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OBJECTIVE—To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among socially disadvantaged populations. RESEARCH DESIGN AND METHODS—Studies that were included targeted interventions toward socially disadvantaged adults with type 1 or type 2 diabetes; were conducted in industrialized countries; were measured outcomes of self-management, provider management, or clinical outcomes; and were randomized controlled trials, controlled trials, or before-and-after studies with a contemporaneous control group. Seven databases were searched for articles published in any language between January 1986 and December 2004. Twenty-six intervention features were identified and analyzed in terms of their association with successful or unsuccessful interventions. RESULTS—Eleven of 17 studies that met inclusion criteria had positive results. Features that appeared to have the most consistent positive effects included cultural tailoring of the intervention, community educators or lay people leading the intervention, one-on-one interventions with individualized assessment and reassessment, incorporating treatment algorithms, focusing on behavior-related tasks, providing feedback, and high-intensity interventions (>10 contact times) delivered over a long duration (≥6 months). Interventions that were consistently associated with the largest negative outcomes included those that used mainly didactic teaching or that focused only on diabetes knowledge. CONCLUSIONS—This systematic review provides evidence for the effectiveness of interventions to improve diabetes care among socially disadvantaged populations and identifies key intervention features that may predict success. These types of interventions would require additional resources for needs assessment, leader training, community and family outreach, and follow-up.

BACKGROUND: Shoulder pain is a common problem and although there are many accepted standard forms of conservative therapy for shoulder disorders including non-steroidal anti-inflammatory drugs, glucocorticosteroid injections, oral glucocorticosteroid medication, manipulation under anaesthesia, physical therapy, hydrodilatation (distension arthrography) and surgery, evidence of their efficacy is not well established. OBJECTIVE(S): To review the efficacy of common interventions for shoulder pain. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group trials register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and Science Citation Index) up to May 1998, and hand searched major textbooks, bibliographies of relevant literature, the fugitive literature, and the subject indices of relevant journals including: American College of Rheumatology;British College of Rheumatologists; the Biennial Conference of the Manipulative Physiotherapy Association of Australia;International Federation of Manual Therapists conference proceedings; British Orthopaedic Association;and American Orthopaedic Association. SELECTION CRITERIA: Each identified study was assessed for possible inclusion by two independent reviewers based on the blinded methods sections.The determinants for inclusion were that the trial include an intervention of interest (non-steroidal anti-inflammatory drugs, intra-articular or subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, manipulation under anaesthesia, hydrodilatation, or surgery); that treatment allocation was randomized; and that the outcome assessment was blinded. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed by two independent, blinded reviewers. Data relating to selection criteria, outcome measurement and treatment effect was extracted from the blinded trials.Range of motion scores were entered as degrees of restriction to movement, and all pain and overall effect scor

The purpose of this study is to investigate the relationship between location and specialty of training and practice characteristics such as type of practice (i.e. community versus academic), socio-demographic profile of patients and their complexity, hospital/health facility affiliations and workload/productivity. The analysis required an extraction of registrant data from the University of Toronto Postgraduate Web Evaluation and Registration (POWER) system for a cohort of exiting residents and fellows from 1993 to 2003. The data extract was linked to several administrative databases held by ICES, including physician practice and billing information from the Ontario Health Insurance Plan (OHIP) and anonymized patient demographic data from the Registered Persons Database (RPDB). Results of this study will inform workforce policy issues such as the overall contribution made by Toronto graduates to Ontario, other Canadian provinces and international practice pool of physicians, trends regarding medical career choice, similarities and differences between career choices of International Medical Graduates versus Canadian Medical Graduates, impact of location/program of training, impact of length of training and profile/geography of patients served by graduates of Toronto. The study will aim to create a methodology/template for analysis that can be applied to other medical schools and catchment areas in human health resource planning. Chan B, Willett J. Factors Influencing Participation in Obstetrics by Obstetrician-Gynecologists. 2004; 103(3):493-498. Noble J, Baerlocher MO. Future Practice Profiles of Canadian Medical Trainees. Clinical and Investigative Medicine 2006; 29(4):288-289. Watson DE, Katz A, Reid RJ, Bogdanovic B, Roos N. Family Physician Workloads and Access to Care in Winnipeg: 1991 to 2001. Canadian Family Physician 2004; 171(4):339-342.