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PubMed2006

[Risk management in the operation room. Results of a pilot project of interdisciplinary "incident reporting"].

BACKGROUND: Methods for error analysis are suitable to increase patients' safety as well as staff satisfaction and may avoid, in a sense of process control, financial damage to the hospital. The aim of the presented pilot study was to establish and evaluate an incident reporting system as a first step towards a new safety culture. METHODS: In June 2003 an incident reporting system was introduced in the central surgical suite, in which the surgical and anaesthesiologic departments took part as well medical and nursing staff. Besides conceiving a report form, a "board of confidence" was elected, kick-off meetings were held and a baseline study on the basis of industrial psychological knowledge was initialised. RESULTS: The process of creating confidence is arduous and depends elementarily on sincere cooperation of management staff, especially of the heads of the departments. The exclusive participation of only two medical departments led to conflicts. Therefore, after finishing the pilot study, the system was expanded to the whole surgical suite including all operating departments. In order to increase the motivation for the strictly voluntarily participation, the frequency of regular echoes to the staff was optimised. To achieve high acceptance in the whole staff, the board of confidence needs a clearly defined position within the system of quality management. CONCLUSIONS: For the first time in Germany an incident reporting system under participation of several medical departments has been installed. After finishing the pilot project, in future we will be able to evaluate changes caused by this system. Simultaneously an electronic database for reported adverse events and strategies to avoid them are being developed based on similar systems in aviation industry. In near future, the system will be of increasing importance likewise for inpatient units and non-operative departments.

Germany↗

PubMed2004

Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria.

BACKGROUND AND PURPOSE: Systemic thrombolysis represents the only proven therapy for acute ischemic stroke, but safe treatment is reported only in established stroke units. One major goal of the ongoing Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria is to extend the use of tissue plasminogen activator (tPA) treatment in nonurban areas through telemedic support. METHODS: The stroke centers in Munich-Harlaching and in Regensburg established a telestroke network to provide consultations for 12 local hospitals in eastern Bavaria. The telemedic system consists of a digital network that includes a 2-way video conference system and CT/MRI image transfer with a high-speed data transmission up to 2 Mb/s. Each network hospital established specialized stroke wards in which qualified teams treat acute stroke patients. Physicians in these hospitals are able to contact the stroke centers 24 hours per day. RESULTS: A total of 106 systemic thrombolyses were indicated via teleconsultations between February 1, 2003, and April 7, 2004. During the first 12 months, the rate of thrombolyses was 2.1% of all stroke patients. Mean age was 68 years, and median National Institutes of Health Stroke Scale score was 13. Mean delay between onset and hospital admission was 65 minutes, and door-to-needle time was on average 76 minutes, which included 15 minutes for the teleconsultation. Symptomatic hemorrhage occurred in 8.5% of patients, and in-hospital mortality was 10.4%. CONCLUSIONS: The present data suggest that systemic thrombolysis indicated via stroke experts in the setting of teleconsultation exhibits similar complication rates to those reported in the National Institute of Neurological Disorders and Stroke trial. Therefore, tPA treatment is also safe in this context and can be extended to nonurban areas.

Aged↗

PubMed2006

Risk assessment of chemicals in foundries: the International Chemical Toolkit pilot-project.

In Brazil, problems regarding protection from hazardous substances in small-sized enterprises are similar to those observed in many other countries. Looking for a simple tool to assess and control such exposures, FUNDACENTRO has started in 2005 a pilot-project to implement the International Chemical Control Toolkit. During the series of visits to foundries, it was observed that although many changes have occurred in foundry technology, occupational exposures to silica dust and metal fumes continue to occur, due to a lack of perception of occupational exposure in the work environment. After introducing the Chemical Toolkit concept to the foundry work group, it was possible to show that the activities undertaken to improve the management of chemicals, according to its concept, will support companies in fulfilling government legislations related to chemical management, occupational health and safety, and environmental impact. In the following meetings, the foundry work group and FUNDACENTRO research team will identify "inadequate work situations". Based on the Chemical Toolkit, improvement measures will be proposed. Afterwards, a survey will verify the efficiency of those measures in the control of hazards and consequently on the management of chemicals. This step is now in course.

Brazil↗

PubMed2004

Pilot project of an intermediate palliative care unit within a registered care home.

In the UK, increasing pressure on the acute sector has meant that intermediate care has become a pertinent issue within the healthcare community. This article reports on a 6-month pilot project to develop a 2-bedded intermediate unit within a registered care home. A total of 27 patients were admitted to the unit for respite and terminal care. The project was monitored through outcome data sheets and discussions with staff. Satisfaction questionnaires were also distributed to GPs and families. It was found that the unit appeared to offer a workable alternative to inpatient care for those patients cared for in the study. More rigorous evaluation is needed to better determine the views of patients and families and to discover whether the service is able to reduce admissions to the acute sector and avoid delayed transfers of care.

England↗

PubMed2006

Examination of 2-DE in the Human Proteome Organisation Brain Proteome Project pilot studies with the new RAIN gel matching technique.

The Human Proteome Organisation (HUPO) Brain Proteome Project (BPP) pilot studies have generated over 200 2-D gels from eight participating laboratories. This data includes 67 single-channel and 60 DIGE gels comparing 30 whole frozen C57/BL6 female mouse brains, ten each at embryonic day 16, postnatal day 7 (juvenile) and postnatal day 54-56 (adult); and ten single-channel and three DIGE gels comparing human epilepsy surgery of the temporal front lobe with a corresponding post-mortem specimen. The samples were generated centrally and distributed to the participating laboratories, but otherwise no restrictions were placed on sample preparation, running and staining protocols, nor on the 2-D gel analysis packages used. Spots were characterised by MS and the annotated gel images published on a ProteinScape web server. In order to examine the resultant differential expression and protein identifications, we have reprocessed a large subset of the gels using the newly developed RAIN (Robust Automated Image Normalisation) 2-D gel matching algorithm. Traditional approaches use symbolic representation of spots at the very early stages of the analysis, which introduces persistent errors due to inaccuracies in spot modelling and matching. With RAIN, image intensity distributions, rather than selected features, are used, where smooth geometric deformation and expression bias are modelled using multi-resolution image registration and bias-field correction. The method includes a new approach of volume-invariant warping which ensures the volume of protein expression under transformation is preserved. An image-based statistical expression analysis phase is then proposed, where small insignificant expression changes over one gel pair can be revealed when reinforced by the same consistent changes in others. Results of the proposed method as applied to the HUPO BPP data show significant intra-laboratory improvements in matching accuracy over a previous state-of-the-art technique, Multi-resolution Image Registration (MIR), and the commercial Progenesis PG240 package.

Algorithms↗

PubMedDate not supplied

Dental implants in edentulous adults with cognitive disabilities: report of a pilot project.

Individuals with cognitive disabilities face many barriers to oral care, often suffering from partial or complete edentulism. While the use of implant reconstruction is becoming more common in the general population, such care is still being used infrequently in individuals with intellectual impairment. A pilot project in 1995 surgically placed and restored implant-supported prostheses in six edentulous adults who had varying degrees of cognitive impairment. This report presents the dentists' reconstruction experiences and the patients' follow-up care, and discusses the results in relationship to current literature. Experiences from these patients suggest that behavior during the restorative process, prosthetic complications post placement, and patients' oral hygiene practices should influence patient selection and prosthetic design. Anteriorly placed fixtures and removable designs, which make self-care and repair easier, can be used to treat an edentulous population.

Adult↗

PubMed1994

A fissure sealant pilot project in a third party insurance program in Manitoba.

The Manitoba Children's Dental Program provides children living in rural Manitoba with provincially-subsidized dental services through private dental offices and school-based clinics. In 1989, the Manitoba government funded a fissure sealant pilot project for an initial period of two years. The first and second molar teeth of high-risk children were targeted for the study. Light-cured Fluoroshield pit and fissure sealant and Max Curing Lites were provided by L.D. Caulk for the sealant trial. After two years, evaluation focused on three specific areas: a) retention rates; b) was there a trend toward decreased treatment requirements?; and c) were sealants a cost-effective measure in preventing dental disease? A total of 1,631 children received fissure sealants during the study. The majority of these sealants, 62.5 per cent, were placed on six-year molars, while the remainder, 37.4 per cent, were placed on 12-year molars. One hundred children were recalled for clinical evaluation. Retention rates averaged as follows: 85 per cent completely present, 13 per cent partially present and two per cent failed. Children in the sample area experienced a decrease in their need for one- and two-surface restorations that was almost double the decrease experienced by children in the equivalent control group (18.5 per cent need decrease in the sample area versus a 10.9 per cent need decrease in the control group over the two years of the study).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

[Pilot project smoke-free workplace].

