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Designers use their tacit knowledge to estimate project design effort needs, which can be enhanced through the understanding of the factors that most influence those needs. Evaluating and assessing project briefs against these factors can assist designers when planning their projects. The Collaborative Project Brief Scorecard (CPDS) Method identifies those factors and produces a scorecard for designers to evaluate project briefs based on these factors and allows for project comparisons, aids in past project recall and provides a focal point for collaborative reflection on design activities.
Although the clinical characteristics of persons in mental health settings are likely to vary in relation to a number of different, age is often considered to be one of the primary factors associated with the strengths, preferences and needs of psychiatric patients. The present study employs data from the mandated use of the interRAI Mental Health (MH) assessment instruments as part of normal clinical practice in Ontario psychiatric hospitals/units. The interRAI MH is a comprehensive assessment tool designed to support care plan development and outcome measurement at the person level, as well as quality monitoring and resource allocation at the organizational level. A sample of 27,530 Ontario psychiatric inpatients aged 18+ was examined with respect to socio-demographic, clinical, patient safety and service utilization characteristics. Younger and middle aged persons were compared with a subsample of 3,219 adults aged 65 years or more, including 112 nonagenarians.
Although there were a number of notable differences across age groups, there were substantial variations within the elderly population when considering source of admission. Elderly patients admitted from the general community were often relatively comparable to their younger counterparts; however, those admitted from nursing homes were a distinctive subgroup from both younger and older patients admitted from the community. This suggests that age alone is rather limited in its utility for describing mental health populations and more comprehensive clinically based measures should be employed to fully understand the needs and experiences of older adults in psychiatric settings.
Falls in residential long-term care (LTC) facilities continue to be a leading cause of injury for residents and cost for the health care system. Interdisciplinary clinical teams are responsible for assessing risk levels for their residents and developing appropriate care plans and interventions in response. This study compares the predictive accuracy of three separate fall risk assessment tools: the interRAI Falls Clinical Assessment Protocol (CAP), derived from the LTC Facility (LTCF) or Minimum Data Set (MDS) 2.0 assessments; the Scott Fall Risk Screen; and a modified Fall Risk Tool that was implemented as part of a provincial Fall Reduction Strategy in Nova Scotia. To conduct this retrospective cohort study, secondary data were collected from 1,553 LTC residents with interRAI assessments completed between March 1, 2015 and September 29, 2016, across Nova Scotia and New Brunswick. For each resident, data were collected regarding the three fall risk assessments, along with fall incident data for use in sensitivity, specificity, and logistic regression analyses. This study found that although all three tools had limitations with sensitivity or specificity thresholds, the interRAI Falls CAP delivered the highest accuracy with a c-statistic of 0.673, compared with the Scott Fall Risk Screen at 0.529 and the modified Fall Risk Tool at 0.609. When diseases that have been established to be a risk factor for falls were added to the model, the overall accuracy of the interRAI Falls CAP combined with those covariates increased to 0.749. These results suggest that the best practice guidelines for fall risk assessment be revisited, and that the interRAI Falls CAP could potentially be updated to include certain diseases and controls for optimal predictive ability.
Long-stay home care clients mostly reside in private homes or retirement homes, and the type of residence may influence risk factors for long-term care placement. This multi-state analytic study uses RAI-Home Care and administrative data from the Hamilton Niagara Haldimand Brant Local Health Integration Network to model conceptualized states of risk at baseline through a 13-month follow-up period. Modifiable risk factors in these states were client loneliness or depressive symptoms, and caregiver distress. A higher adjusted likelihood of being discharged deceased was found for the lowest-risk clients in retirement homes. Adjusting for client, service, and caregiver characteristics, retirement home residency was associated with higher likelihood of placement in a long-term care home; reduced caregiver distress; and increased client loneliness/depression. As an alternative to private home settings as the location for aging in place among these long-stay home care clients, retirement home residency represents some trade-offs between client and informal caregiver.
Design effort, the amount of time required to complete a project or task (Salam et al., 2009; Salam and Bhuiyan, 2016), is a required resource for any design project which can be influenced by a number of factors. Estimating design effort is a significant challenge that can be mitigated through an understanding of these influential factors. This understanding is held as tacit knowledge by experts, earned through experience; yet, although these factors vary in type and impact, understanding their details can provide insight and improve future estimations. Some previous methods to estimate design effort identify these factors, either from: expert opinion, or historical data analysis with each approach has advantages and disadvantages.
This paper is comprised of three parts:
A review of published methods and tools for estimating product design effort and whether they consider and identify influential factors; an analysis of possible trends in the identification of factors influencing product design project length; and a new method for identifying the influential factors of product design project length.
