New article by Lars Wallin
Effect of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality: Cluster-Randomized Controlled Trial.
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Persson LA, Nga NT, Malqvist M, Thi Phuong Hoa D, Eriksson L, Wallin L, et al.
PLoS medicine 2013 May;10(5):e100144
BACKGROUND: Facilitation of local women’s groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period.
CALL FOR ABSTRACTS:
2014 Aging in America Conference
11-15 March 2013 San Diego CA
DEADLINE: Sunday 30 June 2013
We are always looking for fresh perspectives, great ideas, and lessons from the field. Share your expertise and best-practice programs with more than 3,000 attendees who will come to San Diego from across the nation to hear about your experiences, insights, and lessons learned and be inspired by your passion to improve the quality of life for older people. Whether you are a seasoned presenter at Aging in America or submitting for the first time, you are encouraged to submit a proposal to present a workshop or poster, or host a peer group or roundtable session.
CALL FOR ABSTRACTS:
2014 Annual Assembly of American Academy of Hospice and Palliative Medicine & Hospice and Palliative Nurses Association
12-15 March 2013 San Diego CA
DEADLINE: 22 July 2013
Abstract submissions for papers and posters are now being accepted for the 2014 AAHPM & HPNA Annual Assembly in San Diego, CA, March 12-15. A paper is a 20-minute presentation of an original research study or literature review. A poster is a visual presentation of an original research study or literature review.
CALL FOR ABSTRACTS:
International Association of Clinical Research Nurses 5th Annual Conference
23-25 October 2013 San Diego CA
DEADLINE: 30 June 2013
This is an exciting year for IACRN as this year marks a 5 year anniversary of annual conferences, each with hugely successful contributions from members like you in the form of poster or podium presentations. We hope that you will choose to accompany your clinical research nurse colleagues and submit abstracts that will make you an integral part of this year’s conference success. Submit an abstract in your preferred format, podium or poster presentation.
Grants & Awards
AIHS: Partnership for Research and Innovation in the Health System (PRIHS)
DEADLINE: 6 September 2013 at 16:00 MT
PRIHS supports networks of health researchers and clinical practitioners across the continuum of care, with an emphasis on population health and community and primary care, that can reassess potentially inefficient activities within the health system and identify sustainable solutions to improve overall quality of care and value for money in the health system.
Synthesizing research evidence for therapists providing home-based rehabilitative care
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Physical and Occupational Therapy in Geriatrics 2013;31(2):115-127
Background: Accessible and relevant summaries of research findings can facilitate therapists’ ability to practice evidence-informed care. Purpose: Our study used a knowledge translation framework to explore what topics of research evidence rehabilitation therapists who provided home-based care for older adults would like summarized, and whether a short narrative summary was an acceptable format. Methods: An online survey was administered to community-based occupational therapists and physiotherapists who worked for district health authorities across one province. Findings: Respondents identified topics such as effective ways to educate clients and families and how interventions in rural settings differed from urban settings. The short narrative format was not sufficient for therapists to evaluate the strength of the research evidence. Implications: Researchers trying to disseminate research evidence to home-based therapists need to create short summaries that have sufficient details to assess the strength of the evidence which are pertinent to therapists delivering services in the home. © 2013 Informa Healthcare USA, Inc.
Use of evidence-based practice among athletic training educators, clinicians, and students, part 2: Attitudes, beliefs, accessibility, and barriers
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McCarty CW, Hankemeier DA, Walter JM, Newton EJ, Van Lunen BL.
Journal of Athletic Training 2013;48(3):405-415
Context: Successful implementation of evidence-based practice (EBP) within athletic training is contingent upon understanding the attitudes and beliefs and perceived barriers toward EBP as well as the accessibility to EBP resources of athletic training educators, clinicians, and students. Objective: To assess the attitudes, beliefs, and perceived barriers toward EBP and accessibility to EBP resources among athletic training educators, clinicians, and students. Design: Cross-sectional study. Setting: Online survey instrument. Patients or Other Participants: A total of 1209 athletic trainers participated: professional athletic training education program directors (n = 132), clinical preceptors (n = 266), clinicians (n = 716), postprofessional athletic training educators (n = 24) and postprofessional students (n = 71). Main Outcome Measure(s): Likert-scale items (1=strongly disagree, 4=strongly agree) assessed attitudes and beliefs and perceived barriers, whereas multipart questions assessed accessibility to resources. Kruskal-Wallis H tests (P ? .05) and Mann-Whitney U tests with a Bonferroni adjustment (P ? .01) were used to determine differences among groups. Results: Athletic trainers agreed (3.27 ± 0.39 out of 4.0) that EBP has various benefits to clinical practice and disagreed (2.23 ± 0.42 out of 4.0) that negative perceptions are associated with EBP. Benefits to practice scores (P = .002) and negative perception scores (P < .001) differed among groups. With respect to perceived barriers, athletic trainers disagreed that personal skills and attributes (2.29 ± 0.52 out of 4.0) as well as support and accessibility to resources (2.40 ± 0.40 out of 4.0) were barriers to EBP implementation. Differences were found among groups for personal skills and attributes scores (P < .001) and support and accessibility to resources scores (P < .001). Time (76.6%) and availability of EBP mentors (69.6%) were the 2 most prevalent barriers reported. Of the resources assessed, participants were most unfamiliar with clinical prediction rules (37.6%) and Cochrane databases (52.5%); direct access to these 2 resources varied among participants. Conclusions: Athletic trainers had positive attitudes toward the implementation of EBP within didactic education and clinical practice. However, accessibility and resource use remained low for some EBP-related resources. Although the perceived barriers to implementation are minimal, effective integration of EBP within athletic training will present challenges until these barriers dissolve. © by the National Athletic Trainers’ Association, Inc.
Never the twain shall meet? – a comparison of implementation science and policy implementation research.
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Nilsen P, Stahl C, Roback K, Cairney P.
Implementation science : IS 2013 Jun 10;8:63-5908-8-63
BACKGROUND: Many of society’s health problems require research-based knowledge acted on by healthcare practitioners together with implementation of political measures from governmental agencies. However, there has been limited knowledge exchange between implementation science and policy implementation research, which has been conducted since the early 1970s. Based on a narrative review of selective literature on implementation science and policy implementation research, the aim of this paper is to describe the characteristics of policy implementation research, analyze key similarities and differences between this field and implementation science, and discuss how knowledge assembled in policy implementation research could inform implementation science. DISCUSSION: Following a brief overview of policy implementation research, several aspects of the two fields were described and compared: the purpose and origins of the research; the characteristics of the research; the development and use of theory; determinants of change (independent variables); and the impact of implementation (dependent variables). The comparative analysis showed that there are many similarities between the two fields, yet there are also profound differences. Still, important learning may be derived from several aspects of policy implementation research, including issues related to the influence of the context of implementation and the values and norms of the implementers (the healthcare practitioners) on implementation processes. Relevant research on various associated policy topics, including The Advocacy Coalition Framework, Governance Theory, and Institutional Theory, may also contribute to improved understanding of the difficulties of implementing evidence in healthcare. Implementation science is at a relatively early stage of development, and advancement of the field would benefit from accounting for knowledge beyond the parameters of the immediate implementation science literature. SUMMARY: There are many common issues in policy implementation research and implementation science. Research in both fields deals with the challenges of translating intentions into desired changes. Important learning may be derived from several aspects of policy implementation research.
