Epilepsy care for children has been criticized for its lack of impact. Various service models and strategies have been developed in response to perceived inadequacies in care provision for children and their families. Lindsay and Bradley set out to compare the effectiveness of specialist or dedicated teams or individuals in the care of children with epilepsy with usual care services. They searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library February issue, 2010), MEDLINE (1950 to March 2010), EMBASE (1988 to May 2006), PsycINFO (1806 to March 2010) and CINAHL (1982 to March 2010). The scientists included randomized controlled trials, controlled or matched trials, cohort studies or other prospective studies with a control group, or time series studies. Each review author independently selected studies, extracted data and assessed the quality of included studies. Four trials and five reports are included in the review. They report on four different education and counseling programs for children, children and parents, or teenagers and parents. Each program showed some benefits for the well being of children with epilepsy, but each trial had methodological flaws and no single program was evaluated by more than one study.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that while each of the programs in this review showed some benefit to children with epilepsy, their impacts were extremely variable. No program showed benefits across the full range of outcomes. No study appeared to have demonstrated any detrimental effects but the evidence in favor of any single program is insufficient to make it possible to recommend one program rather than another. More trials, carried out by independent research teams, are needed.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER:
The self-management studies on any chronic condition, especially during the development phase, show great heterogeneity when compared to one another. However, as occurred here, it is great that such programs are being developed and tested.

Ferreira and associates described the implantation and the effects of directly-observed treatment short course (DOTS) in primary health care units. Interviews were held with the staff of nine municipal health care units (MHU) that provided DOTS in Rio de Janeiro City, Southeastern Brazil, in 2004-2005. A dataset with records of all tuberculosis treatments beginning in 2004 in all municipal health care units was collected. Bivariate analyses and a multinomial model were applied to identify associations between treatment outcomes and demographic and treatment process variables, including being in DOTS or self-administered therapy (SAT). From 4,598 tuberculosis cases treated in public health units administrated by the municipality, 1,118 (24.3%) were with DOTS and 3,480 (75.7%) with SAT. The odds of DOTS were higher among patients with age under 50 years, tuberculosis relapse and prior history of default or treatment failure. The odds of death were 52.0% higher among patients on DOTS as compared to SAT. DOTS modality including community health workers (CHWs) showed the highest treatment success rate. A reduction of 21.0% was observed in the odds of default (vs. cure) among patients on DOTS as compared to patients on SAT, and a reduction of 64.0% among patients on DOTS with CHWs as compared to those without CHWs.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that patients with a "low compliance profile" were more likely to be included in DOTS. This strategy improves the quality of care provided to tuberculosis patients, although the proposed goals were not achieved.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER: If there was ever a need to combine self-management with other treatments, it comes in combining DOTS with self-management skills. If patients learn and consistently perform the latter skills, DOTS could be faded from more and more TB regimens.

Ferguson and colleagues evaluated the efficacy of a brief cognitive-behavioral therapy (CBT) that is being developed for management of cognitive dysfunction following chemotherapy among breast cancer survivors. Memory and Attention Adaptation Training (MAAT) is a brief CBT designed to improve the quality of life and function among cancer survivors with post-chemotherapy cognitive complaints. An initial, two-group (MAAT versus waitlist, no treatment control), randomized clinical trial (RCT) was conducted. Forty stage I and II female breast cancer survivors (mean age = 50; SD = 6.4) were randomized to conditions and assessed at baseline, post-treatment (8 weeks) and 2-month follow-up assessment points on measures of: (1) self-reported daily cognitive failures; (2) quality of life; and (3) neuropsychological performance. Participants were also assessed for satisfaction with MAAT. With education and IQ as covariates, MAAT participants made significant improvements relative to controls on the spiritual well-being subscale of the quality of life measure and on verbal memory, but statistical significance was not achieved on self-report of daily cognitive complaints. However, moderate-to-large effect sizes were observed on these outcomes. Participants gave MAAT high satisfaction ratings.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that although this initial RCT is a small study, MAAT participants appear to improve on one measure of quality of life and verbal memory performance relative to no treatment controls and rate MAAT with high satisfaction. These data are encouraging and support the continued development and evaluation of MAAT efficacy.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER: The study suggests there are ways to assess quality of life and verbal memory following chemotherapy for cancer. This should enhance the perceptions of someone under going chemotherapy or about to do so. Overall, this is a nice, albeit small in terms of number of subjects, investigation.

