Congratulations to Dr. Elizabeth Dogherty
Liz Dogherty has been awarded with 1 of 8 new Interdisciplinary Fellowship Program (IFP) awards from TVN (Technology Evaluation in the Elderly Network). Her project, Development of an intervention to enhance evidence uptake in managing depression in long-term care, will be supervised by Dr. Carole Estabrooks. Way to go!!!
New KUSP Article
Precision of the Conceptual Research Utilization Scale
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Squires JE, Estabrooks CA, Hayduk L, Gierl M, Newburn-Cook C.
Journal of nursing measurement 2014 -04-01T00:00:00;22(1):145-163
Background and Purpose: Conceptual research utilization (CRU) is one indicator of an optimum practice environment that leads to improved patient and organizational outcomes. Yet, its measurement has not been adequately addressed. In this study, we investigated precision of scores obtained with a new CRU scale using item response theory (IRT) methods. Methods: We analyzed the responses from 1,349 health care aides from 30 Canadian nursing homes using Samejima’s (1969, 1996) graded response model (GRM). Results: Findings suggest that the CRU scale is most precise at low to average trait levels with significantly less precision at higher trait levels. Conclusions: The scale showed acceptable precision at low to average trait levels. New items and/or different response options that capture higher trait levels are needed. Future development of the scale is discussed.
New article by Dr. Les Hayduk
Seeing perfectly-fitting factor models that are causally misspecified: Understanding that close-fitting models can be worse
Educational and Psychological Measurement 2014; doi: 10.1177/0013164414527449
Researchers using factor analysis tend to dismiss the significant ill fit of factor models by presuming that if their factor model is close-to-fitting, it is probably close to being properly casually specified. Close fit may indeed result from a model being close to properly causally specified, but close-fitting factor models can also be seriously causally misspecified. This article illustrates a variety of nonfactor causal worlds that are perfectly, but inappropriately, fit by factor models. Seeing nonfactor worlds that are perfectly yet erroneously fit via factor models should help researchers understand that close-to-fitting factor models may seriously misrepresent the world’s causal structure. Statistical cautions regarding the factor model’s proclivity to fit when it ought not to fit have been insufficiently publicized and are rarely heeded. A research commitment to understanding the world’s causal structure, combined with clear examples of factor mismodeling should spur diagnostic assessment of significant factor model failures-including reassessment of published failing factor models.
CALL FOR ABSTRACTS: Campus Alberta Student Conference on Health 2014
5–6 September Banff AB
DEADLINE Friday 11 July
Abstracts are now being accepted for oral and poster presentations. Presentations may be done by students from various streams in health sciences including but not limited to biostatistics, community rehabilitation/disability studies, epidemiology, health services research (including health policy and health technology assessment), and public, population and global health. Students may submit abstracts based on their research or practicum experiences. This may include your thesis or dissertation research, independent study research, or work term/practicum experiences.
The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership
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Aarons GA, Ehrhart MG, Farahnak LR.
Implementation science 2014 Apr 14;9(1):45-5908-9-45
In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership: the Implementation Leadership Scale (ILS). METHODS: Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California, USA. Initial item development was supported as part of a two United States National Institutes of Health (NIH) studies focused on developing implementation leadership training and implementation measure development. Clinician work group/team-level data were randomly assigned to be utilized for an exploratory factor analysis (n = 229; k = 46 teams) or for a confirmatory factor analysis (n = 230; k = 47 teams). The confirmatory factor analysis controlled for the multilevel, nested data structure. Reliability and validity analyses were then conducted with the full sample. RESULTS: The exploratory factor analysis resulted in a 12-item scale with four subscales representing proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor. The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity. CONCLUSIONS: The ILS is a brief and efficient measure of unit level leadership for EBP implementation. The availability of the ILS will allow researchers to assess strategic leadership for implementation in order to advance understanding of leadership as a predictor of organizational context for implementation. The ILS also holds promise as a tool for leader and organizational development to improve EBP implementation.
Hospitals’ adoption of targeted cognitive and functional status quality indicators for vulnerable elders
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Maxwell CA, Mion LC, Dietrich MS, Fallon WF, Minnick A.
Journal of nursing care quality 2014 Apr 8
Cognitive and functional impairments are leading predictors of poor outcomes in hospitalized older adults. This study reports adoption rates of 9 Assessing Care of Vulnerable Elders quality indicators in a sample of US hospitals (N = 128). Chief nursing officers were surveyed using a 6-point scale (no activity to full implementation) for each Assessing Care of Vulnerable Elders quality indicator. Adoption rates were low, highlighting the need for greater efforts to heighten awareness among senior executives and nursing leaders.
A randomised controlled trial of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services.
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Jones J, Wolfenden L, Wyse R, Finch M, Yoong SL, Dodds P, et al.
BMJ open 2014 Apr 17;4(4):e005312-2014-005312
Childhood overweight and obesity tracks into adulthood, increasing the risk of developing future chronic disease. Implementing initiatives promoting healthy eating and physical activity in childcare settings has been identified as a priority to prevent excessive child weight gain. Despite this, few trials have been conducted to assess the effectiveness of interventions to support population-wide implementation of such initiatives. The aim of this study is to assess the effectiveness of a multicomponent intervention in increasing the implementation of healthy eating and physical activity policies and practices by centre-based childcare services. METHODS AND ANALYSIS: The study will employ a parallel group randomised controlled trial design. A sample of 128 childcare services in the Hunter region of New South Wales, Australia, will be recruited to participate in the trial. 64 services will be randomly allocated to a 12-month implementation intervention. The remaining 64 services will be allocated to a usual care control group. The intervention will consist of a number of strategies to facilitate childcare service implementation of healthy eating and physical activity policies and practices. Intervention strategies will include implementation support staff, securing executive support, consensus processes, staff training, academic detailing visits, performance monitoring and feedback, tools and resources, and a communications strategy. The primary outcome of the trial will be the prevalence of services implementing all healthy eating and physical activity policies and practices targeted by the intervention. To assess the effectiveness of the intervention, telephone surveys with nominated supervisors and room leaders of childcare services will be conducted at baseline and immediately postintervention. ETHICS AND DISSEMINATION: The study was approved by the Hunter New England Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: Australian Clinical Trials Registry ACTRN12612000927820.
Implementing toileting trials in nursing homes: Evaluation of a dissemination strategy.
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Rahman AN, Schnelle JF, Osterweil D.
Geriatric nursing (New York, N.Y.) 2014 Apr 17
This study sought to improve incontinence care in nursing homes (NHs) by administering and evaluating a webinar course that provided extended instruction to help NHs implement toileting trials in accordance with recommended procedures. Of particular interest was: 1) whether the course design would prompt NH staffs to implement the recommended protocol, and 2) whether participants preferred this course design to other models. DESIGN: The study collected descriptive evaluation data. SETTING: The setting was comprised of seven NHs. PARTICIPANTS: Participants were staff members, typically nurses, from enrolled NHs who attended at least three of the six webinars that comprised the course. MEASURES: Data was collected using a course evaluation and implementation survey. RESULTS: Staff in the participating nursing homes attended an average of 4.85 webinars, with an average of nine staff members attending each webinar (range: 3-20). Twelve of 16 responding participants said they preferred the webinar course to other course designs. All respondents said they would recommend the course and take a similar course again. All facilities submitted some evidence that staff providers had completed implementation assignments. Most facilities reported plans to sustain use of the recommended protocol. CONCLUSION: This study found limited evidence that the webinar course prompts NHs to implement a recommended toileting trial protocol and is preferred to other training program designs. Copyright © 2014 Mosby, Inc. All rights reserved.
