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An organized pilot program promoting web access to picture archiving and communications system data: emphasis on offices outside the host institution.

A formal Pilot Program for Web-based access to a host picture archiving and communication system (PACS) can augment the transition to filmless radiology. Beyond the technical issues of PCs and networks, appropriate legal input and documentation is necessary. While it is important to be in line with overall institutional priorities with regard to online access strategies, it is important to recognize that the Radiology Department has the greatest stake in successfully going filmless, and that it is incumbent upon the Radiology Department itself to take on outreach efforts to the medical community at large. The MMC Web Access Pilot Project has been successful in helping key non-MMC offices overcome the issues associated with preparing for and mastering Web access to PACS images. The benefit has been mutual, and MMC is now able to provide better advice to new offices that are coming online, as well as sharpening its focus on logistical issues that need to be resolved if we are to eliminate film from medical practice.

Humans↗

A proven and highly cost-effective method of early detection of breast cancer for developing countries.

Carcinoma of the breast is the third most common cancer in Indian women. With rapid industrialization and effective control of communicable diseases, better diagnostic and treatment facilities, cancer is emerging as a major health problem. Since early detection is the only way to reduce morbidity and mortality from breast cancer, we undertook a pilot project to evaluate efficacy of using existing manpower and resources for screening women in the high risk group. Methodology pros and cons, results, and recommendations are presented. Our method can be adopted by any developing country interested in a screening programme for malignant disease.

Adult↗

The role of nurses in screening for autistic spectrum disorder in pediatric primary care.

This article addresses the issue of integration of routine screening for autism spectrum disorder (ASD) in pediatric primary care. The relationship between screening and patient outcome is discussed. The ASD screening recommendations of the American Academy of Pediatrics and practical issues associated with their application are then reviewed. Finally, data from a pilot project to prepare nurses to conduct ASD screening during routine pediatric health visits are presented. The authors discuss the role of nurses in establishing systems within pediatric primary care to identify and refer children at risk for ASD.

Autistic Disorder↗

Subsidised nicotine replacement therapy in a community pharmacy setting.

ISSUES ADDRESSED: Nicotine replacement therapies are effective, but are mostly under-utilised and often not used for an appropriate duration. The paper reports on a pilot project that used subsidies for NRT as a means to engage community pharmacists to deliver tobacco cessation to the Arabic-speaking community. METHOD: Arabic-speaking community pharmacists were recruited through direct mail-outs and trained in tobacco cessation brief intervention. Fifteen selected pharmacies recruited Arabic smokers through their pharmacies. Pharmacy follow-up was conducted three months after the program was implemented. RESULTS: A total of 65 participants attended the seminar. A total of 31 pharmacy customers received at least one packet of subsidised NRT patches. Twenty (64.5%) clients received both the first and second subsidised pack. Fifteen clients continued to use patches after the third packet, however only three clients continued the patches to the eighth pack. CONCLUSION: The pilot was successful in improving recruitment of pharmacies into training for smoking cessation counselling as well as engaging community pharmacists to deliver tobacco cessation intervention with small incentive.

Arabs↗

Planning, implementation, and evaluation of a fortification program. Control of vitamin A deficiency in the Philippines.

In a three-year pilot project in the Philippines, the magnitude of vitamin A deficiency and its clinical manifestation (xerophthalmia) was determined, and three alternate programs for eliminating and preventing it in various ecologic zones were designed and implemented concurrently in separate areas in each ecologic zone. Results were evaluated, and costs and benefits of each program were determined. The results of the fortification program are reported. Monosodium glutamate (MSG) was selected as the ideal carrier was fortified at a level which provided 15,000 I.U. retinol palmitate to the average family each day. Significant increases in serum A, especially for children with more deficient vitamin A status, resulted. The program's economic benefits significantly outweighted the costs, and the MSG fortification program has been expanded to several additional pilot provinces in the Philippines.

Adolescent↗

The contribution of social science research to population policy and family planning program effectiveness.

Social science research has made important contributions to population policy and to the effectiveness of family planning programs. Social science concepts, theories, and methods potentially are relevant to all aspects of reproductive behavior, including actual fertility, proximate variables, and desired family size. Social science research also contributes to the understanding of the social, economic, and political institutions that potentially affect, either directly or indirectly, the whole biosocial reproductive system and family planning programs. At least as important as its specific theories and findings is the role of social science in testing how to adapt such knowledge to distinctive national and local cultural circumstances of family planning programs. A central point is that carefully monitored pilot projects are desirable before launching full-scale national programs, as well as being continuing resources for program development. The research on early programs in Asia has been important, because those programs encountered and overcame some of the presumed obstacles to new programs.

