Internationalisation and technological innovation : empirical evidence on their relation /

Descripció del recurs: el 25 d'octubre de 2011Internationalisation and innovation of the firms have been considered two of the most important factors determining business success over the last decade (Buckler and Zien, 1996; Wind and Mahajan, 1997; Zahra and George, 2002; Vila and Kuster, 2007). The purpose of this dissertation is to understand better the relation which exists between these two factors. To do so, we undertake empirical investigation which consists of three studies (an initial qualitative and two consequent quantitative ones). We first part from a general idea of the relation extracted from a combination between earlier evidence and academic literature, trying to explore it more in-depth through the application of qualitative methodology. Next, parting from the results, a large sample of manufacturing firm is analysed (data provided by the Spanish Survey of Business Strategy), employing different variables related to both the international and innovative activities of the firm. Last, we address the direction of this relation also to a special type of firms, precisely we separate our sample in family and non-family firms, having the objective to observe how much different is their behaviour in terms of the two processes of the firm discussed in this dissertation. Results outlined the existence of a reciprocal relation between internationalisation and technological advances, as it follows: 1) firms acquired different types of international knowledge and therefore behaved differently in terms of innovation advances once they choose a certain entry mode in the foreign market; 2) product and process innovations are the result of and lead to exports; 4) innovation "Granger causes" internationalisation and internationalisation "Granger causes" innovation; 3) family firms do not have a conservative attitude and are not risk adverse, taking more advantage of their presence abroad in order to reach a higher level of technological advances than non-family ones. Moreover, the dissertation offers various contributions to the literature (theoretical, empirical and methodological) as well to the managers and public policies

Innovation and internasionalisation. A focus on the Spanish exporting firms

International markets are very competitive so innovation seems unavoidable. Some authors describe internationalisation as being an innovation of the firm. In this research these two phenomena will be studied, through a multiple case study method, focusing on the existence of a reciprocal relationship between the processes of internationalisation and innovation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Internationalisation and technological innovation: empirical evidence on their relation

Internationalisation and innovation of the firms have been considered two of the most important factors determining business success over the last decade (Buckler and Zien, 1996; Wind and Mahajan, 1997; Zahra and George, 2002; Vila and Kuster, 2007). The purpose of this dissertation is to understand better the relation which exists between these two factors. To do so, we undertake empirical investigation which consists of three studies (an initial qualitative and two consequent quantitative ones). We first part from a general idea of the relation extracted from a combination between earlier evidence and academic literature, trying to explore it more in-depth through the application of qualitative methodology. Next, parting from the results, a large sample of manufacturing firm is analysed (data provided by the Spanish Survey of Business Strategy), employing different variables related to both the international and innovative activities of the firm. Last, we address the direction of this relation also to a special type of firms, precisely we separate our sample in family and non-family firms, having the objective to observe how much different is their behaviour in terms of the two processes of the firm discussed in this dissertation. Results outlined the existence of a reciprocal relation between internationalisation and technological advances, as it follows: 1) firms acquired different types of international knowledge and therefore behaved differently in terms of innovation advances once they choose a certain entry mode in the foreign market; 2) product and process innovations are the result of and lead to exports; 4) innovation “Granger causes” internationalisation and internationalisation “Granger causes” innovation; 3) family firms do not have a conservative attitude and are not risk adverse, taking more advantage of their presence abroad in order to reach a higher level of technological advances than non-family ones. Moreover, the dissertation offers various contributions to the literature (theoretical, empirical and methodological) as well to the managers and public policies

Innovation and internasionalisation. A focus on the Spanish exporting firms

International markets are very competitive so innovation seems unavoidable. Some authors describe internationalisation as being an innovation of the firm. In this research these two phenomena will be studied, through a multiple case study method, focusing on the existence of a reciprocal relationship between the processes of internationalisation and innovation

Innovation and internasionalisation. A focus on the Spanish exporting firms

International markets are very competitive so innovation seems unavoidable. Some authors describe internationalisation as being an innovation of the firm. In this research these two phenomena will be studied, through a multiple case study method, focusing on the existence of a reciprocal relationship between the processes of internationalisation and innovation

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit:prospective analysis of data from 27 countries

Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10–5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery