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Results for “Community setting”

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PubMed1998

A comparison of performance between third-year students completing a pediatric ambulatory rotation on campus vs in the community.

OBJECTIVE: To compare the performance of third-year medical students who completed the ambulatory component of their pediatric rotation in a community setting with the performance of third-year medical students who had their ambulatory experience on campus. METHODS: As part of a pilot project to implement a third-year Multidisciplinary Ambulatory Clerkship, 61 third-year medical students spent 12 weeks rotating through the primary care disciplines of family medicine, internal medicine, and pediatric practitioners' offices at sites distant from the university campus while 127 students remained on campus for their ambulatory experiences in these disciplines. The components of the overall pediatric grade consisted of a clinical performance evaluation in the ambulatory setting (4 weeks), a clinical performance evaluation on a 4-week inpatient rotation, and a grade from a multiple-choice final examination. RESULTS: The overall mean+/-SD final pediatric grade of students receiving their ambulatory pediatrics experience in the Multidisciplinary Ambulatory Clerkship was 86.5+/-3.4 compared with 88.0+/-3.4 for students receiving their ambulatory experience on campus (P<.007). This difference was accounted for by performance on the written final examination. Multidisciplinary Ambulatory Clerkship students had a mean+/-SD score of 78.9+/-8.3 and a failure rate of 18% compared with a mean score of 83.7+/-8.1 and failure rate of 3.9% for students who remained on campus for their ambulatory experience (P<.001 for both comparisons). No differences were noted between the 2 groups on their clinical performance evaluations for their ambulatory or inpatient experiences. CONCLUSIONS: These data suggest a difference in the learning experience between students receiving their pediatric ambulatory experience in the community vs on campus. Differences in exposure to structured learning experiences that occurred more frequently on campus might account for some of the difference in final examination results. Development of a standardized, structured learning experience across community sites would seem to be an appropriate means of enhancing learning in the community setting.

Achievement↗

PubMed1993

COP-BLAM multidrug infusion chemotherapies for lymphoma: results in a community hospital setting.

Twenty-two patients with malignant lymphoma were treated with three different COP-BLAM infusional chemotherapy protocols at the Jersey Shore Medical Center. The treatment group included 18 patients with large-cell lymphoma, 3 patients with Hodgkin's disease, and 1 patient with composite lymphoma (large-cell lymphoma and Hodgkin's disease). Three patients were treated with COP-BLAM III, 9 with COP-BLAM IV, and 10 with COP-BLAM V. The age of the patients at diagnosis ranged from 18 to 74 years, with a median age of 64 years. One patient had stage I bulky disease, 4 had stage II bulky disease, 3 had stage III disease, and 14 had stage IV disease. Twenty patients were evaluable for response; 2 were too early to evaluate. Complete response (CR) was seen in 18 of the 20 evaluable patients (90%). Potential cure (excludes non-lymphoma-related deaths) at 24 months is projected at 78%. Eleven patients are presently without disease and off therapy (55%). Projected failure-free survival at 2 years is 71% (a failure being death from any cause). Eleven of 22 patients developed 15 febrile episodes. Vincristine neuropathy was seen in 6 patients. Subclinical pulmonary fibrosis was seen in 1 patient. There was one cardiotoxic death. The COP-BLAM infusional protocols are highly effective, tolerable regiments that are applicable in community hospitals and can yield good response rates, with a high percentage of disease-free survivors in all age groups. The treatment can be completed in a short period with acceptable toxicity.

Adolescent↗

PubMedDate not supplied

Economic evaluation of the MEDENOX trial: a Canadian perspective. Medical Patients with Enoxaparin.

