Disruptive crisis management: lessons from managing a hospital during the COVID-19 pandemic

Purpose Healthcare organizations worldwide were badly hit by the "surprise" of the pandemic. Hospitals in particular are trying hard to manage problems it caused, searching for solutions to protect the health of citizens and reorienting operations. The implementation of resilience solutions in the coping phase and the ability to react promptly and redefine activities is essential. Integrating crisis management and resiliency literature, this paper discusses how health organizations were able to cope with adversity during the crisis. Design/methodology/approach The research is conducted through a case study of a large Italian hospital, the Gemelli Polyclinic Foundation, which was one of the leading hospitals in the Italian response to the pandemic. Findings The case reports actions taken in order to continue functioning and to maintain core activities despite severe adversity. The overall response of the Gemelli was the result of the three types of response: behavioral (effective leadership), cognitive (rapid resource reallocation) and the contextual reinforcement (multiagency network response). The authors highlight how an integrative framework of crisis management and resiliency could be applied to healthcare organizations in the coping phase of the pandemic. The experience of the Gemelli can thus be useful for other hospitals and organizations facing external crises and for overall improvement of crisis management and resilience. Responding to crisis brings the opportunity to make innovations introduced during emergencies structural, and embed them moving forward. Research limitations/implications The paper focuses only on the coping phase of the response to the pandemic, whereas building long-term resilience requires understanding how organizations accumulate knowledge from crises and adapt to the "new normal." Originality/value The paper responds to the call for empirical studies to advance knowledge of an integrative framework of crisis management and resiliency theories with reference to complex organizations such as healthcare

Disruptive crisis management: lessons from managing a hospital during the COVID-19 pandemic

Purpose: Healthcare organizations worldwide were badly hit by the “surprise” of the pandemic. Hospitals in particular are trying hard to manage problems it caused, searching for solutions to protect the health of citizens and reorienting operations. The implementation of resilience solutions in the coping phase and the ability to react promptly and redefine activities is essential. Integrating crisis management and resiliency literature, this paper discusses how health organizations were able to cope with adversity during the crisis. Design/methodology/approach: The research is conducted through a case study of a large Italian hospital, the Gemelli Polyclinic Foundation, which was one of the leading hospitals in the Italian response to the pandemic. Findings: The case reports actions taken in order to continue functioning and to maintain core activities despite severe adversity. The overall response of the Gemelli was the result of the three types of response: behavioral (effective leadership), cognitive (rapid resource reallocation) and the contextual reinforcement (multiagency network response). The authors highlight how an integrative framework of crisis management and resiliency could be applied to healthcare organizations in the coping phase of the pandemic. The experience of the Gemelli can thus be useful for other hospitals and organizations facing external crises and for overall improvement of crisis management and resilience. Responding to crisis brings the opportunity to make innovations introduced during emergencies structural, and embed them moving forward. Research limitations/implications: The paper focuses only on the coping phase of the response to the pandemic, whereas building long-term resilience requires understanding how organizations accumulate knowledge from crises and adapt to the “new normal.” Originality/value: The paper responds to the call for empirical studies to advance knowledge of an integrative framework of crisis management and resiliency theories with reference to complex organizations such as healthcare

Differences in telomere length between sporadic and familial cutaneous melanoma

BACKGROUND: Several pieces of evidence indicate that a complex relationship exists between constitutional telomere length (TL) and the risk of cutaneous melanoma. Although the general perception is that longer telomeres increase melanoma risk, some studies do not support this association. We hypothesise that discordant data are due to the characteristics of the studied populations. OBJECTIVES: To evaluate the association of telomere length with familial and sporadic melanoma. METHODS: TL was measured by multiplex quantitative PCR in leukocytes from 310 melanoma patients according to familial/sporadic and single/multiple cancers and 216 age-matched controls. RESULTS: Patients with sporadic melanoma were found to have shorter telomeres as compared to those with familial melanoma. In addition, shorter telomeres, while tending to reduce the risk of familial melanoma regardless of single or multiple tumors, nearly trebled the risk of single sporadic melanoma. CONCLUSIONS: This is the first time that TL has been correlated to opposite effects on melanoma risk according to the presence or absence of familial predisposition. Individual susceptibility to melanoma should be taken into account when assessing the role of TL as a risk factor. This article is protected by copyright. All rights reserved

In Vitro–In Vivo Correlation of Posaconazole–Amphotericin B Combination against Candida albicans:In Vitro Interacting Concentrations Are Associated with In Vivo Free Drug Levels

