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PubMed2005

Benchmark calculations of proton affinities and gas-phase basicities of molecules important in the study of biological phosphoryl transfer.

Benchmark calculations of proton affinities and gas-phase basicities of molecules most relevant to biological phosphoryl transfer reactions are presented and compared with available experimental results. The accuracy of proton affinity and gas-phase basicity results obtained from several multi-level model chemistries (CBS-QB3, G3B3, and G3MP2B3) and density-functional quantum models (PBE0, B1B95, and B3LYP) are assessed and compared. From these data, a set of empirical bond enthalpy, entropy, and free energy corrections are introduced that considerably improve the accuracy and predictive capability of the methods. These corrections are applied to the prediction of proton affinity and gas-phase basicity values of important biological phosphates and phosphoranes for which experimental data does not currently exist. Comparison is made with results from semiempirical quantum models that are commonly employed in hybrid quantum mechanical/molecular mechanical simulations. Data suggest that the design of improved semiempirical quantum models with increased accuracy for relative proton affinity values is necessary to obtain quantitative accuracy for phosphoryl transfer reactions in solution, enzymes, and ribozymes.

Algorithms↗
PubMed2004

The use of a national transplant registry to benchmark transplant outcome for patients undergoing autologous and allogeneic stem cell transplantation in the United Kingdom and Ireland.

As part of its clinical governance programme the British Society for Blood and Marrow Transplantation (BSBMT) undertook an analysis of transplant outcome for adults undergoing human leucocyte antigen - identical sibling allogeneic transplantation for chronic myeloid leukaemia (CML) in first chronic phase (CP1) or autologous transplantation for Hodgkin's disease (HD). The study aimed to compare transplant-related mortality (TRM) and survival for patients reported to the BSBMT with patients transplanted in the rest of Europe, reported to the European Group for Blood and Marrow Transplantation (EBMT). The outcomes for 104 allogeneic transplants for CML in 24 UK/Irish centres were compared with 775 allografts in 145 other European centres. For HD, 241 autografts from 38 UK/Irish centres were compared with 1145 transplants in 239 other European centres. For both diseases, the cohorts were broadly matched with the exception of CML, where 85% of patients were transplanted <1 year from diagnosis in the UK/Ireland compared with 68% in the EBMT (P = 0.001). Cox regression analysis was undertaken using known delineated variables affecting transplant outcome in addition to the registry of origin. The adjusted survival curves for CML showed no significant differences between the two groups, with 3-year survival probabilities of 70.2% and 67.1% for the EBMT and BSBMT cohorts respectively. Likewise, the analysis for HD showed overlapping survival curves, with 3-year survival probabilities of 71.8% (EBMT) and 70.8% (BSBMT). TRM was not statistically different in either disease. This study demonstrates the potential for using national registries to benchmark transplant outcome against the EBMT registry.

Adolescent↗
PubMed2002

Developing benchmark inventories to assess the content of telephone consultations in accident and emergency departments: use of the Delphi technique.

The provision of telephone advice to members of the general public from staff based in accident and emergency departments is common practice. However, it is largely conducted on an ad hoc basis without the use of formal guidelines or decision support. The evidence base from which to derive guidelines for the telephone assessment and advice of many common conditions is lacking. This study, using the Delphi technique, was undertaken to develop a number of benchmarks for use as objective measures against which the comprehensiveness of telephone assessments could be tested. Consensus views on the essential and desirable items to be considered for each of 10 presenting complaints was achieved. It is argued that establishing consensus views on clinical topics provides an effective means of developing an evidence base where other sources of evidence are lacking.

Benchmarking↗
PubMed2001

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

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

Acute Disease↗
PubMed2003

The use of benchmarking to identify top performing critical care units: a preliminary assessment of their policies and practices.

