SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
We first reported on a needle-distribution pilot project undertaken in two prisons in Lower Saxony, a state in Northern Germany, in 1997. Scientific evaluation of the project has now shown what scientific evaluation of such projects in Switzerland had also shown--that needle exchange programs can be successfully implemented in prisons.
A family medicine in-training assessment examination was developed and piloted in 20 programs across the country. Core Content Review questions were used for the examination. Reporting of scores used both the traditional, normative-referenced approach, and a criterion-referenced approach. The latter permitted family medicine faculty to set passing standards for the examination. The pilot project was well received and the examination will be offered to all family medicine residency programs this year.
Large waiting lists for elective surgical operations in Fife stimulated a pilot project to encourage general practitioners (GPs), to undertake more minor surgery operations. A three part evaluation of the work was designed which looked at medical and patient satisfaction aspects of the project; views of the Local Medical Committee (General Practice) and Division of Surgery were sought. All parts of the evaluation appeared satisfactory and health service managers have been provided with sufficient information to make decisions on the implementation of further minor surgical schemes in Fife.
In 1981 a dental prevention pilot-project was started in Deinze with a group of 5-year-old school children. The aim of this project was to evaluate the effect of a preventive dental school-program. During a period of 7 years this program was carried out with 4 items: the motivation of the children; a daily teeth brushing; a weekly mouth rinsing with a 0.2% NaF solution; a trimonthly clinical examination. The effect of this prevention program can be summarized in four points: a reduction in caries prevalence of ca 40%; an increase in dental treatment; a reduction in the incidence of gingivitis in number and degree; a favourable effect on the dental attitude of the target group, the teachers and the immediate environment.
We assessed the acceptability and the use of a community-based needle and syringe disposal project designed to serve injection drug users. In June 1996, three surplus U.S. mail collection boxes were painted red and used as syringe and needle drop boxes in locations with high drug use in East Baltimore. Acceptance of the drop boxes was measured by focus groups of residents, drug users, and police, held before and after project implementation. Use was measured by weekly counts of needles recovered from the red boxes. A sample of all deposited needles was randomly chosen for needle washing and subsequent HIV antibody testing. Community impact was measured by systematic surveys of needles discarded on public sidewalks, in areas with and areas without drop boxes. Before implementation, members of focus groups expressed concerns that drop boxes could convey mixed messages to youth (e.g., seeming to condone drug use), might result in increased loitering, and could further community stigmatization. After project implementation, all focus groups expressed support of project expansion. In the first 10 months, 2971 needles were collected. Of 156 needles tested, 10.9% were positive for HIV antibody. Needle counts on the street showed no significant change in red box areas compared with control areas. In this pilot project, red boxes were accepted by the community and drug users. Police officers also used the boxes to dispose of confiscated needles. Although limited in the number of drop boxes and follow-up time, this pilot project shows promise as a community-based method of safe needle disposal.
The Magdalena Pilot Project provided outreach to Albuquerque women sex workers who were also using illicit drugs, primarily cocaine and heroin. This initial uncontrolled trial evaluated the feasibility and potential impact of motivational interviewing (MI) on change in drug use and HIV risk behaviors. Twenty-seven women were enrolled and interviewed about their substance use, health risk behaviors, and plans for change, using the client-centered, directive method of MI. Four months later, 25 women (93%) were interviewed again to assess their drug use and health risk behaviors. Large reductions were reported in frequency (days) of drug use and sex work, with a corresponding increase in days of lawful employment. In identifying problems that most needed to be addressed in order to help them live healthier lives, the women prioritized (1) basic needs including decent housing, (2) mental health care, and (3) treatment for substance use disorders.
