PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Community setting”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed2006

Magnetic resonance imaging accuracy for the diagnosis of superior labrum anterior-posterior lesions in the community setting: eighty-three arthroscopically confirmed cases.

Magnetic resonance imaging (MRI) has been shown in the literature to have high accuracy for the diagnosis of superior labrum anterior-to-posterior (SLAP) lesions. However, these studies have been performed at specialized institutions and have not been evaluated for community settings. Our hypothesis was that MRI diagnosis of SLAP lesions in the community setting is not as accurate as suggested by previous literature. The MRI reports for 83 consecutive surgically confirmed type II SLAP lesions were evaluated. The findings regarding the presence of SLAP lesions were documented from the community radiologists' MRI readings. Two blinded, fellowship-trained musculoskeletal radiologists evaluated these same 83 MRIs, as well as 17 MRIs with surgically confirmed normal superior labra. The musculoskeletal radiologists also used a visual analog scale to subjectively grade the quality of each MRI. MRIs were performed at 14 different centers and were read by 28 different community radiologists. There were 37 noncontrast MRIs and 46 MRI arthrograms. The community radiologists accurately identified 51% of the SLAP lesions. The sensitivities for the community radiologists were significantly better for the MRI arthrograms than for the noncontrast MRIs (P = .0002). For the two musculoskeletal radiologists, the sensitivities were 60% and 67.5%, and the specificities were 71% and 76.5%. The accuracies for the musculoskeletal radiologists were 62% and 69%. One of the musculoskeletal radiologists had significant correlation between the visual analog score and MRI diagnostic accuracy (P = .0006). The sensitivity for one of the musculoskeletal radiologists was significantly greater than the sensitivity for the community radiologists (P = .0063). The accuracies between the other musculoskeletal radiologist and the community radiologists were not significantly different (P = .0577). In this community setting, MRI was not accurate for the diagnosis of SLAP lesions. Musculoskeletal radiologists were more accurate than the community radiologists; however, the musculoskeletal radiologists were not as accurate as previous literature might predict.

Arthroscopy↗
PubMed2006

Asymptomatic bacteriuria in a population of elderly residents living in a community setting: prevalence, characteristics and associated factors.

BACKGROUND: Asymptomatic bacteriuria (ASB) is common among the elderly in institutional care, but less is known about its prevalence among the elderly living in community settings. Knowledge of the prevalence of ASB in this population could contribute to a reduction in unnecessary use of antibiotics. OBJECTIVE: To study the prevalence of ASB and associated health and social factors in a population of elderly people, aged 80 and over, in a community setting. DESIGN: A cross-sectional study. SETTING: The catchment area of a primary health care centre in a Swedish middle-sized town. METHOD: All residents, aged 80 and over, except for those in institutional living, were invited. A structured interview was carried out and urinary culture obtained. RESULTS: ASB was found in 14.8% of the participants, in 19.0% of the women and 5.8% of the men. In women independent associations with ASB were found for urinary incontinence (OR: 2.99, CI: 1.60-5.60), reduced mobility (OR: 2.68, CI: 1.42-5.03) and oestrogen treatment (OR: 2.20, CI: 1.09-4.45). CONCLUSION: Bacteriuria is common among the elderly living in non-institutional community settings, especially among women, although not as common as among the elderly in institutional settings. A woman over 80, with urinary incontinence, and needing support to walk has a risk of nearly 50% of presenting with ASB, a condition about which there is consensus not to treat with antibiotics. This should be borne in mind when examining patients with diffuse symptomatology and an accidental finding of bacteriuria.

Aged, 80 and over↗
PubMed1992

Audit of mammography in a community setting.

A Northwest community concentrated all mammography services in one location and instituted a program of annual review. The 32,118 mammograms prompted 466 biopsies of women who had no palpable abnormality. Over the 5-year study, there were 142 nonpalpable cancers found for a positive biopsy rate of 30%. In the first year, the positive biopsy rate was 17%, and, in the last year, it was 42%. The increase in apparent selectivity prompted a search for false negatives or missed breast cancers. One percent of women subjected to mammography underwent biopsy, but, interestingly, only 84% of women undergoing mammography received a normal report. Eighty-seven percent of the cancers were invasive, and 13% were considered to be noninvasive. A review of the literature suggests significant variation in the frequency of identifying nonpalpable breast cancer, and respected pathologists report variations in the pathologic evaluation of these nonpalpable cancers.

