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PubMed2005

Global parasite control initiative of Japan (Hashimoto Initiative).

The Asian Centre of International Parasite Control (ACIPAC) was established in Bangkok in March 2000 as a JICA technical cooperation project in collaboration with the Mahidol University and the Ministry of Public Health, Thailand. Since then, ACIPAC carried out its activities with emphasis on the establishment of the concept of school health-based parasite control in the Great Mekong sub-region countries. In addition to contributing human resource development through its training courses on school-based malaria and STH control for programme managers and also through small-scale pilot projects implemented in partner countries, ACIPAC proposed that schoolchildren should be considered as health partners rather than simple recipients of health services including deworming programmes.

Adolescent↗
PubMed1996

The Singapore naltrexone community-based project for heroin addicts compared with drugfree community-based program: the first cohort.

The cornerstone of heroin rehabilitation in Singapore from 1991 to 1993 was the Three Phase Program (3PP). This was a multimodal approach embracing job placement, individual and family counselling, home placement and restriction of movement by electronic monitoring. Opioid addicts in Singapore are detained by executive order. Inmates volunteer to be on the community program. The completion rate (i.e. the number of inmates presumptively drug-free after 1 year) was 24%. In August 1993, naltrexone, an opiate antagonist without euphorigenic properties was added to the 3PP creating the Naltrexone Pilot Project (NPP). Sufficient similarity existed between the 3PP and NPP for some comparison between the two. The missing link was the chemical blockade offered by naltrexone to provide a deconditioning experience for the decay of learned responses to heroin. The subject can confidently be exposed to drug cues without fear of relapse. Subjects on naltrexone for the first year had a completion rate of 76.3%. In the second year without naltrexone, electronic tagging and counselling, 32.2% were still drug-free. The subject type who was successful was married, older and better educated with late onset in heroin abuse.

Journal Article↗
PubMed1994

The neurocysticercosis project in Atteridgeville-Mamelodi townships.

The incidence and prevalence of neurocysticercosis in South Africa are unknown. A hospital-based prospective study to determine the incidence of neurocysticercosis was therefore undertaken. A research questionnaire and strict inclusion and exclusion criteria were used. Apart from determining the incidence, our other aims were to determine the sources of infection and routes of transmission, evaluate therapeutic programmes and, on the basis of our findings, develop prevention programmes. We found that it was impossible to determine the sources of infection and routes of transmission. When strict selection criteria were applied the number of patients (13) was significantly smaller than the 58 patients in an earlier pilot project. The implications of the findings for incidence surveys are discussed. The implications of the enzyme-linked immunosorbent assay (ELISA) of serum and cerebrospinal fluid for diagnosis are discussed. The effectiveness of praziquantel was confirmed, and therapeutic approaches and preventive measures based on our findings are suggested.

Adolescent↗
PubMed1997

Interventional recovery outside the walls of an intensive care environment.

St. Luke's Episcopal Hospital in Houston, Texas, created a cardiology collaborative practice team to review patient flow, to develop and implement process redesign, and to evaluate the effectiveness of the redesign project. The team focused on the recovery of interventional patients outside the critical care or intensive care unit environment. In December 1993, the team opened an interventional cardiology recovery unit on a cardiovascular telemetry floor. One thousand forty-five patients were recovered in this unit in the first year. Complication rates did not change significantly for low-risk patients; patient and family satisfaction scores improved, and the cost per case was reduced by $1,746. The success of the pilot project has become the standard for implementing new programs within the cardiology services.

Case Management↗
PubMed2001

Building a generic architecture for medical information exchange among healthcare providers.

Due to the inability to exchange clinical information among hospitals, continuity of care cannot be maintained and a tremendous amount of medical resource has been wasted. This paper describes an architecture that would facilitate exchange of clinical information among heterogeneous hospital information systems. It is dubbed 'Medical Information Exchange Center' or MIEC as part of a six-year Health Information Network Project hosted by the Department of Health. MIEC was designed so that it is innovative yet technically feasible today. It is convenient for authorized users yet secure enough so people can trust and has minimal impact to participated hospitals. Authorized users will be able to access information through two web-based interfaces directed to physician and non-physician users respectively. Hospitals are connected through a virtual private network to exchange patient information and users need to obtain a private key from the certificate authority in order to securely connect to MIEC. A pilot project was conducted to demonstrate the feasibility of this architecture and the problems encountered were discussed.