In 1991 SAN had acquired wide experience with firms which had introduced rules about smoking, governing where and when smoking is permitted at the workplace. A dossier was produced, based on this expertise, with the title: "Smoke-free Workplaces". A pilot project, taking Zurich as a model, was intended to demonstrate how health-promoting measures could be successfully put into effect in the context of smoking. The results of experimentation with six different, interlocking measures were collated, and evaluated with a view to their implementation throughout the whole of Switzerland. The basic components covered the three areas of Information, Raising Awareness, and Motivation, and focussed particularly on the following six points: Information materials; text/cartoons for internal company PR use; bids to wean people off smoking; the "5-day-campaign" (a communication game, 5 min. a day); an information event raising the interest of the personnel on to a wide range of possibilities: Information, experience the reactions of your body on tobacco-smoke, expositions, opinion-walls. And sixth: advice on strategy for employers and personnel managers.

Audiovisual Aids↗

PubMedDate not supplied

A pilot project to detect and forecast harmful algal blooms in the northern Gulf of Mexico.

More timely access to data and information on the initiation, evolution and effects of harmful algal blooms can reduce adverse impacts on valued natural resources and human health. To achieve this in the northern Gulf of Mexico, a pilot project was initiated to develop a user-driven, end-to-end (measurements to applications) observing system. A key strategy of the project is to coordinate existing state, federal and academic programs at an unprecedented level of collaboration and partnership. Resource managers charged with protection of public health and aquatic resources require immediate notice of algal events and a forecast of when, where and what adverse effects will likely occur. Further, managers require integrated analyses and interpretations, rather than raw data, to make effective decisions. Consequently, a functional observing system must collect and transform diverse measurements into usable forecasts. Data needed to support development of forecasts will include such properties as sea surface temperature, winds, currents and waves; precipitation and freshwater flows with related discharges of sediment and nutrients; salinity, dissolved oxygen, and chlorophyll concentrations (in vivo fluorescence); and remotely-sensed spatial images of sea surface chlorophyll concentrations. These data will be provided via a mixture of discrete and autonomous in situ sensing with near real-time data telemetry, and remote sensing from space (SeaWiFS), aircraft (hyperspectral imagery) or land (high-frequency radar). With calibration across these platforms, the project will ultimately provide a 4-dimensional visualization of harmful algae events in a time frame suitable to resource managers.

Aircraft↗

PubMed2003

[Supervisor training in psychosomatic approach to work--a successful pilot project. Communication increases trust in the professional].

A question from the Director of Health and Social Security--"What happens when so many patients seek help, and apparently don't get any?"--resulted in an enquiry, which mapped how the medical staff thought about "psychosomatic" problems. One consequence was the pilot project discussed in this article: a training programme with two aims--to increase knowledge of psychosomatic illness, and to offer training in a method for supervision. The training included theory and practise. The course lasted for one and a half years, two days once a month. Participants (n = 18) included physicians, physiotherapists, nurses, medical social workers and occupational therapists. The course evaluation showed that working on different levels (theoretical, practical, personal) was appreciated, meeting the needs of working with complex health issues. The evaluation of the supervision given by the course participants that reached about 85 persons showed that the supervision brought increased trust to professional ability with the participants in the supervision groups.

Communication↗

PubMed2005

[Problems of emergency transfers of patients after a stroke. Results of a telemedicine pilot project for integrated stroke accommodation in southeast Bavaria (TEMPiS)].

