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PubMed2004

The US EPA reference dose for methylmercury: sources of uncertainty.

The US Environmental Protection Agency (EPA) derived a reference dose for methylmercury in 2001, based on an extensive analysis by the National Research Council (NRC) of the National Academy of Sciences. The NRC performed benchmark dose analysis on a number of endpoints from three longitudinal prospective studies: the Seychelles Islands, the Faroe Islands, and the New Zealand studies. Adverse effects were reported in the latter two studies, but not in the Seychelles study. The NRC also performed an integrative analysis of all three studies. Dose conversion from cord blood or maternal hair mercury concentration was performed by EPA using a one-compartment pharmacokinetic model. A total uncertainty factor of 10 was applied for intrahuman pharmacokinetic and pharmacodynamic variability. There are numerous decisions made by the NRC/EPA that could greatly affect the value of the reference dose (RfD). Some of these include the choice of a linear model for the relationship between mercury body burden and neuropsychological performance, the choice of values of P0 and the benchmark response, the use of the "critical study/critical endpoint" approach in the interpretation of the maternal body burden that corresponds to the RfD, the use of central tendencies in a one-compartment pharmacokinetic model rather than the inclusion of the distributions of variables for the population of reproductive-age women, the assumption of unity for the ratio of fetal cord blood to maternal blood methylmercury concentrations, the choice of a total of 10 as an uncertainty factor, and the lack of dose-response analysis for other health effects such as cardiovascular disease. In addition, it may be argued that derivation of a RfD for methylmercury is inappropriate, given that there does not appear to be a threshold for adverse neuropsychological effects based on available data.

Adult↗
PubMed2004

Improving documentation of patient acuity level using a progress note template.

BACKGROUND: Accurately documenting patient comorbidities and complications improves case-mix representation, coding accuracy, and risk-adjusted mortality estimates for benchmarking. We hypothesized that a progress note template containing comorbidities and complications would improve documentation and teach residents to correctly document comorbidities and complications. STUDY DESIGN: Surgical residents and patients on three inpatient services were followed for a 1-year prospective cohort study. After a 6-month baseline period, a progress note template was developed and implemented for 6 months, and administrative data were retrieved. Residents were given three case examinations assessing documentation knowledge pre- and postintervention, and a satisfaction survey. Demographics, Charlson comorbidity score, ICD-9 codes, template-specific ICD-9 codes, All Patient Refined (APR)-DRG patient severity, DRG relative weight, predicted mortality (University Healthcare Consortium), pre- and postexam scores, and resident satisfaction were collected. RESULTS: No difference in age, gender, race, or Charlson comorbidity score existed between pre- and postintervention patient groups. The length of stay decreased from 5.5 days to 4.8 days (p = 0.013). In the intervention group, total ICD-9 codes, template-specific ICD-9 codes, APR-DRG, DRG weight, and UHC predicted mortality had significant increases. Residents exposed to the progress note template improved their knowledge scores from 52% to 63% (p < 0.001), and 73% agreed that the progress note template was an improvement over handwritten notes. Residents not exposed to the progress note template did not improve their scores. CONCLUSIONS: A progress note template improves documentation of comorbidities and complications, APR-DRG patient severity for benchmarking, and case-mix index, and increases patient-specific predicted mortality. The progress note template also improves surgical residents' documentation knowledge and satisfaction.

Acute Disease↗
PubMed2004

Ground based radon-222 observations and their application to atmospheric studies.

The aim of this paper is to review recent trends in the application of ground based radon observations to atmospheric research. In spite of over four decades of atmospheric radon monitoring, only in the past decade has the potential of this passive tracer been realised through a series of atmospheric model evaluation studies. Firstly, the key operational requirements for baseline radon detectors are briefly discussed, including lower limit of detection and response time. Then, current radon-related benchmarks for the evaluation of regional and global models are reviewed, with particular consideration given to the implications of data availability, resolution, site location and model spatial/temporal resolution. An 8-year subset of radon observations from the Cape Grim Baseline Air Pollution Station is used to suggest new benchmarks that exploit long-term data sets. Lastly an overview is presented of a technique that uses radon to estimate regional fluxes of climatically sensitive gases, with specific examples for CO2, CH4 and N2O.

