A Multicenter, International Cohort Analysis of 1435 Cases to Support Clinical Trial Design in Acute Pancreatitis

Background: C-reactive protein level (CRP) and white blood cell count (WBC) have been variably used in clinical trials on acute pancreatitis (AP). We assessed their potential role. Methods: First, we investigated studies which have used CRP or WBC, to describe their current role in trials on AP. Second, we extracted the data of 1435 episodes of AP from our registry. CRP and WBC on admission, within 24 h from the onset of pain and their highest values were analyzed. Descriptive statistical tools as Kruskal-Wallis, Mann-Whitney U, Levene's F tests, Receiver Operating Characteristic (ROC) curve analysis and AUC (Area Under the Curve) with 95% confidence interval (CI) were performed. Results: Our literature review showed extreme variability of CRP used as an inclusion criterion or as a primary outcome or both in past and current trials on AP. In our cohort, CRP levels on admission poorly predicted mortality and severe cases of AP; AUC: 0.669 (CI:0.569-0.770); AUC:0.681 (CI: 0.601-0.761), respectively. CRP levels measured within 24 h from the onset of pain failed to predict mortality or severity; AUC: 0.741 (CI:0.627-0.854); AUC:0.690 (CI:0.586-0.793), respectively. The highest CRP during hospitalization had equally poor predictive accuracy for mortality and severity AUC:0.656 (CI:0.544-0.768); AUC:0.705 (CI:0.640-0.769) respectively. CRP within 24 h from the onset of pain used as an inclusion criterion markedly increased the combined event rate of mortality and severe AP (13% for CRP > 25 mg/l and 28% for CRP > 200 mg/l). Conclusion: CRP within 24 h from the onset of pain as an inclusion criterion elevates event rates and reduces the number of patients required in trials on AP.Peer reviewe

Assessment of digital maturity: the role of resources and capabilities in digital transformation in B2B firms

Digital transformation is a major organisational challenge for manufacturing firms due to the extremely low success rate of such transformations to date. Capability Maturity theory suggests that firms need to develop digital transformation capability incrementally by focusing on a ‘vital few’ improvement priorities for advancing progress. The practitioner literature lacks empirical studies that validate extant capability maturity models (CMM) for digital transformation despite their importance. Moreover, there is a lack of assessment methods, and those that exist do not specify improvement points explicitly, nor prioritise them. Our research aims to address this gap through a systematic, quantitative analysis of digital capability by understanding the deployment of IT-enabled resources. Based on a sample of 302 manufacturing firms, results indicate that the digital transformation stages are punctuated by various resource-capability combinations. Results highlight that strategy- and organisation-related IT-enabled resources are the key drivers of digital transformation. We also observe that as a firm’s digital capability grows at each maturity stage, successively greater IT-enabled resources are required to support this in a stepwise function. To succeed, firms should be incentivised and supported to think beyond technology and develop five specific digital capabilities simultaneously. We also indicate the limitations that underlie our empirical work