Calls for Abstracts
CALL FOR ABSTRACTS:
Care of the Older Person into the 21st Century – Alaska (27 May – 3 June 2018)
The theme for this conference is: “What does the future look like as we age into the 21st Century and what are the implications for health care delivery?” This conference will offer the opportunity to explore what ageing will look like into the 21st century and how health care services will be delivered. For Nursing, in particular, it will provide a platform to investigate how Nursing services across the health care spectrum may alter.
Grants & Awards
New for 2017, the MSFHR Reach Awards will provide funding to support the dissemination and uptake of research evidence to inform and improve further research, practice and policy-making. Each award will consist of up to $10,000 to help teams of health researchers and research users collaboratively plan and implement dissemination activities, adapting messages and mode of delivery in order to reach audiences who can directly use the knowledge.
The AB SPOR SUPPORT KT Platform will support up to two graduate students and/or faculty members who will be attending the KT Canada Scientific Meeting for the purpose of expanding their understanding of knowledge translation and/or knowledge synthesis. Each of the 2 award amounts will vary to a maximum of $1,200. For more information, please contact Morgan Potter, SPOR KT Training Coordinator at firstname.lastname@example.org
RATIONALE, AIMS, AND OBJECTIVES: “Implementation science,” the scientific study of methods translating research findings into practical, useful outcomes, is contested and complex, with unpredictable use of results from routine clinical practice and different levels of continuing assessment of implementable interventions. The authors aim to reveal how implementation science is presented and understood in health services research contexts and clarify the foundational concepts: diffusion, dissemination, implementation, adoption, and sustainability, to progress knowledge in the field. METHOD: Implementation science models, theories, and frameworks are critiqued, and their value for laying the groundwork from which to implement a study’s findings is emphasised. The paper highlights the challenges of turning research findings into practical outcomes that can be successfully implemented and the need for support from change agents, to ensure improvements to health care provision, health systems, and policy. The paper examines how researchers create implementation plans and what needs to be considered for study outputs to lead to sustainable interventions. This aspect needs clear planning, underpinned by appropriate theoretical paradigms that rigorously respond to a study’s aims and objectives. CONCLUSION: Researchers might benefit from a return to first principles in implementation science, whereby applications that result from research endeavours are both effective and readily disseminated and where interventions can be supported by appropriate health care personnel. These should be people specifically identified to promote change in service organisation, delivery, and policy that can be systematically evaluated over time, to ensure high-quality, long-term improvements to patients’ health.
In the 10 years since the inception of Implementation Science, we have witnessed a continued rise in the number of submissions received, reflecting the continued global interest in methods to enhance the uptake of research findings into healthcare practice and policy. We receive over 750 submissions annually, and there is now a large gap between what is submitted and what gets published. In this editorial, we restate the journal scope and current boundaries. We also identify some specific reporting issues that if addressed will help enhance the scientific reporting quality and transparency of the manuscripts we receive. We hope that this editorial acts as a further guide to researchers seeking to publish their work in Implementation Science.
Health Care Administration and Organization
OBJECTIVE: To examine the relationship between dietary service staff and dietary deficiency citations in nursing homes (NHs). METHOD: 2007-2011 Online Survey and Certification and Reporting data for 14,881 freestanding NHs were used to examine the relationship between dietary service staff and the probability of receiving a dietary service-related deficiency citation. An unconditional logit model with random effects was employed. RESULTS: Findings suggest that higher staffing levels for dietitians (odds ratio [OR] = .955; p < .01), dietary service personnel (OR = .996; p < .01), and certified nursing assistants (CNAs; OR = .981; p < .05) decrease the likelihood of receiving a dietary service deficiency citation. CONCLUSION: Higher levels of dietary service and CNA staffing levels have the potential to improve the quality of nutritional care in NHs. Findings help substantiate the Centers for Medicare and Medicaid Services’ proposed rules for more stringent Food and Nutrition Services in the NH setting and signify the need for further research relative to the impact of dietary service staff on nutritional and clinical outcomes.
