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PubMed2001

Benchmarking safety climate in hazardous environments: a longitudinal, interorganizational approach.

Safety climate is an important element of organizational reliability. This study applied benchmarking strategies for monitoring safety climate across nine North Sea oil and gas installations that were surveyed in consecutive years. Examination of absolute changes in safety climate complemented the benchmarking approach. Discriminant function analyses (DFA) identified the elements of safety climate predictive of self-reported accidents; correlational analyses were applied to the scale scores and accident proportions across the year period. Absolute improvements were substantial, with safety climate profiles converging in the second year. Large relative improvements were also observed. DFA highlighted perceived management commitment to safety and willingness to report accidents as significant predictors of personal accident involvement. Changes in perceived management commitment to safety were closely associated with changes in safety behavior.

Benchmarking↗
PubMed2005

Benchmarks for antibiotic use and cost in long-term care.

OBJECTIVES: To evaluate previously described antibiotic use and cost indicators in community nursing homes to determine whether they may be useful as benchmarks and to evaluate the association between functional status, infection occurrence, and antibiotic use. DESIGN: Retrospective observational study. SETTING: Eleven proprietary long-term care facilities owned by one company. PARTICIPANTS: Only facility-specific cumulative data were used. MEASUREMENTS: Antibiotic use and cost indicators (incidence of antibiotic use, antibiotic utilization ratio, cost of antibiotics per resident care day (RCD), and cost per antibiotic day), infection rates, and functional status as measured using the case-mix index (CMI) of the Resource Utilization Groups II system. Mean yearly values for each measure were calculated for each facility. RESULTS: There was significant variation in all of the antibiotic indicators between the 11 nursing homes, but there was no correlation between mean facility CMI and infection rate. However, there was a trend toward a significant correlation between mean facility CMI and mean facility incidence of antibiotic use, antibiotic utilization rate, and cost per RCD. Variation in mean facility infection rate explained 66% of the variation in mean facility incidence of antibiotic use (P<.001). In a multivariate analysis, mean facility infection rate (P=.003) and mean facility CMI (P=.046) were predictors of mean incidence of antibiotic use and explained 83% of the variation in dependent variable. CONCLUSION: The significant variation in mean antibiotic use and cost indicators between the 11 study facilities suggests that these indicators may be useful as benchmarks for quality-improvement efforts. For the first time, objective evidence is provided demonstrating the influence of functional status on antibiotic use in the nursing home setting.

Aged↗
PubMed2005

Benchmark analysis: shopping with proper confidence.

We discuss the issue of using benchmark doses for quantifying (excess) risk associated with exposure to environmental hazards. The paradigm of low-dose risk estimation in dose-response modeling is used as the primary application scenario. Emphasis is placed on making simultaneous inferences on benchmark doses when data are in the form of proportions, although the concepts translate easily to other forms of outcome data.

Aflatoxin B1↗
PubMed2005

Benchmark dose of lead inducing anemia at the workplace.

To estimate the critical dose of lead inducing anemia in humans, the effects of lead on hemoglobin (Hb) and hematocrit (Hct) levels and red blood cell (RBC) count were examined in 388 male lead-exposed workers with blood lead (BPb) levels of 0.05-5.5 (mean 1.3) micromol/L by using the benchmark dose (BMD) approach. The BPb level was significantly related to Hb (regression coefficient beta=-0.276), RBC (beta=-11.35), and Hct (beta=-0.563) among the workers (p < 0.001) when controlling for age and working status. The average BPb levels were significantly higher in the workers with anemia (1.85 micromol/L), based on the WHO criteria, than in those without anemia (1.26 micromol/L). The benchmark dose levels of BPb (i.e., lower 95% confidence limits of BMD), calculated from the K-power model set at an abnormal probability of 5% in unexposed workers and an excess risk of 5% in exposed workers were estimated to be 0.94 micromol/L (19.5 microg/dl) for Hb, 0.94 micromol/L (19.4 microg/dl) for RBC, and 1.43 micromol/L (29.6 microg/dl) for Hct. These findings suggest that reduction in hematopoietic indicators may be initiated at BPbs below the level currently considered without effect.

