Readiness for interprofessional learning among health science students: a cross-sectional Q-methodology and likert-based study.

BACKGROUND: Interprofessional education (IPE) prepares healthcare students for collaboration in clinical practice, but the effectiveness of this teaching method depends on students' readiness for and perceptions of IPE. Evaluating students' readiness for and perceptions of IPE is challenging, due to the lack of comprehensive measures. This study characterized the level of IPE readiness and perspectives across first-year undergraduate and graduate health science students using the readiness for interprofessional learning Likert Scale (RIPLS) and Q-methodologies. METHODS: This is a cross-sectional, online study. Students were randomized to answer the Likert-scale version of RIPLS (80%) or a matched Q-methodology survey (20%). An ANCOVA compared RIPLS scores between students from different program levels (graduate/undergraduate) and specialization (health professional and general programs). The Q-data was analysed using a by-person factor analysis. RESULTS: Three hundred and four (33% response rate) and 71 (30% response rate) students completed the Likert scale and the Q-methodology surveys, respectively. Students from graduate programs demonstrated high readiness for IPE (higher total RIPLS scores p < 0.001) in comparison to undergraduates. Three factors, associated with program specialization (p = 0.04), emerged from the Q-methodology analysis characterizing students learning priorities. Students in undergraduate general programs were focused on IPE relevance and benefits to "the clinical team", students in graduate programs focused on "the patient", and those in undergraduate health professional programs focused on themselves ("me"). CONCLUSIONS: This novel mixed-methods approach combining traditional Likert-scales with Q-methodology elucidated not only associations between program and specialization with readiness (Likert) but also which components of IPE were valued the most (Q-methodology) and by whom.

Impact of the COVID-19 pandemic on non-small-cell lung cancer pathologic stage and presentation.

BACKGROUND: It is believed that the cessation of normative cancer care services during the COVID-19 pandemic may be resulting in pathologic upstaging and higher long-term mortality rates. We aimed to understand how the pandemic has affected our patients diagnosed with non-small-cell lung cancer (NSCLC). METHODS: We conducted a single-centre retrospective analysis to assess how the COVID-19 pandemic has affected patient referrals, pathologic stage of NSCLC, mortality rates and surgical procedures at our cancer care centre in Ontario, Canada. At our centre, physicians advocated for and followed recommendations that operations in cancer patients should be among the last procedures to be delayed. Patients were included if they were aged 18 years or older, were not receiving palliative care, and had been screened, diagnosed and treated for NSCLC (primary tumours). We compared outcomes between a prepandemic period (January 2019 to February 2020) and a period during the pandemic (March 2020 to February 2021). RESULTS: A total of 695 patients were included for statistical analysis, of whom 650 underwent surgery. There was no statistically significant difference in any of the outcomes of interest between patients seen before (n = 330) and during (n = 320) the pandemic. CONCLUSION: Cancer care services at our centre were maintained during the COVID-19 pandemic, and potential adverse effects on prognosis and survival that have been seen in other countries were avoided. The results inform health care providers how the effects of future pandemics can be blunted by using proactive preservative strategies and surgeon advocacy.

Preliminary instrument development to measure implementing a population health approach in sexual health.

OBJECTIVES: This study aims to describe the preliminary development and validation of an instrument to measure the extent that a population health approach was applied in sexual health by public health units in Ontario, Canada. DESIGN: Preliminary scale development and administration occurred in two phases that included item development and validity testing. MEASUREMENT AND SAMPLE: Two phases of development included: (1) using literature and expert input (n = 6) to develop items; and (2) validation of items by content experts (n = 5) and pre-testing (n = 3). RESULTS: The validated scale consisted of 69 items across the eight key elements of a population health approach. 15 out of 35 health units completed the survey, representing 43% of health units. Instrument administration revealed that Focus on the Health of Populations and Address the Determinants of Health and their Interactions were implemented more frequently compared to Collaborate Across Sectors and Levels and Employ Mechanisms for Public Involvement, which were infrequently implemented. CONCLUSION: This preliminary scale is a way for sexual health programs to measure the extent that a population health approach is implemented by their organization. Further testing with a broader sample is needed to strengthen generalizability and address reliability.

