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PubMed2001

Shared experience in 13 local Danish EPR projects: the Danish EPR Observatory.

In 1996 a national strategy for the development of electronic patient records (EPR) for the Danish hospitals and primary care was launched. An element in the strategy was to support a number of regional EPR development projects. The EPR-Observatory has in the two recent years collected data from the regional projects, dealing with the expectations in four areas: 1) Impact on organisational issues, 2) Benefits of EPR, 3) Integration of EPR with other information systems and 4) security aspects of EPR. Among the observations an increasing teamwork and im-proved knowledge about the patient was found. What was expected, but not found, was resistance to EPR, as a result of changes in skills and power. The most obvious benefits are increased data accessibility and improved decision ma-king. The most considerable disadvantage is an enormous growth in discontent with the systems performance and the fact, that all the projects are delayed. Many different types of integration solutions are chosen, because of a lack of a common model for integration. Generally the projects find, that EPJ yields increased security, but logistical problems arise in having the systems running 24 hours 7 days a week. Economical benefits cannot be documented. This relates to the fact, that the regional projects are stand-alone projects. The ongoing growth in discontent with the EPR-systems and the fact, that all the projects are delayed must be subject to further exploration.

Attitude to Computers↗
PubMed2002

Ramazzini Foundation cancer program: history and major projects, life-span carcinogenicity bioassay design, chemicals studied, and results.

The Ramazzini Foundation research program was started over thirty years ago. The features of this program are: (1) systematic and integrated project design; (2) consistency over time; (3) homogeneity of approach: key members of the team remain unchanged; and (4) choice to work on new frontiers of scientific research. The program centers mainly on three projects: Project 1: experimental carcinogenicity bioassays; Project 2: experimental anticarcinogenesis assays to identify factors and active principles (compounds) capable of opposing the onset of tumors while being suitable for preventive/chemopreventive intervention; Project 3: epidemiological studies, both descriptive and analytical, on tumor incidence and mortality in persons professionally and environmentally exposed to industrial carcinogenic risks. The project involving experimental carcinogenicity bioassays for the identification of exogenous carcinogens (environmental and industrial above all) began in 1966. This project has included 398 experimental bioassays on 200 compounds/agents using some 148,000 animals monitored until their spontaneous death. Among the studies already concluded, 47 agents have shown "clear evidence" of carcinogenicity. The results have demonstrated for the first time that (1) vinyl chloride can cause liver angiosarcoma as well as other tumors; (2) benzene is carcinogenic in experimental animals for various tissues and organs; (3) formaldehyde may produce lymphomas and leukemias; and (4) methyl-tert-butyl ether (MTBE), the most common oxygenated additive used in gasolines, can cause lymphomas/leukemias. Many of the results achieved have led to the introduction of norms and measures of primary prevention.

Animals↗
PubMed2003

Why bad projects are so hard to kill.

Even at the prototype stage, experts were saying the technology was obsolete. Yet, in the face of tepid consumer response, the company stubbornly kept increasing production capacity and developing new models. By the time it was finally killed, the initiative had cost the company an astounding $580 million and had tied up resources for 14 years. The product was RCA's SelectaVision videodisc recorder, and its story is hardly unique. Companies make similar mistakes--if on a somewhat smaller scale--all the time. But why? No one comes to work saying, "I'm going to pursue a project that will waste my company millions of dollars." Quite the opposite. They come to work full of excitement about a project they believe in. And that, surprisingly, can be the root of all the trouble--a fervent belief in the inevitability of a project's ultimate success. Starting, naturally enough, with a project's champion, this faith can spread throughout the organization, leading everyone to believe collectively in the product's viability and to view any signs of impending doom merely as temporary setbacks. This phenomenon is documented here in two chillingly detailed case studied, one involving Essilor, the world's largest maker of corrective lenses for eyeglasses, and the other involving Lafarge, the largest producer of building materials. By counterexample, they point the way toward avoiding such morasses: assembling project teams not entirely composed of like-minded people and putting in place--and sticking to--well-defined review processes. Both cases also show that if it takes a project champion to get a project up and running, it may take a new kind of organizational player--an "exit champion"--to push an irrationally exuberant organization to admit when enough is enough.

Commerce↗
PubMed2003

Auditory centre projection of the lower brainstem to the dorsal cochlear nucleus in the rabbit.

