Patient-centered medical home technology effects on hypertension and diabetes control

Background: Hypertension and Diabetes is a public health and economic concern in the United States. The utilization of medical home concepts increases the receipt of preventive services, however, do they also increase adherence to treatments? This study examined the effect of patient-centered medical home technologies such as the electronic health record, clinical support system, and web-based care management in improving health outcomes related to hypertension and diabetes. Methods: A systematic review of the literature used a best evidence synthesis approach to address the general question " Do patient-centered medical home technologies have an effect of diabetes and hypertension treatment?" This was followed by an evaluation of specific examples of the technologies utilized such as computer-assisted recommendations and web-based care management provided by the patient's electronic health record. Ebsco host, Ovid host, and Google Scholar were the databases used to conduct the literature search. Results: The initial search identified over 25 studies based on content and quality that implemented technology interventions to improve communication between provider and patient. After further assessing the articles for risk of bias and study design, 13 randomized controlled studies were chosen. All of the studies chosen were conducted in various primary care settings in both private practices and hospitals between the years 2000 and 2007. The sample sizes of the studies ranged from 42 to 2924 participants. The mean age for all of the studies ranged from 56 to 71 years. The percent women in the studies ranged from one to 78 percent. Over one-third of the studies did not provide the racial composition of the participants. For the seven studies that did provide information about the ethnic composition, 64% of the intervention participants were White. All of the studies utilized some type of web-based or computer-based communication to manage hypertension or diabetes care. Findings on outcomes were mixed, with nine out of 13 studies showing no significant effect on outcomes examined, and four of the studies showing significant and positive impact on health outcomes related to hypertension or diabetes Conclusion: Although the technologies improved patient and provider satisfaction, the outcomes measures such as blood pressure control and glucose control were inconclusive. Further research is needed with diverse ethnic and SES population to investigate the role of patient-centered technologies on hypertension and diabetes control. Also, further research is needed to investigate the effects of innovative medical home technologies that can be used by both patients and providers to increase quality of communication concerning adherence to treatments.^

Las expresiones motrices y la construcción de ciudadanía : Una reflexión desde las experiencias significativas

Con esta presentación he buscado sustentar la función significativa que cumplen las Expresiones Motrices en la configuración de derechos ciudadanos que se manifiestan en identidad,interacción, inclusión, interculturalidad, visibilización, vinculación, democracia, respeto, resistencia, arraigo, diferencia, autonomía, transformación. Para ello he abordado la ciudadanía como ese rasgo sustantivo de la estructura social y cultural que permite el reconocimiento de los derechos diferenciados en función de la pertenencia al grupo, en la tensión autonomía-democracia. Una suerte de insistencia en la búsqueda del bien común, en el sentido de lo público y en la protección del sentido propio. A partir de la evidencia recabada a lo largo de mi historia profesional, denominada aquí "experiencia significativa", intento dar cuenta de los derechos ciudadanos que se promueven en las Expresiones Motrices, de ahí la referencia permanente a prácticas y producciones personales

Las expresiones motrices y la construcción de ciudadanía : Una reflexión desde las experiencias significativas

Con esta presentación he buscado sustentar la función significativa que cumplen las Expresiones Motrices en la configuración de derechos ciudadanos que se manifiestan en identidad,interacción, inclusión, interculturalidad, visibilización, vinculación, democracia, respeto, resistencia, arraigo, diferencia, autonomía, transformación. Para ello he abordado la ciudadanía como ese rasgo sustantivo de la estructura social y cultural que permite el reconocimiento de los derechos diferenciados en función de la pertenencia al grupo, en la tensión autonomía-democracia. Una suerte de insistencia en la búsqueda del bien común, en el sentido de lo público y en la protección del sentido propio. A partir de la evidencia recabada a lo largo de mi historia profesional, denominada aquí "experiencia significativa", intento dar cuenta de los derechos ciudadanos que se promueven en las Expresiones Motrices, de ahí la referencia permanente a prácticas y producciones personales

Las expresiones motrices y la construcción de ciudadanía : Una reflexión desde las experiencias significativas

