MASTERING DIGITAL TRANSFORMATION: THE PATH OF A FINANCIAL SERVICES PROVIDER TOWARDS A DIGITAL TRANSFORMATION STRATEGY

To master the challenges of a digital transformation and to systematically address IT’s multifaceted transformative impacts on an organization’s inner and outer environments, top management is increasingly formulating and implementing a digital transformation strategy (DTS). To date, there have been few details of DTS formation concerning its underlying processes and activities. In this study, an interpretive case study approach is employed and DTS formation is investigated from a process/activity perspective. By using an activity-based process model that builds on IS strategizing, an in-depth case study at a large financial services provider was conducted. The results show that this DTS was predominantly shaped by a diversity of emergent strategizing activities through a bottom-up process and prior to the introduction of a holistic approach by top management. Top management then sought to formalize emergent strategy contents by formulating and implementing a DTS that comprised a shared target picture, distinct digital transformation governance, and measures to increase the share of deliberate strategy contents. Besides providing practical implications for DTS formulation and implementation, this study contributes to the literature on digital transformation, IS strategy, and IS strategizing

Hematocrit Self-Testing in Patients with Polycythemia Vera and Other Hematological Conditions: Assessing the Accuracy of the StatStrip Xpress® 2 LAC/Hb/Hct Device and User Opinion about the Device in Real-World Clinical Practice.

Maintaining hematocrit (Hct) levels below 45% can reduce morbidity and mortality in patients with polycythemia vera (PV). A device that patients can use to self-monitor Hct levels could enable timely interventions if Hct levels increase above 45%, and could improve quality of life (QoL). This study evaluated the accuracy of the StatStrip Xpress® 2 LAC/Hb/Hct meter (Hb/Hct meter) when used by healthcare professionals (HCPs) or patients in clinical practice. Blood samples from 68 visits for 60 patients with PV or other hematological conditions were collected and analyzed by HCPs using a laboratory hematological analyzer, and by patients (self-test) and HCPs (professional test) using the Hb/Hct meter at two Swiss centers. Accuracy was assessed as the mean difference in readings between two users/methods (mdiff, 90% confidence interval; Spearman correlation [r]). The Hct values were similar between the professional test and analyzer (n = 66 comparisons, mdiff = 0.1% [-0.5 to 0.8]; r = 0.95, p < 0.001), the self-test and professional test (n = 62 comparisons, mdiff = -0.2% [-1.1 to 0.7]; r = 0.93, p < 0.001), and the self-test and analyzer (n = 63 comparisons, mdiff = 0.0% [-0.8 to 0.7]; r = 0.94, p < 0.001). The hemoglobin values across users/methods were also similar. Reporting their opinion on the Hb/Hct meter at visit 1, 100% of the patients found it easy to use, and 97% were willing to use it at home. Of the patients with PV, approximately 71% and 56%, respectively, stated that they would feel safer using a self-testing device, and that it would improve their QoL. These findings demonstrate the potential of the Hb/Hct meter for HCP and patient use in real-world settings

Tracing digital transformation in educational organizations

This chapter describes the quantitative approaches for assessing various aspects of digital transformation from the joint research and development project #ko.vernetzt. In an application-oriented case study approach, the operationalization of a maturity model of digital transformation for educational organizations (MMEO) and the design and implementation of a multi-perspective evaluation concept are outlined. While the MMEO provides a state perspective on the digital transformation of an educational organization and its employees, the evaluation concept aims at tracing developments of media-related professional competencies. MMEO has been implemented in a study with N = 222 participants, while N = 59 learners were subject to the evaluation polls. The results provide the necessary evidence for implementing and continuously improving a qualification program in the regarded research context. However, the methodology can also be transferred to other organizations in the education sector and beyond

Survey on Recommended Health Care for Adult Patients with Myelodysplastic Syndromes Identifies Areas for Improvement

