Congratulations to Dr. Carole Estabrooks
Carole has been awarded with the 2014 CIHR Betty Havens Prize for Knowledge Translation in Aging
This prize recognizes outstanding achievements and excellence in knowledge translation in aging at a local or regional level. The prize of $20,000 is to foster excellence and innovation in knowledge translation activities. Estabrooks will receive the award at the 2014 meeting of the Canadian Association on Gerontology in Niagara Falls in October. Way to go Carole!!
New article by Dr. Jennifer Baumbusch
Practising family medicine for adults with intellectual disabilities: Patient perspectives on helpful interactions.
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Baumbusch J, Phinney A, Baumbusch S.
Canadian family physician Medecin de famille canadien 2014 Jul;60(7):e356-61
To explore the perspectives of adults with intellectual disabilities (IDs) on helpful interactions with their family physicians. DESIGN: Exploratory, qualitative study. SETTING: Vancouver, BC. PARTICIPANTS: Purposive sample of 11 community-dwelling adults with IDs. METHODS: In-depth, semistructured interviews were conducted face to face with participants. Interviews were audiorecorded and transcribed verbatim. Research team members read the transcripts, which were then coded into categories and subcategories and discussed at collective analysis meetings. The main study themes were generated through this iterative, collective process. MAIN FINDINGS: Two themes about helpful interactions were identified: helping patients understand and helping patients navigate the health care system. The first theme reflected helpful ways of communicating with patients with IDs. These approaches focused on plain-language communication and other strategies developed jointly by the patients and their physicians. The second theme reflected ways in which the family physicians helped adults with IDs manage their health needs despite the complex constraints of their socioeconomic situations. CONCLUSION: Adults with IDs want to play an active role in managing their health as they age, and helpful interactions with family physicians make this possible. Copyright© the College of Family Physicians of Canada.
CALL FOR ABSTRACTS:
7th Annual Conference on the Science of Dissemination and Implementation
DEADLINE 8 August
8-9 December 8-9 2014 Bethesda MD
Cohosted by AcademyHealth and the National Institutes of Health this is a forum for discussing the science of dissemination and implementation, the 7th annual conference aims to grow the research base by bridging the gap between evidence, practice, and policy in health and medicine. Researchers, evaluators and implementers who are interested in identifying opportunities, challenges, and strategies for disseminating the findings and implementation of research to key stakeholders are encouraged to attend. Discuss, debate, and explore in-depth approaches to advance dissemination and implementation science.
Overview of Evidence-based Practice and Translation Science
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Nursing Clinics of North America 2014
Evidence-based practice and translation science are not interchangeable terms; EBP is the application of evidence in practice (the doing of EBP), whereas translation science is the study of implementation interventions, factors, and contextual variables that affect knowledge uptake and use in practices and communities. The use of collaborative networks such as the National Nursing Practice Network maximizes sharing of resources and knowledge about EBPs, an infrastructure for conducting multi-site translation studies, and a venue for large scale-up of EBP projects across multiple healthcare settings. © 2014 Elsevier Inc. All rights reserved.
Leadership for Evidence-Based Practice: Strategic and Functional Behaviors for Institutionalizing EBP.
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Stetler CB, Ritchie JA, Rycroft-Malone J, Charns MP.
Worldviews on evidence-based nursing 2014 Jul 1
Making evidence-based practice (EBP) a reality throughout an organization is a challenging goal in healthcare services. Leadership has been recognized as a critical element in that process. However, little is known about the exact role and function of various levels of leadership in the successful institutionalization of EBP within an organization. AIMS: To uncover what leaders at different levels and in different roles actually do, and what actions they take to develop, enhance, and sustain EBP as the norm. METHODS: Qualitative data from a case study regarding institutionalization of EBP in two contrasting cases (Role Model and Beginner hospitals) were systematically analyzed. Data were obtained from multiple interviews of leaders, both formal and informal, and from staff nurse focus groups. A deductive coding schema, based on concepts of functional leadership, was developed for this in-depth analysis. RESULTS: Participants’ descriptions reflected a hierarchical array of strategic, functional, and cross-cutting behaviors. Within these macrolevel “themes,” 10 behavioral midlevel themes were identified; for example, Intervening and Role modeling. Each theme is distinctive, yet various themes and their subthemes were interrelated and synergistic. These behaviors and their interrelationships were conceptualized in the framework “Leadership Behaviors Supportive of EBP Institutionalization” (L-EBP). Leaders at multiple levels in the Role Model case, both formal and informal, engaged in most of these behaviors. LINKING EVIDENCE TO ACTION: Supportive leadership behaviors required for organizational institutionalization of EBP reflect a complex set of interactive, multifaceted EBP-focused actions carried out by leaders from the chief nursing officer to staff nurses. A related framework such as L-EBP may provide concrete guidance needed to underpin the often-noted but abstract finding that leaders should “support” EBP. © 2014 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International.
New directions in evidence-based policy research: a critical analysis of the literature.
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Oliver K, Lorenc T, Innvaer S.
