Electronic Reminders to Improve Medication Adherence in Diabetes: A Quality Improvement Project

BACKGROUND: Diabetes often contributes to many co-morbid conditions and their complications. Non-adherence to medications is common in patients with chronic disease. The project aimed to improve medication adherence through the implementation of electronic messaging. The project was set in a private medical practice within a critical access hospital. Participants were patients of the practice with diabetes. METHODS: Baseline assessment included review and documentation of HgBA1cs, prescription requests, and past medical history. The development of an intervention to improve medication adherence utilizing electronic reminders was based on Bandura’s (1989) Social Cognitive Theory and Ajzen’s (1991) Theory of Planned Behavior. INTERVENTION: The HgBA1cs of patients with diabetes were followed for the three months before the intervention and during the three-month intervention to trend improvements in HgBA1c. Monthly prescription monitoring for the three months before the intervention and during intervention also occurred as an additional measure of adherence. Read receipts of electronic messages were also tracked. RESULTS: There was a sample of 21 patient-participants. The median aggregate HgBA1c pre-intervention was 8.5. The median aggregate HgBA1c post-intervention was 7.7 which was a significant median aggregate change. The patients reading the messages over the twelve weeks totaled 95% and prescription requests totaled 46 pre-intervention and 37 during the intervention. CONCLUSION: The evidence suggests that using electronic reminders can be beneficial to help improve medication adherence in participants

Waiting for Mifepristone

Physically, it is just a little white pill. But oh, what it could do: take abortion out of easily-identified clinics and disburse it to hospitals and doctor's offices, making what is so often called a "a private choice" actually private. And deprive pro-life activists of targets, publicity, and possibly support. For this potential to alter the current landscape, the New York Times Magazine has called it "The Little White Bombshell." But at the moment, RU-486 is available at only a handful of clinics throughout the country, while everyone else is waiting for final approval of the drug from the FDA

Situating emotional experience

Psychological construction approaches to emotion suggest that emotional experience is situated and dynamic. Fear, for example, is typically studied in a physical danger context (e.g., threatening snake), but in the real world, it often occurs in social contexts, especially those involving social evaluation (e.g., public speaking). Understanding situated emotional experience is critical because adaptive responding is guided by situational context (e.g., inferring the intention of another in a social evaluation situation vs. monitoring the environment in a physical danger situation). In an fMRI study, we assessed situated emotional experience using a newly developed paradigm in which participants vividly imagine different scenarios from a first-person perspective, in this case scenarios involving either social evaluation or physical danger. We hypothesized that distributed neural patterns would underlie immersion in social evaluation and physical danger situations, with shared activity patterns across both situations in multiple sensory modalities and in circuitry involved in integrating salient sensory information, and with unique activity patterns for each situation type in coordinated large-scale networks that reflect situated responding. More specifically, we predicted that networks underlying the social inference and mentalizing involved in responding to a social threat (in regions that make up the “default mode” network) would be reliably more active during social evaluation situations. In contrast, networks underlying the visuospatial attention and action planning involved in responding to a physical threat would be reliably more active during physical danger situations. The results supported these hypotheses. In line with emerging psychological construction approaches, the findings suggest that coordinated brain networks offer a systematic way to interpret the distributed patterns that underlie the diverse situational contexts characterizing emotional life

Nurse Practitioner Clinical Education: Evaluation of a Clinical Residency Model

A new clinical residency education model was developed and implemented in response to a family nurse practitioner program’s difficulty in securing and maintaining qualified preceptors and clinical sites for students in the program, and a community hospital’s shortage of nurse practitioners for their rural healthcare clinics. This Doctor of Nursing Practice project conducted an evaluation on this new model. The evaluation results showed that the clinical residency model met standards of nurse practitioner education, incorporated nursing leader recommendations for new clinical models, and proved to be an effective model for clinical education

Discourses of dominance : Saskatchewan adult basic education curriculum and Aboriginal learners

The intention of this work is to explore how Aboriginal learners are produced in the Saskatchewan Adult Basic Education (ABE) curriculum. In addition, this study examines the production of instructor identities in the curriculum. This thesis explores the social and historical contexts influencing the production of the ABE curriculum. Current prevailing discourses about Aboriginal people influence the curriculum documents. These discourses construct a grand narrative about Aboriginal people, producing Aboriginal people in particular ways that become acceptable and legitimate ways of thinking about and behaving toward Aboriginal people. This work examines how such a grand narrative functions to uphold dominance and structural inequalities rather than challenge them. The effect of reinforcing the current, particular grand narrative about Aboriginal people is that, rather than challenge dominant ideologies, the new curriculum re-inscribes them. This work employs the methodology of discourse analysis as a means of examining the production of particular identities for Aboriginal learners in ABE and uses deconstruction to explore the ways that the documents betray themselves in relation to their objectives. This thesis provides analysis of the ways that the curriculum documents produce and reproduce Aboriginal people as deficient and requiring change. This work provides analysis of the conflict within the documents between a desire to challenge dominance and the re-inscription of dominance through discursive practices. In addition, this work demonstrates how the ABE curriculum aids in the production of dominant instructor identities, and how such dominant identities assist instructors to define themselves as innocent and helpful. This analysis of the ABE curriculum reveals that while the curriculum aspires to be a proponent of social justice for Aboriginal learners it has many weaknesses in this regard. This work concludes with recommendations for changes to the curriculum and instructor practices, and for further critical analysis