OBJECTIVE: To perform an economic evaluation of the Prophylaxis in Medical Patients with Enoxaparin (MEDENOX) trial from a Canadian perspective. METHOD: Using a decision tree model, cost effectiveness analysis was carried out to compare the costs and consequences of thromboprophylaxis using enoxaparin 40 mg with placebo in tertiary and community settings. From a third party payer's perspective, the model calculated the expected rate of symptomatic venous thromboembolism (VTE), and the total expected cost of prophylaxis and VTE management, including inpatient and outpatient treatment, professional fees and long term therapy. Data were derived directly from the MEDENOX trial. Costs are direct medical costs in year 2000 Canadian dollars. RESULTS: In a tertiary setting in which the estimated inpatient to outpatient deep vein thrombosis treatment ratio was 10%:90%, the total expected cost per patient was 64 dollars in the enoxaparin group and 62 dollars in the placebo group. The expected symptomatic VTE rates were 0.8% and 3.1% in the enoxaparin and placebo groups, respectively. The incremental cost effectiveness of enoxaparin 40 mg versus placebo was 87 dollars/VTE avoided. In a community hospital setting (with a 50%:50% inpatient to outpatient deep vein thrombosis treatment ratio), the total expected cost per patient was 68 dollars in the enoxaparin group compared with 72 dollars in the placebo group, indicating that prophylaxis with enoxaparin 40 mg was cost saving. The model was sensitive to the inpatient to outpatient ratio. However, within each setting, the results were not sensitive to changes in key variables. CONCLUSION: For patients hospitalized for acute respiratory failure, congestive heart failure or acute infectious disease and who are at moderate risk of developing VTE, thromboprophylaxis with enoxaparin 40 mg daily is a cost effective strategy in both tertiary and community settings.

Adult↗

PubMed1996

Omeprazole and clarithromycin with and without metronidazole for the eradication of Helicobacter pylori.

OBJECTIVES: To treat previously untreated adult patients infected with Helicobacter pylori with one of two regimens in an ambulatory community setting to assess the efficacy and safety of these regimens. METHODS: Sixty five adult patients with histologically confirmed H. pylori infection were randomly assigned in this open cohort study to 2 wk, low dose, twice daily treatment with omeprazole 20 mg and clarithromycin 250 mg (OC) (n = 31) or OC plus metronidazole 500 mg (OCM) (n = 34). At least 4 wk after treatment, H. pylori status was assessed by histology (four gastric biopsies, two each from antrum and body). RESULTS: Triple therapy with OCM was significantly better than dual therapy with OC in intent-to-treat (82.4 vs 58.1%, p = 0.03) and per protocol analysis (93.3 vs 62.1%, p = 0.004). Although there were frequent side effects (OC 19/31 61.3%; OCM 22/34 64.7% with at least one side effect), these were generally mild, and patients were able to complete nearly all of their medications (OC 97.2%, OCM 96.7% of pills taken). The only patient withdrawn due to medication side effects was in the OC arm. CONCLUSIONS: Triple therapy with OCM in a community setting eradicates H. pylori more effectively than dual therapy with OC. OCM is tolerated with high compliance despite frequent minor side effects and appears safe without the development of serious adverse events.

Anti-Bacterial Agents↗

PubMed1999

Prevalence of leg wound complications after coronary artery bypass grafting: determination of risk factors.

BACKGROUND: The reported prevalence of leg wound complications after coronary artery bypass grafting is 2% to 24%. Decreased length of hospital stay for patients who have this surgical procedure poses new care requirements in both acute care and community settings. OBJECTIVE: To determine the prevalence of postoperative leg wound complications in patients undergoing coronary artery bypass grafting and the risk factors associated with these complications. METHOD: In this prospective, observational study, 547 consecutive patients who had coronary artery bypass grafting alone or in combination with other cardiac surgical procedures were examined for evidence of leg wound complications each day after surgery during hospitalization. After discharge, problems were detected by home care nurses. RESULTS: The prevalence of leg wound complications was 6.8%. Factors significant by multiple logistic regression included preoperative hospitalization, use of an Ace elastic bandage in the operating room, the length of time the leg incision remained open in the operating room, and administration of nicardipine intravenously in the intensive care unit. Odds ratios were calculated for each variable. Premorbid factors such as diabetes or peripheral vascular disease were not predictive of complications. On average, most problems occurred on postoperative day 10, when many patients were at home. CONCLUSIONS: The results highlight the need to detect complications early, in both the hospital and the community settings. The determination of factors related to poor outcomes may assist clinicians in improving healthcare delivery.

