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PubMedDate not supplied

The development of a palliative care program.

Palliative care, which neither hastens death nor prolongs life, provides comfort through the final stages of life. The focus is on comfort for the patient and quality of life for both patient and family. A three-month pilot project used the team approach, involving a physician, nurse, and social worker, to assess how the palliative care needs of the terminal cancer patient were being met at the Cleveland Clinic. Data are presented to demonstrate that such needs exist and are not currently being met by existing services, as perceived by the patient population surveyed. During the pilot project, the palliative care team was in compliance with the Joint Commission on Accreditation of Hospitals hospice standards.

Adult↗

PubMedDate not supplied

Prevention in Poland: health care system reform.

Despite the political and economic reforms that have swept Eastern Europe in the past 5 years, there has been little change in Poland's health care system. The Ministry of Health and Social Welfare has targeted preventive care as a priority, yet the enactment of legislation to meet this goal has been slow. The process of reform has been hindered by political stagnation, economic crisis, and a lack of delineation of responsibility for implementing the reforms. Despite the delays in reform, recent developments indicate that a realistic, sustainable restructuring of the health care system is possible, with a focus on preventive services. Recent proposals for change have centered on applying national goals to limited geographic areas, with both local and international support. Regional pilot projects to restructure health care delivery at a community level, local health education and disease prevention initiatives, and a national training program for primary care and family physicians and nurses are being planned. Through regionalization, an increase in responsibility for both the physician and the patient, and redefinition of primary health care and the role of family physicians, isolated local movements and pilot projects have shown promise in achieving these goals, even under the current budgetary constraints.

Health Care Reform↗

PubMed2004

Enhancing quality of care for acute myocardial infarction: shifting the focus of improvement from key indicators to process of care and tool use: the American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice Project in Michigan: Flint and Saginaw Expansion.

OBJECTIVES: This project evaluated if by focusing on process changes and tool use rather than key indicator rates, the use of evidence-based therapies in patients with acute myocardial infarction (AMI) would increase. BACKGROUND: The use of tools designed to improve quality of care in the American College of Cardiology AMI Guidelines Applied in Practice Pilot Project resulted in improved adherence to evidence-based therapies for patients, but overall, tool use was modest. METHODS: The current project, implemented in five hospitals, was modeled after the previous project, but with greater emphasis on tool use. This allowed early identification of barriers to tool use and strategies to overcome barriers. Main outcome measures were AMI quality indicators in pre-measurement (January 1, 2001 to June 30, 2001) and post-measurement (December 15, 2001 to March 31, 2002) samples. RESULTS: One or more tools were used in 93% of patients (standard orders = 82%, and discharge document = 47%). Tool use was associated with significantly higher adherence to most discharge quality indicator rates with increases in aspirin, angiotensin-converting enzyme inhibitors, and smoking cessation and dietary counseling. Patients undergoing coronary artery bypass grafting (CABG) had low rates of discharge indicators. Patients undergoing percutaneous coronary revascularization were more likely to receive evidence-based therapies. CONCLUSIONS: These data validate the results of the pilot project that quality of AMI care can be improved through the use of guideline-based tools. Identifying and overcoming barriers to tool use led to substantially higher rates of tool use. The low rates of adherence to quality indicators in patients undergoing CABG suggest that these patients should be particularly targeted for quality improvement efforts.

Adrenergic beta-Antagonists↗

PubMed2002

Options for alternative types of sewerage and treatment systems directed to improvement of the overall performance.

Technology for future houses may well include a high-tech water recycling unit that makes tapwater while people drink bottled water of high quality. There may be toilets that produce just a bag of dry fertiliser per year, hopefully without fossil energy. Rainwater infiltration is increasingly replacing storm sewers anyway. Many urban areas of the future could simply be without sewerage systems. Technical feasibility is given even today and economic feasability is coming closer by advances in membrane technology. However, there are more likely scenarios than this. One person produces about 500 litres of urine and 50 litres of faeces per year (= blackwater). The same person, produces in a range of 20,000 to over 100,000 litres of wastewater. Black- and greywater (wastewater without toilet) do have very different characteristics. If blackwater is collected separately with low dilution it can be converted to safe natural fertiliser, replacing synthetic products and preventing spreadout of pathogens and other pollutants to receiving waters. New sanitation concepts are now built in several countries as pilot projects. One example is a vacuum-biogas system for around 400 inhabitants that has been built in Lübeck, Germany. It does perform recovery of resources and energy in an urban area. This type of sanitation can serve around up to 10,000 people and can be arranged in independent modules for larger settlements. Another pilot project based on urine-sorting flush toilets (no-mix-toilets) has been built in the rural water-mill museum "Lambertsmühle" near Cologne, Germany. Urine or yellow water is collected with low dilution and can be used as fertiliser as projects in Sweden have shown--the nutrient composition suits many types of soil. Brownwater (the solids and flush from the sorting toilet) is converted to small volume by a two-chamber composting tank with a filtration system. The compost can be used as soil conditioner. These and other concepts can be economic and show new ways for the many water scarce areas around the world, too.

