Severe and Refractory Peptic Ulcer Disease: The Diagnostic Dilemma

The recognition of Helicobacter pylori infection as a cause of peptic ulcer disease, medical regimens to eradicate the organism, and the widespread use of proton pump inhibition to suppress gastric acid secretion have revolutionized the management of peptic ulcer disease. As a result, successful medical management of peptic ulcer disease has largely supplanted the need for gastric surgery by general surgeons. Surgery is reserved for complications of the disease, refractory disease, or rare causes of ulcer disease such as gastrinoma and Zollinger–Ellison syndrome. In this report, we describe a case of intractable peptic ulcer disease that progressed to gastric outlet obstruction despite maximal medical therapy. We review the diagnostic studies utilized to evaluate the potential etiologies of peptic ulcer disease and the difficulty in diagnosing gastrinoma and Zollinger–Ellison in the setting of potent medical acid suppression therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44437/1/10620_2005_Article_2999.pd

Human resource practices, employee attitudes and small firm performance

This article uses the matched employee–employer dataset from the Workplace Employment Relations Study of 2011 (WERS2011) in Britain to empirically examine the direct relationship between human resource management (HRM) practices and small and medium-sized enterprise (SME) performance in the United Kingdom, as well as the potential moderating effect of organisational commitment/job satisfaction on the HRM-performance linkage. We find a positive and direct relationship between the use of certain formalised human resource (HR) practices and SME performance, measured by financial performance and labour productivity. More importantly, we find that the positive relationship between HR practices and financial performance varies between SMEs with high job satisfaction and low job satisfaction, and that the relationship is weakened in SMEs with high job satisfaction. The results suggest that certain HR policies and practices may improve small firm performance, especially within firms with low levels of commitment and satisfaction