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PubMed1997

Stability of personality traits in schizophrenia and schizoaffective disorder: a pilot project.

This study was performed in an effort to begin characterization of personality traits in schizophrenia. Specific concerns included personality profiles relative to normal adults, personality profile stability over time, and trait-state issues. The authors administered the NEO Personality Inventory as well as symptom ratings at two time points to 21 patients. Patients were all stabilized outpatients attending an adult continuing day treatment program and diagnosed with either schizophrenia or schizoaffective disorder. Personality profiles were determined for all patients. Compared with a normal adult sample, this sample's scores on three out of five of the personality domains assessed were not distinguishable from normal adults. Test-retest correlations were highly significant over an average 28.2-week time interval. In general, the presence of positive symptoms did not appear related to NEO-PI stability, while negative symptoms did show a relationship to the stability of personality profiles. These data suggest that personality profiles can be looked at in schizophrenia, that these profiles do appear stable over time, and that negative symptoms have a strong influence on profile stability and appear to be "trait-like."

Adult↗

PubMed2005

[Internal quality management: use of a patient questionnaire in a urological university clinic. Results of a pilot project].

INTRODUCTION AND OBJECTIVE: In order to support the introduction of quality management, a systematic patient questionnaire was used in the Urology Clinic of the University Hospital of Münster and in another comparable clinic. The aim was to distinguish between well established areas and areas needing improvement. METHODS: A multidimensional questionnaire with emphasis on items involving patient satisfaction was developed and handed out to the patients before they left the clinic. The questionnaire could be sent back with an enclosed envelop free of charge. RESULTS: Hospital hygiene was rated as most important factor by the patients, followed by professionalism of the physicians and nurses. Patients were dissatisfied with hospital hygiene, making this an issue for improvement. Physicians and nurses were rated positively in both clinics. Furthermore, a high proportion of patients (82%) said that they had no pain after surgery. Overall, patients were very satisfied with their hospital stay in both clinics. CONCLUSIONS: After analyzing the questionnaires, we could identify areas in need of improvement and areas of high performance. In particular, hospital hygiene needs to be improved. In order to reach more patients, the inquiries need to be performed in all departments of the University Hospital of Münster.

Academic Medical Centers↗

PubMed2005

Knowledge of type 2 diabetic patients about their illness: pilot project.

OBJECTIVE: To evaluate the baseline level of knowledge and awareness of diabetic patients about their disease and it's complications. METHODS: It was a Cross Sectional Survey conducted at Foundation Clinic, Shifa College of Medicine, Islamabad, in April 2004. A structured questionnaire was used. Forty diabetic patients were interviewed to know their knowledge attitude and practices about diabetes. All data was entered into SPSS version 10.0. The data was re-validated and analyzed. RESULTS: Mean age of study participants was 45.35 +/- 13.05 years, 11(27.5%) were male and 29(72.5%) were female. The mean BMI of the study participants was 27.06 +/- 6.29 kg/m2. Majority of the patients 27(67.5%) had type 2 diabetes. The mean fasting blood sugar was 159 +/- 73.89 mg/dl and random blood sugar was 200 +/- 91.2 mg/dl, 50% of the patients were using antidiabetic drugs regularly and only 15% of the patients were regularly monitoring their blood glucose at home using a glucometer. Awareness level of the study participants was low. CONCLUSION: The awareness about the disease in majority of diabetic patients was not adequate in this study. Routine individual teaching and counseling represents an effective educational model.

Cross-Sectional Studies↗

PubMed2006

A pilot project to design, implement and evaluate an electronic integrated care pathway.

The project focused on the design, implementation and evaluation of an electronic integrated care pathway (eICP), within a Mother and Baby Unit. Health care professionals and service users (stakeholders) were involved in the process in order to promote patient centred, co-constructed care. Questionnaire and discussion groups were used for data collection regarding the initial eICP development. Of 15 participants who took part in the design and development of the eICP, seven were able to take part in the evaluation process on the Unit. Results show that 100% (n = 7) of the participants were in agreement with the eICP and the format that was produced and implemented for trial on the Unit. Increased ownership of records, greater multi disciplinary involvement and enhanced patient experience were also reported. Recommendations for clinical practice include resource management, ownership of the research group, holism maintenance and the acquisition of computer skills.

