B-type natriuretic peptide-guided treatment for heart failure

Background Heart failure is a condition in which the heart does not pump enough blood to meet all the needs of the body. Symptoms of heart failure include breathlessness, fatigue and fluid retention. Outcomes for patients with heart failure are highly variable; however on average, these patients have a poor prognosis. Prognosis can be improved with early diagnosis and appropriate use of medical treatment, use of devices and transplantation. Patients with heart failure are high users of healthcare resources, not only due to drug and device treatments, but due to high costs of hospitalisation care. B‐type natriuretic peptide levels are already used as biomarkers for diagnosis and prognosis of heart failure, but could offer to clinicians a possible tool to guide drug treatment. This could optimise drug management in heart failure patients whilst allaying concerns over potential side effects due to drug intolerance. Objectives To assess whether treatment guided by serial BNP or NT‐proBNP (collectively referred to as NP) monitoring improves outcomes compared with treatment guided by clinical assessment alone. Search methods Searches were conducted up to 15 March 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (OVID), Embase (OVID), the Database of Abstracts of Reviews of Effects (DARE) and the NHS Economic Evaluation Database in the Cochrane Library. Searches were also conducted in the Science Citation Index Expanded, the Conference Proceedings Citation Index on Web of Science (Thomson Reuters), World Health Organization International Clinical Trials Registry and ClinicalTrials.gov. We applied no date or language restrictions. Selection criteria We included randomised controlled trials of NP‐guided treatment of heart failure versus treatment guided by clinical assessment alone with no restriction on follow‐up. Adults treated for heart failure, in both in‐hospital and out‐of‐hospital settings, and trials reporting a clinical outcome were included. Data collection and analysis Two review authors independently selected studies for inclusion, extracted data and evaluated risk of bias. Risk ratios (RR) were calculated for dichotomous data, and pooled mean differences (MD) (with 95% confidence intervals (CI)) were calculated for continuous data. We contacted trial authors to obtain missing data. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, we assessed the quality of the evidence and GRADE profiler (GRADEPRO) was used to import data from Review Manager to create a 'Summary of findings' table. Main results We included 18 randomised controlled trials with 3660 participants (range of mean age: 57 to 80 years) comparing NP‐guided treatment with clinical assessment alone. The evidence for all‐cause mortality using NP‐guided treatment showed uncertainty (RR 0.87, 95% CI 0.76 to 1.01; patients = 3169; studies = 15; low quality of the evidence), and for heart failure mortality (RR 0.84, 95% CI 0.54 to 1.30; patients = 853; studies = 6; low quality of evidence). The evidence suggested heart failure admission was reduced by NP‐guided treatment (38% versus 26%, RR 0.70, 95% CI 0.61 to 0.80; patients = 1928; studies = 10; low quality of evidence), but the evidence showed uncertainty for all‐cause admission (57% versus 53%, RR 0.93, 95% CI 0.84 to 1.03; patients = 1142; studies = 6; low quality of evidence). Six studies reported on adverse events, however the results could not be pooled (patients = 1144; low quality of evidence). Only four studies provided cost of treatment results, three of these studies reported a lower cost for NP‐guided treatment, whilst one reported a higher cost (results were not pooled; patients = 931, low quality of evidence). The evidence showed uncertainty for quality of life data (MD ‐0.03, 95% CI ‐1.18 to 1.13; patients = 1812; studies = 8; very low quality of evidence). We completed a 'Risk of bias' assessment for all studies. The impact of risk of bias from lack of blinding of outcome assessment and high attrition levels was examined by restricting analyses to only low 'Risk of bias' studies. Authors' conclusions In patients with heart failure low‐quality evidence showed a reduction in heart failure admission with NP‐guided treatment while low‐quality evidence showed uncertainty in the effect of NP‐guided treatment for all‐cause mortality, heart failure mortality, and all‐cause admission. Uncertainty in the effect was further shown by very low‐quality evidence for patient's quality of life. The evidence for adverse events and cost of treatment was low quality and we were unable to pool results.</p

Psychological Resilience of Entrepreneurs: A Review and Agenda for Future Research

Given that entrepreneurs face substantial adversity in initiating and developing new ventures, a burgeoning stream of research has sought to understand the concept of entrepreneurs’ psychological resilience. To structure and synthesize what we know about entrepreneurs’ psychological resilience, we systematically review the empirical literature to provide insights on how it has been conceptualized and operationalized, along with its key antecedents and outcomes. Based on our review, we advance a promising agenda for future research, grounded in connecting the psychological resilience of entrepreneurs to other research areas connected to the new venture development process. Overall, we point to the urgent need for theoretical precision to enhance the utility of empirical contributions, suggest promising research designs, expand on the important role of adversity, discuss potential boundary conditions, elaborate on the link between entrepreneurs’ psychological resilience and organizational resilience, and address the potential dark side of resilience

