Using Technology to Improve Diabetes Self-Management within a Federally Qualified Community Health Center

The Patient Centered Medical Home (PCMH) concept places the patient and family at the center of healthcare. The patient becomes actively involved in their own care. One aspect of PCMH is managing care and increasing chronic disease self-management. Diabetes, a chronic disease, is a leading diagnosis among the patients served by the federally qualified community health center (FQCHC). The prevalence of diabetes in Mississippi in 2012 was 12.3%. The purpose of this DNP Capstone project was to implement a pilot study to increase diabetes self-management knowledge. The program utilized the current technology of text messaging to send biweekly supportive and educational text messages over a four week period. The level of patient knowledge was measured by a before and after implementation survey. Improving diabetes self-management will ultimately lead to improved compliance to the treatment plan while also improving self-management skills and education. The measures of improving diabetic self-management followed the 2014 Diabetes Clinical Practice Recommendations (Cefalu, 2014). To increase communication and improve relationships, the project was guided by the Relationship Based Care Theory and the Chronic Care Model. In an attempt to improve diabetic outcomes, measures of diabetic self-management were provided to patients through text messages. Communication provided through text messaging reminded patients to check blood sugar levels, provided diet recommendations, and provided exercise tips and suggestions. These communications provided a positive and proactive attitude toward diabetes self-management. By providing this information to patients through texting technology, the DNP Capstone Project measured if diabetes self-management skills improved or changed. By increasing the frequency of contact to the diabetic patients through text messages, the health care provider demonstrated an improved patient-provider relationship. The frequent communication will provide reassurance and encouragement to the diabetic patients and ultimately lead to improved diabetic self-management

Understanding older women\u27s leisure: The value of biographical research methods

The phenomenal growth in the number of older people in the western world is well documented, with the fastest growing group being those aged over 80 years, the majority of whom are women. Despite this demographic transformation, little research has sought to understand the meaning of tourism and leisure both for older people in general and specifically for women in the \u27oldest old\u27 phase. The research that does exist is typically quantitative and provides an essentialist view of leisure in old age, often failing to recognise the diversity of older people\u27s experiences. In contrast, this paper aims to provide a more fine-grained discussion of older people\u27s leisure. Drawn from the first author\u27s doctoral study, it reports and considers a biographical interview with a seventy-nine year old woman in order to provide insight into how a person\u27s history and the cultural, social and historical contexts of their life can determine their life choices. We conclude that it is not possible to study older people\u27s leisure behaviour through \u27snapshot\u27 research (which isolates one moment in time); instead if we are to more fully understand how their leisure and tourism experiences are constructed, we must try to engage with the context from which those experiences emerged

Using impairment and cognitions to predict walking in osteoarthritis: A series ofn-of-1 studies with an individually tailored, data-driven intervention

Objectives First, this study compares the ability of an integrated model of activity and activity limitations, the International Classification of Functioning, Disability and Health (ICF), and the Theory of Planned Behaviour (TPB) to predict walking within individuals with osteoarthritis. Second, the effectiveness of a walking intervention in these individuals is determined. Design A series of n-of-1 studies with an AB intervention design was used. Methods Diary methods were used to study four community-dwelling individuals with lower-limb osteoarthritis. Data on impairment symptoms (pain, pain on movement, and joint stiffness), cognitions (intention, self-efficacy, and perceived controllability), and walking (step count) were collected twice daily for 12 weeks. At 6 weeks, an individually tailored, data-driven walking intervention using action planning or a control cognition manipulation was delivered. Simulation modelling analysis examined cross-correlations and differences in baseline and intervention phase means. Post-hoc mediation analyses examined theoretical relationships and multiple regression analyses compared theoretical models. Results Cognitions, intention in particular, were better and more consistent within individual predictors of walking than impairment. The walking intervention did not increase walking in any of the three participants receiving it. The integrated model and the TPB, which recognize a predictive role for cognitions, were significant predictors of walking variance in all participants, whilst the biomedical ICF model was only predictive for one participant. Conclusion Despite the lack of evidence for an individually tailored walking intervention, predictive data suggest that interventions for people with osteoarthritis that address cognitions are likely to be more effective than those that address impairment only. Further within-individual investigation, including testing mediational relationships, is warranted. Statement of contribution What is already known on this subject? N-of-1 methods have been used to study within-individual predictors of walking in healthy and chronic pain populations An integrated biomedical and behavioural model of activity and activity limitations recognizes the roles of impairment and psychology (cognitions) Interventions modifying cognitions can increase physical activity in people with mobility limitations What does this study add? N-of-1 methods are suitable to study within-individual predictors of walking and interventions in osteoarthritis An integrated and a psychological model are better predictors of walking in osteoarthritis than a biomedical model There was no support for an individually tailored, data-driven walking interventio

