Congratulations to Dr. Janet Squires
Janet has been awarded a CIHR operating grant. Her project is entitled Understanding Context in Knowledge Translation: Development and Validation of a Conceptual Framework. The purpose of this project is to develop, refine and validate with international experts a comprehensive framework of context that identifies the domains of context and their features that can facilitate or hinder: (1) healthcare professionals’ use of research in clinical practice and (2) KT interventions aimed to improve healthcare professionals’ use of research in clinical practice.
Way to go Janet!!!
New article by Dr. Janet Squires
Are multifaceted interventions more effective than single-component interventions in changing health-care professionals’ behaviours? An overview of systematic reviews.
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Squires JE, Sullivan K, Eccles MP, Worswick J, Grimshaw JM.
Implementation science 2014 Oct 6;9:152-014-0152-6
One of the greatest challenges in healthcare is how to best translate research evidence into clinical practice, which includes how to change health-care professionals’ behaviours. A commonly held view is that multifaceted interventions are more effective than single-component interventions. The purpose of this study was to conduct an overview of systematic reviews to evaluate the effectiveness of multifaceted interventions in comparison to single-component interventions in changing health-care professionals’ behaviour in clinical settings. METHODS: The Rx for Change database, which consists of quality-appraised systematic reviews of interventions to change health-care professional behaviour, was used to identify systematic reviews for the overview. Dual, independent screening and data extraction was conducted. Included reviews used three different approaches (of varying methodological robustness) to evaluate the effectiveness of multifaceted interventions: (1) effect size/dose-response statistical analyses, (2) direct (non-statistical) comparisons of multifaceted to single interventions and (3) indirect comparisons of multifaceted to single interventions. RESULTS: Twenty-five reviews were included in the overview. Three reviews provided effect size/dose-response statistical analyses of the effectiveness of multifaceted interventions; no statistical evidence of a relationship between the number of intervention components and the effect size was found. Eight reviews reported direct (non-statistical) comparisons of multifaceted to single-component interventions; four of these reviews found multifaceted interventions to be generally effective compared to single interventions, while the remaining four reviews found that multifaceted interventions had either mixed effects or were generally ineffective compared to single interventions. Twenty-three reviews indirectly compared the effectiveness of multifaceted to single interventions; nine of which also reported either a statistical (dose-response) analysis (N = 2) or a non-statistical direct comparison (N = 7). The majority (N = 15) of reviews reporting indirect comparisons of multifaceted to single interventions showed similar effectiveness for multifaceted and single interventions when compared to controls. Of the remaining eight reviews, six found single interventions to be generally effective while multifaceted had mixed effectiveness. CONCLUSION: This overview of systematic reviews offers no compelling evidence that multifaceted interventions are more effective than single-component interventions.
New article by Dr. Janet Squires & Dr. Lars Wallin:
Managerial leadership for research use in nursing and allied health care professions: a narrative synthesis protocol
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Gifford WA, Holyoke P, Squires JE, Angus D, Brosseau L, Egan M, et al.
Systematic reviews 2014 Jun 5;3:57-4053-3-57
Nurses and allied health care professionals (physiotherapists, occupational therapists, speech and language pathologists, dietitians) form more than half of the clinical health care workforce and play a central role in health service delivery. There is a potential to improve the quality of health care if these professionals routinely use research evidence to guide their clinical practice. However, the use of research evidence remains unpredictable and inconsistent. Leadership is consistently described in implementation research as critical to enhancing research use by health care professionals. However, this important literature has not yet been synthesized and there is a lack of clarity on what constitutes effective leadership for research use, or what kinds of intervention effectively develop leadership for the purpose of enabling and enhancing research use in clinical practice. We propose to synthesize the evidence on leadership behaviours amongst front line and senior managers that are associated with research evidence by nurses and allied health care professionals, and then determine the effectiveness of interventions that promote these behaviours. Methods/Design Using an integrated knowledge translation approach that supports a partnership between researchers and knowledge users throughout the research process, we will follow principles of knowledge synthesis using a systematic method to synthesize different types of evidence involving: searching the literature, study selection, data extraction and quality assessment, and analysis. A narrative synthesis will be conducted to explore relationships within and across studies and meta-analysis will be performed if sufficient homogeneity exists across studies employing experimental randomized control trial designs. Discussion With the engagement of knowledge users in leadership and practice, we will synthesize the research from a broad range of disciplines to understand the key elements of leadership that supports and enables research use by health care practitioners, and how to develop leadership for the purpose of enhancing research use in clinical practice.
Two new articles by Dr. Whitney Berta on accountability
Home and Community Care Sector Accountability.
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Gray CS, Berta W, Deber RB, Lum J.
Healthcare policy = Politiques de sante 2014 Sep;10(SP):56-66
This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care.Copyright © 2014 Longwoods Publishing.
This paper discusses the array of approaches to accountability in Ontario long-term care (LTC) homes. A focus group involving key informants from the LTC industry, including both for-profit and not-for-profit nursing home owners/operators, was used to identify stakeholders involved in formulating and implementing LTC accountability approaches and the relevant regulations, policies and initiatives relating to accountability in the LTC sector. These documents were then systematically reviewed. We found that the dominant mechanisms have been financial incentives and oversight, regulations and information; professionalism has played a minor role. More recently, measurement for accountability in LTC has grown to encompass an array of fiscal, clinical and public accountability measurement mechanisms. The goals of improved quality and accountability are likely more achievable using these historical regulatory approaches, but the recent rapid increase in data and measurability could also enable judicious application of market-based approaches.
Copyright © 2014 Longwoods Publishing.