Air Pollutants, Radioactive↗
PubMed2006

A practical tool to assess the incidence of nosocomial infection in Japanese intensive care units: the Japanese Nosocomial Infection Surveillance System.

SUMMARY: Infection control professionals have the means to calculate infection rates in their hospitals but not to assess them. They require a practical tool that enables them to compare observed infection rates with external standards. Based on the data obtained from the intensive care unit (ICU) component of the Japanese Nosocomial Infection Surveillance (JANIS) system, a spreadsheet was developed to calculate a standardized infection ratio (SIR) as a risk-adjusted indicator. Out of the factors associated with the development of nosocomial infections in a multi-variate analysis, the following three factors were selected for stratification: APACHE II score (0-10, 11-20, 21+), operation (yes, no) and ventilator use (user, non-user). Infection rates in 2001 were determined (per 1000 patient-days), stratified by the three factors, as a benchmark. The spreadsheet was designed to calculate SIRs on the basis of the Japanese benchmark infection rates using Microsoft Excel software. The user of the spreadsheet should input the number of observed nosocomial infections and patient-days by APACHE II score, operation and ventilator use. When applied to eight Japanese ICUs, the spreadsheet revealed relative differences and temporal changes in the incidence of nosocomial infections within these ICUs.

Adolescent↗
PubMed2006

The perceptions of undergraduate student nurses of high-fidelity simulation-based learning: a case report from the University of Tasmania.

This paper reports a qualitatively informed curriculum research project in the three-year Bachelor of Nursing (BN) at the School of Nursing and Midwifery (SNM) at the University of Tasmania. The project investigated the perceptions of second year undergraduate nurses and their academic teachers of their experiences of high-fidelity simulation using the Laerdal Vital Sim Nursing Kelly and Nursing Anne technology(2) as part of their preparation for clinical practice. An associated curriculum benchmarking audit was also undertaken. A voluntary purposeful sample of students enrolled in a clinically-based practise unit(3) participated in the research, along with a small cohort of academic teachers. The results indicated that undergraduate nursing students value the opportunity to practice nursing activities in a safe environment prior to clinical placement. Students believed that simulation is an innovative strategy that promotes active learning and has great potential for developing clinical competence and increasing confidence prior to practise. The academic staff reported a similar belief about the potential of high-fidelity simulation in a case-based curriculum. The associated curriculum benchmarking audit provided evidence to support further integration of high-fidelity simulation in the undergraduate nursing program.

Attitude of Health Personnel↗
PubMedDate not supplied

Best practices in Web-based courses: generational differences across undergraduate and graduate nursing students.

The demand for online courses is greatly increasing across all levels of the curriculum in higher education. With this change in teaching and learning strategies comes the need for quality control to determine best practices in online learning communities. This study examines the differences in student perceptions of the use of technology, educational practices, and outcomes between undergraduate and graduate students enrolled in Web-based courses. The multisite study uses the benchmarking process and the Flashlight Program Evaluating Educational Uses of the Web in Nursing survey instrument to study best practices and examine generational differences between the two groups of students. The outcomes of the study establish benchmarks for quality improvement in online learning. The results support the educational model for online learning and postulates about generational differences for future study.

Adult↗
PubMed2005

Managing information.

Information management is an essential component in risk management and clinical governance. In neonatology, the areas related to information management are: (1) clinical records; (2) clinical information databases; (3) evidence-based practice; and (4) audit and outcome measures. Record keeping is an integral part of clinical practice and medical records should be an accurate account of clinical details. Clinical information is used for many purposes other than patient-care documentation. Evidence-based medicine is the use of current best evidence to make decisions about the care of individual patients. Benchmarking using illness severity adjustment is a crucial tool for studying variations in outcomes. Neonatal intensive care is well suited to such benchmarking but further development of standardised audit tools - both for interventions and for outcome measures - are required.

