Funds for MH research, training raised in 1978-79 appropriations, community funds set at same level.
Explore the source record for details and available documents.
Community Mental Health Services↗
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.
Cancer risk assessment in the community practice setting.
Explore the source record for details and available documents.
Community Medicine↗
Recognition of sleep disorders in a community-based setting following an educational intervention.
BACKGROUND AND PURPOSE: To determine the recognition of sleep disorders in a community-based outpatient health setting following an educational intervention for health care professionals. Previously we have reported very low rates of recognition of sleep disorders in minority and medically indigent populations in a community-based setting. This omission is significant, since there is evidence of an increased number of sleep disorders among minority populations. PATIENTS AND METHODS: In-service training on sleep and sleep disorders was conducted over a 4-year period. Patients screened at the health center with suspected sleep disorders were referred to a hospital-based sleep laboratory. Rates of recognition and referral for sleep-related disorders were compared over the 4-year period using the sleep lab and health center databases and patient chart review at the health center. RESULTS: The intervention program was highly rated and well attended by staff. Rates of referral for sleep testing significantly increased from pre-intervention (0.06%) to the last year post-intervention (0.21%). Overall prevalence rate for sleep diagnoses increased similarly (0.11 vs. 0.26%). CONCLUSIONS: The educational intervention was effective in increasing rates of recognition and diagnosis, although the rate remains low compared to the estimated prevalence of sleep disorders in the general population. Despite broad coverage of sleep disorders during the training program, OSA was the primary diagnosis. Further examination of factors leading to the lack of recognition of other primary sleep disorders needs to be addressed in this patient group.
Adolescent↗
Use of 5-HT3 receptor antagonists to prevent nausea and emesis caused by chemotherapy for patients with breast carcinoma in community practice settings.
BACKGROUND: Although 5-HT3 receptor antagonists are clinically more effective in controlling emesis, particularly that caused by high dose cisplatin, than previously available agents, they appear to be less effective against nausea. This report focuses on the effectiveness of these agents against nausea and emesis in patients receiving two moderately emetogenic combination chemotherapy regimens as treatment for breast carcinoma in community practice settings. METHODS: Six hundred ninety-two breast carcinoma patients (688 female, 4 male; mean age, 51 years) enrolled in a nonrandomized study completed the Morrow Assessment of Nausea and Emesis (MANE) following 4 consecutive chemotherapy treatments. The frequency, duration, and severity of postchemotherapy nausea (PN) and postchemotherapy emesis (PE) were compared by type of antiemetic (5-HT3 receptor antagonist vs. other) and chemotherapy regimen (cyclophosphamide and doxorubicin with or without 5-fluorouracil [CA/CAF] vs. cyclophosphamide, methrotrexate, and 5-fluorouracil [CMF]). RESULTS: Within each regimen, the mean duration of PN was significantly longer for patients who received a 5-HT3 receptor antagonist than for those who were not given an antiemetic of that type (CA: 40.3 hours vs. 29.6 hours, P < 0.05; CMF: 37.6 hours vs. 30.2 hours, P < 0.05). There were no significant differences in the frequency or severity of nausea or in the frequency, severity, or duration of emesis by type of antiemetic for patients receiving either regimen. CONCLUSIONS: The results of this observational study suggest that 5-HT3 receptor antagonists are no more effective than other commonly used medications in controlling postchemotherapy nausea and emesis in women with breast carcinoma who are treated with moderately emetogenic chemotherapy in community practice settings. In fact, they may be associated with significant prolongation of the course of postchemotherapy nausea.
Adult↗
The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines. Americans Associations for Neurologic Surgeons.
