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PubMed1990

Performance goals for internal quality control of multichannel haematology analysers.

Performance goals for analytic bias and analytic imprecision are presented for multichannel haematology analysers. These goals represent a compromise between limits that would cause minimal degradation in the information content for clinical decisions and limits that are achievable by current instruments. For midrange measurements the maximal limits for total analytic bias are +/- 14.6% for WBC, +/- 5.3% for RBC, +/- 4.5% for Hb concentration, +/- 4.2% for MCV, and +/- 22% for platelet counts. The limits include error inherent in calibrator value assignment, instrument calibration, instrument drift, and instrument non-linearity as well as the quality control systems necessary to monitor each of these processes. If analytic biases are held within the proposed limits, the clinical specificities of the assays will be decreased by less than 7% for all assays except that platelet counts will have a decrease in specificity of about 15%. Analytic imprecision has minimal direct effect on clinical decisions because the influence of within-person and across-person biological variation dominates. However, analytic imprecision is a major factor in the control of analytic bias and thereby remains an important quality control factor.

Blood Cell Count↗
PubMedDate not supplied

Changes in life goals as related to success in a nursing leadership role.

Based on questionnaire returns from 50 nurses in leadership positions, this study revealed major differences in the life goals of successful nurses before and after assuming a leadership role. Our reason for success, the study found, was the nurses' ability to develop life goals consistent with their leadership role.

Follow-Up Studies↗
PubMed1989

[Goal related observation of motor behavior in psychiatry].

The goals to be attained by the patients frequently are determined by the various professions in psychiatry solely before the background of their various specialities. The new observation tool--LOVIPT--is aimed at enabling an integrative approach to be taken, leading from purposive observation of problem behaviour to the formulation of therapy goals. The potential range of objectives is worded in such a way that they can be taken over by other disciplines as well. Development and scientific validation are described in some detail.

Arousal↗
PubMed1978

Physiologic monitoring goals for the critically ill patient.

Definition of the appropriate therapeutic goals for physiologic monitoring of patients postoperatively was approached by analyzing more than 50,000 values of the 20 most commonly monitored variables in a series of 113 critically ill patients throughout their immediate postoperative course. In general, normal values were poor criteria for monitoring, since normal values were restored in an average of 75 per cent of the survivors and 76 per cent of the nonsurvivors for the five most frequently measured variables; that is, arterial pressure, heart rate, central venous pressure, wedge pressure and cardiac output. Moreover, an average of 56 per cent of the 20 most commonly monitored variables of nonsurvivors was restored to the normal range. Furthermore, 34 per cent of all the nonsurvivors' values were within the normal range; this was only 2.4 per cent less than the percentage of normal values for the survivors. The empirically determined median value of the survivors taken in the late stage during periods remote from therapy was found to be a better criterion for therapeutic goals for most variables, including blood flow, oxygen transport and most intravascular pressures. However, normal values were satisfactory for arterial pressure, peripheral resistance, pH, mixed venous oxygen tension and arterial carbon dioxide tension, largely because of the biphasic patterns of these variables.

Blood Chemical Analysis↗
PubMed1987

Biological variation of blood acid-base status: consequences for analytical goal-setting and interpretation of results.

Analytical, intra-individual, and interindividual components of variation have been determined for pH, pCO2, bicarbonate, base excess, and total CO2 in capillary specimens of whole blood from a cohort of 14 healthy subjects. Calculated analytical goals (SD) are pH less than or equal to 0.008, pCO2 less than or equal to 0.9 mmHg, bicarbonate less than or equal to 0.5 mmol/L, base excess less than or equal to 0.5 mmol/L, and total CO2 less than or equal to 0.5 mmol/L. Because pH and base excess vary little between individuals, population-based reference values for them will be of utility in interpretation of results; pCO2, bicarbonate, and total CO2 show more marked variation between individuals, and reference values for them will be of more limited use. The generally applicable differences required for two results to be significantly different (P less than or equal to 0.05) when goals are met--which is currently feasible--are pH: 0.04, pCO2: 0.745 kPa (5.6 mmHg), bicarbonate: 2.6 mmol/L, base excess: 2.2 mmol/L, and total CO2: 2.7 mmol/L.

