August 17th, 2015

Grants & Awards


August’s TREC newsletter now available

Learn about our latest successful CIHR grant, summer students, trainees, and the KUSP FYI!!!

TREC research featured in news story

The latest issue of WAVE, Winnipeg’s Health and Wellness magazine highlights TREC’s work in Manitoba that is being led by Dr. Malcolm Doupe. The team’s goal is to work in partnership with many of the 125 personal care homes in the province to explore how they grapple with issues of care and how they communicate with each other.

New TREC article
Job Satisfaction among Care Aides in Residential Long-Term Care: A Systematic Review of Contributing Factors, Both Individual and Organizational
Janet E. Squires, Matthias Hoben, Stefanie Linklater, Heather L. Carleton, Nicole Graham and Carole A. Estabrooks.
Nursing Research and Practice 2015

Despite an increasing literature on professional nurses’ job satisfaction, job satisfaction by nonprofessional nursing care providers and, in particular, in residential long-term care facilities, is sparsely described. The purpose of this study was to systematically review the evidence on which factors (individual and organizational) are associated with job satisfaction among care aides, nurse aides, and nursing assistants, who provide the majority of direct resident care, in residential long-term care facilities. Nine online databases were searched. Two authors independently screened, and extracted data and assessed the included publications for methodological quality. Decision rules were developed a priori to draw conclusions on which factors are important to care aide job satisfaction. Forty-two publications were included. Individual factors found to be important were empowerment and autonomy. Six additional individual factors were found to be not important: age, ethnicity, gender, education level, attending specialized training, and years of experience. Organizational factors found to be important were facility resources and workload. Two additional factors were found to be not important: satisfaction with salary/benefits and job performance. Factors important to care aide job satisfaction differ from those reported among hospital nurses, supporting the need for different strategies to improve care aide job satisfaction in residential long-term care.

New article by Dr. Carole Estabrooks, Dr. Janet Squires, & Dr. Lars Wallin
Health system context and implementation of evidence-based practices—development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings
Anna Bergström, Sarah Skeen, Duong M. Duc, et al.
Implementation Science 2015 08;10(1):120-120

The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose.METHODS:The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries.RESULTS:The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge.CONCLUSIONS:Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Article recommended by Dr. Estabrooks
Variability in Antibiotic Use Across Nursing Homes and the Risk of Antibiotic-Related Adverse Outcomes for Individual Residents.
Non UofA Access
N. Daneman, S. E. Bronskill, A. Gruneir, et al.
JAMA Intern Med 2015 Aug 1;175(8):1331-1339

Antibiotics are frequently and often inappropriately prescribed to patients in nursing homes. These antibiotics pose direct risks to recipients and indirect risks to others residing in the home. OBJECTIVE: To examine whether living in a nursing home with high antibiotic use is associated with an increased risk of antibiotic-related adverse outcomes for individual residents. DESIGN, SETTING, AND PARTICIPANTS: In this longitudinal open-cohort study performed from January 1, 2010, through December 31, 2011, we studied 110 656 older adults residing in 607 nursing homes in Ontario, Canada. EXPOSURES: Nursing home-level antibiotic use was defined as use-days per 1000 resident-days, and facilities were classified as high, medium, and low use according to tertile of use. Multivariable logistic regression modeling was performed to assess the effect of nursing home-level antibiotic use on the individual risk of antibiotic-related adverse outcomes. MAIN OUTCOMES AND MEASURES: Antibiotic-related harms included Clostridium difficile, diarrhea or gastroenteritis, antibiotic-resistant organisms (which can directly affect recipients and indirectly affect nonrecipients), allergic reactions, and general medication adverse events (which can affect only recipients). RESULTS: Antibiotics were provided on 2783000 of 50953000 resident-days in nursing homes (55 antibiotic-days per 1000 resident-days). Antibiotic use was highly variable across homes, ranging from 20.4 to 192.9 antibiotic-days per 1000 resident-days. Antibiotic-related adverse events were more common (13.3%) in residents of high-use homes than among residents of medium-use (12.4%) or low-use homes (11.4%) (P < .001); this trend persisted even among the residents who did not receive antibiotic treatments. The primary analysis indicated that residence in a high-use nursing home was associated with an increased risk of a resident experiencing an antibiotic-related adverse event (adjusted odds ratio, 1.24; 95% CI, 1.07-1.42; P = .003). A sensitivity analysis examining nursing home-level antibiotic use as a continuous variable confirmed an increased risk of resident-level antibiotic-related harms (adjusted odds ratio, 1.004 per additional day of nursing home antibiotic use; 95% CI, 1.001-1.006; P = .01). CONCLUSIONS AND RELEVANCE: Antibiotic use is highly variable across nursing homes; residents of high-use homes are exposed to an increased risk of antibiotic-related harms even if they have not directly received these agents. Antibiotic stewardship is needed to improve the safety of all nursing home residents.

New Article by Dr. Susan Slaughter & Dr. Adrian Wagg
Affirming the Value of the Resident Assessment Instrument: Minimum Data Set Version 2.0 for Nursing Home Decision-Making and Quality Improvement
Lindsay S. Drummond, Susan E. Slaughter, C. Allyson Jones and Adrian S. Wagg.
Healthcare 2015;3(3):659-665.

Background: We examined the agreement over time of the physical functioning domains of the Resident Assessment Instrument: Minimum Data Set Version 2.0 (RAI-MDS) and the Functional Independence Measure (FIM) in nursing home residents with dementia. Methods: We completed a secondary analysis of data from a longitudinal quasi-experimental study of residents who could transfer independently or with the assistance of one person. FIM assessments were completed at up to three time points by researchers using interviews. RAI-MDS assessments, completed by nursing home staff, were matched to the FIM assessment by nearest time. FIM and RAI-MDS assessments were correlated based on time between assessments using Pearson’s correlation. Items for activities of daily living (ADL) from the RAI-MDS were rescaled using two previously published crosswalks. Motor and ADL subscales were also used, containing eight and six items, respectively. Results: A total of 362 paired interviews and assessments were collected from 130 residents. The mean scores and standard deviations were as follows: FIM: 19.64 (7.60); William’s RAI-MDS crosswalk: 18.04 (5.25); and Velozo’s RAI-MDS crosswalk: 18.09 (6.50). Using both crosswalks, most items showed medium (r > 0.3) or large (r > 0.5) correlations, even at greater than 41 days between assessments. Subscales showed large correlations for all time intervals for both crosswalks. Conclusions: The RAI-MDS remains stable when data are collected greater than 41 days from the FIM assessment. These findings should add confidence in the RAI-MDS data and its clinical utility.

New Article by Dr. Jennifer Baumbusch
Aging Together: Caring Relations in Families of Adults With Intellectual Disabilities
Non UofA Access
J. Baumbusch, S. Mayer, A. Phinney and S. Baumbusch.
Gerontologist 2015 Jul 29

To examine the dynamics of caring relations in older families that include an adult with Intellectual Disabilities (ID). To date, there has been very little research exploring the experiences of aging families of community-dwelling adults with ID. DESIGN AND METHODS: An exploratory, qualitative study was conducted in British Columbia, Canada. Eight participants were recruited through purposive sampling. In-depth, semistructured interviews were conducted to explore the experience of aging concurrently with a community-dwelling relative with ID. Data were analyzed using a thematic approach. RESULTS: Three main themes emerged: (a) Recognizing the Changes of Aging, (b) Strengthening Connections, and (c) Planning for the Future. IMPLICATIONS: Aging concurrently with a community-dwelling relative with ID is a unique experience for older adults and challenges traditional views of familial caring relations. These relationships are characterized by evolving patterns of care and exchange. There is also a sense of urgency to securing future care arrangements for the adult relative with ID. Advanced care-planning is complicated by the adult with ID’ understanding of death and dying. Family caregiving policies and practices that take into account the complexities of these relationships are needed.

New Article by Professor Jo Rycroft-Malone
‘I have the world’s best job’ – staff experience of the advantages of caring for older people.
Non UofA Access
A. C. Eldh, T. van der Zijpp, C. McMullan, B. McCormack, K. Seers and J. Rycroft-Malone.
Scand J Caring Sci 2015 Aug 12

Besides a growing demand for safe high-quality care for older people, long-term care (LTC) often struggles to recruit appropriately qualified nursing staff. Understanding what LTC staff value in their work may contribute to a more comprehensive understanding of what can attract staff and support person-centred care. AIM: To explore staff experience of the advantages of working in LTC settings for older people. METHODS: Narrative descriptions of 85 LTC staff in Ireland, the Netherlands and Sweden on what they value in their work were analysed with qualitative content analysis. ETHICS: Ethical approval was obtained according to the requirements of each country, and participants provided informed consent prior to the individual interviews. FINDINGS: Working in LTC signifies bonding with the older people residing there, their next of kin and the team members. It means autonomy in one’s daily tasks amalgamated with being a part of an affirmative team. Participants reported a sense of accomplishment and fulfilment; caring meant consideration and recognition of the older people and the relationships formed, which provided for professional and personal growth. The sharing of compassion between staff and residents indicated reciprocity of the relationship with residents. STUDY LIMITATIONS: The findings may be transferable to LTC in general although they address only the positive aspects of caring for older people and only the experiences of those staff who had consented to take part in the study. CONCLUSIONS: The findings add to what underpins the quality of care in nursing homes: compassion in the nurse-resident relationship and person-centred care in LTC. They indicate reciprocity in the relations formed that may contribute to the empowerment of older people, but further studies are needed to explore this in more detail.


CFS: Advances in Nursing Science Special Topics Issues

Women & Girls Manuscript Due Date – October 15, 2015
Palliative Care Manuscript Due Date – January 15, 2016
Toxic Stress- December 2016 Manuscript Due Date – April 15, 2016
ANS Retrospective – March 2017 Manuscript Due Date – July 15, 2016

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Grants & Awards

2016-17 Harkness/CFHI Fellowship in Health Care Policy and Practice
DEADLINE 16 November

The Commonwealth Fund’s Harkness Fellowships in Health Care Policy and Practice provide a unique opportunity for mid-career health services researchers and practitioners from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, and the United Kingdom to spend up to 12 months in the United States, conducting original research and working with leading U.S. health policy experts.

