Outcomes research in the development and evaluation of practice guidelines

BACKGROUND: Practice guidelines have been developed in response to the observation that variations exist in clinical medicine that are not related to variations in the clinical presentation and severity of the disease. Despite their widespread use, however, practice guideline evaluation lacks a rigorous scientific methodology to support its development and application. DISCUSSION: Firstly, we review the major epidemiological foundations of practice guideline development. Secondly, we propose a chronic disease epidemiological model in which practice patterns are viewed as the exposure and outcomes of interest such as quality or cost are viewed as the disease. Sources of selection, information, confounding and temporal trend bias are identified and discussed. SUMMARY: The proposed methodological framework for outcomes research to evaluate practice guidelines reflects the selection, information and confounding biases inherent in its observational nature which must be accounted for in both the design and the analysis phases of any outcomes research study

Ghosts in the machine : do the dead live on in Facebook?

Of the many ways in which identity is constructed and performed online, few are as strongly ‘anchored’ to existing offline relationships as in online social networks like Facebook and Myspace. These networks utilise profiles that extend our practical, psychological and even corporeal identity in ways that give them considerable phenomenal presence in the lives of spatially distant people. This raises interesting questions about the persistence of identity when these online profiles survive the deaths of the users behind them, via the practice of ‘memorialising’ social network profile pages. I situate these practices within a phenomenology of grief that accounts for the ways in which the dead can persist as moral patients, and show how online survival in this case illuminates an important difference between persons and selves within contemporary philosophy of personal identity. Ultimately, the online persistence of the dead helps bring into view a deep ontological contradiction implicit in our dealings with death: the dead both live on as objects of duty and yet completely cease to exist

Parental influences on youths' career construction

Increasingly, scholars are urging that there should be a careful examination of the role of social relations, especially those between parents and children, on the professional development of youth. In this chapter, we first present the recent models and theoretical approaches (e.g., contextual action theory, social cognitive model, and the life design approach) that recognize the need to carefully consider the role that parents play in their children\u2019s career development. Next, the parental support role in their children\u2019s professional development is explored, in relation to socioeconomic circumstances. Poverty, unemployment, precariousness, and underemployment are becoming characteristic of the context even in the richest countries; thus today\u2019s parents find themselves playing their support role in their children\u2019s professional development within much more complex societies. Some parents, especially those with low socioeconomic status (SES), are pessimistic in their overall perception of the economy, and, despite being concerned about their children\u2019s future, may find it hard to plan for it; thus, they do not encourage their children and do not start interactions centered on the future with them. Adolescent career development is affected by two interdependent contextual family factors: (a) structural family variables and (b) process family variables (e.g., parents\u2019 aspirations, parental support, family interactions). As regards structural variables, we examined socioeconomic background and social class. In research across multiple cultures, youth from families of low SES and social class have been found to have more limited opportunities for career development and more difficulties in accessing educational and social opportunities. Social class is a more difficult structural variable to define than SES. It is characterized as a cultural, psychological, and subjective factor internalized by the individual which goes beyond income, upbringing, and education, and shapes the construction of the self. As regards contextual process family variables, we focused on parental support and family interactions. Across ethnic groups (e.g., African-Americans, Italian, North Americans, French), adolescents who report greater support and more positive interactions with their parents are more engaged in designing their school\u2013career future. Specifically, greater parental support and positive relationships between parents and children are associated with more career decision-making, vocational exploration, career self-efficacy beliefs, career adaptability, less irrational career beliefs, and a greater propensity to optimism and hope in youth. In addition, it is in the family that children begin to give meaning to the world of work and construct their idea of education and work and of their career lives. Lastly, in relation to the relevance of relationships between parents and their children for the latter\u2019s career development, in this chapter we discuss how to help parents to support the realization of their children\u2019s professional projects. Parents are a key source for enabling youth to achieve preventive goals related to career education. Specifically, we provide two examples of parent training programs that are aimed at promoting parental skills in supporting their children\u2019s career construction