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PubMed1997

Breaking down barriers: multidisciplinary education model.

A pilot project was implemented involving students from three disciplines: dental hygiene, physical therapy, and physician assistant. The purpose was to prepare students to work together in multidiscipline teams utilizing concepts of problem-based learning (PBL) on both simulated and real patients. The project was divided into three phases. Phase I introduced discipline specific information, team concepts, and PBL concepts. Phase II involved students working in multidisciplinary teams solving a simulated patient case in the PBL format. Phase III consisted of students working in small groups and on real patients, performing an extraoral/intraoral and periodontal examination, a problem oriented physical examination, and a neuromuscular assessment. Pre and posttest evaluation of Phase I revealed no difference in knowledge among the three disciplines. Of those students evaluating Phase II and III, 100% felt PBL was an effective means of presenting multidisciplinary material; 93% reported enhanced problem-solving; 98% indicated improvements in working in groups; and 98% felt they had learned more about each other's discipline. This model may provide a viable means to prepare interdisciplinary teams to work effectively together.

Adult↗

PubMedDate not supplied

Field research in humanitarian medical programmes. Treatment of a cohort of tuberculosis patients using the Manyatta regimen in a conflict zone in South Sudan.

This is a descriptive report of a pilot project of tuberculosis (TB) treatment in a conflict zone. A TB programme was implemented by Médecins Sans Frontières(MSF)-Holland in a semi-nomadic population in a very insecure and underdeveloped area of Upper Nile province in Southern Sudan. Outcome measures were operational feasibility, default rate, and sputum smear conversion at 4 months. A cohort of TB patients was admitted over a 10-week period (July-September 2001). Adherence strategy, project implementation, and and contingency planning were adapted to local conditions. The treatment regimen (4 HRZE [4-month daily supervised regimen] followed by 3EH or 3TH [3-month unsupervised regimen]: isoniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E) and thiacetazone (T)) was a variant on the Manyatta regimen developed for semi-nomads in Kenya. Of 163 patients, 84 (52%) were children aged < 15 years. Lymph node TB comprised 34% and spinal TB 15% of all patients. Among adults, 41% had smear-positive pulmonary disease. Only 1 patient (0.6%) defaulted. All sputum smear-positive patients who completed 4 months of therapy converted to smear-negative, although 2 were subsequently found to have relapsed. TB in complex emergency situations is an underrecognized priority. Using an approach adapted especially to this setting, TB treatment was successfully implemented with minimal risk of promoting drug resistance, in an unstable setting.

Adolescent↗

PubMedDate not supplied

Using computers to reduce medication misuse of community-based seniors: results of a pilot intervention program.

Persons over the age of 65 are at high risk for conditions related to medication misuse. Addressing this issue is important to prevent serious outcomes such as falls, drug interactions, rehospitalization, and addiction. The role of community-based organizations, such as senior centers, in preventing medication misuse can be enhanced by the use of standardized interventions. This article reports a pilot project implementing laptop computer interventions for medication misuse by seniors. The study was conducted in Cleveland, Ohio, with 412 seniors participating in Area Agency on Aging programs. Seniors completed a computerized simple screening for medication misuse and watched short video clips related to their own potential misuse. Seniors also received a medication reminder checklist and a 7-day pill-dispensing box. Results of a 2-month follow-up interview revealed promising results, with 55% of participants using the medication reminder checklist. One-third of participants visited their doctor to discuss the medication misuse feedback. Almost all of the participants found the computerized administration of the intervention to be easy and helpful. The study supports the further development of community-based interventions for seniors using computerized administration.

Aged↗

PubMed2000

Community based intervention of iron deficiency anemia in females and iodine deficiency disorders in school children in Lao PDR.

Under the supervision of the central and local health authorities, a pilot project was conducted in four villages in the Luangprabang Province, Lao PDR. The objective of the project was to test different regimes to supplement females with oral iron preparations to reduce iron deficient anemia (IDA) and control iodine deficiency disorders (IDD) in school children. Compared with iron sulphate tablets, iron fumerate tablets were well accepted and good compliance results were achieved. Hemoglobin concentration improved only in the group of females taking iron fumerate tablets. The goiter rate decreased from approximately 90% to about 45% for school children, regardless of whether iodine salt were used by their families or whether iodine capsules were used to treat the children. The latter attempt was hampered by the fact that also in the control village iodine fortified salt was used. This was due to a governmental attempt to control IDD nation-wide. Therefore, also in the control village a significant decrease in the goiter rate was observed.

Adolescent↗

PubMed1995

Protein binding of acetylsalicylic acid and salicylic acid in porcine and human serum.