Adult↗
PubMed1988

[Food guidelines and nutritional goals for aging].

As a contribution to the formulation of food guidelines and nutritional goals for Latin America, this article examines the singular situation of the elderly, defined as those persons over 60 years of age. The projected data for the year 2025, published by the Population Department of the United Nations, show that this age group represents an important sector--6.4% of the population in 1980--that is growing. Some countries, however, do have a rate that is comparable to the United States, 11.3%, such as Argentina, 12.7%, and Uruguay, 14.8%, which is similar to that of Europe. Along with other comparative demographic information, the analysis covers some of the biological, physiological, pathological, and psychosocial characteristics that become more common in senescence. To a certain extent, these characteristics bear a direct or indirect relationship with the energy, protein, and nutrient content of the diet. This becomes more evident upon examining the causes of mortality and morbidity in the elderly, whose diseases are quite often chronic and degenerative. Those with the highest incidence, such as the cardiovascular ones--including cerebrovascular accidents, atherosclerosis, and hypertension--diabetes, obesity, osteoporosis, anemias from lack of iron and folates, and some forms of cancer, reveal the influence of certain nutrients in their pathogenesis. Very few studies have been done on the over-70 age group to determine their requirements for energy, proteins, and various nutrients that serve as the basis for appropriate food guidelines. Usually, estimates are extrapolated from data on the 40-and-over age group. Some maintain that the variations for the elderly are small, but since this group is growing and is far from homogeneous, such a hypothesis must be tested. Following a review of recent literature, the article proposes a set of Food Guidelines and Nutritional Goals for persons over 60 in Latin America. It also recommends to countries interested in formulating their own guidelines how to proceed for the short, medium, and long terms. In Latin America and the Caribbean, the elderly are the most neglected group with reference to government programs, and most forgotten by society. They depend to a great extent on the labor force of each country. They suffer most frequently from chronic diseases and have the most need for medical care, they use a broad range of drugs that may interfere with the absorption and utilization of nutrients, as well as foods when may impair the bioavailability of drugs. They show the highest mortality rates, and, in a high proportion, require a normal diet.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMedDate not supplied

Effect of perceived malpractice insurance costs on the family practice career goals of medical students.

A questionnaire regarding perceived training and practice goals was distributed to 185 consecutive medical students interviewing for a 1986-87 internship at a community hospital in Southern California. Students were asked to estimate the dollar cost of professional liability insurance for a hypothetical family physician in the first year in practice performing low-risk obstetrics in Southern California. Family physician applicants who planned to do obstetrics estimated an initial average yearly premium cost of $16,406, whereas those not planning to do obstetrics estimated costs of $25,710 per year. Non-OB directed family practice applicants had a statistically significant (P = .0018) higher estimate of professional liability insurance costs. Average premium costs were obtained from three separate professional liability insurance carriers. Cost estimates of mature rates were not necessarily unrealistic, but student ignorance of significantly lower initial rates was widespread. The broad ranges of estimates suggested that subsets of students may be dramatically overestimating these costs. The data and direct questioning of students suggest that perceived insurance costs may affect training goals and career choices of medical students.

California↗
PubMed1988

Ways of assessing quality goals for diagnostic tests in clinical situations.

Although clinical reasoning may be very complex, it is possible to evaluate the effects of analytical variability and error for an analyte in situations in which clinical decisions are mainly based on the results of quantitative measurements of the specific analytical component. The consequences, or the validating of these consequences, can then define the quality goals for the component in the clinical situation. Two situations are investigated: a bimodal situation, ie, a situation in which the component is used for classifying patients into diagnostic groups and the diagnosis can be confirmed; and a unimodal situation, in which the risk of later development of a certain disease increases with the concentration of the component. The bimodal situation is illustrated by the application of creatine kinase isoenzyme measurements in the early diagnosis of acute myocardial infarction and by measurement of blood thyroid-stimulating hormone in screening for congenital hypothyroidism. The unimodal situation is evaluated by serum cholesterol measurement results for identifying individuals at risk regarding ischemic coronary heart disease. It is shown that this system is extremely sensitive to the effects of analytical bias and imprecision. The evaluation of clinical consequences as caused by analytical bias and imprecision makes it possible to define goals for stable analytical performance and for the maximal tolerable unstable performance when the clinical application of the test is well known.

