Digital business model innovation: toward construct clarity and future research directions

In times of unprecedented change related to the ongoing digital transformation of business and society at large, a pressing contemporary management challenge is recognizing and translating these changes into digital business model innovation (DBMI). Academia potentially has much to offer in aiding this managerial challenge, yet research in the field remains vague with regard to what DBMI is. We detect conceptual ambiguity among scholars as a bottleneck that prevents advancements in the field of DBMI research. In this article, we aim to trace the foundation of key attributes of the DBMI concept and propose a novel definition. Our insights are based on a targeted, state-of-the-art literature review of 57 publications. We conclude with an exploration of avenues for future research, which we closely link to the broader fields of strategic management, information systems, and organization studies, thereby exposing the issue of DBMI to a wider audience. Overall, we aim to make a significant step toward construct clarity in DBMI research.

Pulmonary tuberculosis and COVID-19 coinfection: A new medical challenge

Radiological findings in chest radiography and respiratory symptomatology represent a great challenge of interpretation during the COVID-19 (Coronavirus Disease 2019) pandemic, as their patterns can generate uncertainty at the time of diagnosis. This case highlights the importance in achieving an adequate correlation between diagnostic imaging and the clinical picture. We present a male adult who was admitted for 8 days of respiratory symptoms. Management with steroids was initiated according to the RECOVERY (Randomized Evaluation of COVID-19 Therapy) protocol and later confirmation of SARS-CoV-2 infection was received. In the following weeks, he deteriorated slowly and progressively clinically, without reaching respiratory failure. Imaging showed a thick-walled cavitation in the right lower lobe. Tuberculosis was suspected and confirmed. The uniqueness of this case of COVID-19 coinfection in a patient with undiagnosed tuberculosis, represents a diagnostic and clinical management challenge, where the proper interpretation of chest radiology is a fundamental tool.

Adding climate change to the mix: responses of aquatic ectotherms to the combined effects of eutrophication and warming

The threat of excessive nutrient enrichment, or eutrophication, is intensifying across the globe as climate change progresses, presenting a major management challenge. Alterations in precipitation patterns and increases in temperature are increasing nutrient loadings in aquatic habitats and creating conditions that promote the proliferation of cyanobacterial blooms. The exacerbating effects of climate warming on eutrophication are well established, but we lack an in-depth understanding of how aquatic ectotherms respond to eutrophication and warming in tandem. Here, I provide a brief overview and critique of studies exploring the cumulative impacts of eutrophication and warming on aquatic ectotherms, and provide forward direction using mechanistically focused, multi-threat experiments to disentangle complex interactions. Evidence to date suggests that rapid warming will exacerbate the negative effects of eutrophication on aquatic ectotherms, but gradual warming will induce physiological remodelling that provides protection against nutrients and hypoxia. Moving forward, research will benefit from a greater focus on unveiling cause and effect mechanisms behind interactions and designing treatments that better mimic threat dynamics in nature. This approach will enable robust predictions of species responses to ongoing eutrophication and climate warming and enable the integration of climate warming into eutrophication management policies.

New Therapies of Liver Diseases: Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a common complication of advanced liver disease which has profound implications in terms of the patients’ ability to fulfil their family and social roles, to drive and to provide for themselves. Recurrent and persistent HE is still a serious management challenge, translating into a significant burden for patients and their families, health services and society at large. The past few years have been characterized by significantly more attention towards HE and its implications; its definition has been refined and a small number of new drugs/alternative management strategies have become available, while others are underway. In this narrative review we summarize them in a pragmatic and hopefully useful fashion.

698 ENDOLUMINAL VACUUM THERAPY (EVT) AS A TREATMENT FOR ESOPHAGEAL LEAKS; 10-YEARS’ EXPERIENCE FROM A TERTIARY UK ESPHAGOGASTRIC CENTRE

Esophageal leaks present a significant management challenge, especially in patients with delayed presentation and established sepsis. Endoluminal vacuum therapy (EVT) is an emerging treatment strategy which may reduce morbidity and mortality compared to traditional treatments in this patient group. We report the outcomes for patients with esophageal leaks from a range of different causes that were treated with EVT in a tertiary UK hospital over a 10-year period. Methods Between April 2011 and March 2021, 45 patients with a median age of 67 years (31–92) who had an esophageal leak were treated with EVT. All patients were treated with an ad-hoc endoluminal vacuum device (EVD) constructed using V.A.C GRANUFOAMTM (KCI) and a standard nasogastric (Ryles) tube. The median Apache II score for patients at the time of leak diagnosis was 20 (6–36). The cause of the leak was anastomotic in 16 patients (36%), iatrogenic in 14 patients (31%), spontaneous in 14 patients (31%), and traumatic in 1 patient (2%). Information related to treatment and outcome was recorded prospectively. Results Successful resolution of the leak was achieved in 39 (87%) patients. The median number of EVD changes required to heal the leak was 6 (1–17). There were no complications related to insertion of the EVD. The median length of hospital stay was 49 days (1–108). Six (13%) patients died during treatment. Six (13%) patients had complications during treatment requiring further intervention; 2 (4%) had a significant bleed requiring angiography and aortic stent placement, 1 (2%) had a stroke, 1 (2%) had a pulmonary embolism, 1 (2%) had a myocardial infarction, and 1 (2%) contracted COVID-19. Conclusion EVT is a safe and effective treatment that can be used successfully to treat esophageal leaks from a disparate range of leak causes in selected critically unwell patients. Further studies are required to develop a standardized procedure and management pathway which will enable broader adoption of EVT in this group of patients.

Getting around the gut: a unique management challenge of thyroid storm precipitated by amphetamine-associated duodenal ischaemia leading to compromised enteric absorption

Thyroid storm is a rare, life-threatening endocrine emergency with a high mortality rate of up to 30%. We present a unique management challenge of a critically ill patient who developed thyroid storm in the setting of a duodenal perforation from amphetamine-associated non-occlusive mesenteric ischaemia. The diagnosis of ‘thyroid storm’ was made based on clinical criteria and a Burch-Wartofsky score of 100. During emergent exploratory laparotomy, a 1 cm duodenal perforation with surrounding friable tissue was found and repaired. Intraoperatively, a nasogastric tube was guided distal to the area of perforation to allow for enteric administration of medications, which was critical in the setting of thyroid storm. Therapeutic plasma exchange achieved biochemical control of our patient’s thyroid storm but ultimately did not prevent in-hospital mortality.

A masked ST-elevation myocardial infarction

Acute cardio-cerebral infarction is a rare circumstance characterized by high morbidity and mortality. It represents a management challenge due to the difficulty to choose which condition needs to be treated first. We describe the therapeutic challenge of a patient presenting with ischemic stroke and ST-elevation myocardial infarction. Keywords: Ischemic stroke; STEMI; cardio-cerebral infarction; myocardial infarction; haemodynamic stroke.