Congratulations to Professor Jo Rycroft-Malone
She will be the new director for the NIHR Health Services and Delivery Research Programme
Professor Jo Rycroft-Malone is the new director of the NIHR Health Services and Delivery Research (HS&DR) Programme. The appointment has been made in succession to Professor Ray Fitzpatrick who will be stepping down at the end of October 2015. Speaking about her appointment, Professor Rycroft-Malone said “I am delighted to have been appointed to this role and look forward to leading the NIHR Health Services and Delivery Research Programme for the next few years.”
New article by Dr. Carole Estabrooks, Dr. Joanne Profetto-McGrath, Dr. Jo Rycroft-Malone:
The hidden complexity of long-term care: how context mediates knowledge translation and use of best practices.
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Cammer A, Morgan D, Stewart N, McGilton K, Rycroft-Malone J, Dopson S, Estabrooks C.
The Gerontologist 2014 Dec;54(6):1013-1023
Context is increasingly recognized as a key factor to be considered when addressing healthcare practice. This study describes features of context as they pertain to knowledge use in long-term care (LTC). DESIGN AND METHODS: As one component of the research program Translating Research in Elder Care, an in-depth qualitative case study was conducted to examine the research question “How does organizational context mediate the use of knowledge in practice in long-term care facilities?” A representative facility was chosen from the province of Saskatchewan, Canada. Data included document review, direct observation of daily care practices, and interviews with direct care, allied provider, and administrative staff. RESULTS: The Hidden Complexity of Long-Term Care model consists of 8 categories that enmesh to create a context within which knowledge exchange and best practice are executed. These categories range from the most easily identifiable to the least observable: physical environment, resources, ambiguity, flux, relationships, and philosophies. Two categories (experience and confidence, leadership and mentoring) mediate the impact of other contextual factors. Inappropriate physical environments, inadequate resources, ambiguous situations, continual change, multiple relationships, and contradictory philosophies make for a complicated context that impacts care provision. IMPLICATIONS: A hidden complexity underlays healthcare practices in LTC and each care provider must negotiate this complexity when providing care. Attending to this complexity in which care decisions are made will lead to improvements in knowledge exchange mechanisms and best practice uptake in LTC settings. © The Author 2013.
New article by Dr. Greta Cummings & Dr. Joanne Profetto-McGrath
Interventions that promote retention of experienced registered nurses in health care settings: a systematic review.
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Lartey S, Cummings G, Profetto-McGrath J.
Journal of nursing management 2014 Nov;22(8):1027-1041
The aim of this review was to report the effectiveness of strategies for retaining experienced Registered Nurses. BACKGROUND: Nursing researchers have noted that the projected nursing shortage, if not rectified, is expected to affect healthcare cost, job satisfaction and quality patient care. Retaining experienced nurses would help to mitigate the shortage, facilitate the transfer of knowledge and provision of quality care to patients. EVALUATION: A systematic review of studies on interventions that promote the retention of experienced Registered Nurses in health care settings. KEY ISSUES: Twelve studies were included in the final analysis. Most studies reported improved retention as a result of the intervention. Team work and individually targeted strategies including mentoring, leadership interest and in-depth orientation increased job satisfaction and produced higher retention results. CONCLUSIONS: Few published studies have examined interventions that promote the retention of experienced Registered Nurses in healthcare. Retention was highest when multiple interventions were used. Further research is needed to inform nurse leaders of ways to retain nurses and to maintain quality care in health care settings. IMPLICATIONS FOR NURSING MANAGEMENT AND LEADERSHIP: Programmes targeting the retention of experienced nurses need to be considered when implementing measures to decrease the nursing shortage and its effects on quality care. © 2013 John Wiley & Sons Ltd.
New article by Dr. Lisa Cranley
Factors influencing home care nurse intention to remain employed.
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Tourangeau A, Patterson E, Rowe A, Saari M, Thomson H, MacDonald G, Cranley L, Squires M.
Journal of nursing management 2014 Nov;22(8):1015-1026
AIM: To identify factors affecting Canadian home care nurse intention to remain employed (ITR). BACKGROUND: In developed nations, healthcare continues to shift into community settings. Although considerable research exists on examining nurse ITR in hospitals, similar research related to nurses employed in home care is limited. In the face of a global nursing shortage, it is important to understand the factors influencing nurse ITR across healthcare sectors. METHODS: A qualitative exploratory descriptive design was used. Focus groups were conducted with home care nurses. Data were analysed using qualitative content analysis. RESULTS: Six categories of influencing factors were identified by home care nurses as affecting ITR: job characteristics; work structures; relationships/communication; work environment; nurse responses to work; and employment conditions. CONCLUSION: Findings suggest the following factors influence home care nurse ITR: having autonomy; flexible scheduling; reasonable and varied workloads; supportive work relationships; and receiving adequate pay and benefits. Home care nurses did not identify job satisfaction as a single concept influencing ITR. IMPLICATIONS FOR NURSING MANAGEMENT: Home care nursing management should support nurse autonomy, allow flexible scheduling, promote reasonable workloads and create opportunities for team building that strengthen supportive relationships among home care nurses and other health team members. © 2013 John Wiley & Sons Ltd.
Articles & Reports recommended by Dr. Carole Estabrooks
Analysing organisational context: case studies on the contribution of absorptive capacity theory to understanding inter-organisational variation in performance improvement.
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Harvey G, Jas P, Walshe K.
BMJ quality & safety 2014 Oct 21
Organisational context is frequently cited as an important consideration when implementing and evaluating quality improvement interventions in healthcare, but limited guidance is available on which aspects of context are most influential or modifiable. This paper examines how internal and external contextual factors mediate organisational-level performance improvement through applying the knowledge-based theory of absorptive capacity (AC). METHODS: Three healthcare case studies are presented. Each case is a UK National Health Service organisation that had been identified as having performance problems. Qualitative data were collected through semi-structured interviews with general and clinical managers within the organisation and members of external teams supporting or overseeing performance improvement (n=22). Interview data were analysed using an existing AC framework from the literature. RESULTS: The organisation with the highest AC showed the quickest and most comprehensive performance improvement. Internal characteristics including strategic priorities, processes for managing information, communication and orientation to learning and development impacted on the organisation’s ability to engage successfully with external stakeholders and make use of available knowledge. This enabled the organisation to thrive despite the challenging external environment. Lower levels of AC appeared to delay or limit the improvement trajectory. CONCLUSIONS: Developing a more detailed and nuanced understanding of how context influences improvement is an important step towards achieving more effective and sustainable quality improvement programmes in healthcare. AC, with its focus on knowledge and organisational learning, provides a useful way to explore the relationship between context and quality improvement and represents a potentially valuable area for future research and development.
-The United States stands out for having the highest rates of chronic health conditions, such as diabetes and heart disease: 87 percent of older adults in the U.S. reported at least one chronic illness,and 68 percent reported two or more.
-Despite having Medicare coverage, U.S. adults age 65 or older were the most likely to report that cost posed a barrier to care. One-fifth (19%) said cost was the reason they did not visit a doctor, skipped a medical test or treatment recommended by a doctor, did not fill a prescription, or skipped doses.
-U.S. survey respondents were also the most likely to report trouble paying their medical bills (11%). Only 1 percent in Norway and Sweden reported the same.
-Canadian, Swedish, Norwegian, and U.S. respondents were the least likely to be able to get a same- or next-day doctor’s appointment when sick or to find it somewhat or very easy to get after-hours care without using the emergency department.
-Older adults in all countries face care coordination and safety problems. In the U.S., 35 percent reported at least one problem with care coordination, such as not having a recommended medical test, receiving conflicting information from different doctors, or experiencing a lack of communication between a primary care doctor and a specialist. In every country but France, one-fifth or more of older adults have experienced at least one of these problems.
-Along with the U.K., the U.S. did well in areas related to managing chronic illness: 58 percent of chronically ill older adults in the U.S. and 59 percent in the U.K. had discussed their treatment goals with their doctor and had clear instructions about when to seek further care. Fewer than half of chronically ill people in the other nine countries said the same.
-More than three-quarters (78%) of older adults in the U.S. said they reported talking to a family member, friend, or health professional about their care preferences if they become unable to make decisions for themselves. Two-thirds said they had a written plan naming a health care proxy and more than half (55%) said they had a written plan regarding the treatment they want at the end of life.
CALL FOR ABSTRACTS:
Health Services Research Network (HSRN) Symposium
1-2 July Nottingham UK
DEADLINE 16 January
The Health Foundation invites abstracts on the theme of Improvement Science, that is new approaches to achieve measurable and timely improvement in care processes; development of the underlying theory and evaluation of methods to improve quality, safety and value; implementation of evidence-based healthcare
CALL FOR ABSTRACTS:
14th Qualitative Methods Conference
28-30 April Melbourne, Australia
DEADLINE 3 December
Qualitative methods are constantly evolving and are more diverse than ever, yet ever more contentious. New philosophies and questions have fostered arts-based qualitative methods using photography, poetry, and theatre. Innovative experimental writing styles have emerged, focusing on personal experience and the therapeutic benefits of research. All the while, there is simultaneous growth in applied qualitative methods that are time-limited, seemingly atheoretical, and ultra-practical.
CALL FOR ABSTRACTS:
Gerontological Society of America Annual Scientific Meeting
18-22 November 2015 Orlando FL
DEADLINE 5 March
The 2015 conference theme challenges researchers to highlight possible consequences of early life effects on aging, be it through biomedical events, nutrition, socioeconomic status, educational opportu-nities, stressful life experiences, or social relationships. The conference theme also challenges educators, both in the formal academic setting, and in communicating with the general public, to transmit the importance of lifelong experiences and lifestyle choices on the process of aging.
CALL FOR ABSTRACTS:
7th International Shared Decision Making Conference and the 4th International Society for Evidence-Based Health Care Conference
19-22 July Sydney Australia
DEADLINE 20 February
This is the first time the two conferences have come together reflecting the wider international interest in bringing research evidence and clinical decision-making closer together. ISDM-ISEHC 2015 invites abstracts for presentations that are related to Shared Decision Making and/or Evidence-Based Practice for the upcoming conference in Sydney on 19-22 July 2015. Proposals may be for individual papers, posters, symposia or workshops.
Grants & Awards
Upcoming SSHRC Knowledge Synthesis Grants
The call for proposals is scheduled to be released on SSHRC’s website in early January 2015, with an application deadline in late February 2015.
This competition will be launched in support of the objectives of the Imagining Canada’s Future initiative, with a focus on one of the six future challenge areas. The knowledge synthesis will address the challenge area of: What new ways of learning, particularly in higher education, will Canadians need to thrive in an evolving society and labour market?
Knowledge Translation and Strategic Communications: Unpacking Differences and Similarities for Scholarly and Research Communications
Barwick M, Phipps D, Myers G, Johnny M, Coriandoli R.
Scholarly and Research Communication 2014;5(3).
Knowledge translation (KT) involves communication of research evidence. Within research-relevant organizations there is considerable overlap in the roles and activities associated with KT and strategic communications (SC), which calls for greater role clarity. We untangle the differences and similarities between KT and SC, bringing clarity that may benefit organizations employing both types of workers. As KT practitioners (KTPs) take hold in organizations that have long had SC personnel, there is tension but also opportunities for defining roles and exploring synergies. What follows is a description of how we have explored this duality within our networks and an analysis of how SC and KT roles are similar and divergent.