Diagnostic Tests, Routine↗
PubMed1986

Providing health care for low-income children: reconciling child health goals with child health financing realities.

The goal of equitable access to health care continues to be elusive for poor children. Medicaid, the major source of financing such care, has been eroded by a series of actions by the administration and the Congress. A survey of the Medicaid-based EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) programs in the fifty states pinpoints shortcomings in adequate financing and sound standards of practice. Reconciling child health goals with program realities will require new federal and state initiatives.

Aid to Families with Dependent Children↗
PubMed1986

Preventive nutrition intervention in coronary heart disease: risk assessment and formulating dietary goals.

Risk factor screening and establishing realistic goals are key steps for the dietitian to follow in planning strategies to prevent coronary heart disease. The major risk factors that are responsive to dietary intervention include: elevated plasma total cholesterol and low-density-lipoprotein cholesterol, elevated blood pressure, glucose intolerance, and obesity. The criteria used in assessing nutrition-related risk in coronary heart disease are presented. The long-term goals of preventive nutrition intervention in heart disease are discussed, with emphasis on a unified and progressive approach to diet planning.

Adult↗
PubMed1978

Husband-wife agreement about reproductive goals.

Data from Malaysia on the reproductive goals of husbands and wives are analyzed to determine level of agreement, using new scale measures on preferences for number and sex of children as well as the conventional measure of desired number of children. The level of agreement between husband and wife varies considerably depending on the focus of analysis and the measure of agreement used. Overall aggregate agreement of men and women is high but lower for subgroups of the population, particularly among various ethnic groups. For marital partners, the agreement is much lower, especially on sex preferences. The level observed depends on whether the measure is identity of responses or an index of homogeneity which allows for couple concordance based on chance or common socialization factors. The views about the reproductive goals of one marital partner cannot with confidence be assumed to represent the views of the other.

Age Factors↗
PubMed1984

The 33rd John Stanley Coulter memorial lecture. The goals of rehabilitation.

The present system of service provision to people with disability is very complex, fragmented, and costly. The large number of disabilities receiving separate consideration contributes to the complexity and cost. Major costs to society associated with disability are institutional care and income support programs. An action plan is proposed based upon two national goals--reduction in the need for institutional care by 30% and reduction in the level of unemployment among employable disabled people to the national average by 1990. Basic considerations for implementing an action plan are outlined, including the need for morbidity indices to measure progress towards goal attainment.

Canada↗
PubMed1983

Goals for oral health in the year 2000: cooperation between WHO, FDI and the national dental associations.

The member countries of the WHO have decided to adopt a global strategy for achieving health for all in the year 2000. As a part of this goal the FDI has decided to participate with 'goals for oral health in the year 2000'. The FDI already has many joint activities with WHO, serving as a link between that organization and the national dental member associations. One joint activity is the International Collaborative Study of Dental Manpower Systems. Another is the joint working group set up to look into The Changing Patterns in Oral Health. An important task associated with this study is the project on the International Deployment of Dental Manpower investigating the uneven distribution of dental manpower between various parts of the world, especially between industrialized and developing countries. For all these projects it is necessary to have the support of the Federation's national member associations, which also have to supply FDI and WHO with facts for a data base for monitoring changes in oral health. To meet these important targets it is necessary to have: the willing support of the Federation's national dental member associations: a FDI which includes most of the national dental associations in the world; and a continuation of the good cooperation with WHO and an acceptance by WHO that the FDI is a partner representing the absolute majority of the national dental associations in the world.

Adolescent↗
PubMedDate not supplied

A health needs index based on the health goals model.

A new quantitative index is proposed to measure the degree to which the health care needs of a population are met. It is based on the health goals model of Lester Breslow and A. R. Somers, who listed the kinds and frequencies of health services appropriate for each of 10 developmental and maturational stages of life. The population is further divided into the sick and well segments of each of the 10 groups; the sick need treatment and the well and asymptomatic need preventive care. The index is the geometric mean of the proportions of the people in the stages whose utilization experiences conform to the services and goals appropriate for their respective group. The counting system requires the minimum information as to whether the person has received the necessary treatment for his condition if he is sick or made the requisite number of professional visits for preventive care if he is well. The index is best considered a heuristic tool for understanding a complex problem.