Adult↗
PubMed2001

Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: within treatment and posttreatment findings.

This study evaluated the short-term effectiveness of cognitive-behavioral treatment (CBT) for substance abuse delivered in a community setting. At entry into outpatient community substance abuse treatment, participants (N = 252) were randomly assigned to 3 conditions: high-standardization CBT, low-standardization CBT, and treatment as usual. Treatment consisted of 12 weekly individual therapy sessions. There was a significant decrease in substance use from baseline, with participants reporting being abstinent on 90% of within-treatment days and 85% of days during the 6 months posttreatment. However, there were no significant differences in outcomes across conditions. Findings do not support the hypothesis that disseminating CBT to community settings will improve outcomes and suggest that standard substance abuse counseling may be more effective than previously thought.

Adult↗
PubMedDate not supplied

A hospital and community in partnership: "case management coordinated care model in a community setting.".

Eighteen months ago, a small Ontario community hospital teamed up with Home Care to develop and implement a system of care delivery that would provide quality care within existing financial obligations and constraints. This article describes why the model, "Case Management Coordinated Care Model in a Community Setting," was chosen, how it works and how it is evaluated. Readers are encouraged to examine the successful implementation of this new collaborative concept of care, given today's limited funds and mandate to improve the use of community and hospital resources.

Community-Institutional Relations↗
PubMed1985

Social validation of heterosexual social behavior in community settings: a comparison of mentally retarded and non-mentally retarded adults.

Adaptive heterosexual social interaction in community settings is an age-appropriate social skill. Subjective evaluation methodology was used as a social validation procedure to establish the appropriateness and optimal rate of occurrence of heterosexual social behaviors in bar and restaurant settings. Professionals working with mentally retarded persons and college students completed rating scales for hypothetical mentally retarded as well as non-mentally retarded subjects, respectively. The results show congruity between the behavioral expectations for mentally retarded and non-mentally retarded people in community settings. The findings suggest appropriate behaviors for training mentally retarded clients who lack adequate heterosexual community social skills.

Adolescent↗
PubMed2002

Uterine balloon therapy for menorrhagia: a feasibility study of its use in the community setting.

OBJECTIVES: To determine whether uterine balloon therapy (UBT) for menorrhagia can be performed safely in the community setting, obviating the need for hospital admission or general anaesthesia. DESIGN: Prospective case studies of 20 women undergoing Thermachoice endometrial ablation for menorrhagia. SETTING: Glasgow Centre for Family Planning and Reproductive Health Care, Greater Glasgow Primary Care NHS Trust, Glasgow, UK. PARTICIPANTS: Twenty women with menorrhagia unresponsive to medical therapy. MAIN OUTCOME MEASURES: Pain levels experienced by women during the procedure, measured by visual analogue scores and analgesia requirements postoperatively. RESULTS: Pain scores were in the range 0.1-6.6 (median 1.1) for outpatient hysteroscopy, compared to 0.1-9.8 (median 4.0) for uterine balloon therapy. No procedure was abandoned due to pain. CONCLUSION: UBT performed under local anaesthetic is tolerated well by patients. It is an effective treatment for menorrhagia, which is safe and easy to perform in the community setting.

Adult↗
PubMed2004

Cohort study of examination performance of undergraduate medical students learning in community settings.

OBJECTIVES: To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards. DESIGN: Cohort study. SETTING: Flinders University four year graduate entry medical course. In their third year, students are able to choose to study at the tertiary teaching hospital in Adelaide, in rural general practices, or at Royal Darwin Hospital, a regional secondary referral hospital. PARTICIPANTS: All 371 medical students who did their year 3 study from 1998-2002. MAIN OUTCOME MEASURES: Mean student examination score (%) at the end of year 3. RESULTS: The unadjusted mean year 3 scores at each location differed significantly (P < 0.001); the mean score was 65.2 (SE = 0.43) for Adelaide students, 68.2 (0.83) for Darwin students, and 69.3 (0.97) for students on the rural programme. Mean year 2 scores were similar for each location. Post hoc tests of means adjusted for sex, age, year 2 score, and cohort year showed that the rural and Darwin groups had a significantly improved score in year 3 compared with the Adelaide group (adjusted mean difference = 3.08, 95% confidence interval 1.25 to 4.90, P < 0.001 for rural group; 1.91, 0.47 to 3.36, P = 0.001 for Darwin group). CONCLUSIONS: These findings show that the concern that student academic performance in the tertiary hospital would be better than that of students in the regional hospital and community settings is not justified. This challenges the orthodoxy of a tertiary hospital education being the gold standard for undergraduate medical students.

