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Cardiovascular-related proteins identified in human plasma by the HUPO Plasma Proteome Project pilot phase.

Proteomic profiling of accessible bodily fluids, such as plasma, has the potential to accelerate biomarker/biosignature development for human diseases. The HUPO Plasma Proteome Project pilot phase examined human plasma with distinct proteomic approaches across multiple laboratories worldwide. Through this effort, we confidently identified 3020 proteins, each requiring a minimum of two high-scoring MS/MS spectra. A critical step subsequent to protein identification is functional annotation, in particular with regard to organ systems and disease. Performing exhaustive literature searches, we have manually annotated a subset of these 3020 proteins that have cardiovascular-related functions on the basis of an existing body of published information. These cardiovascular-related proteins can be organized into eight groups: markers of inflammation and/or cardiovascular disease, vascular and coagulation, signaling, growth and differentiation, cytoskeletal, transcription factors, channels/receptors and heart failure and remodeling. In addition, analysis of the peptide per protein ratio for MS/MS identification reveals group-specific trends. These findings serve as a resource to interrogate the functions of plasma proteins, and moreover, the list of cardiovascular-related proteins in plasma constitutes a baseline proteomic blueprint for the future development of biosignatures for diseases such as myocardial ischemia and atherosclerosis.

Arteriosclerosis↗

Evaluation of needle exchange pilot projects shows positive results.

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.

Germany↗

An in-training assessment examination in family medicine: report of a pilot project.

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.

Connecticut↗

General practitioner minor surgery facilitated by a Fife District General Hospital. Evaluation of a pilot project.

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.

Consumer Behavior↗

[The Deinze pilot project for caries prevention, 1981-1988].

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.

Belgium↗

Operation Red Box: a pilot project of needle and syringe drop boxes for injection drug users in East Baltimore.

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.

Adolescent↗

Magdalena Pilot Project: motivational outreach to substance abusing women street sex workers.

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.

Adult↗

[Can we and must we organize cervical cancer screening in France? Results of the pilot project "EVE" in the department of Bas-Rhin].

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.

Adult↗

A pilot project on community based rehabilitation in south India--a preliminary report.

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.

Community Health Services↗

Virologic and immunologic outcomes and programmatic challenges of an antiretroviral treatment pilot project in Abidjan, Côte d'Ivoire.

BACKGROUND: In Côbte d'Ivoire, a pilot project was developed by UNAIDS and the Ministry of Health to improve access to AIDS care, including antiretroviral therapy, for adults and children infected with HIV. This evaluation of the project is the first to provide results of a large number of HIV-infected patients receiving antiretroviral therapy in West Africa. METHODS: We evaluated records of persons who presented for care from August 1998 to August 2000 at six accredited centers in Abidjan. Patients were treated with two nucleoside reverse transcriptase inhibitors (2NRTI) or highly active antiretroviral therapy (HAART). RESULTS: Of 2878 patients who were screened, 2351 (83%) were HIV-infected and eligible (CD4 T lymphocyte count < 500 x 10(6) cells/l or plasma HIV-RNA level > 10 000 copies/ml) for antiretroviral therapy. Of those who were eligible, 81% were symptomatic, 63% had a CD4 cell count < 200 x 10(6) cells/l, 12% had previously taken antiretroviral drugs, and 56% returned to the clinic for follow-up. Of the patients screened, 768 (27%) were started on antiretroviral therapy, including 450 on HAART, 296 on 2NRTI, and 22 on other regimens. We analyzed data from 480 HIV-1-infected adults, who were naive to therapy, were prescribed HAART or 2NRTI, and had at least one clinic visit after starting therapy. In an intent-to-treat analysis of patients who received HAART, the estimated plasma HIV-1 RNA level was approximately 1.9 log10 copies/ml (80-fold) lower, while estimated CD4 cell count was > 100 x 10(6) cells/l higher than baseline values, after 1 year of therapy. Approximately 25% of adults on 2NRTI and 50% of those on HAART had < 200 copies/ml, after 1 year of therapy. The probability of an adverse event occurring within 6 months after starting therapy was 0.20. The probability of survival for at least 1 year was 0.84 (95% confidence interval, 0.80-0.89). CONCLUSION: After starting antiretroviral therapy, these HIV-1-infected patients in West Africa had similar virologic and immunologic outcomes, probability of an adverse event, and estimated survival, as patients enrolled in clinical trials in the USA and Europe. However, only one-third of eligible patients received therapy, highlighting the importance of providing adequate education and support for initiating and adhering to therapy in this and similar programmes.