Using the Diffusion of Innovations theory to understand the uptake of genetics in nursing practice: identifying the characteristics of genetic nurse adopters.
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Andrews V, Tonkin E, Lancastle D, Kirk M.
Journal of advanced nursing 2014 Apr;70(4):878-893
To identify the characteristics of nurses who are using genetics in practice and consider the implications of the findings for optimizing its wider uptake. BACKGROUND: Nurses are crucial in realizing the benefits from advances in genetic and genomic health care. Although many recognize genetics as an important component of disease, most feel unprepared to engage with it in practice. The Diffusion of Innovation theory provides a useful framework to describe different levels of engagement. Identifying the characteristics of nurses who have engaged with genetics (adopters) may provide insights of relevance to promoting wider adoption. DESIGN: A primarily quantitative approach over two phases, using online surveys conducted during 2011. METHOD: In phase 1, consensus (>75%) was sought from experts in genetics and nursing on four potential Indicators of Genetic Adoption could identify nurses who have adopted genetics. In phase 2, oncology and primary care nurses were surveyed to identify the characteristics and demographic indicators of genetic nurse adopters. RESULTS: A consensus was achieved to include all Indicators of Genetic Adoption (phase 1). In phase 2, 27·3% of respondents (n = 24/88) were categorized as being adopters. Eighteen characteristics were determined to be statistically significant (Mann-Whitney) in defining an adopter and included being open to experience and being more knowledgeable of and confident in using genetics. CONCLUSION: Nurses can be categorized in terms of their engagement with genetics through several distinguishing characteristics. Further research is needed to test the generalizability of the findings to a larger sample and other areas of nursing practice. © 2013 John Wiley & Sons Ltd.
Promoting Evidence-Based Practice Through a Research Training Program for Point-of-Care Clinicians.
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Black AT, Balneaves LG, Garossino C, Puyat JH, Qian H.
The Journal of nursing administration 2014 Nov 10
The purpose of this study was to evaluate the effect of a research training program on clinicians’ knowledge, attitudes, and practices related to research and evidence-based practice (EBP). BACKGROUND: EBP has been shown to improve patient care and outcomes. Innovative approaches are needed to overcome individual and organizational barriers to EBP. METHODS:: Mixed-methods design was used to evaluate a research training intervention with point-of-care clinicians in a Canadian urban health organization. Participants completed the Knowledge, Attitudes, and Practice Survey over 3 timepoints. Focus groups and interviews were also conducted. RESULTS: Statistically significant improvement in research knowledge and ability was demonstrated. Participants and administrators identified benefits of the training program, including the impact on EBP. CONCLUSIONS: Providing research training opportunities to point-of-care clinicians is a promising strategy for healthcare organizations seeking to promote EBP, empower clinicians, and showcase excellence in clinical research.
A complementary marriage of perspectives: understanding organizational social context using mixed methods.
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Beidas RS, Wolk CL, Walsh LM, Evans AC, Hurford MO, Barg FK.
Implementation science 2014 Nov 23;9(1):175
Organizational factors impact the delivery of mental health services in community settings. Mixed-methods analytic approaches have been recommended, though little research within implementation science has explicitly compared inductive and deductive perspectives to understand their relative value in understanding the same constructs. The purpose of our study is to use two different paradigmatic approaches to deepen our understanding of organizational social context. We accomplish this by using a mixed-methods approach in an investigation of organizational social context in community mental health clinics.MethodsNineteen agencies, representing 23 sites, participated. Enrolled participants included 130 therapists, 36 supervisors, and 22 executive administrators. Quantitative data was obtained via the Organizational Social Context (OSC) measure. Qualitative data, comprised of direct observation with spot sampling generated from agency visits, was coded using content analysis and grounded theory. The present study examined elements of organizational social context that would have been missed if only quantitative data had been obtained and utilized mixed methods to investigate if stratifying observations based on quantitative ratings from the OSC resulted in the emergence of differential themes.ResultsFour of the six OSC constructs were commonly observed in field observations (i.e., proficiency, rigidity, functionality, stress), while the remaining two constructs were not frequently observed (i.e., resistance, engagement). Constructs emerged related to organizational social context that may have been missed if only quantitative measurement was employed, including those around the physical environment, commentary about evidence-based practice initiatives, leadership, cultural diversity, distrust, and affect. Stratifying agencies by best, average, and worst organizational social context impacted interpretation for three constructs (affect, stress, and leadership).ConclusionsResults support the additive value of integrating inductive and deductive perspectives in implementation science research. This synthesis of approaches facilitated a more comprehensive understanding and interpretation of the findings than would have been possible if either methodology had been employed in isolation.
Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study
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Mold JW, Aspy CB, Smith PD, Zink T, Knox L, Lipman P, et al.
Implementation science 2014 Nov 23;9(1):169
Four practice-based research networks (PBRNs) participated in a study to determine whether networks could increase dissemination, implementation, and diffusion of evidence-based treatment guidelines for chronic kidney disease by leveraging early adopter practices.MethodsMotivated practices from four PBRNs received baseline and periodic performance feedback, academic detailing, and weekly practice facilitation for 6 months during wave I of the study. Each wave I practice then recruited two additional practices (wave II), which received performance feedback and academic detailing and participated in monthly local learning collaboratives led by the wave I clinicians. They received only monthly practice facilitation. The primary outcomes were adherence to primary care-relevant process-of-care recommendations from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Guidelines. Performance was determined retrospectively by medical records abstraction. Practice priority, change capacity, and care process content were measured before and after the interventions.ResultsFollowing the intervention, wave I practices increased the use of ACEIs/ARBs, discontinuation of NSAIDs, testing for anemia, and testing and/or treatment for vitamin D deficiency. Most were able to recruit two additional practices for wave II, and wave II practices also increased their use of ACEIs/ARBs and testing and/or treatment of vitamin D deficiency.ConclusionsWith some assistance, early adopter practices can facilitate the diffusion of evidence-based approaches to other practices. PBRNs are well-positioned to replicate this process for other evidence-based innovations.
Using the Knowledge to Action Framework in practice: a citation analysis and systematic review.
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Field B, Booth A, Ilott I, Gerrish K.
Implementation science 2014 Nov 23;9(1):172
Conceptual frameworks are recommended as a way of applying theory to enhance implementation efforts. The Knowledge to Action (KTA) Framework was developed in Canada by Graham and colleagues in the 2000s, following a review of 31 planned action theories. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. This review sought to answer two questions: `Is the KTA Framework used in practice? And if so, how?¿MethodsThis study is a citation analysis and systematic review. The index citation for the original paper was identified on three databases¿Web of Science, Scopus and Google Scholar¿with the facility for citation searching. Limitations of English language and year of publication 2006-June 2013 were set. A taxonomy categorising the continuum of usage was developed. Only studies applying the framework to implementation projects were included. Data were extracted and mapped against each phase of the framework for studies where it was integral to the implementation project.ResultsThe citation search yielded 1,787 records. A total of 1,057 titles and abstracts were screened. One hundred and forty-six studies described usage to varying degrees, ranging from referenced to integrated. In ten studies, the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. All ten described using the Action Cycle and seven referred to Knowledge Creation. The KTA Framework was enacted in different health care and academic settings with projects targeted at patients, the public, and nursing and allied health professionals.ConclusionsThe KTA Framework is being used in practice with varying degrees of completeness. It is frequently cited, with usage ranging from simple attribution via a reference, through informing planning, to making an intellectual contribution. When the framework was integral to knowledge translation, it guided action in idiosyncratic ways and there was theory fidelity. Prevailing wisdom encourages the use of theories, models and conceptual frameworks, yet their application is less evident in practice. This may be an artefact of reporting, indicating that prospective, primary research is needed to explore the real value of the KTA Framework and similar tools.
Rethinking capacity building for knowledge mobilisation: developing multilevel capabilities in healthcare organisations.
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Kislov R, Waterman H, Harvey G, Boaden R.
Implementation science 2014 Nov 15;9(1):166
Knowledge mobilisation in healthcare organisations is often carried out through relatively short-term projects dependent on limited funding, which raises concerns about the long-term sustainability of implementation and improvement. It is becoming increasingly recognised that the translation of research evidence into practice has to be supported by developing the internal capacity of healthcare organisations to engage with and apply research. This process can be supported by external knowledge mobilisation initiatives represented, for instance, by professional associations, collaborative research partnerships and implementation networks. This conceptual paper uses empirical and theoretical literature on organisational learning and dynamic capabilities to enhance our understanding of intentional capacity building for knowledge mobilisation in healthcare organisations.DiscussionThe discussion is structured around the following three themes: (1) defining and classifying capacity building for knowledge mobilisation; (2) mechanisms of capability development in organisational context; and (3) individual, group and organisational levels of capability development. Capacity building is presented as a practice-based process of developing multiple skills, or capabilities, belonging to different knowledge domains and levels of complexity. It requires an integration of acquisitive learning, through which healthcare organisations acquire knowledge and skills from knowledge mobilisation experts, and experience-based learning, through which healthcare organisations adapt, absorb and modify their knowledge and capabilities through repeated practice. Although the starting point for capability development may be individual-, team- or organisation-centred, facilitation of the transitions between individual, group and organisational levels of learning within healthcare organisations will be needed.SummaryAny initiative designed to build capacity for knowledge mobilisation should consider the subsequent trajectory of newly developed knowledge and skills within the recipient healthcare organisations. The analysis leads to four principles underpinning a practice-based approach to developing multilevel knowledge mobilisation capabilities: (1) moving from `building¿ capacity from scratch towards `developing¿ capacity of healthcare organisations; (2) moving from passive involvement in formal education and training towards active, continuous participation in knowledge mobilisation practices; (3) moving from lower-order, project-specific capabilities towards higher-order, generic capabilities allowing healthcare organisations to adapt to change, absorb new knowledge and innovate; and (4) moving from single-level to multilevel capability development involving transitions between individual, group and organisational learning.
How does context influence collaborative decision-making for health services planning, delivery and evaluation?
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Gagliardi AR, Webster F, Brouwers MC, Baxter NN, Finelli A, Gallinger S.
BMC health services research 2014 Nov 19;14(1):545-014-0545-x
Collaboration among researchers (clinician, non-clinician) and decision makers (managers, policy-makers, clinicians), referred to as integrated knowledge translation (IKT), enhances the relevance and use of research, leading to improved decision-making, policies, practice, and health care outcomes. However IKT is not widely practiced due to numerous challenges. This research explored how context influenced IKT as a means of identifying how IKT could be strengthened. METHODS: This research investigated IKT in three health services programs for colon cancer screening, prostate cancer diagnosis, and the treatment of pancreatic cancer. Qualitative methods were used to explore contextual factors that influenced how IKT occurred, and its impact. Data were collected between September 1, 2012 and May 15, 2013 from relevant documents, observation of meetings, and interviews with researchers and decision-makers, analyzed using qualitative methods, and integrated. RESULTS: Data were analyzed from 39 documents, observation of 6 meetings, and 36 interviews. IKT included interaction at meetings, joint undertaking of research, and development of guidelines. IKT was most prevalent in one program with leadership, clear goals, dedicated funding and other infrastructural resources, and an embedded researcher responsible for, and actively engaged in IKT. This program achieved a variety of social, research and health service outcomes despite mixed individual views about the value of IKT and the absence of a programmatic culture of IKT. Participants noted numerous challenges including lack of time and incentives, and recommendations to support IKT. A conceptual framework of factors that influence IKT and associated outcomes was generated, and can be used by others to plan or evaluate IKT. CONCLUSIONS: The findings can be applied by researchers, clinicians, managers or policy-makers to plan or improve collaborative decision-making for health services planning, delivery, evaluation or quality improvement. Further research is needed to explore whether these findings are widespread, and further understand how IKT can be optimized.