Asia↗

Effectiveness of weekly iron-folic acid supplementation to prevent and control anemia among women of reproductive age in three Asian countries: development of the master protocol and implementation plan.

The master protocol for studying the impact and process of implementation of weekly iron-folic acid supplementation under program conditions is described. Pilot projects guided by the protocol were carried out in the Philippines, Vietnam, and Cambodia, where anemia rates are high and different socioeconomic and cultural conditions exist. Each country utilized the same supplement but adapted implementation processes to their specific conditions. Social marketing and community mobilization were considered to be essential tools for sustainability.

Adult↗

Evaluating the introduction of a pilot client attachment scheme in mental health nursing education.

Client attachment (CA) allows student nurses to gain clinical experience through forming therapeutic attachments with individual clients, rather than through a series of location-based placements. This paper describes a pilot project that evaluated CA with pre-registration student mental health nurses. Using semi-structured interviews, the researchers identified the students', their supervisor's, and their clients' experiences of CA. Most participants agreed that students were able to learn relevant and appropriate clinical skills, and to consolidate experience-increasing motivation, autonomy, organizational skills, and confidence.

Attitude of Health Personnel↗

Using peer-group intervention with problem students in a secondary school.

Twenty adolescent girls whose records showed poor academic performance and frequent truancies and referrals to the guidance office were selected to participate in a pilot project to provide a peer-group experience for students having difficulty at school. Half the students were placed in a control group and received regular services from the school. Students in the experimental group attended 12 discussion sessions held during the school day. A one-year follow-up showed that seven in the experimental group and one in the control group had improved.

Adolescent↗

Evaluation of a cancer awareness campaign: experience with a selected population in Karachi.

The incidence and prevalence of cancer is rapidly increasing in both developed and developing countries. The most common cancers reported in Pakistan are breast and cervical cancers in females, and lung and oral cancers in males. Public awareness of cancer can play a vital role in its prevention, early diagnosis and treatment. A pilot survey conducted by the Cancer Support Group (CSG) of Aga Khan University Hospital from 2001 till 2004 to gauge the public awareness of cancer in Pakistan revealed that people were afraid of cancer and had little knowledge about its prevention and early detection. The survey also identified several social, religious and cultural misconceptions which hinder cancer screening and treatment. In order to create awareness amongst the general public, especially the young generation, members of the CSG also organized fifteen health education sessions in schools, colleges, hospitals and communities in Karachi which were attended by more than 1,500 people. With the help of the results generated in the pilot project, education material was designed and developed for these health education sessions. Ten percent of the participants contacted CSG members for some unusual finding after administering a self screening tests taught in these sessions. This indicates the importance of holding cancer awareness sessions and the positive feedback obtained suggests that people would like to have cancer awareness sessions continued.

Adolescent↗

[A neuro-epidemiologic survey in a Limousin town].

One characteristic of the Limousin district is the raised average age of its population. Given the growing average age found in France and the ensuing potential problems, it was thought useful to undertake a neuro-epidemiological study of the distribution of neurological diseases in this region. The initial step involved checking the techniques to be used and the form of questionnaire relevant to this type of study. Following W.H.O. recommendations, the total population of one small town was surveyed, and the distribution of various neurological ailments was thus measured (headaches, migraine, cluster headaches: 12.73 p. 100, transient ischemic attack: 1.89 p. 100, stroke: 1.36 p. 100, epilepsy: 1.68 p. 100. Parkinson's disease 1.47 p. 100, dementia: 0.31 p. 100, misc: 0.84 p. 100). These figures were compared with the results from similar pilot projects carried out elsewhere around the world. The results obtained in this preliminary study enabled us to perfect the methods, and to perform a more extensive survey of a representative cross section of the Limousin population. This larger study will be published later.

Adolescent↗

Telemedicine may help change the face of medical care in eastern Canada.

Pilot projects in eastern Canada that use personal computers and telephone lines to link patients and rural physicians with specialists in urban centres indicate that telemedicine may be a cost-effective adjunct to clinical medicine. Dermatology, radiology, cardiology and oncology are among the areas that have been tested in Nova Scotia. Although physicians say telemedicine may have many useful applications, such as providing efficient continuing medical education for doctors in remote communities, they say it must respect traditional referral patterns.

