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Abstracts
New article by Shannon Scott
Protocol for a systematic review of the use of narrative storytelling and visual-arts-based approaches as knowledge translation tools in healthcare
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Scott SD, Brett-Maclean P, Archibald M, Hartling L.
Systematic reviews 2013 Mar 20;2(1):19
BACKGROUND: The arts are powerful, accessible forms of communication that have the potential to impart knowledge by attracting interest and developing meaningful connections. Knowledge translation aims to reduce the ‘evidence-practice’ gap by developing, implementing and evaluating strategies designed to enhance awareness and promote behavior change congruent with research evidence. Increasingly, innovative approaches such as narrative storytelling and other arts-based interventions are being investigated to bridge the growing gap between practice and research. This study is the first to systematically identify and synthesize current research on narrative storytelling and visual art to translate and disseminate health research. METHODS: A health research librarian will develop and implement search strategies designed to identify relevant evidence. Studies will be included if they are primary research employing narrative storytelling and/or visual art as a knowledge translation strategy in healthcare. Two reviewers will independently perform study selection, quality assessment, and data extraction using standard forms. Disagreements will be resolved through discussion or third party adjudication. Data will be grouped and analyzed by research design, type of knowledge translation strategy (that is, a narrative or visual-arts-based approach), and target audience. An overall synthesis across all studies will be conducted. DISCUSSION: The findings from this research project will describe the ‘state of the science’ regarding the use of narrative storytelling and visual art as knowledge translation strategies. This systematic review will provide critical information for: (1) researchers conducting knowledge translation intervention studies; (2) nursing, medicine, and allied healthcare professionals; (3) healthcare consumers, including patients and families; and (4) decision makers and knowledge users who are charged to increase use of the latest research in healthcare settings.
CALL FOR PROPOSALS: Canadian Journal on Aging
DEADLINE: Monday April 15, 2013
The Canadian Journal on Aging/ La revue canadienne du vieillissement invites proposals for special issues or sections of the journal to be published in 2014 and/or 2015. Topic areas are open but should fall within the scope of the journal.
CALL FOR PAPERS: Ageing International
DEADLINE for Submission: October 15, 2013
The purpose of the proposed special issue is to examine the issues related to Ageing in USA and other countries. This issue is open , but not limited, to theoretical and empirical papers in international health, nursing homes, health economics policy, healthcare financing, health disparities for the elderly.
Grants & Awards
International Primary Care Research Leadership Programme
30 June 2013-5 July 2013, University of Oxford, Oxford UK
DEADLINE 29 March 2013
The International Primary Care Research Leadership programme is designed to foster and develop future leaders in primary care research. The programme consists of three residential meetings in Oxford designed to help participants explore different aspects of leadership in primary care research.
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Methodology
Bibliometrics
Aging
KT
What supports physiotherapists’ use of research in clinical practice? A qualitative study in Sweden.
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Dannapfel P, Peolsson A, Nilsen P.
Implementation science : IS 2013 Mar 14;8(1):31
Background Evidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice. Methods Patients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis. Results Analysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education). Conclusions Supportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.
Exploring attitudes and barriers toward the use of evidence-based nursing among nurse managers in Taiwanese residential aged care facilities.
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Chang HC, Jones MK, Russell C.
Journal of gerontological nursing 2013 Feb;39(2):36-42
This article reports findings from a qualitative study on nurse managers’ perspectives of evidence-based practice (EBP) in residential aged care facilities (RACFs) in Taiwan. Six RACFs were randomly selected for inclusion in the study. The sample consisted of the nurse manager from each facility (N = 6) who participated in an in-depth interview. Thematic qualitative content analysis was used to identify patterns of experience. The majority of managers expressed positive attitudes toward research and EBP but reported little experience in its implementation. Barriers to EBP included individual barriers such as lack of motivation and confidence to embrace change. Research-related barriers included difficulty in finding and understanding research articles, and systemic barriers included lack of funding and time, lack of authority, and workplace culture. Some implications of these findings for policy and practice are discussed. Copyright 2013, SLACK Incorporated.
An innovative approach to facilitating nursing research.
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Nixon E, Young S, Sellick V, Wright K.
British journal of nursing (Mark Allen Publishing) 2013 Feb 14-28;22(3):160-2, 164-7
BACKGROUND: Competing demands on the clinical time of nurses and midwives presents challenges to developing a research active culture. AIM: To engage nurses and midwives in a trust-wide research project. METHOD: A needs assessment of the local obstacles to participating in research was undertaken and a nursing and midwifery research strategy developed by representatives from clinical, research and academic departments. Following consultation with nursing and midwifery groups, an infection control research project was initiated and participatory workshops established. FINDINGS: In total 50 nurses and midwives contributed to questionnaire design, data collection and analysis. Initial results were discussed at nursing/midwifery forums and presented at a newly formed grand round. Overall there were 573 nursing and midwifery contacts throughout the research process. CONCLUSIONS: This approach to facilitating nursing and midwifery research across an NHS trust has enabled large numbers of clinical staff to experience and contribute to a ‘live’ research project.
Assessing availability of scientific journals, databases, and health library services in Canadian Health Ministries: a cross-sectional study. 
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Leon G, Ouimet M, Lavis JN, Grimshaw J, Gagnon MP.
