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At least 667 records · Page 37Linked to original sources
PubMed2006

First-year results of a community peripheral vascular screening program at an academic community hospital.

Disease associated with the vascular system, including peripheral arterial disease, poses a serious health problem with incidence growing annually. Recognizing this, several health care organizations across the United States have developed programs for public education and community awareness, and for screening individuals at risk for vascular disease. Lehigh Valley Hospital developed and implemented a screening program that evaluated more than 160 individuals during a 12-month period. Results suggest that screening should be limited to patients at high risk; however, the intrinsic value of patient education and patient peace of mind is worth proceeding with the screening effort because patients reported a positive experience.

Aged↗
PubMed1996

Prevalence of depression among patients seen in community health centres and community mental health centres.

Depression is a common disorder in the general population. However, its prevalence among patients attending various health-care facilities is less well known. There have been very few Finnish studies of this topic. The Tampere Depression Project (TADEP) dealt with the prevalence of depression and factors associated with it in individuals seen in community health centres (CHC) and in psychiatric-service (PS) patients. The diagnosis of depression was based on a standardized Present State Examination interview and a DSM-III-R assessment, carried out on 436 CHC patients and 428 PS patients. The severity of depression was assessed using the Hamilton Rating Scale of Depression. About 10% of CHC patients and 50% of PS patients suffered from clinical depression. In addition to these, some depressive symptoms were displayed by just under 10% of subjects. Similar prevalence rates were obtained by the various methods used. The 1-year prevalence rate of clinical depression was 20% for the CHC patients and almost 60% for the PS patients. Mild depression represented the largest group. In the CHC group, depression was found more often in middle-aged and widowed subjects and in patients with a lower educational level and blue-collar workers than in others. In the PS group, depression was found more often in women, the oldest subjects and the widowed than in others.

Adolescent↗
PubMedDate not supplied

Characterizing and developing strategies for the treatment of community-acquired pneumonia at a community hospital.

BACKGROUND: Patients admitted to Lions Gate Hospital, North Vancouver, British Columbia, with a primary diagnosis of community-acquired pneumonia (CAP) have a mean length of stay (LOS) of 9.1 days compared with 7.9 days for peer group hospitals. This difference of 1.2 days results in an annual potential savings of 406 bed days and warranted an investigation into the management of CAP. OBJECTIVE: To characterize and provide recommendations for the management of CAP. METHODS: A retrospective chart review of patients admitted with a primary diagnosis of CAP between May 1, 2000 and August 31, 2000. RESULTS: Fifty-one patients were included in the study, with a mean LOS of 9.9 days and a median LOS of five days. Based on pneumonia severity index scores calculated for each patient, eight patients (16%) were admitted inappropriately. Initial empirical antibiotic choices were consistent with the Canadian CAP guidelines in 27 patients (53%), with inconsistencies arising mainly because cephalosporin or azithromycin monotherapy regimens were prescribed. Step-down from intravenous to oral antibiotics occurred in approximately 20 patients (39%). An additional 12 patients (24%) could have undergone step-down, and step-down was not applicable in 19 patients (37%). The potential annual cost avoidance from implementing admission criteria based on a pneumonia severity index score, applying step-down criteria and promoting early discharge criteria was estimated to be $220,000. CONCLUSIONS: Considerable variability exists in the treatment of CAP. A CAP preprinted order sheet was developed to address the issues identified in the present study and provide consistency in the management of CAP at Lions Gate Hospital.

Aged↗
PubMed1999

Patients who miss initial appointments in community psychiatry? A Spanish community analysis.

OBJECTIVES: To identify factors that predict which patients, when referred by their GP, make a first appointment at a Mental Health Centre and then fail to attend. METHOD: Sequential observational study in which data was collected for one year on all the people (1311) with an arranged date for an initial appointment at an urban Community Mental Health Centre. RESULTS: Approximately 25% of patients who request an initial appointment fail to attend. The variables that predict non-attendance are: the lack of a telephone number for contact, the time lapse before the appointment, and when drug-addiction is the reason for requesting the appointment. One variable that results in a specific kind of behaviour is the timing of the initial appointment, since males and females tend to miss at different times. We also found that missing the appointment followed a seasonal pattern. CONCLUSIONS: In order to optimise the service, it is necessary to discover the proportion of probable misses, and aim to arrange the appointment with the shortest possible time lapse and to take into consideration the sex of the patient when fixing the time of the interview.

