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PubMed1999

Community learning: the Reach for Health Nursing Program-Middle School Collaboration.

Nursing faculty and students have a vital role to play in promoting adolescent health at the community level. However, few nursing education programs have developed programs which provide nursing students with the skills and hands-on experiences they need to work with adolescents in community settings. A successful model for integrating community-based adolescent health promotion into nursing education is described in this article. Developed by nursing faculty from Medgar Evers College Department of Nursing, teachers and staff from a large middle school in Brooklyn, New York serving economically disadvantaged Black and Hispanic youth, and Education Development Center, Inc., the Reach for Health (RFH) Nursing Program-Middle School Collaboration has two mutually reinforcing components: (a) classroom-based health instruction taught by teachers with assistance from nursing students and faculty, and (b) community youth service in which middle school students spend approximately 3 hours per week providing assistance in health-related facilities under the guidance of nursing faculty and student nurse mentors. As part of an evaluation study, the authors conducted focus groups with nursing students involved in this program and administered an identical survey before and after intervention to assess potential benefits of participation. Compared to a control group of nursing students, those who participated in the RFH program reported increased skills and comfort working in school and community settings and with young adolescents, their teachers, and their parents. An example of other benefits was a greater understanding of the health and developmental needs of adolescents. At the same time they provided a service to the community, nursing students gained the skills and experience needed to be effective in community health promotion efforts.

Adolescent↗
PubMed2003

Postoperative deep vein thrombosis prophylaxis: a retrospective analysis in 1000 consecutive hip fracture patients treated in a community hospital setting.

The occurrence of deep vein thrombosis (DVT) following cases of major trauma, in particular pelvic and hip fracture, has ranged from 36% to 60%, depending on the study quoted and the method of detection. The frequency of fatal pulmonary embolism (PE) has been reported as 0.5%-12.9% of the cases. A retrospective study of 1000 consecutive hip fracture patients in a community hospital setting reveals that 95% received a combination of mechanical and pharmacologic prophylaxis for prevention of DVT. Sixty-one patients were excluded for insufficient data, leaving 939 for analysis. There were 724 female patients with an average age of 83 years and 215 male patients with an average age of 78 years. Fifty-one patients (18.4%) received no prophylaxis in the eligible population. Three hundred eighty-seven patients (41.2%) received only aspirin as the pharmacologic agent for anticoagulation. Four hundred twenty-nine patients (45.6%) were treated with the low-molecular-weight heparin (LMWH), enoxaparin. Ten patients (1.1%) received heparin for anticoagulation and 17 patients (1.8%) were treated with warfarin. A total of 43 patients received a combination of therapies. Four hundred ninety-five of the patients used concomitant intermittent pneumatic compression in addition to pharmacologic prophylaxis. There were 15 perioperative deaths from all causes, including five cases of DVT two distal and three proximal). One distal DVT occurred prior to surgery. A second distal DVT and one fatal PE occurred in the aspirin group. The rates of minor bleeding complications in the aspirin group, the < 12-hour postoperative dosing of the enoxaparin group, and the 12 to 24-hour postoperative dosing of the enoxaparin group were 3.1%, 5.7%, and 2.8%, respectively. There were no major bleeds in the aspirin group and 0.9% in the enoxaparin group. The LMWH group also had two proximal DVTs but no PEs. The combination of a relatively short half-life, predictable pharmacokinetics, and favorable safety profile makes enoxaparin an excellent drug for use in hip fracture patients. Additional trials will be necessary to establish an optimal duration of prophylaxis in this population.

Adolescent↗
PubMedDate not supplied

Laparoscopic anti-reflux surgery in the community hospital setting: evaluation of 100 consecutive patients.

BACKGROUND: Laparoscopic anti-reflux surgery has been shown to be superior to medical management for treatment of complicated gastroesophageal reflux disease (GERD). This study encompasses 100 consecutive patients undergoing laparoscopic Nissen-Rossetti or Toupet fundoplications for GERD refractory to medical management. STUDY DESIGN: All 100 patients had failed maximum medical management (behavioral and dietary modifications, antacids, and H2 and acid PUMP blockers). All patients underwent esophagogastroduodenoscopy with biopsy prior to surgery. Ninety-eight patients had esophageal manometry to evaluate the lower esophageal sphincter pressures and determine the amplitude of contractions of the body of the esophagus. Twenty-four hour pH studies were used selectively when the preceding studies were equivocal. RESULTS: All 100 patients' surgeries were accomplished laparoscopically. The mortality rate was zero. The postoperative complication rate was 2%. The average hospital stay was 1.85 days. Follow-up was achieved in 98%. The mean follow-up was 17.6 months. All patients had significant improvement of their symptoms. No patients have long-term dysphagia. CONCLUSIONS: The study demonstrates that laparoscopic anti-reflux surgery can be safely and effectively accomplished in the community hospital setting.

