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PubMed2003

Unipolar electrogram in identification of successful targets for radiofrequency catheter ablation of focal atrial tachycardia.

OBJECTIVE: To analyze the unipolar electrogram from successful and unsuccessful ablation sites of focal atrial tachycardia (AT), and to evaluate its value in the identification of successful targets. METHODS: Fifteen consecutive patients with focal AT were referred for radiofrequency catheter ablation (RFCA). Both unipolar (from the tip electrode of ablating catheter) and bipolar (from the distal pair of electrode of ablating catheter) electrograms were used to identify the ablation targets of focal AT. RESULTS: Successful ablation was echieved in 14 patients. Radiofrequency energy was delivered at a total of 27 sites. The bipolar electrograms associated with successful ablation sites showed earlier atrial deflection relative to P wave onset (36 ms +/- 15 ms vs 30 ms +/- 11 ms, P < 0.05) than the electrograms associated with failed ablation sites. At the 14 successful ablation sites, the unipolar electrograms displayed a completely negative atrial wave ("QS" morphology) beginning with intrinsic deflection. However, at the 13 unsuccessful ablation sites, a "rS" morphology of atrial wave was shown on the unipolar electrogram. CONCLUSION: The "QS" morphology of the atrial wave on unipolar electrograms appears to represent a reliable marker for identifying the successful ablation targets of focal AT, with a high sensitivity and specificity.

Adolescent↗

PubMed2000

[Concepts of success in the treatment of tuberculosis in the early 20th century].

This paper deals with the social construction of medical success in various therapies used to treat tuberculosis during the first half of the 20th Century. The three main therapies discussed-Tuberculin treatment, sanatorium therapy and chest surgery-show distinctly different success patterns. For example, the success of sanatorium treatment was evaluated differently during and after treatment: during treatment, quantifiable data such as weight and body temperature were seen as indicators of health. After discharge, however, success was defined as long-term survival. On the other hand, when chest surgery was used, success meant simply that patient was able to survive the surgery itself-long-term effects and patient's survival after discharge were not addressed. Such comparisons illustrate that the definition of medical success rested as much on the dismissal of negative data as on positive empirical results.

History, 20th Century↗

PubMed2003

Uterine contraction frequency before and after successful tocolytic therapy for preterm uterine contractions.

OBJECTIVE: To examine the association between prelabor uterine contraction frequency (UCF) and the success of tocolytic therapy for preterm labor (PTL). STUDY DESIGN: Eleven centers conducted a prospective, observational study of UCF recorded between 22(0/7) and 36(6/7) weeks' gestational age or until delivery > or = 2 times/d on > or = 2 d/wk in women with singleton pregnancies with and without risk factors for preterm birth. Uterine contraction data obtained from patients diagnosed with PTL allowed comparison of mean UCF both before and after an acute episode of PTL treated with either intravenous, subcutaneous or oral tocolysis. The signed rank test was used to analyze differences in UCF before and after tocolytic therapy and between women who were or were not successfully treated with a labor-inhibiting agent. RESULTS: Of 454 enrolled women, 128 were diagnosed with PTL, and 74 were successfully treated with a labor-inhibiting agent. The mean UCF preceding PTL was not different between those women successfully treated and those who delivered as a consequence of the PTL episode. There was no difference (P = .653) in mean UCF between the week before PTL (UCF 0.60 +/- 0.8, median 0.30) and the first week of monitoring after successful tocolysis (UCF 0.82 +/- 1.4, median 0.27). CONCLUSION: The mean UCF immediately preceding PTL does not predict tocolytic success or failure.

Adult↗

PubMedDate not supplied

The 360 degrees nature of change implementation and the essential three Ds for successful and sustainable change.

