Guidelines for Facilitating a Patient Empowerment Program

The traditional medical treatment model often ignores the emotional, spiritual, social, and cognitive aspects of living with a chronic disease such as diabetes. Empowerment programs address these psychosocial areas by helping individuals develop skills and self-awareness in goal setting, problem solving, stress management, coping, social support, and motivation. Although many diabetes educators have been taught to use an empowerment curriculum to facilitate self-management, there is minimal research concerning the actual process of providing such programs to patients. We evaluated an empowerment curriculum (Empowerment: A Personal Path to Self-Care) with a diverse group of individuals with diabetes to determine the key elements of planning and implementing a successful diabetes patient empowerment program.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68728/2/10.1177_014572179502100408.pd

Comprehensive determination of the high-pressure structural behaviour of BaTiO₃

We have mapped the phase diagram of BaTiO3 more extensively than previous attempts using high-pressure neutron-powder diffraction. The mapping of the phase diagram has been performed using isothermal compression at fixed temperatures (175, 225, 290, 480 K) within each of the known crystallographic phases, up to ∼6 GPa using a large volume press. The crystallographic structure of each phase has been measured, and the determined absolute atomic displacements of all atoms within the cell have provided detailed information on the order of the phase transitions observed, and the behaviour of the ferroelectric dipole moment.Publisher PDFPeer reviewe

Investigation of the factors contributing to indigenous students’ retention and attrition rates at the University of Adelaide

First published online: 30 April 2019Aboriginal and Torres Strait Islander peoples remain significantly under-represented in higher education systems. There are significant disparities in university completion rates for Aboriginal and Torres Strait Islander students compared with their non-Indigenous counterparts. The poor-retention and high-attrition rates among Aboriginal and Torres Strait Islander students come at significant financial and personal cost for the individual, families, community, universities and governments. Existing evidence in relation to attrition has identified complex and multifaceted reasons including ill health, family and community responsibilities, financial difficulties, lack of social support, academic disadvantage and issues surrounding personal well-being. The current study aimed to add to evidence of the academic, financial, social support and well-being factors affecting Aboriginal and Torres Strait Islander student's decision to continue or withdraw from their university studies. Contrary to expectation, students' decision to withdraw was not related to academic and social factors. It was found that students between 22 and 25 years old strongly agreed they were likely to withdraw from studies. There was a significant association between withdrawal and type of enrolment. This study provided important insights into the factors that contribute to a students' decision to withdraw from their university studies, with implications for future educational interventions.Shane Hearn, Madeleine Benton, Sarah Funnell and Fernando Marmolejo-Ramo

Artificial Intelligence in Brain Tumour Surgery—An Emerging Paradigm

Artificial intelligence (AI) platforms have the potential to cause a paradigm shift in brain tumour surgery. Brain tumour surgery augmented with AI can result in safer and more effective treatment. In this review article, we explore the current and future role of AI in patients undergoing brain tumour surgery, including aiding diagnosis, optimising the surgical plan, providing support during the operation, and better predicting the prognosis. Finally, we discuss barriers to the successful clinical implementation, the ethical concerns, and we provide our perspective on how the field could be advanced

Can programme theory be used as a 'translational tool’ to optimise health service delivery in a national early years’ initiative in Scotland: a case study

Background Theory-based evaluation (TBE) approaches are heralded as supporting formative evaluation by facilitating increased use of evaluative findings to guide programme improvement. It is essential that learning from programme implementation is better used to improve delivery and to inform other initiatives, if interventions are to be as effective as they have the potential to be. Nonetheless, few studies describe formative feedback methods, or report direct instrumental use of findings resulting from TBE. This paper uses the case of Scotland’s, National Health Service, early years’, oral health improvement initiative (Childsmile) to describe the use of TBE as a framework for providing feedback on delivery to programme staff and to assess its impact on programmatic action.<p></p> Methods In-depth, semi-structured interviews and focus groups with key stakeholders explored perceived deviations between the Childsmile programme 'as delivered’ and its Programme Theory (PT). The data was thematically analysed using constant comparative methods. Findings were shared with key programme stakeholders and discussions around likely impact and necessary actions were facilitated by the authors. Documentary review and ongoing observations of programme meetings were undertaken to assess the extent to which learning was acted upon.<p></p> Results On the whole, the activities documented in Childsmile’s PT were implemented as intended. This paper purposefully focuses on those activities where variation in delivery was evident. Differences resulted from the stage of roll-out reached and the flexibility given to individual NHS boards to tailor local implementation. Some adaptations were thought to have diverged from the central features of Childsmile’s PT, to the extent that there was a risk to achieving outcomes. The methods employed prompted national service improvement action, and proposals for local action by individual NHS boards to address this.<p></p> Conclusions The TBE approach provided a platform, to direct attention to areas of risk within a national health initiative, and to agree which intervention components were 'core’ to its hypothesised success. The study demonstrates that PT can be used as a 'translational tool’ to facilitate instrumental use of evaluative findings to optimise implementation within a complex health improvement programme.<p></p&gt

Perceived Effectiveness, Cost, and Availability of Patient Education Methods and Materials

To determine the efficacy of and need for patient education methods and media, a needs assessment was sent to 816 members of the American Association of Diabetes Educators. Respondents (n=325, 40%) included 62% RNs, 36% RDs, 1% other; 62% CDEs. Their mean number of years experience in diabetes education was 8.5, and 99% routinely provided patient education. Respondents indicated that videotapes and slide tapes were the most educationally effective media and books and audiotapes were the least effective. Booklets and videotapes were the most cost-effective and computer-assisted instruction the least effective. While respondents perceived one-to-one counseling, skills training, and diabetes content sessions to be the three most educationally effective methods, support groups and large and small discussion groups were seen as the three most cost-effective educational methods. Among nine potential barriers to quality patient education listed, educators rated lack of third-party reimbursement as a major barrier most frequently and national availability of quality education materials as a barrier least frequently.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68739/2/10.1177_014572179201800207.pd

Promoter keyholes enable specific and persistent multi-gene expression programs in primary T cells without genome modification

Non-invasive epigenome editing is a promising strategy for engineering gene expression programs, yet potency, specificity, and persistence remain challenging. Here we show that effective epigenome editing is gated at single-base precision via 'keyhole' sites in endogenous regulatory DNA. Synthetic repressors targeting promoter keyholes can ablate gene expression in up to 99% of primary cells with single-gene specificity and can seamlessly repress multiple genes in combination. Transient exposure of primary T cells to keyhole repressors confers mitotically heritable silencing that persists to the limit of primary cultures in vitro and for at least 4 weeks in vivo, enabling manufacturing of cell products with enhanced therapeutic efficacy. DNA recognition and effector domains can be encoded as separate proteins that reassemble at keyhole sites and function with the same efficiency as single chain effectors, enabling gated control and rapid screening for novel functional domains that modulate endogenous gene expression patterns. Our results provide a powerful and exponentially flexible system for programming gene expression and therapeutic cell products

Healthcare Game Design: Behavioral Modeling of Serious Gaming Design for Children with Chronic Diseases

This article introduces the design principles of serious games for chronic patients based on behavioral models. First, key features of the targeted chronic condition (Diabetes) are explained. Then, the role of psychological behavioral models in the management of chronic conditions is covered. After a short review of the existing health focused games, two recent health games that are developed based on behavioral models are overviewed in more detail. Furthermore, design principles and usability issues regarding the creation of these health games are discussed. Finally, the authors conclude that designing healthcare games based on behavioral models can increase the usability of the game in order to improve the effectiveness of the game’s desired healthcare outcomes