Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study

Background: Home care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario. Methods: A retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences. Results: The study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death. Conclusions: Our study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring.This work was supported by the Canadian Patient Safety Institute; Canadian Institutes of Health Research (CIHR) (Institutes of Health Services and Policy Research, Aging, Circulatory and Respiratory Health and Musculoskeletal Health and Arthritis); the Change Foundation; and the Canadian Health Services Research Foundation (grant number HC-10-05 Doran-Blais

Examining a "Household" Model of Residential Long-term Care in Nova Scotia

In 2006, Nova Scotia began to implement its Continuing Care Strategy which was grounded in a vision of providing client-centered care for continuing care clients, including residents of nursing homes. Considerable evidence pointed to the benefits of the “household” model of care—which led the province to adopt the smaller self-contained household model as a requirement for owners/operators seeking to build government-funded new and replacement nursing homes. The specific goals of the reform (the adoption of the household model) included increasing the proportion of single rooms, improving the home-likeness of the facility, and more generally, providing high-quality care services. The reform was influenced by recognition of the need for change, rapid population aging in the province, and strong political will at a time when fiscal resources were available. To achieve the reform, Nova Scotia Department of Health released two key documents (2007) to guide the design and operation of all new and replacement facilities procured using a request for proposal process: The Long Term Care Program Requirements and the Space and Design Requirements. Results from a research study examining resident quality of life suggest regardless of physical design or staffing approach high resident quality of life can be experienced, while at the same time recognizing that the facilities with “self-contained household” design and expanded care staff roles were uniquely supporting relationships and home-likeness and positively impacting resident quality of life. La Nouvelle-Écosse a lancé en 2006 la mise en oeuvre de la Stratégie pour les Soins de Longue Durée, bâtie sur l’idée de procurer des soins centrés sur le client pour ceux ayant besoin de soins de longue durée, y compris les résidents des institutions. Les avantages du modèle de soins dit de “domicile” étaient amplement démontrés empiriquement, ce qui a conduit la province à imposer aux propriétaires ou opérateurs cherchant à construire ou rénover des institutions de long-terme financées par le gouvernement un modèle de logement autonome de petite taille. La réforme (adoption du modèle de domicile) avait pour objectifs spécifiques d’accroître la proportion de chambres simples, de rendre l’institution plus proche d’un domicile privatif, et, plus généralement, de procurer des services de très bonne qualité. La réforme a été motivée par la reconnaissance d’un besoin de changement, le vieillissement rapide de la population de la province, et une forte volonté politique à une époque où les ressources fiscales étaient encore abondantes.  Pour réussir la réforme, le Ministère de la Santé de Nouvelle-Écosse a publié deux documents clé (2007) détaillant la conception et le fonctionnement de toutes les institutions créées ou rénovées à travers un appel d’offres: les normes du programme de soins de longue durée, et les normes d’espace et d’agencement. Une étude mesurant la qualité de vie des résidents a montré que, si une qualité de vie élevée pouvait être atteinte quels que soient l’agencement physique et la dotation en personnel, les institutions organisées en domiciles autonomes et confiant plus de responsabilités aux soignants étaient idéalement placées pour encourager la socialisation et le sentiment d’être chez soi, et influencent donc positivement la qualité de vie

Examining a "Household" Model of Residential Long-term Care in Nova Scotia

In 2006, Nova Scotia began to implement its Continuing Care Strategy which was grounded in a vision of providing client-centered care for continuing care clients, including residents of nursing homes. Considerable evidence pointed to the benefits of the “household” model of care—which led the province to adopt the smaller self-contained household model as a requirement for owners/operators seeking to build government-funded new and replacement nursing homes. The specific goals of the reform (the adoption of the household model) included increasing the proportion of single rooms, improving the home-likeness of the facility, and more generally, providing high-quality care services. The reform was influenced by recognition of the need for change, rapid population aging in the province, and strong political will at a time when fiscal resources were available. To achieve the reform, Nova Scotia Department of Health released two key documents (2007) to guide the design and operation of all new and replacement facilities procured using a request for proposal process: The Long Term Care Program Requirements and the Space and Design Requirements. Results from a research study examining resident quality of life suggest regardless of physical design or staffing approach high resident quality of life can be experienced, while at the same time recognizing that the facilities with “self-contained household” design and expanded care staff roles were uniquely supporting relationships and home-likeness and positively impacting resident quality of life

A molecular marker for, and the organization of, a cluster of loose smut resistance genes in oat