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


Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada. Canada-flat-icon
Non UofA Access
S. H. Alamri, C. C. Kennedy, S. Marr, L. Lohfeld, C. J. Skidmore and A. Papaioannou.
BMC Geriatr 2015 Aug 1;15:94-015-0099-8

bone fractures, few LTC homes actually adhere to these practical recommendations. The purpose of this study was to identify barriers to the implementation of evidence-based practices for osteoporosis and fracture prevention in LTC facilities and elicit practical strategies to address these barriers. METHODS: We performed a qualitative analysis of action plans formulated by Professional Advisory Committee (PAC) teams at 12 LTC homes in the intervention arm of the Vitamin D and Osteoporosis Study (ViDOS) in Ontario, Canada. PAC teams were comprised of medical directors, administrators, directors of care, pharmacists, dietitians, and other staff. Thematic content analysis was performed to identify the key themes emerging from the action plans. RESULTS: LTC teams identified several barriers, including lack of educational information and resources prior to the ViDOS intervention, difficulty obtaining required patient information for fracture risk assessment, and inconsistent prescribing of vitamin D and calcium at the time of admission. The most frequently suggested recommendations was to establish and adhere to standard admission orders regarding vitamin D, calcium, and osteoporosis therapies, improve the use of electronic medical records for osteoporosis and fracture risk assessment, and require bone health as a topic at quarterly reviews and multidisciplinary conferences. CONCLUSIONS: This qualitative study identified several important barriers and practical recommendations for improving the implementation of osteoporosis and fracture prevention guidelines in LTC settings.

Accreditation and improvement in process quality of care: a nationwide study.
Non UofA Access
S. B. Bogh, A. M. Falstie-Jensen, P. Bartels, E. Hollnagel and S. P. Johnsen.
Int J Qual Health Care 2015 Aug 3

To examine whether performance measures improve more in accredited hospitals than in non-accredited hospital. DESIGN AND SETTING: A historical follow-up study was performed using process of care data from all public Danish hospitals in order to examine the development over time in performance measures according to participation in accreditation programs. PARTICIPANTS: All patients admitted for acute stroke, heart failure or ulcer at Danish hospitals. INTERVENTION: Hospital accreditation by either The Joint Commission International or The Health Quality Service. MEASUREMENTS: The primary outcome was a change in opportunity-based composite score and the secondary outcome was a change in all-or-none scores, both measures were based on the individual processes of care. These processes included seven processes related to stroke, six processes to heart failure, four to bleeding ulcer and four to perforated ulcer. RESULTS: A total of 27 273 patients were included. The overall opportunity-based composite score improved for both non-accredited and accredited hospitals (13.7% [95% CI 10.6; 16.8] and 9.9% [95% 5.4; 14.4], respectively), but the improvements were significantly higher for non-accredited hospitals (absolute difference: 3.8% [95% 0.8; 8.3]). No significant differences were found at disease level. The overall all-or-none score increased significantly for non-accredited hospitals, but not for accredited hospitals. The absolute difference between improvements in the all-or-none score at non-accredited and accredited hospitals was not significant (3.2% [95% -3.6:9.9]). CONCLUSIONS: Participating in accreditation was not associated with larger improvement in performance measures for acute stroke, heart failure or ulcer.

Development and psychometric evaluation of a measure to evaluate the quality of integrated care: the Patient Assessment of Integrated Elderly Care.
Non UofA Access
R. J. Uittenbroek, S. A. Reijneveld, R. E. Stewart, S. L. Spoorenberg, H. P. Kremer and K. Wynia.
Health Expect 2015 Jul 31

Novel population-based integrated care services are being developed to adequately serve the growing number of elderly people. Suitable, reliable and valid measurement instruments are needed to evaluate the quality of care delivered. OBJECTIVE: To develop a measure to evaluate the quality of integrated care from the perspective of elderly people, the Patient Assessment of Integrated Elderly Care (PAIEC), and then to assess its psychometric properties. METHODS/DESIGN: After the Patient Assessment of Chronic Illness Care was adapted to the PAIEC, a cross-sectional postal-survey study was performed among 223 elderly people who received integrated elderly care and support. We assessed the factor structure, internal consistency, known groups and divergent validity using robust nonparametric tests. RESULTS: Mean age of participants was 83 years (standard deviation 4.7), and 69% was female. The original five-factor model was rejected; a good fit was found for a three-factor model, when excluding the item on patients’ satisfaction with care. The PAIEC and its subscales showed good internal consistency (ordinal alphas > 0.90). Known-groups validity was supported regarding number of medications, prevalence of chronic conditions and home care received. No differences were found between groups based on sociodemographic aspects. Divergent validity was supported by low correlations (Spearman’s rank correlation coefficients < 0.30) between PAIEC scales and measures of quality of life, complexity of care needs and frailty. CONCLUSION: The PAIEC seems to have considerable potential as a reliable and valid measurement instrument that evaluates quality of integrated care and support from the perspective of elderly people.

Developing educational competencies for dissemination and implementation research training programs: an exploratory analysis using card sorts.
Non UofA Access
M. Padek, G. Colditz, M. Dobbins, et al.
Implement Sci 2015 Aug 12;10(1):114-015-0304-3

With demand increasing for dissemination and implementation (D&I) training programs in the USA and other countries, more structured, competency-based, and tested curricula are needed to guide training programs. There are many benefits to the use of competencies in practice-based education such as the establishment of rigorous standards as well as providing an additional metrics for development and growth. As the first aim of a D&I training grant, an exploratory study was conducted to establish a new set of D&I competencies to guide training in D&I research. METHODS: Based upon existing D&I training literature, the leadership team compiled an initial list of competencies. The research team then engaged 16 additional colleagues in the area of D&I science to provide suggestions to the initial list. The competency list was then additionally narrowed to 43 unique competencies following feedback elicited from these D&I researchers. Three hundred additional D&I researchers were then invited via email to complete a card sort in which the list of competencies were sorted into three categories of experience levels. Participants had previous first-hand experience with D&I or knowledge translation training programs in the past. Participants reported their self-identified D&I expertise level as well as the country in which their home institution is located. A mean score was calculated for each competency based on their experience level categorization. From these mean scores, beginner-, intermediate-, and advanced-level tertiles were created for the competencies. RESULTS: The card sort request achieved a 41 % response rate (n = 124). The list of 43 competencies was organized into four broad domains and sorted based on their experience level score. Eleven competencies were classified into the “Beginner” category, 27 into “Intermediate,” and 5 into “Advanced.” CONCLUSIONS: Education and training developers can use this competency list to formalize future trainings in D&I research, create more evidence-informed curricula, and enable overall capacity building and accompanying metrics in the field of D&I training and research.

Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study.
Non UofA Access
T. J. Waltz, B. J. Powell, M. M. Matthieu, et al.
Implement Sci 2015 Aug 7;10(1):109-015-0295-0

Poor terminological consistency for core concepts in implementation science has been widely noted as an obstacle to effective meta-analyses. This inconsistency is also a barrier for those seeking guidance from the research literature when developing and planning implementation initiatives. The Expert Recommendations for Implementing Change (ERIC) study aims to address one area of terminological inconsistency: discrete implementation strategies involving one process or action used to support a practice change. The present report is on the second stage of the ERIC project that focuses on providing initial validation of the compilation of 73 implementation strategies that were identified in the first phase. FINDINGS: Purposive sampling was used to recruit a panel of experts in implementation science and clinical practice (N = 35). These key stakeholders used concept mapping sorting and rating activities to place the 73 implementation strategies into similar groups and to rate each strategy’s relative importance and feasibility. Multidimensional scaling analysis provided a quantitative representation of the relationships among the strategies, all but one of which were found to be conceptually distinct from the others. Hierarchical cluster analysis supported organizing the 73 strategies into 9 categories. The ratings data reflect those strategies identified as the most important and feasible. CONCLUSIONS: This study provides initial validation of the implementation strategies within the ERIC compilation as being conceptually distinct. The categorization and strategy ratings of importance and feasibility may facilitate the search for, and selection of, strategies that are best suited for implementation efforts in a particular setting.

Creating Positive Environments in Skilled Nursing Facilities to Support Best Practice Implementation: An Overview and Practical Suggestions
Non UofA Access
N. F. Douglas and E. Hickey.
Semin Speech Lang 2015 Aug;36(3):167-178

The purpose of this article is to discuss various types of organizational cultures and climates in relationship to best practice implementation. Although not specific to speech-language pathology, positive organizational cultures and climates are associated with better clinician and patient outcomes in health care services than dysfunctional and/or hierarchical organizational cultures and climates. A goal of this article is to help the practicing speech-language pathologist (SLP) promote positive culture change in the skilled nursing facility (SNF) setting. Recommendations to improve the organizational culture and climate of SNFs will be presented through practical examples of collaborative practice. Further suggestions will be surmised from the organizational psychology and interprofessional education literature. The connection between organizational culture and climate, interprofessional education, collaborative practice, and SLPs’ best practice implementation in the SNF setting will be discussed. Avenues for future work are suggested.

Knowledge brokering in public health: A critical analysis of the results of a qualitative evaluation. Canada-flat-icon
Non UofA Access
C. Dagenais, M. C. Laurendeau and M. Briand-Lamarche.
Eval Program Plann 2015 Jul 8;53:10-17

Empirical data on the processes underlying knowledge brokering (KB) interventions, including their determining factors and effects, remain scarce. Furthermore, these interventions are rarely built on explicit theoretical foundations, making their critical analysis difficult, even a posteriori. For these reasons, it appeared relevant to revisit the results of a qualitative evaluation undertaken in the province of Quebec in parallel with a Canada-wide randomized controlled trial (RCT) evaluating various KB strategies in public health. This paper looks critically at the theoretical foundations of the KB interventions in light of two conceptual models: (1) the dissemination model underlying the KB interventions used in the Canadian trial and (2) a systemic KB model developed later. This critical analysis sheds light on the processes involved in KB interventions and the factors influencing their implementation and effects. The conclusions of the critical analysis are consistent with the systemic model, in which interpersonal contact is an essential condition for effective KB interventions. This analysis may advance knowledge in the field by enhancing our understanding of the role of knowledge brokers as essential mediators in KB processes and outcomes.

(Re)theorizing Integrated Knowledge Translation:
A Heuristic for Knowledge-As-Action.
Non UofA Access
G. H. Doane, S. Reimer-Kirkham, E. Antifeau and K. Stajduhar.
ANS Adv Nurs Sci 2015 Jul-Sep;38(3):175-186

Approaches to knowledge translation (KT) have undergone substantial transformation in an effort to find more effective strategies to ensure the best available knowledge informs nursing practice. However, the fundamental epistemology underpinning KT itself has gone largely unquestioned. Of particular concern is the inadequacy of current representational models to depict the complex, social process of KT. To address the limitations of representational models we propose an inquiry heuristic that conceptualizes KT as a knowledge-as-action process. Developed through a series of KT research projects, the heuristic is intended to guide the KT process and support effective navigation in the complexities of contemporary health care milieus.

