Community-engaged healthcare model for currently under-served individuals involved in the healthcare system.

In the US, many people are excluded from healthcare structures and systems, due to multiple macro and micro factors. Poverty, health ecosystems, mental health, and community amenities are some of the issues confronting those who are not able to access appropriate support. This population is often referred to as 'high needs, high cost' (HNHC), a term that has been applied to refer to people who repeatedly utilize services without significant benefit (we have replaced this term with 'currently under-served'; C-US). For many traditional health solutions may not address the fundamental issues confronting their health. Community-Engaged Healthcare (CEH) is an approach that equips members of the community to levy power to advocate for their own health or social solutions, designing their own interventions to address needs with support from health providers. A realist review was conducted to identify the existing literature around CEH. This yielded ten papers that were reviewed by at least two authors and rated in terms of quality. A model describing the processes underpinning CEH was then iteratively generated, resulting in additional terms that were used in a second review of the literature. A further 16 peer-reviewed articles were identified and were independently reviewed and quality rated. These articles were used to refine further iterations of the model and included in the review where appropriate. The resulting model schematically posits a set of relational factors identified to be important in the establishment of CEH. Notably, the transfer of autonomy and power over health decision-making processes is emphasized, which will require revolutionary thinking about how healthcare is delivered for patients.

Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole.

BACKGROUND: The prevalence of onychomycosis, the most frequent cause of nail disease, ranges from 2% to 13%. Standard treatments include debridement, topical medications, and systemic therapies. This study assesses the efficacy and tolerability of topical application of 1% clotrimazole solution compared with that of 100% Melaleuca alternifolia (tea tree) oil for the treatment of toenail onychomycosis. METHODS: A double-blind, multicenter, randomized controlled trial was performed at two primary care health and residency training centers and one private podiatrist's office. The participants included 117 patients with distal subungual onychomycosis proven by culture. Patients received twice-daily application of either 1% clotrimazole (CL) solution or 100% tea tree (TT) oil for 6 months. Debridement and clinical assessment were performed at 0, 1, 3, and 6 months. Cultures were obtained at 0 and 6 months. Each patient's subjective assessment was also obtained 3 months after the conclusion of therapy. RESULTS: The baseline characteristics of the treatment groups did not differ significantly. After 6 months of therapy, the two treatment groups were comparable based on culture cure (CL = 11%, TT = 18%) and clinical assessment documenting partial or full resolution (CL = 61%, TT = 60%). Three months later, about one half of each group reported continued improvement or resolution (CL = 55%; TT = 56%). CONCLUSIONS: All current therapies have high recurrence rates. Oral therapy has the added disadvantages of high cost and potentially serious adverse effects. Topical therapy, including the two preparations presented in this paper, provide improvement in nail appearance and symptomatology. The use of a topical preparation in conjunction with debridement is an appropriate initial treatment strategy.

Non-Hodgkin lymphoma of the ureter: CT demonstration with pathologic correlation.

A case of a 42-year-old man with non-Hodgkin lymphoma of the ureter is reported. Diffuse lymphomatous infiltration of the ureter occurs rarely and is an uncommon cause of ureteral obstruction. Imaging-pathologic correlation is presented with CT images and autopsy specimens.

Point prevalence of tuberculosis among central Americans sheltered in Houston.

A study to determine the point prevalence of tuberculosis, as defined by a positive tuberculin skin test, was conducted among the inhabitants of a Central American shelter. The point prevalence was found to be 50% (17/34). This high point prevalence demonstrates the need to test Hispanics who have recently arrived in the United States for tuberculosis. The difficulty in completing evaluations of those with positive skin tests makes tuberculin skin testing ineffective in controlling tuberculosis in this population and setting. To improve control, local, state, and federal health agencies will need to coordinate their efforts and increase the accessibility of health care to populations at high risk.

Autologous bone marrow transplantation following high-dose busulfan and VP-16 for advanced non-Hodgkin's lymphoma and Hodgkin's disease.

Ten patients with non-Hodgkin's lymphoma (NHL) and nine with Hodgkin's Disease (HD) received high-dose busulfan and etoposide (VP-16) prior to autologous bone marrow transplantation (ABMT). All patients with NHL and eight with HD had poor prognostic factors. Marrows from patients with NHL were purged with 4-hydroperoxy-cyclophosphamide. Busulfan (16 mg/kg body weight) was given orally over 4 days; VP-16 was administered as a single 4-h infusion. VP-16 was initiated at a dose of 60 mg/kg but reduced to 50 mg/kg after three of the first seven patients developed fatal toxicity. The 100-day regimen-related mortality was 21% (95% confidence interval 14%-46%). An absolute neutrophil count of 500/microliters was achieved at a median of 18 days in NHL and 23 days in HD. The median time to achieve a platelet count of 50,000/microliters was slower in HD (100 days) than in NHL (31 days) (p less than 0.05). Complete remissions were documented in four of nine evaluable patients with NHL and two of eight evaluable patients with HD. Actuarial survival at 18 months was 21% (95% confidence interval 3%-39%). The combination of high-dose VP-16 and busulfan as used in this study, although comparable to other regimens in efficacy, is associated with several toxicities.