November 17, 2014

Grants & Awards


New article by Dr. Carole Estabrooks
Organizational readiness for knowledge translation in chronic care: a Delphi study.
Non UofA Access
Attieh R, Gagnon MP, Estabrooks CA, Legare F, Ouimet M, Vazquez P, et al.
BMC health services research 2014 Nov 8;14(1):534

Health-care organizations need to be ready prior to implement evidence-based interventions. In this study, we sought to achieve consensus on a framework to assess the readiness of health-care organizations to implement evidence-based interventions in the context of chronic care.MethodsWe conducted a web-based modified Delphi study between March and May 2013. We contacted 76 potentially eligible international experts working in the fields of organizational readiness (OR), knowledge translation (KT), and chronic care to comment upon the 76 elements resulting from our proposed conceptual map. This conceptual map was based on a systematic review of the existing frameworks of Organizational Readiness for Change (ORC) in health-care. We developed a conceptual map that proposed a set of core concepts and their associated 17 dimensions and 59 sub-dimensions. Experts rated their agreement concerning the applicability and importance of ORC elements on a 5-point Likert scale, where 1 indicates total disagreement and 5 indicates total agreement. Two rounds were needed to get a consensus from the experts. Consensus was a priori defined as strong (¿75%) or moderate (60-74%). Simple descriptive statistics was used.ResultsIn total, 14 participants completed the first round and 10 completed the two rounds. Panel members reached consensus on the applicability and importance of 6 out of 17 dimensions and 28 out of 59 sub-dimensions to assess OR for KT in the context of chronic care. A strong level of consensus (¿75%) was attained on the Organizational contextual factors, Leadership / participation, Organizational support, and Motivation dimensions. The Organizational climate for change and Change content dimensions reached a moderate consensus (60-74%). Experts also reached consensus on 28 out of 59 sub-dimensions to assess OR for KT. Twenty-one sub-dimensions reached a strong consensus (¿75%) and seven a moderate consensus (60-74%).ConclusionThis study results provided the most important and applicable dimensions and sub-dimensions for assessing OR-KT in the context of chronic care. They can be used to guide the design of an assessment tool to improve knowledge translation in the field of chronic care.

New article by Dr. Kim Fraser
Data for improvement and clinical excellence: report of an interrupted time series trial of feedback in long-term care
Sales AE, Schalm C, Baylon M, Fraser KD.
Implementation science 2014 Nov 11;9(1):161

There is considerable evidence about the effectiveness of audit coupled with feedback for provider behavior change, although few feedback interventions have been conducted in long-term care settings. The primary purpose of the Data for Improvement and Clinical Excellence-Long-Term Care (DICE-LTC) project was to assess the effects of a feedback intervention delivered to all direct care providers on resident outcomes. Our objective in this report is to assess the effect of feedback reporting on rates of pain assessment, depression screening, and falls over time. Methods The intervention consisted of monthly feedback reports delivered to all direct care providers, facility and unit administrators, and support staff, delivered over 13 months in nine LTC units across four facilities. Data for feedback reports came from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated in LTC facilities throughout Alberta. The primary evaluation used an interrupted time series design with a comparison group (units not included in the feedback intervention) and a comparison condition (pressure ulcers). We used segmented regression analysis to assess the effect of the feedback intervention. Results The primary outcome of the study, falls, showed little change over the period of the intervention, except for a small increase in the rate of falls during the intervention period. The only outcome that improved during the intervention period was the proportion of residents with high pain scores, which decreased at the beginning of the intervention. The proportion of residents with high depression scores appeared to worsen during the intervention. Conclusions Maintaining all nine units in the study for its 13-month duration was a positive outcome. The feedback reports, without any other intervention included, did not achieve the desired reduction in proportion of falls and elevated depression scores. The survey on intention to change pain assessment practice which was conducted shortly after most of the feedback distribution cycles may have acted as a co-intervention supporting a reduction in pain scores. The processing and delivery of feedback reports could be accomplished at relatively low cost because the data are mandated and could be added to other intervention approaches to support implementation of evidence-based practices.

Aging Families, Changing Families: An International Conference
3-6 June Syracuse, NY
DEADLINE 15 December

This international conference will provide a forum for scholarly papers on aging in the context of family life with an emphasis on social change and global perspectives.
Topics Include (but are not limited to):
-Intergenerational, spousal and sibling relations over the second half of life,
-Widowhood, changing family forms (divorce, remarriage, step-relations, cohabitation),
-Filial piety,
-Intersections of older families with race, class, and/or gender,
-Implications of family life for well-being,
-Welfare-state policies as they relate to older families,
-Historical, comparative, and developmental perspectives on aging families.

Global Implementation Conference
26-28 May Dublin Ireland

How can implementation make a real difference by producing socially significant results for end-users of services? What capacities are needed, and how can they be built? What types of collaborative planning and action can strengthen implementation processes? Implementation for Impact is the topic of the 3rd biennial Global Implementation Conference. Please join us in Dublin, Ireland for an opportunity to learn, share, network and socialise with others, who are passionate about implementation science, practice, and policy!

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Grants & Awards

Developing Centers of Excellence in knowledge translation in maternal and perinatal health and preventing unsafe abortion: grants for institutional capacity building
DEADLINE 12 December

These funds are an institutional capacity building grant, intended to facilitate the establishment and build the capacity of Centers of Excellence in knowledge translation, focusing on maternal and perinatal health and preventing unsafe abortion. Institutions working in the area of maternal, perinatal health and/or preventing unsafe abortion in selected African countries (Cameroon, Cote d’Ivoire, Ethiopia, Guinea Bissau, Liberia, and Zimbabwe) can apply for this funding.

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


A mixed-methods study of research dissemination across practice-based research networks.
Non UofA Access
Lipman PD, Lange CJ, Cohen RA, Peterson KA.
The Journal of ambulatory care management 2014 Apr-Jun;37(2):179-188

Practice-based research networks may be expanding beyond research into rapid learning systems. This mixed-methods study uses Agency for Healthcare Research and Quality registry data to identify networks currently engaged in dissemination of research findings and to select a sample to participate in qualitative semistructured interviews. An adapted Diffusion of Innovations framework was used to organize concepts by characteristics of networks, dissemination activities, and mechanisms for rapid learning. Six regional networks provided detailed information about dissemination strategies, organizational context, role of practice-based research network, member involvement, and practice incentives. Strategies compatible with current practices and learning innovations that generate observable improvements may increase effectiveness of rapid learning approaches.

Outcomes of a Partnered Facilitation Strategy to Implement Primary Care-Mental Health.
Non UofA Access
Kirchner JE, Ritchie MJ, Pitcock JA, Parker LE, Curran GM, Fortney JC.
Journal of general internal medicine 2014 Oct 30

Implementing new programs and practices is challenging, even when they are mandated. Implementation Facilitation (IF) strategies that focus on partnering with sites show promise for addressing these challenges. OBJECTIVE: Our aim was to evaluate the effectiveness of an external/internal IF strategy within the context of a Department of Veterans Affairs (VA) mandate of Primary Care-Mental Health Integration (PC-MHI). DESIGN: This was a quasi-experimental, Hybrid Type III study. Generalized estimating equations assessed differences across sites. PARTICIPANTS: Patients and providers at seven VA primary care clinics receiving the IF intervention and national support and seven matched comparison clinics receiving national support only participated in the study. INTERVENTION: We used a highly partnered IF strategy incorporating evidence-based implementation interventions. MAIN MEASURES: We evaluated the IF strategy using VA administrative data and RE-AIM framework measures for two 6-month periods. KEY RESULTS: Evaluation of RE-AIM measures from the first 6-month period indicated that PC patients at IF clinics had nine times the odds (OR=8.93, p<0.001) of also being seen in PC-MHI (Reach) compared to patients at non-IF clinics. PC providers at IF clinics had seven times the odds (OR=7.12, p=0.029) of referring patients to PC-MHI (Adoption) than providers at non-IF clinics, and a greater proportion of providers’ patients at IF clinics were referred to PC-MHI (Adoption) compared to non-IF clinics (β=0.027, p<0.001). Compared to PC patients at non-IF sites, patients at IF clinics did not have lower odds (OR=1.34, p=0.232) of being referred for first-time mental health specialty clinic visits (Effectiveness), or higher odds (OR=1.90, p=0.350) of receiving same-day access (Implementation). Assessment of program sustainability (Maintenance) was conducted by repeating this analysis for a second 6-month time period. Maintenance analyses results were similar to the earlier period. CONCLUSION: The addition of a highly partnered IF strategy to national level support resulted in greater Reach and Adoption of the mandated PC-MHI initiative, thereby increasing patient access to VA mental health care.

Evidence-Based Practice: Knowledge, attitudes, practice and perceived barriers among nurses in Oman.
Non UofA Access
Ammouri AA, Raddaha AA, Dsouza P, Geethakrishnan R, Noronha JA, Obeidat AA, et al.
Sultan Qaboos University medical journal 2014 Nov;14(4):e537-45

The aim of this study was to describe nurses’ practices, attitudes, knowledge/skills and perceived barriers in relation to evidence-based practice (EBP) in Oman. METHODS: This descriptive cross-sectional study was conducted between February and November 2012. A self-reported 24-item questionnaire was used to measure EBP practices, attitudes and knowledge/skills among a convenience sample of 600 nurses working in four governmental hospitals in Muscat, Oman. Responses were scored on a one to seven rating scale. Barriers to EBP were measured on a five-point Likert scale using two subscales. Descriptive statistics and general linear regression were used to analyse the data. RESULTS: A total of 414 nurses were included in the study. The greatest barriers to developing EBP among nurses were insufficient time for research (3.51 ± 0.97) and insufficient resources to change practices (3.64 ± 0.99). Nurses with more years of experience reported increased use of EBP (P <0.01), more positive attitudes towards EBP (P <0.001) and fewer barriers to research (P <0.01). Significant positive correlations were found between years of experience and practice (r = 0.16) and attitudes (r = 0.20). Nurses with a baccalaureate degree reported fewer barriers to research than those qualified at a diploma level (P <0.001). Nurses who perceived more barriers to research reported less use of EBP (P <0.001), less positive attitudes towards EBP (P <0.001) and limited EBP knowledge/skills (P <0.001). CONCLUSION: These findings provide a basis for enhancing nursing practices, knowledge and skills. Continuing education for nurses and minimising barriers is crucial to increasing the use of EBP in Oman.

