Pilot Initiative Research Articles

A case-finding strategy for familial hypercholesterolaemia in Irish hospitals

Aim: Familial hypercholesterolaemia (FH) is an under-diagnosed and under-treated condition with a significant public health burden. Given an estimated FH prevalence of 1:250, this suggests there are approximately 23,000 persons with FH in the Republic of Ireland, the vast majority of whom are undiagnosed. To further enhance diagnosis and optimise the management of FH within this population we describe a pilot initiative based on retrospective review of laboratory lipid profiles and clinical liaison with primary care doctors.

Learn CPS curriculum: Satisfaction survey of final year paediatric residents who participated in a pilot initiative to improve uptake of CPS position statements and practice points.

Learn CPS curriculum: Satisfaction survey of final year paediatric residents who participated in a pilot initiative to improve uptake of CPS position statements and practice points.

Open innovation and the evaluation of internet-enabled public services in smart cities

This article is focused on public service innovation from an innovation management perspective. It presents research experience gained from a European project for managing social and technological innovation in the production and evaluation of citizen-centred internet-enabled services in the public sector. It is based on six urban pilot initiatives, which sought to operationalise a new approach to co-producing and co-evaluating civic services in smart cities – commonly referred to as open innovation for smart city services. Research suggests that the evidence base underpinning this approach is not sufficiently robust to support claims being made about its effectiveness. Instead evaluation research of citizen-centred internet-enabled urban services is in its infancy and there are no tested methods or tools in the literature for supporting this approach. The paper reports on the development and trialing of a novel Co-evaluation Framework, indicators and reporting categories, used to support the co-production of smart city services in an EU-funded project. Our point of departure is that innovation of services is a sub-set of innovation management that requires effective integration of technological with social innovation, supported by the right skills and capacities. The main skills sets needed for effective co-evaluation of open innovation services are the integration of stakeholder management with evaluation capacities.

The Benefits, Risks, and Challenges of Get-Tough and Support-Oriented Approaches to Improving School Safety

Schools have adopted get-tough policies and support-oriented policies, each of which creates not only potential benefits but also potential risks for youth delinquency and education. This article identifies potential benefits and risks of get-tough approaches and support-oriented approaches, respectively, to reduce delinquency. It then identifies challenges that can arise when schools seek to balance both get-tough and support-oriented policies. We illustrate these challenges by drawing on prior scholarship on these policies as well as a process evaluation of a large metropolitan school district’s pilot initiative to promote school safety and academic performance by assisting court-involved youth. We argue for developing a stronger empirical foundation for school-based approaches that aim to improve school safety and educational outcomes of youth.

MRI in spondyloarthritis: when and how?

To summarize recent advances and challenges of using MRI toward early recognition of axial spondyloarthritis (SpA). Low-grade bone marrow edema (BME) on sacroiliac joint (SIJ) MRI is nonspecific and may be misleading in recognition of axial SpA. Structural features on SIJ MRI along with BME may not only facilitate recognition of early disease, but also enhance specificity. Structural lesions on MRI and low-dose computed tomography are highly concordant, adding to criterion validity of SIJ MRI. There is accumulating evidence that SIJ MRI due to superior reliability of structural lesions may supplant the traditional imaging approach by pelvic radiographs in healthcare settings in which MRI is readily available. Pilot initiatives exploring the bone remodeling cascade in SIJs showed early reparative response upon biological treatment. Methodological challenges regarding evaluation and data processing of imaging examinations need to be addressed to enhance reproducibility and specificity of imaging in SpA. Evaluation of SIJ MRI is contextual incorporating structural lesions and BME. MRI is but one element in pattern recognition toward diagnosis. An unmet need is dissemination of advances in imaging in SpA to the broad community of rheumatologists and radiologists.

Results from a Population Health Strategy for Diabetes in a Large Health Care System

