CASE STUDY.The key elements in organizational design are work specialization, chain of command, span of control, departmentalization, centralization-decentralization, and formalization. Traditionally, work specialization was viewed as a way to divide work activities into separate job tasks. Today's view is that it is an important organizing mechanism but it can lead to problems. The chain of command and its companion conceptsauthority, responsibility, and unity of commandwere viewed as important ways of maintaining control in organizations. The contemporary view is that they are less relevant in today's organizations. The traditional view of span of control was that managers should directly supervise no more than five to six individuals. The contemporary view is that the span of control depends on the skills and abilities of the manager and the employees and on the characteristics of the situation. The various forms of departmentalization are as follows: Functional groups jobs by functions performed; product groups jobs by product lines; geographical groups jobs by geographical region; process groups jobs on product or customer flow; and customer groups jobs on specific and unique customer groups. Authority refers to the rights inherent in a managerial position to tell people what to and to expect them to do it. The acceptance view of authority says that authority comes from the willingness of subordinates to accept it. Line authority entitles a manager to direct the work of an employee. Staff authority refers to functions that support, assist, advise, and generally reduce some of managers' informational burdens. Responsibility is the obligation or expectation to perform assigned duties. Unity of command states that a person should report to only one manager. Centralizationdecentralization is a structural decision about who makes decisionsupper-level managers or lower-level employees. Formalization concerns the organization's use of standardization and strict rules to provide consistency and control.

Question 11 I am confused whether clubbing is a feature of chronic obstructive pulmonary disease (COPD) or not - you have mentioned that it is not a feature of COPD but some books do say that clubbing is a clinical feature of COPD.

Question 12 A 70-year-old man with chronic obstructive pulmonary disease (COPD) and a past history of myocardial infarction with a left ventricular ejection fraction (LVEF) of 25% is dyspnoeic on slight exertion such as walking, bathing. He is not orthopnoeic and claims to have no paroxysmal nocturnal dyspnoea (PND). He has no wheezing or productive cough and his blood pressure is normal. He has had three episodes of ventricular tachycardia (VT) and has been on amiodarone for the past year. What is the best way to determine the exact cause of dyspnoea in this case?

Question 13 In bronchiectasis, what is the reason for using a bronchodilator if the airways are already dilated?

Question 14 Why is it that asthmatics having a severe attack can be seen clawing their hands?

Question 15 Practical use of steroids: Which form of regimen is better (alternate-day, daily or in pulse form)? What should be the dose (once daily or three times daily or {2/3} in the morning)? For how long, especially when to give short courses as in asthmatics, when we don't need to taper it down?

Question 16 In pregnancy, what is the recommended treatment for bronchial asthma? Is the use of the long-acting beta-adrenergic agonist Seretide, the corticosteroid Symbicort and leucotriene receptor antagonists (LTRAs) recommended?

Question 17 In asthma patients, which is the safest analgesic to use?

Question 18 Is the use of nebulized heparin in the treatment of asthmatic attacks recommended?

Question 19 I would like to ask you about pneumonia and its classifications in particular; what are they?

Question 20 What are the pathological differences in typical and atypical pneumonia?