Grants & Awards
Alzheimer’s Society 2015 spring grant rounds (UK)
DEADLINE 27 March
Alzheimer’s Society is funding research across all areas of dementia, the research programme is organised into two streams, biomedical research and care, services and public health research that cover the full scope of dementia research. The grants are:
-Clinician and healthcare professional training fellowships – for practicing professionals in dementia health and care services to study for a higher research degree (usually a PhD)
-Junior fellowships – for post-doctoral researchers from all health and care professions
-Senior fellowships – for post-doctoral or other successful researchers who wish to build on a number of successful years of dementia research
-Project grants – for researcher led applications to enable world-class research in to the cause, cure, care or prevention of any form of dementia
-PhD studentships – funding for new PhD studentships in the areas of cause, cure, care or prevention of all types of dementia; the host institution must be in the UK
TVN Knowledge Synthesis Projects
DEADLINE for Pre-application Intent to Apply Monday 23 March 15:00 MT
Projects funded under this competition will inform future research priorities for the Network and guide in the future development of its knowledge translation activities, through a comprehensive review and analysis of frailty measures, the utility of operationalizing a frailty measure in various health care settings, and possible preventive and therapeutic treatment options for frailty. All forms of knowledge synthesis are eligible, including systematic and scoping reviews, meta-analyses, meta-syntheses and environmental scans.
TVN Implementation Projects
DEADLINE for Pre-application Intent to Apply Monday 23 March 15:00 MT
Projects funded under this competition will investigate the feasibility of operationalizing a frailty measure in one or more health care settings such as acute care, residential care and home care. Creative, novel and innovative proposals are being sought, and pilot, feasibility and translation studies are eligible.
Innovation processes in moderately innovative countries: The competencies of knowledge brokers
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Cannavacciuolo L, Capaldo G, Rippa P.
International Journal of Innovation and Sustainable Development 2015;9(1):63-82
Successful innovation processes are strongly related to collaborations among actors in the business environment, including small and medium enterprises, local institutions, business associations, liaison offices, and technology transfer offices. Such collaborations are not well guided in moderately developed regions, where actors are not well supported by local institutions, and the level and quality of communication among them is extremely low. The success of collaborative processes is strongly related to the competence level of professionals known in the literature as ‘individual knowledge brokers’. In this paper, results from a field research aimed at exploring the types, roles, activities, and competences of knowledge brokers in different brokerage processes in Southern Italy are presented. Results are discussed in order to define guidelines for education and training policy to enhance the coverage and to strengthen the capacity of the knowledge brokers in moderately developed countries.
The diverging perception among physiotherapists of how to work with the concept of evidence: A phenomenographic analysis.
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Snoljung A, Mattsson K, Gustafsson LK.
Journal of evaluation in clinical practice 2014 Dec;20(6):759-766
Changes in Sweden’s municipal care have impacted the situation of physiotherapists by the adoption of practice based on research evidence. Even if physiotherapists appear to be in favour of the idea of evidence-based practice, barriers still exist that prevent many from keeping up with current research. The aim of this study was to identify and describe the different ways in which physiotherapists in municipal care perceive the concept of evidence in rehabilitation. METHODS: A phenomenographic design with semi-structured interviews was carried out with physiotherapists working with frail older people in three municipal care units in two neighbouring municipalities in Sweden. The physiotherapists’ perceptions of evidence were explored in 12 interviews. RESULTS: Distinct perceptions of the concept of evidence are identified in three categories: ‘Confidence with the concept of evidence in relation to measurement instruments’; ‘Perception of evidence-based practice as a duty, condition and demand of the profession’; and ‘Evidence-based work as a separate rather than directly patient-oriented activity’. CONCLUSIONS: Physiotherapists take full responsibility to comply with what they perceive to be the demands of their profession. However, what evidence actually meant, and therefore what the practical element of this responsibility consisted of, was not as clear. © 2014 John Wiley & Sons, Ltd.
Barriers to evidence-based medicine: a systematic review.
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Sadeghi-Bazargani H, Tabrizi JS, Azami-Aghdash S.
Journal of evaluation in clinical practice 2014 Dec;20(6):793-802
Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM. METHODS: Different database searching methods and also manual search were employed in this study using the search words (‘evidence-based’ or ‘evidence-based medicine’ or ‘evidence-based practice’ or ‘evidence-based guidelines’ or ‘research utilization’) and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID. RESULTS: Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines. CONCLUSION: The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled. © 2014 John Wiley & Sons, Ltd.
A scoping review of classification schemes of interventions to promote and integrate evidence into practice in healthcare
Lokker C, McKibbon K, Colquhoun H, Hempel S.
Implementation Science 2015;10(1):27
Many models and frameworks are currently used to classify or describe knowledge translation interventions to promote and integrate evidence into practice in healthcare. Methods We performed a scoping review of intervention classifications in public health, clinical medicine, nursing, policy, behaviour science, improvement science and psychology research published to May 2013 by searching MEDLINE, PsycINFO, CINAHL and the grey literature. We used five stages to map the literature: identifying the research question; identifying relevant literature; study selection; charting the data; collating, summarizing, and reporting results. Results We identified 51 diverse classification schemes, including 23 taxonomies, 15 frameworks, 8 intervention lists, 3 models and 2 other formats. Most documents were public health based, 55% included a literature or document review, and 33% were theory based. Conclusions This scoping review provides an overview of schemes used to classify interventions which can be used for evaluation, comparison and validation of existing and emerging models. The collated taxonomies can guide authors in describing interventions; adequate descriptions of interventions will advance the science of knowledge translation in healthcare.
Health Care Administration and Organization
Does organizational ownership matter? Objectives of employees in public, nonprofit and for-profit nursing homes
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Van Puyvelde S, Caers R, Du Bois C, Jegers M.
Applied Economics 2015
Does organizational ownership matter for employees? We conducted a discrete choice experiment to reveal employees’ objectives in for-profit, nonprofit and governmental nursing homes. The results indicate that differences in objectives among nursing home staff are at least partially related to differences in ownership type. More specifically, we find that employees of public nursing homes are less extrinsically motivated than their for-profit and nonprofit counterparts. However, the results also show that employees of for-profit, nonprofit and governmental nursing homes are trading off output quality and output quantity differently, in line with the view that public providers of elderly care are pursuing a supplier-of-last-resort objective function.
Conceptualizing clinical nurse leader practice: an interpretive synthesis.