Caring ahead: Mixed methods development of a questionnaire to measure caregiver preparedness for end-of-life with dementia.

BACKGROUND: Family caregivers of persons with dementia often feel unprepared for end-of-life and preparedness predicts caregiver outcomes in bereavement. Existing questionnaires assessing preparedness have limitations. A multi-dimensional questionnaire assessing family caregiver preparedness for the end-of-life of persons with dementia is needed to identify caregivers at risk for negative outcomes in bereavement and evaluate the quality of strategies within a palliative approach. AIM: To develop a multi-dimensional questionnaire titled 'Caring Ahead' to assess feelings of preparedness for end-of-life in family caregivers of persons with dementia. DESIGN: A mixed methods, sequential design employed semi-structured interviews, a Delphi-survey and pilot-testing of the questionnaire, June 2018 to July 2019. SETTING/POPULATION: Participants included five current and 16 bereaved family caregivers of persons with symptoms advanced dementia from long-term care homes in Ontario, Canada; and 12 professional experts from clinical and academic settings in Canada, Europe, United States. RESULTS: Interviews generated three core concepts and 114 indicators of preparedness sampling cognitive, affective and behavioural traits in four domains (i.e., medical, psychosocial, spiritual, practical). Indicators were translated and reduced to a pool of 73 potential questionnaire items. 30-items were selected to create the 'Caring Ahead' preparedness questionnaire through a Delphi-survey. Items were revised through a pilot-test with cognitive interviewing. CONCLUSIONS: Family caregivers' feelings of preparedness for end-of-life need to be assessed and the quality of strategies within a palliative approach evaluated. Future psychometric testing of the Caring Ahead questionnaire will evaluate evidence for validity and reliability.

Wait times in the management of non-small cell lung carcinoma before, during and after regionalization of lung cancer care: a high-resolution analysis.

Background: Timeliness can have a substantial effect on treatment outcomes, prognosis and quality of life for patients with lung cancer. We sought to evaluate changes in wait times for patients with non-small cell lung carcinoma (NSCLC) and to identify bottlenecks in cancer care. Methods: We included patients who received treatment with curative intent or palliative treatment for NSCLC, diagnosed through mediastinal staging by a thoracic surgeon. Data were collected from 3 cohorts over 3 time periods: before the regionalization of lung cancer care (2005-2007, C1), immediately postregionalization (2011-2013, C2) and 5 years after regionalization (2016-2017, C3). Total wait time and delays along treatment pathways were compared across cohorts using multivariate Cox proportionality models. Results: Our total sample size was 299 patients. Overall, there was no significant difference in total wait time among the 3 cohorts. However, wait time from symptom onset to first physician visit significantly increased in C3 compared with C2 (hazard ratio [HR] 0.41, p < 0.01) and C1 (HR 0.43, p < 0.01). Time from first physician visit to computed tomography (CT) scan significantly decreased in C3 compared with C2 (HR 1.54, p < 0.01). Time from abnormal CT scan to first surgeon visit also significantly decreased in C2 (HR 1.43, p < 0.01) and C3 (HR 4.47, p < 0.01) compared with C1, and between C3 and C2 (HR 2.67, p < 0.01). In contrast, time from first surgeon visit to completion of staging significantly increased in C2 (HR 0.36, p < 0.01) and C3 (HR 0.24, p < 0.01) compared with C1, as well as between C3 and C2 (HR 0.60, p < 0.01). Time to first treatment after completion of staging was significantly shorter for C3 than C1 (HR 1.58, p < 0.01). Conclusion: Trends toward a reduction in wait time are evident 5 years after the regionalization of lung cancer care, primarily led by shorter wait times for CT scans and thoracic surgeon consults. However, wait times can further be reduced by addressing delays in staging completion and patient and provider education to identify the early signs of NSCLC.

