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PubMed2004

The scoring scheme of the informant questionnaire on cognitive decline in the elderly needs revision: results of rasch analysis.

The purpose of this study was to examine the optimal scoring scheme (category use), unidimensionality, item fit, and redundancy of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in a cohort of Hong Kong Chinese stroke survivors. At 3 months after the index stroke, a research assistant administered the IQCODE to relatives of 284 Chinese patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blinded to the IQCODE scores, interviewed all 284 patients and made DSM-IV diagnosis of dementia, which served as the benchmark for judging the performance of IQCODE in screening dementia. The results suggest that the optimal IQCODE scoring scheme has 2 rather than the original 5 categories. Although the IQCODE was unidimensional overall, there was evidence of item redundancy, thus indicating that a shortened version is desirable.

Aged↗
PubMedDate not supplied

Investigation of 208 consecutive cases of cervical cone biopsies with regard to indication, negative samples and quality control.

OBJECTIVE: To analyze factors in preoperative management and cytologic screening leading to a conization specimen free of neoplasia. STUDY DESIGN: From January 2001 through December 2003, cervical conization was performed on 208 consecutive cases at the Gynecologic Department, Krankenhaus Lainz, Vienna. Indications for cone biopsy were based on suspicious internal and/or external conventional cytologic screening results followed by punch biopsies in selected cases. RESULTS: Benign cervical lesions were diagnosed in 22 women (10.6%). Histologic results in negative cone biopsies were cervicitis (n = 12), infection with HPV without cervical intraepithelial neoplasia (n = 1), tubal metaplasia (n = 4) and combined diagnoses indicating no neoplasia (n = 5). Regarding cytologic screening results prior to conization, long-lasting infections with HPV can cause repeated findings of cells of unknown origin or reversible mild to moderate dysplasia eventually leading to conization specimens free of neoplasia. Furthermore, tubal metaplasia is a frequent pitfall in misinterpretation of cytologic smears. CONCLUSION: Reevaluation of cytologic screening results after the final histologic diagnosis becomes available following cone biopsy is a key issue in continuous quality assurance for the diagnostic procedure. In this article we also present a method of stratifying screening results according to the correctness of the results. Along with other established measures of diagnostic performance, this may support benchmarking and interpretation of the overall cytologic screening quality.

Adult↗
PubMed2001

Self-organization of topographic mixture networks using attentional feedback.

This article proposes a neural network model of supervised learning that employs biologically motivated constraints of using local, on-line, constructive learning. The model possesses two novel learning mechanisms. The first is a network for learning topographic mixtures. The network's internal category nodes are the mixture components, which learn to encode smooth distributions in the input space by taking advantage of topography in the input feature maps. The second mechanism is an attentional biasing feedback circuit. When the network makes an incorrect output prediction, this feedback circuit modulates the learning rates of the category nodes, by amounts based on the sharpness of their tuning, in order to improve the network's prediction accuracy. The network is evaluated on several standard classification benchmarks and shown to perform well in comparison to other classifiers.

Attention↗
PubMed2006

The effect of the development of an emergency transfer system on the travel time to tertiary care centres in Japan.

BACKGROUND: In Japan, the emergency medical system is categorized into three levels: primary, secondary, and tertiary, depending on the severity of the condition of the patient. Tertiary care centres accept patients who require 24-h monitoring. In this research, the average travel times (minutes) from the centroids of all municipalities in Japan to the nearest tertiary care centre were estimated, using the geographic information system. The systems affecting travel time to tertiary care centres were also examined. Regression analysis was performed to determine the factors affecting the travel time to tertiary care centres, using selected variables representing road conditions and the emergency transfer system. Linear regression analysis was performed to identify specific benchmarks that would be effective in reducing the average travel time to tertiary care centres in prefectures with travel times longer than the average 57 min. RESULTS: The mean travel time was 57 min, the range was 83 min, and the standard deviation was 20.4. As a result of multiple regression analysis, average coverage area per tertiary care centre, kilometres of highway road per square kilometre, and population were selected as variables with impact on the average travel time. Based on results from linear regression analysis, benchmarks for the emergency transfer system that would effectively reduce travel time to the mean value of 57 min were identified: 26% pavement ratio of roads (percentage of paved road to general roads), and three tertiary care centres and 108 ambulances. CONCLUSION: Regional gaps in the travel time to tertiary care centres were identified in Japan. The systems we should focus on to reducing travel time were identified. Further reduction of travel time to tertiary care centres can be effectively achieved by improving these specific systems. Linear regression analysis showed that a 26% pavement ratio and three tertiary care centres are beneficial to prefectures with an average time longer than the mean score, to achieve a reduction of travel time. Measures for reducing travel time need to be considered in policy-making to re-evaluate the current locations of tertiary care centres to provide equality of access to emergency medicine.

Catchment Area, Health↗
PubMed2006

Improving patient safety through quality assurance.

CONTEXT: Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety. OBJECTIVE: To review some of the anatomic pathology laboratory patient safety quality assurance practices. DESIGN: Different standards and measures in anatomic pathology quality assurance and patient safety were reviewed. MAIN OUTCOME MEASURES: Frequency of anatomic pathology laboratory error, variability in the use of specific quality assurance practices, and use of data for error reduction initiatives. RESULTS: Anatomic pathology error frequencies vary according to the detection method used. Based on secondary review, a College of American Pathologists Q-Probes study showed that the mean laboratory error frequency was 6.7%. A College of American Pathologists Q-Tracks study measuring frozen section discrepancy found that laboratories improved the longer they monitored and shared data. There is a lack of standardization across laboratories even for governmentally mandated quality assurance practices, such as cytologic-histologic correlation. The National Institutes of Health funded a consortium of laboratories to benchmark laboratory error frequencies, perform root cause analysis, and design error reduction initiatives, using quality assurance data. Based on the cytologic-histologic correlation process, these laboratories found an aggregate nongynecologic error frequency of 10.8%. Based on gynecologic error data, the laboratory at my institution used Toyota production system processes to lower gynecologic error frequencies and to improve Papanicolaou test metrics. CONCLUSION: Laboratory quality assurance practices have been used to track error rates, and laboratories are starting to use these data for error reduction initiatives.

Humans↗
PubMed1995

Computer-based records. Still searching for the 'Holy Grail'.

The developers of three new databases propose to evaluate computer-based patient record systems in great detail. They promise to rigorously benchmark how CPR systems perform on a suite of tests in what they are calling a 'CPR certification laboratory.'

Certification↗
PubMed1999

American Academy of Pediatrics. Committee on Practice and Ambulatory Medicine and Committee on Medical Liability. Pediatric physician profiling.

Employers, insurers, and other purchasers of health care services collect data to profile the practice habits of pediatricians and other physicians. This policy statement delineates a series of recommendations that should be adopted by health care purchasers to guide the development and implementation of physician profiling systems.

Benchmarking↗
PubMed2000

Hybrid fold recognition: combining sequence derived properties with evolutionary information.

Recent assessments of structure prediction have demonstrated that (i) although fold recognition methods can often identify remote similarities when standard sequence search methods fail, the score of the top-ranking fold is not always significant enough to allow a confident prediction; (ii) the use of structural information such as secondary structure increases recognition accuracy; (iii) modern sequence-based methods incorporating evolutionary information from neighboring sequences can often identify very remote similarities; (iv) there is no one single method that is superior to other methods when evaluated over a wide range of targets, and (v) extensive human-expert intervention is usually required for the most difficult prediction targets. Here, I describe a new, hybrid fold recognition method that incorporates structural and evolutionary information into a single fully automated method. This work is a first attempt towards the automation of some of the processes that are often applied by human predictors. The method is tested with two cases that are often applied by human predictors. The method is tested with two fold-recognition benchmarks demonstrating a superior performance. The higher sensitivity and selectivity enable the applicability of this method at genomic scales.

Algorithms↗
PubMedDate not supplied

[Epidemiological features of admitted patients to a psychiatric unit in a Prepaid Medical Organization in Buenos Aires City].

OBJECTIVE: This paper addresses the issue of monitoring the features of the psychiatric inpatient population of a Prepaid Medical System in Buenos Aires City, paying special attention to its length of stay, diagnosis and readmission rate. METHOD: Between april 1 2000 and march 31 2002 all the psychiatric admissions have been registered and readmission rates and diagnosis prevalence were studied in a naturalistic setting. RESULTS: There were 244 admissions (0.8 per thousand enrollees per year) and 17% was readmitted during this period (1 out of every 4 readmissions in the month following discharge). Their length of stay was an average of 11,8 days. 66% was admitted due to a suicidal attempt or suicidal thoughts. 42% had a discharge diagnosis of Mood disorder, 34% Personality disorder and 12% Schizophrenia or other psychosis. CONCLUSIONS: Inpatients belonging to this Prepaid Medical System seem to be different from other inpatient populations making the comparison among them hard to analyze. Future research should bring more data in order to perform further matching and benchmarking. This kind of information should be no secret and every System should be requested to show its results to allow users' and buyers auditory as well as State's control.

Adult↗
PubMed2004

[Immunohistochemical expression of PTEN antigen: a new tool for diagnosis of early endometrial neoplasia].

We examined immunohistochemical PTEN protein expression in endometrial samples obtained from perimenopausal women with uterine bleeding in order to diagnose early endometrial neoplasia. Paraffin sections of endometrial samples (biopsies, endometrium resection, hysterectomy) were reviewed and tested for immunocytochemical PTEN expression by epithelial cells. Immunohistochemical studies were performed with the Ventana Benchmark device and the immunoperoxidase technique with monoclonal anti-PTEN (6H2.1/Cascade Biosciences). We studied 45 samples of proliferative endometria, 42 samples of atypical hyperplasia (neoplasia), and 55 samples of endometrial carcinomas (30 endometrioid, 5 serous papillary, 10 clear cell, 5 adenosquamous, and 5 MMMT). A strong positive PTEN immunoreaction was observed in all 45 normal proliferative endometria, 2/30 endometrioid carcinomas, and 23/25 non endometrioid carcinomas. In contrast, PTEN immunoexpression was negative or weak in 40/42 atypical hyperplasia and 28/30 endometrioid carcinomas. Negative or weak PTEN expression correlated with endometrial neoplasia (atypical proliferation) (p < 0.001). Thus (i) PTEN immunoexpression in endometrial paraffin sections is a new diagnostic tool, distinguishing PTEN-positive cyclic abnormal monoclonal proliferative endometrium (anovulatory, non atypical, simple and complex hyperplasia) from PTEN-negative (or decreased) endometrial neoplasia, and especially early endometrial neoplasia (atypical simple and complex hyperplasia, in situ carcinoma, superficial carcinoma with focal invasion). (ii) Given the lack of reproducibility of histological identification of atypical (precancerous invasive) and non atypical (precancerous non invasive) endometrial hyperplasia, the new criteria (PTEN-negative crowded glands, gland/stroma ratio > 55%, nuclear pleomorphism, in areas > 1 mm) recently proposed to diagnose early endometrial neoplasia appear to be clinically relevant.

Biomarkers, Tumor↗
PubMed2005

Leaders with heart.

Although cardiovascular care is typically a lucrative service line, competition from other providers is often fierce. To gain market advantage, providers should follow best practices of top-performing organizations and use benchmarking data to identify areas in need of process improvement.

Benchmarking↗
PubMed1998

Statistical significance of ungapped sequence alignments.

Statistical significance of a local sequence alignment depends not only on the similarity score and on the sequence lengths, but also on a length of the alignment. Dependence of the alignment significance on the length of the sequences has been analyzed earlier, and is based on the idea that the longer sequences have more chances to share a local similarity with a bigger score. To the best of our knowledge, a dependence of the statistical significance on the length of an alignment has not been used in selecting the best alignments. We have applied to real proteins formulas for assessing the statistical significance of ungapped local alignments. Let L be a length of the alignment, then the expected value of a similarity score is Sexp = * L, where is the expected similarity between two randomly chosen residues. Value of can be calculated from a similarity (substitution) matrix M and amino acid frequencies P. = sigma ij pi*pj*mij. The probability of observing a score S greater than or equal to x for an alignment of length L is given by the normal distribution: Prob(S > or = x) = 1-integral of N ((S-Sexp)/sigma) = 1-integral of N((S- *L)/sigma m square root of L), where sigma m is a standard deviation of m. From these formula, we conclude, that we should select the best alignment using a normalized value of the similarity score as follows: S' = max ¿(S- *L)/ sigma m square root of L¿. The proposed normalization of the similarity score has been tested on the representative benchmark. To evaluate a performance of the normalization, we have calculated several measures of the recognition quality. Our normalization has improved all these measures. This procedure is important for choosing the correct alignment for homology modelling as well as for selecting distantly related sequences in databases.

Amino Acid Sequence↗
PubMed1998

Comparing change readiness, quality improvement, and cost management among Veterans Administration, for-profit, and nonprofit hospitals.

Health care organizations throughout the country are facing increasing pressure to improve their quality of care while reducing cost. This article describes a model of organizational change and develops a change readiness matrix that managers can use to benchmark their organization's performance on three dimensions: (1) change readiness, (2) quality improvement, and (3) cost management. The model and the matrix combine to offer managers a framework for pursuing organizational change and operational innovation within their organization. A survey methodology is used to compare VA hospitals (n = 44), for-profit hospitals (n = 108), and nonprofit hospitals (n = 449) on the three performance dimensions. The results indicate that Veterans Administration hospitals react differently than either for-profit or nonprofit hospitals on these dimensions. However, responses from for-profit and nonprofit hospitals were not significantly different from each other. Additional insights are presented into how hospitals in general can facilitate the organizational change process.

Financial Management, Hospital↗
PubMed2004

Semi-active control of a cable-stayed bridge under multiple-support excitations.

This paper presents a semi-active strategy for seismic protection of a benchmark cable-stayed bridge with consideration of multiple-support excitations. In this control strategy, Magnetorheological (MR) dampers are proposed as control devices, a LQG-clipped-optimal control algorithm is employed. An active control strategy, shown in previous researches to perform well at controlling the benchmark bridge when uniform earthquake motion was assumed, is also used in this study to control this benchmark bridge with consideration of multiple-support excitations. The performance of active control system is compared to that of the presented semi-active control strategy. Because the MR fluid damper is a controllable energy- dissipation device that cannot add mechanical energy to the structural system, the proposed control strategy is fail-safe in that bounded-input, bounded-output stability of the controlled structure is guaranteed. The numerical results demonstrated that the performance of the presented control design is nearly the same as that of the active control system; and that the MR dampers can effectively be used to control seismically excited cable-stayed bridges with multiple-support excitations.

Computer Simulation↗
PubMed1999

Benchmarking for the competitive marketplace.

One would get little argument these days regarding the importance of performance measurement in the health care industry. The traditional approach has been the straightforward use of measurable units such as financial comparisons and clinical indicators (e.g., length of stay). Also we in the health care industry have traditionally benchmarked our performance and strategies against those most like ourselves. Today's competitive market demands a more customer-focused set of performance measures that go beyond traditional approaches such as customer service. The most important task in today's environment is to study the customers' emerging priorities and adjust our business to meet those priorities.

Ambulatory Care↗
PubMed2026

Proficiency-based training and evidence-based methodology: a systematic review and meta-analysis.

OBJECTIVE: To assess adherence of self-labelled proficiency-based progression (PBP) studies to evidence-based PBP criteria and examine associations with training outcomes. METHODS: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the International Prospective Register of Systematic Reviews. PubMed, CENTRAL, EMBASE, MEDLINE, and Scopus were searched from inception to 1 March 2023. Prospective English-language studies on healthcare procedural training reporting objective performance outcomes were included; non-prospective, non-quantitative, non-procedural, non-English studies, and reviews were excluded. Pre-specified outcomes included adherence to 18 evidence-based PBP criteria and objective performance metrics (errors, steps, time); secondary outcomes included proficiency benchmark achievement and Likert ratings. Data extraction was performed independently by multiple reviewers. Study quality was assessed using the Medical Education Research Study Quality Instrument and risk of bias by two investigators. Effect sizes were pooled using random-effects models (DerSimonian-Laird), expressed as the ratio of means (ROM) for continuous outcomes and bias-corrected odds ratios for dichotomous outcomes. RESULTS: Of 646 studies identified 175 met inclusion criteria. In the PBP studies (n&#x2009;=&#x2009;18), 94% fulfilled minimum criteria (use of a proficiency benchmark, its quantitative definition, and requirement for demonstration prior to progression) vs 36% of non-PBP studies (n&#x2009;=&#x2009;157). If all PBP criteria were included, 83% of PBP studies used these criteria vs only 2% of non-PBP-studies. In quantitative analysis (27 randomised clinical studies, 761 participants), ROM results showed that PBP training reduced the number of performance errors by 58% (P&#x2009;<&#x2009;0.001) and procedural time by 28% (P&#x2009;=&#x2009;0.006), increasing number of steps performed by 22% (P&#x2009;=&#x2009;0.03). When stratified based on number of criteria fulfilled, meta-regression demonstrated that increasing the number of PBP criteria fulfilled was associated with progressive and systematic trainee performance improvement. CONCLUSIONS: The more training methodologies adhere to established PBP criteria, the better training outcome will be.

Humans↗