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PubMedDate not supplied

Long-term epidemiological survey of hepatitis B virus infection in a hyperendemic area (Afragola, southern Italy): results of a pilot vaccination project.

In 1983, a pilot project of universal hepatitis B vaccination was introduced in a hyperendemic area in southern Italy (Afragola) and is ongoing to date. In this area before the start of vaccination, we found significant evidence of HBV endemicity: the acute viral hepatitis B incidence in the general population averaged 63/100,000; the HBsAg and anti-HBc prevalence rates were 13.4% and 66.9%, respectively; there was involvement of hepatitis B virus (HBV) in 48.1% of chronic liver pathologies (46.3%) in chronic viral hepatitis, 49.5% in cirrhosis and 71.7% in hepatocellular carcinoma cases). We studied the acute viral hepatitis incidence during the vaccination period from 1983 to 1997 and compared the HBsAg and anti-HBc prevalences in 1978 to those in 1997, after 15 years of vaccination. The HBV-related chronic pathology prevalence was also studied. We found a remarkable drop in the acute viral hepatitis incidence, from an average annually of 63/100,000 in the five years before vaccination to 3/100,000 in the last five years of vaccination. In addition, the HBsAg carrier prevalence in the general population decreased from 13.4% in 1978 to 3.7% in 1997. The percentage dropped in children and adolescents from 6.8% to 0.7%, in young people from 10.2% to 1.1% and in adults from 15.8% to 4.0%. The anti-HBc carrier prevalence, found to be 66.9% in 1978, was 34.2% in 1997. Finally, we found a much less significant involvement of HBV in chronic liver pathologies; in fact, it was present in only 18.2% of cases in 1997 and in 48.2% in 1982. In the light of the data, we can assert that universal hepatitis B vaccination has had a substantial effect on HBV endemicity in the Afragola area. We believe that the reduction found in the incidence of acute viral hepatitis B and HBV-related chronic liver pathologies is connected to the decrease in HBV carriers in the area, which therefore reduces the risk of contagion for the unvaccinated.

Adolescent↗
PubMed2002

Advanced practice nurses: a study of client satisfaction.

PURPOSE: To describe the satisfaction of clients with care provided by advanced practice nurses (APNs) in the Wright State University (WSU) Pilot Project. The Pilot Project was created through state legislation that recognized APNs associated with three universities in Ohio for the purpose of granting the APNs title protection, prescriptive authority, and recognition leading to reimbursement. DATA SOURCES: The Interactional Model of Client Health Behavior (Cox, 1982), which proposes that client characteristics and interactions with health professionals determine health outcomes, served as the framework for this descriptive study. The study measured client (n = 506) satisfaction with care delivered by 36 APNs at 26 different practice sites using an adapted Client Satisfaction Tool (CST). The internal consistency of the adapted CST was 0.935. CONCLUSIONS: Client (n = 506) satisfaction scores ranged from 28 to 50, with a mean score of 47.15 (SD = 4.00). Findings suggest that clients are very satisfied with APNs in the WSU Pilot Project. IMPLICATIONS FOR NURSING PRACTICE: Client satisfaction is one indicator used to determine quality of care. Consumer satisfaction benefits the individual client and provides important information for the health care payer. Measuring and reporting client satisfaction with care provided by APNs may increase the visibility and marketability of APNs.

Humans↗
PubMed1999

Towards a methodology for developing and implementing best practices in telehealth and telemedicine.

One objective of the growing telehealth and telemedicine literature base is to inform potential adopters and raise their awareness through pilot projects. However, pilot studies often fail to create sustainable solutions because certain conditions are needed for long term success: (1) matching needs to appropriate solutions: while needs assessment can identify needs, adopters must view, test, and experience potential solutions under a number of circumstances; (2) change and new technology: technological implementation brings both foreseen and unforeseen changes, difficult to forecast, and pilot projects can create artificial expectations; (3) awareness of context: there has been a pervasive tendency to treat telemedicine or telehealth as separate from the context of health care delivery, but telemedicine is only a communication and information tool, and should not be considered as separate from other health care delivery activities; (4) availability of long term funding; while loans, government grants and private sector partnering can bridge gaps temporarily, sustainable solutions require that savings from existing systems can be applied to pay for telehealth and telemedicine installations. This paper makes a case for adopting best practices by proposing that a data base of case studies documenting best practices and success factors be developed and made widely available.

