Traditional Management Paradigm Research Articles

Updates in Management of Large Hemispheric Infarct.

This review delves into updates in management of large hemispheric infarction (LHI), a condition affecting up to 10% of patients with supratentorial strokes. While traditional management paradigms have endured, recent strides in research have revolutionized the approach to acute therapies, monitoring, and treatment. Notably, advancements in triage methodologies and the application of both pharmacological and mechanical abortive procedures have reshaped the acute care trajectory for patients with LHI. Moreover, ongoing endeavors have sought to refine strategies for the optimal surveillance and mitigation of complications, notably space-occupying mass effect, which can ensue in the aftermath of LHI. By amalgamating contemporary guidelines with cutting-edge clinical trial findings, this review offers a comprehensive exploration of the current landscape of acute and ongoing patient care for LHI, illuminating the evolving strategies that underpin effective management in this critical clinical domain.

Proverbs of Nonprofit Financial Management

Whereas the field of public administration has benefited from periods of critical reflection and reform aimed at reexamining the field’s traditional management paradigms, the related field of nonprofit management has generally lacked such an analogously explicit and sustained research program to reevaluate its own conventional wisdoms. Meanwhile, accumulated findings from the last several decades of nonprofit management research have problematized many traditional assumptions and practices in nonprofit management, specifically regarding the soundness of nomothetic management theory, the unintended negative consequences of certain management norms, and underlying assumptions about the nature and purpose of nonprofit management. This article critically reexamines four well-known “proverbs” of nonprofit financial management—minimize overhead, diversify revenues, be lean, and avoid debt—to demonstrate the need for a critical and reflective research program that takes stock and reconsiders the field’s foundational principles and assumptions. Implications are derived for scholars and practitioners, as well as for information intermediaries that evaluate nonprofits based on financial information.

Blind ending vessels on diagnostic laparoscopy for nonpalpable testis: Is a nubbin present?

The traditional management paradigm for nonpalpable testis (NPT) has been that inguinal or scrotal exploration for a nubbin may be omitted when blind ending vessels are observed during diagnostic laparoscopy. Our aim was to examine whether blind ending vessels excluded the presence of a nubbin in a series of boys who underwent exploration in this setting. Using a surgical database and chart review, pre-pubertal boys (≤12 years) with the diagnosis of undescended or atrophic testis who underwent a diagnostic laparoscopy for unilateral NPT between 2000 and 2015 were retrospectively identified. Physical exam, procedural and pathologic findings were confirmed by chart review. 595 boys underwent diagnostic laparoscopy for NPT by 11 surgeons. Of these, 318 had an intra-abdominal testis and 18 underwent diagnostic laparoscopy alone. Of the remaining 259, 32 had an open internal ring and inguinal or scrotal exploration was performed. The remaining 227 with a closed ring comprised the cohort for our analysis, of whom 188 had vessels entering the ring, 36 had blind ending vessels, and in three the vessel status was unavailable. In the 188 boys with vessels entering the ring, 164 (87%) had a nubbin excised during inguinal or scrotal exploration, of which 93% were grossly identified as an atrophic testis. Pathology confirmed the presence of hemosiderin in 44% and calcifications in 54%. In the 36 boys with blind ending vessels, 26 (72%) had a nubbin excised during inguinal or scrotal exploration, of which 96% were grossly identified as an atrophic testis. Pathology confirmed hemosiderin in 54% and calcifications in 58%. All seven cases with both blind ending vas and vessels had an atrophic testis grossly identified. Of all 207 excised remnants in this series, nubbins with viable testicular elements (seminiferous tubules in 11, germ cells in two) were only excised during cases that reported a non-atretic vas or any vessels entering the internal ring. In this large multi-institutional series, blind ending vessels were associated with a nubbin noted during inguinal or scrotal exploration in the majority of cases. Based on this series if the surgeon's goal is to remove all nubbins, exploration is necessary regardless of vessel appearance. However, viable testicular elements were rarely identified and only when either a non-atretic vas or any vessels were observed to enter the ring.

Coeliac disease in the 21st century: paradigm shifts in the modern age.

The epidemiology of coeliac disease (CD) is changing. Presentation of CD with malabsorptive symptoms or malnutrition is now the exception rather than the rule and, it now affects those underweight and overweight equally. In concert with these epidemiological shifts, the incidence of CD is increasing. These changing patterns of disease presentation are challenging traditional management paradigms, and clinicians now need to adapt to these changes and respond to the demands of an increasingly well-informed consumer population. This article aims to provide historical context to the epidemiological changes in CD, which provides context to direct future research. Changing definitions and diagnostic paradigms are complicating the management of CD. The gold standard of diagnosis, treatment goals, guidelines for follow-up, and the role of population screening in CD remain controversial and unresolved. Although the patient population is interested in new treatments for CD and alternatives to a gluten-free diet, most therapies are not yet widely available or sufficiently researched, and our understanding of the natural history of CD is limited despite a number of retrospective and population-based studies. The management of asymptomatic CD has only recently been examined despite up to half of patients now presenting with no or minimal symptoms. There is surprisingly little evidence to resolve many of these issues, and only with robust prospective studies will our understanding of the true natural history of coeliac disease be clarified.