Adult↗
PubMed2005

Community participation in the treatment development process using community development teams.

Little literature exists about methods for adapting research-based treatments to typical practice settings. This report describes a 2-step process and associated methods used to adapt a school-based treatment program for middle-school youth with attention deficit hyperactivity disorder (ADHD) that operates in a controlled setting to one that can operate in a typical practice setting. Step 1 included a feasibility study that yielded important findings regarding potential obstacles to successful implementation. These data, along with original treatment manuals and literature on treatments for youth with ADHD, were utilized for Step 2--the Community Development Team (CDT) process. Data collected about the CDT process indicate that its strengths outweigh potential limitations. These methods are discussed in the context of successful collaborative procedures for developing and evaluating research-based treatments in practice settings.

Adolescent↗
PubMed2000

Antimicrobial selection for hospitalized patients with presumed community-acquired pneumonia: a survey of nonteaching US community hospitals.

OBJECTIVE: To describe and evaluate empiric antimicrobial regimens chosen for hospitalized patients with presumed community-acquired pneumonia (CAP) in US hospitals, including compliance with the American Thoracic Society (ATS) guidelines. Secondary outcomes included length of stay (LOS) and mortality associated with the choice of therapy. METHODS: A nonrandomized, prospective, observational study was performed in 72 nonteaching hospitals affiliated with a national group purchasing organization. Patients with an admission diagnosis of physician-presumed CAP and an X-ray taken within 72 hours of admission were eligible for the study. Demographic, antibiotic selection, and outcomes data were collected prospectively from patient charts. RESULTS: 3035 patients were enrolled; 2963 were eligible for analysis. Compliance with the ATS guidelines was 81% in patients with nonsevere CAP. The most common antibiotic regimen used for empiric treatment was ceftriaxone alone or in combination with a macrolide (42%). The overall mortality rate was 5.5%. The addition of a macrolide to either a second- or third-generation cephalosporin or a beta-lactam/beta-lactamase inhibitor was associated with decreased mortality and reduced LOS. CONCLUSIONS: Most hospitalized patients with CAP receive antimicrobial therapy consistent with the ATS guidelines. The addition of a macrolide may be associated with improved patient outcomes.

Adolescent↗
PubMed2001

The role of community advisory boards: involving communities in the informed consent process.

Ethical research involving human subjects mandates that individual informed consent be obtained from research participants or from surrogates when participants are not able to consent for themselves. The existing requirements for informed consent assume that all study participants have personal autonomy; fully comprehend the purpose, risks, and benefits of the research; and volunteer for projects that disclose all relevant information. Yet contemporary examples of lapses in the individual informed consent process have been reported. The authors propose the use of community advisory boards, which can facilitate research by providing advice about the informed consent process and the design and implementation of research protocols. These activities could help reduce the number of individual informed consent lapses, benefiting study participants and the scientific integrity of the research in question.

Advisory Committees↗
PubMed2003

Rapid assessment of the HIV/AIDS crisis in racial and ethnic minority communities: an approach for timely community interventions.

OBJECTIVES: The US Department of Health and Human Services, in collaboration with the Congressional Black Caucus, created a new initiative to address the disproportionate ongoing HIV/AIDS crisis in racial/ethnic minority populations. METHODS: This initiative included deploying technical assistance teams through the Office of HIV/AIDS Policy. The teams introduced rapid assessment and response methodologies and trained minority communities in their use. RESULTS: The first 3 eligible cities (Detroit, Miami, and Philadelphia) focused assessments in small geographic areas, using multiple methodologies to obtain data. CONCLUSIONS: Data from the first 3 eligible cities provided critical information about changing the dynamics of the HIV/AIDS epidemic at the local level, including program and policy changes and infrastructure redeployment targeted at the most serious social and environmental conditions.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Should third-generation cephalosporins be the empirical treatment of choice for severe community-acquired pneumonia in adults?