PURPOSE: To describe the policies and practices of intensive care units (ICUs) with good patient survival and highly efficient resource use and to identify relevant variables for future investigation. MATERIALS AND METHODS: We used clinical data for 359,715 patients from 108 ICUs to compare the ratios of actual with Acute Physiology and Chronic Health Evaluation (APACHE) III predicted hospital mortality, ICU and hospital stay, and the proportion of low-risk monitor patients. The best performing ICUs (top 10%) were defined by a mortality ratio of 1.0 or less, and either the lowest ratio for ICU stay, hospital stay, or percentage of low-risk monitor patients. The medical and nursing directors of top performing ICUs completed a questionnaire to describe their unit's structure policies and practices. RESULTS: Among the 108 ICUs, 61 (56%) had a ratio of actual to predicted hospital mortality of 1.0 or less and the best performing units had ICU stay ratios of 0.62 to 0.79, hospital stay ratios of 0.73 to 0.77, and admitted 10% to 38% low-risk monitor patients. ICU structure varied among the best performing ICUs. Units with the shortest ICU and hospital stay had alternatives to intensive care, methods to facilitate patient throughput, used multiple protocols for high-volume diagnoses and care processes, and continuously monitored resource use. Units with the fewest low-risk monitor patients screened potential admissions, had intermediate care areas, extended-stay recovery rooms, and care pathways for high-volume diagnoses. CONCLUSIONS: Benchmarking can be used to identify ICUs with good patient survival and highly efficient resource use. The combination of policies and practices used by these units might improve resource use in other ICUs.

APACHE↗
PubMedDate not supplied

[Duration of inpatient depression treatment--fair benchmarking between hospitals].

Process and outcome quality of inpatient treatment of depression in Germany was described in a multicenter study of 10 hospitals in North-Rhine Westphalia, Baden-Württemberg and Bavaria. The treatment of more than 2000 depressive patients was assessed by quality indicators and outcome was compared between the hospitals (benchmarking). Results show great variance in length of stay between the hospitals. While in one hospital patients with depressive episodes were discharged after 36.8 days (average), the average length of stay in another hospital was 64.3 days. Furthermore the study revealed that hospitals differ strongly regarding their case-mix. Using stepwise multiple regression analyses potential confounding variables (sociodemographics, history of previous treatment, severity of depression) were identified and their influence on length of stay was calculated. After cross validation the regression analyses model explained 7% of the variance and included 5 predictors. Length of stay is prolonged by patients with a recurrent depressive disorder, by patients with impairment of social functioning and by severity of the depression. Length of stay is reduced if the indication of inpatient treatment was crisis intervention and if there was a previous suicide attempt. It was shown that differences in patient case-mix only account for a small percentage of hospital differences in length of stay. Method, effort and benefit of the regression analyses approach are discussed.

Adult↗
PubMedDate not supplied

Nurses Improving Care for Healthsystem Elders (NICHE): using outcomes and benchmarks for evidenced-based practice.

This article describes Nurses Improving Care for Healthsystem Elders (NICHE), a project begun in 1992 with four pilot hospitals. These pilot hospitals gathered baseline data using a geriatric institutional assessment profile (GIAP) with a pre- and postdesign to capture changes in staff attitudes, knowledge, and perceptions of the care of older adults. Based on the success of the pilot effort, NICHE, now in its eighth year, has evolved into a program that involves 32 health systems comprising 105 hospitals nationally. To date, more than 10,000 GIAPs have been collected by NICHE hospital staff. All NICHE settings are able to benchmark their GIAP data against comparable institutions (eg, urban, rural, university, community settings) to understand how they compare and then interpret the data at their unique sites. The opportunities for continuous quality improvement through the NICHE program are described.

Aged↗
PubMed2003

Surgical site infections in patients undergoing major operations in a university hospital: using standardized infection ratio as a benchmarking tool.

BACKGROUND: Because patterns of infection acquired in patients undergoing operation are ever changing, it is an essential part of nosocomial infection surveillance programs to periodically document the epidemiologic features of infection in these patients. This study was conducted with the primary intention of describing the incidence and risk factors of the surgical site infection (SSI). METHODS: We performed a prospective study in patients undergoing certain major operations at a 750-bed university hospital in Thailand. The National Nosocomial Infection Surveillance (NNIS) system method and criteria were used for identifying and diagnosing infection. The infection rates were benchmarked with the NNIS report by means of indirect standardization and reported in terms of standardized infection ratio. Risk factors for SSI were evaluated using the multiple logistic regression model. RESULTS: From September 1998 to March 2000, the study included 4193 patients with 4437 major operations. The study identified 192 SSIs, 76 urinary catheter-related urinary tract infections, 26 central line-related bloodstream infections, and 39 instances of ventilator-associated pneumonia (VAP), yielding an infection rate of 4.3 SSIs/100 operations, 11.0 catheter-related urinary tract infections/1000 urinary catheter-days, 6.1 central line-related bloodstream infections/1000 central line-days, and 11.0 VAPs/1000 ventilator-days. When compared with data from NNIS, the standardized infection ratio of SSI, catheter-related urinary tract infection, central line-related bloodstream infection, and VAP were 2.3, 2.1, 1.1, and 0.8, respectively. The factors that significantly associated with SSI were duration of operation in minutes, American Society of Anesthesiologists (ASA) class, and degree of wound contamination. CONCLUSION: All of the infection rates identified, except VAP, were higher than the average NNIS rates. The risk factors for SSI were prolonged duration of operation, poor physical status according to ASA classification, and higher degree of wound contamination.

