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Happy Holidays!!!
Congratulations to Stephanie Chamberlain
Stephanie is the recipient of the Thelma R Scrambler Scholarship
This award goes to an exceptional graduate student studying gerontology or geriatrics at the University of Alberta. Way to go Stephanie!!!
Abstracts
New Article by Dr. Carole Estabrooks:
A systematic review of instruments to assess organizational readiness for knowledge translation in health care.
Non UofA Access
Gagnon MP, Attieh R, Ghandour el K, Legare F, Ouimet M, Estabrooks CA, et al.
PloS one 2014 Dec 4;9(12):e114338
The translation of research into practices has been incomplete. Organizational readiness for change (ORC) is a potential facilitator of effective knowledge translation (KT). However we know little about the best way to assess ORC. Therefore, we sought to systematically review ORC measurement instruments. METHODS: We searched for published studies in bibliographic databases (Pubmed, Embase, CINAHL, PsychINFO, Web of Science, etc.) up to November 1st, 2012. We included publications that developed ORC measures and/or empirically assessed ORC using an instrument at the organizational level in the health care context. We excluded articles if they did not refer specifically to ORC, did not concern the health care domain or were limited to individual-level change readiness. We focused on identifying the psychometric properties of instruments that were developed to assess readiness in an organization prior to implementing KT interventions in health care. We used the Standards for Educational and Psychological Testing to assess the psychometric properties of identified ORC measurement instruments. FINDINGS: We found 26 eligible instruments described in 39 publications. According to the Standards for Educational and Psychological Testing, 18 (69%) of a total of 26 measurement instruments presented both validity and reliability criteria. The Texas Christian University -ORC (TCU-ORC) scale reported the highest instrument validity with a score of 4 out of 4. Only one instrument, namely the Modified Texas Christian University – Director version (TCU-ORC-D), reported a reliability score of 2 out of 3. No information was provided regarding the reliability and validity of five (19%) instruments. CONCLUSION: Our findings indicate that there are few valid and reliable ORC measurement instruments that could be applied to KT in the health care sector. The TCU-ORC instrument presents the best evidence in terms of validity testing. Future studies using this instrument could provide more knowledge on its relevance to diverse clinical contexts.
New Article by Dr. Janet Squires & Dr. Ali Hutchinson:
Understanding context in knowledge translation: a concept analysis study protocol.
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Squires JE, Graham ID, Hutchinson AM, Linklater S, Brehaut JC, Curran J, et al.
Journal of advanced nursing 2014 Nov 28
To conduct a concept analysis of clinical practice contexts (work environments) that facilitate or militate against the uptake of research evidence by healthcare professionals in clinical practice. This will involve developing a clear definition of context by describing its features, domains and defining characteristics. BACKGROUND: The context where clinical care is delivered influences that care. While research shows that context is important to knowledge translation (implementation), we lack conceptual clarity on what is context, which contextual factors probably modify the effect of knowledge translation interventions (and hence should be considered when designing interventions) and which contextual factors themselves could be targeted as part of a knowledge translation intervention (context modification). DESIGN: Concept analysis. METHODS: The Walker and Avant concept analysis method, comprised of eight systematic steps, will be used: (1) concept selection; (2) determination of aims; (3) identification of uses of context; (4) determination of defining attributes of context; (5) identification/construction of a model case of context; (6) identification/construction of additional cases of context; (7) identification/construction of antecedents and consequences of context; and (8) definition of empirical referents of context. This study is funded by the Canadian Institutes of Health Research (January 2014). DISCUSSION: This study will result in a much needed framework of context for knowledge translation, which identifies specific elements that, if assessed and used to tailor knowledge translation activities, will result in increased research use by nurses and other healthcare professionals in clinical practice, ultimately leading to better patient care. © 2014 John Wiley & Sons Ltd.
New Article by Dr. Greta Cummings:
Strengthening Moral Reasoning Through Dedicated Ethics Training in Dietetic Preparatory Programs.
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Hewko SJ, Cooper SL, Cummings GG.
Journal of nutrition education and behavior 2014 Dec 9
Moral reasoning skills, associated with the ability to make ethical decisions effectively, must be purposively fostered. Among health professionals, enhanced moral reasoning is linked to superior clinical performance. Research demonstrates that moral reasoning is enhanced through dedicated, discussion-based ethics education offered over a period of 3-12 weeks. Current dietetic students and practicing dietitians seeking to strengthen their moral reasoning skills can undertake elective ethics education. Further research within dietetic preparatory programs is warranted to better inform the development and implementation of ethics courses. Copyright © 2014 Society for Nutrition Education and Behavior.
New Article by Dr. Kim Fraser & Dr. Greta Cummings:
Factors influencing nurse managers’ intent to stay or leave: a quantitative analysis.
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Hewko SJ, Brown P, Fraser KD, Wong CA, Cummings GG.
Journal of nursing management 2014 Dec 10
To identify and report on the relative importance of factors influencing nurse managers’ intentions to stay in or leave their current position. BACKGROUND: Effective nurse managers play an important role in staff nurse retention and in the quality of patient care. The advancing age of nurse managers, multiple job opportunities within nursing and the generally negative perceptions of the manager role can contribute to difficulties in retaining nurse managers. METHODS: Ninety-five Canadian nurse managers participated in a web survey. Respondents rated the importance of factors related to their intent to leave or stay in their current position for another 2 years. Descriptive, t-test and mancova statistics were used to assess differences between managers intending to stay or leave. RESULTS: For managers intending to leave (n = 28), the most important factors were work overload, inability to ensure quality patient care, insufficient resources, and lack of empowerment and recognition. Managers intending to leave reported significantly lower job satisfaction, perceptions of their supervisor’s resonant leadership and higher burnout levels. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations wishing to retain existing nurse managers and to attract front-line staff into leadership positions must create and foster an environment that supports nurse managers. © 2014 John Wiley & Sons Ltd.
CALL FOR ABSTRACTS:
AcademyHealth 2015 Annual Research Meeting
14-16 January Minneapolis MN
DEADLINE 15 January
AcademyHealth is seeking abstracts on 18 themes across multiple areas of study in health services research, as well as proposals for panels that present research or discuss key health policy topics. Abstracts submitted to the call for presentations will also be considered for publication in JAMA and HSR.
CALL FOR ABSTRACTS:
Understanding Society’s Scientific Conference 2015
DEADLINE 16 February
The scientific conference provides an international forum for the exchange of research based on longitudinal data; in particular using household panel studies. An important aim of the event is to bring together people from different disciplines and to share research covering a broad range of themes.
CALL FOR SESSION PROPOSALS:
3rd Annual TVN Conference on improving care for the frail elderly
DEADLINE 2 February noon ET
TVN is pleased to invite proposals for sessions at the 2015 Annual Conference. To ensure a broad slate of session offerings from different individuals and institutions, this is an open call. Proposals will be selected to ensure the conference program offers a comprehensive and diverse treatment of issues related to TVN’s mission. Attention will be given to diversity of institutions, presenters, and geographic location.
CALL FOR ABSTRACTS:
KT Canada Annual Scientific Meeting
11-12 May Halifax NS
DEADLINE 16 February
Join the discussion on PATIENT AND PARTNER ENGAGEMENT through attendance at the KT Canada Annual Scientific Meeting. We invite interested people to submit an abstract on any topic related to advancing KT science.
CALL FOR ABSTRACTS:
5th Annual Advancing Quality Improvement Science for Children’s Health Care Research Conference
24 April San Diego
DEADLINE 6 January
The conference will focus on methodological and technical issues of major importance in the fi eld of pediatric health care QI research, a leading component of modern health services research. Speakers and participants will focus on barriers and facilitators to the development, extension, and use of state-of-the-art methodologies and research methods for health care QI research.
CALL FOR ABSTRACTS:
Alzheimer’s Research UK Conference
10-11 March London UK
DEADLINE 16 January
This meeting is the UK’s largest dementia research conference, covering a wide range of topics.
CALL FOR ABSTRACTS:
2015 British Society of Gerontology’s annual conference
1-3 July Newcastle Upon Tyne, UK
DEADLINE 16 January
The conference welcomes submissions from researchers, practitioners, educators, policy-makers, the third sector, students, and all other stakeholders interested in ageing.
Grants & Awards
Institute for Work & Health Syme Training Fellowship
DEADLINE 30 April
The fellowships are for young researchers at the master’s or doctoral level intending to study work and health. Preference will be given to candidates whose research interests include understanding the social determinants of health and illness in work environments, evaluating workplace interventions to improve health, and/or exploring the measurement issues associated with either of these two areas. IWH is particularly interested in candidates who show a commitment to research that promises to reduce work-related injury, illness and disability in Ontario.
CIHR Planning Gratns – Aging
DEADLINE 16 February
The Planning Grants – Aging opportunity will provide funding for applications that address research priority areas that are consistent with the mandate of the Institute, that will stimulate planning activities and/or partnership development, and exchange. The maximum amount awarded per grant is $25 000.
CIHR Knowledge Synthesis Grant
DEADLINE 15 May
The Knowledge Synthesis grant seeks to support teams of researchers and knowledge users to produce knowledge syntheses and scoping reviews that will contribute to the use of synthesized evidence in decision-making and practice.
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice & Methodology
Bibliometrics
Aging
KT
What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review
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Williams B, Perillo S, Brown T.
Nurse education today 2014
The responsibility to implement evidence-based practice (EBP) in a health care workplace does not fall solely on the individual health care professional. Organisational barriers relate to the workplace setting, administrational support, infrastructure, and facilities available for the retrieval, critique, summation, utilisation, and integration of research findings in health care practices and settings. Objective Using a scoping review approach, the organisational barriers to the implementation of EBP in health care settings were sought. Method This scoping review used the first five of the six stage methodology developed by Levac et al. (2010). The five stages used are: 1) Identify the research question; 2) identify relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results. The following databases were searched from January 2004 until February 2014: Medline, EMBASE, EBM Reviews, Google Scholar, The Cochrane Library and CINAHL. Results Of the 49 articles included in this study, there were 29 cross-sectional surveys, six descriptions of specific interventions, seven literature reviews, four narrative reviews, nine qualitative studies, one ethnographic study and one systematic review. The articles were analysed and five broad organisational barriers were identified. Conclusions This scoping review sought to map the breadth of information available on the organisational barriers to the use of EBP in health care settings. Even for a health care professional who is motivated and competent in the use of EBP; all of these barriers will impact on their ability to increase and maintain their use of EBP in the workplace.
Practice change toward better adherence to evidence-based treatment of early dental decay in the National Dental PBRN
Rindal D, Flottemesch T, Durand E, Godlevsky O, Schmidt A, Gilbert G, et al.
Implementation Science 2014;9(1):177
Significant national investments have aided the development of practice-based research networks (PBRNs) in both medicine and dentistry. Little evidence has examined the translational impact of these efforts and whether PBRN involvement corresponds to better adoption of best available evidence. This study addresses that gap in knowledge and examines changes in early dental decay among PBRN participants and non-participants with access to the same evidence-based guideline. This study examines the following questions regarding PBRN participation: are practice patterns of providers with PBRN engagement in greater concordance with current evidence? Does provider participation in a PBRNs increase concordance with current evidence? Do providers who participate in PBRN activities disseminate knowledge to their colleagues? Methods Logistic regression models adjusting for clustering at the clinic and provider levels compared restoration (dental fillings) rates from 2005?2011 among 35 providers in a large staff model practice. All new codes for early-stage caries (dental decay) and co-occurring caries were identified. Treatment was determined by codes occurring up to 6 months following the date of diagnosis. Provider PBRN engagement was determined by study involvement and meeting attendance.Results In 2005, restoration rates were high (79.5%), decreased to 47.6% by 2011 (p?<?.01), and differed by level of PBRN engagement. In 2005, engaged providers were less likely to use restorations compared to the unengaged (73.1% versus 88.2%; p?<?.01). Providers with high PBRN involvement decreased use of restorations by 15.4% from 2005 to 2008 (2005: 73%, 2008: 63%; p?<?.01). Providers with no PBRN involvement decreased use by only 7.5% (2005: 88%, 2008: 82%; p?=?.041). During the latter half of 2008 following the May PBRN meeting, attendees reduced restorations by 7.5%, compared to a 2.4% among non-attendees (OR?=?.64, p?<?.01).Conclusions Based on actual clinical data, PBRN engagement was associated with practice change consistent with current evidence on treatment of early dental decay. The impact of PBRN engagement was most significant for the most-engaged providers and consistent with a spillover effect onto same-clinic providers who were not P
Predictors of research use among staff in aboriginal addiction treatment programs serving women 
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Davey CJ, Niccols A, Henderson J, Dobbins M, Sword W, Dell C, et al.
Journal of ethnicity in substance abuse 2014;13(4):315-336
The objective of this study was to identify the predictors of research use among staff from Aboriginal addiction programs serving women. A total of 89 staff from 26 Aboriginal addiction programs completed an online survey that included items assessing the theory of planned behavior constructs (attitudes, subjective norms, perceived behavioral control), intent to use research, and research use. Consistent with the theory of planned behavior, research use was predicted by attitudes, subjective norms, and perceived behavioral control. Intent to use research was not a mediator, demonstrating partial applicability of the theory of planned behavior to staff in Aboriginal addiction programs serving women.
Positioning Clinical Nurse Specialists and Nurse Practitioners as Change Champions to Implement a Pain Protocol in Long-Term Care.
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Kaasalainen S, Ploeg J, Donald F, Coker E, Brazil K, Martin-Misener R, et al.
Pain management nursing 2014 Nov 6
Pain management for older adults in long-term care (LTC) has been recognized as a problem internationally. The purpose of this study was to explore the role of a clinical nurse specialist (CNS) and nurse practitioner (NP) as change champions during the implementation of an evidence-based pain protocol in LTC. In this exploratory, multiple-case design study, we collected data from two LTC homes in Ontario, Canada. Three data sources were used: participant observation of an NP and a CNS for 18 hours each over a 3-week period; CNS and NP diaries recording strategies, barriers, and facilitators to the implementation process; and interviews with members of the interdisciplinary team to explore perceptions about the NP and CNS role in implementing the pain protocol. Data were analyzed using thematic content analysis. The NP and CNS used a variety of effective strategies to promote pain management changes in practice including educational outreach with team members, reminders to nursing staff to highlight the pain protocol and educate about practice changes, chart audits and feedback to the nursing staff, interdisciplinary working group meetings, ad hoc meetings with nursing staff, and resident assessment using advanced skills. The CNS and NP are ideal champions to implement pain management protocols and likely other quality improvement initiatives. Copyright © 2014 American Society for Pain Management Nursing
Impact of Evidence and Health Policy on Nursing Practice.
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Geurden B, Adriaenssens J, Franck E.
The Nursing clinics of North America 2014 Dec;49(4):545-553
The story of evidence-based practice in nursing is long, with many successes, contributors, leaders, scientists, and enthusiasts. Nurse educators have great advantages offered from a wide variety of educational resources for evidence-based practice. These resources offer students the opportunity to connect their emerging competencies with clinical needs for best practices in clinical and microsystem changes. Copyright © 2014 Elsevier Inc. All rights reserved.
Stakeholders’ contributions to tailored implementation programs: an observational study of group interview methods.
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Huntink E, van Lieshout J, Aakhus E, Baker R, Flottorp S, Godycki-Cwirko M, et al.