Health Care Innovation and Quality Assurance
PURPOSE OF REVIEW: Nursing home residents are at high risk for colonization and infection with bacterial pathogens that are multidrug-resistant organisms (MDROs). We discuss challenges and potential solutions to support implementing effective infection prevention and control practices in nursing homes. RECENT FINDINGS: Challenges include a paucity of evidence that addresses MDRO transmission during the care of nursing home residents, limited staff resources in nursing homes, insufficient infection prevention education in nursing homes, and perceptions by nursing home staff that isolation and contact precautions negatively influence the well being of their residents. A small number of studies provide evidence that specifically address these challenges. Their outcomes support a paradigm shift that moves infection prevention and control practices away from a pathogen-specific approach and toward one that focuses on resident risk factors.
OBJECTIVE: This study aimed to evaluate whether using the interRAI Palliative Care instrument (the interRAI PC) in nursing homes is associated with reduced needs and symptoms in residents nearing the end of their lives. METHOD: A quasi-experimental pretest-posttest study using the Palliative care Outcome Scale (POS) was conducted to compare the needs and symptoms of residents nearing the end of their lives in the control and intervention nursing homes. Care professionals at the intervention nursing homes filled out the interRAI PC over the course of a year for all residents aged 65 years and older who were nearing the end of their lives. This intervention was not implemented in the control nursing homes. RESULTS: At baseline, POS scores in the intervention nursing homes were lower (more favorable) than in the control nursing homes on the items “pain”, “other symptoms”, “family anxiety”, and the total POS score. Posttest POS scores for “wasted time” were higher (less favorable) than pretest scores in the intervention nursing homes. In the intervention nursing homes where care professionals did not have prior experience with the interRAI Long-Term Care Facilities (LTCF) assessment instrument (n = 8/15), total POS scores were lower (more favorable) at posttest. SIGNIFICANCE OF RESULTS: One year after introducing the interRAI PC, no reduction in residents’ needs and symptoms were detected in the intervention nursing homes. However, reductions in needs and symptoms were found in the subgroup of intervention nursing homes without prior experience with the interRAI LTCF instrument. This may suggest that the use of an interRAI instrument other than the interRAI PC specifically can improve care. Future research should aim at replicating this research with a long-term design in order to evaluate the effect of integrating the use of the interRAI PC in the day-to-day practices at nursing homes.
This mixed-methods study evaluated the feasibility of the Translating Innovations into Practice (TIP)-toolbox. This toolbox guided nursing staff in 6 practical steps in developing a structured and tailored implementation plan to sustainably implement an innovation. For 9 weeks, 12 registered nurses (RNs) at 3 nursing homes in the Netherlands used the TIP-toolbox to develop an implementation plan related to promoting functional activity among nursing home residents. Data were collected by questionnaires, telephone interviews, participant observations, and focus group interviews. The RNs conducted most steps according to the plan. The main hampering and facilitating factors were a lack of support and collaboration. Most RNs were satisfied with the TIP-toolbox, but some considered it somewhat complex. To increase satisfaction and reduce the toolbox’s complexity, the participants made suggestions for improvements. The findings of this study indicate that the TIP-toolbox was feasible and supported nursing staff in developing an implementation plan, although minor adaptations are needed.
Improving transitions of care across the spectrum of healthcare delivery: A multidisciplinary approach to understanding variability in outcomes across hospitals and skilled nursing facilities
Non UofA Access
INTRODUCTION: Improving coordination during transitions of care from the hospital to Skilled Nursing Facilities (SNF)s is critical for improving healthcare quality. In 2014, we formed (Improving Nursing Facility Outcomes using Real-Time Metrics, INFORM) to improve transitions of care by identifying structural and process factors that lead to poor clinical outcomes and hospital readmission. METHODS: Stakeholders from 10 SNFs and 4 hospitals collaborated to assess the current hospital and system-level challenges to safe transitions of care and identify targets for interventions. RESULTS: The INFORM collaborative identified areas for improvement including improving accuracy and timeliness of discharge information, facilitating congruent medication reconciliation, and developing care plans to support functional improvement. DISCUSSION: Hospital and SNF stakeholder engagement prioritized the challenges in patient transitions from inpatient to skilled nursing facility settings. Innovative solutions that address barriers to safe and effective transitions of care are critical to improving clinical outcomes, decreasing adverse events and avoiding readmission.
