TQM in dental practice.

Society now expects more from its doctors and dentists, and these increasing demands can be summed up in one relatively new term for the medical profession: "quality management" (QM). Doctors and dentists formerly took the view that their performance could be assessed solely on the basis of their technical skills, ethics and expertise, but are now confronted with a new social imperative, from outside the profession--quality management. The author, prize-winner of the European Quality Award 2000 describes his approach to introduce the European Foundation for Quality Management (EFQM) Excellence Model in his dental practice. He shows that the EFQM model is well suited as a basis for a quality management system in healthcare.

Characterization of spermatozoa by planar morphometry.

OBJECTIVE: To define the morphometric characteristics of normal sperm heads, and compare them to sperm head measurements used to define normal morphology using strict criteria. DESIGN: Computerized image analysis of selected normal and abnormal seminal fluid specimens collected for routine male fertility studies. SETTING: Research laboratory at the Department of Medical Technology, Bowling Green State University, Bowling Green, OH. PATIENTS: Sixty adult male patients who submitted semen samples for routine analysis. Fifty percent had normal seminal fluid analysis results. The remaining 50% demonstrated abnormal sperm morphology. CRITERION STANDARD: Microscopic evaluation of sperm head morphology. Sperm fitting the criteria of normal as defined by WHO (1987 and 1992) and Kruger (1988) were classified as normal. Sperm with a post nuclear area of less than 40% were classified as acrosomal deficient. MAIN OUTCOME MEASURES: Measurements made from stained seminal fluid smears included sperm head area, perimeter, acrosomal area, percent acrosome, Ferret's diameters, aspect ratio, shape factor, and specific length. Normal sperm heads (NL group) were compared to sperm heads demonstrating an acrosomal deficiency (AD group) for statistically significant differences using multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA). Stepwise discriminant analysis was used to remove duplicating variables. Discriminant analysis was used to classify the sperm heads into NL and AD groups. Receiver-operating characteristic (ROC) curves were applied to the 2 most influential variables in order to identify a cutoff that best distinguishes normal from acrosomal deficient sperm heads. RESULTS: MANOVA and ANOVA showed all 10 variables to be statistically significant (p < .002). Discriminant analysis correctly assigned 98.7% of the normal sperm heads to the NL group and 99.0% of sperm with acrosomal deficiency to the AD group. The percent acrosome and acrosomal area were determined to be the 2 most influential variables. ROC analysis identified a cutoff of 3.6 mu2 for acrosomal area as having the highest sensitivity and specificity (99.7% and 88.0%, respectively). Similarly, a cutoff of 44% for percent acrosome gave a sensitivity of 92.3% and a specificity of 88.7%. The coefficient of variation (CV) for each of the 10 variables determined from 20 day-to-day replicates of a normal semen smear ranged from 2.6% to 8.4%. CONCLUSION: Computerized image analysis is able to define a reference range for sperm head area, percent acrosome, and acrosomal area that may be used to differentiate normal form abnormal sperm heads. Maximum and minimum Ferret's diameters measure sperm head length and width, respectively. Mean maximum Ferret's diameter, minimum Ferret's diameter, and maximum-minimum Ferret's diameter ratio correspond closely to the WHO (1987) midpoint for normal sperm head length, width, and length-width ratio. The average percent acrosome of normal sperm heads determined by morphometry closely correlate to the WHO (1992) and Kruger (1988) midpoints for percent acrosome.

Measurement of adrenal corticosteroids by high-performance liquid chromatography.

OBJECTIVE: To develop a high-performance liquid chromatography (HPLC) method for simultaneous measurement of adrenal corticosteroids important for the diagnosis of congenital adrenal hyperplasia. DESIGN: Blind comparison using convenience samples. SETTING: Research laboratory at the Department of Medical Technology, Bowling Green State University. PATIENTS: Referred samples for cortisol, 11-deoxycortisol (S), and 17-hydroxyprogesterone (OHP). Stimulation condition unknown. INTERVENTION: Venous blood collected, processed to serum, and frozen. Adrenal steroids measured by radioimmunoassay (RIA) and by HPLC. MAIN OUTCOME MEASURES: Linearity, analytic sensitivity, accuracy, and precision were evaluated using recovery, coefficient of variation (c.v.), correlation coefficient (r), Student's t test, F test, and linear regression. RESULTS: Calibration curves were linear to at least 50 mumol/L, and the low-end sensitivity was 10 nmol/L. Analytic recovery ranged from 89.8% to 103.9%. The CV was below 7.5% (n = 10) for all three steroids. Comparison to RIA yielded r values of 0.909 (n = 25), 0.932 (n = 10), and 0.983 (n = 10) for cortisol, S, and OHP, respectively. Student's t-test results were 1.13 (p = 0.27), 0.10 (p = 0.93), and 0.48 (p = 0.64) for cortisol, S, and OHP, respectively. F-test results were 1.14 (p = 0.75), 1.37 (p = 0.66), 2.39 (p = 0.21) for cortisol, S, and OHP, respectively. Results for cortisol showed a negative bias of 97.0 nmol/L (3 mug/dL). Linear regression analysis revealed proportional errors of -15.0% -7.0%, and +9.0%, for cortisol, S, and OHP, respectively. CONCLUSION: (ABSTRACT TRUNCATED AT 250 WORDS)

Simultaneous measurement of VMA and HVA in 24-hour urine samples.

A simple method is described for the simultaneous measurement of vanillylmandelic acid (VMA) and homovanillic acid (HVA) in 24-hour urine samples based upon isocratic high-performance liquid chromatography with electrochemical detection (HPLC-ECD). VMA was measured using VMA-SKREEN kits (Biochemical Diagnostics), a microcolumn diazo method and HPLC-ECD test method. HVA was measured using Bio-Rad HVA HPLC reagent kits (Bio-Rad Laboratories) and the test method. No significant statistical difference was found in mean or variance when this method was compared with the micro-column diazo method for VMA and HPLC-ECD for HVA using the commercial anion-exchange kit. The linear regression equation for VMA was y = 0.92 x + 0.21, and for HVA was y = 1.10 x + 0.06. The Pearson correlation coefficient for VMA was r = 0.896 and for HVA was r = 0.996. This method yields results for 24-hour urinary VMA and HVA that compare well with established commercial methods.

Measurement of red blood cell adenosine nucleotides by high-performance liquid chromatography.

A new method for measuring ATP in stored red blood cells using high-performance liquid chromatography was compared with an established enzymatic method. The new method is based upon isocratic reverse phase chromatography using a polyvinyl alcohol gel stationary phase. The chromatograms produce quantitative results for ADP, AMP, and other nucleotides, and can be used to determine adenylate energy charge. The correlation coefficient between the two methods was 0.91, and mean ATP was 3.0 mumol/g Hb for both methods. Tests of hypothesis for mean and variance were not significant. The method is recommended as a means to study the relationships between poststorage red blood cell ATP, adenylate energy charge, total adenylates, and posttransfusion erythrocyte survival.