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Implementing National Tobacco Cessation Guidelines in Primary Care: A Practice Improvement Project
Get PDFBackground and Purpose: National guidelines recommend tobacco cessation counseling at every clinic visit using the 5 A’s, defined as asking about status, advising to quit, assessing readiness to quit, assisting in quitting, and arranging for follow-up after quitting. However, providers cite barriers such as lack of time and personal discomfort with the subject as reasons conversations are not held. This practice improvement focuses on overcoming these barriers through an evidence-based intervention in a small, urban, primary care clinic. Methods: A onetime staff education session about guidelines paired with a protocol algorithm and enhanced patient resources was trialed to determine its effect on the frequency of charted cessation conversations. An electronic health record documentation template, or dot phrase, measured the frequency of 5 A use in clinic visits for identified tobacco users. Providers received performance feedback twice during eight weeks of data collection. An attitude survey, administered before implementation and upon completion of data collection, determined the effect of the intervention on provider attitudes toward discussing tobacco use. Conclusions: The average frequency of use of the dot phrase was above the goal of 50% during the data collection period. Frequency of charting of all 5 A’s was higher during the data collection period than at baseline. Provider attitudes about discussing cessation demonstrated no significant changes, based on baseline and post-implementation survey responses. Implications for Practice: Education and enhanced resources to facilitate tobacco cessation conversations have a positive impact on the frequency that clinic providers document tobacco cessation conversations with identified tobacco users
Bringing Down the Oligarchy: Change-Making on Campus
Get PDFStudent groups working within a broader institution may experience positive outcomes, negative outcomes, or a mixture of the two. This research looks at the question of: what does the culture of student groups within the institution look like and how do they perform within a possible unsupportive broader institution? The problem at hand is the question under research, ‘Is the institution effectively guiding student-led groups attempting to implement change within the institution and on campus, or is the institution hindering the growth, impact, and importance of student-led clubs and boards on campus?’ Data was collected through qualitative interviews with student leaders at a private university in the Pacific Northwest. All data collected was thoroughly analyzed through the lens of structuration theory. The data uncovered themes of support/collaboration on behalf of the university, student/self-led initiative and engagement, and non-support. Although these findings look like separate entities, they influence each other. This research is crucial because it can help provide an understanding to the culture of student groups and how they interact with the broader institution that they operate under
Expression in Aromatase Inhibitor Responder vs. Non-Responder HR+ Breast Cancer Cohorts
Get PDFHormone receptor positive (HR+) breast cancer patients have an excellent prognosis with over 85% cure rates. However, 20,000 women with HR+ breast cancer die annually from tumor recurrence. Those at highest risk for recurrence are those women whose tumors continue to proliferate through estrogen blockade (Figure 4). Addition of chemotherapy for these patients failed to improve outcomes. We retrospectively identified women with HR+ breast cancer treated neoadjuvantly with aromatase inhibitors (AI), and selected matched patient cohorts for responders and non-responders determined by post-AI Ki67 o
Solar Water Disinfection with Parabolic and Flat Reflectors
Get PDFSolar water disinfection (SODIS) is a process by which microbially contaminated water is disinfected by transmitting solar ultraviolet (UVA and UVB) radiation to the water, damaging bacterial DNA and rendering them inactive. The purpose of this project was to define a residence time after which the water is effectively disinfected. The water was contained in quartz tubes, which were held over flat and parabolic reflectors. While UVA and UVB radiation are mostly diffuse and independent of reflector style, water temperature is affected by solar concentration. Two reflector styles were studied to identify how insolation level and water temperature are related and how that affects the bacteria inactivation process. A lab strain of E.coli, DH5a, was inoculated into sterile water and treated. 5-log reduction was achieved after two hours, regardless of water temperature or insolation level. The reflector style did not have a measurable effect on inactivation of E.coli. The water temperature, however, greatly increased due to the parabolic reflectors. The parabolic reflectors were, on average, two times more thermally efficient than the flat plates
Implementing Motivational Interviewing and Healthy Behavior Goal Setting at Well-Child Visits: A Practice Improvement Project
