Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.

The Re-emergence of Russia and its Collision Course with Europe. Jean Monnet/Robert Schuman Paper Series Vol. 14 No. 4, March 2014

From the Introduction. In order to understand the historical roots of the current geopolitical confrontation between the EU and Russia, we have to go back to the end of the Cold War and to the catastrophic decade that it was followed by in Russian history. The dissolution of the USSR imposed serious economic hardship for Russia and for all the ex-communist East-European states. Russia was the hardest hit amongst them, as the center of the USSR's economic system it suffered most from the dissolution of regional economic ties. This crisis was just deepened by the IMF's privatization and reform campaign, which imposed austerity measures and state-asset privatization as a “shock-therapy” answer to the country's economic problems. This policy package did nothing to save Russia from economic collapse (which eventually happened in 1998), the only thing it achieved was an even stronger social and economic crisis and the enrichment of the rent-seeking ex-communist top bureaucrats by state-assets, which were sold out under-priced through diverse channels of corruption

Collision deformation classification training program: intermediate level - training/reference module.

National Highway Traffic Safety Administration, Washington, D.C.

Research input for computer simulation of automobile collisions. Volume IV: staged collision reconstructions. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Tri-level study: modification. Task 5: an examination of driver characteristics and collision producing errors of accident and traffic violation repeaters. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Collision avoidance radar braking systems investigation - phase III study. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Effects of various aging heat treatments and solution-annealing and aging heat treatments on tensile, creep, and stress-rupture strengths of inconel x sheet to temperatures of 1,400 degrees F /

Cover title.

Collision avoidance radar braking systems investigation - phase III study, technical report. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

UCLA motor vehicle safety project. Vehicle collision report - task 1.

National Highway Safety Bureau, Washington, D.C.

Volume one (1) - staged collision and damage data report for accident reconstruction of twenty five (25) test vehicles (1980 model year). Final report.

National Highway Traffic Safety Administration, Accident Investigation Division, Washington, D.C.

Volume two (2) - staged collision and damage data report for accident reconstruction of twenty five (25) test vehicles (1980 model year). Final report.

National Highway Traffic Safety Administration, Accident Investigation Division, Washington, D.C.

Test and evaluation of head restraints, seat backs, and anchorages in vehicles subjected to rear impact collision. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Volume one (1) - staged collision and damage data report for accident reconstruction of thirty (30) test vehicles. Final report.

National Highway Traffic Safety Administration, Washington, D.C.