804 research outputs found
Sort by
Medusa as Victim and Tool of Male Aggression
Get PDFWhile Medusa, like many monsters from Greek Mythology, has multiple origin stories, the one arguably best known to modern audiences is the one related in Ovid’s Metamorphoses 4.5750-803, in which Medusa is raped by Neptune in Minerva’s temple and subsequently punished by the goddess by being turned into the monster we all know. This means that Medusa is, to use the modern parlance, a survivor. Furthermore, Medusa’s experience after her violation echoes common elements of the survivor’s experience even millennia later. This suggests that many of the institutional responses to sexual assault that bedevil survivors today existed in some form centuries before European culture had defined the issue
Optic Disc Pits: A Case Report and Review
Get PDFBackground: Congenital optic disc pits (ODP) are a rare clinical finding affecting approximately 1 in 11,000 people. Affected individuals are generally asymptomatic unless fluid accumulates in the macula resulting in severe vision loss. The management of ODPs depends mostly on clinical findings and can range from observation to surgery. Optometrists need to be aware of clinical presentations and possible complications of ODPs.
Case Report: This report will review a case of an asymptomatic optic disc pit and discuss the potential treatment options if complications arise.
Conclusion: Although rare, congenital optic disc pits need to be accurately assessed and diagnosed. Symptoms can range from none to severe vision loss. Proper observation and management may lead to improved visual outcomes
Increasing Adherence to Measurement-Based Depression Management in Primary Care
Get PDFBackground and Review of Literature. Approximately 11 million Americans 18 years or older experienced a severe symptom of depression leading to impairment in 2017. The severity of depressive symptoms is often miscalculated in primary care as measurement-based tools for the diagnosis and ongoing reassessment varies. Purpose. The purpose of the project was to increase provider adherence in using the patient health questionnaire-9 (PHQ-9) for ongoing evaluation of the severity of depressive symptoms in patients with depression at a primary care clinic in San Antonio, Texas. Objectives. The main objective of this Doctor of Nursing Practice project is to improve provider assessment and use of a measurement-based tool to assess depressive symptoms. Another objective is to improve referral rates to behavioral health services for the treatment of depressive disorders that are not responding to their current treatment plan. Planned Intervention. Important intervention includes staff education on the importance of using reliable tools to measure depression severity, such as with the PHQ-9, in patients of the clinic. Additionally, assuring provider adherence to using the PHQ-9 to assess the severity of depressive disorders to guide treatment plans, follow-up care, establish medication regimen, determine psychotherapy needs, and refer to behavior health services. Results. Post-intervention there was a 50% (N=25) increase in PHQ-9 use for depression severity scoring and of those patients screened, 40% were referred to mental health providers post-intervention. Implication. The use of a measurement-based tool to assess depression severity allows for individualized and accurate disease management, making it an essential aspect primary care
Subconjunctival Orbital Fat Prolapse: Diagnosis and Management
Get PDFBackground:
Subconjunctival orbital fat prolapse is a benign condition and most patients who present with it are asymptomatic. Their main concern is the lesions\u27 cosmetic appearance. Many other potentially dangerous orbital pathologies can mimic subconjunctival orbital fat prolapse. The excised orbital fat needs to be evaluated histopathologically to rule-out any malignancy. Surgical repair is straight-forward and cosmetically satisfying to patients.
Case Report:
A 79-year-old male presented with subconjunctival orbital fat prolapse. He wanted the lesion removed for cosmetic reasons. The prolapsed orbital fat was excised successfully and histopathologic analysis confirmed the benign nature of his lesion.
