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A prelminiary report is presented on the results of a small pilot project utilizing acupuncture in the management of chronic painful conditions. Problems associated with patient selection and evaluation are outlined along with a suggested future mechanism for triage and assessment. A description is given of the early clinical results of this pilot project.
BACKGROUND: Organised mammography screening can reduce mortality from breast cancer. A pilot project for organised mammography screening was started in four Norwegian counties in 1995/1996. This paper evaluates the results from the first screening round with focus on early indicators predicting future mortality reduction. MATERIALS AND METHODS: All women aged 50-69 were offered two-view mammography biennially. The screening examinations were performed in dedicated screening units, and the mammograms were read at breast diagnostic centres located in university hospitals. All test results and information about diagnostic procedures and treatment were reported to The Cancer Registry of Norway and registered in a central screening database. This database was essential in order to monitor and evaluate the pilot project. RESULTS: 79.5% of the invited women accepted and about 127,000 women were examined. The detection rate was 6.7 cancers per 1,000 women screened. 53.1% of the invasive tumours were less than 15 mm; about one fifth of the patients had axillary lymph node metastasis. INTERPRETATION: The obtained results met the predefined aims. Thus a future mortality reduction of at least 30% is expected. The parliamentary decision on expanding the pilot project to a nationwide programme seems well founded.
An outline is given of a pilot project to introduce medical students to the broad concept of community medical practice with the emphasis on a rural Aboriginal community. The subjective experiences of the students are recorded and discussed. It is suggested that similar projects are essential to give balance to the bias of hospital training of medical students and to attract doctors to this discipline. The main advantages of such a scheme are that it broadens the perspective of the medical student, widens his potential choice of career, and gives him insight into the medical needs of a socioeconomically deprived group and into the wider role that a doctor can play in the health of the community.
INTRODUCTION: British undergraduate medical education is undergoing change, including a greater emphasis being placed on community-based teaching. These changes need to be evaluated for their educational outcomes, but there also needs to be a review of the process of introducing change and its subsequent management. THE SETTING: During the academic year 1996/97 a new project was piloted at Leeds University. Fifty-three third year medical students were attached in groups of four to general practitioner tutors in a primary care setting for four days in order to improve consultation skills. There was an emphasis on adopting a patient-centered approach, particularly asking patients about their concerns. METHOD: These students were asked to fill in a questionnaire to determine whether the community-based teaching has made any lasting impression on their attitudes and performance. The response rate was 80%. The students commented that even only four days of community-based teaching had helped them realize the importance of asking about patients' concerns. They also reported beginning to concentrate on psychosocial issues while talking to patients, issues that are often ignored by medical students. The students' comments are contrasted with those of the hospital-based tutors, some of whom have looked less than favorably on the project. DISCUSSION: The introduction of any new learning experience needs to be evaluated both in the short term and in the long term. This study begins to address long-term evaluation and suggests that a brief attachment can be memorable to students and beneficial one year later.
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BACKGROUND: Expansion of cardiac rehabilitation (CR) could save both lives and costs by reducing illness and use of health care services. In February 2001, the Ontario Ministry of Health and Long-Term Care (the Ministry) announced a pilot project (the Pilot) to implement and evaluate a comprehensive, multifactoral model of CR service delivery at 17 centres across Ontario. OBJECTIVES: To design, coordinate and evaluate a coordinated model of CR service delivery, and to collect and evaluate an extensive set of clinical and administrative data. METHODS AND RESULTS: The Pilot was a large, province-wide observational investigation of a health service delivery model for CR and secondary prevention care. The present paper is the third in a three-part, policy-related series. In the present paper, the results of the evaluation of the service delivery model and the final health policy recommendations that were made to the Ministry in September 2002 are presented. CONCLUSIONS: Within approximately one year, 4922 patients were enrolled in the Pilot at participating sites throughout Ontario; 88% of sites implemented all elements of the comprehensive services model, either on-site or through internal/external partnerships, and 94% of sites implemented the multidisciplinary Pilot staffing model. Based on this rapid and near-total implementation of the Pilot model, it was concluded that the Pilot model of care was generalizable. Furthermore, regional coordination was achieved through operationalization of the coordinating centres' roles in quality management, regional planning and program development, education and outreach.
OBJECTIVE: This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. METHOD: The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. RESULTS: The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. IMPLICATIONS: The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations.
The HUPO Brain Proteome Project is an initiative coordinating proteomics studies to characterise human and mouse brain proteomes. Proteins identified in human brain samples during the project's pilot phase were put into biological context through integration with various annotation sources followed by a bioinformatics analysis. The data set was related to the genome sequence via the genes encoding identified proteins including an assessment of splice variant identification as well as an analysis of tissue specificity of the respective transcripts. Proteins were furthermore categorised according to subcellular localisation, molecular function and biological process, grouped into protein families and mapped to biological pathways they are known to act in. Involvement in pathological conditions was examined based on association with entries in the online version of Mendelian Inheritance in Man and an interaction network was derived from curated protein-proteininteraction data. Overall a non-redundant set of 1804 proteins was identified in human brain samples. In the majority of cases splice variants could be unambiguously identified by unique peptides, including matches to several hypothetical transcripts of known as well as predicted genes.
The Indian Health Service (IHS) issues this notice to inform the public that additional sites will be added to the IHS Pilot Project now being conducted in the Portland Area. This Pilot Project is to determine whether an alternative method of evaluating and establishing reimbursement rates for contract health services (CHS) will result in greater participation and lower cost to the IHS. The additional sites include the Alaska Native Medical Center and other selected locations within the Alaska Area IHS; the metropolitan Billings, Montana vicinity and other selected locations within the Billings Area IHS; and the Cherokee Service Unit, within the Nashville Area IHS.
This pilot project was conducted to evaluate the effectiveness of the modes of adaptation described by Roy as a framework for assessing psychosexual concerns of adults with diabetes mellitus. A structured interview guide with questions that elicited information in physiologic, self-concept, role function, and interdependence modes was used to interview 10 hospitalized men and women with diabetes. Findings from the study are presented. Limitations in the interview guide are identified and recommendations for refinement and further development of the guide to elicit more specific information and to more clearly separate responses into discrete modes are discussed.
In 1993, a pilot project for the functional analysis of newly discovered open reading frames, presumably coding for proteins, from yeast chromosome III was launched by the European Community. In the frame of this programme, we have developed a large-scale screening for the identification of gene/protein functions via systematic phenotypic analysis. To this end, some 80 haploid mutant yeast strains were constructed, each carrying a targeted deletion of a single gene obtained by HIS3 or TRP1 transplacement in the W303 background and a panel of some 100 growth conditions was established, ranging from growth substrates, stress to, predominantly, specific inhibitors and drugs acting on various cellular processes. Furthermore, co-segregation of the targeted deletion and the observed phenotype(s) in meiotic products has been verified. The experimental procedure, using microtiter plates for phenotypic analysis of yeast mutants, can be applied on a large scale, either on solid or in liquid media. Since the minimal working unit of one 96-well microtiter plate allows the simultaneous analysis of at least 60 mutant strains, hundreds of strains can be handled in parallel. The high number of monotropic and pleiotropic phenotypes (62%) obtained, together with the acquired practical experience, have shown this approach to be simple, inexpensive and reproducible. It provides a useful tool for the yeast community for the systematic search of biochemical and physiological functions of unknown genes accounting for about a half of the 6000 genes of the complete yeast genome.
Thirty-four healthy preschoolers were pretested and posttested as part of a pilot project on preparation programming. Variables associated with their knowledge about medical equipment were identified. The results of this small pilot project are used to present suggestions for future research evaluating the effects of preparation programs for health young children.
Results from four pilot administrations of the Medical College Admission Test essay question are reported. Analyses focused on (a) the performance characteristics of sample groups differentiated by gender, size of hometown, race/ethnicity, and dominant language; (b) the relationships between essay scores and academic/demographic characteristics; and (c) the reliability of one 45-minute versus two 30-minute essays. No differences were found for examinees grouped by gender and size of home community. Mean differences among the racial/ethnic groups were explained largely by reading level differences. Differences in essay performance by language group were large and unexplained by reading level differences. No relationship was found between the essay score and the academic/demographic characteristics. Reliability estimates for two 30-minute essays were higher than for one 45-minute essay; however, the 30-minute period yielded writing of poorer quality. Test-retest reliabilities for the 45-minute topics will remain the focus of future studies as will performance by examinees for whom English is a second language. The impact of the essay on the selection process will also be assessed.
This was a pilot study and therefore only gives us information as to the direction that we can continue looking towards. There were two factors that could have skewed the results. One is the small size of the sample group and the other is that in the Nutritionist III program, not every nutrient, especially in the case of a trace mineral such as selenium, is listed in all foods. Further research is certainly warranted in this area to advance the study of the long term effects of a nutritional intervention on long-term survival of HIV/AIDS persons. A theory was published by the Journal of Medicinal Chemistry (Aug. 1994) that the HIV virus slowly depletes the body of the trace mineral selenium, which it uses to erupt into uninfected cells. The theory proposes that the HIV virus needs selenium, which preserves the elasticity of body tissue and slows the aging process, to trigger its growth. Once the virus uses up all the selenium in one cell, then it breaks out in search of more, spreading the infection to new cells. The researchers at the University of Georgia suggested that the latency period may be attributed to the period of time it takes to deplete the body of selenium storage. (NY Times, Aug. 20, 1994)
In 1982, a pilot program to review the use of ancillary services in 25 hospitals was implemented in Massachusetts. The program analyzed hospital claims data to generate statistical models of ancillary use. Hospitals where the model demonstrated substantially higher use were subjected to clinical review. For laboratory services, three of the four hospitals reviewed were found to have more than 30% inappropriate use of selected tests, compared with approximately 20% in other hospitals. For cardiac services, three hospitals were each found to have more than 30% inappropriate use of selected tests, compared with 16% in other hospitals. When informed of these results, five of the six hospitals used them to develop plans of corrective action. Based on the pilot program, a review of ancillary services began in all Massachusetts hospitals in 1983.
