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PubMed2003

Factors affecting performance of prenatal genetic testing by Israeli Jewish women.

The number of prenatal genetic tests that are being offered to women is constantly increasing. However, there is little national data as to who is performing the tests and the reasons for doing or not doing so. This study evaluated the proportion of Jewish women in Israel who perform the various prenatal genetic tests and the factors affecting the performance of these tests. It was found that 60.9% of the women performed the triple test, 50.8% of women older than 35 years performed amniocentesis, while 63.3 and 24.3% of women performed Tay-Sachs and fragile-X carrier testing respectively. Ninety-six percent of the secular women compared to only 6.7% of the ultrareligious women performed the triple test. It was also found that94.4% of the secular women, 36.4% of the religious, and none of the ultrareligious women older than 35 years performed amniocentesis. In the stepwise regression analysis, being secular, having a higher income, fewer children, and being of Ashkenazi origin remained significant factors in determining performance of Tay-Sachs carrier testing. As regards fragile-X carrier testing, being secular, having fewer than four children, and having a higher income and a supplementary medical insurance remained significant factors. The main reason reported by the women for not performing amniocentesis or the triple test was for religious or moral grounds (53.3 and 67% respectively). The main reason given for not performing Tay-Sachs or fragile-X testing was that they were not referred for the tests (76 and 82% respectively). Consideration should be given to providing first trimester prenatal diagnosis to the ultrareligious group, including state subsidized fragile-X testing and educating the primary care givers about the importance of prenatal genetic testing. The information from the present study is vital for the planning of an equitable prenatal genetic service and provides guidelines for the implementation of such services in other countries.

Amniocentesis↗

PubMed1982

[Catecholamine excretion during physical exercise and mental performance].

The basal and exercise-induced heart rates, lactate levels, and the adrenaline and noradrenaline excretions in the urine were measured during different types of physical exercise and mental performance: during moderate physical exercise (Ia, n = 12), submaximal physical exercise (Ib, n = 24), during moderate mental performance (motorway driving, IIa and IIb, n = 25), higher-grade mental performance (driving car-simulator, III, n = 14), and during submaximal mental performance (car racing, IV, n = 48). The moderate physical exercise and moderate mental performance could not be differentiated from one another, or from the higher-grade mental performance using the above-mentioned parameters. Both the submaximal physical exercise and mental performance resulted in a comparable lactate acidosis, heart rate increase, and noradrenaline excretion; the excretion of adrenaline is, however, 3 times higher after submaximal mental performance, than after submaximal physical exercise. The ratio of adrenaline to noradrenaline excretion changed from approximately 1:4 (during physical exercise and moderate mental performance) to approximately 1:2 during submaximal mental performance. The excretion of adrenaline and the ratio of adrenaline to noradrenaline excretion can therefore be used to differentiate between higher-grade mental performance and physical exercise. These parameters can be easily measured without discomfort to the subjects.

Acidosis↗

PubMed1989

Record performances at the Boston Marathon: biometeorological factors.

Air temperature and relative humidity have long been suspected of affecting the performance of marathon runners. Though these factors are important in their extremes, we show that other factors are even more indicative of race performances. Performances of the top 3 finishers in the last 30 Boston Marathons were correlated with hourly meteorological data for each race day. These 90 individual performances were classified as: record breaking performances (31), average performances (35), and unusually slow performances (24). The factors that help predict record breaking and unusually slow performances are: (i) wet bulb temperature, (ii) percent sky cover, and (iii) presence or absence of a light precipitation. Record breaking performances are characterized by a wet bulb temperature of less than 7.8 degrees C, and 100% sky cover. A light drizzle is also conducive to better performances. On the other hand, unusually low performances are accompanied by a wet bulb temperature of greater than 7.8 degrees C, and a sky cover of 50% or less. No light precipitation was recorded on any of the unusually slow race days. A graphic analysis clearly shows these relationships to exist. In addition, a multiple regression analysis confirms the importance of these variables. The authors advise that these are reliable predictors; however, when considering marathon races held in various geographical regions and differing climatic regimes, the exact numerical thresholds used here may not apply.

