Search

As more and more organizations move from functional to process-based IT infrastructure, ERP systems are becoming one of today's most widespread IT solutions. However, not all firms have been successful in their ERP implementations. Using a case study methodology grounded in business process change theory, this research tries to understand the factors that lead to the success or failure of ERP projects. The results from our comparative case study of 4 firms that implemented an ERP system suggest that a cautious, evolutionary, bureaucratic implementation process backed with careful change management, network relationships, and cultural readiness have a positive impact on several ERP implementations. Understanding such effects will enable managers to be more proactive and better prepared for ERP implementation. Managerial implications of the findings and future research directions are discussed.

A sample of 162 Indian manufacturing and service companies were used to examine different forms of market orientation and the impact of these forms on organizational performance. A cluster-analysis identified four distinct clusters: “undeveloped,” “customer-focused,” “competitor-focused,” and “comprehensive.” The performance of these clusters differed significantly across growth in overall revenue, ability to retain customers, success of new products/services, controlling operational expenses, and return on capital. Implications of these findings for firms competing in India's post-economic liberalization milieu are discussed.

This study attempts to integrate compatible, yet fragmented research streams, related to the association among environmental change, managerial characteristics, strategic orientation, and organizational performance. By combining a variety of theoretical perspectives, an integrated framework is developed that examines these interrelationships. The results show that managerial perception of environmental change influences the strategic adaptive response of the organization and the selection of top managers. Further, it was found that organizations that are able to achieve the alignment among perceived environmental change–strategic adaptive response–managerial characteristics exhibit superior performance in terms of a variety of performance outcomes as compared to organizations where such alignment is lacking.

This study examined the linkages between perceived environmental changes in the health care industry, corresponding strategic adaptations, and their impact on select performance measures as reported by managers. Results from a sample of 187 hospitals indicate that efficiency-oriented strategy is chosen more often by organizations that perceive their industry environment to be relatively stable and certain while market-focused strategies are chosen more often by organizations that perceive greater environmental instability and uncertainty.

The study examined the use of Porter's (1980) generic strategies of overall cost leadership and differentiation in their pure and hybrid forms, and their effect on performance in the context-specific setting of a developing country, viz. India. Results indicated that organizations that followed a combination of cost leadership and differentiation strategies (“hybrids”), in general, had the best performance of all groups on a variety of performance measures.

The buyer market conditions that emerged in India following its decision to liberalize the economy in 1991 provided the setting for studying the effect of market orientation on organizational performance. Results from a sample of 162 manufacturing and service firms provided support for a strong positive relationship between market orientation and growth in overall revenue, return on capital, success of new products and services, ability to retain customers, and success in controlling operating expenses. The study found that competitive hostility, suppliers' power, and market turbulence did not moderate the market orientation–performance relationship.

This study examines the scanning/strategy relationship in the context‐specific setting of the health care industry. It extends the current research on the strategy/scanning relationship to include performance. Results confirm the moderating role played by environmental scanning activities in the strategy/performing relationship, thus providing further evidence for the contingency relationship among the environment, the organization's internal processes, and performance.

Bacterial infections, particularly repeated infections, are significant causes of morbidity and mortality among patients with cirrhosis. We investigated and characterized risk factors for repeat infections in these patients.In a prospective study, we collected data from 188 patients hospitalized with cirrhosis and infections and enrolled in the North American Consortium for the Study of End-Stage Liver Disease (12 centers). Patients were followed up for 6 months after hospital discharge and data were analyzed on type of infections and factors associated with subsequent infections.Six months after hospital discharge, 14% of subjects had received liver transplants, 27% died, and 59% were alive without liver transplantation. After discharge, 45% had subsequent infections, but only 26% of the subsequent infections occurred at the same site. Compared with patients not re-infected, patients with repeat infections were older and a higher proportion used proton pump inhibitors (PPIs) (P = .006), rifaximin (P.001), or prophylactic therapy for spontaneous bacterial peritonitis (SBP) (P.001). Logistic regression showed that SBP prophylaxis (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.56-7.63), PPI use (OR, 2.94; 95% CI, 1.39-6.20), SBP at hospital admission (OR, 0.37; 95% CI, 0.15-0.91), and age (OR, 1.06; 95% CI, 1.02-1.11) were independent predictors of subsequent infections.Patients hospitalized with cirrhosis and infections are at high risk for subsequent infections, mostly at different sites, within 6 months of index infection resolution. Those at highest risk include previously infected older patients receiving PPIs and/or SBP prophylaxis, although these associations do not prove that these factors cause the infections. New strategies are needed to prevent infections in patients with cirrhosis.

