Patient capacity for self-care in the medical record of patients with chronic conditions: a mixed-methods retrospective study

BACKGROUND

Patients with chronic conditions must mobilize capacity to access and use healthcare and enact self-care. In order for clinicians to create feasible treatment plans with patients, they must appreciate the limits and possibilities of patient capacity. This study seeks to characterize the amount, nature, and comprehensiveness of the information about patient capacity documented in the medical record.

METHODS

In this mixed-methods study, we extracted notes about 6 capacity domains from the medical records of 100 patients receiving care from 15 primary care clinicians at a single practice. Using a generalized linear model to account for repeated measures across multiple encounters, we calculated the rate of documented domains per encounter per patient adjusted for appointment type and number. Following quantitative analyses, we purposefully selected records to conduct inductive content analysis.

RESULTS

After adjusting for number of appointments and appointment type, primary care notes contained the most mentions of capacity. Physical capacity was most noted, followed by personal, emotional, social, financial, and environmental. Qualitatively, we found three documentation patterns: patients with broad capacity notes, patients with predominantly physical domain capacity notes, and patients with capacity notes mostly in domains other than physical. Records contained almost no mention of patients' environmental or financial capacity, or of how they coped with capacity limitations. Rarely, did notes ever mention how well patients interacted with their social network or what support they provided to the patient in managing their health.

CONCLUSION

Medical records scarcely document patient capacity. This may impair the ability of clinicians to determine how patients can handle patient work, at what point patient capacity might become overwhelmed leading to poor adherence and health outcomes, and how best to craft feasible treatment programs that patients can implement with high fidelity.

The efficacy of early language intervention in mainstream school settings: a randomized controlled trial

BACKGROUND

Oral language skills are a critical foundation for literacy and more generally for educational success. The current study shows that oral language skills can be improved by providing suitable additional help to children with language difficulties in the early stages of formal education.

METHODS

We conducted a randomized controlled trial with 394 children in England, comparing a 30-week oral language intervention programme starting in nursery (N = 132) with a 20-week version of the same programme starting in Reception (N = 133). The intervention groups were compared to an untreated waiting control group (N = 129). The programmes were delivered by trained teaching assistants (TAs) working in the children's schools/nurseries. All testers were blind to group allocation.

RESULTS

Both the 20- and 30-week programmes produced improvements on primary outcome measures of oral language skill compared to the untreated control group. Effect sizes were small to moderate (20-week programme: d = .21; 30-week programme: d = .30) immediately following the intervention and were maintained at follow-up 6 months later. The difference in improvement between the 20-week and 30-week programmes was not statistically significant. Neither programme produced statistically significant improvements in children's early word reading or reading comprehension skills (secondary outcome measures).

CONCLUSIONS

This study provides further evidence that oral language interventions can be delivered successfully by trained TAs to children with oral language difficulties in nursery and Reception classes. The methods evaluated have potentially important policy implications for early education.

Integrated waste management through producers and consumers education: composting of vegetable crop residues for reuse in cultivation

As part of the design of an integrated waste management scheme through the use of the PRECEDE/PROCEED model in the area of Crete, data concerning the applicability of composting in various agricultural wastes was considered as necessary. Vegetable residues from tomato, cucumber, eggplant, and pepper crops were collected, shredded and composted either alone or with the use of olive press cake, olive tree leaves, and branches and vine branches as bulking agents. Seven random combinations--mixtures of the above materials were composted using windrows, where additional four similar windrows were made up by approximately 10 m3 of the above mentioned vegetable crop residues. All windrows were turned four times during the eight weeks thermophylic phase, with the help of a mechanical turner. A large number of physiochemical parameters were monitored in the raw materials, at the end of the thermophylic phase and at the end of the maturation phase. The temperature which was monitored daily, recorded the highest values (above 55 degrees C) in the windrows where bulking agents were used. All raw vegetable crop residues and their mixtures presented increased electrical conductivity values (above 5 mS/cm and up to 9.7 mS/cm) resulting to end products with respectively high EC values (above 3 mS/cm and up to 15 mS/cm) probably due to the presence of large amounts of soil, rich in fertilisers, attached to the roots of the plants. There was no detection of any remains of the 13 pesticides for which all 11 composts were tested for. The accuracy of the results was tested through a recovery test of the pesticides in mature compost, resulting to acceptable recovery values.