bluuebunny/crossref_metadata_2025 huggingface dataset:
Multistimuli responsive micelles based on well‐defined amphiphilic comb poly(ether amine) (acPEA)
Authors: Di Chunfeng , Jiang Xuesong , Lui Rui , Yin Jie
Published: July 2010

A series of well‐defined amphiphilic comb poly (ether amine)s (acPEAs) were successfully synthesized through nucleophilic addition/ring‐opening reaction of commercial available poly(propylene glycol) (PPO) diglycidyl ether and Jeffamine L100, followed by esterification of hydroxyl groups in backbone by alkyl carboxylic acid with different chain length. acPEAs are comprised of hydrophilic short PEO chains and hydrophobic alkyl chains as comb chains, which are grafted on PPO backbone alternately to form well‐defined structure. With the very low critical micelle concentration (CMC) of around 3.0 × 10−3 g/L, the obtained acPEAs can self‐assemble into stable nanomicelles, whose aggregation is responsive to temperature, pH, and ionic strength with tunable cloud point (CP). The CP of acPEAs' aqueous solution increases with the decrease of the length of graft alkyl chains, the decrease of pH value, and the decrease of ionic strength. A transition behavior in the responsive aggregation of micelles formed by acPEA8 and acPEA10 in aqueous solution, especially at low pH value (<7.0), was observed, which was also revealed by DLS results. © 2010 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 48: 3468–3475, 2010
Synthesis, characterization, and aqueous self‐assembly of amphiphilic poly(ethylene oxide)‐functionalized hyperbranched fluoropolymers
Authors: Du Wenjun , Li Yali , Nyström Andreas M. , Cheng Chong , Wooley Karen L.
Published: July 2010

Complex amphiphilic polymers were synthesized via core‐first polymerization followed by alkylation‐based grafting of poly(ethylene oxide) (PEO). Inimer 1‐(4′‐(bromomethyl)benzyloxy)‐2,3,5,6‐tetrafluoro‐4‐vinylbenzene was synthesized and subjected to atom transfer radical self‐condensing vinyl polymerization to afford hyperbranched fluoropolymer (HBFP) as the hydrophobic core component with a number‐averaged molecular weight of 29 kDa and polydispersity index of 2.1. The alkyl halide chain ends on the HBFP were allowed to undergo reaction with monomethoxy‐terminated poly(ethylene oxide) amine (PEOx‐NH2) at different grafting numbers and PEO chain lengths to afford PEO‐functionalized HBFPs [(PEOx)y‐HBFPs], with x = 15 while y = 16, 22, or 29, x = 44 while y = 16, and x = 112 while y = 16. The amphiphilic, grafted block copolymers were found to aggregate in aqueous solution to give micelles with number‐averaged diameters (Dav) of 12–28 nm, as measured by transmission electron microscopy (TEM). An increase of the PEO:HBFP ratio, by increase in either the grafting densities (y values) or the chain lengths (x values), led to decreased TEM‐measured diameters. These complex, amphiphilic (PEOx)y‐HBFPs, with tunable sizes, might find potential applications as nanoscopic biomedical devices, such as drug delivery vehicles and 19F magnetic resonance imaging agents. © 2010 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 48: 3487–3496, 2010
Diffusiosmessungen an polymeren in lösung mittels tracer‐technik
Authors: Meyerhoff G. , Meier W.
Published: July 2010

A cell for measuring coefficients of diffusion and self‐diffusion by tracer techniques is described. The cell consists of two Teflon disks and is of the rotational shearing type. The amount of polymer is minimal (about 0.1 ml. for both components). Labeled and unlabeled fractionated polymethacrylate of identical molecular weight distribution was used to determine diffusion coefficients in benzene and toluene. The classical optical measurement is impossible, for these solvents exhibit a refraction index very close to that of polymethacrylate. In acetone, where optical as well as tracer techniques are applicable, the measured diffusion coefficients of the two methods are in good agreement. Also, measurements of the self‐diffusion of polymethacrylate in toluene are reported.
Effets des Rayons Gamma sur les Poly‐2‐ et −4‐Vinylpyridmes
Authors: David C. , Verhasselt A. , Geuskens Et G.
Published: July 2010

γ‐Irradiated poly‐2‐vinylpyridine (2‐PVP) and poly‐4‐vinylpyridine (4‐PVP) become crosslinked and partially insoluble. The G value for crosslinking has been determined for atactic (0.27) and isotactic (0.65) 2‐PVP and for atactic 4‐PVP (0.33). The results are compared with published data on polystyrene. ESR spectra of irradiated 2‐PVP and 4‐PVP suggest that a cyclohexadienyl type radical is formed, as in polystyrene. A chain reaction involving direct intramolecular hydrogen transfer is proposed to explain the experimental results.
Kinetic aspects of the copolymerization of tetrahydrofuran with propylene oxide. Part II
Authors: Baijal M. D. , Blanchard L. P.
Published: July 2010

