Cancer diagnoses affect millions of people in the United States each year. Today, cancer patients face many challenges when trying to navigate the complex healthcare system. Patient navigation programs were developed to address and overcome barriers patients may face as they make their way through the healthcare system. The purpose of this project was to provide an analysis and discussion of the current published literature to provide evidence for improving care coordination and patient satisfaction in the oncology clinical setting with a patient navigator program. The practice-focused question for this project asked if a patient navigator program for adult cancer patients improved patient outcomes. The systematic review, guided by Watson's theory of caring, included 11 studies published between 2010 and 2017 identified through Cochrane Library, CINAHL, ProQuest, PubMed, and Joanna Briggs Institute. Initially a total of 679 articles were identified; however the number reduced by removing duplicates and after review of titles and abstracts. The remaining articles were then evaluated by the level of evidence based on the Manly and Fineout-Overholt's guide on hierarchy of evidence. The results identified in this systematic review showed patient navigation can improve care coordination and patient satisfaction. This review offers findings on the impact of cancer care coordination and patient satisfaction, which may be used by healthcare leaders when determining how to improve cancer care and as a result may provide positive social change. If the organization implements a patient navigator program, it is expected that this change would benefit patients, families, healthcare providers and the organization.

Predicting retention and time to graduation within accelerated online and a hybrid RN-to-BSN programs are significant elements in leveraging the pipeline of qualified RNs with BSN degrees, but the literature lacks significant accounts of retention and time to graduation outcomes within these programs and predictive algorithm developments to offset high attrition rates. The purpose of this study was to quantitatively examine the relationships between pre-entry attributes, academic integration, and institutional characteristics on retention and time to graduation within accelerated online RN-to-BSN programs in order to begin developing a global predictive retention algorithm. This study was guided by Tinto's theories of integration and student departure (1975, 1984, 1993) and Rovai's composite persistence model. Retrospective datasets from 390 student academic records were obtained. Findings of this study revealed pre-entry GPA, number of education credits, enrollment status, 1st and 2nd course grades and GPA index scores, failed course type, size and geographic region, admission GPA standards, prerequisite criteria, academic support and retention methods were statistically significant predictors of retention and timely graduation (p <.05). A decision tree model was performed in SPSS modeler to compare multiple regression and binary logistic regression results, yielding a 96% accuracy rate on retention predictions and a 46 % on timely graduation predictions. Recommendations for future research are to examine other variables that may be associated with retention and time to graduation for results can be used to redevelop accurate predictive retention models. Having accurate predictive retention models will affect positive social change because RN-to-BSN students that successfully complete a BSN degree will impact the quality and safety of patient care.

Background The focus of this study is on how far GPs¿ perceptions of dementia map onto the components and contributing factors to stigma as described by Link and Phelan (2001; 2006) and Jones et al. (1984). Aim The study explores GPs¿ perceptions of dementia as a stigma, develops a specific conceptualization of the stigma of dementia and considers implications for timely diagnosis. Methods Data from twenty-three GPs in northern England were collected by semistructured telephone interviews. Within the context of a qualitative design, a combined process of grounded theory and framework analysis was adopted to collect and analyse data. Results The findings reveal that GPs¿ perceptions of dementia map onto Link and Phelan and Jones¿ identification of contributing factors and components of stigma and may hinder timely diagnosis. Three themes emerged reflecting a dynamic process of making sense of dementia, relating perceptions to oneself and considering the consequences of dementia. Within those themes, certain categories had particular salience for GPs, namely the characteristics of the attribute, existential anxiety and discrimination. The themes and categories are inter-related and can be considered as parts of a system. Perceived lack of reciprocity could be detected in most categories which suggests that it is influential in the social construction of the stigma of dementia. Conclusion The data suggest that current conceptualizations of stigma are insufficient to fully account for the stigma of dementia. A specific conceptualization of the stigma of dementia is proposed and the implications of GPs¿ perceptions for timely diagnosis are discussed.

