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The lived experiences of adult female victims of child abuse.

The purpose of this study was to investigate the lived experiences of female victims of domestic violence who also identified themselves as victims of physical abuse as children. There have been numerous studies of identifying perpetrators of violence as having a history of experienced violence in the family of origin. However, few studies address the victims/survivors of domestic violence and the historical significance of abuse in the family of origin. It is estimated that greater than 50% of the victims of domestic violence were also victims of abuse as a child. The research design partially followed the qualitative ethnonursing methodology. This pilot project consisted of seven females between the ages of 37 and 58. These women were members of a long-standing support group for battered women. The Pitts-Williams Inventory was used to obtain data. The instrument contained six major research questions, with sub questions. Data analysis was done by identifying major themes that emerged. Eight themes were identified. The majority of the women identified their mother as the perpetrator. They described a continuous cluster of violence, which included several different forms of violence being used consistently in order to maintain control and foster isolations. This type of violence continued in throughout their childhood and adult life.

Adult↗

Urban catchment management in a developing country: the Lotus River project, Cape Town, South Africa.

This paper describes a 2-year pilot project undertaken in an urban catchment in Cape Town, South Africa. The impermeable area of the Lotus River catchment has doubled over 15 years, from 17% in 1983 to 34% in 1997. Following the abolition of urban influx control in 1990, informal settlements in the catchment grew rapidly and now house about 90,000 out of the catchment's total population of 380,000 people. The informal areas are still largely unserviced, despite a commitment from local government to speed up service delivery to the poorest areas of the city. Within the Lotus River project, hydrological and ecological assessments of the urban watercourses were undertaken, through physico-chemical and microbiological sampling programmes, macro-invertebrate counts, and vegetation sampling. All available information regarding the catchment was integrated within a GIS platform, including demographic and socio-economic data on the various communities, and hydrogeological information on the underlying aquifer obtained from earlier studies. The integrated nature of the project allows a number of conclusions and recommendations to be drawn, regarding the management of this particular catchment. However, important general lessons have also been learned which can be applied by local authorities responsible for urban catchments in developing countries. The necessity of providing the required institutional structures cannot be overemphasised.

Animals↗

The effects of early orthodontic force application on pulp test responses.

The effects of orthodontic tooth movement on pulpal responses are of interest to the clinician. Alterations to pulpal physiology may result in altered responses to external stimuli. This pilot project tested a small group of orthodontic patients during the early stages of treatment. Heat, cold and electrical stimuli were applied prior to treatment, after the placement of fixed appliances and after one month of force application. A smaller group was tested after two months of force application. One month after force application there was a lack of response to electrical stimulation but there was continued response to thermal stimulation. The lack of response to electrical stimulation continued in the smaller group up to two months. The results suggest that the outcome of electric pulp testing during orthodontic treatment should be interpreted cautiously. Thermal testing will offer more reliable data.

Adolescent↗

Using a harm reduction approach with clients who have alcohol/drug dependencies in a spinal cord rehabilitation program.

BACKGROUND: Dissatisfied with the frequently adversarial nature of relationships with clients who use alcohol or drugs while rehabilitation inpatients, and the often less than optimal outcomes for these individuals, the Spinal Cord Program at the G.F. Strong Rehabilitation Center in Vancouver, BC, decided to pilot a new approach. OBJECTIVE: The goal of the pilot project is to promote successful rehabilitation, including less conflict in rehabilitation, a completed rehabilitation program, and continued connection after discharge if needed. METHOD: A dedicated team was formed and trained to work with these clients using harm reduction principles. PARTICIPANTS: From its inception in December 2000, through May 2001, the team worked with 6 inpatients, 12% of admissions to the Spinal Cord Program during that period. RESULTS: Outcomes based on the above goals have been positive. There have been no discharges against a client's will or instances of significant conflict with the team. Several clients have returned to the center for assistance or to visit post-discharge. Only 1 client left rehabilitation prematurely.

Alcoholism↗

[Is the Internet of any help for persons with serious mental disorders?].

