Complex Management Research Articles

NURSE'S ROLE IN CARING FOR A PATIENT WITH FOURNIER'S GANGRENE

Fournier's gangrene is a life-threatening condition characterized by rapidly progressive necrotizing fasciitis, often leading to sepsis and multiple organ failure. While historically associated with males, the condition can affect both genders, with varying degrees of severity. This case report explores the complex management of a 59-year-old male patient with a history of alcohol abuse, diabetes, cirrhosis, and a long-term smoking habit, who presented with Fournier's gangrene. The patient's critical condition and complex medical history presented significant challenges for healthcare providers, particularly nurses, who played a pivotal role in his care. These cases occur rarely in practice and require specific care and compliance with surgical nursing techniques per protocol. This case report not only sheds light on the growing incidence of Fournier's gangrene among both genders but also underscores the indispensable role of nurses in the multidisciplinary care of patients with this challenging condition. Comprehensive nursing care, patient education, and meticulous attention to detail are essential in improving patient outcomes and reducing mortality rates associated with Fournier's gangrene.

Narcotic Consumption Analysis among Severely Injured and Advanced Aged Trauma Patients.

Multimodal pain management has been shown to be effective in treating pain in acutely injured trauma patients. Our community-based, level 1 trauma center previously published in 2022 the efficacy of implementing multimodal pain control (MMPC) protocol in our inpatient trauma population which decreased the use of opioids while maintaining similar pain control. The MMPC group had a trend toward higher age and was significantly less injured. We hypothesize MMPC will reduce opioid consumption in both the advanced aged and more severely injured trauma populations while still providing adequate pain control. Defined by the year of admission, MMPC and physician managed pain control (PMPC) were compared in both advanced age groups and between the severely injured groups. The advanced age group included patients ≥55 years old. The severely injured group included ≥18 years old with ≥15 ISS. Primary outcomes were total opioid utilization per day, calculated in morphine milliequivalents (MME), and median daily pain scores. For the severely injured population, the MMPC group showed a 3-fold decrease in opioid use (30MME/d vs 90.3MME/d, P < .001) and lower pain scores (5/10 vs 6/10, P < .001) than the PMPC group. In the advance age group, there was no significant difference between MMPC and PMPC groups in opioid use (P = .974) or pain scores (P = .553). MMPC effectively reduces opioid consumption in a severely injured patient population while simultaneously improving pain control. Advanced age trauma patients can require complex pain management solutions and future research to determine their needs is recommended.

Cobalt-phenolic nanoparticles-driven self-assembly of hyaluronic acid hydrogels providing a multifactorial approach for chronic wound management

Chronic wounds are persistent non-healing lesions whose complex management is due to the interplay of multiple factors promoting chronicity, such as oxidative stress, overexpressed enzyme activities impeding the tissue repair and bacterial contamination. Currently marketed chronic wound dressings are designed mainly to absorb wound exudate, and at most to release antimicrobial agents, usually ionic silver. However, an effective wound repair requires addressing the multifactorial nature of the wound in a holistic approach. This study explores the potential of metal phenolic network (MPN) nanoparticles (NPs), comprised of epigallocatechin gallate (EGCG) and cobalt, as active agents and structural elements in wound dressings. The MPN NPs were able to generate reactive oxygen species (ROS), disturb bacterial membrane, and inhibit the biofilm of both gram-positive Staphylococcus aureus and gram-negative Pseudomonas aeruginosa. Owing to the high interfacial activity of their phenolic shells, the NPs drove the self-assembly of thiolated hyaluronic acid (THA) hydrogels featuring injectability, self-healing, stimuli-responsive NPs delivery in wound microenvironment, and control over deleterious enzyme activities, oxidative stress and bacterial colonisation. Specifically, the hydrogels inhibited matrix metalloproteinases (MMPs) and myeloperoxidase (MPO) by 60 and 80 %, respectively, and achieved 4-log reduction of S. aureus and 2-log reduction of P. aeruginosa concentrations. Finally, the hydrogels were in-vivo validated in a mouse animal model, showing lack of toxicity and similar wound healing efficiency as an antibiotic-containing commercial product.

