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PubMed1992

The effects of two air-powder abrasive prophylaxis systems on the surface of machined titanium: a pilot study.

This in vitro pilot project compared the effect of two air-abrasive prophylaxis systems on the surface of machined titanium. Single Brånemark titanium abutment cylinders were exposed to the Prophy-Jet and Microprophy systems for 90 seconds each. Both of the test cylinders were compared with an untreated control cylinder by scanning electron microscopy. Machining marks were completely removed by the Prophy-Jet and only partially removed by the Microprophy. Both of the resultant surfaces appeared to be smoother and thus may be more resistant to plaque formation. A rationale for the removal of machining marks is presented, although the reason for the difference in removal by the two systems is unclear. The prophylaxis cleaning powders were also examined by scanning electron microscopy and exhibited similar particle dimensions and morphology. A noncrystalline deposit was observed on the surface of the abutment cylinder exposed to the Microprophy. Energy dispersive spectroscopy analysis revealed that the deposit consisted almost entirely of sodium. Further investigation of the deposit is needed.

Air Pressure↗

PubMed1999

Work related assaults. The impact on victims.

This pilot project employed a case study design consistent with that of Rice to describe the impact of violence on individuals who incurred a work related assault in 1992. Ten randomly selected subjects were interviewed from a population of 429 individuals reporting a work related assault that resulted in a wage loss claim. Half of the subjects had received permanency ratings, thought to be a measure of injury severity. The study hypothesis, stating the impact of the assault (e.g., pain and suffering, decrease in functioning) years after a work related assault was associated with the severity of the injury (i.e., permanency rating), was not supported by the data. However, individuals' health and quality of life 4 years after the assault were affected significantly and resulted in job changes, chronic pain, changes in functional status, and depression. The new hypothesis resulting from this study is employer support and mental health intervention immediately after an assault may prevent employee job changes and decrease mental health sequelae.

Absenteeism↗

PubMed2005

Telehealth for wound management in long-term care.

Telehealth facilitates provision of healthcare services at distant sites using electronic communications. A pilot project utilizing telehealth was initiated in a long-term care community to assess the wounds of geriatric residents. Over a 1-year period, nine patients requiring a total of 21 visits were evaluated by an offsite University of Virginia Health System wound nurse practitioner via telecommunication. Traditionally, frail elders are seen in the local wound care clinic, necessitating often costly and physically strenuous transport. The technology in this program incorporated use of a videoconferencing device, television monitor, and a patient camera. Average round trip cost savings for transporting immobile residents was $650; hence, substantial cost containment was achieved. In addition, quality of care improved because residents were not required to leave their facility for the 3 to 4 hours required to travel to and from the clinic. Although no formal satisfaction surveys were administered, resident and family response to the service was favorable. With continued documentation of patient satisfaction and cost savings, this service eventually may be available to other long-term care facilities in the area.

Aged↗

PubMedDate not supplied

Evaluating the implications of clinical practice guidelines for patient care.

Patient care evaluation studies have been developed by the Commission on Cancer of the American College of Surgeons. The studies were primarily designed to monitor trends in diagnosis, therapy, and outcome of specific oncologic diseases in hospitals and cancer centers. As they reflect the current standards of patient care, patient care evaluation studies have become valid tools of quality management in medicine. In an international pilot project that began in 1996, this approach was redefined to evaluate the impact of current clinical practice guidelines in oncology. Close cooperation between medical societies in the United States and Germany under the coordination of the Commission on Cancer and the Institute of Medical Informatics at the Justus-Liebig-University of Giessen was established. This infrastructure for data collection, data management, analysis, and interpretation of results allows for the recognition of international differences in patient care. Our results indicate discrepancies between current state-of-the-art patient care represented by clinical practice guidelines and the diagnostic and therapeutic procedures in the clinical routine. Patient care evaluation studies are designed as exploratory, not confirmatory, trials. In contrast with confirmatory trials, their aims may not always lead to predefined hypotheses. They reflect routine practice and are not the basis of the formal proof of efficacy, although they may contribute to the total body of relevant evidence. Without this comprehensive approach to evaluation, the potential of clinical practice guidelines to improve patient care remains unknown.

