General Principles Of Management Research Articles

Gastrointestinal fistulae: conservative vs surgical management

Background: Gastrointestinal fistulae are abnormal connections between two hollow organs of the gastrointestinal tract or between the hollow organ and the skin. They remain a major clinical problem, especially if complicated by sepsis, bacteraemia or cancer. General Principles of fistula management consist of- Phase of Diagnosis, Stabilization and Management. Methods: The study was conducted in Sir JJ Group of Hospitals, Mumbai. A total of 34 patients with gastrointestinal fistulae were studied between January 2020 to January 2023. The patients were studied on the basis of presenting signs and symptoms, details of initial surgery performed, investigations pertaining to the condition and their management. Results: Out of the 34 cases, 44% of the cases were from the small intestine, 39% cases we]re from the large intestine, and the rest of the cases were from stomach, duodenum, gastrojejunostomy site and appendicular stump following appendicectomy. Conclusions: The database of our retrospective study regarding age and sex incidence, clinicopathological features and therapeutic outcome was comparable to other studies in various literatures.

Developing a data-driven multimodal injury and illness prevention programme in male professional football based on a risk management model: the IP2 NetWork

BackgroundCurrent injury prevention programmes in football are limited by a one-size-fits-all approach, which predominantly focuses on preventive exercise programmes while ignoring differences in risk profiles between individuals and teams.ObjectiveTo address...

Manajemen Kurikulum Pesantren dalam Meningkatkan Kemampuan Bahasa Arab Siswa Tingkat Madrasah Aliyah

Knowledge of curriculum management is crucial in determining the direction of education. Managing the pesantren curriculum is one of the key foundations for improving students' Arabic language skills. Therefore, research on pesantren-based curriculum management should be conducted. This study aims to understand the general concepts, characteristics, and scope of curriculum management in general and pesantren-based curriculum management. This research employs a qualitative descriptive method with field research. The primary data for this study was obtained from Madrasah Aliyah Attanwir Bojonegoro, while secondary data was sourced from relevant literature. The purpose of this research is to identify the concepts, characteristics, and implementation of pesantren-based curriculum management in enhancing students' Arabic language skills. After conducting an in-depth analysis, this study found that the concept of pesantren curriculum management still adheres to the basic principles of general curriculum management, but there are differences in the objectives, which focus more on the curriculum of Arabic language learning, and Islamic studies. In its implementation, the pesantren curriculum management at Madrasah Aliyah Attanwir Bojonegoro adopts a semi-modern pesantren curriculum, thus positively impacting students' Arabic language learning. Moreover, the semi-modern pesantren curriculum also enhances students' Arabic language skills both theoretically and practically.

Public Management Discretion and Public Management Decision to Engineering, Testing and Application of Legal Innovations

The article is devoted to the topic of the significance and complexity of the managerial decision on the engineering, testing and application of legal innovations. In the author’s opinion, many problems of legal and legal-digital innovation are reduced to the ambiguity of their functional-target load and very high difficulty of confirming that they are really needed, to the extreme difficulty of predicting their implementation. And it is this that complicates the adoption of an appropriate managerial decision. Managerial decision on legal innovations, due to the crystallization of the substrate of managerial discretion in it, always entails a high responsibility for its adoption. The author points out that there are no unified generally recognized ways of operating activities in the field of legal innovation and management of the corresponding innovation process. But there are some general management principles and requirements that are quite transferable to this sphere. The author substantiates that with all the significant differences between the private market legal sector and the public administration sector, in making a decision on the development, testing and implementation of legal and securing legal and digital innovations, both managers — the head of a public authority and the head of a commercial firm — are placed in similar conditions. The author in his article articulates the problem of time resource, objectively required for what is presented as a “legal innovation” to really become a legal innovation and a good legal innovation. According to the author, legal innovation is not a quick process, and it is not a one-time phenomenon, but a responsible discretion in making the appropriate managerial decision — it is always objectively time-consuming. The author raises the question that any innovation, and legal innovation in particular, has its own life cycle, at the end of which it outlives itself, exhausts its potential for innovation. Although there are legal innovations that have transformed into legal axiomatics and traditional legal everyday tools. But in any case, we talk about legal innovations without disconnecting from time, from its flow, from the notches on its scale. The author declares the article as posing a scientific problem, but at the same time the author offers a conceptual answer to some of such questions.

