Evidence On The Chronic Care Model In The New Millennium

Developed more than a decade ago, the Chronic Care Model (CCM) is a widely adopted approach to improving ambulatory care that has guided clinical quality initiatives in the United States and around the world. We examine the evidence of the CCM’s effectiveness by reviewing articles published since 2000 that used one of five key CCM papers as a reference. Accumulated evidence appears to support the CCM as an integrated framework to guide practice redesign. Although work remains to be done in areas such as cost-effectiveness, these studies suggest that redesigning care using the CCM leads to improved patient care and better health outcomes

Impact of long-range interactions on the disordered vortex lattice

The interaction between the vortex lines in a type-II superconductor is mediated by currents. In the absence of transverse screening this interaction is long-ranged, stiffening up the vortex lattice as expressed by the dispersive elastic moduli. The effect of disorder is strongly reduced, resulting in a mean-squared displacement correlator = characterized by a mere logarithmic growth with distance. Finite screening cuts the interaction on the scale of the London penetration depth \lambda and limits the above behavior to distances R<\lambda. Using a functional renormalization group (RG) approach, we derive the flow equation for the disorder correlation function and calculate the disorder-averaged mean-squared relative displacement \propto ln^{2\sigma} (R/a_0). The logarithmic growth (2\sigma=1) in the perturbative regime at small distances [A.I. Larkin and Yu.N. Ovchinnikov, J. Low Temp. Phys. 34, 409 (1979)] crosses over to a sub-logarithmic growth with 2\sigma=0.348 at large distances.Comment: 9 pages, no figure

Matching and surface barrier effects of the flux-line lattice in superconducting films and multilayers.

The flux-line lattice dissipation and the pinning force of Bi2Sr2CaCu2O8 and YBa2Cu3O7 films and a Nb/Cu multilayer are investigated with the vibrating reed technique. In magnetic fields oriented under a small angle with respect to the film surfaces the Bi-2:2:1:2 film shows a series of pronounced dissipation maxima at matching fields BN in the irreversible region of the magnetic phase diagram. The Y-1:2:3 film shows tiny damping maxima, whereas no structure in the dissipation of the Nb/Cu multilayer is detected below the upper critical field. The comparison of the matching fields to an anisotropic London model shows that the dissipation maxima are caused by rearrangements of the flux-line lattice configuration due to interactions with the sample surface. The different behavior of the high-temperature superconductors and the Nb/Cu multilayer is understood by explicitly taking the surface barrier into account. Deviations from the surface induced commensurability of the flux-line lattice due to the intrinsic pinning are discussed. Our results indicate that pancake vortices in the Bi-2:2:1:2 film should be coupled below the irreversibility line and below magnetic fields B??0.5 T perpendicular to the film surface

The mental health expert patient: findings from a pilot study of a generic chronic condition self-management programme for people with mental illness

Author version made available in accordance with the publisher's policyBackground Less than optimal outcomes and escalating costs for chronic conditions including mental illness have prompted calls for innovative approaches to chronic illness management. Aims This study aimed to test the feasibility and utility of combining a generic, clinician administered and peer-led self-management group approach for people with serious mental illness. Method General practitioners and mental health case managers used a patient-centered care model (the Flinders Model) to assist 38 patients with serious mental illness to identify their self-management needs, and match these with interventions including Stanford peer-led, self-management groups and one-to-one peer support. Self-management and quality of life outcomes were measured and qualitative evaluation elicited feedback from all participants. Results Collaborative care planning, combined with a problems and goals focused approach, resulted in improved self-management and mental functioning at 3 to 6 months follow up. The Stanford self-management course was applicable and acceptable to patients with serious mental illnesses. Qualitative feedback was highly supportive of this approach. Conclusions Generic, structured assessment and care planning approaches, resulting in self-management education targeted to the individual, improved self-management and quality of life. Patients and service providers reported considerable gains despite the challenges associated with introducing a generic model within the mental health and general practice sector

The mental health expert patient: findings from a pilot study of a generic chronic condition self-management programme for people with mental illness

