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PubMed1988

Characteristics of a population undergoing treatment for drug addiction in a therapeutic community setting in Spain.

The authors discuss the findings of a study of the personal history characteristics of a population of 223 individuals who underwent treatment for drug addiction at the Masma Therapeutic Community, Lugo, Spain, during the period September 1984 to March 1986. The population consisted of 58 females and 165 males, predominantly from middle-class backgrounds. Nearly all were multiple drug abusers, cannabis and heroin being the most widely abused drugs. Over half the population received treatment prior to admission to the Masma Community for the abuse of either barbiturates or opiates. The research instrument used was a self-report questionnaire, completed by participants anonymously and on a voluntary basis. It included items relating to personal and family background, aspects of drug abuse and type of prior treatment.

Adult↗
PubMed1996

Family medicine research in the community setting: what can we learn from successful researchers?

BACKGROUND: There is little information describing family physician researchers who work outside academic medical centers. This report describes the motivating factors and resources used by community residency faculty and nonfaculty family physicians who perform research. METHODS: We sent a questionnaire to community residency faculty and nonfaculty family physicians who published at least one paper in the family medicine literature from 1992 through 1994. The survey focused on previous research experience, training, and collaboration with university colleagues, and included an open-ended question about motivations and obstacles to research. RESULTS: The majority (60%) of community faculty and nonfaculty family physicians surveyed reported previous research experience on the undergraduate, medical school, or residency level. Research training received during residency was evaluated as poor. Sixty-nine percent of the respondents reported being successful at acquiring research funding, and 60% reported receiving funding from foundations. Reported keys to success included mentoring, a supportive infrastructure, and an inherent enjoyment in doing research. These factors did not differ between community residency faculty and nonfaculty physicians. CONCLUSIONS: For community-based family physicians, success at conducting and publishing research is enhanced by the availability of mentoring, support from local or national foundations, and previous research experience. Respondents identified research training during residency as one area that needs improvement.

Ambulatory Care↗
PubMed1990

Modifying the home environment or community setting for people with cognitive impairments.

We need a great deal of work on household and day care environmental design. Systematic research, linked to the degree of impairment and to individual lifestyles, is appropriate. I have only scratched the surface of environmental considerations, with some attention to distinguishing the issues of home, community, and institutional environments. It is important that we identify some of the unique priorities in each of these settings. To draw conclusions from institutional settings and apply them to the home is to miss some of the strengths inherent in the home. We have come a long way. Once, it was pretty well accepted that older people with dementia were oblivious to their environments. Now, through observation and improvisation, we have come to understand that there are both individual reactions and patterns of responsiveness. In the future, we need to identify environmental design issues appropriate to mild, moderate, and severe levels of impairment; to different types of contexts (urban versus rural or suburban); and to different subcultures and economic groups.

Aged↗
PubMedDate not supplied

Moving research into community settings in the CSAT methamphetamine treatment project: the coordinating center perspective.

The CSAT Methamphetamine Treatment Project (MTP) has been established to conduct a ground-breaking exercise in bringing research into a closer relationship with community-based treatment service organizations. In this article, some of the opportunities and challenges faced by the MTP coordinating center as it has attempted to bring research into community treatment organizations are described. Initially, there has been an active, energetic effort to design the study protocol, focus the activities of the project, and prioritize the tasks to be accomplished. The methods for training the research staff and monitoring the conduct of the research in the community sites are described. A number of observations have been made about the different "cultures and values" of the researchers and the seven clinical organizations where the project has been conducted. The myriad mistakes made and lessons learned about how to conduct a rigorous randomized clinical trial in community treatment organizations may be important for future research-treatment efforts. There has been a wealth of experience gained in the first year of this project that may be of use as efforts move forward to reduce the gap between research and practice.

Central Nervous System Depressants↗
PubMed2006

An exploration of current leg ulcer management practices in an Irish community setting.