BACKGROUND: Traumatic brain injury poses a serious public health challenge. Treatment paradigms have dramatically shifted with the introduction of the American Association of Neurologic Surgeons (AANS) Guidelines for the Management of Severe Head Injury. Implementation of the AANS guidelines positively affects patient outcomes and can be successfully introduced in a community hospital setting. METHODS: Data were collected both retrospectively and prospectively from the records of all trauma patients between 1994 and 1999. A cohort of 93 patients was selected. Thirty-seven patients were treated before the implementation of the AANS guidelines, and these were statistically compared with 56 patients treated after the implementation of the guidelines. RESULTS: Implementation of the recommendations in the AANS guidelines in a standardized protocol resulted in a 9.13 times higher odds ratio of a good outcome relative to the odds of a poor outcome or death compared with a group managed before the practice change. A Glasgow Coma Scale (GCS) admission score > 8 was associated with a 6.58 times higher odds ratio of a good outcome compared with a GCS admission score < or = 8. Odds ratio of a good outcome decreased by a factor of 0.92 for each year increase in age of patients starting at age 9. A dedicated neurotrauma team and comprehensive treatment algorithms are critical elements to this success. Hospital charges increased by more than $97,000 per patient, but are justifiable in the face of significantly improved outcomes. CONCLUSION: Implementation of a traumatic brain injury protocol in a community hospital setting is practical and efficacious. Appropriate invasive monitoring of systemic and cerebral parameters guides care decisions. The protocol results in an increase in resource usage, but it also results in statistically improved outcomes justifying the increase in expenditures.
Adolescent↗
Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting.
Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings.
Adult↗
Performance of cervicovaginal fetal fibronectin in a community hospital setting.
OBJECTIVE: To assess the accuracy of vaginal fetal fibronectin (FFN) as a screening test for preterm delivery in a community hospital. STUDY DESIGN: A prospective cohort of patients at high risk for preterm delivery at a community hospital underwent testing with FFN over a 15 month-period (March 2004-May 2005). Indications for testing were preterm labor, multiple pregnancies, cervical shortening, and cerclage. Pregnancy characteristics were retrieved on all women with positive FFN results and controls in a 1:2 ratio. Outcome variables included interval to delivery; length of hospital stay; and rates of preterm delivery <37 weeks. In the presence of serial FFN testing, only the initial result was used for calculation of diagnostic indices. Statistical analysis utilized t-test, Fisher's exact test and logistic regression analysis to control for gestational age at testing, with P < 0.05 or odds ratio (OR) with 95% confidence interval (CI) not inclusive of the unity considered significant. RESULTS: Two hundred and fifty seven FFN tests were performed in 230 women, of which 33 (14.3%) had positive FFN results. Duration of hospital stay was significantly shorter for patients with negative than positive results (8 h vs. 2.1 days, P = 0.011). Women with positive FFN were more likely to deliver within 14 days (OR = 6.5, 95% CI 1.4; 30.7), within 21 days (OR = 4.8; 95% CI 1.4; 16.6), before 34 weeks (OR = 5.0, 95% CI 1.7; 14.8) and before 37 weeks (OR = 3.1; 95% CI 1.3; 7.1) than women with negative results. CONCLUSION: A negative FFN result provides enough reassurance to allow shorter hospital stay. In a real-world setting (a community hospital with a population heterogeneous for risk factors for preterm delivery, and in a non-protocol setting) the performance of FFN testing closely mirrors that obtained in academic institutions, where the test was studied in more uniform populations under strict protocols. The performance of vaginal fibronectin in patients with heterogeneous risk factors for preterm delivery closely mirrors that obtained in studies conducted in populations with homogeneous risk factors.
Adult↗
Pilot study of a behavioral medicine program in a community hospital setting.
The authors designed and implemented a comprehensive behavioral medicine unit for a diagnostically mixed patient population in a community hospital setting. The unit emphasized behavioral adaptation rather than symptom relief. Behavioral adaptation for each patient was assessed by a 10 parameter Functional Analysis Questionnaire upon admission, at time of discharge and 6 months after discharge. Results of this pilot study indicated success for all treatment groups with greatest gains for patients suffering chronic pain. The study suggests that comprehensive application of behavioral medicine procedures and programs can be successful with a diagnostically mixed patient population and could provide an operational foundation for mixed medical-psychiatric units.