Conflicts of interest and critiques of the use of systematic reviews in policymaking: an analysis of opinion articles
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Forsyth SR, Odierna DH, Krauth D, Bero LA.
Systematic reviews 2014 Nov 18;3(1):122-4053-3-122
Strong opinions for or against the use of systematic reviews to inform policymaking have been published in the medical literature. The purpose of this paper was to examine whether funding sources and author financial conflicts of interest were associated with whether an opinion article was supportive or critical of the use of systematic reviews for policymaking. We examined the nature of the arguments within each article, the types of disclosures present, and whether these articles are being cited in the academic literature. METHODS: We searched for articles that expressed opinions about the use of systematic reviews for policymaking. We included articles that presented opinions about the use of systematic reviews for policymaking and categorized each article as supportive or critical of such use. We extracted all arguments regarding the use of systematic reviews from each article and inductively coded each as internal or external validity argument, categorized disclosed funding sources, conflicts of interest, and article types, and systematically searched for undisclosed financial ties. We counted the number of times each article has been cited in the “Web of Science.” We report descriptive statistics. RESULTS: Articles that were critical of the use of systematic reviews (n = 25) for policymaking had disclosed or undisclosed industry ties 2.3 times more often than articles that were supportive of the use (n = 34). We found that editorials, comments, letters, and perspectives lacked published disclosures nearly twice as often (60% v. 33%) as other types of articles. We also found that editorials, comments, letters, and perspectives were less frequently cited in the academic literature than other article types (median number of citations = 5 v. 19). CONCLUSIONS: It is important to consider whether an article has industry ties when evaluating the strength of the argument for or against the use of systematic reviews for policymaking. We found that journal conflict of interest disclosures are often inadequate, particularly for editorials, comments, letters, and perspectives and that these articles are being cited as evidence in the academic literature. Our results further suggest the need for more consistent and complete disclosure for all article types.
Using the Alzheimer’s Association Web Site to Improve Knowledge of Alzheimer’s Disease in Health Care Providers.
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Hughes ML, Lowe DA, Shine HE, Carpenter BD, Balsis S.
American Journal of Alzheimer’s Disease and Other Dementias 2014 Nov 25
The purpose of the current study was to investigate whether an informative Web site is effective at producing higher scores for an individual’s knowledge of Alzheimer’s disease (AD) relative to those who do not visit a Web site. METHODS: A total of 552 participants completed the study on Amazon’s Mechanical Turk; half were randomly assigned to visit alz.org, while a control group did not. Both groups were given the AD Knowledge Scale (ADKS) to assess their knowledge of AD. RESULTS: Participants who visited alz.org scored significantly higher on the ADKS than those in the control group. Participants who were health care workers demonstrated higher scores than others in the experimental condition. Findings indicate that the Alzheimer’s Association Web site is effective at producing higher scores for AD knowledge relative to no Web site at all and that it is especially helpful for health care workers compared to those who are not health care workers. © The Author(s) 2014.
Bridging the Research-Practice Gap in Climate Communication: Lessons From One Academic-Practitioner Collaboration
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Han H, Stenhouse N.
Science Communication 2014
Recent evidence suggests that a research-practice gap exists for climate change communication, whereby practitioners are not making optimal use of knowledge that exists and scholars are not answering questions most relevant to practitioners. Closer collaboration between academics and practitioners is one way to close this gap. We recount our collaboration with a group of Sierra Club staff and volunteers working to improve their climate advocacy and organizing activities. From our collaboration, four ways of improving future collaborations emerged, relating to broad versus narrow applicability of communication recommendations, strategy versus tactics, academic versus experiential knowledge, and proactive versus reactive support.
Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children
Stevens B, Yamada J, Promislow S, Stinson J, Harrison D, Victor J, et al.
Implementation Science 2014;9(1):120
Despite extensive research, institutional policies and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care) in eight pediatric hospitals in Canada.In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation.Methods Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period.Results Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p<0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies.Conclusion sFurther research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.
Health system decision makers’ feedback on summaries and tools supporting the use of systematic reviews: a qualitative study
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Ellen ME, Lavis JN, Wilson MG, Grimshaw J, Haynes RB, Ouimet M, et al.
Evidence & Policy 2014 -08-01T00:00:00;10(3):337-359
Health system managers and policy makers need timely access to high quality, policy-relevant systematic reviews. Our objectives were to obtain managers’ and policy makers’ feedback about user-friendly summaries of systematic reviews and about tools related to supporting or assessing their use. Our interviews identified that participants prefer key messages up front, such as details regarding background, methods, and applicability, appreciate quality ratings, and prefer bullets and tables to paragraphs. There were mixed views about the relevance-assessment tool and positive views about the use-assessment tool. The findings can be used to support evidence-informed decision making among managers and policy makers.
Health Care Administration and Organization
The first year: employment patterns and job perceptions of nursing assistants in a rural setting.
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Meyer D, Raffle H, Ware LJ.
Journal of nursing management 2014 Sep;22(6):769-778
The aim of this study was to follow rural certified nursing assistants (CNAs) (n=123) in the United States for 1 year post-training to identify retention and turnover issues in the long-term care (LTC) setting by exploring the CNAs’ perceptions of the LTC work experience. BACKGROUND: Turnover among CNAs impacts the quality of care, imposes a financial burden on facilities and taxpayers, and creates increased stress and workloads on those who remain. METHOD: A longitudinal survey design was used to track individuals completing CNA training for 1 year. RESULTS: At 1 year post-training, 53.7% of respondents currently worked in LTC, 30.9% worked in LTC and left, and the remaining 15.4% never worked in LTC. CONCLUSION: While the training site does not appear to impact retention, the first 6 months of employment appear critical. The CNAs cited pay as a reason for leaving LTC, but better pay did not characterize the jobs taken by the CNAs who left. Implications for nursing management. This study highlights the importance of the first 6 months of employment to retention and provides practical information for nurse managers evaluating the resource-effectiveness of hosting training programmes. Additionally, the key issues influencing retention were identified and practical suggestions for nurse managers to improve retention are provided. © 2012 John Wiley & Sons Ltd.
Health Care Innovation and Quality Assurance
REACH VA: Moving from Translation to System Implementation.
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Nichols LO, Martindale-Adams J, Burns R, Zuber J, Graney MJ.
The Gerontologist 2014 Nov 13
Resources for Enhancing All Caregivers Health in the Department of Veterans Affairs (REACH VA) has been implemented in the VA system as a national program for caregivers. DESIGN AND METHODS: We describe the trajectory of REACH VA from national randomized clinical trial through translation to national implementation. The implementation is examined through the six stages of the Fixsen and Blasé implementation process model: exploration and adoption, program installation, initial implementation, full operation, innovation, and sustainability. Different drivers that move the implementation process forward are important at each stage, including staff selection, staff training, consultation and coaching, staff evaluation, administrative support, program evaluation/fidelity, and systems interventions. RESULTS: Caregivers in the REACH VA 4 session intervention currently implemented in the VA had similar outcomes to longer REACH interventions, including Resources for Enhancing Alzheimer’s Caregivers Health (REACH II). Caregivers experienced significant decreases in burden, depression, anxiety, number of troubling patient behaviors reported, caregiving frustrations, stress symptoms (feeling overwhelmed, feeling like crying, being frustrated as a result of caregiving, being lonely), and general stress. Effect sizes (Cohen’s d) for these significant variables were between small and medium ranging from .24 to .46. IMPLICATIONS: The implementation of REACH VA provides a road map for implementation of other behavioral interventions in health care delivery settings. Lessons learned include the importance of implementing a proven, needed intervention, support from both leadership and clinical staff, willingness to respond to staff and organization needs and modify the intervention while preserving its integrity, and fitting the intervention into ongoing routines and practices.
Enriching the care of patients with dementia in acute settings? The Dementia Champions Programme in Scotland
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Banks P, Waugh A, Henderson J, Sharp B, Brown M, Oliver J, et al.
Dementia (London, England) 2014 Nov;13(6):717-736
Admission to hospital has been found to have a negative impact on people with dementia. The Scottish Dementia Champions programme was developed to prepare health and social service Dementia Champions working in acute settings as Change Agents. The programme was initially delivered to a cohort of 100 health professionals via blended learning, and comprised five study days, a half day spent in a local community setting, and e-learning. In order to complete the programme and graduate, participants were required to complete and submit reports relating to three work-based activities. The evaluation of the project adopted a two-pronged approach: Impact on programme participants was assessed by scores derived from the Approaches to Dementia Questionnaire (ADQ) (Lintern, 1996) completed at Study Days 1 and 5, and analysis of qualitative data derived from the three written assignments. Participants were asked to evaluate course materials and input for each of the five study days, as well as satisfaction with delivery. Analysis of data derived from the ADQ and 100 reflective reports of the community experience indicate that participants’ perceptions of people with dementia shifted significantly during the Programme. Participants identified a range of issues which should be addressed with a view to improving the experiences of people with dementia in acute settings, and put in place actions to bring about change. The format of the programme provided a cost effective means to prepare NHS and Social Service Dementia Champions as Change Agents for practice within a relatively short period of time, and would be transferrable to other staff groups as well as different organisational structures in other countries. © The Author(s)
Merging person-centered care with translational research to improve the lives of older adults: creating community-based nursing research networks.
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Hill NL, Penrod J, Milone-Nuzzo P.
Journal of gerontological nursing 2014 Oct;40(10):66-74
Translational research is a leading trend in science with the aim of bridging the research-practice gap to significantly speed the implementation of effective interventions in clinical practice. Integrating the values and preferences of older adults and their families into this process is critical to the success of translational research. Engaging communities in meaningful research is an important part of advancing translational science in which older adults are partners in developing solutions to the health needs of individuals within communities. The current article describes one approach to developing an infrastructure (i.e., community-based nursing research network) to support patient-centered care within translational research. Nurses are uniquely poised and prepared to assume leadership roles in community-based research networks to support a true collaboration among stakeholders that prizes the voices of older adults and integrates them into practice efforts. Copyright 2014, SLACK Incorporated.
Harnessing implementation science to improve care quality and patient safety: a systematic review of targeted literature
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Braithwaite J, Marks D, Taylor N.
International journal for quality in health care 2014 Jun;26(3):321-329
Getting greater levels of evidence into practice is a key problem for health systems, compounded by the volume of research produced. Implementation science aims to improve the adoption and spread of research evidence. A linked problem is how to enhance quality of care and patient safety based on evidence when care settings are complex adaptive systems. Our research question was: according to the implementation science literature, which common implementation factors are associated with improving the quality and safety of care for patients? METHODS: We conducted a targeted search of key journals to examine implementation science in the quality and safety domain applying PRISMA procedures. Fifty-seven out of 466 references retrieved were considered relevant following the application of exclusion criteria. Included articles were subjected to content analysis. Three reviewers extracted and documented key characteristics of the papers. Grounded theory was used to distil key features of the literature to derive emergent success factors. RESULTS: Eight success factors of implementation emerged: preparing for change, capacity for implementation-people, capacity for implementation-setting, types of implementation, resources, leverage, desirable implementation enabling features, and sustainability. Obstacles in implementation are the mirror image of these: for example, when people fail to prepare, have insufficient capacity for implementation or when the setting is resistant to change, then care quality is at risk, and patient safety can be compromised. CONCLUSIONS: This review of key studies in the quality and safety literature discusses the current state-of-play of implementation science applied to these domains. © The Author 2014.