Health research policy and systems / BioMed Central 2014 Jul 14;12(1):34
Despite 40 years of research into evidence-based policy (EBP) and a continued drive from both policymakers and researchers to increase research uptake in policy, barriers to the use of evidence are persistently identified in the literature. However, it is not clear what explains this persistence – whether they represent real factors, or if they are artefacts of approaches used to study EBP. Based on an updated review, this paper analyses this literature to explain persistent barriers and facilitators. We critically describe the literature in terms of its theoretical underpinnings, definitions of ‘evidence’, methods, and underlying assumptions of research in the field, and aim to illuminate the EBP discourse by comparison with approaches from other fields. Much of the research in this area is theoretically naive, focusing primarily on the uptake of research evidence as opposed to evidence defined more broadly, and privileging academics’ research priorities over those of policymakers. Little empirical data analysing the processes or impact of evidence use in policy is available to inform researchers or decision-makers. EBP research often assumes that policymakers do not use evidence and that more evidence – meaning research evidence – use would benefit policymakers and populations. We argue that these assumptions are unsupported, biasing much of EBP research. The agenda of ‘getting evidence into policy’ has side-lined the empirical description and analysis of how research and policy actually interact in vivo. Rather than asking how research evidence can be made more influential, academics should aim to understand what influences and constitutes policy, and produce more critically and theoretically informed studies of decision-making. We question the main assumptions made by EBP researchers, explore the implications of doing so, and propose new directions for EBP research, and health policy.
Knowledge brokering in public health: a tale of two studies.
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Traynor R, DeCorby K, Dobbins M.
Public health 2014 Jun;128(6):533-544
A Knowledge Broker is one approach for facilitating the integration of evidence-informed decision making in public health practice. In this paper, the findings from two studies investigating a Knowledge Broker intervention as a means of enhancing capacity for evidence-informed decision making are presented. Contextual factors that facilitate this strategy are also identified. STUDY DESIGN: This paper describes work done through a single mixed-methods study (randomized controlled trial with a qualitative component) and a case study. METHODS: The Health Evidence team conducted two studies examining Knowledge Broker impact in Canadian public health departments. The effectiveness of knowledge translation strategies of varying intensities for promoting the use of research evidence in decisions related to child obesity prevention were explored via a randomized controlled trial with a fundamental descriptive component (2003-2007). In a case study (2010-2013), the authors partnered with three health departments to develop and implement tailored strategies targeted at the organization. Knowledge Brokers worked with designated staff in these studies via one-on-one consultations, small group meetings, and/or workshops and presentations. The Knowledge Broker role was assessed by analysing data from close-ended surveys, interviews, organizational documents, and reflective journals. RESULTS: In this paper, the authors focus on findings from the qualitative analysis of implementing the Knowledge Broker role in both studies and explore several contextual factors that impacted study outcomes. Knowledge Brokers were shown to enhance individual capacity by improving knowledge and skill in searching for, critically appraising, and applying research evidence to practice-based issues. Organizational capacity was also enhanced with strong management support and policies. Effective Knowledge Broker attributes included both expertise in research methodology and public health, as well as intangible traits such as approachability and patience. Finally, optimal positioning and ways of working were identified, including the importance of in-person meetings and neutrality of the Knowledge Broker. CONCLUSIONS: Knowledge brokering is a potentially promising knowledge translation strategy for public health, though additional feasibility and cost-effectiveness data are still needed. The research presented here further highlights the importance of context and adopting a tailored approach to implement a Knowledge Broker strategy. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Exploring conceptualizations of knowledge translation, transfer and exchange across public health in one UK region: a qualitative mapping study.
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Visram S, Goodall D, Steven A.
Public health 2014 Jun;128(6):497-503
Knowledge translation (KT) is becoming common vocabulary, but as a concept it is not clearly defined. Many related terms exist; these are often used interchangeably and given multiple interpretations. While there is a growing body of literature exploring these concepts, using it to inform public health practice, strategy, research and education is challenging given the range of sources and need for local ‘contextual fit’. This study explores how various public health stakeholders make sense of, and experience, KT and related concepts. STUDY DESIGN: A qualitative mapping study using a phenomenographic approach. METHODS: Thirty-four academics, students and practitioners working in public health across the north east of England participated in six focus groups and five one-to-one interviews. Discussions were audio-recorded, transcribed and analysed using a thematic framework approach. The framework drew on findings from reviews of the existing literature, whilst allowing unanticipated issues to emerge. RESULTS: Three main themes were identified from the stakeholder discussions: CONCLUSIONS: This study has enabled further development of theoretical understandings of the KT discourses at play in public health, and identified the ways in which these may be bound by discipline and context. Ironically, the findings suggest that terms such as knowledge translation, transfer and exchange are seen as themselves requiring translation, or at least debate and discussion. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Health Care Administration and Organization
A patient-centered longitudinal care plan: vision versus reality.
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Dykes PC, Samal L, Donahue M, Greenberg JO, Hurley AC, Hasan O, et al.