A systematic review of the use of theory in randomized controlled trials of audit and feedback.
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Colquhoun HL, Brehaut JC, Sales A, Ivers N, Grimshaw J, Michie S, et al.
Implementation science 2013 Jun 10;8(1):66
BACKGROUND: Audit and feedback is one of the most widely used and promising interventions in implementation research, yet also one of the most variably effective. Understanding this variability has been limited in part by lack of attention to the theoretical and conceptual basis underlying audit and feedback. Examining the extent of theory use in studies of audit and feedback will yield better understanding of the causal pathways of audit and feedback effectiveness and inform efforts to optimize this important intervention. METHODS: A total of 140 studies in the 2012 Cochrane update on audit and feedback interventions were independently reviewed by two investigators. Variables were extracted related to theory use in the study design, measurement, implementation or interpretation. Theory name, associated reference, and the location of theory use as reported in the study were extracted. Theories were organized by type (e.g., education, diffusion, organization, psychology), and theory utilization was classified into seven categories (justification, intervention design, pilot testing, evaluation, predictions, post hoc, other). RESULTS: A total of 20 studies (14%) reported use of theory in any aspect of the study design, measurement, implementation or interpretation. In only 13 studies (9%) was a theory reportedly used to inform development of the intervention. A total of 18 different theories across educational, psychological, organizational and diffusion of innovation perspectives were identified. Rogers’ Diffusion of Innovations and Bandura’s Social Cognitive Theory were the most widely used (3.6% and 3%, respectively). CONCLUSIONS: The explicit use of theory in studies of audit and feedback was rare. A range of theories was found, but not consistency of theory use. Advancing our understanding of audit and feedback will require more attention to theoretically informed studies and intervention design.
Development of a framework and coding system for modifications and adaptations of evidence-based interventions.
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Stirman SW, Miller CJ, Toder K, Calloway A.
Implementation science 2013 Jun 10;8:65-5908-8-65
BACKGROUND: Evidence-based interventions are frequently modified or adapted during the implementation process. Changes may be made to protocols to meet the needs of the target population or address differences between the context in which the intervention was originally designed and the one into which it is implemented [Addict Behav 2011, 36(6):630-635]. However, whether modification compromises or enhances the desired benefits of the intervention is not well understood. A challenge to understanding the impact of specific types of modifications is a lack of attention to characterizing the different types of changes that may occur. A system for classifying the types of modifications that are made when interventions and programs are implemented can facilitate efforts to understand the nature of modifications that are made in particular contexts as well as the impact of these modifications on outcomes of interest. METHODS: We developed a system for classifying modifications made to interventions and programs across a variety of fields and settings. We then coded 258 modifications identified in 32 published articles that described interventions implemented in routine care or community settings. RESULTS: We identified modifications made to the content of interventions, as well as to the context in which interventions are delivered. We identified 12 different types of content modifications, and our coding scheme also included ratings for the level at which these modifications were made (ranging from the individual patient level up to a hospital network or community). We identified five types of contextual modifications (changes to the format, setting, or patient population that do not in and of themselves alter the actual content of the intervention). We also developed codes to indicate who made the modifications and identified a smaller subset of modifications made to the ways that training or evaluations occur when evidence-based interventions are implemented. Rater agreement analyses indicated that the coding scheme can be used to reliably classify modifications described in research articles without overly burdensome training. CONCLUSIONS: This coding system can complement research on fidelity and may advance research with the goal of understanding the impact of modifications made when evidence-based interventions are implemented. Such findings can further inform efforts to implement such interventions while preserving desired levels of program or intervention effectiveness.
Compliance with clinical guidelines for whiplash improved with a targeted implementation strategy: a prospective cohort study.
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Rebbeck T, Macedo LG, Maher CG.
BMC health services research 2013 Jun 13;13(1):213
BACKGROUND: Implementation strategies for clinical guidelines have shown modest effects in changing health professional’s knowledge and practice, however, targeted implementations are suggested to achieve greater improvements. This study aimed to examine the effect of a targeted implementation strategy of the Australian whiplash guidelines on health professionals’ knowledge, beliefs and practice and to identify predictors of improved knowledge. METHODS: 94 health professionals (Physiotherapists, Chiropractors and Osteopaths) who manage whiplash participated in this study. Prior to their inclusion in the study, health professionals were classified as compliant with clinical guidelines for whiplash (n = 52) or non-compliant (n = 42), according to a record of clinical practice. All participants completed a 2- day interactive workshop with outcomes measured at baseline and 3 months following the workshop. The workshop was delivered by opinion leaders, with the educational content focused on the pre-identified knowledge and practice gaps in relation to clinical guidelines for whiplash. Knowledge and health professional beliefs were assessed by a questionnaire and professional practice by record of clinical practice. RESULTS: Participants significantly increased knowledge (p < 0.0001) and were more likely to be compliant with the guidelines at follow-up (compliant at baseline 58%, follow-up 79%, p = 0.002). Health professional belief systems significantly changed to be more behavioural (p = 0.02) and less biomedical (p = 0.000). Predictors of improved knowledge were baseline knowledge (parameter estimate = -0.6, p = 0.000) and profession (parameter estimate = -3.8, p = 0.003) (adj R2 = 35%). CONCLUSIONS: A targeted implementation strategy improved health professional’s knowledge and clinical practice so that they became more compliant with clinical guidelines for whiplash. In addition health professionals’ belief systems significantly changed to be more behavioural in orientation. Baseline knowledge and profession predicted 35% of the variance in improved knowledge.
Ontario primary care reform and quality improvement activities: an environmental scan
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Sibbald SL, McPherson C, Kothari A.
BMC health services research 2013 Jun 10;13(1):209
BACKGROUND: Quality improvement is attracting the attention of the primary health care system as a means by which to achieve higher quality patient care. Ontario, Canada has demonstrated leadership in terms of its improvement in healthcare, but the province lacks a structured framework by which it can consistently evaluate its quality improvement initiatives specific to the primary healthcare system. The intent of this research was to complete an environmental scan and capacity map of quality improvement activities being built in and by the primary healthcare sector (QI-PHC) in Ontario as a first step to developing a coordinated and sustainable framework of primary healthcare for the province. METHODS: Data were collected between January and July 2011 in collaboration with an advisory group of stakeholder representatives and quality improvement leaders in primary health care. Twenty participants were interviewed by telephone, followed by review of relevant websites and documents identified in the interviews. Data were systematically examined using Framework Analysis augmented by Prior’s approach to document analysis in an iterative process. RESULTS: The environmental scan identified many activities (n = 43) designed to strategically build QI-PHC capacity, identify promising QI-PHC practices and outcomes, scale up quality improvement-informed primary healthcare practice changes, and make quality improvement a core organizational strategy in health care delivery, which were grouped into clusters. Cluster 1 was composed of initiatives in the form of on-going programs that deliberately incorporated long-term quality improvement capacity building through province-wide reach. Cluster 2 represented activities that were time-limited (research, pilot, or demonstration projects) with the primary aim of research production. The activities of most primary health care practitioners, managers, stakeholder organizations and researchers involved in this scan demonstrated a shared vision of QI-PHC in Ontario. However, this vision was not necessarily collaboratively developed nor were activities necessarily strategically linked. CONCLUSIONS: Within the scope of this research, the scan affirmed that there is currently no province-wide, integrated, and measured quality improvement program for the primary healthcare sector in Ontario. This could be improved by the development of a coordinated plan, an accompanying accountability framework, and an appropriate sustainable funding envelope for QI-PHC at the provincial level.
