Psychosocial predictors of actual turnover among Belgian health care workers

Background: Turnover of nursing staff is a major challenge for healthcare settings and for healthcare in general, urging the need to improve retention. Aim: The aim was to explore the prospective relations between personal and psychosocial work-related factors and actual turnover among Belgian healthcare workers. Methods: Predictors of actual turnover were assessed using the longitudinal Belgian data from the Nurses Early Exit Study (NEXT). Two self-administered questionnaires with a time lag of one year were distributed, covering physical and psychosocial work-related factors, private life, turnover intentions and future perspectives. During follow-up, 90 employees who left the organization voluntary (leavers) and who had a complete data set were identified. These subjects were each matched with two stayers based on gender, age and organization type. Multiple logistic analyses were performed. Results: The first model adjusting for education level showed that quantitative job demands, job satisfaction, burnout, work-home interference, commitment to the institution, pay satisfaction, effort-reward imbalance and intent to leave the organization were significantly associated with actual turnover. When additionally adjusting for intent to leave the organization, job satisfaction (OR 0.29; 95% CI 0.13-0.62) and work-home interference (OR 1.35; 95% CI 1.00-1.81) were found to be the most important independent predictors of turnover. Conclusion: To tackle turnover, special attention should be given to turnover intention, work-home interference and job satisfaction because these risk factors were found to be the strongest predictors of actual turnover among nurses and nursing aids

Development of Red Flags Index for Early Referral of Adults with Symptoms and Signs Suggestive of Crohn's Disease: An IOIBD Initiative

International audience; BACKGROUND AND AIMS:Diagnostic delay is frequent in patients with Crohn's disease (CD). We developed a tool to predict early diagnosis.METHODS:A systematic literature review and 12 CD specialists identified 'Red Flags', i.e. symptoms or signs suggestive of CD. A 21-item questionnaire was administered to 36 healthy subjects, 80 patients with irritable bowel syndrome (non-CD group) and 85 patients with recently diagnosed (<18 months) CD. Patients with CD were asked to recall symptoms and signs they experienced during the 12 months before diagnosis. Multiple logistic regression analyses selected and weighted independent items to construct the Red Flags index. A receiver operating characteristic curve was used to assess the threshold that discriminated CD from non-CD. Association with the Red Flags index relative to this threshold was expressed as the odds ratios (OR).RESULTS:Two hundred and one subjects, CD and non-CD, answered the questionnaire. The multivariate analysis identified eight items independently associated with a diagnosis of CD. A minimum Red Flags index value of 8 was highly predictive of CD diagnosis with sensitivity and specificity bootstrap estimates of 0.94 (95% confidence interval 0.88-0.99) and 0.94 (0.90-0.97), respectively. Positive and negative likelihood ratios were 15.1 (9.3-33.6) and 0.066 (0.013-0.125), respectively. The association between CD diagnosis and a Red Flags index value of ≥8 corresponds to an OR of 290 (p < 0.0001).CONCLUSIONS:The Red Flags index using early symptoms and signs has high predictive value for the diagnosis of CD. These results need prospective validation prior to introduction into clinical practice

A comparison between the APACHE II and Charlson Index Score for predicting hospital mortality in critically ill patients

<p>Abstract</p> <p>Background</p> <p>Risk adjustment and mortality prediction in studies of critical care are usually performed using acuity of illness scores, such as Acute Physiology and Chronic Health Evaluation II (APACHE II), which emphasize physiological derangement. Common risk adjustment systems used in administrative datasets, like the Charlson index, are entirely based on the presence of co-morbid illnesses. The purpose of this study was to compare the discriminative ability of the Charlson index to the APACHE II in predicting hospital mortality in adult multisystem ICU patients.</p> <p>Methods</p> <p>This was a population-based cohort design. The study sample consisted of adult (>17 years of age) residents of the Calgary Health Region admitted to a multisystem ICU between April 2002 and March 2004. Clinical data were collected prospectively and linked to hospital outcome data. Multiple regression analyses were used to compare the performance of APACHE II and the Charlson index.</p> <p>Results</p> <p>The Charlson index was a poor predictor of mortality (C = 0.626). There was minimal difference between a baseline model containing age, sex and acute physiology score (C = 0.74) and models containing either chronic health points (C = 0.76) or Charlson index variations (C = 0.75, 0.76, 0.77). No important improvement in prediction occurred when the Charlson index was added to the full APACHE II model (C = 0.808 to C = 0.813).</p> <p>Conclusion</p> <p>The Charlson index does not perform as well as the APACHE II in predicting hospital mortality in ICU patients. However, when acuity of illness scores are unavailable or are not recorded in a standard way, the Charlson index might be considered as an alternative method of risk adjustment and therefore facilitate comparisons between intensive care units.</p

Comparison of Artificial Neural Network and Logistic Regression Models for Predicting In-Hospital Mortality after Primary Liver Cancer Surgery

BACKGROUND: Since most published articles comparing the performance of artificial neural network (ANN) models and logistic regression (LR) models for predicting hepatocellular carcinoma (HCC) outcomes used only a single dataset, the essential issue of internal validity (reproducibility) of the models has not been addressed. The study purposes to validate the use of ANN model for predicting in-hospital mortality in HCC surgery patients in Taiwan and to compare the predictive accuracy of ANN with that of LR model. METHODOLOGY/PRINCIPAL FINDINGS: Patients who underwent a HCC surgery during the period from 1998 to 2009 were included in the study. This study retrospectively compared 1,000 pairs of LR and ANN models based on initial clinical data for 22,926 HCC surgery patients. For each pair of ANN and LR models, the area under the receiver operating characteristic (AUROC) curves, Hosmer-Lemeshow (H-L) statistics and accuracy rate were calculated and compared using paired T-tests. A global sensitivity analysis was also performed to assess the relative significance of input parameters in the system model and the relative importance of variables. Compared to the LR models, the ANN models had a better accuracy rate in 97.28% of cases, a better H-L statistic in 41.18% of cases, and a better AUROC curve in 84.67% of cases. Surgeon volume was the most influential (sensitive) parameter affecting in-hospital mortality followed by age and lengths of stay. CONCLUSIONS/SIGNIFICANCE: In comparison with the conventional LR model, the ANN model in the study was more accurate in predicting in-hospital mortality and had higher overall performance indices. Further studies of this model may consider the effect of a more detailed database that includes complications and clinical examination findings as well as more detailed outcome data

