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PubMed1998

FORUM: Partnership Forum Framework: Participative Framework for Protected Area Outreach.

/ Contemporary trends in natural resource management are reviewed, with specific reference to the shift in conservation management strategies away from law enforcement-based strategies towards strategies aimed at facilitating local community participation in the management of natural resources. This review lays a foundation for the presentation of a conceptual framework, the partnership forum framework, for the planning, implementation, and evaluationof protected area outreach programmes. The framework proposes that protected areas should function as integral components of the local social, economic, and environmental systems and that the integration of the protected area into these systems should be managed through comanagement institutions. The establishment of such institutions is discussed, and it is argued that the development of comanagement institutions can be characterized into four progressive phases: a preliminary communication phase, a problem-solving phase, a pilot project phase, and a comanagement phase. The framework proposes that during the three initial phases the partnership forum members will develop management procedures that they will use during the comanagement phase. The framework is presented as a design skeleton around which the site-specific characteristics of specific protected area outreach programs will combine to form an outreach program, i.e., the framework is process rather than project based.KEY WORDS: Sub-Saharan Africa; Integrated conservation and development

Journal Article↗
PubMed2004

[A new possibility for imaging the lacrimal draining system. Three-dimensional rotation dacryocystography].

BACKGROUND: The aim was to investigate the applicability of a 3D rotation angiography system for imaging lesions of the lacrimal draining system. PATIENTS AND METHODS: Five patients with stenosis of the lacrimal system were enrolled in this pilot project to undergo a distension dacryocystography as 3D rotation angiography. The 3D reconstructions are derived from 100 radiographic projection images, which are obtained during a 240 degrees rotation of an angiographic C-arm. Volume-rendering techniques show plastic representations of the contrast-enhanced ductal system with the possibility of additional virtual dacryoendoscopy. The adjacent bony structures and the nasal cavity can also be visualized by special window settings and cuts through the 3D data set. Exact calibration of the X-ray system allows for precise measurements of distances. A sufficient 3D representation needs permanent injection of contrast material for about 5.5 s. Outpatient examination under surface anesthesia is well tolerated. RESULTS: The high-resolution 3D reconstructions show detailed images of lesions of the endoluminal surface and give a plastic impression of the site of obstructions. In contrast to normal DSA dacryocystography, the contrast-enhanced ductal system, the adjacent bone, and even the soft tissues of the nasal cavity are demonstrated simultaneously. A disadvantage is an incomplete representation of the residual lumen of subtotal stenoses and the one and one-half times higher radiation dose compared to normal dacryocystography. CONCLUSION: Dacryocystography with 3D rotation angiography opens a new dimension of minimally invasive imaging of the lacrimal drainage system, which may be helpful for exact planning of dacryocystorhinostomy procedures.

Contrast Media↗
PubMed2003

Use of a supportive care team for screening and preemptive intervention among multiple myeloma patients receiving stem cell transplantation.

Although peripheral blood stem-cell transplantation (PBSCT) has assumed a growing role in the treatment of multiple myeloma, very few studies have examined the functional and quality-of-life changes experienced by myeloma patients in the transplant setting. Multiple myeloma is characterized by a range of debilitating physical and psychosocial symptoms. However, supportive care needs for patients with this disease are often overlooked or managed only episodically. The current study pilot-tested an interdisciplinary supportive care program designed to provide screening and identify patients at risk early in the course of care. Participants in this pilot project were 61 patients with hematological disorders, predominantly multiple myeloma (85.3%), evaluated during their initial workup. Mean time since diagnosis was 7.4 months. Participants were interviewed by an advanced-practice nurse and completed standardized measures of heath-related quality of life (SF-12), fatigue (POMS-Fatigue), nutritional risk (PG-SGA), pain (Brief Pain Inventory), emotional functioning (Hospital Anxiety and Depression Scale), and sexual concerns (FACIT). Results indicated that difficulties were prevalent across multiple functional domains; 61.4% of patients displayed significant nutritional deficits. Physical functioning was below age-adjusted national norms for 53.5%. Moderate-to-severe fatigue was reported by 39.0%, and one third experienced clinically significant levels of pain, impaired daily functioning associated with pain, and emotional distress. A similar proportion of respondents (33.9%) reported disrupted sexual functioning and difficulty with body image. Findings suggest that early, systematic screening is feasible in a busy transplant center. The prevalence of symptoms highlights the importance of providing screening and proactive intervention for multiple myeloma patients early in the course of treatment and even prior to beginning protocols for high-dose therapy and transplantation.

Aged↗
PubMed2006

An economic comparison of risperidone and olanzapine use within an integrated managed mental health program.

