Successful Management Research Articles

(048) Synchronous Management of Urethral Stricture Disease and Penile Prosthesis Implantation: A Case Series

Abstract Introduction Urethral stricture disease (USD) is found in approximately 0.9% of all men in developed countries; however, the prevalence of USD is expected to increase with time due to an aging population, a rising incidence of prostate cancer, the use of radiotherapy, and increasing utilization of endoscopic procedures in urology. Due to an increasing prevalence of USD, surgeons may encounter an undiagnosed urethral stricture at increasing rates during penile prosthesis (PP) implantation, and there is currently limited data to evaluate the risk of treating the stricture at that time. Objective Our study aims to monitor the outcomes of PP placement in the event of a urethral stricture. Methods A retrospective IRB-approved review (IRB00205900) was performed using the Johns Hopkins EMR for patients that had undergone PP implantation and incidentally found USD at the time of procedure from 2009 to 2023. Patients undergoing PP implantation without incidentally finding USD were excluded. Cases that could proceed as planned were classified as “completed,” while cases that could not proceed were classified as “aborted.” Stricture characteristics (location, size), procedural information, pertinent demographic data, and comorbidities were noted. Successful management was defined as the absence of complications requiring explantation, including device infection, erosion, or failure, within 90 days of the procedure. Recurrence of stricture was defined as the presence or worsening of obstructive lower urinary symptoms at any post-operative follow-up visits. Results Of the 2375 PP implantations performed from 2009 to 2023, twenty-four cases were identified in which an incidental USD was found. Out of the twenty-four patients, eighteen patients (75%) had IPPs implanted, while six patients (25%) had their procedures aborted. Of the eighteen patients, thirteen (13/18, 72.2%) underwent urethral dilation with Amplatz dilators, three patients (3/18, 16.7%) had passive dilation with a 16 F flexible cystoscope, and two patients (2/18, 11.1%) received a direct vision internal urethrotomy (DVIU). Within 90 days after the procedure, only one patient presented with urinary retention four days after the procedure (1/18, 5.6%). No PP infections were reported within 90 days in any patient. Only one patient (1/18, 5.6%) had their device explanted due to extrusion five years after the procedure. One patient had a recurrence of their stricture after four years (1/18, 5.6%). Of the six patients that had their procedures aborted, three patients (3/6, 50.0%) underwent urethroplasty. One patient (1/6, 16.7%) underwent urethral dilation and suprapubic tube placement, and two patients (2/6, 33.3%) underwent a DVIU. Five of these six cases had strictures greater than 2 cm with urethral lumens between 8-10F (5/6, 83.3%), while one patient had an obliterated urethra (1/6, 16.7%). Conclusions This retrospective case study of patients receiving synchronous USD management and PP implantation yielded high success and low complication rates. While a large, multi-institutional study should be performed, our study displays promising results and creates a framework that other surgeons may follow. Disclosure No.

THE LINK BETWEEN ORGANISATIONAL CULTURE AND JOB SATISFACTION IN THE PORTUGUESE PRIVATE INSTITUTIONS OF SOCIAL SOLIDARITY (IPSS): AN EXPLORATORY APPROACH

This exploratory research studies the relationship between organisational culture and job satisfaction in social economy organisations. Specifically, 269 participants from 15 Portuguese Private Institutions of Social Solidarity (IPSSs) were studied. The results indicate that employees’ and managers’ perspectives differ regarding the organisation’s cultural profile and that employees indicate a moderate level of job satisfaction. Findings show a significant relationship between the types of culture market and hierarchy and employees’ low level of satisfaction, which is different from the for-profit organisations. Given the importance of the topic for organisations, this study opens a research path for the social economy, namely IPSSs, and contributes to the success of IPSS people management.