Adolescent↗
PubMed2002

Outcomes of carotid endarterectomy: how does the Australian state of New South Wales compare with international benchmarks?

OBJECTIVES: The objective of this study was to determine the outcomes of carotid endarterectomy (CEA) in New South Wales, Australia. METHODS: This state-wide prospective audit of all public and private hospitals during a 6-month period had main outcome measures of 30-day mortality, 30-day fatal stroke, 30-day nonfatal stroke, and 30-day combined stroke and mortality. RESULTS: Fifty-three of 54 eligible surgeons participated (response rate, 98%). The audit obtained inpatient data for 689 internal CEA procedures performed on 666 patients. Of 666 first or only procedures, 462 (69.4%) were performed on patients who were symptomatic and 204 (30.6%) on patients who were asymptomatic. After adjustment for cluster by surgeon, we determined a state-wide 30-day death rate of 1.2% (95% CI, 0.3% to 2.1%), a 30-day fatal or nonfatal stroke rate of 3.0% (95% CI, 1.6% to 4.4%; ipsilateral stroke, 2.6%), a 30-day nonfatal stroke rate of 2.3% (95% CI, 1.1% to 3.4%; ipsilateral stroke, 2.0%), and a 30-day combined stroke and death rate of 3.5% (95% CI, 2.1% to 4.9%). A significant linear relationship was found between patient preoperative hypertensive status and the combined 30-day stroke and death rate (trend odds ratio, 3.5; 95% CI, 1.6 to 7.7). No association was seen between any main outcome measures and hospital volume (<10 CEAs versus > or = 10 CEAs). Four patients underwent surgery outside guideline recommendations (CEA performed for either < or = 30% stenosis or occluded carotid artery). CONCLUSION: This first comprehensive state-wide audit confirms that Australian surgeons achieve 30-day outcomes comparable with international benchmarks.

Age Factors↗
PubMed2001

International mental health outcomes and benchmarking using the FACE (functional analysis of care environments) approach.

This article describes and compares the nature and severity of problems encountered by persons receiving mental health services in the United Kingdom and Australia, and the outcome of their treatment. The perspective of service providers and service users in the two countries was strikingly similar. Treatment was effective in alleviating problems with social circumstances, and in increasing adaptive and interpersonal functioning. Treatment was less effective in addressing psychological or physical problems. Service users in the United Kingdom were more involved in developing their treatment care plan than those in Australia. The study demonstrates how data required for benchmarking and outcome evaluation purposes can be generated as part of routine clinical processes.

Activities of Daily Living↗
PubMed2002

Benchmarking working time in health care: the case of Excelcare.

In the 2000-2004 Enterprise Bargaining round between the Australian Nursing Union and the South Australian state government, it was agreed that public hospitals would be staffed according to Excelcare timings or benchmarks. Excelcare is a computerised workload produce that measures the number of hours and minutes needed to perform a range of nursing tasks for patients on a given ward. This brought into sharp relief disagreements between the various parties over Excelcare timings, but more importantly, it illustrates the unions' strategic use of the Enterprise Bargaining process to de-intensify nursing labour.

Benchmarking↗
PubMed2002

Dietary fat: assessing the evidence in support of a moderate-fat diet; the benchmark based on lipoprotein metabolism.

