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Six Sigma, LEAN and other similar disciplines of analysis and control have been utilized for decades. Ever since former GE CEO Jack Welch sang its praises in his 2001 book, [...]

Targeted therapy (BRAF inhibitor plus MEK inhibitor) is now among the possible treatment options for patients with BRAFmutation-positive stage III or stage IV melanoma. This makes prompt BRAFmutation testing an important step in the management of patients diagnosed with stage III or IV melanoma; one that can help better ensure that the optimal choice of systemic treatment is initiated with minimal delay. This article offers guidance about when and how BRAFmutation testing should be conducted when patients are diagnosed with melanoma in Australia. Notably, it recommends that pathologists reflexively order BRAFmutation testing whenever a patient is found to have American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) stage III or IV melanoma (i.e., any metastatic spread beyond the primary tumour) and that patient's BRAFmutation status is hitherto unknown, even if BRAFmutation testing has not been specifically requested by the treating clinician (in Australia, Medicare-subsidised BRAFV600mutation testing does not need to be requested by the treating clinician). When performed in centres with appropriate expertise and experience, immunohistochemistry (IHC) using the anti-BRAF V600E monoclonal antibody (VE1) can be a highly sensitive and specific means of detecting BRAFV600Emutations, and may be used as a rapid and relatively inexpensive initial screening test. However, VE1 immunostaining can be technically challenging and difficult to interpret, particularly in heavily pigmented tumours; melanomas with weak, moderate or focal BRAFV600Eimmunostaining should be regarded as equivocal. It must also be remembered that other activating BRAFV600mutations (including BRAFV600K), which account for ∼10–20% of BRAFV600mutations, are not detected with currently available IHC antibodies. For these reasons, if available and practicable, we recommend that DNA-based BRAFmutation testing always be performed, regardless of whether IHC-based testing is also conducted. Advice about tissue/specimen selection for BRAFmutation testing of patients diagnosed with stage III or IV melanoma is also offered in this article; and potential pitfalls when interpreting BRAF mutation tests are highlighted.

Nearly 60 percent of all corporate Six Sigma initiatives fail to yield desired results, according to Praveen Gupta, a noted author on methodology and master Six Sigma black belt who [...]

Case description of a pregnant woman at term with a history of Multiple Sclerosis, scheduled for C-section and with a diagnosis of fetal macrosomia; the patient had undergone a C-section in the past during pro-dromal labor. The physical examination showed no motor or sensory deficit. The CBC showed anemia and mild lymphocytosis. The patient underwent cesarean section under single-dose epidural anesthesia with no complications and favorable evolution. Multiple sclerosis is a rare neurological condition, even rarer in pregnant women undergoing C-section. So a literature search was undertaken aimed at improving the management of anesthesia in this group of patients.

Se describe el caso de una gestante a término de 26años con antecedente de esclerosis múltiple programada a cesárea con diagnóstico de macrosomía fetal y cesareada anterior una vez, en pródromos de trabajo de parto. Al examen físico, no déficit motor ni sensitivo. Hemograma: anemia y linfocitosis leve. La paciente fue sometida a cesárea con anestesia epidural dosis única sin complicaciones y con evolución favorable. La esclerosis múltiple es una enfermedad neurológica poco frecuente, y aún menos frecuente en gestantes con esclerosis múltiple sometidas a cesárea, por lo que se realizó una búsqueda de la literatura para un mejor manejo anestésico de este grupo de pacientes.

The article reports on various failures on the use of Six Sigma. According to Praveen Gupta, a noted author on methodology and master in Six Sigma black belt, nearly 60% of all corporate Six Sigma initiatives fail to yield desired results. It notes that since Jack Welch, former General Electric CEO popularized Six Sigma in 1990s, it has profoundly impacted the corporate world. It also state that the global electronic supplier 3M struggled with Six Sigma. In addition, experiences in the field indicated that most managers come up short in their approach to the behavioral elements of change, but, it inferred that implementing the Six Sigma methodology can still be very effective approach.