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

http://science.sciencemag.org/content/sci/201/4359/899.2.full.pdf

Phenomenology of perception.

The power of feedback.

OBJECTIVES: To consider methods and related evidence for evaluating bias in non-randomised intervention studies. DATA SOURCES: Systematic reviews and methodological papers were identified from a search of electronic databases; handsearches of key medical journals and contact with experts working in the field. New empirical studies were conducted using data from two large randomised clinical trials. METHODS: Three systematic reviews and new empirical investigations were conducted. The reviews considered, in regard to non-randomised studies, (1) the existing evidence of bias, (2) the content of quality assessment tools, (3) the ways that study quality has been assessed and addressed. (4) The empirical investigations were conducted generating non-randomised studies from two large, multicentre randomised controlled trials (RCTs) and selectively resampling trial participants according to allocated treatment, centre and period. RESULTS: In the systematic reviews, eight studies compared results of randomised and non-randomised studies across multiple interventions using meta-epidemiological techniques. A total of 194 tools were identified that could be or had been used to assess non-randomised studies. Sixty tools covered at least five of six pre-specified internal validity domains. Fourteen tools covered three of four core items of particular importance for non-randomised studies. Six tools were thought suitable for use in systematic reviews. Of 511 systematic reviews that included non-randomised studies, only 169 (33%) assessed study quality. Sixty-nine reviews investigated the impact of quality on study results in a quantitative manner. The new empirical studies estimated the bias associated with non-random allocation and found that the bias could lead to consistent over- or underestimations of treatment effects, also the bias increased variation in results for both historical and concurrent controls, owing to haphazard differences in case-mix between groups. The biases were large enough to lead studies falsely to conclude significant findings of benefit or harm. Four strategies for case-mix adjustment were evaluated: none adequately adjusted for bias in historically and concurrently controlled studies. Logistic regression on average increased bias. Propensity score methods performed better, but were not satisfactory in most situations. Detailed investigation revealed that adequate adjustment can only be achieved in the unrealistic situation when selection depends on a single factor. CONCLUSIONS: Results of non-randomised studies sometimes, but not always, differ from results of randomised studies of the same intervention. Non-randomised studies may still give seriously misleading results when treated and control groups appear similar in key prognostic factors. Standard methods of case-mix adjustment do not guarantee removal of bias. Residual confounding may be high even when good prognostic data are available, and in some situations adjusted results may appear more biased than unadjusted results. Although many quality assessment tools exist and have been used for appraising non-randomised studies, most omit key quality domains. Healthcare policies based upon non-randomised studies or systematic reviews of non-randomised studies may need re-evaluation if the uncertainty in the true evidence base was not fully appreciated when policies were made. The inability of case-mix adjustment methods to compensate for selection bias and our inability to identify non-randomised studies that are free of selection bias indicate that non-randomised studies should only be undertaken when RCTs are infeasible or unethical. Recommendations for further research include: applying the resampling methodology in other clinical areas to ascertain whether the biases described are typical; developing or refining existing quality assessment tools for non-randomised studies; investigating how quality assessments of non-randomised studies can be incorporated into reviews and the implications of individual quality features for interpretation of a review's results; examination of the reasons for the apparent failure of case-mix adjustment methods; and further evaluation of the role of the propensity score.

/pdf/evaluating-non-randomised-intervention-studies-2k25cz7x6r.pdf

Evaluating non-randomised intervention studies.

