Angioplasty and Stenting for Intracranial Atherosclerotic Stenosis With Nitinol Stent: Factors Affecting Technical Success and Patient Safety

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons104-ons113 ◽  
Author(s):  
Simon Chun Ho Yu ◽  
Thomas Wai Hong Leung ◽  
Esther Hiu Yee Hung ◽  
Kwok Tung Lee ◽  
Lawrence Ka Sing Wong
Keyword(s):  
Patient Safety ◽  
Failure Rate ◽  
Balloon Catheter ◽  
Technical Failure ◽  
Related Factors ◽  
End Points ◽  
Technical Problems ◽  
Vascular Morphology ◽  
Initial Failure ◽  
Angioplasty And Stenting

Abstract BACKGROUND: Angioplasty and stenting using nitinol stents is a recognized treatment option for intracranial atherosclerosis. OBJECTIVE: To identify procedure-related factors that may affect patient safety and technical outcome. METHODS: In this prospective study of 57 consecutive patients, the primary end points were intraprocedural technical problems, periprocedure morbidity, and complications. Major periprocedure complication was defined as all stroke or death at 30 days. Technical failure was defined as the inability to complete the procedure because of technical or safety problems. Procedure failure was defined as a procedure outcome of technical failure or major periprocedure complication. Secondary end points were procedure-related factors that may affect patient safety and technical outcome. RESULTS: Procedure failure rate was 12.3% (7/57) (major periprocedure complication rate, 5.3% [3/57]; technical failure rate, 7% [4/57]). Initial failure in tracking of balloon or stent occurred in 20 patients, other technical problems occurred in 11 patients, including kinking or trapping of balloon catheter (2 cases), difficulty in unsheathing of stent (3 cases), forward migration of stent during deployment (4 cases), trapping of nose cone after stent deployment (1 case), fracture of delivery system (2 cases), and guidewire fracture (1 case). Unfavorable vascular morphology signified by the presence of 2 or more reverse curves along the access path was found to associate with initial failure in the tracking of instruments (OR = ∞), and occurrence of other technical problems (OR = 25). CONCLUSION: Procedure-related factors could be identified and lead to improvements in patient safety and technical outcome. Tortuous vascular morphology is a key factor to be overcome.

scholarly journals Adverse Events in Home-Care Nursing Agencies and Related Factors: A Nationwide Survey in Japan

2021 ◽  
Vol 18 (5) ◽  
pp. 2546
Author(s):  
Noriko Morioka ◽  
Masayo Kashiwagi
Keyword(s):  
Adverse Event ◽  
Patient Safety ◽  
Adverse Events ◽  
Home Care ◽  
Process Of Care ◽  
Related Factors ◽  
Cross Sectional ◽  
Home Care Nursing ◽  
Number Of Patients ◽  
Care Nursing

Despite the importance of patient safety in home-care nursing provided by licensed nurses in patients’ homes, little is known about the nationwide incidence of adverse events in Japan. This article describes the incidence of adverse events among home-care nursing agencies in Japan and investigates the characteristics of agencies that were associated with adverse events. A cross-sectional nationwide self-administrative questionnaire survey was conducted in March 2020. The questionnaire included the number of adverse event occurrences in three months, the process of care for patient safety, and other agency characteristics. Of 9979 agencies, 580 questionnaires were returned and 400 were included in the analysis. The number of adverse events in each agency ranged from 0 to 47, and 26.5% of the agencies did not report any adverse event cases. The median occurrence of adverse events was three. In total, 1937 adverse events occurred over three months, of which pressure ulcers were the most frequent (80.5%). Adjusting for the number of patients in a month, the percentage of patients with care-need level 3 or higher was statistically significant. Adverse events occurring in home-care nursing agencies were rare and varied widely across agencies. The patients’ higher care-need levels affected the higher number of adverse events in home-care nursing agencies.

scholarly journals Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

2015 ◽  
Vol 8 (6) ◽  
pp. 75 ◽  
Author(s):  
Mu'taman Jarrar ◽  
Hamzah Abdul Rahman ◽  
Mohammad Sobri Don
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Health Plan ◽  
Care Service ◽  
Health Care Service ◽  
Working Environment ◽  
Annual Reports ◽  
Related Factors ◽  
Global Initiatives

<p><strong>BACKGROUND &amp; OBJECTIVE:</strong> Demand for health care service has significantly increased, while the quality of healthcare has become both a national and an international priority. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia.</p><p><strong>DESIGN:</strong> A narrative review of the literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) and the MOH Annual Reports in Malaysia were reviewed.</p><p><strong>RESULTS: </strong>The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10<sup>th</sup> Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors.</p><p><strong>CONCLUSION: </strong>There is no single intervention of optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.</p>

scholarly journals Varicocele surgery or embolization: Which is better?

