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PubMedDate not supplied

Postoperative myocardial ischemia: epidural versus intravenous patient-controlled analgesia. A pilot project.

BACKGROUND AND OBJECTIVES: Continuous postoperative epidural analgesia with bupivacaine (BUP) and morphine (MS) may be associated with a decreased incidence of postoperative myocardial ischemia (ISCH) and infarction (MI). This study evaluated the incidence of ISCH and MI in patients with two or more risk factors for coronary artery disease (CAD) who were admitted to the ICU after upper abdominal surgery for cancer. METHODS: During a 1-year period, 198 patients were studied for the incidence of ISCH and MI in a prospective, nonrandomized fashion. The epidural group (EPI, n = 110) received continuous epidural anesthesia by injection at the T7-9 interspaces with 0.5% BUP/0.013% MS and light general anesthesia followed by 0.1% BUP/0.01% MS epidural analgesia for 5-7 days. The general anesthesia group (GEN, n = 88) received a balanced technique followed by intravenous patient-controlled analgesia with 0.1% MS for 5-7 days. All patients had preoperative and postoperative 12 lead ECGs every 6 hours on the first 3 postoperative days. Patients with ECG changes consistent with myocardial ischemia had creatine kinase levels with isoenzymes drawn every 8 hours. RESULTS: There were no differences in age, sex, number of cardiac risk factors, number taking anti-anginal medication, preoperative heart rate (75 +/- 5 [EPI] vs. 73 +/- 4 [GEN]), and incidence of preoperative or intraoperative ischemia between the two groups. All patients had adequate analgesia. Postoperatively, patients in the EPI group had a lower incidence of tachycardia (15 [14%] vs. 58 [65%], P < .00001), ischemia (5 [5%] vs. 15 [17%], P < .004), and infarction (0 vs. 3 [20% of patients with ischemia]). All episodes of ischemia were silent and occurred more frequently during the first 36 hours postoperatively (14 episodes or 72%). Overall 60% of the ISCH episodes were associated with tachycardia (5/5 in the EPI group and 7/15 in the GEN group). There were no deaths in either group. CONCLUSIONS: These preliminary results suggest that epidural anesthesia and analgesia may decrease the incidence of postoperative tachycardia, ischemia, and possibly infarction in patients undergoing upper abdominal procedures.

Abdomen↗
PubMed2005

Intersectoral coordination in Aedes aegypti control. A pilot project in Havana City, Cuba.

UNLABELLED: Background The 55th World Health Assembly declared dengue prevention and control a priority and urged Member States to develop sustainable intersectoral strategies to this end. To provide evidence for the reorientation of the dengue prevention policy in Cuba, we launched an intervention study to document the effectiveness of a local-level intersectoral approach. METHODS: We used a quasi-experimental design. Social scientists introduced participatory methods to facilitate dialogue in the biweekly meetings of the intersectoral Health Council of the intervention area. This council subsequently developed an intersectoral plan for dengue prevention, of which the core objective was to design and implement activities for communication and social mobilization. In the control area, routine dengue control activities continued without additional input. Knowledge, attitudes and perceptions of dengue, and entomological indices were compared inside and between the areas before and after the 1-year intervention period. RESULTS: In the intervention area the Health Council elaborated an intersectoral plan for dengue prevention focused on source reduction. The Aedes aegypti control methods consisted in eliminating useless containers in the houses and surroundings, covering tanks, and cleaning public and inhabited areas. It was implemented through communication and social mobilization. The Health Council in the control area occasionally discussed dengue issues but did not develop a coordinated action plan. Good knowledge about breeding sites and disease symptoms increased significantly (by 49.7% and 17.1% respectively) in the intervention area as well as the proportion of respondents eliminating containers in and around their houses (by 44%). No changes were observed in the control area. The House Index in the intervention area was 3.72% at baseline and decreased to 0.61% after 1 year. In the control area it remained stable throughout the study period (1.31% and 1.65% respectively). CONCLUSION: The introduction of a participatory approach by social scientists promotes changes in intersectoral management. This facilitates social mobilization which, in its turn, leads to significant changes in knowledge, attitudes and dengue-related practices in the population and eventually to more effective control of Ae. aegypti.

