IntroductionSingle-pass, whole-body computed tomography (pan-scan) remains a controversial intervention in the early assessment of patients with major trauma. We hypothesized that a liberal pan-scan policy is mainly an indicator of enhanced process quality of emergency care that may lead to improved survival regardless of the actual use of the method.MethodsThis retrospective cohort study included consecutive patients with blunt trauma referred to a trauma center prior to (2000 to 2002) and after (2002 to 2007) the introduction of a liberal single-pass pan-scan policy. The overall mortality between the two periods was compared and stratified according to the availability and actual use of the pan-scan. Logistic regression analysis was employed to adjust mortality estimates for demographic and injury-related independent variables.ResultsThe study comprised 313 patients during the pre-pan-scan period, 223 patients after the introduction of the pan-scan policy but not undergoing a pan-scan and 608 patients undergoing a pan-scan. The overall mortality was 23.3, 14.8 and 7.9% (P < 0.001), respectively. By univariable logistic regression analysis, both the availability (odds ratio (OR) 0.57, 95% confidence interval (CI): 0.36 to 0.90) and the actual use of the pan-scan (OR 0.28, 95% CI: 0.19 to 0.42) were associated with a lower mortality. The final model contained the Injury Severity Score, the Glasgow Coma Scale, age, emergency department time and the use of the pan-scan. 2.7% of the explained variance in mortality was attributable to the use of the pan-scan. This contribution increased to 7.1% in the highest injury severity quartile.ConclusionsIn this study, a liberal pan-scan policy was associated with lower trauma mortality. The causal role of the pan-scan itself must be interpreted in the context of improved structural and process quality, is apparently moderate and needs further investigation with regard to the diagnostic yield and changes in management decisions. (The Pan-Scan for Trauma Resuscitation [PATRES] Study Group, ISRCTN35424832 and ISRCTN41462125)

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Purpose – The purpose of this paper is to explicate why and how modularization of business models can lead to path dependence or strategic flexibility, thus either inhibiting or favoring business model innovation. Design/methodology/approach – Conceptual paper that depicts a model based on the extant literature. The derived implications for business model innovation are illustrated by several examples. Findings – Modularity can be used as cognitive frame to explore issues of dynamics, evolution and transformation of business models. Thereby, the paper reveals drivers as well as barriers to business model innovation which sensitizes managers that modularity as a design principle is a two-edged sword: managers cannot simply rely on what they know about the benefits of modularity because this might lead to path dependence in the future. Practical implications – The authors suggest that middle managers might best focus on managing modules and their direct relations. Senior management should put more emphasis on encouraging extra-modular thinking. Originality/value – By outlining the concept of business model modularity, the authors add to the scarce literature that addresses modularity beyond the fields of products, production and organization design. The discussion also advances to the literature on drivers as well as barriers to managing business model innovation. While most of the extant literature has portrayed modularity as a means to increase flexibility, only a few studies have revealed the downside of modularity and explained how it gives rise to path dependence. In this respect, the authors highlight the relation between managerial action, self-reinforcing mechanisms and characteristics of the environment. Finally, the paper’s findings provide a lens to consider contradictory strategies simultaneously which is crucial for managing complex business models.

18 nicht ausgewählte Patienten mit chronisch-entzündlichen rheumatischen Erkrankungen – darunter 10 mit einer gesicherten chronischen Polyarthritis – wurden in einer prospektiven, offenen, unkontrollierten Beobachtungsstudie nach den Prinzipien der anthroposophischen Therapierichtung behandelt und über eine mittlere Beobachtungszeit von 12 Monaten verfolgt. Als Hauptzielvariablen dienten die lokale und systemische Entzündungsaktivität (Gelenkindex, CRP im Serum), psychische Befindlichkeit und funktionelle Kapazität (MOPO-Fragebogen). Die Therapie bestand im wesentlichen in einer individuell für den Einzelfall entwickelten Kombination anthroposophischer Arzneimittel pflanzlicher, mineralischer und tierischer Herkunft, unter Einschluss spezieller äusserer Anwendungen, heileurythmischer und meist auch krankengymnastischer Bewegungstherapie sowie diätetischer und kunsttherapeutischer Verfahren. In der Gesamtbeurteilung des geschilderten Therapiekonzeptes über die im Mittel ljährige Beobachtungszeit wurde bei alien Patienten eine wesentliche subjektive und objektive Besserung der systemischen und lokalen Entzündungsaktivität, der funktionellen Kapazität, des Beschwerdebildes und Allgemeinbefindens einschliesslich krankheitsbezogener psychosozialer Phänomene wie Depressivität, Ängstlichkeit, sozialer Rückzug erzielt. Dabei konnte auf gelenkinvasive Strategien vollständig, auf den Einsatz konventioneller langwirkender Antirheumatika und NSAR weitgehend verzichtet bzw. deren Dosis erheblich reduziert werden.