July 8, 2014

Grants & Awards

Congratulations to TREC!!!

TREC is the successful recipient of a Partnerships for Health System Improvement (PHSI) grant from the Canadian Institutes of Health Research’s Institute of Research. This grant also includes funding from across Canada (Alberta Innovates-Health Solutions, Manitoba Health Research Council, Michael Smith Foundation for Health Research, and the Nova Scotia Health Research Foundation. This grant will fund a project that will explore the informal communication networks between nursing home leaders and nursing homes. Personal congratulations go out to the many people involved in making this grant successful:

Carole Estabrooks, Heather Cook, Don McLeod, Jennifer Baumbusch, Malcolm Doupe, Janice Keefe, Adrian Wagg, Whitney Berta, Lisa Cranley, Greta Cummings, Jim Dearing, Lianne Ginsburg, Jennifer Knopp-Sihota, Margaret McGregor, Peter Norton, Joanne Profetto-McGrath, Colin Reid, Janet Squires, Gary Teare, Genevieve Thompson, Carole Anderson, Marian Anderson, Karen Bloemink, Debra Boudreau, Marlene Collins, Lorraine Dacombe Dewar, Heather Davidson, Donna Dill, Hana Forbes, Lori Lamont, Lynne Mansell, Keith McBain, Eleanor Risling, Corinne Schalm, Deanne Taylor, Gina Trinidad, Les Hayduk, Vivien Lai, Wendy Nicklin, Sentil Senthilselvan, Ingrid Sketris.

Way to go!!!


New article by Elizabeth Dogherty
Examining the use of facilitation within guideline dissemination and implementation studies in nursing.
Non UofA Access
Dogherty EJ, Harrison M, Graham I, Keeping-Burke L.
International journal of evidence-based healthcare 2014 Jun;12(2):105-127

Facilitation is a mechanism for implementing practice guidelines in nursing. Facilitation aims to prepare clinicians and organisations for implementation and to provide support and help in problem-solving as implementation progresses. However, any evidence supporting its effectiveness is limited due to a lack of empirical testing. AIM: : To examine the presence and role of facilitation in studies included in an existing systematic review of guideline dissemination and implementation in nursing. METHODS: Using a descriptive, exploratory approach, we examined 28 studies for elements of facilitation that were included in a review of the effectiveness of interventions to increase the use of practice guidelines in nursing. We conducted a content analysis of a subset of studies that included facilitation activity to gather descriptions of study interventions, characteristics and skills required, use of theory, and effectiveness. Extracted data were analysed using a previously developed taxonomy containing 53 activities related to facilitation. RESULTS: Ten of the 28 studies exhibited evidence of facilitation process and activity. Only two of the 10 studies explicitly referred to ‘facilitators,’ with just one indicating that facilitators were a part of the implementation intervention being tested. We identified facilitation processes in the eight remaining studies even though the authors did not report it as such. All studies used facilitation activities in combination with other interventions, the most common being educational meetings or distribution of educational materials. We found evidence related to facilitation for 37 of the 53 facilitation activities (70%) in the taxonomy in at least one study or across studies. An additional three novel facilitation-related activities were identified. Most studies exhibited evidence of external facilitation activity whereby researchers outside of the setting assisted nurses to implement guidelines. Theory informed the development or selection of implementation interventions in 60% (n = 6) of the studies. Drawing conclusions regarding effectiveness of interventions involving facilitation was difficult due to the small number of studies that were included. Furthermore, the included studies varied in the detail provided about the intervention or combination of interventions tested and how interventions were delivered. CONCLUSIONS: Using an existing systematic review for the purpose of gaining insight into additional research questions was valuable. Although facilitation process and activities are used in interventions to enhance guideline uptake in nursing, these were not conceptualized or referred to by researchers as ‘facilitation.’ As such, facilitation may be a broader intervention that includes organizing and delivering other interventions. Further research is required to evaluate the relationship between facilitation and other guideline implementation interventions in nursing. The facilitation uncovered within included studies was located primarily in the context of research as it was the researchers who performed most of the facilitation activities. Future inquiries

New article by Greta Cummings, Corrine Schalm, and Carole Estabrooks
On becoming a coach: A pilot intervention study with managers in long-term care.
Non UofA Access
Cummings G, Mallidou AA, Masaoud E, Kumbamu A, Schalm C, Spence Laschinger HK, et al.
Health care management review 2014 Jul-Sep;39(3):198-20

Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments. PURPOSES: The aim of the study reported here was to pilot how a 2-day coaching workshop (“Coaching for Impressive CARE”) conducted as a leadership development strategy influenced frontline care managers’ coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers’ perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers’ intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers’ reports of using coaching practices and employee responses after the workshop. METHODS: We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace. FINDINGS: Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees. PRACTICE IMPLICATIONS: The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.

New article by Janet Squires
Design, implementation, and evaluation of a knowledge translation intervention to increase organ donation after cardiocirculatory death in Canada: a study protocol
Non UofA Access
Squires JE, Grimshaw JM, Taljaard M, Linklater S, Chasse M, Shemie SD, et al.
Implementation science 2014 Jun 20;9(1):80

A shortage of transplantable organs is a global problem. There are two types of organ donation: living and deceased. Deceased organ donation can occur following neurological determination of death (NDD) or cardiocirculatory death. Donation after cardiocirculatory death (DCD) accounts for the largest increments in deceased organ donation worldwide. Variations in the use of DCD exist, however, within Canada and worldwide. Reasons for these discrepancies are largely unknown. The purpose of this study is to develop, implement, and evaluate a theory-based knowledge translation intervention to provide practical guidance about how to increase the numbers of DCD organ donors without reducing the numbers of standard NDD donors. METHODS: We will use a mixed method three-step approach. In step one, we will conduct semi-structured interviews, informed by the Theoretical Domains Framework, to identify and describe stakeholders’ beliefs and attitudes about DCD and their perceptions of the multi-level factors that influence DCD. We will identify: determinants of the evidence-practice gap; specific behavioural changes and/or process changes needed to increase DCD; specific group(s) of clinicians or organizations (e.g., provincial donor organizations) in need of behaviour change; and specific targets for interventions. In step two, using the principles of intervention mapping, we will develop a theory-based knowledge translation intervention that encompasses behavior change techniques to overcome the identified barriers and enhance the enablers to DCD. In step three, we will roll out the intervention in hospitals across the 10 Canadian provinces and evaluate its effectiveness using a multiple interrupted time series design. DISCUSSION: We will adopt a behavioural approach to define and test novel, theory-based, and ethically-acceptable knowledge translation strategies to increase the numbers of available DCD organ donors in Canada. If successful, this study will ultimately lead to more transplantations, reducing patient morbidity and mortality at a population-level.

New article by Kim Fraser
Measuring Home Care Caseloads: Development of the Caseload Intensity Tool.
Non UofA Access
Collister B, Slauenwhite CA, Fraser KD, Swanson S, Fong A.
Home Health Care Management & Practice 2014 June 24

In response to caseloads that are increasing in numbers and acuity, Alberta Health Services developed the Caseload Intensity Tool (CIT). The development and testing process led to a valid and reliable tool that connects client clinical condition to clinician response. The CIT allows clinicians to discriminate between levels of client intensity quickly and accurately. The scores for each client are summarized first into a client intensity scale and then a caseload intensity scale. The CIT can facilitate caseload management including matching client needs to resources and improving staff resource management, for example, equitable caseloads. There is potential for the tool to validate the relatively invisible work of case managers making it understandable, measurable, and defensible during times of rising costs and budget restraint.

CANAD 2014 – Canadian Alzheimer’s Disease Research Symposium
DEADLINE 15 August 2014
2-4 October 2014 Québec City, PQ

The Canadian Alzheimer’s Disease Research Symposium (CANAD) is aimed to bring together Canadian scientists and health professionals from the field of Alzheimer’s disease. In detail, the CANAD mission is to:
-Provide a platform for communication and exchange among Canadian researchers and health professionals;
-Share current findings and identify future needs for Alzheimer’s disease research in Canada;
Provide an up-to-date resource of research tools and experimental methods;
-Offer an opportunity for students and residents to meet peers and Canadian leaders on Alzheimer’s disease research;
-Promote Canadian Alzheimer’s disease research at the provincial, national and international levels.

2015 Quality Forum
18-20 February 2015 Vancouver BC
DEADLINE 10 September

Share your work with hundreds of health care professionals who are passionate about improving health care.

TVN 2014 Annual Conference
21-23 September Toronto ON
DEADLINE 15 August

This premier event brings together researchers, health care professionals, patients and their families and caregivers, and health care administrators, decision makers and other knowledge users – all stakeholders interested in improving the care of Canada’s frail elderly.

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Grants & Awards

TVN Interdisciplinary Fellowship Program
DEADLINE Pre-application 10:00 MT on Friday 1 August 2014, Final application 10:00 MT on Friday 15 August 2014

Technology Evaluation in the Elderly Network (TVN) is pleased to announce a call for applicants for its Winter 2015 Interdisciplinary Fellowship Program cohort. Up to four (4) Fellowships will be funded with a stipend of $50,000 per year for two years.

Research Canada Leadership Award
DEADLINE 31 July 2014

The new Research Canada Leadership Award has been created to honour champions in health research advocacy. On an annual basis, Research Canada will recognize an individual or organization who/which has made outstanding efforts in advocating for Canadian health research at the local, provincial and/or national level. Awards will be announced at the Prix Galien and HRF Medal of Honour Award Ceremony in November of each year. This year’s Award will be presented in Toronto on November 19th, 2014.

CIHR: Partnerships for Health System Improvement 2014-2015
DEADLINE 15 October 2014

The intent of the Partnerships for Health System Improvement (PHSI) program is to strengthen Canada’s healthcare system through collaborative, applied, and policy-relevant research. PHSI is Canada’s premier health services and policy research competition — and with its strong emphasis on partnerships and knowledge translation, it is also a major resource for managers and policy makers who want relevant research to inform their decision-making. PHSI funds teams of decision makers and researchers to conduct applied health services and policy research. Because they participate throughout the research process, the research results are more likely to be both relevant to, and used by, decision makers.

CIHR Operating Grant: Knowledge to Action 2014-2015
DEADLINE 1 October 2014

The intent of this funding opportunity is to accelerate the translation of knowledge by linking researchers and knowledge-users to move knowledge into action, and in so doing, increase the understanding of knowledge application through the process.

CIHR Knowledge Synthesis Grant: Fall 2014 Competition
DEADLINE 17 November 2014

The purpose of this funding opportunity is to support teams of researchers and knowledge users to produce knowledge syntheses and scoping reviews that will contribute to the use of synthesized evidence in decision-making and practice.

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Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice & Methodology


Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine
Non UofA Access
Carpenter CR, Bromley M, Caterino JM, Chun A, Gerson LW, Greenspan J, et al.
Annals of Emergency Medicine 2014 May;63(5):e1-3.

In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.

Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system.
Non UofA Access
Atchan M, Davis D, Foureur M.
Women and birth 2014 Jun;27(2):79-85

The Baby Friendly Hospital Initiative is a global, evidence-based, public health initiative. The evidence underpinning the Initiative supports practices promoting the initiation and maintenance of breastfeeding and encourages women’s informed infant feeding decisions. In Australia, where the Initiative is known as the Baby Friendly Health Initiative (BFHI) the translation of evidence into practice has not been uniform, as demonstrated by a varying number of maternity facilities in each State and Territory currently accredited as ‘baby friendly’. This variance has persisted regardless of BFHI implementation in Australia gaining ‘in principle’ support at a national and governmental level as well as inclusion in health policy in several states. There are many stakeholders that exert an influence on policy development and health care practices. AIM: Identify a theory and model to examine where and how barriers occur in the gap between evidence and practice in the uptake of the BFHI in Australia. RESULTS: Knowledge translation theory and the research to practice pipeline model are used to examine the identified barriers to BFHI implementation and accreditation in Australia. CONCLUSION: Australian and international studies have identified similar issues that have either enabled implementation of the BFHI or acted as a barrier. Knowledge translation theory and the research to practice pipeline model is of practical value to examine barriers. Recommendations in the form of specific targeted strategies to facilitate knowledge transfer and supportive practices into the Australian health care system and current midwifery practice are included. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Operationalizing RE-AIM framework to evaluate the impact of
multi-sector partnerships
Non UofA Access
Sweet SN, Ginis KA, Estabrooks PA, Latimer-Cheung AE.
Implementation science 2014 Jun 12;9:74-5908-9-74

The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a reliable tool for the translation of research to practice. This framework has been widely applied to assess the impact of individual interventions. However, RE-AIM has rarely been used to evaluate implementation interventions, especially from multi-sector partnerships. The primary purpose of this paper is to operationalize the RE-AIM approach to evaluate large, multi-sector partnerships. SCI Action Canada, a community-university partnership aimed to promote physical activity among adults with spinal cord injury, is used as an example. A secondary purpose is to provide initial data from SCI Action Canada by using this conceptualization of RE-AIM. METHODS: Each RE-AIM element is operationalized for multi-sector partnerships. Specific to SCI Action Canada, seven reach calculations, four adoption rates, four effectiveness outcomes, one implementation, one organizational maintenance, and two individual maintenance outcomes are defined. The specific numerators based on SCI Action Canada activities are also listed for each of these calculations. RESULTS: The results are derived from SCI Action Canada activities. SCI Action Canada’s reach ranged from 3% (end-user direct national reach) to 37% (total regional reach). Adoption rates were 15% (provincial level adoption) to 76% (regional level adoption). Implementation and organizational maintenance rates were 92% and 100%, respectively. CONCLUSIONS: We have operationalized the RE-AIM framework for larger multi-sectoral partnerships and demonstrated its applicability to such partnerships with SCI Action Canada. Future partnerships could use RE-AIM to assess their public health impact.