Research Practice and Methodology
OBJECTIVES: Implementation studies are often poorly reported and indexed, reducing their potential to inform the provision of healthcare services. The Standards for Reporting Implementation Studies (StaRI) initiative aims to develop guidelines for transparent and accurate reporting of implementation studies. METHODS: An international working group developed the StaRI guideline informed by a systematic literature review and e-Delphi prioritisation exercise. Following a face-to-face meeting, the checklist was developed iteratively by email discussion and critical review by international experts. RESULTS: The 27 items of the checklist are applicable to the broad range of study designs employed in implementation science. A key concept is the dual strands, represented as 2 columns in the checklist, describing, on the one hand, the implementation strategy and, on the other, the clinical, healthcare or public health intervention being implemented. This explanation and elaboration document details each of the items, explains the rationale and provides examples of good reporting practice. CONCLUSIONS: Previously published reporting statements have been instrumental in improving reporting standards; adoption by journals and authors may achieve a similar improvement in the reporting of implementation strategies that will facilitate translation of effective interventions into routine practice.
Background Observation is mentioned in most ethnographic textbooks, but specific details about how it should be conducted and the practicalities to be considered in ethnographic nursing research are not always explicit. This paper explores the experiences of and challenges faced by a novice nurse researcher who used observation to collect data. Aim To provide a novice researcher’s perspective of observation in ethnographic nursing research and to highlight the associated challenges. Discussion Challenges that arose in observation began with determining which perspective to take, followed by rehearsing observation, developing and maintaining a constructive relationship with the observation site, being aware of the influence of the observer, managing interactions between the observed and the observer, and responding to ethical issues. Conclusion Novice nurse researchers considering using observation to collect data should be aware of the potential challenges they might encounter. Implications for practice The information presented in this paper will enable novice researchers to anticipate these issues and develop strategies to prevent or address them.
OBJECTIVES: To describe the level of need and divertibility of newly admitted nursing home residents, describe the factors that drive need, and describe the outcomes of residents across different levels of need. DESIGN: Retrospective cohort study. SETTING: A total of 640 publicly funded nursing homes (also known as long-term care facilities) in Ontario, Canada. PARTICIPANTS: All newly admitted residents between January 1, 2010 and March 1, 2012. MEASUREMENTS: We categorized residents into 36 groups based on different levels of (1) cognitive impairment, (2) difficulty in activities of daily living (ADL), (3) difficulty in instrumental ADLs, and (4) whether or not they had a caregiver at home. Residents were then categorized as having low, intermediate, or high needs; applying results from previous “Balance of Care” studies, we also captured the proportion who could have been cost-effectively diverted into the community. We then contrasted the characteristics of residents across the needs and divertible groupings, and compared 4 outcomes among these groups: hospital admissions, emergency department visits, mortality, and return to home. RESULTS: A population-level cohort of 64,105 incident admissions was captured. About two-thirds had great difficulty performing ADLs (65%) and had mild to severe cognitive impairment (66%); over 90% had great difficulty with instrumental ADLs. Just less than 50% of the new admissions were considered to be residents with high care needs (cognitively impaired with great ADL difficulty), while only 4.5% (2880 residents) had low care needs (cognition and ADL intact). Those with dementia (71.0%) and previous stroke (21.5%) were over-represented in the high needs group. Those that cannot be divertible to anywhere else but an institution with 24 hour nursing care comprised 41.3% (n = 26,502) of residents. Only 5.4% (n = 3483), based on community resources available, could potentially be cost-effectively diverted to the community. Those at higher needs experienced higher rates of mortality, higher total cost across all health sectors, and lower rates of return to home. CONCLUSIONS: The majority of those admitted into nursing homes have high levels of need (driven largely by dementia and stroke) and could not have their needs met cost-effectively elsewhere, suggesting that the system is at capacity. Caring for the long-term care needs of the aging population should consider the balance of investments in institution and community settings.
