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At least 937 records · Page 52Linked to original sources

PubMed2003

Patient and caregiver outcomes 12 months after home-based therapy for hip fracture: a randomized controlled trial.

OBJECTIVE: To compare the effect of early discharge and home-based therapy with conventional hospital rehabilitation on patient and caregiver outcomes at 12 months after hip fracture. DESIGN: Randomized controlled trial. SETTING: Acute and subacute care with follow-up in a community setting in Australia. PARTICIPANTS: Sixty-six older adults admitted to acute care after hip fracture who were assessed as needing rehabilitation. INTERVENTIONS: Eligible patients were randomized to either home-based (n=34) or hospital (n=32) rehabilitation. Patients assigned to the home-based group were discharged home within 48 hours of randomization. Patients assigned to hospital rehabilitation received usual care. MAIN OUTCOME MEASURES: Modified Barthel Index (MBI), timed up and go (TUG) test, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index. RESULTS: At 12 months, 56 of 66 (85%) participants were available for follow-up assessment. Both groups achieved significant improvements in MBI and TUG test scores. Patients in both groups had a significant decline in the physical score of the SF-36 and there were no differences between groups. Caregivers of patients allocated to receive home-based therapy reported a reduction in burden after 12 months. Over that period, there was a significant reduction in the burden for caregivers of those patients who received home rehabilitation (P=.020). CONCLUSION: For patients who were previously functionally independent and living in the community, early return home with increased involvement of caregivers after hip fracture resulted in similar patient outcomes (home vs hospital) and less caregiver burden at 12 months.

Aged↗

PubMed2005

Conscious sedation for the performance of gynecologic examination of individuals with intellectual disability.

OBJECTIVE: Gynecologic examination of some individuals with intellectual disability can be especially problematic. Many of these women reside in a community setting and a widely applicable method for performing these examinations is desirable. METHODS: Intellectually disabled women were referred by their primary care providers for gynecologic examinations under sedation in the emergency room facility of a community hospital. Intravenous conscious sedation was administered under the direction of an emergency room physician. RESULTS: Thirteen adult women underwent 22 examinations over a four-year period. Papanicolau smears, screening for sexually transmitted disease and cervical and endometrial biopsies were obtained without complications. Hospital charges were relatively low and lengths of stay were short. CONCLUSION: In selected individuals with intellectual disability, intravenous conscious sedation in a community hospital emergency room setting provides a safe, effective and relatively inexpensive means for performing gynecologic examinations.

Adult↗

PubMed2005

C-reactive protein and risk of cardiovascular disease in men and women from the Framingham Heart Study.

BACKGROUND: Determination of C-reactive protein (CRP) level has been suggested to improve cardiovascular disease (CVD) risk assessment. This study examines the utility of CRP levels to assess CVD risk in a community setting. METHODS: We performed a prospective observational cohort study on a community population sample. A total of 1949 men and 2497 women without CVD from the Framingham Heart Study underwent CVD risk factor assessment. Initial CVD events during 8 years of follow-up were recorded. RESULTS: There were 283 major CVD and 160 major coronary heart disease incident events. Age-, sex-, and multivariable-adjusted analyses generally used CRP level categories of less than 1, 1 to 3, and greater than 3 mg/L. In age- and sex-adjusted models, the traditional risk factors and elevated CRP levels indicated increased risk. The age- and sex-adjusted relative risk (RR) and 95% confidence interval (CI) of CRP level greater than 3 mg/L for major CVD was elevated (RR, 1.60; 95% CI, 1.19-2.14), with evidence of attenuation (RR, 1.22; 95% CI, 0.90-1.66) in multivariable models. The C statistic, a measure of the discriminatory capability of the prediction models, was 0.74 for prediction of major CVD with age and CRP level. In multivariable models that included traditional risk factors, the C statistic was 0.78, a value that was unchanged with the addition of CRP to the multivariable model. Similar relations were noted for major coronary heart disease events. CONCLUSION: Elevated CRP level provided no further prognostic information beyond traditional office risk factor assessment to predict future major CVD and major coronary heart disease in this population sample.

Biomarkers↗

PubMed2005

Cognitive intervention for community-dwelling older persons with memory problems: telemedicine versus face-to-face treatment.