Adult↗
PubMed1998

Factors determining angiotensin-converting enzyme inhibitor underutilization in heart failure in a community setting.

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors were underprescribed for patients with congestive heart failure (CHF) treated in the community setting in the early 1990s despite convincing evidence of benefit. HYPOTHESIS: We postulated that (1) the prevalence of ACE inhibitor use has increased, and (2) prescribing biases have narrowed, as community physicians have gained additional clinical experience with these drugs for treatment of CHF. METHODS: We examined rates of ACE inhibitor use among 1,150 patients with CHF hospitalized at 10 community hospitals in 1995, evaluated determinants of ACE inhibitor prescription, and compared the results with survey data gathered among similar patients during 1992. RESULTS: Compared with 1992, ACE inhibitor use prior to hospital admission was increased among all patients (42 vs. 33%, p < 0.001) and the subset with a history of CHF (53 vs. 39%, p < 0.0005). Angiotensin-converting enzyme inhibitor prescription at hospital discharge also increased among all survivors (64 vs. 51%, p < 0.00005) and the subset eligible for ACE inhibitor treatment based on clinical trial criteria (77 vs. 66%, p = 0.04). Multivariate analysis suggested no change in the prescribing biases previously observed; ACE inhibitor use was related to lower ejection fraction, lower serum creatinine, documentation of left ventricular systolic function, younger patient age, prescription of any diuretic drug, and nonprescription of alternate vasodilators and calcium blockers. In multivariate analyses, physician specialty did not predict ACE inhibitor use. CONCLUSIONS: Angiotensin-converting enzyme inhibitor use among patients with CHF is increasing but remains below the 80-90% rates of drug tolerance documented in randomized clinical trials. This discrepancy is partially explained by the prevalence of renal impairment and "diastolic" heart failure in the community setting. However, age bias, use of alternative vasodilators, and substandard quality of care may also play a role.

Aged↗
PubMed1999

Situational factors as predictors of pharmaceutical care in a community setting: an application of the adaptive decision-making model.

Various situational factors are perceived to affect the level of pharmaceutical care (PC) delivery. Despite numerous discussions in the literature stating its importance, a literature search showed a lack of studies evaluating this relationship. The objective of this study was to determine the affect of the presence of situational factors, based on the adaptive decision making (ADM) model, on the level of pharmaceutical care delivered by pharmacists in a community setting. Pharmacists in a community setting with access to hypertensive patients were selected for study participation. An exploratory, cross-sectional study was used to acquire pharmacist self-perception of the level of PC delivered (dependent variable) in the state of Ohio.

Antihypertensive Agents↗
PubMedDate not supplied

HIV infection among female injection-drug users recruited in community settings.

BACKGROUND AND OBJECTIVES: To identify relationships between sexual behavior, drug use, and HIV infection among female injection-drug users (IDUs) recruited in community settings. STUDY DESIGN: Risk analysis of 407 survey questionnaires and matched HIV serologies (n = 403) from female IDUs recruited from community settings in 3 inner-city neighborhoods in San Francisco during 1991 and 1992. RESULTS: The HIV seroprevalence of our sample was 11.4%. Fifty-four percent reported using crack cocaine in the past 30 days. HIV seroprevalence was 10.5% among crack cocaine smokers and 12.5% among nonsmokers. In multivariate analysis, HIV infection was associated with a history of sex for money exchanges (adjusted odds ratio [AOR] = 3.11; 95% confidence interval [95% CI] = 1.37, 7.02); history of syphilis (AOR = 3.30; 95% CI = 1.36, 7.99); and African American ethnicity (AOR = 5.31; 95% CI = 2.05, 13.73). Crack smoking in the past 30 days (AOR = 0.33; 95% CI = 0.15, 0.71) and having a current steady sexual partner (AOR = 0.48; 95% CI = 0.24, 0.94) were both inversely associated with HIV infection in the multivariate model. None of our injection-related variables were predictive or protective of HIV infection, when controlled for the above factors. CONCLUSIONS: Unprotected heterosexual activity is a principal risk factor for HIV infection among female IDUs in San Francisco. Greater reported sexual risk behavior of crack smokers was not reflected by a higher HIV rate at present, perhaps because of lower prevalence of HIV among their sexual partners.

