Building a quality culture through small and large successes.

Total quality management (TQM) is a unifying business strategy for achieving and sustaining growth. TQM proceeds, step by step, project by project, to transform the organization into one smoothly working, quality-focused team. For successful implementation of TQM, the small projects are every bit as important as the large ones. The simple, accessible successes validate the skills that employees are acquiring and encourage them to try more complex, long-term endeavors. This article discusses several TQM projects conducted at Baptist Medical Center in Columbia, SC: streamlining medical records processing (a large project that freed up millions of dollars in cash flow); improving the reliability of all hospital equipment; and ongoing small successes in the recovery room. Although the dollar value of the projects varied considerably, all were critical to creating a culture of total quality management at Baptist Medical Center.

Transdermal clonidine versus chlordiazepoxide in alcohol withdrawal: a randomized, controlled clinical trial.

In a prospective, double-blind comparison, we assessed the efficacy of transdermal clonidine with that of chlordiazepoxide in the treatment of moderately severe acute alcohol withdrawal syndrome. While having significant withdrawal symptoms, 50 hospitalized men were randomly assigned to receive either transdermal clonidine or chlordiazepoxide over a 4-day study period. Outcome was evaluated daily, medically and psychiatrically, using both objective and subjective measurements for dependent variables. No patient in either study group had seizures or progression to delirium tremens. The group receiving transdermal clonidine had a more significant response globally for the signs and symptoms of alcohol withdrawal, as measured by the Alcohol Withdrawal Assessment Scale. Also, clonidine more effectively lowered elevated systolic and diastolic blood pressure and heart rate. The core target symptom, anxiety, decreased significantly more in the patients receiving transdermal clonidine when measured by the Hamilton Anxiety Rating Scale and its subscale for somatic anxiety. Cognitive function responded equally in both study populations. Clonidine-treated patients reported less diarrhea, dizziness, headache and fatigue, and the chlordiazepoxide-treated patients reported less nausea and vomiting. We conclude that transdermal clonidine is effective treatment for the acute alcohol withdrawal syndrome.

Development of Pseudomonas aeruginosa resistance to norfloxacin during therapy.

Two elderly patients diagnosed with Pseudomonas aeruginosa urinary tract infections were treated with oral norfloxacin in the recommended dose of 400 mg q12h. Initially, antimicrobial susceptibility data indicated the organisms were sensitive to norfloxacin. Six to eight days into therapy urine cultures became positive for P. aeruginosa once again; this time, however, susceptibility reports indicated the organisms were now resistant to norfloxacin. Since cross-resistance among norfloxacin, other quinolones, and cephalosporins can occur, we recommend repeated urine cultures during and after norfloxacin therapy in elderly patients with complicated P. aeruginosa urinary tract infections.

Clonidine vs chlordiazepoxide in the management of acute alcohol withdrawal syndrome.

To our knowledge, this is the first reported comparison of clonidine with benzodiazepine in the management of acute alcohol withdrawal syndrome. In a double-blind trial, 61 men experiencing acute alcohol withdrawal were randomly assigned to receive clonidine or chlordiazepoxide over a 60-hour treatment period. Clonidine was more effective than chlordiazepoxide at reducing alcohol withdrawal scale scores, systolic blood pressures, and heart rates over the entire study period. Clonidine was as good as chlordiazepoxide at improving Cognitive Capacity Screening Exam, Hamilton Anxiety Rating Scale, and Self-Rating Scale scores. Adverse drug reactions reported by each group were similar, though less nausea and vomiting were observed in the clonidine group. Clonidine may represent a new alternative agent for the management of acute alcohol withdrawal syndrome.

Norfloxacin: clinical pharmacology and clinical use.

Norfloxacin, a nalidixic acid analog, is the first of the fluorinated quinolinecarboxylic acids to be marketed in the United States. It demonstrates potent antibacterial activity against aerobic, gram-negative bacteria including the Enterobacteriaceae, gentamicin-resistant Pseudomonas aeruginosa, and penicillin-resistant Neisseria gonorrhoeae. Norfloxacin exhibits good activity against methicillin-resistant and -sensitive Staphylococcus aureus, but less activity against most other aerobic, gram-positive organisms. Anaerobic bacteria are resistant to the drug. Resistance to norfloxacin is not plasmid mediated, but is secondary to bacterial mutation, and occurs less frequently than nalidixic acid resistance. Its pharmacokinetic properties after a 400-mg oral dose consist of a peak serum concentration of 1.3-1.58 micrograms/ml, an elimination half-life of 3-7 hours, and good penetration into kidney and prostatic tissues. Renal excretion is the major route of elimination. Norfloxacin is highly effective in the treatment of uncomplicated and complicated urinary tract infections, and gonococcal urethritis. Adverse effects are generally well tolerated and usually do not require discontinuation of therapy.

Immunological relationships among some species of extremely halophilic bacteria.

Rabbits were immunized with four strains of halobacteria, Halobacterium halobium NRL, H. halobium R-1, H. salinarium NRL-9, and H. cutirubrum NRL-10, that had been fixed with formaldehyde. The antisera obtained detected the presence of an antigen common to the Halobacterium genus and, after absorption, detected three distinct antigenic groups within the Halobacterium genus. A fourth group was agglutinated only by unabsorbed sera.

A morphological study of Halobacterium halobium and its lysis in media of low salt concentration.

The reported absence of a cell wall in halobacteria cannot be confirmed. Improved fixation techniques clearly show a cell wall-like structure on the surface of these cells. A stepwise reduction of the salt concentration causes the release of cell wall material before the cell membrane begins to disintegrate. The cell membrane breaks up into fragments of variable but rather small size, which are clearly different from a 4S component reported by others to be the major breakdown product of the cell membrane. It appears more likely that the 4S component arises from the dissolution of the cell wall. A residue of large membranous sheets remains even after prolonged exposure of halobacteria envelopes to distilled water. The lipids in these sheets do not differ significantly from the lipids in the lysed part of the cell membrane. The sheets, however, contain a purple-colored substance, which is not present in the lysed part. The easily sedimentable residue that remains after lysis of the cells or envelopes in distilled water also contains "intracytoplasmic membranes" with unusual structural characteristics. They can also be identified in sections through intact bacteria or envelope preparations. Their function is at present unknown but seems to be related to the formation of gas vacuoles in these organisms.