Toward understanding Malaysian fishermen’s decision making on the use of fishing technology: a mental model approach.
Non UofA Access
Hamzah A, Krauss SE, Shaffril HA, Suandi T, Ismail IA, Abu Samah B.
International journal of psychology : Journal international de psychologie 2014 Oct;49(5):397-403

The vast majority of Malaysia’s fishermen are located in rural areas, specifically in the Western and Eastern coastal regions of Peninsular Malaysia and the Sabah and Sarawak central zones. In these areas, the fishing industry is relied upon as a major economic contributor to the region’s residents. Despite the widespread application of various modern technologies into the fishing industry (i.e., GPS, sonar, echo sounder, remote sensing), and the Malaysian government’s efforts to encourage their adoption, many small-scale fishermen in the country’s rural areas continue to rely on traditional fishing methods. This refusal to embrace new technologies has resulted in significant losses in fish yields and needed income, and has raised many questions regarding the inputs to decision making of the fishermen. Drawing on multiple literatures, in this article we argue for the use of a mental model approach to gain an in-depth understanding of rural Malaysian fishermen’s choices of technology adoption according to four main constructs–prior experience, knowledge, expertise and beliefs or values. To provide needed inputs to agricultural specialists and related policy makers for the development of relevant plans of action, this article aims to provide a way forward for others to understand dispositional barriers to technology adoption among fishermen who use traditional methods in non-Western contexts. © 2013 International Union of Psychological Science.

Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators.
Non UofA Access
Purvis T, Moss K, Denisenko S, Bladin C, Cadilhac DA.
Journal of multidisciplinary healthcare 2014 Sep 15;7:389-400

A stroke care strategy was developed in 2007 to improve stroke services in Victoria, Australia. Eight stroke network facilitators (SNFs) were appointed in selected hospitals to enable the establishment of stroke units, develop thrombolysis services, and implement protocols. We aimed to explain the main issues being faced by clinicians in providing evidence-based stroke care, and to determine if the appointment of an SNF was perceived as an acceptable strategy to improve stroke care. Face-to-face semistructured interviews were used in a qualitative research design. Interview transcripts were verified by respondents prior to coding. Two researchers conducted thematic analysis of major themes and subthemes. Overall, 84 hospital staff participated in 33 interviews during 2008. The common factors found to impact on stroke care included staff and equipment availability, location of care, inconsistent use of clinical pathways, and professional beliefs. Other barriers included limited access to specialist clinicians and workload demands. The establishment of dedicated stroke units was considered essential to improve the quality of care. The SNF role was valued for identifying gaps in care and providing capacity to change clinical processes. This is the first large, qualitative multicenter study to describe issues associated with delivering high-quality stroke care and the potential benefits of SNFs to facilitate these improvements.

Positioning Clinical Nurse Specialists and Nurse Practitioners as Change Champions to Implement a Pain Protocol in Long-Term Care
Non UofA Access
Kaasalainen S, Ploeg J, Donald F, Coker E, Brazil K, Martin-Misener R, et al.
Pain Management Nursing

Pain management for older adults in long-term care (LTC) has been recognized as a problem internationally. The purpose of this study was to explore the role of a clinical nurse specialist (CNS) and nurse practitioner (NP) as change champions during the implementation of an evidence-based pain protocol in LTC. In this exploratory, multiple-case design study, we collected data from two LTC homes in Ontario, Canada. Three data sources were used: participant observation of an NP and a CNS for 18 hours each over a 3-week period; CNS and NP diaries recording strategies, barriers, and facilitators to the implementation process; and interviews with members of the interdisciplinary team to explore perceptions about the NP and CNS role in implementing the pain protocol. Data were analyzed using thematic content analysis. The NP and CNS used a variety of effective strategies to promote pain management changes in practice including educational outreach with team members, reminders to nursing staff to highlight the pain protocol and educate about practice changes, chart audits and feedback to the nursing staff, interdisciplinary working group meetings, ad hoc meetings with nursing staff, and resident assessment using advanced skills. The CNS and NP are ideal champions to implement pain management protocols and likely other quality improvement initiatives.

Evidence based nursing and midwifery practice in a regional Australian healthcare setting: Behaviours, skills and barriers
Non UofA Access
Fairbrother G, Cashin A, Conway MR, Symes MA, Graham I.

To establish self-reported skill levels, behaviours and barriers in relation to evidence-based practice (EBP) among a representative sample of regional Australian nurses and midwives in senior roles. Background It has been widely established that nurses and midwives continue to face challenges in relation to putting evidence into practice on the clinical floor. Prior to conducting an EBP capacity building activity in a regional Australian Local Health District, a survey assessing needs and skill and barrier areas was conducted. Methods A quantitative descriptive survey which utilised the ‘Developing Evidence Based Practice Questionnaire’ (DEBPQ) was conducted in early 2012 among senior nurses and midwives of a regional New South Wales Local Health District (LHD). The survey results were contrasted with reported DEBPQ results from a sample of UK metropolitan nurses and a sample of Australian general practice nurses (GPNs). Results One hundred and sixty nine nurses completed the survey (response rate 42%). Survey respondents’ reliance on accepted evidentiary knowledge sources was found to be low. Research literature-related knowledge sources were ranked outside of the top 10 sources, compared with numerous personalised and subjective sources, which ranked within the top 10. Access to and understanding of research material was a primary barrier to reviewing evidence in the study sample. Time-related barriers to changing practice on the basis of evidence figured prominently in the study sample and the UK and Australian GPN samples. The study sample rated their EBP skill levels significantly higher than both their UK counterparts and the Australian GPN sample (P < 0.0001). Conclusion Capacity building interventions are needed among senior nurses and midwives in Australian regional LHDs, as the most prominent knowledge sources reported are non-evidentiary in nature and barriers to finding and reviewing evidence, along with barriers to making practice change, remain significant.

Leadership networks in Catholic parishes: Implications for implementation research in health
Non UofA Access
Negrón R, Leyva B, Allen J, Ospino H, Tom L, Rustan S.
Social science & medicine 2014 12;122(0):53-62

Through two case studies of Catholic parishes in Massachusetts, this study explores the implications of leader-centered versus distributed leadership in Catholic parishes for the implementation of evidence-based health interventions. The two parishes involved in the study differ from each other in several ways. In the first, parishioners are less engaged in leadership activities at the decision-making level in the parish. A small group of lay volunteers work with the parish priest and other ordained leaders on parish activities. In the second parish, a large and active lay volunteer leadership have forged an organizational structure that allows more independence from the pastor’s direct oversight. In this parish, lay volunteer leaders are the prime drivers of organizational programs and events. In 2012–2013, three types of networks were assessed at each parish: discussion, collaboration, and outside-of-parish ties. The contrasts between each parish include differences in density of collaboration, in frequency of discussion, and network centrality of the respective parish priests. We further identified key actors in the network structures at each parish. We discuss the implications of these findings for understanding organizational capacity in the context of health program implementation.

Occupational therapists’ experiences of improvement work: a journey towards sustainable evidence-based practice
Non UofA Access
Sirkka M, Larsson-Lund M, Zingmark K.
Scandinavian journal of occupational therapy 2014 Mar;21(2):90-97

The aim of this qualitative descriptive study was to describe occupational therapists’ experiences of participating in long-term improvement work based on the Occupational Therapy Intervention Process Model. METHOD: Data were collected by focus groups interviewed on two occasions (2006 and 2011). Nineteen occupational therapists participated on each occasion. The data obtained were analysed using a qualitative content analysis. FINDINGS: The long-term improvement work was experienced as a journey towards sustainable and evidence-based occupational therapy practice. The journey, guided by the Occupational Therapy Intervention Process Model, led to increased client-centred and occupation-focused practice. The long journey of change involved three intertwined themes. The first theme describes how the occupational therapists transformed their thoughts and actions on an individual and group level. The second theme describes how they dealt with conflicting feelings and faced the duality of change. The third theme describes a shared professional culture, including confidence, clarity, and inter-professional community. CONCLUSION: The study shows how the collective use of an occupational therapy model of practice can lead to an integration of evidence-based knowledge that has long-lasting achievements in practice.

NHSRU-KTEP Environmental Scan Canada-flat-icon
Lianne Jeffs Andrea Baumann Vera Nincic Laureen Hayes Mary Crea Theresa Noonan
September 2014

The Nursing Health Services Research Unit Knowledge Translation Exchange Program (NHSRU-KTEP), with sites at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and School of Nursing, McMaster University, received 3 year funding (2013-2016) from the Ministry of Health and Long-Term Care (MOHLTC). The purpose of the NHSRU-KTEP is to improve the Ontario health care system by reducing the gap between evidence and the application of knowledge by key stakeholders. Our key objectives are:
1. Creating and linking databases to respond to questions raised by knowledge users.
2. Synthesizing and mobilizing knowledge to improve workforce planning and stability.
3. Evaluating the impact of policy on the effective utilization of nursing and allied health personnel.
4. Assessing the impact of KTE strategies for expanded nursing work, leadership and care innovations on health system performance, sustainability, safety, and quality outcomes. As part of our activities, we undertook an annual environmental scan to:
1. Evaluate the uptake and impact of NHSRU KTEP activities.
2. Assess stakeholder preferences relating to knowledge translation, exchange and dissemination strategies.
3. Examine stakeholder perceptions of current nursing and healthcare priorities/trends.

