Edible Cannabis Legalization and Cannabis Poisonings in Older Adults.

This cross-sectional study examines the association between edible cannabis legalization and emergency department visits for cannabis poisonings in older adults.

Identifying Unexpected Deaths in Long-Term Care Homes.

OBJECTIVES: Predicting unexpected deaths among long-term care (LTC) residents can provide valuable information to clinicians and policy makers. We study multiple methods to predict unexpected death, adjusting for individual and home-level factors, and to use as a step to compare mortality differences at the facility level in the future work. DESIGN: We conducted a retrospective cohort study using Resident Assessment Instrument Minimum Data Set assessment data for all LTC residents in Ontario, Canada, from April 2017 to March 2018. SETTING AND PARTICIPANTS: All residents in Ontario long-term homes. We used data routinely collected as part of administrative reporting by health care providers to the funder: Ontario Ministry of Health and Long-Term Care. This project is a component of routine policy development to ensure safety of the LTC system residents. METHODS: Logistic regression (LR), mixed-effect LR (mixLR), and a machine learning algorithm (XGBoost) were used to predict individual mortality over 5 to 95 days after the last available RAI assessment. RESULTS: We identified 22,419 deaths in the cohort of 106,366 cases (mean age: 83.1 years; female: 67.7%; dementia: 68.8%; functional decline: 16.6%). XGBoost had superior calibration and discrimination (C-statistic 0.837) over both mixLR (0.819) and LR (0.813). The models had high correlation in predicting death (LR-mixLR: 0.979, LR-XGBoost: 0.885, mixLR-XGBoost: 0.882). The inter-rater reliability between the models LR-mixLR and LR-XGBoost was 0.56 and 0.84, respectively. Using results in which all 3 models predicted probability of actual death of a resident at <5% yielded 210 unexpected deaths or 0.9% of the observed deaths. CONCLUSIONS AND IMPLICATIONS: XGBoost outperformed other models, but the combination of 3 models provides a method to detect facilities with potentially higher rates of unexpected deaths while minimizing the possibility of false positives and could be useful for ongoing surveillance and quality assurance at the facility, regional, and national levels.

The Patient Care Delivery Model--an open system framework: conceptualisation, literature review and analytical strategy.

AIMS AND OBJECTIVES: This paper presents the Patient Care Delivery Model to illustrate interrelationships between model components and to support its application in research using advanced analytical techniques, including structural equation modelling. BACKGROUND: Many complex factors contribute to the nature of healthcare environments and to nurse, patient and system outcomes. A better understanding of these factors and their interrelationships would provide insight for decision-makers to develop strategies to improve outcomes. DESIGN: A literature review approach was used to address the objectives. METHOD: A threefold approach used existing theory to explicate a comprehensive conceptual framework, reviewed empirical studies of the proposed relationships and considered the application of advanced analytical techniques to inform future research directions. RESULTS: As per general system theory, inputs (patient, nurse and system characteristics) to the Patient Care Delivery Model interact with throughputs (nursing interventions, work environments and environmental complexity) to produce intermediate (staffing levels) and distal outputs (patient, nurse and system outcomes). Application of the model in research and its relevance for healthcare settings is supported in the current literature. Statistical techniques that allow model testing and the investigation of multiple relationships simultaneously have demonstrated the interconnections among the model components. CONCLUSIONS: Development of the Patient Care Delivery Model is a step towards understanding work environments and providing healthcare managers with evidence-based management tools. Formal testing of comprehensive, multilevel conceptual models will provide empirical linkages between inputs and outputs and will identify potential mediators between predictors and outcomes to offer new insight into organisational practices. RELEVANCE TO CLINICAL PRACTICE: A better understanding of how factors in the work environment impact clinical outcomes can facilitate care processes in the nursing unit. Future studies using comprehensive conceptual frameworks and sophisticated analytical approaches will enhance professional nursing practice and improve clinical outcomes in healthcare organisations.

Evaluation of a patient care delivery model: system outcomes in acute cardiac care.

Hierarchical linear modelling was used to evaluate the influence of nurse staffing, work environment, and nurse and patient variables on system outcomes based on data collected in Canadian cardiac and cardiovascular inpatient units. Staffing utilization levels below 80% at the unit level and less overtime optimized perceived care quality and the completion of therapeutic interventions. Fewer patients per nurse improved perceived care quality and reduced longer-than-expected length of stay. Nurse reports of greater resource adequacy were associated with less absenteeism and fewer uncompleted or delayed nursing interventions. System outcomes were also influenced by patient characteristics (health, pre-operative education, nursing diagnoses); nurse characteristics (experience, expertise, health, effort-reward imbalance); and work-environment factors (autonomy, unit instability).