Using conjoint analysis to develop a system of scoring policymakers’ use of research in policy and program development.
Non UofA Access
S. R. Makkar, A. Williamson, T. Turner, S. Redman and J. Louviere.
Health Res Policy Syst 2015 Aug 4;13(1):35-015-0022-y

The importance of utilising the best available research evidence in the development of health policies, services, and programs is increasingly recognised, yet few standardised systems for quantifying policymakers’ research use are available. We developed a comprehensive measurement and scoring tool that assesses four domains of research use (i.e. instrumental, conceptual, tactical, and imposed). The scoring tool breaks down each domain into its key subactions like a checklist. Our aim was to develop a tool that assigned appropriate scores to each subaction based on its relative importance to undertaking evidence-informed health policymaking. In order to establish the relative importance of each research use subaction and generate this scoring system, we conducted conjoint analysis with a sample of knowledge translation experts. METHODS: Fifty-four experts were recruited to undertake four choice surveys. Respondents were shown combinations of research use subactions called profiles, and rated on a 1 to 9 scale whether each profile represented a limited (1-3), moderate (4-6), or extensive (7-9) example of research use. Generalised Estimating Equations were used to analyse respondents’ choice data, which calculated a utility coefficient for each subaction. A large utility coefficient indicated that a subaction was particularly influential in guiding experts’ ratings of extensive research use. RESULTS: Utility coefficients were calculated for each subaction, which became the points assigned to the subactions in the scoring system. The following subactions yielded the largest utilities and were regarded as the most important components of each research use domain: using research to directly influence the core of the policy decision; using research to inform alternative perspectives to deal with the policy issue; using research to persuade targeted stakeholders to support a predetermined decision; and using research because it was a mandated requirement by the policymaker’s organisation. CONCLUSIONS: We have generated an empirically derived and context-sensitive means of measuring and scoring the extent to which policymakers used research to inform the development of a policy document. The scoring system can be used by organisations to not only quantify the extent of their research use, but also to provide them with insights into potential strategies to improve subsequent research use.

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Health Care Administration and Organization

When care situations evoke difficult emotions in nursing staff members: an ethnographic study in two Norwegian nursing homes.
Non UofA Access
A. M. Sandvoll, E. K. Grov, K. Kristoffersen and S. Hauge.
BMC Nurs 2015 Jul 30;14:40-015-0093-7. eCollection 2015

Caring practice in nursing homes is a complex topic, especially the challenges of meeting the basic needs of residents when their behaviour evokes difficult emotions. Cognitive and physical changes related to aging and disability can contribute to behaviours considered to be unacceptable. For example, resident behaviours such as spitting, making a mess with food or grinding teeth are behaviours that most people do not want to see, hear or experience. The aim of this study was to gain a deeper understanding of how nursing home staff members deal with such behaviours in care situations. METHODS: This article draws on ethnographic data to describe how nursing home staff members manage unpleasant resident behaviours. The study was based on two long-term units in two Norwegian public nursing homes. The Region’s Medical Ethics Committee and the Norwegian Social Science Data Services granted approval. In total, 45 participants (37 nursing aides and eight nurses) agreed to participate in this study. Ten of the participants were interviewed at the end of the field study. RESULTS: This study indicates that nursing home staff members experience difficult emotions related to some residents’ behaviours. However, they found these feelings difficult to express and rarely verbalized them openly. In addition, they were characterized by a strong obligation to help all residents, despite their own feelings. Therefore, it appears that an inner struggle occurs as a part of everyday practice. CONCLUSIONS: Despite these difficult emotions, nursing staff members believed that they needed to manage their responses and continued to offer good care to all residents. These findings extend our understanding of this unarticulated part of nursing home practice.

Individual and contextual antecedents of workplace aggression in aged care nurses and certified nursing assistants
Non UofA Access
J. Rodwell, D. Demir and A. Gulyas.
Int J Nurs Pract 2015 Aug;21(4):367-375

Employees in aged care are at high risk of workplace aggression. Research rarely examines the individual and contextual antecedents of aggression for specific types of workers within these settings, such as nurses and certified nursing assistants (CNAs). The study aimed to explore characteristics of the job demands-resources model (JD-R), negative affectivity (NA) and demographics related to workplace aggression for aged care workers. The survey study was based on 208 nurses and 83 CNAs working within aged care. Data from each group were analysed separately using ordinal regressions. Both aged care nurses and CNAs reported high rates of bullying, external emotional abuse, threat of assault and physical assault. Elements of the JD-R model and individual characteristics were related to aggression types for both groups. Characteristics of the JD-R model, NA and demographics are important in understanding the antecedents of aggression observed among aged care workers.

Speaking Out and Being Heard Residents’ Committees in Quebec’s Residential Long-Term Care Centre Canada-flat-icon
Non UofA Access
E. Gagnon, M. Clement and L. Bordeleau.
Health Care Anal 2015 Jul 31

Residents’ councils in Quebec’s residential and long-term care centres have the mandate to promote the improvement of living conditions for residents, to assess their level of satisfaction, and to defend their rights. Based on two studies on the autonomy of councils, we examined how committees can express themselves on topics other than those the management is already aware of, to reveal various previously unknown aspects of the services, and to voice unexpressed concerns. We are especially interested in what makes management receptive, or not, to what the committee members say. The councils’ ability to express them selves is, in fact, inseparable from its capacity to listen to the management teams, and we seek to determine the conditions required to perform this dual capacity.

Verbal and nonverbal indicators of quality of communication between care staff and residents in ethnoculturally and linguistically diverse long-term care settings. Canada-flat-icon
Non UofA Access
J. Small, S. M. Chan, E. Drance, et al.
J Cross Cult Gerontol 2015 Aug 11

Linguistic and ethnocultural diversity in long-term residential care is a growing trend in many urban settings. When long-term care staff and residents do not share the same language or ethnocultural background, the quality of their communication and care are jeopardized. There is very little research addressing how staff and residents communicate when they experience a mismatch in their language and ethnocultural backgrounds. Thus, the goals of the present study were to 1) document the verbal and nonverbal behaviours used by staff and residents in diverse interactions, and 2) identify and account for behaviours that either promoted or detracted from positive communication by drawing on principles from ‘Communication Accommodation Theory’. Two long-term care facilities in British Columbia Canada were selected due to the diverse linguistic and ethnocultural backgrounds of their staff and residents. Twenty-seven staff and 27 residents consented to being video-recorded during routine activities (e.g., mealtimes, recreational activities). The recorded observations were transcribed, translated, and coded using qualitative descriptive and interpretive analyses. A number of verbal and nonverbal behaviours were identified and interpreted in relation to whether they promoted or detracted from positive communication. The findings point to considering a variety of proactive strategies that staff and administrators could employ to effectively accommodate to language and ethnocultural diversity in long-term care practice.

Does job satisfaction mediate the relationship between healthy work environment and care quality?
Non UofA Access
J. Bai.
Nurs Crit Care 2015 Aug 10

A healthy work environment can increase nurse-reported job satisfaction and patient care outcomes. Yet the associations between healthy work environment, nurse job satisfaction and QC have not been comprehensively examined in Chinese ICUs. AIM: To investigate the mediating effect of nurse job satisfaction on the relationship between healthy work environment and nurse-reported quality of care (QC) in Chinese intensive care units (ICUs). METHODS: A total of 706 nurses were recruited from 28 ICUs of 14 tertiary hospitals. The nurses completed self-reported questionnaires to evaluate healthy work environment, job satisfaction and quality of patient care. Mediation analysis was conducted to explore the mediating effect between nurse-reported healthy work environment and QC. RESULTS: Nurse work environment showed positive correlations with nurse-reported QC in the ICUs. Nurse-reported job satisfaction showed full mediating effects between healthy work environment and QC in the medical-surgical ICUs, surgical ICUs and neonatal/paediatric ICUs and indicated a partial mediating effect in the medical ICUs. RELEVANCE TO CLINICAL PRACTICE: Significant mediating effects of nurse job satisfaction provide more support for thinking about how to use this mediator to increase nurse and patient care outcomes. Nurse administrators can design interventions to increase nurse work environment and patient care outcomes with this mediating factor addressed.

Tackling Communication Barriers Between Long-Term Care Facility and Emergency Department Transfers to Improve Medication Safety in Older Adults.
Non UofA Access
S. M. Callinan and N. J. Brandt.
J Gerontol Nurs 2015 Jul;41(7):8-13

In 2013, the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine created geriatric emergency department guidelines, making recommendations for staffing/administration, follow up and transitions of care, education, quality improvement, equipment/supplies, and other policies, procedures, and protocols to be implemented. Awareness of these guidelines, as well as communication barriers, can help improve the delivery of care for older adults during transitions in care, particularly regarding medication safety.

Geriatricians’ views of advance decisions and their use in clinical care in England: qualitative study.
Non UofA Access
C. J. Bond and K. Lowton.
Age Ageing 2011 Jul;40(4):450-456

BACKGROUND: an anticipatory decision document records a person’s wishes regarding medical treatment at a time when they have capacity to make choices, to be enacted when this capacity is lost. In England and Wales an advance decision to refuse treatment (ADRT, or advance decision), a legally binding document, is currently rarely used. A disparity is suggested to exist between physicians’ support for anticipatory decisions in principle and their lack of impact on decision-making in practice. OBJECTIVE: to elicit geriatricians’ views on advance decisions and their use in decision-making in England. DESIGN: a qualitative approach was taken. Semi-structured interviews were conducted with 10 geriatricians. An inductive approach was used for data analysis. RESULTS: geriatricians held positive views on anticipatory decisions in principle. In practice, they reported being highly likely to follow a decision which was in line with their clinical view. They would also favour an ADRT which was prescriptive in terms of the situation and treatment to which it applied. However, geriatricians expressed concerns in relation to patient understanding of the role and limits of these documents. Participants expressed discomfort in following an ADRT which, in their professional opinion, did not represent the patient’s best interests, despite it being a legally binding document. A conflict between doctors’ beneficence and patients’ autonomy was apparent, with geriatricians differing in their views on how ADRTs should fit into medical decision-making; particularly how far anticipatory decisions can represent ongoing patient autonomy. CONCLUSION: despite their status in law, an ADRT which conflicts with a geriatrician’s clinical opinion may not be implemented, in breach of the Mental Capacity Act. To avoid this, they must be seated within wider advance care planning.

