Improving Breast Health Care Through the Implementation of a Nurse Navigator

Abstract In a rural Northern California setting, a Clinical Nurse Leader intern was implemented as a designated Nurse Navigator (NN) for a regional breast health population. The global aim of this project is to improve care for potential and actual newly diagnosed breast cancer patients by increasing access to care, decreasing barriers, and improving timeliness of care. Using evidence based on an extensive scholarly literature review, the designated NN will accomplish the aim through care coordination, thereby improving patient outcomes, decreasing outmigration of care, and increasing the financial viability of the breast health program. The ultimate goal of the breast health team is to obtain accreditation as a Breast Center of Excellence (BCoE) by the National Accreditation Program for Breast Centers (NAPBC). The NN first observed the microsystem and performed an RCA and SWOT analysis. Theory U and the IHI MFI are used to guide the implementation of the project. An existing software program, the Mammography Reporting System (MRS), was utilized to collect specific quality metrics for baseline data, and will be used to evaluate expected improvements. In comparison to the Oncology Roundtable Cancer Quality Metric Selection Tool, targeted metrics to improve include: Time from screening to diagnostics, diagnostics to biopsy, biopsy to surgery, as well as needle core biopsy rate, and outmigration of care. More time is needed to mature data for a viable evaluation of this project, although preliminary feedback has been positive from patients and providers

Functional decline in residents living in nursing homes : a systematic review of the literature

Objectives To describe the functional dependence progression over time in older people living in nursing homes (NHs). Design A systematic review of the literature was performed. Studies involving individuals 65 years and older living in NHs, describing their functional decline, improvement or stability in activities of daily living (ADLs), were eligible. The search strategy was applied in MedLine, Cochrane, CINAHL, and SCOPUS databases; aimed at identifying an unbiased and complete list of studies, searching by hand was also performed. The methodological quality of the 27 studies included was assessed. Results Functional trajectories were documented mainly through multicenter study design including sample size ranging from 2 to 9336 NHs, from 1983 to 2011 throughout a single or multiple follow-ups (>20). The average rate of decline was expressed in different metrics and periods of time: from 3 months with a decline of −0.13 points of 28, to 6 months (−1.78 points of 2829) to 1.85 years (−0.5 points of 6). Eating and toileting were the most documented ADLs and the decline is approximately 0.4 points and 0.2 to 0.4 points of 5 a year, respectively. Among the covariates, individual factors, such as cognitive status, were mainly considered, whereas only 13 studies considered facility-level factors. Conclusions Findings report the slow functional decline mainly in women living in US NHs, in years when residents were admitted with a low or medium degree of functional dependence. Considering that in recent years residents have been admitted to NHs with higher-level functional dependence, studies measuring each single ADL, using standardized instruments capable of capturing the signs of decline, stability, or improvement are strongly recommended. Among the covariates, evaluation of both individual and facility-level factors, which may affect functional decline, is also suggested

Provider-initiated testing and counselling programmes in sub-Saharan Africa: a systematic review of their operational implementation.

OBJECTIVE: The routine offer of an HIV test during patient-provider encounters is gaining momentum within HIV treatment and prevention programmes. This review examined the operational implementation of provider-initiated testing and counselling (PITC) programmes in sub-Saharan Africa. DESIGN AND METHODS: PUBMED, EMBASE, Global Health, COCHRANE Library and JSTOR databases were searched systematically for articles published in English between January 2000 and November 2010. Grey literature was explored through the websites of international and nongovernmental organizations. Eligibility of studies was based on predetermined criteria applied during independent screening by two researchers. RESULTS: We retained 44 studies out of 5088 references screened. PITC polices have been effective at identifying large numbers of previously undiagnosed individuals. However, the translation of policy guidance into practice has had mixed results, and in several studies of routine programmes the proportion of patients offered an HIV test was disappointingly low. There were wide variations in the rates of acceptance of the test and poor linkage of those testing positive to follow-up assessments and antiretroviral treatment. The challenges encountered encompass a range of areas from logistics, to data systems, human resources and management, reflecting some of the weaknesses of health systems in the region. CONCLUSIONS: The widespread adoption of PITC provides an unprecedented opportunity for identifying HIV-positive individuals who are already in contact with health services and should be accompanied by measures aimed at strengthening health systems and fostering the normalization of HIV at community level. The resources and effort needed to do this successfully should not be underestimated

