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

Early detection, timeliness and competence of clinical response are a triad of determinants of clinical outcome in people with acute illness. In 2012, the Royal College of Physicians published the National Early Warning Score (NEWS) with the aim of standardising the response to, assessment of and monitoring of acutely ill patients. This was subsequently updated in December 2017 to become NEWS2. Alongside the development of NEWS/NEWS2, it was clear that a supportive educational package was going to be essential for dissemination, learning and national adoption of NEWS/NEWS2 across all healthcare settings. Another driver for the early development of an e-learning package to accompany the launch of NEWS in 2012 was the opportunity that it provided not only to standardise the early warning system across the NHS but also to use that standardised process to facilitate better and more consistent education and training across the entire healthcare system; building on the concept of NEWS providing a common language.

The development and introduction of a national e-learning programme to support the dissemination of NEWS2.

Accepted 18 November 1986 vascular disease. On admission the patient was febrile (38°C) and abdominal examination showed previous operative scars, with a discharging sinus in the left iliac fossa. The remainder of the clinical findings were entirely normal. Apart from a slightly raised leucocyte count (11-2 x IO9/1) and a growth of Staphylococcus aureus from the sinus discharge fluid, routine investigations all gave normal results. A sinogram failed to show any communication between the sinus and the bowel. A right transfemoral angiogram

https://thorax.bmj.com/content/thoraxjnl/42/5/397.full.pdf

Intrathoracic mycotic aneurysm detected by indium-111 labelled autologous neutrophils with single photon emission computed tomography.

What is acute medicine and do we need it

The aim of this paper is to describe and discuss the experience of HIV disease in Central Middlesex Hospital, London up to June 1993. A retrospective study of the total number of HIV-positive patients cared for was performed. In addition, prospectively collected data as part of local epidemiological surveillance from January 1987 to June 1993 on all HIV test requests was analysed. Between January 1987 and June 1993 3695 individuals were tested for HIV-1 antibody at Central Middlesex Hospital. Of these, 101 HIV-1 seropositive individuals were identified and have attended this District General Hospital. Seven HIV-1 seropositive individuals were identified from before December 1986. Sixty (56%) had acquired their infection heterosexually. Thirty-eight (35%) originated from the UK and 47 (44%) from sub-Saharan Africa; the remaining 23 (21%) originated from the rest of Europe, South America and the Caribbean. Thirty-four (31%) of the patient group developed AIDS during follow-up at the hospital and in 26 individuals AIDs developed within 2 months of their first positive HIV result. The mean survival of 20 patients after AIDS-defining diagnoses was 7 months 18 days. This unselected group of HIV-1 seropositive patients present late in the course of their HIV disease and survival following AIDS is poor.

Experience of HIV Disease in a London District General Hospital

Introduction: GINA guidelines recognise the importance of correct inhaler technique and patient preference when individualising therapy. A novel BTI (Flutiform® K‑haler®) has been developed to deliver fluticasone propionate/formoterol (FP/FORM). Aims and Objectives: To investigate correct inhaler handling of FP/FORM BTI vs. budesonide/formoterol (BUD/FORM) DPI (Symbicort® Turbohaler®). The primary objective was to show superiority of FP/FORM BTI vs. BUD/FORM DPI as determined by the proportion of patients performing all critical steps correctly 12 weeks after initial training on Day 1. Methods: This was a multicentre, randomised, open-label study. 369 patients aged ≥18 years with persistent asthma, asthma-COPD overlap or COPD and naive to both study devices were randomised. Patients received FP/FORM BTI or BUD/FORM DPI twice daily for 12 weeks then crossed over to the alternate treatment for 12 weeks. In each period, patients were trained and assessed on device handling by a HCP on Day 1 and handling technique was assessed at Week 12. Results: FP/FORM BTI was superior to BUD/FORM DPI for proportion of patients performing all critical steps correctly at Week 12 (94.0% vs. 82.4%; odds ratio: 2.89; 95% CI: 1.57, 5.33; p Conclusions: The study met its primary objective and demonstrated superiority in correct inhaler handling of FP/FORM BTI versus BUD/FORM DPI 12 weeks after training. EudraCT: 2014-004564-38. Funded by Mundipharma Research Ltd.

Derek Bell

Papers

The development and introduction of a national e-learning programme to support the dissemination of NEWS2.

Intrathoracic mycotic aneurysm detected by indium-111 labelled autologous neutrophils with single photon emission computed tomography.

What is acute medicine and do we need it

Experience of HIV Disease in a London District General Hospital

Patients’ ability to use a novel fluticasone propionate/formoterol breath-triggered inhaler (BTI) vs. budesonide/formoterol dry powder inhaler (DPI)