Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial.

BackgroundThe incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic's scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease.Methods/designThis will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome.DiscussionThe results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study.Trial registrationClinicalTrials.gov: NCT02034045. Date: 9 January 2014

Covert research and adult protection and safeguarding: An ethical dilemma?

Purpose: This paper aims to consider the contentious issue of covert research in studying the social contexts of vulnerable groups. It explores its potential utility in areas where overt strategies may be problematic or denied; and examines and problematises the issue of participant consent. Design/methodology/approach: Using a literature-based review and selected previous studies, the paper explores the uses and abuses of covert research in relation to ethics review proceedings governing social research, with an especial focus on vulnerability. Findings: Findings indicate that although the use of covert research is subject to substantial critique by apparently transgressing the often unquestioned moral legitimacy of informed consent, this carries ethical and practical utility for research related to safeguarding concerns. Arguably covert research enables research access to data likely to reveal abusive and oppressive practices. Research limitations/implications: Covert research assists in illuminating the hidden voices and lives of vulnerable people that may otherwise remain inaccessible. Such research needs to be subject to rigorous ethical standards to ensure that it is both justified and robust. Practical implications: Emphasising the need to consider all angles, questions and positions when addressing the social problem of adult protection and safeguarding. Originality/value: Increasingly social research is treated as being as potentially harmful as medical research. Ethics review tends towards conservative conformity, legitimising methodologies that may serve less social utility than other forms of investigation that privilege the safeguarding of vulnerable people. © Emerald Group Publishing Limited

The Use of Marketing Knowledge in Formulating and Enforcing Consumer Protection Policy

The purpose of this first chapter of the handbook is to discuss how the findings and approaches offered by the marketing discipline are used in consumer protection policy

Nutrition Labeling in the United States and the Role of Consumer Processing, Message Structure, and Moderating Conditions

It has been since 1990 that the landmark Nutritional Labeling Education Act (NLEA) was passed in the United States, and since 1969 that the first White House Conference on Food, Nutrition and Health occurred. In the time since these important events, considerable research has been conducted on how U.S. consumers process and use nutritional labeling. An up-to-date review of nutritional labeling research must address key findings on the processing and use of nutrition facts panels (NFPs), restaurant labeling, front-of-pack (FOP) symbols, health and nutrient content claims, new labeling efforts (e.g., for meat products), and claims not regulated by the U.S. Food and Drug Administration (FDA). Message structure mediates the ways in which consumers process nutritional labeling while moderating conditions affect research outcomes associated with labeling efforts. The most recent policy issues and problems to be considered (e.g., by the FDA) include nutritional labeling as well as identifying opportunities for consumer research in helping to promote healthy lifestyles and reducing obesity in the United States and throughout the world. For example, several unanswered research questions remain regarding how the proposed changes to the NFPs—beef, poultry, and seafood labeling; restaurant chain calorie labeling; alternative FOP formats; and regulated and unregulated health and nutrient content claims—will affect consumers. Researchers have yet to examine not only these different labeling and nutrition information formats, but also how they might interact with one another and the role of key moderating conditions (e.g., one’s motivation, ability opportunity to process nutrition information) in affecting consumer processing and behavior

PSRO update

Newsletter for Massachusetts physicians, providing updates on the development of Professional Standards Review Organizations (PSROs) as Medicare and Medicaid standards were established.Index from January 1976 through December 197

A theoretical model for the application of Web 2.0 in e-Government

Government organisations in many countries have started embracing modern technologies such as second generation web (Web 2.0) in an attempt to maximize on the benefits of these technologies as well as keeping up with the current trend. Nevertheless, the advancement and the adoption of these of technologies is in its initial stages in the public sector. Therefore, the research problem is that the literature surrounding the application of Web 2.0 is still highly tentative and exploratory. In particular, there is a lack of research exploring the application of Web 2.0 technologies in the context of local e-Government. This study aims to address this research problem by presenting a comprehensive decision-making tool to aid the effective application of Web 2.0 technologies amongst local government authorities (LGAs). In doing so, resulting in the development of a theoretical model that is underpinned by information systems evaluation criteria and impact factors of Web 2.0 from an internal organizational perspective. By addressing the research problem, this study will make a significant contribution to the normative literature by providing new insights of Web 2.0 technologies within the public sector. This will be of specific relevance to scholars, policy makers, LGAs and practitioners who are interested in the adoption of Web 2.0 technologies in an e-Government context. This paper presents the proposed theoretical model and is largely devoted to an explanation on the development of the model