This study assessed differences in total mental health care costs for 1 year following initiation of risperidone or olanzapine in individuals within NorthSTAR, an integrated managed mental health pilot project. A retrospective database analysis of individuals with schizophrenia or schizoaffective disorder and newly started on either agent was conducted. Antipsychotic medication costs were significantly lower for individuals prescribed risperidone than olanzapine (1763 dollars versus 2582 dollars; p<0.001). Individuals prescribed risperidone had lower (but not significant) expenditures for mental health services (4714 dollars versus 5077 dollars; p=0.792), as well as total mental health care costs (7407 dollars versus 9011 dollars; p=0.255).

Antipsychotic Agents↗
PubMed2006

Comparative analysis of the risk-handling procedures for gene technology applications in medical and plant science.

In this paper we analyse how the risks associated with research on transgenic plants are regulated in Sweden. The paper outlines the way in which pilot projects in the plant sciences are overseen in Sweden, and discusses the international and national background to the current regulatory system. The historical, and hitherto unexplored, reasons for the evolution of current administrative and legislative procedures in plant science are of particular interest. Specifically, we discuss similarities and differences in the regulation of medicine and plant science, and we examine the tendency towards dichotomizing risk--focusing on social/ethical risks in medicine and biological risks in plant science. The context of this article is the Synpraxia research project, an inter-disciplinary program combining expertise in sciences and the humanities.

Biomedical Technology↗
PubMed1994

Screening mammography in British Columbia: 1988-1993.

Breast carcinoma continues to be the most common cause of death due to malignancy for women in Canada. The Screening Mammography Program of British Columbia, the first provincial screening program in Canada, was established in 1988 with funding from the Ministry of Health to diagnose the disease as early as possible. The program has grown rapidly, increasing from 7,100 examinations in a pilot project in 1988 to 89,390 examinations between April 1, 1992 and March 31, 1993 for a cumulative total of 201,937 examinations of 128,325 women, and it now offers free screening mammography throughout the province. The program has maintained quality control standards and low cost per mammogram while developing different operational models for the differing requirements of the various areas of the province. Similar proportions of women older or younger than age 50 have favourable characteristics such as small size of tumor (median: 15 to 16 mm) and negative lymph nodes (86% to 89%).

Breast Neoplasms↗
PubMed1987

Care of the injured in the Third World--what can we learn?

There is a need to put more emphasis on primary surgical care centred on provincial and district hospitals in the developing world using simple equipment which needs little maintenance and low running costs. The general duty doctors and paramedicals who are at the first point of contact with the patient, need practical on-site instruction in dealing with common surgical emergencies, of which injury forms a large part. To achieve this change in emphasis, provision should be made for surgical trainees and experienced surgeons from the United Kingdom or else where to work in selected provincial and district hospitals where support services can be adequately provided. The experience they would gain, would in turn benefit their patients in the National Health Service. If this activity is to have any chance of success, the training and research potential must be recognized by the Royal Colleges as valid experience in higher surgical training programmes. The National Health Service and the Health Authorities must accept these periods overseas as integral parts of a career in the National Health Service. This would include provision for superannuation, encouraging proleptic appointments to consultant posts, and secondment or early retirement of Consultants. Funding should be sought from international and national agencies for a pilot project based on a direct link between a district hospital in this country and a selected district or provincial hospital in a developing country.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa, Eastern↗
PubMed1993

Measuring university student satisfaction with a campus family planning clinic in Costa Rica.

Family planning clinics for university students play a valuable role in promoting health. This research project, a pilot study among women students who sought family planning services through a Costa Rican university clinic, introduced student evaluation of the family planning clinic, documented services provided in family planning visits, and identified issues for further study. Aged 18-33 years, the 53 respondents (a convenient sample) who completed a self-administered questionnaire were mostly (64%) single; all were sexually active; and 78% wished to have children (or more children) some day. Though all were sexually active at the time of their visit, only 62% were currently using contraception, and fewer than half of these were using effective methods. Nearly all students (96%) reported they learned new information during their appointment, and many received screening tests and examinations. Respondents rated their satisfaction with aspects of clinic service as high, citing the clinic's low visibility on campus as the most important area for improvement. All of the students said they would definitely return (85%) or would consider returning (15%). The results support the continuance of such a clinic on the campus, as well as of the practice of student evaluation. This collaborative study demonstrated areas for future research and stimulated interest in the university clinic as a research setting.

Adolescent↗
PubMed1982

A model system for mass spectrometric sequencing of orthophthalaldehyde peptide derivatives.