Loose smut (Ustilago avenae) resistance breeding is hampered by the many distinct smut races, and the different, poorly characterized resistance genes. Three pathotypes (A13, A60, A617) represent the most common races present in the prairie regions of western Canada (Kibite et al. 2000). Markers linked to a group of smut resistance genes located on linkage group 14 (Kanota/ Ogle) have been developed (Eckstein et al. 2002). One co-dominant SCAR marker was used to study the relationship between the marker and the three resistance genes. Molecular markers and plant populations used were described in Eckstein et al. (2002). Another population (OT369/89Ab4088) segregating for the three genes was also evaluated. All lines were inoculated with separate isolates of A13, A60, and A617 using a vacuum protocol, and grown over several locations and years in western Canada. SCAR marker Ua300co (co-dominant) was linked (~ 5 cM) to a resistance gene specific for pathotype A13. Two other pathotype specific genes clustered on the same side of the marker at genetic distances of 8 cM (A617) and 18 cM (A60). The genes are linked in coupling and are likely often inherited as a group. Attempts to find a flanking marker for the cluster are in progress. Eckstein et al. 2002. In: American Oat Workers Conference, Wilmington, NC, USA, May 5-7, 2002. pp33; Kibite et al. 2000. In: Cross, R.J. (ed). Proceedings of the 6th International Oat Conference, Lincoln, NZ. November 13-16 2000. pp298-301.vokMyynti MTT tietopalvelu

The m6A RNA demethylase FTO is a HIF-independent synthetic lethal partner with the VHL tumor suppressor.

Loss of the von Hippel-Lindau (VHL) tumor suppressor is a hallmark feature of renal clear cell carcinoma. VHL inactivation results in the constitutive activation of the hypoxia-inducible factors (HIFs) HIF-1 and HIF-2 and their downstream targets, including the proangiogenic factors VEGF and PDGF. However, antiangiogenic agents and HIF-2 inhibitors have limited efficacy in cancer therapy due to the development of resistance. Here we employed an innovative computational platform, Mining of Synthetic Lethals (MiSL), to identify synthetic lethal interactions with the loss of VHL through analysis of primary tumor genomic and transcriptomic data. Using this approach, we identified a synthetic lethal interaction between VHL and the m6A RNA demethylase FTO in renal cell carcinoma. MiSL identified FTO as a synthetic lethal partner of VHL because deletions of FTO are mutually exclusive with VHL loss in pan cancer datasets. Moreover, FTO expression is increased in VHL-deficient ccRCC tumors compared to normal adjacent tissue. Genetic inactivation of FTO using multiple orthogonal approaches revealed that FTO inhibition selectively reduces the growth and survival of VHL-deficient cells in vitro and in vivo. Notably, FTO inhibition reduced the survival of both HIF wild type and HIF-deficient tumors, identifying FTO as an HIF-independent vulnerability of VHL-deficient cancers. Integrated analysis of transcriptome-wide m6A-seq and mRNA-seq analysis identified the glutamine transporter SLC1A5 as an FTO target that promotes metabolic reprogramming and survival of VHL-deficient ccRCC cells. These findings identify FTO as a potential HIF-independent therapeutic target for the treatment of VHL-deficient renal cell carcinoma

Adverse Events Associated with Hospitalization or Detected through the RAI-HC Assessment among Canadian Home Care Clients

Background: The occurrence of adverse events (AEs) in care settings is a patient safety concern that has significant consequences across healthcare systems. Patient safety problems have been well documented in acute care settings; however, similar data for clients in home care (HC) settings in Canada are limited. The purpose of this Canadian study was to investigate AEs in HC, specifically those associated with hospitalization or detected through the Resident Assessment Instrument for Home Care (RAI-HC). Method: A retrospective cohort design was used. The cohort consisted of HC clients from the provinces of Nova Scotia, Ontario, British Columbia and the Winnipeg Regional Health Authority. Results: The overall incidence rate of AEs associated with hospitalization ranged from 6% to 9%. The incidence rate of AEs determined from the RAI-HC was 4%. Injurious falls, injuries from other than fall and medication-related events were the most frequent AEs associated with hospitalization, whereas new caregiver distress was the most frequent AE identified through the RAI-HC. Conclusion: The incidence of AEs from all sources of data ranged from 4% to 9%. More resources are needed to target strategies for addressing safety risks in HC in a broader context. Tools such as the RAI-HC and its Clinical Assessment Protocols, already available in Canada, could be very useful in the assessment and management of HC clients who are at safety risk.Canadian Patient Safety Institute, Canadian Institutes of Health Research (Institutes of Health Services and Policy Research, Aging, Circulatory and Respiratory Health and Musculoskeletal Health and Arthritis), the Change Foundation, the Canadian Health Services Research Foundation (grant number HC-10-105 Doran-Blais

Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study

Abstract Background Home care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario. Methods A retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences. Results The study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death. Conclusions Our study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring