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At least 19 recordsLinked to original sources
PubMed1992

Audit of mammography in a community setting.

A Northwest community concentrated all mammography services in one location and instituted a program of annual review. The 32,118 mammograms prompted 466 biopsies of women who had no palpable abnormality. Over the 5-year study, there were 142 nonpalpable cancers found for a positive biopsy rate of 30%. In the first year, the positive biopsy rate was 17%, and, in the last year, it was 42%. The increase in apparent selectivity prompted a search for false negatives or missed breast cancers. One percent of women subjected to mammography underwent biopsy, but, interestingly, only 84% of women undergoing mammography received a normal report. Eighty-seven percent of the cancers were invasive, and 13% were considered to be noninvasive. A review of the literature suggests significant variation in the frequency of identifying nonpalpable breast cancer, and respected pathologists report variations in the pathologic evaluation of these nonpalpable cancers.

Adult↗
PubMed1992

Multiple medication use in the elderly. Use of prescription and non-prescription drugs in an Australian community setting.

OBJECTIVE: To document the extent of polypharmacy or multiple medication use in the elderly. DESIGN: Cross-sectional examination of an age cohort of a community. SETTING: Community-based study in Dubbo, NSW, in 1988-1989. SUBJECTS: All non-institutionalised residents aged 60 years and over, numbering 1237 men and 1568 women. MAIN OUTCOME MEASURES: Assessment of use of prescription and non-prescription drugs, recent hospitalisation, years of education, psychosocial variables. RESULTS: 18% of men and 25% of women were currently using three or more classes of prescription drugs. The corresponding values for two or more classes of non-prescription drugs were 29% and 44%. Of those who were using multiple prescription drugs 56% of men and 76% of women were also using multiple non-prescription drugs. In a multiple logistic model, the following possible predictors of multiple drug use were included: hospitalisation in the last six months, age, sex, depression, life satisfaction and education. Multiple prescription drug use was significantly predicted by recent hospitalisation (odds ratio [OR] = 2.40; 95% confidence interval [CI], 1.63-3.56), increasing age (e.g. 70-79 years versus 60-69 years; OR = 2.54; CI, 1.97-3.25), female sex (OR = 1.59; CI, 1.25-2.01) and increasing depression (e.g. highest tertile of depression scale versus lowest; OR = 2.52; CI, 1.84-3.42). Multiple non-prescription drug use was significantly predicted by female sex (OR = 2.38; CI, 1.95-2.92) and increasing depression (OR = 2.77; CI, 2.16-3.56). For prescription items, non-prescription items, and both categories in combination levels of use 20% above the population average have been documented. CONCLUSIONS: Polypharmacy in the elderly population appears to be predicted by recent hospitalisation, increasing age, female sex and increasing depression. There is potential for drug-drug interaction to occur, but the findings suggest target areas for preventive action.

Aged↗
PubMed1976

Outpatient chemotherapy of advanced breast cancer in a community setting: a five-drug regimen.

Forty-two (37 evaluable) unselected women with advanced breast carcinoma were treated with a modified "Cooper regimen" in a community setting. After 12 weeks of induction therapy, the patients were evaluated for response and toxicity. The 74% overall response rate (78% in the evaluable group) compares favorably with that of other series. The median duration of remission was 13.7 months. The median survival was 17 months for the evaluable patients and 14 months for the entire group. Twenty-two percent of the patients required hospitalization during the induction phase, and 35% were treated exclusively as outpatients during all phases of therapy. There was only one drug-related death. It is concluded that a complex chemotherapeutic regimen can be managed adequately by physicians experienced in chemotherapy in a community setting with results comparable to those from cancer centers.

Adult↗
PubMed1992

Drug prevention in a community setting: a longitudinal study of the relative effectiveness of a three-year primary prevention program in boys & girls clubs across the nation.

