Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting

We evaluated blood pressure control, quality of life, quality of care, and satisfaction of patients who were monitored by specially trained community pharmacists in a group medical practice. After participating in an intensive skill development program, pharmacists performed in an interdisciplinary team in a rural clinic. The primary objective was assessed by evaluating outcome variables at 6 months compared with baseline in 25 patients randomly assigned to a study group. A control group of 26 patients was also evaluated to determine if outcome variables remained constant from baseline to 6 months. Systolic blood pressure was reduced in the study group (151 mm Hg baseline, 140 mm Hg at 6 mo, p<0.001) and diastolic blood pressure was significantly lower at 2, 4, and 5 months compared with baseline. Ratings from a blinded peer review panel indicated significant improvement in the appropriateness of the blood pressure regimen, going from 8.7 +/- 4.7 to 10.9 +/- 4.5 in the study group (p<0.01), but they did not change in the control group. Several quality of life scores improved significantly in the study group after 6 months (p<0.05). These included physical functioning (61.6 vs 70.7), physical role limitations (56.8 vs 72.8), and bodily pain (60.0 vs 71.7) at baseline and 6 months, respectively. There were no significant changes in the control group. Patient satisfaction scores were consistently higher in the study group at the end of the study. Our results indicate that when community pharmacists in a clinic setting are trained and included as members of the primary care team, significant improvements in blood pressure control, quality of life, and patient satisfaction can be achieved.     

The effectiveness of functional family therapy for youth with behavioral problems in a community practice setting.

The study examined the effectiveness of Functional Family Therapy (FFT), as compared to probation services, in a community juvenile justice setting 12 months posttreatment. The study also provides specific insight into the interactive effects of therapist model specific adherence and measures of youth risk and protective factors on behavioral outcomes for a diverse group of adolescents. The findings suggest that FFT was effective in reducing youth behavioral problems, although only when the therapists adhered to the treatment model. High-adherent therapists delivering FFT had a statistically significant reduction of (35%) in felony, a (30%) violent crime, and a marginally significant reduction (21%) in misdemeanor recidivisms, as compared to the control condition. The results represent a significant reduction in serious crimes 1 year after treatment, when delivered by a model adherent therapist. The low-adherent therapists were significantly higher than the control group in recidivism rates. There was an interaction effect between youth risk level and therapist adherence demonstrating that the most difficult families (those with high peer and family risk) had a higher likelihood of successful outcomes when their therapist demonstrated model-specific adherence. These results are discussed within the context of the need and importance of measuring and accounting for model specific adherence in the evaluation of community-based replications of evidence-based family therapy models like FFT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pygmalion goes to work: The effects of supervisor expectations in a retail setting.

The extent to which the Pygmalion effect occurs in a work organization was investigated. In this study, which took place over a 3-month period in a retail setting, the relationship between a supervisor's expectations of a subordinate and the resulting performance of the subordinate was investigated. Ss included newly hired sales associates and their first-level sales managers. The results revealed little evidence of the Pygmalion effect in the overall sample. However, the results indicate that the Pygmalion effect may have been more operative among men than among women. Although previous research has provided ample evidence of the Pygmalion effect in educational and military settings, this study's lack of significant findings suggests that the process through which supervisory expectations are translated into changes in subordinate behavior is considerably more complex than has been commonly believed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward reflective practice: A multicultural competence training model from a community mental health center.

Despite the importance of multicultural competence in clinical practice and training, there is a surprising dearth of innovative training models from fieldwork sites that would be replicable in other practicum settings. The authors illustrate a multicultural competence training model from a community mental health center that highlights the Guidelines on Multicultural Education, Training, Research, Practice, and Organization Change for Psychologists (American Psychological Association, 2003). The model focuses on providing multicultural training through two separate but linked training teams for the dual purposes of internal reflection and reflective practice. The authors conclude with a discussion of the implications of this training model for practice, research, and organizational change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The reciprocal effects of science on practice: Insights from the practice and science of goal setting.

The hypothesis of this paper is that the science and practice of psychology are interdependent. Science drives practice which drives science. The science and practice of 25 years of programmatic research on goal setting theory in industrial-organizational psychology (I/O) is used in support of this hypothesis. I/O research on goal setting includes findings that (1) high goals lead to higher performance; (2) there is a linear relationship between goal difficulty and performance; (3) variables such as feedback, participative decision making, and competition affect performance to the extent that they lead to the setting of and commitment to high goals; and (4) mediators of goal setting are motivational and cognitive, with other variables mediating the effects of goals on performance in I/O settings. Scientists, practitioners, and scientist–practitioners alike are encouraged to work in unison in order to advance psychology for all. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching and counselling behaviour: an applied study with community pharmacists