The choice of empirical treatment for community-acquired pneumonia (CAP) is highly controversial. Our survey of 42 Australian emergency department doctors showed that monotherapy with a third-generation cephalosporin was the preferred regimen for severe CAP (14/42; 33%). We argue that cheaper regimens with a narrower spectrum are likely to be just as effective as third-generation cephalosporins and will have fewer adverse effects on the microbial ecology of hospitals. We suggest penicillin or ampicillin (to cover pneumococci--even if penicillin "resistant"--and Haemophilus influenzae), plus a macrolide (e.g., azithromycin or erythromycin; to cover Legionella and other "atypical" pathogens), plus a single large dose of an aminoglycoside (e.g., gentamicin; to cover gram-negative bacilli such as Klebsiella pneumoniae) as empirical therapy for severe CAP.

Adult↗
PubMedDate not supplied

Revisiting the concepts of community care and community health nursing.

As care moves away from hospital settings, continual re-evaluation of community nursing and health care is essential for the wellbeing of patients. With the approach of the year 2000, Jean Clarke examines World Health Organization objectives, particularly in light of the Health for All (1998) policy.

Community Health Nursing↗
PubMed1995

[Community management needs a community that cares--the attitude of the population to psychiatric management and psychiatric patients].

Since community mental health care started public attitudes towards mentally ill and mental health care had been development to an important influencing factor in planning mental health care and in rehabilitation of patients. This paper describes the historical development of research in public attitudes in psychiatry, which started with deinstitutionalization. It discusses the interaction between types and quality of mental health care and public opinions or attitudes towards the care of mentally ill patients, considering own empirical results.

Community Mental Health Services↗
PubMed1997

[Community psychiatric treatment and needs of admission of psychiatric patients. A controlled study 5 years after introduction of a community psychiatric center].

The utilization of the psychiatric in-patient services was evaluated in the intervention district and compared with a selected control district. The number of admissions and in-patient days were similar before admission to the community psychiatric service. As a result of the intervention the number of admissions to hospital and the length of in-patient hospital stay decreased significantly, resulting in a reduction of total number of in-patient days by 47%. The findings of other recent studies follow the same pattern. The reduction in in-patient days was significant in the group of schizophrenic patients.

Adult↗
PubMed1998

Community-based mental health care: bridging the gap between community care and primary care.

Australian nursing is undergoing major changes in practice, education and research in a climate of burgeoning health-care costs, and changing priorities and service directions. The government is searching for new ways to deliver services that are appropriate and equitable while focusing on containing costs. These are signs that it is an opportune time for nurses to test new roles, and one suggested way to provide extra cost-effective service is through the use of nurse practitioners. In order to improve the delivery of mental health services, the nurse practitioner specializing in mental health can provide a link between the community and the primary care provided by general practitioners. A proposed model for nurse practitioners in mental health is presented as a means of bridging this gap.

Community Health Nursing↗
PubMed1976

The nature and correlates of community mental health ideology in community mental health centers.

Five hundred ninety-five staff at 20 CMHCs were surveyed as part of a large study of mental health worker roles. Data on the endorsement of the ideology of community mental health (CMHI) were obtained. Significant associations were found between ideology and level of education and time allocated to Direct and Indirect Services. Different patterns were noted when specific occupations were considered. Significant associations were also found between CMHI and organizational personal role and role discrepancy. Significant increments in the variance associated with CMHI were accounted for by personal role definition and time spent in Direct and Indirect Services. The absolute level of CMHI among staff was not high. The extent to which CMHCs are carrying out the ideology and the implications of this for the future of the movement is questioned.

Attitude of Health Personnel↗
PubMed1997

Copenhagen Community Psychiatric Project (CCPP): characteristics and treatment of homeless patients in the psychiatric services after introduction of community mental health centres.