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Health Care Innovation and Quality Assurance

Environmental Considerations for Improving Nutritional Status in Older Adults with Dementia: A Narrative Review.
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J. W. Douglas and J. C. Lawrence.
J Acad Nutr Diet 2015 Jul 30

As the number of older adults in the United States continues to grow, the American health care system will face the unique challenge of providing care for these individuals, including many who will be diagnosed with some form of dementia. As dementia progresses, patients require increasing amounts of care and nutrient intake usually declines. This tends to result in weight loss, malnutrition, and increased morbidity and mortality. Various interventions have been developed with the goal of improving meal intake and reducing unintentional weight loss in patients with dementia. Several studies have shown that meal intake improves with the provision of adequate assistance, either from staff members or from volunteer feeding assistants. Some studies have focused on the method of meal service and its influence on meal intake and nutrition status. Both buffet-style and family-style dining have shown promising results in terms of improving meal intake and quality of life among older adults in long-term-care settings. Other environment-related interventions include improving lighting and visual contrast, altering the dining room to more closely resemble a home-style setting, using the aroma of food to stimulate appetite, using routine seating arrangements, and using relaxing or familiar music in the dining room to provide a calmer environment. The purpose of this review is to evaluate the research on environment-based interventions to improve nutritional status among older adults with dementia, to describe potential for practical applications, and to identify gaps in the existing literature whereon further research is warranted.

The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study.
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J. Y. Yoon, R. L. Brown, B. J. Bowers, S. S. Sharkey and S. D. Horn.
Int J Nurs Stud 2015 Jul 29

Growing attention in the past few decades has focused on improving care quality and quality of life for nursing home residents. Many traditional nursing homes have attempted to transform themselves to become more homelike emphasizing individualized care. This trend is referred to as nursing home culture change in the U.S. A promising culture change nursing home model, the Green House nursing home model, has shown positive psychological outcomes. However, little is known about whether the Green House nursing home model has positive effects on physical function compared to traditional nursing homes. OBJECTIVES: To examine the longitudinal effects of the Green House nursing home model by comparing change patterns of activities of daily living function over time between Green House home residents and traditional nursing home residents. DESIGN: A retrospective longitudinal study. SETTINGS: Four Green House organizations (nine Green House units and four traditional units). PARTICIPANTS: A total of 242 residents (93 Green House residents and 149 traditional home residents) who had stayed in the nursing home at least 6 months from admission. METHODS: The outcome was activities of daily living function, and the main independent variable was the facility type in which the resident stayed: a Green House or traditional unit. Age, gender, comorbidity score, cognitive function, and depressive symptoms at baseline were controlled. All of these measures were from a minimum dataset. Growth curve modeling and growth mixture modeling were employed in this study for longitudinal analyses. RESULTS: The mean activities of daily living function showed deterioration over time, and the rates of deterioration between Green House and traditional home residents were not different over time. Four different activities of daily living function trajectories were identified for 18 months, but there was no statistical difference in the likelihood of being in one of the four trajectory classes between the two groups. CONCLUSIONS: Although Green House nursing homes are considered to represent an innovative model changing the nursing home environment into more person-centered, this study did not demonstrate significant differences in activities of daily living function changes for residents in the Green House nursing homes compared to traditional nursing homes. Given that the Green House model continues to evolve as it is being implemented and variations within and across Green House homes are identified, large-scale longitudinal studies are needed to provide further relevant information on the effects of the Green House model.

Specific Physician Orders Improve Pain Detection and Pain Reports in Nursing Home Residents: Preliminary Data.
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T. B. Monroe, S. Misra, R. C. Habermann, et al.
Pain Manag Nurs 2015 Aug 7

Despite evidence that many nursing home residents’ pain is poorly managed, reasons for this poor management remain unanswered. The aim of this study was to determine if specific order sets related to pain assessment would improve pain management in nursing home (NH) residents. Outcomes included observed nurse pain assessment queries and resident reports of pain. The pretest/post-test study was performed in a 240-bed for-profit nursing home in the mid-southern region of the United States and participants were 43 nursing home residents capable of self-consent. Medical chart abstraction was performed during a 2-week (14-day) period before the implementation of specific order sets for pain assessment (intervention) and a 2-week (14-day) period after the intervention. Trained research assistants observed medication administration passes and performed participant interviews after each medication pass. One month after intervention implementation, 1 additional day of observations was conducted to determine data reliability. Nurses were observed to ask residents about pain more frequently, and nurses continued to ask about pain at higher rates 1 month after the intervention was discontinued. The proportion of residents who reported pain also significantly increased in response to increased nurse queries (e.g., “Do you have any pain right now?”), which underscores the importance of nurses directly asking residents about pain. Notably 70% of this long-stay NH population only told the nurses about their pain symptoms when asked directly. Findings uncover that using specific pain order sets seems to improve the detection of pain, which should be a routine part of nursing assessment.

Inpatient Pulmonary Rehabilitation Program in a Long-Term Care Facility: Short-Term Outcomes and Patient Satisfaction.
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G. M. Kiongera and S. C. Houde.
J Gerontol Nurs 2015 Aug;41(8):44-52

The purpose of the current study was to evaluate short-term outcomes of inpatient pulmonary rehabilitation (IPR) programs for older patients with chronic obstructive pulmonary disease (COPD). IPR comprises medical management, exercise, nutrition counseling, and coping skills education programs, among other interventions. The current study used a pretest-posttest design with 21 participants evenly split by gender between the ages of 46 and 95. Effects of IPR on functional tolerance exercise capacity and perceived dyspnea on exertion level had a statistically significant difference by the end of the program. Scores for health-related quality of life and subscales of symptoms, impact, and activity in participants younger than 65 were not statistically significant, whereas St. George’s Respiratory Questionnaire scores for participants older than 65 showed a statistically significant improvement. Results showed that early IPR is an effective intervention for the management of symptoms of COPD in older adults recovering from a COPD exacerbation.

Nursing home report card and performance gap.
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A. S. Kim.
Health Care Manage Rev 2015 Aug 5

With the aging of our society, concerns about the quality of nursing homes have been increasing. The Nursing Home Compare (NHC) report card is believed to reduce information asymmetry between the facility and potential residents and, consequently, improve nursing home quality. However, there is limited evidence about how nursing homes use this publicly disseminated performance information. PURPOSE: The aim of this study was to analyze the performance gap between nursing home administrators’ self-assessment and the NHC report card performance ratings and explore the factors contributing to the gap. METHODOLOGY: All 515 Medicare- and Medicaid-certified nursing homes in Indiana were surveyed between August and December 2013. The response rate was approximately 45%. The survey data were compared with the NHC data to identify the gap. Ordered logistic regression analysis was conducted. FINDINGS: Despite voluntary participation, a reasonably high response rate, and anonymity, this study found that 62% of respondents either under- or overrated their facilities’ performance, with the majority overrating their performance. The following factors were associated with a smaller performance gap: nonprofit or government-owned status, higher staffing levels, a higher percentage of hours worked by registered nurses, and a higher market concentration. Longer work experience and greater county occupancy rates were associated with a larger performance gap. PRACTICE IMPLICATIONS: The significant gap implies that administrators either do not regularly review the NHC report card or do not concur with the NHC ratings. To reduce the gap and thereby improve performance, it is necessary to stabilize the administrators’ position so that administrators know how they stand in the market and are consequently better equipped to successfully respond to the market. Facilities may also need to provide regular training on current technologies and facilitate use of the NHC report card, targeting administrators who are old and have many years of work experience.

Adapting the adult social care outcomes toolkit (ASCOT) for use in care home quality monitoring: conceptual development and testing.
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A. M. Towers, J. Holder, N. Smith, et al.
BMC Health Serv Res 2015 Aug 4;15:304-015-0942-9

Alongside an increased policy and practice emphasis on outcomes in social care, English local authorities are now obliged to review quality at a service level to help in their new role of ensuring the development of diverse and high-quality care markets to meet the needs of all local people, including self-funders. The Adult Social Care Outcomes Toolkit (ASCOT) has been developed to measure the outcomes of social care for individuals in a variety of care settings. Local authorities have expressed an interest in exploring how the toolkit might be used for their own purposes, including quality monitoring. This study aimed to explore how the care homes version of the ASCOT toolkit might be adapted for use as a care home quality indicator and carry out some preliminary testing in two care homes for older adults. METHODS: Consultations were carried out with professional and lay stakeholders, with an interest in using the tool or the ratings it would produce. These explored demand and potential uses for the measure and fed into the conceptual development. A draft toolkit and method for collecting the data was developed and the feasibility of using it for quality monitoring was tested with one local authority quality monitoring team in two homes for older adults. RESULTS: Stakeholders expressed an interest in care home quality ratings based on residents’ outcomes but there were tensions around who might collect the data and how it might be shared. Feasibility testing suggested the measure had potential for use in quality monitoring but highlighted the importance of training in observational techniques and interviewing skills. The quality monitoring officers involved in the piloting recommended that relatives’ views be collected in advance of visits, through surveys not interviews. CONCLUSIONS: Following interest from another local authority, a larger evaluation of the measure for use in routine quality monitoring is planned. As part of this, the ratings made using this measure will be validated against the outcomes of individual residents and compared with the quality ratings of the regulator, the Care Quality Commission.

Optimizing Eating Performance for Long-Term Care Residents With Dementia: Testing the Impact of Function-Focused Care for Cognitively Impaired.
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W. Liu, E. Galik, E. S. Nahm, M. Boltz and B. Resnick.
J Am Med Dir Assoc 2015 Aug 5

The objective of this study was to evaluate the impact of a well-developed theory-based function-focused care for cognitively impaired (FFC-CI) intervention on eating performance among long-term care (LTC) residents with moderate-to-severe cognitive impairment. DESIGN: A secondary analysis of longitudinal data from 2 cluster-randomized controlled trials that originally tested the impact of FFC-CI on all function and physical activities. PARTICIPANTS AND SETTING: Participants were 199 residents with moderate-to-severe cognitive impairment from 4 nursing homes and 4 assisted living facilities. MEASUREMENTS: Data at baseline, and 3 and 6 months were used. Resident outcome data used in this analysis included eating performance conceptualized using the single self-care “feeding” item in the Barthel Index, cognitive function by Mini-Mental State Examination, sitting balance conceptualized using the single “chair sit-sitting balance” item in the Tinetti Gait and Balance scale, physical capability by Physical Capability Scale, depression by Cornell Scale for Depression in Dementia, and agitation by Cohen-Mansfield Agitation Inventory (short form). RESULTS: At baseline, almost one-third (32.2%) of the 199 residents needed help with eating. There was no significant change with regard to eating performance over time in both groups, and no significant treatment by time difference between groups in eating performance (P = .195). CONCLUSION: Current findings support a need to revise the FFC-CI to better address eating performance. Future work may benefit from a stronger focus on eating performance rather than the more commonly addressed functional tasks, such as bathing, dressing, and ambulation. In addition, the inclusion of a more heterogeneous group of LTC residents with regard to eating performance is needed to test the impact of the revised approach on eating performance.

