Assessing organisational factors in aircraft accidents using a hybrid Reason and AcciMap model

Despite the use of high safety standards in aircraft design and operations, accidents do occur. In a process of continuous improvement it is essential that we learn from each accident so we can take measures to prevent such accidents from happening in the future. It is often the case that an accident is the result of a sequence of, seemingly minor and often unrelated, events. The challenge is to identify the major causes, which can include deficiencies in organisational processes which may have been present well before the accident itself. This paper discusses tools which can be used to identify key organisational factors which contribute to aviation accidents. The research uses a thoroughly-investigated helicopter accident as a case study, to determine the extent to which analytical and visualisation tools can be used to assess maintenance organisational issues which contributed to the accident

Short-term results of the First-in-Man new Non-Complaint Balloon Catheter clinical study

Objective: Nowadays, non-compliant (NC) balloon cathetersare used to predilate heavily calcified lesions before stentingto postdilate the implanted stent to optimize its parameters, tofinalize bifurcation treatment in final kissing balloon techniqueas well as to treat restenosis, especially in implanted earlierstents. The aim of this paper was to verify clinical effectivenessand safety profile of the new non-complaint balloon catheter(Balton, Poland).Methods: It was the first-in-man analysis of the use of BaltonNC balloon angioplasty catheter in patients undergoing percutaneouscoronary interventions. There were included consecutivepatients with age ≥ 18 years old, with coronary artery diseaseundergoing percutaneous coronary interventions in lesionrequiring predilatation or postdilatation and who signed theinformed consent. The local IRB approved the study protocol(No 135/2017). The primary endpoint was to compare balloondiameters obtained in QCA to diameters declared by the producerreached at certain pressures.Results: A total of 21 patients were enrolled. In most casespatients presented with the multivessel disease (61.9%) andlesions of the moderate complexity (type B1 — 71.4%, typeB2 — 4.8%). Lesions were located most frequently in the leftcircumflex artery (47.6%, n = 10). The device success ratewas 100%. All procedures were performed via the 6F guidingcatheter (100%) and in 95.2% (n = 20/21) the radial accesswas preferred. There were no significant differences betweenQCA and expected balloon diameters when applied the nominalpressure both in predilatation (2.32 ± 0.31 mm vs. 2.38 ± 0.43mm, D 2.5%) as well as in postdilatation (2.90±0.38 mm vs.2.96 ± 0.47 mm, D 2.0%). There were only two dissectioncases (1 type A and 1 type B).Conclusions: The presented data confirm the effectivenessand safety profile of Balton NC balloon catheters. There thedevice success rate was 100%, and there were no severecomplications. In QCA analysis Balton NC balloon cathetersreached assumed diameters and lengths at given pressures.Background: Nowadays, non-complaint balloon catheters are used to predilate heavily calcified lesions before stenting, to postdilate the implanted stent to optimize its parameters, to finalize bifurcation treatment in final kissing balloon technique as well as to treat restenosis, especially in implanted earlier stents. The aim of this paper was to verify clinical effectiveness and safety profile of the new non-complaint balloon catheter (Balton, Poland). Methods: It was a first-in-man analysis of the use of Balton NC balloon angioplasty catheter in patients undergoing percutaneous coronary interventions. There were included consecutive patients with age ≥ 18 years old, with coronary artery disease undergoing percutaneous coronary interventions in lesion requiring predilatation or postdilatation and who signed the informed consent. The local IRB approved the study protocol (No 135/2017). The primary endpoint was to compare balloon diameters obtained in QCA to diameters declared by the producer reached at certain pressures. Results: A total of 21 patients were enrolled. In most cases patients presented with the multivessel disease (61.9%) and lesions of the moderate complexity (type B1 – 71.4%, type B2 – 4.8%). Lesions were located most frequently in the left circumflex artery (47.6%, n = 10). The device success rate was 100%. All procedures were performed via the 6F guiding catheter (100%) and in 95.2% (n = 20/21) - the radial access was preferred. There were no significant differences between QCA and expected balloon diameters when applied the nominal pressure both in predilatation (2.32±0.31 mm vs 2.38 ± 0.43 mm, 2.5%) as well as in postdilatation (2.90±0.38 mm vs 2.96 ± 0.47 mm, 2.0%). There were only two dissection cases (1 type A and 1 type B). Conclusions: The presented data confirm the effectiveness and safety profile of Balton NC balloon catheters. There the device success rate was 100%, and there were no severe complications. In QCA analysis Balton NC balloon catheters reached assumed diameters and lengths at given pressures