Aedes↗
PubMed2002

Experience of the first survey of the pilot project of Asian Quality Assurance Survey program.

The Asian Network for Clinical Laboratory Standardization (ANCLS) decided to start her First Inter-laboratory Quality Assurance survey at the business meeting during the Second Asian Colloquium on October 21-22, 2000 in Kobe, Japan. The first survey materials of Asian Quality Assurance Survey (AQuAS) were distributed in July 2001 to 21 hospitals in the field of chemistry and 22 hospitals in the field of hematology among total 24 participating laboratories from seven Asian countries: Indonesia, Japan, Korea, Malaysia, Philippines, Singapore and Thailand. The survey methods in chemistry and in hematology were somewhat different. In chemistry the survey material was considered as unknown but handled similarly to the sample from the patient. Nineteen routine tests were performed only once. The hematology samples were considered as unknown but handled similarly to control or calibration material. Five parameters were tested five times repetitively and their average for each parameter was calculated. All the results were supposed to be sent back to the office within two weeks. Although it took more than two weeks, the return rate was 100%. The analysis was performed in several ways such as all the results together, by instruments and by methods. Mean, standard deviation (SD), standard deviation index (SDI), coefficient of variation (CV) and variance index score (VIS) were to be calculated in chemistry, and in hematology the same parameter were to be calculated except CV and VIS. In the first survey, the CV in chemistry was not calculated and the analysis by instrument or by methodology was also not attempted since there were not enough participating hospitals to do such analysis. In hematology the analysis was done by instrument only. The survey process was carried out successfully though there were some difficulties in communication tools, transportation methods and handling of specimens due to different weather conditions, and returning the report in the correct unit and to the correct place. The submitted data were acceptable for analysis. There were some differences in the units of measurement in different countries or laboratories. It was necessary to convert some of the units. Some laboratories apparently do not perform certain tests such as calcium, potasium and gamma-glutamyltransferase (gamma-GT). The gamma-GT is the most frequently not performed test. With the experience of this first survey, all the members involved in the survey have been trained well to do future surveys.

Asia↗
PubMed1996

The Cardiothoracic Outreach Programme--a pilot project.

OBJECTIVE: To test the practicality, safety and benefits of major cardiothoracic surgery in two rural hospitals. DESIGN: Analysis of morbidity and mortality outcomes of a random collection of 35 patients, who underwent diverse surgical procedures. At each visit, the cardiothoracic team of Ga-Rankuwa Hospital-one surgeon, three registrars, two medical officers, six nurses, and four perfusionists-moved all equipment for major surgery, including bypass machines, to two small rural hospitals. Ga-Rankuwa Hospital, as a tertiary hospital attached to a medical school (Medical University of Southern Africa), mounted an outreach programme on a trial basis. The exercise was designed to render assistance, offer decentralised services, and test the skills of the cardiothoracic team in an environment where high-technology procedures have never been undertaken by the local health professionals. SETTING: Two rural hospitals, viz. Tintswalo and Mankweng, in the referral area of MEDUNSA, with no conventional ICU facilities. The support services for operative, pre-operative and postoperative care were very basic. The local personnel consisted only of general nurses and medical officers. None had experience of high-technology or complex theatre work. PARTICIPANTS: Thirty-five randomly selected patients of both sexes with ages ranging from 11 years to 64 years. Pre-operative diagnoses of diverse cardiac and lung conditions were made. The operations performed comprised 35 major procedures, including open heart operations and major lung procedures. The personnel comprised the MEDUNSA cardiothoracic team, who were assisted by local nurses. INTERVENTION AND OUTCOME: Thirty-five patients underwent 35 major procedures, all under general anaesthesia. Twenty cardiopulmonary bypasses were performed. There was 1 intra-operative death, due to low-output state. Intra-operative morbidity occurred in 2 of the 35 operations. These consisted of a cerebrovascular accident (CVA) (air embolism), and a temporary heart block. Late outcomes (after 1 week) were also analysed; the incidence was 1/35 operations. This was a CVA due to a left atrial appendage clot. Staff morale at the local hospital improved remarkably. The process of teaching the local professional nurses was surprisingly easy. Benefits included a decreased referral rate (100%), lower costs (transport, medicines, operations), excellent patient and community confidence in the work of the hospitals (increased hospital outpatient numbers), and political support (new tools, upgraded facilities and new equipment). RESULTS: The exercise was a resounding success in both measurable and general terms. All operations were successfully performed, with very low adverse outcomes (morbidity, mortality) and good quality of life for all the subjects. The safety and cost-effectiveness of cardiothoracic surgery under primitive conditions were demonstrated. The standard of patient care improved, and local staff acquired good basic skills in patient care. The referral patterns changed for the better and the confidence of the community in the services was enhanced. The risk/benefit ratio of the exercise was commendable. The feasibility of an extended service was encouraging.

