187 research outputs found
Transradial access for renal artery intervention
INTRODUCTION: Percutaneous interventional procedures in the renal arteries are usually performed using a femoral or brachial vascular access. The transradial approach is becoming more popular for peripheral interventions, but limited data exists for renal artery angioplasty and stenting. METHODS: We have analyzed the clinical, angiographic and technical results of renal artery stenting performed from radial artery access between 2012 and 2013. The radial artery anatomy was identified with aortography using 100 cm pig tail catheter. After engagement of the renal artery ostium with a 6F Multipurpose or 6F JR5 guiding catheter, the stenosis was passed with a 0.014" guidewire followed by angioplasty and stent implantation. RESULTS: In 27 patients (mean age: 65.4 +/- 9.17) with hemodynamically relevant renal artery stenosis (mean diameter stenosis: 77.7 +/- 10.6%; right, n = 7; left, n = 20), interventional treatment with angioplasty and stenting was performed using a left (n = 3) or right (n = 24) radial artery access. Direct stenting was successfully performed in 13 (48%) cases, and predilatations were required in ten cases 10 (37%). Primary technical success (residual stenosis <30%) could be achieved in all cases. The mean contrast consumption was 119 +/- 65 ml and the mean procedure time was 30 +/- 8.2 min. There were no major periprocedural vascular complications and in one patient transient creatinine level elevation was observed (3.7%). In one patient asymptomatic radial artery occlusion was detected (3.7%). CONCLUSION: Transradial renal artery angioplasty and stenting is technically feasible and safe procedure
A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda
BACKGROUND: Many approaches to improving health managers’ capacity in poor countries, particularly those pursued
by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen)
weak public management structures. This limits opportunities for strengthening local health managers’ capacity,
improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory
action research approach to strengthening health managers’ capacity in Eastern Uganda.
METHODS: This was a qualitative study that used open-ended key informant interviews, combined with review of
meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken.
The Competing Values Framework of organisational management functions guided the deductive process of analysis
and the interpretation of the findings. The framework builds on four earlier models of management and regards them
as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and
control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus
external organisational focus.
RESULTS: The findings indicate that the participatory action research approach enhanced health managers’ capacity to
collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces,
encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension
and conflict across different management functions was apparent; for example, while there was a need to collaborate,
maintaining control over processes was also needed. These tensions meant that managers needed to learn to
simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in
order to maximise their effectiveness.
CONCLUSIONS: Improved health manager capacity is essential if sustained improvements in health outcomes in lowincome
countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of
local managers, and the promotion of reflection and accountability were the key means by which participatory action
research strengthened health managers’ capacity. The participatory approach to implementation therefore
created opportunities to strengthen health managers’ capacity
Carotid Artery Stenting to Prevent Stroke in a Patient with Bilateral Extracranial Internal Carotid Dissection and Vasospasm following Rupture of an Intracranial Aneurysm
Stenting for Abrupt Closure of the Intracranial Vertebral Artery Complicating Balloon Angioplasty
Clinical, Angiographic, and Procedural Factors Presumably Related to Persistent Success After Percutaneous Transluminal Coronary Angioplasty
Percutaneous Transluminal Coronary Angioplasty in the Management of Recurrent Angina Pectoris Following Coronary Bypass Grafting
Clinical and angiographic assessment 6 months after double vessel percutaneous coronary angioplasty
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