Contexte: La rapidité d'intervention peut avoir un effet considérable sur l'issue du traitement, le pronostic et la qualité de vie des patients atteints d'un cancer du poumon. Nous avons voulu évaluer les changements des temps d'attente des patients ayant un carcinome pulmonaire non à petites cellules et recenser les obstacles aux soins oncologiques. Méthodes: Nous avons inclus des patients ayant reçu un traitement curatif ou palliatif pour un carcinome pulmonaire non à petites cellules diagnostiqué par stadification de lésions médiastinales par un chirurgien thoracique. Les données ont été recueillies auprès de 3 cohortes, à 3 moments : avant la régionalisation des soins oncologiques (2005­2007; C1), immédiatement après la régionalisation (2011­2013; C2) et 5 ans après la régionalisation (2016­2017; C3). Le temps d'attente total et les délais au cours du processus de traitement des cohortes ont été comparés au moyen de modèles à risques proportionnels de Cox multivariés. Résultats: Au total, l'échantillon comptait 299 patients. Dans l'ensemble, aucune différence statistiquement significative n'a été observée entre les 3 cohortes pour ce qui est du temps d'attente total. Cependant, la C3 présentait un temps d'attente entre l'apparition des symptômes et la première consultation médicale significativement plus long que la C2 (rapport de risque [RR] 0,41; p < 0,01) et que la C1 (RR 0,43; p < 0,01). Le temps d'attente entre la première consultation médicale et la tomodensitométrie (TDM) était par contre significativement plus court dans la C3 que dans la C2 (RR 1,54; p < 0,01). Le délai entre l'obtention d'un résultat anormal à la TDM et la première consultation chirurgicale était également significativement moindre dans la C2 (RR 1,43; p < 0,01) et dans la C3 (RR 4,47; p < 0,01) que dans la C1, mais aussi entre la C3 et la C2 (RR 2,67; p < 0,01). À l'inverse, le temps écoulé entre la première consultation chirurgicale et la fin de la stadification était significativement plus long dans la C2 (RR 0,36; p < 0,01) et la C3 (RR 0,24; p < 0,01) que dans la C1; il en était également ainsi entre la C3 et la C2 (RR 0,60; p < 0,01). Enfin, le délai entre le premier traitement et la fin de la stadification était significativement plus court dans la C3 que dans la C1 (RR 1,58; p < 0,01). Conclusion: Cinq ans après la régionalisation des soins oncologiques, on peut observer une réduction des temps d'attente, principalement une diminution du temps d'attente pour une TDM ou une consultation chirurgicale. Les temps d'attente pourraient être davantage raccourcis par une réduction des délais dans la stadification, ainsi que par la sensibilisation des patients et des fournisseurs de soins à l'égard de la reconnaissance des signes précoces de carcinome pulmonaire non à petites cellules.

Methods of competing risks flexible parametric modeling for estimation of the risk of the first disease among HIV infected men.

BACKGROUND: Patients infected with the Human Immunodeficiency Virus (HIV) are susceptible to many diseases. In these patients, the occurrence of one disease alters the chance of contracting another. Under such circumstances, methods for competing risks are required. Recently, competing risks analyses in the scope of flexible parametric models have risen to address this requirement. These lesser-known analyses have considerable advantages over conventional methods. METHODS: Using data from Multi Centre AIDS Cohort Study (MACS), this paper reviews and applies methods of competing risks flexible parametric models to analyze the risk of the first disease (AIDS or non-AIDS) among HIV-infected patients. We compared two alternative subdistribution hazard flexible parametric models (SDHFPM1 and SDHFPM2) with the Fine & Gray model. To make a complete inference, we performed cause-specific hazard flexible parametric models for each event separately as well. RESULTS: Both SDHFPM1 and SDHFPM2 provided consistent results regarding the magnitude of coefficients and risk estimations compared with estimations obtained from the Fine & Gray model, However, competing risks flexible parametric models provided more efficient and smoother estimations for the baseline risks of the first disease. We found that age at HIV diagnosis indirectly affected the risk of AIDS as the first event by increasing the number of patients who experience a non-AIDS disease prior to AIDS among > 40 years. Other significant covariates had direct effects on the risks of AIDS and non-AIDS. DISCUSSION: The choice of an appropriate model depends on the research goals and computational challenges. The SDHFPM1 models each event separately and requires calculating censoring weights which is time-consuming. In contrast, SDHFPM2 models all events simultaneously and is more appropriate for large datasets, however, when the focus is on one particular event SDHFPM1 is more preferable.

