Economic Evidence for Home and Community Care Investment: The Case for Ontario Personal Support Workers' Wage Parity.

The home and community care (HCC) sector is in a health human resource crisis. Particularly concerning is the shortage of personal support workers (PSWs) who provide the majority of HCC. This paper outlines a strategy to mitigate the HCC PSW shortage by applying appropriate funding to HCC and focusing on equal pay between HCC and institutional long-term care facilities' PSWs. Using publicly available data, our calculations estimate substantial government cost-savings from investing in HCC PSWs to increase HCC capacity. Beyond the economic evidence, how such investments would benefit those seeking care are also highlighted.

A Good Investment: Expanding Capacity to Care for Older Adults in the Home and Community Care Sector Through Increased Personal Support Worker Wages.

Most older adults prefer to age in place, which for many will require home and community care (HCC) support. Unfortunately, HCC capacity is insufficient to meet demand due in part to low wages, particularly for personal support workers (PSWs) who provide the majority of paid care. Using Ontario as a case study, this paper estimates the cost and capacity impacts of implementing wage parity between PSWs employed in HCC and institutional long-term care (ILTC). Specifically, we consider the cost of increased HCC PSW wages versus expected savings from avoiding unnecessary ILTC placement for those accommodated by HCC capacity growth. The expected increase in HCC PSW retention would create HCC capacity for approximately 160,000 people, reduce annual health system costs by approximately $7 billion, and provide an 88 per cent return on investment. Updating wage structures to reduce turnover and enable HCC capacity growth is a cost-efficient option for expanding health system capacity.

Case Report of an Ectopic Molar Pregnancy in the Presence of an Intrauterine Device.

BACKGROUND: Ectopic molar pregnancy is a rare phenomenon and has not been reported in the presence of an intrauterine device (IUD). Clinical diagnosis of molar pregnancy is challenging and requires careful follow-up. CASE: A 25-year-old woman (gravida 2, para 0) with a copper IUD in place presented with a positive pregnancy test. Diagnosis of the complete hydatidiform mole was pathologically confirmed after surgery following clinical and sonographic investigations that identified a left-sided ectopic pregnancy. CONCLUSION: Gestational trophoblastic disease (GTD) presenting as an ectopic pregnancy is a very rare occurrence. This patient recovered without event through a combined management and follow-up for ectopic pregnancy and gestational trophoblastic disease. Appropriate identification and management of this clinical problem is essential in order to prevent initial complications as well as subsequent malignant sequelae.

Case 5: non-healing traumatic wound colonised with MRSA.

A traumatic wound colonised with MRSA failed to respond to topical antimicrobial dressings. Following the combined use of octenilin Wound Gel and octenilin Wound Irrigation Solution, the MRSA was removed in 4 weeks, the necrotic tissue was debrided and the wound started healing.

Case 9: heavily exuding, malodorous, necrotic pressure ulcer.

In this case, the necrotic tissue was so hard it was not possible to categorise the ulcer. Octenilin products were able to debride the necrotic tissue, so that the wound depth could be determined. After 4 weeks, the wound was covered with granulation tissue, improving the patient's quality of life.

Case 10: venous leg ulcer that was significantly impairing quality of life.

This heavily exuding, sloughy ulcer was so painful that the patient had difficulty tolerating any physical contact with it. After treatment, pain levels subsided, so that she was better able to tolerate dressing changes, could sleep in her own bed instead of a chair, and started compression therapy.

Incorporating novel solutions to lower-limb problems into compression formularies.

This study investigates the effect of a new short-stretch two-layer compression system in eight patients with common chronic lower-limb conditions in three locations in the UK. Chronic leg ulcers are the most common type of lower-limb ulceration with 70% caused by chronic venous hypertension. An appropriate level of compression is proven to heal chronic venous leg ulcers. The study was only a small sample of patients; however, the underlying conditions included chronic venous eczema, diabetes, sarcoma, cellulitis and mixed-aetiology ulcers. During the study, the UK experienced some of the hottest temperatures in the last 30 years. This had an impact on five patients, who noted an increase in malodour associated with their leg ulcers. CoFlex TLC (Aspen Medical Europe Ltd) foam comfort layer is impregnated with cyclodextrin-a naturally based oligosaccharide known to reduce malodour. The zinc-impregnated foam bandages in this study were viewed very favourably by both patients and staff, particularly those who had chronic venous eczema.

An integrated genetic linkage map for white clover (Trifolium repens L.) with alignment to Medicago.

