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PubMed2006

Registry of shoulder arthroplasty - the Scottish experience.

INTRODUCTION: Recognising that timely dissemination of information in the orthopaedic community was important and in the absence of any national guidelines for shoulder arthroplasty, the Scottish shoulder arthroplasty registry, a voluntary registry, was started in 1996. The goals of the registry were to assess contemporary practice, provide a benchmark against which surgeons could compare their practice, identify risk factors for a poor outcome, and to improve outcomes through continuous feedback to the participating surgeons. PATIENTS AND METHODS: A standardised proforma was used to collect information on the diagnostic and demographic data, type of procedure performed, type of implant used, any associated procedures performed in conjunction with the arthroplasty, and peri-operative complications. Postoperative pain, activity and patient satisfaction were assessed annually using another standardised proforma. RESULTS: Twenty surgeons have contributed to the register and 451 shoulder arthroplasties were registered over a 5-year period. Of patients, 23.2% were male and 76.8% female. The mean age was 65 years (range, 37-90 years). Shoulder arthroplasty was commonly performed for rheumatoid arthritis followed by trauma, osteoarthritis and avascular necrosis of the humeral head. Overall, 397 (88%) patients had a hemi-arthroplasty and 54 (12%) had a total shoulder replacement. Of the 54 cases that had a glenoid replacement, 28 were performed for inflammatory arthritis, 21 for osteoarthritis and 5 were for revisions. The humeral component was cemented in 204 (45%) cases, 160 of whom had a shoulder replacement for trauma. The glenoid component was cemented in 48 (89%) cases. Cross referencing our data with the figures of the actual number of shoulder arthroplasties performed, however, indicated that our registry at best collected only 53% of all the shoulder arthroplasties performed in Scotland annually. CONCLUSIONS: The value of a joint registry is dependent on the accuracy and completeness of the data entered. Our registry, therefore, fails as an implant registry. We believe that compliance for data registration can only be ensured if dedicated data collection staff are employed to co-ordinate the data collection and collation process.

Adult↗

PubMed2004

Generic scheme for independent performance assessment in the molecular biology laboratory.

BACKGROUND: A variety of proficiency testing schemes are available for specific molecular analyses, but there is an acute need for more widely accessible schemes to assess and demonstrate general competence in DNA analysis. METHODS: Fifteen laboratories, including academic, clinical, and commercial organizations, were recruited into the prototype assessment exercise. A range of test samples were provided, and participants were required to extract DNA from simple matrices, perform PCR amplification, and score the samples as positive or negative by electrophoretic analysis of the amplification products. Results were requested as both gel images and a completed results table, and the performance of each laboratory was then scored on the submitted analytical results. RESULTS: Overall, laboratories performed the analysis successfully, with participants scoring a high proportion of the samples correctly in the two rounds of the scheme. However, not all of the laboratories were able to achieve amplification for all samples, and the performance of some laboratories was not consistent in the two rounds. In addition, several analytical problems were encountered at all stages of the process, including DNA extraction, PCR amplification, and correct recording of results. CONCLUSIONS: The generic approach described here has enabled effective cross-sectoral benchmarking of laboratories from a variety of analytical sectors. The problems encountered by some participating laboratories highlight the need for quality control and checks at all stages of the process to ensure accuracy of results. A statistical analysis of the results (ANOVA) allowed meaningful comparison of the consistency and sensitivity achieved by laboratories, demonstrating that an effective balance was achieved between the level of data obtained from laboratories and the time expenditure required from participants.

Chemistry, Clinical↗

PubMed2004

Observations from a national multiple institution autotransfusion (ATS) quality indicator program.