Implementing Evidence-Based Practice Education in Social Work: A Transdisciplinary Approach
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Bellamy JL, Mullen EJ, Satterfield JM, Newhouse RP, Ferguson M, Brownson RC, et al.
Research on Social Work Practice 2013;23(4):426-436
Evidence based practice (EBP) is reflected in social work publications, accreditation standards, research, and funding opportunities. However, implementing EBP in social work practice and education has proven challenging, highlighting the need for additional resources. This paper describes the Transdisciplinary Model of EBP, a model based on advances in EBP across health disciplines including social work and its application to the development of an online EBP training portal. Utility of the Transdiciplinary Model and a training portal for social work education is discussed. Also included is a description of the training modules, the Council on Social Work Education Educational Policy and Accreditation Standards competencies reflected in the modules, and a case example using the modules in a master s of social work course. © The Author(s) 2013.
Health Care Administration and Organization
Home care nurses’ experience of job stress and considerations for the work environment.
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Samia LW, Ellenbecker CH, Friedman DH, Dick K.
Home health care services quarterly 2012;31(3):243-265
Home care nurses report increased stress in their jobs due to work environment characteristics that impact professional practice. Stressors and characteristics of the professional practice environment that moderate nurses’ experience of job stress were examined in this embedded multiple case study. Real life experiences within a complex environment were drawn from interviews and observations with 29 participants across two home care agencies from one eastern U.S. state. Findings suggest that role overload, role conflict, and lack of control can be moderated in agencies where there are meaningful opportunities for shared decision making and the nurse-patient relationship is supported.
Forecasting supply and demand in nursing professions: impacts of occupational flexibility and employment structure in Germany.
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Maier T, Afentakis A.
Human resources for health 2013 Jun 5;11(1):24-4491-11-24
BACKGROUND: In light of Germany’s ageing society, demand for nursing professionals is expected to increase in the coming years. This will pose a challenge for policy makers to increase the supply of nursing professionals. METHODOLOGY: To portray the different possible developments in the supply of nursing professionals, we projected the supply of formally trained nurses and the potential supply of persons who are able to work in a nursing profession. This potential supply of nursing professionals was calculated on the basis of empirical information on occupational mobility provided by the German Microcensus 2005 (Labour Force Survey). We also calculated how the supply of full-time equivalents (FTEs) will develop if current employment structures develop in the direction of employment behaviour in nursing professions in eastern and western Germany. We then compared these different supply scenarios with two demand projections (‘status quo’ and ‘compression of morbidity’ scenarios) from Germany’s Federal Statistical Office. RESULTS: Our results show that, even as early as 2005, meeting demand for FTEs in nursing professions was not arithmetically possible when only persons with formal qualification in a nursing profession were taken into account on the supply side. When additional semi-skilled nursing professionals are included in the calculation, a shortage of labour in nursing professions can be expected in 2018 when the employment structure for all nursing professionals remains the same as the employment structure seen in Germany in 2005 (demand: ‘status quo scenario’). Furthermore, given an employment structure as in eastern Germany, where more nursing professionals work on a full-time basis with longer working hours, a theoretical shortage of nursing professionals could be delayed until 2024. CONCLUSIONS: Our analysis of occupational flexibility in the nursing field indicates that additional potential supply could be generated by especially training more young people for a nursing profession as they tend to stay in their initial occupation. Furthermore, the number of FTEs in nursing professions could be increased by promoting more full-time contracts in Western Germany. Additionally, employment contracts for just a small number of weekly working hours (marginal employment) cannot be considered an adequate instrument for keeping formally trained nursing professionals employed in the nursing field.
Utilization of technology by long-term care providers: comparisons between for-profit and nonprofit institutions.
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Hamann DJ, Bezboruah KC.
Journal of aging and health 2013 Jun;25(4):535-554
OBJECTIVE: We examine ownership differences in the use of technology in long-term care facilities. METHOD: We analyze two nationally representative surveys of administrators collected by the Centers for Disease Control (CDC): the 2004 National Nursing Home Survey and the 2010 National Survey of Residential Care Facilities. RESULTS: We find that nonprofit nursing homes are more likely to use some computerized administrative functions and digital laboratory reports, and report use rates similar to for-profit organizations in other areas of health IT. Nonprofit residential care facilities are more likely to use electronic medical records and information exchange systems than their for-profit counterparts. In addition, nonprofit residential care facilities are more likely than for-profit facilities to digitize more types of information and use larger health information exchange networks. DISCUSSION: The reasons for which nonprofit long-term care organizations report higher levels of some types of technology utilization are explored, and future research is recommended.
The Consequences of Poor Communication During Transitions from Hospital to Skilled Nursing Facility: A Qualitative Study.
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King BJ, Gilmore-Bykovskyi AL, Roiland RA, Polnaszek BE, Bowers BJ, Kind AJ.
Journal of the American Geriatrics Society 2013 Jun 3
OBJECTIVES: To examine how skilled nursing facility (SNF) nurses transition the care of individuals admitted from hospitals, the barriers they experience, and the outcomes associated with variation in the quality of transitions. DESIGN: Qualitative study using grounded dimensional analysis, focus groups, and in-depth interviews. SETTING: Five Wisconsin SNFs. PARTICIPANTS: Twenty-seven registered nurses. MEASUREMENTS: Semistructured questions guided the focus group and individual interviews. RESULTS: SNF nurses rely heavily on written hospital discharge communication to transition individuals into the SNF effectively. Nurses cited multiple inadequacies of hospital discharge information, including regular problems with medication orders (including the lack of opioid prescriptions for pain), little psychosocial or functional history, and inaccurate information regarding current health status. These communication inadequacies necessitated repeated telephone clarifications, created care delays (including delays in pain control), increased SNF staff stress, frustrated individuals and family members, contributed directly to negative SNF facility image, and increased risk of rehospitalization. SNF nurses identified a specific list of information and components that they need to facilitate a safe, high-quality transition. CONCLUSION: Nurses note multiple deficiencies in hospital-to-SNF transitions, with poor quality discharge communication being identified as the major barrier to safe and effective transitions. This information should be used to refine and support the dissemination of evidence-based interventions that support transitions of care, including the Interventions to Reduce Acute Care Transfers program. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Registered nurses’ views on nursing competence at residential facilities
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Furåker C, Agneta N.