Presented is a pilot project describing a new strategy for mass spectrometric peptide sequencing. Using orthophthalaldehyde (OPA), two peptides were derivatized and their fluorescent adducts isolated using reversed phase high performance liquid chromatography. The OPA-peptides were permethylated and the derivatized molecules subjected to direct probe mass spectral analysis. The spectra obtained from OPA-peptides was analogous to those observed for standard N-acyl permethyl derivatives enabling the complete sequence of the peptides to be determined.

Aldehydes↗
PubMed1977

Anticoagulation in urologic surgery.

The present report describes a pilot project to apply the principle of minidose heparinization to patients undergoing prostatectomy, comparing a control group of 50 prostatectomies treated in conventional fashion to a study group of 43 prostatectomies treated with minidose heparinization. Results of the study indicate that perioperative minidose heparinization in patients undergoing prostatectomy is associated with longer hospitalization, greater need for blood transfusion, greater degree of immediate and delayed postoperative bleeding, and a higher incidence of "rebound" pulmonary embolization after cessation of heparin, than in patients treated in conventional fashion.

Heparin↗
PubMed1991

Quality of life issues in chronic otitis media with effusion: parameters for future study.

This pilot project studied 61 children with chronic otitis media with effusion. The 12-month period prior to ventilation tube surgery was compared with the 12 months after surgery with respect to numbers of health care visits, the use of antibiotics, parental perceptions of hearing and speech problems, and other selected parameters. Significant decreases were found in total health care visits (mean decrease: 6.18 visits, P less than 0.001). Ear-related health care visits also decreased significantly (mean decrease = 10.93, P less than 0.001). Total health care visits correlated strongly with visits for ear problems both before and after surgery (r = 0.4474, P less than 0.001). Usage of antibiotics significantly decreased. Parental reports concerning the issues of secondary speech and hearing problems raised questions for additional study. In addition, the qualitative comments offered by parents suggest the breadth of impact of chronic otitis media with effusion in this patient population, and point the direction for future research.

Child↗
PubMedDate not supplied

Data analysis needs for health sector reform.

This paper addresses the role of information in health policy reform. It recognizes that reform can be based on data, but that there are other influences on health policy. The steps involved in making policy, including problem identification, comparison of solutions, policy adoption, implementation, and amendment, all require information. When information is unavailable for any of these steps, the policy process sometimes proceeds without it. The policy makers must make difficult choices regarding the potential benefit of comprehensive information to the policy outcome versus the potential drawbacks, in terms of time and cost, of seeking the missing information. Different areas where data are needed within health policy are enumerated, as are sources of health policy data, and examples of strategies are given. Finally, three case studies are presented, highlighting the use of information in policy making. The National Epidemiology Board in Thailand commissioned studies by experts on relevant policy topics. It had a substantial impact on changing policies in the areas of AIDS control, iodine deficiency, essential drugs and vaccination. The attempt at decentralizing health administration to the province level in Papua New Guinea is the second example presented. At the time of the evaluation, this effort had not yet attained its objectives of improving the health of the people, nor had it reduced costs or lessened inequity among regions. If this reform had been tested in a pilot project, its problems may have been discovered at an earlier stage of implementation when they would have been easier to correct. The final case concerns the UNICEF child survival interventions during the 1980s. These interventions were chosen based on cost-effectiveness analysis and were successfully implemented. The use of cost-effectiveness analysis in prioritizing interventions is one example of the way in which information can improve policy and health outcomes.

Data Collection↗
PubMed1989

Implementing change in nursing education.

Nursing education faces a period of change within the next decade. Blueprints for educational change have been developed in the United Kingdom, Australia and Canada. Change in education needs to be planned rather than a reaction to internal or external pressures. Blueprints for education should extend beyond the entry to practice level and include specialisation, baccalaureate and graduate education. A plan for practice for the future should encompass both hospital and community based health care. Nursing practitioners as well as nurse educators need to be involved in educational planning. In light of the changing student body and societal needs, consideration must be given to the development of a variety of models for nursing education. Prior to instituting wholesale change, pilot projects need to be developed and tested. Plans for preparing adult educators competent in the use of modern technology, are a necessary adjunct to new programme development. Education also needs to be available to the practising nurse to enable professional growth. Professional associations must play a role in educating nurses, other professionals and consumers of nursing care on the changing roles and functions of the nurse, as movement is made toward the goal of 'Health For All By The Year 2000'.

Education, Nursing↗
PubMed1986

Preliminary toxicity findings in dogs and rodents given the iron chelator ethylenediamine-N,N'-bis(2-hydroxyphenylacetic acid) (EDHPA).

