Pre-intervention Analysis Research Articles

212How ‘Older-Person-Friendly’ is our General Medical Ward? A Cross Sectional Study and Pre-Intervention analysis

212How ‘Older-Person-Friendly’ is our General Medical Ward? A Cross Sectional Study and Pre-Intervention analysis

Isotonic versus isometric exercises on core muscle in patients with low back pain

To observe the effects of isotonic and isometric exercises with conservative therapy on core muscle in patients with low back pain. Twenty participants, 10 male and 10 female aged between 30 and 50 years suffering from low back pain were taken. Sample was divided into two groups, group A isometric exercises and group B isotonic exercises, both the group received conservative therapy of transcutaneous electrical neuromuscular stimulation and hot pack. Outcomes measure Visual Analog Scale (VAS) and Modified Oswestry Disability Index (MODI) were used the pre-treatment and at the end of 4 weeks. There was no significant differences for the demographic data between the groups. Both group were comparable in term of age, height, weight, and BMI. Intergroup analysis of VAS score was done using Mann–Whitney test. Pre interventional analysis showed no significant differences between group A and group B ( P = 0.6469) and also post-intervention analysis showed no significant difference between group A and group B ( P = 0.3525). Analysis of MODI score was done using Mann–Whitney test, there was significant difference between group A (mean = 9.90, SD = 5.87) and group B (mean = 19.39, SD = 7.27) in their posttest measurements ( P = 0.002). Experiment of results showed isotonic and isometric exercises were effective in all measured variables (pain intensity and functional disability) in treatment of patients with low back pain. There was no difference between the use isotonic and isometric in decrease pain intensity, but there were significant differences in improvement functional disability where isometric exercises allow a greater improvement in functional disability than isotonic in low back pain.

Green grabbing debate and Madagascar: did we learn anything?

Green grabbing is a scholarly critique of conservation efforts. Scholars of green grabbing argue that many conservation strategies - such as the designation of protected areas and the creation of market-based conservation mechanisms - are designed with the intent to dispossess local peoples and capitalise natural assets. First, to provide some context on the green grabbing debate, we discuss the trade-offs between conservation and development objectives. In addition, we refer briefly to the broader land grabbing debate of which green grabbing is a sub-component. Second, we question the theoretical foundations of green grabbing, the concepts of primitive accumulation and commodification of nature. Third, we compare data collected by the green grabbing scholars and conservation NGOs from the very same site in Madagascar. We conclude that rigorous post-intervention stakeholder analysis, rather than pre-intervention analysis, is needed to effectively evaluate conservation outcomes, and that research on conservation strategies should pay attention to the role of the state, and the heterogeneity of local communities.

Green grabbing debate and Madagascar: did we learn anything?

Green grabbing is a scholarly critique of conservation efforts. Scholars of green grabbing argue that many conservation strategies - such as the designation of protected areas and the creation of market-based conservation mechanisms - are designed with the intent to dispossess local peoples and capitalise natural assets. First, to provide some context on the green grabbing debate, we discuss the trade-offs between conservation and development objectives. In addition, we refer briefly to the broader land grabbing debate of which green grabbing is a sub-component. Second, we question the theoretical foundations of green grabbing, the concepts of primitive accumulation and commodification of nature. Third, we compare data collected by the green grabbing scholars and conservation NGOs from the very same site in Madagascar. We conclude that rigorous post-intervention stakeholder analysis, rather than pre-intervention analysis, is needed to effectively evaluate conservation outcomes, and that research on conservation strategies should pay attention to the role of the state, and the heterogeneity of local communities.

Lean techniques to improve flow of critically ill patients in a health region with its epicenter in the intensive care unit of a reference hospital

