Improve Success Rates Research Articles

Improving neonatal intubation safety: A journey of a thousand miles.

Neonatal intubation is one of the most common procedures performed by neonatologists, however, the procedure is difficult and high risk. Neonates who endure the procedure often experience adverse events, including bradycardia and severe oxygen desaturations. Because of low first attempt success rates, neonates are often subjected to multiple intubation attempts before the endotracheal tube is successfully placed. These factors conspire to make intubation one of the most dangerous procedures in neonatal medicine. In this commentary we review key elements in the journey to improve neonatal intubation safety. We begin with a review of intubation success rates and complications. Then, we discuss the importance of intubation training. Next, we examine quality improvement efforts and patient safety research to improve neonatal intubation safety. Finally, we evaluate new tools which may improve success rates, and decrease complications during neonatal intubation.

The Status of Biofilms in Penile Implants.

Erectile dysfunction is prevalent among men and will continue to become more so with the aging population. Of the available treatment options, implantable prosthetic devices are typically thought of as a third line treatment even though they have the highest satisfaction rate and continually improving success rates. Infection and mechanical failure are the most common reasons for implant revision in the past. Since the development of more reliable devices, bacterial biofilms are coming to the forefront of discussion as causes of required revision. Biofilms are problematic as they are ubiquitous and exceedingly difficult to prevent or treat.

Treat the Patient, Not the Angiogram.

Opposing Viewpoint, see p 1385 Millions of people are living with refractory angina and ischemic pain despite maximal medical therapy and are told that they have no revascularization option. The most common reason patients are told that they have no option for revascularization is the presence of a coronary chronic total occlusion (CTO).1 Although no rigorous data exist, anecdotally, the majority of CTOs are now approachable with percutaneous techniques using drug-eluting stents owing to advances in the techniques that have resulted in improved success rates regardless of anatomy (>85%) and significant relief of ischemic symptoms while maintaining adequate safety. However, attempt rates for CTO percutaneous coronary intervention (PCI) range from 1% to 16% between institutions.2 The question then arises: Among patients with a good indication for revascularization (particularly those with refractory angina and a CTO), why are so many not offered revascularization options? Here, the Canadian Cardiovascular Society Task Force on Refractory Angina provides some insights: “…[T]he nonrevascularization status will be influenced by the local expertise and operator tolerance to risk.”3 Controversy persists over what constitutes a good indication for CTO PCI. Although observational data are encouraging, it is important to acknowledge that the potential for CTO PCI to improve survival remains unproven. Until such data are available from randomized trials, asymptomatic patients can only be informed about the uncertain benefits …

Using an array of implementation strategies to improve success rates of pharmacist-initiated medication therapy management services in community pharmacies.

With the introduction of the Centers for Medicare and Medicaid Services Stars Measure program has come a greater expectation of Medication Therapy Management (MTM) services from community pharmacies. To meet the growing demand of these services, pharmacies have sought out various methods of engaging pharmacists to provide MTM. Barriers for completing MTM include inadequate time to complete the services, insufficient staffing, lack of sufficient compensation, billing difficulty, lack of interest among patients (including refusing MTM services when offered), inadequate training/experience, and lack of support from management. To evaluate the impact of a financial incentive alone versus the incentive plus a package of individualized implementation strategies on the success rate of MTM services. To increase MTM completion rates, The Kroger Company implemented a financial incentive for pharmacists in one of its market services areas. The following year the incentive was continued and an array of training and support strategies were implemented. The numbers of MTM claims and success rates for 2013 (no intervention), 2014 (financial incentive alone), and 2015 (incentive plus required training and ongoing support) were compared. A total of 7038 claims were extracted from 2013 to 2015. The number of completed claims had increased from 1385 in 2013 to 3265 in 2015. The total MTM success rates rose significantly from 42.9% in 2013 to 49.0% in 2014 (p=0.001) and to 64.0% in 2015 (p<0.001). A financial incentive plus a package of individualized implementation strategies increases success rates of MTM services compared to a financial incentive alone.

Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review.