Organizational Culture Changes Result in Improvement in Patient-Centered Outcomes: Implementation of an Integrated Recovery Pathway for Surgical Patients.
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E. C. Wick, D. J. Galante, D. B. Hobson, et al.
J Am Coll Surg 2015 Jun 8

BACKGROUND: The goals of quality improvement are to partner with patients and loved ones to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste, yet few programs have successfully worked on of all these in concert. STUDY DESIGN: We evaluated implementation of a pathway designed to improve patient outcomes, value, and experience in colorectal surgery. The pathway expanded on pre-existing comprehensive unit-based safety program infrastructure and used trust-based accountability models at each level, from senior leaders (chief financial officer and senior vice president for patient safety and quality) to frontline staff. It included preoperative education, mechanical bowel preparation with oral antibiotics, chlorhexidine bathing, multimodal analgesia with thoracic epidurals or transversus abdominus plane blocks, a restricted intravenous fluids protocol, early mobilization, and resumption of oral intake. Eleven months of pre- and post-pathway outcomes, including length of stay (LOS), National Surgical Quality Improvement Program surgical site infection (SSI), venous thromboembolism, and urinary tract infection rates, patient experience, and variable direct costs were compared. RESULTS: Three hundred ten patients underwent surgery in the baseline period, the mean LOS was 7 days, and the mean SSI rate was 18.8%. There were 330 patients who underwent surgery on the pathway, the LOS was 5 days, and the rate of SSI was 7.3%. Patient experience improved and variable direct costs decreased. CONCLUSIONS: Our trust-based accountability model, which included both senior hospital leadership and frontline providers, provided an enabling structure to rapidly implement an integrated recovery pathway and quickly improve outcomes, value, and experience of patients undergoing colorectal surgery. The study findings have significant implications for spreading surgical quality improvement work.

Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments.
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L. M. Schnitker, M. Martin-Khan, E. Burkett, et al.
Acad Emerg Med 2015 Mar;22(3):273-284

The purpose of this study was to identify the structural quality of care domains and to establish a set of structural quality indicators (SQIs) for the assessment of care of older people with cognitive impairment in emergency departments (EDs). METHODS: A structured approach to SQI development was undertaken including: 1) a comprehensive search of peer-reviewed and gray literature focusing on identification of evidence-based interventions targeting structure of care of older patients with cognitive impairment and existing SQIs; 2) a consultative process engaging experts in the care of older people and epidemiologic methods (i.e., advisory panel) leading to development of a draft set of SQIs; 3) field testing of drafted SQIs in eight EDs, leading to refinement of the SQI set; and 4) an independent voting process among the panelists for SQI inclusion in a final set, using preestablished inclusion and exclusion criteria. RESULTS: At the conclusion of the process, five SQIs targeting the management of older ED patients with cognitive impairment were developed: 1) the ED has a policy outlining the management of older people with cognitive impairment during the ED episode of care; 2) the ED has a policy outlining issues relevant to carers of older people with cognitive impairment, encompassing the need to include the (family) carer in the ED episode of care; 3) the ED has a policy outlining the assessment and management of behavioral symptoms, with specific reference to older people with cognitive impairment; 4) the ED has a policy outlining delirium prevention strategies, including the assessment of patients’ delirium risk factors; and 5) the ED has a policy outlining pain assessment and management for older people with cognitive impairment. CONCLUSIONS: This article presents a set of SQIs for the evaluation of performance in caring for older people with cognitive impairment in EDs.

What happens when healthcare innovations collide? Canada-flat-icon
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S. R. Pendharkar, J. Woiceshyn, G. J. da Silveira, et al.
BMJ Qual Saf 2015 Aug 13.

In late March 2013, the Alberta Health Services Executive Committee determined that P2H overlapped with two similar initiatives, Care Transformation and Workforce Model Transformation (see table 1 for a description of each initiative).1 Each project was seeking organisational resource support for province-wide implementation. Budgets were frozen on all three initiatives pending a strategic re-evaluation. Uncertainty set in, and stakeholders at all levels began to ask questions about what happened, and what was going to happen. Excitement and enthusiasm were slowly replaced by frustration, doubt and resignation.

Narrative review of models and success factors for scaling up public health interventions
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A. J. Milat, A. Bauman and S. Redman.
Implement Sci 2015 Aug 12;10(1):113-015-0301-6

BACKGROUND: To maximise the impact of public health research, research interventions found to be effective in improving health need to be scaled up and delivered on a population-wide basis. Theoretical frameworks and approaches are useful for describing and understanding how effective interventions are scaled up from small trials into broader policy and practice and can be used as a tool to facilitate effective scale-up. The purpose of this literature review was to synthesise evidence on scaling up public health interventions into population-wide policy and practice, with a focus on the defining and describing frameworks, processes and methods of scaling up public health initiatives. METHODS: The review involved keyword searches of electronic databases including MEDLINE, CINAHL, PsycINFO, EBM Reviews and Google Scholar between August and December 2013. Keywords included ‘scaling up’ and ‘scalability’, while the search terms ‘intervention research’, ‘translational research’, ‘research dissemination’, ‘health promotion’ and ‘public health’ were used to focus the search on public health approaches. Studies included in the review were published in English from January 1990 to December 2013 and described processes, theories or frameworks associated with scaling up public health and health promotion interventions. RESULTS: There is a growing body of literature describing frameworks for scaling health interventions, with the review identifying eight frameworks, the majority of which have an explicit focus on scaling up health action in low and middle income country contexts. Key success factors for scaling up included the importance of establishing monitoring and evaluation systems, costing and economic modelling of intervention approaches, active engagement of a range of implementers and the target community, tailoring the scaled-up approach to the local context, the use of participatory approaches, the systematic use of evidence, infrastructure to support implementation, strong leadership and champions, political will, well defined scale-up strategy and strong advocacy. CONCLUSIONS: Effective scaling up requires the systematic use of evidence, and it is essential that data from implementation monitoring is linked to decision making throughout the scaling up process. Conceptual frameworks can assist both policy makers and researchers to determine the type of research that is most useful at different stages of scaling up processes.

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Research Practice and Methodology

Protocol—the RAMESES II study: developing guidance and reporting standards for realist evaluation
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T. Greenhalgh, G. Wong, J. Jagosh, et al.
BMJ Open 2015 Aug 3;5(8):e008567-2015-008567

Realist evaluation is an increasingly popular methodology in health services research. For realist evaluations (RE) this project aims to: develop quality and reporting standards and training materials; build capacity for undertaking and critically evaluating them; produce resources and training materials for lay participants, and those seeking to involve them. METHODS: To achieve our aims, we will: (1) Establish management and governance infrastructure; (2) Recruit an interdisciplinary Delphi panel of 35 participants with diverse relevant experience of RE; (3) Summarise current literature and expert opinion on best practice in RE; (4) Run an online Delphi panel to generate and refine items for quality and reporting standards; (5) Capture ‘real world’ experiences and challenges of RE-for example, by providing ongoing support to realist evaluations, hosting the RAMESES JISCmail list on realist research, and feeding problems and insights from these into the deliberations of the Delphi panel; (6) Produce quality and reporting standards; (7) Collate examples of the learning and training needs of researchers, students, reviewers and lay members in relation to RE; (8) Develop, deliver and evaluate training materials for RE and deliver training workshops; and (9) Develop and evaluate information and resources for patients and other lay participants in RE (eg, draft template information sheets and model consent forms) and; (10) Disseminate training materials and other resources.Planned outputs: (1) Quality and reporting standards and training materials for RE. (2) Methodological support for RE. (3) Increase in capacity to support and evaluate RE. (4) Accessible, plain-English resources for patients and the public participating in RE. DISCUSSION: The realist evaluation is a relatively new approach to evaluation and its overall place in the is not yet fully established. As with all primary research approaches, guidance on quality assurance and uniform reporting is an important step towards improving quality and consistency.

The implausibility of ‘usual care’ in an open system: sedation and weaning practices in Paediatric Intensive Care Units (PICUs) in the United Kingdom (UK).
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B. Blackwood and L. Tume.
Trials 2015 Jul 31;16:325-015-0846-3

The power of the randomised controlled trial depends upon its capacity to operate in a closed system whereby the intervention is the only causal force acting upon the experimental group and absent in the control group, permitting a valid assessment of intervention efficacy. Conversely, clinical arenas are open systems where factors relating to context, resources, interpretation and actions of individuals will affect implementation and effectiveness of interventions. Consequently, the comparator (usual care) can be difficult to define and variable in multi-centre trials. Hence outcomes cannot be understood without considering usual care and factors that may affect implementation and impact on the intervention. METHODS: Using a fieldwork approach, we describe PICU context, ‘usual’ practice in sedation and weaning from mechanical ventilation, and factors affecting implementation prior to designing a trial involving a sedation and ventilation weaning intervention. We collected data from 23 UK PICUs between June and November 2014 using observation, individual and multi-disciplinary group interviews with staff. RESULTS: Pain and sedation practices were broadly similar in terms of drug usage and assessment tools. Sedation protocols linking assessment to appropriate titration of sedatives and sedation holds were rarely used (9 % and 4 % of PICUs respectively). Ventilator weaning was primarily a medical-led process with 39 % of PICUs engaging senior nurses in the process: weaning protocols were rarely used (9 % of PICUs). Weaning methods were variably based on clinician preference. No formal criteria or use of spontaneous breathing trials were used to test weaning readiness. Seventeen PICUs (74 %) had prior engagement in multi-centre trials, but limited research nurse availability. Barriers to previous trial implementation were intervention complexity, lack of belief in the evidence and inadequate training. Facilitating factors were senior staff buy-in and dedicated research nurse provision. CONCLUSIONS: We examined and identified contextual and organisational factors that may impact on the implementation of our intervention. We found usual practice relating to sedation, analgesia and ventilator weaning broadly similar, yet distinctively different from our proposed intervention, providing assurance in our ability to evaluate intervention effects. The data will enable us to develop an implementation plan; considering these factors we can more fully understand their impact on study outcomes.