The cationic copolymerization of tetrahydrofuran with propylene oxide was carried out in the presence of boron fluoride etherate, 1,2‐propanediol, and ethylene chloride, used as catalyst–cocatalyst–solvent system. Reactions were carried out in the −40 to +20°C. temperature range, at atmospheric pressure. The influence of various other parameters on the composition and structure of the copolyetherdiols obtained has been studied. Kinetic data, including energies of activation (E) and frequency factors (A) for the comonomer (THF and PO) consumptions and data on the molecular weights and the per cent yields of the copolyetherdiols obtained are reported.
Ideas on the ultrastructural organization of the cell wall components
Authors: Fengel D.
Published: July 2010

The wood cell wall is composed of chemically and structurally different components. The cellulose molecules are smooth long chains, able to aggregate in longitudinal direction to compact fibrils. The polyoses consist of shorter chains with side groups and branching points so that they are not able to aggregate in such a strict order as cellulose. The orientation system of the cell wall and the behavior of isolated polyoses give reason to suppose that the polyoses are not coiled forming globular particles within the cell wall. From the ontho‐genetic point of view, lignin is the last component which is incorporated into the cell wall. The different possibilities of branching resulting from the chemical characteristics of the phenylpropanone monomer enables the formation of large molecules embedding the polysaccharide elements and filling up the remaining cavities. The results of chemical and electron microscopic studies are projected into a model representing a possible ultra‐structural organization of the components within the wood cell wall.
Clinical and biochemical study of 29 Brazilian patients with metachromatic leukodystrophy
Authors: Artigalás Osvaldo , Lagranha Valeska Lizzi , Saraiva‐Pereira Maria Luiza , Burin Maira Graeff , Lourenço Charles Marques , van der Linden Hélio , Santos Mara Lúcia Ferreira , Rosemberg Sergio , Steiner Carlos Eduardo , Kok Fernando , de Souza Carolina F. Moura , Jardim Laura B. , Giugliani Roberto , Schwartz Ida Vanessa
Published: July 2010

Metachromatic leukodystrophy (MLD) is a lysosomal disorder caused by arylsulfatase A (ARSA) deficiency. It is classified into three forms according to the age of onset of symptoms (late infantile, juvenile, and adult). We carried out a cross‐sectional and retrospective study, which aimed to determine the epidemiological, clinical, and biochemical profile of MLD patients from a national reference center for Inborn Errors of Metabolism in Brazil. Twenty‐nine patients (male, 17) agreed to participate in the study (late infantile form: 22; juvenile form: 4; adult form: 1; asymptomatic: 2). Mean ages at onset of symptoms and at biochemical diagnosis were, respectively, 19 and 39 months for late infantile form and 84.7 and 161.2 months for juvenile form. The most frequently reported first clinical symptom/sign of the disease was gait disturbance and other motor abnormalities (72.7%) for late infantile form and behavioral and cognitive alterations (50%) for juvenile form. Leukocyte ARSA activity level did not present significant correlation with the age of onset of symptoms (r = −0.09, p = 0.67). Occipital white matter and basal nuclei abnormalities were not found in patients with the late infantile MLD. Our results suggest that there is a considerable delay between the age of onset of signs and symptoms and the diagnosis of MLD in Brazil. Correlation between ARSA activity and MLD clinical form was not found. Further studies on the epidemiology and natural history of this disease with larger samples are needed, especially now when specific treatments should be available in the near future.
The role of plant–soil feedbacks and land‐use legacies in restoration of a temperate steppe in northern China
Authors: Jiang Lili , Han Xingguo , Zhang Guangming , Kardol Paul
Published: July 2010

Plant–soil feedbacks affect plant performance and plant community dynamics; however, little is known about their role in ecological restoration. Here, we studied plant–soil feedbacks in restoration of steppe vegetation after agricultural disturbance in northern China. First, we analyzed abiotic and biotic soil properties under mono‐dominant plant patches in an old‐field restoration site and in a ‘target’ steppe site. Second, we tested plant–soil feedbacks by growing plant species from these two sites on soils from con‐ and heterospecific origin. Soil properties generally did not differ between the old‐field site and steppe site, but there were significant differences among mono‐dominant plant patches within the sites. While soil species origin (i.e., the plant species beneath which the soil was collected) affected biomass of individual plant species in the feedback experiment, species‐level plant–soil feedbacks were ‘neutral’. Soil site origin (old‐field, steppe) significantly affected biomass of old‐field and steppe species. For example, old‐field species had higher biomass in old‐field soils than in steppe soils, indicating a positive land‐use legacy. However, soil site origin effects depended on the plant species beneath which the soils were collected. The predictive value of abiotic and biotic soil properties in explaining plant biomass differed between and within groups of old‐field and steppe species. We conclude that the occurrence of positive land‐use legacies for old‐field species may retard successional replacement of old‐field species by steppe species. However, high levels of idiosyncrasy in responses of old‐field and steppe plant species to con‐ and heterospecific soils indicate interspecific variation in the extent to which soil legacies and plant–soil feedbacks control successional species replacements in Chinese steppe ecosystems.
Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: A prospective randomised single blind study
Authors: Pountos Ippokratis , Clegg John , Siddiqui Asim
Published: July 2010

Objective

The management and the diagnostic modalities used in cases of undisplaced greenstick and torus fractures of the distal radius in children vary between different treatment centres. The aim of this study was twofold: firstly, to analyse the sensitivity of X-rays versus ultrasound to diagnose these fractures; secondly, to compare three available treatment options (plaster cast, Futuro splints, and double Tubigrip) in terms of pain, analgesia requirements, grip strength, deformity, stiffness and interference with a child's activities of daily living.

Methods

We prospectively included 79 patients suffering from undisplaced greenstick and torus fractures of the distal radius. Patients were randomized (single blindly) to the studied treatment groups.

Results

In terms of diagnosis, the ultrasound was found to be more sensitive than X-rays for diagnosing these fractures. Our results also showed that Tubigrip was superior in terms of interference with a child's ADLs, stiffness and grip strength. However, there was no difference in the levels of pain, analgesia required, and deformity.

Conclusion

These results support the idea that ultrasound is an effective and sensitive tool for detecting undisplaced greenstick and torus fractures of the distal radius in children. Treating these fractures with functional nonrigid devices (Tubigrip) results in improved function without increased discomfort or deformity.
The Consumer, Politics and Everyday Life
Authors: Devinney Timothy M.
Published: July 2010

A serious limitation of work in the field of ethical consumerism and social consumption is the contextualization of the research, independent of the methodology. In this article, we hint at how we can resolve these dilemmas by applying techniques that give us information involving trade-offs amongst a larger range of issues across a broader sample of people. In doing so, we also show that the complexity that we see in individual decision making is in evidence at the macro level as well. Just as individuals refuse to follow the idealized patterns represented by “ethical consumerism” in purchasing, so, too, do they fail to conform to simple rules around general social, economic and political preferences.
Nursing and Patient Outcomes: It's Time for Healthcare Leadership to Respond
Authors: Nicklin Wendy , Graves Elan
Published: July 2010

An increasing body of research confirms the link between nursing variables (e.g. staffing ratios, skill mix) and patient outcomes including morbidity and mortality. This article presents the key themes that have emerged in this research and translates them into action for senior healthcare leaders. Immediate action is required in order for hospitals to effectively recruit and retain nurses, and to provide high quality patient care that minimizes risk.
Volunteer Governance of Health Services in Canada: Redundant or Relevant?
Authors: Lum Lillie , Gough Jim
Published: July 2010

With the continued growth in size and complexity of healthcare organizations, trustees/directors are increasingly called upon to provide strategic leadership. In response, new recruitment methods have been adopted in order to meet the need for skilled and knowledgeable trustees. Volunteer governance models need to be carefully evaluated in comparison to government control models in order to determine how relations of accountability and responsibility change with a shift in models. The central question is whether volunteer governance remains a viable concept in Canada.
The Cost of Hospital Care in Canada: A Comparison of Two Alternatives
Authors: Borsa Joan , Anis Aslam
Published: July 2010

This article compares resource intensity weight costs with case costs for selected patient groups at St. Paul's Hospital, British Columbia. Analysis found that average case costs for surgical patients were 23.9% higher than their resource intensity weight costs, whereas case costs for non-surgical patients were 14.8% lower. Average case costs for patients receiving surgical implants were 32.8% higher than resource intensity weight costs. For patients receiving internal defibrillators average case costs were three times higher.
Medicare: Innovation is the Key to Sustainability?
Authors: Rachlis Michael M.
Published: July 2010

Money is important to healthcare; many of the problems of the past decade are a result of capricious decisions by government, slashing funding and then pouring it into the system. Healthcare needs stable, predictable funding. But, overall, Canada's health system has neither been a glutton for funding nor has it been starved. The real problems in our system relate to quality of care.
How to Make Allocation Decisions: A Theory and Test Questions
Authors: Browne Alister , Anderson Terry , Brown Don , Cooledge Carson , Leal Bonnie , McDonald Dan , Saxe-Braithwaite Marcy
Published: July 2010

Hospital administrators are regularly faced with having to cut patient services. Such decisions are essentially questions of distributive justice, and administrators may welcome some guidance. We begin with a key idea from the most influential theory of justice of our times, that of John Rawls, and generate from it a series of test questions against which the ethical dimensions of allocation decisions can be judged.
Soins infirmiers et résultats pour les patients: les dirigeants des soins de santé doivent réagir
Authors: Nicklin Wendy , Graves Elan
Published: July 2010

On accumule de plus en plus de preuves confirmant le lien qui existe entre les variables des soins infirmiers (par ex., taux de dotation, compétence collective) et les résultats pour les patients, y compris la morbidité et la mortalité. Cet article présente les grands thèmes qui sont ressortis de cette recherche et les traduit en mesures concrètes pour les hauts dirigeants des soins de santé. Une intervention immédiate s'impose afin que les hôpitaux puissent recruter efficacement et garder du personnel infirmier, et pour fournir aux patients des soins de haute qualité qui réduise le risque au minimum.
Therapists' Perspectives on the Management and Delivery of Occupational Therapy and Physical Therapy Services
Authors: Rivard Annette , Hollis Vivien , Darrah Johanna , Madill Helen , Warren Sharon
Published: July 2010

