasal valves.

  20. Removal of a partially covered stent by endoscopic substent dissection

    Directory of Open Access Journals (Sweden)

    Iyad Khamaysi

    2016-01-01

    Full Text Available Herein we describe a new technical endoscopic removal of embedded partially covered esophageal stent that was inserted to treat a iatrogenic perforation of esophagus. Usually, partially covered stents can be removed by the stent-in-stent technique. In this case, the embedded stent could not be removed safely with this technique; so we performed a sub stent dissection to detach the stent from the esophageal wall.

  1. Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery.

    Science.gov (United States)

    Shim, Dong Jae; Shin, Ji Hoon; Ko, Gi-Young; Kim, Yook; Han, Kichang; Gwon, Dong-Il; Ko, Heung-Kyu

    2017-04-01

    Background Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7-1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery.

  2. Percutaneous coronary angioscopy and stents

    Science.gov (United States)

    Heuser, Richard R.

    1994-05-01

    With the expanding array of therapies available for coronary intervention, the invasive cardiologist has many choices for treating a specific lesion in an individual patient. Certain types of lesions might respond more effectively with stents, particularly the rigid Palmax- Schatz device. Thrombus and dissection immediately following stent placement are associated with early occlusion, and the interventionist must be able to assess their presence pre- and post-stenting. Angiography is deficient in quantifying minimal disease and in defining lesion architecture and composition, as well as the plaque rupture and thrombosis associated with unstable angina. It is also imprecise in detecting dissection and thrombus. Intravascular ultrasound (IVUS) provides high-resolution images that delineate irregularities and other structures inside the lumen and within the vessel wall and surrounding tissues. Like angiography, IVUS has limited specificity for thrombus differentiation. Angioscopy is superior to angiography and IVUS in detecting thrombus and dissection. Angioscopy allows the clinician to assess the appearance of stent struts after deployment and at follow-up. This may aid in reducing acute complications as well as restenosis. Follow-up angioscopy of stents to detect thrombus or exposed struts may guide therapy in a patient who has clinical symptoms of restenosis.

  3. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis.

    Science.gov (United States)

    Anderloni, Andrea; Buda, Andrea; Vieceli, Filippo; Khashab, Mouen A; Hassan, Cesare; Repici, Alessandro

    2016-12-01

    Endoscopic ultrasound-guided transmural stenting for gallbladder drainage is an emerging alternative for the treatment of acute cholecystitis in high-risk surgical patients. A variety of stents have been described, including plastic stents, self-expandable metal stents (SEMSs), and lumen-apposing metal stents (LAMSs). LAMSs represent the only specifically designed stent for transmural gallbladder drainage. A systematic review was performed to evaluate the feasibility and efficacy of EUS-guided drainage (EUS-GBD) in acute cholecystitis using different types of stents. A computer-assisted literature search up to September 2015 was performed using two electronic databases, MEDLINE and EMBASE. Search terms included MeSH and non-MeSH terms relating to acute cholecystitis, gallbladder drainage, endoscopic gallbladder drainage, endoscopic ultrasound gallbladder drainage, alone or in combination. Additional articles were retrieved by hand-searching from references of relevant studies. Pooled technical success, clinical success, and adverse event rates were calculated. Twenty-one studies met the inclusion criteria, and the eligible cases were 166. The overall technical success rate, clinical success rate, and frequency of adverse events were 95.8, 93.4, and 12.0 %, respectively. The technical success rate was 100 % using plastic stents, 98.6 % using SEMSs, and 91.5 % using LAMSs. The clinical success rate was 100, 94.4, and 90.1 % after the deployment of plastic stents, SEMSs, and LAMSs, respectively. The frequency of adverse events was 18.2 % using plastic stents, 12.3 % using SEMSs, and 9.9 % using LAMSs. Among the different drainage approaches in the non-surgical management of acute cholecystitis, EUS-guided transmural stenting for gallbladder drainage appears to be feasible, safe, and effective. LAMSs seem to have high potentials in terms of efficacy and safety, although further prospective studies are needed.