ObjectivesTo review the safety and efficacy of surgical management for spontaneous cerebrospinal fluid (CSF) leaks of the anterior and lateral skull base.Data SourcesA systematic review of English articles using MEDLINE.Review MethodsSearch terms included spontaneous, CSF, cerebrospinal fluid, endoscopic, middle fossa, transmastoid, leak, rhinorrhea. Independent extraction of articles by 3 authors.ResultsPatients with spontaneous CSF leaks are often obese (average BMI of 38 kg/m2) and female (72%). Many patients also have obstructive sleep apnea (∼45%) and many have elevated intracranial pressure when measured by lumbar puncture. In addition to thinning of the skull base, radiographic studies also demonstrate cortical bone thinning. Endoscopic surgical repair of anterior skull base leaks and middle cranial fossa (MCF) approach for repair of lateral skull base leaks are safe and effective with an average short‐term failure rate of 9% and 6.5%, respectively. Long‐term failure rates are low. One randomized trial failed to show improved success of anterior leak repairs with the use of a lumbar drain (LD) (95% with vs. 92% without; P = 0.2). In a large retrospective cohort of MCF lateral skull base repairs, perioperative LD use was not necessary in >94% of patients.ConclusionsSpontaneous CSF leaks are associated with female gender, obesity, increased intracranial hypertension, and obstructive sleep apnea. Endoscopic repair of anterior skull base leaks and MCF or transmastoid approaches for lateral skull base leaks have a high success rate of repair. In most cases, intraoperative placement of lumbar drain did not appear to result in improved success rates for either anterior or lateral skull base leaks.Level of Evidence2a, Systematic Review.

Evaluation of a new method to determine the tibial tuberosity advancement distance required to reduce the patellar tendon-tibial plateau angle to 90° with the modified Maquet technique in dogs.

OBJECTIVE To assess use of a new radiographic method to determine the distance by which the tibial tuberosity should be advanced to reduce the patellar tendon-tibial plateau angle (PTA) to 90° by means of the modified Maquet technique (MMT) in dogs. SAMPLE 24 pelvic limbs from 12 adult medium-sized to large-breed canine cadavers. PROCEDURES Radiographs of stifle joints at 135° extension in true lateral position were used to determine tibial tuberosity advancement distances for use in the MMT. A method was devised to incorporate the planned osteotomy axis; distal patellar translations of 0, 3, 5, or 10 mm; and advancement cage implant application level along the osteotomy site in advancement planning measurements. Concordance correlation coefficients (CCCs) were calculated to compare these adjusted advancement measurements with true advancement measurements obtained for the same joints in another study after treatment by MMT. Intraobserver, interobserver, and total agreement for selected measurements were determined by assessment of CCCs for results obtained by 3 blinded observers. RESULTS Agreement between true advancement measurements and measurements obtained with osteotomy axis and cage position method calculations that incorporated a 5-mm distal patellar translation distance was excellent (CCC, 0.96). Intraobserver and interobserver agreements for the planning measurements evaluated were good to excellent (CCC, 0.83 to 0.96). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the osteotomy axis and cage position method incorporating a 5-mm distal patellar translation distance has the potential to improve success rates for achieving a PTA of 90° in medium-sized to large-breed dogs undergoing MMT for treatment of cranial cruciate ligament rupture. Further research is warranted.

Contrast-enhanced US-guided Interventions: Improving Success Rate and Avoiding Complications Using US Contrast Agents.

Ultrasonography (US) is an established modality for intervention. The introduction of microbubble US contrast agents (UCAs) has the potential to further improve US imaging for intervention. According to licensing, UCAs are currently approved for clinical use in restricted situations, but many additional indications have become accepted as having clinical value. The use of UCAs has been shown to be safe, and there is no risk of renal toxic effects, unlike with iodinated or gadolinium contrast medium. Broadly speaking, UCAs can be injected into the bloodstream (intravascular use) or instilled into almost any accessible body cavity (endocavitary use), either in isolation or synchronously. In microvascular applications, contrast-enhanced US (CEUS) enhances delineation of necrotic areas and the vascularized target to improve real-time targeting. The ability of CEUS to allow true assessment of vascularity has also been used in follow-up of devascularizing intervention. In macrovascular applications, real-time angiographic images can be obtained with CEUS without nephrotoxic effects or radiation. In endocavitary applications, CEUS can achieve imaging similar to that of iodinated contrast medium-based fluoroscopy; follow-up to intervention (eg, tubography and nephrostography) can be performed at the bedside, which may be advantageous. The use of UCAs is a natural progression in US-guided intervention. The aim of this article is to describe the indications, contraindications, and techniques of using UCAs as an adjunctive tool for US-guided interventional procedures to facilitate effective treatment, improve complication management, and increase the overall success of interventional procedures. Online supplemental material is available for this article. ©RSNA, 2016.

