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PubMed2005

What patients and carers want to know: an exploration of information and resource needs in adult mental health services.

OBJECTIVE: The objectives of this study were to: (i) obtain baseline data on the extent of carer involvement across a representative sample of hospital and community patients within an integrated area health service; and (ii) examine perspectives on discharge planning and community care among patients and their carers to identify information and resources they consider important. METHOD: Over a 4-month period, inpatients before discharge and patients accessing community mental health services participated in face-to-face interviews. Information was collected about carer involvement and, with the patient's consent, the identified carer was sent a similar survey to determine demographics and information needs. This resulted in a representative sample of patients and carers accessing inpatient and community settings across a metropolitan mental health service. Support needs and carer burden were also assessed but are not reported here. RESULTS: A total of 407 interviews were completed, 207 in inpatient settings and 200 in the community. An inpatient response rate of 70% and a community response rate of 75% was achieved. Across both settings, 67% of patients identified a carer and a carer response rate of 28% was then obtained. We found carers and patients have different priorities regarding the information they want and information is often not provided to carers. Furthermore, patients were more confident in their ability to manage their mental health in the community than carers. CONCLUSIONS: This study yielded important baseline data about the number of patients who have a carer. We were also able to determine that routine clinical information provided to patients and carers is inadequate from their perspective. It is anticipated that this initiative will assist ongoing service planning and improve partnerships with patients and their carers.

Adult↗

PubMed2003

Reliability of a modified medication appropriateness index in community pharmacies.

BACKGROUND: The medication appropriateness index (MAI) has demonstrated reliability in selected outpatient clinics where medical data were easily accessible from medical charts. However, its use in the community setting where patient data may be limited has not been examined. OBJECTIVE: To evaluate the usefulness of a modified MAI for use in the community pharmacy setting by testing interrater reliability using 3 different rating schemes. METHODS: Two raters evaluated 160 medications for 32 elderly ambulatory patients. Patient information was acquired using community pharmacist-collected medication histories. A summated MAI score, percent agreement, kappa, positive agreement, negative agreement, and intraclass correlation coefficient were calculated for each criterion using 3 scoring schemes. A paired samples t-test (95% CI) was used to test interrater reliability. RESULTS: The kappa statistics were >0.75 for indication and effectiveness, but good (0.41-0.66) for the remaining criteria using the Hanlon scoring scheme. The intraclass coefficients (0.82, 0.86, 0.87) and overall kappa (0.65, 0.66, 0.61) were similar for the 3 schemes. CONCLUSIONS: This study suggests that the modified MAI has the potential to detect medication appropriateness and inappropriateness in the community pharmacy setting; however, it is not without limitations. Because the MAI has the most clinimetric and psychometric data available, the instrument should be studied further to increase its reliability and generalizability.

Data Collection↗

PubMed1999

Exploring instructional quality indicators in ambulatory medical settings: an ethnographic approach.

BACKGROUND AND OBJECTIVES: As medical education moves to community settings, the quality of learning is influenced by differences in the practice environment, organization, resources, patient case mix, and demographics. This ethnographic study identified experiences and processes that influence student learning in community-based practice settings. METHODS: Trained field researchers conducted participant observation in eight community teaching sites. Data were analyzed using a qualitative, grounded theory approach. RESULTS: Three dominant themes emerged: 1) the preceptor's role in situating learning opportunities, 2) the learner's role in transforming experience into learning, and 3) the practice organization as a classroom setting. The findings highlight the importance of exploiting learning opportunities and the contributions of other medical staff and patients in facilitating unique learning experiences. CONCLUSIONS: This research suggests the need to move beyond the typical student ratings of teacher effectiveness to consider and assess additional important factors and processes that affect instructional quality.

Anthropology, Cultural↗

PubMed2000

Classifying specialist student practice: debates and dilemmas.

At present, the practice elements of the Specialist Community Practitioner Awards within the BSc (Hons) in the Community Health degree course at Manchester Metropolitan University do not directly contribute to degree classification. Student evaluation and external examiner concerns about the heavy assessment load motivated the course team to consider classifying practice at 20 Level III credits which would replace 20 theory credits. The process of developing a credible assessment tool for specialist practice was long and hard but the course team is now in a position to undertake an exploratory study of the assessment and classification of practice. This paper provides an overview of the discussion and debates that took place in the years before the study began. A future paper will provide detail of the study and will include practice educators, students and managers views on the structure, process and outcomes of marking specialist student practice in community settings.

