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PubMed2002

Effects of backpack load and task demand on trunk forward lean: Pilot findings on two boys.

Trunk forward lean (TFL) has been identified as a postural adaptation to increases in backpack load, and spinal forces have been presumed based on TFL. This pilot project examined the combined effects of increasing backpack load and task demand on TFL. Two boys with typical development, aged 11 and 9, were participants. Peak5 Motion Analysis Videography was used to gather 2D kinematic data under three levels of backpack load (0%, 8.5% and 17% body weight) and three levels of task demand (stand, walk and run). Passive reflective markers were placed on anatomical landmarks, and TFL was calculated by the angle formed by a line joining the right acromion and right greater trochanter and a vertical reference line. Descriptive statistics were performed to compare TFL under the nine experimental conditions. Although TFL most often increased with increases in backpack load and task demand, TFL was not dose dependent. Postural patterns varied between participants, and the findings supported a ceiling effect. In conclusion, to compensate for changes in inertia and center of gravity when wearing a backpack, TFL represents a dynamic emergent strategy that varies based on task demand and characteristics of the individual. Further research on TFL is warranted, and clinicians should be cautious when recommending safe carrying loads for children based on posture.

Back↗

PubMed1990

Risk factors for HIV seropositivity among people consulting for HIV antibody testing: a pilot surveillance study in Quebec.

The surveillance of AIDS (acquired immune deficiency syndrome) through case reporting only reflects the epidemiologic features of HIV (human immunodeficiency virus) transmission a few years earlier and not the prevalence of HIV seropositivity. HIV infection is not a notifiable condition in Quebec. We were asked by the ministère de la Santé et des Services sociaux du Québec to perform a pilot project for the surveillance of HIV seropositivity using a network of sentinel physicians. From May 15, 1988, to Sept. 30, 1989, physicians from four collaborating centres collected data on the serologic status, demographic characteristics and risk factors for 4209 patients who underwent HIV antibody testing. Of the 3899 subjects included in the study 7.9% were HIV positive. Through logistic regression analysis the following variables were found to be significantly associated with HIV seropositivity: presence of HIV-related symptoms (prevalence odds ratio [POR] 36.5), origin from an endemic area (POR 9.1), homosexuality or bisexuality (POR 8.4), intravenous drug use (POR 4.2), male sex (POR 2.8), previous HIV antibody testing (POR 2.5) and previous sexually transmitted disease (POR 1.8). Over the study period we found a large increase in HIV seroprevalence among intravenous drug users (4.2% in 1988 to 19.0% in 1989) (p = 0.02). This increase might reflect a recent change in the epidemiologic pattern of HIV transmission in Quebec. Surveillance of HIV seropositivity through a network of sentinel physicians may be a reasonable alternative to mandatory reporting.

Adult↗

PubMed1979

Sampling gastro-enterologists' opinions--an OMGE study.

This study describes a pilot project to sample gastroenterologists' opinions on a variety of interesting and controversial topics. At the Madrid World Congress, a sample of delegates were asked to respond to a questionnaire distributed at the meeting itself. A total of 224, representative of those attending by discipline and by geographical area, did so. The results were analysed in two days and presented to the Congress within 72 hours. Amongst the findings were several of interest. Vagotomy is now the most common operation for (elective) duodenal ulcer surgery. Three-quarters of those responding prescribe high-fibre diet for chronic diverticular disease. Over 80% routinely prescribe sulphazalazine for patients with ulcerative colitis--even in remission. The most useful mode of detection of gastro-intestinal cancer is now felt to be endoscopy, even ahead of double contrast radiology. The results should be interpreted with caution, although the survey represents findings in over 200 hospitals. The principle of an on-the-spot rapid attitude survey has been established as feasible. It is proposed to repeat the exercise on a wider scale at the next World Congress in Stockholm in 1982.

Attitude of Health Personnel↗

PubMed2001

Zora: a pilot virtual community in the pediatric dialysis unit.

We describe a five-month pilot project conducted in the dialysis unit at Boston's Children's Hospital. Pediatric patients with renal disease used the Zora therapeutic community program while undergoing hemodialysis. Zora is a 3D multi-user computer environment designed at the MIT Media Laboratory to help young people explore issues of identity, while engaging in a virtual community. Users build "virtual rooms" and populate them with objects and characters, program them with storytelling behaviors, and converse with other young people in real-time through a virtual character representing themselves. It was specifically designed to help young people explore issues of identity, while engaging in a participatory virtual community. This paper presents the experience and evaluates the feasibility and safety of using Zora in a hospital setting. It describes how Zora facilitated explorations of identity and mutual patient support and interaction. Finally it also presents design recommendations for future interventions of this kind. More generally, this paper explores the potential of technology specifically designed with therapeutic purposes to help patients cope with their illness.

