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PubMed2006

Educational needs assessment for pediatric health care providers on pesticide toxicity.

PURPOSE: This pilot project, carried out under the National Strategies for Health Care Providers: Pesticides Initiative, assessed the attitudes, beliefs and practices of pediatricians, nurse practitioners, physicians assistants, and nurses in the metropolitan Washington, D.C., area and the surrounding rural counties regarding health effects of pesticide toxicity and continuing education on pesticide toxicity in the years 2001-2002. METHODS: Data were collected from practitioners (physicians, physician assistants, and nurse practitioners) and nurses using questionnaires as well as from practitioners using focus groups. Sites for questionnaire distribution and focus groups were selected to represent a variety of practice types and geographic settings. One-hundred-sixty questionnaires from practitioners and 43 from nurses were analyzed. These issues were probed further in six focus groups with 29 participants. RESULTS: Most respondents in both groups did not frequently diagnose or ask questions about pesticide toxicity on patient histories. Most focus group participants were more comfortable answering questions about acute pesticide toxicity, and many relied on poison control centers for assistance with management of acute cases. They expressed less understanding and more uncertainties about chronic toxicity. When asked questions by patients, 64% of practitioners and 69% of nurses felt poorly prepared to answer them. Forty percent of practitioners but only 26% of nurses felt it was important to obtain more information on pesticides. There were divergent preferences on ways to obtain continuing medical education (CME) in general, but a recurrent theme was the need to make CME on pesticide toxicity clinically relevant and one topic among several in a CME conference. Lectures and short courses were the most commonly preferred modes of education among both practitioners and nurses. CONCLUSION: Educational materials to reach this population of pediatric clinicians on pesticides, as well as other environmental health topics, should make the case justifying the importance of the topics, highlight information of clinical relevance, and use a variety of media. These results should be confirmed before being generalized to a broader group of clinicians, although the consistency of findings between focus groups suggests they are robust, at least for this geographic area.

Environmental Health↗
PubMed1997

The American College of Gastroenterology Bleeding Registry: preliminary findings.

OBJECTIVES: The American College of Gastroenterology (ACG) Institute for Clinical Research and Education conducted a survey study to assess demographics, management strategies, and outcome for patients with gastrointestinal bleeding. This pilot project was intended to determine the feasibility of surveying the ACG membership about common clinical issues. METHODS: Color-coded survey forms were sent to all ACG members and Fellows, with instructions to supply information about demographics, presenting symptoms, management, and outcome for bleeding patients and procedure-matched controls. Forms returned between June 1 and August 31, 1995, were tabulated and analyzed for differences between the bleeding group and procedure-matched controls. RESULTS: A total of 1235 forms were returned by respondents, 60% of whom were in private practice. Patient demographics indicated that bleeding patients were significantly older, more likely to be male, and more likely to use alcohol, tobacco, and prescription or over-the-counter aspirin or nonsteroidal anti-inflammatory drugs and anticoagulants than were controls. Upper GI bleeding accounted for 76% of bleeding events, with duodenal and gastric ulcers being the source in more than 50% of the upper GI bleeders. Diverticula was the most common bleeding source identified in lower GI bleeders. In the bleeding group, 78.8% were anemic, with 60.9% having hemoglobin of <10 g/dl; 31% presented with orthostatic changes in blood pressure or shock. Most bleeding subjects, regardless of source, were hospitalized, 58.2% received blood transfusions, and 45.5% received endoscopic therapy. Rebleeding (11.2%), need for surgery (7.1%), and fatalities (2.1%) were uncommon. Over-the-counter aspirin and nonsteroidal anti-inflammatory drugs were used significantly more often in the bleeding population (47.6%) than in controls (19.4%). CONCLUSIONS: The success of the GI Bleeding Registry supports the feasibility of surveying ACG members about common clinical problems. Data suggest that ACG members manage sick patients with severe gastrointestinal bleeding who require hospitalization, transfusions, and endoscopic treatment. These preliminary results will serve as an impetus to conduct further survey studies of gastrointestinal bleeding and other common digestive disease conditions.

Age Factors↗
PubMedDate not supplied

Modified oral ondansetron regimen for cyclophosphamide-induced emesis in lupus nephritis.

