The cross-cultural adaptation of the Work Role Functioning Questionnaire in Canadian French

The Work Role Functioning Questionnaire (WRFQ) is a new work disability measurement tool assessing the perceived impact of a health problem on the worker's ability to perform his job. The objective of this study was to make the cross-cultural adaptation of the WRFQ for the French Canadian population. The methodology was composed of five steps: forward translation, synthesis of the translations, back translation, revision by an expert committee and test of the pre-final version. The psychometric properties of the translated version were evaluated by administering the questionnaire to forty workers with a musculoskeletal disorder (MSD). Results indicated good content validity and internal consistency (Cronbach alpha > 0.80 for each scale). Construct validity was tested and confirmed through three hypotheses: (1) subjects with MSD scored higher for the Physical, Work Scheduling and Output demands scales than for the Mental and Social demands scales, (2) subjects having back pain had lower scores than subjects having pain at other body sites and (3) subjects with an MSD had lower scores than healthy workers working full time. This study confirmed that the process used for the adaptation of the Canadian French version of the WRFQ was successful and that this version had good psychometric properties.     

Functioning of women in the postpartum period: an International Classification of Functioning,Disability and Health-based consensus of physical therapists

BackgroundPhysical therapists provide treatment for pain and other common complaints for women in the postpartum period, thereby contributing to the improvement of their functioning. However, before applying any interventions, physical therapists should assess their patients to identify the desired therapeutic goals. In this context, the International Classification of Functioning, Disability and Health (ICF) may be a useful tool for documenting functioning data and operationalizing collaborative goal setting.ObjectiveTo identify ICF categories and the respective domains that should be considered in the evaluation of women postpartum.MethodsA consensus-building, three-round e-mail survey was conducted using the Delphi method. The sample included Brazilian physical therapists with expertise in women’s health. Meaningful content was analyzed in accordance to the ICF linking rules. The kappa coefficient and content validity index (CVI) were calculated.ResultsThe panel consisted of 45 participants with a median age of 33 years and more than 10 years of experience in women’s health. A total of 1261 meaningful contents were identified from the responses in the first round. After consensus was achieved, a final list of 62 items was prepared, including 53 categories (11 were on structures; 15 on body functions; 12 on activities and participation; 15 on environmental factors) and nine personal factors (CVI = 0.89).ConclusionFrom the perception of physical therapists, an ICF-based postpartum assessment to describe functioning and disability must comprise 53 ICF categories and nine personal factors.     

The French Haemovigilance System: organization and results for 2003.

In 1993 by law, in France, haemovigilance became a national system of surveillance and alert, from blood collection to the follow-up of the recipients, gathering and analysing all adverse events of blood transfusion in order to prevent their recurrences. In 2003, 2911 incidents with strong imputability have been specially analysed, among them seven confirmed cases of bacterial contamination, 137 incorrect blood components transfused with 12 cases of ABO incompatibility, 15 adverse reactions diagnosed as TRALI and 12 deaths. The analysis of information provided by haemovigilance has led to the implementation of new guidelines.     

Identification of relevant categories for inpatient physical therapy care using the International Classification of Functioning,Disability and Health: a Brazilian survey

BackgroundHospitalized patients are at risk for the loss of function and impairment. Physical therapists aim to improve functionality and prevent disabilities. The International Classification of Functioning, Disability and Health (ICF) propose a universal language to classify the functionality of patients across different health care settings and over diverse health conditions.ObjectivesTo identify the International Classification of Functioning, Disability and Health categories that describe most common and relevant patient problems managed by physical therapists in Brazilian hospitals in the acute and post-acute care settings.SubjectsThe participants were physical therapists who worked in hospitals with a minimum work experience of two years.MethodsA consensus-building, two-round, emailed survey was conducted using the Delphi technique.ResultsFor the development of an ICF short list, 47 physical therapists from the acute care setting and 30 physical therapists from the post-acute care setting responded to the Delphi exercise. Most of the professionals were from the cardiorespiratory physical therapy area. A 80% level of consensus or higher was established for the selection of the categories of the ICF components (Body Functions, Body Structures, Activities and Participation, and Environmental Factors). We obtained two short lists to be used in clinical practice comprising 39 ICF categories for acute care settings and 53 for post-acute care settings.ConclusionThis study is the first to identify the most relevant aspects for physical therapy in Brazilian hospitals using the ICF framework. Our results can help to promote the adoption of the ICF in physical therapy clinical practice in the hospital setting.     