Tested the effectiveness of a youth drug prevention program in a community setting. Boys & Girls Clubs of America's Stay SMART program, adapted from a school-based personal and social competence drug prevention program, was offered, with and without a 2-year booster program, to 13-year-old members of Boys & Girls Clubs. Over 27 months, (a) 5 Boys & Girls Clubs offered the Stay SMART program, (b) 5 Boys & Girls Clubs offered the Stay SMART program with the booster programs, and (c) 4 Boys & Girls Clubs served as a control group. The Stay SMART program alone and the Stay SMART program with the booster programs showed effects for marijuana-related behavior, cigarette-related behavior, alcohol-related behavior, overall drug-related behavior, and knowledge concerning drug use. The Stay SMART program with the booster programs produced additional effects for alcohol attitudes and marijuana attitudes after each year of booster programs. Results suggest that a school-based personal and social competence program can be adapted effectively to a community setting and that booster programs might enhance program effects. Implications for alternative community models of prevention are discussed.

Adolescent↗
PubMed2026

The influence of organizational culture on medication safety practices and associated risk factors in the community setting: A systematic review.

BACKGROUND: Increasing attention has been given to the role of organizational culture in influencing medication safety practices across healthcare settings. The lack of widely accepted standardized instrumentation makes operational measurement of organizational culture and medication safety challenging. The purpose of this systematic review was to examine the impact of organizational culture on medication safety within community healthcare settings. METHODS: MEDLINE, CINAHL, Scopus, and Nursing & Allied Health were searched in August 2025 using keywords, subject terms, field codes, and Boolean operators to identify papers relevant to the review question; bibliographies of included studies were also reviewed. Screening and full-text review were completed independently by two reviewers with a third to adjudicate conflicts. The Critical Appraisal Skills Programme was used for quality assessment. The PRISMA statement guided the development and implementation of the review. RESULTS: Thirteen articles were included representing various community settings. Most studies reported on untoward medication events, but few measured systematically collected safety data before and after an intervention. Organizational culture was seldom defined or operationalized. Most studies were methodologically sound, but the overall level of evidence was weak to moderate. CONCLUSION: Organizational culture influences medication safety through aspects such as communication channels, teamwork, training, and an environment that allows error and near-miss reporting. Few studies explicitly evaluate the causal impact of culture interventions on measurable medication safety outcomes in community healthcare settings. Further research should incorporate standardized measurement tools and intervention-based, pre-post designs to better understand how organizational culture influences medication safety in community healthcare settings.

Organizational Culture↗
PubMed1992

The dependency-support script in institutions: generalization to community settings.

This study tested the generalizability of the dependency-support script, a behavioral system describing and explaining dependent behaviors of the institutionalized elderly. A comparative study with 22 community-dwelling elderly was conducted, which identified typical interaction patterns between the elderly and family members or home health nurses. The dominant interaction pattern in the community setting, too, was the dependency-support script. In addition, however, a significant social response to independent self-care behavior was observed, which created a highly ambivalent response contingency. Independent behaviors were followed about twice as often by an incongruent (dependence-supportive) than by a congruent (independence-supportive) response. Expectations of incompetence and of the helping role are offered as explanations.

Activities of Daily Living↗
PubMed1976

Medication maintenance of mentally ill patients by a pharmacist in a community setting.

The use of a community pharmacy as a facility for medication maintenance services usually provided by a mental health center was evaluated. The project pharmacist was affiliated with the community mental health center, the community pharmacy facility was borrowed for purposes of this study. Records and prepackaged medication were transported by the pharmacy-clinic. Medication histories were taken and maintained by the pharmacist. Problems such as medication noncompliance, drug side effects, drug interactions and minor alterations in the patients mental status were handled by the pharmacist. Telephone consultations with a psychiatrist were also available. Twenty-two patients were involved in the study over an eight-month period. The evaluation consisted of a patient acceptance questionnaire and a retrospective chart review analyzing the clinical response of patients. Data suggest that selected stabilized psychiatric patients can be safely maintained in the community pharmacy. A carefully structured program and a pharmacist with special competencies are felt to be prerequisites for this type of service.