A bumpy road to the diagnosis of metastatic lung cancer

Cardiac tumors pose the uncommon group of disorders and most of them are metastases. They are generally localized in the left heart and may present with non-specific symptoms. Diagnosis may be often difficult due to the presence other heart diseases. The gold standard in diagnosing is non-invasive imaging. We present a case of a 77-year-old male admitted to our hospital due to flu symptoms, headaches and loss of weight in the last 2–3 weeks. The diagnostic process including computed tomography (CT) and magnetic resonance imaging revealed pathological contrast enhancement in the left parietal lobe, whereas subsequent transthoracic echocardiography disclosed a pathological oval mass 2.5 x 3.5 cm in the left heart suspected of a metastasis. Results of echocardiography turned the diagnostic process around and extended to bronchoscopy and abdominal CT. Finally, central left lung tumor with metastases to lungs, pleura, lymphoid nodes of the right hilar, left ventricle, left suprarenal gland and central nervous system was diagnosed

Intracoronary ECG guided PCI in the contemporary catheterization laboratory. Part 2

Intracoronary ECG, which was created with unipolar guide introduced into coronary artery to analyze ischemia, was invented in 1974, and firstly performed in human body in 1985, Intracoronary ECG still remains rarely used technique for percutaneous coronary interventions (PCI). The article sums up studies dating from 1974 to 2016 which show that intracoronary ECG is useful for discovering the zones of ischemia, predicting myocardial necrosis, exploring vital myocardium, predicting myocardial recovery during primary PCI and finding new possibilities for the development of PCI. Intracoronary ECG is still very cheap and easily performed, even though it requires additional time and deserves much more interest among the staff incatheterization laboratories.Wewnątrzwieńcowe EKG zarejestrowane za pomocą jednobiegunowego prowadnika wprowadzonego do tętnicy wieńcowej w celu oceny niedokrwienia zostało wynalezione w 1974 roku, a po raz pierwszy zostało wykonane u człowieka w 1985 roku. Wewnątrzwieńcowe EKG wciąż jest bardzo rzadko stosowaną techniką diagnostyczną podczas przezskórnej interwencji wieńcowej (PCI). Artykuł ten podsumowuje badania z lat 1974–2016, pokazując, że wewnątrzwieńcowe EKG może być przydatne w znalezieniu strefy niedokrwienia, przewidywaniu martwicy mięśnia sercowego, detekcji żywotnego miokardium, prognozowaniu zdrowienia mięśnia sercowego po pierwotnej PCI, jak również w poszukiwaniu nowych strategii podczas PCI. Nadal bardzo tanie i łatwe do wykonania, mimo że wymaga dodatkowego czasu, to zasługuje na większe zainteresowanie pracujących w pracowniach hemodynamiki

Intracoronary ECG guided PCI in the contemporary catheterization laboratory. Part 1