Benchmarking↗
PubMed2025

In silico generation of synthetic cancer genomes using generative AI.

Understanding how genomic alterations drive cancer is key to advancing precision oncology. To detect these alterations, accurate algorithms are used; however, due to privacy concerns, few deeply sequenced cancer genomes can be shared, limiting benchmarking and representing a major obstacle to the improvement of analytic tools. To address this, we developed OncoGAN, a generative AI model combining adversarial networks and variational autoencoders to create realistic synthetic cancer genomes. Trained on large-scale genomic datasets, OncoGAN accurately reproduces somatic mutations, copy number alterations, and structural variants across cancer types while preserving donors' privacy. The synthetic genomes reflect tumor-specific mutational signatures and positional mutation patterns. Using DeepTumour, we validated the synthetic data's fidelity, showing high concordance between generated and predicted tumors. Moreover, augmenting the training data with synthetic genomes improved DeepTumour's accuracy, underscoring OncoGAN's potential to generate shareable datasets with known ground truths for benchmarking and enhancement of cancer genome analysis tools.

Humans↗
PubMed2026

Exploring differences across pangenome-graph representations using Escherichia coli O157:H7 as a model.

Pangenome graphs are increasingly used to represent population-scale bacterial diversity, yet construction methods span fundamentally different representation paradigms whose outputs and sensitivities to assembly quality remain poorly quantified. We systematically reviewed microbial pangenome graph tools and benchmarked seven representative methods spanning gene-cluster, compacted coloured de Bruijn graph, one hybrid approach and one multiple sequence alignment method. Using a repeat-rich Escherichia coli O157:H7 dataset with complete genomes and matched short-read data, we constructed graphs from identical inputs and observed orders-of-magnitude differences in graph size and fragmentation, indicating that global topology is driven by representation strategy. Varying completeness composition revealed that assembly fragmentation is a first-order determinant of graph structure: gene-cluster graphs contracted as draft assemblies replaced complete genomes, whereas compacted coloured de Bruijn graphs expanded, with distinct degree-prevalence fingerprints across tools. In contrast, the multiple sequence alignment method could not be evaluated across fragmented inputs because it did not run reliably on draft-assembly datasets. Computational cost mirrored these shifts and depended strongly on completeness composition, including a pronounced runtime penalty for one compacted coloured de Bruijn graph implementation on all-draft inputs. Finally, analysis of Shiga toxin loci showed that pangenome-level reconciliation by gene-cluster-based tools does not reliably correct assembly artefacts at challenging multi-copy genes and that performance varies by locus. Together, these findings show that pangenome graphs are representation-dependent models of bacterial diversity, and that, in this repeat-rich O157:H7 benchmark dataset, assembly completeness is a primary determinant of their topology, scalability, and locus-level accuracy.

Escherichia coli O157↗
PubMed2004

Mainstream smoke constituent yields and predicting relationships from a worldwide market sample of cigarette brands: ISO smoking conditions.

The study objective is evaluation of a benchmark approach for predicting mainstream smoke constituent machine-yields for conventional cigarette brands from worldwide markets. Results for ISO smoke yields support the validity of benchmarking when brands, for which yields are to be predicted, have design characteristics within boundaries established by the exploratory brands. Yields of ISO-method mainstream smoke constituents were generally well described by weighted least squares regression relationships with ISO tar (R2>0.80 and coefficient p values <0.05). The impact of the varied chemical composition of cigarette tobaccos from different regions on smoke constituent yields was recognized. Mainstream smoke nitrogen oxides and tobacco-specific nitrosamine (TSNA) yield prediction relationships improved by including tobacco nitrate or TSNA concentration factors in respective independent parameters. For carbon-filter brands, inclusion of a carbon factor improved the predicting relationships for several vapor-phase constituents. Relationships were validated with a subset of additional validation brands. Greater than 90% of the validation brands' smoke chemistry yields were within the 95% prediction intervals. Average differences between measured and predicted yields were generally within the range of one to two measurement standard deviations. The estimation methods proposed relate to machine-smoking conditions and are not intended to reflect the actual exposure of any given consumer to smoke constituents.

