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PubMedDate not supplied

Costs and outcomes of PAPNET secondary screening technology for cervical cytologic evaluation. A community hospital's experience.

OBJECTIVE: To determine the effectiveness of and costs associated with semiautomated rescreening of Papanicolaou smears with negative findings at a community hospital. DESIGN: A prospective study of 1200 Papanicolaou smear slides with negative findings using the PAPNET screening system (Neuromedical Systems, Incorporated, Suffern, NY). SETTING: Community hospital laboratory. PATIENTS: Patients with negative findings on Papanicolaou smears who agreed to have their smears reviewed using PAPNET. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Results of rescreening and resources involved in processing the PAPNET review. RESULTS: Screening with PAPNET identified 8 patients with atypical squamous cells of undetermined significance (ASCUS) that were not diagnosed on initial screening, yielding a false-negative rate in our laboratory of 0.7% for ASCUS. No low- or high-grade squamous intraepithelial lesions were identified. Based on our laboratory processing 6000 Papanicolaou smears a year, at $19 per slide, it would cost our laboratory $102,600 for PAPNET review of all smears with negative findings. In contrast, the estimated cost to have another cytotechnologist review all such smears manually would cost $11,977. The rate of changed diagnoses in the PAPNET group was similar to the rate in our standard rescreening of 10% of all smears with negative findings. Mean turnaround time for a PAPNET screen was 13.9 days, compared with 3.9 days for manual review. CONCLUSIONS: For a laboratory with a low percentage of smears with abnormal findings, a quality cytotechnologist and pathologist, and required quality assurance standards in place, PAPNET may not improve appreciably the pick-up rate for missed cervical lesions, and may add significantly to the cost and turnaround time of cytologic evaluation of cervical smears.

Carcinoma, Squamous Cell↗
PubMed1990

Intramural and extramural health care in the United Kingdom.

In this article the factors which determine whether health care in the United Kingdom is provided in hospital, at home or through intermediate or shared care arrangements are considered. The following aspects of home health care in the United Kingdom are discussed: continuous ambulatory peritoneal dialysis; parenteral nutrition; cytotoxic therapy; terminal care/pain control; intravenous antibiotics. Pharmaceutical implications of the transfer of the long-term care of the mentally ill, mentally handicapped and elderly from hospital to community settings are also considered. Key changes in the development of pharmacy in the United Kingdom are mentioned and the emergence of a new group, community service pharmacists, is identified.

Community Health Services↗
PubMed2001

Dental health and access to dental treatment: a comparison of drug users and non-drug users attending community pharmacies.

OBJECTIVE: To investigate the self-reported oral health, access to dental treatment and recent use of dental services among a group of drug users attending community pharmacies and to make a comparison with a group of age and gender matched community non-drug users/patients not using services for drug users. METHOD: Review instrument completed by pharmacist interviewing drug users and other pharmacy users. SETTING: Community pharmacists SAMPLING: All known drug users attending participating pharmacies plus an equivalent number of age and gender matched non-drug using pharmacy customers. Final sample size drug users N = 125; non-drug users N = 129. KEY FINDINGS: The data show that drug users self-report considerably more difficulty in accessing dental treatment, are less likely to have visited the dentist in the last 12 months and have a significantly higher level of self-assessed oral health problems, with less use of treatment services than non drug users. CONCLUSIONS: Drug users need to be encouraged to access free dental treatment available to them on the NHS. Closer collaboration between the dental profession and others in contact with drug users, such as community pharmacists, may enhance uptake of dental services.

Adolescent↗
PubMed2001

Evaluating psychosocial nursing interventions for cardiac clients and their caregivers: a case study of the community rehabilitation network in Hong Kong.