Computer Communication Networks↗
PubMed2000

Involvement of community pharmacists in the care of drug misusers: pharmacy-based supervision of methadone consumption.

This article examines the feasibility and acceptability of a supervised consumption of methadone service from local community pharmacies. It builds upon the British Department of Health's recommendations to increase the involvement of community pharmacists in the care of addicted drug users and to expand the range of services they offer to drug users. The article also takes up the ongoing debate on regulating the structure of prescribing and dispensing of methadone and the Department of Health's suggestion to consider methods to reduce the diversion of methadone, for example via supervised consumption of methadone. The pharmacy-based supervised self-administration of methadone scheme (SSA) at the Camden and Islington Community Health Services Trust Substance Misuse Services (CTDS) in London has been found to be valuable by clients, pharmacists and keyworkers. All pharmacists involved regarded the project as workable and expressed their willingness to continue with the provision of supervised dispensing of methadone in the future. Clients stated as main advantages: local access, which saved them time and travelling, and the longer opening hours enabled them flexibility in managing their time. The main negative comments were related to lack of privacy when drinking their methadone within the pharmacy. Most keyworkers welcomed the SSA scheme as another dispensing option available. The fact that another responsible and accountable health professional was involved was positively perceived by the key workers. The Camden and Islington pilot project of providing a supervised consumption of methadone service from local community pharmacies has successfully put into practice the Department of Health's recommendations to increase the involvement of community pharmacists in the care of addicted drug users and to expand the involved health range of services they offer to drug users. This suggests a positive future for the practice and implementation of pharmacy-based self-administered provision of methadone.

Journal Article↗
PubMed1995

Our essential journey. A Denver system decides to "grow" its own leadership.

Last year Provenant Health Partners (PHP), a Denver healthcare system, decided it would begin to "grow" new lay leaders. The idea was to allow PHP personnel to self-select themselves as potential leaders and to guide their development so their daily work would come to reflect the system's heritage and values. PHP is part of Sisters of Charity Health Care Systems (SCHCS), based in Cincinnati. As a foundation for its project, PHP had its senior and middle managers participate in SCHCS's Values in Leadership program, which increases leaders' awareness of their role as stewards of Jesus' healing ministry and encourages them to develop effective skills based on their sponsor's core values. PHP then formed an 11-person leadership development planning team representing its three hospitals and various system departments. The team drafted a plan which encourages PHP leaders and potential leaders to develop leadership skills with the aid of feedback from their colleagues. PHP is currently fine-tuning the plan in a pilot project. In addition to using the plan to develop leaders, the system is considering adapting it for use in employment screening, intraorganizational promotion, and the allocation of educational funds.

Catholicism↗
PubMed2006

Special Populations Networks: themes and lessons learned.

The Special Populations Networks (SPN) Program was a 5-year, nationwide project funded by the National Cancer Institute to reduce cancer-related health disparities in minority and other underserved communities by building community health infrastructure, improving cancer awareness and use of cancer screening services, and increasing the cadre of minority junior scientists studying disparities issues. Through collaborations with a wide range of community and academic partners, the 18 grantee organizations: 1) developed culturally sensitive cancer communications approaches and materials; 2) conducted outreach and educational activities appropriate to their communities' needs and diverse cultures; and 3) trained and mentored young minority investigators who succeeded in winning support for pilot projects addressing local cancer health disparities issues, trained and deployed lay health workers, and worked with community and health provider organizations to improve understanding of cancer risk in these populations and encourage participation in appropriate clinical trials. SPN activities were grounded in community-based participatory research principles and practice. This overview highlights major project themes, provides examples of differing individual grantee approaches to similar issues, and describes key lessons learned, as reported by the SPN projects, that may guide future programmatic and research efforts to eliminate cancer health disparities in the United States. Cancer 2006. Published 2006 by the American Cancer Society.