Leadership in Health Services 2013;26(2):135-147
Purpose: The aim of this paper is to describe registered nurses’ (RNs’) ways of working and their views on what competence they require, make use of and wish to develop when caring for older people at residential facilities. Design/methodology/approach: The participants comprised 23 RNs, trained after 1993 and working at seven residential facilities. The data collection consists of group interviews during spring 2009. The group interviews were subjected to content analysis. Findings: Three main categories and six sub-categories were identified. The findings show that the majority of RNs work in a consultative way although they are responsible for basic care as well as advanced nursing care. They must rely on the staff’s competence. They compare the residential facilities to a “mini-hospital” and they are often frustrated by the staff’s incompetence. Attitudes to research findings and to the use of evidence-based knowledge were limited. Research limitations/implications: RNs require extensive theoretical, technical and medical knowledge as well as knowledge related to persons with dementia conditions and psychiatric disorders and how to lead, teach and supervise. Practical implications: Social and professional isolation influences competence development and working situation and the differences in leadership influence the quality of nursing care. RNs do not critically reflect on what knowledge they require and make use of and how to search for scientific knowledge and this will have a negative influence on the attitude to the competence. Originality/value: There is a need of extensive and varied knowledge in evidence-based nursing as well as in leadership and teaching to be able to work independently. © Emerald Group Publishing Limited.
Development of a checklist for documenting team and collaborative behaviors during multidisciplinary bedside rounds.
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Henneman EA, Kleppel R, Hinchey KT.
The Journal of nursing administration 2013 May;43(5):280-285
OBJECTIVE: The objective of this study was to develop a reliable and valid checklist for documenting team and collaborative behaviors occurring during multidisciplinary bedside rounds. BACKGROUND: Teamwork and collaboration are important for providing high-quality patient care, yet there are no objective means of evaluating the occurrence of team and collaborative behaviors during bedside rounds. METHODS: A checklist was developed and tested on 3 general medical units. Items on the checklist were derived from the literature and our medical center’s patient-family-centered values. RESULTS: The final version of the checklist was determined to be reliable, valid, and easy to use in the clinical setting. CONCLUSION: Clinicians, administrators, and investigators are encouraged to use and/or modify this checklist for use in their setting. Further research identifying instruments to objectively measure teamwork and collaboration is needed.
The evolving role of health care aides in the long-term care and home and community care sectors in Canada.
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Berta W, Laporte A, Deber R, Baumann A, Gamble B.
Human resources for health 2013 Jun 14;11(1):25
Health Care Aides (HCAs) provide up to 80% of the direct care to older Canadians living in long term care facilities, or in their homes. They are an understudied workforce, and calls for health human resources strategies relating to these workers are, we feel, precipitous. First, we need a better understanding of the nature and scope of their work, and of the factors that shape it. Here, we discuss the evolving role of HCAs and the factors that impact how and where they work. The work of HCAs includes role-required behaviors, an increasing array of delegated acts, and extra-role behaviors like emotional support. Role boundaries, particularly instances where some workers over-invest in care beyond expected levels, are identified as one of the biggest concerns among employers of HCAs in the current cost-containment environment. A number of factors significantly impact what these workers do and where they work, including market-level differences, job mobility, and work structure. In Canada, entry into this ‘profession’ is increasingly constrained to the Home and Community Care sector, while market-level and work structure differences constrain job mobility to transitions, of only the most experienced workers, to the long-term care sector. We note that this is in direct opposition to recent policy initiatives designed to encourage aging at home. Work structure influences what these workers do, and how they work; many HCAs work for three or four different agencies in order to sustain themselves and their families. Expectations with regard to HCA preparation have changed over the past decade in Canada, and training is emerging as a high priority health human resource issue. An increasing emphasis on improving quality of care and measuring performance, and on integrated team-based care delivery, has considerable implications for worker training. New models of care delivery foreshadow a need for management and leadership expertise – these workers have not historically been prepared for leadership roles. We conclude with a brief discussion of the next steps necessary to generating evidence necessary to informing a health human resource strategy relating to the provision of care to older Canadians.
The Correlates of Nursing Staff Turnover in Home and Hospice Agencies: 2007 National Home and Hospice Care Survey
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Luo H, Lin M, Castle NG.
Research on aging 2013;35(4):375-392
Using data from the 2007 National Home and Hospice Care Survey, this study provides an update of nursing staff turnover at U.S. home health and hospice agencies and explores correlates of nursing staff turnover. Results show that the three-month turnover rates of registered nurses (RNs), licensed practice nurses (LPNs), home health aides (HHAs), and certified nursing assistants (CNAs) in 2007 were 10.2%, 14.3%, 12.5%, and 12.9%, respectively. A higher nurse staffing level reduced the odds of RN and HHA turnover; the availability of communication aids reduced the odds of LPN turnover. Moreover, among benefit programs, the provision of partial insurance for family reduced the odds of HHA turnover; dental or vision health insurance reduced the odds of RN turnover; mileage reimbursement or agency car reduced the odds of LPN turnover. The provision of a 401k plan and a paid-time-off program increased the odds of RN turnover. The study results suggest that high staffing levels and benefit programs (e.g., health insurance) may reduce the odds of experiencing nursing staff turnover. Initiatives to minimize nursing staff turnover should consider these factors. © The Author(s) 2012.
The perceived impact of advanced practice nurses (APNs) on promoting evidence-based practice amongst frontline nurses: Findings from a collective case study
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McDonnell A, Gerrish K, Kirshbaum MN, Nolan M, Tod A, Guillaume L.
Journal of Research in Nursing 2013;18(4):368-383
The aim of this study was to explore the perceived impact of advanced practice nurses in promoting evidence-based practice amongst frontline nurses. A collective instrumental case study was undertaken involving five extended case studies and eighteen short case studies in a range of hospital and primary care settings across seven Strategic Health Authorities in England. The study participants were a purposive sample of 23 advanced practice nurses selected to represent a range of settings, clinical specialities, organisational responsibilities and ways of working. In-depth interviews were undertaken with the advanced practice nurse and up to 10 interviews with health care professionals with whom they worked. For the extended case studies, non-participant observation and follow-up interviews were also undertaken. Data analysis drew on the principles of the Framework approach.From the perspectives of the participants, these advanced practice nurses enhanced the ability of frontline nurses to provide evidence-based care. They improved the competence, knowledge and skills of frontline nurses and empowered them to deliver care which they considered to be safer, holistic, more timely and of a higher standard. This is likely to have a positive effect on patient outcomes and on patient experience. However, this impact is inherently hard to capture. © The Author(s)
Challenges to using evidence from systematic reviews to stop ineffective practice: An interview study.
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Shepperd S, Adams R, Hill A, Garner S, Dopson S.
Journal of health services research & policy 2013 Jun 18
OBJECTIVES: To examine the challenges to using systematic review evidence to develop guidance for decommissioning ineffective health services, and the problems experienced by clinicians and commissioners when they attempt to implement the evidence from this guidance. METHODS: Interviews with 23 clinicians and 15 commissioners from nine commissioning organizations (Primary Care Trusts) in the south of England. RESULTS: Participants identified generic and intervention-specific barriers to using systematic review evidence to develop and implement decommissioning. Generic barriers included: contradictions within the health care system arising from policy; managing a high volume of evidence; difficulty in applying the evidence to the local context; and patient or parent expectations. Intervention-specific factors included: the influence of industry; an absence of systems for monitoring local implementation of guidance; and the availability of different codes for the same procedure which made monitoring some practices unreliable. CONCLUSIONS: The micro practices of commissioners are shaped by the wider system of health policy, the knowledge producing and delivery agencies associated with health care, and power dynamics within the health care system. If decommissioning is to be guided by evidence, then adequate resources to support the process are necessary. This includes long-term engagement of clinicians, providing alternatives to the decommissioned activity and tackling perverse incentives. An important precursor to decommissioning is obtaining data on the nature and extent of current clinical practice and using these data to monitor variation in the implementation of guidance.