Germany↗

PubMed2005

Testing and implementing signal impact analysis in a regulatory setting: results of a pilot study.

BACKGROUND AND AIM: Statistical signal detection methods such as proportional reporting ratios (PRRs) detect many drug safety signals when applied to databases of spontaneous suspected adverse drug reactions (ADRs). Impact analysis is a tool that was developed as an aid to prioritisation of such signals. This paper describes a pilot project whereby impact analysis was simultaneously introduced into practice in a regulatory setting and tested in comparison with the existing approach. METHODS: Impact analysis was run on signals detected during a 26-week period from the UK Adverse Drug Reactions On-line Information Tracking (ADROIT) database of spontaneous ADRs that met minimum criteria (PRR>or=3.0, chi2>or=4.0 and >or=3 reported cases) and related to established drugs (i.e. those that have been available for at least 2 years and no longer carry the 'black triangle' symbol). The current method of signal prioritisation (i.e. the collective judgement at a weekly meeting) was initially performed without knowledge of the findings of impact analysis. Subsequently, the meeting was presented with the findings and, where appropriate, given the opportunity to reconsider the judgement made. The categories arising from the two methods were compared and the ultimate action recorded. Inter-observer variation between scientists performing impact analysis was also assessed. RESULTS: Eighty-six separate signals were analysed by impact analysis, of which 5% were categorised as high priority (A), 14% as requiring further information (B), 31% as low priority (C) and 50% as no action required (D). In general, the new method tended to give a higher level of priority to signals than the existing approach. Overall, there was 59% agreement between the impact analysis and the collective judgement at the meetings (kappa statistic=0.30). There was slightly greater agreement between impact analysis and the final action taken (kappa statistic=0.39), indicating that the findings of an impact analysis had an influence on the outcome. Assessment of inter-observer variation demonstrated that the method is repeatable (kappa statistic for overall category=0.77). Almost 70% of those who participated in the pilot study believed that impact analysis represented an improvement in how signals were prioritised. CONCLUSIONS: Impact analysis is a repeatable method of signal prioritisation that tended to give a higher level of priority to signals than the standard approach and which had an influence on the ultimate outcome.

Adverse Drug Reaction Reporting Systems↗

PubMed2005

Relaxation and health-related quality of life in multiple sclerosis: the example of autogenic training.

This study was a pilot project to explore the effect of an autogenic training program (AT; a relaxation intervention) on the health-related quality of life (HRQOL) and well-being for people with multiple sclerosis. Participants either met weekly for sessions in AT for 10 weeks (n = 11) or were assigned to the control group (n = 11). The AT group was also asked to practice the technique daily at home. Scales designed to measure HRQOL and aspects of well-being (mood and depressed affect) were taken preintervention and at week 8 of the 10-week program. ANCOVAs using a measure of social support and pretest scores as covariates revealed that at the posttest the AT group reported more energy and vigor than the control group and were less limited in their roles due to physical and emotional problems. Future research should involve studies conducted over an extended period, together with sufficiently sized samples to explore the effect of frequency of practice of relaxation training on HRQOL and well-being for people with multiple sclerosis.

Adaptation, Psychological↗

PubMed2005

Preventing mother-to-child transmission of HIV in Western Kenya: operational issues.

