Going beyond Activity and Participation: Development of the DIF-CHUM-A patient-reported outcome measure for individuals with Dupuytren's contracture.

STUDY DESIGN: This is a cross-sectional clinical measurement. INTRODUCTION: There are currently no Dupuytren's contracture (DC)-specific, patient-reported outcomes (PROs) that can provide a thorough clinical portrait of the patients' perceptions with regard to the execution of regular activities. PURPOSE OF THE STUDY: The purpose of this study was to present the development of the Dupuytren's contracture Impact on Function-Centre Hospitalier de l'Université de Montréal (DIF-CHUM), a DC-specific PRO. METHODS: The development process involved consultation of 45 individuals with DC and 7 health professionals, existing literature, and DC-specific PRO. RESULTS: The DIF-CHUM is composed of 2 sections: section 1, Activity and Participation includes 8 items per hand, scored on Difficulty and Change scales; section 2, General Impact includes up to 18 items, scored on Difficulty, Importance, Change and Satisfaction scales. Preliminary evidence suggests that the DIF-CHUM demonstrates good content validity. DISCUSSION: The DIF-CHUM is designed to be a patient-centered measure of Activity and Participation and Functional Competence for individuals with DC that will provide hand therapists with a unique perspective of the impact of DC on patients' lives. CONCLUSION: Further validation of the DIF-CHUM, including its scoring, is under way.

Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP: a randomized controlled trial.

To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area. Non-specialists (such as PCPs)' training is an internationally supported way to target untreated mental health symptoms. We aimed to evaluate the programme's impact on PCPs' mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training. We conducted an exploratory trial with a combination of designs: a pretest-posttest control group design and a one-group pretest-posttest design were used to assess the training's short-term impact; and a repeated measures design was used to assess the training's long-term impact. The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1). The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers. Data were collected at baseline, following Group 1's training, following Group 2's training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted. Overall, 112 PCPs were randomized to either Group 1 (n = 52) or Group 2 (n = 60). The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice. When comparing pre-training results and results 18 months after training, these changes were maintained. PCPs reported a decrease in referral rates to specialized services 18 months after training in comparison to pre-training. The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries. Future studies should examine relationships among these outcome variables.

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia.

BACKGROUND: Non-specialists' involvement in mental health care is encouraged in the field of global mental health to address the treatment gap caused by mental illness, especially in low- and middle-income countries. While primary care physicians (PCPs) are involved in mental health care in Tunisia, a lower-middle-income country in North Africa, it is unclear to what extent they are prepared and willing to address mental health problems, substance use disorders, and suicide/self-harm. In this context, we aim (1) to report on mental health knowledge, attitudes, and self-efficacy among a sample of PCPs working in the Greater Tunis area, prior to the implementation of a mental health training program developed by the World Health Organization; and (2) to identify what characteristics are associated with these competencies. METHODS: In total, 112 PCPs completed questionnaires related to their socio-demographic and practice characteristics, as well as their mental health knowledge, attitudes, and self-efficacy. Descriptive analyses and regression models were performed. FINDINGS: PCPs had more knowledge about depression, symptoms related to psychosis, and best practices after a suicide attempt; had favourable attitudes about distinctions between physical and mental health, learning about mental health, and the acceptance of colleagues with mental health issues; and believed most in their capabilities related to depression and anxiety. However, most PCPs had less knowledge about substance use disorders and myths about suicide attempts; had unfavorable attitudes about the dangerousness of people with mental health problems, personal disclosure of mental illness, non-specialists' role in assessing mental health problems, and personal recovery; and believed the least in their capabilities related to substance use disorders, suicide/self-harm, and psychosis. Participation in previous mental health training, weekly hours (and weekly hours dedicated to mental health), weekly provision of psychoeducation, and certain work locations were associated with better mental health competencies, whereas mental health knowledge was negatively associated with weekly referrals to specialized services. CONCLUSIONS: Findings suggest that PCPs in our sample engage in mental health care, but with some gaps in competencies. Mental health training and increased interactions/involvement with people consulting for mental health issues may help further develop non-specialists' mental health competencies, and integrate mental health into primary care settings.