Aged↗

PubMed1997

Improving the prescribing of antibiotics for urinary tract infection.

BACKGROUND: In recent years there have been changes in the recommended antibiotic treatment for urinary tract infections (UTIs). In particular, the use of amoxycillin or co-trimoxazole is now discouraged, with amoxycillin-potassium clavulanate, cephalexin and trimethoprim becoming first-line agents for uncomplicated lower UTIs. AIM: To examine whether academic detailing, performed by a pharmacist, could modify prescribing practices for antibiotics used in the treatment of UTI in the community setting. METHODS: The intervention was conducted in Southern Tasmania, using the remainder of the State as a control area. The target group of general practitioners was sent educational material designed to assist in the appropriate prescribing of antibiotics in the treatment of UTI. A pharmacist then visited each general practitioner and discussed the rational use of antibiotics for UTIs directly with him/her. Outcomes were measured using evaluation feedback from the general practitioners and pharmacoepidemiological data, which were not linked to diagnosis. The key variable examined was the total defined daily doses (DDDs) dispensed for the recommended first-line agents (amoxycillin-potassium clavulanate, cephalexin and trimethoprim) compared with amoxycillin (3 g single-dose form) and co-trimoxazole. RESULTS: The educational programme was very well received by the general practitioners. Changes in the prescribing of antibiotics commonly used for UTIs were evident in both study regions over the course of the study, but the improvements were significantly greater in the intervention area. CONCLUSION: Educational programmes utilizing academic detailing by pharmacists can modify prescribing practices within the community setting.

Anti-Infective Agents, Urinary↗

PubMed2025

Artificial Intelligence in Diagnosing Depression Through Behavioural Cues: A Diagnostic Accuracy Systematic Review and Meta-Analysis.

AIM: To synthesise existing evidence concerning the application of AI methods in detecting depression through behavioural cues among adults in healthcare and community settings. DESIGN: This is a diagnostic accuracy systematic review. METHODS: This review included studies examining different AI methods in detecting depression among adults. Two independent reviewers screened, appraised and extracted data. Data were analysed by meta-analysis, narrative synthesis and subgroup analysis. DATA SOURCES: Published studies and grey literature were sought in 11 electronic databases. Hand search was conducted on reference lists and two journals. RESULTS: In total, 30 studies were included in this review. Twenty of which demonstrated that AI models had the potential to detect depression. Speech and facial expression showed better sensitivity, reflecting the ability to detect people with depression. Text and movement had better specificity, indicating the ability to rule out non-depressed individuals. Heterogeneity was initially high. Less heterogeneity was observed within each modality subgroup. CONCLUSIONS: This is the first systematic review examining AI models in detecting depression using all four behavioural cues: speech, texts, movement and facial expressions. IMPLICATIONS: A collaborative effort among healthcare professionals can be initiated to develop an AI-assisted depression detection system in general healthcare or community settings. IMPACT: It is challenging for general healthcare professionals to detect depressive symptoms among people in non-psychiatric settings. Our findings suggested the need for objective screening tools, such as an AI-assisted system, for screening depression. Therefore, people could receive accurate diagnosis and proper treatments for depression. REPORTING METHOD: This review followed the PRISMA checklist. PATIENTS OR PUBLIC CONTRIBUTION: No patients or public contribution.

Humans↗

PubMed2002

Low risk of recurrence of oculorespiratory syndrome following influenza revaccination.

