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PubMed1985

A standardized benchmark approach to the use of cancer epidemiology data for risk assessment.

Clarity and scientific validity are two criteria for assessing the quality of communications between scientists and risk managers. Regulating permissible exposures on the basis of very-low-dose risk extrapolation uses scientific information that may not meet either criterion. With regard to clarity, it is difficult for an individual to conceive of the meaning of risks on the order of 1 in 1,000,000 lifetime excess. With regard to scientific validity, the uncertainties of extrapolating risks at very low doses are evident in the wide variation in results produced depending on the statistical and pharmacokinetic assumptions made. An alternative approach is to fix benchmarks from which safety factors are chosen (Gaylor, 1983). For epidemiological data, we propose a benchmark of that exposure which would cause 1% cancer excess with 10 yr of exposure followed by 30 yr of further followup. These values have been chosen at this stage of development since they are close to observable values in many cancer epidemiology studies. In the first stage, excess cancer risk versus duration of exposure is plotted and the excess risk is estimated for a exposure duration of 10 yr. The next step involves a short linear extrapolation from the exposure levels linked with this excess risk to the exposure levels that would cause a 1% excess risk over a duration of 10 yr. We have established preliminary benchmarks from published data for benzene and radon daughter exposure. Permissable exposure levels might then be set by deciding on safety factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinogens, Environmental↗

PubMed1996

Benchmark analysis on diabetics at high risk for lower extremity amputation.

After the 1990 establishment of a multidisciplinary foot salvage clinic, 1346 diabetic patients, at high risk for the development of foot ulcers and eventual lower limb amputation, were followed for 4 years. Of the 224 high-risk patients admitted to the hospital, 74 amputations (5.5%) of all or part of a lower limb were performed. Patients undergoing amputation were younger, more severely ill, and required more frequent hospitalizations because of greater organ system involvement. They were also more likely to be institutionalized after discharge. Overall, patients with long-standing adult-onset diabetes, identified as at high risk for foot ulcer development, have a substantially increased risk for lower limb amputation, multiple organ system failure, hospitalization, and institutionalization than do diabetic patients as a whole. Clinical benchmarking facilitates the identification and reduction of unnecessary variations in patient care practices. Here, a formal benchmark analysis provides the current outcome expectations for amputation rates and co-morbidities in patients with diabetes who are classified as at high risk for lower extremity amputation. Management of these patients in a structured, multidisciplinary foot salvage clinic, augmentation of baseline services, and preliminary benchmark data may provide a standard for the measurement of therapeutic interventions that improve patient care.

Adult↗

PubMed2001

Speeds and wingbeat frequencies of migrating birds compared with calculated benchmarks.

Sixteen species of birds passing Falsterbo in southwest Sweden during the autumn migration season were observed using short-range optical methods. Air speeds and wingbeat frequencies were measured, reduced to sea level, and compared with benchmark values computed by Flight.bas, a published flight performance program based on flight mechanics. The benchmark for air speed was the calculated sea-level value of the minimum power speed (V(mp)). The mean speeds of three raptor species that flew by flap-gliding were below V(mp), apparently because the flap-glide cycle involved slowing down below V(mp) when gliding and accelerating back up to V(mp) when flapping. The mean speeds of 11 species that flew by continuous flapping were between 0.82V(mp) and 1.27V(mp). Two passerine species that flew by bounding had mean speeds of 1.70V(mp) and 1.96V(mp), but these high mean speeds reflected their ability to fly faster against head winds. These results do not support predictions from optimal migration theory, which suggest that migrating birds 'should' fly faster, relative to V(mp). However, observations were restricted for technical reasons to birds flying below 200 m and may not represent birds that were seriously committed to long-distance migration. The benchmark wingbeat frequency (f(ref)) was derived from dimensional reasoning, not from statistical analysis of observations. Observed wingbeat frequencies ranged from 0.81f(ref) to 1.05f(ref), except in the two bounding species, whose wingbeat frequencies appeared anomalously high. However, the mechanics of bounding with a power fraction q imply that gravity during the flapping phase is increased by a factor 1/q, and when the value of gravity was so adjusted in the expression for f(ref), the wingbeat frequencies of the two bounding species were predicted correctly as a function of the power fraction. In small birds with more muscle power than is required to fly at speeds near V(mp), bounding is an effective method of adjusting the specific work in the muscle fibres, allowing conversion efficiency to be maximised over a wide range of speeds.