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Health Care Administration and Organization

Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan.
Non UofA Access
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 evolution and development of an instrument to measure essential professional nursing practices.
Non UofA Access
Kramer M, Brewer BB, Halfer D, Hnatiuk CN, MacPhee M, Schmalenberg C.
The Journal of nursing administration 2014 Nov;44(11):569-576

Nursing continues to evolve from a task-oriented occupation to a holistic professional practice. Increased professionalism requires accurate measurement of care processes and practice. Nursing studies often omit measurement of the relationship between structures in the work environment and processes of care or between processes of care and patient outcomes. Process measurement is integral to understanding and improving nursing practice. This article describes the development of an updated Essentials of Magnetism process measurement instrument for clinical nurses (CNs) practicing on inpatient units in hospitals. It has been renamed Essential Professional Nursing Practices: CN.

Workforce utilization in three continuing care facilities Canada-flat-icon
Non UofA Access
Suter E, Deutschlander S, Makwarimba E, Wilhelm A, Jackson K, Lyons SW.
Health Sociology Review 2014 03;23(1):65-76

The recent commitment to investment in continuing care services demands a sound grasp of workforce utilization in continuing care facilities. This article examines workforce utilization in continuing care as a key component of effective service delivery. We used a case study design with three continuing care facilities in Alberta, Canada. Data were collected over one year through interviews, group discussions and observations. The data revealed workforce issues around staff mix, responsibilities and role clarity that negatively affect staff and residents. Using an ecological framework, we developed ‘upstream’ workforce strategies targeting barriers that can be influenced by the three facilities. Limited research exists on how regulated and unregulated healthcare providers are organized and deployed in different continuing care environments. In our sociological analysis of workforce utilization at three continuing care facilities, we illuminated the relations between staff and the contextual elements surrounding them.

How much do residential aged care staff members know about the nutritional needs of residents?
Non UofA Access
Beattie E, O’Reilly M, Strange E, Franklin S, Isenring E.
International journal of older people nursing 2014 Mar;9(1):54-64

Undernutrition, weight loss and dehydration are major clinical issues for people with dementia in residential care, with excessive weight loss contributing to increased risk of frailty, immobility, illness and premature morbidity. This paper discusses a nutritional knowledge and attitudes survey conducted as part of a larger project focused on improving nutritional intake of people with dementia within a residential care facility in Brisbane, Australia. AIMS: The specific aims of the survey were to identify (i) knowledge of the nutritional needs of aged care facility residents; (ii) mealtime practices; and (iii) attitudes towards mealtime practices and organisation. METHODS: A survey based on those used in other healthcare settings was completed by 76 staff members. The survey included questions about nutritional knowledge, opinions of the food service, frequency of feeding assistance provided and feeding assessment practices. RESULTS: Nutritional knowledge scores ranged from 1 to 9 of a possible 10, with a mean score of 4.67. While 76% of respondents correctly identified risk factors associated with malnutrition in nursing home residents, only 38% of participants correctly identified the need for increased protein and energy in residents with pressure ulcers, and just 15% exhibited correct knowledge of fluid requirements. Further, while nutritional assessment was considered an important part of practice by 83% of respondents, just 53% indicated that they actually carried out such assessments. Identified barriers to promoting optimal nutrition included insufficient time to observe residents (56%); being unaware of residents’ feeding issues (46%); poor knowledge of nutritional assessments (44%); and unappetising appearance of food served (57%). CONCLUSION: An important step towards improving health and quality of life for residents of aged care facilities would be to enhance staff nutritional awareness and assessment skills. This should be carried out through increased attention to both preservice curricula and on-the-job training. IMPLICATIONS FOR PRACTICE: The residential facility staff surveyed demonstrated low levels of nutrition knowledge, which reflects findings from the international literature. This has implications for the provision of responsive care to residents of these facilities and should be explored further. © 2013 Blackwell Publishing Ltd.

Experiences of Nursing Staff Using Dementia-Specific Case Conferences in Nursing Homes.
Non UofA Access
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.

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Health Care Innovation and Quality Assurance

Don’t use antipsychotics routinely to treat agitation and aggression in people with dementia.
Non UofA Access
Corbett A, Burns A, Ballard C.
BMJ (Clinical research ed.) 2014 Nov 3;349:g6420.

Although current guidance promotes more judicious use of these drugs, with regular review of prescriptions, the guidelines are difficult to interpret, particularly as thresholds for severity are unclear.

Person-centred dementia care: a reality check in two nursing homes in Ireland.
Non UofA Access
Colomer J, de Vries J.
Dementia (London, England) 2014 Nov 3

The introduction of a person-centred care (PCC) approach to dementia care has been a major paradigmatic shift in the care provision in residential settings for older adults in Ireland. However, policy implementation in nursing homes relies very much on the preparedness of nursing staff. This study explored this through semi-structured interviews with care assistants in two nursing homes which professed to support the PCC philosophy. We addressed their knowledge and perspectives of person-centred dementia care and views on various factors affecting its delivery. Findings showed considerable disparity between policy and practice, in particular because care assistants lacked clarity on what PCC is and reported that they were not educated in it. Notwithstanding this, carers’ perspectives on ‘good care’ for people with dementia included elements of PCC which suggested its ‘implicit’ use in practice. Besides the necessity of more (and more explicit) training on PCC, the findings also suggest concerns around communication between staff and management and the need for improvement of staffing resources and available time in residential settings in order to make the delivery of person-centred dementia care a reality.

Effectiveness of facilitated introduction of a standard operating procedure into routine processes in the operating theatre: a controlled interrupted time series.
Non UofA Access
Morgan L, New S, Robertson E, Collins G, Rivero-Arias O, Catchpole K, et al.
BMJ quality & safety 2014 Nov 3

Standard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed. METHODS: In a controlled interrupted time series, we evaluated three team process measures (compliance with WHO surgical safety checklist, non-technical skills and technical performance) and three clinical outcome measures (length of hospital stay, complications and readmissions) before and after a 3-month staff-led development of SOPs. Process measures were evaluated by direct observation, using Oxford Non-Technical Skills II for non-technical skills and the ‘glitch count’ for technical performance. All staff in two orthopaedic operating theatres were trained in the principles of SOPs and then assisted to develop standardised procedures. Staff in a control operating theatre underwent the same observations but received no training. The change in difference between active and control groups was compared before and after the intervention using repeated measures analysis of variance. RESULTS: We observed 50 operations before and 55 after the intervention and analysed clinical data on 1022 and 861 operations, respectively. The staff chose to structure their efforts around revising the ‘whiteboard’ which documented and prompted tasks, rather than directly addressing specific task problems. Although staff preferred and sustained the new system, we found no significant differences in process or outcome measures before/after intervention in the active versus the control group. There was a secular trend towards worse outcomes in the postintervention period, seen in both active and control theatres. CONCLUSIONS: SOPs when developed and introduced by frontline staff do not necessarily improve operative processes or outcomes. The inherent tension in improvement work between giving staff ownership of improvement and maintaining control of direction needs to be managed, to ensure staff are engaged but invest energy in appropriate change. Published by the BMJ Publishing Group Limited.

The Consistency of Self-Reported Preferences for Everyday Living: Implications for Person-Centered Care Delivery.
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Van Haitsma K, Abbott KM, Heid AR, Carpenter B, Curyto K, Kleban M, et al.
Journal of gerontological nursing 2014 Sep 8:1-13

Preferences are the expression of an individual’s basic psychosocial needs and are related to care outcomes. The current study tested the consistency of 87 individuals’ everyday preferences over 1 week, comparing responses of nursing home residents (n = 37; mean age = 82) and university students (n = 50; mean age = 20). Participants completed the Preferences for Everyday Living Inventory at baseline and 5 to 7 days later. Preference consistency was calculated three ways: (a) correlations (range = 0.11 to 0.90); (b) overall percent of exact agreement (e.g., response was “very important” at both time points) (66.1%); and (c) responses collapsed as “important” or “not important” (increase in percent agreement to 86.6%). Personal care preferences were more stable, whereas leisure activities were less stable. The groups did not have significant differences in consistency. Some preferences are more consistent than others; age and frailty do not appear to be related to preference instability

Project JOINTS: What factors affect bundle adoption in a voluntary quality improvement campaign?
Non UofA Access
Khodyakov D, Ridgely MS, Huang C, DeBartolo KO, Sorbero ME, Schneider EC.
BMJ Quality & Safety 2014

Diffusion and adoption of effective evidence-based clinical practices can be slow, especially if complex changes are required to implement new practices. Objective To examine how hospital adherence to quality improvement (QI) methods and hospital engagement with a large-scale QI campaign could facilitate the adoption of an enhanced prevention bundle designed to reduce surgical site infection (SSI) rates after orthopaedic surgery (hip and knee arthroplasty). Methods We conducted telephone interviews with hospital QI leaders from 73 of the 109 hospitals (67% response rate) in five states that participated in Project JOINTS (Joining Organizations IN Tackling SSIs), a QI campaign run by Institute for Healthcare Improvement (IHI). Using QI methods grounded in the IHI Model for Improvement, this campaign encouraged hospitals to implement an enhanced SSI prevention bundle. Hospital QI leaders reported on their hospital’s adherence to the Project JOINTS QI methods; their level of engagement with Project JOINTS activities; and adoption of the SSI prevention bundle components. Interview data were analysed quantitatively and qualitatively. Results Both adherence to the QI methods and hospital engagement were positively associated with complete bundle adoption. Hospital engagement, especially the use of project materials and tools, was also positively associated with the initiation of and improved adherence to individual bundle components. Conclusions Our findings suggest that greater adherence to the QI methods and active hospital engagement in a QI campaign facilitate adoption of evidence-based patient safety bundles in orthopaedic practice.

