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PubMed2002

What can Johnson & Johnson do to remain a giant in the health care industry?

As a major Fortune 500 corporation and manufacturer of significant drug products for the pharmaceutical industry, Johnson & Johnson has also had its share of marketing crisis, including the classic case example of The Tylenol Scare in Fall, 1982, so they can appreciate the need for effective marketing performance and customer responsiveness. This article will examine how Johnson & Johnson has adapted to a highly volatile business environment and how they can be benchmarked for highly competitive marketing strategies and practices.

Consumer Behavior↗
PubMed2003

Evaluating behavioral health services in Minnesota's Medicaid population using the Experience of Care and Health Outcomes (ECHO) Survey.

Performance data on Medicaid managed behavioral health care are for the most part unavailable. The purpose of the current study is to provide a benchmark of Medicaid enrollees' evaluations of access to, and quality of, behavioral health services and to examine the factors that influence these ratings. Eight hundred eighty-five Minnesota Medicaid managed care enrollees who received behavioral health services in 2000 completed the Experience of Care and Health Outcomes Survey, a multidimensional satisfaction survey that included measures of access to services, communication with clinicians, functional improvement, and the effect of treatment. Between 29 and 59 percent of the respondents gave the highest possible ratings to the behavioral health services they received. Access to services and functional improvements were rated less favorably than communication with clinicians and the effects of treatment. Ratings within certain domains varied by age, race, education, and region.

Adult↗
PubMed1993

Self-organizing neural networks as a means of cluster analysis in clinical chemistry.

Connectionist systems (often termed "neural networks") are an alternative way to solve data processing tasks. They differ radically from conventional "von-Neumann" computing devices. Recent work on neural networks in clinical chemistry was done using supervised learning schemes, resulting in models which resemble classical discriminant analysis. The aim of the present study is to make clinical chemists familiar with basic concepts of self-organizing neural networks employing unsupervised learning schemes. Using a benchmark data set on the composition of milk from 22 different mammals, it is demonstrated that self-organizing neural networks are capable of performing tasks similar to classical cluster analysis and principal component analysis. Self-organizing neural networks could be envisaged to provide an alternative way for reducing the dimensionality of complex multivariate data sets, thus producing easily comprehensible low-dimensional "maps" of essential features.

Animals↗
PubMedDate not supplied

Performance comparison of structural stormwater best management practices.

This paper describes a method for comparing the pollutant removal of a number of structural stormwater treatment devices, commonly referred to as best management practices (BMPs). Historically, the pollutant removal ability of a BMP has been expressed as a percent reduction in concentration or load. Unfortunately, the calculated percent reduction in pollutant concentration is strongly affected by the influent concentration, with the calculated reduction generally being much lower when the event mean concentrations (EMCs) in the untreated runoff from the test watershed are low. The objective of the proposed methodology is to eliminate this problem by predicting BMP performance for an arbitrary influent concentration, so that BMPs evaluated in different watersheds can be compared as if the influent quality at all sites were the same. This method allows BMPs to be compared based on the quality of effluent produced and the mass reduction. The proposed method uses linear regression as the primary tool to compute the expected effluent concentration from a BMP, given a specific influent concentration of interest and was developed using data collected in the California Department of Transportation BMP Retrofit Pilot Program. This technique reveals that for media filters, the concentration of sediment and other particle-associated pollutants in treated runoff is generally unrelated to influent quality and is relatively constant. Wet basins with large permanent pool volumes also have effluent concentrations that are constant for most constituents and unrelated to influent concentrations. In these situations, the "percent reduction" in a pollutant EMC is not an inherent characteristic of the BMP, but a function of the influent EMC, because the quality of effluent produced is constant. Predicting the effluent quality of several types of conventional BMPs based on a common influent concentration allows an objective comparison of their performance and the selection of a BMP that addresses specific constituents of concern.

Benchmarking↗
PubMed2005

The investigation and analysis of critical incidents and adverse events in healthcare.

OBJECTIVES: To carry out a review of published and unpublished work on the analysis on methods of accident investigation in high-risk industries, and of critical incidents in healthcare. To develop and pilot guidelines for the analysis of critical incidents in healthcare for the hospital sector, mental health and primary care. DATA SOURCES: Literature already available in the Clinical Risk Unit, University College London. Work by known experts in the field of accident investigation and analysis. Electronic databases including PsycINFO and MEDLINE. Websites for accident investigation reports. REVIEW METHODS: Twelve techniques from other high-risk industries were reviewed in detail using criteria developed for the purpose. This review provided a conceptual framework for the healthcare review and appraisal process, as well as providing a critical assessment of the industry techniques. Rigorous searching and screening identified 138 papers for formal appraisal and a further 114 were designated as providing potentially useful background information. A formal appraisal instrument was designed, piloted and modified until acceptable reliability was achieved. From the 138 papers, six techniques were identified as representing clearly definable approaches to incident investigation and analysis. All relevant papers were reviewed for each of the six techniques: Australian Incident Monitoring System, the Critical Incident Technique, Significant Event Auditing, Root Cause Analysis, Organisational Accident Causation Model and Comparison with Standards approach. RESULTS: All healthcare techniques had the potential of being applied in any specialty or discipline related to healthcare. While a few studies looked solely at death as an outcome, most used a variety of outcomes including near misses. Most techniques used interviewing and primary document review to investigate incidents. All techniques included papers that identified clinical issues and some attempt to assess underlying errors, causes and contributory factors. However the extent and sophistication of the various attempts varied widely. Only a third of papers referred to an established model of accident causation. In most studies examined there was little or no information on the training of investigators, how the data was extracted or any information on quality assurance for data collection and analysis. There was some variation in the level of expertise and training required but to undertake the investigation to an acceptable depth all required some expertise. In most papers there was little or no discussion of implementation of any changes as a result of the investigations. A quarter of publications gave some description of the implementation of changes, though few addressed evaluation of changes. CONCLUSIONS: The reviews demonstrate that, while much valuable work has been accomplished, there is considerable potential for further development of techniques, the utilisation of a wider range of techniques and a need for validation and evaluation of existing methods which would make incident investigation more versatile and use limited resources more effectively. Further exploration of techniques used in high-risk industries, with interviews and observation of actual investigations should prove valuable. Existing healthcare techniques would benefit from formal evaluation of their outcomes and effectiveness. Studies should examine depth of investigation and analysis, adequacy and feasibility of recommendations and cost effectiveness. Examining implementation of recommendations is a key issue.

Benchmarking↗
PubMed2003

How to assess prognostic models for survival data: a case study in oncology.

OBJECTIVES: A lack of generally applicable tools for the assessment of predictions for survival data has to be recognized. Prediction error curves based on the Brier score that have been suggested as a sensible approach are illustrated by means of a case study. METHODS: The concept of predictions made in terms of conditional survival probabilities given the patient's covariates is introduced. Such predictions are derived from various statistical models for survival data including artificial neural networks. The idea of how the prediction error of a prognostic classification scheme can be followed over time is illustrated with the data of two studies on the prognosis of node positive breast cancer patients, one of them serving as an independent test data set. RESULTS AND CONCLUSIONS: The Brier score as a function of time is shown to be a valuable tool for assessing the predictive performance of prognostic classification schemes for survival data incorporating censored observations. Comparison with the prediction based on the pooled Kaplan Meier estimator yields a benchmark value for any classification scheme incorporating patient's covariate measurements. The problem of an overoptimistic assessment of prediction error caused by data-driven modelling as it is, for example, done with artificial neural nets can be circumvented by an assessment in an independent test data set.

Breast Neoplasms↗
PubMed2003

Periphyton collectors as a tool to measure environmental performance of ocean outlets.