Population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. Awareness of population health management is increasing but the concept is not clearly defined or understood. Nevertheless, the overarching goal is to keep the patient population as healthy as achievable. Since diabetes is a chronic and progressive illness, population health management strategies hold promise and can be measured using health outcomes, disease burden or metabolic status. University of Washington Medicine, a large healthcare system in the greater Seattle area comprised of academic and community-based primary care clinics, recently initiated a diabetes population health (DPH) program. The is a centralized outlier management and surveillance system where a specialized team (endocrinologist and certified diabetes educator) remotely supports care teams (primary care providers, nurses) in diabetes management. In this pilot initiative, focus was on the highest risk patients with type 2 diabetes such as individuals who had chronically elevated A1C >9% over the past 12 months. The DPH team identified these individuals from an internal database, conducted chart reviews to identify potential areas for improvement, reached out to clinical care teams and offered individualized patient management strategies for the identified patients. Care of all identified patients remained with primary care teams. In 6 months there was a 1.4% point reduction in A1C (10.8% to 9.4%, n=34, p<0.01) primarily through the team’s work with care management nurses who in turn conducted outreach to patients to enable engagement, offered diabetes self-management support and improved care coordination. Thus, the number of individuals with diabetes and elevated A1C at any given period in the past 8 months was decreased by 60%. These early results suggest that an active diabetes surveillance program has the potential to improve health outcomes in diabetes. Disclosure S. Subramanian: Advisory Panel; Self; Intarcia Therapeutics, Inc., Akcea Therapeutics. I.B. Hirsch: Research Support; Self; Medtronic MiniMed, Inc.. Consultant; Self; Abbott, Bigfoot Biomedical, Roche Diabetes Care Health and Digital Solutions, ADOCIA. A. Evert: None.

Family reunification in child welfare practice: A pilot study of parent and staff experiences

Current knowledge about the types of child welfare interventions that best promote family reunification has increased over the years. However, evidence remains fairly limited regarding the process of implementing these programs and the experiences of families participating in these services. This study addresses these gaps by examining how a child welfare agency implemented an innovative pilot initiative designed to promote timely family reunification. This research study explored a program that included three core components: Family to Family program model, reduced worker caseloads, and caseworker continuity. The study aimed to answer three research questions: (1) how was the program envisioned, created and implemented, (2) what were staff members' experiences implementing the program, and (3) what were parents' experiences receiving services from this program? Findings indicated that the implementation of pilot program was consistent with the original program design. Both staff and parents perceived the program to be valuable and effective. Participants highlighted how the program's unique structure helped families reunify, especially by fostering trusting relationships between caseworkers and parents, and close collaboration between the child welfare agency and the local community. Results from the study offer recommendations regarding alternative approaches to achieving family reunification or permanency for children. Implications for child welfare practice, policy and research are provided.

Estimating farmers\u2019 willingness to pay for weather index-based crop insurance uptake in West Africa: Insight from a pilot initiative in Southwestern Burkina Faso

Weather index-based crop insurance is increasingly becoming important as a risk mitigation strategy that farmers may use to mitigate adverse climate shocks and natural disasters encountered during farming. While Europe, North America, and Asia account for 20.1%, 55%, and 19.5% of the total agricultural insurance premium worldwide, respectively, Africa accounts for only 0.5% of the world insurance industry. One of the key reasons advanced against the low index insurance participation rate in Africa is the failure to involve farm households at the initial conceptualization and design of pilot initiatives. Therefore, the main purpose of this paper is to design an improved participatory methodology that could help elicit information on the value placed by farm households in Southwestern Burkina Faso on a new weather index-based crop insurance management initiative. A key concept in the improved participatory methodology is that of the willingness to pay (WTP) of farm households for the scheme. Knowledge of the maximum amount that farmers are willing to pay for the scheme can help insurance policy providers and public policy makers to design and put in place measures that sustain index insurance schemes in a developing country context and improve welfare among participating farmers.

VR Online in Rehabilitation Counseling Preparation: An Integrative Pilot Initiative

This collaboration involves VR Online research at Wright State (WSU) and the Vocational Rehabilitation Counseling (VRC) Long-term Training Project at University of Southern Maine (USM). The NIDILRR-funded VR Online research team developed and piloted online resources for vocational rehabilitation (VR) consumers and counselors using an online portal to meet consumers via videoconference. To address VRC shortages in state VRs and community rehabilitation providers, the Rehabilitation Services Administration (RSA) funded Northern New England VRC project which provides graduate education to VR employees in order to increase the number of qualified VRCs throughout the rural northeast. This article will examine a partnership of these two projects to provide training and technical assistance to VRC students during internships, which includes: use of tele-rehabilitation technology in delivering VR services; integration of video conference technology into rehabilitation counselor education (RCE) graduate level curriculum during internship; trainee supervision and preparation applying HIPPA compliant, webbased, video-conference technology; and assessing benefits and limitations using advanced technologies in internship experiences and process considerations to improve VR Online application in practice.

