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PubMed2004

High heterogeneity of CFTR mutations and unexpected low incidence of cystic fibrosis in the Mediterranean France.

In this report, we present updated spectrum and frequency of mutations of the CFTR gene that are responsible for cystic fibrosis (CF) in Languedoc-Roussillon (L-R), the southwestern part of France. A total of 75 different mutations were identified by DGGE in 215 families, accounting for 97.6% of CF genes and generating 88 different mutational genotypes. The frequency of p.F508del was 60.23% in L-R versus 67.18% in the whole country and only five other mutations (p.G542X, p.N1303K, p.R334W, c.1717-1G>A, c.711+1G>T) had a frequency higher than 1%. The mutations were scattered over 20 exons or their border. This sample representing only 5.7% of French CF patients contributed to 24% of CFTR mutations reported in France. This is one of the highest molecular allelic heterogeneity reported so far in CF. We also present the result of a neonatal screening program based on a two-tiered approach "IRT/20 mutations/IRT" analysis on blood spots, implemented in France with the aim to improve survival and quality of life of patients diagnosed before clinical onset. This 18-month pilot project showed an unexpected low incidence of CF (1/8885) in South of France, with only six CF children detected among 43,489 neonates born in L-R, and 13 among 125,339 neonates born in Provence-Alpes-Côte-d'Azur (PACA).

Adult↗

PubMed1998

TELONC system for oncology education.

The paper describes a pilot project of TELONC computer system designed to assist oncology education. At present the system is being implemented and its elements are subject to more detailed preliminary examinations. The system is of module structure and at the present stage of implementation special attention is being paid to patterns for histopathological examinations, information on drugs with aggressive impact on human organism together with suitable instructions on their usage, as well as to certain elements of the training simulator module.

Computer-Assisted Instruction↗

PubMed2005

Community psychiatry in Singapore: a pilot assertive community treatment (ACT) programme.

Severe mental illnesses cause their sufferers dismal functional impairment. The Global Burden of Disease lists schizophrenia among the top 10 contributors to health burden and disability around the world. In the Institute of Mental Health (IMH) of Singapore, 9 out of 10 Class-C beds are occupied by patients whose hospitalisation periods last 300 days on average. Whilst de-institutionalisation has not seen its expected level of success overseas, the provision of community-based psychiatric care has been shown to be more cost-effective than hospital-based inpatient care. As such, there is a need for increased emphasis on community psychiatric services, both to provide and to effectively utilise available resources to assist patients with severe mental illnesses in living and functioning within the community. In line with several other efforts, a pilot Assertive Community Treatment or ACT Programme was launched by IMH in November 2003. This article details the aims, set-up and services of this pilot project funded by the Health Service Development Programme (HSDP) for 3 years, which receives referrals from IMH psychiatrists. With the services provided by the ACT team including psychosocial rehabilitation, it is hoped that patients will continue to receive adequate psychiatric care as well as maintain sufficient skills for self-care and independent living within the community despite the well-documented deteriorating course of psychotic illnesses like schizophrenia.

Behavior Therapy↗

PubMed1994

[Ambulatory surgery--a sensible future perspective].

Increasing costs in health system, reduction of bed capacities and lack of nurses force to search for solution. To prove that day surgery may be a kind of solution, a pilot project was analysed during 8 months. This project was fully integrated in normal clinical management. Operated patients (n = 100; hernias, varicosis, proctological and other indications), preoperatively selected by specific criterias, and the family doctors were questioned retrospectively of their experiences. The results were very encouraging. Moreover we stated that day surgery is cost-covering. So day surgery is to consider as an important factor to cost-reduction.

Adolescent↗

PubMed2006

Achieving Magnet accreditation in the UK: a case study at Rochdale NHS Trust.

AIMS: This study explored the Magnet accreditation process in the first health care organization outside the USA to attempt to gain the award, Rochdale NHS Trust United Kingdom. The development was supported by the American Nurses Credentialing Center as a pilot project and the research conducted as a case study in organizational response to the requirements of a new accreditation system. METHOD: Information was collected via 23 face-to-face and three telephone interviews carried out with 11 senior figures at Rochdale during the 2-year period of the Magnet project, from field notes of meetings attended by the researchers and from analysis of documents associated with the project. RESULTS: The work of applying for Magnet accreditation built upon a previous 2-3 year programme of shared governance and clinical leadership throughout the Trust which senior staff felt had been an essential foundation for the Magnet project. The process enabled staff to assemble evidence which held up a mirror to their practice and contributed to other quality-related initiatives. The experience at Rochdale suggests that Magnet enables care areas to identify and celebrate examples of good practice and for lessons to be learned and shared within the organization. Although the Magnet concept is primarily nursing oriented, medical and allied health professionals were able to contribute and benefit. The application was successful and Rochdale was awarded Magnet status in April 2002. CONCLUSIONS: The Magnet project at Rochdale was essentially a process of collecting evidence to formally recognize previous leadership initiatives and their effects within the organization. The emergent approach to implementing the Magnet project was one which attempted to integrate and utilize existing systems and resources. The project provides evidence that Magnet can be transferred to non-US health care systems. The principal issues associated with this transfer were the costs incurred, the interpretation of terminology and the engagement of medical and allied health professionals.