Financial aspects of the functioning of executive agencies in Poland

Public tasks are carried out by entities forming the public finance sector. The article focuses on executive agencies and has been limited to the financial aspects of their functioning. The aim of the study is to determine the sources of financing of executive agencies operating in Poland and the share of subsidies from the state budget in them. The comparative descriptive analysis method was used in the study. The first part of the article is theoretical in nature. It presents the general principles of financial management of executive agencies as well as the specificity of the operation of individual agencies and the sources of their revenues. In the empirical part, the financial data of executive agencies for the years 2020-2022 was analysed. The total financial condition of the study group should be assessed positively. The analysis of the generated revenues, including subsidies from the state budget and the financial result, showed a significant differentiation of this group of public finance sector entities in the examined area.

Management and Delivery of a Patient with Maternal Myelomeningocele: A Case Report

Objective: To report and discuss the pregnancy course and delivery of a patient with maternal myelomeningocele at term Background: Spina bifida is a congenital malformation which results from incomplete closure of the neural tube. Open neural tube defects (NTD) comprise 80% of all NTDs. The most common open NTD is myelomeningocele (MMC), a form of spina bifida characterized by herniation of both the meninges and spinal cord. The incidence rate of MMC is approximately 1/1,000 live births worldwide, and is inversely related to socioeconomic status. There is a paucity of data on pregnant women with spina bifida, however a study by Shepard et al. investigated deliveries among 10,000 women with spina bifida and 42 million women without. This study revealed that women with spina bifida were significantly more likely to be delivered via cesarean section, even when vaginal delivery was possible. Also, pregnancy rates in spina bifida patients have risen over time. Case Description: A 29-year-old gravida 1 female at 12 weeks gestation presented to the Maternal Fetal Medicine (MFM) clinic due to maternal MMC. Past medical history was significant for MMC, Chiari malformation type II, neurogenic bowel, and neurogenic bladder. Past surgical history was significant for MMC repair, ventriculoperitoneal shunt, spine-to-abdomen shunt, cervical spine fusion, spinal cord untethering, and club foot correction. Patient ambulated using a walker. Noninvasive prenatal testing was low-risk. The alpha-fetoprotein was unremarkable at 22 ng/ml. Ultrasound revealed unilateral fetal pyelectasis. Fetal echocardiogram showed normal anatomy and function. The patient was admitted for 4 days at 33 weeks for a unilateral vulvar infection and hematoma that developed from repeated self-catheterization. The patient was admitted out of precaution due to past history of labial Fournier’s gangrene. Wound cultures grew prevotella bivia. Infectious disease recommended outpatient oral antibiotics at discharge. Anesthesiology recommended maternal MRI prior to delivery planning. MRI showed lumbar lordosis and severe canal compromise in the lumbosacral region. The low-lying conus terminated at L3-L4. Cauda equina nerve roots extended to the sacral region. Morphology of the sacrum and coccyx was abnormal, consistent with MMC. Imaging determined epidural and spinal anesthesia carried a high likelihood of analgesic failure from scar tissue due to prior surgeries. The patient ultimately agreed to general anesthesia. A primary low-transverse cesarean section was performed at 39 weeks 0 days. The baby was delivered without delayed cord clamping and had 1- and 5-minute APGAR scores of 6 and 9. Dense adhesions were present throughout the abdomen, which prevented uterine exteriorization during hysterotomy repair. The remainder of the surgery was uncomplicated and indwelling foley was kept in place postpartum. At 6-week postpartum visit, patient was fully healed and had resumed self-catheterization. Discussion: Pregnant women with spina bifida require complex multi-disciplinary co-management. This patient received care from MFM, neurology, urology, anesthesiology, infectious disease, and neurosurgery. Currently, there are no universally established guidelines on the management of pregnant women with spina bifida, but general principles of management exist. In the pre-conception period, it is recommended that patients at high-risk for fetal spina bifida, including type 1 diabetics, take 4mg of folate daily. High-risk patients should take folate for at least 3 months prior to conception and up until 12 weeks’ gestation. Since 9-12% of this population is affected by epilepsy, optimizing seizure medications is prudent. Lamotrigine or Carbamazepine monotherapy is preferred, as they pose the least risk of congenital malformations. In the antepartum period, providers should anticipate treating common comorbidities. Bladder dysfunction includes either hyper-reflexive or areflexive bladders. Intermittent self-catheterization is a viable option for those with incomplete bladder emptying. Pregnant patients with ventriculoperitoneal shunts are susceptible to displacement from the gravid uterus. Since limited mobility is prevalent in this population, risk assessments for venous thromboembolism should be completed, and prophylactic anticoagulation may be considered. Vaginal delivery is possible in some patients. However, epidural or spinal anesthesia can increase the risk of spinal cord injury in those with tethered cords or prior surgery. Patients with limited mobility may require cesarean section due to inability to position for labor. In conclusion, MMC is rarely encountered in obstetrical contexts but is becoming increasingly more commonplace. MMC requires co-management by multiple specialties to surveil and optimize common comorbidities. In this case, the patient’s pregnancy course was mainly complicated by her pre-existing neurogenic bladder and resulting vulvar wound secondary to self-catheterization. For MMC patients who are interested in pregnancy, preparations should be started in the pre-conception period, with close monitoring throughout the antepartum period to follow. Currently, there are generally accepted guidelines for managing MMC patients in pregnancy, but there is a lack of global standardization. The development of standardized treatment guidelines may be possible as more of these cases are discussed and appear in the literature.

