<p><b>Introduction</b>: Cancer registries collect tumor-related data to monitor incident rates and support population-based research. A common concern with using population-based registry data for research is reporting timeliness. Data timeliness have been recognized as an important data characteristic by both the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM). Yet, few recent studies in the United States (U.S.) have systemically measured timeliness. </p><p> The goal of this research is to evaluate the quality of cancer data and examine methods by which the reporting process can be improved. The study aims are: 1- evaluate the timeliness of cancer cases at the Indiana State Department of Health (ISDH) Cancer Registry, 2- identify the perceived barriers and facilitators to timely reporting, and 3-reengineer the current reporting process to improve turnaround time. </p><p> <b>Method</b>: For Aim 1: Using the ISDH dataset from 2000 to 2009, we evaluated the reporting timeliness and subtask within the process cycle. For Aim 2: Certified cancer registrars reporting for ISDH were invited to a semi-structured interview. The interviews were recorded and qualitatively analyzed. For Aim 3: We designed a reengineered workflow to minimize the reporting timeliness and tested it using simulation. </p><p> <b>Result</b>: The results show variation in the mean reporting time, which ranged from 426 days in 2003 to 252 days in 2009. The barriers identified were categorized into six themes and the most common barrier was accessing medical records at external facilities. </p><p> We also found that cases reside for a few months in the local hospital database while waiting for treatment data to become available. The recommended workflow focused on leveraging a health information exchange for data access and adding a notification system to inform registrars when new treatments are available. </p>

Despite there being pragmatic national guidelines for assigning risk to women with a family history of breast cancer, the evidence base is still sparse. There are three major questions: First, how can an assignment of "low" risk be made most efficiently? Second, what are the actual outcomes for higher-risk women enrolled in special surveillance programmes? Third, what are the costs and benefits of current management of members of breast cancer families? My thesis reviews the evolution of clinical services for familial breast cancer and the existing literature in the field. I describe the gathering of information from the service records of the Tayside Breast Cancer Family History Clinic and from specific research exercises that involved collaboration with other centres in the UK and abroad. My findings are as follows: 1. Histories provided by the families are not sufficient to assign risk accurately. They must be extended and verified from other records by clinical geneticists. Women assigned a low risk can be informed by post, but some may require further support. The 2004 NICE guidelines for assigning risk are fairly accurate, but may under-estimate it for some women aged 45--55 years. 2. Annual screening of young women at increased risk results in detection of most cancers at a curable stage. Women who carry BRCA1 mutations fare less well, even when tumours are detected at an apparently early stage. 3. Costs of accurate risk assessment are outweighed by savings from the better targeting of surveillance programmes. Early cancer detection in young women enrolled in these programmes achieves a substantial gain in life expectancy at a cost of £3,700 per quality adjusted life year (QALY). Prophylactic surgery for carriers of BRCA1 mutations is highly cost-effective. The thesis concludes with a discussion as to how these findings might be extended and clinical practice improved in the future.

<p> Substance use disorders (SUD) can lead to many adverse health effects including nutritional deficiencies and malnutrition. Research shows that proper nutrition can have a positive effect on recovery outcomes; however, nutrition services and education are often undervalued and not adequately utilized in substance abuse treatment centers. Previous research indicates that barriers to healthy eating are often due to ones lack of self-confidence in preparing and purchasing healthy foods. The purpose of this study was to investigate the effectiveness of a "hands-on" nutrition and culinary intervention in a SUD treatment center. Specifically, this study measured the participants' positive and negative attitudes towards cooking, as well as their perceived self-efficacy in relation to purchasing and preparing healthy foods. </p><p> There was a significant difference in the participants' overall self-efficacy related to food preparations skills, specifically in their ability to prepare whole grains. Participants also became more confident in purchasing whole grain products by the end of intervention. Further review of the study revealed that the participants' enjoyment of cooking increased significantly after completion of the cooking classes.</p>

This study had two purposes: (1) to formulate and test for sensitivity and comparability of Resource variables based on data collected across multiple sites; (2) to formulate and test for sensitivity and comparability of Fiscal variables based upon data collected across multiple sites. This exploratory descriptive study utilized data collected during the Differentiated Group Professional Practice project. Global analysis was utilized in creation of nurse Resource and Fiscal variables. Correlational statistics were utilized to evaluate performance of Resource and Fiscal variables within the project model. The Professional Practice index of Autonomy demonstrated a positive relationship with the nurse Resource variables of Retention and Stability. Increases in Professional Practice indices demonstrated negative relationships with Fiscal variables. Satisfaction demonstrated relationship to Resource or Fiscal variables.