Increasing symptom awareness, encouraging help-seeking, and facilitating timely referral are key for improving cancer outcomes, particularly for cancers such as oesophageal and gastric (stomach), where five-year survival is less than 20%. In this research, I used multiple methods to explore factors that influence timely diagnosis of these cancers from a patient's perspective, with a particular focus on health literacy (accessing, understanding and using health information, and navigating healthcare systems). I started by exploring current knowledge in this field before conducting a systematic review investigating health literacy in the timely diagnosis of symptomatic cancer. Literature was searched from January 1990-May 2017 using six bibliographic databases. I screened 2304 titles/abstracts, assessed 26 full-text papers and included three, although they were methodologically weak, therefore limiting the conclusions. To examine pathways to diagnosis for oesophageal and gastric cancer, I conducted a questionnaire study of newly diagnosed patients across two hospitals in the East and North East of England. 127 participants were recruited (39.6% recruitment rate), aged 44-96 (median 71); 102 male (80%). Most had oesophageal cancer (n=102, 80%); 64 (50%) of the total cohort were late-stage at diagnosis. Common pre-diagnostic symptoms varied between cancers (oesophageal: difficulty swallowing (n=66, 65%), painful swallowing (n=55, 54%); gastric: fatigue/tiredness (n=20, 80%), weight loss (n=13, 52%)). The questionnaire included two domains (engagement, understanding) of the Health Literacy Questionnaire with participants demonstrating high health literacy (mean 4.18 and 4.28, score 1-5). The median time from noticing the trigger symptom (prompting help-seeking) to diagnosis was 81 days (IQR 45-137.5, n=107). Twenty-six participants were purposively sampled, from questionnaire respondents, for face-to-face interviews (aged 55-88, 18 male, 15 with oesophageal cancer). I undertook thematic analysis to explore participant accounts of their pathways to diagnosis, identifying that the symptom nature was important for appraisal, while health literacy ability influenced the health system interval. Descriptions of 'heartburn', 'reflux' and 'indigestion' differed between participants, suggesting these terms may introduce uncertainty in relation to symptom experience. This is the first study to explore the role of health literacy in the timely diagnosis of symptomatic cancer, and pathways to diagnosis for oesophageal and gastric cancers, from a patient's perspective. Findings provide important insights for the development of targeted awareness campaigns and strategies enhancing GP symptom exploration.

This thesis consists of three related essays that examine the role of information in the market for corporate debt. The three essays collectively examine the role of information produced by the firm and its agents on alleviating information asymmetries facing public debtholders. In particular, the thesis examines the impact of bondholders' demand for reputation and information on the firm's disclosure choices and accounting attributes; and the impact of information produced by monitoring the firm's private debt before its entry to the public debt market on the yield spread of its initial bond. The first essay investigates the influence of public corporate debt on the willingness of UK firms to issue profit warnings. UK firms operate within a legal environment that is less litigious compared to their US counterparts. This setting allows for motives other than fear of litigation to affect UK companies' decision to warn. The results of this essay indicate that UK firms with public debt are more forthcoming with the disclosure of permanent negative news. Also, the results show that UK firms without public debt are more likely to hide bad news when they are closer to financial distress. However, for firms with public debt, the results indicate that the effect of closeness to financial distress on the willingness to warn is attenuated. These findings suggest that firms with public debt are deterred from hiding negative news for fear of damaging their reputation for truthful and timely disclosure. Public debt appears to act as a disciplinary mechanism on corporate disclosure policy.The second essay examines the impact of the initial public debt offering (IPDO) on the timeliness properties of the firm's accounting income. Firms are more likely to communicate with private lenders on a private, insider-basis, while they are more likely to communicate with bondholders using public information. Therefore, bondholders, compared to private lenders, are expected to be more sensitive to the quality of public information. The results indicate that firms adopt a timelier policy of economic loss recognition after their initial public debt offering using Basu's (1997) time series measure of timely loss recognition. These findings suggest that firms face higher demand for public information from a large number of external and dispersed bondholders.The third essay investigates the impact of information associated with prior private debt financing on the yield spread of companies' initial public debt offerings. Specifically, this essay focuses on information produced through monitoring by credit rating agencies and monitoring by banks. The findings indicate that IPDOs with the same or upgraded credit ratings enjoy significantly lower yield spreads. This finding suggests that changes in credit ratings could convey new information to investors regarding the firm's commitment to maintain a high credit quality. In addition, the findings of this essay indicate that strong banking relationships significantly reduce yield spreads for initial public debt offerings. This suggests that a strong banking relationship conveys a positive signal to bondholders regarding the bank's assessment of the quality of the firm.

No description available.

Standard empirical models of operating efficiency (OE) and managerial ability (MA) assume a symmetric linear relation of OE and MA with firm performance. However, OE and MA metrics are likely to respond faster to a demand decrease than a demand increase due to cost stickiness and respond faster to negative returns than to positive returns due to accounting conservatism. As predicted, I find large asymmetries in the behavior of OE and MA measures. OE and MA in levels (changes) are 2.4 (1.4) times and 1.5 (1.6) times more sensitive to demand decreases than demand increases. Similarly, OE and MA levels (changes) are 1.7 (1.5) times and 3.6 (2.3) times more sensitive to negative returns than to positive returns. The incremental explanatory power of modeling asymmetry in OE and MA levels (changes) is 20.9% (39.5%) and 263.3% (27.6%), measured as incremental adjusted R2. Cross-sectionally, asymmetry in OE and MA varies with the determinants of cost stickiness: (1) asset intensity and (2) employee intensity. Moreover, the degree of asymmetry also varies with the determinants of accounting conservatism: (1) book-to-market value of equity, (2) leverage, and (3) market capitalization. In addition, demand decline (i.e., cost stickiness) and bad news (i.e., accounting conservatism) during prior and successive periods have an incremental impact on the asymmetry in OE and MA. The standard models of OE and MA do not control for these correlated-omitted variables or incorporate the cost stickiness and accounting conservatism asymmetries, which yield biased measurements and render incorrect regression estimates and inferences. / Business Administration/Accounting

