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

Critical care patients often experience significant pain and anxiety. These symptoms may be rooted existentially as patients endure fear and uncertainty, but disease and treatment sources are other common offenders, as are noxious environmental stimuli. Unrelieved pain induces a generalized sympathetic response (increasing heart rate, blood pressure, respiratory rate, and peripheral resistance), disturbs sleep and appetite patterns, and heightens anxiety. Anxiety can also increase the perception of pain. Thus, these symptoms often go hand in hand, interfering with the healing process. On any given day, nurses exert considerable time and energy employing interventions to enhance comfort and ultimately, the patient’s experience. Some of these are dependent functions—namely, administering pharmacological agents—whereas many others are nonpharmacological approaches within autonomous nursing practice such as therapeutic listening, emotional support, family presence, repositioning, distraction, or integrative therapies. The purpose of this clinical review is to explore an integrative therapy, the use of music, for symptom management in the acute/critically ill population. Music listening interventions can be used to reduce stress/ anxiety, pain, depression, and feelings of isolation; foster relaxation; improve mood and movement; facilitate expression of emotion; provide meaningful stimuli; alleviate boredom by offering diversion; and buffer noise. Although music may have many applications in the clinical setting, this review addresses the following PICO question: How effective are music interventions at reducing pain and/or anxiety in critically ill patients? A regular feature of the American Journal of Critical Care, Clinical Evidence Review unveils available scientific evidence to answer questions faced in contemporary clinical practice. It is intended to support, refute, or shed light on health care practices where little evidence exists. To send an eLetter or to contribute to an online discussion about this article, visit www.ajcconline.org and click “Respond to This Article” on either the full-text or PDF view of the article. We welcome letters regarding this feature and encourage the submission of questions for future review.

Does Music Ease Pain and Anxiety in the Critically Ill

The prevalence of inadequate symptom control among cancer patients is quite high despite the availability of definitive care guidelines and accurate and efficient assessment tools. We will conduct a hybrid type 2 stepped wedge pragmatic cluster randomized clinical trial to evaluate a guideline-informed enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) care model. Teams of clinicians at five hospitals that care for patients with various cancers will be randomly assigned in steps to the E2C2 intervention. The E2C2 intervention will have two levels of care: level 1 will offer low-touch, automated self-management support for patients reporting moderate sleep disturbance, pain, anxiety, depression, and energy deficit symptoms or limitations in physical function (or both). Level 2 will offer nurse-managed collaborative care for patients reporting more intense (severe) symptoms or functional limitations (or both). By surveying and interviewing clinical staff, we will also evaluate whether the use of a multifaceted, evidence-based implementation strategy to support adoption and use of the E2C2 technologies improves patient and clinical outcomes. Finally, we will conduct a mixed methods evaluation to identify disparities in the adoption and implementation of the E2C2 intervention among elderly and rural-dwelling patients with cancer. The E2C2 intervention offers a pragmatic, scalable approach to delivering guideline-based symptom and function management for cancer patients. Since discrete EHR-imbedded algorithms drive defining aspects of the intervention, the approach can be efficiently disseminated and updated by specifying and modifying these centralized EHR algorithms. ClinicalTrials.gov, NCT03892967
 . Registered on 25 March 2019.

/pdf/pragmatic-cluster-randomized-trial-to-evaluate-effectiveness-4ctgqud84s.pdf

Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2).

Objective: To determine if self-reported anxiety levels decreased after tracheostomy placement in a sample of mechanically ventilated intensive care unit patients. Background: There is limited research regarding the impact of a tracheostomy on patients’ anxiety. Elevated anxiety delays healing and contributes to long-term mental health complications. Methods: This was a secondary analysis of data from a large clinical trial conducted in urban Minnesota. Fifty-one of 116 patients received a tracheostomy. Anxiety scores were obtained daily using the Visual Analog Scale-Anxiety. Mixed model analysis was used to compare anxiety ratings pre- and posttracheostomy. Results: There was no significant decrease in anxiety following tracheostomy after controlling for time and gender (all p > .16). Age was the only variable to impact anxiety levels: anxiety scores increased as

Linda L. Chlan

Papers

Does Music Ease Pain and Anxiety in the Critically Ill

Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2).

Care of Critically Ill Adults and Their Family Caregivers Impact of tracheostomy placement on anxiety in mechanically ventilated adult ICU patients

Effects of music intervention on inflammatory markers in critically ill and post-operative patients: A systematic review of the literature

Burnout Syndrome Among Critical Care Professionals: A Cause for Alarm