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PubMed2005

[Virtual polyclinic--consultant health service for rural areas and islands].

The development of medical sciences and digital revolution in health care have made possible the creation of new models for hospital care and primary health care. Health care management usually does not follow all possible solutions of new computer technology. Croatian health system is based on large hospital centers in the mainland and small, poorly equipped remote medical units. The possibility of sharing medical information using telematic technologies brings all knowledge of the large, powerful hospital centers close to remote medical units. Working in a small, remote consultation office on the island Cres, the author A. M. became part of medical periphery far from the security of hospital on the mainland. After five years of the work on telemedicine projects for the islands, we have introduced a new medical practice concept of communication between remote medical units and clinical hospital centers in the mainland. The pilot project Virtual Polyclinic-Medical Consultation System for the Islands and Remote Areas is a good example of the possible new models in health care structure. Our experience indicates that organization of health care in remote areas depends not only on advanced technical solutions but also on team work and medical professionals.

Croatia↗
PubMed1998

Quality improvement at the national level. Lessons from the Cooperative Cardiovascular Project.

Most quality improvement projects address care delivered in one service of a hospital, such as the operating suite or the obstetrics service. Some projects are collaborative efforts involving groups of hospitals with similar interests. Few projects attempt to change care on a population basis (i.e., involving all providers in entire states or the nation as a whole.) The Cooperative Cardiovascular Project (CCP), sponsored by the Health Care Financing Administration, is attempting to improve care for all Medicare patients suffering from acute myocardial infarctions nation-wide. The CCP has been active since 1993 and, in a pilot project, has demonstrated that care can be improved on a population basis (i.e., in four entire states). This article explores the lessons learned from the CCP pilot and from the evolving CCP national experience.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Image display for clinicians on medical record workstations.

Image display on electronic medical record (EMR) workstations is an important step in widespread implementation of picture archiving and communications systems (PACS). We describe a pilot project for implementing image display capability that is integrated with the EMR software, and will allow display of images on the physician's workstation. We believe this pilot will provide valuable information about usage patterns in image display needs, which will be valuable in planning further expansion of PACS in our institution.

Data Display↗
PubMed2005

[Possibilities of application of distance learning in medical curriculum].

Possibilities of introduction of distance learning in medical curriculum is the title of project which commenced in 2002 at Cathedra for Medical Informatics of the Medical faculty in Sarajevo. Project is approved by Federal and Cantonal ministries of science and education. The purpose of this project is to support improvement of the educational process at biomedical faculties using contemporary methods, methodologies and information technologies in accordance with strategies and objectives given by Bologna declaration. Pilot project is attained after three years, theoretical and practical part of subject Medical Informatics are adapted to modern concepts of education using world trends of distance learning. One group of students from Medical faculty was involved in this project, which was finalized by electronic registration of exam and electronic testing on June 20, 2005 in public, in Physiological amphitheatre of Medical faculty in Sarajevo. In this article we have given complete description of this project as well as its basic adventages and disadvantages.

Bosnia and Herzegovina↗
PubMed1990

Fumarylacetoacetase measurement as a mass-screening procedure for hereditary tyrosinemia type I.

Fluorometric quantitative tyrosine determination on dried-blood spots is the primary neonatal screening test used for tyrosinemia type I (HT) in the province of Quebec. Succinylacetone determination on these same spots is used as the complementary test when the tyrosine level is higher than a given threshold. This procedure has proved to be less discriminant over the past few years because of changes in newborn feeding and because of early discharge of newborns from the nursery. We have developed an enzyme-linked immunosorbent assay (ELISA) to measure the deficient enzyme in HT in dried-blood spots. Fumarylacetoacetase (FAH) (E.C.3.7.1.2) was measured retrospectively by an ELISA on 25 dried-blood samples from proven patients with HT and prospectively in 72,000 specimens received in the neonatal screening program. In this pilot project, FAH was measured first, and, if necessary, succinylacetone was determined as the complementary test. All 25 samples from proven patients and specimens from four other patients detected in the pilot study have shown almost complete absence of FAH in dried-blood samples. At a cutoff level of 12.5% of normal adult blood spotted on the same type of paper, only 30 other cases disclosed FAH levels low enough to warrant succinylacetone measurement but had no detectable succinylacetone. The false-positive rate is thus 1:2,400 with this primary ELISA. However, blood transfusion in newborns prior to blood collection on filter paper may yield false-negative tests, since FAH is present in erythrocytes of normal donors.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Metabolism, Inborn Errors↗
PubMed1999

Outcomes assessment in the NCCN: 1998 update. National Comprehensive Cancer Network.