Intracoronary ECG was invented in 1974 and in 1985 it was shown for the first time that intracoronary wire could be used as an ECG unipolar lead to detect ongoing ischemia in humans. Intracoronary ECG still remains highly underused technique for guiding percutaneous coronary interventions. This article summarizes studies dating from 1974 through 2016 showing intracoronary ECG usefulness in finding zones of ischemia, predicting myocardial necrosis, exploring vital myocardium, predicting myocardial recovery during primary PCI and finding new possibilities for developing better strategies for PCI. Still very cheap and easy to perform, it however requires additional time and deserves better integration in the catheterizationlaboratory.Wewnątrzwieńcowe EKG zarejestrowane za pomocą jednobiegunowego prowadnika wprowadzonego do tętnicy wieńcowej w celu oceny niedokrwienia wynaleziono w 1974 roku, a po raz pierwszy zostało wykonane u człowieka w 1985 roku. Wewnątrzwieńcowe EKG wciąż jest bardzo rzadko stosowaną techniką diagnostyczną podczas przezskórnej interwencji wieńcowej (PCI). Artykuł ten podsumowuje badania z okresu 1974–2016, pokazując że wewnątrzwieńcowe EKG może być przydatne w znalezieniu strefy niedokrwienia, przewidywaniu martwicy mięśnia sercowego, detekcji żywotnego miokardium, prognozowaniu zdrowienia mięśnia sercowego po pierwotnej PCI, jak również w poszukiwaniu nowych strategii podczas PCI. Nadal bardzo tanie i łatwe do wykonania, mimo iż wymaga dodatkowego czasu, to zasługuje na większe zainteresowanie przez pracujących w pracowniach hemodynamiki

Przezskórne leczenie zwężenia dystalnego pnia LTW według XII konsensusu opracowanego przez ekspertów EBC

Experts of the European Bifurcation Club hold meetings annually since 2004. Up to now they published eight general consensuses and three dedicated to a specific topic. In this year in EuroIntervention the newest European Bifurcation Club consensus has been released and is dedicated to percutaneous coronary interventions in lesions located within distal left main.Eksperci Europejskiego Klubu Bifurkacyjnego (ang. European Bifurcation Club) odbywają coroczne spotkania od 2004 roku, czego owocem jest opublikowanie dotychczas ośmiu ogólnych konsensusów oraz trzech poświęconym konkretnym zagadnieniom. W tym roku w EuroIntervention ukazał się najnowszych konsensus EBC poświęcony przezskórnemu leczeniu zwężeń zlokalizowanych w dystalnym pniu lewej tętnicy wieńcowej (LTW)

Assessing organisational factors in aircraft accidents: Methodologies and limitations

This paper discusses tools which can be used to identify key organisational factors which contribute to aviation accidents. The research uses a thoroughly-investigated helicopter accident as a case study, to determine the extent to which analytical and visualisation tools could be used to assess maintenance organisational issues which contributed to an accident

Mortality Rates above Emergency Threshold in Population Affected by Conflict in North Kivu, Democratic Republic of Congo, July 2012-April 2013

The area of Walikale in North Kivu, Democratic Republic of Congo, is intensely affected by conflict and population displacement. Médecins-Sans-Frontières (MSF) returned to provide primary healthcare in July 2012. To better understand the impact of the ongoing conflict and displacement on the population, a retrospective mortality survey was conducted in April 2013. A two-stage randomized cluster survey using 31 clusters of 21 households was conducted. Heads of households provided information on their household make-up, ownership of non-food items (NFIs), access to healthcare and information on deaths and occurrence of self-reported disease in the household during the recall period. The recall period was of 325 days (July 2012-April 2013). In total, 173 deaths were reported during the recall period. The crude mortality rate (CMR) was of 1.4/10,000 persons/day (CI95%: 1.2-1.7) and the under-five- mortality rate (U5MR) of 1.9/10,000 persons per day (CI95%: 1.3-2.5). The most frequently reported cause of death was fever/malaria 34.1% (CI95%: 25.4-42.9). Thirteen deaths were due to intentional violence. Over 70% of all households had been displaced at some time during the recall period. Out of households with someone sick in the last two weeks, 63.8% sought health care; the main reason not to seek health care was the lack of money (n = 134, 63.8%, CI95%: 52.2-75.4). Non Food Items (NFI) ownership was low: 69.0% (CI95%: 53.1-79.7) at least one 10 liter jerry can, 30.1% (CI95%: 24.3-36.5) of households with visible soap available and 1.6 bednets per household. The results from this survey in Walikale clearly illustrate the impact that ongoing conflict and displacement are having on the population in this part of DRC. The gravity of their health status was highlighted by a CMR that was well above the emergency threshold of 1 person/10,000/day and an U5MR that approaches the 2 children/10,000/day threshold for the recall period

