The Oophorectomy decision explorer: a decision support intervention to facilitate deliberation and coping efforts in women at increased risk of ovarian cancer

Background: Traditionally, coping and decision making have been viewed as separate concepts. However, analysis of the role of emotions during decision making in healthcare suggests that coping with health threats, and associated emotions, should be viewed as an integral part of deliberation processes. This thesis reports on the development of a framework that merges deliberation and coping processes. Subsequently, this framework is operationalised by adapting it to specifically describe deliberations about risk-reducing salpingo-oophorectomy (RRSO) by women at increased genetic risk of ovarian cancer. Methods: A narrative review of the literature on decision making and coping theories informed the development of a novel framework that integrates theories from both fields. A multi-methods approach, which included a systematic literature search and qualitative methods, examined women’s decision making about RRSO and informed adaptation of the framework to specifically describe such decisions. The adapted framework was then used to develop a decision support intervention for women at increased risk of ovarian cancer in the UK. Incremental prototypes of the intervention were reviewed by a group of stakeholders and usability of the final prototype was tested using cognitive interviews. Results: The Coping in Deliberation (CODE) framework describes deliberations as multi-step appraisal and coping processes. The framework was successfully adapted to decisions about RRSO and used to develop a two part patient decision support intervention, consisting of a brief paper-based tool (Option Grid) and a longer website (the Oophorectomy Decision Explorer, OvDex). Conclusions: Emotions and coping are integral parts of deliberations in healthcare and the CODE framework, which acknowledges the importance of these concepts during deliberations, can be used to guide the development of patient decision support interventions. Future research should apply this framework to other healthcare decisions. The intervention developed in this thesis requires field testing to assess its impact before implementation in clinical practice

Stories in Song : Voice Faculty Recital

The talented members of the KSU voice faculty present a special recital with the works of Britten, Schubert, and Schumann. Featured Faculty artists include: Todd Wedge, Heather Witt, Jana Young, and Dr.s Nathan Munson and Eric Jenkins.https://digitalcommons.kennesaw.edu/musicprograms/2307/thumbnail.jp

KSU Chorale, Chamber Singers and KSU Symphony Orchestra

The KSU School of Music presents a special performance featuring the KSU Symphony Orchestra, led by Director of Orchestral Studies Dr. Nathaniel Parker, and KSU Chamber Singers and University Chorale led by Dr. Leslie Blackwell, Director of Choral Activities. The program concludes with a performance of Mozart\u27s Requiem (K. 626) and will also include additional works performed during the first half: Ola Gjeilo\u27s The Rose performed by KSU Chamber Singers and Chorale and Michael Daugherty\u27s Red Cape Tango performed by KSU Symphony Orchestra.https://digitalcommons.kennesaw.edu/musicprograms/2181/thumbnail.jp

Honors Voice Recital

One of the highlights of the KSU Bailey School of Music Voice Department is the prestigious Honors Recital. Upon recommendation from our panel of applied teachers, advanced singers are selected to perform in Bailey Hall to showcase their talent. Repertoire ranges from Handel to Hoiby and Bach to Bernstein in this gala evening for friends and family accompanied by our professional collaborative pianists. These singers have the opportunity to coach with visiting professional artists such as Metropolitan Opera Mezzo Soprano, Jennifer Larmore as well as artists from the Atlanta Opera. We are proud of the high level of singing and technical training that is a hallmark of our KSU Voice Department, and we are pleased to be able to offer this wonderful evening of vocal music to the public.https://digitalcommons.kennesaw.edu/musicprograms/2389/thumbnail.jp

National Cancer Diagnosis Audits for England 2018 versus 2014: a comparative analysis

BACKGROUND: Timely diagnosis of cancer in patients who present with symptoms in primary care is a quality-improvement priority. AIM: To examine possible changes to aspects of the diagnostic process, and its timeliness, before and after publication of the National Institute for Health and Care Excellence's (2015) guidance on the referral of suspected cancer in primary care. DESIGN AND SETTING: Comparison of findings from population-based clinical audits of cancer diagnosis in general practices in England for patients diagnosed in 2018 or 2014. METHOD: GPs in 1878 (2018) and 439 (2014) practices collected primary care information on the diagnostic pathway of cancer patients. Key measures including patient characteristics, place of presentation, number of pre-referral consultations, use of primary care investigations, and referral type were compared between the two audits by descriptive analysis and regression models. RESULTS: Among 64 489 (2018) and 17 042 (2014) records of a new cancer diagnosis, the percentage of patients with same-day referral (denoted by a primary care interval of 0 days) was higher in 2018 (42.7% versus 37.7%) than in 2014, with similar improvements in median diagnostic interval (36 days versus 40 days). Compared with 2014, in 2018: fewer patients had ≥3 pre-referral consultations (18.8% versus 26.2%); use of primary care investigations increased (47.9% versus 45.4%); urgent cancer referrals increased (54.8% versus 51.8%); emergency referrals decreased (13.4% versus 16.5%); and recorded use of safety netting decreased (40.0% versus 44.4%). CONCLUSION: In the 5-year period, including the year when national guidelines were updated (that is, 2015), there were substantial improvements to the diagnostic process of patients who present to general practice in England with symptoms of a subsequently diagnosed cancer

