Care Website Research Articles

Other Publications of Note: Greening Early Childhood Education

 2014 Children, Youth and Environments Children, Youth and Environments 24(2), 2014 Other Publications of Note: Greening Early Childhood Education International Journal of Early Childhood Environmental Education North American Association for Environmental Education ISSN 2331-0464 (online) This new publication of the North American Association for Environmental Education focuses on the education of young children from birth to eight years. Its initial issue was published in the winter of 2013, with sections on “Research,” “Advocacy Initiatives,” such as The Natural Start Alliance, “Advocacy Models,” such as the growing culture of nature play, and “Highlights of Resources and Books in Early Childhood Environmental Education.” In addition to children, articles focus on the caregivers, communities, institutions, and systems that form the larger context of learning. The journal seeks to apply research and theory to environmental education policy and practice at the local, state, regional, national and international level. For a sample issue and to subscribe, see www.naaee.net/publications. Go Green Rating Scale Handbook for Early Childhood Settings: Improving Your Score Phil Boise (2010). St. Paul, MN: Redleaf Press. $29.95 USD (paperback). ISBN 978-1-60554-007-8. Go Green Rating Scale for Early Childhood Settings Phil Boise (2009). St. Paul, MN: Redleaf Press. $19.95 USD (paperback). ISBN 978-1-60554-006-1. Greening early childhood education has the visible dimension of naturalizing school grounds, planting gardens and bringing nature indoors, but equally importantly, it has the invisible dimension of ensuring that the environment will be toxin-free for the well-being of children, staff, and larger ecosystems, and that daily operations will embody an ethic of stewardship. This comprehensive handbook and rating Other Publications of Note: Greening Early Childhood Education 256 scale condense a large amount of complex information into a sequence of sections that begin with establishing a system for staffing, reviewing, and record keeping related to environmental hazard management, and then proceed to every facet of day-to-day operations, with recommendations that go beyond minimum requirements for state licensing. A section on “Green Living and Stewardship” covers the conservation of water and energy, green building, reducing a school or center’s carbon footprint, moving to zero-waste food and food packaging, promoting organic foods, and the three R’s of reducing, reusing and recycling materials. Importantly, it also suggests how to involve children and families in these practices. Whereas the REACH program of the European Union places the burden of proof for product safety on companies, not consumers, and requires the gradual replacement of hazardous substances with safer alternatives, the United States remains mired in an outdated and inadequate regulatory system that is heavily controlled by the chemical industry. Therefore it falls to the directors and staff of early childhood settings to ensure the safety of environments for the children in their charge. This handbook and scale show how to do this, step by step. Sections on hazards and safer alternatives cover air quality, lead and other contaminants, cleaning and hygiene products, pests and pesticides, fire retardants, outdoor materials like treated lumber and playground surfaces, and chemicals in plastics, toys and art supplies. The rating scale enables early childhood settings to consider all aspects of going green, and to monitor their progress on this path. While the handbook and scale acknowledge state licensing requirements and help child care centers meet them, they advocate the precautionary principle, which requires the use of safer alternative strategies whenever there is any potential for serious harm—the principle that underlies the European Union’s REACH program but that U.S. regulations fail to reflect. The handbook’s recommendations for best practices and the highest scores on the rating scale identify the goals that early childhood settings should aim for. Eco-Healthy Child Care website of the Children’s Environmental Health Network www.cehn.org/ehcc A 30-item checklist for “eco-healthy” child care centers and family home providers can be downloaded for free in English or Spanish from the Children’s Environmental Health Network (CEHN), a national organization that is grounded in pediatric and environmental health science, with the mission of protecting the developing child from environmental health hazards and promoting a healthier environment. If settings comply with...

Directed use of the internet for health information by patients with chronic kidney disease: prospective cohort study.