Brown and Root has participated in extensive investigations of the effects of the discharges from Perth's Ocean Outlets, as part of the Perth Long-Term Ocean Outlet Monitoring (PLOOM) Programme (1995 to 2001). The major environmental concern with these discharges is the potential for nutrients in the wastewater to stimulate excess primary production in the sea. PLOOM, and its predecessor, the Perth Coastal Waters Study, have been instrumental in developing parameters for the measurement of the performance of Perth's ocean outlets. These parameters are currently being integrated in the development of Environmental Quality Criteria (EQC) for the Perth region. EQC play an important role in the management framework by providing the quantitative benchmarks for measuring success in achieving the environmental quality objectives. PLOOM has monitored a range of environmental parameters in the Perth Metropolitan area, including water quality, nutrient levels, water circulation and plume dilution, levels of metals and pesticides present in the marine environment, and the environmental health of benthic communities, in particular of temperate reef systems. During the PLOOM studies, a valuable tool was being developed to monitor outlet performance. Artificial reef structures ("periphyton collectors") were placed in the plume trajectory. Here, periphyton is defined as: the microalgae (diatoms and microscopic filamentous forms), algal propagules, bacteria, microfauna and particulate material that are found in a mucous-like layer commonly coating seagrass leaves, and that initially colonise artificial surfaces. The advantage of periphyton collectors is that these largely remove the effects of natural variability, can be placed at any depth and distance from a potential nutrient source, provide an easy, cost effective measure of environmental impact, integrated over an extended period (one month), and produce tangible results which can be interpreted by the wider community, as well as legislative authorities and by outlet managers. In addition, outlet performance can be measured by means of these tools, and tested against accepted environmental criteria. Between 1995-2001, periphyton collectors, consisting of 15 x 15 cm PVC plates attached to moorings at fixed depths (2, 4 and 8 m), were deployed for one month during spring, summer and autumn, at increasing distance from the source (250 and 500 m distance to the north, east, west, and south, and at 1,000, 2,000, 4,000 m to the north and south only). After retrieval, the collectors were analysed for total biomass (g AFDW m(-2)), calcium carbonate content (% AFDW) and chlorophyll levels (chlorophyll a m(-2)). The results confirmed the predictions made by hydrodynamic modelling (e.g. Zic and Gondinoudis, 2002) and are in accordance with measured nutrient and chlorophyll a levels around the outlets, and demonstrated that the zone of influence was strongly determined by the prevailing currents (to the north), and largely restricted to surface layers (2-4 m depth). Both biomass and chlorophyll content proved reliable parameters, which have the potential to be used as Environmental Quality Criteria (EQC's) for the management of Perth's coastal waters. These EQC's were developed in collaboration with legislative authorities, as part of draft criteria, in accordance with national guidelines: ANZECC/ARMCANZ (2000) Australian and New Zealand Guidelines for Fresh and Marine Water Quality.

Biomarkers↗
PubMed1994

A survey-based benchmarking approach for health care using the Baldrige quality criteria.

BACKGROUND: Since 1988, manufacturing and service industries have been using the Malcolm Baldrige National Quality Award to assess their management processes (for example, leadership, information, and analysis) against critical performance criteria. Recognizing that the typical Baldrige assessment is time intensive and dependent on intensive training, The Pacer Group, a consulting firm in Dayton, Ohio, developed a self-assessment tool based on the Baldrige criteria which provides a snapshot assessment of an organization's management practices. STUDY: The survey was administered at 25 hospitals within a health care system. Hospitals were able to compare their scores with other hospitals in the system, as well as the scores of a Baldrige award winner. Results were also analyzed on a systemwide basis to identify strengths and weaknesses across the system. RESULTS: For all 25 hospitals, the following areas were identified as strengths: management of process quality, leadership, and customer focus and satisfaction. Weaknesses included lack of employee involvement in the quality planning process, poor design of quality systems, and lack of cross-departmental cooperation. EXAMPLE: One of the surveyed hospitals launched improvement initiatives in knowledge of improvement tools and methods and in a patient satisfaction focus. A team was formed to improve the human resource management system. Also, a new unit was designed using patient-centered care principles. A team re-evaluated every operation that affected patients on the unit. CONCLUSION: A survey modeled after the Baldrige Award criteria can be useful in benchmarking an organization's quality improvement practices.

