Adapting an in‐person patient–caregiver communication intervention to a tailored web‐based format

Background : Interventions that target cancer patients and their caregivers have been shown to improve patient‐caregiver communication, support, and emotional well‐being. Objective : To adapt an in‐person communication intervention for cancer patients and caregivers to a web‐based format, and to examine the usability and acceptability of the web‐based program among representative users. Methods : A tailored, interactive web‐based communication program for cancer patients and their family caregivers was developed based on an existing in‐person, nurse‐delivered intervention. The development process involved: (1) building a multidisciplinary team of content and web design experts, (2) combining key components of the in‐person intervention with the unique tailoring and interactive features of a web‐based platform, and (3) conducting focus groups and usability testing to obtain feedback from representative program users at multiple time points. Results : Four focus groups with 2–3 patient–caregiver pairs per group ( n = 22 total participants) and two iterations of usability testing with four patient–caregiver pairs per session ( n = 16 total participants) were conducted. Response to the program's structure, design, and content was favorable, even among users who were older or had limited computer and Internet experience. The program received high ratings for ease of use and overall usability (mean System Usability Score of 89.5 out of 100). Conclusions : Many elements of a nurse‐delivered patient–caregiver intervention can be successfully adapted to a web‐based format. A multidisciplinary design team and an iterative evaluation process with representative users were instrumental in the development of a usable and well‐received web‐based program. Copyright © 2011 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90066/1/pon1900.pd

Barriers of technology integration in kindergarten through fifth grade

Many teachers understand the benefits of integrating technology in K through 5th grade classrooms, however, technology is not being effectively integrated. The purpose of this review is to identify the barriers of technology integration in kindergarten through 5th grade and discuss ways in which to remove those barriers. This review includes many research articles, books, websites, a blog, and an interview. For the purposes of this review, the barriers to integration have been divided into two categories: first and second-order barriers. First-order barriers are extrinsic to the teacher and include issues such as lack of time, money, and technical support. Second-order barriers are intrinsic to the teacher and are often the underlying causes that prevent integration from occurring. The results of this review conclude that for true technology integration to occur, second-order barriers must be addressed. Within this review, several ideas are presented that will assist educators in removing the barriers that currently exist in technology integration

Patterns in the Poetry of Sylvia Plath, Denise Levertov, and Howard Nemerov

Nearly all would agree that the first purpose of literary criticism is to determine the artistic merit of a written work. Of course, this general agreement founders when it is carried to its logical step: deciding on the criteria for this aesthetic evaluation. The multiplicity of critical approaches currently appreciated create a morass of aesthetic criteria that largely leaves the initial purpose of literary criticism without any definitive statement. We all know the purpose of criticism is to discern art from non-art, but the subjectivity of this intended purpose, coupled with its sheer simplicity of expression, leaves the critic with his own basic dilemma. This dilemma arises since the general agreement that criticism should be the determination of art is lost a priori. For why would the critic, excluding extreme personal prejudices or messianic attitude, bother in the first instance to expand his talent on a work devoid of artistic merit? The answer is self-evident: he would not. Therefore, the general agreement on the first purpose of literary criticism is only tenable insofar as the determination of art is made solely through the critical effort and the desires that initiate it. The literary critic has determined in his own mind that a particular work, or collection of works, is art before he begins to examine it from a specific critical viewpoint

Randomized clinical trial of a family intervention for prostate cancer patients and their spouses

BACKGROUND. Few intervention studies have been conducted to help couples manage the effects of prostate cancer and maintain their quality of life. The objective of this study was to determine whether a family-based intervention could improve appraisal variables (appraisal of illness or caregiving, uncertainty, hopelessness), coping resources (coping strategies, self-efficacy, communication), symptom distress, and quality of life in men with prostate cancer and their spouses. METHODS. For this clinical trial, 263 patient-spouse dyads were stratified by research site, phase of illness, and treatment; then, they were randomized to the control group (standard care) or the experimental group (standard care plus a 5-session family intervention). The intervention targeted couples' communication, hope, coping, uncertainty, and symptom management. The final sample consisted of 235 couples: 123 couples in the control group and 112 couples in the experimental group. Data collection occurred at baseline before randomization and at 4 months, 8 months, and 12 months. RESULTS. At 4-month follow-up, intervention patients reported less uncertainty and better communication with spouses than control patients, but they reported no other effects. Intervention spouses reported higher quality of life, more self-efficacy, better communication, and less negative appraisal of caregiving, uncertainty, hopelessness, and symptom distress at 4 months compared with controls, and some effects were sustained to 8 months and 12 months. CONCLUSIONS. Men with prostate cancer and their spouses reported positive outcomes from a family intervention that offered them information and support. Programs of care need to be extended to spouses who likely will experience multiple benefits from intervention. Cancer 2007. © 2007 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57507/1/23114_ftp.pd

