Measuring workplace psychosocial factors in the federal government.

BACKGROUND: The National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard) identifies 13 psychosocial factors affecting psychological health and safety in the workplace that employers should measure and monitor with the goal of addressing areas for improvement. The present study sought to determine the suitability of the Public Service Employee Survey as a tool for the assessment of these psychosocial factors in public service employees. It also aimed to explore-in a preliminary manner-predictors of job satisfaction in these employees. DATA AND METHODS: Data from the 2017 and 2019 Public Service Employee Survey (PSES) were analyzed. Specifically, exploratory structural modelling and tests of measurement invariance were used to identify a measurement model reflecting the psychosocial factors outlined in the Standard and to evaluate the equivalence of this model across both PSES administrations. RESULTS: The analyses uncovered 10 of the 13 psychosocial factors, as well as 2 closely related factors-diversity and inclusion-and supported the full invariance of the resulting measurement model across both PSES administrations. Lastly, preliminary results pointed to recognition and reward (encompassing leader reward behaviours) and involvement and influence (touching on participative decision making, innovation and initiative) as predictors of job satisfaction in both samples of public service employees. INTERPRETATION: The present study identified the PSES as a tool for the assessment-in public service employees-of the majority of the psychosocial factors outlined in the Standard as well as two additional factors of particular importance to the federal government, diversity and inclusion. Future research to address current limitations is discussed, as are preliminary implications for practice.

Predictive value of S-100ß protein for prognosis in patients with moderate and severe traumatic brain injury: systematic review and meta-analysis.

OBJECTIVES: To determine the ability and accuracy of the S-100ß protein in predicting prognosis after a moderate or severe traumatic brain injury. DESIGN: Systematic review and meta-analysis of randomised controlled trials and observational studies. DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, BIOSIS (from their inception to April 2012), conference abstracts, bibliographies of eligible articles, and relevant narrative reviews. STUDY SELECTION: Two reviewers independently reviewed citations and selected eligible studies, defined as cohort studies or randomised control trials including patients with moderate or severe traumatic brain injury and evaluating the prognostic value of S-100ß protein. Outcomes evaluated were mortality, score on the Glasgow outcome scale, or brain death. DATA EXTRACTION: Two independent reviewers extracted data using a standardised form and evaluated the methodological quality of included studies. Pooled results were presented with geometric means ratios and analysed with random effect models. Prespecified sensitivity analyses were performed to explain heterogeneity. RESULTS: The search strategy yielded 9228 citations. Two randomised controlled trials and 39 cohort studies were considered eligible (1862 patients). Most studies (n=23) considered Glasgow outcome score ≤ 3 as an unfavourable outcome. All studies reported at least one measurement of S-100ß within 24 hours after traumatic brain injury. There was a significant positive association between S-100ß protein concentrations and mortality (12 studies: geometric mean ratio 2.55, 95% confidence interval 2.02 to 3.21, I(2)=56%) and score ≤ 3 (18 studies: 2.62, 2.01 to 3.42, I(2)=79%). Sensitivity analysis based on sampling time, sampling type, blinding of outcome assessors, and timing of outcome assessment yielded similar results. Thresholds for serum S-100ß protein values with 100% specificity ranged from 1.38 to 10.50 µg/L for mortality (six studies) and from 2.16 to 14.00 µg/L for unfavourable neurological prognosis as defined by the Glasgow outcome score. CONCLUSIONS: After moderate or severe traumatic brain injury, serum S-100ß protein concentrations are significantly associated with unfavourable prognosis in the short, mid, or long term. Optimal thresholds for discrimination remain unclear. Measuring the S-100ß protein could be useful in evaluating the severity of traumatic brain injury and in the determination of long term prognosis in patients with moderate and severe injury.

Factors associated with the withdrawal of life-sustaining therapies in patients with severe traumatic brain injury: a multicenter cohort study.

PURPOSE: To identify factors associated with decisions to withdraw life-sustaining therapies in patients with severe traumatic brain injury (TBI). MATERIALS AND METHODS: We conducted a 2-year multicenter retrospective cohort study (2005-2006) in mechanically ventilated patients aged 16 years and older admitted to the intensive care units (ICUs) of six Canadian level I trauma centers following severe TBI. One hundred and twenty charts were randomly selected at each center (n = 720). Data on ICU management strategies, patients' clinical condition, surgical procedures, diagnostic imaging, and decision to withdraw life-sustaining therapies were collected. The association of factors pertaining to the injury, interventions, and management strategies with decisions to withdraw life-sustaining therapies was evaluated among non-survivors. RESULTS: Among the 228 non-survivors, 160 died following withdrawal of life-sustaining therapies. Patients were predominantly male (69.7 %) with a mean age of 50.7 (±21.7) years old. Brain herniation was more often reported in patients who died following decisions to withdraw life-sustaining therapies (odds ratio [OR] 2.91, 95 % confidence interval [CI] 1.16-7.30, p = 0.02) compared to those who died due to other causes (e.g., cardiac arrest, shock, etc.). Epidural hematomas (OR 0.18, 95 % CI 0.06-0.56, p < 0.01), craniotomies (OR 0.12, 95 % CI 0.02-0.68, p = 0.02), and other non-neurosurgical procedures (OR 0.08, 95 % CI 0.02-0.43, p < 0.01) were less often associated with death following withdrawal of life-sustaining therapies than death from other causes. CONCLUSIONS: Death following decisions to withdraw life-sustaining therapies is associated with specific patient and clinical factors, and the intensity of care.