BACKGROUND: Memory complaints and decline in cognitive function are common in the elderly. Cognitive intervention has been shown to be beneficial in Alzheimer's disease (AD). However, few community-based cognitive intervention programs are available in Hong Kong. The aim of this project is to examine and compare the feasibility, acceptability, and clinical outcome of a cognitive intervention program for older patients with mild cognitive impairment and mild dementia using telemedicine versus a conventional face-to-face method. METHODS: Community-dwelling older subjects with mild dementia or mild cognitive impairments were recruited from a community center. A total of 12 sessions of assessment and cognitive intervention were conducted via videoconferencing or by face-to-face method. Assessment included: Cantonese version of Mini Mental State Examination (C-MMSE), Cantonese version of Rivermead Behavioural Memory test (C-RBMT) and Hierarchic Dementia Scale (HDS). RESULTS: Twenty-two clients were recruited. There was significant and comparable cognitive improvement in clients in both treatment arms. The videoconference arm was highly accepted by the clients and the community center. Overall compliance rate of participants was above 95%. CONCLUSIONS: Telemedicine was a feasible, effective and acceptable means in providing cognitive assessment and intervention to older persons with mild cognitive deficits. Promoting such a program to other community settings would further enhance the accessibility of dementia service to the community.

Aged↗

PubMed1976

Issues in developing quality aftercare clinics for the chronic mentally ill.

Two large aftercare clinics were established to provide treatment and rehabilitative care for a chronic mentally ill population requiring neuroleptic drugs. The clinics have evolved rapidly and expanded their service over the past 3 years but have required constant monitoring and modification in order to provide quality as well as quantity care in the community setting. These modifications are described and the importance of further community-based investigation in the rehabilitation and treatment of the chronic mentally ill is stressed.

Aftercare↗

PubMedDate not supplied

Parental reports of community activity patterns: a comparison between young children with disabilities and their nondisabled peers.

The extent and nature of community activities of families of children with disabilities in comparison with their nondisabled peers were examined. Parents of 82 children with disabilities and 132 children without disabilities, ages 2 through 5 years, completed a Demographic Questionnaire, Community Activities Questionnaire (CAQ), and Parent Experience Survey (PES). The CAQ assessed frequency of child participation in age-appropriate community activities, and the PES was a retrospective self-evaluation by parents of the experience of introducing the child to common community settings. Both groups of parents reported highly similar experiences when shopping with their children, although parents of children with disabilities reported more fear and risk associated with public settings. Overall, parents of children with disabilities reported participation in fewer community activities than parents of children without disabilities. This difference was largely accounted for by a lower level of participation by families having children with disabilities in a subset of activities that reflect opportunities for family enrichment.

Activities of Daily Living↗

PubMed2005

Validation of the Reintegration to Normal Living Index in a population of community-dwelling people with mobility limitations.

OBJECTIVE: To validate the Reintegration to Normal Living Index (RNLI) in a population of community-dwelling adults with mobility limitations. DESIGN: Cross-sectional survey. SETTING: Community. PARTICIPANTS: Six hundred four people between the ages of 18 and 80 years who had a mobility limitation, lived in the community, and had been discharged from rehabilitation for at least 1 year. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The RNLI. RESULTS: The RNLI is a reliable measure of community reintegration. A 2-factor structure emerged from a principal components analysis that indicates there are 2 subscales of the RNLI in a population with mobility impairments. CONCLUSIONS: The RNLI is a reliable and valid measure for studies of community integration among people living with long-term consequences of a chronic health condition.

Adolescent↗

PubMed2005

A qualitative study of pharmacists' perspectives on the supply of emergency hormonal contraception via patient group direction in the UK.

AIM: To investigate pharmacists' views and experiences of supplying emergency hormonal contraception (EHC) via a group prescribing protocol in community pharmacies in the UK. DESIGN: Qualitative study using depth interviews. SETTING: Community pharmacists in Manchester, Salford and Trafford (Greater Manchester), and Lambeth, Southwark and Lewisham (London) Health Action Zones in the UK. PARTICIPANTS: Forty-four community pharmacists supplying EHC in Manchester, Salford and Trafford, and Lambeth, Southwark and Lewisham (London). RESULTS: Pharmacists were broadly very positive about their experiences supplying EHC via the group prescribing protocol. Pharmacists identified many benefits of the EHC schemes for clients, in particular, improved access to EHC at no cost to clients. The confidential nature of the scheme was also seen as an advantage as was the scope for referral to other service providers. Pharmacists also believed that the scheme had benefits for the profession in terms of enhanced professional standing. However, their concerns included the extent of repeated use of EHC, the possible impact on contraceptive behaviors and sexually transmitted infections and its impact on male coercive sexual behavior. CONCLUSIONS: Although pharmacy supply of EHC may improve access for some clients and is perceived as a popular service, research into the implications of the schemes as identified in this study need to be conducted.