Benchmarking↗
PubMed2004

Dose-response modeling of in vivo genotoxicity data for use in risk assessment: some approaches illustrated by an analysis of acrylamide.

Methods for dose-response modeling of in vivo genotoxicity data are introduced and applied to a case study of acrylamide. Genetic toxicity results are typically summarized as being either positive or negative, with no further consideration of the dose-response patterns that can be estimated from such studies. This analysis explores the use of three modeling approaches: Poisson regression of counts of genetic effects per cell; dynamic modeling of the time-course of micronucleus production and loss as a function of exposure; and categorical regression of sets of genetic toxicity experiments, the results of which are recoded in terms of severities of response. Estimates derived from these models (benchmark doses and predictions of response rates for predetermined doses of interest) are then used to assess the relevance and role of the genetic toxicity results in a risk assessment. With respect to the acrylamide data base, the results suggest that the genetic damage studies do not appear to be consistent or congruent with the thyroid tumor endpoints observed in two long-term bioassays in rats. This suggests that acrylamide's mechanism of action with respect to production of such tumors may not be genotoxic, and that a cancer risk assessment that applied a linear, no-threshold approach to such endpoints might be inappropriate. Benchmark doses derived from the genetic toxicity data base do not appear to be the critical ones for acrylamide risk assessment. Dose metric and modeling issues associated with the proposed dose-response approach to evaluation of genetic toxicity data are explored, and it is recommended that further advancements of the methodology be developed and employed for optimal use of such data for risk assessment purposes.

Acrylamide↗
PubMed2003

Resident self-assessment of operative performance.

BACKGROUND: In medicine, the development of expertise requires the recognition of one's capabilities and limitations. This study aimed to verify the accuracy of self-assessment for the performance of a surgical task, and to determine whether self-assessment may be improved through self-observation or exposure to relevant standards of performance. METHODS: Twenty-six senior surgical residents were videotaped performing a laparoscopic Nissen fundoplication in a pig. Experts rated the videos using two scoring systems. Subjects evaluated their performances after performance of the Nissen, after self-observation of their videotaped performance, and after review of four videotaped "benchmark" performances. RESULTS: Expert interrater reliability was 0.66 (intraclass correlation coefficient). The correlation between experts' and residents' self-evaluations was initially moderate (r = 0.50, P <0.01), increasing significantly after the residents reviewed their own videotaped performance to r = 0.63 (Deltar = 0.13, P <0.01), yet did not change after review of the benchmarks. CONCLUSIONS: Self-observation of videotaped performance improved the residents' ability to self-evaluate.

Animals↗
PubMed2002

Improving the development of event-driven control systems in the batch processing industry. A case study.

This paper presents the results of an academia-industry collaborative project whose main objective was to test novel techniques for the development of event-driven control systems in the batch processing (e.g., pharmaceutical, fine chemicals, food) industries. Proposed techniques build upon industrial standards and focus on (i) formal synthesis of phase control logic and its automatic translation into procedural code, and (ii) verification of the complete discrete-event control system via dynamic simulation. In order to test the techniques in an engineering environment, a complete discrete-event control system was produced for a benchmark batch process plant based on a standard development method employed by one of the industrial partners. The control system includes functional process specification, control architecture, distributed control system (DCS) proprietary programming code for procedural control at equipment, unit, and process cell levels, and human-machine interfaces: A technical assessment of the development method and the obtained control system was then carried out. Improvements were suggested using the proposed techniques in the specification, code generation and, verification steps. The project assessed the impact of these techniques from both an engineering and economic point of view. Results suggest that the introduction of computer aided engineering (CAE) practices based on the benchmarked techniques and a structured approach could effect a 75% reduction of errors produced in the development process. This translates into estimated overall savings of 7% for green-field projects. Figures were compared with other partners' experience. It is expected that the work load on a given project will shift, increasing the load on process engineers during the specification stage and decreasing the load on the software engineers during the code writing.

