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\"Making Sense of Change Management is the best-selling classic text, providing a thorough overview of the subject of change for both students and professionals. Along with explaining the theory and practice of change management and comprehensively covering the models, tools, and techniques of successful change management, this completely revised and updated fourth edition includes more international examples and case studies throughout the book. The chapter on cultural change has been re-written to reflect the emerging new thinking and practice in this area, offering ways to help managers implement cultural change processes within their organization. It also explores cultural sensitivity and what to do when cultures collide.Additionally, the chapter on IT based process change has now been replaced with one on the inter-relationship with project management (PM) and change management. It defines \"project success,\" explains how PM approaches are increasingly being used to manage transformational change, and covers complexity models, agile approaches, and stakeholder management.With free online resources for professors/instructors, this is an ideal textbook for MBA or graduate students focusing on leading or managing change\"-- Provided by publisher.

Human cytomegalovirus (HCMV) can be managed by monitoring HCMV DNA in the blood and giving valganciclovir when viral load exceeds a defined value. We hypothesised that such pre-emptive therapy should occur earlier than the standard 3000 genomes/ml (2520 IU/ml) when a seropositive donor transmitted virus to a seronegative recipient (D+R-) following solid organ transplantation (SOT). Our local protocol was changed so that D+R- SOT patients commenced valganciclovir once the viral load exceeded 200 genomes/ml; 168 IU/ml (new protocol). The decision point remained at 3000 genomes/ml (old protocol) for the other two patient subgroups (D+R+, D-R+). Virological outcomes were assessed three years later, when 74 D+R- patients treated under the old protocol could be compared with 67 treated afterwards. The primary outcomes were changes in peak viral load, duration of viraemia and duration of treatment in the D+R- group. The secondary outcome was the proportion of D+R- patients who developed subsequent viraemia episodes. In the D+R- patients, the median values of peak viral load (30,774 to 11,135 genomes/ml, p<0.0215) were significantly reduced on the new protocol compared to the old, but the duration of viraemia and duration of treatment were not. Early treatment increased subsequent episodes of viraemia from 33/58 (57%) to 36/49 (73%) of patients (p< 0.0743) with a significant increase (p = 0.0072) in those episodes that required treatment (16/58; 27% versus 26/49; 53%). Median peak viral load increased significantly (2,103 to 3,934 genomes/ml, p<0.0249) in the D+R+ but not in the D-R+ patient subgroups. There was no change in duration of viraemia or duration of treatment for any patient subgroup. Pre-emptive therapy initiated at the first sign of viraemia post-transplant significantly reduced the peak viral load but increased later episodes of viraemia, consistent with the hypothesis of reduced antigenic stimulation of the immune system.

Background Endotracheal tube (ETT) fasteners such as the AnchorFast™ claim to assist with the prevention of oral pressure injuries in intubated patients, however evidence to support their clinical efficacy is limited. This retrospective observational study aimed to investigate the impact of the introduction of the AnchorFast™ device on the incidence of oral pressure injuries in mechanically ventilated patients. Methods Data was collected from patient case notes and clinical incident reports for October 2010 to June 2013 ( pre-AnchorFast) and July 2013 to March 2016 ( post-AnchorFast) . Incidence and location of oral pressure injuries associated with securing device, and compliance with institutional policies related to reducing oral pressure injuries were recorded. Results Incidence of oral pressure injuries increased from 1.53/100 intubated patients in the pre-AnchorFast period to 3.73/100 intubated patients in the post-AnchorFast period (IRR = 2.43, 95%CI = 1.35–4.38; p  = 0.003). Across both study periods, patients with an ETT secured using AnchorFast™ had significantly increased risk of oral pressure injuries (IRR = 2.03, 95%CI = 1.17–3.51; p  = 0.02). There was also a significant difference in location of pressure injuries sustained with ETTs secured using cloth tapes (53.6% in corner of the mouth) vs. AnchorFast™ (75% on the lips) ( p  = 0.008). Among patients with oral pressure injuries, compliance with institutional policies relating to the prevention of pressure injuries was significantly greater after the introduction of the AnchorFast™ (9.1% vs 64.5%, p  = 0.004). Conclusions The incidence of oral pressure injuries increased significantly following the introduction of the AnchorFast™ device. Further research is required to establish the reasons for this observed increase to and identify ways to reduce the risk of pressure injuries with ETT securement devices.

\"This book presents recent advancements in positive psychology, specifically its application across broad areas of current interest. Chapters include submissions from various international authors in the field and cover discussion and presentation of relevant research, theories, and applications. The volume covers topics such as CBT, Psychotherapy, Coaching, Workplaces, Aging, Education, Leadership, Emotion, Interventions, Measurement, Technology, Design, Health, Relationships, Experiences, Communities. With the growing interest in the applications of positive psychology across diverse fields within psychology and beyond, this book will make a worthwhile contribution to the field. It will also fill the current need for a volume that highlights specifically the various recent advancements in positive psychology into diverse fields and as such will be of benefit to a wide range of professionals, including psychologists, educators, clinicians, therapists, and many others.\" -- Publisher's website.