Adolescent↗
PubMed1980

Goals, objectives, and outcomes: case study of a program assessment.

This manuscript assesses the outcome of a dental educational program in relation to institutional goals and program objectives. The study, covering the total population of 841 graduates of a dental school from 1972 through 1978, focused on the first classes to complete a significantly revised curriculum. The data identified specific characteristics such as (1) the distribution of dental practices, (2) general practices versus specialization, (3) solo vis-s-vis multiple or group practices, (4) residency training and advanced education, (5) faculty positions, (6) publications and research, (7) hospital affiliations, and (8) community activities. A pattern of responses developed that appears to indicate that those outcomes noted above, when combined with end-of-course and licensure examinations, supports an assumption of achievement of program objectives and institutional goals.

Community-Institutional Relations↗
PubMed1980

Patient package inserts: goals, success measures and research needs.

The distribution of written, patient-oriented information with most prescription drugs is a likely reality of the 1980s. This article briefly reviews the events leading up to today's patient package insert (PPI) momentum. More importantly, the article summarizes and clarifies the diversity of PPI goals, the difficulties of formulating and obtaining success measures on those goals, and, to a lesser extent, the differing priorities placed on the criteria by the mixture of PPI-affected publics. The framework presented here highlights the most pressing needs for PPI research.

Drug Labeling↗
PubMed1980

Dietary goals, sensible eating and nutrition in the future.

Compared with our ancestor's diet, that consumed by present-day Western populations is higher in intake of energy, of protein (especially animal protein) and of fat (especially animal fat), but lower in intake of fibre-containing cereal foods; this diet is associated with high rates of morbidity and mortality from degenerative diseases. In the USA, the Dietary Goals report has recommended partial reversion to our ancestors' diet, including decreased intake of animal fat and protein, cholesterol, salt, sugar and alcohol--hopefully to reduce mortality from the six leading causes of death. 'Dietary goals', 'sensible eating' and the extreme 'longevity diet' are discussed. It is concluded that the general public will not voluntarily accept dietary changes of the magnitude required to promote a meaningful decrease in the burden of ill-health from degenerative diseases, because of: (i) conservativeness of dietary habits; and (ii) uncertainties about the extent of benefits likely to accrue. It is speculated, however, that in the distant future dietary changes of the type recommended will gradually but compulsorily be introduced, because of: (i) increases in population numbers; and (ii) the far greater economy of land usage linked with production of a near-vegetarian diet.

Adult↗
PubMed1995

Goals of asthma therapy.

OBJECTIVE: The purpose of this article is to facilitate the management of patients with asthma. The article will discuss the components of optimal care and asthma therapy. DATA SOURCES: References are limited to the English language. Also included are descriptions of experiences based on the clinical practice of the author. STUDY SELECTION: Papers were selected on the basis of their timeliness, explanation of important findings related to clinical practice, and the treatment of asthma. RESULTS: Effective asthma management requires understanding of asthma pathophysiology and how and when to provide asthma treatment, which includes specific, symptomatic, and adjunctive therapies. Optimal care entails a thorough knowledge of the goals of asthma therapy, including preventing asthma symptoms, maintaining nearly normal pulmonary function and activity levels, preventing asthmatic exacerbations, and avoiding adverse effects from asthma medications. For patients with an allergic component to their disease, allergen avoidance and immunotherapy can cure or at least significantly improve a patient's asthma. Using an "Asthma Action Plan," patients can be instructed on how to prevent symptoms of asthma from occurring and how to maintain normal or nearly normal pulmonary function by monitoring their pulmonary function "zone," based on daily peak flow meter results. At the present time, asthma is treated inadequately in the United States, but the situation can be improved primarily through education. CONCLUSIONS: The goals of asthma therapy are achievable in the US if several objectives are met: physicians are taught asthma pathophysiology; patients are educated about the prevention and treatment of asthma; the importance of an evaluation by an allergist is recognized; and patients are provided access to good medical care.

Asthma↗