Learning from positive deviants in fisheries

AbstractDespite progress in the management of assessed fish populations, many countries lag behind international commitments to restore overexploited stocks to healthy abundances. Here we use a mixed‐methods positive deviance approach, also known as ‘bright spot’ analysis, to understand what drives the successful governance of exploited species by learning from positive outliers, or ‘deviants’. We use Canada as a case study, identifying factors driving the abundance of 230 commercially exploited fish and invertebrate populations, of which only 28% were classified at healthy abundance in 2022. We first applied a generalized linear model to test how diverse socio‐ecological fishery attributes relate to stock health. We found healthier stocks are positively and significantly correlated with certain management regions, more selective gears, eco‐certification, and high fishery value. Counterintuitively, healthier stocks were also associated with high inherent fishing vulnerability and the absence of reference points. We then used fishery expert surveys and interviews to investigate the social and institutional characteristics of stocks healthier than expected, given their circumstances. We found that fisheries targeting these positive outliers have lower conflict among users, balanced stakeholder involvement in data collection and decision‐making, and improved accounting of mortality sources. Lessons from these positive deviants can be applied to improve underperforming management systems that are struggling to reverse overexploitation in Canada and elsewhere. More generally, we suggest that a positive deviance approach, already used in public health, could be a promising tool to learn about successful fisheries management interventions, and the diverse actors responsible for ensuring these interventions are successful.

(050) Safety and Efficacy of Hyaluronic Acid Injections Using the UroFill™ Technique for Penile Girth Enhancement

Abstract Introduction Penile girth enhancement (PGE) has gained significant popularity and is in high demand among individuals seeking to improve their sexual experiences and self-confidence. Perception of penile length and girth are integral components of the male psyche. Unfortunately, current treatment options for motivated patients looking to enhance penile girth fall short of patient and clinical expectations. While the safety of penile augmentation methods has been a subject of debate, hyaluronic acid (HA) fillers have demonstrated proven efficacy and safety, offering potential solutions for those interested in PGE. Advancements in the field of penile cosmetics with HA has led to the development of the UroFill™ patented technique for PGE. Objective To assess the safety and efficacy of injecting HA using the UroFill™ technique for PGE. Methods We performed a retrospective analysis of men undergoing penile girth enhancement with FDA-approved HA fillers between October 2021 and March 2023. Patients completed a series of validated questionnaires including the COPS-P, IIEF, and BAPS. Peri- and post-procedure adverse events were closely monitored. Physician follow-up appointments and patient questionnaires were utilized to identify and document these events. The determination of unsatisfactory cosmetic outcomes and the need for revision was made by the treating physician in consultation with the patient. The UroFill™ standardized technique was employed for all injections. Results A total of 300 men (mean age: 37, range 21-80) received treatment using the UroFill™ standardized technique. 4,879 injections were performed over this time. Mean injection volume was 16.5 cc (range: 4-78cc) of HA once treatment had been completed. The study observed an average of 3.85 injection sessions (range: 1-44 sessions) and 5.25 post-injection modeling sessions (range 0-55) per patient. After receiving HA dermal fillers, patients experienced local injection site reactions such as bruising, tenderness, swelling, and erythema. These events were generally mild in intensity, and no patient reported bruising lasting longer than 7 days. None of the patients in this cohort required removal of filler. Adverse reactions were limited to 8 cases of localized skin infections which were successfully treated with conservative antibiotic therapy. All localized skin infections were a result of premature sexual intercourse or shaving in the area following injection. Patients reported high levels of satisfaction with 272/300 (91%) reporting “completely satisfied” or “mostly satisfied”. Mean filler retention was 90% after 12 months. Conclusions This study provides evidence that the UroFill™ standardized technique for penile girth enhancement using HA fillers is both safe and efficacious. With no instances of filler removal and successful management of adverse reactions, the safety profile of HA fillers is further supported. These findings reinforce HA’s potential for sustainable penile enhancement. It is essential these procedures be performed in the described fashion by qualified urological professionals. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, UroFill.

Improving the competences of public servants regarding the management of local development on the basis of process management

The article substantiates directions for improving the competencies of public officials in managing local development on the basis of process management. It is noted that improving the competences of public officials in managing local development on the basis of process management is an urgent need today. The need to systematize public officials ideas about the essential features and features of process management is proven, namely: basic types of activities in process management; models and measurements of process maturity; process efficiency index calculations; process management success factors; optimization of processes (rules and principles of reengineering).
 For effective management of local development on the basis of process management, the development of professional competencies of public servants should be carried out through the formation of a holistic vision of the desired state of the municipal entity as a system with detailed outcomes. This will require skills and abilities to align strategic processes with a holistic vision, digitize processes, and further optimize them. Key in this context are the marketing competence of public officials and their mastery of techniques for activating behavioral insights, including community members.