Afferent projection to dCN from SOC and the periolivary regions was studied in the rabbit by retrograde transport of WGA-HRP. The projection originates primarily from the bilateral TrV and TrL with a very clear contralateral and ipsilateral predominance, respectively. A clear-cut topographical relationship was disclosed between location of neurons in these nuclei and projection sites in dCN. Thus, the medial region of dCN is target of projection arising from the medial regions of TrV and TrL, whereas the lateral region of dCN is supplied by projection from their lateral regions. Although participation in the projection of the ipsilateral TrV is smaller and the contralateral TrL is very weak, the pattern of these preferential connections is also apparent. Minute connections were traced from the other principal olivary nuclei, i.e. MSO, LSO and TrM, mainly from neurons located in their peripheral regions. In the periolivary region the cells of origin of the projection were found in VLPO and VMPO, and in lesser extent in DPO, DMPO, DLPO, RPO and CPO. The present results are discussed in comparison with those of earlier studies and with reference to other inputs to CN.

Animals↗
PubMed2001

The national health demonstration projects.

The White Paper Towards a Healthier Scotland pledged 15 million Pounds to support four national health demonstration projects to lead the way in achieving sustained improvement in child health, young people's sexual health, coronary heart disease and cancer. The Starting Well project aims to demonstrate that child health in Glasgow can be improved by a programme of activities which both supports families and provides them with access to enhanced community-based resources. The Healthy Respect project aims to help young people in Lothian develop a positive attitude to their own sexuality and that of others, and a healthy respect for their partners, in order to reduce unplanned teenage pregnancies and sexually transmitted infections. The Have a Heart Paisley project is targeting coronary heart disease among the population of Scotland's largest town. The Cancer Challenge project is piloting a screening programme in the North East of Scotland for the detection of colorectal cancer. Though each project has specific objectives, appropriate to its own topic, all share underlying principles. The projects will act as test beds for action and a learning resource for the rest of Scotland.

Cardiovascular Diseases↗
PubMed2003

Interim 2001-based national population projections for the United Kingdom and constituent countries.

This article describes new 2001-based national population projections which were carried out following the publication in September 2002 of the first results of the 2001 Census. These "interim" projections, carried out by the Government Actuary in consultation with the Registrars General, take preliminary account of the results of the Census which showed that the base population used in previous projections was overestimated. The interim projections also incorporate a reduced assumption of net international migration to the United Kingdom, informed by the first results of the 2001 Census and taking account of more recent migration information. The population of the United Kingdom is now projected to increase from an estimated 58.8 million in 2001 to reach 63.2 million by 2026. The projected population at 2026 is about 1.8 million (2.8 per cent) lower than in the previous (2000-based) projections.

Adolescent↗
PubMed2003

Independent projection streams from macaque striate cortex to the second visual area and middle temporal area.

The interareal wiring of the neocortex is usually depicted as a network of single point-to-point connections, often side-stepping the possibility that some neurons may project to multiple cortical areas. The prevalence of such neurons is unknown; if they are abundant, cortical circuits are more likely to be connectionally diffuse. We used a dual-tracer approach to determine whether single neurons in the macaque primary visual cortex (V1) project to two extrastriate areas, the second visual area (V2) and the middle temporal area (MT). We found two large intermingled groups of single-labeled neurons in layer 4B of V1 projecting independently to either V2 or MT. A third, sparser group of double-labeled neurons projected to both areas; we termed these manifold neurons. We also found that MT-projecting cells were distributed indiscriminately with respect to cytochrome oxidase compartment in layer 4B, revealing a subpopulation that provides a potential source of patch input from V1 to MT. The results demonstrate that primary sensory cortices can use multiple projection strategies to distribute signals to higher areas, and suggest that feedforward projections may route signals with more specificity than feedback pathways.

Animals↗
PubMed1992

Evidence for octopaminergic nature of peripherally projecting DUM-cells, but not DUM-interneurons in locusts.

