Platform-Based Internationalization of Smaller Firms: The Role of Government Policy.

Governments are recognizing anticompetitive concerns and market distortions associated with the rise of e-commerce platforms. Thus, policies are being crafted to level the playing field between large platform operators and small platform sellers. In addition, policies mitigating barriers to internationalization associated with using e-commerce platforms are also being developed. This study aims to explore these policy actions impacting the platform-based internationalization of small and micro enterprises (SMEs). The case study method is adopted to provide rich insights into the Indian Government policy actions impacting the e-commerce platform-based internationalization of Indian SMEs. More specifically, this investigation analyzes the extent to which the Indian Government policy actions have mitigated the home market and industry-level barriers to export for SMEs leveraging e-commerce platforms for their internationalization efforts. Study findings provide rich policy implications and fodder for future empirical testing of key qualitative insights uncovered in this study. Supplementary Information: The online version contains supplementary material available at 10.1007/s11575-022-00492-z.

Breast cancer liver metastases: systematic review and time to event meta-analysis with comparison between available treatments.

INTRODUCTION: The current gold standard treatment for breast cancer liver metastases (BCLM) is systemic chemotherapy and/or hormonal therapy. Nonetheless, greater consideration has been given to local therapeutic strategies in recent years. We sought to compare survival outcomes for available systemic and local treatments for BCLM, specifically surgical resection and radiofrequency ablation. METHODS: A review of the PubMed (MEDLINE), Embase and Cochrane Library databases was conducted. Data from included studies were extracted and subjected to time-to-event data synthesis, algorithmically reconstructing individual patient-level data from published Kaplan-Meier survival curves. FINDINGS: A total of 54 studies were included, comprising data for 5,430 patients (surgery, n=2,063; ablation, n=305; chemotherapy, n=3,062). Analysis of the reconstructed data demonstrated survival rates at 1, 3 and 5 years of 90%, 65.9% and 53%, respectively, for the surgical group, 83%, 49% and 35% for the ablation group and 53%, 24% and 14% for the chemotherapy group (p<0.0001). CONCLUSION: Local therapeutic interventions such as liver resection and radiofrequency ablation are effective treatments for BCLM, particularly in patients with metastatic disease localised to the liver. Although the data from this review support surgical resection for BCLM, further prospective studies for managing oligometastatic breast cancer disease are required.

Systemic neoadjuvant chemotherapy in modern pancreatic cancer treatment: a systematic review and meta-analysis.

BACKGROUND: Pancreatic ductal adenocarcinoma remains a disease with a poor prognosis despite advances in surgery and systemic therapies. Neoadjuvant therapy strategies are a promising alternative to adjuvant chemotherapy. However, their role remains controversial. This meta-analysis aims to clarify the benefits of neoadjuvant therapy in resectable pancreatic ductal adenocarcinoma. METHODS: Eligible studies were identified from MEDLINE, Embase, Web of Science and the Cochrane Library. Studies comparing neoadjuvant therapy with a surgery first approach (with or without adjuvant therapy) in resectable pancreatic ductal adenocarcinoma were included. The primary outcome assessed was overall survival. A random-effects meta-analysis was performed, together with pooling of unadjusted Kaplan-Meier curve data. RESULTS: A total of 533 studies were identified that analysed the effect of neoadjuvant therapy in pancreatic ductal adenocarcinoma. Twenty-seven studies were included in the final data synthesis. Meta-analysis suggested beneficial effects of neoadjuvant therapy with prolonged survival compared with a surgery-first approach, (hazard ratio 0.72, 95% confidence interval 0.69-0.76). In addition, R0 resection rates were significantly higher in patients receiving neoadjuvant therapy (relative risk 0.51, 95% confidence interval 0.47-0.55). Individual patient data analysis suggested that overall survival was better for patients receiving neoadjuvant therapy (P = 0.008). CONCLUSIONS: Current evidence suggests that neoadjuvant chemotherapy has a beneficial effect on overall survival in resectable pancreatic ductal adenocarcinoma in comparison with upfront surgery and adjuvant therapy. Further trials are needed to address the need for practice change.

Blood transfusion practices at a level one trauma centre: a one-year retrospective review.

INTRODUCTION: Knowledge of blood usage patterns helps to address major issues such as the management of massive transfusion events, minimisation of transfusion risks, as well as in dealing with blood shortages. The aim of our study was to audit blood component usage at a Level I trauma centre blood bank. METHODS: A retrospective analysis of the transfusion data of 4,320 patients who were admitted to the General Surgery, Neurosurgery, Orthopaedics and Emergency Medicine departments during a one-year period was conducted. RESULTS: A total of 4,054 patients underwent transfusion. 88 percent, 94 percent, 80 percent and 100 percent of patients admitted to the General Surgery, Orthopaedics, Neurosurgery and Emergency Medicine departments, respectively, received transfusions. Packed cells were the most commonly utilised component, followed by fresh frozen plasma (FFP) and platelets in the ratio 3:2:1. The highest number of FFPs (2,052 units) and platelet concentrates (950 units) were used in the General Surgery and Neurosurgery departments, respectively. The calculated cross-match to transfusion (C:T) ratio did not exceed 2.5 in any of the departments. Among those transfused, the massive blood transfusion rate was low (1.77 percent). The rates of transfusion reactions and non-group-specific transfusions were also low (0.42 percent and 0.07 percent, respectively). CONCLUSION: The rate of transfusion of trauma patients was high (94 percent). Using the C:T ratio as a marker, optimal blood utilisation was noted in all departments. The methods of reporting transfusion reactions need to be revised. Future studies on the appropriateness of blood use and blood ordering schedules are required.