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A six-week double-blind randomized cross-over trial comparing the safety and efficacy of 250 mg naproxen administered twice daily and 500 mg naproxen administered as a single dose at night in osteoarthritic patients stabilized on naproxen 250 mg twice daily is reported. There was no significant difference between the two regimens. This study provides evidence that naproxen can be given to patients with osteoarthritis on a single-daily-dose regimen without any loss of anti-inflammatory/analgesic activity.

AMONG the many problems which must A be solved in providing adequate care to long-term patients in the acute hospital and in the community is that of placement in an appropriate level of care. These patients do not, as has been assumed by many, automatically find the appropriate setting. Placement is too often "by chance, not by choice." In the long-term care institution, a related problem is the expeditious movement of patients to a new level of care as their needs change. Finding a solution to these problems is crucial, both for the patient who needs the care and for the community which pays the bills. This paper reports the development of a program directed toward solving these problems. This requires defining and evaluating the patient's needs for care; planning to meet these needs; and placing the patient in a care setting appropriate to these needs. A Department of Community Medicine in a 1,600-bed chronic disease institution in New York City has developed policies, procedures, methods, and staff to evaluate the needs of long-term patients in municipal acute general hospitals, recommend a plan for their future care, and place those patients who require the services of the chronic hospital. The Department of Community Medicine operates a field program in three acute hospitals serving East Harlem, Central Harlem, and South Bronx. A public health nurse consultant from the Center for Chronic Disease regularly visits each hospital once or twice a week. She seeks out and interviews members of the medical staff, and discusses patients apparently needing long-term care. From the physician, from the medical record, and from the head nurse she obtains and records significant medical information about each patient. She then evaluates the patient's functional status and the nursing care needs and records this information. Obviously, a program of this type calls for considerable experience, skill, and aptitudes on the part of the public health nurse consultant. She must have the ability to develop a good working relationship with a large and diverse group of physicians and nurses in the acute hospital while continuing to give paramount consideration to the needs of the patient. A social service case aide, also from the Center for Chronic Disease, interviews the patient, the family if available, and the hospital social service personnel to obtain and record significant information about social needs, social function prior to admission to the acute hospital, and social needs and potential for care, either in an institution or in the community.