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PubMedDate not supplied

Beyond the acute care setting: community-based nonacute care nursing-sensitive indicators.

In 1994, concerns about the effects of hospital restructuring on patient care resulted in the American Nurses Association (ANA) undertaking a major, long-term initiative. Nursing's Safety & Quality Initiative (the Initiative) was designed to measure the impact of such changes on patient care. The Initiative has three major foci: research, continuing education, and legislation/policy. This article addresses a recent development in the research component of the Initiative, involving the identification of nursing-sensitive indicators for community-based nonacute care.

Community Health Nursing↗
PubMed2001

Anaphylaxis management in primary care.

The United Kingdom Resuscitation Council Project Team has issued revised guidelines on the emergency treatment of anaphylactic reactions in the community setting in response to community nurses' concerns. A consensus has now been reached.

Anaphylaxis↗
PubMedDate not supplied

Symptoms related to the reproductive tract and mental health among women in rural southern India.

BACKGROUND: Symptoms related to the reproductive tract and symptoms of psychological distress are commonly seen in women living in South Asia. This study aimed to determine the association, if any, between symptoms related to the reproductive tract and mental health among women in rural southern India. METHODS: The study was conducted in a community setting of a comprehensive community health programme in a development block in rural southern India. It was a cross-sectional survey with a nested case-control study. The main outcome measure was the probability of mental distress as assessed by the Tamil version of the General Health Questionnaire-12 (GHQ). RESULTS: Of the 622 subjects recruited, 150 (24.4%) complained of at least one symptom related to the reproductive tract. The commonest symptom was vaginal discharge (17.5%). Significantly higher scores on the GHQ were associated with the presence of many current and past symptoms related to the reproductive tract, and receiving treatment for the same, even after adjusting for age, education, current marital status and type of house, using multiple regression analysis. GHQ scores were positively correlated with a higher number of current and past symptoms. Significantly higher scores were also associated with greater knowledge about prevention of sexually transmitted diseases and reproductive tract infections. Being currently married and educated were significant protective factors. A nested case-control study was done with the presence of a current common mental disorder as the outcome. Symptoms and other factors dated prior to this outcome were considered potential risk factors. Logistic regression models were developed. The presence of a symptom related to the reproductive tract for more than one month (OR 3.6; 95% CI 1.8, 7.2) and a history of similar symptoms over the past year (OR 2.2; 95% CI 1.3, 3.7) were risk factors for the development of common mental disorders. Higher education (OR 0.5; 95% CI 0.3, 0.7) and being currently married (OR 0.2; 95% CI 0.1, 0.6) were protective factors. CONCLUSION: The cross-sectional data suggest an association between symptoms pertaining to the reproductive tract and psychological distress. The results of the nested case-control study suggest that symptoms related to the reproductive tract are risk factors for common mental disorders, while education and being currently married are protective factors.

Adolescent↗
PubMed1990

Conservative surgery and radiation therapy for early stage breast cancer. Can large trial experiences be reproduced in a community hospital setting?

Conservative surgery and radiation therapy were used to treat 212 patients with AJC clinical Stage I or II breast carcinoma at the Baptist Hospital of Miami. All had lumpectomy and most axillary lymph node dissection, followed by breast irradiation to a dose of 45 Gy and a boost dose of 14 to 16 Gy to the surgical bed. Median follow-up was 55 months. The five-year actuarial local control and survival rates were 94% and 86% respectively. Eighty-six percent of the patients had excellent or good cosmetic results with minimal differences between the treated and untreated breasts. Treatment-related complications were minor and infrequent. These results appear comparable to retrospective reviews at major university centers and ongoing prospective randomized trials.

Breast Neoplasms↗
PubMed1986

A prenatal screening system for use in a community-based setting.

An obstetrical risk and a nutritional risk screening system were developed and implemented in Massachusetts to be used for the identification of high-risk pregnant women. Components of the obstetrical risk score include age, parity, length of interconceptual periods, a pregravid weight-for-height index, and prior history of miscarriages and low birth weight (LBW) infants. The nutritional risk screening system is based on a modified food frequency using four food groups--meat and their alternates, milk, bread and cereal, and fruits and vegetables. Results from this study on 910 WIC and 418 non-WIC pregnant women indicate that women classified as at high obstetrical risk had a significantly higher incidence of LBW infants than women in the low-risk group. However, the nutritional risk score had no predictive value in identifying those women likely to produce LBW infants.

Female↗
PubMed1984

Comparison of methods for classifying community residential settings for mentally retarded individuals.

Research on differential effects of residential environments has been hampered by the lack of a formal classification scheme for placement types. Two systematic approaches (dimensional and typological) were used to develop classification systems. Each approach was evaluated on criteria applicable to general classification schemes and residential environments for retarded persons. A third, nested system was derived that satisfied rules for development and evaluative criteria.

Adolescent↗
PubMed1997

Creating community agency placements for undergraduate medical education: a program description.