Evidence-based narratives to improve recall of opioid prescribing guidelines: a randomized experiment.
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Kilaru AS, Perrone J, Auriemma CL, Shofer FS, Barg FK, Meisel ZF.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2014 Mar;21(3):244-249
Physicians adopt evidence-based guidelines with variable consistency. Narratives, or stories, offer a novel dissemination strategy for clinical recommendations. The study objective was to compare whether evidence-based narrative versus traditional summary improved recall of opioid prescribing guidelines from the American College of Emergency Physicians (ACEP). METHODS: This was a prospective, randomized controlled experiment to compare whether narrative versus summary promoted short-term recall of six themes contained in the ACEP opioid guideline. The experiment was modeled after the free-recall test, an established technique in studies of memory. At a regional conference, emergency physicians (EPs) were randomized to read either a summary of the guideline (control) or a narrative (intervention). The fictional narrative was constructed to match the summary in content and length. One hour after reading the text, participants listed all content that they could recall. Two reviewers independently scored the responses to assess recall of the six themes. The primary outcome was the total number of themes recalled per participant. Secondary outcomes included the proportion of responses in each study arm that recalled individual themes and the proportion of responses in each arm that contained falsely recalled or extraneous information. RESULTS: Ninety-five physicians were randomized. Eighty-two physicians completed the experiment, for a response rate of 86%. The mean of the total number of themes recalled per participant was 3.1 in the narrative arm versus 2.0 in the summary arm (difference = 1.1, 95% confidence interval [CI] = 0.6 to 1.7). For three themes, the proportion of responses that recalled the theme was significantly greater in the narrative arm compared to the summary arm, with the differences ranging from 20% to 51%. For one theme, recall was significantly greater in the summary arm. For two themes, there was no statistically significant difference in recall between the arms. In the summary arm, 54% of responses were found to contain falsely recalled or extraneous information versus 21% of responses in the narrative arm (difference = 33%, 95% CI = 14% to 53%). CONCLUSIONS: Physicians exposed to a narrative about opioid guidelines were more likely to recall guideline content at 1 hour than those exposed to a summary of the guidelines. Future studies should examine whether the incorporation of narratives in dissemination campaigns improves guideline adoption and changes clinical practice.
Barriers and facilitators to evidence-use in program management: a systematic review of the literature.
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Humphries S, Stafinski T, Mumtaz Z, Menon D.
BMC health services research 2014 Apr 14;14(1):171
The use of evidence in decision-making at the program management level is a priority in health care organizations. The objective of this study was to identify potential barriers and facilitators experienced by managers to the use of evidence in program management within health care organizations. METHODS: The authors conducted a comprehensive search for published, peer-reviewed and grey literature that explores the use of evidence in program management. Two reviewers selected relevant studies from which data was extracted using a standard data abstraction form and tabulated for qualitative analysis. The results were summarized through narrative review. The quality of the included studies was assessed using published criteria for the critical appraisal of qualitative, quantitative and mixed methods research. RESULTS: Fourteen papers were included in the review. Barriers and facilitators were categorized into five main thematic areas: (1) Information, (2) Organization – Structure and Process, (3) Organization – Culture, (4) Individual, and (5) Interaction. CONCLUSION: This paper reviews the literature on barriers and facilitators to evidence-informed decision-making experienced by program management decision-makers within health care organizations. The multidimensional solutions required to promote evidence-informed program management can be developed through an understanding of the existing barriers and facilitators of evidence-use.
From Innovation to Adoption Successfully Spreading Surgical Innovation (UK)
Royal College of Surgeons of England 2014
This report sets out what makes adoption of surgical innovation different and why we need a new approach. It is based on a review of five mainstream surgical procedures across a number of specialties, in which we analyse patterns of uptake and explore the factors that helped and hindered surgical adoption in England, based on the insights of clinical experts. As a result, we have developed a pathway of surgical innovation, made up of six critical factors that underpin surgical adoption.
Health Care Administration and Organization
Nurse staffing, medical staffing and mortality in Intensive Care: An observational study.
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West E, Barron DN, Harrison D, Rafferty AM, Rowan K, Sanderson C.
International journal of nursing studies 2014 May;51(5):781-794
To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. BACKGROUND: Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. DATA: Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. DESIGN: A cross-sectional, retrospective, risk adjusted observational study. METHODS: Multivariable, multilevel logistic regression. OUTCOME MEASURES: ICU and in-hospital mortality. RESULTS: After controlling for patient characteristics and workload we found that higher numbers of nurses per bed (odds ratio: 0.90, 95% confidence interval: [0.83, 0.97]) and higher numbers of consultants (0.85, [0.76, 0.95]) were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death (0.98, [0.96, 0.99]) whereas the effect of medical staffing was unchanged across the range of patient acuity (1.00, [0.97, 1.03]). No relationship between patient outcomes and the number of support staff (administrative, clerical, technical and scientific staff) was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8h made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on hospital mortality which gives the study additional credibility. CONCLUSION: This study supports claims that the availability of medical and nursing staff is associated with the survival of critically ill patients and suggests that future studies should focus on the resources of the health care team. The results emphasise the urgent need for a prospective study of staffing levels and the organisation of care in ICUs. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
It is a scandal!: Comparing the causes and consequences of nursing home media scandals in five countries
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Lloyd L, Banerjee A, Harrington C, Jacobsen FF, Szebehely M.
International Journal of Sociology and Social Policy 2014;34(1):2-18
This study aims to explore the causes and consequences of media scandals involving nursing homes for older persons in Canada, Norway, Sweden, the UK and the USA. Design/methodology/approach: This study uses a descriptive case-study methodology which provides an in-depth, focused, qualitative analysis of one selected nursing home scandal in each jurisdiction. Scandals were selected on the basis of being substantive enough to potentially affect policy. An international comparative perspective was adopted to consider whether and how different social, political and economic contexts might shape scandals and their consequences. Findings: This study found that for-profit residential care provision as well as international trends in the ownership and financing of nursing homes were factors in the emergence of all media scandals, as was investigative reporting and a lack of consensus around the role of the state in the delivery of residential care. All scandals resulted in government action but such action generally avoided addressing underlying structural conditions. Research limitations/implications: This study examines only the short-term effects of five media scandals. Originality/value: While there has been longstanding recognition of the importance of scandals to the development of residential care policy, there have been few studies that have systematically examined the causes and consequences of such scandals. This paper contributes to a research agenda that more fully considers the media’s role in the development of residential care policy, attending to both its promises and shortcomings. © Emerald Group Publishing Limited.