The impact on health care of patients with myelodysplastic syndromes (MDS) is continuously rising. To investigate the perception of hemato-oncologists concerning the recommended MDS patient care in Switzerland, we conducted a web-based survey on diagnosis, risk-stratification and treatment. 43/309 physicians (13.9%) replied to 135 questions that were based on current guidelines between 3/2017 and 2/2018. Only questions with feedback-rates >50% were further analysed and ratios >90% defined “high agreement”, 70–90% “agreement”, 30–70% “insufficient agreement” and <30% “disagreement”. For diagnosis, we found insufficient agreement on using flow-cytometry, classifying MDS precursor conditions, performing treatment response assessment after hypomethylating agents (HMA) and evaluating patients with suspected germ-line predisposition. For risk-stratification, we identified agreement on using IPSS-R but insufficient agreement for IPSS and patient-based assessments. For treatment, we observed disagreement on performing primary infectious prophylaxis in neutropenia but agreement on using only darbepoetin alfa in anaemic, lower-risk MDS patients. For thrombopoietin receptor agonists, insufficient agreement was found for the indication, preferred agent and triggering platelet count. Insufficient agreement was also found for immunosuppressive treatment in hypoplastic MDS and HMA dose adjustments. In conclusion, we identified areas for improvement in MDS patient care, in need of further clinical trials, information, and guiding documents

The effects of exercise programming on health-related physical fitness of individuals with an intellectual disability : a meta-analysis of studies

A quantitative research synthesis (meta-analysis) was conducted to determine the effects of exercise on health-related physical fitness of people with an intellectual disability. While studies on this topic have been qualitatively reviewed (e.g., Fernhall, 1993; Fernhall, Tymeson, & Webster, 1988; Pitetti, Rimmeri & Fernhall, 1993), the effects of exercise on some of the health-related physical fitness components remains unclear, or unknown. Further, none of the reviews determined the influence of study characteristics on study outcomes.The data were 24 studies yielding 104 effect sizes based on 826 subjects.These analyses revealed that the outcomes of the studies related to cardiovascular endurance and muscular endurance were influenced by the variables of document source and length of program. More specifically, published studies produced significantly larger mean effect size than unpublished studies, and longer programs ($ge$9 weeks) produced significantly larger mean effect size than shorter programs (58 weeks). Further it was found that the level of exercise frequency, influenced flexibility. More specifically, programs with higher exercise frequency ($>$3 times per week) produced significantly larger mean effect size than programs with lower exercise frequency (3 times per week). (Abstract shortened by UMI.

Άγχος και κατάθλιψη ασθενών με αναφερόμενο θωρακικό άλγος μη καρδιακής αιτιολογίας