Algorithms↗
PubMed2002

A framework for diabetes documentation and quality management in Germany: 10 years of experience with DPV.

The DPV approach for quality management and documentation of diabetes in Germany consists of three basic modules: the diabetes documentation software DPV, semi-annual benchmarking for diabetes units (QC-DPV), and a data pool for diabetes research (DPV-SCIENT). The documentation system is available for general practices as well as for hospitals, and it supports the daily routine work of the diabetes team. The system covers a superset for all important data sets of quality initiatives in Germany. Longitudinal analyses of quality indicators related to diabetes are integrated. Twice a year, nation-wide benchmarking for pediatric diabetic units are performed, evaluating the outcome of their diabetes therapy. An improvement in completeness of control examinations could be observed during the last years in QC-DPV. The DPV-SCIENT data pool contains about 251000 single examinations of 21000 patients with diabetes. At least 53% of all patients with Type 1 diabetes in Germany who are less than 20 years of age are documented in DPV-SCIENT.

Benchmarking↗
PubMed2003

Indirect human exposure to pharmaceuticals via drinking water.

There are numerous observations of pharmaceuticals (or their metabolites) as contaminants in wastewater, surface water and groundwater. This implies a potential for indirect human exposure to pharmaceuticals via drinking water supplies. Various effect benchmarks may be employed in an evaluation of the significance of such indirect exposure. In this study a comparison was made between reported concentrations of pharmaceuticals in German drinking water and therapeutic dose. The margin between potential indirect daily exposure via drinking water and daily therapeutic dose was at least three orders of magnitude and typically much more. For certain compounds it was also possible to benchmark exposure against ADIs derived within the context of meat and food stuff residues following veterinary use. In all cases potential exposure was less than the ADIs, similarly suggesting that for these compounds there are no substantial concerns with regards to indirect exposure via drinking water.

Benchmarking↗
PubMed1997

Pursuing clinical and operational improvement in an academic medical center.

BACKGROUND: An academic medical center in an increasingly competitive market, the University of California-Davis Medical Center in Sacramento started working with a consulting firm in 1995 to reduce overall operational costs and costs for the clinical processes involved in treating patients with specific conditions. ESTABLISHING THE TEAMS: Twelve operational efficiency (OE) teams and five clinical teams were commissioned, with a combined total of nearly one-half of the target cost reduction. The second wave of six clinical teams was simultaneously initiated in late spring 1996. THE IMPROVEMENT METHOD: The quality improvement process for clinical improvement teams included the review and inquiry method, which enables many pilot experiments to be conducted in parallel by work groups and coordinated by the main task team. RESULTS AND CASE STUDIES: Within six weeks of launching, the 12 OE teams achieved their goals and identified savings opportunities of more than $27 million. One OE team, medical records, had set a goal of $514,000 in cost reduction for a three-year period and achieved the first-year goal of $190,000. For a clinical team on interventional cardiology, the clinical benchmark data revealed that the cost per case of providing cardiac catheterization was greater than for all three benchmark groups. These patients, including 270 patients per year, showed a possible savings through process improvement of nearly $1.4 million. From January 1996 through March 1997, the rate of occurrence of complications decreased from 5.5% to 3%. EPILOGUE: Physicians gradually accepted more responsibility and accountability for controlling and reducing costs, while maintaining their traditional role as advocates for improved patient care.

Academic Medical Centers↗
PubMed1999

Lessons from Europe on quality improvement: report on the Velen Castle WHO meeting.