  4. An Assessment of Radiologically Inserted Transoral and Transgastric Gastroduodenal Stents to Treat Malignant Gastric Outlet Obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Bethany H. T., E-mail: bmiller@doctors.org.uk [Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Department of Upper Gastrointestinal Surgery (United Kingdom); Griffiths, Ewen A., E-mail: Eagriffiths@doctors.org.uk [The New Queen Elizabeth Hospital, Department of Upper Gastrointestinal Surgery (United Kingdom); Pursnani, Kishore G., E-mail: Kish.Pursnani@lthtr.nhs.uk; Ward, Jeremy B., E-mail: Jeremy.Ward@lthtr.nhs.uk [Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Department of Upper Gastrointestinal Surgery (United Kingdom); Stockwell, Robert C., E-mail: Robert.Stockwell@lthtr.nhs.uk [Lancashire Teaching Hospitals NHS Foundation Trust, Chorley and South Ribble Hospital, Department of Radiology (United Kingdom)

    2013-12-15

    IntroductionSelf-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist. Methods: Patients were identified from a prospectively collected database held by one consultant radiologist. Data were retrieved from radiological reports, multidisciplinary team meetings, and the patients' case notes. Univariate survival analysis was performed. Results: Between December 2000 and January 2011, 100 patients (63 males, 37 females) had 110 gastroduodenal stenting procedures. Median age was 73 (range 39-89) years. SEMS were inserted transorally (n = 66) or transgastrically (n = 44). Site of obstruction was the stomach (n = 37), duodenum (n = 50), gastric pull-up (n = 10), or gastroenterostomy (n = 13). Seven patients required biliary stents. Technical success was 86.4 %: 83.3 % for transoral insertion, 90.9 % for transgastric insertion. Eleven patients developed complications. Median GOO severity score: 1 pre-stenting, 2 post-stenting (p = 0.0001). Median survival was 54 (range 1-624) days. Post-stenting GOO severity score was predictive of survival (p = 0.0001). Conclusions: The technical success rate for insertion of palliative SEMS is high. Insertional technique can be tailored to the individual depending on the location of the tumor and whether it is possible to access the stomach percutaneously. Patients who have successful stenting and return to eating a soft/normal diet have a statistically significant increase in survival.

  5. Coronary stenting approaches in the treatment of chronic total occlusion: contemporary registry-based experience.

    Science.gov (United States)

    Vaduganathan, Muthiah; Kornowski, Ran; Vaknin-Assa, Hana; Greenberg, Gabriel; Bental, Tamir; Lev, Eli I; Assali, Abid R

    2016-09-01

    This 'real-world' investigation attempted to determine the long-term prognoses of patients who have undergone successful revascularization of chronic total occlusion (CTO) lesions. All consecutive unselected patients from January 2006 to June 2011, undergoing stenting for CTO (n = 272), were retrospectively identified through an institutional registry. Procedural failure was defined as final diameter stenosis greater than 30% or postdilatation thrombolysis in myocardial infarction flow less than 3. Outcomes were assessed based on stenting type [bare metal stent (BMS), drug-eluting stent (DES), or mixed] in the successful procedural cohort. Multiple logistic regression analyses were used to account for known baseline cardiovascular risk imbalances. The primary endpoint was 2-year target vessel revascularization. Overall procedural failure occurred in 55 (20.2%) patients presenting with CTO lesions. Failed revascularization was independently associated with multivessel disease, lesion lengths greater than 15 mm, tortuous segments, and presence of calcifications. Major complications included coronary dissection (10%) and perforation (2%). Of the successful procedures, 141 (64%) underwent pure DES, 46 (21%) pure BMS, and 34 (15%) mixed stenting. At 2-year follow-up, fewer patients in the DES group required repeat revascularization compared to the mixed stenting group (6 vs. 26%; P = 0.002). Mixed stenting was an independent predictor of long-term target vessel revascularization (adjusted odds ratio 2.1, 95% confidence interval 1.1-4.1, P = 0.02) compared to DES. Failed revascularization of CTO lesions occurs in a fifth of patients and appears to be associated with complex vessel anatomy. Our data suggest that DES use in this setting are associated with improved 2-year clinical endpoints compared with pure BMS or mixed stenting approaches.