BACKGROUND: Information and communication technology may represent unique opportunities as well as challenges for persons who are socially isolated due to serious mental disorders. MATERIAL AND METHODS: In order to explore how such persons use and experience Internet technology, a pilot project was conducted in collaboration with eight subjects. These accepted a PC with Internet access in their homes for a period of one year. The experiences reported are based on self-reports, and observations made by clinical and project personnel. RESULTS: Three of the eight subjects reported little or no use of the Internet. For the five active users, Internet opened up for social contact and support without provoking the same degree of social anxiety as face-to-face interaction. Four of the five subjects wish to use e-mail contact as a supplement to face-to-face contact with their therapist. INTERPRETATION: Internet can represent a lifeline to society for persons isolated due to mental disorders. Electronic based interaction between patients and health care professionals will provide unique opportunities as well as challenges in efforts towards improving the quality of and access to health care services.

Adult↗

Compassion fatigue and burnout in nurses who work with children with chronic conditions and their families.

INTRODUCTION: With the current and ever-growing shortage of nurses in the United States, it is imperative that nurses find ways to prevent burnout and effectively manage compassion fatigue that can result from working with traumatized populations. The aim of this study is to identify the triggers and coping strategies that nurses who work with children with chronic conditions use to manage compassion fatigue and prevent burnout. METHOD: In this descriptive qualitative pilot project, 20 experienced nurses who work with children with chronic conditions were interviewed about their experiences with compassion fatigue and burnout. RESULTS: Findings indicate that compassion fatigue is commonly and episodically experienced by nurses working with children with chronic conditions and their families. Participants reported that insight and experience helped them develop short- and long-term coping strategies to minimize and manage compassion fatigue episodes and prevent burnout. DISCUSSION: Nurses need to be able to identify signs of compassion fatigue and develop a range of coping strategies and a support system to revitalize their compassion and minimize the risk of burnout.

Adaptation, Psychological↗

The effect of short-term administration of theophylline on erythropoietin levels in healthy adults.

A previous study demonstrated suppression of erythropoietin production in patients treated with long-term theophylline. This effect could exacerbate anemia of prematurity in neonates receiving this drug for apnea of prematurity. In this pilot project we evaluated the effect of short-term theophylline administration on serum erythropoietin in healthy adults. Six subjects were given a bolus followed by a continuous infusion of theophylline targeted to achieve a serum level of at least 10 micrograms/ml, followed by oral theophylline for 36 hours. Serum erythropoietin and theophylline levels were measured before, during, and after drug infusion. Complete hemograms were performed before and after completion of the infusion. No significant changes in serum erythropoietin levels were seen at any time (F = 1.57, p = 0.12). Hematologic values also remained unaltered. We conclude that short-term administration of theophylline is unlikely to have any effect on serum erythropoietin levels in healthy adults.

Administration, Oral↗

Structures of prevention: a safe-sex/safe-injecting audit of Mount Alexander Shire, a methodological pilot.

This paper reports the findings of a methodological pilot project that examined the availability of safe-sex and safe-injecting products in a rural shire in central Victoria. The study mapped the distribution and audited the availability of condoms, water-based lubricants, needles/syringes and needle disposal units to provide baseline data on access to and the availability of products that are directly related to the prevention of the human immunodeficiency virus, sexually transmissible infections and blood-borne viruses. Clear disparities were observed in the availability and pricing of safe sex/safe use materials between regional centres and outlying areas in the Shire. The findings make it clear that an emphasis on overcoming structural impediments to the adoption of safe sex/safe injecting practices is required.

Condoms↗

Staff training in cognitive-behavioral family intervention in mental illness using the multiple-family group approach: a pilot study.

This article describes a pilot project in which eight Community Mental Health Centre staff were trained in a cognitive-behavioral intervention for families of 37 mentally ill clients. After involvement in training, the staff demonstrated more regular inclusion of family members in routine clinical practice, and a trend towards an increase in relevant knowledge. After involvement in the program, the families experienced a decrease in burden (Family Burden Interview Schedule) even though the primary clients' functioning (Global Assessment of Functioning) did not change. The results are encouraging, indicating that it is possible to train staff in ordinary clinical settings in effective cognitive-behavioral family interventions. The findings need to be replicated in a controlled study with larger samples.

