SEARCH · PubMed Health

Results for “Community setting”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources

PubMed1994

A means of tying provision with need. Audit of pressure-relieving aids in community-based hospitals.

1. The use of pressure-relieving mattresses should be agreed with the multidisciplinary team according to specific criteria. 2. Criteria led to appropriate mattress being used, with standardised practice based on patients' individual clinical needs. 3. Nurses ensure pressure area care is prescribed, delivered and documented. 4. The audit tools could be amended for use in the community setting and other hospital specialties.

Beds↗

PubMed2000

Anxiety and depression after spinal cord injury: a longitudinal analysis.

OBJECTIVE: To examine the prevalence of anxiety and depression longitudinally in a sample of patients with a spinal cord injury (SCI). DESIGN: A prospective, longitudinal, multiple wave panel design with measures taken on 14 observational periods ranging from initial contact in the acute stages of hospitalization to 2 years' postdischarge to the community. SETTING: The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK, and the general community. PARTICIPANTS: The cohort consisted of 104 patients with traumatic SCI (19 women, 85 men), although the numbers assessed at each interval ranged from 5 to 85. MAIN OUTCOME MEASURES: Measures included the Beck Depression Inventory, the Beck Hopelessness scale, the State Anxiety Inventory, the functional independence measure, and the Social Support Questionnaire. RESULTS: When examined longitudinally, the data illustrate a consistent pattern of results across measures, with scores highest in the acute phase of the injury and during the months leading up to discharge. CONCLUSION: The numbers of persons scoring above clinical cut-off scores for anxiety and depression highlight the need to continue to ensure that appropriate psychological care is available within SCI rehabilitation settings. Moreover, the nature of the longitudinal results provides an indicator of subtle changes in anxiety and depression over time.

Adolescent↗

PubMed2005

Effects of antipsychotic medication on psychiatric service utilization and cost.

BACKGROUND: Based on randomized clinical trials, consensus has been emerging that the first line of treatment for individuals with psychotic disorders should be the newer atypical or second generation antipsychotic medications rather than the older neuroleptics. Given that acquisition costs of atypical antipsychotics are generally higher than typical antipsychotics, uncertainty exists whether the newer atypicals are cost effective alternatives when used in ordinary practice settings. AIMS OF THE STUDY: The introduction of newer atypical antipsychotic agents has prompted evaluation of their overall effectiveness in reducing health care costs given their higher acquisition costs. This paper focuses on the effects of differing classes of atypical versus typical antipsychotic medications on psychiatric service utilization and cost for persons with serious mental illness treated in usual practice settings. METHODS: Descriptive statistics are used to compare patient characteristics, service rates and costs across psychotropic medication groups. Prediction equations employing ordinary least squares regression models are used to explain variation in cost due to pharmacy group membership controlling for demographics, clinical diagnoses and symptoms. Subjects were 338 Medicaid clients with serious mental illness from Florida, Pennsylvania and Oregon treated in ordinary clinical settings. Resource utilization and costs were operationalized using administrative databases to measure consumption of treatment services and pharmaceuticals for a six month period. RESULTS: Inpatient service use was significantly higher for individuals on atypical only and combination atypical/typical medications compared to those on typical medications only, whereas outpatient use was highest for those on typicals. Furthermore, six-month costs for both pharmacy and psychiatric services were significantly greater for persons in the atypical only (USD 6528) and combination typical/atypical groups (USD 6589) compared to those on typicals only (USD 3463). There were still significantly higher costs associated with atypical only and the combination typical/atypical users after multivariate controls were used. DISCUSSION: This study showed that Medicaid clients in community settings using atypical only and typical/atypical combination medications had the highest costs both in pharmacy and service use when compared to those on typical only medications. However, this study design does not allow us to ascribe a causal relationship between medication group and service costs. Given that olanzapine was the most recent medication in the compendium of available drugs at the time of this study, it is possible that those in the olanzapine only group were failing on other drugs. Caution must be used in drawing policy implications regarding cost effectiveness of newer medications since individuals who are getting the newer atypical or combination medications in community mental health center settings may be unstable on the older medications. IMPLICATIONS FOR FUTURE RESEARCH: A longer follow-up period is needed to determine if the cohort remaining on current atypical medications stabilize over time while those taking the newest drug on the market become the most costly population.

Adult↗

PubMed2006

Colonoscopy completion and complication rates in a community gastroenterology practice.