Gallium and silicon synergistically promote osseointegration of dental implant in patients with osteoporosis

Over the last few decades, a wide variety of dental implants have been successfully placed in jaw bones to restore tooth function. But major challenges still remain in patients with osteoporosis involving compromised osseointegration, and the therapeutic methods is far from optimism. Gallium can directly inhibit bone osteolysis, prevent bone calcium release and augment bone mass, which makes Ga unique among the potential antiresorptive drugs. Silicon, as an indispensable modulator in bone formation, presents its bone anabolic effects, while reduces, at least doesn’t increase, bone resorption. We hypothesize that the combination of bone anabolic effects of Si and antiresorptive effects of Ga will result in synergistic effects on the improvement of osteointegration under osteoporotic condition. In our strategy, in order to maximize the efficacy while minimize the side effects of ions, a novel titania mesoporous layer fabricated by electrochemical anodization on the surface of titanium implant will be employed as a promising local drug delivery system. The synergistic effects of Ga and Si on improving osseointegration will be verified by animal experiments, and be furthered by clinical trials. Our hypothesis could help to create an option to improve success rate of dental implants in osteoporotic patients.

Progress in clinical application of caffeine in neonates

Caffeine is a methylxanthine alkaloid compound, which is not only effective, but also safe and needn′t monitor the plasma concentration for the prevention and treatment of apnea in preterm infants, compared with theophylline.In recent years, it has been reported that caffeine is beneficial to improve weaning extubation success rate, reduce the incidence of bronchopulmonary dysplasia in preterm infants, reduce the risk of surgical closure of patent ductus arteriosus, and improve the long-term neurological outcome in preterm infants. Key words: Caffeine; Apnea; Newborn

The scoring bias in reverse docking and the score normalization strategy to improve success rate of target fishing.

Target fishing often relies on the use of reverse docking to identify potential target proteins of ligands from protein database. The limitation of reverse docking is the accuracy of current scoring funtions used to distinguish true target from non-target proteins. Many contemporary scoring functions are designed for the virtual screening of small molecules without special optimization for reverse docking, which would be easily influenced by the properties of protein pockets, resulting in scoring bias to the proteins with certain properties. This bias would cause lots of false positives in reverse docking, interferring the identification of true targets. In this paper, we have conducted a large-scale reverse docking (5000 molecules to 100 proteins) to study the scoring bias in reverse docking by DOCK, Glide, and AutoDock Vina. And we found that there were actually some frequency hits, namely interference proteins in all three docking procedures. After analyzing the differences of pocket properties between these interference proteins and the others, we speculated that the interference proteins have larger contact area (related to the size and shape of protein pockets) with ligands (for all three docking programs) or higher hydrophobicity (for Glide), which could be the causes of scoring bias. Then we applied the score normalization method to eliminate this scoring bias, which was effective to make docking score more balanced between different proteins in the reverse docking of benchmark dataset. Later, the Astex Diver Set was utilized to validate the effect of score normalization on actual cases of reverse docking, showing that the accuracy of target prediction significantly increased by 21.5% in the reverse docking by Glide after score normalization, though there was no obvious change in the reverse docking by DOCK and AutoDock Vina. Our results demonstrate the effectiveness of score normalization to eliminate the scoring bias and improve the accuracy of target prediction in reverse docking. Moreover, the properties of protein pockets causing scoring bias to certain proteins we found here can provide the theory basis to further optimize the scoring functions of docking programs for future research.

A randomized study of training with large versus small vessel size on successful ultrasound-guided peripheral venous access

Our objective was to investigate whether training on phantoms with smaller or larger vessels would improve success rate in novice medical students learning this skill. Medical students who participated in a voluntary, extracurricular ultrasound training day were asked to participate in the study as part of their procedural training. They were given a standardized education and demonstration of how to use ultrasound to place a peripheral intravenous (IV) catheter. They were then randomized to practice three times on homemade phantom models with either a 5-mm or a 2.5-mm diameter simulated vessel. Afterwards, they were observed attempting to place an ultrasound-guided IV on a 5-mm diameter vessel. Successful cannulation rates was the primary outcome. Fifty-one students from five institutions were included in the analysis. No significant difference in success rate, time to cannulation, number of sticks, or number of redirects was seen between the group who trained on the phantoms with the smaller vessels versus those who trained on the phantoms with the larger vessel. A trend towards significance was seen for success rate and number of redirects, favoring the group trained on the smaller vessels, but this did not reach significance. In our small sample, there was no difference in success rate of novice students trained in ultrasound-guided peripheral IV access using either a smaller or a larger vessel phantom. Future work should focus on elucidating other aspects of training in ultrasound-guided procedures and should attempt a similar study with a larger sample size.

Anti-HCV Activity from Semi-purified Methanolic Root Extracts of Valeriana wallichii.

Hepatitis C virus (HCV) is a serious global health problem affecting approximately 130-150 million individuals. Presently available direct-acting anti-HCV drugs have higher barriers to resistance and also improved success rate; however, cost concerns limit their utilization, especially in developing countries like India. Therefore, development of additional agents to combat HCV infection is needed. In the present study, we have evaluated anti-HCV potential of water, chloroform, and methanol extracts from roots of Valeriana wallichii, a traditional Indian medicinal plant. Huh-7.5 cells infected with J6/JFH chimeric HCV strain were treated with water, chloroform, and methanol extracts at different concentrations. Semi-quantitative reverse transcription polymerase chain reaction result demonstrated that methanolic extract showed reduction in HCV replication. The methanolic extract was fractionated by thin layer chromatography, and the purified fractions (F1, F2, F3, and F4) were checked for anti-HCV activity. Significant viral inhibition was noted only in F4 fraction. Further, intrinsic fluorescence assay of purified HCV RNA-dependent RNA polymerase NS5B in the presence of F4 resulted in sharp quenching of intrinsic fluorescence with increasing amount of plant extract. Our results indicated that methanolic extract of V.wallichii and its fraction (F4) inhibited HCV by binding with HCV NS5B protein. The findings would be further investigated to identify the active principle/lead molecule towards development of complementary and alternative therapeutics against HCV. Copyright © 2017 John Wiley & Sons, Ltd.

Comparison between Ologen implant and different concentrations of Mitomycin C as an adjuvant to trabeculectomy surgery.

CONTEXT:Trabeculectomy is the most common surgical procedure for treatment of glaucoma. To improve success rates, adjuvants were utilized as Mitomycin C (MMC) and Ologen implant.AIMS:This study aims to establish efficacy and safety of Ologen implant versus MMC in trabeculectomy.SETTING AND DESIGN:A prospective, comparative clinical study was conducted at the Department of Ophthalmology, Assiut University, between December 2014 and April 2016.SUBJECTS AND METHODS:Patients with primary open-angle glaucoma (OAG), primary narrow-angle glaucoma and secondary OAG were assigned equally to trabeculectomy with Ologen, 0.4 mg/mL or 0.2 mg/mL MMC. The study outcome measures were reduction in intra-ocular pressure (IOP), success rates, survival analysis, and rate of complications.STATISTICAL ANALYSIS USED:SPSS software Version 17.0 (SPSS, Inc., IL, USA) was utilized.RESULTS:Thirty eyes were included in the study. Mean baseline IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 27.43 ± 2.97, 28.4 ± 3.24, and 27.56 ± 2.69 mmHg, respectively. At week 24 follow-up, mean IOP in Ologen, MMC 0.4 and MMC 0.2 groups were 18.55 ± 3.18, 16.2 ± 3.22, and 16.93 ± 3.04 mmHg, respectively. No significant inter-group difference was noticed at any visits. Complete success was achieved in 10%, 40%, and 30%, whereas incomplete success in 70%, 50%, and 60%, respectively in Ologen, MMC 0.4 and MMC 0.2 groups. No treatment group difference was reported by Kaplan–Meier analysis. Shallow anterior chamber occurred more in Ologen and MMC 0.4 groups. A single case of serous choroidal effusion had occurred in MMC 0.4 group.CONCLUSION:Ologen implant is a promising alternative to MMC for improving the success rate of trabeculectomy.