Licensed Nurse Staffing and Health Service Availability in Residential Care and Assisted Living
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Beeber AS, Zimmerman S, Reed D, Mitchell CM, Sloane PD, Harris-Wallace B, et al.
Journal of the American Geriatrics Society 2014
To create data-driven typologies of licensed nurse staffing and health services in residential care and assisted living (RC/AL). Design Cluster analysis was used to describe the patterns of licensed nurse staffing and 47 services and the extent to which these clusters were related. Setting RC/AL communities in the United States. Participants A convenience sample of administrators and healthcare supervisors from 89 RC/AL communities in 22 states. Measurement RC/AL characteristics, licensed nurse staffing (total number of hours that registered nurses (RNs) and licensed practical nurses (LPNs) worked), number of hours that contract nurses worked, and availability of 47 services. Results Analysis revealed four licensed nurse staffing clusters defined according to total number of hours and the type of nurse providing the hours (RN, LPN, or a mix of both). They ranged from no or minimal RN and LPN hours to high nursing hours with a mix of RNs and LPNs. The 47 services clustered into five clusters: basic services; technically complex services; assessments, wound care, and therapies; testing and specialty services; and gastrostomy and intravenous medications. The availability of services was related to the presence of nurses (RNs and LPNs) except for the gastrostomy and intravenous medication services, which were not readily available. Conclusion The amount and skill mix of licensed nurse staffing varies in RC/AL and is related to the types of services available. These findings may have implications for resident care and outcomes. Future work in this area, including extension to include nonnurse direct care workers, is needed.
Economic and Social Integration of Immigrant Live-in Caregivers in Canada
Institute for Research on Public Policy
16 April 2014
Unlike most other temporary foreign workers in Canada, participants in the Live-In Caregiver Program (LCP) are eligible to apply for permanent residence after completing 24 months of paid employment within a period of four years. The LCP was introduced in 1992 to address a lack of live-in workers to care for dependent people. It is estimated that a total of 17,500 former caregivers, their spouses and dependants will be admitted as permanent residents in 2014. Few studies have addressed the economic and social integration of LCP workers after the program or explored how different types of caregiving — for children, disabled people or older adults — affect integration. This study helps fill these gaps through extensive qualitative research, including interviews and focus groups with 58 live-in caregivers.
Health Care Innovation and Quality Assurance
Resident Outcomes of Person-Centered Care in Long-Term Care: A Narrative Review of Interventional Research
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Li J, Porock D.
International journal of nursing studies
To outline and compare the principal models and to synthesize current evidence of the effects of multiple person-centered care models on resident outcomes. Results Twenty-four studies from three countries were reviewed and compared in terms of person-centered interventions, measurement, and resident outcomes. 15 culture change studies for residents who were cognitively intact or with minor cognitive impairment and 9 studies for residents with dementia were reviewed. Across the studies, culture change models had some beneficial effects on residents’ psychological wellbeing. Person-centered dementia care had significant effects on decreasing behavioral symptoms and psychotropic medication use in dementia residents in long-term care. Conclusion An agreed upon definition of person-centered care is essential for researchers and clinicians to guide person-centered care development and implementation. Rigorous study design and objective and subjective measurement use are needed for future studies, especially those guided by culture change models. The effectiveness of person-centered care on residents’ bio-psycho-social outcomes like sleep, stress, and physical wellbeing need to be addressed and systematically examined with subjective and objective measures in future studies.
Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study
Dixon-Woods M, Baker R, Charles K, Dawson J, Jerzembek G, Martin G, et al.
BMJ Quality & Safety 2013 September 09
Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS). Methods Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a high-level summary. Results We found an almost universal desire to provide the best quality of care. We identified many ‘bright spots’ of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. Conclusions Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.
Leadership, safety climate, and continuous quality improvement: Impact on process quality and patient safety
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McFadden KL, Stock GN, Gowen CR,3rd.
Health care management review 2014 Feb 21
Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. PURPOSE:: We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. METHODOLOGY/APPROACH:: The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. FINDINGS:: The results provide empirical evidence that a safety climate, which is connected to the chief executive officer’s transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. PRACTICAL IMPLICATIONS:: The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.
Does regulating private long-term care facilities lead to better care? A study from Quebec, Canada.
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Bravo G, Dubois MF, Demers L, Dubuc N, Blanchette D, Painter K, et al.
International journal for quality in health care 2014 Apr 15
In the province of Quebec, Canada, long-term residential care is provided by two types of facilities: publicly funded accredited facilities and privately owned facilities in which care is privately financed and delivered. Following evidence that private facilities were delivering inadequate care, the provincial government decided to regulate this industry. We assessed the impact of regulation on care quality by comparing quality assessments made before and after regulation. In both periods, public facilities served as a comparison group. DESIGN: A cross-sectional study conducted in 2010-12 that incorporates data collected in 1995-2000. SETTING: Random samples of private and public facilities from two regions of Quebec. PARTICIPANTS: Random samples of disabled residents aged 65 years and over. In total, 451 residents from 145 care settings assessed in 1995-2000 were compared with 329 residents from 102 care settings assessed in 2010-12. INTERVENTION: Regulation introduced by the province in 2005, effective February 2007. MAIN OUTCOME MEASURE: Quality of care measured with the QUALCARE Scale. RESULTS: After regulation, fewer small-size facilities were in operation in the private market. Between the two study periods, the proportion of residents with severe disabilities decreased in private facilities whereas it remained >80% in their public counterparts. Meanwhile, quality of care improved significantly in private facilities, while worsening in their public counterparts, even after controlling for confounding. CONCLUSIONS: /st>The private industry now provides better care to its residents. Improvement in care quality likely results in part from the closure of small homes and change in resident case-mix.
Increasing the scale and adoption of population health interventions: experiences and perspectives of policy makers, practitioners, and researchers
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Milat AJ, King L, Newson R, Wolfenden L, Rissel C, Bauman A, et al.
Health research policy and systems / BioMed Central 2014 Apr 15;12(1):18
Decisions to scale up population health interventions from small projects to wider state or national implementation is fundamental to maximising population-wide health improvements. The objectives of this study were to examine: i) how decisions to scale up interventions are currently made in practice; ii) the role that evidence plays in informing decisions to scale up interventions; and iii) the role policy makers, practitioners, and researchers play in this process. METHODS: Interviews with an expert panel of senior Australian and international public health policy-makers (n = 7), practitioners (n = 7), and researchers (n = 7) were conducted in May 2013 with a participation rate of 84%. RESULTS: Scaling up decisions were generally made through iterative processes and led by policy makers and/or practitioners, but ultimately approved by political leaders and/or senior executives of funding agencies. Research evidence formed a component of the overall set of information used in decision-making, but its contribution was limited by the paucity of relevant intervention effectiveness research, and data on costs and cost effectiveness. Policy makers, practitioners/service managers, and researchers had different, but complementary roles to play in the process of scaling up interventions. CONCLUSIONS: This analysis articulates the processes of how decisions to scale up interventions are made, the roles of evidence, and contribution of different professional groups. More intervention research that includes data on the effectiveness, reach, and costs of operating at scale and key service delivery issues (including acceptability and fit of interventions and delivery models) should be sought as this has the potential to substantially advance the relevance and ultimately usability of research evidence for scaling up population health action.
Tweets about hospital quality: a mixed methods study
Greaves F, Laverty AA, Ramirez Cano D, Moilanen K, Pulman S, Darzi A, et al.
BMJ Quality & Safety 2014 April 19
Twitter is increasingly being used by patients to comment on their experience of healthcare. This may provide information for understanding the quality of healthcare providers and improving services. Objective To examine whether tweets sent to hospitals in the English National Health Service contain information about quality of care. To compare sentiment on Twitter about hospitals with established survey measures of patient experience and standardised mortality rates. Design A mixed methods study including a quantitative analysis of all 198 499 tweets sent to English hospitals over a year and a qualitative directed content analysis of 1000 random tweets. Twitter sentiment and conventional quality metrics were compared using Spearman’s rank correlation coefficient. Key results 11% of tweets to hospitals contained information about care quality, with the most frequent topic being patient experience (8%). Comments on effectiveness or safety of care were present, but less common (3%). 77% of tweets about care quality were positive in tone. Other topics mentioned in tweets included messages of support to patients, fundraising activity, self-promotion and dissemination of health information. No associations were observed between Twitter sentiment and conventional quality metrics. Conclusions Only a small proportion of tweets directed at hospitals discuss quality of care and there was no clear relationship between Twitter sentiment and other measures of quality, potentially limiting Twitter as a medium for quality monitoring. However, tweets did contain information useful to target quality improvement activity. Recent enthusiasm by policy makers to use social media as a quality monitoring and improvement tool needs to be carefully considered and subjected to formal evaluation.
Reporting adverse events at geriatric facilities: categorization by type of adverse event and function of reporting personnel.
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Shmueli T, Noy RH, Ben Natan M, Ben-Israel J.
International journal of health care quality assurance 2014;27(2):91-98
Adverse events and patient care-related adverse events are a challenging universal problem, among elder residents of geriatric facilities. The aim of this study was to examine which types of adverse events are characteristic of the geriatric center studied and which of the nursing staff reported this event. DESIGN/METHODOLOGY/APPROACH: Data were retrieved from the computerized adverse event management system at a large geriatric center in central Israel, and all adverse events reported over the past three years were examined. FINDINGS: The study findings indicate that the most common type of adverse event was falls. Older nurses with greater seniority in the facility show a higher tendency to report adverse events. In addition, registered nurses were found to report more often than practical nurses. PRACTICAL IMPLICATIONS: This study highlights the important role that nurses can play in reporting and reducing adverse events. The role of the nurse is becoming increasingly complex, especially in geriatric facilities, which serve people with complex mental and physical states who are more susceptible to adverse events to begin with. ORIGINALITY/VALUE: Despite the large number of adverse events, few studies have been undertaken on adverse events in geriatrics in general, and in nursing homes and long-term facilities in particular. Answers to these questions will enable improvement in the quality of care provided and ensure a safe care environment for residents. Systematically examining types of adverse events and the characteristics of those who do and do not report them, can contribute to improvement of processes in the healthcare system in general, and in the facility in particular. Additionally, efficient investigation can improve the behavior of those who enable adverse events.
The International Association of Gerontology and Geriatrics (IAGG) Nursing Home Initiative.
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Rolland Y, Tolson D, Morley JE, Vellas B.
Journal of the American Medical Directors Association 2014 Mar 29.
Nursing homes have a long history of providing inconsistent standards of care quality to older persons. In 2010, under the leadership of Professor Bruno Vellas, the International Association of Gerontology and Geriatrics (IAGG) developed a task force to focus on the needs of nursing homes and how to develop research in nursing homes. This led to a position paper setting out a global development agenda on nursing homes3 that was widely publicized. The position paper focused on 4 major areas:
1.Reputational enhancement and leadership
2.Clinical essentials and care quality indicators
OECD: OECD Reviews of Health Care Quality: Sweden 2013
This report reviews the quality of health care in Sweden. It begins by providing an overview of the range of policies and practices aimed at supporting quality of care in Sweden (Chapter 1). It then focuses on three key areas particularly relevant to elderly populations: strengthening primary care in Sweden (Chapter 2), better assurance for quality in long-term care (Chapter 3), and improving care after hip fracture and stroke (Chapter 4). In examining these areas, this report highlights best practices and provides recommendations to improve the quality of care in Sweden.
Building Capacity to Manage Change looks at change management from the perspective of the HR leader. The briefing draws on relevant literature and a Conference Board survey to explore how organizations are experiencing and managing change.
Research Practice & Methodology
The triple challenge of recruiting older adults with dementia and high medical acuity in skilled nursing facilities
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Kolanowski A, Mulhall P, Yevchak A, Hill N, Fick D.
Journal of nursing scholarship 2013 Dec;45(4):397-404
To describe strategies, culled from experience, for responding to several recruitment challenges in an ongoing randomized clinical trial of delirium in persons with dementia. ORGANIZING CONSTRUCT: Delirium in people with dementia is common across all cultures. Little research supports the use of specific interventions for delirium. Recruitment of an adequate sample is critical to the validity of findings from intervention studies that form the foundation for evidence-based practice. METHODS: The trial referenced in this article tests the efficacy of cognitive stimulation for resolving delirium in people with dementia. Participants are recruited at the time of admission to one of eight community-based skilled nursing facilities (SNFs). Eligible participants are 65 years of age or older and community dwelling, and have a diagnosis of dementia and delirium. Recruitment challenges and strategies were identified during weekly team meetings over a 2-year period. FINDINGS: Recruitment challenges include factors in the external and internal environment and the participants and their families. Strategies that address these challenges include early site evaluation and strong communication approaches with staff, participants, and families. CONCLUSIONS: The recruitment of an adequate sample of acutely ill older adults with dementia in SNFs can pose a challenge to investigators and threaten the validity of findings. Recruitment strategies that help improve the validity of future studies are described. CLINICAL RELEVANCE: Worldwide, over 100 million people will have dementia by 2050, placing them at increased risk for delirium. Recruitment strategies that improve the quality of nursing research and, by extension, the care and prevention of delirium in older adults with dementia during rehabilitation in SNFs are greatly needed. © 2013 Sigma Theta Tau International.
Health Care in Canada
This study measures health system efficiency in Canada to gain insight into factors that help explain variations in efficiency at the health region level. The study builds on findings from the CIHI report Developing a Model for Measuring the Efficiency of the Health System in Canada and examines questions such as why some of Canada’s health regions are more efficient than others.
ACOs are promising vehicles for aligning physician and hospital interests in improving quality and reducing cost. However, successful implementation and realization of the ACO mission requires that attention be paid to supporting capacity building within the ACOs, development of a culture of learning and improvement, as well as rigorous monitoring and evaluation. While the jury is still out on success of ACO implementation efforts in the United States, the results presented here suggest that further exploration of their potential in Canada is warranted, and that distinct characteristics of the Canadian system might require a slightly different approach.
