The determinants of quality healthcare: Implications for Canadian health leaders

The Accreditation Canada program supports organizations in delivering quality healthcare using a quality framework that recognizes the complex interplay of multiple factors that define quality. This article highlights the Accreditation Canada quality framework and how these dimensions of quality together promote quality care. Using three dimensions of quality – population focus, safety, and worklife – we discuss how these quality dimensions can be utilized by healthcare leaders to improve quality in their organizations.     

Rational and Experiential Decision-Making Preferences of Third-Year Student Pharmacists

Objective. To examine the rational (systematic and rule-based) and experiential (fast and intuitive) decision-making preferences of student pharmacists, and to compare these preferences to the preferences of other health professionals and student populations.Methods. The Rational-Experiential Inventory (REI-40), a validated psychometric tool, was administered electronically to 114 third-year (P3) student pharmacists. Student demographics and preadmission data were collected. The REI-40 results were compared with student demographics and admissions data to identify possible correlations between these factors.Results. Mean REI-40 rational scores were higher than experiential scores. Rational scores for younger students were significantly higher than students aged 30 years and older (p<0.05). No significant differences were found based on gender, race, or the presence of a prior degree. All correlations between REI-40 scores and incoming grade point average (GPA) and Pharmacy College Admission Test (PCAT) scores were weak.Conclusion. Student pharmacists favored rational decision making over experiential decision making, which was similar to results of studies done of other health professions.     

Molecular characterization of the transition to mid-life in Caenorhabditis elegans

We present an initial molecular characterization of a morphological transition between two early aging states. In previous work, an age score reflecting physiological age was developed using a machine classifier trained on images of worm populations at fixed chronological ages throughout their lifespan. The distribution of age scores identified three stable post-developmental states and transitions. The first transition occurs at day 5 post-hatching, where a significant percentage of the population exists in both state I and state II. The temperature dependence of the timing of this transition (Q ₁₀?~?1.17) is too low to be explained by a stepwise process with an enzymatic or chemical rate-limiting step, potentially implicating a more complex mechanism. Individual animals at day 5 were sorted into state I and state II groups using the machine classifier and analyzed by microarray expression profiling. Despite being isogenic, grown for the same amount of time, and indistinguishable by eye, these two morphological states were confirmed to be molecularly distinct by hierarchical clustering and principal component analysis of the microarray results. These molecular differences suggest that pharynx morphology reflects the aging state of the whole organism. Our expression profiling yielded a gene set that showed significant overlap with those from three previous age-related studies and identified several genes not previously implicated in aging. A highly represented group of genes unique to this study is involved in targeted ubiquitin-mediated proteolysis, including Skp1-related (SKR), F-box-containing, and BTB motif adaptors.     

Recent Chemical Exposures and Blood Volatile Organic Compound Levels in a Large Population-Based Sample

Little is known about factors that influence blood levels of volatile organic compounds in nonoccupationally exposed populations. The authors examined the possible relationship between recent self-reported chemical exposures and elevated blood volatile organic compound levels among 982 adult participants in the Third National Health and Nutrition Examination Survey. A strong dose-response effect was indicated (p < .001) for increasing lifetime pack-years of cigarettes smoked for elevated levels of toluene, styrene, and benzene. A positive dose-response effect was indicated for daily alcohol consumption with respect to elevated blood levels of 2-butanone and acetone. For volatile organic compounds typically found in 10-75% of the population, the establishment of a link with specific environmental exposures is relatively easy because there is less effect of confounding in this group. Some volatile organic compounds, however, are seen in less than 10% of the general population; finding these compounds at any level may warrant a search for a particular exposure.     

The Effects of Connectedness on Health-Promoting and Health-Compromising Behaviors in Adolescents: Evidence from a Statewide Survey

Using a social ecological perspective, we examined the effects of connectedness in multiple domains on health-promoting and health-compromising behaviors among Asian American (AA), Pacific Islander (PI), and Caucasian/White American (WA) adolescents in California. After adjusting for age, gender, and socioeconomic status, the following consistent results emerged across the three ethnic groups: (a) community connectedness increased the odds of physical activity; (b) internal, family, and school connectedness decreased, whereas friend connectedness increased, the odds of substance use; and (c) internal and family connectedness decreased the odds of violent behavior. We also found specific ethnic variations pertaining to the effects of connectedness. Friend connectedness increased the odds of violent behavior for AAs and WAs, but not for PIs. Meanwhile, community connectedness increased the odds of substance use and violent behavior for AAs and PIs, but decreased the odds of these behaviors for WAs. Findings for healthy dietary behavior were inconsistent across ethnic groups and connectedness domains. Our overall findings suggest that the effects of connectedness were more salient for health-compromising behaviors than for health-promoting behaviors. Health prevention and intervention efforts in adolescents could target the role of their connectedness to their multiple social domains.