AIM OF THE STUDY: The purpose of this exploratory study was to describe the type and nature of psychosocial nursing interventions provided for cardiac clients in Hong Kong's Community Rehabilitation Centres (CRNs). DESIGN/METHODS: Using a two-phase case study design data were collected from nurses, cardiac clients and their caregivers. The initial phase focused on identifying the types of psychosocial interventions provided. These data were obtained by observing nursing activities and the keeping of daily journals by the nurses. The second phase acquired data from structured telephone interviews, that reviewed clients' perceptions of the psychosocial interventions provided by the nurses and face-to-face interviews with clients and their caregivers. FINDINGS: These findings revealed that the nurses' interpersonal skills of information giving, social support and counselling were highly valued by cardiac clients and their caregivers. Both clients and caregivers outlined a concern about the lack of individual care and this was reflected in the focus of the CRN on group processes. CONCLUSION: Recommendations for psychosocial cardiac care are made for public health nurses and nurses working in community settings.

Aged↗
PubMed2000

Prospective validation of a standardized questionnaire for estimating childhood mortality and morbidity due to pneumonia and diarrhoea.

This paper reports the validation of a 'best-judgement' standardised questionnaire using guidelines and algorithms developed by an expert working group conducted in Nicaragua between 1995 and 1997. Prospective hospital data, including standardised medical recording of selected signs and symptoms, laboratory and radiographic test results and physician diagnoses were collected for children < 5 years admitted with any serious life-threatening condition in 3 study hospitals. The mothers or caregivers of the children were later traced and interviewed using the 'best-judgement' questionnaire. Interviews were completed 1-22 months after admission to hospital for 1115 children (400 who died during the stay in hospital and 715 who were discharged alive). The cause of death or admission to hospital was determined by an expert algorithm applied to hospital data. A similar procedure was used to derive the cause using the answers to questions from interviews. Hospital causes were compared with interview causes and sensitivity and specificity calculated, together with the estimated cause-specific fraction for diarrhoea and pneumonia. Multiple diagnoses were allowed; 378 children in the sample (104 deaths, 274 survivors) had a reference diagnosis of diarrhoeal illness, and 506 (168 deaths, 338 survivors) a reference diagnosis of pneumonia. When results for deaths and survivors in all age groups were combined, the expert algorithms had sensitivity between 86% and 88% and specificity between 81% and 83% for any diarrhoeal illness; and sensitivity between 74% and 87% and specificity between 37% and 72% for pneumonia. Algorithms tested in previous validation studies were also applied to data obtained in this study, and the results are compared. Despite less than perfect sensitivity and specificity, reasonably accurate estimates of the cause-specific mortality and morbidity fractions for diarrhoea were obtained, although the accuracy of estimates in other settings using the same instrument will depend on the true cause-specific fraction in those settings. The algorithms tested for pneumonia did not produce accurate estimates of the cause-specific fraction, and are not recommended for use in community settings.

Algorithms↗
PubMed2005

Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke.

OBJECTIVES: To determine the effect of two different community-based group exercise programs on functional balance, mobility, postural reflexes, and falls in older adults with chronic stroke. DESIGN: A randomized, clinical trial. SETTING: Community center. PARTICIPANTS: Sixty-one community-dwelling older adults with chronic stroke. INTERVENTION: Participants were randomly assigned to an agility (n=30) or stretching/weight-shifting (n=31) exercise group. Both groups exercised three times a week for 10 weeks. MEASUREMENTS: Participants were assessed before, immediately after, and 1 month after the intervention for Berg Balance, Timed Up and Go, step reaction time, Activities-specific Balance Confidence, and Nottingham Health Profile. Testing of standing postural reflexes and induced falls evoked by a translating platform was also performed. In addition, falls in the community were tracked for 1 year from the start of the interventions. RESULTS: Although exercise led to improvements in all clinical outcome measures for both groups, the agility group demonstrated greater improvement in step reaction time and paretic rectus femoris postural reflex onset latency than the stretching/weight-shifting group. In addition, the agility group experienced fewer induced falls on the platform. CONCLUSION: Group exercise programs that include agility or stretching/weight shifting exercises improve postural reflexes, functional balance, and mobility and may lead to a reduction of falls in older adults with stroke.