Get PDFObjective: Pediatric obesity is a growing epidemic, yet effective preventative interventions remain elusive. The American Academy of Pediatrics recommends universal exercise and nutrition counseling as the initial step in prevention of pediatric obesity; however, there is no one established method for the ideal delivery of this counseling in the primary care setting. This practice improvement project aimed to improve the delivery and documentation of pediatric healthy behavior counseling by implementing the use of motivational interviewing (MI) and patient-driven goal setting during well-child visits. Methods: The clinic team in this federally qualified health center implemented use of an interactive behavior survey and goal-setting worksheet during all well-child checks to guide delivery of MI-based pediatric obesity counseling. Patient goals were documented in the EHR for future reference and reinforcement. Follow-up counseling was scheduled for patients with BMI in the overweight or obese range. Results: In the 2 weeks prior to implementation, healthy behavior counseling was documented in 0% of well-child chart notes; no charts included patient-specific goals. During the 12-week implementation, healthy behavior counseling was documented in 50% and patient-specific goals in 37% of well-child visits. Additionally, 31% of well-children were scheduled for follow-up counseling, including 100% of children with BMI in the overweight or obese range. The provider and team expressed satisfaction with the intervention, citing increased patient engagement. Conclusion: Motivational interviewing with the use of patient-specific goal setting during well-child visits is an effective method for improving the delivery of pediatric obesity prevention counseling in the primary care setting
Women As Ritualistic Agents In The Roman Catholic Church: A Comparative Theological Dialogue With Bede Benjamin Bidlack And Tracy Sayuki Tiemeier
Get PDFIn sub-Saharan African religious worldview, a woman inhabits the interstitial space of connectedness. She serves as the medium for the birthing of physical and spiritual life. Today, many in the continent have embraced Christianity and many profess the Roman Catholic faith. African Catholics can contribute to the ongoing discourse on the role of women as ministerial agents in the Catholic Church. To do this, they can articulate a theology of ministry that is grounded in the religious worldview of African indigenous religions
Discerning Disciples: A Mixed Methods Study on Attitudes Toward and Practices of Evaluation Among Lay Catechetical Leaders
Get PDFDespite the work of catechetical leaders to help fellow Catholics deepen their relationship with Jesus Christ, the Catholic Church in the US continues to lose members at an alarming rate. In other educational and professional settings, practices of assessment and evaluation have been employed to determine whether and how their missions are achieved. The literature reveals that there is very little research on evaluative practices and attitudes among professional catechetical leaders and suggests that there is a great lack of evaluation in the field of catechesis and religious education in the US. This study utilized an explanatory sequential mixed methods design to learn about the attitudes and practices of evaluation among catechetical leaders. The research questions were: (1) What are the attitudes of catechetical leaders toward evaluation of adult volunteers’ discipleship status?, (2) What methods, formal and informal, do catechetical leaders report to use in evaluating discipleship?, and (3) Is there a relationship between attitudes toward evaluation among catechetical leaders and their reported practice of evaluation for discipleship? The study featured two phases, a quantitative phase, facilitated by a researcher-designed survey, and a iv qualitative phase, comprised of two focus groups of catechetical leaders. Survey participants (N = 61) were professional lay catechetical leaders in parishes from across a state in the Pacific Northwest. Focus group participants (N = 7) were volunteers who had taken the survey. Attitudes toward evaluation among survey participants were generally positive, with 90.2% of participants agreeing or strongly agreeing that is helpful to discern whether volunteers are disciples. However, focus group participants expressed ambivalent attitudes. The survey also revealed that participants practiced evaluation of their volunteers’ discipleship frequently, with 86.3% reporting that they do so either almost always or more than half the time. Focus group participants showed a preference for practicing informal and incidental methods of evaluation. Survey results also revealed a correlation coefficient of ρ = .47 (p \u3c .001) between attitudes toward evaluation and practices of evaluation. The study concludes by recommending: (a) increased training on active, intentional evaluation in formation of catechetical leaders, (b) the creation and promotion of simple, easy-to-use tools for intentional evaluation, (c) increased use of regular performance evaluation of professional catechetical leaders by their supervisors, (d) an increase in opportunities for collaboration across diocesan lines, and (e) a renewed emphasis on the discipleship formation of adult volunteers