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PubMed2000

Malaria control through impregnated bednets--a pilot project in selected villages in Lao PDR.

In 7 villages on the foothills of the Houayxai district of the Bokeo Province in Lao PDR between midyear 1995 to midyear 1997 an attempt was made to test the acceptability and use of DDT impregnated bed nets as well as environmental and behavioral risk factors. About 380 women between 15 to 45 years old and their children in the age range of 1 to 14 years had been studied. A pre-tested questionnaire had been applied and blood from women and children was taken from the finger prick and a conventional thick and thin blood smear was performed, fixed Giemsa stained and examined for malaria parasites. DDT (dichlorodiphenyltrichloroethane) impregnated mosquito nets were distributed in the intervention villages. The availability of mosquito nets increased statistically significant from approximately 50% to 70% for all family members in the intervention area between 1995 and 1997 and statistically significant decreased in the control area from 79% to 45.1%. There was a statistically significant decrease in malaria attacks as claimed by the females for the intervention area but not for the control villages. The proportion of positive blood smears did decrease overall for women and children in between 1995 to 1997. Occupation, location of the house and use of mosquito nets had been determined as the most important risk factors.

Adolescent↗

PubMed1999

A unique drug treatment program for pregnant and postpartum substance-using women in New York City: results of a pilot project, 1990-1995.

In the 1980s, there was virtually no drug treatment for pregnant women in New York City, especially women who used crack cocaine. The purpose of the Parent and Child Enrichment (PACE) demonstration project was to assess the effectiveness of the one-stop shopping model of drug treatment for this population. Among PACE clients, 88% were primarily users of crack cocaine. The mean total length of stay was 100.0 days (median 55.5 days). Client retention 42 days after intake was 54.3%. This paper describes the essential components of this program model. "Long-stay" and "short-stay" clients were compared using urine toxicology tests and activity logs. In addition, the birth outcomes of clients were compared to two similar populations. A strong positive correlation was found between total length of stay and low rate of positive urine drug tests (UDTs). Infants of PACE long-stay clients had greater mean birth weight, less low birth weight, and less intrauterine growth retardation than the infants of the comparison groups. Fetal exposure to cocaine was decreased dramatically among women who were enrolled for 42 or more days during their pregnancy. This model of drug treatment for pregnant and postpartum women seems to improve mothers' lives, fetal drug exposure, and birth outcome significantly.

Child↗

PubMed2006

A pilot project of a cancer patient library in Italy: results of a customer-satisfaction survey and its products.

AIMS: The purpose of this study is to determine the degree of satisfaction of users of the Cancer Information Point section of the Library for Patients (CIP-LP), active since 1998 at the National Cancer Institute of Aviano, Italy. The CIP-LP is based on a skilled intermediary, adequate informative material and a specific location, within the Scientific Library of the Institute. PATIENTS AND METHODS: A survey was developed to assess service functionality and quality from the users' viewpoint. During a 6-month period, a questionnaire was mailed to 194 patients and relatives who previously used the CIP-LP; 113 (58%) were returned and processed. RESULTS: Of the respondents, 91% were pleased with the CIP-LP and 95% would recommend the service to other people. The information obtained contributed to a clearer understanding of the illness and treatment (45% as first answer) and a better control of the situation (33%). Fifty-one per cent evaluated the information received as 'good', 42%'excellent' and 4%'of sufficient quality'. CONCLUSION: This survey shows the appreciation and usefulness in the users' perception of a specific hospital library for cancer patients and their relatives, providing an information service supplementary to doctor-patient communication.

Adult↗

PubMed2000

Identification of adult populations at high risk for dental caries using a computerized database and patient records: a pilot project.