Implementation science 2014 Dec 6;9(1):185
Tailored strategies to implement evidence-based practice can be generated in several ways. In this study, we explored the usefulness of group interviews for generating these strategies, focused on improving healthcare for patients with chronic diseases.MethodsParticipants included at least four categories of stakeholders (researchers, quality officers, health professionals, and external stakeholders) in five countries. Interviews comprised brainstorming followed by a structured interview and focused on different chronic conditions in each country. We compared the numbers and types of strategies between stakeholder categories and between interview phases. We also determined which strategies were actually used in tailored intervention programs.ResultsIn total, 127 individuals participated in 25 group interviews across five countries. Brainstorming generated 8 to 120 strategies per group; structured interviews added 0 to 55 strategies. Healthcare professionals and researchers provided the largest numbers of strategies. The type of strategies for improving healthcare practice did not differ systematically between stakeholder groups in four of the five countries. In three out of five countries, all components of the chosen intervention programs were mentioned by the group of researchers.ConclusionsGroup interviews with different stakeholder categories produced many strategies for tailored implementation of evidence-based practice, of which the content was largely similar across stakeholder categories.
Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study
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Ellen ME, Leon G, Bouchard G, Ouimet M, Grimshaw JM, Lavis JN.
Implementation science 2014 Dec 5;9(1):179
Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place.Methods This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software.Results Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to implementing supports for EIDM. The most frequently cited views about emerging development of supports for EIDM were implementing accessible and efficient systems to support the use of research in decision-making (e.g., documentation and reporting tools, communication tools, and decision support tools) and developing and implementing an infrastructure or position where the accountability for encouraging knowledge use lies. The most frequently stated priorities for bridging the gaps in the current mix of supports that these organizations have in place were implementing technical infrastructures to support research use and to ensure access to research evidence and establishing formal or informal ties to researchers and knowledge brokers outside the organization who can assist in EIDM.ConclusionsThese results provide insights on the type of practical implementation imperatives involved in supporting EIDM.
A Framework for Enhancing the Value of Research for Dissemination and Implementation.
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Neta G, Glasgow RE, Carpenter CR, Grimshaw JM, Rabin BA, Fernandez ME, et al.
American Journal of Public Health 2014 Nov 13:e1-e9
A comprehensive guide that identifies critical evaluation and reporting elements necessary to move research into practice is needed. We propose a framework that highlights the domains required to enhance the value of dissemination and implementation research for end users. We emphasize the importance of transparent reporting on the planning phase of research in addition to delivery, evaluation, and long-term outcomes. We highlight key topics for which well-established reporting and assessment tools are underused (e.g., cost of intervention, implementation strategy, adoption) and where such tools are inadequate or lacking (e.g., context, sustainability, evolution) within the context of existing reporting guidelines. Consistent evaluation of and reporting on these issues with standardized approaches would enhance the value of research for practitioners and decision-makers
Exploring knowledge exchange at the research-policy-practice interface in children’s behavioral health services.
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Leslie LK, Maciolek S, Biebel K, Debordes-Jackson G, Nicholson J.
Administration and Policy in Mental Health 2014 Nov;41(6):822-834
This case study explored core components of knowledge exchange among researchers, policymakers, and practitioners within the context of the Rosie D. versus Romney class action lawsuit in Massachusetts and the development and implementation of its remedial plan. We identified three distinct, sequential knowledge exchange episodes with different purposes, stakeholders, and knowledge exchanged, as decision-making moved from Federal Medicaid policy to state Medicaid program standards and to community-level practice. The knowledge exchanged included research regarding Wraparound, a key component of the remedial plan, as well as contextual information critical for implementation (e.g., Federal Medicaid policy, managed care requirements, community organizations’ characteristics).
Radiologists’ perspectives about evidence-based medicine and their clinical practice: a semistructured interview study
Tong A, Mahady SE, Craig JC, Lau G, Peduto AJ, Loy C.
BMJ Open 2014 12/01;4(12)
To describe radiologist’s attitudes and perspectives on evidence-based medicine (EBM) and their practice. Design Face-to-face semistructured interviews, thematic analysis. Setting 24 institutions across six Australian states and New Zealand. Transcripts were imported into HyperRESEARCH software and thematically analysed. Participants 25 radiologists. Results Six themes were identified: legitimising decisions (validated justification, prioritising patient preferences, reinforcing protocols), optimising outcomes (ensuring patient safety, maximising efficiency), availability of access (requiring immediacy, inadequacy of evidence, time constraints, proximity of peer networks, grasping information dispersion), over-riding pragmatism (perceptibly applicability, preserving the art of medicine, technical demands), limited confidence (conceptual obscurity, reputation-based trust, demands constant practice, suspicion and cynicism), and competing powers (hierarchical conflict, prevailing commercial interests). Conclusions Radiologists believe EBM can support clinical decision-making for optimal patient outcomes and service efficiency but feel limited in their capacities to assimilate and apply EBM in practice. Improving access to evidence, providing ongoing education and training supplemented with practical tools for appraising evidence; and developing evidence-based guidelines and protocols may enhance feasibility and promote the confidence and skills among radiologists in applying EBM in radiology practice for better patient care.
Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings.
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Aarons GA, Green AE, Willging CE, Ehrhart MG, Roesch SC, Hecht DB, et al.
Implementation science 2014 Dec 10;9(1):183
This study examines sustainment of an EBI implemented in 11 United States service systems across two states and delivered in 87 counties. The aims are to 1) determine the impact of state and county policies and contracting on EBI provision and sustainment; 2) investigate the role of public, private, and academic relationships and collaboration in long-term EBI sustainment; 3) assess organizational and provider factors that affect EBI reach/penetration, fidelity, and organizational sustainment climate; and 4) integrate findings through a collaborative process involving the investigative team, consultants, and system and community-based organization (CBO) stakeholders in order to further develop and refine a conceptual model of sustainment to guide future research and provide a resource for service systems to prepare for sustainment as the ultimate goal of the implementation process. Method sA mixed-method prospective and retrospective design will be used. Semi-structured individual and group interviews will be used to collect information regarding influences on EBI sustainment including policies, attitudes, and practices; organizational factors and external policies affecting model implementation; involvement of or collaboration with other stakeholders; and outer- and inner-contextual supports that facilitate ongoing EBI sustainment. Document review (e.g., legislation, executive orders, regulations, monitoring data, annual reports, agendas and meeting minutes) will be used to examine the roles of state, county, and local policies in EBI sustainment. Quantitative measures will be collected via administrative data and web surveys to assess EBI reach/penetration, staff turnover, EBI model fidelity, organizational culture and climate, work attitudes, implementation leadership, sustainment climate, attitudes toward EBIs, program sustainment, and level of institutionalization. Hierarchical linear modeling will be used for quantitative analyses. Qualitative analyses will be tailored to each of the qualitative methods (e.g., document review, interviews). Qualitative and quantitative approaches will be integrated through an inclusive process that values stakeholder perspectives. Discussion The study of sustainment is critical to capitalizing on and benefiting from the time and fiscal investments in EBI implementation. Sustainment is also critical to realizing broad public health impact of EBI implementation. The present study takes a comprehensive mixed-method approach to understanding sustainment and refining a conceptual model of sustainment.
Ethnographic process evaluation in primary care: explaining the complexity of implementation.
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Bunce AE, Gold R, Davis JV, McMullen CK, Jaworski V, Mercer M, et al.
BMC health services research 2014 Dec 5;14(1):607
The recent growth of implementation research in care delivery systems has led to a renewed interest in methodological approaches that deliver not only intervention outcome data but also deep understanding of the complex dynamics underlying the implementation process. We suggest that an ethnographic approach to process evaluation, when informed by and integrated with quantitative data, can provide this nuanced insight into intervention outcomes. The specific methods used in such ethnographic process evaluations are rarely presented in detail; our objective is to stimulate a conversation around the successes and challenges of specific data collection methods in health care settings. We use the example of a translational clinical trial among 11 community clinics in Portland, OR that are implementing an evidence-based, health-information technology (HIT)-based intervention focused on patients with diabetes. Discussion Our ethnographic process evaluation employed weekly diaries by clinic-based study employees, observation, informal and formal interviews, document review, surveys, and group discussions to identify barriers and facilitators to implementation success, provide insight into the quantitative study outcomes, and uncover lessons potentially transferable to other implementation projects. These methods captured the depth and breadth of factors contributing to intervention uptake, while minimizing disruption to clinic work and supporting mid-stream shifts in implementation strategies. A major challenge is the amount of dedicated researcher time required.Summary The deep understanding of the how and why behind intervention outcomes that can be gained through an ethnographic approach improves the credibility and transferability of study findings. We encourage others to share their own experiences with ethnography in implementation evaluation and health services research, and to consider adapting the methods and tools described here for their own research.
Process evaluation of a point-of-care cluster randomised trial using a computer-delivered intervention to reduce antibiotic prescribing in primary care
McDermott L, Yardley L, Little P, van Staa T, Dregan A, McCann G, et al.
BMC Health Services Research 2014;14(1):594.
The study aimed to conduct a process evaluation for a cluster randomised trial of a computer-delivered, point-of-care intervention to reduce antibiotic prescribing in primary care. The study aimed to evaluate both the intervention and implementation of the trial. Methods The intervention comprised a set of electronic educational and decision support tools that were remotely installed and activated during consultations with patients with acute respiratory infections over a 12 month intervention period. A mixed method evaluation was conducted with 103 general practitioners (GPs) who participated in the trial. Semi-structured telephone interviews were conducted with 20 GPs who had been in the intervention group of the trial and 4 members of the implementation staff. Questionnaires, consisting of both intervention evaluation and theory-based measures, were self-administered to 83 GPs (56 control group and 27 intervention group). Results Interviews suggested that a key factor influencing GPs’ use of the intervention appeared to be their awareness of the implementation of the system into their practice. GPs who were aware of the implementation of the intervention reported feeling confident in using it if they chose to and understood the purpose of the intervention screens. However, GPs who were unaware that the intervention would be appearing often reported feeling confused when they saw the messages appear on the screen and not fully understanding what they were for or how they could be used. Intervention evaluation questionnaires indicated that GPs were satisfied with the usability of the prompts, and theory-based measures revealed that intervention group GPs reported higher levels of self-efficacy in managing RTI patients according to recommended guidelines compared to GPs in the control group. Conclusions Remote installation of a computer-delivered intervention for use at the point-of-care was feasible and acceptable. Additional measures to promote awareness of the intervention may be required to promote health care professionals’ utilisation of the intervention and these might sometimes compromise the pragmatic intention of a trial.
Health systems and policy research evidence in health policy making in Israel: what are researchers’ practices in transferring knowledge to policy makers?
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Ellen ME, Lavis JN, Sharon A, Shemer J.
Health research policy and systems 2014 Dec 10;12(1):67
Ensuring the use of research evidence in health system management and policy decisions is an important challenge in this century. Knowledge transfer and exchange (KTE) has emerged as a paradigm to address the challenges and start closing the ‘know-do’ gap. This area of work is gaining momentum in most developed countries, yet, to date, no work has been performed in Israel within this area. The purpose of this study was to identify which KTE activities health systems and policy researchers in Israel have undertaken. METHODS: A cross-sectional web-based survey of researchers who have conducted health systems and policy research in Israel was developed. The survey consisted of a demographics section, quantitative scales, and open-ended questions. The survey was sent to all health systems and policy researchers in Israel (n = 125). RESULTS: The study response rate (28%) was relatively low as compared to other studies in the same field (range of 42% to 88%). Our survey found that more than a third of the health systems and policy researchers in Israel reported that they were frequently or always involved in the following KTE activities: interactions with target audience through the research process (i.e., during developing a research question or executing the research; 35% to 42%) or through formal or informal meetings during conferences, workshops, or conversations (40%). Less than half of the health systems and policy researchers in Israel are engaged in bridging activities aimed to facilitate target audiences to use research. CONCLUSIONS: This is a fairly new area in Israel and therefore the level of engagement of researchers in KTE activities is not very high. The low response rates could be because KTE is a new field in Israel and minimal KTE initiatives have been undertaken. It is preferable to have higher response rates, yet, after several initiatives, this was the outcome. While the findings are relevant, they may not reflect the total population of health system and policy researchers in Israel. Health system and policy researchers in Israel need to be introduced to the benefits and potential advantages of KTE in an organized and systematic way.
Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting.
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Armstrong R, Waters E, Moore L, Dobbins M, Pettman T, Burns C, et al.
Implementation science 2014 Dec 14;9(1):188
The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.MethodsThe study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n¿=¿175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health. Results In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making.ConclusionsThis study makes an important contribution to understanding how evidence is used within the public health LG context.Trial registration ACTRN12609000953235.
Bridging the research/policy gap: policy officials’ perspectives on the barriers and facilitators to effective links between academic and policy worlds
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van der Arend J
Policy Studies 2014 11/02; 2014/12;35(6):611-630
Evidence-based policy has become rhetoric for many western governments across a broad range of health and social policy areas. However, the transfer and uptake of academic research in policy contexts has often been problematic. Academics frequently argue that policy makers ignore the research they produce, while policy makers argue that academic research is seldom relevant to their needs. Research relationships and collaborations have long been regarded as key strategies to create pathways for research into policy contexts. They are also understood to better support the application of research in understanding policy issues, and in designing and implementing policy initiatives. This paper reports on findings from a large scale project, which targeted public servants undertaking policy work in Australian federal and state departments to investigate their experiences around the availability and use of academic social research. The paper explores the relevance of networks and linkages between academics and public servants in supporting research transfer and uptake. Reported barriers and facilitators to linkages are outlined. The paper concludes that a research-informed understanding of the factors and processes that promote and prevent effective linkages between academics and policy officials is needed to develop more realistic efforts to address the research/policy gap.
Quantifying complexity in translational research: an integrated approach.
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Munoz DA, Nembhard HB, Kraschnewski JL.
Int J Health Care Qual Assur 2014;27(8):760-776
The purpose of this paper is to quantify complexity in translational research. The impact of major operational steps and technical requirements is calculated with respect to their ability to accelerate moving new discoveries into clinical practice. DESIGN/METHODOLOGY/APPROACH: A three-phase integrated quality function deployment (QFD) and analytic hierarchy process (AHP) method was used to quantify complexity in translational research. A case study in obesity was used to usability. FINDINGS: Generally, the evidence generated was valuable for understanding various components in translational research. Particularly, the authors found that collaboration networks, multidisciplinary team capacity and community engagement are crucial for translating new discoveries into practice. RESEARCH LIMITATIONS/IMPLICATIONS: As the method is mainly based on subjective opinion, some argue that the results may be biased. However, a consistency ratio is calculated and used as a guide to subjectivity. Alternatively, a larger sample may be incorporated to reduce bias. PRACTICAL IMPLICATIONS: The integrated QFD-AHP framework provides evidence that could be helpful to generate agreement, develop guidelines, allocate resources wisely, identify benchmarks and enhance collaboration among similar projects. ORIGINALITY/VALUE: Current conceptual models in translational research provide little or no clue to assess complexity. The proposed method aimed to fill this gap. Additionally, the literature review includes various features that have not been explored in translational research.
Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model.
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Khanassov V, Vedel I, Pluye P.