We Missed Our Youth : The Identity Formation of Child Migrants, Refugees, and Jewish Children in France From 1940 to 1942

From 1940 – 1942, hundreds of Jewish children from Germany, Austria, Russia, and France were hidden from Nazi and Vichy French authorities in children’s homes in France. These homes were administered by the Oeuvre de Secours aux Enfants, a Jewish aid organization that assisted children in need during World War II. This study employs a quantitative content analysis of the testimonies of twenty Holocaust survivors who were hidden children in France between 1940 and 1942 to investigate to what extent the experience of outsider status and trauma affected these children’s personal and religious identity formation. The analysis finds that the experience of forced familial separation and trauma had adverse effects on survivors’ formation of a personal identity and affiliation links and had other unexpected consequences in their lives. This thesis integrates scholarship about Vichy France and its persecution of Jews with modern literature about identity, racialization, and immigration in France. Finally, this thesis uses the historical analysis and modern scholarship to provide insight into the experience of contemporary refugee children in France and the world

Preliminary X-ray diffraction analysis of YqjH from Escherichia coli: a putative cytoplasmic ferri-siderophore reductase

YqjH is a cytoplasmic FAD-containing protein from Escherichia coli; based on homology to ViuB of Vibrio cholerae, it potentially acts as a ferri-siderophore reductase. This work describes its overexpression, purification, crystallization and structure solution at 3.0 A resolution. YqjH shares high sequence similarity with a number of known siderophore-interacting proteins and its structure was solved by molecular replacement using the siderophore-interacting protein from Shewanella putrefaciens as the search model. The YqjH structure resembles those of other members of the NAD(P)H:flavin oxidoreductase superfamily

Migrant women’s experiences of pregnancy, childbirth and maternity care in European countries: A systematic review

Background: Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities. Objective: To provide up-to-date systematic evidence on migrant women’s experiences of pregnancy, childbirth and maternity care in their destination European country. Search strategy: CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017. Selection criteria: Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe. Data collection and analysis: Qualitative data were extracted and analysed using thematic synthesis. Results: The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: ‘Finding the way—the experience of navigating the system in a new place’, ‘We don't understand each other’, ‘The way you treat me matters’, and ‘My needs go beyond being pregnant’. Conclusions: Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs

Using Disaster Surveys to Model Business Interruption

Business interruption after disasters is an important metric for community resilience planning because has both economic and social consequences. Each additional day that a business is nonoperational further compounds lost revenue, wages, and lack of access to goods and services needed for recovery. Therefore, the use of surveys has grown in the literature as a way to capture the diverse information needed for modeling business disaster outcomes. However, variable inclusion and measurement can vary widely across studies, and there is a lack of guidance on how to structure surveys most effectively to facilitate this effort. This study fills these gaps through an analysis of variable choice, variable measurement, and measurement timing using data from an interdisciplinary field study in Lumberton, North Carolina after 2016 Hurricane Matthew. We found that empirical business interruption models can be improved significantly by using a comprehensive set of utility and damage variables; integrating damage information based on damage states for building, contents, and machinery; and capturing recovery-time dynamics by using business downtime and utility outage durations, rather than binary measurements. The results suggest that making these relatively small changes to survey design in future studies can yield large returns in empirical business models for community resilience research

Synthesis and Characterization of Novel Organometallic Complexes

https://scholarworks.seattleu.edu/fss-2019/1010/thumbnail.jp