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Journal of nursing management 2015 Feb 5
The Institute of Medicine’s Future of Nursing report identifies the clinical nurse leader as an innovative new role for meeting higher health-care quality standards. However, specific clinical nurse leader practices influencing documented quality outcomes remain unclear. Lack of practice clarity limits the ability to articulate, implement and measure clinical nurse leader-specific practice and quality outcomes. PURPOSE AND METHODS: Interpretive synthesis design and grounded theory analysis were used to develop a theoretical understanding of clinical nurse leader practice that can facilitate systematic and replicable implementation across health-care settings. RESULTS: The core phenomenon of clinical nurse leader practice is continuous clinical leadership, which involves four fundamental activities: facilitating effective ongoing communication; strengthening intra and interprofessional relationships; building and sustaining teams; and supporting staff engagement. CONCLUSION: Clinical nurse leaders continuously communicate and develop relationships within and across professions to promote and sustain information exchange, engagement, teamwork and effective care processes at the microsystem level. IMPLICATION FOR NURSING MANAGEMENT: Clinical nurse leader-integrated care delivery systems highlight the benefits of nurse-led models of care for transforming health-care quality. Managers can use this study’s findings to frame an implementation strategy that addresses theoretical domains of clinical nurse leader practice to help ensure practice success. © 2015 John Wiley & Sons Ltd.
The connection between illness representations of Alzheimer’s disease and burnout among social workers and nurses in nursing homes and hospitals: a mixed-methods investigation.
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Shinan-Altman S, Werner P, Cohen M.
Aging & mental health 2015 Feb 12:1-10
To examine the relationship between Alzheimer’s disease (AD) illness representations and burnout among social workers and nurses, based on the self-regulatory model. Method: A mixed-methods study was conducted. First, 327 social workers and nurses completed measures of cognitive and emotional representations, burnout (emotional exhaustion, depersonalization, lack of personal accomplishment), role variables, knowledge about AD, emotion-focused coping, problem-focused coping, and demographic and occupational characteristics. Second, interviews were conducted with eight social workers and nurses to uncover their perceptions about AD and their burnout experience. Results: Using structural equation modeling and controlling background variables, findings indicated that emotional representations were associated with burnout while only some of the cognitive illness representations were associated with burnout. While cognitive illness representations were associated directly to burnout, the association between emotional representations and burnout was mediated by emotion-focused coping. The trimmed model showed a good fit of the data and explained 32.2% of the variance in emotion-focused coping, 51% of the variance in emotional exhaustion, 37.7% of the variance in depersonalization, and 22.6% of the variance in lack of personal accomplishment. Interviews demonstrated that AD characteristics were perceived as affecting participants on both personal and professional levels; the participants expressed negative feelings towards AD and stated that these perceptions and feelings had led them to burnout. Conclusions: AD illness representations may be a risk factor for developing burnout. New directions for intervention programs, aiming to reduce burnout, should be examined.
Transformation by design: nursing workforce innovation and reduction strategies in turbulent times of change.
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Nursing administration quarterly 2015 Apr-Jun;39(2):164-171
The evolution of care delivery from an acute care and inpatient standard to the outpatient setting and health promotion model is generating the need for innovative workforce and infrastructure adjustments to meet the new paradigm of population health management. Successful transformation of the nursing workforce necessitates a positive style of thinking that addresses rational concerns during times of difficult transition. Nurse leaders are called to recognize and appreciate the strengths of the nursing workforce by involving them in the course of change through collaboration, planning, and discussion. One unique way to plan and develop new care delivery models is to adopt the framework used in health facility planning and design for new services, units, or hospitals. This framework is flexible and can be adjusted easily to meet the objectives of a small nursing workforce innovation project or expanded to encompass the needs of a large-scale hospital transformation. Structured questioning further helps the team to identify barriers to care and allows for the development of new concepts that are objective and in accord with evidence-based practice and data. This article explores the advantages and disadvantages of implementing innovative workforce redesign and workforce reduction strategies.
Changes in turnover and vacancy rates of care workers in England from 2008 to 2010: panel analysis of national workforce data.
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Hussein S, Ismail M, Manthorpe J.
Health & social care in the community 2015 Mar 4
The combination of growing demand for long-term care and higher expectations of care staff needs to be set in the context of long-standing concerns about the sustainability of recruitment and retention of front-line staff in the United Kingdom. Organisational and work environment factors are associated with vacancy levels and turnover rates. The aim of the current analysis was to investigate changes in turnover and vacancy rates over time experienced by a sample of social care employers in England. Taking a follow-up approach offers potentially more accurate estimates of changes in turnover and vacancy rates, and enables the identification of any different organisational characteristics which may be linked to reductions in these elements over time. The study constructed a panel of 2964 care providers (employers) using 18 separate data sets from the National Minimum Data Set for Social Care during 2008-2010. The findings indicate slight reductions in vacancy rates but the presence of enduring, high turnover rates among direct care workers over the study period. However, the experience of individual employers varied, with home-care providers experiencing significantly higher turnover rates than other parts of the sector. These findings raise questions around the quality and motivations of new recruits and methods of reducing specific vacancy levels. At a time of increased emphasis on care at home, it is worthwhile examining why care homes appear to have greater stability of staff and fewer vacancies than home-care agencies. © 2015 The Authors
“Here for the residents”: a case study of cultural competence of personal support workers in a long-term care home.
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Tayab A, Narushima M.
Journal of transcultural nursing 2015 Mar;26(2):146-156
This study explores the perception of cultural competence of personal support workers (PSWs) in a long-term care (LTC) home in Ontario. As Canada’s demography becomes older and more diverse, LTC homes will increasingly accommodate residents from various cultural backgrounds. However, few studies have examined cultural competence among PSWs in the LTC home setting. DESIGN: The study employed a qualitative case study approach. Data collection and analysis were conducted in three phases: document analysis of organizational policies, a key informant interview with the Director of Care, and two focus groups with PSWs. RESULTS: Our findings illuminated the PSWs’ broad definition of culture, the process of developing cultural competence and its strong connections to person-centered care, and the organizational factors that facilitate or hinder PSWs’ cultural competence. IMPLICATIONS: The ambiguous perception of cultural competence reported by PSWs suggests the need for more education and further research on this topic. © The Author(s) 2014.
Leadership and leadership development in health care The evidence base
The King’s Fund, 2015
A key challenge facing all NHS organisations is to nurture cultures that ensure the delivery of continuously improving high-quality, safe and compassionate health care. Leadership is the most influential factor in shaping organisational culture and ensuring the necessary leadership behaviours, strategies and qualities are developed is fundamental. But what do we really know about leadership in health care services? The Faculty of Medical Leadership and Management, The King’s Fund and the Center for Creative Leadership share a commitment to evidence-based approaches to developing leadership and collectively initiated a review of the evidence by a team including clinicians, managers, psychologists, practitioners and project managers. This report summarises the evidence emerging from that review.
Health Care Innovation and Quality Assurance
SveDem, the Swedish Dementia Registry – A Tool for Improving the Quality of Diagnostics, Treatment and Care of Dementia Patients in Clinical Practice.
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Religa D, Fereshtehnejad SM, Cermakova P, Edlund AK, Garcia-Ptacek S, Granqvist N, et al.
PloS one 2015 Feb 19;10(2):e0116538
The Swedish Dementia Registry (SveDem) was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden. METHODS: SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se). The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes. RESULTS: The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to inform medical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden. CONCLUSION: SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.
