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

New Histories: Creating Video Work to Fill Adoption Absences

Adopted at birth and brought up Pākehā, I discovered as an adult that I have Ngāi Tahu tūpuna (ancestors). Adoptees seek birth kin and stories to try to fill the gaps and absences that haunt us, so I undertook my roots journey, travelling three times to Riverton/Aparima, where my ancestors had lived, taking my video camera. In this article I describe how initially I did not find the belonging I was looking for, but through my creative practice of filmmaking, and the three short videos I made, I did connect to place, and began making a new history for myself

The education of children in the local church about India

https://place.asburyseminary.edu/ecommonsatsdissertations/2167/thumbnail.jp

The feasibility and potential effectiveness of a conventional and exergame intervention to alter balance-related outcomes including fall risk: a mixed methods study

Introduction: Fall risk, occurrence and injury is increasing as the world ages, and Africa and other emerging regions will not be spared. Similarly, the rise of noncommunicable diseases, compressed morbidity and lack of physical activity present major challenges. This novel feasibility study explored the use of an exergaming technology compared with a conventional, evidence-based exercise programme (Otago Exercise Programme) to reduce fall risk by improving balance, and to inform a large-scale randomised control trial. Methodology: Mixed methods study in independent older adults with established fall risk. The quantitative component employed feasibility RCT methodology. Cluster randomisation assigned interventions to sites. Single blinding was used. Both interventions were offered for six months. A variety of balance-related endpoints (e.g., Timed Up and Go, Dynamic Gait Index, Mini-BESTest) were used to find the most applicable. Patient-centred variables included questionnaires regarding depression, physical activity levels, quality of life and estimates of self-efficacy for exercise. Qualitative focus groups explored participants' experiences of falls and the exergaming intervention using a phenomenology lens. Results: Site and participant recruitment was simple and readily achievable, with low numbers need to screen required. Eligibility criteria were confirmed and more added. Adherence and attrition were major challenges. Cluster randomisation appeared to exacerbate between-group differences at baseline. The exergaming intervention produced preliminary evidence in its favour, with results approaching Minimal Clinically Important Difference compared with the evidence-based intervention. The experience of the exergaming intervention was regarded as positive by focus group participants. Barriers and facilitators are reported. Discussion: Methodological issues in the literature have prevented firm consensus on the use of exergaming in falls prevention, although studies are abundant. The current study used rigorous methodology in the novel context of a developing region, which offers numerous challenges for older adults. Implications for a large-scale, fully funded RCT are discussed. Lessons learned can be used to scale up service delivery for an under-served population; and promote the aim of well-being for all at all ages

New Histories: Creating Video Work to Fill Adoption Absences

Adopted at birth and brought up Pākehā, I discovered as an adult that I have Ngāi Tahu tūpuna (ancestors). Adoptees seek birth kin and stories to try to fill the gaps and absences that haunt us, so I undertook my roots journey, travelling three times to Riverton/Aparima, where my ancestors had lived, taking my video camera. In this article I describe how initially I did not find the belonging I was looking for, but through my creative practice of filmmaking, and the three short videos I made, I did connect to place, and began making a new history for myself

Presbyastasis: a multifactorial cause of balance problems in the elderly

Presbyastasis is the result of age-related physiological changes in the three sensory systems and their central connections that contribute to balance. In all likelihood, presbyastasis is a complex condition involving many intertwined systems rather than a lesion within the vestibular system only, thus evaluation and management need to be holistic. Balance problems can have detrimental consequences and are associated with falls, loss of quality of life and psychological sequelae such as anxiety, depression and panic. Healthcare practitioners need increased awareness of the pathophysiology of presbyastasis and its possible impact

What Specific Characteristics Influence Patients To Receive Their Health Care From A Physician Assistant?

Background. This research investigated patient satisfaction with physician assistants in a primary health care. The literature reviewed concluded high patient satisfaction ratings resulted because of the clinicians strong interpersonal skills, easy accessibility, adequate time was spent, were good listeners, explained medical issues well, and were courteous and respectful. The study looked at what specific characteristics influenced high patient satisfaction ratings with physician assistants. It also looked at the top three characteristics that were important to the patient and whether the patient would see the PA again. Methods. A patient satisfaction survey was give n to 92 patients at Allina clinic of Hastings, who were scheduled to see a PA that day. Descriptive and inferential statistics were used to calculate frequencies, modes, and correlations using statistical package of social sciences on the 42 completed surveys. Results. The most important characteristic of PAs was courtesy at 56.4%, followed by understanding the medical issue, clear explanations and being respectful. Confidence in the PA and overall patient satisfaction were strongly correlated with the amount of time the PA spent with the patient, how courteous the PA was, and how well the PA listened to the patient. patients whom were wilting to see a PA again rated overall patient satisfaction high. Conclusion. The literature reviewed and the research findings supported the hypothesize that when patients experienced a PA with strong interpersonal skills, good communication skills, were competent decision makers, and spent adequate time with patients, the outcome was a positive health care experience

The Relationship Between Exposure to Lead and Criminal Behavior

In recent years it has been made apparent that exposure to lead is a significant problem for many individuals and families. Lead exposure–whether through the air, water, or by ingestion–has been linked to numerous physical, cognitive, and social problems (Chandramouli, 2009; Nevin, 2007). Furthermore, urban, poor and immigrant populations are at a higher risk for lead exposure (Bakhireva, et al., 2013). And increasingly a connection between lead exposure and criminal behavior has been identified through both correlation studies and experiments. The high cost of exposure to lead is apparent when looking at the effects of lead over a lifetime, and should be avoided if at all possible