This study developed a comprehensive measure of market orientation and examined the market orientation-performance relationship in the health care industry. A survey of 159 hospitals yielded a strong positive relationship between market orientation and various measures of organizational performance. Additionally, the study found that market turbulence, competitive hostility, and supplier power moderated the market orientation-performance relationship.

This study investigated the impact of three physician-hospital contractual arrangements (PHCAs)--joint ventures, management service organizations, and not-for-profit foundations--on physician involvement in hospital governance and physician-hospital relationships. Analysis of data collected from a national sample of 1,013 hospitals revealed that PHCAs generate greater physician involvement in hospital decision making and result in lower physician-hospital conflict.

This article identifies the strategic types in the hospital industry based on the hospital's use of Porter's generic strategies in their pure and hybrid forms. The article also examines differences in performance of hospitals across strategic types. Results indicate that hospitals that follow a focussed cost leadership strategy, in general, have superior performance on a variety of performance measures, while hospitals that use a combination of cost leadership and differentiation perform the poorest. Implications of findings for hospital administrators are also discussed.

Hepatopulmonary syndrome (HPS) is a unique form of hypoxemia found in patients who have chronic liver disease. The definitive treatment for HPS is liver transplantation (LT), with resolution of hypoxemia occurring weeks to months after LT. Because there has been an increase in the use of LT to treat severe HPS (PaO2 ≤ 50 mm Hg), alternatives to oxygen administration via nasal cannula (NC) or face mask must be examined to facilitate early postoperative mobilization and to minimize postoperative pulmonary complications. Transtracheal oxygen (TTO) therapy is a practical alternative that has been shown to improve oxygen requirements, facilitate patient mobility, and improve exercise tolerance in advanced lung disease. In this case series, we describe the use of TTO in the management of hypoxemia associated with severe HPS after LT. A transition from NC to TTO resulted in a significant reduction in oxygen requirements, early postoperative mobilization and discharge from the hospital, and a subsequent expedited liberation from supplemental oxygen. This case series emphasizes the potential utility of TTO therapy as an alternative to conventional oxygen delivery modalities in the management of severe HPS after LT.

A 1997 project established by the Vera Institute of Justice, a New York-based non-government organisation, aimed to alleviate overcrowding in South African prisons by assisting magistrates in bail proceedings and thereby decreasing the number of admissions into awaiting trial facilities. Understanding the context in which the project operated leads to the important observation that efforts to launch and sustain discrete experiments in justice innovation will necessarily come under strain when faced with aggressively adverse macro circumstances, like the ones that faced Vera’s pre-trial project. However, the legal and social milieu has changed over the last twelve years. It is perhaps time to once again explore how innovations in criminal justice administration (a much-needed initiative) might best work in the various criminal justice management areas, given the discrete circumstances of each.

All service organizations need to be concerned about globalization and successful growth in the ever changing economic environment. Service companies in the midwest part of the United States were surveyed to determine how managers and their subordinates actually felt about the concept of "innovation through total quality." A discrepancy between the perception of total quality as a means to achieve sustainable advantage and the actual implementation of such a strategy was perceived. Some conclusions posed were that managers need to invest more in promoting quality by increasing training, measuring the efforts of individuals within the organization more effectively, and rewarding these individuals with higher compensation for superior performance.