Stakeholder Views on Solutions to Improve Health System Performance.

Context: Significant reforms are needed to improve healthcare system performance in Quebec. Even though the characteristics of high-performing healthcare systems are well-known, Quebec's reforms have not succeeded in implementing many critical elements. Converging evidence from political science models suggests stakeholders' preferences are central in determining policy content, adoption, and implementation. Objective: To analyze whether doctors', nurses', pharmacists' and health administrators' preferences could explain the observed inability to implement known characteristics of high-performing healthcare systems. Design: A questionnaire on various propositions identified in the scientific literature was sent to 2,491 potential respondents. Results: Overall response rate was 37%. There was considerable consensus on identified solutions to improve the healthcare system. Resistance was observed in two major areas: information systems and changes directly affecting doctors' practice. The groups' positions cannot explain the inability to implement important characteristics of high-performing systems. The findings raise new questions on the actual sources of resistance.

Healthcare reforms, inertia polarization and group influence.

Healthcare systems performance is the focus of intense policy and media attention in most countries. Quebec (Canada) is no exception, where successive governments have struggled for decades with apparently intractable problems in care accessibility overall, poor performance, and rising costs. This article explores the underlying causes of the disconnection between the high salience of healthcare system dysfunctions in both media and policy debates and the lack of policy change likely to remedy those dysfunctions. Academically, public policies' evolution is usually conceptualized as the product of complex, long-term interactions among diverse groups with specific power sources and preferences. In this context, we wanted to examine empirically whether divergences in stakeholders' views concerning various healthcare reform options could explain why certain policy changes are not implemented despite consensus on their programmatic coherence. The research design was an exploratory sequential design. Data were analyzed narratively as well as graphically using a method derived from social network analysis and graph theory. Results showed striking intergroup convergence around a programmatically sound policy package centred on the general objective of strengthening primary care delivery capacities. Those results, interpreted in light of political science elitist perspectives on the policy process, suggest that the incapacity to reform the system might be explained by one or two groups' having a de facto veto in policy-making.

Which Characteristics are Associated with the Timing of the First Healthcare Consultation, and Does the Time to Care Influence the Duration of Compensation for Occupational Back Pain?

Purpose To identify the characteristics associated with the timing of the first healthcare consultation and to measure the impact of that timing on the duration of the first episode of compensation for occupational back pain following the injury. Methods We analyzed data from a cohort of workers with compensated back pain in 2005 in Ontario obtained from the Workplace Safety and Insurance Board. Cox multivariable survival models were performed to identify factors associated with the time to care and to measure its association with the length of the first episode of 100 % compensation. Results Among the 5520 claims analyzed, 93.7 % of workers accessed care within the first week (average = 2.1 days; median = 1 day). Time to care was shorter for males, for workers who had received previous compensation and for those with access to an early return to work program. Age, number of employees in the company and personal earnings were positively associated with the time to care. More severe nature of injury, employers doubt about the work-relatedness of the injury and consulting a physiotherapist as the first healthcare provider were also associated with longer time to care. Considering potential confounders, longer time to care was significantly associated with a delay in the end of the first episode of compensation (hazard ratio = 0.98; P < 0.001). Conclusion Temporal access to a source of care is not problematic for the vast majority of Ontarian workers who receive compensation for occupational back pain; however, for the minority of workers who do not rapidly access care, the timing of the first healthcare consultation is a significant predictor of the duration of the first episode of compensation.

Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain.

Objective To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers. Methods We analyzed data from a cohort of 5511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2-year follow-up period. Results Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10-1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71-0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02-2.19], P value = 0.040) rather than a physician (reference). Conclusion The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest. These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker's compensation system. Further investigation is required to understand the between-provider differences.