OBJECTIVES: The purpose of this study is to test the usefulness of dental insurance claims history, supplemented with radiographic caries diagnoses, as a means of identifying caries-active and caries-inactive working adults, as determined by bacterial levels. Computerized identification of at-risk groups may facilitate subject selection for clinical trials designed to test caries-preventive strategies. METHODS: Two groups of subjects were initially selected from an insurance database based upon their dental service utilization during a one-year period: a "low restorative" group of individuals defined as persons who had received no restorative treatment, and a "high restorative" group comprised of individuals who had received at least three multisurfaced restorations. A chart review confirmed a diagnosis of caries in the high restorative group and an absence of caries in the low restorative group. Subjects were then approached for saliva collection. The low and high restorative groups were compared for salivary mutans streptococci and lactobacilli levels, stimulated flow rate, and buffer capacity (n = 48). RESULTS: The high and low restorative groups differed in mutans streptococci levels, but not on other measures. CONCLUSIONS: A group of subjects who had recently received multisurfaced restorations that were placed for reasons of caries had significantly higher levels of mutans streptococci and potential for continued caries activity when compared to a group of subjects who had received no restorations and were caries free.

Adult↗

PubMed2002

[Screening for congenital hearing loss--a pilot project].

BACKGROUND: Until recently in Norway, congenital hearing loss has on average been diagnosed at 2.8 years of age. Delayed diagnosis is associated with loss of valuable opportunities for auditory habilitation and speech development. MATERIAL AND METHODS: Since September 1999 we have carried out universal screening for congenital hearing loss in both healthy and sick newborns. During the first screening period, all newborns were screened with automated auditory brainstem response audiometry. In the second period all healthy infants were screened primarily with otoacoustic emission audiometry, with automated auditory brainstem response audiometry as a second stage screening for those who failed the otoacoustic emission test. 3,996 infants were screened from start-up until December 2001. RESULTS: Hearing loss was confirmed in 25 patients (11 unilateral and 14 bilateral). A further two patients were referred but found to have normal hearing. The incidence of congenital hearing loss was 0.16% in presumed healthy infants and 2.2% in infants admitted to the intensive care nursery. INTERPRETATION: Screening for congenital hearing loss can be carried out with a very low rate of referrals and a low rate of false positive tests, particularly if there is access to otoacoustic emission as well as automated auditory brainstem response testing. In our opinion, Norway now needs to legislate for universal screening for congenital hearing loss in the neonatal period. Our departments of audiology should be given the opportunity and resources to upgrade their skills in relation to this new group of patients.

Audiometry↗

PubMed2005

Contrast sonography, video densitometry and intervillous blood flow: a pilot project.

PURPOSE: To examine the feasibility of constructing time-intensity (TI) curves from the intervillous space with an intravascular ultrasound contrast agent and computer assisted video densitometry. STUDY DESIGN: We sedated nine pregnant baboons, optimized the grey scale and color Doppler images of their placentas, and then fixed the transducers in place. For each injection of contrast, we recorded images on videotape without changing the ultrasound image processing functions. Video images were captured using a Macintosh personal computer equipped with a video-capture board using image analysis software (Image 1.4, W Rasband, NIH). For each injection, we sampled digitized images of a fixed region of interest at regular intervals. After computing the mean video density of each image, we used the sampling frequency to construct TI curves depicting any change over time as the contrast agents washed into and out of the intervillous space. RESULTS: Three of four agents tested produced changes in the video density of the placenta. TI curves were established using both grey scale and color Doppler signal augmentation. As expected, intra-arterial agents produced rapid accumulation and decay. Intravenous agents produced more protracted effects secondary to bolus dilution and transit through the right heart and pulmonary vascular bed. CONCLUSION: TI curves may be generated from the intervillous space with the use of a transpulmonary ultrasound contrast agent and video densitometry. If validated by further study, this may allow investigators to apply ultrasound and indicator-dilution theory to intervillous blood flow.

Animals↗

PubMed2005

Chronic illness care in Russia: a pilot project to improve asthma care in a "closed city".