Nursing home (NH) nurses play a key role in hospital transfer decisions. In case of unavailability of physicians, they have to decide alone. In doing so, they consider potential threats to residents’ quality of life (QoL), but they also fear the consequences of wrong decisions. The present study examines the causal influence of these deliberations on nurses’ transfer decisions and emotional strain. In all, 241 NH nurses participated in the experiment. The vignette describing a resident with deteriorating health state elicited either thoughts on residents’ QoL, on legal consequences, or on QoL and legal consequences. In the QoL condition, the likelihood of a hospital transfer was lower compared with all other conditions. Emotional strain was stable across experimental conditions. When thoughts on QoL and legal consequences were induced at the same time, strain was positively correlated with the inclination to transfer the resident. Promoting QoL considerations can help to reduce avoidable transfers.
This paper reports on part of a doctoral study which explored stakeholder perceptions of the importance of a homelike environment in a care home and which factors contributed to this. The changes in institutional care for older people have evolved from being a ‘warehouse’ type of environment for those too poor, too mad, too sick and too unloved, to a place where older people in need of care can spend their days in safety, in a ‘homely’ environment. Such an environment is one of the quality indicators of care home provision. Yet defining what ‘homeliness’ means is fraught with difficulties. This article presents a narrative literature review on the concept of ‘home’ and the common measures taken to address homeliness in a care home setting. The results show that although the word ‘homely’ is used with the presumption of a shared understanding, the concept is elusive and highly subjective. Given that long-term care now provides homes for an increasingly wide range of age groups and individuals with increasingly diverse backgrounds and personal histories, is a shared viewpoint on homeliness possible? Indeed, is it ever possible to make an institution homely?
Undiagnosed and untreated persistent pain, often related to musculoskeletal diseases, complex comorbidities or injuries, is common in older adults. This has substantial consequences for the person experiencing the pain and leads to reduced physical and cognitive function. Pain is a critical factor for underlying neuropsychiatric symptoms such as agitation, depression and sleep disturbances, and these frequently trigger institutionalisation and entail the prescription of potentially harmful drugs such as antipsychotics.
No abstract available.
OBJECTIVE: To investigate whether polypharmacy is associated with a higher incidence of frailty in a large cohort of North Americans during 8 years of follow-up. DESIGN: Longitudinal study, follow-up of 8 years. PARTICIPANTS: A total of 4402 individuals at high risk or having knee osteoarthritis free from frailty at baseline. MEASUREMENTS: Details regarding medication prescription were captured and categorized as 0-3, 4-6, and >/=7. Frailty was defined using the Study of Osteoporotic Fracture index as the presence of >/=2 out of (1) weight loss >/=5% between baseline and the subsequent follow-up visit; (2) inability to do 5 chair stands; and (3) low energy level according to the Study of Osteoporotic Fracture definition. Cox’s regression models calculating a hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for potential confounders, were undertaken. RESULTS: During the 8-year follow-up, from 4402 participants at baseline, 361 became frail. Compared with participants taking 0-3 medications, the incidence of frailty was approximately double in those taking 4-6 medications and 6 times higher in people taking >/=7 medications. After adjusting for 11 potential baseline confounders, participants using 4-6 medications had a higher risk of frailty of 55% (HR = 1.55; 95% CI 1.22-1.96; P < .0001), whereas those using more than 7 drugs were at approximately 147% (HR = 2.47; 95% CI 1.78-3.43; P < .0001). Each additional drug used at the baseline increased the risk of frailty at the follow-up of 11% (HR = 1.11; 95% CI 1.07-1.15; P < .0001). CONCLUSIONS: Polypharmacy is associated with a higher incidence of frailty over 8-year follow-up period. Our data suggest evidence of a dose response relationship. Future research is required to confirm our findings and explore underlying mechanisms.
OBJECTIVES: To determine the prevalence of and resident characteristics associated with the prescription of medications of questionable benefit (MQBs) near the end of life in older adults with advanced dementia in nursing homes. DESIGN: Population-based, cross-sectional study using Resident Assessment Instrument Minimum Data Set 2.0 linked to health administrative data. SETTING: Ontario, Canada. PARTICIPANTS: All 9,298 nursing home residents with advanced dementia who died between June 1, 2010, and March 31, 2013; were aged 66 and older at time of death; and received at least one MQB in their last year of life. MEASUREMENTS: Prevalence of eight classes of MQBs (e.g., lipid-lowering agents, antidementia drugs) used in the last 120 days and last week of life. RESULTS: Of older nursing home residents with advanced dementia who received at least one MQB in the last year of life, 8,027 (86.3%) received them in the last 120 days and 4,180 (45.0%) in the last week of life. The most commonly prescribed MQB were antidementia (63.6%) and lipid-lowering agents (47.8%). Severe cognitive impairment (adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.07-1.33, P = .002) and fewer signs and symptoms of health instability (aOR = 1.58, 95% CI = 1.44-1.74, P < .001) were associated with MQB use into the last week of life. Seeing a neurologist or psychiatrist was associated with less likelihood of MQB use in the last week of life. CONCLUSION: Many nursing home residents with advanced dementia are dispensed MQBs in the last week of life. Given that MQBs may cause more harm than benefit in this vulnerable population, it is important for physicians to actively reassess the role of all medications toward the end of life.
