Strategic Points Research Articles

The Key Impact of Management Modes for Innovation in SMEs

This study assists in obtaining a better knowledge of managerial and organizational factors favoring different types of innovation, highlighting the critical role of creativity, risk-taking, and performance management for operational innovation. Also, this study aims to simultaneously investigate interactions of exploration and exploitation innovation to show how managers and organizations are usually treated in exploration and exploitation innovation. A sample of 755 valid questionnaires from small and mid-size enterprises (SMEs) from diverse firms in the global south were employed and analyzed using the partial least square structural equation model to examine the proposed research model and assumptions. This study shows that creativity, risk-taking, and performance management are positively and significantly affect operational innovation in global south SMEs. From a strategic point of view, our findings demonstrate that SMEs must create innovation in order to maintain their performance. Managers of SMEs would be aware of the influence of various types of innovation on various aspects of business performance, such as marketing, operations, and finance. On a management level, the research findings assist SMEs in achieving high performance levels with their innovation projects. In addition, this research helps readers to develop a better knowledge of how organizations combine operating innovations and exploration.

MIGRATION OF AHISGA (MESKHETI) TURKS TO THE UNITED STATES AND LIVING THERE

The purpose of this study is to assess what Ahisga Turks have adopted in the process of immigrat-ing to the United States and to discuss the methods individuals have developed to preserve their cul-ture in the process of acculturation. Many factors influence this process at the same time. The Ahisga Turks, consisting of about 600 families from the Krasnodar region of Russia, settled in various states of the United States and later in the State of Ohio, forming the source of information. This study is based on data collected through in-depth interviews with ten people, nine Ahisga Turks and one cleric from Turkey, living in Dayton, Ohio, USA. The article contains both interviews and literature studies about Ahisga Turks living in the United States. The return of Ahisga Turks, who were exiled to Central Asia by the Soviet regime in 1944 for strategic reasons, is still being postponed for strategic reasons. In many countries, including Turkey, where Ahisga Turks live, international organizations and think tanks continue to solve the issue from a political and strategic point of view. As a concrete example, it can be shown that although the return of Ahisga Turks to their land is a condition for Georgia's membership in the Council of Europe (1999), neither the Georgian state nor the Council of Europe can implement the return process as intended.

Evaluating enablers for digital transformation readiness and resulting benefits

Digital transformation (DT) readiness is usually associated with the technological maturity of an organisation more than with its readiness from a strategic point of view, which makes it essential to have artefacts that allow this type of evaluation, which still needs to be sufficiently expanded and tested. Based on Rogers’s [1] framework, this work developed a conceptual model to assess the impact and relevance of the six enablers in strategic readiness and benefits resulting from a DT project. Through a qualitative study with a panel of experts from six Portuguese organisations, it was possible to validate the model, conclude which are the most relevant strategic enablers for greater DT readiness, and also that conducting more business through digital platforms significantly improves the resulting benefits. Furthermore, it will be possible to apply this model in broader quantitative contexts to determine which factors are most prevalent according to the context, be it an industry, a region, or an organisation’s dimension.

Supply chain modelling and LARG performance evaluation under severe disruptions: the case of the fast-food industry

the LARG paradigm involves and combines different perspectives: Lean, Agile, Green, and Resilience. These four perspectives are recognized as a suitable response to the strong demand fluctuations and characteristics of modern variables and unpredictable markets. Their integration into modern supply chains is also crucial from a strategic point of view. This study develops a simulation model useful for measuring and evaluating the LARG performance of a supply chain operating in the fast-food industry. Different configurations have been tested varying the number of players and the target service level. Then, different scenarios with distortions have been compared. Results show that the service level influences the LARG performance regardless of the kind of disruption. The supply chain structure can affect LARG performance when the demand increases, while it seems not relevant if the demand decreases.