Improving quality of life in nursing homes: the structured resident interview approach.
Non UofA Access
Degenholtz HB, Resnick AL, Bulger N, Chia L.
Journal of aging research 2014;2014:892679

The quality of life (QOL) of the approximately 1.5 million nursing facility (NF) residents in the US is undoubtedly lower than desired by residents, families, providers, and policy makers. Although there have been important advances in defining and measuring QOL for this population, there is a need for interventions that are tied to standardized measurement and quality improvement programs. This paper describes the development and testing of a structured, tailored assessment and care planning process for improving the QOL of nursing home residents. The Quality of Life Structured Resident Interview and Care Plan (QOL.SRI/CP) builds on a decade of research on measuring QOL and is designed to be easily implemented in any US nursing home. The approach was developed through extensive and iterative pilot testing and then tested in a randomized controlled trial in three nursing homes. Residents were randomly assigned to receive the assessment alone or both the assessment and an individualized QOL care plan task. The results show that residents assigned to the intervention group experienced improved QOL at 90- and 180-day follow-up, while QOL of residents in the control group was unchanged.

Foreign-Born Care Givers in Washington State Nursing Homes: Characteristics, Associations With Quality of Care, and Views of Administrators.
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Acker K, Pletz AM, Katz A, Hagopian A.
Journal of aging and health 2014 Oct 29

Following national trends, Washington State relies heavily on foreign-born workers to provide long-term care. Our study assesses state nursing facility characteristics, quality ratings, and the views of facility administrators about the implications of an increasing number of foreign-born employees. METHODS: We used independently available data to supplement a survey of nursing home administrators. RESULTS: Nearly half of the administrators reported difficulty hiring U.S.-born job applicants. Three in four administrators reported problems related to language differences, and just more than a third reported challenges related to cultural and/or religious differences. Nonetheless, the proportion of foreign-born employees was positively associated with independent facility quality ratings. Almost half of the administrators reported discrimination by patients/clients toward their foreign-born workers. Quality ratings were negatively associated with for-profit, chain, or multi-ownership status. DISCUSSION: The proportion of foreign-born employees in nursing facilities may be associated with improved performance.

A System-Wide Analysis Using a Senior-Friendly Hospital Framework Identifies Current Practices and Opportunities for Improvement in the Care of Hospitalized Older Adults. Canada-flat-icon
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Wong KS, Ryan DP, Liu BA.
Journal of the American Geriatrics Society 2014 Oct 30

Older adults are vulnerable to hospital-associated complications such as falls, pressure ulcers, functional decline, and delirium, which can contribute to prolonged hospital stay, readmission, and nursing home placement. These vulnerabilities are exacerbated when the hospital’s practices, services, and physical environment are not sufficiently mindful of the complex, multidimensional needs of frail individuals. Several frameworks have emerged to help hospitals examine how organization-wide processes can be customized to avoid these complications. This article describes the application of one such framework-the Senior-Friendly Hospital (SFH) framework adopted in Ontario, Canada-which comprises five interrelated domains: organizational support, processes of care, emotional and behavioral environment, ethics in clinical care and research, and physical environment. This framework provided the blueprint for a self-assessment of all 155 adult hospitals across the province of Ontario. The system-wide analysis identified practice gaps and promising practices within each domain of the SFH framework. Taken together, these results informed 12 recommendations to support hospitals at all stages of development in becoming friendly to older adults. Priorities for system-wide action were identified, encouraging hospitals to implement or further develop their processes to better address hospital-acquired delirium and functional decline. These recommendations led to collaborative action across the province, including the development of an online toolkit and the identification of accountability indicators to support hospitals in quality improvement focusing on senior-friendly care.© 2014, Copyright the Authors Journal compilation

For-profit medicare home health agencies’ costs appear higher and quality appears lower compared to nonprofit agencies.
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Cabin W, Himmelstein DU, Siman ML, Woolhandler S.
Health affairs (Project Hope) 2014 Aug;33(8):1460-1465

For-profit, or proprietary, home health agencies were banned from Medicare until 1980 but now account for a majority of the agencies that provide such services. Medicare home health costs have grown rapidly since the implementation of a risk-based prospective payment system in 2000. We analyzed recent national cost and case-mix-adjusted quality outcomes to assess the performance of for-profit and nonprofit home health agencies. For-profit agencies scored slightly but significantly worse on overall quality indicators compared to nonprofits (77.18 percent and 78.71 percent, respectively). Notably, for-profit agencies scored lower than nonprofits on the clinically important outcome “avoidance of hospitalization” (71.64 percent versus 73.53 percent). Scores on quality measures were lowest in the South, where for-profits predominate. Compared to nonprofits, proprietary agencies also had higher costs per patient ($4,827 versus $4,075), were more profitable, and had higher administrative costs. Our findings raise concerns about whether for-profit agencies should continue to be eligible for Medicare payments and about the efficiency of Medicare’s market-oriented, risk-based home care payment system.

The INTERACT Institute: Observations on Dissemination of the INTERACT Quality Improvement Program Using Certified INTERACT Trainers
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Bonner A, Tappen R, Herndon L, Ouslander J.
The Gerontologist 2014

Unnecessary hospitalizations of vulnerable nursing home (NH) residents can lead to hospital-acquired conditions, morbidity, mortality, and excess health care expenditures. Previous research has shown that a substantial percentage of these hospitalizations are preventable. Interventions to reduce acute care transfers (INTERACT) is a quality improvement program that has been adopted by many NHs throughout the United States. The original INTERACT toolkit was first created in a project supported by the Centers for Medicare and Medicaid Services. The toolkit was further refined and tested in a collaborative quality improvement project involving 30 NHs in 3 states, which resulted in a 17% reduction in all-cause hospitalizations. This study was limited because it was not randomized or controlled. Nevertheless, the data provide evidence that the program, even in the absence of strong regulatory oversight or financial incentives, is feasible to implement and that more active program engagement is associated with higher reductions in hospitalization. This paper describes dissemination of the INTERACT program using a pragmatic and relatively low cost model to prepare certified INTERACT Trainers in collaboration with several professional organizations.

Nursing-sensitive indicators: a concept analysis.
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Heslop L, Lu S.
Journal of advanced nursing 2014 Nov;70(11):2469-2482

To report a concept analysis of nursing-sensitive indicators within the applied context of the acute care setting. BACKGROUND: The concept of ‘nursing sensitive indicators’ is valuable to elaborate nursing care performance. The conceptual foundation, theoretical role, meaning, use and interpretation of the concept tend to differ. The elusiveness of the concept and the ambiguity of its attributes may have hindered research efforts to advance its application in practice. DESIGN: Concept analysis. DATA SOURCES: Using ‘clinical indicators’ or ‘quality of nursing care’ as subject headings and incorporating keyword combinations of ‘acute care’ and ‘nurs*’, CINAHL and MEDLINE with full text in EBSCOhost databases were searched for English language journal articles published between 2000-2012. Only primary research articles were selected. METHODS: A hybrid approach was undertaken, incorporating traditional strategies as per Walker and Avant and a conceptual matrix based on Holzemer’s Outcomes Model for Health Care Research. RESULTS: The analysis revealed two main attributes of nursing-sensitive indicators. Structural attributes related to health service operation included: hours of nursing care per patient day, nurse staffing. Outcome attributes related to patient care included: the prevalence of pressure ulcer, falls and falls with injury, nosocomial selective infection and patient/family satisfaction with nursing care. CONCLUSION: This concept analysis may be used as a basis to advance understandings of the theoretical structures that underpin both research and practical application of quality dimensions of nursing care performance. © 2014 The Authors.

Spreading and sustaining best practices for home care of older adults: a grounded theory study.
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Ploeg J, Markle-Reid M, Davies B, Higuchi K, Gifford W, Bajnok I, et al.
Implementation science : IS 2014 Nov 7;9:162-014-0162-4

Improving health care quality requires effective and timely spread of innovations that support evidence-based practices. However, there is limited rigorous research on the process of spread, factors influencing spread, and models of spread. It is particularly important to study spread within the home care sector given the aging of the population, expansion of home care services internationally, the high proportion of older adult users of home care services, and the vulnerability of this group who are frail and live with multiple chronic conditions. The purpose of this study was to understand how best practices related to older adults are spread within home care organizations. METHODS: Four home care organizations in Ontario, Canada that had implemented best practices related to older adults (falls prevention, pain management, management of venous leg ulcers) participated. Using a qualitative grounded theory design, interviews were conducted with frontline providers, managers, and directors at baseline (n =44) and 1 year later (n =40). Open, axial, and selective coding and constant comparison analysis were used. RESULTS: A model of the process of spread of best practices within home care organizations was developed. The phases of spread included (1) committing to change, (2) implementing on a small scale, (3) adapting locally, (4) spreading internally to multiple users and sites, and (5) disseminating externally. Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits. Project leads, champions, managers, and steering committees played vital roles in leading the spread process. Strategies such as educating/coaching and evaluating and feedback were key to sustaining the change. Spread occurred within the home care context of high staff and manager turnover and time and resource constraints. CONCLUSIONS: Spread of best practices is optimized through the application of the phases of spread, allocation of resources to support spread, and implementing strategies for ongoing sustainability that address potential barriers. Further research will help to understand how best practices are spread externally to other organizations.

