Abstract Purpose Diabetes self-management is essential for diabetes control, yet little is known about patient preferences for sources of health information or about the extent to which information ...is sought directly or received passively through various media sources. The aim of this qualitative study was to identify how individuals with diabetes seek and use health care information. Methods Using a health information model to guide our research, we conducted 9 focus groups with 46 adults with a diagnosis of diabetes and then analyzed the transcripts and notes from these focus groups. Results Five themes emerged: (1) passive receipt of health information about diabetes is an important aspect of health information behavior; (2) patients weave their own information web depending on their disease trajectory; (3) patients' personal relationships help them understand and use this information; (4) a relationship with a health care professional is needed to cope with complicated and sometimes conflicting information; and (5) health literacy makes a difference in patients' ability to understand and use information. Conclusions Patients make decisions about diabetes self-management depending on their current needs, seeking and incorporating diverse information sources not traditionally viewed as providing health information. Based on our findings, we have developed a new health information model that reflects both the nonlinear nature of health information-seeking behavior and the interplay of both active information seeking and passive receipt of information.
Since the Institute of Medicine (IOM) reports on medical errors and quality, national attention has focused on improving patient safety through changes in "systems" of care. These reports resulted in ...a new paradigm that, rather than centering on individual errors, focuses on the "systems" necessary to facilitate and enhance quality and protect patients.
To assess the status of hospital patient safety systems since the release of the IOM reports and to identify changes over time in 2 states that collaborated on a patient safety project funded by the Agency for Healthcare Research and Quality.
Survey of all acute care hospitals in Missouri and Utah at 2 points in time, in 2002 and 2004, using a 91-item comprehensive questionnaire (n = 126 for survey 1 and n = 128 for survey 2). To assess changes over time, we also studied the cohort of 107 hospitals that responded to both surveys.
Responses to the 91-question survey as well as changes in responses to the survey questions over an 18-month period. Seven latent variables were constructed to represent the most important patient safety constructs studied: computerized physician order entry systems, computerized test results, and assessments of adverse events; specific patient safety policies; use of data in patient safety programs; drug storage, administration, and safety procedures; manner of handling adverse event/error reporting; prevention policies; and root cause analysis. For each hospital, the 7 latent variables were summed to give an overall measure of the patient safety status of the hospital.
Development and implementation of patient safety systems is at best modest. Self-reported regression in patient safety systems was also found. While 74% of hospitals reported full implementation of a written patient safety plan, nearly 9% reported no plan. The area of surgery appears to have the greatest level of patient safety systems. Other areas, such as medications, with a long history of efforts in patient safety and error prevention, showed improvements, but the percentage of hospitals with various safety systems was already high at baseline for many systems. Some findings are surprising, given the overall trends; for example, while a substantial percentage of hospitals have medication safety systems, only 34.1% corrected reported full implementation at survey 2 of computerized physician order entry systems for medications, despite the growth of computer technology in general and in hospital billing systems in particular.
The current status of hospital patient safety systems is not close to meeting IOM recommendations. Data are consistent with recent reports that patient safety system progress is slow and is a cause for great concern. Efforts for improvement must be accelerated.
Mentoring has been acknowledged as a critical factor in the development of family medicine academicians. Specific aims were to describe the research mentoring in family medicine from the experience ...of both mentors and protégés and identify characteristics that mentors and protégés associated with a successful mentoring relationship. The Grant Generating Project (GGP) Fellowship, a training and mentoring program for family medicine researchers, provided a natural opportunity to study these issues and better understand what is successful in research mentoring.
Separate mentor and protégés surveys measured perceptions about the extent of mentoring assistance, perceived relationship success, costs and benefits of the relationship, and the nature and duration of the relationship. Correlations between demographic characteristics and the mentoring relationship were also examined.
Mentors were generally professors (78%), male (82%), with a mean age of 53 years, while protégés were assistant professors (53%) and almost evenly divided between male (51%) and female (49%) with mean age of 44 years. Both mentors and protégés describe the mentoring relationship in general to be of benefit to both mentor and protégé. Nonetheless, statistically significant differences between mentor-protégé responses were found for nine of the 20 survey items. Mentors tended to give higher values in their ratings of specific mentor-protégé relationship variables. Significant positive correlations were found between benefit, quality of the relationship, and mentoring assistance and the number of hours per month of mentor-protégé interaction, the number of mentor-protégé meetings per month, and the number of months the mentor worked with the protégé. Mentor-protégé acquaintance before the GGP fellowship was significantly correlated with cost, benefit, and mentoring assistance.
This study shows agreement between mentor and protégé regarding the mentors' ability to promote the protégés, provide important technical skills, convey respect for the protégés, and serve as a friend and role model. Protégés tend to be more connected with their colleagues and with their profession, perhaps in part because the mentoring relationship facilitates networking opportunities provided by the mentor. In particular, excellent mentors can provide protégés with opportunities to meet other influential scholars at conferences and/or through various forms of correspondence. Such relationships can be helpful to the protégé in developing a constellation of mentoring relationships that may result in more successful research careers. Future studies should examine the relationship upon various outcomes.
