Reliability of Standardized Assessment for Adults who are Deafblind

This study assessed the reliability of the interRAI Community Health Assessment (interRAI CHA) and Deafblind Supplement (DbS). The interRAI CHA and DbS represents a multidimensional, standardized assessment instrument for use with adults (18 and older) who are deafblind. The interrater reliability of the instrument was tested through the completion of dual assessments with 44 individuals who were deafblind in the province of Ontario, Canada. Overall, nearly 50% of items had a kappa value of at least 0.60, indicating fair to substantial agreement for these items. Several items related to psychosocial well-being, mood, and sense of involvement had kappa scores of less than 0.40. However, among these items with low kappa values, most (78%) showed at least 70% agreement between the two assessors. The internal consistency of several health subscales, embedded within the assessment, was also very good and ranged from 0.63 to 0.93. The interRAI was also very good and ranged from 0.63 to 0.93. The interRAI CHA and DbS represents a reliable instrument for assessing adults with deafblindness to better understand their needs, abilities, and preferences

Organization specific predictors of job satisfaction: findings from a Canadian multi-site quality of work life cross-sectional survey

BACKGROUND: Organizational features can affect how staff view their quality of work life. Determining staff perceptions about quality of work life is an important consideration for employers interested in improving employee job satisfaction. The purpose of this study was to identify organization specific predictors of job satisfaction within a health care system that consisted of six independent health care organizations. METHODS: 5,486 full, part and causal time (non-physician) staff on active payroll within six organizations (2 community hospitals, 1 community hospital/long-term care facility, 1 long-term care facility, 1 tertiary care/community health centre, and 1 visiting nursing agency) located in five communities in Central West Ontario, Canada were asked to complete a 65-item quality of work life survey. The self-administered questionnaires collected staff perceptions of: co-worker and supervisor support; teamwork and communication; job demands and decision authority; organization characteristics; patient/resident care; compensation and benefits; staff training and development; and impressions of the organization. Socio-demographic data were also collected. RESULTS: Depending on the organization, between 15 and 30 (of the 40 potential predictor) variables were found to be statistically associated with job satisfaction (univariate analyses). Logistic regression analyses identified the best predictors of job satisfaction and these are presented for each of the six organizations and for all organizations combined. CONCLUSIONS: The findings indicate that job satisfaction is a multidimensional construct and although there appear to be some commonalities across organizations, some predictors of job satisfaction appear to be organization and context specific

The Use of ACE Inhibitors, ß-Blockers, and Warfarin in Congestive Heart Failure: A Community Hospital Study

ABSTRACTBackground: Canadian, European, and US guidelines describe the benefits of angiotensin-converting enzyme (ACE) inhibitors, ß-blockers, and warfarin (for atrial fibrillation) in the treatment of congestive heart failure. However, few studies have examined the prescribing of these drugs and the dosages used for this condition in the community hospital setting.Objectives: To evaluate the use of ACE inhibitors, ß-blockers, and warfarin for inpatients with congestive heart failure in a community hospital (the primary objective) and to identify any significant differences in prescribing practices between family physicians and general internists (the secondary objective).Methods: Charts of patients with a primary or secondary diagnosis of congestive heart failure during the period April 2002 to February 2003 were identified. The charts were reviewed against the quality indicators of the Canadian Cardiovascular Outcomes Research Team (CCORT), including exclusion and inclusion criteria for congestive heart failure and exclusion criteria for use of ACE inhibitors, ß-blockers, and warfarin. The total daily doses of ACE inhibitors and ß-blockers were compared against those recommended in the European Society of Cardiology (ESC) guidelines.Results: A total of 93 patients (49% male) were studied. The mean age (± standard deviation) was 78.8 ± 9.5 years. The percentage of eligible patients with prescriptions for an ACE inhibitor (94%), ß-blocker (64%), or warfarin for atrial fibrillation (86%) was similar between the 26 patients treated by a family physician and the 67 patients treated by a general internist. Among the patients for whom ACE inhibitors would have been beneficial, 47% of those in the family physician group and 66% of those in the general internist group received the recommended daily dose of this type of therapy (p = 0.18). No patients in the family physician group and 4 patients (19%) in the general internist group received the recommended daily dose of ß-blockers (p = 0.18). There was a trend for the prescribed dose of ramipril and metoprolol to be closer to the ESC guidelines in the general internist group than the family physician group (p = 0.16 and p = 0.20, respectively).Conclusions: Physicians in this study achieved a relatively high degree of adherence to the guidelines in drug use for patients with congestive heart failure. These findings suggest that a close partnership between family physicians and general internists in a small community hospital may improve prescribing for patients with this condition. Additional studies examining therapy for patients with congestive heart failure from other institutions or physicians’ offices are required to confirm the findings of this retrospective study.RÉSUMÉHistorique : Les lignes directrices canadiennes, européennes et américaines décrivent les avantages des inhibiteurs de l’enzyme de conversion de l’angiotensine (ECA), des bêta-bloquants et de la warfarine (pour la fibrillation auriculaire) dans le traitement de l’insuffisance cardiaque congestive. Cependant, peu d’études ont examiné la prescription et les doses de ces médicaments dans le traitement de cette affection au sein d’hôpitaux communautaires.Objectifs : Évaluer l’utilisation des inhibiteurs de l’ECA, des bêta-bloquants et de la warfarine dans le traitement des patients hospitalisés pour une insuffisance cardiaque congestive dans un hôpital communautaire (objectif primaire) et cerner toute différence significative dans les habitudes de prescription entre les médecins de famille et les internistes généralistes (objectif secondaire).Méthodes : Les dossiers médicaux des patients qui ont reçu un diagnostic primaire ou secondaire d’insuffisance cardiaque congestive entre avril 2002 et février 2003 ont été sélectionnés. Ils ont été examinés à la lumière des indicateurs de qualité de la Canadian Cardiovascular Outcomes Research Team (CCORT), dont les critères d’inclusion et d’exclusion d’insuffisance cardiaque congestive ainsi que les critères d’exclusion de l’emploi des inhibiteurs de l’ECA, des bêta-bloquants et de la warfarine. Les doses journalières totales d’inhibiteurs de l’ECA et de bêta-bloquants prescrites ont été comparées à celles recommandées dans les lignes directrices de la Société européenne de cardiologie (SEC).Résultats : Au total, 93 patients (49 % des hommes) ont fait l’objet de l’étude. Leur âge moyen (± l’écart type) était de 78,8 ± 9,5 ans. Le pourcentage de patients admissibles ayant reçu une prescription d’inhibiteur de l’ECA (93 % de l’échantillon total), de bêta-bloquant (64 % de l’échantillon total) ou de warfarine pour la fibrillation auriculaire (86 % de l’échantillon total) était semblable chez les 26 patients traités par un médecin de famille (groupe MF) et chez les 67 autres traités par un interniste généraliste (groupe IG). Parmi les patients qui auraient pu bénéficier d’un inhibiteur de l’ECA, 47 % de ceux du groupe MF et 66 % de ceux du groupe IG ont reçu la dose journalière recommandée pour ce type de traitement (p = 0,18). Aucun patient du groupe MF n’a reçu la dose journalière recommandée de bêta-bloquant et 4 (19 %) du groupe IG l’ont reçue (p = 0,18). On a observé que les doses de ramipril et de métoprolol prescrites avaient tendance à être plus près de celles recommandées dans les lignes directrices de la SEC dans le groupe IG que dans le groupe MF (p = 0,16 et p = 0,20, respectivement).Conclusions : Les médecins dans cette étude ont adhéré de façon relativement soutenue aux lignes directrices sur l’emploi de ces médicaments chez les patients atteints d’insuffisance cardiaque congestive. Ces résultats laissent croire qu’une collaboration étroite entre les médecins de famille et les internistes généralistes d’un petit hôpital communautaire pourraient améliorer les habitudes de prescription au bénéfice des patients présentant une telle affection. D’autres projets étudiant les médicaments prescrits aux patients atteints d’insuffisance cardiaque congestive au sein d’autres établissements de santé ou de cabinets de médecins sont nécessaires pour corroborer les résultats de la présente étude rétrospective