A process to collect universal, mandatory autotransfusion (ATS) procedure quality indicators to measure and monitor ATS quality improvement was designed and implemented by Fresenius Medical Care Extracorporeal Alliance (FMCEA) an outsource provider of extracorporeal services. The indicator program collected and evaluated data that reflect real-world extracorporeal clinical practices and outcomes. The indicator reports provide our clinicians, client physicians, and partner institutions with confidential reports that allow comparison of their practice to evidenced-based performance standards. All ATS procedures reviewed were performed on non-open-heart surgery procedures (on pump or off pump), including vascular, thoracic, orthopedic, and general surgery. After continuous collection and analysis of the indicator data, a hospital is given a report with three components: 1) data analysis that reports summary results and benchmarks the hospital against the other reporting hospitals, 2) corrective action plan that allows the clinical manager to document their investigations and outline plans for continuous quality improvement; and 3) raw data tabulation that allows the clinical manager to identify individual cases that are outliers from the target goal to facilitate local chart reviews. This communication describes FMCEA's ATS Quality Indicator Program and presents the collective results for the first 13 months (January 2002--January 2003) of data collection. Physicians and ATS service client hospitals value the Quality Indicator Process Reports. ATS service managers use the reports and the subsequent process improvement to meet AaBB (American Association of Blood Banks) and JCAHO (Joint Commission on Accreditation of Healthcare Organizations) standards and guidelines for providing safe patient-care services.

Benchmarking↗

PubMed2001

Leveraging performance measurement and management: the quality and efficiency edge.

The University HealthSystem Consortium (UHC) is a mission-based, member driven alliance of academic health centers. UHC's objectives are to pool resources, create economies of scale, improve clinical and operating efficiencies, and influence the direction and delivery of health care. To assist our members in developing these strategies, UHC conducted concurrent clinical and operational cardiology benchmarking projects. The goals of the cardiology-benchmarking project were to: Identify successful organizational structures and operational processes used by members to provide cardiology service. Identify methods to maximize productivity, and manage supply and equipment costs. Share methods of measuring and reporting outcomes (report cards, databases).

Academic Medical Centers↗

PubMed2003

A revision of the gamma-evaluation concept for the comparison of dose distributions.

A method for the quantitative four-dimensional (4D) evaluation of discrete dose data based on gradient-dependent local acceptance thresholds is presented. The method takes into account the local dose gradients of a reference distribution for critical appraisal of misalignment and collimation errors. These contribute to the maximum tolerable dose error at each evaluation point to which the local dose differences between comparison and reference data are compared. As shown, the presented concept is analogous to the gamma-concept of Low et al (1998a Med. Phys. 25 656-61) if extended to (3+1) dimensions. The pointwise dose comparisons of the reformulated concept are easier to perform and speed up the evaluation process considerably, especially for fine-grid evaluations of 3D dose distributions. The occurrences of false negative indications due to the discrete nature of the data are reduced with the method. The presented method was applied to film-measured, clinical data and compared with gamma-evaluations. 4D and 3D evaluations were performed. Comparisons prove that 4D evaluations have to be given priority, especially if complex treatment situations are verified, e.g., non-coplanar beam configurations.

Algorithms↗

PubMed2000

The ORYX initiative: goals and potential application to physician quality improvement efforts.

Demands for public accountability in health care are more widespread today than at any time in the past. A number of national performance measurement efforts, including the ORYX initiative of the Joint Commission on Accreditation of Healthcare Organizations, represent an effort to provide stakeholders with the data they need to make judgments about the quality of health care provided to the public. The underlying premise of performance measurement is that organizations and clinicians can only improve what they can measure. Clinicians are the natural leaders in effecting broad-based change because of their direct influence on patient care and the respect they command in the health care environment. As performance measurement initiatives evolve, the ability of health care organizations to implement empirically based, structured improvement will increase and become commonplace.

Accreditation↗

PubMed2005

Development of a set of strategy-based system-level cancer care performance indicators in Ontario, Canada.