Cities↗

PubMed1995

Computer mediated learning experiences spanning the globe: a pilot study between schools of nursing in the United States and the Netherlands.

The use of telecommunications in health care, education, and our daily lives has become a popular topic in both the professional and lay literature. The promise of the "Information Superhighway" and the expanded use of the Internet by other professionals have precipitated the examination of computer mediated communication as an instructional tool that transcends geographic boundaries and time barriers. This paper will discuss the development and implementation of a pilot project to foster collaborative learning experiences for nursing students between two schools of nursing in two different countries. The pilot is framed within the context of a Global Collaborative Learning Project in Nursing Informatics. A pilot project was initiated between the Schools of Nursing at the University of Colorado Health Sciences Center and the Hogeschool Holland during the 1994-95 academic year. Each school taught a nursing informatics course and assignments were designed to allow students from each school to participate in a collaborative learning experience. The presentation will highlight the outcomes of this pilot project and project future plans.

Colorado↗

PubMed2005

Chemical leasing: cooperative business models for sustainable chemicals management. Summary of research projects commissioned by the Austrian Federal Ministry of Agriculture, Forestry, Environment and Water Management.

BACKGROUND, AIM AND SCOPE: Chemicals play a vital role in the day-to-day life of industrialised societies. Their use is not restricted to the chemical enterprises per se, but is a crucial part of production processes in a lot of industrial sectors. Traditional instruments of environmental policy (such as bans, restrictions) can only deal with the most hazardous substances. The Johannesburg Implementation Plan of 2002 calls for more sustainable patterns of production and consumption, and sets the year of 2020 as a goal to use chemicals in a way that human health and the environment are not endangered. Political instruments should not only gather more knowledge about the properties of chemicals, but should also stimulate the environmentally sound use of chemicals. Existing business models should therefore be reviewed in relation to this strategic approach to encourage marketing options with respect to the environmental focus. MAIN FEATURES: Business models were examined for their effects on the consumption of chemicals and amount of waste emissions in relation to their economic potential. Different possibilities for cooperation of supplier, user and disposal companies were elaborated and examined with a view to the specific situation in Austria. RESULTS AND DISCUSSION: A range of cooperative models--summarised under the term 'chemical leasing'--was identified, which can contribute to a more efficient use of resources. 12 main possible application areas (cleaning, lubrication, paint stripping and others) have been identified in Austria. If chemical leasing models were applied in these areas, the amounts of chemicals currently used could be reduced by one third (53,000 tonnes per year). Cost reductions of up to 15% can be expected. CONCLUSION: The application of chemical leasing models can contribute considerably to achieving more sustainable and resource-efficient patterns of production. The Austrian Ministry for Environment has therefore decided to subsidise the further practical implementation of these new service-oriented business models. Pilot projects in 4 enterprises, which are supervised by consulting companies, are currently being carried out. RECOMMENDATION AND OUTLOOK: The experiences of the pilot projects will serve as valuable building blocks for the wider use of chemical leasing models. Furthermore, the UNIDO Cleaner Production Centres have expressed their clear interest and will examine the possibility to use chemical leasing as a part of their Cleaner Production Programmes.

Austria↗

PubMed1993

[Promoting competence in a model trial of a complementary course of study in health sciences/public health at the Berlin Technical University in cooperation with the Free University and other science and general practice institutions].

Since October 1992 (winter semester 92/93) graduates are being educated in Public Health at Berlin Technical University in cooperation with the Free University of Berlin as well as with the Humboldt University of Berlin and other institutions of science and practice in Berlin and Brandenburg. For the time being the course of studies is a pilot project for 4 years. The aim of the postgraduate studies is the creation of permanent structures and therefore institutionalisation. It is open to graduates and college graduates of public-health relevant subject areas of specialisation are "Health Promotion in the community and at the workplace" and "Planning and Management in Health Services". The course of studies takes 4 semesters and is divided into basic studies, studies of main points of emphasis and project studies. Social medicine and especially epidemiology are part of the basic disciplines, which are indispensable for finding the way of looking at problems concerning public health. The reason for the peculiarity with regard to establishing public health at other German universities are the main topics representing the interaction between the technical and ecological development of health. The graduate degree is "Magister of Public Health". During the time of the pilot project the course of studies is subjected to external and internal surveillance regarding quality assurance and quality optimisation of teaching and organisation of the studies. On the one hand this is done by an external advisory committee and on the other hand by internal and external evaluation.