Columbia Fellow Leads Effort To Help Those on Temporary Protected Status

Back to table of contents Previous article Next article Community NewsFull AccessColumbia Fellow Leads Effort To Help Those on Temporary Protected StatusMark MoranMark MoranSearch for more papers by this authorPublished Online:29 May 2018https://doi.org/10.1176/appi.pn.2018.6a24AbstractSevere and her colleagues hope to link individuals who may have to return to Haiti with health and mental health care services.Psychiatrist Jennifer Severe, M.D., a public psychiatry fellow at Columbia University, is leading an effort by a small group of physicians to rally support for Haitians and other foreign nationals in the United States residing under Temporary Protected Status (TPS). Jennifer Severe, M.D., hosted a booth in the Exhibit Hall during APA’s 2018 Annual Meeting to talk to attendees about the plight of individuals who may lose Temporary Protected Status.Mark Moran Part of that effort involved reaching out to attendees at APA’s 2018 Annual Meeting by sponsoring a booth in the Exhibit Hall. The TPS program is a visa program created by Congress for immigrants who are unable to safely return to their home countries because of ongoing armed conflict, environmental disaster, or other extraordinary conditions.TPS was granted to Haitians in January 2010 after a devastating earthquake destabilized the country’s fragile infrastructures, resulting in over 300,000 deaths. The Trump administration terminated the program in November 2017 on the basis that the extraordinary conditions under which the status was granted no longer existed in Haiti. The Department of Homeland Security extended Haitians’ stay to July 2019 “to allow for an orderly transition.” (TPS has been terminated for individuals from several other countries. Most recently, TPS was terminated for individuals from Honduras.) Severe and her colleagues hope to start a pilot program to reach out to Haitian communities in the states with the highest density of Haitians. The goal of the program, called the Pilot Initiative to Empower Haitians on Temporary Protected Status and Support Their Mental Health, is to create a cushioned transition for Haitians returning to their home country (or to permanent residence in the United States when possible). This will be achieved by providing a platform for coordinating psychiatric and psychological support services to TPS holders and information to help TPS holders and their U.S.-based health providers familiarize themselves with the Haitian mental health system and make an educated decision about care options when they return. Such information will include the location of clinics and providers, psychotropic medications available in Haiti, costs of care, and support groups in Haiti that can help returning TPS holders. More information can be accessed here.“Our goal is to raise awareness around the anguish of individuals and families affected by the termination of TPS and this includes trainees, colleagues, and patients,” Severe told Psychiatric News. Severe was appointed by APA President Altha Stewart, M.D., to be a corresponding member of the Council on International Relations. The Council is reviewing a proposal for a position statement addressing the mental health needs of individuals on Temporary Protected Status, as well as of individuals residing in the United States on other visas who may be facing challenges related to immigration. Severe’s group is supported by the Haitian American Psychiatric Association, the Association of Haitian Physicians Abroad, and Professional Risk Management Services Inc. ■ ISSUES NewArchived

Optimizing engagement of undergraduate students in medical education research: The eMERG training network.

BackgroundThe practice of evidence-based medicine and critical appraisal are essential for the modern doctor. Early engagement of medical students in research methodology is considered as a rising need for most medical school curricula; however, few peer-reviewed initiatives have been reported so far. We developed a Medical Education Research Group (eMERG) as part of a novel undergraduate surgical masterclass, which aimed to train undergraduate students on basic research methodology, as well as to motivate them to pursue a clinical and academic career in surgical specialties.Methods: eMERG consists of an international structured network of senior academics, consultant-level clinicians, senior and junior trainees who support undergraduate trainees. Students are selected from a competitive pool of applicants. Several small prospective studies in skills-based education, as well as systematic reviews on similar topics, have run under the umbrella of this framework, in the form of scholarship awards. Structured feedback questionnaires were distributed to evaluate the experience of the first three years.Results12 students have participated in this pilot initiative. 11 manuscripts have been submitted for publication and 8 were accepted following peer-review in MEDLINE-indexed journals. Delegates perceived this experience as an excellent training opportunity which improved their research productivity. Delegates also stated engagement in research developed interest in the relevant surgical speciality, impacting their career aspirations.ConclusionseMERG is one of the first reported European educational research networks for undergraduates. Research outcomes and students' perceptions conclude that eMERG enhances engagement with research methodology and motivation towards a career in surgery.

Assessing indicators of glioblastoma care quality in neuro-oncology centers: Baseline results of a pilot initiative.

e18880Background: Reports of quality improvement (QI) programs and metrics for care processes in glioblastoma (GBM) are lacking. We initiated a retrospective QI analysis for GBM teams at 2 major U....

Creating a Culture of Continuous Improvement in a Radiation Therapy Planning Department: A Pilot Initiative Using Quality Conversations

Creating a Culture of Continuous Improvement in a Radiation Therapy Planning Department: A Pilot Initiative Using Quality Conversations

Virtual Telemedicine Visits in Pediatric Home Parenteral Nutrition Patients: A Quality Improvement Initiative.