In locusts, a median neuroblast in each segmental ganglion gives rise to numerous unpaired progeny--the well known peripherally projecting dorsal-, occasionally ventral-, unpaired median (DUM-, resp. VUM-) neurones together with the lesser known DUM-interneurones 12. We examine the reputed octopaminergic nature of this nerve cell lineage using an anti-octopamine serum recently developed by M. Eckert and J. Rapus 7. This antiserum labels in each segmental ganglion numerous midline neurones, identifiable as DUM- and VUM-cells by their some sizes and positions, projections in DUM-tracts and characteristic T-junctions with bilaterally projecting axons. All octopamine immunoreactive DUM-, and VUM-neurones appear to project to peripheral nerves; their numbers correspond to the number of peripherally projecting DUM- and VUM-neurones identified so far in the examined ganglia. Presumptive DUM-interneurones, i.e. smaller somata interspersed between the peripherally projecting DUM-cells are not octopamine immunoreactive, but, confirming other studies 25, display GABA-like immunoreactivity. We thus suggest, that of the whole DUM-cell population in the examined ganglia, all and only peripherally projecting DUM-neurons are octopaminergic.

Animals↗
PubMed2004

Lessons learned-UME-21 project.

The Undergraduate Medical Education for the 21st Century (UME-21) project evolved from two prior projects that were aimed at studying the interface between managed care and undergraduate medical education. The project provided funding for 18 US medical schools to demonstrate how they would produce graduates who eventually could practice in a rapidly changing health care environment. Medical schools were required to provide educational opportunities in nine content areas or outline why such educational opportunities could not be provided in their individual projects. Participating schools were chosen via an involved process after careful evaluation by a panel of experienced medical educators. In a project of this type, many lessons are learned. In the UME-21 project, lessons learned were gleaned from progress reports, participant annual reports, proceedings from annual project meetings and a National Symposium, findings of a National Education Group, and published papers. A lesson must have been reported by a least two involved schools to be included. The lessons learned were divided into six categories as follows: content areas, implementation, collaboration, evaluation, governance, implications- summary. Many lessons emanated from each of these categories; however, only the 10 most important lessons in each category are presented. The implications of the lessons learned are outlined and provide direction for the future of medical education innovation and research.

Clinical Clerkship↗
PubMed2004

Increasing the use of arteriovenous fistulas (AVF): a network QI project.

In 2002, the Intermountain End-Stage Renal Disease Network Inc., Network 15, initiated a quality improvement project, "Increasing Arteriovenous Fistulas Within Network 15." The primary objective of this project was to maximize the placement of arteriovenous fistulas (AVF) within the adult in-center hemodialysis population in Network 15. A closely related objective was to ensure policies and procedures were in place at each facility to encourage placement and maintenance of fistulae after they had been placed. Based on the facility-specific percentage of adult patients reported to have a fistula in January 2001, eight facilities were selected to participate in the project. Approximately 100 project partners (facility staff, nephrologists, and surgeons) collaborated to improve AVF rates for incident and prevalent patients. The interventions for this project were multifaceted and included face-to-face meetings with project partners, dissemination of a National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) summary paper on vascular access, video materials and written information for patient and staff, post-operative "Fistula Care Packages" educational meetings, and data feedback to facility staff nephrologists and surgeons. Of the seven indicators selected for this project, the predicted improvement was met in four. Overall improvement was noted in six of the seven process/outcome measures. A statistically significant (p=0.05) improvement was noted in the rate of fistulas used for treatment for prevalent (all) hemodialysis patients. This rate increased by about one-third from baseline to remeasurement.

Arteriovenous Shunt, Surgical↗
PubMed1992

[Intervention framework of the Quebec Healthy Heart Demonstration Project].

Cardiovascular diseases are Canada's primary cause of death and hospitalisation, and are the second major cause of restricted physical activity. Quebec province, with a mortality rate of 399/100,000, has figures even higher than the national average of 323/100,000, and 7 out of every 10 Quebecois present at least one of the major cardio-vascular risk factors. Following an exploratory task force on this question, the Canadian government initiated a partnership programme with the provinces wherein the federal government and provincial governments would each contribute one million Canadian dollars over a five year period for heart disease prevention programmes. Quebec province selected three different projects in which multifactorial, multisectorial community-based programmes were to be implemented. The sites chosen for the projects were: a rural region situated on the banks of the St. Laurence River, a Montreal suburban district, and a multi-ethnic, socio-economic disadvantaged community in downtown Montreal. Despite a common public health approach and the ultimate goal of improving heart health through the lowering of risk factors, each project had its own specific major intervention strategy and primary target population. The projects were linked by a study design to evaluate community and family mechanisms which favour the adoption of low risk behaviours. A coordinating committee was formed to supervise the overall project which included strategic planning, consultancy services to project staff, methodology, development and implementation, and evaluation. Each specific project team was free, however, to choose its particular orientations.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular Diseases↗
PubMed2005

[Project on disease-related proteomics and a proteome factory for drug innovation].