Dedicated bifurcation stents or regular drug eluting stents in distal left main stenosis: A retrospective study

  Background: In the distal left main (LM) atherosclerosis mainly develops within bifurcation or trifur­cation. The aim of this study was to analyze the strategy of distal LM stenosis treatment and associated clinical outcomes in a large hospital in Northern Poland. Methods: The study population consisted of consecutive patients with stable coronary artery disease or acute coronary syndrome (ACS) and distal LM stenosis who were hospitalized between June 2012 and June 2013. Patients were treated with regular drug-eluting stents (rDES), including bioresorbable vascular scaffolds, or dedicated bifurcation stents (BiOSS LIM®). Clinical outcomes were analyzed at 12, 24 and 36 months. Primary endpoint was cumulative major adverse cardiovascular events (MACE) inducing rate of cardiac death, myocardial infarction, and target lesion revascularization (TLR) after 36 months. Results: One hundred and two patients were identified, 90 of whom were treated with percutaneous coronary intervention (56 rDES, including 9 Absorb, and 34 BiOSS) with no stent implantation fail­ure. In 15 (16.7%) patients rDES was required within side branch (SB). After 36 months MACE rate was 19.0% (BiOSS: 18.8% vs. rDES 19.2%), whereas TLR rate was 10.7% (BiOSS 12.5% vs. rDES 9.6%). In logistic regression for 36-month TLR rate proximal optimization technique (OR 0.311, 95% CI 0.211–0.644) was a prognostic factor of better clinical outcome, whereas non-ST-elevation ACS (OR 2.211, 95% CI 1.642–5.110), ST-elevation myocardial infarction (OR 2.771, 95% CI 1.325–7.209) and SB stenting (OR 1.141, 95% CI 1.002–1.881) were risk factors of poor outcome. Conclusions: Regular drug-eluting stents as well as dedicated bifurcation BiOSS LIM® stents enabled a simple and fast distal LM treatment option with a single stent. Both resulted in comparable MACE and TLR rates

The approach to coronary bifurcation treatment and its outcomes in Poland: The single center experience

Background: Coronary bifurcation lesions pose therapeutic problems during percutaneous coronary interventions. The aim of this study was to analyze the strategy of coronary bifurcation treatment and associated angiographic as well as clinical outcomes in a large hospital in Northern Poland. Methods: Between January 2012 and January 2014 patients with stable coronary artery disease or non-ST-elevation acute coronary syndrome (NSTE-ACS) were treated with regular drug-eluting stents (rDES) or dedicated bifurcation stents (BiOSS Expert® or BiOSS LIM®). Clinical and angiographic controls were planned at 12 months. The primary endpoint was major adverse cardiovascular events (MACE) rate composed of cardiac death, myocardial infarction, and target lesion revascularization (TLR) at 12 months. Results: In total, 152 patients were enrolled in whom 158 stents were deployed (99 BiOSS stents and 59 rDES). Left anterior descending artery (50%) was the dominant target vessel followed by left circum¬flex (25%). There was no stent implantation failure. In 10 (6.3%) patients rDES was required within the side branch. At 12 months MACE rate was 11.2%, whereas TLR rate was 7.9%. In the logistic regression analysis final kissing balloon technique was the prognostic factor for better clinical outcome, whereas NSTE-ACS and true bifurcations were risk factors of a poor outcome. Conclusions: Percutaneous coronary bifurcation treatment is a safe and effective procedure, and pro¬visional T-stenting is the preferred technique. Both rDES as well as dedicated bifurcation stents enabled a simple and fast bifurcation treatment option with comparable MACE and TLR rates. (Cardiol J 2017; 24, 6: 589–596