BACKGROUND: White clover (Trifolium repens L.) is a temperate forage legume with an allotetraploid genome (2n=4×=32) estimated at 1093 Mb. Several linkage maps of various sizes, marker sources and completeness are available, however, no integrated map and marker set has explored consistency of linkage analysis among unrelated mapping populations. Such integrative analysis requires tools for homoeologue matching among populations. Development of these tools provides for a consistent framework map of the white clover genome, and facilitates in silico alignment with the model forage legume, Medicago truncatula. RESULTS: This is the first report of integration of independent linkage maps in white clover, and adds to the literature on methyl filtered GeneThresher®-derived microsatellite (simple sequence repeat; SSR) markers for linkage mapping. Gene-targeted SSR markers were discovered in a GeneThresher® (TrGT) methyl-filtered database of 364,539 sequences, which yielded 15,647 SSR arrays. Primers were designed for 4,038 arrays and of these, 465 TrGT-SSR markers were used for parental consensus genetic linkage analysis in an F1 mapping population (MP2). This was merged with an EST-SSR consensus genetic map of an independent population (MP1), using markers to match homoeologues and develop a multi-population integrated map of the white clover genome. This integrated map (IM) includes 1109 loci based on 804 SSRs over 1274 cM, covering 97% of the genome at a moderate density of one locus per 1.2 cM. Eighteen candidate genes and one morphological marker were also placed on the IM. Despite being derived from disparate populations and marker sources, the component maps and the derived IM had consistent representations of the white clover genome for marker order and genetic length. In silico analysis at an E-value threshold of 1e-20 revealed substantial co-linearity with the Medicago truncatula genome, and indicates a translocation between T. repens groups 2 and 6 relative to M. truncatula. CONCLUSIONS: This integrated genetic linkage analysis provides a consistent and comprehensive linkage analysis of the white clover genome, with alignment to a model forage legume. Associated marker locus information, particularly the homoeologue-specific markers, offers a new resource for forage legume research to enable genetic analysis and improvement of this forage and grassland species.

The ALIVE program: developing a web-based professional development program for nursing leaders in the home healthcare sector.

Home healthcare nurses often work in isolation and rarely have the opportunity to meet or congregate in one location. As a result, nurse leaders must possess unique leadership skills to supervise and manage a dispersed employee base from a distance. The nature of this dispersed workforce creates an additional challenge in the ability to identify future leaders, facilitate leadership capacity, and enhance skill development to prepare them for future leadership positions. The ALIVE (Actively Leading In Virtual Environments) web-based program was developed to meet the needs of leaders working in virtual environments such as the home healthcare sector. The program, developed through a partnership of three home healthcare agencies, used nursing leaders as content experts to guide program development and as participants in the pilot. Evaluation findings include the identification of key competencies for nursing leaders in the home healthcare sector, development of program learning objectives and participant feedback regarding program content and delivery.

Recurrent, purulent vaginal discharge associated with longstanding presence of a foreign body and vaginal stenosis.

A 13-year-old presented with malodorous, purulent, vaginal discharge following each menses for the last three months since menarche. This discharge resolved following antibiotic therapy but recurred with each menses. On exam, the patient was found to have a blind ending vagina with a small, midline perforation. Ultrasound and MRI examinations done prior to surgery did not identify the vaginal foreign body. She was taken to the operating room for examination under anesthesia and vaginoscopy. During surgery this area was found to be comprised of dense adhesions which nearly obliterated the distal vagina. The vaginal adhesions were lysed and a plastic foreign body was discovered in the upper vagina. After removing the foreign body the superior vagina was undermined, pulled down, and sutured to normal inferior vagina. A Mentor mold was placed in the vagina to maintain patency.

Case report: detection of an advanced ovarian malignancy by cervical cytology.

There are currently no recommended screening tests for the early detection of ovarian cancer. Ovarian malignancies are most often discovered on bimanual exam at advanced stages, resulting in a high mortality from this disease. While the Papanicolaou (Pap) smear is not a reliable screen for the detection of ovarian cancer, abnormal cytology may be the initial indicator of ovarian malignancy. This is a case report of an invasive serous adenocarcinoma of the ovary that was discovered as the result of a clinical work-up for abnormal cytology reported on a Pap smear.

Assessment of knowledge and practice of high risk sexual behavior at a private Midwestern University.

In the United States, an estimated 15.3 million new cases of sexually transmitted infections (STIs) occur each year. Approximately two-thirds of people who acquire STIs in the U.S. are younger than 25 years of age. In addition, approximately 57% (3.1 million) of all pregnancies in the United States are classified as unintended. It is only logical that the consequences of high-risk sexual behavior (unintended pregnancy and contraction of an STI) would most affect those who exhibit high-risk sexual behavior. Thus, one would expect to find high-risk sexual behavior in the same populations that have high rates of STIs and unintended pregnancy. The purpose of this study was to survey freshman students living in the residence halls at a local college to assess their knowledge and the prevalence of high-risk sexual behavior, and give feedback to the participating institution about these results. The survey was designed to answer two questions: (1) What is the current level of high-risk sexual behavior at a small private Midwestern College? (2) What is the current level of knowledge about high-risk sexual behaviors of those surveyed? A total of 38 men and 131 women participated in the survey. Forty-seven percent of men and 41% of women respondents reported having sexual intercourse at least once in their lifetimes. Of those respondents who were sexually active, 67% of men and 54% of women reported that they "always use a condom" with sexual activity. Fifty-six percent of men and 51% of women that were sexually active reported that they were "not at all concerned" about contracting an STI. Twenty-two percent of men and 17% of women answered that they were "not at all concerned" about pregnancy. Three true/false questions about STIs were answered correctly over 95% of the time by those surveyed. Seventy-nine percent of respondents reported never having attended educational opportunities about STIs and safe sexual practices at the college.