Effectiveness of IT-based diabetes management interventions: a review of the literature

Background : Information technology (IT) is increasingly being used in general practice to manage health care including type 2 diabetes. However, there is conflicting evidence about whether IT improves diabetes outcomes. This review of the literature about IT-based diabetes management interventions explores whether methodological issues such as sample characteristics, outcome measures, and mechanisms causing change in the outcome measures could explain some of the inconsistent findings evident in IT-based diabetes management studies.

Methods : Databases were searched using terms related to IT and diabetes management. Articles eligible for review evaluated an IT-based diabetes management intervention in general practice and were published between 1999 and 2009 inclusive in English. Studies that did not include outcome measures were excluded.

Results : Four hundred and twenty-five articles were identified, sixteen met the inclusion criteria: eleven GP focussed and five patient focused interventions were evaluated. Nine were RCTs, five non-randomised control trials, and two single-sample before and after designs. Important sample characteristics such as diabetes type, familiarity with IT, and baseline diabetes knowledge were not addressed in any of the studies reviewed. All studies used HbA1c as a primary outcome measure, and nine reported a significant improvement in mean HbA1c over the study period; only two studies reported the HbA1c assay method. Five studies measured diabetes medications and two measured psychological outcomes. Patient lifestyle variables were not included in any of the studies reviewed. IT was the intervention method considered to effect changes in the outcome measures. Only two studies mentioned alternative possible causal mechanisms.

Conclusion : Several limitations could affect the outcomes of IT-based diabetes management interventions to an unknown degree. These limitations make it difficult to attribute changes solely to such interventions.

Mermaids and sirens as myth fragments in contemporary literature

This thesis examines three works: Margaret Atwood's The Robber Bride and Alias Grace, and Angela Carter's Nights at the Circus. All three novels feature female characters that contain elements or myth fragments of mermaids and sirens. The thesis asserts that the images of the mermaid and siren have undergone a gradual process of change, from literal mythical figures, to metaphorical images, and then to figures or myth fragments that reference the original mythical figures. The persistence of these female half-human images points to an underlying rationale that is independent of historical and cultural factors. Using feminist psychoanalytic theoretical frameworks, the thesis identifies the existence of the siren/mermaid myth fragments that are used as a means to construct the category of the 'bad' woman. It then identifies the function that these references serve in the narrative and in the broader context of both Victorian and contemporary societies. The thesis postulates the origin of the mermaid and siren myths as stemming from the ambivalent relationship that the male infant forms with the mother as he develops an identity as an individual. Finally, the thesis discusses the manner in which Atwood and Carter build on this foundation to deconstruct the binary oppositions that disadvantage women and to expand the category of female.