Management and Delivery of a Patient with Maternal Myelomeningocele: A Case Report

Objective: To report and discuss the pregnancy course and delivery of a patient with maternal myelomeningocele at term Background: Spina bifida is a congenital malformation which results from incomplete closure of the neural tube. Open neural tube defects (NTD) comprise 80% of all NTDs. The most common open NTD is myelomeningocele (MMC), a form of spina bifida characterized by herniation of both the meninges and spinal cord. The incidence rate of MMC is approximately 1/1,000 live births worldwide, and is inversely related to socioeconomic status. There is a paucity of data on pregnant women with spina bifida, however a study by Shepard et al. investigated deliveries among 10,000 women with spina bifida and 42 million women without. This study revealed that women with spina bifida were significantly more likely to be delivered via cesarean section, even when vaginal delivery was possible. Also, pregnancy rates in spina bifida patients have risen over time. Case Description: A 29-year-old gravida 1 female at 12 weeks gestation presented to the Maternal Fetal Medicine (MFM) clinic due to maternal MMC. Past medical history was significant for MMC, Chiari malformation type II, neurogenic bowel, and neurogenic bladder. Past surgical history was significant for MMC repair, ventriculoperitoneal shunt, spine-to-abdomen shunt, cervical spine fusion, spinal cord untethering, and club foot correction. Patient ambulated using a walker. Noninvasive prenatal testing was low-risk. The alpha-fetoprotein was unremarkable at 22 ng/ml. Ultrasound revealed unilateral fetal pyelectasis. Fetal echocardiogram showed normal anatomy and function. The patient was admitted for 4 days at 33 weeks for a unilateral vulvar infection and hematoma that developed from repeated self-catheterization. The patient was admitted out of precaution due to past history of labial Fournier’s gangrene. Wound cultures grew prevotella bivia. Infectious disease recommended outpatient oral antibiotics at discharge. Anesthesiology recommended maternal MRI prior to delivery planning. MRI showed lumbar lordosis and severe canal compromise in the lumbosacral region. The low-lying conus terminated at L3-L4. Cauda equina nerve roots extended to the sacral region. Morphology of the sacrum and coccyx was abnormal, consistent with MMC. Imaging determined epidural and spinal anesthesia carried a high likelihood of analgesic failure from scar tissue due to prior surgeries. The patient ultimately agreed to general anesthesia. A primary low-transverse cesarean section was performed at 39 weeks 0 days. The baby was delivered without delayed cord clamping and had 1- and 5-minute APGAR scores of 6 and 9. Dense adhesions were present throughout the abdomen, which prevented uterine exteriorization during hysterotomy repair. The remainder of the surgery was uncomplicated and indwelling foley was kept in place postpartum. At 6-week postpartum visit, patient was fully healed and had resumed self-catheterization. Discussion: Pregnant women with spina bifida require complex multi-disciplinary co-management. This patient received care from MFM, neurology, urology, anesthesiology, infectious disease, and neurosurgery. Currently, there are no universally established guidelines on the management of pregnant women with spina bifida, but general principles of management exist. In the pre-conception period, it is recommended that patients at high-risk for fetal spina bifida, including type 1 diabetics, take 4mg of folate daily. High-risk patients should take folate for at least 3 months prior to conception and up until 12 weeks’ gestation. Since 9-12% of this population is affected by epilepsy, optimizing seizure medications is prudent. Lamotrigine or Carbamazepine monotherapy is preferred, as they pose the least risk of congenital malformations. In the antepartum period, providers should anticipate treating common