Journal of the American Medical Informatics Association 2014 Jul 4
As healthcare systems and providers move toward meaningful use of electronic health records, longitudinal care plans (LCPs) may provide a means to improve communication and coordination as patients transition across settings. The objective of this study was to determine the current state of communication of LCPs across settings and levels of care. MATERIALS AND METHODS: We conducted surveys and interviews with professionals from emergency departments, acute care hospitals, skilled nursing facilities, and home health agency settings in six regions in the USA. We coded the transcripts according to the Agency for Healthcare Research and Quality (AHRQ) ‘Broad Approaches’ to care coordination to understand the degree to which current practice meets the definition of an LCP. RESULTS: Participants (n=22) from all settings reported that LCPs do not exist in their current state. We found LCPs in practice, and none of these were shared or reconciled across settings. Moreover, we found wide variation in the types and formats of care plan information that was communicated as patients transitioned. The most common formats, even when care plan information was communicated within the same healthcare system, were paper and fax. DISCUSSION: These findings have implications for data reuse, interoperability, and achieving widespread adoption of LCPs. CONCLUSIONS: The use of LCPs to support care transitions is suboptimal. Strategies are needed to transform the LCP from vision to reality.
Communication between residential aged care facilities and the emergency department: A review of the literature.
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Griffiths D, Morphet J, Innes K, Crawford K, Williams A.
International journal of nursing studies 2014 Jun 14
Western countries have encountered an increase in elderly patients transferred from residential aged care facilities to emergency departments. This patient cohort frequently experiences impaired physical and cognitive function. Emergency department staff require important clinical and personal patient information to provide quality care. International studies show that documentation and handover deficiencies are common. OBJECTIVE: The purpose of this literature review was to explore transitional communication practices, and to consider the specific patient information deemed essential for the management of residents in the emergency department. METHODS: A literature review was conducted to examine the studies exploring the documentation accompanying elderly people who were transferred from residential aged care facilities to emergency departments. Scopus, OVID Medline and Cinahl Plus data bases were searched using combinations of the following key words: ‘nursing home’, ‘long-term care’, ‘skilled nursing facility’, ‘aged care facility’, ‘communication’, ‘documentation’, ’emergency department’, ’emergency room’, ‘hospital’, ‘acute’, ‘transfer’, and ‘transition’. Additional data was located with the use of Google Scholar. Review of titles and exclusion of duplicates identified 69 relevant studies. These 69 papers were independently reviewed by three members of the research team for eligibility for inclusion in the review, and seven papers were retained. RESULTS: There is currently no consensus regarding what information is essential when residents are transferred from aged care facilities to emergency departments, and practices vary. Key information which should accompany the resident has been reported by various authors and include the reason for transfer, past medical history, current medications, cognitive function and advance directives. Some authors also suggest that facility contact details are essential. Without agreement by key stakeholders as to what constitutes ‘essential transfer information’, clinical practices will continue to vary and resident care will be affected. CONCLUSION: This paper identifies frequent communication deficits in the information provided to the emergency department from aged care facilities. There is an imperative to identify suitable items of information which health care professionals agree are essential. Future research should focus on methods to improve the transfer of information between facilities, including consensus regarding what information is essential transfer data. Copyright © 2014. Published by Elsevier Ltd.
Grief After Patient Death: Direct Care Staff in Nursing Homes and Homecare.
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Boerner K, Burack OR, Jopp DS, Mock SE.
Journal of pain and symptom management 2014 Jul 1
Patient death is common in long-term care. Yet, little attention has been paid to how direct care staff members, who provide the bulk of daily long-term care, experience patient death and to what extent they are prepared for this experience. OBJECTIVES: To 1) determine how grief symptoms typically reported by bereaved family caregivers are experienced among direct care staff, 2) explore how prepared staff members were for the death of their patients, and 3) identify characteristics associated with their grief. METHODS: This was a cross-sectional study of direct care staff experiencing recent patient death. Participants were 140 certified nursing assistants and 80 homecare workers. Standardized assessments and structured questions addressed staff (e.g., preparedness for death), institutional (e.g., support availability), and patient/relational factors (e.g., relationship quality). Data analyses included bivariate group comparisons and hierarchical regression. RESULTS: Grief reactions of staff reflected many of the core grief symptoms reported by bereaved family caregivers in a large-scale caregiving study. Feelings of being “not at all prepared” for the death and struggling with “acceptance of death” were prevalent among staff. Grief was more intense when staff-patient relationships were closer, care was provided for longer, and staff felt emotionally unprepared for the death. CONCLUSION: Grief symptoms like those experienced by family caregivers are common among direct care workers following patient death. Increasing preparedness for this experience via better training and support is likely to improve the occupational experience of direct care workers, and ultimately allow them to provide better palliative care in nursing homes and homecare. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
The effect of nurse manager turnover on patient fall and pressure ulcer rates.
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Warshawsky N, Rayens MK, Stefaniak K, Rahman R.