Workers' characteristics associated with the type of healthcare provider first seen for occupational back pain.

BACKGROUND: Few studies have compared the factors that drive patients' decision to choose a chiropractor, physician or physiotherapist as their first healthcare provider for occupational back pain. The purpose of this study is to identify characteristics associated with the choice of first healthcare provider seen for acute uncomplicated occupational back pain. METHODS: We analyzed data collected by the Workplace Safety and Insurance Board from a cohort of workers with compensated back pain in 2005 in Ontario (Canada). Multivariable logistic regression models were created to identify factors associated with the type of first healthcare provider seen (chiropractor, physician, or physiotherapist). Adjustments to the final models were evaluated using the area under the receiver-operating characteristics curve (ROC). RESULTS: According to the 5520 analyzed claims, 85.3 % of the patients saw a physician, 11.4 % saw a chiropractor, and 3.2 % saw a physiotherapist. Longer job tenure (odds ratio (OR) = 1.02, P = 0.004), higher gross personal income (OR = 1.06, P = 0.018), mixed-manual job (OR = 1.35, P = 0.004) and previous similar injury (OR = 1.60, P < 0.001) increased the odds of seeing a chiropractor rather than a physician, while the size of the community (>500,000 inhabitants) and the availability of an early return to work program in the workplace (OR = 0.77, P = 0.035) decreased it. The odds of seeing a physiotherapist rather than a physician increased with increasing age (OR = 1.19, P = 0.019), previous similar injury (OR = 1.71, P < 0.001) and severity of injury (OR = 2.03, P = 0.010). Increased age (OR = 1.28, P = 0.008) and size of community (>1,500,000 inhabitants; OR = 2.58, P = 0.002) increased the odds of seeing a physiotherapist rather than a chiropractor, while holding a mixed-manual job significantly decreased those odds (OR = 0.63, P = 0.044). The area under the ROC curve of our multivariable models varied from 0.62 to 0.64. CONCLUSION: The type of first healthcare provider sought for occupational back pain is influenced by injury-and work-related factors and by the worker's age, income and community size. Contrary to previous studies, the workers who first sought a physician did not have higher odds of having a severe injury.

Chiropractors' characteristics associated with their number of workers' compensation patients.

STUDY DESIGN: A cross-sectional survey. OBJECTIVE: The purpose of this study was to identify characteristics of Canadian doctors of chiropractic (DCs) associated with their number of workers' compensation patients. SUMMARY OF BACKGROUND DATA: It has been previously hypothesized that DCs that treat a relatively high volume of workers' compensation cases may have different characteristics than the general chiropractic community. METHODS: Secondary data analyses were performed on data collected in the 2011 survey of the Canadian Chiropractic Resources Databank (CCRD). The CCRD survey included 81 questions concerning the practice and concerns of DCs. Of the 6,533 mailed questionnaires, 2,529 (38.7%) were returned. Of these, 652 respondents did not meet our inclusion criteria, and our final study sample included 1,877 respondents. Bivariate analyses were conducted between predetermined independent variables and the annual number of workers' compensation patients. A negative binomial multivariate regression was performed to identify significant factors associated with the number of workers' compensation patients. RESULTS: On average, DCs received 10.3 (standard deviation (SD) = 17.6) workers' compensation cases and nearly one-third did not receive any such cases. The type of clinic (other than sole provider), practice area population (smaller than 500,000), practice province (other than Quebec), number of practice hours per week, number of treatments per week, main sector of activity (occupational/ industrial), care provided to patients (electrotherapy, soft-tissue therapy), percentage of patients with neuromusculoskeletal conditions, and percentage of patients referred by their employer or a physician were associated with a higher annual number of workers' compensation cases. CONCLUSION: Canadian DCs who reported a higher volume of workers' compensation patients had practices oriented towards the treatment of injured workers, collaborated with other health care providers, and facilitated workers' access to care.