The impact of restructuring healthcare services on the day-to-day practice of occupational therapists and physical therapists was examined. Four main issues emerged: Limited understanding of scopes of practice; absence of a rehabilitation perspective at decision-making tables; lack of a career ladder; and barriers to the maintenance and enhancement of professional competence. This article describes the reported impact of these issues on patient care specifically and on the healthcare system in general. Recommendations for an improved structure within an interdisciplinary management paradigm that would ensure effective and efficient use of healthcare resources are provided.
Utility of the Regina Risk Indicator Tool among Case Managed Elderly Clients
Authors: Hadjistavropoulos Heather , Bierlein Cecily , Neville Sue , Tuttosi-White Tandy , Quine Allisson , Sagan Mark
Published: July 2010

The Regina Risk Indicator Tool (RRIT) is used to identify how at risk clients are for requiring admission to long-term care. This study examined the potential use of this tool by case managers of older community dwelling clients receiving home care. The RRIT exhibited moderate to good inter-rater reliability, and good predictive validity as clients of varying degrees of risk differed in amount of case management and services used. Healthcare managers may wish to consider using the tool to support decision-making related to case management and home care service.
Creating Frameworks for Providing Services Closer to Home in the Context of a Network
Authors: Popp Janice , Douglas-England Kathleen , Casebeer Ann , Tough Suzanne C.
Published: July 2010

Networks can be used to develop shared frameworks that extend limited specialized healthcare services beyond tertiary level settings to provide services closer to home. This article provides an overview of networks, describes the context and purpose of the Southern Alberta Child & Youth Health Network, reports on early experiences with implementation of an Outreach Services Framework, and discusses implications from a network perspective.
A Centralized System to Access Acute Healthcare Services: The Pros and Cons
Authors: Brown Susan
Published: July 2010

Having a centralized access service results in a daily interconnectedness between hospital sites, which can create many benefits but also much controversy. Knowing the pros and cons of a centralized service and understanding the role and work environment of the access coordinator will assist you in deciding if this service would be of benefit to your health region. In this descriptive analysis of a centralized access model, a regional perspective is presented; however many of the strategies can be adapted to a single hospital service resulting in improved flow in clinical areas.
The Impact of Reducing In-Patient Stay on Long-Term Geriatric Rehabilitation Outcome
Authors: Knoefel Frank-D.
Published: July 2010

Clinicians at the SCO Health Service were concerned that frail elderly patients who had shorter lengths of stay in rehabilitation would not be able to maintain their gains following discharge. A follow-up telephone survey was administered 300 days after discharge to 197 patients. This study found that the functional status of the group was maintained as measured by Barthel, type of mobility aid, and type of discharge location.
Managerial and Professional Collaboration in the Provision of Home Care Rehabilitation
Authors: Hollis Vivien , May Laura
Published: July 2010

Demand for home care rehabilitation continues to grow in response to faster hospital discharges. One solution is to expand rehabilitation services using therapist assistants. Professionals voice concerns regarding many instances of assistants providing interventions outside their expertise and practicing without therapist supervision. This paper provides principles elicited from practitioners' experiences of an effective management culture and collaboration in one home care organization that effectively assimilated assistants, with reports of consequent improvements to rehabilitation service and client outcomes.
Physicians' Perceptions of Integration in Three Western Canada Health Regions
Authors: Triska Olive H. , Church John , Wilson Douglas , Roger Rick , Johnston Robert , Brown Ken , Noseworthy Tom W.
Published: July 2010

Over the past decade, provincial governments have embarked on ambitious plans to better integrate their healthcare systems, through the introduction of regional governance and management structures. The objective of this study was to examine physicians' perceptions of the current level and facilitators/barriers to integration in three Western Canada Health Regions. Three approaches to integration were investigated: functional, clinical services, and physician system integration. Physicians perceived that functional integration within each region was questionable. Clinical services were the least integrated approach. Physician system integration was rated highest of the approaches, particularly adherence to clinical practice guidelines usage. Physicians' perspectives of integrated health delivery systems do not appear to be influenced by regional size, maturity, urbanicity or facilities. Facilitators of integration were communication among health professionals and service providers, and using a multi-disciplinary team approach in delivery of healthcare in both regions. Barriers to integration were organizational culture, access to specialists and clinical services, and health information records. On a scale of 1–5, all three regions are at the beginning of an integrated health delivery system. Three global suggestions were provided to further integration of health delivery services: physicians should be involved in decision-making process at the Board level, clinical services should be patient-centred, and physicians endorsed the use of multi-disciplinary teams.
The Direct Public-Sector Costs for Mental Health in Alberta
Authors: Block Ray , Slomp Mel , Jacobs Philip , Ohinmaa Arto
Published: July 2010

The purpose of the study was to estimate the direct 2002 fiscal year costs for mental health services in Alberta. Data were collected on mental health publicly funded services and costs. Mental health services cost $573 million annually, amounting to about 8.4% of all provincial health services. The greatest share of costs was for regional inpatient services and physician services (both at 22%). The more direct method used in this study shows higher estimates of mental health costs than previous studies.
Factors Influencing Successful Physician Recruitment in Pediatrics and Internal Medicine
Authors: King Kelvin , Camfield Peter , Breau Lynn
Published: July 2010

