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PubMed1995

Lamotrigine in Parkinson's disease--a double blind study.

Antiglutamatergic acting substances are considered to be useful tools for the treatment of hypokinesia in animal models for Parkinson's disease (PD). Moreover, most known antiglutamatergic compounds act postsynaptically and are either toxic or weak with regard to their clinical potency. The antiepileptic drug "Lamotrigine (LTG)" inhibits presynaptic glutamate release and may therefore provide a novel approach for PD therapy. Encouraging results from a pilot project led us to establish a placebo controlled trial including 20 patients with PD. The substance was generally well tolerated. There was a significant difference in the investigator's overall assessment of efficacy (6/10 vs. 2/10 improvement; p < 0.05) and a tendency for LTG to exhibit a beneficial effect in some registration parameters, but no significant differences in motor response were found between the two groups. We failed to confirm that LTG mediates a strong antiparkinsonian effect in this small study, but to clearly demonstrate slight or moderate beneficial effects larger groups are required.

Adult↗

PubMedDate not supplied

Creating a successful relationship with customers.

In 1997, several employers commissioned an inpatient survey for a group of businesses that included hospitals in southeast Michigan. Its results indicated that the University of Michigan Health System (UMHS) needed to become more customer-focused. To meet this challenge, UMHS mandated that customer service to its patients and their families should be its first priority. A pilot project in the radiology department's pediatric division was established to recognize and reward employees for outstanding service to customers. The program is now used to reward employees throughout the radiology department, on the assumption that when employees feel special, so will their customers. Management's focus is on employees--they are the health system. The department also invested in employee development, a continuous training program that centers on customer service and teaches tools and skills for better communication. The goal of the development program at UMHS is to exceed the needs of its customers.

Data Collection↗

PubMed1996

Conceptual frameworks for setting environmental standards.

Following the Second European Conference on Environment and Health, held from 20 to 22 June 1994 in Helsinki, the World Health Organization (WHO) established a National Environmental Health Action Plan pilot project. During 1995, and as part of its work for this project with the WHO European Environmental Health Committee, the UK Royal Commission on Environmental Pollution began to seek evidence for the basis of setting environmental standards and to ask if a more consistent and robust basis can be found for establishing them. This paper explores the conceptual frameworks needed to help establish policy and address practical questions associated with different pollutants, exposures and environmental settings. It addresses sustainable development, inter-generational equity and environmental quality, the European Charter on Environment and Health, the Treaty of Maastricht, economic, educational and training issues, risk assessment, the role of environmental epidemiology, and definitions of environmental quality objectives, environmental health indicators, environmental epidemiology and environmental impact assessment.

Environmental Health↗

PubMed1993

A reference system in clinical anesthesia.

We have developed, as a pilot project, a hypertext-based reference system for anesthesia in a neurosurgical clinic. The intention is to give passive decision support prior to the operation. The information is presented according to the different needs and knowledge levels of the anesthesiologists. Therefore, with the aid of a simple and universal user interface (mouse and screen keys, no keyboard) the information is structured from basic to more detailed information. To complete the operation-related material the system also offers relevant data from the "anesthesia-related background knowledge" (pre-existing diseases, drugs, and medication, etc.). As an example, a short path through the system is shown to illustrate the presentation and linkage of information.

Anesthesiology↗

PubMed2005

To examine the effectiveness of a hospital-based nurse-led secondary prevention clinic.

Modification of cardiovascular risk factors can reduce the incidence of myocardial infarction (MI), effectively extend survival, decrease the need for interventional procedures, and improve quality of life in persons with known cardiovascular disease. Pharmacological treatments and important lifestyle changes reduce people's risks substantially (by 1/3 to 2/3) and can slow and perhaps reverse progression of established coronary disease. When used appropriately, these interventions are more cost-effective than many other treatments, currently provided by the National Health Service [Department of Health National Service Frameworks: coronary heart disease. Preventing coronary heart disease in high risk patients. 2000. HMSO.] Secondary prevention clinics are effective means by which to ensure targets are achieved and assist primary care in long-term maintenance of lifestyle change and drug optimisation. A 2-year hospital-based pilot project was established at the Royal Hospitals, April 2001-April 2003. The aim of the project was to target patients with coronary heart disease, post-MI and/or coronary artery bypass grafting and/or percutaneous coronary intervention, 6 months following their cardiac event. The plan was to assess patient risk factors and medication a minimum of 6 months following their cardiac event to ascertain if government targets were being achieved; secondly, to examine the effectiveness of a hospital-based nurse-led secondary prevention clinic on modifying risk factors and optimising drug therapies.