OBJECTIVE: To evaluate the antiemetic efficacy of a modified regimen of oral ondansetron and dexamethasone in patients with lupus nephritis undergoing treatment with cyclophosphamide whose conventional antiemetic regimen had failed. DESIGN: A before-after prospective observational pilot project. SETTING: A federal research hospital. PATIENTS: Fourteen outpatients with lupus nephritis receiving intravenous cyclophosphamide 0.75-1.0 g/m2 had previously experienced chemotherapy-induced emetic events (vomiting or retching) while receiving a standard combination intravenous antiemetic regimen. The regimen consisted of four doses of thiethylperazine 10 mg and diphenhydramine 25 mg every 6 hours, and two doses of lorazepam 0.5 mg every 6 hours starting at 1 hour prior to cyclophosphamide. A subset of 8 patients previously completed a blinded study in which they received the intravenous formulation of ondansetron (4 doses of 4-16 mg q4h) administered orally beginning 30 minutes prior to the cyclophosphamide infusion. MAIN OUTCOME MEASURES: The number of emetic events and cost of drug administration were assessed for the modified ondansetron intervention and compared with those of the standard antiemetic regimen. The incidence of emetic events and visual analog nausea scores for the subset of eight patients were also evaluated. INTERVENTIONS: To account for the delayed onset of emesis associated with cyclophosphamide, patients received both ondansetron 8 mg orally every 4 hours (3 doses) and dexamethasone 10 mg orally (1 dose) beginning 4 hours after the cyclophosphamide infusion. This is different from the manufacturer's recommended dose schedule, in which ondansetron is administered prior to chemotherapy. RESULTS: No emetic events were observed following the administration of oral ondansetron/dexamethasone. The 95% confidence interval for the true rate of emesis was 0% to 19.3%. There was a significant difference in efficacy between ondansetron/dexamethasone and the triple antiemetic regimen (p < 0.0002). None of the patients experienced adverse effects while receiving the ondansetron/dexamethasone regimen. Cost comparisons (including admixture and nursing administration times) for standard combination therapy and oral ondansetron/dexamethasone were $109.09 and $70.24, respectively. No difference in emetic events or nausea ratings was observed between oral ondansetron/dexamethasone tablets and oral administration of ondansetron using the intravenous formula. CONCLUSIONS: This study suggests that a modified oral ondansetron/dexamethasone regimen is safe and efficacious, and costs less than alternative regimens to prevent cyclophosphamide-induced emesis in patients with lupus nephritis.

Administration, Oral↗
PubMed2002

Neurological and social long-term outcome after early rehabilitation following traumatic brain injury. 5-year report on 240 TBI patients.

The long term courses of patients after traumatic brain injury (TBI) are particularly influenced by the quality of neuropsychological rehabilitation and social reintegration. Though we do have data from different European countries about the success of surgery and intensive care, we don't know much about the long term courses, mirrored by the patients, their relatives and local physicians in their domestic environment. Supported by a pilot project of the government of Nordrhein--Westfalia we reviewed 252 patients with different grades of TBI, which were treated in our department from emergency to the end of early rehabilitation. At least 240 files could be completed, including observations up to 5 years after trauma (mean 26 months). 66% of the patients suffered from severe TBI according to the initial Glasgow Coma Scale (GCS), 23% showed moderate and 11% mild TBI. After discharge from early rehabilitation and during further treatment in rehabilitation hospitals patients with persistent vegetative state (PVS) did not show a significant benefit from therapy: Only 1 patient improved to GOS 3, fatal courses were observed in 3 patients, 11 patients remained unchanged. Patients with GOS 3 at the end of early rehabilitation on the other hand could improve in 51 cases to GOS 4 and 5. At the time of the actual investigation 32% of the patients reached GOS 5, 27% GOS 4. Unfavourable courses showed 21% (GOS 3), 5% (GOS 2) and 15% (GOS 1). Referred to the initial GCS only 16% of the severe, 27% of the moderate and 33% of the mild TBI could return to their former social activities and profession without any cuts. 145 of the total of surviving patients could return to their families, in the group of vegetative patients all except 1 patient were submitted for nursing homes. Only 58% of the patients practiced any kind of outpatient rehabilitation, a specialized neuropsychological training has been restricted to 7% of the patients. So we observe a significant gap between a high impact clinical medicine on one side and a deficient outpatient treatment on the other. At least many patients are standing alone after discharge from rehabilitation hospitals, resulting in prolonged stationary treatment with extensive costs to minimize damage from this situation. Our consequence for a more efficient treatment is, that we substantially need better programs by local administrations, insurance companies and employers for better and earlier reintegration to avoid isolation and unnecessary invalidation, especially of those patients with the best medical prognosis.