Community Networks↗
PubMed2001

Traditional versus hazard analysis and critical control point-based inspection: results from a poultry slaughter project.

Federal meat and poultry inspection has changed little since the Federal Meat Inspection Act was passed in 1906, followed by the Poultry Products Inspection Act of 1957 and related amendments. These acts mandate sensory or organoleptic (sight, smell, and touch) inspection of all carcasses. For several decades, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) has been urged by various organizations to move to a scientific, risk-based inspection system. In partial response to these calls, the FSIS has developed new slaughter inspection models that are currently being tested with volunteer plants in the hazard analysis and critical control point (HACCP)-based inspection models project. To evaluate whether plants operating under the new inspection models perform at least as well as they did under the current or traditional system, microbial and organoleptic data are being collected before and after the implementation of the new inspection models. In this article, we describe the baseline and models data collection procedures and present the results of the baseline and models data collection for eight plants that slaughter young chickens. The results from the first eight volunteer plants suggest that inspection under the new models is equivalent and in some ways superior to that of traditional inspection. This pilot project suggests that new slaughter inspection systems, which rely on HACCP principles with FSIS oversight and verification services, can maintain or even improve food safety and other consumer protection conditions relative to traditional hands-on inspection methods.

Animals↗
PubMed2000

A visual intracellular classification strategy for uncharacterized human proteins.

The human cDNA and genomic sequencing projects will result in the identification and isolation of some 140,000 genes, the majority of which lack predicted functions and for which the cellular localizations are not known. The identification and characterization of protein components of specific cell structures and machineries are essential steps not only toward defining functions of genes but also toward understanding cell function and regulation. We describe here a new approach, termed PROLOC, which uses full-length cDNAs for systematic classification of novel proteins as a functional pointer. We have PCR-amplified 25 uncharacterized human genes and expressed the encoded proteins as GFP fusions in a human cell line. This pilot project has identified novel proteins associated with the nucleolus, mitochondria, the ER, the ER-Golgi-intermediate compartment (ERGIC), the GC, the plasma membrane, and cytoplasmic foci. This visual classification approach may be scaled up to handle a large number of novel genes and permit the generation of a global cellular protein localization map. Such information should be valuable for many aspects of functional genomics and cell biology.

Carcinoma, Hepatocellular↗
PubMed2005

Meeting the information needs of the 'Health for all' challenge--lessons from Scotland.

OBJECTIVE: To create a public health data resource for Scotland that is based on a socio-ecological model of the determinants of health and would, therefore, meets the needs of the emerging public health agenda. DESIGN: Action research, in which the approach moved logically through stages of action (conception, feasibility study, pilot projects, leading to a national set of integrated health and well-being profiles). Each stage built on the results of the previous research. RESULTS: The conceptual stage identified the need for an approach to public health data that kept pace with the increasingly accepted socio-ecological models of the determinants of health. A feasibility study concluded that sufficient data were available to populate the health fields that represented the important determinants of health. At this time strengths and weakness in data were defined. This led to the articulation of a 'vision' for integrated public heath data in Scotland that was the subject of a wide consultation. Pilot studies provided local stakeholders with imaginatively presented data (on population demographics, health and function, behaviour, social environment, economy, physical environment, morbidity and mortality) for their local communities. The response to these was so positive that a demand was created for a comprehensive set of 'community profiles'. These, in addition to parliamentary constituency profiles, have now been created and widely disseminated. CONCLUSIONS: It has been possible, despite many difficulties, to develop approaches to public health information that are informed by the socio-ecological model of health and create outputs that represent a significant advance on previous approaches to public health data. This is a work in progress and many issues remain unresolved. Interaction with others engaged in parallel tasks will facilitate the next steps.

Community Participation↗
PubMed2000

Genetics services in a social, ethical and policy context: a collaboration between consumers and providers.