BACKGROUND: During the 2000-2001 influenza vaccination season, a new adverse event associated with the influenza vaccine, called oculorespiratory syndrome (ORS), was identified in Canada. We examined the risk of recurrence of ORS for individuals affected in 2000-2001 who were revaccinated in the community setting in 2001-2002. METHODS: We conducted a telephone survey in May 2002 in which participants were asked whether they had been revaccinated in the 2001-2002 immunization season and whether they had experienced any recurrence of ORS or any other adverse event. Eligible individuals (n = 609) included residents of British Columbia aged 18 years or more who had reported any type of adverse event associated with the influenza vaccine in 2000 and who had participated in a survey in September 2001 that characterized their adverse event experience. RESULTS: The response rate to this survey was 92% (561 of 609 people approached). Of the 561 participants, 202 were revaccinated in 2001. Among the 202 revaccinated, 122 individuals had previously reported ORS in 2000: 40 had described their ORS experience in 2000 as mild (present but not bothersome), 44 as moderate (interrupting daily activities), 35 as severe (preventing daily activities) and 3 did not provide specific details. Six of the 122 individuals experienced a recurrence of ORS following revaccination. The estimated risk of recurrence for ORS following revaccination in the community setting was 5% (95% confidence interval 2.2%-10.5%). Four of the 6 individuals described their ORS recurrence in 2001 as milder than the ORS they had experienced in 2000. INTERPRETATION: We found a low risk of recurrence of ORS for individuals previously affected in 2000 when they were revaccinated in 2001, including those whose ORS in 2000 had prevented daily activities but was not clinically severe. Health care providers should be confident in the safety of recommending revaccination of these individuals. As with all vaccines, however, a detailed risk-benefit assessment should be undertaken before revaccination of people whose previous adverse event experience may have included collapse, respiratory difficulty (including throat tightness) and/or chest discomfort requiring emergency intervention.

Aged↗

PubMed2003

Randomized, multicenter, phase II trial of two multicomponent regimens in androgen-independent prostate cancer.

PURPOSE: Several multicomponent regimens have been reported to be useful in advanced androgen-independent prostate cancer. We used a randomized phase II design to evaluate and compare two such regimens. Patients were accrued primarily in the community setting. PATIENTS AND METHODS: Patients with progressive, androgen-independent prostate cancer were randomly assigned to one of two treatments: either ketoconazole/doxorubicin alternating with vinblastine/estramustine (KA/VE) or paclitaxel, estramustine, and oral etoposide (TEE). Patients were prospectively stratified on the basis of disease volume. The primary end points were response and overall survival time. RESULTS: A total of 75 patients were registered; 71 are included in the analysis. By the criterion of an 80% prostate-specific antigen reduction maintained for at least 8 weeks, 11 (30%) of 37 patients in the TEE arm responded, whereas 11 (32%) of 34 assigned to KA/VE responded. Median survival was 16.9 months (95% confidence interval [CI], 10.5 to 21.2 months) in the TEE arm and 23.4 months (95% CI, 12.9 to 30.6 months) for patients treated with KA/VE. Many patients (24%) failed to complete at least 6 weeks of therapy, including five (8%) treatment-related early deaths. CONCLUSION: Each of these regimens produced clinically significant responses, and the observed median survival (18.9 months for all 71 patients) compares favorably with previously published results, especially in the community setting. Nonetheless, it is apparent that these first-generation regimens must be applied judiciously, and thus we view efforts at better patient selection and the development of more tolerable therapies as higher priorities than carrying either of these regimens to phase III evaluation in the cooperative group setting.

Adenocarcinoma↗

PubMed2005

Efforts to improve subsequent treatment of cardiovascular risk factors in older patients with diabetes hospitalized for a cardiac event.

OBJECTIVE: To improve the treatment of risk factors of cardiovascular disease (CVD) for older patients with diabetes after a cardiac event by using a low-literacy reminder card describing these risk factors in community settings. STUDY DESIGN: A multicenter, randomized, interventional study. METHODS: Patients aged 55 years or older with diabetes hospitalized with an acute myocardial infarction, congestive heart failure exacerbation, or unstable angina were eligible to enter the study. Control and experimental patients were recruited from 4 sites and were enrolled in the study before discharge from the hospital. Experimental subjects received education and a reminder card describing risk factors of CVD. They were instructed to discuss the risk factors described on the reminder card with their primary care physician on their first appointment after discharge. Control subjects did not receive any intervention but were given consent to be able to review their charts. RESULTS: One hundred sixty patients completed the study, 82 in the control group and 78 in the experimental group. At the end of the study there was no difference in blood pressure control, lipid levels, and glycosylated hemoglobin levels between the control and experimental patients. Aspirin use and ACE inhibitor use were found to be significantly higher in the control group (P = .001 and .03, respectively). CONCLUSIONS: Reminder cards given to patients to discuss with their primary care providers in community settings did not improve process measures of CVD risk in patients with documented CVD and diabetes. Other approaches will be needed to improve the treatment of risk factors in these high-risk patients.

