Background: Our objective in this multicenter retrospective study is to discuss the optimum timing for CABG after STEMI. The second question is whether the Off-Pump technique differs regarding the timing or affects the outcome compared to the On-Pump technique.

Methods: Between September 2009 and June 2016 in Saudi German hospitals group in Saudi Arabia and central Hospital BadBerka in Germany, 379 STEMI patients, who were not candidates for or failed PCI; were operated for CABG. 200 (52.77%) were operated Off-Pump and 179(47.23%) On –Pump; with an age range of 36-63years. 195 males in the off-pump patients (97.5%) and 175 males (97.76%) in the on-pump patients. we arranged them into 2main groups; group A as off-Pump and group B as on-pump. Both groups were further subdivided into groups A1 (off-pump early surgery; 100 patients), group A2 (off-pump late surgery; 100 patients) group B1 (on-pump early surgery; 88 patients) and group B2 (late surgery; 91 patients). We excluded patients with Complicated PCI, Mechanical complications, Cardiogenic shock, Life threatening arrhythmias and Late presentation of ischemia or infarction after PCI.

Results: 25 mortalities occurred in early operated cases. There were no intra-operative mortality in the groups operated late after the infarction, and only one late postoperative mortality in group B2. 9 mortalities in group A1 (4.5% of the off-pump CABG-9% of group A1) and 16 mortalities of group B (8.9% of group B, 15 cases in group B1; 17% and 1 case in group B2; 1.09%). There was significant statistical difference between group A and group B, A1 and A2, B1 and B2; regarding the intra-and postoperative mortality with p-value of 0.004, 0.0022, 0.001 intraoperatively and 0.0047, 0.001, 0.003 postoperatively. The postoperative duration for mechanical ventilation was longer in group B than in group A, and longer in group A1 compared to group A2. The use of intra-aortic balloon pump was more in group B than A and more in A1 compared to A2 also more in cases of group B1 than B2. The use of inotropic support was more in group B than A while it was less in A2 than A1 and more in B1 than B2. The total ICU and hospital stay were longer in cases of B than A and more in A1 than A2, also longer in B1 than B2. The intra and post operative arrhythmias and complications were more in A1 than A2 and in B1 than B2.

Conclusion: The more we wait after STEMI for surgical intervention for cases not candidate or failed for primary PCI, the better the outcome of surgery With no sharp time limit for postponing the surgery.

E-learning is an emerging field in the intersection of education learning, and business, referring to delivered information and education services or improved via Internet services and related technologies. The paper is an attempt to show how knowledge management (KM) and E-learning (EL) specifically can be of prominent support in the workplace. Aligning firm as a whole to a continually changing environment as far as learning and innovation are concerned is a challenge. The paper posits that KM consists of enablers such as Information systems infrastructure, Team working, Employees involvement, Top management leadership and commitment, and Employee empowerment that are critical to the success of a knowledge-based organization.
The presented model in this paper integrates Knowledge management and elearning into adaptable framework that offers integrated support as well as effect on various Medias involved in the education systems. The model is a suggestion to improve teaching and learning process and how KM adds a successful help for educational consumers in selecting and evaluating e-learning media. The model is based on an analysis of KM and elearning literature and the information search process.

Recently, E-learning has emerged as modern field with in the cooperation of education and business sectors by means of information, based-Internet services, and education services that are delivered or improved. This paper is an attempt to highlight how knowledge management (KM) and E-learning (EL), specifically, can be of prominent support in the workplace.

The purpose of the paper is to develop a model that is composed of a range of components and factors that affect integration between knowledge management and e-learning. It is characterised by dynamic alignment between information systems infrastructure, staff involvement and the flows of knowledge towards the success of knowledge acquisition in academic institutions.

The developed model will contribute to offer support to the process of integrating e-learning and knowledge management. In addition, the suggested model will present certain suggestions to improve the teaching learning process and shows how KM provides successful help for educational consumers in selecting and evaluating e-learning technologies. The model is based on analysis of KM and e-learning literature and the information of this study.