Adolescent↗

Experimental teleradiology. Novel telematics services using image processing, hypermedia and remote cooperation to improve image-based medical decision making.

We illustrate the possible impact of information technology on digital radiology using two pilot projects. The first aimed to improve the transfer of radiological information and the interaction between radiologist and referring physician, using hypermedia documents and hypermedia electronic mail. During a 12-month evaluation period, approximately 100 hypermedia reports were generated and distributed to hepatologists and neurosurgeons. The second project aimed to improve planning of orthopaedic surgery, using an image processing service for three-dimensional visualization and a conferencing system to support active cooperation. Over two months, 12 routine cases were reconstructed in three dimensions and conferencing was carried out between surgeons and radiologists in hospitals 15 km apart. Initial results were encouraging. Telematics may be valuable in reconciling the growing need for multidisciplinary cooperation with the growing geographical and organizational separation of different experts. We conclude that to benefit from information technology, the focus should not be on a direct translation of traditional working methods, but rather on possibilities that were not available in the film-based environment.

Belgium↗

The urinary levels of catecholamines, aldosterone and cortisol in hypertensive East Africans: a pilot study.

This pilot project studies the prevalence of hypertension among unique social groups in Kenya, as well as the hormonal profiles accompanying the hypertensive and normotensive states in these populations. The purpose of this report is to enlarge and improve upon the statistical data currently available concerning the prevalence, etiology and prognosis of hypertensive disease in this region. In this study, the urinary concentrations of three vasoactive metabolites were measured in hypertensive and normotensive outpatients. The excretion values for the metabolites were ultimately tabulated as the quantity excreted per milligram of creatinine. The results demonstrate that the subjects with elevated blood pressures (>140/90 mm Hg) excreted double the concentrations (ng/mg creatinine) of cortisol and aldosterone excreted by normotensives. There were no apparent differences in urinary catecholamines between hypertensives and normotensives.

Adolescent↗

Depression and occupational injury: results of a pilot investigation.

OBJECTIVE: Even mild clinical depression can cause decreased vigilance, attention span, increased irritability, and insomnia-all well-known precursors to occupational injury. This pilot project explores the relationship between occupational injury and depression. METHOD: One hundred twenty-one individuals with recent work-related injuries and 140 without work-related injuries completed a self-administered depression screening instrument (PHQ-9). We compared the two groups using bivariate analyses. The impact of depression on injury was examined using logistic regression analysis controlling for employment history, marital status, age, and sex. RESULTS: Overall, injured workers in this study were not more likely to be depressed than a comparison group of uninjured workers. However, injured women had significantly higher depression scores than non-injured women (P = 0.04); no such difference was found for men. CONCLUSIONS: These data suggest that depression may serve as a precursor to occupational injury for women.

Adult↗

Cost-savings from subsidized pro-active pharmacist interventions.

PURPOSE: This paper evaluates a pilot project to determine the desirability of implementing a reimbursement model for pro-active interventions. A drug plan administration conducted an experiment in which a pharmacist could recommend to physicians the substitution of lower-cost therapies with equivalent health outcomes. The pharmacist shared any cost savings with the insurer. METHODS: Drug plan costs without the intervention were estimated using time-series forecasting models and compared to actual costs with the intervention. RESULTS: Over the course of this experiment, there were some cost savings generated by reactive pharmacist interventions but pro-active interventions, intended to influence subsequent physician behaviour, appear to have had no significant effect on the profile of drug expenditures. CONCLUSIONS: The evidence does not lend extensive support for full implementation of this type of reimbursement model.

Cost Savings↗

Results of the peer assessment program of the College of Physicians and Surgeons of Ontario.