comorbidities. Bladder dysfunction includes either hyper-reflexive or areflexive bladders. Intermittent self-catheterization is a viable option for those with incomplete bladder emptying. Pregnant patients with ventriculoperitoneal shunts are susceptible to displacement from the gravid uterus. Since limited mobility is prevalent in this population, risk assessments for venous thromboembolism should be completed, and prophylactic anticoagulation may be considered. Vaginal delivery is possible in some patients. However, epidural or spinal anesthesia can increase the risk of spinal cord injury in those with tethered cords or prior surgery. Patients with limited mobility may require cesarean section due to inability to position for labor. In conclusion, MMC is rarely encountered in obstetrical contexts but is becoming increasingly more commonplace. MMC requires co-management by multiple specialties to surveil and optimize common comorbidities. In this case, the patient’s pregnancy course was mainly complicated by her pre-existing neurogenic bladder and resulting vulvar wound secondary to self-catheterization. For MMC patients who are interested in pregnancy, preparations should be started in the pre-conception period, with close monitoring throughout the antepartum period to follow. Currently, there are generally accepted guidelines for managing MMC patients in pregnancy, but there is a lack of global standardization. The development of standardized treatment guidelines may be possible as more of these cases are discussed and appear in the literature

Організаційно-економічний механізм функціонування компетентної організації

In the article, methodological aspects of forming the organizational and economic mechanism for the functioning of a competent organization are examined. The concepts of «organizational and economic mechanism», «competent organization» and «organizational and economic mechanism for the functioning of a competent organization» are defined. An author’s definition of a competent organization is proposed as an organization that possesses the necessary knowledge, skills, and resources to achieve its goals, effectively utilizes its assets to create value for stakeholders (customers, employees, shareholders, society) through the implementation of innovations, while maintaining its competitive positions under the influence of external and internal environmental factors. The main characteristics of a competent organization are highlighted (presence of a clear strategy, strong leadership, effective processes, competent employees, high level of organizational culture, result orientation). A conceptual scheme of the organizational and economic mechanism for the functioning of a competent organization is proposed, which includes the following elements: object, subject, goal, tasks, principles (general management principles, general principles of organization functioning, specific principles of competent organization functioning), support subsystems, functions, means of management influence (approaches, methods, levers, tools), three basic components (organizational, economic, competency-based). Specific principles of the functioning of a competent organization are defined. The essence and features of the competency-based approach in organizational management are considered. The competency-based approach is an effective tool for improving organizational management efficiency and developing its personnel, ensuring quick adaptation to changes in the external and internal environment. Digital management tools are systematized, the use of which will allow the organization to improve operational efficiency, adapt more quickly to the impact of external and internal factors, and ensure market competence. Keywords: competent organization, competence, organization development, organization management, organizational and economic mechanism, functioning of a competent organization, management principles, competency-based approach, digital tools.