Clinical interventions in aging 2014 Jun 11;9:915-928
The purpose of this study was to examine factors associated with the implementation of case management (CM) interventions in primary health care (PHC) and to develop strategies to enhance its adoption by PHC practices. METHODS: This study was designed as a systematic mixed studies review (including quantitative and qualitative studies) with synthesis based on the diffusion of innovation model. A literature search was performed using MEDLINE, PsycInfo, EMBASE, and the Cochrane Database (1995 to August 2012) to identify quantitative (randomized controlled and nonrandomized) and qualitative studies describing the conditions limiting and facilitating successful CM implementation in PHC. The methodological quality of each included study was assessed using the validated Mixed Methods Appraisal Tool. RESULTS: Twenty-three studies (eleven quantitative and 12 qualitative) were included. The characteristics of CM that negatively influence implementation are low CM intensity (eg, infrequent follow-up), large caseload (more than 60 patients per full-time case manager), and approach, ie, reactive rather than proactive. Case managers need specific skills to perform their role (eg, good communication skills) and their responsibilities in PHC need to be clearly delineated. CONCLUSION: Our systematic review supports a better understanding of factors that can explain inconsistent evidence with regard to the outcomes of dementia CM in PHC. Lastly, strategies are proposed to enhance implementation of dementia CM in PHC.
Process evaluation of the implementation of dementia-specific case conferences in nursing homes (FallDem): study protocol for a randomized controlled trial.
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Holle D, Roes M, Buscher I, Reuther S, Muller R, Halek M.
Trials 2014 Dec 11;15(1):485
Challenging behaviors exhibited by individuals with dementia might result from an unmet need that they cannot communicate directly due to cognitive restrictions. A dementia-specific case conference represents a promising means of analyzing and exploring these unmet needs. The ongoing FallDem study is a stepped-wedged, cluster-randomized trial evaluating the effects of two different types of dementia-specific case conferences on the challenging behaviors of nursing home residents. This study protocol describes the process evaluation that is conducted, along with the FallDem study.The goal of the process evaluation is to explain potential discrepancies between expected and observed outcomes, and to provide insights into implementation processes and recruitment strategies, as well as the contexts and contextual factors that promote or inhibit the implementation of dementia-specific case conferences. METHODS: The process evaluation will use a mixed-method design comprising longitudinal elements, in which quantitative and qualitative data will be gathered. Qualitative data will be analyzed using content analysis, documentary analysis and a documentary method. Quantitative data (standardized questionnaires) will be analyzed using descriptive statistics. Both types of data will complement one another and provide a more comprehensive picture of the different objects under investigation. DISCUSSION: The process evaluation will allow for a comprehensive understanding of the changing processes and mechanisms underlying the ‘black box’ of the complex intervention of the FallDem study. These findings will provide practical knowledge regarding issues related to the implementation of dementia-specific case conferences in nursing homes.Trial registration: Current Controlled Trials identifier: ISRCTN20203855, registered on 10th July 2013.
Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use.
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Ukawa N, Tanaka M, Morishima T, Imanaka Y.
International journal for quality in health care 2014 Dec 12
Quality of life (QOL) in dementia has become increasingly recognized as an important clinical and policy concern, but little is known about the progression of QOL in patients with advanced dementia on psychogeriatric units of nursing homes. Therefore, the primary goal of the current study was to assess the evolution of QOL in advanced dementia patients on a psychogeriatric unit. METHODS: The QUALIDEM scale, a reliable and validated QOL instrument developed for patients with advanced dementia in residential settings who are unable to self-report, was assessed at baseline and 2 years later. Of the 75 patients with advanced dementia included at baseline, 32 patients participated at follow-up. RESULTS: Average QUALIDEM QOL scores did show a trend towards a significant improvement over a 2-year period. For 61.8% of the subjects at follow-up, the average scores improved. On the subscales that assessed ‘feeling at home’, ‘social isolation’ and ‘negative affect’, improvement was significant. CONCLUSIONS: Although it could be expected that QOL would decline over time in advanced dementia patients, results of the current study suggest that QOL is stable or improves despite the global cognitive deterioration, particularly in the more advanced stages of dementia. QOL is a distinctive domain of disease severity that should receive more attention in the advanced stages of dementia. © 2014 The Authors
From theory to practice: an illustrative case for selecting evidence-based practices and building implementation capacity in three Canadian health jurisdictions
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Duda MA, Riopelle RJ, Brown J.
Evidence & Policy: A Journal of Research, Debate & Practice 2014 11;10(4):565-577
Using principles of Applied Implementation Science, this paper examines strategies for systematically selecting and operationalising National clinical practice guidelines and intentionally creating implementation supports to ensure high fidelity use and sustainable application and outcomes. In the spirit of participatory action research, key pan-Canadian stakeholders including funders, researchers, providers and patients were brought together around shared interests of optimal patient outcomes, improved provider performance, and continuous quality improvement of practices targeting the three most common secondary complications that patients with spinal cord injuries experience: pressure ulcers, bladder dysfunction and pain. Implementation capacity development at site and project levels will be described.
Practice-based Research Networks (PBRNs) Are Promising Laboratories for Conducting Dissemination and Implementation Research.
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Heintzman J, Gold R, Krist A, Crosson J, Likumahuwa S, DeVoe JE.
Journal of the American Board of Family Medicine 2014 Nov-Dec;27(6):759-762
Dissemination and implementation science addresses the application of research findings in varied health care settings. Despite the potential benefit of dissemination and implementation work to primary care, ideal laboratories for this science have been elusive. Practice-based research networks (PBRNs) have a long history of conducting research in community clinical settings, demonstrating an approach that could be used to execute multiple research projects over time in broad and varied settings. PBRNs also are uniquely structured and increasingly involved in pragmatic trials, a research design central to dissemination and implementation science. We argue that PBRNs and dissemination and implementation scientists are ideally suited to work together and that the collaboration of these 2 groups will yield great value for the future of primary care and the delivery of evidence-based health care.
How to achieve more effective services: the evidence ecosystem (UK)
What Works Network & Cardiff University
June 2014
This report identifies the elements of the evidence supply chain and then to identify gaps and barriers to evidence production, flow and implementation.
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Health Care Administration and Organization
Impact of 12h shift patterns in nursing: A scoping review.
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Harris R, Sims S, Parr J, Davies N.
International journal of nursing studies 2014 Nov 1
To provide a comprehensive scoping review of evidence of the impact and effectiveness of 12h shifts in the international nursing literature, supplemented by a review of evidence in other, non-nursing related industries. DATA SOURCES: A search of the academic literature was undertaken in electronic databases (AMED, MEDLINE, CINAHL, PsychInfo, Scopus, HMIC, the Cochrane Library, Business Source Premier, Econ Lit, ASSIA and Social Policy and Practice). REVIEW METHODS: A total of 158 potentially relevant nursing research papers and reviews were published between 1973 and 2014. Two reviewers independently reviewed the articles, leaving 85 primary research studies and 10 review papers in the nursing field to be included in the scoping review. Thirty-one relevant primary research papers and reviews were also identified in the non-nursing related industries literature. RESULTS: Research into 12h nursing shifts fell within five broad themes: ‘risks to patients’, ‘patient experience’, ‘risks to staff’, ‘staff experience’ and ‘impact on the organisation of work’. There was inconclusive evidence of the effects of 12h shift patterns in all five themes, with some studies demonstrating positive impacts and others negative or no impacts. This also mirrors the evidence in other, non-nursing related industries. The quality of research reviewed is generally weak and most studies focus on the risks, experience and work/life balance for staff, with few addressing the impact on patient outcomes and experience of care or work productivity. CONCLUSIONS: There is insufficient evidence to justify the widespread implementation or withdrawal of 12h shifts in nursing. It is not clearly understood where there are real benefits and where there are real and unacceptable risks to patients and staff. More research focusing on the impact of 12h nursing shifts on patient safety and experience of care and on the long term impact on staff and work organisation is required. Copyright © 2014 Elsevier Ltd. All rights reserved.
High Functioning Nurse Teams: Collaborative Decisions for Quality Patient Care
NHSRU
2014
Healthcare organizations are facing challenges to provide quality care in an increasingly complex environment. The number of regulatory roles in the province of Ontario is proliferating. Consequently, it is important to understand the dynamics of care as provided by teams. Although many studies have examined the contribution of interdisciplinary teams, there is a dearth of studies on the outcomes of registered nurse (RN)/ registered practical nurse (RPN) teams. The purpose of this project was to describe and assess how RNs, RPNs and their clinical managers perceive high functioning nursing teams. Interviews were conducted in six cross-sector healthcare organizations in Ontario. The project investigated how RN/RPN teams communicate, assign work and make decisions. A striking finding was that managers were able to immediately identify high functioning teams at the sites, which ranged from large acute hospitals to smaller community organizations. Results indicated there was a relationship between individual attributes of team members and team performance. Team members were flexible, cooperative, open-minded, compassionate, committed and knowledgeable. Successful high functioning teams were fluid, confident, non-hierarchal, patient-focused and included the right nurses in the right job. Team members had autonomy over decisions within their scope of practice. They made decisions about complex patients through collaboration, negotiation and recognition of each member’s expertise. The teams had an intuitive understanding of time and place and an awareness of how they fit within the larger organization and healthcare system. When dealing with complex patient populations, team members worked seamlessly to assess patients, analyze problems, negotiate an approach, divide roles and find a solution. Organizations had clear mission, enabled their employees, encouraged sharing of opinions and information and promoted a culture of fairness and harmony. High functioning RN/RPN teams are an invisible asset within the healthcare system. Organizations should recognize effective team functioning and value the contribution of teams to the provision of safe, quality patient care. An understanding of high functioning RN/RPN teams should be included in recruitment strategies, orientation packages and annual performance evaluations. Additionally, the measurable indicators should be added to the concept of teamwork and expanded in accreditation standards and within the professional regulatory framework.
Key to Care: Report of the Burstow Commission on the Future of the Home Care Workers (UK)
2014
This report outlines recommendations on what needs to change to have a professional, well-paid, well-trained and properly regulated workforce who can provide the quality of care at home that people need. It also features the stories of care workers, in their own words, who speak on both what needs to change and what could be the future of care.
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Health Care Innovation and Quality Assurance
Best practice and needs for improvement in the chain of care for persons with dementia in Sweden: a qualitative study based on focus group interviews.
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Bokberg C, Ahlstrom G, Karlsson S, Hallberg I, Janlov AC.
BMC health services research 2014 Nov 30;14(1):596
Persons with dementia receive health care and social services from a wide range of professional care providers during the disease trajectory, presenting risks of miscommunication, duplication and/or missed nursing interventions. Accordingly, the aim of this study was to investigate professional care providers¿ views on conditions for best practice in terms of collaboration and improvement needs in the chain of care from early to end-of-life stage for persons with dementia in Sweden.MethodsThe study had a qualitative design based on three focus group interviews. A strategic sample of 23 professional care providers was included. Data were subjected to content analysis based on the three stages of dementia (early, moderate, end-of-life).Results The results were divided into five categories: Diagnosis is a prerequisite for specialized dementia care, Creating routines in the chain of care, Competent staff a prerequisite for high-quality care, Day care facilitates transition in the chain of care and Next-of-kin participation is a prerequisite for continuity in the chain of care. It was clear that, according to the participants, best practice in dementia care in Sweden is not achieved in every respect. It appeared that transitions of care between different organizations are critical events which need to be improved. The further the disease progresses, the less collaboration there seems to be among professional care providers, which is when the next of kin are usually called upon to maintain continuity in the chain of care.Conclusions The results indicate that, according to the care providers, best practice in terms of collaboration is achieved to a higher degree during the early stage of dementia compared with the moderate and end-of-life stages. Lack of best practice strategies during these stages makes it difficult to meet the needs of persons with dementia and reduce the burden for next of kin. These are experiences to be taken into account to improve the quality of dementia care. Implementation research is needed to develop strategies for best practice on the basis of national knowledge-based guidelines and to apply these strategies in the moderate and end-of-life stages.
Reorganizing a hospital ward as an accountable care unit.
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Stein J, Payne C, Methvin A, Bonsall JM, Chadwick L, Clark D, et al.
Journal of hospital medicine 2014 Nov 17
Traditional hospital wards are not specifically designed as effective clinical microsystems. The feasibility and sustainability of doing so are unclear, as are the possible outcomes. To reorganize a traditional hospital ward with the traits of an effective clinical microsystem, we designed it to have 4 specific features: (1) unit-based teams, (2) structured interdisciplinary bedside rounds, (3) unit-level performance reporting, and (4) unit-level nurse and physician coleadership. We called this type of unit an accountable care unit (ACU). In this narrative article, we describe our experience implementing each feature of the ACU. Our aim was to introduce a progressive approach to hospital care and training. © 2014 Society of Hospital Medicine.
Leadership education, certification and resident outcomes in US nursing homes: Cross-sectional secondary data analysis.
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Trinkoff AM, Lerner NB, Storr CL, Han K, Johantgen ME, Gartrell K.
International journal of nursing studies 2015 Jan;52(1):334-344
Leadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. OBJECTIVES: To examine associations of education and certification among NHAs and DONs with resident outcomes. DESIGN: Cross-sectional secondary data analysis. SETTINGS: This study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). PARTICIPANTS: 1142 nursing homes in the survey which represented 16628 nursing homes in the US. METHODS: Leadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. RESULTS: Nursing homes led by NHAs with both Master’s degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor’s degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. CONCLUSIONS: Selected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships. Copyright © 2014 Elsevier Ltd. All rights reserved.
The role of the dementia specialist nurse in acute care: a scoping review.
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Griffiths P, Bridges J, Sheldon H, Thompson R.
Journal of clinical nursing 2014 Dec 3
To identify the potential benefits of dementia specialist nursing and to inform the implementation of roles to support people with dementia during hospital admission. BACKGROUND: Extended stays and adverse events mean that hospital admissions are costly for people with dementia, and patient experiences and outcomes can be poor. Specialist nurses have been identified as having potential to enhance care quality, reduce excess stays and reduce costs, but the evidence base for dementia specialist nurse roles has not previously been synthesised. DESIGN: Scoping review. DATA SOURCES: Cochrane Library, Campbell Collaboration, Clinical Evidence, Evidence-Based Medicine, York Centre for Reviews and Dissemination, PubMed, Medline, CINAHL and PsycInfo databases and internet searches and personal libraries/expert consultation to identify grey literature. METHODS: Initial scoping searches were used to inform more focused systematic searches. Studies directly evaluating dementia nurse specialist roles or giving evidence of effectiveness of interventions/services that could be delivered by them to improve core outcomes were identified by one reviewer and verified by a second reviewer. RESULTS: While direct evidence for the effectiveness of these roles is lacking, a number of areas were identified in which a nurse specialist role could make a contribution, including preventing adverse events and improving patient experiences and outcomes. There is a considerable body of evidence for the effectiveness of these interventions although the volume of evidence for specific interventions is not always significant. CONCLUSIONS: The evidence indicates that a skilled dementia specialist nurse, undertaking a clearly defined role, and working directly with people with dementia and their carers for a significant proportion of the time, could benefit people with dementia in hospitals and their family carers. RELEVANCE TO CLINICAL PRACTICE: Clear guidance for the development and implementation of dementia specialist nurse roles in acute hospital settings. © 2014 John Wiley & Sons Ltd.
Racial segregation and quality of care disparity in US nursing homes.
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Rahman M, Foster AD.
Journal of health economics 2014 Oct 22;39C:1-16
In this paper, we examine the contributions of travel distance and preferences for racial homogeneity as sources of nursing home segregation and racial disparities in nursing home quality. We first theoretically characterize the distinctive implications of these mechanisms for nursing home racial segregation. We then use this model to structure an empirical analysis of nursing home sorting. We find little evidence of differential willingness to pay for quality by race among first-time nursing home entrants, but do find significant distance and race-based preference effects. Simulation exercises suggest that both effects contribute importantly to racial disparities in nursing home quality. Copyright © 2014 Elsevier B.V. All rights reserved.