ObjectiveTo analyze whether the application of Lean techniques to improve the flow of critically ill patients in a health region with its epicenter in the intensive care unit (ICU) of a reference hospital. DesignObservational study with pre and post intervention analysis. SettingICU of a reference hospital. PatientsWe design projects and a value stream map of flow and compared pre and post intervention. InterventionsWe recorded demographic data, patient transfers by EMS for lack of beds and delay times in the discharge from ICU to ward. Multidisciplinary meetings and perform daily visual panel, with high priority ICU discharge. We promote temporary relocation of critically ill patients in other special areas of the hospital. We performed a professional satisfaction questionnaire with pre and post implementation of process. We make a statistical analysis of pre and post-intervention comparisons. ResultsWe planned for 2013 and progressively implemented in 2014. Analysis of patients entering the critical process flow (1) evaluate patients who must transfer for lack of beds, focusing on a diagnosis: pre 10/22 vs. 3/21 post (p=.045); (2) analysis of time delay in the discharge from the ICU to ward: 360.8±163.9min in the first period vs. 276.7±149.5 in the second (p=.036); and (3) personal professional satisfaction questionnaire, with 6.6±1.5 points pre vs. 7.5±1.1 in post (p=.001). Analysis of indicators such as the ICU acquired infections, length of ICU stay, the rate of re-admissions and mortality, with no significant differences between the two periods. ConclusionsThe application of Lean techniques in the critically ill process had a positive impact on improving patient flow within the health region, noting a decrease of transfers outside the region due to lack of beds, reduced delayed discharge from ICU to conventional ward and increased satisfaction of ICU professionals.

In a single-blind, matched group design: branched-chain amino acid supplementation and resistance training maintains lean body mass during a caloric restricted diet.

BackgroundAthletes and active adults many times have the goal of improving/maintaining fitness while losing weight and this is best achieved by caloric restriction in combination with exercise. However, this poses a risk for lean tissue loss, which can limit performance. Thus, the purpose of this study was to determine the effectiveness of a branched-chain amino acid (BCAA) supplement, in conjunction with heavy resistance training and a carbohydrate caloric-restricted “cut diet” on body composition and muscle fitness.MethodsSeventeen resistance-trained males (21–28 years of age) were randomized to a BCAA group (n = 9) or a carbohydrate (CHO) group (n = 8) who both received their respective supplement during the 8 weeks of a prescribed body building style resistance training protocol. Subjects were prescribed a hypocaloric diet (based upon pre-intervention analysis) that was to be followed during the study.ResultsThe BCAA group lost fat mass (−0.05 ± 0.08 kg;p < .05) and maintained lean mass, while the CHO group lost lean mass (−0.90 ± 0.06 kg; p < .05) and body mass (−2.3 ± 0.7 kg; p < .05). Both groups increased 1RM squat, but the increase in the BCAA group (15.1 ± 2.2 kg; p < .05)was greater (P < 0.05) than the CHO group. The BCAA group increased 1RM bench press (7.1 ± 1.6 kg; P < 0.05), while the CHO group decreased strength (−3.7 ± 2.3 kg; P < 0.05). The only change in muscular endurance was an increase in repetitions to fatigue (5.3 ± 0.2; p < .05) in the CHO group.ConclusionThese results show that BCAA supplementation in trained individuals performing resistance training while on a hypocaloric diet can maintain lean mass and preserve skeletal muscle performance while losing fat mass.

Assessment of Drug Prescribing Pattern and Cost Analysis for Skin Disease in Dermatological Department of Tertiary Care Hospital: An Interventional Study

Objective: To study and assess the prescribing pattern and cost analysis in dermatology outpatient department (OPD) in a tertiary care hospital. Methods: Data was collected for three months by reviewing OPD cards and prescription data and rationality and cost were assessed by WHO/DSPRUD Indicators and WHO Recommended clinical guidelines 2013 (Diagnosis and treatment manual). Average per prescription cost was calculated. For cost analysis, we used Cost-Minimization method. Although we only considered total drug treatment cost. All drugs cost were calculated in Indian rupee from the Current Index of Medical Specialties (CIMS). For each drug cost was calculated in as either cost per μg, mg, gm or ml as appropriate. We further divided total drug cost into two parts, first the total cost of drugs which are purchased from Paid pharmacy shops and second, the total cost of drugs which are freely available in Free OPD pharmacy. Findings: Pre and post interventional data analysis showed that, average no. of drugs prescribed was 2.95/ prescription and 2.62/prescription respectively. Before Intervention average cost of drugs per prescription was found to be 376.97 INR and after intervention average cost of drugs per prescription was found to be 299.20 INR. During pre-intervention study period, combination preparations (28.54%) were the most commonly prescribed class of drugs followed by others(Multivitamins, topical Vasodialators, antipyretic, retinoid etc.) (18.86%) and antihistamines (17.69%) while during post-intervention study period, combination preparations (32.37%) were the most commonly prescribed class of drugs followed by antifungals (19.42%) and antihistamines (17.62%). Conclusion: Clinical pharmacist can conduct such periodic audit to rationalize the prescription, reduce errors and suggest a cost effective management of skin diseases. The programs should conduct into the hospital for Physicians and Post graduate students, to show comparison and benefits of generic versus branded drugs also to improve generic prescribing practice and to make therapy economic to the patients.

