New article by Susan Slaughter, Adrian Wagg, Carla Ickert, Doris Milke, Corinne Schalm, and Carole Estabrooks
Mobility of Vulnerable Elders Study: Effect of the Sit-to-Stand Activity on Mobility, Function, and Quality of Life
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Slaughter SE, Wagg AS, Jones CA, Schopflocher D, Ickert C, Bampton E, et al.
Journal of the American Medical Directors Association 2014/09
The aim of this study is to assess the effect of the sit-to-stand activity on the mobility, function, and health-related quality of life of nursing home residents with dementia. Design A longitudinal quasi-experimental intervention study with intervention and control groups. Setting The study was conducted in 7 nursing homes (4 intervention; 3 control) in Edmonton, Canada. Participants Eligible residents had a diagnosis of dementia and were able to transfer independently, or with the assistance of 1 person. Intervention Health care aides prompted residents to repeat the sit-to-stand activity daily during care routines on day and evening shifts. Measurements Mobility was measured using the 30-second sit-to-stand test and the time to complete one sit-to-stand. Function (Functional Independence Measure), health status (Health Utilities Index Mark 2 & 3) and disease-specific quality of life (Quality of Life–Alzheimer’s Disease instrument) were also measured. Outcome measures were collected at baseline, and at 3 and 6 months. The covariates cognition, depression, and medical instability were derived from the Resident Assessment Instrument Minimum Data Set (Version 2.0), and the facility context covariate was measured using the Alberta Context Tool. Results A total of 111 residents completed the 6-month trial (56 intervention; 55 control). Residents in the intervention facilities maintained mobility, as measured by the time to complete one sit-to-stand (P = .01), and experienced a slower functional decline, as measured by the Functional Independence Measure (P = .01), from baseline to 6 months compared with residents in the control facilities, after adjusting for age, sex, cognition, depression, medical instability, and context. Conclusions Maintaining the ability to transfer using the sit-to-stand activity is a promising means of optimizing the mobility and function for residents with dementia in nursing homes.
Resources Recommended by Dr. Carole Estabrooks
Economic Evaluation of Complex Health System Interventions
A discussion paper on Economic Evaluation of Complex Health System Interventions: A Discussion Paper has been produced in response to a request from and in partnership with CIHR Institute of Health Services and Policy Research (CIHR IHSPR). The discussion paper provides guidance to those tasked with conducting an economic evaluation of complex health system interventions. The guidance will be an elaboration of existing National guidelines for economic evaluation and serve as a discussion paper to aid investigators conducting economic evaluations of complex health interventions. This paper is intended to be a starting point for health system and policy researchers who wish to understand some of the fundamentals of economic evaluation and its application complex interventions.
ABC of Behaviour Change Theories: An Essential Resource for Researchers, Policy Makers and Practitioners
Susan Michie, Robert West, Rona Campbell, Jamie Brown & Heather Gainforth
Surrey UK: Silverback Publishing 2014
This book describes 83 theories of behaviour change, identified by an expert panel of psychologists, sociologists, anthropologists and economists as relevant to designing interventions. For each theory, the book provides a brief summary, a list of its component constructs, a more extended description and a network analysis to show its links with other theories in the book. It considers the role of theory in understanding behaviour change and its application to designing and evaluating interventions.
Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications in People With Dementia Resident in Care Homes: A Systematic Review
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Thompson Coon J, Abbott R, Rogers M, Whear R, Pearson S, Lang I, et al.
Journal of the American Medical Directors Association 2014 Oct;15(10):706-718
Antipsychotic medications are commonly used to manage the behavioral and psychological symptoms of dementia. Several large studies have demonstrated an association between treatment with antipsychotics and increased morbidity and mortality in people with dementia. Aims To assess the effectiveness of interventions used to reduce inappropriate prescribing of antipsychotics to the elderly with dementia in residential care. Method Systematic searches were conducted in 12 electronic databases. Reference lists of all included studies and forward citation searching using Web of Science were also conducted. All quantitative studies with a comparative research design and studies in which recognized methods of qualitative data collection were used were included. Articles were screened for inclusion independently by 2 reviewers. Data extraction and quality appraisal were performed by 1 reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Results Twenty-two quantitative studies (reported in 23 articles) were included evaluating the effectiveness of educational programs (n = 11), in-reach services (n = 2), medication review (n = 4), and multicomponent interventions (n = 5). No qualitative studies meeting our inclusion criteria were identified. Eleven studies were randomized or controlled in design; the remainder were uncontrolled before and after studies. Beneficial effects were seen in 9 of the 11 studies with the most robust study design with reductions in antipsychotic prescribing levels of between 12% and 20%. Little empirical information was provided on the sustainability of interventions. Conclusion Interventions to reduce inappropriate prescribing of antipsychotic medications to people with dementia resident in care homes may be effective in the short term, but longer more robust studies are needed. For prescribing levels to be reduced in the long term, the culture and nature of care settings and the availability and feasibility of nondrug alternatives needs to be addressed.
CALL FOR ABSTRACTS:
International Nursing Home Research Conference
2-3 December 2015 Toulouse France
DEADLINE 30 June 2015
Abstracts accepted for presentation at the International Nursing Home research conference will be published
in a special supplement of the Journal of Nutrition Health and Aging – JNHA for the event.
CALL FOR ABSTRACTS:
Building an evidence base for active ageing policies: Active Ageing Index and its potential International Seminar
16-17 April Brussels
DEADLINE TODAY 6 October
The seminar will be dedicated to the studies focusing on how to achieve better outcomes — measured, for instance, by AAI — through appropriate policies including those that address life course determinants of active and healthy ageing. The seminar aims to bring together researchers, civil society representatives, policymakers and other stakeholders and will provide a multidisciplinary forum for those interested in the use of AAI and other research to enhance the knowledge about ageing and older people and lead to the development of better policies.
CALL FOR ABSTRACTS:
Evidence Live 2015
13-14 April Oxford UK
DEADLINE 1 December
Health scientists and researchers are invited to submit abstracts to Evidence Live 2015. Submissions can be made for oral or poster presentations. All will be reviewed and selected on merit for inclusion in the program or guided poster session. Evidence Live is a platform for the dissemination and use of evidence to benefit health care systems and influence treatment of chronic health issues from across the globe.
Grants & Awards
CIHR: eHealth Innovations Partnership Program (eHIPP)
DEADLINE 3 February
eHIPP is a collaborative funding opportunity designed to create a new generation of
cost-effective patient- and population-centered health care solutions.
IIQM Dissertation Award
DEADLINE 28 October
The International Institute for Qualitative Methodology (IIQM) at the University of Alberta, with sponsorship from ATLAS.ti, will annually make an award to the best Masters level dissertation and the best PhD level dissertation, from any academic discipline, containing research based on qualitative methodology. You could win:
-$3000 cash award
-ATLAS.ti software licence
-Complimentary ATLAS.ti training
-Complimentary registration to either QM 2015 or QHR 2015
TVN Strategic Impact Grant Program
DEADLINE: Expressions of Interest (EOI) by 12:00 ET Wednesday 29 October
TVN is seeking Expressions of Interest for a second round of funding under its collaborative Strategic Impact Grant Program. This Program is non-traditional and unique in that we are seeking researchers with potential projects interested in achieving greater impact by collaborating with other like-minded researchers and projects, and partnering with industry partners, knowledge users and trainees on a wider basis. For this round of funding, TVN is seeking projects that aim to investigate system changes for the benefit of the seriously ill, frail elderly, or improve the update or application of existing evidence to improve the care of the seriously ill, frail elderly.
Developing evidence for public health policy and practice: The implementation of a knowledge translation approach in a staged, multi-methods study in England, 2007-09
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South J, Cattan M.
Evidence and Policy 2014;10(3):379-396
Effective knowledge translation processes are critical for the development of evidence-based public health policy and practice. This paper reports on the design and implementation of an innovative approach to knowledge translation within a mixed methods study on lay involvement in public health programme delivery. The study design drew on scientific and experiential knowledge, and included iterative feedback loops to ensure that lay and professional perspectives shaped the research process and dissemination outputs. The paper concludes by discussing the application of this approach as a means to close the knowledge-practice gap in public health.
Capacity building for evidence-based decision making in local health departments: scaling up an effective training approach
Jacobs J, Duggan K, Erwin P, Smith C, Borawski E, Compton J, et al.