BACKGROUND: In conjunction with the German Ministry of Health, the European Regional Office of the World Health Organization (WHO/EURO) held a workshop, "Experiences with Quality Management in an International Context," at Velen Castle, Velen (Nordrhein-Westfalen), Germany, January 15-17, 1998. The approximately 50 participants were selected in part on the basis of recommendations of their respective countries' health ministries. IMPLEMENTATION AND EVALUATION OF QUALITY MANAGEMENT: Possible ways to introduce quality management ranged from introduction of specific process control projects to total quality management (TQM) and reengineering. STRATEGIES FOR IMPLEMENTING QUALITY MANAGEMENT: Working group sessions identified specific strategies for high-level managers, health care providers, and various kinds of consumers to facilitate quality management. For example, managers need to transmit a vision, create a quality management infrastructure, develop reporting structures, establish a system of incentives, and manage the hospital according to the principles of continuous improvement. QUALITY MANAGEMENT MODELS AND TOOLS: Hospitals and other health care providers in Sweden are testing various methods and systems to assess and improve their organizations' ability to meet patients' demands. Benchmarking is being used as a tool for quality management of diabetes care (DiabCare-France). The benchmarking data are processed centrally and made available to the health care providers in a user-friendly format for application to their own quality improvement processes. Clinical databases-registries containing process and outcome data for a well-defined patient population-can be used for quality and technology assessment, to answer questions of treatment effectiveness, and as an information tool. PRINCIPLES AND STRATEGIES FOR QUALITY MANAGEMENT AND DEVELOPMENT: Successful implementation of quality improvement benefits from local, professional, and national policies and objectives. A balance of incentives can reward efficiency or specific activities. Laws, rules, and regulations can be useful, especially if used sparingly. More education is needed at all levels of the health care system about how to understand and use information and information systems. Research is needed on what processes result in favorable outcomes. Despite optimism about the cost-saving potential of quality improvement efforts, many interventions are likely to be cost-effective without actually saving costs. Public release of performance data requires careful consideration, with participation of the professions.

Benchmarking↗
PubMedDate not supplied

Measurement of pain in the prehospital setting using a visual analogue scale.

INTRODUCTION: The aim of this study was to use a visual analogue scale (VAS) to measure the adequacy of prehospital pain management. Patients reported pain severity at two points in time during treatment and transport by ambulance paramedics. The change in pain score was compared with a benchmark reduction of 20 mm that has been shown to correspond with the minimum clinically significant change in pain perception reported by patients. METHODS: This prospective, observational study used a VAS to record pain severity among patients reporting pain who were transported to a hospital by paramedics. Patients used a VAS to score pain severity during the initial patient assessment process (T0), and again at the hospital of destination (Tend). This study reports the mean changes in the scores, and the percentage of cases for whom the difference between T0 and Tend in the study population achieved or exceeded the 20 mm benchmark. A survey also was administered to paramedics who participated in this study in order to identify attitudes, values, and beliefs relating to the measurement of pain. RESULTS: A total of 262 patients were enrolled in this study. The mean value for the reduction in VAS (T0-Tend) was 18.2+/-23.9 mm [+/-SD] (Median = 14.0mm, 95% confidence interval (CI) = 15.3-21.1 mm). One hundred and thirty-four patients (51.1%) did not receive analgesia (either morphine sulfate or methoxyflurane). The mean initial (T0) pain score for the no-analgesia group was 54.5+/-24.7 mm [+/-SD], with the mean value for the change in VAS (T0-Tend) = 10.6 mm (median = 5 mm, 95% CI = 6.4-14.8 mm). Forty-six patients (17.6%) recorded some deterioration in their pain score at Tend (T0-Tend<0 mm). Survey results identified attitudes that may affect paramedics' pain management practice. CONCLUSION: The results suggest that inadequate analgesia is an issue in this study setting. Effective analgesia requires formal protocols or guidelines supported by effective analgesic therapies along with education that addresses attitudes that may inhibit pain assessment or management by paramedics. Regular audits form part of clinical quality assurance programs that assess analgesic practice. However, such audits must have access to data obtained from patient self-reporting of pain using a valid and reliable pain measurement tool.

Analgesics↗