Animal Migration↗

PubMedDate not supplied

Benchmark matrix and guide: Part I. Headquarters Air Force Logistics Command, Wright-Patterson Air Force Base, OH.

The President's Award for Quality and Productivity Improvement is the highest recognition of improvements in quality and productivity in the federal government and is equivalent to the Malcolm Baldrige Award. It is awarded to agencies, or major components of agencies, that have implemented total quality management (TQM) in an exemplary manner resulting in high quality products and services, and effective use of taxpayers' dollars. On May 23, 1991, Headquarters Air Force Logistics Command at Wright-Patterson Air Force Base was notified that it had won this prestigious award. This first article of a three-part series was authored by a special working group within Headquarters Air Force Logistics Command that was tasked with developing a benchmarking system to measure progress in implementing total quality management (TQM). The tasking was in support of the near-term vision initiative to develop a guideline pamphlet for measurement. This benchmark matrix should be used periodically to identify those categories that need additional emphasis, but it should be seen as a self-assessment tool only. The intent was to provide a method of measuring behaviorally oriented activity that can be documented or observed. Real process improvement can begin only when a process cna be understood and measured. Benchmarking is a viable means to do this and should be used in combination with other TQM methodology.

Outcome and Process Assessment, Health Care↗

PubMedDate not supplied

Benchmark matrix and guide: Part II.

In the last issue of the Journal of Quality Assurance (September/October 1991, Volume 13, Number 5, pp. 14-19), the benchmark matrix developed by Headquarters Air Force Logistics Command was published. Five horizontal levels on the matrix delineate progress in TQM: business as usual, initiation, implementation, expansion, and integration. The six vertical categories that are critical to the success of TQM are leadership, structure, training, recognition, process improvement, and customer focus. In this issue, "Benchmark Matrix and Guide: Part II" will show specifically how to apply the categories of leadership, structure, and training to the benchmark matrix progress levels. At the intersection of each category and level, specific behavior objectives are listed with supporting behaviors and guidelines. Some categories will have objectives that are relatively easy to accomplish, allowing quick progress from one level to the next. Other categories will take considerable time and effort to complete. In the next issue, Part III of this series will focus on recognition, process improvement, and customer focus.

Behavior↗

PubMed1994

Health care benchmarking: a team approach.

The management tool of benchmarking, widely used in industry for more than a decade, is today being adapted for health care organizations. Hospitals and other health care providers are developing ways to compare their practices, processes, and resulting outcomes with other organizations in order to discover "best practices." This article describes a team approach to health care benchmarking and details several projects being conducted by hospitals in The SunHealth Alliance. The examples include benchmarking for both operational and clinical processes.

Cardiology Service, Hospital↗

PubMed1994

How hospitals can use internal benchmark data to create effective managed care arrangements.

Hospitals are now adopting benchmarking techniques, along with total quality management techniques, in order to provide employers with detailed data and process comparisons with hospital competitors. Traditionally, employers have relied on inpatient price and length of stay as primary measures of hospital performance. However, successful hospital benchmarking can expand those measures to include additional factors such as quality, value, and outcome. This article describes how hospitals can use internal benchmark data to create effective managed care arrangements with employers.

Contract Services↗

PubMedDate not supplied

Benchmarking: breakthrough results through structured analysis.

Benchmarking is the continuous process of measuring processes, services and practices against the toughest competition, or against companies recognized as industry leaders, for the purpose of identifying and adopting best practices. To facilitate this process, the Hamilton Civic Hospitals has developed a series of benchmarking templates, loosely based on the "unified model" of quality. This article presents the templates and describes their application as part of a benchmarking feedback loop.