The main purpose of the study was to describe the characteristics of homeless psychiatric patients, and to compare the treatment they are offered to that offered to domiciled patients by the psychiatric services. Another purpose was to analyse the prevalence of homelessness among psychiatric patients before and after the introduction of community mental health centres in Copenhagen. Cross-sectional studies were conducted in two intervention and two control districts before and after introduction of the new treatment modalities. In 1991, 80 of 1008 patients (8%) were homeless. Male sex, young age, living on general welfare, schizophrenia and alcohol or substance abuse were the factors that most markedly differentiated homeless from domiciled patients. Compared with the treatment of domiciled patients, the homeless were more likely to be offered no further treatment after consultation in a psychiatric emergency and, if admitted, they were more likely to be placed in locked wards, given compulsory medication, and medicated with depot neuroleptics. The homeless were also less likely to be offered psychotherapy and consultation with a social worker. Schizophrenia and alcohol or substance abuse characterised the majority of the patients discharged homeless. In the intervention districts, the number of homeless patients in contact with the psychiatric services was found to increase at the same rate as the number of all patients in contact with the psychiatric services. In the control districts, no changes in prevalence of homeless patients or other patients in contact with the psychiatric services occurred. It is concluded that homeless psychiatric patients comprise a difficult patient group, with problems of schizophrenia, substance abuse and lack of motivation for treatment. It is recommended that special efforts be made to create housing facilities that fit the needs of different types of homeless patients, and that the homeless mentally ill are assisted in obtaining and maintaining an acceptable housing situation.

Adolescent↗
PubMed1975

Training the secretary in community mental health: a second model for integrating secretaries into the therapeutic team in community mental health.

The secretaries in community mental health centers have functions that transcend their job descriptions. Their performance of these functions contributes to the success or failure of their centers' therapeutic programs. The Mental Health Training Institute of North Carolina initiated two separate pilot training programs within 1971-1972, aimed at heightening the secretaries' appreciation of their role within their centers and at facilitating their integration into the therapeutic team. This paper is a discussion of the second of these two programs.

Community Mental Health Services↗
PubMed2006

Does cognition predict community function only in schizophrenia?: a study of schizophrenia patients, bipolar affective disorder patients, and community control subjects.

Cognitive deficits predict functioning in schizophrenia; however, little is known as to whether the association is present in other mental disorders. If specific cognitive deficits uniquely predict functional impairment in schizophrenia the association of select aspects of brain dysfunction with daily living would suggest an intervention target and perhaps a means by which to improve the functioning of schizophrenia patients. The relationship of cognition and functioning was investigated in schizophrenia (n=39), bipolar affective disorder (n=27), and nonpsychiatric control (n=38) participants to determine whether the associations varied across groups. We examined verbal memory, verbal learning, verbal fluency, vigilance, executive functioning, symptomatology, and generalized cognitive functioning for associations with social function. Correlational analyses revealed particular cognitive domains (e.g., verbal memory) to be associated with social functioning in schizophrenia, bipolar, and control subjects; however generalized cognitive function and symptomatology were also associated with social functioning in patients. Multiple regression analyses revealed that in schizophrenia poor verbal memory predicted worse social functioning even after the effects of generalized cognitive dysfunction were considered. Verbal memory indices failed to account for variance in social function in bipolar patients and control subjects after consideration of generalized cognitive function. Bipolar patients with worse planning and problem solving tended to have worse social functioning. Therefore, unlike schizophrenia patients who may fail to process verbally mediated material, bipolar patients' difficulty with logical approaches to problems in daily living may have the greatest impact on their community function.

Adult↗
PubMedDate not supplied

Community-based nursing versus community health nursing: what does it all mean?

These are exciting times in nursing, with great possibilities for reforming nursing as we now know it. The desired outcome is to improve any nurse's ability to care for individuals, families, and communities wherever they are. We believe that articulating CBN and CHN practice is a necessary first step in achieving this outcome; however, it now becomes our challenge to advance this vision. We ask you to join us in this endeavor.

Clinical Competence↗