“Evidence-Based Mentorship” – Presented by Dr. Sharon Straus
Dr. Sharon Straus is a Professor in the Department of Medicine at the University of Toronto and author of Mentorship in Academic Medicine, Evidence-Based Medicine: How to Practice and Teach, and Knowledge Translation in Health Care.
Register for Summer Institute 2017 where researchers, patients, clinicians, students, policy makers and more gather to share insights, connect with colleagues, and promote patient-oriented research. SPOR Summer Institute at a glance: an outstanding line-up of engaging speakers, workshops on patient-oriented research topics, networking opportunities with colleagues, capacity building opportunities for patient-oriented research.
The theme for this year’s symposium is Evidence and Impact: Engaging consumers, practitioners, researchers and policy-makers. Cochrane Canada will also host trainings related to systematic reviews before and after the symposium. Early registration ends April 24.
The Alberta SPOR SUPPORT Unit (AbSPORU) Knowledge Translation Platform is hosting a FREE event April 27th at 28th. This event aims to inform researchers about the services AbSPORU offers and how to access the services, provide workshops with a knowledge synthesis and knowledge translation focus, and offer individual research consultations for people with specific questions. Workshops (pre-booking required – see the poster for details): How to do a Systematic Review – Thursday, April 27th, 1:00 PM – 3:00 PM // Integrated Knowledge Translation – Friday, April 28th, 9:00 AM – 12:00 PM.
Social Media & Research Unconference: What works? What’s next?
This event is for people who are interested in using social media for research, for knowledge mobilization, or for people who are researching social media! Stay tuned for more details on this one-day social media and research event! To receive an email notification once registration for the Social Media & Research Unconference opens, please contact email@example.com.
Do you conduct or evaluate health research? Are you interested in an overview of methods for integrating sex and gender variables in health research contexts? Join us for a webinar to learn about the Online Training Modules for Integrating Sex and Gender in Health Research.
Please join Dr. Susan Snelling (NCCMT) and Mr. Daniel Fong (MPH, CPHI(C)) (National Collaborating Centre for Environmental Health) for a practice-oriented discussion of how public health professionals can adapt information and implement and evaluate policy change.
As part of the Advanced Topics in Implementation Science webinar hosted by the National Cancer Institute Division of Cancer Control & Population Sciences Implementation Science Team, the host, Dr. David Chambers, will speak with Dr. Ross Brownson and Dr. Enola Proctor about the characteristics of high-impact implementation science as well as efforts to build capacity of the field through D&I research training. Registration for this webinar is required.
The Michael Smith Foundation for Health Research (MSFHR) and Arthritis Research Canada have partnered to co-develop a new series of KT training webinars for researchers and trainees new to KT. Led by KT experts in BC, KT Connects provides opportunities to build knowledge and skills to incorporate KT into your work. The next webinar “Citizen as a KT agent: Keeping the government informed about research” features Cheryl Koehn (Founder & President, Arthritis Consumer Experts).
In this 60-minute live webinar Seniors Advocate Isobel Mackenzie, will focus on debunking some of the myths about senior healthcare. She will highlight some of the key policy changes that are required at all levels of government to ensure cost incentives align with desirable care outcomes. Many of the stereotypes that exist about seniors are not supported by facts, and often it is these stereotypes that affect our perception of our own health as we age. For example, we say that 20% of people over the age of 85 have a diagnosis of dementia, this means that 80% do not. Yet, for the most part we talk about dementia as a natural part of aging.