Adult↗
PubMed2004

Effectiveness of electroconvulsive therapy in community settings.

BACKGROUND: Clinical trials indicate that electroconvulsive therapy (ECT) is the most effective treatment for major depression, but its effectiveness in community settings has not been examined. METHODS: In a prospective, naturalistic study involving 347 patients at seven hospitals, clinical outcomes immediately after ECT and over a 24-week follow-up period were examined in relation to patient characteristics and treatment variables. RESULTS: The sites differed markedly in patient features and ECT administration but did not differ in clinical outcomes. In contrast to the 70%-90% remission rates expected with ECT, remission rates, depending on criteria, were 30.3%-46.7%. Longer episode duration, comorbid personality disorder, and schizoaffective disorder were associated with poorer outcome. Among remitters, the relapse rate during follow-up was 64.3%. Relapse was more frequent in patients with psychotic depression or comorbid Axis I or Axis II disorders. Only 23.4% of ECT nonremitters had sustained remission during follow-up. CONCLUSIONS: The remission rate with ECT in community settings is substantially less than that in clinical trials. Providers frequently end the ECT course with the view that patients have benefited fully, yet formal assessment shows significant residual symptoms. Patients who do not remit with ECT have a poor prognosis; this underscores the need to achieve maximal improvement with this modality.

Adult↗
PubMed1992

Multiple medication use in the elderly. Use of prescription and non-prescription drugs in an Australian community setting.

OBJECTIVE: To document the extent of polypharmacy or multiple medication use in the elderly. DESIGN: Cross-sectional examination of an age cohort of a community. SETTING: Community-based study in Dubbo, NSW, in 1988-1989. SUBJECTS: All non-institutionalised residents aged 60 years and over, numbering 1237 men and 1568 women. MAIN OUTCOME MEASURES: Assessment of use of prescription and non-prescription drugs, recent hospitalisation, years of education, psychosocial variables. RESULTS: 18% of men and 25% of women were currently using three or more classes of prescription drugs. The corresponding values for two or more classes of non-prescription drugs were 29% and 44%. Of those who were using multiple prescription drugs 56% of men and 76% of women were also using multiple non-prescription drugs. In a multiple logistic model, the following possible predictors of multiple drug use were included: hospitalisation in the last six months, age, sex, depression, life satisfaction and education. Multiple prescription drug use was significantly predicted by recent hospitalisation (odds ratio [OR] = 2.40; 95% confidence interval [CI], 1.63-3.56), increasing age (e.g. 70-79 years versus 60-69 years; OR = 2.54; CI, 1.97-3.25), female sex (OR = 1.59; CI, 1.25-2.01) and increasing depression (e.g. highest tertile of depression scale versus lowest; OR = 2.52; CI, 1.84-3.42). Multiple non-prescription drug use was significantly predicted by female sex (OR = 2.38; CI, 1.95-2.92) and increasing depression (OR = 2.77; CI, 2.16-3.56). For prescription items, non-prescription items, and both categories in combination levels of use 20% above the population average have been documented. CONCLUSIONS: Polypharmacy in the elderly population appears to be predicted by recent hospitalisation, increasing age, female sex and increasing depression. There is potential for drug-drug interaction to occur, but the findings suggest target areas for preventive action.

Aged↗
PubMed2006

The Overt Behaviour Scale (OBS): a tool for measuring challenging behaviours following ABI in community settings.