Adolescent↗
PubMedDate not supplied

Some haematological parameters in human immunodeficiency virus (HIV) infected Africans: the Nigerian perspective.

BACKGROUND: Haematologic abnormalities are among the most common manifestations of advanced human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). A specific diagnosis of cause, severity and mechanism of cytopenia should be sought because of specific treatments or intervention may be indicated for its correction. This study was to determine some haematological parameters in HIV/AIDS infected Nigerians. METHOD: One hundred HIV/AIDS infected previously antiretroviral naïve adult Nigerians, aged 18-58 year (males 47 and females 53) consisting of 88 symptomatic and 12 asymptomatic patients recruited into the antiretroviral pilot project in the Haematology department of the University of Port Harcourt Teaching Hospital between June 2002 to July 2003 were studied. Haematological parameters of hemoglobin, white cell count, platelet count, erythrocyte sedimentation rate and differential leucocyte count were determined. Data was analyzed using a multipurpose statistical package version 9 SPSS. RESULT: The mean haemoglobin was 10.25 +/- 1.97 g/dl (range 6.31-14.2 g/dl), severe anaemia occurred in 80% of subjects while 20% were non-anaemic. Haemoglobin values was found positively correlated to lymphocyte count (r = .319, P = 0.01) and inversely correlated to ESR (r = -.343, P = 0.01) and neutrophil count (r = -.343, P = 0.01). Red cell morphology was variable with majority normochromic and normocytic (64%) and 36% showing hypochromia and anisopoikilocytosis. The mean total WBC count was 4.51 +/- 1.82 x 10(9)/l (range 0.9-8.2 x 10(9)/l). Leucopaenia occurred in 10/100 (10%) of study population. Total white cell count showed a significant inverse correlation to lymphocyte count (r = -.326, P = 0.01). The mean neutrophil count was 2.32 +/- 1.58 x 10(9)/l (range 0.00-5.48). Neutropaenia occurred in 24% of subjects. Neutrophil count showed a significant positive correlation with total white cell count (r = .314, P = 0.01) and a negative correlation with lymphocyte count (r = -.982, P = 0.01). Striking eosinophilia occurred in 3% of subjects. The mean platelet count was 170.07 +/- 49.03 x 10(9)/l (range 72-158 x 268 x 10(9)/l). Thrombocytopaenia occurred in 10/100 (10%) of subjects. The mean erythrocyte sedimentation rate was higher than that in healthy Africans (mean 78.87 +/- 39.33mm fall/hour (range 0.2-158mm fall/hour). CONCLUSION: Observation from this study will serve as a guide to clinicians caring for HIV patients in taking rational decision on haematological complications of HIV infection. This constitutes further evidence of the need for routine monitoring of some haematological parameters of HIV/AIDS infected Africans and before commencement of highly active antiretroviral therapy to ensure that mortality and morbidity are minimized and quality of life optimized.

AIDS Serodiagnosis↗
PubMed1986

[Electrocardiographic changes in a cohort of hypertensive patients in a community intervention program].