Despite being less costly than prolonged hospitalization, home parenteral nutrition (HPN) is associated with high rates of post-discharge complications, including frequent readmissions and central line-associated bloodstream infections (CLABSIs). Telemedicine has been associated with improved outcomes and reduced healthcare utilization in other high-risk populations, but no studies to date have supported effectiveness of telemedicine in pediatric HPN. We prospectively collected data on pediatric patients managed at a single HPN program who participated in postdischarge telemedicine visits from March 1, 2014 to March 30, 2016. We excluded patients with a history of HPN and strictly palliative care goals. Univariate analysis was performed for primary outcomes: Community-acquired CLABSI and 30-day readmission rate. Twenty-six families participated in the pilot initiative with median (interquartile range) patient age 1.5 (5.7) years old, diagnosis of short bowel syndrome in 16 (62%), and in-state residence in 17 (55%). Ishikawa (fishbone) diagram identified causes of post-discharge HPN complications. Areas of focus during telemedicine visit included central venous catheter care methods, materials, clinical concerns, and equipment. Compared to historical comparison group, the telemedicine group experienced CLABSI rates of 1.0 versus 2.7 per 1,000 line days and readmission rates of 38% versus 17% (p = 0.03, 0.02, respectively). Telemedicine visits identified opportunities for improvement for families newly discharged on HPN. In a small cohort of patients who experienced telemedicine visits, we found lower CLABSI rates alongside higher readmission rates compared with a historical comparison group. Further studies are needed to optimize telemedicine in delivering care to this high-risk population.

Transitional care post TAVI: A pilot initiative focused on bridging gaps and improving outcomes

Interventions focused on ensuring safe transitions for patients from hospital to home can assist in providing continuity of care, preventing readmissions, and reducing duplication of services. Patients undergoing a Transcatheter Aortic Valve Implantation (TAVI) procedure are often frail, elderly, and have multiple co-morbidities. A pilot initiative evaluating transitional care strategies through telephone follow up was implemented in a tertiary centre with the aim to identify gaps and intervene, preventing re-admission and improving patient outcomes. TAVI patients or caregivers were contacted at 3 days and 30 days post discharge by an Advanced Practice Nurse (APN). Telephone follow up centered on best practices for transitional care. Outcomes revealed fluid balance monitoring, medication management, and feelings of anxiety and depression post TAVI were the most frequent areas requiring intervention. Findings from this initiative reinforce the need to establish consistent processes that support elderly patient populations during potentially vulnerable points in the care trajectory.

Facilitating Home Hospice Transitions of Care in Oncology: Evaluation of Clinical Pharmacists’ Interventions, Hospice Program Satisfaction, and Patient Representation Rates

The importance of medication reconciliation and the pharmacist's role within the interdisciplinary team at the point of transition to home hospice is understudied. A transitions of care pilot initiative was developed to streamline the transition for patients at end of life from inpatient cancer center care to home hospice. The initiative consisted of using a hospice discharge checklist, pharmacist-led discharge medication reconciliation in consultation with the primary team responsible for inpatient care, review of discharge prescriptions, and facilitation of bedside delivery of discharge medications. This was a single-center, prospective, pilot initiative. The objectives of this study were to characterize pharmacist interventions at the time of transition, to assess changes in hospice organizations' perceptions of discharge readiness, and to evaluate differences in representation rates with the implementation of the pilot discharge process. Fifteen patients in the preimplementation period and 12 patients in the postimplementation period were included. One hundred eleven pharmacist interventions were captured, an average of 9.3 interventions per patient, with an acceptance rate of 82.9% by providers. There was a statistically significant ( P = .035) improvement in hospice organizations' perceptions of discharge readiness. There was no difference in 30-day representation rates postdischarge ( P = 1). This well-received pilot initiative demonstrated an improvement in local hospice's perception of patient readiness for discharge and a high percentage of accepted pharmacist interventions during discharge medication reconciliation. A larger sample size of patients and longer follow-up period may be needed to demonstrate statistically significant improvements in representation rates postintervention.