Grants & Awards
CIHR: SPOR Networks in Chronic Diseases
Registration Deadline: 2 December
In October 2014, the Canadian Institutes of Health Research as a partner in the Strategy for Patient-Oriented Research (SPOR) will launch the SPOR Networks in Chronic Disease funding opportunity. This funding opportunity will provide support for the development and implementation of SPOR Networks in non-communicable Chronic Diseases. The primary objective of the opportunity will be to translate existing and new knowledge generated by basic biomedical, clinical, and population health research into testing of innovations that can improve clinical science and practice and foster policy changes, leading to transformative and measureable improvements in patient health outcomes, and in efficiency and effectiveness of healthcare delivery within five years.
CIHR: Science Policy Fellowships
DEADLINE 12 December
Support will be provided through short-term policy assignments for highly qualified individuals who are engaged in health research at the PhD, post-doctoral and independent researcher levels to participate in and contribute to the policy making processes while learning first-hand about the science policy interface.
Facilitating Lewin’s change model with collaborative evaluation in promoting evidence based practices of health professionals.
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Manchester J, Gray-Miceli DL, Metcalf JA, Paolini CA, Napier AH, Coogle CL, et al.
Evaluation and program planning 2014 Dec;47:82-90
Evidence based practices (EBPs) in clinical settings interact with and adapt to host organizational characteristics. The contextual factors themselves, surrounding health professions’ practices, also adapt as practices become sustained. The authors assert the need for better planning models toward these contextual factors, the influence of which undergird a well-documented science to practice gap in literature on EBPs. The mechanism for EBP planners to anticipate contextual effects as programs Unfreeze their host settings, create Movement, and become Refrozen (Lewin, 1951) is present in Lewin’s 3-step change model. Planning for contextual change appears equally important as planning for the actual practice outcomes among providers and patients. Two case studies from a Geriatric Education Center network will illustrate the synthesis of Lewin’s three steps with collaborative evaluation principles. The use of the model may become an important tool for continuing education evaluators or organizations beginning a journey toward EBP demonstration projects in clinical settings. Copyright © 2014 Elsevier Ltd. All rights reserved.
A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care
Currie G, Burgess N,White L,Lockett A,Gladman J, Waring J
Health Services and Delivery Research 2014; 2(32)
Background: Brokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people. Objectives: Generate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs. Design: We utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups. Setting: NHS East and NHS West Midlands. Participants: One hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK. Main outcome measures: Which H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care? Results: Health-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement. Conclusions: Clinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs are central. Intervention needs to mediate interprofessional and intraprofessional hierarchy, which, combined with compliance pressures, engender a ‘broken’ chain for applying PSK for service improvement, rather than a ‘brokering’ chain. Lower-status H-MLMs need to have their legitimacy and disposition enhanced to broker knowledge for service improvement. More informal ‘social mechanisms’ are required to complement clinical governance for development of a brokering chain. More research is needed to (1) examine why some H-MLMs are more disposed and able than others to broker PSK for service improvement, and (2) understand how knowledge brokering might be enhanced so that exogenous and endogenous knowledge is better fused for service improvement.
Effectively implementing health policies, programs and interventions is a constant challenge at local, national and global levels. This draft WHO statement calls for expanding the policy use of implementation research and delivery science (IRDS) It states that IRDS can best address the barriers, inefficiencies, and inequitable allocations that impede both scale-up and sustainability.
This report examines the literature on interorganizational networks that has evolved over the past decade, which has been written from the perspective of a wide range of academic disciplines, such as sociology, business management, public administration, and political science. The authors seek to distill key concepts and trends from the literature in order to help busy government readers make sense of what is out there, and where they might most fruitfully spend their time when they find a need for a “deeper dive.” This includes an exploration of the types and structures of networks, their governance and leadership, their evolution over time, and how they are evaluated for effectiveness.
Health Care Administration and Organization
A consensus is emerging in England around the concept of ‘integrated care’ as the best hope for a sustainable NHS. For leaders in the health care system, this represents an immense challenge. Leading across complex interdependent systems of care is a new and different role, undertaken alongside the already difficult task of leading successful institutions. This paper seeks to identify the skills, knowledge and behaviours required of new system leaders and to learn from systems attempting to combine strong organisational leadership with collaborative system-level leadership approaches. The paper draws on three years’ development work with leaders in health care systems in north-west England, undertaken by the Advancing Quality Alliance (AQuA) and The King’s Fund which has adopted a ‘discovery’ approach to developing integrated care and the leadership capabilities supporting it.
Health Care Innovation and Quality Assurance
Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study.
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Giguere A, Labrecque M, Haynes R, Grad R, Pluye P, Legare F, et al.
Implementation science 2014 Oct 5;9(1):144
Decision boxes (Dboxes) provide clinicians with research evidence about management options for medical questions that have no single best answer. Dboxes fulfil a need for rapid clinical training tools to prepare clinicians for clinician-patient communication and shared decision-making. We studied the barriers and facilitators to using the Dbox information in clinical practice.Methods We used a mixed methods study with sequential explanatory design. We recruited family physicians, residents, and nurses from six primary health-care clinics. Participants received eight Dboxes covering various questions by email (one per week). For each Dbox, they completed a web questionnaire to rate clinical relevance and cognitive impact and to assess the determinants of their intention to use what they learned from the Dbox to explain to their patients the advantages and disadvantages of the options, based on the theory of planned behaviour (TPB). Following the 8-week delivery period, we conducted focus groups with clinicians and interviews with clinic administrators to explore contextual factors influencing the use of the Dbox information.Results One hundred clinicians completed the web surveys. In 54?% of the 496 questionnaires completed, they reported that their practice would be improved after having read the Dboxes, and in 40?%, they stated that they would use this information for their patients. Of those who would use the information for their patients, 89?% expected it would benefit their patients, especially in that it would allow the patient to make a decision more in keeping with his/her personal circumstances, values, and preferences. They intended to use the Dboxes in practice (mean 5.6???1.2, scale 1?7, with 7 being ?high?), and their intention was significantly related to social norm, perceived behavioural control, and attitude according to the TPB (P?<?0.0001). In focus groups, clinicians mentioned that co-interventions such as patient decision aids and training in shared decision-making would facilitate the use of the Dbox information. Some participants would have liked a clear ?bottom line? statement for each Dbox and access to printed Dboxes in consultation rooms.Conclusions Dboxes are valued by clinicians. Tailoring of Dboxes to their needs would facilitate their implementation in practice.