Objectives Primary objective: To estimate the effect of corticosteroids compared with usual care or placebo on mortality up to 28 days after randomization. Secondary objectives: To examine whether the effect of corticosteroids compared with usual care or placebo on mortality up to 28 days after randomization varies between subgroups related to treatment characteristics, disease severity at the time of randomization, patient characteristics, or risk of bias. To examine the effect of corticosteroids compared with usual care or placebo on serious adverse events. Study design Prospective meta-analysis of randomized controlled trials. Both placebo-controlled and open-label trials are eligible. Participants Hospitalised, critically ill patients with suspected or confirmed COVID-19. Intervention and comparator Intervention groups will have received therapeutic doses of a steroid (dexamethasone, hydrocortisone or methylprednisolone) with IV or oral administration immediately after randomization. The comparator groups will have received standard of care or usual care or placebo. Main outcome All-cause mortality up to 28 days after randomization. Search methods Systematic searching of clinicaltrials.gov , EudraCT, the WHO ISRCTN registry, and the Chinese clinical trials registry. Additionally, research and WHO networks will be asked for relevant trials. Risk of bias assessments These will be based on the Cochrane RoB 2 tool, and will use structured information provided by the trial investigators on a form designed for this prospective meta-analysis. Summary of findings We will use GRADE to assess the certainty of the evidence. Statistical analyses Trial investigators will provide data on the numbers of participants who did and did not experience each outcome according to intervention group, overall and in specified subgroups. We will conduct fixed-effect (primary analysis) and random-effects (Paule-Mandel estimate of heterogeneity and Hartung-Knapp adjustment) meta-analyses. We will quantify inconsistency in effects between trials using I 2 statistics. Evidence for subgroup effects will be quantified by ratios of odds ratios comparing effects in the subgroups, and corresponding interaction p-values. Comparisons between subgroups defined by trial characteristics will be made using random-effects meta-regression. Comparisons between subgroups defined by patient characteristics will be made by estimating trial-specific ratios of odds ratios comparing intervention effects between subgroups then combining these using random-effects meta-analysis. Steroid interventions will be classified as high or low dose according to whether the dose is greater or less than or equal to 400 mg hydrocortisone per day or equivalent. We will use network meta-analysis methods to make comparisons between the effects of high and low dose steroid interventions (because one trial randomized participants to both low and high dose steroid arms). PROSPERO registration number CRD42020197242 Full protocol The full protocol for this prospective meta-analysis is attached as an additional file, accessible from the Trials website (Additional file 1 ). To expedite dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol for the systematic review.

To investigate the impact of delay in rapid response call (RRC) activation on Hospital mortality. This study was conducted in a university affiliated hospital providing medical, surgical, mental health, maternity, and pediatric services. RRCs were considered delayed if RRC activation was delayed by ≥15min. The primary outcome measure was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), requirement of ICU admission, as well as requirement of mechanical ventilation and ICU LOS for patients requiring ICU admission. A total of 826 RRCs occurred in 629 patient admissions. A quarter of all RRCs were delayed by ≥15min, with a median delay of 1h and 20min. Patients with a delayed RRC had significantly higher in-hospital mortality (34.7% vs. 21.2%; p=0.001,) and significantly longer hospitalizations (11.6 vs. 8.4days; p=0.036). After adjusting for confounders, RRC activation was independently associated with increased in-hospital mortality (OR=1.79; 95% CI=1.17–2.72: p=0.007). A delay of ≥15min was associated with significantly increased in-hospital mortality and longer hospitalization. The factors contributing to the observed increase in mortality with delayed RRCs require further exploration. •Delay in rapid response call activation is common even in mature rapid response systems.•A delay in rapid response call activation is associated with poorer patient outcomes.•Factors contributing to delay in rapid response call activation and observed increase in mortality require further exploration.

IntroductionPercutaneous Endoscopy Gastrostomy (PEG), used as a long term feeding conduit, should be provided by every endoscopic unit along with related basic procedures.1 Its primary indication is to help patients meet their metabolic requirements who have inadequate oral intake. Last national guidance in 2010 by the British Society of Gastroenterology reviews indications, common complications and outlines a generic referral pathway.AimsWe aimed to audit local (an east London District General Hospital) PEG related procedures in contest to recommendations from the BSG, 2010 PEG evaluation and to review any sparsity of guidance.Methods21 patient case files (total PEG procedures from October 22-November 23) were reviewed with particular focus on: indications, waiting times, complications, 1 year mortality.ResultsIndications aligned with those in the BSG guidance however with a lack of clear pre-procedure MDT documentation. Waiting times averaged 24 days (inpatient), 85 days (outpatient) with nil clear national targets to aim for. No complications were encountered, with 1 year mortality post procedure at 5%.ConclusionLocal data is in keeping with national recommendations. However, there is lack of guidance on target wait times for PEG related procedures. There is also minimal usage of key performance indicators when deciding upon appropriate patients for PEGs, especially in the geriatric population, such as Clinical Frailty Score which is now routinely used in pre-operative general surgery cases.2ReferencesWestaby D. (2010) The provision of a percutaneously placed enteral tube feeding service.Mendiratta P. (2023) Clinical frailty scale - statpearls - NCBI bookshelf, Clinical Frailty Scale. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559009/(Accessed: 29 January 2024).