The TRANSFORM Patient Safety Project: A Microsystem Approach to Improving Outcomes on Inpatient Units.
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Braddock CH,3rd, Szaflarski N, Forsey L, Abel L, Hernandez-Boussard T, Morton J.
Journal of general internal medicine 2014 Oct 28

Improvements in hospital patient safety have been made, but innovative approaches are needed to accelerate progress. Evidence is emerging that microsystem approaches to quality and safety improvement in hospital care are effective. OBJECTIVE: We aimed to evaluate the effects of a multifaceted, microsystem-level patient safety program on clinical outcomes and safety culture on inpatient units. DESIGN: A 1-year prospective interventional study was conducted, followed by a 6-month sustainability phase. SETTING AND PARTICIPANTS: Four medical and surgical inpatient units within an academic university medical center were included, with registered nurses and residents representing study participants. INTERVENTIONS: In situ simulation training; debriefing of medical emergencies; monthly patient safety team meetings; patient safety champion role; interdisciplinary patient safety conferences; recognition program for exemplary teamwork. OUTCOMES: Hospital-acquired severe sepsis/septic shock and acute respiratory failure; unplanned transfers to higher level of care (HLOC); weighted risk-adjusted mortality. Safety culture was measured using a widely accepted, validated survey. RESULTS: Rates of hospital-acquired severe sepsis/septic shock and acute respiratory failure decreased on study units, from 1.78 to 0.64 (p = 0.04) and 2.44 to 0.43 per 1,000 unit discharges (p = 0.03), respectively. The mean number of days between cases of severe sepsis/septic shock increased from baseline to the intervention period (p = 0.03). Unplanned transfers to HLOC increased from 715 to 764 per 1,000 unit transfers (p = 0.08). The weighted risk-adjusted observed-to-expected mortality ratio on all study units decreased from 0.50 to 0.40 (p < 0.001). Overall scores of safety culture on study units improved after the 1-year intervention, significantly for nurses (p < 0.001), but not for residents (p = 0.06). Scores significantly improved in nine of twelve survey dimensions for nurses, compared to in four dimensions for residents. CONCLUSION: A multifaceted patient safety program suggested an association with improved hospital-acquired complications and weighted, risk-adjusted mortality, and improved nurses’ perceptions of safety culture on inpatient study units.

Insights from staff nurses and managers on unit-specific nursing performance dashboards: a qualitative study. Canada-flat-icon
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Jeffs L, Beswick S, Lo J, Lai Y, Chhun A, Campbell H.
BMJ quality & safety 2014 Sep 5

Performance data can be used to monitor and guide interventions aimed at improving the quality and safety of patient care. To use performance data effectively, nurses need to understand how to interpret and use data in meaningful ways to guide practice. Dashboards are interactive computerised tools that display performance data. In one large, urban teaching hospital in Toronto, Canada, unit-specific dashboards were implemented across the organisation. METHODS: A qualitative study was undertaken to explore the perceptions and experiences of front-line nurses and managers associated with the implementation of a unit-level dashboard. Six units were selected to participate in the study. Data were analysed using a directed content analysis approach. RESULTS: The sample included 56 study participants, including 51 front-line nurses and 5 unit managers. Three key themes emerged around nurses’ and unit managers’ perspectives on the implementation of unit-specific dashboards. Nurses and managers described that the Care Utilising Evidence dashboard was a visual tool that displayed data on the impact of the nursing care provided to patients. This tool also was used by the nurses and managers to keep track of processes of care and patient outcomes and experiences at a unit level. Further, nurses were able to use performance data to identify quality care improvements specific to their unit. CONCLUSIONS: The results highlight how unit-specific dashboards are being used to monitor performance and drive quality improvement efforts from the perspectives of nurses and unit managers. In practice, nurse leaders may consider investing in dashboards as a quality improvement strategy to optimise the use of performance data at their organisations.

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.

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Research Practice & Methodology

Development and Evaluation of ‘Briefing Notes’ as a Novel Knowledge Translation Tool to Aid the Implementation of Sex/Gender Analysis in Systematic Reviews: A Pilot Study Canada-flat-icon
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Doull M, Welch V, Puil L, Runnels V, Coen SE, Shea B, et al.
PloS one 2014 Nov 5;9(11):e110786

There is increasing recognition of sex/gender differences in health and the importance of identifying differential effects of interventions for men and women. Yet, to whom the research evidence does or does not apply, with regard to sex/gender, is often insufficiently answered. This is also true for systematic reviews which synthesize results of primary studies. A lack of analysis and reporting of evidence on sex/gender raises concerns about the applicability of systematic reviews. To bridge this gap, this pilot study aimed to translate knowledge about sex/gender analysis (SGA) into a user-friendly ‘briefing note’ format and evaluate its potential in aiding the implementation of SGA in systematic reviews. Methods Our Sex/Gender Methods Group used an interactive process to translate knowledge about sex/gender into briefing notes, a concise communication tool used by policy and decision makers. The briefing notes were developed in collaboration with three Cochrane Collaboration review groups (HIV/AIDS, Hypertension, and Musculoskeletal) who were also the target knowledge users of the briefing notes. Briefing note development was informed by existing systematic review checklists, literature on sex/gender, in-person and virtual meetings, and consultation with topic experts. Finally, we held a workshop for potential users to evaluate the notes. Results Each briefing note provides tailored guidance on considering sex/gender to reviewers who are planning or conducting systematic reviews and includes the rationale for considering sex/gender, with examples specific to each review group’s focus. Review authors found that the briefing notes provided welcome guidance on implementing SGA that was clear and concise, but also identified conceptual and implementation challenges. Conclusions Sex/gender briefing notes are a promising knowledge translation tool. By encouraging sex/gender analysis and equity considerations in systematic reviews, the briefing notes can assist systematic reviewers in ensuring the applicability of research evidence, with the goal of improved health outcomes for diverse populations.

AHRQ: Systematic Reviews of Complex Multicomponent Health Care Interventions
March 2014

The purpose of this report is to outline approaches to address the challenges of conducting systematic reviews of complex multicomponent health care interventions. Methods: We performed a literature scan and conducted semi-structured interviews with international experts who conduct research or systematic reviews of complex multicomponent interventions, or organizational leaders who implement complex multicomponent interventions in health care. Results: Challenges identified include: a lack of consistent terminology for such interventions (e.g., complex; multicomponent; multidimensional; multifactorial); a wide range of approaches used to frame the review, from grouping interventions by common features to using more theoretical approaches; decisions regarding whether and how to quantitatively analyze the interventions, from more holistic to individual component analytic approaches; and incomplete and inconsistent reporting in primary and secondary studies of those elements critical to understanding the success and impact of such interventions, such as the methods used to implement the intervention, and the context in which it is implemented. Conclusions: We provided a framework to understand the spectrum of conceptual and analytic approaches and an initial list of critical reporting elements for primary and secondary studies of multicomponent interventions. This information will help reviewers understand the options and tradeoffs available for such reviews.

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The Lancet Special Series on Ageing

This Series on Ageing highlights a neglected area in the health sector and in social and economic-policy development. The six papers address issues related to mortality, morbidity and disability, wellbeing, and potential health-system responses. The Series provides a much-needed synthesis of the evidence, and suggests possible strategies to address the health and wellbeing of older adults. Scope for improving health of older adults is underlined in the Series papers by Martin Prince and Somnath Chatterji and their respective colleagues. Interventions that are targeted towards older people, including health promotion, disease prevention, and the entire range of care provision, from primary to palliative care, hold the promise of keeping older adults in good health for longer.
Older people’s health in sub-Saharan Africa
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Multimorbidity—older adults need health care that can count past one
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Frailty in the clinical scenario
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Towards a comprehensive public health response to population ageing
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Causes of international increases in older age life expectancy
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The burden of disease in older people and implications for health policy and practice
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Health, functioning, and disability in older adults—present status and future implications
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Subjective wellbeing, health, and ageing
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Macroeconomic implications of population ageing and selected policy responses
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Shared decision-making in dementia: A review of patient and family carer involvement.
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Miller LM, Whitlatch CJ, Lyons KS.
Dementia (London, England) 2014 Nov 3

This paper reviews empirical findings concerning the decision-making process of persons with dementia and their family carers, with a particular focus on the extent and determinants of involvement of persons with dementia in the decision-making process. To be included in this review, studies needed to be published in peer-reviewed journals between 1999 and 2014, report empirical data from participants with dementia and/or their family carers, and pertain to the involvement of persons with dementia and their family carers in decisions about everyday care, medical care and treatment, or long-term care. A total of 36 studies were included. Results indicated that not all persons with dementia are excluded from participating in the decision-making process, but there is a broad spectrum of what constitutes shared decision-making in dementia. Studies concerning the determinants of shared decision-making mostly focused on non-modifiable factors. Future research is needed to better promote shared decision-making among persons with dementia and their family carers.© The Author(s) 2014

Remaining in the nursing home versus transfer to acute care: resident, family, and staff preferences.
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Tappen RM, Worch SM, Elkins D, Hain DJ, Moffa CM, Sullivan G.
Journal of gerontological nursing 2014 Oct;40(10):48-57

Resident and family insistence on transfer is a major factor in the occurrence of potentially avoidable transfers from nursing homes (NHs) to acute care. The purpose of this study was to explore resident, family, and staff preferences regarding transfer to acute care. A sample of 271 NH residents, family members, staff, and medical providers were interviewed. Seventy-seven percent of residents reported that they had not given any thought to the question of whether they would want to be transferred to acute care. Family members wanted more information than residents, but more residents (39%) thought they should be fully involved in the transfer decision than their family members (12%) or staff (12%). Staff preferred keeping residents in the NH. Families were divided between transferring residents and having them remain in the NH. More residents indicated that their desire to transfer would depend on the severity of their condition and their prognosis. Ethnic group differences were noted. Results suggest that discussion of this issue should occur soon after admission and that differences in perspectives may be expected from those involved.

