Future Directions In Management Research Articles

Current challenges of suicide and future directions of management in Bangladesh: a systematic review

Objectives Bangladesh is a densely populated country in south-east Asia with paucity of research in suicide. This systematic review was aimed at critical appraising various aspects of suicide in Bangladesh based on available literature and systematic search. Methods Extensive literature search was conducted in Scopus, PubMed, PubMed Central, Google, Google Scholar and BanglaJOL with searching key words without any date boundary and without any basis of types of studies, that is, all types of studies were scrutinised. The author focused on sources of suicide data along with epidemiological variables of suicides in Bangladesh such as suicide rate, gender of victims, methods of suicides, risk factors and prevention activities and role of media in suicide. Results After exclusion of repetitions, screening was performed, and finally, 35 articles were selected for review. Amongst the 35 articles, 16 articles were original contributions, 2 systematic reviews, 6 narrative reviews, 2 scoping reviews, 3 editorials, 3 case reports and rest correspondence article. The review revealed that the actual rate of suicide in Bangladesh is yet to come out and quality data is a real challenge. Women are dying more than the men, and early adulthood is the most vulnerable time of life. Discussion Suicide is a under attended problem in Bangladesh, as the country yet to reveal the actual rate of suicide along with the challenge of quality data. Prevention activities have been started but yet to be visualised. Decriminalisation of suicide in the legal criteria and establishment of suicide surveillance can be the top priorities in the country.

512 - The placebo effect and the future direction in management of overactive bladder: A systematic review and meta-analysis

512 - The placebo effect and the future direction in management of overactive bladder: A systematic review and meta-analysis

Asthma in children during the COVID-19 pandemic: lessons from lockdown and future directions for management

Asthma in children during the COVID-19 pandemic: lessons from lockdown and future directions for management

Evolution of Surgical Management of Colorectal Liver Metastasis

AbstractThe treatment of colorectal liver metastasis (CRLM) has progressed markedly in the past decades. Main contributions stem from improvement in surgical approach and applications of chemotherapy. The availability of several perioperative and surgical techniques, including portal vein embolization, ablation techniques, and two-stage hepatectomies, has expanded surgical indications. In addition, preoperative imaging methods have contributed to these advances.In patients with high oncological risk of recurrence, or initially unresectable CRLM, highly individualized treatment regimens are becoming more widely utilized. These patients should be evaluated for surgical resection after several cycles of chemotherapy given the survival benefit afforded by liver resection for CRLM. Several biomarkers, including RAS mutation, BRAF mutation, and microsatellite stability, have become essential in guiding therapy. Immunotherapy has recently been highlighted, especially for cases of microsatellite instability. Looking forward, biomarkers will likely to continue to guide individualized treatment patterns.Liver transplantation as an option for patients with unresectable CRLM may boast comparable outcomes to patients with primary liver tumors, but it remains controversial considering the limited supply of donor livers.Management of CRLM requires the complex decision making process common to contemporary tumor board discussions, and a multidisciplinary approach likely figures into future directions of management for CRLM.

A case of near-fatal bronchospasm in a child with severe bronchopulmonary dysplasia during tracheostomy

Bronchopulmonary dysplasia (BPD) is a condition marked by prolonged ventilator and oxygen requirement due to underlying arrested lung development. Tracheostomy is a staple in long-term establishment of pediatric airways in this condition, and has many benefits. However, these children's airways can be very tenuous. We present a case of a child with severe BPD who developed extreme bronchospasm during tracheostomy. We also briefly review current literature in the management of such children's airways and potential directions for future management.

Sustainable Construction Project Management (SCPM) Evaluation—A Case Study of the Guangzhou Metro Line-7, PR China

As a pillar industry of the Chinese national economy, the construction sector needs to improve its level of management to embrace sustainable development. Sustainable construction project management (SCPM) performance evaluation can help to raise the level of management. However, the existing evaluation system that takes into account both the sustainable development and the dimension of traditional project management is meager. In order to address this problem, this study sets out an integrated sustainable performance evaluation method for SCPM, along with a comprehensive analysis of both traditional and future management directions. Through literature review and enterprise data analysis of the relevant factors of finance, schedule, quality, and safety, etc., indicators are filtered and classified. In order to determine the strength of each indicator, a questionnaire is administered to construction professionals within a large construction enterprise (group). From the result of the weight with an improved Group-G1 (iG1) method (finance 0.206, schedule 0.206, quality 0.185, safety 0.134, informatization 0.134, and greenization 0.134), it indicates that finance, schedule and quality management are still top three important dimensions in SCPM. However, amazingly, the greenization and informatization management is as significant as safety management. Finally, based on set pair analysis, the Guangzhou Metro Line 7 project is used as a verifying case, affirming the validity of the sustainable performance evaluation model. The above SCPM evaluation model can not only provide a guideline for construction companies’ sustainable management in China, but also serve as reference cases for other countries/regions to carry out relevant research work.

Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management.

The assessment, diagnosis, operative and nonoperative management of degenerative cervical myelopathy (DCM) have evolved rapidly over the last 20 years. A clearer understanding of the pathobiology of DCM has led to attempts to develop objective measurements of the severity of myelopathy, including technology such as multiparametric magnetic resonance imaging, biomarkers, and ancillary clinical testing. New pharmacological treatments have the potential to alter the course of surgical outcomes, and greater innovation in surgical techniques have made surgery safer, more effective and less invasive. Future developments for the treatment of DCM will seek to improve the diagnostic accuracy of imaging, improve the objectivity of clinical assessment, and increase the use of surgical technology to ensure the best outcome is achieved for each individual patient.

Ischemic Mitral Regurgitation: Current Understanding and Surgical Options.

Secondary, or functional, mitral regurgitation (MR) occurs with impaired coaptation of structurally normal valve leaflets due to abnormal structure and/or function of the left ventricle (LV). A leading cause of functional mitral regurgitation is ischemic cardiomyopathy, resulting in left ventricular dysfunction and subsequent congestive heart failure (CHF) and ischemic mitral regurgitation (IMR). The value of surgical or transcatheter correction of IMR remains controversial, since the underlying pathology of IMR is attributed to a dysfunctional left ventricle. However, even mild IMR has been shown to be harmful to CHF patients, as IMR is both a surrogate of advanced CHF and an independent contributor to CHF morbidity and mortality. While observational and randomized studies have examined surgical treatment of IMR with conflicting outcomes, additional well-designed randomized controlled trials should be performed to further clarify the optimal treatment for IMR. Additionally, close attention should be paid to the quality of interventions performed, as durable reduction in IMR provides the best hope of a positive clinical outcome. This review focuses on the pathophysiology of IMR, current evidence regarding surgical and transcatheter interventions, and future directions in management of IMR.

Current challenges of suicide and future directions of management in Bangladesh: a systematic review

Abstract Objectives Bangladesh is a densely populated country in south-east Asia with paucity of research in suicide. This systematic review was aimed at critical appraising various aspects of suicide in Bangladesh based on available literature and systematic search. Methods Extensive literature search was conducted in Scopus, PubMed, PubMed Central, Google, Google Scholar and BanglaJOL with searching key words without any date boundary and without any basis of types of studies, that is, all types of studies were scrutinised. The author focused on sources of suicide data along with epidemiological variables of suicides in Bangladesh such as suicide rate, gender of victims, methods of suicides, risk factors and prevention activities and role of media in suicide. Results After exclusion of repetitions, screening was performed, and finally, 35 articles were selected for review. Amongst the 35 articles, 16 articles were original contributions, 2 systematic reviews, 6 narrative reviews, 2 scoping reviews, 3 editorials, 3 case reports and rest correspondence article. The review revealed that the actual rate of suicide in Bangladesh is yet to come out and quality data is a real challenge. Women are dying more than the men, and early adulthood is the most vulnerable time of life. Discussion Suicide is a under attended problem in Bangladesh, as the country yet to reveal the actual rate of suicide along with the challenge of quality data. Prevention activities have been started but yet to be visualised. Decriminalisation of suicide in the legal criteria and establishment of suicide surveillance can be the top priorities in the country.

Cardiac Management of the Patient With Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD) results in a progressive cardiomyopathy that produces significant morbidity and mortality. To improve the quality of life in patients with DMD, cardiac care is focused on surveillance and management, with the goal of slowing the onset and progression of heart failure complications. The current article is intended to be an expanded review on the cardiac management data used to inform the 2018 DMD Care Considerations recommendations as well as be a discussion on clinical controversies and future management directions. The new cardiac guidance includes changes regarding noninvasive imaging surveillance of cardiac function and pharmacologic therapy. Many emerging therapies lack sufficient evidence-based data to be recommended in the 2018 DMD Care Considerations. These are discussed in the present article as clinical controversies and future directions. Important emerging therapies include new heart failure medications, mechanical circulatory support with ventricular assist devices, heart transplantation, and internal cardiac defibrillators. Future research studies should be focused on the risks and benefits of these advanced therapies in patients with DMD. We conclude this review with a brief discussion on the relationship between the heart and the recently developed medications that are used to directly target the absence of dystrophin in DMD.