IntroductionThe efficacy of bowel preparation is internationally recognised as an independent factor for high quality colonoscopy. MoviPrep®, a commonly prescribed colonic lavage, is a low-volume polyethylene glycol (PEG) osmotic colonoscopy preparation that is proven to effectively cleanse the colon). The specific recommendations for taking MoviPrep® are dependent on the time of the colonoscopy but conventionally involves avoiding solid food for more than 24 hours prior to the planned procedure.It is well recognised that poor bowel preparation is associated with lower caecal intubation rates, prolonged colonoscopy time and increased patient discomfort leading to poor quality colonoscopy. The period of starvation required for conventional bowel preparation is challenging for patients and has been shown to cause a significant burden. Whilst direct causation between the period of starvation and adherence to bowel preparation has not been shown previously it is predictable that patients are more likely to adhere to a bowel preparation regime if the perceived hunger burden is reduced.MethodologyA single centre retrospective analysis comparing the quality of bowel preparation using Moviprep® with standard procedure (last meal for morning procedure 9 am on previous day, for afternoon procedure last meal 1 pm on previous day) and reduced duration of starvation (last meal for morning procedures 1 pm and for afternoon procedures 3 pm) with split dose of Moviprep® administration for morning procedures at 5 pm and 8 pm and for afternoon procedures 7 pm and 6 am on the day of procedure.Procedures were recorded on Unisoft reporting programme and bowel cleanliness scored using the Aronchick scale. These procedures were audited over this period of change and compared with procedures conducted with conventional bowel preparation regime. The two-time data sets were compared using chi-squared test for statistical significance.ResultsThere were 6440 colonoscopies performed between October 2018 – December 2019. The results are shown as per table 1 below. There was no significant statistical differences between the two groups (table 1).Abstract P26 Table 1Bowel cleanliness score following colonoscopy performed with conventional MoviPrep® compared with shortened MoviPrep® regime Bowel Preparation Outcome Conventional MoviPrep® Regime Shortened MoviPrep® Regime P-value Excellent 651 (12.5%) 126 (11.2%) P = 0.6843 Good 2984 (57.5%) 637 (56.8%) P = 0.7457 Fair 1272 (24.5%) 292 (26.1%) P = 0.5681 Inadequate 286 (5.5%) 66 (5.9%) P = 0.8986 ConclusionFrom this study we conclude that the shortened MoviPrep® regime did not cause a clinically significant reduction in quality of bowel preparation when undertaking colonoscopy. The study also demonstrates however that bowel preparation in both groups was less than good in 30%. We concluded that a shortened duration of hunger followed by split dose standard time MoviPrep® is equal to longer duration of fast. Further work is required to improve the quality of the bowel preparation in all, perhaps by assessment of the low residue diet preceding the period of hunger. In view of the conclusions from this study we continue to implement the shortened duration of fast for bowel preparation.

Transplantation of neural stems cells (NSCs) could be a useful means to deliver biologic therapeutics for late-stage Alzheimer's disease (AD). In this study, we conducted a small preclinical investigation of whether NSCs could be modified to express metalloproteinase 9 (MMP9), a secreted protease reported to degrade aggregated Aβ peptides that are the major constituents of the senile plaques. Our findings illuminated three issues with using NSCs as delivery vehicles for this particular application. First, transplanted NSCs generally failed to migrate to amyloid plaques, instead tending to colonize white matter tracts. Second, the final destination of these cells was highly influenced by how they were delivered. We found that our injection methods led to cells largely distributing to white matter tracts, which are anisotropic conduits for fluids that facilitate rapid distribution within the CNS. Third, with regard to MMP9 as a therapeutic to remove senile plaques, we observed high concentrations of endogenous metalloproteinases around amyloid plaques in the mouse models used for these preclinical tests with no evidence that the NSC-delivered enzymes elevated these activities or had any impact. Interestingly, MMP9-expressing NSCs formed substantially larger grafts. Overall, we observed long-term survival of NSCs in the brains of mice with high amyloid burden. Therefore, we conclude that such cells may have potential in therapeutic applications in AD but improved targeting of these cells to disease-specific lesions may be required to enhance efficacy.