OBJECTIVE: To pilot-test a simple checklist designed to improve coding of acute myocardial infarction (AMI) in hospital discharge abstracts. BACKGROUND: Health records technologists review hospital charts to code discharge diagnoses according to the International Classification of Diseases, 9th revision (ICD-9). Many studies have suggested that there is a high false positive rate in coding AMI, ie, ICD-9 410, on hospital discharge abstracts. PATIENTS AND METHODS: The checklist required either at least two of suggestive symptoms, diagnostic electrocardiographic changes, or diagnostic rise in serum cardiac enzymes; or confirmation by autopsy. First case of use was confirmed-typical time to complete the checklist was 3 to 4 mins. Then 16 Ontario community hospitals were recruited to apply the checklist on a blinded basis to 1000 randomly drawn in-patient records-10% were audited for another study to confirm AMI; and 90% were originally coded with 'most responsible diagnosis' (MRD) of AMI, other cardiovascular diagnoses and various noncardiac conditions. Percentage agreement (95% CI) between the checklist and the confirmed or coded diagnosis was analyzed; coding of AMI as a secondary diagnosis was examined in further analyses. RESULTS: One hospital withdrew for logistical reasons; the final useable sample from 15 hospitals was 943 records. The checklist correctly identified 100% of AMIs independently confirmed for another study; usual coding identified 89.7% of cases (70 of 78; 95% CI 80.8 to 95.5). For cases not confirmed, but where the physician had nonetheless diagnosed AMI, six of 11 charts were miscoded as AMI in hospital records; none were miscoded by the checklist. For records with AMI as MRD, 11.6% (44 of 380; 95% CI 8.5 to 15.2) were classified as false positives by the checklist. Where an AMI was coded as a secondary diagnosis, 52.9% (36 of 68; 95% CI 40.5 to 65.2) met the checklist criteria for AMI. Finally, among records where the MRD was other than AMI, 6.8% (38 of 563; 95% CI 4.8 to 9.2) met checklist criteria for AMI during admission, but 94.7% had an ICD-9410 code as a secondary diagnosis. CONCLUSION: A simple checklist can be very easily applied, has extremely high sensitivity for confirming the presence of AMI, and identifies a clinically significant proportion of charts with false positive codes for AMI. Conversely, these findings support the high sensitivity (low false negative rates) of conventional coding practices for AMI in Canadian hospital records, be it as a primary or secondary diagnosis (eg, 95% detection rate). Usual coding, combined with the checklist for tentative ICD-9 410 diagnoses, would improve the accuracy of Canadian hospital records.
In February 2001, the Ontario Ministry of Health and Long-Term Care announced a $9.6 million, 15-month pilot project (the Pilot) to implement and evaluate a comprehensive, multifactoral model of cardiac rehabilitation (CR) service delivery at 17 sites across Ontario. This is the second paper in a three-part, policy-related series which provides a summary of the Ontario CR Pilot model and the Pilot implementation and evaluation methodology. The aim of the present paper was to outline the goals of the Pilot, the Pilot model of care, the organizational structure that facilitated implementation of the model, and the operational procedures that were put in place to evaluate patient outcomes and the generalizability of a regional model of CR service delivery. The model was based on the findings and recommendations of the Cardiac Care Network of Ontario's 1999 Consensus Panel on Cardiac Rehabilitation and Secondary Prevention, which was described in part one of this series. An upcoming final paper will describe the outcomes of the project and its recommendations for CR health policy decisions in Ontario.
The Central Leprosy Training and Research Institute, Chengalpattu, Tamil Nadu, undertook an interventional study, as a pilot project, on integration of the National Leprosy Eradication Programme (NLEP) vertical activities into the PHC system in two selected districts of Visakhapatnam and Krishna of Andhra Pradesh, between September 1997 and March 1999. The objective of the study was to assess the various operational aspects and implications of integrated implementation of the activities of the NLEP through the PHC system. 1,304,163 people (239,142 in the study group and 1,065,020 in the control group) were enrolled in the study. The methodology employed in carrying out the pilot project in the two selected districts is described. MDT was in operation for more than 5 years in these two districts through vertical approach. Prevalence has declined from >50/10000 at the start of MDT to about 3/10000 at the start of the project. During the implementation phase, 1459 new leprosy cases were detected (NCDR 5.39/10000 person-years) and 1458 cases were released from treatment (RFT rate: 93.04%) and towards the end of the project 450 cases were under treatment (PR 1.66/10000). Simple rates, ratios and proportions were used in the analysis of data and results were compared. The interventional study was designed to assess the implications and impact of implementation of NLEP activities through PHC staff. The study design, rationale, data collection, data processing, quality control methods employed in the study project and the results are discussed. The results of the study indicate that integrated implementation of the NLEP by PHC staff is feasible, if proper support is provided.