Técnicas «Lean» para la mejora del flujo de los pacientes críticos de una región sanitaria con epicentro en el servicio de medicina intensiva de un hospital de referencia

ObjectiveTo analyze whether the application of Lean techniques to improve the flow of critically ill patients in a health region with its epicenter in the intensive care unit (ICU) of a reference hospital. DesignObservational study with pre and post intervention analysis. SettingICU of a reference hospital. PatientsWe design projects and a value stream map of flow and compared pre and post intervention. InterventionsWe recorded demographic data, patient transfers by EMS for lack of beds and delay times in the discharge from ICU to ward. Multidisciplinary meetings and perform daily visual panel, with high priority ICU discharge. We promote temporary relocation of critically ill patients in other special areas of the hospital. We performed a professional satisfaction questionnaire with pre and post implementation of process. We make a statistical analysis of pre and post-intervention comparisons. ResultsWe planned for 2013 and progressively implemented in 2014. Analysis of patients entering the critical process flow 1) evaluate patients who must transfer for lack of beds, focusing on a diagnosis: pre 10/22 vs. 3/21 post (P=.045); 2) analysis of time delay in the discharge from the ICU to ward: 360.8±163.9minutes in the first period vs. 276.7±149.5 in the second (P=.036); and 3) personal professional satisfaction questionnaire, with 6.6±1.5 points pre vs. 7.5±1.1 in post (P=.001). Analysis of indicators such as the ICU acquired infections, length of ICU stay, the rate of re-admissions and mortality, with no significant differences between the two periods. ConclusionsThe application of Lean techniques in the critically ill process had a positive impact on improving patient flow within the health region, noting a decrease of transfers outside the region due to lack of beds, reduced delayed discharge from ICU to conventional ward and increased satisfaction of ICU professionals.

Effects of an Educational Module in Rationalizing Surgical Prophylaxis.

Assessment of current antibiotic prescribing patterns is an important step towards appropriate use of antimicrobial agents. This study was planned to know the surgical prophylaxis practices and the influence of educational intervention. In this educational interventional study, only clean and clean-contaminated surgeries were included. Preinterventional study was done by collecting data regarding the use of surgical prophylaxis in the Department of Surgery. After analyzing the preinterventional data, educational intervention was done. A pretest questionnaire was given to all the surgeons to assess knowledge and practice of surgical prophylaxis in our institute. The questionnaire was designed to collect information regarding the use of prophylactic antibiotic, its duration, time of administration, and prevention of surgical site infections (SSI). In our study, third-generation cephalosporin was used in maximum cases in preinterventional analysis and prophylaxis was continued for 3-5days. Surgeon's decision in selecting a prophylactic agent was based on information taken from departmental colleagues or drug companies. Two or more doses of antibiotic were used even when duration of surgery did not exceed more than two and half hours. Definite improvement was seen after the education where single antibiotic was used as prophylactic drug and the first dose of antibiotic was administered 30 to 60min before incision. This shows that educational intervention makes a change in antibiotic prescribing habit. Hence, there is an urgent need for adoption of specific guidelines to ensure standardization of surgical antibiotic prophylaxis practices in hospitals.

Enabling Better Conversations Between a Man With Aphasia and His Conversation Partner: Incorporating Writing Into Turn Taking

This article reports an intervention in the conversations between a man with chronic aphasia, Barry, and his wife, Louise (both names are pseudonyms). Preintervention analysis revealed the potential of writing as a resource for turn construction. Intervention consisted of enabling Barry to use writing to produce more complete turns at talk, thereby increasing the likelihood of mutual understanding, and encouraging Louise to modify her responses to Barry’s turns and thus enhance his interactional potential. Quantitative analysis revealed that Barry significantly increased his use of writing after intervention, but there was no change in other trained strategies. Louise eradicated correct production sequences (designed to elicit the correct production of a word despite her knowing the target) but did not implement trained strategies. In conclusion, individually tailored input underpinned by Conversation Analysis principles can alter the conversational behavior of a person with aphasia. It appears easier for a conversation partner to reduce unhelpful behaviors than to adopt facilitatory strategies. Data are in British English.

Medication waste reduction in pediatric pharmacy batch processes.