Pancoast Syndrome Due to Metastatic Hepatocellular Carcinoma

Pancoast tumors are aggressive and locally invasive apical lung cancers that often compress and infiltrate adjacent structures including the brachial plexus, stellate ganglion, ribs, and vertebral bodies. Symptoms of Pancoast tumors include Pancoast Syndrome, characterized by Horner Syndrome and pain and weakness of the ipsilateral upper extremity. Pancoast tumors by definition are primary lung cancer and are nearly always non-small cell lung cancer (NSCLC). There are rare case reports of metastatic non-pulmonary malignancies forming apical lung tumors mimicking Pancoast tumors and causing Pancoast Syndrome. Here, we present a case of a 66-year-old male with a history of unresectable hepatocellular carcinoma (HCC) who presented with one year of progressive left wrist and forearm pain and hand weakness and was found on cross-sectional imaging to have a left upper lobe lung mass invading the T1 and T2 vertebral bodies. Pathology showed very poorly differentiated carcinoma that required specialized testing to achieve diagnostic clarity. The tumor was positive for albumin mRNA, which aided in confirming the lung mass as metastatic HCC. This case highlights a rare incidence of Pancoast Syndrome due to metastatic HCC and emphasizes the importance of considering this diagnosis as an etiology of left upper extremity pain in a patient with previously diagnosed malignancy. This case also demonstrates the utility of albumin mRNA in-situ hybridization as an additional tool in identifying metastatic HCC and reviews general principles of symptomatic management of Pancoast Syndrome.

Evolution of the State-Legal Foundations of the Soviet Agrarian System in the 20s of the XX Century

