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At least 649 records · Page 36Linked to original sources
PubMed2003

Community action against asthma: examining the partnership process of a community-based participatory research project.

BACKGROUND: Community Action Against Asthma (CAAA) is a community-based participatory research (CBPR) project that assesses the effects of outdoor and indoor air quality on exacerbation of asthma in children, and tests household- and neighborhood-level interventions to reduce exposure to environmental asthma triggers. Representatives of community-based organizations, academia, an integrated health system, and the local health department work in partnership on CAAA's Steering Committee (SC) to design and implement the project. OBJECTIVE: To conduct a process evaluation of the CAAA community-academic partnership. DESIGN: In-depth interviews containing open-ended questions were conducted with SC members. Analysis included established methods for qualitative data, including focused coding and constant comparison methods. SETTING: Community setting in Detroit, Michigan. PARTICIPANTS: Twenty-three members of the CAAA SC. MEASUREMENTS: Common themes identified by SC members relating to the partnership's ability to achieve project goals and the successes and challenges facing the partnership itself. MAIN RESULTS: Identified partnership accomplishments included: successful implementation of a complex project, identification of children with previously undiagnosed asthma, and diverse participation and community influence in SC decisions. Challenges included ensuring all partners' influence in decision-making, the need to adjust to "a different way of doing things" in CBPR, constraints and costs of doing CBPR felt by all partners, ongoing need for communication and maintaining trust, and balancing the needs of science and the community through intervention. CONCLUSIONS: CBPR can enhance and facilitate basic research, but care must be given to trust issues, governance issues, organizational culture, and costs of participation for all organizations involved.

Asthma↗
PubMed2004

Out-of-hospital death: advance care planning, decedent symptoms, and caregiver burden.

OBJECTIVES: To examine the end-of-life experiences of elderly decedents dying out of the hospital and their family caregivers in a state in which the vast majority of Medicare deaths occur in community settings. DESIGN: Telephone survey of family caregivers 2 to 5 months after decedents' deaths. SETTING: Statewide (Oregon) random sample of death certificates. PARTICIPANTS: One thousand one hundred eighty-nine family caregivers of decedents aged 65 and older who died of natural deaths in community settings between 2000 and 2002. MEASUREMENTS: A 69-item telephone questionnaire with single-item indicators and embedded scales that indexed advance directives, use of life-sustaining treatments, hospice enrollment, decedent symptom experience and perceived distress, family financial hardship, out-of-pocket expenses, and caregiver strain. RESULTS: Most decedents had advance directives (78.3%) and were enrolled in hospice (62.4%). Although perceived decedent symptom distress was low overall, certain symptoms (e.g., pain, dyspnea, constipation) were distressing for approximately half of decedents experiencing them. Financial hardship, out-of-pocket expenses, and caregiver strain were frequently reported. American Indian race and younger age were associated with decedent symptom distress. Greater perceived decedent symptom distress, hospice enrollment, more caregiver involvement, and more financial burden were associated with greater caregiver strain. CONCLUSION: Despite high rates of advance directives and hospice enrollment, perceived symptom distress was high for a subset of decedents, and caregiver strain was common. As location of death increasingly shifts nationwide from hospital to community, unmet decedent and family needs require new clinical skills and healthcare policies.

Advance Care Planning↗
PubMed2006

Can evidence-based prevention programs be sustained in community practice settings? The Early Risers' Advanced-Stage Effectiveness Trial.

This study evaluated institutional sustainability of the Early Risers "Skills for Success" conduct problems prevention program. In a previous early-stage effectiveness trial Early Risers had been successfully implemented by a nonprofit community agency with guidance, supervision, technical assistance and fiscal support/oversight provided by program developers. The current advanced-stage effectiveness trial applied a randomized, control group design to determine whether this community agency could replicate earlier positive findings with a new cohort of participants, but with less direct involvement of program developers. An intent-to-intervene strategy was used to compare children randomly assigned to Early Risers or a no-intervention comparison group. Compared to results obtained in an early-stage effectiveness trial, program attendance rates were much lower and only one positive outcome was replicated. Failure to replicate program effects was not attributed to poor program implementation, because data collected pertaining to exposure, adherence and quality of delivery were acceptable, and a participation analysis showed that families who attended at higher levels did benefit. It was difficulties that the community agency experienced in engaging families in program components at recommended levels that primarily accounted for the results. Possible organizational barriers that impeded sustainability included unreliable transportation, poor collaboration between the agency and the local public school system, high staff turnover, agency downsizing, and fiduciary responsibility and accountability. It was concluded that both program developers and program providers need to be proactive in planning for sustainability.

Child↗
PubMed2006

A model for training pediatricians to expand mental health services in the community practice setting.

A model of training pediatricians in mental health diagnosis and intervention was developed to increase the pediatrician's competency in dealing with the increasing number of children with these problems. The model consisted of a pediatric psychiatrist working in collaboration with community pediatricians and training pediatricians in mental health interview and evaluation techniques, recognition and diagnosis of behavioral and mental disorders, and intervention and treatment. Following implementation of this model, the community pediatricians demonstrated an increase in mental health diagnoses in their practices. This model represents one approach in preparing pediatricians to respond to the increasing number of children with mental health and behavioral problems.

Child↗
PubMedDate not supplied

Translational research principles of an effectiveness trial for diabetes care in an urban African American population.

PURPOSE: Large-scale effectiveness trials designed to translate evidence-based diabetes care to community settings are few. Studies describing these methods among high-risk minority populations are particularly limited. METHODS: The authors describe Project Sugar, a randomized controlled trial conducted in 2 phases: Project Sugar 1 (1994-1999), which piloted a 4-arm clinic and home-based intervention using nurse case management and community health workers in 186 urban African Americans with type 2 diabetes, and Project Sugar 2 (2000-2005), which examined effectiveness of this intervention among 542 diabetic, urban African Americans. Results and Conclusions Project Sugar had success with regard to recruitment and retention, both in phase 1 (80% rate at 24 months) and phase 2 (>90% at 24 months). Using the RE-AIM framework, planning and research design for Project Sugar 2 is described in detail for elements that contributed to the reach, effectiveness, adoption, implementation, and maintenance of this study within a minority community setting. In addition to successful strategies, challenges to conducting effectiveness trials in an inner-city African American community are identified.

Black People↗
PubMed2001

Reflections on building community: a different perspective on academic-community partnerships using the integration matrix.

Implementation of interdisciplinary rehabilitation services and clinical training in community settings is a complex process. Documented methods for analyzing, evaluating and monitoring the process within federally funded grant projects are limited. This paper reports on the use of one proposed method, the Integration Matrix of Konrad, as a framework for formative assessment and analysis of project operations. Based upon ongoing experiences implementing a Health Resources and Services Administration (HRSA) funded clinical training program in a community setting, a revision of the Integration Matrix is proposed to better reflect a community-centered, pervasive communication approach to program operations and analysis.

Academic Medical Centers↗
PubMed1999

Improving support for mental health staff: a qualitative study.

BACKGROUND: High levels of both burnout and job satisfaction have been found in recent studies of mental health professionals. A qualitative methodology was used in a related study to explore reasons for these findings and to investigate staff's accounts of their strategies for coping with their work, and their views of support provided for them and how their jobs might be made less stressful and still more satisfying. METHOD: A semi-structured schedule was used to interview a purposive sample of 30 mental health staff drawn from three South London geographical sectors, selected to include junior and senior members of each profession in both hospital and community settings. Interviews were transcribed and analysed using QSR NUD.IST software. RESULTS: Informal contacts with colleagues were the most frequently mentioned way of coping with the difficult and demanding aspects of work in both hospital and community settings, closely followed by time management techniques. The main formal sources of support described by staff were individual supervision and staff support groups. Accounts of the former were generally positive, but there was great variation in opinions about whether support groups are useful. Almost all the interviewees believed that their jobs could be improved by further training. For community mental health staff the main training gaps were the development of skills in various forms of clinical intervention, whilst ward staff identified the need for further skills in diffusing potentially confrontational and aggressive situations.

Burnout, Professional↗
PubMed1992

Fine-needle aspiration in the diagnosis of salivary gland disorders in the community hospital setting.

From 1983 to 1988, 47 patients with salivary gland disorders were assessed with fine-needle aspiration (FNA) before surgery. The preoperative fine-needle diagnoses were then compared with the postoperative pathologic findings. In the same period, 63 patients from two other community hospitals who had been evaluated preoperatively with FNA were studied retrospectively. The overall sensitivity of FNA for salivary neoplasms was 80.6%. Fine-needle aspiration was more sensitive in identifying benign tumors (88.4%) than malignant neoplasms (58.3%) and was least sensitive in identifying nonneoplastic salivary diseases (35.3%). Pleomorphic adenomas were correctly identified preoperatively in 96.2% of cases, whereas for malignant neoplasms, the diagnostic accuracy was highest for mucoepidermoid carcinoma (50%). To demonstrate the strengths of FNA as a diagnostic tool, as well as to delineate its limitations, we present our 5-year experience. Our FNA results are similar to those reported by the major European and American referral centers. Because our medical centers are community based, our results may more accurately reflect those seen by otolaryngologists in private practice. To date, no evidence of tumor seeding along the FNA tract has been reported.

Biopsy, Needle↗
PubMed2005

What determines patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a community hospital setting?

The Iowa Satisfaction with Anesthesia Scale (ISAS) is a reliable and valid tool to measure patient satisfaction with monitored anesthesia care. We used the ISAS to discover determinants of patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a small community hospital. The ISAS (scored 1 to 6) was administered to 306 patients immediately after cataract surgery. All patients received topical local anesthesia and IV sedation administered by an anesthesiologist. Patient satisfaction was high: mean ISAS was 5.6 (sd 0.46; range: 3.3-6.0). The incidence of intraoperative and postoperative pain was 13% and 37%; other adverse events were infrequent (<5%). In multivariable logistic regression, significant predictors of satisfaction were postoperative pain (odds ratio [OR]: 4.84; 99% confidence interval [CI]: 2.21, 10.60), surgeon (OR: 0.21; 99% CI: 0.05, 0.91), and preoperative anxiety (OR: 1.17; 99% CI: 1.03, 1.34). ISAS mean scores (OR = 0.28; 99% CI: 0.13, 0.59) and preoperative anxiety (OR = 1.12; 99% CI: 0.99, 1.28) emerged as significant predictors of low rating of quality of experience. Our results indicate that the ISAS can be used to track patient satisfaction with monitored cataract care. Pain during and after cataract surgery is common and is a major reason for lower patient satisfaction with their cataract care.

Aged↗
PubMed1998

The Taps Project 40: quality of care provisions for the elderly mentally ill--traditional vs alternative facilities.

The study evaluates some aspects of care reprovision for psychogeriatric patients. Seven hospital wards are compared with four community settings, established as part of the reprovision programme for Friern Hospital in London. Each facility was assessed for policy and programme, social climate and physical characteristics; staff attitudes in regard to their tasks, training needs and job satisfaction were also explored. Community settings were superior to hospital wards in providing more privacy for the residents and were better equipped with physical amenities and safety features. There were relatively small differences between the way staff perceived the social climate in community homes and in hospital. The former were regarded as encouraging greater independence. Care staff in the hospital were more likely to express dissatisfaction with pay, working conditions and social status, while community staff were more dissatisfied with the quality of cooperation between staff members. Clients transferred to Social Services facilities had a higher level of functioning and needed less on-site medical care. This was further reflected by the lower frequency of nursing care tasks being performed by staff in community facilities. Overall, the shift towards a less medical model of care in community-based homes appears to be beneficial to psychogeriatric patients, provided that current and prospective physical needs of the residents are adequately addressed.

Attitude of Health Personnel↗
PubMedDate not supplied

Correlation of emergency department radiographs: results of a quality assurance review in an urban community hospital setting.