Critical issues facing Georgia residents: An application of the Delphi technique and community capitals framework

The 21st century has brought with it unforeseen challenges and influential trends that will have significant impact of the livelihood and wellbeing of Georgia residents. Extension personnel within Georgia can extend their mandate by identifying issues that represent present and near-present threats and use these issues to inform programming and direct resource allocation. The conceptual basis for this study relied upon the community capitals framework and the consensus-building theory. Data were collected using a three-round Delphi process, with an expert panel comprised of 19 Extension leadership and administrative personnel. Descriptive statistics, including mean importance scores and absolute frequency counts, were computed. A final list of 21 unique issues resulted from the Delphi process and was analyzed thematically using the constant comparative method. Five heuristic themes resulted from this analysis: 1) Investment in Youth and Adults, 2) Agricultural and Rural Economic Development, 3) Agriculture and Food Safety Information, 4) Resource Access and Availability, 5) Social and Personal Economic Concerns. Comparison with the community capitals framework revealed that multiple capitals interacted within each of the resulting themes. Utilizing the Delphi technique in conjunction with the community capitals framework enables extension professionals to compare community resources and strengths and may allow for greater efficiency in addressing critical issues. The immediate efforts of extension personnel should be directed towards addressing issues within the Investment in Youth and Adults and Resource Access and Availability themes. We recommend using the associated community capitals as strategic entry points for further discussion and program development.

철도교통과 한반도 지형 변화

Railways are an indispensable civilization for modernization, but on the other hand, imperialism has two sides as a typical means of invading and colonizing weaker countries. Japan was able to seize and further colonize transportation and logistics on the Korean Peninsula through the construction of railroads. In addition, it used this as a bridgehead to develop a policy of invading the continent.
 After the opening of the port, Japan developed Busan as a base city to promote an aggression policy. Busan was the base city of the railway network, the last stop of the government-affiliated contact line, and the starting point of the Eurasian International Railway. In this process, while Dongnae, a traditional strategic point in the southeastern region of the Korean Peninsula, declined, Busan overtook Pyongyang to grow into Korea's second-largest city. In this process, Dongnae strengthened its character as a recreational tourism city for the Japanese living in Busan.
 The railroads established by Japan reorganized traditional transportation and logistics, and further changed the power relations and topography between cities. The presence or absence of railroads became the main criterion for the rise and fall of cities. As such, it can be seen that railroads were the main means of Japan's colonization of Korea, and were a fundamental force that changed the traditional power relations, topography, logistics, and markets between cities.

Marketing action plan in Micro and Small Enterprices of San Martín Texmelucan, Puebla

This article is part of a research that develops a strategic plan according to the needs of companies in the region to improve their profitability, and due to its nature, qualitative research is carried out. The section of the research is exploratory-descriptive, to know and describe the characteristics of the companies under study, which correspond to a highly commercial region, being located in a strategic geographical point. A research instrument (interview) was developed and applied to the directors/marketing managers at Mypes in the San Martín Texmeluan region, complemented with observation of the means used to promote the company and its products/services offered; supporting the identification of areas of improvement in the operation of those involved, preparing proposals and from said research emerged the development of two undergraduate theses and the training of resources through around 20 undergraduate students who contributed to the research, as interviewers and information processing

Using structural equation modeling to assess the genotoxic and mutagenic effects of heavy metal contamination in the freshwater ecosystems: A study involving Oreochromis niloticus in an urban river