PLAN D'ÉTUDE: Une enquête transversale. OBJECTIF: Cette étude visait à déterminer les caractéristiques des chiropraticiens canadiens associées à leur nombre de patients traités pour accidents de travail. INTRODUCTION: Selon des hypothèses émises précédemment, les chiropraticiens qui traitent un nombre relativement élevé de patients pour accidents de travail peuvent avoir des caractéristiques différentes de l'ensemble des chiropraticiens. MÉTHODOLOGIE: Des analyses secondaires de données ont été effectuées sur des données recueillies dans l'enquête de 2011 de la banque de données de ressources chiropratiques canadiennes (CCRD). Cette enquête comportait 81 questions relatives à l'exercice et aux préoccupations des chiropraticiens. Sur les 6 533 questionnaires envoyés, il y a eu 2 529 (38,7 %) réponses. Parmi celles-ci, 652 ne répondaient pas à nos critères d'inclusion. Donc, l'échantillon final utilisé pour notre étude comprenait 1 877 répondants. Des analyses bivariées ont été menées entre les variables indépendantes prédéterminées et le nombre annuel de patients traités pour accidents de travail. Une régression multivariée binomiale négative a été réalisée pour déterminer les facteurs importants associés avec le nombre de patients traités pour accidents de travail. RÉSULTATS: En moyenne, les chiropraticiens ont traité 10,3 (écart-type = 17,6) patients pour accidents de travail et près d'un tiers n'ont pas reçu de tels cas. Les facteurs suivants ont été associés à un nombre annuel plus élevé de patients traités pour accidents de travail : type de clinique (autre que fournisseur unique), population de la ville de la clinique (inférieure à 500 000), province de la clinique (autre que le Québec), nombre d'heures de cabinet par semaine, nombre de traitements par semaine, principal secteur d'activité (professionnelle / industrielle), soins prodigués aux patients (électrothérapie, thérapie des tissus mous), pourcentage de patients atteints de maladies neuromusculo-squelettiques, et pourcentage de patients référés par leur employeur ou un médecin. CONCLUSION: Les chiropraticiens canadiens qui ont déclaré un nombre plus élevé de patients traités pour accidents de travail avaient des pratiques axées sur le traitement des travailleurs blessés, ont collaboré avec d'autres fournisseurs de soins de santé, et ont facilité l'accès aux soins des travailleurs.

Chiropractors' characteristics associated with physician referrals: results from a survey of Canadian doctors of chiropractic.

OBJECTIVE: The purpose of this study was to identify characteristics of Canadian doctors of chiropractic (DCs) associated with the number of patients referred by medical doctors (MDs). METHODS: Secondary data analyses were performed on the 2011 cross-sectional survey of the Canadian Chiropractic Resources Databank. The Canadian Chiropractic Resources Databank survey included 81 questions about the practice of DCs. Of the 6533 mailed questionnaires, 2529 (38.7%) were returned and 489 did not meet our inclusion criteria. Our analyzed sample included 2040 respondents. Bivariate analyses were conducted between predetermined potential predictors and the annual number of patients referred by MDs, and negative binomial multivariate regression was performed. RESULTS: On average, DCs reported receiving 15.6 (standard deviation, 31.3) patient referrals from MDs per year and nearly one-third did not receive any. The type of clinic (multidisciplinary with MD), the province of practice (Atlantic provinces), the number of treatments provided per week, the number of practicing hours, rehabilitation and sports injuries as the main sector of activity, prescription of exercises, use of heat packs and ultrasound, and the percentage of patients referred to other health care providers were associated with a higher number of MD referrals to DCs. The percentage of patients with somatovisceral conditions, using a particular chiropractic technique (hole in one and Thompson), taking his/her own radiographs, being the client of a chiropractic management service, and considering maintenance/wellness care as a main sector of activity were associated with fewer MD referrals. CONCLUSION: Canadian DCs who interacted with other health care workers and who focus their practice on musculoskeletal conditions reported more referrals from MDs.