To inform pediatric cart-fill batch scheduling for reductions in pharmaceutical waste using a case study and simulation analysis. A pre and post intervention and simulation analysis was conducted during 3 months at a 205-bed children's center. An algorithm was developed to detect wasted medication based on time-stamped computerized provider order entry information. The algorithm was used to quantify pharmaceutical waste and associated costs for both preintervention (1 batch per day) and postintervention (3 batches per day) schedules. Further, simulation was used to systematically test 108 batch schedules outlining general characteristics that have an impact on the likelihood for waste. Switching from a 1-batch-per-day to a 3-batch-per-day schedule resulted in a 31.3% decrease in pharmaceutical waste (28.7% to 19.7%) and annual cost savings of $183,380. Simulation results demonstrate how increasing batch frequency facilitates a more just-in-time process that reduces waste. The most substantial gains are realized by shifting from a schedule of 1 batch per day to at least 2 batches per day. The simulation exhibits how waste reduction is also achievable by avoiding batch preparation during daily time periods where medication administration or medication discontinuations are frequent. Last, the simulation was used to show how reducing batch preparation time per batch provides some, albeit minimal, opportunity to decrease waste. The case study and simulation analysis demonstrate characteristics of batch scheduling that may support pediatric pharmacy managers in redesign toward minimizing pharmaceutical waste.

Low invasive in vivo tissue sampling for monitoring biomarkers and drugs during surgery

The techniques currently used for drug, metabolite, and biomarker determination are based on sample collection, and therefore they are not suitable for repeated analysis because of the high invasiveness. Here, we present a novel method of biochemical analysis directly in organ during operation without need of a separate sample collection step: solid-phase microextraction (SPME). The approach is based on flexible microprobe coated with biocompatible extraction phase that is inserted to the tissue with no damage or disturbance of the organ. The method was evaluated during lung and liver transplantations using normothermic ex vivo liver perfusion (NEVLP) and ex vivo lung perfusion (EVLP). The study demonstrated feasibility of the method to extract wide range of endogenous compounds and drugs. Statistical analysis allowed observing metabolic changes of lung during cold ischemic time, perfusion, and reperfusion. It was also demonstrated that the level of drugs and their metabolites can be monitored over time. Based on the methylprednisolone as a selected example, the impairment of enzymatic properties of liver was detected in the injured organs but not in healthy control. This finding was supported by changes in pathways of endogenous metabolites. The SPME probe was also used for analysis of perfusion fluid using stopcock connection. The evaluation of biochemical profile of perfusates demonstrated potential of the approach for monitoring organ function during ex vivo perfusion. The simplicity of the device makes it convenient to use by medical personnel. With the microprobe, different areas of the organ or various organs can be sampled simultaneously. The technology allows assessment of organ function by biochemical profiling, determination of potential biomarkers, and drug monitoring. The use of this method for preintervention analysis could enhance the decision-making process for the best possible personalized approach, whereas post-transplantation monitoring would be used for graft assessments and fast response in case of organ failure.

Grief, Anger, and Relationality: The Impact of a Research-Based Theater Intervention on Emotion Work Practices in Brain Injury Rehabilitation.

Therapeutic emotion work is performed by health care providers as they manage their own feelings as well as those of colleagues and patients as part of efforts to improve the physical and psychosocial health outcomes of patients. It has yet to be examined within the context of traumatic brain injury rehabilitation. To evaluate the impact of a research-based theater intervention on emotion work practices of neurorehabilitation staff. Data were collected at baseline and at 3 and 12 months postintervention in the inpatient neurorehabilitation units of two rehabilitation hospitals in central urban Canada. Participants (N = 33) were recruited from nursing, psychology, allied health, recreational therapy, and chaplaincy. Naturalistic observations (N = 204.5 hr) of a range of structured and unstructured activities in public and private areas, and semistructured interviews (N = 87) were conducted. Preintervention analysis indicated emotion work practices were characterized by stringent self-management of empathy, suppression of client grief, adeptness with client anger, and discomfort with reactions of family and spouses. Postintervention analysis indicated significant staff changes in a relationality orientation, specifically improvements in outreach to homosexual and heterosexual family care partners, and support for sexual orientation and intimacy expression. No improvements were demonstrated in grief support. Emotion work has yet to be the focus of initiatives to improve neurorehabilitative care. Our findings suggest the dramatic arts are well positioned to improve therapeutic emotion work and effect cultures of best practice. Recommendations are made for interprofessional educational initiatives to improve responses to client grief and potential intimate partner violence.