How funding agencies can support research use in healthcare: an online province-wide survey to determine knowledge translation training needs. Canada-flat-icon
Non UofA Access
Holmes BJ, Schellenberg M, Schell K, Scarrow G.
Implementation science : IS 2014 Jun 6;9:71-5908-9-71

Health research funding agencies are increasingly promoting evidence use in health practice and policy. Building on work suggesting how agencies can support such knowledge translation (KT), this paper discusses an online survey to assess KT training needs of researchers and research users as part of a Canadian provincial capacity-building effort. METHODS: The survey comprised 24 multiple choice and open-ended questions including demographics, interest in learning KT skills, likelihood of participating in training, and barriers and facilitators to doing KT at work. More than 1,200 people completed the survey. The high number of responses is attributed to an engagement strategy involving partner organizations (health authorities, research institutes, universities) in survey development and distribution. SPSS was used to analyze quantitative results according to respondents’ primary role, geographic region, and work setting. Qualitative results were analyzed in NVivo. RESULTS: Over 85 percent of respondents are interested in learning more about the top KT skills identified. Research producers have higher interest in disseminating research results; research users are more interested in the application of research results. About one-half of respondents require beginner-level training in KT skills; one-quarter need advanced training. Time and cost constraints are the biggest barriers to participating in KT training. More than one-half of respondents have no financial support for travel and almost one-half lack support for registration fees. Time is the biggest challenge to integrating KT into work. CONCLUSIONS: Online surveys are useful for determining knowledge translation training needs of researchers, research users and ultimately organizations. In this case, findings suggest the importance of considering all aspects of KT in training opportunities, while taking into account different stakeholder interests. Funders can play a role in developing new training opportunities as part of a broad effort, with partners, to build capacity for the use of health research evidence. Survey results would ideally be complemented with an objective needs assessment based on core competencies, and should be acted on in a way that acknowledges the complexity of knowledge translation in healthcare, existing training activities, and the expertise stakeholders already have but may not refer to as knowledge translation.

Enhancing Dissemination and Implementation Research Using Systems Science Methods.
Non UofA Access
Burke JG, Lich KH, Neal JW, Meissner HI, Yonas M, Mabry PL.
International Journal of Behavioral Medicine 2014 May 23

Dissemination and implementation (D&I) research seeks to understand and overcome barriers to adoption of behavioral interventions that address complex problems, specifically interventions that arise from multiple interacting influences crossing socio-ecological levels. It is often difficult for research to accurately represent and address the complexities of the real world, and traditional methodological approaches are generally inadequate for this task. Systems science methods, expressly designed to study complex systems, can be effectively employed for an improved understanding about dissemination and implementation of evidence-based interventions. PURPOSE: The aims of this study were to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity. METHOD: Case examples of three systems science methods-system dynamics modeling, agent-based modeling, and network analysis-are used to illustrate how each method can be used to address D&I challenges. RESULTS: The case studies feature relevant behavioral topical areas: chronic disease prevention, community violence prevention, and educational intervention. To emphasize consistency with D&I priorities, the discussion of the value of each method is framed around the elements of the established Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. CONCLUSION: Systems science methods can help researchers, public health decision makers, and program implementers to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity.

Translating research into practice: case study of a community-based dementia caregiver intervention.
Non UofA Access
Mittelman MS, Bartels SJ.
Health affairs (Project Hope) 2014 Apr;33(4):587-595

One of the most devastating impacts of Alzheimer’s disease and related dementias is the toll on caregivers. Evidence from randomized clinical trials has demonstrated the effectiveness of providing psychosocial interventions for caregivers to lessen their burden. However, the implementation of such interventions in community settings has proved challenging. This case study describes outcomes of the implementation of an evidence-based intervention in a multisite program in Minnesota. Consistent with the original randomized clinical trial of the intervention, assessments of this program showed decreased depression and distress among caregivers. Participating in a greater number of caregiver counseling sessions was also associated with longer time to nursing home placement for the person with dementia. Some of the challenges in the community setting included having caregivers complete the full six counseling sessions and acquiring complete outcome data. Given the challenges faced in the community setting, web-based training for providers may be a cost-effective way to realize the maximum benefits of the intervention for vulnerable adults with dementia and their families.

Mechanisms which help explain implementation of evidence-based practice in residential aged care facilities: A grounded theory study.
Non UofA Access
Masso M, McCarthy G, Kitson A.
International journal of nursing studies 2014 Jul;51(7):1014-1026

The context for the study was a nation-wide programme in Australia to implement evidence-based practice in residential aged care, in nine areas of practice, using a wide range of implementation strategies and involving 108 facilities. The study drew on the experiences of those involved in the programme to answer the question: what mechanisms influence the implementation of evidence-based practice in residential aged care and how do those mechanisms interact? METHODS: The methodology used grounded theory from a critical realist perspective, informed by a conceptual framework that differentiates between the context, process and content of change. People were purposively sampled and invited to participate in semi-structured interviews, resulting in 44 interviews involving 51 people during 2009 and 2010. Participants had direct experience of implementation in 87 facilities, across nine areas of practice, in diverse locations. Sampling continued until data saturation was reached. The quality of the research was assessed using four criteria for judging trustworthiness: credibility, transferability, dependability and confirmability. RESULTS: Data analysis resulted in the identification of four mechanisms that accounted for what took place and participants’ experiences. The core category that provided the greatest understanding of the data was the mechanism On Common Ground, comprising several constructs that formed a ‘common ground’ for change to occur. The mechanism Learning by Connecting recognised the ability to connect new knowledge with existing practice and knowledge, and make connections between actions and outcomes. Reconciling Competing Priorities was an ongoing mechanism whereby new practices had to compete with an existing set of constantly shifting priorities. Strategies for reconciling priorities ranged from structured approaches such as care planning to more informal arrangements such as conversations during daily work. The mechanism Exercising Agency bridged the gap between agency and action. It was the human dimension of change, both individually and collectively, that made things happen. CONCLUSIONS: The findings are consistent with the findings of others, but fit together in a novel way and add to current knowledge about how to improve practices in residential aged care. Each of the four mechanisms is necessary but none are sufficient for implementation to occur. Copyright © 2013 Elsevier Ltd. All rights reserved.

Clinician-led improvement in cancer care (CLICC) – testing a multifaceted implementation strategy to increase evidence-based prostate cancer care: phased randomised controlled trial – study protocol.
Non UofA Access
Brown BB, Young J, Smith DP, Kneebone AB, Brooks AJ, Xhilaga M, et al.
Implementation science 2014 May 29;9:64-5908-9-64

Clinical practice guidelines have been widely developed and disseminated with the aim of improving healthcare processes and patient outcomes but the uptake of evidence-based practice remains haphazard. There is a need to develop effective implementation methods to achieve large-scale adoption of proven innovations and recommended care. Clinical networks are increasingly being viewed as a vehicle through which evidence-based care can be embedded into healthcare systems using a collegial approach to agree on and implement a range of strategies within hospitals. In Australia, the provision of evidence-based care for men with prostate cancer has been identified as a high priority. Clinical audits have shown that fewer than 10% of patients in New South Wales (NSW) Australia at high risk of recurrence after radical prostatectomy receive guideline recommended radiation treatment following surgery. This trial will test a clinical network-based intervention to improve uptake of guideline recommended care for men with high-risk prostate cancer. METHODS/DESIGN: In Phase I, a phased randomised cluster trial will test a multifaceted intervention that harnesses the NSW Agency for Clinical Innovation (ACI) Urology Clinical Network to increase evidence-based care for men with high-risk prostate cancer following surgery. The intervention will be introduced in nine NSW hospitals over 10 months using a stepped wedge design. Outcome data (referral to radiation oncology for discussion of adjuvant radiotherapy in line with guideline recommended care or referral to a clinical trial of adjuvant versus salvage radiotherapy) will be collected through review of patient medical records. In Phase II, mixed methods will be used to identify mechanisms of provider and organisational change. Clinicians’ knowledge and attitudes will be assessed through surveys. Process outcome measures will be assessed through document review. Semi-structured interviews will be conducted to elucidate mechanisms of change. DISCUSSION: The study will be one of the first randomised controlled trials to test the effectiveness of clinical networks to lead changes in clinical practice in hospitals treating patients with high-risk cancer. It will additionally provide direction regarding implementation strategies that can be effectively employed to encourage widespread adoption of clinical practice guidelines. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001251910.

Measuring use of research evidence in public health policy: a policy content analysis.
Non UofA Access
Zardo P, Collie A.
BMC public health 2014 May 23;14(1):496-2458-14-496

There are few Australian studies showing how research evidence is used to inform the development of public health policy. International research has shown that compensation for injury rehabilitation can have negative impacts on health outcomes. This study examined transport injury compensation policy in the Australian state of Victoria to: determine type and purpose of reference to information sources; and to identify the extent of reference to academic research evidence in transport related injury rehabilitation compensation policy. METHODS: Quantitative content analysis of injury rehabilitation compensation policies (N = 128) from the Victorian state government transport accident compensation authority. RESULTS: The most commonly referenced types of information were Internal Policy (median = 6 references per policy), Clinical/Medical (2.5), and Internal Legislation (1). Academic Research Evidence was the least often referenced source of information. The main purpose of reference to information was to support injury treatment and rehabilitation compensation claims decision-making. CONCLUSIONS: Transport injury compensation policy development is complex; with multiple sources of information cited including legislation, internal policy, external policy and clinical/medical evidence. There is limited use of academic research evidence in Victorian state government injury treatment and rehabilitation compensation policies. Decisions regarding compensation for injury treatment and rehabilitation services could benefit from greater use of academic research evidence. This study is one of the first to examine the use of research evidence in existing Australian public health policy decision-making using rigorous quantitative methods. It provides a practical example of how use of research evidence in public health policy can be objectively measured.

Implementing a Knowledge Translation Intervention in Long-Term Care: Feasibility Results From the Vitamin D and Osteoporosis Study (ViDOS). Canada-flat-icon
Non UofA Access
Kennedy CC, Thabane L, Ioannidis G, Adachi JD, Papaioannou A, ViDOS Investigators.
Journal of the American Medical Directors Association 2014 Jun 18

To evaluate the feasibility of implementing an interdisciplinary, multifaceted knowledge translation intervention within long-term care (LTC) and to identify any challenges that should be considered in designing future studies. DESIGN: Cluster randomized controlled trial. SETTING: Forty LTC homes across the province of Ontario, Canada. PARTICIPANTS: LTC teams composed of physicians, nurses, pharmacists, and other staff. MEASUREMENTS: Cluster-level feasibility measures, including recruitment, retention, data completion, and participation in the intervention. A process evaluation was completed by directors of care indicating which process/policy changes had been implemented. RESULTS: Recruitment and retention rates were 22% and 63%, respectively. Good fidelity with the intervention was achieved, including attendance at educational meetings. After ViDOS, 7 process indicators were being newly implemented by more than 50% of active intervention homes. CONCLUSION: Despite recruitment and retention challenges, the multifaceted intervention produced a number of policy/process changes and had good intervention fidelity. This study is registered at ClinicalTrials.gov NCT01398527. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Integrative review of implementation strategies for translation of research-based evidence by nurses.
Non UofA Access
Wuchner SS.
Clinical nurse specialist CNS 2014 Jul-Aug;28(4):214-223

The purpose of this review was to synthesize and critique experimental and/or quasi-experimental research that has evaluated implementation strategies for translation of research-based evidence into nursing practice. BACKGROUND: Successfully implementing evidence-based research can improve patient outcomes. Identifying successful implementation strategies is imperative to move research-based evidence into practice. RATIONALE: As implementation science gains popularity, it is imperative to understand the strategies that most effectively translate research-based evidence into practice. DESCRIPTION: The review used the CINAHL and MEDLINE (Ovid) databases. Articles were included if they were experimental and/or quasi-experimental research designs, were written in English, and measured nursing compliance to translation of research-based evidence. An independent review was performed to select and critique the included articles. OUTCOME: A wide array of interventions were completed, including visual cues, audit and feedback, educational meetings and materials, reminders, outreach, and leadership involvement. Because of the complex multimodal nature of the interventions and the variety of research topics, comparison across interventions was difficult. CONCLUSION: Many difficulties exist in determining what implementation strategies are most effective for translation of research-based evidence into practice by nurses. IMPLICATIONS: With these limited findings, further research is warranted to determine which implementation strategies most successfully translate research-based evidence into practice.