Hospitals have made slow progress in meeting the Institute of Medicine's patient safety goals, and implementation of safety systems has been inconsistent. The next logical question is this: What ...organizational characteristics predict greater implementation of patient safety systems, in terms of both extent of systems and progress over time? To answer this question, a survey was administered to 107 hospitals at two points in time. Data were consolidated into seven latent variables measuring progress in specific areas. Using the overall measure, Joint Commission-accredited hospitals showed statistically significant improvement, as reflected in the sum score (p = .01); nonaccredited hospitals did not show statistically significant improvement (p = .21). Joint Commission accreditation was the key predictor of patient safety system implementation. Management type and urban/rural status were secondary predictors. Several factors may account for the strong association between accreditation and patient safety system implementation. In 2003, the Joint Commission began tying accreditation to patient safety goals. Also, Joint Commission data are now widely available to the public and may stimulate hospitals to address safety issues. Healthcare executives, hospital trustees, regulators, and policymakers should encourage Joint Commission accreditation and reward hospital efforts toward meeting Joint Commission standards. The Joint Commission should continually strive to maintain evidence-based and state-of-the-art standards that advance the aim of providing the best possible care for hospitalized patients.
Context and Purpose:With heightened attention to medical errors and patient safety, we surveyed Utah and Missouri hospitals to assess the "state of the art" in patient safety systems and identify ...changes over time. This study examines differences between urban and rural hospitals.Methods:Survey of all acute care hospitals in Utah and Missouri at 2 points in time (2002 and 2004). Factor analysis was used to develop 7 latent variables to summarize the data, comparing rural and urban hospitals at each point in time and on change between the 2 survey times.Findings:On 3 of the 7 latent variables, there was a statistically significant difference between rural and urban hospitals at the first survey, with rural hospitals indicating lower levels of implementation. The differences remained present on 2 of those latent variables at the second survey. In both cases, 1 of those variables was computerized physician order entry (CPOE) systems. Rural hospitals reported more improvement in systems implementation between the 2 survey times, with the difference statistically significant on 1 of the 7 latent variables; the greatest improvement was in implementation of "root cause analysis."Conclusions:Adoption of patient safety systems overall is low. Although rates of adoption among rural versus urban hospitals appear lower, most differences are not statistically significant; the gap between rural and urban hospitals relative to quality measures is narrowing. Change in rural and urban hospitals is in the right direction, with the rate of change higher in rural hospitals for many systems.
Pay for performance is a concept recently on the agenda of many health care providers, administrators, insurers, and payors in their search for methods to provide the best care at the most efficient ...price. At the same time it promises to promote quality care by paying financial incentives to providers who perform well clinically. As the fields continue to debate this approach, the following article explores how the pay-for-performance concept may be applied to one of the most prevalent chronic illnesses: diabetes. It identifies some of the issues and problems that may be faced with diseases such as diabetes, in which outcomes rely greatly on the role of the patient in self-management. Such considerations must be taken into account in the event of the refinement and implementation of pay for performance.
We surveyed Missouri's acute-care hospitals twice to assess the "state of the art" in patient safety systems. We found improvements in all areas studied, but progress is modest and falls short of ...national recommendations. We urge all Missourians to become more knowledgeable and assertive consumers of hospital care, and we ask them to support Missouri hospitals in their patient safety efforts, including provision of financial resources to put necessary systems in place.
Severe dietary restriction, catabolic states and even short-term caloric
deprivation impair fertility in mammals. Likewise, obesity is associated with
infertile conditions such as polycystic ovary ...syndrome.
The reproductive status of lower organisms such as Caenorhabditis elegans
is also modulated by availability of nutrients. Thus,
fertility requires the integration of reproductive and metabolic signals.
Here we show that deletion of insulin receptor substrate-2 (IRS-2), a component
of the insulin/insulin-like growth factor-1 signalling cascade, causes female
infertility. Mice lacking IRS-2 have small, anovulatory ovaries with reduced
numbers of follicles. Plasma concentrations of luteinizing hormone, prolactin
and sex steroids are low in these animals. Pituitaries are decreased in size
and contain reduced numbers of gonadotrophs. Females lacking IRS-2 have increased
food intake and obesity, despite elevated levels of leptin. Our findings indicate
that insulin, together with leptin and other neuropeptides, may modulate hypothalamic
control of appetite and reproductive endocrinology. Coupled with findings
on the role of insulin-signalling pathways in the regulation of fertility,
metabolism and longevity in C. elegans and Drosophila,
we have identified an evolutionarily conserved mechanism in mammals that regulates
both reproduction and energy homeostasis.
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