An exploratory study investigating factors associated with adherence to chest physiotherapy and exercise in adults with cystic fibrosis

Copyright @ 2009 European Cystic Fibrosis Society. This article is available through Elsevier's Open Access Archives and covered by Elsevier's user license: http://www.elsevier.com/about/open-access/open-access-policies/oa-license-policy/elsevier-user-license.This study explored the relationship between psychological and demographic variables relating to chest physiotherapy (CP) and exercise in adults with cystic fibrosis. The main results were that adherence to both treatments was low and analysis of variance indicated that severity and gender were associated with exercise adherence, importance and burden. These results suggest potential areas for interventions to improve exercise adherence

A Critical Case Study of Program Fidelity in TennCare

Purpose: The purpose of this study was to evaluate the fidelity of the design of Tennessee\u27s Medicaid managed care program in comparison to the actual program operation. Program fidelity is a broad measurement of how true the implemented program is to the intended program (Heflinger & Northrup, 2000). Background: In the span of only 15 years, the introduction of managed care and other market-based strategies from the private sector precipitated a transformation of the delivery of Medicaid services in the United States. These monumental changes remain poorly understood. The implementation of managed care in Tennessee\u27s Medicaid program is an excellent public policy exemplar because of the far-reaching scope of the program and the ongoing development of the program. Method: A hallmark of case study research is that detailed information is collected from multiple sources (Creswell, 2003; Feagin, Orum and Sjoberg, 1991; Stake, 2000; Yin, 2003). Source data for this single case study design included interview data from key stakeholders and a variety of documents. Documents analyzed included: newspaper and journal articles; correspondences; the original TennCare and TennCare Partners waiver applications; judicial decrees; legislative documents; task force reports; and other case studies. Interviews were conducted with 26 informants, including two former Governors of Tennessee; a former HCFA Administrator; a variety of state government and managed care executives and advocates; and a complement of provider representatives including administrators, managers and caregivers. Themes were developed to organize the vast amount of interview data. The salience of themes that emerged in early interviews were challenged, clarified and further distilled by an iterative process of content analysis and data triangulation that included multiple close readings of interview transcripts and documents, clarification and testing of ideas with selected stakeholders and confirmation of details with document sources. The triangulation of retrospective recollections of events and key impressions captured in recorded interviews with a wide variety of time-stable documents provided a rich understanding of people and events that shaped the development and operation of TennCare. Each theme was also organized and developed through the construction of a chronological history of events. Findings: An intricate web of circumstances and people shaped the initial development and evolution of TennCare. Although TennCare has been successful in extending health care coverages, this success has been overshadowed by a myriad of operational problems. Thematic analysis illuminated both the promises and failures of TennCare. Three themes were prominent in the telling of the TennCare story: authority, management and fragmentation. Governor McWherter (1987-1995), the creator of TennCare, established a strong executive authority to model and implement TennCare; a void was created when he left office. Subsequent administrations have not adequately transitioned to a more balanced and inclusive authoritative structure, nor have they developed an adequate oversight model. Continued mismanagement of the administration of benefits and failure to meet established care standards set the stage for the imposition of federal judiciary authority. Management of the operational phase of TennCare has largely been reactionary and politicized and, in many instances, inappropriately abdicated or conferred upon the wrong or unprepared people or entities. Turmoil and turnover in state government hindered stabilization of the program. The stability and evolution of the marketplace that McWherter expected has not been broadly realized; the state has retreated from basic managed care principles. The state failed to integrate the management the health, behavioral health and pharmacy carve-outs. This fragmentation resulted in diffuse accountability across vendors and within state government, unnecessary duplication of services, gaps in the delivery and management of patient care and increased patient hassle and frustration. More broadly, the state was found to have conflicting roles as both the manager of the behavioral health vendors and a direct provider of behavioral health services. The web of connectivity between themes changed over time, as themes presented as a cause, catalyst or consequence of the others at different times in TennCare\u27s history. A poignant example of this connectivity is how the mismanagement of TennCare program after the initial implementation led to the breakdown in key alliances and the eventual imposition of federal judicial authority in the form of the consent decrees. Consent decrees resulted in reactive and disjointed management which significantly contributed to the gap between what was envisioned for TennCare and what actually resulted. Conclusions: The study illustrated that an intricate web of circumstances and people shaped the initial development and evolution of TennCare, a program designed to solve a state-level problem with national implications. Although TennCare has been successful in increasing the number of Tennesseans with health care coverage, these successes have been overshadowed by pervasive operational problems, a failure to fully implement basic building blocks of managed care, such as risk-sharing and competition, and effectively manage the vendors employed by the state. Conclusions related to the three themes show a pattern of missed opportunities and a troubling inability to transition from the chaos of TennCare\u27s implementation to effective program operation. The illuminated themes will be informative to planners of similar state initiatives

Reflective Conversations: Exploring Faculty’s Perceptions of Reflection to Enhance Teaching Effectiveness

The purpose of this pragmatic qualitative research study is to examine the impact of a faculty development program’s reflection component on teaching effectiveness as perceived by the faculty participants. This study utilizes Schön’s (1983) reflective practice, which calls professionals to move from the technical rationality position of development and practice (theoretical and detached) into a reflective position (practical and applicable). Schön contends that this movement occurs by focusing on reflection in the forms of reflection-in-action, reflection-on-action, and reflective conversations. This study specifically examines the reflection component embedded into the inaugural class of the Excellence in Teaching Program (ETP) at pseudonymous South Central University (SCU), which was designed using questions modeled after Schön’s reflection-in-action and reflection-on-action frameworks. This study affords participants the opportunity to engage in reflective conversations about the reflection component of the ETP. The participants identify four themes, including violated expectations curb motivation, perceived meaningfulness promotes engagement, feedback promotes reflection, and the notion that learners will learn whether developmental programming is perceived favorably or negatively

Focusing on Management in the Family: Your Values, A Basis for Management.