Adherence of pain assessment to the German national standard for pain management in 12 nursing homes.
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Osterbrink J, Bauer Z, Mitterlehner B, Gnass I, Kutschar P.
Pain research & management 2014 May-Jun;19(3):133-140
Pain is very common among nursing home residents. The assessment of pain is a prerequisite for effective multiprofessional pain management. Within the framework of the German health services research project, ‘Action Alliance Pain-Free City Muenster’, the authors investigated pain assessment adherence according to the German national Expert Standard for Pain Management in Nursing, which is a general standard applicable to all chronic⁄acute pain-affected persons and highly recommended for practice. OBJECTIVES: To evaluate the state of pain assessment and to identify need for improvement in 12 nursing homes in a German city. METHODS: In the present study, the authors used an ex-post-facto design (survey methodology). Available written policies for routine pain assessment in residents ≥65 years of age were reviewed and a standardized online survey completed by 151 of 349 nurses in 12 nursing home facilities was conducted between September 2010 and April 2011. RESULTS: Most of the included nursing homes provided written policies for pain assessment, and the majority of nurses reported that they assess and regularly reassess pain. However, observational tools for residents with severe cognitive impairment and written reassessment schedules were lacking in many facilities or were inconsistent. CONCLUSIONS: Essentially, pain assessment appeared to be feasible in the majority of the German nursing homes studied. However, the absence or inconsistency of reassessment schedules indicate that pain management guidelines should include a detailed and explicit reassessment schedule for the heterogenic needs of nursing home residents. For residents with severe cognitive impairment, assessment tools are needed that are simple to use and clearly indicate the presence or absence of pain.
Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience.
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Edvardsson D, Sandman PO, Borell L.
International psychogeriatrics / IPA 2014 Jul;26(7):1171-1179
Person-centeredness has had substantial uptake in the academic literature on care of older people and people with dementia. However, challenges exist in interpreting and synthesizing the evidence on effects of providing person-centered care, as the person-centered components of some intervention studies are unclear – targeting very different and highly specific aspects of person-centeredness, as well as not providing empirical data to indicate the extent to which care practice was actually perceived to become more person-centered post-intervention. METHODS: The study employed a quasi-experimental, one-group pre-test-post-test design with a 12-month follow-up to explore intervention effects on person-centeredness of care and the environment (primary endpoints), and on staff strain and stress of conscience (secondary endpoints). RESULTS: The intervention resulted in significantly higher scores on person-centeredness of care at follow-up, and the facility was rated as being significantly more hospitable at follow-up. A significant reduction of staff stress of conscience was also found at follow-up, which suggests that, to a larger extent, staff could provide the care and activities they wanted to provide after the intervention. CONCLUSIONS: The results indicated that an interactive and step-wise action-research intervention consisting of knowledge translation, generation, and dissemination, based on national guidelines for care of people with dementia, increased the staff self-reported person-centeredness of care practice, perceived hospitality of the setting, and reduced staff stress of conscience by enabling staff to provide the care and activities they want to provide.
Facilitating system-wide organizational change in health care
Westerlund A, Garvare R, Höög E, Nyström ME, Dahlgaard-Park SM, Dahlgaard-Park SM.
International Journal of Quality and Service Sciences 2015;7(1).
The purpose of this study was to investigate the role of an intra-organizational change facilitating function in relation to a multi-level development initiative to build a sustainable quality improvement structure in a health care organization and study different actors’ views on important factors to address in a change process. Perceptions by managers, staff and change facilitating functions members regarding factors and situations that needed to be attended to, and which factors that were addressed, have been compared in order to describe the change facilitating functions role in a situation of complex organizational change.
Improving person-centered mobility care in nursing homes: A feasibility study.
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Taylor J, Barker A, Hill H, Haines TP.
Geriatric nursing (New York, N.Y.) 2015 Feb 28
Person-centered care is often equated with quality nursing home care. At the same time, quality mobility care contributes to residents’ independence and quality of life. Realist evaluation and mixed methods were employed to evaluate the feasibility of a multi-faceted training intervention focused on person-centered mobility care. Staff and ambulatory residents of a ninety bed Australian nursing home with 3 units-one dementia-specific-participated. The intervention consisted of training sessions, weekly mobility care huddles and reflective practice sessions with individual staff. This study demonstrated the feasibility of an intervention aiming to improve person-centered mobility care in nursing homes; it was practical and well accepted. Study methods and outcome measures were suitable. Outcome measures demonstrated capacity to determine the effectiveness of the intervention in a larger randomized controlled trial. Focus groups provided insights regarding the context and mechanisms of change. Future research is recommended to evaluate intervention effectiveness and sustainability. Copyright © 2015 Elsevier Inc.
Improving the quality of life for older people in long-term care settings.
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Murphy K, Cooney A, Casey D.
Journal of comparative effectiveness research 2014 May;3(3):301-315
Many governments across Europe and America set maintaining the quality of life (QoL) of older people living in long-term care as a key policy objective; however, much of the evidence reveals that life in many care environments is still routinized and institutionalized. QoL is a term that is widely used but poorly defined and understood. The focus of this Review is on identifying the components of QoL and reviewing strategies for improving QoL in long-term care. Six components of QoL were consistently identified across studies: autonomy, environment, connectedness, meaningful activity, independence and sense of self. A review of strategies for improving QoL revealed that the evidence of effectiveness across studies remains inconclusive. The judgment of quality was often hampered by inadequate details on the study design and the use of nonspecific and wide-ranging QoL tools. Furthermore, high-quality studies are required to determine effectiveness.
This Health Foundation report describes how five UK trusts tackled quality improvement. It provides a checklist to consider when planning, designing and delivering “improvement capability building programmes”.
Research Practice and Methodology
Our objective was to develop guidance on integrating bodies of evidence from systematic reviews and primary studies in new reviews. Different uses of existing systematic review, such as checking references and summarizing existing evidence in introduction or discussion, have been adequately described in prior work. We specifically focused on methods for using reviews when there are multiple reviews, assessing risk of bias of primary studies in existing reviews, and summarizing and assessing the strength of bodies of evidence that include or are limited to existing systematic reviews. The immediate intended audience is the EPC program, but we hope that this guidance may be useful to all systematic reviewers facing these issues.
Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada.
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Maxwell CJ, Amuah JE, Hogan DB, Cepoiu-Martin M, Gruneir A, Patten SB, et al.