The challenge and real key to future success is to be more than just receptive to change. Lasting success will come to those that encourage innovation and create change. But most of our organizations have not been successful at implementing change initiatives, let alone sustaining them. We fail to recognize that change is a process that requires definition, decisiveness, and leadership to deliver the success and sustainability we so badly need. Successful and sustainable change can happen with the "3 Ds": define, decide, and deliver. Making sure that change is successful is every stakeholder's responsibility, and making change sustainable is something that must be driven by leadership.

Laboratories↗

PubMed2004

[Effects of climate change on forest succession].

Forest regeneration is an important process driven by forest ecological dynamic resources. More and more concern has been given to forest succession issues since the development of forest succession theory during the early twentieth century. Scientific management of forest ecosystem entails the regulations and research models of forest succession. It is of great practical and theoretical significance to restore and reconstruct forest vegetation and to protect natural forest. Disturbances are important factors affecting regeneration structure and ecological processes. They result in temporal and spatial variations of forest ecosystem, and change the efficiencies of resources. In this paper, some concepts about forest succession and disturbances were introduced, and the difficulties of forest succession were proposed. Four classes of models were reviewed: Markov model, GAP model, process-based equilibrium terrestrial biosphere models (BIOME series models), and non-linear model. Subsequently, the effects of climate change on forest succession caused by human activity were discussed. At last, the existing problem and future research directions were proposed.

Climate↗

PubMed2004

Improving the success rate of laryngeal mask airway insertion during etomidate induction by using fentanyl or succinylcholine.

BACKGROUND: Smooth and successful insertion of a laryngeal mask airway (LMA) during etomidate induction requires a proper mouth opening and efforts to minimize airway reflexes such as gagging, coughing, or laryngospasm. We hypothesized that the concurrent use of fentanyl or succinylcholine with etomidate, the induction agent, could reduce the occurrence of airway reflexes and increase the success rate of LMA. METHODS: Sixty adult patients, ASA class I-II, scheduled for surgery under general anesthesia, were randomly allocated into three groups: group I in which patients were given etomidate 0.3 mg/kg alone; group 2 in which patients were given fentanyl 2 microg/kg and etomidate 0.3 mg/kg; groups 3 in which patients were give etomidate 0.3 mg/kg and succinylcholine 1 mg/kg. All patients were premedicated with atropine 0.01 mg/kg. When induction of anesthesia began we recorded the time from administering the designated regiminal agent or agents to the time of relaxation of jaw (the ease of mouth opening) and checked the patient for any excitatory movement after administering the induction agents. After inserting the LMA, we checked for signs of airway reflexes. Student's t test, Chi-square and Fisher's exact test were used to analyze the data. A value of P < 0.05 was considered significant. RESULTS: There were no significant differences in demographic data among the the three groups. The concurrent use of fentanyl or succinylcholine with etomidate during induction could significantly reduce the occurrence of excitatory movements and airway reflexes after LMA insertion, and increase the success rate of LMA insertion in comparison with using etomidate alone. Comparing the two adjutant agents, the concurrent use of succinylcholine could provide a significantly better jaw relaxation, shorten the time to insert the LMA and increase the success rate of LMA insertion. CONCLUSIONS: As an induction agent to facilitate insertion of LMA, etomidate alone was far from perfect. The concurrent use of 2 microg/kg of fentanyl with etomidate might significantly reduce the occurrence of airway reflexes in response to LMA insertion and increase the success rate of insertion. However, concurrent use of 1 mg/kg succinylcholine with etomidate might provide better results in terms of shortened time for the LMA insertion, jaw relaxation, and the success rate of LMA insertion than that of fentanyl.

Adult↗

PubMed2004

Project Sugar: a recruitment model for successful African-American participation in health research.

