Usual medical care often fails to meet the needs of chronically ill patients, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of evidence-based, planned care; reorganization of practice systems and provider roles; improved patient self-management support; increased access to expertise; and greater availability of clinical information. The challenge is to organize these components into an integrated system of chronic illness care. Whether this can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care remains unanswered.

Organizing care for patients with chronic illness.

Patient-centredness: a conceptual framework and review of the empirical literature.

Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care

Two myths about qualitative research are that real qualitative researchers do not count and cannot count. These antinumber myths have led to the underutilization of numbers in qualitative research and to the simplistic view of qualitative research as non- or antinumber. Yet numbers are integral to qualitative research, as meaning depends, in part, on number. As in quantitative research, numbers are used in qualitative research to establish the significance of a research project, to document what is known about a problem, and to describe a sample. But they are also useful for showcasing the labor and complexity of qualitative work and to generate meaning from qualitative data; to document, verify, and test researcher interpretations or conclusions; and to re-present target events and experiences. Although numbers are important in the treatment of qualitative data, qualitative researchers should avoid the counting pitfalls of verbal counting, overcounting, misleading counting, and acontextual counting.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/nur.1025

Real qualitative researchers do not count: the use of numbers in qualitative research.

Patient-centredness in chronic illness: what is it and does it matter?

Explanatory models of diabetes: Patient practitioner variation

Appalachians: a neglected minority.

In a study in historical demographic anthropology conducted during 1976-77 on an urban Greek immigrant community in Columbus, Ohio, demographic and social data were obtained for 1,286 individuals through parish records, census information, 102 structured interviews with family units, and participant observation. The results show that the generations of immigrants differed from each other in rates of fertility, mortality, and migration. This generational variation affects the estimation of natural selection, genetic drift and gene flow. The population exhibited a trend showing differential fertility to be a more significant factor in natural selection than was mortality. However, microdifferentiation from natural selection as well as from genetic drift was low when compared with other human populations. Gene flow was deduced to have been the major evolutionary force operative in the Columbus Greek community. Population structure and the demographic vital rates of fertility, mortality and migration have proven useful to anthropologists concerned with determining patterns and potentials for microe volution. Past studies have related demographic vital rates to genetic drift (Glass, et al. 1956; McKusick, et al. 1964; Giles, et al. 1966; Roberts, 1968; Cavallia-Sforza, 1969; and Halberstein, 1973); to gene flow (Lasker, 1960; Roberts, 1967; Boyce, Kuchemann and Harrison, 1967; Wienker, 1972; Halberstein, 1973; Lamb, 1975); to natural selection (Halberstein, 1973; Morgan, 1973; and Crawford and Goldstein, 1975). Most of these investigations utilizing demographic parameters to evaluate microe volution have been concerned with only one microevolutionary force. Few studies have considered demographic variables and multiple microevolutionary factors simultaneously, even though this approach is necessary for a comprehensive understanding of the microevolution of a population. The importance of studying the demography of groups living at different cultural levels has recently been stressed. Zubrow (1976), in particular, has called for more descriptive studies over a wider range of population types and has noted the importance of learning about the demography of subcultural groups living in highly industrialized nations. Investigations of endogamous groups in record-keeping societies facilitate xThe University of Iowa, College of Nursing, Iowa City IA 52242 Human Biology , May 1980, Vol. 52, No. 2, pp. 255-267. © Wayne State University Press , 1 980 This content downloaded from 157.55.39.253 on Wed, 08 Jun 2016 05:08:03 UTC All use subject to http://about.jstor.org/terms 256 Toni Tripp-Reimer an understanding of microevolutionary dynamics because more accurate trends in the population's history can be established. The major purpose of this investigation is to examine and describe the potential processes of microevolution in the urban Greek immigrant community of Columbus, Ohio, since its formation in the late nineteenth century. In this study, the potential for natural selection, gene flow, and genetic drift are inferred from the population structure as well as the demographic rates of fertility, mortality and migration. Materials and Methods

https://ir.uiowa.edu/cgi/viewcontent.cgi?article=1100&context=nursing_pubs

Toni Tripp-Reimer

Papers

Explanatory models of diabetes: Patient practitioner variation

Appalachians: a neglected minority.

Genetic demography of an urban Greek immigrant community.

Research in cultural diversity. Qualitative methods in cultural research. II.

A defect in tyrosine metabolism as a common basis for alcoholism and an affective disorder