A quasi-experimental design was used to examine the differences in myocardial infarction (MI) patients' self-care behaviors, satisfaction, knowledge, and feelings of security after participation in a structured cardiac teaching program presented by one designated patient educator. Thirty subjects diagnosed with first time uncomplicated MIs were randomly assigned to the experimental group (n = 15) or the control group (n = 15) which received conventional unstructured teaching. Four self-report questionnaires were developed and used. Patient satisfaction with teaching was greater for the experimental group (t = -2.65; df = 28; p ≤ 0.05). No differences were found between groups regarding information retained at time of discharge from the hospital or two weeks later, or in readiness for post-hospital self-care. Self-care behaviors were improved clinically in both groups, but somewhat more in the experimental group. The findings suggest this structured cardiac teaching program presented by one designated patient educator enhanced patient satisfaction and may have improved self-care.

<p> Leaders within the long-term care industry face a myriad of challenges as the U.S. population ages at exponential rates. Long term care is an industry that requires strong, well-developed leaders; yet, while Directors of Nursing (DONs) are viewed as key leaders in the long term care setting, few studies have focused on their leadership styles. The goal of this quantitative, non-experimental research was to determine if a relationship existed between leadership styles, personnel retention, and job satisfaction. Based on findings from this study, the `PST2 Leadership Model' was developed. This model is unique as it conceptualized various leadership theories and offers suggestions for implementation of specific leadership styles. This model may prove useful as an important teaching instrument within the long term care arena. As healthcare leaders and stakeholders continue to evaluate salient matters within the long term care community, it is prudent to utilize research such as this and comparable studies to guide the decision making process as this evidence may contribute to the viability of a challenged long term care system.</p>

<p>Abstract The purpose of this study was to examine the relationship of work stressors and perceived organizational support on front line nurse manager work engagement. A non-experimental descriptive, cross sectional design examined the relationship in a convenience sample of 97 front line nurse managers from the New York tri-state area and members of the American Organization of Nurse Executives. Instruments used to measure work engagement, work stressors and perceived organizational support, were: (1) the Utrecht Work Engagement Scale (UWES); (2) Challenge-Hindrance Stressor Scale and (3) Survey of Perceived Organizational Support (SPOS). Pearson's correlation and linear regression analyses indicated support for the relationship between all variables. There was a negative direct relationship between work engagement and work stressors and a positive significant relationship between perceived organizational support and work engagement. The conceptual framework of Kahn's work engagement and the Job Demands-Resources Model revealed that organizational support is needed to promote front line nurse manager work engagement. Work engagement, perceived organizational support and work stressors are professional environmental factors that impact the leadership and well-being of FLNM. These factors, properly promoted and implemented, lead to FLNM's success, retention and job performance.

The purpose of this thesis was to analyze factors related to labour market survival and withdrawal behaviour in the profession of Occupational Therapy in Ontario from 1997 to 2006. To provide a portrait of the OT labour market in Ontario overall, and in relation to sector and age, three types of analysis were used: descriptive statistics (including “stay, switch, and leave” analysis), “Stickiness” and “Inflow” analysis, and survival analysis. The largest proportion of OTs worked in the Hospital sector, which had a great ability to retain OTs according to the “Stickiness” analysis. However, when controlling for other variables using survival analysis, none of the sector variables had a significant effect on survival. The youngest and oldest age groups had the highest propensity of leave, due to mobility, family commitments, and retiring (oldest group only). Overall, the profession in Ontario had a strong ability to retain OTs working in the profession during the study period.

<p> The elderly population, defined as 65 and older, is the fastest growing demographic group in the United States. As baby boomers' reliance on healthcare systems increase, housing with medical accessibility becomes a vital need in today's economy. As the market appears to signal an increase in the need and desire for home and community based services, important questions arise about how assisted living executives' leadership styles affects his/her entrepreneurial orientation. This study analyzed the relationship between the full range of leadership model as measured by the multifactor leadership questionnaire and entrepreneurial orientation (innovativeness, proactiveness, and risktaking) of executives within the licensed assisted living facility industry in Indiana. The researcher used the multifactor leadership questionnaire and the entrepreneurial orientation questionnaire to determine whether assisted living executives were innovative, proactive, and risk-taking based on their leadership style. </p>

<p> The American Academy of Pediatrics (AAP) delineated four criteria for management of perinatal care and discharge (DC) of high-risk neonates: 1) physiological stability, 2) tracking and surveillance of growth and development for each infant, 3) active parental involvement with the infant's care, and 4) follow-up care arranged with experienced primary care provider. Registered Nurses in California Neonatal Intensive Care Units (NICUs) were surveyed about NICU DC transitioning programs to 1) identify current common standards of care used in DC transitioning and 2) define the nature and extent of additional criteria and procedures used in DC transitioning. Useable surveys were obtained from 32 of the 79 facilities queried (41%): 17 (53%) Level II, 10 (31%) Level III, and 5 (16%) Level IV. All responding facilities were located in communities of 100,000 people or more. All but one of the facilities (97%) used all four AAP criteria for determining readiness for DC. Facilities differed in whether they also used weight, corrected gestational age, or both as criteria for DC. They differed in the definition of active parental involvement with care, the degree to which parents participated in DC planning, who arranged for post-DC primary care, and how outcomes of DC planning practices were evaluated. Profiles derived from these data can be used to expand procedures, guidelines, and policies for DC transitioning of the NICU graduate.</p>