Dallas, TX 75251 This will measure the efficiency of the improvement process. The process of measure development is lengthy and expensive, and requires review of evidence, analysis of care gaps, feasibility assessment, determination of data sources, development of detailed specifications, and field testing. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Which of the following is not a consideration when choosing a product line? The results of physician and other provider activities. What is general percentage markup for retail products in a salon? National policies and strategies aimed at improving quality of care provide a strong foundation for improving quality across the health system and need to be closely aligned with broader national health policy and planning. What term refers to products intended to improve the skin's health and appearance? Another key factor is the competence of the key staff the partner assigns to the project. what determines the quality and effectiveness of professional products? What is the term for substances such as mineral dyes that give products color? Decide what "value" means to your firm, then measure how long it takes to achieve that value. When autocomplete results are available use up and down arrows to review and enter to select. Once the goals have been identified, they need to be translated into measurable criteria. Every organization must determine how best to address and manage their performance where quality is concerned. What is the vitamin of which retinol is the natural form? cruelty-free (ingredients are not tested on animals). On the line provided, write C for clear or S for squinting modifier. should be: To realize the benefits of quality health care, health services must be: The Sustainable Development Goals urge countries to achieve Universal Health Coverage (UHC), including financial risk protection and access to quality essential health care services. Given the size of this investment, there . Washington (DC): National Academy Press; 2002. These should include both short-term and long-term goals. The number needed to treat (NNT) is a less subjective accounting of the likely benefits of a drug (or any other intervention). To sign up for updates or to access your subscriberpreferences, please enter your email address below. (they release substances at a microscopically controlled rate, they are chemical compounds, they are formed by small molecules, they are botanicals), they are botanicals (Polymers are chemical compounds formed by a number of small molecules. insoluble pigments (Lakes are insoluble pigments made by combining a dye with an inorganic material and are commonly used in colorful cosmetics. However, surrogate outcomes should ideally be proved to correlate with patient-oriented outcomes. Peter Furst Identify the expected outcomes and the goals of the training. Process. Firstly, it means that the approach to quality improvement used in an organisation probably matters less than how and by whom . In addition to these ingredients, daily use of a broad-spectrum sunscreen, preferably physical SPF 30 or greater, is highly recommended to prevent further darkening of pigmented areas.). Quality needs to be continually measured and monitored to drive improvement, which relies on accurate, timely and actionable data. Relates to meeting patients' needs and preferences and providing education and support. This information can be used to track trends over time and identify problems associated with specific items. The trusted provider of medical information since 1899, Introduction to Concepts in Pharmacotherapy, Last review/revision May 2022 | Modified Sep 2022. The committee evaluates measures submitted by developers, issues a draft report of findings, gathers member and public comment, and votes to reach a consensus on endorsement recommendations. Milbank Mem Fund Q 1966 Jul;44(3):Suppl:166-206. It is then rubbed, or "rolled," off the skin, taking dead skin cells with it. For example, if a drug increases the incidence of bleeding from 0.1% to 1%, the increase is more likely to be reported as 0.9% than 1000%. These include: Additionally, measures should be evaluated for: Quality measures are typically developed based on evidence generated through research and clinical practice, with most measures beginning as clinical guidelines. are due to poor-quality care in low- and middle-income countries, up to 15% of deaths overall, each year due to inadequate quality of care in low- and middle income countries, of their health system, such as disrespectful care, short consultations, or long-waiting times, WHO releases new family planning and abortion care competency standards for health workers, Guideline on fluid management of acutely ill children, Midwives are essential to the provision of quality of care, in all settings, globally, "My quality" real stories from the ground, National Quality Policy & Strategy Eight Elements, WHO Global Quality Rounds - Setting national strategic direction on quality of care: focus on Malaysia and Namibia. WHO, World Bank and the OECD have proposed a series of actions from key constituencies governments, health systems, citizens and patients, and health workers that need to work together to achieve the goal of quality health service delivery at the front line. The system should be able to identify problem areas and trends and devise possible improvements or gains achieved through the implementation of change initiatives. This product does not contain any animals ingredients or animal by -products. This feedback can come in many forms, including surveys, interviews, questionnaires, and complaint records. We offer Certified Manager of Quality/Organizational Excellence (CMQ/OE), Certified Six Sigma Green Belt (CSSGB), Certified Six Sigma