BackgroundHealth information technology has become common in the care of patients with chronic diseases; however, there are few such applications employed in kidney disease.ObjectiveThe aim of the study was to evaluate the use of a website providing disease-specific safety information by patients with predialysis chronic kidney disease.MethodsAs part of the Safe Kidney Care (SKC) study, an educational website was designed to provide information on safety concerns in chronic kidney disease. Phase I study participants were provided a medical alert accessory with a unique ID number, the Safe Kidney Care website, and an in-person tutorial on the use of the Internet and accessing the SKC website at baseline. Participants were asked to visit the website and enter their unique ID as frequently as they desired over the next 365 days or until their annual follow-up visit, whichever occurred first. Participants’ visits and dwell times on specific safety modules were tracked using embedded webpage PHP scripts linked to a MySQL database, enabling the collection of website usage statistics.ResultsOf 108 Phase I participants, 28.7% (31/108) visited the website from 1-6 times during the observation period (median follow-up 365 days). Median access time was 7 minutes per visit (range <1-46) and 13 minutes per person (range <1-123). The three most frequently visited pages were “Renal function calculator”, “Pills to avoid”, and “Foods to avoid”. High school education and frequent Internet use were significantly associated with website entry (P=.02 and P=.03, respectively).ConclusionsPreliminary results show general interest in a Web-based platform designed to improve patient safety in chronic kidney disease.Trial RegistrationClinicaltrials.gov NCT01407367; http://clinicaltrials.gov/show/NCT01407367 (Archived by WebCite at http://www.webcitation.org/6KvxFKA6M).

Choosing and using screening criteria for palliative care consultation in the ICU: a report from the Improving Palliative Care in the ICU (IPAL-ICU) Advisory Board.

To review the use of screening criteria (also known as "triggers") as a mechanism for engaging palliative care consultants to assist with care of critically ill patients and their families in the ICU. We searched the MEDLINE database from inception to December 2012 for all English-language articles using the terms "trigger," "screen," "referral," "tool," "triage," "case-finding," "assessment," "checklist," "proactive," or "consultation," together with "intensive care" or "critical care" and "palliative care," "supportive care," "end-of-life care," or "ethics." We also hand-searched reference lists and author files and relevant tools on the Center to Advance Palliative Care website. Two members (a physician and a nurse with expertise in clinical research, intensive care, and palliative care) of the interdisciplinary Improving Palliative Care in the ICU Project Advisory Board presented studies and tools to the full Board, which made final selections by consensus. We critically reviewed the existing data and tools to identify screening criteria for palliative care consultation, to describe methods for selecting, implementing, and evaluating such criteria, and to consider alternative strategies for increasing access of ICU patients and families to high-quality palliative care. The Improving Palliative Care in the ICU Advisory Board used data and experience to address key questions relating to: existing screening criteria; optimal methods for selection, implementation, and evaluation of such criteria; and appropriateness of the screening approach for a particular ICU. Use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Existing data and resources can be used in developing such criteria, which should be tailored for a specific ICU, implemented through an organized process involving key stakeholders, and evaluated by appropriate measures. In some settings, other strategies for increasing access to palliative care may be more appropriate.

Equity in Care: Picking Up the Pace

Eliminating disparities in healthcare is a goal of every American hospital. Despite our best efforts, we know that race, ethnicity, and language preference continue to affect the chance that patients will receive the care they need and the outcomes they deserve. For example, Hispanic adults with diabetes are far less likely to receive recommended preventive services and African American women are more likely to die after they are diagnosed with breast cancer than are their white counterparts. Because each hospital comprises and serves a unique community, increasing both the collection and the use of race, ethnicity, and language preference (REAL) data is an essential part of achieving equity in care for all Americans. With good data, hospitals can test the validity of their assumptions about the quality of care they provide. That care may be ideal, but without measurement, it is impossible to know. With careful measurement, every provider can document whether differences in outcomes and opportunities exist so it can improve the quality of care delivered by implementing customized approaches using evidence-based care. Supporting hospital efforts to eliminate disparities is one reason the American Hospital Association is a founding partner in the National Call to Action to Eliminate Health Care Disparities. With our partners, the American College of Healthcare Executives, Association of American Medical Colleges, Catholic Health Association of the United States, and National Association of Public Hospitals and Health Systems, we set out to achieve three interrelated goals: increase collection of REAL data, increase cultural competency training, and increase diversity in leadership. We have set up the Equity of Care website (http://www.equityofcare.org) to help hospitals, health systems, clinicians, and others improve the quality of care for each and every patient by sharing resources and best practices. We believe that most healthcare providers are moving in the right direction and that many are taking important steps to make care more equitable. But given the speed of change in our communities, we feel that this process must be accelerated, and information sharing is an important way to facilitate that. Healthcare providers must begin with a basic understanding of the population trends in the community they serve. American communities are undergoing huge demographic changes that may not immediately appear in the patient population of a given provider--but most surely will in the future. For the first time last year, most babies born in the United States were nonwhite. As health insurance coverage increases, each provider will be challenged to provide the best possible care to a unique patchwork of patient populations with different beliefs, lifestyles, family structures and support, and healthcare experiences. Planning for equitable care involves developing ongoing relationships with community organizations that can support providers' efforts to build cultural competency in delivering that care. Providers must anticipate community needs to, for example, ensure access to those with no or limited English proficiency or to develop patient education materials that consider differences in both language and culture. With careful measurement of REAL data, quality indicators, and patient outcomes--and using that information to constantly improve the quality of the care for each patient and for the community at large--providers will position themselves for future success. Measures of clinical quality and patient experience have increased significantly in recent years, and they are driving improvements across the board. But overall national quality measures cannot be readily broken down by race, ethnicity, and language preference. Recently, the Institute for Diversity in Health Management surveyed hospitals and found that 81 percent of hospitals collect REAL data, but only 18 percent used these data for quality interventions. …

Computed tomography scans and cancer risk: Safety efforts

Computed tomography scans and cancer risk: Safety efforts

Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review

BackgroundParticipatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults.ObjectiveTo review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s).MethodsA systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles.ResultsMost interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions.ConclusionsThere is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease.

Rigorous scoping review of randomized trials in pediatric critical care highlights need for a rigorous rethink

The randomized controlled trial (RCT) remains the highest-ranked study design when grading recommendations for clinical practice. In the previous issue of Critical Care, Duffett and colleagues published a scoping review of RCTs in pediatric critical care medicine and identified some serious gaps in the body of research underlying the field. Relatively few published RCTs were identified, and they were mostly small and potentially susceptible to bias. High patient heterogeneity, relatively low prevalence of specific disorders such as acute respiratory distress syndrome or septic shock, along with relatively low mortality rates, all make it difficult to improve this situation without the collaboration of pediatric critical care research networks internationally. Designing a robust RCT that can impact clinical practice has always been challenging. First, one must assess current clinical practice and disease prevalence, refine definitions and measurements, and pilot-test the intervention to be studied. The first step, however, is to rigorously assess what has already been done. This step will be facilitated by the now available, innovative, online, searchable repository of RCTs in pediatric critical care on the Evidence in Pediatric Critical Care website.

Developing a patient-led cancer care website, ‘CanCare': what do end users want?

The role of the internet, and in particular e-health, in chronic illness is a burgeoning phenomenon but its use to date in cancer care is somewhat limited. In this study an iterative consultative process was undertaken with the aim to develop a cancer care website that was patient-led, facilitated cancer self-management and had the potential to improve communication between patients, family and friends and health care professionals. The process involved multiple demonstrations of an already established base platform (SeeCare©) to potential end users (patients, family members and friends and health professionals) to identify required functions of a cancer care specific platform. An exhaustive list of specifications was prioritised and operationalised resulting in a web platform for people affected by cancer that was ready for testing in the clinical setting: CanCare.

Trialling a patient-led cancer care website in an acute cancer care setting

Health ICT is rapidly gaining popularity among policy makers and health consumers. Specific platforms for use in cancer care are missing. Aim: The aim of this pilot study was to: 1) test the feasibility, functionality and usability of a patient-led cancer care web platform: CanCare, in a sample of people undergoing cancer treatment and 2) ascertain if CanCare could enhance communication between patients, family, friends and health professionals. Methods: Cancer patients receiving chemotherapy were invited to participate. Data were collected via semi-structured interviews, online surveys and a website usage program. Results: Nine patients with four different types of cancer completed the study. All saw the potential of the website but many found it too complex to use, particularly when unwell post treatment. Many were frustrated by the lack of integration with existing hospital systems and the need to enter relevant data manually. The cancer-specific information tab rated highly and was used extensively. The website used alone did not promote interactions between family and/or health professionals. Conclusion: A patient-led cancer care website has the potential to help patients manage their cancer care but needs to be intuitive to use, integrated into hospital systems and requires significant family/carer and health professional engagement.