Addressing Depression in a Long-Term Care Setting: A Phase II Pilot of Problem-Solving Treatment.
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Reinhardt JP, Horowitz A, Cimarolli VR, Eimicke JP, Teresi JA.
Clinical therapeutics 2014 Nov 6;36(11):1531-1537
This was a Phase II pilot study of a problem-solving treatment (PST) to address subsyndromal depression in residents of long-term care facilities. Our goal was to demonstrate PST implementation feasibility and to identify PST’s potential for reducing depressive symptoms in this geriatric health care setting. METHODS: Eligible participants were randomized to receive a PST treatment (six 1-hour sessions) or a social contact comparison (6 “friendly” visits) after an initial baseline assessment. Follow-up assessments occurred 7 weeks later (after treatment) and 2 months posttreatment. The basic analytic approach was based on an intention-to-treat analysis. FINDINGS: We enrolled 21 elderly subjects in the PST group and 16 elderly subjects in the social contact comparison group. The PST group experienced a decline in depression scores compared with the social contact group. Although not statistically significant (likely due to the small sample size), PST was associated with decreased depressive symptom scores for those who were able to complete the intervention. Implementation proved to be difficult in terms of study recruitment and intervention acceptance and adherence. IMPLICATIONS: These study findings point to the potential benefits of an integrated mental health component in long-term care, involving rehabilitation professionals who are already working with the older adults in both postacute/short-stay and long-stay settings. Copyright © 2014 Elsevier HS Journals, Inc. All rights reserved.
“Small” things matter: Residents’ involvement in practice improvements in long-term care facilities.
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Boelsma F, Baur VE, Woelders S, Abma TA.
Journal of aging studies 2014 Dec;31:45-53
The process of involving older clients with regard to their care arrangements has been the subject of previous studies. However, a more general overview of the issues addressed by older people living in long-term care (LTC) facilities, in order to inform practice improvements, is missing. This article explores which aspects of care that older people in LTC facilities want to improve, by means of a collective policy agenda-setting project, during which the participants voice their own experiences and concerns regarding LTC. DESIGN AND METHODS: Seven LTC facilities for older people in the Netherlands joined a collective agenda-setting project in which a total of 58 residents participated. Qualitative methods were used: participant observations (80h in total) and semi-structured interviews (n=16), which were analysed according to the principles of a qualitative content analysis. FINDINGS: There were many similarities between the seven organisations with regard to the proposed practice improvements. Nine topics were found to be important in improving the lives of older residents: a sense of community, feeling at home, social contacts between residents, independence, maintaining own hobbies and lifestyle, interpersonal conduct between residents and caregivers, being informed, security within the LTC facility, and food. IMPLICATIONS: Narratives about the daily lives and experiences of residents provided a rich understanding of what living in a LTC facility means, as well as the changes the residents wish to see. We found that according to the residents, the relatively ‘small things’ in life may have a big influence on improving the quality of life within LTC facilities. Copyright © 2014 Elsevier Inc. All rights reserved.
Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities.
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Bhuyan SS, Zhu H, Chandak A, Kim J, Stimpson JP.
International journal of medical informatics 2014 Oct 2
Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs. METHODS: We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs. RESULTS: In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption. CONCLUSIONS: Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients’ records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in RCFs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Improving Food and Fluid Intake for Older Adults Living in Long-Term Care: A Research Agenda.
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Keller H, Beck AM, Namasivayam A, International-Dining in Nursing home Experts (I-DINE) Consortium.
Journal of the American Medical Directors Association 2014 Dec 3
Poor food and fluid intake and malnutrition are endemic among older adults in long-term care (LTC), yet feasible and sustainable interventions that target key determinants and improve person-centered outcomes remain elusive. Without a comprehensive study addressing a range of determinants to identify those that are of greatest importance for targeting with interventions, expert consensus can be used to develop a research agenda. International experts and stakeholders convened for a 2-day meeting to participate in a nominal group process to identify and prioritize determinants of food and fluid intake for persons living in LTC. Top determinants to address with intervention research included social interactions of residents at mealtime; self-feeding ability; the dining environment; the attitudes, knowledge, and skills of staff; adequate time to eat/availability of staff to provide assistance; sensory properties of the food; hospitality and mealtime logistics; choice and variety in the dining experience; and nutrient density of food. Multimodal interventions that could target these prioritized determinants were also suggested. This consensus process has resulted in a prioritized research agenda for the development and testing of interventions to improve food and fluid intake of older adults living in LTC. Copyright © 2014 AMDA
The Quality, Implementation, and Evaluation Model: A Clinical Practice Model for Sustainable Interventions.
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Talsma A, McLaughlin M, Bathish M, Sirihorachai R, Kuttner R.
Western journal of nursing research 2014 Jun 2;36(7):929-946
Major efforts have been directed toward the implementation of sustainable quality improvement. To date, progress has been noted using various metrics and performance measures; however, successful implementation has proven challenging. The Quality, Implementation, and Evaluation (QIE) model, derived from Donabedian’s structure component, presents a framework for implementation of specific activities. The QIE model consists of Policy, Patient Preparedness, Provider Competency, and Performance and Accountability, to guide specific practice initiatives. The implementation of alcohol-based pre-operative skin prep was evaluated in a sample of 17 hospitals and demonstrated that hospitals actively engaged in the components of the model demonstrated a significantly higher use of alcohol-based skin preparation agent than hospitals that did not engage in QIE model activities. The QIE model presents a powerful and actionable implementation model for mid-level management and clinical leadership. Future studies will further evaluate the impact of the specific components of the QIE model. © The Author(s) 2014.
Fidelity of implementation to a care team redesign and improved outcomes of diabetes care
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Grace SM, Rich J, Chin W, Rodriguez HP.
International journal for quality in health care 2014 Nov 27
We assessed fidelity of implementation (FOI) to the intended features of a primary care team redesign that integrated registered nurse care managers and patient health coaches onto existing care teams. The relation of FOI ranking and improvements in intermediate outcomes of diabetes care was examined. DESIGN: We assessed FOI by interviewing frontline primary care team members (n = 20). We explored the relation of FOI and outcomes of diabetes care (n = 10 206 patients) over a 3-year period (2010-12). Multilevel, multivariate regression estimated the relation of FOI and improvements in outcomes of diabetes care. SETTING: Five primary care practices in greater Los Angeles, CA, USA. PARTICIPANTS: Ten thousand, two hundred and six adult patients with diabetes; 20 frontline primary care clinicians and staff. MAIN OUTCOME MEASURES: Blood pressure, hemoglobin A1c (HbA1c) and low-density lipoprotein cholesterol (LDL-C) control among adult diabetic patients. RESULTS: All practices improved diabetic patients’ LDL-C control over time. In adjusted analyses, the practice with the highest FOI achieved the largest improvement in blood pressure and HbA1c control among diabetic patients. In contrast, the practice with the lowest FOI had the least improvements in blood pressure, HbA1c and LDL-C control. FOI was an inconsistent predictor of intermediate outcomes of diabetes care for other practices. CONCLUSIONS: FOI assessment can be useful for identifying low FOI to a redesign so that technical assistance and resources can be provided to improve team functioning and patient outcomes. High FOI can enable greater improvements in patient outcomes in the context of primary care practice redesign. © The Author 2014.
Client satisfaction as a driver of quality improvement in services for older people: A Western Australian case study.
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Boldy D, Davison M, Duggan R.
Australasian journal on ageing 2014 Dec 3
This paper aims to describe a practical example of the use of adapted versions of a resident satisfaction questionnaire for quality improvement purposes in a large aged care service organisation. Residential care and home care questionnaires each covered 11 aspects, the ‘housing’ questionnaire nine. Each aspect included Likert scale-type satisfaction questions. Questionnaires were distributed for completion by residents or by a friend/family member where a resident was unable to self-complete (e.g. because of dementia). Over the six separate customer satisfaction surveys conducted by the organisation since 1999, the analysis scheme has been refined and forms the basis of a report to the Board highlighting major findings and making recommendations regarding future actions. Most recently, the Board has decided to focus on three main areas, with actions identified for each, namely satisfaction with staff (e.g. enhanced staff training), social activities and involvement (e.g. increased occupational therapy), and opportunities for enhanced feedback. © 2014 AJA Inc.
Identification of promising strategies to sustain improvements in hospital practice: a qualitative case study.
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Ament SM, Gillissen F, Moser A, Maessen JM, Dirksen CD, von Meyenfeldt MF, et al.
BMC health services research 2014 Dec 16;14(1):641
A quality improvement collaborative is an intensive project involving a combination of implementation strategies applied in a limited breakthrough time window. After an implementation project, it is generally difficult to sustain its success. In the current study, sustainability was described as maintaining an implemented innovation and its benefits over a longer period of time after the implementation project has ended. The aim of the study was to explore potentially promising strategies for sustaining the Enhanced Recovery After Surgery (ERAS) programme in colonic surgery as perceived by professionals, three to six years after the hospital had successfully finished a quality improvement collaborative.MethodsA qualitative case study was performed to identify promising strategies to sustain key outcome variables related to the ERAS programme in terms of adherence, time needed for functional recovery and hospital length of stay (LOS), as achieved immediately after implementation. Ten hospitals were selected which had successfully implemented the ERAS programme in colonic surgery (2006¿2009), with success defined as a median LOS of 6 days or less and protocol adherence rates above 70%. Fourteen semi-structured interviews were held with eighteen key participants of the care process three to six years after implementation, starting with the project leader in every hospital. The interviews started by confronting them with the level of sustained implementation results. A direct content analysis with an inductive coding approach was used to identify promising strategies. The mean duration of the interviews was 37 minutes (min 26 minutes ¿ max 51 minutes).ResultsThe current study revealed strategies targeting professionals and the organisation. They comprised internal audit and feedback on outcomes, small-scale educational booster meetings, reminders, changing the physical structure of the organisation, changing the care process, making work agreements and delegating responsibility, and involving a coordinator. A multifaceted self-driven promising strategy was applied in most hospitals, and in most hospitals promising strategies were suggested to sustain the ERAS programme.ConclusionsJoining a quality improvement collaborative may not be enough to achieve long-term normalisation of transformed care, and additional investments may be needed. The findings suggest that certain post-implementation strategies are valuable in sustaining implementation successes achieved after joining a quality improvement collaborative.
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.
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Research Practice & Methodology
(un) Disciplining the nurse writer: doctoral nursing students’ perspective on writing capacity.
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Ryan MM, Walker M, Scaia M, Smith V.
Nursing inquiry 2014 Dec;21(4):294-300
In this article, we offer a perspective into how Canadian doctoral nursing students’ writing capacity is mentored and, as a result, we argue is disciplined. We do this by sharing our own disciplinary and interdisciplinary experiences of writing with, for and about nurses. We locate our experiences within a broader discourse that suggests doctoral (nursing) students be prepared as stewards of the (nursing) discipline. We draw attention to tensions and effects of writing within (nursing) disciplinary boundaries. We argue that traditional approaches to developing nurses’ writing capacity in doctoral programs both shepherds and excludes emerging scholarly voices, and we present some examples to illustrate this dual role. We ask our nurse colleagues to consider for whom nurses write, offering an argument that nurses’ writing must ultimately improve patient care and thus would benefit from multiple voices in writing. © 2013 John Wiley & Sons Ltd.
Ethical use of social media to facilitate qualitative research.
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Lunnay B, Borlagdan J, McNaughton D, Ward P.
Qualitative health research 2015 Jan;25(1):99-109
Increasingly, qualitative health researchers might consider using social media to facilitate communication with participants. Ambiguity surrounding the potential risks intrinsic to social media could hinder ethical conduct and discourage use of this innovative method. We used some core principles of traditional human research ethics, that is, respect, integrity, and beneficence, to design our photo elicitation research that explored the social influences of drinking alcohol among 34 underage women in metropolitan South Australia. Facebook aided our communication with participants, including correspondence ranging from recruitment to feeding back results and sharing research data. This article outlines the ethical issues we encountered when using Facebook to interact with participants and provides guidance to researchers planning to incorporate social media as a tool in their qualitative studies. In particular, we raise the issues of privacy and confidentiality as contemporary risks associated with research using social media.
Mixed Methods and Wicked Problems
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Mertens DM.
Journal of Mixed Methods Research 2015;9(1):3-6.
Donna Mertens uses this editorial space to present some challenges for our community of mixed methods researchers. The challenges emanate from the concept of wicked problems and the promises associated with mixed methods to understand complexity through diverse approaches.
Methodological and ethical issues in research using social media: a metamethod of Human Papillomavirus vaccine studies
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Gustafson DL, Woodworth CF.
BMC medical research methodology 2014 Dec 2;14(1):127
Online content is a primary source of healthcare information for internet-using adults and a rich resource for health researchers. This paper explores the methodological and ethical issues of engaging in health research using social media. METHODS: A metamethod was performed on systematically selected studies that used social media as a data source for exploring public awareness and beliefs about Human Papillomaviruses (HPV) and HPV vaccination. Seven electronic databases were searched using a variety of search terms identified for each of three concepts: social media, HPV vaccine, and research method. Abstracts were assessed for eligibility of inclusion; six studies met the eligibility criteria and were subjected to content analysis. A 10-item coding scheme was developed to assess the clarity, congruence and transparency of research design, epistemological and methodological underpinnings and ethical considerations. RESULTS: The designs of the six selected studies were sound, although most studies could have been more transparent about how they built in rigor to ensure the trustworthiness and credibility of findings. Statistical analysis that intended to measure trends and patterns did so without the benefit of randomized sampling and other design elements for ensuring generalizability or reproducibility of findings beyond the specified virtual community. Most researchers did not sufficiently engage virtual users in the research process or consider the risk of privacy incursion. Most studies did not seek ethical approval from an institutional research board or permission from host websites or web service providers. CONCLUSIONS: The metamethod exposed missed opportunities for using the dialogical character of social media as well as a lack of attention to the unique ethical issues inherent in operating in a virtual community where social boundaries and issues of public and private are ambiguous. This suggests the need for more self-conscious and ethical research practices when using social media as a data source. Given the relative newness of virtual communities, researchers and ethics review boards must work together to develop expertise in evaluating the design of studies undertaken with virtual communities. We recommend that the principles of concern for welfare, respect for person, and justice to be applied in research using social media.
Mining Implicit, Oblique, and Deeper Understandings in Videotaped Research Data
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Cooper KA, Hughes NR.
Qualitative Inquiry 2015;21(1):28-35
In this article, we report upon the adoption of Jerome Bruner’s narrative approach, which served as a theoretical framework for analyzing, representing, and disseminating more than 60 hrs of documentary research footage. We invited international scholars in the field of the social sciences and humanities to document their philosophies and autobiographies on videotape. We asked the following questions: What are the overarching themes or theories that unite the scholars’ methodological and conceptual frameworks? How have the scholars’ unique lived experiences contributed to their interpretivist or critical viewpoints? What autobiographical stories rise to the forefront? Can these stories be linked or connected to represent an unfolding narrative through both space and time? Through the course of narrative analysis, significant themes such as poverty, social inequality, classism, oppression, and colonization emerged from the videotaped dialogues. The scholars’ unique narratives coalesced into a single narrative that traced and documented the history of qualitative research.