Current Management of Low Risk Differentiated Thyroid Cancer and Papillary Microcarcinoma

Each year, the proportion of thyroid cancer patients presenting with low risk disease is increasing. Moreover, the definition of low risk thyroid cancer is expanding and several histological subtypes beyond papillary microcarcinomas are now classified as low risk disease. This shift in the landscape of thyroid cancer presentation is forcing clinicians to critically re-evaluate whether or not traditional management paradigms that were effective in treating intermediate and high risk disease are applicable to these low risk patients. Here we review the definition of low risk disease, examine the various histological subtypes that are considered low risk in the 2015 American Thyroid Association guidelines for the management of thyroid nodules and thyroid cancer, and review our current approach to the management of these low risk tumours.

Towards a more flexible water concession system in Spain: public water banks in Andalusia

The traditional management paradigm that has governed water policy in Spain during the last century is currently undergoing a critical process of change. Recently, regional Andalusian and national legislation have developed a new framework, where novel strategies, based on the reallocation of concessional rights, can be adopted to respond to water shortage conditions. The purpose of this study is to examine the factors that could potentially affect the legal reform in Andalusia, which is targeted at developing a market-based redistribution system of water rights in the various river basins within the region.

The extra mile deconstructed: a critical and discourse perspective on employee engagement and HRD

The paper explores the construct of employee engagement (EE) from a critical and discourse perspective. It is argued that the win-win discourse which characterizes much discussion on EE within a traditional management paradigm presents a decontextualized, depoliticized vision of the organization. The paper examines mainstream critiques of the construct of EE and the contribution of HRD, and notes that HRD processes and practices are seen as important contributors to engagement. It introduces a critical perspective on EE and HRD, viewing EE as a social construction. It highlights problematic assumption in mainstream literatures, such as of the accordance of employee and organization interests. The paper examines how the discourse ‘talks employee engagement into being’, how cultural management programmes serve to construct the ‘engaged employee’ and the impact of competing discourses. A discussion on disengagement reflects on the mismatch between Fordist work practices and EE. The paper concludes by arguing that viewing EE through a critical lens can potentially help towards an HRD practice that is focused on employee interests rather than largely on organizational interests.

Current role of short‐term intensive insulin strategies in newly diagnosed type 2 diabetes (短期胰岛素强化治疗策略对初诊2型糖尿病患者的作用)

AbstractType 2 diabetes mellitus (T2DM) is a progressive disease characterized by worsening insulin resistance and a decline in β‐cell function. Achieving good glycemic control becomes more challenging as β‐cell function continues to deteriorate throughout the disease process. The traditional management paradigm emphasizes a stepwise approach, and insulin has generally been reserved as a final armament. However, mounting evidence indicates that short‐term intensive insulin therapy used in the early stages of type 2 diabetes could improve β‐cell function, resulting in better glucose control and more extended glycemic remission than oral antidiabetic agents. Improvements in insulin sensitivity and lipid profile were also seen after the early initiation of short‐term intensive insulin therapy. Thus, administering short‐term intensive insulin therapy to patients with newly diagnosed T2DM has the potential to delay the natural process of this disease, and should be considered when clinicians initiate treatment. Although the early use of insulin is advocated by some guidelines, the optimal time to initiate insulin therapy is not clearly defined or easily recognized, and a pragmatic approach is lacking. Herein we summarize the current understanding of early intensive insulin therapy in patients with newly diagnosed T2DM, focusing on its clinical benefit and problems, as well as possible biological mechanisms of action, and discuss our perspective.

Should systematic risk assessment and immediate intervention of the acutely ill patient replace the traditional management paradigm?

The outcome of the traditional diagnostic history and physical depends entirely on the availability, ability and diligence of an individual doctor. An alternative is a team-based approach that performs the following tasks: a focused assessment, monitoring of the response to initial treatment, and then determining what further management is appropriate (calling for urgent help if it is required). This concept is based on risk prediction rather than diagnosis, and is captured by the mnemonic FAITH3 (Focused Assessment, Initial Treatment, hAssessing response, calling for Help and Handing over care)...