Adaptation, Psychological↗
HEALTH C.H.I.P.s: opportunistic community use of computerized health information programs.
Computerized health information programs have been shown to have potential to improve knowledge, attitudes and behavior. However, relatively little is known regarding their capacity to engage the public for opportunistic, spontaneous use in community settings. Two studies were undertaken to provide insight to this practical issue. An intercept survey of adults from a shopping center where a computer kiosk had been located for 7 months was undertaken to investigate exposure to, attention to, use and acceptability of kiosks. A total of 99.7% of participants were exposed to the kiosk, 77.4% of these noticed it and 20.8% of these used it. Program acceptability was high; the most common barriers to use related to time constraints and disinterest. A utilization study was then undertaken to describe program utilization in greater detail, with kiosks installed in 18 community settings over 1 year. These were used 57,064 times (19.4 uses per kiosk per day). Additional data described demography of users, preferred topics selected, preferred formats and presentation styles, and a comparison of use across different community settings. Both studies provide insight to practical application of this health education strategy, indicating that is has substantial capacity to engage people for opportunistic use in community settings.
Adult↗
Screening for spousal or partner abuse in a community health setting.
The most frequent victims of domestic violence are women. Although estimates of spousal or partner abuse vary from 3.8% to 44%, this type of abuse is unrecognized and underreported. A screening study for abuse occurred in a community health setting. Some 2,410 women were screened. The results indicated an incidence rate of 8.4%. Health care providers have an obligation to identify, treat, and provide appropriate resources for victims of spousal abuse. Screening for spousal or partner abuse should take place in primary care settings.
Adult↗
Effects of a nurse-based heart failure clinic on drug utilization and admissions in a community hospital setting.
OBJECTIVE: To evaluate the effect of a nurse-led heart failure clinic on drug therapy and hospitalization in a community hospital setting. DESIGN: Prospective, observational study of outpatients referred to a heart failure clinic. Nurses directed drug uptitration and delivered patient education. Utilization and doses of ACE inhibitors and beta-blockers were analyzed as were heart failure related admissions in the years before and after establishing the clinic. RESULTS: 138 patients (median age 68.5 years) were enrolled. After three months 94% of patients were taking an ACE inhibitor and beta-blockade was prescribed for 91%. Mean ACE inhibitor dose relative to target dose after three months was 77+/-30% and mean beta-blocker dose was 53+/-31% of the target dose. Heart failure admissions decreased by 45% after the clinic was established. CONCLUSIONS: Community hospital based heart failure clinics may promote utilization of evidence based drug therapy and cause a substantial decrease in heart failure admissions, producing results comparable to those obtained in studies of university hospital based heart failure management programs.
Adrenergic beta-Antagonists↗
Chemotherapy-induced nausea and vomiting: incidence and impact on patient quality of life at community oncology settings.
GOALS OF WORK: The present study sought to determine the prevalence of acute and delayed chemotherapy-induced nausea and vomiting (CINV) across ten community oncology settings. The effect of CINV on quality of life (QOL) was also evaluated. MATERIALS AND METHODS: Cancer patients who were scheduled for their first cycle of a new chemotherapy regimen were recruited from ten community oncology clinics. Study participants recorded occurrence of CINV by completing a daily diary each day for the first 8 days after treatment during each cycle and the Functional Living Index-Emesis (FLIE) before chemotherapy, at the end of day 1 and day 6 after chemotherapy. Mixed model regression analysis was used to explore the association between occurrence of CINV at cycle 1 and subsequent cycles and its impact on patient QOL. MAIN RESULTS: One hundred and fifty-one patients provided information for at least one cycle. During cycle 1, only 33% had neither acute nor delayed CINV. Of the 36% patients who developed acute CINV, 8% developed acute CINV only. Of the 59% who developed delayed CINV, 53% reported delayed only and 47% reported acute and delayed CINV. A similar pattern was seen at cycles 2 and 3. Experience of CINV at cycle 1 was associated with the development of CINV at cycles 2 and 3. Occurrence of CINV significantly interfered with patient QOL as assessed by the FLIE. CONCLUSIONS: CINV remained a substantial problem for patients receiving chemotherapy in this community-based sample, especially delayed CINV. CINV significantly interfered with patient QOL and daily functioning.