Adrenergic beta-Antagonists↗

PubMed1992

Learning from local knowledge to improve disease surveillance: perceptions of the guinea worm illness experience.

Surveillance is an essential tool in any campaign to eradicate disease; guinea worm (dracunculiasis), which is targeted for eradication before the year 2000, is no exception. One criterion of an eradicable disease is that it be easy to recognize as the program advances. Few experts doubt that the experience of a meter-long subcutaneous worm protruding through a painful ulcer can be missed or confused with another disease, thus ensuring that guinea worm meets this criterion. Field experiences of anthropologists and health educators have shown that one should never assume that community perceptions of illness experience coincide fully with medical case definitions of disease. This paper describes efforts to learn how the Yoruba people of southwestern Nigeria perceive sobia, the local name for guinea worm. Qualitative methods including informal interview, village discussion and participant observation were used to discern a pattern of illness presentation and progression. Interestingly, local perceptions were found to include a variety of illness manifestations beyond the common clinical case definition of an emergent worm, thus creating the potential for a high level of false positive reports. Local knowledge was then used to design a pilot project that trained volunteers to become part of the surveillance network for the national eradication program. The volunteers, who were largely illiterate, were able to distinguish between cultural and clinical definitions, and submit quite accurate reports on the guinea worm status of their villages. Among the 164 volunteers, only two submitted false reports due to incorrect disease definition. In contrast local government health workers who were conducting village searches during the same period were significantly more likely to register false positive reports. The culturally sensitive training based on local knowledge received by the village volunteers is thought to have contributed to their superior performance.

Culture↗

PubMed1997

A curriculum for the times: an experiment in teaching health policy to residents in family medicine.

The Department of Family Medicine at Queen's University in Kingston, Ont., recently undertook a pilot project to familiarize residents in family medicine with physician-related health policy issues. The objective of the project was to ease the residents' transition into practice and to equip them to participate effectively in future policy debates. All first-year residents assigned to a 4-month clinical rotation in the Department of Family Medicine took part in the program, which consisted of 5 weekly 1-hour lecture and discussion sessions. The program was offered as one component of the 130-hour core curriculum for first-year residents. Participants evaluated the program as highly informative and extremely relevant to their career plans. The authors conclude that health policy is a subject that can be incorporated into the core curriculum of residency training programs.

Curriculum↗

PubMed1985

[The care of elderly patients by their relatives].

New concepts are needed for the still increasing number of geriatric patients who require long term institutional care and for the often difficult situation of caregiving relatives. We investigated the possibility to integrate relatives of institutionalized patients in the nursing care. 323 geriatric patients were randomly selected and the relatives contacted. Only four (1%) had no relatives or friends. Of 86% of the patients it was possible to interview 343 relatives or close friends. Of those 147 (43%) were favorably disposed towards a cooperation in the care with the ward staff. Persons willing to cooperate were characterized by female sex, middle class status, good health, not too demanding jobs, and close contacts prior to institutionalization of their next of kin. In a second part 29 of 196 relatives were willing to take part in a pilot project. Unfortunately, for technical reasons only five patients could be hospitalized on the experimental ward in the given time. The practical experience demonstrated that relatives can cooperate on a part time basis with the nursing staff in the care of institutionalized geriatric patients. It is estimated that probably 12% of the geriatric patients in institutions have relatives willing and capable to take part in the nursing or other activities on the ward. Smaller nursing facilities appear more suitable than large geriatric clinics for this type of cooperation.

Aged↗

PubMed2001

Does teaching scald burn prevention to families of young children make a difference? A pilot study.

This article reports a pilot project designed to ascertain what scald burn prevention practices parents of young children used and whether teaching would lead to implementation of burn-related home-safety practices. The sample (n = 49) was followed up longitudinally, and participants completed a survey during two home interviews conducted at 4-week intervals. There was a statistically significant change in the number of scald burn prevention measures (p <.001) implemented by parents after public health nurses provided teaching. Changes in parental behavior were correlated with ethnicity (p <.05). The results have implications for teaching families effective scald burn prevention strategies.

Accidents, Home↗

PubMed1981

Use of NBME examinations to assess retention of basic science knowledge.

