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The purpose of this paper is to pilot‐test the feasibility and impact of protocol‐driven point‐of‐care HbA1c testing on levels of glycemic control and on rates of diabetic…
The purpose of this paper is to pilot‐test the feasibility and impact of protocol‐driven point‐of‐care HbA1c testing on levels of glycemic control and on rates of diabetic regimen intensification in an urban community health center serving low‐income patients.
The paper suggests a primary care process re‐design, using point of care finger‐stick HbA1c testing under a standing order protocol that provided test results to the provider at patient visit.
The paper finds that the protocol was well received by both nurses and physicians. HbA1c testing rates increased from 73.6 percent to 86.8 percent (p=0.40, n=106). For the 69 patients who had both pre‐ and post‐intervention results, HbA1c levels decreased significantly from 8.55 to 7.84 (p=0.004, n=69). At baseline, the health center as a system was relatively ineffective in responding to elevated HbA1c levels. An opportunity to intensify, i.e. a face‐to‐face visit with lab results available, occurred for only 68.6 percent of elevated HbA1c levels before the intervention, vs. 100 percent post‐intervention (p<0.001). Only 28.6 percent of patients with HbA1c levels >8.0 had their regimens intensified in the pre‐intervention phase, compared with 53.8 percent in the post‐intervention phase (p=0.03).
This was a pilot‐study in one urban health center. Larger group‐randomized controlled trials are needed.
The health center's performance as a system, improved significantly as a way of intensifying diabetic regimens thereby achieving improved glycemic control.
This intervention is feasible, replicable and scalable and does not rely on changing physician behaviors to improve primary care diabetic outcomes.
ATTENTION has been repeatedly drawn to certain drawbacks in the library profession which tend to hinder progress in many ways, and recently some discussion has taken place concerning the long hours and short pay of library assistants. Some years ago there appeared, we believe, in one of Mr. Greenwood's valuable Library Year Books, an analysis of the hours of work in a large number of British Municipal Libraries, and it was made plain from this that a majority of assistants had to work considerably more than forty‐eight hours weekly. Conditions may have changed since then, although it is open to doubt, but the fact remains that too many assistants, and a considerable number of librarians in small places, are now working so long, and in such broken spells, as to preclude any possibility of attaining self‐culture or reasonable recreation. The case of the small town librarian is particularly distressing. In some instances he is a man who has been well‐trained in a large town library, and inspired by a mistaken ambition, elects to attain a position of independence by accepting the chief librarianship in a library of which he afterwards finds himself the sole officer. He is responsible for the cleaning, as well as the ordinary work of a librarian, and his efforts to convert a miserable library rate of a few pounds into an engine of immense efficiency (as expected by the local authority) are enough to make the financial operations of even an American millionaire seem petty in comparison. We have had several cases like this brought to notice within a few weeks, and they give added point to any plea for reform which may be advanced. One young man, well‐educated and well‐trained, undertook the charge of a small municipal library, chiefly because it happened to be near London, and he wished to be in touch with that great and attractive centre. He very soon discovered that the hours of the library were so arranged as to occupy his whole time and keep him employed all day, from 9 a.m. or earlier, till 10 p.m., with two short breaks which did not suffice for a visit to London. On Sunday he was too tired to think of London, apart from which, the institutions which interested him were closed, so that it is possible this librarian has not yet seen the longed‐for London of his cherished anticipations ! There are cases like this in the smaller libraries all over the country, where one official has to perform all the work in an unlimited number of hours. If, as is done in some places, the hours of opening are greatly curtailed in order to give the librarian his deserved and well‐earned rest, then the public suffer. On the other hand, a library administered by a single officer and kept open from nine to ten hours daily, is rather of the nature of a slave‐compound, in which an official is kept prisoner in the interests of the omnipotent ratepayer. Wherever small staffs are kept, there exists this tendency towards long hours, and a consequent eterioration in the efficiency and educational qualifications of assistants. A standing complaint among those who are engaged in the educational work of the Library Association is that so many candidates are deficient in the most elementary subjects, such as composition, spelling and arithmetic. This is undoubtedly caused by the employment of imperfectly educated assistants, who are afterwards tied so fast to their library duties that they are unable to find any time for study and reading. In libraries where small staffs and long hours of opening are found together, it is almost certain that the work‐hours of the assistants will be excessive, and the efficiency of the service impaired.
For me the earliest number of The Library Assistant still has upon it the silver glow which in middle age belongs to remembered dreams. To our Bournemouth Library in 1898 the modest bantling came, its pale blue cover crowded with advertisements, on the front of binder and bookseller; of the Cotgreave indicator and magazine racks on the back. A simply‐printed affair of twelve pages, as unpretentious as a country‐town bulletin, but a veritable window into life for many, however, and, in my sober judgment, a chief influence in the making of the library spirit of to‐day.
FOR me the earliest number of The Library Assistant still has upon it the silver glow which in middle age belongs to remembered dreams. To our Bournemouth Library in 1898 the modest bantling came, its pale blue cover crowded with advertisements, on the front of binder and bookseller; of the Cotgreave indicator and magazine racks on the back. A simply‐printed affair of twelve pages, as unpretentious as a country‐town bulletin, but a veritable window into life for many, however; and, in my sober judgment, a chief influence in the making of the library spirit of to‐day.
The structure of social relations between staff and line managers is systematically reviewed and staff‐line models are developed on a basis of coalition theory. A typology…
The structure of social relations between staff and line managers is systematically reviewed and staff‐line models are developed on a basis of coalition theory. A typology of staff‐line coalitions is then suggested, including —the “long arm”, the “counsellor”, the “marginal staff” type, —the “servant”, the “brains trust”, and the “autonomous” type. Basic characteristics of a staff‐line coalition are: —its relative independence of the type of organisation structure —its temporal character, acquiring some stability only for the duration of a particular “project” —its multiple network of managerial relationships, most “elegantly” represented by means of a pentagon, a five‐party system.
SYMPATHY will be extended to our colleagues in the beautiful lands of Denmark and Norway, whose civilisation is so far in advance in all its political and social qualities of that of the invaders. Denmark has for years had a library service unequalled in Europe, in particular for its country services, and its town libraries have been administered with a liberality that becomes a country where a happy, cultured and lovable people dwell—or did so dwell until the catastrophe. Norway, too, has much the same liberality of spirit, and amongst its librarians are many who are valued personal friends of their British comrades, who have studied in our library schools and worked in our libraries. We hope they and their libraries will come through safely.
WHEN the open access method of lending books was first introduced on safe‐guarded lines at Clerkenwell, over twelve years ago, a considerable amount of dolorous prophecy was set free, which sometimes formed rather depressing reading for those responsible for the experiment. As time went on, it became clear that many of the prophets based their vaticinations on imperfect knowledge of the actual arrangements in use, and it was then only a simple matter of allowing complete play to one's sense of humour, while the comedy of errors proceeded. One imaginative prophet pictured the time when painstaking librarians would be supplanted by a uniformed janitor, who would assume the functions of librarian, by the easy process of supervising the filtration of readers through a turnstile, like sheep through a hurdle. Another equally resourceful Quidnunc saw in his mind's eye, all the riff‐raff of London, filing through the little Clerkenwell wicket, like a Cup‐tie crowd at the Crystal Palace, without introduction, guarantee, or slightest degree of responsibility. Probably it was only a humorist, and not a prophet, who forsaw the introduction of weighing machines at both entrance and exit wickets, as a means of preventing wholesale thefts. These, and many other absurd misconceptions of the actual mechanical arrangements employed to overcome various anticipated difficulties, formed a considerable proportion of the prophetic utterances which advertised the open access system in its early days.
THE first number of a new volume of THE LIBRARY WORLD offers an occasion for brief retrospect and reflection. For seventeen years the magazine has appeared regularly, untrammelled by official connexion and presenting a catholic view of libraries and the library profession. It began its career at a time when discussions of methods such as open‐access, classified cataloguing, and even library bulletins, created an excitement which they rarely create now; and in these and all subsequent discussions THE LIBRARY WORLD has endeavoured to keep level with, or even in advance of, the best opinion of the day. The leading men in the profession—both living and dead—have contributed to these pages; and altogether the magazine has stood consistently for progress, for advanced methods, and for the importance and dignity of the librarian's office.
THE relinquishing of the Presidency of the Library Association by Dr. Arundell Esdaile must of course receive the attention it deserves. This will probably be when the new President, Mr. Cashmore, is inducted into the office at Birmingham—an event which we understand will take place early in February.
THE provisional programme of this year's L.A. Conference at Southport on September 20–23 is now in our hands. The theme, the library and the community, is the perennial one for our conferences and, in that, is blameless ; everything will depend on the handling of the subjects. No one who considers what is promised can accuse the Council of the L.A. of a partial view of the field, because whole areas are given representation in general sessions and if, as we expect from such writers as Messrs. R. O. MacKenna, W. S. Haigh, D. J. Foskett and F. C. Francis, the papers have the requisite range, the Proceedings will prove to be a comprehensive Statement of library practice today. All are well‐tried speakers and amongst them we anticipate, for example, a model paper from Mr. Haigh, who was frank in his view of the endurance required of the listeners at Hastings. The gifted Editor of The Assistant Librarian, Mr. A. C. Jones, who, unfortunately for us all, is relinquishing that office, is to occupy the A.A.L. with the assistant librarian in the community, and county libraries are to be represented by papers by Mr. B. Oliph Smith and Mr. H. Thompson at their own Section meetings. University libraries again come into the picture at theirs with a discussion opened by Dr. L. W. Sharp. Mystery is suggested by Mr. B. C. Vickery's “Tower of Babel: the language barrier in science” which seems to indicate some form of Interglossa or, possibly, since he is an enthusiast for Dr. Ranganathan, that teacher's Meta‐language. It certainly would be an achievement if whenever a scientist used a word it could be made to convey the same thing in every reader's mind. The Youth Section will listen to that practical teacher and thinker, Mr. J. F. Wolfenden; and the Annual Lecturer on Wednesday, September 21, will be by Mr. J. L. Longland, the chief education officer of Derbyshire, whose co‐operative sympathy and support was no doubt of great service to Mr. Edgar Osborne in the organizing of the most fully co‐ordinate county service in this country. Five British “internes” will render account of their experiences in America, under the chairmanship of Mr. J. C. Harrison, we hope to the encouragement of others of us “to go and do likewise.” Nothing better for the creation of fresh enthusiasms and for a high international level of library practice in all its variants can be imagined than this prolonged employment in the libraries of other countries ; every librarian should encourage it to the limit of his means and feel, as we do, gratitude to Messrs. Sydney and Harrison for acting as the selection committee so far as British candidate “internes” are concerned.