Community Health Nursing↗

PubMed2001

Principles for pressure ulcer prevention in the community.

This article aims to examine the prevention of pressure ulcers in the community. Pressure ulcers continue to cause needless distress and anxiety for patients, carers and their families. Health professionals in the community often face extreme challenges when caring for patients who are at risk of developing pressure ulcers. This could be due to lack of appropriate assessment skills and having insufficient time to conduct an appropriate assessment. Having an understanding and awareness of the function of the skin and the aetiology of pressure ulcer development can assist the health professional in attempting to take a proactive approach to prevent pressure ulcer formation in the community setting.

Community Health Nursing↗

PubMed1995

Nurses' knowledge and beliefs about AIDS: comparing nurses in hospital, community and hospice settings.

The literature reports an ongoing debate amongst nurses regarding the risk of contracting human immunodeficiency virus (HIV) through routine nursing care. An emotionally charged dilemma appears to exist for many nurses regarding what they perceive as conflict between professional obligation and personal risk. This study investigates nurses' beliefs, knowledge and perceptions of risk of contracting HIV while implementing their nursing care. The study focuses on qualified nurses in the hospice, hospital and community settings. No other similar comparative study that also focuses on hospice nurses has been identified. This quantitative study was implemented within Northern Ireland, by way of a respondent-administered questionnaire. The study's sample consisted of 45 qualified nurses and a response rate of 93% (42 respondents) was achieved. Analysis of the data involved the use of descriptive and correlational statistics. Overall findings indicated that many nurses, but particularly those who work in the hospital and community settings, hold negative and biased beliefs, and have inadequate knowledge and misguided perceptions regarding their risk of contracting HIV through the implementation of routine nursing care of clients. Many of those nurses readily admit their lack of knowledge. On the whole, hospice nurses appear more knowledgeable and exhibit a more positive approach to AIDS clients, and appear less fearful than do nurses in the other two settings. Implications for hospital management, for nurse education, for nurses themselves and for clients are discussed. This study should be seen as a springboard for future research within Northern Ireland.

Acquired Immunodeficiency Syndrome↗

PubMed2026

Management of complex lipid disorders in a community lipid clinic setting: Implementing a multidisciplinary model.

BACKGROUND: Large treatment gaps exist in the management of lipid disorders, and many high-risk patients have factors that complicate management efforts. While lipid clinics exist within academic medical centers, most of these patients are cared for in community settings. OBJECTIVE: To report our experience and results managing challenging and complex lipid disorders in a community-based lipid clinic. METHODS: We established a specialized lipid clinic in a community medical setting, with a focus on patients with management challenges and/or suspicion of a genetic lipid disorder, employing a multidisciplinary approach to optimize patient outcomes, emphasizing appropriate medical therapies and lipid genetic testing in selected patients. Retrospective electronic health record data were collected to analyze patient characteristics, treatment patterns, and lipid results. RESULTS: Over the period 2022 through 2024, 183 patients were seen (mean 63 years, 62% female). The challenging nature of the patient population was highlighted by high rates of statin intolerance (50%), no lipid medical therapy at baseline (50%), and comorbidities (atherosclerotic cardiovascular disease [ASCVD], diabetes, and/or hypertension-61%). Despite this, over a mean follow-up of 9.4 ± 7.3 months, we observed a mean low-density lipoprotein cholesterol decrease of 49 mg/dL (-24.5%, P < .001), along with significant decreases in total cholesterol and triglycerides. Pathogenic dyslipidemia genetic variants were discovered in 21 patients (of 105 tested). Significant lipid improvements in the whole cohort, as well as multiple subgroups, were associated with greater utilization of combination therapies. CONCLUSION: Patients with complex lipid disorders can be successfully managed within a specialized lipid clinic in community medical settings. Applying such a multidisciplinary model outside of traditional academic medical centers offers the potential to raise the level of lipid management and ASCVD prevention more broadly in larger populations.

Combination medical therapy↗

PubMed1996

Congruence between education and reading levels of older persons.

The educational levels of 57 middle-aged and elderly persons were compared with their reading levels as assessed by the Wide Range Achievement Test-Reading. Participants were recruited from mental health and community settings in a predominantly black community. Thirty-six participants (63 percent) were reading at a median of five years below their educational level. Forms used in the settings were written at a level above the reading ability of most participants. Results suggest that older persons may have difficulty comprehending written instructions for medications and diets and that such materials should be written at lower than an eighth-grade level.