Conclusion:
Optometrists should be aware of these unusual orbital lesions and refer the patient for surgical repair
Anterior Subcapsular Cataract Secondary to Black Mold Exposure
Get PDFA case report of a 31-year-old woman who developed anterior subacapsular cataracts, and associated dermatological signs, after exposure to black mold. While atopic illness is commonly seen in childhood, a growing body of literature supports adult onset atopic dermatitis. Anterior subcapsular cataracts are pathognomonic for atopic illness, and can support a definitive and expedited dermatologic diagnosis of adult onset disease
Nursing Leaders’ Ethical Decision-Making About Professional Boundaries and Nurse-Patient Relationships: A Mixed Methods Explanatory Sequential Design
Get PDFThe purpose of this mixed methods explanatory sequential design study was to ascertain nursing leaders’ knowledge and skill in ethical decision-making when evaluating and managing professional nurse-patient relationship boundaries. It was also the purpose of this study to better understand nursing leaders’ perception of moral, cognitive, and organizational factors influencing their ethical decision-making in evaluating and managing professional nurse-patient relationships, with the intent of generating a theory grounded in the views of the participants as a final outcome of the study. The two theories, virtue ethics and self-efficacy comprise the ethicality construct of the conceptual framework explaining the nurse leaders’ beliefs about themselves and their ability to conduct ethical decision-making. The professional boundaries construct of the conceptual framework delineates the attributes and expectations of nursing as a profession, thus further explaining the nurse leaders’ role in ascertaining ethical professional boundaries among nurses and patients. Participants in the quantitative phase of this study included 28 female and 13 male nurse leaders selected by a convenience sampling approach from San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas. The participants were asked to complete a researcher designed Ethical Decision-Making Survey Instrument consisting of two scenario based vignettes with six Likert questions per vignette and a demographic questionnaire. The Ethical Decision-Making Survey Instrument was designed to assess nurse leader’s ethical decision-making about nurse-patient relationships and professional boundaries. Data analysis revealed by 48 bivariate Pearson product-moment correlation coefficients that the greater the number of years of work experience as an RN and the greater the number of years of work experience as a nurse manager, the more comfortable a nurse manager felt speaking with a nurse about his/her behavior regarding nurse-patient professional boundary transgressions. Additionally, the greater number of years of work experience as a nurse manager, the more knowledge she/he believed she/he had to appropriately manage nurse-patient professional boundary transgressions. Calculating six paired-samples t-tests revealed significantly greater mean scores for a nurse leader’s belief that nurses violate boundaries and exhibit unethical behavior in the scenario depicting a nurse involved in a personal relationship with a patient than a flirtatious relationship. Calculating 48 mixed between-within subjects ANOVAs revealed substantial main effects for nurse manager’s ethical decision-making in determining violations of nurse-patient professional boundary breaches and the unethicality of the behavior revealing higher scores on the scenario depicting a nurse involved in a personal relationship with a patient than a nurse involved in a flirtatious relationship with a patient. The qualitative phase was designed to further explain the results of the quantitative analysis. Participants in the qualitative phase of this study included seven female and zero male nurse leaders initially selected through purposeful sampling followed by a snowball sampling approach from San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas. The participants were interviewed utilizing 12 guided open-ended questions with the aim of assessing moral, cognitive, and organizational factors influencing ethical decision-making about nurse-patient relationships and professional boundaries. Thematic analysis revealed the following themes: (a) ascribing conscience, (b) codifying knowledge repertoire, (c) summoning support systems, and (d) weighing elements affecting judgment. Each theme is discussed in depth and supported by exact participant quotations. The study culminates in a grounded theory. The study concludes with implications for nursing leadership, health care organizations, and nursing academia. As a result of the study findings, recommendations are highlighted that may promote a skill set conducive to improving nursing leader’s ethical decision-making about nurse-patient relationships and professional boundaries
MED12 Mutations Promote Castration-Resistant Prostate Cancer Through Hyperactivated GLI3/SHH Signalling
Get PDFWhen cells of the prostate gland start growing uncontrollably, it results in cancer due to genetic aberrations. The development and progression of prostate cancer depend on androgenic stimulation. Although prostate cancer is temporarily treated by depriving a tumor of androgen, the patient relapses getting a castration-resistant form of the disease called castration-resistant prostate cancer (CRPC). CRPC can specifically develop through crosstalk of androgen receptor signalling pathways. One such pathway that is of specific interest in this paper is the MED12 regulated SHH signalling pathway. The mediator is a signal processor that helps in the transduction of gene-specific transcription factors to RNA Polymerase II (Pol II). The activation of SHH ligand activates a transcription factor called GLI3 which physically targets the MED12 interface within the mediator complex so as to functionally reverse mediator dependent suppression of SHH target gene transcription. In this paper, we have shown that MED12 expression is critical in regulating androgen independent prostate cancer cell and therefore progression towards CRPC. Also, GLI3-dependent SHH signalling is indeed required for the progression of MED12 mutated prostate cancer cells to CRPC, after castration
Leadership for Promoting Sustainable Development: A Study of Nongovernmental Organization Leaders in Haiti
Get PDFNongovernmental organizations (NGOs) have played an increasingly important role in global governance. Since the end of the Second World War, they have been involved in every aspect of social, economic, environmental, and institutional life in the whole world. The presence of NGOs has been seen as a necessity for the developing world, but much more so for low-income countries such as Haiti. The amount of scholarship dedicated to the post-2010 Haiti earthquake revitalization indicates that Haiti must heavily rely on the leadership of nongovernmental organizations so that the country can achieve its sustainable development goals by 2030. However, significant delays in progress to date makes one question NGO leaders’ readiness for leading sustainable development initiatives. Since achievement of sustainable development requires certain characteristics and acumen among the NGO leaders, more must be known about the NGO leadership.