Adult↗
Community as client: appropriate baccalaureate- and graduate-level preparation.
This article focuses on the theoretical concept of community as client and its application in community health nursing education and practice. Although the concept of community as client has been widely accepted, it was observed that care to individuals and families within community settings constitutes the bulk of current community health nursing practice. The argument is made that undergraduate nursing students should be prepared as generalists to provide care within community settings. Undergraduate nursing students should be introduced to the concept of community as client, with an emphasis on understanding the relationship between individual or family needs and community needs. It is also argued that graduate nursing students should be prepared at the specialist level, focusing primarily on providing care to the community as client. An example of undergraduate and graduate levels of preparation in one university nursing program is described.
Community Health Nursing↗
Simulated and community-based instruction involving persons with mild and moderate mental retardation.
In this study of simulated instruction and/or community training of four functional living tasks was compared across groups of adolescents and young adults with mild and moderate retardation. Forty individuals participated in the assessment and training activities of this study, including 20 participants with mild retardation and 20 individuals with moderate retardation. A mixed factorial design was used to evaluate differences associated with level of mental retardation, simulated versus community-based instruction, and assessments in school and community settings. Participants with mild retardation performed better than their counterparts with moderate retardation on the simulated tasks and in the community settings. Participants with mild retardation were more successful in generalizing from the simulated instructional experiences to the community settings than were their counterparts with moderate retardation. However, in many of the situations, community training was sufficiently powerful to eliminate any advantage associated with some of the participants having experienced prior simulated instruction. Results are discussed in relation to the need to more closely examine the design and delivery of functional living skills instruction involving individuals with different levels of mental retardation. Specifically, the effectiveness of instructional simulations for teaching functional living skills does not appear to be uniform across level of retardation and targeted tasks. The highest priority question no longer appears to be whether or not simulated versus community-based instruction is more efficacious. Future research might more productively focus on the quality of different instructional simulations in combination with community assessment and/or training opportunities for teaching functional living skills to persons who experience different levels of mental retardation.
Adult↗
A population-based study of drug resistance and transmission of tuberculosis in an urban community.
SETTING: A low-income neighborhood of Sao Paulo, Brazil. OBJECTIVE: To determine the incidence, risk factors and transmission patterns of multidrug-resistant tuberculosis (MDR-TB). DESIGN: Prospective longitudinal study of patients with pulmonary TB (PTB). METHODS: Sputum culture-confirmed patients with PTB were recruited between March 2000 and May 2002. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with MDR-TB. Mycobacterium tuberculosis isolates were tested for drug susceptibility and typed by IS6110-RFLP analysis. RESULTS: Of 420 patients, respectively 71% and 27% were new and previously treated; 15.5% of the patients' M. tuberculosis isolates were resistant to at least one drug; of these, 11% and 27% were found among new and previously treated cases, respectively. Respectively 1% and 16.7% of the new and previously treated cases were MDR-TB. RFLP analysis showed that new transmission of MDR strains was uncommon. By multivariate logistic regression analysis, previous TB and hospitalization in the 24 months before TB diagnosis were identified as independent predictors of MDR-TB. CONCLUSIONS: The results showed an intermediate level of MDR-TB incidence in a neighborhood of Sao Paulo and identified predictors that can be targeted for intervention by national and local TB control programs.
Adolescent↗
Restriction fragment length polymorphism screening of Mycobacterium tuberculosis isolates: population surveillance for targeting disease transmission in a community.