Black or African American↗

PubMed1992

Improving social skills and disruptive behavior in children with autism through self-management.

The literature suggests that children with autism typically are unresponsive to verbal initiations from others in community settings, and that such unresponsiveness can lead to problematic social interactions and severely disruptive behavior. The present study assessed whether self-management could be used as a technique to produce extended improvements in responsiveness to verbal initiations from others in community, home, and school settings without the presence of a treatment provider. The results showed that children with autism who displayed severe deficits in social skills could learn to self-manage responsivity to others in multiple community settings, and that such improvements were associated with concomitant reductions in disruptive behavior without the need for special intervention. The results are discussed in terms of their significance for improved development of social skills in children with autism.

Autistic Disorder↗

PubMedDate not supplied

Trajectory of weight changes in the first 6 weeks postpartum.

OBJECTIVE: To determine the trajectory of postpartum weight changes and to examine associations between weight change in the first 6 weeks postpartum and demographic, clinical, psychosocial, and behavioral variables. DESIGN: Prospective, longitudinal design. SETTING: Community hospital and university research setting. PARTICIPANTS: 26 low-income women (9 White, 8 Black, and 9 Hispanic) with uncomplicated term pregnancies. MAIN OUTCOME MEASURE: Body mass index measured weekly. RESULTS: Among White women, body mass index decreased significantly for the first 3 weeks of the postpartum period. Black women experienced a significant reduction in body mass index for only the first 2 postpartum weeks. Similarly, the postpartum body mass index decreased for the first 2 weeks for Hispanic women. Prepregnancy body mass index and gestational weight gain each had a significant positive effect on postpartum body mass index. Perception of social support at 4 weeks had a significant positive effect on postpartum body mass index in Black women. CONCLUSIONS: The trajectory of weight change was nonlinear with large initial weight losses during the first 2 to 3 weeks postpartum followed by weight plateaus for the remainder of the first 6 weeks postpartum.

Adult↗

PubMed2006

Status and trends in Swedish dissertations in the area of cardiovascular nursing.

In Europe, cardiovascular nursing (CVN) is a young branch of nursing science. The explicit knowledge contained in CVN dissertations has, so far, not been studied in Europe, and this is especially true in the case of Sweden. Accordingly, the aim of this literature study was to describe the status of and compare trends in Swedish dissertations in the area of CVN in terms of organisational structure, approach, research strategy, social orientation and socio-demographic aspects. The literature search resulted in 29 dissertations and a 26-item questionnaire that illuminated the problem areas. Most dissertations were produced in the universities of Göteborg, Halmstad and Linköping; a minority had a nurse as main supervisor; rehabilitation was the most common CVN approach; very few of the dissertations had an experimental design; and the majority was hospital-based. The main trends were (A) an increase in dissertations that were written during the last 6 years, (B) an increased number of nurses as main supervisors as well as publication in nursing journals, (C) an increase in hospital care settings while a decrease in community settings, and finally, (D) an increased number of dissertations addressing the issues of tertiary prevention as well as focusing on patients and next-of-kin as target groups. An important implication is to stimulate nurse-led interventions at all preventative levels in order to maintain or improve the cardiac health of both healthy and sick individuals, but also in order to visualize CVN and distinguish it from cardiology.

Academic Dissertations as Topic↗

PubMed1998

Preoperative vs. postoperative radiation prophylaxis of heterotopic ossification: a rural community hospital's experience.

