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At least 1,783 records · Page 99Linked to original sources
PubMed2005

Pediatric endoscopy: new information from the PEDS-CORI project.

The PEDS-CORI (Pediatric Endoscopy Database System-Clinical Outcomes Research Initiative) was created in December 1999 to develop and maintain a database of pediatric endoscopy procedures and to promote scientific inquiry into the need, efficacy, costs, and outcomes of pediatric endoscopy. The PEDS-CORI database was queried to determine the type, frequency, indication, and findings of all procedures. Of the 27,710 now in the database, 62% were esophagogastroduodenoscopies (EGDs), 24% were colonoscopies, 7.5% were flexible sigmoidoscopies, 1.5% were endoscopic retrograde cholangiopancreatographies, and 5% were other procedures. The male-to-female ratio was approximately 1:1. Eighty-three percent were outpatients, 12% were inpatients, and 5% were not recorded. Forty percent of patients were aged from 5 to 10 years. EGD is 2.5 times as common as colonoscopy. Most procedures are performed on children aged from 5 to 10 years. PEDS-CORI is a powerful tool that can be used to determine the patterns of use in pediatric endoscopy.

Adolescent↗
PubMed2005

Structural characterization of components of protein assemblies by comparative modeling and electron cryo-microscopy.

We explore structural characterization of protein assemblies by a combination of electron cryo-microscopy (cryoEM) and comparative protein structure modeling. Specifically, our method finds an optimal atomic model of a given assembly subunit and its position within an assembly by fitting alternative comparative models into a cryoEM map. The alternative models are calculated by MODELLER [J. Mol. Biol. 234 (1993) 313] from different sequence alignments between the modeled protein and its template structures. The fitting of these models into a cryoEM density map is performed either by FOLDHUNTER [J. Mol. Biol. 308 (2001) 1033] or by a new density fitting module of MODELLER (Mod-EM). Identification of the most accurate model is based on the correlation between the model accuracy and the quality of fit into the cryoEM density map. To quantify this correlation, we created a benchmark consisting of eight proteins of different structural folds with corresponding density maps simulated at five resolutions from 5 to 15 angstroms, with three noise levels each. Each of the proteins in the set was modeled based on 300 different alignments to their remotely related templates (12-32% sequence identity), spanning the range from entirely inaccurate to essentially accurate alignments. The benchmark revealed that one of the most accurate models can usually be identified by the quality of its fit into the cryoEM density map, even for noisy maps at 15 angstroms resolution. Therefore, a cryoEM density map can be helpful in improving the accuracy of a comparative model. Moreover, a pseudo-atomic model of a component in an assembly may be built better with comparative models of the native subunit sequences than with experimentally determined structures of their homologs.

Cryoelectron Microscopy↗
PubMed2002

Evidence-based practice for young people who self harm: can it be sustained and does it improve outcomes?

In 1998-1999, two Area Health Services in NSW conducted a project to implement evidence-based service enhancements for the clinical management of young people who present with Deliberate Self Harm (DSH) behaviour. The present study examined what structures and procedures were required to implement and sustain evidence-based practice in different health care settings for patients with DSH behaviour. Service provision was assessed at three points during the initial project to assess the degree of change that occurred, and 9 months after the completion of the project to allow an assessment of sustainability of the service provision. We examined staff perceptions of the importance of education, management directives, policy and procedure changes, and cultural/attitudinal changes, in implementing clinical best practice. Results indicated that support from both service management and clinical staff is necessary for successful implementation of service enhancements. High levels of staff education and policy development were also associated with high levels of service performance. The best sustained enhancements were those that were developed by the services themselves.

Adolescent↗
PubMed2025

CLINICAL AND COGNITIVE PHENOTYPING OF COPY NUMBER VARIANTS ASSOCIATED WITH NEURODEVELOPMENTAL DISORDERS FROM A MULTI-ANCESTRY BIOBANK.

Clinical biobanks with electronic health records (EHRs) linked to genotype data continue to expand yielding an opportunity to further characterize disease-relevant genomic risk factors, yet few recall-by-genotype studies from biobanks have been published to date. For example, copy number variants (CNVs) that significantly increase risk for multiple neurodevelopmental disorders (NDDs) and negatively affect neurocognition, may present in up to 2% of population cohorts, with public health implications for ascertaining NDD CNV carriers. From BioMe, a multi-ancestry biobank derived from the Mount Sinai healthcare system (New York, NY), 892 adult participants were recontacted for deep phenotyping, including 335 NDD CNV carriers as well as comparators, 217 individuals with schizophrenia and 340 controls. Clinical and cognitive assessments were administered to each participant. There was no disclosure of genetic information. Eight percent of recontacted biobank participants completed the study (30 NDD CNV carriers across 15 unique loci, 20 schizophrenia and 23 controls). The study sample had a mean age of 48.8 (10.2) years, was 66% female and of diverse ancestry, 36% African, 34% Hispanic, and 26% European. Overall, 70% of 30 NDD-CNV carriers harbored at least one neuropsychiatric or developmental phenotype, including 40% with mood or anxiety disorders. Further, 22 NDD CNV carriers were significantly impaired compared to controls on digit span backwards (Beta=-1.76, FDR=0.04) and digit span sequencing (Beta=-2.01, FDR=0.04), but higher performing than schizophrenia on verbal learning (Beta=4.5, FDR=0.05). Thirty NDD CNV carriers were successfully recruited from a multi-ancestry biobank, as well as healthy controls and low-functioning individuals with schizophrenia. Deep phenotyping corroborated past reports, while also identifying discordance with EHRs. Future recall-by-genotype studies may further benchmark the study design and elucidate feasibility.

Biobank↗
PubMed2004

Automated optimization of JPEG 2000 encoder options based on model observer performance for detecting variable signals in X-ray coronary angiograms.

Image compression is indispensable in medical applications where inherently large volumes of digitized images are presented. JPEG 2000 has recently been proposed as a new image compression standard. The present recommendations on the choice of JPEG 2000 encoder options were based on nontask-based metrics of image quality applied to nonmedical images. We used the performance of a model observer [non-prewhitening matched filter with an eye filter (NPWE)] in a visual detection task of varying signals [signal known exactly but variable (SKEV)] in X-ray coronary angiograms to optimize JPEG 2000 encoder options through a genetic algorithm procedure. We also obtained the performance of other model observers (Hotelling, Laguerre-Gauss Hotelling, channelized-Hotelling) and human observers to evaluate the validity of the NPWE optimized JPEG 2000 encoder settings. Compared to the default JPEG 2000 encoder settings, the NPWE-optimized encoder settings improved the detection performance of humans and the other three model observers for an SKEV task. In addition, the performance also was improved for a more clinically realistic task where the signal varied from image to image but was not known a priori to observers [signal known statistically (SKS)]. The highest performance improvement for humans was at a high compression ratio (e.g., 30:1) which resulted in approximately a 75% improvement for both the SKEV and SKS tasks.

Algorithms↗
PubMedDate not supplied

Does publicizing hospital performance stimulate quality improvement efforts?

This study evaluates the impact on quality improvement of reporting hospital performance publicly versus privately back to the hospital. Making performance information public appears to stimulate quality improvement activities in areas where performance is reported to be low. The findings from this Wisconsin-based study indicate that there is added value to making this information public.

Attitude of Health Personnel↗
PubMed2000

Performance measurement through audit, feedback, and profiling as tools for improving clinical care.

Clinical audits and practice profiling have become popular tools in the attempt to change physician behavior to improve quality of care. Unfortunately, the growing need for information on quality of care has often outpaced the development of standard, valid, and reliable approaches to using these tools. The studies of performance measurement published in the literature to date demonstrate varying impact on ability to improve clinical care; few are randomized controlled trials. While performance measurement has become a common practice, the science surrounding this field is still in its early stages of development; while it seems promising, it should be viewed as largely experimental.

Benchmarking↗
PubMed2006

Pulmonary practice profiles: Results of a practice performance survey.

OBJECTIVES: Physician productivity, practice expense, resource allocation, facilities, staff, and malpractice are variables in medical practice profitability. The ongoing challenge of collecting reliable and consistent data created an opportunity in 2001 for the American College of Chest Physicians (ACCP) Practice Administration Network (PAN) to develop a practice-based survey that measured the variables most related to the bottom line. METHODS: The PAN designed a comprehensive practice survey in 2001 that has been distributed to > 2,000 ACCP members each year. The specialty-specific survey differed from those offered in the market, as its aim was to capture information about pulmonary, critical care, and sleep practices. The single-answer survey included practice expense categories and those related to accounts receivable management. An on-line survey vendor (www.surveymonkey.com) was selected as the platform based on broad functionality and a flexible architecture. RESULTS: The survey was conducted each June for 5 consecutive years. In 2001, survey respondents represented 68 pulmonary physicians. By 2005, 229 practices responded representing 774 individual physicians. Participants included members of ACCP Leadership, ACCP Committees, and related networks, and past survey participants. The data are presented in graphic format as a percentage of total respondents. CONCLUSION: The survey offered participants a mechanism to contrast and compare specialty-based trends in practice expense, staffing levels, clinical services, malpractice cost, facilities utilization, and financial management strategies of "better performing" practices. It has served as the groundwork for related Practice Management Committee and Practice Management Department initiatives. The ACCP anticipates future survey collaboration with the Medical Group Management Association.

Benchmarking↗
PubMed1999

Net one, net two: the primary care network income statement.

Although hospital-owned primary care practices have been unprofitable for most hospitals, some hospitals are achieving competitive advantage and sustainable practice operations. A key to the success of some has been a net income reporting tool that separates practice operating expenses from the costs of creating and operating a network of practices to help healthcare organization managers, physicians, and staff to identify opportunities to improve the network's financial performance. This "Net One, Net Two" reporting allows operations leadership to be held accountable for Net One expenses and strategic leadership to be held accountable for Net Two expenses.

Accounting↗
PubMed2006

A focus on the asthma HEDIS measure and its implications for clinical practice.

With more than $16.1 billion in annual costs, the asthma management system is inadequate and needs revision to improve health and financial outcomes. Solutions may be found in the National Committee for Quality Assurance's guidelines and in such programs as Pay for Performance that financially reward providers for adherence to standards of practice based on Health Plan Employer Data and Information Set measures.

Asthma↗
PubMed1990

From quality assurance to quality improvement.

As we are learning to master the methods of quality assurance, a new conceptual approach focused on quality improvement is being advocated. But this new approach is not a derailment for health care practitioners committed to improve patient care quality. Rather, it is a progressive step that builds upon the concepts and methods of quality assurance. Whereas quality assurance tends to focus on correcting problems in patient care quality--especially individual practitioners' problems--quality improvement focuses on finding opportunities to improve quality by changing systems as well as individual practitioner behavior. Whereas quality assurance tends to rely primarily on standards or guidelines for the structures and processes of care and the intensive review of individual cases with undesirable outcomes, quality improvement also utilizes statistical profiles of outcomes, structures, and processes as baselines against which improvement can be measured. Whereas quality assurance may engender defensiveness in an individual practitioner, quality improvement is based on the health care practitioner's professional ethic and pride in providing even better care to patients tomorrow than is possible today. To improve patient care quality, it is necessary to examine the structures, processes, and outcomes of care. The structures and processes can be controlled by the practitioner and organization; the outcomes are the benchmarks against which the effectiveness of the structures and processes can be evaluated. Outcomes in health care are the effects of more than just the structures and processes controlled by the practitioner and organization. Therefore, outcomes are not direct and complete measures of the quality of the care provided. They are instead indicators of performance. These indicators can focus attention on care that lies outside the normal statistical parameters of performance and can provide baselines against which improvements can be measured. The monitoring and evaluation process described in Joint Commission standards is a method for establishing priorities and using indicators to improve the quality of patient care. This method can be used to focus case-based review of care and to establish baselines for continuous improvement. This conceptual approach that emphasizes quality improvement and the use of the monitoring and evaluation process is guiding the Joint Commission's development of clinical indicators and revision of its standards and survey process to help health care organizations in the transition from quality assurance to quality improvement.

Humans↗
PubMed2026

Benchmarking DNA extraction protocols across use cases for culture-independent Nanopore metagenomics.