Critical Pathways↗

PubMedDate not supplied

[Interview training for patient history inquiry at the first prenatal examination: a pilot project at a women's clinic].

In view of the relevance of preventive examinations to health policy and the prophylactic value of the first meeting between physician and patient, the efficiency which which patients' histories are taken--and hence overall prenatal care--should be improved. The method adopted by duty physicians at the prenatal outpatient clinic of a community hospital furnishes an example. The examination was subdivided into four phases: 1. documentation of the current state of communication between doctor and patient (tape recordings, participatory observation, interviewing the patients and the duty physicians); 2. analysis of the interviews and the participatory observation, linguistic analysis of the history discussions; 3. topic-centered communication training of the duty physicians involved, on the basis of their own tape recordings; 4. feedback, verification of efficiency, and transfer of results to routine practice in the prenatal clinic. As early as in the fourth session changes in behavior and an increased awareness of problem areas in the course of the discussion were noted among the duty physicians. The program has proved easy to implement in practice. It enhances communication and identification for the junior physicians, and has had a highly positive overall effect.

Communication↗

PubMed1997

Self-directed patient education in soft-tissue rehabilitation: rationale and analysis of a pilot project.

OBJECTIVES: To determine the compliance level and topic choice selection frequency of rehabilitation patients in a self-directed education program offered in conjunction with a rehabilitation exercise program. DESIGN: Descriptive study. SETTING: Soft-tissue injury rehabilitation clinic located within a chiropractic college. SUBJECTS: Twenty-four rehabilitation patients with injured spines who were enrolled in a daily in-clinic program. OUTCOME MEASURES: Data was collected from patient log-book pages, which recorded frequency of use, topic, medium and personal satisfaction for each selected resource. Clinic attendance data was collected by the clinical staff. RESULTS: Eighty-one percent (81%) of the patient group voluntarily used the learning center. Average frequency of use was approximately one visit per patient per week. Of the 13 subject areas included in the resource center collection, back injury care (30), nutrition (22) and fitness/exercise (14) received the most use. Patient satisfaction with the resources' value/interest averaged 78.4%. CONCLUSIONS: Most (81%) patients in this group were willing to spend some of their own time learning information that they thought was important. The results may allow for patient education program designs that put more responsibility for learning with the patient and allow for more efficient clinician time allocation.

Adult↗

PubMed2003

[Naltrexone implants--a pilot project].

BACKGROUND: An increasing number of Norwegian heroin addicts have had naltrexone implants abroad without proper documentation. The authors established a joint project to study duration and safety. MATERIAL AND METHODS: Methodology to measure naltrexone in plasma was developed. 10 patients had 21 implants. Plasma samples were collected before, one and three hours after implantation, daily for one week, then weekly. Patient satisfaction, side effects and unwanted medical events were recorded. RESULTS: Patients had a protective level of naltrexone for 35-80 days. Side effects were few. Two patients had abstinence reactions caused by insufficient detoxification. Two patients had their repeat implants removed because of tissue reactions. One patient developed hepatitis C infection in the second week after implantation. One had transient increase in transaminases after heavy multi-drug use. The others were without signs of hepatic toxicity. INTERPRETATION: Use of implants secures a prolonged period of naltrexone protection. Implants are mostly well tolerated, but tissue reactions to repeat implants could be a problem. Evaluation of the patients should be thorough and the treatment integrated in a competent follow up.

Adult↗

PubMed2006

Pilot project for education of patients with type 2 diabetes by pharmacists.

The objective was to adapt and test an educational programme for type 2 diabetes patients. The sample consisted of 24 individuals with type 2 diabetes between 31 and 75 years of age that did not require insulin, without severe complications of diabetes. A patient satisfaction questionnaire was applied in the beginning and at the end of the survey. A five-month education was conducted on: hypo- and hyperglycaemia, nourishing and physical activity, feet care, eye care and possible adverse drug reaction. The costs of the education and the pharmacological treatment were calculated. Improvement was observed in patients' diabetes knowledge and there was a decrease in the frequency of hypo- and hyperglycaemic incidents (about 60% less). At the end of the programme no incidents were matched, saving Euro 10/patient. The benefit to cost ratio is about 1:1 (Euro 140:Euro 142.80). The patients' quality of life improved by about 5% according to the Diabetes Questionnaire (IMG). The educational approach has the potential to decrease diabetes complications and therefore the economic cost of type 2 diabetes. Introduction of the programme will benefit diabetes patients, promote pharmacies as a source of independent drug information and recognise pharmacists as competent healthcare providers.