Humans↗
PubMed1998

Maximizing participation by black Americans in population-based diabetes research: the Project DIRECT pilot experience.

Diabetes and its associated complications and risk factors have a higher prevalence among blacks than whites. To reduce the burden of diabetes within the black community, research is needed to assess the behavioral, social, and environmental correlates associated with this disproportionate burden. Because of some well known instances of historical exploitation and abuse from medical and public health research conducted in black communities, this population has little enthusiasm for additional research, despite pressing health needs. This paper describes the process used to eliminate barriers and enhance trust between the target community and the researchers conducting a population survey of diabetes in Wake County, North Carolina. A community advisory board was organized to (1) review the survey instruments and methodologies, (2) identify persons from the community to serve as interviewers, and (3) promote the survey using the major local communication channels. The response rate to both the household survey and the comprehensive medical exam was 77%. Eighty-one percent of eligible black respondents completed the household exam and 80% completed the comprehensive medical exam. Advantages of building collaborative relationships between the community and research team are discussed.

Adult↗
PubMed1998

Community parenteral therapy project: a pilot study.

The pilot study reported in this paper was devised to develop and compare service delivery models that would achieve the provision of high quality parenteral therapy care to patients in the Gold Coast District Health Service community. All data were collected on 113 patients for a 12-month period, January to December 1996. The study compared the provision of outreach nursing services and contracted nursing services on measures of satisfaction and cost. The study showed that patient and carers indicated a preference for community care, medical officers advocated the benefits of administering parenteral therapies in the community, general practitioners were interested in managing future community parenteral therapies, and contracted (nurse) service providers endorsed the development of a parenteral therapy resource centre. The findings also revealed considerable potential cost savings in community-based care.

Adult↗
PubMed1990

Distance learning: the HVA project's pilot stage.

The second article in this series described the origination, aims and early development of distance learning material to help both health visitors who were returning to practice after a number of years, and also those who had stayed in practice but who had little access to courses to update themselves professionally.

Community Health Nursing↗
PubMed2006

Health information Hispanic outreach in the Texas Lower Rio Grande Valley.

PURPOSE: This paper provides an overview of the two-year Texas Lower Rio Grande Valley Health Information Hispanic Outreach (HI HO) project. The project included a needs assessment, four pilot projects, and focus groups on the use of MedlinePlus and MedlinePlus en español. The needs assessment included a survey of physicians' information usage and a review of the circuit librarian program that had been established in 1989. The pilot projects were located at a high school, a rural health clinic, an urban health clinic, and a community center. Diffusion of innovation theory provided a framework for interpreting the results of the pilot projects. METHODS: The survey of physicians' information usage partially replicated a similar 1990 survey. The review of the circuit librarian program included usage statistics, interviews of administrators, and a survey of participants. Pilot project methodology varied by site. At the high school, four students were trained to instruct their peers in the use of MedlinePlus. At the two clinics, a computer workstation was installed for patients to access MedlinePlus. At the community center, staff were trained to use MedlinePlus en español to train community residents. Project evaluation included surveys, focus groups, and interviews. Indicators of success included increased level of consumer use of MedlinePlus, reports by key informants and consumers of how MedlinePlus was used, reports about training, and development of self-sustaining activity. RESULTS: The physician survey documented usage of health information resources in 2002 compared to 1990. The review of the circuit librarian program documented the change in program usage between 1989 and 2003. The pilot project at the high school was the most successful of the four pilot projects in introducing MedlinePlus to a large number of people, followed by the community center project. In the high school and community center projects, the participating institutions had reinforcing educational missions and paid staff who were highly motivated to achieve the project goals. The computer workstations projects at the two clinics were less successful, due in part to limited staff commitment and conflicting priorities. CONCLUSIONS: The HI HO project tested methods of reaching the Hispanic community in the Lower Rio Grande Valley region of Texas. The four HI HO pilot projects varied in achieving their stated objectives. But taken as a whole, the HI HO project significantly contributed to a better understanding of health information outreach to the Hispanic community, knowledge that should be useful to others with similar outreach activities.

