scholarly journals Adoption of minimally invasive mitral valve surgery in the NHS. A blend of science and psychology.

2021 ◽  
Author(s):  
Megan Joffe ◽  
Steven Hunter ◽  
Roberto Casula ◽  
Inderpaul Birdi ◽  
Ranjit Deshpande ◽  
...  
Keyword(s):  
National Health System ◽  
Mitral Valve Surgery ◽  
Surgical Innovation ◽  
General Belief ◽  
Early Adopters ◽  
Self Reflection ◽  
Early Adoption ◽  
Individual Personality ◽  
Mitral Surgery ◽  
Qualitative Exploration

OBJECTIVES The objectives of this study were to understand the challenges faced by early adopters of MIS mitral surgery in the national health system in the United Kingdom. It was to (i) capture the significance of the scrutiny introduced by reporting surgeon specific results during the introduction of surgical innovation, (ii) understand how individual personality and behaviour helped these surgeons succeed despite, in many cases, little wider support, (iii) to help more surgeons adopt these patient-centred techniques. SETTING AND PARTICIPANTS The study is based on a qualitative exploration of the reported experiences of all ten early adopters of MIS cardiac surgery in the NHS between 2006-2016. Interviewees were recruited by invitation through their professional society (BISMICS). All interviewees consented to the process; ethical permission was not deemed necessary. RESULTS The experience of introducing surgical innovation into the NHS was unanimously noted to be difficult with few incentives and many systemic and institutional obstacles. Despite this there was a general belief in pushing forward with these patient centred procedures while accumulating the evidence to support it. CONCLUSIONS Individual determination, confidence, mental agility and self-reflection were seen as characteristics of those who were successful. All surgeons agreed that the reporting of surgeon specific results were not conducive to adoption of innovation in teams. Starting a new program as two surgeons appeared to help reduce perceived pressures. Surgical innovation and its early adoption are always likely to be difficult and needs to be recognised as such, within the NHS

Bank External Financing and Early Adoption of SFAS 133

2018 ◽  
Vol 21 (03) ◽  
pp. 1850015
Author(s):  
Sophia I-Ling Wang
Keyword(s):  
Balance Sheet ◽  
Accounting Standards ◽  
Financial Accounting ◽  
External Financing ◽  
Bank Holding Companies ◽  
Holding Companies ◽  
Early Adopters ◽  
Early Adoption ◽  
Derivative Instruments ◽  
Sfas 133

This study examines whether and how US bank holding companies that early adopted Statement of Financial Accounting Standards (SFAS) 133, “Accounting for Derivative Instruments and Hedging Activities,” experience changes in their external financing activities relative to banks that did not early adopt the standard. Consistent with predictions, the study shows that early adopters hold higher and experience greater changes in their leverage compared with nonearly adopters. In addition, early adopters experience greater shifts in weights of liabilities other than insured deposits in banks’ funding mix. This finding is consistent with banking literature which states that banks have shifted towards nondeposit debts to finance their balance sheet growth.

scholarly journals Astrophysical Supercomputing with GPUs: Critical Decisions for Early Adopters

2011 ◽  
Vol 28 (1) ◽  
pp. 15-27 ◽  
Author(s):  
Christopher J. Fluke ◽  
David G. Barnes ◽  
Benjamin R. Barsdell ◽  
Amr H. Hassan
Keyword(s):  
Graphics Processing Units ◽  
High Performance ◽  
Best Practice ◽  
New Technology ◽  
General Purpose ◽  
Third Party ◽  
Early Adopters ◽  
Early Adoption ◽  
Open Standard ◽  
Effective Use

AbstractGeneral-purpose computing on graphics processing units (GPGPU) is dramatically changing the landscape of high performance computing in astronomy. In this paper, we identify and investigate several key decision areas, with a goal of simplifying the early adoption of GPGPU in astronomy. We consider the merits of OpenCL as an open standard in order to reduce risks associated with coding in a native, vendor-specific programming environment, and present a GPU programming philosophy based on using brute force solutions. We assert that effective use of new GPU-based supercomputing facilities will require a change in approach from astronomers. This will likely include improved programming training, an increased need for software development best practice through the use of profiling and related optimisation tools, and a greater reliance on third-party code libraries. As with any new technology, those willing to take the risks and make the investment of time and effort to become early adopters of GPGPU in astronomy, stand to reap great benefits.

scholarly journals A Snapshot of Early Adopters of E-journals: Challenges to the Library

2002 ◽  
Vol 63 (6) ◽  
pp. 515-526 ◽  
Author(s):  
Martin J. Brennan ◽  
Julie M. Hurd ◽  
Deborah D. Blecic ◽  
Ann C. Weller
Keyword(s):  
Electronic Journals ◽  
Early Adopters ◽  
Research And Teaching ◽  
Library Resources ◽  
Usage Patterns ◽  
Changing Practices ◽  
Perceptions And Expectations ◽  
The University ◽  
Qualitative Exploration ◽  
The Impact

Studies documenting the usage patterns of electronic journals have compared print and e-journal characteristics, surveyed faculty for their perceptions and expectations, and analyzed the impact on library practices. This study, a qualitative exploration of a wide array of issues related to the research and teaching habits of early adopters of e-journals in a research setting, was conducted in the spring of 2001 with faculty in the basic and health sciences at the University of Illinois at Chicago. Open-ended questionnaires provided a framework to wide-ranging discussions of perceptions, expectations, and changing practices pertaining to e-journals and other electronic resources. The results were analyzed with a specific focus on shared behaviors and values, discipline-dependent variations, and changing research and teaching habits. Several challenges for library resources and services are identified and discussed.

The Use of the Mini-Cardiopulmonary Bypass Circuit in Robotic Mitral Valve Surgery

2008 ◽  
Vol 3 (1) ◽  
pp. 16-18 ◽  
Author(s):  
Robert W. Emery ◽  
Goya V. Raikar ◽  
Barbara Murphy ◽  
Anton Rohan ◽  
Kris Nielsen
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
High Efficiency ◽  
Mitral Valve Surgery ◽  
Circulatory Support ◽  
Valve Repair ◽  
Mitral Repair ◽  
Perfusion Time ◽  
Mitral Surgery

Background Computer enabled robotic mitral valve repair cases have longer cross-clamp and perfusion times because of the more technically difficult procedure. To modify some of the well-documented side effects of standard cardiopulmonary bypass (CPB), we used a new mini-circuit on three robotic mitral cases. Methods Three patients having mitral valve repair (triangular resection of P2 and annuloplasty ring) using the daVinci Robot (Intuitive Surgical, Sunnyvale, CA) had circulatory support using a modified Resting Heart System (Medtronic, Inc., Fridley, MN), a vertically oriented space saving CPB configuration incorporating a high efficiency miniaturized oxygenator, centrifugal pump, shortened heparin coated tubing and an air evacuation system with a closed circuit. Results All patients had successful mitral repair (echo = 0 to trace residual leakage) under a cross-clamp time of 161 ± 54 minutes and perfusion time of 229 ± 31 minutes. No blood was given during CPB and 0.7 ± 1.2 red cell units after the CPB run and 0.7 ± 1.2 units during the postoperative course. Conclusion Miniaturized bypass circuit reducing the level of necessary anticoagulation, hemodilation, and blood trauma can be used despite the increased perfusion time necessary for robotic mitral surgery.

scholarly journals Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The Mitral Surgery in Octogenarians study

2018 ◽  
Vol 155 (4) ◽  
pp. 1474-1482.e2 ◽  
Author(s):  
Pierpaolo Chivasso ◽  
Vito D. Bruno ◽  
Shakil Farid ◽  
Pietro Giorgio Malvindi ◽  
Amit Modi ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Degenerative Disease ◽  
Mitral Surgery ◽  
Surgery In Octogenarians

scholarly journals Adolescents’ adoption of COVID-19 preventive measures during the first months of the pandemic: what led to early adoption?

2021 ◽  
Vol 41 (12) ◽  
Author(s):  
Claude Bacque Dion ◽  
Richard Bélanger ◽  
Scott T. Leatherdale ◽  
Slim Haddad
Keyword(s):  
Structural Equation ◽  
Structural Equation Models ◽  
Preventive Measures ◽  
Anxiety Level ◽  
Perception Of Risk ◽  
Related Factors ◽  
Early Adopters ◽  
Preventive Practices ◽  
Early Adoption ◽  
Study Participants

Introduction The objectives of this study were to explore the extent to which adolescents adopted COVID-19 preventive measures in the first few months of the pandemic and to understand their adoption by looking at interconnected adoption-related factors and determining the strength of these factors, particularly among subgroups not expected to be early adopters. Methods Analyses focus on data collected during Spring 2020 from 29 eastern Quebec secondary schools that participated in the COMPASS study. Participants (n = 6052) self-reported their knowledge, perception of risk and preventive practices to do with the COVID-19 pandemic. Data were analyzed using structural equation models based on gender and anxiety level. Results The majority of respondents reported adopting the recommended COVID-19 preventive measures. The results showed three paths leading to adolescents’ adoption of these measures: pandemic knowledge; perception of risk related to COVID-19; and, in particular, discussions with relatives about preventive measures and what to do in case of infection. Conclusion While most of the adolescent participants in this study appeared to comply with COVID-19 preventive measures, factors such as discussions with relatives emerge as elements to foster in order to improve adolescents’ adoption of preventive measures.

