Evaluation of the role of the breast care nurse at Toowoomba Base Hospital

[Executive Summary]: The Supporting Rural Women with Breast Cancer Project started in Toowoomba in January 2005 with a Breast Care Nurse in a full time position in July 2005. The aim of the project is to develop and implement a revised multidisciplinary model of care resulting in the reorganisation and enhanced coordination of breast care services provided by Toowoomba Health Service District. A key deliverable under the service agreement with the Australian Government is the implementation of an evaluation plan and the compilation of an evaluation report. A decision on continuation of project initiatives will be informed in part by the results of the evaluation reported herein which was conducted by the Centre for Rural and Remote Area Health (CRRAH) based at the University of Southern Queensland. Structured questionnaires were used for both patient and stakeholder feedback. Fifty-one former breast cancer patients were interviewed by telephone. Twenty questions polled patients’ views on their access to the Breast Care Nurse and the nurse’s role in coordinating care, referral to other health professionals, and in providing information and psychosocial, emotional and practical support. Stakeholders received the questionnaire through the Toowoomba Health Services internal email system and returned completed questionnaires by reply paid mail to CRRAH. The questions were designed to provide views on the support that the Breast Care Nurse had made to a multi disciplinary treatment regimen. Views on the reasons for success or failure of the programme were also elicited. Widespread knowledge of the Breast Care Nurse prior to breast cancer treatment was poor; patients were unaware of the Breast Care Nurse until their first contact with her which was usually at the Surgical Outpatients Clinic held at the BreastScreen Toowoomba Service. More information about the position and role could be made available through GPs. Results from the patients revealed enormous gratitude for the support that they received from the Breast Care Nurse. There was overwhelming agreement that the timing of contact, ease of accessibility, information provided and support offered was extremely valuable in making their treatment and recovery easier. The vast majority of participants would recommend to their friends that they should attend hospitals with a Breast Care Nurse. Similar sentiments about the value of the Breast Care Nurse were received from stakeholders who recognised the benefit of the position not only to patients but also to the multidisciplinary team members in terms of coordination and liaison. However stakeholders did believe that a multidisciplinary team approach had not yet been fully achieved. The importance of maintaining a full time position of Breast Care Nurse was noted by both patients and stakeholders as accessibility of the nurse to patients was a key feature of the success of the programme. The study was in agreement with several other Australian reports all of which have demonstrated the success of dedicated Breast Care Nurses. The recommendation from the evaluation team is that the position of a full time Breast Care Nurse should be maintained. The Breast Care Nurse model is one that could be used successfully to support other medical condition

Perceived Alzheimer\u27s Disease Threat as a Predictor of Behavior Change to Lower Disease Risk: The Gray Matters Study

Alzheimer’s disease is a growing public health concern with the current number afflicted of 5 million in the US expected to triple by 2050. Since there is currently no cure or preventive pharmacological treatment, AD prevention research is now recognized as an important enterprise, with a goal to identify modifiable lifestyle factors that can reduce AD risk or delay its onset. Among these, increased physical activity, healthier food choices, more cognitive stimulation, better sleep quality, stress management, and social engagement have been identified as reasonable targets for behavioral intervention. A smartphone application-based behavioral intervention targeting these six behavioral domains was recently developed and a six-month randomized controlled trial was conducted, both to determine feasibility and compliance with technology usage and to test its efficacy. This study, titled the Gray Matters Study, was conducted in Cache County, Utah, enrolling a sample of 146 middle-aged participants (aged 40 to 64 years) randomized to treatment or control condition. Under the Health Belief Model, individuals who perceive a greater susceptibility to a particular health condition are hypothesized to be more likely to engage in more positive behaviors to reduce disease risk. Following this model, perceived threat of AD (operationalized by fear of AD, family history of AD, and metacognitive concerns) was examined for prediction of behavioral change over the six-month Gray Matters intervention period in these same six behavioral domains. Persons with a moderate level of fear of AD made significantly greater improvements in physical activity than those with low or high levels of fear. Family history was not a significant predictor of health-related behavioral change. However, persons with a moderate level of metacognitive concerns made significantly greater improvements in both physical activity and food quality than those with low or high levels of concerns. This is the first study to examine these psychological constructs related to AD risk and the extent to which they predict health-related behavior change. Future studies should extend the length of follow-up to at least one full year, include a more diverse sample of participants to expand generalizability, and build upon these findings to personalize supportive behavioral change interventions in order to be sensitive to these psychological factors

Artists and their dream art

None provided

Historical fiction for children and young people : changing fashions, changing forms, changing representations in British writing, 1934-2014

PhD ThesisIn Language and Ideology in Children’s Fiction (1992) John Stephens forecast the demise of children’s historical fiction as a genre on the grounds that both history itself and the humanist values Stephens saw as underpinning historical fiction were irrelevant to young readers in postmodernity and intrinsically at odds with the attitudes and values of literary postmodernism. In fact, by the end of the millennium juvenile historical fiction was resurgent and continues to propagate humanist ideology. This study explores the changing nature and status of the genre as it has been published in Britain since Geoffrey Trease’s ground‐breaking Bows Against the Barons, a left‐wing retelling of the Robin Hood story, was published in 1934. Consideration is given to the relationship between cultural change and the treatment of the structure, themes, settings and characters that typically feature in historical novels for the young. The work comprises an Introduction and three themed case studies based on a character (Robin Hood), a historical period (the long eighteenth century), and a historical event (the First World War). The case studies are used both to chart changes in the nature, quantity, and reception of historical fiction and to demonstrate the extent to which writers have used historical narratives to explore concerns that were topical at the time the books were written. In addition to the case studies, which of necessity discuss only a proportion of the texts published on each topic, the thesis includes complementary appendices which provide comprehensive bibliographies for the subject. Key changes noted over the period include the rise since the 1970s of historical novels featuring groups that were previously marginalised on the grounds of gender, sexuality, class and/or race; adjustments to the age and audience of historical fiction, and considerable use of fantasy elements including timeslip narratives. Texts discussed in detail include works by Enid Blyton, Hester Burton, Elsie McCutcheon, Marjorie Darke, Penelope Farmer, Leon Garfield, Julia Golding, Stephen R. Lawhead, Robyn McKinley, Linda Newbery, K.M. Peyton, Marcus Sedgwick, Theresa Tomlinson and Geoffrey Trease

Multicultural education as a tool for disarming violence : a study through in-depth participatory action research.

The purpose of this study was to document the academic and interpersonal experiences of nine young people who left school before completing high school, to analyze the impact of violence on their leaving school, and to broaden the information base of multicultural education so that it may become a more effective tool for disarming this violence. This study focused on the participants\u27 experiences with school structure, teachers, peers, and family. The participatory action research data collection methodology was employed to facilitate obtaining the desired information from participants by encouraging dialogue between them and the researcher. The goal of this research was to empower them to become investigators of injustice, in this case with respect to their education, so that they may become subjects (as opposed to objects) in the determination of their own destiny with respect to school and/or education. Engaging in similar dialogue with nine participants from vastly different, broadly interpreted cultural backgrounds helped to establish validity. The findings of this study indicate that young people generally like school and their teachers and love their parents despite often grave dysfunction (i.e., violence) in their experiences with each. These experiences characterize, in a variety of ways, how society in general is largely out-of-touch with the reality of young lives. All of the participants in this study appreciated the opportunity to engage in dialogue about their educational experiences in the context of what did you need that you did not get, yet none of them blamed others for their leaving school. And while all of the participants were visibly emotionally affected by recounting their histories, it is likely that only some of them will transform that emotion into the action necessary to become successful participants in our increasingly diverse and hopefully increasingly democratic society. The implications of this study have relevance for all schools, educators, and parents. It is important for all the participants in young people\u27s lives to become aware of, knowledgeable about, and understanding of the real conditions of existence of young people, which today necessarily include some form of violence, and to reflect this in the organizational structure, curricula, and interpersonal interactions of which young people are a part

The effects of explicit writing instruction

This study explores the effects of explicit writing instruction. Twenty-four seventh graders, attending a low socio-economic middle school, are the participants in this study. Eight of the twenty-four students have a writing goal, which in turn allows the language arts class to be co-taught with a general education teacher and a special education teacher. The study focuses on the effects that writing instruction can have on student writing abilities and attitudes. The general education teacher, in a whole group setting, gave the majority of instruction. Within small groups, some students were able to get additional support from either the general education or special education teacher. The results indicated that with the use of explicit instruction of the writing process, the focus on immediate feedback, and the encouragement of cross-curricular writing, students experienced growth in regards to their writing. The writing abilities of the participants increased and their writing attitudes became more positive from the beginning of the school year to the end of the study