Antibiotic prescribing in long-term care facilities: a qualitative, multidisciplinary investigation
Fleming A, Bradley C, Cullinan S, Byrne S.
BMJ Open 2014;4(11)

To explore healthcare professionals’ views of antibiotic prescribing in long-term care facilities (LTCFs). To use the findings to recommend intervention strategies for antimicrobial stewardship in LTCFs. Design Qualitative semistructured interviews were conducted. The data were analysed by thematic content analysis. After the interviews, the emerging findings were mapped to the theoretical domains framework (TDF), and the behaviour change wheel and behaviour change technique (BCT) taxonomy were used to recommend future intervention strategies. Participants Interviews were conducted with 37 healthcare professionals who work in LTCFs (10 general practitioners, 4 consultants, 14 nurses, 9 pharmacists) between December 2012 and March 2013. Setting Interviews were conducted in the greater Cork region. Results The main domains from the TDF which emerged were: ‘Knowledge’, ‘Environmental context and resources’, ‘Social influences’, ‘Beliefs about consequences’, ‘Memory, attention and decision making’, with the findings identifying a need for ‘Behavioural regulation’. Many participants believed that antibiotic prescribing was satisfactory at their LTCF, despite the lack of surveillance activities. Conclusions This study, using the TDF and BCT taxonomy, has found that antibiotic prescribing in LTCFs is influenced by many social and contextual factors. The challenges of the setting and patient population, the belief about consequences to the patient, and the lack of implementation of guidelines and knowledge regarding antibiotic prescribing patterns are significant challenges to address. On the basis of the study findings and the application of the TDF and BCT taxonomy, we suggest some practical intervention functions for antimicrobial stewardship in LTCFs.

The Prevalence of Uncontrolled Pain in Long-Term Care: A Pilot Study Examining Outcomes of Pain Management Processes.
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Good H, Riley-Doucet CK, Dunn KS.
Journal of gerontological nursing 2014 Nov 7:1-8

Pain in long-term care (LTC) is common among older residents despite the vast options available for optimal pain management. Inadequate pain management affects individual health care outcomes. Researcher evidence has shown that nurse practitioners (NPs) improve the quality of care in LTC but are challenged by multiple barriers that inhibit optimal pain control. The purpose of the current pilot study was to explore both the pain management processes used by nurses in LTC and the documented patient outcomes that come from these processes. In addition, factors were identified that may impact the NP role in providing adequate pain control in LTC. This descriptive study used a retrospective, case-controlled research design that incorporated reviewing 55 LTC resident medical records. Results show how the process of pain management in LTC can be improved by expanding the professional role of the NP.

Non-capable residents: is the experience of dependence understood in nursing homes? A qualitative study.
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Palacios-Cena D, Gomez-Calero C, Cachon-Perez JM, Brea-Rivero M, Gomez-Perez D, Fernandez-de-las-Penas C.
Geriatrics & gerontology international 2014 Jan;14(1):212-219

The aim of the present study was to describe how dependence was experienced by Spanish nursing home residents with functional limitations. METHODS: A qualitative phenomenological approach was followed. An initial purposeful sampling of Spanish residents in for-profit nursing homes in the southern area of Madrid was carried out. Theoretical sampling was also implemented in order to gain a more in-depth understanding of dependence. The inclusion criteria for nursing home residents were: aged 60 years old or older, having a functional impairment (Barthel Index 19) and able to communicate verbally in Spanish. Data were collected using unstructured and semi-structured interviews. The interviews were tape recorded and fully transcribed. Data collection was concluded once theoretical saturation was reached, and the data were analyzed using the Giorgi proposal. RESULTS: A total of 30 residents (15 female and 15 male) with a mean age of 83 years were included. Two main themes that describe the significance of dependence in nursing homes emerged from the data: (i) remaining “capable”, with one subtheme named “building the difference”, where residents described their own dependence classification of “non-capable” residents; and (ii) “sharing life”, with two subthemes named “living together with non-capable residents” and “sharing the environment”. Being considered as “non-capable” is labelling the resident forever. CONCLUSIONS: The dependence experience of Spanish nursing home residents might help us gain a deeper insight into their expectations about functional limitations, as well as to understand the change in the relationship between residents considered “non-capable”, caregivers and the other residents. © 2013 Japan Geriatrics Society.

Baby boomer caregiver and dementia caregiving: findings from the National Study of Caregiving.
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Moon H, Dilworth-Anderson P.
Age and Ageing 2014 Oct 30

BACKGROUND: previous studies have well documented the characteristics of baby boomers but less is known about the experiences of boomer caregivers (CGs) of people with dementia. OBJECTIVE: the purpose of this study was to compare the characteristics of boomer CGs of people with dementia with those of boomer CGs for people without dementia and to ascertain factors associated with outcomes. DESIGN: we selected baby boomer CGs from the National Study of Caregiving (NSOC) with 650 primary boomer CGs (138 CGs of people with dementia and 512 CGs of people without dementia). METHODS: the Stress Process Model (SPM) was used to examine the effects of resources (the use of paid help and informal support) and stressors (primary: level of CG care activities and interrupted sleep; secondary: strain of caregiving on work, other care and social activities) on CGs’ down, depressed or hopeless feelings and self-perceived general health. T-tests and chi-square tests were used to compare SPM domain differences and ordinary least-square multiple regression analysis was used to investigate predictors of CGs’ outcomes. RESULTS: high blood pressure and arthritis were the most prevalent chronic diseases in both groups. Boomer CGs of people with dementia reported providing more help with daily activities, higher level of caregiving and social activity conflict, experiencing more interrupted sleep and more down, depressed or hopeless feelings than CGs of people without dementia. Different factors predicted boomer CGs’ outcomes. CONCLUSION: the current results yield important information about the considerable differences between two baby boomer CG groups within the caregiving experiences. The findings highlight the need to provide tailored interventions to boomer CGs to help them cope with caregiving stress to improve their physical and mental health. © The Author 2014.

Development of Six Arts, a Culturally Appropriate Multimodal Nonpharmacological Intervention in Dementia.
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Wong GH, Ng CK, Lai CK, Lee MN, Lum TY, Jiang N, et al.
The Gerontologist 2014 Nov 6

There is accumulating evidence for the efficacy of nonpharmacological multimodal stimulation interventions in maintaining cognition and improving quality of life in people with mild-to-moderate dementia. However, the complex nature of these interventions limits their application in practice and research. We report here the design and development of a culturally appropriate framework, the Six Arts, to guide delivery of multimodal interventions in a Chinese community. DESIGN AND DEVELOPMENT: The Six Arts are a core set of Confucian philosophy comprising 6 disciplines of rites, music, archery, charioteering, literacy, and numeracy. They correspond to major mind-body functional domains of social functioning; music and rhythm; visuospatial and fine motor skills; kinesthetic and gross motor skills; language and verbal skills; and executive function. Using Six Arts as a framework, we mapped theoretical principles and evidence-based nonpharmacological interventions of cognitive stimulation, physical exercise, and social activities against the 6 functional domains. From 2011, we field-tested the use of Six Arts in structuring intervention programs in 263 people in a dementia day center in Hong Kong. RESULTS: The Six Arts was operationalized through the development of an intervention activity database, a scoring system for intensity level, and a service delivery model for application in dementia day centers. IMPLICATIONS: Six Arts can be used as framework for structuring nonpharmacological group intervention programs in dementia day center in a metropolitan Chinese city. Its cultural appropriateness may facilitate communication and shared decision making with families with dementia in communities influenced by Confucian philosophy. © The Author 2014.

Conditions, components and outcomes of Integrative Validation Therapy in a long-term care facility for people with dementia. A qualitative evaluation study
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Erdmann A, Schnepp W.
Dementia (London, England) 2014 Nov 11

In this study, the practical application of Integrative Validation Therapy (IVA) in a nursing home for people with dementia was investigated and evaluated from the perspectives of professionals and relatives by using Fourth Generation Evaluation. IVA, a complex intervention frequently applied in Germany’s long-term care settings, is a modification of Feil’s Validation Therapy and contains a specific attitude and several components of action. The findings demonstrate that professionals as well as relatives of nursing home residents gave the intervention a positive rating. From the perspective of the participating professionals, the application of IVA results in less agitated residents which also has an influence on the consumption of benzodiazepine and neuroleptics. The authors conclude that IVA is a beneficial nursing intervention helping to facilitate the illness-related transition process of people with dementia. IVA is able to support them to cope with emotional distress during transition (e.g. irritability, anxiety, depression, changes in self-esteem). Another conclusion is that IVA supports person-centred care because, with IVA, professionals react to typical needs people with dementia have: comfort, inclusion, attachment and identity.

Exploring the Service and Support Needs of Families With Early-Onset Alzheimer’s Disease
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Gibson AK, Anderson KA, Acocks S.
American Journal of Alzheimer’s Disease and Other Dementias 2014 Nov;29(7):596-600

Although often cast as a disease of later life, a growing number of people are being diagnosed with Alzheimer’s disease in their 50s and 60s. Early-onset Alzheimer’s disease (EOAD) poses special challenges and needs for individuals and their caregivers, such as employment and access to services. In this cross-sectional study, the researchers surveyed 81 (N = 81) family caregivers to individuals with EOAD to identify service and support usage and need. Descriptive analyses revealed that families utilized a range of formal services (eg, adult day) and informal support from family and friends. In terms of challenges and needs, participants indicated that they struggled most with employment, benefits, and financial issues. Although most caregivers felt that they were coping well, they also indicated that their needs were not well understood by service providers and the public. These findings highlight the need to better understand and respond to the specific issues surrounding EOAD.

