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At least 811 records · Page 45Linked to original sources

PubMed1994

Salmonella enteritidis control programs in the United States.

A sharply rising incidence of salmonellosis in humans caused by Salmonella enteritidis (SE) in the United States between 1985 and 1989 resulted in a government-sponsored outbreak traceback program which was started in 1990. Layer flocks considered the sources of egg-implicated outbreaks would be tested for SE and the eggs from these flocks would be diverted to pasteurization plants. A program to eliminate SE from primary and multiplier breeding flocks was started at the same time. A subsequent spent hen survey and a survey of prepasteurized liquid egg material revealed that SE was much more prevalent than had been suspected, and that the highest prevalence was found in the northeastern and middle Atlantic states. Since the SE rates did not decrease during the next 2 years, a pilot project was started in 1992 in Pennsylvania, in one of the most highly affected areas. The project was designed to reduce the number of SE outbreaks by diverting eggs from SE-affected flocks and at the same time attempting to delineate the epidemiology and control aspects of the disease. With the results generated during the fist 18 months of the Pilot Project, a much larger SE prevention program will start in the same area, in October 1993.

Animals↗

PubMed1980

Evaluation of an EMS algorithm system. American College of Emergency Physicians Algorithm Review Subcommitte.

The American College of Emergency Physicians algorithm project was a pilot study designed to identify a method for evaluating algorithms by peer review and field test. The intent of the pilot project was to make recommendations which would permit a more extensive evaluation of the logic, usefulness, and safety of various algorithms. The project yielded a report which summarized the research design and suggests possible revisions to the phases of peer review, algorithm assignment, and field test. It is anticipated that the report will be used by the National Center for Health Services Research in developing a method to carefully assess the various algorithms developed to date prior to their widespread use. Presented here is the executive summary of the report.

Decision Making↗

PubMed1993

Free radicals, reperfusion and myocardial infarction therapy: European Myocardial Infarction Project--free radicals pilot study. EMIP-FR Pilot Study Group.

Reperfusion injury due to overproduction of free radicals may reduce the efficacy of thrombolytic therapy. Trimetazidine is an agent which could prevent or limit the deleterious effects of free radicals on the myocardium and could, therefore, improve the prognosis for patients with acute myocardial infarction (MI) receiving thrombolytic therapy. In this pilot study, 136 patients with suspected acute MI were randomized to receive either 40 mg trimetazidine as an intravenous (i.v.) bolus followed by an infusion of trimetazidine at 60 mg.24 h-1 for 48 h (n = 69) or matching placebo (n = 67). Stratification was based on the use ('T' stratum; n = 69) or not ('NT' stratum; n = 67) of a thrombolytic. The mean age of patients was 64.2 years (+/- 12.7), and the final diagnosis at discharge was confirmed MI in 92% of patients. No statistically significant difference was observed for the occurrence of major or minor adverse events. Eight patients died before discharge; three in the trimetazidine group and five in the placebo group. The observed compliance was good and the low rate of adverse events suggests that the study treatment can be considered safe in patients with suspected acute MI, either receiving thrombolytic treatment or not. The study is feasible and no major practical problem can be expected from this simple protocol. We started recruitment of patients for the large-scale mortality and morbidity trial in October 1992.

Double-Blind Method↗

PubMed1997

Fundamentals of modern telemedicine in Africa.

The FOMTA (Fundamentals of Modern Telemedicine in Africa) project aims to promote the development of indigenous regional networks between R&D centres and universities of the Developing Countries (DCs) and their European counterparts. While FOMTA prepares the way for the use of broadband technology in Africa, it will also associate the DCs with the generation of knowledge, innovative and appropriate technologies needed to solve some of the specific problems, in order to achieve a sustainable economic development. Designed to eliminate the time-delaying lack of infrastructure, FOMTA will embark on the simulation of the integrated Service Digital Network infrastructure. FOMTA will adopt measures to increase the awareness and stimulate the participation of the DCs in the telemedicine and health care telematics projects through demonstrations, pilot projects, workshops, training and exchange activities. This will demonstrate the feasibility of telemedicine services in the DCs, including trial of services in real-life circumstances, and will provide training possibilities for researchers in the use of methods and tools for advanced communication technologies and telematics. Undoubtedly, telediagnosis, teleconsultation and other areas of telemedicine would thrive in Africa both as remote testing grounds and fields of practical applications.

Africa↗

PubMed1987

Low-birth-weight rate reduced by the obstetrical access project.