Efficiency, Organizational↗

PubMed1997

Don't fret if you can't find your benchmarking mate.

Some satisfaction issues are universal. Almost every industry surveys its customers on issues similar to those examined by health care. Health care providers are not restricted to benchmarking against other providers. There are viable partners in other industries to benchmark against. If your facility's surveys are always 100%, have a low response rate, or show problem areas, it's probably time to benchmark patient satisfaction.

Efficiency, Organizational↗

PubMed2001

System analysis for optimal control of a wastewater treatment benchmark.

The paper presents an analysis and optimisation of a wastewater treatment benchmark. The benchmark is a simulation environment defining a plant layout, simulation model, influent data, test procedures and evaluating criteria that should be used for comparing different control strategies. In this paper an analysis of the benchmark which addresses the influences of potential manipulated variables on control performance under different operating conditions is presented. In the study optimisation is used to define the optimal values of the manipulated variables under constant as well as dynamic influent conditions. The results indicate that such an analysis and optimisation give important information about the manipulated variables under varying influent conditions and consequently about possible control strategies.

Computer Simulation↗

PubMed1997

Benchmarking in physiotherapy education: a collaborative project.

Many factors including demands for accountability and funding reductions give rise to the need for educational institutions to demonstrate their quality for purposes of public accountability and in order to attract students, both local and international. Benchmarking is a process which can address this need. Benchmarking also is a strategy for program evaluation and development which can be used in other fields such as clinical practice. The project reported in this paper concerns the school of physiotherapy in Australia and New Zealand. It utilises the concept of benchmarking within a collaborative context in order to incorporate the most positive aspects of seeking and achieving excellence within a peer review framework.

Journal Article↗

PubMed2002

Pacific steelhead (Oncorhynchus mykiss) exposed to chlorpyrifos: benchmark concentration estimates for acetylcholinesterase inhibition.

Steelhead trout (Oncorhynchus mykiss) were exposed for 96 h to the organophosphate chlorpyrifos to establish benchmark concentration (BMC) values in the low-effect range of brain acetylcholinesterase (AChE) inhibition. The U.S. Environmental Protection Agency (U.S. EPA) benchmark dose software was used to model the data. Benchmark concentrations were determined for a range of inhibition levels at 5, 10, and 20%, at 1 and 2 control standard deviations (SD), and at an experimental limit-of-detection level of 2.5%. One contributing difficulty in establishing precise inhibition BMCs in the lower effect region is the variability associated with the AChE analytical method. To minimize this variability, the Ellman method was modified specifically for analysis of O. mykiss brain tissue. Laboratory-established BMCs for chlorpyrifos were then compared with the U.S. EPA 96-h water quality criteria and with the concentration levels detected in Northwest surface waters that are home to threatened steelhead trout. The U.S. EPA 96-h water quality criteria of 0.083 microg/L is below the BMC(02.5), the limit-of-detection value for this study. The average chlorpyrifos concentration detected during a two-week period in one monitored stream was 0.127 microg/L, which approaches the BMC(02.5). The peak chlorpyrifos concentration detected at 0.482 microg/L is near the BMC(1SD) estimate.

Acetylcholinesterase↗

PubMed2004

[Calculation of the combined renal dysfunction risk in patients co-exposed to arsenicum and cadmium by using benchmark dose method].