  6. Placement of an implantable port catheter in the biliary stent: an experimental study in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Gi Young; Lee, Im Sick; Choi, Won Chan [Asan Medical Center, Seoul (Korea, Republic of)

    2004-04-01

    To investigate the feasibility of port catheter placement following a biliary stent placement. We employed 14 mongrel dogs as test subject and after the puncture of their gaIl bladders using sonographic guidance, a 10-mm in diameter metallic stent was placed at the common duct. In 12 dogs, a 6.3 F port catheter was placed into the duodenum through the common duct and a port was secured at the subcutaneous space following stent placement. As a control group, an 8.5 F drain tube was placed into the gallbladder without port catheter placement in the remaining two dogs. Irrigation of the bile duct was performed every week by injection of saline into the port, and the port catheter was replaced three weeks later in two dogs. Information relating to the success of the procedure, complications and the five-week follow-up cholangiographic findings were obtained. Placement of a biliary stent and a port catheter was technically successful in 13 (93%) dogs, while stent migration (n=3), gallbladder rupture (n=1) and death (n=5) due to subcutaneous abscess and peritonitis also occurred. The follow-up was achieved in eight dogs (seven dogs with a port catheter placement and one dog with a drain tube placement). Irrigation of the bile duct and port catheter replacement were successfully achieved without any complications. Cholangiograms obtained five weeks after stent placement showed diffuse biliary dilation with granulation tissue formation. However, focal biliary stricture was seen in one dog with stent placement alone. Placement of a port catheter following biliary stent placement seems to be feasible. However, further investigation is necessary to reduce the current complications.

  7. Analysis of Success Factors to Implement Sustainable Supply Chain Management Using Interpretive Structural Modeling Technique: A Real Case Perspective

    National Research Council Canada - National Science Library

    2017-01-01

    Sustainability draws increased supply chain management (SCM) attention. This article analyzes critical success to the assessment, evaluation, and attainment of sustainable supply chain management (SSCM...

  8. Primary nitinol stenting in femoropopliteal occlusive disease: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Acin, Francisco; de Haro, Joaquin; Bleda, Silvia; Varela, Cesar; Esparza, Leticia

    2012-10-01

    To determine the efficacy and safety of balloon angioplasty (BA) with optional stenting vs. routine stenting with current open cell nitinol stents for femoropopliteal occlusive disease by analyzing the overall results from all available randomized controlled trials. A bibliographic search of electronic medical databases (MEDLINE, Embase, ISI Web of Knowledge, and the Cochrane Central Register of Controlled Trials) was conducted to identify relevant articles from 1960 to July 2011. Of the 701 published articles retrieved, 17 clinical trials randomized patients with symptomatic femoropopliteal occlusive disease to either primary BA or primary stenting. Of these, 4 RCTs involved the use of currently employed high flexibility nitinol stents. Thirteen other trials that employed obsolete, steel, or coated stents were excluded. The technical success rate, the target lesion revascularization (TLR) rate, and the binary restenosis rate at 12 months were primary efficacy endpoints; mortality was the primary safety endpoint. The results are reported as the odds ratio (OR) with 2-tailed 95% confidence intervals (95% CI). The study population was made up of 627 patients (416 men; mean age 67±10 years) and 665 lesions (361 assigned to the primary stenting and 304 to BA). The mean length of the treated lesion was similar in both groups (74.6±45.7 mm in the stenting group vs. 66.7±41.3 mm in the BA group). Technical success was significantly higher in the stenting group compared to BA (95.8% vs. 64.2%; OR 0.31, 95% CI 0.09 to 0.92, p<0.001). Follow-up ranged from 12 to 24 months. Based on 3 studies, the TLR at 12 months favored the stent group (OR 2.47, 95% CI 0.72 to 8.49, p=0.065), but the difference did not reach statistical significance. However, the 12-month binary restenosis rate was significantly lower in the primary stenting group (OR 3.02, 95% CI 1.3 to 6.71, p<0.001). With respect to the safety endpoint, mortality was similar in both groups (OR 0.83, 95% CI 0.39 to 1