The objective of the study was to survey recently hired physicians to Canadian Academic Departments of Pediatric and Internal Medicine to understand the factors that underlay successful recruitment. Recruits and Chairs agreed on the 10 most important values. Chairs overvalued the 10 least important Recruit values. Statistical analysis revealed five core themes — in order of importance they are: family lifestyle and opportunities, compensation methodology, children/community (housing, schools, recreational), professional working conditions (technology, staffing, facilities), and academic opportunities. Core themes varied by demographics and academic profile.
Relationships among Work Climate, Absenteeism, and Salary Insurance in Teaching Hospitals
Authors: Sounan Charles , Gagnon Serge
Published: July 2010

This two-tier study, involving employees at a university health centre, explored the relationship between work climate and absenteeism, and also looked at the relationship between work climate and salary insurance. Study findings show that the more positive the perception of work climate, the less employees have the tendency to stay away from work or to stay longer on salary insurance. Regression analyses showed that absenteeism can be predicted significantly by specific work climate indicators such as “challenge,” “conflict,” and “cooperation.” Also, the length of time receiving salary insurance benefits can be predicted by the indicators “trust and support” and “warmth.”
Estimating Nursing Home Bed Demand: 20-Year Projection from Administrative Data and Stakeholder Input
Authors: De Coster Carolyn , Frohlich Norman , Dik Natalia
Published: July 2010

We describe methods to project the requirement for nursing home beds in Manitoba until 2020. Three methods were developed: Trend, Recent Use, and Combined. The first two methods yielded widely divergent projections, differing by 3,400 beds. Stakeholder feedback and theoretical analysis suggested the third (Combined) method, the arithmetic mean of the first two. Model testing found the Combined method to be the most accurate. The projections have been used by RHAs for their planning activities.
Soins de longue durée dans la région de St. John's: Incidence du point d'admission unique et prévision du besoin de lits
Authors: McDonald Jacqueline , Hibbs Jennette , Reddy Madhuri , Stuckless Susan , O'Reilly Daria , Barrett Brendan J. , Parfrey Patrick S.
Published: July 2010

En 1996 la région de St. John's comptait une population de 8 435 personnes âgées de plus de 75 ans, 996 lits dans des foyers de soins infirmiers (FSI) et 550 lits de soins sous surveillance (SSS). Un système d'admission à point unique à ces établissements a été mis en œuvre en 1995.

Afin de déterminer l'incidence du système d'admission à point unique, les caractéristiques démographiques et cliniques des résidents de FSI ont été évaluées en 1997 (N = 1 044) et en 2003 (N = 963). Afin de déterminer l'efficacité du placement et le besoin de lits de soins de longue durée, deux cohortes d'incidents nécessitant un placement ont été étudiées en 1995–1996 (N = 467) et en 1999–2000 (N = 464). Le niveau de déficience a été déterminé à l'aide de la classification des Resource Utilization Groups III (RUG-III) et l'Alberta Resident Classification Score (ARCS), puis le temps écoulé entre le placement et le décès a été mesuré.

Chez les résidents courants des FSI le pourcentage de clients ne souffrant d'aucune déficience aux termes de la classification RUGS-III a diminué de 18,5 % en 1997 et de 9,9 % en 2003. La proportion recommandée de ces clients dans les FSI était de 75 % en 1995–1996 et de 72 % en 1999–2000, malgré le fait que la proportion de résidents atteints d'une déficience aux termes de la classification RUGS-III était de 64 % au cours des deux périodes. À l'aide d'un arbre de décision, un placement optimal pour la cohorte de 1999–2000 a été établi à 36 % dans les établissements de SSS, à 20 % pour les résidents de SSS souffrant de facultés cognitives altérées et à 44 % dans les FSI. Le besoin prévu de lits de soins de longue durée en 2004 ne correspondait que faiblement à l'inventaire actuel de lits de FSI et de SSS et ce manque à gagner sera bien pire en 2014.

Nous avons conclu que le système d'admission à point unique était associé à une utilisation améliorée des lits en FSI de façon appropriée. Cependant, il y avait un manque à combler dans le besoin de lits de soins de longue durée en établissement et l'inventaire de ces lits. Un investissement dans la reconfiguration des lits de soins de longue durée par composition de la clientèle et par géographie est nécessaire.
Process Evaluation of the Community Support Connections Merger
Authors: Porter Heather B. , Tindale Joseph A. , Mark Kristen P.
Published: July 2010

Community Support Connections (CSC) is the result of the merger of four private not-for-profit community health care agencies. The purpose of this research project was to evaluate the progress of CSC toward its stated goal: improvement of coordination and accessibility of health services. As of this writing, more than one year into the merger, managers, staff and volunteers believe that the goals of serving more clients more completely through case management are being achieved.
Understanding Failure: Taking and Maintaining Control
Authors: Keeler Colleen , Johnson Adrian , Lee Amy
Published: July 2010

Here we discuss the use of Advanced Product Quality Planning (APQP) as an effective tool in analyzing risk within current processes in a health care environment. The analysis focuses on the management of urgent product or process recalls or alerts within the diverse and multiple sites of London Health Sciences Centre and St. Joseph's Health Care, London. Quality tools were used to transform a previously undeveloped process into a planned, predictable and controlled framework.
The Executive Training for Research Application (EXTRA) Program: Perceptions of the First Cohort of Fellows
Authors: Lavoie-Tremblay Mélanie , Anderson Malcolm
Published: July 2010