Implementation Science 2014;9(1):124
There are few studies describing how to scale up effective capacity-building approaches for public health practitioners. This study tested local-level evidence-based decision making (EBDM) capacity-building efforts in four U.S. states (Michigan, North Carolina, Ohio, and Washington) with a quasi-experimental design.Methods Partners within the four states delivered a previously established Evidence-Based Public Health (EBPH) training curriculum to local health department (LHD) staff. They worked with the research team to modify the curriculum with local data and examples while remaining attentive to course fidelity. Pre- and post-assessments of course participants (n?=?82) and an external control group (n?=?214) measured importance, availability (i.e., how available a skill is when needed, either within the skillset of the respondent or among others in the agency), and gaps in ten EBDM competencies. Simple and multiple linear regression models assessed the differences between pre- and post-assessment scores. Course participants also assessed the impact of the course on their work.Results Course participants reported greater increases in the availability, and decreases in the gaps, in EBDM competencies at post-test, relative to the control group. In adjusted models, significant differences (p?<?0.05) were found in `action planning,? `evaluation design,? `communicating research to policymakers,? `quantifying issues (using descriptive epidemiology),? and `economic evaluation.? Nearly 45% of participants indicated that EBDM increased within their agency since the training. Course benefits included becoming better leaders and making scientifically informed decisions.Conclusions This study demonstrates the potential for improving EBDM capacity among LHD practitioners using a train-the-trainer approach involving diverse partners. This approach allowed for local tailoring of strategies and extended the reach of the EBPH course.
The effect of late adoption of Canadian innovations: a case for implantable cardiac monitors.
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Sadri H, Winsor P.
Healthcare management forum;27(1 Suppl):S46-57
Syncope is a sudden and generally momentary loss of consciousness, which can have serious adverse events. The outcomes of the syncope episode can vary from a fall to fatal accidents. Syncope has a major negative effect on the patient’s health-related quality of life. The economic burden of syncope on healthcare systems is considerable. There are no clear diagnostic pathways for identifying the cause of syncope; patients can be admitted to hospital and undergo expensive and often repeated and inconclusive diagnostic tests. Implantable cardiac monitors have been available for more than a decade to help early diagnosis of syncope in unexplained cases. However, despite being a Canadian invention, the use of the implantable cardiac monitors has been suboptimal in the Canadian healthcare system. This study provides an overview of syncope, its management, and presents the estimated potential cost savings per diagnosis of systematic use of implantable cardiac monitors in Ontario.
Rapid innovation diffusion in social networks.
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Kreindler GE, Young HP.
Proceedings of the National Academy of Sciences of the United States of America 2014 Jul 22;111 Suppl 3:10881-10888
Social and technological innovations often spread through social networks as people respond to what their neighbors are doing. Previous research has identified specific network structures, such as local clustering, that promote rapid diffusion. Here we derive bounds that are independent of network structure and size, such that diffusion is fast whenever the payoff gain from the innovation is sufficiently high and the agents’ responses are sufficiently noisy. We also provide a simple method for computing an upper bound on the expected time it takes for the innovation to become established in any finite network. For example, if agents choose log-linear responses to what their neighbors are doing, it takes on average less than 80 revision periods for the innovation to diffuse widely in any network, provided that the error rate is at least 5% and the payoff gain (relative to the status quo) is at least 150%. Qualitatively similar results hold for other smoothed best-response functions and populations that experience heterogeneous payoff shocks.
Measuring the Effectiveness of Mentoring as a Knowledge Translation Intervention for Implementing Empirical Evidence: A Systematic Review.
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Abdullah G, Rossy D, Ploeg J, Davies B, Higuchi K, Sikora L, et al.
Worldviews on evidence-based nursing 2014 Sep 23
Mentoring as a knowledge translation (KT) intervention uses social influence among healthcare professionals to increase use of evidence in clinical practice. AIM: To determine the effectiveness of mentoring as a KT intervention designed to increase healthcare professionals’ use of evidence in clinical practice. METHODS: A systematic review was conducted using electronic databases (i.e., MEDLINE, CINAHL), grey literature, and hand searching. Eligible studies evaluated mentoring of healthcare professionals responsible for patient care to enhance the uptake of evidence into practice. Mentoring is defined as (a) a mentor more experienced than mentee; (b) individualized support based on mentee’s needs; and (c) involved in an interpersonal relationship as indicated by mutual benefit, engagement, and commitment. Two reviewers independently screened citations for eligibility, extracted data, and appraised quality of studies. Data were analyzed descriptively. RESULTS: Of 10,669 citations from 1988 to 2012, 10 studies were eligible. Mentoring as a KT intervention was evaluated in Canada, USA, and Australia. Exposure to mentoring compared to no mentoring improved some behavioral outcomes (one study). Compared to controls or other multifaceted interventions, multifaceted interventions with mentoring improved practitioners’ knowledge (four of five studies), beliefs (four of six studies), and impact on organizational outcomes (three of four studies). There were mixed findings for changes in professionals’ behaviors and impact on practitioners’ and patients’ outcomes: some outcomes improved, while others showed no difference. LINKING EVIDENCE TO ACTION: Only one study evaluated the effectiveness of mentoring alone as a KT intervention and showed improvement in some behavioral outcomes. The other nine studies that evaluated the effectiveness of mentoring as part of a multifaceted intervention showed mixed findings, making it difficult to determine the added effect of mentoring. Further research is needed to identify effective mentoring as a KT intervention. © 2014 The Authors
Nurses` perception of barriers to research utilization in a public hospital in Saudi Arabia.
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Aboshaiqah AE, Qasim A, AlBashaireh A, Patalagsa JG.
Saudi medical journal 2014 Sep;35(9):1136-1139
To explore nurses` perception of barriers to research utilization. METHODS: A descriptive study was implemented. A total of 243 registered nurses in a public hospital in Riyadh, Saudi Arabia was selected using convenience sampling during the first quarter of 2013. The 29-item BARRIERS scale was used. RESULTS: The top 5 items were rated as great or moderate barriers were either setting- or nurse-related: `insufficient time to implement new ideas` (n=157, 64.6%); `nurse sees little benefit for self` (n=150, 61.7%); `nurse does not feel she/he has enough authority to change patient care procedures` (n=146 60.1%); `nurse is isolated from knowledgeable colleagues` (n=145; 59.7%); and `nurse does not have time to read research` (n=143, 58.8%). CONCLUSION: Setting- and nurse-related items comprised the top 5 barriers. Motivation issues, and knowledge-translation issues appeared to be the themes drawn from this study. Further studies using both quantitative and qualitative methods are needed.
Systematic implementation of evidence-based practice in a clinical nursing setting: a participatory action research project.
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Friesen-Storms JH, Moser A, van der Loo S, Beurskens AJ, Bours GJ.
Journal of clinical nursing 2014 Sep 25
To describe the process of implementing evidence-based practice in a clinical nursing setting. BACKGROUND: Evidence-based practice has become a major issue in nursing, it is insufficiently integrated into daily practice and its implementation is complex. DESIGN: Participatory action research. METHODS: The main participants were nurses working in a lung unit of a rural hospital. A multi-method process of data collection was used during the observing, reflecting, planning and acting phases. Data were continuously gathered during a 24-month period from 2010 to 2012, and analysed using an interpretive constant comparative approach. Patients were consulted to incorporate their perspective. RESULTS: A best-practice mode of working was prevalent on the ward. The main barriers to the implementation of evidence-based practice were that nurses had little knowledge of evidence-based practice and a rather negative attitude towards it, and that their English reading proficiency was poor. The main facilitators were that nurses wanted to deliver high-quality care and were enthusiastic and open to innovation. Implementation strategies included a tailored interactive outreach training and the development and implementation of an evidence-based discharge protocol. The academic model of evidence-based practice was adapted. Nurses worked according to the evidence-based practice discharge protocol but barely recorded their activities. Nurses favourably evaluated the participatory action research process. CONCLUSIONS: Action research provides an opportunity to empower nurses and to tailor evidence-based practice to the practice context. Applying and implementing evidence-based practice is difficult for front-line nurses with limited evidence-based practice competencies. RELEVANCE TO CLINICAL PRACTICE: Adaptation of the academic model of evidence-based practice to a more pragmatic approach seems necessary to introduce evidence-based practice into clinical practice. The use of scientific evidence can be facilitated by using pre-appraised evidence. For clinical practice, it seems relevant to integrate scientific evidence with clinical expertise and patient values in nurses’ clinical decision-making at the individual patient level. © 2014 John Wiley & Sons Ltd.
A Diffusion of Innovations Approach to Understand Stakeholder Perceptions of Renewable Energy Initiatives
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Silk KJ, Hurley A, Pace K, Maloney EK, Lapinski M.