两种全自动微生物鉴定系统在布鲁菌鉴定中的应用比较

目的 比较Vitek2 Compact和Walkaway 40全自动微生物鉴定系统在布鲁菌鉴定中的应用。方法 临床分离菌株,采用Vitek2 Compact和Walkaway 40全自动微生物鉴定系统进行鉴定,并将鉴定结果和16S rRNA基因序列检测的结果进行比较。结果 临床分离菌株经Vitek2 Compact GN鉴定卡鉴定为马耳他布鲁菌,Walkaway 40 NC31鉴定卡鉴定为动物溃疡威克斯菌、莫拉菌属等。16S rRNA基因序列分析表明,该临床分离菌株的16S rRNA基因序列与布鲁菌匹配,排除动物溃疡威克斯菌、莫拉菌属等的可能,确定该菌株为马耳他布鲁菌。结论 Vitek2 Compact可以准确的鉴定出布鲁菌,经Vitek2 Compact鉴定为布鲁菌后,可采用分子生物学方法进行佐证,大大地提高了布鲁菌的检出率,降低误诊的可能性。Walkaway 40无法准确的鉴定出布鲁菌,误鉴定会导致错误的治疗并使工作人员处于实验室获得性感染的危险之中。建议使用Walkaway 40的实验室在鉴定出动物溃疡威克斯菌或莫拉菌属等细菌时应谨慎报告,并使用Vitek2 Compact或分子生物学方法进行复查。     

Toward Spanning the Quality Chasm: An Examination of Team Functioning Measures

Objective

To examine the effect of 5 measures of team functioning on patient outcomes.

Design

Observational, exploratory, measurement. Team functioning surveys and patient outcomes collected 1 year apart in a clinical trial were analyzed. The findings are discussed in context of the domains of team functioning, team effectiveness, and quality improvement.

Setting

27 Veterans Affairs medical centers.

Participants

Staff (t1: N=356; t2: N=273) on inpatient teams and patients (t1: N=4266; t2: N=3213) treated by the teams.

Interventions

Not applicable.

Main Outcome Measures

Five measures of team functioning (Physician Engagement, Shared Leadership, Supervisor Team Support, Teamness, and Team Effectiveness scales) and 3 measures of patient outcomes (functional improvement, discharge destination, and length of stay) were assessed at 2 time points with hierarchical generalized linear models to evaluate the association between team functioning measures and changes in patient outcomes.

Results

Associations (P<.05) between team functioning measures and patient outcomes were found for 3 of the 15 analyses over the study period. Higher Physician Engagement scale score was associated with lower length of stay (P=.017), and increased scores on Teamness and Team Effectiveness scales correlated with higher rates of community discharge (P=.044 and .049, respectively).

Conclusions

This exploratory analysis revealed trends that team functioning corresponds with patient outcomes in clinically relevant patterns. An increase in community discharge and a decrease in length of stay were associated with higher scores of team functioning. Here, we find evidence that modifiable attributes of team functioning have a measurable effect on patient outcomes. Such findings are promising and support the need for further research on team effectiveness.     

Spirituality and the International Classification of Functioning,Disability and Health: content comparison of questionnaires measuring mindfulness based on the International Classification of Functioning

Purpose.?To identify and compare the concepts contained in questionnaires measuring mindfulness using the International Classification of Functioning (ICF) as external reference.

Method.?Questionnaires which are published in peer-reviewed journals and listed in Pubmed or PsycInfo were included. The questionnaires were analysed and, using a content-analytical approach, the respective items were categorised and linked to the ICF.

Results.?Ten questionnaires were included. Ninety-four per cent (N == 341) of the concepts could be linked to 37 different ICF categories. One hundred and seventy-one (50.1%%) concepts were linked to ICF categories of the component Body Function, 74 (21.7%%) to categories of the component Activity and Participation and none to categories of the component Environmental Factors. In total, 28.2%% of the linked concepts belonged to Personal factors, which are not yet classified in the ICF. The questionnaires exhibited considerable differences regarding content density (i.e. the average number of concepts per item) and content diversity (i.e. the number of ICF categories per concept).

Conclusions.?The ICF provides an useful external reference to identify and compare the concepts contained in mindfulness questionnaires. Also, mindfulness questionnaire concepts suggest potentially useful factors for classification within the ICF.     

Children on the Autism Spectrum: Grandmother Involvement and Family Functioning

Background This study investigated associations between the presence of a child with autism or Asperger’s disorder in the family, family functioning and grandmother experiences with the goal of better understanding grandparent involvement in the lives of grandchildren on the autism spectrum and their families. Methods Mothers and grandmothers of children who were either typically developing or on the autism spectrum completed parallel forms of a grandparent involvement measure. Mothers reported on the functioning of the immediate family. Data were analysed via multilevel modelling with mother–grandmother dyads as the unit of observation. Results Autism spectrum disorders in children were associated with more flexible family functioning, lower levels of family satisfaction, greater grandmother difficulties and more grandmother information needs. Conclusions Participation of grandparents in diagnostic and treatment meetings and increased communication among family members may facilitate grandparent support and involvement in families with a child on the autism spectrum.     