Journal of the American Medical Directors Association 2015 Feb 21
Assisted living (AL) is an increasingly used residential option for older adults with dementia; however, lower staffing rates and service availability raise concerns that such residents may be at increased risk for adverse outcomes. Our objectives were to determine the incidence of hospitalization over 1 year for dementia residents of designated AL (DAL) facilities, compared with long-term care (LTC) facilities, and identify resident- and facility-level predictors of hospitalization among DAL residents. METHODS: Participants were 609 DAL (mean age 85.7 ± 6.6 years) and 691 LTC (86.4 ± 6.9 years) residents with dementia enrolled in the Alberta Continuing Care Epidemiological Studies. Research nurses completed a standardized comprehensive assessment of residents and interviewed family caregivers at baseline (2006-2008) and 1 year later. Standardized administrator interviews provided facility level data. Hospitalization was determined via linkage with the provincial Inpatient Discharge Abstract Database. Multivariable Cox proportional hazards models were used to identify predictors of hospitalization. RESULTS: The cumulative annual incidence of hospitalization was 38.6% (34.5%-42.7%) for DAL and 10.3% (8.0%-12.6%) for LTC residents with dementia. A significantly increased risk for hospitalization was observed for DAL residents aged 90+ years, with poor social relationships, less severe cognitive impairment, greater health instability, fatigue, high medication use (11+ medications), and 2+ hospitalizations in the preceding year. Residents from DAL facilities with a smaller number of spaces, no chain affiliation, and from specific health regions showed a higher risk of hospitalization. CONCLUSIONS: DAL residents with dementia had a hospitalization rate almost 4-fold higher than LTC residents with dementia. Our findings raise questions about the ability of some AL facilities to adequately address the needs of cognitively impaired residents and highlight potential clinical, social, and policy areas for targeted interventions to reduce hospitalization risk. Copyright © 2015 AMDA
Identifying Potentially Preventable Emergency Department Visits by Nursing Home Residents in the United States
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Burke RE, Rooks SP, Levy C, Schwartz R, Ginde AA.
Journal of the American Medical Directors Association 2015 Feb 18
To identify and describe potentially preventable emergency department (ED) visits by nursing home (NH) residents in the United States. These visits are important because they are common, frequently lead to hospitalization, and can be associated with significant cost to the patient and the health care system. DESIGN: Retrospective analysis of the 2005-2010 National Hospital Ambulatory Care Survey (NHAMCS), comparing ED visits by nursing home residents that did not lead to hospital admission (potentially preventable) with those that led to admission (less likely preventable). SETTING: Nationally representative sample of US EDs; federal hospitals and hospitals with fewer than 6 beds were excluded. PARTICIPANTS: Older (age ≥65 years) NH residents with an ED visit during this time period. MEASUREMENTS: Patient demographics, ED visit information including testing performed, interventions (both procedures and medications) provided, and diagnoses treated. RESULTS: Older NH residents accounted for 3857 of 208,956 ED visits during the time period of interest (1.8%). When weighted to be nationally representative, these represent 13.97 million ED visits, equivalent to 1.8 ED visits annually per NH resident in the United States. More than half of visits (53.5%) did not lead to hospital admission; of those discharged from the ED, 62.8% had normal vital signs on presentation and 18.9% did not have any diagnostic testing before ED discharge. Injuries were 1.78 times more likely to be discharged than admitted (44.8% versus 25.3%, respectively, P < .001), whereas infections were 2.06 times as likely to be admitted as discharged (22.9% versus 11.1%, respectively). Computed tomography (CT) scans were performed in 25.4% and 30.1% of older NH residents who were discharged from the ED and admitted to the hospital, respectively, and more than 70% of these were CTs of the head. NH residents received centrally acting, sedating medications before ED discharge in 9.4% of visits. CONCLUSION: This nationally representative sample of older NH residents suggests ED visits for injury, those that are associated with normal triage vital signs, and those that are not associated with any diagnostic testing are potentially preventable. Those discharged from the ED often undergo important testing and receive medications that may alter their physical examination on return to the nursing facility, highlighting the need for seamless communication of the ED course to NHs. Copyright © 2015 AMDA
Physical frailty predicts incident depressive symptoms in elderly people: prospective findings from the obu study of health promotion for the elderly.
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Makizako H, Shimada H, Doi T, Yoshida D, Anan Y, Tsutsumimoto K, et al.
Journal of the American Medical Directors Association 2015 Mar;16(3):194-199
The purpose of this study was to determine whether frailty is an important and independent predictor of incident depressive symptoms in elderly people without depressive symptoms at baseline. DESIGN: Fifteen-month prospective study. SETTING: General community in Japan. PARTICIPANTS: A total of 3025 community-dwelling elderly people aged 65 years or over without depressive symptoms at baseline. MEASUREMENTS: The self-rated 15-item Geriatric Depression Scale was used to assess symptoms of depression with a score of 6 or more at baseline and 15-month follow-up. Participants underwent a structural interview designed to obtain demographic factors and frailty status, and completed cognitive testing with the Mini-Mental State Examination and physical performance testing with the Short Physical Performance Battery as potential predictors. RESULTS: At a 15-month follow-up survey, 226 participants (7.5%) reported the development of depressive symptoms. We found that frailty and poor self-rated general health (adjusted odds ratio 1.86, 95% confidence interval 1.30-2.66, P < .01) were independent predictors of incident depressive symptoms. The odds ratio for depressive symptoms in participants with frailty compared with robust participants was 1.86 (95% confidence interval 1.05-3.28, P = .03) after adjusting for demographic factors, self-rated general health, behavior, living arrangements, Mini-Mental State Examination, Short Physical Performance Battery, and Geriatric Depression Scale scores at baseline. CONCLUSIONS: Our findings suggested that frailty and poor self-rated general health were independent predictors of depressive symptoms in community-dwelling elderly people. Copyright © 2015 AMDA
An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised, malnourished older adults.
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Pouyssegur V, Brocker P, Schneider SM, Philip JL, Barat P, Reichert E, et al.
Age and Ageing 2015 Mar;44(2):245-251
BACKGROUND AND OBJECTIVE: to evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults >70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis(®), Solidages, France). DESIGN: an open, multicentre, randomised controlled trial. SETTING: seven nursing homes. PARTICIPANTS: one hundred and seventy-five malnourished older adults, aged 86 ± 8 years. INTERVENTION: all participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0-w6). MEASUREMENTS: five visits (w-4, w0, w6, w10 and w18). MAIN OUTCOME: percentage of weight gain from w0 to w6 (body mass in kg). SECONDARY OUTCOMES: appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea. RESULTS: average weight increased in Intervention group (n = 88) compared with Control group (n = 87) without cookies supplementation (+1.6 versus -0.7%, P = 0.038). Weight gain persisted 1 month (+3.0 versus -0.2%, P = 0.025) and 3 months after the end of cookies consumption (+3.9 versus -0.9%, P = 0.003), with diarrhea reduction (P = 0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P = 0.024), appetite increase (P = 0.009) and pressure ulcers reduction (P = 0.031). CONCLUSION: the trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations. © The Author 2014.
Baby boomer caregiver and dementia caregiving: findings from the National Study of Caregiving.
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Moon H, Dilworth-Anderson P.
