Perioperative Nutrition: Recommendations from the ESPEN Expert Group

Background and aims: Malnutrition has been recognized as a major risk factor for adverse postoperative outcomes. The ESPEN Symposium on perioperative nutrition was held in Nottingham, UK, on 14-15 October 2018 and the aims of this document were to highlight the scientific basis for the nutritional and metabolic management of surgical patients. Methods: This paper represents the opinion of experts in this multidisciplinary field and those of a patient and caregiver, based on current evidence. It highlights the current state of the art. Results: Surgical patients may present with varying degrees of malnutrition, sarcopenia, cachexia, obesity and myosteatosis. Preoperative optimization can help improve outcomes. Perioperative fluid therapy should aim at keeping the patient in as near zero fluid and electrolyte balance as possible. Similarly, glycemic control is especially important in those patients with poorly controlled diabetes, with a stepwise increase in the risk of infectious complications and mortality per increasing HbA1c. Immobilization can induce a decline in basal energy expenditure, reduced insulin sensitivity, anabolic resistance to protein nutrition and muscle strength, all of which impair clinical outcomes. There is a role for pharmaconutrition, pre-, pro- and syn-biotics, with the evidence being stronger in those undergoing surgery for gastrointestinal cancer. Conclusions: Nutritional assessment of the surgical patient together with the appropriate interventions to restore the energy deficit, avoid weight loss, preserve the gut microbiome and improve functional performance are all necessary components of the nutritional, metabolic and functional conditioning of the surgical patient

The role of national culture in Total Quality Management

This paper discusses the role of national culture in adopting total quality management (TQM) in developing countries, using the ICT organisations in Jordan as the basis of the study. employing a methodology of semistructured interviews, the data was collected from General and TQM managers. The ten largest organisations, based on the number of employees, were used as the basis of the study. The results indicated that the national culture characteristics have a negative impact on adopting and supporting TQM implementation. This paper introduces a key dimension (Wasta) hasn’t been studied in the TQM literature and focuses on its impact on TQM implementation

A review of current issues and challenges for TQM implementations in the Jordanian information and communications technology sector

This paper discusses the application of Total Quality Management (TQM) in Jordanian Information and Communications Technology (ICT) sector. Utilising a methodology based upon questionnaires and semi-structure interviews, investigation of Jordanian ICT organisations and their significant stakeholders has revealed that although they have endeavoured to put into practice the strategies, tools and techniques of TQM, there are barriers to achieving successful implementation. The most significant relate to government influences and internal cultural characteristics. This research has further identified that effective information systems play a successful role in TQM implementations, an issue that is not well demonstrated in the literature

An investigation of the role of leadership in the implementation of TQM in Medical Universities of Iran

In the developing countries, management is one of the big challenges in the running of academic organisations. Total Quality Management (TQM) is a management approach that aims for long term success. Since the mid 1980s “quality” has been a major issue in higher educational institutions. Universities are under a lot of pressure from a range of stakeholders. After successful implementation of TQM in higher educational institutes in developed countries it is now the right time for implementation of TQM in developing countries. This paper aims to discuss the role of top management (leadership) in the successful implementation of TQM in Iranian Medical Sciences Universities (MSUs). The Baldrige quality model was chosen as the framework for the research. Two MSUs were identified and a questionnaire was delivered to different groups within the Universities. The relationships between the leadership category and other categories were identified. The findings indicated that top management (leadership) is highly related to the other categories and hence by improving this category there will be a positive impact on other categories. The results also revealed that the employees' opinions on the senior leaders in terms of the commitment, participation, and adoption of the TQM were low and needs to be addressed

Modelling the changing apparel supply chain

This paper describes a research project funded by the Engineering and Physical Sciences Research Council. Twenty case-study companies operating across a range of industrial sectors participated in the project. Sectors chosen for the development of these architectures were those where the use of the traditional manufacturing resource planning (MRPII) model is not the optimum operating solution. In particular, the paper describes the process mapping and analysis approach applied to the study of a sector-based group of apparel manufacturing companies who collaborated in the research. The planning issues that confront the companies, the control solutions they employ in response to their present commercial environment as they seek to address the changing demands being made of the industry are outlined. A generic planning and control reference architecture developed from the study for the apparel sector is presented

Modelling the changing apparel supply chain

This paper describes a research project funded by the Engineering and Physical Sciences Research Council. Twenty case-study companies operating across a range of industrial sectors participated in the project. Sectors chosen for the development of these architectures were those where the use of the traditional manufacturing resource planning (MRPII) model is not the optimum operating solution. In particular, the paper describes the process mapping and analysis approach applied to the study of a sector-based group of apparel manufacturing companies who collaborated in the research. The planning issues that confront the companies, the control solutions they employ in response to their present commercial environment as they seek to address the changing demands being made of the industry are outlined. A generic planning and control reference architecture developed from the study for the apparel sector is presented

Integrated planning and scheduling in the engineer-to-order sector

The key focus in the 1990s for manufacturers of capital equipment and high-value goods has been to optimize their responsiveness to customer requirements without compromising the performance of their products. Important elements which underpin such agility must be the information links to the customer and the interfaces to key suppliers. The extended lead-time for engineer-to-order (ETO) products typically requires a review of the whole order fulfilment process and the software systems that support this to improve responsiveness. Research shows that a key factor for manufacturing responsiveness is the performance of the firm's manufacturing control function. Whilst there is a wide range of generic proprietary software available that meets a company's planning and scheduling requirements with varying degrees of success, the main difficulty lies in understanding the match between the business needs and the capabilities of the software. This is a particular problem for small and medium enterprises (SMEs) which are common in the ETO sector. The EPSRC-funded work covered by this paper is aimed at developing novel planning and scheduling reference models for industrial sectors where the MRPII paradigm is not a good fit. The work is based upon detailed case studies within 13 industrial companies. This paper presents the research aims and objectives, gives an overview of the ETO sector, explains the data capture method used for the case study companies, and the use of extended event process chains and planning and scheduling process models which underpin the development of the reference models, and finally, presents and discusses the reference model for the ETO sector