Implementation of a Nursing Home Quality Improvement Project to Reduce Resident Pain: A Qualitative Case Study.
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Abrahamson K, DeCrane S, Mueller C, Davila HW, Arling G.
Journal of nursing care quality 2014 Nov 18
This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Interviews were conducted with 24 nursing home employees from within 8 facilities participating in the quality improvement project. Findings were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges.
Oral health-related quality of life among institutionalized patients after dental rehabilitation.
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Ilhan B, Cal E, Dundar N, Guneri P, Daghan S.
Geriatrics & gerontology international 2014 Nov 19
The aim of the present study was to determine the changes in oral health-related quality of life before and 3 months after dental rehabilitation among geriatric patients residing in a state-owned nursing home, using the General Oral Health Assessment Index (GOHAI). METHODS: Data from 40 patients were collected through the administration of a structured questionnaire, as well as from medical records and intraoral examinations. Sociodemographic and behavioral variables, and denture use/length of use were recorded. The GOHAI questionnaire was completed before and 3 months after dental rehabilitation by the same examiner. Normality of the GOHAI scores was examined with the Kolmogorov-Smirnov test. Data were analyzed using descriptive statistics, t-tests, one-way ancova and ancova (P < 0.05). RESULTS: The study sample included 32 men (80%) and eight women (20%) with a mean age of 72.75 years. Mean GOHAI scores increased from 41.275 (low) to 53.100 (moderate) 3 months after dental rehabilitation (t = 1.42, P 0.05). The after treatment GOHAI scores, which were corrected according to gender and age, showed no significant differences regarding the education level, income, behavioral variables, use of dentures, oral hygiene status and presence of systemic diseases (F = 0.62, P = 0.69). CONCLUSIONS: Dental rehabilitation of institutionalized geriatric patients resulted in a significant improvement in GOHAI scores, indicating an improvement in oral health-related quality of life after receiving proper dental care.
Assessing the effect of a physical activity intervention in a nursing home ecology: a natural lab approach.
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Jansen CP, Classen K, Hauer K, Diegelmann M, Wahl HW.
BMC geriatrics 2014 Nov 18;14(1):117
Physical activity (PA) is not only an important marker of physical impairment, but also a pathway to improve quality of life and enhance cognitive and social functioning of old individuals. Yet, making interventional use of PA training as a means for prevention and enhancement of quality of life of nursing home residents has found very limited attention worldwide so far. That said, the project ‘Long-term Care in Motion’ (LTCMo) as a part of the INNOVAGE consortium (funded by the European Commission) has the following aims: Overall: Install and assess a socially innovative intervention in the nursing home ecology. Concrete: (a) Conceptualization of a multidimensional intervention program (resident and staff oriented) with the potential to promote PA in nursing home residents; (b) Mixed-methods assessment of the program based on automated recording as well as questionnaire data. METHODS: LTCMo’s PA-related intervention has several components which are applied in parallel manner: (1) Residents are engaged in a physical exercise program that is based on multiple approaches: supervised group sessions, a serious games approach, and specific training in severely impaired persons; (2) Staff members will receive a competence training with a focus on PA motivation and facilitation of residents’ PA engagement. Primary outcome assessment (movement-related behavior of residents) is completely conducted by means of automated data collection strategies (accelerometer-based activity recording, sensor-based life space recording). This is enriched by a broad range of secondary outcomes (e.g., cognitive performance, depression of residents; behavioral and attitudinal components of staff). Pre-, post- and 3-month follow-up assessment will take place in the target intervention setting as well as in a waiting control condition in which we will also replicate the training and its assessment in a later step. DISCUSSION: Although we are faced with methodological challenges (e.g., rather small sample size; no randomized control trial), we believe that our approach has something to offer and indeed has some unique characteristics that may have the potential to contribute to the enhancement of nursing home residents’ quality of life and at the same time further PA-related research with vulnerable populations at large.
Sustainable effects of a low-threshold physical activity intervention on health-related quality of life in residential aged care.
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Quehenberger V, Cichocki M, Krajic K.
Clinical interventions in aging 2014 Nov 3;9:1853-1864
Mobility is a main issue for health-related quality of life in old age. There is evidence for effects of physical activity (PA) interventions on several dimensions of health for the aged and also, some specific evidence for vulnerable populations, like residents of residential aged care. Research on low-threshold PA interventions for users of residential aged care and documentation of their sustainability are scarce. “Low threshold” implies moderate demands on the qualification of trainers and low frequency of conduct, implying low demands on the health status and discipline of users. Yet the investigation of low-threshold interventions in residential aged care seems important as they might foster participation of users and implementation in everyday routines of provider organizations. An initial study (October 2011 to June 2012) had found intervention effects on health-related quality of life. The objective of this study was to examine sustainability of the effects of a low-threshold PA intervention on health-related quality of life in residential aged care. METHODS: Data collection took place in three residential aged care homes in Vienna, Austria. At 1-year follow-up (June 2013), participants from the intervention group were interviewed using a standardized questionnaire. Using general mixed linear models and Friedman tests followed by paired t- and Wilcoxon signed-rank tests, we compared outcome measures at follow-up with measures obtained at baseline and at the end of the intervention. RESULTS: At the 1-year follow-up assessment, participants’ (mean age 84.7 years; 89.7% female) subjective health status was still significantly increased, equaling a small sustainable intervention effect (Cohen’s d=0.38, P=0.02). In comparison with baseline, a significant decline of reported pain/discomfort (P=0.047) was found. Regarding the subdimensions of health-related quality of life, favorable trends could be observed. CONCLUSION: The study indicates that effects of a low-threshold PA intervention on health-related quality of life in residential aged care can be sustainable. Addressing hindering factors like poor health status and implementing proactive support and individualization of the program to enable PA for residents might foster sustainability of effects.
Evaluation of the performance improvement CME paradigm for pain management in the long-term care setting.
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Fine PG, Bradshaw DH, Cohen MJ, Connor SR, Donaldson G, Gharibo C, et al.
Pain medicine (Malden, Mass.) 2014 Mar;15(3):403-409
A performance improvement continuing medical education (PI CME) activity was designed to assist clinicians with accurately identifying and appropriately managing persistent pain in long-term care facility (LTCF) residents. DESIGN: Volunteer LTCFs participated in a three-stage PI CME model consisting of: 1) baseline assessment, 2) implementation of practice improvement interventions, and 3) reassessment. Expert faculty chose performance measures and interventions for the activity. A champion was designated ateach LTCF to collect resident charts and enter data into an online database. SETTING: Eight LTCFs located across the United States participated in the activity. PATIENTS: Fifty resident charts were randomly selected by each LTCF champion (25 for stage 1 and 25 for stage 3); a total of 350 charts were reviewed. INTERVENTIONS: In addition to a toolkit containing numerous performance improvement resources, an in-service meeting led by an expert faculty member was conducted at each LTCF. OUTCOME MEASURES: Stage 3 data were collected 6 weeks after implementation of interventions and compared with stage 1 baseline data to measure change in performance. RESULTS: Aggregate data collected from seven LTCFs completing the PI CME activity through stage 3 revealed improvements from baseline in four of five performance measures. CONCLUSIONS: This CME activity allowed for collection of data demonstrating performance improvement in persistent pain management. The tools used as part of the intervention (available at http://www.achlpicme.org/LTC/toolkit) may help other clinicians enhance their management of LTCF residents with persistent pain.
Sensitivity and specificity of the minimum data set 3.0 discharge data relative to medicare claims.
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Rahman M, Tyler D, Acquah JK, Lima J, Mor V.
Journal of the American Medical Directors Association 2014;15(11):819-824
The objective of this study was to determine whether the Minimum Data Set (MDS) 3.0 discharge record accurately identifies hospitalizations and deaths of nursing home residents. DESIGN: We merged date of death from Medicare enrollment data and hospital inpatient claims with MDS discharge records to check whether the same information can be verified from both the sources. We examined the association of 30-day rehospitalization rates from nursing homes calculated only from MDS and only from claims. We also examined how correspondence between these 2 data sources varies across nursing homes. SETTINGS: All fee-for-service (FFS) Medicare beneficiaries admitted for Medicare-paid (with prospective payment system) skilled nursing facility (SNF) care in 2011. RESULTS: Some 94% of hospitalization events in Medicare claims can be identified using MDS discharge records and 87% of hospitalization events detected in MDS data can be verified by Medicare hospital claims. Death can be identified almost perfectly from MDS discharge records. More than 99% of the variation in nursing home-level 30-day rehospitalization rate calculated using claims data can be explained by the same rates calculated using MDS. Nursing home structural characteristics explain only 5% of the variation in nursing home-level sensitivity and 3% of the variation in nursing home-level specificity. CONCLUSION: The new MDS 3.0 discharge record matches Medicare enrollment and hospitalization claims events with a high degree of accuracy, meaning that hospitalization rates calculated based on MDS offer a good proxy for the “gold standard” Medicare data.
The public gets what the public wants: experiences of public reporting in long-term care in Europe.
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Rodrigues R, Trigg L, Schmidt AE, Leichsenring K.
Health policy (Amsterdam, Netherlands) 2014 May;116(1):84-94
Public reporting of quality in long-term care is advocated on the basis of allowing providers to improve their performance by benchmarking and supporting users to choose the best providers. Both mechanisms are intended to drive improvements in quality. However, there is relatively scarce comparative research on the experiences and impact of public reporting on quality in long-term care in Europe. METHODS: Using information gathered from key informants by means of a structured questionnaire and country profiles, this paper discusses experiences with public reporting mechanisms in seven European countries and available information on their impact on quality in long-term care. RESULTS: Countries surveyed included a variety of public reporting schemes, ranging from pilot programmes to statutory mechanisms. Public reporting mechanisms more often focus on institutional care. Inspections carried out as part of a legal quality assurance framework are the main source of information gathering, supplemented by provider self-assessments in the context of internal quality management and user satisfaction surveys. Information on quality goes well beyond structural indicators to also include indicators on quality of life of users. Information is displayed using numerical scores (percentages), but also measures such as ratings (similar to school grades) and ticks and crosses. Only one country corrects for case-mix. The internet is the preferred medium of displaying information. DISCUSSION: There was little evidence to show whether public reporting has a significant impact on driving users’ choices of provider. Studies reported low awareness of quality indicators among potential end users and information was not always displayed in a convenient format, e.g. through complicated numerical scores. There is scarce evidence of public reporting directly causing improved quality, although the relative youth and the pilot characteristics of some of the schemes covered here could also have contributed to downplay their impact. The establishment of public reporting mechanisms did however contribute to shaping the discussion on quality measurement in several of the countries surveyed. CONCLUSIONS: The findings presented in this paper highlight the need to consider some factors in the discussion of the impact of public reporting in long-term care, namely, the organisation of care markets, frequently characterised by limited competition; the circumstances under which user choice takes place, often made under conditions of duress; and the leadership conditions needed to bring about improvements in quality in different care settings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
This article is written for both HCAs and their educators and outlines some of the major approaches to developing education and training for the HCA workforce. Referring to major policy recommendations and how this might be translated into working curricula for HCAs, there is discussion of the presuppositions around vocational and academic training for the HCA workforce and how parallel issues in industry have been addressed in practice. E-learning is debated as a mechanism of integrating emergent technology into HCA curricula via the facilitation of learning in both simulation and delivery of academic content. The impact of this on HCA learning in practice is considered. Finally, a set of key objectives for HCAs is identified and the article concludes with an outline of potential innovation for HCA education when regulation of this sector of the healthcare workforce is formalised in the near future.