Sample size used to validate a scale: a review of publications on newly-developed patient reported outcomes measures.
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Anthoine E, Moret L, Regnault A, Sebille V, Hardouin JB.
Health and quality of life outcomes 2014 Dec 9;12(1):176
New patient reported outcome (PRO) measures are regularly developed to assess various aspects of the patients? perspective on their disease and treatment. For these instruments to be useful in clinical research, they must undergo a proper psychometric validation, including demonstration of cross-sectional and longitudinal measurement properties. This quantitative evaluation requires a study to be conducted on an appropriate sample size. The aim of this research was to list and describe practices in PRO and proxy PRO primary psychometric validation studies, focusing primarily on the practices used to determine sample size.MethodsA literature review of articles published in PubMed between January 2009 and September 2011 was conducted. Three selection criteria were applied including a search strategy, an article selection strategy, and data extraction. Agreements between authors were assessed, and practices of validation were described.ResultsData were extracted from 114 relevant articles. Within these, sample size determination was low (9.6%, 11/114), and were reported as either an arbitrary minimum sample size (n?=?2), a subject to item ratio (n?=?4), or the method was not explicitly stated (n?=?5). Very few articles (4%, 5/114) compared a posteriori their sample size to a subject to item ratio. Content validity, construct validity, criterion validity and internal consistency were the most frequently measurement properties assessed in the validation studies.Approximately 92% of the articles reported a subject to item ratio greater than or equal to 2, whereas 25% had a ratio greater than or equal to 20. About 90% of articles had a sample size greater than or equal to 100, whereas 7% had a sample size greater than or equal to 1000.ConclusionsThe sample size determination for psychometric validation studies is rarely ever justified a priori. This emphasizes the lack of clear scientifically sound recommendations on this topic. Existing methods to determine the sample size needed to assess the various measurement properties of interest should be made more easily available.
Assessing physical and cognitive function of older adults in continuing care retirement communities: Who are we recruiting?
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Wrights AP, Fain CW, Miller ME, Jack Rejeski W, Williamson JD, Marsh AP.
Contemporary clinical trials 2014 Dec 12
In partnership with six Continuing Care Retirement Communities (CCRCs), the current study focused on the feasibility of recruiting a representative sample of residents and then assessing their functional health. MATERIAL AND METHODS: With our guidance, each of the six CCRCs recruited a volunteer (V-Group) and random (R-Group) sample of independent living residents. We provided face-to-face training and ongoing remote electronic support to the CCRC staff on the testing battery and the web-based data entry system. The testing battery was consisted of demographic, physical function, and psychosocial assessments. RESULTS: After training, CCRC staff were receptive to the study goals and successfully used the data entry website. In the V-Group (N=189), 76% were already participating in CCRC wellness programs. We attempted to recruit a random, unbiased (R-Group) sample of 20% (n=105) of eligible residents; however, only 30 consented to be tested and 70% of this group (21/30) was also already participating in a wellness program. Mean age of all participants was 82.9 years. The V-Group had a higher Short Physical Performance Battery (SPPB) total score (least squares mean[SE], 9.4[0.2] vs 8.2[0.4], p=0.014) and SPPB gait speed component score (3.5[0.1] vs 3.0[0.2], p=0.007) and spent more time doing moderate-to-vigorous physical activity (300[21] vs 163[49] min/week, p=0.013) compared to the R-Group. IMPLICATIONS: While it is feasible to recruit, assess and transmit data on residents’ functional health in partnership with CCRCs, population validity was severely compromised. Attention needs to be given to the development of more effective methods to recruit less interested residents. Copyright © 2014 Elsevier Inc. All rights reserved.
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Bibliometrics
High-ranked social science journal articles can be identified from early citation information.
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Stern DI.
PloS one 2014 Nov 12;9(11):e112520
Do citations accumulate too slowly in the social sciences to be used to assess the quality of recent articles? I investigate whether this is the case using citation data for all articles in economics and political science published in 2006 and indexed in the Web of Science. I find that citations in the first two years after publication explain more than half of the variation in cumulative citations received over a longer period. Journal impact factors improve the correlation between the predicted and actual future ranks of journal articles when using citation data from 2006 alone but the effect declines sharply thereafter. Finally, more than half of the papers in the top 20% in 2012 were already in the top 20% in the year of publication (2006).
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Aging
Quality of life in people with cognitive impairment: nursing homes versus home care.
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Nikmat AW, Al-Mashoor SH, Hashim NA.
International psychogeriatrics 2014 Dec 11:1-10
The evaluation of quality of life (QoL) among older adults has become increasingly important, and living arrangements play a pivotal role in determining the QoL of people with cognitive impairment (PWCI). Although informal care (home-based) is favored, transition to formal care (residential care) often becomes necessary, especially in the later stages of cognitive impairment. The primary objective was to compare the QoL of PWCI in the community and nursing homes. Additionally, factors differentiate the QoL of PWCI in these two settings were identified. Methods: This is a quasi-experimental study design involving 219 older adults with cognitive impairment, aged 60-89 years old from both nursing home and home care. Participants completed the EUROPE Health Interview Survey-QoL (WHO-8), the Short Mini-Mental State Examination (SMMSE), the Barthel Index (BI), the Geriatric Depression Scale (GDS-15), and the Friendship Scale (FS). Results: There were significant differences in QoL, depression, social connectedness (p < 0.01) and cognitive functions (p = 0.01) between home care recipients and nursing home participants. No significant differences were observed with regards to health condition, co morbidities and physical functions between study cohorts. Conclusions: Older adults with cognitive impairment living at home experienced higher QoL, had better cognitive function, were less depressed and reported higher social connectedness compared to those living in institutional care. Therefore, support should be provided in enabling home care and empowering caregivers to provide better care for PWCI.
Activity Engagement: Perspectives from Nursing Home Residents with Dementia.
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Tak SH, Kedia S, Tongumpun TM, Hong SH.
Educational gerontology 2015 Mar;41(3):182-192
Engagement in social and leisure activities is an indicator of quality of life and well-being in nursing homes. There are few studies in which nursing home residents with dementia self-reported their experiences in activity engagement. This qualitative study describes types of current activity involvement and barriers to activities as perceived by nursing home residents with dementia. Thirty-one residents participated in short, open-ended interviews and six in in-depth interviews. Thematic content analysis showed that participants primarily depended on activities organized by their nursing homes. Few participants engaged in self-directed activities such as walking, visiting other residents and family members, and attending in church services. Many residents felt they had limited opportunities and motivation for activities. They missed past hobbies greatly but could not continue them due to lack of accommodation and limitation in physical function. Environmental factors, along with fixed activity schedule, further prevented them from engaging in activities. Residents with dementia should be invited to participate in activity planning and have necessary assistance and accommodation in order to engage in activities that matter to them. Based on the findings, a checklist for individualizing and evaluating activities for persons with dementia is detailed.
Older people’s experiences of their free will in nursing homes.
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Tuominen L, Leino-Kilpi H, Suhonen R.
Nursing ethics 2014 Dec 8
Older people in institutional care should be allowed to live a meaningful life in a home-like environment consistent with their own free will. Research on actualisation of older people’s own free will in nursing home context is scarce. OBJECTIVES: The purpose of this study was to describe older people’s experiences of free will, its actualisation, promoters and barriers in nursing homes to improve the ethical quality of care. RESEARCH DESIGN: Fifteen cognitively intact older people over 65 years in four nursing homes in Southern Finland were interviewed. Giorgi’s phenomenological method expanded by Perttula was used to analyse the data. ETHICAL CONSIDERATIONS: Chief administrators of each nursing home gave permission to conduct the study. Informants’ written informed consent was gained. FINDINGS: Older people described free will as action consistent with their own mind, opportunity to determine own personal matters and holding on to their rights. Own free will was actualised in having control of bedtime, dressing, privacy and social life with relatives. Own free will was not actualised in receiving help when needed, having an impact on meals, hygiene, free movement, meaningful action and social life. Promoters included older people’s attitudes, behaviour, health, physical functioning as well as nurses’ ethical conduct. Barriers were nurses’ unethical attitudes, institution rules, distracting behaviour of other residents, older people’s attitudes, physical frailty and dependency. DISCUSSION: Promoting factors of the actualisation of own free will need to be encouraged. Barriers can be influenced by educating nursing staff in client-orientated approach and influencing attitudes of both nurses and older people. CONCLUSION: Results may benefit ethical education and promote the ethical quality of older people’s care practice and management. © The Author(s) 2014.
Care staff and family member perspectives on quality of life in people with very severe dementia in long-term care: a cross-sectional study.
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Clare L, Quinn C, Hoare Z, Whitaker R, Woods RT.
Health and quality of life outcomes 2014 Dec 9;12(1):175
Little is known about the quality of life of people with very severe dementia in long-term care settings, and more information is needed about the properties of quality of life measures aimed at this group. In this study we explored the profiles of quality of life generated through proxy ratings by care staff and family members using the Quality of Life in Late-stage Dementia (QUALID) scale, examined factors associated with these ratings, and further investigated the psychometric properties of the QUALID.MethodsProxy ratings of quality of life using the QUALID were obtained for 105 residents with very severe dementia, categorised as meeting criteria for Functional Assessment Staging (FAST) stages 6 or 7, from members of care staff (n¿=¿105) and family members (n¿=¿73). A range of resident and staff factors were also assessed.ResultsCare staff and family member ratings were similar but were associated with different factors. Care staff ratings were significantly predicted by resident mood and awareness/responsiveness. Family member ratings were significantly predicted by use of antipsychotic medication. Factor analysis of QUALID scores suggested a two-factor solution for both care staff ratings and family member ratings.ConclusionsThe findings offer novel evidence about predictors of care staff proxy ratings of quality of life and demonstrate that commonly-assessed resident variables explain little of the variability in family members¿ proxy ratings. The findings provide further information about the psychometric properties of the QUALID, and support the applicability of the QUALID as a means of examining quality of life in very severe dementia.
Development and Application of Medication Appropriateness Indicators for Persons with Advanced Dementia: A Feasibility Study.
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Parsons C, McCann L, Passmore P, Hughes C.
Drugs & aging 2014 Dec 6
No studies have been conducted in the UK context to date that categorise medications in terms of appropriateness for patients with advanced dementia, or that examine medication use in these vulnerable patients. OBJECTIVES: The objectives of this study were to categorise the appropriateness of a comprehensive list of medications and medication classes for use in patients with advanced dementia; examine the feasibility of conducting a longitudinal prospective cohort study to collect clinical and medication use data; and determine the appropriateness of prescribing for nursing home residents with advanced dementia in Northern Ireland (NI), using the categories developed. METHODS: A three-round Delphi consensus panel survey of expert clinicians was used to categorise the appropriateness of medications for patients with advanced dementia [defined as having Functional Assessment Staging (FAST) scores ranging from 6E to 7F]. This was followed by a longitudinal prospective cohort feasibility study that was conducted in three nursing homes in NI. Clinical and medication use for participating residents with advanced dementia (FAST scores ranging from 6E to 7F) were collected and a short test of dementia severity administered. These data were collected at baseline and every 3 months for up to 9 months or until death. For those residents who died during the study period, data were also collected within 14 days of death. The appropriateness ratings from the consensus panel survey were retrospectively applied to residents’ medication data at each data collection timepoint to determine the appropriateness of medications prescribed for these residents. RESULTS: Consensus was achieved for 87 (90 %) of the 97 medications and medication classes included in the survey. Fifteen residents were recruited to participate in the longitudinal prospective cohort feasibility study, four of whom died during the data collection period. Mean numbers of medications prescribed per resident were 16.2 at baseline, 19.6 at 3 months, 17.4 at 6 months and 16.1 at 9 months. Fourteen residents at baseline were taking at least one medication considered by the consensus panel to be never appropriate, and approximately 25 % of medications prescribed were considered to be never appropriate. Post-death data collection indicated a decrease in the proportion of never appropriate medications and an increase in the proportion of always appropriate medications for those residents who died. CONCLUSIONS: This study is the first to develop and apply medication appropriateness indicators for patients with advanced dementia in the UK setting. The Delphi consensus panel survey of expert clinicians was a suitable method of developing such indicators. It is feasible to collect information on quality of life, functional performance, physical comfort, neuropsychiatric symptoms and cognitive function for this subpopulation of nursing home residents with advanced dementia.
Help yourself: perspectives on self-management from people with dementia and their caregivers.
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Toms GR, Quinn C, Anderson DE, Clare L.
Qualitative health research 2015 Jan;25(1):87-98
Self-management interventions are increasingly offered to people with chronic health conditions. However, there has been limited exploration of how applicable such an approach is in early stage dementia. In this study we explored the views of people with dementia and family caregivers on the use of self-management in dementia. We conducted semistructured interviews with 13 people with early stage dementia and 11 caregivers. We analyzed transcripts using thematic analysis. We found eight themes in the analysis, and they indicated that self-management occurs in the context of peoples’ family and social relationships as well as relationships with professional services. Six of the themes involved barriers to and facilitators of self-management. It is evident from these findings that people with dementia and caregivers use self-management techniques. Their use of such techniques could be enhanced by the development of interventions designed to help people with dementia to develop their self-management skills.© The Author(s) 2014.
Exploring factors influencing residents’ health outcomes in long-term care facilities: 1-year follow-up using latent growth curve model.
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Liu LF, Weng RH, Wu JY.
Quality of life research 2014 Nov;23(9):2613-2627
This study explored the residents’ health outcomes of long-term care (LTC) facilities and examined the risk factors in individual and institutional levels during 1 year of admission. METHODS: The study included four stages of interviews with residents in 31 nursing homes and 64 residential care homes. Three hundred and twenty-five residents at baseline were interviewed, and 206 completed the interviews at follow-up. Five outcomes including residents’ physical/mental functional status and subjective health status in Short Form-36 were analyzed using latent growth curve models (LGCMs). RESULTS: Only the physical component summary (PCS) had increased significantly. The most influential risk factors to outcomes were the intra-individual-level time-varying variables, including self-rated health and with/without tubing care. Some predictive inter-individual-level factors were also found. For institutional characteristics, small-sized homes (<49 beds) with low occupancy rates showed a lower growth rate in residents’ mental component summary (MCS) and PCS over 1 year and private sector homes showed the most significant growth rates in MCS. CONCLUSIONS: The methodological strength using LGCMs provides a framework for systematically assessing the influence of risk factors from various levels on residents’ outcomes and follow-up change. It is evident that factors in various levels all influenced residents’ outcomes which support critical information for case mix and quality management in LTC facilities. Under the scenario of a surplus of institutional care in Taiwan, we suggest that institutions must focus more on residents’ psychological well-being and care quality, especially in small-sized homes in relation to the outcomes of its residents.
Systematic review of recent dementia practice guidelines.
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Ngo J, Holroyd-Leduc JM.
Age and Ageing 2015 Jan;44(1):25-33
BACKGROUND: dementia is a highly prevalent acquired cognitive disorder that interferes with activities of daily living, relationships and quality of life. Recognition and effective management strategies are necessary to provide comprehensive care for these patients and their families. High-quality clinical practice guidelines can improve the quality and consistency of care in all aspects of dementia diagnosis and management by clarifying interventions supported by sound evidence and by alerting clinicians to interventions without proven benefit. OBJECTIVE: we aimed to offer a synthesis of existing practice recommendations for the diagnosis and management of dementia, based upon moderate-to-high quality dementia guidelines. METHODS: we performed a systematic search in EMBASE and MEDLINE as well as the grey literature for guidelines produced between 2008 and 2013. RESULTS: thirty-nine retrieved practice guidelines were included for quality appraisal by the Appraisal of Guidelines Research and Evaluation II (AGREE-II) tool, performed by two independent reviewers. From the 12 moderate-to-high quality guidelines included, specific practice recommendations for the diagnosis and/or management of any aspect of dementia were extracted for comparison based upon the level of evidence and strength of recommendation. CONCLUSION: there was a general agreement between guidelines for many practice recommendations. However, direct comparisons between guidelines were challenging due to variations in grading schemes.