Attitude of Health Personnel↗

PubMedDate not supplied

[The Efficacy of homeopathy in the treatment of chronic low back pain compared to standardized physiotherapy].

AIM: The aim of this pilot project was to evaluate the efficacy of treatment of chronic low back pain during two months either by homeopathy or by standardised physiotherapy. METHOD: 43 patients suffering from chronic low back pain were included in this controlled, randomised prospective study. They were divided in two treatment groups: homeopathy and standardised physiotherapy. Based on the initial and final clinical investigations, the Oswestry questionnaire and the visual analogue scale, that were assessed at the beginning, at the end and 18.5 months after therapy, the results were statistically evaluated. A further questionnaire documented the acceptance of treatment. RESULTS: A comparison of the groups from the beginning to the end of treatment reveals a significant decrease of the Oswestry score in patients treated by homeopathy. This tendency could not be confirmed 18.5 months later. Homeopathy was well accepted by most of the patients. CONCLUSIONS: Based on these results, nothing can be said against attempting treatment of chronic low back pain by means of homeopathy. Further research is recommended to confirm the results of our investigation, using a larger number of patients, a third treatment group, homeopathy double blinded.

Adolescent↗

PubMed1995

A pilot program of contraceptive continuation in six school-based clinics.

PURPOSE: Few school-based health centers (SBHC) in the United States dispense contraceptives on-site and little is known about contraceptive continuation in these health centers. METHODS: An 11-month contraceptive continuation pilot project offering monthly reproductive health assessment and counseling to students enrolled in Baltimore school clinics was evaluated. One hundred-forty-three women voluntarily enrolled in the study over a seven month period. A monthly contraceptive calendar was developed to collect data on contraceptive use, pregnancy and STD risk, sexual behavior and parental support for contraceptive use. Physical assessment was provided as needed to assess the presence of STD's or pregnancy. Data were analyzed for the month prior to enrollment in the program and eleven months after entry into the program. RESULTS: Both contraceptive (OCP) use and abstinence increased over the course of the program. Condom use remained at approximately 30% with frequent use of OCP's and condoms, condoms or abstinence. Program drop-out was common. Thirteen students became pregnant while enrolled in the program and 35% of the students were diagnosed with one or more sexually transmitted diseases. Partner-switching was common, although two or more partners within any one month was rare. CONCLUSIONS: Monthly follow-up provided through SBHCs can improve contraceptive use although dropout rate and contraceptive failure remain high.

Adolescent↗

PubMed1994

Hospital-based strategies for improving influenza vaccination rates.

BACKGROUND: Patients at highest risk for complications from influenza have the lowest rates of vaccination. Each year there are thousands of deaths related to influenza. Many of those who are hospitalized or who die from influenza-related conditions were hospitalized during the preceding influenza vaccination season but not vaccinated. METHODS: Six community hospitals in northern Minnesota participated in a pilot project to assess the feasibility and effectiveness of three different community hospital-based influenza vaccination programs during the 1991-1992 immunization season. Records of patients discharged from each institution during November and December 1991 were reviewed for documentation of indications for influenza immunization and to determine whether vaccination was offered and whether vaccination occurred before discharge. RESULTS: In hospitals choosing to implement standing orders for their nursing staffs to review indications for influenza vaccination and administer if indicated, 95.2% of patients were offered vaccination. In hospitals depending on physician chart reminders, 22% of patients were offered vaccination. In hospitals relying on physician education strategies to promote influenza vaccine, only 11.7% of patients were offered vaccination. Documented immunization rates in these three groups were 40.3%, 17%, and 9.6%, respectively. CONCLUSIONS: Programs implementing standing orders for nursing staffs were more effective than educational programs or physician reminders in offering and administering influenza vaccine to hospitalized patients. Hospital policies can expand the number of high-risk and elderly persons who receive influenza vaccination each year, but hospitals need to be reimbursed for this service to ensure institutional support.

Hospitalization↗

PubMed1983

Shared pharmacy services: a cost-effective programme for small hospitals.