Obstetrical (OB) access was a Medicaid pilot project that operated in 13 California counties from July 1979 through June 1982. The project goals were to both improve access to care in underserved areas and improve pregnancy outcomes by providing enhanced prenatal care, including psychosocial, health education, and nutrition services. The project registered 6,774 women. The findings were: 87 percent of the registrants started prenatal care during the first or second trimester; 84 percent of the registrants completed care in the project; OB access mothers had a low-birth-weight rate of 4.7 percent, compared with 7.0 percent for a matched control group, suggesting a 33-percent reduction in low birth weight through the project; and the benefit-cost ratio of this program was about 2 to 1 for the short run because of savings in neonatal intensive care services. The State of California approved legislation in 1984 authorizing the project's scope of services for the Medi-Cal recipients on a statewide basis.

California↗

PubMed2003

Evaluation of the rural South Australian Tri-division Adolescent Health Project.

The Adolescent Health Project (AHP) was a rural pilot project aimed at strengthening the relationship between general practitioners (GPs) and adolescents within three Divisions of general practice. The evaluation assessed the implementation of the AHP model and strategies and their impact. The AHP used a centralised management/support and local delivery model. The AHP improved GP relationships and comfort with dealing with young people, and improved GP relationships with school counsellors. Divisional relationships with local schools improved. Students reported increased knowledge about GPs, increased confidence and comfort with accessing GPs. The AHP delivered a popular project to GPs, GP clinics, schools, school counsellors and students, which built the capacity of divisions, GPs, and schools to improve adolescent health care provision. Further research questions have emerged: What are the patterns of relationships between GPs and adolescents, and between GPs and school counsellors, and what strategies work best to sustain such relationships?

Adolescent↗

PubMed1998

Redesigning a school health workforce for a new health care environment: training school nurses as nurse practitioners.

Diminishing financial resources for school health dictate the most efficient possible deployment of the school health workforce. School nurses trained as nurse practitioners could help resolve the common problems of ready access to and appropriate use of primary care, early detection of potentially costly medical problems, and efficient use of school health staff. To determine how best to use existing resources to meet the increasingly varied and complex health care needs of children and adolescents, a pilot project was conducted in Denver from 1994 to 1996. With physician back-up and health aide support, school nurses were trained as nurse practitioners to provide in-school diagnostic and treatment services. Based on their evaluation study of this pilot project, the authors suggest ways to solve problems in role transition, including well-balanced training; clear role definition and assignment of responsibilities; appropriate back-up and mentoring support; and issues of sustaining long-term programs.

Adolescent↗

PubMed1994

Case-based hospital financing: the case of Norway.

Several European countries are experimenting with new ways of organising and financing the hospital sector. This paper discusses the present Norwegian reform, where a system of fixed grants is replaced by a combination of payment per case and fixed grants. Initially implemented in four hospitals only, the decision to move to a full-scale reform will be based on the evaluation of this pilot project. The paper presents two alternative hypotheses on how a system with case-based financing will influence the performance of hospitals. Given that hospitals adjust passively to the constraints imposed by the financing system, increased efficiency is to be expected. If hospitals and hospital owners (i.e. the counties) interact in a game dominated by the hospital, however, the efficiency of the hospital will not be influenced by the financing system. We argue that the design of the pilot project limits the possibility of discriminating between these two hypotheses. Nevertheless, a comparison of key variables in the pilot hospitals with a set of reference hospitals indicates that the change of financing system has not had any substantial effect on hospital efficiency. Thus we are inclined to believe that hospitals in fact are able to set the level of efficiency independent of whether they are financed by fixed grants or a payment per case.

Data Collection↗

PubMed1998

Establishing the feasibility of cross-mapping independent child health data sets as a means of comparing health status and service quality.

Benefits of comparative data analysis for quality assurance and policy development are clear, but are difficult to establish through traditional means of prospective projects. This paper describes a pilot project to test an alternative method, namely seeking to identify areas of commonality amongst very different pre-existing data sets to provide a starting point. Advantages and disadvantages of this method, together with the critical factors identified in the pilot study, are described. Whilst developed in child health, the lessons learned are relevant for any other client groups.

Austria↗

PubMed1993

Organisation of screening.

The 'Europe against Cancer' programme aims to introduce systematic screening for breast cancer for women aged 50-69 and for cervical cancer for women aged 25-69. The programme initiated pilot projects on breast cancer screening in several European countries in 1989-1990. This initiative was followed by training for radiologists. European guidelines for quality assurance in breast cancer screening became available in 1992, and a working party on treatment of small breast lesions was formed. The 'Europe against Cancer' programme also launched pilot projects in cervical cancer screening and a cervical cancer screening surveillance programme in 1992.

