According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

To provide an update to “Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012”. A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

https://link.springer.com/content/pdf/10.1007%2Fs00134-017-4683-6.pdf

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Established in 2006, TATA Africa Services (Nigeria) Limited operates as the nodal point for Tata businesses in West Africa. TATA Africa Services (Nigeria) Limited has a strong presence in Nigeria with investments exceeding USD 10 million. The company was established in Lagos, Nigeria as a subsidiary of TATA Africa Holdings (SA) (Pty) Limited, South Africa and serves as the hub of Tata’s operations in Nigeria and the rest of West Africa.

What About Us

Qualitative researchers rely — implicitly or explicitly — on a variety of understandings and corresponding types of validity in the process of describing, interpreting, and explaining phenomena of ...

Understanding and Validity in Qualitative Research

Climate change 2014 - Synthesis Report

Acute medicine is the fastest growing medical speciality in the UK and acute medical units, which provide the best possible care for acutely unwell medical patients, are increasingly common.

A guide to the acute medical unit

Concerns about quality and safety highlight the need for further evaluation

Telephone triage, both for in hours and out of hours consultations, has increased dramatically in recent years, and in many respects this is welcome. Telephone consulting can improve access to care for many patients,1 and out of hours care provided by call centres in particular can improve the efficiency of healthcare provision.2 Several unanswered questions remain, however, with respect to the quality and safety of such clinical encounters because of the relative paucity of evidence on this mode of consulting.3

The linked study by Derkx and colleagues (doi: 10.1136/bmj.a1264) highlights the potential shortcomings of telephone based consultations in the context of out of hours triage of patients in the Netherlands.4 Strengths of the study include a carefully considered sampling strategy of call centres and the use of standardised clinical encounters using simulated patients.

Out of hours consultations are …

Telephone triage in out of hours call centres

Aim

To determine if hospital admission rates for diabetes complications (acute complications, chronic complications, no complications and hypoglycaemia) were associated with primary care diabetes management.



Methods

We performed an observational study in the population in England during the period 2004–2009 (54 741 278 people registered with 8140 general practices). We used multivariable negative binomial regression to model the associations between indirectly standardized hospital admission rates for complications and primary healthcare quality, supply and access indicators, diabetes prevalence and population factors.



Results

In multivariate regression models, increasing deprivation (incidence rate ratio: 1.0154; P < 0.001, 95% CI 1.0141–1.0166) and diabetes prevalence (incidence rate ratio: 1.0956; P < 0.001, 95% CI 1.0677–1.1241) were risk factors for admission, while most healthcare covariates, i.e. a larger practice population (incidence rate ratio 0.9999, P = 0.013, 95% CI 0.9999–0.9999), better patient-perceived urgent and non-urgent access to primary care (incidence rate ratio: 0.9989, P = 0.023; 95% CI 0.9979–0.9998 and incidence rate ratio: 0.9988; P = 0.003, 95% CI 0.9980–0.9996, respectively) and better HbA1c target achievement (incidence rate ratio: 0.9971; P < 0.001, 95% CI 0.9958–0.9984), were protective. Diabetes admissions decreased significantly during the period 2004–2009.



Conclusions

After controlling for population factors, better scheduled primary care access and glycaemic control were associated with lower hospital admission rates across most complications. There is little rationale to restrict primary care-sensitive condition definitions to acute complications. They should be revised to improve the usefulness of hospital admission data as an outcome measure, and to facilitate international comparisons. The risk of emergency hospital admission should be monitored routinely.

/pdf/does-higher-quality-of-primary-healthcare-reduce-hospital-418l9il4vp.pdf

Does higher quality of primary healthcare reduce hospital admissions for diabetes complications? A national observational study

Host cell proteins (HCPs) are endogenous impurities, and their proteolytic and binding properties can compromise the integrity, and, hence, the stability and efficacy of recombinant therapeutic proteins such as monoclonal antibodies (mAbs). Nonetheless, purification of mAbs currently presents a challenge because they often co-elute with certain HCP species during the capture step of protein A affinity chromatography. A Quality-by-Design (QbD) strategy to overcome this challenge involves identifying residual HCPs and tracing their source to the harvested cell culture fluid (HCCF) and the corresponding cell culture operating parameters. Then, problematic HCPs in HCCF may be reduced by cell engineering or culture process optimization. Here, we present experimental results linking cell culture temperature and post-protein A residual HCP profile. We had previously reported that Chinese hamster ovary cell cultures conducted at standard physiological temperature and with a shift to mild hypothermia on day 5 produced HCCF of comparable product titer and HCP concentration, but with considerably different HCP composition. In this study, we show that differences in HCP variety at harvest cascaded to downstream purification where different residual HCPs were present in the two sets of samples post-protein A purification. To detect low-abundant residual HCPs, we designed a looping liquid chromatography-mass spectrometry method with continuous expansion of a preferred, exclude, and targeted peptide list. Mild hypothermic cultures produced 20% more residual HCP species, especially cell membrane proteins, distinct from the control. Critically, we identified that half of the potentially immunogenic residual HCP species were different between the two sets of samples.

/pdf/mild-hypothermic-culture-conditions-affect-residual-host-3swowwmcg5.pdf

Mild hypothermic culture conditions affect residual host cell protein composition post-Protein A chromatography.

Phrenic nerve trauma in the absence of direct injury is unusual and may present diagnostic difficulty. Diaphragmatic paralysis resulting from phrenic nerve injury may closely mimic diaphragmatic rupture. This case highlights the value of magnetic resonance imaging in establishing diaphragmatic integrity and of ultrasonographic assessment during respiratory excursion in confirming diaphragmatic paralysis. In cases of non-contact injury involving torsional injury to the neck, an index of clinical awareness may help to establish the diagnosis of phrenic nerve trauma.

https://emj.bmj.com/content/emermed/17/6/419.full.pdf

Derek Bell

Papers

A guide to the acute medical unit

Telephone triage in out of hours call centres

Does higher quality of primary healthcare reduce hospital admissions for diabetes complications? A national observational study

Mild hypothermic culture conditions affect residual host cell protein composition post-Protein A chromatography.

Phrenic nerve injury following blunt trauma