Boston↗

PubMed1994

Use of the iso-inertial force mass relationship in the prediction of dynamic human performance.

The purpose of this investigation was to develop a new test of muscle function, termed the iso-inertial force-mass relationship, and to determine its relationship to dynamic physical performance in comparison to an isometric test. A group of 13 trained subjects performed an isometric, and a series of iso-inertial maximal upper body tests, in a bench press movement at loads of 30%, 60%, 100% (concentric) and 100%, 130% and 150% (eccentric) of maximum. Vertical forces exerted throughout the movement were recorded by a force plate. In addition, the subjects performed the following three performance tests: a maximal bench press, a seated shotput, and two drop bench-press throws from a height of 0.25 m, with loads of 10 kg and 30% of maximum. Correlation analysis demonstrated that in each instance the iso-inertial force mass tests were the best predictors of performance (r = 0.78-0.88) with both contraction type and mass specific effects apparent. Maximal isometric force and rate of force development were significantly related to some performance variables (r = 0.22-0.78). However, for all the performance movements assessed, the iso-inertial test modality recorded the highest relationship to performance. The difference in the relationship between performance and iso-inertial and isometric test modalities was particularly evident in the light load dynamic performance of the seated shotput (r = 0.86 vs r = 0.38, respectively). These results are explained in part by the neural and mechanical differences between iso-inertial and isometric muscle actions and their respective specificity to dynamic physical performance.

Adult↗

PubMed2002

The role of FFM accumulation and skeletal muscle architecture in powerlifting performance.

The purpose of this study was to determine the distribution and architectural characteristics of skeletal muscle in elite powerlifters, and to investigate their relationship to fat-free mat (FFM) accumulation and powerlifting performance. Twenty elite male powerlifters (including four world and three US national champions) volunteered for this study. FFM, skeletal muscle distribution (muscle thickness at 13 anatomical sites), and isolated muscle thickness and fascicle pennation angle (PAN) of the triceps long-head (TL), vastus lateralis, and gastrocnemius medialis (MG) muscles were measured with B-mode ultrasound. Fascicle length (FAL) was calculated. Best lifting performance in the bench press (BP), squat lift (SQT), and dead lift (DL) was recorded from competition performance. Significant correlations (P < or = 0.01) were observed between muscle distribution (individual muscle thickness from 13 sites) and performance of the SQT (r = 0.79 to r = 0.91), BP (r = 0.63 to r = 0.85) and DL (r = 0.70 to r = 0.90). Subscapular muscle thickness was the single best predictor of powerlifting performance in each lift. Performance of the SQT, BP, and DL was strongly correlated with FFM and FFM relative to standing height (r = 0.86 to 0.95, P < or = 0.001). FAL of the triceps long head and vastus lateralis were significantly correlated with FFM (r = 0.59, P < or = 0.01; 0.63, P < or = 0.01, respectively) and performance of the SQT (r = 0.45; r = 0.50, respectively; P < or = 0.05), BP (r = 0.52; r = 0.56, respectively; P < or = 0.05), and DL (r = 0.56; r = 0.54, respectively; P < or = 0.01). A significant positive correlation was observed between isolated muscle thickness and PAN for triceps long-head (r = 0.64, P < or = 0.01) and gastrocnemius medialis (r = 0.48, P < or = 0.05) muscles, but not for vastus lateralis (r = 0.35). PAN was negatively correlated with powerlifting performance. Our results indicate that powerlifting performance is a function of FFM and, therefore, may be limited by the ability to accumulate FFM. Additionally, muscle architecture appears to play an important role in powerlifting performance in that greater fascicle lengths are associated with greater FFM accumulation and powerlifting performance.

Body Height↗

PubMed1989

Unilateral nostril breathing influences lateralized cognitive performance.

