The Testosterone Therapy For Male Sexual Dysfunction: Benefits And Harms Writing Sample

The article “What Are the Benefits and Harms of Testosterone Therapy for Male Sexual Dysfunction? – A Systematic Review” provides advice on the benefits and risks of testosterone treatment in adult men with sexual dysfunction. A study of the potential risks of approved testosterone treatment has been undertaken due to the increased risk of severe cardiovascular events in individuals undergoing this kind of therapy. The purpose of the study is to review the safety and efficacy of testosterone treatment in men with a decline in testosterone levels who suffer from sexual dysfunctions.

The study was based on current controlled trials and comparative studies. The considered indicators included sexual and physical functions, quality of life, energy and vitality, serious side effects, significant cardiovascular side effects, and other adverse events. The authors searched several databases for articles and systematic reviews. The studied databases included EMBASE, MEDLINE, Cochrane Systematic Reviews, WHO International Clinical Trials Registry Platform, and others (Dimitropoulos et al., 2019). They compared the benefits and risks of testosterone treatment in a sample of adult men over 18 who were either eugonadal or hypogonadal. A review of the evidence identified 25 randomized controlled trials that met the inclusion criteria. 17 RCTs studied hypogonadal men, 2 included eugonadal patients, 3 studied borderline eugonadal men, 2 had mixed participants, and 1 study did not mention the status (Dimitropoulos et al., 2019). A technical panel of experts was also convened to review the evidence and help clarify key issues.

Quality of life, erectile function, cognitive function, as well as risks, including serious side effects, severe cardiovascular side effects, deep vein thrombosis, pulmonary embolism, mortality, and prostate cancer were noted as critical outcomes assessed. Energy and vitality, physical function, depression, decreased fracture rates, libido, and lower urinary tract symptoms were classified as important (Dimitropoulos et al., 2019). All critical and important outcomes were considered in making recommendations. Data reported as standardized mean differences were interpreted as low, moderate, and high evidence.

Low-level evidence showed a slight improvement in AMS quality of life, but this may be due to improved sexual function, which is a subset of the AMS. Low-grade data showed small improvements in erectile function as well as marginal improvements in physical function. Low evidence also showed a slight increase in the incidence of cardiovascular side effects. Moderate evidence showed little improvement in global sexual function IIEF and AMS (Dimitropoulos et al., 2019). There is also no evidence of an increased risk of serious side effects or withdrawal symptoms associated with testosterone treatment.

Besides, in studies that looked at different forms of drugs, there was no consistent difference in risks with the use of transdermal testosterone formulas compared with intramuscular ones. Both intramuscular and transdermal testosterone formulas have been associated with improved sexual function. The results of the indirect comparison show no significant differences in clinical efficacy, benefits, or risks between the two forms; however, there are few direct comparison results. Due to the lower cost, patients often prefer intramuscular formulas to transdermal ones (Dimitropoulos et al., 2019). They can be considered preferable today since they are significantly cheaper in the absence of differences in benefits and risks.

Clinicians may debate the need to initiate testosterone treatment in hypogonadal men seeking to improve their sexual function. An increase in the erectile function index on the IIEF scale is regarded as a positive response to hormone replacement therapy. Changes in sexual function are the main criterion for the effectiveness of substitution therapy since erectile dysfunction is the main reason for patients’ treatment. A change in sexological status in response to androgen therapy can be noted within a few weeks, in contrast to other symptoms that require longer therapy. It is also important to reevaluate symptoms within 12 months of starting treatment and periodically thereafter (Dimitropoulos et al., 2019). However, testosterone treatment should be discontinued in men with age-related hypogonadism and sexual dysfunction who do not show improvement in sexual function.

This study relates to the class readings and assumes the increased scientific and practical interest in the treatment of sexual disorders in general. The urgency of diagnosis and treatment of hormonal disorders and sexual dysfunction in men is due to the increase in the average age of the population and high attention to the quality of human life. Many researchers have noted a close relationship between erectile dysfunction and androgen deficiency, which characterizes the importance of studying hormonal levels in men (Dimitropoulos et al., 2019). The issues of the relationship between androgens and male sexual function are reflected in the documents of international communities studying the characteristics of sexual disorders in combination with the problems of male aging (Dimitropoulos et al., 2019). Thus, serum testosterone testing is recommended as an international standard in the evaluation of men with erectile dysfunction. Treatment of the general population with an androgen deficiency is impossible without an accurate diagnosis.

