Organisational culture and TQM implementation: investigating the mediating influences of multidimensional employee readiness for change

Despite the robust evidence for the direct relationship between organisational culture (OC) and total quality management (TQM), the mechanisms underlying this relationship are not fully explored and have received little empirical attention. This paper extends prior TQM research in a novel way by building and then empirically testing a theoretical model that includes the mediating role of employee readiness for change dimensions (ERFCs) in the OC-TQM relationship. The paper adds value through its contextual originality in being one of the first studies that are conducted in Algeria; which has special ties with the EU geographically, politically and economically. The empirical data for this study was drawn by distributing a questionnaire to 226 middle managers of Algerian firms. Our findings support the mediating roles of two dimensions of ERFC, namely: self-efficacy (ERFC1) and personal valence (ERFC4) in the OC-TQM relationship. This indicates that the improvement in TQM implementation is not a direct consequence of supportive organisational culture but rather of self-efficacy and personal valence transferring the impact of group and adhocracy culture to TQM. To this effect, these results go beyond previous research and contribute significantly in explaining the underlying psychological mechanisms in the OC-TQM relationships model

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Chimney technique for aortic arch pathologies:an 11-year single-center experience.

Purpose: To report our single-center experience with the chimney technique for aortic arch pathologies and the mid- to long-term results in these patients. Methods: From June 2002 to May 2013, 26 patients (18 men; mean age 71.2 years, 53–86) underwent thoracic endovascular aortic repair (TEVAR) combined with chimney technique. Indications for treatment were: a proximal landing zone ,15 mm long distal to the left subclavian artery (LSA), thoracic aortic aneurysm (n1⁄413), complicated type B aortic dissection (n1⁄410), type I endoleak after previous TEVAR (n1⁄42), and penetrating aortic ulcer (n1⁄41). Treatment was performed in the emergency setting in 7 cases. The 28 chimney stent- grafts (double chimneys in 2 patients) were deployed in the innominate artery (n1⁄47), left common carotid artery (n1⁄410), and LSA (n1⁄411). All patients underwent computed tomography before discharge, at 1, 6, and 12 months, and yearly thereafter. Results: Technical success was 100%. One (3.8%) perioperative death was due to a cerebral hemorrhage. No major stroke was registered, but 3 (11.5%) minor strokes occurred (all resolved). Paraparesis developed in 2 (7.7%) patients. Median follow-up was 36.8 months (range 1–131), during which an additional 4 (15.4%) patients died, but only 1 death was aneurysm-related. Chimney graft patency was 89.3% (25/28); an asymptomatic fracture was found in a patent chimney stent-graft at the 18-month follow-up. The type I endoleak rate was 23% (n1⁄46); 3 endoleaks associated with aneurysm sac enlargement were treated. Conclusion: The chimney technique for aortic arch pathologies is safe and feasible and may be an option in patients considered at high risk for surgery or who are ineligible for conventional TEVAR, especially in the emergency setting. Concern persists regarding type I endoleak, and long-term follow-up remains mandatory

Aortoiliac steno-occlusive disease

Trattamento endovascolare della patologia steno-occlusiva sorto-iliac

Endovascular treatment options for complex abdominal aortic aneurysms

Purpose To report short-term and midterm outcomes of endovascular aneurysm repair (EVAR) of complex aneurysms requiring revascularization of visceral arteries. Materials and Methods Prospective data were collected from patients deemed unsuitable for conventional EVAR and conventional surgery who were treated with different endovascular approaches according to the clinical presentation of the aneurysm. Custom-made fenestrated endovascular aneurysm repair (CM f-EVAR) was used in the elective setting, homemade fenestrated endovascular aneurysm repair (HM f-EVAR) or HM f-EVAR combined with chimney endovascular aneurysm repair (ch-EVAR) was used in the emergent setting in patients with hemodynamic stability, and ch-EVAR was used in unstable cases. The study included 34 consecutive patients. Primary outcomes measured were perioperative mortality and morbidity, renal function impairment (RFI), target vessel patency, and survival at mean follow-up. Results In the CM f-EVAR group (7 of 34 patients; 20.6%), an intraoperative type III endoleak (1 of 7 patients; 14%) sealed spontaneously. At 8.9 months of follow-up, 1 (1 of 7 patients; 14%) death and 1 (1 of 7 patients; 14%) episode of transient RFI were documented. Visceral vessel patency rate was 95.2%. In the HM f-EVAR group (4 of 34 patients; 11.7%) and the combination of HM f-EVAR and ch-EVAR group (3 of 34 patients; 8.8%), no complications were observed at 17.3 months of follow-up. In the ch-EVAR group (20 of 34 patients; 58.8%), visceral patency was 95% at 30.9 months of follow-up. Two cases of transient RFI and 2 cases of permanent RFI were registered (2 of 20 patients; 10%). One asymptomatic renal artery branch occlusion was observed at 11 months of follow-up. No endoleaks were documented. Conclusions Endovascular aneurysm repair techniques including CM f-EVAR, HM f-EVAR or HM f-EVAR in combination with ch-EVAR, and ch-EVAR are valid tools to maintain blood flow in visceral arteries during treatment of complex aortic aneurysms. The proposed interventional protocol based on clinical presentation was feasible in all cases

Endovascular management of total juxtarenal aortic occlusive disease in high-risk patients: technical considerations and clinical outcome

BaCKground: To report our single-center experience in the endovascular treatment of juxtarenal aorto-iliac occlusions. MeThods: Between december 2008 and december 2012, 13 patients with total juxtarenal aorto-iliac occlusion, considered at high risk for open revascularization, were treated by endovascular means at our department. inclusion criteria were severe intermittent claudication, rest pain and distal tissue loss. antegrade recanalization from percutaneous brachial access and retrograde angioplasty and stenting from percutaneous or surgical femoral accesses were performed. The renal arteries (RAs) were protected using filters or balloons. Aorto-iliac bare-metal stents were deployed in all patients. resulTs: no death was registered. Technical success was 100%. in 11 patients (84.6%) the ankle-Brachial index increased to 0.9-1. renal arteries were involved in 7 cases (53.8%): 3 chimney stent grafts deployment, 2 aorto-iliac stent fenestrations and 2 aorto-iliac stents placement above the renal arteries without renal function impairment. Complication rate was 38.5%: 2 cases of thrombus dislodgement into the ras, 1 distal artery embolization, 1 common iliac artery rupture and 1 pseudo-aneurysm. all complications were treated percutaneously, except for the distal embolization treated surgically. The patient with iliac artery rupture underwent acute renal insufficiency requiring temporary dialysis after hemorrhagic shock because of retroperitoneal hematoma. Mean follow-up was 18 months (range 6-30 months). The primary and secondary patency was respectively 92.3% and 100%. ConClusion: endovascular recanalization of juxtarenal aorto-iliac occlusion in selected patients is feasible and safe, with good early and mid-term results and should be considered in high risk patients