Relative nostril efficiency (nasal cycle) is related to hemispheric EEG differences and performance on cognitive tasks. We investigated how unilateral forced nostril breathing influences spatial and verbal performance. Right-handed males and females performed both tasks under either left-nostril, right-nostril, or free-breathing conditions. Unilateral breathing affects performance differently in males and females. It influences male performance ipsilaterally on both tasks: Their spatial performance is better during right-nostril breathing, and their verbal performance is better during left-nostril breathing. Unilateral breathing influences female performance contralaterally, but only on the spatial task: Their spatial performance is better during left-nostril breathing. These differences within and between sexes may exist because unilateral nostril breathing differentially activates the two hemispheres and thereby facilitates performance, or because attempts of the brain to control the nasal cycle unilaterally interfere with performance.

Adult↗

PubMed1996

Comparison of the reluctance of house staff of metropolitan and suburban hospitals to perform mouth-to-mouth resuscitation.

BACKGROUND: Although performing mouth-to-mouth resuscitation (MMR) during cardiopulmonary resuscitation (CPR) is an effective lifesaving procedure, both the general public and physicians are often unwilling to perform CPR. Fear of contracting infectious diseases, especially AIDS, is often stated as the reason for this reluctance. However, the likelihood of saving a life usually outweighs the chance of contracting an infectious disease, especially when victims are considered to be at low risk for being HIV+ and are in communities with low incidences of HIV antibodies. METHODS: The entire housestaff (58 residents) in the Department of Internal Medicine of a suburban hospital responded to a questionnaire of hypothetical cardiac arrest scenarios in both inpatient and outpatient settings. Their responses were compared to those previously obtained from the housestaff (82 residents) of a hospital in a large metropolitan area with a high incidence of HIV positive patients. RESULTS: The willingness of the suburban housestaff (residents) to perform MMR in the inpatient scenario of a patient with an unknown risk for communicable infections was 43%, with trauma was 12%, with a perceived high risk for being HIV+ was 14%, and in the elderly was 29%, compared to 45, 16, 7 and 39%, respectively of the house staff of the metropolitan hospital. In outpatient scenarios, the willingness of the suburban housestaff to perform MMR on a victim with an unknown risk for communicable infections was 50%, with trauma was 33%, with a perceived high risk for being HIV+ was 34%, in the elderly was 26%, and in a child was 86%, compared to 54, 36, 21, 65, and 99%, respectively, of the metropolitan residents. Overall, the suburban male residents were more likely to be willing to perform MMR than the female ones, as were residents actively practising a religion or having graduated from medical schools in the United States. Suburban residents under 30 years of age seemed more willing to perform MMR in the majority of the scenarios than those over 30 years of age. Of the 31 suburban residents that stated they would be unwilling to perform MMR in at least one of the given scenarios, all stated that their unwillingness was due to fear of becoming infected with HIV or other infectious agents. In 1994, the percentage of known HIV positive individuals admitted to the suburban hospital was approximately five times less than that of the metropolitan hospital whose house staff was interviewed (P < 0.001). CONCLUSIONS: Patients perceived to be at high risk for HIV were less likely to receive MMR than those at low risk. The reluctance of house staff to perform MMR in a suburban community hospital with a low incidence of HIV+ patients is similar to that of house staff in a large metropolitan community with a much higher incidence of infected patients. This reluctance, which was largely due to fear of contracting HIV infections, is not influenced by frequent contact with patients infected with HIV but is based on perceived rather than actual risks of contracting HIV. To increase the willingness of physicians, other medical personnel, and the lay public to perform MMR on victims of cardiac and respiratory arrests, the negligible risk of contracting infectious diseases while performing MMR should be emphasized. Use of portable barrier masks while performing MMR and an increase in their availability would decrease the minimal risks even further, and is recommended by the authors.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Do hospitals with low mortality rates in coronary artery bypass also perform well in valve replacement?