The issue of early detection of this pathology still causes many discussions. Significant difficulties are caused by determining the reference values of the blood testosterone index, taking into account the individual characteristics of a person, as well as daily fluctuations of this value and its correlation with living conditions and exogenous factors (Dimitropoulos et al., 2019). In contrast to primary hypogonadism, with age-related changes, the decrease in testosterone production is relative, not absolute. Age-related androgen deficiency is not characterized by a pronounced decrease in the level of androgens and an increase in the concentration of luteinizing hormone (Dimitropoulos et al., 2019). The clinical symptoms of age-related androgen deficiency are non-specific and are similar to those of other somatic and psychological disorders that accompany the aging process. Thus, neither a laboratory study nor a clinical picture in a significant part of cases allows diagnosing age-related hypogonadism. Thus, a short trial treatment is recommended for the existing clinical picture of sexual dysfunction and borderline testosterone levels.

The reviewed article provides guidance based on the best available evidence regarding the benefits, harms, and costs of testosterone therapy in adult men with testosterone decline who suffer from sexual dysfunction. Most studies provide information on follow-up for a year or less, making it difficult to judge long-term benefits and risks. Without a noticeable improvement in symptoms, such treatment will incur additional costs and no definite benefit. For this reason, patients’ symptoms should be regularly assessed to understand the effectiveness of the therapy. The role of testosterone therapy in the treatment of sexual dysfunction in men is controversial. It is impossible to say for sure whether non-specific symptoms and manifestations, such as sexual dysfunction, are associated with low testosterone levels, or they are the result of other factors, such as chronic illness or taking concomitant medications. Overall, the evidence is insufficient to conclude testosterone treatment for sexual dysfunction due to high data uncertainty, low mortality rates, and the potential fragility of the results.

References

Dimitropoulos, K., Verze, P., Van den Broeck, T., Salonia, A., Yuan, C. Y., Hatzimouratidis, K., & Dohle, G. (2019). What are the benefits and harms of testosterone therapy for male sexual dysfunction? – A systematic review. International Journal of Impotence Research, 1-12.

Resuscitation In Trauma Management: Fluid Options

Introduction

Management of trauma has changed over many years. This is because of more evidence-based research on the major causes of mortality and morbidity in the acute management of trauma patients. Currently, a significant proportion of world morbidity and mortality is attributed to trauma. Hemorrhage accounts for 40% of the deaths related to trauma (Nicola et al., 2011). This is because of blood volume loss that results in shock. Poor tissue perfusion due to inadequate blood flow results in end-organ damage. Strategies have been put in place to control bleeding and coagulopathy resulting from the injury. Fluid resuscitation is a major intervention in trauma management. This involves the use of crystalloids, colloids, blood, and its components for volume replacement. Clinicians have a wide range of choices between which fluid is best for their patients. This has led to controversies on which particular one is the most reliable and cost-effective in the management of trauma. Several studies have been carried out to try to answer this question. This literature tries to look at the merits and demerits of each one of them in practical use.

Use of Crystalloids

Crystalloids are resuscitation fluids that are aqueous solutions with soluble molecules. They are classified as being hypertonic, isotonic, or hypotonic depending on their concentration. Isotonic solutions include normal saline and Ringer’s lactate. High concentrations of normal saline are the main hypertonic fluids and are useful in the management of head trauma. These include 3%, 6%, and 7.5% concentrations of normal saline. 5% dextrose solution and 0.45% normal saline are the hypotonic solutions. After infusion, they are redistributed to extravascular sites hence they are poor in volume replacement during resuscitation and may lead to dilutional hyponatremia and edema. For instance, infusion of 5% dextrose solution results in <10% of the volume being intravascular whereas two-thirds redistributes to intracellular space.