Photos Can Inspire a Thousand Words: Photolanguage as a Qualitative Evaluation Method

Finding ways to encourage expression of individuals who are young, shy, or have limited verbal abilities can be challenging for evaluators. Photolanguage can be used to aid personal expression and small group interaction and as a tool to enhance qualitative evaluation activities. This method offers an interesting evaluation process that uses black-and-white photographic images specifically chosen for their aesthetic qualities; their ability to stimulate emotions, memory, and imagination; and their capacity to stimulate reflection in the viewer. Evaluators may find Photolanguage provides a valuable tool for use with evaluation participants who experience barriers to involvement, actual or perceived

The Lily and its impact on feminist thought in nineteenth century America

iii, 144 leaves : ill. ; 29 cm.Includes abstract.Includes bibliographical references (leaves 138-144).Editor Amelia Bloomer created controversy through her nineteenth century periodical—The Lily—which started out as a temperance journal but quickly came to include women’s rights issues. Her influence on the first women’s rights movement of the nineteenth century can be partially attributed to her success at creating controversy as a way to bring attention to women’s issues in three key areas: through her advocacy of temperance which emphasized, among other things, the vulnerability of a woman married to a drunkard; through her endorsement of the bloomer costume which would help inspire the nineteenth century dress reform movement, and through her use of the comparison between married women and slaves as a way to bring attention to the disadvantages facing married women in nineteenth century America

Making A Difference: Year Two Report of the Pennsylvania High School Coaching Initiative

This report examines the implementation of the second year of three for the Pennsylvania High School Coaching Initiative (PAHSCI). Funded by the Annenberg Foundation, this initiative focuses on literacy and math coaches providing support to teachers from across the major subject areas to create literacy-rich classrooms in which students actively engage in learning tasks that deepen their content knowledge and strengthen their abilities to think critically and communicate well. This report presents findings from the first two years of research. It includes survey research as well as in-depth qualitative research in participating schools and districts and provides recommendations for PAHSCI stakeholders as they refine the program and for other education reformers as they consider the benefits of instructional coaching as a strategy for improving high schools and student achievement

Percutaneous balloon mitral valvotomy with the Inoue single-balloon catheter: Commissural morphology as a determinant of outcome

AbstractObjectives. The aim of this study was to determine the importance to outcome and the predictability of commissural splitting in patients undergoing percutaneous mitral valvotomy with the Inoue single-balloon catheter.Background. Echocardiographic scoring systems devised to predict mitral valvotomy outcome are based on assessment of leaflet and subvalvular morphology, but the specific importance of commissural morphology has not been examined.Methods. In 30 consecutive patients, commissural splitting was predicted on the basis of the two-dimensional echocardiographic commissural morphology: the extent of fusion, fibrosis or calcification of each commissure. Valve morphology also was evaluated according to a previously described echocardiographic scoring system.Results. Splitting of one or both commissures occurred in 24 patients (80%) and was associated with a significantly greater mean increase in valve area (85%) than if neither commissure was split (13%). A good outcome from valvotomy (defined as valve area >1.5 cm2and increase in valve area >25%) was achieved in 96% of those in whom one or both commissures split, but in none of the patients in whom neither commissure split Whether or not splitting of at least one commissure would occur was predicted accurately in 28 (93%) of the 30 patients. Consequently, the prediction that one or both commissures would split was associated with a good outcome in 23 (89%) of 26 patients, whereas the prediction that neither commissure would split was not associated with a good outcome in any patient. There was no significant difference in the increase in mitral valve area between those with a mitral echocardiographic score <8 and those with a score ≥8. New or worsening mitral regurgitation occurred in nine patients, most commonly as a jet directed through a split commissure.Conclusions. Commissural splitting is the dominant mechanism by which mitral valve area is increased with the Inoue balloon technique, and it can be predicted by echocardiographic assessment of commissural morphology. Commissural morphology is a better predictor of outcome than is the mitral echocardiographic score