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

The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

1. Introduction and Overview. 2. Detecting Influential Observations and Outliers. 3. Detecting and Assessing Collinearity. 4. Applications and Remedies. 5. Research Issues and Directions for Extensions. Bibliography. Author Index. Subject Index.

Regression Diagnostics: Identifying Influential Data and Sources of Collinearity

Economic Control of Quality of Manufactured Product.

https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

Background Critical care nurses often have wide discretion in managing the sedative therapy of patients receiving mechanical ventilation. Little is known about the factors and processes that influence sedative practice. Objectives To determine if nurses' personal beliefs about and attitudes toward critical illness and their goals for sedation influence the nurses' sedative practice, to discover whether social factors influence sedative therapy, and to describe the processes that nurses use to assess patients' need for sedative therapy. Methods Audiotapes of focus group interviews with 5 groups of 34 experienced medical and surgical intensive care unit nurses from 2 hospitals were transcribed verbatim. Two investigators independently analyzed the verbatim text, and a sample of the participants validated the category summaries and interpretations. Results Patients' family members can affect sedative practice directly or indirectly, and demands for efficient delivery of care can influence sedative therapy. Primary indications for sedation included patients' comfort and amnesia and prevention of patients' self-injurious behaviors. Conflicts between physicians and nurses arose when explicit and shared goals for sedation were lacking. Participants noted that numerous factors impede routine use of sedation protocols even though use of the protocols may improve communication and promote uniformity of sedative practice. Conclusion Social, personal, and professional factors influence sedative therapy. Future research should establish the relative importance of these factors and determine whether their impact is attenuated when sedation protocols are implemented.

Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy

Anxiety is a common experience for mechanically ventilated patients. There are a number of established instruments available to measure anxiety. However, there are significant limitations with these instruments, particularly the length of many scales when using them with ill persons. An instrument development study was conducted to develop a shortened scale from the 20-item Spielberger State Anxiety Inventory. Two-hundred ventilated patients were recruited from nine ICUs in the urban Midwest. Exploratory factor analysis techniques were used to create a shortened, 6-item scale, which accounted for 66.6 percent of the variance. A Cronbach's alpha of 0.78 with a correlation of 0.92 to the 20-item version resulted based on a 6-item scale, and the shortened scale retained many of the desirable properties of the full-length version. The shortened version of the Spielberger State Anxiety Inventory generally had good psychometric properties. However, additional research is needed to further validate this shortened scale.

Development of a shortened state anxiety scale from the Spielberger State-Trait Anxiety Inventory (STAI) for patients receiving mechanical ventilatory support.

Factors influencing nurse sedation practices with mechanically ventilated patients: A U.S. national survey

Complementary therapies and healing practices: faculty/student beliefs and attitudes and the implications for nursing education

Aims. The primary aim of this paper is to discuss the relationship between the Visual Analog Scale-Anxiety (VAS-A) and the Spielberger State Anxiety Inventory (SAI) in patients receiving mechanical ventilatory support. A secondary aim is to provide suggestions for the nurse-researcher to consider when selecting an instrument to measure anxiety.

Background.  Anxiety is a common experience for critically ill patients receiving mechanical ventilatory support. It is a challenge, however, for nurse-researcher to select an instrument to measure anxiety that is valid and reliable yet does not cause great response burden for participants. Visual analog scales may reduce response burden, but lack sound validation in research participants receiving mechanical ventilatory support.

Methods.  This study used a correlational design. A convenience sample of critically ill patients receiving mechanical ventilatory support (n = 200) were asked to rate their current level of anxiety on the 20-item Spielberger SAI and a 100-mm VAS-A.

Results.  Eight participants were unable to complete the Spielberger SAI; 100% completed the VAS-A. The two instruments were found to be significantly correlated at r = 0·50; P = 0·01.

Conclusion.  The VAS-A was found to be less burdensome for research participants than the Spielberger SAI, resulting in no missing data on the VAS-A. Findings from this study provide initial validation of the VAS-A as a justifiable instrument to measure anxiety in patients receiving mechanical ventilatory support. Researchers are advised to balance reliability and validity properties with response burden when selecting an instrument to measure anxiety in patients with communication challenges and energy limitations.

Linda L. Chlan

Papers

Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy

Development of a shortened state anxiety scale from the Spielberger State-Trait Anxiety Inventory (STAI) for patients receiving mechanical ventilatory support.

Factors influencing nurse sedation practices with mechanically ventilated patients: A U.S. national survey

Complementary therapies and healing practices: faculty/student beliefs and attitudes and the implications for nursing education

Relationship between two anxiety instruments in patients receiving mechanical ventilatory support