Ambulatory Care Facilities↗
PubMed2005

Do we want our data raw? Including binary mass spectrometry data in public proteomics data repositories.

With the human Plasma Proteome Project (PPP) pilot phase completed, the largest and most ambitious proteomics experiment to date has reached its first milestone. The correspondingly impressive amount of data that came from this pilot project emphasized the need for a centralized dissemination mechanism and led to the development of a detailed, PPP specific data gathering infrastructure at the University of Michigan, Ann Arbor as well as the protein identifications database project at the European Bioinformatics Institute as a general proteomics data repository. One issue that crept up while discussing which data to store for the PPP concerns whether the raw, binary data coming from the mass spectrometers should be stored, or rather the more compact and already significantly processed peak lists. As this debate is not restricted to the PPP but relates to the proteomics community in general, we will attempt to detail the relative merits and caveats associated with centralized storage and dissemination of raw data and/or peak lists, building on the extensive experience gained during the PPP pilot phase. Finally, some suggestions are made for both immediate and future storage of MS data in public repositories.

Computational Biology↗
PubMed1991

The Lazarus Project: the politics of empowerment.

The problems associated with institutionalized care of the frail elderly are complicated and require interdisciplinary problem solving. This paper explains the conceptual framework and initial implementation of the Lazarus Project, a pilot project in a nursing home that offers an alternative governing philosophy for residential living. The framework is a community model based on democratic governance, which empowers those who work and live within the nursing home facility. Implementing a community model in an institution is a political process that requires an awareness of power relationships and structures. Strategies for institutional change are directed at alteration of the hierarchical power structures so that power is shared and decision making collaborative.

Aged↗
PubMedDate not supplied

Disease and health seeking patterns among adolescents in Uganda.

UNLABELLED: Adolescents in Uganda have a heavy burden of disease mainly from STD's, HIV and effects of unwanted pregnancy. Currently there are initiatives to address this problem. This paper presents results of a project which piloted a package of adolescent health services with the aim of identifying the best approach for providing quality, accessible, and affordable adolescent friendly services. OBJECTIVE: The main objective of the study was to evaluate the impact of adolescent-friendly health services piloted in the Jinja district Uganda. The specific objectives were to assess adolescents' knowledge, attitudes, and practices related to access and utilization of adolescent friendly services; to assess the perceptions and skills of health workers; and to identify options for scaling up services and sustainability of such services. METHODS: A KAP (Knowledge, Attitude and Practice) study was conducted among adolescents and service providers at eight health units. Four of the health units had implemented a package of adolescent friendly services, while four other health units had not implemented the package, but were comparable in terms of level of service delivery, catchment size and population characteristics. A structured questionnaire and in-depth interviews were used to collect data. RESULTS: A total of 128 adolescents and 42 health workers were interviewed, and focus group discussions were used to collect data. More adolescents utilized routine services at four pilot health units as follows: antenatal care (72.8% vs. 53.7%, p = 0.000), maternity care (70.6% vs. 53.1%, p = 0.005), family planning (69.4% vs. 21.1%, p = 0.000), management of STD's (65.5% vs. 31.9%, p = 0.000) and access to laboratory services (49.8% vs. 4.4%, p = 0.000). Adolescents at pilot sites were more knowledgeable on adolescent health problems (74.8% vs. 48.9%, p = 0.000), factors predisposing adolescents to health problems (73.4% vs. 52.5%, p = 0.003), family planning methods (84.5% vs. 68.7%, p = 0.000), HIV as a problem to adolescents (84.5% vs. 68.7%, p = 0.011), and STD's as a problem to adolescents (76.3 vs. 50.2%, p = 0.004). One of the main constraints to the pilot project was an erratic supply of contraceptives and STD drugs mainly from inadequacies in the national health system. CONCLUSION: Implementation of adolescent friendly services improved access and use of services among adolescents; this lead to reduced morbidity from STD's, HIV, and unwanted pregnancies. In order to reach more adolescents, services have to be scaled to lower health units up to the community level. Training of health workers, ensuring a constant supply of contraceptives, STD drugs, and availing voluntary HIV testing and counseling services are key program issues to consider.