Journal of nursing management 2013 Jul;21(5):725-732
The purpose of this study was to explore the effects of nurse manager turnover on the occurrence of adverse events. BACKGROUND: Nurse managers create professional nurse practice environments to support the provision of quality patient outcomes. Inconsistent findings were reported in the literature testing the relationship between nurse managers and patient outcomes. All prior studies assumed stable nursing management. METHODS: A longitudinal quasi-experimental study of 23 nursing units in two hospitals was used to determine whether unit characteristics, including nurse manager turnover, have an effect on patient falls or pressure ulcers. Statistical analyses included repeated measures and hierarchical modelling. RESULTS: Patients in medical/surgical units experienced more falls than in intensive care units (F1,11 = 15.9, P = 0.002). Patients in units with a nurse manager turnover [odds ratio: 3.16; 95% confidence interval: 1.49-6.70] and intensive care units (odds ratio: 2.70; 95% confidence interval: 1.33-5.49) were more likely to develop pressure ulcers. CONCLUSIONS: Nurse manager turnover and intensive care unit status were associated with more pressure ulcers. Medical/surgical unit status was associated with more falls. The study was limited by a small sample size. IMPLICATIONS FOR NURSE MANAGERS: Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events. © 2013 John Wiley & Sons Ltd.
CIHI: Regulated Nurses, 2013
Regulated Nurses, 2013 highlights current trends in nursing practice across a variety of demographic, education, mobility and employment characteristics. This series highlights data from the three groups of regulated nursing professionals in Canada: registered nurses (RNs, including nurse practitioners or NPs), licensed practical nurses (LPNs) and registered psychiatric nurses (RPNs).
Health Care Innovation and Quality Assurance
The effect of programs to improve oral hygiene outcomes for older residents in long-term care: a systematic review.
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Coker E, Ploeg J, Kaasalainen S.
Research in gerontological nursing 2014 Mar-Apr;7(2):87-100
Nurses have a critical role in promoting oral health in dependent older adults residing in long-term care or having extended hospital stays. Strategies aimed at improving the quality of oral hygiene care nurses provide may contribute to better oral hygiene outcomes. The purpose of this systematic review was to examine the effect of intervention programs designed to enhance the ability of nurses or those to whom they delegate care to improve oral hygiene outcomes in frail older adults. Studies reported an educational program, either alone or augmented in some way. The study interventions consisted of: (a) single in-service education sessions; (b) single in-service education sessions supplemented by a “train-the-trainer” approach; and (c) education sessions supplemented with ongoing active involvement of a dental hygienist. None of the approaches emerged as being desirable over the others, as methodologically strong studies with good intervention integrity were lacking, and a variety of oral health outcomes were used to measure effectiveness of the interventions, making comparisons across studies difficult. Copyright 2014, SLACK Incorporated.
Defining quality outcomes for complex-care patients transitioning across the continuum using a structured panel process.
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Jeffs L, Law MP, Straus S, Cardoso R, Lyons RF, Bell C.
BMJ quality & safety 2013 Dec;22(12):1014-1024
No standardised set of quality measures associated with transitioning complex-care patients across the various healthcare settings and home exists. In this context, a structured panel process was used to define quality measures for care transitions involving complex-care patients across healthcare settings. METHODS: A modified Delphi consensus technique based on the RAND method was used to develop measures of quality care transitions across the continuum of care. Specific stages included a literature review, individual rating of each measure by each of the panelists (n=11), a face-to-face consensus meeting, and final ranking by the panelists. RESULTS: The literature review produced an initial set of 119 measures. To advance to rounds 1 and 2, an aggregate rating of >75% of the measure was required. This analysis yielded 30/119 measures in round 1 and 11/30 measures in round 2. The final round of scoring yielded the following top five measures: (1) readmission rates within 30 days, (2) primary care visit within 7 days postdischarge for high-risk patients, (3) medication reconciliation completed at admission and prior to discharge, (4) readmission rates within 72 h and (5) time from discharge to homecare nursing visit for high-risk patients. CONCLUSIONS: The five measures identified through this research may be useful as indicators of overall care quality related to care transitions involving complex-care patients across different healthcare settings. Further research efforts are called for to explore the applicability and feasibility of using the quality measures to drive quality improvement across the healthcare system.
Establishing a community of practice for dementia champions (innovative practice)
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Mayrhofer A, Goodman C, Holman C.
Dementia 2014 July 14
This discussion paper considers the currently evolving roles of dementia champions and describes an initiative designed to support their activities. The aim of this initiative was to establish a county-wide group that has a shared group identity and sufficient critical mass that is able to identify and implement dementia training and development needs for the health and social care workforce. The approach used to achieve this aim was a Dementia Champion Community of Practice Project, which involved dementia leads in various NHS Trusts. Whilst this approach might be effective at practitioner level, the Dementia Champion Community of Practice Project experience suggests that if such initiatives are to be sustainable they need to be strategically placed within networks that can bring together service providers, educators and commissioners.
Strengthening coordination of care in the U.S. health care system is a priority for policymakers and the medical community. Poor coordination of care can drive up costs and harm patient health, especially for patients with chronic illnesses who see many different providers across many different settings. Some new models of care, such as the patient-centered medical home, focus on improving coordination as a way to provide affordable, high-quality care. Are these new models having the desired effect?