EVE is a pilot project for cervical cancer screening whose aim is to test the feasibility of organized screening in the French liberal health system with a consensus of medical participants. After three and a half years, 74.8% of women aged 25 to 64 had had at least one smear. Coverage varies with age, from 89% between 25 and 29 to 56% between 55 and 60. Only 8% of smears are taken by General Practitioners. There is a tendency to space out smears because only 14% of women had had a second smear within one year and 41.1% within 2 years. On the other hand more then 20% percent of women do not return after 3 years. Pathological smears represent 1.94% of all smears. For these, a questionnaire is sent to the physician in order to get information on follow-up. This enables cytologic/histologic correlation. The histologic exam reveals a pathological lesion in 95% of cytologies consistent with invasive cancer, 91% of those consistent with high grade lesions and 70% of those consistent with low grade lesions.
A pilot project on Community Based Rehabilitation was launched by the Hind Kusht Nivaran Sangh in South Arcot District of Tamil Nadu with the help of the Hemerijckx Rural Centre, Rawttakuppam on an experimental basis to assess the cost effectiveness and suitability of its application in other districts. Twenty cured disabled leprosy patients with grades 1 and 2 deformities from 17 villages were given training in trades like cycle repairing, tailoring, pesticides spraying, doll making, cane work, cigar making, fish net knitting and incense stick making. The duration of the training varied from two to six months depending upon the trade. Local artisans and craftmen from among the community members were identified, motivated, and utilised as trainers. The travel and maintenance costs paid to the trainees was an incentive to learn the trade and the honorarium paid to the trainers motivated them to spare their time to impart the skill within the specified period. On completion of training, start-up funds needed for purchase of tools and accessories required for pursuing the vocation were arranged through banks under DRI scheme, IRDP schemes from BDO office and from other voluntary agencies. The total expenditure incurred for training 20 cured disabled leprosy patients worked out to only Rs. 25,350/-i.e., approximately Rs.1,250/- per patient. Out of the 20 patients trained, 17 have already started earning through the skills imparted to them.
BACKGROUND AND OBJECTIVE: 30-day mortality after operation is generally accepted as a central standard of quality, especially in regard to cardiac operations. The Working Party of Directors of Hospital Cardiology Departments (Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte, ALKK) in Germany set up a pilot project to analyse whether by direct communication with patients by a database centre the expenditure incurred in collecting complete data can be decisively reduced and full documentation of outcome can in this way be obtained even for a large multi-centre patient cohort. PATIENTS AND METHODS: Between 1.6.1997 and 31.3.1998, data were consecutively collected by questionnaire on all patients registered for a cardiac operation at 85 of the 135 ALKK centres. The questionnaire included data about each patient and the indication for operation as well as the estimate of operative risk, assigned to one of five risk categories by the referring cardiologist either alone or in conjunction with the cardiac surgeon. RESULTS: Until 30.9.1998, the data were obtained on 11,349 patients who had given informed consent (response rate 99.99%), including survival figures. 824 (7.3%) patients had not undergone the planned cardiac surgery, 134 having died before the data of operation. The 30-day postoperative mortality, obtained in 99.99% of the 10,525 patients, was 3.92%. The operative mortality was lowest, at 3.73%, for aortocoronary bypass only (n = 7932), highest for aortocoronary bypass plus valvular operation (n = 785), at 8.04%. There was good agreement between the cardiologists' preoperative risk assessment and the observed mortality. CONCLUSIONS: The 30-day mortality after cardiac operation can be obtained almost completely and with reasonable expenditure even for a large patient cohort. The results confirm that hospital mortality data definitely understate the overall operative risk. The methodology used in this pilot project, namely the inclusion of information from the patients by questionnaire, can also be applied to clinical results in other areas.
