Performance outcome measures

Workplace assessments usually lequiie special attention to task demands, performance, and load. The demand measures form the counterpart of the performance measures, they specify the task or demand requirements of the environment (inputs whereas the performance/outcome measures define the way the operational output is assessed. Load measures, which are often the prime focus of ambulatory studies, can only properiy be interpreted in the context of task requirements, on the one hand, and performaiKe, on the other. 

Although many clinical studies have been performed evaluating antibiotics for ABRS, no randomized, double-blind, placebo-controlled studies have used pre- and posttreatment sinus aspirate cultures as an outcome measure. Despite this, antibiotics appear to resolve symptoms more quickly and reduce failure rates and complications compared with no treatment.35-37 Since diagnosis usually is based on clinical presentation and not sinus aspirate cultures, clinicians must attempt to differentiate ABRS from viral rhinosinusitis. Therefore, it is important to limit antibiotic use to cases where infection is unlikely to resolve without causing prolonged disease patients with mild to moderate symptoms that persist for 10 days or worsen over 5 to 7 days and patients with severe symptoms,31,34... 

Recent advances in the treatment of cancer of the colon and rectum now offer the potential to improve patient survival, but for many patients, improved disease- and progression-free survival represent equally important therapeutic outcomes. In the absence of the ability of a specific treatment to demonstrate improved survival, important outcome measures should include the effects of the treatment on patient symptoms, daily activities, performance status, and other quality-of-life indicators. Individualized patient care to balance the risks associated with treatment with the benefits of a specific treatment regimen is necessary to optimize patient outcomes. 

The Liebowitz Social Anxiety Scale (LSAS) measures fear, anxiety and avoidant behavior in 24 commonly feared social situations and performances. There are 13 performance-related items and 11 items that rate the social situations (Heimberg et al, 1999). The LSAS is the standard established outcome measure in most of the pivotal trials for social anxiety. Cut-offs of 30 for social anxiety disorder and 60 for its generalized subtype on the LSAS total scores represent a balance of specificity and sensitivity. There are two valid versions of the LSAS a clinician-administered version and a self-rating version (Fresco et al.. 2001). 

It is the merit of Maciel and Sindorf21,22 to have studied these effects in detail, and to have provided methods and algorithms to perform quantitative measurements with 29Si CP MAS NMR. The final outcome of this study is shown in figure 5.11. 

Step 5 is to establish thresholds for optimal use. Thresholds are the standards against which performance is measured. For example, if the criteria for dosing a medication require that all patients receive a particular dose, without variation, then the threshold will be set at 100% that is, 100% of the patients must receive that dose. It is not necessary to set absolute standards (e.g., 0% therapeutic duplication or 100% compliance with dosage recommendations), because individual variation should be taken into account. A further example of a threshold includes the percentage of patients expected to achieve a certain outcome (e.g., goal blood pressure, 75% adverse reaction, 12%). Clinical pharmacists and physician specialists should... 

The clinical question leads to inclusion and exclusion criteria for studies to be included in the review. These criteria include the patient cohort and setting in which the test is to be used, as well as the outcome measures to be considered. These are all important as both the patient setting and the nature of the question affect the diagnostic performance of a test. ... 

The sponsor needs to monitor CRO accomplishments using objective outcome measures (see discussion of performance metrics below). The sponsor must recognize red flags that signal the need for corrective action. If requested by the CRO, the sponsor should assist in resolving problems by providing needed information and, if appropriate, making amendment to the study protocol. Such assistance should be provided in timely fashion and should involve the appropriate level of authority at the sponsor. 

Healthcare providers are increasingly relying on pharmacists to perform outcomes research and quality-of-life studies. Pharmacists can apply basic quantitative skills in evaluating options and combine the results with qualitative information to make decisions and recommendations. For disease state management programs, measuring outcomes can be the key to success. 

Data collection (compare actual to optimal) This step is the evaluation, where performance is measured against objective criteria for the processes or outcomes of care. Criteria may relate to indications (for selection of a particular medication or procedure), processes (drug dosing and administration, patient assessment and monitoring) or outcome measures (cure, relief of symptoms, treatment failure, adverse drug event, patient satisfaction). 

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