Nuances Of Management Research Articles

Incidence, Management, and Outcomes of Pediatric Infectious Aneurysms.

Infectious intracranial aneurysms (IIAs) are rare cerebrovascular complications of infective endocarditis (IE) accounting approximatively for 0.5% to 6.5% of all aneurysms. In children, mycotic aneurysms secondary to IE are uncommon. This is a retrospective study of patients treated for pediatric IIA secondary to IE at our institution with an emphasis on presentation, etiologies, nuances in management, and outcomes. One hundred fifty-one patients were treated for IE secondary to congenital or acquired heart disease, of which 13 patients (8.6%) presented with intracranial hemorrhage. IIA occurred in 5 patients (2.6%) with IE. IIA accounted for 15% of intracranial aneurysms treated during the study period. Pediatric patients with ruptured IIAs have a high rate of rerupture, and early surgical intervention should be considered through an open or endovascular route when available.

Japanese Cross-Cultural Management in Indian Business-to-Business Marketing Situations: A Study of Evolving Intra-Asian Differences in Cultural Values

ABSTRACT Purpose Extensive research has been conducted on cross-cultural comparisons between Eastern and Western organizational cultures in major trading domains. However, there is a lack of examination of intra-comparative management nuances within Asian regions. This research paper focuses on the under-explored topic of the values, beliefs, and attitudes (VBAs) that influence the outcomes of East Asian (e.g. Japan) marketing strategies and operations when implemented in South Asian (e.g. India) markets and organizational contexts. The study aims to analyze the impact of VBAs on marketing effectiveness and provide insights for marketers in cross-cultural settings. The article analyzes the customer satisfaction orientation (CSO) of Japanese business executives and draws insights that offer lessons related to cultural VBAs for overall marketing strategy and foreign investors. Methodology/approach The paper employs a social constructivist paradigm and gathers empirical research through multiple interviews. These facilitate novel and normally rare access and insights into Japanese business leaders’ lived experience of CSO in B2B Indian intercultural situations. Findings Interpretivist data analysis reveals several push-pull factors that influence CSO practice. The research identifies shared values such as long-termism and harmony that have the potential to boost CSO as a marketing strategy in India. Research implications The paper develops a conceptualization of cultural VBAs that lead to successful CSO practice in India and is of relevance to foreign investors. Practical implications This study suggests that East Asian marketers should carefully consider the impact of VBAs on their marketing strategies. Our research sheds light on the ongoing discussion on static versus evolving nature of culture and highlights the need to pay attention to cultural change, particularly congruence and confluence in workplace values. Originality The intercultural study contributes to the literature on international marketing strategy by highlighting the nature and importance of understanding traditional and evolving cultural VBAs for appreciating receptivity to adoption and thereby efficacy of home country marketing strategy.

Techniques and Surgical Nuances of Management of Comminuted Fronto-Orbital Depressed Fractures: A Single-Surgeon Experience

AbstractCompound fronto-orbital depressed fractures (FODFs) are complex fractures involving the frontal and orbital bones, with associated lacerated wounds on the skin. Repairing such fractures is challenging and requires a multidisciplinary approach. Surgical indications include cerebrospinal fluid rhinorrhea, exposed brain matter, frontal sinus fractures, vision impairment, and cosmetic disfigurement. The repair is typically done using titanium implants (low-profile plates [LPPs] and screws) for a good functional outcome.In this case series of 10 patients operated by a single surgeon (RG), we present different techniques for repairing FODF. Early surgery (< 48 hours) was performed to minimize infection risk.Surgical steps included elevation of depressed fragments, dural repair, and reconstruction of orbital walls using LPP. Some cases required inside-out fixation or suture fixation for better alignment of fragments. Autograft was used for severe bone loss.The results showed good functional outcomes with minimal infection rates. Primary single-stage repair using titanium implants provided satisfactory cosmesis. The use of inside-out repair and sutures was beneficial in specific cases.In conclusion, primary repair of FODF with titanium implants is safe and effective, reducing morbidity and cost. Early surgery and proper techniques are crucial for successful outcomes. Longer follow-up is needed to assess long-term viability and bone resorption.

Mullerian Anomalies with Endometrial Carcinoma: Nuances of Management in a Rare Case and Review of Literature

Mullerian Anomalies with Endometrial Carcinoma: Nuances of Management in a Rare Case and Review of Literature

Approach to the Patient With Bilateral Adrenal Masses.