Screening and Intervention Practices for Alcohol Use by Pregnant Women and Women of Childbearing Age: Results of a Canadian Survey.

OBJECTIVE: To determine health care providers' familiarity with and use of the Society of Obstetricians and Gynaecologists of Canada's (SOGC's) 2010 Alcohol Use and Pregnancy Consensus Clinical Guidelines and to identify barriers and enablers that affected guideline uptake. METHODS: We conducted an online pan-Canadian survey of midwives, obstetricians, family physicians, and nurses. The survey was divided into five sections: knowledge, SOGC guidelines, screening and intervention practices, attitudes and beliefs, and demographic information. RESULTS: Just over half of the 588 respondents who provided care to pregnant women or to women of childbearing age were familiar with and used the guidelines. Most respondents screened for alcohol use by asking women about alcohol consumption, but relatively few used a screening questionnaire. Approximately two-thirds of respondents provided brief intervention and referral to harm reduction or treatment services. Enablers of guideline adherence included knowledge about the risks of alcohol in pregnancy, perceived responsibility to identify and address at-risk drinking, and a belief that women are motivated to reduce their alcohol consumption if pregnant or planning to become pregnant. Lack of confidence in ability to use screening questionnaires and to provide brief intervention, as well as a lack of belief in the effectiveness of both practices, were barriers to use. CONCLUSION: Strategies are needed to improve familiarity with and uptake of the Alcohol Use and Pregnancy Consensus Clinical Guidelines. Particular attention should be given to education and training regarding the use of validated screening questionnaires and brief intervention practices.

Caregiver preparedness for death in dementia: an evaluation of existing tools.

Objectives: Death preparedness amongst family caregivers (CG) is a valuable and measurable concept. Preparedness predicts CG outcomes in bereavement and is modifiable through a palliative approach which includes advance care planning (ACP) interventions. Improving death preparedness is important for CGs of persons with dementia (PwD) whom are more likely to develop negative outcomes in bereavement, and experience less than adequate palliative care. However, the adequacy of existing tools to measure death preparedness in CGs of PwD is unknown, which limits intervention design and prospective evaluation of ACP effectiveness.Methods: We conducted a review and evaluation of existing tools measuring the attribute domains and traits of CG death preparedness. Literature was searched for articles describing caregiving at end of life (EOL). Measurement tools were extracted, screened for inclusion criteria, and data extracted regarding: conceptual basis, population of development, and psychometrics. Tool content was compared to preparedness domains/traits to assess congruency and evaluate the adequacy of tools as measures of death preparedness for CGs of PwD.Results: Authors extracted 569 tools from articles, retaining seven tools for evaluation. The majority of tools, n = 5 (70%) did not sample all preparedness domains/traits. Few tools had items specific to EOL; only one tool had a specific item questioning CG preparedness for death, and only one tool had items specific to dementia.Conclusion: Limitations in existing tools suggest they are not adequate measures of death preparedness for CGs of PwD. Consequently, the authors are currently developing a questionnaire to be titled, 'Caring Ahead' for this purpose.

Trends in Survival Based on Treatment Modality in Non-Small Cell Lung Cancer Patients: A Population-Based Study.