The assessment of outcomes is a major priority of the National Comprehensive Cancer Network (NCCN). To date, the NCCN's outcomes program has (1) made a systematic inventory of member institutions' existing data sources; (2) begun a collaborative project with the National Cancer Data Bank to compare specific surgical patterns of care in NCCN institutions with national norms; and (3) begun the creation of a prospective outcomes database within the NCCN. As the first step in the database initiative, five NCCN institutions participated in a pilot project in one disease, breast cancer, aimed at developing and testing techniques of data collection, aggregation, and analysis. Six more sites were added to the pilot program in 1998. As of September 1998, data on over 1,000 unique cases had been submitted to the database, with the number of additional cases expected to triple or quadruple within the ensuing 12 months. Future plans call for (1) further expansion of the breast cancer database, both in terms of the number of institutions participating and the scope of data being collected; (2) the addition of a second disease, non-Hodgkin's lymphoma, to the database; and (3) the establishment of partnerships with other organizations for whom the database might provide useful information, such as insurers, pharmaceutical and biotechnology firms, and regulatory and accrediting bodies.

Breast Neoplasms↗
PubMed1997

Expressed sequences from conidial, mycelial, and sexual stages of Neurospora crassa.

In the Neurospora Genome Project at the University of New Mexico, expressed sequence tags (ESTs) corresponding to three stages of the life cycle of the filamentous fungus Neurospora crassa are being analyzed. The results of a pilot project to identify expressed genes and determine their patterns of expression are presented. 1,865 partial complementary DNA (cDNA) sequences for 1,409 clones were determined using single-pass sequencing. Contig analysis allowed the identification of 838 unique ESTs and 156 ESTs present in multiple cDNA clones. For about 34% of the sequences, highly or moderately significant matches to sequences (of known and unknown function) in the NCBI database were detected. Approximately 56% of the ESTs showed no similarity to previously identified genes. Among genes with assigned function, about 43.3% were involved in metabolism, 32.9% in protein synthesis and 8.4% in RNA synthesis. Fewer were involved in defense (6%), cell signalling (3.4%), cell structure (3.4%) and cell division (2.6%).

Amino Acid Sequence↗
PubMed1996

[Rendering public health reports in cities and regions--results of a model trial in Brandenburg and North Rhine-Westphalia].

The purpose of health reporting is to give orienting advices for health policy at regional and local level. In fact, there are only few communities and districts engaged in health reporting. A pilot project run in North Rhine-Westphalia and Brandenburg tried to fill the gap by developing and examining methods and procedures of producing regional health reports. Therefore a system of report topics was drawn up which allowed gradual processing and division of work between the five participating local health departments. Each health department chose three topics to be dealt with during a two-year phase of practice. Those working on the project individually advised and supported planning and realisation of the reports. The "health reporter" in the local health department should organize the production of the reports together with experts. Because of lack of experience or fear of not being accepted in an organizing role this person mainly functioned as author of the report. This had a negative effect on quality and continuity of the work. It can however be regarded as a success of the pilote scheme that this development will be continued in form of a broader planned project supported by the Ministry of Employment, Health and Social Affaires of Northrhine-Westphalia.

Adult↗
PubMed1997

The possible use of telemedicine in developing countries.

Telemedicine may be a useful technique for delivering health care in the developing world. However, there is little practical experience to draw on and real concerns that if additional resources were to become available telemedicine might not be the most appropriate use for them. The logical steps to determine the place of telemedicine in the developing world therefore appear to be: (1) to identify potential telemedicine projects-the Telecommunication Development Bureau of the International Telecommunication Union is trying to do this and has recently sponsored missions to various countries in Africa and Asia; (2) to carry out properly controlled pilot projects in order to demonstrate technical feasibility and to quantify the benefits to the healthcare system; (3) to calculate the costs of large-scale deployment. Assuming that telemedicine is shown to be beneficial, it is only at this final stage that a rational decision can be made about whether telemedicine would be an appropriate use of additional resources in a developing country, as opposed to alternative uses of those resources to solve other important problems of health care.