A pilot project for the control of hypertension in the Community was carried out in Italy as a part of the WHO Programme "Community Control of Hypertension". 1190 subjects identified as hypertensive (BP greater than or equal to 160 and/or 95 mmHg at two subsequent measurements, or under treatment) during the screening of a random sample of the population between 20 and 64 years in the District of Camposampiero (Padova) were enrolled in a Hypertension Register during a subsequent visit (Registration Visit: VR) carried out two months after the screening. In the following 5 years they were recalled about once a year at a Hypertension Clinic for a complete visit (VA). On both the VR and the VAs a resting electrocardiogram (ECG) was recorded and subsequently assessed according to the Minnesota Code (MC). Out of the 1190 registered hypertensive subjects, 872 (400 males and 472 females) participated in the last VA visit after 5 years, which corresponds to an overall participation rate of 69.4% in males (M) and 76.9% in females (F). Among subjects with normal and abnormal ECG at the VR, the participation rates at the last VA were, respectively, 67.9 and 71.5% in M (not significant difference); 80.0% and 70.8% in F (significant difference: P less than 0.001). Between the VR and the last VA the mean BP values of the 872 subjects investigated decreased from 162. 9/102.2 mmHg to 148. 6/90.4 mmHg in M and from 168. 7/102.2 mmHg to 155. 3/91.7 mmHg in F. The rate of abnormal ECGs increased from 44.0% to 50.3% in M and from 36.4% to 47.9% in F, involving most single items and all the classes of the MC with the exception of classes 8 and 9. The items which diminished generally had a rather low prevalence or were those indicating minor abnormalities. The apparent regression of some pathological patterns could actually be accounted for by a shift towards more severe abnormalities. The most remarkable changes occurred in codes indicating respectively left ventricular hypertrophy (3: 1 or 3: 3) and myocardial ischaemia (4: 1-3 or 5: 1-3 or 7: 1).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1996

Phase I/II trial of combined 131I anti-CEA monoclonal antibody and hyperthermia in patients with advanced colorectal adenocarcinoma.

BACKGROUND: This pilot project was undertaken to evaluate the toxicity of and tumor response to combined 131I anti-carcinoembryonic antigen monoclonal antibody (131I anti-CEA RMoAb) and hyperthermia in patients with metastatic colorectal adenocarcinoma. METHODS: Nine patients who had colorectal carcinoma with liver metastases were enrolled in this study. Intact 131I anti-CEA RMoAb was used (the specific antibody was IMMU-4, provided by Immunomedics, Inc., Morris Plains, NJ). During the diagnostic phase, dosimetry revealed that the tumor site received a higher radiation dose than the surrounding normal tissues in only six patients. These six, who were treated with radioimmunotherapy and hyperthermia, were the basis of this study. The first three patients were treated with 30 mCi/m2 of 131I anti-CEA RMoAb, and the next three received 60 mCi/m2. Pharmacokinetic clearance data were reported for all nine patients. RESULTS: Thermometry data revealed an average T90 of 40.3 (+/- 1.4 degrees C) and T50 of 41.1 (+/- 1.2 degrees C). The average thermal dose equivalent at 42.5 degrees C was 34.5 (+/- 21.5) minutes. The average Tmin, Tmax, and Tmeam were 40 (+/- 1.2 degrees C), 42.4 (+/- 0.7 degrees C), and 41.1 (+/- 1.1 degrees C), respectively. The pharmacokinetic clearance data of antibody showed monoexponential plasma clearances in all patients except one, in whom a biexponential plasma clearance was observed. In general, similar plasma and whole-body clearances as well as similar urinary excretions were observed when diagnostic and therapeutic phases for each patient were compared. Two of the six patients showed a marked improvement in their symptoms; five patients showed a drop in carcinoembryonic antigen levels. A follow-up computed tomography scan one month after treatment showed no change in tumor volume in five patients; one patient showed a partial response. Three patients developed toxicity, two developed moderate thrombocytopenia (39,000 and 58,000), and the other patient developed hematoma resulting from the insertion of a catheter for thermometry. CONCLUSIONS: It is feasible to combine hyperthermia and radiolabeled monoclonal antibodies, and the combination was well tolerated by these patients. The interaction between hyperthermia and low dose rate radioimmunotherapy is complex. Further studies are necessary to explore the use of this combined modality in the management of maligancies.

Adult↗
PubMed2003

A culturally responsive, family-enhanced intervention model.