Refractory Thyroid Cancer: A Paradigm Shift in Treatment Is Not Far Off

Oncology 1,2 is noteworthy, even without further elaboration. Why has there been limited interest in developmental therapeutics for thyroid malignancies in the past? Much has to do with the natural history of thyroid carcinomas, traditional management paradigms, and the limitations of available chemotherapies. More than 90% of thyroid malignancies are derived from the thyroid follicular cell. The vast majority are differentiated tumors, with the papillary subtype predominating (approximately 80%); most of the remainder are follicular carcinomas and related variants. For these differentiated tumors, standard treatment with primary surgery and thyroidstimulating hormone (TSH) suppression with supraphysiologic thyroid hormone administration often suffices. Depending on disease stage, patient age, and a variety of histopathologic factors, ablation of the thyroid remnant with radioactive iodine 131 (RAI) is added. 3 This collective strategy is associated with an overall survival rate of approximately 90% at 20 years. 4 The prognosis remains relatively favorable even among patients who experience relapse, as the annual mortality rate is far less than the annual rate of recurrence. 5 Indeed, many patients with recurrent disease, even when incurable, will have an indolent course over months to years, with few or no symptoms without active anticancer therapy beyond TSH suppression. At relapse, further surgery, repeat RAI, external-beam radiation, or even observation with continued TSH suppression have all been commonly prioritized before chemotherapy. Drugs such as doxorubicin (the only United States Food and Drug Administration–approved agent), cisplatin, or bleomycin—administered as single agents or as part of some combination regimen— benefit a minority of patients, and related toxicities may be significant. 6-8

Relationships and Participation: A Complexity Science Approach to Change Communication

Formal and planned approaches to strategic management have forced managers to be structured when communicating organizational goals and strategic issues. Current public relations theory, in terms of management and change communication strategy, is very much in line with these general strategic management views of structured planning and top management decision-making. Fast changing environments and complex issues such as those arising from recent corporate scandals, technological changes, and climate changes demand a rethink of the way organizations transform and communicate. Recent examples of alternative strategic management approaches have developed out of a growing mass consciousness because of doubts and concerns about the success of traditional management paradigms. This article explains how communication management challenges can be addressed by coupling complex adaptive process thinking with recent research and some examples from industry. I suggest a new participative and relational approach to change communication strategy in line with high ethical and moral meaning creation. This approach can help an organization cope with change, ensures a positive reputation, builds internal loyalty, and aligns it as a responsible citizen in the larger societal structure.

SHIFTING ENVIRONMENTAL MANAGEMENT PARADIGMS IN TWO FINNISH PAPER FACILITIES: A BROADER VIEW OF INSTITUTIONAL THEORY

Environmental management paradigm shifts are examined in two organizations, a packaging company and a printing paper firm, both of which belong to a Finnish paper corporation. The article looks at how new rules for the social construction of the business–natural environment relationship evolve in a business enterprise when its institutional context changes. The environmental issues with respect to the environmental management paradigm shift studied concern recycling and forest management. Both companies were able to respond to changes in their institutional context, but the change processes differed substantially. Important elements of shifting environmental management paradigms included the external impetus for change, the role of change agents, the influence of the identities of different professional groups on change, and phases in unlearning and relearning. In the packaging firm the results indicate a shift from a traditional management paradigm to an environment-related management. In the paper company, a shift from large-scale Scandinavian forestry to small-scale forest management is ongoing.

SHIFTING ENVIRONMENTAL MANAGEMENT PARADIGMS IN TWO FINNISH PAPER FACILITIES: A BROADER VIEW OF INSTITUTIONAL THEORY

Environmental management paradigm shifts are examined in two organizations, a packaging company and a printing paper firm, both of which belong to a Finnish paper corporation. The article looks at how new rules for the social construction of the business–natural environment relationship evolve in a business enterprise when its institutional context changes. The environmental issues with respect to the environmental management paradigm shift studied concern recycling and forest management. Both companies were able to respond to changes in their institutional context, but the change processes differed substantially. Important elements of shifting environmental management paradigms included the external impetus for change, the role of change agents, the influence of the identities of different professional groups on change, and phases in unlearning and relearning. In the packaging firm the results indicate a shift from a traditional management paradigm to an environment-related management. In the paper company, a shift from large-scale Scandinavian forestry to small-scale forest management is ongoing.

Ecocentric Management for a Risk Society

A central feature of postindustrial modernization is the proliferation of technological and environmental risks and crises. These risks and crises emanate from corporate industrial activities. The traditional management paradigm is limited in several ways for responding to demands of the risk society and should be abandoned. I propose an alternative “ecocentric” paradigm for management in the risk society context, which advocates an ecologically centered conception of interorganizational relations and internal management activities. Thus, organizations are viewed as situated within bioregionally sustainable industrial ecosystems, relating to each other through a logic of ecological interdependence. Within this context, ecocentric management seeks to minimize the environmental impact of organizational vision, inputs, throughputs, and outputs. Implications of this paradigm for management practice and research are examined.