Contemporary outcomes in reoperative mitral valve surgery

Heart ◽  
2017 ◽  
Vol 104 (8) ◽  
pp. 652-656 ◽  
Author(s):  
Hunter J Mehaffey ◽  
Robert B Hawkins ◽  
Sarah Schubert ◽  
Clifford Fonner ◽  
Leora T Yarboro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Artery Bypass ◽  
Random Effect ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Resource Utilisation ◽  
Regional Society ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Mitral Surgery

ObjectiveData suggest that redo mitral valve surgery is being performed in increasing numbers, possibly with superior results according to single-centre studies. The purpose of this study is to describe outcomes of redo mitral valve surgery and identify risk-adjusted predictors of poor outcomes.MethodsAll (11 973) open mitral valve cases were evaluated (2002–2016) from a regional Society of Thoracic Surgery (STS) database. Patients were stratified by primary versus redo mitral valve surgery. Mixed effects logistic regression models including hospital as a random effect were used to identify risk factors for patients undergoing redo mitral valve surgery.ResultsOf all mitral valve cases, 1096 (9.7%) had a previous mitral operation. Redo patients had higher rates of valve replacement and preoperative comorbidities resulting in more complications, operative mortalities (11.1%vs6.5%, p<0.0001) and higher resource utilisation. Several factors independently increased risk for composite STS major morbidity and 30-day mortality, including cardiogenic shock (OR 10.3, p=0.0001), severe tricuspid insufficiency (OR 2.3, p=0.001), urgent/emergent status (OR 1.8, p=0.001) and concurrent coronary artery bypass grafting (OR 2.4, p=0.002). The volume of redo mitral valve surgery increased 10% per year and the observed-to-expected ratios (O/E) for operative mortality in redo mitral surgery improved from 1.44 early in the study period to 0.72 in the most recent era.ConclusionsRedo mitral valve surgery accounts for approximately 10% of mitral valve operations and is associated with increased risk and resource utilisation. However, as the volume of redo mitral surgery increases, outcomes have dramatically improved and are now better than predicted.

Exclusion versus preservation of the left atrial appendage in rheumatic mitral valve surgery

Heart ◽  
2020 ◽  
Vol 106 (23) ◽  
pp. 1839-1846 ◽  
Author(s):  
Wan Kee Kim ◽  
Ho Jin Kim ◽  
Joon Bum Kim ◽  
Sung Ho Jung ◽  
Suk Jung Choo ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Mitral Valve Surgery ◽  
Atrial Appendage ◽  
Clinical Events ◽  
Propensity Matching ◽  
Mitral Surgery ◽  
The Impact

ObjectivesThis study aimed to evaluate the impact of left atrial appendage exclusion on clinical outcomes in patients with atrial fibrillation (AF) undergoing rheumatic mitral surgery.MethodsWe retrospectively reviewed 1226 consecutive patients with AF (54.5±11.6 years; 68.2% females) who underwent rheumatic mitral valve (MV) surgery from 1997 to 2016. The left atrial appendage was preserved in 836 (68.2%) and excluded in 390 (31.8%) patients. Surgical AF ablation was performed in 506 (60.5%) and 304 (77.9%) patients with preserved and excluded left atrial appendage, respectively. For baseline adjustment, propensity matching was used.ResultsDuring a median follow-up of 63.4 months (IQRs, 20–111 months), there were no significant intergroup differences in the risks of mortality (2.77% vs 3.03%/patient-years) and thromboembolic events (0.91% vs 1.02%/patient-years). In the 258 pairs of propensity-score matched patients, death (2.77% vs 3.03%/patient-years) and thromboembolism (1.36% vs 0.82%/patient-years) outcomes were comparable for both groups. In a subgroup undergoing ablation (n=810), there were no significant differences in the adjusted risks of death (HR, 0.67; 95% CI, 0.34 to 1.32) and thromboembolism (HR, 0.47; 95% CI, 0.18 to 1.26). In a subgroup not undergoing ablation (n=416), however, left atrial appendage preservation tended to have higher adjusted risks for death (HR, 2.24; 95% CI, 0.98 to 5.13) and thromboembolism (HR, 4.41; 95% CI, 0.97 to 20.1).ConclusionsLeft atrial appendage preservation did not seem to have greater risks of adverse clinical events in patients with AF undergoing rheumatic MV surgery particularly when ablation procedure is combined.

