The role of employers in community health care systems

The postoperative analgesia and sedation in cats given carprofen (4.0 mg/kg bodyweight by subcutaneous injection preoperatively) was compared to that in cats given pethidine (3.3 mg/kg bodyweight by intramuscular injection postoperatively) in a controlled, randomised, blinded, multicentre clinical trial. Further dosing with the particular analgesic was allowed if a cat was exhibiting unacceptable pain. In total, 57 carprofen cases and 59 pethidine cases were evaluated. Significantly fewer cats in the carprofen group required additional doses of analgesic, and mean pain scores were significantly lower from four hours after ovariohysterectomy, and at 18 to 24 hours after castration, compared to the pethidine group. In conclusion, carprofen provided as good a level of postoperative analgesia as pethidine, but of a longer duration (at least 24 hours) and was well tolerated. It thus provides an option for 'pre-emptive analgesia' in cats about to undergo surgery.     

Developing tomorrow's integrated community health systems: a leadership challenge for public health and primary care

As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health.     

Grass roots participation in health care reform

Concerned citizens have responded to the health care crisis by developing the health decisions movement. American Health Decisions, a national consortium of 21 state organizations, leads a grass roots discussion network of community meetings committed to education and consensus on the ethical, technologic, legal, and economic issues (the tough issues) of health policy. The movement (with its stages of development, structure, process, and accomplishments) is described, and potential roles for physician cooperation and participation in forging functional, community-based health policy are delineated.     

Providing oral health care to individuals with severe disabilities residing in the community: alternative care delivery systems

For some individuals with disabilities who reside in the community, comprehensive oral health care is inaccessible. This deficiency has been noted by health care professionals and advocacy organizations. For example, most dentists who provide care to people with disabilities who reside in the institutional setting perceive that present resources within the community, both private and public, are generally unprepared to provide comprehensive dental care to the adult with severe disabilities; they also believe that special facilities and programs are needed that will be geographically and financially accessible to these individuals. Fortunately, several "special programs" have been established that successfully provide dental care to this population. This article describes these alternative care delivery systems and discusses their characteristics, advantages, and disadvantages. In addition, given the continuing process of community placement, implications for institutional dental programs are presented.     

Coordinated systems of community-based health care delivery: a vehicle for health care reform

The need for health care reform in this country continues to be high on the public agenda. Deficits in the access of United States citizens to needed health care services continues, despite recent efforts at health care reform. In addition, the health status of children in this country is of paramount concern. Significant threats to the health of this nation's children have spurred several proposals for reducing the cost of health care while improving the quality of outcomes. A sample of these proposals is analyzed. An example of a health care program which exemplifies one such proposal for health care reform is then discussed. Findings of a recent research project that is relative to the benefits of such a program are provided.     

The influence of governmental policy on community health partnerships and community care networks: an analysis of three cases

This is a comparative analysis of hospitals' efforts in three communities to pursue collaborative ventures to advance community health. The events occurred over a two-year period characterized by increasing market competition and national debate about comprehensive health care financing reform. The study objectives are to better understand factors that contributed to the initiation of the collaborative efforts, and factors that sustained, hindered, or thwarted these efforts. The study explores how the collaborative ventures in these three communities fared in the face of multiple and conflicting policies and the simultaneous creation of larger, competing health systems. A number of concluding generalizations address the impact of interorganizational dynamics and public policy initiatives on community health partnerships.     

Creating community power in health care

With healthcare systems changing at a rapid pace and resources becoming scarcer, communities and institutions together can create new ways to provide health care and uncover previously overlooked resources. Below, what these partnerships can teach nurses about the power that can come from sharing power.     

Primary care in the community of Zero Hora: a new social approach

The authors, after reflecting about practical nursing, directed a teach-learned nursing process towards the community on a social approach, which implicates in an effective participation of the population and the sanitary authorities. Therefore, they opt for demarcation of an action area, in order to measure the results, to create social nursing necessity, nurse/patient bond and to adapt teaching and research to social reality. The goal is to identify the basics needs of the chosen village and with them establish the priorities to plan the health and educational actions in agreement with primary nursing attention. The method used in this research was a sistematic study of the families by a application form at home. The results are: 70% of the children from zero twelve years old have respiratories problems; 13% of adults use alcohol; 30% are smokers, 60% live in bad housing and sanitary conditions; 35% are illiterate, there are an excess of insects, rodents cats and dogs.     

Patient feedback at a community mental health center: Year three.