Delivery of Health Care↗
PubMedDate not supplied

Improving the time to diagnosis after an abnormal screening mammogram.

INTRODUCTION: Five community-specific interventions to reduce the time to diagnosis after an abnormal breast screen have been evaluated. METHODS: Subjects with abnormal screening mammograms in 1998 were assessed through five community pilot projects (N = 1137) and a control random sample assessed elsewhere in BC (N = 1053). The number, types, dates and physician costs of breast-related interventions after an abnormal screen were compared between pilots and control. RESULTS: The median time to diagnosis for women without a biopsy was reduced from 23 days to 7 days (p = 0.001) in the pilot with facilitated referral to diagnosis. The median time to diagnosis for women with a biopsy was reduced from 57 days to 22-43 days in the pilots. Median physician costs per subject were lower (p = 0.02) in pilots that more frequently used core biopsy to obtain a diagnosis. CONCLUSIONS: Process changes can improve the time to diagnosis after an abnormal breast screen, with similar or lower physician costs per subject. Facilitating the referral process had the greatest impact.

Adult↗
PubMedDate not supplied

Investigations into the indoor environment and respiratory health in Boston public housing.

The self-reported prevalence of asthma in the United States increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. The increase was most marked in children from birth to 14 years of age; and growing evidence indicates that, as with lead poisoning, inner-city and urban populations are most at risk. Attention has turned to the role of indoor environmental risk factors, especially in homes and schools. Such factors include moisture and mold growth, pest infestation, dust mites, the building envelope, heating systems, inadequate ventilation, nitrogen dioxide, and environmental tobacco smoke. The Healthy Public Housing Initiative (HPHI) is a Boston-based community-centered research and intervention project designed to engage Boston Housing Authority residents in a collaborative process to improve respiratory health, quality of life, building conditions, and building maintenance in public housing. This article summarizes the significant research findings from four pilot studies in housing developments that laid the foundation for the larger HPHI asthma-related environmental intervention study. The research design for the pilot projects is informed by principles of community-collaborative research. The strengths of this model of research for our work are also discussed.

Air Pollution, Indoor↗
PubMed1996

Nurse first assistant: an evolving project in Québec.

Changes in the work environment, quotas imposed on the number of resident physicians, scientific and technological advances, and nurses having to play two roles, that of scrub nurse and of nurse first assistant, have all contributed to the development of a new role, that of nurse first assistant. For the purpose of providing optimal quality care to patients and at the request of its surgeons, the Montreal Heart Institute has presented a project to the Ordre des infirmières et infirmiers du Québec and the Professional Corporation of Physicians of Québec. The project was accepted by both bodies. The OIIQ moved in favour of recognizing the function of nurse first assistant in September, 1994, and the PCPQ gave its approval for the project on March 30, 1995. A 186 hour training program was developed. The two selected nurses have been trained and have been integrated into a medico-surgical team since February, 1996. The Nurse First Assistant pilot project will be evaluated in February, 1997.

Curriculum↗
PubMed1989

The Norwegian injection mark study.

By examining persons arrested in Oslo during a certain period, we will try to obtain a better picture of intravenous drug abuse in Oslo. A pilot project was organized for 3 months during the autumn of 1987. In addition to having their arms examined, the arrestees were asked some questions about their abuse and HIV-testing. The paper presents some data from the pilot period: 35% of the arrestees had marks from intravenous drug abuse (almost 2/3 of the females and slightly less than 1/3 of the males); 78% of them were men, 22% were women; the majority were in the age range 21-35 years; 53% stated that they injected opiates, 35% that they injected stimulants and 12% that they injected both types. Nearly 80% stated that they had been HIV-tested. A larger proportion of users of opiates (88%) stated that they had been tested than users of stimulants (66%). The prevalence of HIV-seropositive cases among the arrested intravenous abusers was 13.8%. In the paper we also discuss methodological aspects of the study.

Adolescent↗
PubMed1986

Observations on the prevalence of ear disease in the Inuit and Cree Indian school population of Kuujjuaraapik.