Community Medicine↗

PubMed1985

A pilot study of the clinical problem of regionally anesthetizing the pulp of an acutely inflamed mandibular molar.

The diplomates of the American Association of Endodontists were surveyed regarding difficulties in regionally anesthetizing acutely painful mandibular molar teeth. Frequently patients developed evidence of adequate regional block anesthesia but experienced pain when the dentist attempted access. A pilot projection was undertaken to determine if a scientific basis existed for this problem. With the animal under general anesthesia, the mandibular nerve of a cat was isolated and then regionally blocked. A stimulating electrode was implanted in a cuspid tooth and a receiving electrode in the cortex of the brain. When a state of inflammation was created in the tooth in the presence of a regional block, there was an increasing cortical response to this stimulation. It was concluded that the pilot project offered a realistic technique for the study of this clinical entity.

Acute Disease↗

PubMed1983

Mega-doses of behaviour therapy for treatment-resistant agoraphobics.

This was a pilot project set up to test the feasibility of effectively and inexpensively treating agoraphobic patients who had not responded to adequate trials of behaviour therapy (and other therapy) in the past. We employed a quantitatively intensive program of exposure therapy, calisthenics and muscular relaxation, and have explained the rationales for the choice of each treatment. The results were gratifying in four of the five patients, with follow-up to three years. This pilot project enabled us to set up a cost-effective treatment for all forms of agoraphobia which is as efficient as other programs described. It has also highlighted the fact that some patients exist who may do poorly on schedules of behaviour therapy which are adequate for some patients, and yet may do well if the amount of treatment is drastically increased.

Adult↗

PubMed2005

Introduction and development of NCP using ICNP in Pakistan.

BACKGROUND: Traditionally, nursing care has been described as performing nursing tasks and often focused on nurses carrying out doctors' orders. In many countries of the world, including Pakistan, nurses do not document care in a standardized manner. Because of this limitation many health administrators, policy makers, and consumers make inadequate assumptions about nursing work, often regarding nurses as any other 'health care technician' who can be easily replaced by more economical health care workers. PURPOSE: To overcome this problem, standardized documentation is being introduced into the Aga Khan University School of Nursing and hospital, Aga Khan Health Services, Public Health School in Karachi, and government colleges of nursing, using the International Classification for Nursing Practice (ICNP). The purpose of this paper is to highlight the process of introducing and developing standardized nursing care plans (NCP) using ICNP in Pakistan. PROCESS: The process for introducing ICNP consists of four components, including administrative planning, development, teaching and training, and testing. Subsets of the ICNP for (i) maternity: antenatal, postnatal and natal care; and (ii) cardiology were developed using standardized NCPs. The subsets were developed by nurse experts and introduced at the testing sites. The testing will be conducted as a pilot project. Findings from the pilot will be used to continue and expand standardized nursing documentation using the ICNP across Pakistan. CONCLUSION: Through this project, nurses, midwives and lady health visitors (midwives, vaccinator and health educators) will test standardization of documentation and begin to evaluate efficiency and effectiveness of clinical practice.

Documentation↗

PubMed2003

Pilot study to enhance HIV care using needle exchange-based health services for out-of-treatment injecting drug users.

The introduction of highly active antiretroviral therapy (HAART) has resulted in marked reductions in mortality and acquired immunodeficiency syndrome (AIDS) incidence across all risk groups; however, the proportionate decrease among injecting drug users (IDUs) has been less impressive. Much of the disparity in benefit to IDUs has been a consequence of decreased access to and receipt of potent antiretroviral combinations. Strategies to increase access to and utilization of HAART have included entry into drug treatment and abstinence. Unfortunately, as few as 15%-20% of active drug users in the United States, and in many other countries, are in drug treatment at any one time. We report a pilot project among out-of-drug treatment IDUs infected with human immunodeficiency virus (HIV); HIV therapy was successfully provided to active heroin injectors using the Community Health Care Van (CHCV) at sites of needle exchange. Subjects were willing to initiate, but were not receiving, recommended HIV therapy and were not interested in formal drug treatment. Antiretroviral therapy regimens were selected and linked to heroin injection timing. Weekly visits were scheduled by CHCV staff to assess adverse side effects and encourage adherence. Of the 13 participants, the mean baseline HIV-1 RNA level and CD4 lymphocyte count were 162,369 (log 5.21) copies per milliliter and 265 cells per milliliter, respectively. By 6 months, the proportion whose HIV-1 RNA was below the limits of detection (<400 copies/mL) was 85% (N=11); 77% (N=10) had nondetectable levels by 9 months. By 12 months, 54% (N=7) had a persistently nondetectable viral load, and the net increase in CD4 lymphocyte count was 150 cells per milliliter. As an additional and unintended benefit of this pilot project, 9 (69%) subjects chose to enter drug treatment after achieving a nondetectable viral load. Entry into drug treatment was associated with durability of viral suppression. This small pilot study suggests that health services based on needle exchange may enhance access to HAART among out-of-treatment HIV-infected IDUs. In addition, it demonstrates that this population can benefit from this therapy with the support of a nontraditional, community-based health intervention.