As part of a pilot project establishing a porcine model for aspirin overdose, the percentage protein binding of acetylsalicylate (ASA) and salicylate (SA) in porcine and human sera was evaluated in vitro over a range of concentrations. Serum from 2 pigs and 4 humans were spiked with ASA concentrations of 0.5-100 mg/dL and SA concentrations of 1-120 mg/dL. Protein binding for each concentration of ASA and SA was determined using radiolabeled drug and ultrafiltration with the Centrifree micropartition system. The percentage protein binding for ASA in pig and human sera were similarly low (< 50%) for all concentrations evaluated. Percentage protein binding for SA for pig and human sera were high (approximately 90% and 80%) at low therapeutic concentrations, but then declined to approximately 30% at higher toxic concentrations (120 mg/dL). The protein binding of ASA and SA over a range of concentrations was similar for porcine and human sera.

Animals↗

PubMed1997

The Bentham Unit: a pilot remand and assessment service for male mentally disordered remand prisoners. I: Clinical activity in the first year, and related ethical, practical and funding issues.

BACKGROUND: Because of continuing concern regarding the inadequacy of existing NHS provision for mentally disordered remand prisoners, the Bentham Unit was commissioned as a pilot project to provide rapid assessment and, where appropriate, hospital admission for such prisoners from the former North West Thames catchment area. METHOD: Information is presented on the 150 referrals and 62 admissions in the first year of the service's operation. RESULTS: The service met the Reed Report targets for assessment time. Most of those referred were previously known to psychiatric services. The alleged offences were more serious than anticipated. Those admitted were transferred to appropriate services at the conclusion of their court cases, and remained in contact with services three months later. Waiting for the conclusion of court proceedings significantly prolonged the length of stay. Substantial cost transfers from the criminal justice system to the health system were evident. CONCLUSIONS: Adequate services for mentally disordered remand prisoners are entirely achievable; provision of such services is a resource issue, not a clinical problem.

Adult↗

PubMed2006

"Flying through" and "flying around" a PET/CT scan: Pilot study and development of 3D integrated 18F-FDG PET/CT for virtual bronchoscopy and colonoscopy.

UNLABELLED: The objective of this pilot project was to devise a new image acquisition and processing technique to produce PET/CT images rendered in 3-dimensional (3D) volume that can then be reviewed in several 3D formats such as virtual bronchoscopy and colonoscopy "fly-throughs" and external "fly-arounds." METHODS: We tested the new imaging and processing protocol on 24 patients with various malignancies to determine whether it could dependably acquire and reformat standard tomographic 2-dimensional PET/CT images into 3D renderings. RESULTS: This new technique added helpful information to the diagnostic interpretation for 2 of the 24 patients. Further, in the 6 patients undergoing mediastinoscopy, bronchoscopy, or endoscopy, 3D imaging helped in preprocedural planning. CONCLUSION: In this initial study, we demonstrated both the feasibility of rendering PET/CT images into 3D volumes and the potential clinical utility of this technique for diagnostic lesion characterization and preprocedural planning.

Adult↗

PubMedDate not supplied

Sensory stimulation of severely brain-injured patients.

The research reported here consisted of a series of three studies of the use of a sensory stimulation protocol and assessment scale with brain-injured patients at either Level II or Level III on the Ranchos Los Amigos Cognitive Scale. In the first study, a pilot project with six patients addressed the hypotheses that: (1) immediate changes in responsiveness occur as a result of sensory stimulation; (2) variables such as positioning and level of contact have an effect on responsiveness; and (3) these changes can be measured. The second study established acceptable concurrent validity (n = 20), test-retest (n = 20) reliability and inter-rater reliability (n = 19) values for the procedures. The third study assessed whether change in responsiveness occurs over time secondary to sensory stimulation. General Responsiveness measures for 19 patients were obtained and then remeasured after 3 months. No significant differences in mean General Responsiveness values were found using the t-test for related measures procedure. Relationships were reviewed between General Responsiveness and amount of treatment per day, frequency of family visits, pre-morbid education, age, time since injury and neurological status. No differences were found between those patients who improved and those who did not improve.

Adolescent↗

PubMed2005

Evaluation of a Skilled Birth Attendant pilot training program in Bangladesh.

OBJECTIVES: An evaluation of the pilot project of the Skilled Birth Attendant (SBA) training program has been undertaken to assess the strengths and weaknesses of the training program, the after training performances of the selected SBAs and to ascertain the sustainability of the program. METHODS: The study was conducted in three phases adopting both qualitative and quantitative methods: assessment of training program; evaluation of after training performances of SBAs; and evaluation of performance of providers in non-SBA areas. RESULTS: During the post-training period it was observed that on an average the SBAs performed 3-4 deliveries per month. They were able to perform different life saving skills. In the areas served by the SBAs, they performed 29% deliveries and 47% were performed by the TBAs. In control areas TBAs performed 61% deliveries. CONCLUSION: Overall, the study points to the efficacy of SBAs over traditional hands and the societal need for SBAs.