Academic Medical Centers↗
PubMedDate not supplied

The NCHS pilot project to link birth and infant death records: stage 1.

The National Center for Health Statistics (NCHS) has completed a pilot test of its method to develop national linked files of birth and infant death records. A linked file of the 1982 birth cohort was produced that successfully linked 97 percent of the death records for infants who died in a nine-State area. The method NCHS uses to create national linked files takes full advantage of two existing data sources: the NCHS fully coded natality and mortality files and State files of matched births and infant deaths. For the nine-State pilot area, NCHS obtained computerized linked files from the States and extracted from them the certificate numbers on matching birth and death records. With the use of these numbers, NCHS selected and linked birth and death statistical records from its final natality and mortality files, thus creating new statistical linked records. The initial match rate of 93.2 percent for the project's linked record file was increased to 96.7 percent as a result of efforts by the pilot States to complete the matching of birth and infant death records. Matching in the nine-State linked file appears to be highly accurate, based on the results of two evaluation studies. In the second stage of the project, now underway, NCHS will continue to evaluate and improve State and national linked files for the four birth cohorts of 1983-86. With funding from the Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation, stage 2 will be conducted in collaboration with each of the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, and New York City, an independent registration area.

Birth Certificates↗
PubMed1989

Predictive testing for Huntington disease: I. Description of a pilot project in British Columbia.

The discovery of DNA markers linked to the gene causing Huntington disease (HD) has allowed the development of predictive testing programs for persons at-risk. A pilot program was established in British Columbia in November 1986. Ninety-five persons are currently enrolled. The major objective of this project is to introduce and evaluate a protocol for the delivery of test results to persons at-risk for HD. The criteria for entry and details of the psychosocial assessment before and after receiving a modified risk are presented. The guidelines that are developed from this project will have major applications for predictive testing programs for other late onset autosomal dominant disorders.

British Columbia↗
PubMed1998

[Umbilical cord blood as a biological spare part. Experiences from a pilot project] at the Fredericia hospital].

The haematopoietic stem cells remaining in the placenta after the umbilical cord has been cut can substitute for bone marrow in transplantations. It is argued that these cells should be retrieved and kept frozen as the child's personal biological spare part. A pilot, population-based collection of cord blood was carried out in a small provincial in Denmark. It was found that the pregnant women supported the concept (89%), that the midwives and technicians could carry out sampling and freezing after a short instruction period, and that the cost of sampling and storing for 75 years approx. DKK 12,000 per child. The project group is now seeking partners for further development of the concept.

Blood Specimen Collection↗
PubMed2005

HUPO Brain Proteome Project Pilot Studies: bioinformatics at work.

The data acquisition phase of initial pilot studies (human and mouse brain samples) of the Human Proteome Organisation (HUPO) Brain Proteome Project (BPP) is now complete and the data generated by the participating laboratories has been submitted to the central Data Collection Center. The BPP Bioinformatics Group met on 8th April 2005 at the European Bioinformatics Institute (Hinxton, UK) to discuss strategies for the reanalysis of the pooled data from all the participating laboratories. A summary of the results of the data reprocessing will be presented at the 4th HUPO World Congress that will be held in August/September 2005.

Animals↗
PubMed1987

Fertility awareness / natural family planning for adolescents and their families: report of multisite pilot project.