Potentially Suboptimal Prescribing for Older Veteran Nursing Home Patients With Dementia.
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Hanlon JT, Aspinall SL, Handler SM, Gellad WF, Stone RA, Semla TP, et al.
The Annals of Pharmacotherapy 2014 Nov 7

Nursing home patients with dementia may be more likely to suffer adverse drug events from suboptimal prescribing. Previous studies have not used national samples, nor have they examined multiple types of suboptimal prescribing by dementia severity. OBJECTIVE: To examine the prevalence of and factors associated with potentially suboptimal prescribing in older veteran nursing home patients with dementia. METHODS: This is a retrospective descriptive study of 1303 veterans 65 years or older admitted between January 1, 2004, and June 30, 2005, with dementia for long stays (90+ days) to 133 Veterans Affairs Community Living Centers. Dementia severity was determined by the Cognitive Performance Scale and functional status dependences. RESULTS: Overall, 70.2% with mild-moderate dementia (n = 1076) had underuse because they did not receive an acetylcholinesterase inhibitor (AChEI), and 27.2% had evidence of inappropriate use because of a drug-disease or drug-drug-disease interaction. Of the 227 with severe dementia, 36.1% had overuse by receiving an AChEI or lipid-lowering or other agents, and 25.1% had evidence of inappropriate use as a result of a drug-disease or drug-drug interaction. Multinomial logistic regression analyses among those with mild to moderate dementia identified that living in the South versus other regions was the single factor associated with all 3 types of suboptimal prescribing. In those with severe dementia, antipsychotic use was associated with all 3 suboptimal prescribing types. CONCLUSIONS: Potentially suboptimal prescribing was common in older veteran nursing home patients with dementia. Clinicians should develop a heightened awareness of these problems. Future studies should examine associations between potentially suboptimal prescribing and health outcomes in patients with dementia.

Effective Pain Management in Patients with Dementia: Benefits Beyond Pain?
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Flo E, Gulla C, Husebo BS.
Drugs & aging 2014 Nov 6

This current opinion aims to provide a literature overview of the associations between pain and neuropsychiatric symptoms and the efficacy of pain management for both pain and neuropsychiatric symptoms in patients with dementia. In addition, international guidelines and recommendations for pain management have been collated, and important developing research areas are highlighted. Pain is, in general, under-recognized and undertreated in people with dementia and may therefore trigger or exacerbate neuropsychiatric symptoms. While there is an abundance of pain assessment instruments intended for people with dementia, few have been adequately tested for their feasibility, reliability and validity. In patients with dementia, vocalizations, facial expressions and body movements may be the only valid expressions of pain. Further, pain has been related to the neuropsychiatric symptoms of agitation, aggression, mood syndrome and sleep problems. Unfortunately, health personnel may misinterpret these symptoms as neuropsychiatric symptoms of dementia. A differential assessment of dementia, its presenting neuropsychiatric symptoms and the potential presence of pain is crucial to provide the correct treatment. To achieve this, use of pain assessment tools that are responsive to change and are validated for use in patients with dementia is a prerequisite. To date, there have been few studies, with inconsistent findings on the association between pain and neuropsychiatric symptoms. To ensure a better differential assessment of pain and neuropsychiatric symptoms, and consequently more accurate treatment for patients with dementia, studies with adequate statistical power and high-quality study designs, including randomized controlled trials, are needed.

AHRQ 2014 Nursing Home Comparative Database Report (US)

The second edition of the AHRQ Nursing Home Survey on Patient Safety Culture User Comparative Database Report presents data from 18,968 staff within 263 U.S. nursing homes. The 2014 report provides results that nursing homes can use to compare their patient safety culture to other U.S. nursing homes. The full report contains detailed comparative data for various nursing home characteristics (size and ownership) and respondent characteristics (job titles, work areas, direct patient contact, and shift worked).

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Making Decisions for Seriously Ill Children: Growing up in Hospital
Friday 21 November 12:00-13:00 Dvorkin Centre 2G2.07 WMC

A recent study of patients hospitalized for 6 consecutive months or longer at Stollery Children’s Hospital will be discussed, in the larger context of what we are learning about long hospitalization and its consequences.


KT Canada twitter journal club
Thursday 20 November 10:00

The articles being discussed are: Lost in knowledge translation: Time for a map? & Leg-ulcer care in the community, before and after implementation of an evidence-based service. Sessions will be held by Webex and be followed by 24 hours of tweeting using: #KTCJClub. Interested participants should email Gail Klein to register. We have limited number of spots available and registration will be on a first come first serve basis.

IHI: 100 Million Healthier Lives by 2020
Thursday 20 November 12:00-13:00

When IHI first introduced the framework of the Triple Aim in 2008, we couldn’t have imagined how much it would resonate with health and health care improvers all over the world. Six years and much on the ground experience later, this pursuit of better experience of care, better health, and lower costs, is taking a new, exciting turn and we want to tell you about these developments on the November 20 WIHI: 100 Million Healthier Lives by 2020.

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Becoming a Peer Reviewer
This is an online course that can be completed at any time

This free course is designed to help you become a successful reviewer of a scientific or scholarly journal. You’ll find all of the basics covered in this course, as well as pointers toward more advanced topics.

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IRDS Statement on Advancing Implementation Research and Delivery Science

The Statement was developed by the participants of a series of consultative meetings hosted by the Alliance for Health Policy and Systems Research within the World Health Organization, the United States Agency for International Development (USAID), and the World Bank Group, with the facilitation of the USAID|TRAction Project and Johns Hopkins University.

Devouring your data

You’ve read hundreds of books. You’ve waded through archival material. You’ve got mountains of surveys, folders full of transcripts, notebooks stuffed with barely legible field notes, and rather more photographs than you initially intended. Now what? How is it going to be possible to convert all of this material into something sensible? Where do you start? What is it you don’t know about data analysis ?

The Dutch Village Where Everyone Has Dementia

The town of Hogeway, outside Amsterdam, is a Truman Show-style nursing home.

Why Are Publishers and Editors Wasting Time Formatting Citations?

A scholarly reference at its most basic element is a string that provides readers with sufficient information to track back to the original source of the content being referenced. That information, of course, varies by the type of publication, the source document, and the complexity of the resource being referenced. There will always be a variety of citation styles based on the type of resource, but why do we need so many different styles for the same type of resource?

Coordinated Care Lets Alzheimer’s Patients Stay at Home Longer

Elderly men and women with Alzheimer’s and other serious memory problems who got home visits and care assessments from a nurse and memory care coordinator were able to remain at home much longer than those who didn’t get such visits, a new study found. The results show that relatively simple measures like assessing home safety, vision and hearing checks and daily activity plans can produce improvements at relatively low costs.

‘Networking Seems So Sleazy’ but it is crucial for a career in academia

Like it or not, qualifications and smarts alone will not get you your next job, academic or otherwise. You need connections, too. Knowing people in your desired career field allows them to build trust in you, understand your work ethic, and be aware of your career goals.

IOM Conducting Study on Family Caregiving for Older Adults (US)

An ad hocstudy committee will analyze the most recent information about family caregivers of older adults. Unmet needs, differences in needs associated with race, ethnicity, and other factors, and progress in delivery reform will be examined for caregivers and caregiving. Factors that are likely to affect family caregiving in the next decades will be identified, the likely gap between needed and available caregivers estimated, and the implications for other components of long-term and other health care assessed.

West Middlesex ‘well ahead of the game’ in recognising health care assistants (UK)

Following the Francis report, West Middlesex Hospital has taken various steps to ensure their health care assistants (HCAs) are fully competent to deliver safe and compassionate care. The Trust has invested in HCA training and further support for HCAs continued personal development, including the launch of HCA local registration.

SafeCare BC Tackles Back Injuries In LTC Canada-flat-icon

Earlier this year, SafeCare BC launched is Be Care Aware campaign aimed at increasing awareness of workplace hazards and promoting a culture of safety in the continuing care sector.

Consensus on quality: what matters to you? (UK)

The Nuffield Trust and the Health Foundation are gathering the views of patients, carers, health and social care professionals and policy makers on what is important in understanding the quality of care people receive. This information will help inform the development of QualityWatch, a joint research programme looking at how the quality of health and social care is changing over time.

Re-appointment to the National Seniors Council Canada-flat-icon

Mr. Hubert P. McGrath has been reappointed as member of the National Seniors Council

No dedicated patients for nurse practitioners in PEI Canada-flat-icon

Nurse practitioners will not be dealing with patient lists of their own any time soon. A pilot project launched in 2012 has flagged concerns that Health PEI says need to be addressed first. In particular, regulations need to be put in place so nurse practitioners can prescribe narcotics.

Charting the Road From Attention to Citation

Citation has been the widely accepted metric of impact of a scientific publication for decades. Besides citations, the impact of an article could be reflected and quantified by some alternative metrics, including article views, Mendeley readerships and Altmetric scores, etc. There were lots of studies on the relationship between citations and other metrics to examine the reliability of different metrics. Significant correlation between views and citations is confirmed by previous studies, but some researchers also found that the correlation between altmetrics and citations is low.

The top 5 innovations in knowledge translation

In this post, BioMed Central regular guest blogger Jay Shaw looks at 5 key innovations that are bringing the practice of knowledge translation into the future.

Long-Form Census: Ted Hsu’s Bill To Bring Back Questionnaire Set For Debate Canada-flat-icon

The Commons will debate a private member’s bill to bring back the long-form census, the mandatory questionnaire axed by the Conservative government in 2010.

Breaking new ground in models of care for aging in Australia

From collaborations with the acute and retirement living sectors to the development of new workforce models, aged care providers are pioneering future models of delivering care and services. Australian Ageing Agenda presents snapshots of three initiatives to watch.

Alzheimer’s Society and Royal Society for Public Health to launch joint qualification on understanding dementia (UK)

Alzheimer’s Society and Royal Society for Public Health (RSPH) have joined forces to create a new qualification to help people understand more about dementia.

Bracing for the Falls of an Aging Nation (US)

As the population ages and people live longer in bad shape, the number of older Americans who fall and suffer serious, even fatal, injuries is soaring.

Support for dementia not statistics – Alistair Burns (UK)

As the UK Dementia Congress is staged in Brighton this week Alistair Burns, NHS England’s National Clinical Director for Dementia, explains why providing post diagnostic support to everyone with dementia and their carers is essential.

