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PubMed2000

Use of female controlled microbicidal products for HIV risk reduction.

Many over-the-counter microbicidal contraceptive methods reduce the risk of acquiring sexually transmitted diseases. This pilot project compared the use of female controlled barrier methods in an extremely high-risk population of low-income drug abusing women following an intervention designed to promote HIV risk reduction and barrier use. An HIV transmission risk reduction interactive intervention emphasizing self-esteem, assertiveness and sexual negotiation was offered to 41 drug dependent women. Participants were randomly assigned to one of two conditions, a male and female condom condition or a male and female condom plus N-9 products (vaginal suppositories, film, gel) condition. Results from the three-month follow-up period suggest that there may be a synergistic effect of availability of multiple protective methods on the overall rate of protective behaviours. The use of the male condom for penile/vaginal sex increased from 19% at study entry to 27% during the three-month follow-up period. The total protected sexual episode rate, calculated to include use of the other protective barriers distributed, was 60%. Thus, the condom use rate was not found to decrease because of the availability of alternative methods of protection. Future research should address the use of microbicidal products to empower women to prevent STD/HIV transmission.

Adult↗

PubMed1992

The British Columbia Mammography Screening Program: evaluation of the first 15 months.

We report our experiences in the first 15 months of a government-funded pilot project begun in 1988 to study the feasibility of rapid throughput, low-cost screening mammography in British Columbia. The primary goals of the project were (1) to determine the unit cost of screening mammography within the context of the program; (2) to design and put into operation a centralized system of data collection, analysis, and quality control to enable calculations of cancer detection rates, biopsy rates, biopsy yield ratios, staging, and other specific cancer characteristics; and (3) to study compliance in the community where the program was offered. A total of 11,824 women had mammography at a unit cost of U.S. $32.66. Computerized analysis revealed that (1) 11% of women had known primary risk factors; (2) findings on mammograms were interpreted as abnormal in 9% of screening examinations; (3) breast cancers were confirmed in 47 (22%) of 211 patients who had biopsies, and 87% of these were stage 0-1. The overall cancer detection rate was four per 1000, with five per 1000 for women who had not had mammography in the preceding 2 years and one per 1000 for women who had had mammography in the past 2 years. The results show that screening mammography can be conducted at low cost. Data collection and analysis and compliance were sufficiently convincing to initiate province-wide expansion.

Adult↗

PubMed1998

Financial analysis of savings from telemedicine in Ohio's prison system.

The Ohio Department of Rehabilitation and Corrections (ODRC) implemented a telemedicine pilot project in March of 1995. The project brought together the Southern Ohio Correctional facility in Lucasville, the Corrections Medical Center in Columbus, and The Ohio State University Medical Center, also located in Columbus. Its purpose was to evaluate the use of two-way interactive video for the delivery of health services. With two-way interactive video, physicians in one location established audio and video links with inmates hundreds of miles away. Data were collected on the potential savings as a result of telemedicine usage in the Ohio prison system. Costs associated with telemedicine and those incurred without telemedicine were determined on per-consult basis for comparison. The cost for a medical consult to be performed at the Corrections Medical Center averaged $263.51 per inmate. The cost for a medical consult via telemedicine varied from month to month, depending on the utilization volume. The ODRC experienced savings for telemedicine usage when 129 or more consults were performed each quarter. During the third quarter, 145 telemedicine consults were performed. The cost per consult for telemedicine usage during this quarter was $255.19. There was a savings of $8.48 per consult, resulting in a quarterly savings of $1206. As the utilization of telemedicine continued to increase in the fourth quarter, the amount of savings increased.

Continuity of Patient Care↗

PubMed1997

Phototherapy for patients with Alzheimer disease with disturbed sleep patterns: results of a community-based pilot study.

We examined the entraining effects of phototherapy delivered by light visors on disturbed sleep patterns of community-dwelling research subjects with Alzheimer disease (AD). The pilot project used a single subject design and activity monitoring as the primary outcome measures. The protocol consisted of a 5-day baseline monitoring period, followed by 10 consecutive days of phototherapy (2,000 lux of full spectrum bright light) delivered by light visors for 2 hours each morning; this was followed by an additional 14 days of activity monitoring. Cosinor analyses found no consistent changes in acrophase, mesor, or amplitude. Observed changes in acrophase were consistent with phase advancement of the rest-activity cycle and consistent with the biological intervention. Changes in the number of nighttime awakenings were not found. One subject had a significant increase in total sleep time, whereas another had a significant decrease in total sleep time. Failure to find a consistent biological effect of light on AD subjects may be secondary to: (1) insufficient duration of light exposure; (2) timing of light administration (given at a time when circadian rhythm is refractory to the effects of light); (3) advanced stages of AD making the Y circadian pacemaker in the suprachiasmatic nucleus of the hypothalamus insensitive to the biological effects of light; and (4) inadequacy of light visors as a means of providing light.