Accreditation↗

PubMed2004

Tobacco Use Prevention Education (TUPE) Programs in the State of Florida: correlates and predictors of teachers' perceptions of program effectiveness.

In Florida, data from telephone surveys were used to identify correlates and predictors of teachers' perceptions of the effectiveness of tobacco use prevention education (TUPE) prior to the implementation of the Tobacco Pilot Project (TPP). A 40% random sample of public middle and high schools yielded 296 middle school teachers (MST) and 282 high school teachers (HST). Higher perceived program effectiveness ratings were associated with: using peer leaders, frequent evaluations, parental involvement, few barriers, high student interest, and low tolerance norms for tobacco use. The importance of program features and implementation contexts to teachers' perceived program effectiveness ratings is highlighted.

Adolescent↗

PubMedDate not supplied

Laboratory service sharing for cost containment.

A pilot project implemented by two Montreal hospitals measured the impact on costs of sharing laboratory services for a limited number of biochemical tests while maintaining quality of care. The incremental costs of shared services were compared to the costs of the hospitals performing tests independently and to those of referring tests to another hospital laboratory. The costs of the tests were based on the average price asked by three major Montreal facilities.

Cost Savings↗

PubMed2005

Innovations and issues in the delivery of continuing education to nurse practitioners in rural and northern communities.

This paper addresses the need to provide rural nurse practitioners (NPs) with the distance education that is considered vital to the upgrading of their professional skills. The method of delivering the courses is a critical aspect of their success. The authors trace and describe the innovative delivery of the Rural Ontario Nurse Practitioner Continuing Education Initiative, from the initial needs assessment study through to the implementation and evaluation study. In each study, a multi-method action research model was used. The respondents showed a preference for face-to-face modalities that were perceived to be constrained by barriers. These barriers were subsequently addressed by the pilot project. Those living in rural areas recognized the benefits of information technologies. Implementation was effectively weighted on multiple modes of online course delivery and the use of constructivist pedagogy. The findings suggest that the delivery of continuing education to rural and remote NPs is still wrought with challenges.

Attitude of Health Personnel↗

PubMed1994

Laboratories in patient-centered units.

As part of a hospital pilot project evaluating decentralized patient-focused care, a new laboratory model was studied. Cross-trained personnel (nurses, medical technologists, radiology technologists, and respiratory therapists) performed high-volume, automated laboratory tests in a unit-based laboratory as part of their overall patient care duties. Testing performed in the patient-centered unit laboratory, in general, was comparable in quality to that reported by the hospital's central laboratory.

Academic Medical Centers↗

PubMed1978

Spina bifida: epidemiological data from a pilot study.

The epidemiology of spina bifida has great geographical variation. A small unselected group of patients were registered as part of a pilot project on infantile hydrocephalus. Twenty-two patients, born 1963-69 in Vejle county, Denmark were identified, giving an incidence of 0.77 per 1000 births. The mothers had 26 pregnancies prior to the spina bifida children; 14 of these had resulted in normal viable infants (54%). Seven of the patients had other congenital malformations, unrelated to the neural tube defect. All unoperated patients died. Four of 10 operated children were alive at age 7-12 years, three of them without handicap.

Abnormalities, Multiple↗

PubMedDate not supplied

Implanted cochlear prosthesis analogue in primates.

Electronic cochlear prostheses are currently being implanted in the profoundly deaf. Little, however, is known about the biologic effects of electrical stimulation of the auditory system. To study some effects of intracochlear electrical stimulation in monkeys, a totally implantable device that produces a constant current similar to that produced by devices now used in human implantation was designed and miniaturized. This paper reports on the characteristics of the device and a pilot project designed to test it in vivo. The feasibility of primate implantation and behavioral observation, as well as histopathologic study, was also determined. The device was implanted in each of two Macacca nemestrina monkeys, which were then observed. One monkey was killed and the implanted cochlea studied with scanning electron microscopy. Evidence of osteogenesis of the scala tympani was found.