The Multicultural Interventions for Adolescent Substance Use, referred to as The Shadow Project, was a 3-year, NIAAA-funded pilot study involving 60 American Indian families who had a youth entering alcohol and drug inpatient treatment. Participation was voluntary and involved comparison of two different treatment modalities: treatment as usual and a brief family-enhanced intervention. In adapting this family-based intervention specifically for American Indian families, a cultural approach to assessment and intervention was integrated into the process, with the intervention focusing on building support around the youth to attain abstinence and assuring the youth that their family, community, and substance abuse counselor were motivating influences. Five areas were assessed in the family observation tasks: relationship building, positive reinforcement, limit setting, monitoring, problem solving, and communication. Cultural adaptation was made for two of the five tasks. Two legends were used to assess the families' skill level in relationship building, problem solving, and communication as a family unit. By incorporating Indian stories, families were encouraged to respond in a culturally appropriate manner. Preliminary findings show that these stories were linked to child prosocial behavior and the percentage of days abstinent from individual drug use. This pilot project also adapted culturally responsive instruments, tasks, and validity to this population. The first year required adaptation of recruitment methods, tribal and treatment center agreements, referral contacts, and implementation of intervention and follow-up with adolescents and their families. The second year was composed of intervention implementation and follow-up assessments. To determine the intervention program's long-term effect on reducing adolescent alcohol and other drug use, all families were followed up and assessed 11 months after they left treatment. The third and final year of the study included follow-up, data entry, and data analysis.

Cultural Diversity↗
PubMedDate not supplied

Lessons learned from the national heart failure project: a center for medicare and medicaid services initiative to improve the care of medicare beneficiaries with heart failure.

This column is the seventh in a series reporting on the efforts of the Center for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration, to improve care for Medicare beneficiaries with heart failure. In previous columns we have described the overall structure of Medicare quality improvement efforts, detailed the structure of the national inpatient fee-for-service program known as the National Heart Failure project, and discussed the baseline quality indicator rates for the project, which are focused on rates of ejection fraction documentation and angiotensin-converting enzyme inhibitor prescription. In more recent columns, we reported on quality improvement projects from several participating hospitals, and on a pilot project exploring quality improvement efforts for heart failure based in physicians' offices. This column will focus on ways in which systematic examination of data, such as those from the National Heart Failure project, might shape future quality improvement and research efforts. The National Heart Failure project's quality indicator data are collected primarily to guide and evaluate the efforts of the CMS contractor peer-review organizations to facilitate quality improvement efforts in hospitals throughout the United States. (c)2001 CHF, Inc.

Journal Article↗
PubMed1999

The more things change....

The main messages from the survey were that maternity care varied widely from one district to another and often varied within communities and within hospitals. Much depended on both the attitudes and preferences of the individual providing care and whether a woman was offered care as part of an innovative pilots project. In a number of areas, Changing Childbirth pilots were closed down rather than rolled out across the district, despite good results. Evidence of more woman-centred care suggests that attitudes towards women had changed more than the actual services. However, those women who were interested in a home birth were still experiencing major obstacles. Postnatal care and support for breastfeeding were identified as those aspects of care most in need of improvement.

Adult↗
PubMed2006

Redes En Acción. Increasing Hispanic participation in cancer research, training, and awareness.

Hispanics are affected by many health care disparities. The National Cancer Institute (NCI), through its Special Populations Branch, is supporting networking and capacity-building activities designed to increase Hispanic participation and leadership in cancer research. Redes En Acción established a national network of cancer research centers, community-based organizations, and federal partners to facilitate opportunities for junior Hispanic scientists to participate in training and research projects on cancer control. Since 2000, Redes En Acción has established a network of more than 1800 Hispanic leaders involved in cancer research and education. The project has sustained 131 training positions and submitted 29 pilot projects to NCI for review, with 16 awards for a total of $800,000, plus an additional $8.8 million in competing grant funding based on pilot study results to date. Independent research has leveraged an additional $32 million in non-Redes funding, and together the national and regional network sites have participated in more than 1400 community and professional awareness events. In addition, the program conducted extensive national survey research that provided the basis for the Redes En Acción Latino Cancer Report, a national agenda on Hispanic cancer issues. Redes En Acción has increased participation in cancer control research, training, and awareness among Hispanic scientists and within Hispanic communities. Cancer 2006. (c) 2006 American Cancer Society.

Biomedical Research↗
PubMedDate not supplied

HOPE. Home Care Outreach for Palliative Care Education.