Objectives: We examined the trends in survival based on treatment modality among non-small cell lung cancer (NSCLC) patients in the province of Ontario, Canada, from 2007 to 2015. Methods: We investigated the trends in survival based on treatment modality. Results: Among 56,417 identified patients, the mean age at diagnosis was 70.1 years (SD = 10.7). Treatment modalities varied significantly over time (p<.001). Overall, 23.0% of patients received surgical treatments. We observed more than 20% increase in five-year survival rates for all surgical groups over time. Conclusions: Patients undergoing sublobar/lobar resections had higher survival rate.

Policy to practice: Investment in transitioning new graduate nurses to the workplace.

AIM: To analyse nurses' perceptions of the impact of an extended transition programme on key dimensions of care delivery 1-6 years after graduation. The dimensions included decision-making, communication, care management, system integration and commitment. BACKGROUND: Health care employers in Ontario, Canada, can apply for government funding to support an extended transition programme for new graduate nurses that includes orientation and mentorship. METHODS: A cross-sectional study design was used. Nurses who participated in the transition programme were compared with nurses who did not. A survey was administered to a convenience sample of 2369 nurses. RESULTS: There were statistically significant differences between the two groups. Nurses in the transition programme had higher mean scores on the key dimensions of care delivery. Results were confirmed when controlling for length of time since graduation. CONCLUSION: Extended transition benefits new graduate nurses. It has a lasting effect over time and impacts key dimensions of care delivery. It can also enhance workforce integration and reduce turnover. IMPLICATIONS FOR NURSING MANAGEMENT: Responding to the needs of new graduate nurses has potential long-term advantages for health care organisations and can influence both quality and delivery of care.

Care Delivery Patterns, Processes, and Outcomes for Primary Ovarian Cancer Surgery: A Population-Based Review Using a National Administrative Database.

OBJECTIVES: In this pan-Canadian study, we sought to elucidate the current state of surgical care for primary ovarian cancers and factors influencing selected short-term outcomes; these were in-hospital mortality (IHM), major complications (MCs), failure-to-rescue (FTR), and hospital length of stay (LOS). METHODS: We created a population cohort using inpatient admission records from the Canadian Institute of Health Information data set (2004-2012). Multilevel logistic regression and flexible parametric survival analyses, adjusted for hospital clustering effect, were conducted to determine the effect of patient-specific factors (i.e., age, comorbidities, and admission category); procedural complexity; and the surgical volume and specialty of each care provider on the outcomes of interest. RESULTS: A total of 16 089 women underwent surgeries for primary ovarian cancer across Canada. The crude rates of IHM, MC, and FTR were 0.89%, 5.7%, and 9.09%, respectively, with a median LOS of four days (interquartile range 3 to 6). The majority of surgical procedures were performed by surgeons and hospitals with annual surgical volumes of less than five such procedures. Hospitals with higher surgical volumes were associated with lower risk of IHM (OR 0.95, 95% CI 0.91 to 0.99) and FTR (OR 0.95, 95% CI 0.91 to 0.99) and a higher chance of earlier discharge (hazard ratio [HR] 1.03, 95% CI 1.00 to 1.06). Surgeons with higher surgical volumes were associated with lower odds of early discharge (HR 0.90, 95% CI 0.87 to 0.94) and a higher risk of MC (OR 1.12, 95% CI 1.02 to 1.23). Compared with gynaecologic oncologists, general surgeons had a significantly higher risk of IHM (OR 3.50, 95% CI 1.82 to 6.74) and MC (OR 2.13, 95% CI 1.36 to 3.33) and lower odds of early discharge (HR 0.43, 95% CI 0.40 to 0.47). CONCLUSION: Despite limitations in the administrative data set, valuable information was available for this pan-Canadian analysis. Our findings support centralization of surgical procedures for women with ovarian cancer in tertiary care centres with higher surgical volumes that are staffed by in-house multidisciplinary care teams and specialist surgeons.

Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis.