A pilot project for shared pharmacy service was undertaken to investigate costs and benefits under an agreement established between University Hospital, London and South Huron Hospital, Exeter, Ontario. The programme involved the use of facsimile telecopiers to transmit direct copies of the physicians' orders to the Pharmacy Department at University Hospital where they were entered into the computerized pharmacy system. At South Huron Hospital therapy was initiated from floor stock while the drug, dispensed in unit-of-use packaging, was delivered to the Exeter Hospital by courier service. The shared service pharmacist visited South Huron Hospital once weekly for nursing orientations, inservice lectures, patient consultations, medical staff meetings and direct contact with physicians. With the approval of the Bureau of Dangerous Drugs the pharmacist delivered Narcotic and Schedule G medications once weekly. After three months the patient census and average number of medication orders per patient per day had increased. The hours of pharmacy operation were extended, while the medication costs per patient day were reduced from $2.16 to $1.64. A shared pharmacy service can result in an improved element of drug use control for smaller hospitals in a cost-effective manner.

Cost-Benefit Analysis↗

PubMed1997

Short-term outcome following referral to a psychiatric emergency service.

The study described here is part of an evaluation of a pilot project concerning the implementation of three psychiatric crisis units in general hospitals in Belgium. The purpose was to evaluate the short-term outcome of a multidisciplinary crisis intervention for psychiatric patients referred to the emergency department. Patients were assessed with the General Health Questionnaire (GHQ-28) at the time of referral to the emergency department and again 1 month later. Patients referred for a psychiatric crisis intervention were compared with patients receiving short-term psychiatric inpatient treatment in another hospital. Patients referred to the emergency department showed a considerable degree of psychiatric disturbance. The General Health Questionnaire appeared to be a good measure for assessment of the "state" aspect of a psychiatric disturbance. The state of distress was significantly reduced one month after referral in both treatment conditions. Nevertheless, an important proportion of patients remained in a state of considerable distress. The results indicate that a short hospital-based crisis intervention approach is comparable with more traditional acute inpatient treatment. However, in the case of more severely distressed patients it may be insufficient. Several limitations of this study are also discussed (risk of overestimation of improvement, influence of time or pre-existing differences).

Adult↗

PubMedDate not supplied

Characterization of CD4, CD8, CD56 positive lymphocytes and C4d deposits to distinguish acute cellular rejection from recurrent hepatitis C in post-liver transplant biopsies.

INTRODUCTION: Hepatitis C viral (HCV) infection is the most common cause for liver transplantation (LTx) in USA. Hepatitis C viral recurrence in liver allograft is almost universal, which is often difficult to distinguish from acute cellular rejection (ACR). AIM: Aim of the present study is to examine the differences between distribution of CD4, CD8, CD56 positive lymphocytes, and C4d deposits in patients with ACR and recurrent HCV. PATIENTS AND METHODS: As a pilot project, a group of five post-LTx HCV RNA negative patients, strongly suspicious for ACR based on clinical findings and history of medication non-compliance and another group of five post-LTx HCV positive, medication compliant patients with abnormal liver function were retrospectively selected. Liver biopsies of these patients were stained with monoclonal CD4, CD8, CD56, and polyclonal C4d antibodies and compared. RESULTS: Mean CD4, CD8, and CD56 counts in ACR group were 156.7 +/- 17.6, 35.4 +/- 8.8, and 1.0 +/- 1.8/HPF, respectively and were 89.7 +/- 41.3, 20.3 +/- 23.2, and 0.6 +/- 0.9/HPF, respectively in HCV recurrence group. Biopsies of four of five patients with ACR demonstrated moderate to strong C4d staining, whereas all patients with recurrent HCV had none to mild C4d staining. CONCLUSION: Mean CD4, CD8, and CD56 were similar for acute rejection and recurrent HCV infection. However, 80% of patients with ACR showed moderate to strong staining for C4d and all recurrent HCV patients showed none to mild C4d staining.

Biopsy↗

PubMed2004

Morbidity and medication preferences of individuals with headache presenting to a community pharmacy.

OBJECTIVE: To assess the degree of debilitation and the treatment views of individuals with headache presenting to a community pharmacy. BACKGROUND: Migraine and chronic daily headache are common poorly managed illnesses. Pharmacists recommend an over-the-counter "headache product" to customers more than 53 000 times daily, thus they are well positioned to help those with headache. DESIGN: Pilot project of 22 self-administered surveys of individuals presenting to a community pharmacy with a complaint of headache. RESULTS: Thirteen persons had Migraine Disability Assessment scores of grade III or grade IV. Of the sample population, a substantial minority (41%) did not believe their headaches could be effectively managed with over-the-counter medications, 72% did not feel over-the-counter agents were safer than prescription products, 96% did not indicate that over-the-counter drugs were more effective than prescription drugs, and 50% disagreed that a physician's evaluation was not necessary. Only half of the population was satisfied with their current therapy, and individuals overwhelmingly (91%) wished they could prevent their headaches. CONCLUSIONS: The majority of individuals with headache presenting to a community pharmacy had high levels of morbidity and were in need of education regarding the proper role of over-the-counter medications, the advantages of prescription agents, and the benefits of a physician's referral. These preliminary results indicate that community pharmacies are potentially important locations for identification, education, and referral of individuals with headache.