Attempts to increase the number of African-Americans participating in clinical trials, regardless of age, have been hampered by a lack of published data regarding successful recruitment and retention strategies. Successful strategies can be used as a guide for future researchers in the design of studies to recruit African-Americans, regardless of age, into clinical as well as qualitative studies to promote health among this vulnerable population. The goal of the primary study was to recruit 400 families with 2 or more family members affected with diabetes, totaling 800 participants. Project Sugar utilized the coordinated research principals known as CPR (Community, Plan, Reward) to recruit 615 African-American families totalling 1,230 people known as the Sea Island people (Gullahs) in the first five years of the study. The intention of the study was to identify markers for diabetes among these Sea Island natives who tended to be genetically homogenous. In so doing, specific strategies were identified as serendipitous findings for this study. Nonetheless, these serendipitous findings were thought to be so integral to success in the recruitment of African-Americans, mainly because of their success among this fairly close-knit, historically isolated, and significantly genetically homogenous Sea Islanders (Gullah). In recognizing the success of this model, an alternate aim was examined to devise rigorous scientific strategies to promote methods for recruitment of African-Americans into clinical trials aimed at reducing health disparities among this vulnerable population. This projects success can be attributed to the involvement of a local citizen advisory committee and rewards in the form of services, benefits, and incentives to the community. Findings from this alternative aim, which was scientifically built on the CPR model, suggest that when services are provided to the community, coupled with the use of local community advisory committees, the possibilities of recruiting participants into a clinical trial are significantly enhanced and augmented.

Black or African American↗

PubMed2005

Impact of intraoperative echocardiography/surgery team on successful mitral valve repair: a community hospital experience.

BACKGROUND AND AIM OF THE STUDY: Mitral valve (MV) repair is generally accepted as the preferred treatment of mitral regurgitation (MR) with MV prolapse secondary to myxomatous mitral valve disease (MMVD). However, the incidence of successful valve repair is variable between hospitals and among different surgeons at one hospital, and often results in needless MV replacement. The study aim was to measure the impact of a dedicated echocardiography/surgery team on MV repair at a community hospital. METHODS: The outcome was analyzed of a group of 116 consecutive patients with severe MR secondary to MMVD who underwent surgery by the same surgeon over a six-year period. A dedicated team approach, comprising one echocardiographer and one surgeon was established in January 1999. The results of MV repair between 1996 and 1998 (group I; n = 37) were compared to results obtained between 1999 and 2001 (group II; n = 79). RESULTS: In group I, MV repair was attempted in 25 patients (67.6%) and was successful in 21 (56.8%). In group II, MV repair was attempted in 68 patients (86.1%) and was successful in 67 (84.8%). The success rate between groups was significantly (p = 0.001) different. The rate of successful MV repair in patients with a diffusely redundant prolapsing valve involving both leaflets and multiple segments with chordae elongation was significantly higher in group II (14/20; 70%) than in group I (1/6; 14.3%) (p = 0.011). CONCLUSION: A greater incidence of successful MV repair, even with more diffuse pathology of MMVD, was realized following the institution of dedicated echocardiography/surgery team at a community hospital. It is proposed that a combination of dedicated intraoperative echocardiography and surgical expertise is required for optimal results in MV repair.

Aged↗

PubMedDate not supplied

[Succession of chitinolytic microorganisms in chernozem soil].

The chitinolytic prokaryotic and eukaryotic microbial complex of chernozem soil has been investigated in the course of a succession initiated by the introduction of chitin and humidification. The dynamics of the cell numbers of chitinolytic microorganisms and of their biomass was assessed by fluorescent microscopy and by inoculation of selective media. Emission of carbon dioxide and nitrous oxide, as well as dinitrogen fixation, was assessed by gas chromatography. It was found that, when the succession was initiated by the introduction of both chitin and humidification, it resulted in greater cell numbers and biomass of chitinolytic microorganisms and higher levels of CO2 and N2O emission and of nitrogen fixation than when the succession was initiated by humidification alone. As compared to the control samples, a significant (twofold) increase in the prokaryote cell number and biomass was found on the fourth day of the succession initiated by humidification and introduction of chitin. One week after the initiation of succession, the fungal biomass and length of mycelium were twice as high as those in the control samples. These results led to the conclusion that chitin utilization in chernozem soil starts during the initial stages of succession and is performed by both prokaryotic and eukaryotic microorganisms.

