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ObjectivesTo develop and validate a values clarification tool, the Short Graphic Values History Tool (GVHT), designed to support person-centred decision making during serious illness.MethodsThe development phase included input from experts and laypersons and assessed acceptability with patients/family members. In the validation phase, we recruited additional participants into a before-after study. Our primary validation hypothesis was that the tool would reduce scores on the Decisional Conflict Scale (DCS) at 1-2 weeks of follow-up. Our secondary validation hypotheses were that the tool would improve values clarity (reduce scores) more than other DCS subscales and increase engagement in advance care planning (ACP) processes related to identification and discussion of one's values.ResultsIn the development phase, the tool received positive overall ratings from 22 patients/family members in hospital (mean score 4.3; 1=very poor; 5=very good) and family practice (mean score 4.5) settings. In the validation phase, we enrolled 157 patients (mean age 71.8 years) from family practice, cancer clinic and hospital settings. After tool completion, decisional conflict decreased (-6.7 points, 95% CI -11.1 to -2.3, p=0.003; 0-100 scale; N=100), with the most improvement seen in the values clarity subscale (-10.0 points, 95% CI -17.3 to -2.7, p=0.008; N=100), and the ACP-Values process score increased (+0.4 points, 95% CI 0.2 to 0.6, p=0.001; 1-5 scale; N=61).ConclusionsThe Short GVHT is acceptable to end users and has some measure of validity. Further study to evaluate its impact on decision making during serious illness is warranted.

Objective: People are living longer than ever before. Many arrive at a later stage of life in poor health and with inadequate financial and social resources. The purpose of this paper is to describe people's general state of preparedness for their future as older persons, identify specific attitudes towards ageing and key characteristics that portend a lesser degree of preparedness, and identify the issues that need greater emphasis. Design: Cross-sectional survey. Setting: 502 adult participants enlisted on an online polling panel in Canada. Methods: Demographics, attitudes towards the future self and ageing and the responses to the 'Preparedness for the Future Questionnaire' (Prep-FQ) were analysed. Descriptive statistics were used to highlight overall and domain scores (possible score 0-100). Regression models were used to link key demographic characteristics and attitudes to a lower Prep FQ score. Results: The average age of participants was 54.1 years old (range 30-91). The majority (97%) felt it was important to think about themselves as an older person, yet less than 25% of people regularly spent time thinking about what it would be like for them as an older person. The average score on the Prep FQ was 61.6 (range 25-99). Items with the lowest scores were related to advance serious illness planning (medical care, funeral and legacy planning). Factors associated with a higher Prep FQ score included being female, having more education, thinking about when they are older and feeling positive about themselves as an older person. Conclusion: Helping people think and plan ahead more for healthy ageing may help some people move forward with confidence in creating a long, high-quality life and high-quality death. Helping 'at-risk' people plan for serious illness in advance is a high-priority target for improving people's general state of preparedness for the future.

Context: The impact of alcohol consumption on risks for injury among rural adolescents is an important and understudied public health issue. Little is known about whether relationships between alcohol consumption and injury vary between rural and urban adolescents. Purpose: To examine associations between alcohol and medically attended injuries by urban-rural geographic status using a representative national sample of Canadian adolescents. Methods: The study involved a secondary analysis of a national sample of Canadian adolescents aged 11-15 years (n = 7,031) from the 2001-2002 Health Behavior in School-Aged Children Survey. Respondents were classified into 5 geographic categories of rural-urban status. Multiple logistic regression was used to examine the magnitude and homogeneity of associations between drinking patterns and adolescent injuries across these 5 geographic groupings. Findings: Higher rates of alcohol consumption and adolescent injuries were observed in more rural areas. Alcohol consumption was significantly associated with higher risks for injury occurrence with evidence of a dose-related pattern of risk. Associations between alcohol consumption and injury were consistent by urban-rural geographic status. Conclusions: Misuse of alcohol is an important potential cause of injury. Adolescents whose lifestyle includes alcohol consumption experience higher risks for injury, and this association is observed consistently by urban-rural geographic status. Findings of this study emphasize a need to intervene with high-risk adolescents as a tertiary prevention strategy, irrespective of geographic background.

Purpose Candida spp. are frequently recovered from endotracheal secretions in critically ill patients suspected of having ventilator-associated pneumonia. Observational studies reported an association with worse clinical outcomes but the effect of antifungal therapy in these patients remains unclear. We designed this pilot study to assess the feasibility of a larger trial and to evaluate inflammatory profiles and clinical outcomes in these patients. Methods We conducted a double-blind, placebo-controlled, multicenter pilot randomized trial of antifungal therapy in critically ill patients with a clinical suspicion of ventilator-associated pneumonia with positive airway secretion specimens for Candida spp. We also included an observational group without Candida spp. in their airway secretions. We measured recruitment rate, inflammatory and innate immune function profiles over time, and clinical outcomes. Results We recruited 60 patients into the randomized trial and 29 patients into the observational study. Markers of inflammation and all clinical outcomes were comparable between placebo and antifungal treatment group at baseline and over time. At baseline, plasma TNF-[alpha] levels were higher in patients with VAP and Candida compared to the observational group (mean ± SD) (21.8 ± 23.1 versus 12.4 ± 9.3 pg/ml, p = 0.02) and these patients had lower innate immune function as evidenced by reduced whole blood ex vivo LPS-induced TNF-[alpha] production capacity (854.8 ± 855.2 versus 1,559.4 ± 1,290.6 pg/ml, p = 0.01). Conclusions This study does not provide evidence to support a larger trial examining the efficacy of empiric antifungal treatment in patients with a clinical suspicion of ventilator-associated pneumonia and Candida in the endotracheal secretions. The presence of Candida in the lung may be associated with persistent inflammation and immunosuppression., Author(s): Martin Albert [sup.1], David Williamson [sup.2], John Muscedere [sup.3], Francois Lauzier [sup.4], Coleman Rotstein [sup.5], Salmaan Kanji [sup.6], Xuran Jiang [sup.7], Mark Hall [sup.8], Daren Heyland [sup.3] [sup.7] Author [...]