  9. Transpedal approach for iliac artery stenting: A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Zachariah, Jips J., E-mail: jzachariah@chpnet.org [Mount Sinai Beth Israel Hospital, New York, NY (Israel); Ratcliffe, Justin A.; Ruisi, Michael; Puma, Joseph [Mount Sinai Beth Israel Hospital, New York, NY (Israel); Bertrand, Olivier [Quebec Heart and Lung Institute, Quebec (Canada); Kwan, Tak [Mount Sinai Beth Israel Hospital, New York, NY (Israel)

    2016-12-15

    Objective: To demonstrate the safety and feasibility of the transpedal approach as an alternate arterial access site for iliac artery intervention. Background: The common femoral artery is the traditional access site for the endovascular treatment of iliac artery stenoses. However, this approach is associated with complication rates as high as 2%, including retroperitoneal bleeding which carries high patient morbidity and mortality. Furthermore, the standard femoral approach is associated with longer recovery times and longer time to ambulation which are important considerations especially when performing procedures in an ambulatory setting. Methods: Twelve patients were prospectively followed after treatment for symptomatic iliac artery stenosis via transpedal access. Under ultrasound guidance, one of the pedal arteries was visualized and accessed, and stenting of the iliac arteries were performed as per protocol. The patient was monitored immediately post procedure and clinical follow up was performed at one week and one month later. Results: The average age of the patients was 71 years old. 58% were male. Most patients had Rutherford class III symptoms. Successful stent placement was achieved in all 12 patients via transpedal access. No conversion to femoral access was required. No complications immediately post procedure nor at any time period during follow up were noted. Lower extremity arterial duplex at one month showed patent stents and patent pedal access site vessels in all patients. Conclusion: Transpedal arterial access may be a safe and feasible approach for iliac artery stenting. Given the possible benefits of avoiding femoral artery access, larger studies should be conducted directly comparing the different approaches.

  10. Endovascular stent-graft management of thoracic aortic diseases

    Energy Technology Data Exchange (ETDEWEB)

    Dake, Michael D. E-mail: mddake@stanford.edu

    2001-07-01

    The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence.

  11. Interventional Exclusion of Iliac Artery Aneurysms Using the Flow-Diverting Multilayer Stent

    Energy Technology Data Exchange (ETDEWEB)

    Pieper, Claus Christian, E-mail: Claus.christian.pieper@ukb.uni-bonn.de; Meyer, Carsten, E-mail: Carsten.Meyer@ukb.uni-bonn.de [University of Bonn, Department of Radiology (Germany); Rudolph, Jens, E-mail: jens.rudolph@ukb.uni-bonn.de; Verrel, Frauke, E-mail: frauke.verrel@ukb.uni-bonn.de [University of Bonn, Department of Surgery (Germany); Schild, Hans Heinz, E-mail: hans.schild@ukb.uni-bonn.de; Wilhelm, Kai E., E-mail: kai.wilhelm@ukb.uni-bonn.de [University of Bonn, Department of Radiology (Germany)

    2013-08-01

    PurposeThis study was designed to evaluate retrospectively the results of complex iliac artery aneurysm (IAA) exclusion using the Cardiatis-Multilayer-Stent.MethodsBetween October 2010 and August 2012, ten IAAs were treated in eight males (mean age 75 (59-91) years) using the Multilayer Stent. All IAA exceeded a diameter of 3 cm or were symptomatic. Follow-up (FU) examinations included CT or MR angiography, sonography, and clinical assessment up to 2 years.ResultsPrimary stent placement was technically successful in eight of ten cases. In two cases, severe stent retraction during deployment necessitated placement of an additional stent. Immediately after stent placement, a marked reduction of flow within the sac was observed in all cases (peri-interventional mortality 0 %). During FU, there were two thrombotic stent occlusions, making reintervention necessary (primary patency rate 80 %, secondary patency 100 %). Four IAA were completely occluded at FU, whereas the original vessel and covered branches (n = 8) were patent. In four IAA, there was still residual perfusion. In one patient, IAA diameter decreased slightly, while it remained constant in seven (mean imaging FU 195 (range 1-695) days). There were no adverse events on clinical FU (mean FU 467 (range 101-695) days).ConclusionsOther studies showed the Cardiatis-Multilayer-Stent to be a technically relatively simple treatment option for complex IAA with inadequate landing zones, especially in patients with multiple comorbidities to avoid ipsilateral IIA obstruction. However, in our series complication rate was high. Incomplete sac exclusion, stent-shortening, and thrombotic occlusion can complicate treatment, making meticulous patient selection necessary. Close imaging surveillance is mandatory especially in the early postinterventional period.

