Falls among older adults (age 65 years and older) residing in personal care homes (PCHs) are an important health concern. Atypical antipsychotic drugs (AADs) have been shown to be associated with fall risk among older adults. However, previous studies face some methodological limitations that affect the quality, consistency, and comparability of these studies. Therefore, a population-based study was undertaken to examine the effect of AAD use on the risk of falling among older PCH residents. A nested case-control study was conducted using the administrative healthcare records and Minimum Data Set for PCHs (MDS) housed at the Manitoba Centre for Health Policy in the Faculty of Medicine, University of Manitoba. The study period was from April 1, 2005 to March 31, 2007. Cases (n=626) were fallers as recorded in MDS. Using incidence density sampling, each case was matched to four controls on length of PCH stay, age, and sex (n=2,388). Exposure to AADs was obtained from the Drug Program Information Network database. Conditional logistic regression was used to model the effects of AAD use on the risk of falling while accounting for matching and for confounding of other covariates. While the adjusted odds of falling was statistically greater for AAD users versus nonusers (adjusted odds ratio = 1.60, 95% CI 1.10-2.32), this association was type and dose dependent. Compared to nonusers, the odds of falling was greater for quetiapine users, regardless of this drug's dose, and high dose risperidone users. On the other hand, low dose risperidone and olanzapine, irrespective of drug dose, use was not associated with the risk of falling. Furthermore, the effect of AAD use, in general, on the risk of falling was significantly greater for people with wandering problems (adjusted odds ratio = 1.84, 95% CI 1.09-3.09). Despite some methodological limitations, this research has provided some unique findings that enhance our understanding of AAD use as a fall risk factor. Study findings allow policymakers to further develop evidence-based interventions specific to AADs in order to better manage falls in the PCH setting. However, a great deal of research is still needed to address other important unanswered questions.

Falls among older adults (age 65 years and older) residing in personal care homes (PCHs) are an important health concern. Atypical antipsychotic drugs (AADs) have been shown to be associated with fall risk among older adults. However, previous studies face some methodological limitations that affect the quality, consistency, and comparability of these studies. Therefore, a population-based study was undertaken to examine the effect of AAD use on the risk of falling among older PCH residents. A nested case-control study was conducted using the administrative healthcare records and Minimum Data Set for PCHs (MDS) housed at the Manitoba Centre for Health Policy in the Faculty of Medicine, University of Manitoba. The study period was from April 1, 2005 to March 31, 2007. Cases (n=626) were fallers as recorded in MDS. Using incidence density sampling, each case was matched to four controls on length of PCH stay, age, and sex (n=2,388). Exposure to AADs was obtained from the Drug Program Information Network database. Conditional logistic regression was used to model the effects of AAD use on the risk of falling while accounting for matching and for confounding of other covariates. While the adjusted odds of falling was statistically greater for AAD users versus nonusers (adjusted odds ratio = 1.60, 95% CI 1.10-2.32), this association was type and dose dependent. Compared to nonusers, the odds of falling was greater for quetiapine users, regardless of this drug's dose, and high dose risperidone users. On the other hand, low dose risperidone and olanzapine, irrespective of drug dose, use was not associated with the risk of falling. Furthermore, the effect of AAD use, in general, on the risk of falling was significantly greater for people with wandering problems (adjusted odds ratio = 1.84, 95% CI 1.09-3.09). Despite some methodological limitations, this research has provided some unique findings that enhance our understanding of AAD use as a fall risk factor. Study findings allow policymakers to further develop evidence-based interventions specific to AADs in order to better manage falls in the PCH setting. However, a great deal of research is still needed to address other important unanswered questions.

The purpose of this study was to investigate the relationship between nursing staffing and quality of life (QOL) in nursing homes (NHs). The relationships between nursing staff hours per resident day, nursing staffing skill mix, turnover of nursing staff, and the answers given to QOL questions by 231 residents in Iowa NHs were investigated. Unexpectedly, only part of staffing variables were statistically significantly correlated with QOL of residents and nurse staffing variables seemed to have little influence on predicting QOL of residents in this study. The major differences between this study and previous studies are that previous research focused on quality of care (QOC) and this study measured QOL by measuring residents' outcomes. Previous studies found that nurse staffing is an important factor in improving QOC (and by implication, QOL) of NH residents. Based on the statistically significant relationships, RNs' unique contributions were supported by the findings that NHs with more RNs, compared with LPNs/LVNs and CNAs, had residents with higher scores in the functional competence domain and overall QOL summary items. This study found that nurse staffing turnover is positively correlated with QOL, especially in the individuality domain. However, the whole study takes place in one state, Iowa. Iowa has a homogeneous population with limited racial diversity. Only Iowa NHs were selected and it is questionable whether the findings may be generalizable to the rest of the United States. Further research is required to confirm the relationship and provide policy guidelines, including nurse staffing recommendations, to guarantee optimal QOL for NH residents.