Chemical pollutants represent a leading problem for aquatic ecosystems, as they can induce genetic, biochemical, and physiological changes in the species of these ecosystems, thus compromising their adaptability and survival. The Capibaribe River runs through the state of Pernambuco, located in Northeastern Brazil, and passes through areas of agricultural cultivation, densely populated cities, and industrial centers, primarily textiles. Despite its importance, few ecotoxicological studies have been conducted on its environment, and knowledge about pollution patterns and their effects on its biota is still being determined. The objective of this study was to evaluate the water quality and the damage supposed to be caused by pollutants on the DNA specimens of Nile tilapia (Oreochromis niloticus) obtained from seven strategic points of Capibaribe. Tilapia specimens and water were collected during the rainy and dry seasons from 2015 to 2017. The following characteristics were analyzed: physicochemical (six), metal concentration (seven), local pluviosity, micronuclei, and comet assay. The physicochemical and heavy metal analyses were exploratory, whereas the ecotoxicological analyses were hypothetical. To verify this hypothesis, we compared the groups of fish collected to the results of the micronuclei test and comet assay. We created a Structural Equation Model (SEM) to determine how each metal's micronuclei variables, damage index, pluviosity, and concentration were related. Our results demonstrated that the highest values for markers of genetic damage were detected at points with the highest heavy metal concentrations, especially iron, zinc, manganese, chromium, and cadmium. The SEM demonstrated that metals could explain the findings of the genotoxicity markers. Moreover, other pollutants, such as pesticides, should be considered, mainly where the river passes through rural areas. The results presented here demonstrate that the Capibaribe River has different degrees of contamination and confirm our hypothesis.

Discussion on ESG Information Disclosure of A-SHARE Listed Companies in China Biomedical Industry

In the context of global climate change, countries are actively advocating the construction of a green, low-carbon and recycling economic system and promoting high-quality development and high-efficiency governance. Environmental, social and corporate governance (ESG) , which is in line with the concept of sustainable development, has been widely concerned by the international community, and ESG disclosure is the foundation of ESG development. The biomedical industry is one of the strategic high points of international science and technological and economic competition. Improving corporate disclosure is of great significance to enhance corporate competitiveness, reduce the risks of corporate, improve corporate performance and thus achieve sustainable development of the biomedical industry. Taking the listed companies in the ESG rating report of Runling Global Biomedical Sector from 2020 to 2022 as samples, this paper makes an objective analysis of the disclosed ESG-related reports, and finds that there are some problems in the development of ESG in China􀆳s biomedical industry, such as low disclosure rate and level, diverse disclosure standards, imperfect disclosure indicators and qualitative indicators. In this paper, an enterprise is selected as a specific research object, uses the case study method, and its disclosure report is compared with the key core issues of Runling Global Ratings by case analysis, so as to improve the core issues of ESG disclosure in the biopharmaceutical industry in light of the common problems that exist in the industry􀆳s disclosure of information. In the future, the development of ESG in the biopharmaceutical industry should improve the disclosure rate of enterprises and the disclosure level of ESG reports; unify the compilation standard of ESG reports; reasonably allocate the disclosure proportion of enterprise indicators, and try to make each indicator quantitative.

Optimal location of Power Quality Monitors in distribution grids based on MRA methodology

Distribution grids currently face news paradigms where Power Quality (PQ) has become one of the most important aspects for distribution system operators (DSO) and consumers. To ensure a PQ within the limits defined by international standards, there is a permanent need to monitor all parameters associated with the distributed voltage by the grid. This task is carried out using the installation of Power Quality Monitors (PQM) at strategic points of the grid. The main aim of this paper is to define a methodology to optimize the best location for the PQM installation. To achieve this target the Monitor Reach Area (MRA) matrix is calculated and an Integer Linear Programming (ILP) optimization model was used to find the best solution. Two case studies were carried out, in which residual voltage values were observed when three-phase short circuits are applied to all nodes. The results obtained show the good effectiveness of the developed method, presenting solutions that allow the total monitoring of the studied networks, using the smallest possible number of PQMs. In this way, it is possible for the DSO to keep the network monitored in real-time with huge efficiency gains.

Use of quality tools in optimizing the production process in dental prosthesis laboratory

This article demonstrates the importance of a management and optimization project in the production processes of a dental prosthetics laboratory. It explores the use of quality tools and their contributions to the success of improvement works, enhancing product quality and production flow. All strategic points of the company were restructured by managing change projects, ensuring each directive was aimed at achieving the necessary outcomes for successful planning. Focused on a complete transformation, each department experienced changes and soon witnessed results showcased in reports, including improvements in personnel, production, finances, and strategic management. These improvements aimed to secure new contracts and expand the portfolio of clients and suppliers.

The quality of water from natural sources and human consumption in the Jorro community (Alagoinhas – BA): an analysis of physicochemical aspects

The Jorro community in Alagoinhas (BA) relies on groundwater for subsistence, yet the consumption of this resource occurs without proper supervision or adequate treatment planning by the competent authorities. With the aim of ensuring access to quality potable water, this study seeks to conduct a preliminary analysis of the physicochemical characteristics of the water used in the Jorro community. Samples will be collected at strategic points with higher extraction rates for human consumption at predefined intervals. The analyses will encompass aspects such as temperature, turbidity, pH, hardness, and total solids, employing techniques standardized by competent bodies. The intention is to contribute to enhancing the quality of this essential water resource for the community, ensuring it meets potability standards established by Brazilian regulations. The study underscores the importance of thorough evaluation and regulation to guarantee safe drinking water for the Jorro community.

Water Quality and Environmental Challenges: A Study at Chapéu Virado and Farol Beaches, Mosqueiro Island, Pará-Belém

Purpose: This study emphasizes the importance of water quality at Chapéu Virado and Farol Beaches, on Mosqueiro Island, highlighting its role in ensuring bathers' safety and preserving the local ecosystem. Method/design/approach: Following CONAMA Resolution 274 guidelines, the bathing water quality assessment was conducted using E. coli and pH parameters. Samples were collected at seven strategic points and analyzed using the Colilert method for E. coli, while pH was measured using a field pH meter. Results and conclusion: The results revealed a persistent increase in E. coli levels over five weeks, potentially associated with a rise in visitors during July, suggesting an upsurge in improper waste and sewage disposal practices as the primary hypothesis. As a consequence, several beach points were deemed unfit due to high concentrations of E. coli and sewage detection. Additionally, maintaining an acidic pH in one of the five analysis weeks rendered certain areas unsuitable for bathing. A range of complex factors, including effluent discharges, the presence of acidic groundwater, coastal erosion, and weather conditions, may contribute to the detected acidity. Research implications: The implications of this research are quite significant in various aspects: Public Health: Identifying potential health risks related to water and beach environment quality is crucial to prevent waterborne diseases and ensure the safety of beachgoers. Environment: By highlighting the negative impacts on beach quality, the research underscores the importance of conservation and environmental preservation, encouraging actions to reduce pollution and protect coastal ecosystems. Sustainable Tourism: It reveals the need to promote sustainable tourism practices by educating visitors and tour operators about the importance of preserving beaches for long-term tourism. Public Policies: It can influence governmental policies and regulations to enhance water quality, implement more effective monitoring systems, and establish guidelines for environmental protection. Public Awareness: By disseminating the results, this research can raise public awareness about the importance of caring for beaches and the environment, encouraging both individual and collective actions for conservation. Originality/value: The originality of this research lies in the way it addresses beach problems. It doesn't just focus on water quality but also examines how it affects people's health and tourism. This is important because it helps better understand the issues and find solutions. As for its value, it lies in showcasing how poor beach quality impacts public health and how this can be resolved. It also emphasizes the importance of caring for the environment and promoting more sustainable tourism. All this provides valuable information for decision-makers, aiding in the preservation of beaches for the future.