BACKGROUND: In the United States, colonoscopy completion and complication rates are rarely reported outside academic institutions. Increased transparency of quality measures and outcomes is being driven by professional societies, government agencies, and private enterprise. OBJECTIVE: To collect and report the completion and complication rates of colonoscopy in a community gastroenterology practice. DESIGN: Single-center study, prospective for completion, retrospective for complications. SETTING: Community gastroenterology group practice, conducted from August 2002 through December 2004. PATIENTS: A total of 12,407 consecutive patients referred for colonoscopy; mean age, 59.7 years; 5925 men. INTERVENTIONS: Polypectomy and cautery were completed as indicated. MAIN OUTCOME MEASURES: Completion of colonoscopy to cecum or ileocolonic anastomosis. Complications of hemorrhage and perforation. RESULTS: A colonoscopy was completed in 98.4% of patients. Polypectomy was accomplished in 5074 (40.9%). Polyps occurred more often in men (46.4% vs 35.8%, P < .001). Causes for failure included difficult anatomy (55.9%), inadequate preparation (20.8%), obstructing malignancy (8.6%), discomfort (8.1%), and severe inflammation (6.1%). Failure from difficult anatomy was more likely in women (1.19% vs 0.56%, P < .001). Hemorrhage requiring hospitalization occurred after 25 cases (0.20%). Twenty-three episodes of bleeding occurred after polypectomy (0.46%) and 2 after treatment of arteriovenous malformations. Two perforations occurred (0.016%). One patient developed a posterior circulation stroke. No deaths occurred. LIMITATIONS: Completion not independently verifiable. Complications were collected retrospectively. CONCLUSIONS: Colonoscopy completion and complication rates in this community gastroenterology practice compared favorably with U.S. academic centers. Endoscopic quality in community practices can meet published outcomes.

Adult↗

PubMed2004

'Alukura ... for my daughters and their daughters and their daughters'. A review of Congress Alukura.

OBJECTIVE: To describe the process, findings and limitations of a review of Congress Alukura commissioned in 1998. METHODS: Analysis of documents and reports, service use and perinatal data from Alukura and the Northern Territory Midwives Collection; interviews with staff of Congress Alukura, of Central Australian Aboriginal Congress, of Aboriginal community organisations in Alice Springs and remote communities, of health care providers and other key informants in Alice Springs; community consultations through women's meetings or group discussions in local and remote communities. Interviews were coded for thematic and content analysis. RESULTS: Client visits increased by 42% from 1995/96 (2130) to 1997/98. The proportion of women having a first trimester antenatal visit increased from 23% (1986-88) to 38% (1993-95). Mean birthweight of Aboriginal infants in the Alice Springs urban area was 3168 g in 1986-90, 3271 g in 1991-95, and 3268 g in 1996-99. Other primary and maternity care providers perceived the quality of care to be high and saw Alukura playing a key role through transport, liaison, screening and follow-up. Alukura was much less successful in its role as a place for birth. Expectations of additional outreach by local and remote communities were high. DISCUSSION: The review's limitations included: a lack of direct input from young women, the main users of Alukura; a timeframe that precluded the detailed discussion necessary for seeking access to medical records, and the need for interpreters in community settings. Current and former staff who participated in the review often had other important community roles. Developments since the review are discussed briefly.

Australia↗

PubMed1993

A comparative study of monoclonal gammopathies and immunoglobulin levels in Japanese and United States elderly.

OBJECTIVE: To define the prevalence of monoclonal immunoglobulin (Ig) proteins and quantitative serum immunoglobulin levels in elderly Japanese in comparison with elderly Caucasians as possible factors related to the reported lower incidence of multiple myeloma in elderly Japanese than in elderly Caucasians. DESIGN: Survey study SETTING: Community Center in Yokohama, Japan and Retirement Community in the United States. PARTICIPANTS: Convenience sample of community-dwelling elderly subjects (age 63-95) presenting for health screening examinations in each setting. Frozen serum samples were obtained from routine screening from 146 consecutive Japanese subjects and 111 US subjects. INTERVENTION: None MEASUREMENTS: Presence of monoclonal immunoglobulin protein determined by serum protein electrophoresis and immunofixation and quantitative Ig by laser nephelometry. RESULTS: Four (2.7%) of the Japanese cohort had monoclonal gammopathies compared with 11 (10%) of the American cohort. Two of the monoclonal gammopathies were IgG Kappa and two were IgG Lambda. No cases of multiple monoclonal gammopathy were identified in the Japanese group, compared with 25% of the monoclonal gammopathies in the American group. The mean quantitative serum IgG level for the Japanese group was 1,685 +/- 520 mg/dL versus 1,118 +/- 402 mg/dL for the American group; mean quantitative IgA levels were 283 +/- 116 mg/dL versus 226 +/- 116 mg/dL (P < 0.001). Albumin levels were normal in both populations, suggesting that there was not an increase in occult inflammatory disorders in the Japanese population. CONCLUSION: The low prevalence of monoclonal gammopathy in elderly Japanese is consistent with the reported lower frequency of multiple myeloma. The reason for the higher quantitative immunoglobulin levels in this population is unclear. Further cross-cultural investigation is warranted to explore the genetic influences on altered immune regulation with aging.