Adult↗

PubMed2003

Telemedicine screening for diabetic retinopathy: staff and patient satisfaction.

In a pilot project, telemedicine was used to conduct retinal examinations of diabetic patients in the Alta municipality of Norway. All health-care workers who were involved in the project were interviewed. The ophthalmologists found that the grading of the level of retinopathy was quicker with digital images than with slit-lamp examinations. Fifty patients with type II diabetes were invited to attend a telemedicine check-up and 42 did so. Patients were asked to complete a questionnaire after the telemedicine examination and we received 32 replies (a 76% response rate), of which 12 were from men and 20 from women. The patients expressed a high degree of satisfaction with the telemedicine examination. The results of the evaluation also clearly showed that trust between health personnel was of major importance in engendering positive attitudes. Confidence is the basis of good collaboration between the various professions in the health-care sector, between health-care levels and between patients and treatment providers - in terms not only of individuals' confidence but also of routines, procedures and the system as a whole.

Attitude of Health Personnel↗

PubMedDate not supplied

The Team Nutrition pilot study: lessons learned from implementing a comprehensive school-based intervention.

Team Nutrition (TN) is an educational and promotional initiative developed by the US Department of Agriculture to change children's eating behaviors through social marketing techniques. This article reports on the process evaluation of a TN pilot project targeting students in kindergarten to grade 4 and systematically documents the implementation experience. Even with a very short start-up period, schools implemented most components of this multichannel nutrition intervention and formed new, supportive relationships with local media and community partners. School teachers and administrators, along with foodservice professionals, generally expressed support for and satisfaction with TN, citing the positive experience and gains for students. The lessons learned from this study highlight the management and organizational issues involved in a comprehensive intervention. These include the importance of local coordinators to support and create a bridge between teachers and cafeteria staff and to forge links with key external partners. To function effectively, coordinators themselves may need training in coalition building and working with media. Relationships formed with parents, local businesses, other educational institutions, health organizations, and the media offer promise for helping to sustain nutrition education efforts. The TN process evaluation identified multiple ideas for pursuing these partnerships more successfully.

Adult↗

PubMed2000

Specific and rapid detection by fluorescent in situ hybridization of bacteria in clinical samples obtained from cystic fibrosis patients.

We report on the rapid and specific detection of bacteria commonly isolated from clinical specimens from cystic fibrosis (CF) patients by fluorescent in situ hybridization (FISH). On the basis of comparative sequence analysis, we designed oligonucleotide probes complementary to species-specific 16S rRNA regions of these microorganisms and demonstrated the specificities of the probes by hybridization of different remotely related as well as closely related reference strains. Furthermore, in a pilot project we investigated 75 sputum samples and 10 throat swab specimens from CF patients by FISH and detected Pseudomonas aeruginosa, Burkholderia cepacia, Stenotrophomonas maltophilia, Haemophilus influenzae, and Staphylococcus aureus within these specimens. The specificity of FISH was 100% in comparison to the results of conventional microbial culture. In contrast, the sensitivity of standard laboratory cultivation was moderately higher, since the limit for microscopic detection of bacteria within sputum samples by FISH was approximately 4 x 10(5) CFU/ml of sputum (resulting in a 90% sensitivity for FISH). Moreover, we demonstrated that FISH will be useful for the rapid detection of bacteria that cause acute pulmonary exacerbations in CF patients, as demonstrated in patients with H. influenzae, S. aureus, and P. aeruginosa exacerbations. Therefore, FISH is a valuable additional method for the rapid and specific detection of bacteria in clinical samples from CF patients, in particular, patients with pulmonary exacerbations.

Adult↗

PubMedDate not supplied

California National Animal Health Monitoring System for meat turkey flocks-1988-89 pilot study: management practices, flock health, and production.

A pilot project for a meat turkey National Animal Health Monitoring System was undertaken in California in 1988-89 to explore data gathering techniques and to estimate the frequency, magnitude, and variability of management, flock health (including administration of pharmaceuticals for prevention and treatment of disease), and production variables in order to facilitate planning for future food animal monitoring systems. Enteritis, which occurred in over one-third of the flocks, and colibacillosis, which occurred in nearly one-quarter of flocks, were the most common diseases reported. Mycoplasma synoviae was reported in two flocks and Mycoplasma gallisepticum and Mycoplasma meleagridis each were reported in one flock. Total mortality rate in the sample flocks was 9.0% (95% confidence interval [CI] 8.2%-9.8%). The tom-specific mortality rate was 10.9% (95% CI 9.8%-12.1%) and the hen-specific mortality rate was 6.6% (95% CI 5.7%-7.4%).

Animals↗

PubMed1982

Knowledge, attitude, and compliance dimensions of antibiotic therapy with PPIs: A community pharmacy-based study.