  12. First-in-man evaluation of the MOMO cobalt-chromium carbon-coated stent.

    Science.gov (United States)

    Kesavan, Sujatha; Strange, Julian W; Johnson, Thomas W; Flohr-Roese, Silke; Baumbach, Andreas

    2013-01-22

    Bare metal stents continue to be used for the interventional treatment of coronary artery disease. We report the clinical and angiographic results of a multicentre, single-arm evaluation of safety and feasibility of the MOMO stent (Japan Stent Technology Co., Ltd, Okayama Research Park Incubation Centre, Okayama, Japan). The MOMO stent is a novel thin-strut cobalt-chromium carbon-coated stent for the treatment of de novo coronary artery disease (CAD). In this prospective, non-randomised, single-arm study, 40 patients (stable and unstable angina) with single-vessel CAD were recruited into the study from three centres. Patients with lesions ≤15 mm in length and with a target vessel diameter of ≥3 mm were eligible. Angiographic follow-up was performed at six months. Quantitative coronary angiography (QCA) was used to measure acute gain and late luminal loss (LLL). Intravascular ultrasound (IVUS) was performed in 15 consecutive patients from two centres to assess the degree of neointimal proliferation within the stented segment at six-month follow-up. The MOMO stent performed well without any procedural complications with an acute procedure and technical success rate of 100%. Repeat revascularisation was performed in six patients (15%) during the six-month follow-up. Ischaemia-driven revascularisation was documented in three patients (7.5%). No myocardial infarction, stent thrombosis or cardiac death was observed. One non-cardiac death was reported secondary to lung cancer. Binary restenosis was 12.5% (n=5), and the LLL was 0.54±0.3 mm. This first-in-man experience demonstrates proof of concept of the safety and feasibility of the MOMO cobalt-chromium carbon-coated stent for patients with single focal de novo lesions presenting with stable and unstable CAD.

  13. Management of ureteral stenting for postrenal failure during pregnancy after ureteral reimplantation: a case report.

    Science.gov (United States)

    Yoneoka, Yutaka; Kaku, Shoji; Tsuji, Shunichiro; Yamashita, Hiroto; Inoue, Takashi; Kimura, Fuminori; Murakami, Takashi

    2016-04-01

    Vesicoureteral reflux is thought to predispose to urinary tract infection and renal scarring, and ureteral reimplantation in childhood remains the gold standard for its treatment. It has been reported that the risk of postrenal failure during pregnancy is increased among women with Politano-Leadbetter ureteral reimplantation. In previous case reports on patients with progressive hydronephrosis and renal failure during pregnancy after ureteral reimplantation, percutaneous nephrostomy was always required, so there has been no information about the clinical management of such patients by ureteral stenting. Here we report a patient with a history of bilateral ureteral reimplantation, in whom severe hydronephrosis during pregnancy was managed with ureteral stents. A primigravida with severe hydronephrosis was referred to us at 29 weeks of gestation. Bilateral Politano-Leadbetter ureteral reimplantation had been performed at the age of 3 years. She was hospitalized immediately, and bilateral ureteral stents were successfully inserted. Post-obstructive diuresis occurred after the stents were placed. Urinary tract infection developed after removal of the urethral catheter 1 week later, but responded to antibiotic therapy and catheter replacement. Labor was induced at 39 weeks of gestation, with vaginal delivery of a healthy male infant. Both stents were found to have spontaneously migrated into the urethra after delivery. Repeat stenting under spinal anesthesia was required to improve postpartum symptoms of back pain and fever. Right distal ureteral obstruction persisted at 6 months after delivery and repeat ureteral reimplantation is planned. General obstetricians will not necessarily pay attention to a history of Politano-Leadbetter ureteral reimplantation, but these patients should undergo careful monitoring of renal function and urinary tract morphology during perinatal care. In the present case, ureteral stenting was effective for postrenal failure during pregnancy