Health Care Innovation and Quality Assurance
Integrating evidence on patient preferences in healthcare policy decisions: protocol of the patient-VIP study.
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Dirksen CD, Utens CM, Joore MA, van Barneveld TA, Boer B, Dreesens DH, et al.
Implementation science 2013 Jun 10;8:64-5908-8-64
BACKGROUND: Despite a strong movement towards active patient involvement in healthcare policy decisions, systematic and explicit consideration of evidence of this research on patient preferences seems limited. Furthermore, little is known about the opinions of several stakeholders towards consideration of research evidence on patient preferences in healthcare policy decisions. This paper describes the protocol for an explorative study on the integration of research on patient preferences in healthcare policy decisions. The study questions: to what extent research evidence on patient preferences is considered in current procedures for healthcare policy decisions; opinions of stakeholders regarding the integration of this type of evidence in healthcare policy decisions; and what could be a decision framework for the integration of such research evidence in healthcare policy decisions. METHODS/DESIGN: The study is divided in three sub-studies, predominantly using qualitative methods. The first sub-study is a scoping review in five European countries to investigate whether and how results of research on patient preferences are considered in current procedures for coverage decisions and clinical practice guideline development. The second sub-study is a qualitative study to explore the opinions of stakeholders with regard to the possibilities for integrating evidence on patient preferences in the process of healthcare decision-making in the Netherlands. The third sub-study is the development of a decision framework for research on patient preferences. The framework will consist of: a process description regarding the place of evidence on patient preferences in the decision-making process; and a taxonomy describing different terminologies and conceptualisations of ‘preferences’ and an overview of existing methodologies for investigating preferences. The concept framework will be presented to and discussed with experts. DISCUSSION: This study will create awareness regarding the existence and potential value of research evidence on patient preferences for healthcare policy decision-making and provides insight in the methods for investigating patient preferences and the barriers and facilitators for integration of such research in healthcare policy decisions. Results of the study will be useful for researchers, clinical practice guideline developers, healthcare policy makers, and patient representatives.
Effect of nurse practitioner comanagement on the care of geriatric conditions.
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Reuben DB, Ganz DA, Roth CP, McCreath HE, Ramirez KD, Wenger NS.
Journal of the American Geriatrics Society 2013 Jun;61(6):857-867
OBJECTIVES: To determine whether community-based primary care physician (PCP)-nurse practitioner (NP) comanagement implementing the Assessing Care of Vulnerable Elders (ACOVE)-2 model: (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage to community resources) can improve the quality of care for geriatric conditions. DESIGN: Case study. SETTING: Two community-based primary care practices. PARTICIPANTS: Patients aged 75 and older who screened positive for at least one condition: falls, urinary incontinence (UI), dementia, and depression. INTERVENTION: The ACOVE-2 model augmented by NP comanagement of conditions. MEASUREMENTS: Quality of care according to medical record review using ACOVE-3 quality indicators (QIs). Individuals receiving comanagement were compared with those who received PCP care alone in the same practices. RESULTS: Of 1,084 screened individuals, 658 (61%) screened positive for more than one condition; 485 of these were randomly selected for chart review and triggered a mean of seven QIs. A NP saw 49% for comanagement. Overall, individuals received 57% of recommended care. Quality scores for all conditions (falls, 80% vs 34%; UI, 66% vs 19%; dementia, 59% vs 38%) except depression (63% vs 60%) were higher for individuals who saw a NP. In analyses adjusted for sex and age of patient, number of conditions, site, and a NP estimate of medical management style, NP comanagement remained significantly associated with receiving recommended care (P < .001), as did NP estimate of medical management style (P = .02). CONCLUSION: NP comanagement is associated with better quality of care for geriatric conditions in community-based primary care than usual care using the ACOVE-2 model. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Understanding the components of quality improvement collaboratives: a systematic literature review.
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Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM.
The Milbank quarterly 2013 Jun;91(2):354-394
CONTEXT: In response to national efforts to improve quality of care, policymakers and health care leaders have increasingly turned to quality improvement collaboratives (QICs) as an efficient approach to improving provider practices and patient outcomes through the dissemination of evidence-based practices. This article presents findings from a systematic review of the literature on QICs, focusing on the identification of common components of QICs in health care and exploring, when possible, relations between QIC components and outcomes at the patient or provider level. METHODS: A systematic search of five major health care databases generated 294 unique articles, twenty-four of which met our criteria for inclusion in our final analysis. These articles pertained to either randomized controlled trials or quasi-experimental studies with comparison groups, and they reported the findings from twenty different studies of QICs in health care. We coded the articles to identify the components reported for each collaborative. FINDINGS: We found fourteen crosscutting components as common ingredients in health care QICs (e.g., in-person learning sessions, phone meetings, data reporting, leadership involvement, and training in QI methods). The collaboratives reported included, on average, six to seven of these components. The most common were in-person learning sessions, plan-do-study-act (PDSA) cycles, multidisciplinary QI teams, and data collection for QI. The outcomes data from these studies indicate the greatest impact of QICs at the provider level; patient-level findings were less robust. CONCLUSIONS: Reporting on specific components of the collaborative was imprecise across articles, rendering it impossible to identify active QIC ingredients linked to improved care. Although QICs appear to have some promise in improving the process of care, there is great need for further controlled research examining the core components of these collaboratives related to patient- and provider-level outcomes. © 2013 Milbank Memorial Fund.
State of the science: the relationship between nurse staffing and patient outcomes.
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Brennan CW, Daly BJ, Jones KR.
Western journal of nursing research 2013 Jul;35(6):760-794
Over a decade of research on the relationship between nurse staffing and patient outcomes has demonstrated the important role of nurses in the provision of high-quality, safe care, yet currently, no evidence-based nurse staffing guidelines exist. A systematic review of reviews was conducted to explore reasons why this is the case and recommend directions for future research to improve upon this gap. Authors of the 29 included reviews reported variability in methods and measurement approaches, lack of incorporation of nurse processes and system factors that potentially affect relationships among variables, and overall inconsistencies in results across primary studies. We propose use of an Integrated Framework for a Systems Approach to Nurse Staffing Research to inform the development of applicable conceptual models. Future studies that use a systems approach and focus on establishing causal relationships among variables will potentially strengthen the evidence and advance the science in this area.
Embrace, a model for integrated elderly care: study protocol of a randomized controlled trial on the effectiveness regarding patient outcomes, service use, costs, and quality of care.
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Spoorenberg SL, Uittenbroek RJ, Middel B, Kremer BP, Reijneveld SA, Wynia K.
BMC geriatrics 2013 Jun 19;13(1):62
BACKGROUND: Ongoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care. METHODS: The CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program — combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period. DISCUSSION: This study could provide evidence for the effectiveness of Embrace.Trial registration: The Netherlands National Trial Register NTR3039 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3039.
