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

1 Interventions for cutaneous molluscum contagiosum (Review) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Main results We found 11 new studies for this update, resulting in 22 included studies with a total of 1650 participants. The studies examined the effects of topical (20 studies) and systemic interventions (2 studies). Among the new included studies were the full trial reports of three large unpublished studies, brought to our attention by an expert in the field. They all provided moderate-quality evidence for a lack of effect of 5% imiquimod compared to vehicle (placebo) on shortterm clinical cure (4 studies, 850 participants, 12 weeks after start of treatment, risk ratio (RR) 1.33, 95% confidence interval (CI) 0.92 to 1.93), medium-term clinical cure (2 studies, 702 participants, 18 weeks after start of treatment, RR 0.88, 95% CI 0.67 to 1.14), and long-term clinical cure (2 studies, 702 participants, 28 weeks after start of treatment, RR 0.97, 95% CI 0.79 to 1.17). We found similar but more certain results for short-term improvement (4 studies, 850 participants, 12 weeks after start of treatment, RR 1.14, 95% CI 0.89 to 1.47; high-quality evidence). For the outcome ’any adverse effect’, we found high-quality evidence for little or no difference between topical 5% imiquimod and vehicle (3 studies, 827 participants, RR 0.97, 95% CI 0.88 to 1.07), but application site reactions were more frequent in the groups treated with imiquimod (moderate-quality evidence): any application site reaction (3 studies, 827 participants, RR 1.41, 95% CI 1.13 to 1.77, the number needed to treat for an additional harmful outcome (NNTH) was 11); severe application site reaction (3 studies, 827 participants, RR 4.33, 95% CI 1.16 to 16.19, NNTH over 40). For the following 11 comparisons, there was limited evidence to show which treatment was superior in achieving short-term clinical cure (low-quality evidence): 5% imiquimod less effective than cryospray (1 study, 74 participants, RR 0.60, 95% CI 0.46 to 0.78) and 10% potassium hydroxide (2 studies, 67 participants, RR 0.65, 95% CI 0.46 to 0.93); 10% Australian lemon myrtle oil more effective than olive oil (1 study, 31 participants, RR 17.88, 95% CI 1.13 to 282.72); 10% benzoyl peroxide cream more effective than 0.05% tretinoin (1 study, 30 participants, RR 2.20, 95% CI 1.01 to 4.79); 5% sodium nitrite co-applied with 5% salicylic acid more effective than 5% salicylic acid alone (1 study, 30 participants, RR 3.50, 95% CI 1.23 to 9.92); and iodine plus tea tree oil more effective than tea tree oil (1 study, 37 participants, RR 0.20, 95% CI 0.07 to 0.57) or iodine alone (1 study, 37 participants, RR 0.07, 95% CI 0.01 to 0.50). Although there is some uncertainty, 10% potassium hydroxide appears to be more effective than saline (1 study, 20 participants, RR 3.50, 95% CI 0.95 to 12.90); homeopathic calcarea carbonica appears to be more effective than placebo (1 study, 20 participants, RR 5.57, 95% CI 0.93 to 33.54); 2.5% appears to be less effective than 5% solution of potassium hydroxide (1 study, 25 participants, RR 0.35, 95% CI 0.12 to 1.01); and 10% povidone iodine solution plus 50% salicylic acid plaster appears to be more effective than salicylic acid plaster alone (1 study, 30 participants, RR 1.43, 95% CI 0.95 to 2.16). We found no statistically significant differences for other comparisons (most of which addressed two different topical treatments). We found no randomised controlled trial evidence for expressing lesions or topical hydrogen peroxide. Study limitations included no blinding, many dropouts, and no intention-to-treat analysis. Except for the severe application site reactions of imiquimod, none of the evaluated treatments described above were associated with serious adverse effects (low-quality evidence). Among the most common adverse events were pain during application, erythema, and itching. Included studies of the following comparisons did not report adverse effects: calcarea carbonica versus placebo, 10% povidone iodine plus 50% salicylic acid plaster versus salicylic acid plaster, and 10% benzoyl peroxide versus 0.05% tretinoin. We were unable to judge the risk of bias in most studies due to insufficient information, especially regarding concealment of allocation and possible selective reporting. We considered five studies to be at low risk of bias. Authors’ conclusions No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. We found moderatequality evidence that topical 5% imiquimod was no more effective than vehicle in terms of clinical cure, but led to more application site reactions, and high-quality evidence that there was no difference between the treatments in terms of short-term improvement. However, high-quality evidence showed a similar number of general side effects in both groups. As the evidence found did not favour any one treatment, the natural resolution