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

Music therapy is an effective intervention for critically ill patients for such purposes as anxiety reduction and stress management. The therapy is readily accepted by patients and is an intervention patients thoroughly enjoy. The MAIT is one resource that nurses caring for critically ill patients can use to implement music therapy in clinical practice. Patients can be given the opportunity to select a musical tape they prefer and to negotiate with the nurse for uninterrupted music-listening periods. Allowing patients control over music selection and providing uninterrupted time for music listening gives the patients an enhanced sense of control in an environment that often controls them.

Music therapy in critical care: indications and guidelines for intervention

Music therapy is a nonpharmacologic nursing intervention that can be used as a complementary adjunct in the care of patients supported by mechanical ventilation. This article details the theoretical basis of music therapy for relaxation and anxiety reduction, highlights the research testing the intervention in such patients, and discusses areas of needed research to extend further the implementation of music therapy in critical care nursing practice in an effort to promote a healing environment for patients.

Music therapy as a nursing intervention for patients supported by mechanical ventilation.

Background Mechanical ventilation is one of the most frequently used technological treatments in critical care units and induces great anxiety in patients. Objectives Although mechanical ventilation and critical illness induce great anxiety and distress in hospitalized patients, little is known about anxiety ratings over the course of ventilatory support. Knowledge of anxiety ratings over time is needed to implement effective symptom management interventions. The purposes of this study were to describe anxiety ratings for a subgroup of mechanically ventilated patients over the duration of enrollment in a multisite clinical trial, to discern any pattern of change in anxiety ratings, to determine if anxiety decreases over time, and to explore the influence of sedative exposure on anxiety ratings. Methods Participants were 57 mechanically ventilated patients who were randomly assigned to the usual care group of a randomized controlled trial designed to assess the efficacy of music interventions on anxiety of mechanically ventilated patients in intensive care units. Anxiety ratings were obtained at study entry and daily for up to 30 days. A 100-mm visual analog scale was used to measure anxiety. Visual Analog Scale-Anxiety scores were plotted as a function of study time in days for each participant to discern possible patterns of change. A mixed-models analysis was performed to assess the nature and magnitude of change over time (slope) using 251 observations on 57 patients. Results Results of the unconditional means model indicated that further modeling was appropriate. An autoregressive covariance structure with a random component for participant was chosen as the most appropriate covariance structure for modeling. An unconditional growth model indicated that the Visual Analog Scale-Anxiety ratings declined slowly over time: -.53 points per day (p = .09). Discussion Anxiety is an individual patient experience that requires ongoing management with appropriate assessment and intervention over the duration of mechanical ventilatory support.

/pdf/patterns-of-anxiety-in-critically-ill-patients-receiving-1txu870hyx.pdf

Patterns of anxiety in critically ill patients receiving mechanical ventilatory support.

• BACKGROUND Music is considered an ideal therapy for reducing stress in patients receiving mechanical ventilation. Previous studies of the effect of music on stress in such patients have focused solely on indirect markers of the stress response rather than on serum biomarkers. • OBJECTIVE To explore the influence of music on serum biomarkers of the stress response in patients receiving ventilatory support. • METHODS A convenience sample of 10 patients receiving mechanical ventilation was recruited from an 11-bed medical intensive care unit. Patients were randomly assigned to listen to music or to rest quietly for 60 minutes. Levels of corticotropin, cortisol, epinephrine, and norepinephrine were measured 4 times during the 60 minutes. • RESULTS The levels of the 4 biomarkers of the stress response did not differ significantly between patients who listened to music and patients who rested quietly, though the levels of corticotropin and cortisol showed interesting trends. • CONCLUSIONS Additional research is needed with a larger sample size to evaluate further the influence of music on biochemical markers of the stress response in patients receiving mechanical ventilatory support. In future studies, confounding factors such as endotracheal suctioning and administration of medications that influence the stress response should be controlled for. (American Journal of Critical Care. 2007;16:141-145)

Influence of Music on the Stress Response in Patients Receiving Mechanical Ventilatory Support: A Pilot Study

Background Incidence of vascular complications (VCs) after sheath removal following a percutaneous coronary intervention procedure (PCIP) vary widely by the compression method used to achieve femoral artery hemostasis. Objective To determine if one groin compression method causes the least discomfort and distress for patients and results in fewer VCs. Methods Patients (n = 306, mean age = 62.3 years, 77% male, 96.4% Caucasian) undergoing PCIPs at a tertiary care center in the urban Midwest participated in this three-group experimental design study. They were randomly assigned to Femostop, C-clamp, or manual compression and rated level of groin discomfort and distress on a 0-10 Numeric Rating Scale (NRS) prior to, during, and after arterial compression was released. The groin area was assessed for any VCs (oozing, ecchymosis, hematoma) prior to sheath removal, after compression released, and 12 and 24 hr after sheath removal. Results No significant differences were found by compression method for discomfort, distress, or VCs. Regardless of method, not having a VC prior to femoral sheath removal contributes to less oozing (z = -3.1, p = .0019), hematoma (z = -9.4, p 30 min (z = -2.3, p = .02). Not receiving eptifibatide (Integrilin) contributes to less ecchymosis (z = -2.9, p = .004). Conclusions Nurses need to be vigilant when caring for patients who have a VC prior to femoral sheath removal and have received antiplatelet medications. Further research is needed to identify patient characteristics that may contribute to VCs.

http://lib.ajaums.ac.ir/booklist/Nursing%20Research-Nov-Dec05.pdf

Effects of three groin compression methods on patient discomfort, distress, and vascular complications following a percutaneous coronary intervention procedure.

Linda L. Chlan

Papers

Music therapy in critical care: indications and guidelines for intervention

Music therapy as a nursing intervention for patients supported by mechanical ventilation.

Patterns of anxiety in critically ill patients receiving mechanical ventilatory support.

Influence of Music on the Stress Response in Patients Receiving Mechanical Ventilatory Support: A Pilot Study

Effects of three groin compression methods on patient discomfort, distress, and vascular complications following a percutaneous coronary intervention procedure.