Science Communication 2014 October 01;36(5):646-669
This study uses diffusion of innovations (DOI) as a framework for formative research to understand different stakeholders’ perceptions of renewable energy initiatives (i.e., wind, solar, and biomass). Focus groups (N =12) were conducted with several different stakeholders in Michigan: farmers (n = 17), rural residents (n = 20), urban residents (n = 30), citizen activists/environmentalists (n = 13), and individuals who live in tourist-based economies (n = 7). Data were analyzed based on DOI constructs. Results suggest that farmers would be considered early adopters, while urban residents would fall in the late majority. Overall, stakeholder groups perceived renewable energy to be relatively advantageous and compatible with their values.
Context matters: measuring implementation climate among individuals and groups.
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Jacobs SR, Weiner BJ, Bunger AC.
Implementation science 2014 Apr 17;9:46-5908-9-46
It has been noted that implementation climate is positively associated with implementation effectiveness. However, issues surrounding the measurement of implementation climate, or the extent to which organizational members perceive that innovation use is expected, supported and rewarded by their organization remain. Specifically, it is unclear whether implementation climate can be measured as a global construct, whether individual or group-referenced items should be used, and whether implementation climate can be assessed at the group or organizational level. METHODS: This research includes two cross-sectional studies with data collected via surveys at the individual level. The first study assessed the implementation climate perceptions of physicians participating in the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP), and the second study assessed the perceptions of children’s behavioral health clinicians implementing a treatment innovation. To address if implementation climate is a global construct, we used confirmatory factor analysis. To address how implementation climate should be measured and at what level, we followed a five-step framework outlined by van Mierlo and colleagues. This framework includes exploratory factor analysis and correlations to assess differences between individual and group-referenced items and intraclass correlations, interrater agreements, and exploratory factor analysis to determine if implementation climate can be assessed at the organizational level. RESULTS: The confirmatory factor analysis demonstrated that implementation climate is a global construct consisting of items related to expectations, support and rewards. There are mixed results, however, as to whether implementation climate should be measured using individual or group-referenced items. In our first study, where physicians were geographically dispersed and practice independently, there were no differences based on the type of items used, and implementation climate was an individual level construct. However, in the second study, in which clinicians practice in a central location and interact more frequently, group-referenced items may be appropriate. In addition, implementation climate could be considered an organizational level construct. CONCLUSIONS: The results are context-specific. Researchers should carefully consider the study setting when measuring implementation climate. In addition, more opportunities are needed to validate this measure and understand how well it predicts and explains implementation effectiveness.
Development and verification of an agent-based model of opinion leadership.
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Anderson CA, Titler MG.
Implementation science 2014 Sep 27;9(1):136
The use of opinion leaders is a strategy used to speed the process of translating research into practice. Much is still unknown about opinion leader attributes and activities and the context in which they are most effective. Agent-based modeling is a methodological tool that enables demonstration of the interactive and dynamic effects of individuals and their behaviors on other individuals in the environment. The purpose of this study was to develop and test an agent-based model of opinion leadership. The details of the design and verification of the model are presented. Methods The agent-based model was developed by using a software development platform to translate an underlying conceptual model of opinion leadership into a computer model. Individual agent attributes (for example, motives and credibility) and behaviors (seeking or providing an opinion) were specified as variables in the model in the context of a fictitious patient care unit. The verification process was designed to test whether or not the agent-based model was capable of reproducing the conditions of the preliminary conceptual model. The verification methods included iterative programmatic testing (`debugging¿) and exploratory analysis of simulated data obtained from execution of the model. The simulation tests included a parameter sweep, in which the model input variables were adjusted systematically followed by an individual time series experiment. Results Statistical analysis of model output for the 288 possible simulation scenarios in the parameter sweep revealed that the agent-based model was performing, consistent with the posited relationships in the underlying model. Nurse opinion leaders act on the strength of their beliefs and as a result, become an opinion resource for their uncertain colleagues, depending on their perceived credibility. Over time, some nurses consistently act as this type of resource and have the potential to emerge as opinion leaders in a context where uncertainty exists. Conclusions The development and testing of agent-based models is an iterative process. The opinion leader model presented here provides a basic structure for continued model development, ongoing verification, and the establishment of validation procedures, including empirical data collection.
Exploring mentorship as a strategy to build capacity for knowledge translation research and practice: a scoping systematic review.
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Gagliardi AR, Webster F, Perrier L, Bell M, Straus S.
Implementation science 2014 Sep 25;9(1):122
Knowledge translation (KT) supports use of evidence in healthcare decision making but is not widely practiced. Mentoring is a promising means of developing KT capacity. The purpose of this scoping systematic review was to identify essential components of mentoring that could be adapted for KT mentorship. Methods Key social sciences and management databases were searched from January 2002 to December 2011 inclusive. Empirical research in non-healthcare settings that examined mentorship design and impact for improving job-specific knowledge and skill were eligible. Members of the study team independently selected eligible studies, and extracted and summarized data. Results Of 2,101 search results, 293 were retrieved and 13 studies were eligible for review. All but one reported improvements in knowledge, skill, or behavior. Mentoring program components included combining preliminary workshop-based training with individual mentoring provided either in person or remotely; training of mentors; and periodic mentoring for at least an hour over a minimum period of six months. Barriers included the need for infrastructure for recruitment, matching, and training; lack of clarity in mentoring goals; and limited satisfaction with mentors and their availability. Findings were analyzed against a conceptual framework of factors that influence mentoring design and impact to identify issues warranting further research. Conclusion This study identified key mentoring components that could be adapted for KT mentorship. Overall, few studies were identified. Thus further research should explore whether and how mentoring should be tailored to baseline knowledge or skill and individual KT needs; evaluate newly developed or existing KT mentorship programs based on the factors identified here; and examine whether and how KT mentorship develops KT capacity. The conceptual framework could be used to develop or evaluate KT mentoring programs.
The Science of Science Communication II
Science communication as political communication
Gaining trust as well as respect in communicating to motivated audiences about science topics
Leveraging scientific credibility about Arctic sea ice trends in a polarized political environment
Creating a national citizen engagement process for energy policy
Using narratives and storytelling to communicate science with nonexpert audiences
The cultural side of science communication
Prescriptive scientific narratives for communicating usable science
Communicating science-based recommendations with memorable and actionable guidelines
The science of sharing and the sharing of science
Integrating social networks and human social motives to achieve social influence at scale
Team science for science communication
Communicating scientific uncertainty
Health Care Administration and Organization
Certified Nurse Aide Scope of Practice: State-by-State Differences in Allowable Delegated Activities
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McMullen TL, Resnick B, Chin-Hansen J, Geiger-Brown J, Miller N, Rubenstein R.
Journal of the American Medical Directors Association 2014
To gain a better understanding of the state-by-state differences in allowable delegated activities for Certified Nurse Aides (CNAs) working in long-term care settings, this exploratory descriptive study assessed what are the allowable tasks for CNAs based on findings from each state board of nursing. Specifically, findings from each state determined whether the care tasks allowed were consistent with those delineated by the 42 CFR § 483. Design This descriptive study included data drawn from all 50 states’ regulatory offices or health care services agencies. Data were obtained from the regulations listed on each state’s board of nursing, department of health, department of aging, department of health professions, department of commerce, and office of long-term care, among like agencies. Measures The Code of Federal regulations (42 CFR § 483) listed 9 tasks that are allowable by each state. These tasks are identified as items 1 to 9: (1) personal care skills, (2) safety/emergency procedures, (3) basic nursing skills, (4) infection control, (5) communication and interpersonal skills, (6) care of cognitively impaired residents, (7) basic restorative care, (8) mental health and social service needs, and (9) residents’ rights. Results Nine tasks delineated in the 42 CFR § 483 were identified as allowable in each state. On data analysis, it was found that 11 states noted that CNAs were able to perform workplace tasks that could be considered “expanded” care tasks, tasks beyond the basic care tasks listed in the 42 CFR § 483. Conclusions Findings from this exploratory study aid in limiting the confusion around the application of workplace duties across states, providing a useful description of the care tasks CNAs are allowed to perform in an attempt to find uniformity state-by-state. Overall, states reported considering expanding the scope of practice or authorized duties for CNAs to strengthen patient care and safety. States may choose to expand CNA authorized duties so as to equip CNAs with specific training so that the CNA is able to provide a certain level of care when or if he or she is needed to do so. Without uniformity of CNA authorized duties, it is difficult to interpret whether expanding the scope of the CNA can result in outcomes such as improved patient care. State regulations vary and there were state boards of nursing that were not sure about the true extent of CNA workplace responsibilities.
Acceptability of an e-Learning Program to Help Nursing Assistants Manage Relationship Conflict in Nursing Homes
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Marziali E, Mackenzie CS, Tchernikov I.