Anecdotes as Topic↗

PubMed2006

Running before we walk: how can we maximise the benefits from community service dietitians in KwaZulu-Natal, South Africa?

INTRODUCTION AND AIM: The Department of Health in South Africa, instituted compulsory community service (CS) as one strategy to overcome the chronic shortage of health professionals in underserved and rural areas. A number of articles have listed the reasons for the lack of willingness of health professionals to practice in rural areas. Amongst others they listed the lack of career opportunities, the recruitment of students into health professions from incongruous backgrounds, inappropriate training, bureaucratic problems, poorly equipped hospitals and social isolation. The aim of this study was to examine and explore the factors affecting the professional development of dietitians during CS. METHODS: Thirteen of the 15 community service dietitians (CSDs) currently (2005) undertaking CS in KwaZulu-Natal participated in focus group discussions. Each member of the group was also required to answer a short written questionnaire before the discussions to establish whether there was congruence between the written answers and the verbal discussions. The large group was divided into two sub groups and each session lasted one and a half hours. A list of topics was discussed by each group. The sessions were taped and transcribed and further analysed using the qualitative analysis programme, "QSR NVivo". RESULTS: Analysis of the transcripts revealed a number of thematic areas and included the evaluation of the placement process, obstructions and constraints, the developmental progress of the CSD and means of enhancing professional development. The discussion on the placement process was not contentious, with only three CSDs having reservations about the process. Many obstructions and constraints to service delivery and professional development were revealed and included the lack of supervision and support, the lack of preparedness of the institutions receiving CSDs and the lack of clarity of the CSDs' perception of community service, unhappiness of some CSDs being placed a long way from home, work and role overload, not being part of a team, lack of understanding the CSDs role and the under utilisation of their services. Developmental progress of the CSDs was enhanced by some positive aspects which included the social interactions experienced in the community setting, learning new skills and support that they received from other community service professionals. DISCUSSIONS AND RECOMMENDATIONS: Comparison of the written answers with verbal discussions showed the same results. A number of issues raised in this study have been recorded by other authors. It is recommended that the issue of supervision and support be addressed so that the professional development of CSDs is enhanced. The lack of preparedness of the receiving institutions is a problem that is relatively easy to address and should be made a priority. The training institutions also need to be more proactive in preparing dietetic students for CS. CONCLUSIONS: Compulsory community service as a method of addressing the problems of underserved population has merit. To maximise the benefits the DOH would do well to heed the recommendations by ensuring that there are structures in place to provide adequate resources for and support and supervision of CSDs.

Allied Health Personnel↗

PubMed2003

Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis.

OBJECTIVE: To ascertain the effectiveness of the National Arthritis Foundation (NAF) aquatic and on-land exercise programs on functional fitness and perceived ability to perform activities of daily living (ADL) measures in older adults with arthritis. DESIGN: The effects of aquatic and on-land exercise intervention programs were analyzed by repeated-measures analysis of variance by using a planned comparison approach with an independent 3 x 2 (group by test) design. omega(2) analyses were used to ascertain the relative treatment magnitude of each dependent variable. SETTING: Testing in an indoor track facility; exercise programs conducted in community settings. PARTICIPANTS: A volunteer sample of 30 men and women with arthritis (osteoarthritis, n=22; rheumatoid arthritis, n=8), randomly assigned into either an aquatic exercise (n=10), on-land exercise (n=10), or control group (n=10). INTERVENTION: Eight-week on-land and aquatic exercise program. MAIN OUTCOME MEASURES: Functional fitness, ADLs, and hand-held dynamometry measures assessed on a 1-day pretest and posttest session, before and after an 8-week exercise program. RESULTS: Aquatic and on-land exercise subjects showed significant improvements on 9 of 12 functional fitness, 3 of 4 ADLs, and 7 of 8 hand-held isometric strength tests after their respective exercise programs. No significant changes were found in any of these measures for the control group. CONCLUSION: Both NAF exercise programs appear to be effective in improving functional physical fitness and perceived ability to perform ADL measures in older adults with arthritis.

Activities of Daily Living↗

PubMed2002

Cryptosporidiosis.

