QOC in PUB has improved substantially in Denmark, but the 30-day mortality remains high. Future initiatives to improve outcomes may include earlier endoscopy, having fully trained endoscopists on call, and increased focus on managing coexisting disease.

This nationwide quality improvement initiative was associated with reduced preoperative delay and improved perioperative monitoring in patients with PPU. A non-significant improvement was seen in 30-day mortality.

In anesthetized pigs with ultrasonic flow probes mounted on each renal artery and catheters placed in the abdominal aorta and both renal veins, renal blood flow (RBF), glomerular filtration rate (GFR) and filtration fraction (FF) were investigated during stepwise unilateral ureteral obstruction. Elevation of the ureteral pressure in steps of 10 mm Hg to a maximum of 80 mm Hg decreased ipsilateral RBF by 45 ± 3% from 300 ± 25 to 168 ± 20 ml/min (p < 0.01). Contralateral RBF did not change significantly. The mean arterial pressure was constant during the experimental procedures, suggesting that the decrease of RBF was due to a significant increase in ipsilateral renal vascular resistance. Concomitantly with these changes ipsilateral GFR was reduced by 75% from 40 ± 2 to 10 ± 3 ml/min. In the contralateral kidney, GFR was unchanged during the experiment. The renal extraction of 51Cr-EDTA equal to FF increased temporarily from 0.202 ± 0.013 at start to 0.239 ± 0.015 (p < 0.05) at 20 mm Hg in the ipsilateral kidney, whereafter it was dramatically reduced to 0.090 ± 0.024 at maximum pressure. In addition, renal tubular handling of salt and water in the contralateral kidney were investigated using the lithium clearance technique. No significant changes were found. In conclusion, the renal hemodynamic changes during ureteral obstruction are compatible with a predominant preglomerular vasoconstriction. The interrelationship between obstruction, high pressure and reduction in RBF and GFR is substantiated. Moreover, variation in the reactive mechanisms between species with different kidney activities is established.

PurposeA major IBM consulting survey finds that most CEOs consider themselves and their organizations to be executing change poorly. In contrast, there are a few out‐performers (top 20 percent) who are the change masters. The paper seeks to analyze why most companies are managing change poorly while those few are doing it well.Design/methodology/approachThe IBM Global Making Change Work Study explored differences in how change was implemented by over 1,500 practitioners worldwide. IBM conducted surveys and face‐to‐face interviews with project leaders, sponsors, project managers and change managers from many of the world's leading organizations.FindingsThe study finds that change management is at a turning point: from an art to a professional discussion; from improvisation to a richer, more systematic approach, based on clear empirical perspectives on what works and what does not.Practical implicationsAlthough many practical insights – about closing the “change gap” – were identified, the real message is that companies can no longer justify or afford an improvised approach to change management.Originality/valueThe Making Change Work study shows that executing change well remains the exception, though it is certainly an achievable goal. The research with practitioners revealed practical insights about closing the change gap – including the insight that “soft,” people‐related factors typically present greater challenges than hard, technology‐related factors that are generally easier to identify and measure.