Age and Ageing 2015 Mar;44(2):300-306
BACKGROUND: previous studies have well documented the characteristics of baby boomers but less is known about the experiences of boomer caregivers (CGs) of people with dementia. OBJECTIVE: the purpose of this study was to compare the characteristics of boomer CGs of people with dementia with those of boomer CGs for people without dementia and to ascertain factors associated with outcomes. DESIGN: we selected baby boomer CGs from the National Study of Caregiving (NSOC) with 650 primary boomer CGs (138 CGs of people with dementia and 512 CGs of people without dementia). METHODS: the Stress Process Model (SPM) was used to examine the effects of resources (the use of paid help and informal support) and stressors (primary: level of CG care activities and interrupted sleep; secondary: strain of caregiving on work, other care and social activities) on CGs’ down, depressed or hopeless feelings and self-perceived general health. T-tests and chi-square tests were used to compare SPM domain differences and ordinary least-square multiple regression analysis was used to investigate predictors of CGs’ outcomes. RESULTS: high blood pressure and arthritis were the most prevalent chronic diseases in both groups. Boomer CGs of people with dementia reported providing more help with daily activities, higher level of caregiving and social activity conflict, experiencing more interrupted sleep and more down, depressed or hopeless feelings than CGs of people without dementia. Different factors predicted boomer CGs’ outcomes. CONCLUSION: the current results yield important information about the considerable differences between two baby boomer CG groups within the caregiving experiences. The findings highlight the need to provide tailored interventions to boomer CGs to help them cope with caregiving stress to improve their physical and mental health. © The Author 2014.
Informal Caregiving and Its Impact on Health: A Reappraisal From Population-Based Studies
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Roth DL, Fredman L, Haley WE.
The Gerontologist 2015 02/18
Considerable research and public discourse on family caregiving portrays it as a stressful and burdensome experience with serious negative health consequences. A landmark study by Schulz and Beach that reported higher mortality rates for strained spouse caregivers has been widely cited as evidence for the physical health risks of caregiving and is often a centerpiece of advocacy for improved caregiver services. However, 5 subsequent population-based studies have found reduced mortality and extended longevity for caregivers as a whole compared with noncaregiving controls. Most caregivers also report benefits from caregiving, and many report little or no caregiving-related strain. Policy reports, media portrayals, and many research reports commonly present an overly dire picture of the health risks associated with caregiving and largely ignore alternative positive findings. As the pool of traditional family caregivers declines in the coming years, a more balanced and updated portrayal of the health effects of caregiving is needed to encourage more persons to take on caregiving roles, and to better target evidence-based services to the subgroup of caregivers who are highly strained or otherwise at risk. Recommendations are discussed for research that will better integrate and clarify both the negative and potential positive health effects of informal caregiving.
The Effects of Dementia and Long-Term Care Services on the Deterioration of Care-needs Levels of the Elderly in Japan.
Non UofA Access
Lin HR, Otsubo T, Imanaka Y.
Medicine 2015 Feb;94(7):e525
To investigate the associations between dementia, the use of long-term care (LTC) services, and the deterioration of care-needs levels of elderly persons in Japan.Using a retrospective cohort study, we analyzed 50,268 insurance beneficiaries aged 65 years and older who had utilized LTC services between 2010 and 2011 in Kyoto prefecture, Japan. Logistic regression analyses were used to identify predictors of care-needs level deterioration.Dementia, facility care services, the male sex, older age, and lower baseline care-needs levels were associated with care-needs level deterioration. The disparity between odds ratios of home care services, dementia diagnoses, and facility care services on care-needs level deterioration diminished with increasing baseline care-needs levels. The other risk factors of care-needs level deterioration showed stronger associations as care-needs levels and age increased.The effects of baseline care-needs levels and dementia should be considered when developing LTC policies.
‘Two dead frankfurts and a blob of sauce’: the serendipity of receiving nutrition and hydration in Australian residential aged care.
Non UofA Access
Bernoth MA, Dietsch E, Davies C.
Collegian (Royal College of Nursing, Australia) 2014;21(3):171-177
This paper explores the serendipity of residents accessing adequate food and fluids in aged care facilities. It draws on the findings of two discrete but interrelated research projects conducted in 2009 and 2011 relating to the experience of living in, or having a friend or family member living in, residential aged care. METHODS: Participants were recruited through media outlets. Indepth interviews with participants were audiotaped, transcribed verbatim and thematically analysed. FINDINGS: This paper discusses a theme that was iterated by participants in both projects that is, the difficulty residents in aged care facilities experienced in receiving adequate and acceptable food and fluids. Unacceptable dining room experiences, poor quality food and excessive food hygiene regulations contributed to iatrogenic malnutrition and dehydration. Implications for staffing, clinical supervision, education of carers and the impact of negative attitudes to older people are discussed. CONCLUSION: The inability of dependent residents in aged care facilities to receive adequate nourishment and hydration impacts on their health and their rights as a resident, and is an ongoing issue in Australian residential aged care.
Dementia Care Management in an Underserved Community: The Comparative Effectiveness of Two Different Approaches.
Non UofA Access
Chodosh J, Colaiaco BA, Connor KI, Cope DW, Liu H, Ganz DA, et al.
Journal of aging and health 2015 Feb 4
To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia. METHODS: We randomized 151 patient-caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient-caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up. RESULTS: Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver. DISCUSSION: Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected. © The Author(s) 2015.
Nonpharmacologic Interventions to Heal Pressure Ulcers in Older Patients: An Overview of Systematic of Reviews (The SENATOR-ONTOP Series).
Non UofA Access
Velez-Diaz-Pallares M, Lozano-Montoya I, Abraha I, Cherubini A, Soiza RL, O’Mahony D, et al.
Journal of the American Medical Directors Association 2015 Feb 27
Pressure ulcers (PUs) are more frequent in older patients, and the healing process is usually challenging. Nonpharmacologic interventions may play a role in the treatment of older people with PUs, but most systematic reviews (SRs) have not addressed this specific population using convincing outcome measures. OBJECTIVE: To summarize and critically appraise the evidence from SRs of the primary studies on nonpharmacologic interventions to treat PUs in older patients. DESIGN: SR and meta-analysis of comparative studies. METHODS: PubMed, Cochrane Database of Systematic Reviews, EMBASE, and CINHAL (from inception to October 2013) were searched. A new search for updates in the Cochrane Database was launched in July 2014. SRs that included at least 1 comparative study evaluating any nonpharmacologic intervention to treat PUs in older patients, in any health care setting, were included. Any primary study with experimental design was then identified and included. From each primary study, quality assessment was undertaken as specified by the Cochrane Collaboration and the Grading of Recommendations Assessment, Development and Evaluation working group. Interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis, using complete ulcer healing as the outcome measure. RESULTS: One hundred ten SRs with 45 primary studies satisfied the inclusion criteria. The most frequent interventions explored in these trials were support surfaces (13 studies), nutrition (8), and electrotherapy (6). High or moderate quality of evidence was found in none of the interventions, mainly because of the very serious risk of bias of most studies and imprecision in the treatment effect. Evidence grade is very low or insufficient to support the use of any support surface, nutrition intervention, multicomponent interventions, repositioning or other adjunctive therapy (ultrasound, negative pressure, laser, electromagnetic, light, shock wave, hydrotherapy, radiofrequency, or vibration therapy) to increase the rates of PU healing in older patients. Electrotherapy showed some beneficial effect in the treatment of PUs, although the quality of evidence is low. CONCLUSIONS: In older patients with PUs, evidence to use any nonpharmacologic therapy to increase the rates of wound healing is inconclusive, except for low quality evidence that supports the use of electrotherapy. This situation is especially alarming for interventions that are usually standard clinical practice (repositioning, support surfaces). Although there is some evidence in younger populations and other types of ulcers, studies in older populations with PUs using sound methodology are needed. Copyright © 2015 AMDA
Expectations About Future Use Of Long-Term Services And Supports Vary By Current Living Arrangement
Non UofA Access
Henning-Smith CE, Shippee TP.
