Inequalities in end-of-life care for colorectal cancer patients in Nova Scotia, Canada

Access to high-quality end-of-life (EOL) care is critical for all those with incurable cancer. The objective of this study was to examine inequalities in access to, and quality of, EOL care by assessing registration in a palliative care program, emergency room visits in the last 30 days of life, and location of death among individuals who died of colorectal cancer in Nova Scotia, Canada, between 2001 and 2008. We used population-based linked administrative data and performed multivariate logistic regression models to assess the association between socio-economic, geographic, and demographic factors and outcomes related to access to, and quality of, EOL care (n=1201). This study demonstrates that although access to, and quality of, EOL care appears to have improved, there remain significant inequalities throughout the population. Of primary concern is the variation in access to, and quality of, EOL care based on geographic location of residence and patient age.     

Effect of population ageing on future demand for physicians: a case study of Nova Scotia, Canada, 2000-2025

The health care system has been under pressure for some time to keep pace with its health human resource (HHR) requirements. Future demographic trends, however, are magnifying these pressures. Because of the lengthy training period for physicians, closing the physician supply and demand gap requires time. This paper attempts to explore the future utilization of physicians in terms of full-time equivalent (FTE) in Nova Scotia to the year 2025 by four general types of medical disciplines: General Physicians, Medical Specialties, Surgical Specialties, and Diagnostic Specialties. Further, it makes projections by most responsible diagnosis, in- and out-hospital status, age and sex of the patients. The study shows that for paediatric patients, the incidence of all diseases would decline and for patients between age 15 and 54, the incidence of disease would either decline or increase marginally. Consistent with the baby boom ageing wave, the prevalence of disease would increase significantly for those above 54 years. This would result in requirements for all categories of physicians to decline for patients below age 54, in contrast with those 55 years of age and over where the demand would substantially increase. It is found that the growth in the requirements would be highest for diagnostic specialists, followed by surgical specialists, medical specialists, and the general practitioners.     

Emergency department presentation changes due to the coronavirus disease pandemic in Nova Scotia,Canada

<正>Multiple studies have reported decreased emergency department(ED) patient volumes during the coronavirus disease(COVID-19) pandemic,^[1-6] including areas most affected by the virus.^[7]Most existing studies have investigated general trends in ED presentations and have not examined the impact of COVID-19 on different types of EDs, specific ED patient groups, or illness presentations.     

End-of-life care for nursing home residents dying from cancer in Nova Scotia,Canada, 2000–2003

INTRODUCTION: With our population aging, an increasing proportion of cancer deaths will occur in nursing homes, yet little is known about their end-of-life care. This paper identifies associations between residing in a nursing home and end-of-life palliative cancer care, controlling for demographic factors. METHODS: For this population-based study, a data file was created by linking individual-level data from the Nova Scotia Cancer Centre Oncology Patient Information System, Vital Statistics, and the Halifax and Cape Breton Palliative Care Programs for all persons 65 years and over dying of cancer from 2000 to 2003. Multivariate logistic regression was used to compare nursing home residents to nonresidents. RESULTS: Among the 7,587 subjects, 1,008 (13.3%) were nursing home residents. Nursing home residents were more likely to be female [adjusted odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2-1.7], older (for > or = 90 vs 65-69 years OR 5.4, CI 4.1-7.0), rural (OR 1.5, CI 1.2-1.8), have only a death certificate cancer diagnosis (OR 4.2, CI 2.8-6.3), and die out of hospital (OR 8.5, CI 7.2-10.0). Nursing home residents were less likely to receive palliative radiation (OR 0.6, CI 0.4-0.7), medical oncology consultation (OR 0.2, CI 0.1-0.4), and palliative care program enrollment (Halifax OR 0.2, CI 0.2-0.3; Cape Breton OR 0.4, CI 0.3-0.7). CONCLUSION: Demographic characteristics and end-of-life services differ between those residing and those not residing in nursing homes. These inequalities may or may not reflect inequities in access to quality end-of-life care.     

Continuing professional development and the charity paradigm: interrelated individual, collective and organisational issues about continuing professional development

This paper aims to highlight some issues and tensions that currently challenge the profession, individual nurses and their employers when considering the need for continuing professional development. The Nursing and Midwifery Council states the professional requirements for continuing professional development. However the nature and type required seems to be determined by the individual on the one hand and the organisation on the other, rather than an integral part of professional activity within the context of work. This can lead to a mismatch between personal and organisational goals. Views emerged from participants in a previous case study that focused on learning through work, about support available to nurses for professional development. The perceptions of nurses and their managers about learning through work were explored, using semi structured interviews, picture mapping and structured interviews. The 'Charity Paradigm' is presented as an outcome of major issues within an organisation. It underpins negative perceptions of individuals about employer support of continuing professional development. It is suggested that there is a need for collaborative collective approaches to structured development in order to meet both individual and organisational needs. This is also advocated in order to achieve life long learning and transformational learning within an organisation. The tension between individual personal ambitions and employer demands can adversely affect the professional development of the practitioner and the organisation that employs them. The personal perspectives of nurses and managers about learning within their organisation are therefore important to acknowledge in terms of positive and negative influences. It is also necessary to recognise the contribution of the employer as well as the identifiable charitable contribution of individual practitioners and the input from external contributors to the organisation.     

Clinical biochemistry education, training and continuing professional development in the United Kingdom

Education and training to become a senior professional in UK clinical biochemistry is coordinated at national level and is largely dependent upon completion of the MRCPath examination. The number of training commissions is regulated to accord with workforce planning requirements. Both medical and science graduates are eligible to undertake this training and the core curriculum is similar for both groups. Medical trainees have the option of including additional clinical training in metabolic medicine. Increasingly, with the introduction of new methods of assessment, the MRCPath examination is becoming a measure of competence rather than knowledge. Structured CPD is mandatory for career grade doctors and scientists as part of the requirements for them to maintain their individual licence to practice and in order that the laboratory in which they work may be accredited. The education, training and assessment of trainees in clinical biochemistry enable the production of a flexible workforce that is competent and designed to be fit for purpose. The requirement for structured CPD is one part of maintaining competence.     

The present situation of continuing professional development in nursing

The author reviews continuing professional development in nursing as a demand for quality, its accreditation, the existing demand in our country the entities which provide such services, its relationship to a professional career, and the value-added step as a structural axis of our profession. All these topics are supported with the most recent data.     

The impact of socioeconomic and demographic factors on the utilization of smoking cessation medications in patients hospitalized with cardiovascular disease in Nova Scotia, Canada

OBJECTIVE: To determine whether any demographic or socioeconomic factors affect the use of smoking cessation medications in patients hospitalized with heart disease. METHOD: Data were obtained from the Improving Cardiovascular Outcomes in Nova Scotia (ICONS) Canada database, which includes a registry of all hospitalized patients with a diagnosis of ischaemic heart disease, congestive heart failure, or atrial fibrillation since October 1997. Patients agreeing to provide follow-up were sent an enrollment survey to determine demographic and socioeconomic factors including household income, educational background and private drug insurance plans. RESULTS: Between 15 October 1997 and 31 December 2000, 5442 patients who were current smokers and 270 patients using a smoking cessation medication were admitted to hospital registered in the ICONS database. An enrollment survey was completed by 1071 current smokers and 77 patients using a smoking cessation agent. CONCLUSION: Higher education level, presence of private drug insurance plans, and less difficulty paying for basic needs were associated with higher use of smoking cessation medications.