Research Practice & Methodology
I love to write, both as a solo author and as a member of a writing team. Although writing collaboratively can be enjoyable and highly productive, it can also be fraught with challenges. One way to minimize these challenges, increase productivity, and keep relationships buoyant and intact is to use a dynamic framework for writing in teams. Several years ago, I developed the Formula for Collaborative Writing—a step-by-step guide, plan, or recipe to achieve mutual and achievable writing goals and outcomes. The formula offers a practical approach to scholarly ventures by (a) clarifying relationships, beliefs, roles, and responsibilities, (b) providing clear direction, (c) improving efficiency and communication, and (d) ensuring goal achievement. I hope all writing partners will give it a try.
Authorship ethics in global health research partnerships between researchers from low or middle income countries and high income countries.
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Smith E, Hunt M, Master Z.
BMC medical ethics 2014 May 28;15:42-6939-15-42
Over the past two decades, the promotion of collaborative partnerships involving researchers from low and middle income countries with those from high income countries has been a major development in global health research. Ideally, these partnerships would lead to more equitable collaboration including the sharing of research responsibilities and rewards. While collaborative partnership initiatives have shown promise and attracted growing interest, there has been little scholarly debate regarding the fair distribution of authorship credit within these partnerships. DISCUSSION: In this paper, we identify four key authorship issues relevant to global health research and discuss their ethical and practical implications. First, we argue that authorship guidance may not adequately apply to global health research because it requires authors to write or substantially revise the manuscript. Since most journals of international reputation in global health are written in English, this would systematically and unjustly exclude non-English speaking researchers even if they have substantially contributed to the research project. Second, current guidance on authorship order does not address or mitigate unfair practices which can occur in global health research due to power differences between researchers from high and low-middle income countries. It also provides insufficient recognition of “technical tasks” such as local participant recruitment. Third, we consider the potential for real or perceived editorial bias in medical science journals in favour of prominent western researchers, and the risk of promoting misplaced credit and/or prestige authorship. Finally, we explore how diverse cultural practices and expectations regarding authorship may create conflict between researchers from low-middle and high income countries and contribute to unethical authorship practices. To effectively deal with these issues, we suggest: 1) undertaking further empirical and conceptual research regarding authorship in global health research; 2) raising awareness on authorship issues in global health research; and 3) developing specific standards of practice that reflect relevant considerations of authorship in global health research. SUMMARY: Through review of the bioethics and global health literatures, and examination of guidance documents on ethical authorship, we identified a set of issues regarding authorship in collaborative partnerships between researchers from low-middle income countries and high income countries. We propose several recommendations to address these concerns.
How to Read a Systematic Review and Meta-analysis and Apply the Results to Patient Care
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Murad M, Montori VM, Ioannidis JA,et al.
JAMA 2014 July 9;312(2):171-179
Clinical decisions should be based on the totality of the best evidence and not the results of individual studies. When clinicians apply the results of a systematic review or meta-analysis to patient care, they should start by evaluating the credibility of the methods of the systematic review, ie, the extent to which these methods have likely protected against misleading results. Credibility depends on whether the review addressed a sensible clinical question; included an exhaustive literature search; demonstrated reproducibility of the selection and assessment of studies; and presented results in a useful manner. For reviews that are sufficiently credible, clinicians must decide on the degree of confidence in the estimates that the evidence warrants (quality of evidence). Confidence depends on the risk of bias in the body of evidence; the precision and consistency of the results; whether the results directly apply to the patient of interest; and the likelihood of reporting bias. Shared decision making requires understanding of the estimates of magnitude of beneficial and harmful effects, and confidence in those estimates.
Systematic review on the primary and secondary reporting of the prevalence of ghostwriting in the medical literature
BMJ Open 2014 July 01;4(7)
Ghostwriting of industry-sponsored articles is unethical and is perceived to be common practice. Objective To systematically review how evidence for the prevalence of ghostwriting is reported in the medical literature. Data sources MEDLINE via PubMed 1966+, EMBASE 1966+, The Cochrane Library 1988+, Medical Writing 1998+, The American Medical Writers Association (AMWA) Journal 1986+, Council of Science Editors Annual Meetings 2007+, and the Peer Review Congress 1994+ were searched electronically (23 May 2013) using the search terms ghostwrit*, ghostauthor*, ghost AND writ*, ghost AND author*. Eligibility criteria All publication types were considered; only publications reporting a numerical estimate of possible ghostwriting prevalence were included. Data extraction Two independent reviewers screened the publications; discrepancies were resolved by consensus. Data to be collected included a numerical estimate of the prevalence of possible ghostwriting (primary outcome measure), definitions of ghostwriting reported, source of the reported prevalence, publication type and year, study design and sample population. Results Of the 848 publications retrieved and screened for eligibility, 48 reported numerical estimates for the prevalence of possible ghostwriting. Sixteen primary publications reported findings from cross-sectional surveys or descriptive analyses of published articles; 32 secondary publications cited published or unpublished evidence. Estimates on the prevalence of possible ghostwriting in primary and secondary publications varied markedly. Primary estimates were not suitable for meta-analysis because of the various definitions of ghostwriting used, study designs and types of populations or samples. Secondary estimates were not always reported or cited correctly or appropriately. Conclusions Evidence for the prevalence of ghostwriting in the medical literature is limited and can be outdated, misleading or mistaken. Researchers should not inflate estimates using non-standard definitions of ghostwriting nor conflate ghostwriting with other unethical authorship practices. Editors and peer reviewers should not accept articles that incorrectly cite or interpret primary publications that report the prevalence of ghostwriting.