Adult↗

PubMed1993

Reaching children of the uninsured and underinsured in two rural Wisconsin counties: findings from a pilot project.

Debates about the accessibility, costs, and coverages of health care for the population at large have recently accelerated. This paper addresses some of the demographic, health, and fiscal ramifications of creating a preventive health care bridge to children in uninsured and underinsured families in two rural Wisconsin counties. The study findings revealed that the initial health status of children making a preventive health visit under a minimal copayment plan was noticeably worse than the status of those who had the free Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program available to them on a more or less continual basis. Upon their first visit, the children who did not have access to a free EPSDT program had a greater number of medical and dental health problems and fewer preventive dental care visits than their EPSDT contemporaries. Beyond a greater number of problems, however, we found no noticeable differences between the two groups in the types of health problems present (i.e. the clinical distribution of the problems was similar across the two groups). This paper also contrasts referral completion rates and rates of diagnostic confirmation of identified problems between the two groups. Finally, we provide estimates of the cost of coverage for each unprotected child.

Adolescent↗

PubMedDate not supplied

Integrating improvement competencies into residency education: a pilot project from a pediatric continuity clinic.

OBJECTIVE: The Accreditation Council for Graduate Medical Education (ACGME) requires residents to attain 6 core competencies. This article describes a model for integrating 2 of these competencies (practice-based learning and improvement and systems-based practice) into residency education and assesses the clinical outcomes achieved for patients. STUDY DESIGN: An observational study with before-after comparisons. INTERVENTION: Pediatric faculty facilitated multidisciplinary improvement team meetings (which included 8 residents) and implemented an established improvement model to improve the selected clinical condition (immunizations). MAIN OUTCOME MEASURES: The proportion of consecutive children who were up-to-date on DTP, polio, MMR, HIB, and hepatitis B vaccines by 24 months of age. RESULTS: The residents' improvement team successfully implemented 5 changes in the clinic process, which coincided with an increase in immunization rates for 2-year-olds during the 1-year study period. Clinic immunization rates increased from 60% at baseline to 86% at follow-up (P =.04). CONCLUSION: This study suggests that it is feasible to integrate practice-based learning and improvement and systems-based practice into residency education while providing a valuable learning experience for residents and improving patient outcomes.

Accreditation↗

PubMed2005

Is it possible to actively and purposely make use of plasticity and adaptability in the neurorehabilitation treatment of multiple sclerosis patients? A pilot project.

OBJECTIVE: To investigate whether neurorehabilitation is able to influence clinical parameters and brain function measured radiologically. DESIGN: A group of healthy probands was compared with two groups of multiple sclerosis (MS) patients, one of which received rehabilitative therapy. SETTING: Outpatient in a university hospital. SUBJECTS: Twenty-eight patients with multiple sclerosis (MS), 17 of whom received rehabilitative therapy, and 13 healthy controls. INTERVENTIONS: Two months of rehabilitative eclectic therapy based on principles of sensorimotor learning and adaptation. MAIN MEASURES: Multiple Sclerosis Functional Composite, Modified Fatigue Impact Scale, Beck Depression Inventory Score, Barthel Index, Environment Status Scale and Multiple Sclerosis Quality of Life--54, and functional magnetic resonance imaging (fMRI). RESULTS: Patients who underwent neurorehabilitation showed a greater drop in fatigue, depression, impairment, disability and handicap and more improvement in quality of life than those who did not receive therapy. Correlation of brain activity between the right and the left hemisphere is greater in healthy individuals than in MS patients. Neurorehabilitation resulted in a trend for increased correlation between the left and the right hemisphere in patients (approaching the standard). In comparison with control groups, signal amplitudes in anatomical areas did not show any significant changes. CONCLUSION: Clinical changes seen with neurorehabilitation were not associated with any detectable changes in fMRI observations.

Case-Control Studies↗

PubMed1990

The effect of an educational program on knowledge & attitudes about blood pressure by junior high school students: a pilot project.