Aged↗

PubMed2001

Innovative approaches to comprehensive cardiovascular disease risk reduction in clinical and community-based settings.

We have developed, tested, and successfully implemented an affordable, evidence-based, comprehensive cardiovascular disease risk-reduction program for use in primary and secondary prevention settings. The program is administered at hospitals, physician practices, cardiac rehabilitation programs, work sites, shopping malls, and health clubs. The program is also delivered from a call center using the telephone and the Internet. Program staff are guided by a computerized participant management and tracking system. Lifestyle management interventions are based on several behavior change models, primarily social learning theory, the stages of change model, and single concept learning theory. Typically, the program is administered entirely by non-physician healthcare professionals whose services are integrated with the care provided by the participants' physicians. Outcome data have documented the clinical effectiveness of this innovative approach.

Adaptation, Psychological↗

PubMed1998

A comparison of oral fluid and serum for the detection of rubella-specific antibodies in a community study in Addis Ababa, Ethiopia.

OBJECTIVE: To assess the utility of oral fluid compared with serum for the determination of age-prevalence of rubella-specific antibodies in an urban African community setting. METHOD: Paired serum and oral fluid samples were collected from 439 individuals aged 0-49 years in Addis Ababa, Ethiopia, as part of a larger seroepidemiological survey in 1994. Oral fluid was sampled using a simple sponge device that was well accepted by subjects of all ages; venous blood was collected by Vacutainer system. We measured rubella-specific antibodies in serum by the Radial Haemolysis (RH) test, supported by two confirmatory assays, and in oral fluid by IgG antibody-capture radioimmunoassay (GACRIA). RESULTS: Sensitivity and specificity of oral fluid results compared to serum were 89% and 76%, respectively. Sensitivity declined from 96% in age group 0-19 years to 90% in age group 20-29 and 78% in age group 30-49. Specificity was 86% in 0-9 year olds contrasting with 61% in older groups (10-49 years). The positive predictive value of an oral fluid sample was high in all age groups (range 92-100%), while the negative predictive value declined from > or =80% in those aged <10 years to <10% in those aged > or =30 years. Serum confirmatory tests suggested a proportion of false serum RH negatives, increasing with age, indicating a need to standardize serum as well as oral fluid tests. CONCLUSION: In the community setting of a developing country, oral fluid surveys could be useful to estimate age-prevalence of rubella immunity and identify rubella-susceptible children for follow-up. Further work is required to simplify assays and sample processing, improve assay sensitivity and estimate assay specificity more precisely, and compare and standardise collection methods suitable for surveillance of a variety of childhood viral infections.

Adolescent↗

PubMed1998

Familial aggregation of osteoarthritis: data from the Baltimore Longitudinal Study on Aging.

OBJECTIVE: To evaluate the familial aggregation of osteoarthritis (OA) in a cohort of healthy volunteers drawn from a community setting. METHODS: Hand radiographs obtained between 1978 and 1991 and bilateral standing knee radiographs obtained between 1984 and 1991 were read for changes of OA, using Kellgren-Lawrence (K-L) scales. The hand sites were distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints, and first carpometacarpal (CMC1) joints. For each joint group, the presence of OA in at least 1 joint in a joint group, the number of affected digits in each joint group, and the sum of the K-L grade across all joints were analyzed. Polyarticular OA was recorded if there were OA findings in 2 of 3 hand joint groups plus 1 or both knees. Data from 167 families with hand radiographs, 157 families with knee radiographs, and 148 families with both hand and knee radiographs were analyzed for sib-sib correlations. RESULTS: After adjustment for age, sex, and body mass index, clinically relevant sib-sib common correlations were found for OA of the DIP, PIP, and CMC1 joints, for OA at 2 or 3 hand sites, and for polyarticular OA (r = 0.33-0.81) when OA was defined according to the number of affected joints or as the sum of the K-L grade across all joints. CONCLUSION: These results from a cohort of volunteers drawn from a community setting and ascertained without regard to OA status demonstrate familial aggregation of OA and contribute to the evidence for heritability of OA.