Oxford Nanopore Technologies (ONT) sequencing offers several advantages for metagenomics, including long reads, rapid turnaround, low upfront cost, scalability and portability. However, for ONT metagenomics, DNA yield, quality and integrity are important considerations when selecting an extraction method. Many metagenomic extraction methods use harsh lysis conditions to extract a wide range of species and provide an accurate community composition, but these conditions can compromise DNA fragment length. Therefore, extraction methods for ONT metagenomics must balance DNA shearing and recovery with representative community lysis. We systematically evaluated DNA extraction methods for ONT metagenomic sequencing using a use case-oriented framework. Among nearly 50 extraction methods screened, 7 were selected for detailed comparison based on suitability for metagenomics, variation in methodology, availability, cost and processing time: Norgen BioTek Corp's Stool DNA Isolation (NG), Zymo Research's ZymoBIOMICS Quick-DNA HMW MagBead (ZMG), Qiagen's DNeasy Blood and Tissue (QBT), Macherey-Nagel's NucleoMag DNA Microbiome (MN), Zymo Research's ZymoBIOMICS DNA Mini Prep (ZMI), Qiagen's DNeasy PowerSoil/QIAamp PowerFecal Pro (PS) and Qiagen's QIAamp Fast DNA Stool Mini (QIA). Methods were tested using Zymo Research's ZymoBIOMICS Microbial Community Standard (MCS), a matrix-free mock community with known composition. DNA extracts were sequenced on an ONT PromethION using the Rapid Barcoding Kit, except QIA due to insufficient DNA yield. Metrics for the method, DNA extracts, sequencing and genomes were evaluated, revealing trade-offs between methods. The two magnetic bead methods, MN and ZMG, produced the highest mean read length N50 values (13.9 and 16.5 kb, respectively) but showed apparent community compositions skewed towards Gram-negative bacteria. In contrast, ZMI and PS maintained a community composition close to expected, with reduced mean read length N50 values (4.5 vs. 7.5 kb). Performance across various metrics is presented in the context of the following use cases: maximizing genome coverage and assembly completeness, preserving composition accuracy, targeting specific species and limiting required resources (equipment, time or budget). The metrics and use case considerations presented offer practical guidance for informed selection of DNA extraction methods for ONT metagenomics. For accurate community composition, ZMI or PS are recommended, while PS and ZMG perform best at maximizing genome coverage and assembly completeness. NG and QBT may be the most economical options, though performance trade-offs were observed. Finally, PS may be the preferred method for time-sensitive diagnostic or field applications.

Metagenomics↗
PubMed2004

Patient, surgeon, and treatment characteristics associated with homologous blood transfusion requirement during radical retropubic prostatectomy: multivariate nomogram to assist patient counseling.

OBJECTIVES: To identify the preoperative patient, treatment, and surgeon factors associated with the administration of homologous blood transfusion during or after radical retropubic prostatectomy (RRP) to be able to better inform patients regarding the probability of transfusion. Homologous blood transfusion is sometimes required during or after RRP, but predictive models for estimating transfusion probability using patient and surgical characteristics are lacking. METHODS: Data were prospectively collected regarding patient characteristics, cancer severity, surgeon experience, anesthetic used, operative blood loss, and transfusion among 1123 consecutive RRP cases. Multivariate regression analysis identified baseline factors associated with a homologous transfusion requirement and generated a model for predicting the likelihood of perioperative homologous transfusion. RESULTS: Homologous transfusion was administered in 3.8% of subjects; the mean estimated blood loss was 953 mL. Multivariable regression analysis identified prostate size (P <0.0001, odds ratio [OR] 1.74), use of general anesthesia (P = 0.01, OR 2.22), use of neoadjuvant hormonal therapy (P = 0.006, OR 3.35), and surgeon expertise (P <0.0001, OR 8.63) as independent risk factors associated with a need for perioperative homologous transfusion. The most influential factor, surgical expertise, clustered among surgeons who performed more than 15 RRPs annually, because these surgeons had lower transfusion rates and lower estimated blood loss more consistently than did surgeons who performed fewer RRPs annually. CONCLUSIONS: Larger prostate size, use of general anesthesia, use of neoadjuvant hormonal therapy, and annual surgeon case volume were independently associated with an increased probability that an individual patient would receive homologous transfusion during or after RRP. A nomogram indicating the probability of homologous transfusion based on these factors provides a benchmark of expected homologous transfusion rates according to individual patient and treatment parameters.

Adenocarcinoma↗
PubMed2004

Screening post-stroke depression in Chinese older adults using the hospital anxiety and depression scale.