Solvatochromic dyes as a tool for tracking homeopathic complex activity in water reservoirs of a spring park in Brazil: Physicochemical implications

Introduction: Solvatochromic dyes seem to act as physicochemical markers of homeopathic medicines. Herein, methylene violet was selected from a pilot study to identify the homeopathic complex (Arnica montana 30 cH, Phosphorus 30 cH, Arsenicum album 30 cH, Ignatia amara 30 cH, and Staphysagria 30 cH) designed to be used in the Nascentes do Rio Taquari at IMASUL Environment Institute of Mato Grosso do Sul = Brazil) request, intending to facilitate the ecosystem's bioresilience after being burned down in September 2020. Brazil has no legal restrictions on using dynamized products in the natural environment. Methods: the complex was prepared in ethanol 30% and soaked in biodegradable inert gel (calcium acetate) set at nine strategic points in the park. Water samples were harvested from each point at different times, before and after the insertion of the devices. Then, they were filtered through a 0.22 Micra mesh filter for sterilization and frozen. For analysis, 1 cH potencies of each thawed water sample were prepared using 30% ethanol as solvent. The ready-made samples were submitted (or not) to a magnetic field (2400G average) for 15 minutes, whose flow was generated from a neodymium magnet (5.08 cm x 5.08 cm x 12.7 mm) isolated from any other electromagnetic influence. Soon, after magnetizing, samples were added 1:60 into methylene violet dye, prepared in water pH=4.0, in microplates, and read in an ELISA reader at a wavelength of 598 nm. Controls were 30% ethanol, Ethylicum 1cH, and magnetized water. Statistical analysis was performed by the Shapiro-Wilk normality test and parametric or non-parametric ANOVA, with p≤0.05 considered significant. Results: Significant differences between the homeopathic complex and controls were seen when magnetized samples (p=0.0045). Instead, only one sample (point 2) without magnetization showed statistical significance (p≤0.05) from the controls. Conclusion: using solvatochromic dyes can be considered a good method to track the presence of the homeopathic complex in spring water, and the magnetization of samples seems to be an efficient tool to improve the method’s sensitivity.

Recovery of fire-damaged “cerrado” area treated with homeopathic preparations in slow dispersion devices – a descriptive study.

Given the seasonal climatic characteristics, forest fires in “cerrado” areas in Central Brazil are common and challenging to prevent. Despite fire being a plant stimulation factor, such as breaking seed dormancy, when it covers large areas or occurs very frequently, it can cause irreparable damage to nature. Prevention is difficult and costly, and there are no corrective action options other than waiting for natural regeneration, which is usually slow and, not infrequently, with permanent damage. Due to its physicochemical qualities acting in biological regulation processes, water has been considered the primary vehicle for propagating signals from homeopathic ingredients, as suggested by previous studies carried out with solvatochromic dyes. Therefore, such inputs could, in theory, be inserted into watercourses to stimulate the regeneration of the biome destroyed by fire. This hypothesis motivated this case study. A slow dispersion device was developed aiming at promoting continuous environmental regeneration, containing hydrocolloid and calcium carbonate as a solid base soaked in a homeopathic complex specifically designed for this purpose, composed of Arsenicum album, Arnica montana, Staphysagria, Ignatia amara, and Phosphorus, all at 30cH. The case occurred in Nascentes do Rio Taquari Park, between Mato Grosso and Mato Grosso do Sul state, Brazil. It is a “cerrado” area, with multiple springs that feed the Paraguay River, occupying an area of 26,849 hectares over the Guarani and Bauru aquifers. After the fire in early September 2020, the devices were fixed at 9 strategic points in the park (P1 to P9) over 10 days, between September 29, and October 11, 2020, in water courses close to the main springs. To assess the restoration signs of the post-fire environment, the technicians responsible for monitoring the park made observations of flora and fauna recomposition in different locations close to four device-insertion points (P3, P5, P7, P8). Signs of recovery were observed 40 days after the fire was over. A rapid pioneer plant restructuring was noted, with a significant regrowth of grass, herbaceous and shrub species, such as Mutamba (Guazuma ulmifolia), Murici (Byrsonima spp.), Inga (Inga sp.), Brachiaria (Brachiaria sp.), Jaraguá grass (Hyparrhenia rufa), Colonião grass (Panicum maximum), Gabiroba (Campomanesia sp.), and Pixirica (Miconia sp.). Some species, such as Mimosa (Mimosa sp.), Colonião grass (Panicum maximum), and Jaraguá grass (Hyparrhenia rufa), were not detected in the area before the fire, probably by the seed bank stimulation caused by the heat. There was rapid forest regeneration (4 months after the fire) and restoration of most of the burned trees, both for resisting the fire and for being free of invasive species highly aggressive to native plants, which were controlled by the action of fire. Concerning the fauna, a vast animal population was detected, especially birds, highlighting the “Tuiuiú” (Jabiru mycteria) and “Socó” (Tigrisoma lineatum) close to a water body with a waterfall area (P3). Both species belong to the “Pantanal” biome close to the park. Such species began to frequent the park's lakes, being observed until February 2023 (the last survey date). The park's inventory of lichens and fungi showed an unusual tolerance to fire in species that adhered to burned trees and remained active. In this way, it is suggested that installing slow dispersion devices in watercourses can contribute to the regeneration of other “cerrado” biome areas subjected to fire, protecting the local biodiversity. More studies of this nature are needed to know the real impact of this method on the recovery of different biomes.