Outcomes of cognitively impaired older people in Transition Care.
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Peel NM, Chan KW, Hubbard RE.
Australasian journal on ageing 2014 Nov 25
The benefits of Transition Care Programs (TCPs) for patients with cognitive impairment are not well established. This study aimed to investigate the impact of TCP on patients according to their cognitive status. METHODS: In this prospective cohort study, 351 patients were comprehensively assessed at TCP admission using the interRAI Home Care instrument and divided into two groups based on scores on the Cognitive Performance Scale. RESULTS: Of 346 patients assessed for cognition, 242 (69.9%) were considered cognitively intact, and 104 (30.1%) were classified as cognitively impaired (Cognitive Performance Scale ≥ 2). There were no significant differences in TCP outcomes between the two groups, including community living at six months (P = 0.1), hospital readmission rates (P = 0.6), or achievement of TCP goals (P = 0.3). CONCLUSIONS: Cognitively intact and cognitively impaired patients have similar outcomes post-TCP. Older patients should not be refused Transition Care based on the presence of cognitive impairment. © 2014 AJA Inc.
Relatives’ perceptions of residents’ life in a municipal care facility for older people with a focus on quality of life and care environment.
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Ericson-Lidman E, Renstrom AS, Ahlin J, Strandberg G.
International journal of older people nursing 2014 Dec 3
Relatives’ perceptions of their older loved one’s living conditions at residential care facilities are poorly described in interviews. Older persons often find it difficult to make their voices heard and an alternative is to ask a relative who knows the person well to express their views. AIM: This study aimed to describe relatives’ perceptions of residents’ life in a municipal care facility for older people with a focus on quality of life and care environment. DESIGN: A qualitative study design was used. Data were collected through nine interviews with six relatives of older people living in a residential care facility. METHODS: The interviews were recorded, transcribed and analysed using content analysis. RESULTS: The analysis resulted in three main themes and eight subthemes. The main themes were: Residents’ life/quality of life is perceived to be in the hands of the care providers, Residents’ disabilities and lack of stimulation are perceived to threaten their quality of life, and The secure climate in the residence is perceived to be coloured by Death’s waiting room. CONCLUSIONS: The study emphasizes the importance of cocreating a constructive dependency and to take on the challenge of creating a feeling of at-homeness for each resident. It is important to be aware that what relatives perceive as monotony and passivity may be a problem for some residents, but not for all. IMPLICATIONS FOR PRACTICE: This study highlights the need to create a powerful partnership between relatives, care providers and residents to enhance the quality of life for residents. Every single meeting is important and makes a difference for the resident. Care providers might need to support relatives to understand that the last phase of life might be about focusing inwardly and reflecting on one’s whole life as a way to end it. © 2014 John Wiley & Sons Ltd.
The Effect of Music Therapy on Cognitive Functioning Among Older Adults: A Systematic Review and Meta-Analysis.
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Li HC, Wang HH, Chou FH, Chen KM.
Journal of the American Medical Directors Association 2014 Nov 20
To conduct a systematic review and a meta-analysis of current studies to determine whether music therapy affects the cognitive function of older people. DESIGN: The databases surveyed include PsycINFO, PsycARTICLES, PubMed, MEDLINE, CINAHL, AgeLine, Cochrane Library, and the Chinese Electronic Periodical Services (CEPS) as well as the reference lists of the included studies. The Consolidated Standards of Reporting Trials (CONSORT) extension checklist for nonpharmacologic treatment was used to evaluate the literature. SETTING: Music therapy intervention offered in nursing homes, hospitals, or communities. PARTICIPANTS: A total of 234 participants from 5 studies were assessed in the meta-analysis, with a mean age per study of 71.4 to 82.0 years. MEASUREMENTS: Cognitive outcome domains were analyzed in a systematic review. The short-term effects of music therapy in Mini-Mental State Examination data for meta-analysis were compiled. A forest plot was constructed using a fixed effect model to obtain a pooled mean difference. RESULTS: Active music therapy comprising singing and other musical activities was generally determined to effect a significant improvement in the Mini-Mental State Examination according to individual retrieval studies. However, this study showed no significant improvement in the short-term effects of music therapy when all related studies in meta-analysis were combined. The pooled mean difference was 0.73 (95% confidence interval -0.07 to 1.54; Z = 1.79; P = .07) for using music therapy overall and 0.74 (95% confidence interval -0.08 to 1.56; Z = 1.76; P = .08) for using active music therapy. CONCLUSIONS: The findings of the meta-analysis indicate that the short-term effects of music therapy do not improve the cognitive function of older people. Future studies that utilize a good quality methodology with a long-term design and diversified active music therapy are recommended. Copyright © 2014 AMDA
Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials.
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Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, et al.
The British journal of psychiatry 2014 Dec;205(6):436-442
Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful. Aims To systematically review randomised controlled trial evidence regarding non-pharmacological interventions. Method We reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES). Results Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3-1.8) and for up to 6 months afterwards (SES range 0.2-2.2). Activities and music therapy by protocol (SES range 0.5-0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy. Conclusions There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes. Royal College of Psychiatrists
How nursing home residents develop relationships with peers and staff: A grounded theory study.
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Roberts T, Bowers B.
International journal of nursing studies 2015 Jan;52(1):57-67
Social support and social relationships have been repeatedly identified as essential to nursing home resident quality of life. However, little is known about ways residents develop relationships with peers or staff. OBJECTIVE: This study was conducted to explore the ways resident develop relationships with peers and staff in nursing homes. DESIGN AND METHODS: Fifteen cognitively intact nursing home residents from two facilities were interviewed for this grounded theory study. Sampling, interviewing, and analysis occurred in a cyclical process with results at each stage of the study informing decisions about data collection and analysis in the next. Unstructured interviews and field observations were conducted. Data were analyzed with open, axial, and selective coding. RESULTS: Residents developed relationships with peers and staff largely as an unintended consequence of trying to have a life in the nursing home. Having a life was a two-step process. First, life motivations (Being Self and Creating a Positive Atmosphere) influenced resident preferences for daily activities and interaction goals and subsequently their strategies for achieving and establishing both. Second, the strategies residents used for achieving their required daily activities (Passing Time and Getting Needs Met) and interaction goals then influenced the nature of interaction and the subsequent peer or staff response to these interactions. Residents defined relationships as friendly or unfriendly depending on whether peers or staff responded positively or negatively. There was considerable overlap in the ways peer and staff relationships developed and the results highlight the role of peer and staff responsiveness in relationship development. IMPLICATIONS: The results provide possible explanations for the success of interventions in the literature designed to improve staff responsiveness to residents. The results suggest that adapting these kinds of interventions for use with peers may also be successful. The conceptual model also presents a number of opportunities for developing interventions for residents. Published by Elsevier Ltd.
Staff’s views on managing symptoms of dementia in nursing home residents.
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Koder D, Hunt GE, Davison T.
Nursing older people 2014 Nov 28;26(10):31-36
To identify the most common and distressing behavioural and psychological symptoms of dementia (BPSD) in nursing homes and to identify staff preferences regarding its behavioural management. Method A descriptive cross-sectional survey was completed by a self-selected sample of 247 staff working in 21 nursing homes in a defined catchment area. The survey contained items relating to experience in aged care work, attitudes towards BPSD, ratings of the importance of certain behavioural strategies for managing BPSD, and the Challenging Behaviour Scale. Results Shouting, wandering and restlessness had the highest incidence, frequency and difficulty ratings. Frequency of BPSD and level of satisfaction with how they were managed had the greatest effect on overall level of difficulty in managing behaviours. Staff rated discussing behavioural concerns at a group level and with senior nursing staff as the most important behavioural strategies. Conclusion A strong relationship was found between frequency and difficulty of BPSD. Therefore, interventions targeted at lowering frequency of BPSD are recommended. Communication across a number of levels may enhance the implementation of behavioural interventions.
The nutritional situation in Swedish nursing homes – A longitudinal study.
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Borgstrom Bolmsjo B, Jakobsson U, Molstad S, Ostgren CJ, Midlov P.
Archives of Gerontology and Geriatrics 2015 Jan-Feb;60(1):128-133
Poor nutritional status is widespread among the elderly and is associated with increased morbidity and mortality. The aim of this study was to longitudinally describe the nutritional status in elderly people living in nursing homes. Nutritional status was recorded longitudinally in elderly people living in 11 different nursing homes in Sweden. Participants were examined at baseline by specially trained nurses who also assisted with questionnaires and collected data for current medical treatment from patient records. Nutritional status was evaluated at baseline and after 24 months with the mini nutritional assessment (MNA). The study included 318 subjects. The mean age of the participants was 85.0 years (range 65-101). At baseline, 41.6% were well nourished, 40.3% at risk of malnutrition, and 17.7% malnourished according to the MNA. Survival was significantly lower in the malnourished group. After 24 months, almost half of the population had died. The group of participants who survived at 24 months represents a population of better nutritional state, where 10.6% were malnourished at baseline increasing to 24.6% after 24 months. After 24 months, 38.7% of the participants showed a decline in nutritional state. The group with deteriorating MNA scores had higher weight, BMI values, and a higher hospitalization rate. The prevalence of malnutrition in nursing home residents increased over time and it is important to evaluate nutritional state regularly. Nutritional interventions should be considered in better nourished groups, as well as in malnourished individuals, to prevent a decline in nutritional state. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Six-Month Outcomes of Co-Occurring Delirium, Depression, and Dementia in Long-Term Care.
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McCusker J, Cole MG, Voyer P, Monette J, Champoux N, Ciampi A, et al.
Journal of the American Geriatrics Society 2014 Dec 8
To describe the 6-month outcomes of co-occurring delirium (full syndrome and subsyndromal symptoms), depression, and dementia in a long-term care (LTC) population. DESIGN: Observational, prospective cohort study with 6-month follow-up conducted from 2005 to 2009. SETTING: Seven LTC facilities in the province of Quebec, Canada. PARTICIPANTS: Newly admitted and long-term residents recruited consecutively from lists of residents aged 65 and older admitted for LTC, with stratification into groups with and without severe cognitive impairment. The study sample comprised 274 residents with complete data at baseline on delirium, dementia, and depression. MEASUREMENTS: Outcomes were 6-month mortality, functional decline (10-point decline from baseline on 100-point Barthel scale), and cognitive decline (3-point decline on 30-point Mini-Mental State Examination). Predictors included delirium (full syndrome or subsyndromal symptoms, using the Confusion Assessment Method), depression (Cornell Scale for Depression in Dementia), and dementia (chart diagnosis). RESULTS: The baseline prevalences of delirium, subsyndromal symptoms of delirium (SSD), depression, and dementia were 11%, 44%, 19%, and 66%, respectively. By 6 months, 10% of 274 had died, 19% of 233 had experienced functional decline, and 17% of 246 had experienced cognitive decline. An analysis using multivariable generalized linear models found the following significant interaction effects (P < .15): between depression and dementia for mortality, between delirium and depression for functional decline, and between SSD and dementia for cognitive decline. CONCLUSION: Co-occurrence of delirium, SSD, depression, and dementia in LTC residents appears to affect some 6-month outcomes. Because of limited statistical power, it was not possible to draw conclusions about the effects of the co-occurrence of some syndromes on poorer outcomes. © 2014, Copyright the Authors Journal compilation
Use of medications of questionable benefit in advanced dementia.
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Tjia J, Briesacher BA, Peterson D, Liu Q, Andrade SE, Mitchell SL.
JAMA internal medicine 2014 Nov 1;174(11):1763-1771
Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients’ goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized. OBJECTIVES: To estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, identify resident- and facility-level characteristics associated with such use, and estimate associated medication expenditures. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of medication use by nursing home residents with advanced dementia using a nationwide long-term care pharmacy database linked to the Minimum Data Set (460 facilities) between October 1, 2009, and September 30, 2010. MAIN OUTCOMES AND MEASURES: Use of medication deemed of questionable benefit in advanced dementia based on previously published criteria and mean 90-day expenditures attributable to these medications per resident. Generalized estimating equations using the logit link function were used to identify resident- and facility-related factors independently associated with the likelihood of receiving medications of questionable benefit after accounting for clustering within nursing homes. RESULTS: Of 5406 nursing home residents with advanced dementia, 2911 (53.9%) received at least 1 medication with questionable benefit (range, 44.7% in the Mid-Atlantic census region to 65.0% in the West South Central census region). Cholinesterase inhibitors (36.4%), memantine hydrochloride (25.2%), and lipid-lowering agents (22.4%) were the most commonly prescribed. In adjusted analyses, having eating problems (adjusted odds ratio [AOR], 0.68; 95% CI, 0.59-0.78), a feeding tube (AOR, 0.58; 95% CI, 0.48-0.70), or a do-not-resuscitate order (AOR, 0.65; 95% CI, 0.57-0.75), and enrolling in hospice (AOR, 0.69; 95% CI, 0.58-0.82) lowered the likelihood of receiving these medications. High facility-level use of feeding tubes increased the likelihood of receiving these medications (AOR, 1.45; 95% CI, 1.12-1.87). The mean (SD) 90-day expenditure for medications with questionable benefit was $816 ($553), accounting for 35.2% of the total average 90-day medication expenditures for residents with advanced dementia who were prescribed these medications. CONCLUSIONS AND RELEVANCE: Most nursing home residents with advanced dementia receive medications with questionable benefit that incur substantial associated costs.
Informed palliative care in nursing homes through the interRAI palliative care instrument: a study protocol based on the medical research council framework.
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Hermans K, Spruytte N, Cohen J, Van Audenhove C, Declercq A.
BMC geriatrics 2014 Dec 5;14(1):132
Nursing homes are important locations for palliative care. Through comprehensive geriatric assessments (CGAs), evaluations can be made of palliative care needs of nursing home residents. The interRAI Palliative Care instrument (interRAI PC) is a CGA that evaluates diverse palliative care needs of adults in all healthcare settings. The evaluation results in Client Assessment Protocols (CAPs: indications of problems that need addressing) and Scales (e.g. Palliative Index for Mortality (PIM)) which can be used to design, evaluate and adjust care plans. This study aims to examine the effect of using the interRAI PC on the quality of palliative care in nursing homes. Additionally, it aims to evaluate the feasibility and validity of the interRAI PC. METHODS: This study covers phases 0, I and II of the Medical Research Council (MRC) framework for designing and evaluating complex interventions, with a longitudinal, quasi-experimental pretest-posttest design and with mixed methods of evaluation. In phase 0, a systematic literature search is conducted. In phase I, the interRAI PC is adapted for use in Belgium and implemented on the BelRAI-website and a practical training is developed. In phase II, the intervention is tested in fifteen nursing homes. Participating nursing homes fill out the interRAI PC during one year for all residents receiving palliative care. Using a pretest-posttest design with quasi-random assignment to the intervention or control group, the effect of the interRAI PC on the quality of palliative care is evaluated with the Palliative care Outcome Scale (POS). Psychometric analysis is conducted to evaluate the predictive validity of the PIM and the convergent validity of the CAP ‘Mood’ of the interRAI PC. Qualitative data regarding the usability and face validity of the instrument are collected through focus groups, interviews and field notes. DISCUSSION: This is the first study to evaluate the validity and effect of the interRAI PC in nursing homes, following a methodology based on the MRC framework. This approach improves the study design and implementation and will contribute to a higher generalizability of results. The final result will be a psychometrically evaluated CGA for nursing home residents receiving palliative care.Trial registration: ClinicalTrials.gov NCT02281032. Registered October 30th, 2014.