Adult↗

PubMed2001

[The importance of company interests in shaping occupational rehabilitation programs: empirical findings from company-based retraining].

The pilot project "Occupational Rehabilitation of Women Close to their Place of Residence" is orientated towards the dual system of vocational retraining by combining "on the job training" and "vocational theory in a vocational training school". Training on the job is one of the most important aspects in this programme, and data have therefore been gained from qualitative interviews with representatives of different firms. The results presented are based on the analysis of qualitative interviews with 13 employers involved in the pilot project. All interviewees underline: Training on the job alongside non-disabled persons is thought to offer good opportunities for lasting vocational integration since it enables trainees to grow accustomed to the conditions and demands of work and is thought likely to lead directly to employment. We discussed a range of mechanisms through which a societal obligation to train and/or employ disabled people could be implemented and highlighted the role of "rehabilitation services" which support the trainee by psychological, educational and social services and support the employer.

Persons with Disabilities↗

PubMed1989

Daily packaging of non standard oral unit doses for pediatrics.

A pilot project to examine the feasibility of a computerized one-day supply packaging system for non-standard pediatric oral unit doses was performed on one nursing unit over a 41-day period. The results showed a waste of 18 percent compared to 32 percent for our non-computerized three-day supply system. Technician time to prepare doses decreased from 1.45 minutes to 0.98 minutes per dose when comparing the three-day supply to the one-day supply procedure. Due to the success of the pilot project, all existing unit dose beds were converted to the new system and 81 additional beds were added to the unit dose program without increasing the volume of daily packaging compared to other years.

Canada↗

PubMed1978

Preventing unplanned pregnancies.

A two-year study was undertaken in 1975--1976 to plan, implement and evaluate innovatory family planning educational and service delivery pilot projects, among those at-risk in Sydney. The study was done in three stages, described in the three parts of this paper. Part 1 describes the process of analyzing the major factors and outcomes in unplanned pregnancy and determining some characteristics of women experiencing unplanned pregnancies, from abortion and adoption records. The characteristics analyzed are: are, marital status, occupation, socio-economic status, and ethnic group. Part II describes the process of determing acceptable communication channels and services they would use. Twenty-five women were interviewed in each of eight at-risk categories. Recommendations are made about suitable educational methods, and family planning services. Part 3 describes the implementation and evaluation of pilot projects. Four major projects are described: (i) in a two lower socio-economic housing area(s), (ii) among Greek men, (iii) among South Americans, and (iv) in two factories. Recommendations are made about future educational programmes and services.

Adolescent↗

PubMed2007

Self-scheduling for hospital nurses: an attempt and its difficulties.

AIM: To describe a pilot project on self-scheduling (self-rostering) for hospital nurses and assess its potential values and difficulties in implementation. BACKGROUND: Self-scheduling is one aspect of the effort to make the hospital nursing environment more accommodative of nurses' lives. It is part of the good employment practices that nurses want and that can help recruitment, retention and--possibly--patient care. METHOD: A self-scheduling programme was implemented on one nursing floor for a year. Its effect on nursing perceptions was gauged by an informal questionnaire, and its effect on the nurse manager was gauged by counting change requests and sick calls, as well as her time spent on scheduling and her perceived annoyance in doing it. FINDINGS: During the time of the pilot project nurses felt that they had better control of their time and were able to give better patient care. Also, change requests decreased, as did the time spent by the nurse manager and her sense of annoyance. But since the nurses did not adhere to the rules of the programme, despite repeated efforts by the nurse manager, the attempt floundered. CONCLUSION: Self-scheduling can have positive results for nurses and benefit the nurse manager. But if nurses see this as an individual entitlement instead of a balance between individual and unit benefit, everyone loses. This experience may be of use to others trying to implement a self-scheduling system.

