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PubMed2006

An experimental study on pedestrian classification.

Detecting people in images is key for several important application domains in computer vision. This paper presents an in-depth experimental study on pedestrian classification; multiple feature-classifier combinations are examined with respect to their ROC performance and efficiency. We investigate global versus local and adaptive versus nonadaptive features, as exemplified by PCA coefficients, Haar wavelets, and local receptive fields (LRFs). In terms of classifiers, we consider the popular Support Vector Machines (SVMs), feed-forward neural networks, and k-nearest neighbor classifier. Experiments are performed on a large data set consisting of 4,000 pedestrian and more than 25,000 nonpedestrian (labeled) images captured in outdoor urban environments. Statistically meaningful results are obtained by analyzing performance variances caused by varying training and test sets. Furthermore, we investigate how classification performance and training sample size are correlated. Sample size is adjusted by increasing the number of manually labeled training data or by employing automatic bootstrapping or cascade techniques. Our experiments show that the novel combination of SVMs with LRF features performs best. A boosted cascade of Haar wavelets can, however, reach quite competitive results, at a fraction of computational cost. The data set used in this paper is made public, establishing a benchmark for this important problem.

Algorithms↗
PubMed2001

Organisational strategies for changing clinical practice: how trusts are meeting the challenges of clinical governance.

OBJECTIVES: To describe the use, perceived effectiveness, and predicted future use of organisational strategies for influencing clinicians' behaviour in the approach of NHS trusts to clinical governance, and to ascertain the perceived benefits of clinical governance and the barriers to change. DESIGN AND SETTING: Whole population postal survey conducted between March and June 1999. SUBJECTS: Clinical governance leads of 86 NHS trusts across the South West and West Midlands regions. METHOD: A combination of open questions to assess the use of strategies to influence clinician behaviour and the barriers to clinical governance. Closed (yes/no) and Likert type ratings were used to assess the use, perceived effectiveness, and future use of 13 strategies and the predicted outcomes of clinical governance. RESULTS: All trusts use one or more of 13 strategies categorised as educational, facilitative, performance management, and organisational change methods. Most popular were educational programmes (96%) and protocols and guidelines (97%). The least popular was performance management such as use of financial incentives (29%). Examples of successful existing practice to date showed a preference for initiatives that described the use of protocols and guidelines, and use of benchmarking data. Strategies most frequently rated as effective were facilitative methods such as the facilitation of best practice in clinical teams (79%), the use of pilot projects (73%), and protocols and guidelines (52%). The least often cited as effective were educational programmes (42%) and training clinicians in information management (20%); 8% found none of the 13 strategies to be effective. Predicted future use showed that all the trusts which completed this section intended to use at least one of the 13 strategies. The most popular strategies were educational and facilitative. Scatterplots show that there is a consistent relationship between use and planned future use. This was less apparent for the relationship between planned use and perceived effectiveness. Barriers to change included lack of resources, mainly of money and staff time, and the need to address cultural issues, plus infrastructure support. The anticipated outcomes of clinical governance show that most trusts expect to influence clinician behaviour by improving patient outcomes (78%), but only 53% expect it to result in better use of resources, improved patient satisfaction (36%), and reduced complaints (10%). CONCLUSIONS: Clinical governance leads of trusts report using a range of strategies for influencing clinician behaviour and plan to use a similar range in the future. The choice of methods seems to be related to past experience of local use, despite equivocal judgements of their perceived effectiveness in the trusts. Most expect to achieve a positive impact on patient outcomes as a result. It is concluded that trusts should establish methods of learning what strategies are effective from their own data and from external comparison.

Benchmarking↗
PubMed2000

How universal are fold recognition parameters. A comprehensive study of alignment and scoring function parameters influence on recognition of distant folds.

A choice of sequence-structure similarity scoring function parameters can significantly alter results of the performance of the recognition of distantly related folds. It therefore constitutes a critical part of fold recognition process. In order to increase an understanding of the influence of parameter choice, a comprehensive benchmark of very hard (SFOLD) and medium hard (SFAM) fold recognition examples has been derived from the SCOP database of protein structure families. These benchmarks have subsequently been used to optimize, validate and analyze dependence of recognition sensitivity on alignment and fold similarity score parameters for different scoring functions. Significant variation of the common parameters has been observed for different functions, leading to the conclusion that optimal parameter sets are not universal. The scope of solutions common to any pair of scoring function is relatively small, hence, using jury method for fold prediction seems not appropriate. Also, using a redundant version of fold libraries significantly increases odds of identification of distantly related fold.

Algorithms↗
PubMed2001

Setting the benchmark for research in the management of acute pain in emergency departments.

OBJECTIVE: The aim of this study was to define the degree of change on a visual analogue scale that corresponded to a clinically meaningful reduction in the level of pain reported by patients experiencing acute pain. METHOD: Secondary analysis of data was performed from prospective, descriptive studies of 152 adults and 73 children presenting to emergency departments with acute pain. At presentation and at 20 min intervals to a maximum of three measurements, patients marked the level of their pain on a 100 mm, non-hatched visual analogue scale. At each follow up, they also gave a verbal rating of their pain as 'a lot better', 'a little better', 'much the same', 'a little worse' or 'much worse'. Data from the groups reporting that pain was 'a lot better' and 'about the same' were analysed for mean and median absolute change in visual analogue scale and compared. RESULTS: Of 559 pain comparisons, 60 were rated as 'a lot better' and 257 as 'about the same'. The mean absolute change in visual analogue scale for the group reporting that pain was 'a lot better' was 24 mm (median = 19 mm, 95% confidence interval = 17-31 mm). For the group reporting that pain was 'about the same', the mean visual analogue scale change was 0 mm (median = 0 mm, 95% confidence interval = -1 to 1 mm). CONCLUSION: When evaluating treatments for acute pain, a difference in visual analogue scale pain score of less than about 20 mm is unlikely to be clinically meaningful. Studies should be designed and reported relative to this benchmark rather than the minimum clinically significant difference in visual analogue scale pain score.

Acute Disease↗
PubMed2004

Information-dependent acquisition-mediated LC-MS/MS screening procedure with semiquantitative potential.

The development of a LC-MS/MS general unknown screening procedure for toxicologically relevant substances in blood samples by means of information-dependent acquisition on a Q-TOF is reported. IDA is an artificial intelligence-based product ion scan mode providing automatic "on-the-fly" MS to MS/MS switching. By performing information-dependent scanning at two different fragmentation energies, two collision-induced dissociation product ion spectra for each of the detected compounds are generated. As such, information-rich MS/MS spectra are obtained from precursor ions not known beforehand. In addition, limitation of the MS/MS acquisition time to an acceptable minimum resulted in an almost instantaneous switch back to the MS mode. As such, this approach provided MS chromatograms that still could be of use for semiquantitative purposes. Since the switching intensity threshold, unequivocally related to the background noise, proved a critical parameter, the solid-phase extraction procedure, the liquid chromatographic conditions, and the mass spectrometric parameters all were optimized to the advantage of information-dependent acquisition. Finally, the screening procedure we developed was benchmarked, on one hand, qualitatively against the results obtained from traditional GUS approaches in a number of routine toxicological laboratories (20 samples) and, on the other hand, quantitatively with respect to its potential against established LC-MS/MS methods (7 samples). The procedure performed very well from a qualitative point of view; almost all of the drugs detected by the conventional techniques were identified, as well as additional drugs that were not previously reported. The procedure proved well-suited for an initial semiquantitative assessment, as is customary in, for example, forensic toxicology before accurate intoxication levels are determined using targeted analytical analyses.

Chromatography, Liquid↗
PubMed2005

Bridging the gap: using triangulation methodology to estimate minimal clinically important differences (MCIDs).