Nonpharmacological Interventions in Long-Term Care: Feasibility and Recent Trends.
Non UofA Access
Fitzsimmons S, Barba B, Stump M, Bonner A.
Journal of gerontological nursing 2014 Mar 31:1-4
Numerous studies have found excessive or inappropriate use of antipsychotic drugs in nursing home patients with cognitive impairment or perceived behavioral issues. Inappropriately medicating this vulnerable population can lead to several negative outcomes, including failure to have needs met, injury, illness, and even death. In response to recent literature and government reports highlighting this issue, in 2012, the Centers for Medicare and Medicaid Services (CMS) launched an initiative called the National Partnership to Improve Dementia Care. This article discusses the CMS initiative, as well as the feasibility and recent trends in the use of nonpharmacological interventions that could be implemented when working with patients with cognitive impairment and behavioral and psychological symptoms associated with dementia. Copyright 2014, SLACK Incorporated.
A 52 month follow-up of functional decline in nursing home residents – degree of dementia contributes
Non UofA Access
Helvik AS, Engedal K, Benth JS, Selbaek G.
BMC geriatrics 2014 Apr 10;14(1):45-2318-14-45
Few have studied how personal activities of daily living (P-ADL) develop over time in nursing home residents with dementia. Thus, the aim was to study variables associated with the development of P-ADL functioning over a 52-month follow-up period, with a particular focus on the importance of the degree of dementia. METHOD: In all, 932 nursing home residents with dementia (Clinical Dementia Rating-CDR- Scale ≥1) were included in a longitudinal study with four assessments of P-ADL functioning during 52 months. P-ADL was measured using the Lawton and Brody’s Physical Self-Maintenance Scale. Degree of dementia (CDR), neuropsychiatric symptoms and use of psychotropic medication were assessed at the same four time points. Demographic information and information about physical health was included at baseline. Linear regression models for longitudinal data were estimated. RESULTS: Follow-up time was positively associated with a decline in P-ADL functioning. Degree of dementia at baseline was associated with a decline in P-ADL functioning over time. The association between degree of dementia and P-ADL functioning was strongest at baseline, and then flattened over time. A higher level of neuropsychiatric symptoms such as agitation and apathy and no use of anxiolytics and antidementia medication were associated with a decline in P-ADL functioning at four time points. Higher physical co-morbidity at baseline was associated with a decline in P-ADL functioning. CONCLUSION: P-ADL functioning in nursing home patients with dementia worsened over time. The worsening was associated with more severe dementia, higher physical comorbidity, agitation, apathy and no use of anxiolytics and antidementia medication. Clinicians should pay attention to these variables (associates) in order to help the nursing home residents with dementia to maintain their level of functioning for as long as possible.
Food security: Who is being excluded? A case of older people with dementia in long-term care homes
Non UofA Access
Vahabi M, Schindel Martin L.
The journal of nutrition, health & aging 2014
To explore the extent of food security among older people, particularly those with cognitive impairments residing in Canadian long-term care homes (LTCHs) through a focused review of literature. Method Databases including Medline, Nursing and Health Sciences (SAGE), Psych Info, Social Sciences Abstract, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and HealthSTAR were searched for peer-reviewed articles related to food experiences of older individuals in industrialized countries including Canada. Only articles that were published in English between1997-2012 were included. Results Sixty two studies met the inclusion criteria. Of those 17 focused on older adults in LTCHs. The review found that food security has rarely been examined among older persons living in LTCHs, and has never been examined within the context of cognitive impairment. While a few studies have focused on residents’ satisfaction with foods that are provided to them in LTCHs, none have explored the extent of food security in this population. Furthermore, food satisfaction surveys in the LTCH are limited to the assessment of foods that are served to residents, and do not capture residents’ food accessibility beyond the food dispensing routines of the organization. Thus, food quality, food preferences, and the traditional meanings and rituals associated with food consumption are not purposefully evaluated. In addition, LTCHs are not required to monitor residents’ food satisfaction using a consistent, regular, and standardized approach and there is no regulation in the LTCH Act that requires LTCHs to assess their residents’ food security. Conclusions The findings highlight the need for: 1) expansion of food security research to non-community-based settings including LTCHs; 2) re-conceptualization of food security and modification of measurement tools to assess the extent and determinants of food security among older adults in LTCHs; 3) mandatory monitoring of food security via standardized and regular surveys tailored to meet the unique preferences and needs of the older population, particularly those with dementia; and 4) education of healthcare professionals regarding food security and its assessment in LTCHs. © 2014 Serdi and Springer-Verlag France.
Autonomy and Control in Everyday Life in Care of Older People in Nursing Homes
Non UofA Access
Wikström E, Emilsson U, Melin.
Journal of Housing for the Elderly 2014 2014;28(1):41-62
Self-control and autonomy are not guaranteed when people age and are in need of help from others, especially in institution-based housing. This occurs despite the fact that it is a generally accepted belief that care should be delivered with the greatest possible degree of independence and autonomy. This article discusses older people’s experiences with and the opportunities for autonomy in institution-based housing. Through focus group interviews and observations, the daily lives of residents at two nursing homes in Sweden were studied through a comparative approach using the theoretical framework of organizational culture. Three themes emerged showing how autonomy was not a reality for the residents. The first theme revealed an ambivalent mission, indicating ambiguity as to whether the nursing home was a place to live in or a place in which to be cared for. The second theme was symbolic power, which encompassed the staff’s power embedded in the organization. The third theme was the ageist approach to care, which was noted in the way staff considered the residents to be old people who were unable and unwilling to strive for autonomy. The three themes were embedded in the organizational culture and were created and recreated in the interaction between residents and staff. A key question for further research is how to change the culture to strengthen the residents’ autonomy.
Examination of Family Caregiver Experiences during Care Transitions of Older Adults
Non UofA Access
Giosa JL, Stolee P, Dupuis SL, Mock SE, Santi SM.
Canadian journal on aging 2014 Apr 23:1-17
This study explored informal family caregiver experiences in supporting care transitions between hospital and home for medically complex older adults. Using a qualitative, grounded-theory approach, in-depth semi-structured interviews were conducted with community and resource case managers, as well as with informal caregivers of older hip-fracture and stroke patients, and of those recovering from hip replacement surgery. Six properties characterizing caregiver needs in successfully transitioning care between hospital and home were integrated into a theory addressing both a transitional care timeline and the emotional journey. The six properties were (1) assessment of unique family situation; (2) practical information, education, and training; (3) involvement in planning process; (4) agreement between formal and informal caregivers; (5) time to make arrangements in personal life; and (6) emotional readiness. This work will support research and clinical efforts to develop more well-informed and relevant interventions to most appropriately support patients and families during transitional care.
A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes
Non UofA Access
Konno R, Kang HS, Makimoto K.