The Canadian Health Services Research Foundation (CHSRF) and partners have created an innovative training program to support health care executives who use research evidence to inform decision-making. This article describes the Executive Training for Research Application (EXTRA) program and the perceptions of its first cohort of fellows ( n = 24). Despite challenges in balancing the time required to participate in this trusting learning environment, which encouraged and supported networking, the fellows were able to develop and apply a considerable knowledge base for evidence-informed decision-making.
The WestView Primary Care Network in the First Six Months: Defragmenting the System
Authors: Bailey Allan L. , Moe Grace , Myskiw Joy
Published: July 2010

The objective of this article is to describe the integration of local primary care services through the development of a primary care network in Alberta. WestView Primary Care Network (WPCN) has the vision of integrating primary care teams into the health system. As a result, WPCN has incorporated integrative primary care teams into its clinical programs. Through its strategy of “defragmentation,” WPCN is accomplishing the beginnings of service integration in the local health care context.
Physician Assistants — A Solution to Wait Times in Canada?
Authors: Ashton Chris W. , Aiken Alice , Duffie Denise
Published: July 2010

Access to medical care is limited in most of Canada, and the population often endures lengthy waiting times to see a physician. The use of new and varied health care providers has been suggested as a means to alleviate the shortage of physicians. This paper reviews the history and role of the Physician Assistant (PA), both in Canada and internationally, and outlines the clinical competencies currently held by this provider to fill the role of a physician extender in our country. PAs' experiences are reported in the Canadian Forces (CF), where they have been employed for many years, and in Manitoba, where they are used as surgical assistants. The potential for the PA to be incorporated into our provincial health care systems will be considered in light of common barriers to Health Human Resources (HHR) strategic implementation.
Planning the Restructuring of Long-Term Care: The Demand, Need and Provision of Institutional Long-Term Care Beds in Newfoundland and Labrador
Authors: Hughes Nicole , McDonald Jacqueline , Barrett Brendan , Parfrey Patrick
Published: July 2010

The Canadian population is aging. In Newfoundland and Labrador, nursing homes and supervised care facilities provide Long-Term Care (LTC). There may be a mismatch between the provision of LTC beds and clients' needs. To compare the type and annual rate of clients seeking placement to LTC, incident annual cohorts (N = 1,496) in five provincial health regions within Newfoundland and Labrador were compared using objective measures of disability. Client need was assessed using a decision tree and the optimal distribution of LTC beds was determined.

Within the four island regions, little difference was observed in degree of disability, but Labrador clients differed from the island regions in age, degree and type of disability. A decision tree suggested that optimal placement was 7% to housing, 34% to supervised care, 17% to supervised care for cognitive impairment and 42% to nursing home care.

In Newfoundland and Labrador, institutional LTC is dependent on nursing homes, whereas the major need is for appropriate supervised care for those with modest disability, with or without cognitive impairment. Different approaches to restructuring of long-term care in each region are necessary because of the differences in rates of presentation for LTC and differences in availability of nursing home and appropriate supervised care beds.
Planification de la restructuration des soins de longue durée: La demande, les besoins et la prestation de soins médicaux prolongés en centre hospitalier à Terre-Neuve-et-Labrador
Authors: Hughes Nicole , McDonald Jacqueline , Barrett Brendan , Parfrey Patrick
Published: July 2010

La population canadienne est vieillissante. À Terre-Neuve-et-Labrador, les maisons de soins infirmiers et les centres de santé supervisés offrent des soins de longue durée (SLD). Il peut y avoir une disparité entre l'offre de lits pour soins de longue durée et les besoins des clients. Afin de comparer le genre et le taux annuel de clients à la recherche d'un placement en SLD, les cohortes annuelles (N = 1 496) de cinq régions des services de santé provinciaux de Terre-Neuve-et-Labrador ont été comparées en utilisant des mesures objectives d'invalidité. Les besoins des clients ont été évalués à l'aide d'un arbre de décision et la répartition optimale des lits de SLD a été déterminée.

Dans les quatre régions, une petite différence a été observée en ce qui concerne le niveau d'invalidité. Toutefois, les clients du Labrador différaient de ceux des régions insulaires en âge, en intensité et en genre d'invalidité. Un arbre de décision a suggéré que le placement optimal était de 7% pour l'hébergement, de 34% pour les soins supervisés, de 17% pour les soins supervisés pour les déficiences cognitives et de 42% pour les soins infirmiers à domicile.