Amplifiers, Electronic↗

PubMed1994

Case management of needle localized breast biopsy patients.

This article describes the development of a pilot project for case management (CM) for patients undergoing needle localization breast biopsy within a large military medical center. A case management plan, timelines, and critical path were developed. Four patients were followed through the entire process of needle localization breast biopsy from preadmission to discharge using the pathway. Variances from the critical path are discussed. Quality, efficiency, and efficacy of care given to this patient population at this facility can be improved through the use of CM.

Biopsy, Needle↗

PubMed1988

Alternative work scheduling for professional social workers.

The authors present some practical evidence that the changing nature of today's work force requires innovative alternatives to traditional scheduling based on the 9 to 5, five-day workweek. They support alternative work scheduling (AWS) as an updated and promising approach. Described is their experience with a two-year AWS pilot project in the Social Work Service of an urban medical center, with their focus upon the processes of negotiating, programming, and implementing the concepts of "flex-time," "compressed workweek," and "job sharing." Informal assessment indicates strongly positive responses from the participating social workers, other members of the health care team, and the consumers of the services.

Employment↗

PubMed1998

Evaluation of the provision of fieldwork training through a rural student unit.

A Rural Student Unit was established as a pilot project to trial a model of rural fieldwork placement provision. The Unit aimed to increase the number of student placements available in rural areas and provide undergraduate students with a positive fieldwork experience. The results indicate that the Unit was successful in overcoming some of the barriers to rural fieldwork, for both students and supervisors, and substantially increased the number of students undertaking fieldwork in this area. The results support the further trialing and expansion of the model.

Attitude of Health Personnel↗

PubMed1985

How can pharmacists develop and implement a home antibiotic program?

Many hospital pharmacists are evaluating home antibiotic programs (HAPs). In addition to providing a new role for the pharmacist, commercial activity in this area fosters the idea that providing an HAP is a profitable business. Those evaluating HAPs should take a careful approach to this service, evaluating the market potential and cost feasibility before devoting the time and effort in implementing a program. If the market potential exists, and the program appears to be feasible from a cost standpoint, a pilot project should be performed based on experiences reported in the literature. If this is successful, a training and services program can be fully planned, developed, and implemented. Evaluating an HAP is important to obtain data required to improve the program and establish the need for reimbursement. Joint ventures with vendors or other hospitals may be a way to provide this service without making a major commitment of resources from the hospital.

Anti-Bacterial Agents↗

PubMed2000

Brain oscillations control hand orthosis in a tetraplegic.

The aim of the present study was to investigate whether self-induced brain potential changes could be useful as control signals for patients with severe motor impairment, i.e. due to high-level spinal cord injury. The pilot project was performed in a tetraplegic patient (T.S.), whose residual muscle activity of the upper limbs is restricted to the left biceps. To restore the hand grasp function, an electrical driven hand orthosis fitting his left hand was developed. The operation of this device is directly based on the bioelectrical signals of the brain. After some months of training, T. S. has learned to operate the hand orthosis by mental imagination of specific motor commands.

Adult↗

PubMed1999

Right median nerve electrical stimulation to hasten awakening from coma.

Electrical stimulation of the right median nerve may hasten the awakening of closed head injured, comatose patients. A series of 25 comatose patients have been treated. These patients made better recoveries than similar individuals reported in the literature. In a double-blind pilot project patients in the treated group scored better on interval Glasgow Coma Scale scores, spent fewer days in the intensive care unit, and showed better Glasgow Outcome Scores at 1 month post-injury. Peripheral electrical stimulation of the right median nerve, through activation of the ascending reticular activating system, may be sufficient to arouse the moderate to severely comatose patient.

Adolescent↗

PubMed2001

Maintaining quality care during a nursing shortage using licensed practical nurses in acute care.

Implications of an aging registered nurse workforce, coupled with an inadequate supply of new nurses, presented a unique challenge for the nurse executive in an acute care hospital. This article presents one possible solution: reintroduction of licensed practical nurses to the patient care setting. It describes a pilot project initiated to answer the following question: Is there a change in quality of patient care or staff satisfaction when the nursing care delivery system adds a licensed practical nurse to the registered nurse and patient care assistant care pairs? It also describes the driving forces behind this practice change and presents focus group discussions, the implementation process, and conclusions and recommendations.

Acute Disease↗