BACKGROUND: While hospital performance in coronary artery bypass graft (CABG) surgery is reported widely, patients may find it difficult to learn about their hospital's performance in heart valve replacement. We sought to determine if a hospital's performance in CABG is correlated to its performance in heart valve replacement. METHODS: We studied operative mortality after CABG, aortic valve replacement (AVR), and mitral valve replacement (MVR) using the 1994 to 1999 national Medicare database. After excluding any hospital that did not perform at least 50 CABGs and 20 valve replacements per year we examined the correlation between hospital mortality in CABG and hospital mortality in AVR and MVR using least-squares simple linear regression models. Operative mortality was adjusted for patient characteristics using logistic regression models. RESULTS: A total of 684 hospitals performed 817,606 isolated CABGs, 142,488 AVRs (54% with concomitant CABG), and 61,252 MVRs (45% with concomitant CABG). Hospital mortality rates with AVR ranged from 6.0% to 13.0% between hospitals in the lowest and highest, respectively, 10th percentile of CABG performance. Similarly hospital mortality rates with MVR ranged from 10.1% to 20.5% in the lowest and highest respectively, 10th percentile of CABG performance. Adjusted mortality rates for both AVR and MVR were closely correlated with isolated CABG mortality rates (correlation coefficients 0.592 and 0.538, respectively; p = 0.001 for both correlations). In stratified analyses these correlations persisted regardless of whether valve replacement was performed with or without concomitant CABG or whether valve replacement was performed in a high- or low-volume hospital. CONCLUSIONS: Hospital mortality rates with CABG are closely correlated with mortality rates with valve replacement. These findings suggest that shared processes and systems of care are important determinants of performance in cardiac surgery.

Adult↗

PubMed2001

Artificial selection of rams for sexual performance and its effect on the sexual behavior and fecundity of male and female progeny.

The objective of this study was to determine the effect of a single generation of artificial selection for sexual performance in rams on the sexual behavior and fecundity of their male and female progeny. Ninety-two ram lambs born to sires selected for either high or low sexual performance were evaluated for their sexual behaviors at approximately 8 months of age when individually exposed to four estrous ewes for 30min in four weekly serving capacity tests. Number of mounts and successful matings (ejaculations) were recorded. Fourteen of the 17 high-performing ram lambs identified were sired by high-performing sires, whereas 22 of 37 low-performing ram lambs were sired by low-performing sires (P<0.01). Sons of high-performing sires exhibited more ejaculations (P<0.04) and more mounts without ejaculation (P<0.02) than sons of low-performing sires. The two groups of ram lambs did not differ in mating efficiency (ratio of ejaculations to total mounts). Daughters of high-performing rams (N=79) exhibited their first behavioral estrus approximately 8 days earlier than daughters (N=61) of low-performing sires (P<0.005). Ovulation rates for the two groups of ewe lambs did not differ (P=0.55). It was concluded that there was sufficient genetic variation in the population of sheep studied to obtain a significant response to selection for ram sexual performance in both male and female offspring in a single generation.

Journal Article↗

PubMed2001

Laryngostroboscopic, acoustic, and environmental characteristics of high-risk vocal performers.

Vocal performance often requires excessively high vocal demand. In particular "high-risk" performers, a group of individuals who use their voices at their maximum effort level, are often exposed to unique vocal abuse characteristics which include high environmental and performance demands and inconsistencies of cast performance. Three categories of high-risk performers were studied: musical theater, choral ensemble, and street theater. Musical theater performers produce a Broadway, West End "belting" style voice. Street theater performers use a high-energy pitch varying dialogue in order to imitate a desired character voice. Choral ensemble performance requires group cohesion and blending of four-part harmony. The melodies require sustained vocal durations within each of the respective registers. For each of these studied groups vocal tasks of sustained production of /i/ and /a/ were subjected to analysis. Acoustic measures included fundamental frequency, standard deviation of fundamental frequency, jitter percent, shimmer percent, and noise-to-harmonic ratio. Laryngostroboscopic parameters were assessed during sustained /i/. Environmental acoustic sound field measurements were made using an A weighting and linear weighting sound pressure level. These weightings were used to describe noise levels and vocal output, respectively, within the performance environments. Results of the analysis suggest that high-risk performers are a unique performance type defined by distinctive, acoustic, laryngostroboscopic, and environmental characteristics.