OBJECTIVES: To improve uptake in a program to prevent mother-to-child HIV transmission and describe lessons relevant for prevention of mother-to-child transmission programs in resource-poor settings. METHODS: Implementation of a pilot project that evaluates approaches to increase program uptake at health facility level at New Nyanza Provincial General Hospital, a public hospital in western Kenya, an area with high HIV prevalence. Client flow was revised to integrate counseling, HIV testing, and dispensing of single-dose nevirapine into routine antenatal services. The number of facilities providing PMCT services was expanded to increase district-wide coverage. Main outcome measures were uptake of counseling, HIV testing, nevirapine, and estimated program impact. RESULTS: Uptake of counseling and testing improved from 55 to 68% (P < 0.001), nevirapine uptake from 57% to 70% (P < 0.001), and estimated program impact from 15% to 23% (P = 0.03). Aggregate reports compare well with computer-entered data. CONCLUSION: Addressing institutional factors can improve uptake, but expected program impact remains low for several reasons, including relatively low efficacy of the intervention and missed opportunities in the labor room.

Anti-HIV Agents↗

PubMed2005

Comparison between a low glycemic load diet and a Canada Food Guide diet in cardiac rehabilitation patients in Ontario.

BACKGROUND: A high dietary glycemic load is associated with an increased risk of noninsulin-dependent diabetes mellitus and coronary artery disease. OBJECTIVE: To evaluate the effect of a low glycemic load diet on cardiac rehabilitation patients. METHODS: One hundred twenty patients who were advised to follow a low glycemic load diet were evaluated and compared with 1434 patients who were advised to follow the principles of Canada's Food Guide to Healthy Eating for People Four Years and Over as part of the Ontario Cardiac Rehabilitation Pilot Project. RESULTS: Patients on the low glycemic load diet lost more weight at six months (2.8 kg loss versus 0.2 kg gain, P < 0.0001), had a greater reduction in abdominal obesity (2.9 cm versus 0.4 cm, P < 0.0001), and had a greater improvement in high density lipoprotein cholesterol (0.14 mmol/L versus 0.02 mmol/L, P < 0.0001), triglycerides (-0.44 mmol/L versus -0.08 mmol/L, P < 0.0001) and glycemic control (fasting glucose -0.94 mmol/L versus 0.91 mmol/L, P = 0.0019). After one year of follow-up, the low glycemic load patients had maintained (weight gain 0.7 kg, triglycerides -0.07 mmol/L, fasting glucose -0.10 mmol/L and glycosylated hemoglobin A1c -0.18%; all not significant) or augmented (waist circumference -1.3 cm, P = 0.038; high density lipoprotein cholesterol 0.08 mmol/L, P < 0.0001) the initial results. CONCLUSIONS: Implementation of a low glycemic load diet was associated with substantial and sustained improvements in abdominal obesity, cholesterol and glycemic control.

Blood Glucose↗

PubMed1995

The AMUSE-environment: a didactical environment where active multimedia use stimulates expertise.

The rapidly evolving information technology domain continuously offers new opportunities for computer aided education (C.A.E.). In a pilot project at the Department of Medical Informatics, we studied the possibilities and the limitations of multimedia systems for computer aided education in medicine. Different specialists paid attention to the medical, didactic, conceptual and technical points of view. From this teamwork originated the AMUSE-environment: an environment where Active Multimedia Use Stimulates Expertise. The AMUSE-environment describes a didactic framework that focuses on knowledge acquisition and application in complex content domains (the transfer and stimulation of expertise). In the context of advanced learning and random access instruction, the active involvement of the user is mandatory. Multimedia systems enhance communication by integrating different media (e.g., text, pictures, audio, video, ...) in one natural, user-friendly environment. The first application that uses the AMUSE-environment is developed in cooperation with the Haematology Department of the University Hospital Gasthuisberg. The haematologists filled the didactical framework with more than 500 full color illustrations and corresponding text and audio. The application gives a complete overview of the morphology of the blood and bone marrow cells.

Audiovisual Aids↗

PubMed2000

Development of a district Cord Blood Bank: a model for cord blood banking in the National Health Service.