Using a multidisciplinary classification in nursing: the International Classification of Functioning Disability and Health

AIM: This paper reports a study to explore systematically the usefulness of the International Classification of Functioning, Disability and Health to nurses giving patient care. BACKGROUND: The International Classification of Functioning, Disability and Health has a history of more than 20 years. Although this World Health Organization classification offers multidisciplinary use, nurses are not familiar with it. METHODS: Applications of the International Classification for nursing practice were developed and evaluated in a multi-centre project, composed of a series of 10 projects in a variety of settings. These applications were a variety of tools, such as assessment forms, care plans and transfer forms. The study used information from 653 patients, 469 nurses and 178 others (International Classification experts; other professionals with whom nurses communicate or discuss patient data). FINDINGS: Large sections of the International Classification were used in the 10 projects, revealing a predominant focus on body functions (53% of all three-digit codes and corresponding terms used). Although large sections of the Classification were useful in practice applications, some items were identified that could be added, improved or described with more detail. Positive remarks made by nurses referred to the scope of the International Classification, which encouraged assessing beyond a patient's functional impairments. CONCLUSIONS: The International Classification of Functioning, Disability and Health can be a useful tool in classifying and communicating aspects of patient functioning by nurses. A level of moderate detail within the Classification (three-digit level) seems appropriate for most nursing purposes. Our results on items that could be added or improved can serve as input in future revisions of the Classification. Future use of the International Classification should be encouraged, because of its relevance to nursing and its potential for multidisciplinary use in patient care.     

Anatomy of the CMRR and Proposition of Functioning

Objectives. The main objective was to have a view of the functioning of the Centers Memory of Resources and Research (CMRR) to identify the difficulties which can interfere in the industrial clinical trials. The secondary objective was to make a proposal to optimize them. Methodology. Questionnaires were given in all CMRRs. Results. One hundred thrity-five questionnaires were retrived (26 centers answered on the 27 that exist). Some elements appeared as strong structural factors but some weaknesses were highlighted such as: insufficient staff, lack of dedicated areas, lack of communication, activities multiplications, functional unit (UF) subdivision. Conclusion-proposition. After a Strenghts-Weakness-Opportunities-Threats (SWOT) analysis, we kept 3 main axis to improve: information and formation diffusion, transdisciplinary meetings establishment, better mobilization of doctors for clinical trials. We think that a special "clinical trail" unit within each CMRR should be created. It will enhance the level, the competences and the reactivtity of each clinical trial center which will lead to better collaboration with big pharmaceutical companies.     

Pathways of Ammonia Metabolism in the Intact Functioning Kidney of the Dog

Studies in which ¹⁵N-labeled precursors of urinary ammonia were infused into the artery of an intact functioning kidney of an acidotic dog have led to the following conclusions: Preformed ammonia and ammonia derived from the amide nitrogen of plasma glutamine are added directly to urine without significant incorporation into amino acid intermediates of renal tissue. Thus, reductive amination of α-ketoglutarate to form glutamate does not occur to an appreciable extent nor is there significant transfer of the amide nitrogen of glutamine to the corresponding keto acids to form glutamate, aspartate, alanine, or glycine. The enzyme system “glutaminase II” may participate to a significant extent in the metabolism of glutamine by forming aspartate and alanine by direct transamination of oxalacetate and pyruvate and liberating the amide nitrogen as ammonia. Renal alanine exists as a well mixed pool derived in roughly equal amounts from filtered and reabsorbed plasma alanine and newly synthesized alanine. The alanine pool of tubular cells does not equilibrate with the alanine of peritubular capillary blood. Transfer of the nitrogen of alanine to α-ketoglutarate and subsequent oxidative demination of the resulting glutamate can account for the ammonia formed from alanine. Glycine is not an important intermediate in renal nitrogen metabolism.     

The dream of the Far West: French physicians in the United States

At the end of 1996, there were 115,484 foreign medical graduates in the US. More than one quarter of the US physician workforce were FMGs, among them 973 came from a French medical school (nearly 0.6% of the French physician workforce). French-trained doctors in the US are mainly located in New York, New Jersey, California and Florida, i.e. in the urban areas. However, their membership to the medical learned societies is less frequent than their American colleagues. In general, their ways of practice evidence a lower level of professional status. Based on training costs, the loss for France, due to migration to the US of these 973 doctors could be estimated between 1.2 billion and 8.5 billion French Francs. One has to remind that, at the same time, France "imports" doctors trained in other countries for fulfilling medical posts in hospitals in remote areas. The process occurs in a context of oversupply of physicians in France. A large-scale study of international migration of physicians and nurses was undertaken under the aegis of the World Health Organization in the early 70's. It seems now of interest to re-examine again the issue.