Attitude of Health Personnel↗
PubMed2003

Frequency of seborrheic keratosis biopsies in the United States: a benchmark of skin lesion care quality and cost effectiveness.

BACKGROUND: Most seborrheic keratoses may be readily clinically differentiated from skin cancer, but occasional lesions resemble atypical melanocytic neoplasms. OBJECTIVE: To evaluate the frequency, cost, and intensity of procedures performed that result in the removal and histopathologic evaluation of seborrheic keratoses. METHODS: Episodes of surgical removal of lesions that were identified as seborrheic keratoses by histologic identification were determined using Medicare Current Beneficiary Survey data from 1998 to 1999. These episodes were defined by a histopathology procedure code that is associated with a diagnosis code for seborrheic keratosis. We then identified what procedure(s) generated the histopathology specimen. Biopsy and shave procedures were considered "low intensity," whereas excision and repair procedures were considered "high intensity." RESULTS: Dermatologists managed 85% of all episodes of seborrheic keratoses. Dermatologists managed 89% of seborrheic keratosis episodes using low-intensity procedures compared with 51% by other specialties. For nondermatologists, 46% of the treatment cost (9 million US dollars) to Medicare was generated from high-intensity management compared with 15% by dermatologists (6 million US dollars). CONCLUSION: There is a significant difference in the management of suspicious pigmented lesions between dermatologists and other specialists. This affects both the cost and quality of care.

Benchmarking↗
PubMed2006

Kernel methods for melanoma recognition.

Skin cancer is a spreading disease in the western world. Early detection and treatment are crucial for improving the patient survival rate. In this paper we present two algorithms for computer assisted diagnosis of melanomas. The first is the support vector machines algorithm, a state-of-the-art large margin classifier, which has shown remarkable performances on object recognition and categorization problems. The second method, spin glass-Markov random fields, combines results of statistical physics of spin glasses with Markov random fields. We compared the two approaches using color histograms as features. We benchmarked our methods with another algorithm presented in the literature, which uses a sophisticated segmentation technique and a set of features especially designed for melanoma recognition. To our knowledge, this algorithm represents the state of the art on skin lesions classification. We show with extensive experiments that the support vector machines approach outperforms the existing method and, on two classes out of three, it achieves performances comparable to those obtained by expert clinicians.

Algorithms↗
PubMed2026

Exploring differences across pangenome-graph representations using Escherichia coli O157:H7 as a model.

Pangenome graphs are increasingly used to represent population-scale bacterial diversity, yet construction methods span fundamentally different representation paradigms whose outputs and sensitivities to assembly quality remain poorly quantified. We systematically reviewed microbial pangenome graph tools and benchmarked seven representative methods spanning gene-cluster, compacted coloured de Bruijn graph, one hybrid approach and one multiple sequence alignment method. Using a repeat-rich Escherichia coli O157:H7 dataset with complete genomes and matched short-read data, we constructed graphs from identical inputs and observed orders-of-magnitude differences in graph size and fragmentation, indicating that global topology is driven by representation strategy. Varying completeness composition revealed that assembly fragmentation is a first-order determinant of graph structure: gene-cluster graphs contracted as draft assemblies replaced complete genomes, whereas compacted coloured de Bruijn graphs expanded, with distinct degree-prevalence fingerprints across tools. In contrast, the multiple sequence alignment method could not be evaluated across fragmented inputs because it did not run reliably on draft-assembly datasets. Computational cost mirrored these shifts and depended strongly on completeness composition, including a pronounced runtime penalty for one compacted coloured de Bruijn graph implementation on all-draft inputs. Finally, analysis of Shiga toxin loci showed that pangenome-level reconciliation by gene-cluster-based tools does not reliably correct assembly artefacts at challenging multi-copy genes and that performance varies by locus. Together, these findings show that pangenome graphs are representation-dependent models of bacterial diversity, and that, in this repeat-rich O157:H7 benchmark dataset, assembly completeness is a primary determinant of their topology, scalability, and locus-level accuracy.