Adolescent↗

PubMed2006

Performance evaluation of existing de novo sequencing algorithms.

Two methods have been developed for protein identification from tandem mass spectra: database searching and de novo sequencing. De novo sequencing identifies peptide directly from tandem mass spectra. Among many proposed algorithms, we evaluated the performance of the five de novo sequencing algorithms, AUDENS, Lutefisk, NovoHMM, PepNovo, and PEAKS. Our evaluation methods are based on calculation of relative sequence distance (RSD), algorithm sensitivity, and spectrum quality. We found that de novo sequencing algorithms have different performance in analyzing QSTAR and LCQ mass spectrometer data, but in general, perform better in analyzing QSTAR data than LCQ data. For the QSTAR data, the performance order of the five algorithms is PEAKS > Lutefisk, PepNovo > AUDENS, NovoHMM. The performance of PEAKS, Lutefisk, and PepNovo strongly depends on the spectrum quality and increases with an increase of spectrum quality. However, AUDENS and NovoHMM are not sensitive to the spectrum quality. Compared with other four algorithms, PEAKS has the best sensitivity and also has the best performance in the entire range of spectrum quality. For the LCQ data, the performance order is NovoHMM > PepNovo, PEAKS > Lutefisk > AUDENS. NovoHMM has the best sensitivity, and its performance is the best in the entire range of spectrum quality. But the overall performance of NovoHMM is not significantly different from the performance of PEAKS and PepNovo. AUDENS does not give a good performance in analyzing either QSTAR and LCQ data.

Algorithms↗

PubMed2006

Pay for performance in commercial HMOs.

BACKGROUND: Pay for performance has increasingly become the subject of intense interest and debate, both of which have been heightened as the Centers for Medicare and Medicaid Services moves closer to adopting this approach for Medicare. Although many claims have been made for the effectiveness of this approach, the extent of its national penetration remains unknown. METHODS: We surveyed a sample of 252 health maintenance organizations (HMOs) (response rate, 96%) drawn from 41 metropolitan areas across the nation about use of pay for performance. We determined the prevalence of pay-for-performance programs, detailed the features of such programs, and examined the adoption of pay for performance as a function of the characteristics of both the health plans and markets. RESULTS: More than half the HMOs, representing more than 80% of persons enrolled, use pay for performance in their provider contracts. Of the 126 health plans with pay-for-performance programs, nearly 90% had programs for physicians and 38% had programs for hospitals. Use of pay for performance was statistically associated with geographic region, use of primary care providers (PCPs) as gatekeepers, use of capitation to pay PCPs, and whether the plans themselves received bonuses or penalties according to performance. CONCLUSIONS: Pay for performance is now commonly used by HMOs, especially those that are situated to assign responsibility for a particular patient to a PCP or medical group. As the design of Medicare with pay for performance moves forward, it will be important to leverage the early experience of pay for performance in the commercial market.

Contracts↗

PubMedDate not supplied

A biomechanical analysis of good and poor performers of the vertical jump.

The vertical jump is widely used as a field test of performance capability, particularly in games like soccer. Invariably some players perform better than others and, while this is usually put down to greater strength or 'explosive power', there is no detailed information to explain how the muscles around the major joints contribute to this performance and what the nature of this contribution is, or indeed whether aspects of technique are important to performance. Detailed knowledge of this type would be useful to help understand which muscle characteristics are important in successful performance of jumping and may enable insights to be gained in terms of strength training for players. The aim of this study was to investigate the contribution made by the lower limb joints to vertical jump performance by good and poor performers of the counter-movement jump. Two groups of players were selected who were found to be good and poor jumpers, respectively. Each player was required to perform three maximal vertical counter-movement jumps with, and three jumps without, an arm swing. The jump performance was recorded simultaneously by means of a force platform and a ProReflex automatic motion analysis system at 240 Hz. Values at the ankle, knee and hip were computed from these data for joint moments and power.Generally, better jumpers demonstrated greater joint moments, power and work done at the ankle, knee and hip, and as a result jumped higher under both conditions. It appears that the superior performance of the better jumpers was due to greater muscle capability in terms of strength and rate of strength development in all lower limb joints rather than to technique, which differed less noticeably between the groups. It is concluded that the muscle strength characteristics of the lower limb joints are the main determinant of vertical jump performance with technique playing a smaller role.