Adult↗

PubMed1999

Colorectal cancer screening: a community case-control study of proctosigmoidoscopy, barium enema radiography, and fecal occult blood test efficacy.

OBJECTIVE: To examine the effectiveness of screening proctosigmoidoscopy, barium enema radiography, and the fecal occult blood test (FOBT) in decreasing colorectal cancer mortality in a community setting. PATIENTS AND METHODS: In this population-based case-control study, cases comprised 218 Rochester, Minn, residents who died of colorectal cancer between 1970 and 1993. Controls were 435 age- and sex-matched residents who did not have a diagnosis of colorectal cancer. Screening proctosigmoidoscopy, barium enema radiography, and FOBT results were documented for the 10 years prior to and including the date of diagnosis of fatal colorectal cancer in cases and for the same period in matched controls. History of general medical examinations and hospitalizations was also recorded. RESULTS: Within the 10 years prior to diagnosis, the percentages of cases vs controls with at least 1 screening proctosigmoidoscopy were 23 (10.6%) of 218 cases vs 43 (9.9%) of 435 controls; at least 1 screening barium enema radiographic study was done in 12 (5.5%) of 218 vs 25 (5.7%) of 435. Within 3 years prior to diagnosis, the percentages of cases vs controls with at least 1 screening FOBT were 27 (12.4%) of 218 vs 44 (10.1%) of 435. Adjusted odds ratios were 1.04 (95% confidence interval [CI], 0.21-5.13) for proctosigmoidoscopy (distal rectosigmoid cancers only), 0.67 (95% CI, 0.31-1.48) for barium enema radiography, and 0.83 (95% CI, 0.45-1.52) for FOBT over the above time periods. CONCLUSION: In this case-control study within a community setting, a colorectal cancer-specific mortality benefit could not be demonstrated for screening by FOBT, proctosigmoidoscopy, or barium enema radiography. Screening frequency was low, which may have contributed to the lack of measurable effects.

Aged↗

PubMed2004

Management patterns and outcomes of patients with venous thromboembolism in the usual community practice setting.

OBJECTIVE: The objectives of this study were to observe a commercially insured sample diagnosed with a venous thromboembolism (VTE) event and treated postevent with warfarin and to detail the thromboembolic and bleeding outcomes in the time periods during warfarin therapy and after discontinuation of such therapy. METHODS: This retrospective, observational cohort study used medical, pharmacy, and eligibility data from 2 US health plans. Study inclusion required an inpatient diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE) between January 1, 1998, and December 31, 2000; warfarin, heparin, or low-molecular-weight heparin within 30 days after diagnosis; no VTE diagnosis; and no anticoagulant use for 3 months preceding diagnosis. A random sample of medical charts was abstracted to validate VTE events and collect prothrombin time/international normalized ratio (INR) result data. Recurrent VTE events, bleeding events, and proportion of time within INR range were captured in the postindex VTE event time period. Univariate and multivariate statistical techniques were used to assess outcomes. RESULTS: A total of 2,090 patients were identified with a newly diagnosed VTE event (DVT only, 1450; PE with or without DVT, 640). Mean (SD) age was 61.7 (16) years; mean (SD) follow-up time after the index diagnosis was 21.3 (10) months. Overall mean (SD) length of warfarin therapy was 6.6 (6) months. During the follow-up period, 224 patients (10.7%) experienced a recurrent VTE event and 122 patients (5.8%) experienced a bleeding event requiring hospitalization. The cumulative incidence of recurrent VTE events over 3 and 6 months was 9.0% and 10.9%, respectively. Using the chart abstraction subset, patients were within the appropriate INR range 37.7% of the time while receiving warfarin. CONCLUSIONS: Negative outcomes associated with warfarin therapy-recurrent VTE events and bleeding requiring hospitalization-were experienced by 10.7% and 5.8% of patients, respectively. These data suggest that negative outcomes may be more prevalent in usual community medical practice compared with rates observed in the controlled environment of the clinical trial or specialized anticoagulation clinic.

Aged↗

PubMed2004

Relationship between triclosan and susceptibilities of bacteria isolated from hands in the community.

The possible association between triclosan and bacterial susceptibility to antibiotic was examined among staphylococci and several species of gram-negative bacteria (GNB) isolated from the hands of individuals in a community setting. Hand cultures from individuals randomized to using either antibacterial cleaning and hygiene products (including a hand soap containing 0.2% triclosan) or nonantibacterial cleaning and hygiene products for a 1-year period were taken at baseline and at the end of the year. Although there was no statistically significant association between triclosan MICs and susceptibility to antibiotic, there was an increasing trend in the association the odds ratios (ORs) for all species were compared at baseline (OR = 0.65, 95% confidence interval [95%CI] = 0.33 to 1.27) versus at the end of the year (OR = 1.08, 95%CI = 0.62 to 1.97) and for GNB alone at baseline(OR = 0.66, 95%CI = 0.29 to 1.51) versus the end of year (OR = 2.69, 95%CI = 0.78 to 9.23) regardless of the hand-washing product used. Moreover, triclosan MICs were higher in some of the species compared to earlier reports on household, clinical, and industrial isolates, and some of these isolates had triclosan MICs in the range of concentrations used in consumer products. The absence of a statistically significant association between elevated triclosan MICs and reduced antibiotic susceptibility may indicate that such a correlation does not exist or that it is relatively small among the isolates that were studied. Still, a relationship may emerge after longer-term or higher-dose exposure of bacteria to triclosan in the community setting.

Anti-Bacterial Agents↗

PubMed2004

Management of acute exacerbations of chronic obstructive pulmonary disease in the elderly: physician practices in the community hospital setting.

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and sixth most common reason that Medicare patients are hospitalized. We performed retrospective chart review on a statewide random sample of 409 Medicare patients discharged from October 1, 2000, through January 31, 2001, with a diagnosis of COPD. The most commonly performed diagnostic tests were chest radiography (96.8%) and oxygenation assessment (94.9%). The most common treatments provided were inhaled short-acting beta-agonist bronchodilators (98.5%) and oxygen (94.4%). Antibiotics (89.0%) and systemic corticosteroids (85.1%) were prescribed less frequently. The median length of stay was 5 days. The readmission rate was 27.4% (CI, 23.1-32.0) at 30 days and 43.0% (CI, 38.2-47.9) at 180 days. The in-hospital mortality rate was 1.7% (CI, 0.7-3.5) and the 180-day mortality rate was 23.7% (CI, 19.7-28.1). The morbidity and mortality associated with acute exacerbations of COPD remain high. There are opportunities to improve quality of care for this condition.

Acute Disease↗

PubMedDate not supplied

Effect of preventive dentistry training program for caregivers in community facilities on caregiver and client behavior and client oral hygiene.

The influx of persons with developmental disabilities into community-based programs has required the development, expansion and improved integration of community-based services. The role of caregivers in these community settings has become pivotal. However, with regard to daily activities, oral hygiene is often a low priority. Few attempts have been made to study caregiver participation in oral disease prevention and practices. This study evaluated the effects of an indirect training program, where caregivers were trained but the ultimate effects were demonstrated in adult clients. In addition, these effects were demonstrated in community care settings. A multiple baseline design, across three group homes, included 11 adult clients with developmental disabilities. This study evaluated the effects of training, instruction to use training and coaching on the presence of caregivers during oral hygiene sessions, the duration of toothbrushing and plaque scores of the clients. The results of this investigation demonstrated that there was an increase in caregiver presence and duration of brushing with a concurrent decrease in plaque scores. Caregivers responding to social validation questionnaires believed that 8 out of 11 clients had increased skills. This study demonstrates that caregiver training, combined with specific instructions to use training information and coaching of caregivers, can have a positive impact on the oral health of individuals with developmental disabilities living in community settings.

Adult↗