BACKGROUND: Guided bone regeneration (GBR) frequently is used to augment implants with various types of bone defects. The defects often are grafted with different materials, yet there is insufficient evidence that these materials enhance bone-to-implant contacts. PURPOSE: The purpose of this pilot project was to test the principle of GBR to promote bone formation adjacent to commercially pure titanium implants placed within zero-wall defects. Histologic and histomorphometric measurements were used to evaluate new bone formation. MATERIALS AND METHODS: Under appropriate anesthesia, deep, wide defects were created within the mandibles of two large dogs. Buccolingual bone was removed to the depth of the defects leaving only the mesial and distal walls. Of the eight implants placed, three were augmented with titanium-reinforced expanded polytetrafluoroethylene (e-PTFE) barriers and autogenous bone chips. Three sites were augmented with barrier membranes only, and two sites were not augmented or grafted and served as controls. Seven months after surgery the dogs were sacrificed and block sections were taken for histologic evaluation. RESULTS: Histologic and histomorphometric measurements were used to evaluate new bone formation. Results from this evaluation revealed bone formation at the membrane-only sites and the membrane-plus-bone grafted sites. The bone grafts were completely incorporated by the newly formed marginal compact bone. For all treated sites, there was poor bone-to-implant contact. Histomorphometric measurements showed a trend toward greater bone formation at membrane-treated sites compared with control sites. However, autogenous bone grafting did not seem to affect the amount of newly regenerated bone. CONCLUSIONS: Within the limits of this pilot project, findings show trends toward bone healing, indicating constant and enhanced bone regeneration over the exposed implant. Bone contact to the implant surface generally was poor.
The Medical Photography Department at Peterborough Hospitals NHS Trust set up a pilot project to reduce the turnaround time of fundus fluorescein angiograms to the Ophthalmology Department. Quality management tools were used to analyse current photographic practices and develop more efficient methods of service delivery. The improved service to the Ophthalmology Department demonstrates the value of quality management in developing medical photography services at Peterborough Hospitals.
Explore the source record for details and available documents.
The Washington State Managed Care Pilot Project (MCP) tested the effects of experience-rated capitation on medical and disability costs, quality of care, worker satisfaction with medical care, and employer satisfaction in MCP-covered workers, compared with matched fee-for-service controls. In the MCP, medical costs were reduced by approximately 27%, functional outcomes remained the same, workers were less satisfied with their treatment and access to care initially, and employers were-much more satisfied with the quality and speed of the information received from the providers. The authors believe that it was the occupational medicine-based delivery model, working in conjunction with the method of reimbursement and the cultural context of managed care, that was the most significant innovation leading to the MCP successes. This article describes the occupational medicine-based delivery model implemented for the MCP.
AIM: To undertake a pilot study to determine a possible training programme for orthodontic auxiliaries. DESIGN AND SETTING: Trainee hygienists who had been accepted onto a 2-year programme were asked to attend the Bristol Dental School well before their course was due to begin in order to participate in a pilot orthodontic assistant auxiliary training programme. METHODS: A modular course of one month's duration was constructed based on the programme at the University of British Columbia. This aimed to teach skills such as impression taking, bond placement, debracketing, band cementation as well as core knowledge relevant to these procedures. RESULTS: At the end of the course all participants were judged to be performing the tasks they had been taught competently and safely. CONCLUSION: UK dental nurses can be trained to fill the role of an orthodontic auxiliary. It would appear that an introductory clinical skills course of one week followed by an orthodontic skills training of three weeks is sufficient for a qualified dental nurse of above average abilities such as typifies those who are currently applying for places on UK dental hygiene courses. It is estimated that a further period of nine months supervised training will be necessary for those who have successfully completed such a training to develop clinically useful speeds when delivering these skills.