Adolescent↗

PubMed1993

Intensity and direction dimensions of competitive state anxiety and relationships with performance.

This study examined relationships between intensity and direction dimensions of competitive state anxiety, and also relationships with beam performance in a sample of female gymnasts. The 48 gymnasts, whose ages ranged from 14 to 16 years, competed in a beam competition and were divided, via the median split technique, into poor performance and good performance groups. All the subjects completed a modified version of the Competitive State Anxiety Inventory-2 (CSAI-2) 10 min prior to performance. This inventory included the original intensity scale plus a direction scale in which subjects rated the degree to which the experienced intensity of each symptom was either facilitative of debilitative to subsequent beam performance. Analyses of variance showed no significant group differences on any of the CSAI-2 sub-component intensity scores, or on somatic anxiety and self-confidence direction scores. However, the good performance group reported their cognitive anxiety intensity as being more facilitating and less debilitating to performance than the poor performance group. Stepwise multiple-regression analyses showed that the only significant predictor of beam performance was self-confidence intensity. These findings support the proposal that sports performers' directional perceptions of their anxiety symptoms may provide further understanding of the competitive state anxiety response, and also emphasize the importance of self-confidence in predicting performance.

Adolescent↗

PubMed1998

Structure and process: the relationship between practice management and actual clinical performance in general practice.

OBJECTIVES: The precise relationship between practice management (structure) and the doctor's actual performance (process) in general practice is tenuous. Analysis of their mutual relationship may yield insight into the way they contribute to outcome and into corresponding assessment procedures. METHOD: In a cross-sectional study, consultations of 93 GPs were videotaped in their own practice and assessed by peer-observers on medical performance and on communication with patients, followed by a practice visit by a non-physician observer using a validated Visitation Instrument to assess Practice management and organization (VIP). Pearson correlations (observed and disattenuated for unreliability of the instruments) between scores on 22 practice management dimensions and scores of 16 selected cases on medical performance and communication were calculated. The predictive value of specific practice management aspects for actual performance was determined by multiple regression analysis, with performance scores as dependent variables and scores on the 22 management dimensions and GPs' professional characteristics as independent variables. RESULTS: Nine practice management dimensions correlated significantly with medical performance and so did five dimensions with actual communication. Overall, most associations were weak. Combined with demographic variables (age for medical performance and working single-handedly for communication), 26% of variance in medical performance scores could be explained by only three practice management dimensions. One practice dimension (delegation of medical tasks to the practice assistant) explained 11% of variance in communication with patients. Organization of quality assessment activities explained most of the variation in medical performance. CONCLUSIONS: Practice management (structure) and actual performance (process) seem to be largely autonomous constructs. Quality improvement and assessment activities should emphasize that practice management is different from actual performance. Structure and process may contribute to patient outcome independently of each other.

Adult↗

PubMed2002

Change in physical performance over time in older women: the Women's Health and Aging Study.