In an international survey carried out in 2004, crystalloids are the most used resuscitation fluid in clinical practice. The major reasons cited were the brief time needed for correction of volume loss, the effect duration, affordability, and fewer adverse drug reactions (Schortgen, Deye, & Brochard, 2004). Crystalloids are quite affordable and readily available. During infusion, they immediately replace both intravascular and interstitial volumes and replenish the renal output to normal. The popular use of Ringer’s Lactate could be attributed to its reduced elimination rate in hypovolemic patients. In a study in 1999, volunteer patients were used where stable normal volume patients were found to have an elimination rate of 133mL per min. The marked volume of blood was then withdrawn from the patients. Elimination rates of 100mL per min were found in patients who had lost 450mL of blood whereas those who had lost 900mL had a rate of 34mL per min. this showed that the elimination rate decreased as the volunteers became hypovolemic. This shows how useful ringers lactate would be too acutely hypovolemic patients (Drobin & Hahn 1999).

One of the demerits of fluid resuscitation using crystalloids is edema especially in patients having increased capillary permeability. Patients tend to develop interstitial and intracellular edema. In a study carried out in hemorrhagic rats, resuscitation with normal saline stabilized their homeostatic volume but caused extracellular volume expansion with gut edema and cellular edema on the heart tissues (Moon, Hollyfield-Gilbert, Myers, & Kramer, 1994). It has also been demonstrated that crystalloid use in the resuscitation of head injury in rats made worse the already present cerebral edema. Mesenteric edema was also recorded in the same study. This was however of little significance when it was substituted with blood (Drummond, Patel, Cole, & Kelly, 1998). In resuscitation of post-trauma patients, overzealous administration of ringer’s lactate was reported to cause mesenteric edema leading to the development of abdominal compartment syndrome.

This had high morbidity and mortality (Balogh, McKinley, & Cocanour, 2003). In fact, the volume of crystalloids used is one of the key risk factors for developing the syndrome in patients with multiple injury patients. This is associated with significant morbidity and mortality. The implementation of crystalloid restriction preoperatively has been shown to lower the morbidity associated with nausea and vomiting. It hastens the healing process and recovery of bowel motions. All this helps shorten the number of admission days postoperatively (Nisanevich, Felsenstein, & Almogy, 2005). Compared to colloids, crystalloids need higher volumes to achieve an equivalent volume replacement during resuscitation. High dose infusions of >30ml/kg of normal saline cause hyperchloremic metabolic acidosis that could be detrimental in patients with shock. This is however not observed in Ringers Lactate (Scheingraber, Rehm, & Finsterer, 1999). This is probably because its chloride levels are almost equivalent to plasma levels. Lactate ions too help, and those large volumes may be a risk of alkalosis.

Ringer’s lactate is not indicated in patients with hyperkalemia. This is because of potassium levels in its concentration. Studies have also shown the presence of hyperkalemia in more patients under normal saline infusion than those under Ringer’s Lactate. This was in a study done to compare Ringers Lactate and normal saline (O’Malley, Frumento, & Hardy, 2005). Ringers Lactate has been shown to cause hyponatremia and a low osmolarity, which is harmful to patients with head injury patients.

Several studies have been done in trying to compare the use of colloids and crystalloids as fluids of resuscitation. In a study conducted in 1989, differences were observed in trauma and septic randomly sampled patients. Amongst trauma patients, there was a 12.3% mortality difference that favored the use of crystalloids as a reliable means of resuscitation. This demonstrated that crystalloids were better in hypovolemic patients. However, in septic patients, the mortality difference was 7.8% favoring the use of colloids as a better resuscitative fluid in septic patients. This was explained by the presence of an increased capillary permeability that leads to the leakage of crystalloids (Velanovich, 1989). In another study in 1998 in trauma, burns, and septic patents, colloids were found to have higher mortality over 4% (Schierhout & Roberts, 1998).

Use of Colloids

There is wide use of colloids in trauma resuscitation they are recommended in several guidelines and algorithms that are still in use (Armstrong, 1994). Colloids are classified as either protein or non-protein colloids. Albumin and gelatin solutions are the protein colloids whereas dextran and starches are non-protein. They can also be classified as synthetic and non-synthetic. Gelatins, starches, and dextran are synthetic whereas albumin is processed from plasma. In a study trying to find the possible causes of hemorrhage in cardiothoracic operations, it was concluded that among other risk factors, the use of Hetastarch was a risk factor for the bleeding observed postoperatively.