BACKGROUND: Specific stroke subtypes like subarachnoid hemorrhages or malignant brain infarcts require immediate interventions, but treatment options are offered mainly in specialized centers. For this reason, interhospital transfers from primary hospitals need to be done without delay. METHODS: The telemedic pilot project for integrative stroke care (TEMPiS) connects 2 stroke centers and 12 regional hospitals in Bavaria (Germany). Core elements are the implementation of stroke wards, telemedic consultation and improvement of emergency interhospital transfers. Organization of patient transports is offered by the central telemedic service. During the first 12 months of the continuing project all interhospital transfers initiated by the central telemedic service were prospectively documented. Emergency transports were analysed according to diagnosis, type of transport, distance and time delays. RESULTS: A total of 252 interhospital transfers were recommended in teleconsultations; finally 221 transports took place. Median total duration of transfers (including the necessary arrangements) was 134 min (interquartile range: 105-219) for intracerebral hemorrhages (N = 58), 138 min (95-157) for subarachnoid hemorrhages (N = 31), 161 min (100-230) for malignant infarcts (N = 22) and 147 min (109-180) for suspected basilar artery occlusion (N = 28). Time from admission in the primary hospital to initiation of interhospital transfer was 135 min (median; interquartile range: 86-172), transport time was 81 min (60-116). Helicopter transport did not save time for transfer distances up to 50 kilometres, compared to transport via ambulance (including assistance of hospital physicians). Transport using a special intensive care vehicle was much more time consuming because of the longer transport preparation time. CONCLUSION: Emergency transfers of stroke patients are time consuming. This may contribute to additional harm being done to severely ill patients. Faster organization and conduct of transports is required.

Brain Infarction↗

PubMed2003

Reporting adverse drug reactions on a geriatric ward: a pilot project.

OBJECTIVE: To test a method for registration of adverse drug reactions (ADRs) resulting in hospital admission and of ADRs occurring during hospital stay. Spontaneous reporting was compared with data from patient interview. METHODS: Spontaneous reporting of ADRs by nurses and physicians, as well as patient interviews by pharmacists. This pilot project was carried out in the geriatric ward of the Ghent University Hospital over a period of 8 months in order to develop suitable registration forms and to test feasibility. Causality, severity, type and level of intervention of the reported ADRs were analysed. Reports from physicians and nurses were compared with the data obtained by patient interviews. RESULTS: During the 8 months, for 168 patients, 12 spontaneous reports were received from physicians and nurses. Fifty-six of these patients were interviewed and 32 ADRs were reported. Only 2 ADRs detected by patient interview were also reported spontaneously. The interviews of the 56 geriatric patients indicated that 20% of them were admitted to the hospital because of an ADR. ADRs occurred during hospital stay in another 20% of those patients. CONCLUSION: Spontaneous reporting by physicians and nurses revealed considerably fewer ADRs than patient interview by pharmacists. Physicians and nurses reported the more serious ADRs that occurred during hospital stay, whereas the interviews revealed more ADRs that caused hospital admission. Our data confirm that ADRs are an important cause of hospital admission of geriatric patients and occur frequently during their hospital stay.

Adverse Drug Reaction Reporting Systems↗

PubMed2006

A research pilot project to test the efficacy of current pedorthic practices in the Canadian Forces.

Impact loading is a major factor in the high prevalence of musculoskeletal injuries among military personnel during operational tasks. One of the therapeutic purposes of a pedorthic approach is to attenuate impact load through footwear and supportive device cushioning. The following research pilot project attempts to investigate this relationship. Vertical acceleration was collected at the fourth lumbar level in 30 members of the Canadian Forces (CF) during two ladder descents on a CF warship. Body weight, time of descent, and a description of footwear and any additional supportive appliances were also collected. None of the evaluated variables were significantly different between members wearing standard issue footwear and medically prescribed footwear and supportive devices. Although the results of this research pilot must be viewed with caution, the preliminary findings of this pilot tends to suggest that the current pedorthic practices may not effectively reduce peak impact forces at the fourth lumbar level of the spine among CF personnel during a selected naval activity.

Canada↗

PubMed2006

A comparison of the HUPO Brain Proteome Project pilot with other proteomics studies.