Quality Innovation Network Quality Improvement Organizations’ (QIN-QIOs’) Benefits to Skilled Nursing Facilities and Physicians
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Phillips SL, Kennedy K, Buttaccio JM.
Journal of the American Medical Directors Association
The Medicare Quality Improvement Organization (QIO) program is administered through a nationwide network of quality improvement professionals that provide assistance to health care providers to drive improvements and lower cost. The QIO program was organized into 3-year contract cycles beginning in 1988, with contracts being awarded to QIOs by the Centers for Medicare and Medicaid Services (CMS). Under previous CMS contracts, the QIOs undertook both quality improvement and quality assurance (case review) activities.
Person-centered dementia care and the cultural matrix of othering.
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Doyle PJ, Rubinstein RL.
The Gerontologist 2014 Dec;54(6):952-963
The dominant clinical view of dementia and its treatment are through the biomedical lens-an approach to understanding the dementias that focuses on bodily and mental pathology and symptomology. Person-centered care (PCC) represents a shift in focus away from biomedical approach in elder care. The primary objective of this research was to examine how PCC was defined, shaped, and practiced by staff members within a dementia care setting. DESIGN AND METHODS: Ethnographic data were collected over an 8-month period using participant observation (400hr) and ethnographic interviews with 20 people with dementia and 25 staff members of Cedar Winds, a dementia-specific long-term care setting that had a strong organizational support for using a person-centered approach to dementia care. RESULTS: The observed cultural matrix of othering is the focus of this article and represents the cultural processes that prevented PCC from being enacted within Cedar Winds. The three main characteristics through which the residents were othered and PCC was obstructed were (a) dementia as a master status, (b) functional dependence, and (c) aggressiveness. IMPLICATIONS: This article concludes by examining the efforts that could reduce the extent of othering and improve the person centeredness of elder care settings. © The Author 2013.
Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science.
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Leykum LK, Lanham HJ, Pugh JA, Parchman M, Anderson RA, Crabtree BF, et al.
Implementation science 2014 Nov 19;9(1):165-014-0165-1
The application of complexity science to understanding healthcare system improvement highlights the need to consider interdependencies within the system. One important aspect of the interdependencies in healthcare delivery systems is how individuals relate to each other. However, results from our observational and interventional studies focusing on relationships to understand and improve outcomes in a variety of healthcare settings have been inconsistent. We sought to better understand and explain these inconsistencies by analyzing our findings across studies and building new theory. METHODS: We analyzed eight observational and interventional studies in which our author team was involved as the basis of our analysis, using a set theoretical qualitative comparative analytic approach. Over 16 investigative meetings spanning 11 months, we iteratively analyzed our studies, identifying patterns of characteristics that could explain our set of results.Our initial focus on differences in setting did not explain our mixed results. We then turned to differences in patient care activities and tasks being studied and the attributes of the disease being treated. Finally, we examined the interdependence between task and disease. RESULTS: We identified system-level uncertainty as a defining characteristic of complex systems through which we interpreted our results. We identified several characteristics of healthcare tasks and diseases that impact the ways uncertainty is manifest across diverse care delivery activities. These include disease-related uncertainty (pace of evolution of disease and patient control over outcomes) and task-related uncertainty (standardized versus customized, routine versus non-routine, and interdependencies required for task completion). CONCLUSIONS: Uncertainty is an important aspect of clinical systems that must be considered in designing approaches to improve healthcare system function. The uncertainty inherent in tasks and diseases, and how they come together in specific clinical settings, will influence the type of improvement strategies that are most likely to be successful. Process-based efforts appear best-suited for low-uncertainty contexts, while relationship-based approaches may be most effective for high-uncertainty situations.
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 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.
Exchanging and using research evidence in health policy networks: a statistical network analysis
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Shearer JC, Dion M, Lavis JN.
Implementation science 2014 Oct 30;9(1):126
Evidence-informed health policymaking is a goal of equitable and effective health systems but occurs infrequently in reality. Past research points to the facilitating role of interpersonal relationships between policy-makers and researchers, imploring the adoption of a social network lens. This study aims to identify network-level factors associated with the exchange and use of research evidence in policymaking. Methods Data on social networks and research use were collected from seventy policy actors across three health policy cases in Burkina Faso (child health, malaria, and HIV). Networks were graphed for actors’ interactions, their provision of, and request for research evidence. Exponential random graph models estimated the probability of evidence provision and request between actors, controlling for network- and individual-level covariates. Logistic regression models estimated actors’ use of research evidence to inform policy.Results Network structure explained more than half of the evidence exchanges (ties) observed in these networks. Across all cases, a pair of actors was more likely to form a provision tie if they already had a request tie between them and visa versa (θ = 6.16, p < 0.05; θ = 2.87, p < 0.05; θ = 2.31, p < 0.05). The child health network displayed clustering tendencies, meaning that actors were more likely to form ties if they shared an acquaintance (θ = 2.36, p < 0.05). Actors use of research evidence was positively associated with their centrality (i.e., connectedness).ConclusionsThe exchange and use of research evidence in policymaking can be partly explained by the structure of actors’ networks of relationships. Efforts to support knowledge translation and evidence-informed policymaking should consider network factors.
Effect of an oral healthcare protocol in nursing homes on care staffs’ knowledge and attitude towards oral health care: a cluster-randomised controlled trial.
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Janssens B, De Visschere L, van der Putten GJ, de Lugt-Lustig K, Schols JM, Vanobbergen J.
Gerodontology 2014 Nov 26
To explore the impact of a supervised implementation of an oral healthcare protocol, in addition to education, on nurses’ and nurses’ aides’ oral health-related knowledge and attitude. MATERIALS AND METHODS: A random sample of 12 nursing homes, accommodating a total of 120-150 residents, was obtained using stratified cluster sampling with replacement. The intervention included the implementation of an oral healthcare protocol and three different educational stages. One of the investigators supervised the implementation process, supported by a dental hygienist. A 34-item questionnaire was developed and validated to evaluate the knowledge and attitude of nurses and nurses’ aides at baseline and 6 months after the start of the intervention. Linear mixed-model analyses were performed to explore differences in knowledge and attitude at 6 months after implementation. RESULTS: At baseline, no significant differences were observed between the intervention and the control group for both knowledge (p = 0.42) and attitude (p = 0.37). Six months after the start of the intervention, significant differences were found between the intervention and the control group for the variable knowledge in favour of the intervention group (p < 0.0001) but not for the variable attitude (p = 0.78). Out of the mixed model with attitude as the dependent variable, it can be concluded that age (p = 0.031), educational level (p = 0.009) and ward type (p = 0.014) have a significant effect. The mixed model with knowledge as the dependent variable resulted in a significant effect of the intervention (p = 0.001) and the educational level (p = 0.009). CONCLUSION: The supervised implementation of an oral healthcare protocol significantly increased the knowledge of nurses and nurses’ aides. In contrast, no significant improvements could be demonstrated in attitude. © 2014 John Wiley & Sons
Interventions for improving mealtime experiences in long-term care.
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Vucea V, Keller HH, Ducak K.
Journal of nutrition in gerontology and geriatrics 2014;33(4):249-324
Poor food intake in residents living in long-term care (LTC) homes is a common problem. The mealtime experience is known to be important in the multifactorial causes of food intake. Diverse interventions have been developed, implemented, and/or evaluated to improve the mealtime experience in LTC; it is possible that multicomponent interventions will have a greater benefit than single activities. To identify the range of feasible and potentially useful interventions for including in a multicomponent intervention, this scoping review identified and summarized 58 studies that described and/or evaluated mealtime experience interventions. There were several randomized controlled trials, although most studies used less rigorous methods. Interventions that are multicomponent (e.g., food service, dining environment, staff education) and target multilevel factors (e.g., residents, staff) in LTC appear to be feasible, with a variety of outcomes measured. Further research is still needed with more rigorously designed studies, confirming effectiveness, feasible implementation, and scaling up of efficacious interventions.
In the policy summary authors review the literature on the measurement and reporting of quality information to aid the public in choosing health and long-term care providers, provide insights to support future investment in public reporting systems, and summarize strategies aiming to increase the use of reporting by patients and users. It shows that widespread use of quality information has been slow to materialize across health and long-term care, despite the extensive investment in reporting systems by governments and private sector organizations. There is, however, some evidence that reporting encourages providers to address quality issues to improve their reputation in the sector. The summary synthesizes evidence from a variety of European and US-based public reporting systems to assist policy-makers, care providers and information developers in creating reports more likely to be used and valued by patients and users when choosing health or long-term care providers. It was published as part of a European Commission Seventh Framework Programme project, the European Union Cross-Border Care Collaboration (EUCBCC).
The study found that turning at three and four-hour intervals is as effective as turning every two hours for moderate and high-risk residents on high-density foam mattresses. Less frequent turning may have other beneficial effects, such as decreasing the number of times that sleeping patients are disturbed, and freeing up staff time for other resident-related activities.
The study found that turning at three and four-hour intervals is as effective as turning every two hours for moderate and high-risk residents on high-density foam mattresses. Less frequent turning may have other beneficial effects, such as decreasing the number of times that sleeping patients are disturbed, and freeing up staff time for other resident-related activities. THETA’s economic analysis found that a switch from a two-hour repositioning schedule to a three- or four-hour turning schedule would result in substantial economic benefits for Ontario’s health care system, without placing residents at greater risk for developing pressure ulcers.
Research Practice & Methodology
An investigation of the false discovery rate and the misinterpretation of p-values
Royal Society Open Science 2014 The Royal Society;1(3)
If you use p=0.05 to suggest that you have made a discovery, you will be wrong at least 30% of the time. If, as is often the case, experiments are underpowered, you will be wrong most of the time. This conclusion is demonstrated from several points of view. First, tree diagrams which show the close analogy with the screening test problem. Similar conclusions are drawn by repeated simulations of t-tests. These mimic what is done in real life, which makes the results more persuasive. The simulation method is used also to evaluate the extent to which effect sizes are over-estimated, especially in underpowered experiments. A script is supplied to allow the reader to do simulations themselves, with numbers appropriate for their own work. It is concluded that if you wish to keep your false discovery rate below 5%, you need to use a three-sigma rule, or to insist on p≤0.001. And never use the word ‘significant’.
Impact of adding a limitations section to abstracts of systematic reviews on readers’ interpretation: a randomized controlled trial
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Yavchitz A, Ravaud P, Hopewell S, Baron G, Boutron I.