OBJECTIVE: To establish the prevalence of leg ulceration in the Irish Health Service Executive (HSE) mid-western region and to determine the level of assessment and treatment patients have been receiving in the local community. METHOD: Before the introduction of a Doppler training programme, all public health and community health nurses working in the Irish HSE mid-western area were requested to complete an audit form on each patient being treated for leg ulceration during a predefined one-week period. This form recorded details on patient demographics, ulcer aetiology, assessment and treatment. Out of 97 nurses, 96 responded to this audit, giving a response rate of 98.9%. RESULTS: A total of 429 patients with 449 leg ulcers were identified. Mean age was 75.5 years (standard deviation 10.7). Overall prevalence was 0.12%, which increased to 1.2% in those aged 70 years and over. Women were almost twice as likely as men to be affected (ratio of 1.8:1). The main causes of ulceration were reported as venous incompetence accounting for 63.3% (284/449) and arterial insufficiency accounting for 8% (36/449) of all ulcers. Only 59.9% (269/449) of all ulcerated limbs had ABPI measurements performed. Of those reported as venous in origin, 71.8% (204/284) had ABPI measurements recorded. Evidence-based care was generally apparent in this group, with 47.5% (97/204) receiving high compression and 18.1% (37/204) receiving reduced compression. However, in venous leg ulcers where ABPIs were not recorded (n=80) care appeared haphazard and inappropriate. CONCLUSION: Our study has identified the benefit of ABPI Doppler assessment.This assessment could be done in local health centres by trained nurses who could provide more appropriate and timely care to patients, thereby improving outcomes and relieving pressure on acute hospital clinics.

Age Distribution↗
PubMed1998

Preterm contractions in community settings: II. Predicting preterm birth in women with preterm contractions.

OBJECTIVE: To examine risk factors for preterm delivery in women who present to nontertiary care hospitals with preterm contractions. METHODS: Women who presented to a network of community hospitals in Wisconsin with preterm contractions were followed until delivery. The main outcomes were preterm delivery before completion of 36 weeks of gestation and delivery within 1 week of initial presentation. RESULTS: Of the 266 women presenting with contractions over the 2-year study period, 90% (n=239) consented to participate. Multiple factors were associated with premature delivery, but when examined with a multivariate model, only four (ruptured membranes, multiple gestation, cervical effacement at least 80%, and nonwhite race) were associated with prematurity, whereas five (ruptured membranes, multiple gestation, cervical effacement at least 80%, dilation exceeding 1 cm, and being a nonsmoker) predicted delivery within 1 week. A decision model that combined the presence of ruptured membranes and effacement at least 80% could predict delivery at 34 weeks or less within 7 days of presentation with a sensitivity of 71% and a specificity of 98%. CONCLUSION: Only two clinical cues (ruptured membranes and effacement of the cervix of 80% or more) can predict premature delivery within 7 days. If these results are confirmed prospectively, women with either of these signs could be targeted for administration of steroids, antibiotics, or transfer to tertiary care facilities.

Female↗
PubMed2001

Is tap water a safe alternative to normal saline for wound irrigation in the community setting?

OBJECTIVE: This double-blind randomised controlled trial compared the effects of tap water and normal saline on the healing and infection rates of acute and chronic wounds. METHOD: The trial was conducted in two metropolitan community health centres in New South Wales, Australia. Thirty-five patients with 49 acute or chronic wounds were randomised to receive wound irrigation with either normal saline or tap water. RESULTS: Statistical analysis demonstrated there was no significant difference between the infection and healing rates in wounds irrigated with normal saline or tap water. CONCLUSION: Although the small sample size is a limitation of this study, the researchers conclude that drinkable tap water appears to provide a safe alternative to normal saline for wound cleansing and may be preferred by some patients.

Acute Disease↗
PubMed2002

Increasing diabetes self-management education in community settings. A systematic review.

