Concern about the quality of care must be as old as medicine itself. But an honest concern about quality, however genuine, is not the same as methodical assessment based on reliable evidence. Still less is it quality control, which implies compliance with predetermined standards, as in an industrial process.Among Educational accreditation for training purposes. The royal colleges, the nursing regulatory bodies, and their equivalents in other professions, all inspect the relevant departments, institutions, and services to satisfy themselves that training arrangements in them meet the (generally rather shadowy) standards that they require.The confidential inquiry into maternal deaths. Stemming back to the 1930s, the inquiry consists of a confidential report from the local obstetrician, through a regional assessor, to national assessors. The assessors comment on the causes of death, identifying those that were in their view avoidable. They do so to those concerned with the specific case and (preserving anonymity) they also make a public report. It seems probable that by calling attention to avoidable causes, such as toxaemia, and by suggesting remedial measures, the inquiry has contributed to the progressive reduction in maternal deaths and to the United Kingdom's relatively good international performance on this criterion. But that hypothesis cannot be proved. The confidential inquiry has been applauded as a method and has influenced the approach to (among other problems) perinatal deaths and anaesthetic deaths, though no other British audit is as thorough as this.Clinical

It is some years since, in an article reviewing the state of quality assurance in Britain,' I argued that quality in health care is multidimensional. This was not a new proposition. Donabedian, for example, had recognised that patient satisfaction can often diverge from technical efficiency as perceived by the expert provider.2 As used to be said of one energetic surgeon, "His patients loved him and they died young." The two views of quality are clearly not identical: the methods for measuring them and the people best placed to judge them differ. Although Donabedian and others had recognised multidimensionality, the dimensions of quality I described were, I think, a genuine step forward in describing and explaining six facets of health care quality (box 1). It is gratifying that they struck a chord and that they seem to have been useful, both practically and conceptually, at several different levels in the system. However, they are obviously not the last word on so complex and important a subject. The purpose of this article therefore is, firstly, to reflect on some of the ways in which the dimensions have been used since they were proposed (there may well be many other examples, but those given here are at least illustrative); then to revisit the concepts underlying them; and, finally, to argue that we must not let the search for

A method for lipid isolation is presented that is alternative to the traditional chloroform/methanol extraction methods. This new method allows lipid isolation by solvent elution of a dry column composed of a tissue sample, anhydrous sodium sulfate, and Celite 545 diatomaceous earth ground together. To isolate total lipids, the dry column is eluted with a mixture of dichloromethane/methanol (90:10, v/v). Alternatively, the lipids may be isolated and simultaneously separated into neutral and polar fractions by a sequential elution procedure; neutral lipids free of polar lipids are eluted first with dichloromethane, followed by elution of polar lipids with the dichloromethane/methanol (90:10) mixture. The two dry column methods-isocratic or sequential elution-were compared with the traditional chloroform/methanol methods by gravimetric, thin layer chromatographic and phosphorus analyses.

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