A prototype can be generally defined as a preliminary version of a final product and it can represent both aesthetic and functional features. Prototyping, the process of building a prototype, constitutes an indispensable part of product development processes. Many classifications of prototypes which use a different range of criteria have already been developed and are known as Prototype Taxonomies. This paper proposes an agenda towards the development of a new taxonomic classification which will be based on a prototype's attributes and its intended purpose. This work is justified from the results of an analysis of 8 existing prototype taxonomies which indicate that there is not a taxonomy that explicitly uses the prototypes’ purposes as its basic taxonomic dimension. A definition of the term ‘Prototype Purpose’ is proposed through discussing the differences and relations to the term ‘Prototype Role’. This work results in a list of 23 explicit prototype purposes which arise from 7 roles of prototyping found in relevant literature: Learning, Communication, Demonstration, Integration, Refinement, Exploration and Requirement Elicitation.
Introduction: Elder abuse is infrequently detected in the emergency department (ED) and less than 2% are reported to proper law authorities by ED physicians. This study aims to examine the characteristics of community-dwelling older adults who screened positive for elder abuse during home care assessments and the epidemiology of ED visits by these patients relative to other home care patients. Methods: This study utilized a population-based retrospective cohort study of home care patients in Canada between April 1, 2007 and March 31, 2015. Standardized, comprehensive home care assessments were extracted from the Home Care Reporting System. A positive screen for elder abuse was defined as at least one these criteria: fearful of a caregiver; unusually poor hygiene; unexplained injuries; or neglected, abused, or mistreated. Home care assessments were linked to the National Ambulatory Care Reporting System in the regions and time periods in which population-based estimates could be obtained to identify all ED visits within 6 months of the home care assessment. Results: A total of 30,413 from the 2,401,492 patients (1.3%) screened positive for elder abuse during a home care assessment. They were more likely to be male (40.5% versus 35.3%, p < 0.001), to have a cognitive impairment (82.9% versus 65.3%, p < 0.001), a higher frailty index (0.27 versus 0.22, p < 0.001) and to exhibit more depressive symptoms (depression rating scale 1 or more: 68.7% versus 42.7%, p < 0.001). Patient who screened positive for elder abuse were less likely to be independent in activities of daily living (41.9% versus 52.7%, p < 0.001) and reported having fallen more frequently (44.2% versus 35.5%, p < 0.001). Caregiver expressing distress was associated with elder abuse (35.3% versus 18.3%, p < 0.001) but not a higher number of hours caring for the patient. Victims of elder abuse were more likely to attend the ED for low acuity conditions (Canadian triage and acuity scale (CTAS) 4 or 5). Diagnosis at discharge from ED were similar with the exception of acute intoxication that was more frequent in patients who are victims of abuse. Conclusion: Elder abuse is infrequently detected during home care assessments in community-dwelling older adults. Higher frailty index, cognitive impairment, depressive symptoms were associated with elder abuse during homecare assessments. Patients who are victims of elder abuse are attending EDs more frequently for low acuity conditions but ED diagnosis at discharge, except for acute intoxication, are similar.
Outcomes of adverse events in home care are varied and multifactorial. This study tested a framework combining two health measures to identify home care recipients at higher risk of long-term care placement or death within one year. Both measures come from the Resident Assessment Instrument-Home Care (RAI-HC), a standardized comprehensive clinical assessment. Persons scoring high in the Method for Assigning Priority Levels (MAPLe) algorithm and Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale were at the greatest risk of placement or death and more than twice as likely to experience either outcome earlier than others. The target group was more likely to trigger mood, social relationship, and caregiver distress issues, suggesting mental health and psychosocial interventions might help in addition to medical care and/or personal support services. Home care agencies can use this framework to identify home care patients who may require a more intensive care coordinator approach.
Background: This study is part of the Innovations in Data, Evidence and Applications for Persons with Neurological Conditions project to understand the strengths, preferences, and needs of persons with neurological conditions living in Canada. Objective: To estimate the prevalence and describe the sociodemographic and clinical characteristics of persons with multiple sclerosis in Canadian home care, nursing home, Complex Continuing Care hospitals, and inpatient mental health care settings. Methods: Cross-sectional study of adults aged 18 years and older with multiple sclerosis (MS; n=11,250) across Canada from 1996 through 2011 using interRAI Resident Assessment Instrument (RAI) comprehensive health assessments (RAI Minimum Data Set 2.0, RAI-Home Care, RAI-Mental Health). Comparisons were made to adults with Alzheimer’s disease and related dementias (n=260,910), other neurological conditions (n=163,578) and non-neurological conditions (n=571,567). Results: The prevalence of MS was highest in Complex Continuing Care hospitals (4125 cases per 100,000 patients), followed by home care (2020 cases per 100,000 patients), nursing homes (1424 cases per 100,000 patients), and mental health settings (138 cases per 100,000 patients). Persons with MS experienced greater impairment in the completion of activities of daily living, pain, pressure ulcers, swallowing difficulty, depression, and anxiety compared with peers within care settings. There were also significant differences between settings, particularly the degree of physical and cognitive impairment experienced by persons with MS. Conclusions: Except for mental health care settings, the prevalence of MS in community, institutional and hospital-based care settings exceeded that of the general population. These data describing the sociodemographic and clinical characteristics of persons with MS may be used to inform clinical practice and policy decisions for persons with MS across the continuum of care.