Black Belt (CSSBB), Certified Quality Auditor (CQA), Certified Quality Engineer (CQE), Certified Supplier Quality Professional (CSQP), Certified Quality Improvement Associate (CQIA), and Certified Quality Process Analyst (CQPA) exam preparation courses. The ratio of data to errors. Quality measures can apply to various aspects of health care. Many drug adverse effects are dose related. Also, 5 of the 100 patients will die even though they take the drug and thus also do not benefit. Products and Services that meet or exceed customer expectations result in customer satisfaction. Relative risk is the proportional difference between two risk levels. Quality Management Strategies for Small Businesses, 10 Strategies for Reducing Human Error in Your Workplace, Cause and Effect Diagram, Fishbone or Ishikawa Diagram, Feedback from internal and external stakeholders (including stakeholder complaints). Outcomes can be negative or positive. NNT is the number of patients who need to be treated for one patient to benefit. Quality measures are typically developed based on evidence generated through research and clinical practice, with most measures beginning as clinical guidelines. This type of product is not tested on animals at any stage of the production process. When rates fall outside of normally observed ranges or well below established goals, investigation may be in order. When is the salon responsible for a client's allergic reaction to a product? Traceability refers to the ability to link components or sub-components of an item back to the original source. Pediatrics 2004 Jan;113(1 Pt 2):210-6. and. Indicators are statements about the current status of the goal. As countries commit to achieving Health for All, it is imperative to carefully consider the quality of care and health services. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose.The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses . The percentage of parents reporting "not a problem" in obtaining a specialist referral for their child. All Rights Reserved. Measurement is essential to effectively and efficiently manage any aspect of the organization's performance. Abstract available on PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14702503?dopt=Abstract, Mangione-Smith R, McGlynn EA. The table below defines and provides examples of some common measure types. Importantly, NNT is based on changes in absolute risk; it cannot be calculated from changes in relative risk. To determine whether the quality system is working effectively, one must first identify the purpose of the quality system. Often, there is little to no formal training provided to the staff. It helps an organization achieve its goal of providing consistent, high-quality products and services. In making such judgments, clinicians often consider factors that are somewhat subjective, such as personal experience, anecdotes, peer practices, and expert opinions. Quality measurement results describe an observed level of activity (immunization rate, rate of parental satisfaction with referrals) but not why the level is as it is. We are neither associated nor affiliated with the certification organization(s) mentioned in our courses. Purpose The EPC Program has identified existing evidence reports that can help the healthcare field care for patients during this global pandemic. To receive the gluten-free label, the product must have less than ___ parts per million of gluten. Quality issues should be a permanent topic in all weekly subcontractor meetings and must be carried forward until each is properly addressed and resolved. We do not control or have responsibility for the content of any third-party site. This is determined by dividing the number of parents reporting "not a problem" by the total number of parents in the applicable population who have requested a specialist referral for their child. Content last reviewed June 2020. These criteria provide a normative framework used to determine the merit or worth of an intervention (policy, strategy, programme . The system should be able to identify problem areas (discrepancies), how quickly and effectively the correction was made, and the overall impact the problem may have had on both the project schedule and costs. What is NOT among the purposes of functional ingredients in cosmetic products? Rockville (MD): Agency for Healthcare Research and Quality; 2003 Dec.Go to: https://archive.ahrq.gov/qual/nhqr03/nhqr03.htm, Beal AC, Co JP, Dougherty D, et al. Calculate the number needed to treat (NNT) based on absolute, rather than relative, changes in risks. Abstract available on PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9776949?dopt=Abstract, Internet Citation: Understanding Quality Measurement. It was developed by Dr. Robert Kaplan and Dr. David Norton and has since become widely accepted as a way to monitor corporate performance. Feedback from stakeholders is important because it gives you insight into your organization's strengths and weaknesses. Example: Factors affecting immunization rates may include: Answers to such questions require additional investigation and may serve as the starting point for program management initiatives or quality improvement efforts. The Six Systems of Organizational Effectiveness: 1. ingredients source and the manufacturing process. 