We report a unique, collaborative effort by users and providers of genetic services to arrive at outlines for optimal ethics and clinical practice. Using focus groups of consumers (users) and providers (held separately), a provider-consumer project team developed 1) a consumer wish list, 2) an experientially based ethical overview of situations arising in practice, and 3) detailed suggestions for consumer-provider interactions in clinical settings. Consumers were primarily interested in accurate information, respect for persons, a smoothly functioning team, with the consumer as an equal member of the team, family integrity, and providers who knew the limits of their knowledge and were willing to refer. "Non-directive" counselling and privacy were not major issues in consumer focus groups; some thought providers should openly state their own opinions. Providers had a rather different list of priorities. Books and papers on clinical ethics usually originate from bioethicists and physicians. This pilot project is unique in including consumers and providers equally.

Community Participation↗
PubMed2005

[Notes on the care of mentally ill residents in nursing homes in the Uelzen county district].

From 1999 to 2001 the "Centre of Applied Health Sciences" (University of Luneburg) carried out a research project in cooperation with the Psychiatric Hospital Hacklingen in Luneburg and the department of social psychiatry and psychotherapy of the Hanover College of Medicine. The project covered the prevalence of mental disorders among the residents of nursing and geriatric homes in the district of Uelzen including different aspects of medical, psychiatric and nursing care. The research was based on a survey including all residents of these institutions. The response rate was 925 of a total of 1,100 residents. Results showed that three-quarters of the residents had considerable and different psychiatric symptoms and that almost half of the residents suffered from symptoms of dementia. The provision of health care as well as nursing care for these residents are considerably deficient. Care facilities are hardly of therapeutical standard and guidelines. This refers in particular to treatment with psychoactive drugs. The (few) comparable studies show that -- with the exception of some pilot projects -- the situation in the district of Uelzen may be similar to that in other regions of Germany.

Aged↗
PubMed1992

Barriers to cervical cytology screening in native women in British Columbia.

The British Columbia (BC) Cervical Cytology Screening Programme (CCSP), implemented since 1955, has resulted in a 75% decrease in both the mortality from and incidence of invasive squamous cervical carcinoma. However, despite this effect, the Native Indian population still present an overall mortality rate four times higher than that of the non-Native population. A demonstration project was initiated in four Native Indian Band communities of BC to determine the reasons underlying these findings. The participation patterns to the CCSP were investigated and revealed that the overall percentage of participation to the CCSP among Native Indian women was 30% lower than that of the non-Native population. Reasons for the under-participation to the CCSP were explored. A total of 36 women, 9 in each of the 4 communities, including current users, ex-users and never users, were interviewed. Reasons for not participating in the CCSP were due mainly to (1) the lack of knowledge about the Pap test and about its importance; (2) feelings of embarrassment and shamefulness; (3) lack of continuity of care due to the high turnover of physicians in the Native communities. Based on the study findings, a pilot CCSP clinic will be implemented in each community. In addition to taking cervical smears, this pilot project will include education sessions, notification about the results of the test, and recall for annual check up.

British Columbia↗
PubMed2000

A case for evolutionary genomics and the comprehensive examination of sequence biodiversity.

Comparative analysis is one of the most powerful methods available for understanding the diverse and complex systems found in biology, but it is often limited by a lack of comprehensive taxonomic sampling. Despite the recent development of powerful genome technologies capable of producing sequence data in large quantities (witness the recently completed first draft of the human genome), there has been relatively little change in how evolutionary studies are conducted. The application of genomic methods to evolutionary biology is a challenge, in part because gene segments from different organisms are manipulated separately, requiring individual purification, cloning, and sequencing. We suggest that a feasible approach to collecting genome-scale data sets for evolutionary biology (i.e., evolutionary genomics) may consist of combination of DNA samples prior to cloning and sequencing, followed by computational reconstruction of the original sequences. This approach will allow the full benefit of automated protocols developed by genome projects to be realized; taxon sampling levels can easily increase to thousands for targeted genomes and genomic regions. Sequence diversity at this level will dramatically improve the quality and accuracy of phylogenetic inference, as well as the accuracy and resolution of comparative evolutionary studies. In particular, it will be possible to make accurate estimates of normal evolution in the context of constant structural and functional constraints (i.e., site-specific substitution probabilities), along with accurate estimates of changes in evolutionary patterns, including pairwise coevolution between sites, adaptive bursts, and changes in selective constraints. These estimates can then be used to understand and predict the effects of protein structure and function on sequence evolution and to predict unknown details of protein structure, function, and functional divergence. In order to demonstrate the practicality of these ideas and the potential benefit for functional genomic analysis, we describe a pilot project we are conducting to simultaneously sequence large numbers of vertebrate mitochondrial genomes.