There is a growing database that has evaluated the effects of varying amounts of total fat on risk factors for cardiovascular disease, diabetes and overweight and obesity. The evidence clearly suggests that extremes in dietary fat should be avoided, and instead a diet moderate in total fat (25-35 % energy) is preferable for the majority of individuals. Moreover, we now appreciate the importance of individualizing dietary fat recommendations within this range of total fat. With respect to cardiovascular disease, a diet higher in total fat (30-35 % energy) affects the lipid and lipoprotein risk profile more favourably than a lower-fat diet; this is also the case for individuals with diabetes, with the added benefit of better glycaemic control. Dietary fibre (> or = 25 g/d) attenuates and even prevents the potentially adverse lipid and lipoprotein effects of a lower-fat diet. With respect to weight control, a moderate-fat diet can be as, or even more, effective than a lower-fat diet, because of advantages with long-term adherence and potentially favourable effects on lipids and lipoproteins. Thus, there is now a convincing scientific basis to advocate a diet moderate in total fat for the majority of individuals. Implicit to this position is that unsaturated fat has numerous beneficial health effects. However, because fat is energy dense, moderation in fat intake is essential for weight control. Consequently, a simple message to convey is to avoid diets that are very low and very high in fat. Moreover, within the range of a moderate-fat diet it is still important to individualize the total fat prescription. Nonetheless, the guiding principle is that moderation in total fat is the defining benchmark for a contemporary diet that reduces risk of chronic disease.

Benchmarking↗
PubMed1998

The voice of the customer--Part 2: Benchmarking battery chargers against the Consumer's Ideal Product.

The Rehabilitation Engineering Research Center on Technology Evaluation and Transfer is exploring how the end users of assistive technology devices define the ideal device. This work is called the Consumer Ideal Product program. In this work, end users identify and establish the importance of a broad range of product design features, along with the related product support and service provided by manufacturers and vendors. This paper describes a method for systematically transforming end-user defined requirements into a form that is useful and accessible to product designers, manufacturers, and vendors. In particular, product requirements, importance weightings, and metrics are developed from the Consumer Ideal Product battery charger outcomes. Six battery charges are benchmarked against these product requirements using the metrics developed. The results suggest improvements for each product's design, service, and support. Overall, the six chargers meet roughly 45-75% of the ideal product's requirements. Many of the suggested improvements are low-cost changes that, if adopted, could provide companies a competitive advantage in the marketplace.

Benchmarking↗
PubMedDate not supplied

Long-term air medical services system performance using APACHE-II and mortality benchmarking.

OBJECTIVE: Air medical transport programs have been in existence for two decades. During this time, no outcome measures have been developed for these services. The authors examined severity scoring and mortality data from their air medical service to characterize its performance and to identify trends in acuity and mortality over a 15-year period. METHODS: APACHE-II scores derived at the time of transport and hospital mortality data have been concurrently recorded in the flight database for adult transports since 1986. The authors analyzed these data and examined the correlation between APACHE-II score at the time of transport and hospital mortality for the 15-year period 1986-2001. RESULTS: 13,808 adult transports were identified. APACHE data were available for 8,204 patients (59%) and mortality for 10,845 (79%), respectively. The number of transports increased from 935 to 1,231 per year. Mean APACHE-II for all patients was 11.6 +/- 8.4. Overall mortality was 22%. Both patient acuity and mortality were trending upward over time. The correlation between APACHE-II and mortality was close and linear (mortality = 0.018 x APACHE-II -0.0243, R2 = 0.97). CONCLUSIONS: Both severity of illness and mortality of air-transported patients appear to be increasing slowly over time in response to changes in the health care system. The strong correlation between APACHE-II performed at the time of transport and mortality validates this technique for benchmarking. The slope of this correlation is an outcome-based characteristic of system performance that may allow monitoring of a system over time and comparisons between systems.

APACHE↗
PubMed2004

Incomplete compensation does not imply reduced harm: yields of 40 smoke toxicants per milligram nicotine in regular filter versus low-tar cigarettes in the 1999 Massachusetts Benchmark Study.

The yields of 40 toxic smoke constituents per mg nicotine were computed in three matched pairs of higher- and lower-tar cigarettes tested in the 1999 Massachusetts Benchmark Study. In the three pairs, 19, 20 and 17 compounds, respectively, exhibited significantly greater yields per mg nicotine in the lower-tar than the corresponding higher-tar brand. Based on the assumption that toxicant yields per mg nicotine were independent of smoking intensity, the minimum degree of nicotine compensation necessary to obtain equal or greater dosages of these toxic compounds from the lower-tar cigarette ranged from 0% to 73%. A smoker who compensates only incompletely for nicotine may thus obtain a higher dosage of a specific smoke toxicant from a lower-tar cigarette than from a higher-tar cigarette. From the toxicological standpoint, incomplete compensation for nicotine does not necessarily translate into harm reduction.