BMC medical research methodology 2014 Nov 24;14(1):123-2288-14-123
To allow an accurate evaluation of abstracts of systematic reviews, the PRISMA Statement recommends that the limitations of the evidence (e.g., risk of bias, publication bias, inconsistency, imprecision) should be described in the abstract. We aimed to evaluate the impact of adding such limitations sections on reader’s interpretation. METHOD: We performed a two-arm parallel group randomized controlled trial (RCT) using a sample of 30 abstracts of systematic reviews evaluating the effects of healthcare intervention with conclusions favoring the beneficial effect of the experimental treatments. Two formats of these abstracts were derived: one reported without and one with a standardized limitations section written according to the PRISMA statement for abstracts. The primary outcome was readers’ confidence in the results of the systematic review as stated in the abstract assessed by a Likert scale from 0, not at all confident, to 10, very confident. In total, 300 participants (corresponding authors of RCT reports indexed in PubMed) were randomized by a web-based randomization procedure to interpret one abstract with a limitations section (n = 150) or without a limitations section (n = 150). Participants were blinded to the study hypothesis. RESULTS: Adding a limitations section did not modify readers’ interpretation of findings in terms of confidence in the results (mean difference [95% confidence interval] 0.19 [-0.37-0.74], p = 0.50), confidence in the validity of the conclusions (0.07 [-0.49-0.62], p = 0.80), or benefit of the experimental intervention (0.12 [-0.42-0.44], p = 0.65).This study is limited because the participants were expert-readers and are not representative of all systematic review readers. CONCLUSION: Adding a limitations section to abstracts of systematic reviews did not affect readers’ interpretation of the abstract results. Other studies are needed to confirm the results and explore the impact of a limitations section on a less expert panel of participants. TRIAL REGISTRATION: ClinicalTrial.gov (NCT01848782).
Conditional Poisson models: a flexible alternative to conditional logistic case cross-over analysis.
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Armstrong BG, Gasparrini A, Tobias A.
BMC medical research methodology 2014 Nov 24;14(1):122
The time stratified case cross-over approach is a popular alternative to conventional time series regression for analysing associations between time series of environmental exposures (air pollution, weather) and counts of health outcomes. These are almost always analyzed using conditional logistic regression on data expanded to case-control (case crossover) format, but this has some limitations. In particular adjusting for overdispersion and auto-correlation in the counts is not possible. It has been established that a Poisson model for counts with stratum indicators gives identical estimates to those from conditional logistic regression and does not have these limitations, but it is little used, probably because of the overheads in estimating many stratum parameters. METHODS: The conditional Poisson model avoids estimating stratum parameters by conditioning on the total event count in each stratum, thus simplifying the computing and increasing the number of strata for which fitting is feasible compared with the standard unconditional Poisson model. Unlike the conditional logistic model, the conditional Poisson model does not require expanding the data, and can adjust for overdispersion and auto-correlation. It is available in Stata, R, and other packages. RESULTS: By applying to some real data and using simulations, we demonstrate that conditional Poisson models were simpler to code and shorter to run than are conditional logistic analyses and can be fitted to larger data sets than possible with standard Poisson models. Allowing for overdispersion or autocorrelation was possible with the conditional Poisson model but when not required this model gave identical estimates to those from conditional logistic regression. CONCLUSIONS: Conditional Poisson regression models provide an alternative to case crossover analysis of stratified time series data with some advantages. The conditional Poisson model can also be used in other contexts in which primary control for confounding is by fine stratification.
Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods
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Jakobsen JC, Wetterslev J, Winkel P, Lange T, Gluud C.
BMC medical research methodology 2014 Nov 21;14(1):120-2288-14-120
Thresholds for statistical significance when assessing meta-analysis results are being insufficiently demonstrated by traditional 95% confidence intervals and P-values. Assessment of intervention effects in systematic reviews with meta-analysis deserves greater rigour. METHODS: Methodologies for assessing statistical and clinical significance of intervention effects in systematic reviews were considered. Balancing simplicity and comprehensiveness, an operational procedure was developed, based mainly on The Cochrane Collaboration methodology and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. RESULTS: We propose an eight-step procedure for better validation of meta-analytic results in systematic reviews (1) Obtain the 95% confidence intervals and the P-values from both fixed-effect and random-effects meta-analyses and report the most conservative results as the main results. (2) Explore the reasons behind substantial statistical heterogeneity using subgroup and sensitivity analyses (see step 6). (3) To take account of problems with multiplicity adjust the thresholds for significance according to the number of primary outcomes. (4) Calculate required information sizes (≈ the a priori required number of participants for a meta-analysis to be conclusive) for all outcomes and analyse each outcome with trial sequential analysis. Report whether the trial sequential monitoring boundaries for benefit, harm, or futility are crossed. (5) Calculate Bayes factors for all primary outcomes. (6) Use subgroup analyses and sensitivity analyses to assess the potential impact of bias on the review results. (7) Assess the risk of publication bias. (8) Assess the clinical significance of the statistically significant review results. CONCLUSIONS: If followed, the proposed eight-step procedure will increase the validity of assessments of intervention effects in systematic reviews of randomised clinical trials.
The use of Latin squares and related block designs in implementation research
Non UofA Access
Steen IN, Campbell MK, Eccles MP, Grimshaw JM, Ramsay CR, Russell IT.
Journal of clinical epidemiology 2014;67(12):1299.
A common goal in implementation research is to compare alternative implementation strategies across a range of clinical conditions. Block designs can be used to obtain estimates of effect size while controlling for nuisance variables. A nuisance variable is correlated with the outcome of interest but not of direct interest to the researcher; it might be a characteristic of the participants or institutions under study. In general, blocks correspond to different values of the nuisance variables.
Research funder required research partnerships: a qualitative inquiry
Non UofA Access
Sibbald SL, Tetroe J, Graham ID.
Implementation science 2014 Nov 28;9(1):176
Researchers and funding agencies are increasingly showing interest in the application of research findings and focusing attention on engagement of knowledge-users in the research process as a means of increasing the uptake of research findings. The expectation is that research findings derived from these researcher-knowledge-user partnerships will be more readily applied when they became available. The objective of this study was to investigate the experiences, perceived barriers, successes, and opinions of researchers and knowledge-users funded under the Canadian Institutes of Health Research?s integrated Knowledge Translation funding opportunities for a better understanding of these collaborations.Methods Participants, both researchers and knowledge-users, completed an online survey followed by an individual semi-structured phone interview supporting a mixed methods study. The interviews were analyzed qualitatively using a modified grounded theory approach.Results Survey analysis identified three major partnership types: token, asymmetric, and egalitarian. Interview analysis revealed trends in perceived barriers and successes directly related to the partnership formation and style. While all partnerships experienced barriers, token partnerships had the most challenges and general poor perception of partnerships. The majority of respondents found that common goals and equality in partnerships did not remove barriers but increased participants? ability to look for solutions.Conclusions We learned of effective mechanisms and strategies used by researchers and knowledge-users for mitigating barriers when collaborating. Funders could take a larger role in helping facilitate, nurture, and sustain the partnerships to which they award grants.
Change in quality of life of people with dementia recently admitted to long-term care facilities.
Non UofA Access
Beerens HC, Zwakhalen SM, Verbeek H, Ruwaard D, Ambergen AW, Leino-Kilpi H, et al.
Journal of advanced nursing 2014 Nov 17
To assess which factors are associated with change in quality of life of people with dementia who have recently been admitted to long-term care facilities. BACKGROUND: Many people with dementia will be admitted to long-term care facilities at some point during their disease. It is currently unknown which factors are associated with improvement and/or deterioration of quality of life immediately following admission. DESIGN: An observational and longitudinal survey. METHODS: Data on 343 people with dementia who have been recently admitted to long-term care facilities across eight European countries were collected between November 2010-April 2012. Quality of life was assessed by people with dementia and their proxies using the ‘Quality of Life-Alzheimer’s Disease scale’. Explanatory variables included cognitive status, comorbidities, activities of daily living, depressive symptoms and neuropsychiatric symptoms. Descriptive and multilevel regression analyses were performed. RESULTS: Better cognitive abilities at baseline were associated with a decrease in self-reported quality of life. Greater dependency and more depressive symptoms at baseline were associated with declined proxy-reported quality of life. Furthermore, an increased dependency and an increase of depressive symptoms between baseline and follow-up were associated with a decreased proxy-reported quality of life. On an individual level, three groups were identified, namely people whose quality of life: (1) decreased; (2) stayed the same; and (3) increased. CONCLUSION: Cognitive functioning, functional rehabilitation and treatment of depressive symptoms should receive special attention. However, quality of life of people with dementia does not necessarily decrease after institutionalization. © 2014 John Wiley & Sons Ltd.
Changes in caregiver burden and health-related quality of life of informal caregivers of older people with Dementia: evidence from the European RightTimePlaceCare prospective cohort study.
Non UofA Access
Bleijlevens MH, Stolt M, Stephan A, Zabalegui A, Saks K, Sutcliffe C, et al.
Journal of advanced nursing 2014 Nov 17
To describe differences in caregiver burden and health-related quality of life of informal caregivers of people with dementia in eight European countries and assess changes after transition from home to institutional long-term care. BACKGROUND: Country differences in the experience of burden and health-related quality of life are rarely described. DESIGN: Prospective cohort study. METHODS: Data on burden and health-related quality of life were collected at baseline (conducted between November 2010-April 2012) and follow-up (after 3 months) using face-to-face interviews. Two groups of informal caregivers included those: (1) of people with dementia recently admitted to institutional long-term care facilities; and those (2) of people with dementia receiving home care. Statistical analyses focused on descriptive comparisons between groups and countries. RESULTS: Informal caregivers of about 2014 were interviewed. Informal caregivers of people with dementia at home experienced more burden compared with informal caregivers of recently institutionalised people with dementia. Almost no differences in health-related quality of life were found between groups. Large differences between countries on outcomes were found. Informal caregivers of people with dementia who made the transition to an institutional long-term care facility experienced a statistically significant decrease in burden and psychological distress at follow-up. CONCLUSION: Cross-country differences may be related to differences in health and social care systems. Taking this into account, informal caregiver interventions need to be tailored to (country specific) contexts and (individual) needs. Findings highlight the positive impact of admission to institutional long-term care on informal caregiver well-being. © 2014 John Wiley & Sons Ltd.
Home healthcare teams’ assessments of pain in care recipients living with dementia: a Swedish exploratory study.
Non UofA Access
Karlsson CE, Ernsth Bravell M, Ek K, Bergh I.
International journal of older people nursing 2014 Nov 14
Pain assessment in people living with dementia is a challenge due to the complexity of pain and dementia and the difficulties in self-reporting. In home healthcare, nurses are frequently involved in pain assessment situations and there is a need to explore how home healthcare teams’ manage pain assessment in this setting. AIM: The study aimed to explore home healthcare teams’ experiences of pain assessment among care recipients with dementia. DESIGN: An exploratory qualitative design was used. METHODS: Open-ended individual interviews were conducted with thirteen registered nurses and ten nursing assistants, working in three different home healthcare teams in one municipality in western Sweden. Philosophical hermeneutics was utilised to interpret the home healthcare teams’ experiences. RESULTS: Four interpretations emerged: the need for trusting collaboration, the use of multiple assessment strategies, maintenance of staff continuity in care and assessment situations, and the need for extended time to assess pain. CONCLUSIONS: The home healthcare teams recognise pain assessment in people with dementia as involving a complex interaction of sensory, cognitive, emotional and behavioural components in which efforts to acquire understanding of behavioural changes mainly guides their assessments. The solid team coherence between registered nurses and nursing assistants aided the assessment procedure. To assess pain, the teams used multiple methods that complemented one another. However, no systematic routines or appropriate evidence-based pain tools were used. IMPLICATIONS FOR PRACTICE: The team members’concern for care recipients when assessing pain is evident and needs to be acknowledged by the organisation which is responsible for the quality of care. Future studies should focus on further exploration of nurses’ experiences with pain and dementia in home healthcare settings and address what nurses identify and how they deal with their findings. It is imperative to investigate how organisations and nurses can ensure best practices and how the implementation of evidence-based routines for assessing pain may aid in pain assessment situations. © 2014 John Wiley & Sons Ltd.