Improving Early Childhood Development among Vulnerable Populations: A Pilot Initiative at a Women, Infants, and Children Clinic

Objective. Early childhood development (ECD) programs have demonstrated drastic improvements in survival, growth, health, and social productivity. An ECD pilot intervention was delivered to vulnerable populations of a Women, Infants, and Children (WIC) clinic in Des Moines, Iowa, to assess ECD outcomes and parental receivability in this setting. Study Design. In a randomized, single blinded control initiative, WIC group sessions of mothers (children aged 2 years and younger) were selected for pilot ECD intervention (37 participants) or control (36). Care for Child Development ECD course material was supplemented to intervention groups. Survey results were assessed with paired samples T-testing and by an ANOVA. Results. Pilot session receivability demonstrated significance in all areas relative to control: enjoyment, p=0.008; learning capacity, p=0.011; and participant sharing, p=0.023. Furthermore, the previously validated ECD intervention demonstrated significantly improved cumulative 1 month behavior outcomes following the intervention: p=0.006. Conclusions. The WIC setting provides an ideal environment for delivering ECD education beyond traditional counseling in nutrition. High receivability indices among parents demonstrate remarkable capacity for improvement and growth. The significance in receivability, as well as 1 month behavior outcomes, represents parents’ overall readiness to enhance the home environment for their child if merely educated how.

Proyectos multipropósito para la gestión de recursos hídricos en los Andes tropicales: planteamientos generales basados en proceso participativo

In view of an increasing magnitude of climate change impacts, adaptation has turned into a political priority at international level. The direction and attribution of adaptation measures imply a complex analysis process of characteristics and impacts of hydro-climatic and socioenvironmental systems in high-mountain regions. In the Tropical Andes, changes in the hydrological regime –and their subsequent impact on glacier shrinkage and socio-economic development in the region– require robust response mechanisms based on integrative analysis of multidimensional realities and landscapes. In this context, Multi-Purpose Projects for Water Resources (MPP-WR) represent promising strategies in order to deal with current and future challenges in high-mountain regions, considering a transdisciplinary-participatory approach. The present article aims to present a participatory pilot initiative in the field of water resources management and MPP-WR in Andean glacier areas. The workshop, called Winter School, emphasized a structured formulation process for MPP-WR, through which the elements that condition the design of sustainable water projects in the Tropical Andes were identified and analysed (e.g., access to scientific data, social conflicts, institutionality, local culture). Furthermore, through the design and formulation of the MPP, the relevance (and challenges) of a coordinated work between different disciplines and actors was demonstrated, in which both professional experience and local practical knowledge were considered. Future related studies and programmes should take into account the context, variables and scenarios for the formulation (and implementation) of MPP-WR, in order to contribute to robust adaptation measures on the long term in basins with multiple pressures over water resources.

Impact of Group Prenatal Care Support on Breastfeeding Initiation Rates and Other Maternal and Perinatal Outcomes

Group prenatal care support has been studied in order to increase maternal and neonatal benefits, such as breastfeeding initiation rates, in front of standard care. In our area, especially in some high risk sub-groups, it could be an important intervention to improve individual care. The aim of the pilot initiative is to compare the effect of group prenatal care support versus only standard individual care on breastfeeding initiation rates and other perinatal outcomes. A retrospective cohort study was made analyzing all deliveries at Hospital del Mar in Barcelona during 1 year. All pregnant women were compared depending on whether they had received the group prenatal care support by midwifes or only standard care. 1383 women gave birth at Hospital del Mar in Barcelona in 2015. 207 received group prenatal care support (15% of total). In group prenatal care there significantly were more nulliparous and native women. Breastfeeding initiation rate was higher in group prenatal care women (94.2% vs. 86.7%, p=0.01). Other outcomes like cesarean section rates, prematurity and low birth weight rates also improved in group prenatal care support in front of standard care. Our study suggests that group prenatal care support improves breastfeeding initiation rates and some other maternal and perinatal outcomes.

Welcome to The Backyard: Introducing Calgary’s First Laneway Activation Project ( breakout presentation )

Background Come on over….to Calgary’s backyard. It’s about everyday experiences: walking the dog, riding your bike, making your way over to meet friends. We are bringing the lane to life. Linger in a pop up patio, enjoy BBQ, shoot some hoops, practice yoga, peruse the local marketplace or enjoy local fayre. Watch local bands and artists performing or settle in for an outdoor movie. It’s a shared place for people, and everyone’s invited! Description of Program This is a pilot initiative as part of the City of Calgary’s effort to support businesses that are feeling the effects of street upgrades along 17th avenue. The laneway revitalization will increase available frontage for these businesses and provide a shared space for the public and patrons to enjoy. In the spirit of local community enterprise, many local partners have come together to create the environment and orchestrate the event over two weekends in September. Aims 1) Bring the laneway to life! 2) Realize Calgary’s first official laneway activation project 3) Create a thriving backyard space for Calgary’s art, culture and local businesses to flourish, and 4) pilot the project as a test case for future urban interventions in Calgary. Method All interventions in the laneway are convertible and temporary and components are a modular design, opening possibilities for future re-use and re-interpretation. Implications Come on down and see the results for yourself! The Backyard will be open September 22nd – 24th and September 29th – October 1st.