Type 2 diabetes mellitus self-management is a challenging process that brings forward a variety of emotional responses. The purpose of this work was to explore relationships between diabetes distress, self-efficacy and resilience and outcomes of glycosylated hemoglobin, quality of life and health status. A cross sectional descriptive design was used for this pilot study of 78 individuals enrolled from an Endocrine clinic in the Midwest United States and a Primary Care clinic in the southeast United States. Data were analyzed using descriptive statistics to characterize the sample and model variables. Spearman’s correlation was completed to identify relationships among variables. A stepwise building approach was used to identify significant interactions and determine predictors of the study outcomes. The results of this study confirm the presence of facilitators and barriers in type 2 diabetes mellitus self-management and their relationships with distal outcomes. The findings demonstrate that diabetes distress is a predictor of health status and quality of life. The findings of this study provide a link to other facilitator and barrier variables such as provider collaboration, diabetes self-management education, treatment regimen, ethnicity and years since diagnosis which can be incorporated into the comprehensive theoretical model. This study contributes to the understanding of the emotional aspect of diabetes as it relates to self-management of T2DM. Continuing this work will allow researchers to examine and better understand important factors of self-management. This ongoing work will hopefully lead to improved support in self-management efforts and better outcomes.

There is a practice gap in the self-management education of patients with chronic low back pain. Insufficient self-management leads to increased frequency of flare-ups of low back pain, disability, loss of productivity, and increased cost of health care. The guiding practice-focused question was focused on the unmet self-management support needs of the chronic low back pain patients in a Midwestern state local pain clinic. The purpose of this descriptive cross-sectional study was to ascertain the unmet needs of patients' self-management support by analyzing the results of a patient study performed by this clinic. The theoretical principles of the model for evidence-based practice change, the chronic care model, and the middle-range theory of self-care of chronic illness were used. The evidence included the analysis of the Patient Assessment of Chronic Illness Care Survey (PACIC) data from 100 patients treated in this pain clinic. The clinic used the PACIC questionnaire to collect data from its 100 chronic low back pain patients, selected by simple random sampling method. The average weighted scores of these patients' responses were below the norm on all PACIC subscales and summary scores. According to study results, this pain clinic did not meet the self-management support needs of its chronic low back pain patients. Evidence-based recommendations were made for the improvement in the medical model of patient care by including nurse-led patient education and support. The positive social change is the improvement in the health status of this growing health population by meeting their identified education and support needs. Positive results from this nurse-led intervention could lead to the dissemination and widespread implementation of these recommendations in other pain clinics.

Diabetes mellitus is one of the leading causes of death in the United States, contributing to rising health care costs and increased morbidity and mortality rates. Researchers demonstrated that aggressive heath measures involving ongoing diabetes self-management education are paramount in minimizing associated complications of diabetes. The management and prevention of diabetes is not standardized and providers within a health clinic in Illinois reported challenges in providing self-management education during scheduled patient appointments due to limited resources and time. The purpose of this DNP project was to develop a clinical practice guideline to be used by all providers within the health care clinic for the management of Type 2 diabetes. The goal of the developed guideline was to optimize the time providers spend with patients diagnosed with diabetes and improve the consistency and quality of education and care. The health promotion model provided a guide for the development of the practice guideline. The method and design of this DNP project involved extensive research, literature review, evidence grading, and development of an evidence-based practice guideline for Type 2 diabetes management. A selected team of 3 diabetes experts appraised the developed guideline using the AGREE II instrument, and guideline usability was evaluated by 3 nurse practitioners within the medical clinic using a 10-item questionnaire. Results of the appraisal confirmed the high quality, feasibility, and usability of the developed guideline for diabetes self-management education and support. Improving the delivery of care can bring about positive social change by improving health outcomes in individuals with Type 2 diabetes and reducing morbidity and mortality rates.

Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI guideline components were evaluated via a scoring sheet for pain control and self-management effectiveness for the OA patient. The panels assessed these treatment plans in terms of suitability, tolerance, and patient adherence for inclusion into the educational program. The panel members independently reviewed both sets of guidelines and then convened as a group to share their scores and reach a consensus on these guidelines, in the patient population served. Agreement of 85% among the panel members was needed for inclusion into the practice guideline. Based on the scoring results the panel concluded that the ASA and OARSI guidelines would likely improve pain control, functional ability, and psychological well-being essential to lifestyle modifications and OA symptoms management education program. The social impact of developing nursing practice guidelines for the self-management of OA pain in home-based settings will be manifested in better patient lifestyle and behavior modification leading to better symptom management.

No description available.

The present investigation examined the effects of a parent's intervention to teach students with autism self-management to decrease their stereotypic behaviors. A time-lagged ABA (A represents the first baseline, B does intervention, and A does the second baseline) design was used. Three mothers of children with autism were trained to reduce their children's stereotypic behaviors using a self-monitoring strategy. The training for the parent was conducted in two settings after the first baseline condition. A classroom was used for the first training session and the home was used for the second training session. The intervention by the parent was conducted in the child's natural home. The results of this study revealed the following. First, the intervention decreased the students ' stereotypic behaviors. Second, two students maintained the decreased frequency of stereotypic behavior in a nonintervention condition, the second baseline, when the parent withdrew the intervention for a month. Third, the students showed slight behavior change on their interactive behaviors with their family members after the intervention was withdrawn.

Gamification, the use of game elements in non-game contexts, is an increasingly popular way to incentivize self-management procedures. Despite the growing popularity of such programs, little objective research has been done in the area. This study evaluated the use of a web-based gamification program called HabitRPG through a multiple-baseline across participants design. HabitRPG is designed to increase the productivity of its users. Baseline procedures included parental scoring of task completion. Intervention consisted of training on using HabitRPG. Target behaviors were scored with data sheets provided to parents of the participants. The intervention increased the percentage of compliance for all participants.

The growing number of school-aged children displaying challenging behavior has increased the need for effective interventions. School-based consultants (SBC) report using behavioral consultation to assist teachers in designing behavior intervention plans (BIP) that help students engage in appropriate behavior in the classroom. Research indicates that direct training methods increase teacher's implementation of the BIP. One commonly used direct training method, performance feedback (PF), is used to assess teachers' treatment integrity. Research also indicates that checklists (non-direct measures) are more cost efficient methods. The purpose of this paper was to evaluate a direct training method used to train teachers to self-monitor their own implementation of their student's BIP in an effort to increase accuracy of self-report and sustainable treatment integrity outcomes. Two educators who worked with children with challenging behavior participated in this study. The effect of using self-monitoring on both educators' implementation of BIPs was evaluated. Results indicated that both educators' implementation increased and maintained into the maintenance phase. Also, results indicated that educator's accuracy of reporting was similar to independent observers.