Posidonia oceanica Cartography and Evolution of the Balearic Sea (Western Mediterranean)

The Balearic coastline presents an environmental and biological heterogeneity, which confers great complexity on the marine environment and treasures important biodiversity, both at the level of species and marine communities. The endemic phanerogam of the Mediterranean Sea, Posidonia oceanica, holds a pivotal role in maintaining high biodiversity, warranting protection as stipulated in the Posidonia Decree 25/2018. The purpose of this study is to provide quantitative criteria that will allow the delimitation of areas with Posidonia oceanica for conservation and to aid planning and management of this species, contributing to the reduction of biodiversity loss caused by anthropogenic impacts and global change. Utilizing a comprehensive approach, the study employs photo interpretation of aerial photographs taken at depths between 0 and 5 m, data from Side-Scan Sonar (SSS) campaigns, reprocessing information from the LIFE Posidonia project at depths between 20 and 30 m, and targeted sampling using Remote Operated Vehicles (ROV) and ocular recognition at strategic points. The research not only seeks to assess the present state of the phanerogam but also analyzes its evolution, establishing a technological database for consultation and integrated analysis. This database facilitates effective management by tracking habitat changes, representing a significant contribution to the understanding of the impact of global change on ecosystems through Geographical Information Technologies (TIGs).

Stable posture tracking for modular spatial hyper-redundant serial arms using selective control points

ABSTRACT Robotic arms with redundant degrees of freedom are known to exhibit characteristics that make them more suitable than their non-redundant counterparts in many manipulation tasks. These redundant degrees of freedom allow for multiple control objectives to be pursued simultaneously leading to increased efficiency, dexterity and versatility. Redundancy however brings about structural complexity, difficulties in tasks specification, challenging kinematics and dynamics and high computational cost. This work tackles kinematic hyper redundancy resolution in the context of posture (shape) control of a modular serial link arm by proposing a new take on formulating and solving the problem. In the proposed formulations, strategic points along the arm (termed control points) are explicitly controlled in such way that their overall motion steers the posture of the arm toward the desired target posture. These control points stem from the modular structure of the arm and are chosen in order to achieve specific control characteristics. Desired target posture outlines are specified intuitively and arbitrarily with continuous spline curves. The proposed method has demonstrated the ability to safely steer the arm towards intermediate postures which reduce the overall posture tracking error. It copes well with singularities and is capable of tracking target postures that are significantly distinct from the arm's initial posture. Numerical simulations on a 40 DOF arm are conducted to assess the validity and performance of the method.

