Dialogue: a case study

Dialogue is a useful organizational strategy that supports a shared understanding that is useful in the solving complex problems. A community hospital challenged with publicly transparent quality metrics and the associated financial and reputation penalties developed a culture supportive of dialogue and participation and was the setting for this research. The purpose of the research was to explore the decisions and messages an executive leadership team implemented that support the practice of dialogue and facilitated a culture of participation. This retrospective, qualitative study reviewed documents and artifacts over a seven-year time span from 2007-2014. two sources, 1) the Operation Committee meetings and 2) The all- employee forums provided by the senior leadership were reviewed. These source were coded utilizing a predetermined coding scheme based upon information from 3 theories, 1) Isaac’s dimensions of dialogue, 2) Isaac’s action theory of dialogue and 3) Fischer’s levels of participation. These three theories when integrated provide a three dimensional perspective that supports the practice of dialogue. The conclusions of this study are that 1) A single theory of dialogue is not sufficient. 2. An effective model for communication must include, at a minimum, contain an aspect of action theory, a dimension of dialogue, and a level of participation. 3. Delaying decision-making in order to obtain feedback allows for the prolongation of deliberation and for the emergence of dialogue and deliberation and 4. Expansion of the deliberation time is a mechanism that helps the group to suspend assumptions and is a methodology supportive of dialogue. This research recommends a three step, “how to” approach to supporting dialogue and a culture of participation. The recommended pattern is to 1) ask for feedback thus 2) delaying the decision, and 3) listening to the feedback

Beginning Reading Instruction: Issues in Phonics and Modality Preferences

This thesis reviews the major trends regarding the place of phonics in reading instruction since the 1950\u27s and attempts to integrate current perspectives on phonics in regard to both classroom and individualized instruction. In the 1950\u27s, instruction in the regular classroom tended to emphasize sight-words at the expense of word analysis or phonic skills. The mid-1960\u27s classic study by Chall, Learning to Read: The Great Debate, documented the value of phonic instruction in beginning reading and led to later refinements regarding the place of phonics in beginning reading instruction. The attempt to match individual children\u27s preferred modality for learning to instructional method received widespread attention in the early 1970\u27s following growing interest in the new field of learning disabilities and assumed that many children prefer the visual or auditory modality. Although intuitively logical, this either phonics (for children preferring the auditory modality) or sight-words (for children preferring visual modality) approach to instruction was not supported by research. More recent work with processing style preference, in which suggestions are made for teaching reading via methods geared to the child\u27s most efficient mode of processing information, have limited research support. A few recent studies suggest that some children with extreme processing preferences may benefit from differing instructional approaches. However, the content of instruction needs to include phonic analysis skills for all children. Current views of phonics and reading instruction no longer suggest an either phonics or sight-words approach, but generally accept the importance of phonics instruction in beginning reading for all children. This issue is not the phonics or sight-words dichotomy of earlier decades, but rather the new question of how to most effectively teach word analysis skills and how to incorporate phonic instruction into meaningful reading instruction. The field of emergent literacy, which has developed since the 1970\u27s, describes the range of early reading skills many children acquire informally before entering school. This body of research is pertinent to issues regarding phonics in beginning reading instruction since those children who enter school with several years of informal introduction to print at home or preschool are the most successful with beginning reading instruction. Several effective programs are described which suggest that attention to emergent literacy skills, such as the ability to hear individual sounds in words, is a useful task for explaining why many children continue to have difficulty with beginning reading instruction. Reading Recovery is presented as a model approach to reading instruction. This program targets children not succeeding with first grade instruction and provides daily individualized instruction incorporating word analysis skills in meaningful reading and writing. Reading Recovery is a program which shows educators how to adapt instruction to best meet the needs of children getting off to a slow start in learning to read and integrate the development of phonic skills into meaningful reading

Randomized sham controlled trial of cranial microcurrent stimulation for symptoms of depression, anxiety, pain, fatigue and sleep disturbances in women receiving chemotherapy for early-stage breast cancer