Bilateral adrenal masses, increasingly encountered in clinical practice, manifest across diverse contexts, including incidental discovery, malignancy staging, and targeted imaging after hormonal diagnosis of adrenal disorders. The spectrum encompasses various pathologies, such as cortical adenomas, macronodular adrenal disease, pheochromocytomas, myelolipomas, infiltrative disorders, and primary and secondary malignancies. Notably, not all masses in both adrenal glands necessarily share the same etiology, often exhibiting diverse causes. Recently, the European Society of Endocrinology and the European Network for the Study of Adrenal Tumors updated guidelines, introduced a 4-option schema based on imaging, aiding in targeted hormonal testing and management. This "Approach to the Patient" review delves into the latest advancements in imaging, biochemical, and genetic approaches for the diagnostic and management nuances of bilateral adrenal masses. It provides insights and a contemporary framework for navigating the complexities associated with this clinical entity.

Infective Endocarditis in a Patient of End-stage Kidney Disease and the Nuances of Management

ABSTRACT Nontunneled central venous catheters remain an irreplaceable tool for initiation of haemodialysis in most patients with end-stage kidney disease (ESKD) in the developing and underdevelpoed countries. The low cost and convenience of insertion outweigh their disadvantage of higher rates of infection and mortality. We report a case of right-sided infective endocarditis (IE) in a ESKD patient secondary to uncuffed dialysis catheter and the challenges faced with respect to diagnosing and managing IE in such population. This case is unique because it demonstrates septic pulmonary emboli secondary to tricuspid valve Staphylococcus aureus IE in a patient with ESKD.

MANAGEMENT AND LEADERSHIP: BUILDING PERSONAL AND PROFESSIONAL GROWTH FOR MANAGERS

This article explores in depth the topic of management and leadership in the context of the professional self-realization of managers and its impact on a successful career. The concepts of management and leadership are becoming increasingly important in today's business environment, which requires not only the management of people and resources but also the ability to improve oneself, develop one's personality, and achieve positive results in the workplace. The article emphasizes that successful leadership depends on professional and personal growth. It highlights the importance of personal development and the disclosure of internal resources that are necessary for effective management and leadership. Thus, professional development includes aspects related to the growth and improvement of the individual. It is revealed that enterprise management is continuously confronted with new challenges that necessitate the use of radically new approaches and ideas: methods of managing the organization, effective communication, and identifying the future of the enterprise in the face of rapid transformation, high competition, diversification of the workforce, and continuous changes in the economy and labor market. The article emphasizes that managerial activity determines personal development and can influence the typical ways of responding and behavioral patterns of managers. Successful leadership requires managers to analyze their performance, improve their skills and adapt to changes in the organization. To further study this topic, it is advisable to conduct a thorough analysis of scientific research and methodologies aimed at improving the effectiveness of management and leadership through professional and personal development. In summation, this article stands as an invaluable resource for managers, researchers, and anyone intrigued by the nuances of management, leadership, and personal development in the contemporary professional landscape.

Strategic decisions in healthcare: Impact on goals and enhancing service quality for organizational success

This study underscores the crucial imperatives of governments aiming to establish effective social protection systems: prioritizing human capital development, reinforcing social protection mechanisms, and improving the populace's standard of living. The primary objective is to conduct a comprehensive analysis of central healthcare issues and propose strategic solutions for the advancement of healthcare services. The methodology involves a detailed examination and segmentation of the healthcare sector, tailoring enhancements to specific segments. The article critically examines strategic management nuances within the healthcare sector, offering detailed segmentations and proposals for potential improvements. It extends its focus to advanced healthcare systems worldwide, providing valuable insights for assimilating foreign experiences. The study systematically explores the intricacies of strategic action planning and management in both public and corporate healthcare sectors, including transnational corporations. Findings underscore the imperative of continual development and improvement in healthcare service quality, emphasizing the necessity for judicious strategic decisions to sustain the healthcare market's functionality and vitality. This study is relevant for administrative institutions, organizations, governmental bodies, and corporate entities aiming to enhance decision-making processes and operational aspects while prioritizing healthcare quality.