ANALYSE DES RELATIONS ENTRE LES DONNEES POLYSOMNOGRAPHIQUES ET L'EVALUATION SUBJECTIVE DU SOMMEIL DANS UN GROUPE DE SUJETS NORMAUX

The aim of the present study was to analyse the relationships between polysomnographic variables and the subjective evaluation of sleep quality in a sample of healthy subjects. Thirty one healthy subjects (7 women, 24 men) aged 16 to 74 (mean = 33.8; standard-deviation = 15.6) were included in the study. After one accommodation night, sleep was recorded during three consecutive nights in the sleep laboratory. Subjective evaluation of sleep quality was assessed by a questionnaire including quantitative aspects as well as qualitative aspects of sleep. The data of the third night are analysed here. Two factor analyses were performed on the sleep questionnaire. Two factors were extracted; they were named 'depth' and 'rest'. Using a stepwise multiple regression analysis, these two indices of sleep quality were tested for explanation by 24 polygraphic variables. The 'depth' factor was revealed positively related to the first awakening latency, and negatively to sleep onset latency, Rapid Eye Movement latency and the number of awakenings. The 'rest' factor was shown to be positively related to stage 1 duration and sleep onset latency, and negatively to stage 4 duration and the number of awakenings. Some of these relationships have already been described. Others seem surprising and may seem questionable. These results raise the question of the relations between objective measures of sleep, the polygraphic variables, and the subjective process of perceiving and evaluating sleep.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Analyse des relations entre les données polysomnographiques et l'évaluation subjective du sommeil dans un groupe de sujets normaux.

The aim of the present study was to analyse the relationships between polysomnographic variables and the subjective evaluation of sleep quality in a sample of healthy subjects. Thirty one healthy subjects (7 women, 24 men) aged 16 to 74 (mean = 33.8; standard-deviation = 15.6) were included in the study. After one accommodation night, sleep was recorded during three consecutive nights in the sleep laboratory. Subjective evaluation of sleep quality was assessed by a questionnaire including quantitative aspects as well as qualitative aspects of sleep. The data of the third night are analysed here. Two factor analyses were performed on the sleep questionnaire. Two factors were extracted; they were named "depth" and "rest". Using a stepwise multiple regression analysis, these two indices of sleep quality were tested for explanation by 24 polygraphic variables. The "depth" factor was revealed positively related to the first awakening latency, and negatively to sleep onset latency, Rapid Eye Movement latency and the number of awakenings. The "rest" factor was shown to be positively related to stage 1 duration and sleep onset latency, and negatively to stage 4 duration and the number of awakenings. Some of these relationships have already been described. Others seem surprising and may seem questionable. These results raise the question of the relations between objective measures of sleep, the polygraphic variables, and the subjective process of perceiving and evaluating sleep

Plaidoyer pour l'enseignement et la formation continue des médecins en biostatistique. Résultats d'une enquête auprès de médecins belges.

In order to test physicians' knowledge of statistics, a survey was conducted with a questionnaire in a sample of 250 doctors registered in the province of Brabant. The questionnaire consisted of two parts: a 9-item self-assessment test, and an opinion questionnaire about the importance of biostatistics and of its teaching. Forty-six physicians completed the two parts (18.4% of the sample); two other physicians only completed the second part of the questionnaire. For each subject, a score was computed: this score, ranging from 0 to 9, represents a simple sum of the right answers to the questionnaire. The median score is 2 (mean = 2.4; standard deviation = 1.8). No difference in the scores were found between groups defined by sex, the university of graduation, by the practice, general or specialized. The scores were not correlated to age, nor to graduation. The data from the opinion questionnaire show that the problem of biostatistics is considered important by 69% of the physicians, and that 88% of them think that this problem justifies training. With such training, physicians should be able to read the biomedical literature with discrimination, which supports the viewpoint of several authors. Although the small size of the sample and the small rate of answers might bias these results, we believe that physicians should be trained in statistics, which has become a pillar of medicine

The impact of the new hospital concept on the doctor's education: the place for physician-executives.

Health care cost containment and the involvement of physicians in the hospital management are features spreading throughout the Western nations. In fact, physician-executives are needed to preserve an optimal level of care while achieving the aims of the cost containment policies. Belgium is no exception: the new hospital law outlines the physician's status in relation to the hospital management and provides for the implementation of a prospective payment system. An important point is examined in this paper: the problem of the physician's management skills. In order to solve this problem, two methods were used to collect data. First, an analysis of the tasks provided in the law and its commentary was helpful to determine the main skills needed if physicians want to act as hospital managers. Second, market research in management education was carried out to discern the number and the characteristics of physicians who could be interested in receiving management training. A physician-dedicated curriculum was developed from the first approach. The second approach revealed that half the hospital doctors are willing to train as managers, providing they are actually involved in hospital management. Therefore, universities and their Schools of Medicine should develop such curricula. Nonetheless, studies should be conducted to clarify the relationship between physician-executives and other physicians and to assess the impact of the presence of physician-executives on the hospital organization and on the quality of care