Hepatorenal syndrome type 1 (HRS-1) in patients with cirrhosis and ascites is a functional, potentially reversible, form of acute kidney injury characterized by rapid (2 wk) and progressive deterioration of renal function. Terlipressin is a synthetic vasopressin analogue that acts, via vascular vasopressin V1 receptors, as a systemic vasoconstrictor. We performed a phase 3 study to evaluate the efficacy and safety of intravenous terlipressin plus albumin vs placebo plus albumin in patients with HRS-1.Adult patients with cirrhosis, ascites, and HRS-1 (based on the 2007 International Club of Ascites criteria of rapidly deteriorating renal function) were assigned randomly to groups given intravenous terlipressin (1 mg, n = 97) or placebo (n = 99) every 6 hours with concomitant albumin. Treatment continued through day 14 unless the following occurred: confirmed HRS reversal (CHRSR, defined as 2 serum creatinine [SCr] values ≤1.5 mg/dL, at least 40 hours apart, on treatment without renal replacement therapy or liver transplantation) or SCr at or above baseline on day 4. The primary end point was the percentage of patients with confirmed CHRSR. Secondary end points included the incidence of HRS reversal (defined as at least 1 SCr value ≤1.5 mg/dL while on treatment), transplant-free survival, and overall survival. The study was performed at 50 investigational sites in the United States and 2 in Canada, from October 2010 through February 2013.Baseline demographic/clinical characteristics were similar between groups. CHRSR was observed in 19 of 97 patients (19.6%) receiving terlipressin vs 13 of 99 patients (13.1%) receiving placebo (P = .22). HRS reversal was achieved in 23 of 97 (23.7%) patients receiving terlipressin vs 15 of 99 (15.2%) receiving placebo (P = .13). SCr decreased by 1.1 mg/dL in patients receiving terlipressin and by only 0.6 mg/dL in patients receiving placebo (P.001). Decreases in SCr and survival were correlated (r(2) = .882; P.001). Transplant-free and overall survival were similar between groups. A significantly greater proportion of patients with CHRSR who received terlipressin survived until day 90 than patients who did not have CHRSR after receiving terlipressin (P.001); this difference was not observed in patients who did vs did not have CHRSR after receiving placebo (P = .28). There were similar numbers of adverse events in each group, but patients in the terlipressin group had more ischemic events.Terlipressin plus albumin was associated with greater improvement in renal function vs albumin alone in patients with cirrhosis and HRS-1. Patients had similar rates of HRS reversal with terlipressin as they did with albumin. ClinicalTrials.gov no: NCT01143246.

The objective of this article is to review the latest developments related to the treatment of patients with acute liver failure (ALF).As the treatment of ALF has evolved, there is an increasing recognition regarding the risk of intracranial hypertension related to advanced hepatic encephalopathy. Therefore, there is an enhanced emphasis on neuromonitoring and therapies targeting intracranial hypertension. Also, new evidence implicates systemic proinflammatory cytokines as an etiology for the development of multiorgan system dysfunction in ALF; the recent finding of a survival benefit in ALF with high-volume plasmapheresis further supports this theory.Advances in the critical care management of ALF have translated to a substantial decrease in mortality related to this disease process. The extrapolation of therapies from general neurocritical care to the treatment of ALF-induced intracranial hypertension has resulted in improved neurologic outcomes. In addition, recognition of the systemic inflammatory response and multiorgan dysfunction in ALF has guided current treatment recommendations, and will provide avenues for future research endeavors. With respect to extracorporeal liver support systems, further randomized studies are required to assess their efficacy in ALF, with attention to nonsurvival end points such as bridging to liver transplantation.

Liver failure is a devastating illness with extremely high morbidity and mortality. With the advent of life-saving orthotopic liver transplantation, the mortality and morbidity due to liver failure has been significantly reduced. Many patients awaiting transplant are critically ill. The intensive care management of patients before liver transplantation is aimed at optimizing hepatic and extrahepatic organ function before the transplant operation, with a goal to favorably influence the perioperative and postoperative graft and patient survival.