Journal of advanced nursing 2014 Apr 16
To conduct a best-evidence review of non-pharmacological interventions for resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. BACKGROUND: Resistance to care is a major source of staff burnout in nursing homes and it is also a safety issue for the staff. DESIGN: Best-evidence review. DATA SOURCES: We searched for non-pharmacological intervention studies published from 1990-2012, written in English. REVIEW METHODS: The search identified 19 intervention studies that examined the effects of interventions to reduce the resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. These 19 papers met the quality assessment requirements of the critical appraisal criteria for experimental studies, which were published by the Joanna Briggs Institute. RESULTS: Only three studies were RCTs and the rest were quasi-experimental. The sample size ranged from 7-127. Nine music interventions, such as pre-recorded music played to a group or playing a resident’s preferred music, during his or her personal care, resulted in significant reductions in resistance-to-care behaviours. Resistance-to-care behaviours also were significantly reduced in three of four bathing interventions that focused on person-centred care. In the ability-focused interventions, only two out of five studies reported significant reductions in resistance-to-care behaviours. CONCLUSION: Non-pharmacological interventions are options to consider to reduce resistance-to-care behaviours in older people with dementia, even though the evidence level is low, given the lack of alternatives. More randomized controlled trials are recommended to confirm the effects of non-pharmacological interventions during personal care. © 2014 John Wiley & Sons Ltd.
Antipsychotic use in nursing homes varies by psychiatric consultant.
Non UofA Access
Tjia J, Field T, Lemay C, Mazor K, Pandolfi M, Spenard A, et al.
Medical care 2014 Mar;52(3):267-271
The relationship between psychiatric consultation and antipsychotic prescribing in nursing homes (NH) is unknown. OBJECTIVE: To identify the association between psychiatric consultant groups and NH-level antipsychotic prescribing after adjustment for resident case-mix and facility characteristics. RESEARCH DESIGN AND SUBJECTS: Nested cross-sectional study of 60 NHs in a cluster randomized trial. We linked facility leadership surveys to October 2009-September 2010 Minimum Data Set, Nursing Home Compare, the US Census, and pharmacy dispensing data. MEASURES: The main exposure is the psychiatric consultant group and the main outcome is NH-level prevalence of atypical antipsychotic use. We calculated annual means and interquartile ranges of NH-level antipsychotic use for each consultant group and arrayed consultant groups from lowest to highest prevalence. Generalized linear models were used to predict antipsychotic prescribing adjusting for resident case-mix and facility characteristics. Observed versus predicted antipsychotic prescribing levels were compared for each consultant group. RESULTS: Seven psychiatric consultant groups served a range of 3-27 study facilities. Overall mean facility-level antipsychotic prescribing was 19.2%. Mean prevalence of antipsychotic prescribing ranged from 12.2% (SD, 5.8) in the lowest consultant group to 26.4% (SD, 3.6) in the highest group. All facilities served by the highest-ranked consultant group had observed antipsychotic levels exceeding the overall study mean with half exceeding predictions for on-label indications, whereas most facilities served by the lowest-ranked consultant group had observed levels below the overall study and predicted means. CONCLUSIONS: Preliminary evidence suggests that psychiatric consultant groups affect NH antipsychotic prescribing independent of resident case-mix and facility characteristics.
A Review of Advance Care Planning Programs in Long-Term Care Homes: Are They Dementia Friendly?
Non UofA Access
Wickson-Griffiths A, Kaasalainen S, Ploeg J, McAiney C.
Nursing research and practice 2014;2014:875897
Persons living with dementia in the long-term care home (LTCH) setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning (ACP) programs that have been developed and their impact in order for LTCH settings to select a program that best suits residents’ needs. Methods. Four electronic databases were searched from 1990 to 2013, for studies that evaluated the impact of advance care planning programs implemented in the LTCH setting. Studies were critically reviewed according to rigour, impact, and the consideration of the values of residents with dementia and their family members according to the Dementia Policy Lens Toolkit. Results and Conclusion. Six ACP programs were included in the review, five of which could be considered more “dementia friendly.” The programs indicated a variety of positive impacts in the planning and provision of end-of-life care for residents and their family members, most notably, increased ACP discussion and documentation. In moving forward, it will be important to evaluate the incorporation of residents with dementia’s values when designing or implementing ACP interventions in the LTCH settings.
Most care for older people is not provided by the state or private agencies but by family members, at an estimated value of £55 billion annually. However, as the babyboomer generation ages, a growing ‘family care gap’ will develop as the number of older people in need of care outstrips the number of adult children able to provide it. This is expected to happen for the first time in 2017. Overstretched services will struggle to provide extra care, with two-thirds of all health resources already devoted to older people and social care services facing a funding crisis. Adult children and partners will take on even greater caring responsibilities and more people, particularly women who outnumber men as carers by nearly two to one, are likely to have to give up work to do so. Our plan should be to ‘build’ and ‘adapt’: to build new community institutions capable of sustaining us through the changes ahead and to adapt the social structures already in place, such as family caring, public services, workplaces and neighbourhoods.
Family caregiving today is largely considered to be an issue affecting mainly adult children and their parents. This focus reflects the demographics of an aging population, but it misses a significant group—spouses who are caregivers. A recent national survey of family caregivers of adults conducted by the AARP Public Policy Institute and the United Hospital Fund found that 1 in 5 family caregivers is a spouse. Spousal caregivers are particularly vulnerable because they are older, have lower educational levels and less income, and are less likely to be employed than nonspousal caregivers. Spousal caregivers are more likely than nonspousal caregivers to provide assistance with medical/nursing tasks such as medication management and wound care. Yet they are less likely to receive support from family and friends and are far less likely to have home visits from health care professionals and aides. Efforts to reduce isolation and stress, as well as targeted training and support, are needed to protect the health and well-being of both partners. This is the second of three Insight on the Issues that looks into the different roles a family caregiver is in while performing complex medical/nursing tasks.
Regulating long-term care quality: an international comparison
Cambridge University Press, 2014
Edited by Vincent Mor, Tiziana Leone, Anna Maresso
The number of elderly people relying on formal long-term care services is dramatically increasing year after year, and the challenge of ensuring the quality and financial stability of care provision is one faced by governments in both the developed and developing world. This edited book is the first to provide a comprehensive international survey of long-term care provision and regulation, built around a series of case studies from Europe, North America and Asia. The analytical framework allows the different approaches that countries have adopted to be compared side by side and readers are encouraged to consider which quality assurance approaches might best meet their own country’s needs. Wider issues underpinning the need to regulate the quality of long-term care are also discussed. This timely book is a valuable resource for policymakers working in the health care sector, researchers and students taking graduate courses on health policy and management.
Research Data Management Week
28 April-2 May, University of Alberta
New norms and practices are developing around the management of research data. Canada’s research councils are discussing the introduction of data management plans within their application processes. The University of Alberta’s Research Policy now addresses the stewardship of research records, with an emphasis on the long-term preservation of data. An increasing number of scholarly journals are requiring authors to provide access to the data behind their submissions for publication. Data repositories are being established in domains and institutions to support the sharing and preservation of data. The series of talks and workshops that have been organized will help you better prepare for this emerging global research data ecosystem. Presenters you may be familiar with will be Dr. Carole Estabrooks (presenting on How a Scribbler and a Codebook Became Metadata) and James Doiron (presenting on the Health Research Data Repository).