Unraveling the Dynamics: Understanding the Process of Students Learning in Classroom Management at Balkh University

The paper's primary focus revolves around the pivotal role of effective classroom management in creating an optimal learning environment for students within the English department of an education faculty. Employing field research and a questionnaire, the researchers sought to gauge the significance of classroom management, drawing insights from the experiences and background knowledge of 105 students in their third and fourth years. The study identified key components for successful classroom management, encompassing curriculum and instructional aspects, teacher behavior, and the integration of management technology. The findings underscore the students' recognition of the critical importance of managing the classroom to ensure the smooth execution of learning activities and foster positive learning outcomes. The research advocates for teachers to prioritize various elements such as rule enforcement, strategic lesson planning, and active involvement in assessment processes. The paper concludes by asserting that language teachers must be attentive to the nuances of effective classroom management in their teaching practices, with the hope that the research's outcomes will serve as a valuable resource for language educators seeking to enhance their teaching methodologies.

Surveying Quality Management Methodologies in Wooden Furniture Production

Furniture production is a specific industrial sector with a high human labor demand, a wide range of materials processed, and short production runs caused by high customization of end products. The difficulty of measuring the aesthetic requirements of customers is also specific to furniture. This review of academic papers identifies and explains effective quality management strategies in furniture production. The reviewed literature highlights a range of quality management methodologies, including concurrent engineering (CE), total quality management (TQM), lean manufacturing, lean six sigma, and kaizen. These strategies encompass a variety of pro-quality tools, such as 5S, statistical process control (SPC), quality function deployment (QFD), and failure mode and effects analysis (FMEA). The strengths of these quality management strategies lie in their ability to enhance efficiency, reduce waste, increase product diversity, and improve product quality. However, the weaknesses concern implementation challenges and the need for culture change within organizations. Successful quality management in furniture production requires tailoring strategies to the specific context of the furniture production industry. Additionally, the importance of sustainability in the furniture industry is emphasized, which entails incorporating circular economy principles and resource-efficient practices. The most important finding from the literature analysis is that early detection and correction of poor quality yields the most beneficial outcomes for the manufacturer. Therefore, it is essential to strengthen the rigor of quality testing and analysis during the early stages of product development. Consequently, a deep understanding of consumer perspectives on required furniture quality is crucial. The review identified two research gaps: (1) the impact of unnecessary product over-quality on the efficiency of furniture production and (2) the influence of replacing CAD drawings with a model-based definition (MBD) format on quality management in furniture production.

Successful Management of Fractured Premolar with Veneerlay Following Morphology-driven Preparation Technique Principles

Successful Management of Fractured Premolar with Veneerlay Following Morphology-driven Preparation Technique Principles

Successful Management of Fractured Teeth through Reattachment: Case Series with Follow-up

Successful Management of Fractured Teeth through Reattachment: Case Series with Follow-up

Same-day discharge after elective percutaneous closure of patent foramen ovale.

Percutaneous closure of the patent foramen ovale (PFO) is increasingly performed in specific patients with cryptogenic stroke or clinical evidence of a paradoxical embolism. This study was performed to determine the safety of same-day discharge (SDD) following such procedures. This is a prospective, observational study of patients undergoing elective percutaneous PFO closure in a single tertiary center in Portugal between January 2020 and July 2023. AmplatzerTM devices (St. Jude Medical, St. Paul, MN, USA) and NobblestichTM EL (HeartStitch, Inc., Fountain Valley, CA, USA) were used. After 6 months, the following events were looked at: post-procedural paroxysmal atrial fibrillation, stroke, unplanned cardiac re-hospitalization, urgent cardiac surgery, major vascular complications, pericardial effusions, device embolization, and death. We studied 122 consecutive patients (52% female, 68; 48±12 years old) who had elective percutaneous closure with success and no complications. Forty-nine (40%) had SDD. AmplatzerTM devices were used more frequently in the SDD group, while NobblestichTM EL was more common in the overnight group. During the overnight group's follow-up period, there was one non-cardiovascular death; there were no further events. SDD after elective percutaneous closure of PFO was shown to be a safe and successful patient management method, including NobblestichTM, which we describe for the first time. Our results prove the safety of this same-day discharge strategy. We hypothesize that in the near future, in selected cases, PFO closure might become an ambulatory procedure.

Manual lymphatic drainage: the evidence behind the efficacy.

Manual lymphatic drainage (MLD), a specific type of massage performed by specialists that aims to enhance the filling and emptying of lymph vessels, is often recommended as an essential part of a successful management strategy for lymphoedema. However, the literature on its efficacy is often contradictory, and its addition may not always be necessary. To ensure optimal understanding of practitioners and benefit to patients, Francesca Ramadan summarises the evidence-based advantages and limitations of MLD.