1. Step 4. Number of avoidable complications and deaths. Audit your program regularly. Only 5 of the 100 patients (1 in 20) benefit from taking the drug; thus, 20 need to be treated for 1 to benefit, and the NNT is 20. Tracking and measurement is essential to effectively manage all aspects of the organization's performance. The FDA regulates cosmetics only in relation to safety, labeling, and the claims made for a product.). Committee recommendations are sent to the Consensus Standards Approval Committee (CSAC) where a final endorsement decision is made. Safety. calming (Choose products with ingredients that soothe, calm, and reduce inflammation, heal, and restore the skin's barrier function.). One goal in drug development is to have a large difference between the dose that is efficacious and the dose that causes adverse effects. The following types of ingredients are used: ceramides, emollients, and humectants.) If such advice is needed, consult with your attorney, accountant, or other qualified adviser. Some of them are listed below: Let's briefly look at each of these briefly: A balanced scorecard is a tool that helps companies evaluate their performance by using metrics. To do this, we select partners who are experts in their field, and with whom we can build a long-term relationship and co-create sustainable innovations. Quality measurements typically focus on structures or processes of care that have a demonstrated relationship to positive health outcomes and are under the control of the health care system. Certified Quality Auditor (CQA)Certified Quality Engineer (CQE)Six Sigma Yellow Belt (CSSYB)Six Sigma Green Belt (CSSGB)Six Sigma Black Belt (CSSBB)Quality Process Analyst (CQPA)Quality Improvement Associate (CQIA)Manager of Quality (CMQ/OE) (Discount on top of already low price), __CONFIG_colors_palette__%s__CONFIG_colors_palette__, __CONFIG_colors_palette__{"active_palette":0,"config":{"colors":{"f3080":{"name":"Main Accent","parent":-1},"f2bba":{"name":"Main Light 10","parent":"f3080"},"trewq":{"name":"Main Light 30","parent":"f3080"},"poiuy":{"name":"Main Light 80","parent":"f3080"},"f83d7":{"name":"Main Light 80","parent":"f3080"},"frty6":{"name":"Main Light 45","parent":"f3080"},"flktr":{"name":"Main Light 80","parent":"f3080"}},"gradients":[]},"palettes":[{"name":"Default","value":{"colors":{"f3080":{"val":"var(--tcb-skin-color-0)"},"f2bba":{"val":"rgba(255, 224, 46, 0.5)","hsl_parent_dependency":{"h":51,"l":0.59,"s":1}},"trewq":{"val":"rgba(255, 224, 46, 0.7)","hsl_parent_dependency":{"h":51,"l":0.59,"s":1}},"poiuy":{"val":"rgba(255, 224, 46, 0.35)","hsl_parent_dependency":{"h":51,"l":0.59,"s":1}},"f83d7":{"val":"rgba(255, 224, 46, 0.4)","hsl_parent_dependency":{"h":51,"l":0.59,"s":1}},"frty6":{"val":"rgba(255, 224, 46, 0.2)","hsl_parent_dependency":{"h":51,"l":0.59,"s":1}},"flktr":{"val":"rgba(255, 224, 46, 0.8)","hsl_parent_dependency":{"h":51,"l":0.59,"s":1}}},"gradients":[]},"original":{"colors":{"f3080":{"val":"rgb(23, 23, 22)","hsl":{"h":60,"s":0.02,"l":0.09}},"f2bba":{"val":"rgba(23, 23, 22, 0.5)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.5}},"trewq":{"val":"rgba(23, 23, 22, 0.7)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.7}},"poiuy":{"val":"rgba(23, 23, 22, 0.35)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.35}},"f83d7":{"val":"rgba(23, 23, 22, 0.4)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.4}},"frty6":{"val":"rgba(23, 23, 22, 0.2)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.2}},"flktr":{"val":"rgba(23, 23, 22, 0.8)","hsl_parent_dependency":{"h":60,"s":0.02,"l":0.09,"a":0.8}}},"gradients":[]}}]}__CONFIG_colors_palette__, I consent to having my information processed in order to receive personalized marketing material via email or phone in accordance with the, Certified Manager of Quality/Organizational Excellence (CMQ/OE), Certified Supplier Quality Professional (CSQP), Certified Quality Improvement Associate (CQIA), Seven Quality Management Principles in a Nutshell. break down the purchase price into daily and weekly costs, lubricant ingredients derived from plant oils or animal fats. ASQ is the registered trademark of the American Society for Quality. Centers for Medicare & Medicaid Services. It was also found that a robust QMS function had a positive impact on the contractor's field operations and their bottom line. (800) 827-4242. Equity. To ensure health outcomes for beneficiaries and value for money for payers, there must be a minimum standard of quality for healthcare services. The Child Health Toolbox contains concepts, tips, and tools for evaluating the quality of health care for children. For example, a drug that decreases mortality from 10% to 5% decreases absolute mortality by 5% but decreases relative mortality by 50% (ie, a 5% death rate indicates 50% fewer deaths than a 10% death rate). Also, if the surrogate is merely a marker of disease (eg, HbA1C) rather than a cause of disease (eg, elevated blood pressure), an intervention might lower the marker by means that do not affect the underlying disorder. Therefore, it is imperative that the GC or CM have a partner prequalification process in place to ensure that every selected organization will perform in accordance with the project's quality expectations. Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes. What determines the quality and effectiveness of professional products? ), small, sealed vial (Ampoules are small, sealed vials containing a single premeasured application. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. effective for a person's individual needs. Write the simple subject and simple predicate of given sentence. What do clay masks do as they dry and tighten? This provides management a means of comparatively evaluating each and every adverse event. If the project requires the superintendent to generate a daily construction report, then the superintendent should have a heading in the report specifically dealing with quality issues. In all cases, patient-oriented outcomes are best used. humectants (The goal in treating dry skin is to provide moisturizing, replenishing, and skin-restoring ingredients. The name and title of the certification exams mentioned on this website are the trademarks of the respective certification organization. What are ingredients derived from plants called? This requires defining the goals and objectives of the quality system. Quality systems are designed to produce high-quality products and services. (to create your own products, to explain how to properly use products at home, to explain why they're effective, to set realistic expectations), to create your own products (It is critical to know the basic chemistry of formulations, cosmetic ingredients, benefits, and potential side effects; how to select products and ingredients based on an individual's needs, skin type, and condition; and finally products and ingredients to ingredients that you use in a treatment or recommend for their home care use. It is the responsibility of the GC or CM to ensure that the specified level of quality is achieved as required by the contract. In addition, the main patient-oriented outcomes, death and disability, are dichotomous (ie, yes/no), whereas surrogate outcomes are often continuous, numerical variables (eg, blood pressure, blood glucose). Ultimately, there are two crucial goals of quality control: (1) to ensure that products are as . humectants (The goal in treating dry skin is to provide moisturizing, replenishing, and skin-restoring ingredients. Variables that affect quality are: (a) customer expectations (obtained from marketing and sales, as well as word of mouth and previous experience), (b) actual product/service received (how a service is performed by operational people and actual tangibles received (cold food for example). Agribusiness and Farm Insurance Specialist, Construction Risk and Insurance Specialist, Management Liability Insurance Specialist, Transportation Risk Insurance Professional, Measuring the Effectiveness of Quality Management Systems, Monitors and verifies means and methods are functioning as planned, Monitors and verifies deliverables meet defined standards, Policies, processes, and practices are implemented correctly, Policies, processes, and practices are followed correctly delivering results. Please confirm that you are a health care professional. These have been noted as the "iron triangle," according to researchers. When is a manufacturer responsible for a client's allergic reaction to a product? ingredients source and the manufacturing process Which of the following is not a consideration when choosing a product line? Some QMS managers may also be required to oversee and inspect all active projects on a regular basis, discuss the inspection results with project staff, and follow up to ensure that the suggested corrections were, in fact, implemented. no additional ingredients have been added to provide a fragrance. When is the salon responsible for a client's allergic reaction to a product? There needs to be sufficient detail so that management may determine how to address such issues going forward. For this reason, and because clinical trials may exclude certain subgroups and high-risk patients, adverse effects may not be fully known until a drug has been in widespread clinical use for years (see Drug Development Drug Development Promising compounds can be identified by mass screening of hundreds or thousands of molecules for biologic activity. A large difference is called a wide therapeutic index, therapeutic ratio, or therapeutic window. The resulting calculation, known as the Air Quality Index, tells you how clean the air is and whether it will affect your health. To achieve superior results in the project's quality, the organization must conduct an analysis of its strengths, weaknesses, opportunities, and threats (SWOT). Abstract available on PubMed: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14702501&dopt=Abstract, Ferris TG, Dougherty D, Blumenthal D, et al. plants and herbs (originates from a plant, including herbs, roots, flowers, fruits, leaves, and seeds), What is not a reason to have a thorough understanding of skin care products? Example 1. These folks must be interviewed by the GC/CM to determine their competence and must function at an acceptable level, or the partner must replace them when requested. Technically, AHRQ defines a quality measure as a mechanism to assign a quantity to quality of care by comparison to a criterion. ), What is not among the purposes of functional ingredients in cosmetic products? Rates can be benchmarked through comparison with actual State, regional, or national levels. botanicals (A botanical ingredient originates from a plant, including herbs, roots, flowers, fruits, leaves, and seeds.). The quality discrepancies may impact the time required to make the correction. 1 Although originally developed for mental health interventions, the criteria presented are equally applicable in other health service . This will identify what is working well and also indicate areas where there are opportunities for improvement. What vitamin has NOT been used in skin care products as an antioxidant? https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html. What is the goal in treating dehydrated skin? Examples: The percentage of children age 2 who receive the appropriate immunizations. The work must be inspected, data collected, and quality evaluated to accomplish this. (provide product education, practice professional follow-up, present precise instructions, prepare a business plan with high mark-ups), prepare a business plan with high mark-ups, ingredients that cause actual changes in the appearance of the skin, chemical added to improve the efficacy of the preservative. Washington (DC): National Academy Press; 2001. Internal audits are performed to verify that the planned processes are being followed and are actually improving the quality of the organization's product or service. Visualize Your Data with Box and Whisker Plots! Measures can also prevent