Knowledge translation strategies for enhancing nurses’ evidence-informed decision making: A scoping review Canada-flat-icon
Non UofA Access
Yost J, Thompson D, Ganann R, Aloweni F, Newman K, McKibbon A, et al.
Worldviews on evidence-based nursing 2014 Jun;11(3):156-167

Nurses are increasingly expected to engage in evidence-informed decision making (EIDM); the use of research evidence with information about patient preferences, clinical context and resources, and their clinical expertise in decision making. Strategies for enhancing EIDM have been synthesized in high-quality systematic reviews, yet most relate to physicians or mixed disciplines. Existing reviews, specific to nursing, have not captured a broad range of strategies for promoting the knowledge and skills for EIDM, patient outcomes as a result of EIDM, or contextual information for why these strategies “work.” AIM: To conduct a scoping review to identify and map the literature related to strategies implemented among nurses in tertiary care for promoting EIDM knowledge, skills, and behaviours, as well as patient outcomes and contextual implementation details. METHODS: A search strategy was developed and executed to identify relevant research evidence. Participants included registered nurses, clinical nurse specialists, nurse practitioners, and advanced practice nurses. Strategies were those enhancing nurses’ EIDM knowledge, skills, or behaviours, as well as patient outcomes. Relevant studies included systematic reviews, randomized controlled trials, cluster randomized controlled trials, non-randomized trials (including controlled before and after studies), cluster non-randomized trials, interrupted time series designs, prospective cohort studies, mixed-method studies, and qualitative studies. Two reviewers performed study selection and data extraction using standardized forms. Disagreements were resolved through discussion or third party adjudication. RESULTS: Using a narrative synthesis, the body of research was mapped by design, clinical areas, strategies, and provider and patient outcomes to determine areas appropriate for a systematic review. CONCLUSIONS: There are a sufficiently high number of studies to conduct a more focused systematic review by care settings, study design, implementation strategies, or outcomes. A focused review could assist in determining which strategies can be recommended for enhancing EIDM knowledge, skills, and behaviours among nurses in tertiary care. © 2014 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International.

Deliberative Dialogues as a Strategy for System-Level Knowledge Translation and Exchange Canada-flat-icon
Boyko JA.
Healthcare Policy 2014 05/28;9(4):122-131

We undertook a case study in order to explore deliberative dialogue as a system-level knowledge translation and exchange (KTE) strategy and to describe the design features and intended effects of this dialogue. Our data included observations made during the dialogue, evaluations completed by dialogue participants and interviews. We placed these data in the context of our broader experience. We learned that (a) all the design elements we examined could be maintained in future dialogues, but organizers of dialogues that address similar issues and take place in similar contexts should consider the relative importance of these features and (b) the intended effects of a deliberative dialogue that addresses a low-priority policy issue are mainly apparent at the individual level among dialogue participants. Further research is required to explore the key features and intended effects of deliberative dialogues used to address other issues or in different contexts.

RAND: Investigating time lags and attribution in the translation of cancer research A case study approach (EU)

In 2012, RAND Europe and the Health Economics Research Group (Brunel University) were commissioned by the Wellcome Trust, Cancer Research UK, the National Institute for Health Research and the Academy of Medical Science to conduct a study of the returns to the public/charitable investment in cancer-related research. This study built on previous work published in the 2008 ‘What’s it worth?’ report that estimated the economic returns to medical research in terms of spillover benefits and health gain. The 2008 study was extensively quoted and cited as a clear justification for the economic importance of medical research and appears to have played a role in achieving the protection of the medical science budget in the recent public expenditure cuts. This cancer study used a similar approach to that used in the previous study, but with some methodological developments. One of the methodological developments was the inclusion of case studies to examine the validity and variability of the estimates on elapsed time between funding and health gains, and the amount of health gains that can be attributed to UK research. This report provides the full text of the five case studies conducted as well as some discussion of observations emerging across the case study set.

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Health Care Administration and Organization

Effects of cooperative membership and participation in decision making on job satisfaction of home health aides
Non UofA Access
Berry DP.
Advances in the Economic Analysis of Participatory and Labor-Managed Firms 2013;14:3-25

This paper examines job satisfaction and participation in decision making in three home health aide facilities with different organizational structures (worker-owned for-profit, for-profit with no participation or ownership by workers, and nonprofit).Design/methodology/ approach – More than 600 surveys were completed by home health aides across the three facilities. The author also engaged in participant observation during training sessions and other meetings and conducted a small number of interviews with caregivers and agency management. Findings – Home health aides at the worker-owned, participative decision making organization were significantly more satisfied with their jobs than those at the other agencies. Results for the other agencies were not significantly distinguishable from one another. Research limitations/implications – This study involved respondents from one of each type of business. A study across several of each type of organization would allow more focus on the effects of the structural characteristics of the organizations. Practical implications – In the United States, the work that home health aides perform provides a valuable service to society. On behalf of caregivers and those for whom they provide care, conditions of the work need improvement. If participative democratic workplaces provide better outcomes, they should receive more attention from lawmakers, the business community, and researchers. Social implications – This research highlights the working conditions of the people (primarily women) who perform this work. The poor compensation received is a reminder of inequality in opportunity for some workers and of the value placed on this type of caring labor. Originality/value – This research is unique in its focus on work environment and outcomes in home health care across nonprofit, for-profit, and worker-owned for-profit organizations. The findings of different job satisfaction outcomes from the others in the worker-owned organization and similar outcomes in the nonprofit and conventional for-profit organizations are also unique. Copyright © 2013 Emerald Group Publishing Limited.

Determining and broadening the definition of impact from implementing a rational priority setting approach in a healthcare organization. Canada-flat-icon
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Cornelissen E, Mitton C, Davidson A, Reid C, Hole R, Visockas AM, et al.
Social science & medicine (1982) 2014 Aug;114:1-9

Techniques to manage scarce healthcare resources continue to evolve in response to changing, growing and competing demands. Yet there is no standard definition in the priority setting literature of what might constitute the desired impact or success of resource management activities. In this 2006-09 study, using action research methodology, we determined the impact of implementing a formal priority setting model, Program Budgeting and Marginal Analysis (PBMA), in a Canadian health authority. Qualitative data were collected through post year-1 (n = 12) and year-2 (n = 9) participant interviews, meeting observation and document review. Interviews were analyzed using a constant comparison technique to identify major themes. Impact can be defined as effects at three levels: system, group, and individual. System-level impact can be seen in the actual selection of priorities and resource re-allocation. In this case, participants prioritized a list of $760,000 worth of investment proposals and $38,000 of disinvestment proposals; however, there was no clear evidence as to whether financial resources were reallocated as a result. Group and individual impacts, less frequently reported in the literature, included changes in priority setting knowledge, attitudes and practice. PBMA impacts at these three levels were found to be interrelated. This work argues in favor of attempts to expand the definition of priority setting success by including both desired system-level outcomes like resource re-allocation and individual or group level impacts like changes to priority setting knowledge, attitudes and practice. These latter impacts are worth pursuing as they appear to be intrinsic to successful system-wide priority setting. A broader definition of PBMA impact may also suggest conceptualizing PBMA as both a priority setting approach and as a tool to develop individual and group priority setting knowledge and practice. These results should be of interest to researchers and decision makers using or considering a formal priority setting approach to manage scarce healthcare resources. Copyright © 2014 Elsevier Ltd. All rights reserved.

New Workforce Development in Dementia Care: Screening for “Caring”: Preliminary Data.
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Cottingham AH, Alder C, Austrom MG, Johnson CS, Boustani MA, Litzelman DK.
Journal of the American Geriatrics Society 2014 Jun 10

The United States has a significant shortage of trained geriatricians and of nurses, social workers, and paraprofessionals educated to care for elderly adults. As the aging population continues to grow, providing high-quality care will require new models that better address the many needs of aging individuals and their caregivers, using cost-effective strategies. Responding to this need, the Indiana University Center for Aging Research implementation scientists developed, tested, and are now scaling up a successful collaborative care coordination model for older adults with dementia, depression, or both: the Aging Brain Care program. This model now includes a newly created frontline care provider position, the Care Coordinator Assistant. The Care Coordinator Assistant works with individuals and caregivers to monitor biopsychosocial needs and deliver evidence-based and individualized care protocols, with close supervision from the registered nurse Care Coordinator. Recognizing that current hiring practices for frontline providers were insufficient to screen for critical abilities expected in this new position, including the ability to express “caring” and empathy, a new screening process was created building on the Multiple Mini Interview (MMI) format. The Care Coordinator Assistant MMI comprised six stations, each created to simulate challenging scenarios that will be frequently encountered and to assess important candidate abilities. Overall, the six-station MMI, with two to three items per station, provided factorially valid measures and good predictive ability. The process did not appear to be overly burdensome for candidates, and interviewers noted that it was helpful in discriminating between candidates. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Balancing formal and informal care for older persons: how case managers respond. Canada-flat-icon
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Peckham A, Williams AP, Neysmith S.
Canadian journal on aging 2014 Jun;33(2):123-136

This study examined how front-line home and community-care (H&CC) case managers view the role of informal caregivers, and the factors that contribute to H&CC managers’ resource allocation decisions. The study research used two methods of data collection: (a) secondary analysis of the results from balance of care (BoC) simulations conducted in nine regions of Ontario, and (b) in-depth follow-up interviews with participating BoC case managers. Results suggest that case managers unanimously agree that the unit of care in the H&CC sector is not confined to the individual, as in acute care, but encompasses both the individual and the caregiver. We found, however, considerable variation in the mix and volume of H&CC services recommended by case managers. We conclude that variability in decision making may reflect the lack of regulations, best practices, and accountability guidelines in the H&CC sector.

Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: Cross-sectional secondary data analysis.
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Han K, Trinkoff AM, Storr CL, Lerner N, Johantgen M, Gartrell K.
International journal of nursing studies 2014 Aug;51(8):1135-1141

In the U.S., there are federal requirements on how much training and annual continuing education a certified nursing assistant must complete in order to be certified. The requirements are designed to enable them to provide competent and quality care to nursing home residents. Many states also require additional training and continuing education hours as improved nursing home quality indicators have been found to be related to increased training. OBJECTIVES: This study investigated the associations among state level regulations, initial training quality and focus, and job satisfaction in certified nursing assistants. DESIGN: Cross-sectional secondary data analysis. SETTINGS: This study used the National Nursing Home Survey and National Nursing Assistant Survey as well as data on state regulations of certified nursing assistant training. PARTICIPANTS: 2897 certified nursing assistants in 580 nursing homes who were currently working at a nursing home facility, who represented 680,846 certified nursing assistants in US. METHODS: State regulations were related to initial training and job satisfaction among certified nursing assistants using chi square tests and binomial logistic regression models. Analyses were conducted using SAS-callable SUDAAN to correct for complex sampling design effects in the National Nursing Home Survey and National Nursing Assistant Survey. Models were adjusted for personal and facility characteristics. RESULTS: Certified nursing assistants reporting high quality training were more likely to work in states requiring additional initial training hours (p=0.02) and were more satisfied with their jobs (OR=1.51, 95% CI=1.09-2.09) than those with low quality training. In addition, those with more training focused on work life skills were 91% more satisfied (OR=1.91, 95% CI=1.41-2.58) whereas no relationship was found between training focused on basic care skills and job satisfaction (OR=1.36, 95% CI=0.99-1.84). CONCLUSIONS: Certified nursing assistants with additional initial training were more likely to report that their training was of high quality, and this was related to job satisfaction. Job satisfaction was also associated with receiving more training that focused on work life skills. Federal training regulations should reconsider additional hours for certified nursing assistant initial training, and include work life skills as a focus. As job satisfaction has been linked to nursing home turnover, attention to training may improve satisfaction, ultimately reducing staff turnover. Copyright © 2014 Elsevier Ltd. All rights reserved.

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events-A cross-sectional survey.
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Van Bogaert P, Timmermans O, Weeks SM, van Heusden D, Wouters K, Franck E.
International journal of nursing studies 2014 Aug;51(8):1123-1134

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. BACKGROUND: Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. DESIGN: A cross-sectional design with a survey. METHOD: In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. RESULTS: Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. CONCLUSION: Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Health Care Innovation and Quality Assurance

Local interaction strategies and capacity for better care in nursing homes: a multiple case study
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Anderson RA, Toles MP, Corazzini K, McDaniel RR, Colon-Emeric C.
BMC health services research 2014 Jun 5;14:244-6963-14-244

To describe relationship patterns and management practices in nursing homes (NHs) that facilitate or pose barriers to better outcomes for residents and staff. METHODS: We conducted comparative, multiple-case studies in selected NHs (N = 4). Data were collected over six months from managers and staff (N = 406), using direct observations, interviews, and document reviews. Manifest content analysis was used to identify and explore patterns within and between cases. RESULTS: Participants described interaction strategies that they explained could either degrade or enhance their capacity to achieve better outcomes for residents; people in all job categories used these ‘local interaction strategies’. We categorized these two sets of local interaction strategies as the ‘common pattern’ and the ‘positive pattern’ and summarize the results in two models of local interaction. CONCLUSIONS: The findings suggest the hypothesis that when staff members in NHs use the set of positive local interaction strategies, they promote inter-connections, information exchange, and diversity of cognitive schema in problem solving that, in turn, create the capacity for delivering better resident care. We propose that these positive local interaction strategies are a critical driver of care quality in NHs. Our hypothesis implies that, while staffing levels and skill mix are important factors for care quality, improvement would be difficult to achieve if staff members are not engaged with each other in these ways.

The limits of checklists: handoff and narrative thinking.
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Hilligoss B, Moffatt-Bruce SD.
BMJ quality & safety 2014 Jul;23(7):528-533

Concerns about the role of communication failures in adverse events coupled with the success of checklists in addressing safety hazards have engendered a movement to apply structured tools to a wide variety of clinical communication practices. While standardised, structured approaches are appropriate for certain activities, their usefulness diminishes considerably for practices that entail constructing rich understandings of complex situations and the handling of ambiguities and unpredictable variation. Drawing on a prominent social science theory of cognition, this article distinguishes between two radically different modes of human thought, each with its own strengths and weaknesses. The paradigmatic mode organises context-free knowledge into categorical hierarchies that emphasise member-to-category relations in order to apply universal truth conditions. The narrative mode, on the other hand, organises context-sensitive knowledge into temporal plots that emphasise part-to-whole relations in order to develop meaningful, holistic understandings of particular events or identities. Both modes are crucial to human cognition but are appropriate responses for different kinds of tasks and situations. Many communication-intensive practices in which patient cases are communicated, such as handoffs, rely heavily on the narrative mode, yet most interventions assume the paradigmatic mode. Improving the safety and effectiveness of these practices, therefore, necessitates greater attention to narrative thinking.

Evidence based medicine: a movement in crisis?
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Greenhalgh T, Howick J, Maskrey N, Evidence Based Medicine Renaissance Group.
BMJ (Clinical research ed.) 2014 Jun 13;348:g3725.

Trisha Greenhalgh and colleagues argue that, although evidence based medicine has had many benefits, it has also had some negative unintended consequences. They offer a preliminary agenda for the movement’s renaissance, refocusing on providing useable evidence that can be combined with context and professional expertise so that individual patients get optimal treatment

How nurses and their work environment affect patient experiences of the quality of care: a qualitative study.
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Kieft RA, de Brouwer BB, Francke AL, Delnoij DM.
BMC health services research 2014 Jun 13;14:249-6963-14-249

Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences. METHODS: A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis. RESULTS: The nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care. CONCLUSIONS: According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and they experience a conflict between these two approaches. Nurses must gain autonomy over their own practice in order to improve patient experiences.

Nurse led care coordination: trial protocol and development of a best practice resource guide for a cluster controlled clinical trial in Australian aged care facilities.
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Arendts G, Etherton-Beer C, Howard K, Lewin G, Sim M, Pickstock S, et al.
Archives of Gerontology and Geriatrics 2014 Jan-Feb;58(1):15-19

In this paper we describe (i) the protocol for a cluster controlled clinical trial of nurse led care coordination in residential aged care facilities (RACF); and (ii) the development and content of a best practice resource guide to be implemented as part of this trial. We used published systematic reviews of quantitative studies, existing resources and multidisciplinary expert opinion to develop an intervention for testing in a cluster controlled trial (Australian and New Zealand Clinical Trials Registry Number 12611000933954). The trial will determine whether care coordination of multiple evidenced based strategies can improve quality of life and reduce hospitalization rates amongst people living in RACF. Central to the intervention arm of the trial are two components: (i) experienced nurse practitioners responsible for resident care and (ii) a best practice guide for the care processes being delivered and coordinated by those nurses. In this paper we outline how this practice guide, which is published herein, was refined through consultative processes and practitioner testing. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Scaling up integrated prevention campaigns for global health: costs and cost-effectiveness in 70 countries
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Marseille E, Jiwani A, Raut A, Verguet S, Walson J, Kahn JG.
BMJ open 2014 Jun 26;4(6):e003987-2013-003987

This study estimated the health impact, cost and cost-effectiveness of an integrated prevention campaign (IPC) focused on diarrhoea, malaria and HIV in 70 countries ranked by per capita disability-adjusted life-year (DALY) burden for the three diseases. METHODS: We constructed a deterministic cost-effectiveness model portraying an IPC combining counselling and testing, cotrimoxazole prophylaxis, referral to treatment and condom distribution for HIV prevention; bed nets for malaria prevention; and provision of household water filters for diarrhoea prevention. We developed a mix of empirical and modelled cost and health impact estimates applied to all 70 countries. One-way, multiway and scenario sensitivity analyses were conducted to document the strength of our findings. We used a healthcare payer’s perspective, discounted costs and DALYs at 3% per year and denominated cost in 2012 US dollars. PRIMARY AND SECONDARY OUTCOMES: The primary outcome was cost-effectiveness expressed as net cost per DALY averted. Other outcomes included cost of the IPC; net IPC costs adjusted for averted and additional medical costs and DALYs averted. RESULTS: Implementation of the IPC in the 10 most cost-effective countries at 15% population coverage would cost US$583 million over 3 years (adjusted costs of US$398 million), averting 8.0 million DALYs. Extending IPC programmes to all 70 of the identified high-burden countries at 15% coverage would cost an adjusted US$51.3 billion and avert 78.7 million DALYs. Incremental cost-effectiveness ranged from US$49 per DALY averted for the 10 countries with the most favourable cost-effectiveness to US$119, US$181, US$335, US$1692 and US$8340 per DALY averted as each successive group of 10 countries is added ordered by decreasing cost-effectiveness. CONCLUSIONS: IPC appears cost-effective in many settings, and has the potential to substantially reduce the burden of disease in resource-poor countries. This study increases confidence that IPC can be an important new approach for enhancing global health.

Leading change within health services: The theory behind a systematic process for leading the implementation of new services within a network structure
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Jacobs S, Rouse P, Parsons M.
Leadership in Health Services 2014;27(2):72-86

Much health service delivery occurs within a network structure, with co-operation and competition coexisting. Leading change for successful outcomes is a difficult task even outside of this multi-layered complex context, with reports that up to two-thirds of change processes are unsuccessfully implemented. This can have a major impact on stress, effectiveness and efficiency. This paper aims to address these issues. Design/methodology/approach: Theories supporting a generic implementation system for managers were explored so that people placed into situations in which they needed to lead and manage change could access a systematic approach that enabled clarification of the network’s goal(s), valid communication among members of the network, and performance measurement using indicators the network agrees are meaningful. Findings: The implementation pathway developed provides a change process leaders and managers of change can use within networks. Practical implications: Health service funders and managers will be helped by this systematic implementation process. Originality/value: Health service funders and managers will be assisted by the systematic implementation process. © Emerald Group Publishing Limited.

Scoping review of patient-centered care approaches in healthcare
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Constand MK, MacDermid JC, Dal Bello-Haas V, Law M.
BMC health services research 2014 Jun 19;14:271-6963-14-271

The purpose of this scoping review was to describe how three tenants of patient-centered care provision: communication, partnership, and health promotion are addressed in patient-centered care models/frameworks across the literature. METHODS: A scoping review of literature published in English since 1990 was conducted using Medline, CINAHL, and EMBASE. A key term search strategy was employed using “patient-centered care”, “client-centered care”, “framework” and “model” to identify relevant studies. RESULTS: Application of the search strategy resulted in a hit total of 101 articles. Nineteen articles met inclusion criteria, of which 12 were review articles; 5 were qualitative research papers; one was a randomized control trial; and one was a prospective study. From these articles, 25 different patient-centered care frameworks/models were identified. CONCLUSIONS: The fact that all identified approaches to patient-centered care incorporated strategies to achieve effective communication, partnership, and health promotion indicates that clinicians can select a patient-centered approach from the literature that best suits their patient’s needs, and be confident that it will satisfy the three core elements of patient-centered care provision. While empirical literature on specific patient-centric frameworks and models was limited, much empiric evidence was sourced for the most consistently defined component of patient-centered care, communication.

Nurse-sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues.
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Burston S, Chaboyer W, Gillespie B.
Journal of clinical nursing 2014 Jul;23(13-14):1785-1795

To review nurse-sensitive indicators that may be suitable to assess nursing care quality. BACKGROUND: Patient safety concerns, fiscal pressures and patient expectation create a demand that healthcare providers demonstrate the quality of nursing care delivered. As a result, nurse managers are increasingly encouraged to provide evidence of nursing care quality. Nurse-sensitive indicators are being proposed as a means of meeting this need. DESIGN: Literature review. METHODS: A review of the literature was conducted using CINAHL and MEDLINE from 2002-2011. Key search terms were nurs* and sensitive indicators, outcome measures, indicators, metrics and patient outcomes. RESULTS: Most of the research has examined the relationship between nursing structural variables and patient outcomes in acute care settings and have explored potential indicators for specific patient groups and nursing roles. When using nurse-sensitive indicators, issues concerning the selection, reporting and sustained use are important for nurse managers to consider. CONCLUSION: Evidence for the nurse-sensitivity of some commonly used indicators is inconsistent due to the disparity in definitions used, data collection and analysis methods. Further research on the application and implementation of these indicators is required to assist nurse managers in attempting to quantify the quality of nursing care. Nurses need to continue to strive to achieve agreement on the definitions of indicators, gather strong consistent evidence of nurse-sensitivity, resolve issues of regular data collection and consider selection, reporting and sustainment when implementing nurse-sensitive indicators. RELEVANCE TO CLINICAL PRACTICE: Once identified, nurse-sensitive indicators can be applied for quality improvement purposes, but consensus is required to fully realise their potential. Nurse managers need to be aware of the factors that can influence the use of indicators at unit level. Strategies need to be implemented to promote these indicators becoming integrated with routine nursing care. © 2013 John Wiley & Sons Ltd.

Conference Board of Canada: “Lean” in Canadian Health Care: Doing Less While Achieving More Canada-flat-icon
June 2014

This briefing introduces “Lean,” a relatively new approach that focuses on maximizing customer value by eliminating “waste” from workflow. Lean empowers employees to redesign their own work processes and create a culture of everyday problem solving.

RAND: Improving Dementia Long-Term Care A Policy Blueprint

In 2010, 15 percent of Americans older than age 70 had dementia, and the number of new dementia cases among those 65 and older is expected to double by the year 2050. As the baby boomer generation ages, many older adults will require dementia-related long-term services and supports (LTSS). This blueprint is the only national document to date that engages local, state, and national stakeholders to specifically focus on policy options at the intersection of dementia and LTSS.

