Suchergebnisse

This report summarizes an evaluation of the effectiveness of a welfare-to-work program that is operated by the Montachusett Opportunity Council (MOC) in Central Massachusetts. The study looks at how effective the program was in helping clients achieve goals towards self-sufficiency and tries to understand the particulars of the trusting relationships between staff and clients that provided the base from which they worked to address multiple concerns impeding family financial self-sufficiency.

ImportanceIndividually designed single-patient multi-crossover (n-of-1) trials can facilitate tailoring of treatments directed at various conditions, including chronic musculoskeletal pain (CMSP) but are potentially burdensome, which may limit uptake in research and practice.ObjectivesTo determine whether patients randomized to participate in an n-of-1 trial supported by a mobile health (mHealth) app would experience less pain and improved global health, adherence, satisfaction, and shared decision making compared with patients assigned to usual care.Design, setting, and participantsThis randomized clinical trial compared participation in an individualized, mHealth-supported n-of-1 trial vs usual care. The participating 215 patients had CMSP for at least 6 weeks, had a smartphone or tablet with a data plan, were enrolled in northern California from July 2014 through July 2016, and were followed for up to 1 year by 48 clinicians in academic, community, Veterans Affairs, and military settings.InterventionsIntervention patients met with their clinicians and used a desktop interface to select treatments and trial parameters for an n-of-1 trial comparing 2 pain-management regimens. The mHealth app provided reminders to take designated treatments on assigned days and to upload responses to daily questions on pain and treatment-associated adverse effects. Control patients received care as usual.Main outcomes and measuresThe primary outcome was change in the PROMIS (Patient-Reported Outcomes Measurement Information System) pain-related interference 8-item short-form scale (full scale range, 41-78) from baseline to 6 months. Secondary outcomes included patient-reported pain intensity, overall health, analgesic adherence, trust in clinician, satisfaction with care, medication-related shared decision making, and, for the n-of-1 group only, participant engagement and experience.ResultsAmong 215 patients (108 randomized to the n-of-1 intervention and 107 to control), 102 (47%) were women, and the mean (SD) age was 55.5 (11.1) years. At the 6-month follow-up, pain interference was reduced in both groups, though there was no difference between the intervention and control groups (-1.36 points; 95% CI, -2.91 to 0.19 points; P = .09). There were no advantages in secondary outcomes for intervention patients vs control patients except for higher medication-related shared decision making at 6 months (between-group difference, 11.9 points; 95% CI, 2.6-21.2 points; P = .01). Among patients assigned to the n-of-1 group, 88% (n = 86) affirmed that the mHealth app could help people like them manage their pain.Conclusions and relevanceIn this population of patients with CMSP, mHealth-supported n-of-1 trials were feasible and associated with a satisfactory user experience, but n-of-1 trial participation did not significantly improve pain interference at 6 months vs usual care.Trial registrationClinicalTrials.gov identifier: NCT02116621.

ImportanceIndividually designed single-patient multi-crossover (n-of-1) trials can facilitate tailoring of treatments directed at various conditions, including chronic musculoskeletal pain (CMSP) but are potentially burdensome, which may limit uptake in research and practice.ObjectivesTo determine whether patients randomized to participate in an n-of-1 trial supported by a mobile health (mHealth) app would experience less pain and improved global health, adherence, satisfaction, and shared decision making compared with patients assigned to usual care.Design, setting, and participantsThis randomized clinical trial compared participation in an individualized, mHealth-supported n-of-1 trial vs usual care. The participating 215 patients had CMSP for at least 6 weeks, had a smartphone or tablet with a data plan, were enrolled in northern California from July 2014 through July 2016, and were followed for up to 1 year by 48 clinicians in academic, community, Veterans Affairs, and military settings.InterventionsIntervention patients met with their clinicians and used a desktop interface to select treatments and trial parameters for an n-of-1 trial comparing 2 pain-management regimens. The mHealth app provided reminders to take designated treatments on assigned days and to upload responses to daily questions on pain and treatment-associated adverse effects. Control patients received care as usual.Main outcomes and measuresThe primary outcome was change in the PROMIS (Patient-Reported Outcomes Measurement Information System) pain-related interference 8-item short-form scale (full scale range, 41-78) from baseline to 6 months. Secondary outcomes included patient-reported pain intensity, overall health, analgesic adherence, trust in clinician, satisfaction with care, medication-related shared decision making, and, for the n-of-1 group only, participant engagement and experience.ResultsAmong 215 patients (108 randomized to the n-of-1 intervention and 107 to control), 102 (47%) were women, and the mean (SD) age was 55.5 (11.1) years. At the 6-month follow-up, pain interference was reduced in both groups, though there was no difference between the intervention and control groups (-1.36 points; 95% CI, -2.91 to 0.19 points; P = .09). There were no advantages in secondary outcomes for intervention patients vs control patients except for higher medication-related shared decision making at 6 months (between-group difference, 11.9 points; 95% CI, 2.6-21.2 points; P = .01). Among patients assigned to the n-of-1 group, 88% (n = 86) affirmed that the mHealth app could help people like them manage their pain.Conclusions and relevanceIn this population of patients with CMSP, mHealth-supported n-of-1 trials were feasible and associated with a satisfactory user experience, but n-of-1 trial participation did not significantly improve pain interference at 6 months vs usual care.Trial registrationClinicalTrials.gov identifier: NCT02116621.

