Based on the evolutionary theory of the firm, this paper examines how traditional variables that describe a firm’s organizational structure—formalization, specialization, and centralization—affect ...the adoption of inbound and outbound open innovation. Using a cross-sectional survey of Chinese small and medium enterprises, our study shows that organizational structure matters for open innovation and that formalization, specialization, and centralization have diverse effects on the OI practices implemented by SMEs. Results indicate that specialization and centralization have a critical role in open innovation practices as they both foster the use of inbound and outbound open innovation. Formalization negatively affects outbound, but it is positively associated with inbound open innovation.
Using survey data from companies located in the Wuxi (Taihu) international science park in China, we aim to analyze to what extent science park residents experience barriers to innovation and to what ...extent opening up the innovation process allows them to overcome constraints and increase innovation performance. Findings indicate that surveyed firms that mostly undertake incremental innovation perceive many constraints and that the depth of external knowledge search—that is, the intensity of the relationship with external sources of knowledge—significantly influences innovation performance, mediating the relationships between innovation barriers and innovation performance. Our results allow us to explain how open innovation practices can be used to mitigate existing barriers, and therefore permeate the knowledge filter, and to theorize on the importance of institutional factors for open innovation theory in emerging economies.
Plain English summary
It is quality not quantity that matters! The intensity of relationships with external knowledge sources helps to mitigate innovation constraints, facilitate the flow of knowledge, and enhance innovation performance in emerging market firms. We surveyed high-tech SMEs located in the Wuxi (Taihu) international science park in China to find out to what extent external firm barriers to innovation have an impact on the innovation performance of science park residents, and how open innovation strategies affect this relationship. There are three key implications: First, for research, institutional factors need to be considered when studying open innovation, particularly in an emerging country context. Results emphasize the importance of deeper external knowledge sources as one mechanism to mitigate institutional barriers. Second, for management, we show human resource constraints are an important barrier for SMEs and managers should stimulate learning through reward systems and training that increase absorptive and innovative capacity ability. Third, for policy, we show that local officials responsible for the management of science parks in China should put more effort into providing financial support by creating specialized venture capital and a better knowledge of risk analysis from the financial system.
This paper focuses on the impact of vertical knowledge transfer from foreign affiliates of Transnational Corporations (TNCs) to indigenous Polish suppliers. Firm-level data was collected through a ...survey among foreign affiliates and domestic suppliers in the Polish automotive sector. The study finds that foreign firms contribute to the knowledge base of local firms, and that the knowledge domestic suppliers receive enables them to enhance their performance, but also that it is R&D intensity that is critical for suppliers’ new knowledge creation. Inter-firm relationships are shown to play a significant role in the process of knowledge transfer and acquisition between foreign firms and domestic suppliers
This study examines the cross‐border expansion of four major African banks from 1988 to 2014 in order to investigate the role of CEO vision in influencing their international investment decisions. ...The qualitative case study approach is complemented by a quantitative analysis that examines the multiple factors influencing internationalization patterns. The results from both types of analysis indicate that the vision of the CEO matters, and that it is a key factor in explaining the accelerated internationalization of three of the four banks examined in this study. These results stress the need for considering managerial decision making in international resource commitment decisions, particularly in an emerging market context, where a shared developmental vision might be shaping the behavior of the entrepreneurs.
Delirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association ...between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation.
Prospective cohort study.
Hospital rehabilitation unit.
A total of 2642 patients aged 65 years or older admitted between January 2002 and December 2006.
Dementia predating rehabilitation admission was detected by DSM-III-R criteria. Delirium was diagnosed with the DSM-IV-TR. The primary outcome was that of walking dependence (Barthel Index mobility subitem score of <15) captured as a trajectory from discharge to 1-year follow-up. A mixed-effects multivariate logistic regression model was used to analyze the association between DSD and outcome, after adjusting for relevant covariates. Secondary outcomes were institutionalization and mortality at 1-year follow-up, and logistic regression models were used to analyze these associations.
The median age was 77 years (interquartile range: 71–83). The prevalence of DSD was 8%, and the prevalence of delirium and dementia alone were 4% and 22%, respectively. DSD at admission was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence (odds ratio OR 15.5; 95% Confidence Interval CI 5.6–42.7; P < .01). DSD was also significantly associated with a fivefold increase in the risk of institutionalization (OR 5.0; 95% CI 2.8–8.9; P < .01) and an almost twofold increase in the risk of mortality (OR 1.8; 95% CI 1.1–2.8; P = .01).
DSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should be included in prognostic models of health care.
Aim
The aim of the present study is to investigate how delirium and adverse clinical events (ACE) contribute independently and in combination to functional outcomes in older patients admitted to ...rehabilitation settings after a hip fracture.