The in vitro/in vivo correlation of antifungal combination testing is necessary in order to assess the efficacy of combination regimens. We, therefore, attempted to correlate in vitro chequerboard testing of posaconazole (POS) and amphotericin B (AMB) with the in vivo outcome of combination therapy against experimental candidiasis in a neutropenic murine model. The AMB + POS combination was tested against a Candida albicans isolate. In vitro, a broth microdilution 8 × 12 chequerboard method with serial two-fold drug dilutions was used. In vivo, CD1 female neutropenic mice with experimental disseminated candidiasis were treated with i.p. AMB and p.o. POS alone and in combination at three effective doses (ED20, ED50 and ED80 corresponding to 20%, 50% and 80% of maximal effect, respectively). CFU/kidneys after 2 days were determined. The pharmacodynamic interactions were assessed based on Bliss independence interaction analysis. In vitro, a Bliss antagonism of −23% (−23% to −22%) was observed at 0.03–0.125 mg/L of AMB with 0.004–0.015 mg/L of POS, while a Bliss synergy of 27% (14%–58%) was observed at 0.008–0.03 mg/L of AMB with 0.000015–0.001 mg/L of POS. In vivo, Bliss synergy (13 ± 4%) was found when an AMB ED20 of 1 mg/kg was combined with all POS ED 0.2–0.9 mg/kg, while Bliss antagonism (35–83%) was found for the combinations of AMB ED50 2 mg/kg and ED80 3.2 mg/kg with POS ED80 of 0.9 mg/kg. Free drug serum levels of POS and AMB in in vivo synergistic and antagonistic combinations were correlated with the in vitro synergistic and antagonistic concentrations, respectively. Both synergistic and antagonistic interactions were found for the AMB + POS combination. POS compromised the efficacy of high effective AMB doses and enhanced low ineffective AMB doses. In vitro concentration-dependent interactions were correlated with in vivo dose-dependent interactions of the AMB + POS combination. In vivo interactions occurred at free drug serum levels close to in vitro interacting concentrations.</p

Invasive pulmonary aspergillosis post extracorporeal membrane oxygenation support and literature review

The use of extracorporeal membrane oxygenation (ECMO) for reversible pulmonary failure in critically ill patients has increased over the last few decades. Nosocomial infections are a major complication of ECMO and fungi have been found to be a common cause. Herein, we describe a case of invasive pulmonary aspergillosis following ECMO, which was successfully treated with combination antifungal therapy and interferon-gamma

TERT Promoter Mutations Differently Correlate with the Clinical Outcome of MAPK Inhibitor-Treated Melanoma Patients

Resistance is a major challenge in the management of mitogen-activated protein kinase inhibitor (MAPKi)-treated metastatic melanoma. Tumor genetic alterations can cause MAPK pathway reactivation, leading to lack of response and poor outcome. Characterization of the mutational profile in patients with melanoma might be crucial for patient-tailored treatment choices. Mutations in the promoter region of the telomerase reverse transcriptase gene (TERTprom) lead to increased TERT expression and telomerase activity and are frequent in BRAFV600 mutant melanoma. Reportedly, TERTprom, and BRAFV600 mutations cooperate in driving cancer progression and aggressiveness. We evaluated the effect of the TERTprom status on the clinical outcome in 97 MAPKi-treated melanoma patients. We observed that patients with the c.-146C > T mutation showed a significantly worse progression-free survival (PFS) compared to those carrying the c.-124C > T mutation and a two-fold increased risk of progression (median 5.4 vs. 9.5 months; hazard ratio (HR) 1.9; 95% confidence interval (CI) 1.2-3.2; p = 0.013). This trend was also observed for the overall survival (OS); melanoma patients with the c.-146C > T mutation showed a poorer prognosis compared to those with the c.-124C > T mutation (median 13.3 vs. 25.5 months; HR 1.9, 95% CI 1.1-3.3, p = 0.023). Our results disclose a different correlation of the two TERTprom mutations with MAPKi-treated melanoma patient outcome, highlighting a different impact of the pathway blockade

Hunter-gatherer specialised subsistence strategies in Greece during the Upper Palaeolithic from the perspective of lithic technology

Human occupation of Europe during the late Upper Palaeolithic was facilitated by the adoption of a range of subsistence strategies, honed depending on the extent to which each region was affected by the severity of the last glaciation. One of the ways in which Upper Palaeolithic populations chose to cope with deteriorating conditions and ecological hardship was to intensify their subsistence strategies. This involved the exploitation of new resources and novel locations including inhospitable regions which although visited during earlier periods, were apparently not systematically exploited. This is generally referred to as specialisation, and is considered an important part of both the Upper Palaeolithic as well as modern human behaviour. The question that this research sets out to investigate is whether these changes in subsistence behaviour were accompanied by similar shifts in technology. In the past, this question has been addressed by focusing on single artefact types. Contrary to this, this research takes a holistic approach to the question of technological specialisation, by considering all aspects of lithic technology, from raw material collection to artefact manufacture. The study is based on three broadly contemporary Upper Palaeolithic sites in Greece, Klithi rockshelter, and Franchthi and Kastritsa caves. By comparing lithic characteristics identified at each of the three sites against a series of theoretical expectations, conclusions are drawn as to the presence of specialised technology, and the validity of the specialised versus generalised site dichotomy in Greece.</p