scholarly journals A propensity matched analysis of robotic, minimally invasive, and conventional mitral valve surgery

Heart ◽  
2018 ◽  
Vol 104 (23) ◽  
pp. 1970-1975 ◽  
Author(s):  
Robert B Hawkins ◽  
J Hunter Mehaffey ◽  
Matthew G Mullen ◽  
Wiley L Nifong ◽  
W Randolph Chitwood ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Complication Rates ◽  
Robotic Approach ◽  
Regional Society ◽  
Average Hospital ◽  
Invasive Approach ◽  
Mitral Surgery

ObjectivesInstitutional studies suggest robotic mitral surgery may be associated with superior outcomes. The objective of this study was to compare the outcomes of robotic, minimally invasive (mini), and conventional mitral surgery.MethodsA total of 2300 patients undergoing non-emergent isolated mitral valve operations from 2011 to 2016 were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by approach: robotic (n=372), mini (n=576) and conventional sternotomy (n=1352). To account for preoperative differences, robotic cases were propensity score matched (1:1) to both conventional and mini approaches.ResultsThe robotic cases were well matched to the conventional (n=314) and mini (n=295) cases with no significant baseline differences. Rates of mitral repair were high in the robotic and mini cohorts (91%), but significantly lower with conventional (76%, P<0.0001) despite similar rates of degenerative disease. All procedural times were longest in the robotic cohort, including operative time (224 vs 168 min conventional, 222 vs 180 min mini; all P<0.0001). The robotic approach had comparable outcomes to the conventional approach except there were fewer discharges to a facility (7% vs 15%, P=0.001) and 1 less day in the hospital (P<0.0001). However, compared with the mini approach, the robotic approach had more transfusions (15% vs 5%, P<0.0001), higher atrial fibrillation rates (26% vs 18%, P=0.01), and 1 day longer average hospital stay (P=0.02).ConclusionDespite longer procedural times, robotic and mini patients had similar complication rates with higher repair rates and shorter length of stay metrics compared with conventional surgery. However, the robotic approach was associated with higher atrial fibrillation rates, more transfusions and longer postoperative stays compared with minimally invasive approach.

Unrecognized Cardiac Amyloidosis at the Time of Mitral Valve Surgery: Incidence and Outcomes

Cardiology ◽  
2019 ◽  
Vol 142 (4) ◽  
pp. 253-258 ◽  
Author(s):  
Bo Xu ◽  
Carlos Godoy Rivas ◽  
E. Rene Rodriguez ◽  
Carmela Tan ◽  
A. Marc Gillinov ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Cardiac Amyloidosis ◽  
Cardiac Tissue ◽  
Severe Aortic Stenosis ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Transcatheter Valve ◽  
Mitral Surgery ◽  
Surgery Incidence

Objective: It is increasingly recognized that cardiac amyloidosis can occur in patients with severe aortic stenosis undergoing both surgical and transcatheter valve replacements. We aimed to investigate whether unrecognized cardiac amyloidosis may also occur in patients with severe mitral valve disease undergoing surgery. Methods: The pathology department database at our center was retrospectively analyzed over a 10-year period for cases in which the mitral valve or another type of cardiac tissue removed at the time of mitral surgery demonstrated incidental amyloidosis. Clinical and echocardiographic variables were collected from the electronic medical record and the echocardiographic database. Results: Between 2007 and 2016, a total of 7,733 mitral valve surgical specimens were received. Of these, there were 15 cases in which the mitral valve, or another type of cardiac tissue removed at surgery, demonstrated incidentally detected amyloidosis. The most frequent comorbidities were hypertension (87%) and atrial fibrillation (80%); 13 patients (87%) underwent bioprosthetic mitral valve replacement, and 2 patients (13%) underwent mitral valve repair. Sites of amyloid deposition were the mitral valve (80%), left atrial appendage (33%), and subaortic tissue (7%); 14 patients (93%) had wild-type transthyretin amyloid. The mean duration of follow-up was 1,023 days (range: 29–2,811 days). There were no surgical complications in the follow-up period. Conclusions: Over a 10-year period, incidentally detected cardiac amyloidosis occurred in 0.2% of the mitral valve surgical cases. The outcomes for these patients undergoing mitral valve surgery were excellent, with no complications or deaths attributable to surgery at a mean follow-up of 1,023 days.

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