Implementation science : IS 2013 Mar 21;8(1):34
BACKGROUND: Evidence-informed health policymaking logically depends on timely access to research evidence. To our knowledge, despite the substantial political and societal pressure to enhance the use of the best available research evidence in public health policy and program decision making, there is no study addressing availability of peer-reviewed research in Canadian health ministries.Objectives: To assess availability of (1) a purposive sample of high-ranking scientific journals, (2) bibliographic databases, and (3) health library services in the fourteen Canadian health ministries. METHODS: From May to October 2011, we conducted a cross-sectional survey among librarians employed by Canadian health ministries to collect information relative to availability of scientific journals, bibliographic databases, and health library services. Availability of scientific journals in each ministry was determined using a sample of 48 journals selected from the 2009 Journal Citation Reports (Sciences and Social Sciences Editions). Selection criteria were: relevance for health policy based on scope note information about subject categories and journal popularity based on impact factors. RESULTS: We found that the majority of Canadian health ministries did not have subscription access to key journals and relied heavily on interlibrary loans. Overall, based on a sample of high-ranking scientific journals, availability of journals through interlibrary loans, online and print-only subscriptions was estimated at 63%, 28% and 3%, respectively. Health Canada had a 2.3-fold higher number of journal subscriptions than that of the provincial ministries’ average. Most of the organisations provided access to numerous discipline-specific and multidisciplinary databases. Many organisations provided access to the library resources described through library partnerships or consortia. No professionally led health library environment was found in four out of fourteen Canadian health ministries (i.e. Manitoba Health, Northwest Territories Department of Health and Social Services, Nunavut Department of Health and Social Services and Yukon Department of Health and Social Services). CONCLUSIONS: There is inequity in availability of peer-reviewed research in the fourteen Canadian health ministries. This inequity could present a problem, as each province and territory is responsible for formulating and implementing evidence-informed health policies and services for the benefit of its population.
Policy to implementation: evidence-based practice in community mental health — study protocol
Beidas R, Aarons G, Barg F, Evans A, Hadley T, Hoagwood K, et al.
Implementation Science 2013;8(1):38
Background Evidence-based treatments are not widely available in community mental health settings. In response to the call for implementation of evidence-based treatments in the United States, states and counties have mandated behavioral health reform through policies and other initiatives. Evaluations of the impact of these policies on implementation are rare. A systems transformation about to occur in Philadelphia, Pennsylvania, offers an important opportunity to prospectively study implementation in response to a policy mandate. Methods Using a prospective sequential mixed-methods design, with observations at multiple points in time, we will investigate the responses of staff from 30 community mental health clinics to a policy from the Department of Behavioral Health encouraging and incentivizing providers to implement evidence-based treatments to treat youth with mental health problems. Study participants will be 30 executive directors, 30 clinical directors, and 240 therapists. Data will be collected prior to the policy implementation, and then at two and four years following policy implementation. Quantitative data will include measures of intervention implementation and potential moderators of implementation (i.e., organizational- and leader-level variables) and will be collected from executive directors, clinical directors, and therapists. Measures include self-reported therapist fidelity to evidence-based treatment techniques as measured by the Therapist Procedures Checklist-Revised, organizational variables as measured by the Organizational Social Context Measurement System and the Implementation Climate Assessment, leader variables as measured by the Multifactor Leadership Questionnaire, attitudes towards EBTs as measured by the Evidence-Based Practice Attitude Scale, and knowledge of EBTs as measured by the Knowledge of Evidence- Based Services Questionnaire. Qualitative data will include semi-structured interviews with a subset of the sample to assess the implementation experience of high-, average-, and low-performing agencies. Mixed methods will be integrated through comparing and contrasting results from the two methods for each of the primary hypotheses in this study. Discussion Findings from the proposed research will inform both future policy mandates around implementation and the support required for the success of these policies, with the ultimate goal of improving the quality of treatment provided to youth in the public sector.
What shapes the influence evidence has on policy? The key lesson that emerges from this paper is the primacy of politics in shaping how evidence is used. In order to influence the policy process, the research community must understand both the technocratic and the political aspects of policymaking, and how these shape the choices and incentives of policy elites. The paper proposes guidelines for integrating political economy analysis into different stages of the research and communication process. It addresses three main questions:
- What are the assumptions behind and problems with the concept of evidence-based policy and what can be learnt from this?
- What prevents the effective utilisation of research in policymaking?
- How can we put into practice what we know about the role of politics in shaping how evidence is used?
The paper draws on some examples from Young Lives, a longitudinal study of childhood poverty in Ethiopia, India, Vietnam and Peru, and contains case studies of how researchers engaged with policymakers.
Health Care Administration & Organization
Analyzing the nursing organizational structure and process from a scheduling perspective.
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Maenhout B, Vanhoucke M.
Health care management science 2013 Mar 1
The efficient and effective management of nursing personnel is of critical importance in a hospital’s environment comprising approximately 25 % of the hospital’s operational costs. The nurse organizational structure and the organizational processes highly affect the nurses’ working conditions and the provided quality of care. In this paper, we investigate the impact of different nurse organization structures and different organizational processes for a real-life situation in a Belgian university hospital. In order to make accurate nurse staffing decisions, the employed solution methodology incorporates shift scheduling characteristics in order to overcome the deficiencies of the many phase-specific methodologies that are proposed in the academic literature.
Observing how RNs use clinical time in a nursing home: a pilot study.
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Dellefield ME, Harrington C, Kelly A.