PURPOSE: The goal of this project was to develop and test an educational program to extend the principles of palliative care into home-care agencies. The specific aims were: 1) to assess current practices within select home-care agencies regarding care of the dying; 2) to design the educational program, the HOPE (Home Care Outreach for Palliative Care Education) curriculum, to include relevant content for realistic implementation in home-care agencies; 3) to implement the HOPE project in two home-care agencies; and 4) to assess outcomes of the project and plan for future dissemination to home-care agencies and organizations. DESCRIPTION OF PROGRAM: A pilot project developed and tested five training modules including overview of end-of-life care, pain management, symptom management, communicating with patients and families, and the death event. A needs assessment survey completed by 134 home-care agencies provided input for the training course development. The five-part curriculum was developed by an interdisciplinary team of investigators and consultants and implemented in two agencies with 52 staff members participating. Two agencies then were selected to participate in pilot testing the curriculum. Precourse and postcourse surveys provided evaluation of the program content. RESULTS: Results from the home-care agency survey demonstrated the need for improving end-of-life care. Only 32% of nonhospice agencies reporting the availability of specially trained nurses for care of the terminally ill, and only 16% of the agencies reported providing such training. Pilot testing of the HOPE curriculum suggested that it was well received by staff members. Assessment of both self-effectiveness and agency effectiveness revealed greater comfort with content such as communication and other symptom management followed by the areas of pain management, managing the death at home, and cultural issues in end-of-life care. The overall rating of end-of-life care increased from a mean rating of 5.97 to 7.42 for self-assessment and from 6.59 to 7.94 for agency assessment (on a scale of 0 to 10, with 0 = not at all effective to 10 = very effective). This project identified areas of education needed to improve care at the end of life. The HOPE curriculum will be refined and extended to reach other home-care agencies to benefit their staffs and the patients they serve. CLINICAL IMPLICATIONS: Home care agencies provide extensive care to patients and families facing many physical and psychosocial demands at the end of life. Palliative care education is important to support home-care professionals across all disciplines in optimum end-of-life care. This education should focus on aspects of physical care, such as treatment of pain, dyspnea, confusion, and fatigue, and also to address decisions about physical care, such as hydration/nutrition at the end of life. Psychosocial dimensions of care at home can be improved by attention to issues such as communication with dying patients and families, cultural considerations, and the special care required at the time of the actual death at home.

Community Health Nursing↗
PubMedDate not supplied

Report on the American Cancer Society Workshop on Community Cancer Detection, Education, and Prevention Demonstration Projects for Underserved Populations.

The American Cancer Society has been funding six pilot projects organized with the stated purpose of demonstrating how to implement cancer prevention and control projects for socioeconomically disadvantaged and underserved populations. This article reports on the results of a workshop held to evaluate project experiences and develop recommendations for the future.

Adult↗
PubMed1995

Cambodia. MOE to introduce population education in three subjects.

Cambodia is currently undertaking reforms of its educational system both in structure and substance. Under these reforms, the Ministry of Education (MOE) is revising its curricula and textbooks in selective subjects. The government and UNFPA saw a timely opportunity to introduce population education concepts into three subjects, geography, home science, and moral education and civics from grades 7 to 12. To pave the way for this activity, the UNFPA and the government discussed the development of a pilot project that will concentrate first on the training of small numbers of professional educators and development of a first draft of curricula and textbooks including teacher's guides which could be tried out in this pilot stage and reproduced during the second phase. The project document has been prepared with the assistance of CST adviser on population education, Mr. Ansar Ali Khan, based in CST Bangkok, and is now under review.

Asia↗
PubMed2005

[Health telematics projects in the perspective of the German federal states].

Starting in autumn 2005 with pilot projects, the new German electronic health card (EHC) and electronic health professional cards (HPC) will be implemented in the German health system. These cards are constituents of the full coverage networking of more than 120,000 doctor's practices, 22,000 pharmacies, 2,200 hospitals and 300 health insurance companies. The functions of the EHC, for example electronic prescriptions, the digital medication recording and the European emergency database, need both the interactions with the HPCs and with a complex network of IT systems and telecommunication services, i. e. with a comprehensive health telematics infrastructure. Model regions for the construction of a telematics infrastructure have been established in numerous federal states, e. g. Baden- Wurttemberg, Bavaria, Bremen, Lower Saxony, North Rhine-Westphalia, Rhineland-Palatinate, Saxony and Schleswig-Holstein, and also recently in Mecklenburg-Vorpommern and Brandenburg. These model regions are designed in a way that allows smooth integration of the specifications of the so-called solution architecture of the EHC and also of electronic HPCs as soon as these are available. The implementation of first pilot trials in the model regions, each with 10,000 insured, is planned for the second half of 2005. A project task force was founded by a group from the German federal states in December 2004. The objective of these implementations is to establish a fully networked health system providing patients various e-Health applications which can be used any place and any time.

