Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Management of very low rectal cancer is one of the most challenging issues faced by colorectal surgeons. For tumors in the mid and upper rectum, procedures can be done to resect the cancer while maintaining continence, a major determinant of post-operative quality of life. In the low rectum, however, to optimize oncologic outcomes, many surgeons feel compelled to pursue abdominoperineal (APR) over low anterior resection (LAR), a sphincter-preserving procedure. It was hypothesized that after robust adjustment, procedure choice will not be associated with a difference in disease-free survival in the resection of tumors in the low rectum. To analyze this, the US Rectal Cancer Collaborative Database, a comprehensive, multi-center dataset obtained from six institutions between 2010 and 2016, was queried. Patients undergoing TME resection for Stage I-III very low rectal cancers (involvement) were selected for this study. Patients were categorized by procedure- LAR vs APR. Primary outcome was five-year disease-free survival. Secondary outcomes included overall survival, recurrence, length of stay, and complications. An adjusted analysis was performed to account for all known potential confounders. 431 patients with very low rectal cancer treated by either APR or LAR were identified. 154 (35.7%) underwent APR. The overall recurrence rate was 19.6%. Median follow-up time was 42.5 months. An analysis adjusted for age, gender, BMI, ASA class, and pathologic stage observed no difference in disease free survival between operative types (HR=0.90, 95% CI [0.53-1.52], p=0.70). Similarly, secondary outcomes demonstrated no significant difference between operation types, including length of stay (Beta: 0.04, Std. error = 0.25, p = 0.54), overall survival (HR=1.29, 95% CI [0.71-2.32], p=0.39), or complications (OR = 1.53, 95% CI [0.94 - 2.50], p=0.09). In this analysis, no significant difference in disease-free survival or overall survival was observed between patients undergoing APR or LAR for very low rectal cancer. This comprehensive study supports the treatment of very low rectal cancer, less than 5cm from the anorectal ring with no sphincter involvement, by either abdominal perineal or low anterior resection. Further studies may focus on patient-reported and quality of life outcomes which may influence decision-making.

Title: Improving Diabetes Self-Management Education and Support (DSMES) Referrals in the Primary Care Setting Authors: Stephanie Sossong and Dr. Jean Hemphill, College of Nursing, East Tennessee State University, Johnson City, TN. Purpose: The purpose of this quality improvement project is to implement a standardized referral process to DSMES in primary care. DSMES decreases complications from T2DM and reduces healthcare costs. However, patients diagnosed with T2DM are referred <7% of the time. Aim: To assure that patients diagnosed with T2DM receive referrals to an accredited DSMES program. Processes: Baseline data of the number of patients with T2DM referred to DSMES was collected from a primary care clinic for 4 weeks. An educational in-service highlighting the benefits of DSMES, guidelines for referrals, and the process improvement was presented to providers and medical assistants. Data regarding referrals to DSMES after the process implementation will be collected for 4 weeks, numbers will be compared to pre-implementation data and reported using percent frequency. The IRB determined that the activities of this project are not defined as research involving human subjects. Results: The results of this project have not been determined yet, however; the expected outcome is an increased number of referrals to DSMES. Limitations: The limitations of this project include a small sample size and a short length of study. Conclusions: Implementing a standardized referral process in primary care increases referral rates to DSMES. This is important because DSMES has been proven to reduce diabetes related complications, healthcare spending, and prevalence of other comorbidities.