Introduction. The history of the Soviet state law is of great interest to the modern researchers. A number of aspects of the New Economic Policy development and implementation in Russia are presented in the works of historical, economic and political science scholars. However, in our opinion, the number of research referring to the 20s of the XX century conducted by the legal science scholars is definitely not enough. The article investigates the evolution of the state-legal foundations of the Soviet agrarian system as reflected in the USSR Constitution of 1924, the RSFSR Constitution of 1925, the RSFSR Land Code of 1922, the USSR General Principles of Land Use and Land Management of 1928, and in a number of decrees and other normative legal acts. The relevance of this topic is induced by the theoretical and practical significance of the legal regulation of the agrarian sphere of the society and the reform of the agrarian policy of the modern Russia. On the one hand, the relevance of the topic lies in the need to study the transitional state of the Soviet agrarian legislation, since, according to V. I. Lenin, the New Economic Policy (NEP) implied “transition from the civil war to civil peace”. On the other hand, in the late 20s of the XX century the Soviet leadership had abandoned many of the NEP legislation principles. However, six decades later they were successfully revived and developed in the People's Republic of China during the economic reform. The aim of this study is to reveal the evolution features of the Soviet agrarian system state-legal foundations of the 20s of the XX century. Materials and Methods. The research methodology comprises the general scientific and specific juridical methods, including the historical-legal and legalistic (dogmatic) methods. Due to the rapidly changing attitude towards these methods in the scientific community, the priority in the research has been given to the modern sources. The authors' concept statements have been analysed, which, in synthesis with the authors' empirical background, made it possible to formulate a number of new provisions. Results. The main acts that had legally formalized the state-legal foundations of the Soviet agrarian system in the 20s of the XX century were studied. The huge number of the agricultural laws is explained by the decision of the Soviet party and state leadership of the early 20s to start the recovery of economics with the agrarian sector — the backbone of the national economy of that period. The features of the NEP are elucidated not only as the change of the economic policy, but as the integrated legal policy, being a combination of the public and private law regulation upon absolute predominance of the public principles. It has been substantiated that transition to the NEP entailed the abolishment of the agrarian laws of the times of “war communism” and return to the principles of the peasant Mandate of 1917 — the most important element of the Decree on Land. Deep controversy of the agricultural legislation of the NEP period has been established, which in no way should be defined as a time of abandoning the concept and practice of the collectivization of agriculture. The party and state leadership continued to consider the individual peasant land use as having no economical prospect and dangerous for building socialism. Discussion and Conclusion. The evolution features and distinctions of the Soviet agrarian system state-legal foundations of the 20s of the XX century have been revealed. In normative legal acts and party-state documents of the studied period, the preference continued to be given to the collective farms with the various degree of land and means of production collectivization. Communes and the state-owned agricultural enterprises, sovkhozs (Soviet farms), were considered the most desirable farms, as the ones most closely corresponding to the socialist ideal. The agricultural cooperation, whichhighest form were the kolkhozs (collective farms), was also appreciated by the authorities. The theoretical significance of the conducted research lies in the fact that the state-legal foundations of the socialist agrarian system had been set in the studied period, when the policy of collectivization and public agriculture was stipulated in the Soviet legislation, the rules and norms for creation, organization and operation of the various forms of collective farms were developed, wherein the agricultural commune was considered the form closest to the socialist ideals. Taking into account all the above, further investigation of the process of developing the model Charters of communes, artels and partnerships for joint cultivation of land seems a forward-looking objective.

Systematic Review of Clinical Guidelines for the Treatment of Functional Dyspepsia

An analysis of the literature data on the treatment of functional dyspepsia (FD) was performed. In the Kyrgyz Republic there have been no studies on the prevalence of FD, there are no protocols for diagnosis and management of patients with this pathology. We analyzed clinical recommendations on FD of the leading five world gastroenterological associations, the comparison of which showed the general principles of patient management, as well as some discrepancies.

Community based integrated wound care: Results of a pilot formative research conducted in Benin and Côte d’Ivoire, West Africa

Appropriate treatment of chronic wounds is priority in the management of Neglected Tropical Skin Diseases (NTSDs) and non-communicable diseases. We describe an integrated, community-based wound care pilot project carried out in Benin and Cote d’Ivoire that entailed both outreach education and evidence based wound care training for nurses staffing rural clinics. This research was carried out by a transdisciplinary research. Following the collection of baseline data on wound care at home and in clinics, an innovative pilot project was developed based on a critical assessment of baseline data in three parts: a pragmatic nurse training program; mass community cultural sensitive outreach programs and a mobile consultation. It came out from our investigation that several dangerous homecare and inappropriate wound treatment practices in clinics, gaps in knowledge about Neglected Tropical Skin Diseases (NTSDs), and little health staff communication with patients about appropriate wound care. Nurse training covered 11 modules including general principles of wound management and advice specific to endemic NTSDs. Nurse pre-post training knowledge scores increased substantially. Eight mass community outreach programs were conducted, followed by mobile clinics at which 850 people with skin conditions were screened. Three hundred and three (35.65%) of these people presented with wounds of which 64% were simple, 20% moderate, and 16% severe cases. Patients were followed for ten weeks to assess adherence with wound hygiene messages presented in outreach programs and repeated by nurses during screening. Over 90% of simple and moderate cases were managed appropriately at home and 98% of wounds were healed. Of the 47 cases referred to the health center, 87% came for and adhered to wound care advice. In 90% of cases, wounds healed. This pilot study provides a model for introducing integrated community based wound care in Africa.