Previous researchers have identified that participation in a pulmonary rehabilitation program improves health outcomes yet, continuation in a weekly maintenance program yielded mixed results. Self-management programs have had reported use in chronic obstructive pulmonary disease (COPD). A meta analysis has identified that no self-management program had evaluated the effect of this type of intervention on the functional status of the participant with COPD. Reduced functional status is well reported as an indicator of disease progression in COPD. Adjuvant therapies for people with COPD need to demonstrate an effect in this domain. The Stanford model chronic disease self-management program (CDSMP) had been reported as a program that may optimise the health of people with chronic health conditions. However, its utility has not been formally evaluated for people with COPD. There have not been any reports of a comparison of the Stanford model CDSMP with pulmonary rehabilitation via a randomised controlled study in COPD. Aim: To compare and evaluate the health outcomes from participation in nurse ledwellness-promoting interventions conducted in the ambulatory care setting of a metropolitan hospital. Participants were randomised to either a six-week behavioural intervention: the Stanford model CDSMP or, a six-week pulmonary rehabilitation program and results compared to usual care (a historical control group). The efficacy of the interventions was measured at week seven and repeated at week 26 and 52. Following the week seven evaluation, the pulmonary rehabilitation program participants were rerandomised to usual care or, weekly maintenance pulmonary rehabilitation for 18 weeks and, followed up until the study completion at week 52.Little is reported about the costs of care for people with COPD in Australia. This study prospectively evaluated the costs of the interventions and health resource for the 52 weeks and undertook a cost utility analysis. Methods: Walking tests (The Incremental Shuttle Walking Test) and questionnaires asking participants about their health related quality of life, mood status, dyspnoea and self efficacy were assessed prior to randomisation to either six week intervention and repeated at weeks 7, 26 and 52. The implementation of these adjuvant therapies enabled all costs associated with the interventions to be prospectively examined and compared. Results: During the two years of recruitment 252 people (54% males) with a mean age 71 years (SD 11, range 39-93 years) were referred to the study. Student’s ttests identified that there were no statistically significant differences (P=0.16) between all those referred by age and gender as compared to all those admitted to Hospital A with an exacerbation of COPD. Ninety-seven people (51% male) with a mean age of 68 years (SD 9, range 39-87 years) agreed to participate in the study. Follow up in the study continued for 12 months following enrolment with only a modest level of attrition by week seven (3%) and week 52 (25%). Following the six-week interventions, both the pulmonary rehabilitation and CDSMP groups recorded statistically significant increases in functional capacity, self-efficacy and health related quality of life.Functional performance was additionally evaluated in the intervention arms with participants wearing pedometers for the six-week period of the interventions. There were no statistically significant differences between steps per week (P=0.15) and kilometres per week (P=0.17) walked between these two groups in functional performance. The Spearman rho statistic identified no statistically significant relationship between functional performance and the severity of COPD (rs (33) = 0.19, P = 0.26). No significant correlation between functional capacity and functional performance was identified (rs (32) = 0.19, P = 0.29). This suggests that other factors contribute to daily functional performance. The largest cost of care for people with COPD has been reported to be unplanned admissions due to an exacerbation of COPD.In this study there were no statistically significant differences between the three intervention groups in the prospective measurement of ambulatory care visits, Emergency Department presentations and admissions to hospital. The calculation of costs illuminated the costs of care in COPD are greater than the population norm. In addition, maintenance pulmonary rehabilitation generated a greater quality adjusted life year (QALY) than a six-week program. Despite the strength of the participants preferences (as measured by the QALY) for maintenance PRP, there were no significant differences in use of hospital resources throughout the study period by the three intervention groups, which suggests some degree of equivalence.

<p>A2B Electronics AB is a company that develops and manufactures products and technology for digital cable television. A2B's new EXM-product family translates digital television channels from multiple source networks into a single destination network. Multiple EXM-units are connected in a system to provide a custom set of TV channels. To minimize the administrative effort, the units in a system should be able to interact and collaborate without manual intervention. The purpose of this thesis is to propose an underlying system that supports seamless interaction and collaboration between units.</p><p>The autonomic system concept has served as a foundation for the proposed solution. The requirements for the EXM-system proved to be similar to many properties of an autonomic system. The proposed solution was elaborated by answering five reseach questions. The answers describe how an autonomic system can be implemented with the prerequisites of the EXM-system. Solutions for service availability, configuration preservation, system state changes and automatic addressing and communication are provided.</p><p>The project has resulted in a proposal of a general autonomic system. The solution has also been implemented as prototype that runs both in a simulator and on the EXM-hardware. The simulator was also developed in the scope of this project as a side-effect of the limited access to EXM-hardware.</p><p>The proposed solution together with the prototype can hopefully serve as a base for projects with prerequisites similar to the project described in this thesis.</p>