In 2017, the Training Institute for Dissemination and Implementation Research in Health (TIDIRH) will utilize a combination of a 3-month online course (six webinar sessions with related assignments) between mid-August and mid-November, and a 2-day in-person training to be held November 30 and December 1, 2017, in North Bethesda, MD. Faculty and guest lecturers will consist of leading experts (practitioners and teachers) in theory, implementation, and evaluation approaches to D&I; creating partnerships and multilevel, transdisciplinary research teams; research design, methods, and analyses appropriate for D&I investigations; and conducting research at different and multiple levels of intervention (e.g., clinical, community, policy). The training is open to researchers with interests in studying D&I across health care, public health, and community settings.
Applications for the 2017 postgraduate course “Implementation—Theory and Application in Healthcare” are now being accepted. The course provides a broad introduction to the development of implementation science and the research conducted in this field and meets three times during the fall: September 20-21, October 10-12, and November 30.
University of Saskatchewan (U of S) researchers are featured in a comprehensive new report on addressing Canada’s aging population and the challenges the health-care system will face in the coming decades. The research impact assessment, entitled Impacting Seniors’ Health – The Value of Aging-Related Research in Saskatchewan, is a showcase of research collaborations involving the U of S, the University of Regina (U of R), community groups and partners, as well as the Saskatchewan Health Research Foundation (SHRF). The publication released today in Regina profiles significant challenges to the health-care system as the number of Canadian seniors (aged 65 and over) is projected to double to 25 per cent of the population in the next 20 years.
A drug linked to a raised risk of dementia is taken by millions of older Americans who have an overactive bladder, researchers say. More than one-quarter of patients with the urinary problem had been prescribed the drug oxybutynin (Ditropan), an international team of investigators found.
People nearing the end of life often receive medications they may no longer need, and that’s true even in nursing homes, researchers say. Nearly 9,300 Ontario nursing home residents with dementia received at least one medication of questionable benefit during the last year of life, a study found. And nearly half of these residents received potentially unnecessary drugs in the week before they died.
Cognition data collected at baseline on 51,000 participants in the Canadian Longitudinal Study on Aging (CLSA) are now available for access by researchers. The CLSA is a large, national research platform on health and aging that allows researchers and decision-makers to answer critical questions on the biological, medical, psychological, social, lifestyle and economic aspects of aging, disability and disease. The CLSA follows approximately 51,000 men and women who were between the ages of 45 and 85 at recruitment, for 20 years. Through its large sample, detailed data collection and longitudinal design, the CLSA will enable research on the complex interplay among health determinants.
Canada is at the forefront of the global fight against dementia, and leading the charge is Dr. Yves Joanette, Scientific Director of CIHR’s Institute of Aging and leader of the CIHR Dementia Research Strategy. As Chair of the World Dementia Council, Dr. Joanette is playing a leadership role in coordinating global efforts to find tangible solutions to the challenge of dementia.
By 2050, the 65-and-older population is projected to reach nearly 84 million. That’s nearly double the 2012 number of 43.1 million, according to the Census Bureau. The John A. Hartford Foundation, Institute for Healthcare Improvement and the American Hospital Association, along with other partners, have launched an Age-Friendly Health Systems initiative to meet the complex needs of aging adults.
HSBC UK has announced a number of initiatives aimed at supporting people affected by dementia. This includes an extension of the three year partnership with Alzheimer’s Society and Alzheimer Scotland across HSBC UK, ‘Dementia Friends’ information sessions for staff, and the launch of an advice guide that helps customers living with dementia, and those who support them, handle their finances. Throughout the three year partnership with, HSBC UK has also committed to raising £3 million.
Last spring, Hedda R. Schmidtke learned two things that she was certain would help her stave off a summer slump in productivity.
The toolkit uses strategies from AHRQ’s Comprehensive Unit-based Safety Program (CUSP), which has reduced CAUTI as well as central line-associated bloodstream infections in hospitals. The toolkit is based on the experiences of more than 450 long-term care facilities nationwide and resulted in a significant reduction of CAUTI rates.
Virginia Tech is looking to fill 2 tenure-track faculty positions at the rank of assistant professor. Applications from candidates with implementation research expertise are encouraged to apply. Review of applications begins April 14.