In the last twenty years it has been recognized that hearing loss as the result of middle ear infection and/or noise exposure is a major problem among Canadian Inuit. In the past ten years in the Eastern Canadian Arctic attempts have been made to alleviate the problem and physicians, audiologists and educators have been involved in treatment, training programs and research with varying degrees of success. In the last few years the Quebec Inuit have become more aware of these problems and have asked for assistance. Whatever evolves, Inuit co-operation and advice is essential; their cultural identity must be respected if any project is to be successful. In February, 1984, a program outline working paper entitled "Program for Combatting Hearing Disorders in the Inuit Population of Nouveau Quebec" was circulated by Project Nord-Laval University. The goal of the program was "to ensure the integrity of hearing for the Inuit by preventing hearing loss, identifying hearing loss and minimizing the effects of hearing loss." In October, 1984 a Pilot Project involving the school population at Kuujjuaraapik was carried out involving personnel from the Project Nord-Laval University, the Department of Otolaryngology and the School of Human Communication Disorders-McGill University.

Adolescent↗
PubMed1997

An application of digital network technology to medical image management.

With the advent of network technology, there is considerable interest within the medical community to manage the storage and distribution of medical images by digital means. Higher workflow efficiency leading to better patient care is one of the commonly cited outcomes [1,2]. However, due to the size of medical image files and the unique requirements in detail and resolution, medical image management poses special challenges. Storage requirements are usually large, which implies expenses or investment costs make digital networking projects financially out of reach for many clinical institutions. New advances in network technology and telecommunication, in conjunction with the decreasing cost in computer devices, have made digital image management achievable. In our institution, we have recently completed a pilot project to distribute medical images both within the physical confines of the clinical enterprise as well as outside the medical center campus. The design concept and the configuration of a comprehensive digital image network is described in this report.

Computer Communication Networks↗
PubMed2001

Flexible work hours, health and well-being in the European Union: preliminary data from a SALTSA project.

Demand for flexible work hours (FWH) is increasing in Europe aimed at increasing the number of production hours on one hand, and, on the other, reducing individual working hours and/or increasing autonomy and control on them. In view of the lack of knowledge of the effects of FWH on health and safety, we started a pilot project, funded by the Joint Programme for Working Life Research in Europe (SALTSA), aimed at: a) comparing the most relevant national legislation and how the EU Directive 93/104 "concerning certain aspects of working time" has been implemented in the member States; b) reporting prevalence and trend of FWH in Europe according to the three EU Surveys on Working Conditions carried out in the last decade; c) collecting practical examples of innovative FWH; d) evaluating their impact on health and safety in relation to work sectors, job demands, social life, aging and gender. Consequent actions are going to include information and consultancy for pertinent authorities and social parties involved, as well as training programmes for Union officials and similar groups concerning the organisation of FWH according to ergonomic principles.

Choice Behavior↗
PubMed2006

Eliminating child labour in Malawi: a British American Tobacco corporate responsibility project to sidestep tobacco labour exploitation.

OBJECTIVES: To examine British American Tobacco and other tobacco industry support of the Eliminating Child Labour in Tobacco Growing Foundation. DESIGN: Analyses of internal tobacco industry documents and ethnographic data. RESULTS: British American Tobacco co-founded the Eliminating Child Labour in Tobacco Growing Foundation (ECLT) in October 2000 and launched its pilot project in Malawi. ECLT's initial projects were budgeted at US2.3 million dollars over four years. Labour unions and leaf dealers, through ECLT funds, have undertook modest efforts such as building schools, planting trees, and constructing shallow wells to address the use of child labour in tobacco farming. In stark contrast, the tobacco companies receive nearly US40 million dollars over four years in economic benefit through the use of unpaid child labour in Malawi during the same time. BAT's efforts to combat child labour in Malawi through ECLT was developed to support the company's "corporate social responsibility agenda" rather than accepting responsibility for taking meaningful steps to eradicate child labour in the Malawi tobacco sector. CONCLUSION: In Malawi, transnational tobacco companies are using child labour projects to enhance corporate reputations and distract public attention from how they profit from low wages and cheap tobacco.

Agriculture↗
PubMed1999

Introducing undergraduate dental students to the wider rôle of the primary care team.

The development of interprofessional learning between different members of the primary care team can lead to a better understanding of the various rôles of the primary care team. It can also result in a more collaborative approach to achieving health care goals. A pilot project was carried out involving placing 6 final-year dental students in general medical practices. Feedback from both dental students and medical practitioners suggested a number of educational benefits were achieved. The generally positive results have encouraged the extension of the pilot to include general medical practice placements for all final-year dental students at Liverpool.

Education, Dental↗