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Results for “Community setting”

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At least 1,135 records · Page 63Linked to original sources

PubMed2004

Community-acquired methicillin-resistant Staphylococcus aureus skin infection: an emerging clinical problem.

Community-acquired methicillin-resistant Staphylococcus aureus skin infections at an outpatient university health center were evaluated. In all, 41 cultures were performed in 36 of 853 patients. Of the 19 patients with S aureus infection, methicillin resistance occurred in 10 (53%) and generally manifested as abscesses or cellulitis. Therefore, methicillin resistance should be considered, even in the community setting, and appropriate cultures performed.

Abscess↗

PubMed1991

Patient characteristics and outcomes in institutional and community long-term care.

This paper examines the three-way relationships among patient characteristics, type of care (admission to a nursing home or community setting), and 6-month outcomes of 352 long-term care patients. The study found that patient characteristics influenced the type of care received and that substantial portions of the variance in the outcomes were attributable to initial differences among patients in the two types of care. Controlling for the effect of selective admission, type of care had no significant impact on patients' ADL scores, mobility scores, or disposition after 6 months in the long-term care setting.

Activities of Daily Living↗

PubMedDate not supplied

The care programme approach: a nursing perspective.

The care programme approach is part of a large body of political guidance relating to the Government's policy of caring for mentally ill patients in the community. This policy has been in operation for over three decades and still remains controversial. Recent media attention has focused on mental health care in a far from positive manner, and evidence suggests that the care programme approach has not proved a total success (Hogman, 1992; Huxley, 1993; North et al, 1993; Social Services Inspectorate, 1995). Despite this it remains the foundation on which a series of policy directives have been based over the last 5 years, and it is difficult to disagree with the fundamental philosophy, which reflects the basic principles underpinning the delivery of effective mental health care in the community. There are clear implications for psychiatric nurses, and this article outlines the crucial role that nurses working in both hospital and community settings have to play in the clinical application of the care programme approach.

Community Health Nursing↗

PubMed2003

Nursing students' experiences during a rural community placement programme in Namibia--2001.

The reviewed nursing curriculum in Namibia incorporated issues related to Primary Health Care and diversification in the practical field for student nurses. This means that the students are exposed more to their communities than before. Nurses identify, manage and refer, if need be, the problems at this level. The curriculum facilitates and strengthens problem-solving skills and enhances the ability of nurses to adapt a comprehensive and family centred approach. The aim of this article is to describe the process of the rural placement of nursing students and to describe the experiences of the students as derived from the placement programme in districts in the central health directorate. Both positive and negative experiences are described. It is clear that the students have gained self-confidence in problem management. This article further confirms that learning experiences in the community setting is comparable to the hospital and other clinical learning settings in facilitating student's personal and academic development.

Community Health Services↗

PubMed2004

Screening for diabetes in an African-American community: the Project DIRECT experience.

AIM: To report the results of a community-based screening program associated with Project DIRECT, a multiyear diabetes mellitus prevention and control project targeting African-American residents of southeast Raleigh, NC. METHODS: Between December 1996 and June 1999, 183 screening events took place in community settings. Screening was by capillary glucose concentration. Participants with a positive screen were referred for confirmatory testing and physician follow-up. MAIN RESULTS: Risk factors for diabetes were prevalent, including ethnic minority race (88.2%), obesity (45.6%), and family history of diabetes (41.7%). In all, 197 personshad an elevated screening result; the prevalence of diabetes in the screened population that underwent follow-up testiing was 1.7%. Despite persistent tracking efforts, 28% of the persons with a high screening test received no final diagnosis CONCLUSIONS: In this community-based screening program targeted to high-risk African Americans, risk factors for diabetes were common, but new cases of undiagnosed diabetes among participants were uncommon. Intensive follow-up for persons with high screening values is necessary but difficult to achieve. Our results support national recommendations against community-based screening; opportunistic screening for diabetes in clinical settings is likely a more effective use of resources.

Adult↗

PubMed2004

From directly observed therapy to accompagnateurs: enhancing AIDS treatment outcomes in Haiti and in Boston.

Like tuberculosis, human immunodeficiency virus (HIV) disease is associated with poverty and social inequalities, conditions that hamper the delivery of care. Like tuberculosis, treatment of HIV infection requires multidrug regimens, and the causative agent acquires drug resistance, which can be transmitted to others. A pilot project in rural Haiti introduced DOT-HAART (directly observed therapy with highly active antiretroviral therapy) for the care of patients with advanced acquired immune deficiency syndrome. A similar DOT-HAART effort was launched in Boston for patients with drug-resistant HIV disease who had experienced failure of unsupervised therapy. In both settings, community health promoters or accompagnateurs provide more than DOT: they offer psychosocial support and link patients to clinical staff and available resources. DOT-HAART in these 2 settings presents both challenges and opportunities. These models of care can be applied to other poverty-stricken populations in resource-poor settings.