The Use of Business Intelligence Software to Monitor Key Performance Indicators (KPIs) for the Evaluation of a Computerized Maintenance Management System (CMMS)

The increasing use of electromedical equipment in hospital care services necessitates effective management of complex devices often unsupported by existing control systems. This paper focuses on developing a pool of evaluation indices for the Clinical Engineering Department (CED) of the ASST Grande Ospedale Metropolitano Niguarda in Milano (Italy), aiming to enhance awareness of the economic value, assess operational units, and optimize maintenance processes. Leveraging business intelligence, this study identifies 18 key performance indicators (KPIs) across logistics, technical, and equipment management categories. An interactive dashboard, implemented using Power BI, facilitates dynamic analysis and visualization of these KPIs, providing insights into the maintenance efficiency and obsolescence of medical devices. It offers a comprehensive framework for ongoing monitoring and decision-making. The results showcase the potential of the developed KPIs and dashboard to enhance operational insights and guide improvements in the healthcare facility’s maintenance processes.

A Bibliometric Analysis of Supply Chain Management within Modular Integrated Construction in Complex Project Management

As construction projects become increasingly complex, modular integrated construction (MiC) has emerged as a pivotal solution, driving integrated development in complex projects. However, the reliance on prefabricated modules underscores the crucial role of supply chain management (SCM) in MiC, necessitating strategic planning and operational control. This study aimed to use bibliometric analysis to map the SCM knowledge domain within MiC. Through the use of keywords related to “supply chain” and “MiC”, 196 relevant papers were extracted from the Web of Science database. These papers were subjected to co-citation analysis, keyword co-occurrence analysis, and time span analysis to elucidate the historical evolution, multidisciplinary domains, and future directions in planning and control within SCM-MiC. The research identified two milestones in SCM-MiC’s historical trajectory, enhancing our understanding of its foundations. Moreover, 11 clusters were identified, illustrating the multidisciplinary nature of SCM-MiC. Dividing the literature into seven stages of the supply chain, the research outlined four research directions aligned with project complexity and technological development, highlighting current hotspots and gaps of the strategic planning and control. These directions bridge the construction management and information technology domains, guiding future SCM-MiC research within complex project management.

Integrated Management of Rhizome Rot and Wilt Disease Complex of Ginger (Zingiber officinale) – A Review

This review article focuses on integrated management options for ginger diseases, especially rhizome rot and wilt. We compiled the results of several strategies, including chemical treatments, cultural practices, soil solarization, organic additions, and biological management for rhizome rot and wilt disease complex of ginger. Effective approaches includes (i) raise the temperature by soil solarization, (ii) additions of soil amendments like wood sawdust, oil cakes, neem cakes that prevent soil pathogen and simultaneously improve soil health, (iii) cultural techniques such as soil selection, crop rotation and intercropping, (iv) biological control using Trichoderma species is another useful method to lower infestation and increase ginger yield, and (v) use of chemical control measures such as Ridomil MZ, Metalaxyl, and Streptomycin. The above-listed aspects can be integrated to develop integrated management strategies that aid in developing a treatment strategy for management for rhizome rot and wilt disease complex of ginger.

IS SUSTAINABLE COMPETITIVE ADVANTAGE ANTEDILUVIAN?

This article aims to understand the contemporary relevance of the sustainable competitive advantage (SCA) concept in strategic management. Mainstream management and business training perpetuates the use of SCA despite indications that it is elusive. This study intends to elucidate how, in the 4th Industrial Revolution (4IR) world, SCA has become irrelevant, what the possible reasons are for its continued use and what alternatives can be explored for business success. The study followed an exploratory, constructivist grounded theory approach. Data were obtained from 27 semi-structured interviews to develop a grounded theory. Findings revealed four main themes, and pronounce that in a complex, interconnected business world, SCA is mostly obsolete, which demands an organisation to adapt its strategy, business model and culture to create value, be relevant, have a significant (positive) impact and contribute to the common good. The main implication of the study is therefore that SCA should no longer be promoted as a key concept for organisational success by management and academia. Alternatives to SCA, such as agility and complexity management, are more relevant in an interconnected 4IR business environment. The study enhances the body of knowledge by bolstering the critique on the continued use of SCA in contemporary business management. It furthermore highlights potential erroneous assumptions through a direct explanation of why SCA assumptions are antiquated.

