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They may emerge ally purchase kamagra 50 mg amex, resistant bacterial strains of major concern include during or after antimicrobial drug therapy purchase kamagra 100 mg with amex. Contributing fac- penicillin-resistant Streptococcus pneumoniae, methicillin- tors include: resistant Staphylococcus aureus and Staphylococcus epi- 1. Widespread use of antimicrobial drugs, especially dermidis, vancomycin-resistant enterococcus, and multidrug- broad-spectrum agents. Actually, all of these for which they are prescribed, transient organisms, other organisms are resistant to multiple antibiotics. When the normal ﬂora is are described in Box 33–2; MDR-TB is discussed in Chapter suppressed, space and nutrients become available to sup- 38. Viruses and fungi also develop resistance to antimicrobial port the growth of organisms resistant to the effects of drugs, as discussed in Chapters 39 and 40. Once established, resistant bacteria Mechanisms of Resistance can cause superinfection in the original host, spread to other hosts, and even spread their resistance properties Bacteria have developed numerous ways to acquire resis- for that antibiotic to other species of bacteria. In addi- tance to antimicrobial drugs, including: tion to resistance to the effects of one antibiotic, cross- • Production of enzymes that inactivate the drugs. For ex- resistance to similar antibiotics also occurs because ample, beta-lactamase enzymes change the chemical most antibiotics are variations of a few basic types. Interrupted or inadequate antimicrobial treatment the beta-lactam ring and preventing the antibiotic from of infections. Clients often stop taking a prescribed anti- binding with its target site (called penicillin-binding biotic when symptoms subside or they feel better. Gram-negative bacteria • Changing their cell walls to produce porins that prevent associated with high rates of antibiotic resistance include penetration of the drug.
This tool initiates the process of infor- mation gathering quality kamagra 100mg, is easy to use discount kamagra 50 mg with visa, can be applied almost anywhere, is easily taught to most people, and immediately provides data to help to under- stand and improve a process. Run Chart Run charts are plots of data, arranged chronologically, that can be used to determine the presence of some types of signals of special cause variation Quality Im provem ent System s, Theories, and Tools 77 in processes. A center line (usually the median) is plotted along with the data to test for shifts in the process being studied. Control Chart A control chart consists of chronological data along with upper and lower control limits that define the limits of common cause variation. A control chart is used to monitor and analyze variation from a process to determine if that process is stable and predictable (comes from common cause variation) or unstable and not predictable (shows signals of special cause variation). Histogram A histogram is a graphical display of the frequency distribution of the qual- ity characteristic of interest. A histogram makes variation in a group of data readily apparent and assists in an analysis of how data are distributed around an average or median value. Scatter Diagram Scatter diagrams (or plots) show the relationship between two variables. The scatter diagram can help to establish the presence or absence of correlation between variables, but it does not indicate a cause-and-effect relationship. Management Tools These tools are used to analyze conceptual and qualitatively oriented infor- mation that may be prevalent when planning organizational change or proj- ect management. Affinity Diagram The affinity diagram can encourage people to develop creative solutions to problems. A list of ideas is created, then individual ideas are written on small note cards. Team members study the cards and group the ideas into common categories. The affinity diagram is a way to help achieve order out of a brainstorming session (American Society for Quality 2002).