Do Internal Medicine Residents Know Enough About Skilled Nursing Facilities To Orchestrate a Good Care Transition?
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Ward KT, Eslami MS, Garcia MB, McCreath HE.
Journal of the American Medical Directors Association 2014 Oct 1
Although many older adults require skilled nursing facility (SNF) care after acute hospitalization, it is unclear whether internal medicine residents have sufficient knowledge of the care that can be provided at this site. METHODS: We developed a 10-item multiple choice pre-test that assessed knowledge of the definition of a SNF, SNF staffing requirements, and SNF services provided on-site. The test was administered to trainees on the first day of a mandatory SNF rotation that occurred during their first, second or third year of training. RESULTS: Sixty-seven internal medicine residents [41 postgraduate year (PGY)-1, 11 PGY-2, and 15 PGY-3] were assessed with the test. The mean number of questions answered correctly was 4.9, with a standard deviation of 1.6. Regardless of their level of training, residents had a poor baseline knowledge of SNF care (mean scores 4.2 for PGY-1, 5.3 for PGY-2, and 6.3 for PGY-3) (P < .0001). Performance on some questions improved with increased level of training but others did not. CONCLUSIONS: Medical residents have insufficient knowledge about the type of care that can be provided at a SNF and efforts to improve this knowledge are needed to assure proper triage of patients and safe transitions to the SNF. Copyright © 2014 AMDA
Do Gerontology Nurse Specialists Make a Difference in Hospitalization of Long-Term Care Residents? Results of a Randomized Comparison Trial.
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Boyd M, Armstrong D, Parker J, Pilcher C, Zhou L, McKenzie-Green B, et al.
Journal of the American Geriatrics Society 2014 Oct 3
Residents of long-term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program (RACIP) is a quality improvement intervention to support residential aged care staff and includes on-site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists (GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio (RR) = 0.73, 95% confidence interval (CI) = 0.61-0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) (RR = 0.67, 95% CI = 0.56-0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups (RR = 1.0, 95% CI = 0.68-1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
The role of chief executive officers in a quality improvement : a qualitative study.
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Parand A, Dopson S, Vincent C.
BMJ open 2013 Jan 3;3(1):10.1136/bmjopen-2012-001731
To identify the critical dimensions of hospital Chief Executive Officers’ (CEOs) involvement in a quality and safety and to offer practical guidance to assist CEOs to fulfil their leadership role in quality improvement (QI). DESIGN: Qualitative interview study. SETTING: 20 organisations participating in the main phase of the Safer Patients Initiative (SPI) programme across the UK. PARTICIPANTS: 17 CEOs overseeing 19 organisations participating in the main phase of the SPI programme and 36 staff (20 workstream leads, 10 coordinators and 6 managers) involved in SPI across all 20 participating organisations. MAIN OUTCOME MEASURE: Self-reported perceptions of CEOs on their contribution and involvement within the SPI programme, supplemented by staff peer-reports. RESULTS: The CEOs recognised the importance of their part in the SPI programme and gave detailed accounts of the perceived value that their involvement had brought at all stages of the process. In exploring the parts played by the CEOs, five dimensions were identified: (1) resource provision; (2) staff motivation and engagement; (3) commitment and support; (4) monitoring progress and (5) embedding programme elements. Staff reports confirmed these dimensions; however, the weighting of the dimensions differed. The findings stress the importance of particular actions of support and monitoring such as constant communication through leadership walk rounds and reviewing programme progress and its related clinical outcomes at Board meetings. CONCLUSIONS: This study addressed the call for more research-informed practical guidance on the role of senior management in QI s. The findings show that the CEOs provided key participation considered to significantly contribute towards the SPI programme. CEOs and staff identified a number of clear and consistent themes essential to organisation safety improvement. Queries raised include the tangible benefits of executive involvement in changing structures and embedding for sustainability and the practical steps to creating the ‘right’ environment for QI.
Do structural quality indicators of nutritional care influence malnutrition prevalence in Dutch, German, and Austrian nursing homes?
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van Nie NC, Meijers JM, Schols JM, Lohrmann C, Spreeuwenberg M, Halfens RJ.
Nutrition (Burbank, Los Angeles County, Calif.) 2014 Nov-Dec;30(11-12):1384-1390
The aim of this study was to explore whether structural quality indicators for nutritional care influence malnutrition prevalence in the Netherlands, Germany, and Austria. Furthermore, differences in malnutrition prevalence and structural quality indicators for nutritional care nursing homes in the three countries were examined. METHODS: This was a cross-sectional, multicenter study using a standardized questionnaire at the patient, ward, and institutional levels. Malnutrition was assessed by low body mass index, undesired weight loss, and reduced intake. Structural quality indicators of nutritional care were measured at the ward and institutional levels. RESULTS: The prevalence of malnutrition differed significantly between the three countries (Netherlands 18%, Germany 20%, and Austria 22.7%). Structural quality indicators related to nutritional care as having a guideline of prevention and treatment of malnutrition were related to malnutrition and explained malnutrition prevalence variance between the Netherlands and Germany. Differences between the Netherlands and Austria in malnutrition prevalence still existed after controlling for these quality structural indicators. CONCLUSIONS: Structural quality indicators of nutritional care are important in explaining malnutrition variance between the Netherlands and Germany. However, they did not explain the difference in malnutrition prevalence between the Netherlands and Austria. Investigating the role of process indicators may provide insight in the role of structural quality indicators of nutritional care in explaining the malnutrition prevalence differences between the Netherlands and Austria. Copyright © 2014 Elsevier Inc. All rights reserved.