This pilot project was conducted to measure the effectiveness of patient package inserts (PPIs) when controlled interventions by pharmacists are increased. The PPIs were designed to be easily understood by patients and included information on possible side effects, interactions, compliance and instructions on how to take the medication. PPIs for penicillin and ampicillin were evaluated. Data analysis yielded the following results for respondents receiving PPIs as compared with those who did not: satisfaction with the amount of drug information received; increase in knowledge concerning the drug's proper use; higher rates of compliance; high rating given to the "helpfullness" of the PPI information; interest in receiving PPIs routinely, particularly with new prescriptions. The PPIs developed for this study were found to be valuable tools to respondents for understanding how to take their medications, both in terms of knowledge and behavior. Verbal reinforcement of the PPI by the pharmacist was also found to be helpful.

Anti-Bacterial Agents↗

PubMed1996

Of Lillian Wald, community health nursing education, and health care reform.

A pilot project is described that was initiated to provide a comprehensive clinical experience for community health nursing (CHN) students despite local cutbacks in field nursing services. The project, entitled the Nursing Elementary Education Outreach Project (NEEOP), is used as a basis for discussion on the CHN role in community-focused health care reform. One-third of the CHN students in one school of nursing during one academic year (n = 16) participated in the NEEOP. One salaried CHN faculty member assumed primary responsibility, and equipment funding was granted by a local corporation. Collaboration was established with the county's proactive school nurses' association. CHN students developed and conducted health education presentations in elementary schools, worked with school nurses, and participated in other community health activities. Three levels of evaluation were utilized: elementary students to nursing students, nursing students to nursing faculty, and school nurses to nursing faculty. The NEEOP was a success by all evaluation criteria, and plans are currently in progress to expand its focus. Innovative clinical placements such as the one described can promote student understanding of CHN practice with its broad-based emphasis on the promotion of healthier communities.

California↗

PubMed2005

Reaching the homebound elderly: the Prescription Intervention and Lifelong Learning (PILL) program.

This article describes the Prescription Intervention and Lifelong Learning (PILL) program, a three-year pilot project to develop in-home pharmacy care services to clients of a community-based social service agency. Clients who were homebound, at least 62 years of age, and taking at least five medications were eligible for inclusion. Potential participants were referred by care managers to the pharmacist, who conducted an in-home evaluation of the medication regimen and assessed the risk for medication-related problems. The pharmacist provided instruction for hypertension and diabetes mellitus self-monitoring, extensive medication counseling for clients with complex medications regimens, and conducted other activities to promote positive medication- related outcomes. The clients served were primarily female, between 70 and 90 years of age, and almost one-half lived alone. They were taking an average of more than nine medications daily, and had at least one chronic disease. The clients of the social service agency were highly vulnerable to medication-related problems and were in need of in-home pharmacy care services.

Aged↗

PubMed1998

Resource allocation in general practice care.

OBJECTIVE: Complexity of care provided by general practitioners (GPs) is poorly addressed by current measures. Resource allocation for health care in inpatient settings utilises complex descriptions of clinical content and process to produce 'casemix' resource units. This pilot project explored the potential application of these concepts to the funding of general practice in Australia. METHOD: Prospective data were collected from three practices in the same community on one day in the same week. GP generated data included reasons for encounter, age and gender of the patient, whether the problems were new or old, what tests and referrals were initiated for each problem and global complexity ratings. Data collected from the patients included problems presented, problems not dealt with and satisfaction ratings. These data were used to explore the determinants of consultation complexity in general practice. RESULTS: There were statistically significant correlations between: global complexity and problem type (coded to ICPC Chapter); global complexity and number of problems seen; and global complexity and consultation billing level. A resource allocation formula which considers broader descriptions than current fee descriptors is suggested. CONCLUSIONS: Aspects of the casemix concept may have some relevance to how resources could be allocated in general practice, but this would require substantial further investigation.

Australia↗

PubMed2005

Management of adverse surgical events: a structured education module for residents.

BACKGROUND: This pilot project involved the development of a structured, experiential, educational module using a bench model technical skills simulation and standardized patients. It integrated teaching and assessment of clinical, technical, and interpersonal skills, as well as professionalism within the context of an adverse surgical event. METHODS: General surgery residents (postgraduate year [PGY] 2, 3) were asked to participate in the pre-, intra-, and postoperative management of a patient with a retroperitoneal sarcoma. Residents' performances during the module were assessed by standardized patients and faculty, and residents were provided feedback during debriefing sessions. RESULTS: Resident performance during the module was appropriate for the level of training. Residents found this module to be a realistic, challenging, and beneficial learning experience. CONCLUSIONS: Novel educational modules such as this one may serve as a useful addition to resident education in surgery residency programs, particularly in addressing patient safety and the core competencies. Reliability of the model may be enhanced by modifications of the module.

Clinical Competence↗