Adolescent↗
PubMed2006

Catheter-associated urinary tract infection in primary and community health care.

INTRODUCTION: Although often a last resort, urinary catheterisation is a relatively common management option for bladder dysfunction in older people and others cared for in community settings. Catheter-associated urinary tract infection (CAUTI) is a well-recognised source of increased morbidity and economic burden in acute care services, but much less is known about the prevalence and impact of CAUTI in primary and community care. OBJECTIVES: The aim of this study was to examine the criteria and outcome measures used in reporting CAUTI, to identify sources and quality of data recorded on CAUTI and to determine a base-line prevalence rate for CAUTI in community settings. METHODS: (i) A mapping exercise to identify local, national and international sources of data on CAUTI and (ii) a retrospective prevalence survey of CAUTIs, recorded within three Primary Care Trusts in England during 1 month (October 2004). RESULTS: Published or other recorded data on CAUTI in community settings were very limited. Criteria and outcome measures were variable and commonly failed to distinguish between symptomatic and asymptomatic CAUTI. A prevalence rate of 8.5% was determined by retrospective survey of patient records. CONCLUSIONS: Limitations in the quality and consistency of catheter-related information collected by healthcare services present a major obstacle to robust epidemiological analysis of risk and impact of CAUTI in primary and community care. Standardised routine data collection is essential to determine the magnitude of risk associated with CAUTI, to enable the development of a longitudinal database of long-term catheterised patients and to provide base-line data against which infection-control initiatives in primary and community care can be evaluated.

Female↗
PubMedDate not supplied

Comparison of sight word training procedures with validation of the most practical procedure in teaching reading for daily living.

The effectiveness and efficiency (training trials and training errors through criterion) of stimulus fading, stimulus shaping, time delay, and a feedback only procedure were compared in teaching three adults with moderate developmental delays sight words encountered in activities of daily living. In Experiment 1, the four procedures were assessed during training in a controlled environment to identify the most effective and efficient procedure for each participant. All three adults acquired the target words, and the four procedures were found to be of comparable efficiency in total training sessions, whereas individual differences were found in training errors to criterion. In Experiment 2, the feedback only procedure was used to teach the three participants sight words in community settings. Participants learned new words in the community settings and used the previously trained words in daily living activities. The benefit of conducting a preliminary evaluation of instructional procedures during controlled training is discussed.

Activities of Daily Living↗
PubMed1998

A short questionnaire (IRQ) to assess injecting risk behaviour.

AIM: To develop a short injecting risk questionnaire (IRQ) to measure sharing of injecting equipment. DESIGN: Matrix design with quota assignment, designed to compare the questionnaire when used by interview and self-completion, in agency and community settings, by agency staff and fieldworkers, with different injectors (age < 26 vs. 26+; male vs. female, opiate vs stimulant injectors), and in different geographical areas. SETTINGS: Drug treatment and helping agencies, and community settings, in England. PARTICIPANTS: Drug users who had injected in the last 4 weeks. MEASUREMENTS: Questions measured different aspects of equipment sharing. Questionnaire performance assessed by question acceptability, test-retest (parallel forms) reliability, inter-rater reliability, inter-instrument reliability, internal reliability, construct validity and internal collateral validity. Statistical tests included product moment correlation, principal components analysis, and Cronbach's alpha. FINDINGS: The questionnaire was highly acceptable. Test-retest correlations were all high and significant, questions performed well in all conditions, with no differences by site (agency vs. out-of-contact), order (interview or self-completion first), administration (staff vs. fieldworker), elapsed time or subject characteristics. The questionnaire had high internal reliability (Cronbach's alpha > +0.86), and items measured a similar domain with all questions loading highly (> 0.32) on a single factor which accounted for > 42% of the variance. The complete IRQ elicited higher reports of equipment sharing (77%) than a single question (56%). CONCLUSIONS: IRQ performs well in a variety of settings, when administered in different ways to different kinds of IDUs. A single question on 'sharing' elicits fewer positive responses than the use of multiple questions about different sharing practices.