Methods
This is a multicenter retrospective cohort study of patients aged ≥65 years admitted after hip fracture surgical repair to three Italian rehabilitation units. Delirium on admission was evaluated with the Confusion Assessment Method. ACE during the rehabilitation stay were recorded, including infections (i.e. urinary tract infections, other infections), non‐infectious ACE (i.e. cardiovascular events, respiratory failure, pulmonary embolism) and falls. A multivariable linear regression was used to evaluate the effect of ACE and delirium on functional outcome, adjusting for covariates determined a priori.
Results
A total of 519 patients were included in the study. The mean ± SD age was 82.9 ± 9.4 years. ACE occurred in 277 patients (53.4%), delirium alone was present in 19 patients (3.6%). Both conditions were present in 58 patients (11.2%). Compared with patients without delirium or ACE, those with ACE or delirium were more likely to have a worse functional outcome (−6.7 Barthel Index points −11.6; −1.7; P = 0.008; −13.2 −25.6; −0.8; P = 0.038) at discharge, and patients with both conditions had an even lower Barthel Index score (−18.6 Barthel Index points −26.9; −10.3; P < 0.001).
Conclusions
ACE and delirium are very common in older patients admitted to rehabilitation settings after hip fracture, and frequently coexist. As both ACE and delirium could impact on functional outcome, alone and in combination, a clinical geriatric approach is necessary for this population to minimize risks. Geriatr Gerontol Int 2019; 19: 404–408.
Rehospitalizations for elderly patients are an increasing health care burden. Nonetheless, we have limited information on unplanned rehospitalizations and the related risk factors in elderly patients ...admitted to in-hospital rehabilitation facilities after an acute hospitalization.
In-hospital rehabilitation and aged care unit.
Retrospective cohort study.
Elderly patients 65 years or older admitted to an in-hospital rehabilitation hospital after an acute hospitalization between January 2004 and June 2011.
The rate of 30-day unplanned rehospitalization to hospitals was recorded. Risk factors for unplanned rehospitalization were evaluated at rehabilitation admission: age, comorbidity, serum albumin, number of drugs, decline in functional status, delirium, Mini Mental State Examination score, and length of stay in the acute hospital. A multivariable Cox proportional regression model was used to identify the effect of these risk factors for time to event within the 30-day follow-up.
Among 2735 patients, with a median age of 80 years (interquartile range 74-85), 98 (4%) were rehospitalized within 30 days. Independent predictors of 30-day unplanned rehospitalization were the use of 7 or more drugs (hazard ratio HR, 3.94; 95% confidence interval, 1.62-9.54; P = .002) and a significant decline in functional status (56 points or more at the Barthel Index) compared with the month before hospital admission (HR 2.67, 95% CI: 1.35-5.27; P = .005). Additionally, a length of stay in the acute hospital of 13 days or more carried a twofold higher risk of rehospitalization (HR 2.67, 95% CI: 1.39-5.10); P = .003).
The rate of unplanned rehospitalization was low in this study. Polypharmacy, a significant worsening of functional status compared with the month before acute hospital admission, and hospital length of stay are important risk factors.
Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of ...their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region.
This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death.
Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death.
Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals' lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.
Hip fractures (HF) are a growing cause of death and disability among older people, especially in the very old. Although the incidence of these events increases with age and nonagenarians represent a ...population at high risk, few studies selectively focused on these patients and on their potential to recover gait ability after HF. The aim of this study was to describe the clinical, biological, cognitive, and functional characteristics of a population of HF patients aged 90 years or older, to examine their functional recovery in gait (with or without aids), in-hospital mortality and destination at discharge, and, finally, to assess their 1-year survival according to the functional status achieved at discharge.
Retrospective study.
Department of Rehabilitation and Aged Care.
Seventy-six nonagenarians admitted to a department of rehabilitation after HF surgery.
Patients underwent a multidimensional assessment on admission and at discharge. Outcome measures at discharge were the global scores of Tinetti and the Barthel Index, the score at the transferring and walking subitems of the Barthel Index, and the independence to walk with or without aids. Furthermore, we assessed the rate of discharge to home after rehabilitation and the rate of in-hospital death. Logistic regressions were used to assess clinical variables associated with the inability to walk at discharge. Postdischarge 12-month survival was assessed with Kaplan Meyer analysis and compared with Cox proportional hazard regression models, adjusted for confounders.
A standardized rehabilitation treatment of 2 sessions (40 minutes per session) daily from Monday to Friday and of 1 session on Saturday that included exercises of strengthening, transfers, postural and gait training, and adaptive equipment training.
Five patients died during their admission to the department. Among the 71 survivors, 84.5% were able to walk at discharge with an assistive device, either a cane or a walker. Comorbidity and prefracture Barthel Index global score were the only 2 variables associated with the failure to be independent in walking at discharge. At 1 year, mortality was significantly higher for those patients who did not recover walking ability after rehabilitation.
A large proportion of nonagenarians are able to achieve independence in walking ability (with assistive device) after rehabilitation following HF surgery. The achievement of this ability after rehabilitation is also an important prognostic factor for 1-year survival.
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