Humans↗

The analysis of clinical outcomes: getting started in benchmarking.

BACKGROUND: Computerized clinical outcomes measurement systems are now routinely available to help physicians and hospital administrators assess and improve the quality of care in their organizations. The Voluntary Hospitals of America, Pennsylvania (VHA/PA), used MedisGroups data to help understand the processes of care that contributed to different clinical outcomes at different network hospitals. METHOD: A physician subcommittee decided early on (1) to focus on the best outcomes rather than the poorest and (2) to determine the variations in processes of care that might have led to either superior or inferior clinical outcomes. For two common procedures, appendectomy and cesarean section, the subcommittee identified variation within comparative outcomes data, evaluated that variation, and studied and communicated to the rest of the hospital network the process that produced the best outcomes. CONCLUSION: These pilot projects set the stage for current clinical benchmarking within the VHA/PA system. The committee of physicians learned that each hospital develops its own approach to common clinical conditions. These approaches become standardized at each hospital in the form of institutional attitudes, beliefs, policies, and procedures. The methods of evaluation and treatment by hospital staff can significantly alter the clinical outcomes for the populations served.

Appendectomy↗

Improving a system of care for elderly persons in rural areas.

This article describes a community initiative to improve the care of elders in largely rural areas. An organization development framework guided pilot projects in two communities, with support from a regional geriatric program. Two interdisciplinary teams, representing primary service agencies in the communities, have been trained to serve as local resources in geriatric assessment and intervention. Through the resource teams, the communities are developing a more integrated and coordinated approach to care for the elderly population. The process has yielded valuable insights into the implementation of system change.

Geriatric Assessment↗

[Antileprosy polychemotherapy in the member states of the OCCGE: a decade of implementation (1983-19930). The National Coordinators of the Leprosy Program of the 8 states of the OCCGE].

MDT for leprosy recommended by WHO in 1981 has been introduced and implemented in 8 Member States of OCCGE (an organization for leprosy control in francophone West Africa). This implementation from 1983 to 1993 can be divided in two phases: 1983-1987: introduction phase by pilot projects; 1988-1993: extension phase by national leprosy control programmes. During the ten years, MDT coverage rose to 68%, leprosy prevalence rate widely decreased (40.71 to 6.56 per 10,000), while annual detection rate weakly varied (1.89 to 1.26 per 10,000). Factors influencing this evolution of leprosy are brought out and recommendations are made about strategies to be developed for leprosy control up to year 2000.

Africa, Western↗

Health information multitype library reference referral networking: panacea for the '90s.

Librarians are exploring new approaches to information sharing to cope with a rapidly changing environment dominated by budget cuts, information explosion, and globalization of the economy, science, and culture. In 1990, the University of Illinois at Chicago Library of the Health Sciences (UIC LHS) initiated a pilot project aimed at establishing an effective balance between state-of-the-art information technology and traditional library methods and promoting cooperation among health information professionals by establishing the Health Information Referral Network (HIRN) in the state of Illinois. HIRN's background and development, Internet home page, and networking techniques reviewed in this paper are applicable to multitype libraries and information centers interested in improving information use and the referral process.

Computer Communication Networks↗

Meeting the continuing education needs of pediatric nurses: the Pediatric Nurse Exchange Program.

Today's dynamic health care environment offers multiple challenges as hospitals attempt to design and implement successful nursing career plans and support the development of professional nurses along such plans. The Pediatric Nurse Exchange Program is designed as a means for personal and professional development to support professional nurses as they are challenged to provide quality nursing care to children and their families. A pilot project is designed to provide experiences for professional nurses in three children's hospitals in Ohio. Exchange experiences, of two to five days in length, provide opportunities for nurses to share expertise, exchange patient care strategies, and develop skills as consultants, change agents, educators, and communicators. Nurse participants in the program are awarded continuing education contact hours for the experience.

Clinical Competence↗

A new way of caring for older people in the community.

The government's modernisation agenda is challenging traditional practice by introducing new roles and concepts to meet the increasing healthcare needs of the older population and those with long-term conditions. Over the past two years several national pilots have been trialled to examine different models of managing care for these groups. One is the Evercare model, a case management approach to the delivery of care in the community for older people. This article focuses on a cohort of 12 nurses from three local primary care trusts who participated in the national Evercare pilot project from July 2003-April 2005. It examines the context for change, explores and appraises the development of a new role, and evaluates the educational partnership developed with a local university.

Aged↗