Activities of Daily Living↗

PubMed1995

Economic impact and clinical benefits of pharmacist involvement on surgical wards.

A one-year pilot project was performed to assess the economic and clinical benefit of pharmacist involvement on the surgical wards of a 600-bed tertiary care, teaching hospital. A total of 405 recommendations were collected with a physician acceptance rate of 90%. From these recommendations, 1416 patient follow-ups were performed to document outcome. The total documented cost avoidance of the pharmacists' activities was $33,265.58. The total annual drug expenditure for the department of surgery declined by $59,662 representing a 9% decrease over the previous year with the greatest decline involving antimicrobials which decreased by $52,587 compared with the previous year. Most of the cost-avoidance in this area was attributable to antimicrobial selection and dosing adjustment in renal impairment. Pharmacist-directed pharmacokinetic monitoring of aminoglycosides resulted in a clinical success rate of 93.8% for treatment regimens and a 6.2% incidence of nephrotoxicity. Housestaff education aimed at improving prescribing practices were identified and provided for select agents including midazolam, ketorolac, vancomycin and aminoglycosides. As well, select recommendations were documented which illustrated the benefit to patient care of pharmacist involvement. Pharmacist involvement on the surgery services produced both financial and clinical benefits.

Canada↗

PubMed2005

Implementation of the European protocol for quality control of the technical aspects of mammography screening in Bulgaria.

The results from the national pilot project on implementation of the European protocol for the quality control (QC) of the technical aspects of mammography screening as well as the European protocol for dosimetry in mammography in Bulgaria are presented. A QC programme for mammography equipment and a standardised measurement protocol were created. The full QC programme was tested on four mammography units of different types and ages. A national survey was performed for entrance surface air kerma (ESAK) on 20 units using a 45 mm PMMA standard phantom. Average glandular dose (AGD) was calculated using the conversion coefficients from the European dosimetry protocol. The survey demonstrated considerable differences in the technical condition of the mammography units that resulted in varying image quality. The measured values of ESAK showed significant variations. Doses for approximately 45% of the units were found to be below the European reference level. The values for AGD ranged from 0.35 to 3.47 mGy. The main problems found were film processing, optical density (OD) control settings and AEC adjustment. The results showed the importance of film OD measurements parallel to dose measurements. The X-ray mammography in the country needs optimisation. Comprehensive quality assurance programme should be adopted in all departments covering permanent QC of the equipment, image quality and breast dose.

Breast↗

PubMed2005

Industry experience in promoting weekly iron-folic acid supplementation in the Philippines.

After participating in a pilot project under a government-industry partnership to promote the adoption of weekly iron-folic acid supplementation among women of reproductive age in the Philippines in 1998, United Laboratories (UNILAB), the Philippines' largest private pharmaceutical company, decided in April 2002 to launch a weekly iron-folic acid supplement for pregnant and non-pregnant women under the brand name Femina. The business objective set for the Femina brand was to build the category of preventive iron-folic acid supplements in line with the Philippine Department of Health's advocacy on weekly supplementation as an alternate to daily dosing to reduce the prevalence of anemia in the country. The brand was supported with an integrated mix of traditional advertising media with complementary direct-to-consumer educational programs that aimed to create awareness of iron-deficiency anemia, its causes and effects, and the role of weekly intake of iron-folic acid in preventing the condition. Aggressive marketing support for 1 year was successful in creating awareness among the target women. Significant lessons derived from consumers identified opportunity areas that can be further addressed in developing advocacy programs on weekly iron supplementation implemented on a nationwide scale in the future.

Adolescent↗

PubMed2002

A quality improvement curriculum for medical students.

BACKGROUND: Despite frequent recommendations that quality improvement (QI) be incorporated into medical education, reports of this activity are few. A pilot project to develop and implement a curriculum on QI into a family medicine clerkship was conducted in the 1999-2000 academic year. INTERVENTION: A five-part curriculum was developed and implemented on successive weeks of a family medicine clerkship. The curriculum involved students working alone and in small groups. After an orientation to QI principles, students performed a series of chart audits of diabetes care. They then met with QI coordinators from a local health system to review their results. Improvement recommendations were developed and presented to the clinic director. Evaluation included completion of the module, assessment of student knowledge and opinion, and interviews with the QI coordinators. EVALUATION: Two clinic sites and 30 third-year medical (M3) students participated. Each student conducted at least two chart audits, met with the QI coordinators, and developed at least one improvement recommendation. The QI coordinators felt that students were interested in the subject but needed more training in QI principles and more faculty development. Students assessed the curriculum as being moderately effective and useful. DISCUSSION: A curriculum in QI that involved active learning strategies was successfully implemented during a family medicine clerkship. Students viewed the curriculum as being appropriate to their learning. Future efforts should include more work on faculty development and role modeling of QI activity.