Health affairs (Project Hope) 2015 Jan;34(1):39-47
Most Americans know little about options for long-term services and supports and underestimate their likely future needs for such assistance. Using data from the 2012 National Health Interview Survey, we examined expectations about future use of long-term services and supports among adults ages 40–65 and how these expectations varied by current living arrangement. We found differences by living arrangement in expectations about both future need for long-term services and supports and who would provide such care if needed. Respondents living with minor children were the least likely to expect to need long-term services and supports and to require paid care if the need arose. In contrast, respondents living alone were the most likely to expect that it was “very likely” that they would need long-term services and supports and to rely on paid care. Overall, we found a disconnect between expectations of use and likely future reality: 60 percent of respondents believed that they were unlikely to need long-term services and supports in the future, whereas the evidence suggests that nearly 70 percent of older adults will need them at some point. These findings both underscore the need for programs that encourage people to plan for long-term services and supports and indicate that information about living arrangements can be useful in developing and targeting such programs.
The Effect of Dining Room Physical Environmental Renovations on Person-Centered Care Practice and Residents’ Dining Experiences in Long-Term Care Facilities.
Non UofA Access
Hung L, Chaudhury H, Rust T.
Journal of applied gerontology 2015 Feb 26
This qualitative study evaluated the effect of dining room physical environmental changes on staff practices and residents’ mealtime experiences in two units of a long-term care facility in Edmonton, Canada. Focus groups with staff (n = 12) and individual interviews with unit managers (n = 2) were conducted. We also developed and used the Dining Environment Assessment Protocol (DEAP) to conduct a systematic physical environmental evaluation of the dining rooms. Four themes emerged on the key influences of the renovations: (a) supporting independence and autonomy, (b) creating familiarity and enjoyment, (c) providing a place for social experience, and (d) challenges in supporting change. Feedback from the staff and managers provided evidence on the importance of physical environmental features, as well as the integral nature of the role of the physical environment and organizational support to provide person-centered care for residents. © The Author(s) 2015.
Barthel Index of Activities of Daily Living: Item Response Theory Analysis of Ratings for Long-Term Care Residents.
Non UofA Access
Liu W, Unick J, Galik E, Resnick B.
Nursing research 2015 March/April;64(2):88-99
The Barthel Index (BI) is a frequently used measure of independence in the activities of daily living (ADLs). Item functioning of various versions of the BI have been examined using Rasch analysis. Item response theory (IRT) models for ordered polytomous responses may provide more insight into item functioning across levels of independence in ADLs. OBJECTIVES: To compare the fit and appropriateness of the one-parameter logistic model (1PL), the partial credit model (PCM), and the extension of the generalized partial credit model implemented in ConQuest (GPCM-CQ) for the 15-item BI. METHODS: This article is a secondary analysis of baseline BI data obtained from four randomized controlled trials for 788 residents from multiple long-term care facilities. Parameters of three different IRT-based models (1PL Rasch model, PCM, and GPCM-CQ) were estimated. Fit of items and response vectors was assessed. Overall fit was compared across the three models. RESULTS: Item difficulties were similar for all three models. Most of the 15 items were located at a moderate level of functional independence. In all three models, “don brace” was the easiest ADL but had poor discrimination; “climbing stairs” was the most difficult ADL. Multiple items showed misfit in both 1PL and PCM. Item parameters and person proficiency estimates were highly correlated for the PCM and GPCM-CQ models. The difference in deviance between the PCM and GPCM-CQ was significant. In the GPCM-CQ, most items showed good discrimination, but several had negative or very low discrimination parameters. DISCUSSION: GPCM-CQ results suggested that further revision of the BI may be warranted. Because some items showed poor discrimination, caution should be used when measuring ADL independence with the BI item set.
From Admission to Death: Prevalence and Course of Pain, Agitation, and Shortness of Breath, and Treatment of These Symptoms in Nursing Home Residents With Dementia.
Non UofA Access
Hendriks SA, Smalbrugge M, Galindo-Garre F, Hertogh CM, van der Steen JT.
Journal of the American Medical Directors Association 2015 Feb 23
Burdensome symptoms frequently develop as part of the dementia trajectory and influence quality of life. We explore the course of symptoms and their treatment during nursing home stay to help target adequate symptom management. DESIGN: Data were collected as part of the Dutch End of Life in Dementia study, a longitudinal observational study with up to 3.5 years of follow-up. Physicians performed assessments at baseline, semiannually, and shortly after death of pain, agitation, shortness of breath, and treatment provided for these symptoms. SETTING: Long-term care facilities (28) in the Netherlands. PARTICIPANTS: Newly admitted nursing home residents (372) in variable stages of dementia. MEASUREMENTS: We described prevalence and course of symptoms, and treatment provided for these symptoms. We used generalized estimating equations to evaluate the longitudinal change in symptoms and their treatment, and the associations between the symptoms of pain and agitation, as well as between stage of dementia and symptoms. RESULTS: Pain was common (varying from 47% to 68% across the semiannual assessments) and frequently persistent (36%-41% of all residents); it increased to 78% in the last week of life. Agitation was the most common symptom (57%-71%), and also frequently persistent (39%-53%), yet it decreased to 35% in the last week of life. Shortness of breath was less common (16%-26%), but it increased to 52% at the end of life. Pain was not significantly associated with agitation. Advanced dementia was associated with more pain only. Treatment changed in particular at the end of life. Pain was treated mostly with acetaminophen (34%-52%), and at the end of life with parenteral opioids (44%). Agitation was mostly treated nonpharmacologically (78%-92%), and at the end of life anxiolytics were the most frequently prescribed treatment (62%). Overall, aerosolized bronchodilators were the most frequently prescribed treatment for shortness of breath (29%-67%), but at the end of life, this was morphine (69%). CONCLUSION: Pain and agitation were common and frequently persisted in residents with dementia during nursing home stay, but symptom management intensified only at the end of life. Symptom control may be suboptimal from admission, and a stronger focus on symptom control is needed at an earlier stage than the end of life. Copyright © 2015 AMDA
Senior care: Differences by type of housing, 2012
Statistics Canada 2015
In 2012, 5.4 million Canadians provided care to a senior family member or friend. This care was most often provided to a senior living in their own private residence, though the intensity of care was highest for caregivers who lived with their care recipient. Overall, 62% of caregivers helping seniors said that the care receiver lived in a private residence separate from their own. Another 16% lived with their care recipient, 14% provided help to a senior in a care facility (such as a hospital or a nursing home), and 8% helped seniors in supportive housing. The intensity of care was highest among those living with their care recipient, with more than half (56%) saying that they spent at least 10 hours a week providing care. Caregivers’ weekly commitments were also elevated for those helping someone in a care facility, but to a lesser extent. About 22% of these caregivers spent 10 hours or more providing care to a senior in a care facility.