À Terre-Neuve-et-Labrador, les SLD en centre hospitalier reposent sur les maisons de soins infirmiers, alors que le principal besoin se situe sur le plan des soins supervisés destinés aux personnes souffrant d'une légère invalidité, avec ou sans déficience cognitive. Afin de restructurer les soins de longue durée, diverses approches sont nécessaires en raison de l'incidence de SLD et des disparités en ce qui a trait à la disponibilité des maisons de soins infirmiers et de lits de soins supervisés appropriés.
Advancing the Health Care Supply Chain and Promoting Leadership through Strategic Partnerships with Industry
Authors: Motiwala Sanober S. , McLaughlin Joan E. , King John , Hodgson Brent , Hamilton Michael
Published: July 2010

While supply chain partnerships are common in the private industry, they are unique in health care. This article looks at the novel partnership between St. Michael's Hospital and Baxter Canada. By sharing information and working together, these organizations evaluated and tackled service disruptions caused by backorders. Their formal collaboration has resulted in a streamlined backorder management process, and more importantly, better and timelier patient care.
Improving the Practice Environment: A Pilot Project in a Critical Care Unit
Authors: van der Wal Rena , Globerman Judith , Numata Yuka , Schulzer Michael , FitzGerald Mark , Yassi Annalee
Published: July 2010

The objective of this pilot project was to determine whether engaging critical care unit staff in designing and implementing enhancements to the practice environment would positively impact the clinical environment and staff outcomes. The project used a one-group pre-post test design and a participatory action process. Significant changes in the practice environment were observed in the priority areas identified by the unit staff. Results indicated that team collaboration and respectful work relationships improved following interventions.
Shifting the Lens: The Introduction of Population—Based Funding in Alberta
Authors: Smith Neale , Church John
Published: July 2010

This paper offers a detailed historical description of the development of Alberta's population-based funding model for Regional Health Authorities (RHAs). It focuses on key political factors that may have facilitated this transition — in particular, the role of institutions, organized interests, and ideas and values. Understanding the politics of policy change as exemplified in this case can be useful in assessing future prospects for health system reform in Canada and laying the groundwork for further comparative study.
Comparing Apples with Apples in Clinical Populations: Applications of the Adjusted Clinical Group System in British Columbia
Authors: Reid Robert J. , Verhulst Lorne , Forrest Christopher B.
Published: July 2010

This article reviews the Adjusted Clinical Group Case-Mix System and describes how it is being applied in the management of physician services in British Columbia. Developed in the United States for management and research, adjusted clinical groups are used to measure the illness burden and health service needs of individuals and, when aggregated, of populations, by grouping the range of conditions coded on physician claims and hospital care records over a defined time period, typically one year. In Canadian and United States settings, adjusted clinical groups are up to five times more predictive of ambulatory resource use than are age and sex groups alone. The article describes how adjusted clinical groups are being applied to adjust capitation payments for physician groups in British Columbia's Primary Care Demonstration Project and profiles of physician practice activity.
10 Steps to a Successful Governance Transfer
Authors: Lambert Jessica , Nordal Cliff
Published: July 2010

The governance of several provincial psychiatric hospitals was transferred to the public hospitals across Ontario, with London and St. Thomas being two of them There were many learnings gained from the London/St. Thomas experience that can be taken forward to other transfers such as this. The keys to success included having a central negotiating table across all receiving hospitals, developing principles or values for a common vision across all parties, effective communication and commitment to the process. These learnings will be brought forward into Tier 2 and 3 of the transfers, when beds and programs will decentralize across Southwestern Ontario, and a reinvestment in community mental health will support the de-institutionalization of mental healthcare.
Connecting for Change: Networks as a Vehicle for Regional Health Reform
Authors: Alidina Shehnaz , Jarvis Sheila , Nickoloff Beverley , Tolkin Jonathan , Trypuc Joann
Published: July 2010

The Child Health Network (CHN) for the Greater Toronto Area (GTA) is a partnership of hospital, rehabilitation and community providers committed to developing a regional system to deliver high quality, accessible, family-centred care for mothers, newborns, children and youth. This article reviews the history and model of the CHN, assesses its achievements, and provides insights into the challenges and lessons learned by the network. Stemming from the CHN's commitment to quality, accessibility and efficiency, regionalization of maternal, newborn and children's services is emerging as a success story.
Collaborative Practice: A Strategy to Improve the Relevance of Health Services Research
Authors: Brazil Kevin , MacLeod Stuart , Guest Brian
Published: July 2010

Health services research has emerged as a tool for decision makers to make services more effective and efficient. While its value as a basis for decision making is well established, the incorporation of such evidence into decision making remains inconsistent. To this end, strengthening collaborative relationships between researchers and healthcare decision makers has been identified as a significant strategy for putting research evidence into practice.
Towards 2020 Strategic Triad Partnerships in ICT and Healthcare: Bridging the Chasms in Canada and the European Union
Authors: Caro Denis H.J.
Published: July 2010

This study examines the management challenges and practices of partnerships between the information and communication technology and healthcare sectors through interviews with selected executives of ICT and healthcare organizations in Canada, Germany, Sweden and the United Kingdom. Underscoring the implications for current and future healthcare executives in Canada, the article also takes a glimpse of the world of strategic partnerships management between these two sectors in the year 2020.
Implications of Organizational Ethics to Healthcare
Authors: Ells Carolyn , MacDonald Chris
Published: July 2010

Organizational ethics is an emerging field concerned with the study and practice of the ethical behaviour of organizations. For effective application to healthcare settings, we argue that organizational ethics requires attention to organizations' special characteristics combined with tools borrowed from the fields of business ethics and bioethics. We identify and discuss several implications of this burgeoning field to healthcare organizations, showing how organizational ethics can facilitate policy making, accountability, self-evaluation, and patient and business perspectives. In our conclusion, we suggest an action plan for healthcare organizations to help them respond appropriately to their ethical responsibilities.
La course vers l'immobilisme: le changement et la gestion dans les soins de santé au Canada
Authors: Rathwell Thomas , Persaud David
Published: July 2010

Il règne une croyance prépondérante parmi les tenants de la réforme du système de santé selon laquelle les nouvelles techniques de gestion publique comme la décentralisation et les approches axées sur le marché constituent une panacée aux ennuis qui minent le système de santé. Dans ce premier volet d'un exposé en deux parties, les suppositions et la preuve empirique appuyant ces techniques sont étudiées tandis que l'effet de leur mise en œuvre sur ceux et celles qui sont appelés à gérer le système de santé est évalué. D'autres paradigmes portant sur la prestation de soins de santé seront envisagés et décrits dans un deuxième volet à paraître ultérieurement. Les systèmes de santé du monde entier ont été secoués par l'escalade des coûts, la perception d'un usage inconsidéré des ressources et l'insatisfaction des consommateurs et des fournisseurs de soins quant à la prestation de ces soins et aux résultats obtenus.
Practice-Based Ethics: A Foundation for Human Resources Planning in Community Healthcare
Authors: Wojtak Anne
Published: July 2010

During the last few years, the community health sector has been hit particularly hard by the scarcity of qualified healthcare workers. The Toronto Community Care Access Centre and community health centres of Toronto collaborated on a research program focusing on the development of a sectoral response to the human resource issues affecting the recruitment and retention of workers. Our approach considered the impact of working conditions, staff supports for dealing with difficult situations, ethical issues and other non-salary factors that influence individuals' decisions to remain in the community and seek community-based employment. We believe that the recommendations, based on our findings, will assist the community sector to provide better support to our labour force, enhance overall employee satisfaction and, ultimately, provide better quality care to our clients.
If the Pillars are Shaky, Does Faith in Medicare Crumble?
Authors: Lepnurm Rein , Dobson Roy , Backman Allen
Published: July 2010

The objectives of the study described in this article were to determine whether the faith of physicians in the Canadian system of health insurance depends on their assessment of quality and access to health services and whether their assessments of quality and access to health services affect their support of out-of-pocket and other methods of financing healthcare. To this end, a mail survey of 600 physicians in British Columbia and 240 physicians in Saskatchewan was conducted. The sample was stratified to ensure equal representation from urban and non-urban areas and between female and male specialists and family practitioners. Our conclusions indicate that physicians seem to be open minded in their views on financing. Their overriding concerns are to ensure the provision of sufficient resources to the healthcare system and to maintain full coverage of the population.
You Only Get Out What You Put in Make a Lasting Impression
Authors: Levitt Dan
Published: July 2010

This is the first submission of our new regular feature, the “Members' Speak Out” column. It has been designed to enhance and stimulate dialogue amongst our members and ultimately ignite the fires of debate. We encourage you to respond to these columns and let your voice be heard.
A Test of a Centre's Vision
Authors: LaPorta John A. , King Gillian , Cathers Tamzin , Havens Lisa , Young Cathy , Aylward Sandra
Published: July 2010

The Thames Valley Children's Centre, a regional Children's Rehabilitation Centre, was determined to assess the extent to which its Vision (“Our Clients at Their Best”) was being achieved. With a sample of 50 former clients, and utilizing a specially constructed survey tool based on the important life outcomes literature, they found that they were attaining their vision for a significant proportion of the participants. They also learned about the differing expectations of the role which the Centre should play.
Going Provincial: Preceptoring and Mentoring Revisited in the Health Sciences. Part I
Authors: Mitchell Carol , Sawatzky-Girling Brenda
Published: July 2010

This article describes the Preceptor & Mentor Initiative for Health Sciences in BC, a provincial strategy to facilitate preceptoring and mentoring. A web site was developed with a comprehensive preceptor/mentor framework and resources, based on best practices and applicable to all health sciences. Informal feedback indicates this Initiative is effective in supporting health sciences preceptoring and mentoring in BC. A formal evaluation will be conducted by March 2003 and reported in a future FORUM article.
La gestion des soins de santé au Canada en 2020: une nouvelle maison modèle dans le quartier
Authors: Taylor D. Wayne
Published: July 2010

La Commission sur l'avenir des soins de santé au Canada s'est demandée si le système de santé était viable dans sa forme actuelle. Selon nous, il y a au moins six raisons qui font que le système de santé n'est pas viable. Compte tenu de la longue liste de facteurs comme l'évolution du rapport de dépendance au Canada, le phénomène de diminution du produit d'imposition, les autres priorités financières des provinces, la faible productivité de la main-d'œuvre et de la technologie dans les soins de santé financés par le gouvernement, les attentes de la génération du baby-boom et l'évolution des valeurs des Canadiens, le système de santé appauvrira le Canada au cours des prochaines décennies à moins d'être remanié de fond en comble. Malgré le goût amer que peuvent laisser les systèmes parallèles de soins de santé privés dans la bouche des décideurs et des fournisseurs de soins qui ont grandi dans les années 1960, la réalité des années 2020 en dictera la nécessité comme étant une solution pragmatique à un problème systémique.