DEDICATE: proposal for a conceptual framework to develop dementia-friendly Integrated eCare support

Background: Evidence shows that the implementation of Information and Communication Technologies (ICT) enabled services supporting integrated dementia care represents an opportunity that faces multi-pronged challenges. First, the provision of dementia support is fragmented and often inappropriate. Second, available ICT solutions in this field do not address the full spectrum of support needs arising across an individual’s whole dementia journey. Current solutions fail to harness the potential of available validated e-health services, such as telehealth and telecare, for the purposes of dementia care. Third, there is a lack of understanding of how viable business models in this field can operate. The field comprises both professional and non-professional players that interact and have roles to play in ensuring that useful technologies are developed, implemented and used. Methods: Starting from a literature review, including relevant pilot projects for ICT-based dementia care, we define the major requirements of a system able to overcome the limitations evidenced in the literature, and how this system should be integrated in the socio-technical ecosystem characterizing this disease. From here, we define the DEDICATE architecture of such a system, and the conceptual framework mapping the architecture over the requirements. Results: We identified three macro-requirements, namely the need to overcome: deficient technology innovation, deficient service process innovation, and deficient business models innovation. The proposed architecture is a three level architecture in which the center (data layer) includes patients’ and informal caregivers’ preferences, memories, and other personal data relevant to sustain the dementia journey, is connected through a middleware (service layer), which guarantees core IT services and integration, to dedicated applications (application layer) to sustain dementia care (Formal Support Services, FSS), and to existing formal care infrastructures, in order to guarantee care coordination (Care Coordination Services, CCS). Conclusions: The proposed DEDICATE architecture and framework envisages a feasible means to overcome the present barriers by: (1) developing and integrating technologies that can follow the patient and the caregivers throughout the development of the condition, since the early stages in which the patient is able to build up preferences and memories will be used in the later stages to maximise personalization and thereby improve efficacy and usability (technology innovation); (2) guaranteeing the care coordination between formal and informal caregivers, and giving an active yet supported role to the latter (service innovation); and (3) integrating existing infrastructures and care models to decrease the cost of the overall care pathway, by improving system interoperability (business model innovation)

A systematic review and meta-analysis of bone metabolism in prostate adenocarcinoma

<p/> <p>Background</p> <p>Osteoporosis could be associated with the hormone therapy for metastatic prostate carcinoma (PCa) and with PCa <it>per se</it>. The objective of this review is to determine the incidence of bone loss and osteoporosis in patients with PCa who are or are not treated with hormone therapy (ADT).</p> <p>Methods</p> <p>The Medline, Embase, Cancerlit, and American Society of Clinical Oncology Abstract databases were searched for published studies on prostate cancer and bone metabolism. The outcomes assessed were: fracture, osteoporosis and osteopenia.</p> <p>Results</p> <p>Thirty-two articles (116,911 participants) were included in the meta-analysis. PCa patients under ADT had a higher risk of osteoporosis (RR, 1.30; <it>p </it>< 0.00001) and a higher risk of fractures (RR, 1.17; <it>p </it>< 0.00001) as compared to patients not under ADT. The total bone mineral density was lower in patients under ADT when compared with patients not under ADT (<it>p </it>= 0.031) but it was similar to bone mineral density found in healthy controls (<it>p </it>= 0.895). The time of androgen deprivation therapy correlated negatively with lumbar spine and total hip bone mineral density (Spearman's rho = -0.490 and -0.773; <it>p </it>= 0.028 and 0.001, respectively) and with total hip <it>t </it>score (Spearman's rho = -0.900; <it>p </it>= 0.037).</p> <p>Conclusion</p> <p>We found consistent evidence that the use of androgen deprivation therapy in patients with PCa reduces bone mineral density, increasing the risk of fractures in these patients.</p

When impediments make you jump rather than stumble: Regulatory nonfit, implementation intentions, and goal attainment

This paper examines the relative effectiveness of forming implementation intentions (i. e., making specific plans regarding how to go about achieving a goal) for increasing goal attainment under regulatory fit vs. nonfit. We discuss and empirically test the proposition that regulatory nonfit increases the effectiveness of implementation intentions. Extant research contrasts goals of differing difficulty (e. g., buying a textbook vs. finding an apartment) in order to test the relative effectiveness of implementation intentions. In contrast, the present study focuses on identifying the change in implementation intention effectiveness for the same goal (i. e., collecting and turning in receipts for a reward) under conditions of fit vs. nonfit. We empirically demonstrate that when faced with the same goal, people who experience regulatory nonfit perceive the task to be more difficult to complete than people who experience regulatory fit. In turn, when the task is perceived as being more difficult, implementation intentions prove more effective to enhance goal attainment. Our study provides insight into the interaction between regulatory fit and implementation intentions and subsequent effects on goal attainment. © 2011 Springer Science+Business Media, LLC

Unintended effects of implementation intentions on goal pursuit initiation vs. persistence: Substitution and acceleration

When trying to achieve a goal (such as losing five pounds), people run into problems with getting started (begin controlling one's diet), keeping at it (continue cutting out the sugar), or both. Failure at either initiation or persistence in goal striving reduces goal attainment significantly. One way to overcome these challenges is to form implementation intentions (i.e., make detailed plans on when, where, and how to enact goal-directed behaviors, Gollwitzer 1999). Implementation intentions improve action initiation under cognitive load (Brandstaetter, Lengfelder, and Gollwitzer 2001), and shield goal pursuit behaviors from distractions (Bayer, Gollwitzer, and Achtziger 2010). Most implementation intentions research focuses on the outcome (i.e., goal attainment), not distinguishing between initiation and persistence or examining them independently (Gollwitzer and Sheeran 2006). It is unclear if planning out goal-directed behaviors is equally effective for starting and persisting in goal pursuit and what the underlying mechanisms are. The present research addresses this gap. © 2012

Employer–Employee Congruence in Environmental Values: An Exploration of Effects on Job Satisfaction and Creativity

© 2014, Springer Science+Business Media Dordrecht. This study examines how the match (vs. mismatch) between personal and firm-level values regarding environmental responsibility affects employee job satisfaction and creativity and contributes to three literature streams [i.e., social corporate responsibility, creativity, and person–environment (P–E) fit]. Building on the P–E fit literature, we propose and test environmental orientation fit versus nonfit effects on creativity, identifying job satisfaction as a mediating mechanism and regulatory pressure as a moderator. An empirical investigation indicates that the various environmental orientation fit conditions affect job satisfaction and creativity differently. More specifically, environmental orientation fit produces greater job satisfaction and creativity when the employee and organization both demonstrate high concern for the environment (i.e., a high–high environmental orientation fit condition) than when both display congruent low concern for the environmental (i.e., a low–low environmental orientation fit condition). Furthermore, for employees working in organizations that fit their personal environmental orientation, strong regulatory pressure to comply with environmental standards diminishes the positive fit effect on job satisfaction and creativity, while regulatory pressure does not affect the job satisfaction and creativity of employees whose personal environmental orientation is incongruent with that of the organization