Adolescent↗

[30-day mortality after heart surgery: a pilot project of the Working Party of Directors of Hospital Cardiology Departments].

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.

Adult↗

A magical dream: a pilot project in animal-assisted therapy in pediatric oncology.

For children with cancer, being hospitalized represents a great source of stress. Hospitalized children are not only deprived of their familiar and comforting world, but they must also face various and often painful treatments. They must quickly adapt to new people and to an environment that is very different from that of their homes. They have greater safety needs. Thus, it is important to offer these children concrete ways to better adapt to the stresses of hospitalization. Animal-assisted therapy, considered within this project as a novel approach to care, constitutes an interesting solution. It involves using the privileged relation between children and animals to foster the process of adaptation to illness and the hospital environment. The experience described in this article is a one-year pilot project completed on a pediatric oncology unit. A priori, an already very heavy workload, the vulnerability of the patients, and many constraints added to the concerns related to the presence of animals on a tertiary care unit. A postiori, the rigorous design and implementation process of the pilot project, the strong involvement and engagement of volunteers and professionals, the quality of the participating "therapeutic" dogs, the originality of the entire process, and the satisfaction of the patients and nursing staff contributed to its success and to establishing the basis for a permanent implementation of this special care program for children hospitalized with cancer.

Adaptation, Psychological↗

Formation of bone around titanium implants placed into zero wall defects: pilot project using reinforced e-PTFE membrane and autogenous bone grafts.

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.

Animals↗

Applying quality management tools to medical photography services: a pilot project.

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.

Ancillary Services, Hospital↗

Music therapy with Alzheimer's patients and their family caregivers: a pilot project.

The purpose of this paper is to present the results of a pilot project sponsored by a private foundation in Spain ("Fundació la Caixa"), in order to demonstrate some of the applications of music therapy, and to measure more systematically some of its effects on people with a probable diagnosis of Alzheimer's Disease and Related Disorders (ADRD) in early-moderate stages of the disease, and their family caregivers. Subjects for this project were 14 patients (5 women and 9 men) with a probable diagnosis of Alzheimer's disease, and 14 family caregivers (9 women and 5 men) from a rural area outside of Barcelona. Their age range was 70 to 80 years. Prior to the beginning of the project, a neuropsychologist specialized in gerontology administered a series of standardized tests to the participants. These same tests were administered again 2 days before the end of the project and 2 months later for follow-up purposes. The results of the satisfaction questionnaire showed that the caregivers perceived an improvement in the social and emotional areas of their patients, and statistical tests showed significant differences between pre and posttest scores in the following tests: (a) Dementia Scale (X2 = 12.29, p = .002), (b) NPI (X2 = 17.72, p = .001), (c) the Cohen-Mansfield agitation scale (X2 = 11.45, p = .003), (d) Burden Interview (X2 = 9.19, p = .01), (e) Memory and Behavior Problems Checklist (frequency subscale) (X2 = 11.09, p = .004), (f) STAI-S (X2 = 14.72, p = .001), and (g) Beck's Depression Inventory (X2 = 9.38, p = .009). These results and their implications are discussed extensively.

Adult↗

The success of the Washington Department of Labor and Industries Managed Care Pilot Project: the occupational medicine-based delivery model.

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.

Government Agencies↗

Quality of care in China: scaling up a pilot project into a national reform program.

China's family planning program ranks as history's most intensive effort to control national population growth. Although advocates for global population control have lauded China's effort to limit births as afundamental part of its sustainable development goals, the country's population policy has also generated much international criticism. As China enters the new millennium, a long-overdue reform of its approach to implementing its family planning program has begun to refocus the program on clients' needs, informed choice of contraceptives, and better-quality services. Originally inspired by the 1994 International Conference on Population and Development held in Cairo, the reform program began as a pilot project among six counties and has now become a blueprint for reorienting the national family planning program. This article reviews the process by which a small, innovative pilot project was scaled up into a national reform effort and the key lessons learned about scaling up sensitive but necessary innovation in a difficult political environment.

China↗