Systemic Management Research Articles

«I can't imagine it without my nurse»: Experiences of people with chronic kidney disease in the evaluation process as kidney transplant candidates.

This qualitative study aimed to explore the experiences of 11 adults with chronic kidney disease (CKD) undergoing evaluation for kidney transplant (KT) and examine the role played by the nurse in the process. Employing a descriptive phenomenology approach, semi-structured interviews were conducted between October 2022 and July 2023. Thematic analysis, facilitated by Atlas. ti software, revealed a systemic management diagram with "The candidate for kidney transplant and their reality" at the center, followed by "The process of chronic kidney disease and kidney transplantation," and concluding with the most distal category centered on "The kidney transplant access nurse." This organizational framework provided insights into the layers of relationships between emerging themes. The findings underscored the complexity and multidimensionality of the CKD and KT process, emphasizing the nurse's pivotal role as a guide and protector throughout the evaluation process for accessing kidney transplantation. The convergence of results with existing literature highlighted the need to address challenges such as lack of time, resources, and emotional support to enhance the quality of care. Recognizing the nurse's crucial importance in this process, the study emphasizes the significance of addressing these challenges to improve patient care and calls for attention to the nurse's role in guiding individuals through the intricate journey of CKD and kidney transplantation.

Survey on Findings and Utilization of Preoperative Chest Radiography in Ophthalmic Surgery.

Objective: The objective of this paper is to reconsider the significance of preoperative chest radiography (CXR) before ophthalmic surgery through investigation of imaging findings and usage status. Methods: This retrospective observational clinical study involved 1616 patients who underwent ophthalmic surgery at Saga University Hospital from 1 January 2019 to 31 December 2020. The patients' radiology reports were obtained from the electronic medical records, and their CXR findings, therapeutic interventions, and progress were investigated. Results: Among all patients, 539 (33.4%) had abnormal preoperative CXR findings. Of these patients, 74 (4.6%) had newly identified abnormal findings. In both patient groups, approximately 70% of patients with abnormal findings were aged ≥70 years, and interstitial shadows were the most common finding. Among all patients with abnormal findings, three (0.19%) received preoperative therapeutic interventions, and all surgeries were performed safely. Forty-three patients with abnormal findings were referred to our hospital or other hospitals for further investigation and treatment postoperatively. Among those patients, eight (0.5%) had primary lung cancer, seven underwent surgery, and one received chemoradiation. The other patients were also followed up and received appropriate therapeutic interventions. Conclusions: Before ophthalmic surgery, few patients required actual therapeutic interventions based on their CXR results. However, many abnormal findings were revealed in elderly patients, including some serious diseases. Furthermore, research has suggested that appropriate therapeutic intervention after ophthalmologic surgery may reduce the risk of a poor life prognosis. This study clearly shows that preoperative CXR is not only useful for perioperative systemic management but also ultimately benefits patients. It is also considered particularly meaningful for patients aged ≥70 years.

Combination Therapy of Oral Tofacitinib with Phototherapy in Severe Pediatric Atopic Dermatitis

Atopic dermatitis (AD) is an itchy skin condition commonly seen in children. It is usually controlled with emollients and topical corticosteroids, but severe cases require systemic management. Tofacitinib is a promising molecule tried in various inflammatory dermatoses. It suppresses the expression of cytokines and improves the skin barrier function. Phototherapy is a second-line treatment modality in AD. Here, we describe a case report of a 6-year-old child of severe AD with predominantly lichenified lesions not responding to the conventional first-line therapeutics and cyclosporine. A combination therapy of tofacitinib with narrow-band ultraviolet B phototherapy (NB-UVB) was tried with impressive results in terms of symptomatic relief of pruritus and significant reduction in lichenification of the lesions.