About 10 years ago results of the National Board of Medical Examiners (NBME) "Minitest," comprised of samples of questions from NBME Part I and Part II tests, indicated that the change in performance in the total basic science examinations would be minimal between the second and fourth years of medical school. By inserting samples of Part I basic science questions into Part II, large scale tests could be made of the change in performance. In two pilot projects, in a longitudinal study of the same students at a two-year interval, in a cross-sectional study of two groups of students at the same time, and in a comparison of performance of basic science questions in the Federation Licensing Examination (FLEX), the prediction of the minitest results was sustained. Overall performance on all basic science questions decreased only a little. However, the changes in the individual disciplines ranged from a consistent improvement in pathology to a substantial decrease in biochemistry. Pharmacology and behavioral sciences fluctuated between small increases and decreases. Physiology, microbiology, and anatomy decreased consistently, but not as much as biochemistry.

Certification↗

PubMed1998

Model of computerized academic medical clinic.

In the traditional medical graduation course, the student receives a great amount of information while training at the Outpatient Care; the student assumes the physician's role, collecting all the information regarding the patient's clinical history and learns to get along with patients as well. During the attendance process, several factors interfere in the academic teaching, such as limitations of room numbers, amount of patients, difficulties in obtaining medical records, paper illegibility, among other problems. Due to those difficulties, the Model of Computerized Academic Health Clinic, implies in a new learning paradigm in the medical practice, rethinking the traditional process of learning-attendance, where the old model, in which attendance is restricted to a place, is extended in an open atmosphere of shared knowledge, rich of computer resources. The pilot project was implanted in the Pediatrics General Health Clinic of UNIFESP/EPM. It allows that the fifth-year medical students, residents, trainees and tutors use computerized clinics, connected with the academic net of UNIFESP and to the Internet. All the computing and information resources settled at the Outpatient Care improved the organization of its services, increased the medical students' curiosity, improved their participation in learning through interactive programs and clinical attendance.

Academic Medical Centers↗

PubMed1985

Application in continuing education for the health professions: chapter five of "Andragogy in Action".

Although the threat of human obsolescence confronts all of humanity, given the accelerating pace of change in our society, it has a particularly strong impact on the professions--especially the health professions. The half-life of the knowledge, skills, attitudes, and values required by physicians, nurses, allied health professionals, and pharmacists is shrinking with increasing speed. Citizens worry about being treated by health practitioners who have not kept up to date and have reacted by passing laws mandating relicensing and continuing professional education. The health care professions and institutions have responded to the threat by mounting massive programs of continuing professional education; in fact, this is probably the fastest-growing aspect of all of education. And, since the clientele of continuing professional education consists exclusively of adults, these programs have tended increasingly to be based on principles of adult learning. This chapter opens with a description of a pilot project for physicians at the University of Southern California, in which the central theme is self-directed learning. The selection presents the need for and assumptions and goals of the project and the major program components, including needs assessment, individualized learning plans, information brokering, and the use of peer resource groups. Then follow three selections focused on the continuing education of nurses. Selection 2, by the American Nurses' Association, sets forth a policy statement and guidelines for self-directed continuing education in nursing. Its provisions could easily be adapted to other professions. The application of the andragogical model to highly technical training in cardiovascular nursing at Doctors Hospital in Little Rock is presented in selection 3, and selection 4 describes an innovative inservice education program in which primary responsibility is placed on the clinical nursing units at St. Mary's Hospital in Waterbury, Connecticut.

Education, Medical, Continuing↗

PubMed1991

An inner city cancer prevention clinic. Design, methods, and early results.

An American Cancer Society demonstration pilot project is underway that is designed to provide comprehensive cancer prevention-related services to the underserved community of West Oakland, California. An array of cancer prevention services are being made available through an inner-city clinic (West Oakland Health Center), including cancer risk assessments and education about cancer, physical examinations for cancer, teaching of self-examination procedures, smoking cessation, and nutrition counseling, appointments for Pap smears, sigmoidoscopy, mammography, and other more specialized screening procedures, case management for findings suspicious for cancer, and community education programs. Described is the process of implementing these services, their utilization, and their impact (after 6 months).

Adult↗

PubMed1993

Advantages and disadvantages of the alternatives of private practice, public health office and clinic out-patient department as dispensaries for methadone substitution of drug users.