Long-term functional outcome of older adults after a traumatic brain injury.

PURPOSE: To identify factors associated with long-term independence in mobility and self-care activities of daily living of older adults after traumatic brain injury (TBI). PARTICIPANTS: One hundred thirty-six TBI survivors 55 years or older were assessed 2 to 4 years postinjury (mean of 3.2 years). SETTING: Level I or level II trauma centers in Quebec, Canada. MAIN MEASURES: Personal, injury-related, and environmental factors were gathered from hospital records or by telephone interview; a telephone version of the Functional Independence Measure motor scale was collapsed to 4 levels. ANALYSIS: Logistic regression analyses identified factors associated with independence in mobility and self-care. RESULTS: The strongest and most consistent factors associated with independence in mobility and self-care were fewer comorbid conditions, no difficulty of access to home modification services and home support services, male gender, younger age at time of injury, and shorter acute care length of stay. CONCLUSION: Factors associated with long-term functional outcome should be considered in the development of practice guidelines for rehabilitation of older adults who sustained a TBI.

Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study.

BACKGROUND: Severe traumatic brain injury often leads to death from withdrawal of life-sustaining therapy, although prognosis is difficult to determine. METHODS: To evaluate variation in mortality following the withdrawal of life-sustaining therapy and hospital mortality in patients with critical illness and severe traumatic brain injury, we conducted a two-year multicentre retrospective cohort study in six Canadian level-one trauma centres. The effect of centre on hospital mortality and withdrawal of life-sustaining therapy was evaluated using multivariable logistic regression adjusted for baseline patient-level covariates (sex, age, pupillary reactivity and score on the Glasgow coma scale). RESULTS: We randomly selected 720 patients with traumatic brain injury for our study. The overall hospital mortality among these patients was 228/720 (31.7%, 95% confidence interval [CI] 28.4%-35.2%) and ranged from 10.8% to 44.2% across centres (χ(2) test for overall difference, p < 0.001). Most deaths (70.2% [160/228], 95% CI 63.9%-75.7%) were associated with withdrawal of life-sustaining therapy, ranging from 45.0% (18/40) to 86.8% (46/53) (χ(2) test for overall difference, p < 0.001) across centres. Adjusted odd ratios (ORs) for the effect of centre on hospital mortality ranged from 0.61 to 1.55 (p < 0.001). The incidence of withdrawal of life-sustaining therapy varied by centre, with ORs ranging from 0.42 to 2.40 (p = 0.001). About one half of deaths that occurred following the withdrawal of life-sustaining therapies happened within the first three days of care. INTERPRETATION: We observed significant variation in mortality across centres. This may be explained in part by regional variations in physician, family or community approaches to the withdrawal of life-sustaining therapy. Considering the high proportion of early deaths associated with the withdrawal of life-sustaining therapy and the limited accuracy of current prognostic indicators, caution should be used regarding early withdrawal of life-sustaining therapy following severe traumatic brain injury.

A descriptive portrait of human assistance required by individuals with brain injury.

BACKGROUND: Human assistance is a counterweight to disabilities for people living with a traumatic brain injury (TBI). However, there is no clear description of the human assistance used by this population in relation with specific life habits (LH). OBJECTIVES: (1) to describe the proportion of LH performed with human assistance; (2) to explore the characteristics of TBI persons with greater needs for human assistance; (3) to clarify the categories of LH for which persons with TBI need human assistance; and (4) to determine the relationship between the human helper and the person with TBI across different residential settings. METHOD: One hundred and thirty-six individuals with moderate or severe TBI were interviewed using the LIFE-H. RESULTS: Human assistance is used to perform one out of three LH. A greater need for human assistance was associated with the number of impairments, motor limitation to the upper limbs, hemiplegia and receiving public insurance. Human assistance was used more often to perform LH pertaining to social roles than those pertaining to daily living. Close relatives were the most frequent providers of human assistance regardless of the residential setting. CONCLUSION: Given the importance of human assistance in TBI, it is essential to support human helpers during and after rehabilitation.