Adolescent↗

PubMed2001

Telephone support group intervention for persons with hemophilia and HIV/AIDS and family caregivers.

The purpose of this pilot project was to test the feasibility of a telephone support group intervention for persons with hemophilia and HIV/AIDS and for their family caregivers. Their support needs were unique because they did not identify with predominant groups of persons with AIDS and were geographically dispersed from peers. The 12 week intervention involved separate telephone support groups for hemophiliacs and for family caregivers. The two groups, comprised of a predetermined maximum of six people, were co-led by a professional and a peer. The support group for family caregivers involved six people and the group for men with hemophilia included five people, including one peer facilitator and one professional facilitator in each group. The telephone support group discussions were taped, transcribed, and analyzed for prevalent themes. The peer and professional facilitators maintained weekly field notes. All participants reported that the telephone groups had a positive impact on meeting their support needs. They believed that they had benefitted from sharing information and that the support groups had decreased their feelings of isolation and loneliness. Participants, however, contended that the intervention should be longer than 12 weeks.

Adaptation, Psychological↗

PubMed2004

Evaluation of a pilot service designed to provide support following stroke: a randomized cross-over design study.

OBJECTIVE: To evaluate a day service for people aged 18-55 years who had a stroke. DESIGN: A randomized cross-over study design was used, randomly allocating individuals to attend the service for six months followed by a period of no attendance for six months. SETTING: A day service pilot project was launched in Cardiff in July 1995 for people who were aged between 18 and 55 years and had a stroke. It met one day a week. SUBJECTS: Twenty-six participants were recruited to the study between June 1998 and February 2000. Their mean age was 48 years (SD = 7). INTERVENTIONS: The service aimed to offer participants the opportunity to identify and pursue meaningful and realistic opportunities within the community. A range of activities occurred at the service including creative activities and social outings. MAIN OUTCOME MEASURES: The Barthel ADL Index, Extended ADL Scale, Nottingham Leisure Questionnaire, Short Form 36, the Hospital Anxiety and Depression Scale, the Canadian Occupational Performance Measure, the Role Checklist and the Semantic Differential Self Concept Scale were used to assess the outcomes from the service. RESULTS: Attending the service increased occupational performance and satisfaction with performance but there was no evidence that depression and anxiety were reduced or that quality of life and self-concept were improved. CONCLUSION: Although there were some gains from attending the service there were also many unmet needs. Further research is required to continue to identify how best to meet the needs of individuals post stroke under retirement age.

Adolescent↗

PubMed2005

Adapting the chronic care model to treat chronic illness at a free medical clinic.

This pilot project was designed to determine the feasibility and effectiveness of an adaptation of the chronic care model applied to uninsured patients in a free medical clinic staffed by volunteer physicians. Of the 149 enrolled patients, 117 had hypertension, 91 had diabetes, and 51 had hyperlipidemia. Patients were enrolled in a chronic disease registry from March 1, 2001 through September 30, 2002 at the Salvation Army Free Clinic (SAFC). Two part-time registered nurses served as care managers providing disease-specific management using evidence-based guidelines. Consistent specialty consultation was available via phone, e-mail, or physician visit. Patient self-management was encouraged through collaborative goal setting. There were 40 patients lost to follow-up; 109 completed the study. A clinically significant improvement was obtained in at least one chronic disease for 79 patients. The chronic care model was a useful template for the delivery of effective chronic disease care to a group of uninsured patients at a free medical clinic.

Adult↗

PubMedDate not supplied

Testing of the palatability of Thymus vulgaris L. and Origanum vulgare L. as flavouring feed additive for weaner pigs on the basis of a choice experiment.

The objective of the study at hand was to investigate within the framework of a pilot project the preference of weaner pigs for either an ad libitum standard feed with thyme or oregano herb as flavouring additive or an ad libitum standard feed without any herbal additive. Thyme or oregano herbs or a combination of both were offered in two different concentrations each (1% and 0.1%) as additive (experimental diets) in standard diet in comparison to the latter without herbal additive (control diet) free of choice. The dosage of the two herbs in terms of total essential oil(s) in the feeds used in the study was 0.02% or 0.002% (v/w), which was equivalent to 1% or 0.1% herbs in the mixture, respectively. A Latin square according to Williams (1949) was used with 6 groups in order to record possible differences in feed intake. All experimental diets aside from that mixed with 0.1% thyme herb were, in comparison to the control diet, significantly less ingested. Where the weanling was given the choice, it did not choose feed with any flavouring additive. Further studies aimed at assessing the use of herbs as aroma additive in the form of a choice experiment are recommended.

