The multiplicity of performance management systems:Heterogeneity in multinational corporations and management sense-making

This field study examines the workings of multiple performance measurement systems (PMSs) used within and between a division and Headquarters (HQ) of a large European corporation. We explore how multiple PMSs arose within the multinational corporation. We first provide a first‐order analysis which explains how managers make sense of the multiplicity and show how an organization's PMSs may be subject to competing processes for control that result in varied systems, all seemingly functioning, but with different rationales and effects. We then provide a second‐order analysis based on a sense‐making perspective that highlights the importance of retrospective understandings of the organization's history and the importance of various legitimacy expectations to different parts of the multinational. Finally, we emphasize the role of social skill in sense‐making that enables the persistence of multiple systems and the absence of overt tensions and conflict within organizations

Cost-effectiveness of mohs micrographic surgery vs surgical excision for basal cell carcinoma of the face

If one carefully reads the study by Essers et al1 along with the trial published in the Lancet2 on which it is based, it is apparent that the trial did not involve a randomization of patients to Mohs micrographic surgery (MMS) vs surgical excision. Therefore, conclusions about cost and therapeutic effectiveness may be misleading. The form of MMS performed in the study by Essers et al used a 3-mm Mohs margin and resulted in a defect 4 mm larger than that obtained with a standard 1-mm Mohs margin. Whereas in standard MMS the surgeon performs pathologic analysis for a single fee, this study used a separate pathologist thereby increasing costs. Based on these 2 important methodological differences, the findings regarding tissue sparing, cost, and cosmesis may be inapplicable to MMS in the United States. Additionally, patients did not undergo standard surgical excision. A standardized resection of 3 mm . . . [Full text of this article

Incidence of and risk factors for skin cancer after heart transplant

OBJECTIVE: To examine the incidence, tumor burden, and risk factors for nonmelanoma and other skin cancer types in this heart transplant cohort. DESIGN: Retrospective review of patient medical records. SETTING: Tertiary care center. Patients All heart transplant recipients at Mayo Clinic from 1988 to 2006. MAIN OUTCOME MEASURES: Cumulative incidence of skin cancer and tumor burden, with Cox proportional hazards regression models used to evaluate risk factors for posttransplant primary and secondary nonmelanoma skin cancer. RESULTS: In total, 312 heart transplant patients had 1395 new skin cancers in 2097 person-years (mean, 0.43 per year per patient) with a range of 0 to 306 for squamous cell carcinoma (SCC) and 0 to 17 for basal cell carcinoma (BCC). The cumulative incidence rates of any skin cancer were 20.4%, 37.5%, and 46.4% at 5, 10, and 15 years after heart transplant, respectively. Cumulative incidence of SCC after the first BCC was 98.1% within 7 years. Multivariate analysis showed that posttransplant nonskin cancer, increased age, and heart failure etiologic factors other than idiopathic disease were associated with increased risk of SCC. Posttransplant herpes simplex viral infection, increased age, and use of mycophenolate mofetil for immunosuppression were associated with increased risk of BCC. CONCLUSIONS: With prolonged survival, many heart transplant patients have numerous skin cancers. Vigilant sun protection practices, skin cancer education, and regular skin examination are appropriate interventions in these high-risk patient