Better Care Faster is proposing the following seven recommendations to help put promising innovation in CDM to work for the benefit of all Ontarians:
1. Standardize the evaluation framework for innovative CDM initiatives
2. Simplify tracking and reporting of key performance indicators related to CDM
3. Formally mandate Health Quality Ontario to track and report on innovations in chronic disease
4. Create clear points of accountability for government efforts to support innovation in chronic disease management
5. Give innovators and early adopters greater ﬂexibility to pursue innovation at the local level
6. Support efforts to communicate the impact of localized innovation and the potential for system benefit
7. Empower patients and their families to drive innovation in chronic disease management
As ageing societies are pushing a growing number of frail old people into needing care, delivering quality long-term care services – care that is safe, effective, and responsive to needs – has become a priority for governments. Yet much still remains to be done to enhance evidence-based measurement and improvement of quality of long-term care services across EU and OECD countries. This book offers evidence and examples of useful experiences to help policy makers, providers and experts measure and improve the quality of long-term care services.
Innovation sustainability in challenging health-care contexts: embedding clinically led change in routine practice.
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Martin GP, Weaver S, Currie G, Finn R, McDonald R.
Health services management research 2012 Nov;25(4):190-199
The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change – especially organizational change led ‘bottom-up’ by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities.
Acceptance Checklist for Clinical Effectiveness Pilot Trials: a systematic approach.
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Charlesworth G, Burnell K, Hoe J, Orrell M, Russell I.
BMC medical research methodology 2013 Jun 13;13(1):78
Conducting a pilot trial is important in preparing for, and justifying investment in, the ensuing larger trial. Pilot trials using the same design and methods as the subsequent main trial are ethically and financially advantageous especially when pilot and main trial data can be pooled. For explanatory trials in which internal validity is paramount, there is little room for variation of methods between the pilot and main trial. For pragmatic trials, where generalisability or external validity is key, greater flexibility is written into trial protocols to allow for ‘real life’ variation in procedures. We describe the development of a checklist for use in decision-making on whether pilot data can be carried forward to the main trial dataset without compromising trial integrity. We illustrate the use of the checklist using a pragmatic trial of psychosocial interventions for family carers of people with dementia as a case study.
This article explicates the intragroup social dynamics and work of a nursing and education research team as a community of research practice interested in organizational cultures and occupational subcultures. Dynamics were characterized by processes of socialization through reeducation and group social identity formation that enabled members to cross discipline-bordered traditions and produce interdisciplinary mixed methods combinations. Combinations were achieved at the paradigm level through the generation of a shared viewing position and theoretical model. At methods and technique levels, such achievements were accomplished through methodological capitalization and prioritization and the development of a quantitative culture assessment tool that can be used in combination with complementary qualitative observation and interview protocols. Recommendations for other teams are provided.
Practices for Embedding an Interpretive Qualitative Approach Within a Randomized Clinical Trial
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Plano Clark VL, Schumacher K, West C, Edrington J, Dunn LB, Harzstark A, et al.
Journal of Mixed Methods Research} 2013;7(3):219-242
The embedded approach is a mixed methods design that is most commonly used when qualitative methods are embedded within intervention designs such as randomized clinical trials (RCTs). Scholars have noted challenges associated with embedded procedures and expressed concern that embedded designs undervalue and underutilize interpretive qualitative approaches. This article examines these issues in the context of a study about cancer pain management where qualitative methods were embedded within an RCT design. We describe our practices for stating embedded research questions, designing embedded qualitative data collection within the constraints of the RCT, and developing enriched understandings of the RCT through an interpretive qualitative analysis. These practices provide guidance for intervention researchers planning to embed qualitative components within RCT designs.
Restoring invisible and abandoned trials: a call for people to publish the findings.
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Doshi P, Dickersin K, Healy D, Vedula SS, Jefferson T.
BMJ (Clinical research ed.) 2013 Jun 13;346:f2865.
Unpublished and misreported studies make it difficult to determine the true value of a treatment. Peter Doshi and colleagues call for sponsors and investigators of abandoned studies to publish (or republish) and propose a system for independent publishing if sponsors fail to respond.
Development of two shortened systematic review formats for clinicians.
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Perrier L, Persaud N, Ko A, Kastner M, Grimshaw J, McKibbon KA, et al.
Implementation science : IS 2013 Jun 14;8(1):68
BACKGROUND: Systematic reviews provide evidence for clinical questions, however the literature suggests they are not used regularly by physicians for decision-making. A shortened systematic review format is proposed as one possible solution to address barriers, such as lack of time, experienced by busy clinicians. The purpose of this paper is to describe the development process of two shortened formats for a systematic review intended for use by primary care physicians as an information tool for clinical decision-making. METHODS: We developed prototypes for two formats (case-based and evidence-expertise) that represent a summary of a full-length systematic review before seeking input from end-users. The process was composed of the following four phases: 1) selection of a systematic review and creation of initial prototypes that represent a shortened version of the systematic review; 2) a mapping exercise to identify obstacles described by clinicians in using clinical evidence in decision-making; 3) a heuristic evaluation (a usability inspection method); and 4) a review of the clinical content in the prototypes. RESULTS: After the initial prototypes were created (Phase 1), the mapping exercise (Phase 2) identified components that prompted modifications. Similarly, the heuristic evaluation and the clinical content review (Phase 3 and Phase 4) uncovered necessary changes. Revisions were made to the prototypes based on the results. CONCLUSIONS: Documentation of the processes for developing products or tools provides essential information about how they are tailored for the intended user. One step has been described that we hope will increase usability and uptake of these documents to end-users.
Systematic review of the effectiveness of training programs in writing for scholarly publication, journal editing, and manuscript peer review
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Galipeau J, Moher D, Skidmore B, Campbell C, Hendry P, Cameron DW, et al.
Systematic reviews 2013 Jun 17;2(1):41
BACKGROUND: An estimated $100 billion is lost to ‘waste’ in biomedical research globally, annually, much of which comes from the poor quality of published research. One particular area of waste involves bias in reporting research, which compromises the usability of published reports. In response to this, there has been an upsurge in interest and research in the scientific process of writing, editing, peer reviewing, and publishing (that is, journalology) of biomedical research. One possible reason for bias in reporting and the problem of unusable reports could be due to authors lacking knowledge or engaging in questionable practices while designing, conducting, or reporting their research. Another might be that the peer review process for journal publication has serious flaws, including possibly being ineffective, as well as having poorly trained and poorly motivated reviewers. Similarly, many journal editors have limited knowledge related to publication ethics. This can ultimately have a negative impact on the healthcare system. There have been repeated calls for better, more numerous training opportunities for academic writing, peer review, and publishing. However, little research has taken stock of journalology training opportunities or related evaluations of their effectiveness. METHODS: We plan to conduct a systematic review to synthesize studies that evaluate the effectiveness of training programs in journalology. A comprehensive three-phase search approach will be employed to identify evaluations of training opportunities, involving: 1) forward-searching using the Scopus citation database, 2) a search of the MEDLINE In-Process and Non-Indexed Citations, MEDLINE, Embase, ERIC, and PsycINFO databases, as well as the databases of the Cochrane Library, and 3) a grey literature search. DISCUSSION: This project aims to provide evidence to help guide the journalological training of authors, peer reviewers, and editors, as well as the development of future training opportunities in this domain. While there is ample evidence that many members of these groups are not getting the necessary training needed to excel at their respective journalology-related tasks, little is known about the characteristics of existing training opportunities, including their effectiveness. The proposed systematic review will provide the evidence regarding the effectiveness of training, therefore giving potential trainees, course designers, and decision-makers evidence to help inform their choices and policies regarding the merits of a specific training opportunity or type of training.