Thesis (M.S.)--Boston University / Anxiety is a common reponse in patients undergoing cardiac surgery. The source of this anxiety is attributed to a multitude of factors. Research findings support the relationship between preoperative preparation and a reduction in anxiety. However, a lack of information exists as to the role of critical care nurses in this process. This purpose of this study was to examine the effect of a structured preoperative education/orientation visit by the critical care nurse on the level of patient anxiety. A sample of 21 patients were drawn from the population of cardiac surgical patients and randomly assigned to the experimental or control group. Subjects in the experimental group received a structured preoperative education/orientation visit by a critical care nurse the evening prior to surgery. Subjects in the control group did not receive the visit. Subjects in both groups completed the State-Trait Anxiety Inventory preoperatively and the A-State Scale plus an additional questionaire postoperatively. Data were analyzed using analysis of covariance on repeated measures and a t-test comparison of mean anxiety scores. Findings revealed no significant differences in postoperative state anxiety scores between the experimental and control group. Results from the second questionaire indicated that subjects in the experimental group felt the preoperative visit was helpful. Furthennore, those patients who had the continuity of the same nurse conducting the preoperative visit and assuming primary care postoperatively in the intensive care unit responded more favorably on the questionaires. There were however, significant pre-existing differences in age and trait anxiety scores between the groups. This fact, in addition to the small sample size limit the ability to evaluate the effectiveness of the experimental intervention. Thus, further research is warranted to determine the effect of a preoperative education/orientation visit by critical care nurses utilizing a larger sample size.

Magister Scientiae Dentium - MSc(Dent) / The purpose of this study was to compare the accuracy of direct versus indirect bracket placement in orthodontics in a controlled setting. The more accurate the initial bracket placement is the less time will be required in terms of treatment. Accurate bracket placement can reduce the envelope of error in the three dimensions of vertical (incisal height, height of tooth), horizontal (mesial-distal) and angular (degrees incisal to root apex causing rotational irregularities) based on Andrews’ six keys to normal occlusion (Andrews, 1979). In this comparative experimental study, 10 Class I molar relation study models were selected from the researcher’s practice archives. Only the MBT pre-adjusted or angulated orthodontic brackets were used on manikins, followed by the use of 3D CAD CAM technology to evaluate the results against a pre-determined golden standard.

Hearing loss and tinnitus are the two most common service-connected disabilities in Veterans. Patients with a chief complaint of hearing loss and/or tinnitus typically undergo a hearing evaluation to determine the severity and type of hearing loss. The standard treatment for sensorineural hearing loss is the fitting of personal amplification.Up to 95% of tinnitus patients have an underlying hearing loss and could benefit from hearing aids for both improved communication and as an effective treatment to reduce the impact of tinnitus, ((Shargorodsky, Curhan, & Farwell, 2010). It is not uncommon, however, for some of these patients to decline hearing aids although they elect to undergo tinnitus counseling. The observation that some of these patients elected to obtain hearing aids following tinnitus counseling compelled an investigation of tinnitus counseling’s role in the patient’s revised decision to accept hearing aid fitting. An electronic medical records review (2015- 2020) identified Veterans meeting the following criteria: (1) diagnosis of sensorineural hearing loss and tinnitus, (2) declined hearing aids at the time of the hearing evaluation, (3) received tinnitus counseling, (4) elected to obtain hearing aids following tinnitus counseling, and (5) affirmed regular use of the hearing aids for more than one year. 30 qualified veterans provided informed consent to participate. Enrolled participants were interviewed using a brief survey that allowed patients to report a variety of tinnitus and hearing-related challenges. Participants also completed a validated tinnitus intake form, the tinnitus handicap inventory (THI), which reports a patient’s self-assessed tinnitus handicap. A total of six Veterans (white males, average age of 60 years, with bilateral sensorineural hearing loss and bothersome tinnitus) participated. The number of hours of daily hearing aid use was related to the self-perceived benefit of hearing aids for the management of tinnitus, as the 5 participants who wore their hearing aids >5 hours/day reported benefit in contrast to the single participant who wore their hearing aids /day. The reported benefit of tinnitus counseling, however, was not reflected as a significant improvement in the post-counseling THI score. All participants reported the counseling was useful and recommended that other veterans experiencing tinnitus and hearing loss undergo a trial with hearing aids . A narrative analysis of additional information provided by participants was made to identify counseling elements that supported the use of hearing aids for tinnitus management. In general, the analysis indicated that when patients were provided accurate information regarding tinnitus management strategy options, then they might be more likely than uninformed patients to accept and act upon hearing aid recommendations in a timely manner. All participants suggested that the provision of more information regarding tinnitus and management options at the time of the hearing evaluation would have likely expedited hearing aid acceptance. The preliminary findings of this survey suggest that patients with a diagnosis of sensorineural hearing loss and tinnitus might benefit from some form of tinnitus management counseling at the time of the initial hearing evaluation, and that the counseling might facilitate uptake of hearing aids.