The Residential Continuum From Home to Nursing Home: Size, Characteristics and Unmet Needs of Older Adults
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Freedman VA, Spillman BC.
The journals of gerontology.Series B, Psychological sciences and social sciences 2014 Nov;69 Suppl 1:S42-50
Older adults with care needs live in a variety of settings-from traditional community housing to nursing homes. This analysis provides new estimates of the size and characteristics of the older population across settings and examines unmet needs for assistance. METHOD: Data are from the 2011 National Health and Aging Trends Study (N = 8,077). Multinomial logistic regressions focus on people in settings other than nursing homes who are at risk for unmet needs, defined as receiving help or having difficulty with household, self-care, or mobility activities (N = 4,023). RESULTS: Of 38.1 million Medicare beneficiaries ages 65 and older, 5.5 million (15%) live in settings other than traditional housing: 2.5 million in retirement or senior housing communities, nearly 1 million in independent- and 1 million in assisted-living settings, and 1.1 million in nursing homes. The prevalence of assistance is higher and physical and cognitive capacity lower in each successive setting. Unmet needs are common in traditional community housing (31%), but most prevalent in retirement or senior housing (37%) and assisted living settings (42%). After controlling for differences in resident characteristics across settings, those in retirement or senior housing communities have a higher likelihood of unmet needs than those in traditional community housing, while those in independent or assisted living settings have a lower relative likelihood. DISCUSSION: Substantial numbers of older adults, many with care needs, live in a continuum of settings other than traditional community housing. Unmet needs are prevalent among older adults with limitations across all settings and warrant further investigation and monitoring. © The Author 2014.
Activities of daily living and quality of life across different stages of dementia: a UK study.
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Giebel CM, Sutcliffe C, Challis D.
Aging & mental health 2015 Jan;19(1):63-7
People with dementia (PwD) require an increasing degree of assistance with activities of daily living (ADLs), and dependency may negatively impact on their well-being. However, it remains unclear which activities are impaired at each stage of dementia and to what extent this is associated with variations in quality of life (QoL) across the different stages, which were the two objectives of this study. METHODS: The sample comprised 122 PwD, and their carers, either living at home or recently admitted to long-term care. Measures of cognition and QoL were completed by the PwD and proxy measures of psychopathology, depression, ADLs and QoL were recorded. Using frequency, correlation and multiple regression analysis, data were analysed for the number of ADL impairments across mild, moderate and severe dementia and for the factors impacting on QoL. RESULTS: ADL performance deteriorates differently for individual activities, with some ADLs showing impairment in mild dementia, including dressing, whereas others only deteriorate later on, including feeding. This decline may be seen in the degree to which carers perceive ADLs to explain the QoL of the PwD, with more ADLs associated with QoL in severe dementia. RESULTS of the regression analysis showed that total ADL performance however was only impacting on QoL in moderate dementia. CONCLUSION: Knowledge about performance deterioration in different ADLs has implications for designing interventions to address specific activities at different stages of the disease. Furthermore, findings suggest that different factors are important to consider when trying to improve or maintain QoL at different stages.
Increasing Fluid Intake and Reducing Dehydration Risk in Older People Living in Long-Term Care: A Systematic Review.
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Bunn D, Jimoh F, Wilsher SH, Hooper L.
Journal of the American Medical Directors Association 2014 Dec 11
To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities. DESIGN: Systematic review of intervention and observational studies. DATA SOURCES: Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked. ELIGIBILITY CRITERIA: Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally. REVIEW METHODS: Two reviewers independently screened, selected, abstracted data, and assessed risk of bias from included studies; narrative synthesis was performed. RESULTS: A total of 4328 titles and abstracts were identified, 325 full-text articles were obtained and 23 were included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at the resident, institutional, or policy level. Overall, the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment. Reported findings from 6 of the 9 intervention studies investigating the effect of multicomponent strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, and increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, P = .01. Two smaller studies reported positive effects: one on fluid intake in 9 men with Alzheimer disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages, and mode of delivery (straw vs beaker; prethickened drinks vs those thickened at the bedside) were inconclusive. Two large observational studies with good internal validity investigated effects of ownership; in Canada, for-profit ownership was associated with increased hospital admissions for dehydration; no difference was seen in dehydration prevalence between US for-profit and not-for-profit homes, although chain facilities were associated with lower odds of dehydration. This US study did not suggest any effect of staffing levels on dehydration prevalence. CONCLUSIONS: A wide range of interventions and exposures were identified, but the efficacy of many strategies remains unproven due to the high risk of bias present in many studies. Reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management, and care staff, but these require further investigation using more robust study methodologies. The review protocol was registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012003100). Copyright © 2014 AMDA
Awareness of dementia by family carers of nursing home residents dying with dementia: A post-death study.
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Penders YW, Albers G, Deliens L, Vander Stichele R, Van den Block L, EURO IMPACT, et al.
Palliative medicine 2015 Jan;29(1):38-47
High-quality palliative care for people with dementia should be patient-centered, family-focused, and include well-informed and shared decision-making, as affirmed in a recent white paper on dementia from the European Association for Palliative Care. AIM: To describe how often family carers of nursing home residents who died with dementia are aware that their relative has dementia, and study resident, family carer, and care characteristics associated with awareness. DESIGN: Post-death study using random cluster sampling. SETTING/PARTICIPANTS: Structured questionnaires were completed by family carers, nursing staff, and general practitioners of deceased nursing home residents with dementia in Flanders, Belgium (2010). RESULTS: Of 190 residents who died with dementia, 53.2% of family carers responded. In 28% of cases, family carers indicated they were unaware their relative had dementia. Awareness by family carers was related to more advanced stages of dementia 1 month before death (odds ratio = 5.4), with 48% of family carers being unaware when dementia was mild and 20% unaware when dementia was advanced. The longer the onset of dementia after admission to a nursing home, the less likely family carers were aware (odds ratio = 0.94). CONCLUSION: Family carers are often unaware that their relative has dementia, that is, in one-fourth of cases of dementia and one-fifth of advanced dementia, posing considerable challenges for optimal care provision and end-of-life decision-making. Considering that family carers of residents who develop dementia later after admission to a nursing home are less likely to be aware, there is room for improving communication strategies toward family carers of nursing home residents.
Quality of life ratings in dementia care A cross-sectional study to identify factors associated with proxy-ratings.
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Graske J, Meyer S, Wolf-Ostermann K.
Health and quality of life outcomes 2014 Dec 12;12(1):177
Quality of life (QoL) is one major outcome parameter in the care for people with dementia (PwD); however, their assessment is lacking a gold standard. The purpose of this study was to evaluate potential factors associated with nurse-rated quality of life of PwD in nursing homes in Berlin, Germany.MethodAn explorative cross-sectional study was performed in five nursing homes to evaluate QoL. Nurses rated the QoL for all residents with dementia by completing two different standardised assessments (ADRQL, QUALIDEM). Potential associated factors were evaluated concerning resident and nurse related factors. A fixed-effects models of analysis of co-variance (ANCOVA) was used to analyse effects of assumed associated factors of the major outcome parameters ADRQL and QUALIDEM. Associated factors were severity of dementia (GDS), challenging behaviour (CMAI), and other characteristics. Regarding the nurses, burnout (MBI), satisfaction with life (SWLS), attitude (ADQ) and empathy toward residents (JSPE), as well as circumstances of the ratings and days worked in advance of the ratings were assessed.ResultsIn total, 133 PwD and 88 nurses were included. Overall, the ratings show moderate to high QoL in every subscale independent of the instrument used. Assumed confounders relevantly influenced 14 out of 17 ratings. Predominantly, residents¿ challenging behaviour, nurses¿ burnout and satisfaction with life as well as the circumstances of the ratings are significant and clinically relevant associated factors.ConclusionAssessing QoL of PwD is acknowledged as a central component of health care and health care research. In later stages of dementia, proxy-reported information obtained from quality of life questionnaires is and will continue to be essential in this research. However, methodological issues that underline this research – matters of measurement and instrument validity – must receive more attention. Associated factors in proxy-ratings have to be routinely assessed in order to get more valid and comparable estimates.
Determinants of oral health-related quality of life of the institutionalized elderly.
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Zenthofer A, Rammelsberg P, Cabrera T, Schroder J, Hassel AJ.
Psychogeriatrics 2014 Dec;14(4):247-254
Diminished oral health of the institutionalized elderly has frequently been reported. This is not only of significance with regard to nutrition and general health, but it can also affect oral health-related quality of life. This paper evaluates the effects of oral and general conditions on oral health-related quality of life for the institutionalized elderly, as measured by the Geriatric Oral Health Assessment Index (GOHAI). MATERIALS AND METHODS: Ninety-four residents of four long-term care homes in southern Germany agreed to participate in this study, and interviews were conducted using the GOHAI questionnaire. The Revised Oral Health Assessment Guide was applied to allocate participants into two groups: satisfactory oral health and poor oral health. To evaluate the effects of age, gender, number of chronic diseases, frequently taken drugs, care level, Mini-Mental State Examination score, periodontitis (for participants with their own teeth), pressures caused by prostheses, and type of denture worn, a linear regression model with the total GOHAI score was calculated with these determinants. RESULTS: The mean ± SD GOHAI score was 53.3 ± 6.2 in the satisfactory oral health group and 48.7 ± 7.3 in the poor oral health group. Statistical analysis showed that the GOHAI scores were significantly different in satisfactory oral health and poor oral health groups (P = 0.030) and were affected by care level (P = 0.008) and type of dentures worn (P = 0.006). CONCLUSIONS: Within the limitations of this study, it can be concluded that oral health-related quality of life of the institutionalized elderly is low and is positively associated with better oral health. © 2014 The Authors. Psychogeriatrics
Quality of life in nursing home residents with advanced dementia: a 2-year follow-up.
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Oudman E, Veurink B.
Psychogeriatrics 2014 Dec;14(4):235-240
Quality of life (QOL) in dementia has become increasingly recognized as an important clinical and policy concern, but little is known about the progression of QOL in patients with advanced dementia on psychogeriatric units of nursing homes. Therefore, the primary goal of the current study was to assess the evolution of QOL in advanced dementia patients on a psychogeriatric unit. METHODS: The QUALIDEM scale, a reliable and validated QOL instrument developed for patients with advanced dementia in residential settings who are unable to self-report, was assessed at baseline and 2 years later. Of the 75 patients with advanced dementia included at baseline, 32 patients participated at follow-up. RESULTS: Average QUALIDEM QOL scores did show a trend towards a significant improvement over a 2-year period. For 61.8% of the subjects at follow-up, the average scores improved. On the subscales that assessed ‘feeling at home’, ‘social isolation’ and ‘negative affect’, improvement was significant. CONCLUSIONS: Although it could be expected that QOL would decline over time in advanced dementia patients, results of the current study suggest that QOL is stable or improves despite the global cognitive deterioration, particularly in the more advanced stages of dementia. QOL is a distinctive domain of disease severity that should receive more attention in the advanced stages of dementia. © 2014 The Authors
Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools.
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Lichtner V, Dowding D, Esterhuizen P, Closs SJ, Long AF, Corbett A, et al.
BMC geriatrics 2014 Dec 17;14(1):138
There is evidence of under-detection and poor management of pain in patient with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment. METHODS: We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach. RESULTS: We retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a ‘gold standard’ significantly hinders the evaluation of tools’ validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations. CONCLUSIONS: There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence.
Quality of life in dementia: a systematically conducted narrative review of dementia-specific measurement scales.
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Bowling A, Rowe G, Adams S, Sands P, Samsi K, Crane M, et al.
Aging & mental health 2015 Jan;19(1):13-31
Ascertaining the quality of life (QoL) in people with dementia is important for evaluating service outcomes and cost-effectiveness. This paper identifies QoL measures for people with dementia and assesses their properties. METHOD: A systematic narrative review identified articles using dementia QoL measures. Electronic databases searched were AMED, CINAHL, EMBASE, Index to Theses, IBSS, MEDLINE, PsycINFO, Sociological Abstracts, and Web of Science. All available years and languages (if with an English language abstract) were included. RESULTS: Searches yielded 6806 citations; 3043 were multiple duplicates (759 being true duplicates). Abstracts were read; 182 full papers were selected/obtained, of which 126 were included as relevant. Few measures were based on rigorous conceptual frameworks. Some referenced Lawton’s model (Dementia Quality of Life [DQOL] and Quality of Life in Alzheimer’s Disease [QOL-AD]), though these tapped part of this only; others claimed relationship to a health-related QoL concept (e.g. DEMQOL), though had less social relevance; others were based on limited domains (e.g. activity, affect) or clinical opinions (Quality of Life in Late-Stage Dementia [QUALID]). Many measures were based on proxy assessments or observations of people with dementia’s QoL, rather than their own ratings. The Bath Assessment of Subjective Quality of Life in Dementia (BASQID) was developed involving people with dementia and caregivers, but excluded some of their main themes. All measures were tested on selective samples only (ranging from community to hospital clinics, or subsamples/waves of existing population surveys), in a few sites. Their general applicability remains unknown, and predictive validity remains largely untested. CONCLUSION: The lack of consensus on measuring QoL in dementia suggests a need for a broader, more rigorously tested QoL measure.
The Determinants of the Propensity to Receive Publicly Funded Home Care Services for the Elderly in Canada
Canadian Centre for Health Economics
November 2014
Increases in Home Care (HC) services for the elderly have been a policy priority in recent decades. HC services include Home Health Care (HHC) and Homemaking/Personal Support (HM). We explored the interrelationship between receipt of publicly funded HM and HHC, and the determinants of the receipt of each type of services. A household home care decision model was extended, to develop an understanding of the demand for HHC and HM services separately and to include different household arrangements. Individual panel data for those aged 65 and over were derived from 9 biannual waves of the Canadian National Population Health Survey (1994-95 to 2010-11). A Panel Two-Stage Residual Inclusion method was used to estimate the likelihood of the receipt of HC services. Receipt of publicly funded HM is complementary with receipt of publicly funded HHC services after adjusting for functional and health status. Dependence on help with activities of daily living, health status, household arrangement, and income are determinants of the propensity to receive publicly funded HHC and HM services.
CD Howe Institute: Managing the Costs of Healthcare for an Aging Population: How Alberta Can Confront its Fiscal Glacier
December 2014
Albertans carry a $580 billion fiscal burden – the future tax bill for increased healthcare costs over the next half-century – and should prepare now for the coming demographic squeeze, says a report released today from the C.D. Howe Institute. In “Managing the Costs of Healthcare for an Aging Population: How Alberta Can Confront its Fiscal Glacier,” authors William B.P. Robson, Colin Busby and Aaron Jacobs recommend changes to protect young Albertans from the burden they will otherwise bear as the tax base grows more slowly and healthcare costs rise.