American Journal of Alzheimer’s Disease and Other Dementias 2014 September 22
Management of nursing assistants’ (NAs) emotional stress from relationship conflicts with residents, families, and coworkers is rarely the focus of educational programs. Our objective was to gather feedback from NAs and their nursing supervisors (NSs) about the utility of our e-learning program for managing relationship stress. Methods: A total of 147 NAs and their NSs from 17 long-term care homes viewed the educational modules (DVD slides with voice-over), either individually or in small groups, and provided feedback using conference call focus groups. Results: Qualitative analysis of NA feedback showed that workplace relationship conflict stress was associated with workload and the absence of a forum for discussing relationship conflicts that was not acknowledged by NSs. Conclusion: This accessible e-learning program provides NAs with strategies for managing stressful emotions arising from workplace relationship conflict situations and underscores the importance of supervisory support and team collaboration in coping with emotionally evoked workplace stress.
Role expectations in dementia care among family physicians and specialists.
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Hum S, Cohen C, Persaud M, Lee J, Drummond N, Dalziel W, et al.
Canadian geriatrics journal 2014 Sep 5;17(3):95-102
The assessment and ongoing management of dementia falls largely on family physicians. This pilot study explored perceived roles and attitudes towards the provision of dementia care from the perspectives of family physicians and specialists. METHODS: Semi-structured, one-to-one interviews were conducted with six family physicians and six specialists (three geriatric psychiatrists, two geriatricians, and one neurologist) from University of Toronto-affiliated hospitals. Transcripts were subjected to thematic content analysis. RESULTS: Physicians’ clinical experience averaged 16 years. Both physician groups acknowledged that family physicians are more confident in diagnosing/treating uncomplicated dementia than a decade ago. They agreed on care management issues that warranted specialist involvement. Driving competency was contentious, and specialists willingly played the “bad cop” to resolve disputes and preserve long-standing therapeutic relationships. While patient/caregiver education and support were deemed essential, most physicians commented that community resources were fragmented and difficult to access. Improving collaboration and communication between physician groups, and clarifying the roles of other multi-disciplinary team members in dementia care were also discussed. CONCLUSIONS: Future research could further explore physicians’ and other multi-disciplinary members’ perceived roles and responsibilities in dementia care, given that different health-care system-wide dementia care strategies and initiatives are being developed and implemented across Ontario.
Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan.
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Tsukamoto E, Abe T, Ono M.
Psychology, Health & Medicine 2014 Sep 29:1-10
Emotional labour increases among long-term care workers because providing care and services to impaired elders causes conflicting interpersonal emotions. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. We conducted a cross-sectional study among 132 established, private day care centres in Tokyo using a mail survey. The outcome variables included two health-related variables and four job satisfaction variables: physical and psychological health, satisfaction with wages, interpersonal relationships, work environment and job satisfaction. We performed multiple regression analyses to identify significant factors. Directors from 36 facilities agreed to participate. A total of 123 responses from long-term care workers were analysed. Greater emotional dissonance was associated with better physical and psychological health and worse work environment satisfaction (partial regression coefficient: -2.93, p = .0389; -3.32, p = .0299; -1.92, p = .0314, respectively). Fewer negative emotions were associated with more job satisfaction (partial regression coefficient: -1.87, p = .0163). We found that emotional labour was significantly inversely associated with health and job satisfaction. Our findings indicated that the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, and suggests that care quality and stable employment among long-term care workers might affect their emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and a self-care programme to educate workers regarding emotional labour would be beneficial.
The Job Embeddedness instrument: An evaluation of validity and reliability.
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Geriatric nursing (New York, N.Y.) 2014 Jul 7
A cross sectional correlational mailed survey was used to assess the validity and reliability of the Job Embeddedness (JE) instrument for predicting nurse retention. A regression model using the variables of JE and age were predictive of nurse retention in a sample of Registered Nurses (RNs) working in long term care (LTC) settings. This study supports the multi-dimensionality, validity and reliability of the underlying JE construct. However a different factor structure was suggested that better fit the data. Long term care organizations (LTC) may benefit from a strategy of increasing the embeddedness of their existing employees in order to increase nurse retention. Job embbededness could be used as a foundation to provide effective nurse retention strategies in LTC settings. Copyright © 2014 Mosby, Inc. All rights reserved.
A descriptive retrospective study of time consumption in home care services: how do employees use their working time?
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Holm SG, Angelsen RO.
BMC health services research 2014 Sep 26;14(1):439
Home care services in Norway are provided for free, and municipalities are responsible for their provision to all those in need of them, in accordance with the Act on Municipal Health and Care Services. The costs of home care services are increasing. Many municipalities are now working to find the best cost-effective solutions to ensure that home care services are of sufficient quality but still affordable. This paper describes how nurses and health workers spend their working time, with a hypothesis that driving time and time required to document details of the care given are underestimated in weekly planning schedules. METHODS: This article sets out a descriptive retrospective study of day-schedules and driving routes for staff working in home care services. Data were analyzed using GIS. RESULTS: The driving time was between 18% and 26% of working time in municipality A, and between 21% and 23% in municipality B. Visiting time varied between 44% and 62% in municipality A, and 40% and 56% in municipality B. Other tasks, including the legally-required documentation of the care given, varied between 19% and 32% in municipality A and 21% and 38% in municipality B. Overall, 22% of the driving routes in municipality A, and 14% in municipality B, took more time than expected. In municipality A, 22% of the day-schedules underestimated overtime; this figure was 14% in municipality B. CONCLUSIONS: In home care services, time taken for driving and to write statutory documentation seems to have been underestimated. Better planning and organization of driving routes would reduce driving time and allow more time for other necessary work.
Safe staffing for older people’s wards (UK)
Royal College of Nursing 2012
This report gives evidence-based recommendations on the range of staffing levels required for safe care in acute and long-term care facilities, the requirement for strong leadership, high levels of training and a positive-practice environment.
Health Care Innovation and Quality Assurance
A Measure of Person-Centered Practices in Assisted Living: The PC-PAL
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Zimmerman S, Allen J, Cohen LW, Pinkowitz J, Reed D, Coffey WO, et al.
Journal of the American Medical Directors Association 2014
Develop self-administered questionnaires of person-centeredness for completion by residents and staff in assisted living (AL), in response to concerns that AL is not person-centered; also, demonstrated person-centeredness is necessary for Medicaid support as a home- and community-based services provider. Design Community-based participatory research partnership among a research team, a consortium of 11 stakeholder organizations, and others. Methods included literature review, item generation and reduction, cognitive testing, field testing, exploratory factor analysis, and convergent and discriminant validity testing. Setting Cognitive testing conducted in 2 AL residences and field testing conducted in 19 diverse, stratified AL residences in 6 states. Participants Eight residents and staff participated in cognitive testing, and 228 residents and 123 staff participated in field testing. Measurements Feasibility and psychometric testing of draft questionnaires that included 75 items (resident version) and 102 items (staff version), with parallel items on both versions as appropriate. Results The final resident questionnaire included 49 items and 4 factors: well-being and belonging, individualized care and services, social connectedness, and atmosphere. The staff questionnaire included 62 items and 5 factors: workforce practices, social connectedness, individualized care and services, atmosphere, and caregiver-resident relationships. Staff scored person-centeredness higher than did residents, reflecting their different perspectives. Conclusion The Person-Centered Practices in Assisted Living (PC-PAL) questionnaires measure person-centeredness from the perspectives of residents and staff, meaning that they reflect the concepts and items considered to be important to these key stakeholders. Use of these instruments to describe, assess, quantify, ensure, and ultimately improve person-centeredness in AL is feasible and appropriate for all AL settings, and supported by numerous national organizations.
The Aged Residential Care Healthcare Utilization Study (ARCHUS): A Multidisciplinary, Cluster Randomized Controlled Trial Designed to Reduce Acute Avoidable Hospitalizations From Long-Term Care Facilities
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Connolly MJ, Boyd M, Broad JB, Kerse N, Lumley T, Whitehead N, et al.
Journal of the American Medical Directors Association 2014
To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. Design Cluster randomized controlled trial. Setting RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. Participants A total of 1998 residents of 18 intervention facilities and 18 control facilities. Intervention A facility-based complex intervention of 9 months’ duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Main outcome measures Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. Results The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85–1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76–1.61; P = .62). Conclusions This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging.
Experiences of Nursing Staff Using Dementia-Specific Case Conferences in Nursing Homes.
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Holle D, Kruger C, Halek M, Sirsch E, Bartholomeyczik S.