Continuing education aims at improving practice. In this article, three main research questions are addressed: Which methodology is optimal to improve counselling behaviour? Are learning outcomes influenced by learning style? Does knowing imply doing? Four educational methods, transferring information on cough medicines, are assessed: a lecture, an interactive workshop, an audiocassette and a textbook. Attendants of the first three methods also received the textbook. Pharmacists completed a learning-style inventory in addition to a pretest. After the instruction phase, they were interviewed by telephone (post-test). We also evaluated the counseling behaviour by an 'incognito' visit to participants as well as to controls. Seventy-eight pharmacists participated. Their learning-style cannot be related to the results of pre- or posttest. Each educational method improved the level of knowledge significantly, but none of them proved to be better than the others. The pharmacists who in addition read the textbook, acquired more knowledge than those who did not. Self-study at home led to more fundamental rather than practical knowledge. Improving knowledge does not result in better counselling: 75% of the pharmacists asked only one question, especially concerning the type of cough. However 9 out of 10 mentioned how to use the drug. About half of the pharmacists told the patient about the action of the medicine. Other items were hardly ever mentioned. There was no difference in counselling behaviour between the intervention group and a group of pharmacists who did not attend the course. This investigation does not reveal any particular method of in-service training as being more efficient. Active use of self-study materials helps to improve pharmacological knowledge. Implementing educational strategies to improve counselling behaviour remains a future aim.     

Preventing Halloween arson in an urban setting: a model for multisectoral planning and community participation

Arson is a violent crime and a public health problem that causes injuries and deaths, destroys homes, and destabilizes neighborhoods. During the late 1970s, pre-Halloween pranks in Detroit, Michigan, turned destructive when hundreds of fires were set deliberately throughout the city; in 1984, a record of 810 fires were set during the Halloween period. In 1985, a city wide anti-arson campaign that involved the mobilization and training of thousands of community volunteers was begun in Detroit. This report describes the multiple components of the anti-arson intervention from 1985 through 1996 and changes in the incidence of Halloween fires. Both the decrease in annual Halloween arson fires after the intervention began and the inverse relationship between the number of volunteers and the number of fires suggest a causal effect. This study illustrates the capacity of an urban community to mobilize its residents and stakeholders, the importance of community participation and multisectoral partnerships in program planning and implementation, and the challenges faced in retrospectively evaluating an apparently successful, complex, community-based intervention.     

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.     

Reliability of the pretransfusion bedside compatibility test: association with transfusion practice and training

BACKGROUND: The utility of a pretransfusion bedside blood compatibility protocol to decrease immunohemolytic accidents has been questioned for years. STUDY DESIGN AND METHODS: The reliability of a standard bedside ABO compatibility test was evaluated with a stratified random sample of 48 nurses who performed agglutination testing by using Bristol cards, interpreted compatibility, and decided whether to transfuse red cells for 12 randomly and blindly selected donor-and-recipient blood sample pairs. An expert judged technical performance and the interpretation of each card. RESULTS: Erroneous decisions occurred in 18.2 percent of 576 tests, including 12 decisions to transfuse incompatible blood. Errors involved both testing protocols and the interpretation of compatibility. Anti-A and anti-B were detected with 92.8-percent sensitivity and 95.9-percent specificity. The expert judged 17.7 percent of tests to be technically inadequate, most often because of the application of excess blood to the card and a lack of rotation of the card. Testing errors (16.1% of tests) were significantly linked to infrequent transfusion activity by the nursing service, inexperience, and insufficient training. Compatibility misinterpretation occurred in 14.6 percent of the tests and was significantly linked to the nurses' infrequent transfusion activity, inexperience, insufficient training, lack of practical experience, and confusion regarding the use of ABO-compatible but not identical blood. CONCLUSION: Bedside pretransfusion compatibility determination should not be considered a reliable supplemental safety procedure in the hands of inexperienced and insufficiently trained operators.     

Community psychiatric nursing: promoting health in a community setting

With the development of care in the community, some mental health nurses have adopted approaches focused on health. This article explores one model of this approach which is aimed at secondary and tertiary health promotion in a community setting.     

Cardiovascular risk reduction in a community setting: some comments

Four case reports are presented of patients who ate the meat of a hog inadvertently fed seed treated with fungicides containing ethyl mercury chloride. The clinical, electrophysiological, and toxicological, and in two of the patients the pathological data, showed that this organic mercury compound has a very high toxicity not only for the brain, but also for the spinal motoneurones, peripheral nerves, skeletal muscles, and myocardium.     

Persistence of stimulus-response compatibility effects with extended practice.

