Hydrodynamic Thrombectomy System versus Pulse-Spray Thrombolysis for Thrombosed Hemodialysis Grafts: A Multicenter Prospective Randomized Comparison

Radiology ◽  
2000 ◽  
Vol 217 (3) ◽  
pp. 678-684 ◽  
Author(s):  
Klemens H. Barth ◽  
Mark R. Gosnell ◽  
Aubrey M. Palestrant ◽  
Louis G. Martin ◽  
Jeffrey B. Siegel ◽  
...  
2020 ◽  
Vol 29 (21) ◽  
pp. 1277-1281
Author(s):  
Stephen Taylor ◽  
Alex Manara ◽  
Jules Brown ◽  
Kaylee Sayer ◽  
Rowan Clemente ◽  
...  

Electromagnetic (EM) guided enteral tube placement may reduce lung misplacement to almost zero in expert centres, but more than 60 undetected misplacements had occurred by 2016 resulting in major morbidity or death. Aim: Determine the accuracy of manufacturer guidance in trace interpretation against what is referred to as the ‘GI flexure system’. Methods: The authors prospectively observed the accuracy of the ‘GI flexure system’ of trace interpretation against manufacturer guidance in primary nasointestinal (NI) tube placements. Findings: Contrary to manufacturer guidance, 33% of traces deviated >5 cm from the sagittal midline and 26.5% were oesophageal when entering the lower left quadrant, incorrectly indicating lung and gastric placement, respectively. Conversely, the GI flexure system identified ≥99.4% of GI traces when they reached the gastric body flexure; 100% at the superior duodenal flexure. All lung misplacements were identified by the absence of GI flexures. Conclusion: Current manufacturer guidance should be updated to the GI flexure system of interpretation.


Author(s):  
David Berry

AbstractHealthcare is fully embracing the promise of Big Data for improving performance and efficiency. Such a paradigm shift, however, brings many unforeseen impacts both positive and negative. Healthcare has largely looked at business models for inspiration to guide model development and practical implementation of Big Data. Business models, however, are limited in their application to healthcare as the two represent a complicated system versus a complex system respectively. Healthcare must, therefore, look toward other examples of complex systems to better gauge the potential impacts of Big Data. Military systems have many similarities with healthcare with a wealth of systems research, as well as practical field experience, from which healthcare can draw. The experience of the United States Military with Big Data during the Vietnam War is a case study with striking parallels to issues described in modern healthcare literature. Core principles can be extracted from this analysis that will need to be considered as healthcare seeks to integrate Big Data into its active operations.


Author(s):  
Md Shakir Mahmud ◽  
Matthew Motz ◽  
Travis Holpuch ◽  
Jordan Hankin ◽  
Anthony J. Ingle ◽  
...  

A series of field evaluations was performed at three freeway interchange ramps in Michigan that possessed significant horizontal curvature to assess the impacts of a dynamic speed feedback sign (DSFS) on driver speed selection and brake response while approaching and entering the ramp curve. A DSFS with a 15 in. full-matrix display was temporarily installed at each of the three exit ramp locations. The sign was programmed to display the same feedback message at each location, which included the speed number for all approaching vehicles, which alternated with a “Slow Down” message for vehicles approaching above 40 mph. The effectiveness of the feedback sign was tested across various sign locations (at the point of curvature versus 350 ft upstream), interchange types (system versus service), time of day (peak versus off-peak), light conditions (daylight versus darkness), and vehicle types (passenger vehicles versus trucks). Compared with the pre-DSFS site condition, the DSFS reduced curve entry speeds and improved brake response at two of the three ramp locations. In general, the greatest beneficial effects on driver behavior were achieved when the DSFS was positioned at the point of curvature, during which curve entry speeds were reduced by approximately 2 mph. These findings were consistent between the system interchanges and service interchanges, and across all vehicle types. The DSFS was also found to be most effective during daytime off-peak periods compared with peak periods and at night. Further evaluation of DSFS at additional ramp locations, and considering an expanded set of conditions, is recommended.


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