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Research Practice & Methodology

Exploring the many facets of research in late-life issues.
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Joanette Y, Gutman G, McElhaney J, Upshur R, Muscedere J.
Canadian journal on aging 2014 Jun;33(2):220-225.

This is an interesting article that discusses and outlines the issues and complexities of conducting research and determining the best care/quality of life in later life from a Canadian perspective.

Use of the h-index to measure the quality of the output of health services researchers.
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Birks Y, Fairhurst C, Bloor K, Campbell M, Baird W, Torgerson D.
Journal of health services research & policy 2014 Apr;19(2):102-109

To assess the use of the h-index to measure the quality of the output of health services researchers. METHOD: Online survey, with bibliometric analysis of a convenience volunteer sample of researchers mainly in the UK, North America and Australasia. Self-reported from Google Scholar: h-index; number of papers; number of citations; number of papers with ≥ 10 citations. RESULTS: There were complete responses from 532 health services researchers of whom 371 (70%) were from the UK. Of the bibliometric measures, the h-index appeared to be the best discriminator between other measures of quality (e.g. seniority; entry into the last UK Research Assessment Exercise). The median h-index was 12, with 90th and 95th quantiles of 40 and 52, respectively. Statisticians had the highest h-index with qualitative researchers the lowest (median 16 and 7, respectively). The h-index was predicted to increase by approximately 1 point annually with the biggest increase in statisticians and smallest in qualitative researchers when estimated by quantile regression. CONCLUSIONS: The h-index is a useful summary measure of output and quality of health services researchers. However, any accurate interpretation of bibliometric measures needs to take into account a person’s research discipline.

Quality of reporting of systematic reviews published in “evidence-based” Chinese journals.
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Li JL, Ge L, Ma JC, Zeng QL, Yao L, An N, et al.
Systematic reviews 2014 Jun 7;3(1):58-4053-3-58

The number of systematic reviews (SRs)/meta-analyses (MAs) has increased dramatically in China over the past decades. However, evaluation of quality of reporting of systematic reviews published has not been undertaken. The objective of this study is to evaluate the quality of reporting of SRs/MAs assessing efficacy and/or harms of clinical interventions published in “evidence-based” Chinese journals. METHODS: Web-based database searches were conducted for the Chinese Journal of Evidence-based Medicine, the Journal of Evidence-Based Medicine, the Chinese Journal of Evidence Based Pediatrics, and the Chinese Journal of Evidence-Based Cardiovascular Medicine. SRs/MAs assessing efficacy and/or harms of clinical interventions were included. The cut-off was December 31st 2011. The PRISMA statement was applied to assess the quality of reporting. Each item was assessed as follows: ‘Yes’ for total compliance, scored ‘1’; ‘partial’ for partial compliance, scored ‘0.5’; and ‘No’ for non-compliance, scored ‘0’. The review was considered to have major flaws if it received a total score of ≤15.0, minor flaws if it received a total score of 15.5 to 21.0, and minimal flaws if it received a total score 21.5 to 27.0. Odds ratios were used for binary variables, and the mean difference was used for continuous variables. Analyses were performed using RevMan 5.0 software. RESULTS: Overall, 487 SRs/MAs were identified and assessed. The included reviews had medium quality with minor flaws based on PRISMA total scores (range: 8.5-26.0; mean: 19.6 ± 3.3). The stratified analysis showed that SRs/MAs with more than 3 authors, from a university, hospital + university cooperation, multiple affiliations (≥2), and funding have significantly higher quality of reporting of SRs/MAs; 58% of the included reviews were considered to have minor flaws (total score of 15.6 to 21.0). Only 9.6% of reviews were considered to have major flaws. Specific areas needing improvement in reporting include the abstract, protocol and registration, and characteristics of the search. CONCLUSIONS: The reporting of SRs published in “evidence-based” Chinese journals is poor and needs to be improved in order for reviews to be useful. SR authors should use the PRISMA checklist to ensure complete and accurate accounts of their SRs

Exploring perceived barriers, drivers, impacts and the need for evaluation of public involvement in health and social care research: a modified Delphi study.
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Snape D, Kirkham J, Britten N, Froggatt K, Gradinger F, Lobban F, et al.
BMJ open 2014 Jun 17;4(6):e004943-2014-004943

To explore areas of consensus and conflict in relation to perceived public involvement (PI) barriers and drivers, perceived impacts of PI and ways of evaluating PI approaches in health and social care research. BACKGROUND: Internationally and within the UK the recognition of potential benefits of PI in health and social care research is gathering momentum and PI is increasingly identified by organisations as a prerequisite for funding. However, there is relatively little examination of the impacts of PI and how those impacts might be measured. DESIGN: Mixed method, three-phase, modified Delphi technique, conducted as part of a larger MRC multiphase project. SAMPLE: Clinical and non-clinical academics, members of the public, research managers, commissioners and funders. FINDINGS: This study found high levels of consensus about the most important barriers and drivers to PI. There was acknowledgement that tokenism was common in relation to PI; and strong support for the view that demonstrating the impacts and value of PI was made more difficult by tokenistic practice. PI was seen as having intrinsic value; nonetheless, there was clear support for the importance of evaluating its impact. Research team cohesion and appropriate resources were considered essential to effective PI implementation. Panellists agreed that PI can be challenging, but can be facilitated by clear guidance, together with models of good practice and measurable standards. CONCLUSIONS: This study is the first to present empirical evidence of the opinions voiced by key stakeholders on areas of consensus and conflict in relation to perceived PI barriers and drivers, perceived impacts of PI and the need to evaluate PI. As such it further contributes to debate around best practice in PI, the potential for tokenism and how best to evaluate the impacts of PI. These findings have been used in the development of the Public Involvement Impact Assessment Framework (PiiAF), an online resource which offers guidance to researchers and members of the public involved in the PI process.

Integration of existing systematic reviews into new reviews: identification of guidance needs.
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Robinson KA, Whitlock EP, Oneil ME, Anderson JK, Hartling L, Dryden DM, et al.
Systematic reviews 2014 Jun 23;3(1):60-4053-3-60

An exponential increase in the number of systematic reviews published, and constrained resources for new reviews, means that there is an urgent need for guidance on explicitly and transparently integrating existing reviews into new systematic reviews. The objectives of this paper are: 1) to identify areas where existing guidance may be adopted or adapted, and 2) to suggest areas for future guidance development. METHODS: We searched documents and websites from healthcare focused systematic review organizations to identify and, where available, to summarize relevant guidance on the use of existing systematic reviews. We conducted informational interviews with members of Evidence-based Practice Centers (EPCs) to gather experiences in integrating existing systematic reviews, including common issues and challenges, as well as potential solutions. RESULTS: There was consensus among systematic review organizations and the EPCs about some aspects of incorporating existing systematic reviews into new reviews. Current guidance may be used in assessing the relevance of prior reviews and in scanning references of prior reviews to identify studies for a new review. However, areas of challenge remain. Areas in need of guidance include how to synthesize, grade the strength of, and present bodies of evidence composed of primary studies and existing systematic reviews. For instance, empiric evidence is needed regarding how to quality check data abstraction and when and how to use study-level risk of bias assessments from prior reviews. CONCLUSIONS: There remain areas of uncertainty for how to integrate existing systematic reviews into new reviews. Methods research and consensus processes among systematic review organizations are needed to develop guidance to address these challenges.

Challenges associated with the secondary use of nursing data.
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Hardiker NR, Sermeus W, Jansen K.
Studies in health technology and informatics 2014;201:290-297

There is a prevailing ‘collect once, use many times’ view of clinical data and its secondary use. This study challenges this view through an assessment of the degree to which the International Classification for Nursing Practice (ICNP) might be used to provide raw data for the Belgian Nursing Minimum Data Set (B-NMDS). A mapping exercise identified exact matches between ICNP and B-NMDS for just 8% of B-NMDS care descriptions; no matches at all for 23%; possible broader matches in ICNP for 55%; possible narrower matches for 8%; and a possible broader and narrower match for 1%. Refining ICNP content and developing and implementing purposive data sets or catalogues that accommodate both ICNP concepts and B-NMDS care descriptions would lay the foundations for the potential re-use of primary ICNP-encoded data in populating the B-NMDS. One unexpected result of the study was to re-affirm the utility of ICNP as a reference terminology.

Meta-ethnography 25 years on: challenges and insights for synthesising a large number of qualitative studies
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Barker K.
BMC medical research methodology 2014 Jun 21;14(1):80

Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. Our team was funded to complete a meta-ethnography of patients’ experience of chronic musculoskeletal pain. It has been 25 years since Noblit and Hare published their core text on meta-ethnography, and the current health research environment brings additional challenges to researchers aiming to synthesise qualitative research. Noblit and Hare propose seven stages of meta-ethnography which take the researcher from formulating a research idea to expressing the findings. These stages are not discrete but form part of an iterative research process. We aimed to build on the methods of Noblit and Hare and explore the challenges of including a large number of qualitative studies into a qualitative systematic review. These challenges hinge upon epistemological and practical issues to be considered alongside expectations about what determines high quality research. This paper describes our method and explores these challenges. Central to our method was the process of collaborative interpretation of concepts and the decision to exclude original material where we could not decipher a concept. We use excerpts from our research team’s reflexive statements to illustrate the development of our methods.

The practice of ‘doing’ evaluation: lessons learned from nine complex intervention trials in action
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Reynolds J, DiLiberto D, Mangham-Jefferies L, Ansah EK, Lal S, Mbakilwa H, et al.
Implementation science 2014 Jun 17;9:75-5908-9-75

There is increasing recognition among trialists of the challenges in understanding how particular ‘real-life’ contexts influence the delivery and receipt of complex health interventions. Evaluations of interventions to change health worker and/or patient behaviours in health service settings exemplify these challenges. When interpreting evaluation data, deviation from intended intervention implementation is accounted for through process evaluations of fidelity, reach, and intensity. However, no such systematic approach has been proposed to account for the way evaluation activities may deviate in practice from assumptions made when data are interpreted. METHODS: A collective case study was conducted to explore experiences of undertaking evaluation activities in the real-life contexts of nine complex intervention trials seeking to improve appropriate diagnosis and treatment of malaria in varied health service settings. Multiple sources of data were used, including in-depth interviews with investigators, participant-observation of studies, and rounds of discussion and reflection. RESULTS AND DISCUSSION: From our experiences of the realities of conducting these evaluations, we identified six key ‘lessons learned’ about ways to become aware of and manage aspects of the fabric of trials involving the interface of researchers, fieldworkers, participants and data collection tools that may affect the intended production of data and interpretation of findings. These lessons included: foster a shared understanding across the study team of how individual practices contribute to the study goals; promote and facilitate within-team communications for ongoing reflection on the progress of the evaluation; establish processes for ongoing collaboration and dialogue between sub-study teams; the importance of a field research coordinator bridging everyday project management with scientific oversight; collect and review reflective field notes on the progress of the evaluation to aid interpretation of outcomes; and these approaches should help the identification of and reflection on possible overlaps between the evaluation and intervention. CONCLUSION: The lessons we have drawn point to the principle of reflexivity that, we argue, needs to become part of standard practice in the conduct of evaluations of complex interventions to promote more meaningful interpretations of the effects of an intervention and to better inform future implementation and decision-making.

Using qualitative comparative analysis (QCA) in systematic reviews of complex interventions: a worked example.
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Thomas J, O’Mara-Eves A, Brunton G.
Systematic reviews 2014 Jun 20;3(1):67-4053-3-67

Systematic reviews that address policy and practice questions in relation to complex interventions frequently need not only to assess the efficacy of a given intervention but to identify which intervention – and which intervention components – might be most effective in particular situations. Here, intervention replication is rare, and commonly used synthesis methods are less useful when the focus of analysis is the identification of those components of an intervention that are critical to its success. METHODS: Having identified initial theories of change in a previous analysis, we explore the potential of qualitative comparative analysis (QCA) to assist with complex syntheses through a worked example. Developed originally in the area of political science and historical sociology, a QCA aims to identify those configurations of participant, intervention and contextual characteristics that may be associated with a given outcome. Analysing studies in these terms facilitates the identification of necessary and sufficient conditions for the outcome to be obtained. Since QCA is predicated on the assumption that multiple pathways might lead to the same outcome and does not assume a linear additive model in terms of changes to a particular condition (that is, it can cope with ‘tipping points’ in complex interventions), it appears not to suffer from some of the limitations of the statistical methods often used in meta-analysis. RESULTS: The worked example shows how the QCA reveals that our initial theories of change were unable to distinguish between ‘effective’ and ‘highly effective’ interventions. Through the iterative QCA process, other intervention characteristics are identified that better explain the observed results. CONCLUSIONS: QCA is a promising alternative (or adjunct), particularly to the standard fall-back of a ‘narrative synthesis’ when a quantitative synthesis is impossible, and should be considered when reviews are broad and heterogeneity is significant. There are very few examples of its use with systematic review data at present, and further methodological work is needed to establish optimal conditions for its use and to document process, practice, and reporting standards.