OBJECTIVES: To develop a set of scientifically sound and managerially useful system-level cancer care performance indicators for public reporting in Ontario, Canada. IMPLEMENTATION: Using a modified Delphi panel method, comprising a systematic literature review and multiple rounds of structured feedback from 34 experts, the Cancer Quality Council of Ontario developed a set of quality indicators spanning cancer prevention through to end-of-life care. To be useful to decision-makers and providers, indicator selection criteria included a clear focus on the cancer system, relevance to a diversity of cancer providers, a strong link to the mission and strategic objectives of the cancer system, clear directionality of indicator results, presence of targets and/or benchmarks, feasibility of populating the indicator, and credibility of the measure as an indicator of quality. To ensure that the selected indicators would measure progress over time against specific and widely accepted goals, we created a strategy map based on the five strategic objectives of the Ontario cancer system: (i) to improve the measurement and reporting of cancer quality, (ii) to increase the use of evidence and innovation in decision-making, (iii) to improve access to cancer services and reduce waiting times, (iv) to increase efficiency across the system, (v) to reduce the burden of cancer. An analysis of the mean indicator ratings by experts, and the strategy mapping exercise resulted in the identification of 36 indicators deemed suitable for routine performance measurement of the Ontario cancer system. LESSONS LEARNED: The resulting instrument incorporates a credible evidence basis for performance measurement aligned to the five strategic goals for the Ontario cancer system. It represents the integrating of a management culture, focused on the implementation of a new strategic direction for the cancer system, with the underlying evidence-based culture of clinicians.

Benchmarking↗

PubMed2003

Using tools to assess and prevent inpatient falls.

BACKGROUND: Inpatient falls and fall-related injuries continue to be a complex challenge that health care organizations face. Protecting patients from falls and injury and ensuring a safe environment are fundamental to providing high-quality care. FACING THE PROBLEM: In June 2000 NorthEast Medical Center (Concord, North Carolina) experienced an inpatient fall rate (6.1 falls/1,000 patient days) that exceeded the internal benchmark (4.1 falls/1,000 patient days). The interdisciplinary Fall Team developed the Fall Risk Assessment tool. Patients were given a fall risk score and were categorized as either low or high risk. Interventions were chosen by the caregiver and became part of each patient's overall safety plan of care. THE NEXT STEP: Root cause analyses were performed for each inpatient fall to expose possible relationships between assessed fall risks and root causes. For example, approximately 80% of the patients who fell were confused, had gait disturbance, and were attempting to toilet alone. Through use of Failure Mode and Effects Analysis, the team was able to review the fall process in a prospective fashion. FOCUS ON HIGH-RISK INPATIENT POPULATIONS: In January 2001 the Fall Team began to focus on preventing falls in this patient population. An action plan for fall prevention was implemented, resulting in a decrease from 67 to 28 falls per 1,000 patient days. RESULTS: From the team's inception in June 2000 to the first quarter of 2003, the inpatient fall rate decreased from 6.1 to 2.6 falls per 1,000 patient days--a 43% decrease. With increased patient acuity and specialization in care of new and more challenging patient populations, health care organizations must quickly identify patients' fall risks and develop innovative methods to prevent falls.

Accidental Falls↗

PubMed2006

Perceptual image hashing via feature points: performance evaluation and tradeoffs.

We propose an image hashing paradigm using visually significant feature points. The feature points should be largely invariant under perceptually insignificant distortions. To satisfy this, we propose an iterative feature detector to extract significant geometry preserving feature points. We apply probabilistic quantization on the derived features to introduce randomness, which, in turn, reduces vulnerability to adversarial attacks. The proposed hash algorithm withstands standard benchmark (e.g., Stirmark) attacks, including compression, geometric distortions of scaling and small-angle rotation, and common signal-processing operations. Content changing (malicious) manipulations of image data are also accurately detected. Detailed statistical analysis in the form of receiver operating characteristic (ROC) curves is presented and reveals the success of the proposed scheme in achieving perceptual robustness while avoiding misclassification.