2013 ◽  
Vol 6 (4) ◽  
pp. 266 ◽  
Author(s):  
Darby Cassidy ◽  
Keith Jarvi ◽  
Ethan Grober ◽  
Kirk Lo
Keyword(s):  
Failure Rate ◽  
Attractive Alternative ◽  
Published Data ◽  
Technical Failure ◽  
Failure Rates ◽  
Male Factor Infertility ◽  
Male Factor ◽  
Gonadal Vein ◽  
Microsurgical Approach ◽  
The Right

Introduction: Varicocele remains the most commonly identifiedcorrectable cause of male factor infertility. Surgical correction isthe most commonly performed technique to treat varicoceles with a technical failure rate of less than 5%. An attractive alternative to surgery is the selective catheterization and embolization of the gonadal vein. This data are limited by small series.Methods: We reviewed a total of 158 patients. These patientsunderwent embolization for clinical varicoceles and male factorinfertility between 2004 and 2008. Of these, 56% underwentattempted bilateral embolization, 43% unilateral left-sided embolization and 1.3% unilateral right-sided embolization.Results: Of these patients who underwent attempted bilateralembolization, 19.3% did not experience a successful obliterationof the right gonadal vein and 2.3% (2/88) experienced a failure rate in the embolization of the left gonadal vein. Of the 2 attempts at unilateral right-sided embolization, there were no failures. Of the 68 unilateral left-sided embolization attempts, there was a 4.4% failure rate. Of all of the right-sided embolization attempts, 18.9% failed, while 3.2% of the left-sided attempts failed.Conclusion: This review represents the largest contemporary series of varicocele embolization outcomes currently in the literature. Our 19.3% technical failure rate for bilateral varicocele embolization is higher than the current published rate of 13% and is largely related to failure to successfully occlude the right gonadal vein. This supports our belief that bilateral varicoceles are best managed with a primary microsurgical approach, where technical failure rates are expected to be less than 5% based on published data. Men withunilateral left-sided varicoceles should be offered both options as they have similar failure rates, but with embolization offering some clear advantages to the patient.

scholarly journals Clinical field-testing of ATLAS prosthetic system for trans-tibial amputees

2002 ◽  
Vol 26 (2) ◽  
pp. 86-92 ◽  
Author(s):  
J. S. Jensen ◽  
W. Raab
Keyword(s):  
Patient Safety ◽  
Failure Rate ◽  
Field Testing ◽  
Tropical Areas ◽  
In Trans

The ATLAS prosthetic system was tested on 81 trans-tibial amputees in two tropical areas and followed for about two years. At the conclusion 19% (15/81) had given up its use; mostly because of unsatisfactory socket fit, but in 7% (6/81) system related failures were the cause of non-compliance; mostly because of a shrieking noise from the shin-foot piece during use. System related failures were encountered in 62% (41/66) of users; the most serious threat to patient safety was fractures of the shank in 39% (26/66) and badly worn feet in 12% (8/66). With a failure rate of about 41% after one and a half years the ATLAS system is considered unacceptable for general use in trans-tibial amputees.

scholarly journals Clinical Results and Problems of Percutaneous Transluminal Angioplasty and Stenting for Extracranial Internal Carotid Stenoses

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 41-44
Author(s):  
M. Tsuura ◽  
T. Terada ◽  
O. Masuo ◽  
H. Matsumoto ◽  
T. Itakura ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Balloon Catheter ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Symptomatic Case ◽  
Carotid Stenoses ◽  
Angioplasty And Stenting ◽  
Ica Stenosis ◽  
Percutaneous Transluminal ◽  
Extracranial Ica

110 patients with extracranial ICA stenosis were treated by PTA or stenting. In 21 of 55 cases of only PTA and in 40 of 55 cases of stenting, we used our blocking balloon systems to prevent distal embolism. The morbidity and the mortality rates were 5.4% and 0%, respectively. There was only one embolic complication in cases of PTA or stenting where blocking balloon systems were used. In contrast, distal embolism occurred in 3 of 34 cases of PTA without blocking balloon systems (one symptomatic case) and in 4 of 15 cases of stenting without blocking balloon systems (3 symptomatic cases). Our blocking balloon catheter system is a useful device to reduce the risk of symptomatic distal embolism.

scholarly journals Mixed-method investigation of health consumers’ perception and experience of participation in patient safety activities

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035831
Author(s):  
Nam-Ju Lee ◽  
Shinae Ahn ◽  
Miseon Lee
Keyword(s):  
Patient Safety ◽  
Focus Group ◽  
Patient Participation ◽  
Healthcare Providers ◽  
Willingness To Participate ◽  
Focus Group Interviews ◽  
Related Factors ◽  
Healthcare Environment ◽  
Health Consumers ◽  
Group Interviews