Towards a Mechanistic Understanding and Treatment of a Progressive Disease: Atrial Fibrillation.

Atrial fibrosis appears to be a key factor in the genesis and/or perpetuation of atrial fibrillation (AF). The pathological distribution of atrial fibrosis is geographically consistent with the attachments between the posterior left atrium and the pericardium along the reflections where wall stiffness is increased and structural changes are found. While there is a wide range of complex etiological factors and electrophysiological mechanisms in AF, there is evidence for a common pathophysiological pathway that could account for deliberate substrate formation and progression of AF. Anatomical stresses along the atrium, mediated by the elastic modulus mismatch between atrial tissue and the pericardium, result in inflammatory and fibrotic changes which create the substrate for atrial fibrillation. This may explain the anatomical predominance of pulmonary vein triggers earlier in the development of atrial fibrillation and the increasing involvement of the atrium as the disease progresses. Ablative treatments that address the progressive nature of atrial fibrillation and fibrosis may yield improved success rates.

Learning Curve for Endoscopic Endonasal Dacryocystorhinostomy.

PurposeTo elucidate the learning curve for endoscopic endonasal dacryocystorhinostomy (EE-DCR) based on the results of EE-DCR performed by three surgeons at three different tertiary hospitals.MethodsA retrospective review of the medical records of 386 eyes of 337 patients who had undergone EE-DCR by three surgeons at three tertiary hospitals and who were available for a >6-month postoperative observation period was conducted. The success of a given surgery was determined based on the results of a test performed during the patient's last outpatient visit to the hospital. The learning curve was identified by dividing the patients into four groups (20, 30, 40, and 50 eyes in each respective group) and comparing their success rates.ResultsThe overall success rate of the entire study population was 86.3%. The success rates for each of three surgeons was 83.3%, 85.6%, and 88.1%, respectively. After dividing the patients into groups of 30 eyes each, all three surgeons showed a significant increase in surgery success rates after their first group of 30 eyes (p < 0.05). The overall success rate excluding the first 30 eyes was 92.9%, and all three surgeons exhibited a significantly improved success rate of >90% (A, 94.4%; B, 90.8%; C, 95.4%).ConclusionsA surgeon should be required to perform at least 30 EE-DCR procedures to obtain stable surgical skill for this procedure.

How to improve success rates of the compounds acting on CNS using biomarkers.

医薬品の研究開発費が年々増加しているにもかかわらず，中枢神経系に作用する医薬品候補化合物が上市に至る確率は未だ低い．中枢疾患の病態を正確に反映する動物モデルはほとんど存在しない．このためヒトで本当に有効であるのかは，大規模な後期臨床試験による検証までわからない．前臨床段階において臨床開発に値する化合物を選択した後，早期臨床試験段階において，作用機序から有効性が見込まれる適切な被験者集団を選定し，標的を十分に占有する投与条件で，真のエンドポイントに対する効果が予測可能な指標を用いて有効性を確認できれば，現在の状況は改善され，後期臨床試験における成功確率は向上すると期待される．バイオマーカー，なかでもポジトロン断層撮影（PET）を活用することにより，これらの課題を克服できる可能性があることを，アルツハイマー型認知症に対する医薬品候補化合物の治験，新規トランスロケータータンパク質18 kDa（TSPO）拮抗薬であるONO-2952，及びニューロキニン1（NK1）受容体拮抗薬の例を挙げて述べる．中枢疾患の患者において生きたままの状態でPETにより得られる脳内変化の情報は，病態生理の理解に貢献するだけでなく，新規創製標的の同定にも非常に有用であることから，リバーストランスレーションという観点からも益々有効活用されることを期待する．

The history behind successful uterine transplantation in humans.