American Journal of Alzheimer’s Disease and Other Dementias 2014 Sep 26
Dementia specific-case conferences with the Innovative dementia oriented assessment tool (CC-IdA) could be an important tool with which to analyze and manage challenging behavior. The study gives an insight into nursing staff’ experiences using CC-IdA in dementia care. METHODS: Qualitative interviews were conducted with 18 nursing teams from 12 nursing homes alongside a quasi-experimental study. In addition, observational field notes were taken. Interviews and observational field notes were analyzed using the thematic content analysis. RESULTS: CC-IdA contributed to a reflective handling of challenging behavior, to changes in the communication with residents and to the identification of potentially triggers of challenging behavior. Factors influencing the implementation of CC-IdA were among others a lack of moderation skills, limited knowledge of dementia, a lack of biographical information and a lack of involvement by other professionals. CONCLUSIONS: CC-IdA represents an important tool in the management of challenging behavior of people with dementia. For the successful implementation of these case conferences, both structural and personal resources are needed. © The Author(s) 2014.
Multi-level factors influence the implementation and use of complex innovations in cancer care: a multiple case study of synoptic reporting.
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Urquhart R, Porter GA, Sargeant J, Jackson L, Grunfeld E.
Implementation science 2014 Sep 16;9(1):121
The implementation of innovations (i.e., new tools and practices) in healthcare organizations remains a significant challenge. The objective of this study was to examine the key interpersonal, organizational, and system level factors that influenced the implementation and use of synoptic reporting tools in three specific areas of cancer care.MethodsUsing case study methodology, we studied three cases in Nova Scotia, Canada, wherein synoptic reporting tools were implemented within clinical departments/programs. Synoptic reporting tools capture and present information about a medical or surgical procedure in a structured, checklist-like format and typically report only items critical for understanding the disease and subsequent impacts on patient care. Data were collected through semi-structured interviews with key informants, document analysis, nonparticipant observation, and tool use/examination. Analysis involved production of case histories, in-depth analysis of each case, and a cross-case analysis. Numerous techniques were used during the research design, data collection, and data analysis stages to increase the rigour of this study.ResultsThe analysis revealed five common factors that were particularly influential to implementation and use of synoptic reporting tools across the three cases: stakeholder involvement, managing the change process (e.g., building demand, communication, training and support), champions and respected colleagues, administrative and managerial support, and innovation attributes (e.g., complexity, compatibility with interests and values). The direction of influence (facilitating or impeding) of each of these factors differed across and within cases.ConclusionsThe findings demonstrate the importance of a multi-level contextual analysis to gaining both breadth and depth to our understanding of innovation implementation and use in health care. They also provide new insights into several important issues under-reported in the literature on moving innovations into healthcare practice, including the role of middle managers in implementation efforts and the importance of attending to the interpersonal aspects of implementation.
Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people.
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Nystrom ME, Strehlenert H, Hansson J, Hasson H.
BMC health services research 2014 Sep 18;14:401-6963-14-401
Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. METHODS: A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. RESULTS: This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. CONCLUSIONS: There is no blue-print on how to approach the challenging task of leading large scale change programs in complex contexts, but our conclusion is that more attention has to be given to the multidimensional strategies that program management need to consider. This multidimensionality comprises different strategies depending on types of actors, system levels, contextual factors, program progress over time, program content, types of learning and change processes, and the conditions for sustainability.
Antipsychotic medication use in nursing homes: a proposed measure of quality.
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Lucas JA, Chakravarty S, Bowblis JR, Gerhard T, Kalay E, Paek EK, et al.
International journal of geriatric psychiatry 2014 Oct;29(10):1049-1061
The potential misuse of antipsychotic medications (APMs) is an ongoing quality concern in nursing homes (NHs), especially given recent black box warnings and other evidence regarding the risk of APMs when used in NH populations. One mechanism regulators could use is public reporting of APM use by NHs; however, there is currently no agreed-upon measure of guideline-inconsistent APM use. In this paper, we describe a proposed measure of quality of APM use that is based on Centers for Medicare and Medicaid Services (CMS) Interpretive Guidelines, Food and Drug Administration (FDA) indications for APMs, and severity of behavioral symptoms. METHODS: The proposed measure identifies NH residents who receive an APM but do not have an approved indication for APM use. We demonstrate the feasibility of this measure using data from Medicaid-eligible long-stay residents aged 65 years and older in seven states. Using multivariable logistic regressions, we compare it to the current CMS Nursing Home Compare quality measure. RESULTS: We find that nearly 52% of residents receiving an APM lack indications approved by CMS/FDA guidelines compared with 85% for the current CMS quality measure. APM guideline-inconsistent use rates vary significantly across resident and facility characteristics, and states. Only our measure correlates with another quality indicator in that facilities with higher deficiencies have significantly higher odds of APM use. Predictors of inappropriate use are found to be consistent with other measures of NH quality, supporting the validity of our proposed measure. CONCLUSION: The proposed measure provides an important foundation to improve APM prescribing practices without penalizing NHs when there are limited alternative treatments available. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.
Effective health care for older people resident in care homes: the optimal study protocol for realist review.
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Goodman C, Gordon AL, Martin F, Davies SL, Iliffe S, Bowman C, et al.
Systematic reviews 2014 May 24;3:49-4053-3-49
Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. METHODS/DESIGN: A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. DISCUSSION: This realist review will explore why and for whom different approaches to providing health care to residents in care homes improves access to health care in the five areas of interest. It will inform commissioning decisions and be the basis for further research. This systematic review protocol is registered on the PROSPERO database reference number: CRD42014009112.
Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives.
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Lim CJ, Kong DC, Stuart RL.
Clinical interventions in aging 2014 Jan 13;9:165-177
Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS) programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions.
Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare study.
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Beerens HC, Sutcliffe C, Renom-Guiteras A, Soto ME, Suhonen R, Zabalegui A, et al.
Journal of the American Medical Directors Association 2014 Jan;15(1):54-61
To explore how quality of life (QoL) and quality of care (QoC) for people with dementia (PwD) vary across 8 European countries; to explore how QoL and QoC for PwD vary across living arrangements; and to assess the association between QoL and QoC. DESIGN: Cross-sectional survey. SETTING: Institutional long term care and home care in 8 European countries (England, Estonia, Finland, France, Germany, the Netherlands, Spain, and Sweden). PARTICIPANTS: PwD receiving formal home care but at risk for admission to an institutional setting, and PwD who were recently admitted. MEASUREMENTS: QoL was assessed by the PwD and by their best informed proxies using the Quality of Life-Alzheimer’s Disease scale (QoL-AD) (range 13-52). QoC was measured using quality of care indicators (eg, the presence of depressive symptoms, the presence of pressure ulcers). RESULTS: A total of 1123 PwD living at home (mean age 82.2, 63%women) and 791 PwD living in institutional care (mean age 84.1, 74% women) participated. QoL of PwD was most often rated highest in Sweden and England and lowest in Estonia and Spain. No differences in QoL were detected among the settings. For the QoC indicators, no consistent patterns were visible in such a way that certain countries or settings scored “higher” or “lower.” The presence of depressive symptoms was most consistently associated with lower QoL (P ≤ .001). CONCLUSION: There is great variation in QoL and QoC scores among European countries and settings. To gain insight into the underlying causes of these differences, more knowledge is needed about the effect of different national health care systems and dementia strategies on QoL and QoC indicators. Depressive symptoms were associated with QoL, and executing longitudinal studies investigating which factors are associated with change in QoL is highly recommended. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Research Practice & Methodology
The value of including observational studies in systematic reviews was unclear: a descriptive study.
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Seida J, Dryden DM, Hartling L.
Journal of clinical epidemiology 2014 Sep 20
OBJECTIVES: To evaluate (1) how often observational studies are included in comparative effectiveness reviews (CERs); (2) the rationale for including observational studies; (3) how data from observational studies are appraised, analyzed, and graded; and (4) the impact of observational studies on strength of evidence (SOE) and conclusions. STUDY DESIGN AND SETTING: Descriptive study of 23 CERs published through the Effective Health Care Program of the U.S. Agency for Healthcare Research and Quality. RESULTS: Authors searched for observational studies in 20 CERs, of which 18 included a median of 11 (interquartile range, 2-31) studies. Sixteen CERs incorporated the observational studies in their SOE assessments. Seventy-eight comparisons from 12 CERs included evidence from both trials and observational studies; observational studies had an impact on SOE and conclusions for 19 (24%) comparisons. There was diversity across the CERs regarding decisions to include observational studies; study designs considered; and approaches used to appraise, synthesize, and grade SOE. CONCLUSION: Reporting and methods guidance are needed to ensure clarity and consistency in how observational studies are incorporated in CERs. It was not always clear that observational studies added value in light of the additional resources needed to search for, select, appraise, and analyze such studies. Copyright © 2014 Elsevier Inc. All rights reserved.
Network meta-analyses could be improved by searching more sources and by involving a librarian.
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Li L, Tian J, Tian H, Moher D, Liang F, Jiang T, et al.
Journal of clinical epidemiology 2014 Sep;67(9):1001-1007
Network meta-analyses (NMAs) aim to rank the benefits (or harms) of interventions, based on all available randomized controlled trials. Thus, the identification of relevant data is critical. We assessed the conduct of the literature searches in NMAs. STUDY DESIGN: Published NMAs were retrieved by searching electronic bibliographic databases and other sources. Two independent reviewers selected studies and five trained reviewers abstracted data regarding literature searches, in duplicate. Search method details were examined using descriptive statistics. RESULTS: Two hundred forty-nine NMAs were included. Eight used previous systematic reviews to identify primary studies without further searching, and five did not report any literature searches. In the 236 studies that used electronic databases to identify primary studies, the median number of databases was 3 (interquartile range: 3-5). MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were the most commonly used databases. The most common supplemental search methods included reference lists of included studies (48%), reference lists of previous systematic reviews (40%), and clinical trial registries (32%). None of these supplemental methods was conducted in more than 50% of the NMAs. CONCLUSION: Literature searches in NMAs could be improved by searching more sources, and by involving a librarian or information specialist. Copyright © 2014 Elsevier Inc. All rights reserved.
Methods for constructing and assessing propensity scores.
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Garrido MM, Kelley AS, Paris J, Roza K, Meier DE, Morrison RS, et al.
Health services research 2014 Oct;49(5):1701-1720
To model the steps involved in preparing for and carrying out propensity score analyses by providing step-by-step guidance and Stata code applied to an empirical dataset. STUDY DESIGN: Guidance, Stata code, and empirical examples are given to illustrate (1) the process of choosing variables to include in the propensity score; (2) balance of propensity score across treatment and comparison groups; (3) balance of covariates across treatment and comparison groups within blocks of the propensity score; (4) choice of matching and weighting strategies; (5) balance of covariates after matching or weighting the sample; and (6) interpretation of treatment effect estimates. EMPIRICAL APPLICATION: We use data from the Palliative Care for Cancer Patients (PC4C) study, a multisite observational study of the effect of inpatient palliative care on patient health outcomes and health services use, to illustrate the development and use of a propensity score. CONCLUSIONS: Propensity scores are one useful tool for accounting for observed differences between treated and comparison groups. Careful testing of propensity scores is required before using them to estimate treatment effects. © Health Research and Educational Trust.
Use of Antipsychotic Drugs Among Residents With Dementia in European Long-Term Care Facilities: Results From the SHELTER Study
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Foebel AD, Liperoti R, Onder G, Finne-Soveri H, Henrard JC, Lukas A, et al.
Journal of the American Medical Directors Association 2014/09
Behavioral and psychological symptoms of dementia (BPSD) are common reasons for use of antipsychotic drugs among older individuals with dementia. These drugs are not approved for such use and both the Food and Drug Administration and European Medicines Agency have issued warnings to limit such use. Objectives This study aimed to describe patterns of antipsychotic drug use in a sample of nursing home residents with dementia in 7 European countries and Israel. Design This cross-sectional, retrospective cohort study used data from the SHELTER study that collected comprehensive resident data using the interRAI Long-Term Care Facility instrument. Methods Fifty-seven long-term care facilities participated from 8 countries, and the sample included 4156 long-term care residents from these settings. Individuals with dementia, both Alzheimer and non-Alzheimer types, were identified. Potential correlates of any antipsychotic and atypical versus conventional antipsychotic drug use among residents with dementia were identified using generalized estimation equation modeling. Results A total of 2091 individuals with dementia were identified. Antipsychotic drug use among these individuals varied by country, with overall prevalence of use being 32.8% (n = 662). Among antipsychotic users, 7 in 10 were receiving atypical agents. Generalized estimation equation analysis revealed that the strongest correlate of any antipsychotic drug use was severe behavioral symptoms, which increased the likelihood by 2.84. Correlates of atypical versus conventional antipsychotic drug use included psychiatric services, more than 10 medications, moderate behavioral symptoms, and female gender. Conclusion Despite recommendations to avoid the use of antipsychotic drugs in patients with dementia, a large proportion of residents in European long-term care facilities continue to receive such agents. Future work should not only establish the appropriateness of such use through outcomes studies, but explore withdrawal strategies as well as alternative treatment modalities.
Managing heart failure in the long-term care setting: nurses’ experiences in Ontario, Canada.
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Strachan PH, Kaasalainen S, Horton A, Jarman H, D’Elia T, Van Der Horst ML, et al.
Nursing research 2014 Sep-Oct;63(5):357-365
Implementation of heart failure guidelines in long-term care (LTC) settings is challenging. Understanding the conditions of nursing practice can improve management, reduce suffering, and prevent hospital admission of LTC residents living with heart failure. OBJECTIVE: The aim of the study was to understand the experiences of LTC nurses managing care for residents with heart failure. METHODS: This was a descriptive qualitative study nested in Phase 2 of a three-phase mixed methods project designed to investigate barriers and solutions to implementing the Canadian Cardiovascular Society heart failure guidelines into LTC homes. Five focus groups totaling 33 nurses working in LTC settings in Ontario, Canada, were audiorecorded, then transcribed verbatim, and entered into NVivo9. A complex adaptive systems framework informed this analysis. Thematic content analysis was conducted by the research team. Triangulation, rigorous discussion, and a search for negative cases were conducted. Data were collected between May and July 2010. RESULTS: Nurses characterized their experiences managing heart failure in relation to many influences on their capacity for decision-making in LTC settings: (a) a reactive versus proactive approach to chronic illness; (b) ability to interpret heart failure signs, symptoms, and acuity; (c) compromised information flow; (d) access to resources; and (e) moral distress. DISCUSSION: Heart failure guideline implementation reflects multiple dynamic influences. Leadership that addresses these factors is required to optimize the conditions of heart failure care and related nursing practice.
Are There Racial-Ethnic Disparities in Time to Pressure Ulcer Development and Pressure Ulcer Treatment in Older Adults After Nursing Home Admission?
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Bliss DZ, Gurvich O, Savik K, Eberly LE, Harms S, Mueller C, et al.
Journal of aging and health 2014 Sep 25
The objective of this study was to assess whether there are racial and ethnic disparities in the time to development of a pressure ulcer and number of pressure ulcer treatments in individuals aged 65 and older after nursing home admission. METHOD: Multi-level predictors of time to a pressure ulcer from three national surveys were analyzed using Cox proportional hazards regression for White Non-Hispanic residents. Using the Peters-Belson method to assess for disparities, estimates from the regression models were applied to American Indians/Alaskan Natives, Asians/Pacific Islanders, Blacks, and Hispanics separately resulting in estimates of expected outcomes as if they were White Non-Hispanic, and were then compared with their observed outcomes. RESULTS: More Blacks developed pressure ulcers sooner than expected. No disparities in time to a pressure ulcer disadvantaging other racial/ethnic groups were found. There were no disparities in pressure ulcer treatment for any group. DISCUSSION: Reducing disparities in pressure ulcer development offers a strategy to improve the quality of nursing home care. © The Author(s) 2014.
The use of potentially inappropriate medications and changes in quality of life among older nursing home residents.
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Al Aqqad SM, Chen LL, Shafie AA, Hassali MA, Tangiisuran B.
Clinical interventions in aging 2014 Jan 22;9:201-207
Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL) have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs) and the changes observed in the HRQoL among older nursing home residents. METHODS: A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old) taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person’s potentially inappropriate Prescriptions (STOPP) criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D) and EuroQol-visual analog scale (EQ-VAS) at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. RESULTS: The median age of the 211 participants was 77 years (interquartile range 72-82 years) and the median number of prescription medicines was four (interquartile range three to six). The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months also showed no statistically significant differences. CONCLUSION: PIMs were found to be relatively common among older nursing home residents. However, no significant changes were observed in HRQoL among these residents. Further studies with a bigger sample size and longer follow up period are required to establish this association.
Testing the psychometric properties of the Cognitions Checklist, a measure to differentiate anxiety and depression among older adults.
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Ayers CR, Riskind JH.