  14. Indications for stenting during thrombolysis

    DEFF Research Database (Denmark)

    Bækgaard, N; Broholm, R; Just, Sven Richardt Lundgren

    2013-01-01

    The most important vein segment to thrombolyse after deep venous thrombosis (DVT) is the outflow tract meaning the iliofemoral vein. Iliofemoral DVT is defined as DVT in the iliac vein and the common femoral vein. Spontaneous recanalization is less than 50%, particularly on the left side...... of a stent in this position is the treatment of choice facilitating the venous flow into an unobstructed outflow tract either from the femoral vein or the deep femoral vein or both. The stent, made of stainless steel or nitinol, has to be self-expandable and flexible with radial force to overcome...... with catheter-directed thrombolysis of iliofemoral deep venous thrombosis....

  15. Local Delivery of Antiproliferative Agents via Stents

    Directory of Open Access Journals (Sweden)

    Hyuck Joon Kwon

    2014-03-01

    Full Text Available A stent is a medical device for serving as an internal scaffold to maintain or increase the lumen of a body conduit. Stent placement has become a primary treatment option in coronary artery disease for more than the last two decades. The stenting is also currently used for relieving the symptoms of narrowed lumen of nonvascular organs, such as esophagus, trachea and bronchi, small and large intestines, biliary, and urinary tract. Local delivery of active pharmaceutical agents via the stents can not only enhance healing of certain diseases, but it can also help decrease the potential risk of the stenting procedure to the surrounding tissue. In this review, we focus on reviewing a variety of drug-impregnated stents and local drug delivery systems using the stents.

  16. The trabecular bypass stent in a pseudophakic glaucoma patient: A 1-year follow-up.

    Science.gov (United States)

    Fea, Antonio M; Dogliani, Monica; Machetta, Federica; Lale-Lacroix, Gabriella; Brogliatti, Beatrice; Grignolo, Federico M

    2008-12-01

    To describe the 1-year success of a trabecular stent implant in a pseudophakic glaucoma patient. The stent is implanted through a small corneal incision under gonioscopic control. Intraocular pressure control was reported in cultured human anterior segment. Observational case report. We report the case of a patient who was implanted and followed-up for 1 year at the Dipartimento di Fisiopatologia Clinica. The main outcome measures were intraocular pressure and visual field. The patient's intraocular pressure was controlled with topical beta-blockers for 6 months and without therapy for 6 months. Two diurnal curves demonstrated achievement of target pressure during the day. The 1-year visual field was unchanged. We are not aware of previous reports of trabecular stent implantation in pseudophakic patients. The trabecular stent had minimal peri-operative morbidity. Identification of the implantation site is challenging and reduction of efficacy over time may occur.

  17. Self-Expanding Metal Stenting for Palliation of Patients with Malignant Colonic Obstruction

    DEFF Research Database (Denmark)

    Meisner, Søren; González-Huix, Ferran; Vandervoort, Jo G

    2012-01-01

    Background. Self-expanding metal stents can alleviate malignant colonic obstruction in incurable patients and avoid palliative stoma surgery. Objective. Evaluate stent effectiveness and safety on palliation of patients with malignant colorectal strictures. Design. Two prospective, one Spanish...... and one global, multicenter studies. Settings. 39 centers (22 academic, 17 community hospitals) from 13 countries. Patients. A total of 257 patients were enrolled, and 255 patients were treated with a WallFlex uncovered enteral colonic stent. Follow-up was up to 12 months or until death or retreatment...... for patients with malignant colonic obstruction should be self-expanding metal stent placement due to high rates of technical success and efficacy in symptom palliation and few complications....