IMPORTANCE: Individually designed single-patient multi-crossover (n-of-1) trials can facilitate tailoring of treatments directed at various conditions, including chronic musculoskeletal pain (CMSP) but are potentially burdensome, which may limit uptake in research and practice. OBJECTIVES: To determine whether patients randomized to participate in an n-of-1 trial supported by a mobile health (mHealth) app would experience less pain and improved global health, adherence, satisfaction, and shared decision making compared with patients assigned to usual care. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial compared participation in an individualized, mHealth-supported n-of-1 trial vs usual care. The participating 215 patients had CMSP for at least 6 weeks, had a smartphone or tablet with a data plan, were enrolled in northern California from July 2014 through July 2016, and were followed for up to 1 year by 48 clinicians in academic, community, Veterans Affairs, and military settings. INTERVENTIONS: Intervention patients met with their clinicians and used a desktop interface to select treatments and trial parameters for an n-of-1 trial comparing 2 pain-management regimens. The mHealth app provided reminders to take designated treatments on assigned days and to upload responses to daily questions on pain and treatment-associated adverse effects. Control patients received care as usual. MAIN OUTCOMES AND MEASURES: The primary outcome was change in the PROMIS (Patient-Reported Outcomes Measurement Information System) pain-related interference 8-item short-form scale (full scale range, 41-78) from baseline to 6 months. Secondary outcomes included patient-reported pain intensity, overall health, analgesic adherence, trust in clinician, satisfaction with care, medication-related shared decision making, and, for the n-of-1 group only, participant engagement and experience. RESULTS: Among 215 patients (108 randomized to the n-of-1 intervention and 107 to control), 102 (47%) were women, and the mean (SD) ...

The fourteen authors in this collection used phenomenology (the study of consciousness) and hermeneutics (the interpretation of meaning) to conduct deep inquiry into perplexing and wondrous events in their work and personal lives. These seasoned scholar-practitioners gained remarkable insight into areas such as health care and illness, organ donation, intercultural communications, high-performance teams, artistic production, jazz improvisation, and the integration of Tai Chi into education. All authors were transformed by phenomenology's expanded ways of seeing and being

Frontmatter -- Acknowledgements -- Foreword -- Contents -- Part I: Lifeworlds in Deathworlds in Łódź, Poland -- Chapter 1 From Deathworlds to Lifeworlds Through Collaborative Transformative Phenomenology -- Chapter 2 Deathworld of the City of Łódź: Insider Experience -- Chapter 3 Deathworld of the City of Łódź: Outsider Lived Experiences -- Chapter 4 Phenomenology of Trash -- Chapter 5 Walking with Homeless Persons in Kraków and Łódź -- Chapter 6 The Experience of Precognition -- Chapter 7 Personal Discovery and Transformation Through the Study of Lived-Experience -- Part II: Experiences of Lifeworlds and Deathworlds -- Chapter 8 Restoring Lifeworlds Through Phenomenological Writing, Reflection and Collaboration -- Chapter 9 Be-ing with Dying: A Personal Experience with the Death of a Young Person -- Chapter 10 Inspiration in Times of Personal Challenge: A Mindful Inquiry -- Chapter 11 The Deathworld of First Responders: Being a Stranger to Oneself -- Part III: Lifeworlds and Deathworlds in We-Relationships -- Chapter 12 Grief and Unraveling in Romantic We-Relationships -- Chapter 13 Overcoming Deathworlds of Addiction, Self-Injury, and Stress -- Chapter 14 Military Wife and Mother: Lifeworlds and Deathworlds Surrounding Military Life -- Chapter 15 Embracing Endless Liminality: Improvisation and the "Practical Mystic" -- Part IV: Deathworlds and the Indigenous -- Chapter 16 Indigenous Worldview and the Vision of a Peace Educator -- Chapter 17 Colonization of the Lifeworld of Sheepherder Communities of Mongolia -- Chapter 18 Deathworld Encroachments on the Amazon Rainforest -- Chapter 19 Sustaining Lifeworlds in the Face of Famine, Water Shortages, and Malaria -- Part V: Transformative Phenomenology Practice -- Chapter 20 Transformative Phenomenology as an Antidote to Technological Deathworlds -- Epilogue: The Essence of Collaborative Transformative Phenomenology -- About the Authors -- About the Editors -- Endorsements -- Index