Purpose Women with breast cancer may experience symptoms of depression, anxiety, pain, fatigue and sleep disturbances during chemotherapy. However, there are few modalities that address multiple, commonly occurring symptoms that may occur in individuals receiving cancer treatment. Cranial electrical stimulation (CES) is a treatment that is FDA cleared for depression, anxiety and insomnia. CES is applied via electrodes placed on the ear that deliver pulsed, low amplitude electrical current to the head. Methods This phase III randomized, sham-controlled study aimed to examine the effects of cranial microcurrent stimulation on symptoms of depression, anxiety, pain, fatigue, and sleep disturbances in women receiving chemotherapy for early-stage breast cancer. Patients were randomly assigned to either an actual or sham device and used the device daily for 1 h. The study was registered at clinicaltrials.gov, NCT00902330. Results The sample included N = 167 women with early-stage breast cancer. Symptom severity of depression, anxiety, and fatigue and sleep disturbances were generally mild to moderate. Levels of pain were low. Anxiety was highest prior to the initial chemotherapy and decreased over time. The primary outcome assessment (symptoms of depression, anxiety, fatigue, pain, sleep disturbances) revealed no statistically significant differences between the two groups, actual CES vs. sham. Conclusion In this study, women receiving chemotherapy for breast cancer experienced multiple symptoms in the mild to moderate range. Although there is no evidence for the routine use of CES during the chemotherapy period for symptom management in women with breast cancer, further symptom management modalities should be evaluated to mitigate symptoms of depression, anxiety, fatigue, pain and sleep disturbances over the course of chemotherapy

Does child sexual abuse affect long-term intimacy development and functioning

The purpose of this study was to examine practitioners\u27 views of the long-term effects of child sexual abuse on intimacy development and to determine if child sexual abuse leads to an underdeveloped sense of intimacy in the adult. Problems with intimacy development are defined as trouble forming close interpersonal relationships, not being able to trust others, being sexually promiscuous, and avoiding emotion

Beginning Reading Instruction: Issues in Phonics and Modality Preferences

This thesis reviews the major trends regarding the place of phonics in reading instruction since the 1950\u27s and attempts to integrate current perspectives on phonics in regard to both classroom and individualized instruction. In the 1950\u27s, instruction in the regular classroom tended to emphasize sight-words at the expense of word analysis or phonic skills. The mid-1960\u27s classic study by Chall, Learning to Read: The Great Debate, documented the value of phonic instruction in beginning reading and led to later refinements regarding the place of phonics in beginning reading instruction. The attempt to match individual children\u27s preferred modality for learning to instructional method received widespread attention in the early 1970\u27s following growing interest in the new field of learning disabilities and assumed that many children prefer the visual or auditory modality. Although intuitively logical, this either phonics (for children preferring the auditory modality) or sight-words (for children preferring visual modality) approach to instruction was not supported by research. More recent work with processing style preference, in which suggestions are made for teaching reading via methods geared to the child\u27s most efficient mode of processing information, have limited research support. A few recent studies suggest that some children with extreme processing preferences may benefit from differing instructional approaches. However, the content of instruction needs to include phonic analysis skills for all children. Current views of phonics and reading instruction no longer suggest an either phonics or sight-words approach, but generally accept the importance of phonics instruction in beginning reading for all children. This issue is not the phonics or sight-words dichotomy of earlier decades, but rather the new question of how to most effectively teach word analysis skills and how to incorporate phonic instruction into meaningful reading instruction. The field of emergent literacy, which has developed since the 1970\u27s, describes the range of early reading skills many children acquire informally before entering school. This body of research is pertinent to issues regarding phonics in beginning reading instruction since those children who enter school with several years of informal introduction to print at home or preschool are the most successful with beginning reading instruction. Several effective programs are described which suggest that attention to emergent literacy skills, such as the ability to hear individual sounds in words, is a useful task for explaining why many children continue to have difficulty with beginning reading instruction. Reading Recovery is presented as a model approach to reading instruction. This program targets children not succeeding with first grade instruction and provides daily individualized instruction incorporating word analysis skills in meaningful reading and writing. Reading Recovery is a program which shows educators how to adapt instruction to best meet the needs of children getting off to a slow start in learning to read and integrate the development of phonic skills into meaningful reading

Integrating Students into Interdisciplinary Health and Health Disparities Research Teams