Algorithms↗

PubMed2005

Validation in pharmaceutical analysis. Part II: Central importance of precision to establish acceptance criteria and for verifying and improving the quality of analytical data.

Validation of analytical procedures is a vital aspect not just for regulatory purposes, but also for their efficient and reliable long-term application. In order to address the performance of the analytical procedure adequately, the analyst is responsible to identify the relevant parameters, to design the experimental validation studies accordingly and to define appropriate acceptance criteria. Establishing an acceptable analytical variability for the given application is of central importance as many other acceptance criteria can be derived from such a precision. Acceptable precision ranges for types of control tests and/or analytes can be obtained from validation, but also related activities such as transfer, control charts, or extracted from routine applications such as batch release or stability studies (data mining). Apart from compiling a database for general benchmarking, during such an information-building process, the reliability of the analytical variability of the specific procedure is more and more increased. This is important as a reliable target variability facilitates to detect or investigate atypical or out-of specification behaviour of analytical data in a routine application, thus improving the data quality and reliability. According to the life-cycle concept of validation, measures should be taken to maintain and control the validated status of analytical procedures during long-term routine application, such as monitoring relevant performance parameters (system suitability tests), control charts, etc. If the analytical system is demonstrated to be stable, i.e. under statistical control, a major variability contribution in LC originating from the standard preparation and analysis can be reduced. A concept of quantification by pre-determined calibration parameters instead of the classical approach of simultaneous calibration is described.

Chemistry, Pharmaceutical↗

PubMed2004

Effects of methylmercury on neurodevelopment in Japanese children in relation to the Madeiran study.

OBJECTIVES: A cross-sectional study was carried out to assess the effects of methylmercury exposure on neurodevelopment in Japanese children, in relation to the Madeiran cross-sectional study, and to estimate benchmark dose (BMD) levels using the data of two studies. METHODS: Mercury levels in hair samples obtained from 327 Japanese mothers and their 7-year-old children, and methylmercury levels in the umbilical cord, were determined. Neurodevelopmental examinations, including the brainstem auditory evoked potential (BAEP), were performed on the children. RESULTS: The medians of hair mercury were 1.63 (0.11-6.86) mug/g for mothers and 1.65 (0.35-6.32) mug/g for children, and a significant correlation was seen between the hair mercury levels in mothers and children. The maternal hair mercury was significantly correlated with the methylmercury in the umbilical cords obtained from 49 children. In 210 children whose mothers had not changed their dietary habits since pregnancy, most of the neurodevelopmental variables were not significantly related to hair mercury levels. The BAEP latencies were significantly shorter in the Japanese children than in the 113 Madeiran 7-year-old children, whose mothers had hair mercury of 1.12-54.5 (median 10.9) mug/g. Significant relationships between the maternal hair mercury level and BAEP latencies (peaks III and V, and interpeak I-III) were found only in the merged data of Japanese and Madeiran children. When the lower 95% confidence limit of BMD (BMDL) was calculated, the BMDLs of mercury exposure for BAEP latencies in the merged data were between 6.9 and 10.5 mug/g, and lower than those in the Madeiran children. CONCLUSIONS: It is suggested that Japanese children may ingest similar doses per body weight of methylmercury to their mothers. If maternal hair mercury was used as a proxy for mercury exposure at birth, no significant dose-effect associations with the BAEP latencies were observed in Japanese children with exposure levels below 6.9 mug/g of hair mercury, but only when higher-level exposures from Madeiran children were included. The BMDL was lower for the merged data than for Madeiran children alone.

Adult↗

PubMed1997

Core outcomes measures for inguinal hernia repair.