Attitude↗
PubMed1992

Comparison of partial and modified radical mastectomy in the community setting--"10 years later".

Conservative surgery followed by postoperative radiation is considered equivalent to a modified radical mastectomy (MRM) for the treatment of early breast cancer. It cannot be assumed that results from selected academic centres are equivalent to those obtained in the general community setting, because there may be differences in patient selection or surgical or radiotherapy techniques that may adversely affect outcome. A quality-control study of women who were seen at the British Columbia Cancer Agency and were treated by partial mastectomy (PM) was begun in 1983. Eighty-four women who underwent conservative surgery between January 1979 and November 1982 and were referred to the British Columbia Cancer Agency were matched with 84 women who underwent MRM. The mean follow-up was 10.5 years. At 10 years disease-free survival in both groups was 63%. Survival overall for the PM group was 72.6% and for the MRM group was 69%. The survival rate decreased with increasing size of the tumour and increasing number of nodes. In women with lymph-node involvement there was a survival advantage for those treated by PM and radiation compared with those treated by MRM. The woman's age at diagnosis did not affect these findings. Recurrence and complication rates were similar in both groups, and treatment was considered equivalent.

Adult↗
PubMed1992

Laparoscopic cholecystectomy in a private community setting.

In order to evaluate early results and safety of laparoscopic cholecystectomy in community hospitals, the charts of 380 consecutive patients, scheduled between February 8 and November 28, 1990, were reviewed. There were 294 women and 86 men, with a mean age of 48 years. Forty-one patients required conversion to open cholecystectomy, for reasons including adhesions in 18 patients, intraductal filling defects in 11, marked inflammation in 6, excessive bleeding in 3, poor visualization of the operative field in 2, and gangrenous gallbladder in 1. Hospital stay (excluding patients converted to laparotomy) ranged from 0.29-18 days, with a mean of 1.4 days. Operative time ranged from 29-280 min, with a mean of 114 min. Cystic duct operative cholangiography was performed in 71% of patients. In 29%, operative cholangiography was either not performed at all or was attempted and unsuccessful, due to inability to cannulate the cystic duct. Procedure-related morbidity was 2.6%, which includes three common bile duct injuries, three intraabdominal abscesses requiring drainage, and one pneumonia. There was one death resulting from respiratory failure. Our results compare favorably with those reported in the literature. We conclude that laparoscopic cholecystectomy in community hospitals is a safe procedure in properly selected patients.

Cholangiography↗
PubMed1979

Pre-hospital coronary care in the community setting.

Technological advances have made pre-hospital coronary care programs possible for communities of all sizes. The author describes and illustrates with case reports a successful Newport News program in which physicians, hospitals, paramedics, and local government services work together.

Adolescent↗
PubMed1977

Aspects of outcome in a therapeutic community setting. How patients are seen by themselves and others.

How patients are seen by themselves and others close to them may influence the process of re-integration in the community after discharge. In a study in a psychiatric admission unit employing a therapeutic community approach, patients who sought little or no contact with the unit after discharge saw themselves, and were seen by others, as less "pleasant" but less "ill" than those who continued more regular contact. Perceptions were measured with the semantic differential technique. Patients' social class and household position were found to have a marked effect on the level of contact and on its association with how patients were seen. Diagnosis did not appear to influence hospital contact.

Adult↗
PubMed1976

Family therapy research in applied community settings.

This paper discusses family therapy research in applied settings and highlights those methodological issues relevant to the program evaluator as compared to those relevant to the basic researcher. Four general methodological issues are discussed: design adequacy, issues related to dependent measures, situational factors, and issues of generalization and duration of treatments. Two specific, well-validated applications of family therapy are elaborated; and finally several conclusions are drawn regarding future research strategies.

Behavior Therapy↗