Impact of geography on Scottish cancer diagnoses in primary care:Results from a national cancer diagnosis audit

Funding The National Cancer Diagnosis Audit (NCDA) in Scotland received enabling support from Cancer Research UK and the Scottish Government. Acknowledgements This audit used data provided by patients and collected by NHS as part of their care and support. The authors would like to thank all GPs and health professionals who participated in the NCDA in Scotland, the members of the NCDA Steering Group, as well as contributing staff at Cancer Research UK; Information Services Division (NHS Scotland); Scottish Government; the Royal College of General Practitioners; and Macmillan Cancer Support. National Cancer Diagnosis Audit (2014) Steering Group: Sue Ballard (patient †), Patricia Barnett, David H Brewster, Cathy Burton, Anthony Cunliffe, Jane Fenton-May, Anna Gavin, Sara Hiom (chair), Peter Hutchison, Dyfed Huws, Maggie Kemmner, Rosie Loftus, Georgios Lyratzopoulos, Emma McNair, John Marsh (patient), Jodie Moffat, Sean McPhail, Peter Murchie, Andy Murphy, Sophia Nicola, Imran Rafi, Jem Rashbass, Richard Roope, Greg Rubin, Brian Shand, Ruth Swann, Janet Warlow, David Weller, and Jana Witt.Peer reviewedPostprin

Parkinson’s disease speech production network as determined by graph-theoretical network analysis

AbstractParkinson’s disease (PD) can affect speech as well as emotion processing. We employ whole-brain graph-theoretical network analysis to determine how the speech-processing network (SPN) changes in PD, and assess its susceptibility to emotional distraction. Functional magnetic resonance images of 14 patients (aged 59.6 ± 10.1 years, 5 female) and 23 healthy controls (aged 64.1 ± 6.5 years, 12 female) were obtained during a picture-naming task. Pictures were supraliminally primed by face pictures showing either a neutral or an emotional expression. PD network metrics were significantly decreased (mean nodal degree, p < 0.0001; mean nodal strength, p < 0.0001; global network efficiency, p < 0.002; mean clustering coefficient, p < 0.0001), indicating an impairment of network integration and segregation. There was an absence of connector hubs in PD. Controls exhibited key network hubs located in the associative cortices, of which most were insusceptible to emotional distraction. The PD SPN had more key network hubs, which were more disorganized and shifted into auditory, sensory, and motor cortices after emotional distraction. The whole-brain SPN in PD undergoes changes that result in (a) decreased network integration and segregation, (b) a modularization of information flow within the network, and (c) the inclusion of primary and secondary cortical areas after emotional distraction

Understanding older women's decision making and coping in the context of breast cancer treatment

Background: Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer. Choice of treatment is preference-sensitive and may require decision support. Older patients are often conceptualised as passive decision-makers. The present study used the Coping in Deliberation (CODE) framework to gain insight into decision making and coping processes in a group of older women who have faced breast cancer treatment decisions, and to inform the development of a decision support intervention (DSI). Methods: Semi-structured interviews were carried out with older women who had been offered a choice of PET or surgery from five UK hospital clinics. Women's information and support needs, their breast cancer diagnosis and treatment decisions were explored. A secondary analysis of these interviews was conducted using the CODE framework to examine women's appraisals of health threat and coping throughout the deliberation process. Results: Interviews with 35 women aged 75-98 years were analysed. Appraisals of breast cancer and treatment options were sometimes only partial, with most women forming a preference for treatment relatively quickly. However, a number of considerations which women made throughout the deliberation process were identified, including: past experiences of cancer and its treatment; scope for choice; risks, benefits and consequences of treatment; instincts about treatment choice; and healthcare professionals' recommendations. Women also described various strategies to cope with breast cancer and their treatment decisions. These included seeking information, obtaining practical and emotional support from healthcare professionals, friends and relatives, and relying on personal faith. Based on these findings, key questions were identified that women may ask during deliberation. Conclusions: Many older women with breast cancer may be considered involved rather than passive decision-makers, and may benefit from DSIs designed to support decision making and coping within and beyond the clinic setting

Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit.

BACKGROUND: Continual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this. AIM: To characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit. DESIGN AND SETTING: Clinical audit of cancer diagnosis in general practices in England. METHOD: Information on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management. RESULTS: Data were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15-86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0-27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more. CONCLUSION: The findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer