Mesurer le capital organisationnel comme combinaison de ressources

Au regard de la baisse tendancielle du ratio book-to-market, résultant d'une reconnaissance très imparfaite des différentes formes de capital immatériel, la présente communication a pour objectif de réexaminer les fondements de la mesure du capital organisationnel. Partant du non respect de la règle de la représentation (Ijiri, 1975) — qui fonde la légitimité de tout processus d'évaluation sur l'homomorphisme devant exister entre le système de mesure et l'objet mesuré — nous suggérons que la nature combinatoire du capital organisationnel telle qu'elle est appréhendée par la littérature (essentiellement la Resource-based view) — et les bases de l'arithmétique financière classique conduisent à une mesure imparfaite. Afin de lever cette inconsistance, nous avancerons l'hypothèse que le capital organisationnel devrait être évalué à partir d'un processus de nature combinatoire, mesurant l'aptitude à coordonner efficacement des ressources complémentaires. A cette fin, prenant appui sur la théorie des capacités (Choquet, 1953) et relaxant le postulat standard d'additivité des valeurs, nous proposons une modélisation des interactions créatrices de valeur qui nous semble ouvrir une perspective de mesure du capital organisationnel.Capital immatériel ; capital organisationnel ; postulat d'additivité ; synergies ; agrégations non additives ; capacités de Choquet ; évaluation d'entreprise

Five days of postoperative antimicrobial therapy decreases infectious complications following pancreaticoduodenectomy in patients at risk for bile contamination

AbstractObjectivesPancreaticoduodenectomy (PD) is associated with high morbidity, in part as a result of infectious complications increased by preoperative bile contamination. The aim of the present study was to assess the effect on the incidence of infectious complications of short‐term antimicrobial therapy (AMT) in high‐risk patients.MethodsPatients with a high risk for positive intraoperative bile culture (i.e. those with ampulloma or pancreatic adenocarcinoma with preoperative endoscopic procedures) (high‐risk group, n = 99) were compared with low‐risk patients (i.e. those with pancreatic adenocarcinoma without preoperative endoscopic procedures) (low‐risk group, n = 76). The high‐risk group received a 5‐day course of perioperative AMT secondarily adapted to the bile antibiogram. The low‐risk group received only the usual antimicrobial prophylaxis.ResultsPositive bile cultures were significantly more frequent in high‐risk patients (81% versus 12%; P < 0.001). The overall rate of infectious complications was lower in the high‐risk group (29% versus 46%; P = 0.018). The statistically significant decrease in the rate of infectious complications reflected reduced rates of urinary tract infections, pulmonary infections and septicaemia. Rates of wound infection (3% versus 5%; P = 0.639) and intra‐abdominal abscess (7% versus 7%; P = 0.886) were similar in the high‐ and low‐risk groups, as was the need for curative AMT.ConclusionsThis exploratory study suggests that a postoperative short course of AMT in patients at high risk for biliary contamination reduces the overall rate of infectious complications after PD. The adaptation of perioperative antimicrobial policy to the patient's risk for bile contamination seems promising and should be further evaluated

Des lecteurs, des usages. Actualités des études enssib-Bpi 2012

Dans le cadre de leur rendez-vous annuel autour de l’actualité des études, l’enssib et la Bpi ont proposé une rencontre intitulée « des lecteurs, des usages ». Cette édition 2012 a été l’occasion d’approcher, dans un premier temps, les lectorats de genres longtemps négligés : jeunes adultes amateurs de presse magazine, « mangados » et lecteurs de bandes dessinées. Des focus sur des catégories d’usages - ou de non usages - des bibliothèques ont été proposés durant la deuxième partie de la journée. Ont été abordés successivement le cas des personnes déficientes visuelles, celui des personnes sans domicile fixe et enfin celui des étudiants qui ne fréquentent guère, voire pas du tout, les bibliothèques

Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure

AIMS: The aim of this study was to assess the prevalence of abnormal liver function tests (LFTs) and the associated clinical profile and outcome(s) in acute decompensated heart failure (ADHF) patients. Alteration in LFTs is a recognized feature of ADHF, but prevalence and outcomes data from a broad contemporary cohort of ADHF are scarce and the mechanism(s) of ADHF-induced cholestasis is unknown. METHODS AND RESULTS: We conducted a post hoc analysis of SURVIVE, a large clinical trial including ADHF patients treated with levosimendan or dobutamine. All LFTs were available in 1134 patients at baseline. Abnormal LFTs were seen in 46% of ADHF patients: isolated abnormal alkaline phosphatase (AP) was noted in 11%, isolated abnormal transaminases in 26%, and a combination of abnormal AP and transaminases in 9%. Abnormal AP was associated with marked signs of systemic congestion and elevated right-sided filling pressure. Abnormal AP had no relationship with 31-day mortality but was associated with worse 180-day mortality (23.5 vs. 34.9%, P = 0.001 vs. patients with normal AP). Abnormal transaminases were associated with clinical signs of hypoperfusion and with greater 31-day and 180-day mortality compared with normal transaminase profiles (17.6 vs. 8.4% and 31.6 vs. 22.4%, respectively; both P < 0.001). There was no additive value of abnormal AP plus abnormal transaminase on a long-term outcome. CONCLUSION: Abnormal LFTs were present in about a half of patients presenting with ADHF treated with inotropes. Abnormal AP and abnormal transaminases were associated with specific clinical, biological, and prognostic features, including a short-term overmortality with increased transaminases but not with biological signs of cholestasis, in ADHF patient

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Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

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