Εισαγωγή: Το θωρακικό άλγος αποτελεί ένα από τα συχνότερα αίτια αναζήτησης υπηρεσιών υγείας. Σε πολλές περιπτώσεις το θωρακικό άλγος είναι μη καρδιακής αιτιολογίας και σχετίζεται με την ύπαρξη ψυχοπαθολογίας. Σκοπός: Η εκτίμηση των επιπέδων άγχους και κατάθλιψης ασθενών που προσέρχονται στο ΤΕΠ με αναφερόμενο θωρακικό άλγος μη καρδιακής αιτιολογίας. Υλικό και Μέθοδος: Η μελέτη ήταν συγχρονική και συμμετείχαν 56 ασθενείς με θωρακικό άλγος μη καρδιακής αιτιολογίας, οι οποίοι προσήλθαν στο ΤΕΠ γενικού νοσοκομείου της Αττικής από το Δεκέμβριο του 2017 έως και τον Απρίλιο του 2018. Η εκτίμηση του άγχους και της κατάθλιψης των ασθενών έγινε με τη χρήση της κλίμακας HADS. Η στατιστική ανάλυση περιελάμβανε έλεγχο Mann-Whitney, το έλεγχο Kruskal-Wallis και το συντελεστή συσχέτισης του Spearman. Το αμφίπλευρο επίπεδο στατιστικής σημαντικότητας ορίστηκε στο 0,05. Η ανάλυση των δεδομένων πραγματοποιήθηκε με το IBM SPSS 20.0. Αποτελέσματα: Η μέση ηλικία των ασθενών ήταν 44,4 (±15,4) έτη, με την πλειοψηφία (58,9%) να είναι άντρες. Η βαθμολογία της υποκλίμακας άγχους (HADS-Α) έδειξε ότι 55,3% των ασθενών εμφάνιζαν άγχος, ενώ από την υποκλίμακα της κατάθλιψης (HADS-D) φάνηκε ότι 44,6% είχαν κατάθλιψη. Ως προς τη βαρύτητα των συμπτωμάτων, η πλειοψηφία των συμμετεχόντων είχε μέτρια συμπτωματολογία για το άγχος (25%) και ήπια για την 69 κατάθλιψη (23,2%). Η ύπαρξη άγχους σχετίστηκε θετικά, σε στατιστικά σημαντικό βαθμό, με το γυναικείο φύλο (p=0,002), το χρονικό διάστημα από την πρώτη εμφάνιση του θωρακικού άλγους (p=0,001) και τον αριθμό των επισκέψεων στο Τ.Ε.Π για θωρακικό άλγος το τελευταίο έτος (p=0,004). Αντίθετα, βρέθηκε αρνητική σχέση με το ύψος (p<0,013) και το βάρος (p=0,048). Αναφορικά με την κατάθλιψη προέκυψε στατιστικά σημαντική θετική σχέση με το γυναικείο φύλο (p=0,002), το χρονικό διάστημα από την πρώτη εμφάνιση του θωρακικού άλγους (p<0,001), τον αριθμό των επισκέψεων στο Τ.Ε.Π (p<0,001) και τον αριθμό των παιδιών (p=0,014). Αντίθετα, βρέθηκε αρνητική σχέση με το ύψος (p<0,001) και το βάρος (p=0,036). Συμπεράσματα: Περίπου οι μισοί ασθενείς που προσέρχονται στο ΤΕΠ με θωρακικό άλγος μη καρδιακής αιτιολογίας εμφανίζουν άγχος ή κατάθλιψη. Οι επαγγελματίες υγείας, ανάμεσά τους και οι νοσηλευτές, οφείλουν να λαμβάνουν σοβαρά υπόψη τους τη πιθανότητα ύπαρξης ψυχοπαθολογίας σε αυτούς τους ασθενείς και να διενεργούν τον ενδεδειγμένο διαγνωστικό έλεγχο, ώστε να αποφασίζεται η κατάλληλη θεραπευτική αγωγή.Introduction: Chest pain is one of the most common causes for the usage of health services. In many cases chest pain is non-cardiac and it is related to the existence of psychopathology. Aim: The assessment of the levels of anxiety and depression of patients who visit Emergency Department (ED) with reported non-cardiac chest pain. Material and Methods: The study was cross-sectional and involved 56 patients with non-cardiac chest pain, who arrived at the ED of a General Hospital of Attica, from December 2017 to April 2018. Patient’s anxiety and depression were estimated by the use of HADS scale. The statistical analysis included Mann-Whitney test, Kruskal-Wallis test, and Spearman's correlation coefficient. The two-sided level of statistical significance was set at 0.05. Data analysis was performed with IBM SPSS 20.0. Results: The mean age of patients was 44.4 (±15.4) years, with the majority of them (58.9%) being men. The anxiety score (HADS-A) showed that 55.3% of the patients had anxiety, while the depression subscale (HADS-D) showed that 44.6% were depressed. Concerning the severity of the symptoms, the majority of participants had moderate symptoms for anxiety (25%) and mild for depression (23.2%). Anxiety was significantly associated with female gender (p=0.002), time from the first appearance of chest pain (p=0.001) and the number of visits to the ED for chest pain during the last year (p=0.004). Also, a negative relationship 71 was found with height (p<0.013) and weight (p=0.048). Regarding depression, a statistically significant positive relationship came up with the female sex (p = 0.002), the time from the first occurrence of chest pain (p <0.001), the number of visits to the ED during the last year (p <0.001) and the number of children (p=0.014). In contrast, height (p <0.001) and weight (p=0.036) were negatively correlated with depression. Conclusions: Approximately half of patients who visit ED with chest pain of non-cardiac etiology develop anxiety or depression. Healthcare professionals, nurses among them, should seriously consider the possibility of psychopathology in these patients and carry out the appropriate diagnostic tests to determine the appropriate treatment

Current Standard of Care in Patients with Myelodysplastic Syndromes and Future Perspectives

The myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal disorders caused by somatic driver mutations affecting the hematopoietic stem and progenitor cells (HSPCs). MDS are characterized by ineffective hematopoiesis with inflammation, dysplasia, cytopenia, and a variable risk of transformation into secondary acute myeloid leukemia (AML). As in many other malignancies, clonal evolution is caused by a stochastic accumulation of genetic hits in HSPCs with a selective pressure imposed by intrinsic growth advantage, extrinsic factors, and loss of immunogenic tumor surveillance. With the aging of the population, higher diagnostic sensitivity in detecting clonality, and improved cancer survivorship, incident cases are on the rise with a relevant impact on health care resources. WHO classification, disease-based as well as patient-based risk-stratifications remain the cornerstone for appropriate treatment allocation. The advent of next-generation sequencing (NGS) has improved our understanding of the genetic origin of the disease. This is paving the way to improve diagnostic accuracy for detection of clonality, risk stratification, prognostication, treatment allocation as well as monitoring of response to therapy. In lower-risk MDS patients, median survival reaches 3 to 8 years, and mortality is mainly caused by cytopenia-related complications (cardiovascular events, infections, and bleeding). Therefore, the treatment for these patients should focus on the improvement of cytopenia, inflammation, quality of life as well as disease progression. In contrast, in higher-risk MDS patients, median survival ranges from 1 to 3 years, and death from transformation to AML exceeds non-leukemic mortality. Treatment in these patients is aimed to delay progression to AML and improve overall survival. The only curative treatment option remains allogeneic hematopoietic stem cell transplantation, which is an intensive treatment requiring careful selection of patients. Most patients are not eligible due to advanced age or comorbidities and they receive palliative treatment with transfusions, growth factors, and hypomethylating agents. New treatment options are on the horizon that promise to improve cytopenia, reduce progression to higher-risk MDS/AML, and prolong survival. However, the Holy Grail that rejuvenates HSPCs with the abrogation of clonal evolution remains out of our reach. Keywords: Myelodysplastic syndromes, managemen

UNDERSTANDING DIGITAL TRANSFORMATION STRATEGY FORMATION: INSIGHTS FROM EUROPE’S AUTOMOTIVE INDUSTRY

An increasing number of firms are responding to new opportunities and risks originating from digital technologies by introducing company-wide digital transformation strategies as a means to systematically address their digital transformation. Yet, what processes and strategizing activities affect the formation of digital transformation strategies in organizations are not well understood. We adopt a phenomenon-based approach and investigate the formation of digital transformation strategies in organizations from a process perspective. Drawing on an activity-based process model that links Mintzberg’s strategy typology with the concept of IS strategizing, we conduct a multiple-case study at three European car manufacturers. Our results indicate that digital transformation strategies are predominantly shaped by a diversity of emergent strategizing activities of separate organizational sub-communities through a bottom-up process and prior to the initiation of a holistic digital transformation strategy by top management. As a result, top management’s deliberate strategies seek to accomplish the subsequent alignment of preexisting emergent strategy contents with their intentions and to simultaneously increase the share of deliberate contents. Besides providing practical implications for the formulation and implementation of a digital transformation strategy, we contribute to the literature on digital transformation and IS strategizing

Diagnostic Approach, Clinical Implications and Management of Clonal Cytopenia of Undetermined Significance

Due to demographic aging of the general population, cytopenia and especially anemia of unknown origin is on the rise, with an increasing need for a structured clinical assessment of these conditions. The advent of next-generation sequencing (NGS) in our clinical practice has facilitated the detection of clonal hematopoiesis (CH), which is present in more than 20−40% of individuals above 80 years of age. This poses unprecedented challenges as CH, especially clonal cytopenia of undetermined significance (CCUS), is associated with the development of myeloid malignancies, cardiovascular diseases and other chronic inflammatory-degenerative conditions. CH comprises an array of entities that are distinct from overt myeloid malignancies, but consensus recommendations are currently lacking for the management of affected patients. Many questions remain unsolved, such as which patients with unclear cytopenia should undergo molecular testing, what distinguishes age-associated CH from overt hematological malignancy, how CH impacts comorbidities and what might be the most appropriate treatment plan. In this review, we provide a structured approach to the assessment of unclear cytopenia and summarize the clinical implications of CH, as well as our current management of CCUS patients

Diagnostic Approach, Clinical Implications and Management of Clonal Cytopenia of Undetermined Significance

Due to demographic aging of the general population, cytopenia and especially anemia of unknown origin is on the rise, with an increasing need for a structured clinical assessment of these conditions. The advent of next-generation sequencing (NGS) in our clinical practice has facilitated the detection of clonal hematopoiesis (CH), which is present in more than 20−40% of individuals above 80 years of age. This poses unprecedented challenges as CH, especially clonal cytopenia of undetermined significance (CCUS), is associated with the development of myeloid malignancies, cardiovascular diseases and other chronic inflammatory-degenerative conditions. CH comprises an array of entities that are distinct from overt myeloid malignancies, but consensus recommendations are currently lacking for the management of affected patients. Many questions remain unsolved, such as which patients with unclear cytopenia should undergo molecular testing, what distinguishes age-associated CH from overt hematological malignancy, how CH impacts comorbidities and what might be the most appropriate treatment plan. In this review, we provide a structured approach to the assessment of unclear cytopenia and summarize the clinical implications of CH, as well as our current management of CCUS patients