Clinical Clerkship↗

PubMed1997

Determinants of 6-12 month postoperative functional status and pain after elective total hip replacement.

OBJECTIVE: The goal of this pilot project was to quantify outcomes of elective total hip replacement through risk adjustment modeling. DESIGN: A retrospective cohort study of patients who underwent elective total hip replacement (THR) during 1991 at the Orthopaedic and Arthritic Hospital in Toronto. STUDY PARTICIPANTS: All patients undergoing elective total hip replacement with a confirmed diagnosis of osteoarthritis were asked to participate in the study; 193 patients agreed. OUTCOME MEASURES: Participants were asked to complete the WOMAC Osteoarthritis Index and the RAND 36-item Health Survey 6 months to 1 year post-operatively. Pre-operative information on pain and functional status was obtained from the patients' medical record. RESULTS: The results indicate that 93% of patients studied reported at least one significant co-morbidity. The mean pre-operative pain score was 7.5 on a 0-10 scale and average change in pain was 4.8. Regression analyses indicate that increased body mass index is associated with lower post-operative functional status and increased post-operative pain. The amount of pain relief the patient was able to obtain pre-operatively using non-surgical interventions was associated with a better outcome.

Activities of Daily Living↗

PubMed2004

Automatic target selection for structural genomics on eukaryotes.

A central goal of structural genomics is to experimentally determine representative structures for all protein families. At least 14 structural genomics pilot projects are currently investigating the feasibility of high-throughput structure determination; the National Institutes of Health funded nine of these in the United States. Initiatives differ in the particular subset of "all families" on which they focus. At the NorthEast Structural Genomics consortium (NESG), we target eukaryotic protein domain families. The automatic target selection procedure has three aims: 1) identify all protein domain families from currently five entirely sequenced eukaryotic target organisms based on their sequence homology, 2) discard those families that can be modeled on the basis of structural information already present in the PDB, and 3) target representatives of the remaining families for structure determination. To guarantee that all members of one family share a common foldlike region, we had to begin by dissecting proteins into structural domain-like regions before clustering. Our hierarchical approach, CHOP, utilizing homology to PrISM, Pfam-A, and SWISS-PROT chopped the 103,796 eukaryotic proteins/ORFs into 247,222 fragments. Of these fragments, 122,999 appeared suitable targets that were grouped into >27,000 singletons and >18,000 multifragment clusters. Thus, our results suggested that it might be necessary to determine >40,000 structures to minimally cover the subset of five eukaryotic proteomes.

Algorithms↗

PubMed2005

The content of morning time conversations between nursing home staff and residents.

AIM: The aim of this paper was to investigate what nursing home staff and residents converse about when they first meet each other in the morning and to investigate who starts the conversation. It is a pilot project about communication in a nursing home in Sweden and a basis for a practice development programme. BACKGROUND: Studies in Sweden have shown that nurse assistants working in care of the older people felt they had too little training in how to communicate. Communicative behaviour influences patients, but little is known about the content of morning time communication in nursing homes. METHOD: Non-participant observation of 18 staff was carried out using an observation schema. Content analysis was performed. RESULTS: The findings were that it was the staff who initiated conversation and chose the content of conversation. The most common topic in morning time conversation was residents' health and sickness. CONCLUSION: Staff in nursing homes, both nurses and nurse assistants need to reflect on their interaction with residents and be conscious of their important role because they create the climate on the ward through conversation. Further studies are needed in order to explore residents' opinions of what the content of a good communication could be and also to find out how nurses and other staff members' communication with residents could be improved. Relevance to clinical practice. Staff need more training and knowledge about how to communicate with older people.

Adult↗

PubMed1997

Risk of tuberculosis transmission in dentistry. Results of a retrospective chart review.