Review: Trialling a patient-led cancer care website in an acute cancer care setting

Review: Trialling a patient-led cancer care website in an acute cancer care setting

Review: Developing a patient-led cancer care website, ‘CanCare’: what do end users want?

Review: Developing a patient-led cancer care website, ‘CanCare’: what do end users want?

Usability of a CKD Educational Website Targeted to Patients and Their Family Members

Web-based technology is critical to the future of healthcare. As part of the Safe Kidney Care cohort study evaluating patient safety in CKD, this study determined how effectively a representative sample of patients with CKD or family members could interpret and use the Safe Kidney Care website (www.safekidneycare.org), an informational website on safety in CKD. Between November of 2011 and January of 2012, persons with CKD or their family members underwent formal usability testing administered by a single interviewer with a second recording observer. Each participant was independently provided a list of 21 tasks to complete, with each task rated as either easily completed/noncritical error or critical error (user cannot complete the task without significant interviewer intervention). Twelve participants completed formal usability testing. Median completion time for all tasks was 17.5 minutes (range=10-44 minutes). In total, 10 participants had greater than or equal to one critical error. There were 55 critical errors in 252 tasks (22%), with the highest proportion of critical errors occurring when participants were asked to find information on treatments that may damage kidneys, find the website on the internet, increase font size, and scroll to the bottom of the webpage. Participants were generally satisfied with the content and usability of the website. Web-based educational materials for patients with CKD should target a wide range of computer literacy levels and anticipate variability in competency in use of the computer and internet.

Australian Online Public Information Systems:An Evaluative Study of an Evolving Public Health Website

Rapid developments in ICT are extending and transforming the ways public services are delivered to citizens. The area of public healthcare has always been viewed as particularly as information intensive. This phenomenon is made more complex by rapid changes and continual increases in technological capability as well as increasing demands for new functions by users. Therefore, when conducting research in this area it is essential to take a holistic approach that integrates the latest ICT tools and processes with the needs of individuals. Q methodology is a research design that provides a foundation for the systematic study of subjectivity. The use of Q in the dynamic health context, we propose, is appropriate as a way of fostering deeper understandings of online public health phenomena. This paper reports on the results of a subjective study of the usefulness and usability of online public health information systems. The study used Q-methodology to investigate the perceptions of an Australian palliative care website with a group of available potential users of the website, which was composed of medical practitioners and students, and the general public, mostly from the computer-literate academic community. The most significant finding of this subjective study of internet-literate participants’ perceptions towards online palliative care is the recognition of four groups: interactive, superficial, medical and service.

Viewpoint: Going Green in the Emergency Department

Viewpoint: Going Green in the Emergency Department

Quality of Life and Experience of Care in Women With Metastatic Breast Cancer: A Cross-Sectional Survey

ContextDespite developments in the medical management of metastatic breast cancer, little is known about the quality of life (QoL) and experience of care in women with it. ObjectivesTo explore QoL, experience of care, and support needs of women living with metastatic breast cancer in the U.K. MethodsQuestionnaire-based, cross-sectional study, undertaken in two U.K. cancer centers and online via the Breast Cancer Care website, assessing QoL and experience of care in 235 women with metastatic breast cancer. ResultsQoL was assessed using the Functional Assessment of Cancer Therapy—Breast QoL measure. Overall, QoL was low (mean 89.0, standard deviation 21.8) for total score. Low scores were seen uniformly in physical, social, emotional, and functional well-being domains. Symptom burden was a significant problem, with over one-third of women (34%) reporting high levels of pain and other uncontrolled symptoms. In multiple regression analysis, social well-being was significantly better for older women (P<0.001) but was lower in those with bone metastases only (P=0.002). Functional well-being was significantly higher in women without children (P=0.004). Satisfaction with experience of care was low and appeared to be predominantly in the hospital setting, with little evidence of involvement of general practitioners and palliative care services. ConclusionDespite improvements in treatment and survival of women with metastatic breast cancer, this group reports high symptom burden and dissatisfaction with elements of their care, indicating that alternative models of service delivery should be explored.