Adult↗
PubMed1994

House calls: a support group for individuals with AIDS in a community residential setting.

The author describes a support group led by two psychiatrists for individuals with AIDS set in the participants' residence, the AIDS Community Residence Association (ACRA) House. Similar to other AIDS groups described in the literature, the residents spoke of existential fears such as losing their physical beauty or intellect. In contrast to the intimate and familial atmosphere of many other AIDS groups, the members' strong sense of invasion by the facilitators and their ongoing ambivalence were striking. This reaction toward the group and the co-leaders appeared to be metaphorically related to the "invasion" of illness and health care workers into their lives. As members better tolerated and expressed these thoughts and feelings, a greater intimacy and sense of "family" emerged.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Patterns of utilization, disposition, and length of stay among stroke patients in a community hospital setting.

This retrospective descriptive study of stroke patients in a community hospital examined the relationship of discharge disposition and length of stay to sociodemographic variables and use of hospital services. Age-related patterns emerged. Younger patients were more ambulatory, more frequently discharged to home or rehabilitation units, and used more diagnostic services. Older patients were discharged more frequently to nursing homes and used more social services. Next to level of clinical impairment at discharge, age and admission from home had the greatest effect on whether a patient was discharged to their home. Clinical conditions and the need to await placement in a rehabilitation facility or nursing home correlated with longer lengths of stay.

Aged↗
PubMed1995

Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group.

OBJECTIVE: To assess the feasibility and impact of introducing the Ottawa ankle rules to a large number of physicians in a wide variety of hospital and community settings over a prolonged period of time. DESIGN: Multicentre before and after controlled clinical trial. SETTING: Emergency departments of eight teaching and community hospitals in Canadian communities (population 10,000 to 3,000,000). SUBJECTS: All 12,777 adults (6288 control, 6489 intervention) seen with acute ankle injuries during two 12 month periods before and after the intervention. INTERVENTION: More than 200 physicians of varying experience were taught to order radiography according to the Ottawa ankle rules. MAIN OUTCOME MEASURES: Referral for ankle and foot radiography. RESULTS: There were significant reductions in use of ankle radiography at all eight hospitals and within a priori subgroups: for all hospitals combined 82.8% control v 60.9% intervention(P < 0.001); for community hospitals 86.7% v 61.7%; (P < 0.001); for teaching hospitals 77.9% v 59.9%; (P < 0.001); for emergency physicians 82.1% v 61.6%; (P < 0.001); for family physicians 84.3% v 60.1%; (P < 0.001); and for housestaff 82.3% v 60.1%; (P < 0.001). Compared with patients without fracture who had radiography during the intervention period those who had no radiography spent less time in the emergency department (54.0 v 86.9 minutes; P < 0.001) and had lower medical charges ($70.20 v $161.60; P < 0.001). There was no difference in the rate of fractures diagnosed after discharge from the emergency department (0.5 v 0.4%). CONCLUSIONS: Introduction of the Ottawa ankle rules proved to be feasible in a large variety of hospital and community settings. Use of the rules over a prolonged period of time by many physicians of varying experience led to a decrease in ankle radiography, waiting times, and costs without an increased rate of missed fractures. The multiphase methodological approach used to develop and implement these rules may be applied to other clinical problems.

Ankle Injuries↗
PubMed1991

Accuracy of breast frozen section diagnosis in the community hospital setting: a detailed analysis of 628 cases.

The author presents a detailed analysis of 628 breast frozen sections performed at Columbia Hospital over a 35-month period. These 628 frozen sections came from a total of 574 females and 13 males (mean age 55.3 years and range 20.1 to 95.0 years). Frozen section diagnosis was deferred in 18 cases (2.8%) and diagnostic accuracy for presence or absence of malignant neoplasia was 99.2%; one false positive case (pathologist judgement error) and four false negative cases (two sampling errors and two pathologist judgement errors) were detected. Strict diagnostic accuracy for this series was 98.7%. Fifty-three of 223 positive frozen sections (23.8%) were immediately followed by completion mastectomy. The author discusses the philosophy of frozen section technique and concludes that breast frozen section analysis in a busy community hospital setting can meet and even exceed the accuracy level attained at large academic medical centers.

Adult↗
PubMed2003

Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting.

Roux-en-Y gastric bypass (RYGB) operation has become a popular choice for weight-reduction surgery. We report an outcome analysis of our early results with laparoscopic Roux-en-Y gastric bypass for superobese (BMI >50) patients. Between January 2000 and October 2001, we operated on 71 superobese patients. The mean body mass index (BMI) of patients at time of surgery was 57 kg/m2. The prospectively collected data included patient demographics, comorbidities, operative times, postoperative weight loss, and complications. Conversion to open gastric bypass was required in one patient. The overall complication rate was 10 per cent. Preoperative comorbidities were resolved or improved in 93 per cent of patients at 1-year postoperative. Average operative time and length of hospital stay were 196 minutes and 2.3 days, respectively. Mean percentage excess weight loss at 3, 6, 9, and 12 months was 27 per cent, 39 per cent, 49 per cent, and 55 per cent, respectively. Mean BMI decreased to 36 kg/m2 over a 12-month period. Laparoscopic Roux-en-Y gastric bypass surgery for superobese patients as performed in the community hospital setting can be both safe and effective with respect to overall postoperative course, early weight loss, and reduction of comorbidity.

Adult↗
PubMed2001

Tolerability of antihypertensive drugs in a community-based setting.

BACKGROUND: Outside the experimental environment of clinical trials, the tolerability of angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), and the angiotensin II antagonist losartan has not been compared. OBJECTIVES: The purpose of this study was to estimate, in current clinical practice, the 3-month cumulative incidence of side effects among first-time users of losartan, ACEIs, and CCBs for hypertension. METHODS: We conducted a prospective cohort study through a network of 173 pharmacies across Canada to identify patients with hypertension who were newly prescribed monotherapy with losartan, an ACEI, or a CCB. Individuals were interviewed by telephone 3 times over a 3-month period to determine perceived side effects of the antihypertensive medication prescribed. Data were analyzed using a multivariate logistic regression model. RESULTS: Among the 663 eligible individuals, the 3-month cumulative incidence of perceived side effects was 52.5% (42/80), 60.2% (222/369), and 69.6% (149/214) for those treated with losartan, an ACEI, and a CCB, respectively. After adjustment for sex, age, level of education, number of symptoms perceived the week before entering the study, prior use of antihypertensive drugs, current use of any other drug, drug insurance coverage, and duration of hypertension, the odds of reporting a side effect were significantly higher among patients treated with an ACEI (odds ratio [OR] = 1.78: 95% CI, 1.02-3.12) or a CCB (OR = 2.65; 95% CI, 1.47-4.78) compared with patients treated with losartan. CONCLUSIONS: In a community-based setting, we observed that losartan is better tolerated than ACEIs and CCBs. Given that the occurrence of side effects may contribute to lower adherence to drug treatment, the low incidence of side effects associated with losartan makes it an attractive antihypertensive drug choice.

Adolescent↗
PubMedDate not supplied

Documentation of patient care services in a community pharmacy setting.

OBJECTIVE: To assess the types of patient care documentation systems currently being used by community pharmacists and determine the preferred characteristics of an ideal patient care documentation system. DESIGN: Mailed survey. SETTING: United States. PARTICIPANTS: One pharmacist from each of 125 targeted community pharmacies. INTERVENTION: Survey mailed in February 2003, followed by a second mailing to nonrespondents in March 2003. MAIN OUTCOME MEASURES: Responses to survey items about (1) patient care services provided at the pharmacy, (2) characteristics of the current documentation system, and (3) characteristics of an ideal documentation system. RESULTS: A total of 48 usable responses were received from 106 pharmacies to which surveys were delivered (45.3%). Independent pharmacies accounted for 50% of survey respondents. More than 80% of respondents were providing patient screening or management services associated with a chronic disease such as diabetes, hypertension, or dyslipidemia. Approximately 54% of the pharmacists were using a paper documentation system. However, challenges identified with a paper system included documentation time, retrieval of patient data, tracking patient outcomes, and storage. Respondents indicated that an ideal documentation system would be comprehensive, easy and efficient to use, and affordable. CONCLUSION: Pharmacists recognize the importance of documenting patient care services. While the majority of respondents are using paper charts to document patient care services, computerized systems appear to offer advantages over paper charts. This information offers community pharmacists a summary of previous experiences and a starting point when trying to identify or modify a documentation system that would better meet the pharmacies' needs.

