A critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare

<p>Abstract</p> <p>Background</p> <p>U.S. healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance. This article examines the peer-reviewed literature from the U.S. for evidence of effectiveness among three current popular transformational strategies: Six Sigma, Lean/Toyota Production System, and Studer's Hardwiring Excellence.</p> <p>Methods</p> <p>The English language health, healthcare management, and organizational science literature (up to December 2007) indexed in Medline, Web of Science, ABI/Inform, Cochrane Library, CINAHL, and ERIC was reviewed for studies on the aforementioned transformation strategies in healthcare settings. Articles were included if they: appeared in a peer-reviewed journal; described a specific intervention; were not classified as a pilot study; provided quantitative data; and were not review articles. Nine references on Six Sigma, nine on Lean/Toyota Production System, and one on StuderGroup meet the study's eligibility criteria.</p> <p>Results</p> <p>The reviewed studies universally concluded the implementations of these transformation strategies were successful in improving a variety of healthcare related processes and outcomes. Additionally, the existing literature reflects a wide application of these transformation strategies in terms of both settings and problems. However, despite these positive features, the vast majority had methodological limitations that might undermine the validity of the results. Common features included: weak study designs, inappropriate analyses, and failures to rule out alternative hypotheses. Furthermore, frequently absent was any attention to changes in organizational culture or substantial evidence of lasting effects from these efforts.</p> <p>Conclusion</p> <p>Despite the current popularity of these strategies, few studies meet the inclusion criteria for this review. Furthermore, each could have been improved substantially in order to ensure the validity of the conclusions, demonstrate sustainability, investigate changes in organizational culture, or even how one strategy interfaced with other concurrent and subsequent transformation efforts. While informative results can be gleaned from less rigorous studies, improved design and analysis can more effectively guide healthcare leaders who are motivated to transform their organizations and convince others of the need to employ such strategies. Demanding more exacting evaluation of projects consultants, or partnerships with health management researchers in academic settings, can support such efforts.</p

Anxiety Disorders and Sensory Over-Responsivity in Children with Autism Spectrum Disorders: Is There a Causal Relationship?

Anxiety disorders and sensory over-responsivity (SOR) are common in children with autism spectrum disorders (ASD), and there is evidence for an association between these two conditions. Currently, it is unclear what causal mechanisms may exist between SOR and anxiety. We propose three possible theories to explain the association between anxiety and SOR: (a) SOR is caused by anxiety; (b) Anxiety is caused by SOR; or (c) SOR and anxiety are causally unrelated but are associated through a common risk factor or diagnostic overlap. In this paper, we examine support for each theory in the existing anxiety, autism, and neuroscience literature, and discuss how each theory informs choice of interventions and implications for future studies

A naturally protective epitope of limited variability as an influenza vaccine target

Current antigenic targets for influenza vaccine development are either highly immunogenic epitopes of high variability or conserved epitopes of low immunogenicity. This requires continuous update of the variable epitopes in the vaccine formulation or boosting of immunity to invariant epitopes of low natural efficacy. Here we identify a highly immunogenic epitope of limited variability in the head domain of the H1 haemagglutinin protein. We show that a cohort of young children exhibit natural immunity to a set of historical influenza strains which they could not have previously encountered and that this is partially mediated through the epitope. Furthermore, vaccinating mice with these epitope conformations can induce immunity to human H1N1 influenza strains that have circulated since 1918. The identification of epitopes of limited variability offers a mechanism by which a universal influenza vaccine can be created; these vaccines would also have the potential to protect against newly emerging influenza strains

Scholarship on Gender and Sport in Sex Roles and Beyond

In this paper we critically review how research on girls or women and sport has developed over the last 35 years. We use a post-positivist lens to explore the content of the papers published in Sex Roles in the area of women, gender and sport and examine the shifts in how gender and sport have been conceptualized in these accounts. In order to initiate a broader dialogue about the scholarly analysis of gender and sport, we subsequently explore ideas inspired by feminist theorizing that have dominated/guided related research in other outlets over this time period but have received relatively little attention in papers published in Sex Roles. We conclude by briefly making suggestions for further research in this area

Case Reports: Chemokine and Cytokine Profiling in Patients with Herpetic Uveitis

Nam V Nguyen,1,2,&ast; Susanne L Linderman,3,&ast; Tolulope Fashina,1,&ast; Max Devine,1,2 Christopher D Conrady,1,4 Jessica G Shantha,5,6 Rafi Ahmed,3,&ast; Steven Yeh1,6,&ast; 1Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE, USA; 2College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; 3Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA; 4Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA; 5Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA; 6Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA&ast;These authors contributed equally to this workCorrespondence: Steven Yeh, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA, Tel +1 402 559-2020, Email [email protected]: To report cytokine/chemokine profiles of ocular fluid in two patients with herpetic uveitis.Methods: Cytokine and chemokine profiling of ocular fluid was performed in two patients with herpetic uveitis. Ocular fluid findings were correlated with disease manifestations and the patients’ clinical course.Observation: Case 1 was a 45-year-old female, who was evaluated for an 11-day history of recurrent redness, and decreased vision in the right eye (OD) and was diagnosed with acute retinal necrosis. Ocular fluid from anterior chamber paracentesis was positive for varicella zoster virus (VZV) via PCR testing. Subsequently, the patient developed proliferative vitreoretinopathy requiring a pars plana vitrectomy. Ocular fluid sample cytokine/chemokine analysis detected IFN-γ, TNF-α, IL-8, IL-18, MIP-1β, IP-10, and MCP-1 with MCP-1 being the most abundant cytokine. Case 2 was a 30-year-old female with a two-month history of progressive pain and decreased vision OD. She was diagnosed with hypertensive anterior uveitis after diagnostic anterior chamber paracentesis. Despite successful therapy for the anterior uveitis, her intraocular pressure remained elevated and required a glaucoma filtration procedure. Ocular fluid sample was collected at the time of surgery for cytokine/chemokine profiles analysis, and levels of 7 cytokines/chemokines were detected including IL-6, IL-8, IL-18, MIP-1β, IP-10, MCP-1, and IL-1RA with IL-1RA being the most abundant cytokine.Conclusion: Cytokine/chemokine profiles of two patients with herpetic uveitis showed elevated levels of MCP-1, IP-10, IL-8, and IL-18 while IL-1RA was elevated in the chronic phase of hypertensive anterior uveitis. Further studies of cytokines and chemokines will improve our understanding of soluble mediators and potential targets for herpetic uveitis.Keywords: case reports, cytokine, chemokine, acute retinal necrosis, anterior hypertensive uveiti