Remimazolam in perioperative management of Eisenmenger syndrome: a case report.

Eisenmenger syndrome (ES) is characterized by severe and irreversible pulmonary hypertension stemming from an uncorrected intracardiac shunt of significant size. The imbalance between systemic and pulmonary artery pressures predisposes patients with ES to the risk of cardiac arrest. Remimazolam has caused less circulatory depression, which may be advantageous for ES. However, no studies reported the use of remimazolam in perioperative ES management. A 45-year-old female patient with ES derived from a ventricular septal defect was scheduled to undergo bilateral adnexectomy for an ovarian tumor. Her oxygen saturation was 80% with 3 L/min oxygen at rest, and her pulmonary and systemic flow ratio was 0.53. She underwent general anesthesia with remimazolam, and intraoperative hemodynamics was stable without hypotension or reduced oxygen saturation. Our successful management of ovarian tumor surgery in a patient with ES using remimazolam reveals its potential effectiveness in perioperative care.

Analisis Surplus-Defisit Air Daerah Irigasi Gondang Kabupaten Lamongan

Population growth in Indonesia has increased by an average of 1.25% from the previous population every year from 2020 to July 2022 (Badan Pusat Statistik, 2022). Population growth is in line with increasing food needs, where development in agriculture is one of the priorities in building food security in the future. Lamongan Regency contributed 564,139 tons of rice in 2020 and was nominated for 5 (five) largest major contributors at the national level (Redaktur Jatim, 2021). High population growth and increasing food demand require adequate infrastructure, including efficient irrigation systems. The balance of available irrigation water and required water determines success in irrigation water management. This study aims to analyze reliable water discharge using the F.J. Mock method, calculating plant needs to determine water surpluses. This research was conducted in the Gondang Irrigation Area located in Sugio District, Lamongan Regency. The area of gondang irrigation area is 10588 ha. From the results of the study, the highest discharge occurred in 2013, in April period II amounting to 77.71 m3 / s. The water needs of plants experience water shortages for 3 months (July-September).

Estimation of river discharge using Monte Carlo simulations and a 1D hydraulic model based on the artificial multi-segmented rating curves at the confluence of two rivers

During extreme floods caused by climate change, reliable flow discharge data are essential for successful reservoir operation to mitigate downstream flood damage. Generally, the flow discharge is computed using the rating curve (RC) established from the relationship between the flow rate and water stage level. Determining the parameters of rating curves is subject to uncertainties related to the difficulties and limitations of flow monitoring in covering a wide range of flow variations. Especially at river confluences, the uncertainties are pronounced when floods occur owing to several factors such as roughness change, backwaters, and levee overflow. The Seomjin River Basin in Korea suffered from flood inundation that occurred at the tributary confluence during an extreme flood in 2020. To identify a reliable flow rate of the main stream and tributary, this study proposes an indirect flow assessment scheme using a 1D hydrodynamic simulation model to find the best simulated water level in an iterative manner based on Monte Carlo (MC) simulations. With a large amount of discharge data generated from random-number combinations, it is possible to obtain the best results automatically by specifying the reliability limitation considering the uncertainty of the predetermined RC parameters associated with the roughness coefficient. Nash Sutcliffe Efficiency (NSE) was incorporated to evaluate the reproduced water level to meet the threshold specified for NSE ≥ 0.75. The simulated flowrates computed from the revised RC and roughness coefficients revealed an error range of 8%–36.6% compared with the design flood. The approach proposed in this study is applicable for determining the valid parameters necessary to create a revised RC at an existing water level gauge station, where the uncertainties of the RC are pronounced, particularly in the vicinity of the channel confluence.

How User Requirements Affect the Success of an Enterprise System Implementation Project?

The paper examines the collection, preparation, and improvement of user requirements for a complex ERP case study implementation in an international organisation. The study presents a case study of the ERP system implementation project. We address the user requirements and their quality with regard to the scope of the case study on the ERP implementation project and wider as an integral aspect of successful project management within an organisational context. In the discussion, we address and support the notions that: 1.) the choice of the type of solution and the software company; 2.) strong leadership and control from the investor side; 3.) the activities prior to the start of the ERP implementation project and a clearly defined scope at the time of contract conclusion; 4.) the quality of system requirements based on well-specified user requirements; and 5.) the alignment of the scope definition and user requirements within the organisation contribute to the success of the enterprise system implementation project.

