Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Modernity, development and representation: International transfers of western management expertise in Malaysia

Inspired by writings from anthropology, postcolonial studies, and sociology highlighting the situatedness of modern disciplinary knowledges, this dissertation explores alternative possibilities for understanding, researching, and representing knowledge in the international and cross-cultural arena. Through its focus on transfers of management knowledge and expertise, this dissertation investigates the specific intersections among culture, knowledge, and practice informing received understandings about transfers as a globalization process. The methodologies of institutional ethnography and multivocality, which ‘write-in’ multiplicity and social particularities, are used to explore and problematize these intersections. Within this project, Malaysia is a theoretical and empirical space for investigating these representational, methodological, and textual issues. ^ Research was undertaken in Malaysia for a year at two electronics multinationals and several government, statutory and academic institutions. Data were drawn from observations, interviews, and a variety of secondary materials. Findings indicate that knowledge transfer is a process marked by a series of translations, appropriations, and reinterpretations, rather than the literal or linear transmission of knowledge that is usually assumed. The project shows how concepts and practices transferred, such as TQM, are constantly changing, producing a multiplicity of meanings, practices and identities, and reconstituting a series of shifting simultaneities. ^ Informed by local culture, history, social locations, and local knowledges, this project challenges the assumption that Others are knowable, and ‘transferability’ is possible. It does so through a focus on issues governing research process, and by highlighting concerns about representation and voice. It situates engagements between Self and Other in terms of practices and relations of knowledge, power, knowers, and known. Of particular significance is the project\u27s attentiveness to the researcher-self as an agent of knowledge/power. This attentiveness re-situates knowledge in terms of ‘who speaks’ and ‘what for’. ^ Through this focus on relations and engagements, knowledge and power, representation and voice, the project provides a framework and a methodology for reconstituting a form of knowing and doing which is accountable and able to re-situate and problematize ‘differences’, ‘knowledge’, and ‘change’ as these concepts are traditionally represented in the managerial literature.

Towards an anthropology of globalization

We started this book with Paul Rabinow’s (1986) call to anthropologise the West. In this conclusion we return to his call, and locate the contributions and theoretical framing of the book in terms of the insights offered such endeavours in relation to globalisation. By attending to the ‘domains of truth and economy’ that make globalisation real, the intent is to show its historicised character and socially constructed nature

The imperial formations of globalization

In this book, the nexus between organization theory, globalization and imperialism is explored. Rather than debate the convergence or divergence produced by globalization between different spatial and temporal theaters, the authors are trying instead to focus attention on what makes globalization itself possible, as a form of economic or social organization