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

Attachment--and loss.

Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

ALAT
: alanine aminotransferase
ASAT
: aspartate aminotransferase
APAH
: associated pulmonary arterial hypertension
BAS
: balloon atrial septostomy
BMPR2
: bone morphogenetic protein receptor 2
BNP
: brain natriuretic peptide
BPA
: balloon pulmonary angioplasty
BREATHE
: Bosentan

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2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).

Background Audit and feedback continues to be widely used as a strategy to improve professional practice. It appears logical that healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. Yet, audit and feedback has not been found to be consistently effective. Objectives To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. Search strategy We searched the Cochrane Effective Practice and Organisation of Care Group's register up to January 2001. This was supplemented with searches of MEDLINE and reference lists, which did not yield additional relevant studies. Selection criteria Randomised trials of audit and feedback (defined as any summary of clinical performance over a specified period of time) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. Data collection and analysis Two reviewers independently extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken. Main results We included 85 studies, 48 of which have been added to the previous version of this review. There were 52 comparisons of dichotomous outcomes from 47 trials with over 3500 health professionals that compared audit and feedback to no intervention. The adjusted RDs of non-compliance with desired practice varied from 0.09 (a 9% absolute increase in non-compliance) to 0.71 (a 71% decrease in non-compliance) (median = 0.07, inter-quartile range = 0.02 to 0.11). The one factor that appeared to predict the effectiveness of audit and feedback across studies was baseline non-compliance with recommended practice. Reviewer's conclusions Audit and feedback can be effective in improving professional practice. When it is effective, the effects are generally small to moderate. The absolute effects of audit and feedback are more likely to be larger when baseline adherence to recommended practice is low.

Audit and feedback: effects on professional practice and healthcare outcomes

/pdf/reply-to-evidence-for-short-term-psychodynamic-psychotherapy-4ys8w6ua2d.pdf

Reply to Evidence for Short-Term Psychodynamic Psychotherapy for Depression

The Dialectical Behavior Therapy Adherence Coding Scale (DBT ACS) is an observer-rated measure used to evaluate the extent to which therapists deliver individual and group DBT with adherence to the manual. Despite its frequent use in clinical trials of DBT, relatively little is known about its psychometric properties. The present study utilized data from six clinical trials conducted in research and community settings with a variety of patient populations. Across these studies, the DBT ACS was used to code a total of 1,271 DBT individual therapy sessions and 180 DBT group sessions. Results indicate the DBT ACS computed global score has good internal consistency (α = .81) and excellent interrater reliability (ICC = .93). A confirmatory factor analysis found that a single factor yielded acceptable goodness of fit indices. The DBT ACS discriminated between DBT and another treatment and between research and community therapists. Across studies, variability in adherence scores was attributable more to therapists (33%) than to patients (15%). Both therapist and patient variability were higher in effectiveness than efficacy trials. Generalizability coefficients indicated that 5 sessions are needed to estimate a dependable adherence score at the patient level, whereas 9-15 sessions are needed to achieve adequate generalizability at the therapist level. Fewer sessions were needed to yield dependable scores for community therapists compared to research therapists. The DBT ACS appears to be a reliable, valid, and dependable method of assessing therapist adherence to individual and group DBT across diverse treatment settings, therapist types, and patient populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Dialectical Behavior Therapy Adherence Coding Scale (DBT ACS): Psychometric properties

The present study identified moderators of Multisystemic Therapy’s (MST) effects on adolescent conduct problems, considering facilitation and proximal process moderation models. The sample included 164 adolescents (mean age = 14.6 years; 83% male) randomly assigned to receive MST or services as usual; parent, youth, and teacher reports of adolescent functioning were obtained. A number of significant moderators were identified. Proximal process moderation patterns were identified (e.g., families with parents with lower levels of adaptive child discipline skills gained more from MST), but the majority of significant interactions showed a facilitation moderation pattern with, for instance, higher levels of adaptive functioning in families and parents appearing to facilitate MST (i.e., greater benefits from MST were found for these families). This facilitation pattern may reflect such families being more capable of and/or more motivated to use the resources provided by MST. It is suggested that factors consistently identified as facilitation moderators may serve as useful foci for MST’s strength-based levers of change approach. Other implications of these findings for individualized treatment also are discussed.

/pdf/test-of-facilitation-vs-proximal-process-moderator-models-1fqaye9rp7.pdf

Test of "Facilitation" Vs. "Proximal Process" Moderator Models for the Effects of Multisystemic Therapy on Adolescents with Severe Conduct Problem

We developed three methods (rating, ranking, and discrete choice) for identifying patients' preferred depression treatments based on their prioritization of specific treatment attributes (e.g., medication side effects, psychotherapy characteristics) at treatment intake. Community mental health patients with depressive symptoms participated in separate studies of predictive validity (N = 193) and short-term (1-week) stability (N = 40). Patients who received non-preferred initial treatments (based on the choice method) switched treatments significantly more often than those who received preferred initial treatments. Receiving a non-preferred treatment at any point (based on rating and choice methods) was a significant predictor of longer treatment duration. All three methods demonstrated good short-term stability.

/pdf/methods-for-incorporating-patient-preferences-for-treatments-dtn1tshieu.pdf

Methods for Incorporating Patient Preferences for Treatments of Depression in Community Mental Health Settings.

Reports an error in "A tutorial on count regression and zero-altered count models for longitudinal substance use data" by David C. Atkins, Scott A. Baldwin, Cheng Zheng, Robert J. Gallop and Clayton Neighbors (Psychology of Addictive Behaviors, 2013[Mar], Vol 27[1], 166-177). The URL for the supplemental material was incorrect throughout the text due to a production error. Supplemental material for this article is available at: http://dx.doi.org/10.1037/a0029508.supp. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2012-22398-001.) Critical research questions in the study of addictive behaviors concern how these behaviors change over time: either as the result of intervention or in naturalistic settings. The combination of count outcomes that are often strongly skewed with many zeroes (e.g., days using, number of total drinks, number of drinking consequences) with repeated assessments (e.g., longitudinal follow-up after intervention or daily diary data) present challenges for data analyses. The current article provides a tutorial on methods for analyzing longitudinal substance use data, focusing on Poisson, zero-inflated, and hurdle mixed models, which are types of hierarchical or multilevel models. Two example datasets are used throughout, focusing on drinking-related consequences following an intervention and daily drinking over the past 30 days, respectively. Both datasets as well as R, SAS, Mplus, Stata, and SPSS code showing how to fit the models are available on a supplemental website. (PsycINFO Database Record (c) 2013 APA, all rights reserved). Language: en

Robert Gallop

Papers

Reply to Evidence for Short-Term Psychodynamic Psychotherapy for Depression

The Dialectical Behavior Therapy Adherence Coding Scale (DBT ACS): Psychometric properties

Test of "Facilitation" Vs. "Proximal Process" Moderator Models for the Effects of Multisystemic Therapy on Adolescents with Severe Conduct Problem

Methods for Incorporating Patient Preferences for Treatments of Depression in Community Mental Health Settings.

Correction to Atkins et al. (2012): "A tutorial on count regression and zero-altered count models for longitudinal substance use data"