This has led to the concern that synthetic colloids are associated with hemorrhage hence their use in trauma is now being limited (Herwaldt et al., 1998). Colloids are also more expensive than crystalloids and the use of blood makes their use more controversial. They however remain intravascular for a longer duration than crystalloids. They are therefore less likely to cause edema after infusion. A lesser infusion volume is needed to achieve a similar volume of expansion. Cases of anaphylaxis have been reported with their use. This has particularly been observed with Pentastar in asthmatic patients. A dose-related coagulopathy has been reported with the use of Hetastarch. Some studies have also associated starches with end-organ damage. For instance, starch molecules have been reported to be a cause of renal tubular injury leading to acute renal failure.

In 2004 and 2007, studies by the Cochrane group in 8000 patients in trauma, surgery, and burns put up a different argument. Colloids had no superiority to crystalloids in those patients. They had no particular improvement in the mortality and morbidity of patients despite being expensive (Roberts, Alderson, & Bunn, 2004). A similar conclusion was made by the SAFE study in 2004 where 7000 patients were used in a randomized study. This was a comparison between isotonic saline and albumin (Finfer, Bellomo, & Boyce 2004). These more current demonstrated no difference between the two fluids apart from the fact that crystalloids were more affordable.

Colloids have a more rapid and higher volume expansion property than crystalloids. In a study in 2003, differences between the rate and volume of expansion were established when a crystalloid (Ringer’s lactate) and a Colloid (Hetastarch) were infused in 8 healthy subjects. 900mL of blood was withdrawn from them before the infusion to achieve moderate hypovolemia. An intravascular volume of 1000mL with each of the solutions was achieved through infusion over 5-7 minutes.

Peak expansion volumes were then obtained by hematocrit after 5 minutes. Ringer’s lactate had 630 ± 127 mL volume expansion compared to Hetastarch 1123 ± 116 mL after 5 minutes. This was suggestive of a rapid increase in volume in the colloids after a short time compared to crystalloids even when rapidly administered (McIlroy & Kharasch, 2003). This makes colloids more reliable in the resuscitation of severely hypovolemic post-trauma patients than crystalloids. Other studies have also demonstrated that colloids are at least two times more effective in plasma expansion than crystalloids (Wills, Nguyen, & Ha 2005). According to the current guidelines, the severity of hypovolemia is used as a basis for deciding on the choice between crystalloids and colloids as a resuscitation agent in trauma. Colloids are used in severe cases whereas crystalloids are in mild and severe cases.

Studies have demonstrated both anti-inflammatory and antioxidant characteristics in albumin. This is because of its inherent ability to increase the level of thiols in plasma after an infusion. It also increases the levels of glutathione in the lung. These multiple physiological properties help in reducing inflammation that usually follows tissue injury after trauma. This property gives it an advantage over the use of crystalloids (Quinlan et al., 2004).

Use of Blood Replacement

Blood transfusion is trauma is lifesaving when all the safety measures are observed to the later. Whole blood or its specific components can also be transfused to address specific deficiencies and to avoid wastage. Fractionated components include platelet concentrates, which addresses platelet dysfunction and deficiencies. Fresh frozen plasma helps replace coagulation factors. Cryoprecipitate is also another component that is important in fibrinogen deficiency. Packed red blood cells are used in patients whose hemoglobin levels have fallen below 6g/dl. Indications of whole blood transfusion include active bleeding leading to shock and at times clinical evidence of hypoxia in critical care. It is also indicated in several forms of anemia.

Most severe traumatic incidences are accompanied by a “lethal triad.” This is descriptive of acutely developed coagulopathy that leads to bleeding, low body temperatures (hypothermia), and metabolic acidosis. Bleeding during trauma leads to hypoperfusion due to blood volume loss. This results in reduced oxygen delivery to tissues leading to anaerobic respiration due to tissue hypoxia. This presents lactic acidosis with increased lactic acid production. Hypothermia develops due to the administration of cold resuscitation fluids and anaerobic respiration that limits heat production. In a study, temperatures less than 35oC was found to be a risk factor to mortality in patients (Martin et al., 2005). An acute coagulopathy also develops immediately due to procoagulant protease loss due to consumption and bleeding (Brohi, Singh, Heron, & Coats, 2003). All these factors in the lethal tried if not addressed well in the management of trauma patients have a poor prognostic index (Moore & Thomas, 1996).