CONTEXT: In Russia, where health status has deteriorated since the late 1960s, asthma is a growing medical and public health problem. OBJECTIVE: To create a model for improving care and outcomes of patients with asthma through altering the culture of health care, physician behavior, and public policy in a Russian community. DESIGN: A 6-month, nonrandomized, before-and-after intervention evaluation. SETTING: Outpatients of Medical-Sanitary Unit No. 50, the central health authority in Sarov, Russia, a "closed" nuclear city. PARTICIPANTS: A consecutive sample of 85 adult patients with severe-persistent or moderate-persistent asthma. INTERVENTIONS: A comprehensive asthma-care program that emphasized patient education and self-management with treatment based on internationally accepted guidelines modified for local resources. MAIN OUTCOME MEASURES: Missed work or school, patients requiring emergency department visits, number of patients hospitalized, daytime symptoms, nighttime symptoms, rescue inhaler use, patient satisfaction, and FEV(1). RESULTS: After 6 months, significant reductions were observed in the proportion of patients missing work or school (1.2% vs 11.8%), emergency department visits (4.8% vs 15.7%), hospitalizations (0% vs 9.4%), daily symptoms (47.1% vs 65.9%), and nightly symptoms (14.1% vs 37.6%). Patient satisfaction with asthma control (81.2% vs 31.8%) and average level of FEV(1) (84.0% vs 72.4%) significantly increased from baseline. CONCLUSIONS: The model for changing asthma management in this Russian community was effective in improving asthma outcomes and offers a reproducible paradigm approach for improving chronic illness care.

Adult↗

PubMed1988

From pilot project to national implementation: experiences from the North Karelia Project.

The North Karelia Project started in 1972 as a response to the request of the local people. It was aimed at reducing the exceptionally high mortality and morbidity from cardiovascular diseases in the area. The Project's activities have been directed towards inducing behavioural changes amongst the entire population. Equally, the care of those already sick (such as hypertensives) has also simultaneously been reorganized. The Project has involved the whole of that society, in addition to the health care system, and has collaborated with the food industry, schools and various voluntary organizations. The most recent new activity is a programme to promote marketing of local vegetables and berries to have a substitution for dairy farming, as consumption of dairy products reduce with new dietary habits. The results are encouraging. The individually reported health behavioural changes are reflected by a clear net reduction in biological risk factors (serum cholesterol, blood pressure) compared to the reference community. Also statistics show that mortality from ischaemic heart disease has been reduced more significantly in North Karelia (-22%) than in the rest of Finland (-11%) during the period 1974-1979. The activities tested in North Karelia, and found to be feasible, have been recommended for implementation nationwide in Finland. For instance, anti-smoking activities were first tested in North Karelia before the introduction of national legislation, and experiences obtained in health education have been conveyed to other sectors of the Finnish population through national television in several programmes. The county of North Karelia continues to be a demonstration area in Finland, at present for the Integrated Programme for the Prevention of Noncommunicable Diseases.

Cardiovascular Diseases↗

PubMed2004

Pediatric pedestrian trauma study: a pilot project.

OBJECTIVE: To evaluate the implementation of the WalkSafe Program, a school based educational injury prevention program for children grades Kindergarten through 5. METHODS: A randomized comparative design was used for this study. The study was conducted in two high-risk urban school districts, which were chosen based on the geographic areas with the highest pedestrian injury and fatality rates. Four elementary schools (two in each district) were identified as potential study sites. Two intervention schools, one in each school district, were randomly chosen to receive the WalkSafe program; the other two schools served as controls, and received no intervention. The data was collected within the classroom setting for both the intervention and control schools. All elementary school children were administered the same pedestrian safety questionnaire as a pre-test, post-test and at three months following the intervention. RESULTS: A total of 2300 children participated in the WalkSafe program. The intervention (I) schools showed significant improvement in post-test scores then the control (C) schools (p = 0.012), and the (I) schools were able to maintain their test scores as reflected in a three-month follow-up evaluation (p = 0.47). Grades 3-5 of the (I) schools showed significant improvement in their test scores over grades K-2 (p < 0.0001). CONCLUSION: The WalkSafe program was shown to improve the pedestrian safety knowledge of elementary school children. Future research will include implementing the WalkSafe program at each elementary school within a single high-risk district.

Accidents, Traffic↗

PubMed1999

Interdisciplinary pilot project in a rehabilitation setting.