The proteome is expected to be thoroughly researched in Post Genome Projects following the completion of the Human Genome Sequencing Project. Many research projects to investigate disease-related proteins are being undertaken worldwide. Analysis of the proteome, which has an intimate involvement in biogenics, should provide a breakthrough in vital activity and provide substantial clues for new treatments, diagnoses and new target of drugs. In the 2003 fiscal year, The Ministry of Health, Labour and Welfare (MHLW) started the Health, Labour and Welfare Scientific Research Founding Program "Disease Related Proteomics". At the time, the Japan Health Sciences Foundation was delegated the project from MHLW, along with the Japan Pharmaceutical Manufactures Association, and established a consortium with 22 pharmaceutical companies for this project, collaborating with the National Institute of Health Science to start the Project on Disease Related Proteomics and a Proteome Factory for Drug Innovation. In this report, the project overview and its facilities will be introduced.

Databases, Protein↗
PubMed2005

Capturing change in a community--university partnership: Si Se Puede! Project.

BACKGROUND: Community health interventions are increasingly employing partnerships combined with multilevel intervention models to achieve their objectives. Resources and methods for project evaluation are often limited to changes in population health status or health behaviors, while broader contextual questions that may illuminate mechanisms for change across ecological levels and project sustainability may not be addressed. CONTEXT: This paper describes a project to prevent and control diabetes in a Latino community and presents practical methods for addressing some challenges to evaluation, using data sources that often may be overlooked. METHODS: A case study method was used to examine approaches to capture data that can help explain changes across ecological levels. An ecological framework was used to organize sources of data. Data sources and findings are related to project timelines and goals. CONSEQUENCES: Although not a direct focus of the original research, substantial changes in community capacity were observed and measured over the course of the five-year project. Documentation on community change was found in routine project reports, logs, the news media, meeting minutes, and community documents. INTERPRETATION: A logical progression of community change across ecological levels became evident. A modest post hoc evaluation was feasible, using data routinely available from project and target community sources. Specific questions for future research on how community change occurs and how such changes may relate to population health and sustainability are suggested.

Chicago↗
PubMed2005

Working IT out in e-Science: experiences of requirements capture in a HealthGrid project.

This paper reports on our experiences of being involved in requirements capture for a HealthGrid project. Large scale, collaborative projects with multiple partners tend to experience numerous problems in the requirements capture phase (and often beyond) and HealthGrid projects are no exception. Projects with highly innovative objectives often have additional sets of problematics, however. In carving out new visions of, for example, clinical research and healthcare service delivery, HealthGrid projects have to reckon with--and work within--existing healthcare policy, legislative frameworks, professional cultures and organisational politics as well as the more common integration problem of dealing with legacy systems. Such factors are not conducive to the achievement in healthcare of the e-Science vision of seamless integration of information and collaborative working across administrative, professional and organisational boundaries. In this paper, we document some of the challenges we encountered in investigating the requirements for eDiaMoND, a flagship pilot UK e-Science project. We discuss what we might learn from these challenges, especially approaches to requirements capture that are appropriate for projects with innovative aims and are also sensitive to representing and addressing what may be complex professional and organisational interests.

Computer Communication Networks↗
PubMed1992

1991 survey of recent health sciences library building projects.

Twenty health sciences libraries reported building planning, expansion, or construction of new facilities in the association's second annual survey of recent building projects. Six projects are new, freestanding structures in which the library occupies all or a major portion of the space. Six other projects are part of new construction for separately administered units in which the library is a major tenant. The final eight projects involve additions to or renovations of existing space. Seven of these twenty libraries were still in projected, predesign, or design stages of awaiting funding approval; of those seven, five were not prepared to release the requested information. Six projects are reported here as illustrative of current building projects.

China↗
PubMed2005

Camp for all connection: a community health information outreach project.