of molluscum contagiosum remains a strong method for dealing with the condition. P L A I N L A N G U A G E S U M M A R Y Treatments for molluscum contagiosum, a common viral skin infection in children Review question 2 Interventions for cutaneous molluscum contagiosum (Review) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. We reviewed the evidence for the effect of any treatment on the common viral skin infection molluscum contagiosum. We excluded people with a repressed immune system or sexually transmitted molluscum contagiosum. Background Molluscum contagiosum in healthy people is a self limiting, relatively harmless viral skin infection. It mainly affects children and adolescents and is rare in adults. It occurs worldwide, but seems much more frequent in geographic areas with warm climates. Molluscum contagiosum usually presents as single or multiple pimples filled with an oily substance. People may seek treatment for social and cosmetic reasons and because of concerns about spreading the disease to others. Treatment is intended to speed up the healing process. Study characteristics We searched the literature to July 2016. We included 22 trials (total of 1650 participants). Twenty of the studies evaluated topical treatment, and two studies evaluated treatment taken by mouth (oral). Comparisons included physical therapies, as well as topical and oral treatments. Most studies were set in hospital outpatient or emergency departments, and were performed in North America, the UK, Asia, or South America. Participants were of both sexes and were mainly children or young adults. Follow-up duration varied from 3 to 28 weeks after randomisation. Only five studies had longer than 3 months’ follow-up. Five studies reported commercial funding, three studies obtained medication for free from pharmaceutical companies, 12 studies did not mention the source of funding, one study reported charity funding, and one study reported they had had no financial support. Key results We found that many common treatments for molluscum, such as physical destruction, have not been adequately evaluated. Some of the included treatments are not part of standard practice. We found moderate-quality evidence that topical 5% imiquimod is probably no more effective than vehicle (i.e. the same cream but without imiquimod) in achieving short-, medium-, and long-term clinical cure. High-quality (and thus more certain) evidence showed that topical 5% imiquimod is no better than placebo at improving molluscum up to three months after the start of treatment. High-quality evidence showed that 5% imiquimod differed little or not at all in the number of side effects compared to vehicle. However, moderate-quality evidence suggests that there are probably more application site reactions when using topical 5% imiquimod compared with vehicle. Low-quality evidence, based on one or two mostly small studies, revealed the following results for the outcome short-term clinical cure: 5% imiquimod less effective than cryospray or 10% potassium hydroxide; 10% Australian lemon myrtle oil more effective than olive oil; 10% benzoyl peroxide cream more effective than 0.05% tretinoin; 5% sodium nitrite co-applied with 5% salicylic acid more effective than 5% salicylic acid alone; and iodine plus tea tree oil more effective than tea tree oil or iodine alone. We found more uncertain (low-quality) evidence to suggest that 10% potassium hydroxide is more effective than saline; homeopathic calcarea carbonica is more effective than placebo; 2.5% solution of potassium hydroxide is less effective than 5% solution of potassium hydroxide; and 10% povidone iodine solution and 50% salicylic acid plaster are more effective than salicylic acid plaster alone. Except for the severe application site reactions of imiquimod, none of these treatments led to serious adverse effects (low-quality evidence). Pain during treatment application, redness, and itching were among the most reported adverse effects. We found no differences between the treatments assessed in the other comparisons. We found no randomised trials for several commonly used treatments, such as expressing lesions with an orange stick or topical hydrogen peroxide. Since most lesions resolve within months, unless better evidence for the superiority of active treatments emerges, molluscum contagiosum can be left to heal naturally. Quality of the evidence For topical imiquimod, the quality of the evidence for clinical cure, short-term improvement, and adverse effects was moderate to high. For all other comparisons, the quality of the evidence for short-term clinical cure and adverse effects was low. Common limitations of the included studies were that the numbers of participants were small, the investigators were not blinded, and participants who did not complete the study (numerous in some studies) were not included in the analyses. 3 Interventions for cutaneous molluscum contagiosum (Rev