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Refrigerators and Freezers.

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Selection, Use and Care of Major Home Appliances.

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Rural Child Care in Missouri: How to Improve it

Includes bibliographical references.During 1997 and 1998, a large study called Project REACH (Rural EArly CHildhood Professional Development Initiative), was conducted in a series of interventions over a 16 month period in rural Missouri. The training and follow up was intensive, continuous and individualized. An overview of the results are provided

Women With Breast Cancer: Photo-elicitation Interviews Using Photographs of Women with the Same Disease

AbstractSince the 1970s there has been an increase in the number of fine art photographs of women with breast cancer. The objectives of this study were to examine: a) how women who have experienced breast cancer reacted and related to a book of nude photographs of other women with breast cancer, and b) their recommendations concerning the presentation of such photos to other women with breast cancer. This photo-elicitation study involved interviews with 15 women who had experienced breast cancer and the findings revealed that the majority of the women felt that the book of nude photographs gave them a sense of hope for the future. In addition, the findings showed some diversity of opinion about when, how and where to use the book of photos. They disagreed if it should be viewed as soon as women are diagnosed with breast cancer or later in their treatment. Finally, the recommendations included having the photos: a) presented to patients by physicians, b) available in physicians’ waiting rooms and chemotherapy rooms, c) available for women’s partners/husbands, and d) included as part of therapy. The results suggest that some women who have had breast cancer, perhaps with more of a postmodern versus modern orientation, benefit from viewing fine art photographs of other women with the same disease.  Viewing such photographs assists them in identifying with other women with breast cancer who appear elegant, beautiful, in satisfying relationships and accepting for their physical conditions. 论文摘要 乳腺癌患者：利用同病女性的图片进行的照片引谈调查 自20世纪70年代以来，以罹患乳腺癌女性为拍摄对象的艺术摄影数量不断增加。这篇论文旨在对两方面进行调查研究：一、乳腺癌患者面对一本其他女性患者裸体人像图册的反应与共鸣；二、她们对此类照片的展示方式有何建议。这项照片引谈研究访问了15名乳腺癌患者。绝大部分受访者认为这本图册让她们感觉对未来充满希望。另外，研究还显示受访者对于何时何地以何种方式展示这本图册持有不同见解。有些人认为患者一旦被确诊就应该接触这类图片，另外一些人则认为应该在随后的治疗中使用。受访者对图册使用的建议包括：一、由医生向患者展示；二、放置于候诊区和化疗室；三、向患者的配偶或伴侣展示；四、把图册展示作为治疗的一部分。研究结果表明，那些具有后现代主义而非现代主义倾向的患者更能从这些艺术摄影中汲取正面能量。气质优雅、形象美丽，对两性关系满意并接纳自身生理状况，图片主人公所传达的这些积极信息能帮助此类受访者找到身份认同。 关键词：乳腺癌，摄影，照片引谈Frauen mit Brustkrebs: Photo Elicitation-Interviews unter Verwendung von Fotografien von Frauen mit derselben Krankheit Seit den 1970er Jahren gibt es eine vermehrte Anzahl an Kunstfotografien zu Frauen mit Brustkrebs. Ziel dieser Studie war es zu untersuchen wie a) Frauen, die an Brustkrebs litten, auf ein Buch mit Nacktbildern von andern Frauen mit Brustkrebs reagierten und b) ihre Empfehlungen für eine Präsentation dieser Fotografien für andere Frauen mit Brustkrebs ausfielen. Diese Photo Elicitation-Untersuchung  beinhaltete Interviews mit 15 Frauen, die an Brustkrebs litten und die Ergebnisse zeigten, dass das Betrachten des Bandes einer Mehrheit der Frauen ein Gefühl von Hoffnung verlieh. Weiter zeigten die Ergebnisse eine Diversität von Meinungen darüber, wann, wie und wo der Fotografieband zu verwenden sei. Schliesslich könnten die Fotografien gemäss ihren Meinungen a) vom behandelnden Arzt/der behandelnden Ärztin  den Patientinnen gezeigt werden oder b) in Warteräumen und Chemotherapieräumen aufgelegt werden oder c) den Ehemännern/Partnern der Frauen zur Verfügung gestellt werden oder d) in die Therapie integriert werden. Die Ergebnisse deuten darauf hin, dass einige der Frauen, die Brustkrebs hatten und wahrscheinlich eher über eine postmoderne, denn moderne Gesinnung verfügen, von der Ansicht von Kunstfotografien von Frauen mit derselben Krankheit profitieren. Das Betrachten solcher Fotografien hilft ihnen, sich mit andern Frauen mit Brustkrebs, die elegant, schön, in befriedigenden Beziehungen lebend und ihre körperliche Verfassung akzeptierend erscheinen, zu identifizieren Schlüsselwörter: Brustkrebs, Fotografie, Photo Elicitation 

Your Buying Decisions.

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Decisions About Dishwashers.

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