Little is known about the performance of the Hospital Anxiety and Depression Scale (HADS) in screening post-stroke depression (PSD) in Chinese older adult patients. One hundred Chinese geriatric patients with first-ever stroke, consecutively admitted to a rehabilitation facility, were assessed by occupational therapists using the depression subscale of the HADS. Psychiatric diagnoses, which served as the benchmark for judging the usefulness of HADS in screening PSD, were made using the Structured Clinical Interview for DSM-III-R (SCID-DSM-III-R) supplemented by all available clinical information. The optimal cut-off point of HADS was 6/7. The sensitivity, specificity, positive and negative predictive value of the HADS, and the area under the receiver operating characteristic curve, were 88%, 53%, 0.28, 0.96 and 0.75, respectively. The HADS does not appear to be a useful tool in screening for PSD in Chinese older adults.

Aged↗
PubMed2003

Length of stay data as a guide to hospital economic performance for ICU patients.

CONTEXT: Length of stay data are increasingly used to monitor ICU economic performance. How such material is presented greatly affects its utility. OBJECTIVE: To develop a weighted length of stay index and to estimate expected length of stay. To assess alternative ways to summarize weighted length of stay to evaluate ICU economic performance. DESIGN: Retrospective database study. SUBJECTS: Data for 751 ICU patients in 1998 at two hospitals used to develop weighted length of stay index. Data on 42,237 patients from 72 ICUs used as the basis of economic performance evaluation. MAIN OUTCOME MEASURES: Difference between actual and expected weighted length of stay, where expected weighted length of stay is based on patient clinical characteristics. RESULTS: Length of stay statistically explains approximately 85 to 90% of interpatient variation in hospital costs. The first ICU day is approximately four times as expensive, and other ICU days approximately 2.5 times as expensive, as non-ICU hospital days. In a regression model for weighted length of stay, patient clinical characteristics explain 26% of variation. ICU economic performance can be measured by excess weighted length of stay of a "typical" patient or by occurrence of long excess weighted lengths of stay. Although different summary measures of performance are highly correlated, choice of measure affects relative ranking of some ICUs' performance. CONCLUSION: Providers of statistical data on ICU economic performance should adjust length of stay for patient characteristics and provide multiple summary measures of the statistical distribution, including measures that address both the typical patient and outliers.

Accounting↗
PubMed2006

Combining pay for performance with gainsharing.

Combining gainsharing with pay for performance offers the potential to deal simultaneously with the nation's healthcare quality, affordability, and profitability issues by more equitably rewarding contributions toward enhanced quality of care, increased efficiency, and reduced case costs.

Benchmarking↗
PubMed2001

What are the baselines for protein fold recognition?

MOTIVATION: What constitutes a baseline level of success for protein fold recognition methods? As fold recognition benchmarks are often presented without any thought to the results that might be expected from a purely random set of predictions, an analysis of fold recognition baselines is long overdue. Given varying amounts of basic information about a protein-ranging from the length of the sequence to a knowledge of its secondary structure-to what extent can the fold be determined by intelligent guesswork? Can simple methods that make use of secondary structure information assign folds more accurately than purely random methods and could these methods be used to construct viable hierarchical classifications? EXPERIMENTS PERFORMED: A number of rapid automatic methods which score similarities between protein domains were devised and tested. These methods ranged from those that incorporated no secondary structure information, such as measuring absolute differences in sequence lengths, to more complex alignments of secondary structure elements. Each method was assessed for accuracy by comparison with the Class Architecture Topology Homology (CATH) classification. Methods were rated against both a random baseline fold assignment method as a lower control and FSSP as an upper control. Similarity trees were constructed in order to evaluate the accuracy of optimum methods at producing a classification of structure. RESULTS: Using a rigorous comparison of methods with CATH, the random fold assignment method set a lower baseline of 11% true positives allowing for 3% false positives and FSSP set an upper benchmark of 47% true positives at 3% false positives. The optimum secondary structure alignment method used here achieved 27% true positives at 3% false positives. Using a less rigorous Critical Assessment of Structure Prediction (CASP)-like sensitivity measurement the random assignment achieved 6%, FSSP-59% and the optimum secondary structure alignment method-32%. Similarity trees produced by the optimum method illustrate that these methods cannot be used alone to produce a viable protein structural classification system. CONCLUSIONS: Simple methods that use perfect secondary structure information to assign folds cannot produce an accurate protein taxonomy, however they do provide useful baselines for fold recognition. In terms of a typical CASP assessment our results suggest that approximately 6% of targets with folds in the databases could be assigned correctly by randomly guessing, and as many as 32% could be recognised by trivial secondary structure comparison methods, given knowledge of their correct secondary structures.

Computational Biology↗