The prevalence of asthma and associated mortality is higher among adults than among children, as are associated morbidity and hospital readmission rates. The literature shows that promoting patient self-care behaviors and self-efficacy helps reduce recurrence and hospital readmission rates. Therefore, self-care behaviors and self-efficacy represent critical issues in successful asthma management. A study by Chen and associates was developed to investigate the effects of a self-efficacy intervention on (a) the self-care behaviors of adult asthma patients and (b) the self-efficacy of adult asthmatic patients. The study used a pretest-posttest experimental design. A total of 60 asthma outpatients who visited the chest medicine division of a medical center in Kaohsiung City between March 2, 2009, and January 31, 2010, were assessed. Patients were randomly divided into two groups (experimental and control), with 30 patients assigned to each. Experimental group participants received the self-efficacy intervention program, which included watching a 15- to 20-minute DVD and reading a healthcare booklet on self-efficacy for adult asthmatic patients, were asked to share their illness experience with support groups; they received medical follow-ups by telephone. Control group patients received conventional health education administered by the outpatient department. Study instruments included a self-care behavior scale for adult asthmatic patients (content validity index = .95, Cronbach's α = .82) and a self-efficacy scale for adult asthmatic patients (content validity index = .98, Cronbach's α = .82). The two key findings of this study were: (a) There was a significant improvement in the self-care behaviors of patients who received self-efficacy intervention in terms of medication adherence (p= .008), self-monitoring (p= .000), avoidance of antigens (p = .001), regular follow-up visits (p = .000), and regular exercise (p = .016); and (b) the program improved participant self-efficacy in terms of both asthma attack prevention (p = .030) and management during asthma attacks (p = .017).

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: On the basis of these results, the authors concluded that self-efficacy intervention was demonstrated to be a beneficial addition to adult asthmatic patient self-care regimens.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER: Once again, self-management and self-efficacy were shown to be effective in the control of asthma.

Asthma prevalence and morbidity is especially elevated in adolescents, yet few interventions target this population. Bruzzese and colleagues tested the efficacy of Asthma Self-Management for Adolescents (ASMA), a school-based intervention for adolescents and medical providers. A total of 345 primarily Latino/a (46%) and African American (31%) high school students (mean age=15.1; 70% female) reporting an asthma diagnosis, symptoms of moderate to severe persistent asthma, and asthma medication use in the last 12 months were randomized to ASMA, an 8-week school-based intervention, or a wait-list control group. They were followed for 12 months. Students completed bimonthly assessments. Baseline, 6-month, and 12-month assessments were comprehensive; the others assessed interim health outcomes and urgent health care utilization. Primary outcomes were asthma self-management, symptom frequency, and quality of life (QOL); secondary outcomes were asthma medical management, school absences, days with activity limitations, and urgent health care utilization. Relative to controls, ASMA students reported significantly: (a) more confidence to manage their asthma; (b) taking more steps to prevent symptoms; (c) greater use of controller medication and written treatment plans; (d) fewer night awakenings, days with activity limitation, and school absences due to asthma; (e) improved QOL; and (f) fewer acute care visits, ED visits, and hospitalizations. In contrast, steps to manage asthma episodes, daytime symptom frequency, and school-reported absences did not differentiate the two groups. Most results were sustained over the 12 months.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that ASMA is efficacious in improving asthma self-management, and reducing asthma morbidity and urgent health care use in low-income urban minority adolescents.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER: This is yet another example of a program that shows that adolescents can learn and perform self-management skills over a period of time.