Career Management in a VUCA World – An Ongoing Debate between Threats and Opportunities under the Technological Imperative

Abstract In today's VUCA world (acronym which stands for Volatile, Uncertain, Complex and Ambiguous), building up and managing a career can be extremely challenging, since society undergoes fundamental and irreversible transformations driven by the new technological wave. Technological developments have impacted all areas of an organization and all phases of a business process, from basic operations to sales to financial management and human resource management. In this framework, where new industries emerge, new skills are required and new professional roles are designed, career management is a syntagm which can no longer be viewed just as a social construct of personal significance, but rather as an active endeavor to grasp the future of professions, adapt to the new reality, and capitalize on the opportunities in order to thrive in the long run. The aim of this paper is to address career management within the VUCA world shaped by technological advancements, and the ongoing discussion surrounding the dual nature of technology as both a threat and an opportunity. Drawing on statistical data, we highlight the need for of a different and more effective approach to career management in the current complex and unpredictable times, and a more alert and purposefully designed work-life balance. As a qualitative study, the paper involved the collection and selection of the relevant literature in the field, the analytical inquiry and interpretation, as well as the use of statistical data and their analysis to defend the argument and conclude the results.

‘Y’ Modification of the cutaneous incision of the preseptal transconjunctival approach for the management of zygomatico-maxillary complex fractures: A prospective clinical study

AimThe purpose of this clinical study was to evaluate the efficacy of the preseptal transconjunctival approach with Y modification of the cutaneous extension for the management of zygomaticomaxillary complex (ZMC) fractures. MethodsThis prospective interventional study was conducted at our institute from 2012 to 2020. The study included patients aged 15–65 years with displaced ZMC fractures. Patients with uncontrolled systemic conditions, infected and/or comminuted fractures were excluded. The variables evaluated were age, gender, mechanism of injury, fracture side, clinical features, surgical exposure time, adequacy of exposure, complications, scar evaluation scores and cosmetic outcomes. The parameters for comparison were operated versus non operated side Eye Fissure Index (EFI) and surgical exposure time was compared with respect to the types of scars. ResultsA total of 49 patients were included in this study. The average exposure time was 18.87 ± 1.92 min. The exposure of fracture site was excellent in 73.5 % and satisfactory in 26.5 %. The mean EFI of operated side was 34.2 ± 5.04 mm while that of non-operated side was 34.22 ± 5 mm. On comparison of the same there was no significant difference. Invisible scars were noted in 71.4 % and barely visible scars in 22.4 %. The comparison of exposure time with type of scars showed a significant association (p = 0.02). The complications noted were chemosis, lower eyelid edema, conjunctival granuloma and entropion. Cosmetic outcomes were fairly satisfactory. ConclusionThe Y modification of the transconjunctival approach can provide excellent surgical exposure without the need for a second incision. Although this approach is technique sensitive and requires experience, the advantages outweigh the learning curve. Since this approach has been widely studied, a systematized review is recommended to further substantiate its reliability and advantages.

Improving ambulatory patient access through strategic reorganisation and implementation of innovative ambulatory care best practices

John Muir Health, a large health system in northern California, struggled with a complex practice management structure that lacked role clarity and core positions, making it difficult to bring about positive change within the ambulatory setting. As part of a broader, strategic partnership to improve operations and deliver healthcare, health system leaders partnered with Optum Advisory to reorganise the practice management structure and optimise primary care patient access. Across its duration, the partnership improved access within primary care while reducing the administrative burden on providers through care team redesign, and with a new structure, physicians received administrative clarity and practice managers have leaders providing support for access, project management and innovation. These changes led to greater innovation and efficiency, resulting in higher satisfaction for patients, providers and staff. Optimising access and productivity, John Muir Health primary care practices have decreased the amount of time it takes for patients to get into the practice, increasing the overall number of patients they have been able to see. In addition, centralised prescription refills have allowed patients to receive their medications quicker while enabling physicians to concentrate on direct patient care. The overall result has been less administrative burden for providers and staff, allowing for more top-of-licence work and time with patients.

WITHDRAWN: A rare case of high-grade synovial sarcoma of the hindfoot

Aim of the workto report our personal experience on hindfoot reconstruction by means of anterolateral thigh (ALT) flap after radical resection of a high-grade synovial sarcoma. Methodspatient underwent clinical and instrumental assessments, and a biopsy of the lesion confirmed the diagnosis of synovial sarcoma of the hindfoot. A multidisciplinary team was required to decide the better therapeutic strategy. ResultsAfter radical tumor mass resection, the coverage of the large skin gap was achieved with an ALT flap. No recurrences were observed during the follow-up. Today, after eighteen months after surgical treatment, the patient can walk independently with no major limitations in everyday life. Conclusionsthe complex management of this rare disease requires the presence of a reference center for foot and ankle surgery, and a multidisciplinary team including expert orthopedics and plastic surgeons, as well as oncologists, to ensure an optimal and correct treatment of the disease.

Exploring Factors Affecting Acceptance of Fecal Microbiota Transplantation for Patients with Recurrent Urinary Tract Infections: a Descriptive Qualitative Study.

Patients with recurrent urinary tract infections face complex management challenges. Fecal microbiota transplantation is a superior treatment for chronic infectious diseases, but limited patient knowledge affects treatment decisions. This study aims to identify factors associated with hesitancy towards fecal microbiota transplantation among patients with recurrent urinary tract infections, to help physicians and nurses in providing accurate and useful information to patients. A descriptive qualitative approach was employed, utilizing semi-structured interviews conducted with patients experiencing recurrent urinary tract infections who expressed hesitancy towards fecal microbiota transplantation. The interviews took place between September 2021 and December 2022. Thematic analysis was conducted on the semi-structured interviews to identify perceived facilitators and barriers associated with fecal microbiota transplantation. The analysis included interviews with thirty adult female patients with recurrent urinary tract infections. Four facilitators influencing patients' decision-making regarding fecal microbiota transplantation were identified: (1) the motivating role of hope and expectations for active patient participation; (2) the influence of healthcare providers, as well as family members and friends on patients' decisions to pursue fecal microbiota transplantation; (3) the patients' perception of fecal microbiota transplantation as a low-risk treatment option; and (4) the dedication to the advancement of medical treatments. In contrast, two primary barriers to accepting fecal microbiota transplantation were identified: (1) that conventional treatment controls disease activity, while fecal microbiota transplantation effects remain uncertain; and (2) that safety concerns surrounding fecal microbiota transplantation. Comprehensive information about fecal microbiota transplantation, including donor selection, sample processing, the procedure, and potential discomfort, is essential for patients and families to make informed treatment decisions. CHiCTR2100048970.

The role of management consulting in the corporate governance system

The article is devoted to the study of topical issues related to management consulting in corporate governance. Management consulting plays an important role in the corporate governance system, helping companies to achieve their strategic goals and optimize their operations through innovative approaches and solutions. It has been determined that management consultants are becoming key figures in helping companies develop strategies, optimize processes and solve complex management problems. In the context of globalization and rapid technological transformation of business, management consulting is becoming an integral component for companies seeking to remain competitive and adapt to new market realities. The author characterizes that the development of management consulting is not only diverse, but also takes two main forms. On the one hand, (and this has developed historically), consulting is a method of improving the existing forms of management and business, because initially the consulting process was a process of imitating the experience of the most successful managers. On the other hand, consulting is becoming an independent profession. The article analyzes risk management in a corporate enterprise, which includes identification, assessment and mitigation of risks that may affect the organization's goals, operations or stakeholders. It is highlighted that corporate governance is the systems, processes and principles by which a business is managed, regulated and controlled. The importance of effective governance increases linearly with the size of the business and the number of shareholders. It is noted that foreign investors often look for companies with effective management, transparent and accountable business. For small and medium-sized enterprises seeking to expand their operations and enter foreign markets, having a sound corporate governance practice can be a significant advantage. For foreign investors, it demonstrates the reliability of the business, reduces the potential risks associated with investments, and can create more favorable conditions for investment. It is proved that the creation of reliable mechanisms is necessary to control the financial integrity and operational efficiency of the enterprise.

Management of the olive decline disease complex caused by Xylella fastidiosa subsp. pauca and Neofusicoccum spp. in Apulia, Italy

Xylella fastidiosa subsp. pauca (Xfp) is associated with olive quick decline syndrome (OQDS), a severe disease affecting the olive groves of Salento (Apulia, Italy). Through a series of interdisciplinary studies, an effective management strategy aimed at maintaining the traditional olive germplasm has been developed and evaluated. Specifically, a systemic biocomplex formulation containing zinc (4%), copper (2%) and citric acid, is sprayed on the tree canopy once per month from spring to early autumn. The strategy also includes sustainable vector control through agronomical techniques as well as regular tree pruning and soil fertilization. Quantitative real-time PCR assessments performed in a mid- and long-term studies showed a significant reduction in the Xfp concentration in the leaf xylem tissue upon treatment, improving olive tree yield. Both 1H-NMR metabolomic and mass spectrometric lipidomic analyses of leaf extracts revealed the occurrence of biomarkers linked to disease or tree restoration. The effects of mannitol and oleuropein derivatives, 13-oxylipins/DOX-oxylipins and 9-oxylipins appear to be related to the attenuation of disease symptoms. Both techniques indicate rapid reprogramming of metabolic tree activity upon spray treatment to regain tree health. Multiscale satellite imagery monitoring through high-resolution Sentinel-2, very high-resolution Pleiades and vegetation indices confirmed the robustness of the strategy over several years in both experimental and productive olive groves. Currently, this strategy is applied in many infected olive groves in Salento. Notably, some aggressive fungal species belonging to the Neofusicoccum genus have been recently found to be associated with olive trees that show symptoms similar to those induced by Xfp. Coinfections between this bacterium and fungi have also been frequently observed, suggesting the need for a more in-depth assessment of the epidemiology and management of OQDS.

Appropriateness of ChatGPT in Answering Heart Failure Related Questions

Heart failure requires complex management, and increased patient knowledge has been shown to improve outcomes. This study assessed the knowledge of Chat Generative Pre-trained Transformer (ChatGPT) and its appropriateness as a supplemental resource of information for patients with heart failure. A total of 107 frequently asked heart failure-related questions were included in 3 categories: "basic knowledge" (49), "management" (41) and "other" (17). Two responses per question were generated using both GPT-3.5 and GPT-4 (i.e., two responses per question per model). The accuracy and reproducibility of responses were graded by two reviewers, board-certified in cardiology, with differences resolved by a third reviewer, board-certified in cardiology and advanced heart failure. Accuracy was graded using a four-point scale: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. GPT-4 provided 107/107 (100%) responses with correct information. Further, GPT-4 displayed a greater proportion of comprehensive knowledge for the categories of "basic knowledge" and "management" (89.8% and 82.9%, respectively). For GPT-3, there were two total responses (1.9%) graded as "some correct and incorrect" for GPT-3.5, while no "completely incorrect" responses were produced. With respect to comprehensive knowledge, GPT-3.5 performed best in the"management"category and"other"category (prognosis, procedures, and support) (78.1%, 94.1%). The models also provided highly reproducible responses, with GPT-3.5 scoring above 94% in every category and GPT-4 with 100% for all answers. GPT-3.5 and GPT-4 answered the majority of heart failure-related questions accurately and reliably. If validated in future studies, ChatGPT may serve as a useful tool in the future by providing accessible health-related information and education to patients living with heart failure. In its current state, ChatGPT necessitates further rigorous testing and validation to ensure patient safety and equity across all patient demographics.

Exploring positionality management in complex interpreting interactions: a simulation method

Exploring positionality management in complex interpreting interactions: a simulation method

Sheep Wool Waste Availability for Potential Sustainable Re-Use and Valorization: A GIS-Based Model

Worldwide, 1.3 to 2.1 billion tons of agricultural waste are generated yearly, including livestock wastes (i.e., sheep wool), which create several critical environmental issues if not properly treated. In order to reduce the environmental issues related to the management and disposal, their use as natural fibers for green building components has notably developed over the last years. Indeed, sheep wool, which is a natural animal fiber that comes from shearing sheep fleece, is considered to be a problem of increasing concern due to its complex and difficult disposal management. Recently, several researchers have demonstrated that “low-quality wool” (i.e., not appropriate for textile uses) is suitable for the thermal and acoustic insulation of buildings. Indeed, thanks to its thermo-hygrometric and acoustic characteristics, it can be used as a reinforcing fiber for composite materials. In this study, a Geographic Information System (GIS)-based model to locate and quantify both the yearly amount of livestock waste, i.e., sheep wool, and the territorial distribution of sheep farms through their Global Positioning System (GPS) coordinates, was developed and applied within the selected study area (i.e., the Sicily region). The aim was to identify the territorial areas highly characterized by this kind of waste and therefore most suitable for localizing new shared sheep wool collection centers to sustainably manage the reuse of this waste as a potential green building component.