Author version made available in accordance with the publisher's policyBackground Less than optimal outcomes and escalating costs for chronic conditions including mental illness have prompted calls for innovative approaches to chronic illness management. Aims This study aimed to test the feasibility and utility of combining a generic, clinician administered and peer-led self-management group approach for people with serious mental illness. Method General practitioners and mental health case managers used a patient-centered care model (the Flinders Model) to assist 38 patients with serious mental illness to identify their self-management needs, and match these with interventions including Stanford peer-led, self-management groups and one-to-one peer support. Self-management and quality of life outcomes were measured and qualitative evaluation elicited feedback from all participants. Results Collaborative care planning, combined with a problems and goals focused approach, resulted in improved self-management and mental functioning at 3 to 6 months follow up. The Stanford self-management course was applicable and acceptable to patients with serious mental illnesses. Qualitative feedback was highly supportive of this approach. Conclusions Generic, structured assessment and care planning approaches, resulting in self-management education targeted to the individual, improved self-management and quality of life. Patients and service providers reported considerable gains despite the challenges associated with introducing a generic model within the mental health and general practice sector

The Effects of Media and their Logic on Legitimacy Sources within Local Governance Networks: A Three-Case Comparative Study

__Abstract__ Although theoretical and empirical work on the democratic legitimacy of governance networks is growing, little attention has been paid to the impact of mediatisation on democracies. Media have their own logic of news-making led by the media’s rules, aims, production routines and constraints, which affect political decision-making processes. In this article, we specifically study how media and their logic affect three democratic legitimacy sources of political decision-making within governance networks: voice, due deliberation and accountability. We conducted a comparative case study of three local governance networks using a mixed method design, combining extensive qualitative case studies, interviews and a quantitative content analysis of media reports. In all three cases, media logic increased voice possibilities for citizen groups. Furthermore, it broadened the deliberation process, although this did not improve the quality of this process per se, because the media focus on drama and negativity. Finally, media logic often pushed political authorities into a reactive communication style as they had to fight against negative images in the media. Proactive communication about projects, such as public relation (PR) strategies and branding, is difficult in such a media landscape

Cultural orientations and preference for HRM policies and practices:the case of Oman

This study empirically examines the influence of cultural orientations on employee preferences of human resource management (HRM) policies and practices in Oman. Data were collected from 712 employees working in six large Omani organizations. The findings indicate that there is a number of differences among Omani employees regarding value orientations due especially to age, education and work experience. The findings show a strong orientation towards mastery, harmony, thinking and doing, and a weak orientation towards hierarchy, collectivism, subjugation and human nature-as-evil. The results demonstrate a clear link between value orientations and preferences for particular HRM policies and practices. Group-oriented HRM practices are preferred by those who scored high on collectivism and being orientations, and those who scored low on thinking and doing orientations. Hierarchy-oriented HRM practices are preferred by those scoring high on hierarchy, subjugation and human nature-as-bad orientations, and those scoring low on thinking and mastery orientations. Finally, preference for loose and informal HRM practices was positively associated with being, and negatively associated with thinking, doing and harmony orientations. The theoretical and practical implications of these findings are discussed in detail

Spanning forests and the q-state Potts model in the limit q \to 0

We study the q-state Potts model with nearest-neighbor coupling v=e^{\beta J}-1 in the limit q,v \to 0 with the ratio w = v/q held fixed. Combinatorially, this limit gives rise to the generating polynomial of spanning forests; physically, it provides information about the Potts-model phase diagram in the neighborhood of (q,v) = (0,0). We have studied this model on the square and triangular lattices, using a transfer-matrix approach at both real and complex values of w. For both lattices, we have computed the symbolic transfer matrices for cylindrical strips of widths 2 \le L \le 10, as well as the limiting curves of partition-function zeros in the complex w-plane. For real w, we find two distinct phases separated by a transition point w=w_0, where w_0 = -1/4 (resp. w_0 = -0.1753 \pm 0.0002) for the square (resp. triangular) lattice. For w > w_0 we find a non-critical disordered phase, while for w < w_0 our results are compatible with a massless Berker-Kadanoff phase with conformal charge c = -2 and leading thermal scaling dimension x_{T,1} = 2 (marginal operator). At w = w_0 we find a "first-order critical point": the first derivative of the free energy is discontinuous at w_0, while the correlation length diverges as w \downarrow w_0 (and is infinite at w = w_0). The critical behavior at w = w_0 seems to be the same for both lattices and it differs from that of the Berker-Kadanoff phase: our results suggest that the conformal charge is c = -1, the leading thermal scaling dimension is x_{T,1} = 0, and the critical exponents are \nu = 1/d = 1/2 and \alpha = 1.Comment: 131 pages (LaTeX2e). Includes tex file, three sty files, and 65 Postscript figures. Also included are Mathematica files forests_sq_2-9P.m and forests_tri_2-9P.m. Final journal versio