UNLABELLED: PROGRAM OBJECTIVE: To provide first- and second-year medical students with stimulating learning experiences in the community. SETTING: Three hundred placements representing a broad array of urban community agencies providing both general and specialized health care services. PARTICIPANTS: All first- and second-year medical students at the University of Toronto (n = 354). Other participants include staff of community agencies and tutors from the Faculty of Medicine and from the community. PROGRAM: The Health, illness and the Community course is mandatory and consists of 3 components. The first, in the first semester of first year, emphasizes the provision of health care in the community for individuals and populations. The second, in the second semester of first year, introduces a health promotion paradigm. The third component, throughout second year, allows students to engage in an in-depth study of the interconnection between a health problem and a social issue in a community agency setting. OUTCOMES: Students have expressed high levels of satisfaction with the community agency placements. The feedback from agencies has also been enthusiastic. Patients in the home care program have reported that visits by medical students are a positive experience. CONCLUSION: It is possible to recruit and maintain large numbers of urban community agencies as learning sites for medical students. It is hoped that this approach will help to produce socially responsive medical practitioners.

Canada↗
PubMedDate not supplied

Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies). PARTICIPANTS: Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services). RESULTS: Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index. CONCLUSION: Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.

Community Pharmacy Services↗
PubMed2000

The impact of changing pathogens of serious infections in hospitalized patients.

New epidemiological patterns are being observed for multidrug-resistant nosocomial organisms. Current problems include the appearance of resistance determinants in organisms that are virulent enough to cause infection in patients with normal host defenses. In addition, multidrug-resistant organisms are spreading from health care to community settings, and organisms from the community are spreading to health care settings. The appearance and spread of resistance can be examined both at a molecular level and on a larger scale involving several pathways. Potential pathways within institutions include the following: introduction of new strains from outside sources (e.g., patients or health care workers from other institutions); exchange of resistance determinants via genetic mutation or transfer of genetic material; emergence or selection of resistant strains following exposure to antimicrobials; and clonal dissemination. Strategies such as multidisciplinary management of infections, appropriate infection control measures, and surveillance of resistance patterns are necessary to address the problem of resistance.

Bacteria↗
PubMed1995

Training internal medicine residents in the community: the Minnesota experience.

The University of Minnesota Internal Medicine Residency Program has developed ambulatory general medicine rotations in rural community settings and urban managed care settings in Minnesota. Based on what had been learned from community focus groups, from discussions with residents about what they perceived to be training holes in the traditional curriculum, and from resident evaluations of pilot rotations, an educational framework for the rotations was established. The authors describe the process of developing these rotations, their educational rationale and objectives, the structure of the rotations, teaching strategies, faculty development, and the evaluation system, and outline the important elements of the successful implementation of these new rotations. The community practice setting has offered a unique, important, and previously untapped resource for residency training, and the community rotations have been highly valued both by housestaff and by community preceptors. As residency programs begin to offer more community-based ambulatory care opportunities for their trainees, the impact of this trend on quality of training, residents' career choices, and patient outcomes will need to be evaluated.

Ambulatory Care↗
PubMed1997

Sibling abuse: another component of domestic violence.

As the issue of domestic violence is explored, components of the problem emerge. Sibling abuse as one component of domestic violence is described in this case study. The incidence, risk factors, and nursing care for sibling abuse are discussed. Nursing care for sibling abuse occurs in both the hospital and the community setting. The majority of care must occur in the community health setting because of shortened hospital stays. A review of the literature highlights a lack of research despite an indication of the potential magnitude of the problem. Further research in this area of domestic violence is needed.

Adolescent↗
PubMed2005

Is preceptorship valuable?

Preceptorship programmes for newly-qualified practitioners have been advocated by the UKCC (1999), therefore a preceptorship programme for midwives was introduced in Oxfordshire in 2000. The programme consisted of a three-month placement in a delivery suite (DS) and a three-month placement in an antenatal/postnatal ward environment. In 2001, it was decided to offer newly-registered midwives the opportunity to work in a community setting, rotating between DS and community on a fortnightly basis. To ascertain whether a community placement in a preceptorship programme provided the right balance between consolidation of skills and confidence, a research project was undertaken. This took the form of semi-structured interviews carried out before and after the completion of the amended programme. The project was conducted over a one-year period by the midwifery practice development team. A professional transcriber interpreted the interviews and the data was analysed by an independent reviewer. The research sample consisted of ten newly-qualified midwives and four preceptors. Findings identified that midwives valued and desired a period of initial support to consolidate their skills and knowledge, which helped to increase their confidence in their abilities regardless of the placement setting. Interestingly, midwives who had opted for a community placement continued to view childbirth as a normal life event, whereas hospital-based preceptees found their philosophy of care had changed at the end of the six-month programme. However, the midwives who had opted for a community placement found the fortnightly rotation too fragmented. The preceptorship programme also had a positive influence on retention rates, which may have been as a result of the midwives feeling more supported. In response to the findings of this research project, it was concluded that the community placement needed to be altered to a three-month placement, but should still be available to newly-qualified midwives as a placement option.

Adult↗