Age Factors↗

PubMed1992

Utilization of image-derived computer-assisted stereotaxis in a community-based practice setting.

The success of a community-based stereotactic program is dependent upon community commitment, technological capability, referral base, patient/family support and, most importantly, proper patient selection. To develop a program of superior quality requires not only a substantial financial commitment, but also a basic philosophical approach which fully supports acquisition and education of support staff, physical plant renovation and an establishment of an expanding referral base. This report details the development of a highly sophisticated stereotactic program in Cedar Rapids, Iowa, a semirural community with a base referral population of approximately 300,000.

Brain Diseases↗

PubMed1999

Sigmoidoscopy in a nurse-practitioner community clinic using telemedicine.

We evaluated the feasibility of remote endoscopy in a community setting. Realtime teleconsultation and telesigmoidoscopy were carried out by a nurse practitioner at a community clinic while a colorectal specialist was present at the main hospital. Rigid video-sigmoidoscopes were used and the images were transmitted via ISDN lines at 384 kbit/s. Over three months, 32 patients (mean age 35 years; 19 men and 13 women) with bleeding per rectum took part in the study. Evaluation was carried out using satisfaction questionnaires for the patients, the nurse practitioner and the clinicians. The mean grade for clarity of intraluminal views was 3.5 (1 poor, 4 excellent). Only two cases had views graded less than 3, due to the presence of excessive faecal residue. All the patients were satisfied with the teleconsultation and video-endoscopy and would return for a similar visit. User satisfaction was also high on the part of the nurse practitioner and the clinician.

Adult↗

PubMed2001

OpSite Plus in the management of exuding wounds.

This article discusses the use of OpSite Plus (formerly known as OpSite Post-Op ) in the community setting. This semi permeable film dressing with an absorbent pad was evaluated by the community hospital and by practice and district nurses within Plymouth's NHS Primary Care Trust.

Bandages↗

PubMed2000

Community services landscape in Canada: survey of developmental disability agencies.

A survey of support services for adults with development disabilities living in community settings in Canada was conducted. Information gathered on services and changes occurring in the community services landscape is discussed. Along with a diminution of government's role in funding and guiding service provision, Canada has witnessed the emergence of private-for-profit services, a relatively recent phenomenon in human services. Differences between the private-for-profit and nonprofit sectors are discussed, including a greater propensity in the nonprofit agencies to engage in advocacy and community education. Overall, evidence indicates that some services are beginning to incorporate individualized approaches to funding and support. Implications for government and for services of emergent patterns of support are noted.

Adult↗

PubMed2002

In vivo amplified skills training: promoting generalization of independent living skills for clients with schizophrenia.

In Vivo Amplified Skills Training, IVAST, functions to bridge the gap between clinic-based skills training and use of social and independent living skills in everyday life for persons with schizophrenia and other serious and persistent mental illness. IVAST utilizes a specialist case manager who provides individualized, community-based teaching using behavioral techniques to promote clients' use of skills that were learned in classroom group sessions. The IVAST trainer also liaises with the client's psychiatrist and other clinic-based staff, family members, and community agencies to create opportunities, encouragement and reinforcement for the client's independent use of skills in the community. The aim of IVAST is to accelerate autonomous functioning of persons with mental disabilities in the community and thereby reduce their dependency on case managers and other therapists. To the extent that IVAST can empower clients to solve their own problems and attain their personal goals, enduring improvements in social role functioning and quality of life should ensure. A controlled study of IVAST has documented improvements in social adjustment when behavioral learning techniques are employed in the community settings of the clients. An IVAST case study is presented to illustrate the community-based use of medication management, symptom management, and social problem solving in the attainment of personally relevant goals. Obstacles to success of IVAST may derive from deficits in personal motivation, family involvement, community support, financial resources, premorbid functioning, and medication compliance.