AIM: To report a concept analysis of interprofessional collaboration in the context of chronic disease management, for older adults living in communities. BACKGROUND: Increasing prevalence of chronic disease among older adults is creating significant burden for patients, families and healthcare systems. Managing chronic disease for older adults living in the community requires interprofessional collaboration across different health and other care providers, organizations and sectors. However, there is a lack of consensus about the definition and use of interprofessional collaboration for community-based chronic disease management. DESIGN: Concept analysis. DATA SOURCES: Electronic databases CINAHL, Medline, HealthStar, EMBASE, PsychINFO, Ageline and Cochrane Database were searched from 2000 - 2013. METHODS: Rodgers' evolutionary method for concept analysis. RESULTS: The most common surrogate term was interdisciplinary collaboration. Related terms were interprofessional team, multidisciplinary team and teamwork. Attributes included: an evolving interpersonal process; shared goals, decision-making and care planning; interdependence; effective and frequent communication; evaluation of team processes; involving older adults and family members in the team; and diverse and flexible team membership. Antecedents comprised: role awareness; interprofessional education; trust between team members; belief that interprofessional collaboration improves care; and organizational support. Consequences included impacts on team composition and function, care planning processes and providers' knowledge, confidence and job satisfaction. CONCLUSION: Interprofessional collaboration is a complex evolving concept. Key components of interprofessional collaboration in chronic disease management for community-living older adults are identified. Implications for nursing practice, education and research are proposed.

Critical care nurses' perceptions of the outcomes of working overtime in Canada.

BACKGROUND: Nursing overtime is being integrated into the normal landscape of practice to ensure optimal staffing levels and addresses variations in patient volume and acuity. This is particularly true in critical care where fluctuations in either are difficult to predict. PURPOSE: The goal of this study was to explore critical care nurses' perceptions of the outcomes of working overtime. METHODS: Sally Thorne's interpretive description guided the collection and analysis of data. Participants were recruited from 11 different critical care units within three large teaching hospitals in Southern Ontario, Canada. A total of 28 full- and part-time registered nurses who had worked in an intensive care unit for at least one year took part in this study. Data were collected through semistructured, audio-recorded, individual interviews that took place in rooms adjacent to participants' critical care units. Template analysis facilitated the determination and abstraction of themes using NVivo for Mac 10.1.1. FINDINGS: Major themes highlighting the perceived outcomes of overtime included (a) physical effects, (b) impact on patient-centered care, (c) balancing family and work, (d) financial gain, and € safety is jeopardized. CONCLUSIONS: Nursing managers and institutions need to be accountable for staffing practices they institute, and nurses themselves may require further education regarding healthy work-life balance. There are both negative and positive consequences of nursing overtime for nurses and patients, but nurses at large valued the option to work it.

Long-term trends in the incidence and relative survival of pancreatic cancer in Canada: A population-based study.

BACKGROUND/OBJECTIVE: The poor survival among pancreatic cancer patients accounts for a disproportionate number of cancer deaths, and there has been little or no improvement in the long-term survival of these patients. This study examines the long-term trends in incidence and relative survival of patients diagnosed with pancreatic cancer in Canada between 1992 and 2008. METHODS: We used pancreatic cancer data from the Canadian Cancer Registry. Incidence rate per age group was estimated over the aforementioned period. A flexible parametric model was used to estimate trends in one- and five-year relative survival for each age group and sex. Excess mortality rate was estimated to illustrate additional mortality due to a cancer diagnosis. RESULTS: In total, 34,577 patients with pancreatic cancer were identified, of which 49.3% were male. Mean age at diagnosis was 70.1 (SD = 12.3) years. Approximately 60.0% of patients were older than 70 years at diagnosis. There has been no change in the incidence rate of pancreatic cancer in Canada; however, it significantly decreased for men (80+) (p = 0.011). Although one-year relative survival increased over time for all patients, five-year relative survival increased only 5% for the youngest age group (<50 years). CONCLUSIONS: Overall survival of patients with pancreatic cancer remains low, although advances in chemotherapy and palliative care may have provided some improvement. Excess mortality remains highest shortly after diagnosis, which is likely attributable to the late diagnosis of pancreatic cancer.