This pilot project was conducted for the purpose of performing a retrospective chart review on selected clients and using the results for evaluating purified protein derivative (PPD) conversion rates among the student population. The occupational risk of exposure to active tuberculosis was assessed in a large dental educational setting. Charts of clients seen in the College's Oral Medicine Clinic, referred out for health care consultation for one of several reasons potentially associated with active tuberculosis disease over a 1 year period, were reviewed. Data sources included the medical consultation log and the tuberculosis log, which were maintained by faculty in the Oral Medicine Clinic. Ninety-six clients met the authors' criteria. However, compiling data was severely hampered for two reasons: missing charts (19 of 96, or 19.8%) and non-returning clients (55, or 57%). Four clients with potentially active cases of tuberculosis were identified. Follow up revealed, however, that none of these four clients was contagious when seen at the Dental Center. The protocol and definition recommended by the Centers for Disease Control and Prevention 1994 Guidelines, and the results of PPD screening and chart audit conducted by the authors, suggest that the employees and students of the College of Dentistry are at low risk for workplace exposure to active tuberculosis.

Adolescent↗

PubMedDate not supplied

Report of a continuous quality improvement program in a tertiary-care medical center.

OBJECTIVE/DESIGN: Changes in the health system in Israel have led to an increasingly competitive environment, decentralization, and economic constraints. We evaluated the use of a continuous quality improvement (CQI) program. SETTING: Three medical departments and three administrative wings in a 700-bed, tertiary-care, teaching hospital in Jerusalem. INTERVENTION: The program was planned as a short-term pilot project for long-term extension throughout the institution. The objectives were improved institutional efficiency and provision for change. The program was implemented through departmental improvement teams under a hospital management team and a steering committee, guided by an outside consultant firm. RESULTS: The Orthopedics Department experienced a 3-day reduction in patient length of stay (P<.008). The Emergency Room experienced a significant reduction in time to discharge through reduced waiting times for consulting physicians (P<.007) and for blood tests (P<.001). The Office of Patient Admissions streamlined procedures for admission and discharge, accomplished physical restructuring, and installed a telephone hot line. In Medical Records, a significant improvement in records availability was realized. In Outpatient Clinics, reductions in waiting times were realized, but were not statistically significant. The Supply Division showed savings on monthly orders and increased efficiency, with 95% of orders completed promptly and accurately. CONCLUSIONS: Several factors were identified as essential to the success of the program, including staff cooperation and commitment. We conclude that the CQI program was a useful tool to help our tertiary-care medical center adjust to changes in the Israeli healthcare system. It also served as a valid vehicle for maintaining and furthering optimal quality of care.

Emergency Service, Hospital↗

PubMed1984

Multimodality approach to treatment of carcinoma of the esophagus.

We conducted a combined treatment pilot project in 17 patients with squamous cell carcinoma of the thoracic esophagus. Thirteen of the patients initially had stage I or II disease, and four had stage III disease. Each patient received three cycles of chemotherapy consisting of a high dose of cisplatin (100 mg/sq m), followed by continuous infusion of fluorouracil (1,000 mg/sq m/day for five days). Thirteen patients had a favorable response to the chemotherapy, and ten of the 11 responding patients with stage I or II disease were offered surgical resection. Total thoracic esophagectomies and cervical gastroesophagostomies were done in the six patients who accepted the surgical recommendation. Pathologically, five patients had stage I disease, and one had stage III disease (even in this patient the local tumor was confined within the wall of the esophagus). All six patients were alive, without evidence of disease, four to 34 months after diagnosis. Two patients with stage II disease had tumor progression, as did two of the four patients with stage III disease. Three of the nonresponding patients died of their disease two to seven months after diagnosis. The eight remaining patients, three of whom received irradiation after chemotherapy, were alive, but with evidence of persistent disease, one to seven months after entrance into the study.

Aged↗

PubMed1997

Results of a pilot study of endoscopic screening of first degree relatives of colorectal cancer patients in Italy.

STUDY OBJECTIVE: Screening recommendations for colorectal cancer include sigmoidoscopy in asymptomatic, average risk persons aged 50 and over and colonoscopy every three to five years in high risk groups. Little is known about the eligible population's compliance with endoscopic screening. This is the first Italian report of an endoscopic screening programme for colorectal cancer patients' relatives. DESIGN: In 1986, a pilot project for colorectal cancer screening by endoscopy in high risk subjects was started in the Desio (Milan, Italy) public health service region. The results obtained after seven years are described. SETTING: The names of 536 inhabitants with colorectal cancer diagnosed between January 1975 and December 1984 and their relatives' addresses were obtained from the Regione Lombardia Health System records and from the municipal registry offices respectively. PARTICIPANTS: From October 1986 to October 1993, 778 first degree relatives aged 20-75 were offered colonoscopy. MAIN RESULTS: After seven years, 233 (29.9%) had undergone endoscopic examination, mostly up to the splenic flexure. Being > 60 in age at the start of the programme negatively affected the participation (p < 0.05). Two cancers were detected and adenomatous polyps were found in another 24 of those screened (frequencies 0.9% and 10.3% respectively). Male gender (p < 0.05), increasing age in males (p < 0.01), and two or more affected relatives in females (p < 0.01) positively affected the frequency of polyps detection. CONCLUSION: These results suggest that about 30% of the eligible population would comply at least with sigmoidoscopic screening. The collaboration of family doctors and more widespread public information about the ability to cure colorectal cancer are necessary for better compliance.