the overuse, underuse, and misuse of health care services and can identify disparities in care delivery and outcomes. Management reviews help ensure that the organization is achieving its stated objectives and that there aren't any significant issues that need addressing. Learn more about the MSD Manuals and our commitment to, Balancing Drug Benefits and Adverse Effects. Across all levels there is a need for engagement and empowerment of the communities served by the health system. ), surfactant (Detergents and emulsifiers are surfactants.). In developing a quality measure, it must be tested to ensure that it is: The further a measure is from these ideal technical conditions, the greater the difficulty will be in using the measurement information to compare health plan or program results or in answering specific questions about the health care being provided. ), What is not a consideration when choosing a product line? Example: People have always enjoyed novelty acts. Your manager may review how often you make decisions independently or ask others for advice. Many hospitals have quality improvement teams or . Which term is often used loosely because there is no specific legal definition? The next meeting of the (consul, council, counsel) will concern property taxes. The Institute of Medicine defines health care quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.". You must ensure that the training meets the stakeholders' expectations and/or the business needs and that the evaluation measures against these expectations. Achieving good quality in completed projects enhances their reputation and invariably leads to the securing of more projects. In health care quality measurement today, expert consensus is often used to reach agreement on precise definitions and measurement specifications. There must be some form of measurement to manage properly. Thus, rates are easily determined and compared. Telephone: (301) 427-1364. Such comparisons are increasingly available. Another metric that may be useful in managing project quality is to track the amount of time it took from the discovery of the discrepancy to the time it was resolved. I&R programs help individuals, families and communities identify, understand, and effectively us e the programs that are part of the human service delivery system. The National Healthcare Quality Report. Example: To assess the quality of a health plan or program in delivering health care to enrolled children, a State agency may choose to use several parental perception measures as well as several measures of the delivery of preventive care. For example, the poor work of an individual worker may delay just that worker's work, or it may delay the completion of that trade's work and possibly the start of the following trade, or it may cause the delay of the project as a whole. The system must be able to determine how well the organization is meeting its goals and objectives in any of its endeavors. physical method of rubbing dead cells off of the skin. Every week you get an email that explains a quality concept, provides you with the study resources, test quizzes, tips and special discounts on our other e-learning courses. when the product is taken directly from the manufacturer's packaging. However, the reality in many settings is that providing quality care remains a significant challenge, and inadequate quality results in avoidable mortality, human suffering and significant economic losses. 1. The experience with health care and/or the level of satisfaction with care. Rockville, MD 20857 gender, age, an advanced degree, or even state certification of competenceare not ordinarily found to be associated with effectiveness in the classroom. Percent of providers using an electronic health record (EHR), Percent of diabetic patients tracked in a registry, Ischemic vascular disease: use of aspirin or another antithrombotic, Diabetes long-term complications admission rate, Consumer Assessment of Healthcare Providers and Systems (CAHPS): patient experience, Gains in patient activation scores (PAM) at 12 months, Avoidance of antibiotics for adults with acute bronchitis, Are relevant to your practice and the population you serve, Align with national or regional initiatives, such as the Merit-based Incentive Payment System (MIPS), Core Quality Measures Collaborative, payers. https://www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/understand/index.html, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, Challenge and Potential for Assuring Quality Health Care for the 21st Century, About AHRQ's Quality & Patient Safety Work, http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/indicators/index.html, http://nationalacademies.org/hmd/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx, http://www.ahrq.gov/chtoolbx/understn.htm#domains, http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/uses/index.html#mgmt, http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/uses/index.html#quality, http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/understand/index.html#domains, https://www.ahrq.gov/research/findings/nhqrdr/index.html, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14702502&dopt=Abstract, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14702501&dopt=Abstract, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11134448&dopt=Abstract, http://www.nationalacademies.org/hmd/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx, https://www.nap.edu/catalog/10073/envisioning-the-national-health-care-quality-report, https://www.nap.edu/catalog/10512/guidance-for-the-national-healthcare-disparities-report, https://www.ncbi.nlm.nih.gov/pubmed/14702503?dopt=Abstract, https://www.ncbi.nlm.nih.gov/pubmed/9776949?dopt=Abstract, U.S. Department of Health & Human Services.