OBJECTIVE: To test a pilot screening program for colorectal cancer. DESIGN: Subjects, chosen at random and recruited by mail, were examined by flexible sigmoidoscopy. PARTICIPANTS AND SETTING: Normal-risk, asymptomatic men and women aged 55-59 years recruited from the community, July to December, 1995. MAIN OUTCOME MEASURES: Number of polyps detected and cancers diagnosed, and compliance with screening. RESULTS: Letters of invitation were sent to 3500 subjects; of these, 2881 were eligible for inclusion in the study and 342 (12%) consented to participate. A further 3.5% of non-compliant subjects attended the screening program after a telephone survey assessing reasons for non-attendance. Common reasons for non-attendance were a lack of interest (30%) or a lack of time, mainly due to work commitments (28%). A third of subjects had polyps and 46% of these were adenomas. Three subjects were found to have adenocarcinoma: in two the cancer was confined to a polyp and treated with polypectomy, and one subject underwent anterior resection (overall prevalence of cancer, 0.9%). The median depth of insertion achieved with flexible sigmoidoscopy was 55 cm (range, 25-100 cm). Median pain level (on a scale of 0 = no pain to 10 = worst pain imaginable) was 2 (range, 0-8.5), and 99% of the subjects would have the test again if required. CONCLUSIONS: Flexible sigmoidoscopy was well tolerated and had an acceptable detection rate of adenomatous polyps and early cancer. Subject compliance emerged as a major issue which requires further evaluation to maximise participation in future programs.
Over 20 years the Orangi Pilot Project has been working to understand the problems of Orangi, a district of Karachi largely characterised by high-density informal settlement, and enable its residents to develop and implement solutions. Sanitation was identified as the major problem and a sewerage system was built. From this work was developed the "internal-external" concept for sanitation, which has 4 levels: sanitary latrines in houses; underground sewer in lane; neighbourhood collector sewer; and trunk sewer and treatment plant. The first three components are "internal" and can be undertaken by low-income communities; the "external" fourth component has to be funded and carried out by government or similar agency. Successful and unsuccessful attempts elsewhere to replicate this model have both confirmed the effectiveness and practicality of such community-based action and shown the - largely organisational pitfalls that must be avoided.
The training of pharmacists allowed to prescribe under protocol in California health manpower pilot projects (HMPPs) and the specific program at San Francisco General Hospital (SFGH) are described. From 1972 to 1983, several bills were passed allowing pharmacists to prescribe and administer drugs or devices in HMPPs under specified conditions. The main objective of the HMPPs was to train pharmacists to assist physicians and other providers in providing good follow-up care for chronically ill patients. Programs for pharmacists consisted of a training phase followed by an employment phase in which all primary care delivered by the pharmacists was performed under protocols and supervised by physicians. At SFGH ambulatory-care clinics beginning in early 1978, a pharmacist assisted by a licensed vocational nurse monitored patients receiving anticoagulant therapy. A cardiologist reviewed all the medical records at the end of each clinic period. Through July 1, 1983, 3,800 patients had been seen at the SFGH site; a total of 201,000 patients were seen by all HMPP pharmacists. Questionnaires answered by the supervising physicians and by patients indicated that pharmacists prescribed appropriately and were accepted in their roles as primary-care providers. Evaluations of the HMPPs at SFGH and at other sites indicate the success of and the need for these innovative programs.
The Norwegian Department of Health and Social Affairs initiated a national screening program for cervical cancer in 1990, with all women aged 25 to 70 years to be offered cervical screening every three years. During the first three years of the program (November 1991-October 1994), all spontaneous cervical cytology in Norway was recorded at the Norwegian Cancer Registry. In addition, women in the counties of Vestfold and Sør-Trøndelag were invited individually to be screened. The aim of the present study was principally to evaluate the organization aspects of a nationwide, population-based screening program for cervical cancer in Norway. Special attention was paid to the coverage, the attendance rate, and the cytologic findings in the two-county study area. A total of 1,581,379 Pap smears were recorded from November 1991 to October 1994. Most smears were taken from women under age 30 years (31.7 percent). About 25 percent of the women aged 25 to 29 years had more than one normal smear. In the study area, a coverage of about 71 percent in the age group 25 to 69 years was achieved. The pilot project also has shown that it is possible to recruit elderly women into screening. However, no difference was noted between the study and the reference area with regard to findings per smear of precursor lesions (CIN 3, modified SNOMED coding system). The experiences from three years of recording and the implementation of the pilot project have provided useful guidelines for the national screening which began in January 1995.