BACKGROUND: Demands on the medical profession to develop performance measures and demonstrate cost-effectiveness make it imperative that a uniform approach to the measurement of outcomes for common conditions be adopted. We report here on patient acceptance, response rates, and utility of a new set of core outcomes measures for patients with inguinal hernia (IH), which incorporates patient reporting of outcomes. METHODS: Beginning in March 1994, a convenience sample of patients scheduled for IH repair completed a series of questionnaires addressing a range of patient case mix and outcomes dimensions, including demographics, comorbid conditions, SF-36 health status (Medical Outcomes Study 36-item short-form health survey), and condition-specific questions, expectations, and responses to the surgical experience before and after operation. Surgical data were abstracted from the medical records. RESULTS: One hundred three patients were entered in the study; 63 completed 2-month reports and 44 completed 6-month reports. Acceptance of the study and response rates were excellent. Differences in health status associated with IH have been identified in two SF-36 domains, and changes in function after repair noted in several others, supporting the applicability of this measure. Outcomes may also differ by type of hernia and type of repair performed. CONCLUSIONS: A core outcomes measurement set for IH that encompasses demographics, comorbidities, health status, expectations, utilization, and condition-specific data provides a portrait of patient outcomes that is useful to providers and patients, and combined with cost and satisfaction data, it can be used for benchmarking and improving surgical care.

Adult↗

PubMed2005

The use of word-reading to estimate "premorbid" ability in cognitive domains other than intelligence.

Diagnostic neuropsychological assessment requires the clinician to estimate a patient's premorbid abilities. Word reading tests, such as the National Adult Reading Test-Revised (NART-R), provide reasonably accurate estimates of premorbid IQ, but their capacity to benchmark other premorbid cognitive abilities remains unclear. In this extension of an earlier report, we administered the NART-R, an abbreviated Wechsler Adult Intelligence Scale (WAIS-R or WAIS-III), and 26 other cognitive measures to 322 reasonably healthy adults. While NART-R performance correlated robustly (rs > or = .72) with concurrent Verbal and Full Scale IQ, its correlation with all other cognitive measures was significantly lower. Thus, while it is appealing to use word reading as a proxy for premorbid functioning in other cognitive domains, the NART-R has limited utility for this because it does not predict current performance on other cognitive tests as well as it predicts IQ in healthy adults.

Adolescent↗

PubMed2006

[Pilot benchmarking study of thoracic surgery in Spain: comparison of cases of lung resection and indicators of quality].

OBJECTIVE: This article describes the methods and conclusions of the first Spanish benchmarking study of thoracic surgery. The proposed aims were to describe cases of lung resection in 9 Spanish hospitals, compare indicators of quality among the 9 participating centers, and identify and propose common areas where lung-resection processes could be improved. METHODS: Information was taken from the minimum basic data set for lobectomy and pneumonectomy processes performed in 2002 and 2003. The chosen outcome indicators were in-hospital mortality, morbidity, length of hospital stay, and emergency readmissions within 30 days of discharge, adjusted according to surgical complexity. Once the results had been analyzed, the participating centers with best outcomes were identified and a variety of proposed improvements were discussed. RESULTS: A total of 1666 procedures (1276 lobectomies and 390 pneumectomies) were studied. We found differences in mean length of stay, mortality, readmission rate, and morbidity that identified centers with lower mortality or shorter hospital stay for comparable or more complex surgical procedures. However, higher morbidity and readmission rates were found in these centers. CONCLUSIONS: Measures were proposed to ensure that relevant diagnostic information is recorded on discharge. It was also proposed to reduce unnecessarily long hospital stays and to standardize the procedures. With such an approach, reliable criteria that improve the quality of lung-resection processes can be established in the future.

Benchmarking↗

PubMedDate not supplied

Survival of rectal cancer patients in Belgium 1997-98 and the potential benefit of a national project.