PRINCIPLES OF EFFECTIVE RISK MANAGEMENT IN TELECOMMUNICATIONS ENTERPRISES

The article is devoted to the study of the principles of risk management at telecommunications enterprises. The general principles of management at the enterprise are systematized as a theoretical basis for the principles of risk management. The principles of risk management at the telecommunications enterprise are grouped into three main groups: general (pertain to the management system as a whole); private (refer to individual parts and elements of the management system); regulatory (regulate the order and rules of management of specific types of activities or phenomena (in particular, risks). An analysis of the principles of risk management was made according to international standards, well-known models of global companies and scientists. A system of principles was proposed taking into account the specifics of telecommunications enterprises, which includes general management, general principles of risk management and principles specific to telecommunications enterprises Additional specific principles of risk management at telecommunications enterprises (modularity, multi-criteria assessment, individuality, timeliness, confidentiality, security and secrecy, transparency, maximization (scale) and minimization, proportionality) are defined. The use of the proposed system of principles will contribute to effective risk management at the enterprise.

Large Bowel Obstruction: Etiologies, Diagnosis, and Management.

Large bowel obstructions (LBOs) often require urgent surgical intervention. Diagnosis relies on astute history and physical examination, as well as imaging with computed tomography (CT) scan for stable patients. Because of the high mortality associated with colonic perforation in patients with LBOs, decisive surgical decision-making is needed for optimal outcomes. This review seeks to provide an overview of the etiologies of LBO, diagnosis, and general management principles, as well as specific management for the most common etiologies, including colorectal cancer and strictures.

General Principles for Counseling and Management of Triplet Pregnancies.

Compared with singleton pregnancies, triplet pregnancies are associated with a significantly increased risk of adverse pregnancy outcomes. Early ultrasound examination is the best way to diagnose triplets, establish dating, and determine the number of placentas to provide appropriate counseling and monitoring. Dichorionic placentation adds risks specifically associated with a shared placenta, and limits options for intervention. Multifetal reduction is an option that can significantly improve pregnancy outcomes compared with non-reduced triplet pregnancies. Integration of a Maternal-Fetal Medicine specialist in the prenatal care for a triplet pregnancy reduces the risk of preeclampsia, preterm birth, low birthweight infants, perinatal mortality, and major neonatal morbidity.

Hong Kong Guangdong Rheumatology Meeting

The availability of biological or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) has revolutionized the treatment of rheumatoid arthritis (RA). Given the changing landscape of RA management with the ever-expanding armamentarium of advanced therapeutic agents, guidelines are important to provide clinicians with recommendations for decisions frequently faced in clinical practice. To reflect the latest developments in RA research, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) updated their RA management guidelines in 2021 and 2022, respectively. While the general principles of management are largely similar, there are a few divergent recommendations. Two circumstances of particular attention include the polarized view on systemic glucocorticoid bridging and the position of Janus kinase (JAK) inhibitors in the RA treatment cascade. On the other hand, the EULAR recommendations might appear more directly applicable, whereas the ACR counterpart provides treatment guidance in special at-risk populations. In this presentation, the two latest recommendations from ACR and EULAR will be compared, highlighting the salient differences. The supporting literature will also be discussed, including the latest studies attempting to address the controversies in the management of patients with RA.

The General Principles of Crisis Management from Typical Cases

In the face of the business crisis, some companies are cautious in their words and deeds, and take every step of the way, some companies are still in shock and bravely respond, and some companies are at a loss. In the face of the sudden crisis, how should the enterprise face it? This article will take the Toyota "recall door" incident as an example to analyze the connotation of crisis management, summarize the principles and ideas of enterprise crisis management, and provide reference guidance for enterprise crisis management.