The Cochrane Database of Systematic Reviews

Patient preferences for shared decisions: A systematic review

Benign Prostatic Hyperplasia Specific Health Status Measures in Clinical Research: How Much Change in the American Urological Association Symptom Index and the Benign Prostatic Hyperplasia Impact Index is Perceptible to Patients?

Background:Communicationabouttakinganewmedication is critical to proper use of drug therapy and to patient adherence. Despite ample evidence that medicationsarenottakenasprescribed,fewinvestigationshave detailedtheelementsofcommunicationaboutnewmedicationtherapy.Thisarticledescribesandassessesthequalityofphysiciancommunicationwithpatientsaboutnewly prescribed medications. Methods: This was an observational study that combinedpatientandphysiciansurveyswithtranscribedaudiotapedofficevisitsfrom185outpatientencounterswith 16 family physicians, 18 internists, and 11 cardiologists in2Sacramento,Calif,healthcaresystemsbetweenJanuary and November 1999, in which 243 new medications were prescribed. We measured the quality of physician communication when prescribing new medications. Results:Physicians stated the specific medication name for 74% of new prescriptions and explained the purpose of the medication for 87%. Adverse effects were addressed for 35% of medications and how long to take the medicationfor34%.Physiciansexplicitlyinstructed55% of patients about the number of tablets to take and explainedthefrequencyortimingofdosing58%ofthetime. Physicians fulfilled a mean of 3.1 of 5 expected elements of communication when initiating new prescriptions. They counseled the most about psychiatric medications,fulfillingameanof3.7,3.5,and3.4,pulmonary, and cardiovascular elements, respectively.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/410942/ioi60078.pdf

Physician Communication When Prescribing New Medications

Pharmacists in Wisconsin were surveyed about their assessment of patients' needs for medication counseling and factors that hinder or facilitate counseling. Pharmacists attending regional meetings for a state board of pharmacy project completed the survey. The questionnaire was pretested on pharmacists from one area and refined; the study population then included pharmacists from all areas except this one. Questions were asked about criteria for determining the amount and content of oral counseling, the importance of oral versus written counseling, and factors that impede or facilitate counseling. Responses concerning criteria, barriers, and facilitators were grouped by two judges trained in content analysis. Information was collected about years spent in practice, counselor role orientation (scored on responses to eight statements), type of practice setting and position, and use of technicians and daily prescription volume in that setting. Of 708 pharmacists asked to complete the survey 697 (98%) provided usable responses. Seventy percent of respondents were in community practice; 63% were managing pharmacists; 74% of their practice sites used technicians, and 40% averaged 76-150 prescriptions per day. Patient motivation was the most frequently cited determinant of the amount and type of counseling, followed by type of medication, patient abilities, and time available for counseling. Sixty-one percent of respondents indicated that it was important to give both oral and written counseling. Pharmacists in different practice settings and positions reported different barriers to and facilitators of counseling. Pharmacists in this survey said patient-oriented criteria and type of medication determined the amount and content of counseling given to patients. They said it was important to provide both oral and written counseling.