Geriatric nursing (New York, N.Y.) 2012 Jul-Aug;33(4):256-263
Registered nurses (RNs) working in nursing homes (NHs) are a scarce professional resource. Their responsibilities include direct (e.g., assessment, physical care, and medication administration) and indirect care (e.g., documentation, supervision, and other activities performed away from the resident to manage their care environment). The purpose of the study was to describe the direct and indirect care distribution of RNs working day shift in an NH. All RN care was observed, although RN care associated with pressure ulcer prevention as a clinical outcome was highlighted. Work sampling was conducted using a personal data assistant-based RN Observation Measure. RNs spent 59% of their time on indirect care. Little direct care could be linked with specific clinical categories relevant to pressure ulcer prevention. RNs are challenged to use RN clinical time more strategically. Copyright © 2012 Mosby, Inc. All rights reserved.
King’s Fund: Making integrated care happen at scale and pace
March 2013
The current fragmented services in health and social care fail to meet the needs of the population. A shift to an approach that develops integrated models of care for patients, especially older people and those with long-term conditions, can improve the patient experience and the outcomes and efficiency of care. Making integrated care happen at scale and pace: Lessons from experience is intended to support the process of converting policy intentions into meaningful and widespread change on the ground. The authors summarise 16 steps that need to be taken to make integrated care a reality and draw on work by The King’s Fund and others to provide examples of good practice.
This PHI report provides a thorough analysis of the home care and personal care industries in the U.S., as well as of the workers who provide both types of care. The authors detail the many difficulties facing workers in both fields, including uncompetitive wages with little to no benefits offered, inconsistent and often inadequate training requirements, high injury rates, and unpredictable hours. The report lists several recommendations to improve the quality of these jobs.
Health Care Innovation and Quality Assurance
Exploratory study of nursing home factors associated with successful implementation of clinical decision support tools for pressure ulcer prevention.
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Sharkey S, Hudak S, Horn SD, Barrett R, Spector W, Limcangco R.
Advances in Skin & Wound Care 2013 Feb;26(2):83-92; quiz p.93-4
OBJECTIVES: To determine those factors that are associated with nursing homes’ success in implementing the On-Time quality improvement (QI) for pressure ulcer prevention program and integrating health information technology (HIT) tools into practice at the unit level. DESIGN: Observational study with quantitative analysis of nursing home characteristics, team participation levels, and implementation milestones collected as part of a QI program. SETTING: Fourteen nursing homes in Washington, District of Columbia, participating in the On-Time Pressure Ulcer Prevention program. MAIN OUTCOME MEASURES: The nursing home level of implementation was measured by counting the number of implementation milestones achieved after at least 9 months of implementation effort. MAIN RESULTS: After at least 9 months of implementation effort, 36% of the nursing homes achieved level III, a high level of implementation, of the On-Time QI-HIT program. Factors significantly associated with high implementation were high level of involvement from the administrator or director of nursing, high level of nurse manager participation, presence of in-house dietitian, high level of participation of staff educator and QI personnel, presence of an internal champion, and team’s openness to redesign. One factor that was identified as a barrier to high level of implementation was higher numbers of health inspection deficiencies per bed. CONCLUSION: The learning from On-Time QI offers several lessons associated with facility factors that contribute to high level of implementation of a QI-HIT program in a nursing home.
Engaging home health care providers in a fall prevention best practice initiative.
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Shaw J, Sidhu K, Kearney C, Keeber M, McKay S.
Home health care services quarterly 2013 Jan;32(1):1-16
This article reports key findings regarding the engagement of home health care providers in the implementation of a fall prevention best practice initiative. Participants were 29 home health care providers from physiotherapy, occupational therapy, and nursing. Each participant completed a self-efficacy for evidence-based practice survey, and a smaller subgroup of volunteers participated in focus groups for each discipline individually. Findings suggest home health care providers value the implementation of best practice in everyday care, but may need to be highly involved in the development of best practice initiatives and implementation strategies to foster engagement with the initiative in everyday practice.
Refining a taxonomy for guideline implementation: results of an exercise in abstract classification.
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Mazza D, Bairstow P, Buchan H, Chakraborty SP, Van Hecke O, Grech C, et al.
Implementation science : IS 2013 Mar 15;8(1):32-5908-8-32
BACKGROUND: To better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strategies. METHODS: A draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. We piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. Five authors classified the strategies in each abstract individually. Final categorisation was then carried out in a face-to-face consensus meeting involving three authors. RESULTS: The implementation strategies described in 71 conference abstracts were classified. Approximately 15.5% of abstracts utilised strategies that could not be categorised using the draft taxonomy. Of those strategies that could be categorised, the majority were professionally focused (57%). A total of 41% of projects used only one implementation strategy, with 29% using two and 31% three or more. The three most commonly used strategies were changes in quality assurance, quality improvement and/or performance measurement systems, changes in information and communication technology, and distribution of guideline materials (via hard-copy, audio-visual and/or electronic means). CONCLUSIONS: Further refinement of the draft taxonomy is required to provide hierarchical dimensions and granularity, particularly in the areas of patient-focused interventions, those concerned with audit and feedback and quality improvement, and electronic forms of implementation, including electronic decision support.
Evidence-Based Practice Process Quality Assessment: EPQA Guidelines.
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Lee MC, Johnson KL, Newhouse RP, Warren JI.