Anemia↗
PubMed2004

Benchmark solution for the prediction of temperature distributions during radiofrequency ablation of cardiac tissue.

Several studies on radiofrequency (RF) ablation are aimed at accurately predicting tissue temperature distributions by numerical solution of the bioheat equation. This paper describes the development of a solution that can serve as a benchmark for subsequent numerical solutions. The solution was obtained using integral transforms and evaluated using a C program. Temperature profiles were generated at various times and for different convection coefficients. In addition, a numerical model was developed using the same assumptions made in obtaining the benchmark solution. Comparison of surface and axial temperature profiles shows that the two solutions match very closely, cross validating the numerical methods used in evaluating both solutions.

Algorithms↗
PubMed2000

Fitting and benchmarking of dosimetry data for new brachytherapy sources.

New source designs of encapsulated low-energy gamma emitting nuclides for permanent implants require dosimetric analysis and calibration standardization. The dosimetry measurements can be incorporated into a treatment planning system by fitting the data. The use of a fitting function whose behavior at range limits mimics the physical phenomena, using as few parameters as possible, eliminates noisy outliers and lends credence to calculations beyond the measured range. Clinical implementation of the new sources also requires benchmarking against existing sources, where the current clinical experience lies. We present an analysis of measured dosimetry data for three brachytherapy sources recently available from North American Scientific, Inc. (North Hollywood, CA): 103Pd source model MED3633 ("PdGold"), 125I source models MED3631-A/M ("IoGold-AM") and MED3631-A/S ("IoGold-AS"). Using the formalism of the Interstitial Collaborative Working Group (ICWG) the radial dose function, g(r), the anisotropy function, F(r, theta), and the anisotropy factor, phi an(r), were previously evaluated from measurements of each source design. In this report we use fitting functions whose forms are chosen to approach reasonable values at data limits. These forms are quite similar to those used in a previous analysis of TG43 Iodine and palladium compendium data. Fitting parameter results for each function are provided for each brachytherapy source model. Fit-data discrepancies are smaller than measurement uncertainties, meaning that incorporation into treatment planning systems will not introduce significant errors in clinical use. Current clinical experience is based on the Theragenics (Norcross, GA) 103Pd seed ("PdThera"), and the Nycomed-Amersham (Arlington Heights, IL) 125I seed models 6711 ("6711") and 6702 ("6702"). The new sources are benchmarked against these seeds.

Anisotropy↗
PubMed2006

Raising the benchmark for the 21st century--the 1000 cataract operations audit and survey: outcomes, consultant-supervised training and sourcing NHS choice.

PURPOSE: Clinical outcomes for phacoemulsification surgery are still compared with the almost 10-year-old benchmark of the 1997-98 National Cataract Surgery Survey (NCSS) published in this journal. Extraneous to the peer-reviewed research literature, more recent databases suggest much better results may be being obtained. This offered the rare opportunity to perform an audit as research investigating if this was indeed the case and a new benchmark is needed, with the additional standard of rigorous study peer review by independent senior ophthalmologists. At this pilot centre for Patient Choice provision, all cataract surgery was performed on Consultant-supervised training lists, a novel extension in-sourcing care using public resources rather than to an independent sector that may not be supervised by NHS Consultants. Patient satisfaction was also surveyed. We asked whether the NCSS is out-of-date, and whether good outcomes on Choice schemes are compatible with Consultant-led training within the National Health Service? METHODS: An audit of 1000 consecutive patients undergoing cataract surgery on Patient Choice at the Western Eye Hospital between October 2002 and September 2004. All subjects were scheduled for phacoemulsification. A novel policy was extending "choice" onto training list slots for this period. A validated questionnaire assessed patient satisfaction. RESULTS: A best corrected visual acuity of 6/12 or better was obtained in 93% of cases. Over 80% of cases were +/-1 D of target refraction (65.7% within 0.5 D). The total incidence of complications was 8.7%. Overall incidence of major complications was 2.4%. Incidence of vitreous loss was 1.1% and that of endophthalmitis 0.1%. Complications rates were lowest for consultants (less than 1%). User satisfaction with having cataract surgery on "patient choice" was high. CONCLUSIONS: Cataract surgery under patient choice on supervised training lists is associated with a visual outcome and an incidence of complications at least as good as the published national average. User satisfaction is high. Cataract surgery under patient choice is compatible with training activity in receiving hospitals. The improvement in outcomes since the 1997-98 NCSS suggest that the accepted standards for complication rates should be updated to reflect the fact that phacoemulsification has become an established procedure.