Конкурентоустойчивость экономики региона как квазикорпорации с позиции системного подхода

The presented article describes the essence and economic content of a quasi-corporate approach to the management of modern regions, which are independent subjects of economic relations with key stakeholders of their development. As part of the study, the author's approach to the formation of competitive sustainability of the regional economy is presented based on systemic management of the competitiveness and investment attractiveness of the territorial product. The result of the study was a strategic matrix of measures to achieve the competitive sustainability of the region, which can be implemented in the road maps of executive authorities to clarify plans for long-term socio-economic development in the constituent entities of the Russian Federation, and also a conceptual model for managing the competitive sustainability of the region has been developed from the perspective of a systems approach, which complements current economic research in this field.

Circular Economy Matrix Guiding Manufacturing Industry Companies towards Circularity—A Multiple Case Study Perspective

AbstractManufacturing companies struggle with overwhelming expectations, disruptions and trends sweeping over their business environment. The evident climate change, together with rising sustainable development goals, is forcing companies to discover their environmental impact, in addition to the more familiar economic one. The transformation from a linear economy to a circular economy (CE) reduces waste and improves resource efficiency through the deployed R-cycles, such as recycle, reuse and repair. This transformation is feasible for multinational enterprises because they can allocate sufficient resources for their strategic development goals. For small and medium-sized enterprises (SME), any additional investment must be carefully assessed and planned. Thus, SMEs need support and tools to select their next development investments. Generally, maturity models help companies find their status (compared to others) and identify the most important development areas and actions. This paper presents the CE maturity matrix, which comprises five maturity levels mapped with seven linear manufacturing value chain phases. The matrix was piloted with nine manufacturing industry companies, four of which were from Finland, one from Italy, one from Germany and three from Ireland. The CE matrix interview results showed that none of the interviewed manufacturing industry companies remained at the linearity level. The most common levels varied between systemic material management and CE thinking. In the interviews, over 40 CE actions were identified as the argument for a company reaching a CE maturity level. The transition towards sustainable manufacturing has already started but will require efforts to accelerate and to engage companies to proceed.

Flexing to outperform: workforce differentiation, HR flexibility and firm performance

PurposeResource orchestration theory proposes that firms need resources, capabilities, and horizontal and vertical alignment to achieve high performance. Thus, we investigate which combinations of horizontal fit of resources (commitment-based HR systems for managers and nonmanagers) and capabilities (HR flexibility) together with vertical fit with business strategy (innovation versus cost leadership strategies) relate to superior performance.Design/methodology/approachOur study is based on a sample of 113 Spanish firms from which we collected data on commitment-based HR systems for managers and nonmanagers, HR flexibility, business strategy and performance. We employ a fuzzy set qualitative comparative analysis (fsQCA) to analyze which configurations lead to firm performance.FindingsThe empirical analysis shows that both HR practices and policies (commitment-based HR systems) and HR capabilities (HR flexibility) need to be aligned for high performance. The path for performance is comprised of a combination of commitment-based HR systems for staff and HR flexibility and by the absence of an innovation strategy or commitment-based HR systems for managers, HR flexibility, and a cost leadership strategy. We also find four paths where performance relies on efficiently combining an innovation and cost leadership business strategy.Originality/valueOur findings make three key contributions to the literature. First, we help elucidate multicausal relationships inside the black box of the “HR–performance” relationship for firm performance. Second, we study the vertical fit with business strategy by considering innovation and cost leadership strategies. Third, we analyze multicausal pathways, thus uncovering different combinations of resources and capabilities for performance.

Natural Hazards and Their Environmental Impact: Flood Risks in the Systemic Management of Non-Hazardous Municipal Waste

Natural Hazards and Their Environmental Impact: Flood Risks in the Systemic Management of Non-Hazardous Municipal Waste

Associations between systemic inflammation indicators and nonalcoholic fatty liver disease: evidence from a prospective study.