Actinobacteria↗

PubMed2006

Successful introduction of Macaca nemestrina infants to their mothers after cesarean delivery.

Four Macaca nemestrina infants delivered via cesarean section were introduced to their mothers after surgery. All 4 introductions were successful, although methods differed slightly between dam-infant pairs. Pairs were considered successful when the mother displayed affiliative behavior towards the infant (including grooming), cradled it ventrally, and nursed it sufficiently to maintain infant health. The dams were sedated lightly with ketamine prior to introduction to reduce the possibility of aggression to caregivers and infants. The dams were checked for lactation, and each infant was swabbed with its placenta and with its mother's vaginal secretions prior to placement in the dam's cage. During the initial exposure, all 4 mothers picked up their infants within 1.5 h after introduction. Three of the 4 dam-infant pairs were fully successful during the initial exposure (24 h postdelivery), that is, the infants began to nurse within 2.5 h of affiliative contact. The 4th dam-infant pair required 3 d of successive exposures before the infant was nursed adequately. Infant health and maternal behavior determined the length of exposure. The optimal duration of these introductory encounters appeared to be between 2 and 3.5 h, to allow sufficient time for the dam's recovery from sedation while avoiding adverse effects on infant health. These observations demonstrate that cesarean-delivered M. nemestrina infants can be successfully united with their mothers, although it sometimes may require prolonged exposures on successive days.

Animals↗

PubMed2006

Vaginal birth after one caesarean section: analysis of indicators of success.

A study was carried out among 81 women with previous one caesarean section (CS) done for non-recurrent indications to confirm the efficacy and safety of trial of labour (TOL) and to examine the effect of various factors on the mode of delivery. Singleton term pregnancy, vertex presentation and adequate pelvic capacity were the pre-requisites for case selection. Careful monitoring was done during labour and effect of various factors on the outcome was analysed statistically. Success rate of TOL was 73%. A non-recurrent indication for previous CS, such as malpresentation and foetal distress is associated with higher success rate of vaginal birth after caesarean (VBAC) compared to recurrent indications, such as cephalopelvic disproportion (CPD) and failure to progress (FTP). Prior vaginal birth improves the success rate (87%) of VBAC. Factors like premature rupture of membranes, hypertensive disorders of pregnancy, and post-date pregnancy did not affect the outcome adversely. Rate of emergency CS was 44% in women with floating head foetus, 39% in induction/augmentation group and 43% when birth weight of the foetus was > 3000 g. No maternal/perinatal mortality observed. Maternal/perinatal morbidity was low in cases with successful TOL. Uterine rupture occurred in one woman. There are few absolute contra-indications to attempted VBAC. Though the success rate does vary with different pre-existing factors, the clinician may anticipate greater than 50% chance for success in any individual labour.

Female↗

PubMed2006

[Predicting the success of a benzodiazepine discontinuation programme: myths or clinical wisdom?].

BACKGROUND: After successful completion of a benzodiazepine withdrawal programme it nevertheless is hard to remain abstinent in the long term. AIM: To determine to what extent the success of a benzodiazepine discontinuation programme for psychiatric patients with chronic benzodiazepine use (> or = 3 months) can be predicted from the severity of the anxiety, sleep disorders and depressive symptoms, and from the level of benzodiazepine dependence. The predictive values of coping style and personality characteristics were also studied. METHOD: A prognostic cohort study with patients of the Radboud University Nijmegen Medical Centre was conducted. Before entering the programme 92 patients were given a psychological assessment. Anxiety level, benzodiazepine dependence, coping style and personality traits were measured by means of psychological questionnaires. The DSM-IV axis I classification for each patient was known. Patients who had stopped their medication immediately after the discontinuation programme ended (n = 6o) were compared with patients who had not been successful in completing the programme (n = 32). Thereafter, patients who were still abstinent at the follow-up about 2 years later (n = 25) were compared with patients who at that time /used benzodiazepine (n = 43). RESULTS: Of all the variables examined, it was only a specific coping style whereby patients expressed their (negative) emotions which was associated with the short- and long-term success of the discontinuation programme. The more patients expressed their negative emotions, the greater the chance of a successful outcome and permanent abstinence. Coping style, however, predicted for only a small proportion of the variance in the success of the discontinuation programme. CONCLUSION: The psychological characteristics and the DSM-IV axis I classifications should not exert undue influence on the clinician's decision to advise the patient to stop or continue taking benzodiazepines.