Because of a projected pilot study with EDHPA in Cooley's anemia patients, animal studies with emphasis on reversibility of potential toxic signs were performed. Young dogs were treated iv with 6-18 mg/kg or orally with 30-240 mg/kg for 14 days followed by a 16-day recovery period. Drug-induced emesis, elevated BUN changes in kidney, spleen, and thymus weights diminished during recovery. One deceased dog exhibited nephrotoxicity consisting of tubular necrosis and deposition of the iron-EDHPA complex. The latter was observed in the excreta of survivors but kidney damage was not evident. Atrophy of the spleen and thymus in the deceased dog was consistent with less intense organ weight changes in recovered survivors. In the absence of morphologic changes after recovery, the precise effect on the immune system is unknown. The iv LD50 was 53 mg/kg for rats and mice. No rodent deaths occurred at an oral dose of 6000 mg/kg. An elevated BUN and changes in kidney, spleen, and thymus weights were confirmed in rodents given iv doses of 5-20 mg/kg or oral doses of 150-600 mg/kg for 5 days. It is cautioned that during the use of EDHPA derivatives that the functions of the renal and immune systems be monitored.

Animals↗
PubMed1990

Health, attitudes and beliefs of working women.

A cross-sectional case-control study was conducted comparing working women employed by the Women's Work Centres of the Orangi Pilot Project with non-working matched controls. Differences in the knowledge, attitude and practice of several variables were elicited. Working women's families had significantly higher immunization rates, 73% vs 55%, and shorter duration of illness, 5.9 days vs 8.8 days, compared to controls. More working than non-working women supported contraception, 100% vs 74%, desired equal education for sons and daughters (P less than 0.005), and had a dominant role in family health decision-making, 48% vs 12%. We conclude that these working women in Orangi have a different set of beliefs and practices than non-working women and this may be one important factor responsible for the lower morbidity in their children.

Attitude↗
PubMed1982

Possible effects of emergency caesarian section on the mother--child relationship.

This study was a pilot project to explore the mother-child relationship in a group of mothers delivered by emergency caesarian section and to compare them with a control group of mothers delivered by normal vaginal delivery. The mothers delivered by caesarian section had a period of amnesia after the birth so that their recollected first contact with their baby was later than the control group and at one month the mothers delivered by caesarian section had much less eye-to-eye contact with their baby. There were differences in attitudes and behaviour between the caesarian and control group of mothers at one month and at one year. The mothers delivered by caesarian section had more doubts about their capacity to care for their babies, were more depressed with symptoms and felt their babies did not become a person until later. There were no differences between the two groups of children in general behaviour and development although the babies delivered by caesarian section were larger and this difference persisted through to one year. This caesarian group of mothers found adjusting to the birth of their first baby and parenthood more difficult than the control group of mothers.

Adult↗
PubMed1991

Yeast artificial chromosome-based genome mapping: some lessons from Xq24-q28.

Yeast artificial chromosomes (YACs) have recently provided a potential route to long-range coverage of complex genomes in contiguous cloned DNA. In a pilot project for 50 Mb (1.5% of the human genome), a variety of techniques have been applied to assemble Xq24-q28 YAC contigs up to 8 Mb in length and assess their quality. The results indicate the relative strength of several approaches and support the adequacy of YAC-based methods for mapping the human genome.

Chromosome Mapping↗
PubMed1990

Efficiency of a computer network in the administrative and medical field of cardiac surgery. Concept of and experience with a departmental system.

We report on a pilot project implementing electronic data processing (EDP) in the Department of Cardiac Surgery of the University of Heidelberg, based on a concept of complete integration of a medical database system into everyday clinical routine. A computer network was installed and has been in use since August 1988 as a department system supporting both the administrative and the medical side of the department (documentation, information, research, archives, organization, secretarial office, billing, statistics and communication). With a computer-assisted documentation system and standardized data acquisition, nearly 80% of letters and reports on operations are written automatically without any further need for dictation. Automatic computer controlled follow-up has been initiated to cover all patients operated on in our hospital. The complete integration of a new method of clinical documentation and EDP into everyday clinical routine and the extensive use of computer-derived information have proved to be significant advances. Our practice of computer-assisted information management and departmental organization serves the patient by; (1) providing up-to-date valid information for the clinical staff; (2) establishing and stabilizing contact and communication with physicians elsewhere, e.g. cardiologists; (3) facilitating pre- and postoperative contact with patients; (4) helping to optimize medical treatment by routine statistical data analysis (quality assurance); (5) creating a clear and logical computer-assisted departmental organizational structure; (6) permitting long-term evaluation of operative results based on a standardized computer-controlled follow-up procedure; (7) improving the quality of medical and administrative data.

Cardiac Surgical Procedures↗