PURPOSE OF REVIEW: Cryptosporidiosis is a self-limited diarrheal disease that occurs in the community setting but can be chronic and potentially serious in immunocompromised patients. Community outbreaks are often associated with water-borne transmission. Cryptosporidium research has increased dramatically since the human disease was first recognized in 1976. The present review summarizes recent work in three of the several areas of active Cryptosporidium investigation. RECENT FINDINGS: Molecular techniques have revealed that current taxonomic designations need re-evaluation and that humans are host to several Cryptosporidium spp. that were once believed to be limited to the veterinary realm. These findings have important public health implications for water quality standards in the USA and other developed countries. Second, techniques for detecting the parasite in infected individuals (or environmental samples) have progressed from acid-fast staining of fecal smears to the currently used antibody-based systems (enzyme immunoassays and immunofluorescent assays). New molecular methodologies, based on polymerase chain reaction amplification of gene loci, are being developed to improve the sensitivity and specificity for diagnostic and epidemiologic purposes. Third, curative therapy is attained only by an effective immune response or the reconstitution of a failing immune system in the compromised host. However, several drugs are in development, and compounds such as nitazoxanide appear to hold some promise. SUMMARY: Cryptosporidiosis continues to be a serious problem in immunocompromised patients and on a worldwide scale in undernourished infants and children. The lack of an effective treatment, and the propensity of the parasite to survive in and be transmitted through source waters make this an important public health threat.

Animals↗

PubMedDate not supplied

Student projects enhance competency in community-based nursing practice.

Trends in healthcare delivery toward community-based care challenge nurse educators to design nursing curricula and learning experiences that prepare students for practice in community settings. The authors describe how faculty used student projects to enhance community learning experiences. The projects were designed to help students gain skill in the process of program design and evaluation and an appreciation and enthusiasm for community-based nursing practice.

Clinical Competence↗

PubMed2000

The role of the community psychiatrist as medical director: a delineation of job types.

To examine the variety of roles filled by psychiatrists functioning as medical directors in community settings, a survey of all members of the American Association of Community Psychiatrists was undertaken. A total of 168 respondents classified themselves as agency medical directors or program medical directors. Medical directors also classified their breadth of supervisory responsibility as including medical staff only, medical and other clinical staff, or all staff (including administrative staff). A classification scheme of six types of medical director positions based on level of operation and breadth of supervisory responsibility was created. This classification helps clarify the medical director's role, providing guidance to psychiatrists and agencies negotiating job descriptions for this position.

Analysis of Variance↗

PubMed2003

Pyrazinamide and rifampin vs isoniazid for the treatment of latent tuberculosis: improved completion rates but more hepatotoxicity.

CONTEXT: American Thoracic Society guidelines recommend a 9-month course of therapy with isoniazid for treatment of persons with latent tuberculosis infection who are at high risk for reactivation of disease. Major liver injury has been reported with the alternative regimen, a 2-month course of pyrazinamide and rifampin. OBJECTIVE: To evaluate the rate of completion and incidence of hepatotoxicity of a short regimen of pyrazinamide and rifampin for latent tuberculosis as compared with standard isoniazid therapy before and after instituting an intensive monitoring program. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 224 patients in a community setting between 1999 and 2001. INTERVENTIONS: Daily pyrazinamide and rifampin for 2 months or daily isoniazid for 6 months. MAIN OUTCOME MEASURES: Treatment completion, hepatotoxicity (fourfold increase of alanine transaminase [ALT]), severe hepatotoxicity (40-fold increase in ALT). RESULTS: Treatment was completed by 71% (78 of 110 patients) in the pyrazinamide/rifampin group and by 59% (67 of 114 patients) in the isoniazid group (p = 0.07). Hepatotoxicity (ALT > 160 U/L) was documented in 13% (14 of 110 patients) in the pyrazinamide/rifampin group and in 4% (5 of 114 patients) in the isoniazid group (p = 0.03). Severe hepatotoxicity (ALT > 1,600 U/L) occurred in 2 of 43 patients (5%) receiving pyrazinamide/rifampin prior to instituting intensive monitoring. Once more intensive monitoring of liver enzymes was implemented, severe hepatotoxicity occurred in none of 67 patients. CONCLUSION: The risk of hepatitis in patients receiving pyrazinamide/rifampin for prevention of latent tuberculosis is increased threefold as compared to patients receiving isoniazid. When patients were monitored more intensively, severe hepatotoxicity did not develop, but the difference did not reach statistical significance (p = 0.15).

Adolescent↗

PubMedDate not supplied

Charity care: a proposal for reform.

Changing political attitudes and new financing trends jeopardize our commitment to providing equitable access to medical services for all citizens regardless of ability to pay. The commitment is further threatened by the lack of coordination and the fragmentation that make charity care expensive and ineffective. This article proposes that we bring continuity and consistency to our charity care efforts by considering four options for reform: reallocate health spending to emphasize primary, preventive care in the community setting: create special HMOs for the medically disadvantaged through a revitalized community health center program; develop a voucher program to ensure access to the HMOs as well as risk-sharing pools to ensure access to secondary and tertiary care; and radically restructure the public hospital systems and eliminate most hospitals in the veterans administration system.