Con esta presentación he buscado sustentar la función significativa que cumplen las Expresiones Motrices en la configuración de derechos ciudadanos que se manifiestan en identidad,interacción, inclusión, interculturalidad, visibilización, vinculación, democracia, respeto, resistencia, arraigo, diferencia, autonomía, transformación. Para ello he abordado la ciudadanía como ese rasgo sustantivo de la estructura social y cultural que permite el reconocimiento de los derechos diferenciados en función de la pertenencia al grupo, en la tensión autonomía-democracia. Una suerte de insistencia en la búsqueda del bien común, en el sentido de lo público y en la protección del sentido propio. A partir de la evidencia recabada a lo largo de mi historia profesional, denominada aquí "experiencia significativa", intento dar cuenta de los derechos ciudadanos que se promueven en las Expresiones Motrices, de ahí la referencia permanente a prácticas y producciones personales

Examining the Complex Relationships of Early Intervention on Language and Psychosocial Development in Families Facing Multiple Risks with a Focus on Children of Hispanic Immigrants

Abundant research has shown that poverty has negative influences on young child academic and psychosocial development, and unfortunately, disparities in school readiness between low and high income children can be seen as early the first year of life. The largest federal early care and education intervention for these vulnerable children is Early Head Start (EHS). To diminish these disparate child outcomes, EHS seeks to provide community based flexible programming for infants and toddlers and their families. Given how relatively recent these programs have been offered, little is known about the nuances of how EHS impacts infant and toddler language and psychosocial development. Using a framework of Community Based Participatory Research (CBPR) this paper had 5 goals: 1) to characterize the associations between domain specific and cumulative risk and child outcomes 2) to validate and explore these risk-outcome associations separately for Children of Hispanic immigrants (COHIs), 3) to explore relationships among family characteristics, multiple environmental factors, and dosage patterns in different EHS program types, 4) to examine the relationship between EHS dosage and child outcomes, and 5) to examine how EHS compliance impacts child internalizing and externalizing behaviors and emerging language abilities. Results of the current study showed that risks were differentially related to child outcomes. Poor maternal mental health was related to child internalizing and externalizing behaviors, but not related to emerging child language skills. Although child language skills were not related to maternal mental health, they were related to economic hardship. Additionally, parent level Spanish use and heritage orientation were associated with positive child outcomes. Results also showed that these relationships differed when COHIs and children with native-born parents were examined separately. Further, unique patterns emerged for EHS program use, for example families who participated in home-based care were less likely to comply with EHS attendance requirements. These findings provide tangible suggestions for EHS stakeholders: namely, the need to develop effective programming that targets engagement for diverse families enrolled in EHS programs.

Incidencia e influencia de las políticas en el cambio social: responsabilidad de las trabajadoras sociales e implicaciones para su educación teórica y práctica

La incidencia en las políticas sociales es una importante función profesional de las trabajadoras sociales que precisa ser integrada en la educación teórica y práctica en Trabajo Social. Este artículo indaga sobre los fundamentos de esta función de incidencia en los cambios sociales promoviendo políticas sociales que reconozcan los derechos humanos. Partiendo de los referentes internacionales del trabajo social, se analiza el caso de España teniendo en cuenta los códigos deontológicos, los planes de estudio en Trabajo Social, la práctica profesional y los nuevos Grados en Trabajo Social. Se concluye planteando interrogantes sobre el grado de responsabilidad y de implicación de las universidades y Colegios profesionales en coherencia con los principios y valores del Trabajo Social.

The vacuous concept of dignity

Rights talk dominates contemporary moral discourse. It is also having a growing impact on the development of legal principle and doctrine. One of the best known general arguments in support of rights-based moral theories is the one given by John Rawls, who claims that only rights-based theories take seriously the distinction between human beings; only they can be counted on to protect certain rights and interests that are so paramount that they are beyond the demands of net happiness (Rawls 1971). Charges and assertions of this nature have been extremely influential. After the Second World War, there was an immense increase in rights talk, both in the sheer volume of that talk and in the number of supposed rights being claimed. Rights doctrine has progressed a long way since its original modest aim of providing “a legitimization of … claims against tyrannical or exploiting regimes” (Benn 1978: 61). As Tom Campbell points out: The human rights movement is based on the need for a counter-ideology to combat the abuses and misuses of political authority by those who invoke, as a justification for their activities, the need to subordinate the particular interests of individuals to the general good (Campbell 1996: 13).