SETTING: Alabama State Tuberculosis Control Program, USA. OBJECTIVE: To combine molecular screening data with routine information to assess transmission of Mycobacterium tuberculosis and improve control efforts. DESIGN: Since January 1994, samples from tuberculosis cases statewide have been systematically analyzed by IS6110 restriction fragment length polymorphism (RFLP). All cases during 1994-1995 with a predominate RFLP pattern were evaluated and risk factors assessed. pTBN12 was used to evaluate a large cluster in the Birmingham-Jefferson County (BJC) area. RESULTS: Statewide, a common two-band pattern was found, named JH2 (99/566, 17.5%). The most important risk associated with this pattern was homelessness (odds ratio, 8.9; P < 0.001). In the BJC area, the homeless accounted for 29% (51/175) of new cases diagnosed during the study period. For the BJC homeless, there were 13 unique RFLP patterns, and JH2 was predominant (29/33, 88%) among three clusters. Secondary analysis of the homeless JH2 cluster revealed a large group that included 19 of 24 (79%) isolates analyzed. Compared with the BJC non homeless (n = 124), the homeless were younger (P < 0.001), of male gender (P < 0.001), black race (P = 0.002), and were heavy alcohol (P < 0.001) and non-injection drug (P = 0.001) users. CONCLUSIONS: By screening tuberculosis cases statewide, a common two-band RFLP pattern was identified. Its predominance is explained by an ongoing tuberculosis epidemic among Birmingham's homeless population, highlighting RFLP as a tool for population surveillance. The pattern differences observed by pTBN12 typing clearly demonstrate that the isolates might be related but are not clonal.
Adult↗
Holding chambers versus nebulisers for beta-agonist treatment of acute asthma.
BACKGROUND: In acute asthma inhaled beta-agonists are often administered to relieve bronchospasm by wet nebulisation, but some have argued that metered-dose inhalers with a holding chamber (spacer) can be equally effective. In the community setting nebulisers are more expensive, require a power source and need regular maintenance. OBJECTIVES: There is controversy as to whether wet nebulisers are better than metered dose inhalers with holding chambers to deliver beta2-agonist medications for acute asthma. Comparisons of hospital and home use are also of interest. The objective of this review was to assess the effects of holding chambers compared to nebulisers for the delivery of beta2-agonists for acute asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials in adults and children (from two years of age) with asthma, where holding chamber beta2-agonist delivery was compared with wet nebulisation. DATA COLLECTION AND ANALYSIS: One reviewer applied study inclusion criteria and extracted the data. Trial quality was assessed independently by two reviewers. Missing data were obtained from the authors or estimated. MAIN RESULTS: This review analysed 686 children and 375 adults included in 16 trials. Method of delivery of beta2-agonist did not appear to affect hospital admission rates. In adults, the odds ratio of holding chamber versus nebuliser was 1.12, 95% confidence interval 0.45 to 2.76. The odds ratio for children was 0.91, 95% confidence interval 0.4 to 2.1. Children's length of stay in the emergency department was significantly shorter when the holding chamber was used, with a weighted mean difference of -0.62 hours, 95% confidence interval -0.84 to -0.40 hours. Adults' length of stay in the emergency department was similar for the two delivery methods. Peak flow and forced expiratory volume were also similar for the two delivery methods. Pulse rate was lower for holding chamber in children, weighted mean difference -8.3% baseline, 95% confidence interval -11.5 to -5.0,. REVIEWER'S CONCLUSIONS: Metered-dose inhalers with holding chamber produced outcomes that were at least equivalent to nebuliser delivery. Holding chambers may have some advantages compared to nebulisers for children with acute asthma.
Acute Disease↗
Pinworm eradication in community residential settings for people with developmental disabilities.
Pinworm, a common parasitic infestation, can be a chronic nuisance in community and institutional residences for people with developmental disabilities. Asymptomatic human carriage of the parasite and its eggs often prevents eradication from a communal residential setting. The elimination of pinworm from a system of community residential settings through a public health approach was described.
Education of Persons with Intellectual Disabilitie↗