No description available.

Sexualitet är en del av att vara människa och berör själva meningen med livet. Den finns med oss i alla åldrar och livssituationer. Vid sjukdom och behandling påverkas sexualiteten på olika sätt och det är därför viktigt att allmänsjuksköterskan uppmärksammar och berör patientens sexualitet i omvårdnadsarbetet. Trots vetskapen om detta väljer många sjuksköterskor att borste från patientens sexualitet, vilket kan orsaka mycket onödigt lidande för patienten. Sexuell dysfunktion kan även vara det enda tecknet på allvarlig sjukdom och det är därför av stor vikt att sjusköterskan införlivar sexualiteten i omvårdnadsarbetet. Syftet med litteraturstudien var att undersöka allmänsjuksköterskans förhållningssätt kring sexualitet i mötet med patienter i olika åldrar. Studien genomfördes som en litteraturstudie där elva vetenskapliga artiklar samlades in och granskades. Både kvalitativa och kvantitativa artiklar inkluderades i studien. Resultatet visade att det fanns ett antal faktorer som påverkade sjuksköterskans förhållningssätt till patientens sexualitet. Många av deltagarna i studierna var medvetna om att det låg inom deras ansvarsområde att uppmärksamma och beröra patientens sexualitet i omvårdnadsarbetet, men få gjorde det. Av de hinder som identifierades, var brist på sexologisk kunskap och utbildning det mest framträdande hindret bland såväl sjuksköterskor som sjuksköterskestudenter. / Sexuality is integral to every person and affects the individual in all developmen-tal stages. Sexuality is affected by both illness and treatments, which is a reason why nurses ought to incorporate sexuality into nursing practice. Despite being aware of the importance of patients’ sexuality, many nurses choose not to address the issue, which could possibly cause the patient unnecessary suffering as sexual dysfunction can be the only symptom indicating severe illness. The aim of this study was to explore nurses’ attitude towards patients’ sexuality throughout life. The study was conducted as a literature review based on eleven scientific articles. Qualitative as well as quantitative articles were included in the study. Results showed that there are a number of barriers that affect nurses’ attitudes towards patients’ sexuality. The majority of all informants were well aware that addressing patients’ sexuality formed part of their duties as nurses, however, only a small number of nurses actually did address the issue. The most prominent barrier iden-tified by both nurses and nursing student was their self-reported lack of education in sexology.

Yes / This article reports the use of a mobile cancer care unit (Cancer Van) to provide continuity of care to patients with cancer who utilise the services of Airedale NHS Foundation Trust. The article contains data that shows the resilience of this service during the Covid19 pandemic and provides evidence that this type of service is beneficial for patient care. / Hope for Tomorrow

The emerging health care culture of accountability for patient outcomes compounds problems for already overwhelmed clinicians struggling to fit everything entailed in complicated office visits into 15-minute appointments. Unprocessed frustrations tempt clinicians to use ineffective and outdated methods for trying to get their patients to comply or adhere to their care plans, undermining effective health care management. The intention of this project was to evaluate whether educating medical assistants in the health coaching method of motivational interviewing can improve the patient care approach while simultaneously assisting clinicians struggling with insufficient time. Several individual scheduling conflicts limited the target population into two primary care medical assistants and two auxiliary primary care office staff who voluntarily chose to learn the new approach. Guided by the adult learning theory, an educational lecture project was designed to capture the spirit of motivational interviewing through basic descriptions and strategies that will assist learners to focus on person-centered conversation skills, helping to balance both the needs of the patient and clinician. Following the education, participants filled out an anonymous post-lecture evaluation questionnaire to provide immediate feedback about learner understanding. Responses indicated the project met its stated objectives, and results showed the versatility of the motivational interviewing method which can be learned and effectively applied by health care workers from a wide range of professional backgrounds. Motivational interviewing is an innovative approach that utilizes therapeutic communication to promote behavior changes that lead to improved health of our communities and country.