Use of landscape simulation modeling to quantify resilience for ecological applications

AbstractGoals of fostering ecological resilience are increasingly used to guide U.S. public land management in the context of anthropogenic climate change and increasing landscape disturbances. There are, however, few operational means of assessing the resilience of a landscape or ecosystem. We present a method to evaluate resilience using simulation modeling. In this method, we use historical conditions (e.g., in North America, prior to European settlement), quantified using simulation modeling, to provide a comparative reference for contemporary conditions, where substantial departures indicate loss of resilience. Contemporary ecological conditions are compared statistically to the historical time series to create a resilience index, which can be used to prioritize landscapes for treatment and inform possible treatments. However, managing for resilience based on historical conditions is tenuous in the Anthropocene, which is characterized by rapid climate change, extensive human land use, altered disturbance regimes, and exotic species introductions. To account for the future variability of ecosystems resulting from climate and disturbance regime shifts, we augment historical simulations with simulations of ecosystem dynamics under projected climate and land use changes to assess the degree of departure from benchmark historical conditions. We use a mechanistic landscape model (FireBGCv2) applied to a large landscape in western Montana, USA, to illustrate the methods presented in this paper. Spatially explicit ecosystem modeling provides the vehicle to generate the historical and future time series needed to quantify potential resilience conditions associated with past and potential future conditions. Our methods show that given selection of a useful set of metrics, managers could use simulations like ours to evaluate potential future management directions.

Ductal Carcinoma In Situ.

Ductal carcinoma insitu has been stable in incidence for a decade and has an excellent prognosis. Breast conservation therapy is safe and effective for most patients. Adjuvant whole breast radiation therapy is recommended to reduce the risk of local recurrence. Accelerated partial breast irradiation is a promising alternative to decrease toxicity and improve cosmetic results. Adjuvant hormonal therapy can reduce local recurrence, but should be used cautiously. Future directions in management include developing predictive tools for guidance for use of adjuvant therapy and selecting low-risk patients with ductal carcinoma insitu in whom surgery may be safely omitted.

Contemporary Management of the High-Risk Pulmonary Embolism: The Clot Thickens.

Pulmonary embolism (PE) is a common disease process encountered in the acute care setting. It presents on a spectrum of severity with the most severe presentations carrying a substantial risk of morbidity and mortality. In recent years, a wide range of competing treatment strategies have been proposed for the high-risk PE including new catheter-based and extracorporeal techniques, and management has become more challenging. There is currently no consensus as to the optimal approach to treatment. Contemporary management decisions are informed by the balance between the risk of deterioration and the risk of harm from intervention, within the available resources. This review will summarize the current evidence to better inform clinical decision-making in high-risk PE and highlight future directions in management.

Current and Future Directions of Management of Hepatitis B: Steps Toward a Cure

Universal hepatitis B virus vaccination has been effective in reducing incident chronic hepatitis B but will not have the requisite effect on the prevalence of end-stage liver disease in chronically infected persons. The natural history and immunological stages of hepatitis B virus infection are still being defined. Over three decades, current therapies have reduced morbidity from chronic hepatitis B. The majority require nucleoside analog maintenance therapy. The preferential preservation of covalently closed circular DNA (cccDNA), and capsid reverse transcriptase–cccDNA interactions currently precludes cure in most. A functional cure in the host may require several synergistic antiviral and immunological intercessions. The correct sequencing and combinations of treatment with either host or viral targeting agents have yet to be determined. Proven surrogates for cccDNA for clinical trials are required. Different strategies may become apparent for patients at different stages of the disease. Curative therapies will require affordability. This review focuses on steps toward a cure.

Abandonment landscapes: user attitudes, alternative futures and land management in Castro Laboreiro, Portugal

Land abandonment is an important process for the European Union, which primarily occurs in less productive, remote and mountainous areas with unfavourable conditions for agriculture. Future management directions of these abandonment areas are under debate, with increasing calls to adjust policies to the local characteristics, including the promotion of rewilding and the management of succession of larger areas of less-productive land. While there is an increase in studies focusing on the environmental impacts of land abandonment, there are few studies that focus on the perceptions of abandonment by different user groups, even though an understanding of local perceptions, opportunities and trade-offs associated with changing land management is crucial for landscape-related policies and planning measures. In a case study in Northern Portugal, we used a combination of statements, photograph rating exercises and open questions to assess the perceptions of local inhabitants, visitors and experts regarding land abandonment and their preferences of different possible trajectories after abandonment. The results show that all user groups have a negative response towards abandonment and associate it mainly with negative emotions and the loss of heritage and traditions. The assessment of the different abandonment stages and outcomes clearly yielded different preferences and explanations, which can be used as input for finding a common ground for landscape management, reducing conflict and as a starting point for a more spatially targeted and nuanced management approach.