Escherichia coli O157↗
PubMed1998

Post-discharge surveillance and infection rates in obstetric patients.

OBJECTIVE: To study the impact of post-discharge surveillance on the detection of nosocomial surgical site infection (SSI) after cesarean section and vaginal delivery. METHODS: During a 21-month period, all patients attending the obstetrics service in labor were recruited for a observational study on the incidence of SSI. Examinations to detect SSI were performed daily during the hospitalization period and up to 30 days after hospital discharge in an outpatient clinic supervised by the Infection Control Committee. The stratification of risk-factors and the criteria for the diagnosis of SSI were done in accordance with the methods described by the Centers for Disease Control and Prevention. The rates of surgical site infection detected during the hospitalization period were compared with those reported by the Centers for Disease Control and Prevention's National (United States) Nosocomial Infection Surveillance System (CDCNNIS) 'benchmarks'. The incidence of SSI detected by post-discharge outpatient surveillance was compared with that from in-hospital surveillance, for both cesarean section and vaginal delivery. RESULTS: A total of 4463 deliveries were performed during the study period, 2431 (54.5%) by the vaginal route and 2032 (45.5%) by cesarean section. In-hospital surveillance was done on all patients. Post-discharge examinations were done on 951 (46.8%) of the 2032 cesarean section patients. The incidence of SSI in cesarean section detected by in-hospital surveillance was 1.6% (32 cases) and lower than the 3.6% mean rate reported by the CDCNNIS. When SSIs detected by post-discharge surveillance were included, the total number of SSI was 196 cases (9.6%), a value much higher than that for the SSI detected by in-hospital surveillance alone. Only 5 cases (0.21%) of SSI were detected among the 2431 vaginal deliveries. CONCLUSIONS: The results of our study demonstrate that most of SSI following cesarean section were detected only after patient's discharge from the hospital and seems to indicate that failing to do follow-up evaluation of these patients could result in a substantial mis-calculation of the authentic SSIs rates. Therefore data on post-discharge surveillance should be included to realistically estimate the true rates of SSI in obstetric patients and to allow the implementation of measures to reduce post-partum infection.

Brazil↗
PubMed2000

Health-related quality of life after different types of solid organ transplantation.