PURPOSE: In vivo data employing a rat model, suggest equivalent suppression of ectopic bone formation by single-fraction irradiation given either pre (< or = 4 h)- or post (< or = 24 h)-surgery. Two subsequent randomized clinical trials, from tertiary academic centers with robust experience in heterotopic bone prophylaxis, have reached similar conclusions. To assess the transferability of the above data to the community setting we reviewed our rural community hospital experience with pre- and postoperative radiation prophylaxis. METHODS AND MATERIALS: Between 11/90 and 6/96, 16 surgerized hips with high risk of heterotopic bone formation received 7.00-8.00 Gy in one fraction either preoperatively (< or = 4 h) (n = 9) or postoperatively (< or = 3 days for six hips; day 7 for one hip) (n = 7). Initial patients were routinely treated postoperatively. In late 1992, treatment preference was switched to preoperative irradiation in response to evolving data. The two groups were similar with respect to age, sex, nature of surgery, presurgical Brooker and Harris scores, and in U. of Rochester risk classification distribution. Irradiation was given via 4-20 MV photons through equally weighted AP:PA portals to the periacetabular tissues and proximal one third to one-half of the femoral component. Radiation dose, energy, portal, and blocking design were all similar for the two groups. Hip radiographs were obtained immediately postsurgery and at last follow-up: Delta grades (Brooker grade at follow-up--Brooker grade immediately postsurgery) were computed. Harris scale scores of hip function and movement were assigned via personal interviews and examinations performed prior to irradiation and at last follow-up. RESULTS: All 16 hips are evaluable. Follow-up interval among the post-operative group (mean = 39.8 months; range 18.6-65.8) was significantly longer than among the preoperative group (mean = 20.4 months; range 8.6-41.3) (p < 0.02). The mean Delta grade among the postoperative and preoperative groups was identical (-0.02). Similarly, improvement in Harris scale scores, from preirradiation to last follow-up, were nonsignificantly different among postoperative (+43.3) and preoperative (+44.8) groups. There was one postoperative infection in either group; there was no acute or late toxicity attributable to irradiation. CONCLUSION: As heterotopic bone formation is complete within 6 months, the data for both treatment groups may be considered mature. Our community generated results parallel those derived from tertiary care centers. Single-fraction radiation prophylaxis of heterotopic ossification may be given with similar efficacy either < or = 4 h pre- or < or = 24 h postsurgery. For reasons of minimizing patient discomfort, postsurgical movement and radiation staff resource utilization, we prefer and recommend preoperative radiation prophylaxis.

Aged↗

PubMed1998

Educating young people about drugs: a systematic review.

AIMS: To assess the effectiveness of interventions directed at the prevention or reduction of use of illicit substances by young people or those directed at reducing harm caused by continuing use. DESIGN: A systematic review was conducted. Reports were identified through electronic and hand searching and contact with known workers in the area. Studies were included if they reported evaluations of interventions targeting illicit drug use and provided sufficient detail of the intervention and design of the evaluation to allow judgements to be made of their methodological soundness. Meta-analyses were conducted combining the data of the methodologically sound studies. PARTICIPANTS AND SETTINGS TARGETED BY INTERVENTIONS: Evaluations of interventions were included if their targeted audience included young people aged between 8 and 25 years. Identified evaluations were delivered in a range of settings including: schools and colleges; community settings; the family; medical/therapeutic settings; mass media. MEASUREMENTS: Data extracted from each report included details of design, content and theoretical orientation of intervention, setting of the intervention, target audience, methods, population size, subject refusal rates, rates of attrition, outcome measures, length of follow-up and findings, including statistical power. FINDINGS: The majority of studies identified were evaluations of interventions introduced in schools and targeting alcohol, tobacco and marijuana simultaneously. These studies were methodologically stronger than interventions targeting other drugs and implemented outside schools. Meta-analyses showed that the impact of evaluated interventions was small with dissipation of programme gains over time. Interventions targeting hard to reach groups have not been evaluated adequately. CONCLUSIONS: Effort needs to be directed towards the development of improved evaluative solutions to the problems posed by these groups. There is still insufficient evidence to assess the effectiveness of the range of approaches to drugs education; more methodologically sound evaluations are required. There is also a need to target interventions to reflect the specific needs and experiences of recipients.

Adolescent↗

PubMed2002

Nurse practitioners and traditional healers: an alliance of mutual respect in the art and science of health practices.

The indigenous people of Hawaii have had difficulty adapting to the Western diet and stressful lifestyle of today's mixed cultural and economic development. This has left a health toll of high rates of diabetes, hypertension, hypercholesterolemia, cardiovascular problems, asthma, and obesity. To promote a healthy lifestyle and promote the U.S. Department of Health and Human Services (DHHS) goal of 100% access to health care and 0% disparity (no one will be denied health care), nurse practitioner/traditional Hawaiian healing clinics have been placed in community settings, which are known to community people and comfortable to access. These clinics provide health care to uninsured and underinsured people in an atmosphere that assures respect for the culture and the health needs. This pilot study examines the perceptions of 30 residents of Hawaii and the type of provider sought. Seventy-five percent of the respondents were generally satisfied with the health care received from both Hawaiian and Western care providers. Back and neck problems and injuries were associated with the use of Hawaiian therapies and appeared to reflect chronic conditions. Western health care is sought for predominantly acute conditions (infections, allergies, and upper respiratory conditions) and for diabetes and hypertension.

Acute Disease↗

PubMedDate not supplied

Educational implications of community health preceptors' practice values.