This paper aimed to describe the basic aspects of uterine transplant (UTx) research in humans, including preliminary experiences in rodents and domestic species. Studies in rats, domestic species, and non-human primates validated and optimized the UTx procedure in terms of its surgical aspects, immunosuppression, rejection diagnosis, peculiarities of pregnancy in immunosuppressed patients, and patients with special uterine conditions. In animal species, the first live birth from UTx was achieved in a syngeneic mouse model in 2003. Twenty-five UTx procedures have been performed in humans. The first two cases were unsuccessful, but established the need for rigorous research to improve success rates. As a result of a controlled clinical study under a strictly designed research protocol, nine subsequent UTx procedures have resulted in six healthy live births, the first of them in 2014. Further failed UTx procedures have been performed in China, Czech Republic, Brazil, Germany, and the United States, most of which using living donors. Albeit still an experimental procedure in, UTx is the first potential alternative for the treatment of absolute uterine factor infertility (AUFI).

Improving success rates for Indigenous business engagement

Although some oil and gas projects have successfully engaged Indigenous businesses in their supply chain, other projects have found this difficult to achieve. Understanding the risk factors in the process of Indigenous engagement and successfully managing those risks creates a positive environment for Indigenous business engagement, one that is much more likely to support long-term success and minimise business and contract failure. Risk management areas to consider include not understanding Traditional Owner community goals and priorities, not assisting communities to build their capabilities and poor communication. This paper maps these risks and outlines four practical strategies to mitigate these risks: (1) giving local Indigenous businesses the lead time to prepare for work opportunities and build their capabilities; (2) including a mix of large, medium-sized and small local Indigenous businesses in the supply chain; (3) using culturally respectful pathways for Indigenous employment; and (4) maintaining the relationship with Traditional Owner groups. Managing risks and using these practical approaches will improve and increase Indigenous business engagement in project supply chains.

Randomised controlled trial of central venous catheterisation through external jugular vein: A comparison of success with or without body manoeuvres.

Background and Aims:The external jugular vein (EJV), often used for resuscitation, has been underutilised for central venous catheterisation (CVC) in view of an unpredictable success rate. There is an encouraging literature on the improved success rate of CVC through EJV with the inclusion of certain body manoeuvres. This prospective randomised controlled study was conducted with the aim of evaluating the efficacy of body manoeuvres in improving the success rate of CVC through EJV.Methods:One hundred patients aged 18–50 years, scheduled for elective surgery requiring CVC, were randomly assigned to either undergo CVC using Seldinger technique with body manoeuvres or a control group undergoing CVC without body manoeuvres. The primary outcome was the success rate of CVC, as observed in the post-procedure chest radiograph. Secondary outcomes included quality of central venous pressure waveform, catheterisation attempts, total time for CVC, complications.Results:CVC was achieved in 98% (49/50) of patients in study group and 80% (40/50) of patients in control group (P = 0.008). Mean catheterisation time was significantly lower in the study group (151.06 ± 40.50 s) compared to control group (173.50 ± 50.66 s) (P = 0.023). The incidence of catheter misplacement and failure to cannulate were lower in the study group (0%, 2% vs. 20%, 12.5%, respectively). Groups did not differ in a number of catheterisation attempts and incidence of haematoma.Conclusion:Inclusion of various body manoeuvres to Seldinger technique significantly improves the success rate of CVC through EJV.

Updated Hypopharyngeal Surgery for Sleep Apnea.

The failure of traditional upper airway surgery such as uvulopalatopharyngoplasty has been attributed to lower airway obstruction related to base of tongue collapse. Multiple procedures, including glossectomy, tongue base radiofrequency, genioglossus advancement, and tongue suspension techniques, have been advocated to improve success rates. No consensus exists on which subsets of patients are best treated by individual approaches and direct comparative data are lacking. The selection of procedures must be based on individual patient needs and the relative potential benefits and risks.