The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.
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B. Hutton, G. Salanti, D. M. Caldwell, et al.
Ann Intern Med 2015 Jun 2;162(11):777-784

The PRISMA statement is a reporting guideline designed to improve the completeness of reporting of systematic reviews and meta-analyses. Authors have used this guideline worldwide to prepare their reviews for publication. In the past, these reports typically compared 2 treatment alternatives. With the evolution of systematic reviews that compare multiple treatments, some of them only indirectly, authors face novel challenges for conducting and reporting their reviews. This extension of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement was developed specifically to improve the reporting of systematic reviews incorporating network meta-analyses. A group of experts participated in a systematic review, Delphi survey, and face-to-face discussion and consensus meeting to establish new checklist items for this extension statement. Current PRISMA items were also clarified. A modified, 32-item PRISMA extension checklist was developed to address what the group considered to be immediately relevant to the reporting of network meta-analyses. This document presents the extension and provides examples of good reporting, as well as elaborations regarding the rationale for new checklist items and the modification of previously existing items from the PRISMA statement. It also highlights educational information related to key considerations in the practice of network meta-analysis. The target audience includes authors and readers of network meta-analyses, as well as journal editors and peer reviewers.

Is crowdfunding a viable source of clinical trial research funding? Canada-flat-icon
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A. Sharma, J. Khan and P. J. Devereaux.
Lancet 2015 Jul 25;386(9991):338-6736(15)61407-6.

As public research grants for randomised controlled trials (RCTs) have diminished and become increasingly competitive, researchers have to search for alternative funding sources. Crowdfunding, in which projects are funded directly from the public through the internet, might represent a potential source of RCT funding. However, whether or not crowdfunding campaigns for clinical RCTs are successful is unclear.

Squaring the circle: a priority-setting method for evidence-based service development, reconciling research with multiple stakeholder views.
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R. Hutten, G. D. Parry, T. Ricketts and J. Cooke.
BMC Health Serv Res 2015 Aug 12;15:320-015-0958-1

BACKGROUND: This study demonstrates a technique to aid the implementation of research findings through an example of improving services and self-management in longer-term depression. In common with other long-term conditions, policy in this field requires innovation to be undertaken in the context of a whole system of care, be cost-effective, evidence-based and to comply with national clinical guidelines. At the same time, successful service development must be acceptable to clinicians and service users and choices must be made within limited resources. This paper describes a novel way of resolving these competing requirements by reconciling different sources and types of evidence and systematically engaging multiple stakeholder views. METHODS: The study combined results from mathematical modelling of the care pathway, research evidence on effective interventions and findings from qualitative research with service users in a series of workshops to define, refine and select candidate service improvements. A final consensus-generating workshop used structured discussion and anonymised electronic voting. This was followed by an email survey to all stakeholders, to achieve a pre-defined criterion of consensus for six suggestions for implementation. RESULTS: An initial list of over 20 ideas was grouped into four main areas. At the final workshop, each idea was presented in person, visually and in writing to 40 people, who assigned themselves to one or more of five stakeholder groups: i) service users and carers, ii) clinicians, iii) managers, iv) commissioners and v) researchers. Many belonged to more than one group. After two rounds of voting, consensus was reached on seven ideas and one runner up. The survey then confirmed the top six ideas to be tested in practice. CONCLUSIONS: The method recruited and retained people with diverse experience and views within a health community and took account of a full range of evidence. It enabled a diverse group of stakeholders to travel together in a direction that converged with the messages coming out of the research and successfully yielded priorities for service improvement that met competing requirements.

Findings from a novel approach to publication guideline revision: user road testing of a draft version of SQUIRE 2.0.
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L. Davies, K. Z. Donnelly, D. J. Goodman and G. Ogrinc.
BMJ Qual Saf 2015 Aug 11

The Standards for Quality Improvement Reporting Excellence (SQUIRE) Guideline was published in 2008 (SQUIRE 1.0) and was the first publication guideline specifically designed to advance the science of healthcare improvement. Advances in the discipline of improvement prompted us to revise it. We adopted a novel approach to the revision by asking end-users to ‘road test’ a draft version of SQUIRE 2.0. The aim was to determine whether they understood and implemented the guidelines as intended by the developers. METHODS: Forty-four participants were assigned a manuscript section (ie, introduction, methods, results, discussion) and asked to use the draft Guidelines to guide their writing process. They indicated the text that corresponded to each SQUIRE item used and submitted it along with a confidential survey. The survey examined usability of the Guidelines using Likert-scaled questions and participants’ interpretation of key concepts in SQUIRE using open-ended questions. On the submitted text, we evaluated concordance between participants’ item usage/interpretation and the developers’ intended application. For the survey, the Likert-scaled responses were summarised using descriptive statistics and the open-ended questions were analysed by content analysis. RESULTS: Consistent with the SQUIRE Guidelines’ recommendation that not every item be included, less than one-third (n=14) of participants applied every item in their section in full. Of the 85 instances when an item was partially used or was omitted, only 7 (8.2%) of these instances were due to participants not understanding the item. Usage of Guideline items was highest for items most similar to standard scientific reporting (ie, ‘Specific aim of the improvement’ (introduction), ‘Description of the improvement’ (methods) and ‘Implications for further studies’ (discussion)) and lowest (<20% of the time) for those unique to healthcare improvement (ie, ‘Assessment methods for context factors that contributed to success or failure’ and ‘Costs and strategic trade-offs’). Items unique to healthcare improvement, specifically ‘Evolution of the improvement’, ‘Context elements that influenced the improvement’, ‘The logic on which the improvement was based’, ‘Process and outcome measures’, demonstrated poor concordance between participants’ interpretation and developers’ intended application. CONCLUSIONS: User testing of a draft version of SQUIRE 2.0 revealed which items have poor concordance between developer intent and author usage, which will inform final editing of the Guideline and development of supporting supplementary materials. It also identified the items that require special attention when teaching about scholarly writing in healthcare improvement.

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The Effect of Depressive Symptoms and Antidepressant Use on Subsequent Physical Decline and Number of Hospitalizations in Nursing Home Residents: A 9-Year Longitudinal Study.
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H. Luo, J. Y. Tang, G. H. Wong, et al.
J Am Med Dir Assoc 2015 Jul 31

To investigate whether depressive symptoms and antidepressant use at baseline predict the subsequent decline in physical functioning and number of hospitalizations in nursing home residents. DESIGN: Observational study based on Minimum Data Set (MDS) 2.0. SETTING: Six nursing homes in Hong Kong. PARTICIPANTS: All nursing home residents (n = 1076) assessed with the MDS 2.0 in 2005 followed until 2013. MEASUREMENTS: Outcome variables included annual performance in activities of daily living (ADLs) and number of hospitalizations within 90 days before each assessment. The presence of depressive symptoms at baseline was measured by the Resident Assessment Protocol triggered from the MDS 2.0 assessment. Records of antidepressant use and other control variables were exacted directly from the MDS 2.0 assessment. RESULTS: The presence of baseline depressive symptoms did not have significant association with baseline ADLs and number of hospitalizations according to the multilevel mixed-effect model. However, it was associated with a faster deterioration of physical functioning (coefficient 0.03; 95% confidence interval [CI] 0.00-0.07) and an increase in the number of hospitalizations (coefficient 0.05; 95% CI 0.03-0.07). No significant difference between elders using antidepressants and elders who were free from depressive symptoms was observed. If depressive symptoms were presented but antidepressants were not used, a much sharper decline was evident (coefficient 0.06; 95% CI 0.02-0.09). CONCLUSIONS: This study provided evidence that the presence of depressive symptoms is associated with more utilization of health care services. However, the use of antidepressants may play a significant role in altering the trajectory. The presence of depressive symptoms is a worrisome but treatable condition. Effective intervention/treatment should be called on.

Validation of the Care-Related Quality of Life Instrument in different study settings: findings from The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS).
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J. E. Lutomski, N. J. van Exel, G. I. Kempen, et al.
Qual Life Res 2015 May;24(5):1281-1293

Validity is a contextual aspect of a scale which may differ across sample populations and study protocols. The objective of our study was to validate the Care-Related Quality of Life Instrument (CarerQol) across two different study design features, sampling framework (general population vs. different care settings) and survey mode (interview vs. written questionnaire). METHODS: Data were extracted from The Older Persons and Informal Caregivers Minimum DataSet (TOPICS-MDS, ), a pooled public-access data set with information on >3,000 informal caregivers throughout the Netherlands. Meta-correlations and linear mixed models between the CarerQol’s seven dimensions (CarerQol-7D) and caregiver’s level of happiness (CarerQol-VAS) and self-rated burden (SRB) were performed. RESULTS: The CarerQol-7D dimensions were correlated to the CarerQol-VAS and SRB in the pooled data set and the subgroups. The strength of correlations between CarerQol-7D dimensions and SRB was weaker among caregivers who were interviewed versus those who completed a written questionnaire. The directionality of associations between the CarerQol-VAS, SRB and the CarerQol-7D dimensions in the multivariate model supported the construct validity of the CarerQol in the pooled population. Significant interaction terms were observed in several dimensions of the CarerQol-7D across sampling frame and survey mode, suggesting meaningful differences in reporting levels. CONCLUSIONS: Although good scientific practice emphasises the importance of re-evaluating instrument properties in individual research studies, our findings support the validity and applicability of the CarerQol instrument in a variety of settings. Due to minor differential reporting, pooling CarerQol data collected using mixed administration modes should be interpreted with caution; for TOPICS-MDS, meta-analytic techniques may be warranted.

Discharging older patients from the emergency department effectively: a systematic review and meta-analysis.
Non UofA Access
J. A. Lowthian, R. A. McGinnes, C. A. Brand, A. L. Barker and P. A. Cameron.
Age Ageing 2015 Aug 10

BACKGROUND: a decline in health state and re-attendance are common in people aged >/=65 years following emergency department (ED) discharge. Diverse care models have been implemented to support safe community transition. This review examined ED community transition strategies (ED-CTS) and evaluated their effectiveness. METHODS: a systematic review and meta-analysis using multiple databases up to December 2013 was conducted. We assessed eligibility, methodological quality, risk of bias and extracted published data and then conducted random effects meta-analyses. Outcomes were unplanned ED representation or hospitalisation, functional decline, nursing-care home admission and mortality. RESULTS: five experimental and four observational studies were identified for qualitative synthesis. ED-CTS included geriatric assessment with referral for post-discharge community-based assistance, with differences apparent in components and delivery methods. Four studies were included in meta-analysis. Compared with usual care, the evidence indicates no appreciable benefit for ED-CTS for unplanned ED re-attendance up to 30 days (odds ratio (OR) 1.32, 95% confidence interval (CI) 0.99-1.76; n = 1,389), unplanned hospital admission up to 30 days (OR 0.90, 95% CI 0.70-1.16; n = 1,389) or mortality up to 18 months (OR 1.04, 95% CI 0.83-1.29; n = 1,794). Variability between studies precluded analysis of the impact of ED-CTS on functional decline and nursing-care home admission. CONCLUSIONS: there is limited high-quality data to guide confident recommendations about optimal ED community transition strategies, highlighting a need to encourage better integration of researchers and clinicians in the design and evaluation process, and increased reporting, including appropriate robust evaluation of efficacy and effectiveness of these innovative models of care.