Anti-HIV Agents↗

PubMed2005

Chronic pain in individuals with spinal cord injury: a survey and longitudinal study.

STUDY DESIGN: Cross-sectional and longitudinal postal survey. OBJECTIVES: To (1) compare the severity of pain in persons with spinal cord injury (SCI) to national norms, (2) examine the association between pain and measures of (a) psychological functioning, (b) community integration and (c) pain interference with daily activities, and (3) examine the change in the prevalence and intensity of pain over time. SETTING: Community. METHODS: A total of 147 adults with SCI were surveyed twice, 2-6 years apart. Main outcome measures included presence/absence of pain in general and at specific body sites, 0-10 numerical rating scale of average pain intensity, modified Brief Pain Inventory Pain Interference scale, SF-36 Bodily Pain scale, SF-36 Mental Health scale, Community Integration Questionnaire. RESULTS: Pain was more severe, on average, in this sample of patients with SCI than it is in normative samples. The presence of pain was associated with trends towards poorer psychological functioning and social integration, and the intensity of pain was associated with interference with a number of important basic activities of daily living. Little systematic change was found in pain over a 2-6-year-period, although there was evidence that the prevalence of shoulder pain increases over time. CONCLUSION: The current findings underscore the serious nature of pain in persons with SCI and provide additional support for the need to identify effective treatments for SCI-related pain.

Chronic Disease↗

PubMed1991

Infections and antibiotic use in a community hospital, 1971-1990.

OBJECTIVE: To determine the prevalence of infections and antibiotic use at a community hospital in 1990 and to compare the results with those from previous surveys in 1971, 1979, and 1984. DESIGN: Point prevalence survey. SETTING: Community teaching hospital. PATIENTS: All hospitalized patients, excluding those on the nursery, psychiatry, and short-stay wards. INTERVENTION: Medical records were reviewed and a pertinent physical examination was performed on each patient. RESULTS: Overall, 46 (20.1%) of 229 patients had infection in 1990. Community-acquired and hospital-acquired infections were present in 26 (11.4%) and 24 (10.5%) of the patients, respectively. The most common site of community-acquired infection was the deep abdomen in 8 (25.8%) of 32 sites, while hospital-acquired infection most frequently involved the lower respiratory tract in 8 (25.0%) of 32 sites. Antimicrobial agents were being administered to 88 (38.4%) of the patients. Cephalosporins (particularly newer, broad-spectrum agents) were the most frequently used antibiotics, comprising 53 (45.3%) of the 117 total antimicrobial prescriptions. Seven (18.4%) of the 38 antibiotics used for surgical prophylaxis were given for more than 48 hours. Trend analysis revealed no significant changes in the proportions of patients with community-acquired, hospital-acquired, or total infection over the last 20 years (p = .18, p = .12, and p = .07, respectively). While the overall use of antibiotics increased (p less than .001), the administration of prophylactic perioperative antibiotics for greater than 48 hours decreased (p = .009). CONCLUSIONS: Despite major shifts in factors associated with an increased risk of infection, the overall prevalences of hospital-acquired and community-acquired infections remained remarkably constant during the last 20 years. Although total antibiotic use increased, the duration of surgical prophylaxis decreased and the pattern of use of therapeutic antibiotics also changed with increased use of broad-spectrum agents.

Anti-Bacterial Agents↗

PubMed2001

Comparison of self-reported initial treatment with medical records: results from the prostate cancer outcomes study.

Medical records are generally accepted as the most accurate source of information documenting cancer treatments. However, as the health care system becomes more decentralized and more cancer care is delivered in outpatient settings, it is increasingly difficult and expensive to review records from the many surgeons and medical/radiation oncologists who administer cancer therapies in the community setting. Using 1994-1995 data, the authors compared initial treatment for prostate cancer self-reported (from a mailed questionnaire or telephone/in-person interview) by 3,196 US men in the population-based Prostate Cancer Outcomes Study with information obtained from medical records. Agreement between self-reports and medical records varied by type of treatment. Generally, agreement was excellent for more invasive procedures such as prostatectomy or radiation (kappa values > 0.8), with decreasing agreement for hormone shots and pills (kappa values < 0.7). If the medical record abstract is assumed to be the "gold standard," the estimated sensitivity was generally high (>80%) for prostatectomy and radiation but low (68%) for hormone pills, although the estimated specificity was 90% or greater for all treatments. These results can serve as a useful guide to researchers contemplating the use of surveys as an alternative to medical record abstraction to ascertain treatment in studies of patient outcomes.