BACKGROUND: PROCARE, a Belgian multidisciplinary project on rectal cancer (RC), will be launched in 2006. Guidelines have been developed, but remain to be implemented. AIM: A population-based study on RC treatment and outcome in Belgium and comparison with recent international benchmarks in order to better define targets that should be reached. PATIENTS AND METHODS: Anonymous data of 3079 patients with rectal cancer registered in the National Cancer Registry in 1997 and 1998 were analysed. Observed (OS) and relative survival (RS) were compared with figures from nationwide projects and multi-centre studies. RESULTS: The 5-yr OS and RS were 46.6% and 58.5%, respectively. For patients with stage I-III tumours 5-yr OS was 57.1% and 5-yr RS 70.1%. Adjuvant or neo-adjuvant treatment was given in 54.8% stage II-III patients who were < 70 years old. There were marked differences between the provinces in the use of radiotherapy for stage II-III patients and in 5-yr RS for all stages. In stage IV, the median OS was 13 months and the 2-yr OS was 28%. Comparison with recent multi-centre trials indicates significant potential benefits from the PROCARE project: an absolute increase of the 5-yr OS by 10 to 20% after chemoradiotherapy and TME in stage II-III patients 75 years old or less, a 7-month increase of the median OS and an absolute 15% increase of the 2-yr OS in unresectable stage IV patients with combined chemotherapy. CONCLUSION: Significant improvement seems to be achievable. Implementation of the PROCARE guidelines with quality assurance through prospective registration in a specific database, however, is a crucial prerequisite for credible audit of performance and feedback to individual teams.

Adolescent↗

PubMedDate not supplied

Some benchmark searches for testing search capabilities and medical coverage of internet discovery tools.

The past few years have seen a proliferation of search engines for the World Wide Web (WWW), as well as a growing number of specialized subject directories geared to the needs of health care professionals. Yet documentation on scope, coverage, and search features is often uneven at best; and even documented search features may not perform as advertised. This paper will present a group of sample searches to assist users in gauging database size, determining default search operators, and testing for the presence of advanced search features such as case sensitivity, stemming, and concept mapping for medical topics on English-language web sites.

Databases, Factual↗

PubMed1982

Daytime sleep stage organization in three-month-old infants.

Sleep monitoring at 3 months post term of clinically normal term infants, pre-term infants with no demonstrable pathologic clinical signs, and pre-term and term infants with a history of metabolic disorders show that these infants have EEG sleep stages resembling those seen in adults, as well as the adult pattern of sleep stage organization. The presence of NREM stage organization and stage sequencing suggest that sleep regulatory mechanisms are approaching a level of functional maturity in the human infant at 3 months post term. There is a significant relationship between sleep staging at 3 months post term and mental and motor performance at 12 months post term. In light of this, it is hypothesized that early bioelectric maturation may reflect the development of neural mechanisms which are also the substrate for later cognitive and behavioral functioning. Sleep stage organization at 3 months post term may be utilized as a benchmark of CNS development and for research on the pathophysiology of sleep disorders.

Brain↗

PubMed2001

Evaluation of protein multiple alignments by SAM-T99 using the BAliBASE multiple alignment test set.

MOTIVATION: SAM-T99 is an iterative hidden Markov model-based method for finding proteins similar to a single target sequence and aligning them. One of its main uses is to produce multiple alignments of homologs of the target sequence. Previous tests of SAM-T99 and its predecessors have concentrated on the quality of the searches performed, not on the quality of the multiple alignment. In this paper we report on tests of multiple alignment quality, comparing SAM-T99 to the standard multiple aligner, CLUSTALW. RESULTS: The paper evaluates the multiple-alignment aspect of the SAM-T99 protocol, using the BAliBASE benchmark alignment database. On these benchmarks, SAM-T99 is comparable in accuracy with ClustalW. AVAILABILITY: The SAM-T99 protocol can be run on the web at http://www.cse.ucsc.edu/research/compbio/HMM-apps/T99-query.html and the alignment tune-up option described here can be run at http://www.cse.ucsc.edu/research/compbio/HMM-apps/T99-tuneup.html. The protocol is also part of the standard SAM suite of tools. http://www.cse.ucsc.edu/research/compbio/sam/

Computational Biology↗