Care home life unacceptable, says older people’s watchdog (UK)

Many older people living in care homes have an “unacceptable quality of life” and quickly become institutionalised, says a watchdog. A review of homes in Wales said they were seen as places of “irreversible decline” where residents were unable to do things that matter to them.

Dementia care experts discuss innovation and sustainable care in Tokyo

Experts in innovation in care and risk reduction recently met at the third Global Dementia Legacy event in Japan to explore how new technology can improve the lives of those with dementia, as well as looking at whether lifestyle choices can reduce the risk of developing dementia.

Mentoring the next generation of peer reviewers

Peer review is at the heart of scientific publishing. It provides the opportunity to discuss and improve upon a manuscript before publication and helps to ensure quality standards of articles published. But current complexities in the academic landscape, variations in the approach to assessing research, and difficulty securing reviewers due to demands on time are pulling at the seams of the peer review structure.

‘Sandwich generation’ carers say choosing care is one of life’s most stressful events (UK)

8 out of 10 users identify choosing care as a major source of stress. These findings come as the Care Quality Commission introduces ratings that will give clearer guidance for those choosing social care services.

Home care challenges frustrate patient’s family Canada-flat-icon

Ethel Turner’s mother continues to take up a hospital bed in Truro, Nova Scotia, even though she has been discharged. Turner tried to arrange home care for her mother after doctors recently gave her the OK to go home, but the family was informed by the local Victorian Order of Nurses office that there is a freeze on taking new patients in their area.

Take action today to bring back the long-form census! Canada-flat-icon

Right now, there is a bill before parliament that proposes to amend the Statistics Act in order to reinstate the long form census and expand the authority of the Chief Statistician of Canada. MP Ted Hsu introduced Bill C-626 as a private member’s bill in September 20141. The bill is currently up for debate and will come to a vote this winter.

We All Have a Dog in the Fight When Researchers Lie

Systematic research into the causes of scientific misconduct is scarce. However, occasionally committees of investigation and research organisations have offered some comment. Some see the researcher as a “bad apple”. A researcher’s own ambition, vanity, desire for recognition and fame, and the prospect for personal gain may lead to behavior that crosses the limits of what is admissible. Others point to the culture that may prevail in certain disciplines or research groups (“bad barrel”).

Dementia education lacking in Nova Scotia: advisory committee Canada-flat-icon

A group appointed by the province to examine dementia care, now half way through its research, said it’s clear people in Nova Scotia have a lot to learn about this growing problem.

Who will support people who are ageing without children? (UK)

By 2030, a quarter of people in the UK will get old without having children. Measures need to be put in place to fill the care gap.

Hospitals Are Finally Starting to Put Real-Time Data to Use (US)

To make the most of their data, providers should follow in the footsteps of pioneering health care systems like ThedaCare in Wisconsin, and Salem Health in Oregon and make clinical business intelligence (CBI) a priority. CBI is an IT system that collects and analyzes data and delivers the results to frontline clinicians in real time, helping them to make better decisions. It can be used to keep clinicians informed about everything from infections and iatrogenic injuries (those caused unintentionally by physicians) to whether units are over- or understaffed.

Yukon blasted for using hospital beds for long-term care Canada-flat-icon

Health minister Doug Graham was criticized in the Yukon Legislature for allowing the use of hospital beds for long-term care.

College of Family Physicians of Canada call for a national home-care strategy Canada-flat-icon

Canada’s family doctors are calling on the federal government to develop a national home-care strategy for seniors.

1 in 5 nursing home residents abused (US)

Researchers say that such injuries are often inflicted not by overworked health aides, but by a seemingly harmless roommate, or someone living just down the hall.

Centers for Medicare and Medicaid Services announced several changes to the Nursing Home 5-Star Rating System (US)

Beginning in 2015, CMS will implement a number of improvements.

Centers for Medicare and Medicaid Services Will Expand MDS 3.0 Focused Surveys in 2015 (US)

The Centers for Medicare and Medicaid Services (CMS) announced that it will expand its 2014 5-State MDS 3.0 Focused Survey Pilot to a nationwide sample in 2015, and that it also plans to include an evaluation of staffing in some of the selected focused-survey facilities.

Redesigning how health services are delivered in Japan would better meet the needs of a super-ageing population, says OECD

Elderly individuals with complex, chronic diseases need continuous and tailored care to maintain their health and maximise their ability to participate in society. Japan must change the way it delivers health services for older citizens by strengthening its specialist primary care and making mental health care services more widely available, according to a new OECD report.

B.C. commits an additional $4 million for dementia care Canada-flat-icon

Health Minister Terry Lake announced $4 million in funding for the Alzheimer Society of B.C. to help expand a key program the organization provides so even more people can access supports and services.

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Watch the Global Dementia Legacy Event Japan from anywhere

Experts in dementia care and risk reduction met in Japan in early November for the third Global Dementia Legacy event. The sessions were lived streamed and are archived. Just follow the link to view them.

How and why researchers share data (and why they don’t)

Results from a survey of 90 000 researchers Wiley conducted into their views of data sharing.

How Do I Pitch Myself for Associate-Professor Positions?

Applying for associate-level positions is a largely mysterious process, and while there are plenty of online articles discussing how to achieve tenure, there’s very little information on how to apply for an associate-professor position at another campus.

GUIDE-M Canada-flat-icon

The GUIDE-M (The Guideline Implementabilty for Decision Excellence Model) is comprised of components intrinsic to practice guidelines (PGs) that play a role in optimising the implementability of PGs. Developed to reflect an evidence-informed international and multidisciplinary perspective to PG implementability, the GUIDE-M can be used by (i) PG developers, (ii) clinicians and other PG users; and (iii) the research community.

Dementia Gateway

This is a great resource from SCIE (Social Care Institute for Excellence) in the UK. There is now so much interest in supporting people to live well with dementia and the list of reports, reviews, guides, toolkits and checklists that relate to dementia care grows daily. Keeping up can be difficult. Look here for up-to-date lists of ‘Useful links’ on a wide range of key topics in dementia care. Almost all the resources listed are available to view online or download for free.

Eatwell, tableware for people with dementia

Eatwell is a tableware set for people with cognitive impairments, such as Alzheimer’s.

Users’ Guide to Dissemination and Implementation in Health for Researchers and Practitioners

Closing the gap between research discovery and clinical and community practice is essential if we are to succeed in improving our nation’s health. Understanding how best to disseminate and implement evidence-based healthcare and prevention, while not implementing inappropriate or unnecessary services, is challenging. The content is divided into five sections:
• Why D&I is important
• Definitions, theories and concepts
• Strategies and tools for designing successful D&I interventions
• Recommendations for evaluation design and measurement
• Tips for success – for researchers and practitioners
In each section we point you to key references and online resources to aid you in further study and application. This Guide was developed by the Center for Research in Implementation Science and Prevention (CRISP) in partnership with colleagues from the Colorado Clinical and Translational Sciences Institute (CCTSI), the Kaiser Permanente Center for Health Education Dissemination and Implementation Research, and the Department of Veterans Affairs.


JournalGuide is a free tool that helps researchers match their manuscripts with relevant target journals.

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NCI-funded Post-Doctoral Training Opportunity in Implementation Science
UMass Medical School Worcester, MA
DEADLINE 15 February

Trainees are placed under the mentorship of our world-renowned faculty with vast expertise in implementation science, including areas such as health informatics, health equity and cultural adaptation. Trainees are matched with a clinical, public health and community partners and provided with the opportunity to conduct collaborative pilot research. This supports trainees to initiate an independent research program focused on translating evidence into practice across the cancer continuum, including prevention, early detection, diagnosis, treatment and survivorship.

ASPIRE WP2 Research Fellow
Faculty of Medicine & Health, University of Leeds, Leeds UK
DEADLINE 30 November

We are seeking a researcher for [period of post] to work in a major NIHR-funded programme. Action to Support Practices Implementing Research Evidence (ASPIRE) aims to develop and evaluate an intervention package to improve adherence to guideline recommendations in primary care. You will manage a qualitative process evaluation to examine how the intervention package works in practice.

Research Associate
Age and Ulster University; Faculty of Life and Health Sciences – Institute of Nursing and Health Research
Belfast UK

The principal aim of the post is to support researchers based at Engage with Age (EWA), the Ulster University and Queen Margaret University (Scotland) who have been funded to undertake research exploring the lived experience of people with dementia, and their carers when a technology enriched supported housing model is the living option of choice. This research has been funded by HSC Research & Development Division, Public Health Agency (Northern Ireland) in collaboration with The Atlantic Philanthropies.

Senior Advisor, Knowledge Outreach/Translation-Maternity Leave Replacement
Canadian Institute for Advanced Research (CIFAR) Canada-flat-icon
DEADLINE 30 November Toronto

At CIFAR, knowledge outreach (i.e. knowledge translation, knowledge mobilization) connects the knowledge and ideas of CIFAR’s research programs with those that are best able to act on this knowledge while also ensuring that the perspectives of those individuals inform our broad research directions. The Senior Advisor, Knowledge Outreach has twofold responsibilities: draw on his/her experience in an academic and/or knowledge user environment to bring new insights and perspectives into the Institute’s long-term knowledge outreach strategy and be responsible for key aspects of the Institute’s knowledge outreach plan by providing leadership, advice and support to CIFAR’s program directors in the development, and evaluation of their program’s knowledge outreach plans and associated activities.

Community Engagement and Development Officer Canada-flat-icon
McMaster University, Hamilton ON
DEADLINE 17 November

A Community Engagement and Development Officer is required to work with the CanChild team and will be responsible for knowledge translation, including developing and maintaining sustainable partnerships with community groups , developing both traditional and web communications plan aimed at strengthening engagement with families, youth with disability and other stakeholders. This individual will work within various projects/activities at CanChild including Ontario Brain Institute CP-Net, 25th Anniversary, etc.

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