“How May I Help You?” Improving Telephone Customer Service in a Medical Clinic Setting

The current study was carried out per management request to improve the overall quality of telephone customer service among appointment coordinators in a medical clinic. Exceptional telephone customer service included (a) using a standard greeting, (b) speaking in the appropriate tone of voice throughout the call, and (c) answering every call received by the unit. A preintervention analysis suggested that performance deficiencies resulted from weak antecedents, poor knowledge and skills, and weak performance contingencies. Task clarification, goal setting, feedback, and performance-contingent consequences were combined to improve these customer service behaviors for 20 full-time appointment coordinators at the clinic. The study used an ABÁ reversal design with weekly maintenance and 5-month follow-up observations. Introduction of the multicomponent intervention produced visible improvements in greeting (38% increase) and friendly voice tone (22% increase) behaviors; performance was maintained above baseline levels at 5 months postmaintenance. Abandon rates (the percentage of calls not answered by a live voice) remained fairly stable, on average. Findings support the use of a multicomponent intervention to increase telephone customer service behavior in medical clinic settings.

Innovative Pesticide Kit Model for Vegetable Farm Safety Surveillance Program

To develop 4-groups innovative pesticide test kit and vegetable farm safety surveillance program, the quasai study was performed in intervention klongtabak and control ta-ngoy village groups, Nakhonratchasima province. 62 Chinese kale samples were screened for pesticide residues using innovative test kit and confirmed by GLC/HPLC. Percent acetyl cholinesterase inhibition was measured in vegetable samples, containing anti-cholinesterase pesticide residues, using spectrophotometer. Pre-intervention analysis, two detected chlorpyrifos (>MRL) in control group, two detected cypermethrin (<MRL) and one detected <MRLs methomyl, carbofuran and carbofuran-3-OH in study group. No pesticides were detected in both groups at post-intervention. Self-test was trained to agriculturists, 92% accuracy competence results was acceptable at post-laboratory kit test training. Small farm land pesticide safety manual was used to educate agriculturists and %enzyme inhibition measurement at post-intervention period, compared with pre-intervention period was decreased 51.9% at p-value <0.011, reveal that intervention program affect reduction of pesticide inhibition at 0.05% significance level.

Initial Impact of Tailored Web-Based Messages About Cigarette Smoke and Breast Cancer Risk on Boys’ and Girls’ Risk Perceptions and Information Seeking: Randomized Controlled Trial

BackgroundRecent evidence indicates a causal link between both active smoking and secondhand smoke (SHS) exposure and breast cancer (BC).ObjectiveThe objective of the present study was to evaluate the initial reactions of girls and boys to tailored Web-based messages that describe the relationship between SHS and BC, using a parallel, single-blinded cluster randomized controlled trial.MethodsThis trial was nested within a cycle of an ongoing longitudinal study of 1498 students from 74 secondary schools. Self-reported assessments were used to evaluate the impact of study messages on participants’ risk perception and interest in obtaining additional information after participants were randomized by schools to control or intervention groups. The intervention group received a tailored visual message (based on gender and Aboriginal status) about BC and tobacco smoke. The control group received a standard visual message about smoking and cancer.ResultsSHS exposure was identified as a BC risk factor by 380/1488 (25.54%) participants, during the preintervention analysis. Compared to the female participants in the control group (491/839, 58.5%), girls who received the intervention (339/649, 52.2%) were 14% more likely to agree that exposure to SHS increased their BC risk (relative risk [RR] 1.14, 95% CI 1.07-1.21). Nonsmoking girls who received the intervention were 14% more likely to agree that starting smoking would increase their BC risk (RR 1.14, 95% CI 1.07-1.21). Compared to the male participants in control group (348/839, 41.5%), boys who received the intervention (310/649, 47.8%) were 10% more likely to agree that girls’ exposure to SHS increased their BC risk (RR 1.10, 95% CI 1.02-1.18). Compared to controls, girls who received the intervention were 52% more likely to request additional information about SHS and BC (RR 1.52, 95% CI 1.12-2.06).ConclusionsBrief gender-sensitive messages delivered via the Internet have the potential to increase awareness and to stimulate information seeking about the risk for BC associated with SHS.