Successful management of an unstable Jefferson fracture in pregnancy

Successful management of an unstable Jefferson fracture in pregnancy

Successful management of a pregnancy complicated by ollier disease and coagulation factors deficiency – A rare case report

Successful management of a pregnancy complicated by ollier disease and coagulation factors deficiency – A rare case report

Alcaligenes faecalis: A bacterium for sustainable management of environment

AbstractFor successful management of pollution problems, the use of bacteria is now a popular and widespread technique. Alcaligenes faecalis, an inhabitant of the natural environment, is equipped with machinery for cleaning up different types of contaminants, including heavy metals and xenobiotics. A. faecalis, a gram‐negative, flagellated, nonfermentive, aerobic member of the subgroup proteobacteria, often shows anaerobic respiration using nitrate or nitrite as terminal electron acceptors. It is also gifted with the power of nitrogen fixation and thereby could be used as a biofertilizer. The bacterium also has the unique ability to act as a probiotic and can often be used as a biocontrol agent due to its antimicrobial properties. Hence, for sustainable management of the environment, various strains of this bacterium as active bio‐remediators, bio‐pesticides, biofertilizers, and probiotics are being increasingly applied.

Historical specimens and photographs reveal long‐term changes in Smalltooth Sawfish (Pristis pectinata) age class distribution and average size during U.S. population decline

Abstract Population‐level, historical studies can provide insights on the distribution, abundance and demographic characteristics of imperiled species prior to human exploitation, habitat modification or climate change. These studies provide a baseline for contemporary data, which often shape successful management and recovery. The smalltooth sawfish (Pristis pectinata) occupies ~20% of its historical range due to declines driven primarily by mortalities in fisheries and coastal habitat loss over the last century. As a result, they are listed as Critically Endangered on the International Union for Conservation of Nature (IUCN) Red List of Threatened Species and as Endangered federally in the United States (U.S.). Because P. pectinata grow to a large size and have a toothed rostrum, many historical photographs and specimens are archived in natural history collections. Metadata and morphometric data were collected and analysed from P. pectinata photographs (n = 84) and specimens (n = 429) to evaluate temporal changes in average size and historical distribution of five age classes in U.S. waters. Historically, smaller age classes were well‐distributed throughout the northern Gulf of Mexico, while only larger age classes were recorded on the U.S. east coast, north of Florida. All age classes were found in both Florida and Texas historically, but records from Texas decline after the 1980s and remain persistent in Florida, indicative of a strong‐hold for the U.S. population. Regardless of origin, individuals in three of the five age classes were larger on average historically than those observed today. Understanding which age classes used previously occupied areas will help direct habitat restoration efforts and support recovery, especially in the face of climate change. Non‐traditional data sources, such as those used here, may often be the only means of providing historical context to modern research on imperiled species, ultimately guiding restoration and conservation efforts.

Caesarean section under spinal anesthesia for a mother with dilated cardiomyopathy in a resource-limited setting: a case report

Introduction and importance: Peripartum cardiomyopathy is an uncommon form of cardiomyopathy that develops in the latter stages of pregnancy or in the first few weeks following delivery. Anaesthetic management of caesarean section of a parturient with dilated cardiomyopathy is challenging due to its nature of impaired ventricular contractility coupled with cardiovascular changes during pregnancy. This is significantly worse in a resource-constrained environment with restricted access to medications and equipment. Case presentation: We report a case of a 31-year-old multigravida parturient presented with a diagnosis of dilated cardiomyopathy and a low ejection fraction undergoing emergency caesarean section. Successful management of a parturient with dilated cardiomyopathy undergoing a caesarean section under spinal anaesthesia is reported in this case report. Clinical discussion: Spinal anaesthesia is another alternative for the successful management of patients with dilated cardiomyopathy (DCM) using a low dose of bupivacaine with intrathecal adjuvants. Our report indicates that caesarean section also may be managed safely with spinal anaesthesia alone in patients with DCM, by using low-dose bupivacaine and intrathecal morphine. The slight haemodynamic changes were adjusted with fluid infusion. The use of vasopressors was not required to manage the hypotension. Conclusion: General anaesthesia, epidural alone, and epidural combined with spinal anaesthesia are the widely used anaesthetics techniques for caesarean section in patients with heart disease. Spinal anaesthesia with low-dose bupivacaine with opioids is another suitable choice. The case report is written according to the CARE guideline (https://www.care-statement.org).