BACKGROUND: The study objective was to compare the accuracy of radiograph interpretation by emergency and family physicians with radiologists' overreadings. METHODS: We undertook a historical chart review of patients seen consecutively during a 1-year period at an inner-city emergency department of a medium-volume community hospital. The participants were a racially mixed group of 22,141 patients for whom 12,083 radiographs had been ordered. We compared interpretations by emergency and family physicians with those of radiologists who performed overreadings within 24 hours. This intervention was performed retrospectively. Measurements consisted of descriptive statistics, such as percentages and chi-square analysis. RESULTS: The main result was an overall discrepancy rate (ODR) of 1.1 percent. This figure is significantly different (P < 0.0001) from the lowest reported overall discrepancy rate to date (2.8 percent). CONCLUSIONS: Consistently low overall discrepancy rates have specific implications for the medical practice and reimbursement of primary care physicians for radiograph interpretation.

Clinical Competence↗
PubMed2003

Should patients with chronic psychiatric disorders remain in hospital? Results from a service inquiry.

The pattern of mental health care in Israel is undergoing major reform. In this report we explored hospitalization rates of 1,448 former long-stay psychiatric inpatients (70% of them with ICD-10 diagnosis of schizophrenia) subsequent to their transfer from countrywide psychiatric hospitals to 57 community-based hostels or alternative community settings between the years 1996-1999. Using data from the National Psychiatric Case Registry and a mirror image design, we examined the rates of readmission and calculated the number of saved hospital days during the community residence period, which compares more than two and four years, respectively, for 80% and 48% residents. T-tests, Mann-Whitney tests and analysis of variance were performed to examine differences in hospitalization rates and associated variables. Results showed that a minority, 36.2% of the former inpatients, was readmitted during their hostel residence. In comparison with an equivalent pre-hostel period, the time spent in hospital for those hostel residents that needed readmission was significantly shorter and the related day savings were considerably higher. The rehospitalized residents tended to be younger at their first hospitalization and at referral to the hostels, compared to those nonhospitalized. In addition, age by gender interaction, and length of hostel residence affected readmission rates. We may conclude that the policy decision to move the inpatients to a community setting is supported by the fact that the majority of the hostel residents was able to stay away from hospitalization.

Adolescent↗
PubMed1992

Unidimensionality of alcohol dependence syndrome?

To evaluate the coherence of Alcohol Dependence Syndrome (ADS), as per DSM-III-R criteria, 72 and 223 subjects with alcohol dependence disorder from Hospital and Community settings, respectively, were interviewed. Nine DSM-III-R criteria assessing the dependence syndrome were factor-analysed. A single factor model provides an adequate description of the interrelationship among the nine criteria and supports the coherence of the dependence syndrome for the hospital sample but not for the community. A two factor model, namely 'withdrawal' and 'social', fits the community data. When the criteria were combined into cumulative scales, they formed good approximations of unidimensional Guttman scales for both the hospital and community settings. For hospital data, preoccupation was the highly central criterion (lambda = 0.95) in defining the dependence syndrome while 'can't stop' (v = 0.11) measured the most severe level of dependence. In the community the 'socially dysfunctional use' identified as a separate secondary factor measured the most severe level of dependence.

Adolescent↗
PubMed2001

Patient-centred medicine through student-centred teaching: a student perspective on the key impacts of community- based learning in undergraduate medical education.

CONTEXT: The UK General Medical Council has proposed that increased use of community settings is essential to enhancement of medical education. However, such curriculum developments have been directed by educationalists and clinical faculty; there is to date little to show whether student perspectives accord with such expectations. AIM: To examine student views on whether community-based learning during a UK undergraduate medical education course results in new learning in the areas expected, and to elucidate any process factors which enhance attainment of learning objectives. METHOD: Nominal group technique, to develop consensus on important learning outcomes and process factors, and questionnaire survey, developed from the views of the nominal groups. RESULTS: 89 students participated (response rate 70% for the nominal groups, and 88% for questionnaire). Students perceived increased learning in many of the areas expected. In particular, students reported significant learning from: witnessing the impact of a longer term and more personal relationship with patients; the visible impact of social environment on health; the importance of dealing with people rather than diseases, and the use of the whole team for care. In addition, they emphasized that tutor, staff and patient enthusiasm for student presence and learning greatly enhanced the student learning experience. CONCLUSIONS: Community settings appear to achieve the expected attitudinal adaptation of students. The role of the committed tutor and team is seen as pivotal to learning. The conclusions support an increased emphasis in contemporary medical education and related research activity on the key impact of relationships in the learning environment.

Community Medicine↗