Dementia today and tomorrow: A new deal for people with dementia and their carers (UK)
Deloitte UK Centre for Health Solutions & Alzheimer’s Society
Dementia today and tomorrow: A new deal for people with dementia and their carers has been produced by the Deloitte UK Centre for Health Solutions and Alzheimer’s Society. The report presents the outcome of a series of events and initiatives aimed at collecting the views of people with an interest in continuing to drive improvements in services for people with dementia and those caring for them. As a result the report reflects the views of the individual participants and does not necessarily mean endorsement by the organisations to which they belong.
This guidance is intended to support health and social care professionals in the community, in outpatient clinics, in community hospitals and other intermediate care settings and in older people’s own homes. Guidance for professionals encountering older people with frailty in acute hospitals has been published in the Silver Book and work to develop checklist to support the management of older people with frailty in acute hospital settings is ongoing.
The Alzheimer’s Mystery
Speaker: Jay Ingram
Tuesday 10 March Lister Hall 19:00-20:00 followed by reception
Join Jay Ingram to learn more about Alzheimer’s disease and the research being done in Alberta to understand the Alzheimer’s mystery
The Cochrane Mid-Year Meeting
3-8 May Athens, Greece
There are a number of courses and events organised in parallel with the Cochrane meetings and places are limited. Courses: Network Meta-analysis, Systematic Reviews, Evidence-Based Practice, Referees and editors training. Systematic review guidance: Are you working on a systematic review and need one-to-one help? Book a session at the authors’ clinic. Symposium – 7 May 2015: The need for evidence in contemporary Greek clinical practice.
Walk with me 2016: Changing the culture of aging in Canada
10-11 March Edmonton
Building on the success of Walk with Me 2014, the conference program will address aging across the life course, with a special focus on later life, and will highlight culture change initiatives from across the country. Who should attend this conference? Older adults/residents; community members; family members; caregivers; health professionals; care providers/owners; staff at all levels; professional/provider associations; older adult advocacy groups; researchers; educators; policy makers. More details coming soon! Walk with Me 2016 is co-hosted by the Schlegel-University of Waterloo Research Institute for Aging (RIA) and the CapitalCare Foundation. People and Progress Conference 2016 is pleased to merge with Walk with Me 2016.
Save the Date: Building Momentum for Long-Term Care
9-10 November Ottawa
We hope you will join us for this exciting opportunity to discover, learn, connect and share as we work together to enhance the quality of care provided to long-term care residents, to increase the knowledge and skills of the long-term care workforce, and to shape the long-term care system of the future. Conference Objectives:
Discover how the Ontario Centres for Learning, Research and Innovation in Long-Term Care are supporting innovation in LTC evidence-informed care, education and system planning.
Gain knowledge, tools and ideas to enhance the quality of care provided to LTC residents, to increase the knowledge and skills of the LTC workforce and to shape the LTC system of the future. Connect and share with colleagues, residents and families as we work together to build and plan for the future of LTC.
Conference registration will become available soon.
Cochrane Canada Symposium 2015
21-22 May Calgary
The 12th Symposium is an opportunity to learn from and network with leading healthcare experts from Canada and around the world. Whether you are already involved in Cochrane or new to evidence-based research, the information shared at this event will help you develop your knowledge and skills in systematic reviews.
UK Knowledge Mobilisation Forum 2015
13-14 April Edinburgh UK
Following on from the success of last year’s event, the 2nd Annual UK Knowledge Mobilisation Forum is being held on 13th-14th April 2015 at the Royal College of Physicians of Edinburgh. The more effectively we use the knowledge we produce through research and practice the better our services, processes and products will be. The UK Knowledge Mobilisation Forum provides a space for knowledge producers, knowledge brokers and knowledge users to come together to learn from each other, sharing good (and bad) practice about improving what we do and help maximise the impact of all types of knowledge in practice.
The Canadian Longitudinal Study on Aging: A National Research Platform
Friday 13 March 10:00-11:30
The webinar will be conducted by Dr. Christina Wolfson from McGill University, CLSA co-principal investigator, Director of the CLSA’s Statistical Analysis Centre at the Research Institute of the McGill University Health Centre, and Chair of the CLSA Data and Sample Access Committee. Dr. Nancy Edwards, Scientific Director of the Canadian Institutes of Health Research Institute of Population and Public Health, will provide the introduction to the webinar, which will offer an overview of the CLSA, describe the data now available to researchers and the access process.
KT Canada Twitter Journal Club
Thursday 26 March 10:00-11:00 MT
Article being discussed is McCormack B, Rycroft-Malone J, DeCorby K, Hutchinson A, Bucknall T, Wilson V, et al. A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency,. Implementation Science 2013.
Interested participants should email Meghan Storey to register. There are a limited number of spots available and registration will be on a first come first served basis.
Webinar on The Toolkit: Implementation of Best Practice Guidelines from the Registered Nurses’ Association of Ontario
Tuesday 24 March 11:00-12:00 MT
The Toolkit: Implementation of Best Practice Guidelines, developed by the Registered Nurses Association of Ontario (RNAO), helps with the systematic and well-planned implementation of best practice guidelines based on known factors for success. The toolkit, now in its second edition, provides a step-by-step approach to introduce and apply best practice guidelines, and to ensure that those best practices are sustained.
AHRQ Webinar Decision Aids to Facilitate Shared Decision Making
Wednesday 18 March 13:30 MT Free
In this webinar you’ll learn:
-Current NCQA requirements for patient-centered medical homes and accountable care organizations regarding shared decision making to foster patient-centered care
-How patient decision aids based on PCOR can facilitate shared decision making
-How the SHARE Approach, AHRQ’s five-step process for shared decision making, helps providers learn key shared decision making skills and using PCOR information tools from AHRQ’s Effective Health Care Program
More than £300m is to be spent by the government on research into dementia, the prime minister has announced. David Cameron said an international dementia institute would be established in England over the next five years in a bid to make the UK a world leader for research and medical trials.
