Press release
Study sheds light on quality of care in nursing homes
p. 1441 Quality of care in unlicensed homes for the aged in the Eastern Townships of Quebec — G. Bravo, PhD; et al [ abstract ]
p. 1463 "Mine own countree": quality of care in nursing homes — J. Chouinard [full text]
An important issue concerning nursing homes is that some are licensed, and therefore must meet government standards of care, and some are unlicensed. Unlicensed homes are generally smaller with fewer staff caring for residents requiring less intensive care. However, previous research shows that as these residents age, their care requirements increase. Therefore, it remains important to determine if the unlicensed homes provide high quality care.
In their study comparing quality of care in licensed versus unlicensed nursing homes in Quebec, Gina Bravo and colleagues found that while unlicensed homes performed worse in the provision and management of physical care, the overall quality of care was similar in both types of facility. However, they also determined that 25% of the homes, both licensed and unlicensed, provided inadequate care to at least 1 resident.
They caution that reasons for providing inadequate care may vary, and also note that residents who received inadequate care were concentrated in a small number of facilities, which generally had fewer than 40 residents.
In an accompanying editorial, Jean Chouinard argues for the establishment of ongoing testing of the quality of care provided in all nursing homes.
Danger on the bright side of the road
p. 1471 Living a "shady life": sun-protective behaviour for Canadians — John E. Adam, MHA, MD [full text]
The threat of basal and squamous cell carcinoma — better known as skin cancer — should be enough to make even the most dedicated sun worshipper think twice about baking on beach this summer. However, after a long frigid winter most Canadians long to feel the warm sun, regardless of the potential dangers. To coincide with Sun Awareness Week (May 1723) John Adam says a commonsense approach to avoiding long-term skin damage caused by exposure to the sun is needed. He recommends physicians use the easily remembered SCHEGS mnemonic device when counseling patients on correct behaviour to combat the sun's harmful rays.
| S | Sunscreen with a sun protective factor of at least 15 |
| C | Clothing that is sun protective (tightly woven and dark in colour) |
| H | Hats with a wide, all-around brim |
| EG | Eyeglasses that block both UVA and UVB light |
| S | Shade, especially between 10 am and 4 pm |
Drug-resistant bugs raise concern
p. 1436 Risk factors for resistance to "first-line" antimicrobials among urinary tract isolates of Escherichia coli in children — Upton D. Allen, MB, BS, MSc; et al [ abstract ]
Organisms that have developed antimicrobial resistance are quickly becoming a global issue, but there are few data on the prevalence, patterns of resistance and risk factors associated with resistant organisms in children.
Upton Allen and colleagues tested isolated cultures of Escherichia coli (E. coli) taken from the urinary tracts of 967 children with urinary tract infections who were treated at the Children's Hospital of Eastern Ontario between December 1992 and December 1994. They found that 45% of the isolates were resistant to ampicillin and 31% were resistant to trimethoprim-sulfamethoxazole, both important first line therapies. They further determined that children admitted to hospital 1 or more times in the previous year were more likely to have resistant isolates than those with no admissions in the previous year.
The authors recommend that children who have had multiple admissions to hospital and/or have been prescribed a specific antimicrobial drug have their antimicrobial regimens reassessed periodically.
Blood pressure control part of the bigger puzzle
p. 1449 Impact of treating hyperlipidemia or hypertension to reduce the risk of death from coronary artery disease — Sylvie Perreault, PhD; et al [ abstract ]
Patients with hypertension, who are therefore at increased risk of heart attack and stroke, are often plagued by health risks such as obesity and high cholesterol levels. Physicians usually concentrate on controlling the hypertension before tackling the other risk factors but Sylvie Perreault and colleagues show this might be the wrong approach.
The authors studied the prevalence of several risk factors for coronary artery disease (CAD) in a random sample of more than 11 000 Canadians aged 3574 years to estimate whether treating hyperlipidemia (excess amounts of fat in the blood) or hypertension (high blood pressure) did more to reduce the risk of death from CAD.
They report that the potential benefits of treating hyperlipidemia among hypertensive adults demonstrate the need for screening and treating cardiovascular problems other than hypertension.