Activities of Daily Living↗

PubMed2001

Assessment of a community pharmacy-based program for patients with asthma.

STUDY OBJECTIVE: To implement and assess a community-based pharmaceutical care program for patients with asthma. DESIGN: Prospective, randomized, controlled trial. SETTING: Community pharmacies (11 control, 11 intervention) in Malta. PATIENTS: Community-dwelling patients with asthma. INTERVENTIONS: A comprehensive asthma education and monitoring program was implemented. Intervention patients received verbal counseling, an educational video, an information leaflet, and subsequent monitoring with reinforcement; control patients received routine dispensing services. MEASUREMENTS AND MAIN RESULTS: Parameters assessed at baseline and at 4, 8, and 12 months were health-related quality of life, peak expiratory flow (PEF), inhaler technique, compliance with therapy, hospitalization rates, days lost from work, asthma symptoms, and patient satisfaction. Health-related quality of life of the intervention patients improved at 12 months (p=0.044). In the same time period, PEF significantly decreased in control patients compared with intervention patients (p=0.009) whereas inhaler technique improved in the intervention group (p=0.021). There were significantly fewer self-reported hospitalizations in intervention patients. CONCLUSIONS: A community-based pharmaceutical care program was appreciated by the participants and had a positive impact on the vitality of patients with asthma, inhaler technique, and PEE.

Adolescent↗

PubMed2004

Improving efficacy of diabetes management using treatment algorithms in a mainly Hispanic population.

OBJECTIVE: To compare clinical outcomes obtained using treatment algorithms versus standard "usual care" to treat patients with type 2 diabetes in a community setting. RESEARCH DESIGN AND METHODS: An observational group comparison was implemented in three community-based clinics in San Antonio, Texas: 1). a community clinic following treatment algorithms (CC-TA), 2). university clinic following treatment algorithms (UC-TA), and 3). a community clinic following standard "usual care" practices (CC-SC). Three hundred fifty-eight recently diagnosed type 2 diabetic patients (90% Mexican American, from low-income neighborhoods) who were consecutively identified at the three clinics were recruited. Following medical and laboratory evaluation, participants were started on treatment for hyperglycemia, hypertension, and dyslipidemia and followed for 12 months. RESULTS: Decrements in HbA(1c) at 12 months in the CC-TA and UC-TA were 3.1 and 3.3%, respectively, compared to 1.3% in the CC-SC (P < 0.0001). Corresponding decrements in fasting plasma glucose at 12 months were 94 and 99 mg/dl, respectively, versus 38 mg/dl in CC-SC (P < 0.0001). Reductions in total cholesterol, LDL cholesterol, and triglycerides at 12 months were greater in both algorithm-managed clinics compared to standard care-managed clinics (P < 0.0001). In algorithm-managed clinics, there were 30% more documented eye exams and 24% more documented foot exams than in standard care-managed patients. CONCLUSIONS: Adherence to the treatment algorithms improved metabolic outcomes in type 2 diabetic patients to a greater extent than standard care practices. These results have important clinical implications for the treatment of type 2 diabetic patients.

Adult↗

PubMed1997

Urinary diagnosis of gonorrhoea and Chlamydia in men in remote aboriginal communities.

AIMS: (1) To evaluate the acceptability and validity of an intervention based on urine tests for diagnosis and treatment of gonorrhoea and chlamydia in men in remote Aboriginal communities. (2) To provide a prevalence estimate of these infections in the male population in the surveyed communities. METHODS: First-void urine samples from 460 men in remote communities and 33 men in the Alice Springs Gaol were tested for gonorrhoea and chlamydia with at least one of polymerase chain reaction (PCR), enzyme immunoassay (EIA) and culture (gonorrhoea only). RESULTS: One hundred and three men (20.9%) were infected with gonorrhoea or chlamydia. The prevalence of infection for gonorrhoea only was 11.7%, for chlamydia only 4.1% and for dual infection 5.1%. Eighty-eight infected men and 45 of their sexual partners were recorded as having been treated within two months of testing. PCR tests detected the largest number of infections and were the easiest to use. CONCLUSIONS: The prevalence of these infections was higher than anticipated. Urine PCR tests were acceptable to men and are well suited to the remote-community setting. As an effective alternative to urethral swabs, they permit a range of community-based strategies to address high rates of infection with gonorrhoea and chlamydia.

Adolescent↗

PubMed1997

Pre- and post-admission attrition of homeless, mentally ill chemical abusers referred to residential treatment programs.