Educators in baccalaureate nursing programs realize that clinical experiences in community health differ from those in acute care facilities. Competencies required in community settings must be identified to ensure that students have had opportunities to develop necessary skills before obtaining clinical experience. Such identification is also necessary for evaluating student competence in the clinical setting. The authors identify valued community health practice competencies that could be used by educators to evaluate students and help them prepare for clinical practice.

Clinical Competence↗

PubMedDate not supplied

Scavenger hunt: a community-based learning experience.

The author reports one innovative teaching strategy that is a result of the development and implementation of a community-based, interdisciplinary curricular model for health professionals. This model program brought together the disciplines of medicine, nursing, and public health in a community setting. Finding methods to incorporate communities more in the educational process of health professionals is a challenge. The scavenger hunt became one useful avenue to meet several course outcomes within the interdisciplinary curriculum.

Community Health Nursing↗

PubMed2004

Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients' preference.

OBJECTIVES: Firstly, to compare the effectiveness of a brief physiotherapy intervention with "usual" physiotherapy for patients with neck pain. Secondly, to evaluate the effect of patients' preferences on outcome. DESIGN: Non-inferiority randomised controlled trial eliciting preferences independently of randomisation. SETTING: Physiotherapy departments in a community setting in Yorkshire and north Lincolnshire. PARTICIPANTS: 268 patients (mean age 48 years) with subacute and chronic neck pain, who were referred by their general practitioner and randomly assigned to a brief physiotherapy intervention (one to three sessions) using cognitive behaviour principles to encourage self management and return to normal function or usual physiotherapy, at the discretion of the physiotherapist concerned. MAIN OUTCOME MEASURES: The Northwick Park neck pain questionnaire (NPQ), a specific measure of functional disability resulting from neck pain. Also, the short form 36 (SF-36) questionnaire, a generic, health related, quality of life measure; and the Tampa scale for kinesophobia, a measure of fear and avoidance of movement. RESULTS: At 12 months, patients allocated to usual physiotherapy had a small but significant improvement in NPQ scores compared with patients in the brief intervention group (mean difference 1.99, 95% confidence interval 0.45 to 3.52; P = 0.01). Although the result shows a significant inferiority of the intervention, the confidence interval shows that the effect could be in the non-inferiority range for the brief intervention (below 1.2 points of NPQ score). Patients who preferred the brief intervention and received this treatment had similar outcomes to patients receiving usual physiotherapy. CONCLUSIONS: Usual physiotherapy may be only marginally better than a brief physiotherapy intervention for neck pain. Patients with a preference for the brief intervention may do at least as well with this approach. Additional training for the physiotherapists in cognitive behaviour techniques might improve this approach further.

Adolescent↗

PubMed2000

Racial variation in cardiovascular morbidity and mortality in essential hypertension.

OBJECTIVES: To perform a longitudinal comparison of morbidity and mortality among white, south Asian and Afro-Caribbean hypertensive patients in relation to baseline demographic characteristics and clinic and ambulatory blood pressure variables. DESIGN: Observational follow up study. SETTING: District general hospital and community setting in Harrow, England. PATIENTS: 528 white, 106 south Asian, and 54 Afro-Caribbean subjects with essential hypertension who had undergone 24 hour ambulatory intra-arterial blood pressure monitoring. INTERVENTIONS: Follow up for assessment of all cause morbidity and mortality over a mean (SD) of 9.2 (4.1) years. MAIN OUTCOME MEASURES: Non-cardiovascular death, coronary death, cerebrovascular death, peripheral vascular death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularisation. RESULTS: South Asians had the highest all cause event rate of 3.46, compared with 2.50 (NS) and 0.90 (p = 0.002) events/100 patient-years for whites and Afro-Caribbeans, respectively. This was because of an excess of coronary events (2.86 v 1.32 events/100 patient-years in south Asians v whites, respectively; p = 0.002). Age (p < 0.001), sex (p < 0.001), race (south Asians : whites, hazard ratio 1.79; p = 0.008), diabetes (p = 0.05), previous history of cardiovascular disease (p < 0.001), and 24 hour ambulatory systolic blood pressure (p = 0.006) were independent predictors of time to a first event. Clinic blood pressure did not provide additional prognostic information. CONCLUSIONS: South Asian origin was an independent predictor of all cause events, mainly because of an excess of coronary events in this group. Ambulatory but not clinic blood pressure was of additional value in predicting subsequent morbidity and mortality.

Adult↗