Worldviews on evidence-based nursing / Sigma Theta Tau International, Honor Society of Nursing 2013 Feb 6
BACKGROUND: Nurses are increasingly engaged in evidence-based practice (EBP) processes to answer significant questions and guide nursing practice. However, there are no criteria to evaluate the rigor and quality of EBP projects, making the decision about whether to implement a recommended practice change questionable. AIM: The purpose of this study was to achieve consensus among nationally recognized EBP nurse experts on criteria that could be used to appraise the methodological quality of an EBP project as well as to serve as a guideline to plan for an EBP project. METHODS: A modified two-round Delphi method was used. Twenty-three nationally known EBP experts were invited by e-mail to participate in completing a web-based questionnaire. RESULTS: Items converged after two rounds (response rate [52% (n = 12/23) for Round 1 and 35% (n = 8/23) for Round 2]) and resulted in the development of the EBP Process Quality Assessment (EPQA) guidelines that include 34 items. IMPLICATIONS: The EPQA guidelines can be used to guide and evaluate the methodological quality of EBP projects. They can be used in practice settings to critically appraise an EBP project prior to translating recommendations into practice. Educators can use the EPQA guidelines as a rubric to evaluate student EBP projects. EPQA guidelines can be utilized in research to assess interventions and to build or improve EBP capacity. © 2013 Sigma Theta Tau International.
Process antecedents of challenging, under-cover and readily-adopted innovations
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Adams R, Tranfield D, Denyer D.
Journal of Health, Organisation and Management 2013;27(1):42-63
Purpose: The purpose of the study is to test the utility of a taxonomy of innovation based on perceived characteristics in the context of healthcare by exploring the extent to which discrete innovation types could be distinguished from each other in terms of process antecedents. Design/methodology/approach: A qualitative approach was adopted to explore the process antecedents of nine exemplar cases of “challenging”, “under-cover” and “readily-adopted” healthcare innovations. Data were collected by semi-structured interview and from secondary sources, and content analysed according to a theoretically informed framework of innovation process. Cluster analysis was applied to determine whether innovation types could be distinguished on the basis of process characteristics. Findings: The findings provide moderate support for the proposition that innovations differentiated on the basis of the way they are perceived by potential users exhibit different process characteristics. Innovations exhibiting characteristics previously believed negatively to impact adoption may be successfully adopted but by a different configuration of processes than by innovations exhibiting a different set of characteristics. Research limitations/implications: The findings must be treated with caution because the sample consists of self-selected cases of successful innovation and is limited by sample size. Nevertheless, the study sheds new light on important process differences in healthcare innovation. Practical implications: The paper offers a heuristic device to aid clinicians and managers to better understand the relatively novel task of promoting and managing innovation in healthcare. The paper advances the argument that there is under-exploited opportunity for cross-disciplinary organisational learning for innovation management in the NHS. If efficiency and quality improvement targets are to be met through a strategy of encouraging innovation, it may be advantageous for clinicians and managers to reflect on what this study found mostly to be absent from the processes of the innovations studied, notably management commitment in the form of norms, resource allocation and top management support. Originality/value: This paper is based on original empirical work. It extends previous adoption related studies by applying a configurational approach to innovation attributes to offer new insights on healthcare innovation and highlight the importance of attention to process. © Emerald Group Publishing Limited.
Changes in patient health outcomes from admission to discharge in acute care.
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McGillis Hall L, Wodchis WP, Ma X, Johnson S.
Journal of nursing care quality 2013 Jan-Mar;28(1):8-16
Clinical databases comprising data that are available at a national level provide the opportunity to explore the relationships between nursing interventions and patient health outcomes. This research examined baseline and changes in patient health outcomes between admission and discharge using data from 59 157 acute-care hospital-based patient records at 44 hospitals in Canada. Statistically significant improvements in all of the health outcomes were noted, with the exception of pressure ulcers. The standardized indicators offer a mechanism for evaluating the effectiveness and quality of nursing care interventions.
Engaging primary care practitioners in quality improvement: making explicit the program theory of an interprofessional education intervention.
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Vachon B, Desorcy B, Camirand M, Rodrigue J, Quesnel L, Guimond C, et al.
BMC health services research 2013 Mar 20;13(1):106
BACKGROUND: The scientific literature continues to advocate interprofessional collaboration (IPC) as a key component of primary care. It is recommended that primary care groups be created and configured to meet the healthcare needs of the patient population, as defined by patient demographics and other data analyses related to the health of the population being served. It is further recommended that the improvement of primary care services be supported by the delivery of feedback and performance measurements. This paper describes the theory underlying an interprofessional educational intervention developed in Quebec’s Monteregie region (Canada) for the purpose of improving chronic disease management in primary care. The objectives of this study were to explain explicitly the theory underlying this intervention, to describe its components in detail and to assess the intervention’s feasibility and acceptability. METHOD: A program impact theory-driven evaluation approach was used. Multiple sources of information were examined to make explicit the theory underlying the education intervention: 1) a literature review and a review of documents describing the program’s development; 2) regular attendance at the project’s committee meetings; 3) direct observation of the workshops; 4) interviews of workshop participants; and 5) focus groups with workshop facilitators. Qualitative data collected were analysed using thematic analysis. RESULTS: The theoretical basis of the interprofessional education intervention was found to be work motivation theory and reflective learning. Five themes describing the workshop objectives emerged from the qualitative analysis of the interviews conducted with the workshop participants. These five themes were the importance of: 1) adopting a regional perspective, 2) reflecting, 3) recognizing gaps between practice and guidelines, 4) collaborating, and 5) identifying possible practice improvements. The team experienced few challenges implementing the intervention. However, the workshop’s acceptability was found to be very good. CONCLUSION: Our observation of the workshop sessions and the interviews conducted with the participants confirmed that the objectives of the education intervention indeed targeted the improvement of interprofessional collaboration and quality of care. However, it is clear that a three-hour workshop alone cannot lead to major changes in practice. Long-term interventions are needed to support this complex change process.
