An Evidence-Based Proposal Supporting Prostate Specific Antigen in Protective Service Occupations

Clinical Problem: Prostate cancer is the most common cancer among men in the United States and is the leading cause of death (CDC, 2021). Etiology of prostate cancer remains unclear but in recent research it has been shown that there is an association between occupation and prostate cancer risk (Sritharan, et al., 2019). Specifically protective service occupations including firefighters, policeman and detectives, guards, and watchmen (Sritharan et al., 2019). Significance: With new evidence of risk factors, it is important that these individuals understand that they are at an increased risk of being diagnosed with prostate cancer. In 2018, New York State reported 15,714 cases of prostate cancer. With such a high incidence it is important that these individuals are participating in secondary prevention measures in the hopes that prostate cancer is caught early. PICOT Question: This EBP proposal is framed around the following PICOT question: Among persons who are in protective service occupations, what is the impact of a Nurse Practitioner led shared decision coaching program that utilizes a decision aid on improved knowledge of prostate cancer, confidence in shared decision making for prostate cancer screening and patient satisfaction over 12 weeks? Clinical Change: The change that will be implemented in this proposal is a nurse practitioner led shared decision coaching that will occur in a primary care setting with participants in protective service occupations. Education will be provided during the decision coaching and an opportunity to ask questions about prostate cancer and an individual’s specific risk factors will be allotted. Following the decision coaching the patient will be given the choice to have a PSA test ordered for them and if they decide to follow through with PSA testing, the nursing staff with take their blood draw then. Desired Outcome: The desired outcome of this evidence-based proposal will include improved knowledge of prostate cancer specifically anatomy and function, risk factors, screening, and symptoms of prostate cancer. Other outcomes include increase in PSA testing with improved confidence in decision making regarding the testing and improved satisfaction with the interaction between the patient and nurse practitioner. Summary: Through a review and synthesis of the literature, it was determined that the use of decision coaching and the use of decision aids are effective interventions for improving knowledge, satisfaction, and confidence

Apollo experience report guidance and control systems: Primary guidance, navigation, and control system development

The primary guidance, navigation, and control systems for both the lunar module and the command module are described. Development of the Apollo primary guidance systems is traced from adaptation of the Polaris Mark II system through evolution from Block I to Block II configurations; the discussion includes design concepts used, test and qualification programs performed, and major problems encountered. The major subsystems (inertial, computer, and optical) are covered. Separate sections on the inertial components (gyroscopes and accelerometers) are presented because these components represent a major contribution to the success of the primary guidance, navigation, and control system

Provider Opinion about Guidance Provided by a Prostate Cancer Screening Educational Pamphlet

cancer screening was addressed by providers in two Denver Veteran Affairs Medical Center (VAMC) primary care clinics testing a detailed prostate cancer screening educational pamphlet. Designing a prostate cancer screening educational pamphlet, educating primary care providers via email messages and measuring the providers’ perceptions of guidance provided by the pamphlet using an eight question survey were the means by which VAMC providers engaged in the type of shared decision making that practice guidelines recommend. The completed surveys indicated that the detailed pamphlet did offer providers guidance in explaining, considering, and engaging male veterans in deciding about prostate specific antigen testing. Providers in Firm B Clinic, the comparison group, did not routinely order PSAs because it is no longer a clinical reminder, but fear of liability often led to screening discussions. Despite the challenges, VAMC health care providers educated patients about the risks and benefits of screening before undergoing PSA testing. Public approval of the pamphlet that reflects current evidence based practice ensured that informed prostate cancer decision making was the standard of care within the VA Eastern Colorado Health Care System

Does Medical Malpractice Law Improve Health Care Quality?

Despite the fundamental role of deterrence in justifying a system of medical malpractice law, surprisingly little evidence has been put forth to date bearing on the relationship between medical liability forces on the one hand and medical errors and health care quality on the other. In this paper, we estimate this relationship using clinically validated measures of health care treatment quality constructed using data from the 1979 to 2005 National Hospital Discharge Surveys and the 1987 to 2008 Behavioral Risk Factor Surveillance System records. Drawing upon traditional, remedy-centric tort reforms — e.g., damage caps — we estimate that the current liability system plays at most a modest role in inducing higher levels of health care quality. We contend that this limited independent role for medical liability may be a reflection upon the structural nature of the present system of liability rules, which largely hold physicians to standards determined according to industry customs. We find evidence suggesting, however, that physician practices may respond more significantly upon a substantive alteration of this system altogether — i.e., upon a change in the clinical standards to which physicians are held in the first instance. The literature to date has largely failed to appreciate the substantive nature of liability rules and may thus be drawing limited inferences based solely on our experiences to date with damage-caps and related reforms

Tracking Foodborne Pathogens from Farm to Table: Data Needs to Evaluate Control Options

Food safety policymakers and scientists came together at a conference in January 1995 to evaluate data available for analyzing control of foodborne microbial pathogens. This proceedings starts with data regarding human illnesses associated with foodborne pathogens and moves backwards in the food chain to examine pathogen data in the processing sector and at the farm level. Of special concern is the inability to link pathogen data throughout the food chain. Analytical tools to evaluate the impact of changing production and consumption practices on foodborne disease risks and their economic consequences are presented. The available data are examined to see how well they meet current analytical needs to support policy analysis. The policymaker roundtable highlights the tradeoffs involved in funding databases, the economic evaluation of USDA's Hazard Analysis Critical Control Point (HACCP) proposal and other food safety policy issues, and the necessity of a multidisciplinary approach toward improving food safety databases.food safety, cost benefit analysis, foodborne disease risk, foodborne pathogens, Hazard Analysis Critical Control Point (HACCP), probabilistic scenario analysis, fault-tree analysis, Food Consumption/Nutrition/Food Safety,

Apollo guidance, navigation and control - Design survey of the Apollo inertial subsystem

Design, development, and testing of inertial guidance and navigation systems for Apollo projec

Alaska pretrial project proposal: organizational structure change to incorporate a mental health focus

Master's Project (M.A.) University of Alaska Fairbanks, 2018The Pretrial Enforcement Division (PED) for the Alaska Department of Corrections (DOC) came into operation on January 1, 2018. PED emerged out of senate bill ninety-one (91) in hopes to reduce incarceration population, and the overall costs of corrections to the state. In response to the new division, a closer look at how this may or may not affect the prison population with behavioral health needs is analyzed. DOC is the number one mental health provider in the state, and often individuals with behavioral health needs are incarcerated longer than those without. With the proposal of assessing all defendants prior to initial arraignment for behavioral health needs, and making referrals to identified community providers, it is hopeful that this can be mitigated. Pretrial supervision for those with identified needs will include Pretrial Enforcement Officers (PEO) to handle specialized caseloads, Crisis Intervention Training (CIT), community behavioral health services, and access to social services