We established a surveillance program that implemented and refined a process to assess the need for updating CERs. The process combined methods for prior projects on identifying signals for updating: an abbreviated literature search, abstraction of the study conditions and findings for each new included study,solicitation of expert judgments on the currency of the original conclusions, and an assessment of whether the new findings provided a signal according to the Ottawa Method and/or the RAND Method, on a conclusion-by-conclusion basis. Lastly, an overall summary assessment was made that classified each Compartive Effectiveness Review as being of high, medium, or low priority for updating. If a CER was deemed to be a low or medium priority for updating, the process would be repeated 6 months later; if the priority for updating was deemed high, the CER would be withdrawn from subsequent 6-month assessments.
For many household surveys in the United States, responses rates have been steadily declining for at least the past two decades. A similar decline in survey response can be observed in all wealthy countries. Efforts to raise response rates have used such strategies as monetary incentives or repeated attempts to contact sample members and obtain completed interviews, but these strategies increase the costs of surveys. This review addresses the core issues regarding survey nonresponse. It considers why response rates are declining and what that means for the accuracy of survey results. These trends are of particular concern for the social science
Views on the peer review system of biomedical journals: an online survey of academics from high-ranking universities.
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Ho RC, Mak KK, Tao R, Lu Y, Day JR, Pan F.
BMC medical research methodology 2013 Jun 7;13:74-2288-13-74
BACKGROUND: Peer review is the major method used by biomedical journals for making the decision of publishing an article. This cross-sectional survey assesses views concerning the review system of biomedical journals among academics globally. METHODS: A total of 28,009 biomedical academics from high-ranking universities listed by the 2009 Times Higher Education Quacquarelli Symonds (THE-QS) World University Rankings were contacted by email between March 2010 and August 2010. 1,340 completed an online survey which focused on their academic background, negative experiences and views on biomedical journal peer review and the results were compared among basic scientists, clinicians and clinician scientists. RESULTS: Fewer than half of the respondents agreed that the peer review systems of biomedical journals were fair (48.4%), scientific (47.5%), or transparent (25.1%). Nevertheless, 58.2% of the respondents agreed that authors should remain anonymous and 64.4% agreed that reviewers should not be disclosed. Most, (67.7%) agreed to the establishment of an appeal system. The proportion of native English-speaking respondents who agreed that the “peer review system is fair” was significantly higher than for non-native respondents (p = 0.02). Similarly, the proportion of clinicians stating that the “peer review system is fair” was significantly higher than that for basic scientists and clinician-scientists (p = 0.004). For females, (β = -0.1, p = 0.03), the frequency of encountering personal attacks in reviewers’ comments (β = -0.1, p = 0.002) and the frequency of imposition of unnecessary references by reviewers (β = -0.06, p = 0.04) were independently and inversely associated with agreement that “the peer review system is fair”. CONCLUSION: Academics are divided on the issue of whether the biomedical journal peer review system is fair, scientific and transparent. A majority of academics agreed with the double-blind peer review and to the establishment of an appeal system. Female academics, experience of personal attacks and imposition of unnecessary references by reviewers were related to disagreement about fairness of the peer review system of biomedical journals.
A citation analysis of nurse education journals using various bibliometric indicators
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Hunt GE, Jackson D, Watson R, Cleary M.
Journal of advanced nursing 2013 Jul;69(7):1441-1445
Here, we demonstrate how to identify a core set of journals that frequently publish in a particular field and rank them using various bibliometric indicators rather than the JIF in isolation and to list the top 10 articles that have received the most number of citations. The nurse education field is used to illustrate how this method can be used to rank like journals to help readers identify a more inclusive family of journals relevant to their particular field and interests
The influence of cognitive impairment, special care unit placement, and nursing facility characteristics on resident quality of life.
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Abrahamson K, Lewis T, Perkins A, Clark D, Nazir A, Arling G.
Journal of aging and health 2013 Jun;25(4):574-588
OBJECTIVE: We examined the (a) influence of nursing facility characteristics on resident quality of life and (b) the impact of cognitive impairment and residence on a dementia special care unit(SCU) on QOL after controlling for resident and facility characteristics. METHOD: Multilevel models (resident and facility) were estimated for residents with and without cognitive impairment on conventional units and dementia SCU. Data came from the 2007 Minnesota Nursing Home Resident Quality of Life and Consumer Satisfaction Survey (N = 13,983). RESULTS: Level of resident CI was negatively related to QOL, although residing on a dementia SCU was positively related to QOL. Certified Nursing Assistant and activity personnel hours per resident day had a positive relationship with resident QOL. DISCUSSION: Our results highlight the need to ensure adequate levels of paraprofessional direct care staff and the availability of dementia-focused (SCU)s despite current constraints on long-term care funding.
Apathy and weight loss in nursing home residents: longitudinal study.
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Volicer L, Frijters DH, van der Steen JT.
Journal of the American Medical Directors Association 2013 Jun;14(6):417-420
OBJECTIVES: Determine which behavioral syndromes of dementia are independently related to weight loss. DESIGN: Longitudinal study using four subsequent quarterly Minimum Data Set (MDS) 2.0 assessments. Characteristics obtained in one period were related to weight loss observed in the next period. SETTING: Eight nursing homes in the Netherlands. PARTICIPANTS: The initial population was 2031 nursing home residents with four quarterly MDS assessments within a period of 15 months. We selected 1850 subjects who were at least 65 years old at the time of the first assessment and who were not comatose. MEASUREMENTS: Information about the presence of four behavioral syndromes (depression, apathy, agitation, and rejection of care), demographic data, cognition status, body mass index (BMI), and time that residents were involved in activities were obtained from MDS 2.0. RESULTS: Bivariate correlation showed that weight loss at follow-up assessments was related to all baseline behavioral syndromes, degree of cognitive impairment, body mass index, and time that residents were involved in activities. Multivariable binary logistic regression with these factors showed that the only behavioral syndrome that was independently related to subsequent weight loss was apathy. In multivariable analysis, the degree of cognitive impairment and BMI were also independently related to weight loss. CONCLUSION: These results suggest that of all behavioral factors we have assessed, apathy had the strongest association with weight loss in nursing home residents even when adjusted for the degree of cognitive impairment. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Pain Characteristics and Pain Control in European Nursing Homes: Cross-sectional and Longitudinal Results From the Services and Health for Elderly in Long TERm care (SHELTER) Study.
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Lukas A, Mayer B, Fialova D, Topinkova E, Gindin J, Onder G, et al.