A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice
Flottorp S, Oxman A, Krause J, Musila N, Wensing M, Godycki-Cwirko M, et al.
Implementation Science 2013;8(1):35
Background Determinants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive, integrated checklist of determinants of practice (the TICD checklist). Methods We performed a systematic review of frameworks of determinants of practice followed by a consensus process. We searched electronic databases and screened the reference lists of key background documents. Two authors independently assessed titles and abstracts, and potentially relevant full text articles. We compiled a list of attributes that a checklist should have: comprehensiveness, relevance, applicability, simplicity, logic, clarity, usability, suitability, and usefulness. We assessed included articles using these criteria and collected information about the theory, model, or logic underlying how the factors (determinants) were selected, described, and grouped, the strengths and weaknesses of the checklist, and the determinants and the domains in each checklist. We drafted a preliminary checklist based on an aggregated list of determinants from the included checklists, and finalized the checklist by a consensus process among implementation researchers. Results We screened 5,778 titles and abstracts and retrieved 87 potentially relevant papers in full text. Several of these papers had references to papers that we also retrieved in full text. We also checked potentially relevant papers we had on file that were not retrieved by the searches. We included 12 checklists. None of these were completely comprehensive when compared to the aggregated list of determinants and domains. We developed a checklist with 57 potential determinants of practice grouped in seven domains: guideline factors, individual health professional factors, patient factors, professional interactions, incentives and resources, capacity for organizational change, and social, political, and legal factors. We also developed five worksheets to facilitate the use of the checklist. Conclusions Based on a systematic review and a consensus process we developed a checklist that aims to be comprehensive and to build on the strengths of each of the 12 included checklists. The checklist is accompanied with five worksheets to facilitate its use in implementation research and quality improvement projects.
Research Methodology
A graphical tool for locating inconsistency in network meta-analyses.
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Krahn U, Binder H, Konig J.
BMC medical research methodology 2013 Mar 9;13(1):35
BACKGROUND: In network meta-analyses, several treatments can be compared by connecting evidence from clinical trials that have investigated two or more treatments. The resulting trial network allows estimating the relative effects of all pairs of treatments taking indirect evidence into account. For a valid analysis of the network, consistent information from different pathways is assumed. Consistency can be checked by contrasting effect estimates from direct comparisons with the evidence of the remaining network. Unfortunately, one deviating direct comparison may have side effects on the network estimates of others, thus producing hot spots of inconsistency. METHODS: We provide a tool, the net heat plot, to render transparent which direct comparisons drive each network estimate and to display hot spots of inconsistency: this permits singling out which of the suspicious direct comparisons are sufficient to explain the presence of inconsistency. We base our methods on fixed-effects models. For disclosure of potential drivers, the plot comprises the contribution of each direct estimate to network estimates resulting from regression diagnostics. In combination, we show heat colors corresponding to the change in agreement between direct and indirect estimate when relaxing the assumption of consistency for one direct comparison. A clustering procedure is applied to the heat matrix in order to find hot spots of inconsistency. RESULTS: The method is shown to work with several examples, which are constructed by perturbing the effect of single study designs, and with two published network meta-analyses. Once the possible sources of inconsistencies are identified, our method also reveals which network estimates they affect. CONCLUSION: Our proposal is seen to be useful for identifying sources of inconsistencies in the network together with the interrelatedness of effect estimates. It opens the way for a further analysis based on subject matter considerations.
Developing the next generation of dissemination and implementation researchers: insights from initial trainees.
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Stamatakis KA, Norton WE, Stirman SW, Melvin C, Brownson RC.
Implementation science : IS 2013 Mar 12;8(1):29
BACKGROUND: Dissemination and implementation (D&I) research is a relatively young discipline, underscoring the importance of training and career development in building and sustaining the field. As such, D&I research faces several challenges in designing formal training programs and guidance for career development. A cohort of early-stage investigators (ESI) recently involved in an implementation research training program provided a resource for formative data in identifying needs and solutions around career development. RESULTS: Responses outlined fellows’ perspectives on the perceived usefulness and importance of, as well as barriers to, developing practice linkages, acquiring additional methods training, academic advancement, and identifying institutional supports. Mentorship was a cross-cutting issue and was further discussed in terms of ways it could foster career advancement in the context of D&I research. CONCLUSIONS: Advancing an emerging field while simultaneously developing an academic career offers a unique challenge to ESIs in D&I research. This article summarizes findings from the formative data that outlines some directions for ESIs and provides linkages to the literature and other resources on key points.
Qualitative Research on Dementia in Ethnically Diverse Communities: Fieldwork Challenges and Opportunities.
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Shanley C, Leone D, Santalucia Y, Adams J, Ferrerosa-Rojas JE, Kourouche F, et al.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Mar 19
Australia, like other ethnically diverse societies, needs to provide culturally appropriate health care to all its citizens. One way of facilitating this is to ensure that health services research adequately reflects the circumstances and needs of culturally and linguistically diverse (CALD) communities within the population. This article discusses the fieldwork phase of a qualitative research project on dementia caregiving in 4 CALD communities in south west Sydney, Australia. Rather than focusing on the study results-which have been published elsewhere-this article presents and discusses crucial fieldwork issues that arose in the conduct of the project, particularly regarding participant recruitment and facilitation of focus groups. In being transparent about some of the difficulties encountered and how these were managed, we offer suggestions for other researchers wanting to include CALD communities in a meaningful way in their research projects.