Administration, Inhalation↗
PubMed2004

Benchmark of PENELOPE code for low-energy photon transport: dose comparisons with MCNP4 and EGS4.

The expanding clinical use of low-energy photon emitting 125I and 103Pd seeds in recent years has led to renewed interest in their dosimetric properties. Numerous papers pointed out that higher accuracy could be obtained in Monte Carlo simulations by utilizing newer libraries for the low-energy photon cross-sections, such as XCOM and EPDL97. The recently developed PENELOPE 2001 Monte Carlo code is user friendly and incorporates photon cross-section data from the EPDL97. The code has been verified for clinical dosimetry of high-energy electron and photon beams, but has not yet been tested at low energies. In the present work, we have benchmarked the PENELOPE code for 10-150 keV photons. We computed radial dose distributions from 0 to 10 cm in water at photon energies of 10-150 keV using both PENELOPE and MCNP4C with either DLC-146 or DLC-200 cross-section libraries, assuming a point source located at the centre of a 30 cm diameter and 20 cm length cylinder. Throughout the energy range of simulated photons (except for 10 keV), PENELOPE agreed within statistical uncertainties (at worst +/- 5%) with MCNP/DLC-146 in the entire region of 1-10 cm and with published EGS4 data up to 5 cm. The dose at 1 cm (or dose rate constant) of PENELOPE agreed with MCNP/DLC-146 and EGS4 data within approximately +/- 2% in the range of 20-150 keV, while MCNP/DLC-200 produced values up to 9% lower in the range of 20-100 keV than PENELOPE or the other codes. However, the differences among the four datasets became negligible above 100 keV.

Benchmarking↗
PubMed2003

A benchmark study with sealchip planar patch-clamp technology.

Although conventional patch-clamp methods provide high information content, they are labor-intensive and suffer from low throughput and high overall cost. Several approaches for achieving high throughput electrophysiology are under development, among which microchip-based patch-clamp systems uniquely achieve a higher degree of miniaturization, faster perfusion and mixing, and lower reagent cost without losing information content. The goal of this study was to establish a benchmark for our biochip technology with 52 chips tested sequentially. We demonstrate that our microfabrication and processing technology is sufficiently mature to produce a consistent hole size. We further demonstrate high-quality planar whole-cell patch clamping with >75% overall success rate at achieving gigaohm seals, followed by stable whole-cell access lasting at least 15 min with access resistance (Ra) below 15 MOmega and membrane resistance (Rm) above 200 MOmega. These biochips are ideally suited for high throughput compound screening for ion channel targets.

Animals↗
PubMed1999

Evaluating a benchmarking database and identifying cost reduction opportunities by diagnosis-related group.

Pharmacy cost data from the University HealthSystem Consortium (UHC) Clinical Database for specific diagnosis-related groups (DRGs) were reviewed to assess their applicability to a university medical center and to identify opportunities to reduce costs. UHC headquarters was contacted by telephone to determine UHC's data collection methods. Pharmacy costs for DRG 302 (kidney transplant) at the University of Kansas Medical Center (KUMC) were compared with the costs shown in the UHC Clinical Database. Appropriate drug use for DRGs 302 and 480 (liver transplant) was assessed by contacting transplant pharmacists and pharmacy administrators at the five top-performing hospitals (in terms of cost per DRG) as listed in the UHC database to find opportunities for reducing pharmacy costs. KUMC's actual pharmacy costs for DRG 302 ($4635) were 46% lower than those listed in the UHC Clinical Database ($8546). There was a disparity between the amount of both intravenous immune globulin (IVIG) and lymphocyte immune globulin used by KUMC and the top-performing hospitals. Guidelines for use of IVIG, acyclovir, and azathioprine in liver transplant patients at KUMC were revised. A potential cost saving of $53,000 was identified in relation to the use of lymphocyte immune globulin in kidney transplant patients. Data in the UHC Clinical Database were not representative of pharmacy costs at a university medical center for DRG 302 (kidney transplant), overstating pharmacy costs by 46%; benchmarking was found to be a useful tool for identifying opportunities for reducing costs.

Benchmarking↗