Accidental Falls↗
PubMed2005

[Catheter-related urinary tract infections in the community].

The prevalence of urinary catheterization in the community ranges from 0.02% to 0.07%. Despite the generalized use of closed systems, the risk of bacteriuria in patients with urethral catheters is 3%-10% per day and its presence is universal when the device remains in place for 30 days or longer. Although most of these episodes of bacteriuria are asymptomatic, up to 30% of them lead to clinical symptoms and complications, including severe sepsis and death. The microorganisms infecting the urine of catheterized patients frequently belong to species less susceptible to antibiotics and form biofilms on both the device's surfaces and probably also on the urothelium. Biofilm formation greatly hampers eradication of the involved flora by antibiotics, probably favors the development of resistance and, in some instances, constitutes the substrate on which crystal precipitates are deposited, eventually resulting in blockage of the catheter lumen. Due to the scarce number of controlled studies, there are still many gaps in our knowledge of important issues concerning the clinical management of patients with indwelling urinary catheters in the community. The present study reviews the epidemiology, risk factors, microbiology, pathogenesis, clinical manifestations, diagnosis, prevention and treatment of catheter-related urinary tract infections in the community setting.

Adult↗
PubMed1992

Building systems of care for youth with serious mental illness.

In 1990 the Robert Wood Johnson Foundation's Mental Health Services Program for Youth awarded grants to eight state-community partnerships to develop systems of care for mentally ill children and adolescents. The authors describe approaches to system building in the program's first two years of implementation. The evolving systems consist of government agencies in child welfare, mental health, public health, education, and juvenile justice, as well as private-sector health and mental health care providers. Basic system features include interagency steering committees and long-term intensive case management. Fundamental principles guiding system development are individualization of care to meet the needs of the specific child, organization of care to empower families to manage care over the long term, flexible financing of care, and normalization of care in family and community settings.

Adolescent↗
PubMed2003

Accessing the community: gaining insider perspectives from the outside.

Accessing participants for research projects is often treated as unproblematic. However the experience outlined here of negotiating access to participants within a community setting illustrates the inherent difficulties of recruitment. The authors describe the techniques used and practical challenges faced when accessing participants within a socially deprived community for a qualitative research project on social capital. They used a number of different strategies to generate a diverse sample including advertising, snowballing, accessing gatekeepers, and street surveys. The value of a stakeholder analysis is described alongside issues surrounding the use of gatekeepers. Rather than acting as outsiders seeking participants at every available opportunity, a more fortuitous strategy involved the ethnographic approach of "being there" as active contributors to community life. Here, the cornerstones of credibility and trust were addressed in a process of continually negotiating access from a semi-insider position.

Adult↗
PubMed1991

Identification of stress buffers in school-age children.

Dealing with stress has become an important issue in health education in community settings. With increasing demands and changes in the daily lives of families, helping children to deal with stress has become increasingly more significant in community health nursing. Nurses who want to mediate effects of stress in children need more information about stress buffers in the daily lives of children. This study attempted to identify and describe stress buffers as actually experienced by school-age children. Qualitative data were drawn from 32 well children, aged 8 through 11 years, by completion of daily semistructured journals over a period of 6 weeks. Diaries produced 764 stress buffer responses. All data were subjected to content analysis. Sixteen categories among four general themes of intrapsychic comfort, physical-social activities, social support, and physical comfort emerged, beginning a taxonomy of stress buffers as perceived by children. Interesting differences between boys and girls were identified, with implications for research and community nursing practice.

Adaptation, Psychological↗
PubMedDate not supplied

Clinical Oncology Program: a community cancer control model.

The majority of cancer patients are diagnosed and treated in their local communities, making it imperative to upgrade cancer management at the community level. The Clinical Oncology Program has demonstrated that sophisticated cancer control programs are possible in a community setting. Moreover, if "quality of survival" data collection is included in such programs, valuable information emerges that can further improve cancer management in the community.

Hospitals, Community↗
PubMed1995

Building inclusive community: a challenge for occupational therapy. 1994 Eleanor Clarke Slagle Lecture.

