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

Background: This study aimed to show that pulmonary BA of FP and FORM via the BTI (Flutiform® K‑haler®) was no less than via pMDI without a spacer, to establish a bridge from the efficacy of the pMDI to the BTI (EudraCT: 2012-003728-19). Methods: Single-dose, randomised, open-label, 3 treatment, 3 period, cross-over study in healthy adults. Treatments were FP/FORM 125/5µg, 2 puffs via BTI, pMDI or pMDI with spacer (pMDI+S). To measure pulmonary BA only, all subjects ingested charcoal suspension pre-dose and at 15min and 1h post-dose. The primary objective was to compare relative BA of FP and FORM via BTI and pMDI (secondary objectives included BTI vs pMDI+S). Acceptable pulmonary BA was concluded if the lower limit of the confidence intervals (CIs) of the BAI/pMDI ratios were ≥80%. Blood samples were taken pre-dose and for 36h post-dose. Results: Of 47 subjects randomised, 45 (95.7%) completed. The AUCt and Cmax ratios of BTI:pMDI for both FP and FORM analytes were between 107-131%. As the lower limits of the CIs of all BTI:pMDI ratios were >80% the study goal was met (Table). Conclusion: Pulmonary BA of FP/FORM via BTI was no less than via pMDI without spacer, indicating that the Flutiform K-haler product would be at least as effective as pMDI. Sponsor: Mundipharma Research Ltd Table. BA comparisons

Relative pulmonary bioavailability (BA) of fluticasone propionate/formoterol (FP/FORM) via pressurised metered-dose inhaler (pMDI) and a novel breath-triggered inhaler (BTI)

The production and use of malaria rapid diagnostic tests (RDTs) has risen dramatically over the past 20 years. In view of weak or non-existing in vitro diagnostics (IVD) regulations and post-marketing surveillance (PMS) systems in malaria endemic countries, the World Health Organization, later joined by the Foundation for Innovative New Diagnostics, established an independent, centralized performance evaluation and Lot Testing (LT) programme to safeguard against poor quality of RDTs being distributed through the public health sector of malaria endemic countries. RDT performances and manufacturer quality management systems have evolved over the past decade raising questions about the future need for a centralized LT programme. Between 2007 and 2017, 6056 lots have been evaluated, representing approximately 1.6 Billion RDTs. A total of 69 lots (1.1%) failed the quality control. Of these failures, 26 were detected at receipt of the RDT lot in the LT laboratory, representing an estimated 7.9 million poor quality RDTs, and LT requesters were advised that RDTs were not of sufficient quality for use in patient management. Forty-three were detected after long-term storage in the laboratory, of which 24 (56%) were found to be due to a major issue with insufficient buffer volume in single use buffer vials, others predominantly showing loss of sensitivity. The annual cost of running the programme, based on expenses recorded in years 2014–2016, an estimated volume of 700 lots per year and including replenishment of quality control samples, was estimated at US$ 178,500 ($US 255 per lot tested). Despite the clear benefits of the centralized LT programme and its low cost compared with the potential costs of each country establishing its own PMS system for RDTs, funding concerns have made its future beyond 2020 uncertain. In order to manage the risks of misdiagnosis due to low quality RDTs, and to ensure the continued safety and reliability of malaria case management, there is a need to ensure that an effective and implementable approach to RDT quality control continues to be available to programmes in endemic countries.

/pdf/keep-the-quality-high-the-benefits-of-lot-testing-for-the-vqpt6xqcr0.pdf

Keep the quality high: the benefits of lot testing for the quality control of malaria rapid diagnostic tests

The structural organization of the Golgi stacks in mammalian cells is intrinsically linked to function, including glycosylation, but the role of morphology is less clear in lower eukaryotes. Here we investigated the link between the structural organization of the Golgi and secretory pathway function using Pichia pastoris as a model system. To unstack the Golgi cisternae, we disrupted 18 genes encoding proteins in the secretory pathway without loss of viability. Using biosensors, confocal microscopy and transmission electron microscopy we identified three strains with irreversible perturbations in the stacking of the Golgi cisternae, all of which had disruption in genes that encode proteins with annotated function as or homology to calcium/calcium permeable ion channels. Despite this, no variation in the secretory pathway for ER size, whole cell glycomics or recombinant protein glycans was observed. Our investigations showed the robust nature of the secretory pathway in P. pastoris and suggest that Ca2+ concentration, homeostasis or signalling may play a significant role for Golgi stacking in this organism and should be investigated in other organisms.

Knockout of RSN1, TVP18 or CSC1‐2 causes perturbation of Golgi cisternae in Pichia pastoris

https://www.bmj.com/content/bmj/s1-10/29/338.full.pdf

On the Objects of the Provincial Medical and Surgical Association

Most examples of the use of quality improvement (QI) methodologies currently come from acute care. They often demonstrate more efficient processes, improved staff morale and patient satisfaction and better health outcomes for specific service users but they are rarely able to indicate whether a service improvement has impacted on the population as a whole by targeting those most in need, improving access or identifying which aspects of service provision should be top priorities for improvement.

One way of addressing this is to set QI in the context of whole populations. The practicalities of introducing a more strategic approach are not easy, and it requires innovative new partnerships, but there are well-established proxy measures of healthcare needs. Mapping data geographically can help identify ‘hot spots’ of high incidence or prevalence or areas of low service usage where high need would be expected. Adopting this approach has significant potential for ensuring that services are provided more appropriately and efficiently and for improving population health overall.

The benefits that modern medicine can bring to society have not been fully realized. The knowledge, therapies and technology is there, but we fall down on implementation. We have systems that are unreliable from day to day and which do not deliver complete care. In the USA, for example, patients receive just over half of the interventions they need, regardless of insurance status [1]. The shortfall is …

Derek Bell

Papers

Relative pulmonary bioavailability (BA) of fluticasone propionate/formoterol (FP/FORM) via pressurised metered-dose inhaler (pMDI) and a novel breath-triggered inhaler (BTI)

Keep the quality high: the benefits of lot testing for the quality control of malaria rapid diagnostic tests

Knockout of RSN1, TVP18 or CSC1‐2 causes perturbation of Golgi cisternae in Pichia pastoris

On the Objects of the Provincial Medical and Surgical Association

Aligning quality improvement to population health