Adult↗

PubMed2002

Implementation of the DOTS strategy for tuberculosis in the Leningrad Region, Russian Federation (1998-1999).

SETTING: The DOTS pilot project for tuberculosis control in the Leningrad Region of the Russian Federation, supported by the Finnish Lung Health Association and the World Health Organization (WHO). OBJECTIVE: To assess the efficacy of WHO-recommended standard short-course chemotherapy in newly detected pulmonary tuberculosis cases positive by smear or with extensive lung lesions suggestive of culture positivity, under project conditions. METHODS: Analysis of data on case detection, sputum smear conversion and treatment outcome based on standardised (WHO) registers from districts and a central computerised database. RESULTS: Of 859 adult pulmonary tuberculosis cases (292 smear-positive) notified in the Leningrad Region in the study period, 312 new cases were included in the project. The sputum conversion rate at the end of the second month was 82.8% and 91.1% at the end of the third month. Of bacteriologically confirmed cases, 71.3% were successfully treated, 4.9% died, 11.7% defaulted and 8.1% failed. CONCLUSION: In the first year of the pilot project in the Leningrad Region, the DOTS strategy revealed feasibility and moderate efficacy among new pulmonary tuberculosis cases who were either smear-positive or showed extensive lung lesions on chest X-ray, and who were therefore of high epidemiological and medical priority.

Adolescent↗

PubMedDate not supplied

The Integrated Care in Shropshire project: lessons from experience.

Support for the idea of teamwork as an abstract ideal is not matched by practice. The Integrated Care in Shropshire project formed a partnership between Shropshire Social Services Department, Shropshire District Health Authority and Shropshire Family Health Services Authority together with the Helen Hamlyn Foundation. The first strand of the project was the development of procedures for assessment; it had a relatively clear goal and a firm deadline. The second strand was the development of better-integrated primary health care teams, but insufficient time and resources limited what could be achieved. Collaboration between the agencies has been extended for a further period and local units will be invited to put forward their own schemes. The ICIS project illustrates the need for 'pilot projects' to be conceived and managed by their sponsor agencies as sites for organisational learning if they are to be effective.

Aged↗

PubMed2005

Internet in clinical research based on a pilot experience.

Computing has become an integral part of many disciplines nowadays, turning it into an evermore necessary working tool. Internet provides a fast and easy way to collect scientific data and is becoming a more and more effective and safe way to transmit data. It is also an efficient means for interaction and information sharing within a work group that provides the necessary flexibility. A pilot project was conducted replacing the traditional hardcopy version of the case report form for an electronic one (e-CRF) and with access to Internet within the Naturalistic Randomized Clinical Trial of the Effectiveness of Olanzapine and Risperidone in the Treatment of Schizophrenia. Carrying out this pilot project has given us the opportunity to determine the advantages electronic data collection (EDC) by Internet has to offer both researchers and sponsors. The results have optimized time management, since it is easier to work in real time; data quality is improved, since intermediates are eliminated, and it facilitates communication amongst the different parties involved in the project. The use of this technology requires updated Internet connections and adequate personal computers, since the possibilities offered by the computer system and high-speed connection are critical in conducting the project. Obviously, this may involve a higher initial investment, but the results have revealed to us that these start-up costs are later offset by lowering personnel costs or by decreasing the number of monitoring visits. On the basis of our experience and that of the participating investigators, certain recommendations for future clinical trials using e-CRF can be made. We will go into these recommendations in greater depth throughout this paper. In short, EDC can dramatically improve the clinical trial process, opening the door to new technologies in the world of clinical research, not only for sponsors, but also for clinicians.

Antipsychotic Agents↗

PubMed1989

Assuring the quality of home-delivered long-term care: the Ohio Quality Assurance Project.

Home-delivered care is an important development for functionally disabled clients and for the long-term care system. However, questions and concerns about home care quality have been raised. At this point, home care quality is not well understood, and most case management and provider agencies have very little experience designing and implementing quality assurance programs. This article reports on the Ohio Quality Assurance Project. During this 17-month pilot project, the Ohio Department of Aging and the Scripps Gerontology Center, Miami University, collaborated on a model quality assurance system for case managed, in-home care. Using two demonstration sites within Ohio's PASSPORT program, the Ohio Quality Assurance Project developed and tested quality assurance standards and strategies that could be applicable to home care and case management agencies nationwide.