Care and Service at Home for Persons With Dementia in Europe.
Non UofA Access
C. Bokberg, G. Ahlstrom, H. Leino-Kilpi, et al.
J Nurs Scholarsh 2015 Aug 7

PURPOSE: To describe available and utilized formal care and service at home for persons with dementia, from diagnosis to end-of-life stage, in eight European countries. DESIGN: A descriptive cross-country design concerning eight European countries as a part of the European research project RightTimePlaceCare. METHODS: The research team in each country used a mapping system to collect country-specific information concerning dementia care and service system. The mapping system consists of 50 types of care and service activities. Sixteen of the 50 predefined activities concerning care and service at home were selected for this study and subdivided into three categories, following the stages of dementia. FINDINGS: Availability was reported to be higher than utilization, and the findings indicated more similarities than differences among the eight countries involved. Even though there were several available activities of “basic care and services” and “healthcare interventions,” they were utilized by few in most countries. Furthermore, “specialized dementia care and services” were sparsely available and even more sparsely utilized in the participating countries. CONCLUSIONS: The findings indicated that persons with dementia in Europe received formal care and service on a general, basic level but seldom adjusted to their specific needs. CLINICAL RELEVANCE: This study describes the gap between service provision and utilization enabling nurses to develop individually adjusted care plans for persons with dementia during the progress of the disease. The findings do not include matters of quality of care or how to best organize effective care and services. However, the activities of care and services presented here should shed light on what room there is for improvement when it comes to enabling persons with dementia to go on living at home.

Enabling resources in people with dementia: a qualitative study about nurses’ strategies that may support a sense of coherence in people with dementia.
Non UofA Access
D. Lillekroken, S. Hauge and A. Slettebo.
J Clin Nurs 2015 Aug 9

To explore nurses’ strategies that may support the sense of coherence in people with dementia. BACKGROUND: People with dementia are often described as people with no resources, people who need support from family or from healthcare personnel to function in everyday life. Despite the disease, some people still have the resources needed to cope well with parts of their lives and experience coherence. To date, no research has explored any nurses’ strategies that may support the sense of coherence in people with dementia. DESIGN: The design of the study is qualitative and exploratory. METHODS: Data were collected by participant observation and focus group interviews. Sixteen registered nurses from two different Norwegian nursing homes were recruited and participated in the study. Qualitative content analysis was used to analyse the data. RESULTS: The empirical material consisted of field notes from participant observation and transcripts from focus group interviews. Three generic categories were identified as strategies that may support sense of coherence in people with dementia: ‘Finding and nurturing the individual’s resources’, ‘Customising meaningful activities’ and ‘Finding creative solutions’. These categories were identified as strategies that may support and possibly enhance the sense of coherence in people with dementia. CONCLUSIONS: The findings provide an empirical base for assuming that with support and help from nurses, people with dementia may experience and strengthen their sense of coherence, therefore, the nurses need to be aware of the activities that may support and possibly enhance the sense of coherence in people with dementia. RELEVANCE TO CLINICAL PRACTICE: Despite the contextual limitations, this study highlights the need to identify and nurture resources in people with dementia, thus supporting their sense of coherence. The findings may contribute in enhancing the quality of care for people with dementia.

Prevalence of Frailty in Nursing Homes: A Systematic Review and Meta-Analysis.
Non UofA Access
G. Kojima.
J Am Med Dir Assoc 2015 Aug 6

Nursing home patients are expected to be very frail. However, evidence on frailty in a nursing home setting is scarce in the literature. Especially prevalence of frailty in this population is unknown. OBJECTIVE: To systematically search and analyze the prevalence of frailty among nursing home patients in the literature and synthesize pooled estimates of overall prevalence of frailty and prefrailty as well as prevalence of frailty stratified by age, gender, and frailty definitions. DESIGN: Systematic review using 5 databases: Embase, MEDLINE, CINAHL Plus, PsycINFO, and Cochrane library, and meta-analysis. SETTING: Cross-sectional studies or observational studies with baseline data in a nursing home setting. PARTICIPANTS: Nursing home patients aged 60 years or older. MEASUREMENTS: Prevalence of frailty and prefrailty based on validated criteria or definitions of frailty was collected. In the included studies, meta-analysis was performed using random-effects models to calculate pooled estimates of prevalence of frailty and prefrailty. Methodological quality, heterogeneity, and publication bias were assessed. RESULTS: Nine studies with a total of 1373 nursing home patients were found to report prevalence of frailty. The included studies were highly heterogeneous and mean prevalence of frailty ranged widely from 19.0 to 75.6%. Pooled estimates of prevalence of frailty and prefrailty were 52.3% (95% confidence interval 37.9%-66.5%) (9 studies, n = 1373) and 40.2% (28.9%-52.1%) (7 studies, n = 1163), respectively. CONCLUSIONS: As high as about one-half of the nursing home patients were frail. Approximately 40% were still prefrail and could be targeted by interventions for frailty prevention or treatment to avoid its negative health outcomes.

The prevalence, impact and management of musculoskeletal disorders in older people living in care homes: a systematic review.
Non UofA Access
T. O. Smith, R. Purdy, S. K. Latham, S. R. Kingsbury, G. Mulley and P. G. Conaghan.
Rheumatol Int 2015 Aug 6

The aim was to systematically review the literature describing the prevalence, impact and current management of musculoskeletal pain in older people living in care homes. Published literature (AMED, CINAHL, EMBASE, psycINFO, MEDLINE, Cochrane Library) and unpublished literature (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials, UK National Research Register Archive) were searched on 1 March 2015. All studies assessing the prevalence, impact and management of musculoskeletal disorders in older people living in care homes were included. Literature was appraised using the CASP cohort and qualitative critical appraisal tools. Data were analysed using descriptive statistical approaches, meta-analysis and meta-ethnography techniques. Twenty-four papers reporting the results of 263,775 care home residents in 12 countries were identified. The evidence base was moderate in quality. Prevalence of musculoskeletal pain for people in care homes was 30.2 % (95 % confidence intervals 29.9-30.5 %; n = 105,463). Care home residents reported that musculoskeletal pain had a significant impact on their perceived independence and overall ability to participate in everyday activities of daily living. Three papers which presented data on interventions demonstrated that whilst multi-component assessment and management packages did not significantly change clinical outcomes, these empowered care home staff to feel more confident in managing these patients. Musculoskeletal pain is a common problem in care homes worldwide, and residents report significant impact on their lives. However, there is uncertainty regarding how to assess and manage such pain. PROSPERO Registration Number: CRD42014009824.

Advance Care Planning in Nursing Home Patients With Dementia: A Qualitative Interview Study Among Family and Professional Caregivers.
Non UofA Access
M. C. van Soest-Poortvliet, J. T. van der Steen, G. Gutschow, et al.
J Am Med Dir Assoc 2015 Aug 5

OBJECTIVE: The aim of this study was to describe the process of advance care planning (ACP) and to explore factors related to the timing and content of ACP in nursing home patients with dementia, as perceived by family, physicians, and nurses. DESIGN: A qualitative descriptive study. METHODS: A total of 65 in-depth qualitative interviews were held with families, on-staff elderly care physicians, and nurses of 26 patients with dementia who died in the Dutch End Of Life in Dementia (DEOLD) study. Interviews were coded and analyzed to find themes. RESULTS: Family, nurses, and physicians of all patients indicated they had multiple contact moments during nursing home stay in which care goals and treatment decisions were discussed. Nearly all interviewees indicated that physicians took the initiative for these ACP discussions. Care goals discussed and established during nursing home stay and the terminology to describe care goals varied between facilities. Regardless of care goals and other factors, cardiopulmonary resuscitation (CPR) and hospitalization were always discussed in advance with family and commonly resulted in a do-not-resuscitate (DNR) and a do-not-hospitalize (DNH) order. The timing of care planning discussions about other specific treatments or conditions and the content of treatment decisions varied. The factors that emerged from the interviews as related to ACP were general strategies that guided physicians in initiating ACP discussions, patient’s condition, wishes expressed by patient or family, family’s willingness, family involvement, continuity of communication, consensus with or within family, and general nursing home policy. Two influential underlying strategies guided physicians in initiating ACP discussions: (1) wait for a reason to initiate discussions, such as a change in health condition and (2) take initiative to discuss possible treatments (actively, including describing scenarios). CONCLUSIONS: ACP is a multifactorial process, which may lean on professional caregivers’ guidance. The most acute decisions are covered in advance, but a responsive as well as a proactive style is seen with other treatment decisions. Further research is needed to increase understanding of whether and how the physicians’ strategies affect care processes and outcomes.

Meaningful Activity for Persons With Dementia: Family Caregiver Perspectives. Canada-flat-icon
Non UofA Access
K. P. Roland and N. L. Chappell.
Am J Alzheimers Dis Other Demen 2015 Sep;30(6):559-568

Dementia threatens the capacity to engage in activity, suggesting meaningful activity may be helpful for persons with dementia (PWDs). This study explores the concept of meaningful activity, as defined by caregivers of PWDs. Family caregivers of PWDs, who provide 3 hours of care over 3 days/week, were interviewed after 6 months of cholinesterase inhibitors (ChEIs) therapy. Caregiver responses (N = 906) to the open-ended question What do you believe getting involved in activities outside the home means for someone with dementia are assessed. The themes are analyzed in terms of content, frequency, co-occurrence, and dementia severity. Caregivers emphasize the benefits of social connectedness, physical health, and mental stimulation. Activity is also viewed as respite, difficult, and has no meaning for care recipient. The implications of activity for self- and social-identity in PWD and caregiver are discussed. The benefits of activity varied by stage of disease. This knowledge indicates areas for improved activity provision and health care support.