Caught in the web: informed consent for online health research.
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Vayena E, Mastroianni A, Kahn J.
Science translational medicine 2013 Feb 20;5(173):173fs6
A context-specific approach to informed consent for Web-based health research can facilitate a dynamic research enterprise and maintain the public trust.
Bibliometrics
Exploring the bibliometric and semantic nature of negative results
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Gumpenberger C, Gorraiz J, Wieland M, Roche I, Schiebel E, Besagni D, et al.
Scientometrics 2013;95(1):277-297
Negative results are not popular to disseminate. However, their publication would help to save resources and foster scientific communication. This study analysed the bibliometric and semantic nature of negative results publications. The Journal of Negative Results in Biomedicine (JNRBM) was used as a role model. Its complete articles from 2002-2009 were extracted from SCOPUS and supplemented by related records. Complementary negative results records were retrieved from Web of Science in “Biochemistry” and “Telecommunications”. Applied bibliometrics comprised of co-author and co-affiliation analysis and a citation impact profile. Bibliometrics showed that authorship is widely spread. A specific community for the publication of negative results in devoted literature is non-existent. Neither co-author nor co-affiliation analysis indicated strong interconnectivities. JNRBM articles are cited by a broad spectrum of journals rather than by specific titles. Devoted negative results journals like JNRBM have a rather low impact measured by the number of received citations. On the other hand, only one-third of the publications remain uncited, corroborating their importance for the scientific community. The semantic analysis relies on negative expressions manually identified in JNRBM article titles and abstracts and extracted to syntactic patterns. By using a Natural Language Processing tool these patterns are then employed to detect their occurrences in the multidisciplinary bibliographical database PASCAL. The translation of manually identified negation patterns to syntactic patterns and their application to multidisciplinary bibliographic databases (PASCAL, Web of Science) proved to be a successful method to retrieve even hidden negative results. There is proof that negative results are not only restricted to the biomedical domain. Interestingly a high percentage of the so far identified negative results papers were funded and therefore needed to be published. Thus policies that explicitly encourage or even mandate the publication of negative results could probably bring about a shift in the current scientific communication behaviour. © 2012 Akadémiai Kiadó, Budapest, Hungary.
Aging
Nutritional status among older residents with dementia in open versus special care units in municipal nursing homes: an observational study.
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Aukner C, Eide HD, Iversen PO.
BMC geriatrics 2013 Mar 14;13(1):26
BACKGROUND: Undernutrition is widespread among institutionalised elderly, and people suffering from dementia are at particularly high risk. Many elderly with dementia live in open units or in special care units in nursing homes. It is not known whether special care units have an effect on the nutritional status of the residents. The aim of this study was therefore to examine the nutritional status of residents with dementia in both open units and in special care units. METHODS: Among Oslo’s 29 municipal nursing homes, 21 participated with 358 residents with dementia or cognitive impairment, of which 46% lived in special care units. Nutritional status was assessed using the Malnutrition Universal Screening Tool and anthropometry. RESULTS: We found no differences (p > 0.05) in risk of undernutrition, body mass index, mid-upper arm muscle circumference or triceps skinfold thickness between residents in open units and those in special care units. Residents in special care units were significantly younger and stronger when measured with a hand-grip test. CONCLUSIONS: We found no difference in nutritional status between nursing home residents with dementia/cognitive impairment in open units versus in special care units.
Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes.
Non UofA Access
Allgaier AK, Kramer D, Saravo B, Mergl R, Fejtkova S, Hegerl U.
International journal of geriatric psychiatry 2013 Mar 6
OBJECTIVE: The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. METHODS: Data from 92 residents aged 65-97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. RESULTS: Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 (0.92) at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 (0.69) at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression (0.92), whereas the GDS-15 was sensitive only for major depression (0.85), but not for minor depression (0.54). For specificity, there was no significant difference between WHO-5 (0.79) and GDS-15 (0.88), but both instruments outperformed the GDS-4 (0.53). CONCLUSIONS: The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents. Copyright © 2013 John Wiley & Sons, Ltd.
The inquiry has found that although many older people receive care at home which respects and enhances their human rights, this is by no means a universal experience. It uncovered areas of real concern in the treatment of some older people and significant shortcomings in the way that care is commissioned by local authorities.
Alzheimer’s Society Low expectations report (UK)
2013
Alzheimer’s Society Low expectations report on attitudes on choice, care and community for people with dementia in care homes.
Alzheimer’s Association: 2013 Alzheimer’s Disease Facts and Figures (US)
2013
Specific information in this yeAr’s Alzheimer’s Disease Facts and Figures includes:
• Proposed new criteria and guidelines for diagnosing Alzheimer’s disease from the National Institute on Aging and the Alzheimer’s Association.
• Overall number of Americans with Alzheimer’s disease nationally and for each state.
• Proportion of women and men with Alzheimer’s and other dementias.
• Estimates of lifetime risk for developing Alzheimer’s disease.
• Number of family caregivers, hours of care provided, economic value of unpaid care nationally and for each state, and the impact of caregiving on caregivers.
• Number of deaths due to Alzheimer’s disease nationally and for each state, and death rates by age.
• Use and costs of health care, long-term care and hospice care for people with Alzheimer’s disease and other dementias.
• Number of long-distance caregivers and the special challenges they face.
In 2011, we carried out 100 unannounced inspections of NHS hospitals, and found that a ifth of these were failing to meet standards of dignity and nutrition on wards caring for older people. In 2012, we mirrored this programme, but this time looked at the care provided to older people across 500 care homes, including 217 homes registered to provide nursing care. Our inspections focused on respecting and involving people who use services, and meeting their nutritional needs.