Abstract This thesis set out to achieve the following objectives: (1) To identify the priorities and expectations that the Geelong community has of its public health care system. (2) To determine if there is a common view on the attributes of a just health system. (3) To consider a method of utilising the data in the determination of health care priority setting in Barwon Health. (4) To determine a model of community participation which enables ongoing input into the decision making processes of Barwon Health. The methodology involved a combination of qualitative and quantitative research. The qualitative work involved the use of focus groups that were conducted with 64 members of the Geelong community. The issues raised informed the development of the interview schedule that was the basis of the quantitative study, which surveyed a representative sample of 400 members of the Geelong community. Prior to reporting on this work, the areas of distributive justice, scarcity and community participation in health care were considered. The research found that timely access to public hospitals, emergency care and aged care services were the major priorities; for many people, the cost was less relevant than a quality service. Shorter waiting times and increased staffing levels were strongly supported. Increased taxes were nominated as the best means of financing the health system they sought. Community based services were less relevant than hospital services but health education was supported. An egalitarian approach to resource distribution was favoured although the community was prepared to discriminate in favour of younger people and against older people. There was strong support for the community to be involved in decision making in the public health care system through surveys or focus groups but very little support was given to priorities being determined by politicians, administrators and to a lesser extent, medical professionals.

Globalization has led to the growth of international financial markets, as one of the results, the EU adopted IFRS in 2005 to meet the need of accounting globalization and harmonization. This action has triggered a debate about whether the adoption of IFRS is beneficial to accounting quality and information comparability. Meanwhile, China, playing a key role in the global economic development stage, realizes the importance of accounting harmonization and attempts to move towards the IFRS as well. However, to reach the goal that the Chinese companies produce financial statements that are the same as those that apply IFRS, there is still a long way to go. The purpose of this thesis is to examine whether the adoption of IFRS by EU has enhanced the quality of financial reporting and accounting information comparability. Additionally, the thesis further identified the seminal undertakings for the convergence of IFRS in Europe and pointed out the implication for China’s convergence with IFRS. The empirical findings in this thesis were obtained through qualitative interviews. The empirical findings suggest that accounting quality and information comparability has been enhanced with EU’s strong and full enforcement with IFRS. With the confidence in IFRS which is gained from the success of the EU’s adoption of IFRS, a coherent result was found that the convergence towards IFRS would also benefit China in accounting quality and information comparability, and further lead to more international investments. However, when it comes to the question whether China should emulate EU’s example to adopt IFRS directly or keep CAS (Chinese Accounting Standards) which is similar to IFRS, two mixed opinions were obtained basically from Europe side and China side. Through in-depth analysis with these empirical findings, the conclusion is that it is necessary for China to take steps to build intensive programs to enhance its capacity of the adoption of IFRS, so that it could adapt itself to the fact that the IFRS is already making its way around the world as a single set of high quality global accounting standards.

本研究以美國證券市場為樣本，探討銀行業之法規開放是否對非金融業公司之會計穩健性造成影響。銀行法規開放可使銀行透過併購於州內擴張，借款公司可能面對之銀行議價能力上升，使得銀行要求融資顧客出具高品質之財務報表。另一方面，州際銀行法規開放可能使他州銀行進入本地金融市場，進而提高金融市場之競爭度。由於會計穩健性可降低管理階層與投資人的資訊不對稱，被視為高品質的財務報表，本文推測銀行業法規鬆綁會影響公司會計穩健性。實證結果顯示，州內銀行法規開放與會計穩健性間具有顯著正向關係；然而，州際銀行法規開放與會計穩健性間具有顯著負向關係。額外分析顯示，大型企業更傾向於對銀行法規開放作出反應，而較依賴發行公司債融資方式之公司在面對銀行法規開放時則減少財務報導中認列損失之即時性。 / This study uses US banking deregulation as a research setting to examine whether banking deregulation has an impact on the degree of accounting conservatism of non-financial firms. Since banking deregulation would enable large banks expand within states through merge and acquisition, bank’s bargaining power to lenders may increase. Banks may require their clients to provide higher quality of financial statements. On the other hand, banking deregulation may increase competition in local financial markets by enabling large banks to enter into local markets. As accounting conservatism could alleviate information asymmetry between management and investors, and serves as an indicator of high quality of financial statements, I expect that banking deregulations would have an impact on firms’ reporting conservatism. I find that there is a significantly positive relationship between intrastate banking deregulation and firms’ timely loss recognition. In contrast, interstate banking deregulation has a significantly negative influence on firms’ timely loss recognition. Additional analyses reveal that large firms are more likely to respond to the banking deregulation and that firms that rely more on public debt financing respond to the banking deregulation by decreasing their degree of timely loss recognition in financial reporting.