The aim of this paper is to explore current state-of-the-art on lean in High-Mix/Low-Volume (HMLV) industry. For this purpose, authors propose a systematic literature review of 110 articles published ...in 66 peer-reviewed international journals that explicitly discuss lean in HMLV context. The purpose is to investigate research that is available, in order to analyse theoretical aspects of lean considerations in HMLV context, identify the level of lean maturity, the scope of lean, the way lean is implemented, and tools and practices that are commonly used. The results of the analysis show that current research is mainly focussed on practice, with little attention to theory development. The maturity of lean implementation is rather low, as articles mostly address obvious waste reduction, while more advanced concepts such as variability management and buffering remain under-researched. Studies are often operationally and internally oriented, with shop-floor improvements being the area of interest, while embedding lean in strategy is not sufficiently addressed. Lean implementation frameworks presented in the literature are usually tool-based, addressing a narrow set of simplified cases that do not take fully into account complexities of HMLV industry. Lastly, a rather narrow set of tools is used, with tools often being adapted without proper consideration of relevance of a certain tool for HMLV industry. As publications reviewing lean in HMLV context are scarce, this study presents valuable insight and serves as an excellent resource for research on the subject, since it not only presents the existing knowledge in a structured way, but also identifies possible directions for future research.
Educational turn in art as a term was first introduced during the last decade of the twentieth century in curatorial practices, although the very concept of turning art into educational vehicle, or ...into production of a new knowledge can be traced earlier into the art movements, schools and alternative pedagogical approaches. However, the idea that the art world could be transformed into an art network, an educational space that encourages the production and exchange of knowledge, certainly opens up a lot of questions both to the academic field and the field of artistic and representational practices. The text 'Educational turn in art: Turning art into the production of a new knowledge' attempts to give an overview on the concepts of the educational turn in art, and also to shed some light on the important issues regarding the status of art in the contemporary information age.
Introduction:
Ischemic postconditioning (IPCT) represents one of the several therapeutic strategies to attenuate ischemic reperfusion injury (IR) after carotid endarterectomy (CEA). We here present ...the first in-human study of IPCT in carotid surgery.
Methods:
The study represents an observational case-control study, with the data collected in our Institution carotid database. From December 2015 to December 2020, a total of 300 patients were included in our study; IPCT group consisted of 148 patients in whom ischemic postconditioning was performed while control group consisted of 152 patients in whom IPCT was not performed. Indications for IPCT technique were: severe unilateral internal carotid artery (ICA) stenosis (>90%), severe bilateral ICA stenosis (>80%), severe ICA stenosis (>80%) with contralateral ICA occlusion and ICA subocclusion. IPCT was performed by applying 6 cycles of 30 sec reperfusion (declamping of ICA)/30 sec ischemia (clamping of ICA) after finishing the procedure and initial declamping. Two groups of patients were compared in terms of occurrence of intrahospital and early postoperative stroke, TIA (transient ischemic attack) and neurologic morbidity.
Results:
Cumulative incidence of intrahospital postoperative stroke or TIA was significantly higher in the control group (5.3% vs 0.7%, P = .036). According to carotid plaque characteristics, patients in the IPCT group had significantly more frequent presence of heterogenous plaque, as well as ulcerated plaque, which was associated with the absence of postoperative stroke and significantly lower cumulative rate of TIA/stroke when compared to the control group (43.9% vs 8% and 47.3% vs 1.5%). During the follow-up period of 1 month after the surgery, there were no cases of stroke, TIA and deaths due to neurological causes in both groups of patients.
Conclusion:
Our results showed that IPCT significantly reduced the incidence of postoperative cerebral ischemic complications after CEA in high-risk patients for IR injury when compared to the control group.
(Cerebral oximetry and carotid surgery) During carotid endarterectomy and carotid artery cross-clamping, various methods for monitoring of cerebral perfusion and function are suggested, including ...electroencephalography, measurement of the stump pressure, transcranial Doppler, somatosensory evoked potentials, regional cerebral oxygen saturation monitoring (NIRS-rSO2) or direct neurological monitoring of the awake patient during carotid cross-clamping. NIRS is a non-invasive monitoring method that may provide useful information on the most appropriate management during the procedure and postoperative recovery period in carotid endarterectomy patients. It is not possible to specify an absolute rSO2 reading as the critical value below which cerebral ischemia may develop. A relative decrease of rSO2 > 20% after carotid occlusion has an elevated negative predictive value - if rSO2 does not decrease, ischemia is unlikely, but a low positive predictive value - a decrease in rSO2 may not always indicate cerebral ischemia.
Perioperative pulmonary embolism Unić-Stojanović Dragana
Serbian Journal of Anesthesia and Intensive Therapy,
01/2016, Volume:
38, Issue:
1-2
Journal Article
Peer reviewed
Open access
All perioperative patients are at increased risk of pulmonary thromboembolism (PTE). The most common findings of PTE in patients undergoing general anesthesia are hypotension, tachycardia, hypoxemia, ...and decreased end-tidal CO2 air. Computed tomographic scanning is the preferred definitive diagnostic study, but transesophageal echocardiography may be valuable in making a presumptive diagnosis in the operating room. Early diagnosis allows supportive therapy and anticoagulation.
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