Government of Ontario: Living Longer, Living Well
December 2012
While aging is inevitable, the proportion of Ontario’s population living longer and living well into their later years has never been greater. Our province is also aging faster than ever before. In 2011, there were 1,878,325 Ontarians aged 65 years and older, representing 14.6 per cent of the province’s overall population.1 However, as the boomers started turning 65 last year, this demographic imperative will continue well into the future. In fact, the number of older Ontarians, defined in this report as those 65 years and older, is expected to double over the next two decades. In the pages that follow, this Seniors Strategy seeks to lay out the findings and recommendations that we believe will help to define and shape, in the most sustainable ways possible, Ontario’s opportunity to achieve its vision to be the healthiest place in North America to grow up and grow old.
Events
UofA
Context and research implementation in German Nursing Homes
Presenter: Matthias Hoben
Tue, 9 April, 12:30 – 13:30 ECHA 5-001
This is a KUSP presention. Please join Matthias, a PhD candidate from Heidelberg University and postdoctoral candidate with Dr. Carole Estabrooks, to learn about his research.
Facilitation in the Implementation of Evidence in Nursing Practice: A Multi-Phase Inquiry
Presenter: Elizabeth Dogherty. Queens University, postdoctoral candidate
Thurs, 11 April, 12:00 – 13:00 ECHA 5-001
This is a KUSP presention. Please join Elizabeth, a postdoctoral candidate from Queen’s University, to learn about her research.
Complex budgeting and the dreaded budget justification in operating and programmatic grants
Presenter: Dr. Carole Estabrooks
Wednesday April 10, 2013 12:00-13:00 ECHA 5-140
This is presentation is co-sponsored by Dr. Estabrooks and the Health Systems AOE.
Quit Complaining! The Ethics of Complaints Resolution in Patient Care
Friday, 5 April 12:00-1:00pm Dvorkin Centre (2G2.07 WMC)
“To err is human; to forgive, divine”…or was that “to complain is human”? Health care organizations and health professionals confront a myriad of ethical challenges each day. Although “complaints management” isn’t a sexy genre of health ethics, it is on par in its ethical importance with highly publicized cases of withdrawing life-sustaining therapies at end of life. The potential implications such as the erosion of patient trust, compounding staff distress, and the subtle manipulation of the health system warrant a deeper look at the ethical undercurrents of “complaining”. In this session we will briefly explore the ethical tensions of complaints resolution and discuss the value of the complaints management process for clinicians at the bedside.
Testing the NIRN Implementation Model and the CFIR Implementation Constructs: Lessons Learned from a Multi-Site Implementation of Motivational Interviewing
Presenter: , Dr. Mel Barwick from the University of Toronto
Thursday April 11, 2013 13:00-14:00 L4-036
Implementation of evidence-based practices in mental health care is essential for improving health outcomes. Together, the NIRN model and CFIR constructs provide a comprehensive approach to guide the implementation process, but both frameworks require further empirical investigation. To this end, we implemented Motivational Interviewing in four child mental health organizations in Canada, using NIRN as a guide and measuring key CFIR constructs. These findings have significant implications for implementation, theory, research and practice. Please RSVP rachel.flynn@ualberta.ca
Non UofA
KGH Connect, 2013 Knowledge Exchange Conference – Transforming the patient experience
May 9-10, 2013 Kingston, ON
Kingston General Hospital is pleased to host Transforming the Patient Experience, a highly interactive knowledge exchange symposium about today’s leading approaches to patient- and family-centred care including collaborative practice models and interprofessional education.
Policy and Politics: Shaping Health Policy at the Intersection
May 13-14, 2013, Toronto, ON
Offered by the Bloomberg School of Nursing, University of Toronto. The acquisition of expertise in policy development and political skill has become increasingly important in the development of a successful leadership career in health care. This dynamic and interactive workshop will focus on ways health professionals can successfully navigate at the intersection of policy and politics. The workshop focus will be on demystifying political situations and processes and suggest strategies to further develop your effectiveness and confidence in the policy arena.
Health Data Users Day
May 27, 2013 Vancouver, BC
The Canadian Institute for Health Information (CIHI) invites you to explore innovative approaches to data use and analysis at a unique one-day event on Monday, May 27, that will be held with our colleagues from Statistics Canada and Population Data BC.
Online
KT Canada: Wikis and Collaborative Writing Applications as KT Interventions in Health Care
Presenter: Patrick Archambault, Université Laval
ECHA 3-001 10:00-11:00 MT
Learning Objectives
To learn about the existing evidence supporting the use of wikis and collaborative writing applications in healthcare
To learn about the barriers and facilitators in implementing a wiki and collaborative writing applications in healthcare
To learn about a theory-based approach to implement a wiki reminder system to implement best practices in trauma care
KT Canada: Workshop Exploring the Theoretical Domains Framework in Behaviour Change Research
In December 2012, KT Canada hosted a Workshop Exploring the Theoretical Domains Framework (TDF) in Behaviour Change Research. International and local experts presented on their use of the TDF in behavior change research. This workshop is now available online. Just follow the link above.
Courses
Programme Observatory Venice Summer School 2013
21-27 July, Venice, Italy, €1,950 (includes accommodation, meals and social programme)
Participants: Participants will be senior to mid-level decision-makers in health policy and management at a regional, national or European level. Candidates from Europe are preferred but if there is space, candidates from outside Europe may be considered.