Adult↗
PubMed2006

An audit of the indications for the reporting of blood films: results from the National Pathology Benchmarking Study.

BACKGROUND: The National Pathology Benchmarking Review has completed seven years of analysis of the workload of haematology laboratories in the United Kingdom. OBJECTIVE: To audit criteria that laboratories use for preparing blood films against guidelines published by the International Consensus Group for Haematology Review. METHODS: Each laboratory completed a standard questionnaire about the number of blood counts and blood films done each year. Information was collected on the criteria that were used for preparing a blood film and the manufacturer of the equipment used to carry out the full blood count. RESULTS: 46 NHS trusts (93 laboratory sites) participated in the study. There was wide variation in the criteria used for preparing blood films when compared with the consensus guidelines. The variation in practice appeared to be irrespective of the type of hospital or the manufacturer of the equipment used for the blood count. CONCLUSIONS: There is a wide range in laboratory practice in preparing blood films. The publication of the consensus guidelines should help to standardise practice in this area. The next step in the study is to determine what the film review rate should be if these guidelines are implemented. This will then provide a benchmark of good practice which laboratories can use to assess their performance.

Benchmarking↗
PubMed1999

Setting benchmarks and determining psychiatric workloads in community mental health programs.

Administrators and clinicians must find ways to effectively and efficiently use psychiatric resources without compromising the quality of care. The author outlines a model for setting benchmarks for allocating psychiatrists' time in a community mental health service setting. After the percentage of time for direct-care activities is agreed on (for example, 60 percent), the amounts of time necessary for three direct-care clinical activities-assessment of new patients, follow-up of stable patients, and follow-up of unstable patients and emergencies--are established. Time for documentation should be included in each task. At the end of six months, workloads are evaluated, and benchmarks are reset as appropriate.

Benchmarking↗
PubMed1999

Benchmark analysis of diabetic patients with neuropathic (Charcot) foot deformity.

During a 10-year period, 237 patients (129 women, 108 men) with a diagnosis of neuropathic (Charcot) arthropathy of the foot and ankle were treated in a tertiary care university hospital medical center. During this period, 115 of the patients (48.5%) were treated nonoperatively as outpatients with local skin and nail care, accommodative shoe wear, and custom foot orthoses. A total of 120 (50.6%) underwent 143 operations. Surgery included 21 major limb amputations, 29 ankle fusions, 26 hindfoot fusions, 23 exostectomies, and 23 debridements for osteomyelitis. It is widely accepted that patients with diabetes are at risk for developing foot ulcers, which can lead to lower extremity amputation. Within the population of diabetic patients, it is widely accepted that patients with neuropathic (Charcot) arthropathy of the foot and ankle have one of the highest likelihoods of having to undergo lower extremity amputation. The current emphasis in care of the foot of a diabetic patient involves a multidisciplinary team approach combining patient education, skin and nail care, and accommodative shoe wear. As data from prophylactic programs become available, resource allocation and cost of care can be compared with this benchmark baseline. This benchmark analysis can be used by those who are responsible for allocating resources and projecting healthcare costs for this "high utilization"/high risk patient population.

Ankle Joint↗
PubMed1999

Benchmarking: our stamp and its effects.

All children are entitled to high quality care Providing quality care is everyone's responsibility. Benchmarking promotes comparison and sharing of best practice. Effectiveness of benchmarking can not merely be considered in quantitative terms.

Benchmarking↗
PubMed2005

A software tool for creating simulated outbreaks to benchmark surveillance systems.

BACKGROUND: Evaluating surveillance systems for the early detection of bioterrorism is particularly challenging when systems are designed to detect events for which there are few or no historical examples. One approach to benchmarking outbreak detection performance is to create semi-synthetic datasets containing authentic baseline patient data (noise) and injected artificial patient clusters, as signal. METHODS: We describe a software tool, the AEGIS Cluster Creation Tool (AEGIS-CCT), that enables users to create simulated clusters with controlled feature sets, varying the desired cluster radius, density, distance, relative location from a reference point, and temporal epidemiological growth pattern. AEGIS-CCT does not require the use of an external geographical information system program for cluster creation. The cluster creation tool is an open source program, implemented in Java and is freely available under the Lesser GNU Public License at its Sourceforge website. Cluster data are written to files or can be appended to existing files so that the resulting file will include both existing baseline and artificially added cases. Multiple cluster file creation is an automated process in which multiple cluster files are created by varying a single parameter within a user-specified range. To evaluate the output of this software tool, sets of test clusters were created and graphically rendered. RESULTS: Based on user-specified parameters describing the location, properties, and temporal pattern of simulated clusters, AEGIS-CCT created clusters accurately and uniformly. CONCLUSION: AEGIS-CCT enables the ready creation of datasets for benchmarking outbreak detection systems. It may be useful for automating the testing and validation of spatial and temporal cluster detection algorithms.

Algorithms↗
PubMed2006

The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research.

BACKGROUND: There is widespread interest in measuring healthcare provider attitudes about issues relevant to patient safety (often called safety climate or safety culture). Here we report the psychometric properties, establish benchmarking data, and discuss emerging areas of research with the University of Texas Safety Attitudes Questionnaire. METHODS: Six cross-sectional surveys of health care providers (n = 10,843) in 203 clinical areas (including critical care units, operating rooms, inpatient settings, and ambulatory clinics) in three countries (USA, UK, New Zealand). Multilevel factor analyses yielded results at the clinical area level and the respondent nested within clinical area level. We report scale reliability, floor/ceiling effects, item factor loadings, inter-factor correlations, and percentage of respondents who agree with each item and scale. RESULTS: A six factor model of provider attitudes fit to the data at both the clinical area and respondent nested within clinical area levels. The factors were: Teamwork Climate, Safety Climate, Perceptions of Management, Job Satisfaction, Working Conditions, and Stress Recognition. Scale reliability was 0.9. Provider attitudes varied greatly both within and among organizations. Results are presented to allow benchmarking among organizations and emerging research is discussed. CONCLUSION: The Safety Attitudes Questionnaire demonstrated good psychometric properties. Healthcare organizations can use the survey to measure caregiver attitudes about six patient safety-related domains, to compare themselves with other organizations, to prompt interventions to improve safety attitudes and to measure the effectiveness of these interventions.

Ambulatory Care Facilities↗
PubMed2006

Emergency department performance measures and benchmarking summit.

The findings are presented of a consensus group created to address the standardization of performance measures for emergency medicine. This group, whose members have affiliations with most major organizations interested in emergency medicine performance, benchmarking and quality improvement, was tasked with standardizing definitions pertinent to emergency department performance measures, creating a set of general and operational measures, developing a comparison system for benchmarking and creating a plan for the dissemination of this information. The formation of this group, the problem statement, and the mission statement for the summit are all described, and the consensus document is presented.

Benchmarking↗
PubMed1999

The X-ray and electron benchmarking of the Monte Carlo codes MCNP-4A and 4B on different computers.

MCNP (Monte Carlo N-Particle) is a Monte Carlo transport code which has been of widespread use in modelling the dosimetry of ionizing radiations. The most recent version (4B) features improved electron transport compared with the previous version 4A. The processing time required by a number of computing systems to carry out X-ray and electron transport calculations using both versions of the code was compared. Version 4A was installed onto a Dec Alpha Server 8200, a personal computer (Pentium 90 MHz), and a Sun Sparc20, 10, 4 and 1+. MCNP-4B was also installed onto the Sun Sparc20. The benchmark tests consisted of determining the transmission of 2 MeV X-rays and 30 MeV electrons through lead. It was found that the Dec Alpha Server 8200 was the fastest computing platform, and the Sun Sparc1+ was the slowest for both tests. The difference in computational speed between different platforms was not matched by the corresponding differences in price. The time required by version 4B to complete the X-ray and electron benchmark tests was found to be 1.4 and 2.3 times greater than version 4A, respectively, without any difference in the results of the calculation for each type of radiation. This suggests that in cases where computing time is important, it may be preferable to use version 4A instead of 4B.