Residents in long-term care (LTC) often require physical rehabilitation (PR) to maintain/improve physical function. This scoping review described the breadth of literature regarding PR in LTC to date, synthesizing PR interventions that have been evaluated, outcomes used, and tools for determining service eligibility. A structured search, conducted in six licensed databases and grey literature, identified 381 articles for inclusion. Most interventions were delivered and evaluated at the resident level and typically were multicomponent exercise programs. Performance-based measures, activities of daily living, and mood were the most frequently reported outcomes. A key knowledge gap was PR in relation to goals, such as quality of life. Future studies should reflect medically complex residents who live in LTC, and length of residents’ stay should be differentiated. Intervention studies should also explore realistic delivery methods; moreover, tool development for determining service eligibility is necessary to ensure equality in rehabilitative care across the LTC sector.
Few studies have focused on falls among home care (HC) clients with neurological conditions. This study identified factors that increase risk of falling among HC clients with no recent history of falls, and explored whether risk profiles varied among those with dementia or parkinsonism compared to those without selected neurological conditions. A retrospective cohort design was used and analysis of data from community-based HC clients across Ontario was conducted on a sample of ambulatory clients with dementia, parkinsonism, or none of the selected neurological conditions. Data were obtained from the Resident Assessment Instrument for HC (RAI-HC) assessment. The outcome used in multivariable analyses was whether clients fell during follow-up. Unsteady gait was a strong predictor of falls across all three groups. Co-morbid parkinsonism most strongly predicted falls in the dementia group. Clients with borderline intact to mild cognitive impairment had higher odds of falling within the parkinsonism and comparison groups.
With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa.
The Durban Diabetes Study (DDS) is a population-based cross-sectional survey of an urban black population in the eThekwini Municipality (city of Durban) in South Africa. The survey combines health, lifestyle and socioeconomic questionnaire data with standardised biophysical measurements, biomarkers for non-communicable and infectious diseases, and genetic data. Data collection for the study is currently underway and the target sample size is 10 000 participants. The DDS has an established infrastructure for survey fieldwork, data collection and management, sample processing and storage, managed data sharing and consent for re-approaching participants, which can be utilised for further research studies. As such, the DDS represents a rich platform for investigating the distribution, interrelation and aetiology of chronic diseases and their risk factors, which is critical for developing health care policies for disease management and prevention. For data access enquiries please contact the African Partnership for Chronic Disease Research (APCDR) at firstname.lastname@example.org or the corresponding author.
Quality of life (QoL) of long-term care (LTC) facility residents is an important outcome of care. This cross-sectional, descriptive study examined the self-reported QoL of LTC facility residents in Canada using the interRAI Self-Report Nursing Home Quality of Life Survey instrument. A secondary purpose was to test the instrument’s psychometric properties. Psychometric testing of the instrument supported its reliability and its convergent and content validity for assessing the residents’ QoL. Findings showed that residents rated positively several aspects of their life, such as having privacy during visits (76.9%) and staff’s being honest with them (73.6%). Residents gave lower ratings to other aspects such as autonomy, staff-resident bonding, and personal relationships. The findings point to gaps between facility philosophies of care and their translation into a care environment where care is truly resident-directed. Moreover, the findings have potential implications for resident care planning, facility programming, social policy development, and future research.
The opening chapter has introduced the field of talent management, its evolution, and the core practices it involves. In this chapter we take the resource-based view (RBV) of the firm and use it as a lens to explore and critique talent-management practices. We begin with a brief summary of the RBV and use this to highlight a number of implications for the talent debate. We then summarize some of the assumptions to identify nine tenets inherent in the talent perspective, and use ideas from an RBV perspective to challenge and critique this paradigm. This critique, we argue, should make us question the idea of “manageability” within the talent agenda. Many of the assumptions of a talent-management perspective are antithetical to the key principles and notions that underpin the RBV. We conclude by suggesting six developments to practice that should be made by adopting a more strategic RBV-influenced approach to talent management.
The RBV perspective
The RBV tries to explain how some firms are able to sustain competitive advantage, and as a consequence they can continually earn superior profits compared to rival firms (Rumelt, 1984; Wernerfelt, 1984; Barney, 1986, 1991; Dierickx and Cool, 1989; Conner, 1991; Kogut and Zander, 1992; Amit and Schoemaker, 1993; Peteraf, 1993; Teece, Pisano, and Shuen, 1997). The RBV locates these sources of advantage in the firm’s special assets and capabilities. These assets and capabilities have qualities, referred to as “isolating mechanisms” (Rumelt, 1984), that make it difficult for rival firms to replicate them and compete with the firm that has built these qualities. These isolating mechanisms include situations where:
it is hard or even impossible to relate the consequences or effects of a phenomenon to its initial states or causes, and decision makers find it hard to understand the relationship between organizational inputs and outputs, referred to as “causal ambiguity”
the set of decisions one faces for any given circumstance is limited by the decisions one has made in the past, even though past circumstances may no longer be relevant (path dependency)
interconnected social relationships and macro- and micro-factors of a social system create new properties (social complexity)
knowledge is created that is difficult to capture, codify, or transfer, and people may not be aware of the knowledge they possess or how it can be valuable to others (tacit knowledge)
complex synergies exist between assets, infrastructure, or capabilities.
This study describes the socio-demographic and clinical profile of persons with amyotrophic lateral sclerosis (ALS) in home care, nursing homes and complex continuing care settings in several Canadian jurisdictions.
A cross-sectional study was conducted using available Resident Assessment Instrument (RAI 2.0 and RAI Home Care) national databases from 1996- 2011. The profile of ALS patients was compared with patients without pre-specified neurological conditions.
There were 2,092 ALS patients identified in these settings. Persons with ALS were more likely than those in the comparison group to suffer from health instability (25.4%) and minor to major depressive symptoms (27.2%) , to experience falls (44.0%) and weight loss (22.9%), to require extensive assistance in activities of daily living (54.9%), and to receive rehabilitation services: physical (23.9%), speech language pathology (8.9%), and occupational therapy 43.3%).
The ALS population in this study are greatly affected by a number of health issues. They are more likely than the comparison group to require therapies, medical interventions, and psychotropic drug use. While persons with ALS have a poor prognosis, a great deal could be done to enhance their quality of life and the quality of care they receive.
Hospital and physician services for Canadians of all ages are shared responsibilities of the federal government and the governments of ten provinces and three territories. However, long-term care is regulated, funded and delivered only under the auspices of provincial/territorial governments with no major role for the federal government. Therefore, one cannot accurately refer to the ‘Canadian healthcare system’ as a singular entity. Rather healthcare, and long-term care, is delivered by thirteen different systems with national legislation guiding some, but not all, aspects of service delivery, regulation and administration (Beland and Shapiro, 1994). In addition, healthcare in Canada is provided by a mixture of public and privately funded services, and the balance between those sources of payment varies by region. The complexity of the Canadian healthcare mosaic has increased further with the introduction of regional authorities responsible for ‘local’ management of health services in the last two decades.
Rather than provide an encyclopedic summary of the regulatory structure of healthcare for the elderly in all regions of Canada, this chapter will focus on the experience of the province of Ontario to illustrate the experience of the country’s most populous province. It is also the province with the most fully integrated health information system across the continuum of care for older people, which is intended to improve clinical practice, quality, public accountability and funding of health services. That said, one must remain aware that this overview represents a single province’s experience that shares much, but not all, in common with other regions of the country. The chapter begins with a brief overview of the three levels of government (federal, provincial, regional) that have an influence over healthcare in Canada. The remainder deals specifically with the continuum of care for the elderly in Ontario.
This study examines predictors of caregiver distress among community-based palliative care clients. Analyses are based upon interRAI Palliative Care (interRAI PC) assessment data from palliative home care programs in three regions in Ontario, Canada.
The study sample involved all community-based palliative care clients in Ontario who were assessed with the interRAI PC as part of normal clinical practice during pilot implementation of the instrument between 2007 and 2009 (N = 3,929). The assessments were performed by trained case managers and were used as the basis for determining service needs to be addressed through services contracted from provider agencies. The main study outcome of interest was the presence of one or more indicators of caregiver distress: helper(s) unable to continue caring activities; primary informal helper expresses feelings of distress, anger, or depression; family or close friends report feeling overwhelmed by person's illness.
Caregiver distress was evident among about 22% of palliative home care clients. Multivariate analyses identified included clinical instability (Changes in Health, End Stage disease, Signs and Symptoms [CHESS] scale), depressive symptoms, cognitive impairment, and positive outlook as significant client-level predictors. Significant caregiver characteristics included hours of informal care. Three service use/provider variables were significant predictors of caregiver distress: the specific home care agency, hospitalizations in the last 90 days, and nursing visits.
Significance of results:
Caregiver distress affects approximately one in five palliative care clients in the community. This may lead to a number of adverse outcomes for the caregiver and client. The experience of distress is affected by client, caregiver, and agency characteristics that are readily identified by the interRAI PC assessment instrument. The present results point to the need for a care planning protocol that may be used on a targeted basis for clients experiencing or at elevated risk of caregiver distress.