Yes / Purpose: To identify a minimum list of metrics of international relevance to public health, research and service development which can be extracted from practice management systems and electronic patient records in primary optometric practice. Methods: A two stage modified Delphi technique was used. Stage 1 categorised metrics that may be recorded as being part of a primary eye examination by their importance to research using the results from a previous survey of 40 vision science and public health academics. Delphi stage 2 then gauged the opinion of a panel of 7 vision science academics and achieved consensus on contentious metrics and methods of grading/classification. Results: A consensus regarding inclusion and response categories was achieved for nearly all metrics. A recommendation was made of 53 metrics which would be appropriate in a minimum data set. Conclusions: This minimum data set should be easily integrated into clinical practice yet allow vital data to be collected internationally from primary care optometry. It should not be mistaken for a clinical guideline and should not add workload to the optometrist. A pilot study incorporating an additional Delphi stage prior to implementation is advisable to refine some response categories. / This work was supported by the College of Optometrists.

Rising health care costs place increased burden on patients, health care personnel, administrators and policymakers. Decisions in health care are influenced by data which can be transferred into valuable information and knowledge. Data sets that facilitate data collection, information management and knowledge building are needed by nurse managers to support administrative decision- making. The Nursing Management Minimum Data Set (NMMDS,,¦) offers a standardized method to capture core data that can be collected in information systems, shared and reused for multiple purposes to support safe and cost-effective care. The purpose of this descriptive study was to adapt to Iceland and clinically test the NMMDS-ICE in all adult inpatient care units in the country of Iceland (excluding psychiatry). The aims of the study were to 1) translate the NMMDS from source language (English) to target language (Icelandic); 2) to validate the translated instrument; and 3) to describe the environment, nursing care resources, and financial resources across acute adult inpatient care units in Iceland. Instrument development consisted of translation, expert validation, and psychometric testing. The target population was all adult acute care units in hospitals in Iceland, and the nurse managers (n=38) representing these units. Data collection included a mailed survey. The sample equaled the population. Furthermore, 134 staff nurses on these units (excluding staff nurses at Landspitali) completed a job satisfaction survey. Return rate was 74% for nurse managers and 71% for staff nurses. Semantic and content equivalence of the NMMDS-ICE was established. Five of seven subscales of the instrument received Cronbach¡¦s alpha score of 0.70 or higher. Results indicated that it was feasible to collect the NMMDS-ICE in hospitals in Iceland, albeit, there was an issue with time commitment to do so. The specialty services that best described the patient population were medical-, surgical services, birthing, and geriatrics. Furthermore, nurse managers seem to perceive good control on their units, and both nurse managers and staff nurses are satisfied with their job. A positive correlation was found between autonomy and satisfaction with nursing management, nursing administration, and own level of autonomy. Statistical differences were identified in environmental and staffing resources between hospitals.

<p dir="ltr">Recurrent stroke, infection, and seizure are some of the most common complications in stroke survivors. Recurrent stroke leads to death in 38.6% of survivors, and infections are the most common risk factor for seizures, with stroke survivors that experience an infection being at greater risk of experiencing a seizure. Two predictive models were generated, recurrent stroke and post-infection seizure, to determine stroke survivors at greatest risk to help providers focus on prevention in higher risk residents.</p><p dir="ltr">Predictive models were generated from a retrospective study of the Long-Term Care Minimum Data Set (MDS) 3.0 (2014-2018, n=262,301). Techniques included three data balancing methods (SMOTE for up sampling, ENN for down sampling, and SMOTEENN for up and down sampling) and three feature selection methods (LASSO, RFE, and PCA). The resulting datasets were then trained on four machine learning models (Logistic Regression, Random Forest, XGBoost, and Neural Network). Model performance was evaluated with AUC and accuracy, and interpretation used SHapley Addictive exPlanations.</p><p dir="ltr">Using data balancing methods improved the prediction performances of the machine learning models, but feature selection did not remove any features or affect performance. With all models having a high accuracy (78.6% to 99.9%), interpretation on all four models yielded the most holistic view. For recurrent stroke, SHAP values indicated that treatment combinations of occupational therapy, physical therapy, antidepressants, non-medical intervention for pain, therapeutic diet, anticoagulants, and diuretics contributed more to reducing recurrent stroke risk in the model when compared to individual treatments. For post-infection seizure, SHAP values indicated that therapy (speech, physical, occupational, and respiratory), independence (activities of daily living for walking, mobility, eating, dressing, and toilet use), and mood (severity score, anti-anxiety medications, antidepressants, and antipsychotics) features contributed the most. Meaning, stroke survivors who received fewer therapy hours, were less independent, and had a worse overall mood were at a greater risk of having a post-infection seizure.</p><p dir="ltr">The development of a tool to predict recurrent stroke and post-infection seizure in stroke survivors can be interpreted by providers to guide treatment and rehabilitation to prevent complications long-term. This promotes individualized plans that can increase the quality of resident care.</p>

Master of Science / Department of Agricultural Economics / Timothy J. Dalton / Given the changing climate paradigm, food and poverty are likely to become more severe in Africa. Farmers can adapt to climate change, especially through conservation agriculture. This study relies on a minimum data approach developed by Antle and Valvidia (2006) to estimate the spatial distribution of opportunity cost for farmers in switching to conservation practices in Wa, Ghana. It assesses the economic feasibility of several scenarios that rely on production techniques currently studied by the CRSP SANREM project. We also explore the possibility that these practices can provide income from carbon sequestration payments implemented by the Kyoto protocol’s Clean Development Mechanisms. The methodology uses data from both a recent survey and information from secondary sources to assess simulated management practices. Results indicate that all the simulated management practices would theoretically benefit farmers. In fact, adoption rates for the four scenarios range from 52% to 65%, even without any carbon payment. Adding a proportional payment to the amount of carbon sequestered with these practices does not seem enough to influence farmers switch to switch to alternative scenarios. The analysis shows that these results hold even when additional fixed costs to adopt these practices are included. This case study demonstrates the usefulness of the minimum data approach in estimating the economic potential of conservation practices in Ghana. These production techniques may represent environmentally-friendly alternatives that are more profitable for farmers than current practices. The next step in assessing implementation of such practices would require studying farmers’ willingness to adopt these production systems, given their ex-ante economic returns.

Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.

Funding of services to residents in publicly funded long-term care (LTC) facilities has historically rested upon a list of physical needs. However, more than 60% of residents in nursing homes have dementia; a condition in which physical needs are only a part of the overall clinical picture. Since past funding formulas focused primarily on the physical characteristics of residents, the Ontario government has adopted the RUG (Resource Utilization Groups)-III (34 Group) for use in LTC facilities which follows the adoption of the Minimum Data Set (MDS) 2.0 assessment instrument. Some still question whether the newer formula adequately reflects the care needs of residents with dementia despite its validation in many countries. The purpose of this study was to determine the comprehensiveness of the RUG-III (34 Group) in addressing the needs of residents with dementia living in LTC. First, a critical systematic review of the literature was conducted to determine the needs of residents with dementia. Numerous electronic databases were searched for articles published between January 2000 and September 2010, and later cross-referenced. Second, needs identified from the literature were matched to the items of the RUG-III which are selected variables of the MDS 2.0. Third, the priority of the items in the RUG-III was analysed in accordance with the importance of the identified needs. The documented needs were taken from 68 studies and classified into 19 main categories. The needs most supported by the literature were the management of behavioural problems, social needs, the need for daily individualized activities/care and emotional needs/personhood. Among the needs identified, activities of daily living (ADLs), cognitive needs and general overall physical health met the most RUG-III items. These needs were found to be well represented within the system. Other needs of importance such as social needs are not thoroughly considered in the grouping methodology though matched to MDS variables. The fact that these needs are not well addressed in the RUG-III poses concerns. Future research is needed to validate the significance of these needs. Considerations should be made as to the adequacy of the funding system and the allocation of funding.

El colectivo enfermero español no redacta de forma generalizada ningún Informe de Cuidados de Enfermería al Alta (ICEA) tras la atención hospitalaria del paciente que permita la continuidad de los cuidados. Desde que el Ministerio de Sanidad, Política Social e Igualdad presentara el Plan de Calidad para el Sistema Nacional de Salud (2006) donde se enmarcó el proyecto Historia Clínica Digital, diferentes grupos de trabajo han definido los Informes del Conjunto Mínimo de Datos, entre los que se incluye el Informe de Cuidados de Enfermería. Tomando una muestra aleatoria de enfermeras de los hospitales correspondientes a las nueve áreas de salud de la Región de Murcia, se analizan las capacidades científicas, las capacidades tecnológicas, el nivel de conocimientos y el acceso a la formación continuada que tienen sobre el contenido del ICEA. Los datos muestran que es necesaria una importante consolidación teórica y metodológica de las enfermeras hospitalarias más veteranas de la Región de Murcia, en diagnósticos NANDA, intervenciones recogidas en las NIC y medición de resultados enfermeros (NOC) que les permita redactar el ICEA. / The Spanish nursing profession does not write any report widely to Alta Care Nurse after the patient's hospital care will allow for continuity of care. Since the Ministry of Health, Social Affairs and Equal submit the Quality Plan for the National Health System (2006) which framed the Medical Records project, various working groups have defined the reports of the Minimum Data Set, among which are included, the Nursing Care Report. We taking a random sample of nurses from hospitals for the nine health areas in the region of Murcia, discusses the scientific, technological capabilities, the level of knowledge and access to ongoing training with the nurses on the content of the discharge nurse. These data show that consolidation needs major theoretical and methodological most senior hospital nurses in the region of Murcia, in matters of NANDA diagnoses, interventions included in the NIC and measurement of nursing outcomes (NOC) to allow them to draft the Report of High Nursing.