The influence of extended practice on stimulus–response (S–R) compatibility effects was investigated. Three experiments, each extending over a period of 8 sessions, were conducted. The nature and degree of compatibility were manipulated across experiments. In all experiments, a persistent effect of S–R compatibility on reaction times (RTs) was observed. Thus, the lower bound for RTs appears to be less for compatible assignments than for incompatible assignments. This persistence of S–R compatibility indicates that the initial codings used to perform a novel task continue to exert an influence on later performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The practice of dynamic pscyhotherapy in a circumscribed community

The paper describes the changes produced in the practice of dynamic psychotherapy when conducted within a circumscribed region. The authors discuss changes in anonymity, roles, and transference relationships for both therapist and patient. The paper demonstrates these effects on the therapist's professional training, his practice, and his family.     

Quality of life assessment by community pharmacists: an exploratory study

MtDNA sequencing was used to investigate the genetic population structure of Litoria pearsoniana, a wet forest-restricted hylid frog, endemic to southeast Queensland and northeast New South Wales, Australia. L. pearsoniana is regarded as endangered under Queensland legislation. Significant genetic divergence among populations of frogs from different rainforest isolates was identified, but the lack of reciprocal monophyly among adjacent isolates suggests this is the result of a relatively recent disruption to gene flow. A paired catchment study within a single rainforest isolate, the Conondale Range, revealed no substantial genetic structuring, indicating the occurrence of terrestrial dispersal among nearby streams either in the recent past or currently. Two major reciprocally monophyletic clades of mtDNA alleles were identified. These corresponded to two geographical regions separated by the Brisbane River valley; one consisting of the Conondale and D'Aguilar Ranges, and the other of the southern isolates in the Main, Border and Gibraltar Ranges. Sequence divergence between the two regions was more consistent with a late Miocene or Pliocene rather than late Pleistocene separation, and is similar to that found among phylogeographic divisions of rainforest reptiles and amphibians in north Queensland rainforests. The molecular evidence for long-term separation of these two regions is corroborated by the pattern of species turnover in the distributions of species of rainforest-restricted amphibians and reptiles. Bioclimatic modelling suggests that appropriate conditions for L. pearsoniana would have been restricted to isolated refugees in each phylogeographic division under cooler and drier climates, such as predicted for the last glacial maximum. Currently isolated montane areas may have been connected transiently during the past 2000 years. Identification of long-term zoogeographic divisions among southeast Queensland rainforest herpetofauna has important implications for conservation and management. Conservation management of L. pearsoniana should be applied at the scale of major rainforest isolates and the conservation status of the species should be assessed independently north and south of the historical division.     

The professional psychologist as evaluator in a community agency setting.

Describes a process evaluation of an industrial work unit for persons with disabilities and comments on the role of the psychologist as evaluator in an agency of this type. The relationship of process evaluation to other aspects of evaluation is discussed, and reasons are offered for establishing aims before embarking on an outcome evaluation. Suggestions are offered for ways of using ranked aims in every phase of the evaluation, and steps to facilitate the implementation of evaluation results are outlined. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The chief of nursing practice: a model for nursing leadership

The role and structure of the Canadian Health Care System and its facilities are changing rapidly. Regionalization, decentralization, and flattening of hierarchical structures have occurred in governments and institutions. Traditional management roles, including the Vice President/Director of Nursing have been eliminated. There is a need to create a new model of nursing leadership if nurses are to continue to provide quality patient care. This article describes the initiative at Women's College Hospital to meet the expressed needs of nurses by developing a unique nursing role. The development of the chief of nursing practice role is defined within the context of the changing environment and Kanter's theory of empowerment. The position of the chief of nursing practice is a role model for nursing leadership and one that is pivotal for the professional identity of nursing, and for the provision of high quality patient care.     

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.     

Comprehensive clinical assessment in community setting: applicability of the MDS-HC

A cohort of 759 coronary artery bypass grafting (CABG) patients (269 women and 490 men) was enrolled in the prospective POST CABG Biobehavioral Study at 5 clinical centers in the United States and Canada. Sociodemographic and medical data were obtained by interview and from medical charts. Health-related quality of life and psychosocial data were ascertained preoperatively by interview and questionnaire for those patients whose condition allowed preoperative assessment and was compared among patients from hospitals enrolling both male and female patients (143 women and 267 men). Women enrolled in the Biobehavioral Study were older than men (65.4 +/- 9.0 vs 61.8 +/- 9.7 years, p < 0.001) and more likely to have a preoperative medical condition which precluded biobehavioral evaluation (47% vs 34%, p < 0.001). Women were less likely to be high school graduates (59% vs 74%, p < 0.001), were less likely to be earning > or = $25,000 per year (39% vs 69%, p < 0.001), and were married less often at the time of surgery (59% vs 85%, p < 0.001). Fewer women than men were able to perform basic self-care activities (p < 0.001) and social activities (p < 0.001). Women were also less able to perform the more demanding activities required for independent living, recreation, and maintaining a household (p < 0.001). Women were also more anxious (p = 0.01) and reported more depressive symptoms (p < 0.001) than men. These data suggest that plans for perioperative and convalescent care for women undergoing CABG should take into account their less favorable medical and psychosocial status relative to men.