The Bristol Cord Blood Bank was established as a pilot project within existing health services to establish cost-effective recruitment, collection and processing suitable for use in the NHS should cord blood become a routine source of haemopoietic stem cells for transplantation in the UK. An important aim of the project was to evaluate the feasibility of establishing a midwifery-based collection network, thus utilising expertise already in place. Collection was performed on the delivery suite immediately after the placenta was delivered. The clinical experience of the midwife collector/counsellors allowed rapid pre-collection assessment of the condition of the cord and placenta. This prevented collection attempts from diseased or otherwise damaged placentas, leading to conservation of resources by preventing collection of most small volume donations. The bank was established within the National Blood Service, Bristol Centre to achieve Good Manufacturing Practice standards and ensure that processing was subject to the same stringency required for other sources of haemopoietic stem cells. Cord blood is an expensive resource. By utilising existing expertise in district Obstetric and National Blood Services, the Bristol Cord Blood Bank may serve as a model for health economic evaluation of cord blood banking of volunteer donations within the NHS.

Blood Banks↗

PubMed2000

Principal-agent relationships in general practice: the first wave of English Personal Medical Services pilot contracts.

OBJECTIVES: To investigate how far English National Health Service (NHS) Personal Medical Services (PMS) contracts embody a principal-agent relationship between health authorities (HAs) and primary health care providers, especially, but not exclusively, general practices involved in the first wave (1998) of PMS pilot projects; and to consider the implications for relational and classical theories of contract. METHODS: Content analysis of 71 first-wave PMS contracts. RESULTS: Most PMS contracts reflect current English NHS policy priorities, but few institute mechanisms to ensure that providers realise these objectives. Although PMS contracts have some classical characteristics, relational characteristics are more evident. Some characteristics match neither the classical nor the relational model. CONCLUSIONS: First-wave PMS contracts do not appear to embody a strong principal-agent relationship between HAs and primary health care providers. This finding offers little support for the relevance of classical theories of contract, but also implies that relational theories of contract need to be revised for quasi-market settings. Future PMS contracts will need to focus more on evidence-based processes of primary care, health outputs and patient satisfaction and less upon service inputs. PMS contracts will also need to be longer-term contracts in order to promote the 'institutional embedding' of independent general practice in the wider management systems of the NHS.

Cooperative Behavior↗

PubMed1989

[Association among general health, diet and need of dental care among retired pensioners living at home].

A pilot project was established in a Danish municipality with the aim of improving the nutrition of 67-85-year-olds living at home but who were dependent on domestic aid for purchasing or preparing their food. The project comprised health education and information concerning dietary habits as well as an offer of dental treatment to those who were physically or mentally handicapped. At initiation of the project, the persons (n = 110; 89% of the target population) were interviewed about their general and dental health, ailments, drug consumption, and diet. Furthermore, a clinical dental examination was made (n = 106). From these baseline registrations, the elderly were divided into subgroups: unbalanced, moderate, and balanced diet; low, moderate, and high consumption of, respectively, water/milk and coffee/tea; great, moderate, and no need for dental care. Systematic associations were found between general health problems and unbalanced diet. A tendency was observed toward more frequent complaints in the groups with relatively high consumption of water/milk and water/milk/coffee/tea. The strongest associations were found between general health complaints, handicaps, and masticatory deficiency on the one hand and great need for dental care on the other. Also, the group with great need for dental care was overrepresented in the group with unbalanced diet. It is argued that accessibility to dental care would improve the chances for the elderly to stay in their own homes.

Aged↗

PubMed1998

Assessment of patient preferences among men with prostate cancer.

PURPOSE: We developed a self-administered paper based instrument to assess patient preferences quantified as utilities for common outcomes associated with the management of prostate cancer. MATERIALS AND METHODS: A total of 50 patients was invited to test a self-administered paper based instrument designed to assess preferences for health outcomes associated with the management of localized prostate cancer. The 50 patients were selected from a group of 625 randomly identified men with prostate cancer who responded to a survey instrument designed to assess health related quality of life. The 50 patients selected for this pilot project were chosen because of the wide range of responses to the quality of life survey. Patient utilities were assessed for the 5 health states of overall quality of life, problems related to prostate cancer, and problems related to urinary, bowel and sexual dysfunction. RESULTS: Patients were able to complete the assigned tasks. The self-administered instrument had high test-retest reliability. In addition results obtained from this instrument showed a correlation with results obtained from assessments using other instruments, including an analog scale, a computer based system known as U-Titer, a quality of life survey and the Health Utility Index:3. CONCLUSIONS: A self-administered paper based instrument can be used to assess patient utilities for health states associated with prostate cancer management. Results from the instrument tested appear to be reliable and valid, and are comparable to those obtained from other assessment techniques. A self-administered paper based instrument has distinct advantages when conducting large survey studies because it can be incorporated at relatively low cost.

Aged↗

PubMed2005

Tailoring an HIV-prevention intervention for cocaine injectors and crack users in Porto Alegre, Brazil.

Brazil has the second largest number of reported AIDS cases in the world. Porto Alegre, like most other large urban centres in Brazil, has been greatly impacted by an AIDS epidemic driven by high rates of drug use and risky sexual behaviours. While epidemiologic surveillance of HIV/AIDS and treatment initiatives for HIV-infected individuals are well developed in Brazil, comparatively little attention has focused on developing interventions directed toward high-risk populations. Intervention programmes, particularly those tailored for chronic drug users, are lacking. This pilot project successfully adapted and tailored a cognitive behavioural HIV intervention developed in the US to the cultural setting in Porto Alegre. The project established feasibility and acceptability of the approach for targeting risky drug and sexual behaviours among a group of male Brazilian drug users. A sample of 120 male cocaine users was recruited from a public health clinic serving the target population in the city of Porto Alegre. The average age of the participants was 29; they averaged less than 8 years of formal education; and less than half (41%) were married. Lifetime self-reported drug use was high with 93% reporting cocaine use, 87% reporting crack use, and 100% reporting marijuana use. 43% of the sample reported ever injecting drugs. Reports of risky sexual behaviours were similarly elevated. Almost half (45%) tested positive for HIV. Preliminary evidence suggests that intervention acceptability was high among participants. Given the reported high risk sexual and drug use behaviours among these men, HIV interventions must be evaluated and expanded to include this population as well as their sexual partners.

Adolescent↗

PubMedDate not supplied

An evaluation of a volunteer-support program for families at risk.

A descriptive comparative design was used to evaluate the Cottage Community Care Pilot Project, a family support/child protection initiative linking trained volunteers with "vulnerable" first-time parents. Fifty-eight eligible and consenting families enrolled in the program and formed the intervention group. A further 35 eligible families consented to participate in the evaluation and received assessments only and formed the comparison group. No differences were evident between the intervention and comparison groups on parenting readiness. For the intervention group (n = 25), improvements occurred in seven aspects of family functioning (items on the Scale of Family Functioning) when contrasted to the comparison group (n = 24). Two areas of family functioning were found to be statistically significant: access to social support (p = 0.02) and age appropriate expectations of infants (p < 0.001). Participants reported satisfaction with the program, and the study emphasized the need to include all families, not just those at risk. This evaluation supports the continued development of volunteer-support programs and the active role that public health nurses play in the growth and development of children in our communities.

Adaptation, Psychological↗

PubMed1999

Medical radiologic technologist review: effects on a population-based breast cancer screening program.

PURPOSE: To evaluate the effects of medical radiologic technologist review of mammograms in a population-based breast cancer screening program. MATERIALS AND METHODS: A technologist review pilot project was incorporated into the Regina, Saskatchewan, Canada, reading center. Technologists received special training in mammographic interpretation. They reviewed all 27,863 mammograms obtained at the center from July 1995 to September 1996 that were reviewed by a radiologist and selected cases for second blind reading by another radiologist. When the two radiologists' readings were in agreement, the report was sent. When the readings differed, a third opinion was obtained from the program's consulting radiologist. Changes in the number of mammograms interpreted as abnormal and the number of cancers detected were assessed. RESULTS: The technologist review was responsible for the detection of nine cancers missed at the first radiologist's interpretation. Technologists were very discriminating; only 391 cases (1.4%) were sent for double reading. The positive predictive value of screening did not change significantly (7.5% without review, 8.1% with review; P > .20). CONCLUSION: A substantial number of cancers were found with the technologist review. The number of mammograms interpreted as abnormal was reduced slightly. The technologist review proved to be a cost-effective alternative to double reading by two radiologists.

Breast Neoplasms↗

PubMed2001

Recovery of locomotor function in adult paraplegic frogs by inductive lability in the distal isolated spinal cord neural networks.

We postulated (Krishnan, 1991) that in a spinal cord transected adult paraplegic mammal locomotor functions can be revived if polyneuronal innervation is reinduced in the paralyzed hind limb muscles. This procedure destabilizes the neural networks and induces new synaptic growth in the distal isolated cord. In this pilot project we tested the hypothesis in cord-transected adult paraplegic frogs. Polyneuronal innervation was reinduced by crushing the sciatic nerve in the right upper thigh. Left limb sciatic nerve was not crushed and served as control. Another group of adult frogs had only cord transection without nerve crush. Five to seven weeks postnerve crush, full powered flexion-extension movements in the hip and knee joints appeared in the right hind limb and were used for swimming and surface progression. Movements gradually declined over the next weeks, which in some animals was seen preserved even beyond 120 days. Paraplegic frogs without nerve crush did not show any recovery of locomotor function. Interestingly, the uncrushed contralateral limb also produced transient, weak locomotor-like movements. This lasted for 4 to 6 days and waned out completely thereafter. These results validate our hypothesis on methods to generate new synaptic sprouts and reconnections to redrive the locomotor system. We had recommended earlier that destabilization procedure should be included as an essential component in treatment strategies for spinal cord injury repair for effective relinking of the severed cord ends.

Animals↗

PubMed2005

A pilot examination of the impact of cancer patients' fatigue on their spousal caregivers.

OBJECTIVE: In this pilot project we examined the quality of life of spouses of cancer patients who had significant fatigue. METHODS: We assessed both the spouses of cancer patients and the patients who presented with chemotherapy-induced fatigue and anemia. Study endpoints included the impact that cancer patients' fatigue had on their spouses' quality of life, including their own levels of fatigue, depressive symptoms, activity levels, work absenteeism, and marital adjustment. We examined the extent to which changes in patients' fatigue from baseline to one month follow-up were associated with changes in spouses' quality of life indices. RESULTS: 25 couples completed the study. Seven (28%) spousal caregivers reported handling fewer responsibilities at work, 8 (32%) had reduced their work hours, and 8 (32%) felt that they were less effective overall at work. Spousal caregivers also missed a significant amount of time at work during the month long study, missing an average of 2.7 (SD = 2.95) days, with an additional 1.29 (SD = 2.97) sick days and 1.76 (SD = 2.63) vacation days during that time. Spouses reporting greater levels of caregiver strain were more likely to have increased fatigue at baseline (F1,23 = 8.11, p < .01), and worse dyadic adjustment at both time points (baseline: F1,23 = 7.80, p < .01; follow-up: F1,21 = 9.24, p < .01). Also, those with more caregiver strain were less likely to engage in social activity at baseline (F1,23 = 6.11, p < .05) and more likely to engage in less work by the one month follow-up (F1,20 = 8.36, p < .01). SIGNIFICANCE OF RESULTS: Spouses who were identified as having elevated burden experienced more personal fatigue, had worse dyadic adjustment, reported poor energy levels, and tended to engage in fewer work and social activities; the impact of patient's fatigue level on these parameters was highly variable in this small pilot study.

Absenteeism↗