Impact of peer review on reports of randomised trials published in open peer review journals: retrospective before and after study.
Non UofA Access
Hopewell S, Collins GS, Boutron I, Yu LM, Cook J, Shanyinde M, et al.
BMJ (Clinical research ed.) 2014 Jul 1;349:g4145

OBJECTIVE: To investigate the effectiveness of open peer review as a mechanism to improve the reporting of randomised trials published in biomedical journals. DESIGN: Retrospective before and after study. SETTING: BioMed Central series medical journals. SAMPLE: 93 primary reports of randomised trials published in BMC-series medical journals in 2012. MAIN OUTCOME MEASURES: Changes to the reporting of methodological aspects of randomised trials in manuscripts after peer review, based on the CONSORT checklist, corresponding peer reviewer reports, the type of changes requested, and the extent to which authors adhered to these requests. RESULTS: Of the 93 trial reports, 38% (n=35) did not describe the method of random sequence generation, 54% (n=50) concealment of allocation sequence, 50% (n=46) whether the study was blinded, 34% (n=32) the sample size calculation, 35% (n=33) specification of primary and secondary outcomes, 55% (n=51) results for the primary outcome, and 90% (n=84) details of the trial protocol. The number of changes between manuscript versions was relatively small; most involved adding new information or altering existing information. Most changes requested by peer reviewers had a positive impact on the reporting of the final manuscript-for example, adding or clarifying randomisation and blinding (n=27), sample size (n=15), primary and secondary outcomes (n=16), results for primary or secondary outcomes (n=14), and toning down conclusions to reflect the results (n=27). Some changes requested by peer reviewers, however, had a negative impact, such as adding additional unplanned analyses (n=15). CONCLUSION: Peer reviewers fail to detect important deficiencies in reporting of the methods and results of randomised trials. The number of these changes requested by peer reviewers was relatively small. Although most had a positive impact, some were inappropriate and could have a negative impact on reporting in the final publication. © Hopewell et al 2014.

Supporting Policy In health with Research: an Intervention Trial (SPIRIT)-protocol for a stepped wedge trial.
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CIPHER Investigators.
BMJ open 2014 Jul 1;4(7):e005293-2014-005293

Governments in different countries have committed to better use of evidence from research in policy. Although many programmes are directed at assisting agencies to better use research, there have been few tests of the effectiveness of such programmes. This paper describes the protocol for SPIRIT (Supporting Policy In health with Research: an Intervention Trial), a trial designed to test the effectiveness of a multifaceted programme to build organisational capacity for the use of research evidence in policy and programme development. The primary aim is to determine whether SPIRIT results in an increase in the extent to which research and research expertise is sought, appraised, generated and used in the development of specific policy products produced by health policy agencies. METHODS AND ANALYSIS: A stepped wedge cluster randomised trial involving six health policy agencies located in Sydney, Australia. Policy agencies are the unit of randomisation and intervention. Agencies were randomly allocated to one of three start dates (steps) to receive the 1-year intervention programme, underpinned by an action framework. The SPIRIT intervention is tailored to suit the interests and needs of each agency and includes audit, feedback and goal setting; a leadership programme; staff training; the opportunity to test systems to assist in the use of research in policies; and exchange with researchers. Outcome measures will be collected at each agency every 6 months for 30 months (starting at the beginning of step 1). ETHICS AND DISSEMINATION: Ethics approval was granted by the University of Western Sydney Human Research and Ethics Committee HREC Approval H8855. The findings of this study will be disseminated broadly through peer-reviewed publications and presentations at conferences and used to inform future strategies.

University of Canberra: ‘Feeling Better Connected’: Academics’ Use of Social Media (Aus)

This report outlines findings from an international online survey of 711 academics about their use of social media as part of their work conducted in January 2014. The survey sought to identify the tools that the respondents used, those they found most useful and the benefits and the drawbacks of using social media as a university faculty member or postgraduate student. The results offer insights into the sophisticated and strategic ways in which some academics are using social media and the many benefits they have experienced for their academic work. These benefits included connecting and establishing networks not only with other academics but also people or groups outside universities, promoting openness and sharing of information, publicising and development of research and giving and receiving support. While the majority of the respondents were very positive about using social media, they also expressed a range of concerns. These included issues of privacy and the blurring of boundaries between personal and professional use, the risk of jeopardising their career through injudicious use of social media, lack of credibility, the quality of the content they posted, time pressures, social media use becoming an obligation, becoming a target of attack, too much self-promotion by others, possible plagiarism of their ideas and the commercialisation of content and copyright issues. The report ends by contextualising the findings within the broader social and political environment and outlining areas for future research.

How Do We Know if a Program Made a Difference? A Guide to Statistical Methods for Program Impact Evaluation
Lance, P., D. Guilkey, A. Hattori and G. Angeles.
Chapel Hill, North Carolina: MEASURE Evaluation;2014

This manual provides an overview of core statistical and econometric methods for program impact evaluation (and, more generally, causal modelling). More detailed and advanced than typical brief reviews of the subject, it also strives to be more approachable to a wider range of readers than the advanced theoretical literature on program impact evaluation estimators. It thus forms a bridge between more basic treatments of the essentials of impact evaluation methods and the more advanced discussions. It seeks to discuss impact evaluation estimators in a thorough manner that does justice to their complexity, but in a fashion that is approachable.

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START (STrAtegies for RelaTives) coping strategy for family carers of adults with dementia: qualitative study of participants’ views about the intervention.
Non UofA Access
Sommerlad A, Manela M, Cooper C, Rapaport P, Livingston G.
BMJ open 2014 Jun 4;4(6):e005273-2014-005273

To analyse the experience of individual family carers of people with dementia who received a manual-based coping strategy programme (STrAtegies for RelaTives, START), demonstrated in a randomised-controlled trial to reduce affective symptoms. DESIGN: A qualitative study using self-completed questionnaires exploring the experience of the START intervention. Two researchers transcribed, coded and analysed completed questionnaires thematically. SETTING: Three mental health and one neurology dementia clinic in South East England. PARTICIPANTS: Participants were primary family carers of a patient diagnosed with dementia who provided support at least weekly to their relative. We invited those in the treatment group remaining in the START study at 2 years postrandomisation (n=132) to participate. 75 people, comprising a maximum variation sample, responded. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Important aspects of the therapy. (2) Continued use of the intervention after the end of the therapy. (3) Unhelpful aspects of the therapy and suggestions for improvement. (4) Appropriate time for intervention delivery. RESULTS: Carers identified several different components as important: relaxation techniques, education about dementia, strategies to help manage the behaviour of the person with dementia, contact with the therapist and changing unhelpful thoughts. Two-thirds of the participants reported that they continue to use the intervention’s techniques at 2-year follow up. Few participants suggested changes to the intervention content, but some wanted more sessions and others wanted the involvement of more family members. Most were happy with receiving the intervention shortly after diagnosis, although some relatives of people with moderate dementia thought it should have been delivered at an earlier stage. CONCLUSIONS: Participants’ varied responses about which aspects of START were helpful suggest that a multicomponent intervention is suited to the differing circumstances of dementia carers, providing a range of potentially helpful strategies. The continued use of the strategies 2 years after receiving the intervention could be a mechanism for the intervention remaining effectiv

The value of the use of participatory arts activities in residential care settings to enhance the well-being and quality of life of older people: A rapid review of the literature
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Fraser A, Bungay H, Munn-Giddings C.
Arts & Health 2014 06/12; 2014/07:1-13.

This rapid review of the literature explores the value of using participatory arts activities in residential care settings to enhance the health and well-being of older people. A rapid review of the literature published between 2000 and 2013 was undertaken and focused on participants aged 65 years and over living in residential care settings participating in arts activities such as music, dance, singing and the visual arts. The research methods used in the studies were varied, and a range of outcome measures were used, making overall synthesis of the studies difficult. Despite the methodological limitations of the studies, there is some suggestion that in the short term participating in arts activities improves mood, engagement and memory. There is some evidence that participating in arts-based activities has a role to play in improving the quality of life of older people living in residential care settings.

Variables associated to quality of life among nursing home patients with dementia.
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Mjorud M, Kirkevold M, Rosvik J, Selbaek G, Engedal K.
Aging & mental health 2014 Jun 9:1-9

To study which variables are associated with quality of life (QOL) in persons with dementia (PWD) living in nursing homes (NHs). Methods: A cross-sectional study included 661 PWD living in NH. To measure QOL the quality of life in late-stage dementia scale (QUALID) was applied. Other scales were: the clinical dementia rating scale (CDR), physical self-maintenance scale (PSMS), and neuropsychiatric inventory questionnaire (NPI-Q). Results: The patients’ mean age was: 86.9 (SD 7.7), 472 (71.4%) were women. Of all, 22.5% had CDR 1, 33.6% had CDR 2, and 43.9% had CDR 3. The mean PSMS score was 18.2 (SD 5.0), 43.1% lived in special care units, 56.9% in regular units. In a linear regression analysis NPI-affective score (β = 0.360, p-value < 0.001), NPI-agitation score (β = 0.268, p-value < 0.001), PSMS total score (β = 0.181, p-value < 0.001), NPI-apathy (β = 0.144, p-value < 0.001), NPI psychosis (β = 0.085, p-value 0.009), CDR sum of boxes score (β = 0.081, p-value 0.026) were significantly associated with QUALID total score (explained variance 44.5%). Conclusion: Neuropsychiatric symptoms, apathy, severity of dementia, and impairment in activities in daily living are associated with reduced QOL in NH patients with dementia.

Promoting and Protecting Against Stigma in Assisted Living and Nursing Homes.
Non UofA Access
Zimmerman S, Dobbs D, Roth EG, Goldman S, Peeples AD, Wallace B.
The Gerontologist 2014 Jun 13

To determine the extent to which structures and processes of care in multilevel settings (independent living, assisted living, and nursing homes) result in stigma in assisted living and nursing homes. DESIGN AND METHODS: Ethnographic in-depth interviews were conducted in 5 multilevel settings with 256 residents, families, and staff members. Qualitative analyses identified the themes that resulted when examining text describing either structures of care or processes of care in relation to 7 codes associated with stigma. RESULTS: Four themes related to structures of care and stigma were identified, including the physical environment, case mix, staff training, and multilevel settings; five themes related to processes of care and stigma, including dining, independence, respect, privacy, and care provision. For each theme, examples were identified illustrating how structures and processes of care can potentially promote or protect against stigma. IMPLICATIONS: In no instance were examples or themes identified that suggested the staff intentionally promoted stigma; on the other hand, there was indication that some structures and processes were intentionally in place to protect against stigma. Perhaps the most important theme is the stigma related to multilevel settings, as it has the potential to reduce individuals’ likelihood to seek and accept necessary care. Results suggest specific recommendations to modify care and reduce stigma.

Screening for Geriatric Depression in Residential Care Facilities: A Systematic Narrative Review. Canada-flat-icon
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Azulai A, Walsh CA.
Journal of gerontological social work 2014 Jun 13

Studies in residential care facilities suggest that routine screening can assist in the early detection of geriatric depression. However, the effectiveness of screening instruments in residential care in the US and Canada has not been adequately evaluated. We conducted a systematic narrative review of the English-language literature published between 2000 and 2010 on screening instruments used for depression detection in older adults living in residential care facilities. The review yielded nine scales and their modifications tested in residential care, which we evaluated. We provide specific recommendations for the use of effective scales and discuss implications for practice, policy and research.