International Tax Simplification in South Africa through Managing Substantive Complexity and Improving Drafting Efficiency

This chapter discusses the complexity of the South African international tax legislation in terms of both its substantive complexity and drafting complexity. Substantive complexity is established by examining the current legislation governing tax jurisdiction, the taxation of resident taxpayers and non-resident taxpayers as well as international tax incentive measures and anti-avoidance rules. Drafting complexity is established by comparing the South African Income Tax Act to the Canadian Income Tax Act in respect of the drafting of individual provisions and arrangement of provisions. The chapter recommends ways to simplify the South African international tax legislation by: (a) accepting substantive complexity that is necessary and making it work for the local context, and (b) improving drafting efficiency

Management Characteristics of Agents and Multiagents in Electronic Commerce

Business alliances are becoming ubiquitous globally. We are studying agent and multiagent tasks in electronic commerce, representative of normal business functioning. Our work is a study of the need for management functions in agent and multiagent tasks in electronic commerce. We observed and documented management tasks among multiagent networks and recommended specific roles for management that may be applied to business alliances

The International Tax Environment and Simplification of South African Tax Legislation: A Double-Edged Sword

In this paper, we examine the relationship between the international tax environment and legislative complexity in South Africa’s international tax system. We suggest that the international tax environment is a double-edged sword. It causes complexity in South Africa’s tax legislation as it largely responds to the needs of OECD countries and produces tax rules to deal with ‘sophisticated’ tax problems and taxpayers (such as multinational enterprises). When such rules are transplanted into South Africa, they are typically more complex than local rules dealing with local taxpayers. On the other hand, the international tax environment offers ideas for ‘scientific’ drafting of South Africa’s tax legislation, which may lead to simplification and enhanced effectiveness in tax compliance and administration. We contribute to the literature on tax simplification by focusing on legislative complexity and distinguishing between intrinsic complexity and drafting-led complexity. We recommend ways of legislative simplification by drawing on the international tax environment

Alert During What? Beyond the Big O to a Culturally-Cognizant, Process View of Entrepreneurial Alertness

Entrepreneurial alertness is a psychological aptitude generally associated with aspects of nascent venturing, centered on individuals\u27 environmental observations, the association of resources, and idea evaluation. A decade following the Tang et al. (2012) consensus construct and scale, critiques remain questioning its utility and unique value to the major conversations in entrepreneurship. Proponents put great emphasis on entrepreneurial alertness\u27s proven association with opportunity recognition and entrepreneurial actions. Yet, critics suggest it might be an unnecessary step offering little more than a positive association with opportunity recognition in a highly generalized and static way. The purpose of this paper is to address this tension. We do so through a \u27steel man\u27 approach to these valid concerns. Further, we question the logic of limiting a cognitive construct to a singular event: \u27opportunity recognition\u27 for a new venture (which we term here, the Big O ). Drawing on a comprehensive framework inclusive of the full entrepreneurship phenomenon, and integrating insights from cross-cultural psychology, we put forth the case for an ongoing culturally contextualized process perspective towards venturing where individuals are alert to and pursue opportunities (and cope with threats) continuously. This paper provides a new framework for delineating a theoretically grounded what and when of entrepreneurial alertness

An Internet EDI Model for E-Government

Many businesses and governments outside of North America do not have the current technologies needed to fully implement e-government. Our research combines older EDI technology with current telecommunications to produce a hybrid Internet EDI model for e-government, illustrated with standard taxation processes. This model enables e-government for all businesses and governments at a level that is reasonable and will work for them. Many countries are still using old technologies and need to make them work with newer ones. In particular in the public service, many systems have been in place for many years and there is minimal money to upgrade or revamp systems extensively. Our solution allows these governments to get reasonably up-to-date with minimal time and money. Background is provided on traditional EDI issues, the Internet and e-government application services, followed by a description of the proposed hybrid architecture, system and administrative requirements, functionality, security features and strengths

WIN-EC: An Electronic Commerce Model for Small Business

The accessibility of the Internet and the World Wide Web has provided an excellent means for presenting, disseminating and distributing information. As well, this is a new and convenient channel for businesses to reach customers and other businesses. In this paper, we describe WIN-EC, an electronic commerce model for small business. We discuss various services that a typical small business may want to provide its customers. Possible technologies to implement the services are examined and finally, a prototype to generate such a model will be suggested