In Germany, methadone substitution will be expanded considerably. Pilot projects and single private practitioners collected first experiences. Other programmes and practitioners follow, since important obstacles have been removed. Instead of individual solutions for limited numbers, broader concepts must be developed. Private practice, public health office and clinic out-patient departments each offer advantages and disadvantages. In several surveyed cities, there are a variety of substitution facilities and no general solution. Local facilities have to be examined for their advantages and disadvantages and should be connected cooperatively--e.g. containing a central out-patient department and a number of private practitioners--to serve the needs of the patients and the efficacy of the system.

Ambulatory Care Facilities↗

PubMedDate not supplied

A day in the life of a psychiatry resident: a pilot qualitative analysis.

OBJECTIVE: The topic "A Day in the Life of a Psychiatry Resident" is an opportunity to explore residents' experiences to inform the delivery of education. METHODS: An open-ended, qualitative approach was used in a pilot project to explore contemporary residents' experiences with education, similar to a patient-centered model of health care. RESULTS: Key themes for residents include balancing multiple roles at work, balancing work and home, identity formation, diversity (gender, ethnic, cultural, learner styles, and other dimensions), and challenges in training with advances in the field (e.g., neuroscience, technology, culture, spirituality). Contemporary residents have some issues as did their predecessors, but they also have unique experiences, issues, talents, and interests. CONCLUSIONS: A larger qualitative analysis of these issues, followed by testing of theories by quantitative methods, is indicated.

Evaluation Studies as Topic↗

PubMed1990

[Prevention and therapy of obesity with diet and sports, an ambulatory therapy program for overweight children].

Dietary restriction together with ongoing power-orientated training provide best results in the therapy and prevention of obesity. Diet can reduce the resting metabolic rate by up to 20% within 14 days. Physical activity stimulates the resting metabolic rate and counteracts this energy saving effect, but is especially important for maintaining a steady state after weight reduction. Exercise reduces the risk factors accompanying obesity by favorable adaptation of the sympathoadrenergic system to physical activity. This can be seen in the effects on heart rate, stroke volume, blood pressure, as well as glycogenolytic and lipolytic activities. Body fat especially in the abdominal area, which is particularly connected with atherogenic risk, is diminished. Weight reduction is accompanied by a decrease of the cardioprotective cholesterol fraction. Diets high in unsaturated fatty acids combined with a staying power training have a synergistic effect: they reduce a decrease of HDL. It is difficult to demonstrate risk factors connected with overweight children. However, from the preventive medicine point of view it is advisable to start with therapeutic measures during childhood. In an out-patient pilot project we surveyed 18 obese children aged 9 to 13 years. The therapy plan consisted of dietary restriction (1200 kcal/d), an exercise program performed 3 times a week, and psychological assistance. All children of 12 to 13 years arrived at an overweight level less than 20%, the younger ones displayed a lower weight reduction effect. All 18 improved their aerobic capacity. In the 1st months of treatment, HDL-cholesterol decreased slightly, but increased above pre-treatment level, later on. We did not see any vitamin deficiencies during the therapeutic regimen.

Cardiovascular System↗

PubMed2003

Comparison of frontal teaching versus problem-oriented learning at the school of healthcare and nursing: nursing neurological patients.

In view of conflicting opinions about the advantages and disadvantages of frontal teaching (FT) and problem-oriented learning (POL), we carried out a pilot project in which both of these methods were used for teaching one specific course namely, 'Nursing Neurological Patients'. The aim was to determine whether there are short- or long-term differences in student performance at examinations. The results showed that over a short term (4 weeks after completion of the course), students remembered very well what they had learnt in their frontal teaching course, but lost some of this knowledge in the long term (7 months after completion of the course). In contrast, in the long term, students retained better what they had learnt under the method of POL.

Adult↗

PubMed1989

Prehospital use of intraosseous infusion by paramedics.

Vascular access in young children frequently proves difficult in the prehospital setting. To assess the feasibility of training paramedics in the placement of intraosseous (IO) lines as an alternative to intravenous (IV) access, this pilot project studied a training program and treatment protocol for prehospital IO use. Paramedics underwent a training program in IO placement. Patients enrolled were less than five years of age and in cardiac arrest. During a 10-month period, paramedics attempted 12 IO placements, of which 10 (85%) were successful, nine on the first attempt. Although no patients achieved long-term survival, three were initially resuscitated from arrest. Paramedics can be trained in IO placement, and IO infusion can be used in prehospital pediatric care. Training methods, limitations, and implications for future use are discussed.

Adolescent↗