Animals↗
PubMed2003

Empowerment of patients and communication with health care professionals through an electronic health record.

OBJECTIVE: The aim of this project was to design and develop a personal electronic health record (EHR) in order to support patient empowerment and additionally to enhance their communication and information exchange with health professionals through this EHR. METHOD: The functionality of a personal Electronic Healthcare Record (EHR) may vary from a simple web-based interface for interactive data entry and data review up to a much more powerful system additionally supporting electronic data/document communication between clinical information systems of primary care practitioners or hospitals and even reminder based support for the empowered citizen, to actively take care of his health, based on relevant disease management programs. It is one means to support patient empowerment, additionally supported by tools for building a patient community. Since storage and communication of data in an EHR comprises sensible personal health data, each of those functions needs specific security and access management requirements to be considered and implemented. RESULT: Clinical pilot projects are already done or under development.

Communication↗
PubMed1999

Screening for submicroscopic chromosome rearrangements in children with idiopathic mental retardation using microsatellite markers for the chromosome telomeres.

Recently much attention has been given to the detection of submicroscopic chromosome rearrangements in patients with idiopathic mental retardation. We have screened 27 subjects with mental retardation and dysmorphic features for such rearrangements using a genetic marker panel screening. The screening was a pilot project using markers from the subtelomeric regions of all 41 chromosome arms. The markers were informative for monosomy in both parents at 3661902 loci (40.6%, 95% confidence interval 37.0-44.2%) in the 22 families where DNA was available from both parents. In two of the 27 subjects, submicroscopic chromosomal aberrations were detected. The first patient had a 5-6 Mb deletion of chromosome 18q and the second patient had a 4 Mb deletion of chromosome 1p. The identification of two deletions in 27 cases gave an aberration frequency of 7.5% without adjustment for marker informativeness (95% confidence interval 1-24%) and an estimated frequency of 18% if marker informativeness for monosomy was taken into account. This frequency is higher than previous estimates of the number of subtelomeric chromosome abnormalities in children with idiopathic mental retardation (5-10%) although the confidence interval is overlapping. Our study suggests that in spite of the low informativeness of this pilot screening, submicroscopic chromosome aberrations may be a common cause of dysmorphic features and mental retardation.

Adolescent↗
PubMed1995

Improving quality through cost recovery in Niger.

New evidence on the quality of health care from public services in Niger is discussed in terms of the relationships between quality, costs, cost-effectiveness and financing. Although structural attributes of quality appeared to improve with the pilot project in Niger, significant gaps in the implementation of diagnostic and treatment protocols were observed, particularly in monitoring vital signs, diagnostic examination and provider-patient communications. Quality improvements required significant investments in both fixed and variable costs; however, many of these costs were basic input requirements for operation. It is likely that optimal cost-effectiveness of services was not achieved because of the noted deficiencies in quality. In the test district of Boboye, the revenues from the copayments alone covered about 34% of the costs of medicines or about 20% of costs of drugs and administration. In Say, user fees covered about 50-55% of the costs of medicines or 35-40% of the amount spent on medicines and cost-recovery administration. In Boboye, taxes plus the additional copayments covered 120-180% of the cost of medicines, or 75-105% of the cost of medicines plus administration of cost recovery. Decentralized management and legal conditions in the pilot districts appeared to provide the necessary structure to ensure that the revenues and taxes collected would be channelled to pay for quality improvements.

Clinical Protocols↗