Pharmacists' perceptions of patients' needs for counseling

The objective of this study was to identify participant and environment variables that affect pharmacist-patient communication, and test their effects in a range of community pharmacy practices. Data were collected through unobtrusive observation, patient interviews, and pharmacist interviews in 12 community pharmacies. Random samples of 30 patients who received a prescription from a participating pharmacist were selected at each of the 12 pharmacies, yielding a total sample size of 360 patients. Relationships for Pharmacist Counselor Role Orientation, Patient Counselee Role Orientation, Lack of Time, Patient Privacy, Prescription Transfer by the Pharmacist, and Importance of Information with Occurrence of Communication, were tested using logistic regression analysis. Relationships among the independent variables with Length and Content of Communication were tested using multiple regression analysis. Of the 360 patients who were observed and asked to participate in an interview, 304 (84%) provided usable responses. Significant relationships (P < 0.01) were found for Prescription Transfer by the Pharmacist and Importance of Information with Occurrence of Communication. Prescription Transfer by the Pharmacist was found to be a mediating variable for Counselor Role Orientation, Importance of Information, and Lack of Time with Occurrence of Communication. Multiple regression analysis results showed positive relationships for Importance of Information and Patient Counselee Role Orientation with Length and Content of Communication. The results can be used for improving communication between pharmacists and patients to foster appropriate medication use by patients.

A field investigation of participant and environment effects on pharmacist-patient communication in community pharmacies

In 1984 the Wisconsin Division of Health showed interest in patients' receipt of verbal consultation for prescription drugs and included relevant questions in the Wisconsin Health Status survey to: 1) investigate the receipt of verbal consultation for new and refill prescriptions, 2) allow a comparison of state results with those of a national study that used similar sampling and data collection procedures, and 3) more closely examine the relationships between receipt of verbal consultation and such variables as prescription status (new or refill), age, sex, race, and education. Data were collected from 2,135 randomly selected respondents using Computer Assisted Telephone Interviewing with random digit dialing. After controlling for elapsed time since last prescription, log-linear analyses showed the importance of prescription status (new and refill) and respondent's age as correlates of consultation by pharmacy personnel, while prescription status, age, and sex were significant for prescribers. For both prescribers and pharmacy personnel, the authors found no association between client education and receipt of verbal consultation. The absence of verbal consultation cannot be entirely accounted for by client characteristics or prescription status. Based upon their experience, the authors encourage continued monitoring of prescribers' and pharmacists' provision of verbal consultation through questions contained in state and national health status surveys.

Verbal consultation regarding prescription drugs: findings from a statewide study.

Purpose and Methods. Data from 358 pharmacist−patient encounters in 12 community pharmacies were used to investigate the association of prescription status, patient age, patient gender, and patient question asking with the content of pharmacist−patient communication.

The association of prescription status, patient age, patient gender, and patient question asking behavior with the content of pharmacist-patient communication.

The objectives of this study were (1) to design an instrument which identifies the attributes of evaluative criteria that are used by patients in selecting a pharmacy for obtaining prescrip tion drugs, (2) to analyze these attributes and formulate dimensions of evaluative criteria, and (3) to assess the reliability of the instrument. The instrument contained 51 items describing various attributes of evaluative criteria. After pretesting the instrument, it was mailed to a systematic random sample of 500 households in Madison and Middleton, Wisconsin. The response rate was 69.5%. Using multivariate analysis, eleven dimensions (factors) were identified which explained 64.9% of the variance. Pharmacist-related factors accounted for approximately 39% of the variance. Reliability assessment of the instrument suggested that the sampling of items for the domain of evaluative criteria was adequate. As the practice of pharmacy evolves in the health care system, researchers must be cognizant of the fact that patient...

Joseph B. Wiederholt

Papers

Pharmacists' perceptions of patients' needs for counseling

A field investigation of participant and environment effects on pharmacist-patient communication in community pharmacies

Verbal consultation regarding prescription drugs: findings from a statewide study.

The association of prescription status, patient age, patient gender, and patient question asking behavior with the content of pharmacist-patient communication.

Development of an Instrument to Measure Evaluative Criteria that Patients Use in Selecting a Pharmacy for Obtaining Prescription Drugs