This paper proposes the use of triangulation methodology to derive guidelines for interpreting change scores on health outcome measures. Triangulation integrates results from global ratings with clinical benchmarks of change, statistical estimates of magnitude, and qualitative data from patients and/or clinicians to derive guidelines that are not field-specific or method bound. A case study is presented to illustrate how this methodology can be applied. Secondary analyses were performed on blinded data from 2,971 patients enrolled in three phase IlIa clinical trials to develop guidelines for interpreting change scores on the Breathlessness Diary (BD), a relatively new approach for evaluating dyspnea outcomes in patients with chronic obstructive pulmonary disease. BD scores were examined by disease severity and rescue medication use. In addition, mean BD change scores by physician global ratings of efficacy were juxtaposed with changes in forced expiratory volume (FEV1) and St. George's Respiratory Questionnaire scores. Percent change, effect size, one-half standard deviation, and the standard error of measurement were used as statistical indicators of magnitude. Data from qualitative interviews provided insight into patient perspectives of change in dyspnea. Taking into consideration results across estimation methods, guidelines were developed for defining large, moderate, and small group-level mean changes on the BD. Areas of divergence and convergence across statistical indicators and clinical benchmarks in this case study highlight the importance of using triangulation methodology to derive guidelines that are both empirically sound and clinically relevant.

Adult↗
PubMed2006

Treating the right patient at the right time: Access to cardiac catheterization, percutaneous coronary intervention and cardiac surgery.

The Canadian Cardiovascular Society Access to Care Working Group was formed with a mandate to use the best science and information available to establish reasonable triage categories and safe wait times for common cardiovascular services and procedures through a series of commentaries. The present commentary discusses the rationale for access benchmarks for cardiac catheterization and revascularization procedures for patients with stable angina, and access benchmarks for cardiac catheterization and surgery for patients with valvular heart disease. Literature on standards of care, wait times and wait list management was reviewed. A survey of cardiac centres in Canada was performed to develop an inventory of current practices in identifying and triaging patients. The Working Group recommends the following medically acceptable wait times for access to cardiac catheterization: 14 days for symptomatic aortic stenosis and six weeks for patients with stable angina and other valvular disease. For percutaneous coronary intervention in stable patients with high-risk anatomy, immediate revascularization or a wait time of 14 days is recommended; six weeks is recommended for all other patients. The target for bypass surgery in those with high-risk anatomy or valve surgery in patients with symptomatic aortic stenosis is 14 days; for all others, the target is six weeks. All stakeholders must affirm the appropriateness of these standards and work continuously to achieve them. There is an ongoing need to continually reassess current risk stratification methods to limit adverse events in patients on waiting lists and assist clinicians in triaging patients for invasive therapies.

Angioplasty, Balloon, Coronary↗
PubMed2001

'What do our patients really want from us?': Investigating patients perceptions of the validity of the Chartermark criteria.

BACKGROUND: The 'restructuring' of the NHS over the last decade has demanded a 'market oriented' service more receptive to the needs and priorities of 'clients'receiving health care. These changes have been important to the provision of dental health care in which there has been a similar need to provide increasingly patient and market oriented services. One of the ways in which quality care has been assessed within NHS Trusts is through the national 'Chartermark' award, which identifies national centres of excellence in health care and research. AIM: The aim of this paper is to assess whether patients themselves considered the criteria identified by the Chartermark award important in the provision of good quality dental services METHOD: This is a pilot study consisting of a structured questionnaire conducted face-to-face with a 'convenience' sample of 46 patients. ANALYSIS: Data were inputted into SPSS and thematic analysis was conducted on the data. RESULTS: The Chartermark criteria relevant to patient involvement were divided into four main themes.The findings from this small pilot study suggest that in relation to dental care, although patients are interested in information on standards, performance and complaints, there is considerable disinterest in organisational and financial dimensions.

Awards and Prizes↗
PubMed1996

The measurement of quality of care in the Veterans Health Administration.

The Veterans Health Administration (VHA) is committed to continual refinement of its system of quality measurement. The VHA organizational structure for quality measurement has three levels. At the national level, the Associate Chief Medical Director for Quality Management provides leadership, sets policy, furnishes measurement tools, develops and distributes measures of quality, and delivers educational programs. At the intermediate level, VHA has four regional offices with staff responsible for reviewing risk management data, investigating quality problems, and ensuring compliance with accreditation requirements. At the hospital level, staff reporting directly to the chief of staff or the hospital director are responsible for implementing VHA quality management policy. The Veterans Health Administration's philosophy of quality measurement recognizes the agency's moral imperative to provide America's veterans with care that meets accepted standards. Because the repair of faulty systems is more efficient than the identification of poor performers, VHA has integrated the techniques of total quality into a multifaceted improvement program that also includes the accreditation program and traditional quality assurance activities. VHA monitors its performance by maintaining adverse incident databases, conducting patient satisfaction surveys, contracting for external peer review of 50,000 records per year, and comparing process and outcome rates internally and when possible with external benchmarks. The near-term objectives of VHA include providing medical centers with a quality matrix that will permit local development of quality indicators, construction of a report card for VHA's customers, and implementing the Malcolm W. Baldrige system for quality improvement as the road map for systemwide continuous improvement. Other goals include providing greater access to data, creating a patient-centered database, providing real-time clinical decision support, and expanding the databases.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Reaping benefits from intellectual capital.