Physical and Psychological Distress Are Related to Dying Peacefully in Residents With Dementia in Long-Term Care Facilities.
Non UofA Access
M. L. De Roo, G. Albers, L. Deliens, et al.
J Pain Symptom Manage 2015 Jul;50(1):1-8

CONTEXT: Although dying peacefully is considered an important outcome of high-quality palliative care, large-scale quantitative research on dying peacefully and the factors associated with a peaceful death is lacking. OBJECTIVES: To gain insight into how many residents with dementia in long-term care facilities die peacefully, according to their relatives, and whether that assessment is correlated with observed physical and psychological distress. METHODS: This was a retrospective cross-sectional study of deceased nursing home residents in a representative sample of long-term care facilities in Flanders, Belgium (2010). Structured post-mortem questionnaires were completed by relatives of the resident, who were asked to what extent they agreed that the resident “appeared to be at peace” during the dying process. Spearman correlation coefficients gave the correlations between physical and psychological distress (as measured using the Symptom Management at the End of Life with Dementia and Comfort Assessment in Dying at the End of Life with Dementia scales) and dying peacefully (as measured using the Quality of Dying in Long Term Care instrument). RESULTS: The sample comprised 92 relatives of deceased residents with dementia. In 54% of cases, relatives indicated that the resident died peacefully. Weak-to-moderate correlations (0.2-0.57) were found between dying peacefully and physical distress in the last week of life. Regarding psychological distress, weak-to-moderate correlations were found for both the last week (0.33-0.44) and last month of life (0.28-0.47). CONCLUSION: Only half of the residents with dementia died peacefully as perceived by their relatives. Relatives’ assessment of whether death was peaceful is related to both physical and psychological distress. Further qualitative research is recommended to gain more in-depth insights into the aspects on which relatives base their judgment of dying peacefully.

Dementia: Statistics on prevalence and improving diagnosis, care and research (UK)
House of Commons Briefing Note July 2015

This note outlines Government, NHS and other statutory bodies’ work to improve dementia diagnosis, care and support and research. It also provides statistics on rates and expected rises of dementia prevalence, including prevalence rates for each English Parliamentary constituency.

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John Dossetor Health Ethics Centre Symposium
Friday 2 October 2015 Lister Conference Centre

Presentations by Eric Wasylenko (Provincial Medical Advisor, Alberta Health Services), Dawn Davies (Director Pediatric Palliative Care Program, Stollery Children’s Hospital), Austin Mardon (Order of Canada), Carol Hodgson (J Allan Gilbert Chair for Medical Education Research, University of Alberta) and Brendan Leier (Clinical Ethicist, Alberta Health Services).

Networks as Interventions: Policy Tool or Panacea?
22-24 September Lister Centre

The 2015 symposium will explore if and/or how inter-organizational networks can help address critical policy issues and practice challenges. Specifically, can networks be used successfully as deliberate tools or interventions to create better public policy, services and practice; or are they simply so ubiquitous that they have become the universal remedy, effective or not, for any wicked problem?

Non UofA

International Forum on Quality and Safety in Healthcare: Asia
28-30 September Hong Kong

Join over 1,100 of your healthcare colleagues at the very first International Forum: Asia! “Improve, Innovate, Inspire” features keynote speakers from the US, UK and Asian countries and will showcase the very best of international and regional thinking and practice in quality and safety in healthcare. The Conference Programme includes feedback from the World Health Organization Summit and innovative Experience Day visits to Ocean Park, to Princess Margaret Hospital and Prince of Wales Hospital.


AHRQ Webinar: Adaptive Trial Design and Learning Evaluation: Methods for PCOR and Quality Improvement Assessment
Tuesday August 18 08:30-10:00 MT

Presenters will discuss the minimum standards recommended for the design, conduct, and reporting of adaptive clinical trials as applied to patient-centered outcomes research (PCOR). A detailed overview of how to apply the learning evaluation approach to quality improvement assessments across multiple organizations will also be discussed.

KT Canada Twitter Journal Club
Thursday 20 August 10:00-11:00 MT

Articles being discussed are Making sense of implementation theories, models and frameworks and Knowledge translation in Uganda: a qualitative study of Ugandan midwives’ and managers’ perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework. Interested participants should email Meghan Storey at to register. There are a limited number of spots available and registration will be on a first come first served basis.

Conducting Culturally Humble Rehabilitation Research
Wednesday 19 August 13:00-14:00 MT

Researchers from the Rehabilitation Research and Training Center on Developing Strategies to Foster Community Integration and Participation for Individuals with Traumatic Brain Injury) discuss important issues related to conducting research with ethnic and racial minorities and the medically underserved.

KTDRR Developing High Quality Research Syntheses
Available anytime

This online workshop presents the archive version of KTDRR’s in-person workshop on “Tips of the Trade: Developing High Quality Research Syntheses.” The workshop sessions were recorded and the archived files are now available as an on-line workshop, designed for grantees of RSA and NIDILRR, and anyone interested in synthesizing hiqh quality research.

KTDRR Knowledge Translation Solutions for Overcoming Barriers to Research Use
26, 28, 30 October

Knowledge translation (KT) strategies are used by NIDILRR grantees to share their research with a variety of audiences. KT activities are used to create a change in awareness, behavior, or action on the part of the identified audience. This online conference is designed to help grantees identify barriers, as well as strategies to overcome barriers, to the use of their NIDILRR-funded research. The conference will be oriented to identifying solutions to problems or limitations in participants’ planned KT activities.

TVN Webinar: Hip fracture quality indicators: a scoping review
Wednesday 19 August 10:00 MT

Join Dr. Susan Jaglal of the Toronto Rehabilitation Institute, and PhD candidate Kristen Pitzul as they share the results of their synthesis of the evidence surrounding current quality-of-care indicators for patients who have sustained a hip fracture.

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Quality Improvement MOOC: Improvement FUNdamentals
Begins in September, lasts 8 weeks

NHS Improving Quality, the University of Jönköping and Qulturum bring you a new and innovative online course for those involved in health and care.

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Dementia is striking victims earlier and death rates are soaring: international study

The study, which compared 21 Western countries between the years 1989 and 2010, found that the disease is now being regularly diagnosed in people in their late 40s and that death rates are soaring.

Need to define patient engagement in research Canada-flat-icon

The federal government has ponied up with the cash and researchers want more patient engagement in health research, but defining what this means — and developing a framework for implementing it — is an ongoing process.

Pain Often Hinders Community Living Seniors With Dementia

Elderly Americans with dementia who live at home may need help managing their pain, a new study suggests.

The ‘Revise and Resubmit’

When submitting your writing for publication in a journal, the best you can often hope for is to receive a “revise and resubmit” request from the editor.

When Researchers State Goals for Clinical Trials in Advance, Success Rates Plunge

Apparently, requiring scientists to state their objectives ahead of time makes a big difference.

Long-Distance Networking

How to start building a circle of contacts in a place you aspire to live.

Health research agency Cochrane Canada is running out of money Canada-flat-icon

It’s an organization that sifts through health research to inform patients, doctors and groups of the best options available. But 90% of its funding is about to disappear. All in a Day spoke with Cochrane Canada about the campaign to save it.

The Latest Example of the Anechoic Effect – AllTrials US Initiative Launches to Deafening Media Silence

AllTrials has come to America. And it perhaps should not be a surprise that its advent on this side of the pond generated essentially no notice, particularly, no notice in the US mainstream media or in US scholarly health care and medical journals.

Pain huddle leads to less medication, lower readmissions (US)

Like other health care organizations, Virginia Mason struggled with the complexities of caring for patients with persistent or chronic pain.

What to do when you’re late with a peer review report: advice from an editor

So, you’ve agreed to review that paper from so-and-so et al. From the title and abstract, it sounded worth your time, and you really were going to do it before July 15th. But now . . .

Bed blocking a problem of equity, not just efficiency Canada-flat-icon

A recent study from Ontario offers a very interesting perspective on bed blocking, one which could help us address the problem more effectively.

LGBT seniors face challenges in long-term care facilities Canada-flat-icon

This audio discussion examines the issues and concerns many LGBT elders face when entering in to long-term care.

Quebec seniors’ home ordered to act after video shows residents left on floor Canada-flat-icon

Poor staff scheduling at a Quebec seniors’ residence is being blamed for an incident in which two elderly people were left unattended on the floor for at least two minutes after falling.

Population Projections: Alberta 2015-2041 Canada-flat-icon

Alberta’s population is expected to expand by about 2.1 million people by the end of the projection period, reaching just over 6.2 million in 2041 from around 4.1 million in 2014. The document also notes that Alberta’s population is aging due to below replacement fertility rates and rising life expectancies, although the province remains one of the youngest populations in the country. Under the medium scenario, the median age of Alberta’s population is projected to climb from 36.0 years in 2014 to 38.3 years in 2024, and rise further to 40.4 years by the end of the projection period in 2041.

Term renewal for the CIHR Institute of Aging Scientific Director Canada-flat-icon

Dr. Yves Joanette’s term as Scientific Director of the Canadian Institutes of Health Research – Institute of Aging (CIHR-IA), has been renewed from August 1, 2015 to July 31, 2019.

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Cochrane Canada Webinar: Stakeholder Dialogues, presented by Dr. John Lavis Canada-flat-icon

Dr. John N. Lavis explored the key features of stakeholder dialogues, what we’ve learned about them and how you can request one.

How to turn your dissertation into journal articles

Depending on your institution’s guidelines, you will either finish your PhD by having a number of papers accepted for publication, or by writing a “big book”-style thesis.

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Research Professor in Health and Aging at Université Laval Canada-flat-icon
Quebec City, PQ
DEADLINE 30 October

The Faculty of Medicine of Université Laval seeks a research professor in the field of health and aging, who will join the Department of Social and Preventive Medicine

Full Professor – Research Scientist, North York General Hospital Canada-flat-icon
Faculty of Medicine, University of Toronto Toronto ON
DEADLINE 7 September

North York General Hospital (NYGH) is seeking two Research Scientist(s) to lead research and innovation in the following strategic areas: patient-centred outcomes; process improvement and health outcomes; informatics and patient safety; health care for diverse populations; and knowledge transfer and implementation. The Research Scientist(s) will work alongside NYGH’s Gordon F. Cheesbrough Research Chair in Family and Community Medicine and leader of the University of Toronto Practice-Based Research Network (UTOPIAN), an innovative approach to electronic medical records.

Postdoctoral Research Fellow IATSL & McMaster Health Forum Canada-flat-icon
Toronto & Hamilton

A Postdoctoral Research Fellow is sought for a unique joint fellowship through the IATSL in Toronto and the McMaster Health Forum in Hamilton. The fellowship will be full-time, one year with possible renewal for 1-2 years based on mutual satisfaction and funding availability. The successful candidate’s primary responsibility will be to conduct research, and coordinate and carry out knowledge translation activities for the project “Aging, Disability and Technology: A framework for research, implementation and policy (ADT)”.

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