This study tested the effectiveness of a 10 minute videotape and complementary print program guide on the knowledge and attitudes of junior high school students about blood pressure (BP). A randomized two group pre-test, post-test and delayed post-test design was used. The experimental group received an educational session on BP, designed for this study, which consisted of a 40-minute session, comprised of a 10-minute video presentation and discussion by the teacher on BP (guided by the program guide). The educational session was effective in improving students knowledge of BP at one week post-test; however, this positive effect did not persist at the three month post-test. Student interest in, or knowledge of, their own BP was not obviously affected by the session. The findings were interpreted in light of Social Learning Theory (SLT) and the PRECEDE Model of Health Education (PMHE). In testing the effect of one component of an educational program, i.e., the videotape and teacher lesson the environmental determinants of behaviour change could not be addressed in this study. The educational session was able, however, to achieve the desired knowledge change. The 10-minute videotape and complementary print program guide was shown to be a viable educational tool and can therefore be utilized as a resource in a broader multi-faceted program of cardiovascular (CV) health promotion.

Adolescent↗

PubMed2001

Examining the effect of intervention to nutritional problems of the elderly living in an inner city area: a pilot project.

OBJECTIVE: To examine the effect of interventions provided to home-delivered meal service recipients living in an inner city neighborhood for the purpose of improving their nutritional conditions. DESIGN: Intervention study. SETTING AND PARTICIPANTS: Both the Study Group (42 seniors) and the Control Group (39 seniors), all of whom are over 60 years old, received home delivered meal services. In addition, only the Study Group received the following services through the trained neighborhood residents: 1) health education, 2) referrals to other community resources for unmet health needs, and 3) follow-up services to assure that the health problems were addressed appropriately. The nutritional condition, depression and cognitive status of the Study Group were assessed by medical staff before and after the six-month intervention. The same assessments were conducted to the Control Group with the same interval. Data was analyzed using ANOVA (repeated). MEASUREMENTS: MNA, GDS, and MMSE. RESULTS: Compared to the Control Group, the nutritional condition (p=0.052) and depression (p=0.02) of the Study Group were improved, while no significant difference was observed in their cognitive status. CONCLUSION: A combination of interventions by medical professionals and by trained neighborhood residents seemed to be an effective strategy to approach nutritional problems of seniors living in inner city areas.

Aged↗

PubMed2005

Development and evaluation of a prostate sexual rehabilitation clinic: a pilot project.

OBJECTIVE: To evaluate a sexual rehabilitation service for men with prostate cancer and to use these results to inform the development of future care. PATIENTS AND METHODS: The study participants included 155 men with prostate cancer referred to a sexual rehabilitation clinic by their urologists or radiation oncologists, of whom the partners of 58 were in attendance. Questionnaires to measure sexual function and positive feelings towards the partner were completed before the clinic visit; and for satisfaction with the clinic service immediately after the appointment; and for sexual function, positive feelings towards the partner, and satisfaction with treatments at 4 months afterward. RESULTS: Ninety patients completed the 4-month evaluation, of whom 35 were couples. Enhancement of erection and understanding sexual changes related to treatment were the two main concerns of patients. Phosphodiesterase-5 inhibitors and intracavernosal injections were the treatments of choice. Compared with partners, patients had significantly greater positive feelings towards their partners at both measurement times and were more satisfied with their prescribed treatment. The total scores on sexual function were significantly higher at 4 months. CONCLUSIONS: These results support the need to include partners as a necessary part of these men's sexual rehabilitation. A structured follow-up is necessary to monitor the success of treatment and to document the quality of erection.

Aged↗

PubMedDate not supplied

Standardized Trauma Admission Orders, a pilot project.

The Standardized Trauma Admission Orders (STAOs) were developed in collaboration with the trauma team. Data supporting the development of the STAOs consisted of a retrospective chart review (group 1, n = 30) and a user satisfaction survey before the implementation of STAOs. A user satisfaction survey was administered before and after the STAOs were implemented. Both surveys showed a positive response to using the STAOs. STAOs were implemented in a surgical-trauma intensive care unit to reduce in-patient admission laboratory charges, the frequency of missed admission orders, and physician ordering variability. The difference between group 1 and group 2 (n = 30, STAOs) in-patient admission laboratory charges was significant. There was a $345 per patient reduction in the mean score between group 1 and group 2. Of the selected orders reviewed, completeness of orders was significantly improved in 5 of 21 orders. Survey results show that 11 (79%) of the staff surveyed were in favor of using the STAOs. The majority agreed that in-patient admission orders needs were being met. The STAOs are still being used in the surgical-trauma intensive care unit with some minor changes. Efforts are being directed toward the development of standardized admission orders for the neurosurgical intensive care unit and the trauma floor.