PURPOSE: The purpose of the Camp For All Connection project is to facilitate access to electronic health information resources at the Camp For All facility. SETTING/PARTICIPANTS/RESOURCES: Camp For All is a barrier-free camp working in partnership with organizations to enrich the lives of children and adults with chronic illnesses and disabilities and their families by providing camping and retreat experiences. The camp facility is located on 206 acres in Burton, Texas. The project partners are Texas Woman's University, Houston Academy of Medicine-Texas Medical Center Library, and Camp For All. BRIEF DESCRIPTION: The Camp For All Connection project placed Internet-connected workstations at the camp's health center in the main lodge and provided training in the use of electronic health information resources. A train-the-trainer approach was used to provide training to Camp For All staff. RESULTS/OUTCOME: Project workstations are being used by health care providers and camp staff for communication purposes and to make better informed health care decisions for Camp For All campers. EVALUATION METHOD: A post-training evaluation was administered at the end of the train-the-trainer session. In addition, a series of site visits and interviews was conducted with camp staff members involved in the project. The site visits and interviews allowed for ongoing dialog between project staff and project participants.

Chronic Disease↗
PubMed2006

[Projections of future resource use and the costs of asthma and COPD in the Netherlands].

OBJECTIVE: To determine the health-care utilisation and associated costs for asthma and chronic obstructive pulmonary disease (COPD) in the Netherlands for the year 2000 and to estimate future costs by means of projections. DESIGN: Descriptive and explorative. METHOD: The costs were based on data regarding resource use in 2000 obtained from representative national registries and surveys. The costs were specified by gender and age category and for COPD also by severity. Three projections for the costs of asthma and COPD were made by means of prevalence projections: first assuming constant resource use and constant prices, second assuming asthma- and COPD-specific trends in the costs for hospital care (asthma, -4.7% and COPD, -4.1% per year) and medication (+4.9% per year), and third by adding general trends for the remaining types of care. RESULTS: Total costs for the year 2000 for asthma (452,000 patients) and COPD (306,000 patients) were estimated to be 141 and 280 million Euros, amounting to 313 en 915 Euros per patient or 9 and 18 Euros per inhabitant, respectively. Projections of total prevalence for the year 2025 varied between 478,000 and 568,000 patients for asthma and between 479,000 and 494,000 patients for COPD. Assuming constant resource use and prices, the costs in 2025 were projected to increase to amounts between 167 and 181 million Euros for asthma and 443 and 495 million Euros for COPD. Projections including the estimated trends in costs for hospital care, medication and the costs for other types of care predicted a sharper increase. CONCLUSION: Costs for asthma and COPD together (421 million Euros) amounted to 1.3% of the total Dutch health-care budget in 2000. Almost 70% of these costs were for COPD. Projections for 2025 showed that the costs for COPD will increase more than the costs for asthma.

Asthma↗
PubMed2001

Environmental factors and health problems among workers of the national project in Toshka.

The National Project in Toshka is a recognized agricultural one, as well as a comprehensive developmental project. The present study was carried out to investigate environmental factors and health problems among workers in this National Project. Environmental levels of vibration, noise, heat stress, total suspended particulates and respirable dust were measured in the different activities of the project during May 2000. The health records of Behera Company Incorporation, the project main implementing contractor, in the period 1997-1999 were analyzed. Workers were classified according to the nature of occupational exposure into three groups namely; earth workers, concrete workers, and services and administration workers. Records of occupational accidents of the same group of workers and in the same period were analyzed as well. Results showed that all the measured environmental factors were within the permissible levels of exposure in the different project activities. Workers showed a significant lower rate of total health problems in the last studied year (1999) as compared to the previous two years (1997-1998) (p=0.001). Prevalence rates of musculoskeletal disorders, urinary tract troubles, ear-nose-throat (ENT) problems and chest problems were significantly higher in earth and concrete workers than in services and administration workers (p=0.001, 0.011, 0.036 and 0.044, respectively). Both occupational accident frequency and severity rates were very low in comparison to other major construction projects such as the High Dam. These rates showed decreasing trends throughout the studied years; however, relatively higher rates were observed among earth workers than the other groups. Miscellaneous wounds were the commonest presentation of occupational injuries among the three occupational groups. In conclusion, the current use of modern technology accounted for the low levels of enviro mental exposure factors, as well as the high safety standards. Workers showed a significant degree of acclimatization to work in this region; therefore, inhabitants and workers should be encouraged to engage this new community. The low rates of health problems among workers observed in this study reflected a satisfactory level of medical services. Preplacement and periodic medical examinations of construction workers aught to consider musculoskeletal, urinary tract, ENT and chest conditions among them.

Accidents, Occupational↗