The development and application of audit criteria for assessing knowledge exchange plans in health research grant applications
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Ruppertsberg AI, Ward V, Ridout A, Foy R.
Implementation science 2014 Jul 14;9(1):93
Research funders expect evidence of end user engagement and impact plans in research proposals. Drawing upon existing frameworks, we developed audit criteria to help researchers and their institutions assess the knowledge exchange plans of health research proposals.FindingsCriteria clustered around five themes: problem definition; involvement of research users; public and patient engagement; dissemination and implementation; and planning, management and evaluation of knowledge exchange. We applied these to a sample of grant applications from one research institution in the United Kingdom to demonstrate feasibility.Conclusion Our criteria may be useful as a tool for researcher self-assessment and for research institutions to assess the quality of knowledge exchange plans and identify areas for systematic improvement.
Cognitive decline after entering a nursing home: a 22-year follow-up study of institutionalized and noninstitutionalized elderly people.
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Gonzalez-Colaco Harmand M, Meillon C, Rullier L, Avila-Funes JA, Bergua V, Dartigues JF, et al.
Journal of the American Medical Directors Association 2014 Jul;15(7):504-508
The objective of this study is to compare cognitive decline of elderly people after entering an institution with that of elders living in the community with similar clinical conditions. DESIGN: The Personnes Agées QUID (PAQUID) cohort is a prospective population-based study which included, at baseline, 3777 community-dwelling people aged 65 years and older. Participants were followed-up for 22 years. Among those who were nondemented and living at home at baseline, 2 groups were compared: participants who entered a nursing home during study follow-up (n = 558) and those who remained living at home (n = 3117). Cognitive decline was assessed with Mini-Mental State Examination (MMSE), Benton visual retention test, and verbal fluency Isaacs Set Test. RESULTS: After controlling for numerous potential confounders, including baseline MMSE and instrumental activities of daily living scores, incident dementia, depressive symptoms, and chronic diseases, nursing home placement was significantly associated with a lower score on MMSE between the last visit before and after institutionalization (difference of 2.8 points, P < .0001) and greater further cognitive decline after institutionalization (difference of 0.7 point per year, P < .0001). Similar results were found for the Benton memory test. In a second series of analysis in which the persons who became demented over the study follow-up were excluded, the results remained unchanged. CONCLUSIONS: The present study suggests that institutionalized elderly people present a greater cognitive decline than persons remaining in the community. The reasons of that decline remain unclear and may be related to physical and psychological effects of institutionalization in elderly people. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia.
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Zwijsen SA, Smalbrugge M, Eefsting JA, Twisk JW, Gerritsen DL, Pot AM, et al.
Journal of the American Medical Directors Association 2014 Jul;15(7):531.e1-531.e10
The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes. It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints. DESIGN: A randomized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects. An assessment of challenging behavior and psychoactive medication was undertaken every 4 months on all participating units followed by the introduction of the care program in a group of 3 to 4 units. A total of 6 time assessments took place over 20 months. SETTING: Seventeen dementia special care units of different nursing homes. PARTICIPANTS: A total of 659 residents of dementia special care units. All residents with dementia on the unit were included. Units were assigned by random allocation software to 1 of 5 groups with different starting points for the implementation of the care program. INTERVENTION: A care program consisting of various assessment procedures and tools, which ensure a multidisciplinary approach and which structure the process of managing challenging behavior in dementia. MEASUREMENTS: Challenging behavior was measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory. Research assistants (blinded for intervention status of the unit) interviewed nurses on the units about challenging behavior. Data on psychoactive drugs and restraints were retrieved from resident charts. RESULTS: A total of 2292 assessments took place involving 659 residents (1126 control measurements, 1166 intervention measurements). The group of residents who remained in the intervention condition compared with the group in the control condition differed significantly in the CMAI change scores between successive assessments [-2.4 CMAI points, 95% confidence interval (CI) -4.3 to -0.6]. No significant effects were found for the control-to-intervention group compared with the group who remained in the control group (0.0 CMAI points, 95% CI -2.3 to 2.4). Significant effects were found on 5 of the 12 Neuropsychiatric Inventory items and on the use of antipsychotics (odds ratio 0.54, 95% CI 0.37- 0.80) and antidepressants (odds ratio 0.65, 95% CI 0.44-0.94). No effect on use of restraints was observed. CONCLUSIONS: The Grip on Challenging behavior program was able to diminish some forms of challenging behavior and the use of psychoactive drugs. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
A comprehensive profile of the sociodemographic, psychosocial and health characteristics of Ontario home care clients with dementia.
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Vu M, Hogan DB, Patten SB, Jette N, Bronskill SE, Heckman G, et al.