Although inflammation has been linked to nonalcoholic fatty liver disease (NAFLD), most studies have focused only on a single indicator, leading to inconsistent results. Therefore, a large prospective study that includes a variety of well-documented single and composite indicators of inflammation is needed. This study aimed to thoroughly investigate the potential associations between different systemic inflammatory indicators and NAFLD in the UK Biobank cohort. After excluding ineligible participants, 378,139 individuals were included in the study. Associations between systemic inflammatory indicators and hepatic steatosis were assessed using multivariate logistic regression. The relationships between systemic inflammatory indicators and nonalcoholic fatty liver disease were analysed using Cox proportional hazards models, and nonlinear associations were investigated using restricted cubic splines. According to the cross-sectional analysis, systemic inflammatory indicators significantly correlated with hepatic steatosis. Over a median follow-up of 13.9 years, 4,145 individuals developed NAFLD. After sufficient adjustment for confounding factors, CRP levels were found to be nonlinearly positively associated with NAFLD risk (P<0.001), representing the strongest correlation among the tested relationships; lymphocyte count and the LMR showed an L-shaped correlation; monocyte count and neutrophil count showed a linear positive correlation (all P< 0.001); and the NLR, PLR, and SII showed a U-shaped correlation (all P<0.001). Multiple systemic inflammatory indicators are strongly associated with the development of NAFLD, and aggressive systemic inflammation management may have a favourable impact on reducing the burden of NAFLD; further randomized controlled studies are needed.

Water quality and surroundings for systemic management of springs in rural areas

Springs enable the passage of groundwater to flow to the ground surface, forming and sustaining watercourses. Despite the importance of these ecosystems, their functionality and the availability of water in terms of quantity and quality in rural areas have been threatened. The objective of this study was to evaluate the water quality of springs under different care and preservation scenarios in rural areas and assess the need to combine water potability analysis with biological indicators and the effects of the interaction between aquatic and terrestrial environments on the characteristics of surroundings to generate a systemic and robust representation of the impact of human actions on these threatened environments. The study was developed considering the Ijuí River Basin, in the northwestern state of Rio Grande do Sul, Brazil. It involved the evaluation of springs in a native forest area protected by drainage and a preserved vegetation; in a reforested area with concrete protection and surrounding vegetation; and in a livestock area with no vegetation fragments in the surroundings and with an outcrop protected by concrete pipes. Physicochemical and microbiological analyses are essential for determining the potability of spring water. However, these are specific assessments that do not reflect historical environmental conditions. The use of bioindicators enables these analyses and, together with the determination of surroundings' characteristics, allows for evaluating the degree of preservation to ensure spring quality, providing perspectives that combine care and sustainable use.

Protocol for the development of a tool to map systemic sclerosis pain sources, patterns, and management experiences: a Scleroderma Patient-centered Intervention Network patient-researcher partnership

IntroductionSystemic sclerosis (SSc) is a rare, complex autoimmune rheumatic disease with multiple factors that contribute to pain. People with SSc emphasize the effect pain has on their quality of life, but no studies have systematically examined the frequency and relative importance of different SSc pain sources, patterns of pain from different sources, and pain management experiences. Our objectives are to (1) develop a tool, jointly with researchers, health care providers, and patients, to map sources of pain in SSc, determine patterns of pain from different sources, and understand pain management experiences; and (2) administer the final tool version to participants in the large multinational Scleroderma Patient-centered Intervention Network (SPIN) Cohort.MethodsFirst, we will use validated pain assessment tools as templates to develop an initial version of our pain assessment tool, and we will obtain input from patient advisors to adapt it for SSc. The tool will include questions on pain sources, pain patterns, pain intensity, pain management techniques, and barriers to pain management in SSc. Second, we will conduct nominal group technique sessions with people living with SSc and health care providers who care for people with SSc to further refine the tool. Third, we will conduct individual usability testing sessions with SPIN Cohort participants. Once the tool has been finalized, we will administer it to individuals in the multinational SPIN Cohort, which currently includes over 1,300 active participants from 54 sites in 7 countries. We will perform unsupervised clustering using the KAy-Means for MIxed LArge data (KAMILA) method to identify participant subgroups with similar profiles of pain sources (present or absent) and to evaluate predictors of subgroup membership. We will use latent profile analysis to identify subgroups of participants with similar profiles based on pain intensity scores for each pain source and evaluate predictors.DiscussionOnce completed, our pain assessment tool will allow our team and other researchers to map sources of pain in SSc and to understand pain management experiences of people living with SSc. This knowledge will provide avenues for studies on the pathophysiology of pain in SSc and studies of interventions to improve pain management.