Compensation benefits in a population-based cohort of men and women on long-term disability after musculoskeletal injuries: costs, course, predictors.

OBJECTIVES: The aim of this study is to assess costs, duration and predictors of prolonged compensation benefits by gender in a population characterised by long-term compensation benefits for traumatic or non-traumatic musculoskeletal injuries (MSIs). METHODS: This study examined 3 years of data from a register-based provincial cohort including all new allowed long-term claims (≥3 months of wage replacement benefits) related to neck/shoulder/back/trunk/upper-limb MSIs in Quebec, Canada, from 2001 to 2003 (13,073 men and 9032 women). Main outcomes were compensation duration and costs. Analyses were carried out separately for men and women to investigate gender differences. An extended Cox model with Heaviside functions of time was used to account for covariates with time-varying effects. RESULTS: Male workers experienced a longer compensation benefit duration and higher median costs. At the end of follow-up, 3 years postinjury, 12.3% of men and 7.3% of women were still receiving compensation benefits. Effects of certain predictors (e.g., income, injury site or industry) differed markedly between men and women. Age and claim history had time-varying effects in the men's and women's models, respectively. CONCLUSIONS: Knowing costs, duration and predictors of long-term compensation claims by gender can help employers, decision makers and rehabilitation specialists to identify at-risk workers and industries to engage them in early intervention and prevention programmes. Tailoring parts of long-term disability prevention and management efforts to men's and women's specific needs, barriers and vulnerable subgroups, could reduce time on benefits among both male and female long-term claimants.

[Strategies to increase the brief interventions in smoking cessation among nurses in hospital settings: experimental study]. / Evaluation comparative de stratégies visant à augmenter les interventions de courte durée pour le sevrage tabagique auprès du personnel infirmier de milieux hospitaliers: résultats d'une étude expérimentale.

INTRODUCTION: Research results demonstrate a decrease in cigarette smoking when preventive professional interventions are routinely carried out. Literature reports that 30% of hospital nurses assess their patient smoking habits. The objective of the present study is to compare, on medical and surgical units, the effectiveness of three strategies (interactive educational session, recall, and both together) to a control group, on the number of nursing interventions pertaining to cessation of cigarette smoking. Research design is experimental with group randomisation. Pre and post strategy multi-measurements (at 1 and 3 months) are sought from nursing staff (69), patients and patient charts (351). Results show that nursing staff assesses cigarette smoking habits for only 35.7% of the patients, and their intent to stop smoking only of the time. Results show that the educational strategy increases the number of nursing interventions during a short period (1 month), and decreases perception of barriers to tobacco counselling. Impact of recall could not be assessed as it was not introduced as planned. CONCLUSION: Considering modest results from the strategies, the interactive educational sessions shows a short- term effect on the nursing staff's interventions.

Exploring the diversity of conceptualizations of work (dis)ability: a scoping review of published definitions.

PURPOSE: Researchers are confronted to numerous definitions of work ability/disability, influenced by their context of emergence, discipline, purpose, underlying paradigm and relationship to time. This study provides an in-depth analysis of the concept through a systematic scoping review and the development of an integrative concept map of work (dis)ability. The research questions are: How has work (dis)ability been conceptualized from the perspectives of research, practice, policy and industry in the published scientific literature? How has the conceptualization of work (dis)ability evolved over time? METHODS: A search strategy was designed with a library scientist to retrieve scientific publications containing explicit definition(s) of work (dis)ability in leading-edge databases. The screening and the extraction of the definitions were achieved by duplicate assessment. The definitions were subject to a comparative analysis based on the grounded theory approach. RESULTS: In total, 423 abstracts were retrieved from the bibliographic databases. After removing duplicates, 280 unique records were screened for inclusion. A final set of 115 publications containing unique original conceptual definitions served as basis for analysis. CONCLUSIONS: The scientific literature does not reflect a shared, integrated vision of the exact nature and dimensions of work (dis)ability. However, except for a few definitions, there seems to be a consensus that work (dis)ability is a relational concept resulting from the interaction of multiple dimensions that influence each other through different ecological levels. The conceptualization of work (dis)ability also seems to have become more dynamic over time. The way work (dis)ability is defined has important implications for research, compensation and rehabilitation.

Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

OBJECTIVE: To examine the associations of four distinct nursing care organizational models with patient safety outcomes. DESIGN: Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. SETTING: Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. PARTICIPANTS: Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. MAIN OUTCOME MEASURE: Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. RESULTS: After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. CONCLUSIONS: Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.

A taxonomy of nursing care organization models in hospitals.

BACKGROUND: Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. METHODS: This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units' profile data. RESULTS: The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses' professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses' perceptions that the practice environment is less supportive of their professional work. CONCLUSIONS: This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an "ideal" nursing professional practice model described by some leaders in the contemporary nursing literature. While the two professional models appear closer to this ideal, the two functional models are farther removed.

Measuring actual scope of nursing practice: a new tool for nurse leaders.

OBJECTIVE: : This project describes the development and testing of the actual scope of nursing practice questionnaire. BACKGROUND: : Underutilization of the skill sets of registered nurses (RNs) is a widespread concern. Cost-effective, safe, and efficient care requires support by management to facilitate the implementation of nursing practice at the full scope. METHODS: : Literature review, expert consultation, and face validity testing were used in item development. The instrument was tested with 285 nurses in 22 medical units in 11 hospitals in Canada. RESULTS: : The 26-item, 6-dimension questionnaire demonstrated validity and reliability. The responses suggest that nurses practice at less than their optimal scope, with key dimensions of professional practice being implemented infrequently. CONCLUSIONS: : This instrument can help nurse leaders increase the effective use of RN time in carrying out the full scope of their professional practice.

Gender differences in personal and work-related determinants of return-to-work following long-term disability: a 5-year cohort study.

OBJECTIVE: To assess the differential effect of personal and work-related psychosocial, physical and organizational determinants by gender on time to return-to-work (RTW) following long-term disability. METHODS: Data come from a larger study conducted in the province of Quebec, Canada. A cohort of 455 adults on long-term disability due to work-related musculoskeletal disorders at the back/neck/upper limb was followed for 5 years through structured interviews and administrative databases. Left-truncated Cox regression modeling stratified by gender was used to assess time to a first partial or full RTW of at least 3 days. RESULTS: Survival curves of time to RTW were similar between men and women on long-term disability (log-rank test p value = 0.920) but many personal and occupational factors influencing RTW differed by gender. Women's risk factors included older age (HR = 0.734--in 10 years unit), poor to very poor perceived economic status (HR = 0.625), working ≥40 h/week and having dependents (HR = 0.508) and awareness of workplace-based occupational health and safety program (HR = 0.598); higher gross annual income (in $10,000 s) was a facilitator (HR = 1.225). In men, being over 55 years old (HR = 0.458), poor perceived economic status (HR = 0.653), working ≥40 h/week and high perceived physical workload (HR = 0.720) and higher job insecurity (HR = 0.825) negatively influenced time to RTW. For both men and women, probabilities of not returning to work varied widely according to workers' specific profile of personal and occupational factors (high or low risk profile). CONCLUSION: Results confirm the importance of gender-sensitive strategies to investigate RTW determinants from a gender perspective.