Chronic diseases and injuries in Canada 2014 Jul;34(2-3):132-144
This study provides a comprehensive summary of the sociodemographic, psychosocial and health characteristics of a large population-based cohort of Ontario home care clients (aged 50 years and over) with dementia and examines the variation in these characteristics in those with co-existing neurological conditions. METHODS: Clients were assessed with the Resident Assessment Instrument-Home Care (RAI-HC) between January 2003 and December 2010. Descriptive analyses examined the distribution of these characteristics among clients with dementia relative to several comparison groups, as well as clients with other recorded neurological conditions. RESULTS: Approximately 22% of clients (n=104 802) had a diagnosis of dementia (average age 83 years, 64% female) and about one in four within this group had a co-existing neurological condition (most commonly stroke or Parkinson disease). About 43% of those with dementia did not live with their primary caregiver. Relative to several comparison groups, clients with dementia showed considerably higher levels of cognitive and functional impairment, aggression, anxiety, wandering, hallucinations/delusions, caregiver distress and a greater risk for institutionalization. Conversely, they showed a lower prevalence of several chronic conditions and lower levels of recent health service use. Depressive symptoms were relatively common in the dementia and other neurological groups. CONCLUSION: Clients with co-existing neurological conditions exhibited unique clinical profiles illustrating the need for tailored and flexible home care services and enhanced caregiver assistance programs.
The NIH research portfolio is both informed by and reflected in the National Plan to Address Alzheimer’s Disease, a national research and caregiving initiative. NIH is leading the Plan’s goal of finding ways to effectively treat or prevent Alzheimer’s disease by 2025. NIH is pleased to present the 2013-2014 Alzheimer’s Disease Progress Report, which this year more closely coincides with the update of the Plan each spring. This annual report details NIH-supported and -conducted Alzheimer’s disease research initiatives, objectives, and advances during calendar year 2013 and early 2014. New findings and investments are described in this report in terms of how they help meet the research goals specified under the Plan.
Seniors Care for a Change Stories of how reducing red tape can enhance frontline service delivery
BC Care Providers Association
Overlapping jurisdictions, rigid nutritional regulations and excessive paperwork are a few of the issues BC’s care homes face on a daily basis. A new report titled Seniors Care for a Change was produced for the BC Care Providers Association (BCCPA) by Izen Consulting. The report provides real-life stories of the increasingly complex regulatory and policy environment facing care providers across the province.
Commissioning home care for older people (UK)
Social Care Institute for Excellence
As people are living longer, the number of older people with complex needs who live at home is increasing. The home care market will have to respond to the needs of this expanding group of older people who use services (referred to in the rest of this guide as ‘users’). A tightening in eligibility criteria for those in receipt of home care means that those receiving care have more complex conditions including long-term, chronic health needs and multiple conditions. This guide captures the latest research findings on this important and emerging area of social care. It also provides some practice examples of good work in this area. The guide is aimed at health and social care commissioners of home care services for older people with complex needs. Providers of these care services may also find it useful.
Medical students in the UK spend little more than a week learning about older people’s ailments and needs
The Expert Advisory Group on Data Access, or EAGDA, in partnership with the Medical Research Council, Economic and Social Research Council and Cancer Research UK has established some strategic advice on data access issues, particularly on how biomedical sciences and the social sciences should work together to approach data access and sharing.
If health policy professor Terry Sullivan had his way, there would be fewer inequities with publicly funded home and community care across Canada. And there would be more funding available to address the shortage of services.
Simon Stevens, chief executive of NHS England, said that he believes better community care and advances in dementia research can be used to help people stay in their homes.
Roberts came out when he was 80, shortly after moving into Fudger House, a long-term care facility for seniors in Toronto. “I was a church organist for years and a music teacher, and you are very careful in those positions,” he said. “You don’t want everybody to know.” For most of his life, Roberts would remain vague about his identity, responding “I am who I am,” when people asked him if he was gay. Then, relief came when he realized that Fudger House touted a gay-positive environment.
The number of American nursing home residents 65 and older decreased by 20% within 10 years, the Census Bureau reported Monday. From 2000 to 2010, the number fell from 1.6 million to 1.3 million.
Officially there may be no positions lost but upcoming changes to staffing in long-term care units at three hospitals has some union members nervous.
The UN Human Rights Council has appointed Rosa Kornfeld-Matte as the new Independent Expert on the full enjoyment of the human rights of all older persons.
At the heart of scientific method lies the often elusive concept of reproducibility. It is increasingly apparent that much data churned out of labs across disciplines doesn’t meet this crucial criterion. Getting to grips with how to tackle this problem requires a firm understanding of exactly what is required to attain the badge of reproducibility. What is really meant by the catchphrase ‘reproducible research’? What is needed to practically achieve this? In this video Q&A Carole Goble, Editorial Board member for GigaScience, offers some much needed answers.
Every now and then a scholarly journal retracts an article because of errors or outright fraud. In academic circles, and sometimes beyond, each retraction is a big deal. Now comes word of a journal retracting 60 articles at once.
Deborah Prowse, Q.C., will bring extensive human rights and patient safety advocacy experience to her new role as Alberta’s Health Advocate.