Community Pharmacy Services↗
PubMed2005

Community epidemiology of Chlamydia and Mycoplasma pneumoniae in LRTI in France over 29 months.

BACKGROUND: The role of Chlamydia pneumoniae (CP) and Mycoplasma pneumoniae (MP) in lower respiratory tract infections (LRTI) is still little known in community settings. METHODS: In all, 3207 adult cases of LRTI (871 with pneumonia, and 2336 with acute bronchitis) were prospectively included in the ETIIC1 ETIIC : ETude de l'Incidence des Infections respiratoires basses d'origine Communautaire dues A Chlamydia pneumoniae et Mycoplasma pneumoniae (Incidence of CP and MP in LRTI in community settings) program by 303 general practitioners and 24 hospital physicians in France between September 1997 and February 2000. The polymerase chain reaction and immunoassays were used to detect CP or MP in 3198 pharyngeal specimens obtained by gargling. RESULTS: Of these 3198 patients, 232 (7.3%), were PCR-positive for CP and/or MP. Immunoassays were far less sensitive than PCRs (Se = 2 and 13% for MP and CP). Among the 2336 patients with acute bronchitis, PCR was positive for CP in 95 (4.1%), and for MP, in 54 (2.3%). Among the 671 patients with radiologically confirmed pneumonia, PCR was positive for CP in 23 (3.4%), and for MP in 49 (7.3%). CP and MP displayed significant geographic heterogeneity. Independent clinical determinants of positive PCR for CP and/or MP were age below 45 years, previous antimicrobial therapy (especially betalactams). Clinical signs were not of practical use in distinguishing accurately between etiologic diagnoses. CONCLUSIONS: CP or MP diagnosed by PCR were found in more than 7% of patients with LRTI in community settings with a significant geographical heterogeneity and significant temporal trends in the incidence.

Adult↗
PubMed2005

A literature review on off-label drug use in children.

UNLABELLED: The aim was to compare results of studies performed in different settings worldwide and identify common therapeutic areas to allow for focused interventions, because off-label drug use can be a measure of the lack of knowledge concerning paediatric treatments. A secondary objective was to provide a brief review of efforts to date. A literature review of articles on off-label and unlicensed drug use in children involving general prescription samples was performed using Medline and Embase. In all, 30 studies from 1985-2004 were included. Eleven involved paediatric hospital wards, seven neonatal hospital wards, and 12 the community setting. The off-label and unlicensed classification methods varied, making results difficult to compare. In general, off-label/unlicensed prescription rates ranged from 11%-80%, and higher rates were found in younger versus older patients and in the hospital versus community settings. On the paediatric hospital wards, off-label/unlicensed prescriptions ranged from 16%-62% and most often concerned acetaminophen, cisapride, chloral hydrate, and salbutamol. In the neonatal wards, rates ranged from 55%-80% and often involved caffeine. In the community setting, rates ranged from 11%-37% and the most commonly implicated drugs were salbutamol and amoxicillin. CONCLUSION: A lack of harmonization between the evidence, the information available to doctors, and its use in clinical practice exists and this is part of the reason off-label therapies are so common. Attempts have been made to improve knowledge concerning paediatric treatments, but more focused interventions are needed, also taking into consideration this lack of harmonization.

Adolescent↗
PubMed1991

Nursing and medical care of primary dementia patients in a community hospital setting.

A group of 480 hospital discharges systematically drawn from elderly, community hospital discharges were examined in order to describe the hospitalization experiences of individuals with admitting or coexisting diagnoses of primary dementia. Demented patients (7.1% of the sample) were most likely to be among the oldest hospitalized elders. The most frequently recorded patient problem was "alteration in thought processes." Most nursing interventions emphasized safety precautions, often to the exclusion of psychosocial intervention to maximize and support the patient's level of cognitive functioning. Over one fourth of the demented patients had written "no code" prescriptions. Approximately 44% of the elders in the dementia subsample had prescriptions for psychotropic medications.

Aged↗