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

Objective To ascertain the impact of the introduction of a unitary patient record (UPR) on clerking documentation of emergency medical admissions. Design Retrospective casenote audit. Subjects and setting Random sample of 100 unselected admissions to the medical assessment unit of a major teaching hospital, comprising two groups pre- and post-introduction of the UPR. Results Statistically significant improvements in the documentation of several items were achieved; function before episode, ethnic origin, chest pain, breathlessness, ankle oedema, cough, bowel habit and locomotor symptoms and recording of blood pressure and peripheral pulses. There were trends towards improvement in other areas and there were no areas in which the UPR performed less well than standard documentation. Conclusions Introduction of the UPR represents the successful application of multidisciplinary principles to over 10,000 acute general medical admissions. It has improved some, but not all, aspects of documentation. Revision of the design of the UPR should lead to further progress, as part of an ongoing process of development and re-audit.

A unitary patient record improves admission documentation in a medical assessment unit in a major teaching hospital.

Live clinical trials of e-Health infrastructures require extensive testing and evaluation prior to legal and ethical approval. This paper presents the Patient Simulator, a method for simulating patient data catered towards evaluating e-Health infrastructures and services in regards to efficiency, reliability, security and scalability at an early stage without the need to use real patient data. Using discrete event based simulation in conjunction with random normal distribution techniques, preliminary prototyping of the Patient Simulator shows that it is capable of generating five vital physiological signs including heart rate, blood pressure, body temperature, oxygen levels and respiration rate. In conducting a comparison of simulated heart rate against real-life heart rate samples, evaluation shows that this technique enables generation of values which resemble real life patients. Future work will be carried out to improve upon the methodology of patient simulation along with conducting comprehensive testing and validation of e-Health infrastructures.

Patient simulator: towards testing and validation.

This paper outlines a structured argument for the use of routine health and demographic data to support the delivery of equitable services that are better aligned to the needs of the populations they serve. The paper describes case studies from a nationally funded research and quality improvement programme in London, UK as examples of targeting existing services, without top-down reconfiguration, using quality improvement methodology.Three case studies are presented each demonstrating a differing use of geocoded routine data. The first demonstrates the use of a novel composite metric for the prospective targeting of service improvement; the second shows how routine geo-coded health data can be used to support the geographical location of services; the third demonstrates how routine data can be used to evaluate the impact of improvement initiatives on disparities in healthcare. All methods provide a novel way of analyzing current service provision to ensure targeting of services where needed and contributing to the quality and cost challenges faced by healthcare providers and commissioners.

Using routine geo-coded data to identify geographical heterogeneity to reduce disparities: case studies in UK

Background Identifying older people with clinical frailty, reliably and at scale, is a research priority. We measured frailty in older people using a novel methodology coding frailty syndromes on routinely collected administrative data, developed on a national English secondary care population, and explored its performance of predicting inpatient mortality and long length of stay at a single acute hospital. Methodology We included patient spells from Secondary User Service (SUS) data for those ≥65 years with attendance to the emergency department or admission to West Middlesex University Hospital between 01 July 2016 to 01 July 2017. We created eight groups of frailty syndromes using diagnostic coding groups. We used descriptive statistics and logistic regression to explore performance of diagnostic coding groups for the above outcomes. Results We included 17,199 patient episodes in the analysis. There was at least one frailty syndrome present in 7,004 (40.7%) patient episodes. The resultant model had moderate discrimination for inpatient mortality (area under the receiver operating characteristic curve (AUC) 0.74; 95% confidence interval (CI) 0.72–0.76) and upper quartile length of stay (AUC 0.731; 95% CI 0.722–0.741). There was good negative predictive value for inpatient mortality (98.1%). Conclusions Coded frailty syndromes significantly predict outcomes. Model diagnostics suggest the model could be used for screening of elderly patients to optimise their care.

https://www.rcpjournals.org/content/clinmedicine/20/2/183.full.pdf

Validating a methodology to measure frailty syndromes at hospital level utilising administrative data

Cell-free extract and purified enzyme-based systems provide an attractive solution to study biosynthetic strategies towards a range of chemicals. 4-(4-hydroxyphenyl)-butan-2-one, also known as raspberry ketone, is the major fragrance component of raspberry fruit and is used as a natural additive in the food and sports industry. Current industrial processing of the natural form of raspberry ketone involves chemical extraction with a yield of ~1-4 mg kg-1 of fruit. Due to toxicity, microbial production provides only low yields of up to 5-100 mg L-1. Herein, we report an efficient cell-free strategy to probe a synthetic enzyme pathway that converts either L-tyrosine or the precursor, 4-(4-hydroxyphenyl)-buten-2-one (HBA), into raspberry ketone at up to 100% conversion. As part of this strategy, it is essential to recycle inexpensive cofactors. Specifically, the final enzyme step in the pathway is catalysed by raspberry ketone/zingerone synthase (RZS1), an NADPH-dependent double bond reductase. To relax cofactor specificity towards NADH, the preferred cofactor for cell-free biosynthesis, we identify a variant (G191D) with strong activity with NADH. We implement the RZS1 G191D variant within a ‘one-pot’ cell-free reaction to produce raspberry ketone at high-yield (61 mg L-1), which provides an alternative route to traditional microbial production. In conclusion, our cell-free strategy complements the growing interest in engineering synthetic enzyme cascades towards industrially relevant value-added chemicals.

Derek Bell

Papers

A unitary patient record improves admission documentation in a medical assessment unit in a major teaching hospital.

Patient simulator: towards testing and validation.

Using routine geo-coded data to identify geographical heterogeneity to reduce disparities: case studies in UK

Validating a methodology to measure frailty syndromes at hospital level utilising administrative data

High-yield 'one-pot' biosynthesis of raspberry ketone, a high-value fine chemical.