The wealth and value of organizations are increasingly based on intellectual capital. Although acquiring talented individuals and investing in employee learning adds value to the organization, reaping the benefits of intellectual capital involves translating the wisdom of employees into reusable and sustained actions. This requires a culture that creates employee commitment, encourages learning, fosters sharing, and involves employees in decision making. An infrastructure to recognize and embed promising and best practices through social networks, evidence-based practice, customization of innovations, and use of information technology results in increased productivity, stronger financial performance, better patient outcomes, and greater employee and customer satisfaction.

Attitude of Health Personnel↗
PubMed2001

A proposed max-product threshold unit for classification of pattern vectors.

This paper proposes a max-product threshold unit (maptu) that can successfully perform dichotomous classifications of pattern vectors. Maptu, with weight vector, w, classifies a pattern vector, x, by comparing x max-prod w to 0.5. Results obtained by other methods in classification of benchmark data are used for comparison to the method using maptu. The benchmark data consists of the Australian credit data set, cervical cell data set, diabetes data set and the iris data set.

Databases, Factual↗
PubMed2005

DIALIGN-T: an improved algorithm for segment-based multiple sequence alignment.

BACKGROUND: We present a complete re-implementation of the segment-based approach to multiple protein alignment that contains a number of improvements compared to the previous version 2.2 of DIALIGN. This previous version is superior to Needleman-Wunsch-based multi-alignment programs on locally related sequence sets. However, it is often outperformed by these methods on data sets with global but weak similarity at the primary-sequence level. RESULTS: In the present paper, we discuss strengths and weaknesses of DIALIGN in view of the underlying objective function. Based on these results, we propose several heuristics to improve the segment-based alignment approach. For pairwise alignment, we implemented a fragment-chaining algorithm that favours chains of low-scoring local alignments over isolated high-scoring fragments. For multiple alignment, we use an improved greedy procedure that is less sensitive to spurious local sequence similarities. To evaluate our method on globally related protein families, we used the well-known database BAliBASE. For benchmarking tests on locally related sequences, we created a new reference database called IRMBASE which consists of simulated conserved motifs implanted into non-related random sequences. CONCLUSION: On BAliBASE, our new program performs significantly better than the previous version of DIALIGN and is comparable to the standard global aligner CLUSTAL W, though it is outperformed by some newly developed programs that focus on global alignment. On the locally related test sets in IRMBASE, our method outperforms all other programs that we evaluated.

Algorithms↗
PubMed1999

What does a 'top 50' hospital look like?

A new guide rating U.S. hospitals, developed by The Center for HealthCare Industry Performance Studies (CHIPS), debunks some myths and offers some surprises. One surprise is the outstanding performance by a public hospital in Denver. Ed Egger analyzes the factors in the success of Denver Health Medical Center.

Benchmarking↗
PubMed1999

ADS (adult day services) centers test a new data set to improve care.

The adult day services (ADS) center is an approach to the treatment of adults whose ability to live independently is threatened or impaired. In practice, it can be referred to by many names, including adult day support centers, adult day health care, medical day care, day treatment, and Alzheimer's day care programs. As a model of care, the ADS concept has taken on many different "flavors" as far as the mix of services it offers in response to community-level needs, which is not an altogether good thing. An assessment tool that will enable performance measurement and help establish bench-marks for ADS centers is now being field-tested.

Activities of Daily Living↗
PubMed2001

Managed care organizations publicly reporting three years of HEDIS measures.