Study of dyadic communication in couples managing prostate cancer: a longitudinal perspective

Objective : Cancer patients and partners often report inadequate communication about illness‐related issues, although it is essential for mutual support and informal caregiving. This study examined the patterns of change in dyadic communication between patients with prostate cancer and their partners, and also determined if certain factors affected their communication over time. Method : Using multilevel modeling, this study analyzed longitudinal data obtained from a randomized clinical trial with prostate cancer patients and their partners, to examine their communication over time. Patients and partners ( N =134 pairs) from the usual‐care control group independently completed baseline demographic assessment and measures of social support, uncertainty, symptom distress, and dyadic communication at baseline, and 4‐, 8‐, and 12‐month follow‐ups. Results : The results indicated that (1) patients and partners reported similar levels of open communication at the time of diagnosis. Communication reported by patients and partners decreased over time in a similar trend, regardless of phase of illness; (2) phase of illness affected couples' open communication at diagnosis but not patterns of change over time; and (3) couples' perceived communication increased as they reported more social support, less uncertainty, and fewer hormonal symptoms in patients. Couples' demographic factors and general symptoms, and patients' prostate cancer‐specific symptoms did not affect their levels of open communication. Conclusions : Perceived open communication between prostate cancer patients and partners over time is affected by certain baseline and time‐varying psychosocial and cancer‐related factors. The results provide empirical evidence that may guide the development of strategies to facilitate couples' interaction and mutual support during survivorship. Copyright © 2010 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89519/1/pon1861.pd

Advancing tendencies? PR leadership, general leadership, and leadership pedagogy

What are the best ways to advance PR leadership? In exploring answers, we consider the last two decades of PR literature and identify two main tendencies. We link those two with general leadership literature and practices, as well as with literature on leadership pedagogy. We conclude that, rather than recent moves to look within the field, without self-reflection, to existing PR perspectives and figures for solutions, looking outwards has greater potential to transform not only the PR leadership literature, and PR practice, but also to create less hierarchical, and more democratic and "leaderful," PR workplaces. © 2014

Comparative effectiveness research: Using systematic reviews and meta-analyses to synthesize empirical evidence

The increased demand for evidence-based health care practices calls for comparative effectiveness research (CER), namely the generation and synthesis of research evidence to compare the benefits and harms of alternative methods of care. A significant contribution of CER is the systematic identification and synthesis of available research studies on a specific topic. The purpose of this article is to provide an overview of methodological issues pertaining to systematic reviews and meta-analyses to be used by investigators with the purpose of conducting CER. A systematic review or meta-analysis is guided by a research protocol, which includes (a) the research question, (b) inclusion and exclusion criteria with respect to the target population and studies, (c) guidelines for obtaining relevant studies, (d) methods for data extraction and coding, (e) methods for data synthesis, and (f) guidelines for reporting results and assessing for bias. This article presents an algorithm for generating evidence-based knowledge by systematically identifying, retrieving, and synthesizing large bodies of research studies. Recommendations for evaluating the strength of evidence, interpreting findings, and discussing clinical applicability are offered

A family-based model to predict fear of recurrence for cancer survivors and their caregivers

Although fear of cancer recurrence is a great concern among survivors and their families, few studies have examined predictors of fear of recurrence. The purpose of this study was to identify factors associated with fear of recurrence in a population-based sample ( N = 246) and determine if survivors and family caregivers influenced one another's fear of recurrence. A family framework guided the study and analyses included multilevel modeling using the Actor-Partner Interdependence Model. Results indicated that survivors and family caregivers influenced each other's fear of recurrence and that caregivers had significantly more fear of recurrence than survivors. More family stressors, less positive meaning of the illness, and age were related to elevated fear of cancer recurrence for both survivors and caregivers. Copyright © 2006 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55961/1/1074_ftp.pd

Against the Public's Will

This summary of responses to the U.S. Environmental Protection Agency's (EPA) plans to cut toxic reporting offers a detailed analysis of the comments submitted to EPA's public docket on the proposed changes to the Toxics Release Inventory (TRI). The report identifies nine stakeholder groups, details the level of support or opposition of each group, and summarizes the main points raised by each group