OBJECTIVE: To research the impairment of renal function and the combined effects of arsenic and cadmium exposure in population residing in polluted area, and to calculate the benchmark doses of urinary arsenic (UAs) and cadmium (UCd) in renal dysfunction. METHODS: The concentrations of Uas and UCd were used as as exposure biomarker. Urinary beta(2)-microglobulin (Ubeta(2)-MG), N-acetyl-beta-glucosaminidase (UNAG), and albumin were calculated as biomarkers of renal dysfunction. The benchmark dose (BMD) and the lower confidence limit of the benchmark dose (BMDL) were calculated. Totally 245 patients were enrolled in the study, them, of 122 were from the exposed area, and 123 from the control area. RESULTS: UAs and UCd concentrations in the exposed group were shown significantly higher than those in the control group (P < 0.01). The levels of Ubeta(2)-MG, UNAG and urinary albumin in the exposed group were significantly higher than those of the controls (P < 0.01). There existed positive correlation among the concentrations of UAs, UCd, Ubeta(2)-MG, urinary albumin and UNAG, showing a significant dose-effect relationship. The combination of cadmium and arsenic caused even more renal injury than by chemicals alone in a same dose. The BMD/BMDL of UAs were estimated as 121.91-171.88 microg/g Cr and 102.11-144.44 microg/g Cr. Of UCd, the BMD/BMDL were 1.05-1.48 microg/g Cr and 0.88-1.24 microg/g Cr. CONCLUSIONS: This study indicates the combination of cadmium and arsenic might cause even more renal injury than by chemicals given alone, and cadmium might cause potential arsenic nephrotoxicity during long-term coexposure to arsenic and cadmium in human beings. It also suggests that UAs and UCd should be kept below 102.11 and 0.88 microg/g creatinine as to preventing renal damage from coexposure to arsenic and cadmium. The BMD method should be used in calculating the BMD of UAs and UCd on renal dysfunction.

Acetylglucosaminidase↗

PubMedDate not supplied

Benchmarking for clinical pathways in hospitals: a summary of sources.

Benchmarks are criteria and standards for resource expenditure, as well as other variables, derived from organizations or communities which have been identified as models of the most effective and efficient practices. The development of benchmarks is crucial to reducing lengths of stay and related costs in hospitals. Useful sources for benchmarking data and how to access them are summarized.

Critical Pathways↗

PubMedDate not supplied

The application of collaborative benchmarking to the prevention and treatment of pressure ulcers.

In the spring of 1995, 42 hospitals participated in a collaborative benchmarking study on the prevention and treatment of pressure ulcers. The study resulted in the discovery of 54 best practices that, taken together, provide a blueprint for successful actions and processes that can easily be adapted to individual institutional needs. An important finding of this benchmarking study showed that the four hospitals with lowest risk-adjusted, hospital-acquired prevalence rates were the same four hospitals identified as benchmarks in at least four other critical-success factors. During the study, representatives were exposed not only to the practices of care delivered at other hospitals, but also to the rationale, limitations, and success of those practices. This understanding, coupled with the best practices, has helped representatives improve their facilities' pressure ulcer programs.

Humans↗

PubMedDate not supplied

Using benchmarking to identify standards for restructuring.

Benchmarking is a process of comparing an organization's performance to that of a selected standard. Because the standard is one selected from other organizations for their "best" performance, benchmarking establishes a vision or goal for restructuring. This author, who is experienced in helping organizations restructure using the benchmarking process describes the steps and how to use it to guide an organization to successful restructuring.

Hospital Administration↗

PubMedDate not supplied

Using benchmarking in the hospital environment: a case study.

As the industry becomes more competitive, many hospitals and other healthcare companies are turning to benchmarking to help them make appropriate changes to their organizations. Benchmarking allows companies to identify "best practices" and make process comparisons with other organizations. The University of Cincinnati Hospital is one example of a hospital that has effectively used benchmarking for process improvement.

Hospitals, University↗

PubMed1996

Assessing the performance of fold recognition methods by means of a comprehensive benchmark.

Recently there has been an explosion of methods for fold recognition. These methods seek to align a protein sequence to a three-dimensional structure and measure the compatibility of the sequence to the structure. In this work, we present a benchmark to assess the performance of such methods. The benchmark consists of a set of protein sequences matched by superposition to known structures. This set covers a wide range of protein families, and includes matching proteins with insignificant sequence similarity. To demonstrate the usefulness of this benchmark, we apply it here to compare different fold-recognition methods developed through the years in our group as well as several sequence-sequence substitution matrices. The results show that "global-local" alignments are superior to either local or global alignments. The most effective sequence-sequence matching matrix is the Gonnet table. The best performance overall is obtained by a method which combines the 3D-1D profiles of Bowie et al. with a substitution matrix and takes into account residue pairwise interactions.

Amino Acid Sequence↗