Évaluation des projets pilotes préhospitaliers: rapport final / Evaluation of pre-hospital pilot projects: final report

INTRODUCTION: En novembre 2006, le ministère de la Santé et des Services sociaux mettait en place un comité technique provincial sur la transformation des horaires de travail des techniciens ambulanciers paramédicaux (TAP) et le déploiement dynamique de la flotte ambulancière dans certaines régions du Québec. Le mandat de ce comité technique consistait à proposer au ministère de la Santé et des Services sociaux, des recommandations sur les meilleures façons d'améliorer l'organisation des services ambulanciers au Québec, ce en accordant une attention particulière aux réalités régionales. Plus spécifiquement, il s'agissait, tout en préservant la qualité des services préhospitaliers à la population, d'initier un ensemble de mesures devant aboutir à la transformation des horaires de travail de faction des TAP en horaires à l'heure, ainsi que de procéder à un positionnement stratégique des véhicules ambulanciers sur les territoires desservis. Suite à l'examen des propositions de projets, le comité technique retint cinq projets pilotes à l'échelle provinciale afin d'expérimenter cette nouvelle approc

A modified Risser grading system predicts the curve acceleration phase of female adolescent idiopathic scoliosis.

BACKGROUND: The Risser sign can be assessed with the United States method or the European method. The Tanner-Whitehouse method estimates skeletal age on the basis of hand radiography and digital skeletal age. Digital skeletal age scores between 400 and 425 are associated with the beginning of the curve acceleration phase or peak growth velocity in adolescent idiopathic scoliosis. The first objective of the present study was to evaluate the agreement between the two Risser grading systems. The second objective was to identify which grading system best predicts a digital skeletal age of between 400 and 425. The third objective was to explore a new system that could be used to replace the Risser method. METHODS: One hundred female patients with adolescent idiopathic scoliosis were recruited in this cross-sectional descriptive study. Each patient was evaluated with posteroanterior spine and hand radiographs. The Risser sign was measured according to both the United States and European grading systems. Digital skeletal age was calculated, and triradiate cartilage ossification was assessed. RESULTS: With use of kappa statistics, moderate agreement between the United States and European grading systems was seen. Risser stages alone were not good predictors of the curve acceleration phase. A new system with three groups was tested, and the second group (Risser 0 with closed triradiate cartilage and Risser 1) was the best predictor of a digital skeletal age score of between 400 and 425. CONCLUSIONS: Two Risser grading systems coexist, and the agreement between them is moderate. No Risser stage was found to be a good clinical landmark for the beginning of the curve acceleration phase of adolescent idiopathic scoliosis. A new group, Risser 0 with closed triradiate cartilage and Risser 1, was the best predictor of the beginning of the curve acceleration phase. This new system is easy to implement and is based on findings that are available on spine radiographs. It should be used at the first visit and for scoliosis follow-up to assess skeletal maturity and correlation with the curve acceleration phase.

Effects of a diet higher in carbohydrate/lower in fat versus lower in carbohydrate/higher in monounsaturated fat on postmeal triglyceride concentrations and other cardiovascular risk factors in type 1 diabetes.

OBJECTIVE: To compare the effects of a eucaloric diet higher in carbohydrate/lower in fat versus lower in carbohydrate/higher in monounsaturated fat on postmeal triglyceride (TG) concentrations and other cardiovascular disease risk factors in nonobese subjects with type 1 diabetes and in good glycemic control. RESEARCH DESIGN AND METHODS: In a parallel group design study, 30 subjects were randomly assigned and completed one of the two eucaloric diets. Assessments included: BMI, blood pressure, A1C, plasma lipids, and markers of oxidation, thrombosis, and inflammation. At 6 months, subjects were hospitalized for 24 h to measure plasma TG excursions. RESULTS: There were no significant differences between groups other than decreased plasminogen activator inhibitor 1 (PAI-1) levels and weight gain in the lower-carbohydrate/higher-monounsaturated fat group. During the 24-h testing, the lower-carbohydrate/higher-monounsaturated fat group had a lower plasma TG profile. CONCLUSIONS: A diet lower in carbohydrate/higher in monounsaturated fat could offer an appropriate choice for nonobese type 1 diabetic individuals with good metabolic and weight control.