This report presents the results of a systematic review of the effectiveness and economic efficiency of self-management education interventions for people with diabetes and forms the basis for recommendations by the Task Force on Community Preventive Services. Data on glycemic control provide sufficient evidence that self-management education is effective in community gathering places for adults with type 2 diabetes and in the home for adolescents with type 1 diabetes. Evidence is insufficient to assess the effectiveness of self-management education interventions at the worksite or in summer camps for either type 1 or type 2 diabetes or in the home for type 2 diabetes. Evidence is also insufficient to assess the effectiveness of educating coworkers and school personnel about diabetes.

Blood Glucose Self-Monitoring↗
PubMedDate not supplied

Preschool children of battered women identified in a community setting.

This study describes and compares health, developmental, and behavioral manifestations of witnessing domestic violence in a health department population of preschool children (n = 15) of women detected to be battered (Conflict Tactics Scale [CTS], Straus, 1979). Comparisons included a community sample of the preschool children of nonbattered women (n = 62) to study the effect of mothers being battered, and a shelter sample of the preschool children of battered women (n = 53) to study the effect of "sheltering" on children's characteristics. Instrumentation included behavioral subscales, physical assessment, Denver II Developmental Screening, hemoglobin and lead levels, immunization, and nonmotor vehicle accident histories. Results showed more similarities between children of community (nonsheltered), battered and nonbattered women, but showed more differences between the children of community (nonsheltered) battered women and the children of sheltered, battered women. Battering intensity of the women was more severe in the shelter sample according to the CTS (p < .001), and more abnormal findings in their children were detected than in the community sample. When children of community (nonsheltered), battered women (n = 15) and children of sheltered, battered women (n = 53) were included in discriminant analysis of demographic characteristics, health status, and psychosocial variables, 87% of each group was classified correctly.

Battered Women↗
PubMed2003

Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP).

BACKGROUND: Early identification of persons at risk for kidney disease provides an opportunity to prevent or delay its progression and decrease morbidity and mortality. Our hypothesis was that implementation of a targeted screening program in communities with high-risk populations would detect previously unidentified persons with or at high risk for chronic kidney disease (CKD) with a prevalence that exceeds that predicted for CKD in the general population. METHODS: Persons with hypertension or diabetes or a first-order relative with hypertension, diabetes, or kidney disease were screened for kidney disease risk factors. Blood pressure, blood glucose level, serum creatinine level, hemoglobin level, microalbuminuria, hematuria, pyuria, body mass index, and estimated glomerular filtration rate (EGFR) were evaluated. RESULTS: Six thousand seventy-one eligible persons were screened from August 2000 through December 2001: of these persons, 68% were women, 43% were African American, 36% were white, 10% were Hispanic, and 5% were Native American. Most reported high-school education or more (84%) and health insurance coverage (86%). Twenty-seven percent met the screening definitions for diabetes; 64%, for hypertension; 29%, for microalbuminuria; 8%, for anemia; 18%, for hematuria; 13%, for pyuria; 5%, for elevated serum creatinine level; 16%, for reduced EGFR; and 44%, for obesity. Among participants without a reported history of specified conditions, screening identified 82 participants (2%) with diabetes, 1,014 participants (35%) with hypertension, 277 participants (5%) with elevated serum creatinine levels, 839 participants (14%) with reduced EGFRs, and 1,712 participants (29%) with microalbuminuria. Thirty-five percent of participants with a history of diabetes had elevated serum glucose levels at screening (> or =180 mg/dL [10 mmol/L]), and 64% with a history of hypertension did not have blood pressure controlled to less than 140/90 mm Hg. Only 18% of participants with a history of diabetes and 31% with a reduced EGFR had blood pressure controlled to less than 130/80 mm Hg and less than 135/85 mm Hg, respectively. CONCLUSION: Targeted screening is effective in identifying persons with previously unidentified or poorly controlled kidney disease risk factors, as well as persons with a moderately decreased EGFR.