Absenteeism↗

PubMed2002

National program for preventing mother-child HIV transmission in Thailand: successful implementation and lessons learned.

OBJECTIVE: To describe the development, components, and initial uptake of Thailand's national program for preventing mother-child HIV transmission. DESIGN: Historical review, interpretation of experience, national program monitoring. SETTING: Public health system, Thailand. PARTICIPANTS: Policymakers, clinicians, HIV-infected pregnant women. INTERVENTION: Voluntary counseling and HIV testing of pregnant women; short-course zidovudine for HIV-infected women and their infants and formula feeding for infants. MAIN OUTCOME MEASURES: Program components implemented and program uptake. RESULTS: Research, monitoring and evaluation of pilot projects, training, and policy-making provided the information, experience, infrastructure, and guidance to develop a program for preventing mother-child HIV transmission that was implemented in all Ministry of Public Health hospitals in Thailand in 2000. A national system was established to monitor program implementation. Monitoring reports were received from 669 hospitals in 65 provinces for the period October 2000 through July 2001. During this period, 93% of 318 721 women who gave birth were tested for HIV; 69% of 3958 HIV-infected women giving birth received zidovudine; and 86% and 80% of the 3865 children born to HIV-infected women received zidovudine and infant formula, respectively, through the program. CONCLUSIONS: A national program for preventing mother-child HIV transmission was successfully implemented in Thailand. Early monitoring indicates good program uptake. Lessons learned from implementing this program include the importance of paying attention to counseling, communication, and training in the program, and using pilot projects and focused monitoring and evaluation data to guide the program development, expansion, and improvement.

AIDS Serodiagnosis↗

PubMed1997

[Evaluation of clinical competence in urology: innovative approach based on performance observation].

OBJECTIVE: The authors present a pilot project for the evaluation of clinical skills in urology using a method of evaluation based on observation of real performance. MATERIAL AND METHODS: An objective and structured clinical examination (OSCE) applied to urology was developed according to a precise predetermined design: 1) Identification of the objectives to be evaluated. 2) Choice of sampling of clinical situations representative of routine urological practice. 3) Construction, on the basis of these cases, of physician-patient interaction stations and question stations, with, for each case, weighting of objectives, construction of observation grids and writing of instructions for candidates, simulated patients and observers. RESULTS: An OSCE circuit of 10 clinical cases and 16 stations was constructed. The main poles of activity and urological settings were represented. Objective complementary investigations, diagnosis and treatment received the highest weightings. The reliability coefficient, the content validity and the construct validity will be verified on the basis of the overall score obtained by candidate. CONCLUSION: Establishment of the score and the expected results in terms of reliability, validity, and feasibility are discussed. The psychometric qualities of the OSCE have been demonstrated. Although a single instrument is not sufficient, it is currently the measuring tool which most closely approximates ideal evaluation of clinical skills. If the feasibility of this method is confirmed, this pilot project in urology could provide a new approach to evaluation strategies and could participate in the current reflection concerning urology training.

Clinical Competence↗

PubMed1994

Evaluation of school children at high risk for fragile X syndrome utilizing buccal cell FMR-1 testing.

We describe a pilot project utilizing saliva to identify the FMR-1 mutation in high-risk special education students from four public school districts in Colorado. The program included presentations to special education teachers regarding fragile X syndrome, parental consent for testing, completion of a behavior checklist by the teachers, identification of special education students at high risk for fragile X syndrome, subsequent brief examination of face and hands, collection of a saliva sample by either Gatorade swish or brushing of the inside of the cheek, and analysis for the FMR-1 mutation by PCR. Equivocal samples were studied by direct DNA testing using Southern blot analysis, and abnormal results were confirmed by a blood analysis for the FMR-1 mutation. Mutant individuals received genetic counseling and medical and educational assessments to optimize treatment and intervention. This pilot project was met with enthusiasm by the schools. Of the first 439 students evaluated, 68% were male with an average age of 7.75 years; 13% were mentally retarded or autistic. Most students referred for the evaluation were learning disabled (51%) and/or had an Attention Deficit Hyperactivity Disorder (ADHD) (35%). The overall prevalence of the FMR-1 mutation was 5 of 439 or 1.1%. This relatively low yield is probably due to the high number of non-retarded but learning disabled students tested. Of the mentally retarded patients tested, 3.5% were positive for the FMR-1 mutation; however, of the non-retarded or learning disabled patients, only 0.79% were FMR-1 positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