Revolution or evolution:the challenges of conceptualizing patient and public involvement in a consumerist world

Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice. Objective This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly. Conclusions A framework for conceptualizing PPI is presented that differentiates between the different types and aims of involvement and their potential impact. Approaches to involvement are different in those countries that adopt a rights-based rather than a regulatory approach. I conclude with a discussion of the tension and interaction apparent in the globalization of both involvement and patient choice in both policy and practice. © 2009 Blackwell Publishing Ltd.

Neurophysiological investigations for the diagnosis of non-epileptic attack disorder in neuropsychiatry services:from safety standards to improved effectiveness

OBJECTIVE: The discipline of clinical neuropsychiatry currently provides specialised services for a number of conditions that cross the traditional boundaries of neurology and psychiatry, including non-epileptic attack disorder. Neurophysiological investigations have an important role within neuropsychiatry services, with video-electroencephalography (EEG) telemetry being the gold standard investigation for the differential diagnosis between epileptic seizures and non-epileptic attacks. This article reviews existing evidence on best practices for neurophysiology investigations, with focus on safety measures for video-EEG telemetry. METHODS: We conducted a systematic literature review using the PubMed database in order to identify the scientific literature on the best practices when using neurophysiological investigations in patients with suspected epileptic seizures or non-epileptic attacks. RESULTS: Specific measures need to be implemented for video-EEG telemetry to be safely and effectively carried out by neuropsychiatry services. A confirmed diagnosis of non-epileptic attack disorder following video-EEG telemetry carried out within neuropsychiatry units has the inherent advantage of allowing diagnosis communication and implementation of treatment strategies in a timely fashion, potentially improving clinical outcomes and cost-effectiveness significantly. CONCLUSION: The identified recommendations set the stage for the development of standardised guidelines to enable neuropsychiatry services to implement streamlined and evidence-based care pathways.

Perceptions and experiences of the implementation, management, use and optimisation of electronic prescribing systems in hospital settings:protocol for a systematic review of qualitative studies

Introduction: There is increasing evidence that electronic prescribing (ePrescribing) or computerised provider/physician order entry (CPOE) systems can improve the quality and safety of healthcare services. However, it has also become clear that their implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, qualitative approaches have been particularly useful and their interpretative synthesis could make an important and timely contribution to the field. This review will aim to identify, appraise and synthesise qualitative studies on ePrescribing/CPOE in hospital settings, with or without clinical decision support. Methods and analysis: Data sources will include the following bibliographic databases: MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, Social Policy and Practice via Ovid, CINAHL via EBSCO, The Cochrane Library (CDSR, DARE and CENTRAL databases), Nursing and Allied Health Sources, Applied Social Sciences Index and Abstracts via ProQuest and SCOPUS. In addition, other sources will be searched for ongoing studies (ClinicalTrials.gov) and grey literature: Healthcare Management Information Consortium, Conference Proceedings Citation Index (Web of Science) and Sociological abstracts. Studies will be independently screened for eligibility by 2 reviewers. Qualitative studies, either standalone or in the context of mixed-methods designs, reporting the perspectives of any actors involved in the implementation, management and use of ePrescribing/CPOE systems in hospital-based care settings will be included. Data extraction will be conducted by 2 reviewers using a piloted form. Quality appraisal will be based on criteria from the Critical Appraisal Skills Programme checklist and Standards for Reporting Qualitative Research. Studies will not be excluded based on quality assessment. A postsynthesis sensitivity analysis will be undertaken. Data analysis will follow the thematic synthesis method. Ethics and dissemination: The study does not require ethical approval as primary data will not be collected. The results of the study will be published in a peer-reviewed journal and presented at relevant conferences.