Dementia and well-being: A conceptual framework based on Tom Kitwood’s model of needs.
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Kaufmann EG, Engel SA.
Dementia (London, England) 2014 Jun 19

The topic of well-being is becoming increasingly significant as a key outcome measure in dementia care. Previous work on personhood of individuals with dementia suggests that their subjective well-being can be described in terms of comfort, inclusion, identity, occupation and attachment. The study aimed to examine Tom Kitwood’s model of psychological needs and well-being in dementia based on the self-report of individuals with moderate or severe dementia and to differentiate and elaborate this model in the light of the empirical qualitative data. Nineteen inhabitants of a special long-term care unit were interviewed using a semi-structured interview. Data were analysed using content analysis. Thirty components within Kitwood’s model have been identified. A conceptual framework of subjective well-being in dementia was developed based on a theoretical background. The study was able to find indications that Kitwood’s model has empirical relevance. Nevertheless, it requires to be extended by the domain agency. Furthermore, the study suggests that individuals with dementia are important informants of their subjective well-being. © The Author(s) 2014

Coping with cognitive impairment and dementia: Rural caregivers’ perspectives. Canada-flat-icon
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Branger C, Burton R, O’Connell ME, Stewart N, Morgan D.
Dementia (London, England) 2014 Jun 20

Caregiving in a rural context is unique, but the experience of rural caregivers is understudied. This paper describes how rural caregivers cope with caring for a loved one diagnosed with mild cognitive impairment or dementia using qualitative description to generate a low-inference summary of a response to an open-ended question. This approach allowed these rural caregivers to describe their positive experiences in addition to the more commonly explored caregiver experiences related to stress. Analyses of coping revealed use of social support, engaging in relaxing and physical activity, and cognitive reframing. In addition, caregivers reported strong faith and religiosity, and to a lesser frequency behavioral changes, checking in with the person with dementia via telephone, and joint activity. Predominantly, these methods reflect approach-based strategies. The current data suggest that these caregivers manage well and adopt adaptive coping strategies to meet the demands of the caregiving role. © The Author(s) 2014

Current prevalence of dementia, depression and behavioural problems in the older adult care home sector: the South East London Care Home Survey.
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Stewart R, Hotopf M, Dewey M, Ballard C, Bisla J, Calem M, et al.
Age and Ageing 2014 Jul;43(4):562-567

BACKGROUND: a large and increasing number of older people in the UK are living in care homes. Dementia is a frequent reason underlying admission and determining care needs, but prevalence data are becoming increasingly outdated and reliant on brief screening instruments. OBJECTIVE: to describe the prevalence and severity of dementia, depression, behavioural problems and relevant medication use in a representative sample of residential and nursing care home residents. DESIGN/SETTING: a survey conducted in 15 randomly selected South East London care homes. Consensus clinical dementia diagnoses were made from multi-source information, and the Clinical Dementia Rating (CDR) Scale applied. Depression was ascertained using the Cornell Depression in Dementia Scale and psychological/behavioural problems using the Neuropsychiatric Inventory (NPI). PARTICIPANTS: three hundred and one residents with a mean (SD) age of 83.5 (9.8) and 65.8% female were included. RESULTS: dementia (CDR 1-3) prevalence was 75.1% overall, 55.8% in residential homes, 91.0% in residential elderly mentally infirm care and 77.0% in nursing homes. Depression prevalences were 26.5, 22.0 and 29.6%, respectively, and mean (95% CI) NPI severity scores 3.99 (3.47-4.50), 6.34 (5.29-7.39) and 6.10 (5.50-6.70) with 87.3% of the sample exhibiting at least one NPI symptom. Antidepressants were prescribed in 25.6, 25.0 and 41.3%, respectively, and antipsychotics in 7.0, 34.1 and 19.1%. CONCLUSION: dementia is substantially more common in care homes than recorded diagnoses would suggest, but studies using brief screening instruments may overestimate prevalence. High prevalences of depressive and/or behavioural symptoms and psychotropic use suggest significant unmet need. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society.

Barriers to the provision of high-quality palliative care for people with dementia in England: a qualitative study of professionals’ experiences.
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Davies N, Maio L, Vedavanam K, Manthorpe J, Vernooij-Dassen M, Iliffe S.
Health & social care in the community 2014 Jul;22(4):386-394

Approaches to palliative care that were originally developed for people with cancer are now being adopted for people with dementia, as a response to many reports of poor-quality care for people with dementia at the end of life. This study explored perceived barriers to the delivery of high-quality palliative care for people with dementia using semi-structured interviews. Recordings were transcribed verbatim and analysed using thematic analysis with an inductive approach and a coding strategy. To improve the trustworthiness of the analysis, independent reading and coding of the transcripts were undertaken, followed by discussions among the four researchers to reach agreement and consensus of the themes. Two group interviews (n = 7 and n = 6), 16 individual interviews and five interviews of pairs of professionals were conducted in 2011/2012 with participants from backgrounds in palliative care, dementia services, palliative care research and policy making. Four themes were identified as barriers to providing high-quality palliative care for people with dementia: (i) ambivalence towards the systematisation of palliative care; (ii) disconnection between services; (iii) different assumptions about training needs; and (iv) negotiation of risk. Understanding these barriers to providing high-quality palliative care for people with dementia could help in the development of a dementia-specific palliative care pathway. © 2013 The Authors.

The abuse, neglect and mistreatment of older people with dementia in care homes and hospitals in England: The potential for secondary data analysis: Innovative practice.
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Manthorpe J.
Dementia (London, England) 2014 Jun 24

There is concern that people with dementia may be at particular risk of elder abuse however there is little data to confirm such fears. This paper presents findings from an up-dated investigation of secondary sources of data about the abuse of older people with dementia in England conducted in 2013. There are many sources of data about poor care, abuse and neglect of people with dementia in care home and hospital settings but these are collected for different purposes and hard to link. The article discusses the ways in which dementia care practitioners may be able to make the most of existing data. © The Author(s) 2014

Measuring the quality of life and well-being of people with dementia: A review of observational measures.
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Algar K, Woods RT, Windle G.
Dementia (London, England) 2014 Jun 24

The dynamic nature of psychosocial interventions implies that trying to measure their effects using standardised clinical trial measures may not capture their full effects. Rich and valuable data during the sessions may be missed by using standard quality of life questionnaires. This paper compares observational measures in the context of recording the well-being of a person with dementia during and outside of a visual arts intervention. A literature search was conducted using systematic principles of searching, screening and retrieval to identify peer-reviewed English language evaluations of research projects using observational measures with people with dementia. Psychometric properties, strengths and weaknesses of 11 observational tools are reviewed in order to identify the most appropriate one for evaluating a visual art intervention for people with dementia. This review supports the Greater Cincinnati Chapter Well-Being Observation Tool as an appropriate measure to evaluate a visual art programme for people with dementia. The results of this review will help researchers plan projects to show the full range of effects for people with dementia for taking part in art sessions. © The Author(s) 2014

Supporting residents moving into long-term care: multiple layers shape residents’ experiences.
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Sussman T, Dupuis S.
Journal of gerontological social work 2014 Jul;57(5):438-459

This interpretive grounded theory study explores 10 residents’ retrospective accounts of the relocation process, including the decision to move into a long-term care home, the pre-move preparations, the moving day circumstances, and the initial adjustment period following the move. Analysis of the data revealed a complex intersection of conditions at multiple layers that shaped residents’ experiences of the transitional process. Recommendations to enhance circumstances at individual, interpersonal, and systemic layers, for each temporal stage of the relocation process are proposed. Implications for social work practice across the continuum of care are also discussed.

Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision. Canada-flat-icon
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Armstrong JJ, Zhu M, Hirdes JP, Stolee P.
Disability and rehabilitation 2014 Jul 1:1-7

To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System. Methods: Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n = 299 262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment. Results: Regional differences accounted for 9% of the variation in PT service provision and 20% of OT service provision. After controlling for the differences across regions, the most powerful predictors of service provision were identified for both OT and PT. The most highly associated client characteristics related to PT service provision were hip fracture, impairments in activities of daily living/instrumental activities of daily living, cerebrovascular accidents, and cognitive impairment. For OT, hazards in the home environment was the most powerful predictor of future service provision. Conclusions: Where a client lived was an important determinant of service provision in Ontario, raising the possibility of inequities in access to rehabilitation services. Health care planners and policy makers should review current practices and make adjustments to meet the increasing and changing needs for rehabilitation therapies of the aging population. Implications for Rehabilitation For older adults in home care, the goal of rehabilitation therapy services is to allow individuals to maintain or improve physical functioning, quality of life and overall independence while living within their community. Previous research has demonstrated that a large proportion of home care clients specifically identified as having rehabilitation potential do not receive it. This article used clinical assessment data to identify the predictors of and barriers to rehabilitation services for older adults in the Ontario Home Care System. Barriers of PT included dementia diagnosis and French as a first language. Barriers to OT included dementia diagnosis. Policies and practices related to service provision for older adults should be reconsidered if we are going to meet the demands of aging populations and increasing rates of functional and cognitive impairments.

Data sharing between home care professionals: a feasibility study using the RAI Home Care instrument. Canada-flat-icon
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Guthrie DM, Pitman R, Fletcher PC, Hirdes JP, Stolee P, Poss JW, et al.
BMC geriatrics 2014 Jun 30;14(1):81

Across Ontario, home care professionals collect standardized information on each client using the Resident Assessment for Home Care (RAI-HC). However, this information is not consistently shared with those professionals who provide services in the client’s home. In this pilot study, we examined the feasibility of sharing data, from the RAI-HC, between care coordinators and service providers. METHODS: All participants were involved in a one-day training session on the RAI-HC. The care coordinators shared specific outputs from the RAI-HC, including the embedded health index scales, with their contracted physiotherapy and occupational therapy service providers. Two focus groups were held, one with care coordinators (n = 4) and one with contracted service providers (n = 6). They were asked for their opinions on the positive aspects of the project and areas for improvement. RESULTS: The focus groups revealed a number of positive outcomes related to the project including the use of a falls prevention brochure and an increased level of communication between professionals. The participants also cited multiple areas for improvement related to data sharing (e.g., time constraints, data being sent in a timely fashion) and to their standard practices in the community (e.g., busy workloads, difficulties in data sharing, duplication of assessments between professionals). CONCLUSIONS: Home care professionals were able to share select pieces of information generated from the RAI-HC system and this project enhanced the level of communication between the two groups of professionals. However, a single information session was not adequate training for the rehabilitation professionals, who do not use the RAI-HC as part of normal practice. Better education, ongoing support and timely access to the RAI-HC data are some ways to improve the usefulness of this information for busy home care providers.

Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review.
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Renom-Guiteras A, Uhrenfeldt L, Meyer G, Mann E.
BMC geriatrics 2014 Jun 22;14(1):80

Residents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents. METHOD: Systematic review of the literature of two databases (PubMed and CINAHL(R)). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data. RESULTS: Twenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2% to 77%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents’ characteristics prior to admission (n = 6), residents’ or families’ wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools. CONCLUSIONS: Most assessment tools are not comprehensive and do not take into account residents’ individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.

Personalisation and dementia : a guide for person-centred practice
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Sanderson, H.
London: Jessica Kingsley Publishers, 2014.

This practical guide aims to explain how to deliver personalised services and support for people with dementia through simple, evidence-based person-centred practices. The authors explain personalisation and current person-centred thinking and practice, providing many vivid examples of how it has been achieved in community as well as residential care settings. They also guide the reader through using a range of person-centred practices.

StatsCan: Receiving care at home Canada-flat-icon

This StatsCan release focuses on StatsCan’s analytical paper, entitled Receiving care at home, which uses data from the 2012 General Social Survey on Caregiving and Care Receiving to examine Canadians who rely on care in the home, including the reason for care, the types of people providing help and the nature and intensity of care. It also looks at the satisfaction with the care received.

Joseph Rowntree Foundation: Improving quality of life in care homes through community visiting (UK)
June 2014

A pilot Community Visitor (CV) scheme in three Essex care homes has shown potential to support community engagement in care homes and improve residents’ quality of life. CVs visited care homes every week for a couple of hours, aiming to befriend older people and enhance communication between care home managers, staff, residents and their families.

Issue Brief: Long-Term Care in California
The Associated Press-NORC Center for Public Affairs Research
June 2014

The Associated Press-NORC Center for Public Affairs Research released an issue brief with survey results on long-term care in California. The brief provides new data on how Californians are, or are not, planning for long-term care and their views on the roles of family and government. This analysis compares Californians to the rest of the country based on findings from a national poll released in May.

Building on the National Dementia Strategy: Change, progress and priorities (UK)
June 2014

Members of the All-Party Parliamentary Group on Dementia (APPG) have joined Alzheimer’s Society to call for an urgently needed long-term national plan for dementia. Five years on from the launch of the first ever National Dementia Strategy, a new report from the All-Party Parliamentary Group (APPG) on dementia, launched Wednesday 18 June 2014, assesses progress made in three key areas of health and social care and calls for strong local leadership in executing plans, more integrated services and involvement of people with dementia in commissioning services.