Thinking as a subversive activity: scholarship and values in the corporate university
Presenter Professor Gary Rolfe, Swansea University, UK
Wednesday 21 May 4-036 ECHA 15:00-17:00
It is now nearly twenty years since the writer and scholar Bill Readings proclaimed that the institution of the university was in ruins. He added that there was no prospect of a return to the values and practices of the Enlightenment University of the nineteenth and twentieth centuries, and even less hope of overthrowing the new corporate monolith which has taken its place. His advice to those of us who were unhappy with where we found ourselves was, rather enigmatically, to ‘dwell in those ruins without recourse to romantic nostalgia’. How we might do this was not described in any detail. In this lecture I will take up Readings’ invitation to explore other ways of thinking in the university which do not compromise the values and practice of scholarship and education I will conclude by outlining a ‘fourth mission’ of everyday subversive activity.
Questions in Philosophy of Nursing: In Conversation with Nurse-Philosophers
Featured special guests: John S. Drummond (UK), Mary Ellen Purkis (Canada), Gary Rolfe (UK), Trudy Rudge (Australia) and Derek Sellman (Canada)
Thursday 22 May 4-036 ECHA 15:00-17:00
5 Questions (2013) is a recently released collection of interviews that offers one snapshot of the current ‘state of the art’ of nursing philosophy. Edited by Anette Forss, Christine Ceci and John S. Drummond, 24 key thinkers in philosophy of nursing respond to 5 questions concerning the past, present and future of nursing philosophy. On May 22, 2014, the unit for Philosophical Nursing Research is pleased to welcome five contributors to this collection for conversation about the promises and challenges of nursing philosophy. What is the significance of philosophy to nursing, or nursing to philosophy? What are our most interesting, pressing or overlooked problems? Where is the field of philosophy of nursing headed?
How Do We Justify Biomedical Animal Research for Human Benefits
Wednesday 30 April 12:00-13:00 Dvorkin Centre (2G2.07 WMC)
Two questions will be discussed. First, is animal research predictive of human response to drugs and disease? Second, is there an ethical argument that justifies animal research? It will be suggested that the answer to both questions is “no”.
IHE Innovation Forum: Meeting the Challenge: Dementia and Continuing Care
Tuesday 27 May 2014 14:30-17:50 Sutton Place
This event features two distinguished speakers on the topic of “Meeting the Change: Dementia and Continuing Care.” Dr. Sube Banerjee – Professor & Associate Dean for Strategy, Brighton and Sussex Medical School and Dr. David C. Grabowski– Professor, Harvard Medical School. Both lectures will be discussed by a panel of Alberta health system leaders. The program will be followed by a reception where our guests can meet with the speakers and other health care leaders, including members of the IHE Board of Directors.
Knowledge into Action
University of Oxford
Oxford UK 2-6 June 2014
Dr Mickan runs Oxford’s course Knowledge into Action. The course has been designed for health professionals to support the development of critical appraisal skills, and includes using research evidence to inform decisions and identifying local barriers and facilitators to improve clinical care. It also forms part of Oxford’s part-time MSc in Evidence-Based Health Care.
The importance of considering hearing needs in individuals with cognitive impairment
Presenters: Kate Dupuis, a registered Clinical Neuropsychologist and a postdoctoral fellow at the University of Toronto & Debbie Ostroff, a Clinical Audiologist at Baycrest Health Sciences
Wednesday 14 May 10:00-11:00 MT
In this webinar we will address how to factor sensory loss into your clinical decisions and recommendations. Specific strategies that can be implemented in clinical practice will be discussed, and preliminary findings from ongoing clinic-based research projects will be presented.
The Ontario government is pouring money into community health clinics in a bid to get more patients out of hospital. Health Minister Deb Matthews on Tuesday unveiled $60-million over three years to repair and expand existing community health centres – non-profit organizations that provide medical services – and create new ones.
The Canadian Foundation for Healthcare Improvement (CFHI) has launched a pan-Canadian collaborative focused on improving care for patients with chronic obstructive pulmonary disease (COPD), supported by Boehringer Ingelheim (Canada) Ltd. (BICL).
A Toronto Star investigation has found that some long-term care homes, often struggling with staffing shortages, are routinely doling out these risky drugs to calm and “restrain” wandering, agitated and sometimes aggressive patients. At more than 40 homes across the province, roughly half the residents are on the drugs. At close to 300 homes, more than a third of the residents are on the drugs.
Saskatchewan residents now have access to more information about personal care homes in the province. Personal care home inspection results are now available online after recent changes to legislation were made to allow inspection information to be shared with the public. “Online access to the most recent inspection results will help families select a personal care home,” Health Minister Dustin Duncan said. “It will also provide increased incentive for operators to provide the best care possible.”
Almost nine out of ten elderly people with depression are getting no help because doctors struggle to spot the symptoms or confuse it with dementia.
The Health Quality Council (HQC) has analyzed Saskatchewan health care data from 1996-2012 to better understand who (number of people, age, gender, and location) has dementia, and learn about the various types, and sequence, of health care services received by people with dementia. This is one part of the Gaps in Saskatchewan Dementia Care Research Project involving the Rural Dementia Action Research Team at the University of Saskatchewan (U of S) and HQC. Researchers at the U of S have gathered information on best practices in dementia care in Canada and elsewhere, and they are comparing those practices to dementia services currently available in urban and rural communities in our province.
The Montérégie Health Agency is giving a long-term care facility 30 days to comply with recommended changes after two caregivers were arrested last December and charged with mistreating elderly patients at the CHSLD in Saint-Lambert sur-le-golf.
Less than one-third of the province’s 650 seniors facilities are equipped with sprinkler fire prevention systems, and critics say the PC government is dragging its feet on protecting Alberta’s aging population.
Recognizing the changing demographics of central Newfoundland and future health care needs, the Provincial Government is moving forward with a study to examine long-term care and community support services requirements in the region. Budget 2014 Shared Prosperity, Fair Society, Balanced Outlook provides $600,000 to develop a plan to increase long-term care beds in the central Newfoundland region.
“As soon as it was announced that Chad was stepping down, my inbox was flooded by colleagues from Memorial and across the country expressing concern and worry,” said Noreen Golfman, dean of graduate studies at Memorial University and a former president of the Canadian Federation for the Humanities and Social Sciences. She said she and others are concerned that this government-appointed position may go to someone who isn’t as committed to research in the humanities and social sciences as Dr. Gaffield.”
The number of older people in England needing care will “outstrip” the number of family members able to provide it by 2017, a think tank has warned.
The Government of Canada today announced the creation of the Canadian Clinical Trials Coordinating Centre (CCTCC) – a collaborative effort of the Canadian Institutes of Health Research (CIHR), Canada’s Research-Based Pharmaceutical Companies (Rx&D), and the merged organizations of the Association of Canadian Academic Healthcare Organizations and the Canadian Healthcare Association (ACAHO/CHA). The CCTCC will be housed at the offices of the Health Charities Coalition of Canada, in Ottawa.