Strategic Workforce Planning for Health Human Resources: A Nursing Case Analysis.

Background Health-care organizations provide services in a challenging environment, making the introduction of health human resources initiatives especially critical for safe patient care. Purpose To demonstrate how one specialty hospital in Ontario, Canada, leveraged an employment policy to stabilize its nursing workforce over a six-year period (2007 to 2012). Methods An observational cross-sectional study was conducted in which administrative data were analyzed to compare full-time status and retention of new nurses prepolicy and during the policy. The Professionalism and Environmental Factors in the Workplace Questionnaire® was used to compare new nurses hired into the study hospital with new nurses hired in other health-care settings. Results There was a significant increase in full-time employment and a decrease in part-time employment in the study hospital nursing workforce. On average, 26% of prepolicy new hires left the study hospital within one year of employment compared to 5% of new hires during policy implementation. The hospital nurses scored significantly higher than nurses employed in other health-care settings on 5 out of 13 subscales of professionalism. Conclusions Decision makers can use these findings to develop comprehensive health human resources guidelines and mechanisms that support strategic workforce planning to sustain and strengthen the health-care system.

A review of instruments to measure interprofessional collaboration for chronic disease management for community-living older adults.

It is acknowledged internationally that chronic disease management (CDM) for community-living older adults (CLOA) is an increasingly complex process. CDM for older adults, who are often living with multiple chronic conditions, requires coordination of various health and social services. Coordination is enabled through interprofessional collaboration (IPC) among individual providers, community organizations, and health sectors. Measuring IPC is complicated given there are multiple conceptualisations and measures of IPC. A literature review of several healthcare, psychological, and social science electronic databases was conducted to locate instruments that measure IPC at the team level and have published evidence of their reliability and validity. Five instruments met the criteria and were critically reviewed to determine their strengths and limitations as they relate to CDM for CLOA. A comparison of the characteristics, psychometric properties, and overall concordance of each instrument with salient attributes of IPC found the Collaborative Practice Assessment Tool to be the most appropriate instrument for measuring IPC for CDM in CLOA.

The impact of age and race on longevity in pediatric astrocytic tumors: A population-based study.

OBJECTIVE: Despite improvements in pediatric brain tumor outcomes, the survivors of childhood brain tumor are burdened by multiple comorbidities. This work reports on the relative survival ratios and excess mortality rate in children with astrocytic tumors over the past four decades. METHODS: Survival analysis was conducted using flexible parametric model to estimate relative survival and excess mortality rate for non-white and white children (0-19 years old) using the Surveillance, Epidemiology & End Results (SEER) database. We incorporated age group and year of diagnosis into the model to estimate these indices for the period of 1973-2010. RESULTS: Progressive decline in relative survival ratios was noted over time. Non-white children had lower survival rates than white children, and these survival patterns persisted over the four-decade span of the study. Fifty percent of non-white survivors were deceased 30 years post diagnosis, compared to 35 years in white survivors. CONCLUSIONS: Survivors of childhood brain tumors have progressively lower survival rates as they get older, and this is higher in non-white when compared to white children. Future research efforts need to focus on understanding the factors mediating the effect of the tumor or its treatment on survival in these patients, and the ethnic variations that derive these survival trends.

Further insights into long-term trends in relative survival of vulvar cancer patients: a population-based study.