Follow-up of 99 former patients (ages ranged from 13 to over 55 yrs) at a community mental health center revealed that more than 85% felt they had been helped by therapy; that income and education variables did not influence perceived degree of help received, number of therapy sessions, or perceived interest of the counselor in the patient; and that most Ss neither sought further help nor felt that they needed it after termination. The more that Ss felt the therapists were interested in them, the more they felt helped. Results replicate those of E. Kaschak (see record 1980-23693-001). New variables included in the current study suggest that therapists may be more stringent evaluators of therapy outcome than patients. Sex of client also appeared to influence therapist's ratings, as women were considered improved more often than men. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dermatology in southwestern Ethiopia: rationale for a community approach

The objective of our follow-up study was to evaluate the success of two different types of partially prefabricated post-and-core systems following crown placement. Two hundred and thirty-seven Permador posts and 49 Radix posts were evaluated clinically. Radiological follow-up was performed for 230 Permador posts and 47 Radix posts. The restorations had been in situ for an average of 3.9 years (Permador posts) and 2.3 years (Radix posts), respectively. Root canal fillings were evaluated as to their length, their homogeneity and their flushness with the walls of the root canal. The post-and-cores were evaluated for their orientation in the root canal and for the length of the inserted post relative to the length of the root. The position of the post was classified as centric in 78.0% of the restorations followed, and eccentric in 19.5%, while 2.5% showed a root perforation. The minimal requirement that the length of the post-and-core should at least be equal to the length of the clinical crown was met in 85% of the cases. Eighteen (6.3%) of the 286 teeth examined had to be extracted. There were significant correlations between insertion periods, horizontal bone loss, length of the root canal filling, and position of the post on one hand and tooth loss on the other.     

Increased health care utilization as a function of participation in trauma research

The MR features of a 57-year-old man with multiple tendinous xanthomas are reported. The lesions of the peroneus longus tendons and the Achilles tendons showed diffuse reticulated pattern, which is the typical MR finding of tendinous xanthomas. However, the lesions of the patellar tendons showed no diffuse pattern and contained focal regions of high signal intensity on T 1-weighted images suggesting the deposition of triglycerides. The regions showed high signal intensity on T 2-weighted images and moderate enhancement on contrast-enhanced T 1-weighted images suggesting the presence of associated inflammation.     

Visiting the dentist: a behavioral community analysis of participation in a dental health screening and referral program

One-hundred and twenty-five families in the Medicaid Early Periodic Screening, Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children: (a) a control procedure, in which parents were given a dentist's name; (b) a multiple contact procedure, in which parents received a postcard and two telephone call reminders; (c) a problem-solve procedure, in which a social worker aide conducted a brief session with the parent; (d) an incentive procedure, in which parents selected among four gifts that were contingent on seeking care; (e) an incentive + problem-solve procedure, in which the latter two treatments were combined. The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures. Families assigned to the intensive strategies were most likely to complete treatment. A cost-efficiency analysis showed the multiple contact technique to be a low-cost and highly effective procedure.     

Community health centers and quality of care: a goal to provide effective health care to the community

The uniqueness of community health centers provides for a sound environment for total quality management (TQM). Structure, process, and outcome are valued equally under TQM. With strong management leadership and a framework for quality of care, community health care specialists (e.g., advanced practice nurses) can easily incorporate the TQM measurement criteria in their daily practice routines. By applying the principles of TQM, the community health center will advance toward its goal of enhancing the effectiveness of health care delivery to a community and its members in partnership with the community.     

Experience with clozapine in a community mental health care setting

BACKGROUND: Clozapine has been heralded as the first major breakthrough in antipsychotic drug therapy for treatment-resistant schizophrenia in 40 years. This study reports on the experience with clozapine in an outpatient, community mental health care setting. METHODS: All clinic patients receiving clozapine during the 4-year period 1992 to 1996 were retrospectively studied. Measures of improvement were changes in the Clinical Global Improvement (CGI) Scale and reduction in the number of hospital days after clozapine therapy. RESULTS: Testing with the CGI scale showed moderate or marked improvement in 63% of patients. Hospital days dropped from 7,919 to 1,833 for comparable time periods. Clozapine therapy had to be discontinued in only 21% of patients, and no serious side-effects occurred. CONCLUSION: Clozapine is an effective medication for treatment-resistant schizophrenia and can be safely used in chronic mental illness. Although the drug is expensive, the cost is offset by a remarkable reduction in hospital days.     

Decision support systems in health care

The systemic intraperitoneal (i.p.) administration of the adenosine A2A agonist CGS 21680 was found to dose-dependently antagonize spontaneous and amphetamine-induced (1 mg/kg i.p.) motor activity with similar ED50 values (about 0.2 mg/kg). The ratios between the ED50 values for induction of catalepsy and for antagonizing amphetamine-induced motor activity for CGS 21680, haloperidol, and clozapine were 12, 2, and > 30, respectively. Furthermore, CGS 21680 was comparably much stronger than haloperidol or clozapine at antagonizing the motor activity induced by phencyclidine (2 mg/kg subcutaneously) than motor activity induced by amphetamine (1 mg/kg i.p.). In conclusion, the present results show a clear "atypical" antipsychotic profile of the adenosine A2A agonist CGS 21680 in animal models.