急性呼吸窮迫症候群の病態・治療の最前線

急性呼吸窮迫症候群の病態・治療の最前線

Spanning from the West to East: An Updated Review on Endovascular Treatment of Intracranial Atherosclerotic Disease.

Ischemic stroke is a major cause of morbidity and mortality, incurring significant cost. Intracranial atherosclerotic disease (ICAD) accounts for 10-15% of ischemic stroke in Western societies, but is an underlying pathology in up to 54% of ischemic strokes in Asian populations. ICAD has largely been treated with medical management, although a few studies have examined outcomes following endovascular treatment. Our objective was to summarize the major trials that have been performed thus far in regard to the endovascular treatment of ICAD and to provide direction for future management of this disease process. Systematic review of the literature from 1966 to 2015, was conducted in regard to intracranial angioplasty and stenting. Studies were analyzed from PubMed, American Heart Association and Society of Neurointerventional Surgery databases. SAMMPRIS and VISSIT are the only randomized controlled trials from which Western guidelines of intracranial stenting have been derived, which have displayed the superiority of medical management. However, pooled reviews of smaller studies and other nonrandomized trials have shown better outcomes with endovascular therapy in select patient subsets, such as intracranial vertebrobasilar stenosis or in the presence of robust collaterals. Suboptimal cases, including longer lesions, bifurcations and significant tortuosity tend to fair better with medical management. Medical management has been shown to be more efficacious with less adverse outcomes than endovascular therapy. However, the majority of studies on endovascular management included a diverse patient population without ideal selection criteria, resulting in higher adverse outcomes. Population analyses and selective utilization of endovascular therapy have shown that the treatment may be superior to other management in select patients.

Conserving and restoring endangered southern populations of the Squirrel Glider (Petaurus norfolcensis) in agricultural landscapes

SummarySouthern Squirrel Glider (Petaurus norfolcensis) populations are genetically distinct and generally found in the agricultural landscapes inland of Australia's Great Dividing Range. These populations are considered to be under greater threat of extinction than northern, coastal populations and face a unique set of environmental conditions and conservation challenges. For these reasons, we suggest that southern populations qualify as a separate evolutionarily significant unit to those from the northern, coastal segment of the range and should be managed separately. We summarize the species’ ecology specific to southern populations and relevant to management. We conduct a basic SWOT (strengths, weaknesses, opportunities, threats) analysis to highlight potential future management directions. From our review of new and existing ecological data and SWOT analysis, we outline ten points of action important for securing the future of southern Squirrel Glider populations.

An Australasian perspective on the curative treatment of patients with pancreatic cancer, supportive care, and future directions for management.

The management of patients with pancreatic cancer requires an individualised approach and the support of a multidisciplinary team to accurately stage patients and determine their suitability for curative treatment. Guidelines have been developed in Australasia to define the operability for patients who have been diagnosed with pancreatic cancer. This is supported by advances in pancreatic cancer genetics, which show potential for developing targeted therapies for pancreatic cancer. Both surgery and targeted therapies aim to extend the overall survival of patients. Patients who are cured of their cancer may live with permanent changes in gut anatomy and physiology leading to distressing symptoms that may not be addressed. Patients who cannot be cured of pancreatic cancer may have supportive care issues that are often complex, and a strategic approach to manage these needs for patients with pancreatic cancer is underdeveloped in Australasia. Supportive care services need to be in a position to adapt patient care as the evidence base develops.

Contemporary management of ductal carcinoma in situ and lobular carcinoma in situ.

The management of in situ lesions ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) continues to evolve. These diagnoses now comprise a large burden of mammographically diagnosed cancers, and with a global trend towards more population-based screening, the incidence of these lesions will continue to rise. Because outcomes following treatment for DCIS and LCIS are excellent, there is emerging controversy about what extent of treatment is optimal for both diseases. Here we review the current approaches to the diagnosis and treatment of both DCIS and LCIS. In addition, we will consider potential directions for future management of these lesions.