Introduction We report a case of rapid progression of acute oxaliplatin-induced portal hypertension and liver disease successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS). Our patient was receiving oxaliplatin-based chemotherapy for colorectal cancer and presented with massive variceal gastrointestinal (GI) bleeding caused by hepatoportal sclerosis, obliterated portal venules, and portal hypertension. Oxaliplatin-induced portal hypertension is uncommon, and the use of TIPS to successfully treat the sequelae of oxaliplatininduced hepatic injury with a favorable long-term prognosis has not yet been reported to our knowledge.

Data from a survey of 159 hospitals was used to test the relationship between market orientation and firm performance for low cost and differentiation strategies. Hospitals pursuing a differentiation strategy had stronger market orientation than those pursuing a cost leadership strategy. Market orientation had a more positive impact on the performance of organizations pursuing a differentiation strategy than on those pursuing a cost leadership strategy. In the cost leader group, the inter-functional coordination component of market orientation significantly affected firm performance, while in the differentiator group the customer orientation and competitor orientation components of market orientation had significant impact on performance. The implications of these findings for managers also are discussed.

This study tested the relationship between performance and the readability of annual reports. Style analysis of 60 annual reports using a computer style analyzer revealed that the annual reports of good performers were easier to read than those of poor per formers. Good performers used strong writing in their annual reports unlike poor performers, but did not use significantly more jargon or modifiers.

The critical care management of patients before liver transplantation is aimed at optimizing hepatic and extrahepatic organ function before the transplant operation, with a goal to favorably influence perioperative and postoperative graft and patient outcomes. Critical illness in liver disease can present in the context of acute liver failure or acute on chronic liver failure. The differing pathophysiologic processes underlying these 2 types of liver failure necessitate specific approaches to their intensive care management. In their extreme presentations, both types of liver failure present as multiorgan system failure; and therefore, the critical care management of these entities requires a systematic multiorgan system approach to address hepatic and extrahepatic organ dysfunction. This review provides a multiorgan system–based description of critical care management of acute liver failure and acute on chronic liver failure before liver transplantation.

We sought to study effectiveness, survival, and complications after transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis and symptomatic refractory hepatic hydrothorax.Consecutive patients who underwent TIPS between January 1992 and December 2008 for refractory hydrothorax were reviewed retrospectively. Clinical, laboratory, and procedural data were collected for all patients by retrospective chart review. Chi-square test was used to compare categorical variables and t-test to compare continuous variables. The Kaplan-Meier method was used for survival analysis. Survival curves were compared using the log-rank test.Seventy-three patients were included in the study, and their mean age at TIPS creation was 55.62 years (s.d. 11.65). The mean pre- and post-TIPS portosystemic gradients were 18.9 (s.d. 4.7) mm Hg and 5.7 (s.d. 2.4) mm Hg (P0.001), respectively. The rates of favorable clinical response within 1 month and at 6 months after TIPS were 79% (58/73) and 75% (30/40), respectively. Median survival of the study group was 517 days (95% CI 11-626). The short-term survival rates at 30, 60, and 90 days were 81, 78, and 72%, respectively. The long-term survival rates at 1, 3, and 5 years were 48, 26, and 15%, respectively. Multivariate analysis by Cox proportional hazards method showed that pre-TIPS model for end-stage liver disease (MELD) score (P=0.039, HR 1.9 (95% CI 1.0-3.7)) and clinical response (P=0.003, HR 2.5 (95% CI 1.4-4.5)) were significantly and independently associated with overall survival. The 30-day mortality rate was 19%. Pre-TIPS creatinine levels (P=0.024, HR 3.42 (95% CI 1.2-9.9)) were significantly associated with 30-day mortality.TIPS can be successfully used to achieve symptomatic relief in patients with refractory hepatic hydrothorax. Better clinical response after TIPS and pre-TIPS MELD score less than 15 were associated with longer survival after TIPS.