This project qualitatively evaluated the planning, implementation, and outcome of an interdisciplinary model of clinical education. Expectations of physiotherapy (PT), occupational therapy (OT), and speech-language pathology (SLP) students and clinicians were assessed to determine whether the model allowed for the acquisition of the interdisciplinary knowledge and skills needed for current practice. Students from OT (n = 5), PT (n = 3), and SLP (n = 1) undertook normally scheduled five-to-eight-week clinical placements, beginning on the same start date. All students were at intermediate or senior levels in their programs. Discipline-specific activities were supervised by clinical instructors from the disciplines. Interdisciplinary sessions during the first five weeks covered cross-disciplinary activities related to clinical reasoning, interviewing techniques, professionalism, and communication skills for team reporting. Themes related to the clinical experience were derived from student and supervisor responses to pre-and post-placement questionnaires, post-placement focus group interviews, and student journals. The response to the model was positive. The students felt they had gained insights into developing interdisciplinary skills, although they did feel that some discipline-specific needs were not met. The instructors were less enthusiastic but, given better planning and communication before the placement, welcomed the opportunity to try it again.

Canada↗

PubMed1999

Medical ethics curriculum for surgical residents: results of a pilot project.

INTRODUCTION: This study sought to develop and evaluate a medical ethics curriculum designed specifically for surgical residents. METHODS: The learning needs of surgical residents relevant to ethics were determined by using a structured literature review and synthesis strategy. We identified 5 primary areas of importance for ethics education for surgical residents: withdrawing and withholding treatment, advance directives, do-not-resuscitate orders, informed consent, and communicating bad news. Learning objectives were developed, and teaching plans were designed for four 90-minute interactive teaching episodes on the basis of adult learning principles. We surveyed residents using a published survey instrument modified for surgery to identify residents' beliefs about the usefulness of ethics training, confidence in addressing ethical issues, and factual knowledge of ethics questions. RESULTS: Twenty surgical residents at a single institution completed the pretest and posttest close-ended surveys. Results showed that although 88% had formal ethics exposure in medical school, 93% considered ethics education at the resident level to be a "very important" or "important" topic. Residents' confidence in addressing ethical issues showed statistically significant improvement between pretest and posttest surveys for 13 of 23 items. There were no statistically significant linear relationships between postgraduate year of residency and the pretest confidence items or the number of correct responses on the pretest multiple-choice items. CONCLUSIONS: Despite the prevalence of ethics education during medical school, surgical residents welcome formal instruction on numerous ethical issues pertinent to surgical practice. A focused curriculum can be developed that has a measurable impact on residents' confidence in addressing ethical issues.

Adult↗

PubMed2006

Dietary effects of universal-free school breakfast: findings from the evaluation of the school breakfast program pilot project.

OBJECTIVE: To determine the effects of offering universal-free school breakfast in elementary schools on students' dietary outcomes. DESIGN: Experimental study with random assignment of 153 matched elementary schools in six school districts. Treatment schools offered universal-free school breakfast, and control schools continued to operate the traditional means-tested School Breakfast Program. Twenty-four-hour dietary recalls were collected from sample students near the end of the first year. SUBJECTS: About 30 students in second through sixth grades were randomly selected from each school (n=4,358). INTERVENTION: Free school breakfasts were made available to all students in treatment schools, regardless of family income, for three consecutive school years (2000-2001 to 2002-2003). MAIN OUTCOME MEASURES: Breakfast consumption and food and nutrient intake. STATISTICAL ANALYSES: Hierarchical mixed-models and logistic regression, adjusting for age, sex, minority status, and income eligibility for the regular school meal programs, were used to estimate effects. RESULTS: Despite a significant increase in school breakfast participation among sample students in treatment schools (from 16% to 40%, P<0.01), the rate of breakfast skipping did not differ between groups (4% overall). Treatment school students were more likely to consume a nutritionally substantive breakfast (P<0.01), but dietary intakes over 24 hours were essentially the same. CONCLUSIONS: Making universal-free school breakfast available in elementary schools did not change students' dietary outcomes after nearly 1 year. To improve children's diets overall, efforts should focus on ensuring all students have access to a healthful breakfast, at home or at school.

Body Weight↗

PubMed1986

[Viral respiratory infections in children: new diagnostic methods for early detection. Initial results of a pilot project in Switzerland].