Overweight and obesity in adults: general principles of treatment and conservative management

The prevalence of overweight and obesity is steadily increasing in Austria as well as internationally. Obesity in particular is associated with multiple health risks, comorbidities, functional disability, and social stigma. Obesity is an independent, complex, chronic disease and should be treated as such by amultidisciplinary team of appropriately qualified personnel. In addition to recent international guidelines, this consensus paper outlines the overall principles of the management of overweight and obesity and provides guidance for the diagnosis and conservative treatment, focusing on lifestyle modifications and pharmacotherapy. Using the "5A" framework of behavioral health intervention, guidelines for astructured, pragmatic, and patient-centered medical care of adults with overweight or obesity are presented.

Interventions to reduce peripheral intravenous catheter failure: An international e-Delphi consensus on relevance and feasibility of implementation

BackgroundAround 1 billion peripheral intravenous catheters (PIVC) fail annually worldwide before prescribed intravenous therapy is completed, resulting in avoidable complications, dissatisfaction, and avoidable costs surging to ∼€4bn. We aimed to provide an international consensus on relevance and feasibility of clinical practice guideline recommendations to reduce PIVC failure. Methodse-Delphi study with three rounds through an online questionnaire from March-September 2020 recruiting a multispecialty panel formed by clinicians, managers, academic researchers, and experts in implementation from seven developed and three developing countries, reflecting on experience in PIVC care and implementation of evidence. Further, we included a panel of chronic patients with previous experience in the insert, maintenance, and management of PIVC and intravenous therapy from Ireland and Spain as public and patient involvement (PPI) panel. All experts and patients scored each item on a 4-point Likert scale to assess the relevance and feasibility. We considered consensus descriptor in which the median was 4 with less than or equal to 1,5 interquartile intervals. FindingsOver 90% participants (16 experts) completed the questionnaire on all rounds and 100% PPI (5 patients) completed round 1 due to high consensus they achieved. Our Delphi approach included 49 descriptors, which resulted in an agreed 30 across six domains emerged from the related to (i) general asepsis and cutaneous antisepsis (n = 4), (ii) catheter adequacy and insertion (n = 3), (iii) catheter and catheter site care (n = 6), (iv) catheter removal and replacement strategies (n = 4), (v) general principles for catheter management (n = 10), and (vi) organisational environment (n = 3). ConclusionWe provide an international consensus of relevant recommendations for PIVC, deemed feasible to implement in clinical settings. In addition, this methodological approach included substantial representation from clinical experts, academic experts, patient and public expertise, mitigating uncertainty during the implementation process with high-value recommendations to prevent PIVC failure based contextual and individual features, and economic resources worldwide.

Review article: Emerging and current management of acute-on-chronic liver failure.

Acute-on-chronic liver failure (ACLF) is a clinically and pathophysiologically distinct condition from acutely decompensated cirrhosis and is characterised by systemic inflammation, extrahepatic organ failure, and high short-term mortality. To provide a narrative review of the diagnostic criteria, prognosis, epidemiology, and general management principles of ACLF. Four specific interventions that are explored in detail are intravenous albumin, extracorporeal liver assist devices, granulocyte-colony stimulating factor, and liver transplantation. We searched PubMed and Cochrane databases for articles published up to July 2023. Approximately 35% of hospital inpatients with decompensated cirrhosis have ACLF. There is significant heterogeneity in the criteria used to diagnose ACLF; different definitions identify different phenotypes with varying mortality. Criteria established by the European Association for the Study of the Liver were developed in prospective patient cohorts and are, to-date, the most well validated internationally. Systemic haemodynamic instability, renal dysfunction, coagulopathy, neurological dysfunction, and respiratory failure are key considerations when managing ACLF in the intensive care unit. Apart from liver transplantation, there are no accepted evidence-based treatments for ACLF, but several different approaches are under investigation. The recognition of ACLF as a distinct entity from acutely decompensated cirrhosis has allowed for better patient stratification in clinical settings, facilitating earlier engagement with the intensive care unit and liver transplantation teams. Research priorities over the next decade should focus on exploring novel treatment strategies with a particular focus on which, when, and how patients with ACLF should be treated.