Fertility awareness is experiential learning about cyclic fertility. This awareness, used as a family planning method, differs from contraception because it does not isolate the procreative capacity of either partner. The acceptability and effect of teaching fertility awareness on teen sexual activity and decision making was tested in a multisite pilot program which taught fertility awareness via the prospective marker of the cervical mucus (ovulation method of natural family planning). 200 US and 35 Guatemalan volunteer women ages 15-17 in a structured 1 year curriculum, monitored cycle charting and explored the implications of experiencing one's signs of fertility. Control subjects were recruited from the general population and from family planning clinics. 9% of the US study group were sexually active prior to entry. By cycle 12, 1/2 had discontinued activity. Conception rate was 0.0044. The continuation rate dropped from 90% at cycle 7 to 71% at cycle 8 due to scheduling constraints for 2 classes and to 57% at cycle 12. Postprogram follow-up of early leavers showed only 1/3 the expected rate of onset of sexual activity and pregnancy. Parent involvement correlated positively with postponement and/or discontinuation of sexual activity. Reported movement away from peer group pressure appeared 3 months after entry.

Adolescent↗
PubMed1999

A Pilot Project: Continuing Education for Pharmacists on Substance Abuse Prevention.

The American Association of Colleges of Pharmacy advocates that pharmacists can have a significant impact on substance abuse prevention provided they receive adequate training. Continuing education programs are needed to enable practicing pharmacists to augment their limited education. This paper examines the process the Society of Teachers of Family Medicine (STFM) used to develop a pilot continuing education program for pharmacists. With limited literature and a small number of pharmacy teaching about substance abuse, input on topics and training methods was obtained from a convenience sample of practicing pharmacists to enhance the information from the pharmacist faculty regarded as content experts. Results of this pilot study revealed lack of agreement between faculty and practicing pharmacists regarding the prioritizing of content and educational methods. Consequently, input must be obtained from targeted audiences instead of relying solely on the advice of identified academic content experts when designing continuing educational programs. Other professions should consider this process when designing continuing education programs. Pharmacists are poised to play an important role in the prevention of substance abuse problems, but they need continuing education about substance abuse.

Journal Article↗
PubMed2000

Providing personalized assessment feedback for problem drinking on the Internet: a pilot project.

OBJECTIVE: This project developed an Internet program that conducts a brief assessment of an individual's drinking habits and then provides normative feedback comparing the user's drinking to that of others of the same gender and age group. The Internet program, "Try Our Free Drinking Evaluation," was based at the Addiction Research Foundation Internet web site (now at http://notes.camh.net/efeed.nsf/ newform). METHOD: A voluntary survey linked to the participant's feedback summary collected respondents' impressions of the program. RESULTS: During the trial period, the site received approximately 500 hits per month. While the feedback was generally well received, the weekly summary format was less credible to those individuals who drink less than once per week or whose consumption varies a great deal over time. CONCLUSIONS: Given these pilot results indicating that there is an audience for Internet-based interventions, the next step is to evaluate whether receiving such personalized feedback materials on the Internet leads to any change in drinking behavior by participants

Adolescent↗
PubMed1978

Adjuvant methotrexate and leucovorin in head and neck squamous cancer. Two-year follow-up of a pilot project.

A series of 17 patients with stage III and IV head and neck cancer received three cycles of methotrexate and leucovorin calcium during an interval of two weeks prior to surgery and/or radiotherapy. The dosage of methotrexate was sequentially escalated to produce mucositis (the usual dose-limiting toxicity). All patients have been followed up for a minimum of two years (range, 24 to 44 months). Two recurrences and two second primary tumors occurred in seven patients with stage III cancer, and one recurrence and one postoperative death (pulmonary embolism) occurred in ten patients with stage IV cancer. Seventy-six percent of patients survived, with 71% disease free. Mucositis occurred in 88% but was transient and prevented oral fluid intake in only one patient. Bone marrow suppression was usually mild and did not delay surgery. Escalation of dosage was thought to be important in achieving these encouraging results. A controlled trial is under way to better define the degree of efficacy of this regimen of adjuvant chemotherapy.