The impact of a drama-based intervention on the emotion work of neurorehabilitation staff

To assess the impact of a drama-based educational intervention on emotion work in neurorehabilitation. The study was a three-year multiple case study qualitative evaluation of an educational intervention to improve client centred brain injury rehabilitation. Analysis of baseline, and 3 and 12 months post-intervention dataexamined institutional-, staff-, and patient-related factors that were implicated in staff emotion work practices. The neurorehabilitation units of two inpatient rehabilitation hospitals in Ontario, Canada. Thirty-three practitioners from nursing, psychology, occupational therapy, physical therapy, speech language pathology, social work, recreational therapy, and chaplaincy. The intervention, “After the Crash: A Play About Brain Injury,” is a research-based drama that conveys the importance of client-centred care while capturing the challenges of the clinical presentation of traumatic brain injury. In-depth interviews and naturalistic observations of structured and unstructured activities in public and private areas of the units. Pre-intervention analysis indicated that staff emotion work practices were characterized by stringent self-management of empathy, the suppression of the grief of clients, and the effects of the organization of rehabilitation including meager psychological services, and the emphasis on physical functioning and quantitative outcome measures. Post-intervention analysis of interviews and observations indicated a newfound appreciation for clients' needs for emotional expression and sexual intimacy. These findings suggest that using drama as an innovative educational strategy can effect changes in the emotion work practices of neurorehabilitation staff and thereby improve brain injury rehabilitation.

Digital Animation versus Textbook in Teaching Plastic Surgery Techniques to Novice Learners

The authors present a prospective, randomized, blinded trial comparing the educational efficacy of digital animation versus a textbook in teaching the Ivy loop technique to novice learners. Medical student volunteers (n = 32) were anonymously videotaped as they fastened dental wire to the teeth of a skull model (preintervention analysis) and then were randomly assigned to one of two study groups. The animation and text groups (n = 16 each) were shown either a digital animation or textbook demonstrating the Ivy loop surgical technique. Volunteers were then videotaped as they performed the technique (postintervention analysis). Volunteers were then shown the educational material provided to the other study group and given a validated educational survey to compare the educational value of both materials. Preintervention and postintervention video recordings were graded using a validated surgical competency scale. Surgical performance grades, time to task completion, and educational survey scores were compared. Preintervention analysis performance scores did not significantly differ between the animation and text groups (10.7 [2.8] versus 11.1 [3.9]; p = 0.74), but postintervention analysis demonstrated significantly higher performance scores in the animation group (18.8 [2.9] versus 13.0 [3.5]; p < 0.001). Time to task completion was similar. The educational survey demonstrated significantly higher scores in the animation group. A prospective, randomized, blinded study comparing the educational efficacy of a surgical textbook to digital animation demonstrates that, in novice learners, digital animation is a more effective tool for learning the Ivy loop technique. Test takers found digital animation to be the superior educational medium.

Echokardiographische Diagnostik bei interventioneller Mitralklappenrekonstruktion

Interventional treatment of mitral insufficiency has recently become possible on a limited basis. The developed percutaneous procedures aim at minimizing the trauma in high-risk surgical candidates. Echocardiography has a major role in the preinterventional evaluation, during the interventional procedure, and in the postinterventional follow-up. The preinterventional analysis is focused on the assessment of valvular morphology and mitral insufficiency severity. This allows definition of patients potentially treatable by percutaneous therapy as well as the most suitable interventional approach. During interventional treatment, echocardiography is used as the integral tool to guide the procedure and for immediate assessment of the obtained therapeutic effect. Immediately post intervention, echocardiography should be performed to define the obtained status, allowing detection of subsequent changes in left ventricular function and mitral insufficiency severity.

A Brief Pre-Intervention Analysis and Demonstration of the Effects of a Behavioral Safety Package on Postural Behaviors of Pharmacy Employees

This study employed a pre-intervention analysis to determine factors that contributed to safe ergonomic postures in a small pharmacy. The pharmacy was located on a university campus and employed both pharmacists and pharmacy technicians. Three of the eight pharmacy employees had experienced various repetitive motion injuries that resulted in a total of 36 lost days and 161 restricted days in the year prior to treatment onset. Observers collected detailed naturalistic data on the pharmacy employees' ergonomic behaviors when participants were on and off the phone. Results indicated that the participants' ergonomic postures were more at risk when the participants were using the phone. The preintervention analysis proved valuable for identifying variables responsible for the participants' at-risk behavior and aiding in the development of an intervention.