Evaluation of a patient care delivery model: patient outcomes in acute cardiac care.

PURPOSE: To evaluate the influence of nurse staffing and work environment variables on patient outcomes by testing a conceptual model. DESIGN: A prospective, correlational design with cross-sectional and longitudinal components was conducted in Canadian cardiac and cardiovascular care inpatient units. METHODS: Data were collected from multiple sources. Hierarchical linear modeling was used to examine relationships among variables. CONCLUSIONS: The findings indicate that patient outcomes are influenced not only by patient and nurse characteristics, but also by organizational staffing practices. Organizations that manage the complexity of work conditions and target staffing utilization levels between 80% and 88% at the unit level can optimize patient outcomes. CLINICAL RELEVANCE: Empirical validation of the model provides evidence to inform management decisions about hospital nurse staffing.

Creating work environments that are violence free.

Workplace violence is a global phenomenon with recent research demonstrating that the incidence of violence is high and increasing, particularly in health-care settings. The current study reported the prevalence of workplace violence in nursing and examined the impact of it on nurses' work life and health based on a national Canadian survey. Results demonstrated that workplace violence significantly increases the likelihood of nurses' absenteeism, job dissatisfaction and poor physical and mental health, and can negatively impact quality of nursing care. Various workplace violence interventions and the need for further research in addressing the issue of violence are discussed.

Who married how? Modeling marital decisions in early-twentieth century Taiwan.

Marriage in Taiwan in the early twentieth century was a very diverse phenomenon. Marriages could be in the "minor" fashion, in which the bride was adopted at an early age by her parents-in-law. They could also be of the virilocal "major" type, in which young adults married and lived in the household of the husband's parents. Finally, they could be "uxorilocal," in which the husband came to live with his in-laws. The diversity of types reflects a complex mixture of motives on behalf of parents, who aimed to secure the patrilineage, but in the meantime were motivated to save on wedding expenses, safeguard their hold on the younger generation, forge alliances between clans, and bring in additional labor. In our paper, we assess the relative importance of these parental motives by applying a competing risks analysis on household registry data from nine Taiwanese communities. By combining data on the levels of the individuals, the composition of their households, the characteristics of their communities, and economic fluctuations, we demonstrate the remarkable flexibility and adaptability of Taiwanese marriage within the overriding constraint of producing male offspring.

Innovations in health care delivery: responses to global nurse migration--a research example.

Using data from a large survey of Canadian nurses, we examined how internationally born nurses (IBNs) in Canada experience their work environment. There are significant differences in demographics and in work status and practice environment. Significantly more IBNs are members of visible minorities than are their Canadian-born counterparts. IBNs work more hours, including more overtime, and are more likely to experience physician, verbal, and emotional abuse. Self-rated health status was worse for IBNs in physical and mental health. Changes are needed to improve the nursing work environment and nurses' perception of the effectiveness of care, and to improve their health status.

Where are nurses working? Employment patterns by sub-sector in Ontario, Canada.

OBJECTIVE: As care shifts to home and community, have nursing jobs followed? We examined changes in the absolute and relative size of the nursing workforce by sector/sub-sectors in Ontario, Canada. METHODS: All nurses registered with the Ontario College of Nurses over the 11 years from 1993 to 2003 were categorized as Active, Eligible or Not Eligible. Active nurses were then categorized by sector (Hospital, Community, Other) and sub-sector. The analysis was repeated by age group and for registered nurses and registered practical nurses. RESULTS: The decline in Active and Eligible nurses was particularly pronounced for younger workers. Both the absolute number and proportion of nurses working in the hospital sub-sector has dropped. In the community sector, growth was evident in the use of nurses as case managers (in the CCAC sub-sector), community agencies and community mental health (representing a shift from hospital-based workers). However, the steady growth in the number and proportion of nurses working in home care agencies was reversed in 1999, with this sub-sector shedding 19% of its nurses by 2003. CONCLUSION: Despite considerable rhetoric to the contrary, nurses still tend to work within institutions (hospitals and long-term-care facilities). However, compared to their numbers in 1993, there were fewer nurses providing direct patient care in Ontario in both the hospital and community sectors, and a higher proportion of older nurses.