Adolescent↗

PubMedDate not supplied

[Trans-surgical ablation of atrial flutter in patients treated with closure of atrial septal defect. Pilot project].

Atrial flutter is one of the most common arrhythmias in patients with atrial septal defect, after surgery 14% of patients can develop it and may be associated with high morbidity. In this study we performed prophylactic and therapeutic ablation of atrial flutter during atrial septal closure surgery drawing 4 lines; line 1, isthmus cavo-tricuspid, the area between the inferior vena cava and the tricuspid ring; line 2, the area between coronary sinus ostium and inferior vena cava; line 3, the area between tricuspid valve annulus and coronary sinus ostium; and line 4, the area between lateral atriotomy and atrial septal defect. Twenty-one patients were included, 6 (28.5%) patients had atrial flutter before surgery and 15 (71.4%) were in sinus rhythm. There were no new cases of atrial flutter, but at six months follow up 2 (33.3%) patients recidivated with atrial flutter. One patient developed high degree atrio-ventricular block and a pacemaker had to be implanted. Older age at the time of surgery and high systolic pulmonary pressure were significantly higher in those patients with atrial flutter before surgery and in patients with arrhythmias recurrence. Ablation of atrial flutter during atrial septal closure surgery can be a good option for the treatment and prevention of atrial arrhythmias, but more studies are still needed.

Adolescent↗

PubMed1996

[A documentation procedure for community social psychiatry services--a pilot project in Bielefeld and Minden].

The status of health reporting (on community levels) has improved considerably during recent years. It is being increasingly used as an instrument for planning, controlling and evaluating political processes. In addition to individual studies the statistics within the departments of the health authorities are an important factor for meaningful health reporting on a local level. The IDIS (from Jan. 1st, 1995 LOGD) and the social psychiatric services on the Minden-Lübbecke district and the city of Bielefeld have developed a programme for automation-aided management of the statistics for social psychiatric services on a local level. Details on the personal situation and illnesses of the clients as well as on the activities of the services staff are recorded and analysed. Based on the WHO programme EPI-info 6.01 the documentation programme SPD-STAT was developed. This programme is menudriven and, in addition to the functions for the statistical data input and retrieval of fixed table sets, also offers the possibility of processing data with the full functionality of the ANALYSIS-module of EPI-Info. Thus interactive ad-hoc evaluations for current questions are made possible. Using SPD-STAT in as many local regions in NRW as possible may be a big step forward for health reporting on local levels as well as for health reporting on a state level.

Community Health Planning↗

PubMed2004

A smoking-cessation program consisting of extensive counseling, pharmacotherapy, and office spirometry: results of a pilot project in a Veterans Administration Medical Center.

STUDY OBJECTIVE: To describe the 1-year outcomes of a Veterans Administration smoking-cessation program that demonstrates a standard of care comprising extensive counseling, pharmacotherapy, and office spirometry. DESIGN: Prospective one-group pretest-posttest, with an intervention of state-of-the-art practice in smoking cessation. SETTING: Outpatient clinic in a Veterans Administration Medical Center (VAMC). PATIENTS: Two hundred fifty-two veterans receiving health care at the VAMC. MEASUREMENTS AND MAIN RESULTS: The primary outcome measured was the 1-year cessation rate of smokers. Demographic and clinical covariates also were collected. Of the 252 patients who enrolled in the program, 120 never quit smoking for even 1 day. Of the remaining 132 patients, 32 (24%) achieved long-term (1 yr) cessation. The number of visits to the clinic and the number of methods used during the attempt to quit were the only variables significantly associated with long-term smoking cessation (p<0.0001 for each). CONCLUSION: The availability of a standard-of-practice clinic for smoking cessation within a primary care clinic can help patients who have a desire to quit. A combination of intensive counseling, pharmacotherapy, and office spirometry helped patients in a Veterans Administration population to achieve long-term smoking cessation.

Adult↗