AIMS: To assess the magnitude and psychopathologic predictors of attrition among homeless, mentally ill chemical abusers (MICAs) referred to residential treatment programs in New York City. DESIGN: Homeless, MICAs were randomly referred to a therapeutic community (TC) or community residence (CR) and monitored with regard to pre- and post-admission attrition. SETTINGS: Community based treatment facilities modified to treat both substance abuse and major mental illness. PARTICIPANTS: Homeless individuals with a major mental illness (DSM-III-R) and a history of abusing alcohol or other drugs. MEASUREMENTS: Attrition rates and selected scales of psychopathology. FINDINGS: From an initial pool of 694 treatment candidates, 147 (22%) were rejected for admission at their assigned facility; 247 (36%) failed to show up for treatment; and 212 (31%) dropped out of treatment at some point during the first 12 months. Contrary to expectation, those with severe levels of psychotic ideation, depressive symptoms and hostility were admitted to treatment more frequently and stayed in treatment longer at the TC, a high demand approach, than the CR, a low demand approach. CONCLUSION: Clinicians should consider the TC as a viable treatment option for MICAs.

Adult↗

PubMed2004

Delivering cognitive therapy to people with psychosis in a community mental health setting: an effectiveness study.

OBJECTIVE: Cognitive therapy (CT) has been shown to be an efficacious treatment for persistent psychotic symptoms. However, there is some debate regarding whether this is transportable to real life clinical settings. This study aimed to evaluate the effectiveness of CT for psychosis in a community mental health team (CMHT) setting. METHOD: Patients referred for CT for psychosis were naturalistically allocated (determined by the availability of a therapist) to CT or waiting-list (WL)/treatment-as-usual (TAU). Outcome assessments were performed at WL, pre-CT, post-CT and 1-year follow-up. Data from 59 patients were analysed. RESULTS: Random effects regression analyses showed there was a significant improvement, attributable to CT, on most outcome measures, and that many of the symptomatic improvements were maintained at follow-up. Wilcoxon signed ranks tests indicated that there was a significant reduction in psychiatric hospital use following CT. CONCLUSION: These results confirm that CT is an effective treatment for psychosis that is generalizable to a community setting.

Adolescent↗

PubMed2004

Stroke risk after transient ischemic attack in a population-based setting.

BACKGROUND AND PURPOSE: Stroke risk after transient ischemic attack (TIA) has not been examined in an ethnically diverse population-based community setting. The purpose of this study was to identify stroke risk among TIA patients in a population-based cerebrovascular disease surveillance project. METHODS: The Brain Attack Surveillance in Corpus Christi (BASIC) Project prospectively ascertains stroke and TIA cases in a geographically isolated Southeast Texas County. The community is approximately half Mexican American and half nonHispanic white. Cases are validated by board-certified neurologists using source documentation. Cumulative risk for stroke after TIA was determined using Kaplan-Meier estimates. Cox proportional hazards regression was used to test for associations between stroke risk after TIA and demographics, symptoms, risk factors, and history of stroke/TIA. RESULTS: BASIC identified 612 TIA cases between January 1, 2000, and December 31, 2002; 60.9% were female and 48.0% were Mexican American. Median age was 73.8 years. Stroke risk within 2 days, 7 days, 30 days, 90 days, and 12 months was 1.64%, 1.97%, 3.15%, 4.03%, and 7.27%, respectively. Stroke risk was not influenced by ethnicity, symptoms, or risk factors. CONCLUSIONS: Using a population-based design, we found that early stroke risk after TIA was less than previously reported in this bi-ethnic population of Mexican Americans and nonHispanic whites. Approximately half of the 90-day stroke risk after TIA occurred within 2 days.

Aged↗

PubMed1984

The political and administrative context of primary health care in the Third World.

Despite increasing knowledge about technical aspects of Primary Health Care (PHC), there has been as yet only limited research into political and administrative influences on the effectiveness of PHC programs. A three-stage model of the policy process is developed as a framework for organizing the relationships between elements of (1) the national political setting and PHC policy formulation; (2) the implementing agency and program administration; and (3) the community setting and service delivery. Drawing upon the literature on PHC and related programs, hypotheses are proposed for each of these stages as a basis for future study and practical application. Possible output indicators are suggested for each stage of the model. Several basic methodological issues must be addressed in the design of empirical research on political-administrative factors, including variable selection, identification of data sources, and choice of analytical approach. It is hoped that this review will encourage more systematic investigation in this area.

Community Health Services↗