  18. Clinical usefulness of the memokath stent as a second-line procedure after sphincterotomy failure.

    Science.gov (United States)

    Pannek, Juergen; Göcking, Konrad; Bersch, Ulf

    2011-02-01

    To assess the clinical usefulness of Memokath® stent placement in the external sphincter region in men with neurogenic bladder dysfunction from spinal cord injury after failed sphincterotomy. Twenty-two men with elevated (> 100 mL) residual urine and/or voiding difficulties/autonomic dysreflexia were treated with a Memokath stent. Follow-up examinations comprised residual urine, video-urodynamics, renal sonography, and assessment of subjective outcome. No intraoperative complications were observed. Transient autonomic dysreflexia developed in one patient. Stent repositioning from dislocation was necessary in four (18.2%) patients. After a median follow-up of 10.3 months, 18 (81.8%) patients still had a stent in place. In two men, the stents were removed because of newly diagnosed urothelial bladder cancer; in another two patients, they were removed because of lack of success. At follow-up, residual urine was significantly reduced from 229 to 105 mL. Residual urine was < 100 mL in 14 of 18 (77.8%) patients. Changes in bladder capacity, detrusor leak point pressure, bladder compliance, and maximum detrusor pressure were not statistically significant. Renal sonography did not reveal any pathologic findings. According to our data, the Memokath stent is not only an alternative treatment option to sphincterotomy, but it is a safe and successful second-line treatment after sphincterotomy failure.

  19. Malignant Hilar Biliary Obstruction: Treatment by Means of Placement of a Newly Designed Y-Shaped Branched Covered Stent

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Jong Hyouk, E-mail: xell1015@naver.com; Jung, Gyoo-Sik, E-mail: gsjung@medimail.co.kr; Park, Jung Gu [Kosin University College of Medicine, Departments of Diagnostic Radiology (Korea, Republic of); Kang, Byung Chul [Ewha Womans University College of Medicine, Departments of Radiology, Mokdong Hospital (Korea, Republic of); Shin, Dong-Hoon [Kosin University College of Medicine, Departments of General Surgery (Korea, Republic of); Yun, Byung Chul; Lee, Sang Uk [Kosin University College of Medicine, Departments of Internal Medicine (Korea, Republic of)

    2016-04-15

    PurposeTo evaluate the technical feasibility and clinical efficacy of placement of a newly designed Y-shaped branched covered stent for palliative treatment of malignant hilar biliary obstruction.MethodsFrom June 2011 to September 2014, 34 consecutive patients with malignant hilar biliary obstruction underwent percutaneous placement of a Y-shaped branched covered stent for palliative treatment. Technical and clinical success, complications, cumulative patient survival, and stent patency were evaluated.ResultsStent placement was technically successful in all patients. All patients showed adequate biliary drainage on the follow-up cholangiogram. Mean serum bilirubin level (10.9 mg/dl) decreased significantly 1 week (5.7 mg/dl) and 1 month (2.6 mg/dl) after stent placement (p < 0.01). Complications associated with the procedure included hemobilia (n = 3) and biloma (n = 1). During the mean follow-up period of 225 (range 12–820) days, nine patients (26.5 %) developed stent occlusion caused by tumor overgrowth (n = 8) and sludge (n = 1). Two of them underwent coaxial placement of a second stent with good results. The median survival time was 281 days and median primary stent patency was 337 days. There were no significant differences in the patient survival and stent patency rates in relation to age, sex, or Bismuth type.ConclusionPercutaneous placement of the Y-shaped branched covered stent seems to be technically feasible and clinically effective for palliative treatment of malignant hilar biliary obstruction.

  20. An in Vitro Twist Fatigue Test of Fabric Stent-Grafts Supported by Z-Stents vs. Ringed Stents

    Directory of Open Access Journals (Sweden)

    Jing Lin

    2016-02-01

    Full Text Available Whereas buckling can cause type III endoleaks, long-term twisting of a stent-graft was investigated here as a mechanism leading to type V endoleak or endotension. Two experimental device designs supported with Z-stents having strut angles of 35° or 45° were compared to a ringed control under accelerated twisting. Damage to each device was assessed and compared after different durations of twisting, with focus on damage that may allow leakage. Stent-grafts with 35° Z-stents had the most severe distortion and damage to the graft fabric. The 45° Z-stents caused less fabric damage. However, consistent stretching was still seen around the holes for sutures, which attach the stents to the graft fabric. Larger holes may become channels for fluid percolation through the wall. The ringed stent-graft had the least damage observed. Stent apexes with sharp angles appear to be responsible for major damage to the fabrics. Device manufacturers should consider stent apex angle when designing stent-grafts, and ensure their devices are resistant to twisting.