Geriatric nursing (New York, N.Y.) 2014 Jun 5
Considerable debate has been waged in the field about whether anxiety and depressive cognitions can be discriminated, and whether they can discriminate anxiety and depression symptoms. The current study examined a standard measure of cognitions, the Cognitions Checklist (CCL) that has yielded mixed results when tested in older age samples. A community sample of older adults (N = 169; mean age = 75.70; SD = 8.55) completed a series of self-report questionnaires, including the CCL as well as measures of anxiety and depression symptoms. The CCL, which yielded a three-factor structure rather than the typical two-factor structure, did not cognitively discriminate anxiety from depression. The results have implications for understanding cognitive factors that differentiate between anxiety and depression symptoms in older adults and suggest the importance of assessing cognitions that are tailored to the concerns of this population. Copyright © 2014 Mosby, Inc. All rights reserved.
To systematically review the efficacy and safety of negative pressure wound therapy (NPWT) for treatment of chronic wounds in the home setting. Data Sources: On June 2014, we searched MEDLINE®, Embase®, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL®). Review Methods: Two independent reviewers screened search results. We included studies examining the use of NPWT in patients with chronic wounds, including venous leg ulcers, arterial leg ulcers, diabetic foot ulcers, pressure ulcers, and mixed etiology chronic wounds. We searched for comparative trials that followed subjects in the home setting. We extracted data into standardized forms and summarized results qualitatively. Results: We retrieved 5,912 citations, and found seven studies which met our criteria for inclusion. Six of the studies compared NPWT devices to other wound care methods. One study compared two different NPWT devices. Data were limited by variability in the types of comparator groups, variable quality in study design, and limited reporting of outcomes. Conclusions: We were unable to draw conclusions about the efficacy or safety of NPWT for the treatment of chronic wounds in the home setting due to insufficient evidence. Though NPWT has been used across the wound care spectrum, significant research gaps remain. Standardization of wound care research protocols, such as providing consistency in comparator groups, robust randomized study designs, larger trials, and common definitions of outcomes, would be helpful in providing evidence to inform decisions about the use of NPWT.
Husband, Partner, Dad, Son, Carer? A survey of the experiences and needs of male carers (UK)
Carers Trust & Men’s Health Forum
The Carers Trust and Men’s Health Forum recently carried out a survey of over 600 male caregivers to examine their experiences as a caregiver, the impact it has on their lives and to determine how social services can better support them. The findings of the survey can be found in the report, Husband, Partner, Dad, Son, Carer?. Some of the highlights from the report:
-Over half the male carers (53%) felt the needs of male caregivers were different to the needs of female caregivers;
-Taking on domestic tasks previously carried out by a female family member can be difficult for men;
-47.9% felt being a carer had a negative impact on their mental health;
-7 out of 10 carers said they miss out on spending time socially with other friends and family members; and,
-In terms of social support, male carers want to be able to access: Breaks or time away from caring; financial and benefits advice; discreet and interpersonal support for managing personal or unfamiliar tasks.
Using data from the 2012 General Social Survey (GSS) on Caregiving and Care Receiving, this report presents the number of young caregivers in Canada, the relationship of the caregiver to care recipient, the intensity of caregiving, and the types of care provided. The report also highlights the impact of caregiving duties on young caregivers, examining the possible consequences on education, paid work and mental and physical health.
The intent of this study – Long Term Care in Ontario: Fostering Systemic Neglect – was to speak directly to Personal Support Workers (PSWs) and Registered Practical Nurses (RPNs) working in long-term care (LTC) in Ontario about:
-what kind of care they are currently able to provide residents;
-any barriers presently impeding delivery and quality of care;
-what better care would look like, and what resources would be necessary in order to ensure its delivery.
The data in this report comes from the knowledge, experiences, observations and feedback shared by PSWs and RPNs during focus-group discussion.
Improving care of residents with depression in long term care: A Multiphase study
Tuesday 7 October 12:oo-13:00 ECHA 5-001
Dr. Elizabeth Dogherty will be presenting her research on depression in long term care.
Can Leadership Be Taught?
Thursday 9 October 16:30-17:30 150 Telus Centre
A free public lecture by Kim Campbell.
KT Canada Seminar: Have I got a book for you!
Presenter: Ian Graham
Thursday 9 October 10:00-11:00 MT
UofA: session will be presented in ECHA 5-099
-to understand the knowledge to action cycle,
-to be able to determine what is and is not KT in healthcare,
-to have an appreciation of the contents of Knowledge Translation in Health Care (2nd edition)
Health Quality Transformation 2014
20 November Toronto
Join HQO on November 20 for Health Quality Transformation 2014, our third annual conference for health system users, providers, partners and leaders. Conveniently located at the Metro Toronto Convention Centre, Health Quality Transformation 2014 will provide all attendees with the opportunity to see compelling exhibits, network, and attend informative breakout sessions.
IHE & AIHS: Introducing Evidence Based Innovation-Lessons from a Series of UK Studies
Tuesday 21 October 07:30-09:00 Edmonton $30 (includes breakfast)
John Gabbay is emeritus professor of public health. Having qualified in medicine, he lectured in the history and philosophy of science at Cambridge University in the 1970s, researched NHS management and helped introduce clinical audit to the NHS while working at universities of Oxford and London in the 1980s, founded and directed Southampton University’s Wessex Institute for Health R&D in the 1990s and directed the National Coordinating Centre for HTA until he retired in 2004. Since then he has intensively researched the way that healthcare practitioners use knowledge to improve services.
Andrée le May graduated in nursing from the University of London. Following her appointment in 1986 as Specialist Nurse for R&D at West Middlesex University Hospital she became interested in how nurses use knowledge in practice. She has since continued to research and publish on evidence-based practice, the dissemination and implementation of research and the use of communities of practice for improving learning and care. Recently retired from her chair at Southampton University, she still supervises doctoral students, undertakes health-service development, writes textbooks and chairs the NIHR Journals Library Editorial Group.
Canadian Alternate level of Care Conference
8-10 December Toronto ON
The Canadian Alternate level of Care Conference is all about identifying and exploring tools aimed at improving patient flow and access to care across all silos of the healthcare system. The conference format will include case based presentations, 1st hand experiences, workshops & more to encourage sharing of best practices to improve the continuum of care. Our goal is to create an environment to foster collaborative dialogue, plan of action development & strategic partnering from stakeholders representing the spectrum of care on shared priorities to improve the delivery of the appropriate level of care in the proper setting to all patients.
Canada’s Forum on Patient Safety and Quality Improvement
29-30 October Edmonton
-Review the impact of patient safety in Canada in the last 10 years and the implications of both successes and challenges for future developments.
-Identify the enablers of and barriers to improved safety and quality.
-Identify areas where innovative risk taking is essential to improvement and develop strategies for developing a culture where innovative risk taking is encouraged and supported.
-Identify cultural factors that promote or inhibit improved safety and quality, and proven strategies for changing the culture at all levels of the organization.
-Identify strategies to accelerate the involvement of patients in safety improvement initiatives.
-Reinforce the importance of collaboration and partnerships when dealing with patient safety.
-Identify the top priority actions essential to finding practical solutions to significant issues in patient safety.
Public policy and wicked problems: How can we approach them?
Monday 24 November Québec City
This 3-hour workshop will present the characteristics of wicked problems and, using practical exercises, the ways to address them. It is particularly aimed at professionals who work in the public health field and those who are called on to intervene and make decisions in the policy realm. The workshop will help participants to better understand the different types of problems encountered in healthy public policy and to sharpen their ideas about possible modes of resolution for wicked problems.
The Canadian Longitudinal Study on Aging (CLSA) Webinar Series presents: Older Canadians, food intake and nutritional status: How the CLSA will advance knowledge
Speaker: Prof. Heather Keller
4 December 12:00-13:00 MT
Prof. Keller is a scientist with the Agri-Food For Healthy Aging research group and is currently conducting research focused on improving the nutritional status and food intake of older adults.
CFHI: Caring for the 5%: Healthcare for Those Who Need it Most – Webinar Series
Begins 14 October 10:00-11:00 MT
Commencing fall 2014, CFHI is pleased to present this new series, which focuses on caring for those who need it most. The ‘5%’ need no introduction – we commonly speak of high users, frequent fliers, high-risk, high-cost patients, and complex patients. But do we really know them?
October 14, 2014 – Practicing Population-Based Healthcare in Quebec: Better Clarity for Better Quality and Costs of Care
December 9, 2014 – Healthcare “Hot Spotting”: Identifying and Caring for High–Needs Patients in Alberta and British Columbia
January 20, 2015 –Managing Multimorbidities in Nova Scotia: An Integrated and Collaborative Care Approach
Sometime in 2015-Better Health and Lower Costs for Patients with Complex Needs: Results from organizations across Canada on applying the IHI Triple Aim
CFHI: Measurement for Quality Improvement Webinar series
Begins 22 October 10:00-11:00
How do you know a change is an improvement? That’s the critical question for which data and timely measurement is always the answer. Getting that dashboard or framework of measures assembled and working for you to inform and enhance improvement efforts is critical. In this series, CFHI gets back to basics, starting with the importance and challenges of using and collecting data as well as creating run charts and control charts to track progress on improvement in real-time.