Blood transfusion reactions do occur and carry a high risk of morbidity and mortality if safety measures are not observed. These range from febrile reactions that are self-limited to life-threatening hemolytic reactions. Statistics from the Centre for Disease Control (CDC) in the U.S.A indicate that hemolytic reactions have been recorded at a rate of 1 case of reaction in 40,000 units of packed red blood cells transfused. Febrile reactions have been noted as being the most occurring reaction together with minor allergic reactions. They do occur in up to 3-4% of recorded blood transfusions. Anaphylaxis too has been recorded at a rate of 1 case in 20,000 transfusions. Graft vs. Host disease is relatively well controlled with recorded cases being < 0.15%. Acute lung injury has been diagnosed in only 0.1-0.2% transfusions. The majority of the transfusion-related infections are hepatitis B and C. The risk attached to HIV infection is 1 in every 150,000 transfused units of blood. These statistics show how significant blood reactions occur during a blood transfusion. Safe transfusion practices, therefore, need to be practiced to the latter to avoid them.

Blood Transfusion Reactions
Immediate

  • Febrile Reactions
  • Urticaria (Allergic) Reactions
  • Severe Allergic (Anaphylactic) Reactions
  • Acute Hemolytic Reactions
  • Bacterial Contamination
  • Transfusion-Related Acute Lung Injury
  • Volume Overload
  • Hypothermia
  • Citrate Toxicity
  • Potassium Effects

Delayed and Long Term

  • Delayed Hemolysis
  • Alloimmunization
  • Transfusion-associated Graft Versus Host Disease
  • Immunomodulatory effects
  • Iron accumulation
  • Infectious Disease transmission

Table 1: Transfusion Reactions. Source: (Kirkman, et al., 2008).

Several strategies have been put in place to counter the lethal triad. It has been established that rapid management and control of coagulopathy carries a far much better prognosis in trauma patients (Kirkman et al., 2008). Immediate and steadfast use of blood and its products after trauma has been noted as an important step in the management of trauma to replace lost coagulant factors. Fluid resuscitation alters the clotting process by diluting the coagulation factors. This may aggravate the bleeding process. These fluids should therefore be restricted until bleeding is controlled. The coagulopathy may also be controlled using blood components like FFP, cryoprecipitate, and platelets. All these strategies should however proceed simultaneously with damage control surgery (Jansen et al., 2009). This is a major reason advocating for the use of blood transfusion in preference to crystalloids in post-trauma resuscitation.

The optimum use of blood in resuscitation has no edematous effects like the ones recorded in the use of crystalloids. However, overzealous transfusion can lead to heart failure leading to generalized body edema. In a study, the use of crystalloids during emergency resuscitation of head injury in rats made worse the already present cerebral edema. Mesenteric edema was also recorded in the same study. This was however of little significance when it was substituted with blood (Drummond, Patel, Cole, & Kelly, 1998).

Conclusion

Hemorrhage has been acknowledged as the leading cause of mortality and morbidity in trauma patients. Proper management of trauma with particular emphasis on blood volume replacement is therefore essential. The choice between the use of blood, colloids, and crystalloids has raised a raging debate. The use of blood has been encouraged because of its ability to manage the lethal triad noted immediately after trauma. It controls the acute coagulopathy and restores perfusion to help acutely reduce metabolic acidosis. Blood transfusion can however be accompanied by adverse effects if safe practices are not followed to the later. The use of colloids has its positives in quick and constant volume expansion. Albumin too has an inherent anti-inflammatory ability. Colloids are however expensive rendering them unaffordable and having no effect on mortality and morbidity when compared to crystalloids. Crystalloids are cheaper but need to be given in more volumes to achieve volume expansion. They are also associated with edematous states especially on the gastrointestinal system.

References

Armstrong, R. F., Bullen, C., Cohen, S. L., Singer, M., & Webb, A. R. (1994) Critical Care Algorithms. Oxford: Oxford University Press.

Balogh, Z., McKinley, B. A., & Cocanour, C. S. (2003). Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Archives of Surgery, 138(1), 637–643.

Brohi, K., Singh, J., Heron, M., & Coats, T. (2003) Acute traumatic coagulopathy. Journal of Trauma, 54(1), 1127-1130.

Drobin, D., & Hahn, R. G. (1999). Volume kinetics of Ringer’s solution in hypovolemic volunteers. Journal of Anesthesiology, 90(1), 81–91.