Adult Learners and the Work of Amnesty International

This study explores how various adults perceive their work and learning in a chapter of a human rights-based non-governmental organization using the Characteristics of Adults as Learners (Cross, 1981) model of adult learning.

Sri Lanka: moving on

Promoting a rights-based approach to sustainable small-scale fisheries development through participatory and consultative processes was discussed at a workshop in Colombo.

No caminho da cidadania...

No pós-guerra iniciou-se um processo de internalização política dos direitos fundamentais das mulheres com base na Declaração Universal dos Direitos do Homem, (10 de dezembro de 1948), onde são enaltecidos direitos e valores como a Liberdade e a Igualdade. A adoção da Declaração por parte de países democráticos, como o caso de Portugal, conduziu ao exercício de cidadania plena, independentemente do género, da raça e da religião. Assim, a não discriminação tornou-se um princípio a aplicar nas esferas familiares, públicas e laborais. Tal significa, por exemplo, partilha de tarefas domésticas entre homens e mulheres, participação na vida comunitária e iguais oportunidades laborais. Mas foram superadas as discriminações? Que se passa a nível laboral? A presente dissertação resulta de uma investigação sobre a situação laboral das mulheres em serviços onde constitucionalmente usufruem dos mesmos direitos que os seus colegas homens. Incide sobre os serviços públicos, privados e empresas de Ponte de Sor e tem por referencial o III Plano Nacional para a Igualdade de Cidadania e Género (2007/2010), cuja principal linha orientadora é "o aprofundamento de atividade política e de realidade social (gendermainstreaming)" (2007, p.l5). Com a realização deste estudo concretizámos um trabalho constituído por 3 capítulos, onde se constata que “No Caminho da Cidadania..." é um processo lento. No primeiro capítulo procurou-se abordar a origem histórica do conceito de cidadania e no capítulo segundo tratou­ se da relação da mulher com o trabalho e o poder. O terceiro capítulo, e último, dá conta dos resultados de questionários realizados em Ponte de Sor, nos serviços públicos e privados, e empresas. A conclusão revela a perplexidade causada pela quase indiferença em relação às questões de género nos Serviços questionados em Ponte de Sor. SUMMARY: After World War I began a process of political antinationalization of the women fundamental rights based on the Universal Declaration of the Human Rights, (1Oth December 1948), where rights and values like liberty and equality are exalted. The adoption of the Declaration by the democratically countries, like Portugal, leaded to the execution of full citizenship, independently of gender, race and religion. Therefore, nondiscrimination became a principle to apply in the family, public and labor spheres. This means, for example, share of domestic tasks between men and women, participation in the communal life, and equal opportunities of labor. But were the discriminations surpassed? What is going on the labor level This dissertation results from an inquiry about the labor situation of women in service where constitutionally make uses of the same rights as their colleague’s men. It reflects on the public, private and companies of Ponte de Sor which has for yardstick the III National Plan for Equality of Citizenship and Gender (2007/2010), whose mainline adviser is "the political activity and the social reality deepening (gender mainstreaming)" (2007, p.15). Through this study we fixed a work constituted by three chapters, where it established that "On the Path of Citizenship ..." is a slow process. ln the first chapter tried to broach the historical origin of the concept of citizenship and in the second paragraph was approached the relation of women with labor and power. The third, and last, chapter tries to show the results of questionnaires carried out in Ponte de Sor, in the public, private services and companies. The conclusion reveals the perplexity caused by the barely indifference regarding the questions of genre in the Services questioned in Ponte de Sor.

