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

/pdf/2015-esc-ers-guidelines-for-the-diagnosis-and-treatment-of-y26yabnnom.pdf

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

Objective: The Ways of Responding (WOR) instrument measures compensatory skills, a central construct in some theories of the mechanism of cognitive therapy for depression. However, the instrument is time-consuming and expensive to use in community settings, because it requires trained independent judges to rate subjects’ open-ended written responses to depressogenic scenarios. The present study evaluated the reliability and validity of a self-report version of the WOR (WOR-SR) in a community mental health sample with depressive symptoms (N = 467). Method: Subjects completed the WOR-SR, a modified version of the original WOR, and other measures of depressive symptoms, dysfunctional cognitions, functioning, quality of life, and interpersonal problems at multiple time points. Results: An exploratory factor analysis confirmed the two-factor structure of the WOR-SR. The positive and negative subscales both demonstrated excellent internal consistency (Cronbach’s alphas = .91) and moderate convergent val...

/pdf/a-self-report-version-of-the-ways-of-responding-reliability-10g53l7e8m.pdf

A self-report version of the Ways of Responding: Reliability and validity in a clinical sample.

Treatment of levodopa-induced dyskinesias with donepezil.

Trajectories of change in maternal and adolescent depressive symptoms in the depression prevention initiative.

Large Scale Genotyping in an African American Trauma Population Identifies Angiopoietin-2 Variants Associated with ALI.

One core assumption of mindfulness interventions is that engagement via session attendance and at-home mindfulness practices is essential to the program’s efficacy. In two samples of pregnant women who underwent Mindfulness-Based Cognitive Therapy for Perinatal Depression (MBCT-PD), we aimed to evaluate predictors of engagement as well as associations between engagement and clinical outcomes. Pregnant adult women with depression histories received MBCT-PD in an open trial (N = 49) or a pilot randomized clinical trial (N = 43). Engagement was measured by quantity of at-home practice and class attendance. Clinical outcomes were self-reported depressive symptoms measured at post-intervention and at 6-months postpartum. Potential predictors of engagement included baseline demographic and clinical characteristics. On average, women reported engaging in formal mindfulness practice 3.35 (SD = 1.86) times per week for 13.95 (SD = 7.25) minutes per session. Greater engagement was significantly associated with decreased depressive symptoms at post-intervention and 6 months postpartum, with medium to large effect sizes. The number of children was negatively associated with attendance and occasions of practice, with medium to large effect sizes, although not statistically significant. Prior depressive episodes, age, income, and education were not associated with engagement variables. Engagement is associated with improvements in mothers’ mental health following MBCT-PD. Given the association between mothers’ depression and their parenting behavior, MBCT-PD may be a useful intervention for enhancing parenting skills.

Robert Gallop

Papers

A self-report version of the Ways of Responding: Reliability and validity in a clinical sample.

Treatment of levodopa-induced dyskinesias with donepezil.

Trajectories of change in maternal and adolescent depressive symptoms in the depression prevention initiative.

Large Scale Genotyping in an African American Trauma Population Identifies Angiopoietin-2 Variants Associated with ALI.

The Role of Engagement in Mindfulness-Based Cognitive Therapy for the Prevention of Depressive Relapse/Recurrence in Perinatal Women