CD Howe Institute: Managing Healthcare for an Aging Population: Ontario’s Troubling Collision Course
December 2014
Ontarians carry a $1.19 trillion fiscal burden – the higher tax bill for increased healthcare costs over the next half-century – and should prepare now for the coming demographic squeeze, says a report released today from the C.D. Howe Institute. In “Managing Healthcare for an Aging Population: Ontario’s Troubling Collision Course,” authors William B.P. Robson, Colin Busby and Aaron Jacobs recommend that Ontario prefund selected healthcare services and benchmark against other provinces to get better health bang for their tax bucks.
Disability and Care Needs of Older Americans: An Analysis of the 2011 National Health and Aging Trends Study (US)
US Department of Health and Human Services
April 2014
The economic cost of dependency at older ages is large and projected to grow rapidly as the number of older adults increases in the coming decades, and reduced well-being for individuals facing loss of functioning and their families, who provide the bulk of uncompensated care, also is an important societal concern. The purpose of this report is to describe disability and care needs of the older population using baseline (2011) measures from the National Health and Aging Trends Study, a new study designed to support understanding of both trends and trajectories in health and disability in later life. To provide a context for framing policy discussions of disability and care needs of older adults, Two overarching topics were investigated: (1) the extent of activity limitations and use of assistance by older adults; and (2) care resources available to and used by older adults and the extent of unmet need in the population with care needs.
Living and dying with dementia in England: Barriers to care
Marie Curie Cancer Care & Alzheimer’s Society UK
December 2014
This report from Marie Curie and Alzheimer’s Society reveals the barriers that prevent people with dementia from accessing high-quality care at the end of life in England. It also sets out the charities’ plans to work with partner organisations to address these barriers and develop an action plan.
People, partners and possibilities: Transforming dementia care in the community, June 13 & 14 2014, Toronto – Report
brainXchange
2014
In June 2014, the brainXchange worked with the Alzheimer Society of Ontario, the Ontario College of Family Physicians and other stakeholders to hold an event called People, Partners & Possibilities. The purpose of this symposium was to explore and begin to answer the question “What must we do to increase primary care’s capacity to respond effectively to the needs of community-dwelling people living with dementia and their care partners along their journey?” 50 people living with dementia, family members, primary care and other service providers, researchers and others came together to roll-up their sleeves and through discussion with each other, better understand the needs and challenges, identify opportunities and develop solutions to this question. Six key topics for discussion were identified: early identification and diagnosis; whole person needs; accessibility; collaboration; defining the role of primary care providers; and primary care training. Out of the discussions on each of these topics, 3 focus areas for moving forward emerged: increased coordination; early identification and diagnosis of cognitive impairment; and a person-centered approach.
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Events
CADTH Rapid Review Summit: Then, Now, and in the Future
3-4 February Vancouver
The summit objectives are, as follows:
-to provide a forum for rapid review producers, health care decision-makers, and providers and representatives from organizations interested in rapid reviews, to share knowledge, information, and experiences
-to facilitate discussions on specific topic areas concerning the production and applications of rapid reviews
-to develop a research priority agenda to continue to advance the science of rapid reviews.
Courses
Systematic reviews for policy and practice: conducting and using reviews
17-18 March AND 14-15 April Also available online £670 London UK
This course will enable you to conduct and appraise systematic reviews. On successful completion, you will be familiar with the strengths and limitations of systematic reviews and have a critical appreciation of evidence-informed policy and practice.
CIHR Summer Program In Aging Launch
1-5 June Toronto
The Summer Program in Aging (SPA) 2015 is focused on the theme “ More Years, Better Lives: The Health, Wellness and Participation of Older Adults in the World of Work”. The CIHR Institutes of Aging (IA), Gender and Health (IGH) and Musculoskeletal Health and Arthritis (IMHA) have partnered with the Institute for Work & Health to host this exciting and innovative training event. Trainees who are conducting or who have an interest in learning about the area of health, wellness and participation of older Adults in the world of work and specifically in areas and/or with the perspective that is relevant to the mandate of any of the partner Institutes, are encouraged to apply to this program.
Online
Introduction to Statistics for Health Care Research
19 January to 27 March £1640
DEADLINE for application 19 December
This ten week online statistics module is designed for health and social care professionals who want to understand the basics of analysis methods commonly used in medical research, in order to understand published research and to participate in more specialised courses. Students will learn to use and interpret basic statistical methods using SPSS, with reference to cohort studies, case control studies and randomized controlled trials. Online discussion forums enable communication between students and the tutor to provide support and to interpret and understand real-life scenarios.
News
Alberta hospitals crumbling, rural facilities underused & system manipulated by politics
A five-month investigation by the Edmonton Journal has found disturbing details about the condition of the province’s aging hospitals, how the facilities are evaluated, and who gets money for upgrades or new buildings.
Make seniors’ health care an election issue, says president of Canadian Medical Association
CMA president Chris Simpson, a cardiologist based in Kingston, Ont., is travelling the country to convince doctors, policy-makers and journalists that it’s time to face this fact: A hospital system designed for a young population is no place to treat the chronically ill.
Toronto Star report on wandering & dementia
Six in 10 people with Alzheimer’s and other forms of dementia become lost at least once. Why do they wander, and how do we stop them?
Using altmetrics and social media for research and networking
Today it’s easy to connect with people around the world and participate in communities of interest. For researchers, there are also many ways to measure the influence of their research. Altmetrics provide a useful tool to identify who is sharing research in your area with his/her own broader communities.
An Illustrated Look at Quality Improvement in Healthcare
Dr. Mike Evans, Associate Professor of Family Medicine and Public Health at the University of Toronto, has become well known in health care circles for his informative, humorous, and fast-paced videos that have attracted millions of views on YouTube. Long a fan of his unique perspective on improving health care and health, IHI has now collaborated with Dr. Evans to create a new whiteboard video that introduces the concepts of quality improvement in health care.
Saskatchewan ombudsman investigating state of long-term care
Saskatchewan’s ombudsman will investigate whether there are system-wide problems in long-term care. Mary McFadyen was asked by the health minister to review the case of a senior who died after a fall in a Regina care home.
Montreal woman in elderly care centre not bathed in a tub in 9 months
Quebec Health Minister Gaétan Barrette says some policies in elder care facilities may have to be changed after learning that an 85-year-old woman in Montreal has not been given a bath in nine months, and has only received a sponge bath once a week.
Scientists will be forced to knock on doors under health research grant changes
Future of health research in fledgling fields at stake, researchers say.
New CRC guidelines aim to reduce unconscious hiring bias against women
Canada Research Chairs program is responding to research that shows referees write weaker letters of recommendation for female candidates than for male candidates.
Seniors sedated without documentation, Saskatchewan auditor says
Staff at long-term care facilities in the Heartland Region Health Authority have been sedating residents with no evidence of written consent, according to the provincial auditor.
Living or existing – the Namaste Care Programme for people with advanced dementia (UK)
The Namaste Care programme integrates compassionate nursing care with meaningful activities, and takes place seven days a week in a welcoming, attractive space protected from interruptions.
Old And Overmedicated: The Real Drug Problem In Nursing Homes (US)
It’s one of the worst fears we have for our parents or for ourselves: that we, or they, will end up in a nursing home, drugged into a stupor. And that fear is not entirely unreasonable. Almost 300,000 nursing home residents are currently receiving antipsychotic drugs, usually to suppress the anxiety or aggression that can go with Alzheimer’s disease and other dementia.
Stories or numbers OR stories and numbers
The notion of numbers OR stories is a false dichotomy. Stories use numbers, numbers tell stories, numbers can paint pictures – and so on. The skilful story teller crafts the narrative according to what is more likely to persuade their audience.
Saskatchewan Premier Brad Wall promises to look at staffing ratios in care homes
Saskatchewan Premier Brad Wall is promising to look at staffing ratios at long-term care homes in Saskatchewan, in time for the next provincial budget expected in the spring.
Morning care for residents transformed by giving staff supplies they need
Morning care, the time when residents get cleaned and dressed for the day, is often the only one-on-one time long-term care residents spend with a care provider. At Wascana Rehabilitation Centre (WRC) in Regina, that time was interrupted when care providers needed to get towels, sheets, and other supplies. Now, thanks to improvement work that started on two units and has spread to others using Lean methods, care providers have found ways to ensure they have all the supplies they need on hand, fewer steps to walk, and uninterrupted time with residents.
Auditor says seniors in long-term care need better management of medication
Saskatchewan’s auditor is raising concerns about the management of medication for residents in long-term care homes
Improving dementia care with patient-focused apps (EU)
EU-funded researchers have developed new apps that enable healthcare workers to provide more personalised care to dementia sufferers.
This Nursing Home Calms Troubling Behavior Without Risky Drugs (US)
It seems residents can always find something to do around here. That can help to relieve the agitation common in some people with Alzheimer’s or other forms of dementia — agitation that in other nursing homes might be managed with antipsychotic drugs.
Joan Bakewell, on BBC Radio 4, explores the topic of dementia, how dementia affects people and their families, the importance of early diagnosis, the services available post-diagnosis, and the broader importance of dementia-friendly communities.
The Revise and Resubmit Series, Part 1: Coping with Criticism
Writing for the Chronicle of Higher Education’s Vitae, Theresa MacPhail discusses how to respond to anonymous reviewers’ comments on your work.
Are You Training People to Think or to Follow a Checklist?
Success of improvement projects are also linked to training methodology. In so many of our training programs, we focus so much on the tools used in each step of the scientific problem solving process, perhaps we don’t spend enough time on the principles: the “why” behind each step.
Writing a highly cited paper – a sceptical view
An academic has been somewhat irritated recently, as most academics have been, by the increasing interest that our universities have in citations.
Some Alberta continuing care residents still not getting two baths per week
More than a year and a half after the province announced new rules for continuing care residents to receive at least two baths a week, facilities across Alberta are still falling short.
Tens of millions of elderly are abused each month – UN health agency reports
Millions of elderly people report significant abuse each month, “an important public health problem” expected to increase in many countries as the number of people aged 60 and older is forecasted to reach about 1.2 billion by the year 2025, the World Health Organization reported.
The Seniors Health Strategic Clinical Network latest newsletter is now available
This newsletter contains lots of information on seniors research and events occurring in Alberta.
People with dementia suffer less depression in care homes – but why? (EU)
Looking at dementia and the state of many care homes, then, one might expect depression to be more of a feature in those living in care homes. But in a study we published in International Psychogeriatrics we found the opposite. Instead, we found that those with severe dementia living in care homes were less depressed than those receiving home care.
One-third of nursing homes “over-coding” to get bigger share of $930M pie
One-third of Alberta’s nursing homes are inflating their assessments of resident needs and qualifying for a larger but unwarranted slice of the $930-million pie for ailing seniors care, according to audits by the province’s health authority.
Nursing Homes Rarely Penalized For Oversedating Patients (US)
Antipsychotic drugs have helped many people with serious mental illnesses like schizophrenia or bipolar disorder. But for older people with Alzheimer’s or other forms of dementia, they can be deadly.
Prescription for danger: Medication errors inside nursing homes lead to hospitalization, death (US)
In Michigan nursing homes, significant medication errors are all too common. Data shows some patients have received too much, not enough, or the wrong medicine altogether.
AIHS Knowledge Translation Needs Assessment Survey
DEADLINE 23 December
The results of this survey will help us and our partners in the Strategy for Patient Oriented Research (SPOR) initiative, the Strategic Clinical Networks (SCNs), the KT group, and the Knowledge Management team at Alberta Health Services (AHS), and the University of Calgary’s O’Brien Institute for Public Health develop KT training and resources to meet identified needs.
Ireland launches a national dementia stregy and implementation plan
This Strategy identifies key principles to underpin and inform the full range of health and social care services provided to people with dementia, their families and carers.
Resources
Knowledge Mobilization (KMb) Toolkit
The Knowledge Mobilization toolkit: Doing more with what you know will help you mobilize valuable knowledge and information in your community. It’s designed to inform and equip you with the knowledge and tools you need to mobilize knowledge, and ultimately improve outcomes for children, youth and families. You’ll also find inspiring stories from the field.
NCCMT Understanding Research Evidence videos
-Understanding what a P value tells us
-6S Pyramid: a tool that helps you find evidence quickly and efficiently
-Evidence-Informed Decision Making: A guiding framework for public health
Understanding and interpreting research evidence is an important part of practising evidence-informed public health. You need to understand some basic concepts. That’s why we developed this series of short videos to explain some important terms that you are likely to encounter when looking at research evidence.These concise videos explain each term in plain language using realistic public health examples and engaging visuals.
How to target a journal that’s right for your research
Some researchers are under pressure to publish anywhere, while others are lured by prestigious but often unattainable journals. Either case can lead researchers away from journals that might give them the audience and impact they need. Here are some guidelines on how to target a truly appropriate journal for your research.
Seven practical tools to support dignity and compassion in care
Ensuring dignity and compassion in care requires commitment at all levels. But many of the most effective ways of making changes to improve patient experience of care start with simple steps. Here are seven practical tools which will help to explore and implement dignity and compassion in care.
A Toolkit for Long-Term Care Employers to increase influenza vaccination among employees
Within this comprehensive toolkit are a number of resources intended to help long-term care facility, agency, or corporation owners and administrators provide access to influenza vaccination for their workforce and to help any employer of workers in long-term care understand the importance of influenza vaccination for their employees.
Opportunities
Postdoc in Dissemination and Implementation
Center for Dissemination and Implementation (D&I) at the Institute for Public Health, Washington University, St. Louis MO
This program provides transdisciplinary, guided mentoring in dissemination and implementation science. Training appointments are for two years, pending satisfactory completion of the first year.
Health Quality of Ontario Policy Analyst
Toronto
DEADLINE 9 January
Ontario is building an exciting team to support our vision for ensuring the highest quality of care in our health system. As the province’s advisor on quality, Health Quality Ontario is looking for an experienced Policy Analyst to join the policy and strategy team. In this newly created role, the Policy Analyst is responsible for researching and analysing health trends, issues, and health delivery models across multiple jurisdictions, contributing to proposal and budget development; and formulating innovative strategy based tactics to support the development of recommendations that support policy-making.
Postdoctoral Research Fellow in Shared Decision-Making in Contraceptive Care
The Dartmouth Institute for Health Policy and Clinical Practice & The Dartmouth Center for Health Care Delivery Science, Hanover NH
DEADLINE 12 January
Principal Investigators Dr Rachel Thompson and Professor Glyn Elwyn have recently been awarded funding by the Patient Centered Outcomes Research Institute to evaluate the effectiveness of two interventions for increasing shared decision-making about contraceptive methods by patients and health care providers. We will conduct a cluster randomized trial in close collaboration with researchers across multiple institutions and both patient and stakeholder research partners from 1 January, 2015 to 31 December, 2017. We are seeking an experienced Postdoctoral Research Fellow to coordinate the implementation of the project in collaboration with the Principal Investigators.
AuthorAID is a global network that provides support, mentoring, resources and training for researchers in developing countries. AuthorAID aims to support developing-country researchers to publish and communicate their research. Mentoring is one of the key components of the project and volunteer mentors play an essential role. Mentors come from diverse backgrounds and include journal editors, , science communicators, librarians, senior researchers, retired academics and postdoctoral students. They can decide on the level and nature of support they want to give, whether it’s short-term, task-based support or longer-term, mentoring support. They can also choose the tasks they want to accept and decline any they don’t have time for, or don’t feel comfortable with.