Implementing Oral Care Practices and Policy Into Long-Term Care: The Brushing up on Mouth Care Project.
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McNally M, Martin-Misener R, McNeil K, Brillant M, Moorhouse P, Crowell S, et al.
Journal of the American Medical Directors Association 2014 Oct 8
Optimal mouth care is integral to the health and quality of life of dependent older adults.Yet, a persistent lack of adequate oral care in long-term care (LTC) facilities exacerbates the burden of disease experienced by residents. The reasons for this are complex and create enormous challenges for care providers, clinicians, and administrators dedicated to comprehensive high quality care. OBJECTIVE: The aim of this study was to develop, implement, and evaluate a comprehensive program for daily mouth care for LTC. DESIGN: A case study design using a participatory and qualitative approach examined how individual, organizational (workplace practices and culture), and system factors (standards and policy) influenced the development and implementation of a comprehensive program to improve the delivery of daily oral care in LTC. SETTING AND PARTICIPANTS: The research was undertaken in 3 LTC residences administered under the same health authority and included personal care providers, nurse managers, and directors of care. INTERVENTION: A comprehensive program for care providers including, education, resources, and organizational guidelines, to improve the delivery of daily mouth care to LTC residents was created, rolled out, and refined over a 12-month period. MEASUREMENTS: Data was collected through diary studies, targeted interviews, field notes, oral care activities records, site team meetings, and direct feedback from members of the care team. RESULTS: The oral care intervention resulted in a heightened awareness, support and greater efficiency amongst care team. The presence of a “champion” was a key feature for sustaining processes. Management had a clear role to play to ensure support and accountability for the intervention. CONCLUSIONS: Optimizing oral care in long-term care can be achieved through an integrated approach that includes education, provision of resources, an oral care champion, support from managers and administrators, and appropriate organizational policy. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine.
Accountability in the City of Toronto’s 10 Long-Term Care Homes.
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Wyers L, Gamble B, Deber RB.
Healthcare policy = Politiques de sante 2014 Sep;10(SP):99-109
Long-term care (LTC) residential homes provide a supportive environment for residents requiring nursing care and assistance with daily living activities. The LTC sector is highly regulated. We examine the approaches taken to ensure the delivery of quality and safe care in 10 LTC homes owned and operated by the City of Toronto, Ontario, focusing on mandatory accountability agreements with the Local Health Integration Networks (LHINs). Results are based on document review and seven interviews with LTC managers responsible for the management and operation of the 10 LTC homes. One issue identified was the challenges associated with implementing new legislative and regulatory requirements to multiple bodies with differing requirements, particularly when boundaries do not coincide (e.g., the City of Toronto’s Long-Term Care Homes and Services Division must establish 10 different accountability agreements with the five LHINs that span into the City of Toronto’s geographic area). Copyright © 2014 Longwoods Publishing.
Should I report? A qualitative study of barriers to incident reporting among nurses working in nursing homes.
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Winsvold Prang I, Jelsness-Jorgensen LP.
Geriatric nursing (New York, N.Y.) 2014 Oct 8
Adverse events, errors and acts of inadequate care have been shown to occur quite frequently in hospitals, and there is growing evidence that this poor care may also occur in nursing homes. Based on hospital studies, we know that incidents are only reported to a limited extent and that there may be a high number of unrecorded cases. Moreover, little is known about the barriers to incident reporting in nursing homes compared to hospitals. Consequently, the aim of this study was to explore the barriers to incident reporting in nursing homes. Thematic analysis of 13 semi-structured interviews with nurses revealed that unclear outcomes, lack of support and culture, fear of vilification and conflicts, unclear routines, technological knowledge and confidence, time and degree of severity were the main drivers of not reporting incidents. These findings may be important in planning quality and safety improvement interventions in nursing homes. Copyright © 2014 Elsevier Inc. All rights reserved.
Increasing the scale and adoption of population health interventions: experiences and perspectives of policy makers, practitioners, and researchers.
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Milat AJ, King L, Newson R, Wolfenden L, Rissel C, Bauman A, et al.
Health research policy and systems / BioMed Central 2014 Apr 15;12:18-4505-12-18
Decisions to scale up population health interventions from small projects to wider state or national implementation is fundamental to maximising population-wide health improvements. The objectives of this study were to examine: i) how decisions to scale up interventions are currently made in practice; ii) the role that evidence plays in informing decisions to scale up interventions; and iii) the role policy makers, practitioners, and researchers play in this process. METHODS: Interviews with an expert panel of senior Australian and international public health policy-makers (n = 7), practitioners (n = 7), and researchers (n = 7) were conducted in May 2013 with a participation rate of 84%. RESULTS: Scaling up decisions were generally made through iterative processes and led by policy makers and/or practitioners, but ultimately approved by political leaders and/or senior executives of funding agencies. Research evidence formed a component of the overall set of information used in decision-making, but its contribution was limited by the paucity of relevant intervention effectiveness research, and data on costs and cost effectiveness. Policy makers, practitioners/service managers, and researchers had different, but complementary roles to play in the process of scaling up interventions. CONCLUSIONS: This analysis articulates the processes of how decisions to scale up interventions are made, the roles of evidence, and contribution of different professional groups. More intervention research that includes data on the effectiveness, reach, and costs of operating at scale and key service delivery issues (including acceptability and fit of interventions and delivery models) should be sought as this has the potential to substantially advance the relevance and ultimately usability of research evidence for scaling up population health action.
It is a paradox. Although physicians do not control patient behavior, physician effectiveness is increasingly determined by patient behavior. There is a trend toward physician ratings being based on specific metrics related to the management of chronic illness. Such markers include glycosylated hemoglobin levels, blood pressure, body mass index, and smoking rates, along with other factors known to affect risk of morbidity and mortality. However, the physician contribution to changing the actual outcomes is limited.
Designing quality improvement initiatives: the action effect method, a structured approach to identifying and articulating programme theory
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Reed JE, McNicholas C, Woodcock T, Issen L, Bell D.