The Blaufeuer measure for employees with mental stress and simultaneous workplace problems-Is the target group being reached?

Employees with mental burden and simultaneous workplace problems have an increased risk of chronification and disability pension. To support this group of people, the German Pension Insurance (Deutsche Rentenversicherung Bund) developed the Systemic Integration Management for People with Mental Impairments (SEMpsych) project as part of the rehapro federal program. The Blaufeuer counselling service was implemented in three model regions (Berlin, Cologne, and Nuremberg). The measure usually comprises up to 12counselling sessions in 12months. This article describes the characteristics of the participants and examines whether they belong to the intended target group. During September 2020 and June 2022, the participants completed aquestionnaire between the first and second counselling sessions. Socio-demographic-, clinical- and work-related variables were assessed. The data were analysed using descriptive statistics and 95% confidence intervals. Data from n = 482 participants (66.4% female; MAge = 45.2 years (±10.2 years); 64.1% working full-time; 49.8% currently on sick leave) were included. The participants have high psychological impairments (e.g. PHQ-9: M = 14.6 (±5.4)) and low subjective work ability (e.g. WAS: M = 3.2 (±2.6)). Most participants report overload at work and problems with superiors. Participants exhibit mental burden values that correspond to those of patients at the beginning of outpatient psychotherapy or the first contact in an inpatient psychiatric clinic. Blaufeuer addresses ahighly stressed group of people who have not yet received adequate treatment. Further studies on process and outcome evaluation will follow.

Advancements in targeted therapies for scleroderma: navigating the complexities of systemic and localized disease management

Background: Scleroderma, encompassing systemic sclerosis (SSc) and localized scleroderma (LoS), presents complex challenges due to its multifaceted pathophysiology and clinical manifestations. Targeted therapies have emerged as promising interventions, addressing specific pathways implicated in scleroderma pathogenesis. Methods and Materials: A systematic literature review was conducted following SANRA guidelines, focusing on randomized controlled trials, observational studies, and systematic reviews evaluating targeted therapies in SSc and LoS. Inclusion criteria encompassed studies investigating immunomodulatory agents, antifibrotic drugs, and vasodilators, reporting clinical outcomes and safety profiles. Objectives: This review aimed to analyze the efficacy, safety, and mechanisms of action of targeted therapies in scleroderma subtypes, highlighting advancements in treatment paradigms. Discussions: Targeted therapies in SSc predominantly target vascular dysfunction, fibrosis, and immune dysregulation, with promising results observed for biological agents and hematopoietic stem cell transplantation. In LoS, antifibrotic and anti-inflammatory agents have shown efficacy in skin fibrosis reduction. Emerging therapies, including JAK-STAT inhibitors and monoclonal antibodies, hold potential in both subtypes. Overall, targeted therapies herald a new era in scleroderma management, emphasizing personalized and effective interventions for improved patient outcomes.

Decision Support Systems Based on a Multiple-Criteria Decision Analysis to Promote a Whole-of-Resource Approach for Water Management, with a Case Study of Rural Bengaluru in India

The sustainable availability and resilient supply of safe drinking water remains a challenge that is far from fulfilled. As of 2024, around 2 billion people worldwide do not have access to safe drinking water. The regions of Sub-Saharan Africa and South Asia are the most vulnerable regions in this regard. This is despite the fact that these regions are home to some of the world’s fastest-growing economies. However, economic growth and rapid urbanization may also be connected to the increasing water stress in the suburban and rural areas. We propose addressing the two main challenges in this regard, which are the selection of the suitable treatment and distribution systems for different contexts using a decision support system following a Whole-of-Resource Approach (WORA). This approach considers the different water sources and sinks as contributing to a positive or negative change in the single resource, irrespective of whether the resource, in this case water, is used for domestic, industrial, or agricultural purposes. In this regard, this paper presents an illustrative proof of concept for such a decision support tool based on a multiple-criteria decision analysis. The decision support tool is aimed at facilitating water management within a WORA by providing recommendations regarding rainwater harvesting and savings in agricultural water consumption, in addition to suggesting water treatment and distribution systems, enabling systemic water resource management adapted to local context-specific conditions and needs.

