Abstract Cluster analysis refers to a class of data reduction methods used for sorting cases, observations, or variables of a given dataset into homogeneous groups that differ from each other. The present paper focuses on hierarchical agglomerative cluster analysis, a statistical technique where groups are sequentially created by systematically merging similar clusters together, as dictated by the distance and linkage measures chosen by the researcher. Specific distance and linkage measures are reviewed, including a discussion of how these choices can influence the clustering process by comparing three common linkage measures (single linkage, complete linkage, average linkage). The tutorial guides researchers in performing a hierarchical cluster analysis using the SPSS statistical software. Through an example, we demonstrate how cluster analysis can be used to detect meaningful subgroups in a sample of bilinguals by examining various language variables.

The study examined individual differences in code-switching to determine the relationship between code-switching frequency and performance in verbal and non-verbal task switching. Seventy-eight Cantonese-English bilinguals completed a semi-structured conversation to quantify natural code-switching, a verbal fluency task requiring language switching, and two non-verbal switching tasks. Participants who engaged in more conversational code-switching showed smaller costs in verbal task switching than those who switched languages less frequently. Participants performed similarly to bilinguals in previous studies on non-verbal switching tasks, but in this case performance was not linked to the degree of conversational code switching. The difference in the influence of code-switching for verbal and non-verbal executive control tasks indicates a dissociation between domains for the mechanism of task switching.

BackgroundHome care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario.MethodsA retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences.ResultsThe study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death.ConclusionsOur study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring.

Background: The occurrence of adverse events (AEs) in care settings is a patient safety concern that has significant consequences across healthcare systems. Patient safety problems have been well documented in acute care settings; however, similar data for clients in home care (HC) settings in Canada are limited. The purpose of this Canadian study was to investigate AEs in HC, specifically those associated with hospitalization or detected through the Resident Assessment Instrument for Home Care (RAI-HC). Method: A retrospective cohort design was used. The cohort consisted of HC clients from the provinces of Nova Scotia, Ontario, British Columbia and the Winnipeg Regional Health Authority. Results: The overall incidence rate of AEs associated with hospitalization ranged from 6% to 9%. The incidence rate of AEs determined from the RAI-HC was 4%. Injurious falls, injuries from other than fall and medication-related events were the most frequent AEs associated with hospitalization, whereas new caregiver distress was the most frequent AE identified through the RAI-HC. Conclusion: The incidence of AEs from all sources of data ranged from 4% to 9%. More resources are needed to target strategies for addressing safety risks in HC in a broader context. Tools such as the RAI-HC and its Clinical Assessment Protocols, already available in Canada, could be very useful in the assessment and management of HC clients who are at safety risk. Résumé Contexte : L' occurrence d' événements indésirables (EI) dans les établissements de soins est une préoccupation en matière de sécurité des patients qui a des répercussions significatives dans les systèmes de services de santé. Les problèmes touchant la sécurité des patients sont bien documentés pour les établissements de soins de courte durée; cependant, de telles données pour les clients qui reçoivent des soins à domicile au Canada sont plus rares. Cette étude canadienne a pour objet d' examiner la question des EI dans le contexte des soins à domicile, particulièrement ceux qui sont associés à l'hospitalisation ou qui sont détectés à l' aide du Resident Assessment Instrument for Home Care (RAI-HC). Méthode : Nous avons effectué une étude rétrospective de cohorte. La cohorte était formée de clients recevant des soins à domicile en Nouvelle-Écosse, en Ontario, en Colombie-Britannique et sur le territoire de l'Office régional de la santé de Winnipeg. Résultats : Le taux d'incidence général des EI associés à une hospitalisation variait de 6 % à 9 %. Le taux d'incidence des EI déterminés à l' aide du RAI-HC était de 4 %. Les EI les plus fréquemment associés à l'hospitalisation sont les blessures causées par une chute, les autres types de blessures et les événements liés à la prise de médicaments, tandis que l'EI le plus fréquemment détecté à l' aide du RAI-HC est la détresse des nouveaux soignants. Conclusion : L'incidence des EI provenant de toutes les sources de données varie de 4 % à 9 %. Il faut davantage de ressources pour concevoir des stratégies afin de traiter les risques liés à la ...

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