The new methods of rapid viral diagnosis make it possible to specify a number of the most prevalent agents of respiratory tract infections within 24 hours. The techniques are based on the immunological detection of antigens of respiratory syncytial (RSV), adeno, parainfluenza type 1, 2 and 3, as well as of influenza A and B viruses in nasopharyngeal secretions. During a one-year period we have used these methods to evaluate diagnostically 1541 outpatients presenting with upper and lower respiratory tract infections. The patients included babies, infants and children under 16. In about 50% of all sick babies below the age of three months a definite viral infection could be established, and in approximately 30% of infants and children aged up to 4 years. RSV was most frequently observed, accounting for 53.6% of all infections (80% of all babies below the age of 3 months, in whom specified agents could be identified, had RSV infection). The next most frequent pathogens were parainfluenza type 3 (18,8%), influenza A (11,3%) and, finally, adenoviruses (10.2%). The epidemiological and clinical characteristics of these infections are summarized. In addition, the results of these antigen detecting assays have been compared with those of concomitantly conducted virus isolation techniques in cell cultures. This comparative analysis most impressively revealed the time saved by attempting an etiological diagnosis using the antigen detecting system: in only 6% was a specific diagnosis established on the basis of virus isolation, whereas the delay was equal or more than 8 days in 36% of all patients enroled.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoviridae↗

PubMed1964

EPIDEMIOLOGICAL DATA CONCERNING ONE YEAR OF A MALARIA SURVEILLANCE PILOT PROJECT IN SOUTHERN RHODESIA.

Few factual data have been published on the problem of disappearing malaria due to Plasmodium falciparum in Africa. In Southern Rhodesia a surveillance project has been under way since January 1961. The author describes malaria surveillance procedures, methods, organization and costs for the year 1962-63 and presents data relevant to a sparsely populated part of rural Africa where a surveillance visitor can cover a population of only some 3500 by monthly house-to-house visits. Through such visits, and through special surveys, an annual blood examination rate of 25% was achieved in the area at fairly low cost.It was found in the area studied, where 98% of infections are due to P. falciparum, that even Africans who have previously attained a high level of immunity will produce typical fever and associated malaria symptoms on reinfection after several years. Methods of case detection have proved adequately sensitive, despite the problem of asymptomatic carriers and despite the difficulty of obtaining true medical histories. Evidence is produced that much residual low-level transmission occurs indoors, although Anopheles gambiae are found in low density in human dwellings. Drug dosages and preventive treatment are described in detail; to reduce the number of asymptomatic carriers, single-dose presumptive treatment is advocated, at least in the last year of the attack phase. Many of the findings presented will be applicable to other African countries where malaria has been reduced to a low incidence.

Adolescent↗

PubMed2003

Smoking status identification: two managed care organizations' experiences with a pilot project to implement identification systems in independent practice associations.

OBJECTIVE: To determine whether managed care organizations (MCOs) can effectively promote the sustained use of smoking status identification systems among independent practice associations. STUDY DESIGN: Quasi-experimental design measuring smoking status documentation before and after an intervention. METHODS: A chart review of the MCOs' patients at 4 participating primary care clinics determined the baseline for smoking status documentation before intervention. Baseline data were unavailable from a fifth participating clinic. Two quality improvement personnel were sent by the MCOs to help the clinics chose and implement a system for identifying smoking status. All of the clinics chose a sticker system. The change in smoking status documentation was assessed by chart reviews of patients enrolled in the MCOs who were seen during the period between 3 and 16 months after implementation of the system. RESULTS: Following the intervention, a significant increase in smoking status documentation was noted among participating clinics. The proportion of patients whose smoking status was identified and documented by any method increased from 50% to 87% (P < .01) at the 4 clinics with baseline data. By clinic, the increase varied from 6% to 60%. The sticker system was the method by which most patients' smoking status was documented (77%). There were no controls, so the influence of outside factors, including a regional smoking cessation campaign that coincided with this study, cannot be quantified. CONCLUSIONS: Managed care organizations may be an effective change agent for implementing the guidelines for tobacco use and dependence treatment.

Blue Cross Blue Shield Insurance Plans↗

PubMed2003

Antiretroviral therapy in a community clinic--early lessons from a pilot project.