Computer Communication Networks↗
PubMed2006

Emergency medicine training for Croatia: a Croatia-Australia partnership.

As part of a health system improvement project, the Republic of Croatia has been conducting a pilot project aimed at rationalizing care delivery across the primary care, hospital and secondary care systems. One component was the development of an emergency department at Dr T Bardek Hospital in Koprivnica and training of its staff. This paper describes how a training programme was conducted, using an established emergency department in Australia as the training host, and the outcome of the project. This type of training programme could form a model for specialist Emergency Medicine training in the future.

Australia↗
PubMed1991

Origins of the Human Genome Project.

The Human Genome Project has become a reality. Building on a debate that dates back to 1985, several genome projects are now in full stride around the world, and more are likely to form in the next several years. Italy began its genome program in 1987, and the United Kingdom and U.S.S.R. in 1988. The European communities mounted several genome projects on yeast, bacteria, Drosophila, and Arabidospis thaliana (a rapidly growing plant with a small genome) in 1988, and in 1990 commenced a new 2-year program on the human genome. In the United States, we have completed the first year of operation of the National Center for Human Genome Research at the National Institutes of Health (NIH), now the largest single funding source for genome research in the world. There have been dedicated budgets focused on genome-scale research at NIH, the U.S. Department of Energy, and the Howard Hughes Medical Institute for several years, and results are beginning to accumulate. There were three annual meetings on genome mapping and sequencing at Cold Spring Harbor, New York, in the spring of 1988, 1989, and 1990; the talks have shifted from a discussion about how to approach problems to presenting results from experiments already performed. We have finally begun to work rather than merely talk. The purpose of genome projects is to assemble data on the structure of DNA in human chromosomes and those of other organisms. A second goal is to develop new technologies to perform mapping and sequencing. There have been impressive technical advances in the past 5 years since the debate about the human genome project began. We are on the verge of beginning pilot projects to test several approaches to sequencing long stretches of DNA, using both automation and manual methods. Ordered sets of yeast artificial chromosome and cosmid clones have been assembled to span more than 2 million base pairs of several human chromosomes, and a region of 10 million base pairs has been assembled for Caenorhabditis elegans by a collaboration between Washington University and the Medical Research Council laboratory in Cambridge, U.K. This project is now turning to sequencing C. elegans DNA as a logical extension of this work. These are but the first fruits of the genome project. There is much more to come.

Europe↗
PubMed2001

[Evaluation of health policy intervention on the community level--the "Neighborhood Coordination of Health and Social Care" Model Project in North Rhine-Westphalia].

Between October 1995 and December 1998 the pilot project 'Local Coordination of Health and Social Care' was conducted in 28 communities of the state of North Rhine-Westphalia. The project has been evaluated by two university research teams. The aim of the project was basically to establish new structures of health planning and coordination at the community level, in order to improve health reporting and health care as well as health promotion. To realize this aim round tables, working groups and project-offices were implemented in the communities. The evaluation was focused on the following question: What were the conditions (structures) and processes that influenced the project outcomes? Qualitative and quantitative methods were applied (interviews, standardised self-administered questionnaires, analyses of documents) to this end. Evaluation of structures showed that most communities succeeded in integrating relevant health policy actors into the newly created round tables and working groups. Working climate and achievements were evaluated favourably by most of the involved actors. All communities succeeded in developing and enacting recommendations for programmes, and about 40% of these programmes were implemented during the project. The probability of programme implementation was particularly high if the programme was based on reliable local data and if execution was effected only on the community level. The possibly beneficial effects on health care and welfare produced by the new programmes could not be assessed within the short project period. The paper concludes with a brief discussion of practical consequences for future health policy at community level.

Community Health Centers↗