Journal of the American Medical Directors Association 2013 Jun;14(6):421-428
OBJECTIVE AND DESIGN: Few studies have compared cross-national characteristics of residents with pain in European long term care facilities. The SHELTER project, a cross-national European study on nursing home residents, provides the opportunity to examine this issue. The present study aimed to evaluate key figures about pain and compare them with seven European countries and Israel. SETTING, PARTICIPANTS, AND MEASUREMENTS: A total of 3926 nursing home residents were assessed by the interRAI instrument for Long Term Care Facilities (interRAI LTCF). Prevalence of pain, frequency, intensity, consistency, and control were estimated and compared cross-nationally. Correlates between patient-related characteristics and inadequate pain management were tested using bivariate and multivariate logistic regression models. RESULTS: Overall, 1900 (48.4%) residents suffered from pain. Pain prevalence varied significantly among countries, ranging from 19.8% in Israel to 73.0% in Finland. Pain was positively associated with female gender, fractures, falls, pressure ulcers, sleeping disorders, unstable health conditions, cancer, depression, and number of drugs. It was negatively associated with dementia. In a multivariate logistic regression model, all associations remained except for sleeping disorders. Clinical correlations varied considerably among countries. Although in 88.1% of cases, pain was self-rated by the residents as sufficiently controlled, in only 56.8% of cases was pain intensity self-rated as absent or mild. Pain control and intensity improved within 1 year. CONCLUSION: Pain prevalence is high and varies considerably across Europe. Although most residents considered pain as adequately controlled, a closer look confirmed that many still suffer from high pain intensities. Analyzing the reasons behind these differences may help to improve pain management. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Systematic review: health-related characteristics of elderly hospitalized adults and nursing home residents associated with short-term mortality.
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Thomas JM, Cooney LM,Jr, Fried TR.
Journal of the American Geriatrics Society 2013 Jun;61(6):902-911
OBJECTIVES: To identify the domains of health-related characteristics of older hospitalized adults and nursing home residents most strongly associated with short-term mortality. DESIGN: Systematic review. SETTING: Studies published in English in MEDLINE, Scopus, or Web of Science before August 1, 2010. PARTICIPANTS: Prospective studies consisting of persons aged 65 and older that evaluated the association between at least one health-related participant characteristic and mortality within a year in multivariable analysis. MEASUREMENTS: All health-related characteristics associated with mortality in multivariable analysis were extracted and categorized into domains. The frequency, with all studies combined, with which particular domains were associated with mortality in multivariable analysis was determined. RESULTS: Thirty-three studies (28 in hospitalized individuals, five in nursing home residents) reported a large number of characteristics associated with mortality that could be categorized in seven domains: cognitive function, disease diagnosis, laboratory values, nutrition, physical function, pressure ulcers, and shortness of breath. Measures of physical function and nutrition were the domains most frequently associated with mortality up to 1 year from the time of evaluation for hospitalized individuals and nursing home residents; measures of physical function, cognitive function, and nutrition were the domains most frequently associated with in-hospital mortality for hospitalized individuals. CONCLUSION: Of a large number of health-related characteristics of older persons shown to be associated with short-term mortality, measures of nutrition, physical function, and cognitive function were the domains of health most frequently associated with mortality. These domains provide easily measurable factors that may serve as helpful markers for individuals at high mortality risk.
NICHE: STARForUM: Crossing the Quality Chasm in Care Transitions
Wed 10 July 2013 11:00 MT $99 for non-NICHE sites, free for NICHE sites
This webinar will enable the learner to obtain information on how to formulate a work group of nursing facilities (independent, assisted, skilled), EMS, home healthcare agencies, non-licensed medical providers, and RNs to partner and address deficiencies in process of care. Tools will be shared along with outcome metrics.
Scientist Knowledge Translation Training (SKTT) Workshop
2-3 Dec 2013 Halifax NS
The Scientist Knowledge Translation Training (SKTT™) course is intended for researchers in health, mental health, education, and social sciences who have an interest in sharing research knowledge with (multiple) audiences beyond the traditional academic community, as appropriate, and in increasing the impact potential of their research.
This article discusses the confusion families face when trying to figure out how to get a loved one into a LTC facility in Ontario.
Music at bath time, aromatherapy and walking programs are among practices that have helped reduce the use of anti-psychotic drugs in B.C. seniors’ homes, according to a guide by the British Columbia Care Providers Association. The guide, released Tuesday by the BCCPA, includes accounts from seven care homes around the province of “best practices” for use of anti-psychotic drugs.
This profile describes the Delaware Health Information Network is the country’s first operational statewide health information exchange and how it was implemented.
One million people; two billion dollars. Those are the numbers Quebec faces as it confronts an aging population. Its dilemma is shared by every province. By about 2030, Quebec will have another one million seniors. Providing them with home care and long-term care will cost about $2-billion. Where will the money come from?
Story about engaging front line health care workers to find their own solutions to problems such as hand-washing.
Care minister Norman Lamb is meeting care providers later to discuss what he says is a crisis in care of the elderly and disabled at home. Mr Lamb says a quarter of all clients in England are unhappy with the service they receive.
As Quebec’s population rapidly ages and more people move to long-term-care facilities, horror stories about deaths and allegations of abuse or negligence continue to make headlines and spark lawsuits.
Davidson, who has served in numerous health executive roles around the country and internationally, said she will report directly to Horne and will provide strategic oversight and advice when requested, but does not plan to involve herself in the day-to-day operations of AHS.
A new open access, peer-reviewed, online journal publishing concise, plain-language analyses of individual health reforms related to the governance, financing and delivery of health care in the Canadian provinces and territories, as well as in-depth, cross-issue and cross-jurisdictional “roll-ups” of these reforms. Launched in May 2013, the journal is actively seeking submissions and building its list of reviewers.
How a political battle between Alberta’s health minister and its provincial health board ended in a dramatic mass firing.
In addition to the creation of a timeline, the 2013 Update includes new provisions such as:
-Creation of important milestones to facilitate achieving the goal of preventing and effectively treating Alzheimer’s by 2025;
-Development of a curriculum on Alzheimer’s disease for primary care practitioners so that providers have the necessary skills to provide high-quality dementia care;
-Convening an expert panel on advanced dementia to examine the unique and often unaddressed needs of those in the late stages of the disease; and
-Expanding public outreach efforts to increase awareness of the disease and connect those with Alzheimer’s and their caregivers to available resources.
“There is no doubt that we don’t have enough staff;” says Gail Donner, who chaired Ontario’s Long Term Care Task Force on Resident Care and Safety, “It’s past even talking about – you just have to go to a long term care facility to see that.”
This blog contains information for professionals, researchers, and caregivers.
Includes glossary, overview of barriers and chlallenges, strategies, succesful interventions, information on scaling up. Intended audiences are resarchers, program managers, and policy makers.
Education and training manager
Centre for Statistics in Medicine, Oxford UK
DEADLINE 10 July 2013
The successful candidate will take a leading role in the following activities:
a) Development and delivery of an education and training programme relating to health research conduct and reporting
b) Development of online learning and teaching resources (toolkits)
c) Establishing a network of external training advisors and collaborators
CHSPR: Policy Researcher
DEADLINE: Monday 1 July 2013
A motivated self-starter with an interest in conducting and publishing policy-relevant research. We are seeking a conscientious, organized, and bright individual with an interest in research relating to pharmaceutical policies and disparities in prescription drug access, use and outcomes. The policy researcher will lead and contribute to research design, analyses, and publication of findings in articles for scholarly and lay audiences.