The Summer School will build on participants’ own knowledge and expertise in public health and marshal the latest evidence on new developments to
- Provide a state of the art account of innovative strategies to improve population health
- Assess the implications of improved measurement (of burden of disease, determinants of health; health outcomes and well-being) for both old and new challenges;
- Interpret what innovative interventions mean for improving population health; and
- Draw practical policy and implementation lessons to deliver better public health interventions.
populationdataBC: Latent Variable Modeling
July 8-12, 2013 Vancouver BC
$750 (grad students), $850 (early bird before April 30), $950 (after April 30)
This five-day intensive course will focus on the practical application of latent variable modeling with specific applications for health and social science researchers. Mornings will consist of a series of lectures and computer demonstrations covering the theory and practice of latent variable modeling methods. Afternoons will include hands-on applications of specific data analysis techniques. Participants will learn how to apply specific modeling methods in the development of instruments, measures and survey designs. Topics include: factor analysis (FA) including item response models via FA, multi-group FA, and mixture latent class models.
populationdataBC: Expanding Evaluation through Use of Administrative Data
Friday May 31st, 2013, Vancouver, BC $250, $195 (students)
During this one day workshop, participants will increase their understanding of the types of questions that can be answered through administrative data, explore the strengths and limitations of using administrative data in evaluations, and appreciate the considerations for using administrative data. Through the examination of a case study, participants will also hear about lessons learned, success factors, and best practices for using administrative data in evaluations.
News
National Post Editorial Board: Our growing elder-care crisis
This editorial discusses resident-on-resident violence in LTC facilities.
NY Times: Healing the Hospital Hierarchy
A hospital is, by its nature, the scene of constant life-or-death situations. It’s the work we nurses, doctors and other health professionals do; we chose it. The threat of harm can jazz you up or bring you down, but what it should demand, always, is the highest possible level of professionalism. Who’s at risk when that doesn’t occur?
Elderly Care In The US Could Use Lessons From Abroad
A professor at Case Western Reserve University (CWRU) says that Americans could learn a thing or two about how to improve the quality of life for the elderly. Aging expert M.C. Terry Hokenstad, PhD, social work professor in aging from the Mandel School of Applied Social Sciences at CWRU, calls his findings “lessons from abroad,” based on comparison of the US system of health care for the aging and other nations.
Globe & Mail: Health costs, elderly loom large over this budget
Over the next decade, federal spending on the elderly will rise by $10-billion and on health care by $7.4-billion. Together, that spending represents about half of all new federal spending anticipated between 2013-2014 and 2017-2018.
Provinces, territories may expand home care to deal with aging population
Provinces and territories will likely have to expand home care as a way to deal with the demographic deluge of aging Canadians, two premiers said Friday during a gathering of provincial health ministers.
This short guide gives you some examples of successful communication activities, offers a word of warning about commercial organisations seeking to sell their dissemination services and provides an elaborate checklist to help you develop a sound strategy for communication about your work.
4 Ways To Bring PowerPoint Presentations Online
Every day in offices, schools and cafeterias all around the globe, zillions of PowerPoint presentations are built to present, convince, inform and sell. Most of these presentations are presented live to an audience and then… Then what? Most of the time, nothing. So much of the intelligence, knowledge and expertise embedded in these presentations is lost and never reused. This is an enormous waste and often a missed opportunity for authors who could spread their message to a wider audience then the one who attended the live presentation or webinar.
Research to Action: Using film to communicate research: Useful guides and blogs
There has been a lot of talk and discussion around the use of film and video throughout the last year and it is becoming an increasingly popular use of media amongst researchers and communication specialists.
How do I find out if my manuscript is in scope for a BioMed Central journal?
Try using the journal analyzer from BMC. Just input your abtract and click the button and it will try and match your description up with the right journal. I did try and it seemed to work but I only used it for one article.
AHRQ: Re-Engineered Discharge (RED) Toolkit
A variety of forces are pushing hospitals to improve their discharge processes to reduce readmissions. Researchers at the Boston University Medical Center (BUMC) developed and tested the Re-Engineered Discharge (RED). Research showed that the RED was effective at reducing readmissions and posthospital emergency department (ED) visits. The Agency for Healthcare Research and Quality contracted with BUMC to develop this toolkit to assist hospitals, particularly those that serve diverse populations, to replicate the RED.
Living with Dementia – Resources for Living Well
The intent of this site is to provide information and resources to persons with dementia and their family partners in care – information and resources that will help enable those newly diagnosed with dementia and their families to have the necessary information to live well and help prepare for the road ahead. Everything is collected in one place, so your search for current and reliable information is easy.
Created by Michigan Antibiotic Resistance Reduction (MARR) Coalition, Michigan Department of Community Health, Michigan Society for Infection Prevention and Control (MSIPC), and the Centers for Disease Control and Prevention (CDC) Division of Healthcare Quality Promotion. This toolkit is designed to help LTC facilities implement the 12 Steps to Prevent Antimicrobial Resistance Among Long-Term Care Residents, a set of recommendations developed by the CDC as part of its Campaign to Prevent Antimicrobial Resistance in Healthcare Settings.
Opportunities
Associate Research Fellow in Evidence Synthesis
University of Exeter Medical School, Cornwall, UK £24,766 – £27,854
DEADLINE April 3, 2013
The above full time post is available for 6 months (ending no later than November 2013) at the European Centre for Environment and Human Health, part of the University of Exeter Medical School, in Truro, Cornwall. This post is funded with support from the European Regional Development Fund.