OBJECTIVE: The main objective of this article was to investigate the trends in relative survival in women diagnosed with invasive squamous cell vulvar cancer in the United States during the periods of 2004 to 2011 and to examine how these trends are associated with the stage of tumor at diagnosis. METHODS: We identified patients with primary invasive squamous cell vulvar cancer and recorded tumor stage in the Surveillance, Epidemiology, and End Results cancer registry database. Women younger than 40 years were excluded because of small number of patients in this age group. A flexible parametric model was used to estimate 1- and 2-year relative survival ratios and excess mortality rate. RESULTS: In total, 4647 women were identified with invasive squamous cell vulvar cancer and known tumor stage in the data set. One- and two-year relative survival ratios increased over time for women with tumors staged I to III but it decreased for women with tumor staged IV. The excess mortality rate was much larger for stage IV compared to the other stages. CONCLUSIONS: Trends in relative survival ratio for invasive vulvar cancer patients have opposite directions depending on the stage of tumor. The mechanism of such behavior is not fully known and yet to be examined in future studies. However, this finding highlights the importance of early detection of preinvasive and early stage disease.

Quality of prenatal care questionnaire: psychometric testing in an Australia population.

BACKGROUND: The quality of antenatal care is recognized as critical to the effectiveness of care in optimizing maternal and child health outcomes. However, research has been hindered by the lack of a theoretically-grounded and psychometrically sound instrument to assess the quality of antenatal care. In response to this need, the 46-item Quality of Prenatal Care Questionnaire (QPCQ) was developed and tested in a Canadian context. The objective of this study was to validate the QPCQ and to establish its internal consistency reliability in an Australian population. METHODS: Study participants were recruited from two public maternity services in two Australian states: Monash Health, Victoria and Wollongong Hospital, New South Wales. Women were eligible to participate if they had given birth to a single live infant, were 18 years or older, had at least three antenatal visits during the pregnancy, and could speak, read and write English. Study questionnaires were completed in hospital. A confirmatory factor analysis (CFA) was conducted. Construct validity, including convergent validity, was further assessed against existing questionnaires: the Patient Expectations and Satisfaction with Prenatal Care (PESPC) and the Prenatal Interpersonal Processes of Care (PIPC). Internal consistency reliability of the QPCQ and each of its six subscales was assessed using Cronbach's alpha. RESULTS: Two hundred and ninety-nine women participated in the study. CFA verified and confirmed the six factors (subscales) of the QPCQ. A hypothesis-testing approach and an assessment of convergent validity further supported construct validity of the instrument. The QPCQ had acceptable internal consistency reliability (Cronbach's alpha = 0.97), as did each of the six factors (Cronbach's alpha = 0.74 to 0.95). CONCLUSIONS: The QPCQ is a valid and reliable self-report measure of antenatal care quality. This instrument fills a scientific gap and can be used in research to examine relationships between the quality of antenatal care and outcomes of interest, and to examine variations in antenatal care quality. It also will be useful in quality assurance and improvement initiatives.

Integrative review: an evaluation of the methods used to explore the relationship between overtime and patient outcomes.

AIMS: To analyse, critically, methods employed to explore the relationship between nursing overtime and patient outcomes to strengthen future research. BACKGROUND: Nursing overtime hours have been increasing in the Western world since the 1980's; however, research detailing its implications for patient outcomes has not kept pace. Studies exploring the relationship between nursing overtime and patient outcomes have produced conflicting results and are deficient in number and rigour. DESIGN: Whittemore and Knafl's revised framework for integrative reviews guided the analysis. DATA SOURCES: A comprehensive multi-step search (1980-2012) of literature related to nursing overtime and patient outcomes in the CINAHL, Medline, PubMED, EMBASE and PsychInfo databases was performed. Reference lists and Google searches were completed for additional sources. Nine research papers met the inclusion criteria. REVIEW METHODS: All nine articles were included in the review. A systematic, iterative approach was used to extract and reduce the data to draw conclusions. RESULTS: There appears to be a positive relationship between nursing overtime and patient outcomes, however, eight of the nine studies revealed limitations in: (1) the definition and measurement of overtime; (2) data aggregation (organizationally and temporally) and (3) recognition or control of potential confounding variables. CONCLUSION: The quality in this research sample limits the ability of this body of work to be the basis of staffing policies. Future researchers need to be explicit in detailing their methods alongside a renewed commitment from administration to develop a tracking system of important parameters at the individual and bedside level.