Adult↗
PubMed2001

Evaluation of the effectiveness of educational interventions in the Pennsylvania Central Region Farm Safety Pilot Project.

BACKGROUND: Evaluation of agricultural safety interventions has frequently been identified as an area requiring further research. This study prospectively evaluates the effectiveness of three specific educational safety interventions in reducing farm hazards. METHODS: Farm characteristics and hazard conditions at 216 farms in Pennsylvania were assessed through a questionnaire and objective audit, respectively, at both pre- and post-intervention time points. Counties were assigned to one of the following interventions: youth education, community coalition, self-audit, pre/post control, or post-only control group. Changes in hazard were analyzed through linear regression. RESULTS: Self-audit was the most effective intervention, leading to a 20% reduction in hazard scores. The community coalition and pre/post control group also showed reductions. CONCLUSIONS: Intervention effectiveness significantly differed depending on initial hazards, indicating the need to target specific interventions for more or less hazardous farms. Findings of this prospective evaluation differed from the initial cross-sectional results, thus underscoring the need for longitudinal investigations.

Agriculture↗
PubMed1989

[Surveillance and assessment of undesirable effects in drug treatment: pilot project].

Since 1986 the Institute for Health Systems Research Kiel has been constructing a system of intensive post marketing surveillance of new drugs by general practitioners. The purpose of the project is to develop a methodology for documenting the applications of new drugs and recording adverse drug reactions (ADR). The primary goal is to quantify adverse drug reactions and to discover previously unknown ADR. Participating physicians record their treatment of the patient and atypical events, which are then analysed for suspected ADR. This paper describes the documentation and evaluation methods and the current stage of research. The validity of the data collected on suspected ADR is evaluated by comparing the results obtained to those of other post marketing studies.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

[Drug interactions in clinical practice. A pilot project for quality assurance in prescribing].

BACKGROUND AND OBJECTIVE: The aim of the project was to document and evaluate the safety of combinations of drugs prescribed during hospitalization, producing a method of quality assurance assessment. PATIENTS/METHODS: The medications of 396 patients already taken at home as well as the drugs given in the hospital during an acute illness were analyzed. Potential drug interactions were detected using a computerized drug-interaction checking system i.e. Micromedex CD-ROM database DRUG-REAX. This program differentiates between contraindicated, major, moderate or minor interactions. RESULTS: No contraindicated combinations of medications were found but in 265 instances (66,9%) potentially relevant ( major or moderate) combinations could be detected. There was a correlation between potentially dangerous drug combinations and the number of coadministered drugs. Despite the detection of a large number of potentially troublesome combinations, no significant clinical problems were observed over at least three days of observation. CONCLUSIONS: The number of potentially relevant drug interactions represents a severe problem in drug prescribing.

Adverse Drug Reaction Reporting Systems↗
PubMed2004

[Telemedicine stroke department network. Introduction of a telemedicine pilot project for integrated stroke management in South Bavaria and analysis of its efficiency].

More than 100 stroke units have been established in Germany. In rural areas, however, acute stroke care needs to be improved. In order to advance clinical stroke therapy, two specialized stroke centers founded a telemedicine network (TEMPiS) among 12 community hospitals in eastern Bavaria. Each network hospital established specialized stroke wards where qualified teams manage acute stroke patients. Twenty-four hours daily, physicians in local hospitals are able to contact the stroke centers via videoconferencing including transmission of digital DICOM data. To study the efficacy of this network, a controlled trial will be performed. Five TEMPiS-network hospitals will be matched with five other hospitals equal in size, catchment area, and diagnostic techniques. For about 1 year, all consecutive stroke cases in the matched study hospitals will be prospectively recorded in a database. Neurological deficits will be quantified on the National Institute of Health Stroke Scale within 24 h after stroke onset. Mortality and institutional care as a combined primary endpoint will be assessed after 3 and 12 months. Furthermore, functional outcome according to the modified Rankin scale, Barthel score, and quality of life will be assessed using a standard telephone interview. Data acquisition started in July 2003, and final results are expected in 2005.

Centralized Hospital Services↗