The European Hernia Society (EHS) is proud to present the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS. They are evidence-based and, when necessary, a consensus was reached among all members. The Guidelines have been reviewed by a Steering Committee. Before finalisation, feedback from different national hernia societies was obtained. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) instrument was used by the Cochrane Association to validate the Guidelines. The Guidelines can be used to adjust local protocols, for training purposes and quality control. They will be revised in 2012 in order to keep them updated. In between revisions, it is the intention of the Working Group to provide every year, during the EHS annual congress, a short update of new high-level evidence (randomised controlled trials [RCTs] and meta-analyses). Developing guidelines leads to questions that remain to be answered by specific research. Therefore, we provide recommendations for further research that can be performed to raise the level of evidence concerning certain aspects of inguinal hernia treatment. In addition, a short summary, specifically for the general practitioner, is given. In order to increase the practical use of the Guidelines by consultants and residents, more details on the most important surgical techniques, local infiltration anaesthesia and a patient information sheet is provided. The most important challenge now will be the implementation of the Guidelines in daily surgical practice. This remains an important task for the EHS. The establishment of an EHS school for teaching inguinal hernia repair surgical techniques, including tips and tricks from experts to overcome the learning curve (especially in endoscopic repair), will be the next step. Working together on this project was a great learning experience, and it was worthwhile and fun. Cultural differences between members were easily overcome by educating each other, respecting different views and always coming back to the principles of evidence-based medicine. The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project.

/pdf/european-hernia-society-guidelines-on-the-treatment-of-3gpmvq0mxo.pdf

European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

Today the issue of ‘educational change’ is widely discussed. Such change, so we can hear, is needed because of increasing linguistic heterogeneity and cultural diversity, because of technological developments and because of the persisting correlation between social background and educational success. In this context ‘educational’ seems to refer to the institutional practice of the school. But what do we mean by school? In our contribution, we offer some elements of what we call an internal pedagogical perspective on school and on scholastic learning which clarifies its emancipatory potential as pedagogic form. This will allow us to address the issue of educational change differently and to substantiate a plea for bringing more ‘school’ into our educational institutions. We (1) distinguish between an internal perspective and various external perspectives on the school. We, than, (2) sketch the basic assumptions, operations and experiences of the school as pedagogic form emphasizing (3) that school is technically, pedagogically and practically composed and (4) indicating very briefly how school has and is been tamed. Finally (5) we suggest some challenges for making or reinventing school today, relating it briefly to the issue of teacher education.

Bringing more ‘school’ into our educational institutions. Reclaiming school as pedagogic form

Curating the European University: On Experiments, Roundtables and Containers

The particular relationship between a teacher and his/her subject is the focus
of this article. It reports on an analysis of the way in which this relationship is conceptualized
in educational research. Four thematic fields emerged from the review i.e., teachers� beliefs on, knowledge of, emotions on, and commitment to the subject.
Within each thematic field we described major findings regarding the way in which
the relation between the teacher and the subject taught is described in educational
research. Based on the review, we stress the need for research that takes not only
seriously the cognitive, but also the affective relationship of the teacher with its
subject.

Do teachers have a relationship with their subject? a review of the literature on the teacher-subject matter relation

The transnational independent learner has become the new hero of the European learning space. In order to describe the mode of existence of the independent learner, an analysis in terms of deinstitutionalization falls short. Such analysis focuses on what disappeared but easily loses out of sight what comes instead. Especially in the case of the independent learner, the risk is taking the proclaimed ambition of liberation and emancipation of the learner from institutional settings for real. The person of the learner is not just what simply appears when the student is liberated from national and institutional frames. It is the carefully measured, calculated, monitored and framed architecture of new learning spaces that allow for recognizing oneself as a person, that is, as someone with specific learning needs. The need for authorization and recognition is part of the learner’s ontological make-up and means that the learner’s mode of existence is susceptible to verification, calculation and tracing. It is argued that this is the present-day manifestation of what Foucault termed as the ‘double bind’; what turns someone into an independent learner is subjecting her at once to governmental intervention.

Refiguring the European Student: Mixed Transnational Feelings

https://lirias.kuleuven.be/bitstream/123456789/224660/1/The+University+as+a+matter+of+public+concern.pdf

Maarten Simons

Papers

Bringing more ‘school’ into our educational institutions. Reclaiming school as pedagogic form

Curating the European University: On Experiments, Roundtables and Containers

Do teachers have a relationship with their subject? a review of the literature on the teacher-subject matter relation

Refiguring the European Student: Mixed Transnational Feelings

The university as a matter of public concern: Thinking about and of a world-university