Uptake of Web-Based Clinical Resources from the MacArthur Initiative on Depression and Primary Care

This study assessed the usability and desired enhancements for the MacArthur Foundation's Depression and Primary Care (MDPC) Web site to determine if resources for integrated depression care that are disseminated through the Web site are incorporated into routine clinical care. Since its launch in 2003, more than 20,000 users registered as members of the MDPC website to read and download depression care resources. Subjects were randomly selected from MDPC Web site users who had previously downloaded the depression toolkit. Web-based survey, which was administered anonymously, included the following domains: (1) socio-demographic data, (2) confidence in managing depression (3) Web site content and design features, (4) desired enhancements to Web site and content, (5) use of resources downloaded from the Web site, and (6) importance of depression care resources. Of the 3,478 randomly selected participants, 666 (19.1%) responded. Web site content was rated "good" or "excellent" for screening and diagnosis (84.3%), treatment (69.8%), patient education (66.2%), and care management (66.9%). The Patient Health Questionnaire-9 (PHQ-9) was rated "very useful" by 68.3%; 47.1% reported using it in at least 25% of encounters with patients who are depressed. PHQ-9 use was significantly associated with higher self-confidence in managing depression (P=0.05). Evidence-based resources for depression care can be disseminated effectively through a dedicated Web site and may help clinicians incorporate effective care models into routine practice.

A pre-visit tailored website enhances counselees’ realistic expectations and knowledge and fulfils information needs for breast cancer genetic counselling

Counselees who are the first in their family to request breast cancer genetic counselling often don't know what to expect or have unrealistic expectations of genetic counselling. Receiving tailored information might help them to prepare for their first visit. We conducted a study of the effects of a pre-visit website providing computer-tailored information (E-info gene(ca)), on counselees' expectations, knowledge about breast cancer and heredity and information needs. Counselees were randomized to receive usual care (UC) or UC plus website. All counselees completed a baseline questionnaire and those randomized to the intervention group also completed a questionnaire after having viewed the website. After having accessed E-info gene(ca) counselees (n=101) better knew what to expect of their first visit (χ(2)=4.43; P=.04) and less often showed unrealistic expectations about possibilities for DNA-testing (χ(2)=4.84; P=.03) than counselees in the UC group (n=89). In addition, the website increased counselees' knowledge of breast cancer and heredity (B=.23; P=.003) and lowered their information needs (B=-.16; P=.000) compared to the UC group. Especially, information concerning procedural aspects and emotional consequences of genetic counselling was considered less important. This study showed that counselees know more and need less when they are provided with extended pre-visit information through a tailored website and counselees enter the visit with more realistic expectations of genetic counselling. This might facilitate and focus communication within the subsequent consultation.

Skills for Care.

As a voluntary sector project manager in health and social care, I need to keep up to date with developments in training standards. The Skills for Care website is a tremendous resource for social care workers and employers.

Current Resources for Evidence‐Based Practice July/August, 2011

An overarching goal of the Affordable Care Act is to increase access to high‐quality, affordable health care for all Americans. To meet this goal, the Secretary of the Department of Health and Human Services has established a National Strategy for Quality Improvement in Health Care.1 The National Quality Strategy sets priorities for quality improvement efforts in the US health care system as well as provides a strategic plan for achieving quality goals. Developed with input from stakeholders across the United States, including patients and health care providers, representing community level to state and federal agencies, the National Quality Strategy will pursue three broad aims: better care, affordable care, and healthy people/healthy communities.

Current Resources for Evidence‐based Practice, July/August 2011

Cathy Emeis, PhD, CNM, is an assistant professor in the School of Nursing at Oregon Health & Science University, Portland, OR. Childbirth Connection’s New Transforming Maternity Care Web Site is Timely As US Strategy for Quality Improvement in Health Care Begins An overarching goal of the Aiordable Care Act is to increase access to high-quality, aiordable health care for all Americans. To meet this goal, the Secretary of the Department of Health and Human Services has established a National Strategy for Quality Improvement in Health Care. The National Quality Strategy sets priorities for quality improvement eiorts in the US health care system as well as provides a strategic plan for achieving quality goals. Developed with input from stakeholders across the United States, including patients and health care providers, representing community level to state and federal agencies, the National Quality Strategy will pursue three broad aims: better care, aiordable care, and healthy people/healthy communities.