BACKGROUND: Although lower and upper extremity performance measures are widely used and represent validated physical function measures in older adults, there is limited information regarding the magnitude of changes in these measures over time. This study (i) assesses prospective changes in physical performance measures, (ii) defines a summary score that demonstrates a significant amount of change over time, and (iii) examines rates of decline according to age and baseline performance levels. METHODS: Data from the Women's Health and Aging Study (WHAS) were analyzed to assess change in the one third most disabled older women living in the community. Lower extremity function was assessed using walking speed, balance, and chair stands tests. The putting-on-blouse test, the lock and key test, the Purdue Pegboard test, and grip strength were used to gauge upper extremity function. Continuous and categorical summary performance scores were calculated using continuous and categorical data of lower and upper performance measures. RESULTS: After 3 years, lower extremity performance measures declined by 16%-27%, while upper extremity performance measures declined less (7%-24%). For lower extremity function, the continuous summary performance score showed a slightly greater 3-year decline from baseline (decline vs baseline mean: 23%; decline vs SD of the baseline mean: 59%) than the categorical score (22% and 41%, respectively). Older age and intermediate level of baseline performance were associated with the greatest decline, especially for lower extremity function. CONCLUSIONS: In moderately to severely disabled women aged 65 or older, lower extremity measures show more change over 3 years than upper extremity measures. Among the lower extremity summary scores, the continuous score changes more over time than the categorical score with respect to the baseline SD. The lower extremity continuous summary performance score may be a useful outcome measure for clinical studies of physical performance in older women.

Aged↗

PubMed1994

Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur studies of successful aging.

BACKGROUND: Performance-based measures of physical performance were examined for an older cohort of relatively high-functioning men and women. Relationships between baseline physical performance and sociodemographic and health status characteristics were also examined. Three-year pattern changes in performance are described, and sociodemographic and health status predictors of change are investigated. METHODS: A cohort of relatively high-functioning men and women, aged 70-79, was identified in 1988 by subsampling from three community-based studies on the basis of physical and cognitive function. Baseline in-home assessments included tests of physical performance and measurement of sociodemographic characteristics and health status. A summary measure of physical performance was developed from tests of balance, gait, lower body strength and coordination, and manual dexterity. In-home assessments were repeated at follow-up in 1991. RESULTS: Better physical performance at baseline was more common among males, Whites, those reporting higher income and education, and those with fewer chronic conditions. In linear regression models, declines in performance were predicted by older age, lower income, higher education, relative weight and blood pressure, lower peak expiratory flow, prevalent diabetes and incident health conditions and hospitalizations during follow-up. Improvements in performance were also observed; the only significant association was with race (i.e., being Black). CONCLUSIONS: Declines in physical performance within a high-functioning cohort are predictable from sociodemographic and health status characteristics. The patterns of both decline and improvement in performance observed in this cohort suggest that older age is not uniformly associated with declines, indicating the potential for effective interventions to promote more successful aging.

Activities of Daily Living↗

PubMed2005

A performance assessment framework for hospitals: the WHO regional office for Europe PATH project.

OBJECTIVE: The World Health Organization (WHO) Regional Office for Europe launched in 2003 a project aiming to develop and disseminate a flexible and comprehensive tool for the assessment of hospital performance and referred to as the performance assessment tool for quality improvement in hospitals (PATH). This project aims at supporting hospitals in assessing their performance, questioning their own results, and translating them into actions for improvement, by providing hospitals with tools for performance assessment and by enabling collegial support and networking among participating hospitals. METHODS: PATH was developed through a series of four workshops gathering experts representing most valuable experiences on hospital performance assessment worldwide. An extensive review of the literature on hospital performance projects was carried out, more than 100 performance indicators were scrutinized, and a survey was carried out in 20 European countries. RESULTS: Six dimensions were identified for assessing hospital performance: clinical effectiveness, safety, patient centredness, production efficiency, staff orientation and responsive governance. The following outcomes were achieved: (i) definition of the concepts and identification of key dimensions of hospital performance; (ii) design of the architecture of PATH to enhance evidence-based management and quality improvement through performance assessment; (iii) selection of a core and a tailored set of performance indicators with detailed operational definitions; (iv) identification of trade-offs between indicators; (v) elaboration of descriptive sheets for each indicator to support hospitals in interpreting their results; (vi) design of a balanced dashboard; and (vii) strategies for implementation of the PATH framework. CONCLUSION: PATH is currently being pilot implemented in eight countries to refine its framework before further expansion.

Benchmarking↗