The National Institute for Health and Care Excellence said having more than eight patients to one nurse on a ward in the day should act as a trigger for checking if care was being compromised. It also set out a series of “red flag” events that should prompt concern. The government said the move was a “major step forward”.
Dr. Warren Pearce asks why, when there is such widespread support for evidence-based policy, is it so hard in practice? The answer, he argues, can be found in an array of definitions used for evidence and the shifting nature of policy that demands different kinds of evidence at different times.
The Government of Quebec has extended deadline for three articles in the regulation on obtaining a certificate of compliance and standards for operating a private seniors’ residence. These articles relate to minimum staffing, responding to emergency calls from the call system and mechanisms for criminal checks.
An innovative training programme for care home staff has cut the use of inappropriate anti-psychotic drugs, which double the risk of death in people with dementia, by a third according to research.
The Honourable Rona Ambrose, Minister of Health, officially announced that the Government of Canada and the Government of France will welcome international dementia experts to Ottawa on September 11 and 12, 2014 for one of four global dementia Legacy Events. The Canada-France Legacy Event aims to find practical ways to fast-track the development of new and innovative approaches to better support people living with dementia, and their families. International academia and industry experts from G7 countries and international organizations are being invited on the basis of their knowledge and abilities to provide concrete solutions. It expands on the Government of Canada’s commitment in the 2013 Speech from the Throne and Economic Action Plan 2014 to tackle the growing onset of dementia and related illnesses.
A system of special measures designed to improve failing hospitals in England is to be extended to care homes, the government has announced.
The government has announced legislation which introduces fundamental standards for health and social care providers. Subject to parliamentary approval, they will become law in April 2015.
The Honourable Alice Wong, Minister of State (Seniors), and members of the National Seniors Council (NSC) met today in Gatineau with seniors’ organizations, service and health providers, researchers and practitioners to discuss how social isolation affects seniors and explore ways to prevent and/or reduce its occurrence.
Edmonton seniors who are facing difficult issues will soon have more support, the Honourable Kevin Sorenson, Minister of State (Finance), announced today on behalf of the Honourable Alice Wong, Minister of State (Seniors). Two Alberta organizations are receiving a total of $42,890 through the New Horizons for Seniors Program (NHSP).
As part of the changes to aged care fees that took effect on 1 July 2014, the Government of Australia has launched two new fee estimators aimed at assisting seniors understand their new home care and residential care fees.
The Alzheimer Society is asking us to push for a national dementia plan. In less than 20 years, 1.4 million Canadians will have Alzheimer’s disease or other dementia. It could be someone you care about. And the costs to our economy and society will be enormous. Now is the time for government action. That’s why this August, when provincial and territorial premiers meet in Charlottetown to discuss issues important to Canadians, we’re calling on the premiers to show their commitment to addressing dementia. We’re asking them to speak with one voice and tell the federal government that Canada needs a national dementia plan.In less than 20 years, 1.4 million Canadians will have Alzheimer’s disease or other dementia. It could be someone you care about. And the costs to our economy and society will be enormous. Follow the link to an email template you can send to your premier.
A film has been made by the NICE collaborating centre for social care to support the NICE quality standard The film focuses primarily on an a roundtable event which took place in March 2014 at the Royal Hospital Chelsea, and included key organisations from the health and social care sector discussing each of the six quality statements; what they mean and how they can be put into practice. Also in attendance at the event were some of the older people resident at the Royal Chelsea Hospital infirmary who discussed what the quality statements meant to them and recounted their own experiences of living in a care home.
The Sexualities and Dementia is an e-learning resource intended for healthcare professionals who support caregivers and individuals with dementia living in long-term care. The resource, written by Dr. Cindy Jones and produced by the DTSC, is organized into four modules which cover a variety of aspects related to sexuality and dementia. It can be used as a guide for educators, or as a framework to develop guidelines and policy to properly support sexual expression in long-term care facilities.
University of Alberta hosting Canada’s First Falling Walls Lab
DEADLINE: 25 August 2014
UAlberta was recently invited to host Canada’s first Falling Walls Lab 1 of only 20 international Labs (1 of 3 in North America—UCLA and McMaster also hosting). This event is being driven by the Office of the VP Research and we need your help in two key areas:
1. Promoting/communicating open call for applications
2. Identifying specific potential applicants – excellent and talented young researchers, scientists, entrepreneurs, and big thinkers with amazing ideas or research projects. Specific focus is Masters and PhD students, Post Docs, and young innovators, entrepreneurs, researchers, and academics under 35. Please send your suggestions to Mara.firstname.lastname@example.org with FWLab in subject line.
Call for Co-Editor: Journal of Mixed Methods Research
DEADLINE 15 August
The Journal of Mixed Methods Research invites nominations and applications for the position Co-Editor. The Journal of Mixed Methods Research focuses on empirical, methodological, and theoretical articles about mixed methods research across the social, behavioral, health, and human sciences. The journal is currently ranked in the Thomson-Reuters Journal Citation Reports®. It is expected that the new Co-Editor will maintain disciplinary and geographic diversity.