Prospective Observational Study on acute Appendicitis Worldwide (POSAW)

Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments.info:eu-repo/semantics/publishedVersio

Retinal function and histopathology in rabbits treated with Topiramate.

Purpose To evaluate retinal function and histopathology in rabbits treated orally with the antiepileptic drug topiramate. Methods Six rabbits were treated with a daily oral dose of topiramate during a period of eight months. Six rabbits receiving water served as controls. Blood samples were analyzed for determination of topiramate serum levels in order to ensure successful drug exposition. Standardized full-field electroretinograms (ERGs) were performed before treatment and then at 2, 3 and 8 months during the treatment period. After terminating treatment the rabbits were sacrificed and the morphology of the sectioned retina was studied. Results After eight months of treatment the fullfield ERG demonstrated normal rod function in treated and control rabbits, but the light adapted 30 Hz flicker b-wave amplitude was significantly reduced in the treated rabbits. This was the case for both the light adapted (Wilcoxon signed ranks test, P=0.046) and the dark adapted (Wilcoxon signed ranks test, P=0.028) 30 Hz flicker response from the treated rabbits. Retinal immunohistology revealed a severe accumulation of GABA in amacrine cells and in the inner plexiform layer in 4 of 6 treated rabbits compared to the controls. Conclusions Topiramate, orally administrated to rabbits, may cause a significant reduction of the retinal function demonstrated by the reduced b-wave amplitude in the full-field ERG, as well as changes in immunohistology characterized by a severe accumulation of GABA in the inner retina. The retinal dysfunction and the morphological changes indicate that topiramat may damage the retina, similarly to vigabatrin (another antiepileptic drug)

Adding requirements on customers to current quality models toimprove quality : development of a customer ‐ vendor interaction

In most descriptions of business development and models for Corporate Governance, contacts between supplier and customer are for the most part focused on the supplier’s responsibility to identify and document customer requirements in order to enable the organization to meet customer requirements (stated and unstated). In the actual contact between customer and supplier it has been observed in several cases that there are aspects of the interaction not described in traditional theoretical quality models. What seems to be missing is a more explicit requirement for customers and for customers' actions. The logic is that a qualified customer performing based on supplier instructions will result in a better performing product. The apparent lack of theoretical models describing this aspect indicates that this is an interesting area for research and development. The purpose of this paper is to highlight a seemingly "forgotten" area within quality management, which is the lack of requirements put on customers in quality models.  The first objective is to review existing quality models to explore the extent of requirement on customers included. The second objective is to propose additions to current models that include requirements placed on customers. A limited review of the award criteria and the most common models for quality and improvement techniques shows that there is no explicit and documented way to set requirements for customers. Our interpretation is that EFQM is the model closest to our description of “demands on customer” due to their clauses connected to “partnership”. The ISO/DIS 26000 is moving the requirements further against the customer for the social responsibility than the quality standards are doing. Further research could focus on how requirements on customer will affect the performance of the entire supply chain both from a quality and social point of view

Implementing Lean : Discussing Standardization Versus Customization with Focus on National Cultural Dimensions

Lean or Toyota Production System (TPS) has more or less successfully been implemented in the Western world’s businesses and organizations for the past 20 years. Several authors have discussed what it is that creates a successful implementation, and several studies have been presented where strategies for implementations have been studied. Culture’s impact and possible mitigation for Western companies have been studied and described by for example Womak & Jones. Proponents of the concept of Lean argue that culture is not a constraint for implementation of Lean. Lean Management is called a philosophy but it is often used as a change strategy in the sense that it is implemented with the view of improving performance. A change strategy could be seen as a product that might have to be customized with the view of improving the effectiveness of the implementation. On the other hand abandoning a standardized approach comes with the risk of severely altering the change strategy, possibly to its detriment. Implementing Lean will have an effect on the company culture. Does it make any sense customizing the implementation to culture if the issue is changing the culture? The purpose of this paper is to highlight and discuss the balance between a customized implementation and a standardized implementation. Which are the main arguments for standardization and customization and how could these be reconciled? A literature study of Lean implementation has been carried out and compared with Lean principles and theories from change management with focus on change drivers and change barriers. Main drivers of Hofstede’s national cultural dimensions are compared with Lean principles to identify possible drivers and barriers in different cultures. The theory synthesis on drivers and barriers is subjected to a first test in a case study on Lean implementation according to a standardized approach. The implementation is made in a small Swedish factory belonging to a worldwide industrial company. Results from the literature review and the case study indicate that both customization and standardization are needed

The peculiarities of learning motivation in primary school

Lean or Toyota Production System (TPS) has more or less successfully been implemented in the Western world’s businesses and organizations for the past 20 years. Several authors have discussed what it is that creates a successful implementation, and several studies have been presented where strategies for implementations have been studied. Culture’s impact and possible mitigation for Western companies have been studied and described by for example Womak & Jones. Proponents of the concept of Lean argue that culture is not a constraint for implementation of Lean. Lean Management is called a philosophy but it is often used as a change strategy in the sense that it is implemented with the view of improving performance. A change strategy could be seen as a product that might have to be customized with the view of improving the effectiveness of the implementation. On the other hand abandoning a standardized approach comes with the risk of severely altering the change strategy, possibly to its detriment. Implementing Lean will have an effect on the company culture. Does it make any sense customizing the implementation to culture if the issue is changing the culture? The purpose of this paper is to highlight and discuss the balance between a customized implementation and a standardized implementation. Which are the main arguments for standardization and customization and how could these be reconciled? A literature study of Lean implementation has been carried out and compared with Lean principles and theories from change management with focus on change drivers and change barriers. Main drivers of Hofstede’s national cultural dimensions are compared with Lean principles to identify possible drivers and barriers in different cultures. The theory synthesis on drivers and barriers is subjected to a first test in a case study on Lean implementation according to a standardized approach. The implementation is made in a small Swedish factory belonging to a worldwide industrial company. Results from the literature review and the case study indicate that both customization and standardization are needed

Integrated Management Systems : testing a model for integration

Management systems are widely used for creating order, minimising risks and for assuring performance. Management systems are in many occasions integrated since this has been found to be beneficial. In this paper a model for a fully integrated management system (IMS) based on the three axes of level, extent and scope of integration is tested for relevance. The studied system permits the integration of all relevant process dimensions. The research is only in a pilot stage, but the initial results are promising and indicate that there are advantages in using the process view as a base for identifying critical aspects to be managed. A review of the current situation for system integration is studied and the model is subjected to some tests using Sweden as a case. The background study shows that system integration still is limited, especially when comparing with a fully integrated IMS. The feedback from the organisations interviewed is positive and supports continued work with development of the model