Major initiatives by the U.S. Department of Health and Human Services as well as the World Health Organization have produced a large and compelling body of evidence on how to reduce health disparities, which entails having a clear understanding of how social factors shape health and healthcare outcomes. Specifically, there is a need for healthcare professionals to understand social determinants of health (e.g., low socioeconomic status, lack of health insurance, and poor education) and how these lead to disparities in health for people of minority racial and ethnic groups. Little is known about how students are developed as health disparities researchers or how their research experiences impact their views about addressing social determinants of health as a career goal. The purpose of this paper is to describe how health and human sciences students were integrated into three minority HIV prevention and testing projects using the lifelong learning for health professionals (LLHP) principles and activities framework, which entails a focus on: (a) education, (b) community, and (c) organization in the planning, development, implementation, and evaluation of interdisciplinary research

Bupropion and Nicotine Patch as Smoking Cessation Aids in Alcoholics

This is a double blind placebo controlled study of sustained release bupropion as a smoking cessation aid in alcoholics undergoing treatment for their alcoholism. Participants (N=58) were enrolled within one week of entry into alcohol treatment from community and Veterans Affairs Substance Use Disorder programs. All participants received nicotine patch and were invited to attend a smoking cessation lecture and group. Cigarette smoking and alcohol outcomes were measured at six months. Bupropion when added to nicotine patch did not improve smoking outcomes. One-third of participants on bupropion reported discontinuing the drug during weeks 1-4. Participants reported cigarette outcomes with nicotine patch which are similar to those seen in the general population. All study participants significantly reduced cigarette use. Co-morbid affective disorder or antipersonality disorder did not affect outcomes. Alcohol outcomes were improved in those who discontinued cigarettes

Selecting Outcomes to Ensure Pragmatic Trials Are Relevant to People Living with Dementia

Outcome measures for embedded pragmatic clinical trials (ePCTs) should reflect the lived experience of people living with dementia (PLWD) and their caregivers, yet patient‐ and caregiver‐reported outcomes (PCROs) are rarely available in large clinical and administrative data sources. Although pragmatic methods may lead to use of existing administrative data rather than new data collected directly from PLWD, interventions are truly impactful only when they change outcomes prioritized by PLWD and their caregivers. The Patient‐ and Caregiver‐Reported Outcomes Core (PCRO Core) of the IMbedded Pragmatic Alzheimer's Disease (AD) and AD‐Related Dementias Clinical Trials (IMPACT) Collaboratory aims to promote optimal use of outcomes relevant to PLWD and their caregivers in pragmatic trials. The PCRO Core will address key scientific challenges limiting outcome measurement, such as gaps in existing measures, methodologic constraints, and burdensome data capture. PCRO Core investigators will create a searchable library of AD/AD‐related dementias (ADRD) clinical outcome measures, including measures in existing data sources with potential for AD/ADRD ePCTs, and will support best practices in measure development, including pragmatic adaptation of PCROs. Working together with other Cores and Teams within the IMPACT Collaboratory, the PCRO Core will support investigators to select from existing outcome measures, and to innovate in methods for measurement and data capture. In the future, the work of the IMPACT Collaboratory may galvanize broader embedded use of outcomes that matter to PLWD and their care partners in large health system

The Vulnerable Elders Survey‐13 Predicts Hospital Complications and Mortality in Older Adults with Traumatic Injury: A Pilot Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86959/1/j.1532-5415.2011.03493.x.pd

American-Indian diabetes mortality in the Great Plains Region 2002–2010

Objective To compare American-Indian and Caucasian mortality rates from diabetes among tribal Contract Health Service Delivery Areas (CHSDAs) in the Great Plains Region (GPR) and describe the disparities observed.Research design and methods Mortality data from the National Center for Vital Statistics and Seer*STAT were used to identify diabetes as the underlying cause of death for each decedent in the GPR from 2002 to 2010. Mortality data were abstracted and aggregated for American-Indians and Caucasians for 25 reservation CHSDAs in the GPR. Rate ratios (RR) with 95% CIs were used and SEER*Stat V.8.0.4 software calculated age-adjusted diabetes mortality rates.Results Age-adjusted mortality rates for American-Indians were significantly higher than those for Caucasians during the 8-year period. In the GPR, American-Indians were 3.44 times more likely to die from diabetes than Caucasians. South Dakota had the highest RR (5.47 times that of Caucasians), and Iowa had the lowest RR, (1.1). Reservation CHSDA RR ranged from 1.78 to 10.25.Conclusions American-Indians in the GPR have higher diabetes mortality rates than Caucasians in the GPR. Mortality rates among American-Indians persist despite special programs and initiatives aimed at reducing diabetes in these populations. Effective and immediate efforts are needed to address premature diabetes mortality among American-Indians in the GPR