Most research reports are about as interesting to read as car manuals or insurance plans. They’re long, boring, inaccessible, jargon-filled and impossible to make sense of. This is how most people feel about research articles across different fields — medicine, health, psychology, education and so forth — and with good reason. Honestly, who among us actually reads this stuff?
Earlier this week Japanese researcher Takaomi Saido told the The Japan Times that “Alzheimer’s disease will destroy Japan’s social-welfare mechanisms in the near future,” and the same can be said for countries all around the world, including Canada.
To be the child of parents who are alive but no longer present is bit like being in state of suspended animation. There is no more communication, no more sharing memories, no more laughter. Their physical being still exists, but the person they were has vanished. That’s what dementia does. And as the daughter of parents who are caught in this, I decided rather than be muzzled by my sadness I would speak out.
Originally published in Australia, this short book has been expanded from a university postgraduate-level course on scientific research. Aimed at novice researchers in academic settings, the book provides a framework to complete the transition to independent research and contains guideline proposals and self-help exercises. Many topics are discussed such as the nature of research and innovation, the life cycle of a project, how to plan and manage a project, and communicating research.
This guide from the Australian Government is designed to help departments and agencies formulate robust implementation plans that clearly articulate how new policies, programs, and services will be delivered on time, on budget and to expectations. It supports the Australian Government’s approach to strengthening Cabinet decision-making and improving program governance and implementation. This guide aims to assist those involved in implementation planning to understand how they should formulate an implementation plan. It is not intended to be a mechanical guide on how to complete an implementation plan, because it is not possible to formulate an implementation plan using a mechanistic or template-driven approach. Nor is it intended to be used in isolation from other guidance: implementation planning requires a much deeper understanding of management approaches than can be conveyed in a single guidance document.
A new resource commissioned by MSFHR will help define how nurses move through their careers in developing knowledge, skills, and competencies related to research and research use. The Health Services Researcher Pathway, developed through the BC Nursing Research Initiative, describes five distinct levels of nurses’ research competency. The document is intended to support greater use of research at the point of care, where most nurses work.
Conversations Matter, launched by Alberta Health Services (AHS) to coincide with National Advance Care Planning Day on April 16, provides information on advance care planning and an interactive online tool designed to help individuals determine their personal preferences in the event that they become incapable of consenting to or refusing treatment or other care. The interactive online tool, soon to be available through the AHS mobile app, has been created to help Albertans understand advance care planning before they enter into the health care system.
The Alzheimer Society of Alberta and the NWT has developed this online community for individuals, family members, care partners and friends – anyone whose life is affected by Alzheimer’s disease and other dementias. Imagine this site is a warm, welcoming café, stocked with information contributed by friends and experts who want to help you find answers.
Canadian Longitudinal Study on Aging (CLSA) – Research Assistant
Competition will remain open until a suitable candidate is found
The UVic Canadian Longitudinal Study on Aging (CLSA) research team is currently looking for a research assistant who will be responsible for various aspects of data collection, including neuropsychological tests, carotid intima thickness and bone density, with research participants.
Clinical Research Assistant
University of Victoria Victoria BC
DEADLINE 30 April
Duties will revolve around the research project entitled, “The Carer Support Needs Assessment Tool (CSNAT): Supporting Family Caregivers of Palliative Patients at Home”. This study, led by Dr. Kelli Stajduhar was funded by Technology Evaluation in the Elderly Network (TVN) and the Canadian Cancer Society Research Institute (CCSRI). Reporting to the Project Coordinator, the Clinical Research Assistant (CRA) will assist the Project Coordinator with various aspects of the study including helping with Home Care Nurse (HCN), recruitment, and training in the CSNAT intervention. You will also be extensively involved in Family Care Giver (FCG) recruitment, screening, data collection, interviewing, and related follow-up activities.
Home Care Nurse Research Assistant
University of Victoria Victoria BC
DEADLINE 30 April
Your duties will revolve around the research project entitled, “The Carer Support Needs Assessment Tool (CSNAT): Supporting Family Caregivers of Palliative Patients at Home”. This study, led by Dr. Kelli Stajduhar was funded by Technology Evaluation in the Elderly Network (TVN) and the Canadian Cancer Society Research Institute (CCSRI). Reporting to the Project Coordinator, the Home Care Nurse Research Assistant (HCNRA) will assist the Project Coordinator with various aspects of the study including helping with Home Care Nurse (HCN), Recruitment, and CSNAT training. You will also be involved in supporting participating HCNs throughout the project and will be actively collecting data from HCN participants (demographics, interviewing, chart audits, and related follow-up activities). There will also be some data entry involved.
Post-Doctoral Fellowship Supporting 2-year Research Project: The Search for Sustainable Development in the Toquaht Nation
Priority will be given to applications received by April 22 (so apply right away if interested)
The University of Victoria (UVic) invites applications for the position of a post-doctoral fellow who will support a two-year research project, “The Search for Sustainable Development in the Toquaht Nation”. The project is a partnership between the Toquaht Nation, Tribal Resources Investment Corporation (TRICORP), and the University of Victoria. The position is located in the Gustavson School of Business. The candidate will work closely with the Principle Investigator, Dr. Matthew Murphy, as well as with the project’s co-applicants from the schools of Business and Law (Johnny Mack, LLB, LLM, Dr. Judith Sayers, Dr. Brent Mainprize), partners within the Toquaht Nation and TRICORP, co-investigators from the University of Alberta and Trinity College Dublin, and graduate research assistants who will be hired to support the project.
The Journal for Nurse Practitioners Seeks Associate Editor
DEADLINE May 15
JNP: The Journal for Nurse Practitioners offers high-quality, peer-reviewed clinical articles, original research, continuing education, and departments that help practitioners excel as providers of primary and acute care across the lifespan. JNP supports advocacy by demonstrating the role that policy plays in shaping practice and influencing outcomes. The journal is an official publication of the American Association of Nurse Practitioners and is affiliated with the Australian College of Nurse Practitioners.
Quality Improvement Resource Analyst Job
HealthSouth Birmingham, AL
This position will work with the CMO and the Clinical Leadership Board chairs in the analysis, planning, and strategic formation of clinical and quality initiatives and provide follow-up on the success and sustainability of the initiatives. The main objective of the positoin is to increase the effectiveness of HealthSouth’s quality programs (as measured by dashboard metrics and compliance with all regulatory, accreditation, and development expectations), while reducing the burden on individual hospitals, regions and/or corporate office staff.
Six PhD studentships in public health research
Fuse, UKCRC Centre for Translational Research in Public Health, Northumbria Univesity, Newcastle UK
DEADLINE 9 May
Each studentship will be aligned with one of Fuse’s six research programmes and will provide excellent training and experience in a vibrant postgraduate research environment. Students will be based at one of the Centre’s five partner universities and have supervisory input from another north east university.
Michael Smith Foundation for Health Research, Vancouver BC
Open until filled
The Data Analyst will manage and analyze health research data from a variety of sources and present it in a variety of formats for internal and external end-users. In this position, you will leverage the value of data for evaluation, planning and communications for the organization and its many stakeholders.