This research study examined the relationship between leaders’ characteristics—leadership experience, knowledge of sustainable development, internalized moral perspective, balanced processing of information, and relational transparency—and the impact or location of their organizations. MANOVA results revealed significant group differences. The difference was that low impact NGO leaders reported higher levels of leadership experience and knowledge of sustainable than their medium and high impact counterparts. This study contributes to the NGO research literature by shedding light on some leader characteristics that should be emphasized in NGO leadership development programs in Haiti
Implementing a Result Notification and Referral System in a Nurse-Led Wellness Center
Get PDFCervical and breast cancer screenings reduce the risk of morbidity and mortality for American women. In 2017, about 70% of U.S. women over the age of 21 obtained a Papanicolaou (Pap) test, which screens for cervical cancer. African American women have a cervical cancer screening rate of 74.6% and Hispanic women have a rate of 68.6%. The cervical cancer screening rates decrease to 51% for women who are uninsured (Centers for Disease Control and Prevention, 2017). In the United States, 50% of women older than 40 are current on their screening mammogram. African American women have a screening mammogram rate of 55% and Hispanic women have a rate of 46%. Women who are uninsured have a screening mammogram rate of 21% (American Cancer Society, 2017a).
This data suggests that underserved populations may not be appropriately screened, or followed up on in the instance of an abnormal finding, which causes delays in treatment. There are established standards of care that guide practice regarding how often women are screened, based on age and risk factors. Despite these set standards, delivery of care varies by provider, patient population, and facility location. A nurse-led wellness center in an urban south-central city in Texas was the site of this quality improvement project, aimed at improving the follow up process after cervical and breast cancer screening.
This project established a system for patient notification of test results and a referral process for ongoing care. Results indicated that the center was able to successfully implement this process by establishing a workflow that included the creation of an algorithm, a reference binder, and a checklist for staff to follow. Preliminary results indicate that 100% of patients have been notified of test results
Increasing Adult Annual Wellness Visits
Get PDFThe purpose of this quality improvement project was to increase adult annual wellness visits in a high-volume family practice clinic. The significance of an adult annual wellness exam is health maintenance, disease prevention, early disease detection, and management of chronic diseases. Approximately 133 million Americans are diagnosed with at least 1 chronic disease, including cancer, diabetes, and heart disease, and 1 in 4 adults are diagnosed with multiple chronic diseases (Raghupathi & Raghupathi, 2018). In 2011, the Affordable Care Act mandated insurance companies to remove deductibles for preventative health services, relieving the financial burden of out-of-pocket expenses (Borsky et al., 2018). Despite this financial relief, only 8% of adults 35 years of age and older reported receiving all of the recommended preventative health care services as of 2015 (Borsky et al., 2018). Recommended medical screenings and risk assessments are based on the U.S. Preventive Services Task Force derived from evidence-based practice. The screenings are dependent on sex, age, tobacco use, and sexual history (Owolabi & Simpson, 2012; Viera, 2018). The aim of this study was to increase the number of completed adult annual wellness visits. Interventions included staff education, implementation of a provider prompt slip to include “schedule adult annual wellness visit,” and sending electronic reminders and recalls for patients to schedule an annual wellness visit. These interventions resulted in a 28% increase in completed adult annual wellness visits. To maintain sustainability, it is crucial to have provider buy-in. Patients also expected that their provider recommend the need to complete an annual wellness visit