Adenomatous Polyposis Coli↗

PubMed1997

Human papillomavirus type in anal epithelial lesions is influenced by human immunodeficiency virus.

BACKGROUND AND OBJECTIVE: Infection with human immunodeficiency virus (HIV) increases the risk for human papillomavirus (HPV)-associated genital neoplasia. Human immunodeficiency virus-infected patients also have higher rates of treatment failure and more rapid neoplastic progression. Impaired immune function does not entirely explain these clinical observations. This pilot project was designed to investigate the hypothesis that HIV infection is associated with changes in HPV type and integration within anogenital lesions that could explain the increased risk of neoplastic progression. METHODS: Anal neoplastic lesions from patients with and without HIV infection were analyzed for the presence, type, and integration status of HPV by colorimetric in situ hybridization. Tissue localization of HIV was evaluated by p24 immunohistochemistry and HIV-1 DNA polymerase chain reaction. Results for matched histology were compared for the two patient groups. RESULTS: For all lesions, the presence of high-risk HPV types and multiple HPV types was strongly associated with HIV infection (P = .003 and .0003, respectively). For lesions with matched histology there was no association of HPV integration with HIV status. Tissue localization of HIV did not significantly influence HPV type or integration. CONCLUSIONS: The presence of high-risk HPV types and multiple types within low-grade lesions may explain the increased risk of neoplastic progression in HIV patients. Colocalization of HIV and HPV does not appear to be required for this effect. There is no evidence that HPV integration is influenced by HIV infection.

Adolescent↗

PubMed2001

Networked information and clinical decision making: the experience of Birmingham Heartlands and Solihull National Health Service Trust (Teaching).

OBJECTIVES: The paper presents the findings of the evaluation of a pilot project to introduce networked information resources into clinical settings in a large NHS Trust and describes the subsequent developments of networked information within the Trust. DESIGN: The main purpose of the evaluation was to ascertain whether access to electronic journals and other resources via a networked system offered real benefits to clinical effectiveness. SETTING: Birmingham Heartlands and Solihull NHS Trust (Teaching). SUBJECTS: Medical and administrative staff at Birmingham and Solihull NHS Trust. RESULTS: The main conclusions of the evaluation were that: (1) appropriate location of terminals close to clinical areas is vital to ensure that best use is made of networked information resources; (2) rapid access to networked information services saves staff time and allows educational opportunities to be realized; (3) networked information resources enhance rather than replace existing information sources; (4) training and support are essential to maximizing the benefits of networked information services, and (5) such a network can support clinical decision making. CONCLUSIONS: With the development of clinical governance, the clinical network has assumed even greater importance within the Trust. Timely and easy access to clinical and educational information is crucial to the practice of evidence-based medicine which underpins high quality clinical care. The evaluation led to a number of recommendations which have since been used to develop the clinical network at Birmingham Heartlands and Solihull NHS Trust.

Adult↗

PubMed2002

[Telecommunication and telepathology. New diagnostic routes for orthopaedics and orthopaedic pathology].

In a pilot project of the Department of Bone Pathology of the University of Hamburg and the Orthopaedic Department of the University of Heidelberg, the cases of 121 patients with suspicion of a primary bone tumour have been discussed at weekly interdisciplinary conferences during the period from July 2001 to May 2002., The consequent differential diagnoses were made prior to the biopsy, the optimal location of the biopsy and the further strategy was determined according to the guidelines of the international bone tumour centres. The latter includes the decision if a conventional biopsy or a intraoperative pathology examination on frozen sections should be performed. In 27 cases an intraoperative pathology examination was performed and then assessed in Hamburg. In 24 cases this diagnosis was identical with the final diagnosis. In three cases no definitive diagnosis could be made from the frozen sections. Additionally the pathohistological diagnoses of the cases of the previous week have been discussed in the video-conferences. Through this a unusually close interdisciplinary cooperation over a large distance has evolved, that is highly appreciated especially by the young and less experienced colleagues at the department of bone pathology and the orthopaedic department in Heidelberg. The awareness of the potential and limitations of a medical subject leads to an improved safety in the diagnostic process for bone tumours. The interdisciplinary discussion of all aspects of the diseases may also optimise the therapy of bone tumours.

Bone Neoplasms↗