Drummond, J. C., Patel, P. M., Cole, D. J., & Kelly, P. J. (1998). The effect of the reduction of colloid oncotic pressure, with and without reduction of osmolality, on posttraumatic cerebral edema. Journal of Anesthesiology, 88(1), 993–1002.

Herwaldt, L. A., Swartzendruber, S. K., Edmond, M. B., Embrey, R. P., Wilkerson, K. R., Wenzel, R. P., & Perl, T. M. (1998). The epidemiology of hemorrhage related to cardiothoracic operations. Infection Control Hospital Epidemiology Journal, 32(1), 755-759.

Jansen, J. O., Rhys, T., Malcolm, A. L., & Brooks, A. (2009). Damage control resuscitation for patients with major trauma. British Medical Journal, 338(1), 1778-1783.

Kirkman, E., Watts, S., Hodgetts, T., Mahoney, P., Rawlinson, S., & Midwinter, M. (2008). A proactive approach to the coagulopathy of trauma: The rationale and guidelines for treatment. Journal of the Royal Army Medical Corps, 153(1), 302-306.

Martin, R. S., Kilgo, P. D., Miller, P. R., Hoth, J. J., Meredith, J. W., & Chang, M. C. (2005). Injury associated hypothermia: An analysis of the 2004 national trauma data bank. Critical Care Medicine, 24(1), 114-118.

McIlroy, D. R., & Kharasch, E. D. (2003). Acute intravascular volume expansion with rapidly administered crystalloid or colloid in the setting of moderate hypovolemia. Journal of Anesthesiology. 96(1), 1572–1577.

Moon, P. F., Hollyfield-Gilbert, M. A., Myers, T. L., & Kramer, G. C. (1994).Effects of isotonic crystalloid resuscitation on fluid compartments in hemorrhaged rats. Journal Intensive Care Medicine, 2(1), 355–361.

Moore, E. E., & Thomas, G. (1996). Staged laparotomy for the hypothermia, acidosis, and coagulopathy syndrome. America Journal of Surgery, 172(1), 405– 410.

Nicola, C., Hopewell, S., Dorée, C., Hyde, C., Brohi, K., & Stanworth, S., (2011) The acute management of trauma hemorrhage: a systematic review of randomized controlled trials. Journal of Critical Care,15(2), 1750-1762.

Nisanevich, V., Felsenstein, I., & Almogy, G. (2005). Effect of intraoperative fluid management on outcome after intraabdominal surgery. Journal of Anesthesiology, 103(1), 25–32.

O’Malley, C. M., Frumento, R. J., & Hardy, M. A. (2005). A randomized, double-blind comparison of lactated Ringer’s solution and 0.9% NaCl during renal transplantation. Journal of Anesthesiology, 100(1), 1518–1524.

Quinlan, G. J., Mumby, S., Martin, G., S., Bernard, G. R, Gutteridge, J. M., & Evans, T. W. (2004). Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury. Critical Care Medicine, 32(3), 755-792.

Roberts, I., Alderson, P., & Bunn, F. (2004). Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database System.

Scheingraber, R., & Finsterer, U. (1999) Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Journal of Anesthesiology, 90(1), 1265–1270.

Schierhout, G., & Roberts, I. (1998). Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: A systematic review of randomized trials. British Medical Journal, 316(1), 961–964.

Schortgen, F., Deye, N., & Brochard, L. (2004). Preferred plasma volume expanders for critically ill patients: Results of an international survey. Journal Intensive Care Medicine, 30(8), 2222–2229.

Wills, B. A., Nguyen, M. D., & Ha T. L. 2005. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. New England Journal of Medicine, 353(1) 877–89.

Velanovich, V. (1989). Crystalloid versus colloid fluid resuscitation: a meta-analysis of mortality. Archives of Surgery, 105(1), 65–71.

The Disney Difference: Making Magic Happen

Magic is something that everyone around the world loves to get no matter how. Hence, Walt Disney Corporation (Disney) aims at doing it for society everywhere. Therefore, this essay will provide information about the Disney Difference and its effects on its corporate, competitive, and functional strategies. It will then highlight issues like the challenges the corporation might be facing while operating in Russia and China. Also, the ways the management could best equip themselves against those difficulties and the strategies they might use to maintain the company’s successes will be examined. The paper will conduct some research on the CEO’s succession.

Disney Difference is the high-quality content supported by a Consistent approach to optimize quality across audiences and markets. From now on, its corporate strategy will be affected, and in that, it will have to widen its client base. This would involve the corporate heads deciding which products would generate the most money in Hong Kong (Bedford & Aksu, 2018). Regarding Walt Disney’s competitive strategy, they will be required to enter some of the potential markets such as Russia, where they intend to establish their new broadcasting channel. The company discovered an opportunity and decided to pursue it. Bob Iger, the CEO since 2005, noticed how important media areas were and leveraged the company’s vast media content on different platforms. The Disney Difference would impact the company’s practical approach so that it has to look for alternative means of advertising. With the current state of the economy globally, the company would be required to conduct extensive marketing to maintain its client base.

Disney has a challenging task ahead of them after announcing the move to Russia. Since the fall of 2008, the Russian stock market was closed almost every other day, and their stock was down considerably. US and Russian relations are not stable, and they have never been. On some level, they will have to deal with the communist government too. It means that anything they would intend to broadcast will have to be scrutinized by the government. There are media content rules in Russia. In addition, Disney invested an immense amount of money in Hong Kong. Iger and his team should use the strategic management process, beginning with their mission statement, next doing an external analysis, followed by an internal analysis, and lastly formulate strategies, implementing them. and evaluating the attained results.

Disney’s move to Hong Kong should involve setting both strategic and financial goals. For example, their strategic objectives would necessitate producing more miniature figurines because the external analysis performed revealed that the neighboring companies faltered in manufacturing enough of that merchandise. They would need a mission statement that pertains to what they would like to do in Hong Kong, as well as a list of real goals (Gnizy & Shoham, 2018). Disney will need to continually assess their employees, ensuring that whatever they desire is being done.

They would have to apply the strategic management process for Iger and his group to maintain the ‘magic’ flowing. It is a process that includes strategy, planning, implementation, and evaluation. Beginning with the first one, one must create a mission statement. It should, for instance, include something like, “We will show you the hottest trends among children in the western world by keeping the magic coming” (Alaux & Boutard, 2017). Next, they would have to conduct an external analysis. In this stage, the company will acquire the necessary information to know its competitors better. It would also present opportunities to capitalize on those threats which would reveal their strengths and weaknesses.

With this knowledge, they could particularly identify exactly which products need to be manufactured in the majority and which ones would be produced elsewhere. The next step would be for the company to formulate a strategy. It is here where they will have to apply all the information they got from their external and internal analyses. After that, the implementation phase would follow, where the organization would implement the strategy they had developed. The evaluation of the results would be the last step, where the management takes comprehensive scrutiny at everything that has been analyzed, formulated, and implemented and evaluate the outcomes. To keep the magic coming, Disney will need to apply these six steps to its business practices effectively in the current economic climate.

After evaluating how the corporation is preparing to enter the Russian market, I would advise the board of directors to keep the process simple but at the same time unique by adhering to both their brand image and company culture. For the CEO’s succession, the company ought to understand that each leader brings in a different style of leading, and it would be a challenge for the people who work with the new CEO to acclimatize to that altered way of undertaking things. The board would also have to look for someone who shares the same core traits that the current boss has, to maintain the company’s efficiency (Alaux & Boutard, 2017). The new CEO should possess the same qualities in adaptability, insight, trustworthiness, charisma, problem-solving.

In conclusion, Disney corporation’s management should understand that established brand recognition and loyalty are immeasurable. This is because clients tend to identify themselves with brands that they deem to be their favorite. This trust and dedication are also built over the years, and it is incredibly hard to break this allegiance. To have a genuine chance of contending with those reputable entities, one needs a comprehensive approach that will permit one’s product to stand out within the marketplace. The company did recognize this and decided to use the right procedure before they could enter the new market.

References

Alaux, C., & Boutard, L. (2017). Place attractiveness and events: From economic impacts to place marketing. Journal of International Business Research and Marketing, 2(4), 25-29.

Bedford, N., & Aksu, B. (2018). Post-2015 strategies to improve business models incorporate Turkey. Innovative Marketing, 14(3), 1-7.

Gnizy, I., & Shoham, A. (2018). The power of international marketing functions: Antecedents and consequences. Journal of Business-to-Business Marketing, 25(2), 67-89.

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