Universities need to foster new channels of engagement with policymakers. Policymakers could have an increasing presence on our campuses to develop the questions that are key to their policy concerns.
Women are bearing the brunt of the dementia epidemic that is spreading through Britain. A study by Alzheimer’s Research UK, available next month, reveals that the condition has not only become the leading cause of death among British women but that women are far more likely to end up as carers of sufferers than men – suffering physical and emotional stress and job losses in the process
Only 11% of Nursing Homes Have Dedicated Dementia Care Units According to First National Survey The DSIDC & Trinity Study Found Private Sector Provides Majority of Special Care Units But Receives Least Funding From the National Treatment and Purchase Fund The first national survey to map demographic trends in the provision of specialist long-term care for people with dementia in Ireland was launched by Adjunct Professor in Medical Gerontology at Trinity College Dublin, Davis Coakley recently at a special event in the Trinity Long Room Hub. The study, carried out by the Dementia Services Information and Development Centre and Trinity researchers from the School of Social Work and Social Policy at Trinity College, found very low numbers of dementia-specific care units (SCUs) throughout the Republic of Ireland. The researchers identified large gaps in service provision, especially in Leinster, and excessive numbers of patients in individual housing units. They argued that the findings showed that ‘SCUs have evolved in an arbitrary, fragmented and uncoordinated manner’.
The Dementia Elevator team at Dublin City University will be offering retail training to promote dementia awareness and give customer-facing retail staff skills to engage effectively with customers who may have dementia. The training will be solution-focused with opportunities for interaction and reflection. It is suitable for all types of retail outlets and pharmacies.
The World Health Organization (WHO) is holding the First Global Ministerial Conference on Global Action Against Dementia on 16 and 17 March, at its headquarters in Geneva. Following on from the G8 Dementia Summit in London in December 2013, this event brings together a much larger number of countries from across the world to focus on dementia. The aim of the conference is to place action on dementia higher on the national and global political agendas, and to highlight the potential benefits of co-ordinated global action.
It hurts to see scientists cave to the pressure of a funding organization to alter their research to fit bureaucratic goals.
Congratulations to Julianne Moore on winning the Best Actress Oscar for her performance in “Still Alice.” Her acceptance speech is inspiring people affected by Alzheimer’s disease.
Mary Dixon-Woods is Professor of Medical Sociology and Wellcome Trust Senior Investigator at the University of Leicester, Deputy Editor of BMJ Quality & Safety, and a member of the Health Foundation’s Improvement Science Development Group. We spoke to her about why change in the NHS is so hard, and how national bodies can do more to help.
ICES Research Findings
Mortality rate gap between Ontarians with and without rheumatoid arthritis unchanged from 1996 to 2009
Chemotherapy-associated toxicities linked to high rates of ED and hospital use in women treated for early breast cancer
Blood glucose level can predict mortality and hospitalization risk in patients with acute heart failure syndromes
Sub-Saharan African women remain at greatest risk for severe maternal morbidity after immigrating to Western countries
New tool predicts risk of hospital readmission for psychiatric patients
Changes to long-term care policies will ensure more timely access and make better use of the province’s long-term care beds for those with the greatest need.
By July some people in Regina needing long-term care could spend weeks waiting in a bed outside the city until a spot in Regina opens up. The Regina-Qu’Appelle Health Region says patients could go up to 150 kilometres away from Regina General Hospital, under its “first available bed” protocol.
B.C.’s Seniors Advocate Isobel Mackenzie said it’s important to exercise caution when creating policies around patients with dementia in the aftermath of a CBC Go Public story that shared the stories of two families dealing with financial decisions made by loved ones with Alzheimer’s.
One of nurses’ many barriers against the utilization of research in clinical practice is the ominous force of nursing’s group mentality, which occasionally plays a suppressing role to the nurses’ individual opinions, motivation and goals, and mentally coerce them into adhering to the norm.
Unconscious bias still plays a role in keeping women scientists from the top tier.
Are you looking for instruments and measures to study and evaluate interventions to improve primary care? Use these searchable databases to explore conceptual frameworks and to identify and compare measures. A significant challenge in studying and evaluating primary care improvement and transformation is finding the right instruments and measures to capture useful information about services, innovations, and outcomes. Now, researchers and evaluators have access to searchable databases to help researchers and evaluators efficiently identify and select the most appropriate instruments and measures in four key areas of primary care services: care coordination, clinical-community relationships, team-based care, and behavioral health integration. The databases include conceptual frameworks for measurement in each area, profiles of existing instruments that include information about validation and use, and other information designed both to assist current investigators and advance primary care research and evaluation.
How do you know if a systematic review has been done well? First you need to know the parts that make up a systematic review; then you need to know where to focus your attention to assess the quality. This tool describes the anatomy of a systematic review so you can quickly and easily find the information you need to complete the critical appraisal process.
Here are some tips and tricks on creating a podcast about your research.
A seasoned editor gives advice to get your work published in an international journal.
Journal editors and reviewers are looking for novelty, significance and relevance to their readers when they read your submitted article. Your abstract can make claims about these features, but does not provide space for the evidence to back them up. The introduction is the place for that. Guidelines for selecting, ordering and presenting that evidence effectively are available from the results of research in the field of Applied Linguistics (AL) over the past 25 years. Here we present a summary designed for ease of use by authors.
Social media associate editor for Evidence Based Nursing
DEADLINE 1 April
Evidence-Based Nursing is seeking a new associate editor to take responsibility for the journal’s social media activity. There will be an honorarium of £1,000 a year (paid at the end of June and end of December) to recognise your contribution to the journal.
Coordinator, Knowledge Translation
Parachute Toronto ON
DEADLINE 17 March
Parachute is seeking an experienced, results driven Coordinator, Knowledge Translation. In this role you will be responsible for the implementation and evaluation of a variety of research and knowledge translation initiatives within Parachute. You will act as the first point of contact to a variety of internal and external stakeholders as well as a central resource to assist with building capacity related to knowledge translation and exchange at Parachute. Parachute is a national, charitable organization dedicated to preventing injuries and saving lives. Parachute’s injury prevention solutions, knowledge mobilization, public policy, and social awareness efforts are designed to help Canadians reduce their risks of injury while achieving Parachute’s vision of an injury-free Canada where Canadians enjoy long lives lived to the fullest.
Postdoctoral Fellowship Opportunity in the Department of Community Health Sciences
Cummings School of Medicine at the University of Calgary, Calgary AB
The successful applicant will perform research in the area of secondary fracture prevention among older adults. The research is part of a larger program of activities externally funded through Alberta Innovates – Health Solutions. The training environment will provide a diverse set of experiences. Working with colleagues at University of Alberta, University of Calgary, and Alberta Health Services, the successful applicant will be exposed to researcher leaders, an innovative health service delivery setting, and a practice- and policy- relevant research project. The successful applicant will take on a leadership position to develop, conduct, and disseminate the project’s qualitative health research components.