Early Stage Melanoma of the Vermillion with Mucosal Melanoma in Situ: A Clinical Conundrum

BackgroundMelanoma is a predominantly cutaneous malignancy associated with sun exposure. Mucosal melanoma is rare and carries a distinct pathogenesis from cutaneous tumors. The vermillion of the lip is a unique site that divides cutaneous from mucosal tissues. Tumors arising on the dry aspect are classified as cutaneous and those of the wet aspect are mucosal. The distinction is importation in tumor staging as all mucosal melanomas are classified as T3-T4b under the current 8th edition American Joint Committee of Cancer (AJCC) guidelines.MethodsWe describe a case of early stage melanoma of the vermillion with associated mucosal melanoma in situ. We discuss nuances of management at this site and the distinctions between cutaneous versus mucosal melanomas with a review of the literature.ResultsOur patient was treated surgically with 2-3 cm margins. Residual melanoma in situ was present at the mucosal margin on final pathology which required a second surgery for margin revision. The case was discussed at tumor board with recommendation for no further treatment.ConclusionsThe nuances between the vermillion and mucosal lip must be understood for appropriate staging and treatment of melanomas. The paucity of literature on melanomas affecting this site render management decisions challenging. Multidisciplinary discussion is essential for guiding care.

Detailed Management of Brachial Plexus Birth Injuries: The Miami Protocol at Nicklaus Children's Hospital.

The management of children with brachial plexus birth injuries is complex and requires a multidisciplinary approach. In the following article, we describe our approach to evaluation and management at Nicklaus Children's Hospital. It is our aim is to elucidate nuances in management.

Delayed Posttraumatic Tension Pneumocephalus: Case Report and Review of Literature

AbstractDelayed tension pneumocephalus is a rare entity. Twelve cases of posttraumatic delayed tension pneumocephalus have been reported. This study is a case report of a patient presenting with delayed posttraumatic tension pneumocephalus, and highlights the nuances of management.

Public Services: Forced Digitalization in a Pandemic - The Nuances of Management

The aim of the article is to assess the digital transformation quantitatively and qualitatively in the management of public services against the background of the pandemic. The E-Government Development Index (EGDI) analog for evaluating the effectiveness of digital public services was developed. Qualitative and quantitative changes in digital transformation in the management of public services on the background of the pandemic were determined. It was found that no more extensive range of non-mandatory actions aimed at improving the client-oriented nature of public services and communication is observed in the innovative regions of the Russian Federation. It is established that the main transformations are qualitative, as the trend of increasing digitalization of public services was observed even before the pandemic, but during the pandemic the requirements for the expansion of such services, their efficiency, "customer centricity", and communication both within the organization and with users have increased.

Group B Streptococcus and Pregnancy: Critical Concepts and Management Nuances

Group B Streptococcus (GBS) is a common pathogen with an effective treatment. However, it remains a significant cause of neonatal sepsis, morbidity, and mortality. The screening and management of this infection are some of the first concepts learned during medical training in obstetrics. However, effective screening and evidence-based management of GBS are nuanced with many critical caveats. The objectives of this review are to discuss the essential aspects of GBS screening and management and to highlight recent changes to recommendations and guidelines. Original research articles, review articles, and guidelines on GBS were reviewed. The following recommendations are based on review of the evidence and professional society guidelines. Screening for GBS should occur between 36 weeks and the end of the 37th week. The culture swab should go 2 cm into the vagina and 1 cm into the anus. Patients can perform their own swabs as well. Penicillin allergy testing has been shown to be safe in pregnancy. Patients with GBS in the urine should be treated at term with antibiotic prophylaxis, independent of the colony count of the culture. Patients who are GBS-positive with preterm and prelabor rupture of membranes after 34 weeks are not candidates for expectant management, as this population has higher rates of neonatal infectious complications. Patients with a history of GBS colonization in prior pregnancy who are GBS-unknown in this current pregnancy and present with labor should receive intrapartum prophylaxis. Work on the GBS vaccine continues. Although all of the efforts and focus on neonatal early-onset GBS infection have led to lower rates of disease, GBS still remains a major cause of neonatal morbidity and mortality requiring continued vigilance from obstetric providers.

Outcomes and surgical nuances in management of giant pituitary adenomas: a review of 108 cases in the endoscopic era.

