Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial

Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used

A review of the theory and practice of managing TQM: An integrative framework

This paper on Total Quality Management (TQM) is concerned with the problem of defining quality as well as examining a universal set of precepts to safeguard it as a management philosophy. In contrast to the traditional approaches to the subject, which tends to see things largely in universalistic terms, this paper, through a comparative analysis of this view versus contingent approach, argues that the actual practice of TQM is deeply rooted in specific contexts. Having recognised the implications of various definitions, precepts and approaches in more detail, this paper then goes on to consider whether quality-driven organisations are in a state of transition, or if not, what would be the main barriers that impede transition to a stable total quality (TQ) environment. Here, particular attention is given to the role and status of senior management. Based on these issues, the paper suggests an integrative hypothesised framework of the linkages between top management commitment and TQM success or failure; and concludes with critical challenges ahead for organisational researchers to advance knowledge in the field of TQM