OBJECTIVES: The Overt Behaviour Scale (OBS) was designed as a comprehensive measure of common challenging behaviours observed after acquired brain injury (ABI) in community settings. The OBS comprises 34 items in nine categories that measure aggression, inappropriate sexual behaviour, perseveration, wandering, inappropriate social behaviour and lack of initiation. The aim of the current study was to determine the reliability, validity and responsiveness of the OBS. METHOD: Two adult community-based samples of people with ABI were recruited. Sample 1 (n= 30) were concurrently evaluated on the OBS by two raters and again 1 week later to test stability. Other validating scales were also administered. Sample 2 (n= 28) were clients of the ABI Behaviour Consultancy who were treated for challenging behaviours and were administered the OBS before treatment commenced and then again 4 months later. RESULTS: Inter-rater reliability and stability coefficients for the OBS total score was strong (0.97 and 0.77, respectively). Initial evidence of convergent and divergent validity was shown by the differential pattern of correlations with other measures. Moderate-to-strong coefficients (range 0.37-0.66) were observed between the OBS and other measures that had behavioural content (i.e. Mayo-Portland Adaptability Inventory, Current Behaviour Scale, Neurobehavioural Rating Scale-Revised). Divergent validity was shown by the lack of correlation between the OBS and the sub-scales of these tools that do not measure challenging behaviour. Finally, responsiveness was demonstrated with a significant decrease in OBS scores in the expected direction over the 4-month period. This improvement was confirmed by corroborating evidence from key informants. CONCLUSION: The OBS shows promise as a reliable, valid and responsive measure that can be used for the systematic assessment of challenging behaviours in community settings.

Adolescent↗
PubMed2006

Early intensive behavioral treatment: replication of the UCLA model in a community setting.

Although previous studies have shown favorable results with early intensive behavioral treatment (EIBT) for children with autism, it remains important to replicate these findings, particularly in community settings. The authors conducted a 3-year prospective outcome study that compared 2 groups: (1) 21 children who received 35 to 40 hours per week of EIBT from a community agency that replicated Lovaas' model of EIBT and (2) 21 age- and IQ-matched children in special education classes at local public schools. A quasi-experimental design was used, with assignment to groups based on parental preference. Assessments were conducted by independent examiners for IQ (Bayley Scales of Infant Development or Wechsler Preschool and Primary Scales of Intelligence), language (Reynell Developmental Language Scales), nonverbal skill (Merrill-Palmer Scale of Mental Tests), and adaptive behavior (Vineland Adaptive Behavior Scales). Analyses of covariance, with baseline scores as covariates and Year 1-3 assessments as repeated measures, revealed that, with treatment, the EIBT group obtained significantly higher IQ (F = 5.21, p = .03) and adaptive behavior scores (F = 7.84, p = .01) than did the comparison group. No difference between groups was found in either language comprehension (F = 3.82, p = .06) or nonverbal skill. Six of the 21 EIBT children were fully included into regular education without assistance at Year 3, and 11 others were included with support; in contrast, only 1 comparison child was placed primarily in regular education. Although the study was limited by the nonrandom assignment to groups, it does provide evidence that EIBT can be successfully implemented in a community setting.

Autistic Disorder↗
PubMed1976

Outpatient chemotherapy of advanced breast cancer in a community setting: a five-drug regimen.

Forty-two (37 evaluable) unselected women with advanced breast carcinoma were treated with a modified "Cooper regimen" in a community setting. After 12 weeks of induction therapy, the patients were evaluated for response and toxicity. The 74% overall response rate (78% in the evaluable group) compares favorably with that of other series. The median duration of remission was 13.7 months. The median survival was 17 months for the evaluable patients and 14 months for the entire group. Twenty-two percent of the patients required hospitalization during the induction phase, and 35% were treated exclusively as outpatients during all phases of therapy. There was only one drug-related death. It is concluded that a complex chemotherapeutic regimen can be managed adequately by physicians experienced in chemotherapy in a community setting with results comparable to those from cancer centers.

Adult↗
PubMed2006

Use of computer kiosks for breast cancer education in five community settings.

Finding ways to bring effective computer-based behavioral interventions to those with limited access to technology is a continuing challenge for health educators. Computer kiosks placed in community settings may help reach such populations. The Reflections of You kiosk generates individually tailored magazines on breast cancer and mammography and was adapted from an evidence-based intervention that increased mammography use in African American women. This usage study tracked patterns of use and characteristics of kiosk users in beauty salons, churches, neighborhood health centers, Laundromats, and social service agencies in St. Louis. Kiosks were used 4,527 times in 470 kiosk days at 40 different host sites. Highly significant differences among community settings were found in rates and patterns of kiosk use as well as user characteristics, breast cancer knowledge, and use of mammography. Findings inform strategic decision making about technology dissemination and community outreach to women needing information about breast cancer and mammography.

Adolescent↗