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.

Troubled Waters Ahead: An Evaluation of Shoreline Land Use Policies for Water Quality Protection in Renfrew County, Ontario

Increases in the rate and extent of lakeshore development along inland lakes in Ontario are adversely impacting water quality. Despite growing awareness, there is a lack of knowledge about the land use policies and tools in place to protect inland lakes in rural Ontario. This research evaluated official plans for water quality protection policies for inland lakes in the County of Renfrew, Ontario to address this gap. The findings suggest that municipalities implicitly link water quality to land use planning policy and fail to incorporate innovative methods to protect water quality.

The Discursive double game of EMU reform: the clash of titans between French White Knight and German Iron Lady. Paper presented at the 9th Biennial Conference European Community Studies Association–Canada (ECSA-C), Ottawa, Ontario, April 27-28, 2012

From the Introduction. In the aftermath of the EU’s enlargement towards Central and Eastern Europe, many scholars and observers of European integration were proclaiming that the French-German “engine” of Europe had come to an end. The political legitimacy of French-German initiatives was contested by coalitions of smaller member states and the ‘new Europe’ was calling for new leadership dynamics. However, the experience of the Eurozone debt crisis provided dramatic evidence that no alternative to the Franco-German partnership has yet to emerge in the enlarged EU. In a time of existential crisis, Franco-German initiatives appear to have remained the basic dynamic of integration. However, unlike in the past, agreements on steps forward have proven to be particularly difficult. This is largely due to these countries’ contrasting political economic policy ideas, cultures, and practices....the paper analyses the ideational ‘frames’ of the two leaders while tracing their discursive interactions against changing background conditions since the European debt crisis was triggered by Greece in October 2009 until the last measures taken in 2012 before the French Presidential elections. The empirical analysis is based on a systematic corpus of press conferences and media interviews by Nicolas Sarkozy and Angela Merkel after European summits. It is complemented by a number of press interviews including some given by their respective Finance Ministers) and important speeches in that same period of time.

(Table 1, page 605) Chemistry of concretions from Grand Lake (GL) and Ship Harbour Lake (SH), Nova Scotia and Mosque Lake (ML), Ontario

Studies by optical microscopy, x-ray diffraction, and electron probe techniques of ferromanganese concretions from three Canadian lakes reveal chemical banding of amorphous hydrated iron and manganese oxides. The average ratio of iron to manganese in concretions from these lakes varies from 0.43 to 2.56. The concentrations of cobalt, nickel, copper, and lead are one to two orders of magnitude below those reported for oceanic ferromanganese concretions.

(Table I, page 1348) Composition of ferromanganese oxide concretions from lake Ontario (Extract)

A large deposit of ferromanganese oxide concretions has been found in the northern portion of Lake Ontario. The concretions occur mainly in the form of coatings on sand grains but manganese nodules are present at several localities. Mineralogically, the ferromanganese oxide phases are amorphous, and their Fe and Mn contents are similar to those in concretions from other environments. However, their Ni, Co, and Cu contents are significantly higher than those reported in previously described North American lacustrine ferromanganese concretions, and this may, in part, be a reflection of their probable low rates of accumulation.

Chattel exemptions from writs of execution in Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland, Nova Scotia, Ontario, Prince Edward Island, Quebec, Saskatchewan and Yukon Territory,

Mode of access: Internet.

History and general catalogue of LaGrange Collegiate Institute : situated at Ontario, LaGrange Co., Ind.

Mode of access: Internet.

Impacts of airborne pollutants on wilderness areas along the Minnesota-Ontario border /

Mode of access: Internet.

History of the Genesee country (western New York) : comprising the counties of Allegany, Cattaraugus, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Steuben, Wayne, Wyoming and Yates /

Volumes 3-4 contain biographical matter.

Devon & Cornwall notes & queries.

"A quarterly journal devoted to the local history, biography and antiquities of the counties of Devon and Cornwall."