Cultivating Resilience: Multiple Case Study of School Heads’ Leadership in Integrated Senior High Schools

School leaders must be resilient in order to navigate the always shifting challenges in the field of education. This study employed a qualitative multiple case study, having three (3) distinct cases aimed to explore the perspectives of the school heads on resilient leadership in integrated senior high schools of Division of Davao de Oro. There were three (3) participants and six (6) informants underwent in-depth interviews. Participants were chosen through a purposive sampling technique. Each data was analyzed through thematic analysis and cross-case analysis. Case 1’s unique characteristics were resource management and optimization, hierarchical communication and strategic delegation, and crisis management and contingency planning. Participant experiences were complex stakeholder management, innovative problem-solving, and resilience amidst bureaucratic challenges. In times of challenges, the coping mechanism was structured decision-making processes delegation and team empowerment professional support networks. The policy recommendations were promotion of interpersonal communication skills, development of community engagement strategies, and investment in staff well-being programs. Further, Case 3’s unique characteristics were the following: strategic financial management and sustainability, stakeholder engagement and partnerships, brand differentiation and market positioning. The experiences were cultivating philanthropic relationships, navigating parental expectations, and ensuring financial sustainability. The coping mechanisms were strategic partnerships and fundraising initiatives, ethical leadership and values integration, and self-care and well-being practices while the policy recommendations were introduction of ethics and values integration policies, creation of leadership succession plans, and investment in infrastructure and technology. Moreover, cross-case analysis shows each case about distinct characteristics and commonalities such as strategic vision and planning, effective communication and collaboration, and resource management and optimization. Each case has distinct experiences, the common themes were resourcefulness and creativity, and community engagement and collaboration. Their coping mechanisms were effective leadership practices and ethical leadership and well-being. Their policy recommendations were leadership development policies and data-informed policies. This suggests that resilient leadership was crucial for school heads in managing and leading integrated senior high schools, despite the challenges and circumstances they faced in their workplace. Both teachers and learners benefit from the leadership styles promoted by the school heads.

Characteristics of Patients Receiving Complex Case Management in an Acute Care Hospital.

Improving transitions in care is a major focus of health care planning. In the research team's prior intervention study, the length of stay (LOS) was reduced when patients at high risk for readmission were identified early in their acute care stay and received complex management. This study will describe the characteristics of patients receiving complex case management in an urban acute care hospital. Acute care hospital. This was a retrospective chart review of patients in a previous quality assurance study. A random selection of patients who previously underwent high-risk screening using the LACE (Length of stay; Acuity of the admission; Comorbidity of the patient; Emergency department use) index and received complex case management (the intervention group) were reviewed. The charts of a random selection of patients from the previous comparison group were also reviewed. Patient characteristics were collected and compared using descriptive statistics. In the intervention group, more patients had their family physicians (FPs) documented (93.1% [81/87] vs. 89.2% [66/74]). More patients in the intervention group (89.7% [77/87] vs. 85.1% [63/74]) lived at home prior to admission. More patients in the intervention group had a family caregiver involved (44.8% [39/87] vs. 41.9% [31/74]). At discharge, more patients in the intervention group (87.1% [74/85]) were discharged home compared with the comparison group (78.4% [58/74]). (1) Having an identified FP, living at home, and having family caregiver(s) characterized those with lower LOS and discharged home. (2) Case management, risk screening, and discharge planning improve patient outcomes. (3) This study identified the importance of having a FP and engaged family caregivers in improving care outcomes.

Evolution of the institutional mechanism of digitalization of management of the agroindustrial complex of the Republic of Belarus in the context of new challenges

Nowadays the domestic agroindustrial complex is faced with a number of new challenges, so the institutional mechanism of its digital transformation in general and its management in particular needs a phased restructuring and adaptation to changing economic conditions. In the context of current trends in digitalization of agroindustrial complex management, directions for its development have been determined; the key components of its institutional mechanism at the present stage are highlighted. The results of the study can be used by agricultural authorities at all levels.