Quality of life of nursing home residents with dementia: validation of the German version of the ICECAP-O.
Non UofA Access
Makai P, Beckebans F, van Exel J, Brouwer WB.
PloS one 2014 Mar 14;9(3):e92016
To validate the ICECAP-O capability wellbeing measure’s German translation in older people with dementia living in a nursing home, and to investigate the influence of proxy characteristics on responses. METHOD: Cross-sectional study. For 95 residents living in a German nursing home, questionnaires were completed by nursing professionals serving as proxy respondents. We investigated the convergent validity of the ICECAP-O with other Quality of Life (Qol) measures, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer’s Disease Related Quality of Life (ADRQL) measures, and the Barthel-index measure of Activities of Daily Living (ADL). Discriminant validity was investigated using bivariate and multivariate stepwise regression analysis, comparing ICECAP-O scores between subgroups varying in dementia severity, care dependency, ADL status and demographic characteristics. RESULTS: Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL and Barthel-Index scores was moderate to good (with correlations of 0.72, 0.69 and 0.53 respectively), but differed considerably between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.58 below 65 points on the Barthel-index and 0.80 above 65 points) and other characteristics. The ICECAP-O scores based on available tariffs were related to proxy characteristics gender (0.52 males versus 0.65 females) and work experience (0.61 below 2 years of experience versus 0.68 above 2 years). DISCUSSION: The results of this study suggest that the ICECAP-O is a promising generic measure for general Qol and capability of people with dementia living in a nursing home. Validity tests generally yielded favorable results. Work experience and gender appeared to influence proxy response, which raises questions regarding appropriate proxies, especially since the ICECAP-O may be completed by proxies relatively often. Further research is necessary to validate the German version of the ICECAP-O, with specific attention to proxy completion for people with dementia.
The Association for the Advancement of Wound Care (AAWC) Venous and Pressure Ulcer Guidelines.
Non UofA Access
Bolton LL, Girolami S, Corbett L, van Rijswijk L.
Ostomy/wound management 2014 Nov;60(11):24-66
Guidelines based on best available evidence to support pressure ulcer (PU) or venous ulcer (VU) management decisions can improve outcomes. Historically, such guidelines were consensus-based and differed in content and development methods used. Since 2002, the Association for the Advancement of Wound Care (AAWC) Guideline Task Force has used a systematic approach for developing “guidelines of guidelines” that unify and blend recommendations from relevant published guidelines while meeting Institute of Medicine and Agency for Healthcare Research and Quality standards. In addition to establishing the literature-based strength of each recommendation, guideline clinical relevance is examined using standard content validation procedures. All final recommendations included are clinically relevant and/or supported by the highest level of available evidence, cited with every recommendation. In addition, guideline implementation resources are provided. The most recent AAWC VU and PU guidelines and ongoing efforts for improving their clinical relevance are presented. The guideline development process must be transparent and guidelines must be updated regularly to maintain their relevance. In addition, end-user results and research studies to examine their construct and predictive validity are needed.
Using the Environment to Support Communication and Foster Independence in People with Dementia demonstrates the importance of building a supportive environment to improve communication skills and quality of life among long term care residents. This report, a series of 3 case studies, is based on the Environment & Communication Assessment Toolkit. Staff at three different long-term care facilities were asked to identify aspects of the physical environment that were negatively impacting residents. They were given a limited budget and had the opportunities to make changes over a 3-6 month period. Many of the changes were small, such as installing a grab bar, re-organizing bedroom furniture and improving signage. However they all made a big impact with the residents.
The National Seniors Council was directed in August 2013, to consult with seniors, key players from the not-for-profit, public and private sectors to assess how social isolation affects seniors and explore ways to prevent and reduce social isolation of seniors in Canada. The objective of this report is to share the input received through the Council’s consultation efforts on the issue and provide advice in the form of suggested measures for federal consideration that could help to prevent and reduce social isolation of seniors in Canada.
Commission on Hospital Care for Frail Older People (UK)
The Commission on Hospital Care for Frail Older People reviewed probably the main question facing the NHS, namely how to care for the country’s increasing number of frail older people. The commission’s conclusion is that hospital providers and commissioners should take action themselves to tackle the problem now, instead of awaiting elusive conclusive evidence on the benefits of better integration between health and social care, and / or relying on government plans for greater integration.
The Bigger Picture: Policy insights and recommendations (UK)
The Strategic Society Centre & Independent Age
The Bigger Picture: Understanding disability and care in England’s older population has been produced to help councils and other organisations involved in delivering care understand the needs of key groups of older people:
-older people limited by a longstanding health condition or disability
-older people who receive paid or unpaid care
The Care Act, which comes into effect from April 2015, represents the biggest legal change to England’s care and support system for decades. It places specific new duties on councils to target older people experiencing unmet needs, carers and other groups currently independent of the local authority care system. People who pay for their own care will be encouraged to present themselves for assessment to their council. In this way, the Care Act places councils a duty on local authorities in relation to their entire population of older people, rather than just those individuals who meet the council’s eligibility threshold. The ‘Bigger Picture’ therefore aims to paint a picture of the lives of older people providing unpaid care or experiencing day-to-day difficulties, such as washing and getting dressed. It provides new insights into disability and who provides and who receives care at a national, regional and local level.
Evaluation of the Genio Dementia Programme (Ireland)
Genio, Prof. Eamon O’Shea and Edel Murphy, Irish Centre for Social Gerontology, NUI Galway
An evaluation of the Genio Dementia Programme will be published for each year of its operation. The evaluation of year one report examines the workings of the Genio Dementia Programme in 2013, the first year of operation, and its impact in relation to the public awareness of dementia, diagnosis, community-based supports, integrated provision, and sustainability. The report also covers the relevance and implications of the programme over the coming years for public policy and its role in heralding and showcasing a new, person-centred approach to dementia care in Ireland. The report draws on information provided by Genio, information-gathering visits to each site to meet with key personnel, and a structured questionnaire completed by each site as part of this evaluation process, which invited the sites to reflect on their progress in the first year.
In 2010/2011, an estimated 55,000 Canadians aged 18 or older living in private households reported that they had been diagnosed with Parkinson’s disease. This represented 0.2% of the household population. As well, 12,500 (4.9%) of residents of long-term residential care facilities were reported to have a Parkinson’s diagnosis.
Who Cares? Preparing the System and the Caregiver for What Lies Ahead
8 December 19:00-20:30 Hamilton ON
Presentation will be live streamed here
Dr. Janice Keefe, a Canadian leader in research about preparing the health system to care for older adults, will deliver a public talk entitled Who Cares? Preparing the System and the Caregiver for What Lies Ahead. Following the presentation, McMaster’s Allison Williams, who holds a Research Chair in Gender, Work and Health from the Canadian Institutes of Health Research, as well Diane Charter, a retired professional and family caregiver, will comment on Keefe’s ideas, then all three will accept questions from the audience.
Alzheimer’s Disease Caregiving: Health Effects and Treatment Strategies
9 December 19:00-20:30 Hamilton ON
Presentation will be live streamed here
Dr. Richard Schulz, a professor from the University of Pittsburg and a leader in research on the health effects of caregiving, will talk specifically about the challenges faced by caregivers of those with Alzheimer’s disease. Schulz will share some of the findings and views from his extensive research on adult development and aging, and from his significant contributions to the study of the health effects of caregiving. Those who provide care to people with Alzheimer’s face significant challenges and often report high emotional stress, severe fatigue and depression, and can experience social isolation. With the number of people with Alzheimer’s disease expected to grow and the important role that caregivers play in their lives, it is imperative to ensure they are supported. McMaster’s Jenny Ploeg, who is scientific director of the Aging, Community and Health Research Unit, will comment on Schulz’s ideas, then both will answer questions from the audience.
TVN Webinar-Knowledge Translation: moving evidence into practice and policy
Wednesday 3 December 10:00-11:00 MT
Join us online with Dr. Jayna Holroyd-Leduc for a primer in translating knowledge into practice to benefit Canada’s seriously ill, frail elderly. We believe that caring for the frail elderly is a complex, Canada-wide issue that requires multi-faceted, national strategies and solutions, and this webinar is one way we bring together talented people to focus on this goal.
CLSA Webinar Series: Older Canadians, food intake and nutritional status: How the CLSA will advance knowledge
4 December 12:00-13:00 MT
Speaker: Heather Keller, RD, PhD
Heather Keller, RD, PhD, is the Schlegel Research Chair in Nutrition & Aging and a Professor of Kinesiology at the University of Waterloo. She is the Chair of the Canadian Malnutrition Task Force (CMTF) and leads the Making the Most of Mealtimes (M3) research program focused on improving food intake in residents living in long-term care. Prof. Keller is a scientist with the Agri-Food For Healthy Aging research group and is currently conducting research focused on improving the nutritional status and food intake of older adults.
Conference board of Canada Webinar: Tackling Resistance to Change at an Individual Level
This is a recorded webinar and can be watched anytime
How do your people react to the relentless pressure of change? Often, they resist—and, thus, executives must work to help people adapt. Unfortunately, leaders too often only react to resistance as it happens, at which point it’s sometimes too late. What if, instead, you could predict which employees might be especially resistant to change and could take action preemptively? This session reviews a case study of an enterprise-wide ERP project in which individual resistance was measured and successfully managed.
KT Canada webinar: Patients in research 2.0: Successful cases on patient engagement and collaboration in health research
Thursday 11 December 10:00-11:00
-To discuss the emerging roles of patients / consumers in research.
-To illustrate how to meaningfully engage patients in research using 2 recent arthritis projects.
-To discuss lessons learned from patient-researcher collaboration.
Systematic Review and Meta-Analysis of Direct, Indirect and Mixed Treatment Evidence 2015
15-17 April Glasgow, UK £950
The course is designed for health service researchers, healthcare professionals and health technology assessment practitioners who are interested in learning the key concepts involved in the design and undertaking of systematic reviews and meta-analyses.
What are the learning objectives?