NHS: Dementia Diagnosis and Care in England Learning from Clinical Commissioning Groups (UK)

This report details the findings from a series of CCG visits led by Alistair Burns (National Clinical Director for Dementia), with support from NHS Improving Quality . The purpose of the visits was to help build a national picture of what was working well in improving timely diagnosis of dementia and post-diagnostic support, to improve understanding about the challenges faced by CCGs and whether there were any common factors influencing diagnosis rates.

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Challenges in Mental Health Ethics
Friday 12 September 2014
Lister Conference Centre, University of Alberta

The John Dossetor Health Ethics Centre invites you to attend a one-day symposium on mental health ethics. Presenters will discuss challenges in the areas of public awareness, stigma of mental illness, relational practice, patients’ rights and values, addiction as a mental disorder, health care decisions, treatment and care of patients, and personal experiences. Proposals for creating a more desirable future will be discussed. Keynote presentations by: Senator Denise Batters (Parliament of Canada), Louise Bradley (Mental Health Commission of Canada) and Carol Robertson Baker (Office of the Alberta Health Advocates: Mental Health).

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Implementation Science: Translating Evidence into Practice
14-15 August University of Melbourne Melbourne Australia

This two-day workshop is an introduction into the world of implementation science – the science of translating evidence into practice. Using a mix of presentations, forums and workshops you will join a community of implementation scientists in the primary care setting to share information and workshop ideas about how to implement change and how to know that you are making a difference.

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Dementia-friendly technology charter (UK)

The Dementia-friendly technology charter has been produced as part of the dementia-friendly communities strand of the Prime Minister’s challenge on dementia. The charter, developed by a diverse working group led by Tunstall Healthcare, gives people with dementia and their carers information on how to access technology. It also provides guidance to health, housing and social care professionals on how to make technology work for people based on their individual needs.

HQCA announces new Chief Executive Officer Canada-flat-icon

Effective September 8, 2014 Mr. Andrew Neuner will be the Health Quality Council of Alberta’s new Chief Executive Officer. Mr. Neuner is an accomplished and visionary healthcare executive leader. He has more than 30 years of experience in healthcare, most recently with Interior Health in British Columbia, one of the largest health regions in Canada, where he is Vice President, Community Integration.

In-home care a far better option Canada-flat-icon

A national dementia strategy is certainly a good idea. But in Alberta, patients and families need concrete support today. Alberta Health Services has an effective program, but unfortunately it’s underfunded and difficult to access. The Self Managed Care (SMC) program provides funds to hire staff to support children and adults with disabilities and chronic health problems, including dementia, in their homes.

Province of Manitoba Introduces Blueprint to Improve Continuing Care Canada-flat-icon

The government is planning to launch a new, five-year blueprint for continuing care to help meet the growing demand for services for seniors and to introduce new caregiver supports to help people live as independently as possible. Entitled Advancing Continuing Care – A Blueprint to Support System Change, the blueprint is intended to guide provincial plans to support seniors and their family caregivers including help for Manitobans living in the community, those receiving home care and those in long-term care. The blueprint is expected to be released in the coming months

Long-term care must truly focus on clients Canada-flat-icon

This editorial focuses on the HQCA reports that were released on June 5, 2014. It calls on Alberta Health, Alberta Health Services, private contractors and other services to develop a long-term care that is client-focused. It was also noted that there needs to be more compassion for families and a more transparent and accountable bureaucracy.

B.C. launches elder abuse awareness social media campaign Canada-flat-icon

Using the hashtag #RespectSeniors and the BC Centre for Elder Advocacy and Support handle, @BCCEAS, British Columbians of all ages are encouraged to take a stand and to show their support for seniors by spreading the word about the Seniors Abuse and Information Line, and other available resources, to help ensure every British Columbian knows how to better recognize and respond to elder abuse.

Virtual house calls: Can video conferencing help people with dementia in rural communities? Canada-flat-icon

The answers may lie in two research projects funded by the Alzheimer Society Research Program (ASRP) investigating the potential benefits of video-linking people with dementia and their caregivers to health-care professionals in urban centres.

Provincial premiers put spotlight on dementia Canada-flat-icon

For the Council of the Federation, a working group of 13 provincial and territorial premiers committed to strengthening federal-provincial relations, dementia has become a permanent fixture in the Canadian political landscape.

The Alberta government is teaming up with community partners to do more to prevent elder abuse. Canada-flat-icon

Beginning in August, under a new $3 million grant program over three years, communities can apply for up to $150,000 in funding to develop, implement or enhance elder abuse prevention initiatives.

Canada’s top doc says health care system ‘woefully unprepared’ for aging society Canada-flat-icon

Canada’s top doctor is determined to make senior care — including that for aging veterans — a priority. President-elect of the Canadian Medical Association (CMA), Dr. Chris Simpson told a packed room of over 1,200 Royal Canadian Legion delegates in Edmonton that in its current state, Canada’s public healthcare system is “woefully unprepared for an aging society.”

An interview with David O’Toole, CIHI’s new CEO Canada-flat-icon

Meet David O’Toole, the man who’s signed up to head one of the most well-known not-for-profit, independent organizations dedicated to forging a common approach to Canadian health information.

Government of Manitoba announces new Alzheimer’s framework to guide Dementia services Canada-flat-icon

The province has launched a new, five-year framework to guide planning and investments to further address dementia in Manitoba.

Government of British Columbia appoints new Parliamentary Secretary for Seniors Canada-flat-icon

Michelle Stilwell has been appointed Parliamentary Secretary to the Minister of Health for Seniors, adding this role to her existing Parliamentary Secretary for Healthy Living responsibilities.

Most people want to stay at home if diagnosed with dementia but less than half know how

5 per cent of people would want to stay living at home for as long as possible if diagnosed with dementia. Yet a third of the general public wouldn’t know where to find information about how to make their home suitable,

How Do We Define Effective Impact Of Research Knowledge? Canada-flat-icon

Impact can be defined as: a powerful or major influence or effect; a force or impression of one thing on another – or an economic, social or cultural change or benefit to the quality of life within society. If we apply this to the potential impact of research – impact can be defined as a measurable change in policy, services or products. However, researchers don’t make policy, they usually don’t offer services, and they generally don’t produce products.

Simple Steps May Simplify Home Alzheimer’s Care

Among Americans with Alzheimer’s disease or other forms of dementia, an estimated 70 percent are cared for at home by family members and friends. Yet most people with dementia and their caregivers skip certain personal safety and health care measures that can make home care less stressful and allow those with dementia to remain at home longer, a new study found.

AHS creates continuing care resolution team Canada-flat-icon

A new continuing care resolution team reporting directly to Alberta Health Services’ CEO has been created to ensure patients and families receive appropriate, timely continuing care placement and care.

Minister Ambrose Launches Advisory Panel on Healthcare Innovation Canada-flat-icon

Health Minister Rona Ambrose officially launched her new Advisory Panel on Healthcare Innovation. The Minister named Dr. David Naylor to chair the panel, which is made up of prominent Canadians from across the country providing a range of perspectives and expertise. The other members are: Cy Frank, Neil Fraser, Francine Girard, Toby Jenkins, Jack Mintz, Chris Power, and Heather Reisman.

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edanz Journal Selector

The Journal Selector uses cutting-edge semantic technology to help you achieve publication success. Enter your abstract or sample text and the Journal Selector returns a list of journals that publish in related areas. You can refine your results based on the factors that matter to you, like publication frequency, Impact Factor or publishing model, including open access. If you use this, please get in touch with me and let me know if this works or not.

Elsevier Journal Finder

Elsevier Journal Finder helps you find journals that could be best suited for publishing your scientific article.
Powered by the Elsevier Fingerprint Engine™, Journal Finder uses smart search technology and field-of-research specific vocabularies to match your article to Elsevier journals. If you use this, please get in touch with me and let me know if this works or not.

Putting dementia on the map (UK)

Around 670,000 people in England live with dementia – a number which will double in the next 30 years. This map sets out what we currently know about dementia care, support and research across the country.

Long-term care resource: Meeting Needs and Reducing Distress website (UK)

The Meeting Needs and Reducing Distress website was created in partnership with the NHS, with the aim of ensuring that health care professionals can safely prevent and manage responsive behaviours in health care settings, including long-term care facilities. This website hosts comprehensive information for staff, students and managers in long-term care and hospitals. It is the result of an ongoing project managed by NHS and members of an Expert Group, and includes the resources, strategies and good practice gathered and/or created by these leaders in the field. The website hosts a variety of resources including:
o Best practice guidelines for staff, managers, security personnel and residents/caregivers, including information on managing risk, organizational responsibilities and using physical interventions.
o Case studies that are taken from real-life events and demonstrate the application of practical solutions, including one on dementia.
o Training videos for health care staff on managing risks and care strategies.
The website emphasizes good communication skills and the importance of compassionate care, staff training and creating a supportive care environment.

The King’s Fund: Patient and Family-Centred Care Toolkit (UK)

Patient and Family-Centred Care (PFCC) is a simple, step-by-step method for understanding what a care experience is like, what needs to change, and which small improvements can make a big difference to patients, families and staff alike. Across the country, teams have implemented the approach to improve services, ranging from paediatric accident and emergency to the care of frail older people, with measurable results.

Prioritising person-centred care – the evidence

On this website you can find the evidence from 779 systematic reviews of ways to make person centred care happen.

CFHI elects new board members Canada-flat-icon

The Canadian Foundation for Healthcare Improvement today announced the election of Janet Davidson and Murray Ross to its Board of Directors, for three-year terms beginning October 1, 2014.

Directory of Nursing Journals

This Directory of Nursing Journals was put together by Nurse Author & Editor and INANE (International Academy of Nursing Editors). All the journals listed have been screened; only journals that are known to be authentic, reliable, and congruent with the purposes of INANE are listed. There is a submission form to add any unlisted journals to the directory.

McMaster Optimal Aging Portal Canada-flat-icon
Registration is required

The overall goal of the Portal is to ensure you know about and have access to high-quality information that can help older adults remain healthy, active and engaged as long as possible and to manage their health conditions. The Portal aims to be a trusted voice on optimal aging for citizens, clinicians, public health professionals and policymakers.

Dementia Learning Resource for Ambulance Staff

From the NHS and Dementia Partnerships, this handout is specifically aimed at ambulance and emergency personnel who interact with people with dementia. This handout includes basic information on dementia, tips on communicating, and management strategies for disruptive behaviours.

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Editor Journal of Nursing Management

The Journal of Nursing Management is an international forum which informs and advances the discipline of nursing management and leadership. The Journal encourages scholarly debate and critical analysis resulting in a rich source of evidence which underpins and illuminates the practice of management, innovation and leadership in nursing and health care.

Come and work work for TREC
Research Assistant – Interviewers (Data Collection)

The Research Assistant – Interviewers (Data Collection) are responsible for data collection for the Translating Research into Elder Care (TREC) program. TREC is a collaborative partnership of investigators and decision makers whose aim is to improve quality of life and quality of care for older people in residential care. The successful candidates will collect survey and other data at the unit level in 90 nursing homes across Alberta, British Columbia and Manitoba and will be appointed to work from hubs based in Calgary, Edmonton, Winnipeg, New Westminster, Kelowna and Kamloops. As nursing homes may be up to 110km from the hub, the successful candidates must be prepared to travel.

Chair/Reader – Centre for Implementation Science (CIS) and Associate Director – NIHR CLAHRC South London
King’s College London UK

Key responsibilities and objectives of the job
 To demonstrate and grow international level research activity in Implementation Science and
secure the funding required to underpin the long-term growth of this research, as appropriate
for either Reader (Associate Professor) or Full Professor level.
 To have a very strong track record commensurate with his/her experience in the field of
quantitative or qualitative or mixed methods research, as evidenced by peer-reviewed
 To provide research leadership within their research field, and contribute to post-graduate
teaching in a field related to the work of the CLAHRC, including contributing to the teaching
and capacity building programmes of the CLAHRC, and to supervise students at the MSc and/or
Doctoral levels.
 To build and extend international collaborations and networks to ensure that the CLAHRC
research is internationally competitive, visible and recognised.
 To demonstrate the highest level of commitment to, and track record of, academic integrity and
alignment with the ethical and research standards of the partner organisations within the
 To have a close understanding of the NHS health service (and wider health and social care
economy) context within which the work of the CLAHRC takes place
 To engage in external academic activities in accordance with the CLAHRC’s research strategy,
which will enhance its national/international research profile.
 To supervise, on a regular basis, CLAHRC and CIS research staff and post-graduate students.

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