Administrative Personnel↗

PubMed2003

Does participation in a pain course based on the International Association for the Study of Pain's curricula guidelines change student knowledge about pain?

BACKGROUND: The People in Pain course was set up as a joint initiative of the Departments of Occupational Therapy and Physiotherapy within the School of Health and Rehabilitation Sciences at The University of Queensland. It was instigated in response to the publication of Pain Curricula for Occupational Therapy and Physiotherapy by the International Association for the Study of Pain (IASP) in 1994 (1). The first year it was offered, the "People in Pain" course comprised 14 h of lecture content. It was then expanded to encompass 28 h of lectures and seminar involvement. OBJECTIVES: To evaluate the impact of participation in a university pain course that meets the IASP pain curricula guidelines to increase health professional students' knowledge about pain. METHODS: Students who participated in the People in Pain course over the first three years were invited to complete the Revised Pain Knowledge and Attitudes Questionnaire (R-PKAQ) pre- and postcourse. Data obtained from 22 students in the short course formed a pilot project, and data from 22 students in the longer version of the course were used in the present study. RESULTS: Examination of the correlation matrix indicated substantial correlations between all R-PKAQ subscales except physiological basis of pain and pharmacological management of pain. In both the pilot project during the first year of the course and the expanded course in the following two years, significant improvement was found in the students' knowledge on five of the six subscales of the R-PKAQ: physiological basis of pain, psychological factors of pain perception, assessment and measurement of pain, cognitive-behavioural methods of pain relief, and pharmacological management of pain. Improvements in the developmental aspects of pain perception subscale failed to reach significance. CONCLUSIONS: An integrated pain course developed according to the pain curriculum guidelines developed by the IASP resulted in increased student knowledge regardless of the length of the program attended.

Analysis of Variance↗

PubMedDate not supplied

Decentralization, health care and policy process in the Punjab, Pakistan in the 1990s.

The Province of the Punjab underwent a number of attempts to decentralize the health sector in the 1990s. Among the most important were the decentralization of financial management within the district, the Sheikhupura PHC Pilot Project, the establishment of the District Health Authorities and District Health Management Teams, the creation of semi-autonomous hospitals and the programme of District Health Government (DHG). These usually received donor support and promotion, and emerged from within the provincial Department of Health, and more specifically the Secretariat and the internationally supported Second Family Health Project (FH2). Of particular significance was the DHG change, which involved a decentralization to the district, the appointment of powerful Chief Executives, the formation of District Management Committees and purchaser-provider separation. The paper reviews these proposals, focusing on the need to build on experiences and learning lessons from pilot projects, reform continuity, developing consultation and involvement and policy analysis. The latter indicates the importance of developing more in-depth policy analysis around the role of the central organization, the form of decentralization and the purchaser-provider separation. The paper concludes by underlining the need to ensure that political strategy and in-depth policy are appropriately coordinated in the policy process.

Developing Countries↗

PubMed1993

A psychosocial summary flow sheet: facilitating the coordination of care, enhancing the quality of care.

To improve the continuity of care and to better coordinate psychosocial care, the Psychosocial Oncology Program at the Ontario Cancer Institute/Princess Margaret Hospital developed a psychosocial summary flow sheet. The objectives of the pilot project evaluation were: (a) to examine preparation to use the flow sheet prior to its implementation, (b) to gather information on how staff used the flow sheet, and (c) to determine how its design and implementation could be improved. The charts of all the patients on the units participating in the pilot project were examined and a questionnaire was sent to all staff involved with patient care on these units. The results of the evaluation indicated that the psychosocial summary flow sheet was perceived to be an asset to psychosocial care and could be implemented hospital-wide. Based on the evaluation, a number of changes were made in its design and a strategy for hospital-wide implementation was planned.

Continuity of Patient Care↗

PubMed1997

Food security and nutrition programme, Benin.

From 1990 to 1994, the Benin government and the World Bank planned a pilot project that aimed to improve household food security through production and income-generating activities. Results showed that stocking (reducing losses) and selling food crops promoted access to food in villages, and the small development project--building roads and bridges--increased movement and rendered food more accessible. This pilot project resulted in a 5-year program, which incorporates nutrition in addition to the household food security objectives. The nutrition component of this program aims to reduce malnutrition through education and the empowerment of women to take charge of the problems in their village. Areas where food production does not cover the needs of the population are identified and targeted using national statistical data.

Africa↗