Adult↗

PubMed2006

Removing barriers to knowing HIV status: same-day mobile HIV testing in Zimbabwe.

OBJECTIVES: We developed a mobile HIV voluntary counseling testing (VCT) strategy. Our aims were (1) to describe those using the services, (2) to assess the acceptability of such services, (3) to assess reasons for not testing previously, and (4) to compare those who used the services with those who did not to determine how to increase acceptability. METHODS: We provided free anonymous mobile VCT using 2 rapid HIV tests in 12 marketplaces in Epworth and Seke, Zimbabwe. Qualitative interviews were conducted to assess motivations for and barriers to testing. A subsample of HIV testers and individuals near testing vans who declined testing (nontesters) completed a questionnaire. RESULTS: A total of 1099 individuals participated in mobile VCT between March 2002 and August 2003. The proportion of participants infected with HIV was 29.2%. Overall, 98.8% of participants elected to receive HIV test results the same day. Reasons for not testing previously were often logistic (eg, inconvenience of hours [25.6%] and location [20.7%] or cost [8%]). Those who used the same-day mobile testing services (testers vs. nontesters) perceived themselves at higher risk for HIV infection (adjusted odds ratio [AOR] = 1.8) but were less likely to have known people with HIV (AOR = 0.49) or where to get tested (AOR = 0.57). CONCLUSIONS: Same-day HIV testing in community settings seems to be acceptable in sub-Saharan Africa. Barriers to HIV testing are often logistic and can be overcome with community-based strategies. These strategies need to be refined to address the needs of those not using mobile testing services.

AIDS Serodiagnosis↗

PubMed2004

The positive impact of initiation of hospitalist clinician educators.

OBJECTIVE: Although hospitalists have been shown to improve both financial and educational outcomes, their ability to manage dual roles as clinicians and educators has been infrequently demonstrated, particularly in the community setting where large numbers of residents train. We evaluated the impact of hospitalists on financial and educational outcomes at a mid-sized community teaching hospital 1 year after implementation. DESIGN: Two hospitalist clinician educators (HCEs) were hired to provide inpatient medical care while participating in resident education. Length of stay and cost per case data were calculated for all patients admitted to the hospitalist service during their first year and compared with patients admitted to private physicians. The hospitalists' top 11 discharge diagnoses were individually assessed. For the same time period, categorical medicine residents (N = 36) were given an anonymous written survey to assess the HCEs' impact on resident education and service. RESULTS: Resource consumption: length of stay was reduced by 20.8% and total cost per case was reduced by 18.4% comparing the HCEs with community-based physicians. Reductions in both length of stay and cost per case were noted for 8 of the 11 most common discharge diagnoses. Resident survey: over 75% of residents responded, with all noting improvement in the quality of attending rounds, bedside teaching, and the overall inpatient experience. Residents' roles as teachers and team leaders were largely unchanged. CONCLUSION: Hospitalist clinician educators as inpatient teaching attendings effectively reduce length of stay and resource utilization while improving resident education at community-based teaching hospitals.

Adult↗

PubMed1999

The oral health of older people from minority ethnic communities in south east England.

OBJECTIVES: To describe the clinical health status and subjective oral health status of older adults from minority ethnic communities resident in South East England. DESIGN: Cross sectional survey incorporating a clinical examination and a questionnaire assessment of subjective oral health status. SETTING: Community groups working with individuals from minority ethnic communities. SUBJECTS: A total of 540 individuals from 7 minority ethnic communities. MEASURES: Clinical assessment of oral health status using BASCD criteria. Assessment of oral symptoms and impact experienced together with satisfaction with oral status, by structured questionnaire. RESULTS: On all measures of clinical health status the participants were healthier than a comparison group based on data from the Adult Dental Health Survey. The participants expressed high levels of subjective oral symptoms. Levels of satisfaction were lower than those found in the Adult Dental Health Survey. There was evidence of some variation across minority ethnic communities in clinical and subjective oral health status. CONCLUSIONS: Approximately 20% of the 540 adults from minority ethnic communities resident in the South East of England surveyed were relatively fit orally. They experienced a great many oral symptoms, and in approximately 30% of individuals these were sufficient to interfere with their quality of life. ETHICAL APPROVAL: The research described in this paper was approved by the Ethics committee of King's College London.

Black or African American↗

PubMed1977

A study of former state hospital employees at a community-based outpatient clinic.

The current trend toward providing community-based services for the mentally ill has had substantial impact on state hospital employees who transfer to community mental health centers. A study, through interviews and questionnaires, of 30 Grafton State Hospital employees who transferred to a community outpatient clinic indicated initial anxiety about the hospital's closing, the relocation process, and the lack of structure in the new community setting. Many employees stated that those initial reactions were gradually replaced by satisfaction and personal growth stemming from successful adaptation to the community-based placement.

Adaptation, Psychological↗

PubMed2003

How do we know if we are making a difference with our program or community initiative?

In this article, the authors discuss issues related to knowing if health workers are making a difference with their community initiatives or programs being delivered in a community setting. Issues relating to the choice of evaluation questions, relevance of data sets used to answer those questions, and the rigor by which the answer can be evaluated--and the ability to generalize to other communities or populations--are explored. Finally, relevant resources to help you pursue these issues are provided.

Community Health Planning↗

PubMedDate not supplied

Building population data bases: lessons from a community project.

Observational data bases that tract patient outcomes and quality of life over long periods of time offer an alternative to traditional randomized clinical trials in assessing treatment effectiveness. This article reviews our experience building an observational database in a community setting. Thirty-eight urologists, radiation therapists, oncologists, and pathologists working at the five major hospitals in Hartford County, Connecticut, established a community-based observational data base to quantify the risks and benefits associated with different treatment options for clinically localized prostate cancer. In addition to classic demographic data, the data base includes information concerning patient comorbidities, bowel and bladder function, sexual function, and quality of life captured both before and after medical intervention. Case finding is accomplished via a rapid case ascertainment system. As part of this system, a trained abstractor reviews all the pathology reports generated by each hospital on a weekly basis and forwards reports of prostate biopsies and surgical specimens to the study office within 1 week. Patients with positive prostate biopsies are contacted by a trained nurse registrar to gather additional information using a structured interview. Patient consent for this project is obtained at the time of biopsy in the participating physician's office. To date, biopsy reports have been obtained on 581 patients of whom 202 have been diagnosed with localized prostate cancer. Interviews have been conducted with 42 patients. Initial review of the data base shows that prostate biopsies in Hartford are being performed primarily on men aged 59 to 77 years, but ages range from age 45 to 93.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Health Services↗

PubMedDate not supplied

Emerging problems in antimicrobial resistance.

The ability of many different species of bacteria to resist the inhibitory action of antimicrobial agents has become a global problem. As the magnitude of the problem continues to increase, it is imperative that healthcare professionals, particularly nurses who administer antimicrobial agents on a daily basis, become familiar with the causes of antibiotic resistance and the ways in which the emergence of resistance can be prevented or minimized. It also is important that the proper use of antimicrobial agents and the problems associated with misuse be conveyed to patients receiving intravenous therapy, particularly those receiving therapy outside of traditional healthcare settings. This article will highlight some of the factors leading to the development of resistance in bacteria and the problems facing the medical community and the public regarding the spread of resistant bacteria in hospital and community settings.

Cross Infection↗

PubMed2003

Transportable two-dimensional gait assessment: routine service experience for orthotic provision.

PURPOSE: The purpose of the pilot service was to establish the potential of the newly developed system to achieve, in a community setting, more effective orthotic outcomes for patients in whom alignment of ground reaction force is an important treatment objective. METHODS: Twelve visits were arranged to a paediatric community physiotherapy department. Up to six patients at each visit were selected for assessment of their lower limb orthotic prescription. The patient's gait was assessed using the video vector generator to determine alignment of ground reaction force. Where necessary, adjustments to the orthotic set-up were made to achieve more closely the stated objective. At the conclusion a specification of the orthosis was agreed. RESULTS: In only two of 61 assessments that were conducted was it not possible to achieve a useful outcome. CONCLUSIONS: Improvements in biomechanical alignment were achieved in more than 68% of assessments. The pilot service was sufficiently successful for it to be extended to a routine clinical service.

Adaptation, Physiological↗

PubMed1995

Settings as an important dimension in health education/promotion policy, programs, and research.

Settings--community, worksite, schools, and healthcare sites--constitute an important dimension of health education/health promotion policy and programs and for research about program needs, feasibility, efficacy, and effectiveness. These settings vary in the extent of coverage of and relationships with their respective constituencies, valued outcomes, and quantity and quality of evidence about the effectiveness of setting-specific and cross-setting programs. Main sources of evidence for program efficacy and effectiveness are summarized, leading to the conclusion that strides have been made toward building a strong evidentiary base for health education/health promotion in these settings. Gaps in research exist, especially for diffusion of effective programs, new technologies, the influence of policy, relations between settings, and approaches to marginal and special subgroups. Recommendations are offered for cross-setting and within-setting research related to intervention.

Community Health Services↗