Trauma in critically ill children : transfusion and osmotherapy practices

Les accidents sont la cause la plus fréquente de décès chez l’enfant, la plupart du temps à cause d’un traumatisme cranio-cérébrale (TCC) sévère ou d’un choc hémorragique. Malgré cela, la prise en charge de ces patients est souvent basée sur la littérature adulte. Le mannitol et le salin hypertonique (3%) sont des traitements standards dans la gestion de l’hypertension intracrânienne, mais il existe très peu d’évidence sur leur utilité en pédiatrie. Nous avons entrepris une revue rétrospective des traumatismes crâniens sévères admis dans les sept dernières années, pour décrire l’utilisation de ces agents hyperosmolaires et leurs effets sur la pression intracrânienne. Nous avons établi que le salin hypertonique est plus fréquemment utilisé que le mannitol, qu’il ne semble pas y avoir de facteurs associés à l’utilisation de l’un ou l’autre, et que l’effet sur la pression intracrânienne est difficile à évaluer en raison de multiples co-interventions. Il faudra mettre en place un protocole de gestion du patient avec TCC sévère avant d’entreprendre des études prospectives. La transfusion sanguine est employée de façon courante dans la prise en charge du patient traumatisé. De nombreuses études soulignent les effets néfastes des transfusions sanguines suggérant des seuils transfusionnels plus restrictifs. Malgré cela, il n’y a pas de données sur les transfusions chez l’enfant atteint de traumatismes graves. Nous avons donc entrepris une analyse post-hoc d’une grosse étude prospective multicentrique sur les pratiques transfusionnelles des enfants traumatisés. Nous avons conclu que les enfants traumatisés sont transfusés de manière importante avant et après l’admission aux soins intensifs. Un jeune âge, un PELOD élevé et le recours à la ventilation mécanique sont des facteurs associés à recevoir une transfusion sanguine aux soins intensifs. Le facteur le plus prédicteur, demeure le fait de recevoir une transfusion avant l’admission aux soins, élément qui suggère probablement un saignement continu. Il demeure qu’une étude prospective spécifique des patients traumatisés doit être effectuée pour évaluer si une prise en charge basée sur un seuil transfusionnel restrictif serait sécuritaire dans cette population.

Trauma in critically ill children : transfusion and osmotherapy practices

Les accidents sont la cause la plus fréquente de décès chez l’enfant, la plupart du temps à cause d’un traumatisme cranio-cérébrale (TCC) sévère ou d’un choc hémorragique. Malgré cela, la prise en charge de ces patients est souvent basée sur la littérature adulte. Le mannitol et le salin hypertonique (3%) sont des traitements standards dans la gestion de l’hypertension intracrânienne, mais il existe très peu d’évidence sur leur utilité en pédiatrie. Nous avons entrepris une revue rétrospective des traumatismes crâniens sévères admis dans les sept dernières années, pour décrire l’utilisation de ces agents hyperosmolaires et leurs effets sur la pression intracrânienne. Nous avons établi que le salin hypertonique est plus fréquemment utilisé que le mannitol, qu’il ne semble pas y avoir de facteurs associés à l’utilisation de l’un ou l’autre, et que l’effet sur la pression intracrânienne est difficile à évaluer en raison de multiples co-interventions. Il faudra mettre en place un protocole de gestion du patient avec TCC sévère avant d’entreprendre des études prospectives. La transfusion sanguine est employée de façon courante dans la prise en charge du patient traumatisé. De nombreuses études soulignent les effets néfastes des transfusions sanguines suggérant des seuils transfusionnels plus restrictifs. Malgré cela, il n’y a pas de données sur les transfusions chez l’enfant atteint de traumatismes graves. Nous avons donc entrepris une analyse post-hoc d’une grosse étude prospective multicentrique sur les pratiques transfusionnelles des enfants traumatisés. Nous avons conclu que les enfants traumatisés sont transfusés de manière importante avant et après l’admission aux soins intensifs. Un jeune âge, un PELOD élevé et le recours à la ventilation mécanique sont des facteurs associés à recevoir une transfusion sanguine aux soins intensifs. Le facteur le plus prédicteur, demeure le fait de recevoir une transfusion avant l’admission aux soins, élément qui suggère probablement un saignement continu. Il demeure qu’une étude prospective spécifique des patients traumatisés doit être effectuée pour évaluer si une prise en charge basée sur un seuil transfusionnel restrictif serait sécuritaire dans cette population.