Charities↗

PubMed1991

Disciplines within general practice.

The disciplines within general practice derive partly from its community setting, and partly from the nature of professional expertise. The maladies range from a high prevalence of low risk, self-limited illness to a low prevalence of high risk, persistent disease. Each set calls on different knowledge and skills. The setting offers the substrate for studying social and behavioural sciences and community health development in action. Choosing a few particular fields, and developing those with rigour, could strengthen general practice as a discipline with special insights and skills to offer all branches of clinical practice. Four fields of activity have been identified. In each, general practice has a clear responsibility and opportunity. I have suggested some knowledge and skill areas for their success--clinical 'working' knowledge, decision making and judgment, predictive knowledge, planning knowledge, calibration of investigators, intuitive knowledge, local knowledge, leadership skills and people management, measurement of burden of illness, calculation of cost-benefit trade-offs, building of local databases, re-learning fine discrimination in clinical perception, and understanding of community development. These subjects have not been part of formal medical education, or of much academic study in family practice. Despite their being central to the success of daily practice, the curriculum is silent about the study of these areas of practical knowledge, reasoning, judgment and skill. Worse, we do not have a common language to express clearly what we are talking about. Experience and skill lie within the practitioner, and are used in practical, concrete situations.(ABSTRACT TRUNCATED AT 250 WORDS)

Family Practice↗

PubMed2001

Israeli nurses' knowledge of health care reforms.

OBJECTIVES: This study examines health care reforms' implementation processes from the perspective of nurses' knowledge regarding the reforms. The research has been carried out in the Israeli context, where health care reforms were initiated in 1995. Three specific research questions were formulated: (a) What is the level of nurses' knowledge regarding the recommendations of the Netanyahu committee? (b) What is the level of nurses' knowledge concerning the basic principals of the National Insurance Law? and (c) Are there knowledge differences relating to employment setting (hospital, community, and educational settings), nurses' roles (managerial vs. staff nurses), years of experience, and level and type of education? METHOD: The stratified nonproportional random sample consisted of a total of 468 nurses. Of these nurses, 206 were employed in community settings (136 in curative care, and 70 in preventive care), 137 were employed in hospital settings, and 125 worked in schools and departments of nursing. Research tools, developed for the purpose of this study, included the nurses' knowledge questionnaire comprised of five subscales, and the knowledge relevancy questionnaire. RESULTS: Overall, data demonstrated a low to moderate level of knowledge on all knowledge scales. Knowledge level on the criteria questions was particularly low. Contrary to the low level of knowledge, nurses regarded health care reforms' knowledge as highly relevant to their work life. Curative setting, an extensive work experience, managerial position, and non-nursing academic degree were all positively related to higher levels of reforms' knowledge. CONCLUSION: These findings should encourage both policy makers and managers in various health care organizations to develop programs for informing health care providers on central aspects of health care reforms considered most relevant to the practice setting.

Adult↗

PubMedDate not supplied

Development and implementation of a smoking cessation clinic in community pharmacy practice.

OBJECTIVE: To describe a pharmacist-operated program to help people stop smoking. SETTING: Community chain (mass-merchandise) pharmacy practice sites in Virginia. PARTICIPANTS: Faculty at the Virginia Commonwealth University School of Pharmacy (VCU) and 15 practicing pharmacists. PRACTICE DESCRIPTION: Smoking cessation clinics within the pharmacy departments of seven Target stores. PRACTICE INNOVATION: With input from the practicing pharmacists and using the most current strategies reported in the literature, faculty at VCU developed a training manual for smoking cessation counseling. This manual was used to facilitate a 4-hour training session and also served as a resource for pharmacists in the smoking cessation clinics. Pharmacists were taught about behavioral modifications, the Transtheoretical Model of Change as applied to smoking cessation, documentation, the Fagerström Test for Nicotine Dependence, smoking cessation therapies, patient counseling techniques, physical assessment skills, and how to develop an individualized action plan for smoking cessation. As pharmacists established smoking cessation clinics, issues such as workflow, continuous quality improvement, and marketing were addressed by the faculty members and practitioners. RESULTS: Using the process and tools described in this article, pharmacists successfully established and operated smoking cessation clinics. CONCLUSION: The process and materials developed for this demonstration project can serve as templates for other pharmacy faculty members and community pharmacists who wish to offer smoking cessation clinics.

Community Pharmacy Services↗