Biomedical subjects

Janice Clarke

Publications and source records attributed to Janice Clarke.

6 recordsLinked to original sources

PubMed2006

A discussion paper about 'meaning' in the nursing literature on spirituality: an interpretation of meaning as "ultimate concern" using the work of Paul Tillich.

Spirituality is often explained in the nursing literature as the patient's quest to find meaning in life and in their experiences. This is most often described in an unlimited and unconditional way defined by whatever interpretations the person places upon it. This opens it to a variety of understandings, some of which may be negative and unhelpful in terms of what we usually consider to be spiritual well being. This discussion paper attempts to look beyond the generality of this idea to examine whether our concept of having meaning, if used in terms of spirituality, should be conditional on meanings which are actually to do with the depth of our being and not meanings which only give pleasure and satisfaction. The paper attempts to do this in two ways. First it explores the beliefs of Victor Frankl to ask the question whether having meaning alone is sufficient to provide spiritual comfort or whether the content of the particular beliefs associated with meaning, may matter. Frankl is often used as a source for the idea of spirituality being to do with meaning and in this paper Frankl's thought is explored in detail to see his own underlying beliefs which helped in his life experiences. Secondly, an understanding of 'meaning' as being conditioned by something "ultimate" described by Paul Tillich is explored. This would give nursing a more structured and purposeful approach to using the term 'meaning' in relation to spiritual care and in addition it would open up a way forward in terms of researching which particular meanings might be most helpful in illness and adversity.

Christianity↗

PubMed2005

Religion and spirituality: a discussion paper about negativity, reductionism and differentiation in nursing texts.

BACKGROUND: The last 30 years have seen a proliferation of literature about spirituality in the nursing press. A dominant theme has been the need to differentiate spirituality from religion and this has provoked a number of authors to attempt to define and describe religion. As nursing advocates respect for the person's religious beliefs the way in which it is portrayed is very relevant. AIMS: This work explores how religion is defined and discussed in the nursing literature about spirituality to consider whether the way religion is portrayed could be said to demonstrate 'respect' for religious beliefs. METHODS: Texts about religion were examined in relation to theories of religion from anthropology, sociology and religious studies. These disciplines have produced substantive or irreducible accounts in contrast to functional and reductive theories about religion. RESULTS: The result of this analysis is that there appears to be a tendency to talk about religion without using sources which itself suggests a lack of respect as well as an inclination to view it only in reductive and functional terms. This is proved by the similarity of ideas in the nursing literature to the functionalist and reductionist theories of Frazer, Tylor, Marx, Durkheim and Freud. This approach is criticised with reference to the work of Otto, Bellah, Berger and Pals who suggest that religion should be seen as irreducibly to do with the sacred. It is proposed that this is a more appropriate outlook to take for an occupation which professes to respect the religious beliefs of all individuals. However, viewing religion in this more meaningful way, acknowledging their spirituality has implications for attempts to differentiate religion and spirituality. CONCLUSION: Reductive accounts of religion imply, probably inadvertently but nevertheless negative, attitudes towards religious belief. A more serious and deeper exploration of the meaning of religion from the standpoint of irreducibility might be more respectful and tolerant of religious belief. This is particularly salient in a society where religious practice is increasing both in the indigenous population and as a result of immigration.

Adaptation, Psychological↗

PubMed2005

Comparative effectiveness of total population versus disease-specific neural network models in predicting medical costs.

The objective of this research was to compare the accuracy of two types of neural networks in identifying individuals at risk for high medical costs for three chronic conditions. Two neural network models-a population model and three disease-specific models-were compared regarding effectiveness predicting high costs. Subjects included 33,908 health plan members with diabetes, 19,264 with asthma, and 2,605 with cardiac conditions. For model development/ testing, only members with 24 months of continuous enrollment were included. Models were developed to predict probability of high costs in 2000 (top 15% of distribution) based on 1999 claims factors. After validation, models were applied to 2000 claims factors to predict probability of high 2001 costs. Each member received two scores-population model score applied to cohort and disease model score. Receiver Operating Characteristic (ROC) curves compared sensitivity, specificity, and total performance of population model and three disease models. Diabetes-specific model accuracy, C = 0.786 (95%CI = 0.779-0.794), was greater than that of population model applied to diabetic cohort, C = 0.767 (0.759-0.775). Asthma-specific model accuracy, C = 0.835 (0.825-0.844), was no different from that of population model applied to asthma cohort, C = 0.844 (0.835-0.853). Cardiac-specific model accuracy, C = 0.651 (0.620-0.683), was lower than that of population model applied to cardiac cohort, C = 0.726 (0.697-0.756). The population model predictive power, compared to the disease model predictive power, varied by disease; in general, the larger the cohort, the greater the advantage in predictive power of the disease model compared to the population model. Given these findings, disease management program staff should test multiple approaches before implementing predictive models.

Age Factors↗

PubMed2005

Remote physiological monitoring: clinical, financial, and behavioral outcomes in a heart failure population.

This article reports on the outcomes associated with remote physiological monitoring (RPM) conducted as part of a heart failure disease management program. Claims data, medical records, data transmission records, and survey results for 91 individuals ages 50-92 (mean 74 years) successfully completing a heart failure RPM program were analyzed for time periods before, during, and after the monitoring intervention. The program was associated with significant reductions in per member per month costs and emergency room and hospital utilization. More detailed analyses were performed for specific gender and age subgroups. Participant surveys indicated high levels of satisfaction, and improvements in self-perceived health status, self-efficacy, and self-management behaviors. This study is the first to assess the impact of a RPM program following removal of the monitoring equipment. The results indicate that RPM, as a component of a traditional disease management program, has a sustained, beneficial effect on participants' lifestyles after the monitoring period has ended.

Aged↗

PubMed2005

Pharmacy utilization and the Medicare Modernization Act.

To control expenditures and use medications appropriately, the Medicare drug coverage program has established pharmacy utilization management (PUM) measures. This article assesses the effects of these strategies on the care of seniors. The literature suggests that although caps on drug benefits lower pharmaceutical costs, they may also increase the use of other health care services and hurt health outcomes. Our review raises concerns regarding the potential unintended effects of the Medicare drug program's PUM policies for beneficiaries. Therefore, the economic and clinical impact of PUM measures on seniors should be studied further to help policymakers design better drug benefit plans.

Aged↗

PubMed2004

Impact of appropriate pharmaceutical therapy for chronic conditions on direct medical costs and workplace productivity: a review of the literature.

This paper presents the findings of a literature review investigating the economic impact of appropriate pharmaceutical therapy in treating four prevalent chronic conditions - asthma, diabetes, heart failure, and migraine. The goal of the review was to identify high-quality studies examining the extent to which appropriate pharmaceutical therapy impacts overall medical expenditure (direct costs) and workplace productivity (indirect costs). The working hypothesis in conducting the review was that the costs of pharmaceuticals for the selected chronic conditions are offset by savings in direct and indirect costs in other areas. The literature provides evidence that appropriate drug therapy improves the health status and quality of life of individuals with chronic illnesses while reducing costs associated with utilization of emergency room, inpatient, and other medical services. A growing body of evidence also suggests that workers whose chronic conditions are effectively controlled with medications are more productive. For employers, the evidence translates into potential direct and indirect cost savings. The findings also confirm the importance of pharmaceutical management as a cornerstone of disease management.

Aged↗