SummaryUnselected coagulation testing is widely practiced in the process of assessing bleeding risk prior to surgery. This may delay surgery inappropriately and cause unnecessary concern in patients who are found to have 'abnormal' tests. In addition it is associated with a significant cost. This systematic review was performed to determine whether patient bleeding history and unselected coagulation testing predict abnormal perioperative bleeding. A literature search of Medline between 1966 and 2005 was performed to identify appropriate studies. Studies that contained enough data to allow the calculation of the predictive value and likelihood ratios of tests for perioperative bleeding were included. Nine observational studies (three prospective) were identified. The positive predictive value (0AE03-0AE22) and likelihood ratio (0AE94-5AE1) for coagulation tests indicate that they are poor predictors of bleeding. Patients undergoing surgery should have a bleeding history taken. This should include detail of previous surgery and trauma, a family history, and detail of anti-thrombotic medication. Patients with a negative bleeding history do not require routine coagulation screening prior to surgery.Keywords: surgery, coagulation screen, bleeding, clinical history. ObjectiveThe aim of this guideline is to provide a rational approach to the use of bleeding history and coagulation tests prior to surgery or invasive procedures to predict bleeding risk. The aim is to evaluate the use of indiscriminate testing. Appropriate testing of patients with relevant clinical features on history or examination is not the topic of this guideline. The target population includes clinicians responsible for assessment of patients prior to surgery and other invasive procedures. MethodsThe writing group was made up of UK haematologists with a special interest in bleeding disorders and an anaesthetist. First, the commonly employed coagulation screening tests were identified and their general and specific limitations considered. Second, Medline was systematically searched for English language publications from 1966 to September 2005. Relevant references generated from initial papers and published guidelines/reviews were also examined. Meeting abstracts were not included. Key terms: routine, screening, preoperative, surgery, coagulation testing, APTT, PT, bleeding, invasive procedures. Inclusion criteria: studies had to contain enough data to enable the calculation of (i) the predictive value (PV) and likelihood ratio (LR) of the coagulation test for postoperative bleeding and/or (ii) the PV and LR of the bleeding history for postoperative bleeding. The rationale and methods for the calculations are described in Appendix 1. Nine observational case series with usable data (Table I) and one systematic review were identified (Table II).Data elements extracted from these articles were study type, surgical setting, number and age of patients and coagulation tests performed. Outcome data extracted included abnormal tests, positive bleeding history,...

Studies on the three types of process improvement programmes (Continuous Improvement, Reengineering and Benchmarking) have appeared many times in the literature. These studies suggest that certain organizational variables act as enablers and their presence or absence can significantly influence success rates. Such studies have tended to examine companies where a single programme has been implemented. In contrast, this paper examines a sample of companies who have experienced all three programmes. Our aim is to compare and contrast each programme's impact on firm performance and identify which organizational variables are common and which are programme-specific enablers of success. We build and test an integrative framework to support our analysis. Our study found that: (1) Reengineering delivered the greatest impact on performance; (2) executive commitment was needed to make this happen; (3) strategic alignment was the major influence on the success rate of Reengineering and Continuous Improvement programmes; and (4) employee empowerment was necessary for each programme to work effectively. Copyright Blackwell Publishing Ltd 2005.

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The debate concerning the importance of adopting a market orientation in collaboration with market positioning strategies has gone on for years. Nevertheless, on their own, market orientation and market positioning do not guarantee profitable firm performance unless marketers employ and integrate both on a long-term basis. Achieving this synergy is somewhat problematic owing to focus on short-term operational exigency, as well as the lack of research identifying the relationship between the two concepts. This review fills the gap in the literature by answering two questions: What is the relationship between firm market orientation capability and firm market positioning strategies? How does this relationship impact the performance of organisations? The article sheds light on these issues and contributes to the debate by proposing relationships between positioning strategy and market orientation. Furthermore, the researchers propose how positioning mediates the relationship between market orientation and business benefits.

This study examines the effectiveness of the human resource management (HRM) function of a public sector entity as it became corporatized. There has been little empirical research regarding the effectiveness of the people management functions within the Australian public sector as these entities went through a period of transition to commercialization. A questionnaire obtaining perceptions on different aspects of HR effectiveness, both before and after corporatization, was administered to a sample (N = 122) representing a number of different stakeholder groups of the corporate HRM unit. The results showed a moderate, but statistically significant, improvement in the effectiveness of HRM, and of the corporate HRM unit, as the host organization went through corporatization. Perceptions on HR effectiveness were not found to vary significantly between the different stakeholder groups. Regression analysis showed that the major predictors of the improvement in the overall effectiveness of the corporate HR unit were, firstly, changes in the level of satisfaction with the quality of the HR outcomes as a result of commercialization and, secondly, the change in extent to which the senior HR practitioner had effective influence over strategic decision-making processes.

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