This paper describes the experience of the College of Physicians and Surgeons of Ontario in developing and conducting a program for the peer assessment of physicians' office practices that would allow the standards of medical practice to be reviewed and assessed. Following two pilot projects in 1978 and 1979 that demonstrated the need, the feasibility and the acceptance of a peer assessment program the office practices of 391 randomly selected physicians were reviewed in 1981 and 1982. Included in the sample were 255 general/family practitioners and 136 specialists in seven fields. Serious deficiencies were found in the medical records of or in the care provided by 30 of the general/family practitioners and 3 of the specialists, accounting for 8% of the practices studied. The difference between the two groups of physicians was statistically significant (p less than 0.01). No predictors of significance were demonstrated in the general/family practitioner group. When follow-up assessments were done most of the physicians were found to have made the improvements that had been recommended.

Ambulatory Care↗

A clinical exercise system for paraplegics using functional electrical stimulation.

A low cost clinical exercise system was developed for the spinal cord injured, based on a bicycle ergometer and electrical stimulation. A pilot project was conducted, using the system, to examine the effects of stimulation induced cycling in long term paraplegics. The project comprised 2 phases of exercise, a strengthening phase involving a 12 week programme of electrical stimulation to the quadriceps and hamstrings and a 12 week cycling phase. Physiological, morphological and biochemical parameters were measured for each subject, at the beginning of the programme and following each phase. Results showed that a programme of stimulation induced lower limb exercise increased the exercise tolerance of all patients, as determined by a progressive increase in exercise time, cycling rate and exercise load. The enhanced exercise tolerance was a result of increases in local muscle strength and endurance. Increases in thigh muscle area and joint range of motion were recorded and all incomplete subjects reported an improvement in functional capabilities and general wellbeing.

Adult↗

[Local school attendance by students with cancer during and after therapy].

The pilot project brought to attention in this study aims to improve social integration and reintegration at school of pupils inflicted by cancer. The guidelines include an intensive, long-range individual care and accompanied visits in the patients' own classes. Conversations are offered by hospital-teachers and, eventually, by physicians in the classroom proper. This approach results in reducing fear, insecurity and ignorance of both school-mates and teachers at the school of origin, thus mediating better human implications facing children and adolescents involved. The experience attained from over 80 visits in schools of origin indicates that these contacts strengthen the patients' prospects and reduce their social and school-associated problems in terms of promotising their psycho-social conditions.

Absenteeism↗

Quality management in psychiatry.

Over the past 50 years, treatment possibilities in psychiatry have drastically improved, but the results we actually achieve under everyday treatment conditions fall far short of what could be accomplished. Quality management represents a suitable method of reducing this gap. Although it has been successfully practiced in other medical disciplines for a long time, its implementation in psychiatry has previously been restricted to pilot projects. Quality management programs in psychiatry have been slow to be accepted because, up to now, only a few mental health professionals have received training in quality management techniques. In order to compensate for this information deficit and to familiarize psychiatrists and other mental health care workers with this increasingly important topic, we will provide in this paper a brief survey of the most important principles and techniques of quality management. This information should encourage psychiatrists to apply this new method to their own areas of responsibility. The results of one of our own studies on schizophrenic outpatients, which are presented at the end of the paper, are intended to show that the outcome can be improved and costs reduced by implementing quality management programs in psychiatry.

Ambulatory Care↗

Geriatric rehabilitation on an acute-care medical unit.

This study examined a geriatric rehabilitation pilot project on an acute-care medical unit. Over a 6-week period, using a 35-item geriatric rating scale and a mental assessment tool, changes in behaviours of 23 patients admitted to the geriatric rehabilitation module were compared to changes in behaviours of 10 elderly patients on a regular medical unit. The patients' demographic characteristics, their nursing and medical diagnoses, and discharge patterns were reviewed. Significant changes in behaviours of patients on the rehabilitation model included: increased ability to care for themselves, to maintain balance, and to communicate with others; decreased restlessness at night; decreased confusion; decreased incidence of incontinence; and improved social skills. The paper describes the geriatric rehabilitation programme and discusses implications for nursing of elderly patients in acute-care hospitals.

Activities of Daily Living↗