Opening the Closet Door on Reproductive Cancer Care for Sexual Minority Women: Interactions with Health Providers

The aim of this critical feminist study was to illuminate aspects of interactions between sexual minority women with reproductive cancers and their health care providers (HCPs) that may perpetuate or challenge barriers to receiving equitable care. For this qualitative inquiry, one-on-one interviews were conducted with six reproductive cancer survivors who self-identified as lesbian or bisexual women, four of whom were also health or service providers, and one Registered Nurse who was not also a cancer survivor (n=7). Four themes emerged from these interviews: the reproductive cancer journey, the meaning of family, interactions with HCPs, and environmental barriers. The participants outlined areas they felt were most important to their cancer care and interactions with HCPs, as well as some of the barriers they encountered. Aspects related to gender, sexuality, reproduction, and their intersections were pervasive throughout the findings and shaped the meaning of reproductive cancers for sexual minority women

Meaningful support for lesbian and bisexual women navigating reproductive cancer care in Canada: An exploratory study

Health inequities for sexual minorities are well documented, but there is a gap in nursing research addressing the specific experiences faced by lesbian and bisexual women with reproductive cancers. This critical feminist study explored interactions between sexual minority women with reproductive cancers and their health care providers and how these interactions enable and create barriers to meaningful support. Purposeful convenience sampling was used to recruit lesbian and bisexual reproductive cancer survivors from Ontario, Canada and providers who have cared for this population. Five lesbian and one bisexual woman who were reproductive cancer survivors participated, as well as one registered nurse who was not a survivor but who has cared for sexual minority women with reproductive cancers. Face-to-face interviews were conducted and conventional content analysis was used to analyze the data. The authors report on findings related to meaningful support, interactions with providers and organisational environments. Narratives showed that an understanding of gender norms influenced women’s perceptions of supportive and inclusive care, such as the acknowledgment of social supports and barriers to supportive care that included disclosure of sexual orientation. There are implications for nursing education and policy change to enhance inclusive interactions and environments for diverse sexual minority women with reproductive cancers

Shallow stratigraphic control on pockmark distribution in north temperate estuaries

This paper is not subject to U.S. copyright. The definitive version was published in Marine Geology 329-331 (2012): 34-45, doi:10.1016/j.margeo.2012.09.006.Pockmark fields occur throughout northern North American temperate estuaries despite the absence of extensive thermogenic hydrocarbon deposits typically associated with pockmarks. In such settings, the origins of the gas and triggering mechanism(s) responsible for pockmark formation are not obvious. Nor is it known why pockmarks proliferate in this region but do not occur south of the glacial terminus in eastern North America. This paper tests two hypotheses addressing these knowledge gaps: 1) the region's unique sea-level history provided a terrestrial deposit that sourced the gas responsible for pockmark formation; and 2) the region's physiography controls pockmarks distribution. This study integrates over 2500 km of high-resolution swath bathymetry, Chirp seismic reflection profiles and vibracore data acquired in three estuarine pockmark fields in the Gulf of Maine and Bay of Fundy. Vibracores sampled a hydric paleosol lacking the organic-rich upper horizons, indicating that an organic-rich terrestrial deposit was eroded prior to pockmark formation. This observation suggests that the gas, which is presumably responsible for the formation of the pockmarks, originated in Holocene estuarine sediments (loss on ignition 3.5–10%), not terrestrial deposits that were subsequently drowned and buried by mud. The 7470 pockmarks identified in this study are non-randomly clustered. Pockmark size and distribution relate to Holocene sediment thickness (r2 = 0.60), basin morphology and glacial deposits. The irregular underlying topography that dictates Holocene sediment thickness may ultimately play a more important role in temperate estuarine pockmark distribution than drowned terrestrial deposits. These results give insight into the conditions necessary for pockmark formation in nearshore coastal environments.Graduate support for Brothers came from a Maine Economic Improvement Fund Dissertation Fellowship

A Feasibility Study for CODE-MI: High-Sensitivity Cardiac Troponin - Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women.

Objectives This feasibility study was conducted to inform the design and power evaluation of CODE-MI, a pan-Canadian trial evaluating the impact of using the female-specific 99th-percentile threshold for high-sensitivity cardiac troponin (hs-cTn) on the diagnosis, treatment and outcomes of women presenting to the emergency department with symptoms suggestive for myocardial ischemia. Approach CODE-MI is a multi-center, stepped-wedge cluster randomized trial. The cohort and outcomes will be obtained from routinely collected administrative data. Using linked administrative data from 11 hospitals in Ontario from 2014/10 to 2017/09, this feasibility study obtained the following estimates: number of eligible patients, i.e., women presenting to the emergency department with symptoms suggestive of myocardial ischemia and a 24-hour peak hs-cTn value within the female-specific and overall thresholds (i.e. primary cohort); the rate of the 1-year composite outcome of all-cause mortality, re-admission for non-fatal myocardial infarction, incident heart failure, or emergent/urgent coronary revascularization. Study power was evaluated via simulations. Results Overall, 2,073,849 emergency department visits were assessed. Among women, chest pain (with or without cardiac features) and shortness of breath were the most common complaints associated with a diagnosis of acute coronary syndrome. An estimated 7.7% of women with these complaints are eligible for inclusion in the primary cohort. The rate of the 1-year outcome in the primary cohort varied significantly across hospitals with a median rate of 12.2% (95%CI: 7.9%-17.7%). With 30 hospitals, randomized at 5-month intervals in 5 steps, approximately 19,600 women are expected to be included in CODE-MI, resulting in >82% power to detect a 20% decrease in the odds of the primary outcome at a 0.05 significance level. Conclusion Routinely collected administrative health data serve as a rich and essential resource for conducting pragmatic trials assessing process change, such as CODE-MI. We demonstrated the strength of using linked administrative health data to guide the design of pragmatic clinical trials and accurately evaluate the study power

Alien Registration- Legere, Laura (Jay, Franklin County)

https://digitalmaine.com/alien_docs/19840/thumbnail.jp

Alien Registration- Legere, Laura (Jay, Franklin County)

https://digitalmaine.com/alien_docs/19840/thumbnail.jp

Approaches to health-care provider education and professional development in perinatal depression: a systematic review

Abstract Background Perinatal depression is the most common mental illness experienced by pregnant and postpartum women, yet it is often under-detected and under-treated. Some researchers suggest this may be partly influenced by a lack of education and professional development on perinatal depression among health-care providers, which can negatively affect care and contribute to stigmatization of women experiencing altered mood. Therefore, the aim of this systematic review is to provide a synthesis of educational and professional development needs and strategies for health-care providers in perinatal depression. Methods A systematic search of the literature was conducted in seven academic health databases using selected keywords. The search was limited to primary studies and reviews published in English between January 2006 and May/June 2015, with a focus on perinatal depression education and professional development for health-care providers. Studies were screened for inclusion by two reviewers and tie-broken by a third. Studies that met inclusion criteria were quality appraised and data extracted. Results from the studies are reported through narrative synthesis. Results Two thousand one hundred five studies were returned from the search, with 1790 remaining after duplicate removal. Ultimately, 12 studies of moderate and weak quality met inclusion criteria. The studies encompassed quantitative (n = 11) and qualitative (n = 1) designs, none of which were reviews, and addressed educational needs identified by health-care providers (n = 5) and strategies for professional development in perinatal mental health (n = 7). Consistently, providers identified a lack of formal education in perinatal mental health and the need for further professional development. Although the professional development interventions were diverse, the majority focused on promoting identification of perinatal depression and demonstrated modest effectiveness in improving various outcomes. Conclusions This systematic review reveals a lack of strong research in multi-disciplinary, sector, site, and modal approaches to education and professional development for providers to identify and care for women at risk for, or experiencing, depression. To ensure optimal health outcomes, further research comparing diverse educational and professional development approaches is needed to identify the most effective strategies and consistently meet the needs of health-care providers. Trial registration A protocol for this systematic review was registered on PROSPERO (Protocol number: CRD42015023701 ), June 21, 2015

Structured electronic operative reporting: Comparison with dictation in kidney cancer surgery

► First study operative report quality in kidney cancer surgery. ► First system evaluated that: (i) uses real time POC documentation embedded in the EPR; (ii) uses data fields that are searchable for research and quality assessment. ► Documentation with structured electronic templates improves quality of OR note. The purpose of this study was to evaluate the functionality of eKidney as a structured reporting tool in operative note generation. To do this, we compared completeness and timeliness of eKidney template-generated nephrectomy OR notes with standard narrative dictation. A group of academic uro-oncologists and medical informaticians at the University Health Network designed and adopted an electronic online, point-of-care clinical documentation tool, eCancerCareKidney (eKidney) for kidney cancer patient care. The optimal components of clinic and operative note templates, including those for nephrectomy, were agreed upon by expert consensus of the uro-oncologists. Clinician nephrectomy OR reports were analyzed for completeness, comparing those generated in eKidney with conventionally dictated notes. Patterns of missing information from both dictated and eKidney-generated reports were analyzed. The procedure, note completion and transcription dates were recorded which generated time intervals between these events. The records of 189 procedures were included in the analysis. Comparison of clinicians who used both note generation modalities, revealed a mean completion rate of 92% for eKidney/structured notes and 68% for dictated notes (p<0.0001). There was no significant difference in completion rates between attending staff and trainees (residents and fellows) (p=0.131). Most notes were dictated/entered on the day of surgery. Dictated notes were transcribed to EPR a median of 2 days after dictation, however roughly 30% of dictated notes took 5 days or more to get transcribed. All notes generated using eKidney were uploaded to the EPR immediately. Our study has three significant limitations. Firstly, our study was not randomized: physicians could elect to dictate or use eKidney. Secondly, we did not identify data from dictated notes that were not captured by eKidney. Third, we did not compare the time it took physicians to complete the fields in eKidney with the time it takes to dictate a note. We have demonstrated that the use of structured reporting improves the completeness and timeliness of documentation in kidney cancer surgery. eKidney is an example of the power of templates in ensuring that important details of a procedure are recorded. Future studies looking at user satisfaction, and research and educational potential of eKidney would be valuable