Retrieval of zirconium ions from laboratory solutions upon insitu-gel-precipitated aluminium based composite sorbents

Synthesis of innovative substances that serve as potential adsorbents used to reduce pollution impacts or even capture valuable elements is still a target. The strategic point of this work is the preparation of aluminum silicate vanadate nano particles (AlSiV-NPs) and aluminum silicate vanadate tungstate nano particles (AlSiVW-NPs) via the insitu technique. The prepared adsorbents were characterized using FTIR, TGA, TEM, XRD, and SEM-EDX analyses. Studies were conducted on the effects of pH variation, feeding solution concentrations, equilibrium times, and adsorbent weight on the Zr4+ adsorption process on the synthesized adsorbents. With the experimental maximum adsorption capacities of 89 and 95 mg/g for AlSiV-NPs and AlSiVW-NPs, respectively, the equilibrium adsorption results for Zr4+ were in good agreement with the Langmuir isotherm and the qe values were more fitting. The pseudo-second-model kinetically matches both adsorbents suggesting that chemisorption was the approach of adsorption. Thermodynamic results for composites AlSiV-NPs and AlSiVW-NPs show similar values for enthalpy change (−31.5 and −21.08 kJ/mol), entropy change (−47.8 and −7.8 J/mol.. K), and negative free energy change. In summary, Zr4+ adsorption over AlSiV-NPs and AlSiVW-NPs is exothermic, spontaneous, and has a lower degree of disorder. These findings proved the promising future of these composites to recover Zr4+ from aqueous media.

Active Control of the Reflection Coefficient of an Underwater Surface

From a strategic point of view, it is essential to protect underwater vehicles from being detected by opponents. Modern mono- or bistatic sonar systems are capable of precisely determining the position of a watercraft. In order to triangulate the positions of watercrafts, the sonar sends out acoustic signals that are reflected by the vehicles’ surfaces. These deflected sound waves are subsequently detected and evaluated. How well an object can be detected using a sonar can be measured according to the target strength. Through their shape, construction and choice of materials, modern underwater vehicles are optimized in relation to minimizing their radiated and reflected sound waves; in this way, their target strength is minimized. These passive measures are particularly effective in the medium- and high-frequency range down to 1500 Hz. To effectively reduce reflections at lower frequencies, an active system is developed in this study and evaluated in a laboratory test with a water-filled impedance tube. The incident sound waves were measured in front of an active surface and then processed using an adaptive control system based on an FPGA platform. The system operates with a very thin piezoceramic applied to the surface in order to minimize the reflections of the sound waves. The laboratory tests showed the high effectiveness of the system under the influence of sonar-like signals.

Clinical value of a tool for managing oral anticoagulation in nonvalvular atrial fibrillation in primary health care. Randomized clinical trial

Introduction and objectivesThe management of atrial fibrillation is complex and requires improvement at strategic points, such as in the control of patients treated with vitamin K antagonists. The aim of this study was to evaluate the impact on health outcomes of a nonvalvular atrial fibrillation decision support tool based on visualization of the time in therapeutic range in primary care. MethodsThe present randomized clinical trial was conducted in 2018 with a 1-year follow-up in 325 primary care centers in Catalonia. In the intervention centers, the decision support tool was installed to control the time in therapeutic range of patients treated with vitamin K antagonists. The tool was not visualized in the control group. ResultsIn total, 44 556 patients were studied. The intervention protected against admission for stroke (adjusted odds ratio [OR], 0.70; 95% confidence interval [95%CI], 0.55-0.88). The number needed to treat was 3502 (95%CI, 3305-3725) while the number of admissions for stroke avoided was 12.63 (95%CI, 11.88-13.38). The intervention also protected against mortality (adjusted OR, 0.78; 95%CI, 0.67-0.90), with a number needed to treat of 13 687 (95%CI, 10 789-18 714) and number of deaths avoided of 3.23 (95%CI, 2.36-4.10). ConclusionsThe decision support tool was associated with slight reductions in the numbers of admissions for ischemic stroke and mortality. Although the follow-up time was short and the effect of the intervention was small, the results are valuable and could improve implementation of the tool.This clinical trial was registered with ClinicalTrials.gov (NCT03367325).