Short-term geriatric assessment units: 30 years later

<p>Abstract</p> <p>Background</p> <p>The increasing number of hospitalized elderly persons has greatly challenged decision makers to reorganize services so as to meet the needs of this clientele. Established progressively over the last 30 years, the short-term Geriatric Assessment Unit (GAU) is a specialized care program, now implemented in all the general hospital centres in Quebec. Within the scope of a broader reflection upon the appropriate care delivery for elderly patients in our demographic context, there is a need to revisit the role of GAU within the hospital and the continuum of care. The objective of this project is to describe the range of activities offered by Quebec GAU and the resources available to them.</p> <p>Methods</p> <p>In 2004, 64 managers of 71 GAU answered a mail questionnaire which included 119 items covering their unit's operation and resources in 2002-2003. The clinical and administrative characteristics of the clientele admitted during this period were obtained from the provincial database Med-Echo. The results were presented according to the geographical location of GAU, their size, their university academic affiliation, the composition of their medical staff, and their clinical care profile.</p> <p>Results</p> <p>Overall, GAU programs admitted 9% of all patients aged 65 years and older in the surveyed year. GAU patients presented one or more geriatric syndromes, including dementia. Based on their clientele, three distinct clinical care profiles of GAU were identified. Only 19% of GAU were focused on geriatric assessment and acute care management; 23% mainly offered rehabilitation care, and the others offered a mix of both types. Thus, there was a significant heterogeneity in GAU's operation.</p> <p>Conclusions</p> <p>The GAU is at the cutting edge of geriatric services in hospital centres. Given the scarcity of these resources, it would be appropriate to better target the clientele that may benefit from them. Standardizing and promoting GAU's primary role in acute care must be reinforced. In order to meet the needs of the frail elderly not admitted in GAU, alternative care models centered on prevention of functional decline must be applied throughout all hospital wards.</p

Utilisation non médicale des médicaments d’ordonnance chez les adolescents utilisant des drogues au Québec

Abstract : OBJECTIVE: To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec. METHOD: Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors. RESULTS: Among adolescents who had used drugs in the previous 12 months, 5.4% (95% CI 4.9% to 6.0%) reported NMUPM. Based on multivariate analyses, having an ADD (adjusted odds ratio [AOR] 1.47; 95% CI 1.13 to 1.91), anxiety disorder (AOR 2.14; 95% CI 1.57 to 2.92), low self-esteem (AOR 1.62; 95% CI 1.26 to 2.08), low self-control (AOR 1.95; 95% CI 1.55 to 2.45), low parental supervision (AOR 1.43; 95% CI 1.11 to 1.83), regular alcohol use (AOR 1.72; 95% CI 1.36 to 2.16), and polysubstance use (AOR 4.09; 95% CI 3.06 to 5.48) were associated with increased odds of reporting NMUPM. CONCLUSIONS: The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.OBJECTIF: Déterminer la prévalence de l’utilisation non médicale des médicaments d’ordonnance (UNMMO) et les facteurs qui y sont associés chez les adolescents (de 12 à 17 ans) qui utilisent des drogues au Québec. MÉTHODE: Des analyses de données secondaires ont été exécutées avec les données d’une étude de 6 mois, l’Enquête québécoise sur la santé des jeunes du secondaire 2010-2011, une enquête de grande envergure visant à obtenir une meilleure compréhension de la santé et du bien-être des jeunes québécois du secondaire. Des analyses de régression logistique bivariée et multivariée ont été menées pour étudier l’UNMMO chez les adolescents qui utilisent des drogues, selon les facteurs des caractéristiques sociodémographiques, des caractéristiques des pairs, des indicateurs de la santé (anxiété, dépression, ou trouble de déficit de l’attention [TDA] avec ou sans hyperactivité), de l’autoefficacité, de l’environnement familial, et de l’utilisation de substances (utilisation d’alcool et de drogues). RÉSULTATS: Parmi les adolescents qui avaient utilisé des drogues dans les 12 mois précédents, 5,4 % (IC à 95 % 4,9 % à 6,0 %) déclaraient une UNMMO. Selon les analyses multivariées, un TDA (ratio de cotes ajusté [RCC] 1,47; IC à 95 % 1,13 à 1,91), un trouble anxieux (RCC 2,14; IC à 95 % 1,57 à 2,92), une faible estime de soi (RCC 1,62; IC à 95 % 1,26 à 2,08), un faible autocontrôle (RCC 1,95; IC à 95 % 1,55 à 2,45), une faible supervision parentale (RCC 1,43; IC à 95 % 1,11 à 1,83), une utilisation d’alcool régulière (RCC 1,72; IC à 95 % 1,36 à 2,16), et une utilisation de polysubstances (RCC 4,09; IC à 95 % 3,06 à 5,48) étaient associés à des probabilités accrues de déclarer une UNMMO. CONCLUSIONS: La prévalence observée de l’UNMMO était plus faible que prévu. Cependant, les associations notées entre certains troubles de santé mentale et l’utilisation régulière ou intensive d’autres substances psychoactives sont inquiétantes. Les implications cliniques sont discutées

A discharge summary adapted to the frail elderly to ensure transfer of relevant information from the hospital to community settings: a model

<p>Abstract</p> <p>Background</p> <p>Elderly patients admitted to Geriatric Assessment Units (GAU) typically have complex health problems that require multi-professional care. Considering the scope of human and technological resources solicited during hospitalization, as well as the many risks and discomforts incurred by the patient, it is important to ensure the communication of pertinent information for quality follow-up care in the community setting. Conventional discharge summaries do not adequately incorporate the elements specific to an aging clientele.</p> <p>Objective</p> <p>To develop a discharge summary adapted to the frail elderly patient (D-SAFE) in order to communicate relevant information from hospital to community services.</p> <p>Methods</p> <p>The items to be included in the D-SAFE have been determined by means of a modified Delphi method through consultation with clinical experts from GAUs (11 physicians and 5 pharmacists) and the community (10 physicians and 5 pharmacists). The consensus analysis and the level of agreement among the experts were reached using a modified version of the RAND^®/University of California at Los Angeles appropriateness method.</p> <p>Results</p> <p>A consensus was reached after two rounds of consultation for all the items evaluated, where none was judged «inappropriate». Among the items proposed, four were judged to be « uncertain » and were eliminated from the final D-SAFE, which was divided into two sections: the medical discharge summary (22 main items) and the discharge prescription (14 main items).</p> <p>Conclusions</p> <p>The D-SAFE was developed as a more comprehensive tool specifically designed for GAU inpatients. Additional research to validate its acceptability and practical impact on the continuity of care is needed before it can be recommended for use on a broader scale.</p

Discretionary power of project managers in knowledge intensive firms and gender issues

The scarcity of women among the highly qualified professionals in business-to-business information and communication technologies (ICT), either in Europe andor in North America, has been noted as recently as the late 1990’s (Panteli, Stack, Atkinson, & Ramsay, 1999). The organization and management of work in such organizations firms is typically project-based. This has many consequences, including: long working hours with fierce resistance to shorter hoursany reduction, unpaid overtime, high management expectations of employee flexibility to meet unanticipated client demands, and the need for employees to negotiate flexible work arrangements on a case-by-cases basis with a project manager who often has much discretion on whether to accommodate such requests. We found that women are particularly disadvantaged in such a system, which could partly explain their under-representation in such jobs

Household food insecurity and childhood overweight in Jamaica and Québec: a gender-based analysis

Background - Childhood overweight is not restricted to developed countries: a number of lower- and middle-income countries are struggling with the double burden of underweight and overweight. Another public health problem that concerns both developing and, to a lesser extent, developed countries is food insecurity. This study presents a comparative gender-based analysis of the association between household food insecurity and overweight among 10-to-11-year-old children living in the Canadian province of Québec and in the country of Jamaica. // Methods - Analyses were performed using data from the 2008 round of the Québec Longitudinal Study of Child Development and the Jamaica Youth Risk and Resiliency Behaviour Survey of 2007. Cross-sectional data were obtained from 1190 10-year old children in Québec and 1674 10-11-year-old children in Jamaica. Body mass index was derived using anthropometric measurements and overweight was defined using Cole's age- and sex-specific criteria. Questionnaires were used to collect data on food insecurity. The associations were examined using chi-square tests and multivariate regression models were used to estimate odds ratios (OR) and 95% confidence intervals. // Results - The prevalence of overweight was 26% and 11% (p < 0.001) in the Québec and Jamaican samples, respectively. In Québec, the adjusted odds ratio for being overweight was 3.03 (95% CI: 1.8-5.0) among children living in food-insecure households, in comparison to children living in food-secure households. Furthermore, girls who lived in food-insecure households had odds of 4.99 (95% CI: 2.4-10.5) for being overweight in comparison to girls who lived in food-secure households; no such differences were observed among boys. In Jamaica, children who lived in food-insecure households had significantly lower odds (OR 0.65, 95% CI: 0.4-0.9) for being overweight in comparison to children living in food-secure households. No gender differences were observed in the relationship between food-insecurity and overweight/obesity among Jamaican children. // Conclusions - Public health interventions which aim to stem the epidemic of overweight/obesity should consider gender differences and other family factors associated with overweight/obesity in both developed and developing countries