Cirrhosis with complications of portal hypertension portends a poor prognosis. Transjugular intrahepatic portosystemic shunts (TIPS) can successfully treat some of these complications in select patients. While the safety and efficacy of TIPS have improved significantly over the past decade, certain patients are categorized as high-risk based on various demographic, laboratory, and comorbid factors. Herein, we provide an in-depth review of TIPS in these settings, including high model for end-stage liver disease score, hepatic malignancy, advanced age, cardiac disease, renal dysfunction, and pregnancy, and discuss their impact on patient selection and procedural considerations.

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<p><b>Discretion is inevitable when public policy is implemented and is closely linked to policy success. It is a controversial phenomenon in Vietnam, a one-party state and developing country. Scholars often call out the discretion of local governments as a critical reason for policy failure, attributing to it the wide gap between policy intentions and policy outcomes. However, Vietnam’s unique political system, economic and sociocultural conditions, and accountability systems also pose challenges to analysing policy implementation and attributing success to policies. These observations led to the overall research question: What influences the operation of local discretion in policy implementation, and what are the implications?</b></p> <p>“Local discretion” is introduced to add precision to a Vietnamese concept of discretion, which recognises local governments rather than individual public officials, as is predominant in Western literature, as a subject of the exercise of discretion. Following a review of literature on policy success and failure, and on accountability, a framework for analysis was developed to support a qualitative and inductive investigation of a case through three sub-questions: (1) What are the local settings for policy implementation?; (2) How do local governments and local officials respond to these settings, and with what effects on policy implementation?; and (3) What other factors affect local governments’ and public officials’ responses?</p> <p>The selected case study examined changes between 2002 and 2020 in policies to provide farmland, residential land, housing, and sanitary water for poor ethnic minorities, referred to for brevity as farmland policy, in two provinces, Thua Thien Hue and Gia Lai, allowing some embedded comparison. Empirical work included the thematic analysis of documents and 22 semi-structured interviews.</p> <p>Four main findings emerged from the research. First, local settings for policy implementation in Vietnam give rise to significant challenges. As frequently noted in the Western literature, local governments and officials experience unclear goals, high service demands, and limited resources. However, the case also shows that local governments and officials deal with supply–demand mismatches, unsustainable investments, complex legal procedures, delayed and vague policy implementation guidance, and weak governance. Second, in response to these local settings, local governments and officials take discretionary actions, referred to as “flexibility”, “proactivity”, or “creativity”, to make the policy more suitable for the local context and workable for local governments to implement. This finding aligns with the literature on street-level bureaucrats, with their considerable, and often necessary, discretion on how to implement policy. Third, local discretion is both positive and negative for policy implementation. Local discretion brings policy to life by making a “one size fits all” policy, mandated by the Central Government, suitable to local contexts. However, local discretion limits policy effectiveness, focusing more on the short-term rather than the long-term. These findings confirm that local discretion is not only inevitable but also significant for policy implementation. In addition, the findings align with the perspective that local discretion can be both bad and good for policy implementation. Fourth, the research contributes to the literature when indicating that accountability, both external and internal, influences local governments’ and officials’ local discretion. Notably, local government leaders pursue a policy’s goals using vertical pressure and authority to motivate the actions of both vertical and horizontal actors, as well as being driven by an internal sense of responsibility. In addition, there is a lack of incentives to enforce accountability. </p> <p>This research contributes to knowledge and practice in several ways. It describes how Vietnam responded to poverty and landlessness among ethnic minorities between 2002 and 2020. Significantly, it offers a relevant framework for analysing local discretion, which may be applied to Vietnam and other one-party states and developing countries. Through an empirical investigation, the research explores the mechanisms through which local discretion takes place in Vietnam. As a result, the concept of local discretion is clearly defined as follows:local discretion is local governments' and public officials’ responses to the challenging local settings for policy implementation regarding how to interpret and implement policies mandated by the Government in their localities.</p> <p>The empirical fieldwork also contributes to the knowledge about the Vietnamese implementation literature; that is, local discretion is more complicated and can no longer be claimed as generally true, or without more careful study, that discretion leads to policy failure. Notably, the research offers scholars and others a base for considering how to improve Vietnamese policy design, implementation, and evaluation practice. Finally, at a more general level, it offers insight into how a one-party state in a developing country addresses the question of policy implementation.</p>

In the context of managerial effectiveness, self-management is an important variable which helps employee fully accountable and responsible for making and keeping commitments to improve individual performance. This opens many opportunities and challenges for tourism and hospitality organizations of high power distance culture such as Vietnam to take advantages of well-performed employee to be competitive in the market. In an effort to help local tourism and hospitality companies to have an overview about employees’ behavior in working performance, this study examined the consequences of front-line service employee self-management in the tourism and hospitality organizations in HCM City, Vietnam. Employing the CFA and SEM analyses, the research findings indicated the positive relationships among self-management, psychological empowerment, self-efficacy; and these antecedents had a significant impact on job performance of Vietnamese employees. The study also points out useful managerial implications to help managers use suitable human resource management (HRM) strategies to gain employee self-management and job performance in tourism and hospitality industry