Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Intellectual Capital and Regions: Origins, Theoretical Foundations, Decision-makers Implications

Researchers are increasingly investigating the strategic management of knowledge assets and Intellectual Capital (IC) for a company's performance improvement. We look instead at the role and the relevance of IC at the regional level. Sharing a knowledge-based approach to IC and through an intensive and structured literature review, this paper examines the concept of IC in the local systems and regional studies research streams and provides an analysis of the origins and the theoretical foundations of IC and its related components. A clear understanding of the concept is useful both to develop a theory about IC at the regional level and to help regional decision-makers to activate and drive regional development dynamics based on the exploitation of their regions' knowledge assets

Managing knowledge processes for value creation

Nowadays organizations have realized that knowledge, its effective use and the fast acquisition and utilization of new knowledge represent the only source of sustainable competitive advantage. In fact, an effective exploitation and management of knowledge resources are at basis of the development of those capabilities that ground the organization’s capacity to deliver successfully targeted value propositions. During the last decades, a growing interest in the processes of management of knowledge resources has been experimented. Several theoretical models and approaches aimed to explain how organizational knowledge is created, transferred and crystallized have been produced. Currently the debate on knowledge management processes is still lively. The dynamics which link knowledge processes to value creation, the valuation of their impact on organizational performance and, the role of some organizational and technological resources as enablers or hampers of a successful knowledge management, emerge as relevant topics to be investigated more in depth. In this introduction to the special issue we develop some theoretical and managerial reasons explaining the importance of an effective management of knowledge processes to deal with the uncertainty, change, and turbulence of the current socio-economic scenario