PurposeThe purpose of this study is to highlight a key strategic initiative within the former ADC Company (now part of TE Connectivity) called “Lean Pull Replenishment”, designed and implemented to achieve Six Sigma customer service excellence. This case study would also help facilitate problem‐based learning pedagogy.Design/methodology/approachThe study showcases implementation of the Lean Pull Replenishment approach using the define, measure, analyze, improve and control (DMAIC) framework. Key input variables were analyzed that contributed to historically inconsistent and unsatisfactory customer delivery performance. Analysis resulted in improving the allocative efficiency of critical input variables through pilot programs on strategic value streams by deploying dozens of kaizen events, and sustaining the gains through leveraging best practices and effective change management principles.FindingsThe study presents a strong case for the team work and the cultural transformation that occurred during the course of implementing this initiative across ADC supply chain. The paper also summarizes the improvement in customer service metrics and financials of the company.Originality/valueThrough this study, it has been established that with consistency of purpose, using the right tools for solving problems and through teaching Lean principles, remarkable results can be achieved, which can be sustained for the long‐term and become a self‐sustaining business philosophy.
Early detection of asymptomatic coronary artery disease (CAD) is essential but underdeveloped. The aim of this study was to assess micro-RNA (miRNA) expression profiles in patients with or without CAD as selected by coronary CT angiography (CTA) and stratified by risk of CAD as determined by Framingham Risk Score (FRS). In this pilot study, patients were divided into two groups based on the presence or absence of CAD. Disease status was determined by Coronary CTA by identification of atherosclerosis and/or calcified plaque in coronary arteries. There were 16 control subjects and 16 subjects with documented CAD. Groups were then subdivided based on FRS. Pathway-specific microarray profiling of 86 genes using miRNAs isolated from whole peripheral blood was analyzed. MiRNA were differentially expressed in patients with and without CAD and who were stratified on the basis of FRS with miRNA associated with endothelial function, cardiomyocyte protection and inflammatory response (hsa-miR-17-5p, hsa-miR-21-5p, hsa-miR-210-3p, hsa-miR-29b-3p, hsa-miR-7-5p and hsa-miR-99a-5p) consistently upregulated by greater than twofold in groups with CAD. The present study reveals that miRNA expression patterns in whole blood as selected on the basis of coronary CTA and risk scores vary significantly depending on the subject phenotype. Thus, profiling miRNA may improve early detection of CAD.
Introduction:
Through various systematic initiatives, cardiac centers routinely reach targeted door-to-balloon (DTB) treatment times of less than 90 minutes resulting in improved outcomes. However, in an effort to further optimize outcomes, by reducing total ischemic time, focus on symptom onset and their impact on presentation is needed.
Hypothesis:
This study aimed to identify whether the type and nature of specific symptoms are associated with delays in presentation in STEMI patients.
Methods:
549 patients with complete data presenting with STEMI from April 2008 to December 2012 to a tertiary hospital were retrospectively studied. False activations were excluded. 449 patients were included in this analysis. Symptom-onset-to-hospital arrival time (symptom-onset time was identified by review of medical records, pre-hospital emergency services data and by interviewing patient’s and their family) was analyzed for the following factors: type of symptoms (chest pain, dyspnea, cardiac arrest) and nature of symptoms (constant or intermittent). Non-parametric univariate and multivariate analyses (PROC GLIMMIX) were carried out using Statistical Analysis Systems version 9.1 (SAS Institute, Cary, NC) statistical software package.
Results:
See table
Conclusion:
As expected, STEMI patients presenting with cardiac arrest who survived pre-hospital resuscitation presented the fastest, while patients with dyspnea had a significantly longer delay than patients with chest pain. Patients with intermittent symptoms presented significantly later than those with constant symptoms. Of particular interest, symptom-onset-to-door presentation remains long even with the classical symptom of constant chest pain (the most common STEMI symptom presentation). Thus, continued and enhanced population education and awareness is necessary to see further significant decreases in total ischemic time in STEMI patients.
Background
: Growing numbers of American Veterans are diagnosed with psychological disorders and myocardial infarctions without known preexisting cardiac risk factors. Confronted with this information, we studied the association between psychological disorders and the presence of coronary artery calcium. High risk coronary calcification [Agatston method coronary artery calcium score (CAC) >100] is associated with a striking increase in cardiovascular events (hazard ratio>10) making it an excellent surrogate marker.
Methods
: From a database of VA patients who have undergone cardiac computed tomography, 483 were studied (age 59±12 years, 86% male). Regression analysis was utilized for comparison of CAC score for individuals with depression, anxiety, post-traumatic stress disorder (PTSD) and substance abuse..
Results
: After adjustment for age, gender and cardiac risk factors, the odds ratio of CAC≥100 vs. CAC=0 was 1.24 (95% CI 1.02–2.08, p=0.044) for depression, 2.04 (95% CI 1.11– 6.17, p=0.027) for anxiety, 2.28 (95% CI 1.15–5.76, p=0.026) for PTSD and 2.61 (95% CI 1.14 – 6.03, p=0.022) for substance abuse as compared to normal cohort.
Conclusion
: Veterans with psychological disorders were found to have a significantly higher coronary artery calcification score than those without such disorders. These findings are independent of age, gender and other traditional cardiac risk factors.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.