October 22, 2014 – Making Data Matter: Measurement Basics for Quality Improvement
November 12, 2014 – Improvement Cost-Benefit Analysis
January 28, 2015 – Analyzing Data Over Time for Quality Improvement
CDRAKE and the Alzheimer Society of Canada: Prevention of Alzheimer’s Dementia: The Ultimate Cure. Can We Get There From Here?
Thursday 23 October 10:00-11:00 MT
After decades of intensive research, we still don’t know the root causes of Alzheimer’s disease. If we did, it might be possible to come up with cures that attack these causes directly. As it is, however, we need to look for other ways around the problem. These fall into two broad categories. The first is to eat and act in ways that promote health in general, and heart health in particular. The second is to track the development of the brain disease, so we can “see” the effects of treatments that could slow it down.
Translating Research into Policy and Practice – The Next Level
March 26-27 Ottawa ON $765
Knowledge translation and transfer are complex and abstract. It can be difficult to know if you are getting the outcome you want and even more difficult to quantify results and evaluate the success of your strategies. Building on Translating Research into Policy and Practice – An Introduction, this workshop presents advanced techniques to help you implement, evaluate, and enhance knowledge transfer and exchange strategies.
IIQM NVIVO Workshop
15-16 November 09:00-16:00 ECHA L1-250, UofA
Due to popular demand IIQM is proud to offer a weekend of NVivo 10 qualitative software training with a highly skilled and professional instructor. Participants can register for one workshop day or two workshop days depending on their needs. The workshop on November 15 is directed towards beginners and those who do one have a lot of experience with NVivo. The workshop on November 16 is for those who have some experience with NVivo and are encouraged to bring their own data to work on. You will bring your data, or a sample there of, to class on a USB stick and be able to move beyond the basics of data analysis.
Pilot project cut anti-psychotic drug use in half.
Patients waiting in hospital because there is no suitable level of care in the community has reached new heights at 27 per cent, with ramifications throughout the hospital, and it is costing taxpayers an exorbitant sum, says the Alberta Medical Association.
September marked World Alzheimer’s Month, and it’s time to ask the most critical question: Why is Stephen Harper’s government failing us on dementia?
Alzheimer’s will remain a serious health concern without more federal investment and real leadership. Like the Alzheimer Society, the NDP has been calling for years for a national strategy on dementia.
A comprehensive review of health care in Alberta’s rural communities will ensure care is coordinated in an efficient and predictable manner.
Tasked with bringing down the prescriptions by 66 per cent, the Dementia and Prescribing Antipsychotic Project in London found that GPs and pharmacists were successful when they worked together.
How do those involved in home care, from the government to providers, track the quality of what they’re offering? And how should client satisfaction get taken into account?
Between the end of 2011 and the end of 2013, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 15.1 percent, decreasing from 23.8 percent to 20.2 percent nationwide. The National Partnership is now working with nursing homes to reduce that rate even further.
New Health Minister Stephen Mandel is promising immediate action on the issue of so-called bed blockers — patients who need continuing care but are instead forced into hospital beds because of a lack of facilities.
As Alberta’s emergency room waits grow longer because hospitals are clogged with patients waiting for a nursing home bed, the province’s health authority is abandoning a plan to cut nearly 1,000 long-term-care spaces over a four-year period.
The Canadian Consortium on Neurodegeneration in Aging (CCNA)has funded a study called “Team 20: Issues in dementia care for rural and indigenous populations” over the next five years which will spend its first two years of research working with Manitoulin First Nations health centres. Dr. Debra Morgan (University of Saskatchewan) is leading the rural research projects while Dr. Jacklin and Dr. Carrie Bourassa (First Nations University) are leading the indigenous research stream.
Biomedical research is a tough business at the best of times, but the economic downturn of 2009 took a big bite out of funding. Competition for research dollars has become more fierce, and funders have become more demanding and impatient about seeing quick results for the dollars they still invest.
Lots of information from around the world on aging is in this newsletter.
Starting Monday, Sept. 29, Global National will air a series of reports on living with dementia and how Canadians are adapting to a disease that affects so many — and at a much younger age than you may think.
Mediation between Ontario’s 3,000 registered nurses, registered practical nurses, personal support workers and allied health professionals working in 168 for-profit nursing homes has ended following the private nursing homes’ demand to gut nurse staffing for our residents.
Of the seniors waiting in hospital because there is no suitable level of care in the community, there are some patients holding out for a preferred placement. But it is an occasional situation, says Alberta Health Services.
Numbers released recently by the province’s health authority show the Conservative government is falling behind in fulfilling its promise to add 5,000 continuing-care beds over five years to house a growing population of ailing seniors and the disabled.
Nova Scotians most affected by dementia will help shape the province’s first strategy that targets the illness. Over the next four weeks, consultation sessions will be held with Nova Scotians living with some form of dementia, their care partners, and health-care providers.
Heartbreaking failings to care for the elderly must be consigned to history, says the chief inspector of adult social care, as a new system of regulation is introduced
Canada is the fourth-best country in which to grow old, while Afghanistan is the worst, according to a new global index, which warns nations that they must work quickly to address the implications of a rapidly aging global population.
So what techniques build buzz – and careers? Blogging? Tweeting? Talking with reporters?
Citing the “impending boom” of a dementia health-care crisis, Health Minister Rona Ambrose and her provincial and territorial counterparts agreed on October 1st to work together to develop a national strategy to fight it. Canada is the only G7 nation without a national dementia strategy.
Unpaid caregivers typically want and prefer to provide the care to their loved ones, rather than having formal care providers come into the home. But the role can be demanding.
This website is an international educational resource that aims to help geriatricians, primary care physicians and other health care professionals involved in the care of older persons implement frailty solutions into clinical practice. Frailty is a clinical state that develops as a consequence of age-related decline in many physiological systems and increases an individual’s vulnerability for developing further dependency and/or mortality when exposed to a stressor. Along with the portal, this Frailty Newsletter will bring information on ways to identify pre-frail and frail individuals, to prevent disability, to implement frailty into clinical practice. It is also expected to treat subjects about the latest developments, updated research findings, clinical trials, new treatment approaches as well as current recommendations for the care of older persons.
Elders have knowledge and experiences to pass to younger generations to guide them through life, but what happens when Elders need support? With this in mind, the First Nations Health Authority and the B.C. Ministry of Health developed the BC Elders Guide, based on the popular BC Seniors’ Guide, to help Elders find resources as they age in the community, while still acknowledging their strength and wisdom.
The dementia environment in a care home (streaming video)
Social Care Institute for Excellence
This film shows how simple changes to create a more dementia friendly care home environment can have a positive impact on a person living with dementia’s emotional well being and independence.
International Journal of Nursing Practice Seeks Editor
DEADLINE 1 January
The current Editor-in-Chief, Professor Alan Pearson, has retired and stepped down after founding and leading the journal for 20 years. They are therefore seeking applications for this prestigious position with one of the world-leading international nursing journals published by Wiley-Blackwell, part of John Wiley & Sons.
Call for Authors: The SAGE Encyclopedia of Aging
This is also open to graduate students
Academic editorial contributors are being sought for The SAGE Encyclopedia of Aging, a new multi-volume reference to be published in 2016. The SAGE Encyclopedia of Aging includes approximately 1,700 articles on a wide range of topics. Each 1,000 to 5,000-word article will include the name and affiliation of the contributor in the byline of the entry. This comprehensive project will be published by SAGE Publications and the General Editor, who will be reviewing each submission to the project, is Dr. Madonna Harrington Meyer, Syracuse University. Please contact Kara Ward, Author Manager at Golson Media at firstname.lastname@example.org for further information.
Knowledge Mobilization Coordinator
Institute for Community Engaged Scholarship, College of Social and Applied Human Sciences, University of Guelph, Guelph ON
Reporting to the Director, ICES, the Knowledge Mobilization Coordinator (KMbC) will develop and implement knowledge mobilization (KMb) and knowledge transfer & translation (KTT) strategies. The KMbC is housed within the Institute for Community Engaged Scholarship, and supports a broad definition and view of research, scholarship and mobilization to include community based research, general engagement and more traditional knowledge translation and research communications to meet the requirements of a wide range of scholars and audiences. The KMbC will bring considerable interpersonal and relationship building skills to facilitate success in current directions and new initiatives.
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