Giant (maximum diameter ≥ 4 cm) pituitary macroadenomas are complex tumors that require resection for decompression of optic nerves, relief of mass effect, and symptom improvement. Given the lack of surgical accessibility, the lateral extent of the lesions, and the invasion of the cavernous sinus, management presents a significant challenge. Transsphenoidal, transcranial, and combined approaches have been viable options for resection. The authors present their findings from a large series of patients to characterize giant pituitary adenomas, document outcomes, and outline surgical nuances in resection of these tumors. The authors reviewed 887 consecutive patients who underwent resection of pituitary adenomas at a single institution. From this group, 108 patients with giant pituitary adenomas who underwent resection between January 1, 2002, and December 31, 2020, were identified for inclusion in the study. The patient demographics, clinical presentation, tumor imaging characteristics, surgical approaches, and postoperative outcomes were analyzed using descriptive statistics. The mean preoperative tumor diameter in this cohort was 4.6 ± 0.8 cm, with a mean volume of 25.9 ± 19.2 cm3. Ninety-seven patients underwent transsphenoidal approaches only, 3 underwent transcranial resection, and 8 patients underwent a combined approach. Gross-total resection was achieved in 42 patients. Tumor stability without a need for additional therapy was achieved in 77 patients, with 26 patients undergoing subsequent adjuvant radiotherapy. Among 100 patients with sufficient follow-up, 14 underwent adjuvant therapy-repeat operation and/or adjuvant radiation therapy-because of recurrence or tumor progression. Six patients with recurrence were observed without additional treatment. Overall, the morbidity associated with removal of these lesions was 11.1%; the most common morbidities were cerebrospinal fluid leak (5 patients, 4.6%) and hydrocephalus (4 patients, 3.7%). One death due to postoperative pituitary apoplexy of the residual tumor and malignant cerebral edema occurred in this cohort. Giant pituitary tumors still represent a surgical challenge, with significant morbidity. Gross-total resection occurs in a minority of patients. Surgical goals for removal of giant pituitary tumors should include attempts at removal of most tumor tissue to minimize the risk of residual tumor apoplexy by tailoring the approach along the major axis of the tumor. Experience with both transsphenoidal and multiple transcranial techniques is necessary for minimizing complications and improving outcomes.

The growing role of rucaparib in contemporary treatment of metastatic prostate cancer: a review of efficacy and guidance for side effect management

ABSTRACT Introduction In May 2020, the approval of rucaparib – a poly-ADP-ribose polymerase (PARP) inhibitor – in the USA marked the arrival of a new class of targeted therapeutics for a subset of metastatic castration-resistant prostate cancer patients whose tumors harbor germline or somatic BRCA1/2 gene alterations. It has now become critical for physicians to be aware of the role and nuances of management of PARP inhibitor therapies in prostate cancer. Areas covered We focus on rucaparib’s pharmacology, key clinical trials that support its current indication, the competitive landscape, and our considerations for management of adverse events. We also review the ongoing clinical trials that may expand its utility in prostate cancer in our expert opinion. Finally, we discuss the opportunities that exist for further development of this class of targeted agents in prostate cancer. Expert opinion We believe that the time has come to develop functional assays of HRR proficiency or deficiency in order to better guide PARP inhibitor selection for patients with prostate cancer and beyond.

Cochlear Implants in Children with Inner Ear Malformations, A Review of Current Literature

Cochlear implants (CIs) are a key option of hearing rehabilitation in certain children. Scientific, surgical and technological advances in CI technology have enabled implantation in a significant number of children with sensorineural hearing loss (SNHL). There are established criteria to characterize appropriate patients, improving successful performance post operatively by standard metrics of speech perception. Clinical outcomes are, however, modified by several patient-related. An increasing body of evidence in such domains has resulted in expansion of candidacy criteria. Approximately 20% of all congenital hearing loss is associated with inner ear malformations (IEMs). Implantation of such children was associated with uncertain surgical and clinical success, and hence was limited in the early years of CI surgery. To date, the literature regarding outcomes in this special population has varied. Studies have been mixed when comparing children with IEMs to those with normal anatomy regarding success with CI. Results may be related to the type and severity of IEM. There may also be differences in children with congenital deafness versus progressive hearing loss. The current data are limited as there is not a standardized testing paradigm for evaluation in children. The variability in the data suggests further research is required to fully understand the nuances in management of these complex children. The goal of this review is to discuss surgical management and outcomes of children who meet criteria for CI in the setting of an IEM.