At the end of the course, participants should be able to:
· Design and conduct high quality systematic reviews
· Conduct appropriate meta-analyses using Stata
· Explore bias and heterogeneity
· Identify the important aspects of network meta-analysis
CFHI: System Transformation without a Template: Delivering Care for ‘Ms. Smith’ and the Whole Population
Tuesday 9 December 10:00-11:00 MT $100
Healthcare as we know it is highly facility-based and fragmented. Population health needs, as we understand them, are increasingly chronic and complex. How do health system leaders spur change, at the scale required, to align the care that is offered with that which is needed? How do leaders develop ‘whole-population’ approaches to care, while still recognizing the individual care needs of ‘Ms. Smith’ – individual patients and their families? “System innovations of this magnitude have no template” – that’s how Alberta Health Services (AHS) put it when they launched the Strategic Clinical Networks (or SCNs) in 2012. In an effort to deliver the most optimal and effective care to patients, AHS has 10 SCNs (covering such areas as Addiction and Mental Health; Cardiovascular Health and Stroke; Diabetes, Obesity and Nutrition; Respiratory Health; and Seniors Health), each with a provincial scope and mandate to deliver sustainable, high-quality healthcare for all Albertans
A FREE Massive Open Online Course (MOOC) Living with Dementia Impact on Individuals, Caregivers, Communities and Societies
Registration deadline 12 January
Health professionals and students, family caregivers, friends of and affected individuals, and others interested in learning about dementia and quality care will benefit from completing the course. Led by Drs. Nancy Hodgson and Laura Gitlin, participants will acquire foundational knowledge in the care of persons with Alzheimer’s Disease and other neurocognitive disorders in this 5-week course.
It can be really tricky to get better at something. Sometimes it’s even trickier to know if, when, and how much you’re actually getting better. But there are some things you can do to make improvement easier, and right at the top of the list is measurement.
The traditional model for funding science focuses on short-term projects and the ‘publish or perish’ model for publishing research output, which leads to biased outcomes and safe, incremental discovery. So Thinkable is adopting a model that focuses on people, not just one-off projects. Instead of funding being decided by a select committee behind closed doors, Thinkable allows scientists to grow their own support base from around the world without time limits.
A woman who says she found her mother left sitting in her own feces with a fungus growing on her hand in a Fort McMurray continuing care facility is calling on Alberta Health Services to conduct a full inquiry into the centre.
One out of every four adults would rather go to the dentist than talk about their long term care or aging needs. “While the data stating people would rather sit in a dentist chair than talk about long term care might seem amusing, the severity of the issue is very real,” said Mr. Tom McInerney, President and Chief Executive Officer at Genworth.
The two organizations signed a memorandum of understanding recently to create a research and education partnership devoted to aging, and the Director of Care Certificate in Clinical Leadership (DOCL) program is the first step in this process.
By encouraging researchers to publish in international journals, we may be steering their work in the wrong direction.
In broad terms, the Glasgow Declaration calls for the creation of a European Dementia Strategy and national strategies in every country in Europe. The signatories also call upon world leaders to recognise dementia as a public health priority and to develop a global action plan on dementia.
Close to 310,000 people live in health care and related institutions in Canada, excluding Quebec. Of these, approximately 143,000 live in nursing homes, where more than 90% of residents are over the age of 65 and there are twice as many women as men. How much is being spent?
• Total spending by nursing homes was $9.8 billion in 2012, excluding physician and prescription drug costs.
• Spending on salaries represented two-thirds of the total spent, at $6.4 billion.
Gridlocked hospitals around Canada are struggling to make room for incoming arrivals because so many older patients have no other place to go, the president of the Canadian Medical Association said.
The CMA is calling for a national seniors strategy that would get elderly patients with chronic ailments out of hospitals and into institutions and programs better suited to their needs.
The fall issue focuses on Dementia. The increase in the number of elderly Canadians with Dementia, including Alzheimer’s, is driving the need for an understanding of the processes behind dementia that will lead to improved treatments. The research stories told in this issue include:
-Drs. Black and Hachinski’s research is a new approach to dementia treatment: early prevention based on addressing risk factors for vascular health, such as hypertension, diabetes and smoking. Their research was instrumental to the development of the first dementia screening protocol that combines stroke, dementia and overall vascular health.
-In a recent CIHR-funded study, Keefe and colleagues identified best-practice guidelines for the timing of caregiver assessment for those caring for elderly spouses with dementia.
-Between 1996 and 2005, using a combination of clinical experience, research infrastructure and insights from neuropsychology, researchers developed the Montreal Cognitive Assessment (MoCA), a tool to screen for MCI in 10 minutes.
Thousands of older people in England are struggling in their own home with little or no help, research suggests. The analysis by the Independent Age charity and Strategic Society Centre think tank indicates more than two million have difficulty with washing, dressing, cooking or eating.
The Saskatchewan ombudsman office is trying to determine if there are “system-wide” problems in seniors care. The office confirmed that there have been 16 complaints about long term care issues, with 10 of those files coming in the last month. 13 complaints were reported in 2013.
Canada’s family doctors are calling on the federal government to develop a national home-care strategy for seniors and improved health care for young people.
9 out of 10 Ontario patients surveyed say they are satisfied with their
Median wait times for long-term care homes in Ontario are improving
in recent years, but there is a lot of variation across the province.
At the invitation of the League of European Research Universities (LERU) and Leiden University, the U15 Group of Canadian Research Universities joined its counterpart associations to discuss the importance of social sciences and humanities research in solving the world’s pressing challenges.
Funded by and in partnership with the RCN Foundation, researchers in the Department of Health Sciences at the University of York are carrying out research into care and nursing homes. The aim of the project is to identify and map key issues in relation to the care and professional development needs of nursing staff employed in care homes. The findings from this work will inform the RCN Foundation’s discussions of where and how any future project grants could potentially make the most impact on this important area of nursing practice.
The number of people with Alzheimer’s disease in the United States will more than double by 2050 — a trend driven by the aging baby boomer population, a new study predicts. The cost of caring for these Alzheimer’s patients will climb from $307 billion to $1.5 trillion a year by 2050, the researchers estimated. They believe that, 35 years from now, the average annual per-patient cost of the disease will be double that of the $71,000-a-year cost in 2010.
As Canada’s population ages, the need for long-term care (LTC) will continue to rise and so will the demand for high quality, individualized care. The Neighbourhood Team Development (NTD) program provides LTC homes with the tools needed to build cross-functional teams and provide this resident-centred approach. Schlegel Villages has begun implementing the NTD program across 13 LTC and retirement homes. This transition to a new organizational structure provides an exciting opportunity to study the process of implementing NTD and measure its impact.
The money will be used to help pay for renovations and additions to seniors’ lodges in rural areas. The provincial government will work with other organizations to determine which projects are the highest priority.
Addressing a session at the 4th Annual Convention of the European Platform against Poverty and Social Exclusion, Tim Muir, representative of the Organisation for Economic Co-operation and Development (OECD), explained the social protection gaps causing poverty risks for dependent persons. Across the EU, member states offer different protection structures for informal long term carers. In the United Kingdom and the United States, the government offers support only to the poorest of people.
A program called a memory café is helping Saint John-area dementia patients and their families cope through education, socialization and activity.
Recently, the Wellcome Trust, MIT, Digital Science, and others have come together to create a taxonomy of contributorship. It recognizes roles like data curation, development of design methodology, programming and software development, application of statistical or mathematical techniques to analyze data, data visualization, verification or results, and so on.
Your website is how you attract scholarly talent to your research program; so why are you letting it languish?
Care being given residents in long-term care facilities is substandard and the Ontario government is to blame, says a study group of personal support workers and registered practical nurses. About 60 PSWs and RPNs took part in the study which was released in Cornwall on Tuesday, and the biggest issue facing them is staffing levels.
This appointment will be effective January 1, 2015. Dr. Tannenbaum is a Professor of Medicine and Pharmacy at the Université de Montréal where she has held the Michel Saucier Endowed Chair in Geriatric Pharmacology, Health and Aging since 2008.
When a handful of authors were caught reviewing their own papers, it exposed weaknesses in modern publishing systems. Editors are trying to plug the holes.
Alberta Innovates – Health Solutions (AIHS) is conducting a province-wide survey on training needs in knowledge translation.
The EBR Network suggests that all PhD students, supervisors and senior researchers learn about and perform systematic reviews to ground their own research questions and conclusions in all relevant previous studies. Researchers would then have a much better foundation upon which to argue that their project is “research-worthy” and would in fact add to existing knowledge. We support earlier suggestions that ethics committees only support evidence-based research, that editors and scientific journals reject manuscripts that do not systematically review previous research, and that those who fund research focus their resources on that which is evidence-based.
This report outlines work this committee has completed thisyear.
A six-month review of systemic problems in Alberta’s $1.4-billion continuing care system is nearing completion, according to Alberta Health Services officials.
Researchers have found that 19.8 percent of nursing home residents had been involved in what the researchers call “resident-to-resident elder mistreatment” — verbal, physical or sexual — in the previous month.
This guide describes what is needed to evaluate a health information exchange (HIE) project and develop a realistic evaluation plan. It consists of six sections to assist users in all steps of the HIE project evaluation planning process. It also includes six appendixes that provide additional resources to help capture needed information to include in the plan.
Authors and researchers around the world have let us know through survey feedback and one-on-one interviews that time management is a common concern. As the Manager for Learning and Development at Wiley, Joan Capua applies time management techniques learned from her 20 years of experience in training professionals in multiple industries to feedback from authors and researchers.
WHO has launched a new web-platform called Age-Friendly World: Adding life to years which includes a database of age-friendly initiatives called “Age-Friendly Practice”. It constitutes a global platform for information exchange and learning and meeting place for members of the WHO Global Network of Age-friendly Cities and Communities.
The Dementia Engagement and Empowerment Project aims to support the involvement of people with dementia. Some were created for DEEP groups or individuals with dementia, others are for organisations wanting to work well with people who have dementia.
For people who have dementia:
-Travelling with Dementia—A guide developed by the Scottish Dementia Working Group
-Enhancing communication—A ‘By us, For us’ guide for people like us with early stage memory loss
-Using sound recording—A DEEP guide to getting your message heard
-Telling Our Stories—A guide to using film to hear the voices of people with dementia.
For organisations and communities
— Writing dementia-friendly information
—Creating websites for people with dementia
—Tips for consulting people with dementia about written documents
—Choosing a dementia-friendly meeting space
—Collecting the view of people with dementia
—Involving people with dementia at conferences and events
—Film-makers working with people with dementia
—Involving people with dementia in recruitment
—Dementia-friendly tips for employers
10 questions were asked about who is involved in KT conversations on the world wide web in Canada. Here are the results.
One of the key factors in sustaining long-term usage for your research is through search engine optimization (SEO). Authors can also play a crucial role in optimizing search results at the article-level by following these tips.
CFHI created this assessment tool to help healthcare leaders assess their organization’s or system’s capacity to undertake improvement initiatives. The tool is built around six levers that will guide your organization toward making the changes needed to become a high-performing healthcare organization. For each lever, the tool includes statements that help you assess where your organization or system currently performs. These levers were developed after an examination of the key attributes of three high-performing healthcare organizations — Southcentral Foundation in Alaska, Jönköping County Council in Sweden, and Intermountain Healthcare in Utah and a review of Canadian literature on healthcare transformation.
Plagiarism is a serious charge. If true, it has the potential to upend a career and mar a journalist’s reputation for life. And yet, in today’s world of aggregated news, plagiarism is an imprecise word that stands for a spectrum of offenses related to unoriginal work. And its severity varies dramatically depending on a variety of circumstances.
Use this checklist to determine for yourself whether the charges are true.
Whether you’re writing an article for your newspaper, showing the results of a campaign, introducing your academic research, illustrating your team’s performance metrics, or shedding light on civic issues, you need to know how to present your data so that other people can understand it.
This guidance provides examples of ways in which different types of social media are currently being used to involve the public in research, the benefits, challenges, risks and ethics of using social media for involvement, and some top tips and things to think about.