Masa Depan Pekerjaan: Mengapa Keahlian Sistem Informasi Manajemen Sangat Diperlukan?

In this digital era, Management Information System (MIS) has become an integral part of human life, including in the world of work. The rapid development of technology changes many aspects of work, requiring individuals to have skills that are in accordance with the demands of the times. One of the skills that are indispensable in the future is Management Information System (MIS) skills. SIM combines information and communication technology (ICT) with business processes and human resources to provide management with accurate and timely information to support decision making, business operations, and internal and external communications. This article discusses about SIM skills are indispensable in the future because SIM can help organizations improve efficiency and effectiveness. SIM graduates have extensive career opportunities in various fields, such as information systems analysts, information systems architects, information systems consultants, information systems managers, and data scientists.

The Integration of Internet of Things (IoT) in Smart Cities A Systemic Approach to Urban Management

The use of the Internet of Things (IoT) has become an integral part of efforts to develop efficient and sustainable smart cities. This research aims to investigate the integration of IoT in the context of systemic urban management. The research methods employed include in-depth literature studies, comprehensive policy document analysis, and field research to understand IoT implementation in several smart cities. The results indicate that a systemic approach to integrating IoT in urban management is crucial to achieving efficiency and sustainability. This integration involves various aspects, including physical infrastructure, information systems, policies, and community participation. In this context, the research highlights the importance of developing integrated and interoperable IoT infrastructure, open data platforms, and adequate regulatory frameworks. Additionally, community participation in designing and utilizing IoT solutions is a key factor for successful implementation. By analyzing case studies in several smart cities, this research also provides insights into the challenges faced and strategies employed in integrating IoT into urban management. Based on these findings, the research concludes that a systemic approach encompassing cross-sector collaboration, proven technology use, and active community participation is necessary for successful IoT integration in urban management. This research contributes to expanding the understanding of IoT implementation in a broader urban context and provides practical guidance for policymakers, practitioners, and academics involved in smart city development.

Secondary Succession in Fallow Agroforestry Systems Managed in Tropical Dry Forest in Western Mexico

Tropical dry forests (TDFs) are ecosystems of high biocultural value, in which agroforestry systems (AFSs) have been essential in their management and conservation. We aimed to characterize agroforestry practices and analyze their capacity to conserve perennial plant diversity. In addition, we sought to evaluate how the management of TDFs as AFSs, together with their regeneration, influences species diversity and vegetation structure in a landscape with AFSs and TDFs in different conservation states. We compared the species diversity and basal area (BA) of plants in active and fallow AFSs at different regeneration stages in Zacualpan, Colima, Mexico. We found that AFSs harbored 71% of species richness (0D), forming a mosaic that contributed to the gamma diversity (124 species) of TDFs in the area. AFSs supported 23 endemic and 12 protected species. TDFs, active and advanced regeneration AFSs, had the highest number of useful species and diversity. Species richness (0D) in management categories increased as succession progressed, but not the BA, possibly due to frequent browsing and wood and firewood extraction. However, BA may be related to the management of useful trees maintained through agroforestry practices. We suggest increasing the matrix quality through a mosaic of active and fallow AFSs to promote ecological connectivity and biodiversity conservation.

Ocular cicatricial pemphigoid: diagnosis and systemic management

Ocular cicatricial pemphigoid: diagnosis and systemic management

Roles and challenges encountered by midwives in the management of postpartum haemorrhage following normal vaginal delivery: A scoping review