Adolescent↗
PubMed1980

A schistosomiasis pilot control project in Lindu valley, Central Sulawesi, Indonesia.

This pilot control project was an intervention study, consisting of: 1) treating the positive cases with Niridazole; 2) spraying the foci with Niclosamide; 3) improving the water supply system and construction of public latrines. The intervention not only has lowered the human prevalence rate, but has also lowered the transmission of the disease in that area. Niridazole appeared relatively safe and effective, the cure rate after one year was 80%. Spraying the foci with Niclosamide 20-40 mg per litre did not appear very effective. Using this epidemiological data it was estimated that infected persons would become spontaneously negative after 4.75 years, if there was no reinfection.

Animals↗
PubMed1999

[Thoracoscopy versus thoracotomy. The dilemma of the comparison and its meaning for quality assurance in thoracic surgery].

The need for scientific investigation into the benefits of thoracoscopy in comparison to thoracotomy as well as State intervention to assure quality in the field of surgery motivated the members of the commission of endoscopic surgery of the German Society of Thoracic Surgery to conduct a pilot project at their hospitals. This pilot project was expected to analyse data on the outcome and a selection of variables concerning trauma and postoperative quality of life of some 400 patients treated between 8/95 and 10/95 at 5 thoracic surgical clinics. On completion of the pilot project the course of 141 patients undergoing different thoracic operations at 4 thoracic surgery departments had been documented to various degrees. 60 patients for various indications received a thoracoscopy, 72 a thoracotomy. In 9 patients thoracoscopy was converted to thoracotomy (6.4%). Eight of the 141 patients died in the postoperative course (5.7%), overall morbidity was 15.6%. There was a slight but statistically not significant difference concerning mortality and morbidity in favor of thoracoscopy (1.7 vs. 9.7% and 10 vs. 19.4%). But, there was a selection of malignant diseases, higher age and high risk patients towards thoracotomy. In subgroups of patients undergoing operations not bigger than the resection of three lung wedges only time of operation and length of incision revealed to be significantly shorter for thoracoscopy (69(25-190) min vs. 128(24-240)min, p = 0.0013; 6(4-8)cm vs. 23(12-35)cm, p = 0.0001). Borderline significance was reached by the Spitzer-Index in advantage for thoracoscopy (8(2-10)points vs. 7(0-10)points, p = 0.0728). Thoracotomy and thoracoscopy are access procedures used with different indications in different patients. Differences concerning trauma and quality of life if present are marginal and will need studies to be outlined. Quality assurance in thoracic surgery using a standardized documentation will not succeed under the given circumstances.

Adult↗
PubMed2003

The design of pilot telecare projects and their integration into mainstream service delivery.

We studied the introduction of a telecare and rehabilitation scheme in north-west Surrey. It was decided not to create a new team to provide the new services, but to involve established teams and individuals. The introduction of telecare therefore added to the roles and responsibilities of these teams. This staffing policy helped to establish awareness of the project within the local care system and to support its subsequent deployment. An education and training unit was established to demonstrate what the technology could do and to act as a focus for training health and social care professionals. The study suggested that for telecare to achieve its full potential, pilot projects must be designed to be evaluated, and more attention must be paid to the degree of integration with the care system as a whole.

Aged↗
PubMed2003

Evaluation of the Florida coordinated school health program pilot schools project.

The Florida Department of Education, with CDC funding, designed the Florida Coordinated School Health Program Pilot Schools Project (PSP) to encourage innovative approaches to promote coordinated school health programs (CSHP) in Florida schools. Each of eight pilot schools received $15,000 in project funding, three years of technical assistance including on-site and off-site assistance, a project office resource center, mailings of resource materials, needs assessment and evaluation assistance, and three PSP Summer Institutes. Project evaluators created a context evaluation, approaching each school independently as a "case study" to measure the school's progress in meeting goals established at baseline. Data were collected using the How Healthy is Your School? needs assessment instrument, a School Health Portfolio constructed by each school team, a Pilot Schools Project Team Member Survey instrument, midcourse team interviews, final team interviews, and performance indicator data obtained from pilot and control schools. The PSP posed two fundamental questions: "Can financial resources, professional training, and technical assistance enable individual schools to create and sustain a coordinated school health program?" and "What outcomes reasonably can one expect from a coordinated school health program, assuming programs receive adequate support over time?" First, activities at the eight schools confirmed that a coordinated school health programs can be established and sustained. Program strength and sustainability depend on long-term resources, qualified personnel, and administrative support. Second, though coordinated school health programs may improve school performance indicators, the PSP yielded insufficient evidence to support that belief. Future projects should include robust measurement and evaluation designs, thereby producing conclusive evidence about the influence of a coordinated school health program on such outcomes.