Benchmarking↗
PubMed2001

Altered operant responding for motor reinforcement and the determination of benchmark doses following perinatal exposure to low-level 2,3,7,8-tetrachlorodibenzo-p-dioxin.

Pregnant Holtzman rats were exposed to a single oral dose of 0, 20, 60, or 180 ng/kg 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on the 18th day of gestation. Their adult female offspring were trained to respond on a lever for brief opportunities to run in specially designed running wheels. Once they had begun responding on a fixed-ratio 1 (FR1) schedule of reinforcement, the fixed-ratio requirement for lever pressing was increased at five-session intervals to values of FR2, FR5, FR10, FR20, and FR30. We examined vaginal cytology after each behavior session to track estrous cyclicity. Under each of the FR values, perinatal TCDD exposure produced a significant dose-related reduction in the number of earned opportunities to run, the lever response rate, and the total number of revolutions in the wheel. Estrous cyclicity was not affected. Because of the consistent dose-response relationship at all FR values, we used the behavioral data to calculate benchmark doses based on displacements from modeled zero-dose performance of 1% (ED(01)) and 10% (ED(10)), as determined by a quadratic fit to the dose-response function. The mean ED(10) benchmark dose for earned run opportunities was 10.13 ng/kg with a 95% lower bound of 5.77 ng/kg. The corresponding ED(01) was 0.98 ng/kg with a 95% lower bound of 0.83 ng/kg. The mean ED(10) for total wheel revolutions was calculated as 7.32 ng/kg with a 95% lower bound of 5.41 ng/kg. The corresponding ED(01) was 0.71 ng/kg with a 95% lower bound of 0.60. These values should be viewed from the perspective of current human body burdens, whose average value, based on TCDD toxic equivalents, has been calculated as 13 ng/kg.

Administration, Oral↗
PubMed2002

A benchmark dose analysis of prenatal exposure to polychlorinated biphenyls.

Benchmark dose (BMD) analysis is used to determine levels of exposure to environmental contaminants associated with increased public health risk. In this study we used a benchmark approach to evaluate the risks associated with prenatal exposure to polychlorinated biphenyls (PCBs). We evaluated for intellectual impairment a cohort of children whose prenatal PCB exposure had been assessed from biologic specimens. We calculated BMDs and lower-bound confidence limits (BMDLs) for four end points using four sets of risk criteria. BMDLs were estimated using three different statistical methodologies. The BMDs and BMDLs were remarkably consistent across the four end points for each set of risk criteria, but differed substantially for the different risk criteria. The proportion of the sample considered at risk ranged from 9.8% for the least protective criteria to 74.1% for the most protective. Two methodologies, likelihood ratio and bootstrapping, generated generally similar BMDLs. BMD analysis provides a straightforward, reliable method for evaluating levels of exposure associated with increased public health risk. In the analyses performed in this study, the number of individuals considered at risk depended more on the risk criterion selected than on the outcome assessed.

Adult↗
PubMedDate not supplied

Benchmarking best practice for external ventricular drainage.

Sharing of best practice and use of all available evidence is important in developing effective clinical guidelines for nursing practice. This can be achieved through benchmarking. Sharing of good practice and achieving consensus guidelines can avoid repetition of effort by nurses engaged in similar fields of practice. The Pan London Neuroscience Practice Development Forum was established in 1998 to share best practice within the field of neuroscience nursing across London. The Pan London Forum has now achieved consensus and developed evidence-based clinical guidelines for the management of external ventricular drainage. Within the scope of this article, the principles of external ventricular drainage will be highlighted, before identifying the evidence base for nursing management of patients. Approaches for troubleshooting common problems will also be discussed and the benchmarked clinical guidelines will be presented.

Benchmarking↗