Burnout: modeling, measuring, and managing.

As burnout has been neglected in medical and psychiatric education, we seek to provide a summary overview. We extract salient findings from the published literature and offer some challenges. We critique the current principal model of burnout, argue for broadening the symptom constructs and for a diathesis-stress model where a perfectionistic personality style is a key predisposing factor, and observe that burnout is not limited by those in formal work. We argue that burnout is not synonymous with depression, overview biological underpinnings, and summarise a three-fold management model. As many burnout patients are referred to psychiatrists, awareness of its symptom pattern and management nuances is of key importance.

Питання організації менеджменту створення, охорони об’єктів права інтелектуальної власності та трансферу технологій у наукових установах

The successful implementation of the Strategy for the development of the sphere of innovation activity for the period up to 2030 involves taking into account the peculiarities of the organization of management of the creation, protection of intellectual property rights objects (IPRO) and technology transfer. Therefore, the article is aimed at studying these aspects in scientific institutions and developing effective proposals in this context. The article considers the importance of the role of objects of intellectual property rights in the activities of scientific institutions and the need for full functioning in these institutions of the units for technology transfer, innovation activity and intellectual property. The authors examine the problems that hinder the development of such units in scientific institutions and institutions of higher education. Based on the research of the experience of the aforementioned units in both domestic and foreign scientific institutions, it is recommended to introduce and develop in Ukraine mechanisms of the State support for innovation activities, technology transfer, commercialization of research results, intellectual property objects taking into account the experience of the EU Member States, technologically developed countries, directed towards developing innovations in business; combining business and scientific institutions, higher education institutions for research and development for transfer of technologies in the interests of enterprises; support of high-tech industries; development of innovative activities at the regional level. Important issues, in particular, are the development of model agreements for research and development with various options for the distribution of intellectual property rights between scientific organizations and national or foreign counterparties, which would take into account the international practice of concluding such agreements; development of provisions defining the peculiarities of creation and use of intellectual property objects by employees of the NAS of Ukraine who work in foreign projects and scientific institutions, as well as foreign specialists conducting research and development in institutions of the NAS of Ukraine. The nuances of management of the creation, protection of objects of intellectual property rights and technology transfer in scientific institutions related to the innovative attractiveness of enterprises are planned to be highlighted in further scientific research.

Outcomes and Surgical Nuances in Management of Giant Pituitary Adenomas

Makarenko, Serge MD, BS; Alzahrani, Ibrahim; Karsy, Michael MD, PhD, MS; Couldwell, William T MD, PhD; Deopujari, Chandrashekhar MD Author Information

Endotracheal Intubation in the Pharmaceutical-Poisoned Patient: a Narrative Review of the Literature.

Endotracheal intubation (ETI) is an essential component of the supportive care provided to the critically ill patient with pharmaceutical poisoning; however, specific nuances surrounding intubation including techniques and complications in the context of pharmaceutical poisoning have not been well elucidated. A search of the available literature on ETI in pharmaceutical-poisoned patients was undertaken using Medline, ERIC, Cochrane database, and PsycINFO using the following MeSH and keyword terms: ("toxicology" OR "poisons" OR "drug overdose" OR "poisoning") AND ("intubation, intratracheal" OR "intubation, endotracheal" OR "airway management" OR "respiration, artificial"). A hand-search was also performed when the literature in the above search required additional conceptual clarification, including using the "Similar Articles" feature of PubMed, along with reviewing articles' reference lists that discussed intubation in the context of a poisoning scenario. Articles with any discussion around the ETI process in the context of a pharmaceutical poisoning were then included. Intubation may be performed in patients poisoned with pharmaceuticals in the context of both single and multiple organ dysfunction including central and peripheral nervous system, pulmonary, or cardiovascular toxicity with hemodynamic instability, or localized effects resulting in mechanical airway obstruction. Certain classes of poisonings may require modifications to the standard rapid sequence induction airway management algorithm. ETI is a key component of the supportive care provided to the patient poisoned by a pharmaceutical agent. Clinicians should be aware of the spectrum of toxicities that can necessitate intubation, as well as airway management nuances that are specific to various poisoning presentations.