Adolescent↗
PubMed2000

Implementing a stroke risk assessment program in a community setting.

Stroke, one of the most catastrophic medical events to befall an individual, is also one of the most preventable. Stroke risk assessment screenings (SRAS) provide an ideal means of lowering the risk by identifying high-risk individuals and educating the community about recognition and prevention of stroke. To facilitate public awareness in a northwestern Pennsylvania county, a multifocal media campaign was initiated approximately 2 months before the screening program. From April 1 to June 30, 1998, screenings were offered free-of-charge at 61 public sites. The screenings were staffed by volunteer nurses. A brief health history was taken and risk factor assessments (blood pressure, pulse, and carotid bruit screening) were performed. Individualized action plans were developed and discussed with the participants. The signs and symptoms of stroke were reviewed and educational material provided. Utilizing American Heart Association (AHA) guidelines, the nurses recommended medical follow-up as appropriate. With 3,116 individuals evaluated, this program represented the largest coordinated effort by any county in Pennsylvania. This program was thought to be instrumental in increasing community awareness of stroke.

Community Health Services↗
PubMed2005

Application of standard precautions in the community setting.

Healthcare associated infections (HAI) are a major source of morbidity, as well as being a significant cause of concern for patients and healthcare workers. Nurses have a duty to prevent infection wherever possible. This article provides an overview of the standard precautions that all community healthcare workers must implement to reduce the incidence of HAI.

Community Health Nursing↗
PubMed1996

Improving adverse drug reaction reporting in the community setting.

Adverse drug reactions (ADRs) occur on a daily basis and result in much patient suffering as well as increased health care expenditures. Most ADR reports received by the Food and Drug Administration are from hospital-based health care professionals and pharmaceutical manufacturers. Community-based ADR reporting is currently not mandated by any regulatory authority and is an area in need of much attention. Pharmacists working in the community are in a unique position to become involved in ADR monitoring and reporting.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

A day treatment program in a therapeutic community setting: six-month outcomes. The Walden House Day Treatment Program.

Although not well represented in the literature, day treatment programs targeting substance abuse problems have increased in both number and acceptability in recent years. This article reports on a day treatment program based on the Therapeutic Community (TC), and on outcomes for a sample of substance abuse clients (n = 66) entering the program. Participants were interviewed early in treatment and 6 months after admission using the Addiction Severity Index (ASI) and other measures. Clients entering day treatment were demographically diverse, with serious substance-abuse problems and psychiatric morbidity. Median retention in day treatment was about 5 weeks, but many clients received a contiguous episode of residential treatment, so that the median for total time in treatment was 18 weeks. Clients located and interviewed at 6-month follow-up (n = 38) showed significant improvement in alcohol and drug use, legal and social problems, and psychiatric symptoms. Findings suggest that day treatment can be used effectively as a precursor to residential treatment and that some clients applying for residential treatment can be treated effectively in day treatment alone.

Adult↗
PubMed1998

Evaluation of service learning in a school of nursing: primary care in a community setting.

The evolving system of health care delivery, emphasizing prevention and early intervention, presents challenges to schools that educate health care professionals. Nursing faculty in a rural mid-Atlantic state initiated a service-learning project, relating education and service through primary care in the surrounding community. The purpose of the present study was to evaluate the project outcomes. The 45 students involved in the project responded to Beliefs Related to Professional Nursing Competencies, a quantitative measure (Cronbach's alpha = .84), based on the Pew Health Commission's "Competencies Needed by Practitioners for 2005," and to a second measure, Qualitative Questions for Students in Service Learning. Results of quantitative analysis revealed subjects' acceptance of the competencies as nursing responsibilities. Qualitative analysis revealed that students were involved in increasing consumer access to community-based primary care; curricula relating learning to existing problems and rewarding critical thinking was evident; and students were receiving preparation for a health care environment that will rely on their ability to respond to its changing needs.

Adult↗