Why some patients who do not need hospitalization cannot leave: A case study of reviews in 6 Canadian hospitals.

In an optimal healthcare system, patients receive care in the most appropriate, least expensive setting. In Canada, too many patients remain in hospital well after they no longer require hospital-based care. This study examines the observations on this problem by a team with a home and community lens in six cases. The underlying issues across the six are the insufficiency of home and community supports before hospitalization, the routine underestimation of these patients' potential for independence, the deconditioning of patients while in hospital, and hospital staff's lack of understanding of home care. Addressing these issues would help many of these patients transition from hospital to less costly, more fitting settings.

Five opportunities for healthcare leaders to better support person- and family-centred care in long-term care settings.

The benefits of Person- and Family-Centred Care (PFCC) are well documented, and many healthcare organizations have expressed their commitment to take this approach. Yet, it can be a difficult endeavour, with common barriers identified at the point-of-care, organizational and system levels. We implemented a PFCC education program with healthcare leaders, providers, and support staff working in home, community, and long-term care organizations across Canada. Focus groups were then conducted with almost 200 workshop participants and 20 long-term care home residents and family members. Five key opportunities for healthcare leaders to better support the provision of PFCC were revealed. In this article, specific recommendations from focus group participants for addressing each of these five opportunities are provided. These findings can assist healthcare leaders to proactively ensure the supports and processes are in place to enable staff to provide care in a more person- and family-centred way.

Bringing Person- and Family-Centred Care Alive in Home, Community and Long-Term Care Organizations.

It is now more important than ever for person- and family-centred care (PFCC) to be at the forefront of program and service design and delivery; yet, to date, very little guidance is available to assist home, community and long-term care (LTC) organizations to operationalize this concept and overcome inherent challenges. This article provides a list of practical strategies for healthcare leaders to promote and support a culture shift towards PFCC in their organizations and identifies and addresses five common concerns. The unique opportunities and challenges for practicing PFCC in home, community and LTC settings are also discussed.

More time where it matters: improving work environments in home healthcare nursing.

The nursing profession is currently experiencing a shift to community care, more complex clients and a shortage of human resources. Home healthcare organizations can increase job satisfaction and retention by better managing nurses' workloads and ensuring more time for direct client care. This project used innovative technology and dynamic methods to document nurses' work lives, identify areas for process improvements and increase time available for direct client care. This case study provides insight into ways in which organizations can streamline non-care activities and discusses implications for nursing leaders at the local and regional levels.

What is most important to patients when deciding about colorectal screening?

BACKGROUND: Colorectal cancer (CRC) screening can be administered through tests with varied characteristics and is a preference-sensitive decision. OBJECTIVE: To assess patient experiences with a Maximum Differences Scaling (MDS) tool for eliciting values about CRC screening test characteristics and determine whether patients vary in how they prioritize test characteristics and whether this variation relates to test preferences. DESIGN: MDS survey to elicit patients' values for characteristics related to fecal occult blood testing, sigmoidoscopy, colonoscopy, CT colonography and colon capsule endoscopy. PARTICIPANTS: 92 patients enrolled in primary care clinics at a VA hospital and associated university. RESULTS: Patients reported that the tool was easy to use (95%). On completion 62% would choose colonoscopy, 23% colon capsule endoscopy and 10% CT colonography. Of the attributes evaluated, patients valued sensitivity, risk of tear and need for a second test most. Sensitivity was more important to those choosing colonoscopy than those choosing other tests (median importance = 21.5 versus 19.6, p < 0.01). Concern with complications and sedation was positively associated with age (p < 0.001 and p < 0.001), whereas concern with colon preparation and missing work was negatively associated with age (p < 0.009 and p < 0.03). Patients with fair or poor health status were less concerned with sensitivity than patients in good to excellent health (median importance = 19.3 versus 21.4, p < 0.008). CONCLUSIONS: This pilot study suggests that patients vary in how they prioritize colorectal cancer screening test attributes; this variation is associated with test preferences, and this MDS tool is feasible to use and may help patients construct their preferences.

Emerging adult outcomes of adolescent psychiatric and substance use disorders.

This study investigates the age 25 outcomes of late adolescent mental health and substance use disorders. A hierarchical cluster analysis of age 19 DSM-III-R mental health and substance diagnoses placed participants into one of 9 clusters: Anxious, Depressed, Antisocial, Drug Abuser, Problem Drinker, Anxious Drinker, Depressed Drug Abuser and Antisocial Drinker, and No Diagnosis. Diagnoses were generated from the University of Michigan Composite International Diagnostic Interview. Repeated measures multivariate analyses of variance revealed distinct trajectories of improvement and decline among the 9 clusters. Clusters with co-occurring substance and mental health disorders improved over adolescent levels, but continued to have higher levels of depression symptoms, poorer global functioning, and higher levels of substance use than the No Diagnosis cluster. Members of the The Problem Drinkers cluster, who tended to have alcohol use disorders only at age 19, did not differ from their peers with no diagnoses. Drug use disorders in adolescence, with or without a co-occurring mental health disorders, were associated with a poor prognosis in emerging adulthood. Clinical interventions should distinguish among these diverse clinical presentations.

Serotonin transporter polymorphisms and persistent, pervasive childhood aggression.

OBJECTIVE: The purpose of this study was to examine the potential association of the serotonin transporter (5-HTT) gene and childhood aggression by testing the 5-HTT variable-number-tandem-repeat and serotonin transporter promoter polymorphism (5-HTTLPR), including the recently discovered Lg allelic variant of 5-HTTLPR. METHOD: Clinically referred children displaying extreme aggression, with a minimum 2-year history, were genotyped for 5-HTTLPR (N=77) and 5-HTT variable-number-tandem-repeat (N=78). Analyses compared genotype frequencies of the aggressive children with healthy comparison subjects. RESULTS: The "low expressing" genotypic variants of the 5-HTTLPR polymorphism (S/S, Lg/S, Lg/Lg) were significantly associated with childhood aggression. CONCLUSIONS: This is the first study to report a significant association between the 5-HTTLPR gene and childhood aggression.