Occupational therapy was founded on values of choice, relevance, and active participation in meaningful occupations. To assure choice in daily living, learning, work, and play for persons with disabilities or significant health issues, occupational therapy practitioners are challenged to gain increased understanding of the unique culture and community of each person and family with whom they work; create opportunities for these persons to develop their capabilities in community settings of their choice; promote more interactive models of practice in which the practitioner affects the arrangements between the person and society; work with communities to welcome the gifts of diversity; and develop skill in analyzing environments and facilitating environmental interaction. The environment category of the spatiotemporal adaptation theory is expanded and a communication model for collaboration in building individual community is proposed as means for addressing the challenges.

Activities of Daily Living↗
PubMed2003

Developing self-evaluation skills: a pragmatic research-based approach for complex areas of nursing.

Using a newly established community rehabilitation service as the research context, Gill Hek explores ways in which practitioners pragmatically developed self-evaluation research skills. Within the practice setting, community practitioners learnt how to conduct and analyse interviews with service users, and to develop connected database records that could be used across health and social services. The teaching-learning process and the teacher-learner relationship were used as models for researching in this complex area. The project demonstrated how community rehabilitation teams developed self-evaluation research skills to a point where they were able to reflect critically on the service they were providing. Supported by a research team, they were able to use research skills to analyse the volume and throughput of their service. They were also able to establish what needed to be done next within the challenging environment at the interface of health and social care in the community.

Community Health Nursing↗
PubMed2003

Challenges and solutions for care of frail older adults.

Frail older adults are at risk for negative outcomes and are the most significant consumers of health resources across both acute and community settings. Both formal systems and families are involved in this care of frail elders. This article reviews health care issues for frail older adults and addresses the impact of frailty on the future health care system. It also presents challenges for future care, creative solutions that are currently being tested and explored, and suggestions for future nursing priorities. Challenges in the care of frail elders include: the organization and sustainability of the continuum of services, resource allocation, and cultural competence in service delivery. Creative solutions include intensive case management programs, targeting at risk older adults, partnerships with families, enhanced use of telemedicine and assistive technology, and promoting healthy aging. Nurses have the potential to improve elder health across settings through clinical practice, education, leadership, and research.

Aged↗
PubMedDate not supplied

How acute and community nurses are sharing skills.

The shift in emphasis from secondary to primary care has considerable implications for nurses and patients. Initiatives in Avon are seeking to smooth the transition from acute to community-based care. Skill-sharing between nurses working in acute and community settings is highlighted as a way of promoting seamless care.

Acute Disease↗
PubMed2006

Longitudinal change in positive affect in community-dwelling older persons.

OBJECTIVES: To determine whether positive affect, defined as emotional contentment and happiness, remains stable in late life and to identify predictors of longitudinal change in positive affect. DESIGN: Longitudinal observational study. SETTING: Community. PARTICIPANTS: Six hundred sixty-three individuals aged 70 and older without disability at baseline and free of chronically depressed mood. MEASUREMENTS: Positive affect, social network, social activity, chronic health conditions, activities of daily living, instrumental activities of daily living (IADLs), cognitive functioning, and negative affect measured over 54 months, at 18-month intervals, up to four times. RESULTS: Positive affect remained relatively stable over 4.5 years of follow-up. Higher average levels of social activity and lower levels of negative affect were associated with higher positive affect. An increase of 1 point in negative affect (on a 7-point scale) was associated with a 0.23-point concurrent decrease in positive affect (on a 5-point scale). Needing help in an additional IADL was associated with a decrease in positive affect of 0.04 points. A greater number of chronic conditions at enrollment was associated with lower positive affect. CONCLUSION: Positive affect is directly correlated with social involvement and inversely correlated with negative affect, IADL functioning, and comorbidity. Positive affect was mostly related to factors that do not change over time, although it showed some sensitivity to short- and long-term changes in physical health and functioning.

Activities of Daily Living↗