Adaptation, Psychological↗

PubMed2006

High baseline fibrinogen concentration as a risk factor of no tissue reperfusion in ST-segment elevation acute myocardial infarction treated with successful primary percutaneous coronary intervention.

BACKGROUND: In a large group of patients with myocardial infarction, lack of tissue reperfusion following successful recanalisation of the infarct-related epicardial artery is seen. Blood flow in the microcirculation depends not only on structural changes in the microvasculature but also on rheological features of the blood itself. AIM: To investigate the association between baseline fibrinogen concentration and myocardial reperfusion following successful coronary angioplasty. METHODOLOGY: In 105 patients with acute ST-segment elevation myocardial infarction, baseline fibrinogen concentration was compared between patients with successful tissue reperfusion (n=79) and with no myocardial reperfusion (n=26) measured as the degree of ST-segment normalisation after successful recanalisation of the infarct-related artery. RESULTS: Baseline fibrinogen concentration was significantly higher in the no-reperfusion group than in the reperfusion group (523+/-198.02 mg/dl vs 395.56+/-144.98 mg/dl, p=0.0004). In the overall study population, fibrinogen level correlated positively with maximum creatine kinase MB fraction concentration (r=0.25, p=0.012) and duration of chest pain (r=0.31, p=0.002). Mean fibrinogen concentration was higher in patients with anterior myocardial infarction than in patients with the infarct-related artery other than the left anterior descending artery. The risk of no-reflow phenomenon assessed in multivariate analysis was higher if duration of chest pain was longer (OR=1.46, CI 95% 1.06-2.16, p=0.001) and baseline fibrinogen concentration higher (OR=1.51, CI 95% 1.011-4.58, p=0.021). CONCLUSIONS: Baseline fibrinogen concentration following successful mechanical recanalisation of the infarct-related coronary artery is an independent risk factor of a lack of myocardial reperfusion and it positively correlates with maximum creatine kinase MB fraction concentration and duration of chest pain. High fibrinogen concentration may affect rheological parameters of the blood and play an important role in the pathomechanism of myocardial no-reperfusion phenomenon following successful mechanical recanalisation of the infarct-related coronary artery.

Aged↗

PubMed1991

[Simultaneous effects and aftereffects of the intensity and success aspect in coping with stresses].

Intensity and success of coping processes in achievement-related situations are very often tightly connected. Therefore, the specific empirical status of each of the two aspects is unclear. In the current study a technique is introduced which allows orthogonal variation of both components. 64 subjects were confronted with a simple perceptual-speed task in which objective success rate was held constant by a computer-based adaptive process. Graphic feedback was provided about the objective success rate in relation to one of two different success criteria. For half of the subjects the criterion was above (failure condition) and for the other half it was below (success condition) the adaptively controlled success rate. Intensity, the second between-subjects factor, was manipulated by presenting either a high or a low number of items per time unit. As an additional quasi-experimental factor, the degree of action- vs. state-orientation (Kuhl, 1983) was included. The results showed highly specific effects for both the intensity and the failure/success dimension: High intensity resulted in an increase of electrodermal activity which could be observed throughout a one hour post-stressor phase. The failure/success variation had effects mainly on subjective variables representing appraisal of controllability and produced no after-effects. Especially strong effects on subjective variables could be observed when state-oriented subjects were confronted with both failure and high intensity.