The pilot phase of the Brain Proteome Project (BPP), the Human Proteome Organization (HUPO) initiative that focuses on studies of the brain of both humans and mice, has now been completed. Participating laboratories studied the proteomes of two human samples derived from biopsy and autopsy as well as three mouse samples from various developmental stages. With the combined and centrally reprocessed data now available, a comparison in terms of protein identifications and project organization is made between the HUPO BPP pilot and three other proteomics studies: the HUPO Plasma Proteome Project (PPP) pilot, a proteome of human blood platelets and a recently published comprehensive mouse proteome. Finally, as any comparison between large-scale proteomics datasets is decidedly non-trivial, we also evaluate and discuss several ways to go about comparing such different result sets.

Animals↗

PubMed1981

Treating adolescent obesity: a pilot project in a school.

A weight control program for junior high school students was developed to change eating, exercise and habit patterns. The course included dietary management, physical activity and behavior modification techniques. Classes were structured to emphasize peer group involvement and daily practical application. The curriculum was compiled in a book for educational personnel. The program was tested as a pilot project with a selected group of eighth grade obese adolescent girls and a comparison group. Immediately after the course, the subjects' percent of overweight had decreased; at a subsequent eight-month follow-up, additional losses were noted. The percent of overweight of the girls in the comparison group remained relatively unchanged. While the program was successful with this particular group of students, several key questions, requiring further study, were defined.

Adolescent↗

PubMedDate not supplied

Integrating service excellence in a CHF clinical pathway pilot project.

The complex dynamics of the current healthcare environment require healthcare delivery systems to become cost effective and quality driven. Educated healthcare consumers expect superior service and timely responses to their needs. For one healthcare system, customer expectations were an integral part of designing, implementing, and measuring the service components of congestive heart failure pathway outcomes. Service excellence can influence overall clinical outcomes when measured by consumer awareness and patient satisfaction. The inclusion of service excellence as an intrinsic piece of the organizational strategic plan laid the groundwork for this integrated pilot project.

Critical Pathways↗

PubMed1991

Distance learning for rural medical officers in Kenya: the first pilot project.

Representatives from the Ministry of Health, the University of Nairobi and the Kenya Medical Association arranged a workshop in Nairobi in September, 1987 to ensure that policy makers, civil servants, academics and senior members of the medical profession would feel fully informed about the purpose and nature of distance learning. A further meeting was arranged for the supervisors and tutors who would be involved in the pilot project which was designed to validate the usefulness of distance learning materials prepared in London and to evaluate the organisational and educational aspects of the local system for distance learning. Ten rural medical officers, selected by the Ministry, met to be inducted at a briefing workshop in Mombasa. The medical officers were invited to study with three modules at their place of work during a period of six months and to complete a field project during the next six months. They were asked to keep a dairy, to use a notebook for critical comments on each module, and to complete two questionnaires. Their pre-test performance was compared with post-test performance. The results were analysed with a view to improving the modules and the local distance learning system.

Attitude of Health Personnel↗

PubMed2001

Two-year health and employment outcomes among injured workers enrolled in the Washington State Managed Care Pilot Project.

BACKGROUND: Increasing numbers of injured workers are being treated through managed care delivery systems, yet little is known about the long-term effects of care provided through these systems. We analyzed health outcomes, return to work, and employment status at 2 years post-injury among a cohort of workers who were previously enrolled in the Washington State Managed Care Pilot Project. METHODS: Data on functional status, satisfaction with quality of life, return to work and employment status were gathered via telephone interviews and mailed questionnaires from a subset of 374 injured workers who had a time loss claim that involved 4 or more days of lost work time. Of these 374 subjects, 106 were treated through managed care and 268 through fee-for-service (FFS) arrangements. Health outcomes were assessed through the SF-36, the Health Assessment Questionnaire (HAQ), and the Satisfaction with Quality of Life (QOL) instruments. Standard univariate and multivariate statistical methods were used to compare the two groups with respect to the health and employment outcomes. RESULTS: There were no statistically significant differences between the two groups in functional status, satisfaction with quality of life or employment outcomes, except in regard to perceived recovery. FFS patients were more likely to indicate their recovery at 2 years post injury was going well (62 vs. 45%, P = .01). Almost 90% of the injured workers returned to work at some point following their injury and 72% reported working during the 4 weeks prior to their 2-year follow-up interview. CONCLUSIONS: Injured workers treated through managed care, based upon an occupational-medicine model, appear to experience similar long-term health and employment outcomes as workers treated through traditional FFS.

Accidents, Occupational↗