The author compares the results of MCOs that have publicly reported their Health Plan Employer Data and Information Set (HEDIS) rates for 1997 through 1999 with health plans that did not report publicly. Managed care plans that publicly reported for three consecutive years performed better on preventive health measures than those that did not. Newer measures, such as beta-blocker treatment after a heart attack, showed the greatest improvement over time. Health care plans rated high in consumer experience also had higher clinical performance rates. Finally, plans that sought accreditation by the National Committee for Quality Assurance had better performance on their HEDIS measures, although the differences narrowed for those reporting HEDIS rates for three consecutive years.

Accreditation↗
PubMed2004

Croatian pharmaceutical sector reform project: rational drug use.

The Croatian Pharmaceutical Sector Reform Project was one component of a larger Health Reform Project financed by the World Bank. The Croatian government was concerned that Croatia appeared to spend more money on medicinal drugs than most other countries in the region; that the price of drugs purchased in Croatia was higher than in some other countries, and that the prescribing habits of some Croatian physicians were perceived to be unnecessarily expensive. In addition, the Croatian Institute for Health Insurance (CIHI), which pays for most health care, had come under considerable financial pressure due to increasing health expenditure and a decreasing proportion of the population contributing to insurance. The Australian Health Insurance Commission won the contract for the pharmaceutical reform project. Australian experts were matched with Croatian experts in order to share knowledge, learn from each other, and provide the best advice. The project had two main components. The first addressed supply side issues and provided advice about savings that could be made by incorporating pharmacoeconomic principles into the selection and purchase of drugs on the Croatian positive list. The second component addressed demand side issues and provided advice aimed at evaluating and improving the quality and effectiveness of drug prescribing by Croatian physicians. This paper describes the second project component. We quantitatively and qualitatively evaluated the prescribing practice of Croatian physicians and ascertain how these might be improved. Croatian general practitioners are required to enter an International Classification of Diseases, 10th Revision (ICD10) diagnostic code on their prescription in order to indicate the clinical problem being treated. Quantitative research involved sorting CIHI prescription data for 2002 into ICD10 diagnostic categories and comparing the drugs prescribed for particular conditions with the recommendations in local and international best-practice guidelines. The results showed a number of areas where the prescribing of Croatian general practitioners and specialists could be improved, such as the use of antibiotics in upper respiratory tract infections and the treatment of hypertension. Qualitative research involved a series of workshops with local pharmacological experts and general practitioners during which the collected prescribing data was discussed, local factors which influenced prescribing were explored, and suggestions for improvement were collated. Many general practitioners felt pressured by increasingly assertive consumers, relentless pharmaceutical promotion, and strident government (CIHI) demands to restrain escalating health care costs. In addition, there was a lack of information about what constituted cost-effective treatment appropriate to the Croatian economic situation. There was support for the production of concise Croatian therapeutic guidelines that provided a limited number of best-practice treatment options for common conditions. A pilot set of such guidelines was devised and incorporated into a clinical software trialed in a Primary Health Care Information Technology Project in Koprivnica. This initiative received support from the general practitioners involved. It was recommended that a unit for the quality use of medicines should be set up to sustain the production of therapeutic guidelines and coordinate this activity with related initiatives. In addition, a quality assurance system (including performance indicators linked to financial incentives) was recommended that would encourage general practitioners to practice in accord with guidelines. We understand that the Croatian government has accepted a number of these recommendations and, in particular, performance indicators (and financial incentives) are written into new contracts for Croatian general practitioners in 2004.

Benchmarking↗
PubMed1993

Histopathology: old principles and new methods.

Histopathology remains the benchmark and the only reliable means for diagnosing breast cancer in either invasive or preinvasive stages and for classifying morphologically distinct special types of breast cancer that exhibit different prognoses. Careful epidemiological research performed in tandem with histopathology had demonstrated that certain preinvasive lesions progress to invasive cancer at high frequency, and the detection of these lesions seems certain to increase with increased mammographic screening. Comedo and non-comedo DCIS represent examples of distinct preinvasive lesions in which differing histopathology reflects altered biological behaviour. Certain morphological varieties of invasive cancer are also associated with different biological outcomes, notably the special histological types such as tubular, lobular and medullary. Distinguishing these heterogeneous forms of breast cancer is crucial for diagnosis, prognostic prediction and the acquisition of research material for clinically relevant molecular epidemiological studies.

Breast Neoplasms↗