BMJ quality & safety 2014 Oct 15
The identification and articulation of programme theory can support effective design, execution and evaluation of quality improvement (QI) initiatives. Programme theory includes an agreed aim, potential interventions to achieve this aim, anticipated cause/effect relationships between the interventions and the aim and measures to monitor improvement. This paper outlines the approach used in a research and improvement programme to support QI initiatives in identifying and articulating programme theory: the action effect method. Background to method development Building on a previously used QI method, the driver diagram, the action effect method was developed using co-design and iteration over four annual rounds of improvement initiatives. This resulted in a specification of the elements required to fully articulate the programme theory of a QI initiative. The action effect method The action effect method is a systematic and structured process to identify and articulate a QI initiative’s programme theory. The method connects potential interventions and implementation activities with an overall improvement aim through a diagrammatic representation of hypothesised and evidenced cause/effect relationships. Measure concepts, in terms of service delivery and patient and system outcomes, are identified to support evaluation. Discussion and conclusions The action effect method provides a framework to guide the execution and evaluation of a QI initiative, a focal point for other QI methods and a communication tool to engage stakeholders. A clear definition of what constitutes a well-articulated programme theory is provided to guide the use of the method and assessment of the fidelity of its application.
During 2013 and 2014, we carried out a thematic review of the care people living with dementia receive as they moved between care homes and acute hospitals. Overall we found more good care than poor care in the care homes and hospitals our inspectors visited. But the quality of care for people living with dementia varies greatly. It is likely that someone living with dementia will experience poor care at some point while living in a care home or being treated in hospital. We inspected care in 129 care homes and 20 hospitals across England, looking at four areas:
-how people’s care needs were assessed
-how care was planned and delivered
-how providers worked together
-how the quality of care was monitored
As part of our inspections, we asked people and their families to tell us about their experiences of care and what was most important to them. In about 29% of care homes and 56% of hospitals we inspected, we found assessments were not comprehensive in identifying all of a person’s care needs. In about 34% of care homes and 42% of hospitals, we found aspects of variable or poor care in relation to people’s mental health, emotional and social needs. We found that the variation in how care is assessed, planned, delivered and monitored by hospitals and care homes puts people living with dementia at risk of experiencing poor care.
Research Practice & Methodology
The narrated, nonnarrated, and the disnarrated: conceptual tools for analyzing narratives in health services research.
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Vindrola-Padros C, Johnson GA.
Qualitative health research 2014 Nov;24(11):1603-1611
While analyzing the narratives of children receiving pediatric oncology treatment and their parents, we encountered three ways to look at their narratives: what was narrated, nonnarrated, and disnarrated. The narrated refers to the actors (characters) and events (scenes) individuals decided to include in the narration of their experiences, the nonnarrated are everything not included in narration, and the disnarrated are elements that are narrated in the story but did not actually take place. We use our reflection to illustrate how an integrative analysis of these different forms of narration can allow us to produce a holistic interpretation of people’s experiences of illness. This approach is still in the early stages of development, but we hope this article can promote a debate in the field and lead to the refinement of an important tool for narrative analysis.© The Author(s) 2014.
This study compares registry and non-registry approaches to linking 2006 Census of Population data for Manitoba and Ontario to Hospital data from the Discharge Abstract Database.
Potentially Inappropriate Drug Prescribing and Associated Factors in Nursing Homes.
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Cool C, Cestac P, Laborde C, Lebaudy C, Rouch L, Lepage B, et al.
Journal of the American Medical Directors Association 2014 Oct 2
Polymedication is frequent in nursing home (NH) residents. This increases the risk of potentially inappropriate drug prescribing (PIDP), which can lead to adverse drug events, such as falls and hospitalization. OBJECTIVE: To identify PIDP in NH residents and to investigate subject-related and NH structural and organizational factors associated with PIDP. DESIGN: Cross-sectional study. SETTING: A total of 175 NHs in Midi-Pyrénées region, South-Western France. PARTICIPANTS: A total of 974 subjects randomly selected from the 6275 NH residents participating in the IQUARE study. EXPOSURE: Patients with PIDP. MAIN OUTCOMES AND MEASURES: PIDP was the main outcome measure. It was defined using a specific indicator, based on the Summary of Product Characteristics, on the Laroche list, and on residents’ clinical data. PIDP was defined as the presence of at least 1 of the following criteria: (1) drug with an unfavorable benefit-to-risk ratio; (2) drug with questionable efficacy according to the Laroche list; (3) absolute contraindication; (4) significant drug-drug interaction. Associated factors were identified by using multivariable logistic regression models. RESULTS: Among the 974 residents included, 71% had PIDP. PIDP was more frequent in patients without dementia, with several comorbidities and taking multiple medications. In the multivariable analysis, age (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.03) and Charlson Comorbidity Index (CCI; P = .003, CCI = 1 versus 0: OR1/0 1.22; 95% CI 0.85-1.74, CCI ≥ 2 versus 0: OR2/0 1.72; 95% CI 1.23-2.41) were associated with an increased likelihood of PIDP. By contrast, dementia was associated with a lower likelihood of PIDP (OR 0.70; 95% CI 0.53-0.94). Among NH structural and organizational characteristics, the access to psychiatric advice and/or to hospitalization in a psychiatric unit (OR 1.36; 95% CI 1.02-1.82) and the presence of a reevaluation of drug prescriptions (OR 1.45; 95% CI 1.07-1.96) were associated with an increased likelihood of PIDP. CONCLUSIONS AND RELEVANCE: Our work suggests that some NH characteristics are associated with an increased likelihood of PIDP. Gaining a better understanding of the factors influencing PIDP, especially structural and organizational NH factors, can help to determine the interventions that should be implemented. Copyright © 2014 AMDA
Needs of informal caregivers during transition from home towards institutional care in dementia: a systematic review of qualitative studies.
Non UofA Access
Afram B, Verbeek H, Bleijlevens MH, Hamers JP.
International psychogeriatrics / IPA 2014 Oct 7:1-12
Background: Alongside providing care, informal caregivers of people with dementia often need support and guidance themselves, especially during difficult periods such as the care-transition from home towards a nursing home. Knowledge on needs of informal caregivers during this period is sparse. This study aims to provide insight into problems and needs of informal caregivers caring for people with dementia during care-transition from home-based care to institutional long-term care. Methods: A systematic electronic search in CINAHL, Cochrane, Medline, PsycINFO, Pubmed and Web of Knowledge. All qualitative articles up to September 2013 were considered. The included articles underwent a quality appraisal. Thematic analysis was used to analyze problems and needs described in the articles. Results: Thirteen publications were included providing 14 topics comprising needs and problems of informal caregivers during the care-transition period. The most stated topics were: “emotional concerns” (e.g. grief and shame about the decision), “knowledge/information” (e.g. understanding the care system) and “support” (e.g. need for counseling). Similar topics were found prior and after admission, with examples specific to the either the home or nursing home situation. Conclusions: The care-transition period should be considered a continuum, as similar needs and problems were identified prior and after admission. This should be kept in mind in developing support and guidance for informal caregivers during this process. Whereas currently the situation prior and post admission are seen and treated as adjacent stages, they should be considered one integrated stage. Multicomponent programmes should be offered that are designed in a continuous way, starting prior to admission, and continuing after.
Care coordination between convenient care clinics and healthcare homes.
Non UofA Access
Carney Moore JM, Dolansky M, Hudak C, Kenneley I.
Journal of the American Association of Nurse Practitioners 2014 Oct 6
Patient care coordination is foundational to high-quality health care and is a national priority. Since its inception, convenient health care has been criticized for its potential to decrease patient care coordination. The purpose of this study is to investigate care coordination between convenient care clinics and healthcare homes. DATA SOURCES: The care coordination practices of Minute Clinic, which represents over 40% of the convenient care industry, were studied. Patient identification of healthcare homes and consent to transmit visit records were abstracted from the health records of 1,014,249 patients dated July 1 to December 31, 2012. The completeness of record content and timeliness of record transmission were assessed by means of interviewing Minute Clinic’s Director of Quality and reviewing patient electronic health records. CONCLUSIONS: Minute Clinic attempts to coordinate care with healthcare homes, but opportunities for improved care coordination exist. IMPLICATIONS FOR PRACTICE: Increased vigilance on the part of providers, patients, and healthcare systems is needed to mitigate barriers to care coordination. Future research is needed to examine care coordination from multiple convenient care operators and explore how to increase care coordination with healthcare homes. ©2014 American Association of Nurse Practitioners.
Primary care in nursing homes revisited: survey of the experiences of primary care physicians.
Non UofA Access
Gleeson LE, Jennings S, Gavin R, McConaghy D, Collins DR.
Irish medical journal 2014 Sep;107(8):234-236
We reported on experiences of general practitioners (GPs) in Dublin caring for nursing home patients (NHPs) in 2006. We revisit these experiences following publication of HIQA’s standards. 400 GPs received an anonymous postal survey. Of 204 respondents, 145 (71%) felt NHPs required more contact time and 124 (61%) reported more complex consultations compared to other patients. Only 131 (64%) felt adequately trained in gerontology. 143 (70%) reported access to specialist advice, but only 6 (3%) reported a change in this following HIOA standards. 65 (32%) had witnessed substandard care in a NH, of which 16 (25%) made no report, similar figures to 2006. There remains similar levels of concern regarding patient complexity, substandard care, access to specialist support and training in the care of NHPs. Many GPs expressed uncertainty regarding their role in implementing HIQA standards.
ECHO-AGE: An Innovative Model of Geriatric Care for Long-Term Care Residents With Dementia and Behavioral Issues.
Non UofA Access
Catic AG, Mattison ML, Bakaev I, Morgan M, Monti SM, Lipsitz L.
Journal of the American Medical Directors Association 2014 Oct 8
To design, implement, and assess the pilot phase of an innovative, remote case-based video-consultation program called ECHO-AGE that links experts in the management of behavior disorders in patients with dementia to nursing home care providers. DESIGN: Pilot study involving surveying of participating long-term care sites regarding utility of recommendations and resident outcomes. SETTING: Eleven long-term care sites in Massachusetts and Maine. PARTICIPANTS: An interprofessional specialty team at a tertiary care center and staff from 11 long-term care sites. INTERVENTION: Long-term care sites presented challenging cases regarding residents with dementia and/or delirium related behavioral issues to specialists via video-conferencing. METHODS: Baseline resident characteristics and follow-up data regarding compliance with ECHO-AGE recommendations, resident improvement, hospitalization, and mortality were collected from the long-term care sites. RESULTS: Forty-seven residents, with a mean age of 82 years, were presented during the ECHO-AGE pilot period. Eighty-three percent of residents had a history of dementia and 44% were taking antipsychotic medications. The most common reasons for presentation were agitation, intrusiveness, and paranoia. Behavioral plans were recommended in 72.3% of patients. Suggestions for medication adjustments were also frequent. ECHO-AGE recommendations were completely or partially followed in 88.6% of residents. When recommendations were followed, sites were much more likely to report clinical improvement (74% vs 20%, P < .03). Hospitalization was also less common among residents for whom recommendations were followed. CONCLUSIONS: The results suggest that a case-based video-consultation program can be successful in improving the care of elders with dementia and/or delirium related behavioral issues by linking specialists with long-term care providers. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine.
Physical Frailty Predicts Incident Depressive Symptoms in Elderly People: Prospective Findings From the Obu Study of Health Promotion for the Elderly
Non UofA Access
Makizako H, Shimada H, Doi T, Yoshida D, Anan Y, Tsutsumimoto K, et al.
Journal of the American Medical Directors Association 2014 Oct 9
The purpose of this study was to determine whether frailty is an important and independent predictor of incident depressive symptoms in elderly people without depressive symptoms at baseline. DESIGN: Fifteen-month prospective study. SETTING: General community in Japan. PARTICIPANTS: A total of 3025 community-dwelling elderly people aged 65 years or over without depressive symptoms at baseline. MEASUREMENTS: The self-rated 15-item Geriatric Depression Scale was used to assess symptoms of depression with a score of 6 or more at baseline and 15-month follow-up. Participants underwent a structural interview designed to obtain demographic factors and frailty status, and completed cognitive testing with the Mini-Mental State Examination and physical performance testing with the Short Physical Performance Battery as potential predictors. RESULTS: At a 15-month follow-up survey, 226 participants (7.5%) reported the development of depressive symptoms. We found that frailty and poor self-rated general health (adjusted odds ratio 1.86, 95% confidence interval 1.30-2.66, P < .01) were independent predictors of incident depressive symptoms. The odds ratio for depressive symptoms in participants with frailty compared with robust participants was 1.86 (95% confidence interval 1.05-3.28, P = .03) after adjusting for demographic factors, self-rated general health, behavior, living arrangements, Mini-Mental State Examination, Short Physical Performance Battery, and Geriatric Depression Scale scores at baseline. CONCLUSIONS: Our findings suggested that frailty and poor self-rated general health were independent predictors of depressive symptoms in community-dwelling elderly people. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine.
Evidence-based practice for pain identification in cognitively impaired nursing home residents.
Non UofA Access
Sacoco C, Ishikawa S.
The Nursing clinics of North America 2014 Sep;49(3):345-356
Pain identification of cognitively impaired elderly is very challenging. This project aimed to identify best practices for pain assessment in nursing home residents with cognitive impairment and to establish a standardized pain assessment guide to optimize nursing practice and resident outcomes. The Iowa Model of Evidence-Based Practice to Promote Quality of Care guided the project’s process. Phase I of the project analyzed data gained from chart reviews on current practices of pain assessment, and Phase II used the results of Phase I to develop, implement, and evaluate an evidence-based practice standard for nursing assessment of pain for cognitively impaired residents. Copyright © 2014 Elsevier Inc. All rights reserved.
Isolation: the emerging crisis for older men. A report exploring experiences of social isolation and loneliness among older men in England.
International Longevity Centre (ILC-UK) & Independent Age
Using recently released data from the latest wave (2012/2013) of the English Longitudinal Study of Ageing (ELSA) to develop insights for the population of England aged 50+, our research sets out to better understand the needs of older men. This is in order to ensure those who are lonely and/or isolated are encouraged to access the support they need when they most need it.
The Global AgeWatch Index 2014 presents a unique snapshot of the situation of older people in 96 countries of the world today. It highlights which countries are doing best for their older populations and how this links with policies towards pensions, health, education, employment and the social environment in which older people live. This year, the Index Insight report has a special focus on income security. It looks at how different countries are responding to people’s right to a secure income in later life, particularly by extending pension coverage.
Show the impact of your research: alternative metrics for beginners
Wednesday 22 October 12:00-13:00 ECHA 5-001
There are many different ways to measure research impact. In this session, we will explore altmetrics (aka alternative metrics). These measurement tools use social media activity to measure policy, society and community uptake of research. Altmetrics provide a new opportunity to show the value of your research as an alternative to traditional metrics (h-index and citation counts). IN this session presenters will discuss the following:
-Brief introduction to altmetrics
-Overview of the different online tools we can use to track our research
-Discussion on what altmetrics can offer the discipline of nursing
Bringing Research to Life Using Innovative Multimedia Approaches
Friday 14 November 14:00-17:00 Toronto
-Mike Evans: Disruption, Peer to Peer Healthcare, Creativity and YouTube: How to Fail Well in Patient Engagement
-Vrenia Ivonoffski: Creative Chaos – The Art of Transforming Research into Theatre
-Liam O’Rinn: Video 101 – The Basics
-Nancy Viva Davis: Photographic Practice and Knowledge/Strategies
NVivo Brown Bag Webinar: Organizing Your Grant Writing Process with NVivo
Monday 20 October 10:00 MT
Whether you are preparing to submit a grant proposal, or preparing to review or manage many proposals, using the powerful tools within NVivo will allow you to manage, review, analyze and efficiently produce proposals and reports.
CFHI Webinar-Making Data Matter: Real-time Measurement for Healthcare Improvement
Wednesday 22 October 10:00-11:00 MT $100
Healthcare systems are inundated with data, indicators and dashboards. But how well do healthcare providers and their organizations actually use data to understand healthcare pathways, processes and systems, and drive decisions? Oftentimes, data is too old to make timely decisions, or providers are skeptical about the validity of the information. Collecting and displaying data in ‘real-time’ enables healthcare leaders and staff to use data in a meaningful way, improving the quality and efficiency of care for patients and families.
No Home Care Priority without Appropriate Financing: Canada has to Move.
Monday, October 20 17:00-18:30
Keynote speaker: Réjean Hébert
Hébert’s talk will draw on insights from his extensive research and recent political experience to discuss the need for governments to find a way to finance home care and to ensure older adults have access to a variety of options for appropriate types of care, when they need it.