Achievement↗

PubMed1990

[Early detection of successful reperfusion by analysis of serum myoglobin in patients with acute myocardial infarction].

We examined the changes of serum myoglobin (Mb) levels after reperfusion therapy (PTCR, PTCA) in 24 patients with acute myocardial infarction by latex agglutination turbidimetry. In the cases of 13 patients successfully reperfused, significantly higher Mb levels was observed and they disappeared rapidly from blood after the therapy. On the other hand, serum Mb levels disappeared slowly in the cases of patients unsuccessfully reperfused. The disappearance rate of Mb (23.4 +/- 6.7%) in successful reperfused patients was higher than that in unsuccessful reperfusion (5.3 +/- 6.8%) (p less than 0.001), the cut-off value of serum Mb levels in the decision regarding success or failure of reperfusion was set at 17% of disappearance rate, the predictive values for successful and unsuccessful reperfusion were 92% and 91% respectively. The maximum peak time of CK, CK-MB activities and Mb levels after onset of chest pain were also observed. Only the maximum peak time of CK-MB was significantly fasten than others in the cases of patients sera with successful reperfusion (p less than 0.05). We conclude that the measurement of serum Mb levels was useful and suitable for rapid judging on success or failure of reperfusion therapy by use of the disappearance rate of it.

Evaluation Studies as Topic↗

PubMed1987

[New classification of ureter by success rate for transurethro-ureteral lithotripsy].

Between August, 1985 and February, 1987, 4 renal pelvic stones and 49 ureteral stones (28 calculi in the abdominal ureter, 21 in the pelvic ureter) were treated by 55 procedures of transurethro-ureteral lithotripsy (TUL). The success rate for stones in the ureter lying in the paravertebral gutter was 33% (3/9), while those in the ureter overlying the psoas muscle was 85% (17/20). The success rate for calculi impacted at the uretero-vesicle junction was 100% (12/12), and those in the upper part of pelvic ureter was 80% (8/10). Two of 4 renal pelvic stones were successfully fragmented and removed. The overall success rate by the ureterorenoscope was 79% in 53 renoureteral units. Judging from our experience and results of TUL, the stone location seems to be one of the factors affecting the success rate. Thus, we propose a new classification of ureter according to success rate for TUL as follows; uretero-vesical junction, pelvic, psoas, and gutter portion.

Adult↗

PubMed1986

Renewal and release of hemopoietic stem cells: does clonal succession exist?

The term "clonal succession" was proposed 20 years ago by Kay to characterize the release of stem cells from their primary pool, followed by the expansion of each cell to a clone and the succession of new clones as the mature cells of each clone are lost because of their finite life span. The authors point out that the events described by Kay as clonal succession are necessary features of hemopoietic proliferation. Clonal succession is equivalent to the universally recognized existence of a self-replicating primary stem cell pool that continuously supplies cells for amplification and maturation to subsequent compartments. The authors object to the term "clonal succession" because it has been used by a number of investigators to characterize specific schemes rather than the general aspects of hemopoietic proliferation, thus leading to confusion. They suggest that the descriptive term, "continuous release of stem cells for differentiation," would be preferable to the use or misuse of "clonal succession."

Animals↗

PubMed1977

Behavioral and fantasy measures of fear of success in children.

Fear of success was assessed for 61 fifth-, seventh-, and ninth-grade children using Horner's and Baruch's "fantasy" measures and a behavioral measure developed by the authors. Males and females did not differ significantly on fear of success as measured by the fantasy technique. Developmentally, male fear of success remained unchanged in the three grades tested, while female fear of success decreased from grade 5 to grade 7. The behavioral measure of fear of success tapped a drop in achievement striving in grade 7 for the female subjects. Results are discussed in light of a "situational" versus personality theory of the development of fear of success.

Achievement↗