ObjectivesThis study aimed to examine the factors influencing patient safety behaviours and to explore health customers’ experiences of patient participation in the healthcare system.DesignA mixed-method sequential explanatory design was employed using a survey and focus group interviews with health consumers.SettingThe study was conducted in South Korea using an online survey tool.ParticipantsSurvey data were collected from 493 Korean adults, aged 19 years or older, who had visited hospitals within the most recent 1 year. Focus group interviews were conducted in two groups of six participants each among those of the survey participants who agreed to participate in focus groups.Main outcome measuresThe survey measured the recognition of the importance of participation, extent of willingness to participate and experience of engaging in patient safety activities using a 4-point Likert scale. Qualitative data were collected through focus group interviews to explore health consumers’ experience of patient participation in hospital care, and the data were analysed using content analysis.ResultsThe average score for experience of participation in patient safety behaviours (2.13±0.63) was found to be lower than those of recognition of the importance of participation (3.27±0.51) and willingness to participate (2.62±0.52). By integrating the results of the quantitative and qualitative data analysis, the factors associated with the experience of engaging in healthcare behaviour included patient-related factors, illness-related factors, factors involving relationship between patients and healthcare providers, and healthcare environment factors.ConclusionsTo improve patient participation, it is necessary to create a healthcare environment in which patients can speak comfortably and to provide an education programme reflecting the patients’ needs. Also, healthcare providers must consider patients as partners for patient safety. Shared decision-making procedures and patient-centred care and patient safety policies should be established in hospitals.

Balloon Occlusion of Subintimal Tract to Assist Distal Luminal Re-entry During Subintimal Recanalization of Chronic Total Occlusions

2018 ◽  
Author(s):  
Abdel Aziz A. Jaffan
Keyword(s):  
Failure Rate ◽  
Peripheral Circulation ◽  
Balloon Occlusion ◽  
Technical Failure ◽  
True Lumen ◽  
Chronic Total Occlusions ◽  
Femoropopliteal Artery ◽  
Endovascular Recanalization ◽  
Difficult Cases ◽  
Established Technique

The balloon occlusion of subintimal tract (BOST) technique may be used to assist in regaining luminal re-entry in difficult cases during subintimal recanalization of chronic total occlusions in the femoropopliteal artery. Subintimal recanalization or percutaneous intentional extraluminal recanalization (PIER) is an established technique used in endovascular recanalization of chronically occluded arteries of the peripheral circulation. The primary limitation of PIER is the high technical failure rate. Failure is mainly due to the inability to re-enter the patent true lumen distal to the site of the occlusion. The BOST technique can help overcome this limitation. This chapter provides a description of the technique.

An epistemology of patient safety research: a framework for study design and interpretation. Part 3. End points and measurement

2008 ◽  
Vol 17 (3) ◽  
pp. 170-177 ◽  
Author(s):  
C Brown ◽  
T Hofer ◽  
A Johal ◽  
R Thomson ◽  
J Nicholl ◽  
...  
Keyword(s):  
Patient Safety ◽  
Study Design ◽  
End Points ◽  
Safety Research

scholarly journals Screening, Management, and Acceptance of Patients with Aorto-Iliac Vascular Disease for Kidney Transplantation: A Survey among 161 Transplant Surgeons

2021 ◽  
pp. 1-8
Author(s):  
Elsaline Rijkse ◽  
Hendrikus J.A.N. Kimenai ◽  
Frank J.M.F. Dor ◽  
Jan N.M. IJzermans ◽  
Robert C. Minnee
Keyword(s):  
Kidney Transplantation ◽  
Vascular Disease ◽  
Related Factors ◽  
Vascular Surgeon ◽  
Technical Problems ◽  
Cardiovascular Comorbidity ◽  
Tertiary Center ◽  
Risk Patients ◽  
Transplant Candidates ◽  
Vascular Procedure

<b><i>Introduction:</i></b> Aorto-iliac vascular disease (AVD) is frequently found during the workup for kidney transplantation. However, recommendations on screening and management are lacking. We aimed to assess differences in screening, management, and acceptance of these patients for transplantation by performing a survey among transplant surgeons. Second, we aimed to identify center- and surgeon-related factors associated with decline or acceptance of kidney transplant candidates with AVD. <b><i>Methods:</i></b> A survey was sent to transplant surgeons and urologists. The survey contained general questions (part I) and 2 patient-based cases (part II) with Trans-Atlantic Inter-Society Consensus (TASC) D and B AVD supported with videos of their CT scans. <b><i>Results:</i></b> One hundred ninety-one (20.3%) participants responded; 171 were currently involved in kidney transplantation: 161 (94.2%) completed part I and 145 (84.8%) part II. Screening for AVD was often (38.5%) restricted to high-risk patients. The majority of respondents (67.7%) rated “technical problems” as the most important concern in case of AVD, followed by “increased mortality risk because of cardiovascular comorbidity” (29.8%). Pretransplant vascular interventions to facilitate transplantation were infrequently performed (71.4% mentioned &#x3c;10 per year). Ninety (64.3%) respondents answered that an open vascular procedure should preferably be performed prior to kidney transplantation while 42 (30.0%) respondents preferred a simultaneous open vascular procedure. The decline rate was higher in the TASC D case compared to the TASC B case (26.9% and 9.7%, respectively). Respondents from centers with expertise in pretransplant vascular interventions were more likely to accept both patients with TASC D and B for transplantation. <b><i>Conclusion:</i></b> There is no uniformity in the screening, management, and acceptance of patients with AVD for transplantation. If a center declines a patient with AVD because of technical concerns, the patient should be referred for a second opinion to a tertiary center with expertise in pretransplant vascular interventions. Multidisciplinary meetings including a vascular surgeon and a cardiologist could help optimize these patients for transplantation.

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