KT Canada Webinar: The RE-AIM Framework: History, Recent Applications, and Future Directions
13 November 10:00-11:00 MT UofA folks can watch this in ECHA 5-001
Presenter: Dr. Russell Glasgow
-Describe the rationale for development of and the main dimensions of the RE-AIM framework
-Discuss how the RE-AIM framework has been applied to address health disparities
-Describe common challenges to use of and future directions for RE-AIM
IIQM: Researching Meaning
Thursday 30 October 13:00-14:00 MT
Presenter: John Paley,
Qualitative methodologists have no theory of meaning. Some phenomenologists make identifying meaning – the meaning of an experience, or the meaning of a phenomenon –their principal research objective, but rarely pause to explain what kind of thing a ‘meaning’ is. Others identify ‘meaning units’, and perform ‘meaning transformations’, without specifying what such meaning units are, or how such transformations are carried out. Most qualitative researchers routinely use analytical techniques which turn on being able to create ‘categories of meaning’, and on classifying data into meaningful ‘themes’. Here, too, there is little explicit discussion of the basis for these procedures, or of the theories of meaning which underpin and justify them. In this Webinar, I will do three things. First, I will illustrate these observations by showing how arbitrary ‘meaning procedures’ often are. Second, I will argue that ‘meaning’ is not a useful concept for explaining action. Third, I will propose a theory of meaning relevant to qualitative studies, and consider its implications.
University of Oxford: Introduction to Statistics for Health Care Research
19 January to 27 March 2015 £1640
This ten week online statistics module is designed for health and social care professionals who want to understand the basics of analysis methods commonly used in medical research, in order to understand published research and to participate in more specialised courses. Students will learn to use and interpret basic statistical methods using SPSS, with reference to cohort studies, case control studies and randomized controlled trials. Online discussion forums enable communication between students and the tutor to provide support and to interpret and understand real-life scenarios.
The Illinois attorney general has begun drafting legislation that would allow residents and their families to put cameras in their rooms in the state’s 1,200-plus nursing homes. The families would own and install the cameras; facility administrators would not have access to them.
Hospitals across Alberta are operating at overcapacity — South Health Campus was at 97 to 102 per cent capacity this week — as patients occupy much-needed beds. There are an estimated 700 seniors waiting for placement into continuing care in the province.
Seven new ‘ambassadors’ are to begin spreading the word about the importance of diagnosing more patients with dementia in a bid to help improve patients’ and their carers’ quality of life. The seven, who are based in London, the south, the north, the midlands, and Scotland, will be helping local GPs in England to use the best possible methods to diagnose more people.
Why should a profession that trades in words and dedicates itself to the transmission of knowledge so often turn out prose that is turgid, soggy, wooden, bloated, clumsy, obscure, unpleasant to read, and impossible to understand?
Staff and managers working in long-term care homes in Saskatoon Health Region are using information available from the Quality Insight website to help improve resident outcomes and quality of life. New enhancements to Quality Insight are making it even easier for health regions in Saskatchewan, such as Saskatoon Health Region, to track and observe the health care data they are interested in.
idents themselves – to remotely check on mood, general health, medication, food, toileting, and many other issues.
This is an easily digestible overview of current and projected stats on older Canadians.
StatsCan has put together a brief summary of end-of-life care in Canada.
Ambrose called the announcement “early stages,” but she added it’s good news as the country prepares to deal with a crush of dementia cases as the population ages.
Alberta Auditor General Merwan Saher says more must be done to monitor the way the province cares for seniors in long-term care
CARNA appreciates the progress noted in the Auditor-General’s Report in the areas of process and administration in long-term care but is seriously concerned about the lack of monitoring at the resident level.
The Scottish Improvement Science Collaborating Centre – a Scotland-wide initiative to improve quality of patient care and ensure that world-leading research leads to impact across society – has been awarded funding of £3.25 million
To maximise support for workers’ contribution to a multidisciplinary healthcare team, they should be offered the same learning and development opportunities as registered professionals.
The Alberta government is moving to ease pressure on hospitals by addressing the needs of more than 700 senior or complex needs patients who are waiting in acute care for a continuing care space.
The BC Care Providers Association (BCCPA) has issued a new policy backgrounder with proposed recommendations dealing with the Care Aide and Community Health Worker Registry on the subject of Employer Notification.
To support health organizations and providers in creating a “culture shift” from being task-oriented to being person-centred, Saint Elizabeth Health Care is teaming up with the Alzheimer Society of Canada to deliver education and training on embedding the principles and practices of person-centred care within home care and long-term care settings.
The Nobel Prize awards season has just ended and Canada was shut out. But behind the scenes, a small group of university and research leaders is trying to improve Canada’s international awards performance.
The province announced it will open 464 continuing care spaces across Alberta. But how does that stack up to the spaces already in place? We break it down for you.
Four Wiley Editors cover the following topics:
– So you’re thinking of writing a paper? Find out how and where to begin the writing process, and how to choose the right journal.
– How to write? We’ll guide you through what editors are looking for and how to tailor your writing to it.
– The publishing and peer review processes. Everything you need to know about the publishing process including time lines.
– Your paper has published, what next? Learn how to increase the exposure of your paper.
From the Victorian Government (Australia) Department of Health, this brief document provides useful information for assisting residents with eating.
This A-Z of strategies, checklists and tools has practical ideas, checklists and educational tools for particular issues. With over 40 entries, A-Z lists everything from activities to promote living with meaning and purpose, to family involvement, gardens, lighting, pain relief, spirituality, staff development, wayfinding and windows.
Research Associate (Medical Statistics)
University of Edinburgh, Edinburgh, Scotland
DEADLINE: Friday 24 October
You will be qualified at Masters or PhD level in statistics or within the health sciences with a substantial component involving applied statistics. As well as being a tenacious problem solver, you will have a demonstrable record of creating and maintaining strong interdisciplinary partnerships. You will also be experienced in teaching statistics in higher education to non-specialist learners, including through contribution to design and delivery of online learning resources. The appointee will be well-organised, have excellent communication skills and be committed to accuracy and integrity in all aspects of their work. They will also bring enthusiasm about promoting high standards of statistical practice to the role.
Post-Doctoral Fellowships in Improvement Science
King’s College, London
DEADLINE 12 November
The fellows will work on improvement / implementation science research at the King’s Health Partners Trusts. Fellowship post-holders will be employed by King’s College London and receive supervision from senior academic staff at King’s College London.