OBJECTIVE: To describe functional health and health-related quality of life (QOL) before and after transplantation; to compare and contrast outcomes among liver, heart, lung, and kidney transplant patients, and compare these outcomes with selected norms; and to explore whether physiologic performance, demographics, and other clinical variables are predictors of posttransplantation overall subjective QOL. SUMMARY BACKGROUND DATA: There is increasing demand for outcomes analysis, including health-related QOL, after medical and surgical interventions. Because of the high cost, interest in transplantation outcomes is particularly intense. With technical surgical experience and improved immunosuppression, survival after solid organ transplantation has matured to acceptable levels. More sensitive measures of outcomes are necessary to evaluate further developments in clinical transplantation, including data on objective functional outcome and subjective QOL. METHODS: The Karnofsky Performance Status was assessed objectively for patients before transplantation and up to 4 years after transplantation, and scores were compared by repeated measures analysis of variance. Subjective evaluation of QOL over time was obtained using the Short Form-36 (SF-36) and the Psychosocial Adjustment to Illness Scale (PAIS). These data were analyzed using multivariate and univariate analysis of variance. A summary model of health-related QOL was tested by path analysis. RESULTS: Tools were administered to 100 liver, 94 heart, 112 kidney, and 65 lung transplant patients. Mean age at transplantation was 48 years; 36% of recipients were female. The Karnofsky Performance Status before transplantation was 37 +/- 1 for lung, 38 +/- 2 for heart, 53 +/- 3 for liver, and 75 +/- 1 for kidney recipients. After transplantation, the scores improved to 67 +/- 1 at 3 months, 77 +/- 1 at 6 months, 82 +/- 1 at 12 months, 86 +/- 1 at 24 months, 84 +/- 2 at 36 months, and 83 +/- 3 at 48 months. When patients were stratified by initial performance score as disabled or able, both groups merged in terms of performance by 6 months after liver and heart transplantation; kidney transplant patients maintained their stratification 2 years after transplantation. The SF-36 physical and mental component scales improved after transplantation. The PAIS score improved globally. Path analysis demonstrated a direct effect on the posttransplant Karnofsky score by time after transplantation and diabetes, with trends evident for education and preoperative serum creatinine level. Although neither time after transplantation nor diabetes was directly predictive of a composite QOL score that incorporated all 15 subjective domains, recent Karnofsky score and education level were directly predictive of the QOL composite score. CONCLUSIONS: Different types of transplant patients have a different health-related QOL before transplantation. Performance improved after transplantation for all four types of transplants, but the trajectories were not the same. Subjective QOL measured by the SF-36 and the PAIS also improved after transplantation. Path analysis shows the important predictors of health-related QOL. These data provide clearly defined and widely useful QOL outcome benchmarks for different types of solid organ transplants.

Critical Pathways↗
PubMed1993

Artificially generated data sets for testing DNA sequence assembly algorithms.

We have developed a set of tools, genfrag, to fragment and optionally mutate a DNA sequence to generate benchmark data sets for testing DNA sequence assembly algorithms. Data parameters can be systematically and independently varied to explore the range of data--and corresponding performance of assembly tools--encountered on large-scale random, or "shot-gun," sequencing projects.

Algorithms↗
PubMed2006

Comparison between nuclear chromatin patterns of digitalized images of cells of the mammalian testicular and renal tissues: an imaging segmentation study.

Testicular and renal tissue, obtained from adult cattle, pigs, rats, and human was processed by image digital segmentation and pixel texture analytical techniques for comparative evaluation of nuclear chromatin pattern of testicular primary spermatocytes and renal glomerular endothelial cells. The post mortem performed for the animals and the human subject were for reasons not related with either testicular or renal conditions. The objective was to establish a benchmark for identification of rapidly multiplying cells in images of sections of normal, as well as abnormal mammalian tissue. Based on the observed morphological and texture pattern of the nuclear chromatin of the testicular primary spermatocytes, it was determined that the renal glomerular endothelial cells exhibit similar nuclear chromatin morphology consistent with an ongoing rapid multiplication process. The nuclear chromatin of both cell types manifest identical mitotic figures which are strongly indicative of cellular proliferation.

Animals↗
PubMed2006

Determination of joint efforts in the human body during maximum ramp pushing efforts.

Determining with accuracy, the internal efforts in the human body is a great challenge in Biomechanics, particularly in Physical Therapy and Ergonomics. In this context, the present study develops a human body model that permits a non-invasive determination of the joint efforts produced by a seated subject performing maximum ramp pushing efforts. The joint interactions during these experiments are provided by a dynamic inverse model of the human body, using a symbolically generated recursive Newton-Euler formalism. The theoretical investigation is presented in two steps, with increasing complexity and relevance:The dynamic model confirms some previous studies of the effects of biomechanical factors on the performance of the task and is proposed as an accurate method for determining the joint efforts in dynamic contexts. Finally, this application is a preliminary benchmark case that will be extended to: *physical therapy, in order to analyse the joint and muscle efforts in various motion contexts, particularly for patients with fibromyalgia and patients with lumbar diseases; *accidentology, in order to analyse and simulate car occupant dynamics before a crash.

Biomechanical Phenomena↗