AbstractAimsTo establish a comprehensive understanding of the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of postpartum haemorrhage (PPH) following normal vaginal delivery.DesignWe conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis for Scoping Reviews (PRISMA‐ScR) recommendations.MethodsWe considered studies related to the roles of midwives and the challenges they encounter in the prevention, diagnosis and management of PPH during vaginal delivery. We excluded guidelines, consensuses, abstracts of meetings and non‐English language studies. Databases, including the Cochrane Library, PubMed, Web of Science, Ovid, Medline, Embase, JBI EBP and BIOSIS Previews, were searched on January 1, 2023, with no time limitations.ResultsWe included 28 publications. Midwives play important roles in the prevention, diagnosis and management of postpartum haemorrhage during vaginal delivery. In the prevention of PPH, midwives' roles include identifying and managing high‐risk factors, managing labour and implementing skin‐to‐skin contact. In the diagnosis of PPH, midwives' roles include early recognition and blood loss estimation. In the management of PPH, midwives are involved in mobilizing other professional team members, emergency management, investigating causes, enhancing uterine contractions, the repair of perineal tears, arranging transfers and preparation for surgical intervention. However, midwives face substantial challenges, including insufficient knowledge and skills, poor teamwork skills, insufficient resources and the need to deal with their negative emotions. Midwives must improve their knowledge, skills and teamwork abilities. Health care system managers and the government should give full support to midwives. Future research should focus on developing clinical practice guidelines for midwives for preventing, diagnosing and managing postpartum haemorrhage.

Етапи та заходи антикризового управління на підприємстві

The instability of the global economic environment leads to the formation of crisis phenomena, which negatively affect the activities of enterprises and necessitate the implementation of crisis management. The purpose of the work is to study and develop the stages of conducting crisis management at the enterprise based on the identification of the type of crisis and its phases, which will enable the selection of the correct methods of combating and prevention measures. The essence of crisis management lies in systemic management of crisis situations to prevent, adapt to, and overcome their negative consequences. It solves the tasks of ensuring the stability, success of operation, and competitiveness of the enterprise in conditions of market instability by forecasting and analyzing crisis situations, evaluating external and internal threats that may lead to a crisis situation at the enterprise. The subject of crisis management by the enterprise is the factors that cause the crisis, while the object is the enterprise itself and its operational activities. The subjects of crisis management by the enterprise are all interested parties in overcoming the crisis, primarily the leadership of the enterprise. The research conducted in the article allowed to identify a certain algorithm of the sequence of crisis management at the enterprise, which includes ten consecutive stages – from diagnosing the current state of the enterprise and identifying threats to preventive monitoring of possible threats. Moreover, the sequence of stages of crisis measures depends on the type of crisis that has arisen in the external or internal environment of the enterprise. The authors concluded that enterprise management should demonstrate flexibility and the ability to quickly react to changes and, if necessary, use all tools and means of crisis management, which will help it better resist crisis situations and maintain the stability of the enterprise. To overcome manifesta- tions of macroeconomic and microeconomic crises at the enterprise, it is necessary to implement crisis measures, the list of which the enterprise will choose based on the type of crisis, its phase, scale of coverage, as well as a number of other factors.

What is the best set of indices/indicators for evaluating “health promotion governance” in health systems? A proposed methodology for health promotion decision-making

ABSTRACT We aimed to identify the indices/indicators needed for assessing health promotion governance in health systems. Data were obtained from a literature review, a modified Delphi process, and an Analytic Hierarchy Process (AHP). The study was conducted from May 2021 to January 2022 using a multi-method design comprised of four sequential stages: (1) a comprehensive literature review for identifying the health promotion indices/indicators originating from the Ottawa Charter’s action areas; (2) a 3-round Delphi survey to identify, by consensus, which of those indices/indicators would be relevant to the health promotion governance in the health system;(3) Analytic Hierarchy Process technique (AHP) to prioritize the selected indices/indicators; (4) presenting the results of AHP to a group of the health promotion specialists of the selected experts to selecting other indices/indicators if necessary. Health literacy was considered the most important index to assess health promotion governance from experts’ perspectives. The per capita public health expenditure was supposed to be the second most important indicator. The indices ranked third and fourth in priority were the health equality and urban health indexes, respectively. The health promotion specialists selected three other indices: the number of policies changed due to advocacy, social capital, and positive health. Based on the results, a series of essential indices/indicators have been proposed depending on the study’s purpose, which can help health system policymakers and managers to assess the health promotion governance in the health system.