Adolescent↗
PubMed1998

Electronic reserves: the changing landscape of instructional support.

During the spring 1996 academic semester, the University of Maryland Health Sciences Library implemented an electronic course-reserve system as a pilot project with the university's School of Nursing. The pilot project has been very successful because of thorough planning and the effectiveness of the system, which enables library users to retrieve assigned readings easily. This success inspired the staff to begin expanding the scope of the pilot project to include other schools and limited remote access. This paper describes the planning and implementation process, the issues that needed to be resolved, the response to the project, and future plans. Particular attention is paid to issues of copyright and cost recovery.

Baltimore↗
PubMed2004

Coding properties of Oxytricha trifallax (Sterkiella histriomuscorum) macronuclear chromosomes: analysis of a pilot genome project.

The macronuclear genomes of spirotrichous ciliates are almost entirely polyploid, single-gene chromosomes ("nanochromosomes"). We recently performed a pilot genome project for a member of this group, Oxytricha trifallax ( Sterkiella histriomuscorum), in which approximately 2000 nanochromosomes were cloned at random and end-sequenced. Here we describe the global properties of the coding regions predicted for these molecules, including nucleotide composition, codon usage, and intron properties. In identifying splice donor, acceptor and branch sites, we found that longer introns in Oxytricha have a stronger signal at the donor site than do smaller introns, as has been found for Caenorhabditis elegans and Drosophila, despite the overall small size of the introns. A systematic search for multi-gene chromosomes identified 11 candidate nanochromosomes. We compare the results from this large dataset with those obtained from earlier studies and with statistics recorded from ciliates and other eukaryotes.

Animals↗
PubMed1998

Admission to hospitals with on-site cardiac catheterization facilities :impact on long-term costs and outcomes.

BACKGROUND: Admission to a hospital with a capability for cardiac procedures is associated with a higher likelihood of referral for a cardiac procedure but not with a better short-term clinical outcome. Whether there are differences in long-term mortality and resource consumption is not clear. We sought to determine whether elderly Medicare patients with acute myocardial infarction admitted to hospitals with on-site cardiac catheterization facilities have lower long-term hospital costs and better outcomes than patients admitted to hospitals without such facilities. METHODS AND RESULTS: As part of the Cooperative Cardiovascular Project pilot in Connecticut, we conducted a retrospective cohort study using data from medical charts and administrative files. The study sample included 2521 patients with acute myocardial infarction covered by Medicare from 1992 to 1993. The cardiac catheterization rate was higher in the hospitals with facilities (38.6% versus 26.9%; P<0.001), but the revascularization rate was similar (20.5% versus 19.5%) during the initial episode of care and at 3 years (29.7% versus 29.7%). Mortality rates were similar for patients admitted to the 2 types of hospitals at 30 days (OR, 1.08; 95% CI, 0.83 to 1.42) and at 3 years (OR, 1.02; 95% CI, 0.83 to 1.26). The adjusted readmission rates were significantly lower among patients admitted to hospitals with cardiac catheterization facilities (OR, 0.76; 95% CI, 0.61 to 0.94). However, the overall mean days in the hospital for the 3 years after admission was 25.9 for patients admitted to hospitals with facilities and 24.6 for the other patients (P=0.234). Adjusting for baseline patient characteristics, there was no significant difference in the 3-year costs between patients admitted to the 2 types of hospitals. CONCLUSIONS: With higher rates of cardiac catheterization and lower readmission rates, patients admitted to hospitals with on-site cardiac catheterization facilities did not have significantly different hospital costs compared with patients admitted to hospitals without these facilities. There was also no significant difference in short- or long-term mortality rates.

Aged↗