OBJECTIVES: To report on operational and clinical problems encountered during the first 6 months of a community-based antiretroviral therapy (ART) programme. METHODS: ART was implemented in a primary care setting utilising an easily replicable service-delivery model based on a medical officer and nurse. Therapeutic counsellors, themselves HIV-infected, provided counselling and adherence support. Drug and monitoring costs were charitably funded and provincial health authorities supplied the medical infrastructure. The HIV Research Unit, University of Cape Town, supplied training and additional clinical support. Local HIV primary care clinics provided patient referrals. Standardised ART regimens were used with strict entry criteria (AIDS or CD4 count < 200 cells/microliter). RESULTS: Demand for the service was high. Referred patients had advanced disease (AIDS 57%, median CD4 count 96/microliter) and high pre-treatment mortality (83/100 person-years). Mycobacterial disease was a major contributor to this mortality (40%). Scheduled clinic visit hours were six times higher during recruitment than maintenance. Attributable costs were: drugs 61%, staff 27%, viral load and CD4 cell counts 10% and safety monitoring 2%. Viral load after 16 weeks of therapy was < 400 copies/ml in the first 16 patients. CONCLUSIONS: ART can be successfully implemented within a primary care setting. Drug purchases and staff salaries drive programme costing. The service model is capable of managing 250-300 patients on chronic ART, but staffing needs to be increased during recruitment. Attention must be given to the diagnosis of tuberculosis during screening and early ART. Incorporating therapeutic counsellors into the programme increased community involvement and utilised a valuable and previously untapped resource.

Acquired Immunodeficiency Syndrome↗

PubMed1997

[Definition and evaluation of a documentation standard for intensive care medicine: the ASDI(Working Group for Standardization of a documentation system for Intensive care medicine) pilot project].

OBJECTIVES: A comparison of data from different intensive care units (ICUs) needs standardized documentation. In this study the ASDI documentation standard for intensive care was tested in clinical practice. Goal of the study was to evaluate parameters and functionality required for a national, interdisciplinary documentation system for intensive care. DESIGN: 13 ICUs participated in a 4-week trial using the provided program for documentation of all admitted patients during the observation period. In addition, a questionnaire was distributed to the unit coordinators. RESULTS: 376 patients were documented in 1591 patient days. Valid SAPS II scores were found in only 29% of the discharged patients (39.1 +/- 15.5 points). Time needed for data entry exceeded preset limits (ten minutes per patient and day) in 38% of the cases. All participants affirmed the necessity of a documentation standard for intensive care, giving quality control and cost analysis as the most important reasons. CONCLUSION: The ASDI data set fitted existing needs very closely. Only 7 out of 122 parameters (5.7%) were found to be superfluous and thus removed. Measures to reduce documentation effort to the default limits were a) a new, date orientated concept for manual recording, b) rede-sign of the user interface with new, user friendly data entry possibilities, and c) the integration of statistical analysis and reports in the documentation system. The revised data set represents a broad-based consensus, which seems to be well-suited as foundation for the national quality assurance program.

Adolescent↗

PubMed1999

Recruiting minority cancer patients into cancer clinical trials: a pilot project involving the Eastern Cooperative Oncology Group and the National Medical Association.

PURPOSE: Minority accrual onto clinical trials is of significant interest to cooperative oncology study groups. The Eastern Cooperative Oncology Group (ECOG) conducted a study to identify barriers and solutions to African American accrual onto clinical trials. METHODS: We hypothesize that the National Medical Association (NMA) might provide insight into ways to increase minority participation and that ECOG might facilitate that participation. Four sites were selected in which NMA chapters existed and ECOG main institutions with less than half of the corresponding percentage of minorities in their communities entered trials for 1992. Fifteen workshops were conducted using discussions and open-ended, self-administered questionnaires. RESULTS: Seventy percent of NMA physicians cited mistrust of the research centers, fear of losing patients, and a lack of respect from ECOG institutions as the most important barriers to minority cancer patient referrals, compared with 30% for ECOG physicians. Sixty-nine percent of NMA and 43% of ECOG physicians cited a lack of information about specific trials. Nearly half of NMA physicians (47%) cited a lack of minority investigators as a barrier, compared with 4% of ECOG physicians. Solutions by both groups were improved communication (73%) and culturally relevant educational materials (40%). ECOG physicians cited more minority outreach staff as a potential solution (22% v 6%). NMA physicians cited increased involvement of referring physicians (44% v4%). CONCLUSION: NMA physicians who serve a significant sector of the African American population demonstrated a willingness to participate and work with a cooperative group effort to increase participation of minority patients and investigators.

Clinical Trials as Topic↗