Animal Feed↗

PubMed2003

Bexarotene--an alternative therapy for progressive cutaneous T-cell lymphoma? First experiences.

BACKGROUND: A standard therapy for advanced cutaneous T-cell lymphomas has not yet been defined. Bexarotene is a new retinoid x receptor-specific retinoid that has been approved for systemic second-line therapy for cutaneous T-cell lymphomas in the USA and Europe. In order to evaluate the efficacy of bexarotene in cutaneous T-cell lymphomas, a pilot trial was initiated. PATIENTS AND METHODS: In a pilot project 10 patients with advanced cutaneous T-cell lymphomas, who had received a variety of previous treatments, were treated with bexarotene at the departments of dermatology in Münster, Minden and Charité Berlin, Germany. The patients received bexarotene at a dose of 300 mg/m2 body surface daily. According to the percentage of tumour reduction and affected body surface, the response rates were divided in complete and partial remission, stable disease and progressive disease. Laboratory parameters i.e. cholesterol, triglycerides transaminases, T3, T4, and TSH were screened regularly. RESULTS: In 2 patients a short partial remission was achieved; however, after a few weeks progression followed. In 4 patients a lasting stabilisation was obtained. The other 4 patients showed a progressive disease during therapy. 6 patients developed hypertriglyceridemia with levels up to 2000 mg/dl; therapy had to be suspended in 3 patients because of these adverse drug events. CONCLUSION: Weighing benefits and risks, bexarotene can at present not be recommended as standard therapy in the treatment of patients with progressive cutaneous lymphomas.

Adult↗

PubMed2003

Use of telemedicine in evading cholera outbreak in Mahakumbh Mela, Prayag, UP, India: an encouraging experience.

Telemedicine (TM) services a process in which expert medical advice from afar is provided using electronic signals to transfer the medical data from one site to another. As a pilot project to assess the efficacy of TM in developing countries like India, a telemedicine center was set up at the main hospital of Mahakumbh mela--a grand religious fair, at Prayag, a city in north India. The daily reporting of the in-patient and outpatient cases at the fair revealed a surge of diarrhea cases among the pilgrims at the fair. This information was communicated to the referral center at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), which, with the help of its microbiology department, conducted microbiological examinations of stool samples and rectal swabs of patients along with various water samples. Vibrio cholerae was isolated in 22.6% (7/31) of the samples. This information was immediately relayed to the Main Hospital at the fair online, and then to the health authorities, who took strict and prompt measures to improve hygiene. Subsequently, the number of diarrhea cases decreased considerably in a matter of a few days, and thus an epidemic disaster was averted, which could have created havoc in such a large gathering.

Aged↗

PubMed2000

An internet-based learning portfolio in resident education: the KOALA multicentre programme.

CONTEXT AND OBJECTIVES: To describe the Computerized Obstetrics and Gynecology Automated Learning Anaalysis (KOALAtrade mark), a multicentre, Internet-based learning portfolio and to determine its effects on residents' perception of their self-directed learning abilities. METHODS: The KOALA programme allows residents to record their obstetrical, surgical, ultrasound, and ambulatory patient encounters and to document critical incidents of learning or elements of surprise that arose during these encounters. By prompting the student to reflect on these learning experiences, KOALA encourages residents to articulate questions which can be directly pursued through hypertext links to evidence-based literature. Four Canadian residency training programmes participated in the pilot project, from February to May 1997, using a dynamic relational database with a central server. All participants completed the Self-directed Learning Readiness Scale and a learning habits questionnaire. The impact of the KOALA programme on residents' perception of their self-directed learning abilities was measured by comparing KOALA-naive schools (schools 2, 3, and 4) with school 1 (exposed to the KOALA prototype for 1 year). Ordered variables were compared using the Mann-Whitney U test and continuous variables with the Student t test (statistical significance P < 0. 05). RESULTS: During the study period, 7049 patient and 1460 critical incidents of learning were recorded by 41 residents in the four participating universities. Residents at the exposed school (school 1) had a significantly higher perception of their self-directed learning (P < 0.05) and believed their future learning was less likely to be from continuing medical education (P < 0.028), textbooks (P < 0.04), and didactic lectures (P < 0.011) and would be derived from a learning portfolio with online resources. CONCLUSION: This Internet-based, multi-user, multicentre learning portfolio has a significant effect on residents' perception of their self-directed learning abilities.

Canada↗